Exercise and Adrenal Fatigue with Mike T. Nelson – Episode 29

In this episode, Dr. Ruscio welcomes back Dr. Mike T. Nelson to discuss how exercise affects the hypothalamic-pituitary-adrenal axis (HPA axis), can contribute to adrenal dysregulation and solutions to help regulate the axis.

 

Dr. R’s Fast Facts

  • Exercise is a stressor. Dose is important. More does not mean better.
  • The healthier you are the more you can tolerate
  • Exercise is good for you microbiota
  • Dr. Ruscio’s general recommendation for exercise for those who are ill:
  • Play-like activity with a friend while in nature may be best.
  • Exercise to the point of breaking a sweat, 2-3 times per week. 15-30 minutes is ideal.
  • If after a week or so of this you think you are feeling worse, scale back because you are likely over training. If you are feeling better you can ramp up a bit.
  • You are likely over training if any of these things are true:
  • Tired after workouts
  • Fatigued in general
  • Not sleeping well
  • Sore a lot
  • Reason why excessive cardio is warned against is because it’s more cortisol demanding.
  • Muscle mass and function is an important predictor of overall quality of life and morbidity. Resistance training will do more to maintain both of these than cardo

 

 

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Topics:
Fast facts
…..5:09
Exercise and cortisol response…..12:09
Heart rate and the effect on cortisol response…..17:06
Walking, gait and stress management…..26:17
Solutions for regulating and restoring adrenal function…..31:11
Episode wrap-up…..46:20

 

Links:

  1. (7:10) Exercise increases diversity and health of Microbiota:
    a. http://www.ncbi.nlm.nih.gov/pubmed/25021423
  2. (7:16) Exercise has been shown to increase diversity potentially through immune suppression:
    a.http://www.ncbi.nlm.nih.gov/pubmed/17201071
  3. (7:45) Increase growth of certain types of bacteria in the gut. Non-pathogenic commensal E. coli, as well as, other gram-negative bacteria:
    a. http://www.ncbi.nlm.nih.gov/pubmed/12412628
    b. http://www.ncbi.nlm.nih.gov/pubmed/1731173
  4. (8:21) Exercise ‘favorably’ shifts the microbiota in rats and mice
    a. http://www.ncbi.nlm.nih.gov/pubmed/20974015
  5. (10:17) Reason why cardio is warned against is because it’s more cortisol all demanding
    a. http://www.ncbi.nlm.nih.gov/pubmed/2671501
  6. (11:02) Dr. Ruscio Metabolic Edge article
    a. https://drruscio.com/getting-the-metabolic-edge/
  7. (11:46) Jeff Moss Ideal Protein Intake for Body Comp Longevity – Episode 17
  8. Mike T. Nelson’s links:
    a. (12:09) http://journals.lww.com/nsca-jscr/Abstract/2013/03000/Adrenal_Cortical_Responses_to_High_Intensity,.27.aspx
    b. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648788/
    c. http://www.ncbi.nlm.nih.gov/pubmed/20617017
    d. http://www.ncbi.nlm.nih.gov/pubmed/9190120
    e. http://www.ncbi.nlm.nih.gov/pubmed/23715265
    f. http://www.ncbi.nlm.nih.gov/pubmed/16237623
    g. http://www.ncbi.nlm.nih.gov/pubmed/23438233
    h. http://www.ncbi.nlm.nih.gov/pubmed/25074565
    i. http://www.ncbi.nlm.nih.gov/pubmed/26294794http://www.ncbi.nlm.nih.gov/pubmed/9190120

 

 

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Welcome to Dr. Ruscio Radio, discussing the cutting edge of health, nutrition, and functional medicine. To make sure you’re up today on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor.

Now, let’s head to the show!

Dr. Michael Ruscio: Hey guys, I just wanted to make one or two quick notes. Your Fast Facts we’ve finally put in the start of the episode. So, you’ll have your Fast Facts summary at the start of the podcast recording coming up in just a second. We are still having a lot of people ask us if the office is accepting new patients, and yes I am accepting new patients. So, if you are in need of help, feel free to reach out to the office.

Also, just really quick here: Remember that if you are listening to the podcast but you’re not subscribe to the newsletter, you won’t be made aware of everything because I usually do a weekly video and I’m doing more with articles, and, of course, those don’t go out via the podcasts. But anytime anything as was the website, we do make notification through the newsletter. The thing I most want you to make sure to stay abreast of is the piece I’m writing on the microbiota right now, which has been a huge undertaking and it’s a lot of work. That’s going to be primarily disseminated as articles and/or as an e-book.

So, I want to make sure you guys get dialed in on that. I will probably do a short podcast or two on that in tandem with the articles and the e-book releasing. But I think the written form for this is going to be far superior to podcast, because there is quite a bit of stuff. I think just being able to read through it will be a little bit easier than a podcast.

And also, remember that if you want to leave comments, you can post those comments on the corresponding transcript page for every podcast. And there’s also the ‘Ask A Question’ button on the website.

Great call today with Mike T. Nelson about exercise and adrenal fatigue. I think people are going to get a lot out of it because we really kept things practical.

So, with no further ado, we will jump in.

Dr. Michael Ruscio: Hey, guys. This is Dr. Ruscio. Welcome to Dr. Ruscio Radio. I am here with my good friend, Mike T. Nelson, who was on a little while ago and had some really interesting stuff to say about heart rate variability. Then we had a pretty lengthy tangent at the end of the last episode where we got down the rabbit hole of exercise, and exercise and adrenal fatigue. So, I wanted to bring him back on so we could talk about exercise and adrenal fatigue, or just exercise when you’re kind of burnt out, how to use exercise in that application.

So, Mike is here again. Mike, thanks for taking the time out to gab with me again about exercise.

