Recently I interviewed Dr. Izabella Wentz, and we talked about the adrenal transformation protocol. If you would prefer to listen the interview you can access it by Clicking Here [1].
I am beyond excited to interview today’s guest, Dr. Izabella Wentz. If you have Hashimoto’s, then there is a very good chance you’ve heard of Dr. Izabella. Just in case you haven’t, I will dive into her bio. Dr. Izabella Wentz is a compassionate, innovative, solution-focused integrative pharmacist dedicated to finding the root causes of chronic health conditions. Her passion stems from her own diagnosis of Hashimoto’s in 2009, following a decade of debilitating symptoms. She is a New York Times best-selling author of three books on Hashimoto’s. Her newest book focuses on adrenal health, The Adrenal Transformation Protocol: A Four-Week Plan to Release Stress Symptoms and Go from Surviving to Thriving. Thank you for joining us, Dr. Izabella.
Dr. Izabella Wentz:
Thank you so much for having me. It’s such an honor to be here with you. It’s so great to see you again.
Dr. Eric:
I agree. So great to catch up and chat with you about adrenals. As we were talking prior to the recording, years ago, we swapped interviews, and we were focusing on thyroid. We’ll integrate thyroid into today’s talk as well. Really doing a deep dive into adrenals.
People know about your background with Hashimoto’s. If you could maybe elaborate a little bit more, tie in your experience with adrenals, and why you decided to write the new book.
Dr. Izabella:
Sure. I was diagnosed with Hashimoto’s in my 20s after almost a decade of some debilitating symptoms. I was never really interested in thyroid gland and thyroid medications during pharmacy school. I just thought they were boring. I really came to appreciate the condition. All of that was going on with Hashimoto’s.
When I was diagnosed myself, I started taking thyroid meds. I felt a little bit better but not fully better. I realized there were a lot of dysfunctional patterns that were in my body. Some of them were causing me to have Hashimoto’s. Other parts of that were consequences of having hypothyroidism for a while or were worsened by the hypothyroidism. I wanted to figure out if there was anything I could do to make myself feel better and feel human again.
I really focused on looking at the research and patient forums and trying to figure out if I could find out a plan to get myself better. I did, thankfully. I then wrote a book about it in 2013 called Hashimoto’s: The Root Cause. Throughout that process, part of what was really fundamental to my healing journey was changing my nutrition. I went gluten-free and dairy-free, which helped me tremendously. I was able to eliminate acid reflux, joint pain, carpel tunnel, and IBS that I had had for many years prior that was barely responding to medications. This resolved the acid reflux and the IBS and bloating within three days. Holy cow.
Then I still struggled with brain fog and fatigue, especially morning fatigue. I was a night owl, where I had a hard time falling asleep at night. I felt anxious and wired but tired throughout the day. I was always wearing sunglasses and would step outside. Man, I feel like a vampire right now, being outside with these bright lights. I had seasonal affective disorder. If I would stand up too quickly, I would feel faint. Always startled and always anxious in that fight or flight state.
Somebody brought up adrenal fatigue to me. Okay, that’s interesting. What are the adrenals? What’s going on? I go to Google it 10+ years ago. Some reputable medical sites said, “Adrenal fatigue doesn’t exist. It’s a quack diagnosis.” I was a skeptical pharmacist, not going to go down that road because that’s a fake thing.
Finally, it probably took the 15th person who happened to be my local compounding pharmacist, Mr. Carter Black. He said to me, “Hey, have you looked into adrenal fatigue?” Maybe I had a moment of weakness when I was like, “Fine, I will look at that.” Sure enough, I had all the symptoms. I tried the recommendations. I got better. I talk about adrenals in my Hashimoto’s book, in all of my work on Hashimoto’s. That is part of the healing plan: to support the health of your adrenals.
I have worked with thousands of people with Hashimoto’s and hypothyroidism at this point. 90% of them had some degree of adrenal dysfunction when I tested their levels. I had a pretty straightforward protocol for the adrenals. I thought it was straightforward and made a lot of sense. It helped me get better. I was trained through functional medicine.
Then this all came to a big moment when I was a new mom of an eight-month-old baby, who was still waking up a lot throughout the night and needed to eat at night. I was his main source of food. I found my adrenals were dysfunctional again, but I couldn’t utilize the hormones that I had normally recommended for others because I was nursing. I didn’t feel comfortable taking a lot of supplements. I wasn’t going to sleep. That was one of the big things people recommend to heal adrenals. Yes, but I’m not sleeping, so I need something else. People also recommend cutting out coffee. I was like, “But coffee is the reason I function during the day.” I had to come up with a new way to heal and resolve brain fog, energy issues, and sleep issues for myself.
