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Stress and HPA Axis Health
Stress and HPA Axis Health

A New Approach to Overcoming Performance Anxiety at Work

It’s perfectly normal to experience some degree of anxiety before delivering a presentation, or something equally stressful. According to a 2018 survey conducted by the American Psychiatric Association (APA), 68% of people felt a combination of...

Stacey Smith, DC | February 14, 2022

Stress and HPA Axis Health
Stress and HPA Axis Health

4 Tips to Help Your Patients Fend Off the Winter Blues

Shorter days and cold weather may interfere with your patients' normal circadian rhythm. For example, if you live in the northern United States, you may experience a greater health impact due to staying indoors more during the winter, as this can lead to less exposure to natural light. Additional factors during this time of year include less physical activity, stress of the holidays and juggling finances.

Stacey Smith, DC | November 16, 2021

Stress and HPA Axis Health
Stress and HPA Axis Health

3 Targeted Therapies to Help Your Patients Overcome Anxiety

It's normal to feel anxious, worried and fearful from time to time due to the complicated lives we live. Anxiety is a natural part of life, and it helps us cope with the stresses we encounter. But if anxiety occurs more than just occasionally, it can become harmful to our emotional wellbeing and overall health.

Stacey Smith, DC | April 16, 2020

Stress and HPA Axis Health
Stress and HPA Axis Health

Strategies for Helping Patients Reduce Stress and Improve Immune System Function

Stress in appropriate amounts can be beneficial for the body to function better and stay healthy.1 As much as stress is a normal component of daily life, stress in abundance leads to illness and eventually chronic disease conditions.2 In this post, we will define stress, explain how it affects immunity and provide long-term strategies for reducing stress.

Stacey Smith, DC | December 16, 2018

Stress and HPA Axis Health
Stress and HPA Axis Health

Helping Patients Combat Stress with Targeted Nutrition

Your patients' stress stems from many different sources,1 and there is no one-size-fits-all approach to mitigating it. Nutrition is a powerful tool that, when implemented strategically, can help restore key nutrients depleted by chronic stress. In addition, nutrition can help build resiliency to feelings of overwhelm and anxiety, especially when paired with lifestyle interventions. Read on to learn the most common nutrients depleted by stress and clinical strategies to replenish them.

Stacey Smith, DC | September 16, 2018

Stress and HPA Axis Health
Stress and HPA Axis Health

3 Natural, Therapeutic Options to Support Kids Struggling with Stress

Stress is experienced by all ages, not just by adults. A child's life may be perceived by most as carefree and happy because their only job at this time in their life is to play and learn. It's not surprising however, that kids do indeed experience a certain degree of stress even though they don't have the same responsibilities as adults, such as bills to pay and mouths to feed.

Stacey Smith, DC | July 16, 2018

Stress and HPA Axis Health
Stress and HPA Axis Health

The #1 Thing You Can Do to Help Your Patients Get Stress Under Control

As a health care provider, you regularly see patients managing varying levels of stress. This stress comes from external and internal sources, meaning emotional stress, as well as infections or other physiological dysfunction. The number-one challenge I see with patients and a primary internal stressor is blood sugar regulation.

Stacey Smith, DC | February 16, 2018

Stress and HPA Axis Health
Stress and HPA Axis Health

The HPA Axis: A System Beyond the Stress Response

For many years, I have been researching, writing, and teaching about the HPA axis, primarily in the context of the stress response and chronic disease. Along with others, I have been emphasizing that the primary focus of clinicians should not be the adrenal glands, but upon the brain and the stress signals that trigger the hypothalamus in the first place (perceived mental and emotional stress, circadian disruptors, inflammatory signals and glycemic dysregulation).

Thomas G. Guilliams, PhD | July 16, 2017

Stress and HPA Axis Health
Stress and HPA Axis Health

What's the Deal with Cortisol? Assessing Patients Using the Cortisol Awakening Response (CAR)

The circadian rhythm influences many factors in the human body, including sleep-wake cycles, hormone production and release, hunger and satiety, mood, digestion, the immune system, and body temperature. As such, any dysfunction within this process increases the risk for long-term sequelae and chronic disease.

