Recently, I interviewed Dr. Erin Kinney, and we talked about her health journey and expertise in managing stress and adrenal health. If you would prefer to listen to the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
I am very excited to chat with Dr. Erin Kinney. We are going to be talking about adrenal health. Everyone is going to find this to be extremely valuable.
Let me quickly dive into Dr. Erin’s bio. She is a naturopathic doctor, speaker, author, and podcast host who helps stressed-out patients improve their mood, balance their hormones, and increase their energy. She is incredibly passionate about teaching her patients to understand why stress causes so many problems in the body and how they can change their response to stress, so they can take control in both their bodies and their lives. Thanks for joining us, Dr. Erin.
Dr. Erin Kinney:
Thanks so much for having me. It’s good to be here.
Dr. Eric:
Adrenals is something that really applies to everybody, even though some people, like myself, are in denial. When I dealt with Graves’ years ago, I knew stress was a factor, but I thought I was good at handling the stress. When I did some adrenal testing, I realized that wasn’t the case. Definitely something that even if someone feels like they’re doing a good job of managing their stress, might not be the case.
If we could talk about your background briefly, get more into why you are doing what you do now, how you started the podcast. Why are you helping so many people restore the health of their adrenals?
Dr. Erin:
Sure. Like many of us in this field, it started for me with a personal health journey. When I was in my early 20s, I went from being a marathon runner, like this happy, high achieving, college student to within a year’s time, I couldn’t get out of bed, my joints hurt, I gained 30 pounds, and I was crying all the time.
When you’re depressed, it’s hard to admit that you’re depressed. After six months of living this way, my parents were like, “You need to go see a doctor.” I went to my primary care. Before I could finish telling him all the symptoms I was experiencing, because I had a lot more than I just mentioned, he said, “You’re depressed,” gave me some Wellbutrin, and sent me on my way.
I left his office, feeling defeated. This is your answer? I had all these questions. Will I become vegan? I thought I was eating this healthy diet. Maybe I wasn’t doing the right thing with my diet. Maybe there is something emotional going on. He didn’t address any of that.
I was in therapy at the time. My therapist was listening to me talk after this experience with my primary care provider. She suggested I go to this holistic natural doctor. “I just had lunch with him. I don’t really know what he does, but I think you should go see him.” He was a naturopathic doctor. I went and saw him. He spent about two hours with me on the first visit. A lot of details. Really understood my symptoms. Really listened to me, which felt amazing. It’s really nice to feel listened to when you don’t feel well.
He ran a bunch of tests. When the testing came back, my adrenals were really underfunctioning. My B12 was low. All my nutrient levels were low. My hormones were outta whack. He put me on a treatment protocol. About eight weeks later, I felt almost 75-80% better. I’d lost some weight. My energy was back. I’d stopped crying. I could actually enjoy life again. It was so cool.
At the time, I was working for my family business, which was industrial manufacturing. It really wasn’t the best thing to be doing at age 23. I was living in the middle of nowhere in Delaware. He suggested maybe I wasn’t happy in my career.
I got a job in recruiting. This is a long-winded story… I was doing temporary recruitment. I interviewed about 80-100 people a day. I love talking to people. Love it. My boss about six months in sat me down and said, “I don’t think this is the right career for you.” I asked, “What do you mean?” She said, “Well, you keep bringing me all these resumes and you’re like, ‘Listen to this woman. She had lupus and had all these symptoms. Here’s what happened. Here’s why she left her job.’ I don’t really care that she had lupus. I want to know if she can do this job or not. But you really care.
“You keep bringing me these resumes, and all you’re talking about is their health. I think you might want to go into the health field.” I sat with that for a minute and was like, “I think she’s right. I really like health.”
I went back and had lunch with the naturopathic doctor who treated me. I said, “I want to do what you do. How do you do this?” He told me not to do it, which was amusing. He said, “It’s a really tough career. You have to run your own business. It’s going to be an uphill battle.” I was like, “That sounds like fun. Exactly what I want to do.”
I quit my job and went back to naturopathic school. I really wanted to help people who were struggling just like I was. They had a bunch of random symptoms that sounded unrelated. Went to see their doctor, and their doctor said they were depressed, or they just needed the birth control pill if they were female. I felt very dismissed, and that didn’t feel good.
