HPA Axis Commentary Part 3


Corey Schuler, MS, DC, CNS, LN, FAAIM? is a nationally recognized expert in the field of natural health and metabolism. He is a board-certified physician with the certification board of nutrition specialists, licensed nutritionist, and functional medicine practitioner with a profound curiosity about why one medicine heals one person with a condition but not another with the very same condition. He is a member of the American College of Nutrition and American Nutrition Association, holds a master’s degree in human nutrition, and teaches in post-graduate degree (MS, MSACN, MHS) programs of clinical nutrition.


Integrative Medicine: A Clinician?s Journal (IMCJ):?Let?s talk a little bit about adaptogens. Donnie Yance, who wrote a big book on adaptogens, has the philosophy that adaptogens can solve anything, but I don?t know whether that is true or not.

Dr Schuler:?Adaptogens have probably the broadest window of therapeutic effect in the stress response. It is a little bit arbitrary, but we try to break the stress response into 3 or 4 different phases. In a stress state, or an excess-stress state, you can have hypercortisolism, which is too much production. Then you go into this phase of sometimes producing too much and sometimes producing too little, but at different times of the day. Remember I said that the CAR is supposed to be 30 to 45 minutes after awakening. You might have your cortisol spike at 3:00 PM. The worst situation is that you have it at about 9:00 PM, because then you have trouble going to sleep.

The third phase is when you have hypocortisolism, or insufficient cortisol secretion and, of course, insufficient signals to dependent systems, as well. Adaptogenic herbs are useful for that. If you are doing the math at home, this is the clinician?s 80% of people. Twenty percent of people are either hyperstressed, and they are still producing too much or they are not producing enough. The majority of people are just ill-secreting?ill-timing their cortisol response. That is where adaptogens really are useful.

IMCJ: Are they used throughout the day, or do you jumpstart in the morning?

Dr Schuler: There are lots of theories on that. What most people are winnowing in on is that it is probably best to try to recreate the circadian pattern. Just like if you were jet lagged, you have to recreate that circadian pattern. It is probably good to signal it when you are supposed to rather than trying to overmanipulate the system, because it acts so slowly.

Adaptogens are often given first thing in the morning and usually early afternoon, and there are a few that are suggested to be taken in the evening, because they have been helpful in sleep patterns.

IMCJ😕What if you add some melatonin in the evening before you go to bed, as you are trying to wind down, to help you sleep?

Dr Schuler:?If there is any single agent that I have studied the most, it is melatonin. I have read thousands of articles over many years, stretching from 1994 until today, that look at how melatonin works, the dosing, the timing, and all of that. What we are finding is that the lowest effective dose is probably best to shift the circadian pattern. If you don not have a circadian pattern problem, and you just have a stress problem, melatonin may not be sufficient. We like to add it in combination with other things that are known to affect sleep as well.

IMCJ: How would you rate stress in relationship to other lifestyle issues such as diet, exercise, and other things that affect wellness?

Dr Schuler: It would probably be number 1 or 2. The HPA axis is 1 of 3 systems that help humans to interact with their environment. Our genes really are not designed for this fast-paced, modern lifestyle. Our genes are used to longer periods of recovery. The gut interfaces with the environment. The skin interfaces with the environment. Then the HPA axis takes signals directly from the senses.

As far as managing your stress, controlling your diet, or exercising, it probably does fall slightly under diet. I will also say that anybody who has a perfect diet, but is stressed out of their mind, is probably not getting the results they are after, either.

IMCJ: Is there any relationship with the microbiome?

Dr Schuler: The microbiome is shifted significantly through stress response. The details of that are still getting figured out. It? goes both ways. We now know that if you can change the microbiome?at least in animal models?you can affect animals? ability to respond to stressors. We think that, for example, you can give a broad-spectrum antibiotic to a rat and put them in a same situation that you gave them prior to the administration of antibiotic, and they will actually have greater spikes in cortisol with that same stressor. We usually get better at adapting to stressors, so it is actually a greater effect than we realized.

Which species of microbial bacteria affect what? We haven not gotten to that level of understanding yet. We are getting so good at culling through data now, and there are so many different projects out there, like the private projects, uBiome and American Gut. I think that we will get closer to that with our understanding of what happens sooner than we imagined.

IMCJ: Do you agree with those who refer to the microbiome as the second brain?

Dr Schuler: That is not an overstatement at all. The enteric nervous system is its own brain, its own set of neurons, and its own set of connections, essentially. The microbiome?they outnumber us. The bugs outnumber human cells. And we feel like we are taking a ride on their life, rather than them inside of us.

IMCJ: What?s so fascinating about it is that research in the area has just mushroomed in the past 5 years. I look at it and think, ?Were they just ignoring this completely before? What was happening??

Dr Schuler: It is so distant anatomically?there is no easy track between the brain and the lumen of the gut. The funny thing is that for years, we have equated intuition and stress with gut problems. You have a gut ache because you are speaking in public and you don?t like it, or you throw up and get nauseated because you get so nervous. Those are obvious things that make that connection. Within maybe the last year or 2 years, they have shown that the vagus nerve, the cranial nerve, actually probably does some of the transmission between the two, but they have their own interactions once they are there. The vagus nerve might be that train track that we have been missing.

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