 Hi everyone and welcome to today's presentation. We're going to be talking about understanding the impact of adrenal fatigue in the mental health and addiction recovery process. Now, adrenal fatigue has become something of sort of the new buzzword or the new ADHD or the new whatever you want to say. And it seems like there are a lot of people coming up with different suggestions for how to deal with it, how to treat it. And it's one of those that, depending on what website you go to, what resource you use, anything and everything can be caused, it seems, from adrenal fatigue. So I really want to hone it down and look at what we care about, why that might be happening, and then how it might apply to our clients as they're in early recovery and even later recovery. So we'll identify some of the common symptoms of adrenal fatigue. And once you understand what adrenal fatigue is, the symptoms will make a whole lot of sense. We're going to learn about the function of the HPA axis and cortisol. The HPA axis is basically our fight or flight axis. It's our get up and go or relax and go to bed sort of switch mechanism. Then we'll explore how excessive stress may cause adrenal fatigue. And this can be physical or psychological or both and identify interventions for adrenal fatigue. Adrenal fatigue can cause many symptoms that are commonly classified as depression and or anxiety. For example, panic episodes, fatigue, appetite changes. A lot of the things that we think of as depression, apathy, lack of enjoyment actually can be caused from adrenal fatigue. We've talked before about how the brain will actually adjust over a period of time. If it's exposed to consistent high levels of stress, it will actually turn down its responsiveness. And this is one of the things we can look at in terms of adrenal fatigue or as far as conceptualizing adrenal fatigue. So people may start feeling somewhat apathetic and things that used to make them stressed, make them happy, make them something excitatory doesn't do it anymore. They're just blah. Standard antidepressant treatment will likely be unsuccessful or less than optimally successful in addressing these symptoms in this situation. So if you have somebody who truly has a serotonin imbalance and they start taking SSRIs and they start feeling better in four to six weeks, then we know we're dealing with serotonin and we can maybe give them some information so they can prevent themselves from causing some symptoms. But we figured out that that's probably what was going on. But if somebody's taking antidepressants, especially if they've been on a couple of different antidepressants and they seem to be, quote, treatment resistant, which I hate that or phrase, we want to look at some other causes. What else may be going on with this person physically and psychologically that might be contributing or causing these symptoms? It's also important to remember that many people suffering from adrenal fatigue self-medicate with stimulants and may eventually seek relief through the escape that's provided from addiction. So what happens under prolonged stress? In the normal person, there's a stressor, something happens. The fight or flight response stimulates or excites the person. So let's take a very benign stressor, weightlifting. Maybe you decided you were going to compete in some bodybuilding competition. So you start working out six hours a day, seven days a week and not giving your body a break. That's a stressor. You know, we're not even talking about an emotional stressor here. We're talking about a physical one. But the body is having to put out energy. It's having to put out those excitatory neurochemicals to get the muscles to fire in order to lift the weights. In a normal situation, the person eliminates the stressor or the threat. They have a rest day or week and they have a recovery period. Another example would be, you know, tornado comes through the city. Heaven forbid, tornado comes through the city. Half the city's wiped out. That's a huge stressor. The fight or flight response kicks in and people are stressed out. They've got to find somewhere to live. They've got to help their neighbors. They've got to deal with what's happened. Once that has been dealt with, whether it's a week or a month, then people are exhausted and there's a recovery period. It takes people a while to kind of get back on their game and that's normal for, after a big stressor, it's normal for people to take a while to get back to where they feel like they're, you know, operating at 100%. They get tired easier. So they rest. Imagine that. I get in trouble all the time because I'm one of those people who has difficulty sitting still and my kids were laughing at me because my dog hurt his paw and he has not moved from the sofa for three days. And I mean, it's just a sprain. It's not like it's broken or anything, but he is resting and letting it get better through his recovery period and he's actually getting better. He was bearing weight this morning and my daughter's like, see, imagine what would happen if you actually took some recovery time. I'm like, you know, really, go eat your breakfast. So other examples that people encounter on a regular basis, final exams obviously, if you're in school, every semester at the end of the semester, I would cram for final exams because I was a horrible student and I would end up getting sick as soon as final exams was over. My body would just kind of shut down. My immune system was gone and I would get sick. And