 Hey everybody. Thanks for joining us again for Facebook Live and Dr. Jill Live with Dr. Joel Rosen today. A lot of times I've had guests that I know really well. Joel and I know of each other, but we're going to get to know each other even better today and I'm really excited about that. Just a little housekeeping. If you want more videos, you can find them on Facebook here or you can on my Facebook page which is Flat Air and Functional Medicine. If you're on YouTube, you can find all of the and subscribe to the channel there under Jill Carnahan and we've got lots of great interviews and this will just be another one of them. So Dr. Joel, I want to introduce him first and then we'll dive into a story of how you got into what you're doing. He's the founder of The Truth About Adrenal Fatigue.com and an expert in repairing the broken stress response system in the body, resetting the circuiting the rhythms of the body. He's a chiropractic physician, a certified functional medicine practitioner and utilizes his undergraduate degree in exercise physiology and in psychology. What a great combo. We need that nowadays, don't we? His private practice is located in Boca Raton, Florida, but his coaching clients reside all over the world. Joel hosts his podcast, Your Adrenal Fix, and passionate about impacting the practice of healthcare versus sickness care and has made it his personal mission to educate doctors and patients alike on the truth about adrenal fatigue and how the impact of stressors impact more than the adrenals right to the cellular level. Joe suffered with his own adrenal fatigue health crisis and now educates tens of thousands of clients around the world. So and we'll have to talk a little bit about the adrenals, which I'm sure you have talked about on many of your podcasts as well. Welcome Joel. Thanks so much for joining me today. Yes, thanks for having me. Really excited to get to know you in front of everyone and be able to bounce ideas and somewhat nerd out on the information so that we can ultimately help people get over whatever health and challenges they're dealing with. Yeah, I love that and I clearly hear in your bio, you have a story. Do you want to tell everybody a little bit more about how you got into? I'd love to hear the pre, I'm assuming that maybe the adrenal stuff came into after your degree, but tell me your story about how things transpired for you. Sure, sure. So I'm from a traditional approach family. My sister's a family practice doctor. My mom's a public health nurse. My cousins are surgeons and I was always sort of the black sheep member of the family and I was into athletics and so my my undergraduate degree was exercise physiology and when I graduated Jill, I hurt my back and everyone wanted me to go for surgery and I had graduated in a rehab program. So that's where I had been introduced to a chiropractor and and I was like an epiphany. I was like, okay, this is what I want to finally do with my life. However, when I went to undergraduate college or in in Canada, my first two years, I really didn't exert myself with my GPA. So I actually had to go back to school to get my GPA up. That's when I got a second degree in psychology and I load that degree because I had to go back to school. I just wanted to go to graduate school. I thought what a waste of time to do psychology only to know so many years later. It's it's that ace in the hole that makes the huge difference with people that are suffering with problems is that psychological component. So I ended up going through chiropractic college and was probably on a permanent IV with caffeine to be able to get through the long hours, the study, the stress of the exams, the lack of sleep, and really the brain fog focus, concentration. When I graduated Jill, my wife was pregnant with twins. We had to go on bed rest at 1920 weeks because of of incompetent cervix. And we were going to almost lose the the twins. And at that point, it was just every single day. My mantra was happy, healthy babies, happy, healthy babies, happy, healthy babies. And we made it to 36 weeks. Our OB kept saying I had a pager and I thought it was going to be the Rosans, you know, that they just went into labor. So when I graduated and I moved to Florida, I was exhausted and burnt out. I have this this profession, and I re injured my back. And I had a patient of mine who was an acupuncturist bring in a book called Why do I have thyroid symptoms when my blood tests are normal? And I don't have a thyroid problem. So I looked at the book and inside the book, there was a section on adrenal fatigue. And if there wasn't a picture of me in that section, it described me to a T. And I thought, how do I not know about this? I graduated in in chiropractic, I have a psychology degree, I have an exercise physiology degree. So that really led me to if I don't know about this, how many other people do not know about this? And not only to learn how controversial the term is, that it's not accepted, it's not researched. And a lot of the baby gets thrown out with the bathwater when when someone is suffering with exhaustion and fatigue, but they don't fit the medical diagnosis of what it is. So that's been my journey, Jill. And ever since then, I've incorporated so many other things along which we can talk about today with the genomics and the environment and all of these epigenetic factors that create a perfect storm in your body. And even though objectively the blood tests may not capture exactly what's going on in the set algorithm, it will still it will still result in fatigue and exhaustion and burnout. And that's in an epidemic proportions nowadays. Gosh, thank you so much for sharing your story because a lot of us in medicine have been through your exact same journey where we go and go and go and go. And I love that you also said this is controversial because you and I know whatever we call it adrenal fatigue, absolutely 100% exists. We treat it every day. I completely agree with you. But I'll tell you as an allopathic medical doctor, I'm working this world where there's it's back in the old days, like it's very similar to leaky gut. So years and years