(Part 1 of 4)
We decided to sit down and have a chat with our practice owner and MD, Dr. Philip Oubre, and functional nutritionist, Aubree Steen.
We’re diving into another 4 part series. We’re diving into part 1 here, following with:
1. What are the adrenal glands/their function? Why are they important? (this video)
2. Stress and its effects on the adrenal glands
3. How stress hormones affect every other function in the body (i.e. autoimmunity, chronic illness, hormones, energy – weight, mood)
4. Supplementation/lifestyle/nutrition support for adrenals
Feel free to watch the video, or read our transcript below.
Dr. Philip Oubre, MD (00:00):
Hey, everybody. We are going to be talking about the adrenal glands in this month’s content. We’ve got four videos lined up. This first on is, I kind of forget, and so help me out. So the first one is we’re going to talk about the function of the adrenal glands, the good parts about it. Step two is we’re going to be talking about how the adrenal glands affect other hormones.
Aubree Steen, FNTP (00:18):
Dr. Philip Oubre, MD (00:20):
Aubree Steen, FNTP (00:20):
And other functions in the body, basically.
Dr. Philip Oubre, MD (00:22):
And then three, I don’t remember three and four.
Aubree Steen, FNTP (00:25):
Oh, my God. I’ve got to just …
Dr. Philip Oubre, MD (00:25):
You were supposed to remember this.
Aubree Steen, FNTP (00:26):
I don’t know. No. So second one is stress and its effect on the adrenal glands. The third one is how stress hormones affect every other function of the body, chronic illness, on immunity, you name it. And the fourth one is going to be supplementation, lifestyle, nutrition for adrenal glands.
Dr. Philip Oubre, MD (00:40):
Aubree Steen, FNTP (00:41):
We just know so much, so we have to write it down.
Dr. Philip Oubre, MD (00:43):
Yeah. That’s why we split it into four videos. So in this first video, we’re going to be talking about the function of the adrenal glands. The first thing I want to point out, and I was talking about this with Aubree before we started, is that there’s a lot about the adrenal glands going on and in every patient, in every new patient we talk to and people online, and stuff, we always bring up adrenal glands. But one of the things I don’t think I’ve done enough justice online, with YouTube, and my other videos is that I’ve not put enough emphasis on the adrenal glands. It’s very important to remember that even in conventional medical school we are taught that the adrenal glands are what they call the puppeteer.
Dr. Philip Oubre, MD (01:20):
So the adrenal glands being a puppeteer, as far as controlling the other hormones, anytime you have thyroid dysfunction or testosterone or estrogen dysfunction, the first thing you really want to evaluate is the adrenal glands. It’s one of the things that’s really hard to quantify. I shouldn’t say it’s that hard to quantify. It’s that it costs extra money to quantify. So a lot of times in practice, we don’t even run the tests because it costs extra money and usually you can just tell people, “You’ve got adrenal dysfunction. We just have to work on that.”
Dr. Philip Oubre, MD (01:49):
So, Aubree, I’m doing all the talking. Why don’t you run us through the basic HPA axis and what does that stand for, put you on the spot, and what is the basic function of the adrenal glands?
Aubree Steen, FNTP (01:59):
I love talking about the HPA axis.
Dr. Philip Oubre, MD (02:01):
Take it away.
Aubree Steen, FNTP (02:02):
But I talk about it, I think in moreso the nutritional aspect. But it’s all woven in together, right?
Dr. Philip Oubre, MD (02:07):
That’s video four. You can’t talk about that.
Aubree Steen, FNTP (02:09):
We’re not going to. So HPA is hypothalamus-pituitary-adrenals.
Dr. Philip Oubre, MD (02:09):
Aubree Steen, FNTP (02:14):
Right. It’s an axis. It’s not an Illuminati or anything. It’s an axis, guys. I like to think of like a triangle. They all have these levers and pulleys, and they’re all weighted balance on each other. If one part of the HPA axis is off, the whole entire thing is going to be thrown off. Sometimes you’ll hear HPA OT, which is hypothalamus-pituitary-adrenals ovaries and testes, depending on who you’re talking to, HPAT. We’ve commonly talked about the HPA axis and its effect with stress hormones.
Aubree Steen, FNTP (02:43):
The adrenals are the main producers of those stress hormones.
Dr. Philip Oubre, MD (02:49):
They are the producers.