Mike T. Nelson: Yeah, yeah. For sure. I always good stuff.

DR: Yeah, hopefully we won’t put too many people to sleep today, but I am sure…

MN: Maybe a few, but…

(laughter)

DR: All right. So, I had a few opening thoughts I wanted to get out of the way. And maybe I should reiterate, because I’m not really sure how much people know about my exercise background. I don’t discuss it very often, but I do have a degree in exercise science from UMass. And while I was getting my degree, I also did quite a bit of study outside with bodies like Chek Institute, Gary Gray, Gray Cook, Charles Poliquin…I was just super into it. I would go to school all day and read all nigh. I ended up starting a small training company at UMass. Actually, for a little while there, I had an internship program for fellow students in the exercise science program, where they could come see how I was applying some stuff that we were learning in school and what I was learning through independent reading. So, for awhile there I was really, really into exercise, exercise rehab, exercise performance, exercise for Polycom. But admittedly, for the past several years I’ve really been exclusively focusing on Functional Medicine and not really following exercise science literature super close as Mike has been.

So, I figured I can throw out my perspective and the way I look at things. Then Mike can throw out his and we can talk through any kids of disparities between our approaches. Hopefully, that will be a good overview for people to navigate through some of that stuff.

Let me get my stuff out of the way real quick here, so we can have the guy whom actually knows what he is talking about step in and add his.

Fast facts

DR: I think it is important to remember that exercises is a stressor. And the dose is important – more doesn’t necessarily mean better. With any stressor, it’s healthy to the point to which you can recover from it, right? So, it’s a healthy stressor, but if the dose is too high, you will over train; and if the doses is too low, you may not reap the benefits.

So, I generally could exercise as the healthier someone is, the more exercise they can tolerate. But, I am very careful to keep in mind that more doesn’t mean better. Now, for those who are really ill, I like to recommend play-like activity with a friend while in nature, because we will really get three things there: you’ll get some exercise; you’ll get some socialization; and you will get some time in nature; and actually, four you will also get play. So, if you can do some play-like activity – it might be hiking; it might be getting involved in some sort of intramural sports league or something that’s not overly intense. But you’re going to do something that’s fun – stand up paddle boarding – that you do in nature with a friend, you’ll get the exercise benefit, the socialization benefit, the time in nature benefit, and also the play benefit.

So, that’s, I think, a very good starting point for people.

Now, I wanted to chime in a couple of things on the microbiota, because we see a lot about the microbiota, and there is a little bit of what I would consider maybe what borders on a fanatical approach regarding the microbiota – about needing to be crazy and feeding it with all sorts of fancy fibers a prebiotics. Unfortunately,some of the simple interventions that can increase the health of your microbiota are being left out of the conversation. So, I want to just quickly mention here, and I will include the links to these studies in the transcript of this podcast, that exercise has been shown to increase the diversity and health of your microbiota (1a). It’s also been shown to increase diversity potentially through immunosuppression (2a).

Now,you may be saying, ‘Well, isn’t immunosuppression bad?’ But again, I think the dose here is important. A little bit of immunosuppression will prevent an overzealous immune response like we see in autoimmune conditions. So, a little bit of immunosuppression will help keep us from falling into an overzealous immune attack/autoimmunity.

Now along these same lines, exercise has also been shown to increase certain types of bacteria growth in the gut – nonpathogenic commensal E. coli, as well as other gram-negative bacteria (3a) (3b). And it’s important again to mention with E. coli that we hear E. coli and we think E. coli 1517, which was a pathogenic coli that caused a lot of disease. But there are also many forms of very healthy E. coli, like E. coli nissle 1917, which has some very impressive literature, especially for inflammatory bowel disease. So, we see some positive benefits in the microbiota there.

Other studies have shown that exercise favorably shifts the macrobiota in animal and human models (4a). So, a few microbiota cases there.

My general recommendation for people outside of the one above, or maybe a more specific one for people is exercise to the point that of breaking a sweat 2-3 times a week; 15-30 minutes is ideal. That’s just my general starting point for someone…again, these are people I am seeing in the clinic that aren’t feeling well, and aren’t trying to be super aggressive with exercise. But, I want them to get at least a bare minimum. And I have people pay attention and if after a week or so you feel you are more tired than you were before scale back. If you are feeling better than you were before, then you can ramp up. There are two ways I look at this: your general level of fatigue, and then your level of activity right after a workout. If you are doing exercise the right way, if you are having the right dose, you should feel energized after a workout. And you should generally think you have better energy levels overall. The first few days-to-a-week, you may feel a bit more tired as your body adapts. But, if you are starting to feel tired after workouts or more fatigued in general, or not sleeping well, or are sore a lot, then you are probably over training.

And then, the final point or two – one of the reasons a cardiovascular exercise routine or prolonged, steady state cardio, like 60 minutes or an hour-and-a-half on the treadmill or the stepper or the rower, or just running in general, why that’s been recommended against in the Functional Medicine community is because there is some evidence showing that these activities may cause the body to produce more cortisol, or they may be more cortisol demanding (5a). I think that’s where these recommendations come from. I think there is some plausibility there, but also we have to be careful that something like a super-intense workout, that’s resistance-training based but short – something like CrossFit – may also be very significantly cortisol demanding. So, we will want to be careful if we leave the cardiovascular camp and we go into the more resistance training camp, we also want to be careful with the dose there, because I do believe the resistance training may be less cortisol demanding, but the dose and the intensity of the resistance training is going to be important.

Also, a couple years ago, I wrote an article on some of these exercise points – It’s called ‘Getting a Metabolic Edge (6a). I will put a link to that article in the show notes.

