Tired And Wired: How To Heal Adrenal Fatigue 

Mark Hyman, MD

Dr. Mark Hyman is leading a health revolution—one focused on using food as medicine to support longevity, energy, mental clarity, happiness, and so much more. Mark Hyman, MD is a practicing family physician and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, Founder and Senior Advisor for the Cleveland Clinic Center for Functional Medicine, a fifteen-time New York Times best-selling author, and Board President for Clinical Affairs for The Institute for Functional Medicine. He is the founder and chairman of the Food Fix Campaign, dedicated to transforming our food and agriculture system through policy.

He is a co-founder and the Chief Medical Officer of Function Health. He is the host of one of the leading health podcasts, The Dr. Hyman Show with 150+ million downloads. Dr. Hyman is a regular medical contributor to several television shows and networks, including CBS This Morning, Today, Good Morning America, The View, Fox, and CNN.

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Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Introduction: Coming up on this episode of The Doctor's Farmacy.

Izabella Wentz: One of the key stressors is blood sugar imbalances. So just eating too many carbs and too much sugar, and then not enough protein and fat. This is a really, really big stressor for many people.

Dr. Mark Hyman: Welcome to the Doctor's Farmacy. I'm Dr. Mark Hyman. That's pharmacy where we have a place for conversations that matter. And if you've ever struggled with fatigue or feel burnt out, or feel overstressed, or tired and wired when you go to bed and you don't know why, well, you're going to find out why today. Because we're going to have an amazing conversation with Izabella Wentz, who's an acclaimed thyroid specialist, a licensed pharmacist, who's basically dedicated her career to addressing the root causes of autoimmune thyroid issues after being diagnosed with Hashimoto's in 2009.
And she's also focused on this issue of burnout and adrenal issues, which is what we're going to talk about today. She's authored three books on Hashimoto's, Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, Hashimoto's Food Pharmacology, and Hashimoto's Protocol, which became a number one New York Times bestseller, which is no small fete. So now her new book has come out, it's called The Adrenal Transformation Protocol, and I think in our overstress world, we all need it right now. So go get a copy right now and then listen to this podcast because you're going to hear us unpack what's in the book and give you a sense of how to heal from chronic stress and fatigue. So welcome, Izabella.

Izabella Wentz: Thank you so much for having me. It's a pleasure to be here with you.

Dr. Mark Hyman: Okay. Well, we both know the reality of overdoing, overworking, over-giving, overstressing and being burnt out. I'm a doctor, you're a pharmacist. We both went through hazing, which is part of our training. Clearly, people who go into the helping professions maybe are a little codependent, I certainly was, and intend to just burn out. And there's such a massive amount of burnout in healthcare, but it's also a burnout in our whole society. We're constantly stimulated by stressors, whether it's work, family, money, our environment, the climate change stresses, the political environment, the list goes on and on.
I think more than ever in history, we're just bombarded and it gets worse and worse. I'd like you to start by sharing your story of burnout. I ended up having chronic fatigue after working the emergency room, multiple shifts, trying to raise a family, going through divorce, and it was just a disaster. I understood what it's like to have my adrenals just completely crap out and had to recover from that. I want to hear your story because I think it's an important thing to start with. Then we're going to get into what is adrenal burnout? Why doesn't the traditional medical establishment consider this a thing, and it's completely ignored? Why are most people not getting access to that kind of treatment and care they need to actually restore their vitality and energy?

Izabella Wentz: Wow. Yeah. I feel as healthcare professionals, we go through intense training and there's so many exams that we have to do and wake up super early and then you stay up the night before and cram. I personally think that my fatigue issues really started in college, probably in my first year in college. I was taking chemistry, biology, and physics, and I was doing the whole major of that. Then also, I thought it'd be really fun to stay out all night to go to the bars. All the things you do when you're 18 years old and maybe your brain's not fully formed yet. My issues with fatigue actually started with my first year in college, and I went from this really bubbly and bright-eyed and bushy-tailed person that started college to all of a sudden sleeping through my exams.
I slept through one of my final exams, and as you can imagine, being a Type A person, I was like, "Oh my gosh, why did I sleep through my exam?" And I had laid down the day before at 3:00 to 4:00 PM to just take a nap. And then following morning, my exam was supposed to start at 7:00 AM and I ran into the exam room at 8:00 AM because I had just woken up and I was on this journey of you're always so tired, why are you so lazy? I had to eventually come up with accommodations to make up for my fatigue so I could study, and I figured out during my second year in undergrad. By pharmacy school, I just really had a system where I just really learned how to be very efficient and studying and getting things done and very productive and the time with the little energy that I did have.
But I did require 12 hours of sleep a night, and I was just like... I'd wake up tired. I'd be tired all day, and I had to drink six cups of caffeine to get my brain working and get myself through the day. Finally, I was diagnosed with Hashimoto's after becoming a pharmacist, and I went to some conference and it was like, "Oh, you're not supposed to sleep 12 hours a night." I was like, "Huh, is that interesting?" Finally, pursued additional testing. The Hashimoto's diagnosis came. I was like, "This is amazing. Finally going to get on some medications to help me."
The medications helped a little bit, so I went from sleeping like 12 hours a night to 11 hours a night. I was grateful for that. That helped, but I still had the fatigue and I still had all these digestive symptoms and acid reflux and IBS. And so I went through a process of really discovering how to get back my own health, and part of that was the gluten-free, dairy-free diet. That year, books were life changing for me. I was reading them when I was listening to audiobooks on my way to work and getting off of those foods helped me get rid of the acid reflux, but then I still had the brain fog and the fatigue and somebody brought up adrenal fatigue, and I was like... I googled it, and this was 10 plus years ago.
I'm like, "This doesn't exist. Clearly this reputable site says it's not a thing." I just went on and looked for other things and finally the 15th person brought up adrenal fatigue, and I was like, "Oh, okay. Well, maybe this is a thing because I have all the symptoms." I tried the interventions and I got better. Holy cow, my brain works. I'm waking up early in the morning. I don't need 11 hours of sleep. I'm sleeping eight to nine hours, waking up refreshed. I don't have that anxiety. I don't have panic attacks. I'm not hungry anymore. I'm sleeping, and it's a refreshing type of sleep. And so that was over 10 years ago, and that was part of my healing journey where I was like, "Wow, I feel like myself again." Turns out I'm actually a calm and relaxed and happy person. I'm not anxious and exhausted all the time.

