00:00:00:05 - 00:00:24:22 

Noah Reed 

Welcome back to the Dutch podcast, where integrative medicine providers can expand their understanding of functional endocrinology and testing. And everyone, no matter who you are, can learn more about their body’s most complex communication system. I'm Noah Reed, vice president of sales and marketing for the DUTCH test. Coming up on this week's episode, we're asking the expert, Dr. Deb Matthew, about the power of the circadian rhythm. 

00:00:25:04 - 00:00:55:05 

Noah Reed 

She's with us today to talk about how cortisol, melatonin and DHS all work together to maintain a normal, healthy sleep and waking cycle and what you can do to get your sleep back on track. Deb Mathew, America's Happy Hormones Doctor is a bestselling author, international speaker. Wife and mama. Four boys. Dr. Deb suffered for years with exhaustion and irritability due to hormonal imbalances that prevented her from being the wife and mother that she wanted to be. 

00:00:55:15 - 00:01:21:05 

Noah Reed 

After experiencing a life changing transformation, she is now on a mission to spread the message that living well is the best medicine and runs for private practice. Signature Wellness in Charlotte, North Carolina. Dr. Matthew is a diplomat of the American Board of Anti-Aging and Regenerative Medicine and the American Board of Integrative Medicine. She has presented lectures on hormone health across the U.S. and around the world. 

00:01:21:12 - 00:01:31:06 

Noah Reed 

She's also the author of two bestselling books and has been featured on national radio shows, podcast and TV Welcome, Dr. Mathews. And let's get started with the show. 

00:01:31:19 - 00:01:38:03 

Mark Newman 

Thanks, Noah. And thank you to Dr. Deb Matthew for joining us today. So happy to see you and have you on with us today. 

00:01:38:17 - 00:01:39:15 

Deb Matthew 

It's great to be here. 

00:01:40:06 - 00:02:01:03 

Mark Newman 

So, we're having lots of conversations about hormones. You in particular came to mind when we when we started talking about diurnal patterns and rhythms of hormones and that sort of thing. So. So plenty of conversations to be had on. Are you making enough of this hormone or are you making enough of that hormone? What is the metabolism look like? 

00:02:01:03 - 00:02:26:12 

Mark Newman 

And of course, those are conversations with the Dutch test that we love to have. But I wanted to zero in for you on that topic of those daily patterns that we see in some hormones. Of course, cortisol comes immediately to mind, and we'll talk about that. But can you just talk a little bit about the importance of your daily rhythm as it relates to our life and our hormones, and all things related. 

00:02:28:02 - 00:02:55:03 

Deb Matthew 

You know, the body is so fascinating, isn't it? And we naturally have daily cycles. We all know that, right? We're awake in the day and we get tired, and we go to sleep at night. And that has been part of human life forever. And in fact, all organisms have some degree of circadian rhythms. And it's such an important network of communication for how this all works. 

00:02:55:03 - 00:03:16:09 

Deb Matthew 

And our hormones are a really important part of it. And when our circadian rhythms are out of whack, when we're not, when we're not either following what would naturally be the normal circadian rhythm, or when those circadian rhythms are not following a normal cycle that makes us not feel good. We can have all kinds of symptoms and it can actually promote disease. 

00:03:16:16 - 00:03:37:01 

Deb Matthew 

So these daily cycles are really important. And of course, we have monthly cycles, especially women. We have monthly cycles that kind of go along with the moon and how the earth is turning. It's all really fascinating. And we even have cycles that change over the course of the year. So our bodies act a little bit differently in the winter months than they do in the summer months. 

00:03:37:06 - 00:04:02:00 

Deb Matthew 

So this importance of these cycles is something that in modern medicine and in modern times, we kind of forget about and we do tend to mess them up because we've got electric lights for our phones all the time. We don't honor our body's natural circadian rhythms, and that's one of the things that is preventing us from being just as healthy as we can be.

00:04:03:04 - 00:04:23:00 

Mark Newman 

So as it relates to those topics, in terms of daily rhythms, what are some of the top things that you see that people come to see you for and say, Hey, I'm struggling with X, Y and Z? What are some of the things that really lead you into that conversation about those daily rhythms that they're probably screwing up with their iPhones at 2 a.m. and know that sort of thing? 

00:04:23:12 - 00:04:43:22 

Deb Matthew 

So here is what I hear all the time is they will say it's hard to get up in the morning, and a really typical thing will be like the alarm goes off and they press news a couple of times and then they kind of drag them selves over to the coffee pile because they need a little caffeine to wake up their brain. 

00:04:44:06 - 00:05:07:14 

Deb Matthew 

And then once they finally get moving, they're OK for a while. But mid-afternoon to three, 4:00, they get that slow and now they need more caffeine they need more sugar, they need something to eat, something or a nap. Maybe they need something to get them through till suppertime, till dinnertime, and then a lot of people will get tired really early in the evening. 

00:05:07:14 - 00:05:30:05 

Deb Matthew 

730 8:00, you know, they're falling asleep while they're watching TV on the couch. But if they stay up late enough now, nine, 10:00 at night, now their brains are awake and they're getting all this work done and they're clean, not the kids. And now they can't fall asleep. And when they finally do fall asleep, then they wake up at two in the morning and at four in the morning, and then the darn alarm clock goes off way too early and they're not ready to get up yet. 