And then the last point, another reason why I think the resistance training based exercise programs make a lot of sense for people is because muscle mass and muscle function is a great predictor of all-cause mortality, morbidity, or just for overall quality of life, as we recently discussed with Dr.Jeff Moss (7a), resistance training, in addition, to protein consumption, can both be helpful to maintain or enhance muscle mass and muscle function. And we’ll put a link to the conversation on this recently with Dr. Moss.

So, those are some of my thoughts on this issue. Mike, I’d love to get your opinion on these things and what you do, because I know you’re doing this day in and day out with clients you are really honing in on exercise. So please, enlighten us.

 

 

Exercise and cortisol response

MN: Yeah, there are a whole bunch of points there, too.

Just a couple things before I forget them: you mentioned that I think the cortisol response, which could be a whole show in itself, I would agree that, in general, for most of these people, they want to keep that stress relatively low, right?

So I work with fair amount of people whom come to me who have done CrossFit currently or Cross Fit in the past. A lot of them do just fine; there are no issues with it. Some of them have done a little bit too much and kind of burnt themselves out. There is one study showing higher cortisol response in healthy people in relation to CrossFIt. That was published in March 2013 of JSCR (8a), (8b), (8c), (8d), (8e), (8f), (8g), (8h), (8i) Adrenal Cortical Responses to High Intensity, Short Rest, Resistant Exercise in Men and Women. This is actually done in Bill Cramer’s lab. In essence, what they showed was that a CrossFit-type training session – no doubt, most people listening – did show much higher levels of cortisol produced with that.

So, if you are a healthy individual, and you can handle that, no problem. If you’ve got cortisol issues to begin with of various forms, you probably cannot keep up with that output and keep your health at the same time. So, I see a fair amount of people whom are kind of burnt out, who have been doing some pretty high-intensity exercise. And, I don’t think cortisol in general is as bad as what everyone says. The study from Sue Phillip’s lab showing that out of all of the hormonal markers during exercise, cortisol actually was a very small effect, but was associated with muscle hypertrophy. So, we want cortisol to actually be release during exercise. I think cortisol can be thought of better as the hormone trying to direct fuel usage, because it is going to try to shift your body to just free up more energy – it can be carbohydrates, it could be fat, things of that nature.

But, as we talked about last time, once you are done with that exercise, you want the cortisol response to actually go back down as fast as possible, too. So, if you are working with someone whom can’t do that sort of dynamic nature of cortisol, then having them do very, very high intense work is, in my opinion, not going to be the best.

And you had mentioned about very long endurance sessions. In general, I would agree with that. I do find that most of the people I see generally are doing some form of strength training. I’ve only worked with a couple who were more on the endurance spectrum. And, for them actually low-level intensity cardiovascular trainging is actually pretty beneficial. So, the average person I see who has been doing some CrossFit-type or strenth-training-type thing – you know, three, four, five, six days a week – usually has a couple kids, a busy job, and sleeps five-to-six hours per night. And, some added stress happens and this goes on for years, and they end up with some weird funky symptoms of ‘Yeah, you know. I don’t feel very good.’

So, in general for those people, I find that lower-level cardiovascular training is actually beneficial. I will put a heart-rate monitor on them and try to keep them 120-140 beats-per-minute, and sometimes even lower than that – I may even have some people go below 120 (bpm), which, if you’ve ever done exercise with a heart-rate monitor, that’s pretty freaking low. There are some old studies showing elderly people in their 80s get their heart rates well above 100 easy just by walking up stairs. These are not people who are deconditioned, either. So, I think we also need to determine what was the issue that they got to where they got, and if that is very long level – training for ultra marathons, triatholons – yeah, too much endurance training is probably not going to be good. If it was more of the high intensity strength-training stuff, the opposite – I find lower level more aerobic training can be beneficial.

 

 

Heart rate and the effect on cortisol response

DR: So, a question on that point, Mike. If they are coming from a CrossFit, and that’s what burnt them out …

MN: Uh-huh.

DR: …it certainly seems possible that by getting them to keep their exercise intensity – their heart rate – lower would make sense, right? Because it would be less stressful on the body overall.

MN: Yep.

DR: Do you think it’s plausible that it may not be dependent on the type of activity, but rather how high their heart rate gets? For example, could they do a very light resistance training session, as long as their heart rates stay within the acceptable parameters?

MN: Yeah, that is something that I I’ve been playing around with, and probably within the last year or so. I get this from talking to Coach Cal Dietz, from the University of Minnesota. We got to talking one day, and we are like, ‘What if you have an athlete who is strength-based,’ right? Most people are fat-loss based and that type of thing, so you want them to do some type of strength training. And he was saying that he’s got his athletes sometimes do 50-75 percent of their one-rep max by keeping everything under 10 seconds. So, if you look at the energy systems, under about 10 seconds is primarily what we call ATP CP, creatine phosphate. In essence, it’s the very high explosive-type of energy. If you look at that in general, cortisol levels don’t really go up with a lot of that work. It’s much more central demanding. But, cortisol levels don’t go up nearly as high as if you start pushing into the lactate area. So you start doing 30-60-90-120 seconds of continuous high-intensity work, cortisol levels go up super high.

DR: So it’s…kind of a way people might be able to think of that, just for those who aren’t super familiar with these concepts…

MN: Yeah!

DR: …when you do heavier weight, it’s almost like your neurological circuitry gets wired better, so your…thinks like, they are called rate coding…not rate coding. What’s the term, Mike?

MN: Rate-coding is one of them.

DR: Rate coding?

MN: There are different areas of recruiting the amount of muscle…

DR: Maybe it’s more of a neurological adaptation than it is a adaptation you see in hormones are heart rate and everything else, right? So just maybe a simple way to break that down for people. If you lift heavy, it’s more of a neurological-ish adaptation rather than being a metabolic adaptation.