Carrie Jones, ND, FABNE, MPH | June 16, 2017

Stress and HPA Axis Health
Stress and HPA Axis Health

Functional Medicine Therapies for the Burned-Out Brain

In my last post, I introduced the concept of chronic stress causation as a broader scope than previously recognized in medicine. We also learned about the three likely culprits of chronic stress, which cause symptoms of anxiety, depression, sleeplessness, fatigue, poor memory and concentration, and chronic pain. In this post, I want to provide you a paradigm, or road map, for non-prescriptive treatments that support the stress response and reduce or resolve symptoms for nearly everyone who implements them.

Christopher Mote, DO, DC, IFMCP | March 16, 2017

Stress and HPA Axis Health
Stress and HPA Axis Health

A Paradigm for EvaluatingAnxiety and Mood Disorders

Large segments of the global population suffer the effects of a burned-out brain and subsequent symptoms of anxiety, depression, sleeplessness, fatigue, poor memory and concentration, and chronic pain. Functional medicine clinicians have long referred to this constellation of symptoms as "adrenal fatigue," but by refocusing on the true dysfunction, the hypothalamus and its inability to organize a proper stress response, we can help patients overcome their anxiety and mood disorders.

Christopher Mote, DO, DC, IFMCP | January 16, 2017

Stress and HPA Axis Health
Stress and HPA Axis Health

This Will Make You Rethink How You're Treating Chronic Stress

When our patients have symptoms of fatigue, weight gain, dry skin, hair loss and constipation, we evaluate the thyroid with lab testing. When our patients have symptoms of bloating and gas, nausea, heartburn, alternating constipation and diarrhea, a common approach is to order a stool test and assess alterations in enzymes, the microbiome or "leaky gut." And when our patients have symptoms of reduced libido, hot flashes, vaginal dryness, emotional lability and anxiety, it makes sense to check their hormone levels. But are these truly functional approaches?

Christopher Mote, DO, DC, IFMCP | June 16, 2016

Stress and HPA Axis Health
Stress and HPA Axis Health

The Term "Adrenal Fatigue" Should be Abandoned

Sometimes, when we endeavor to understand and describe complicated medical topics, there is a temptation to find a simple explanation to cut through that complexity. Sometimes these simple explanations can help bridge the knowledge gap for a while, but as our knowledge grows, those explanations lose some of their original usefulness (i.e., "good" and "bad" cholesterol). In many cases, those oversimplified explanations actually become a hindrance to helping clinicians and patients understand the important mechanisms and solutions related to their chronic conditions.

Thomas G. Guilliams, PhD | November 16, 2015

Stress and HPA Axis Health
Stress and HPA Axis Health

The 4 Key Stressors and Nutritional Support Protocols for Rebuilding Stress Resiliency

In functional medicine, we focus on finding the root cause of health issues to help our patients achieve lasting recovery and relief from their symptoms. In cases of chronic stress, it is important to dig deeper into what stressors may be affecting the body; here are four key stressors to consider when assessing chronic stress patients:

Christopher Mote, DO, DC, IFMCP | September 16, 2015

Stress and HPA Axis Health
Stress and HPA Axis Health

6 Strategies for Rebuilding Healthy Circadian Rhythms

If resilience is the body's ability to return to homeostasis following a stress of our physiology, what does it look like when we lose resiliency?

Christopher Mote, DO, DC, IFMCP | August 16, 2015

Stress and HPA Axis Health
Stress and HPA Axis Health

Rebuilding Stress Resiliency

Resilience is defined as the ability to recover quickly from difficulties, toughness, or the ability of an object to spring back into shape; elasticity. As it pertains to the human body, resiliency is the ability to return to homeostasis following a stressor. While there are numerous physiologic mechanisms that provide resilience in our bodies, perhaps the most important is the hypothalamus.

