Got Anxiety Here's How Your Gut Microbiome Plays a Part

Learn about the connection between gut health and anxiety and how you can improve your anxiety by improving your gut health.

What is Anxiety?

Anxiety is the most prevalent mental illness affecting those living in the United States with about 40 million sufferers. (1) If you deal with this condition, you know that anxiety can be debilitating and affect your quality of life. But did you also know that the trillions of microbes living in your gut can play a part in your condition and potentially help you heal? That’s right, there is a connection between your gut health and anxiety.

The Gut-Brain Connection: How Gut Health and Anxiety Connect

These microbes living in us are often referred to as the “forgotten organ” because they play such a large role in our well-being, but it is only recently that we’ve started to realize the impact this organ has on the body. (2) Unfortunately, the Western lifestyle takes a significant toll on the health of our microbiome with constant stress, unhealthy diets, lack of sleep, and more leading to a condition called dysbiosis.

Dysbiosis, the imbalance of gut bacteria, has been associated with a variety of mental disorders including anxiety. (3) While there aren’t many studies done on humans, we have seen mice exhibit increased anxious behavior when exposed to pathogenic bacteria in the gut. (4) It’s probably no surprise, then, that those with anxiety are also likely to suffer from a digestive disorder associated with imbalanced gut bacterial as well like Irritable Bowel Syndrome (IBS).

I recommend that you test your microbiome for dysbiosis and pathogens by using a functional medicine lab – your healthcare practitioner can then interpret this information for you and prescribe the correct treatment depending on what is going on in your gut. This is the #1 step anyone with anxiety should take! You don’t want unwanted pathogens hanging around wreaking havoc on your gut health (and in turn your mental health!). offers a number of stool tests that you can order yourself – I have tests from both Metametrix and Doctor’s Data (two of my favorites) listed in my portal here.

Best Probiotics for Anxiety

When humans are given specific strains of probiotics, their anxiety improves as does their HPA axis function. (5) The strains of probiotics used in this study (Bifidobacterium longum R0175 and Lactobacillus helveticus R0052) can be found in two products in the United States: Pure Encapsulations’ ProbioMood (which you can purchase in my supplement dispensary) and Xymogen’s Probio Defense.

Prebiotics for Anxiety

Prebiotics, which feed healthy gut bacteria, are also useful for anxiety. Stress-related disorders seem to respond to the prebiotic GOS (galactooligosaccharide) in particular, which help the HPA axis to function appropriately in addition to making us pay more attention to positive stimuli vs negative stimuli. (6) My go-to GOS prebiotic is Galactomune from Klaire Labs, which you can purchase in my dispensary.

Best Diet for Anxiety

Eating a healthy, ancestral diet is also associated with lower anxiety scores, while Westernized diets are associated with the opposite effect. (7) This is thought to be due to many factors including inflammation, but also to the effects of these diets on the microbiome. Another reason to keep up your healthy diet!

The Gut-Brain Connection

The microbiome and the brain operate on a bi-directional axis, meaning that the gut affects the brain and vice versa. Because of this, anxiety and gut problems can be a vicious cycle where anxiety  makes you more likely to develop dysbiosis (the imbalance of gut bacteria) and dysbiosis makes you more likely to suffer from anxiety. But dealing with both conditions simultaneously (i.e. treating dysbiosis and reducing stress to the degree you can) can help alleviate both problems. To learn more about stress and its impact on the gut, check out my article on the topic here.

While anxiety can be a difficult diagnosis to deal with, there is more and more research coming out every day about the relationship between anxiety and the microbiome. If you suffer from anxiety, your treatment plan should definitely address any problems in the gut!

Gut Health and Anxiety: How to Improve Anxiety by Improving Your Gut

To recap, those with anxiety should focus on:

  • Reducing stress as much as possible by incorporating mind-body activities like meditation, yoga, etc
  • Testing and treating for dysbiosis with a trusted practitioner (I can help!)
  • Adding probiotics to their routine, in particular the Bifidobacterium longum R0175 and Lactobacillus helveticus R0052 strains  which can be found in the probiotic supplements ProbioMood and Probio Defense.
  • Adding prebiotics, especially GOS, which has shown to have a positive impact on the HPA axis and anxiety. Try Galactomune to get more GOS in your diet.
  • Eating a healthy, ancestral diet consisting of fruits, vegetables, meats, nuts, etc. (e.g. a Paleo diet!)

Now I want to hear from you: what have you done to combat your anxiety? Are you focusing on the gut?


For years doctors and dentists believed that malocclusion (teeth that don’t line up correctly) cause pain in the TMJ. However, newer research shows that while structural abnormalities may be part of the picture, this disorder is also associated with biological, behavioral and cognitive factors.

Temporomandibular joint disorders (TMD) cause pain in the temporomandibular joint (TMJ), and those with TMD usually have difficulty opening their mouths widely and may experience clicking or popping of the joint. TMD is also associated with neck and tooth pain, as well as dizziness and tinnitus.

In my most recent guest post on, I talk about the three little known factors that play a part in developing TMD and what you can do about them. Click here to read the full article!

Does Stress Cause Digestive Problems?

Most of us can probably guess that stress affects the body negatively – but what’s the connection between stress and digestion?

The Gut-Brain Axis

Changes in our mental state, like feeling scared or nervous, can lead to problems in the gut. Ever had to do a big presentation or take an important test and experienced heartburn or diarrhea as a result? That’s the brain and the gut in communication. This goes the other way too. Changes in our gut microbiota and changes in our intestinal permeability can affect our mental state, causing depression and anxiety. (1) These bidirectional signals going from the gut to the brain and vice versa can either keep us healthy or they can cause a great deal of discomfort.

It is vital to deal with any significant health issues that affect either the brain or the gut, but it’s important to note that neither will truly heal if you don’t also focus on the other. If you have a parasite and you treat it without dealing with your chronic stress, you leave yourself open to reinfection or sometimes, your body simply won’t be able to get rid of the parasite because of the chronic stress.

Chronic stress leads to negative changes in the gut, while relaxation promotes gut health. On the flip side, poor gut health exaggerates our stress level, while improvement in gut health lowers stress.

The fact that the gut-brain axis is a two-way street is especially important to remember. No matter how hard you try to boost the well-being of your digestive system, you’ll never fully feel better without dealing with stress; it will put you right back where you started if you don’t address it. Chronic stress is a risk factor for digestive disease, and those with digestive conditions are also likely to suffer from mood disorders. (2,3) In a country where over 40 million people suffer from psychiatric illness and 70 million are diagnosed with a digestive disorder, addressing the gut-brain connection is essential. (34)

Before we jump into the wild world of neurogastroenterology (that’s a fun one!) and learn how stress affects our gut, let’s get better acquainted with the nervous systems that make up the gut-brain axis: the central nervous system and the enteric nervous system.

The Central Nervous System (CNS)

The central nervous system consists of the spinal cord and the brain. It sends and receives signals to and from the peripheral nervous system and governs nearly everything we do with our body. Given the crucial role it plays, it is commonly referred to as the “control center” of the body. The CNS communicates with our gut via the vagus nerve, the longest cranial nerve we have, running from near the hypothalamus all the way to our intestines where it reaches the other big player in the gut-brain axis, the enteric nervous system.

The Enteric Nervous System (ENS)

The enteric nervous system is considered to be a part of the autonomic nervous system which is housed under the peripheral nervous system. The ENS is often called the “second brain” which explains why we can sometimes “feel” our emotions in our gut. This “second brain” has many similarities to our true brain – it contains over 100 million neurons (more than the spine, though less than the brain) and produces many of the same neurotransmitters found in the brain such as serotonin, dopamine, and acetylcholine. (5) Despite the fact that under normal circumstances the ENS is in conversation with the central nervous system, research shows that it is entirely capable of functioning all on its own, even when severed from the vagus nerve that connects it to our brain. (6) No other organ can claim this impressive feat – all require signals from the brain to function. Neat, huh?

Consider this other incredible fact: about 95% of our serotonin (the “feel good” chemical) is found in the gut, not the brain. (7) Normally associated with its anti-depressive properties, this chemical serves many different purposes and is mostly found in the enterochromaffin cells in the gut. Serotonin is released by these cells when food finds its way into the GI tract, signaling contractions to move the food down the intestinal tract. It’s also responsible for the stomach upset we experience when we eat spoiled food – serotonin is released in high amounts when the gut comes into contact with an irritating food and triggers both diarrhea and vomiting to expel the dangerous food.

Stress: The “Fight or Flight” Reaction

Two other relevant nervous systems to consider are the parasympathetic and sympathetic nervous systems. In times of great stress our sympathetic nervous system is activated, causing the universal experience of a racing heart and rapid breathing. You may have heard of it referred to as the “fight or flight” reaction, owing to the two courses of action our bodies are preparing us to take in these stressful situations. The parasympathetic nervous system, on the other hand, is often called our “rest and digest” system because when we are in a relaxed state the body focuses on exactly those activities.

In today’s world, we spend far too much time in the “fight or flight” mode and not nearly enough time “resting and digesting”. We’re constantly activating our “fight or flight” response with the many stressors we experience on a daily basis like traffic, a big project at work, financial issues, etc.

This is very different from how our hunter-gatherer ancestors experienced stress. While they may have been chased by predators on occasion, much of their time was spent in the “rest and digest” mode. Their ratio of “fight or flight” time to “rest and digest” time was the exact opposite of ours – and they had better digestive (and overall) health because of it.

I’m going to briefly go over what happens when we come into contact with a stressor so that you can understand the rest of this article, but if you want a more in-depth review, you’ll want to check out our free eBook, Overcoming Adrenal Fatigue, which you’ll receive when you sign up for our newsletter.

The hypothalamic-pituitary-adrenal (HPA) axis is the stress “control center” and begins the activation of the sympathetic nervous system by coordinating the many moving parts in a stressful situation. Upon recognizing a stressor, the HPA axis is stimulated and corticotropin-releasing hormone (CRH) is released from the hypothalamus. CRH travels within the blood to the anterior pituitary gland where it stimulates the production of adrenocorticotropic hormone (ACTH). ACTH then travels to the adrenal cortex where it ultimately stimulates the release of cortisol. You may have heard of cortisol as the body’s main “stress hormone”. During times of crisis, as in our bear attack, cortisol works to keep blood sugar elevated so we can meet the glucose demands of the brain and helps the body retain sodium to keep blood pressure up. It also moves blood away from the digestive tract and instead toward the muscles and brain. This process is vital to keep us alive during a true “fight of flight” situation as it helps us do exactly that – fight or run away.

Our ancestors led lives that allowed them to have a balanced stress level. Despite running from the occasional predator, as long as they survived the attack they would then have plenty of time to rest, calm down, and turn the stress reaction off afterwards. This enabled them to produce the right amount of cortisol – not too much, which has been associated with gaining abdominal fat and developing chronic disease, and not too little, which is correlated with exhaustion.

Unfortunately, most of us don’t live like our ancestors did. Instead, we experience chronic minor stressors all day long for our entire lives. Sadly, the HPA axis can’t differentiate much between major stressors like being attacked by a bear and minor ones like being reprimanded by our boss for being late to work. It’s stimulated just the same either way, going through the same motions and putting us into “fight or flight” mode in either situation.

In the next few sections, we’ll review the connection between chronic stress and digestion and how stress leads to gut issues by altering intestinal permeability, increasing inflammation and lowering immunity, changing the gut microbiota, and finally, actually increasing the amount of pain we feel.

Stress Opens the Intestinal Gates

We want to prevent our gut lining from becoming permeable – you’ve probably heard about the negative effects of “leaky gut” already. Consider the placement of the gut; from mouth to anus it’s not technically “in” our body, it’s outside. If you think of the body as a donut, the gastrointestinal tract is the donut hole, outside the rest of the donut. Pretty amazing to think that our entire digestive system is technically not even “inside” us.