MN: Yeah. So I would definitely agree with that. So, you’re taxing the nervous system a lot more. So they would do a circuit of maybe, you know, top bar dead lifts, or some dead lift, and then maybe a military press, and then maybe a row. And then you would just kind of go between one of those, doing only like 1-3 reps, but staying within 50 percent, maybe 60-70 percent of your one-rep max. So, you are staying with a load that’s quite light, and you are trying to move it fast, though speed isn’t necessarily the main driver. And you are just kind going back and forth between those exercises.

DR: Is the speed predicated upon your heart rate? I am assuming you wouldn’t do another set if your heart rate was starting to climb.

MN: Yeah, so you also…what I do is I put a parameter on it for heart rate. So I will say, “Any time your heart rate goes above 120-130, then you need to rest a little bit longer. So you are taking something that is a little bit more neurologic strength-based and you are toning down the amount of weight that is lifted. And then you are actually putting them in more of a circuit. So, you are trying to get a little bit more volume. What we find is if you were to go out and, let’s say, do sets of three, right? I’m going to beat the piss out of you. I’m going to have you do 10 of them, and I will allow you to rest, you know, a couple minutes between each. The first couple sets, that’s pretty much all ATP CP, or very, very high nervous system driven. By the time you get to that tenth set of that, it’s almost well over 50 percent as more of an aerobic, actually, component – aerobic meaning you are using oxygen. You are actually using fat primarily as a fuel source. With the circuit you are trying to push them a little bit more in that direction.

The caveat, to be 100 percent honest, I haven’t quite figured out is independent of that, there still seems to be a component that is just sort of central fatigue or neurologically fatiguing. So, for example, you had someone come in and you said, “OK, we are going to do all sets of triples – so three reps, multiple exercises, relatively heavy loads, most of the literature supports that it’s going almost 48 hours for most people to recover. That appears to be from the nervous system. So, years ago Dr. Andrew Thrive did a exercise he had moderate-level Olympic athletes, if I remember right – it was a college setting – come in and just beat the piss out of them every day. So, very high – 90-plus percent of one-rep max. This went on for almost two weeks. What he found was that there performance started dropping off. The athletes didn’t feel good. They actually had reported all the same things that sort of adrenal fatigue or insufficiency, or whatever word you want to associate with it. Those people also report, ‘I feel like crap. I have a hard time getting out of bed in the morning. I don’t have energy to do anything.’ Even though he kept them in only the central fatigue area. So, I think there is something going on related to that also.

But, if you pull back on the intensity, so that they are doing a lower amount of load lifted, and you are trying to push it to be a little bit more aerobic, it appears that people can still do some strength work in that area, and it’s not as stressful. So, maybe, if you have more of a strength athlete, to incorporate that as they are trying to recover from all of the accumulated stress.

DR: Gotcha. OK, that makes sense.

MN: It’s a long, convoluted answer.

(laughter)

DR: No, no. I think it’s important that we try to get people some clarity on these different issues because they are certainly be…you know, the belief that cardio is really adrenally taxing, but I think people are also starting to be aware that even aggressive circuits can be adrenally taxing as we’ve seen with these CrossFit athletes. As you are saying, also, heavier lifts can be more neurologically taxing. I’ve noticed that same thing – if it has been a research day for me, and I’ve just been super cerebral all day and I go to the gym – and let’s say I am in one of my heavy lifting phases – there are some times where I am just like, ‘Screw it.’ I just don’t have the neurological drive to be trying lifts of super heavy weights, like, three times.

MN: Yep.

DR: So, I get that. And that maybe opens up an interesting thought, which is, depending on what someone is doing all day, you may want to have a type of exercise that kind of offsets that. So, if someone is doing super neurologically or cerebrally demanding work all day, they may do better with a little bit lighter, more of like a circuit training exercise routine that’s not super nervous system demanding, and vice versa. If they are not doing anything super neurologically engaging all day, then they may really enjoy that. So that’s an interesting thought for people in designing an exercise. You may want to offset your day with your exercise so you are kind of hitting both ends of the spectrum.

MN: Yeah, I would agree with that. Just anecdotally with myself and clients, just simple stuff like very low intensity, get up and go for a walk for a half hour in the morning – just get low-level general movement – usually helps their mental performance also. So usually the people who are mentally burnt out are people with pretty high stress, and then you compound a lack of movement on top of that, and that seems to be a double whammy for them.

DR: I completely agree. One of the things…I think that, A., there is definitely an ancestral plausibility there…

MN: Definitely.

DR: That’s why I think just walking was an important part of day-to-day, and especially, again, walking in nature…

MN: Yep.

DR: So, definitely you can check off the ancestral box.

 

 

Walking, gait and stress management

DR: And anecdotally, I’ve noticed the same things over the past couple of years where I’ve been trying to put together the research study and the clinic has been getting really busy. I’ve been doing a lot more with research and writing, and then try to build up a team to support that. There are times where I just want to pull my hair out.

MN: Oh yeah.

DR: It’s, like, on the edge of losing it. And so, what I’ve done purely just out of following my body’s craving, I’m just like, ‘OK. I am going to step away from this. I am going to go walk in the park for, like, 15 minutes…’

MN: Yep.

DR: ‘…let all this stuff play out in my head, breathe a little bit, and then come back.’ That has been super, super helpful. I remember – gosh, I can’t remember where I heard this, or what the exact neurological implication was, but there was something about walking and gait that helps your body deal with stress. It may have been either the interview with Peter Unger or Aaron Blaisdell recently. But they were talking about how for our paleolithic ancestors, they (when) when they witnessed a traumatic event, like a relative being mauled by a saber-tooth tiger, they were able to deal with that fairly well, at least we think, because of how walking and gait helps the body process stressful emotions, and maybe that it moved it from the hippo campus, which is short-term memory through to I believe it was to the amygdala, which is processing long-term memory and maybe botching some neuro-anatomy there.

