Is “Adrenaline Dominance” Causing Your Issues? Michael Platt, MD

Content By: Ari Whitten & Michael Platt, MD

In this episode, I am speaking with Michael Platt, MD – who is board-certified in internal medicine, president of the Platt wellness centre and one of the most well-known specialists in the realm of natural hormone replacement therapy and bioidentical hormones. More important for this podcast is that Dr. Platt is renowned for his book, Adrenaline Dominance, the only book ever written that explores how excess adrenaline affects our body, which is the topic of this week’s podcast.

Table of Contents

In this podcast, Dr. Platt and I discuss:

  • Adrenaline dominance causes and symptoms
  • The main function of adrenaline and how it can profoundly affect your health
  • How addressing adrenaline dominance may help symptoms like anxiety, early waking, ADD and daytime exhaustion.
  • Is “adrenal fatigue” at the root of chronic fatigue?
  • The best tools to eliminate adrenaline dominance 

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Ari: Hey there, this is Ari. Welcome back to the show. In this episode, I want to introduce you to Dr Michael Platt. He is board-certified in internal medicine and he’s president of the Platt wellness centre and one of the most well-known specialists in the realm of natural hormone replacement therapy and bioidentical hormones successfully treating thousands of patients all over the world.

He’s also a renowned author with his book, adrenaline dominance, being the only book ever written that explores how excess adrenaline affects our body. That is the topic that we are going to be talking about in this episode which is a very novel one that very few, if any people are really talking about, in the way that Dr Platt is. It is also at times an interesting conversation in the sense that some of the things he’s talking about and some of the things that– the ways that he’s presenting them on a paradigm level as you’ll hear in the episode, didn’t make a ton of sense to me.

At times I pushed back on certain topics and we engaged in really wonderful exchanges and back and forths around some of these things that I think was really fruitful. I think that you’re going to get a lot of value from this. I think he’s got a lot of wisdom to share and a lot of novel ideas that most people aren’t talking about or even considering so enjoy the episode. Welcome to the show Dr Platt, such a pleasure to have you.

Dr. Platt: Well, I’m actually very glad to be here.

The most common symptoms of adrenaline dominance

Ari: Great. I am very excited to dig into a lot of the topics that you’ve built out in your work. You’re talking about things from a unique perspective that I haven’t really heard anybody talk about. Having said that, I have seen some indications in the literature of this thing that you’re referring to, that you’ve built out in. Maybe we’ll get there.

One of the avenues that I’ve seen, is something called idiopathic postprandial syndrome, where we start to see some indications of this thing called adrenaline dominance, or maybe adrenaline is playing an issue in certain symptoms. Yet we don’t really have a syndrome for it. We don’t really have a lot of research or clinicians talking about this thing. I guess to start with, could you explain what this whole thing is of adrenaline dominance and how you arrived at this and the big picture, like what is going on in this scenario of adrenaline dominance and what symptoms might a person have?

Dr Platt: I think most people have heard of adrenaline. Adrenaline is both a hormone as well as a neurotransmitter. Most people think of it as the fight or flight hormone, which is true when people are in danger, the body pours out adrenaline, but actually that’s a very rare reason why the body puts out adrenaline.

What is not generally understood is what the main function of adrenaline is. Once people understand that, you can see why it is so important and all-encompassing. The primary function of adrenaline is to raise sugar levels for the brain. Most people do not realize that the brain uses more sugar than any other tissue in the body. Anytime the body detects a drop in sugar in the brain, it simply puts out adrenaline to raise sugar levels.

Now, understandably, the brain runs out of fuel around 2:30 in the morning because the body puts out adrenaline then because the brain is out fuel. A lot of people wake up at that time, they’ll have to urinate because adrenaline actually gets people that urge to urinate. Where I got involved with this is that I’ve always been interested in hormones ever since my mother died at the age of 61 of breast cancer. I realized that I had inherited her hormones. Men and women had the identical hormones, different levels, but the same hormones. She died of breast cancer. I realized because of that, that she was low on progesterone because estrogen is what causes breast cancer. She had a belly on her.

The only thing that puts on fat around the middle is insulin. I knew that she had a lot of insulin, and at that time I used to have to slap my face when I was driving, trying to keep my eyes open. I knew I was overproducing insulin, getting low blood sugars. In any event, I started using progesterone and I never got sleepy in a car again. I realized that progesterone blocks insulin and in any event.

I started getting involved with hormones and I had the luxury of being able to sit down for about two hours with every patient and learn about how their body operates. When you read my books, I started with the miracle of bioethical hormones. You’ll notice that there are no references in my books to articles or other books, because everything I have learned, I’ve learned from talking to my patients. After a while, I realized that there are similarities in a lot of my patients, in other words, they had a lot of the same symptoms.

From, I guess, intuitively or logically, I realized that they’re actually putting out a lot of adrenaline which is a very powerful hormone. When you talk about road rage, that’s adrenaline, it’s a very powerful hormone. What I found was that when people were put on progesterone cream, not the pills, but the cream that the cream seemed to block the effects of adrenaline and that opened up a whole new world to me in terms of adrenaline and had to treat people.

