Adrenal Fatigue with Dr. Minni Malhotra

INTRODUCTION: Welcome to Qualgen's podcast where we talk about all things health and wellness related, including hormones, pharmaceuticals, health trends and ways you can help better your life.  

JENNIFER: Hi everyone! Thank you for taking time out of your day to listen in. Today I am joined by Dr. Minni Malhotra. Dr. Malhotra specializes in patient centered care and is a highly trained Doctor of Family Medicine and is also a Certified Functional Medicine Practitioner. Dr. Malhotra has practiced traditional medicine for 10 years in the USA in addition to a previous 10 years in India. She is a diplomate of the Board of American Academy of Anti-Aging in addition to being board certified from American Academy of Family Medicine. Dr. Malhotra, thank you so much for joining me today! 

DR. MALHOTRA: Thank you so much for having me. It's always been my passion to talk about functional medicine and everything connected to that. 

JENNIFER: Absolutely. We need so many people to talk about it to help educate everyone else in the world that knows nothing about it.  

 DR. MALHOTRA: Yeah. You know today there was a patient who came to see me, and she is diagnosed with Hashimoto's in 2016 but she said she got diagnosed after her daughter got diagnosed because her daughter was having all these symptoms. So, they checked her and she had Hashimoto's and she said she had all the symptoms still since she was a teenager, but nobody had ever checked. After her daughter got diagnosed, she got herself checked and she had Hashimoto's too. So, imagine for about 15 years she was without any care. 

JENNIFER: Yeah, and she was just suffering from it.  

 DR. MALHOTRA: And every year physicals and every year going to the doctors, you know, so it's really really sad. 

JENNIFER: Yeah, so what made you decide to open your own practice? 

DR. MALHOTRA: So, something similar to what you know I'm talking about my patient who came in today, something similar like that with her because I was growing up, I have genetic obesity in my family. It was really very tough. I had to really work out and you know eat restricted to really keep my weight under control. And then I self-diagnosed myself with PCOS and so I knew that I had this insulin resistance. So, I did lifestyle medicine on myself for years and years and then I practiced it on my patients, but you know patients, not everyone is receptive to this kind of care. And then my 10-year-old daughter was diagnosed with PCOS, and her doctor put her on three prescription drugs. And I was like just devastated and I knew I had to find something different. So, I started searching and you know, there wasn't much about functional medicine that I found out. But it got me started and then I attended a conference at A4M, I remember, and this was in 2014. I just got hooked and I came back so excited like a kid in the candy store and was telling my husband, you know this happens and that happens, and you can do this. You don't need to take any prescriptions. I started and I wanted to do everything on my patients, but it was it wasn't that easy in the insurance model. 

JENNIFER: Absolutely. That makes it hard. So, what exactly drew you to functional medicine? I mean was it the non-prescription that type of thing?  

DR. MALHOTRA: So, I really used to feel terrible when I prescribe something for ADHD, or weight loss, or you know diabetes, because I saw my patients coming back every few years and getting added one prescription. Very few people got off prescription medications and they were on it for life, and they accepted it that that was the way it was going to be, but I really wanted people to realize that, and I still see some people who never took any prescription medications even in the 70s and 80s. So, I really started thinking that what is the difference between this person and then this person who's in his 40s and already on so many? There must be something going on. It could be genetics, but it could be lifestyle, it could be so many things. So, and then with all these chronic diseases just exploding I really wanted to get a handle at least for the people who would listen to me.

JENNIFER: Absolutely yeah. So, one of the main things I want to discuss today with you is adrenal fatigue which I think is still so unknown. There's just not a lot out there about it right now. So, can you give us a brief overview of what adrenal fatigue is?  