(laughter)

DR: But, the underlying point is still the same – that may help us process stressful events.

MN: How I think of it on a very simplistic level is your body is very much wired for survival – so, sort of the ancestral health model, which I would agree with. In that model, if you are out collecting your berries and you run into a saber tooth tiger, holy crap, you’d better run really fast, right? Hopefully you can run away from the tiger, and if you don’t, well you’re saber tooth tiger food anyway, and you don’t have to worry about it.

DR: Right.

MN: In most situations when there are high amounts of stress, our bodies are programmed for fight or flight, right? So, if you can move, that’s actually a very beneficial thing. So you fast forward to modern life, got the average person working at their desk, their boss comes over and yells at him, and what do they do? They can’t leave their desk first thing and get up and run down the hallway. So, they have this stress that is compounding, and then their body is then not allowed to move.

DR: They can’t flight or flight.

MN: Right. In essence, we’ve decoupled the stressor with the normal reaction that we should have. I think we have the capacity to buffer that to some degree. But if you now say, ‘OK, now you can’t do a lot of movement.’ Now we’ve got a high, high amount of stress that becomes unresolved, because we are not allowing the normal resolution of that, which would be movement, to occur. I just think that is going to cause all sorts of issues.

DR: So, maybe if your boss is a jerk, you go, ‘You know what? You’re right.’ You walk. You go get him a cup of coffee…

(laughter)

MN: Yeah.

DR: …as a way of getting yourself out of the office. Maybe you spit in the coffee on the way back; that’s up to you. But, at least it is something to give you an out to walk or get some kind of movement maybe really helpful.

MN: Yeah. I remember once years ago, I had an argument with former business partner. At the end, it didn’t go well to say the least, and I couldn’t think straight. So, I just got up and just left and just walked. I didn’t think about what I was trying to do at the time, but to me that was the only way I could think of or find to resolve that stress.

DR: Right.

MN: You think of people trying to work on a very stressful problem. They get up. They pace around. I think, a lot of that stuff is probably hard-wired for good reasons.

DR: Right. And one of the things, just to share a small lifestyle strategy. One of the things I like to do that I try to do – because, on my non-patient days, I am at home in front of a computer pretty much all day; I am either reading on the computer, or writing on the computer, or reading in a chair. When I have calls, I have wireless Bluetooth headset, and I schedule my calls as breaks. When I have a call, I go and I walk outside during the call.

MN: Yep.

DR: I bring a little pen and pad with me, and that just helps me – maybe I have two calls on an average day. And so, when it’s time for their call to come, I’m usually outside in the sun, walking, and that has been super helpful, because when I get back to the desk, I just feel so refreshed.

MN: Yeah, yeah. That’s one thing that I built into morning routine. I’ll get up (and) put my headphones on – usually listen to a podcast – and just go walk for just a half hour/40 minutes in the morning. Because I know that by the time I sit down, I’m going to feel better. I am going to feel less stuck. I am going to be able to write and research, and do those things. And then, usually during the day I will schedule exercise, ideally, mid-afternoon. Usually that’s about the time that I know historically my performance is a little bit better.

DR: Same here. Same here.

MN: And it’s about the time I am going to need some type of movement again. It’s usually enough to get me through then the rest of the day, even until later evening if I have to. So…

DR: Yeah, I do the same exact thing. Maybe around 5 (p.m.) I just notice that I am – even after my midday break at lunch I will eat and walk around a little bit, and then I will come back and then a few more hours in front of the desk. Then, around maybe 5-ish, I start to noticing I’m just getting that antsy feeling…

MN: Yep.

DR: …of getting a break, so I will go to the gym. That helps break it up, definitely. Same here.

 

 

Solutions for regulating and restoring adrenal function

DR: All right, Mike. So, you’ve given some of your strategies for heart rate variability for people who are burnt out. Tell us a little bit more about what you are doing with people whom are burnt out or have quote/unquote adrenal fatigue. What you are finding, and how to help people come back from that.

MN: Yeah so, I think of it as sort of a dose and response, right? So, I agree with your premise on exercise there – exercise as medicine and all of that kind of thing now. So exercise can be given in a dose format, so you are controlling the amount. You can go through the intensity, the amount, and the type and all that sort of thing. What I want to see is the response – the response is measured via heart rate variability, performance, other metrics. I think a lot of times for fitness professionals, we get pretty good at saying, ‘OK, here is the exercise to do. It may or may not measure performance. And we may or may not measure the cost of that.’ What I find is that it is really different for each person. So, one of the worst cases I had was with a person from Canada. She wasn’t able to do any exercise for several months. We had her do a lot more low-level movement – you know, walking, which we monitor with the FitBit and things of that nature.

In her case, even going downstairs just to look at her squat rack, where she had exercised for years, she would literally start to get dizzy and lightheaded. So, her body is going, ‘Hey, remember the last time you were here? You burnt the crap out of us. We’re not even going to let you close. And as ‘woo-woo’ and as weird as it sounds, one of her markers for progression was, can you walk down the stairs, look at the squat rack, and not feel like you’re going to pass out. Literally, that was one of her progressions. ‘Go down; OK, can you hang out in the room and read? I don’t want you to exercise. Just hang out there, right?’