Dr. Mark Hyman: Yeah. Powerful. Let's talk then about what actually happens. What is going on with this phenomenon of adrenal burnout or adrenal exhaustion? Because in traditional medicine, how I was trained, there's something called Addison's disease, which actually President Kennedy had, which is basically adrenal failure, where your adrenal glands can't make cortisol, they can't make the mineralocorticoid that keep your blood pressure up. They really stop working properly, and it's an autoimmune disease of the adrenal. There's some other adrenal conditions that are also problematic, but as a whole, the medical profession doesn't even understand this, doesn't diagnose it and doesn't know how to treat it, and yet most of us are pretty stressed out and feel it. And then there was a wonderful article in the New England Journal of Medicine a number of years ago by Bruce McEwen about stress and the effects of chronic stress. And he really mapped out using very rigorous science.
What happens over time, as we start to get stressed and our bodies respond with high cortisol and then eventually burn out, and then we can't produce enough of the stress hormones when we actually are stressed and we just feel exhausted. Can you talk about this ancient system that allows us to respond to stress, but how our modern life keeps us in a state of chronic stress and survival mode, which ultimately leads to our adrenal dysfunction? So talk about how that works and what are the symptoms? How do people know if they have this?

Izabella Wentz: Absolutely. I know that the term adrenal fatigue, maybe it's not scientifically accurate. There was a naturopathic doctor that coined the term, and his initial theory was that the adrenals were actually sluggish and it was a mild sense of Addison's, but we now understand it's more of an adaptation. We know that it's the way that our adrenal glands and our brain communicate when we've been subject to chronic stress for long, long periods of time. Initial high cortisol response is what we typically will hear about on the news, like, "Cortisol. You have cortisol that's too high, that's bad. You have bad cortisol, bad cortisol, cortisol is too high," but we do need cortisol to actually live. Cortisol helps manage our immunity, it helps to manage our immune function, our inflammation in the body. It gives us energy in the morning, and we actually do want to secrete cortisol throughout the day.
What most of the people I've seen with Hashimoto's, with chronic fatigue syndrome, with autoimmunity, they actually don't have enough cortisol on board and they have these flat lined adrenal curves. Part of why this occurs is our bodies are adapted to respond to stress. In ancient times, it was something like a bear chasing us or a lion or a tiger, and then we'd produce high cortisol. And then we'd get out of the threat, we'd shake it off, we'd go back to maybe sleep it off, shake it off, whatever. We'd go back to having this healthy stress response. But when we're constantly getting stress signals from our environment, our body shifts into this survival mode and in order to conserve resources and energy, eventually, we're not going to be producing lots of cortisol. When we're in that high cortisol state, that can be a very catabolic process on the body and that can be very stressful on the body.
I feel it's a bit of the boy who cried wolf syndrome where the body's like, "Okay, you're stressed. Okay, I get it. You're still stressed, you're still stressed, you're still stressed. We're just going to keep cortisol low, so we're going to save it for when that bear actually comes, so that I can give you a burst of cortisol." And usually, this is in the evening time for many people so that they will say, "I'm so tired all day long, and then I get this burst of cortisol at night," and they don't know that it's cortisol at night. They just think that maybe they're night owls or they just have trouble falling asleep. They'll wake up throughout the night, they have unrefreshed sleep because their body essentially gets out of alignment with our circadian rhythm. They're exhausted during the day and they're wired and tired at night, and-

Dr. Mark Hyman: Yeah, they're tired. If you know you go to bed and you're exhausted and you're laying there and you can't fall asleep and you feel wired, that's what she's talking about.

Izabella Wentz: It's a very real phenomenon, and I feel it's not a disease per se, but it is exactly what happens when your body's been under chronic stress for a long time. There's also a very predictable way of getting out of it. I know people will say they have brain fog, they have trouble waking up in the morning, they have salt cravings, they might have coffee, caffeine dependencies. They're crawling to their coffee maker in the morning. That's probably a sign that you might have some sort of adrenal dysfunction. 3:00 PM crash, feeling hangry, feeling irritable, anxious, like everybody around you is just really draining your energy, flight sensitivity, addiction to or dependency on alcohol in the evenings to help you wind down. These are some of-

Dr. Mark Hyman: And sugar.

Izabella Wentz: And sugar, absolutely, to give you energy. These are some of the patterns that we see with people in this state. And again, it's not a disease, but it is a very predictable way the body adapts when we're under a lot of stress.

Dr. Mark Hyman: Often, I see there's a lot of people get low blood pressure, so they basically stand up and they get dizzy or they get palpitations or they feel like they crave salt, like you said. These are really common things where you can see crash in the morning, can't get out of bed in the morning, crash in the afternoon, can't get out in the morning, tired and wired at night when you go to bed. These are really common symptoms and I've certainly had them, I think you've had them, and I bet you people listening and going, "I kind of recognize that," and it doesn't mean that there's something fundamentally wrong with you. It means our bodies are not adapted to chronic stresses. There's a great book by Robert Sapolsky, who's amazing. I hope to have him on the podcast sometimes. But he's a professor at Stanford who studied baboon's stress responses.
Anyway, he wrote a book called Why Zebras Don't Get Ulcers, which is because they basically get chased by a lion. They go full out, total stress response, the lion kills one of the zebras, and then they all go back to eating grass and they just chill. We just keep going. We just don't stop running. The adrenal system has an adaptive response, so it doesn't just fail all at once or doesn't just get dysfunctional at once. What are the stages that people go through and how do people recognize that so they can actually avert the final thing, which I had, which was chronic fatigue.

