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Episode 38
The Doctor's Farmacy: House Call

Wired and Tired: Fixing Adrenal Burnout

Open the Podcasts app and search for The Doctor’s Farmacy. If you’re viewing this site on your phone, you can just tap on the

Tap the subscribe button and new shows will be added to your library.

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You have likely heard the term “adrenal fatigue.” We commonly associate this term with the feelings of extreme fatigue, hormonal dysregulation, and other physical symptoms that can occur from chronic stress. More accurately, we can look to the hypothalamic-pituitary-adrenal (HPA) axis for the cause of these discomforts. If you have chronic stress, your adrenals get beat up, and your energy plummets and it becomes difficult to manage your life. You could feel tired and wired, all at the same time. All these are clues that you could have an imbalance of your HPA axis.

In this episode, Dr. Hyman sits down with Dr. Elizabeth Boham to discuss the signs of HPA axis dysfunction and how to support your HPA axis to reverse burnout. They also share patient cases that they have treated.

Elizabeth Boham is a physician and nutritionist who practices functional medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the functional medicine approach to keeping your breasts and whole body well.

This episode is sponsored by Starseed and Joovv.

This episode is sponsored by Starseed. Save 20% on your Starseed order at Amazon.com/Starseed by using the code 20MARKHYMAN at checkout. Be sure to try their seeds, Omega oil, and butters.

Ever since I’ve been using Joovv’s at-home red-light therapy devices, I’ve noticed I get deeper, more restful sleep and I feel more energized and focused during the day. Go to Joovv.com/farmacy and use the code FARMACY for an exclusive discount on Joovv’s newest devices.

In this conversation, Dr. Hyman and Dr. Boham discuss:

  • Symptoms of adrenal fatigue and HPA axis dysfunction
  • Acute vs. chronic stress
  • The stages of adrenal burnout
  • Cortisol level testing
  • The connection between your circadian rhythm and adrenal health
  • Stress-causing and stress-reducing foods
  • Why balancing your blood sugar is so important
  • Effectively discharging stress
  • Supplements to support the HPA axis
  • Emerging psychedelic therapies

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. Elizabeth Boham

Dr. Boham is Board Certified in Family Medicine from Albany Medical School, and she is an Institute for Functional Medicine Certified Practitioner and the Medical Director of The UltraWellness Center. Dr. Boham lectures on a variety of topics, including Women’s Health and Breast Cancer Prevention, insulin resistance, heart health, weight control and allergies. She is on the faculty for the Institute for Functional Medicine.

Show Notes

  1. Are You Suffering From Adrenal Dysfunction?
  2. Wired, Tired, and Stressed? How Understanding Your HPA Axis Could be the Key to Achieving Optimal Health with Dr. Zandra Palma
  3. Dr. Hyman’s Sleep Master Class
  4. Biology of Belief
  5. Molecules Of Emotion: The Science Behind Mind-Body Medicine
  6. Why Zebras Don't Get Ulcers

Transcript

Dr. Elizabeth Boham:
But it’s really critical to have a good source of protein, healthy, fat, and great source of fiber at every meal, because it is not allowing for that stress response to happen in the body, it’s nourishing the body, and that’s exactly what the body needs.

Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman. That’s Farmacy with an F, F-A-R-M-A-C-Y. A place for conversations that matter. And if you’ve ever been stressed, which I’m sure some of you might have, this is an important conversation to listen to because it’s with Dr. Elizabeth Boham, who’s my colleague here at the UltraWellness Center in Lenox, Massachusetts. She’s a physician’s physician. I would respect her in any medical circles, especially my family, which I have her take care of. So she is the doctor I go to for advice.
Dr. Mark Hyman:
And today, we’re going to learn about stress and something called the HPA axis, which you probably have never heard of, but which is the central feature of our stress response, and how it goes awry and how to fix it. So if you feel chronically stressed, if you’re really not sleeping, if you’ve all kinds of weird symptoms that you don’t what to do with, this is the podcast for you to listen to. Welcome, Liz.

Dr. Elizabeth Boham:
Thank you, Mark. It’s great to be here.
Dr. Mark Hyman:
Okay. We’re going to talk about this pandemic we have, but not COVID, it’s a pandemic of chronic stress.

Dr. Elizabeth Boham:
It’s coming along with COVID though.
Dr. Mark Hyman:
COVID is making it a lot worse, the economic stress is making a lot worse, the political situation, the social unrest is making it a lot worse. The economics are making it worse. So we are in a very difficult moment right now, I think, as human beings. I’ve never lived through anything like this. And it’s not just one thing, it’s like a perfect storm of everything. And I hope we come out of it soon because I don’t know how long we can last in this. But we are in a state of chronic stress in our society. Can you talk about, what are the biggest drivers of stress for most people?
Dr. Mark Hyman:
And then let’s get into the biology of what happens, because it’s fascinating, because when we look at what people suffer from in terms of chronic disease, most of it is either worsened by or caused by stress.

Dr. Elizabeth Boham:
Absolutely. Absolutely.
Dr. Mark Hyman:
So dealing with this is pretty important.

Dr. Elizabeth Boham:
Yeah. So stress is that real or perceived-
Dr. Mark Hyman:
Threat.

Dr. Elizabeth Boham:
Sorry. Thank you. Is that real or perceived threat. So stress is that real or perceived threat on ourself.
Dr. Mark Hyman:
And it can be your body or your ego.

Dr. Elizabeth Boham:
Absolutely. Right. And it can be emotional stress and it can be physical stress. I think that’s important to recognize. We could talk more about that because sometimes we always think it’s coming from the mind, but we appreciate the fact that it’s all connected and sometimes it’s coming from the body and impacting the mind as well. So it’s either real or perceived, and it impacts our body and our health.
Dr. Mark Hyman:
When you say perceived, you mean imagined? So you could think your spouse is having an affair, and they’re just late at work trying to make money to take care of your family and you can get the same stress response as if he actually was having an affair?