ago, leaky gut was this term that wasn't science based. And so if you talk to a gastroenterologist or anyone like that, they're like, Oh, that doesn't exist. There's no science. If you talk about it as hyperpermeability syndrome, or some of these LPS induced endotoxemia, they know it. There's research, same thing, different names. And if anything, it's just said in a way that's more palatable to the average person to understand, Oh, my adrenals are tired. That makes sense, right? But I love that you're saying this because I know that probably someone listening say an adrenal fatigue doesn't exist. And I want to clarify, because I am on board with you 100%. I with patients and myself have experienced those fluctuations. I've shifted a little to HPA axis dysfunction, because at least at this point in the journals and stuff, it's easier to get people to understand the listening on the same page. It's almost like, again, how we how we name things really does matter. So, but the truth is, I've used that term I've written about it. I know you've written extensively about it and had a whole platform in your website on it, and it's real, and it exists. And in medicine, all that we're taught is Cushing's and Addison. So the two extremes where you have excess cortisol with Cushing's, or you have no production at all. And again, you know this probably well more than I do even, but the types of testing they do with like an ACTH stim test, they give 100 to 1000 times the physiological dose to stimulate your pituitary hormone to induce adrenal secretion of cortisol. And so almost anyone I always say, unless you're, it's enough to wake a dead horse. So I always say that because unless you are completely, you know, there's no function left at all like in Addison's, it will most likely come back negative and you still have dysfunction. So while we're on this topic, tell me Morgan, you're the expert in this area, you had this personal experience and now you teach a lot of people and help a lot of people with it. What's your comments on that nuances and then on the ways that they're testing currently for Addison's and the difference? Yeah, no, you said you had a lot of great things to say in there. There's many shades of gray. And I think most research shows that the dysfunction 80 to 90% occurs outside of the adrenal glands. And so you have the psycho, neuro, immuno, endocrinological, gastrointestinal, they're all crosstalk. And ultimately, I don't even think HPA axis is a suffice term because it's really a mitochondrial based fatigue. And I break it down into simplicity, Jill. I tell people just think of it in terms of cell danger we like to talk about and healing cycle. And for those that aren't aware of that, simply put it's supply and demand. At the 30,000 view foot, if you have more expenses than income, you are going to have to make some tough choices. You're not going to go buy new pairs of shoes. You're hopefully just keeping the power on. And you are maybe having one or two creature comforts. If that same thing in your body, your body prioritizes what's most important. And I think when you look at POTS syndrome, where you have autonomic dysfunction with heart rate, temperature, blood pressure, respiratory rate, and those are failing. Those are not doing well in the in the little bit of stressors that we impart on the body. That's a pretty good sign that supply and demand are not equal. And ultimately, your body is prioritizing the functions that it can do in order to meet the stressors on a day to day basis. And then we tend to mask the symptoms with stimulants and sugary foods and lack of vitamins and minerals. So it creates a very slippery slope. And I would say you're right. The ACTH stim test is a poor test to see those shades of gray because at the end of the day, 80 to 90% of the adrenal dysfunction occurs outside of the adrenal. So they're not on the beach chilling out with the soda because they're so exhausted and they can't output any cortisol. There's feedback loop issues. There's mast cell activation. There's overproduction of histamine. There's genetic susceptibilities. There's the analogy of multiple windows. It's like someone on a computer that has 25 different windows open and they don't have a lot of depth. They just they're very wide in their tasks and they're have an incomplete repetitive healing cycle that doesn't get fixed and your body makes priority. So I think that's how we have to start to look at it. And it's not a mitochondrial based disease that most allopathic doctors look at as very problematic. It's subclinical mitochondrial problems where you're just your demand and supply are not equal. And you start to prioritize important points of the body at the expense of other physiological reactions in the body. And it results in fatigue, brain fog, focus, concentration, crashing in the middle of the day, not handling stress appropriately. Your circadian rhythm is disrupted. It's everything. Everything is involved in the body. Yeah, I love that big view because that's really what we're dealing with with most of our patients is some level. And I love the clarify because years ago, adrenal fatigue is the term we use it. It describes what we're describing, but it's way bigger than that, isn't it? It's like this thing that can affect in so many different levels. It does often, though, affect cortisol and ACTH in the direct physiology with this HPA axis. And even personally, I remember before COVID, I was traveling every other weekend. And when that stopped and shut down, I really had this relief. But then in a whole different way, the clinic got busier. And I remember earlier this summer where for the first time in my life, I wasn't waking up without an alarm. Like I would have just a little bit more trouble getting up in the morning. And I'd be up like wired and so productive at 11pm. And that was not me, my most of my life. Normally I'd be in bed by 9.30 or 10 up by five without an alarm. And so this shift happened. And I remember just observing curiously. It wasn't in crisis. There was nothing awful happening. But being observational and curious about myself saying, what's going on