I now specialize in treating men and women who come into my office feeling similarly to the way that I did. They are like, “I’m really tired. I gained weight. My joints hurt.” They have all these random symptoms. We will talk about what why that happens. For most of them, chronic stress has had a major impact on their body and has affected their adrenals. When we affect the adrenals, and I’ll talk about the physiology of this later, you will start to have an impact on every other system of the body. We can start to see these seemingly unrelated symptoms in different systems of the body act up.
Some people are like, “I don’t know what’s wrong. Should I go see this specialist or this one or this one?” Theses specialists are like, “Nothing’s wrong with you. Your labs are normal. Everything checks out normal.” But they still don’t feel well. I get these people who see five specialists, their primary care, and they all tell me they’re normal, but they feel like shit. They don’t feel well.
That’s how I got into this. I’m really passionate about it because it’s the medicine that really helped me.
Dr. Eric:
As far as the physiology, if we could go even more basic. What are the adrenals? Why are they so important? If you want to talk a little bit about the physiology.
Dr. Erin:
The adrenal glands are the little glands that sit on top of your kidneys, and they are responsible for producing cortisol, epinephrine, and what we think of as your stress hormones, the catecholamines, like adrenaline-type things.
I am going to describe what happens if you’re under acute stress. Let’s say I am sitting in this room, and a lion jumps in, which would never happen, but we’re going to pretend it happens. A lion jumps in here, and my body goes, “Oh my gosh, I either need to run or fight.” Hopefully I choose to run.
What happens is this part of my brain called the amygdala, which senses whether something is a stressor or not. It’s a very black or white- It’s a very old part of our brain. There is no higher reasoning. This is a stress, or it isn’t. If it decides it’s a stress, it will send a signal to another part of my brain called the hypothalamus, and that part of the brain will then send another signal called a hormone called cortico releasing hormone to your adrenal glands. There is a couple more steps, but I am going to simplify here. Your adrenal glands release this signal. They go, “Oh, stress. We better pump out some cortisol and adrenaline.” Those two hormones flood the system.
What happens when those hormones flood our system is all the blood flow goes in our arms and legs because we want to be ready to run or fight. Meaning the blood flow leaves the abdominal organs, the testes, ovaries, the other organs that thrive when we are in that rest or digest state. Our heart rate goes up. Our blood sugar and blood pressure go up. We get into this state where this body is ready to run or fight.
What’s supposed to happen is once I get safe from said lion or whatever the acute stressor is, the body is like, “I’m safe.” That same cortisol molecule will go back to that hypothalamus part of the brain, and it will bind to what I like to call an off button. It binds to a receptor in the hypothalamus that then turns off further production of that cortico releasing hormone. Essentially turns off further production of cortisol. Then the body will go back into that rest or digest state.
What happens is all the blood flow will come back to the abdominal organs. Heart rate goes down. Blood pressure goes down. Blood sugar goes down. The system then relaxes. We were designed to be able to go into this acute stress state when needed. We were also designed to be very able to quickly come out of that state.
In today’s world, most of us end up getting into that acute stress state, and we don’t come out of it. We stay stuck there. I love to use March 2020 as an example. Everyone remembers that really fun month where we had no idea what was happening. Every five minutes, new information was coming out, and our bodies were like, “More stress, more stress.”
That hypothalamus part of our brain, where it should be receiving that cortisol to turn off, that off button, the body is like, “You know what? I’m pretty sure that my stress response is going to keep getting triggered over and over again,” so it stops making that receptor. It downregulates the production of that off button. It’s also known as a glucocorticoid receptor. We stop making that receptor.
Now your body, even if the cortisol goes back there, it can’t turn off, so we get stuck in this fight or flight mode. This is where problems start to arise. We are only designed to spend a short amount of time, about 10-15% of our lives, in this acute stress phase. Most of us in today’s world spend about 80-90% in that fight or flight state.
We can usually exist in the flight or fight stage for some period of time. If you’re in that stage, your adrenals are pumping out that adrenaline and cortisol over and over, constantly. Typically, when we are pumping those out, we don’t sleep or rest very well. The body needs rest in order to continually produce cortisol.
Cortisol is what I like to call a very metabolically expensive hormone. It takes a lot of cofactors. It’s a big steroidal-type molecule. If you stay in that chronic stress state, you will eventually run out of the building blocks to build more cortisol. What we start to see is a decline in cortisol, the longer you stay in this chronic stress state.