Izabella Wentz: Usually, people start off with that heightened stress response where they'll release a lot of cortisol throughout the day. And typically, I think of rock stars in a hotel room. You just have all this energy and you feel like you just drank a whole bunch of Red Bull and you can't sleep. You're wired, you're like on the go, you're doing tons of things. Everybody around you is too slow, not smart enough. They just don't get it. And so this is how people usually feel in the high cortisol state, very irritable, and they're kind of jumpy. If time goes on long enough, then they'll get on what I call the cortisol rollercoaster, where they might start off with high cortisol in the morning, so they jump out of bed and they're ready to go, but then they'll have a dip in cortisol levels maybe in the afternoon.
Sometimes that's irritability. Sometimes that feels like anxiety. Sometimes that feels like getting really hungry, or maybe they need to take a nap at 3:00 PM. Then as the day goes on, they'll have another spike of cortisol where they can't sleep at night. They get to bed and they're like, "Ugh, I have a million things to do. I need to do them." If this goes on long enough, then they'll go into more of the reversed cortisol curve, where their total output of cortisol throughout the day will be lower. Most of the cortisol will be low early in the morning, so they'll have trouble waking up in the morning. They'll be like a person that was an early bird and a early riser will say, "Holy cow, I just woke up at 9:30. I used to wake up at 6:00 AM and go running. What is going on with me?"
Then throughout the day, they'll feel tired, but finally in the evening, they will get that surge of energy where they'll be like, "Oh, well, I finally feel alive now and it's time to sleep," and they'll have a hard time falling asleep. Then if this progresses long enough is where most of my clients that I've worked with end up with the chronic fatigue, with the Hashimoto's, with the autoimmune conditions, is they'll have flat lined adrenals. These are people that are waking up tired and they're going to bed tired and they're sleeping like I was. 11, 12 hours a night in some cases and feeling unrefreshed, and they're like, "Well, people tell me to exercise, but I feel worse when I exercise. People tell me to fast, but if I fast, I feel awful. If I get more sleep, I'll try to sleep for 12 hours and I'm still tired. I sleep less and I'm still tired." And they're really stuck in that state where their body just every little stressor can be so overwhelming, even things positive stressors can be too much for them.

Dr. Mark Hyman: Yeah, I think that's true. I think the sense of being exhausted in the morning is really a big deal. And it's a rush for the coffee, a sign of just being constantly irritated. Think about if you haven't slept for a while and you become more cranky and irritable, it's not because you're a jerk, it's just because your nervous system is just fried. We see this and the question is, symptomatically we can diagnose it, but are there tests that we can do to actually help figure out what's really going on?

Izabella Wentz: I love recommending tests. I do a lot of them myself, and if I had my way, I would have everybody do various functional medicine tests. The adrenal saliva tests can be incredibly helpful for figuring out what your cortisol pattern looks like. Then there's also the DUTCH profile, which goes a little bit deeper. It's a urine test and it could look at how your body metabolizes the various stress hormones and how much it's putting out. The tricky part is I've been recommending this for 10 years now, and then people will say, "I went to my doctor and I asked my doctor to test my adrenals. They said I don't have Addison's." And I'm like, "Okay, well, you've got to go to a doctor that is an integrative practitioner." And they're like, "Oh, well I found one, but they're very expensive and these tests I have to pay out of pocket for."
That's another barrier to getting the help. Then they get the tests, they get them home, and then they're like, "But it's been sitting on my shelf for three months." Then finally they do the test and they get the results a few weeks later, sometimes a couple of months. Six months have gone by where I could have told you based on your symptoms that, if you're chronically fatigued, there's a good chance that you're in that stress response. If you're in that fight or flight mode and you're feeling really irritable all throughout the day and you can't sleep, I'm pretty sure you have too much cortisol. I do love tests and I recommend them, but I wanted to create a program and a protocol that was entirely based on symptoms and how to reverse and address the symptoms so people could work with their doctors and get the tests that they need, or they can really be empowered to take charge of their own health. I don't know if you've had the same experience too.

Dr. Mark Hyman: Yes, I think it's so true because I think most of the time, people walk in and they tell me their symptoms, I can tell what's going on, and then the test will confirm it. I think we do see stages of the test where we'll see, for example, high cortisol at night and low in the morning or high cortisol all day initially. Then it drops in the morning and then it ends up being low all the time, kind of flat lining. I think that's something that is an end stage process. In terms of the treatments and the diagnosis of it, you challenge some of the traditional view of this. You say doctor's talk about this as a bogus diagnosis and dismiss it. Why do you think that is?

Izabella Wentz: Unfortunately, I think it has to do a lot with the nomenclature where the term adrenal fatigue was initially coined, where the brilliant people that coined the term and started educating the world about it, the initial understanding of the mechanism of action behind of what was going on was a mild Addison's. Or that the adrenals were not capable of producing cortisol, where we know it's more of an adaptive system where the adrenals are capable of producing cortisol, they're just not releasing the cortisol at the right times throughout the day. That's what ends up, I think, boggling a lot of people. Some practitioners argue about the terminology, so they'll say adrenal fatigue doesn't exist, but then you'll look at HPA axis dysfunction or hypothalamic-pituitary-adrenal axis dysfunction, and that is a real thing, and there's published literature around it.
Same with leaky gut 10 years ago. It was like it doesn't exist. And then you go to PubMed and there's intestinal permeability. So basically, you just have to use the right terminology, I think, for them to get it. You can call it burnout, you can call it adrenal fatigue. I call it adrenal dysfunction because I feel like it rolls off the tongue a little bit easier than hypothalamic-pituitary-adrenal axis dysfunction. And it's a little bit more of an updated term to reflect the mechanism of what's going on as far as we understand it these days.

