In this episode, Dr. Eric Osansky welcomes back naturopathic doctor Dr. Erin Kinney to discuss her new book, The Cortisol Cure, and a different way of thinking about stress and adrenal health. Drawing from her own experience with burnout and years of working with patients struggling with fatigue, hormone imbalances, thyroid issues, and chronic stress, Dr. Erin introduces her Cortisol Bank Account Framework. Instead of viewing all stress as something that needs to be eliminated, she explains how to think about the activities that “spend” cortisol and the restorative practices that help you make deposits back into your account.
Dr. Erin and Dr. Eric explore low versus high cortisol, adrenal fatigue and HPA axis dysregulation, and the connections between cortisol, thyroid hormones, sex hormones, blood sugar, sleep, and gut health. They also discuss why exercise can be beneficial while still acting as a stressor, how small relaxation practices can train your nervous system to shift out of fight-or-flight mode, and why adequate sleep may be one of your most important cortisol “deposits.” Dr. Erin also shares her thoughts on intermittent fasting, balanced blood sugar, meditation, adrenal-supportive nutrients and herbs, and why supplements can’t make up for a chronically dysregulated nervous system.
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Dr. Eric Osansky:
It is a pleasure to chat with return guest, Dr. Erin Kinney, who has a book called The Cortisol Cure. That is what our conversation is going to be about here, talking about her amazing book.
Dr. Erin Kinney is a naturopathic doctor, speaker, and author of The Cortisol Cure. After helping thousands of patients overcome fatigue, hormone imbalances, thyroid issues, and chronic stress, she developed the Cortisol Bank Account framework, which helps change the way we think about cortisol, and give people a practical roadmap to reclaim their health and energy. Welcome back, Dr. Erin.
Dr. Erin Kinney:
Thank you so much for having me. It’s great to be back.
Dr. Eric:
It’s been a while since you’ve been on the podcast as we were chatting beforehand. Excited to spread the word about your book.
The first question: What motivated you to write this book? When you were first on the podcast, you spoke about adrenal health, so we know that’s a passion of yours. You’ve been talking about this on your podcast, too. I assume that is one of the reasons, your passion for helping people restore their adrenal health and balance their cortisol levels. I’ll let you take over.
Dr. Erin:
I am not sure if I talked about this on our previous episode. In my early 20s, I went through a period of time where I was extremely depressed. I went from running marathons, being this happy, healthy, post-college student to I gained 30 pounds, couldn’t get out of bed, was crying all the time, and was exhausted.
Eventually, my parents were like, “You need to go see your doctor.” I go to my GP. Before I finished describing my symptoms, he wrote me a prescription for antidepressants and sent me on my way. I left that appointment in more tears because I felt not heard, and I felt like he didn’t ask me any questions about my menstrual cycle, my diet, my stress. He didn’t ask me anything.
I was working with a therapist at the time. I talked to her about how frustrated I was. She said, “I think you should go meet with this natural doctor, who just moved to town. He’s some sort of natural something doctor.” He was a naturopathic doctor. I met with him. He spent two hours with me and ran a whole bunch of bloodwork.
When I sat back down in his office to go over my results, he told me my cortisol was low, among other things. I was deficient in nutrients, B12, Vitamin D, iron, but my cortisol was extremely low in the morning. I was confused. “Isn’t that the hormone we want to lower? Isn’t that the bad, scary stress hormone?” He says, “No, cortisol is the thing that wakes you up in the morning. It gives you energy. It’s anti-inflammatory. When you don’t have enough of it, we call this adrenal fatigue.” That was what initially lit my fire in me. I want to understand. There has to be more people like me who feel this same way.
As we talked on the last show, I’ve helped men and women with adrenal fatigue for years. I think this framework and this book idea came about a few years ago. I have always taught how cortisol is important. You have to have it in the morning. It governs our circadian rhythm. I think of it as the fix-it hormone in the body. It gives you energy, helps your brain focus, and is the body’s natural prednisone. Without enough of it, we see unchecked inflammation all over the body.
Too much of it can be too high, which we can touch on later. What a lot of patients feel, and I felt frustrated at points in my life, is you know you have a lot going on. We all know stress makes everything worse. “You need to manage your stress.”
I look at my life now, and I always have a lot going on. I have five kids now. I have since gotten married. I have three step-kids and my own two kids. Business, patients, all the things. The things that stress me out the most are my kids and my work. Those are also the things I love the most. I’m not going to manage those or get rid of those.
I wanted to offer something that would change how we look at stress with the idea that cortisol is a very important hormone. I like to think of cortisol as the currency that your body uses to spend on things, particularly energy.
I developed this framework called the Cortisol Bank Account. Any time you do anything, whether it’s waking up and making breakfast or driving in traffic or writing emails, if you’re a provider treating patients, you are spending your cortisol. Any time you rest or sleep or engage in a parasympathetic activating activity, you’re earning it back.
If you look at your life through this lens, “Okay, I just need to make sure I have enough in my account to cover my expenses.” Does that make sense?
Dr. Eric:
Yeah, it does.