Here’s the thing about cortisol. Most of us think of it as the stress hormone. It is, but it’s really the hormone your body makes in order to give you energy to deal with stress. It’s a slight distinction, but it’s very different.
When I teach workshops, I ask, “What do you think about cortisol?” “It’s bad. It makes you fat.” Actually, too much cortisol is a problem, yes. Too little cortisol is also a problem. It’s very similar to blood sugar. We don’t want cortisol to be too high; we don’t want blood sugar to be too high. We want it to be right in the middle. Cortisol is the thing that gives you energy to deal with stress.
It’s also the thing that gives you energy in your everyday life. It’s what wakes you up in the morning. It’s what governs your Circadian rhythm. We have this natural rhythm of what cortisol is supposed to look like throughout the day.
A third function of cortisol is one of your body’s major anti-inflammatory molecules. Most of you listening may have heard of prednisone or a steroid at some point in your life. Cortisol is the body’s natural form of a steroid. Essentially, prednisone is synthetic cortisol.
When we have stress for a long period of time, and we start to run out of the building blocks of cortisol and start to see a decline in the levels of cortisol, we can start to get unchecked inflammation in the system, which can look like joint pain, depression (inflammation in the brain), digestive disturbances, acne, skin flares. If you’re like, “Wow, I have a lot of these random symptoms,” it’s important to get your cortisol levels checked.
Most of the patients that I see have been super stressed. Most people know they have been stressed. They come in and are like, “My cortisol’s gonna be high.” It’s actually probably gonna be low. It’s very rare I see a case of super high cortisol. Most people have low cortisol levels. “I don’t understand that. I thought cortisol was bad. Why do you want to raise it?” You need that cortisol to give you energy. I call it the fix-it hormone. It’s the hormone that fixes things in the system. If you don’t have enough of it, you will start to see things go wrong.
That’s my basic physiology explanation. I could talk a little more, but that gives you the basic gist of things.
When cortisol levels are low, we call this adrenal fatigue. It’s what the functional medicine space has termed this state of the body.
Dr. Eric:
That described me as far as having low cortisol levels when I dealt with Graves’ years ago. I wouldn’t have guessed that my cortisol would be low. As you mentioned, some people would suspect their cortisol to be high, and then they look at a test, whether it’s a saliva test or dried urine test. We will talk about some of the testing that you prefer. When someone sees a high cortisol pattern, what does that mean? Their body is still adapting to the stress, whereas if it’s low, their body has lost the ability to adapt to the chronic stress?
Dr. Erin:
Here’s the thing. Let’s use you as an example. Your cortisol probably was very high for a period of time. I don’t know all the details about your case, but most people aren’t coming to the doctor when they are in that- Let’s say you go through a divorce, and your stress levels are really high for a couple years. Typically, when you are making excess cortisol to keep you going, you’re functioning okay. That cortisol is giving you energy. You might be not operating on a lot of sleep, but you’re getting through it. Over time, as the cortisol levels start to decline, this is when people start to feel bad. That’s when they go to the doctor.
For most people with low cortisol, there was probably a point in time where their cortisol was high. It’s just probably not when they are getting it checked.
Now, you asked if people are seeing high cortisol, what does that mean? That usually just means they’re still in the initial phases of that fight or flight stage. I will tell you that the cases I see currently where people have elevated cortisol, and they feel like crap, those are usually the cases where people have chronic Lyme, mold exposure, or really bad EBV. I know we were going to talk about this, and we can get into it.
Those are all things I like to call internal stressors. They are causing the stress response to go off on the inside of the body; the inside of the body is triggering that stress response, versus an external stressor, which might be work, pandemic, something outside of your body. In those cases, they will eventually have low cortisol. Some of them are actually coming in because they don’t really feel good because of the other things going on.
Dr. Eric:
Could that be a reason why a lot of times, you see people with stealth infections having trouble sleeping? If they keep on pumping out cortisol.