So I also think there’s also the physical components of that, and there’s also the mental – in essence, associations that she’s built up over time. Her body, going into that area is very threatening. So we needed to obviously build up her capacity, but then retrain her brain over time to say, ‘OK, this isn’t as threatening as what you think it is.’ Low level activity…and, you know, in her case, it ended taking almost like one year, a year and a half, and she had seen tons and tons of people before, and no one had an answer. Her blood work was all kind of wonky, so she was working with a physician on that. So, I think that you always have to look at what is the exercise that you’re doing, and if the response is not the response you want, and it says, ‘Oh wow, this person can’t handle it,’ no matter what you think they should or shouldn’t be able to handle, you actually have pullback and go even less. So, you are trying to get it under the amount that her body can do that stress from exercise, rapidly sort of resolve it, and then start to accumulate a little bit more.

Otherwise, if you…I’ve seen, unfortunately, too many fitness people push people a little bit too hard. (They are), like, “My client is just a big pussy. They can do this.’ And the client will do OK for a couple weeks, and then just completely crash again. Mentally, the client goes, ‘Oh my God, I can’t exercise. Every time I try to exercise, it just goes horribly.’

DR: Right.

MN: So, they start building up those negative mental associations. Now you have to overcome that in addition to the physical part. So, I am very big on what are things they can do to reduce stress also. Breathing, meditation, prayer – things of that nature. A lot of stuff you talk about in terms of digestion health; micronutrition, I find, is huge. More fruits, more vegetables – especially a wider variety, because whatever they got themselves into where they were, it is usually those things may not be the best for them for awhile. So I have them play a game where I am, like, ‘Go to the store. Walk around the outside of the store, and I want you to come home and buy at least one to two things when you’re at the store.’ I don’t care what they are. Just go around and look and go, ‘Hum, does this look good?’ You will probably find a couple items – again, it sounds pretty ‘woo-woo’ – and they are like, ‘Dates sound really good,’ or figs, or kale, or whatever. Try that for awhile, and see how it goes. Measure your response.

DR: Sure.

MN: What I wanted them to do over time is to increase different sources of micronutrition, and to work on expansion. So expanding their capacity, expanding the numbers of foods that they can eat and still have a OK response. They may need to go through an elimination phase and that type of thing. But the end goal is, what can I do to get them to start expanding their overall capacity back out again. But, I am going to start with what are the limits for their current body, and I am going to stay within those. Then, they’ll get a little better over time, right? It’s the same thing as exercise, right? Any guy who’s ever started exercise goes, ‘I started doing bench press, and I did three sets of 10. But then I read Bill Star said five-by-five, right? But anyway, and then they are, like, ‘Wow, so when I first started bench pressing, I could only do 135. Wow, and a few months later I could do 155 on a test day, even though I never benched above 135 the whole time during training.’

DR: Right.

MN: ‘I increased my capacity enough that I had that positive transfer, and now I can do 155 and so on. So, you don’t need to go all the way to the limit of where your body is at. You just need to do a little bit more volume, a little bit more work, and then your capacity gets bigger over time.

DR: You make great points, especially with…and I think we have very close philosophies on this. But, to your first point, which is making sure the person’s not over training.

MN: Yep.

DR: To put it really simply, you have to have some way of being able to tell (if) you are doing more exercise than your body can handle? You like HRV (heart rate variability), which I think can be a great tool. For me in the clinic, people are already kind of doing a lot of stuff, so I try to keep additional things really simple. And so, I will just have them just keep an eye on your sleep, your fatigue, your feelings after workouts, your soreness; just some basic things that can tell you if you are over training. So, we have very similar thoughts there in terms of having a way of just monitoring if you are overdoing it, because you should be feeling better with time, not worse.

And then the other piece about diet, I also do something very similar in the clinic where I encourage people to rotate their foods initially. I don’t give them your classical four-day rotation diet broken up by taxonomic category. I think that’s a little bit too tedious for most people. But what I want them to do is generally start to be more comfortable with if you eat a bunch of foods on Monday, try not to eat most of those foods again for a day or two, because I want to break them out of that habit of eating like a block.

MN: Yep.

DR: The breakfast block is going to be eggs and avocado; the lunch block is going to be chicken and broccoli. I want you to start thinking about this less from a schedule perspective and more from a ‘How can I incorporate different foods into my diet. So, yeah, I definitely agree with you there.

MN: Yeah. Some people are really super stuck. I will be like, “Can you eat lunch for breakfast and breakfast for lunch?” And they are like, “What the hell difference is that?” I’m like, “Honestly, not much. I’m seeing can you mentally do it?”

(laughter)

It sounds a little bit…I look at you, and I’m like, “Why don’t you just try it?” Right? A lot of times it’s the mental capacity of doing something different that they need to get over first before they can do the physical action. You know? It’s the exact same foods, right, so what is the difference? ‘OK, but it just feels weird.’ ‘OK, but were you able to do it?’ ‘Yeah, I was.’ ‘OK, cool.’ Now you are mentally becoming a little bit more flexible, so we can add other things in, and then push that a little bit more.

DR: I really like your angle on that. That’s one of the things, when you are trying to get people on the autoimmune paleo diet protocol, you don’t allow for eggs. For some people they just lose their…”I can’t have eggs for breakfast?” To me it’s like, ‘Holy crap. It’s like come on. There are so many foods that you can have.’ I like the way you do that when you are not telling them they can’t have breakfast. You are just saying, ‘Can you eat breakfast for lunch?’ You are making it easier to kind of get that foot in the door to open up their perspective. I really like that. That’s really cleaver.