Over a period of time, I realized that the most important thing when it came to adrenaline is how people were eating and whatever. Eventually I wrote a book called adrenaline dominance. Just to give you an idea, it is the only book ever written that talks about adrenaline and the clinical consequences. It is completely off the radar of the medical community even though excess adrenaline is the cause of many conditions, which we’ll talk about. I don’t know if that put things in perspective for you, but it’s an important hormone.

Ari: Yes, absolutely. That’s what I was getting at in my initial intro that very few people seem to have this on their radar at all and be aware of it as a thing. Given that, how might someone know if they have excess adrenaline, if this is an issue for them? I suspect that this is very difficult to test for, given my understanding of adrenaline is that it’s very rapidly released and then also goes away pretty rapidly in most scenarios? Correct me if I’m wrong, but how would someone know if they have this as an issue?

Dr Platt: Okay. First of all excess adrenaline is the number one reason why people are trouble sleeping. Some people grind their teeth at night or toss and turn, or have restless light syndrome. These are all things caused by excess adrenaline. The other thing, when people have a lot of adrenaline, they may find they have cold hands and cold feet. The reason for this is that adrenaline is a survival hormone, cuts off blood supply to areas of the body not needed for survival. Most people or most doctors think of cold hands or cold feet as caused by an under-active thyroid, but it actually its adrenaline. Also cuts off blood supply to the intestines because they’re not needed for survival. That’s where constipation of IBS comes from. It also cuts off blood supply to the salivary gland.

People with chronic anxiety– and anxiety is only caused by excess adrenaline. But a lot of people with chronic anxiety have a dry mouth again because the circulation to the salivary glands is cut off. This is why when people do hormone testing, I always suggest that they never do saliva testing. The reason for this is because the adrenaline cuts off blood supply to the salivary glands and hormones don’t get into the saliva. This has resulted in the false or the misdiagnosis of a condition called adrenal fatigue. It’s a condition that doesn’t exist.

But it’s all based on getting low cortisol levels in the morning saliva. If the doctors did a blood test, they would find the cortisol levels actually high and going back to what you brought up, blood cortisol in the morning before nine o’clock is actually the best test for excess adrenaline. This is because the adrenaline creates stress to the body and the body responds to stress by putting out cortisol. Anyway getting back to what people might– when people have a lot of adrenaline they very often will find out they have a lot of tension at the back of the neck.

They’ll be quick to anger, short fused. We talked about road rage, but any kind anger can be caused by excess adrenaline, they may have anxiety, they may find when they sit down that they knee taps up and down, and also on television they talk about an overactive bladder when it comes to women, but actually an overactive bladder is caused by adrenaline. Some women they rush into the bathroom, they can’t make it, they get some leakage and that is called Urgency Incontinence, but again, adrenaline.

Now going back to the early days, you may have heard of babies that get colic and colic is caused by adrenaline. You can actually eliminate colic in about three minutes. You don’t have to stay up all night with a crying baby, just rub some progesterone cream on the baby’s belly. It’ll go away in about three minutes. Then you have bed-wetting in children. Bed-wetting is only caused by excess adrenaline. Later on, people with ADHD– ADHD is all about adrenaline. You could actually eliminate ADHD in 24 hours just by lowering adrenaline. In any event it’s a very pervasive type of situation.

The link between adrenaline dominance and fatigue

Ari: How does it tie-in with fatigue? More broadly chronic fatigue. How do you see adrenaline dominance as far as overlapping with the symptomology of chronic fatigue?

Dr Platt: For a number of reasons. Number one, when people have a lot of adrenaline, they keep that muscle tense. Remember it’s the fight or flight hormone. When you keep muscle tense, you use up a tremendous amount of energy. Fibromyalgia is one of the conditions caught by excess adrenaline. Doctors say there’s no cure for fibromyalgia and there are like 4 million people in this country with fibromyalgia. We’ve all been told there’s no cure for it, but actually it’s a very easy condition to get rid of just by lowering adrenaline.

One of the main things that people complain about when they have fibromyalgia is fatigue and that’s again, because they keep the muscle tense. The other thing is that, adrenaline is a stimulant to the body, so when people have a lot of adrenaline, they do not tolerate thyroid. One of the actions of cortisol that’s released when people are under stress is that it actually is an anti-thyroid hormone and the reason why the body does that is because when people have a lot of adrenaline, like I say, they do not tolerate thyroid.

That could be another reason why people might have fatigue. Now that usually doesn’t kick in until after you lower the adrenaline levels if it’s part of the treatment that underlying low thyroid may kick in and people will become very tired once they get rid of– because they’ve been living on adrenaline for energy and that that’s gone now.

Testing for adrenaline dominance

Ari: Fascinating stuff. Let’s go to adrenal fatigue. This is an interesting thing because I don’t want to take too much credit here for this, but I’ve been one of the most vocal critics of the adrenal fatigue hypothesis. For many, many years now, I originally took a lot of flack for this and now I’m happy to see that the functional medicine community and natural health community has largely not entirely, but largely gotten on board with me and the few other people like yourself who are putting out information that debunks this.

