Adrenal Dysfunction And How To Fix It with Dr. Izabella Wentz

Content By: Ari Whitten & Dr. Izabella Wentz

Dr. Izabella Wentz is an internationally acclaimed thyroid specialist and licensed pharmacist who dedicated her career to helping people address the root causes of Hashimoto’s (autoimmune thyroid disease. She will talk about what she has learned while researching her new book The Adrenal Transformation Protocol which is released on April 18th. 

Table of Contents

In this podcast, Dr. Wentz and I discuss: 

  • The link between adrenal – and thyroid health
  • Is adrenal fatigue the root cause of chronic fatigue?
  • The impact that poor circadian rhythm management has on cortisol output and thyroid health
  • The factors in modern lifestyle that are causing an explosion of stress issues 
  • Simple “safety signals” to show your body that it’s safe to relax and provide more daily energy
  • Basic lifestyle practices to improve thyroid balance, reduce stress and live a happier, healthier life

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Ari: Hey, this is Ari. Welcome back to the Energy Blueprint Podcast. With me today is Dr. Izabella Wentz, who is a personal friend of mine and actually one of the first guests on this podcast 5 years ago, all the way back in 2017. She’s an internationally acclaimed thyroid specialist and licensed pharmacist who has dedicated her career to addressing the root causes of autoimmune thyroid disease after being diagnosed with it herself in 2009. She’s the author of three books on Hashimoto’s, Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, Hashimoto’s Food Pharmacology, and Hashimoto’s Protocol which became a number one New York Times bestseller.

She currently lives in Texas with her husband Michael, also a good friend of mine, and their son, who’s very cute, Dimitri and also a source of Izabella’s sleep deprivation for many years now as she will talk about in this interview. She’s also the author of the new book The Adrenal Transformation Protocol, which is the subject of today’s episode. With no further ado, enjoy the episode. Let’s just jump straight into this. You have a new book that is coming out when exactly?

Dr. Wentz: It’s coming out on April 18th, and it’s called The Adrenal Transformation Protocol.

Ari: Amazing, okay. [inaudible]

Dr. Wentz: ATP for short.

The connection between adrenal – and thyroid health

Ari: ATP, oh, that’s a very nice double meaning there. As a mitochondria guy I have to love that. Okay, so tell me how you developed this. Why did this come about being, and it’s somewhat off-brand, it’s somewhat outside of your niche, somewhat obviously related, overlapping, lots of overlap, but you’re the thyroid pharmacist. That is your brand. How are you now talking about the adrenals?

Dr. Wentz: You really can’t help the thyroid without addressing the health of our adrenals. This is such a common pattern that I’ve seen in people with Hashimoto’s just going through their symptoms and looking at their labs. About 90% of them have alterations, and how much cortisol they release throughout the day. They’ve got all the symptoms, so they’re feeling brain fogged, they’re feeling fatigued, they’re struggling with sleep issues so they’re tired throughout their day. They’re wired at nighttime, they can’t fall asleep, even when they’re on thyroid medications. In fact, sometimes thyroid medications can exacerbate these issues because thyroid medications can actually cause more cortisol to [unintelligible].

How small shifts in hormones can affect anxiety and sleep

Ari: I don’t know what happened there, but you froze as you were talking about, even while they’re on thyroid medication. Then you were going into the explanation of why it still happens while on thyroid medication, which is actually something I’ve always wondered about because I have heard that many times where somebody will report that even very small doses of thyroid hormones will really exacerbate their symptoms cause anxiety, insomnia, things like that.

Dr. Wentz: One of the things we know about hormones is that they work together in symphony, right? There’s a feedback mechanism between thyroid hormones and cortisol. When we have low levels of thyroid hormones, our cortisol is going to counteract to counterbalance, and so we’re going to have a little bit of higher levels of cortisol. Once we get on replacement thyroid hormone, the cortisol clearance is actually going to increase, and so we’re going to have lower levels of cortisol when we get on thyroid meds.

For people with conditions like Addison’s that adrenals cannot produce enough cortisol, it’s actually contraindicated to start on thyroid hormones until we get on cortisol replacement, just to make sure that we’re not really clearing out that cortisol because that can be a dangerous situation in the case of Addison’s. In the case of most people that I see with Hashimoto’s and people with adrenal issues, basically what’s going to happen is you have a falsely elevated cortisol when you don’t have enough thyroid hormone on board.

You bring it on board and that cortisol just gets cleared up pretty quickly, and that can cause a lot of symptoms. People will say, “Oh my gosh, I started on thyroid meds and I was so excited because I thought this was going to be the answer to everything. I felt better for a little bit and then all of a sudden my fatigue came back and it came back with a vengeance and what is happening?” That’s it.

