HPA Axis Commentary Part 4


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):?How does stress drive adrenal fatigue?

Dr Schuler: Adrenal fatigue is one of those phrases or conditions that people either absolutely love or they absolutely hate, I have found. It is all semantics in my book. Adrenal fatigue, or end-stage stress response, is a valid concern, but the thought of simply supporting adrenal-gland function and everything should get better is misleading.

People tend to not get better when only treating the adrenal glands. That is because those glands do not involute in isolation. It is not like a liver failure that just stops, or congestive heart failure, where the heart is really the main problem. There are all these other signals that are feeding into that, which are also being destroyed at the same time. Just supporting the adrenal gland tissue is probably not effective. Unfortunately, I think that is the way that it has been treated for a long time. It has been poo-pooed by both people on conventional and integrative sides. The data suggest that people who have stress-related disorders, about 15% of people, fall into the category of hypocortisolism. I like that term better. They are not producing as much cortisol. They are not producing as much ACTH. They are not producing as much corticotropin-releasing hormone. It is about 15% of those people who have stress disorders who fall under that exhaustion phase that Hans Selye called out in the 1950s. I don?t want to say that it does not exist. It is just not well categorized or not well discussed.

IMCJ: If you start using botanicals or other methods to treat the condition, can you overtreat it?

Dr Schuler: It is more likely to just mistarget your treatment. Someone may come in who has been treated for adrenal fatigue for a long, long time. They are just taking nutrients for the adrenal glands themselves. They have not fixed the problems that the stress ended up causing. They still have intestinal hyperpermeability. They still have an immune system that is suppressed. They have brain fog, and they are not making the connections like they used to because of increased cortisol for many, many years prior to that hypocortisolism.

Then the main problem that is also caused alongside of it, but usually not associated with it, is insulin resistance. That is well documented. Wherever cortisol is high, insulin and glucose tend to be elevated as well. Insulin resistance and HPA-axis disregulation go hand-in-hand.

IMCJ: How would that relate then to people who may be low-level, type 2 diabetics? Is it possible that their insulin levels are higher, and their HbA1C levels are higher, but it is caused from the stress?

Dr Schuler: ?If I could wave my magic wand over diabetes education and diabetes treatment, it would be that every type 2 diabetic has their stress levels evaluated, and they work through some of those things. That they are treated?preferably, naturally?for aberrant cortisol production or HPA-axis. Anecdotally, we find patients who develop type 2 diabetes in their 40s or 50s, and they retire, or they retire early and their diabetes goes away or becomes easier to manage.

IMCJ: The relationship with diabetes to stress is interesting. That is probably not something that most doctors go to first.

Dr Schuler: No, it really isn?t. Working in the nursing field, I always see the new diabetes medications. They are usually just stronger or longer-acting insulin or something that is going to make the pancreas work even harder. None of it is related to the stress response.

IMCJ: What would you tell doctors to help them with either identifying stress or evaluating stress in patients?

Dr Schuler: The first and easiest way is to get relatively comfortable with stress testing and cortisol testing. Even if it is salivary testing?which, like I mentioned, does have some problems?it is a start. We are at least introducing the conversation to the patient. We are bringing stress to a quantifiable thing. I think especially male patients tend to downplay the fact that stress is not a part of their issue, and it is all physiologic rather than maybe psychologic. I would try to quantify the stress.

The next thing I would say is that if you are not going to treat it directly, just work with somebody who will. Have 1 or 2 practitioners who you refer to who are good at handling that. It might be from a biochemical standpoint. They know the herbs to give. They know the nutrients to give to support the systems, or it might be from a psychological, talk therapy: ?How do I change my life habits to reduce the stress?? I encourage doctors to have 1 or 2 support practitioners by their side to make it work if you can not put the time and effort into learning it all yourself. There is a lot to learn, and we still do not know it all.

IMCJ: Do you think that yoga and meditation have a place?

Dr Schuler: If I could put yoga or meditation in a pill, I would be a billionaire. The point is that yoga and meditation not only have a place, but I think it would be hard to manage a stress-response type of condition without introducing actual lifestyle stress management techniques. Even things as simple as deep-breathing exercises have been found to be profoundly helpful. Yes, absolutely. That is where we need to be. Wherever we start, we probably need to incorporate those facets.

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