When we think of the GI tract like this, we realize that it’s exposed to a lot on a daily basis. The gut barrier comes into contact with many different substances, from possibly harmful bacteria to food particles that need to be digested before being allowed into the body. It’s crucial that this barrier functions appropriately to keep the things we don’t want out and only allow the things we need in. When working normally, the gut lining acts as a sieve, only allowing particles that fit through to get to the other side. When the sieve breaks, things that aren’t supposed to get across now flow through freely. When the gut barrier leaks, we’ve got a big problem.

Researchers have known for a long time that severe physical stress such as trauma or surgery causes the intestinal lining to become “leaky”, but more recent research has started to look at the effect of chronic psychological stress on the gut barrier. (8) To approximate chronic psychological stress in humans, rats are repeatedly subjected to water aversion stress where they are placed on a platform surrounded by water. Researchers have found that this is a mild stressor to the rats, similar to the type of chronic mild stressors we face today. So what happens to these rats? They develop intestinal permeability that takes several days of no stress to heal. (9) Yes, several days. When’s the last time you went several days without any stress whatsoever?

This research has also shown that mast cells play a large part in the increased intestinal permeability that occurs as a result of stress. You may have heard of mast cells as the cells involved in allergic responses, as they are responsible for releasing histamine when they become unstable or “degranulate”, causing the typical allergic response – runny nose, watery eyes, congestion, etc. What you might not know about mast cells is that they’re also found along the gut’s mucosal wall and they contain CRH receptors. Remember, CRH is released at the start of the “fight or flight” reaction. Since mast cells have CRH receptors it means that they are responsive to the amount of CRH flowing through the body. When CRH attaches to mast cells, they degranulate and release their many chemicals, including histamine.

Researchers studying rats under water aversion stress found that rats bred to have no mast cells in their intestines didn’t show increased intestinal permeability under stress, unlike their normal mast-cell containing counterparts. (8) This tells us that mast cells play a very important role in the integrity of the gut lining when it comes to stress, and that unstable and degranulated mast cells lead to intestinal permeability. By stabilizing these cells, we can help prevent the breach in our gut barrier.

These rat studies give us a glimpse into what’s going on in our gut while under chronic psychological stress, and it’s not good. Hardly any of us can go a few days without being stressed about something, which never gives our gut barrier time to heal after it’s become permeable thanks to the unstabilized mast cells. Because of this, we’re leaving ourselves open to harmful substances not meant to enter our bodies.

Stress Fuels Inflammation

Glucocorticoids are steroid hormones made by the adrenals in times of stress. We’ve already discussed the most important one in the human body: cortisol. Cortisol plays a significant role in turning off inflammatory reactions. In fact, if you suffer from an inflammatory bowel condition, you may have been prescribed a steroid like prednisone to reduce the inflammation in your gut. When prednisone enters the body it is converted by the liver to prenisolone, a derivative of cortisol, to exert its anti-inflammatory effects.

Let’s say we were running away from the bear chasing us, but we got caught. The bear bit us, but allowed us to survive. The body’s reaction to physical trauma – being bitten – is to rush blood to the wound, which swells the area, turns it red, and makes it hurt a lot. These are all signs of inflammation, which is the body healing itself. Once inflammation’s job is done, the inflammatory reaction is shut off and cortisol helps this happen. Short-term inflammation like this is a completely normal response and under usual circumstances it helps us. It’s chronic inflammation that gets us in trouble.

One of the recent theories suggests that we can develop chronic inflammation – in the gut and elsewhere – when we’re under prolonged stress. (10) This is thought to occur because chronic stress alters the way our cells respond to cortisol. In effect, when cortisol is high for a significant period of time, our body simply becomes less sensitive to its anti-inflammatory effects. When we are under stress for even longer and consistently activating the HPA axis, the axis can eventually become overwhelmed and stop producing the hormones that it’s supposed to (like cortisol).

Think about it like the story of the boy who cried wolf. When the body constantly cries out for help with these little stressors and activates the HPA axis over and over again, eventually the HPA axis doesn’t bother answering the cries anymore – or at least not with as much vigor as it did before. As a result, we produce less cortisol than we’re supposed to. Low cortisol levels also lead to chronic inflammation because we don’t have the ability to fight off bacteria and other unwanted substances that make it through the now permeable gut barrier.

It’s important to remember that we want just enough cortisol: too much, and our tissues become less sensitive to its anti-inflammatory effects; not enough, and we’re open to attack from bacteria and other particles crossing the gut barrier, causing inflammation; just enough, and we’re able to keep inflammation down and respond to stress appropriately.

Are you starting to see the chain reaction developing here? The stress response turns on, our gut gets leaky, cortisol levels soar, and then eventually fall, causing inflammation either way. What’s next?

Stress Lowers Immunity

Did you know that the majority of our immune system is actually housed in the gut? Our gut-associated lymphoid tissue (GALT for short) makes up almost 70% of our immune system by weight. You might be able to imagine why the gut would need to have such a strong immune system – it’s in constant contact with things from the outside world such as food particles, bacteria, and all the other things we inadvertently swallow. That’s a lot to deal with!

As part of the gut’s immune system, our gastrointestinal system secretes something called secretory IgA (sIgA), which is our first line of defense when it comes to all the substances our gut is in contact with. This important antibody is also produced in other parts of the body that are exposed to the outside world – it’s found in saliva, tears, and lung secretions. Chronic stress reduces our production of sIgA and by doing so, leaves us open to colonization by pathogenic bacteria in the gut.

Studies show that students under academic stress have lower levels of sIgA than those under less stress. (11) Up to two weeks after exam stress has dissipated, students still show lower levels of sIgA with no indication of recovery. Relaxation exercises, on the other hand, actively increase sIgA production. (12) Low sIgA leaves us susceptible not only to infections of the gut but also to infections in the rest of the body. With infections come even more inflammation, thus fueling the inflammatory fire already going when we’re under chronic stress. Low sIgA also gives bad bacteria the chance to take charge, changing our gut microbiota.

Stress Unbalances Gut Bacteria

The gut microbiota is absolutely vital to our digestive health (not to mention the health of our whole body!), but stress changes its composition in our gut, shifting it in a less favorable manner. Under chronic psychosocial stress, mice develop a condition called dysbiosis, the relative overabundance of bad bacteria coupled with low amounts of good bacteria in the gut. (13) This imbalance is associated with digestive problems like IBS and Crohn’s disease, and even conditions like fatty liver disease and acne. Not only does stress alter the balance of our bacteria, but it also reduces our gut’s microbial diversity (how many different types of gut bacteria we have). Interestingly, the less diverse our gut bacteria, the more likely we are to be overweight and have allergic diseases.

Using germ-free mice, researchers have been able to prove that the intestinal microbiota also play a vital role in the development of the HPA axis (remember that’s our stress control center). Germ-free mice are often used in studies because they allow us to monitor what happens when the body exists without gut bacteria, providing us the opportunity to see exactly how the microbiota affects physiology. When these adult mice are exposed to stress, they produce higher levels of ACTH and cortisol than mice with normal gut microbiota. (14) To further elucidate this relationship, researchers then colonized the gut of the germ-free mice with bacteria from the normal mice which partially reversed the exaggerated stress response. The effect was fully reversed when the mice were colonized with a specific strain of probiotics (good bacteria).

It is clear that stress alters our gut microbiota, and that the opposite is true too – our gut bacteria affect how we respond to stress. When our microbiota is negatively altered as a result of stress, it then sends signals back to the brain which manifest as even further stress. But wait, there’s more!

Stress Increases Pain

Did you know that most patients with IBS and other gut disorders often show enhanced perception of pain? (The fun science term for that one is visceral hypersensitivity.) While the normal response to stress is to increase the pain threshold, patients with digestive diseases unfortunately experience the exact opposite. Think about it like this: if you were being chased by a bear and you stepped on a sharp twig, you’d probably continue running and barely even notice that you’re hurt. That’s an exaggerated example of the normal pain experience in response to stress – we can handle more of it.

However, in studies looking at the pain response to gastric distention (gas or air in the gut causing bloating), those with gut disorders have a lower pain threshold – meaning they experience more pain – than those without digestive problems. (15) Research further shows that patients with gut conditions exhibit even more digestive symptoms like gas and pain when they’re under mental stress and feeling anxious. These symptoms decrease during periods of relaxation, further proof of the tight link between the brain and the gut. Here’s the unfortunate fact: if you’re someone with a digestive disorder, stress literally makes your stomach hurt.

Let’s go back to how the stress response starts for a moment: CRH is released from the hypothalamus, which begins the cascade of hormones eventually resulting in the production of cortisol. In rats, CRH administration causes mast cell degranulation in the colon. Remember the mast cells? These are the cells that, when not present in the intestines of rats, resulted in the rats no longer developing intestinal permeability as a result of stress. Research has shown that when those with IBS are given a mast cell stabilizer they are less sensitive to pain. (16) This tells us that having stabilized mast cells is vital to having an intact gut barrier and having appropriate pain sensation. It’s theorized that stress management techniques such as yoga can inhibit mast cell activation, thus having a positive effect on all types of conditions where mast cell activation is problematic. (17)

This brings us to the end of the stress train-wreck. When we’re stressed, our gut becomes permeable and inflamed, our immune system is compromised, and we’re subject to an altered balance of the bacteria living in our gut. As if this weren’t enough, being stressed out makes us feel worse by increasing the amount of pain we experience!

Stress and Digestion: Overcoming A Stressful Life for Better Digestive Health

I don’t want all of this to overwhelm you or make you feel like you’re destroying your gut health by being stressed out. I wanted to take you through this so that you can recognize the many negative effects chronic stress can have on the digestive system. So what should you do if you’re always stressed out?

Laura and I have outlined some specific steps to take in our free eBook, Overcoming Adrenal Fatigue that you can get by signing up for our newsletter. You’ll learn exactly what you need to do to help your body overcome the effects of chronic stress.

Now I want to hear from you: Did any of these effects surprise you? What do you plan to do differently now that you know about the connection between stress and digestion?

What Can You Do About Low Blood Sugar (Hypoglycemia)?

Blood sugar regulation is process that is carefully balanced by our bodies.

We break down food to produce glucose and this is used by our cells for energy. Insulin, a hormone, acts as a key to open the door into the cell and allow glucose inside. If our blood sugar goes too low, another hormone called glucagon is released, which allows us to break down a stored form of glucose called glycogen. The process works much like a thermostat – when blood sugar is high, insulin is released to allow it to enter the cells; when it’s too low, glucagon is secreted to release stored glucose. Both high and low glucose can be dangerous, which is why our body works so hard to keep our levels in balance.

Today, I’m going to share my top tips for dealing with low blood sugar, or hypoglycemia.

Prolonged low blood sugar can cause serious medical problems, including seizure, coma, and even death. But the symptoms of a shortened period of low blood sugar can be more subtle.

It’s quite common for someone with hypoglycemia to not know it, and the symptoms are sometimes attributed to anxiety or panic attacks. In my own practice, I often find that patients complaining of brain fog, headache, anxiety, mood swings, or irritability feel instantly better once we start balancing their blood sugar.

What is Low Blood Sugar (Hypoglycemia)?

Hypoglycemia is usually defined as 70mg/dl or lower. It is at this point that a person will start to feel a variety of symptoms, including:

  • Confusion
  • Dizziness
  • Hunger
  • Irritability
  • Feeling shaky
  • Rapid pulse or pounding heartbeat
  • Sleepiness
  • Weakness
  • Lack of coordination
  • Anxiety
  • Headache

So what can you do to prevent episodes of low blood sugar? Here are my top tips.

1. Eat within 30 minutes of waking up

It’s increasingly common for me to see clients who skip breakfast, or just consume Bulletproof coffee in the morning. While this can be healthy for some, it’s often counterproductive for hypoglycemics. Instead, I urge my hypoglycemic clients to eat a well-balanced meal within 30 minutes of waking up if possible. This usually consists of around 30-40 grams of protein (½ filet of salmon, half a chicken breast, 6 oz ground beef, etc) along with fat and some carbohydrates. The ideal amount of carbohydrates really depends on the client, but a good place to start is about 20 g (½ cup sweet potato). You can then experiment from there to determine what level of carbohydrate intake works best for your blood sugar.

