RHR: Overcoming Adrenal Dysfunction, with Dr. Izabella Wentz

In this episode, we discuss:

• What adrenal fatigue or adrenal dysfunction is and how it relates to the thyroid
• The symptoms of adrenal dysfunction and methods to test or diagnose it
• The biological relationship between adrenal dysfunction and autoimmunity
• Ways to treat adrenal dysfunction from a conventional and integrative perspective
• Why the combination of adrenal dysfunction, autoimmunity, and thyroid dysfunction may be more prevalent in women
• Techniques for reducing chronic stress that leads to adrenal dysfunction and autoimmunity
• Pleasure and fun as an antidote to stress
• How Dr. Wentz’s four-week Adrenal Transformation Program works

Show notes:

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Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. Adrenal fatigue is a topic that’s surrounded by misconceptions and misunderstanding. On one end of the spectrum, you have conventional doctors who insist that it’s just a made-up condition and has no basis in reality. And on the other end of the spectrum, you have people who claim that everybody has adrenal fatigue, and it always involves exhaustion of the adrenal glands and inability to produce cortisol. As you might suspect, both extremes are incorrect, and the reality is much more nuanced.

So I was excited to talk to Dr. Izabella Wentz about this. You might already know of her as the thyroid pharmacist. She’s an expert in Hashimoto’s [disease] and has spent most of her career supporting people with Hashimoto’s and finding the root cause and addressing it with a Functional Medicine approach. Over her career, though, she noticed that a lot of her patients were struggling with [hypothalamic–pituitary–adrenal] (HPA) axis dysfunction or adrenal dysfunction, and that became a major part of her work, helping to support people in addressing that issue whether or not they had Hashimoto’s [disease]. So she has a new book out called Adrenal Transformation Protocol, [which is] based on a program that she had developed online to support people with HPA axis dysfunction, and it’s been very successful. So she decided to turn it into a book.

I wanted to sit down with her and talk about the connection between adrenal dysfunction and Hashimoto’s and thyroid issues. And just the general population’s experience of adrenal dysfunction in the United States and other developed countries where it’s pretty much rampant. Most people who are listening to this either are experiencing it, have experienced it, or will experience it at some point. So I think it’s a really important topic, and I really enjoyed this conversation. I think you will, too. Let’s dive in.

Chris Kresser:  Dr. Izabella Wentz, it’s a pleasure to have you on the show.

Izabella Wentz:  Hey, Chris. [It’s] so great to see you again. Thank you so much for having me back.

Chris Kresser:  Oh, it’s a pleasure. So you are the Thyroid Pharmacist, but we’re talking about adrenals. So let’s start with that. For those who have maybe not followed my work or your work for any length of time, why would we be talking about adrenals and the HPA axis against the backdrop of thyroid dysfunction?

Izabella Wentz:  Sure, so if I could start with my own personal story, when I first was diagnosed with Hashimoto’s [disease], and how I kind of became the Hashimoto’s expert/human guinea pig was just trying to get myself to heal and feel well again and feel halfway human, right? And I found that getting off certain foods helped me tremendously with acid reflux, and my bloating, and [irritable bowel syndrome] (IBS), and all of these random symptoms that I didn’t realize were connected. Yet I was still left with fatigue, morning fatigue especially, and brain fog, kind of like irritability, anxiety, sleep issues, unrestorative sleep, overwhelm, all of these symptoms. And everybody kept talking to me about adrenal fatigue, and I was like, “This doesn’t exist.” I’m a pharmacist; I would have learned about it in pharmacy school,” and I Googled it. And of course, it was like, “Oh no, this isn’t a real thing.” It’s not a real thing. I think it took like the 15th person [who] said it to me, and it happened to be a compounding pharmacist. For whatever reason, I just was like, okay. I looked at it from a different lens, and I was like, okay, I do have all the symptoms. So let me just try this voodoo medicine stuff and see what happens. And sure enough, I got better, right? And my brain fog, my fatigue, anxiety, all of these things improved with utilizing the things that worked for the thing that didn’t exist, right?