Being a guinea pig, I stood out to my community. It’s now helped over 3,500 people resolve all these symptoms in just 3-4 weeks. That’s how I began to talk about adrenals. I’m not changing my name to the adrenal pharmacist or anything, but addressing that adrenal dysfunction is a key component to healing when you do have thyroid issues.
Dr. Eric:
I agree. When I dealt with Graves’, the stress and adrenal issues played a role in the development of my condition. Over the years, I have worked with both hyperthyroidism and Hashimoto’s. As you know, I have more of a focus on those with hyperthyroidism and Graves’. Like you see most people with Hashimoto’s having adrenal problems, I would say the same thing with those who have hyperthyroidism or Graves’. It’s even in the literature. If you do some research, I wouldn’t say adrenals are in the literature with Graves’, but stress and Graves’, there is a number of journal articles. If someone is dealing with chronic stress, it’s almost definitely going to affect the adrenals. Your book, your protocol, is definitely well needed.
Let’s talk about why many people have compromised adrenals. I mentioned chronic stress. I’m guessing that’s a big reason why a lot of people have adrenal imbalances.
Dr. Izabella:
Absolutely. Current stressors can cause a whole host of issues. I typically will ask people that I work with: What was going on in your life before you got sick? Most of them will say something very stressful was happening in their lives. Maybe they were going through a divorce. Maybe there was a death in the family. Maybe they were fired from a job or had a major terrible life change.
There was a study that was super interesting talking about a woman who was thrown down the stairs and developed Graves’ shortly thereafter because of that traumatic, stressful experience she had had. That is a big connection for a lot of people: something bad happens that overwhelms your ability to cope and handle it.
There are also good stressors. You have a baby. Yes, bundle of joy, but yes, it’s stressful for your body. Growing a baby takes up nutrients. Then the life change is big. Not sleeping, being nutrient depleted. That is a happy life change for a lot of people, but also stressful. Getting married, getting a new job, getting a job promotion, going to graduate school. All of these things can be incredibly stressful.
We were just talking about the medical profession. How many times doctors have to do 80+ hour weeks at the hospital. I personally had to do two or three exams every week when I had to wake up at 5am and get to those exams. I loved going to graduate school, but I wouldn’t say it wasn’t stressful because it was stressful, right? All the deadlines and all that pressure you can have from creating very positive change in your life, from the personal growth that you can experience, starting a new business or starting a family, moving across the country or going to graduate school.
There are also stressors that happened to us a long time ago that we may not even remember. History of childhood trauma. Something happened when you were three. You may not even have a clear recollection of it, but it stayed with you. It’s this unprocessed stress that could also be present in our bodies and lead to low levels of inflammation. There are a ton of studies that have connected childhood trauma to autoimmunity later on in our adult life.
Then we have physical stressors, things that are in our lifestyle. Sleep deprivation. One of the fastest ways to wreck your adrenals is if you don’t get sleep. I have been there, done that. I have written the book. This is a key component to getting back in balance. If that’s an issue for you, you need to address that.
There are things like overexercising, undereating, being nutritionally deficient, having blood sugar imbalances. Some of these habits of hustling. You have your job, and you have your side hustle, and you have your side hustle. That can be incredibly draining on a person.
There are some of these stressors that I feel like unless you’re working in functional medicine or with a functional medicine doc like yourself, you’re not even aware that they’re present. These could be infections like H-pylori. Such an important trigger for Hashimoto’s and Graves’ and for all kinds of digestive issues. This leads to inflammation and stress in your body. There are protozoal parasites that can be an issue for some people. There are toxic exposures, like people don’t even know they might be exposed to mold or another type of toxin that is sending these stress signals to the body.
Really anything that overwhelms our ability to cope is going to be what I consider a stressor and can get us into that adrenal dysfunction state, where we’re stuck in that stress response rather than going through a stressful time, shaking it off, and then you move on with your life. You feel good again, and you feel normal. Instead, you get stuck in that fight or flight mode. Your body is not really repairing itself, and then you end up having really low levels of energy, fatigue, anxiety, sleep issues, all the things.
Dr. Eric:
I agree. One factor that resonates with me is overexercising. That was also me prior to my Graves’ diagnosis. Emotional stress definitely played a part in my adrenal imbalances, but I was overtraining. With my background, I should have known better, but I didn’t. Looking back, that was a big tax on my adrenals, so I’m glad you mentioned that.
You’re correct about everything you said: the infections potentially could be a factor when it comes to adrenals. We live in a toxic world, so we tend to overlook the impact that these toxins have on our adrenals as well as other areas of the body.
When you dealt with Hashimoto’s, you felt like you had some of the classic symptoms of having compromised adrenals. When it comes to finding out whether someone has an adrenal imbalance, would you recommend relying more on symptoms, do you recommend testing, or a combination of both? The question I’m asking is how does someone know if they have an adrenal imbalance?