I knew a lot of people like this because the body was under so much stress during that period, but then we had a recovery period. If you have a big project at work, you know, maybe you have a grant coming up and you are just burning it at both ends to try to get this out. For the next few weeks afterwards, you kind of coast. It's not like you're going to jump back in and go, okay, that one's out the door. Let's take on this next grant or let's do something else that's huge and time consuming and energy draining. Most people pace themselves and that's the way to prevent one of the ways that we're going to talk about for preventing adrenal fatigue. When there's a big stress or emotional or physical, you know, if you have a heart attack, you have surgery, that's a big stress on your body, you need to give yourself time to rest and recoup. In an abnormal situation, there's a stressor or a threat. The fight-or-flight response happens and it stimulates or excites the person. The person can't totally eliminate the stressor or another stressor comes right along. So there's continued stimulation. Adjustment to the high stress, the body turns down the response and says, okay, you know, we can't get upset about all the little things anymore. We're only going to get upset when there's something really, really stinking big that comes along. So the person starts feeling apathy and depression, things that we would think of in terms of a mood disorder, when it actually may be more physiological. Law enforcement officers are very prone to this because especially if they work in a zone where there is a lot of activity and it's constant, they can have a call, they can get off the call, they can have five minutes maybe to go get something to drink and then they may be on another call. Those days are exhausting. Now for most cops, that is not every day, so they don't get completely run down. But in some situations, in some cities, that is pretty much every day. So they need on their time off, they need to be able to actually relax and not be working a second job and trying to juggle six other balls in the air. People who are type A will typically take on stressors, you know, they want to do everything, they're high strung, they want to do it right, they want to do it perfectly and they're going to say yes to a lot of things and as soon as they finish one project, they're taking something else on, they're not taking a breath, kind of like I'm doing right now and it's really exhausting just to listen to, let alone do. So other situations which we may encounter with our clients are clients who have negative self-talk. If they are regularly telling themselves how worthless they are and how everybody's going to leave them, that is a constant stressor. So they may eventually wear themselves down and excessive stimulant intake. If you have someone who has been abusing methamphetamine, cocaine, or even to an extent caffeine, and I shouldn't admit this, but I will, when I was in college, I would drink so much caffeine, especially during these final exam periods, that when I would drink caffeine, I would actually get tired. It just didn't even work anymore. It's not like it, I got desensitized to it and I could drink three Starbucks or something. I would drink it and I'd actually get sleepy. That's what we call a clue. So if your body is not responding the way you expect it to, in response to a stressor or a stimulant, kind of stand up and take a look at what's going on. I mentioned the HPA axis and we're not going to go into huge detail here because we've only got an hour, but HPA stands for hypothalamic pituitary adrenal axis, which controls the stress response. Your hypothalamus, thinking back to Psychobiology 101, it's the brain center that determines if there's a threat. It takes in the stimulus, compares it to what you already know and it goes, this is really bad mojo or this is something we can let go. Whatever it determines, it tells the pituitary gland. It says, don't worry about it, send out the relaxation sign or this is a problem, send out the all hands on deck. The pituitary gland flips the switch, if you will, if you're thinking of it sort of as a relay system. And the pituitary gland tells the adrenal glands there's a problem. We need to start sending out everything and send out the message that all hands on deck and we need to prepare to fight or flee. Disfunction anywhere in the system can cause the person to be too stimulated, stressed or anxious or not stimulated enough or what we typically call depressed. So again, I'm pointing out the fact and I'll use the word depressed a lot more in this than I probably use in my presentations on depression because we use that term so loosely that I want people to really look at what their symptoms are. What are your symptoms of depression and what's causing them? When people are under significant stress, adrenaline and cortisol levels remain high. So people with PTSD, people who are under a lot of stress for whatever reason they've got that big project at work coming up or whatever it is, they're not able to completely turn it off. So their adrenaline and cortisol levels remain high. This interrupts the natural 24-hour cycle of cortisone levels. So the person is basically permanently alert. I don't think any of us want to be permanently alert. I like sleep a lot. What happens is they may fall asleep but they also may wake up in a very anxious state or panic attack. In the middle, there's early stages of adrenal fatigue, mid