Dr. Mark Hyman: Yeah, amazing. So in your book Adrenal Transformation Protocol, you talk about chronic stress being a huge cause of this and how it creates a demand for high cortisol and adrenaline, but you talk about four different kinds of stress. I think this is important because it's not just psychological stress that can cause adrenal burnout as it was for me, it was something else. It was physical stresses and some psychological stresses, it was a combination of things. I wondered for the audience, would you just unpack the four types of chronic stress that can sabotage our adrenals?

Izabella Wentz: It could be psychological stress. You're going through graduate school and you are waking up three times throughout the week at 5:00 AM to go do your exams. That can be incredibly stressful. You have a really annoying boss who's just a jerk, and that could be incredibly stressful. You have a lot of family drama that's currently stressful. People recognize these kinds of stressors. One of my books, somebody wrote a review that was like, "I didn't need to do anything that she recommended. I just quit my job and my whole life got better. I didn't have autoimmunity anymore." And I was like, "Amazing." If you could recognize there's this one thing in your life that's causing you stress and get rid of it, that can be a big game changer.
But there's also positive stressors. You have a beautiful baby and that beautiful baby doesn't sleep. I know that was a stressor for me five years ago when I got into adrenal dysfunction, another time in my life. You got married and you moved across the country or you got a job promotion. These are positive things in your life, but they can be a bit overwhelming. Then there are hidden psychological stressors. Maybe you had a history of adverse childhood events, something happened in your childhood that was traumatic, you probably don't even have a recollection of it, or maybe you do, but it has shifted your HPA axis to be more on high alert and put you in that survival mode and you've got that on your plate. That could be something that people aren't necessarily aware of because it's not present day stress. Their present life might be perfectly peaceful.
Then we think about the physiological stressors. I'm always like, what is in your life right now that could be causing your ancient genes to think that you're under stress? Let's unpack modern life. If you are not sleeping a lot, if you are skipping meals, if you are exercising, overexercising, if you're eating foods that are inflammatory to you, your cave man or cave woman brain is going to say, "Holy cow, we must be in a war, in a famine or being chased by a herd of bears or something because why on earth would you be eating stuff that's inflammatory? Why would you be starving yourself? You must be in a famine. Let me help you out from a evolutionary perspective and let me shift you into this adrenal fatigue state so that we can conserve your energy, we can conserve your metabolism." These are some of the modern day stressors and sleep deprivation is probably the fastest way to get into this adrenal dysfunction.

Dr. Mark Hyman: Yeah, I mean, what's interesting is that people don't realize that actually their diet can be a stress, that actually sugar and starch when you eat it, causes a flood of adrenaline and cortisol under your system, even if it's oatmeal. David literally showed this, it was really shocking, years ago in a study of obese kids where he gave them oatmeal or eggs for breakfast. The kids who ate the oatmeal had high levels of cortisol and adrenaline because of the glycemic load of the oatmeal, which we think is a healthy breakfast, and cereal is even worse. That drives higher levels of stress hormones and that it makes you hungrier, it makes you crave sugar, and it causes high blood pressure, all kinds of issues. I think it's important to highlight that.

Izabella Wentz: Oh my gosh, absolutely. One of the key stressors is blood sugar imbalances. Just eating too many carbs and too much sugar and then not enough protein and fat. This is a really, really big stressor for many people in being micronutrient deficient. That's actually one of the key transformations as we focus on blood sugar balance and people will say, "I thought I had anxiety. It turns out my blood sugar just needed to get balanced. And I thought I had insomnia and I was waking up at 3:00 AM and I wasn't sleeping through the night. It turns out that it was actually my blood sugar." This is such a really, really important stressor. I thank you for bringing that up because this is a core part of transforming your adrenals and transforming your stress response. It's the nutritional signals, figuring out how to get yourself in balance.
Then there's also the hidden stressors where people might not realize them, they're not in their lifestyle. Their lifestyle might be spot on and perfect, but they might have an H.pylori infection or they might have a toxic exposure, perhaps mold exposure or some other kind of toxin that could just be sending their system haywire and sending them into that survival mode. Even though they're like, "I'm doing everything right. I'm doing all the things. I'm sleeping well. I have a good marriage and I love my job. All of a sudden I just feel terrible." Usually in that case, it could be a hidden source of inflammation in your body.

Dr. Mark Hyman: Totally. I think what's interesting is when I had chronic critique, it was because I had mercury poisoning and that screwed up my adrenal, so it was some external thing. Lyme disease or mold or whatever it is, it can be anything that drives inflammation as you said, can cause adrenal dysfunction independent of what your stress levels are psychologically. That's really, really important. Also, rhythm. We talked about sleep, but having regular wake and sleep cycles is important. Eating at the same times is important. Your body is a biological clock.
There's a whole system of medicine called chronobiology, which is the science of how to, for example, treat cancer with certain chemo drugs given at certain times of day. I think we lose track of that, and we just think we can go buffet about our body with all sorts of irregular schedules, and that is really not good for us. It really requires a discipline of a repeated state of circadian rhythm and of reducing the things that cause adrenal dysfunction to help you fix that. One of the things that people don't realize is that the gut plays a big role in the adrenal function. Can you unpack that for us?