Dr. Erin:
The book talks about how this cortisol bank account relates to energy, sleep, sex drive, digestion, mood. It can look at all these different things. We all want to sleep well. We want to have better energy. We want better digestion. How does that account relate to that?
I think we tend to think of stress as these bad things. I use the example of exercise. Exercise is technically stress. When you go for a run or do a HIIT class, that’s a big spend. Exercise is good for us. We need to be exercising. Stress is not always bad. If we just look at it as a spend, “I have to make sure I have enough deposits coming in to match the spend,” it makes you feel less stressed about your stress. I get people who come in, “Oh my god, I’m so stressed. I’m stressed about being stressed.” That’s not helpful, right?
Dr. Eric:
I agree. I’m glad you mention the importance of cortisol. You mentioned that a lot of people look at cortisol as a bad, scary stress hormone. It does get a bad rap, but it is important. You don’t want to have too much cortisol, like you said, or too little. Like you, I had depressed cortisol levels as well when I was dealing with Graves’.
That leads to the next question. I did an adrenal saliva test, and that’s how I found out. Did you do that test or a different type of test?
Dr. Erin:
I did that test and a morning cortisol blood serum test. In my practice, I typically start with a fasting cortisol before 10am just to get a sense. Here’s the deal. You can usually tell what your cortisol levels are in most cases by how your energy is.
One thing I didn’t mention is cortisol is technically the stress hormone, but if we look at it this way, it’s the hormone that your body makes in response to stress to give you the energy you need to deal with that stress. It’s primarily an energy hormone.
When it is too high, usually that means the body needs a lot of it to deal with some sort of stressor. If it’s high for too long, it can start to disrupt blood sugar, glucose regulation. It’s actually the glucose that ends up causing a lot of the inflammation. It’s not necessarily the cortisol that does that.
I think cortisol gets blamed for a lot of tired but wired feelings. In most of my patients, when they feel “Ugh, I feel like I can’t sleep, and I’m super wired,” they have not enough cortisol, but the body is overcompensating. “I don’t have any cortisol to give me energy, but I still have stuff to do.” It overproduces adrenaline. “I feel like I’ve had 15 Red Bulls, and I haven’t slept all night. I’m so anxious.” That doesn’t feel good. It can cause heart palpitations, hot flashes, headaches. It’s not super sustainable to be in that state.
People feel similar when they have hyperthyroidism. They feel that crazy wired feeling. It doesn’t feel good. It’s very scary, too. It can make anxiety a lot worse. But the brain needs cortisol to keep mood balanced. It’s really important to keep your brain functioning properly.
Dr. Eric:
I agree. When you do the testing, would you say that the majority of patients you work with have low cortisol? Is it a good mixture of people who have high morning cortisol, not necessarily percentage? Is it equal?
Dr. Erin:
No. In my patient population, but I am dealing with patients who are really burned out and fatigued, 90% of my patients have low cortisol. Maybe once or twice a month, I get a patient who has an elevated morning cortisol. Usually, if they have that, I will then recommend a four-point saliva test to see what they’re trending throughout the day. That’s the benefit of the saliva test. You can track what the changes are.
Ideally, you should have high cortisol in the morning. It should slowly fall off throughout the day. This illustrates the bank account analogy perfectly. When you sleep at night, your body earns cortisol, so cortisol rises. It should peak in the morning. That wakes you up. Then you spend it as you spend your energy throughout the day, and then it’s low. You have that natural circadian rhythm going.
When we sleep really well, our energy is good in the morning. It dwindles. We’re tired at night. That’s what we’re working toward. Having them higher, so it slowly drops off throughout the day.
Dr. Eric:
The term “adrenal fatigue.” Some use adrenal fatigue. You also hear “HPA axis dysregulation.” Is there a difference between those two terms? How would you define adrenal fatigue and HPA axis dysregulation?
Dr. Erin:
I think adrenal fatigue is your cortisol bank account is bottomed out. The adrenals are tapped. They don’t have the building blocks, enough of what they need to keep making cortisol. Typically, with true adrenal fatigue, you will see low cortisol all day long.
The HPA axis is the hypothalamus pituitary adrenal axis. There is a process where your hypothalamus will send a signal to your pituitary, which sends a signal to your adrenals. This happens when a stressor occurs.
Let’s say I am sitting here, and a lion jumps in here. My amygdala will say, “There’s a stress” and send a signal to the hypothalamus. The hypothalamus sends a hormone to the pituitary to pump out cortico releasing hormone (CRH), which tells my adrenals to make cortisol.
Here’s what’s supposed to happen. The cortisol gets pumped out, gives me energy. I can run from the lion. I get safe. Once I’m safe, that same cortisol is supposed to go back to the hypothalamus and pituitary and bind to these receptors called glucocorticoid receptors and essentially turns off further production of cortisol.
That’s how it’s supposed to work. We activate. The system floods our system with cortisol, so we have the energy. We feel good and get things done. I call these receptors your off button. Your off button allows you to come out of that fight/flight mode, calm back down, and we are not spending all of our cortisol.
HPA axis dysregulation is when your body loses some of those off buttons. You can’t actually turn off. Your cortisol gets activated. You flood the system. Then the body tries to turn off the production of cortisol, and you can’t do it. You stay stuck in a spend state.