2. Don’t eat carbohydrates alone

When we eat carbohydrates, we break them down into molecules of glucose that then go to the bloodstream. This process can happen quite quickly if there isn’t anything else in the stomach to slow down the digestive process. This can result in a blood sugar spike. For someone with reactive hypoglycemia, this spike causes the body to release too much insulin in response, eventually driving the blood sugar too low. This causes a hypoglycemic episode. Both fat and protein slow down the digestive process, and as a result, glucose is released more gradually into the bloodstream, keeping the blood glucose steady.

Avoid eating carbohydrates on their own, and instead combine them with at least some fat, and possibly some protein for best results. So instead of having an apple for a snack, you might have an apple (carbs) with almond butter (fat + protein)

3. Eat every 2-3 hours

While eating three square meal a day is a healthy choice for many people, it can sometimes cause problems for those with hypoglycemia. This is because their blood sugar has a hard time regulating itself and tends to go too low when they don’t eat for hours at a time. To help stave off low blood sugar, it’s a good idea to eat every 2-3 hours. Typically this means adding a mid-morning and mid-afternoon snack and, depending on the person, potentially a bedtime snack, too.

Your snacks should consist of at protein, fat and carbohydrate just like your meals. Our previous example of an apple with peanut butter checks off all those categories.

4. Pay attention to adrenal health

When I have a client come to me with low blood sugar issues, one of the first things I evaluate is their adrenal health. This is because when the adrenals are worn out (you may have heard of this as “adrenal fatigue”) it leaves the body less able to properly handle low blood sugar. In someone with normal adrenal function, cortisol is released once blood sugar starts getting low and this causes the liver to release glucose, bringing the blood sugar back to normal. Someone with HPA axis dysfunction (adrenal fatigue) can’t make enough cortisol in this situation, and thus the signal to release glucose from the liver never gets turned on. This means that the blood sugar level just keeps getting lower instead of rising.

To learn more about adrenal health, check out my post on HPA axis dysfunction.

Finally, if you ever do have a hypoglycemia event make sure to eat 15 g of carbohydrate as soon as you feel it happening. If you don’t feel better in 15 minutes, eat another 15 g.

So there you have it! My top tips for dealing with low blood sugar.

Now I want to hear from you. Are there any tips you’d like to share?

Ask the RD: How to Make “SMART” Resolutions

Ask-the-RD-Podcast-Artwork-mic-320x320Can you believe it’s 2014 already? I can’t! The past year has been a whirlwind of finishing my Master’s degree, getting my business up and going, and spending time with my friends and family. It’s been absolutely wonderful, but now I’m ready to ring in 2014.

Did you make any New Year’s resolutions? I’ve vowed to do at least 3.5 hours of yoga weekly, since I had gotten out of the habit of doing it on a regular basis. I’ve been doing this for the last two weeks actually and I’m feeling so much better already.

If you’re wondering how to make a SMART resolution, check out the latest Ask the RD podcast on the very subject!

Check out the transcript below (originally posted on ChrisKresser,com), or search “Ask the RD” on iTunes!


A huge thank you to Amy Berger from TuitNutrition for the transcript. This was a long one!

LAURA: Hi Everyone, welcome to this week’s episode of Ask the RD. I’m Laura. I have a master’s degree in Public Health Nutrition and will soon be a registered dietitian.

KELSEY: And I’m Kelsey, a registered dietitian with a master’s in Nutrition and Functional Medicine.

LAURA: We’ll be answering your nutrition-related questions on the show, so remember to submit your questions through the online submission form on Chris’s site. And as a reminder to everyone, this is just general advice and should not be used in place of medical advice from a licensed professional.

So today on Ask the RD, instead of answering a specific question, Kelsey and I are going to discuss everyone’s favorite topic for this time of year, and that’s new year’s resolutions. So that actually might be some listeners’ least favorite topic; it’s one of those love it or hate it kind of things, but we’re going to talk about resolutions today because this podcast will be airing right before new year’s, I believe, and we’d like to share our recommendations with you all as we head into 2014. And I’ve been back and forth about resolutions before. I think they can be helpful because this is the time of year that everyone seems to be more motivated and interested in making changes, which is great. And I think it’s good to have a plan, so writing resolutions can help keep you on track. However, I also think it puts a lot of pressure on people to make major changes at this time of year, and I also think people tend to jump on the resolutions bandwagon without really considering whether they’re fully committed to the change they intend to make.

KELSEY: That’s a good point, Laura.

LAURA: Yeah, or if they even have a plan on how to follow through on these resolutions. So just writing your resolution without creating a plan on how to achieve that resolution can be problematic, especially if your resolution is something like, “Lose ten pounds,” or, “Exercise more.” So when a resolution is vague like that, or it doesn’t have action steps, it makes it really difficult to follow through with. So an easy way to make goals that will stick is by following something called a SMART goal format. And this is an acronym that stands for Specific, Measurable, Attainable, Relevant, and Time-bound. So S-M-A-R-T.

Specific means that you’ve targeted an area for improvement. Measurable means that you can measure your progress towards that goal, or at least quantify it. Attainable means that it’s a realistic goal that’s possible for you to achieve. Relevant means that it’s a worthwhile goal that matches with what you want from your life, and Time-bound means that you’ve set deadlines for when you want to meet the goals that you’ve set. Using these SMART goal formats can…you can apply it to any of the resolution topics that we discuss today. And Kelsey and I are going to help you make resolutions that are not only worthwhile but that also have a good chance of success. And we have six specific topics we’re going to discuss today, and those are: diet, exercise, sleep, stress, play, and socialization. All right, Kelsey, let’s hear your recommendations on how to set a resolution on diet changes.


KELSEY: Sure. So New Year’s is a great time just to check in with yourself and see what’s been going great, and also what hasn’t. And I think, first of all, just to kind of give an overview of how I like to think about new year’s resolutions is, I would rather see you do it in a totally non-judgmental way, but rather in a constructive and honest way. So as we discussed, there are these six places that are great to do a little checkup on—what Laura just mentioned: food, sleep, exercise, stress, socialization, and play. And as we walk through each of them, try to think about whether it’s something that you’ve done really well with this year and you’d like to continue with the things you’ve been doing, or if it’s something that has been somewhat neglected and should be a focus for you.

So, we’ll start with diet here. And I think this is a really good place to start for a lot of us, especially with the holidays behind us. As I’m sure is true for a lot of you, too, I tend to go off of my usual eating plan during the holidays, and for me, that tends to mean more sweets and treats just because that’s kind of part of my family’s traditions that we’ve had for many, many years. And I don’t really go overboard, but I certainly take the opportunity to enjoy those foods and not worry about it too much. And once new year’s comes around, I think it’s just a great time to reset your diet and get back on track.

So some people like to do with a strict Paleo diet or some people, more like what I do, I just need to take the treats out. Because otherwise, my diet is pretty good. For those of you who don’t go off your usual diet plan during the holidays, it’s a good time to check in just make sure you’re getting the most out of your diet. And this is for someone who went off the rails during the holidays too, but more so for people who did pretty well during the holidays. So that means asking yourself, am I eating the most nutrient dense foods possible? Are you regularly including superfoods, like organ meats and tough, gelatinous cuts of meat, bone broth, and fermented foods. I get off track with that sometimes. I just stop making bone broth or doing something like that, and this is a really good time to check in and get back on track with making those habits and keeping them up.

This yearly check-in is also a great opportunity to take out foods you’ve been wondering if you’re sensitive to. Because, you know, I see this with clients all the time. Some people definitely want to push off working with me during the holidays. Have it after new year’s, because then they’re more likely to actually stick to taking some of the foods we’re worried about out of their diet. So this is a great time to experiment and take out those foods that you’ve been suspicious of and then add them back in to see if they are indeed causing you trouble. Don’t put it off for another year. It’s a good time to do this. And lastly, I think it’s a really excellent time to make sure that your relationship with food is doing well. If you’ve been feeling a bit obsessive about your food intake to the point where it’s affecting other parts of your life, of perhaps you’ve stopped caring about what you put in your body at all—either side of these things is not where you want to be. So now is a time to rethink that relationship, and if you feel as though there’s something not quite healthy about that relationship, it’s a good idea to see someone about it, or just to be more aware of it. The relationship we have with food is so, so important. And it can often be more important to our overall health than the food we eat—you know, how we feel about the food we eat is so important to how we actually take that food and use it in our body.

With all that said, if we want to make a SMART goal related to food, it could be something like, “I will eat three servings of fermented foods a week.” That way, you’re saying it’s you. You’re gonna eat three servings, so it’s specific, you’re saying how many. You’re quantifying that. And you’re saying what you’re going to eat, and you could even make that for a determined amount of time, so you could even do it just for six weeks, kind of to get you on track if that’s more your style. Laura, would you change anything about that goal?

LAURA: I think it could potentially be more specific and say, “I will eat fermented foods on Monday, Wednesday, Friday,” if people think that they…some people really do need that…

KELSEY: Extra specificity.

LAURA: Right. And for some people, they like having the flexibility of just saying three times a week, so maybe that’s Tuesday, Wednesday, Thursday, maybe that’s Monday through Wednesday, so it’ll depend on what the listener’s personality is and how they feel they need to be, either very, very specific so that they can basically check it off every time they complete it, or just giving themselves a general idea of three times a week, so that by the time Friday or Saturday rolls around, if they haven’t done it, then they might be able to squeeze in a few servings at the end of the week.

KELSEY: Exactly. And I like what you said about kind of checking it off, and I think you maybe meant mentally, but I think also it would be a great idea to do it physically if you’re that kind of person who loves to do that. So you could have a little chart that you keep on your refrigerator and check off your 1-2-3 for those three times that you’re eating those fermented foods, and if you’re doing it on a specific day, you could have a calendar and check them off on those specific days that you’re supposed to eat them.

LAURA: Right. And I mean, this sounds a little bit juvenile, but even having a sticker, like a small little star that you put…

KELSEY: Right! A gold star! Who wouldn’t want a gold star?

LAURA: Right, exactly! A gold star! Say you just have the three days a week, and it doesn’t matter which day, and every time you eat a fermented food, you put a little star on your calendar. It sounds, like I said, a little bit juvenile, but I think it could be helpful for people that really want to stick to those kind of changes and want to have a visual example of the change that they have made. Especially with food and especially with diet change and those kind of goals that aren’t something like a weight loss goal, it’s a little bit harder to measure sometimes how you’re succeeding.

KELSEY: Right.

LAURA: So it might sound goofy to put a little gold star on every day that you eat an organ meat or—say you want to eat liver once a week and you have a little sticker that you put on every week you eat organ meat, and it’s almost like kind of a fun little challenge to see if you can get the stickers the way that they’re supposed to be every week on the chart.

KELSEY: Right. Plus, you see them add up. You know, if your calendar’s full of gold stickers, come on. That’s gonna be really motivating.

LAURA: Yeah. And you know, some people may not like that strategy, but I think that if people want to have a little fun with it and take it a little less seriously, it might actually be something that can help keep them on track with including superfoods especially, I think would be helpful using that technique.

KELSEY: Yeah, absolutely. Y’know, it’s a little bit harder to make these types of goals if you’re just kind of going back to a stricter Paleo diet. Something that’s a little bit more vague, but you could—instead of just saying, “I will eat a strict Paleo diet starting January 1st,” you could say something like, “I will take out a certain food group,” so grains, etc., etc., and “I will eat…” we could even bring the fermented foods and the organ meats back. “I will eat one serving of organ meats; I will eat three servings of fermented foods, etc.”  That would be much more specific rather than just saying “I’m going to eat a strict Paleo diet.”

LAURA: Right. And especially because the strict Paleo, even if you only do it for 30 days, eventually most people will reintroduce foods, so it’s like you can’t necessarily do that indefinitely, and most people I don’t think would want to do it indefinitely.