And I’ve found over time that most people with Hashimoto’s [disease], with hypothyroidism, with chronic fatigue syndrome and autoimmunity, do have some degree of adrenal dysfunction, which is more of the scientifically accurate term. We can get into the semantics throughout the interview if you’d like. But more than 90 percent of the people I tested that I was working with had this adrenal dysfunction. And part of what was happening for them is they would get started on thyroid hormones and feel a little bit better, and then all of a sudden, they’d have more fatigue, right? The thing that can happen with thyroid hormones is that they can unmask an underlying issue with not having enough cortisol on board. When we are hypothyroid, our body makes adaptations for us, and it’ll say, let’s slow down cortisol clearance to give you at least some sort of energy. Yet, it might be like a wired anxiousness, like I’ve had too much coffee energy, but it’s something, right? And that’s what happens when we are hypothyroid. When we bring in thyroid hormone, that cortisol clearance increases, right? So then a person might be left over with not actually producing enough cortisol at the right times throughout the day. And that’s kind of like one part of what I’ve been seeing is like, just about everybody that has a thyroid condition needs to work on their adrenals. And then on the flip side, I’ve had some people come to me, and they’re like, “I know you’re the Hashimoto’s expert, and you specialize in thyroid. I have a thyroid issue, yet nobody has ever diagnosed it.” They don’t have thyroid antibodies; they don’t have “a thyroid condition” or thyroid disease. They have all the symptoms, and it turns out that it’s their adrenals, right?

So when we have a lot of stress in our lives, this can send too much reverse [triiodothyronine] (T3) into our body, where that can block thyroid hormone receptors. And then our active T3 isn’t able to get into those receptors and activate them. So we can have this kind of thyroid condition and thyroid symptoms without actually having a thyroid condition just because of our adrenals being affected. And I really wanted to focus on the adrenals because this is something that most people with thyroid issues need to do. A lot of people with just being stuck in a chronic stress response also can really benefit from optimizing their adrenal function.

Chris Kresser:  Excellent. Yeah, I think the conversation around adrenal fatigue has—first of all, even that term, “adrenal fatigue,” I think [is] a misnomer and is part of what generated a lot of resistance among endocrinologists and people in the medical field. Because they knew that in most cases, when people say that, [and] are diagnosed with adrenal fatigue, it’s not actually true that their adrenals are fatigued and unable to produce cortisol. It’s that the upstream glands like the hypothalamus, the pituitary, [and] the thyroid are not sending the right signals and that the truth is much more nuanced. It’s really what we call the HPTGA axis with the hypothalamus, pituitary, thyroid, gonads, and adrenals. But of course, that doesn’t really roll off the tongue. So I think adrenal fatigue is the term that gets thrown around a lot. And unfortunately, it’s caused a lot of misconception. So how do you look at this dysfunction, and is it the same in everybody? What’s the range of variation of how people can experience this? Can people diagnose themselves without any testing just based on their symptoms? Those are some of the questions that people often have about this topic.

Izabella Wentz:  Sure. So there’s symptoms that are very suggestive that your adrenals might be not producing the right amounts of cortisol at the right time throughout the day. And it’s not because they’re not able to, right? It’s because there’s a communication breakdown between our brain and our adrenal glands. And a lot of times, it has to do with feeling overwhelmed, feeling irritable, [and] not being connected to the circadian rhythm. So people will wake up kind of groggy. They might wake up and be like, where am I? Who am I? What am I doing here? They wake up late, they have trouble getting out of bed, [and] they might have brain fog and sluggishness during the daytime hours. Or they might just be super irritable, super edgy, they might kind of jump out of bed and feel like everything around them, everybody’s moving too slow[ly]. Everybody’s annoying, right? They might have various things throughout their day, such as the 3 p.m. crash, where at three o’clock, all of a sudden, they just really want to take a nap, or they’re really angry, or everybody around them is really annoying. They might be the people [who] have trouble falling asleep at night because they get a second wind despite being tired all day. They might be people [who] wake up in the middle of the night. They might be people [who] are sleeping 10 to 12 hours a night, but their sleep is unrefreshed.

I used to work with people to test their adrenal function. We would do things like [the] adrenal saliva test, or the [Dried Urine Test for Comprehensive Hormones] (DUTCH) test, which I think you actually introduced me to back in the day. And we can see definite patterns of various abnormalities. And some people, I would say, maybe in the early stages, they’ll have and there’s so many patterns. We can get on to the nuances. But the most common patterns that I’ve seen are like too much cortisol all day. And this is the person [who’s] super edgy, super wired, right? You feel like you had four Red Bulls and like you’re a rock star, but everybody around you is just moving way too slow[ly]. And then we have the cortisol roller coaster, where somebody might start off with high cortisol in the morning, but it dips too quickly. And then they get that 3 p.m. crash, rather than the cortisol healthy curve [where we have] good cortisol in the morning and then we kind of go down this gradual slide; it’ll dip, and then it’ll rise up again in the evenings. This is supposed to be your winding down rest time, but you’re edgy, and you’ve got all these things on your mind, and you just can’t fall asleep. Then that can progress for some people where they will actually have a drop in their morning cortisol. So they’ll wake up tired, and be sluggish all throughout the day until the afternoon. And again, they can’t sleep in the evenings.