Now I approached this from an entirely different angle than you did. I ended up spending about a year of my life exploring the literature on the relationship of cortisol and HPA access, hypothalamic, pituitary, adrenal access more broadly and fatigue syndromes and its relationship to chronic fatigue syndrome and there’s many other fatigue syndromes like stress related exhaustion disorder, vital exhaustion, burnout syndrome and clinical burnout.

There’s over 25 years of research and about 59 studies that have been done all over the world in relationship to testing cortisol levels and HPA access function in relationship to these different fatigue syndromes. What that body of evidence makes very clear is that there is no predictable relationship between cortisol levels and these various fatigue syndromes. There is certainly no evidence for a relationship between chronic stress causing low cortisol levels.

In general, most chronic stressors, and this lines up with what you’re saying, most chronic stressors, whether we’re looking at chronic psychological stressors and there’s studies looking at all kinds of psychological stressors relationships stress, financial stress. There’s studies looking at chronic stress from toxic exposures like cigarette smoking or chronic alcoholism or chronic metabolic stress from various disease states and chronic physical stress from physical over-training.

Virtually none of those studies give evidence for any indication that chronic stress results in fatiguing the adrenals and causing low cortisol levels. In general, that body of evidence supports higher than normal cortisol levels being associated with various kinds of chronic stress, which I think lines up perfectly with what you’re saying.

Dr Platt: While we’re talking about cortisol, when people do testing they have a normal range and the normal range for cortisol usually goes up to 19.4 in some places it’s 23.2. However, the normal range for cortisol was actually obtained from medical students working in hospitals because they’re readily accessible and whatever. Keep in mind that doctors have increased adrenaline, almost all doctors have increased adrenaline. The normal range for cortisol’s actually higher than it should be. To me, anything above 14 is high in the morning before 9 o’clock. I just want to let you know that. Don’t go by the normal ranges.

Ari: Basically there’s a lot of hubbub around low cortisol levels in general, the relation– I guess to summarize, my angle having explored the body of evidence is that there’s no compelling evidence that supports the idea that the adrenals are getting fatigued or that this is resulting in low cortisol, or that this is resulting in the symptom of fatigue. You’re saying there’s a huge, enormous confounding variable in the vast majority of those studies, because most of them are using salivary cortisol, and you’re saying adrenaline dominance will result in a low salivary cortisol measurement, not because there’s actually low cortisol, but because it’s affecting specifically salivary cortisol by affecting blood flow to that region of the body, is that accurate?

Dr Platt: It’s very accurate. Absolutely right.

Ari: The best test to document adrenaline dominance, you’re saying is morning tests of blood cortisol levels, correct?

Dr Platt: Correct, but when people have a lot of adrenaline, actually you don’t need to do any testing. It’s pretty apparent actually. I think to me it is.

Ari: Based on the signs and symptoms?

Dr Platt: Absolutely.

Ari: What are those signs and symptoms again?

Dr Platt: Again, they’ll have trouble sleeping. They’ll be quick to anger. They’ll have tension in the back of the neck, cold hands, cold feet, possibly constipation. They may tap their knee up and down, they might have anxiety, these are all problems related to access adrenaline.

Ari: If I was going to play Devil’s Advocate, let’s say I’m a conventional doctor and I’m skeptical of what you’re saying, and I say, “Oh this, guy’s just making this whole thing up of adrenaline dominance, and we can’t even test for adrenaline. How does he really know that this is, in fact, the result of adrenaline dominance? Maybe some of those signs and symptoms could be resulting from other things.” What is the evidence that led you to strongly conclude that this was in fact adrenaline dominance specifically?

Dr Platt: Everything that I do is based on observational-based medicine, not evidence-based medicine, I didn’t do studies. Double-blind studies and whatever. Observational-based medicine is how medicine progressed over the last thousand years and around 50 years ago they threw it out.

They said it was all anecdotal and not to believe it and this is because the drug companies came in with their evidence-based medicine, which they could manipulate. I2n any event, what I have found is that by lowering adrenaline levels, all these symptoms disappear and I couldn’t really attribute people getting better to anything else.

For example, the primary approach to increased adrenaline is nutritional, and basically, it’s providing the two fuels that the brain requires. I can’t think of anything, any conditions that’ll get better just by providing the brain with glucose from vegetables and ketones from MCT oil and coconut oil. The other thing is that– let me give you an example why I’m such a believer. I had a patient come in, he was 47 years old.

Now, the reason why he came in to see me is because every morning he would wake up and vomit. The only thing that’ll cause that vomiting is adrenaline. They have another condition called sick cyclical vomiting syndrome. Again, they don’t know the cause of it, but actually, the cause of that is also adrenaline.