Dr. Wentz’s view on adrenal fatigue and adrenal dysfunction

Ari: Got it. Okay, so let’s talk adrenals and I want to get into depth with you here perhaps greater depth than you would get in with other podcast interviews because I think you know that I’ve spent a lot of time on this topic and I’ve spent a lot of time debunking notions of adrenal fatigue. I’ve spent probably a good few thousand hours digging into the literature on adrenal function cortisol levels, HPA access function in relation to various chronic stressors, and in relationship to chronic fatigue in particular. I have to imagine there isn’t more than a handful of people who have spent more time on that literature in the world than I have so I know a thing or two about it. There’s also a lot of misconception in this area.

For decades we had everybody in the functional medicine, the natural health alternative health communities, everybody believed in adrenal fatigue. To question that was heresy and you were a crazy person. You were outcasted from the in-group of natural health people and functional medicine people if you dared to question the adrenal fatigue dogma. Now in the last few years, the tides have turned a little bit, and in 2016 there was a paper of review of the literature titled Adrenal Fatigue Does Not Exist. That one also went a long way, I think, to debunking this adrenal fatigue narrative. Let’s go broad with your answer. What exactly is your current paradigm around adrenal dysfunction and how it relates to stress-related symptoms?

Dr. Wentz: Absolutely, and I know when I was first diagnosed with Hashimoto’s, I heard about adrenal fatigue and it was like a quack diagnosis and it didn’t exist. Yet I tried some of the things that were recommended for adrenal fatigue and then they helped. I think both things can be true. It’s not what the old-school naturopathic doctors are saying it is. Your poor little adrenals aren’t just feeling tired. They’re not feeling lazy and they are capable of producing the right hormones in the right amounts. They’re perfectly capable of doing that but because of how we’re responding to stress because our body tends to respond to whatever stress is out there in a similar fashion, that’s what’s going on.

We need to address our stress response, and I say stress and it’s not just somebody yelling at you and being mean. Stress can come from internal sources, it can come from chronic infections, it can come from toxins, so on and so forth. What I typically think about it, it’s not, ooh, you’re just a little bit stressed and you have adrenal fatigue and you need to get on these- you just need to really improve your lifestyle. Because that may help a little bit, but we really do need to go oftentimes a bit deeper to uncover why is your body feeling like it is under so much stress. What is currently happening in your lifestyle where your body feels like it needs to protect itself?

“Adrenal fatigue” or just that impaired stress response I feel like it can be a very protective mechanism for the body when it is feeling like something in the environment or within our body is not safe. That’s my overarching big-picture view of that. The adrenals aren’t damaged. They’re capable of producing the right amount of hormones. Typically, what I see in people with thyroid issues is that they have low levels of cortisol throughout the day. It’s not because they have Addison’s disease. A lot of it has to do with their lifestyle and whatever else is going on physiologically with them.

What is the cause of cortisol imbalance?

Ari: Okay, let’s talk more about that. I was going to ask you to get into some specifics of what exactly the adrenal abnormalities are. That’s a good insight into it. Obviously, there’s this thing called HPA access dysfunction, and I think there’s various different things that might fall under that umbrella term. One of them is an abnormal diurnal curve of cortisol. We’re supposed to have high levels in the morning, and then it’s supposed to decline throughout the day into the night where it’s supposed to be low. One thing that someone can have is too low of levels in the morning and too high of levels in the evening.

They might maybe struggle to get energized in the morning and they might have too much energy and racing thoughts and anxiety and have difficulty sleeping at night. Another thing would be what you’re talking about where somebody’s just more chronically low and it will be worth digging into that if it’s not this narrative of adrenal fatigue, these poor little adrenal glands are getting worn out from the chronic stress now they can’t produce enough cortisol. What is causing that? I want to get into that in a second.

I think the vast majority of the literature on chronic stressors of various types, whether we’re talking about work stress or financial stress or relationship stress or anything, any other- even physical stressors of various kinds, even metabolic stressors, like some people who have diabetes, people who are chronic cigarette smokers, alcohol consumers.

I’ve looked at all that literature and how it relates to cortisol levels, and almost without exception, almost every category you look at the people who have chronic metabolic stress, as an example, people with high job stress versus low job stress, smoke lots of cigarettes, people who smoke lots of cigarettes versus people who don’t smoke or smoke very few, people who drink a lot versus people who drink much less or not at all, almost without exception every category you look at, people with more of that stress have higher levels of cortisol than people who don’t.

Which is exactly the opposite of what the adrenal fatigue hypothesis would predict. It would predict that these various kinds of chronic stressors would be associated with lower levels of cortisol, but they’re not. They’re associated with higher. What you’re seeing in this subset of people that you’re dealing with is more often than not this chronic low level of cortisol.