Often, when you have a really dysregulated HPA axis, you will feel like you’re in a fight/flight state all the time. Your body doesn’t have the ability to turn back off. That’s how I think about it differently.
When your HPA axis is dysregulated for a long time, you will eventually end up with adrenal fatigue. That is the precursor to how you get adrenal fatigue.
Dr. Eric:
Adrenal fatigue, you define it as flatlined cortisol. If someone has elevated cortisol, they probably have HPA axis dysregulation, but not necessarily in that state of adrenal fatigue.
Dr. Erin:
Yes, they might not have gotten there. Some people might differ their definitions. There is phase one of adrenal fatigue. At the end of the day, when your body goes through a chronic stress state, that typically triggers HPA axis dysfunction. The body has lost its ability to come out of fight/flight and turn off production of cortisol.
In this bank account analogy, that puts you in a constant spend state. It’s almost like you’re unable to earn that cortisol back. You’re spending, spending, spending. Eventually, like any bank account, if you keep spending, your account will go to nothing. That would be adrenal fatigue.
Dr. Eric:
This is going to be a trick question.
Dr. Erin:
Okay.
Dr. Eric:
Why don’t medical doctors acknowledge adrenal fatigue? Typically, when I think of flatlined cortisol, they’re concerned with Addison’s. They don’t acknowledge HPA axis dysregulation. We need to support. Why do you think that is?
Dr. Erin:
I think they don’t acknowledge it because they don’t have a treatment for it. There is no drug that treats that. I think? I don’t know.
It’s funny. I have been asked this question on a bunch of podcasts. I think about this quite frequently. I have been interviewed by a couple of magazines, “Is adrenal fatigue real?” Actually, in my experience, it is definitely a real thing.
Between Cushing’s and Addison’s, which are the two extreme states. Cushing’s is way too much cortisol production, and Addison’s is too low. But it is a spectrum. Adrenal fatigue is you don’t quite have Addison’s, but you still feel just as terrible.
I think it takes a lot of time to test and figure these things out, which often Western medical docs, if they’re in the insurance system, don’t have time to do that. They have 15 minutes, so it’s hard to ask all the questions, run the tests, and do those things. I also don’t think they have the protocols to help people. If you don’t know how to help someone, or they don’t even know who to refer to, they probably don’t want to acknowledge it. What do you think? Do you have a thought on that?
Dr. Eric:
I think it goes with everything else. It comes down to their training in medical school. That’s one of the big things. Typically, in med school, someone with Hashimoto’s, we don’t address the autoimmune component. We just give thyroid hormone replacement. With Graves’, it’s just antithyroid medication, radioactive iodine, thyroid surgery.
Like you said, there is not a drug they can give, but they don’t learn about supporting adrenals or looking at circadian rhythm of cortisol. They are just looking at pathologies when it comes to adrenals, not whether someone has low cortisol that is not related to Addison’s or high cortisol not related to Cushing’s.
I think it does come to the training. Not being open-minded. Just because you’re trained. I was brought up with a medical mindset. As a teenager/young adult, my family didn’t really do anything alternatively. It wasn’t until I went to chiropractic school and started opening up my mind. There is nothing stopping medical doctors from-
Dr. Erin:
Learning that.
Dr. Eric:
Thinking beyond Addison’s and Cushing’s.
Dr. Erin:
I have a lot of colleagues who are MDs. I think they all want to help their patients. They don’t have the knowledge, nor do they have the time in the confines of the system. I sometimes feel like I want to blame the system. The insurance model. The insurance companies are not going to pay for that. “That’s not a real thing. Give your patient an antidepressant and the birth control pill. That’s what we’ll pay for.”
Dr. Eric:
You’re right. It’s hard to stray from what they’re currently doing because of fear of what happens of going out of the insurance model. You’re right. They have their routine. If they are only spending 5-10 minutes per patient, some less than that, they don’t have the time.
They definitely don’t have the knowledge, but they could gain the knowledge. Some of them do. To be fair, some of them go through functional medicine training and do open up their mind. Again, it’s not just opening up their mind, but making the decision, “Hey, I want to do more than just recommend medications. I know that there’s more to adrenal health than Addison’s and Cushing’s.” I think it is a combination.
I agree with you that this is the system. Also, they have to make that decision. They feel trapped in the system. There are definitely medical doctors who step outside that system. It’s not easy. I know it’s easy for us to say. When you have been doing that 10, 15, 20 years, it’s hard. You have your routine, your patient base, making a good living.
I want to switch gears. I want to talk more about consequences of high cortisol or low cortisol, cortisol imbalances. When it comes to sex hormones, because I talk about this all the time, how you need healthy adrenals to have healthy sex hormones, it’s not to say that there is not a place for HRT. A lot of practitioners will just recommend HRT without- I’m talking more about functional medicine, more natural hormone doctors who are openminded, but they still won’t pay attention to the adrenals. “Everybody needs estrogen, progesterone.”
Dr. Erin:
Which a lot of people do. Here’s how I think about it. If cortisol is your main energy currency, your sex hormones (estrogen, progesterone, testosterone) are your savings account. If you look at them molecularly, they are all steroidal molecules. The body can move them around and interchange them.
