The holiday season is upon again, which is a great time of year to spend with family and friends. However, it can be a stressful time of year as well. Not to mention, it is also the cold and flu season.
Most of us are too busy and don’t have time to get sick, but that is part of the problem. We push ourselves too hard. Sleep is often never enough, so we open ourselves to illness.
In this episode of the podcast, we discuss the connection between stress, your adrenals, and immune function. Over the years, we have seen it many times with our patients. They are very busy with work, family and just life in general. If an unexpected stressor comes along, they don’t have enough reserves to keep them well. Inevitably, they are laid up in bed with a cold or the flu.
 
PYHP 071 Full Transcript: 
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Dr. Maki: Hi everyone. Thank you for joining us for another episode of Progress Your Health Podcast. I’m Dr. Maki–
Dr. Davidson: –and I’m Dr. Davidson.
Dr. Maki: So have you noticed the weather’s changing a little bit? It’s getting a little cold.
Dr. Davidson: Oh, absolutely. 
Dr. Maki: I think it was like in the 20’s these last couple of days in the morning.
Dr. Davidson: Yeah. I think 30’s because it didn’t completely freeze but when it’s cold here, it usually means that the sun is out which is really pretty. Then with the fall leaves being orange and read, it’s actually been a really beautiful Fall here in Washington.
Dr. Maki: Yeah, you and I went for a hike the other day, we have this called the inner urban trail right behind our house and when we went up to this hike that’s in Bellingham called Fragrance Lake which is a really popular hike. You are telling me about when you went down the trail and all the leaves were on the path and it looks like, kind of, like the yellow brick road from Wizard of Oz.
Dr. Davidson: Yeah, there was a big– kind of like a windy time like a windy night and then the next day when it was really beautiful I went for a walk by myself on that inner ravine trail and nobody had been on there yet. No bikers, no walkers and it was just all these yellow leaves all over and just me that did it. I was like, “I feel like I’m on a brick trail.”
Dr. Maki: Yeah, that’s great.
Dr. Davidson: A yellow brick road.
Dr. Maki: Yeah, yellow brick road. I’m originally from the Midwest Minnesota and there’s a scenic tour, scenic drive you go from Duluth, Minnesota up the, what they call North Shore which is the North Shore of Lake Superior and everyone takes this kind of– I won’t say everyone– but a lot of people take this annual trip to be able to see the change of the leaves and certainly, we never really got a sense of that in Las Vegas when we live

In this episode of the Progress Your Health Podcast, we continue explaining the three main types of Adrenal Fatigue/Dysfunction that we see often. Here is a quick recap: 

Vampire (episode 68): High cortisol at night and low cortisol in the morning. Hard to fall asleep and very difficult to wake in the morning. Weight gain and evening carb and sugar cravings. Feel much better in the evening and will refer to themselves as a night person.'
Ghost (episode 69): Cortisol is very low in the afternoon and early evening. This is why they fall asleep so easily, but there is a lot of difficulty staying asleep through the night. The Ghost is broken up into two subtypes: the Ghoul and the Poltergeist.

Ghoul: The cortisol is low in the afternoon and evening. They fall asleep so easily. But come 2 am the cortisol rises for hours. The cortisol will drop a touch, so they fall back asleep after two hours. But it remains elevated until noontime where the cortisol will dive, along with their energy.
Poltergeist: The cortisol is low in the afternoon and evening (like the Ghoul). And come 2 am the cortisol rises. But the difference here is the cortisol will rise and fall all night long. That is why these people wake up numerous times in the night. Like the Ghoul, the Poltergeist will have good morning energy but will crash come afternoon.