Dr. Wentz: Yes, I’ve tested hundreds of people with the adrenal saliva test, and I used to use this test that is no longer available, but the test was so accurate I could just essentially look at the test and describe the person’s symptom to them and they would say, “Okay, yes, this matches exactly.” 90% of my people, close to 90%, would have low levels of cortisol, what I like to call basically a flatlined adrenal curve where, like you said, it’s supposed to start off with high cortisol in the morning. You get this cortisol kick, you jump out of bed, you’re excited, life is good, and then throughout the day you get a little bit more tired and tired, and at nighttime you have no cortisol, and you drift off into bed and have beautiful dreams.

Most people would have kind of, “Oh, man, I’m barely getting out of bed. I’m barely trudging by. I feel a little bit anxious here, and then towards the end of the day I get this extra little kick,” where you look at their evening cortisol and their morning cortisol and they’re almost the same. Obviously they’re not going to be much more tired than they should be. What I’ve noticed is that typically people will start off and the people that had newer diagnosed or had thyroid issues for shorter, they tended to have higher cortisol levels. They would have that cortisol pattern that’s described in the literature.

We hear a lot about a lot of cortisol is bad, having too much cortisol is bad. What we know is cortisol you need to have just the right amounts of it. Too much is not good, but not enough is not good. That cortisol can be very, I guess, damaging to the body, for lack of a better word. When we have cortisol, basically it tells our body that we’re in survival mode here. Let’s not repair our body, let’s break it down because we need to produce more cortisol, people. Come on, get it done. Typically, that’s how it starts off, but then the longer you’re in under that stress, eventually your body is going to say, this is just unrealistic.

It’s like the boy that cried wolf. You can’t be in a high cortisol all the time. Even when you are stressed out, your body is not going to produce as much, and so your body, to protect itself, will down regulate the cortisol production. This is typically what I see in people with thyroid issues, when they’ve had thyroid issues for a long time and they initially will be very stressed out and essentially they burn out towards the end where their body is like, “I’m not listening to you.” Yes, they’re stressed, but we can’t have this much cortisol happening all the time. This is what I’ve seen in my experience, is just basically the brain, the HPA axis just is like, “No, we’re not doing that.”

Ari: This is interesting. I just want to maybe touch on a couple of nuances. True Addison’s disease is the actual inability of the adrenal glands to produce enough cortisol. You’ve got the brain producing this hormone ACTH that is basically screaming at the adrenals to produce more cortisol, and what you see in that is high ACTH levels and low cortisol levels. The brain is saying we need more cortisol. The adrenal glands can’t produce it. That’s true adrenal insufficiency, Addison’s disease.

What you’re saying is that these people have adrenal glands that are still perfectly capable of producing enough cortisol, but there is an adaptive thing that is occurring in response to chronic stress where you’re saying the body is basically pulling back on cortisol. It’s pumping the brakes in a way and saying, “Calm down, you need to relax. We need more rest, less stress mode, less go, go, go mode,” if I’m catching you correct. Is that accurate to frame it the way I said there?

Dr. Wentz: Yes, you explained it really well.

Ari: Okay, so there’s one more aspect of this that I wanted to elaborate on which is, if that’s the case, have you done 24 hours total cortisol measurements on these people? Have you determined whether they are actually producing normal amounts of cortisol over a 24-hour period and it’s more of a flat diurnal curve, or is it truly low cortisol output over a 24-hour period?

Dr. Wentz: The only tests that I’ve done were tests like the Dutch test which uses urine and then the saliva test. It’s not something that I would hook up somebody to like a measuring tool for 24 hours a day. Typically the patterns are what I would see in people with that would describe symptoms of fatigue and symptoms of brain fog.

Ari: Okay, but particular you see a big drop in morning cortisol levels. It’s where you really identify that these people aren’t getting this big peak like they should be having in the mornings. Is that accurate to say?

Dr. Wentz: Yes, and I would say majority, and of course I have had some people that have high cortisol all throughout the day, but the majority of people with Hypothyroidism and Hashimoto’s, they did present with that way where they just had a tough time getting up in the morning and sure enough their cortisol levels were low at that time.

Is it healthy to be a night owl?

Ari: I’m sure you must have stumbled across the literature on being a night owl chronotype in relationship to this story. Of all the different factors that I looked into, I found that one to be the most impressive as far as the magnitude of how much of an impact it had on morning cortisol levels in relationship, even in healthy people with no symptoms. Just whether somebody was a morning person or a night owl could predict massive differences in morning cortisol levels. Have you seen any of those studies?

Dr. Wentz: I’ve looked at a lot of studies on why people have a hard time getting up in the morning and what’s happening, and there’s a different shift where for whatever reason your circadian rhythm is not aligned to essentially the sun. It might be aligned to more of like the moon cycles, and so you tend to be like a night owl. You’re more of a werewolf than you are a human because you’re more aligned with those kind of cycles.