There’s another condition called Hyperemesis gravidarum where women vomit throughout their entire pregnancy also caused by excess adrenaline and also unknown to the medical community. He complained about morning vomiting, and he had severe fibromyalgia. I had some progesterone cream on my desk and I put some on his forearm and he rubbed his arms together and we started talking again and about five minutes later, he sat back in his chair and he looked at me and he said, “doc in my entire life, I have never felt this good.” [laughs]

Now, that to me is actually evidence-based medicine, but it’s also observational-based medicine. One of the benefits of progesterone is that it blocks adrenaline and that’s why he had such immediate relief. I’ll be honest with you. I can’t think of anything, other than adrenaline that would respond to the treatment to lower it. Again, it’s all observation, it’s not evidence-based medicine.

Ari: I got you. Let’s talk root causes and based on your earlier description and talking about ADHD and some of the other symptoms you mentioned, just looking at ADHD, this is extraordinarily widespread today. This thing of adrenaline dominance it’s not just, 0.3% of the population 0.1% of the population that has fibromyalgia, or 1% of the population maybe, it’s not some rare thing.

This is something that I would imagine you believe maybe 30%, 40%, 50% of the population is suffering from adrenaline dominance. Is that accurate to say?

Dr Platt: I would say so.

The root cause of increased adrenaline

Ari: Okay. Let’s talk root causes and I can take a stab at some of these root causes that we have going on in the modern world as far as stressors that are likely to put our body on high alert and stimulate adrenaline. What would you consider to be the most essential foundational root causes of this, or most common perhaps root causes of adrenaline dominance?

Dr Platt: Actually it’s genetic. If somebody has increased adrenaline, then one or both parents had increased adrenaline, if a child has ADHD, then one of both parents have ADHD. Increased adrenaline always runs in families, always. Again, that’s my own observation, and creative people, people in music industry, interior designers, people in Hollywood, creative people actually have the most adrenaline.

Why that’s so, I can’t explain, but the fact is that creative people had the most adrenaline. That’s why you see why I believe you see a lot of drugs and alcohol in the music industry, and actors and actresses might be getting involved in drugs and alcohol. There’s something going on now with Sean Penn but in any event– and it’s the creative people, for example, you only see bed-wetting in creative type children only and women that vomit throughout their entire pregnancy are always creative type women.

To answer your question, the primary reason why people have increased adrenaline is genetic. Now, there’s certain stresses that will increase adrenaline and whatever. Professional athletes have a lot of adrenaline, that’s why they’re- can Excel in athletes, athletic performance. People in the military, people in the army, law enforcement, they also have a lot of adrenaline.

Ari: Okay, let me ask you this. I want to push back on this statement a bit, let’s take ADHD as an example, the incidents, the prevalence of ADHD has increased dramatically in– I don’t know what the exact percentage 300%, 500% in the last few decades, as far as how common it is. This cannot possibly be due to genetics changing. When you say it’s genetics, we can look at for example, the proportion of, let’s say type 2 diabetes that can be explained genetically or the proportion of cardiovascular disease or Alzheimer’s disease that can be explained genetically, or certain genes like the BRCA gene that’s been linked with breast cancer.

It would be incorrect to say these are genetic diseases, there’s genetic propensity, but the disease is primarily a disease of lifestyle and environment that’s interacting with those genes that’s actually creating the gene, meaning a hunter-gatherer with as much genetic propensity for type 2 diabetes as possible. They could be the most genetically susceptible person in the world, but if they’re eating a traditional diet and moving their body, they won’t get type two diabetes. How do you conceptualize that when it comes to adrenaline dominance?

Dr Platt: Now this is my own personal observation and let me tell you, I have dealt with thousands and thousands of patients. I have always found, somebody with increased adrenaline that one of both parents had it also. What I maintain is that people perhaps might have a genetic propensity to have problems related to excess adrenaline and that there might be something in the environment that brings it out. I do think there’s a very strong genetic component to this.

Ari: Okay. To me, it would seem– we’re just getting out of two years of COVID, which has been enormously stressful. We have these devices in our hand and social media and just the modern world, so many aspects of how we live now are physiological stressors.

To be honest, I’m a bit surprised that you wouldn’t conceptualize those as being a more dominant factor than the genetic aspect. Of course, I’m sure there’s a genetic susceptibility to everything, but you don’t conceptualize a lot of these environment and lifestyle things as being the primary cause of this?

Dr Platt: I don’t. I hear where you’re coming from and now remember COVID has been in the last two years, but I’ve been dealing with this for the last 20 years and before COVID. It’s like when you talk about ADHD, you have the typical ADHD and you have what they call ADD, kids that have trouble focusing but they’re not hyperactive. These are the creative type children by the way. Again, what I have always found is that if somebody is what I hear call a creative-type ADHD, one of both parents were also creative. I just think that there’s a strong genetic component to it. I’m willing to be proved wrong. I really am.

Ari: I hear what you’re saying. I guess, not to harp on this too much. Hopefully, I’m doing it in a respectful way because I don’t doubt that there is a strong genetic susceptibility component. Much of my work focuses on the differential between what human biology is wired to function healthy on the modern world and how that mismatch creates all kinds of pathology and disease states. I’m inclined to see things through that lens. I guess another way of stating this would be let’s say instead of just the last 20 years, you had been doing this for the last 100 years or 150 years. You could quantify how many people, like what proportion of the population has this issue 100 years ago versus what proportion has it now.