stages and late stages. In the middle stages of adrenal fatigue when the adrenal glands are starting to really struggle is hypothesized that they may sort of sputter, if you will, and they're supposed to be sending out cortisol and they're not sending out as much. It's a trickle now but every once in a while there's a gush and that gush can be a panic attack and it can come at any time for no apparent reason, at least in the person's mind. They're just like, I woke up and I was in the middle of a panic attack. So restless sleep is a sign. Restless sleep can also contribute to adrenal fatigue because your body's not able to rest and repair. Difficulty maintaining blood sugar. In the late stage of adrenal fatigue, cortisol levels are too low. The thermostat is just completely turned down. The body has said I am not responding to anything except for a herd of elephants parading in here. It's trying to protect itself from burning out. It's like I can't take it anymore. I've had as much stress as I can possibly handle. The person at this point is probably just barely getting through the day and any stressor, anything that would normally be like a one on a scale of one to 10 will just send them into complete crisis. So the thermostat is turned down. Cortisol is responsible in part for maintaining blood sugar though. So people with adrenal fatigue may find that their blood sugar is all over the place. Now what do we know happens when blood sugar gets low for some people? They start to get shaky. They start to feel dizzy. Very similar to panic attack symptoms. So if someone's had a panic attack, they can worry that a panic attack is getting ready to happen and actually work themselves up with negative self-talk into a full-blown panic attack. So blood sugar all over the place. What have we talked about before with maintaining blood sugar, for panic, for depression, whatever? It's important. People need to eat throughout the day. And you'll find when we get down to interventions, most of these interventions are not surprising. And most of these interventions we've talked about before. So whether you want to label something as adrenal fatigue or label it as let's look at taking better care of yourself so your body can support your recovery, you know, that's going to be up to you in your style. Excessive fatigue, apathy, and depression. In the later stages of adrenal fatigue, your adrenals become unable to produce enough of the hormones that you need. And things that would normally get you excited and that can be happy excited, happy excited, scared, angry, or even affecting a libido. None of that's there. You're just you're Eeyore. You're just there trying to get along, trying not to just completely lose it. Eeyore never lost it. He was always pretty level. But you can see what I mean when we're talking about the later stages with fatigue. People with later stages of adrenal fatigue may do simple things like clean the house. And I'm not talking spring cleaning. I'm talking vacuuming. Or go grocery shopping and come home and just be exhausted. Whereas normally they could go and shop all day long. So it's a departure from what they would normally get exhausted doing. This could mean that your levels of cortisol, along with other neurotransmitters like adrenaline, are lower than they should be. That could be due to a variety of things. Again, it could be the adrenal gland is not functioning well because it's exhausted. It could be that nutrition was poor. So your body couldn't make the neurotransmitters. We don't really know what's going on. But we do know that people who are subjected to extensive stress or excessive stress, you know, so it's moderate stress over a long, long period of time, or a whole lot of stinking stress, just one or two times even, can just completely overwhelm the body. Emotionally, like I said, the person's barely holding it together. Any stressor becomes a crisis. And the person has apathy about or inability to handle even minor stressors due to low hormone levels associated with late stage adrenal fatigue. The adrenals can't keep up. And the demand for cortisol, adrenaline, and norepinephrine production needed to address the stress, it's not there. The hormones that regulate the stress response and allow us to increase our strength, focus, and awareness when we need it are deficient or absent. So people are feeling weak. That can be partly low blood sugar. That can be partly not getting enough sleep. And that can be partly not having the hormones and neurotransmitters necessary to make those muscles contract and feel strong and energetic. Focus is the same way. If you don't sleep enough, even if you're not suffering from adrenal fatigue, if you're not sleeping enough, you're going to have our time focusing. So we need to encourage people to focus on their health and wellness. And I'm not, there are a lot of books out there, there are a lot of websites out there, like I said, that attribute anything and everything under the sun to adrenal fatigue. And they want you to cut out everything processed and drink only spring water that's bottled a certain way and add all these herbs and that may work for some people. And that's obviously a personal choice between them and their healthcare physician. But there are a lot of things that we can do to eliminate our lifestyle stressors that contribute to this. And we'll get into those later. The adrenal function is constantly hovering around the exhaustion threshold level. And the smallest stressor will