Dr. Izabella:
I personally love testing. If I could have my little way, I would have everybody take every single test. Let’s collect all this data. I force my husband and my son to do all kinds of tests. We do stool tests. We don’t do a lot of blood tests with my son because he is little. Let’s test your urine, let’s test your stool, let’s test this, and see what’s going on in your body and how we can optimize it. That testing can be incredibly helpful to figure out if you have adrenal dysfunction.
I love the ZRT adrenal saliva test. I love the Dutch urine test. For the 10 years I have been talking about people getting tested, people oftentimes will go to their endocrinologist and ask them to test for adrenal issues. They test them for Addison’s, and they say they don’t have adrenal issues. There is a disconnect between integrative, functional, natural medicine and conventional medicine, where conventional medicine doesn’t recognize this adrenal dysfunction as a real thing. They are not testing for it.
People get the runaround from their conventional docs, so I’ll be like, “No, you need to find an integrative doctor.” The integrative doctor is too expensive, or they have to pay out of pocket for them, and for these tests because they are not covered on insurance because they are experimental. That’s another barrier to people getting that test and getting the help that they need.
Another part would be they do see the doctors. They get the tests. The tests would be sitting at their house for however long because you have to get off of caffeine and all of that to get an accurate test. They just can’t do it. They don’t have the energy not to have caffeine for a day.
Then you have the test results. Great. They took a few weeks to get back, or sometimes a few months because the person didn’t do the test right away, or the lab had a backlog. Then you are sitting on six months to a few years from the time that you knew you had these symptoms to when you get the plan.
Then you get the plan. For whatever reason, you react to the hormones, or you react to something else. You can’t comply with the plan. Part of the traditional plan is to get off of caffeine, get lots of sleep, take hormones, and take glandulars. Some people took glandulars and had palpitations, or the hormones gave them back-ne, or they are now estrogen dominant because they took too much of the hormones, or there is no way you are taking coffee out of their cold, dead hands. They won’t do it. There is a lot of barriers to it.
The beauty of my program is that it focuses on symptoms. If you have these symptoms, there is a chance your adrenal stress response is off. Here is the good news. Let’s rewire that stress response so that you feel good. I don’t necessarily focus on adrenal testing throughout the program. That’s not a requirement for you to feel better. I hope that eliminates the barrier for people to feeling better.
People can absolutely do tests, and they will be incredibly helpful if they are working with a practitioner. I want to eliminate that one barrier because there are so many people who are suffering, but they don’t have the ability to access these things.
Dr. Eric:
I have been using saliva testing in my practice to look at the Circadian rhythm of cortisol. You mentioned Dutch testing; I also like that test. But you’re right. There are some people who either can’t afford to do the test, or they can afford it, but it sits on their shelf for a few months before they send the test in. It’s nice to know that there is a way where they can just read your book and look at all the symptoms and get a good idea if they have an adrenal problem by looking at the book and bypassing the testing.
If you go to a conventional doctor, they are not going to do anything unless you have Addison’s or Cushing syndrome. They will just do blood testing or ACTH stimulation. When it comes to looking at Circadian rhythm, they won’t go there.
I used to use adrenal fatigue all the time years ago. It kind of gets a bad rap, adrenal fatigue. It’s not really adrenal fatigue; it’s dysregulation of the hypothalamic pituitary axis. We are going back and forth. We’re not saying adrenal fatigue, but we’re saying adrenal dysfunction. What are your thoughts on if adrenal fatigue really exists, or if it’s just a term that was used in the past, and now it’s adrenal dysfunction, or HPA axis dysregulation?
Dr. Izabella:
I think adrenal fatigue has been cancelled. Is that what happened? When I was trained in functional medicine, I understood—this was over 10 years ago—adrenal fatigue as you are fatigued because your adrenals are not functioning properly and because your HPA axis has a disconnect. Your adrenals are capable of making the right amount of hormones at the right time, but they’re not doing it, so we need to reconnect that wiring between your brain and your adrenals.
What I now understand as the original definition and intent of the term “adrenal fatigue” is that the adrenals were actually fatigued and unable to produce adrenal hormones. That’s what people used to think back in the day. Now the endocrinologists are like, “Adrenal fatigue doesn’t exist. Only Addison’s is a thing. We test these people, and their body is capable of producing cortisol.” I do agree with that, that in people with this HPA axis dysregulation, they can produce cortisol in the right amounts at the right time of day, but their body is just not doing it.
I scratch my head because doctors will say, “Adrenal fatigue doesn’t exist,” and they will call it HPA axis dysregulation, where that doesn’t necessarily roll off the tongue. But that is where all of the evidence base is. If you do a search on PubMed, which is the largest database of medical journals, you will be able to find HPA axis dysfunction, but it doesn’t necessarily roll off the tongue, does it?