00:05:30:15 - 00:06:01:15 

Deb Matthew 

That pattern we see all the time, I'm sure a lot of people can relate to that. And needing coffee in the morning and a sleeping pill at bedtime has practically become normal in our society. But that's not normal. It's not normal to have a crash and burn in the afternoon. And I've lived this personally. I remember before I knew about functional medicine and getting my hormones in balance when I was a regular doctor, one of my kids would wake me up so early in the morning and I would he was little. 

00:06:01:15 - 00:06:26:16 

Deb Matthew 

I had to get up with him and I would park him in front of the TV and sit on the couch and there's nothing on at 530 in the morning back then, and I would just try to close my eyes. I was so exhausted I could not function. And, you know, like little kids will do. He's trying to pry my eyes open and I couldn't function until about 7 a.m. And at 7 a.m., I was able to wake up and start moving and get breakfast, etc. Before 70 I couldn't function. 

00:06:27:02 - 00:06:34:12 

Deb Matthew 

And so this is a common thing that my circadian rhythm was ready to wake up at seven was not able to do it at 530. 

00:06:35:09 - 00:06:46:04 

Mark Newman 

So that's the story they tell you. What's the hormone story that you tell them that sort of describes or explains that dysfunction that they're experiencing? 

00:06:47:11 - 00:07:13:16 

Deb Matthew 

So this is a cortisol issue. Cortisol has a natural circadian rhythm. It is supposed to go up in the morning and cortisol, I kind of explain it to patients so that they can understand it's kind of sort of like long acting adrenaline. So it's kind of like we get this little mini adrenalin rush in the morning as our cortisol levels naturally rise and that's what wakes up our brain so that we can get up and get moving. 

00:07:13:19 - 00:07:31:19 

Deb Matthew 

Caffeine gives us a little boost of cortisol in our brain, and that's why everybody's reaching for the coffee pot in the morning if they need a little extra boost of cortisol. So cortisol is going up in the morning that wakes up and gets us going and then it's dropping over the course of the day so that it might cortisol is low. 

00:07:31:23 - 00:07:59:04 

Deb Matthew 

We're relaxed, we're able to fall asleep and sleep soundly through the night. The other hormone that's playing a really important role here is melatonin. So when light comes up in the morning, when the sun shines, when we turn our lights on, that shuts off melatonin so that we can be alert throughout the day. And then in the evening as the light goes down and it becomes dark, that signals our brain to make more melatonin, which makes us sleepy. 

00:07:59:04 - 00:08:14:21 

Deb Matthew 

So now we can sleep through the night. So this darkness of cortisol and melatonin is really, really important for our natural sleep wake cycle. And when these hormones get out of whack, then our system gets really out of whack and then we can't get up in the morning. We're tired all day, and then we can't sleep at night. 

00:08:16:04 - 00:08:41:18 

Mark Newman 

So they tell you your story. You tell them the hormone story, and then you need a tool to try to illuminate that to the both of you. So tell us a little bit about maybe what you use to do that, but maybe start with, you know, since you kind of saw the light in terms of not medicine, but functional medicine and dealing with those types of issues, like where did you start with asking those questions as it relates to labs? 

00:08:42:11 - 00:08:45:02 

Mark Newman 

And then how has that sort of evolved for you over time? 

00:08:46:01 - 00:09:16:09 

Deb Matthew 

Well, so of course, in medical school, when we are thinking about adrenal function, we are taught about cooking which is a tumor and Addison's, which is an autoimmune condition where your adrenal gland can't make cortisol anymore. Those are two extreme, you know, potentially life threatening conditions. That's really all we were taught. So back when I was suffering with my adrenal fatigue and I was exhausted all the time and I needed an afternoon nap every day, I didn't even recognize that there was something wrong with me because I wasn't sick. 

00:09:16:09 - 00:09:33:18 

Deb Matthew 

And nothing in my medical training helped me understand what was going on with me. So it really I'll tell you, the way that I actually initially transitioned into this is I read a book by Suzanne Summers, and you can only imagine how much medical doctors don't want to get their information from celebrities but that's awesome. Terrible. I didn't understand why. 

00:09:33:22 - 00:09:57:10 

Deb Matthew 

And when I read that book and I heard about all these women and their hormone problems and how they felt so much better once they got back into balance totally changed everything. It allowed me to open my mind and realize that there really are places where medical practitioners can go and learn about other ways of addressing the root cause of people's symptoms instead of just handing out sleeping pills and antidepressants all the time. 

00:09:57:22 - 00:10:21:13 

Deb Matthew 

And that book actually had some resources for where I can go to learn. So initially I learned that if we just measure cortisol levels in a blood test, it doesn't work very well because cortisol levels change, of course, over the course of the day, like we've talked about. So whatever hour we would march into the lab to get the blood drawn, we're going to get a different number. 

00:10:21:20 - 00:10:41:21 

Deb Matthew 

And we don't really have very good norms for the values that all the different times of the day. So the one time that we do have norms is 8:00 in the morning, and so we can get a first thing in the morning cortisol level, which is just OK because sometimes even just the stress of getting to the lab and getting your needle drawn, that can be stressful and can kind of affect cortisol levels. 