When you’re in your 20s and have tons of sex hormones, or you are supposed to, if your cortisol dips low, if you spend too much, you can pull from your sex hormones. As we hit midlife, and those sex hormone accounts are dwindling naturally, you are losing your savings.
Here’s what I see all the time. I have patients come to me who don’t feel well. They had brain fog, hot flashes, and weren’t sleeping. They went to their doctor and were immediately put on HRT. They feel better for a week, and then they feel terrible again. “This is supposed to be a miracle thing!” No one looked at their adrenals or talked to them about their lifestyle or how they were burning the candle from both ends.
HRT can be a very powerful tool for the right people, but if you do it without addressing your adrenal health, it’s not going to be the magic fix that everyone is looking for it to be. That’s what I see.
The other thing, and I know you know this, is cortisol impacts thyroid. High cortisol is not great for T4 to T3 conversion. Low cortisol is also not great here. Your normal circadian rhythm helps keep the thyroid on track as well. All the endocrine players, it’s an intricate dance. If one is off, it will affect the other two.
Dr. Eric:
Adrenals are not only necessary for healthy sex hormones but a healthy thyroid, too. This is a thyroid-related podcast, so I’m glad you brought that up.
Dr. Erin:
I remember when I was first in practice and had quite a few thyroid issues coming in. I wasn’t prescribing thyroid hormones at that point. My state wasn’t licensed. “I’m tired. I’m increasing my thyroid dose.” Providers would increase the dose, and patients would feel better initially, but then they would feel worse.
If you increase thyroid without supporting the adrenals, you will crash your cortisol low. If you take too much thyroid or are in a hyperthyroid state, that will crash out your cortisol. It’s important to be addressing all of these things together.
Here’s the thing. Adrenal health and addressing your cortisol is not complicated. It’s actually very simple. The recommendations I make in the book are very simple. A lot of them are free. It’s about making sure I’m making enough deposits into my energy account. Getting enough rest, making sure- I have all these tiny micro deposits. Breathwork practices or ways you get your body to get out of a spend state and teach yourself to calm down.
I want to bring this up because I feel like this is a concept people really like. I don’t know if you see this in your patient population. We’ll talk about stress. I’ll say, “Since we talked about your stressors, what do you like to do to relax?” A lot of my patients will look at me like I have three heads. “I go to the gym.” That’s great, but the gym is not technically relaxing. That’s still an energy spend. That’s still stress. “What does that mean?”
A lot of us in today’s society don’t know how to relax. One of the ways I have tried to work on this so patients can hear me is I like to think of your nervous system as being two muscles. You have your stress muscle and your relax muscle. Your fight/flight muscle and your rest/digest muscle. Just like any muscle, if you work one out all the time, it’s going to get stronger.
If you go through a period of time where you have a lot of stress, or you are busy all the time, your stress muscle will get very strong, which is fine, if you have a lot of stress. If you don’t work out the relax muscle, it’s going to stay weak. Then when you try to relax, or you try to sleep, your body will be like, “I don’t know how to do this. I am much more comfortable operating in the stress muscle.”
A lot of what I talk about in the book is every time you meditate for two minutes or turn off your phone and go sit in the sunshine or spend two minutes washing your hands and smelling the soap, these mini practices, it’s like going to the gym for your relax muscle. It’s training your nervous system that it’s safe to relax.
That angle has landed really well with my high-strung, stressed out patients. It makes sense to them. You might try to relax or meditate, and if you have never done it before, it will feel uncomfortable, just as if you have never done an ab exercise. You go to a Pilates class, which will feel uncomfortable because that muscle isn’t developed yet.
It’s a different way to think about it. I need to work my relax muscle out. It might take a month for that to feel good to me, right?
Dr. Eric:
I agree. I like what you said. I think we’re on the same page. When you mentioned exercise isn’t really a relaxed state, I understand what people say. When I go to the gym, and I work out, I do feel like it’s a form of stress management. It’s more like activating your fight or flight or the parasympathetic nervous system.
Dr. Erin:
Mentally, it makes you feel better because it burns off stuff. I am not trying to say you shouldn’t exercise. Exercise is important for a lot of reasons. If patients have a regular exercise routine or practice, I’ll say, “Let’s habit stack that. You go to the gym. Work out your regular workout. Build an extra 10 minutes to do a shavasana and listen to a meditation at the end.” Your me time includes the endorphin rush and exercise, but it also includes something that is working out your relax muscle. That is how you allow your cortisol bank account to get refilled.
Every time you do a relaxing practice, it also stimulates the brain to make more of those off buttons. They have done so much research on meditation. Meditation will increase the production of those glucocorticoid receptors. The more you meditate, the easier it is for your body to come out of a stress state when you would like to. This is how we treat HPA axis dysfunction. Meditation is one of the best tools that we have for that. It’s free. Not that it’s always easy, but it’s a simple, free practice you can do.
Dr. Eric:
What do you think about the apps out there?
Dr. Erin:
Meditation apps?
Dr. Eric:
Yeah, do you recommend them?