MN: Even with the eggs, I’ve told them, “OK. So, let’s make a concession. Can you just eat egg whites only? Would you be able to do that?” “OK.” Oh, I know an egg white is still part of the egg, and blah blah blah blah. All that other kind of stuff, I get it. But I am just like, can I get them to make half a step instead of a full step. They’ve already told me, ‘Screw you, I’m not going to do a full step.’ Can I get them to do a half step? And then after a few weeks, ‘OK, can I get you to do something a little bit different? Something in place of eggs?’ Or whatever, right? So you are trying to make smaller steps within their capacity. I’ve made this mistake horribly wrong in the past. I’ve just had knockdown, drag out arguments with them. Stupid crap like eating eggs in the morning, you know? Stuff that you shouldn’t really be arguing about. And I can find all of the science to prove that I think I am right. But I couldn’t get them to do it, so it didn’t matter if I quote/unquote was right or not.

So now I always look to see, ‘OK, what is one step easier for them? That still gets me closer to where I want them to go?’ We may have to a series of intermediate steps, but they are still getting better, right? Because this whole notion of, ‘Oh, I want to find what is optimal.’ Optimal doesn’t exist. It’s unicorns and pots of gold at the end of the rainbow and stuff.

(laughter)

I understand what you mean, but you could come in and say, “Hey, I will give you $2 million to find the optimal gut protocol or lifting program, or whatever. You can’t do it, right? You can only say, ‘OK, I took protocol A and protocol B. I compare them. We do all of the nice science. It’s cool. Then at the end, I say, ‘OK, with these parameters, protocol B was better.’ I can’t tell you that protocol B is optimal, because there are a whole bunch of crap I never tested, right?

DR: Sure.

MN: I just try to drill into people that if you just focus on, ‘OK, this is better than that,’ or ‘My result was better with this,’ or ‘I omitted this and I feel better; my digestion is better.’ Over time, you’ll get closer to that mythical optimal. But, the optimal-thinking people, I find, want to be all or nothing. And if they do do the all or nothing, at the end, if they don’t get the optimal result they wanted, then they are really kind of mad. ‘But I did your optimal protocol and I’m not there.’ You know? ‘Well, you know, we didn’t have this, this or that.’ So, I think just thinking about these things ahead of time is very helpful, too.

DR: I agree. I like thinking about it like this is a process, not necessarily do this one thing and everything is going to be fixed. And then we are done. It’s more like, let’s try to make this a hobby, or just part of your daily maintenance of you body, just like you might mow your lawn three days per week to maintain your lawn. This is something that is going to require daily maintenance and some daily tinkering. Thinking about it that way, where we just want to have gradual improvement. At the same time, at the other end of the spectrum, also having people not – kind of what you are alluding to – not get so intense about this that they can’t handle it if they don’t get immediate results. And that they also kind of just lose themselves in health, and they forget have a friend, be a friend, have fun, go out and just forget about health for awhile. That’s another thing that can be detrimental.

MN: Yeah, and tying that back into the adrenal issue, what I see is that a lot of the people personality-wise are Type A, usually very successful, very driven, and they are trying to mold even sort of their recovery process into those parameters also. Exactly what you said: trying to get them to just be aware of that, and kind of pull back a little bit. It’s harder. One thing I had to overcome going through this whole process was last fall to realize that I am not a lifter. I’m never going to get paid to do professional lifting in any form of imagination.

Once I could say that I am not a lifter, but someone who really enjoys lifting – also like kite boarding and doing other stuff – that paradoxically would allow me to keep doing it the rest of my life. If I was only hellbent on reaching X-Y-Z numbers, and my body was not having any of it, I would just be constantly injured then.

DR: Right.

MN: I had to kind of let that part of my identity go, and say, “OK. This is not necessarily who I am (but) something I enjoy doing. That sounds like a very small difference, but to a lot of very driven Type A people, the exercise component is something they really relate to, and it becomes sort of part of their existence. So, I think if they can just tweak that a little bit and say it’s something you do. By all means, if you you can do it in a healthy way, I totally agree with it. But it is not the sole reason you exist on the planet, you know?

DR: Right, right.

MN: I am trying to get them to be a little bit more aware, and to put a little bit more context around it, too.

DR: And I think if that albeit subtle but I think important shift in the way you look at it mentally, can really make a big difference. Because if you are coming into it with such high expectations, you rarely achieve your set goal for the week, or the lift, or whatever it is, then you are going to be feeling like a failure the majority of time.

MN: Yep.

DR: That can very deflating and defeating, and something that I myself being a super overachiever and a super perfectionist and super Type A I’ve struggled with. I’ve had to learn to enjoy the process more so than enjoying the achievement. It’s kind of reminiscent of an old Wayne Dyer quote, which I believe reads: “Infinite patients breeds immediate results.”

MN: Yeah.

DR: Yeah, so, definitely something psychological but a super important part of this process.

 

 

Episode wrap-up

DR: So, Mike, to bring us to a close here, any closing thoughts on this? Or anything you want to recap and leave people with whom are either adrenal fatigued or burnt out and are trying to get themselves back to health buy still exercise and are wondering how exactly do I do this?

MN: My general advice for that is – you know, we’ve talked in the past, too. If you can find a good Functional Medicine doctor, such as (Dr. Ruscio), and get some test to figure out what is going on, I think, obviously, that’s going to be a good approach. As you know, there are a lot of people who – just like trainers – kind of questionable in that area, who are more interested in seeing dollar signs than results. Unfortunately, I know of some people directly who have spent a lot of money on testing – (they) probably aren’t necessarily better right now.

(laughter)

And I think if you can work with a fitness person whom understands how to look at accumulated fatigue – I really think that is the main sort of bugaboo. It could be from under-eating, it could be stress, it could be from training, exercise, lifestyle – all of those things play a part. In essence, your body is just responding to that. Maybe your digestion goes to crap, (or your) hormones crash…whatever. Those are all responses to that unresolved accumulated stress. So, I think you need to work with someone who understands that, and also understands that the progression for that is not going to be nice, perfect, linear response.

How to set up your exercise so that you’re not overtaxing your body. You give it time to recover, but you are still making that progress.