00:10:42:09 - 00:11:01:11 

Deb Matthew 

But what I see is it often misses a lot of things. So it might land somewhere in the normal range but it doesn't give us really all the information that we need in order to understand what's going on. Right. And it certainly isn't telling us anything about that diurnal variation and whether or not that circadian rhythm is really doing what it needs to do. 

00:11:01:23 - 00:11:24:14 

Deb Matthew 

So what I learned is that we can do cortisol testing in a saliva test and the reason that a saliva test is a much better option is because this is something that we can do ourselves at home and we can measure the levels at multiple different times over the course of the day so that we can make sure that that circadian rhythm is doing what it needs to do. 

00:11:24:18 - 00:11:56:21 

Deb Matthew 

Right. And it's so important because a lot of times when people talk about adrenal function and we talk about cortisol, we talk about high cortisol or low cortisol, and we've got a set of symptoms that we think about with cortisol which can be we mean on the belly, depression, insomnia, food cravings, feeling anxious, etc. And we have a set of symptoms that we think about with low cortisol, which is exhaustion, overwhelm the burnout, low blood sugar, blood sugar, dropping in between meals, things like that. 

00:11:57:14 - 00:12:16:06 

Deb Matthew 

The reality that we find for a lot of people is it's not that they're always high all day long or that they're always low all day long. It's that this circadian rhythm isn't functioning properly. So for a lot of people, they are too low in the morning. So they're dragging all through their day and then they're too high at night. 

00:12:16:06 - 00:12:39:23 

Deb Matthew 

And that's why they can't sleep. So in a saliva test, we can get a really nice look at this pattern over the day. We can also look at cortisol in a urine test and the kind of urine test I was trying to do in medical school is a 24 hour urine and a 24 hour urine can give us information about our cortisol level and also our cortisol metabolites, the breakdown products, and that can be helpful. 

00:12:40:06 - 00:12:42:20 

Deb Matthew 

But again, we miss this diurnal variation, right? 

00:12:42:20 - 00:12:43:10 

Mark Newman 

The up and down. 

00:12:43:20 - 00:13:09:06 

Deb Matthew 

The total amount in 24 hours And so again, we're missing a lot of the boat because that circadian rhythm is so important. So if we do urine testing with dry urine where we're just picking up little test strips, kind of like a pregnancy test, again, we can do it over the course of a day so that we can look for that diurnal variation So saliva testing is really the gold standard. 

00:13:09:10 - 00:13:18:19 

Deb Matthew 

Urine testing can also be really useful to give a slightly different information. But in both cases, we can have a look at that diurnal variation, which is really the most important part of the whole thing. 

00:13:19:00 - 00:13:41:11 

Mark Newman 

Yeah, that's a it's a similar story to my transition in that I started in 24 hour urine and you know, one of the first things you do when you get in a lab is you sort of have access to all this free testing just to play around with. And I had tested a family member who was normal and, and it was in this transition period and then also looked in saliva and the diurnal pattern was just totally inverted. 

00:13:41:20 - 00:14:07:04 

Mark Newman 

And, and, you know, that was part of the starting of the process of thinking like, is there a better way to do this? Because the urine testing has all these metabolites that add information, whether it's cortisol or estrogen or whatever. But you are sacrificing the diurnal pattern. And that's where the Dutch complete came from was, hey, can we look at the diurnal pattern of free cortisol while not sacrificing all of this other lovely information that we can get from a urine test? 

00:14:08:07 - 00:14:24:07 

Mark Newman 

And so that so that's where that's where that came from was just like picking at that idea for a while. Exactly that same story is I don't want to give up that diurnal pattern because it is so important. So in your practice now, what's your go to for for those patients Well. 

00:14:25:00 - 00:14:46:00 

Deb Matthew 

More often we do the dry urine testing and we like it because we can see both the tablets would kind of give us an estimate of the total amount of cortisol that was made. And we can also see the free cortisol with the diagonal pattern to it. So we can see, you know, we can get information about the diurnal pattern. 

00:14:46:05 - 00:15:09:15 

Deb Matthew 

And so you would expect if the cortisol is high, then both of those should be high. And if the cortisol flow, both of those should be low, but sometimes there's a mismatch and people can be metabolizing too much cortisol for certain reasons like hypothyroidism, for example, or metabolizing not not doing a good job of metabolizing their cortisol, for example, from hypothyroidism. 

00:15:09:20 - 00:15:29:13 

Deb Matthew 

So it gives us some clues about what kinds of things we need to do to fix the problem. The other thing that is a really good choice, so is the saliva testing and we can even do the cortisol awakening, weakening response, which is where we collect the saliva sample as soon as somebody wakes up before them, basically before they even got out of bed. 

00:15:30:00 - 00:15:54:07 

Deb Matthew 

And then we can do it again in 30 minutes and then again in another 30 minutes. And we can see there's supposed to be a nice rise right after we wake up. That's called the cortisol, a weakening response and that cortisol weakening response is correlated with our stress, resilience, how well we can cope with stress. And so if we can see that that's too high or too low, that can give us a lot of information about how stress is impacting this person and causing symptoms. 