Ari: That doesn’t sound good for a diurnal animal. Sounds like that might be optimal for a nocturnal animal but not so much for the human species.

Dr. Wentz: Right, but I think there’s actually a way to reset it. I used to think I was a night owl and I used to think that was who I was, and I’m a morning person. I know part of the reason, and you and I have talked about this and why I kind of had some new revelations about how do you actually not have trouble waking up in the morning? How do you have energy throughout the day?

How do you deal with the brain fog? Thanks to my sweet son who didn’t sleep for a very, very long time and that meant I didn’t sleep I was essentially a night owl because I had to be up at night taking care of him and I’d have trouble waking up in the morning. At that time I had this thought, “Okay, I can’t quit caffeine and I can’t sleep at night. I can’t do all these things. How do I stay healthy?” This was where some of the new insights about adrenals came to my head and energy production and so on and so forth.

Ari: There was a study published in the Journal Nature maybe seven or eight years ago. It’s one of my favorite studies because it’s so primitive the intervention they did. They basically took a bunch of self-proclaimed night owls, and they put them on a camping trip, essentially, with no artificial light. All these people who normally went to bed at 1:00 or 2:00 AM and swore up and down, “I’m a night owl. I’ve always been a night owl. This is just how I’m wired. My natural bedtime’s 1:00 or 2:00 AM,” all of a sudden, within less than a week, they started going to bed at 9:30 or 10:00 PM and waking up naturally without an alarm clock at 6:00 or 6:30 AM.

What we can extrapolate from that research is that the night owl chronotype is largely, of course, there is a genetic component. Some people are more true night owls than others, but I would go so far as to say that the vast majority of people who believe that they’re night owls are not actually night owls but have just been programmed as such by modern society and modern artificial lighting and that sort of thing.

Dr. Wentz: It’s such a pedestrian recommendation, but one of the things that I recommend actually to help you get more energy in the morning is step outside and get some sunshine first thing in the morning. I know it’s much easier when you live in Costa Rica or Los Angeles or Texas. When I lived in the Netherlands and when I lived in Chicago and even when I lived in Boulder, that wasn’t as easy to do, of course. Just getting bright light therapy, like you said, on a camping trip where you have access to, well, a tent, so you’re going to be outside in the bright lights of natural lighting throughout the day. You’re going to have more energy throughout the day, naturally.

Because you don’t have blue lights and, hopefully, you didn’t ring your cell phone and your laptop on the camping trip, but you’re going to have an easier time falling asleep at night when it’s naturally dark. Those are simple things that people can do. I know when I lived in a different climate, I would use a bright light therapy box. People can definitely still have access to that, even if they live in Alaska and not close to the equator.

Stress, a common symptom of adrenal dysfunction

Ari: Okay, what are some of the key symptoms that you see associated with this? Subjectively, how would someone listening to this know that they fall into this category of people with adrenal dysfunction like you’re describing? Is it something they have to go get their cortisol tested or subjectively do you find that there are symptoms that are really specific to this kind of adrenal dysfunction that don’t have massive overlap with lots of other possible explanations as to what their symptoms could be caused by?

Dr. Wentz: That’s a good question. I think adrenal dysfunction, HPA dysfunction is probably the more accurate term, is how the body reacts to stress. You have this cluster of symptoms and it’s convenient to have a name for them. Maybe it’s not always the most accurate name, but it makes sense when you have fatigue, especially trouble waking up in the morning, chronic fatigue throughout the day. You might feel more wired and tired. You might feel a bit moody throughout the day. Maybe after lunch you might have the three o’clock afternoon slump where you just want to take a nap.

You might kind of feel anxious throughout the day. You might have trouble falling asleep and having a racy mind. Having brain fog and memory issues is common. Feeling overwhelmed, I would say, is going to be a big cardinal sign for me. You’re just like, “Oh my gosh, not one more thing. Basically, doing really easy, not easy, doing very basic household things tends to be overwhelming. Somebody calls to say hi, and you’re like, “Oh, no, what do they want from me?” Just feeling on edge at all times is the way that people describe being in this state.

Ari: I feel like you’re describing 98% of Americans.

Dr. Wentz: Pretty much. It’s true.

You say that and it’s very interesting because I have a lot of girlfriends from high school that would reach out to me after I published my books on Hashimoto’s, and they’d look at some of the symptoms and look at some of my blogs, and they’re like, “But I’m overwhelmed. I’m anxious. I’ve put on some extra weight. I have libido issues. I can’t sleep at night. I don’t have Hashimoto’s though.” Like, “Can you help me?” A lot of it is like, “Yes,” it’s like a lifestyle change. Let’s rewire your stress response. Let’s rewire your circadian rhythm, and then you’re going to feel better.