KELSEY: Exactly. And that even specifies it further. “I will do this for 30 days.”

LAURA: Right. And if it’s a goal like that, where you’re doing the 30-day reset, for example, from Chris’s book, maybe you print out a 30-day calendar and every day that you finish, you just X it off. I mean, I’ve done that before with…when I did Diane Sanfilippo’s 21-Day Sugar Detox, I printed out a little countdown calendar and just X’d off every day that I completed. So it’s a little bit of an extra motivation. It’s sort of a way to keep yourself accountable to the changes that you’re making. I just think having a visual image of your success, especially with food, it’s like…it’s hard to measure whether you’re succeeding unless you can just look at the calendar and say, “Oh, look at all the stars!” Or “Look at all the X’s I’ve completed already!”

KELSEY: Right, exactly. And I think having a calendar like that, it just, it really helps you take it one day at a time rather than just thinking, Oh my God, 30 days is so long. You just have to focus on the day that you’re in, and that’s it, and once you’ve completed it, you put that gold star on and you’re done with that day.

LAURA: I love this gold star idea! I think it’s so funny.

KELSEY: I really want to do this now for people.

LAURA: I know. Seriously. I’m thinking maybe I need to come up with a goal so I can make a sticker chart for myself!

KELSEY: Absolutely. So Laura, would you add anything on to this topic of diet here?

LAURA: I don’t think so. I mean, I think it’s going to mainly have to do with the individual person’s goals. So hopefully we’ve given people some ideas of things that they could do if they wanted to tackle a resolution that’s diet-based, but I think that it’ll really depend on what someone’s desired outcome is, because if they want to lose weight, their goal is going to be entirely different than if someone wants to gain weight, or if someone wants to reduce their autoimmune disease symptoms or something like that.

KELSEY: Right, totally. So I think you’re absolutely right about that. And perhaps listening to some of our older podcasts, because we’ve talked about some of that stuff, and reading Chris’s site, or Chris’s new book when it comes out, can help to give you some ideas of what you should be focused on exactly in regards to diet.

LAURA: Right, and just as an aside, I know we keep promoting this book, but we included some really helpful tools that people can use in the book that they can actually use in their resolution setting. So every chapter has its own little quiz that goes with it, and it’s a symptom quiz basically. And if you fill it out and you have a high score, the quiz basically directs you to that topic as being an area for focus. So the book’s coming out I think December 31st is the date…

KELSEY: Yeah, I believe so.

LAURA:  So if you’ve preordered it, I think Amazon can actually get it to you by maybe January 1st or something. I think Amazon’s kind of crazy like that. But I think that maybe putting off the resolution a couple days and getting that book read and figuring out what your actual priorities should be could be really helpful for people, because that’s where the Relevant part of the SMART goal comes in, because you want to make sure that you’re setting a worthwhile goal that’s gonna really make an impact in your health.

KELSEY: Absolutely. Cool! So I think that’s a really good overview of diet and making those SMART goals. So do you want to move on to exercise now, Laura?


LAURA: Sure! Well, exercise is definitely one of those resolutions that you need to come up with specific changes that you want to make. You can’t just say that your resolution is to exercise more, because as we mentioned before, that’s not measurable or specific. Another poorly worded resolution would be to “get in shape,” which I think back in college, I would be like, “My resolution is to get in shape!” I mean, what does that even mean?

KELSEY: Right. And of course, that kind of sets you up for failure, because who even knows what that means?

LAURA: Like what shape? I want to get into a cube shape. Anyway, sorry, that’s really lame. Okay, so you really need to come up with the specific steps you’re going to take so that you can have an action plan to follow. Otherwise, you’ll just lose focus after a few weeks of just working out more. So, some good examples of goals that would be specific are, “I will exercise a minimum of 150 minutes per week.” Or, “I will attend yoga classes twice a week.” And you can even get more specific if you’d like, so you can use a goal such as, “I will attend yoga class on Tuesday and Thursday every week until the end of March.” So that way you can actually…

KELSEY: Right. Real specific.

LAURA: Right, and you can use your sticker chart that you created! But that way you can easily track how well you’re following your resolution. And if you have a fitness goal, such as weight loss, or some people, improve performance is their goal because they’ve maybe been working out for a long time. It’s not only crucial to have a specific goal and the specific steps you’ll take to meet that goal, but you also need to make sure your goal is realistic. So if your goal is to lose 30 pounds by the end of January, that would probably not be possible for most people. Same thing if your goal is to bench press your body weight by February and you’re only able to bench press 40 pounds right now, that’s probably not a realistic goal. So as far as weight loss goes, losing an average of 1-2 pounds per week is usually pretty realistic for most people. This kind of depends on how much weight you have to lose. If you only have about 10-15 pounds total to lose, it can actually make it hard to lose that one pound a week. And if you have, say, 50 pounds to lose, you might find that you can easily lose 3 or 4 pounds a week. So I would say for most people, aiming to lose about 5 pounds per month until you meet your goal weight is an attainable goal. And it’s also specific and it’s measurable. Say your goal weight loss is 20 pounds. You will say, “I want to lose 5 pounds per month until the end of April, by which time I’ll have lost 20 pounds.” So that’s an attainable and realistic goal to set. And if people are interested, they can look up their ideal body weight based on their height and gender to get a rough idea of what might be an appropriate end goal, because sometimes people set those end goals too low as well. And that’s not likely to be a healthy or sustainable goal in the long run. So I’ll link to a calculator that listeners can use to help determine a healthy weight range for themselves. It’s pretty wide. I think mine is like…it says between 125 to 165 pounds would be healthy. So it’s not like, “145 pounds is your ideal weight and that’s it.” It gives you a really good range, so people can check that out if they’re interested in seeing what would be a good goal for themselves to set.

And there are some different techniques that can help people stick to their exercise plan. One idea is to enlist a buddy that has a similar fitness goal and that way you can both keep each other on track with your workouts. When you have someone that’s holding you accountable, it motivates you to stick to your plan, whether that’s meeting at the gym, going for walks or runs together, or simply just calling to check in with each other on a regular basis to see how things are going. Another idea is to sign up for personal training sessions if you can afford it, because that way, you’re not only accountable to your trainer, but you’re also investing money into it, which is motivating in itself. Joining a group exercise program can also help keep you accountable because a lot of times you make friends in these groups, and they may start to expect to see you regularly. I know when I’ve done CrossFit in the past, if I didn’t show up for a couple days, I would get back and people would be like, “Where have you been?!” Of course they’re just being friendly, but it does kind of motivate you to keep coming if you feel like people are going to be wondering where you are.

Another idea is to pay for a few months of a gym membership or a set of exercise  classes in advance, because if you’ve already paid for it, you may make more of an effort to make the most of what you paid for. So instead of just signing up for a yoga class, or a couple yoga classes, maybe get a package that…you’re gonna want to use it, because you’ve spent the money on it and it’ll help keep you going instead of…

KELSEY: And usually they’re time limited, so you would buy a pack for a month, or two months, or three months, so you have to use them within that timeframe.

LAURA: Right. So if you’re setting a performance goal, such as a PR for a specific lift, or maybe a race time, it helps to keep a log of your training sessions so you can monitor your progress. And sometimes you can even download training plans and fill them out as time goes by to make sure you’re progressing toward your goal. So if your goal is a race that you want to run and you want to have a specific time for it, or if you want to just complete the race, which I think is…y’know, I’ve done that before…

KELSEY: A worthy goal, yeah.

LAURA: Yeah. When I did a 10-mile rice, I had a whole…I think it was six weeks that I had downloaded a training plan for, and that actually helped a lot because I could see every day what I was supposed to do. So they would have like 3 or 4 runs per week and then 2 strength training days or cross training, I guess they called it. So that was helpful for me because it kept me on track with the workouts I was supposed to be doing to prepare myself, and it was created by a professional fitness trainer, so I was confident that it was going to be an actual useful training plan and not just…I wasn’t going to show up on the day of the race and be totally unprepared for what I was going to do.

KELSEY: Right. Yeah, that’s great.

LAURA: So either people can check out downloadable training plans, or if you sign up for a couple of personal training classes, maybe you ask your trainer to set you up with a couple months of training plans or something. And a good trainer won’t have a problem with doing that, because sometimes they’ll say, “No, you need to come back and see me!” But if you buy a couple of training sessions and the trainer shows you what to do, and then you say, okay, can we set up a couple weeks where I can do this on my own and then I can come back and check in with you. That’s a little bit of a cheaper way to do the training thing.

And then also, with the weight loss goal, I do recommend that people weigh themselves weekly and record their weight in some kind of log. Some people do like to weigh themselves daily, which I guess…that’s fine if you like to do that, but it can sometimes be discouraging to people because day to day, weight tends to fluctuate a decent amount. So, for the general population I would suggest just picking a day and time when you’re going to weigh yourself every week so you have a measurement of your progress. So maybe that’s Wednesday morning right after you wake up, that’s the day you’re gonna measure yourself. And then you can keep track on a weekly basis what your progress is. And like I said, I think exercise in particular really requires very specific, measurable goals that are monitored regularly. And once you start to get into this new routine, you might actually find that it takes a lot less motivation to stick with it over time because you just get used to doing it on a regular basis. Did you have any suggestions on exercise?

KELSEY: I loved those, Laura. But I would also add that there are a few kind of…apps or just technological advances that we have now that can help, too. If you have an iPhone or a smart phone, I think there’s some app, and I forget what it’s called right now, but you made me think of it, and you set a goal and I think if you don’t work out one day that you said you would, you basically pay money to the app developer. So when people miss their sessions, they have to pay to do that, so I think that’s a really good motivator, especially…it doesn’t have to be a lot of money, but even if it’s a dollar or two, you’d be like, “No, I have to go to the gym because I’m gonna get charged if I don’t go to the gym.” So I think that can really work for people.

And I have to say that I use a website called Yoga Glo to do yoga at home sometimes, and on there, you can make a goal based on either the number of classes you want to do per week or the amount of hours of yoga you want to do per week. And it’ll keep track of that and show this bar that fills up as you start to get closer to that goal every week. And I think that just seeing stuff like that, like we were talking about with the calendar, is so, so helpful. So look online, find some of these cool apps that can help you stick to your goals. That’s an excellent way to do things too. And just going back to diet for a second, if you wanted to keep a food diary like we’re talking about a training diary type thing, Meal Logger is a great option for an app and there are plenty of others too if you just type “food diary” into the app search, you’ll find plenty of things.

LAURA: Yeah, I think that’s a really good idea. I’ve never heard of that option for Yoga Glo, so I’ll have to look into that. One thing that you jogged my memory about is that a really good fitness goal for a lot of people is number of steps taken per day. So, I think the number that gets thrown around a lot about what the ideal goal should be for the general population is 10,000 steps a day. That might be a lot for someone starting out, especially if you’re fairly sedentary, because I think 10,000 steps is…is it like five miles or something?

KELSEY: I’m not sure, to be honest with you.

LAURA: It’s pretty far, because I think I measured it before as far as my own activity, and it’s difficult to get to that level unless you’re working on a treadmill desk or something. But if you are someone that feels that a steps goal would be good for you, which I think is a great idea for a lot of people, maybe you set the goal to be 5000 steps every day for the first month. And you know, you don’t have to buy a high-tech pedometer. You can use a simple one. I have a Fitbit, which is a little more expensive but I really like it a lot. It measures more than just steps, but if you’re just getting a pedometer, it should be a couple of bucks, basically. Sometimes they even give them away for free at some companies. So if you wanted to set a steps goal, say it’s the 5000 steps a day for the first month. That means that you wear your pedometer every day, and then at the end of every day you go into your…it can literally be just a black and white notebook that you’re writing this down in, and you just write down the number that you’ve achieved every day. So maybe you do the first day and you find that you’ve only done 3500 or 4000 or something. And then the next day maybe you work a little harder and you find that you’ve made your 5000 steps goal. So it gives you kind of an idea of how hard you have to work every day to get to that goal. And then maybe once you’ve met the end of the month, you can say, “Okay, now I’m going to upgrade to 6000 steps a day.” So I think that that’s another really nice goal to set for the general population, mainly because most of us don’t get enough steps in during the day, and it’s really measurable because you can literally just look at this little thing that’s clipped onto your belt and it’ll tell you what you’ve done so you don’t have to figure out certain goals to set.