Dr. Elizabeth Boham:
Absolutely. 100%. Our mind is really powerful, and it is not always right, and it can create a whole bunch of extra stress for us many times as can chronic news and our apps and our phones and all those things that create a lot of perceived threat to our health and our wellbeing as well that creates a lot of stress. That’s absolutely true. So acute stress is something that our body is equipped to handle. So a stressful event occurs, and we’ve got all of the things in place to be able to handle that stress. We have a whole endocrine system, we have hormones, we have cortisol, we have that fight-or-flight response, we can run away from that tiger or give a presentation or go run a race.

Dr. Elizabeth Boham:
And all of that is really good and important, and we have it, we have a body that can do that. And we want to be able to handle stress, that’s good for us. And the problem comes in when it becomes chronic over time, and how that impacts our health longterm. And we wanted to do this episode because there’s this term being thrown around, and people talk about it a lot called adrenal fatigue. And people are always like, “Well, what does that mean? Do I have it? Do I not have it? And really, how is it impacting my health?”
Dr. Mark Hyman:
It’s so true. We can’t change our external circumstances often very easily, right? I can’t snap my fingers and change politics or end climate change or end war or civil unrest or even change the economy. There’s things I do have control over, but there’s a lot of things that are real stressors. Or if I family member who’s difficult or if I have a health condition that’s stressing me out, I can’t control that. But we have tremendous ability to control our thoughts, and our thoughts are things that influence our biology in a very direct way.
Dr. Mark Hyman:
There’s been a lot written about this, a lot of science on this, The Biology of Belief: Unleashing the Power of Consciousness, Matter & Miracles by Bruce Lipton is an incredible book about how our immune cells, for example, listen to our mind-

Dr. Elizabeth Boham:
It’s fascinating, right?
Dr. Mark Hyman:
And Candace Pert, Molecules of Emotion, the psychoendoneuroimmunology, how our thoughts are literally communicating with our hormones, our brain chemistry, our microbiome, with literally everything in our body. And so when we let our minds run ragged and stray and wild without learning how to regulate our own consciousness and thoughts, it leads to this chronic level of stress. And even the best of us who learn how to do that. it’s still hard and you still need to do practices. So we know, we’re very good at, “Oh, I know I want to exercise because that’s good for my body. And I know I need to eat better, that’s good for my body.”
Dr. Mark Hyman:
But most people don’t understand, they need to reorient and recalibrate their relationship to stress. It’s never going to go away, it’s just how you perceive it. Woody Allen has a gun put in his head, he’s going to be freaking out and having a neurotic panic attack. If James Bond has a gun on his head, he’s like, “Eh, whatever,” and he’s going to get out of it.

Dr. Elizabeth Boham:
I like that.
Dr. Mark Hyman:
Same gun, different person. And I think that’s what we all have to learn.

Dr. Elizabeth Boham:
Yeah, How do we respond to that stress that? How do we have how do we respond to it? Well said.
Dr. Mark Hyman:
So tell me about the symptoms. If people are in a state of chronic stress, how will they know it’s affecting their biology? Because there’s a whole list of symptoms that we talk about when we talk about adrenal fatigue or adrenal exhaustion, there’s a lot of, I think, skepticism in the traditional community, medical community about this whole idea of adrenal exhaustion. You’re either have Addison’s disease, which is an autoimmune disease that nukes your adrenal glands, or you’re fine. But it’s not really like that.

Dr. Elizabeth Boham:
Right. So we have this whole… Really, what people are seeing the proper term for this situation is HPA axis dysfunction. The hypothalamic pituitary adrenal access, which are really parts of our endocrine system that handle and manage the stress response in our body. And when it gets out of balance, that that can really influence how we feel. And so we can have, and we’ll get into this a little more, we can have HPA axis overactivity or underactivity. But those hormones, all of those different parts of our endocrine system handle that stress response in our body, so when there is chronic stress over time, when a lot of cortisol gets produced from our adrenal glands.

Dr. Elizabeth Boham:
And at the beginning, as we talked about, that acute stress, that cortisol is really helpful for us because it helps increase our blood pressure, it helps us run away from the tiger, it increases our blood sugar so we can get we can get nutrients and energy to our muscles so we can run away from that perceived threat, which is really important if you were running away from a tiger or a dog or whatever, right? So need to be-
Dr. Mark Hyman:
And it stops your digestion because you want to be digesting your food while you’re running from a tiger. It increases clotting, right?

Dr. Elizabeth Boham:
Absolutely.
Dr. Mark Hyman:
Because you want to make sure if you get cut or bitten when you’re running away, that your blood clots very fast.

Dr. Elizabeth Boham:
It’s a phenomenal system, and it’s really good and really important. But over time, if we’ve got chronic stress for some reason because we’re because of our perception of the world around us or we’re not taking time to take care of ourselves, or we’re eating a diet that’s really stressful on the body, or we’re not getting enough sleep, or we have a chronic infection. We do see this with illnesses too like a chronic infection, those chronic stressful events over time really can disrupt how all aspects of our hormone system works together, that whole HPA axis works, and it can get dysregulated. And so, that’s that whole talk of that HPA axis dysregulation.
Dr. Mark Hyman:
So it’s your hypothalamus, which in your brain, and your pituitary. So it’s all the command control centers in your brain that then send messages to your adrenal glands that are on top of your kidneys and they produce adrenaline, cortisol-

Dr. Elizabeth Boham:
Cortisol, norepinephrine and epinephrin, but also DHEA, which is a hormone that gets turned into testosterone and estrogen, and hormones that impact our blood pressure and electrolyte balance. So it’s involved in a lot of things. And it’s important to recognize that the pituitary also impacts lots of other hormones in our body, our female hormones, our male hormones, our thyroid hormones, and so it’s all really connected, which is interesting as well. So when people are under a lot of chronic stress over time, the cortisol levels are remaining higher than they should be for long periods of time. And so this is the whole feedback loop. This system in our body as a whole feedback loop.