Dr. Erin:
Yes. One of the reasons why the body does that is when cortisol is high, it will activate the immune system. It turns the immune system on. The whole fight or flight thing, we think of it as being like fighting something external when we are usually fighting something internal. If you get COVID and have a really high fever, your cortisol level will go up because that will turn on the immune system. if we are talking about autoimmune conditions, chronic levels of high cortisol can trigger the immune system to start attacking itself. Eventually, if that autoimmune thing has turned into a disease state, we will see low cortisol on the other side. Typically, in most cases, developing an autoimmune thing, there are a lot of other factors, but the high levels of cortisol can play a role in that.
Dr. Eric:
Do you also see when someone typically has low cortisol levels, their DHEA will be low? That was the case with me. I see that a lot with my patients.
Dr. Erin:
Yes. DHEA is a precursor molecule to both cortisol and testosterone. It’s something the body uses as a reserve that it can convert into cortisol. Yes, in most cases, once the adrenals have fully bottomed out, you will see low DHEA. It depends on when you catch it. It also depends on where the body is prioritizing things. With women and their sex hormones, progesterone and estrogen and sometimes testosterone, if the body is prioritizing the sex hormones, we can see a lower level of cortisol.
I also have some cases where all the hormones are bottomed out, but the cortisol looks okay. That could still be an adrenal fatigue type state, where the body is stealing from those other hormones to shunt them over to cortisol, to keep up dealing with whatever stress is going on in their system.
To answer the question about low DHEA, yes, it’s really common to see that. However, I will sometimes see DHEA being normal, and cortisol is low. In some cases, DHEA will be really high, and cortisol is low. There can be conversion issues there, which is a separate issue. You can see DHEA all over the map.
Dr. Eric:
Let’s talk about the testing. What testing do you recommend when it comes to evaluating the adrenals?
Dr. Erin:
I in my practice typically start out with just general bloodwork. I test a fasting DHEA, a fasting cortisol, and a fasting testosterone. Testosterone can also give me some insight. If it’s too low as well, it can tell me if my adrenals are stealing- Women test their other sex hormones. That is usually where I start.
That is just giving us a quick snapshot. If the cortisol is super low, and obviously your adrenals are low. If the cortisol is super high- If it’s middle of the range, and their symptoms are screaming adrenal fatigue, that might be where I might suggest further adrenal testing.
There’s a test called the DUTCH test that I really like, which is urine. It looks at cortisol, cortisone, cortisol metabolites, and all of these other sex hormones. There are options. I like the DUTCH Complete because it gives you a complete picture of what’s going on. That can be great.
You can do what we call a four-point cortisol, a salivary cortisol. You will collect saliva at four points throughout the day, and you will see the cortisol graph. You can see it’s low in the morning and high at night. Or we started out good, and we crashed mid-day. That can be a helpful test.
What I will tell you is 90% of the time, you can probably guess what your cortisol is doing based off of your energy levels without caffeine or stimulants. If you wake up and don’t drink coffee, and your level is great, “I’m an 8/10,” and slowly your energy dwindles throughout the day, that’s a normal, healthy level. Your cortisol levels are normal and healthy.
If you wake up and cannot get out of bed, and are super exhausted, but then by noon, your energy picks up, and at 4pm, you’re flying, that will typically indicate your cortisol is low in the morning and high at night.
For the majority of cases, when I am working with patients, I get that fasting morning cortisol to see where things are. Then I take a really good history. In some cases, if people are drinking a ton of caffeine, I tell people to go off of caffeine for a couple of days and ask them to let me know what their energy is like off of that. Caffeine will mask your energy levels, what you’re truly doing. You can usually get a sense for how your adrenals are functioning just by your energy levels throughout the day.
Dr. Eric:
Okay. It sounds like pretty much across the board, morning cortisol, DHEA, testosterone. All of this is fasting. And then it depends on the person. Not everybody will get a DUTCH test. Not everybody will get a saliva test.
Dr. Erin:
I honestly don’t run them as often as you would think. It’s usually because I pretty much know what they’re going to say. Some patients will come in and want to run this. I have no problem running the test, but they’re expensive. I’d rather my patients spend their money on the treatment protocol to get them better.
Unless it’s a case where they are not responding to the treatment, and it’s a little bit weird, then I would want to order the test. But the majority of the time, I am doing the general bloodwork and going off of clinical symptoms.
Dr. Eric:
Do you see a relationship between adrenal problems and thyroid problems in your practice?