often trigger an adrenal crash, including coffee. Like I said before, sometimes when I was in college, I would drink coffee and I would drink so much in a 24 hour period over a week or so, that my adrenals would just be like, honey, I got no more to give you. So you need to go to sleep. This is important for people to be aware of. This is important for us to be aware of when we're talking with our clients about what supplements they may be taking. If they're taking pre-workout supplements, if they are taking certain herbs that are known to be stimulatory, it's important. I wonder if that's even a word. Anyway, I get distracted easily. It's important to understand that if the body is not responding how you would expect it to, especially for your person, then they need to take a look at what's going on. Immune system issues. Cortisol also has an anti-inflammatory effect that helps regulate the immune system. A lot of people when they have adrenal fatigue will have joint pain and flare ups of gastrointestinal stuff. Lots of belly aches, lots of joint pain. Cortisol is kind of neat because when you get a scratch on yourself, cortisol comes to the rescue and prevents that scratch from becoming this huge black and blue mass, which brings me to people with adrenal fatigue often, bruise easier. Just being aware of what cortisol does and what their symptoms are and how to help people minimize their stress, because it all comes down to minimizing the frequency and intensity of that fight or flight response. Food cravings. Fatigue, quadrenals produce less and excrete large amounts of important minerals in the urine. There's an imbalance in minerals like sodium, potassium, and magnesium in people's blood if they have adrenal fatigue. They'll have cravings for food that will replace the minerals that we've lost. Chocolate is really high in magnesium. Who knew? Just another reason why chocolate is so awesome. Peanut butter can also be high in magnesium and salty foods because as the adrenals are producing less cortisol and the body is starting to excrete more, we're getting dehydrated, salt levels are getting out of whack. Sodium, potassium imbalances can cause heart problems. People with adrenal fatigue may have heart palpitations. One of the things we worry about in clients who are bulimic, especially anorexic to an extent, but definitely bulimic, is the sodium, potassium imbalance because we can see a lot of really negative side effects of that, especially in terms of heart attacks with those patients. So we keep talking about these stressors, but what is a stressor? It is anything that causes your body to speed up, deal with a threat, or do work. Hey, doing work is a stress. You can tell your boss that. Mental stress, anxiety, fear, or anger are stressors. Physical stressors include exercise, recovery after injury, or illness. Even digestion is a little bit of a stressor. I mean, obviously it's not a huge stressor and it's probably not going to cause any major problems for anybody ever, but it is something that causes your body to do work. So it is technically a stressor. Other stressors are things that prevent your body from recovering. So if you're preventing a wound from recovering, my kids are horrible about picking their scabs off and I'm like, that is not going to heal if you keep picking your scab off. The same sort of thing that we're talking about here. If your body has responded to a stress and it needs to recovery, if you keep adding more stress on top of it, it's like picking that scab off. It's never going to heal. Lack of sleep, poor nutrition, and continued stress are all things that can prevent the body from recovering. Some of the things we can look for in our clients would be, again, the type A personality, this client of yours that's driven, they're going to be successful, they are high strong, typically probably not the best with time management. The person who says yes all the time because they don't want to disappoint anybody because they need that validation from other people can add a lot of stress. People who have poor time management, they may not be type A, they may just, you know, not have a calendar. And people with low self-esteem who rely on others for external validation will often take on the extra responsibilities and extra stressors even when they don't have the energy to do it because they don't want people to be angry with them. We need to address these with our clients in terms of, I hear that you want to help Sam move this weekend. How is that going to impact you the following week? You're already exhausted, you've had all this stuff going on. If you help him this weekend, what are the potential consequences for the following week? And is there something else that you could do that might be less stressful that could still help him move but you're not going to be spending 12 hours moving boxes from one end of the county to the other? Hypothalamic stressors, basically things in your brain, what is causing your brain to go, there's a, there's a threat when one may or may not exist. When you interpret something as a threat, it triggers a stress reaction. So rejection and isolation fears, fears of failure, fears of the unknown loss of control and anything that makes people fear death or bodily harm. And again, we're talking about people who have PTSD, people who are in car accidents. There can be a lot of different cognitive stressors out there, but a lot of these are exacerbated or even caused by cognitive distortions and irrational