here? This is not my typical. And the fatigue was a part of it in the morning, at least it was a little bit harder to get going. And again, even for me, it wasn't too bad because I still pop out of bed pretty easy. But I could tell I was on the verge of something that was shifting in the physiology. And it had to do with the adrenals. Now, here's the interesting thing. You might think a hormone dysregulation or stress or infection or something. What happened with me was there was some dynamics in my office and then shifts in relationships. When I got through those emotional psychological stressors, I started waking up no problem again. And it was not funny to me because we know this is real. But for me, it wasn't so much the physical travel, which I wasn't doing at all. It was actually these relational, emotional, you know, stressors that we have that were affecting me more than anything else. So anyone who's listening there, I'm sure you can relate because we sometimes think of like the workload or the lack of sleep or the poor diet. I was doing all those things right. And again, right now, timing more important than ever, there's a 600 times increase in prescriptions for antidepressants. And there is, instead of the average adult population, saying that there's about 20% that are depressed at any one time, the numbers now are around 40%. So this is what's happening in our society is massively affecting our psychology, our physiology, our mood. What are you seeing in practice with the pandemic and people struggling and the adrenals and the fatigue? Does that reflect your experience? Yeah, absolutely. I mean, it's part it's hardwired. It's hardwired into our brain, our limbic system and the amygdala and the prefrontal cortex and everything that puts care, puts meaning on stress. And and that can create a reflex reflex of HPA axis stimulation. So the brain will then signal the adrenals. When there wasn't a commensurate stress, like people will say to me, you know what, I'm aware that my response is inappropriate, I shouldn't have gotten that physiological reaction. And that was one of the things I was always aware of. Like, like I was a criminal, if I was driving a car, and there was a police car behind me, my heart rate would go crazy. My blood pressure, I'd get shortness of breath. And that's inappropriate. That's not an appropriate response. And and that's tied into emotion. And that's where that psychology came degree came in. And and even if we go back to the original godfather of stress theory with Walter Cannon and and and Han Selie, they talk about the the the response of the body doesn't know the difference between a real threat and a perceived stress. And that's what's really great is that you can harness that. And I'm sure that's what got you back into getting up at the right time and and and not having those surges towards the right at later times of the day, because you did address those elephants in the room. And sometimes we want the shiny object of I'm doing all this research, and I really want to know my doctor's not telling me. But it's always like, okay, what's the elephant in the room? How's your relationships? How's your job? How's your finances? And how's your perception of those things? Because those can really be harnessed for your favor. And if you put a different spin on it, or or you have some celebrate celebration and gratitude, so that you realize, okay, this isn't fair. Or, you know, I do have this. But how am I going to harness how I allow the mobilization of the stress response in my body to help me or to hinder me? Yeah. And you know, we're just thinking back to my own experience, I eat really, really clean. I'm pretty strict in my diet. I keep good hours for sleep. So even if I was going to bed later, I'd get good hours of sleep. I actually track it with my or a ring. Most of us now have some device. And so I'm probably getting, you know, two and a half, three hours of deep sleep in an hour and a half of REM. So really good sleep. All that to say those kinds of basics, that's where we start with patients, you know, getting good sleep, good relationships connection, which right now is impaired because of our isolation and the pandemic itself. And then food. So I always say clean water, clean food, clean air, some of the basics. Now for me, I had a lot going, but was what was more important is energetically, and you mentioned mitochondria, some of the things that I found that really took me out of that. Number one, just practicing the quiet meditation and prayer in the morning, making sure that I was centered before I went into my day, no matter what chaos came, I was in a good spot. Number two, making sure relationships were in good, healthy order and condition and actually getting rid of the negativity in the inner circle. So making sure that the people that were the closest to me were those that were positive and encouraging, they don't be perfect. But just that the really, really downer negative toxic kinds of people, it was really hard on me to have those close in the inner circle. And then some of the other things like PEMF and red light therapy and all these things that actually addressed mitochondrial directly, I started using my PEMF mat and using red light therapy. And it really, those things really made a difference. What have you seen made the most difference for you or your patients? Oh, that's a great question. A lot of what you're talking about is just reframing, understanding stress, getting baselines, understanding what are those big elephants in the room for one, and then coming up with a strategy to chip away at the old block, so to speak. As far as specific, what works the best, I'd say establishing a circadian rhythm consciousness. And the best example is if you go if you go for a not necessarily a hike, but if you go camping, and you you get really acclimated to the earth pretty quickly, in terms of if not glamping, we're camping, right? So you have the stars and the moonlight and maybe a campfire. But you don't have your cell phone. I say you don't have a plugged in refrigerator. You don't have your TV. You go to bed fairly early, you know, when