In this episode, we go on to explain the third type of Adrenal Dysfunction that we have encountered with our patients, the Zombie. The Zombie has low cortisol all day and night. It is not Addison's disease. But due to the lower levels of cortisol, the Zombie is tired all day and night. They have no trouble falling asleep. They are the people that will easily sleep 8 to 10 or more hours but not feel rested when they wake up. 
Zombies report that they could sleep all day long. They have a lot of physical fatigue and cannot exercise. If they tried to exercise, they are wiped out for the rest of the day. And it can take them days to recover after intense exercise. They do crave sugar and carbs. In some ways, it gives them a little short-lived energy to eat sugar, soda, or refined carbohydrates. Not only are they physically tired, but they are also mentally tired and comment that they have a lot of brain fog. It is hard to focus and finish a project, and Zombie's report that they have no short term memory. 
As we mentioned in the podcast, we wanted to give you some tools that can help. Some options that include nutrition, lifestyle, supplementation, and prescription medication that can help a Zombie type Adrenal Dysfunction. Before we answer this, we have to put out the disclaimer: All content found in this blog, including text, images, audio, video, or other formats were created for informational purposes only. 

In this episode of the Progress Your Health Podcast, we continue talking about the main types of Adrenal Fatigue that we see. We are certainly not trying to minimize Adrenal Dysfunction but to make it more interesting and easy to understand, we call these main types:

Vampire (episode: 68)
Ghost (this episode 69)
Zombie (episode 70 – next episode)

Adrenal Fatigue or Adrenal Dysfunction (which is what we like to call it) is a real condition that affects millions of people in our country. And the effects can seriously impact a person's health and quality of life. We have seen different types of Adrenal Dysfunction. These three main types are important to know because a person with a Vampire type of Adrenal Fatigue will have a completely different treatment plan than someone that is a Zombie type.  
In this episode, we are to talk about the Ghost type of Adrenal Dysfunction. There are actually two subtypes of the Ghost. We call them, the Ghoul and the Poltergeist.  
But first, just to jog your memory. In the last episode, we talked about the Vampire. The Vampire has very low cortisol levels in the morning and elevated levels at night. This causes a lot of morning tiredness, to the point that Vampires are chronically late to anything in the morning. Vampire types also feel more awake at night and cannot fall asleep.  
On the other hand, the Ghost type has a different dysfunctional secretion of cortisol from the adrenal glands than the Vampire.
The Ghost will have very low levels of cortisol in the early afternoon that continues until the evening. So you will see the Ghost very tired in the afternoon and evening. These are the people that can fall asleep easily at 8-9 pm. But in the middle of the night, the cortisol levels will rise so they will wake up. It is common for Ghost types to fall asleep hard for four hours and then wake up like it is morning when it is only 2 am.    
There are two subtypes of the Ghost:   

Ghoul: They will fall asleep easily in the evening but will wake up after about 3-4 hours of sleep. The Ghouls will be awake easily for two hours straight. Ghouls might not be roaming halls, but they certainly are roaming their iPhones. Because they cannot fall back asleep. Then by the time they do fall back asleep, they need to wake up shortly thereafter.     
Poltergeist: Fall asleep very easy at night. After about 3-4 hours of deep sleep, they wake up. The difference here from the Ghoul is the Poltergeist can fall back asleep within minutes. But then less than an hour later they wake up again. Just lik

In our last episode, we talked about Adrenal Fatigue / Adrenal Dysfunction and how to test for it. In the next three episodes, we are going to focus on three main types of Adrenal Dysfunction that we see.
Three main types of Adrenal Fatigue:

The Vampire
The Ghost
The Zombie

Adrenal Fatigue is quite real and can seriously impact someone's life. We are not trying to make light of the effect that Adrenal Dysfunction can have. But we find by putting some easily remembered descriptions; this medical condition will resonate with people. And it will be more easily understood.  
Symptoms of the Vampire:

Cannot wake up in the morning: these are the people that press the snooze button a lot. Often Vampires will have several alarms to help them get up in the morning 
They might not be drinking your blood, but will drink a lot of caffeine to get going in the morning. Even with copious amounts of coffee but are still tired.  
Morning and daytime brain fog
Weight gain 
Sugar and carbohydrate cravings mainly in the late afternoon and evening. They will say their diet is perfect during the first half of the day. But come later in the day and evening time, they cannot control the sugar cravings. Even if they are full from dinner, Vampires still find themselves snacking in the evening.
Fatigue: mental and physical fatigue
Cannot sleep at night. These are the people that will lie in bed for hours, unable to fall asleep. They were so tired in the morning but come evening, wide awake. 
Feels more awake in the evening. This type of commonly seen Adrenal Fatigue will get all their chores done in the evening.   
More energy at night, especially mental energy. This is when they are getting projects, emails done.  