And then, obviously, working with your physician so that you have the right data, you have the right tests. You figure out, OK, it’s maybe X, Y, and Z; let’s address those three things, and then let’s see how you are doing. I mean, I’ve even talked to people I work with to their physicians and say, “Hey, is it all right (if) I call and talk to your physician? Can I see some of your numbers?” I don’t want to be your physician; I’m not asking to look at your DHA and say, “Oh boy, that’s shitty.” You know? I kind of want to know the picture of what’s going on, right? So they’ll say, “OK, here are my numbers. And the physician has me do, in my case it was, you know, he had me do some DHA, a pregnetial, and things like that.” “Oh, OK. That makes sense, right?” I see, OK, so you are trying to get these numbers up. But in the back of my head I am also thinking, ‘OK, so those numbers crash. That means you had a pretty high amount of accumulated stress.’ Even once you get them quote/unquote “propped up,” you’re probably going to have to cycle off that a little bit. So, I’m really not going to put the gas pedal down on you until you’re all the way back off, and then you are all the way recovered.

I see a few too many people that think they can read lab work. You find that the person is on testosterone or DHA or whatever. Look at their numbers. ‘Oh, your numbers are great,’ and then drop the hammer on them for training. The person is like, “Well crap, I can never get off this stuff that I am trying to get off because that’s my life decision.’ So, I think you have to work with someone who understands that and (is) making sure that’s a long-term process, too.

DR: Absolutely, yeah. And I couldn’t agree more about the context of lab work…

MN: Yes.

DR: …(it is) probably as important, in not more important, than the lab work itself.

MN: Yep.

DR: (I) get family and friends and colleagues who want to – and I’ve said this before – send me their wife’s thyroid panel, for example…

MN: Yeah.

DR: …and expect me to be able to be able to…

(indecipherable cross talk )

DR: You’ve given me 30 percent of the picture. And sometimes I can give them some help – ‘OK, she is hypothyroid,” or, “She has Hashimoto’s.” But, really to fix that requires the other 70 percent, which is knowing the person, what’s going with their life and the whole context.

So, Mike, I know…I believe you are still accepting clients, and you are able to work with people remotely.

MN: Yeah.

DR: So, I think that’s a great resource for people who, if they are looking for help, reach out…why don’t you tell people where you are and how they can follow up with you if they want.

MN: Yeah, thank you. I’m in Minnesota. My website is just MikeTNelson.com. There is an application form on there. If people want to contact me directly whom are listening to this, they can. The email is just [email protected] Just put in the subject line ‘Action Item: Ruscio Podcast’ just so I know where you came from. My assistant will get those over to me.

But, yeah, I do work with mostly people online. The nice part is I have found ways of figuring out the stress through HRV and nutrition, movement efficiency, and all of the other things – and the Involta move online now. I feel like I have a pretty good handle over what is actually going on. There are a lot of online training people – they are just like, ‘Ah, here is a template; just do it.’ It’s like, ‘Oh, OK.’ It may not work out the best for you. It may be better than what you are doing, but if you’ve got a high amount of accumulated stress, you can guarantee things are going to change quite a bit. So…

DR: Sure. That’s where our last call…the HRV, I think, is a really novel tool for that.

MN: Yeah.

DR: So, cool. Hopefully some people will find their way to you, and you can help get them back on the horse here without going too hard, too fast, and feeding an imminent burnout.

MN: Yeah, and that’s…bananas when you see someone who did the right things, you know – when to their doc, the doc did the right testing and got everything going. And then they start up exercising again and they don’t have a clue. And then, they go back and they sadly repeat the cycle again, and they are going, ‘I don’t know what’s going on,’ right? You know, they like, ‘I did this before and it worked fine.’ And I am like, ‘But, you didn’t have that much of a stress built up from before, either. So, your body can handle it and it’s OK. You’re a little bit different now, so it’s going to be a little bit different approach.’

DR: Well, I like it, Mike. Thank you again my friend for coming on. This is a great talk…

MN: I had a great time.

DR: The third one I’d like to do sometime in the near feature here would be the sports supplement one.

MN: Yeah, for sure.

DR: That’s another one where I really think using the literature to help keep us from falling into the snake oil salesmen lore will be really important.

MN: Oh yeah. And there’s none of those people in the supplement world.

DR: None. Probably the lowest percentage of any industry, right?

MN: It’s its own little industry. It’s interesting.

(laughter)

DR: Well, my friend. This was awesome. Thank you so much. And, I am sure we will be in touch in the future.

MN: Yeah, thank you. Really appreciate it.

DR: All right, my man. Take care.

MN: Yep.

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRusso.com to ask a question for an upcoming podcast. Post comments for today’s show and sign-up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

6 thoughts on “Exercise and Adrenal Fatigue with Mike T. Nelson – Episode 29

  1. So would you clarify the type of exercise program for someone whose cortisol levels are lower than normal all day? Have exercised regularly for years but can’t seem to do those levels now. Will aerobic exercise of 30-45 minutes increase my cortisol levels since in normal people that is what happens? I guess my question is how to use exercise to help get cortisol levels back to normal after years of chronic stress and now health issues including SIBO. Your new book arrived this morning, Healthy Gut Healthy You! That’s how I came across this podcast. Thanks for a reply!

  2. So would you clarify the type of exercise program for someone whose cortisol levels are lower than normal all day? Have exercised regularly for years but can’t seem to do those levels now. Will aerobic exercise of 30-45 minutes increase my cortisol levels since in normal people that is what happens? I guess my question is how to use exercise to help get cortisol levels back to normal after years of chronic stress and now health issues including SIBO. Your new book arrived this morning, Healthy Gut Healthy You! That’s how I came across this podcast. Thanks for a reply!

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