Dr. Erin:
Yes, 100%. I treat a lot of thyroid patients. Almost all of them, there is an interplay with adrenals. There is four major players in the endocrine system. We have the thyroid hormones, the adrenal hormones, the sex hormones, and the blood sugar metabolism. If you think about a triangle, the top three—thyroid, adrenals, and sex hormones—are in this very delicate triangular balance. If one goes up or down, it’s going to affect the other two. We can’t move one without moving the other two.
If you make a triangle with your fingers and play around with moving one up or down, you will notice that if one moves, the others have to move. Typically, if we see the adrenal function go up, we will see a dip in thyroid function. If we see sex hormones go down, we will see a shift in adrenal and thyroid hormones. They are always connected.
This is where I get a lot of patients with thyroid, saying, “I went to my endocrinologist. They tell me my TSH is fine, and this is fine,” but they are exhibiting all these symptoms of maybe hyperthyroidism and maybe adrenal stuff. Sometimes, they have an actual thyroid issue. Sometimes, they have slightly underfunctioning thyroid because of what’s going on with their adrenals or their sex hormones.
The last piece is your blood sugar. If you go back to making that triangle with your hands, the blood sugar is the thing that is holding the triangle up. It’s keeping all of these things steady. This is why keeping a healthy diet is important for all of your hormones. If your blood sugar is going all over the place- If you have a triangle sitting on top of something that’s wobbly, it’s very hard to keep those other hormones regulated, if we don’t have steady blood sugar.
That’s a long-winded answer to your question. Yes, I do see patients with thyroid issues have adrenal problems.
Dr. Eric:
Let’s talk more about blood sugar and diet. What do you consider to be a healthy diet?
Dr. Erin:
That will vary per person. If we are looking at this hormone realm, the diet that keeps your blood sugar the most balanced is going to be a healthy diet for you. For some people, that may be eating animal protein several times a day with veggies and low carbs. For other people, that might be eating a really balanced meal three times a day. It will depend on a lot of other factors. If you have someone with severe food allergies and gut stuff going on, they might need a very different diet than someone who has a healthy digestive tract.
When I talk about this stuff on my show, the diet piece, it’s really helpful to get support for this. Work with a practitioner who knows what they’re doing to help you figure out what the right diet/lifestyle program is for you at this given point. Especially for women—men, too—women’s hormones change quite frequently throughout our lives. At each hormonal stage, you might have a different nutritional need. You might have a different diet that will keep your blood sugar more stable.
To answer your question, there is not one diet protocol that I subscribe to. It will be individualized.
Dr. Eric:
Good response. I agree with that. It obviously varies from person to person.
Dr. Erin:
I’m currently a big fan of CGMs, using a continuous glucose monitor to figure out what kind of eating protocol will help keep your blood sugar balanced. The main way blood sugar has an impact on hormones is what it does to the adrenal system. if your blood sugar dips, that will send a signal to the hypothalamus that there is a stress. “Oh my gosh, we don’t have blood sugar.” It will activate your fight or flight response.
We get the cortisol flood because another one of cortisol’s jobs is when we are in fight or flight, our blood sugar goes up, whether you have eaten or not. Typically, what we’ll see is if you skip a meal, and your blood sugar dips down, you will then get a blood sugar rise, whether you have eaten or not. Sometimes, if you haven’t eaten, you will get more of a spike. This is because cortisol will go tell your liver to break down stored glucose in a form of glycogen, which will cause the blood sugar to go up.
I have several patients right now who are pilots. They fly all over the world. Their stress levels are super high. They eat no sugar. Their A1Cs are 7.8. For those of you who don’t know, A1C is a three-month average of your blood sugar. Normal is between 5-5.5. 7.8 is very high, which tells us their blood sugar on average is too high. These guys don’t eat any sugar. The reason their blood sugar is high is because their stress levels are so high. This is where using a CGM to figure out what the best diet is for you to keep your blood sugar balanced can be a helpful tool.
Dr. Eric:
Do you have people on CGMs for many months, or just a few weeks?
Dr. Erin:
If we are dealing with a blood sugar situation, maybe we will have them on it for a few months. But a 2-4-week period where you try out certain things. “Let me see what intermittent fasting does to my blood sugar.” “Let me see what eating protein three times a day does.”
“Let me see what my exercise routine is doing to my blood sugar.” “Let me see what watching scary TV does.” Food is one input, but we have all these other inputs that can impact your blood sugar.