thoughts that that's what we're poised to handle. So score, we can help people with this part. We can help people readdress things that they learned when they were young before they could think abstractly and say, okay, back then, you could only see one possible explanation for whatever happened. Now, as you know, an adult, what are some other possible explanations? Because as a child, you're not able to think of alternative explanations. You can only focus on one thing and interpret what you see. But as an adult, maybe we can reinterpret that so it doesn't continue to cause you to have negative self talk. When a child has a parent that walks out, you know, mom left, mom's nowhere to be found. Mom is supposed to love me in terms of a young child's perspective. So if mom left and mom's supposed to be supposed to love me, then I must be unlovable. Now, as a grown up, who can interpret multiple look at multiple perspectives, we're going, well, that's kind of a reach. But from a four year old's point of view, it actually makes a fair amount of sense. Children are egocentric. So mom must have left because of me. All or nothing thinking she must hate me, which means I am unlovable. As an adult, we can say, okay, I can see how you thought that when you were four. Let's look at it now and see if we can look at it from different perspectives. Maybe there's another explanation for that. Anyhow, physical stressors, low blood sugar. Have people keep their blood sugar up, eat healthfully. I'm not saying to not eat M&M's or pizza or drink soda. Those are vices I hold near and dear, but I don't have them for every meal. Excessive stimulant intake, including caffeine, can produce artificial stress. And caffeine is found not only in coffee, but also in soda, teas, including green tea, unless it's decaffeinated, and chocolate. Lack of sleep or circadian rhythm disruption. This can be due to anxiety, it can be due to stress, it can be due to pain, or it can be due to shift work. People who are on shift work typically have a circadian rhythm issue, difficulty falling and getting good sleep, falling asleep and getting good sleep, in addition to other stressors that are going on. So it's important to consider what may be impacting or what may be causing some of the stress. And like I said before, excessive exercise in intensity or duration. If you have somebody who's training for a marathon, if you have somebody who's training for a bodybuilding competition, they may, if they don't give themselves enough rest time, start to experience some adrenal fatigue. So what do we do? This is kind of the reason you're here. What do we do about it? Frequent, small, high quality meals, and you've heard these, most of these foods before, chicken, tuna, salmon, eggs, yogurt, black beans, raw spinach, broccoli, sesame seeds, sunflower seeds, pumpkin seeds, cashews, walnuts, quinoa, oatmeal, brown rice, whole wheat, most people can find things on that list that they will eat. Does that mean that that's all you should eat? No. Most people would be miserable if that's all they ate. But we want to encourage people to eat a colorful meal, have three colors on their plate at every meal, eat frequently every three to four hours. Now I'm not talking about a huge meal every three to four hours. A small meal. Remember your undistended stomach is about the size of your bald up fist. So if you're eating a plate of pasta that's the size of a basketball, that's probably more than you really need. When we're talking about portion control, I don't want to add more stress onto my client's lives. I don't want to say, okay, now you need to start counting calories and you need to start logging everything. If they want to, that's great. But if they don't want to, let's look at some easy things, you know, have small portions, colorful, frequent, drink plenty of water in order to get all the toxins out. Minimize sugary soda and juices because that just wreaks havoc on blood sugar. If people are going to drink tea or coffee, it should be decaffeinated, preferably naturally decaffeinated. There are some really ugly chemicals that go into chemical decaffeination. And at this point, the body doesn't need it. Most people don't have an aversion to the naturally decaffeinated, whatever it is. One thing I do tell my clients and probably common sense, if you're used to drinking a lot of coffee or a lot of caffeinated stuff, don't go cold turkey because you will get headaches and you will be miserable. I encourage people that if they're going to do it and I really want them to make, I really want them to make it a lifestyle choice, wean down, you know, go two thirds caffeinated, one third decaf, then half and half, and then one third caffeinated and two thirds decaf until they are it completely decaffeinated. Sugar-free sodas, in terms of adrenal fatigue, are not horrible. In terms of a lot of other things, there's a lot of negative research about what artificial sweeteners do to the blood sugar and the body's response to blood sugar. So I would really encourage people to try to actually drink water. I know it sounds crazy, but a lot of people are not going to like that right away. Encourage them to bring a bottle with them and carry it around with them at work. You'd be amazed at how much more you drink if you've just got a water bottle with you handy all the time and the water's cold. But if they want to have their coffee, if they want to have their tea, just talk about moderation. Ideally, eliminate or greatly reduce