it gets dark out. And then you don't lay around in your hot tent the next morning, because the sun's up. And I think we've lost communication with that woo-woo frequency vibration of the earth. And I think we need to establish that. And that's where proper nutrition, proper hydration, proper oxygen is the frequency that's contained in that to be able to help ourselves resonate in a more holistic way. So those are the most common things I would tell people. And then as far as the oar ring, I love the oar ring. They have three buckets. They have the sleep bucket, the activity bucket, and the readiness bucket. And the activity, so movement. I mean, I mean, we do need to move. We're sitting down a lot of the day. And it's a catch 22 for a lot of people, because if I'm exhausted, how am I supposed to move? The paradox is you're exhausted because you're not moving. And I think that the more we can get them moving or at least have a baseline of a little bit and then a little bit more and a little bit more, those are really, really key. And then of course, just as much as you possibly can proper nutrition, it is tough on the go, society to be able to get sit down meals that are nourishing, that are complete with great vitamins and minerals. But they make huge differences. And cheap is expensive in those ways. I know a lot of people are stressed with finances and changes with their income. But I've always loved this saying is instead of wondering why that expensive food is so expensive, try to think about why is that cheap food so cheap? You know, I think that's a great saying. So those are just key things that people can do is getting their circadian rhythm established, going to bed at the same time every night, waking up at the same time every day, having good quality movements, good quality mental thought processes, good quality nutrition, and then go from there. If you're not addressing those things first, then don't pass go, you know, start on those things first. Great, great advice. And tell me more about with, so we're going to shift just a little bit. We've got obviously the pandemic going on immune system. What are some of your favorite things for supporting immune system? I do think it correlates because stress and immune system are connected. Do you want to talk just a little bit about thoughts on that immune system stress and tips for the immune system? Yeah, you know, and you did not prompt me to say this because you didn't. But I do love Dr. Jill's mold kit. I really do. And I think it's unfortunate that it's called a mold kit because it should be just the immune kit. Because I really do feel like what's in there is baseline for someone who's overwhelmed. And I know you've talked with Dr. Miller about the whole histamine and the mast cells and the NOx enzyme. But what ultimately happens is if I had money and stock where a NAD was a stock, I would put it in NAD, because ultimately it is so depleted. And I think that it's a necessary ingredient for those that are overwhelmed. Maybe they have a cytokine consideration going on, or they're stealing away that NAD that could be used for antioxidant production or detoxification things. So those things are key. Jill, I think that the minerals that you get in there for people that are very sensitive, you've seen these people all the time that no matter what you do, if you throw fairy dust on them, they're not doing well with that. Right. Minerals are really good. The isotonic minerals that basically match your osmolality in terms of nutrients. That's key too. And then it also has some really good bees in the liver stuff that it has and the glutathione. And again, that's not to, you know, we didn't talk about that before we got on here. I just think that it shouldn't be called the mold kit. I think it could be called, you know, whatever fill in the blank kit. So I like those things for sure. And potentially the other things that I like are things that can just help with mitochondrial health. So we'd be thinking of an NAD is such a thing. CoQ10. I do find that in a lot of ways, the dosing like 100 milligrams recommended is too low. And if we're looking at repleting some of that mitochondrial health, 400 to 800 with their doctor's advice, making sure there's no contraindications for that. Sometimes we're doing the right things, just not enough of the right things. And then other things for mitochondrial health can be deribos if someone's really fatiguing. So I look at it in terms of that mitochondrial health, reducing inflammation, getting your basic minerals. And then from there, that's where you can't really play around anymore and say, okay, let's customize exactly what you have going on here and prioritize what you have going on here. So now we are not just throwing stuff at the wall and see what sticks, but we're actually making a customizable recovery plan for what's not working in your health. Oh, what a great overview. And that's very kind of you to mention the moldy text box. You're right, that core stuff, just glutathione, liver support, the minerals, and then NAD. I can't get enough of NAD. We'll talk just a minute about that because NAD replets NADPH, which is a key currency to make your cellular ATP. So that's like the money that we run on. And it's depleted by toxins. It's depleted by stress. It's depleted by Lyme disease or co-infections. It's depleted by other infections. It's depleted by mold. So all of these things that come at us and insult us, even viruses, will deplete our NAD. So many people are walking around deficient. And it's a fine line because you need methylated donors like methyl B12, methyl folate, riboflavin, P5P or B6 in order to use the NAD appropriately. So usually it works best if you're taking some methylated B vitamins with it. So that tends to make a really good combination as well. But it's funny because now they have IV NAD, subcutaneous NAD, liposomal NAD, oral NAD, and they're all great sources, but they're really popular because they work. Ironically, hot off the breast, I just came out last week, Joel, with an NAD face cream. So this is going to be so hot because it's for women and skin men too. But it's