00:15:54:12 - 00:16:04:13 

Deb Matthew 

So those are the two, the two methods that I really like to use to look at cortisol Those are OK. 

00:16:04:14 - 00:16:24:20 

Mark Newman 

So Dutch complete and Dutch plus useful. Tell me this. I've heard from providers occasionally they'll tell me a story like you tell, but with enough confidence to say I don't really need to test because when I hear that patient story, I know what that looks like. I know what that sounds like. And then I have this box of tools I can use to fix X, Y, or Z. 

00:16:25:12 - 00:16:34:14 

Mark Newman 

And the testing, like, you know, it's not really worth going to that effort. So what's your experience been with? How will you guess before the testing comes? 

00:16:35:01 - 00:17:04:21 

Deb Matthew 

Yeah, we're sometimes quite surprised. So I basically always test and I feel like a lot of times when people are coming to me to figure out what's wrong, they want me to dig and figure out what's wrong. If I'm just saying, Oh, it's stress like they didn't really need a health practitioner to tell them that. So they really want to understand what's going on and the test can help me determine which of the tools in my toolbox is going to be the best one under the circumstances. 

00:17:05:02 - 00:17:25:22 

Deb Matthew 

So for example, if somebody's cortisol levels are really high but they're exhausted, it may be that they're not maybe making a ton of cortisol, but it's not enough to meet. Their needs are still overwhelmed and stressed out. And that's the kind of person where if I'm going to use my tools that put cortisol higher, they may be more likely to have side effects. 

00:17:26:08 - 00:17:53:05 

Deb Matthew 

And if their cortisol levels are way burned out and everything is really running low, that's a real red flag to me that maybe I need to do more than stress management here. I really need to be digging to figure out what underlying factors may be dragging down their access function, their hypothalamic pituitary adrenal axis function. So I find that it helps me make the right decision for how to start treating them. 

00:17:53:17 - 00:18:16:09 

Deb Matthew 

The other thing that I find is that it really helps validate how people feel when they see that their test is out of range and it helps them to first of all, feel like it's not all in their head. Like there's weird truth that they're not feeling good. In fact, a lot of times I find women, it's really great if we can get women to breathe because a lot of our patients are women for men too. 

00:18:16:09 - 00:18:42:21 

Deb Matthew 

But if they'll bring their spouse in and we can show on the piece of paper like, look where this is low, right? It's very validating and it helps the spouse to understand that their partner isn't feeling that great, because for a lot of these hormonal things, there's new symptoms. It's not like we're having purple splotches all over our face or our elbow is swollen up twice the normal if there was something they could see, everybody wouldn't feel so bad for you and want to help you. 

00:18:42:21 - 00:19:26:07 

Deb Matthew 

And they bring over a casserole or something when there's nothing to see. Sometimes it feels like it's your personality, like you're lazy or, you know, there's just some in here for sure. And if we can see it on a piece of paper, it's very validating and then the third reason that I think the testing is really, really helpful is it gives us a baseline, you know, so that we can then tell if things are improving but it also if we can show them a piece of paper, we can basically show people how stress is affecting their body and I and everybody that you meet knows perfectly well they're supposed to eat healthy and everybody knows 

00:19:26:07 - 00:19:51:17 

Deb Matthew 

perfectly well they're supposed to exercise whether they're doing or not know they know they're supposed to be. But with managing stress, this is just something that we don't really value in our culture. What we value in our culture is go, go, go do it all work, come home, bring home the bacon, multitask, you know, and everything for everybody else. 

00:19:53:03 - 00:20:27:07 

Deb Matthew 

That's kind of what we value. Instead of sitting back and smelling the roses and in fact, if somebody were to just, you know, take some time to just sit in a chair and just relax, we feel guilty. Like, we feel like we should be unloading this washer or folding laundry or whatever. And so if we can show people on paper how stress is impacting their body, I feel like it makes it more real and it helps them to understand the importance of all these treatments that we're going to be talking about. 

00:20:27:07 - 00:20:28:07 

Deb Matthew 

They're going to help them get better. 

00:20:29:07 - 00:20:57:02 

Mark Newman 

That's really great. Thanks. I want to get to your toolbox, but before we do that, a couple other questions to clarify so that we're understanding the hormones properly. So melatonin goes high while you're sleeping, cortisol goes low and then the opposite during the day. How specifically, though, do they impact each other, meaning if I take melatonin, does it suppress my cortisol if I'm stressed and my cortisol is jacked up while I'm sleeping, is that actively making me not make melatonin? 

00:20:57:02 - 00:20:58:12 

Mark Newman 

Like how do they actually interact? 

00:20:58:22 - 00:21:28:14 

Deb Matthew 

Yeah. So definitely stress is one of the causes of low melatonin production, high cortisol interferes with the body making melatonin. And so that's part of why we're not sleeping well when melatonin or sleeping well. If we're really stressed out. So definitely stress impacts melatonin. Maybe you can answer better than me whether you see on the test, if taking a whole bunch of melatonin shuts down cortisol, I don't know the answer to that question. 

00:21:28:14 - 00:21:29:23 

Deb Matthew 

Do you see that when you do the testing? 