You’re going to have more energy when you’re supposed to. You’re going to sleep better at night. Your body’s going to recover much better. I do think it is a chronic thing. Many of us in today’s society are exposed to these stressors and I always say, “We’re cave people living in a modern world with our cave man and cave women genes and all these things are telling our cave genes that something’s off. When would a cave man have lights on all night? If he was keeping watch on something. If something dangerous is going to happen.

Ari: Yes. Absolutely. I’ve spent actually over a long time, but I’ve gone on another little deep dive on this lately, watching videos on hunter-gatherer tribes. A lot of people don’t realize there are still hunter-gatherer tribes that exist in the world today. It’s not just this thing that existed 10,000 years ago. There are still in Africa, in South America, in certain other parts of the world that these tribes still exist. Just a bit of a digression, but I can’t resist. There’s a really interesting island off the coast of India, off the coast of the Anderman Islands called Sentinel Island. It’s considered the last uncontacted tribe in the world.

There’s a really interesting video on YouTube, 30-minute-long video that was just published a few weeks ago where it’s titled something like Going to This Island Will Kill You. Basically, to make a very long story short, most attempts to make contact with this tribe have resulted in the tribe coming out with bows and arrows and shooting at anybody who approaches the island or if somebody lands there like some boats, fishermen and one Christian missionary a few years ago who went there to try to convert them to Christianity, almost everybody is killed. These people still exist there in the same way that they’ve existed for tens of thousands of years.

They have no contact with all of the buildings and technologies and cars and planes and internet and computers, that exist just 30 miles away from them on the Andaman Islands off the coast of India. It’s very interesting. The point of this is to say that when you watch videos on hunter-gatherer lifestyles, you realize that their existence is pretty low stress, especially psychologically. It’s far, far, far lower stress than modern humans. Relatively speaking, they live a very leisurely lifestyle. There’s a lot of lounging around, of just hanging out and not doing a whole lot.

Maybe you’re tending to the kids, you’re fetching water, you’re cooking, you’re eating, you’re going on a hunt, whatever the case may be, but lots of lounging and a pretty chill, relaxed existence. If you ask them what is the meaning of life or what is happiness? What gives you happiness? You ask them to explain how they derive happiness, they’ll say things like having a successful hunt is happiness, getting meat for my tribe, my family is happiness. It’s very simple. It’s a very simple blueprint for happiness. Whereas us modern humans have this endless complexity around these questions, a level of infinite complexity that makes it almost impossible to achieve these states.

Dr. Wentz: A happiness flowchart that you need to have all of these different points met, right? [laughs]

Ari: Yes, exactly. We’re constantly, go, go, go. We’ve got the whole keeping up with the Joneses culture. We’ve got the hustle and grind workaholic type culture, super materialistic culture. Yes, it’s a very superficial culture as far as how we’re constantly comparing ourselves to other people. All of that leads to a very high baseline level of stress and anxiety in our lives that I think humans are not really wired for, biologically speaking, when we examine our ancestral way of life. How much do you think that plays a role in this whole thing, the way that modern culture and society is?

Dr. Wentz: I think it’s a huge stressor for sure. You’ve got TV and it’s programming you and selling you that something dangerous happened. There’s the Next-door app that tells you about something happening in your neighborhood. Somebody got shot or you had a fire. It’s just all this information that’s letting your body know that you’re not safe. You feel this need to constantly be productive. Whether that is working on your side hustle or doing this, or going shopping, or doing all this maintenance and you’ve got emails to check and so on and so forth. I think we should all be ladies and gentlemen of leisure.

One of the things I recommend throughout my book is to actually give yourself opportunities to enjoy life and just enjoy the simple pleasures of life. Find ways to boost your oxytocin levels through being with other people and bonding with other people, creating just for fun. I know a lot of times you’re good at something and you end up turning it into a job. You’re a really good writer and you end up writing books and now you become stressed out because you have all these book deadlines, or maybe I’m just talking about myself. Then there’s other things we can do that are just for fun and that just clears our mind.

That just makes us really present in the moment and having those opportunities throughout the day, not just when we go on a vacation for two weeks and we unplug, but just doing that mindfully throughout the day, every day, just little doses of that that’s going to send a nice safety signal to the body to let you know that, no, we’re not in a famine. We don’t have to produce all these stress hormones. We don’t have to down-regulate. We can reboot and we can rebalance.