A couple weeks can be helpful to learn what works and what doesn’t work for your body. You can get one of those finger prick things, but it’s annoying.
The CGMs have been helpful for some of my patients where we struggled to figure out what is wrong with their insomnia, and they wake up frequently. A lot of patients are finding out that they get blood sugar dips when they wake up, which is what is waking them up. The blood sugar dips, puts the body in a fight or flight, and then the blood sugar spikes. We have worked with adding in some protein before bed and doing some other things to balance blood sugar during the day. Then their sleep improves, which is cool.
Dr. Eric:
You spoke about diet. I want to talk about supplements. Before we do that, stress management. What do you recommend from a stress management perspective?
Dr. Erin:
I don’t love the term “stress management.” I use it sometimes as well, but most of the external stress in our life, you won’t be able to change that. Maybe you can. Maybe you can leave your job. But for most people, if your job is really stressful, leaving your job might be more stress. If you’re in a relationship where there is stress, leaving that situation- Getting away from it is not always the answer.
Essentially, if your body is stuck in that fight or flight state, you need to remind the body that it’s okay to chill out. Typically, my protocols are having the patient build in micro moments of relaxation throughout their day. I usually have patients start with finding 5-10 minutes to lay flat and listen to music or meditate or lay flat and chill out for 10 minutes. I like when you lay flat because it allows the blood pressure and the heart rate to go down. It’s telling the body it’s okay to come out of fight or flight. The more we do this, the more the body will be like, “It’s okay. Let me make more of those glucocorticoid receptors/off buttons,” so it will allow the body to turn off even more.
This is why meditation and the supplements we will talk about are helpful for helping the nervous system. They increase the production of the glucocorticoid receptors in the hypothalamus. One of my favorite herbs is rhodiola, which is a fantastic herb for regulating the nervous system. If the cortisol is too low, it will bring it up. If it’s too high, it will bring it down.
One of its other actions is it increases the production of those off buttons. It gives the body more resiliency. It allows the body to be able to come out of fight or flight after it’s been stressed.
I kind of rewire people’s thought processes. “I need to manage my stress.” No, we need to build in more relaxation periods. I work with a lot of high functioning individuals. I get CEOs and women who run their own businesses and a household; they do a lot of things. I’m not going to tell them, “You need to shut down your business or have fewer children.” You can’t change a lot of things going on in your life, but I can say, “I need you to sit down with your schedule and build in 10 minutes in the morning and 10 minutes in the afternoon. Have some downtime structured into your weekends.” It’s about making some lifestyle changes.
We do supplementation as well and work on diet. But building in relaxation practices is the #1 thing that will get you better. I find my patients who add those things in fare really well.
What’s interesting is when I was first doing this, I recommended meditation to everyone. Meditation is fantastic. It’s probably the best thing you can do for your health. If you’re stuck in this fight or flight stage, meditation is really hard. “I can’t get my thoughts to calm down.” Patients will do it for a week and stop.
I started tweaking things to build in these micro practices that are much easier for someone to digest. It’s meeting the patient where they are in terms of where their nervous system is. Mostly what I find is when my patients will start to incorporate these little moments for a couple of months, they will say, “I finally downloaded that meditation app, and I have been meditating for 20 minutes a day. I lengthened the amount of time I lay horizontal, and I built in a meditation,” which is fantastic. That’s where I wanted you to be. But if I told them to do that initially, it wouldn’t have worked.
That’s been the evolution of my work with my patients on that piece.
Dr. Eric:
If someone is working a 9-5 job, would you say during their lunch break, take 10 minutes, and go to their desk or their car just to have some-
Dr. Erin:
Yeah. If your workplace is busy, and you can’t do it in the office, go outside. I will have some patients go outside and lay on the ground. That’s extra credit. If you get the earth, you will get the good grounding energy.
Occasionally, I will have someone try the lying down thing, and they say, “it feels too foreign. I feel like I can’t relax.” I will have them go take a mindful walk. Be outside. Try to do it quietly with no music, and enjoy the nature. There is so much research. Even just looking at a picture of a plant will help increase the production of those off buttons in the brain. Nature is really beneficial for helping calm our nervous system down.
If you’re someone who can’t do the laying down thing, because that won’t work with your job, go take a walk outside. That can be really helpful as well.