Dr. Elizabeth Boham:
So that high cortisol shifts the way that… There’s a feedback mechanism that occurs, and in a way, the body slows everything down. And so over time, with high levels of cortisol that are getting released all the time, people start to crash, they have what they call burnout, or their body just slows down. We see their thyroid slow down, we can see other hormones shift, but we definitely can over time, if we look, we can see a decrease in cortisol levels. We can do some special tests that look at that.
Dr. Mark Hyman:
It’s so important what you’re saying, because the stress response is a good thing in the short run, but not in a long-term. And we never really had these chronic stresses that we do now, we’d be in threat of danger, we’d mount the response, it was good. Right now, you’re releasing high amounts of cortisol, and it’s like a drug we give for people with auto immune disease called prednisone. Or when you, for example, have a disease called Cushing’s disease, where your adrenal glands are a pituitary tumor will produce a lot of cortisol that is not regulated by any feedback mechanisms.
Dr. Mark Hyman:
And when that happens, you get all these problems. You get high blood pressure, you get diabetes, you brain shrinks, the memory center in your brain shrinks, you can get dementia, you have muscle loss.

Dr. Elizabeth Boham:
You’re more likely to get sick more easily.
Dr. Mark Hyman:
More likely to get sick, your immune system stops working as well. So you’re really accelerating all these age-related diseases, and you’re also suffering from FLC syndrome, which is basically when you feel like crap. So let’s drill down into some of the symptoms that people who might have this dysfunction get.

Dr. Elizabeth Boham:
Absolutely. A lot of times, people with HPA axis dysfunction, they’ll say, “Well, I have a good night’s sleep, but I still feel tired in the morning. I can’t get going.” Or other people, depending on where they are in this whole process, they may feel like they’re anxious all the time, they can’t calm down. They’re tired, but wired and they’re just really feeling anxious.
Dr. Mark Hyman:
And you get in the bed and you lay there, you’re tired, but you can’t fall asleep.

Dr. Elizabeth Boham:
Yeah.
Dr. Mark Hyman:
I’ve been there.

Dr. Elizabeth Boham:
They can have a hard time dealing with the stress of everyday life, they can feel more depressed or irritable. Things that they used to be able to do really easily are hard to do. Their job maybe, or handling going to the grocery store even, things that used to be really easy to do every day become tasks for them. They feel overwhelmed and exhausted. And they might get, as I said, sick more easily they, you can have more cravings for foods.
Dr. Mark Hyman:
Sugar.

Dr. Elizabeth Boham:
You’re looking for things to pick you up, so sugary foods, salty foods, you’s have cravings for them. You may feel more fatigued, when you stand up, you get more tired. You might have low blood pressure over time and low blood sugar over time with an underactive HPA axis.
Dr. Mark Hyman:
Yeah. There’s often this syndrome I see of tall, thin women, which is really common, where they get adrenal burnout. They get low blood pressure, so dizzy when they stand up, they crave salt, they have anxiety, they have palpitations. They tend to get hypoglycemic, so their blood sugar actually is not coming up when it should. And so you can pretty much tell that this is going on with people. But what’s interesting is, it might be worth breaking down, is that adrenal burnout, let’s just call it that, comes in stages.
Dr. Mark Hyman:
Tell us about the first stage and how it progresses to full burnout. Because the symptoms and the treatment a little different from each other.

Dr. Elizabeth Boham:
They are a little different. So at first, when you’ve got that overactive adrenal gland, it’s the beginning, let’s say, of just handling all this chronic stress. People feel that wired and tired, they’re anxious, they feel like they just can’t calm down, they feel up-regulated inside. And then over time, what can happen is with having that chronic levels of high cortisol, what can happen over time, as we talked about with that feedback loop, they get a decreased level of cortisol that occurs.
Dr. Mark Hyman:
So initial you’ll see high levels when you do the testing?

Dr. Elizabeth Boham:
Initial we see high. We’ll talk about this testing in a minute.
Dr. Mark Hyman:
Yeah. Yeah. And then you see a flat line.

Dr. Elizabeth Boham:
And then over time we see low. And when it’s flat line, what it feels like is burnt out, you just feel exhausted, you can’t get going in the morning, you’re getting sick more frequently. That’s when you see a lot of low blood pressure, low blood sugar, salt cravings, but just literally, you feel that burned out, your exhausted feeling.
Dr. Mark Hyman:
So one is chronically high and then it was chronically low. And there’s in-between where you get low in the morning and high at night, so you’re exhausted in the morning, but you can’t fall asleep at night because your whole-

Dr. Elizabeth Boham:
Yeah, it’s flipped.
Dr. Mark Hyman:
… circadian rhythm is all screwed.

Dr. Elizabeth Boham:
That’s what we do differently than what conventional doctors often do. Let me take some few-
Dr. Mark Hyman:
Anyway, this isn’t even a diagnosis in conventional medicine?

Dr. Elizabeth Boham:
No. Really, like you were saying, if somebody has really low cortisol or really high cortisol on blood testing, they’ll call it, might be Cushing’s or Addison’s, or a very serious adrenal issue. And we were taught about that in medical school, but we weren’t really taught about these situations where if you did a blood level first thing in the morning, it probably would look okay and you wouldn’t really see a lot of abnormalities in the blood testing. But if you look a little deeper and you do saliva testing and you check saliva four times in a day, and you can check saliva for cortisol when you first wake up in the morning, they call that the cortisol awakening response.

Dr. Elizabeth Boham:
What we should see with that saliva testing is that when you first wake up in the morning, your cortisol increases, it’s almost like a stress test for your adrenal glands. The cortisol awakening response is like a stress test for your adrenal glands. Getting up in the morning is a little bit of a stress for the body, it needs to get going and wake up. And so what we typically see is the cortisol increase first thing in the morning. And that’s a good thing, we want to see that. That means that the system’s working well. And what we see is the cortisol levels in the beginning of the day are higher. And as the day goes on, they come down.