Izabella Wentz: Oh yeah, absolutely. It's a two-way street, so whenever we have infections in the gut, and I typically see... We talked about all these different stressors, some people just have one stressor. For most people, it's a stress bucket that overflows when we either have one major big stressor and a whole bunch of little ones, or even just a whole bunch of little ones or moderate sized ones. Whatever happens is your stress signals are like you have way too much stress in your life, you have too many danger signals, and you shift into that survival mode. Part of that could be coming from your gut. A lot of times I'll see people that I've worked with in that chronic fatigue state, and interestingly there's research talking about CFS and some of these things, but people will typically have some gut infection.
They might have an H.pylori infection, they might have a protozoal infection in their gut, they might have candida overgrowth, they might have dysbiosis, they might have mold colonization. All of that shifts the body to have more inflammation. Then the other piece of that is when we're under a lot of stress, our secretory IgA levels are depleted. Our secretory IgA is what keeps our immune function in the gut and the respiratory tracts. People end up being more susceptible to all kinds of illnesses and whatever pathogens are in their gut, they're more likely to take over the gut and set up residents when you don't have a good enough secretory IgA response. You might be the person that you go to a restaurant with your friends and you are all eating the same things, but if your secretory IgA is low, everybody will be fine, but you'll get food poisoning because your body won't be strong enough to overcome whatever microbes are naturally present in the food.
It's a really, really big two-way street. Part of my plan with the Adrenal Transformation Protocol is minimizing inflammatory foods that can cause inflammation in the gut. Then we also focus on utilizing a beneficial yeast called Saccharomyces boulardii to raise that secretory IgA response. This can make you more resilient to stress, it can help you overcome food sensitivities. It can clear out some of the pathogens from your gut, like the candida, some of the protozoa, some of the H.pylori and so on and so forth, to just make your gut a little bit more healthy and a little less inflamed.

Dr. Mark Hyman: Amazing. Everything is connected. This is functional medicine 101. Everything is connected to everything. I think we have to realize that. I always say our body has only so many ways of saying, "Ouch." So many different insults can disrupt adrenal function and obviously thyroid function, which you've written about. Why do you think this is so prevalent? I think everybody listening is going, "God, I recognize those symptoms. I've experienced this. I get it." It's this invisible problem that most people don't get the right therapy for. Why do you think that, before we get into what to do about it, so many people and women in particular have thyroid, adrenal and autoimmune stuff going on?

Izabella Wentz: It's so common that people almost think that it's normal. But I'm like, just because it's common doesn't mean it's normal. I think really it is a consequence of our modern life because we are disconnected from the circadian rhythm. We are not sleeping well enough, so we're not getting that rest and digest period. We constantly have a culture to keep working harder to side hustle and do all the things. Then we end up really hearing about how we need to lose weight, and so we restrict calories. I feel like all of these, with modern signs that get interpreted by our ancient genes, our genes don't know what to do with, "Hey, we're always under stress." They're not adapted to cave woman, caveman life was pretty chill. You would eat your food and then you'd relax. You'd go hunting and gathering, and every now and then you'd have a situation, but you weren't doing a side hustle.
You didn't have three different jobs to make ends meet. Certainly there's a lot of things going on in our modern times, especially in the last few years, that I feel have made us feel like we're not safe in our modern world. We have the fear in the last few years like we don't know what's happening in the world. There's war. There's a pandemic. There are people that are also worried about their children throughout the pandemic. You're worried about your relatives and elderly relatives throughout the pandemic or maybe you're immune compromised. I've seen it a lot of it just in the last 10 years, but especially in the last few years. My girlfriends are like, "Hey, I don't have Hashimoto's, but I have all these symptoms. I have the brain fog, I have the fatigue, I have the anxiety, I have all the things."
It's because the body shifts into that stress response and that survival mode when we get the message from our environment that we're not safe. Our body is always trying to help us to adapt and protect our survival. It is very, very common and more common in women because women have more receptors to be tuned into the environment. We do bring new life into this world, and so it's really important to know if it's a safe time to bring new life into the world or not. We're wired with more estrogen and more hormones that are going to be receptive to stress.

Dr. Mark Hyman: It's so true. It's so true. Let's talk about the solution because I think everybody's going, "Okay, I get it. I've had this problem, or I've had some level of it, and it can be mild or can be very severe." What is your Adrenal Transformation Protocol? It's quite different than most integrative doctors who say, "Get checked, test your adrenals, quit caffeine, sleep a little more. Maybe try DHEA." What's different about your approach to restoring adrenal function? Because to be frankly honest in terms of functional medicine, it's one of the hardest things to do.
It takes a long time for me to help people to completely reset. It's like a complete revamp of their lifestyle. They have to get off all the inflammatory foods, sugar and processed food. They have to develop a regular rhythm of waking and sleeping, getting exposed to sunlight in the morning. They have to make sure they don't overexercise, they need to practice meditation, yoga, get acupuncture, take a bunch of herbs. It's like a lot. It's not like, "Oh boy, they get better." It's very slow. Can you talk about how different your protocol is? What is it? Help us understand how to restore our adrenal function. Asking for a friend.