Dr. Eric:
Supplements. You mentioned rhodiola as one of them. What are some of your other favorite supplements to support adrenals?
Dr. Erin:
When patients’ adrenals are pretty bottomed out- A typical morning cortisol range is 6-20. I like to see morning cortisol around 15. If they are under 15, especially under 10, I use a lot of adrenal glandular. I am giving them a bit of adrenal tissue that they take in the morning to bump that adrenal production up in the morning, and then we let the natural progression happen throughout the rest of the day.
I like magnesium, B5, and B6 because those are the major cofactors the body needs in order to build cortisol. Those are my three favorites. They are also calming for the nervous system. Those can be fantastic.
Herb-wise, rhodiola, as I mentioned, and I really like ashwagandha. Those are the two primary herbs I use. There are tons of other adaptogens, but those are the two I use the most.
If there are also some immune issues, I really like mushrooms, a mushroom blend. That helps stimulate the immune system, and they also act as an adaptogen.
Dr. Eric:
What are your thoughts on licorice root?
Dr. Erin:
Licorice root is okay. It tends to spike blood pressure a little bit. If someone has low blood pressure, that can be fantastic. Most people with low adrenals tend to have low blood pressure, but I like to be careful with that one. It tends to be pretty stimulating, so if someone is having trouble sleeping, that is not my favorite go-to. If someone is sleeping fine, and their energy is still pretty low, that can be a nice herb to use.
Dr. Eric:
It sounds like rhodiola is your #1. Ashwagandha, you like a lot.
Dr. Erin:
Yeah. Those are my favorites.
Dr. Eric:
B5, B6, magnesium.
Dr. Erin:
Yep. B5 in the panthothenic acid form and B6 in the pyridoxal. You want to make sure you get the right forms of those guys.
Dr. Eric:
Do you have them take it separately, or as part of a B complex?
Dr. Erin:
I typically have them take it separate. You can take a B complex, but I have some formulas in my office where it’s the adrenal cortex with the magnesium, B5, B6, and rhodiola. That’s a blend I really like to use a lot.
When I am recommending things at workshops, in certain cases, if there is any sort of methylation issue going on, like if someone has a MTHR mutation, which I see a lot in people with adrenal fatigue, the B complex can set them off, particularly if their system has been stressed. I tend to stay away from too much folate or B12. Unless their B12 and folate levels are super low, which is a different case.
I really like the B5 and B6 because they don’t cause the body to overmethylate; they help stabilize the methylation process as well.
Dr. Eric:
Getting back to EBV, mold, and Lyme, which you mentioned earlier. How common do you see these stealth infections in your practice?
Dr. Erin:
Let’s talk about EBV first. Epstein-Barr Virus, probably 90% of the human population gets exposed to that virus at some point in their lives. 90% of people will usually test positive for an old infection of EBV, or a lot of my patients have a reactivated case of EBV.
These stealth infections are major internal stressors. Sometimes, I’ll get patients who come in, and I’ll ask about their stress levels. They’ll say, “I’m not that stressed.” Everything else in their external world is pretty good. “I don’t feel stressed mentally, but my body feels stressed.” Those are the people who I am definitely going to look for a stealth infection.
EBV is really common. It’s not always reactivated in people. but most people have had it. I screen everybody for EBV, mold markers, and Lyme to make sure that’s not something we are dealing with.
Lyme unfortunately is becoming a lot more common. I wish that wasn’t the case because it’s complicated and difficult to treat. There are a lot of nuances even in the testing and diagnosing of it. It can be a major internal stressor that causes a lot of problems and can put someone in adrenal fatigue.
Dr. Eric:
It’s a catch-22. A lot of times, the emotional stressors can drag down the immune system, making someone more susceptible to Lyme, bartonella, EBV, and other viruses.
You mentioned mold markers. Do you recommend mold markers in the blood or a urinary mycotoxin test?
Dr. Erin:
That will depend on clinical history. If someone says they were exposed to mold, “There was water damage in my house,” or “I lived in a moldy basement,” I will definitely run a mycotoxin test to look at what mycotoxins are coming out in the urine.
If someone doesn’t think so, I will run blood markers. The blood markers I look at are a CD57 panel, which is a particular type of white blood cell that fights stealth pathogens. In some cases, exposure to mold can lower that quite drastically. A lot of things can do that, but that’s one thing I look at. I look at Complement C3a and C4a. I look at MMP-l9. I look at Melanocyte-stimulating hormone and trans growth factor beta 1. Those are the markers.