Aubree Steen, FNTP (02:51):
They are the producer. So when we talk about you being overstressed, or overburdened, or on high alert all the time, or in fight or flight, it’s an adrenal issue.
Aubree Steen, FNTP (02:59):
And then when you start talking about [crosstalk 00:03:00]
Dr. Philip Oubre, MD (03:00):
Aubree Steen, FNTP (03:02):
Oh my gosh. You say it four times right, and the fifth time your brain shuts off. The pituitary, then all of a sudden you’re going to see a mood effects. You’re going to see mental cognition decline, things like that.
Aubree Steen, FNTP (03:15):
Unrelated, but my favorite acupuncture point is actually the pituitary when you’re super stressed. You walk out of there, and you put it right on there. You’ve can actually palpate it in a functional nutritional exam too and see the tenderness there. But the second you do that in times of high stress, you walk out and you feel like you’re just happy. Like you’re in like an old ’70s music video. You’re like, “Hey guys, how’s it going?” Your stress will just go away.
Dr. Philip Oubre, MD (03:37):
I only know that is the glabellar tap for Parkinson’s, is if you tap someone that has Parkinson’s they won’t blink in time. If you tap that, you can see I’m blinking, right? The video can’t see I’m blinking. Now everybody at home is like, do I have Parkinson’s?
Aubree Steen, FNTP (03:48):
I’m no blinking at all.
Dr. Philip Oubre, MD (03:48):
Oh, you clearly have Parkinson’s.
Aubree Steen, FNTP (03:48):
Okay, so there you go.
Dr. Philip Oubre, MD (03:56):
That’s a very specific test for Parkinson’s.
Aubree Steen, FNTP (04:01):
Dr. Philip Oubre, MD (04:01):
In regards to the adrenal glands, I think we’re making some assumptions that people know. I want to make sure we go down the basics in this video as far as the function. So Aubrey just said the three tissues or parts of the hormones that are responsible. Yeah, the glands. The hypothalamus, the pituitary, and the adrenal. Each one has a different role. The hypothalamus is deep, deep, deep in the brain. The hypothalamus is the main thing that’s reacting to your environment as far as stressors. Let’s say a lion jumps out in the trail you’re running, then that hypothalamus immediately gets activated. That activates the pituitary. The pituitary releases a hormone. The pituitary’s role here is not as big of a deal. It just responds to what the hypothalamus is doing. It’s kind of the whipping boy or girl. It does what the hypothalamus says. But the pituitary releases ACTH. That’s the hormone that actually goes to the adrenal glands and stimulates the adrenal glands.
Dr. Philip Oubre, MD (04:54):
So the adrenal glands are the one we talk about the most, but it’s important to remember where this whole cascade started. The cascade started in your brain. So one of the key pieces in adrenal health is that the perception of stress matters more than the stressor. We’ve all heard the metaphor or seen stressful situations where a building’s on fire. You got one person running around like their head’s cut off. “Oh my God, the building’s on fire!” Then you’ve got another person there that saying, “Hey, we’ve got to do A, B, and C. We have to rescue.” So those are the same stressor, two totally different perceptions of that stressor. So your hypothalamus is going to react to the perception of that stressor.
Dr. Philip Oubre, MD (05:31):
Then it’s also kind of unusual to think about it, but the brain learns patterns. It learns how to react to things. It learns how you react to things, then you’re training your brain how to react to things based on that. So if lions always jump out on the trail in front of you, that’s something you want to respond to quickly, otherwise you die. So that’s a normal adaptive reaction. But say you’re in some sort of traumatic relationship, or in war, or whatever, PTSD. That’s an easy one to think of. You’ve literally trained your brain to react to those environmental triggers. Then it starts reacting more and more and more. That’s the whole you’ve got a PTSD veteran, who a car backfires, and the next thing you know, you find them under a car or hiding, because they just went into a shock sensation of the hypothalamus took off because it learned how to react to that stimuli. But the adrenal glands are ultimately the one that carry out that actual action.
Dr. Philip Oubre, MD (06:24):
So the adrenal glands, they sit on top of the kidneys. That’s how they got their name, ad – it means on top, renal means kidney. So ad renal or adrenal. They look like little fatty things sitting on top of the kidney. They’re really small, but they make a powerhouse of hormones. So the hormones that they make are really important to understand.