And then another pattern—and this is the pattern that, unfortunately, I’ve seen in the majority of the clients that I’ve come to work with with Hashimoto’s [disease] and autoimmunity—is the kind of burnout flatlined adrenal phase where they start off with low cortisol in the morning, even though it’s supposed to be relatively high, and then it’s just very low all throughout the day. And even in the evenings, it’s low and they sleep just fine. And they’re like, “I’m sleeping. I’m sleeping so much, but I’m still tired, and I wake up tired. [I] go to bed tired; I wake up tired.” So there’s definitely different patterns that it could present with, depending on what point of the healing journey the person is on and at what point they’re diagnosed.

Chris Kresser:  Yeah, that’s been my experience, as well. And there’s never a one-size-fits-all approach. And that’s especially true with HPA axis dysfunction. You can see all different types. And I would agree, I think if you look at statistics and research, the most common is just elevated cortisol. You could say that that’s a cultural affliction that it’s so common that it’s probably more common than not. And then that tends to go along with obesity and diet, and metabolic dysfunction, which are, of course, extremely common now. But then, as you mentioned with Hashimoto’s [disease], or with people who are, let’s say, the quintessential archetype for this in my practice would be a mom who’s busy with kids, and also working outside of the home and maybe doing CrossFit three or four times a week and not eating enough, generally, and maybe has an autoimmune condition like Hashimoto’s or another one, and is just really stressed out, then that is often like a flatline cortisol type of situation where they just feel like they’re dragging themselves through the day for the most part.

So, how does this relate to thyroid function, in your mind? Is it a chicken and egg situation where they just reinforce each other? Is one more of a root cause than the other such that significant adrenal, or dysfunction or HPA dysfunction then increases the risk of autoimmunity or deepens or exacerbates existing autoimmunity? Or the other way around, where autoimmunity itself is a stressor on the system and can influence and worsen HPA axis dysfunction?

Izabella Wentz:  Sure, and I think the body’s always in a feedback system, right? So one thing impacts the other, and both situations can be absolutely true where the autoimmunity is a source of inflammation, and that can have an impact on the HPA axis. But I will say that the majority of the people I talk to and work with, I’ll ask them “What was going on in your life before you got sick?” And most of them will say, “I was going through a significant period of stress in my life.” So I personally believe, and there’s some research that supports [that] the stress comes before the autoimmunity and that stress can be a really impactful trigger and that HPA axis dysfunction can be a really impactful trigger for autoimmunity. And in my experience, like you said, most “healthy volunteers” are people without a diagnosis; they might have higher levels of cortisol. If they don’t get to the root cause of why their body is stuck in a stress state, then they (audio cuts out 12:46) up and progress into an autoimmune condition or something like chronic fatigue syndrome, where their cortisol output is just flatlined. So that’s my personal theory. And of course, chicken or the egg—there [are] always feedback loops within the body. But personally, my hope is if we can catch people in the early stages of the HPA axis dysfunction, we’ll be able to prevent so many cases of autoimmunity.

Chris Kresser:  Yeah, I completely agree. I think we have a habit in conventional medicine of looking at the body as just a big collection of parts that are not related to one another in any way and even how the system is set up, right? You go to a gastroenterologist to talk about your gut health, you go to an endocrinologist to talk about your hormones, [and] you go to a cardiologist to talk about your heart. In theory, the primary care provider is supposed to be playing the role of quarterback and just making sure that all of those pieces are integrated. But in practice, that rarely happens. And there’s rarely any view, like you just shared, of how all of these things are connected, which, of course, they are. And the funny thing is most people, just average people with zero medical training know that intuitively. They can tell you from their own experience how it’s all connected, even when their doctor is insisting that it’s not connected.