I do think just the psychological stress component of everything that’s going on, especially in the last few years with the war, the pandemic, the various people having their rights have changed and it’s just stressful. One of the things I recommend actually is turning off the TV much as you possibly can, especially any news channel tuning that out. Because a lot of times those messages they’re hijacking our bodies. It’s like an amygdala hijack where you’re like, “Oh no, am I in danger? Am I in danger?” That’s stressful for the body.

Ari: This pattern of lowered cortisol seen as an intelligent adaptive way that the body is responding to a state of chronic stress like we talked about earlier this way of pulling back and saying, “Hey, I’m overwhelmed. There’s too much chronic stress. Let’s tone things down.” How does that actually work physiologically? Do you have any sense of what is going on as far as how lower levels of cortisol are translating into protection for that person? I don’t mean necessarily the biochemistry of this, but what is the big picture of that? How is it adaptive? How is it helping that person?

Dr. Wentz: Yes, I love talking about the big picture. Let’s say if you were indeed in a famine or in a war or in a situation that was unfriendly, what would be the best way to survive? Would it be to go outside and run around and be a go-getter and interact with lots of people? Probably not. It probably would be to retreat back in your cave and sit on your couch and sleep as much as you can, conserve your energy, maybe hold onto some weight so that you don’t have to go out and hunt every single day. It is a way for the body to be protective to pull back from whatever danger is going outside. You typically have a person that’s chronically fatigued you’re just not doing much. You’re hanging back in your house and just avoiding things. That can be protective. If there was something dangerous going on outside of your home, just staying inside in your bed is going to keep you safe.

Ari: Yes, totally. I think from this perspective, you can see cortisol as an action hormone, motivating the person to get up and go into action to go do stuff in the world. There’s one interesting study that I remember from when I spent several years doing all this review of all these studies on cortisol and chronic stress and chronic fatigue. It’s a super interesting study. It’s obscure. I’ve never heard anybody else talk about as you probably have never seen it, but it looked at morning cortisol levels in the same individuals on workdays versus non-work days.

Dr. Wentz: I bet on work days they just did not want to get out of bed or I–

Ari: No. The opposite. On workdays, they had higher levels of cortisol and on non-work days they had lower levels.

Dr. Wentz: Interesting.

Ari: That would be what you expect in a healthy person that on a day where they feel some psychological pressure to go out and get stuff done, they’ve got to go get ready, they’ve got to go to work, they’ve got to be productive. The pressure is on, cortisol is elevated, and then on non-work days, it was like almost cut in half. When they didn’t have pressure, when they got to just hang out and chill. What you’re talking about is somewhat different because that’s a healthy person context and that’s describing healthy responses.

What you’re talking about is this pattern of what happens if you’re chronically overwhelmed with too much stressors. Now the body is using the lowered cortisol to pull you back from engagement and action and saying like, “No, you’re, you’ve got too much going on, dude. Let’s tone it back, dude or dudette I should say. Let’s calm down, let’s pull the brakes a little bit, and let’s try to relax a little bit more and not be in go mode so much.”

Dr. Wentz: Interesting the pattern that I see, and it’s not through measuring cortisol, but just what people have described, especially ones that don’t like their jobs, is like, “I just dread getting out of bed in the morning and then on the weekends I just get right up.” If they’re on vacation they’re like, “I jump out of bed in the morning every day,” and that just goes to show, it’s like, “What it is it about your lifestyle that is bringing you so much stress?

Why we need to approach health holistically

Ari: As humans, we also need to be careful not to reduce everything down to assuming our whole subjective state is being controlled by one particular hormone or one particular neurotransmitter. Oh, you’re depressed. Oh, you need to take this serotonin-boosting substance. Oh, you’re lacking energy. It means you’ve got low cortisol levels or whatever. The situation you’re describing is I would say much deeper and more complicated in the sense of humans need lots of things to be happy and a good mood and highly energetic and motivated and focused and productive and for their brain and body to produce lots of energy.

We need good nutrition, we need good sleep, we need good circadian rhythm, we need exercise, we need good hormonal rhythms, good neurotransmitter levels to be providing the precursors of all these different neurotransmitters. We need community and social support. We need to be aligned with working in something that we are passionate about and we enjoy and working towards something that we find purpose and meaning in. When you start removing pieces of that, and maybe even ignoring all the biochemistry stuff of health, but just say, let’s take somebody and socially isolate them instead of allowing them to be with their family or community.

Let’s take somebody who is super passionate about music and stick him in a customer service or tech job doing work that they hate every day. You’re going to have a very complex psycho-spiritual emotional response to that as a human being and which will also be correlated with certain neurotransmitter and hormonal profiles that are related to those symptoms that you’re experiencing. Subjectively for me, if I was asked to do a job every day that I didn’t like, my life, my happiness level, my mood, my energy level would all be dramatically different from what they are.