I call it “adrenal dysfunction.” The symptoms of adrenal dysfunction are the same as symptoms of adrenal fatigue and burnout. It is how the body responds to stress. They are not the same as Addison’s. Addison’s, you would have all of the symptoms of adrenal fatigue, and then some. Addison’s is a different kind of condition. It just happens to be tied in with our stress hormones.
I hope that clarifies it. It’s one of those things where I feel like 10 years ago, people were like, “Leaky gut doesn’t exist.” You would search for “intestinal permeability,” and there is all this research behind it. For a while, I didn’t say “leaky gut.” I said, “intestinal permeability.” People were like, “Okay.” But if I said, “Leaky gut,” they would be like, “Quack! I don’t know what you’re talking about.” Now you have to say, “adrenal dysfunction,” even though we all know it’s the same as adrenal fatigue or burnout. What our bodies do for a prolonged period of stress, that’s how it adapts to stress.
Dr. Eric:
I agree. Definitely easier to say “adrenal fatigue” or “adrenal dysfunction” instead of “HPA axis dysregulation.” Thank you for clarifying that. Can we get into the different components of your adrenal transformation protocol?
Dr. Izabella:
I really focus on figuring out why your body is in this fight or flight mode. What are the signals you’re sending to your body that is telling you that you’re in danger right now? Things like sleep deprivation over exercising, over- and under-eating. These three things that are part of modern culture of “Lose weight, and exercise, and burn the bridge at both ends.”
Oftentimes, if you were thinking of caveman/cavewoman times, the cavewomen, if they were doing this, they would be like, “Okay, I’m not eating enough because there’s a famine. I’m overexercising because I’m being chased by bears. I’m keeping watch because there is some tribe trying to attack me. That’s why I’m not sleeping at night.” They would get shifted into this high alert, fight or flight response. There are things we’re doing in our modern life that are kind of doing the same because we have our ancient genes and ancient wiring that isn’t necessarily tuned into an abundance of food. I’m under immediate threat right now, and I’m not sleeping because there are deadlines. Our body shifts into this survival state.
Part of what I do is I focus on what are the safety signals we can send your body in a language that it understands that we are safe, and we do not need to be in that survival mode. How to shift the body into thriving. When we are in that survival mode, our body is not repairing itself. Our body is essentially breaking itself down. That can be very problematic when you have antibodies because it’s not balancing the immune system or the inflammation. It’s not repairing itself. We want to shift into that repair mode.
What I focus on is replenishing. First, we focus on replenishing any kind of nutrients. We focus on micronutrients. We focus on B vitamins and vitamin C, which are incredibly helpful when people have been under stress for a long period of time, as are magnesium and electrolytes. They help us come back from all that stress.
Then we focus on making sure we get enough protein and fat. Part of what’s happening with the adrenal dysfunction is we’re utilizing amino acids to fuel the stress response. Amino acids are like the little bricks our body uses to fix itself. By eating more protein, we’re getting more amino acids into our system. Protein is made up of amino acids. That’s a big part of the beginning part of the program.
You focus on nutrition safety signals. Nutrient dense foods, not starving yourself, eating frequently every two to three hours for some people to start yourself that way.
Then we go through additional safety signals, which focus on reenergizing. Part of that is you get connected with the Circadian rhythm. You figure out how to give your body more energy throughout the day and less energy at nighttime, so you can sleep and replenish and really heal and save your body another part of that safety signal.
Then we get into revitalizing. This is probably a favorite part and a little bit of what makes my book a bit unique from some of the others out there. We really focus on pleasurable activities that tell us that it’s safe. We focus on things like a lot of us have goals. If you’re an ambitious person, sometimes it feels like you’re just knocking things off of your to-do list. You have your family and your work and your parents who are getting older to take care of. All of these adult responsibilities, where that can make us shift us into that survival fight or flight mode.
Taking some time throughout our day to focus on pleasurable activities. Maybe you like painting, and that brings you a lot of joy, but you haven’t done that for a long time. Maybe scrapbooking is your thing, putting a bunch of stuff on the floor and making some cute scrapbooks. Maybe that brings you a sense of joy, but you haven’t done it for 10 years because you have been on the stress rollercoaster. I give people a prescription for pleasure, just to do the things you love and enjoy. That is such a powerful way for them to shift out of that survival mode into more of a thriving state.
Then we also focus on rebuilding resilience, which is figuring out what weighs you down and how to get rid of those things. A lot of times, it’s past trauma. We focus on giving people trigger tools. If there are things that are really setting off your fight or flight response, like annoying people being one example, then you would focus on that. What do you do if somebody really drives you nuts and annoys you? Here is a list of ideas. Let’s develop a trigger toolkit, so you don’t get into that angry survival state. You figure out how to work with that.
Then we focus on how to build up your body and how to be more resilient to stress. Even though we all have stress in our lives, you can’t always get rid of it, but you have to cope with it and let it bounce off of you rather than absorb into our system and overwhelm us.