Dr. Erin:
I recommend using something that you’re going to use. I have a lot of patients who use Insight Timer and Calm. I had this conversation five times today with patients. I find that if you’re going to do a guided meditation, and you’re trying to train or work this relax muscle out, pick one you like, and do the same one every time. I have been listening to the same guided meditation for three years. I don’t know if you follow Dr. Patrick Porter, BrainTap. Have you used this device?
Dr. Eric:
I’ve heard of it.
Dr. Erin:
It’s a dual voice thing. I have listened to the same one for three years. When I’m feeling stressed, and I need to calm down, all I have to do is listen to the first 30 seconds of that meditation, and my body immediately relaxes. I have trained it that that means relaxation.
You remember Pavlov’s dogs when you took psychology? Our nervous systems are like that. If you want to try to give yourself a tool, I highly recommend you listen to the same songs or the same guided meditation. Something that you pair with a calming body practice. Over time, it will literally train your nervous system. You hear that song and calm down. I’m big on that right now.
That could be within any of the apps. I like Insight Timer. They have tons of free guided ones. There are also ambient noises you can choose. They have chanting monks and falling water. You choose something that feels good to you and practice that regularly.
Dr. Eric:
Have you ever used HeartMath?
Dr. Erin:
I have played around with it. I don’t have it. HeartMath is pretty cool. Do you use it?
Dr. Eric:
I do. I like it. Like you said, most of my patients don’t use it. I tell them to find something that they will use. If it’s meditation or yoga, if you use an app, that’s great. With me, I like the biofeedback. I enjoy using it. It doesn’t mean it’s a good fit for everybody. But it’s been around for a long time.
Dr. Erin:
It has been around for a long time. We’re in this interesting age in healthcare. We have so many tools available.
I use an Oura ring for the data. My favorite thing about the Oura ring is it tracks the amount of time you’re in a stress state versus the amount of time you’re in a relaxed or restore state. I use that as my gauge.
I need to make sure during the day I get at least an hour of restore time. If I have that during the day, I sleep better, my energy is better, my mood is better, my menstrual cycles are better. If I have weeks without any restore time, and my stress levels are high, I see it show up in my body. It’s a cool real-time thing, “No wonder I don’t feel great. I had no restore time this past week.”
Dr. Eric:
That makes sense. It is more about sleep. If you are only getting four hours of sleep, that will affect your cortisol over time cumulatively.
Dr. Erin:
In this bank account analogy, sleep is your biggest deposit. When you sleep at night, that’s when your cortisol levels should be rising. When we’re sleeping, it’s like going to work. If you’re only sleeping four hours a night, that’s not enough sleep. Even six hours for most people is not enough sleep.
Listen. There are seasons of life where you might have a big work project, or you’re moving, going through something where you might not get as much sleep. That’s where you have to double down. “I’m not sleeping as much during the night right now. I might need to make sure I’m meditating for 20 minutes twice a day,” to make that up.
In a normal, eight hours of sleep night, you earn $100 worth of cortisol. $100 is your daily average spend. As long as you’re earning $100 and spending $100, you’re fine. If you only sleep for four hours, you’re earning $50 worth of cortisol. You still have to spend $100.
Your body is like a bank. It will loan you some of that energy. After a certain period of time, the body will be like, “I’m sorry. I have nothing left to give you.” That’s when we start to see symptoms show up in the body.
In the book, I talk about robbing Peter to pay Paul. If you’re only getting $50 worth of cortisol and spending $100, your body will start looking at your sex hormones, stealing from them. We have all the symptoms that come from the sex hormones lowering.
I have seen so many patients where all we do is work on their sleep, protect their circadian rhythm, and all their sex hormone symptoms disappear within a month. We don’t even do HRT. That’s where you always need to start. If you do need to layer in HRT, great. You don’t always have to.
Dr. Eric:
I agree. You want to start with the foundations. Make sure you’re blocking out time for stress management, which we discussed. Getting proper sleep. That leads us to diet. You don’t have to get super specific. There is no diet that fits everyone perfectly. Maybe you can give some basics when it comes to what you recommend. Dos and don’ts. I have asked others’ opinions on intermittent fasting and adrenals. If you could talk about that, too.
Dr. Erin:
In terms of cortisol and adrenals, the #1 important thing that applies to everyone is keeping your blood sugar balanced. For most people, that means eating regular meals and eating enough protein in a nice ratio that keeps your blood sugar managed.
A pattern I see in a lot of patients is they skip breakfast, have caffeine, have a protein bar for lunch, and a big dinner. Their blood sugar is a rollercoaster. If you don’t eat and have caffeine, your sugar will dip, and the caffeine plus the low blood sugar is going to call on cortisol to bring your sugar back up. You will get a dip and a swing and then a dip again. You will have very unstable blood sugar throughout the day. That is arguably one of the things you can do for your adrenals.
If you’re listening and think your cortisol may be dysregulated, balanced blood sugar is the way to go. That might look different for different people. Usually, when I start working with someone, before we even get into what are you eating, are you eating? Are you eating with regularity? That’s the first important thing.