Dr. Elizabeth Boham:
So when you check somebody’s saliva tests during the day, we should see it go up when they first wake up in the morning and then start to come down as the day goes on. And that’s a very normal pattern. And what we were talking about is, over time, if people have a lot of stress and anxiety going on, you might see high levels of cortisol, and then over time you might see it start to flip where they’re low in the morning, but too high at night. And then if things really go on for a while, you might see a low level of cortisol throughout the whole day. And it really gives us a lot of information about how best to treat somebody and how best to take care of them and what they need to really focus on.
Dr. Mark Hyman:
And this is something you wouldn’t get at traditional doctor’s office?

Dr. Elizabeth Boham:
No.
Dr. Mark Hyman:
They’re not going to look at your salivary cortisol levels, they’ll say, “Oh, you have Cushings, and there’s tests for that, or Addison’s, and there’s tests for that.” But short of these two extremes… And that’s what’s so different about functional medicine, it’s really about this continuum of dysfunction. It’s not just on or off, it’s now like you have diabetes or you don’t, like you have high blood pressure or you don’t, it’s a gradual worsening over time. And those diseases are very particular because they’re either a tumor, which is Cushing’s, or they’re an auto immune disease, which is usually caused by gluten, the Addison’s disease, which is what President Kennedy had actually, and it certainly, I’m sure, affected him.
Dr. Mark Hyman:
So when you have these patients come in, you do this history, you find these symptoms, you hear your story, how do you start to approach correcting this? Because I found some things are really easy in functional medicine. Someone has bacterial overgrowth or they have gut issues, a little valve, one, two, three, it’s fixed. This takes a little bit of time because of the amount of stress we’ve put on our adrenals, we have to constantly try to build them back up over time, and it takes a little bit of time to recover.

Dr. Elizabeth Boham:
I think what’s fascinating is, and what we realize is the body has this tremendous ability to heal. This is an area where our body can heal. We see it heal all the time, it just sometimes takes a little TLC and some care. And that’s where the lifestyle factors really make a huge impact. We work with people to really balance their diet and focus on nutrition, and we can delve into each of these more; getting good sleep, resting. Resting is important, we need to give our body time to rest. We’re living in a world where it’s hard sometimes to turn it off, and people aren’t, and so they’re really having issues because of it. So we have to help them rest and recuperate and get in their regular meditation and breath work and take time for themselves and turn off the lights at night and turn off the computer and the cell phone.

Dr. Elizabeth Boham:
Diet makes a huge difference, there’s so much we can do-
Dr. Mark Hyman:
Wait, wait. Before you get into diet, let’s go back to what you just said, because the light thing, the computer is a screen. It’s not just that they’re distracting, there’s a biology around your adrenals that has to do with something called your circadian rhythm. And it requires certain types of stimuli at certain times of the day and different kinds of stimuli the other times of the day. So in the morning, the way to get going with your circadian rhythm and your adrenal glands to properly function is to have sunlight for 20 minutes in the morning. How many of us actually do that and get outside?
Dr. Mark Hyman:
And the same thing, at night, if you are stimulating your eyes with bright light that isn’t having all the blue filtered out, which you can just get blue blocker glasses, or just getting off screens, you will actually stimulate more awakefulness and you will suppress melatonin. Because in the morning, you wake up and you see the sunlight, well, your melatonin levels go down, so you don’t feel sleepy all day. But if you’re having light at night, it actually keeps the melatonin down so you can’t fall asleep.
Dr. Mark Hyman:
Hey everybody, it’s Dr. Hyman. Thanks for tuning in to the Doctor’s Farmacy. I hope you’re loving this podcast. It’s one of my favorite things to do, and introducing you to all the experts that I know and I love, and that I’ve learned so much from. And I want to tell you about something else I’m doing, which is called Mark’s Picks. It’s my weekly newsletter. And in it, I share my favorite stuff, from foods, to supplements, to gadgets, to tools to enhance your health. It’s all the cool stuff that I use and that my team uses to optimize and enhance our health. And I’d love you to sign up for the weekly newsletter. I’ll only send it to you once a week on Fridays. Nothing else, I promise.
Dr. Mark Hyman:
And all you do is go to DrHyman.com/picks to sign up. That’s DrHyman.com/picks, and sign up for the newsletter and I’ll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now, back to this week’s episode.

Dr. Elizabeth Boham:
Circadian rhythm is critical. We’re going touch on it with one of the cases I have because we’ll get into it in a minute. But she was working more in the evening shift, and I think it really is hard for a lot of people, depending on the shifts that they have to work. But you mentioned that, getting up in the morning, getting outside, getting that sunshine helps for so many reasons. It helps our mood, it helps us fall asleep more at night, and it helps us… Our body likes to have regularity and rhythm. And I think that’s one thing we really work on with people when they’re really struggling with this, is getting them in some pattern and rhythm of getting a good sleep cycle, get getting a good eating cycle, not grabbing and going, not skipping meals.

Dr. Elizabeth Boham:
I mean, there’s a lot to be said for fasting. You’ve done a lot of podcasts on this, and there can be really a lot of great things with fasting, but sometimes when people are really… When their HPA axis is really underactive and it’s not working very well, and if they’ve got the signs of burnout or adrenal dysfunction, fasting sometimes for too long can be more stress on their body, or some extreme diets can be more stress on their body.
Dr. Mark Hyman:
Too stressful.

Dr. Elizabeth Boham:
And they might not be at a point where they can feel good with it, they can’t get all the benefit from it. They can still fast for 12 hours, but we might not be fasting them for 16 hours or 18 hours during that time.
Dr. Mark Hyman:
Well, it’s really important, what you bring up about food because there are certain foods that actually because stress in the body, independent of your thoughts. And there are certain foods that reduce stress in the body, independent of what you’re thinking. So actually, food can be a stressor or a relaxer, depending on what you’re eating. Can you talk about the foods that tend to because more cortisol, adrenaline and stress in the body? And then some of the foods that we would be thinking about that might help reduce that.

Dr. Elizabeth Boham:
That’s such a great point. If we eat a donut and with coffee and sugar, I’m going to an extreme here for breakfast.
Dr. Mark Hyman:
That’s not that extreme, it’s probably the breakfast of most Americans. Dunkin’ Donuts and coffee.