Dr. Eric:
That’s amazing. I want to talk a little bit about replenish. In this day and age, intermittent fasting is popular. I’ll admit, I do some intermittent fasting these days. For example, when I dealt with hyperthyroidism, I wanted to do intermittent fasting for a few reasons. I was losing tons of weight due to hyperthyroidism; I lost 42 pounds, so I definitely was not thinking about intermittent fasting back then. A big reason is also now you see it all over the place. Back then, in 2008/2009, it wasn’t as popular. I also mentioned how if someone has compromised adrenals, you do want to be cautious about intermittent fasting. It sounds like we’re on the same page. You’re talking about replenishing, making sure you’re not undereating. Can you talk more about that?
Dr. Izabella:
Of course. I’ve had a lot of ladies go through my program who are struggling with weight issues, so their goal is to lose weight. They are restricting calories, trying intermittent fasting, trying things like the keto diet, doing lots of exercise. They are doing all of these things that are supposed to help them lose weight. I will say these things work really well if you’re a 20-year-old fitness guru. They work so well, and you can get a six-pack that way. But if you have dysfunction in your stress response and your thyroid, these things can actually backfire.
People with flatlined adrenals, where they have this flatlined adrenal curve, where they just don’t produce enough cortisol throughout the day, stressful things will overwhelm them. Doing things like cardio, which is supposed to be really great for most people, when it’s balanced with proper atabolic exercise, like lifting weights, they will do that and be exhausted. “Everybody said if I wanted more energy, I should exercise more. This did not work for me.” Or they will hear things like, “Skip breakfast,” but part of the whole presentation is you will have blood sugar swings. Fasting can actually make you feel worse, and you can crash. Your body is like, “Oh no, we’re in a famine.”
When you have a really balanced response, at this point, you can do fasting because you have worked so much on your health. I can do fasting. I can do aerobic exercises. I can do all the things. But when I was trying to heal my adrenals, and even a few years ago, when I was a new mom and sleep-deprived, a lot of these things were stressors. They were shifting my scale of you have this thriving here, or you’re surviving here, and depending on how many things you put on each side of the scale, your body will shift that way. If you’re a new mom who is sleep-deprived, you already have that stressor. You want to counteract with eating lots of great foods. If you have inflammation, autoimmunity in your body that’s very present right now, that’s a big stressor. We want to reduce that stressor and send more safety signals.
I think it’s simple math. You put a little bit of weight here, and you can do that. If you are overall in a good healthy, balanced state, doing a little bit of intermittent fasting can be game-changing. But if you already have too much stress on your plate, that will cause you further issues. That’s been my experience as well as yours for people with adrenal dysfunction. That’s one of the things I’m trying to raise awareness about for people who beat themselves up. “Well, I must be exercising enough. I must not be fasting enough. Why is everybody else getting results, and I’m not?”
Dr. Eric:
Adrenal imbalances could also be a factor when someone is trying to lose weight. If they are doing everything from a dietary standpoint, they are exercising regularly. Like you said, it could backfire because if they are doing those things. Getting back to exercise, even simple cardio sometimes, but especially these days, you see high intensity interval training. Someone might be doing HIIT along with the intermittent fasting, and that’s just continuously taxing their adrenals, which could make it even more difficult to lose weight. You’re right. It becomes a vicious cycle.
Dr. Izabella:
It does. I’ve had so many women who were so reluctant to take my advice of eating more calories and doing less exercise because they were trying to lose weight. “Is it working?” A lot of times, they’d be like, “No, I’m gaining weight. I do all this exercise,” and it’s further suppressing their metabolism because they’re getting stressed. Part of the plan is you eat more protein, and you get more nutrients, and you focus on destressing your body.
We have had people who have started the program underweight, and we have had people who have started the program overweight. The beauty of adrenals is if your weight issues are caused by adrenal issues, destressing is going to help you get to a healthier weight. We have had 80% of people trying to lose weight, “You know what? I did lose 5-10 pounds on this plan.” 5-10 pounds is a healthy amount of weight to lose over 4-6 weeks. You don’t want to lose 40 pounds in a week or anything like that. The people who were wasting away, we help them shift into gaining more weight.
One of the things I utilize throughout the program is carnitine. People with thyroid issues often get into this state where they’re muscle wasting, and carnitine can be incredibly helpful for that and the resulting brain fog, fatigue, blood sugar issues, supporting their mitochondria. People find they feel better. Weight isn’t a focus on the program, but it tends to normalize as people go through the program.
Dr. Eric:
Do you recommend acetyl-L-carnitine or regular L-carnitine tartrate?