amazing for, as you can imagine, the cellular regeneration or whatever. So we'll see how that goes. But I'm a huge fan of NAD. I mean, that was kind of you to mention. So thank you. I know we didn't talk about it. But I love that. Kokita, I love that you talk about dose because you're right, the classical 100 milligrams isn't enough for many people. And then things like arlypoic acid and acetylcystine, even like D ribose, which is a sugar that can be for the mitochondria, acetylcarnitine. And then shift just a little bit. And let's talk about adrenal specific. There's a ton of nutrients, adaptogens and otherwise. And my perspective is this. And I love your comment. I always want to know their cortisol curve. So instead of doing like a serum cortisol at 9 a.m., what I'll typically do is urinary or salivary cortisol levels throughout the day. Because then we can see if they're low in the morning, then high at night, they have an inverted curve. Or if they are low across the whole flat lines, that's a whole other issue. But depending on their cortisol curve, we'll choose different nutrients. What's your thoughts on that and comments on testing? Sure. So I mean, the best test is historical, right? And what we talked about in terms of being the old doctor that came with their little doctor's bag and made the home visit and actually talked to the patient to get an idea on what's going on. Because that's going to give you two thirds or more of your diagnosis or impression. I do like the salivary cortisol because studies show that they really relate better to the actual circadian rhythm. And now they have the awakening response, as you know, so you can see within 30, 60 minutes after they wake up, they should have a doubling. And a lot of research shows that if they're not getting that nice jolt of cortisol awakening, there's more relationship to chronic health issues. But I'll tell you what, I really like the Dutch test for the different urinary metabolites because of this. I'll give you an example. So it has metabolized cortisol and free cortisol. And you could look at the ratios of those together, but I really like to look at the metabolized cortisol because that can give me an idea of how long is this person running the race at the pace that they're able to run that. If it's really high, and they're in their 30s, 40s, 50s, 60s, today I had a 61-year-old that was really high. And she says, I was surprised to see my cortisol levels being so good. And I said, well, wait a minute, it's actually too good. It's producing way too much cortisol. To me, that's a stressful event. That's your HPA axis continuing to signal to produce. And while it may not be hitting the ground, it still is running that race, burning through the reserves, your B vitamins and mitochondrial health. So I'd look at that one first, Jill. And then on a couple pages after, now I want to look at the 11 beta HSD, which is more the cellular level. So you have the brain level at the HPA axis, the metabolized cortisol, and you could look at the free cortisol. We won't get into really talking about those two relationships. I'm just talking about the brain level, the HPA axis level, the metabolized cortisol level, and then making a decision based on the cellular level, the 11 beta HSD. So the way I explain that to the clients is that is the field general. That isn't really at central command. Central command doesn't really have their ear on the battlefield. They just know that there's a war and you need to output and your brain's really outputting. But the cell, the field general, the 11 beta HSD decides, okay, come on in, make those troops deployed, put them into the battle, or keep them in the tents, or keep them in active reserves. And if we see the cortisol level favoring, and it's going in that right direction, then I know at the cellular level, it's like slow down brain. We have too much cortisol, too much catabolic activity, too much breakdown going on here. Or if the 11 beta HSD is favoring cortisol, and that metabolized cortisol is really high, the body is still under so much stress. So it's really important, I think, and that's a more, hey, I've done a lot of testing to kind of get that nuance in there. But I think that's a really key strategy for practitioners to look at those two ratios, and then make decisions about that based on the history. So if someone is not sleeping, and they have that 11 beta HSD shifted towards cortisol and squeezing that sponge and getting whatever juice you can out of that cortisol, then I want to down regulate that. So things like Pinocchio, Zisfus, Magnolia, those can be really good at deactivating that cortisol. Or if the 11 beta HSD is low, and it's favoring cortisol, and the metabolize is not super high, the brain is slowing down, and you need some field generals putting some troops into the battlefields. That licorice root can be very helpful. It extends that half-life of cortisol provided they don't have high blood pressure. So you can make better decisions on that. When you start getting into the pregnenolones, the DHEAs, that will depend on what your other metabolites look like in terms of estrogens. But as far as just throwing adaptogens, the truth about adrenal fatigue in that aspect is, I'm not a fan of that, because it's just so random. It's like, hey, if you don't have a lot of things going on, it could be helpful. So you could pulse that and think, okay, I'm not so bad. I'm going to try some holy basil, some rhodiola. I'm going to try some other adaptogenic herbs. And if it gives me a little bit of balance, and I feel less stressed when I'm more stressed, or I feel a little more up when I'm low, great. But usually, as you see in today's day and age, it's more complicated than that. Yeah. I love that you're talking about Dutch. It's another one of my favorites. And if you don't mind, I'm going to share without any personal data of a patient. Can you guys see my screen here? Because I wanted to show those listening. I do Dutch all the time too. It's my favorite test for this. So those of you listening out here, if you have a doctor who's open-minded, this is by far our favorite test to