white flour and replace it with whole wheat or rye flour. So instead of getting white bread, get whole wheat bread. Try to replace sugar and corn syrup with honey, partially hydrogenated fats with organic cold pressed coconut oil or some other oil in that genre. I encourage my client, if they want to do these things, and this is obviously something that they're going to want to talk over with their nutritionist and or their physician, and I put that disclaimer out there. I don't think any of them do, but we have to put that out there. If they're going to try to make a change, do one a week. So if they're going to try to reduce how much white flour they're eating, great, good for them. Let's focus on white flour this week and not worry about the sugar and the corn syrup and everything else. Too many people wake up on a Monday morning and they go, I'm going to start living healthfully today. And they clean out their cabinets and they just completely turn their life topsy-turvy to start living this completely pure, healthy lifestyle. And their body goes into shock, but they're also not going to enjoy it as much. They will, when we talk about motivational interviewing, they're going to miss the things that they don't have anymore a lot of times. So I encourage them make one change a week or even one change every two weeks. Rome wasn't built in a day. It's not going to hurt if we, you know, do this gently. Encourage them to keep a food diary. So they're target nutrition. They want to look for magnesium at about 400 milligrams a day, calcium at about 1,000, vitamin C, according to the books and the resources section. They're looking for about two to four grams and vitamin E about 800. Whenever clients start looking at nutrition, if they're not getting it just from what they're eating, if they're looking at starting to take supplements, I urge them. And I do urge at this point, I urge them to talk it over with their doctor because some of these things like vitamin E in large amounts and magnesium can be toxic. So it's important that the client understand what they're taking and how much they need for them. But a lot of times, if they start eating healthfully, they're going to get this in their diet anyway, which is why some of the apps that are out there for tracking your nutrition are awesome because they will tell you the breakdown of the nitty gritty. And your B vitamins, there are some other levels that you want. Pantythenic acid is really hard to get up to 250 milligrams. It is what they would call an excitatory B vitamin. It's one that gives people energy. You'll notice that if you look at propel or any of the electrolyte drink waters, it has pantythenic acid in it. My response to them is leave this for later. B vitamins are water soluble. So most of the time, if you take a megadose of it, you're just going to pee it out anyway, and it's not going to do you any good. But let's see what we can get through good eating and good health practices first before we start adding a whole bunch of other pills and stuff that you're taking. Sleeping, creating a routine. I sound like a broken record. People need to have a wind down routine. There are apps you can get for your iPhone, for your iPad now that will actually turn down the brightness and switch it over from a blue hue to a red hue at a certain time of night. You can set whatever time you want it to dim down. The blue tint in the lights, and I'm missing the word that I'm looking for right now. But like in lights that you have at the office, in the fluorescent lights that tend to be kind of harsh, the daylight bulbs, they encourage you to stay awake. They discourage the release of melatonin. So we really want to switch over to those soft colors, the more orangey tints and reduce the light level as much as possible within an hour or two of going to bed. So not like right before bed. You want to give your body a chance to start secreting the melatonin. One of the gotchas in this, and it gets me a lot, is bathroom lights because people will get all calm and relaxed and they'll be like, okay, I've got to go brush my teeth and wash my face and get ready for bed. So they walk into the bathroom and they turn on like a million watts of lights. No, no, no, no, no, no. If you save your getting ready for bed routine until after you've wound down, try to use a nightlight or a smaller light that's plugged in in the bathroom. Likewise, if you get up in the middle of the night to go to the bathroom, try not to turn on all the lights in the bathroom because it tells your body, hey, it's time to wake up. The sun is amazingly up. So create a sleep routine, keep the lights low from two hours before you go to bed, and then as dark as possible when you're sleeping. And then when you wake up, obviously you want it to be bright. Naps under 45 minutes prevent you from or at least significantly improve the chances that you're not going to mess up your circadian rhythms. So you know, you don't want to get into that deep sleep. Mild to moderate exercise 30 to 45 minutes three times a week. And why did I say specifically that? Because you can tell somebody mild to moderate exercise and that can mean, you know, for me, a moderate exercise would be going and running five miles six days a week. That's probably not going to give my body enough exercise downtime from exercise if I am suffering from adrenal fatigue or getting over an injury or something like that. So being more specific about let's kind of cut down the exercise, we still want