KELSEY: Right. Numbers can be so, so helpful that way. When you just see it like that, there’s no lying about it. You can’t trick yourself into thinking you did more than you actually did.

LAURA: Right. I mean, obviously there’s some level of measurement error that’s possible, but I think that these things are pretty accurate, and I almost think it’s a better goal to set than a specific weight loss goal, because weight’s one of those things that, y’know, maybe you drank more water the day before and that’s why you’ve put on an extra pound.

KELSEY: Right.

LAURA: So it’s a little less…how do I describe it? I just feel like weight can be a very slippery slope as far as setting health goals.

KELSEY: It can, and especially since you mentioned…if you’re measuring every day, it can be a little more discouraging. And yeah, setting goals that are really just about the number of minutes you do something or the number of steps you’re taking, rather than, “I want to weigh 20 pounds less,” which can fluctuate a little bit. That’s just part of our bodies, that it fluctuates. It’s never going to be static, so you have to kind of keep that in mind as you’re going through making these goals too.


LAURA: Right. So, okay, I think that’s good for exercise. Did you want to talk about sleep now?

KELSEY: Sure. So I think sleep is the beginning of the rest of these six areas that we can make goals on, and I separate it out because I think that most of us, when we think goals, we tend to think nutrition and exercise. That’s just kind of where we start. But these last four that we’re going to talk about, I feel like tend to be put on the backburner a little more often. And of course one of those is sleep. Something that really, a lot of us don’t get enough if. In fact, I think it’s almost a third of us get less than 6 hours a night, which is not good when we’re aiming for 7-9 hours a night. And getting less than 6 means we’re way off that mark. So if that sounds like you, definitely make sleep a priority this coming year. That means making time for sleep. So, turning off your computer and other devices a couple hours before bedtime, and taking that time to relax so that you’re ready for bed when that time comes around.

And there are a few ways that you can think about making goals. You can start to keep the lights lower once it gets dark out by using lamps or other low lights, rather than those big, bright overhead lights if you can do that. And that’s because artificial light causes us to produce less melatonin, which in turn disrupts our sleep. So make sure to reduce your exposure to artificial light. That could be an excellent goal. Obviously we’ll make that more specific, so that as much as possible the body can do its job and produce that melatonin, which will make you tired and make sure you sleep through the night.

You could also make a goal to purchase a pair of amber glasses that block the blue light, which is the kind of light that disrupts the melatonin production. And that might also let you sleep better. Laura, I know you have a pair of those, so how have those helped you?

LAURA: Well, they’re super goofy looking, but I do find that if I wear them while I’m either working on the computer in the evening or even watching TV or watching a movie, they make me…like I can’t stay up to do work. And granted, I haven’t really been staying up that late in the last couple days or weeks, to do work since I’m not a graduate student anymore, but when I was a student and I was staying up until 11 doing work on the computer, I would literally be feeling like I was nodding off. Whereas if I don’t wear the goggles, then I can stay up until 1:00 in the morning doing work and it wouldn’t really affect me. So I don’t think it’s something that people really appreciate until they actually use it and see how well they work.

KELSEY: Right, yeah. I think that’s awesome. And I have a couple clients who are using them and they really like how it affects their sleep and they’ve said kind of the same thing that you’ve said. I’ve yet to get a pair yet. Sleep doesn’t tend to be one of my issues. I can fall asleep in a second. But that’s really important. So if you’re the type of person who can just stay up really, really late on the computer or watching TV or something like that, usually that’s related to your exposure to artificial light. So a good goal to make here would be, for example, “When I come home every day from work [if it’s dark out at that time], I will use lamps” – you could even write down specific lamps in particular areas of your home – “and keep them on until a certain time,” or whenever you want to go to bed, make that the end time when the lights go off, so say “until 10:30pm every night, at which point I will get in bed.” So it doesn’t mean you actually have to fall asleep at 10:30, because that’s kind of unrealistic. We don’t know exactly when we’re going to fall asleep. But you can say when you’re going to get in bed. That’s a reasonable goal. What do you think about that, Laura?

LAURA: Yeah, I think setting a bedtime is a good idea basically for anyone, even if you’re not someone who struggles with sleep. Just because it kind of gives you a more concrete goal as far as addressing your sleep issues. Just because I think just saying, “Oh, my goal is to sleep better,” is very nebulous, and if your goal is to be in bed by 10:30 every night, then you can actually see if you’re achieving that. And something that can help is setting an alarm to actually go to bed, as opposed to an alarm that’s waking you up, you need to set an alarm that says, okay, it’s time to start getting ready to go to bed.

And obviously there’ll be some nights that you’re not following this, like on a Saturday night if you’re out to dinner and you don’t get home until 11:00 or something. But I’d say for most nights, if you have that alarm going off, even if it’s an alarm 30 minutes before you need to go to bed just reminding yourself to start getting ready, or it could also be an alarm that goes off telling you when to put the lights down or put your goggles on.

KELSEY: Exactly, exactly.

LAURA: So again, just setting these goals that are very specific and very easy to implement is really important for the success of the goal.

KELSEY: Right. And I think the bedtime goal is a perfect first step. If you’re not really sure where to start, making that bedtime goal is an excellent place to start. So you could say, “I will get in bed at 10:30pm at least four nights a week.” So that gives you a little bit of leeway on some of those nights that it’s just not gonna happen. And I think that’s really an important thing to focus on if you’ve realized that sleep is something that’s been neglected for a while for you. And as we go through these other topics here, they all play into sleep as well. So, for example, managing your movement. So your exercise. They’ve done studies that show people who don’t exercise much or don’t get a lot of movement through their day tend to sleep more poorly. So making sure that you’re exercising enough can help you to sleep better. So sleep is kind of this one that everything else plays into. And I think you want to make these action steps that will help you to sleep better, so keeping lights low, using goggles, setting a bedtime, making sure you’re exercising enough. Managing your stress is another big one which we’ll talk about soon. And getting all those areas of your life under control can greatly help you to better your sleep.

And even going back to diet, we could say stop consuming stimulants, like caffeine and chocolate. Sometimes those affect your sleep and Laura answered a question I think last time on our podcast about sleep nutrition. So that could be really useful for you if you’re having difficulty sleeping and maybe you’ve kind of taken a lot of the other things into consideration and diet seems to be that last step that might be holding you back.

LAURA: Yeah, and Chris has a good chapter on sleep in his book, so if this is something that you want more information about how to address this issue, he’s got a lot of really good recommendations in there.

KELSEY: Right, and he’s got chapters on all these topics, so if any of these are an issue for you, it’s a good idea to grab that book and check out what you can do.

LAURA: Right. So, one other thing I wanted to mention as far as setting alarms, you can also set an alarm that tells you when to turn off electronics. So things like your TV, your iPad, your phone. Maybe set a 10pm limit on those things and just say, “Okay, at 10pm I’m going to turn off all electronic devices that are light-emitting.”

KELSEY: Right.

LAURA: And I think that actually is a very difficult thing for a lot of people to do, especially people that enjoy watching TV late at night, or check their phone a lot before they go to bed, so that in itself could be a pretty important goal for some people to set. And there are some people that really like these late-night TV shows. I personally think it’s a better idea to get a service like Hulu, or a DVR recording device…

KELSEY: Like TiVO or something like that.

LAURA: Right, and record these shows so you can watch them at a more reasonable time during the day, because I just think staying up until 1:00 in the morning watching TV is probably one of the worst things people can do for their health, or for their sleep health. So setting limits on TV and screen time and having an alarm that reminds you to turn the screens off could be a good resolution for some people to make.


KELSEY: Absolutely. Cool, so I think that goes over sleep pretty well for everyone, so do you want to move on to stress now, Laura?

LAURA: Yeah, well, stress is kind of like sleep, where it’s a topic that doesn’t really get enough attention in people’s new year’s resolutions, and again, I think it’s because it’s a hard concept to make concrete goals about. I think most people could say that they want to be less stressed, but knowing how to reduce your stress can be really challenging, especially if you just don’t know what’s causing your stress or how to manage it. But I do think that it’s worth addressing stress as a new year’s resolution, because like sleep, it makes a huge difference in your health. And people can create SMART goals that address their stress levels. One of the best ways to do that is to commit to a regular stress-relieving practice. And there are a number of different options that you can do for stress relief, such as yoga, like you mentioned. There’s meditation, tai chi, visualization practices. Again, Chris has really good ideas in his book, which is coming out very soon, so we highly recommend checking it out, but the important part here, no matter what you choose as your stress relieving activity, is to start slowly, especially with techniques like meditation, which really do take some time to get the hang of. And I think if your resolution is to meditate every morning, make sure you’re setting a reasonable time for yourself, and I think it’s a great place to start at, say, five minutes of meditation every morning, which, for some people that might actually be a lot. And you can always increase it from there, but starting slowly will make this type of resolution much more achievable. You don’t want to start off by saying, “I’m gonna meditate for 30 minutes every morning for the next month.” I mean, I just don’t think that that’s a good place to start for a beginner.

KELSEY: Right. And I will say that I was kind of interested in meditation, so my yoga studio, every week on I think Sunday nights, they do a meditation. And this was my first dive into meditation. It was an hour long, and I just hated it.

LAURA: Oh my gosh.

KELSEY: So I just really suggest that if you want to get into meditation that you definitely start with something really, really small, because you might just feel so uncomfortable doing it for an hour that it’ll turn you off from it for a while.

LAURA: Right. I mean it’s almost like an exercise. You know, if you haven’t been exercising, you’re not going to say, “I’m going to run for an hour today.”

KELSEY: Right.

LAURA: That would be insane.

KELSEY: Right, Like me.

LAURA: Well, maybe not insane. I meant more with the running thing. But with the meditation thing, it’s definitely one of those things that if you’re not used to doing it or you’ve never done it before, you’d be surprised how quickly you get tired of it.

KELSEY: Absolutely.

LAURA: So I think a five-minute goal is a good starting place for most people, and if you find that that’s easy, which I don’t know a whole lot of people who find meditation easy, but you can always increase it to ten, fifteen, twenty minutes, and maybe get up to an hour by the end of the year.

KELSEY: Right.

LAURA: And another option for a stress-related resolution could be to sign up for a stress-reducing education program, and your resolution would be to complete the course. So you can find local or online mindfulness-based stress reduction programs, and they may take from a few days to a few weeks to complete. Or maybe like Kelsey said, your local yoga studio has a multi-week series you can sign up for, either for yoga or meditation. And sometimes it’s easier to have some structure with these programs when you’re first starting out, since like I said, they do take some practice to get comfortable with. And if you sign up for these courses, you can be led step by step through the beginning stages of getting into these practices, so that by the time you finish the program you’ll feel more confident doing it on your own, or just being able to do it on a regular basis. I know in North Carolina near me, they offer the mindfulness-based stress reduction programs I think on a quarterly basis, so every three months they have a different class that you can sign up for. So maybe people can look into that, and I think there are online programs that run continuously that you can sign up for that might take you step by step through the process. I think that would be a good thing for people to sign up for if they’ve never done any of these activities, because it is difficult to start from ground zero basically, with these programs. I almost think it’s harder to do this than exercise, because exercise is at least kind of like a natural thing that…y’know, you at least walk around during the day, so it’s not completely new…

KELSEY: Right, that’s true.

LAURA: Sometimes things like meditation, you can be surprised how hard they can be, because I tried it before too.

KELSEY: But it’s not.

LAURA: Yeah. I am terrible at it, which means I should probably set some kind of resolution related to it.