I would bet a lot of money if this were possible to do. I would bet a lot of money that it’s a thousandfold more common or 1000% more common, let’s say, tenfold more common than it was 100 years ago. The challenge I think for you, having done it for just the last 20 years, is for that entirety of that time, we’ve been in the modern stressful world and in the position that you’re in as a physician, treating these patients, there’s a selection bias where you’re seeing that particular segment of the population. You know what I mean? I think the only way of doing it would be if you could contrast the prevalence from 100 years ago to today and then that can only be explained. It can’t be explained genetically, it could only be explained environmentally.

Dr. Platt: Okay, I’ll go along with that.

Ari: [laughs] Okay. [laughs] Thank you for granting me that. Having said that, I guess part of the reason I’m harping on that so much is because it affects how we think about fixing this solution. If adrenaline dominance is we just say, “Hey, this is purely genetic.” and it happens for random reasons, then the solution is going to be, “Well, just use this pill or that pill.” Whereas if we conceptualize it as environmental, then it becomes much more of a focus on reducing the stress at the environment and lifestyle level. I guess I’m curious now given how you’re conceptualizing this, how you think it should be ideally treated.

Dr. Platt: Well, it’s probably a lot easier to give somebody some progestin cream than it is to try to adjust their environment.

Ari: Sure.

The problem with some types of progesterone

Dr. Platt: What’s nice about progesterone is that basically there’s no downside to it. Unfortunately, doctors are prescribing oral progesterone nowadays like Prometrium. What they’re probably not aware of is that oral progesterone converts into a different hormone called allopregnanum which is not progesterone. Your listeners should understand that when I use the term progesterone, we talk about progesterone cream, not the pills. I’ve had no experience with the pills. I don’t trust them. They they give them at night because one of its side effects is drowsiness so people sleep but that’s the allopregnanum that’s causing this sleepiness.

In any event, there’re other situations that associate with increased adrenaline that we didn’t talk about, things like– My feeling is that a lot of addiction, people getting into drugs and alcohol, is because of excess adrenaline. They’re just trying to chill out. People go into detox and rehab. What happens is once they’re detoxed, they leave, they go right back to drugs and alcohol because they’re not dealing with the underlying cause. That’s one of the problems with our whole medical system is that doctors are not trained to treat the cause of illness. They just give out Band-Aids. They get no training in hormones even though hormones control everything in the body.

Again, that’s the drug companies that have complete control for our whole medical system. They have no interest in people being healthy but it’s for another session. Again, the other thing about why people should be aware of adrenaline is that it’s my contention that it’s the number one cause of weight gain, believe it or not. This weight gain occurs while people are sleeping because remember, adrenaline peaks at 2:30 in the morning. The reason why adrenaline is being released is to raise sugar levels. The whole thing about sugar, it doesn’t matter whether people are eating sugar, if the body is making sugar, if you don’t burn it up, then the body stores sugar as fat in your fat cells.

Not only you have the problem with adrenaline raising sugar levels but as soon as the body releases adrenaline, it creates stress, then the body puts out cortisol. The first thing cortisol does, it also raises sugar levels. Now while people are lying in bed, basically not moving, they’re putting out two hormones at raised sugar levels. I suspect it’s the number one cause of weight gain and nobody talks about this. This is why some people, they diet, they exercise, this, that, whatever, and they find they never lose weight. I suspect it’s because they’re putting on weight while they’re sleeping. Again, that’s my own feeling.

Things like depression, one of the causes of depression is what they call an endogenous depression. This is a depression that comes from within people who are depressed but they don’t know why they’re depressed. Again, my feeling is that this is caused by internalization of anger. Again, adrenaline is an anger hormone. Certainly, people who have trouble sleeping, people with PTSD, and people that are bipolar, this is all adrenaline, restless leg syndrome. I’m just saying that adrenaline is the cause, I think, of a lot of conditions.

When people carry a lot of tension in the back of their neck, one of the things that people complain about is called tinnitus, ringing in the ears. Again, my feeling is that the most common cause of this is the tension in the back of the neck that cuts off the circulation to the inner ear. While we’re talking about the neck, over the years—

The keys to fixing adrenaline dominance

Ari: Dr. Platt, having said all of this, I’m hearing you focus a lot on progesterone cream, it sounds like pretty much the central antidote to this problem of adrenaline dominance. Is that accurate to say?

Dr. Platt: Well, it’s pretty accurate. Actually, the primary approach is eating correctly. Because the reason why the body is putting out adrenaline is to raise sugar levels for the brain. If people actually provide fuel to the brain then the body won’t have to put out adrenaline to do it. Now, the brain uses two different fuels. One is glucose. I found that the best source of glucose actually comes from vegetables. The reason for that is that they’re relatively low glycemic. They don’t produce a lot of insulin. Candy and soda are great sources of glucose but they produce a lot of insulin which defeats the purpose.