The adrenal glands secrete cortisol in a diurnal curve. In a perfect world, you will see the cortisol being highest in the morning and will slowly decline, being lowest at night.  
With the Vampires, you will see what is called a reverse diurnal curve.' With very low cortisol levels in the morning, it makes it very difficult to wake up in the morning. The cortisol can continue to stay reduced in the afternoon, also causing afternoon fatigue.
Come evening time, cortisol levels rise. This makes it difficult to fall asleep. The rise in cortisol in the evening can disrupt insulin and blood sugar. This can cause sugar and carb cravings, which are almost impossible to resist.  

In our last episode we talked about the differences between PCOS and Adrenal Dysfunction, which is often called Adrenal Fatigue.  Adrenal Fatigue or Adrenal Dysfunction is not a ICD10 diagnosis. There is an actual ICD10 billable code called: unspecified adrenocortical insufficiency (E27.40).  But there is controversy in using this code for patients. It is technically meant for conditions where the adrenal glands do not produce enough steroid hormones such as cortisol and aldosterone.  You might be saying, but this sounds exactly like Adrenal Fatigue/Dysfunction! Most people with Adrenal Dysfunction have normal labs, so their doctor cannot code for Adrenocortical Insufficiency (E27.4).  And because their labs and testing look normal people are told they are fine and dismissed.
In this episode, we are going to talk about the testing for Adrenal Dysfunction.  There are some testing that can show Adrenal Dysfunction such as saliva and urine testing.  But most conventional docs are mainly familiar with blood testing. Typical blood testing for adrenals usually will show that a person doesn't have adrenal dysfunction, when in reality, they do. 
We are going to talk about the different methods for testing Adrenal Dysfunction. 
 Let's start by talking about the most common testing method that most docs use, blood testing.
Adrenal Blood Testing:
Cortisol: Blood testing for cortisol is not accurate.  Most, if not all people with Adrenal Dysfunction will test normal for cortisol blood testing.  The reference ranges are vast and a blood test is only done once or twice in one day. And when you have a needle coming to stab you, automatically the body raises the stress hormones.  So cortisol can be falsely elevated in a blood test.
DHEA: DHEA is secreted mainly from the adrenal glands.  In adrenal dysfunction, you will see lower levels of DHEA.  DHEA reference ranges are vast and everyone falls in normal when doing a DHEA total blood test.  But a DHEA-sulfate blood test is fairly accurate for evaluating levels of DHEA in the body. But again, those lab reference ranges are still pretty broad.  But in general, terms, if the DHEA is low or low normal range then you can start to consider that a person has Adrenal Dysfunction.
Testosterone: DHEA is secreted mainly from the adrenal glands and will convert to testosterone for females.  In adrenal dysfunction, you will see lower levels of testosterone in women because of the reduced DHEA levels.  In men with adrenal dysfunction, you will also see lower levels of total testosterone. Testosterone reference ranges are very vast.  Quest has a reference of 2-45 for females and for males the reference range is 250-1100 ng/dL. These are pretty big reference ranges.  But if someone has a low normal testosterone level you can consider that person has Adrenal Dysfunction. 
Pregnenolone: Pregnenolone is secreted from the adrenal glands and there is a small amount made in the spinal cord and brain making it very neuroprotective.  Pregnenolone is accurate as a blood test. But like DHEA and Testosterone, the reference ranges for pregnenolone is huge. For Labcorp the reference range is anything less than 150 is norma

In our last series of episodes, we talked about polycystic ovarian syndrome (PCOS).
We have categorized PCOS into three types:

Classic
Common
Concealed

Classic has the majority of all the symptomatology that pertains to PCOS.
Common has some but not all of the symptoms of PCOS. 
Concealed PCOS is often missed. What we have found is that the Concealed type of PCOS has a lot of properties and similarities with adrenal fatigue.
In this episode, we are going to talk about the similarities between PCOS, and especially the Concealed type and Adrenal Fatigue. We are also going to explain the differences between PCOS and Adrenal Fatigue. 
Let’s differentiate between Concealed PCOS, Adrenal Fatigue:
Concealed PCOS:
As mentioned, the Concealed type of PCOS is not often picked up on. It is often mistaken for Adrenal Fatigue/Dysfunction. These are the women that have been to many doctors looking for answers. Their symptoms seem to develop or get worse when they hit their late 30's to early '40s. Because at this time, the female hormones can be changing due to perimenopause, and the body cannot maintain balance, so the PCOS and Adrenal Fatigue symptoms start manifesting. This is what you typically see in a
Concealed PCOS Symptoms: 

May have a child, so it looks like there are no fertility issues
Regular periods but might be more painful and cramping with terrible PMS
Anxiety and fatigue: feeling wired and tired at the same time
Irritability
Thin Hair
Slender until mid 30's to early '40s. Then it feels like they gain weight overnight. Especially in the belly area. No matter what they do, eating less/exercise more, the weight doesn't budge.

What is Adrenal Fatigue?
This name can be misleading. We actually like the terminology, Adrenal Dysfunction. Because it is the dysfunctional activity of the adrenal glands that creates all the symptoms associated with Adrenal Fatigue.   
Let's explain a little more about Adrenal Dysfunction. Like we mentioned earlier, the adrenal glands are not fatigued per se. They are healthy tissue and healthy glands. It is the hormonal secretion and function of the adrenals glands which are degraded or dysfunctional. We have all heard about cortisol. Cortisol is essential for life. But secreted inappropriately, can cause a lot of symptoms, specifically ones of Adrenal Dysfunction. Cortisol is supposed to be highest in the morning and then will slowly drop and will be very low at night. This allows us to be awake in the morning and daytime, but able to sleep at night. In Adrenal Dysfunction, you will see what is called a Reverse Diurnal Curve of cortisol. Meaning the cortisol is low in the morning and can be especially low in the afternoon. This causes morning tiredness and afternoon crashes in energy. Then the

In this episode, we are going to continue talking about the Types of PCOS that we have seen. As we have said, (repetitively) PCOS is not a one size fits all. There are some women that have most of the symptoms to just a few. We have three types that we have seen in treating patients since 2004. It is important to have this distinction when it comes to health goals and treatment plans. Doctors that routinely treat PCOS will tell you there are different types. They might have their types that they have seen. But in our experience, these are three types that we have seen most regularly.
The three types of PCOS 

Classic
Common
Concealed

Concealed: This type of PCOS is never picked up on. These are the women that have gone to many doctors looking for answers. This is because they have just a small few of the symptoms but not enough to point to PCOS. But they do have a hormone imbalance, and when you break it down, it is a type of PCOS. It seems to get worse when a Concealed Type hits perimenopause or late 30's to early 40’s. The female hormones are changing, and the body cannot maintain.   
This is typically what you will see in the Concealed-Type:

May have a child, so it looks like there are no fertility issues
Really irritable–all the time, and way worse before their period
Yes, they have regular periods but the worst PMS
Anxiety –it seems that they have a lot of low-grade anxiety all the time.
Hair is thin
Slender until they hit mid to late 30's to early 40’s. This is when they gain weight, especially in the stomach. No matter what they do, they cannot lose weight. Even with severe caloric restriction and lots of crazy exercise, there is no real budge to the weight.
Carbohydrate cravings especially for sugar
All these symptoms of the Concealed are blown off as genetics or lifestyle. I have had so many patients with Concealed PCOS say that their previous doctors did not believe that they had a healthy lifestyle.