look at this. This is just the simplest page I thought we could show. And I have two examples I can show you. One that's fairly low. This one, and again, you can comment. I'll just kind of summarize and then let you take over. But this one has pretty low levels of both cortisol and cortisone. Cortisol is still more dominant. So this person probably still feels okay. They're not running through it quite as much, but they're pretty flat line. Would you say any comments seeing this one right here? Yeah. I mean, so their cellular level is saying, okay, get into the battlefield. It's squeezing the sponge as much as it possibly can to be able to put that cortisol level up. Licorice root may not necessarily be helpful because that 11 beta HSD is already giving them that extra deployment. But we could see a little bit higher up. The metabolized cortisol is very low. So this person is in that fatigue that's been going on for quite some time. I'd maybe want to look at some of the other hormones, but the DHEA being high. I had this talk with the client this morning is that DHEA cortisol relationship dances around and there's genetic realities that make it different from everyone to everyone. So you can't just come up with conclusions of, okay, here's the basic conclusion of how they dance around. But what I would be saying is unless they're not taking DHEA, because I'd want to maybe know that, their HPA axis, their signals from the pituitary is still hitting the adrenals. And the adrenals are thereby producing a hormone that will help to balance that cortisol catabolic nature of that stress response by releasing DHEA. If this helps, this was a woman in her fifties on a 10 milligram of DHEA, I believe that's the story here. So probably peri- Postmenopausal and maybe just a little bit of DHEA, but yeah, that makes perfect sense to me too. Yeah, I would be thinking they're taking some perhaps, you know, right. So fun. See if I have any, oh, you know what, I have one more here that's a really high one just to show people because this is so fun. I'm like you, I probably have hundreds of these that I could pull up and share. So this one here, now you can see this is, DHEA is a little bit more normal. This is a different patient, but you can see really high levels. What's comments on this one here? Stress response probably about to burn out in a year or two. Yeah, like what's, what's, what's sitting on the pituitary, right? That's what I'd be thinking about. Like what's, what's this, I mean, the psychological stress that we talked about earlier. Just what is their mold, is their lime, is their- Bingo doll, you know I deal with mold issues. Yeah, mold, right. So it's, I want to talk about that because that's so important. People don't realize, I remember years ago when I first started functional medicine, did a ton of thyroid adrenal, I'd see these high cortisol. Now I look for toxin infection first, right? Would you agree? Because we think of, yeah, psychological stressors and there certainly was with the mold situation, but I didn't mean to interrupt you, but I got excited because this one is really mold. Yeah, well, another good thing that I think that we as practitioners need to be aware of is the body is super intelligent and a lot of the times, if not all of the time, it's doing what it needs to do with dealing with that stress response. So I wouldn't necessarily say, okay, like your 11 beta HSD is favoring more cortisone, which is deactivating it. That's what it should be doing. But we could make recommend, here's what drives me crazy. We'll make recommendations a lot in the profession of, okay, let's just take fossil title searing, because it's the default reflex of you've got high cortisol. So if you have high cortisol, you take fossil title searing. And if you got low cortisol, you take a glandular or you take licorice, it just doesn't work that way. So I would be saying in this case, there's mold, there's the NAD steel, there's all of the other things that deplete your minerals. And we're not even really, it's like, here's the analogy I use, Jill is we're the karate, Mr. Miyagi. And it's like, well, why are we not like learning how to go fight yet? And like, we're waxing on, we're waxing off. And we're not really doing anything that we think is preparing us for the battle. But we are by addressing the core competencies, the foundational stuff, the things that are, I say it like, you're paying your expenses. If I'm a business consultant, and you have an income problem, pay your expenses first before we bring on any more sales. Once you control those expenses, you'll have a little more disposable income to be able to use for other things. So that would be the analogy I would use for that. Gosh, thank you for, I've done this for years and years. And I feel like I know it really well, but I love your insights and love the simplicity at which you just went through those two scenarios. And I'm sure even for listeners who aren't into deep biochemistry, that was super helpful. So just give us a summary. If you're favoring the cortisol, you're pushing, you're still doing pretty well physically, you're feeling okay, but you're going to probably head towards burnout if you're not careful. Is that correct? That's correct. Yeah, that's correct. But you also want to come back to that first page and see where on the side of metabolized cortisol are you to put it into reference? Is the body doing the right thing? But if it's in 11 beta HSD, which is favoring cortisol, your body is really using that cortisol, spending the cortisol. Whereas if the 11 beta HSD is more towards the cortisol, it is deactivating, it's not wanting to spend it. And there's a reason for that. So that's how I look for it. Does that make sense? Perfect. Well, I'm wondering, because I see a ton of women, I'm sure you do too. I see men as well, but the women in their 50s or 40s over permenopausal and in the stress response, probably the number one thing is, gosh, I can't lose weight, right? And this is definitely related to that because if you don't have any expendable epinephrine or epinephrine, those are in the tank and your cortisol in the