you to have the serotonin release, relax the body, increase blood oxygen. If you feel good after you've done 30 to 45 minutes three times in a week, then you can consider upping it a little bit. But let's not go back to, you know, training for that marathon again right away. As clinicians, we can help people address their negative cognitions, manage their time better, encourage them to keep an energy log, or you can call it an energy suck log. Keep a log of everything they do for a week, and then identify which things drain their energy and which things bolster their energy. And you can't necessarily eliminate all of the things that drain your energy. You know, I really detest putting away laundry, but I can't avoid putting away laundry forever. I don't mind doing it. I just hate putting it away. I have a mental block with that. There are little things and these little things that we dread, drain our energy. So how can you make it less aversive? How can you make it a little bit more pleasant to do so it doesn't drain your energy if you have to do it? If it's something you don't have to do, then stop doing it. Imagine that. Now some people are going to say, oh, well, exercise isn't energy drain, so I can't do that. And in excess, exercise can drain energy. And as your body gets used to it, it can drain energy. If you haven't exercised for 10 years and you go to the gym and work out for an hour and a half, yeah, you're going to be stinking exhausted. If you go and work out for 20 minutes, you're priming your body and getting some more oxygen in there. So it's all about figuring out limits, moderation, things that many times our clients are lacking. They'll either not do something at all or they'll do it full bore. The things that bolster your energy, let's do more of those. If it gives you energy to go out hiking in the woods, then maybe plan on doing that once a week. Encourage our clients to do a mind-body scan. First thing in the morning, when they wake up, what are they thinking? What's their mood like? Are they a negative nally or are they feeling pretty happy? Are they able to focus or do they feel foggy? How does their body feel? Is it, is there pain? Is it lethargic? Does it feel heavy? Do they feel energetic? What's going on? Repeat that again before lunch, before dinner, and before bed. Why did I choose those times? Because those are anchor points within the day. Everybody gets up, hopefully. We're hoping, especially if they're trying to eat better and maintain their blood sugar, they're going to eat lunch and dinner, and everybody goes to bed. So those are times of day that they can, that are anchored for everyone that they can remember to do this mind-body scan. It doesn't take 45 seconds to do, but it helps them identify, am I getting too stressed out? Am I getting worn down? Am I feeling agitated? What's causing it? And is there anything I can do about it? Once people start becoming aware of how they feel, oh my gosh, what a concept, they'll find that they tend to be kinder to themselves. Instead of pushing through, they may go, you know, I'm feeling really foggy right now, and I'm tired. I'm going to be much more productive if I pick this up in the morning. Encourage that mindfulness, that mind-body scan. You may even encourage people to write it down. Now, I would be a horrible person to do that, because I would forget to write it down. Or I would only do it haphazardly. But if you can find an easy way for them to write it down or chart it, they might be able to find patterns in their energy levels and patterns in their fogginess, such as before lunch and before bed, or whatever it is for that person. Other alternative interventions. And I use, I add this because it's out there, it's on the internet, it's in the books that I read on adrenal fatigue, so I didn't want to leave it out. But I don't know enough about any of these to speak intelligently about them. So I would strongly suggest that if your client is interested in herbal supplementation or looking at alternative medicine to consult an alternative medicine physician. Licorice root. The supplement, not the candy. So I'll say that first. Too many people see that and they're like, ooh, I can eat licorice all day long every day. No, no licorice root is far different. Ashwagandha is supposed to be a normalizing herb that helps. If you've got too much cortisol, it brings it down. If you've got too little cortisol, it tells your body to bring it up. It stabilizes and normalizes things. Astrologous root has also been found to be helpful. Siberian ginseng for women especially has been found to be helpful. Pan-X ginseng tends to be stimulating. Siberian ginseng has not been found to be as stimulating. And then there is some theories that support like supports like so they talk about using adrenal cell extracts in order to support the adrenal gland. Again, I am not educated on these enough to speak intelligently about who should use them, what dosage they should be used, what is contraindicated. It is out there and your clients may read about it and ask you about it. So we need to know where to refer them preferably to a holistic medicine physician or practitioner who can speak authoritatively on these in terms of that particular patient's care. So some of this information, thinking about clients that you've worked with over the past week, are there one or two things that you're thinking, hmm, you know, maybe this isn't just simple depression as we were thinking about. Maybe there is a adrenal