So speaking of myths or maybe conventional ideas, let’s talk a little bit about treatment. The common advice with adrenal fatigue, I’m doing air quotes there for those [who] are just listening, is quit caffeine, sleep more, and maybe take some [dehydroepiandrosterone] (DHEA), and that’s a good approach for pretty much everybody regardless of what the situation is. So what do you think about that?

Izabella Wentz:  So sure, and I think a step in the right direction is just to think about lifestyle. I feel like conventional doctors will say like, it doesn’t even exist. It’s all in your head. Go to a psychiatrist, right? So if you can get to maybe like an old-school integrative doc[tor], they’ll give you some of these strategies or a naturopath perhaps [will] give you some hormones. I know I was initially trained in using pregnenolone and DHEA. And sometimes, I’ve had clients where hydrocortisone, there were protocols that I was familiar with that, where you would give the body some doses of what it wasn’t making at the right times to try to reestablish that pattern. And I feel like that can work really well for some people. It does take some time to work. And I do recommend working with a practitioner [who] knows how to use hormones. Not just like taking them over the counter and seeing what happens. But there are risks to that, right? So there are risks with DHEA over converting into something that makes us grow chin hair. I have had that personal experience, so I could share proudly about that. But otherwise, it can also work on fueling estrogen dominance and any kind[s] of cancers that are fueled by estrogens. And it’s just not the best fit for everybody.

And then we focus on the caffeine elimination. So yes, caffeine can absolutely make things worse. We can’t sleep as well if we’re drinking too much caffeine, right? And we don’t go into that resting state. But what I’ve noticed is that a lot of people will be drinking caffeine to self-medicate. Because they’re trying to get that energy in the morning, and they’re so tired. And the same goes with drinking wine in the evenings. People [who] tend to have that higher cortisol in the evenings [are] like, “Hmm, I’m going to have a little bit of wine, and that’ll help me wind down. That’ll help me fall asleep better at night.” So a lot of times, when I started working with clients, I’d be like, “I figured out your problem. You drink too much coffee and too much wine. Boom, take that away, and you’re going to be full of energy. You’re going to be able to sleep at night.” And they would follow what I said, and they’d be like, “Yeah, I quit everything. But now I’m still tired throughout the day, and I’m still having trouble waking up at night. I can’t sleep at night; I’m having frequent night wakings.” And then it was just like a big aha moment for me. Wait a minute, people are self-medicating with that, and yes, these strategies are great, but a lot of times, we actually need to get somebody’s energy levels up. And there’s a root cause of why their energy levels are so depleted before we ask them to quit caffeine, right? Or we want to work on their sleep and the root causes of why they’re so sleep deprived, rather than just being like, hey, get more sleep, right? It’s so easy just to tell somebody to get more sleep, but it’s not realistic for everybody, or some people might have barriers to that that are within their body or within their environment, right?

Adrenal dysfunction is a nuanced condition that is running rampant in many developed countries, including the United States. I sat down with the Thyroid Pharmacist, Dr. Izabella Wentz, to discuss the relationship between thyroid health, autoimmunity, and adrenal dysfunction and how her expertise in thyroid function helped her craft her Adrenal Transformation Protocol. #chriskresser #adrenals #thyroidhealth

Chris Kresser:  Definitely. Speaking of that and just the sort of distribution of this condition, how it differs demographically in the population. In my experience, and from what I’ve seen of the literature, this does seem to be a constellation of issues, if you combine thyroid, adrenal, and autoimmunity that disproportionately affect women. It’s not to say that men aren’t affected. They definitely are. But it’s a problem that does appear to affect women more than men. So has that been your experience? Number one. And number two, what’s your take on that?

Izabella Wentz:  Definitely, and, full disclosure, I work primarily with women. So I would say 90 percent of my clients have been women, right? But the literature does support that, that it does tend to be women who are more sensitive to our environment. So they’re going to be the ones [who] are going to have higher rates of HPA axis dysfunction; they’re going to have higher rates of Hashimoto’s [disease] and higher rates of autoimmunity. And again, not to say that this doesn’t happen to men, but I feel like women are just more tuned into the environment. And my personal theory on that is there’s a lot of things that can play a role. So women wear more makeup with toxins, for example, and estrogen can be a hormone that can impact everything within our body. So those are just some of the differences. And women weigh less, so they may be more susceptible to toxins, in general, compared to men, and we have a different metabolic profile. So many things, right?