Izabella Wentz: All of the things that you said can work incredibly well, but like you said, they do take time and they're not the right fit for everybody. 10 plus years ago, when I recovered my health, I utilized pregnenolone and DHEA, and then I would recommend that to my clients. Sometimes hydrocortisone, all the sleep, 10 to 12 hours of sleep a night and letting go of a lot of stressors. That worked really well for a lot of people, but then it didn't work for some people, and I was just like, "Ah, maybe they're just resistant to change," and so on and so forth.
Then I became a mom five years ago, and I was like, "I'm so sleep-deprived. My beautiful baby's eight months old. I thought they were supposed to sleep at three months old. Hold on. What's going on here? I was lied to." When he was eight months old, I was waking up every two to three hours to feed him at nighttime and was just like, "Holy cow, I think I crashed my adrenals." I did a test for myself, and sure enough, they were flat lined. But I'm like, "I can't take DHEA. I'm a nursing mom. I can't sleep for 12 hours a night. I'm a nursing mom. I wish I could sleep. I can't quit coffee. I just started drinking coffee. It helps me so much. You can't take it out of my hands."
I remember having clients, I would tell them, "You're waking up at night and you're so tired throughout the day and you're drinking six cups of coffee, I think you should just quit the coffee and you'll be fine." They'd be like, "Well, I quit the coffee and I still feel like crap. I'm still waking up all night and I'm still tired throughout the day." I was like, "Oh, wow, I really have to, I don't know. I have to get out of this. I have to feel good again. What do I do?" I went deeper into my safety theory where I figured out, "What are the stress signals my body's receiving, and then how do I counteract that with some safety signals, so that I can shift my body out of that survival state into more of a thriving state?" The beautiful thing is when I was going through the functional medicine process and all of the integrative wonderful tools that would take three months to two years to see results, with this it took three to four weeks.
I was like, "Holy cow, this is working." Then I piloted it initially with about 200 people. 92% saw less brain fog, more than 80% had less fatigue and so on and so forth, within just that three to four week time period. That's why I'm writing a book on it because I feel like it's a great approach that is complimentary to the testing and to all of the wonderful precision of utilizing hormones, if that's a route that person wants to go. But I really focus on supporting the body and its stress response. You'll see the things that are foundational from functional medicine and from integrative medicine like the adaptogens, those can be utilized. The B vitamins, vitamin C, magnesium and electrolytes. That's the part of the protocol. But I'll also utilize mitochondrial support, so specifically D-Ribose, Rhodiola and carnitine.
That can really transform a person's brain fog anxiety and their ability to sleep really quickly. As well as myo-inositol to help resolve some of the anxiety, some of the blood sugar swings and help them sleep better. In addition to blood sugar balancing, aligning with the circadian rhythm, and then a lot of the transformational techniques of building energy. Some of them are really focused on creating pleasurable activities throughout your day. That can be just a really big game changer for people who don't do things they enjoy throughout the day, so connecting in nature, having time with friends, things of that nature. We go through a whole process, where I have about 14 different safety signals, to outweigh the stress signals that we're getting, and we're also turning off some of the stress signals throughout the process.

Dr. Mark Hyman: It's a whole combination of things including dietary changes, bringing pleasure in your life, getting your circadian rhythm set. What's different about your approach is some of these unique supplements. Is that what makes it different, the Rhodiola, the myo-inositol, the carnitine?

Izabella Wentz: A big focus of it is on the mitochondrial support. You might have noticed Adrenal Transformation Protocol, it's ATP, so that is part of it.

Dr. Mark Hyman: I did not catch that.

Izabella Wentz: It is our energy throughout the body, how mitochondria creates energy throughout the body. That is a big part of it, but also a lot of transformational work too. Looking at how to create joy in your life. A lot of times I feel like people are fatigued, not because they're doing too many things, but because they're not doing the things that bring them joy and energy and that really bring the spark into their lives. They're drained by doing mundane tasks. Shifting your daily routine to adding some pleasure into your life can actually sometimes be more effective than utilizing supplements in nutrition. I combine it all, and this is why I think people have such fabulous results, and I don't ask them to quit caffeine. So this is-

Dr. Mark Hyman: Oh, yeah. Just love coffee in the morning. But not 12 cups a day,

Izabella Wentz: Gosh, no. Not 12 cups of coffee in the morning, but we focus on really building up their energy levels. Usually by week two or three, they're able to wean off the caffeine naturally and they don't need it. If you get enough bright lights in your morning... You step outside, you get some bright lights into your morning, you do the adrenal kickstart drink that I recommend, which is a little bit of orange juice and sea salt and protein and fat. You do that in the morning and then you're going to be like, "Holy cow, I don't even need my caffeine." Because that's going to raise your cortisol level naturally. Then people sleep really well at night throughout the program, so then they just naturally wean off. Some people are like, "I want to be on coffee, I love coffee, or I love my Earl Gray tea." That's fine. If you're having an unhealthy relationship with your caffeine, with your sugar, with your wine, then we're going to give you the energy-

Dr. Mark Hyman: You need to break up. If you have a bad relationship, you have to break up.

Izabella Wentz: You have to break up with that, absolutely. But we want to get you to a really healthy relationship with the caffeine. Part of that is making sure you have enough energy so you can actually quit the caffeine. If you don't have enough energy, if you're sleep-deprived, you're just going to go back to your habits, so a big part of the process.
We do see shifts in about the first two weeks. I've done the program seven times now with groups of people over 3,500. Initially they're like, "I'm so overwhelmed. I'm so tired. I'm so stressed." By week two or three, they're like, "I'm running up and down my stairs. I clean my whole house. My libido's back, I feel so amazing." It really focuses on supporting your body's energy pathways and also letting go of the things that really weigh us down. A lot of the transformational work focuses on, are we having stories in our heads that maybe are weighing us down? How do we transform that? How do we create a trigger toolkit so that we are not drained on a daily basis by things that trigger us?

Dr. Mark Hyman: That's interesting. You talked about this identifying what is triggering us because one of the things that drives chronic stress response and chronic disease is what we call adverse childhood events. They have the things and bad things that happen to us when we're a kid, whether it's neglect, whether it's a parent yelling at us, whether it's abuse or physical or sexual abuse. I mean any degree of that, depending on the person and their sensitivity and actually even their genetics, because genetically, we actually are designed to respond differently to stress. Some people are much more resilient, others aren't. When we get these events in our childhood, they set us up for feeling like the world's not a safe place. They can lead to PTSD, autoimmune diseases, all kinds of things, cancer, heart disease, early death. They affect this fundamental regulatory system that we're hinting around called the HPA axis, which is the hypothalamic-pituitary-adrenal axis that is so essential to regulate all of our biological functions.
It's our hormonal orchestra, basically our conductor of our orchestra. That becomes adversely affected. You talk about how do we change our response to the triggers that activate these ancient or not ancient, maybe from our childhood software programming that's corrupted and creates a disproportionate response to an event now that may have been big when we were a child, but is now really not like that. How do we begin to deal with those things in a practical way? You did hint at it, but I'd love you to go deeper on that.