We talked about circadian rhythm earlier, and given that cortisol is a hormone that is very strongly tied to the circadian rhythm, and we talked about chronotypes and how much that impacts the story. As you’re looking to fix this problem and fix these symptoms that you’ve described, where would you rank the importance of circadian rhythm in sleep in the hierarchy of priorities of what people need to work on to fix these issues?

Dr. Wentz: That would be a top priority. One of the fastest ways to get your cortisol lower or to get into HPA axis dysfunction is through sleep deprivation. One of the best ways to get out of it is going to be making sure that you are getting adequate sleep. Part of that is, like you said, it’s aligning with the natural rhythms and making sure you get plenty of bright lights throughout the day, you’re eating food throughout the day. I typically like to recommend electrolytes first thing when you wake up in the morning to help you wake up. Then at night time making sure that you have a wind-down routine.

There’s really fundamental things that everybody can do that are important such as sleeping in a colder, darker room that’s going to help you fall asleep better. That’s going to prevent you having nightmares. You can take an Epsom salt bath or take some magnesium at bedtime that’s going to help you wind down and fall asleep making sure that you’re not watching TV or on your phone right before getting all of the different blue lights in your bedroom. Cover those up, so you’re not exposed to that. Sometimes it can go a bit deeper than that, but these are the fundamentals that I recommend.

That is really part of the– I talk about 15 different safety signals that we want to send our bodies. When we think about why we have all these symptoms and why we’re not feeling well is because essentially, we’re sensing the world is hostile. We want to send the body more safety signals to let the body know that it’s safe. You could relax. You can get some rest. Sleep is such an important safety signal as is being aligned with our circadian balance. This is going to let you know that it’s safe. If you get better sleep, your body is going to heal. That’s when we do most of our brain and body healing is when we’re asleep.

Dr. Wentz’s top tips for adrenal transformation

Ari: Absolutely. What are some of the other maybe top 2, 3, 4 biggies in your system of the adrenal transformation protocol?

Dr. Wentz: Blood sugar balance is going to be really important. Making sure that you’re eating throughout the day. You’re eating enough food. You’re eating foods that aren’t inflammatory to you. Inflammation from foods, or from even not getting enough food can be a signal to your body that you’re not safe, and so we’re eating really, really good food throughout the day. We’re hydrating with electrolytes. That’s another safety signal to make sure that you are well-hydrated. Another safety signal is going to be focused on restoring key levels of specific nutrients that might become deficient when we’re super stressed out.

The B vitamins, vitamin C are some of the nutrients that we tend to burn through as well as magnesium. I do recommend getting on some mitochondrial support. That can be very, very helpful. Then there’s this whole thing about your lifestyle and what are you actually doing in your day-to-day life to feel good? A big part of it that I really love to focus on is pleasurable activities throughout the day. Doing things that just you enjoy. I know it sounds so basic, but it works really, really well. I saw somebody saying, “I actually tried relaxing and I tried eating healthy and I tried getting some rest, and I hate to tell you this, but this actually worked. I actually feel better.”

Ari: You know what? For me, this is what it’s all about. We need to recognize the reality that over 80% of the modern disease burden in the West are diseases of nutrition and lifestyle. They’re driven by problems with our diet, problems with too much sedentary lifestyle, problem with circadian rhythm and sleep, problems with chronic stress, problems with toxicity, problems with these cigarette smoking and drinking.

As health geeks, like you and I are, and people who are in the natural health functional medicine space, there is a tendency among practitioners to constantly try to, I would say, to try to one-up one another in terms of their complicated systems and how deep they’re going into the biochemistry of specific diseases. The reality is 80% of the disease burden is driven by nutrition and lifestyle issues. Going into these very complicated biochemistry explanations, “If only you take this substance in this amount, it will alter this chain of duh, duh, duh, duh, duh.”

If you don’t address the foundational nutrition and lifestyle strategies, you’re not going to get a profound change. I think so many people right now are missing the basics. There’s also a strong tendency, I think, for people in the general public because they’ve heard these things so many times like, “Oh, I’m supposed to exercise and I’m supposed to eat right and eat good nutritious foods and eat more salads and stuff like that and eat more protein.” People have a tendency, subjectively, to delude themselves into thinking that they are living an extremely healthy lifestyle when they’re actually not.

I can’t tell you how many times I’ve seen people who are living a very typical lifestyle, eating plenty of processed foods, not doing much exercise, who will tell me how healthy their lifestyle is and how they do so much exercise and how they eat such a great diet and duh, duh, duh, duh. We have to not underestimate the power of self delusion, and this is something that we’re all as humans extraordinarily susceptible to, to making ourselves believe we’re being much more productive than we are, doing much more work than we are, being much healthier, having much healthier habits than we are, eating much fewer calories than we really are.