KELSEY: That’s actually a really good point. If you kind of walk yourself through all these different topics and you’re noticing that maybe one or two of them you’re like, “Ugh, I can’t be bothered with that,” that’s a good sign that that’s exactly what you need to work on.

LAURA: Right.

KELSEY: And I know that that’s something that I notice myself doing, and then I have to stop myself and say, “Okay, maybe I should think a little bit more about this and actually make a goal about one of these things,” because that’s just such a good sign. Especially when I’m working with a client and I ask them about their stress levels, they’re like, “Oh, y’know, whatever. I don’t even want to talk about it.”

LAURA: Yeah.

KELSEY: That, to me, is a really good hint that that’s probably one of their biggest issues, y’know?

LAURA: Or they might think that it’s normal to be that stressed.

KELSEY: Exactly.

LAURA: Which, I think especially in American culture, it’s one of those things that being stressed is almost like a badge of honor, basically.


LAURA: And it’s sometimes hard to kind of take a step back and look at your life and say, okay, there’s a difference between normal stress and stress that could be damaging. Y’know, no one’s going to have a completely stress-free life. We’re not saying that that’s an achievable goal, but at least being aware of what the sources of stress in your life are and addressing them and either removing the sources of stress as much as possible, or figuring out ways to deal with it in a constructive way. Because I know so many people that just work and work and work, and they don’t really pay attention to the fact that they’re running themselves into the ground. And I’ve been there before myself; it’s almost impossible to avoid when you’re a grad student, but it’s something that if you don’t address, it can definitely throw off all of the other resolutions we’ve talked about today, so this may be something people should consider at least addressing. It doesn’t necessarily have to be a resolution that you set, but at least thinking about how stress may be playing into your success in the other goals that you’re setting.

KELSEY: Yeah, absolutely. One other thing I want to mention about stress is that something I’ve found that helps my clients a lot to reduce their overall stress level, y’know, other than these kind of mind-body techniques, is to focus a lot on time management. Because the people who tend to be the most stressed tend to be the kind of people who have a million things going on. Y’know, they’re kind of disorganized, they don’t really have specific things that they’re supposed to be doing at specific times, and for those people, it’s really helpful to get on track with time management. So setting when they’re going to do specific things, making goals for what they’re going to accomplish and when, like when they need to go to the grocery store…kind of having a place for all of the things that they need to do. And that helps immensely to reduce the overall stress level, because if you know exactly what you’re supposed to be doing at any given time, then you can make a choice as to whether you want to incorporate a little bit of play, which we’ll talk about next. You have the ability to kind of alter that a little bit, because you know that you can stretch things a little bit, whereas if you are just all over the place, you don’t even know what you need to accomplish, never mind if you’re going to be able to do it if you introduce a little bit of spontaneous play or something like that within your week.


LAURA: Yeah, so I think that’s a good transition into our next topic, so do you want to tell our listeners about play?

KELSEY: Yeah, absolutely! So this is probably the one that most of us forget about. We relate play to children, and we think that now that we’re adults, we don’t have time for play, or that we shouldn’t play, but I think that we absolutely should. And I think some of us may not even know what play is anymore. So play can be something that you enjoy doing. And it should be creative, it should be all-consuming and improvisational. It could be playing a board game, creating or listening to music or art, or playing a team sport. Really, it’s totally up to you and it should be something that you love and enjoy doing. Also, it doesn’t need to accomplish any type of goal, which is kind of ironic, given what we’re talking about today. But it means that you don’t need to win the board game, so…I mean, that might make it a little more fun, to win the board game, but really the act of playing the game itself is more important when you’re playing. And honestly, this is something I need to focus on in the new year. I’m sure you can relate, Laura, that over the last couple of years, we’ve both been working on our master’s degrees, and now that I’m finally done, the first thing I thought was, yes, now I can do some fun things that I’ve really been avoiding for the last couple of years just while I was doing this. And the first thing that I did, or the first play thing I did was to have a snowball fight…”

LAURA: Nice!

KELSEY: Which was so much fun, yeah! And it had just snowed a ton here, because right now I’m in Massachusetts visiting family for the holidays, and I was outside with my boyfriend doing something practical, of course, and then somehow it ended up turning into a snowball fight, and it was so great! And usually I would just be like, “Oh, I don’t have time to waste doing this…I need to do homework” or something, but doing that, it really woke me up and energized me, and that’s exactly the point of play. You kind of disappear into it and time stops because you’re having so much  fun.

LAURA: And the nice thing is that a lot of these play experiences, like something like a snowball fight or a kickball game or something like that, that’s a little bit more obvious as far as being play, but play could also be something like doing a crossword puzzle on your own. It doesn’t necessarily have to be with another person.

KELSEY: Right.

LAURA: Or it could be, y’know, if you have a dog, just roughhousing with your dog a little bit. The whole point—I think you hit the nail on the head there—I actually think it shouldn’t have a purpose. I mean I guess sometimes they can have purposes, like if you want to do an art project, then you might have a goal in mind as far as the end result, but I think the best type of play is actually stuff that has no purpose, because that way it’s kind of like giving you a little bit of an escape from…a lot of us get into this routine where everything you do has to have a purpose, and if you’re not doing something purposeful you feel like you’re wasting time. Especially, you know, I’m a little bit of a type A, maybe a type half-A or something, where I get into this mode where everything has to be productive and I forget that sometimes you can do stuff just for fun. And I think setting aside time, purposefully, to do something that has no purpose, is a really good idea. So I don’t know if that’s something that you were going to mention.

KELSEY: Yeah, y’know, I think that’s a little bit confusing, honestly, with play, because I do think that play should be very spontaneous. So I think scheduling it in may not be the best way to go about it, however, obviously if you’re a soccer game or something, usually that’s gonna be somewhat set in your schedule, but something like a snowball fight, that was completely spontaneous and just happened on the moment, but going back to what I was talking about, about time management, I think that making sure you’re on track with everything you need to do allows you that flexibility in your schedule to fit in play when it occurs. If I didn’t know that I was all done with my homework or something else that I had to do, then I probably would’ve said I can’t take half an hour to have this snowball fight, and what a bummer that is. So I think really focusing on your stress and time management and making sure that you are on track with everything allows you that flexibility to incorporate play more often.

LAURA: Right. And I think it’ll depend on people’s individual circumstances, because I know for me, if I was going to set a play goal for myself, I would probably find some kind of social sport or something to sign up for, which, like you said, if that’s something you like doing, that’s going to have a scheduled component to it.

KELSEY: And you could probably do bits of both. You know, have a scheduled component so you’re making sure you’re getting a certain amount, but then allowing yourself some extra time during the week for spontaneous play as well.

LAURA: Right. So I think for people that are very lacking when it comes to play in their lives that scheduling something that’s on a recurring basis can actually be helpful because it’ll get them into the habit of doing stuff that’s like that, so then once that starts to become a habit, and like you said, getting time management skills on track is actually another helpful thing for getting enough play in your life. But maybe once they’ve started to incorporate scheduled play time, then they’ll start to appreciate it more, and then when opportunities come up to just be spontaneous in play situations, then they might be more likely to go for it. It’s almost like taking small steps towards that goal.

KELSEY: Right, yeah. Spontaneous play is probably the end goal here, and most people won’t start there. You’re absolutely right.

LAURA: Right. So just as far as resolutions go, I think scheduling maybe a weekly softball game that you go play, or even scheduling like 30 minutes a night that you do Sudoku puzzles that you really enjoy. It seems a little silly to schedule it, but I think the more people commit to doing it, the more they’ll appreciate it and do it on a more regular and spontaneous basis. But that’s me being type A – “I need to schedule my volleyball game because I won’t do it if I don’t have it on my schedule!”

KELSEY: No, and that’s a great point. There are different types of people, and someone who is a type A might feel much more comfortable doing a scheduled activity. But I do think the end goal is to incorporate some type of spontaneous play, and that can be anything. It doesn’t have to be something as grand as a snowball fight.

LAURA: Right.

KELSEY: It could be just five minutes of doing something that you really enjoy, that on the spur of the moment catches your interest. So that’s obviously the end goal, but I think a good first step, especially for someone that’s kind of a type A personality, would be to schedule it in in the form of some type of social activity like we were talking about. And I think that’s actually a really good step into our next topic, which is socialization.


LAURA: Yeah, well when I was looking into the socialization goal setting, it kind of seemed to be blending with play a lot.


LAURA: So this could be kind of a two-part resolution for people if they’re finding that this area of their life is lacking. And I’m sure like me, and maybe you might find this too, I’m sure there’s a lot of people out there that have allowed their social life to take a backseat to things, such as their career, or their family…”

KELSEY: Or their master’s degree…

LAURA: Right, seriously. Even health can sometimes cause people to have their social life put on the back burner. I think this is especially common in the Paleo community because many times people who are intensely focused on their diet and exercise routine actually end up avoiding social situations that might put them off track with their health goals. But as people may be aware, socialization is a really important component of health, and it’s an important part of life that really needs to have as much attention paid to it as diet and exercise, if not maybe more, depending on what your circumstances are.

So socialization goals may actually be easier to set than people might think. You don’t necessarily need to make plans with your current friends. You might actually consider setting a goal to get involved in a new social group and attend social events on a regular basis. For example, you could join a meetup group. There’s a website called, and maybe you resolve to attend one event per month, minimum, for the next year. Or if you’re more ambitious, maybe you could set a resolution to attend one event per week. Or if you’d rather nurture the relationships that you already have, you can find a friend who is also interested in improving their social life and maybe set a weekly or bi-weekly meetup with them that you both can stick to for a few months. So maybe you meet for coffee every Saturday morning, or maybe you find a restaurant that you both like to get lunch at and maybe you can get lunch every Sunday.

And you can combine your socialization goals with your exercise goals, too, or I guess this actually combines it with your play goals as well. Maybe you meet up with a friend for an hour long walk, or you join a kickball team that plays on a weekly basis. And obviously these socialization goals are largely going to depend on people’s age and family situation and health status, but maybe a 25-year-old single person would be interested in joining a weekly trivia team at a bar, whereas a 45-year-old married person may simply choose one day a week where they get to set aside an hour or two to socialize with a friend and get away from their family responsibilities. And then maybe a 65-year-old will want to join a book club that meets monthly. And obviously I’m being wildly stereotypical right now, but I just am trying to demonstrate to our listeners that there are really an infinite number of opportunities for nurturing social connection, and setting a resolution to do this might be a good idea for people who are used to making more health related goals and not really attending to their social lives. So this, like I said, it plays pretty well into the play goal setting, because a lot of times this will overlap with play.

KELSEY: Right, and usually someone who isn’t playing a lot isn’t socializing a lot, either.

LAURA: Right, and I think a lot of times, people that are very focused on things like, like we said, career, or school, or their families, or their health, they tend to kind of put socialization low on their totem pole of priorities. So yeah, once in a while you have to make sacrifices, but if you’re constantly sacrificing your social life for these other things, I think setting a resolution that’s related to socialization might actually be a good idea for some people. And like I said, it could be as easy as finding a friend and saying, “Hey, do you want to meet for coffee one day every two weeks,” or maybe even one day a month, maybe it’s the first Saturday of every month you meet for coffee. It could be something as simple as that, but I think that could make a difference in someone’s life that is struggling to get enough socialization time with their current responsibilities and their current priorities.

KELSEY: Right, and I think going back to play a little bit, too, one of the end goals of socialization could be to say yes to spontaneous events, because I think sometimes that tends to be the thing that we’re always saying no to when our time management is out of whack. When we don’t know what we’re supposed to be doing or what we need to accomplish, our immediate reaction is no, and the end goal should be always, or at least most of the time, to change that answer to yes. Y’know, figure out ways you can make these spontaneous things happen for you, because I think that spontaneousness—if that’s even a word…

LAURA: Spontaneity?

KELSEY: Yes, thank you! That is so important, and it makes us have so much more fun sometimes when we’re doing these things. Scheduling is really helpful of course when you’re trying to make goals, but being spontaneous is excellent and it kind of helps your brain to feel a little bit more creative, I think.