Christopher Mote, DO, DC, IFMCP | July 16, 2015

Stress and HPA Axis Health
Stress and HPA Axis Health

How to Know When It's Time to Start Group Visits in Your Practice

No matter your medical discipline, if you can facilitate behavior change in your patients, you will see incredible results. It is simply the most powerful force in reversing chronic illness. Practitioners are looking for the most effective ways to facilitate behavior change in their patients, and a proven strategy is the Group Visit practice model. Researching this practice model or tuning into the Evolution of Medicine Podcast's Group Visit Series will tell you that Group Visits are innovating the way we practice medicine.

Christopher Mote, DO, DC, IFMCP | March 16, 2015

Stress and HPA Axis Health
Stress and HPA Axis Health

The Role of Stress and Nutrient Availability in Circadian Metabolism

In the last several years, I dove into the research exploring the intersection between circadian rhythm and the HPA axis. As most of you probably know, normal cortisol production follows a predictable circadian output, which rises sharply upon awakening (the cortisol awakening response, or CAR) and then drops quickly over the next few hours, gradually declining and reaching its nadir late at night. What many may not know is that glucocorticoid receptors (i.e., cortisol receptors), found in almost every tissue, are vital in helping to maintain peripheral circadian rhythm, which can greatly influence cellular metabolic function.

Thomas G. Guilliams, PhD | December 16, 2014

Stress and HPA Axis Health
Stress and HPA Axis Health

Resetting Circadian Rhythms of the HPA Axis

After nearly 20 years of clinical practice, I have found one concept makes all the difference between partial and significant clinical effectiveness: understanding and harnessing the power of circadian rhythms.

Christopher Mote, DO, DC, IFMCP | September 16, 2014

Stress and HPA Axis Health
Stress and HPA Axis Health

4 Ways to Make Your Functional Medicine Clinic More Profitable

Profitability: A concept few want to talk about and just about all of us are concerned about.Whether you are just starting out in practice or have reached a point of fatigue and burnout, "how" as well as "how much" you are compensated for your considerable efforts helping patients is extremely important. Regardless of our motivations for entering the medical profession, all of us have some expectation for personal income we can or should attain.

Christopher Mote, DO, DC, IFMCP | June 16, 2014

Stress and HPA Axis Health
Stress and HPA Axis Health

Strategies for De-Stressing Your Practice

We usually discuss stress and its effects on our patients, but today I'd like to discuss the impact of stress on the physician.Physicians, and all health care practitioners, face innumerable stressful conditions every week. In my 18 years of clinical practice, some of the "biggies" have been related to documentation and electronic medical records, technology glitches, staffing and staff-related concerns, maintaining CE requirements, malpractice costs (and ALL costs in general) among others. Over the same time period, it seems these have intensified or even multiplied, and the cumulative effects are significant.

Christopher Mote, DO, DC, IFMCP | August 16, 2013

Stress and HPA Axis Health
Stress and HPA Axis Health

Neurotransmitters, Mood and the Perception of Stress, Part 3

The hypothalamus is directly innervated by neuronal systems that produce neurotransmitters, such as serotonin (5-HT), dopamine and norepinephrine (NE), that are involved in mood regulation and play various other roles in cognitive health. During the acute stress crisis, the mesolimbic dopaminergic reward system is stimulated to help maintain morale. However, during chronic stress or depression, the reward system is down-regulated by stress mediators, resulting in anhedonia.

Thomas G. Guilliams, PhD | June 16, 2013

Stress and HPA Axis Health
Stress and HPA Axis Health

Neurotransmitters, Mood and the Perception of Stress, Part 2

When we talk about "stress," or allostatic load, in terms of the perception of an event, we must realize that these "events" must first be translated into neurochemical signals before they trigger the HPA axis. Therefore, the sensitivity and outcome of translating these events (whether they are ongoing events, memories of past events, or stressful anticipation of unrealized events), is highly dependent upon signaling from other neurotransmitters. In fact, the signaling neurotransmitters that manage mood and affect often overlap with measures of HPA axis activation, and cannot be easily distinguished in some subjects.