This is what their blood work typically looks like:

LH : FSH ratio : the LH is higher than the FSH just a little. There is no 2:1 ratio like you see in the Classic-Types. 
High normal testosterone or just over the edge of normal testosterone. Let me explain again those ridiculous reference ranges for testosterone blood labs. Most labs have the reference range for testosterone to be 2-45, which is a very wide range. Those with Concealed PCOS will have a testosterone at 35-55. The average levels of testosterone for women regardless of age or menstrual status is about 25, so the Concealed are higher than the average. 
Low progesterone
High normal DHEA-sulfate
Lower thyroid function but not hypothyroid 

Low normal FreeT3
Normal FreeT4
Normal TSH 

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In this episode, we continue talking about PCOS. As mentioned in the previous episode, we have seen three main types of PCOS. PCOS is more of a spectrum of symptoms. Some women have most of the symptoms of PCOS and others just a few. The varying degree of hormonal imbalances will help mold the three types of PCOS that we have seen. Many doctors that treat PCOS all can agree that there are different types of PCOS. 
The three types that we have found with PCOS are:

Classic
Common 
Concealed

In this episode, we are going to talk about the Common-Type of PCOS. In the previous episode, we spoke about the Classic type. And in the next episode, we will go over the Concealed Type.  
The reason that we want to differentiate the Types of PCOS is because, in each type, there are different health goals, health consequences, and multiple treatment plans.
 Common PCOS: This is the most common type of PCOS seen. The Common-types should be diagnosed fairly easily. But because they do not fall into the Classic presentation, they may get missed in diagnosis.  
Symptoms that a PCOS Common-type will present with:

Easy weight gain in the middle, the stomach, and the hips and thighs
Thinning hair
Irritable easily
Some cystic acne on the chin and jaw area
Trouble getting pregnant but is usually successful with fertility options or IVF
May get random cysts on or in the ovaries. But there is no string of pearls or multiple ovarian cysts.  
May miss a period occasionally. Common-types are not regular in their periods. But they may get a period every month for five months then miss two. Or have very long cycles up to 45 days. Or they may have a period every other month. Common-types again, are not regular, but they do not miss multiple months like the Classic Types PCOS.

Typical lab work for a PCOS Common Type:

LH is double the FSH
There is high normal to just slightly over the normal level of testosterone
High normal DHEA-sulfate
Insulin is in the normal range but may show up in the teens or anywhere above 9. 
Normal glucose
Estradiol can be high, showing Estrogen-dominance or be normal ranges

There are three main types of PCOS that we have seen treating patients since 2004. As you have heard from the past podcasts, PCOS is a spectrum of symptoms. It is a spectrum of symptoms coming from a set of hormonal imbalances. Every woman with PCOS might have some to all to a few of the symptoms of PCOS. That is because there might be varying degrees of hormonal imbalances. 
While there might be some disagreement, there are three types that we have encountered the most. And each of these three have different goals and treatment plans.  
These are the main types we have seen in treating patients with PCOS. As I mentioned before, PCOS is a spectrum. There can be some women that have all the symptoms to others that have just a few. This is a key concept for treatment. Someone with many symptoms is going to have a completely different treatment plan than someone that has some of the symptoms. 
The three types that we commonly see, we have named: CLASSIC, COMMON, and CONCEALED.   
Classic PCOS: Honestly, this is not seen that often. A Classic-PCOS, you will see all of the symptoms.  

Dark facial hair
Chronic cystic acne.  
Thin hair, especially the top of the head and temples
Weight gain–being it is super easy to gain weight and what feels like, impossible to lose
High blood pressure
High cholesterol
High blood sugar
High insulin: leading to insulin resistance and possibly diabetes, if not already diabetic.  
Irritability
Terrible carb cravings, especially for sugar. 
Miss multiple periods for consecutive months in a row. They might get maybe two periods a year.  
These are the women that have many cysts in and on their ovaries. They have the Classic' string of pearls visualized on a transvaginal ultrasound.  
Infertility 

You will see the full gamete of the blood work readings:

LH to FSH ratio is 2:1 or even more
High levels of testosterone: well above the normal levels. You can see the testosterone anywhere up to 90 or more
No progesterone levels
Normal levels of estradiol and sometimes there can be higher levels such as Estrogen-Dominance from the conversion of testosterone to estradiol.
High DHEA-sulfate
High insulin, high teens to well over 20
High blood sugar and Hemoglobin A1c
Hyp