What I’ve found as kind of a unifying theory for that is that women tend to be more tuned into the environment because we’re the ones [who] are going to be caring and bringing new life into the world. So we have to be super tuned into that. And for our species and the survival of our species, [it’s] probably not good to be pregnant and caring for a newborn when you’re in a famine or when you’re in a war, or there’s something going on in the world. And what adrenal dysfunction does, thyroid issues and autoimmunity, what they do is they prevent us from being vibrant and out in the world. A lot of these conditions do suppress libido; they suppress fertility, reproduction, [and] so on and so forth. And they also, with thyroid and adrenal specifically conditions, they also impact our metabolism. So in a way, I feel like it’s the body’s adaptation to helping us survive, right? So we’re over here being like, hey, I’m trying to lose a few pounds, so I’m not going to eat enough. But I’m going to get on the treadmill. Where our genes are saying, like, hey girl, I see that. I’m picking up that you’re in a state of famine because you’re not eating, and you must be running away from all of these crazy warriors because you’re always running on this treadmill, right? Girl, don’t worry; I got you. We’re going to slow down the metabolism so you’re not going to need as many calories to get you by. So that’s what happens a lot of times in the women I work with, is like, their metabolism is super slow, and the thyroid and the adrenals can slow that down. And I personally think it’s our body’s way of trying to adapt to stress.

And back when our genes first were evolving, we weren’t aware that stress could come from the television set or from work deadlines. It was all about survival. It was, you’re either being chased by a bear or you’re not, right? Or you’re either in a famine, or there’s food that’s available to you.

Chris Kresser:  Yeah, absolutely. It’s a great point, one that I’ve talked about a lot. But I think a lot of people don’t fully understand the binary nature of our stress response system, and how significant the impacts are of being in a chronic stress response. Where, as you just described very well, when the fight-or-flight response is activated, the easiest way to think about it is the body’s prioritizing everything that’s required for immediate short-term survival. And that made sense in an ancestral environment where our lives were literally at risk when we [were] in the fight-or-flight reaction. And I mean, certainly, that is true in some places, still, depending on the circumstances. But, thinking about your 401(k) or having an argument with a co-worker or something like that, [which] triggers fight or flight now, is usually not life threatening, but the body still responds in that same way where it’s triaging and prioritizing short-term survival, and de-prioritizing anything that is required for long-term health and well-being and even reproduction, as you pointed out.

If you’re in a really stressful situation, it’s not sending what you call safety signals to the body and telling the body oh, this is a safe, nurturing environment to bring a child into. So let’s talk about how to work with that. Since most people do experience stress in their lives, it’s not something that necessarily everybody can just eliminate entirely or [is] even desirable to eliminate entirely, because stress helps us to adapt and grow. But if people are experiencing harmful impacts of that stress, what are some steps they can take to send those safety signals to their body?

Izabella Wentz:  Sure, yeah. And I’m a big proponent of feeling into what’s going on in your world. and no, you can’t live in a monastery and meditate 12 hours a day. And obviously, you wouldn’t grow; you wouldn’t change if you hadn’t had stress, and stress helps us with building resilience. But at the same time, we want to think about what are the messages we’re currently sending to our body by our daily actions? And if, let’s say, we’re skipping meals, we’re not eating foods that are compatible with our bodies, foods that are inflammatory, we are undernourished, [and] we don’t have enough nutrients in our bodies, that’s going to be a stress signal, right? Blood sugar imbalances, these are going to be stress signals. And then a lot of pressure, a lot of deadlines, sleep deprivation, psychological stress, these are all stress signals. So we want to counter that with some safety signals. And I developed this plan when my son was eight months old and he was waking up every two to three hours, and I found myself with flatlined adrenal again, after recovering my health many years prior to that. And I was like, I can’t take hormones. Man, I’m not quitting coffee. I just started drinking coffee, and it’s really helpful right now. And I’m like, I can’t sleep; I’m taking care of my son in the middle of the night, right? That’s kind of what a mom’s got to do. So I was like, I can’t sleep, and I can’t do any of these things. These are the things I have to work with, right? I have to work with sleep deprivation at this moment. So what can I do?