Dr. Izabella:
I recommend a combination, just because L-carnitine is going to be helpful for muscles. Acetyl-L-carnitine can be helpful for the brain to waken people up with that brain fog. I find a combination of one supplement that has both of them in there, and the L-carnitine has more with a little acetyl-L-carnitine. You don’t want to do too much of the acetyl-L-carnitine. That tends to work well for the brain fog. 92% of people in my program have had their brain fog resolved. That’s one of our biggest success symptoms in the program.
Dr. Eric:
You mentioned the Circadian rhythm. How important do you feel it is to get sun exposure to get back on track with the Circadian rhythm? Do you recommend getting morning sun exposure? At night, I imagine you tell people to limit blue light and other things just to get back on track there.
Dr. Izabella:
I have lived everywhere. Maybe not everywhere. I have lived in Europe and many parts of the United States. Right now, I live in sunny Austin, Texas. I was in Los Angeles for a few years. I was also in Chicago; Boulder, Colorado; Poland; and rainy Amsterdam. Bear with me. I know people can roll their eyes when they’re like, “Get morning sunshine. Step outside. Spend time in nature.”
If you can do this, this can be incredibly game-changing. If you can get sunshine first thing into your eyes when you step outside, that’s going to let your body know it’s time to wake up. That will raise your cortisol to healthy levels without needing to rely on caffeine to raise your cortisol to wake up. That also sets the clock for your body, so your body knows that it’s waky waky time now. In this amount of hours, it’s going to be time to unwind and go to sleep.
I know it’s not always possible. I have lived in Chicago and Amsterdam and Colorado. Sometimes, I’ll recommend a dawn simulator or light therapy boxes. I actually have a list of things throughout the book and the program. People are like, “Great. If you live in perfect weather year-round, you can do this.” But it’s not realistic for people living everywhere in the world. There is a way around that. Even if it’s raining and snowing on your doorstep right now, which sometimes in Colorado, it would be end of May, and there would be snow. How is there snow in May?
Dr. Eric:
I’ve seen photos of not just snow but lots of snow in May. There have been a few snowstorms over the last few years. I don’t know about last year specifically, but I have seen at least a couple of different years in May where it was completely covered. I’m sure you’re glad to be in Austin, Texas, so you don’t get the May snow.
Dr. Izabella:
Yes, I miss Colorado. I love Boulder so much. I miss all my friends. We miss Colorado so much. But we are also loving our time in Austin. My husband’s family is here, so we’re excited to be here with our little one. I am one of the people who doesn’t mind the heat. I’m saying that now. Ask me again next summer. It is nice to have access to the morning sunshine and nature because that can be really regulating for our Circadian rhythm.
Dr. Eric:
I’m glad you mentioned the light therapy boxes. You’re right. If someone lives in Seattle or Portland, where it’s rainy a good part of the year, they might not be able to get that sun exposure waking up. That’s an excellent idea. Check out her book for some of those resources.
I promise we will get to the supplements. Before we get to that, we can’t have an episode with a thyroid pharmacist without talking about thyroid and adrenals. What connection have you seen between thyroid and adrenals, whether adrenals are affecting thyroid or thyroid affecting adrenals?
Dr. Izabella:
Our hormones talk to each other. It’s not like we have these individual hormones in a vacuum separated from one another, like naughty children that have to be separated in the backseat.
The first thing that can happen is if a person is hypothyroid, when their thyroid is underactive, cortisol will accommodate for that. When we are low in thyroid hormone, our cortisol clearance decreases, so our body keeps cortisol in our system longer. Typically, people will say, “Oh, I’m kind of tired, but I’m kind of wired.” That wire is coming from that cortisol. It’s trying to help you out and keep you alive and not sloth-like. That’s part of the feedback loop system.
Then as people get onto thyroid medications, their cortisol clearance increases. You get on thyroid medications, and it normalizes your thyroid function, but your cortisol clearance increases. All of a sudden, you’re left with really low cortisol. This can be unmasked. Hyperthyroid states as well. Then you have increased cortisol clearance. It’s one of those feedback loops that occurs with thyroid issues.
Then we focus on what’s happening with people who have too much stress. Sometimes, they will have more production of reverse T3, which can block thyroid hormone receptors. People aren’t able to utilize their active thyroid hormone properly. It’s a feedback loop system. For people listening, you don’t have to memorize this. You won’t be quizzed on it. This is us talking about the nerdy things.
The key to remember is if you have a thyroid problem, your adrenals have probably been compensating. There is some kind of feedback system. Oftentimes, people with thyroid issues, 90% of the time, I’m not sure if that’s your experience as well, with hypothyroidism, we do have to support the adrenals for a person to get rid of all their symptoms.
Dr. Eric:
Yeah. I agree. You mentioned cortisol clearance. I don’t do dried urine testing on everybody. It’s interesting because they look at that cortisol metabolism, so you can see that. If someone has hypothyroidism, typically, you’ll see not only a lot of times cortisol low (not all the time). You almost always will see the low cortisol metabolites.