00:21:29:23 - 00:21:42:21 

Mark Newman 

I presume the answer of that to be no, I've not seen any evidence of that. So especially when you get into people taking 15, 20 milligrams, you would definitely see a pronounced effect there. And I've never made that observation now. 

00:21:44:11 - 00:22:11:05 

Deb Matthew 

So I just recently did a deep dove into the medical literature on melatonin, and I did not come across negative like harmful effects or negative feedback from melatonin. So, you know, there's maybe we would always say we need more research, but I don't see anything in the medical literature that says that taking melatonin has negatives in particular. I mean, it can make you drowsy, obviously, but in terms of negative feedback on cortisol. 

00:22:11:09 - 00:22:36:14 

Deb Matthew 

But the flip side definitely is that stress is a cause of insufficient melatonin. And melatonin is so important not just for our sleep wake cycle, but for so many other things. It helps prevent cancer by many different mechanisms. It's an antioxidant it is anti-inflammatory. It's good for pain. So we don't want to allow the melatonin levels to be too low even if people are sleeping. 

00:22:36:14 - 00:22:45:05 

Deb Matthew 

OK, if I see their melatonin level come back low on their test, I think it's important that we try to do the lifestyle things that we can do to help boost their melatonin level. Naturally. 

00:22:45:17 - 00:23:10:12 

Mark Newman 

OK, so melatonin and cortisol are dancing together. And then when I think adrenals, I'm thinking also, of course, of DHEA, DHEA as androstenedione is a neighbor to DHEA. So all that the those those adrenal androgens, the adrenal gland is also making. So, a does that have a diagonal pattern and be like, what's the value of that and how does that tie into this story? 

00:23:11:00 - 00:23:31:04 

Deb Matthew 

Yeah. So, most of our hormones have a little bit of a diagonal pattern in them. They're a little bit higher in the morning compared with in the evening. So, for example, if we have men who are measuring their testosterone level right, we recommended that we get it in the morning instead of late in the afternoon, but nothing to the same degree as the way that cortisol is fluctuating. 

00:23:31:22 - 00:24:00:03 

Deb Matthew 

So, it's much, much smaller level and DHEA and cortisol also have an important relationship. So just in terms of likewise cortisol is a wear and tear hormone in age is us prematurely breaking down bones, catabolic muscle shrinking our brain. Catabolic DHEA is a building repair hormone, anabolic hormone. So, helping to prevent frailty, helping to keep us strong and robust. 

00:24:00:12 - 00:24:19:09 

Deb Matthew 

So, it's important that we have a good balance between the cortisol and DACA. And just naturally with age, cortisol levels tend to climb, DHEA levels tend to go down. So, we get this cortisol to DHEA ratio that gets out of whack and that just accelerates aging. So, we want to make sure that we've got a good balance there. 

00:24:19:22 - 00:24:44:18 

Deb Matthew 

So, when we have when cortisol is high, if we talk about how cortisol impacts or production, right, when cortisol is high, sometimes we get a feedback to the brain to kind of inhibit production. So easy to use, of course is released from the brain. That's the hormone that tells your adrenal glands to make more cortisol and also to make more DHEA. 

00:24:44:21 - 00:25:08:21 

Deb Matthew 

So, with cortisol, sometimes that message can be blunted a little bit and then production can go down somewhat. And so that just widens the cortisol to do a balance. If we were to really go overboard with lots of DHEA, theoretically, we could do the same thing is wanting to minimize cortisol, but it's not the same. It's not the same. 

00:25:08:21 - 00:25:19:20 

Deb Matthew 

We don't see the same problem clinically and generally. If somebody has high cortisol, we want to boost up their DHEA level in order to manage that balance clinically. 

00:25:21:07 - 00:25:39:04 

Noah Reed 

So, you've been through kind of what the different rhythms are, and they've done a great job of explaining to us in great detail what they mean and how we work with them in our bodies. How can we fix those? I know there's different patterns you just talked about low and high and kind of in that middle or high in the morning, low at night. 

00:25:39:04 - 00:25:45:12 

Noah Reed 

But what are the different ways that we might be able to supplement or lifestyle changes that might be able to help impact those? 

00:25:45:23 - 00:26:09:02 

Deb Matthew 

Yes, maybe we can talk about lifestyle things first and then go on to supplements if that's OK. Yeah. So healthy nutrition is important for all of our hormones. We want to fuel our body with the vitamins and minerals that we need and specifically for hormone production. We need healthy fats. We need you know, fruits and vegetables that give us all the vitamins and nutrients that are the building blocks to build the proteins. 

00:26:09:10 - 00:26:32:00 

Deb Matthew 

So, we need healthy nutrition. We want to avoid excessive sugar. Sugar tends to stress our blood sugar metabolism, and cortisol is part of that. Cortisol helps to prevent our blood sugar from dropping in between meals. And so, if our blood sugars spiking up and crashing down, that's a stress on our adrenal function. Alcohol, caffeine, these were stresses on adrenal function that we want to minimize. 

00:26:32:02 - 00:27:02:17 

Deb Matthew 

So healthy nutrition is important, exercise is helpful, but we want moderate exercise here. Really intense competitive exercise is running a marathon, ultra, ultra-marathon. Those are really stressful. So that's not so much what's going to help that can cause part of the problem. But, you know, walking stretching moderate exercise is really going to help adrenal function. But the big thing that is really important for adrenal function is having healthy ways of coping with stress. 