And I just focused on sending my body enough of the safety signals so that the messaging was more balanced. Because if you have 10 danger signals, and one or two safety signals, then your body is going to shift into that fight-or-flight mode. But if you have enough of the safety signals throughout the day and at nighttime, then you’re going to be able to shift more into the thriving state. And I do sleep now; I sleep nine to 10 hours, and my son sleeps 10 to 12 hours. But [we’ve] got to work with what we have. There’s always going to be stressors in our life. So I really focus on blood sugar balance, making sure that you’re eating nutrient-dense foods, utilizing some of the supplements and nutrients that get burned when you’re in a stressed out state. So B vitamins, vitamin C, magnesium, [and] electrolytes are just some really foundational things that people can do to help themselves feel more balanced. And utilizing nutrients that support mitochondrial function. That’s another thing: our mitochondria are super tuned into our environment. And whenever they’re sensing stress or danger, they’re not going to be working as well. So I really focus on things like that, from a foundational nutrition standpoint, making sure we’re spending time in nature. And probably one of the favorite things that people love is focusing on pleasurable activities and really building that within your routine, rather than doing things you don’t enjoy, right?

Chris Kresser:  Yeah, let’s talk about that. It’s one of my favorite topics. Pleasure and fun is an antidote to stress. Because I think when a lot of people think about stress management or stress reduction, they might think exclusively of things like meditation, deep breathing, tai chi, yoga, [and] Qigong, something like that, which, of course, are all fantastic for stress reduction. But they might not think that watching a funny movie or playing with their kid in the backyard, or doing something that’s just purely pleasurable and enjoyable is actually having an impact on stress. So say more about that.

Izabella Wentz:  Sure. And I think many of us I know, our age, we’re kind of in that sandwich generation where we’ve got like little kids to look after or children in general, and perhaps elderly parents. And we can find ourselves between work and caring for other people; there’s not a lot of opportunity to actually focus on doing things for the simple pleasure of doing them. So [one] of the exercises that I have that women and men [who] go through my program focus on is just making a list of things that you enjoy. And take a piece of paper, divide it in half on one side, [and] write down what makes you feel worse. On the other side, write down what makes you feel better. And this can be a really major shift for you for how you feel, how you show up in the world, [and] what your energy looks like. I read this amazing quote, and it talked about how people who are fatigued and don’t have enough energy, it’s not because of all the things that they’re doing, but sometimes it’s because they’re not doing the right things to fuel their energy levels. And I couldn’t agree more with that.

A lot of my clients will say things like spending time in nature, having time to connect with friends, Epsom salt baths, or creating art just for the sake of creating it. These are all wonderful things that we can do that could shift us into more of [a] parasympathetic, resting, digesting, relaxing, healing state, and really shift us away from like, I’ve got a to-do list and this is stressful for me. So this is actually a really big part of the program in addition to utilizing nutrients and supplements and food, which we all love, but incorporating small doses of pleasure into your day-to-day life.

Chris Kresser:  So you mentioned the program a couple of times. Just for those who might not be familiar with it, the adrenal transformation protocol, which is the name of the book, is that also the name of the program? And what does that look like in terms of how long it is and what kind of commitment? Just walk us through it a little bit.

Izabella Wentz:  Sure, so I initially developed the Adrenal Transformation Program. And you may notice the abbreviation is “ATP.” If you’re a nerd, we really focus on utilizing, creating energy in the body. And it’s a four-week program, and the book has all of the same information that the program does. So it’s evolved out of the program. And the amazing thing is, when I used to work with people in focusing on utilizing hormones, or even some of the lifestyle things, it would take three months, sometimes two years, to rebalance their stress response and rebalance their symptoms. With this program, people are seeing a major difference in like three to four weeks of just committing to, I’m going to eat blood sugar balanced, I’m going to utilize a [few key] supplements to support my stress response, I’m going to incorporate pleasurable activities into my routine, [and] I’m going to be focusing on really putting my body into that rest, digest, and heal state that helps build the body back up. And it just takes three to four weeks to see results.

Chris Kresser:  Great. Yeah, that’s amazing. I know in my experience, this can turn around pretty quickly, which is sometimes hard to envision if you’ve been struggling for a long time. And it seems like there’s no light at the end of the tunnel. But the good news is that it can change relatively quickly, and three to four weeks to get some results is just often the beginning. The results will typically accumulate over time as you stick with a program like this, which is, of course, great news. And on the flip side, my experience has also been that people who, and when I say people, I include myself and pretty much everybody I know, the behavior patterns that get us into HPA axis dysfunction don’t tend to just disappear. So it’s a continual process of examining our relationship with our life and our work and the people around us. And it can be easy to, this is a caveat that I’ll often provide to my patients, the scenario is like this. Okay, somebody has pretty significant HPA axis dysfunction, adrenal dysfunction, [and] they’re really tired [and] out of it. They start doing a program like this. A couple of weeks later, they start feeling a lot better. Then all of a sudden, they’re going crazy with activities and working out a lot and staying up late with all of their newfound energy, and then they’re right back to where they started. Or maybe even worse, they crash because they overdid it too soon. Is that something you’ve seen in your work with people? And how do you counsel people to avoid that?