Dr. Elizabeth Boham:
That is really stressful on the body.
Dr. Mark Hyman:
Why?

Dr. Elizabeth Boham:
Because it causes this spike in our blood sugar, because it gets digested and absorbed really quickly, our blood sugar goes up quickly and the body goes, “Oh, no.” It gets stressful for the body, the body produces a bunch of insulin to help lower it. And then what happens is the blood sugar drops afterwards. And so those ups and downs in blood sugar like that are really stressful for the body.
Dr. Mark Hyman:
If your blood sugar is dropping, it’s a life-threatening emergency, you got to go get food.

Dr. Elizabeth Boham:
Right. So if you’re eating a lot of foods that cause your blood sugar to go up and then drop with those easily to digest and absorb, you have a can of soda, those things really are stressful for the body. They create this stress, they create the cortisol response. It’s one of the reasons we get a lot of weight gain around the belly when we eat those kinds of foods, because they are stressful for the body. And so instead, we want to be really balancing our blood sugar.
Dr. Mark Hyman:
Okay. Before you get to how to fix it, I just want to point out this study that was just so mind blowing when I read it years ago by a friend of ours, Dr. David Ludwig from Harvard. And he took, he took kids that were overweight and fed them three different breakfasts: Oatmeal, steel cut oats, and an omelet. Same calories. Same calories, but different carbohydrates, protein, different fat. What he found was that the kids who had the regular oatmeal, the quickly absorbed oatmeal, we think oatmeal is healthy, it’s not like you’re having a doughnut, their insulin went up, obviously, their blood sugar went up. But their cortisol went up, their adrenaline went up.
Dr. Mark Hyman:
So the body perceived it as a stress. Whereas the kids who ate the omelet didn’t happen. And then the kids who ate the oatmeal were hungrier, wanted more food. So we know that starch and sugar create a biological stress response in the body, and that’s bad. In addition to the fact that the sugar causes a problem, your brain chemistry and your neuro-transmitters are talking to your fat cells, and they’re telling them when they’re under stress to store more fat. So literally, stress makes you gain weight independent of what you’re eating. So really, it’s fascinating when we look at weight and other issues. It’s so connected.

Dr. Elizabeth Boham:
It’s so connected. It’s fascinating. So really balancing blood sugar is so powerful. People, sometimes we say these things again and again, like, “Balance your blood sugar, have a good source of protein, healthy, fat, and fiber at each meal.” And sometimes we say it’s so much that I wonder people are just-
Dr. Mark Hyman:
They don’t know what it means.

Dr. Elizabeth Boham:
… “Oh yeah, it’s the same thing. They’re just saying eat healthy.” But it’s really critical to have a good source of protein, healthy fat, and great source of fiber at every meal, because it is not allowing for that stress response to happen in the body, it’s nourishing the body, and that’s exactly what the body needs.
Dr. Mark Hyman:
Yeah. And so I think using food and having the right quality fats, low-glycemic diet, lots of fiber, phytochemicals, these are all messenger molecules that help reduce the stress in the body.

Dr. Elizabeth Boham:
Yes. We always start with food first, and this is a great place to start in this area, really working to balance the blood sugar, preventing those spikes in blood sugar, preventing that stress. We often work to pull people off of caffeine for a period of time. If they’re in that state where they’re really anxious, they don’t need the caffeine. If they’re in that state where they’re burnt out and exhausted, they might feel like they need the caffeine, but that’s actually a little bit of a stress for their body. And so when the adrenal glands or the whole HPA axis isn’t able to handle that stress at this point in time, you don’t want to add to it.

Dr. Elizabeth Boham:
So we often will pull people away from caffeine or really lower their levels, or keep it to a little bit of green tea and just not excessive amount.
Dr. Mark Hyman:
How about alcohol? Is that going to relax you or are they going to cause a problem?

Dr. Elizabeth Boham:
With alcohol, it’s all about moderation. It’s really all about moderation. We know that too much alcohol is going to wake us up in the middle of the night. We know that when it wears off, alcohol is a depressant, when it wears off it, we get that rebound stimulating effect. We really need to be working on sleep during this period of time all the time, but we need to get good restful sleep so we just have to watch the amount. That’s really, really important. And so for some of our patients, we take them off of most of the alcohol for a period of time. And it also wears down your B vitamins, and B vitamins are really important for the-
Dr. Mark Hyman:
So when you drink, you deplete your B vitamins. That’s what you’re saying?

Dr. Elizabeth Boham:
Yeah. And B vitamins are critical for the functioning of our adrenal glands. People will say to me, “I’ve always had two cups of coffee in the morning, and it’s been fine. Why can’t I have two cups of coffee now in the morning?” And when you get to that exhausted, burnt out stage, that’s just too much for your body at this period of time, we just have to be a little more gentle.
Dr. Mark Hyman:
Yeah. I think that’s absolutely right. And I also think what you said before, I want to come back to because it’s such an important point, we jumped right over it. You said something that I think it’s worth underscoring, which is that, infections or any physical illness can cause a stress response. So let’s say you have Lyme disease, or you have a virus, or whatever, independent of all your thoughts or feelings or perceptions, it can cause a stress. And there are certain foods that drive inflammation that causes a physiologic stress response.
Dr. Mark Hyman:
So anything in the body that causes inflammation, either your thoughts, which can cause inflammation or gluten or dairy or food sensitivities, or sugar, all these can cause a stress response. So sometimes getting rid of not just the junk food, obviously the sugar, but actually potential food sensitivities or gluten dairy can be enormously effective.

Dr. Elizabeth Boham:
With the point about the infections, I think that’s something that we see a lot of, people who’ve become debilitated over time from dealing with whether it was Lyme or Epstein-Barr virus or some other chronic infection. And they’re just really having a hard time rebounding from it. And it’s important for us to support the adrenal glands during that time because that’s a really important part of healing, because over time,. if we were to do their saliva test, we often see it being very on the lower side. And that’s an area that we’re supporting their immune system, we’re supporting their digestive system, we’re supporting their detoxification system, but we also have to support them hormonally too. It is important for us to pay attention to.
Dr. Mark Hyman:
What are the other things we have to do, we diet, we cut down the alcohol, sugar, there are certain other lifestyle things that are really important. You mentioned sleep, and that’s a whole other thing because of your stress, it’s hard to get the sleep regulated and we know how to do that. But there’s some other things that are really important, what are the favorite techniques or tools for discharging stress? Because my view is, we can’t eliminate stress from our lives. It’s coming at us, whether we like it or not, but can we do a Tai Chi move on it and actually not have it really overtake us? And how do we discharge that stress?