Izabella Wentz: Sure. Part of the plan is creating yourself a trigger toolkit. Figuring out what are some of the things that trigger you and what can you do when you are triggered? Let's say somebody says something to you that makes you really angry and drains your energy. How do you come back from that? Do you yell at the person? Probably not a good idea. But are there positive ways or ways that you can de-stress from that? Maybe somebody really triggers you and says something that makes you crazy. One of the things to do in the moment, and I encourage people to make a list of things, we have a list of things to consider, but you might find that going for a hike might help you feel better. That might be a way for you to dispel that anger or angry energy by going for a little bit of a hike, if you enjoy time in nature. Or maybe taking an Epsom salt bath to support your body in that way. You might find that giving yourself a hug or talking to a friend might be a very, very great way to deal with those triggers.
Then also making a plan for, if you know that there are things that trigger you, your triggers are your healing plan. It's like this is where the sun comes in. If you notice that you get triggered when people say certain things to you or certain things happen, that's actually a really good thing to be aware of that because you can work on these things and take that trigger response off. One of my favorite approaches to this is called EMDR therapy. This is eye movement desensitization and reprocessing. It was developed by Francine Shapiro, a psychologist who found that when our eyes moved from left to right, this tapped into a part of our brain. You can use this in a therapeutic process where you can essentially reprocess old traumas. You experienced them with... Let's say they were childhood traumas, and they led you to believe certain things 40, 20, 30, 45 years later, something that happened when you're five, still has so much control over you, you can actually reprocess them and re-look at them as adults.
Let's say you were neglected as a five-year-old, you can go back in time essentially and make these different neural connections where you can be that parent for that five year old and show up for yourself. It is just an amazing therapeutic process that can work in one to two sessions to overcome most traumas. Then you'll find the things don't trigger you like they used to. To give an example, I was in a traumatic car accident when I was in my first year in college. I was driving with a girlfriend coming home from school, and then one of my tires popped. We were driving 90 miles an hour on a huge six lane highway in Southern Illinois, and my car tire popped and I swerved into oncoming traffic. There were tons of cars coming at me, and I ended up in a ditch with whiplash, and I had a bit of PTSD after that.
I couldn't drive a car for a while and I would get in a car and I would start crying because it was so scary for me to drive a car. I had one EMDR session on that and after that point I was like, "Okay, I can drive a car again. I'm not stressed out by that." They can be a really amazing therapy that I've recommended for a lot of my clients and they'll find... Talk therapy can be great too. But doing something like this that actually helps you reprocess the trauma so you can shake it off and go on with your life and not let it eat up at you, can be incredibly healing and make you more resilient and strong.

Dr. Mark Hyman: Powerful. It's really how to reset our relationship to stress and our life. I think most of us are chasing things that keep us stressed, whether it's money or success or just trying to get by. I think, like you said, bringing joy back into life is so key because at the end of the day it's what matters. I remember, I don't know, it's a poem written by some woman, who was dying and said, "If I had to live my life over again, I would spend more time smelling the flowers, talking with friends, laughing, taking hikes, doing the things that bring joy and that are really the juicy part of life rather than work, work, which is our crazy culture."
I want to dive a little bit more deep into this whole idea of adaptogens. You were talking about this in your program and there's a whole set of herbs and compounds that are available from nature that seem to help reset our nervous system, that help us adapt to stress. For example, the cosmonauts were on, for example, lots of these adaptogens when they went to outer space to help them be stress resilient in outer space. Can you talk about some of the highlights in this family of adrenal adaptogens that are available to us from herbs to mushrooms to all kinds of stuff?

Izabella Wentz: Yes. There are so many different adaptogens out there, and I typically would recommend for most people to take them if they're in a stress response unless they're pregnant. They're even safe for nursing moms, but usually nursing moms just need to take maybe one or two in smaller amounts and check with their lactation consultant. But all of them have different personalities where some of them may be more beneficial for one aspect versus another. The beautiful thing about adaptogens is whether you have too much stress and too much cortisol or not enough cortisol, they provide a balancing effect in the body. If you have too much cortisol, they'll normalize that. If you have not enough-

Dr. Mark Hyman: Like a thermos, keeps your soup hot and your lemonade cold.

Izabella Wentz: Exactly. They have that beautiful effect. You don't necessarily need to worry about if you have too much cortisol or not enough cortisol, you can utilize them and they'll help you adapt more to stress. Now, I always tell people, when you take adaptogens, you become more resilient. The stress bounces off of you. How it typically manifests for a lot of people is people in their life just become less annoying. Magically everybody is less annoying to them and because they have a little bit more resilience, a little bit more patience, a little bit more joy, less anxiety, less of that fatigue, they're sleeping better at night.
I have a list of them throughout. Some of them are very helpful for depression, anxiety such as Rhodiola, Ashwagandha can be fabulous for people with thyroid issues because it can help with supporting healthy TSH levels. Then we have things like Maca and Shatavari that can be helpful for people with libido issues, that can have some of those wonderful properties. Other ones might be helpful for helping you sleep. I really love Reishi. This is something that can give you some energy in the evenings to feel really good and healthy and also help you sleep really well at night. This is from a mushroom.

Dr. Mark Hyman: Yeah, I think that's really important. Maybe let's dig into the sleep thing because I think this is one of the challenges of people who are so exhausted, they can't sleep and their biology's not giving them a chance to rest. You want to sleep, you're exhausted, you go to sleep tired, but you can't fall asleep, you wake up tired. How do we reset sleep? You mentioned a few things here and there, but go through the protocol for fixing sleep.