The other fuel, which is probably more important, are ketones. People go on a ketogenic diet and this, that, whatever but I don’t recommend that because it’s a tough diet to follow. People can get ketones directly from coconut oil or something derived from coconut oil called MCT oil. Now, the benefit of MCT oil it has no flavor so you can add it to anything. The benefit of coconut oil, it has a very high heat threshold so it’s a very good cooking oil. One side dish that I recommended like sweet potatoes that have been sliced up and fried in coconut oil, rather than baked.

Ari: One of my favorites.

Dr. Platt: Oh, okay. Eating correctly is one thing. I recommend actually people eat something before they go to sleep because remember the brain runs out of fuel while people are sleeping, like some leftover vegetables from dinner. Now, where progesterone comes in, it does two things. I have people if they can, use some progesterone before they eat because as soon as people put food in the mouth the body spits out insulin. When insulin goes up, blood sugar drops, and when you get that drop in sugar, the body will be putting out adrenaline to raise sugar levels back up again. One of the ways to control adrenaline is also to control insulin. What’s nice about progesterone, it blocks both insulin and adrenaline, so you get a double benefit there. I recommend people to eat something before they go to sleep and use some progesterone cream. This way hopefully, they’ll sleep a lot better throughout the night.

Another thing I was going to mention when we were talking about tinnitus, but there’s another problem with tension in the neck. You’ve heard of people that complain about migraine headaches. What’s interesting is that every patient I have ever seen who thought they were having migraine headaches have a different type of headache called occipital neuritis. Now, the difference is occipital neuritis headaches are easy to get rid of, migraine headaches not so much.

What happens, you have what’s called the occipital nerve sheath at the base of the skull and when people have a lot of adrenaline, the muscle squeeze that nerve sheath and it causes excruciating headaches. That’s why they’re always mistaken for migraines. These are the type of headaches that shoot right into the back of the eye. In any event, putting progesterone cream on the back of the neck eliminates these headaches and prevents them. It’s just like it can help get rid of tinnitus. Usually, progesterone is recommended on the forearms but another really good place is the back of the neck.

People with restless leg syndrome they just have to massage the cream into their thighs, it’ll go in about 30 seconds. I should also mention that a lot of your listeners might have dogs and progesterone is really good for dogs also. If they have what’s called separation anxiety, they just have to put the cream inside the ear, which is like skin and it’ll get rid of the separation anxiety in about one minute. I mentioned babies with colic, they just have to rub the progesterone cream on the baby’s belly and it’ll go away in about three minutes. Bedwetting takes about 24 hours, but these are the children that also have to follow the meal plan along with the progesterone cream. ADHD, you can actually get rid of in 24 hours.

Anyway, I’m just saying that one of the nice things about getting people well, it’s very rewarding to doctors to get somebody well. [chuckles] Unfortunately, we don’t see enough of it.

Ari: Got it. To be honest my brain is struggling a bit to form a coherent framework of the paradigm that you’re presenting here. If I can summarize and please correct me where my understanding is inaccurate. It’s primarily driven by genetics that we have adrenaline dominance and this leads to many of the symptoms that you’ve mentioned and fatigue is something that overlaps with that in many cases. The primary solutions that we have to deal with it are using nutrition in the way that you’ve described and using progesterone cream. Correct?

Dr. Platt: [clears throat] Correct.

Ari: From a root cause perspective so if this is being driven by genetics, do these people also have low progesterone genetically?

Dr. Platt: I never test progesterone levels and the thing is that they probably do. It’s an excellent question. I suspect that they very well might. I think that there’s a epidemic of low progesterone levels, actually. This is why women wind up with fibroids, endometriosis, and polycystic ovaries. Of course, being on birth control pills contributes a lot to this because when they’re on birth control pills, they don’t ovulate and they don’t make progesterone. Otherwise, I’d say you’re pretty accurate. [unintelligible 00:45:04] [chuckles]

Brain health

Ari: You’re pretty convinced that there is no significant harms from using progesterone in the way you’re describing, that we don’t have to worry about excessive progesterone levels creating side effects?

Dr. Platt: In general, that’s true. There is one incident or condition. You’re familiar with type 3 diabetes?

Ari: Yes.

Dr. Platt: [clears throat] For your listeners, it’s insulin resistance in the brain. In this case, the insulin in the brain has a real hard time getting glucose into the brain cells. Now, one of the benefits of progesterone is that it does create some degree of what’s called insulin resistance. Why I say this is a benefit, this is what prevents people from getting sleep in the afternoon when insulin peaks or sleep after eating, and also sleepy when they’re driving, it eliminates that, which is a good thing.

If somebody already has insulin resistance in the brain and they use progesterone, it increase the insulin resistance, which results in an immediate outpouring of excess adrenaline. When somebody is using progesterone for the first time and all of a sudden has that increase in adrenaline and gets tensed and palpitations and nervous and anxiety, then they probably have some degree of insulin resistance in the brain. Now, two things can cause this. Number one, they could have type 3 diabetes or the other thing is that they just had no fuel in the brain, the glucose or the ketones.