I had a patient this week say, “Sometimes, I don’t eat at all. I’ll eat at 2am.” Very dysregulated circadian rhythm. “I will sometimes go 30 hours without eating, and then I’ll eat a ton.” Okay. We don’t have to figure out the specificity of what you’re eating. We just need to get on a regular schedule.
Dr. Eric:
I’m not against intermittent fasting. I agree with you. Not everybody can handle intermittent fasting, especially- You gave an extreme case. 30 hours is not intermittent fasting.
Dr. Erin:
Very extreme case.
Dr. Eric:
A person who emailed, she said every day, she doesn’t eat until noon. That is going a long time. If she stops eating at 8pm, which is late-
Dr. Erin:
That’s still a long fast.
Dr. Eric:
16 hours.
Dr. Erin:
16 hours. But her circadian rhythm.
Dr. Eric:
I’m not sure if she’s stopping at 8pm. Like many of us, she could be stopping at 6pm. That’s 18 hours. Having a six-hour eating window from 12-6.
Dr. Erin:
My blanket rule with intermittent fasting is if someone is doing it, and they feel great, their energy is good, their sleep is good, their weight is normal, their benchmarks are in a good place, I won’t tell them to stop intermittent fasting. Most of my patients are coming to me because they don’t feel well. If you start intermittent fasting, and your energy tanks, it’s probably not the best thing for you.
If your cortisol is dysregulated, intermittent fasting, anything over a 12-hour fast will not be great. A 12-12 is good. That’s still plenty of a fast. You stop eating at 6 or 7, and you eat breakfast at 6 or 7.
I find most people feel their best when they eat within 30 minutes of waking up for energy throughout the day. That also means you’re eating around the same time you’re having caffeine if you are a caffeine consumer. If you have caffeine without eating for an hour or an hour and a half, you will start your day off with a blood sugar rollercoaster. I know some people are into bulletproof coffee, and that does help a little bit.
I have worked with thousands of patients. When they make the one change of making sure they eat breakfast with their coffee, they usually feel so much better. A 12-12 is the recommendation. You will usually feel the best.
I also don’t love intermittent fasting for perimenopausal or menopausal women. I think there are too many other changes going on hormonally. The visual I give people is you have this triangle of thyroid hormones, sex hormones, and adrenal hormones. It’s this delicate balance.
The thing that holds those things up is your blood sugar. If your blood sugar is all topsy turvy and goes all over the place, it will be hard for the body to keep the other hormones in place. Keeping that regulated, which usually means eating more regular meals, helps the body with the whole endocrine system. Do you see that in your practice? I’m sure you do.
Dr. Eric:
Agreed. Like you said, if someone is feeling good with intermittent fasting. It also depends. Even if you’re feeling good, doing an 18-6, I still think that’s too extreme on an everyday basis. I don’t see how you will get enough protein, nutrients.
Dr. Erin:
In that short of a period of time, yeah.
Dr. Eric:
I think we’re on the same page. We’re not against intermittent fasting.
Dr. Erin:
No.
Dr. Eric:
But it’s not a good fit for everyone. You definitely want to listen to your body and not force it. Like you said, a lot of people are coming to you becasue they are not really a good fit for intermittent fasting.
Dr. Erin:
They’re not feeling well. They are not coming to my office if they feel amazing.
Dr. Eric:
Exactly. When I dealt with Graves’, I was losing a lot of weight, and my adrenals were shot. I definitely wasn’t a good candidate. Back then, this was 2008, you didn’t hear as much about intermittent fasting then. Now, same thing. Not everybody loses weight with hyperthyroidism. If you are losing a lot of weight, and your adrenals are in poor shape.
I would say 12, maybe 14 hours max. Still isn’t too bad. Once you get into 16 hours, 18 hours, or skipping days, a lot of people just can’t handle it and end up doing more harm than good in the long term.
Is there a relationship between cortisol and the gut? All this talk about the gut microbiome.
Dr. Erin:
Oh yeah. Let me preface this. Nobody ends up with low cortisol without first having had some sort of HPA axis dysregulation or prolonged periods of high cortisol. We don’t usually end up in a crash without a time where we were overspending in that account.
When the body goes through a period of time where you’re in a fight/flight state for a long time, and you’re pumping out cortisol, that can start to wreak havoc on the microbiome, on the gut lining. When you’re in a cortisol spend or fight/flight state, there is no blood flow going to the digestive tract. All the blood flow is going to the arms and legs, so you can run and fight and deal with the stress.
When the gut doesn’t get blood flow, the pH will change slightly. When that happens, the microbiome is going to change. The bugs that would normally thrive in a pH of a nice 7.4, if that pH gets slightly more acidic, the good guy bugs are like, “We don’t like that weather,” and the bad bugs will overgrow. You can start to see some dysbiosis show up.
With chronic stress, we can start to see the gut lining break down a little bit, leading to things like leaky gut, which can increase food allergies and sensitivities. We can start to see histamine problems occur.
Cortisol, whether too high or too low, has a major impact on the gut. When cortisol levels are really low, oftentimes we’ll see sluggish adrenals, and sluggish cortisol production can cause constipation. Slow gut motility. When you add that to an already compromised gut, it’s a perfect storm for a lot of GI issues.