Izabella Wentz:  Oh, yeah, absolutely. And full disclosure, I’m people, as well. So that happened to me when I had Hashimoto’s [disease] and I was chronically fatigued for so many years, and I got my energy back. And I was like, woohoo, I’m making up for lost time. I’m going to take over the world, right? And then you can kind of get yourself in the same patterns where you burn yourself out again. So a big part of my program focuses on building resilience. And I have a whole section on that where we focus on some of the underlying patterns. Let’s say one of the things I recommend is doing gratitude every morning and positive affirmations, and sending all these beautiful safety signals to yourself. When you just do that, but you have underlying trauma that you’re walking around with that tells you that you’re not worth anything in the world unless you’re super productive, or unless you’re working at your max or so on and so forth, whatever the messaging, the negative Nancies we have in our brains saying all those naughty things to us. And then we’re going to just kind of get ourselves into the same patterns, right? So I really focus on figuring out what your triggers are and what your traumas might be so you could work on processing them.

There are a lot of fabulous ways to overcome them. One of my triggers was I have a brother who’s like 6’2”, he’s older than me, and he’s into martial arts, and I’m a foot smaller. I was always the younger sister. So I got this message that I’m not strong and I can’t do things, and you’re little; you’re not strong. And that kind of led me to push myself and to prove that I was strong, even at times where maybe I shouldn’t have been strong. And maybe I should have asked for help, right? So, really working to heal those kinds of underlying patterns that I would say most of us have can be extremely, extremely healing and liberating, and it’s like lifting a huge weight off of our shoulders. And we don’t get triggered as easily. And we’re able to just be more relaxed and present and be more into that healing, resting, digesting state, rather than that fight or flight or I need to prove myself, [and] I need to be strong. So we focus a lot on that. How do you make your mind more resilient? And how do you deal with stressors? Because we all have them, right?

Chris Kresser:  For sure. Not going to avoid it. And again, [it’s] not even desirable to avoid it, that this concept of eustress, e-u-s-t-r-e-s-s (that’s how it’s spelled), means positive stress, like we wouldn’t have evolved as a species if we didn’t have stressors that we had to overcome. That’s just part of being human. And anything that is worth doing is often going to come with stress and difficulty and challenge. So we’re not saying you need to eliminate stress from your life, which is an unrealistic and not even desirable goal. But just these ways that we can bring more balance into our lives and help mitigate the potentially harmful impacts of stress that we can’t avoid. That’s what this is really about.

So Izabella, this has been super interesting and helpful. I’m really excited about your book Adrenal Transformation Protocol. I would wager that virtually everybody listening to this is experiencing the syndrome that you describe, at least to some extent, or has experienced it or is at some stage along the process, and again, myself included. It’s something we’re always, most of us are always working with to some degree or another. So where can people learn more about the book and the program and your work, in general?

Izabella Wentz:  Sure. So my book is available on Amazon and Barnes & Noble, wherever fine books are sold. My website is ThyroidPharmacist.com, and I have a guide, ThyroidPharmacist.com/ABC that talks about some of the different elements of restoring the function, the optimal function of your stress response. And I’m on social media, as well. So find me there.

Chris Kresser:  Fantastic. Well, I’ve always appreciated your balanced approach to thyroid and Hashimoto’s [disease]. And I was excited to see that you were tackling this subject because it’s very important, as we’ve discussed. So thanks, again.

Izabella Wentz:  Thank you so much, Chris, for having me on. And thank you for all the wonderful work that you’ve been doing over the years and helping and empowering people to take charge of their health. You helped me on my thyroid journey so much, and you’ve just been doing a fabulous job helping the world. So thank you.

Chris Kresser:  Okay, everybody. Thanks for listening. Please keep sending your questions in to ChrisKresser.com/podcastquestion, and we’ll see you next time.

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