Opposite with Graves’. If someone has hyperthyroidism, you will see on that test where the cortisol metabolites are elevated. Exactly what you said. You usually do see that pattern with hypothyroidism and hyperthyroidism, increased cortisol metabolites because you are getting the increased cortisol clearance. Also with elevated cortisol, there are a lot of different factors that could affect the conversion of T4 to T3. Also, elevated cortisol could affect that conversion.
One other thing I’ll say: This isn’t really a connection between adrenals and thyroid directly, but just the impact of chronic stress. Chronic stress of course affects adrenals. It could also decrease secretory IGA, which lines the mucosal surfaces of the body, including the gastrointestinal tract, and make someone more susceptible to infections, for example. It serves as a form of protection, which in turn could be a trigger, as you mentioned earlier, talking about H-pylori and parasites. Stress is directly affecting adrenals, but that whole connection between stress affecting adrenals and stress affecting secretory IGA, which can make someone more susceptible to an autoimmune condition such as Graves’ or Hashimoto’s.
So supplements. Let’s talk about some of your favorite supplements. You mentioned L-carnitine, which is a mixture of acetyl-L-carnitine and regular L-carnitine, like L-carnitine tartrate. You mentioned earlier B vitamins. You mentioned Vitamin C. I know there are others, like ashwagandha, rhodiola, licorice root. I’ll shut up and let you talk about supplements.
Dr. Izabella:
We already talked about carnitine. It’s traditionally been used for people with Graves’. People used to think it had antithyroid effects. It’s also been used successfully now for people with hypothyroidism. What we’re learning now is it tends to act as more of a stabilizing effect with thyroid hormones. That’s been really fabulous for thyroid fatigue.
I try not to give too many supplements. I try to pick ones that have multiple uses. The carnitine helps with balancing blood sugar; clearing ammonia in the body, which can cause a lot of the brain fog; muscle strength; brain health; helping our metabolism utilize fatty acids; and a lot of things. I utilize that as part of the protocol. It supports our mitochondria.
Then I focus on saccharomyces boulardii. It helps to raise our secretory IGA levels, even when we’re stressed. Whatever is living in our gut or wants to live in there, we have this extra layer of protection. We talked about how infections can sometimes be a trigger or exacerbating factor for thyroid issues. The saccharomyces boulardii can help you clear out the infections naturally, whether it’s candida or mold or parasites or H-pylori. Sometimes, just the saccharomyces boulardii can do that on its own. Other times, you might need deeper protocols, especially with H-pylori because that pathogen tends to be notorious and can make biofilms and can be something that is resistant to various things. Always having that extra layer of defense will be helpful.
It’s also helpful for preventing infections; preventing some food reactions and making us tolerate more stuff. This is one of the hacks that gives people a little bit of an edge, where they can start recovering a bit faster from the effects of a lot of stress in their bodies.
I focus on utilizing adaptogens. There is a whole host of different herbs, and all of them have different personalities. These herbs can make us a bit more resilient to stress.
Rhodiola is a great herb that I like because it’s helpful for balancing the stress response. It’s been shown to be effective for anxiety, depression. It also helps us grow new mitochondria, which mitochondrial dysfunction is oftentimes a part of the whole fatigue adrenal presentation.
I focus on B vitamins and Vitamin C, which get depleted during a stress response. I will often try to put that in one supplement formulation, but it’s not right for everybody. I have a few options for people.
Licorice is something I really love if you have low cortisol and low blood pressure. If you have high blood pressure, don’t do it because it can make your blood pressure even worse.
I focus on magnesium. Magnesium can be incredibly helpful. It’s a cofactor for hundreds of biological systems in the body. It’s great when people are saying, “I have cramps. I’m anxious. I have trouble sleeping.” This is incredibly helpful for so many people. It gets super depleted when you’re stressed out.
I utilize electrolytes. They have lots of Vitamin C and D ribose. Electrolytes help us with recovery. People with adrenal dysfunction tend not to have enough electrolytes. I use powder. I don’t use Gatorade or anything with junk in it.
The other thing is utilizing myoinositol, which is helpful for blood sugar balance. This is something that many people have found to be very helpful for anxiety and even OCD symptoms.
I have this handful of supplements that people utilize. Of course, not every supplement is right for everybody. I have a section that talks about the pros and cons of each supplement and which ones you might wish to utilize as part of your healing journey.
Dr. Eric:
Wonderful. Thank you for sharing. I like adaptogens as well. I definitely will reinforce what you said about the licorice root. If you have high blood pressure, you don’t want to take it.
Last but not least: stress management. I probably should have brought this up before the supplements. Stress management is not all about taking supplements, like you said. You admitted you don’t want to give people a bunch of supplements to take, but they do help to speed up the recovery process. In some cases, they can be beneficial for adrenal health. But if that’s all you do, it’s not going to fix your adrenals.