Dr. Philip Oubre, MD (06:45):
There’s three basic ones that I’ll boil it down to, is that one is the cortisol. That’s the one we talk about the most, because although if you don’t have cortisol, you die. You literally die without cortisol. So that’s important. You need cortisol. That’s an important thing that we talk too much about. Too much cortisol, and cortisol is a problem, and all this. But you need cortisol to survive. So low cortisol is just as bad as high cortisol, if not worse. By that, I mean, obviously not zero, because zero is dead, and that’s not good either. But low cortisol is an issue. High cortisol is an issue. So that’s the main hormone that we talk about the adrenal glands. They also make DHEA, and that was part of my three actually. DHEA is the precursor to cortisol. So in bloodwork, DHEA is one of the ones we check routinely, because if DHEA is high, I guess we’ll get into the stages of adrenal dysfunction. So I’ll save that for later. So cortisol, DHEA are the main hormones made by the adrenal. But then aldosterone is actually a salt-absorbing hormone. It looks just like cortisol. That’s an important hormone by the adrenals. And then the adrenaline’s, the epinephrine’s, norepinephrines, are the other. Probably the top two hormones we should be talking about is cortisol and then the adrenaline’s.
Dr. Philip Oubre, MD (07:55):
So the way I like to explain cortisol versus adrenaline, because if you have a stressful situation, lion jumps out of the trail, then you release both cortisol and adrenaline, but cortisol is more of a long-term stress response. Adrenaline is the here and now, right. That’s why you have anaphylaxis. You have an allergic reaction to something, Aubree. Then they give you adrenaline. They give you epinephrine. They don’t really give you cortisol. They can give you steroids, and basically steroids is cortisol. But adrenaline is the life-saving component. So the other thing to consider is that after an acute stressor like this, you actually have long-term release of the hypothalamus hormones, the ACTH and cortisol. So basically cortisol gets elevated through chronic stressors, not so much the “Oh my God, this happened once, and then I went about my business.” That’s not where cortisol got wrecked.
Dr. Philip Oubre, MD (08:49):
So the way I like to explain cortisol is cortisol is the whisperer. I said this wrong in one of my videos in the past. The guy that said, “The British are coming,” it’s John Revere? Or Paul? That’s what I said. It was John Revere and I said John Revere. It was Paul Revere.
Aubree Steen, FNTP (09:03):
I hate history, I’m sorry. I’m good at math and science [crosstalk 00:09:06].
Dr. Philip Oubre, MD (09:03):
I’m terrible at history. So Paul Revere goes around saying, “The British are coming. The British are coming, the British are coming.” He is not the militia. He’s not the one carrying out the activities. He’s just the-
Aubree Steen, FNTP (09:14):
Dr. Philip Oubre, MD (09:15):
Right. So cortisol is the one that’s constantly going around the system saying, “Adrenaline is coming, adrenaline is coming, adrenaline is coming.” So if you have chronic elevation of cortisol, your system is primed for any little blip on the radar. Because as far as you know, the British are coming at any moment. So if you’re chronically stressed and you’ve got chronic cortisol elevations, then say, someone pulls out in front of you in traffic. Now you’ve flipped into a panic attack and you might be wondering, why am I having a panic attack over someone pulling out in front of me? That’s because your system’s already been primed by cortisol. Does that happen?
Aubree Steen, FNTP (09:48):
Or when you’re in a constant fight or flight state. Even if you don’t realize it. Like, if work is super stressful, if you’ve had some relationship issues at home or something, and your cortisol is up, I mean, it’s happened here before. When you’ve walked up behind me, and I have literally been like, “Ah!” Seizure screamed from being terrified.
Dr. Philip Oubre, MD (10:11):
I’m so scary.
Aubree Steen, FNTP (10:11):
Literally, she was walking in. So I don’t know.
Dr. Philip Oubre, MD (10:12):
Well, so that’s the basics of the adrenal gland as far as the stress response. That goes all the way back to the amygdala and the brain’s perception of stressors triggers the hypothalamus, which triggers the pituitary, which triggers the adrenal glands. It makes a nasty loop. As the cortisol remains high, it triggers more fight or flight responses in the brain, which triggers more hypothalamus action, and on we go.
Aubree Steen, FNTP (10:35):
Cortisol, really, the only time it’s supposed to be high is right when you wake up. It’s supposed to rise 200% within 30 minutes. 200%, and then have a nice natural bell curve throughout the entire day. That’s literally just to push you up and push you out of bed. Other than that, you don’t want to keep it up. So we’ll talk about the stress and dysfunction of how you keep it down and how to modulate it.