tank, talk just a little bit about how this relates to women or men, but let's talk about women for a moment and difficult weight loss because I see that as part of the puzzle, right? Oh, for sure. You know, and I was just thinking, it's amazing when we talk about it like this, but yet you're negative on your ACTH test so you don't have any type of adrenal problems. Exactly. Exactly. They're perfect. Or their morning cortisol in the serum is like seven or eight. It's okay. It's normal. I consider that kind of low, but it's not like three. You just don't get that quantitative information. But so what I look at first and foremost with weight loss resistance is blood sugar stability, right? Blood sugar stability. And again, I don't tell the women, I think you're in front of the fridge eating cupcakes and I know you're not doing that. But if cortisol, which we just look through for the mold people is through the roof, then you know that's going to dump a lot of glucose into the bloodstream and then that is going to surge your insulin and then that's going to create more storage like things. So that's one of those things that being aware of stability of blood sugar. And I do, it makes it uncomfortable for people, but I really do like the glucose ketone testing just to be able to know like the difference between physiological hunger and psychological craving. Like so many people, I'm sure tell you this, Jill. Oh my goodness, I'm hypoglycemic. And like, well, how do you know that? And then, well, I did a blood test that I was fasting for 12 hours for and my glucose was 80. And even in that range, it's not hypoglycemic, but we're talking real time. Like test your glucose at the level at the time you feel shaky, lightheaded and jittery, I would put money on it. If you're in your 30s, 40s or 50s, it's going to be on the slightly high side. And why is that? Well, because you're not getting the glucose into the blood, into the cellular, you know, uptaking of into the cell. And then to your point, you can release more adrenergic or more sympathetic or more adrenaline like things that are only going to create more overwhelm and over. So I think really getting a good relationship with your blood sugar, and then that comes down to the circadian rhythm. So you have certain time where you can have your meals, where you're getting exposure to light, where you're getting no more exposure to light. And those will have synergistic impacts on how stable your blood sugar is for women that have weight on men to that get get a good relationship with your blood sugar and test is to know and really be able to see how that's changing before you say, Oh, I can't lose weight. Because I think if you don't have those answers, Jill, then you're you're you can't say you've done everything to lose weight, but it's not working. Oh, good. What a great point because a cortisol lecture go hand in hand. One of the things I see frequently is this nighttime awakening with adrenal issues, right? Usually 2am. Not always, but that's a common adrenal time. If we look at traditional Chinese medicine, they know the adrenals right around 2am. And what happens for many people is they, you know, either dinner at 7pm, they go to bed at 10, and they're fasting overnight. And when your adrenals are strong and robust, those the the stuff that's created the mineral corticoids and the cortisol and all the will help to regulate blood sugar, it actually creates the release of glucose from the liver when you're fasting appropriately. So hypothetically, if the adrenals are dysfunctional and they're not optimizing what they're producing, you go to bed you fast around 2am, your blood sugar drops. You don't know what your sound asleep. But our body's compensatory mechanism for that low blood sugar is a raising cortisol. That raising cortisol will then wake you up your wide awake can't get back to sleep. And you wonder why. And for those patients, if we test and find out that's the issue, often a small like fat protein snack before bed to bedtime, sometimes even a little bit of wild honey will actually keep them sleeping because the blood sugar will be stable. And then we work on the adrenals to regulate so that they don't have that low blood sugar. I'm sure you've seen that as well. But it's interesting. And then what they'll do is because that cortisol is spiked if they if they measure blood sugar when they wake up, it'll be high. It'll be in the 90s or 100s, right? Yeah, yeah, they'll have a dom phenomena where there's their cortisol in a person jumps out of bed. Ideally, they're ready to go take on the world. They have that cortisol awakening response where it doubles. It's already starting to come up when the dawn hits. That's going to pump a little bit more glucose into the bloodstream. So don't get discouraged if you see it in the not I have that 96 97. I think the key takeaway is the glucose ketone index, where we like to see that less than 10. So that gives people that maybe on that frustrated level of 95 99, when they start to measure their ketones, and they divide the two into each other, and they're less than 10. Now they don't have to stress so much about, oh, I just can't get my glucose down. And it's because there's certain microbiome, there's so much complication. There's microbiome stuff. There's a lot of players, right? Yeah, right, exactly. Well, on the ketones, let's talk, I love your opinion a little bit on this one. So say you have someone who is in stress response, say a woman in her 50s, stress response, can't lose weight on the higher end of cortisol, and she's having trouble losing weight. And you mentioned this is a glucose ketone ratio. Or did I have that backwards? Yes, correct. Okay, glucose. That's right. And I'm assuming that means that you're recommending some sort of fasting or intermittent fasting. What would you tell that woman to do as far as maybe intermittent fasting or anything to help? And is there a time when intermittent fasting would not be good if your cortisol is too low? It's a lot of, there's those are great questions. So I think the best thing would be a 12 hour fast. And I think that's doable by everyone. Yes, agree. Like, you