What I recommend when people have a reaction that they try incorporating some MCT oil and coconut oil and vegetables whatever, and then retry the progesterone. They don’t have a test for type 3 diabetes, but one test would be the use of progesterone and whether or not they get a reaction of adrenaline. Again, [clears throat] this is unknown to the medical community but I’m just saying.

Ari: Very interesting. This opens up another avenue for exploration. Where my brain is going right now is, to what extent the strategies you’re using, while they may be highly effective in resolving the symptoms, might be a crutch rather than a solution that is addressing the underlying causes? As an example, the recommendation to eat before going to sleep. There is this relationship that you’ve touched on a bit as far as the relationship between insulin resistance and adrenaline dominance.

We can start to see some connections forming here. If somebody’s insulin resistant, they’re going to have blood sugar dysregulation where they might have periods of hyperglycemia and they may also be among the large percentage of adults that has reactive hypoglycemia as well, which is also related to insulin resistance, which is related to carrying excess body fat. Over 80% of the population is carrying excess body fat.

Again, just connecting the dots for people listening, excess body fat is a primary driver of insulin resistance, which is a primary driver of blood sugar dysregulation. I would imagine you would agree with me by saying that blood sugar dysregulation is a key cause in adrenaline dominance in causing adrenaline surges and perhaps the symptoms of night awakening. Is that accurate to say?

Dr. Platt: [clears throat] Yes, I would agree with that.

Ari: You’re talking also about lack of fuel being delivered to the brain. I would relate this also, I would tie it into the relationship with carrying excess body fat, blood sugar dysregulation, and metabolic inflexibility that is also very much related to poor body composition and excess body fat.

My question would be why not also focus or even make the central focus of correcting the body composition and the blood sugar via nutrition and lifestyle approaches to resolve that, rather than just say to somebody who maybe has blood sugar dysregulation, “Eat a meal before bed so it sustains you.” This seems more the difference between addressing the root cause versus providing a crutch. I’m not opposed to providing a crutch temporarily, but why not also address the root cause?

Dr. Platt: First of all, [clears throat] I’m a great believer in treating the cause of problem. What you’re proposing is something that I haven’t really considered but it is very interesting. I guess I like simple, [chuckles] I like easy. Again, to play the devil’s advocate, when people are able to control adrenaline, they’ll also help to control their weight because they’re not [unintelligible 00:50:31]— It’s not as if it’s being completely disregarded.

Ari: Yes, that’s absolutely fair.

Dr. Platt: The thing about progesterone, like I say, it helps to control insulin. If you can control insulin, you can also control your weight. You take a more scientific approach and logical approach. I take an easy approach.


Ari: I’m sure there are people who maybe appreciate both approaches depending on context. Definitely, as a patient, people want simple, easy, low-effort solutions. It sounds like the solutions that you’ve provided are very much that, very fast, effective fixes for the symptoms. My brain is hyper-focused on figuring out the underlying root causes and how we can address those, even if it’s not necessarily the easiest approach and the lowest-effort approach.

Dr. Platt: [chuckles] No, I agree.

Ari: I guess this also begs the question people need a prescription for progesterone to use it in a way you’re describing. Is that true or can you get over-the-counter progesterone?

Dr. Platt: What I recommend is a 5% progesterone cream. 5% means that each pump is 50 milligrams, and that’s the exact strength you need to block adrenaline. We have that on my website. They don’t need a prescription for it.

Ari: Is pregnenolone also effective in this regard or do you need progesterone?

Dr. Platt: Pregnenolone, it does down-regulate into progesterone but you have no control because it can also go into DHEA. By using progesterone, I know they’re getting progesterone. Using pregnenolone couldn’t hurt but it’s not as direct as using progesterone or 5% progesterone.

Ari: Got it. On a personal note, I’m curious because when I go through periods of intense stress like recently, I had my sister come for a visit and I had some unpleasant family drama with her that really stressed me out for a couple of days. When I get stressed I have eye twitches, my left eye will start twitching. I’m curious if you’ve experienced that and if that’s related to adrenaline dominance in any way?

Dr. Platt: [clears throat] Any type of [unintelligible 00:53:28] type behavior could be related to adrenaline, definitely. Yes, I’d say it probably was related to adrenaline.

Ari: I also had some other– My sleep was disturbed, so night awakenings. For the first time in my life, I actually had GERD symptoms. I had some acid reflux because the stress was so intense on me. I’m curious, I guess, just to loop things back into chronic fatigue, in particular. I know you had some specific recommendations for both migraines or what you’re saying is, in most cases, not actually migraines and in fibromyalgia. Do you have any specific recommendations or advice for people who are dealing with chronic fatigue?

Dr. Platt: Again, it all depends on the underlying cause. It doesn’t matter what the problem is, you have to approach it from the cause. Again, if it’s related to excess adrenaline, then the treatment would be to reduce adrenaline. If it’s due to low thyroid, [unintelligible 00:54:45] thyroid [unintelligible 00:54:47]. I don’t know if I answered your question.