We have this tendency to do that. All of this is to say that I think the basics of optimizing nutrition and lifestyle and doing that on an extremely high level, where you really do those foundational nutrition and lifestyle habits really well is where it’s at, and that’s where most of the healing will happen.

Dr. Wentz: It’s really incredible. My program is only four weeks long, and so by week one, I usually would have, and I started doing these lifestyle changes because I was a sleep-deprived mom, and I just was exhausted. I was like, “What else can I do other than take hormones and quit coffee? Obviously, I can’t sleep all night. I wanted to find out some things I could do, and I felt significantly better in just a couple of weeks. I decided to pilot it with my group of people with Hashimoto’s. We’ve had over 3,000 people take the program now that got turned into this book.

80% of them feel better. By week two and week one, I get all these questions about should I get on hydrocortisone? Should I do this adrenal test? Should I do this test? What should I do? It’s all very fancy stuff. Then by week two, they’re like, “Oh, wow, I actually am just stepping outside and I’m drinking your adrenal kickstart drink that supports healthy cortisol production throughout the morning. I’m doing adult coloring books. I have a beautiful adult coloring picture inside of the book and inside of the program. They’re like, “You know what? I don’t feel anxious, and I’m doing your diet, and my anxiety was at an 8. Now it’s at a two.

It’s usually like week two and three. The first week everybody’s super anxious, super overwhelmed. Then by week four, they’re like, “My libido’s back. My husband wants to thank you, send you a package.” It’s just amazing what happens. You can transform your whole body with really simple little safety signals. Yes, nutrition is fundamental. Making sure you’re hydrating. I only use 6 different supplements throughout this program. I know whenever I worked with people, they’re like, “Here is my bag-o-supplements with everything that I’m on.

You’re like, “This interacts with this and this could suppress your levels, and this could boost your levels, and you’re just like, “Okay.” It’s very foundational. It’s very fundamental. It doesn’t require testing. It doesn’t require hormones, and it’ll make you feel better when you just do these fundamental things. Yes, there’s some people that may need to go after chronic infections. They may need to go after toxins, but when your body is in a very rested state, it’s going to be able to fight infections better, naturally, and your detox pathways are going to work better as well.

It’s just very foundational to put your body into this, I guess, I like to call it rest and digest state versus being constantly in a state of like, “Oh, my goodness, what’s going to happen?” It’s a big shift that I see in the people and it’s beautiful to witness every time.

Ari: Absolutely. Dr. Wentz, I want to thank you so much for your time. It’s been a pleasure to reconnect with you after five long years of not having you on the podcast. I’d missed you terribly, but it’s wonderful to have you back on and I’m so glad that you’re coming out with a new book. Tell people where they can get your book and is it an online program as well that’s related to that or is it the book? Let people know everything that you’ve got going on.

Dr. Wentz: Sure. Thank you so much for having me back. I’ve missed you too. I made a promise to myself that I wouldn’t go back to work until my son started sleeping, because it just wasn’t kind to [laughs] make myself work all day and be up all night. I’m back and I’m excited to be back. My book can be found on Amazon and Barnes and Noble, wherever find books are sold, The Adrenal Transformation Protocol.

I also have a quick start guide. It’s an ABC guide. Just some of the basic foundational things you could do. You could find that at and that’ll go over some of the B vitamins, vitamin C as well as magnesium, how to use that, some of the lifestyle changes that we talked about. I have a little quick guide for people to do that on their own. Then I can always send people information about when we’re doing our next live adrenal program. We’re only doing it probably once this year in June. If you wanted to get more information about that, please sign up with me.

Ari: We’ll set links up to all of that information that you just mentioned on the show notes for this page, which I will set up at– What URL should I use? I probably have already used Izabella, so maybe I will use, I don’t know, I might also have used Adrenal something that’s the challenge here. Jeez. All right, I don’t know what I’ll use.

Dr. Izabella Wentz: Izabella [crosstalk]–

Ari: Let’s do a ATP book. We will put links to everything you just mentioned or people can go directly to your site, thyroidpharmacist for more information on that. Dr. Wentz, thank you so much for your time. It was a pleasure. I look forward to our next conversation and hopefully seeing you and your husband in person sometime soon.

Show Notes

00:00 – Intro
00:22 – Guest intro
01:40 – The connection between adrenal – and thyroid health
03:33 – How small shifts in hormones can affect anxiety and sleep
05:30 – Dr. Wentz’s view on adrenal fatigue and adrenal dysfunction
09:33 – What is the cause of cortisol imbalance?
18:08 – Is it healthy to be a night owl?
23:10 – Stress, a common symptom of adrenal dysfunction
37:00 – Why we need to approach health holistically
42:53 – Dr. Wentz’s top tips for adrenal transformation


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