Dr. Elizabeth Boham:
Tai Chi is a great way to do it, actually.
Dr. Mark Hyman:
What else?

Dr. Elizabeth Boham:
Mindfulness activities, meditation and yoga, and just throughout all those practices, we get to recognize how crazy our mind is and how much it can be.
Dr. Mark Hyman:
You call me crazy? Probably you’re right.

Dr. Elizabeth Boham:
Thinking the wrong things that are making us really exhausted and wiped out. And so that’s where the power of mindfulness and meditation is, is because it helps us really stop and identify these things that are taking us down the wrong path.
Dr. Mark Hyman:
Absolutely. I’ve so much stress in my life over the years and I’ve really learned techniques that I can use to change my physiological state. So I use like yoga knee dress, I put on headphones and I lay down and have a guided relaxation for 20 minutes. I’ll do meditation a twice day, I’ll do yoga, I’ll take a steam or a sauna, ice bath, that literally changes all your hormones and adrenaline. I will get a massage sometimes and exercise.

Dr. Elizabeth Boham:
Bodywork. I love bodywork. It works very well for me, acupuncture, hands-on bodywork, neuromuscular therapy, getting out in nature.
Dr. Mark Hyman:
Yeah. Nature. And so all these things, taking a walk, and exercise particularly is important because when I think about exercise, I’m like, we never really exercise, we are hunter gatherers. We’d like run from a tiger and we do normal physical work. But when you look at this book written by Robert Sapolsky, it’s called Why Zebras Don’t Get Ulcers, which is this whole research that he’s done. He’s a neurobiologist from Stanford, he’s a crazy guy. Anyway, he’s studied the stress response and in his book, Why Zebras Don’t Get Ulcers, he talks about the fact that they literally will run like crazy from the tiger or the lion or whatever.
Dr. Mark Hyman:
And then one of them gets killed and then they all just go back to eating the grass. And they had this massive discharge of the stress response through exercise, and then they just can go relax while their whatever cousin is getting eaten, it doesn’t bother them anymore. But we just have this chronic state of stress and we don’t discharge it. So I know for me, exercise, I can be really stressed and I can go for a run or I can go bike rider and I come back and I just feel like I literally burned off all the adrenaline.

Dr. Elizabeth Boham:
Yeah. And I think other things that are really great for this from a lifestyle perspective are journaling, writing down your thoughts and your concerns and your worries. The gratitude journal, really shifting our thought process. Sometimes we can shift our thought process on our own, sometimes we need a little support to do that, whether it’s a health coach or a counselor because we’ve got to work to change some of how we’re viewing the world around us, is really important.
Dr. Mark Hyman:
That is true. I think that’s a very important point, Liz, because many of us have a habit of listening to our lower selves and not our higher selves,. and you all know what I’m talking about. And so sometimes you just shut that lower self-voice up and listen to that higher self that knows better. And all of us struggle with that, me included. I think you have to learn to not let your mind run your life. It’s not always very friendly. There’s a lot of negative self-talk and a lot of fear and understanding that… And meditation can be really helpful with that, journaling can be helpful, there’s all those kinds of approaches, life coaching.
Dr. Mark Hyman:
Let’s talk about, we talked about exercise, we talked about diet, we talked about sleep, we talked about stress reduction, we talked about getting out in nature. Let’s talk about the role of nutritional supplements because we use that a lot in helping people to recover. And partly because during times of stress, you really get depleted in nutrition and nutritional supplements. And I remember reading this paper years ago about Kosovo, which was a war zone back in the ’90s. And what they found was that the people who were in this chronic state of stress in this war zone, had tremendously depleted magnesium.
Dr. Mark Hyman:
They really collected their urine and they found the magnesium was pouring out of them, which is the relaxation mineral.

Dr. Elizabeth Boham:
Yeah, magnesium’s wonderful. And when we’re low in magnesium, we also feel more depressed. There’s been interesting research on that too, so it becomes this vicious cycle. And so magnesium we get a lot from our foods, our whole foods, but sometimes when you’ve been going through this chronic stress period of time, sometimes we need to really give people extra magnesium. And so we use that a lot as a supplement. We use B vitamins, good quality, methylated B complex helps support the body during this time. We use a good multivitamin and just some of the basics.
Dr. Mark Hyman:
Zinc is very important.

Dr. Elizabeth Boham:
Yeah. And sometimes we’ll use things like adaptogens, ashwagandha.
Dr. Mark Hyman:
What are adaptogens?

Dr. Elizabeth Boham:
Adaptogens are herbal substances that really help the adrenal glands. It’s just to support them verbally. They call them adaptogens because they help us, if we’re overstressed, they can help us feel more calm, but if we’re depleted, they can help support you. They can adapt to what we need in a sense, I guess.
Dr. Mark Hyman:
They’ve been used even in space exploration, Russian’s cosmonauts always took these adaptogens to help their stress resilience. And I personally take them because I live a fairly high stress life and I want to create as much resilience. What are the top ones that we use?

Dr. Elizabeth Boham:
Oh, ashwagandha, Rhodiola, Asian ginseng.
Dr. Mark Hyman:
Siberian ginseng.

Dr. Elizabeth Boham:
Yes. Those are really supportive to the adrenal glands. We sometimes we’ll use things like licorice, if somebody is really depleted in their adrenal glands. But you have to be a little careful if you’re doing that on your own. If your adrenal glands aren’t really low, sometimes that makes you feel more anxious. So that when you have to be a little bit more careful with it.
Dr. Mark Hyman:
If you have low blood pressure, if you’re dizzy when you stand up, if you have palpitations, then you probably will have benefit from it.