We treat a ton of SIBO in our clinic. One of my providers is a SIBO specialist. No patient with SIBO has perfect cortisol. If you have SIBO, there is definitely an underlying adrenal issue going on. While we have to do the protocols to get rid of the overgrowth of the bad microbiome stuff, we also have to work on the nervous system.
SIBO is a condition where it is so common that people will treat it, and a couple months later, it comes back. If you’re not doing anything to change the nervous system and the cortisol regulation, the same pattern will keep showing up, even if you keep killing the bugs.
Dr. Eric:
Makes sense. If you’re not addressing the motility issue, you’re right. You can take Rifaximin, the herbs, the Elemental Diet. There are a number of options. They can be effective. If you’re not addressing the cause, if you have low cortisol, which is a factor with low motility, and you’re not doing anything to optimize adrenals, or anything else- There are other causes of low motility. The point is, if you don’t address the cause, the SIBO is likely to come back.
We covered a lot. Is there anything else? We don’t want to give away too much because we want people to read the book. Is there anything you really wanted to discuss? We were talking about the cortisol bank account framework. I didn’t know if you spoke about everything you wanted to with the framework.
Dr. Erin:
I think we covered the framework. In the book, I share a lot of my personal story. I know all this stuff, and I shared about my burnout story earlier in my 20s. I have burned out even in the past few years. In 2021, I was going through a divorce. Tail end of pandemic. I hit a major burnout situation despite knowing all the things that I know. Early readers of the book have said, “Hey, we feel seen.” We are all human. None of us are perfect, even if we have all this knowledge.
I hope the book helps you understand here are some simple things I can build into my life that will make major impacts on my health. It’s got tons of simple things you can try. There are tons of patient stories. You’ll read it and think you’re not alone in this. Other people have gone through this. Even people like me who have all this knowledge, I still mess up. We’re human. Life sometimes throws us things.
The one thing I did want to bring up, which I also explain in the book, I think of stressors as being in two buckets. We have what I call “external stressors.” That is your work, your kids, traffic, things happening outside your body. Then I have what we call “internal stressors.” Those could be a chronic infection like Lyme or EBV. That could be a nutrient deficiency. Could be inflammation markers. Things that are happening in your body that you can test for. This could be hyperthyroidism, Graves’, any sort of autoimmune thing. Those things are also going to cost you cortisol.
If you want to understand what would your cortisol account look like, at the beginning of the book, there is the Cortisol Debt Assessment. It’s a test you can take that assesses your external load and internal load. It’s available on my website, DrErinKinney.com. You’ll see it there. It will give you your score, so you can get a sense of if you’re overspending and totally burned out. You might already know that in your body. It’s a cool quiz for you to take. It’s also in the beginning of the book.
Dr. Eric:
Cool. One thing I forgot to ask you. I’m sure you spent some time in the book on this as well. Are there a couple of favorite supplements, whether it’s herbs? I don’t know if you like adaptogenic herbs or licorice root for low cortisol.
Dr. Erin:
My two favorite herbs are ashwagandha and rhodiola. I like them because they’re not too stimulating. Ashwagandha, you have to be careful if you have ragweed allergies or thyroid issues. Rhodiola can be stimulating. But they are adaptogenic.
Glycerides, I tend to find a little too- I don’t use it much. It works people up too much.
I’m a big fan of, if you don’t tolerate herbs well, magnesium, B5, and B6. Those are my three favorite nutrients. I do talk about those in the book. I give safe doses for most people to take.
Supplements are fantastic. I always teach that you cannot outsupplement a dysregulated nervous system. Using supplements in combination with a lot of the practices that I teach, that’s where the magic happens.
Dr. Eric:
I can’t agree more. I use them the same way. Supplements, not substitutes.
Dr. Erin:
It’s not the main thing. Listen, there has been times, and I have had patients where all they did is supplements. That’s helpful. When I was early in practice, I would put people on adrenal protocols. They would feel better for a couple of months. If they didn’t change their lifestyle, if they didn’t stop spending too much, they would come back in my office with the same symptoms. The supplements weren’t working as well. I learned that lifestyle changes need to be the first thing. The supplements are supplemental.
Dr. Eric:
As far as where people can find out more about you, you mentioned your website. Where is the best place for them to get the book?
Dr. Erin:
Amazon, Barnes & Noble, Target. Anywhere you’d like to buy it. If you go to my website, all those links are there. It’s available in the UK, Australia. It is getting picked up for publication in about 10 other languages at this point. Next year, it should be available in Spanish, Portuguese, German, Taiwanese, and others.
Go to my website. You can check out the Cortisol Debt Assessment score. Take the quiz. See where you are. If you want to read the book, I’d love for you to read it and hear about it.
I’m huge on Instagram. That’s where I spend most of my time. If you want to follow me, I try to respond to messages. You can DM me with questions or if you resonate with what we talked about.
Dr. Eric:
Definitely check out Dr. Erin’s book, The Cortisol Cure. One of those life-changing books that everybody- I’m not just saying that. We all deal with stress. Some people are better than others when it comes to managing it. A lot of us overestimate our stress handling skills. I remember, prior to getting my adrenal saliva test, I was like, “I know stress is a factor, but I don’t think it’s affecting me. I think I’m doing a good job of managing it.” We tend to underestimate the stressors, overestimate the stress handling. I think it is a book that just about everybody can benefit from.