component or a biological component to it. Were there things that you heard in here that you said, you know, none of this would hurt or this particular intervention wouldn't hurt any of my patients if they started trying to drink more water or eat smaller meals more frequently or whatever it is. And thinking about how effective it might be for them in the short term and how you can help them implement it in the long term. Adrenal fatigue mimics many of the symptoms of depression. The biggest thing is that low energy and lack of enjoyment apathy for just about anything. The body has turned down your excitatory neurotransmitters that said, we're going to burn up if we keep running at this high level. So we've got to dial it back. At a certain point, this may be because there is not, the body just can't produce enough cortisol. But before that, you know, in the early stages, the body's turning down the system. Adrenal fatigue is a physical element that can be compounded or caused by mental stress and anxiety. Interventions should start with improving lifestyle factors. And like I said, one per week is more than enough. If somebody starts sleeping better, they're going to have a lot of positive effects. Now, if one of the complaints they have is they can't sleep because they're waking up with panic attacks, then we probably need to A, get them in to see their physician to see if there is a biochemical cause for it that's easily treated. Most physicians, and I'm not saying all, there's, you know, about 20% of physicians out there have heard of adrenal fatigue and are somewhat supportive of it. There aren't easy tests for adrenal fatigue. So it's not like they can go in and say, okay, I want the adrenal fatigue test in order to see if I've got it or not. And there's a definitive thing. If they've tested for hypothyroid, they've tested thyroid hormones, and those all seem to be in balance. Adrenals might be something else to consider talking with their doctor about antidepressants, stimulants, and steroids because a lot of times when someone is in either a lot of pain and having inflammation or feeling tired, they will be given steroids. These typically have little effect on adrenal fatigue because there's just no more cortisol to give. You cannot squeeze blood from a turnip. And these may actually even make it worse. So if the patient starts taking any of these or, like I said, says that, you know, coffee's not even doing it for me anymore, this is something you might want to consider talking to your patient about and saying, okay, well, that might indicate there's a biochemical thing going on here that you're just exhausted. And sometimes instead of saying adrenal fatigue, which sounds very, very overwhelming, or worse yet, HPA axis dysfunction, which sounds completely scary, we may just talk about total bodily exhaustion. And how the body's response, the brain wants to protect the body. So let's look at how this makes sense. You know, if you're completely worn out, and you're drinking coffee to try to push yourself through it, and there's just no more gas left to give, the body is making you shut down. It's trying to protect itself. I'm out of gas. You can't make me do anymore. Helping them understand the functional nature of it. And how their body can recover. If they give it time, you know, they need to give their body time to recover, whether it's from emotional stress, job stress, relationship stress, whatever they want to label it, it had an impact, and they do need time to recover. So there is a host of resources and these are also in your classroom. So you can click on the links really easily and go and look and see what's available and what's there. It does give you some information. Like I said, some of these will attribute every symptom under the sun to adrenal fatigue and talk about some very alternative and extreme interventions. Most of our patients, if we can even help them just start living healthfully and taking care of themselves, it's going to be important. Now a question comes in about how hypothyroidism fits into adrenal fatigue. Symptoms of hypothyroidism are very similar to symptoms of depression. So if the thyroid is dysfunctioning, then you're going to have someone who has dry skin, constipation, exhaustion, fatigue, you know, wanting to sleep all the time. Adrenal fatigue has some very similar symptoms. So we're talking about effective differential diagnosis. If somebody goes in and has a thyroid test done and everything comes back normal, and a lot of times what they're told is it's all in your head. Just go home, chill out for a while, and you'll be fine. And they feel like just regular chilling out isn't doing it. And that's true. That's probably true. There's more to it to whatever's going on that is causing their stress and draining their adrenal system. So I want to know why are they on constant overdrive physically or emotionally? Once you can start eliminating that, people will often start feeling better. Ideally, you'll be working in a multidisciplinary team. But even just the things that we can do, helping them with their cognitions and pointing them in the direction of resources to educate themselves about proper nutrition, and just general health and wellness behaviors will do a lot of good for a lot of our patients. Well, thank everybody for attending today. I really enjoyed this presentation, and I enjoyed you being here with me. And if you have any questions, feel free to send me an email at support at allceus.com.