00:27:02:23 - 00:27:22:19 

Deb Matthew 

So, if we can reduce stress, that's really helpful. A lot of times we do it to ourselves. I'm an over scheduler. I will admit to is I cause a lot of my own stress. I'm not the only one that does that. I know. But if there are things that we can simplify in our life that helps a lot of times that we have stresses that aren't going to go away. 

00:27:22:23 - 00:27:42:05 

Deb Matthew 

And it's really important that we have healthy ways of dealing with it because the reality is it's not how much stress we have that matters as much as how we allow the stress to affect us. Right? So, if somebody is a worrier, if they automatically jump to the worst-case scenarios, they're going to take that stress and make it worse. 

00:27:42:15 - 00:28:05:18 

Deb Matthew 

Whereas if somebody is an optimist, if they can think positive, if they can let things go and move on, they can take the same amount of stress and they can actually help to protect their body from the harmful effects of the cortisol level. So, dealing with stress in healthy ways is important. Reading exercises, meditation, yoga, a lot of prayer, laughter. 

00:28:05:21 - 00:28:24:21 

Deb Matthew 

There are lots of things that we can do, and it's important that we keep these a sort of regular part of our daily routine. Just one solid isn't going to move the needle. One yoga class isn't going to change everything but incorporating these things regularly can make a big difference. And if it's OK, I'd love to share a couple of my quick tips. 

00:28:24:21 - 00:28:27:05 

Deb Matthew 

Free, easy things to get people started. 

00:28:27:05 - 00:28:27:19 

Mark Newman 

Absolutely. 

00:28:28:07 - 00:28:47:21 

Deb Matthew 

Meditation is hard. Like you wouldn't get up and go jogging ten miles. You get up off the couch and walk to the corner and back. So, meditation is fabulous. I love meditation. I always feel better when I do it. I'm not very good at it, but it's a skill that we learn. What's easier is breathing exercises. Anybody can breathe. 

00:28:48:05 - 00:29:07:17 

Deb Matthew 

You don't have to have special training or special practice. We just got to do it. And our phones have a lot of apps that you can download that have free breathing exercises. There's calm and breathe and like a timer, so having a little app on your phone can be a quick, easy way to just get started with some breathing exercises and make them part of your routine. 

00:29:08:11 - 00:29:35:20 

Deb Matthew 

Another quick tip is a lot of us end up on our computers, and when we're on our computers all day, we tend to get kind of hunched in like this. And if you think about it, it's kind of like we're curling into the fetal position to some degree. So, our body, our brain senses stress when we're worried about things, but a physical logic thing is counter stress too, like hormone imbalances or vitamin deficiencies or toxins in the environment and our body. 

00:29:35:20 - 00:30:01:08 

Deb Matthew 

So those are all stresses on our system. But our body also gets messages about stress by what's literally happening in our body. So, if our body can see that we're curling into the fetal position, it assumes there's danger and starts pumping out more cortisol. And so, if we can take a pause and just stretch, open up your your exposing your vulnerable belly and your throat, just like your dog rolls over, gives his belly to rub when he feels safe. 

00:30:01:14 - 00:30:23:08 

Deb Matthew 

If we can stress this way, that can help to send a more calming message to your brain that can at least temporarily help to kind of calm down cortisol. The same thing with breathing. When we're stressed, we tend to take sort of small, shallow breaths and that is what we do when we're in danger. And that gives the danger message to our brain. 

00:30:23:08 - 00:30:45:13 

Deb Matthew 

So, if we can stop and take nice, deep, slow belly breaths, our brain feels like, OK, it's safe and our stress response can calm down a little bit. So those are easy things. You don't have to practice them. You don't have to buy a new exercise outfit or a gym membership or carve out an hour of your day, but they really do make a difference. 

00:30:46:06 - 00:31:18:19 

Mark Newman 

I'm glad you started with Lifestyle. I think that's such a great, healthy way to to address these issues. And sometimes I there was a while back someone suggested to me that meditating for 3 hours in the morning was a really good idea. And I was like, you do not have kids. So, no, but thanks for the suggestion. But when we're incorporating the things that are healthy and dealing with those to the degree that we can and and it's not enough in some of these issues and you still have some of these problems, what are some of the tools you have additionally in your toolbox? 

00:31:19:02 - 00:31:43:13 

Deb Matthew 

Yeah, OK. So, we've got lots of nutritional supplements that we can use. If we talk about nutritional supplements, they're not the only tools not the works, but some of the things that can be really helpful, especially if it's a circadian rhythm problem. It's not that the cortisol is always high or low. You know, this flat lining where the well, we lost sort of circadian rhythm is the most concerning pattern of all. 

00:31:43:19 - 00:32:08:12 

Deb Matthew 

So, when we've lost the circadian rhythm, one of the things that can be really helpful are adaptogen herbs. This is a whole category of herbs that have been used for thousands of years all over the world and all sorts of different cultures to help people cope with stress and to be more resilient. So, for all these generations, we've known that these herbs work and now modern science is starting to catch up and understand how and why they work. 