Thank you so much for this. This has been great. Look forward to hearing all these success stories and positive reviews. I don’t know if you have plans on a second version of the book or another book.
Dr. Erin:
I don’t know. I’m sure it will materialize at some point. I’m going to enjoy-
Dr. Eric:
One book at a time.
Dr. Erin:
I will enjoy this launch and this season. I’m sure there is another one in there somewhere.
Dr. Eric:
I will have to have you back in the future.
Dr. Erin:
Yes, I’d love it.
Dr. Eric:
Thanks, Dr. Erin. This was a great conversation. I learned some things, and I’m sure the audience learned a lot as well.
Dr. Erin:
Thanks for having me. Great to be back.
***
Dr. Eric:
That was an excellent interview from return guest Dr. Erin Kinney. We had a conversation about adrenal fatigue and the difference between that and HPA axis dysregulation. I’ve asked some other guests who focus on adrenal health, cortisol, during their interviews.
Dr. Erin gave a good explanation. She said that what happens is you have dysregulation of the HPA axis, and over time, you get a flatlined cortisol. You start out with HPA axis dysregulation, and eventually, that leads over months, years to low cortisol levels.
Low cortisol and energy. She mentioned this is one way you can tell if you have low cortisol. Definitely not perfect. When I dealt with Graves’, my cortisol was in the tank. I did not have low energy. Not everybody with low cortisol has low energy. Not everybody with low energy has low cortisol.
Low versus high cortisol. She mentioned about 90% of her patient base has low cortisol. I would say maybe 70% has low cortisol for me. About 30% has high cortisol. That’s an approximation. Everybody has a different patient base.
Exercise and stress management. She was just talking about how exercise is more of a fight or flight activity, which I’ve mentioned before. I had Dr. Tricia Pingle on the podcast recently talking about hip-hop. I consider hip-hop more of a fight or flight activity, too.
Dr. Tricia was saying that it’s a little bit of both. It really depends on the situation. If you’re memorizing the dance moves, then it’s more fight or flight. It’s more stressful. If you already have it down like she does, then it’s more parasympathetic. I guess I can see it that way, but I still think of it more as fight or flight, more sympathetic, and not exclusively parasympathetic.
Same thing with exercise. When I exercise, I do feel like it’s a form of stress management, just not the same as deep breathing or meditation or other types of mind-body medicine.
Meditation apps. Dr. Erin likes Insight Timer. She also mentioned Calm. Whatever works is what she said. There are so many apps for stress management. There will definitely be more apps for stress management in the future.
Cortisol and sleep. She mentioned how sleep is your biggest deposit. If you’re not sleeping well, that’s going to be one of the biggest, if not the biggest, factor when it comes to your cortisol levels. Definitely agree. It’s one of the top factors if you’re not sleeping. There will definitely be a negative impact on your adrenal health.
Low cortisol and gut motility. She mentioned how low cortisol can play a role in SIBO by decreasing gut motility. I know hypothyroidism definitely will affect gut motility. Low cortisol maybe to some extent. I can’t say when I was going through Dr. Allison Siebecker’s training that she mentioned low cortisol as a cause of low gut motility that can cause SIBO. Perhaps that is something that Dr. Erin has seen in practice.
Dr. Erin’s two favorite herbs are ashwagandha and rhodiola. She mentioned some nutrients: magnesium, B5, and B6. I love ashwagandha. I also like rhodiola a lot.
I have mentioned ashwagandha may be controversial. If someone is following AIP, it is part of the nightshade family. One can argue that a small amount of ashwagandha might not be a big deal. If someone has hyperthyroidism, ashwagandha can sometimes cause mild hyperthyroidism by stimulating the HPT axis, hypothalamic pituitary thyroid axis. I would say be cautious about ashwagandha.
Dr. Erin doesn’t deal with a lot of hyperthyroid patients like I do. For those who are not dealing with hyperthyroidism, ashwagandha is a great herb.
I’ll also add that it’s not as if people with hyperthyroidism can’t take ashwagandha. Everybody is different. I would be very cautious about taking a separate ashwagandha supplement. It’s not like ashwagandha can exacerbate the autoimmune component of Graves’. It won’t worsen your condition. It will mildly stimulate the thyroid. The good news is if you stop taking ashwagandha, typically the mild hyperthyroidism will stop.
Sometimes, I recommend it in a formulation, which has smaller amounts. Most of the time, there is not a problem. Of course, everybody is different. Sometimes, there will be.
I am not afraid of ashwagandha. I just like to give that warning because some people take it, feel hyper, and stop taking it. Just keep in mind it’s not worsening one’s condition.
I think that’s it. Another great conversation. Really wish Dr. Erin good luck with her book. I’m sure it will be great. The Cortisol Cure. Definitely check it out. Also got my advance copy of that book. Hope you got your advance copy as well.
Thanks again for tuning in. Look forward to catching you in the next episode.
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