Dr. Elizabeth Boham:
Yeah. But it can definitely raise up the blood pressure. So if you run a little high with blood pressure, you need to be careful with regular licorice.
Dr. Mark Hyman:
Why don’t we go into a few cases that you’ve had? Because I think it’s really instructive to learn about how this affects real people. The first one was a nurse, an ER nurse?

Dr. Elizabeth Boham:
Yeah. So she was a 39-year-old woman and she came to see me because she had fatigue. And she was frustrated because this was new to her, she had never really had a lot of fatigue in her life. She was a go-go person. She was a nurse and lots of energy, worked in the ER, really loved her job. And really got a lot of personal reward from her job. And so was really frustrated and concerned where she was feeling so tired, she didn’t want to go to do her job anymore, and it would overwhelm her now. And she couldn’t really respond to some of the stresses at work as easily.

Dr. Elizabeth Boham:
And she was feeling sad about that and concerned about that. And so she had seen her primary doctor who had said, “Well, maybe this is depression and should we start some medication?” And she wasn’t ready to do that. And she wanted to look at things a little bit of a different way so she came to see us. When we delved deeper, we found out that she worked the evening shift, so she would work in the evenings. She was not always that careful with her diet, she’d grab a couple of cups of coffee, she’d grab some food here or there, she would eat in the cafeteria at work. So she tried to be healthy, but it wasn’t the-
Dr. Mark Hyman:
When I worked overnight shifts in the ER, I would have like a quadruple espresso, a giant chocolate chip cookie and a half a pint of ice cream. And I’d head to the ER for my 11:00 at night to 7:00 in the morning shift.

Dr. Elizabeth Boham:
Yeah. And so she’d gained some pounds. She gained like 20 pounds over the last couple of years, and so she was frustrated with that too. And she was so tired, she just couldn’t exercise anymore. She didn’t have the energy to get up in the morning and to exercise before she went on her shift. And then when she came home from work, she had a hard time calming down after the shift and getting a good night’s sleep. And so she was having a hard time getting to sleep at night, she was feeling that wired feeling at night when she needed to go to sleep.

Dr. Elizabeth Boham:
So we did her saliva test, se did the cortisol awakening response with saliva test. And what we saw is that the morning that cortisol awakening was low, she wasn’t able to mount that cortisol response in the morning.
Dr. Mark Hyman:
She was burnt out.

Dr. Elizabeth Boham:
She was burnt out. Exactly. She was burnt out. And it was a little bit high in the evening. So we talked a lot about, it can build up with people. They have been just living their regular life and making it through and feeling fine, and then it just adds up over time, especially having a stressful job like that and not being able to, or not taking the time to take care of herself every day and calm down. So we focused a lot on her lifestyle, she ended up shifting and starting to work more during the days. She was able to do that because she had been there long enough. So she was able to shift her time.

Dr. Elizabeth Boham:
She started getting up in the morning and doing some calming exercises, some meditation first thing in the morning. She started to pack her own food and bring her own food to work. And we worked to clean up her diet, take away some of the caffeine for a period of time, really worked to balance her blood sugar, make sure she was getting that protein, healthy fat and fiber at every meal, really some of the basics there. We also gave her a little bit of the herbal support that had some licorice and ashwagandha first thing in the morning, just to help give her the energy for the day, and a good B complex.

Dr. Elizabeth Boham:
And really focused on her getting outside and getting some sunshine in the morning and getting her exercise in. We started gentle with her exercise because she hadn’t been doing very much and she was tired, but over time, she was able to kick up the intensity and start to do more intense exercise.
Dr. Mark Hyman:
I guess that’s an important point you bring up because a lot of people have adrenal exhaustion, they don’t tolerate intense exercise. They just can’t, because when you’re exercising, you’ve got to mount the stress response. It’s very difficult for them. And I had a terrible flashback when you were talking about her because I worked in Idaho in this small town and worked as a family doctor, probably 80 hours a week, delivering babies on top of my regular schedule, off and up all night, ran the ER as well. We had to rotate through a night or two a week. So we were like on the 24-hour shifts and I had babies on top of that.
Dr. Mark Hyman:
And after almost four years, I decided to stop working there, and I took like a few months off and I was ready to go visit my friend and drive my car with my family to go from Idaho to California. And I literally, when I finished the trip, I literally could not pick myself up off the floor. I was so exhausted in such a deep and profound way, it took me like three months to recover. And I didn’t have chronic fatigue or anything back then, but I was just so burnt out and I thought, “Oh, I’m a doctor, and that stands for medical deity and sleep as an option.” And I would just literally go for days with very little sleep.

Dr. Elizabeth Boham:
I was the same way. I feel like I’ve learned the most about this whole HPA axis on myself because I’ve been burnt out a bunch of times. And the biggest one was after I went through all my cancer treatment and I had my two kids. I finished all the treatment and then I had my two kids. And it was like at the end of that whole process where I had gone through all the treatment when I was 30 and then actually had two children, which is exhausting for the body, I was the same way, I was just burnt out. There’s nobody, especially when people go to the doctor, there’s often not a lot that happens conventionally.

Dr. Elizabeth Boham:
We’re just not training our physicians sometimes I think to recognize that. And so we often go to the depression place first, or the medication place first, where it’s just we really need to have that time of self-care and shifting our mind and process and everything.
Dr. Mark Hyman:
The first case was like in a way a physiological problems, her schedule, it was her rhythm of her life, and it was some of her bad habits. But the next case is a woman who really suffered from psychological trauma. And we know that adverse childhood experiences we call, ACEs, are highly linked to this chronic stress or PTSD, which is an extreme version of it. And that sometimes it’s very difficult for people to get out of that state of alarm or hyper-vigilance that comes from being in an unsafe or unstable environment they grew up in, whether it’s an alcoholic, or abusive parent, or financial insecurity, or wars, people who grew up in war zones.
Dr. Mark Hyman:
And so we don’t really do a good job with helping people with that in medicine. So tell us about this young woman who really suffered in this way and how you helped her to reset not only her biology, but her mind.