00:32:08:16 - 00:32:28:13 

Deb Matthew 

And it's really fascinating if you dove into the medical literature about these. A lot of it comes from countries like Germany and places where they're way more into herbal things. Then we are here. But interestingly, some of these plant compounds in these earth look structurally kind of similar to the decoys. And so that's part of how they exert their effects. 

00:32:28:20 - 00:33:10:01 

Deb Matthew 

But what they do to some degree is the work at the level of the eight axis or hypothalamic pituitary adrenal axis, which is sending the messaging. So, it's not us specifically that it's boosting cortisol or suppressing cortisol, it's normalizing our circadian rhythms. So it can work whether cortisol is too high or too low, and it can work in support of those too high in the morning and or too low in the morning and too high at night or whatever, whatever off kilter we've got to work with, it helps to bring things back into homeostasis and it helps to reset the natural circadian rhythm so some of the herbs that can be really helpful are ashwagandha, 

00:33:10:09 - 00:33:42:07 

Deb Matthew 

which is from Indian Iyer Vedic traditions. We have holy basil, we have ginseng. There's a whole category of these herbs, and I get a lot of questions from new practitioners about winter to use and exactly what dose and the reality is, for most of us who've been doing this for a long time, what ends up happening is we end up picking a blend of herbs that has a mixture of these different adapted herbs in it, because generally speaking, herbs work better if you use a little bit of different ones instead of like a big dose of just one. 

00:33:42:18 - 00:33:58:09 

Deb Matthew 

And then you don't have to really obsess over exactly the dose of this or that. You find a blend of herbs that seems to work well, and then you can kind of stick with a few products that, you know, work well for your patients. But Adaptogen Herbs is something that can be really, really helpful to restore that circadian rhythm. 

00:33:58:14 - 00:34:28:01 

Deb Matthew 

So that would be kind of top of my list. Another one that's really helpful, especially to help lower cortisol when it's too high. Like a lot of people have that high cortisol at night. One that's really helpful for this is part of the title theory and thoughts for title theory is the phospholipid that again works at the level of the brain to help kind of dial down that danger or message so that cortisol levels can just kind of settle down so it doesn't drop cortisol levels too low, but it just kind of helps to normalize. 

00:34:28:06 - 00:34:57:08 

Deb Matthew 

And then one of the happy side effects of title theory is it happens to also be good for memory. So that's another really nice one. Magnesium is helpful for adrenal function. Vitamin C is important for cortisol function B vitamins, especially vitamin B five kind of the acid. So, there's a lot of nutrients that are important. But if I had somebody with a circadian rhythm out of kilter, I had to think for one thing, I would go for a blend of adaptogen herbs. 

00:34:57:08 - 00:34:59:00 

Deb Matthew 

That's my go to use starting place. 

00:34:59:12 - 00:35:01:11 

Mark Newman 

OK, great. That's that's great. Thank you. 

00:35:01:12 - 00:35:11:16 

Noah Reed 

And can I ask a question? You it you said magnesium, is there a specific type of magnesium? Because I know there's lots of different types of magnesium. Is there a specific type of magnesium that helps with this? 

00:35:13:08 - 00:35:37:19 

Deb Matthew 

All the different magnesium can help magnesium. Three in need is one that crosses more to the brain. So especially if somebody is like stressed. So can't sleep feels like a little tightening. They cortisol, you know, is a fight or flight response all the time. They got too much cortisol magnesium three and gets to the brain better and it's calming the other one the other chelating magnesium glycine maladies citrate they can all be OK. 

00:35:37:19 - 00:35:56:16 

Deb Matthew 

The one that I don't recommend is magnesium oxide because it's not well absorbed and how I tell my patients to remember like there's so many different mechanisms that they can't keep them all straight but the one with the X, no, don't do it. Not the one with the X the other ones are OK. And maybe magnesium three and eight might be my favorite for people who are stressed out.

00:35:57:23 - 00:36:22:19 

Mark Newman 

Perfect. Thank you. So, I want to ask you about one specific scenario that we see a lot that can mess up your circadian rhythm and in ways that are dramatic, that sometimes are surprising. And that is if you take something like dexamethasone or prednisone, right? Pretty much any provider knows one, you're going to suppress cortisol. But two, those also replace some of the effects of cortisol. 

00:36:22:19 - 00:36:46:17 

Mark Newman 

So that's complicated. But then you get into things like inhalers and some allergy meds and things where a lot of doctors get really surprised at not the fact that your cortisol is a little off but that it is suppressed. It like you just basically aren't making cortisol because of that. But then the exhaustion and this thing that's suppressing it, I'm guessing isn't really fulfilling the duties of cortisol. 

00:36:46:17 - 00:37:05:08 

Mark Newman 

So, I'm curious, what do you do with patients that come in? They're taking a particular medication and maybe maybe in a situation where they're not willing to get off of it. What do you see symptomatically from the fact that the cortisol is not around because it's being suppressed? And what in the world do you do with those patients to help them out? 

00:37:05:23 - 00:37:31:10 

Deb Matthew 

Yeah, well, so somebody is on something like prednisone. We just wouldn't do the cortisol test, right? It's predictable. It's not going to be helpful. But the people who are so many people on things like these are caught in pulmonary inhalers. And we as doctors are taught, oh, it's just a tiny little trickle. It's right locally and and arguably, of course, it's much less of a thing than being on prednisone or something like that. 