DR. MALHOTRA: So adrenal fatigue is a functional medicine term. So, it's adrenal dysfunction where your adrenal glands, you know, slowly starts to get exhausted and goes into a phase where it cannot react because we know the main hormone is cortisol, which is the stress hormone, and it acts in flight or fight. But if you have small fight and flight episodes every day it reacts and then it goes back to normal. But if you have it in a chronic state, your body is constantly in that state, then what happens at some stage it just collapses. So, your body goes through three stages. One is an alarm stage where you know, it increases, and it is high and it's reacting to the stresses that you're going through. Then it is the resistance phase in which it tries to correct things, but it's not able to and then it goes into the exhaustion phase, where it's completely exhausted and you cannot get any reaction out of it and there's bodies unable to produce any cortisol

JENNIFER: And what are some symptoms that one might experience if they are experiencing this? 

DR. MALHOTRA: So, in the beginning, as I would say, in the alarm state, you can have high blood pressure, anxiety, depression, sleep issues, memory brain fog, you can have sugar cravings, frequently you can develop like colds and coughs so your immune system goes down, and then later on, in the end it's just like chronic fatigue, you can hardly get out of bed, you get other hormonal imbalances so your body starts to kind of break down at that point.

JENNIFER: And are you seeing a lot of this like is it very common in your practice right now?  

DR. MALHOTRA: For the last - this is my sixth year just practicing functional medicine. I haven't seen normal cortisol. I haven't seen the test that we do for the cortisol - I haven't seen it in the normal range. They usually one which is off - one of their points or maybe two points they're always off. 

JENNIFER: So, I guess that brings me to my next question, which is how and what do you test when you're diagnosing this adrenal fatigue? 

DR. MALHOTRA: So, I do a six-point saliva test. The reason why we do a six point is because earlier used to do four points when it was done an hour within your wake-up time and then every 4 to 6 hours and the last one just before you go to bed. Now we realized that there is a cortisol cause like cortisol activation response. So, your cortisol starts to increase way before you actually start to get out of bed. So, we want to get that we want to capture that. So, the first point we do immediately as soon as they you know wake up and then we make them do it within 30 minutes and then after an hour and then the same pattern 4 to 6 hours till they go to bed. So, that's how we do the saliva tests. Blood tests are also there, but it's not that accurate because you will get one reading at the time you go in and so it's not accurate. It doesn't give you it would be completely normal you know that time. But you haven't checked the morning or the evening or the afternoon ones which could be different.

JENNIFER: So, basically just test the cortisol levels?  

DR. MALHOTRA: Cortisol and DHEA levels too, and then I also check the estrogen, progesterone, testosterone, the ratios. So, I do check all of them - melatonin levels, check them too. 

JENNIFER: And what are the correlations between hormones and adrenal fatigue? 

DR. MALHOTRA: So, when your cortisol level is high, which affects all hormones. Cortisol directly affects thyroid – it suppresses the thyroid. So, you could be hypo thyroid, but it could be due to your cortisol. It increases insulin resistance, so you could become a diabetic, but it could be due to your stress and not actually due to your insulin because the cortisol is always keep increasing the insulin secretion because the sugar levels go up, the insulin will keep increasing so you could become a diabetic. So, and then it will also suppress your sex hormones. So, if you have seen the steroid pathway, you get cholesterol produces pregnant progesterone and cortisol. But if you are under high stress or low stress, everything goes into producing cortisol and all the other hormones like progesterone, testosterone, estrogen, they are not produced. So, infertility, low libido, they all could be connected to your low cortisol or high cortisol. 

JENNIFER: Absolutely, that makes sense. So how do you heal your adrenals and regain that energy?  

DR. MALHOTRA: So, I have a protocol that I use, and I always base it on the test, because I use a test as a guide but I look at the person and how they're feeling. So, if your cortisol is low then you need certain nutrients to produce more cortisol because your body is exhausted - you cannot produce. So, you need things like vitamin C, vitamin B. ginseng, ashwagandha – these can help when your cortisol is low. But you also need some glandular extracts you know to give some kind of cortisol to the person who cannot produce it. So, it actually helps while your adrenals are regaining its function. When it's too high, then you need to calm it, and many of these adaptogens like rhodiola, ginseng, ashwagandha, they act both ways so you can use them to actually calm the cortisone levels down. Along with that I tell them to do certain things like meditation, deep breathing, exercise, yoga/ These are known things that help relax and keep your body in the parasympathetic mode. Silence is another thing. So, removing mind chatter, increasing mindfulness. So, this is how I treat my clients, I use the test as a guide and then I tell them and then exercise, I tell them not to exercise high intensity if the cortisol is low in the morning I tell them to do things like stretching and yoga when it is low and when it is on the higher side then I tell them that okay this is the time you can do high intensity if you want to run, you want to bike, you want to do those things when the cortisol is always high. So that way it will, it helps balance the cortisol by doing some lifestyle changes. 