LAURA: Yeah, and I think with the socialization the same issue can came up where we talked about play, where if people aren’t used to doing it, just trying to spontaneously increase it is going to be difficult…

KELSEY: And it probably won’t happen, yeah.

LAURA: Right. So say you set a resolution to meet a friend for coffee every Saturday. Maybe that ends up snowballing and maybe that friend will say, “Oh, do you want to go to a concert on Friday,” or “Do you want to go shopping with me,” and it may actually lead to spontaneous opportunities for socialization. Or say you join a kickball team and you make some friends, and then those new friends you make start inviting you spontaneously to things. I think it’s helpful to have a scheduled socialization time for people that don’t socialize enough, so that way, it may open the door to future unscheduled socialization opportunities, because like you said, it can be difficult to just say, “My goal is to socialize more.” That really doesn’t mean anything until you put some kind of specific goal with that end point.

So hopefully people understand a little bit about how to set SMART goals. Obviously working with somebody can help you set goals, depending on what the topic of the goal is. And really just writing these things down and having a plan of attack, especially with the ones that really do require a level of commitment, those strategies that we talked about earlier can be helpful with the success of the goals that you do set.

KELSEY: Yeah, exactly. Making them specific I think is just…the more specific you can make your goal, the more likely you are to accomplish it. I really think that’s true.

LAURA: Right.

KELSEY: So hopefully this has given you a good overview of how to make those really SMART goals, and we hope to hear about all of your success with your new year’s resolutions later this year.

LAURA: Yeah! And maybe people can post in the comments of this podcast what their goals are and maybe see if you can work on writing it in a SMART format, so making it specific and measurable, and time-based and all that.


LAURA: I know Kelsey and I would love to hear back from you guys what kind of goals you might be setting based on what we’ve talked about today.

KELSEY: Right, and who knows – you might find a buddy in the comments who’s doing the same type of goal as you and you can kind of chat back and forth as you go through things, too.

LAURA: Yeah, definitely! Or share advice about…if you have an exercise program you’ve found that has helped you stay on track, like I know there’s this one by a guy named Steve Kamb, I think, and it’s Nerd Fitness.


LAURA: And they have this Nerd Fitness Academy. I actually signed up for it because it has some really good workout routines that are very structured, and they adjust to your level of fitness and you can go a little bit more intense, you can go more basic, depending on where you are in your fitness, but those kind of things, if people have recommendations for programs that can help people get started on some of these goals we’d love to hear your advice or your recommendations.

KELSEY: Absolutely.

LAURA: So all right, everyone. We hope you enjoyed the show today, our little new year’s themed podcast. And of course we would love any feedback that you have on how we can make our podcast even better, and as reminder, you can submit your nutrition-related questions through the link on Chris’s website. And who knows? We might answer your question on the next show. So have a great week, everyone. Happy New Year, and we’re looking forward to seeing you next time!

KELSEY: All right, take care, Laura.

LAURA: You too, Kelsey.

Know It All: Adrenal Fatigue

Stress: it’s something we all deal with in one form or another, and it takes a major toll on our health. Prolonged stress (or an acute bout of major, major stress) can lead to something called hypoadrenalism or HPA axis dysfunction – more commonly referred to as “adrenal fatigue”. That term gets thrown around a lot, and there are arguments from both sides about whether it exists or not. In my opinion, it exists and it causes a lot of people to suffer. However, it can be induced by our own doing – for example, being too low carb (or being too low carb while exercising a lot) can really tax the adrenals and eventually lead to hypoadrenalism. Hypoadrenalism can also obviously be caused by excessive stress that we do nothing to combat. This article will focus on the causes of HPA axis dysfunction (adrenal fatigue), and exactly what you can do to heal.

Symptoms of Hypoadrenalism (Adrenal Fatigue):

  • Excessive fatigue.  This fatigue is usually most pronounced during the day and you may experience a “second wind” of energy later in the evening
  • In the earlier stages of adrenal fatigue, you may also have trouble sleeping at night. You may experience insomnia or wake up multiple times during the night.
  • Blood sugar crashes – low energy, shaky, “hangry” (angry and hungry!) feelings.
  • Postural hypotension – feeling dizzy or vision blacking out when you go from sitting or lying down to standing. This is due to blood pressure dropping (instead of rising) when you stand up.
  • Increased allergies or asthma symptoms.
  • Recurrent infections.
  • Cognition and memory problems – brain fog, forgetfulness, and cognitive issues are all possible signs of adrenal fatigue.
  • Salt cravings.

The HPA Axis: How We Respond to Stress

As soon as a stressor occurs, the body begins its reaction. The hypothalamic-pituitary-adrenal axis (HPA axis) is the control center for reactions to stress, and in turn regulates many other body functions like digestion and immunity. Upon interaction with a stressor, corticotropin-releasing hormone (CRH) is released from the hypothalamus. CRH travels within the blood to the anterior pituitary gland, where it stimulates the production of adrenocorticotropic hormone (ACTH). ACTH then travels through the blood to the adrenal cortex, where it ultimately stimulates the release of cortisol, the body’s main “stress hormone”, along with other hormones like DHEA. Cortisol works to keep blood glucose elevated and helps the body retain sodium and fluid so that our blood pressure stays high and our blood glucose levels can keep up with the fuel demands of the brain and other vital organs during times of stress. This process is hugely important in keeping us alive during a true “fight or flight” response, but what happens when we start activating the HPA-axis for every little stressor in our lives? The HPA-axis is not meant to be chronically activated and over time our adrenal health suffers.

Under normal circumstances, when the HPA-axis is activated only when truly necessary – negative feedback cycles stimulated by the glucocorticoids produced in the adrenals reduce CRH and ACTH production in the hypothalamus and pituitary, respectively. This feedback cycle serves to deactivate the HPA axis when the body doesn’t need it.[1] A healthy stress response is one that activates the HPA axis when needed, and shuts it down when the stressor ceases. Chronic stress, as experienced by many people in industrialized countries, has a negative effect on health as a result of chronic activation of the HPA axis.


One way of determining HPA axis function is to look at diurnal salivary cortisol curves. In a healthy person, activation of the HPA axis upon rising in the morning causes cortisol to peak, and then decline over the day to its lowest point at about midnight.[2] With increased allostatic load, this pattern starts to change. Allostatic load is defined as “the cost of chronic exposure to fluctuating or heightened neural or neuroendocrine response resulting from repeated or chronic environmental challenge that an individual reacts to as being particularly stressful.”[3] A high allostatic load can cause a flattened diurnal cortisol curve, indicating HPA axis deregulation.

Hans Selye, one of the forefathers of stress research, spoke of this phenomenon in 1950 when he described his “General Adaptation Syndrome” (GAS) concept. GAS develops in three stages: the alarm reaction, resistance stage, and the exhaustion stage.[4]  During the alarm reaction, the body senses a stressor and implements the “fight or flight” response. If the stressor continues for long enough, the body enters the resistance stage, where cortisol, blood glucose, and adrenaline levels stay elevated. If the stressor still persists, eventually the body enters the exhaustion stage where resources to fight the stressor have been depleted. See the chart below for a visual representation of the three stages.



As stress piles on and allostatic load increases, patients go through the three stages of the General Adaptation Syndrome, the end result (exhaustion stage) being fatigue, depression, and low cortisol levels. Interestingly, as allostatic load increases and the body starts going through the three stages of the GAS, cortisol patterns look very much like the diagram above. Compare the stages of the General Adaptation Syndrome to that of the stages of “adrenal fatigue” or hypoadrenalism below.



Let’s also compare a normal diurnal cortisol curve to that of someone with HPA axis dysfunction or “adrenal fatigue”:



What to Do if You Have HPA Axis Dysfunction (Adrenal Fatigue)

You don’t need to do all of these things, but I thought it would be useful to give you all the options out there and you can work with your practitioner to determine what therapies might suit you best.

Diet: A general, healthful diet should be used to treat adrenal insufficiency: high intake vegetable and fruits, avoid sugars and other refined carbohydrates, adequate intake of fiber and water (i.e. a Paleo, Weston A. Price, real food type diet!). A diet like this will be high in many of the nutrients important for the hypoadrenalism patient, including Vitamin C, magnesium, pantothenic acid, and pyridoxine (read on for specific information regarding these nutrients). Patients should also be encouraged to make and eat fermented foods, which contain probiotics beneficial to the hypoadrenalism patient (probiotics are mentioned specifically below). Many patients with hypoadrenalism experience reactive hypoglycemia, thus dietary adjustments for this condition are usually helpful.[5] Reactive hypoglycemics should consume small, frequent meals that are low in simple carbohydrates and high in protein.[6] Nutritional factors that affect glycemic control should also be considered, such as chromium and l-arabinose.[7] Diets for hypoadrenalism patients are also usually not salt-restricted.40 Multivitamin/multimineral should be considered, especially if patients are not consuming a good diet

Medication/Supplementation: Listed below are some medical and nutritional factors that may affect hypoadrenalism.

Hydrocortisone: Cortisol may be used in the lowest effective dose for the patient.41 This is usually only for the most severe of cases, and all nutritional and lifestyle factors have not helped. This is the last resort.

Adaptogens: As defined by Brekhman in 1968, an adaptogen has four main characteristics:

1. The action of an adaptogen should be innocuous and cause minimal disturbance to the normal physiological functions of an organism. It must be absolutely harmless;

2. an adaptogenic agent should not be active only in a specific context or against a particular background. It must have a broad therapeutic spectrum of action;

3. the action of an adaptogen has to be non-specific, that is to say, resistance to a wide variety of action of harmful factors, whether of a physical, chemical or a biological nature, has to increase. In other words, the action of an adaptogen has to be more intense as unfavorable changes occur in an organism;

4. an adaptogen has to have a normalizing or stabilizing action independent of the direction of previous changes.[8]


Licorice root (glycyrrhia glabra), a HPA axis potentiator, is an 11beta-hydroxysteroid dehydrogenase (11B-HSD) inhibitor. 11B-HSD converts active cortisol to inactive cortisone, so when this enzyme is inhibited it enables a potentiated effect of cortisol.[9] In patients on cortisone acetate therapy, ingestion of licorice (or grapefruit juice) increased the amount of cortisol available to tissues after cortisone administration.[10] Licorice root can be taken as a tea, tincture or tablet.[11] (Please note: If you have high blood pressure, licorice root is contraindicated).

Other adaptogens such as eleutherococcus senticosus, ashwaganda, rhodiola rosea, and others have shown to be effective in reducing fatigue related to stress and are likely to be helpful in cases of HPA axis deregulation.[12]

Other Nutritional Factors

Vitamin C: The adrenal gland (specifically the cortex and medulla) contains a very high concentration of Vitamin C compared to all other organs. Vitamin C is required for catecholamine biosynthesis and adrenal steroidgenesis.[13] Vitamin C is released from the adrenals in response to ACTH, so every stressor the body faces causes the adrenals to lose Vitamin C.[14] Thus, Vitamin C intake is very important for the hypoadrenalism patient. Vitamin C infusion treatments have been shown to increase cortisol production[15], however oral Vitamin C is also likely to be effective. Vitamin C doses up to 2,000 – 4,000mg have been shown to be safe and have little adverse effects for the general population[16], so this is a good general guide to work from with the hypoadrenalism patient.

Magnesium: During chronic stress, plasma magnesium is depleted.[17] Magnesium affects the adrenal glands’ sensitivity to ACTH – the start of the activation of the HPA axis.[18] Most Americans do not consume enough magnesium from their diet[19], thus supplementation can be useful, especially for the hypoadrenalism patient. Patients should also eat a magnesium-rich diet containing plenty of green leafy vegetables. Refining or processing food removes up to 85% of magnesium[20], so the hypoadrenalism patient should be encouraged to eat a whole foods, unprocessed diet as much as possible.