Dr. Philip Oubre, MD (10:58):
Then we’ll wrap up this video. It’s just a reminder that the cortisol hormone is the puppeteer of the other hormone. So if you’re someone that’s struggling with thyroid dysfunction, or estrogen issues, testosterone issues, or whatever, make sure you’re addressing the adrenals first. Classically, the line of dominoes that fall in men is adrenals go first, then testosterone. In my opinion, adrenal issues are one of the most common reasons for low testosterone. I don’t have any proof in that. I’m don’t have any research, but that’s my opinion. That’s how we treat you.
Aubree Steen, FNTP (11:27):
That’s how I’ve learned it though, as the adrenals are the driver of sex hormones, and that if they’re shut down you’re going to see no libido. You’re going to see basically anything that’s related to sex hormones. Your periods are going to be thrown off. I personally experienced that when you’ve been in high stress days, work and school full-time right. Your menstrual cycle could be gone for a year or more. Or if it’s irregular, or spotty, of course there’s so many other things going on, but even chronic illnesses can cause internal stress. So even if you have external stress that is pretty much nonexistent, but your body’s living in a chronically stressed state from dysbiosis or toxins, or whatever it might be, then you can see effect on your adrenals, and you can see effect on your stress hormones. So we have to think about more than just things outside of us. It’s also internal stress and the perception of stress.
Dr. Philip Oubre, MD (12:11):
Perception of stress.
Aubree Steen, FNTP (12:12):
We’ve sene that email on the Dutch test. Sometimes we something called the Dutch test by Precision Analytics, and I love it, because it can tell you your cortisol, your cortisone, which it should be raising. But the people on the board there who have reviewed the test with me even say, we’ll tell a patient, your perception of stress is good, but your output is bad. That’s honestly, I think, if the perception is good, that’s one of the most important things, right? You’re not constantly having a trigger in your body.
Dr. Philip Oubre, MD (12:39):
So the whole stress hormone affecting your sex hormones just makes sense. The whole point of sex hormones is to procreate. So if you think rewind back to paleolithic times. If you’re in a cave and you don’t have enough food and a lion is sitting outside, you’re pretty stressed. Now’s a bad time procreate. Like, you don’t need a sex drive, and a woman doesn’t need to get pregnant right now. Like, things are looking bad. So our stress hormones are supposed to mess with your sex hormones. The last point I wanted to make was that in men it’s adrenals first, then testosterone, then low testosterone effects thyroid. That’s the typical paradigm. In women is actually a little bit switched. It’s adrenals first, then thyroid, then female sex hormones. So that’s typically what we see. I think it has something to do with the fact that the female hormones cycle, so it’s a little harder to mess with that. But the thyroid is the first one to take the blame because they’re the consistent. At least that’s what we see clinically.
Dr. Philip Oubre, MD (13:33):
So when we see someone with low thyroid, we typically try not to jump straight to treatment. We typically say, look, your thyroid is off. So that means your adrenals are off, and of course, liver and other things can go along with that.
Aubree Steen, FNTP (13:43):
Then we just like to support the adrenals first and foremost, right? So we’ll do something to support the entire HPA axis instead of just the adrenals. Unless you have specific testing, then you want to treat as a whole, right? Because you don’t know exactly where the cascade is going wrong. So if you can treat an entire HPA axis then you will have better effect on your thyroid and your sex hormones too.
Dr. Philip Oubre, MD (14:04):
We’ll talk about what supplements we use for the adrenal glands. But one of the things I always tell my patients, we always tell our patients is that you can take all the adrenal supplements in the world, but if you don’t change your stressors, if you don’t change your perception of your stress and your actual stressors, then you might as well not take the supplements because they’re really not going to do anything. They may glue the puzzle pieces together, but it’s only a matter of time before that house of cards falls down.
Aubree Steen, FNTP (14:26):
It’s like skydiving without a parachute trying to eat on it the whole time.
Dr. Philip Oubre, MD (14:28):
Jesus, that’s a metaphor. So you’re going to die if you take adrenal supplements and don’t manage your perception. Got it.
Aubree Steen, FNTP (14:35):
Dr. Philip Oubre, MD (14:35):
Got it. Wow, and on note we’re going to end this video. Like our channel. Subscribe to it and hit the little bell on YouTube to follow us along. See you guys.
Aubree Steen, FNTP (14:51):