Thomas G. Guilliams, PhD | May 16, 2013

Stress and HPA Axis Health
Stress and HPA Axis Health

Neurotransmitters, Mood and the Perception of Stress, Part 1

When we talk about "stress," or allostatic load, in terms of the perception of an event, we must realize that these "events" must first be translated into neurochemical signals before they trigger the HPA axis. Therefore, the sensitivity and outcome of translating these events (whether they are ongoing events, memories of past events, or stressful anticipation of unrealized events), is highly dependent upon signaling from other neurotransmitters. In fact, the signaling neurotransmitters that manage mood and affect often overlap with measures of HPA axis activation, and cannot be easily distinguished in some subjects.

Thomas G. Guilliams, PhD | April 16, 2013

Stress and HPA Axis Health
Stress and HPA Axis Health

A Scientific Turn of Mind

"It's all in your head."This is the last thing a patient with stubborn symptoms wants to hear from their doctor. I recently said this to my 40-year-old female patient with chronic insomnia, fatigue, depression and pain, not because I couldn't find the root cause for her health concerns, but precisely because the brain had become the primary initiator and perpetuator of her symptoms.

Christopher Mote, DO, DC, IFMCP | February 16, 2013

Stress and HPA Axis Health
Stress and HPA Axis Health

What Can You Learn From a Salivary Hormone Test?

You know whether your patient has high cortisol, normal cortisol, or low cortisol-so what? Cortisol and DHEA can be high, low or within range and be perfectly appropriate depending on the patient's physiologic condition. How do these markers change your medical decision-making? Read more

Christopher Mote, DO, DC, IFMCP | May 16, 2011

Stress and HPA Axis Health
Stress and HPA Axis Health

Re-assessing the Notion of "Pregnenolone Steal"

When clinicians measure salivary cortisol and DHEA (DHEA-S) to assess stress and HPA axis function, it is common to find DHEA levels below the reference range in a number of individuals. A common explanation for the depletion of DHEA and other hormones (e.g., progesterone, testosterone) due to chronic stress is the phenomenon known as "pregnenolone steal." This notion basically states that since all steroid hormones use pregnenolone (derived from cholesterol) as a precursor, the elevated secretion of cortisol caused by acute or chronic stress will inevitably result in less available pregnenolone to serve as a precursor for the production of DHEA and other down-stream hormones. Read more

Thomas G. Guilliams, PhD | April 16, 2011

Stress and HPA Axis Health
Stress and HPA Axis Health

What You Need to Know Before Running Another Adrenal Profile

One of my earliest clinical mentors used to tell me, "Who we are and how we practice once we are three years out of school/training is who we will be for the rest of our clinical practice."Read more

Christopher Mote, DO, DC, IFMCP | May 16, 2010

Stress and HPA Axis Health
Stress and HPA Axis Health

A Clinician's Perspective on Evaluating Stress

As I eagerly opened the repeat test results for two patients and me, I expected the salivary adrenal profile would demonstrate improved function in the form of healthier hormone levels. After all, the subjects in this initial testing were had symptomatic improvement. It was not slight, but significant reduction in fatigue, sleep problems, concentration, etc. There was every reason to expect our success would be confirmed. It was with great disappointment that I read results for each of us that were nearly identical to the initial testing. No improvement was demonstrated on any of the tests. How could that be? Read more

Christopher Mote, DO, DC, IFMCP | February 16, 2010

Stress and HPA Axis Health
Stress and HPA Axis Health

Is it Adrenal Fatigue? Reassessing the Nomenclature of HPA Axis Dysfunction

Sometimes, when we endeavor to understand and describe complicated medical topics, there is a temptation to find a simple explanation to cut through the complexity.

Thomas G. Guilliams, PhD | January 16, 2010

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