Dr. Elizabeth Boham:
Yeah. She was 28 when she came to see me. And the reason she came in was her digestion. She was frustrated with her irritable bowel, she had a lot of digestive issues, bloating, cramping, diarrhea, and she was anxious. And as we delved into things, we did of course clean up her diet and help her with some digestive issues, but really, as we delved into things, we realized and we learned that this was more her hormone balance in her body and that HPA axis. She had an abusive, her father was an alcoholic and her mom just living with her father being an alcoholic, her husband being an alcoholic, had a lot of stress in her life. And so she often overreacted with her kids, which we see, and she was, not to blame her, but she often overreacted.

Dr. Elizabeth Boham:
And we know that that impacts, we know that how the mom reacts impacts the kids and their offspring, even when they’re a fetus, but definitely when they’re young too. And when the mom overreacts, then the kids learn to overreact in that same way. And of course, the stress and trauma with her dad. And she was very successful, she had a good job, but she was just feeling anxious all the time, feeling anxious all the time. And that anxiety was going into her diet, this diarrhea that she had, this urgency that she had.

Dr. Elizabeth Boham:
She knew she was anxious and she knew she needed to calm down her body, but when she did some breath work or meditation, she couldn’t shut down her mind. She would say, “I just can’t do it.” We get that all the time with our patients. They say, “Oh, I just can’t, I can’t shut down my mind. Meditation doesn’t work for me.” When she came in, we did that saliva test. And what we saw is her levels were high, so she was still in that just high cortisol through the day. So her body was just continually pumping out a lot of excess cortisol, and that was making her feel really anxious and unsettled inside and contributing to her overall health.

Dr. Elizabeth Boham:
Then we got more information, she was also a two to three cup coffee in the morning, she often skipped breakfast, she skipped her lunch many times or just grabbed whatever she could. And so we really worked in many aspects with her. We have a woman, Suda, who works in our clinic and works with people to teach them mindfulness, different exercises and meditation. And I think that can be really helpful. There’s a lot of great apps out there, but sometimes people need a little more handholding than that. And so I had her work with Suda who works in our clinic, and that was very helpful.

Dr. Elizabeth Boham:
She worked with her for a long period of time, but just to do some regular weekly meditation sessions together.
Dr. Mark Hyman:
Sometimes you need a little help from somebody else, energy work, breath work.

Dr. Elizabeth Boham:
Yeah. I had her work with some Reiki specialist as well, because many times, some of those ACEs, those adverse childhood experiences get stuck, that trauma gets stuck in our body and energy work like Reiki really can be helpful at releasing some of that, oh my goodness, stuck trauma, which is important sometimes too, we have to let go of.
Dr. Mark Hyman:
Well, it’s interesting right now, there’s a lot of research going on around psychedelics and stress and trauma. And in fact, just a couple of days ago, published in JAMA, the Journal of the American Medical Association psychiatry, I think there was a study on psilocybin, which is mushrooms called magic mushrooms. It was four times as effective as antidepressants, and it’s used for PTSD for war veterans, for people who have cancer. And it’s not legal yet, there are a lot of research trials going on. So sometimes people can get enrolled. I think Oregon just legalized it for therapy, which is amazing.
Dr. Mark Hyman:
There are states which have decriminalized it as well. So it’s really, I think, going to be an emerging therapy that often works really well to help break down that sense of fear and separateness that makes us stay in this chronic state of trauma. So we’re learning a lot about how to deal with trauma and there’s so many different techniques. And I think what you underscored was that, often the doorway into healing from chronic stress is through your body, not just your mind, through your diet, exercise, circadian rhythms, the right supplements, various kinds of stress reduction techniques, meditation, yoga, Reiki, whatever, maybe even some of these newer therapies that are being used out there like psychedelic-assisted therapy.
Dr. Mark Hyman:
And I think that we’re on the verge of, I think, a real breakthrough in understanding how to help people with this. Because it is so rampant, and I think now given the phase of the world and COVID, and economy, and politics and yada, yada, yada, it’s like enough already. And I think all of us feel it, and I think it’s really important for us to learn how to manage our stress response. And I often say, we think the opposite of stress is relaxation, but I think for most people, relaxation is like, “I’m going to sit and have a beer and watch football or watch my sitcom.”
Dr. Mark Hyman:
That’s not relaxation. We’re talking about an active process of relaxation. So it’s actually active, and it can be meditation or yoga or other things. And I think these are really things that people can access that are available to us, that are mostly free. And for people who are really struggling, sometimes they need for more advanced therapies. And in functional medicine, we do the cortisol testing, we do all these other therapies. We can address the underlying physiological causes of stress, whether they are heavy metals or infection or allergies.
Dr. Mark Hyman:
And also, I think we understand that sometimes people need some adrenal support, and for very few patients over my career, I’ve used very, very low dose hydrocortisone, which is a treatment that’s not normally used in traditional medicine, but can really help rescue people from this complete state of crash until we build them up. So I think there’s just a lot of options for people, and I encourage people to check it out. Come to the UltraWellness Center, we’re seeing patients virtually now at the UltraWellnesscenter.com.
Dr. Mark Hyman:
Liz, you’ve been doing this forever, and so have I, and it’s really gratifying to see these patients, once you give them the guardrails and teach them how their bodies work, that they can learn how to do this. And for me, if I didn’t have these tools, I’d be a mess. I know because I’ve had so much stress in my life and I’ve learned how to actually discharge the stress so I can actually function and have a good life. So thank you so much, Dr. Boham Liz for being on The Doctor’s Farmacy Podcast on this special episode House Call. It’s great to have you again.
Dr. Mark Hyman:
And if you love this podcast, please share with your family and friends, leave a comment. If you’ve found ways to deal with chronic stress, please share them with us, we’d love to hear. Subscribe wherever you get your podcasts, and we’ll see you next time on The Doctor’s Farmacy.

Dr. Elizabeth Boham:
Thank you, Mark.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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