00:37:31:22 - 00:37:54:07 

Deb Matthew 

What I typically try to do is to kind of at least get the best picture is I try to convince people to stop their inhalers for a short period of time before I do the test, depending on how symptomatic they might be or how willing they are. I would love for them to stop it for a week before the test if they feel like they can do without it. 

00:37:54:07 - 00:38:15:09 

Deb Matthew 

We try to talk them into at least 48 hours before we do that, and sometimes they're not willing sometimes I forget to tell them. And a lot of times, depending on what kind of steroid it is, like if it's a hydrocortisone or something like that, sometimes we get this really weird high spike and we get this really weird high spike. 

00:38:15:15 - 00:38:39:18 

Deb Matthew 

We kind of go back and ask questions like, did you use, you know, your eczema cream right before you did this test? And sometimes we can figure that out when they're on inhaled steroid. So, it's a little bit trickier. I feel like I, I, I go with how healthy seal. So, you know, a lot of people are exhausted et cetera. 

00:38:40:14 - 00:39:09:15 

Deb Matthew 

If somebody felt wired and like overstimulated and we saw that the cortisol level was low maybe because of their inhaler. Right. I still my treat. I mean, I still might treat them with the treatments minutes to lower their their stress like the calming things because that's their primary symptom and assume the medication that they're on has affected the results of the test. 

00:39:09:20 - 00:39:22:12 

Deb Matthew 

We try really hard to get people to just understand that it's a little bit unpredictable and it's a little bit hard to interpret. And we want to get the best results for them. Right. And it's hard with those types of medication. 

00:39:22:16 - 00:39:41:13 

Mark Newman 

And if I could push back into that a little bit. So, if I have a person who's taking that regularly and then it's suppressing and then they get off of it and it bounces back, but they're taking it daily. So in in the situation where they continue to take it. So theoretically their their normal day is a suppressed cortisol. 

00:39:42:19 - 00:40:03:04 

Mark Newman 

What and then assuming we're in a situation where they're going to keep taking it because they need it for some reason, is there something you do to sort of counteract the fact that they're suppressing their cortisol on a regular basis with what's you know, a product that's not not thought to like an inhaler or something like that? What do you do to counteract the cortisol not being around? 

00:40:03:16 - 00:40:23:23 

Deb Matthew 

Yeah, that's a good question. So, if I feel like literally they're not making the cortisol, the one of my go to is actually adrenal gland killers. And, you know, so because it's sort of helping more at the level of the adrenals to to make more, I don't even like the word adrenal glandular is it's like not a word that we would have ever used in medical school. 

00:40:23:23 - 00:40:51:23 

Deb Matthew 

Adrenal extract maybe sounds better, but that's what we turn to if we want to help somebody be able to produce more cortisol. It's not just a messaging problem. And I've tried to dig in the research to find some kind of medical literature to support the use of adrenal stress. There is literally nothing like the only thing that I can find is from the 1940s when they were just learning what cortisol is. 

00:40:52:05 - 00:41:22:18 

Deb Matthew 

But there really is no studies that I can find supporting the use of adrenal extracts in clinical use, which is unfortunate. I also would think about the adaptogen and herbs because again, that's going to be working on the messaging system. So we're assuming that these medications are dampening the message they're turning off. That's the feedback cycle. It's not necessarily that they cannot make cortisol is that the message is turned off because of the medication. 

00:41:23:00 - 00:41:52:09 

Deb Matthew 

Then theoretically these herbs can be helpful. And I guess what I can say is I don't find that I have a problem helping people feel better even when they're on the medications. And I would rather that they be on inhaled medications as opposed to, you know, oral prednisone or something like that. Right. So, it can interfere with how the test looks but we still typically are able to help people feel better using, you know, the tools that we have in our toolbox. 

00:41:52:14 - 00:42:16:00 

Mark Newman 

Yeah. And what you're describing there, I think is what makes this industry exciting is that you don't actually know all the answers yet, that we have to approach this stuff with a level of humility as well in that there are more answers and more questions that need answers, especially when we take natural rhythms and we throw, you know, new chemicals at our brains that they haven't seen over these thousands of years that precede us. 

00:42:16:11 - 00:42:31:20 

Mark Newman 

And that's what makes your job difficult, but also exciting. And what me and what also means that we need people like you to come and educate us so thank you for taking the time to take this complex topic and unwrap it for us so that we can understand a little bit more. I think it's been super helpful. 

00:42:33:01 - 00:42:35:13 

Deb Matthew 

Well, thank you so much. For having me. It's one of my favorite things to talk about. 

00:42:36:00 - 00:42:58:03 

Noah Reed 

It's been great having you on the show, Dr. Matthew, and a big thank you to all of our listeners who joined us this week. Stay tuned for next week's episode. With another Dutch expert, Dr. Christina O'Brien. Mark Neumann will be back in studio, and we'll get to learn together about cortisol and the cortisol, the waking response. If you're stressed out and who isn't, this is an episode that you'll definitely want to listen to. 

00:42:58:10 - 00:43:01:08 

Noah Reed 

I'm Noah Reed. Thanks for joining. Until next time.