Izabella Wentz: Okay, great. I'll share something that works for about 50% of the people. The results in the program have about 80% success within sleep, within three to four weeks. I'll go through the whole process. What works for 50% of the people is making sure you get morning sunshine throughout your day. You're eating every two to three hours protein and fat. If you're somebody that has that-

Dr. Mark Hyman: Every two to three hours, really?

Izabella Wentz: Well initially. Initially for people that are really in that low cortisol state, you're going to be eating on a schedule. You're going to have breakfast, and then you're going to have lunch. You might have a 3:00 PM snack if you get that blood sugar hangry crash, and then having dinner around six. A lot of the people that come to me, they're not eating breakfast, they're not hungry throughout the day, and they tend to wake up at 3:00 AM and having to eat a snack. We're shifting your eating to daytime so that you're getting more calories throughout your day and through daylight hours to let your body know when it's time to be wakey, wakey and when it's time to sleep. Part of that is like that circadian eating. Initially for a lot of people that looks like we're eating every few hours because I have a lot of people that skip meals and we're trying to reestablish that, "Hey, it's daytime. We're eating now."
We're trying to eat outside whenever we can. We're getting that bright light throughout the day and we're really trying to get protein and fat into a person's system. Specifically protein cause a lot of times if we don't get enough protein, we're going to be waking up throughout the night with blood sugar swings. This is part of the plan. Then we make sure we're not exposed to bright lights in the evenings as much as possible. After sunset, you could do something like blue blockers and put your phone on a nighttime setting. If you're watching a show, taking out all the blue lights in your house-

Dr. Mark Hyman: Blue lights.

Izabella Wentz: ... in your bedroom so that you're not waking yourself up, that can tell your body to wake up in the middle of the night. Then utilizing something like an Epsom salt bath as part of your evening routine so you can get warmed up, and that lets your body know to relax. The magnesium from the Epsom salts helps you to get more into relaxing, reduces your anxiety, your pain. It has sleep promoting effects you get out of the bath. That little cold exposure also helps you sleep. You sleep in a cold, dark room. This is the lifestyle foundational that can work wonders for a lot of people. Now I get into a little bit deeper into... Okay, if you have trouble falling asleep, what are the things to consider there? Having a good nighttime routine can help. Doing something like GABA for some people might help to get rid of that racy mind. Then we go into, if you're waking up in the middle of the night, that could be a blood sugar issue. I utilize myo-inositol and carnitine in the evenings to help with blood sugar swings, and that usually helps.
If you're waking up frequently throughout the night, that could be an ammonia issue, people with too much ammonia in their system. There's a lot of interesting research with frequent night wakings and brain fog connecting to ammonia. Part of the way we can produce excess ammonia is we're not digesting proteins, CBS gene mutation, H.pylori, various inflammatory pathogens in the gut, having constipation. I'll utilize magnesium to support the clearance of ammonia. Carnitine also supports the clearance of ammonia, as does Saccharomyces boulardii. That's like the people with frequent night wakings. I had a few clients with that, so I had to really dive deep into that.

Dr. Mark Hyman: Really? And how do you get rid of the ammonia?

Izabella Wentz: Well, some of the ways to clear magnesium citrate, if you're constipated, that can be very helpful. You can utilize Saccharomyces boulardii to suppress the pathogens that may produce ammonia in your gut. Carnitine helps to clear out ammonia from the gut as well. The book is organized by a four-week protocol. This is very simple. This is what you do. Here's the diet. Here's the six supplements. Here's the lifestyle changes. Then at the end of the book, if we need to tweak it for those 20% of people that are still having trouble with sleep, you can try these other things. Then Ornithine is something that can be really effective for clearing ammonia out of the body. There's a lot of research with you-

Dr. Mark Hyman: All this is in your book? All this is in your Adrenal Transformation Protocol?

Izabella Wentz: It is. The last section, I had to work so much on trying to get the word count of the book to include all of this, because-

Dr. Mark Hyman: I know how that works.

Izabella Wentz: Yeah, it's always tricky to try to get it all in, but it's a really solid protocol that you can follow for four weeks, that 80 to 92% of people see really amazing results. Then I have a section on how to tweak things. If you're still struggling with sleep issues, here's like additional things to consider for your specific situation.

Dr. Mark Hyman: Well, this is such a great gift to everybody, Izabella. I think this is such a rampant problem in our society. I think that it's underdiagnosed, it's under understood or misunderstood by most physicians. I'm really grateful that you've synthesized all the research and put it in a usable, practical guide for people to reset their nervous systems. Because I think so much of what's wrong with us today in the society is just this chronic stress response that's causing so much. Either, stress causes or makes worse 95% of all illnesses. It's a powerful, powerful thing. I think your book, the Adrenal Transformation Protocol, it's available now. Everybody needs to go get a copy. You've got a wonderful guide online called the ABCs of Adrenal Support, which is free. Of course, check that out. To learn more about your work, where else can they go to learn more about what you're doing?

Izabella Wentz: Sure. Thank you so much for having me, Dr. Hyman. I have a website called thyroidpharmacist.com where people could learn more about the work that I'm doing and I share helpful articles every week. Then I'm also on Facebook as Thyroid Pharmacist, Dr. Izabella Wentz, and then on Instagram as izabellawentzpharmd. Hoping to connect with everybody.

Dr. Mark Hyman: Amazing. Well, so great to have you on the podcast, Doctor's Farmacy. If anybody listening has had adrenal fatigue and understands what it is, make sure you get the book, share it with your friends and family. Share this podcast. I bet you they also struggle and this is a doorway for them to get better. Leave a comment. Have you recovered from exhaustion and adrenal fatigue? What are the practices? Maybe we'll learn something from you and subscribe wherever you get your podcast and we'll see you next week on The Doctor's Farmacy.
Closing: Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search there, find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.