You mentioned getting sufficient protein in your diet and fats. You just mentioned myoinositol to help with blood sugar imbalances, so you want to minimize sugar. That’s important. I don’t know if you want to talk about that as well.
Let’s finish up by talking about sugar and stress management, your thoughts on those two things when it comes to adrenal health.
Dr. Izabella:
Most of us need to eat more protein and fat and probably less carbs than we think we need. I don’t recommend necessarily a keto diet for most people, but we focus on whole food sources of carbohydrates. We focus on proteins and fats. The diet template is very similar to a paleo diet, where we don’t eat a ton of grains, just because they can have an impact on blood sugar.
Blood sugar imbalances are part of that adrenal dysfunction. People end up on this blood sugar rollercoaster, and they end up feeling anxious and tired and very off when their blood sugar is out of balance. They end up storing fat instead of burning it. We shift the nutritional safety signals to focus more on that protein, fat, and lower carb intake to help people balance their blood sugar. People feel more calm, steady throughout the day. They don’t get that 3pm crash. They don’t wake up at 3am, like, “Where am I? Who am I? Why am I so hungry?” That 3am wakeup is usually a person going hypoglycemic and cortisol trying to save us. People get that cortisol surge at 3am. We really focus on how you sleep better and how you have more energy throughout the day. That’s balancing your blood sugar.
Yes, we don’t eat candy. I do have people drink orange juice first thing in the morning to help raise their glucose levels. Oftentimes, glucose is low in the morning when we have low cortisol, and blood pressure is low. We combine that with some protein and some fat from coconut milk. We add some sea salt or electrolytes to that, so you slow down the effect of what I call the blood sugar rollercoaster. If you have orange juice by itself, you go up and you crash. When you combine it with all the different proteins and fats, you have a much smoother ride throughout your day. You get the boost of glucose, so your blood sugar improves in the morning, and you feel a little bit better. You have more energy. But you don’t get the crash. That is part of the nutritional program.
I’m so glad you asked about stress management because people are so willing to take supplements and change their diet, and there are free things you can do. Your stress adjusts. That’s the easiest and the hardest thing to do.
I talk a lot about trading coping mechanisms. We talked about the trigger toolkit. If somebody triggers you, how can you respond? What can you do to soothe yourself? We talk about creating the space for healing and figuring out what in your life is making you feel worse and what is making you feel better. Generally, we try to focus on doing more of the things that make you feel better. If there is a way to eliminate the things that make you feel worse or find a way not to impact you so much, that will be huge for the healing journey.
Dr. Eric:
Is there anything else that I didn’t ask you that I should have asked you? Any final words? Any last things you want to chat about?
Dr. Izabella:
I just wanted to mention to people that if they are struggling with brain fog, fatigue, mood issues, anxiety, trouble sleeping, you do not have to feel like this forever. Just because it’s common doesn’t mean it’s normal. A lot of people are stuck in this survival mode. There is a very targeted way to get out of that with sending your body these safety signals, so you can thrive and feel amazing and have lots of energy and sleep really well and have your brain work and feel strong and fit in your body and pain-free. I hope you will take the time to learn more about your health. Thank you for joining us. Hopefully, this will help you on your healing journey.
Dr. Eric:
I’m sure listeners learned a lot, and I’m sure they will learn a lot more by reading your book, The Adrenal Transformation Protocol. Your website is ThyroidPharmacist.com.
Dr. Izabella:
Yes. I have a free guide at ThyroidPharmacist.com/ABCs that talks about the ABCs of Adrenals, B vitamins, and C vitamins, and some of the stress management techniques. My book is available on Amazon and Barnes & Noble and wherever books are sold.
Dr. Eric:
Since we talked about adrenals, focus on Dr. Izabella’s adrenal transformation protocol book. Highly recommend her Hashimoto’s book and her other books. They’re wonderful. I think I have even listened to some of them on audio.
Dr. Izabella:
Yes. One strategy I hadn’t mentioned for people who maybe cleaning their house they find stressful, or driving in the car they find stressful, consider listening to an audiobook when you’re doing these tasks. This can actually take the stress out of that task. That might be a fun way to get all your reading in rather than focusing on the traffic or whatever is frustrating.
Dr. Eric:
I do that all the time. I listen to books these days more than I read them. I read some, too, but I definitely knock out books quicker listening to them. That’s a great point.
Thank you so much, Dr. Izabella. I appreciate you taking the time. Excited about your new book. I definitely recommend all of your books, like I said. Look forward to not only reading but listening to your new book. As of recording this, it hasn’t come out yet, so I preordered it on Audible. Once it comes out, I will be listening to it as I work out and do my chores.
Dr. Izabella:
That’s amazing. Thank you so much for the wonderful work that you’re doing to save thyroids. Really appreciate you. Thank you for having me on.