If several of those are out of whack, and they have some Lyme markers and some weird symptoms, then I might run a mycotoxin test.
The reasoning for this is insurance will typically cover the lab work I order (if they have good insurance). The mycotoxin test is typically out of pocket. If we are 100% sure they have been exposed to mold, I will go right for the mycotoxin test. This is how I practice. Other practitioners will run all the things, but that’s how I work.
The mycotoxin test is very useful to see if there are mycotoxins present in the system. As you mentioned, exposure to mold will weaken the immune system quite drastically, which can make you more susceptible to Lyme or other coinfections and adrenal fatigue.
The thing I was going to say is another reason why testing for these stealth infections can be really helpful can be for assessing thyroid stuff. A lot of thyroid patients have autoimmune thyroid, whether it’s Graves’ or Hashimoto’s. Hashimoto’s tends to be more common.
EBV, for example, loves to live in the thyroid. If it’s hanging out in the thyroid in a reactivated state, the immune system will go nuts and try to kill the virus. It might make antibodies to the thyroid. A lot of my patients with Hashimoto’s, when we clear out these stealth pathogens, will see a reduction in their thyroid antibodies and thus an improvement in their thyroid symptoms.
The other thing these infections can do is they will affect the conversion factor from T4 to T3. If someone has a normal TSH, normal T4, but their T3 is in the tank, and they have hypothyroid symptoms, that is sometimes a sign to look for infections. Lyme in particular will wreak havoc on that conversion pathway that happens in the peripheral tissues.
Dr. Eric:
You covered so much, Dr. Kinney. Is there anything else I should have asked you that I didn’t ask you? Anything else you’d like to discuss?
Dr. Erin:
If you’re listening, and you think your adrenals are struggling, the stress practices I talked about, layering some of the relaxing things. Going back to the basics is always a good idea. Making sure you have a good sleep hygiene practice. Going to bed at the same time. Turning off screens. Maybe some sort of calming routine in the evening.
Getting morning sunlight is so beneficial for helping reset your Circadian rhythm. Without sunglasses. Go outside in the morning. Have your eyes exposed to sunlight. It’s really great to help boost morning cortisol levels.
The other thing I’ll have patients do, whether they have trouble sleeping or not, is I will have them take a little bit of melatonin before bed. That will help reset the Circadian rhythm. When melatonin is high, it tells the body to have cortisol be low. When melatonin is low, then cortisol naturally is high. If you are not producing enough melatonin in the evening, the body may think it should be making cortisol. A little bit of melatonin initially when I am treating someone will help us reset the Circadian rhythm.
Dr. Eric:
When you say a little, what do you mean? 1mg?
Dr. Erin:
Usually 1-3mg. If they are having trouble sleeping, I might have them take closer to 3mg. It’s not usually for helping of sleep; it’s for resetting the circadian rhythm.
Dr. Eric:
If you could let everyone know where they could find you? Your podcast? Your website? Any other places you want to direct them to?
Dr. Erin:
I hang out a lot on Instagram, @DrKinney. We try to put out content there. My website is DrErinKinney.com. I am in the process of rebranding myself. Eventually, it will be TheKinneyClinic.com.
My show is called The Dr. Kinney Show, which you can find on all major podcast platforms. Dr. Osansky will be a guest in a few episodes, so you can check that out. We have a lot of topics that we cover. A lot of thyroid stuff, adrenal stuff, different types of healing modalities. Those are all the things.
Dr. Eric:
I look forward to being on your podcast as well. That’s how I found you. Whenever I interview someone, I do research. I happened to have found your podcast through one of my guests.
Dr. Erin:
Great.
Dr. Eric:
I listened to some other episodes, and I recommend checking it out.
Thank you so much, Dr. Kinney. I’m sure our listeners learned a lot about adrenals. I learned some things as well. I appreciate it, thanks.
Dr. Erin:
It’s why the podcast thing is great. I feel like I learn something from every episode I interview someone. It’s a win-win-win for everyone. It’s a win for both people on the show and the listeners. It’s a great medium. I love it.
Dr. Eric:
Yeah, I definitely agree.