Ari: Wonderful stuff. Really, really fascinating stuff, Dr. Platt. I’ve enjoyed this, and thank you for the back and forth and indulging me in that. Where can people learn more from you, follow your work, and anything else that you want to direct people to?

Dr. Platt: I have a website, [clears throat], P-L-A-T-T, If they want, they could get either an E-book of my Adrenaline Dominance or they could order the book. We had the 5% progesterone cream but more importantly, [clears throat] I also have a meal plan that they can download to lower adrenaline.

If they ever call my office number which is 760-836-3232, it’ll go straight to my cellphone, so I’m very easy to get hold of if they have any questions or this, that, whatever.

Ari: [chuckles] Are you sure you want to give everyone your personal cellphone number? I’m afraid you might be bombarded with more calls than you want.

Dr. Platt: I’m semi-retired so I have time to– I feel bad about our whole medical system that doctors don’t spend enough time with patients to– I’ve seen some really abusive type practices. Anyway. There’s a time that I wanted to change health care in this country, but let me tell you the roadblocks you run into. Anyway. [crosstalk] Medicine has always been a passion for me.

Ari: I hear you. Say again the name of your website.

Dr. Platt: It’s plattwellness., P-L-A-T-T, If people have questions if they just want to, my email is [email protected].

Ari: Perfect. Thank you so much, Dr. Platt. It was really a pleasure and very, very intriguing thought-provoking stuff. I think there is definitely a lot to what you’re saying. I think a lot of people are going to be benefited by hearing this. They’re going to connect the dots with some of their own symptoms, and realize maybe adrenaline is playing a big role in their symptom. Thank you so much for coming on and sharing your wisdom with my audience. I really appreciate it.

Dr. Platt: Can I add one little thing?

Ari: Absolutely.

Dr. Platt: [unintelligible 00:57:53] ADHD, people need to understand that ADHD is not a learning disorder, it’s an interest disorder. In other words, if a person with ADHD is interested, they will focus. If they’re not interested, they will not focus. The most intelligent, successful, creative people in the world have ADHD.

When I wrote my book Adrenaline Dominance, I talk about the good, the bad, and the ugly. The only condition I put in the good section was ADHD. Again [crosstalk]–

Ari: Interesting. Somebody should’ve told me and my parents that when I was a kid. [chuckles] It would’ve been very helpful to not pathologize it so much but what you just said was very much the story of my childhood. I absolutely, I think, to a way more extreme degree than everybody that I knew, I could not get my brain to pay attention in subjects that didn’t interest me. The school was just painful for that reason for me, up until I got to actually dictate which subjects I was going to study.

Recently, I went back and my parents actually opened up one of their safe that they stored a lot of our childhood documents, early drawings, artwork, and stuff like that. One of the things that was in there was my high school national standardized testing results. I didn’t even know this until just a few years ago when I saw this. I guess I forgot about it or brushed it off. I would say pretty average, probably in the 80s or maybe even high 70s in certain subjects, English, and math, and things of that nature but I was in the 98th and 99th percentiles for science.

As a high school student, where I had no interest in school, I didn’t work hard, I didn’t study, my parents didn’t put any pressure on me to study, I was almost as non-engaged as you could be in school, and I was still, in the entire country 98th, 99th percentile. That’s just a natural talent. The fact that I was interested in science, so I studied it on my own. I was obsessed about it. From the time I was a little kid, I was studying physiology and nutrition, fitness, and how to enhance athletic performance. I was also fascinated as a teenager with coral reefs and marine biology. I had live coral reefs aquariums and I would read. I worked in a coral reef aquarium shop.

I would read encyclopedias and I could memorize the scientific names of hundreds of different coral species and tell you where in the world they’re located and what lighting and current conditions they need and 1000 different fish species. I could tell you everything there is to know about that. That’s the difference between being interested or not interested. What you’re saying very much matches up with my own personal experience.

Dr. Platt: [clears throat] And my own. I never studied in high school or college. It wasn’t until I got into medical school that I started studying because I had no interest in anything in high school or college, but in medical school, I was interested in medicine. I can relate to what you’re saying.

Ari: Wonderful stuff. Thank you for adding that. I really appreciate it. Thank you again for coming on. I really appreciate you sharing your wisdom with my audience and wisdom and accumulated decades of experience in medicine, and really figuring just the brain that you bring to it, to try to question things and figure things out yourself through experimentation with your patients. I think it’s a wonderful contribution to the field. Thank you so much for that.

Dr. Platt: Thank you. It’s been my pleasure. Thank you.

Ari: Mine as well. I hope to chat with you again soon. Thanks so much.

Dr. Platt: [chuckles] Okay. Take care. 

Show Notes

The most common symptoms of adrenaline dominance (01:41)
The link between adrenaline dominance and fatigue (11:33)
Testing for adrenaline dominance (13:35)
The root cause of increased adrenaline (23:00)
The problem with some types of progesterone (33:12)
The keys to fixing adrenaline dominance (38:09)
Brain health (45:10)


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