JENNIFER: That makes sense. I never thought about it that way. You did mention Ashwagandha. So, when you're taking supplements like that, do you feel like they're more effective if taken in the morning compared to at night or does it make a difference? 

DR. MALHOTRA: So, I always look at the levels. So, if your level is low in the morning then I tell you to take an adaptogen in the morning and if it is high in the evening, then I tell you to take adaptogens in the evening to calm it down, but I would not tell you to take a glandular in the evening because it's already high, you want to take a glandular when it's low. The test actually guides you that when you need to take the supplement. Usually taken over a period, you can take it three times a day and sometimes some people - they're low in the morning and it's high in the evening, a different type in the morning in the morning and a different type in the evening to balance it out. So, it all depends on where their levels are because you don't want to overstimulate something which is not working and you don't want to under produce something which needs to be produced more and it takes some time to get this balance right because one - you're never going to stop stressing, we're never going to have adequate sleep because of our lifestyle. So, all these factors and nutritionally also, we may not be, fully a nutrient sufficient in our diet to get what we need to have to give the adrenals. It doesn't take one day to get where it is, it may take about 18 months to two years to get it to where you really want.

JENNIFER: Oh wow. And have you noticed if someone comes in with this issue, but they also have a hormone imbalance, and you do hormone replacement, does that help?  

DR. MALHOTRA: So first I always check the cortisol, especially if it's a thyroid patient and then I will start the adrenal rejuvenation first before I change anything. Unless of course the labs are so bad that you really, they really need the support. But I often have seen that when I balance the cortisol out, other hormones start to also improve tremendously. 

JENNIFER: That makes sense. Everything just goes together. It's such a, you know, I never really knew about it before I came in this industry about hormones or anything but really healing the body from the inside out and how everything just you know, just needs to be balanced and everything works together.  

DR. MALHOTRA: Yeah. Absolutely. Absolutely.

JENNIFER: Well, is there anything additional you would like to add? 

DR. MALHOTRA: Additionally, I just want to add, is that to people listening, is that listen to your body. What is it saying? Don't ignore it. Just like, you know, your car, you get a check in the light on, and you get so frantic that you need to take it to the mechanic. But if something is going on in the body takes you years to actually dig deeper and if you're not getting answers from a conventional doctor then seek a functional medicine doctor go to your website like ifm.org and you can find a doctor that is close to you to help you resolve your health issues in a natural and more optimal way. 

JENNIFER: Absolutely. I think I've said this in a lot of my podcasts now but finding a doctor that will actually listen to you that you can be honest with, that actually tries to heal you, will make such a difference.  

DR. MALHOTRA: Yeah, because you know my client who walked in today, like I saw it today, she started talking and I asked her that, did you get this Hashimoto's in 2016. So, she said no, let me tell you something. Do you have time to listen? I said absolutely, I have time. That means she had tried telling her doctor many times, but she had never been heard. If that is the situation, you need to find someone who will listen to you, take the time to listen to you. 

JENNIFER: Absolutely! 

DR. MALHOTRA: Because it is your body, and we get this one life and one body, and you want to take the best care possible.

JENNIFER: Well, thank you again for joining me. If you guys would like to know more about Dr. Malhotra, please visit her website at anchorwellnesscenter.com. Or you can find her on Facebook at Anchor Wellness Center. Thank you again, Dr. Malhotra! 

DR. MALHOTRA: Thank you so much, Jennifer take care. 

JENNIFER: Thank you. You too!