Pantothenic acid:Pantothenic acid is required for the structural integrity of the adrenal glands, and pantothenic acid-deficient mice have been shown to have decreased adrenal function.[21] There have been limited studies done on humans in this regard, but it is not far-fetched to imagine that given pantothenic acid’s important role in the structural integrity of the adrenal glands that this vitamin is necessary for proper adrenal health. Hypoadrenalism patients should eat a diet high in this vitamin and/or supplement with a B-vitamin complex.

Pyrodoxine (Vitamin B6): The glucocorticoid action of cortisol is decreased in pyridoxine-deficient animals[22] , indicating that pyrodoxine is important to cortisol production and function. As mentioned with pantothenic acid, hypoadrenalism patients should be encouraged to take a B-vitamin supplement. Women who are using oral contraceptives should supplement with B6, as they have been shown to have lower stores of this important vitamin.[23]

Probiotics: Gut health is important to overall health, and it has recently been shown that the gut flora of rats has an affect on the HPA axis. Rats that had no exposure to microorganisms (germfree; GF) had significantly higher ACTH and corticosterone responses to restraint stress than did rats with normal gut bacteria.[24] Another study in rats showed that those exposed to endotoxin (like that which a human would be exposed to if they acquired a pathogen) displayed altered HPA axis activity.[25]  Stress is known to alter the gut microbiota, and in turn this change alters the HPA axis.[26] It seems that normal gut flora is required for proper HPA axis activity and that clearing of pathogens and replacing lost beneficial bacteria with probiotic supplementation will likely benefit those suffering from HPA axis dysfunction.

Anxiolytic Herbal Preparations: To reduce anxiety experienced by many with hypoadrenalism, anxiolytic herbs may be used. Some of these include L-theanine, Passiflora incarnata, Valeriana officinalis, Humulus lupulus, Matricaria chomomilla, Galphimia glauca, Bacopa monniera, Centella asiatica, Melissa officinalis, Piper methysticum, Scutellaria lateriflora, and Ziziphus jujuba.48 Preparations may be made from one or more herbs and used as needed for anxiety relief.

Lifestyle Changes

Mind-body medicine techniques: Exercise can help to attenuate the cortisol response to stress, especially as women age.[27] Yoga, in particular, can help to reduce anxiety, depression, perceived stress, and morning salivary cortisol levels.[28] Tai chi has been shown to decrease salivary cortisol after a stressful event.[29] In a study on mindfulness-based stress reduction, 40% of participants had abnormal cortisol secretion patterns before intervention. After the intervention, there was a shift from “inverted-V shaped” patterns to “V-shaped” patterns of secretion, indicating change to a more normal cortisol rhythm.[30] Guided imagery has been shown to reduce salivary cortisol levels in overweight Latino adolescents.[31] Patients with hypoadrenalism should be encouraged to find a mind-body medicine technique that they enjoy and do it on a regular basis to promote appropriate responses to major and minor stressful events.

Sleep: The hypoadrenalism patient should be encouraged to wake and sleep at approximately the same time every night to help the HPA axis function properly. Lack of sleep and/or shift work disrupting sleeping patterns were likely instrumental in precipitating HPA axis dysfunction (bringing the patient into the Resistance phase), as sleep deprivation and disordered sleeping cause HPA axis hyperactivity.[32] Normalizing sleep patterns should have a beneficial effect on HPA axis activity. Use of blue-blocker glasses at nighttime (if the patient is exposed to blue light, such as that emanating from a computer or TV screen) can prevent the light-induced melatonin suppression.[33] If possible, patients should be advised to avoid blue light sources prior to bedtime.

Religiosity/Spirituality: Those who show medium or high religiosity or spirituality show normal cortisol rhythms (high in the morning, low at night) compared to those with low religiosity or spirituality whose cortisol rhythms appear flattened.[34] It is likely that those with hypoadrenalism may find additional benefit to spiritual or religious support in their lives.

Social Interaction: Oxytocin and social support protect against the negative effects of stress.[35] It is thought that community and social ties and their association with increased health and longevity is due in part to their attenuation of the stress response.[36] Intimacy with partners showed decreases in salivary cortisol levels.[37] In the earlier stages of HPA axis dysfunction (when cortisol levels are high), social interaction and support can be an effective strategy for bringing cortisol rhythm back to normal. Even in the late stages of adrenal fatigue when cortisol is low, finding support is likely effective in regulating cortisol production. It is very important for those who suffer from hypoadrenalism to find support in their community.

Avoidance of toxic compounds: In animals, DDT analogues and metabolites have been shown to inhibit the synthesis of cortisol as well as cause adrenocorticol toxicity.[38] Organochlorines effect cortisol production in polar bears, a species regularly exposed to these contaminants.[39] This is certainly an area that needs further research, but the hypoadrenalism patient would be wise to avoid known toxins in the environment such as BPA, PCBs, organochlorines, among others.

There you have it! I hope this posts answers a lot of your questions related to “adrenal fatigue”. If you have any further questions, feel free to post a comment!


[1] Jones, David S. “Clinical Approaches to Hormonal and Neuroendocrine Imbalances.” Textbook of Functional Medicine. Gig Harbor, WA.: Institute for Functional Medicine, 2010. 611-14. Print.

[2] Stone, Arthur A., et al. “Individual differences in the diurnal cycle of salivary free cortisol: a replication of flattened cycles for some individuals.” Psychoneuroendocrinology 26.3 (2001): 295-306.

[3] McEwen, Bruce S., and Eliot Stellar. “Stress and the individual: mechanisms leading to disease.” Archives of internal medicine 153.18 (1993): 2093.

[4] Selye, Hans. “Stress and the general adaptation syndrome.” British Medical Journal 1.4667 (1950): 1383-1392.

[5] Gaby, Alan. “Hypoadrenalism (adrenocortical Insufficiency).” Nutritional Medicine. Concord, N.H: Fritz Perlberg, 2011. 1118-120. Print.

[6] Sanders, LEONARD R., et al. “Refined carbohydrate as a contributing factor in reactive hypoglycemia.” Southern medical journal 75.9 (1982): 1072.

[7] Kaats, Gilbert R., et al. “A combination of l-arabinose and chromium lowers circulating glucose and insulin levels after an acute oral sucrose challenge.” Nutrition journal 10 (2011): 42-42.

[8] Davydov, Marina, and A. D. Krikorian. “< i> Eleutherococcus senticosus</i>(Rupr. & Maxim.) Maxim.(Araliaceae) as an adaptogen: a closer look.” Journal of ethnopharmacology 72.3 (2000): 345-393.

[9] Anderson, D. “Assessment and nutraceutical management of stress-induced adrenal dysfunction.” Integrative Medicine 7.5 (2008).

[10] Methlie, Paal, et al. “Grapefruit juice and licorice increase cortisol availability in patients with Addison’s disease.” European Journal of Endocrinology 165.5 (2011): 761-769.

[11] “Licorice.” NYU Langone Medical Center. N.p., July 2012. Web. 23 Feb. 2013.

[12] Sleep, Restless. “Nutrients and botanicals for treatment of stress: adrenal fatigue, neurotransmitter imbalance, anxiety, and restless sleep.” Alternative Medicine Review 14.2 (2009): 114-140.

[13] Patak, P., H. S. Willenberg, and S. R. Bornstein. “Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla.” Endocrine research 30.4 (2004): 871-875.

[14] Padayatty, Sebastian J., et al. “Human adrenal glands secrete vitamin C in response to adrenocorticotrophic hormone.” The American journal of clinical nutrition 86.1 (2007): 145-149.

[15] Kodama, M., T. Kodama, and M. Murakami. “Vitamin C infusion treatment enhances cortisol production of the adrenal via the pituitary ACTH route.” In vivo (Athens, Greece) 8.6 (1994): 1079.

[16] Hathcock, John N., et al. “Vitamins E and C are safe across a broad range of intakes.” The American journal of clinical nutrition 81.4 (2005): 736-745.

[17] Cernak, I., et al. “Alterations in magnesium and oxidative status during chronic emotional stress.” Magnesium research: official organ of the International Society for the Development of Research on Magnesium 13.1 (2000): 29.

[18] Eby, George A., and Karen L. Eby. “Magnesium for treatment-resistant depression: a review and hypothesis.” Medical hypotheses 74.4 (2010): 649.

[19] Ford, Earl S., and Ali H. Mokdad. “Dietary magnesium intake in a national sample of US adults.” The Journal of nutrition 133.9 (2003): 2879-2882.

[20] Swaminathan, R. “Magnesium metabolism and its disorders.” The Clinical Biochemist Reviews 24.2 (2003): 47.

[21] Hurley, Lucille S., and Julia B. Mackenzie. “Adrenal Function in the Pantothenic Acid-Deficient Rat Liver Glycogen, Blood Glucose, Adrenal Cholesterol and Adrenal Ascorbic Acid Levels.” The Journal of nutrition 54.3 (1954): 403-415.


[23] Wilson, Stephanie, et al. “Oral contraceptive use: impact on folate, vitamin B6, and vitamin B12 status.” Nutrition reviews 69.10 (2011): 572-583.

[24] Sudo, Nobuyuki, et al. “Postnatal microbial colonization programs the hypothalamic–pituitary–adrenal system for stress response in mice.” The Journal of physiology 558.1 (2004): 263-275.

[25] Shanks, Nola, et al. “Early-life exposure to endotoxin alters hypothalamic–pituitary–adrenal function and predisposition to inflammation.” Proceedings of the National Academy of Sciences 97.10 (2000): 5645-5650.

[26] Foster, Jane A., and Karen-Anne McVey Neufeld. “Gut–brain axis: how the microbiome influences anxiety and depression.” Trends in neurosciences (2013).

[27] Traustadóttir, Tinna, Pamela R. Bosch, and Kathleen S. Matt. “The HPA axis response to stress in women: effects of aging and fitness.” Psychoneuroendocrinology 30.4 (2005): 392-402.

[28] Raghavendra, Rao M., et al. “Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial.” Integrative Cancer Therapies 8.1 (2009): 37-46.

[29] Jin, Putai. “Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress.” Journal of psychosomatic research 36.4 (1992): 361-370.

[30] Carlson, Linda E., et al. “Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients.” Psychoneuroendocrinology 29.4 (2004): 448-474.

[31] Weigensberg, Marc J., et al. “Acute Effects of Stress-Reduction Interactive Guided ImagerySM on Salivary Cortisol in Overweight Latino Adolescents.” The Journal of Alternative and Complementary Medicine 15.3 (2009): 297-303.

[32] Balbo, Marcella, Rachel Leproult, and Eve Van Cauter. “Impact of sleep and its disturbances on hypothalamo-pituitary-adrenal axis activity.” International journal of endocrinology 2010 (2010).

[33] Sasseville, Alexandre, et al. “Blue blocker glasses impede the capacity of bright light to suppress melatonin production.” Journal of pineal research 41.1 (2006): 73-78.

[34] Dedert, Eric A., et al. “Religiosity may help preserve the cortisol rhythm in women with stress-related illness.” The International Journal of Psychiatry in Medicine 34.1 (2004): 61-77.

[35] Heinrichs, Markus, et al. “Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress.” Biological psychiatry 54.12 (2003): 1389-1398.

[36] Seeman, Teresa E., and Bruce S. McEwen. “Impact of social environment characteristics on neuroendocrine regulation.” Psychosomatic medicine 58.5 (1996): 459-471.

[37] Ditzen, Beate, Christiane Hoppmann, and Petra Klumb. “Positive couple interactions and daily cortisol: On the stress-protecting role of intimacy.” Psychosomatic Medicine 70.8 (2008): 883-889.

[38] Sanderson, J. Thomas. “The steroid hormone biosynthesis pathway as a target for endocrine-disrupting chemicals.” Toxicological sciences 94.1 (2006): 3-21.

[39] Oskam, Irma, et al. “Organochlorines affect the steroid hormone cortisol in free-ranging polar bears (Ursus maritimus) at Svalbard, Norway.” Journal of Toxicology and Environmental Health 67.12 (2004): 959-977.