know, 6pm to 6am, 7pm to 7am. I do think the more you shift it to the left, so your last meal is 6.36, you will start to wake up a little bit earlier, or sorry, wake up with your glucose being a little bit lower. Some people, that's the difference. So as far as glucose ketone index goes, glucose is in millimoles per deciliter. So if you divide that by 18, now you're converting that to moles. And then if you divide, then you measure your ketones, it's in moles. So typically, they say therapeutic ketosis is not meaning like, okay, I'm full on keto. It just means you're metabolically flexible. Your body's producing ketones, because maybe you're not exceeding your carb threshold, your protein threshold, you aren't in a state of cortisol stress fight or flight, you have more activity levels, you're burning off your glycogen, you have a lot of things that are going right in your body. So what you do is you measure those two together. And usually it will say 0.5 is the zone that you want to see a little bit of therapeutic ketosis. And then if you times that by 18, then you're going to get somewhere in the five, six or sevens where you're going to have some, that's going to be your millimoles of glucose. It's a little complicated what we're talking about, especially about doing the math. But to answer your question, the other things would be activity, movement. I mean, a lot of times we'll have a meal, and maybe we had a little bit too much, or in terms of absolute calories, or maybe we had a good, good nice starchy based food, the comfort food, especially this time of the year, that is going to cause a spike of your glucose levels, a spike of your insulin levels. And if we can do a little bit of movement so that we take away that extra difference of stored glycogen, it's just only going to help you. I mean, it's that important. Of course, I don't want people to be neurotic about calorie counting and knowing their carbs and being under 20 grams. I think that's that does a disservice. And then what I'll tell with a lot of women too that do intermittent fasting or diet variation, when they're still having their cycle, it's very important to re-bring in those carbs in those early phases of menses so that when they do have their period and they're depleted, that they can bring in a little bit more carbs to replete themselves and not really necessary think about, oh, I got to be like the textbook keto intermittent fasting, I can't have more than this, because we really are cyclical people. We have the different phases of the cycle where it's preparing and then it's sloughing off. And that's when you can pick your spots. So it takes a little more sophistication, but there's some good clinical tools in terms of movement, in terms of 12-hour fasting, in terms of being aware of good healthy carbs, proteins and fats, and then really figuring it out for yourself where you feel better with certain percentages. This is so helpful, and even though it's complex, I mean, my listeners love the science and the depth, and so thank you for bringing that, bringing your knowledge. And again, it's interesting because we had an idea of where this might go. We went a different direction, but I think this was really, really valuable information, and I really enjoyed. And like I said, I always learn things from my guests, and it's no different with you, Dr. Joel. So it's been a pleasure. I have a question before we go for you, and that's, you know, COVID's been crazy for all of us, family, kids, you know, all these different situations or clinics. What would be the one lessener thing that you've most so far taken away from the pandemic and the changes in our life? Has there been anything that's really impacted you? Yeah, I mean, there's been so many. How would I, that's a great question. So I think it's in terms of how important relationships are, because we are mandated to restrict and be isolated, and I do think that's important. I don't think we should be having mass gatherings, but we are really, as the theme underlines the whole talk today, Joel, we are, we are programmed to be, you know, ancestrally speaking, we have programmed environmental stimulus in our, or stimuli in our body, and connection and touch and socialization is really, really important. And so that a lot of people have the blues, they're depressed, they're overwhelmed, and a lot of it has to do with just not having that social interaction, and it's that much more important to do that. And it really also gives you an idea on prioritizing what's important in life. You know, having great relations, you talked about that when you were having challenges on your own, and it wasn't so much the metabolic thing, it was the psychological thing. And I think the more we realize how much we have control over our physiology through thought processes, especially healthy thought processes, and socialization, I want to always hold things in, and I always know that's not a good thing. So I think that's probably the best take home advice for me, at least, is the is the social socialization, the things that are important in life, and then the control of the response of your mind as to the reality of it, and putting sort of a different, a favorable, healthy spin on it. Yeah. Yeah. Gosh, I love that love ending there. You know, I just started, I love being grateful and gratitude, but I've just started really deliberately writing them down every day. So if you're listening, one little simple tip, you know, if you journal or have a notebook, write down what you're grateful for, because no matter how bad of a day you've had, there's always a few things you can be grateful for. And it really shifts, like you said, the mind and the way we view things. I find starting my day with that way is a wonderful way to just get that framework so that I'm looking for the good in that day that's coming up. Dr. Joel, it has been my absolute pleasure to have you. Thank you so much for your time today. I'll be sure and put links to your clinic, and we can both be sharing this. But thanks again for your time. I appreciate it. Thank you for having me. I enjoyed talking with you today.