PRECONCEPTION

029: What Are Adaptogens? w/ Shelese Pratt, ND

029

029: What Are Adaptogens? w/ Shelese Pratt, ND

Welcome to the Hey Mami podcast!

Our guest today is Dr. Shelese Pratt, who believes in integrative and holistic medicine. Her practice and clinic are focused on neurology and complex medical conditions relating to metabolic disease.

Dr. Pratt uses functional medicine and her expertise in biochemistry (methylation) and physiology to help her patients get to the root cause of their symptoms through a strategic approach.

The modalities used in her practice are nutrition (diet and nutritional supplements), botanicals, environmental medicine, classical homeopathy, and hydrotherapy.

Or listen on Apple Podcasts | Spotify | Stitcher | TuneIn | YouTube

In today’s episode we are talking all about stress, cortisol, and adaptogenic herbs.

Highlights:

  • What do stress and cortisol do to female hormones?
  • How does food affect your cortisol and circadian rhythm?
  • Why is sleep so important?
  • What are adaptogens?
  • Common adaptogens
  • Can adaptogens trigger anxiety?
  • What’s the deal with mushrooms? (Cordyceps)

Important Links

Find Dr. Pratt online

Follow Dr. Pratt on Instagram

029: What Are Adaptogens? w/ Shelese Pratt, ND TRANSCRIPT

Dr. Maren:                          Welcome back to The Hey, Mommy Podcast. In today’s episode, we’re talking about stress, adaptogenic herbs, and lifestyle modifications to support hormones. Our guest today is Dr. Shelese Pratt. Dr. Pratt’s is a naturopathic doctor. And her practice in clinic are focused on neurology and complex medical conditions relating to metabolic disorders. She uses functional medicine and expertise in biochemistry, also known as methylation and physiology to help patients get to the root cause of their symptoms through a strategic approach.

Dr. Maren:                          The tools she uses most often are nutrition, supplements, botanicals, environmental medicine, classical homeopathy, and hydrotherapy. She is also a very close friend of mine and more or less a neighbor. So I get to see her often, and I’m just so impressed with her knowledge, especially when it comes to botanical medicine and supplements, and so really excited to have her here today and share her wisdom. So thanks for being here.

Dr. Pratt:                              It’s my honor. Super happy to be here. Nice to see both of you.

Dr. Maren:                          Yeah. So we always start our interviews out just by asking our guests if you could share a little bit about why you do what you do?

Dr. Pratt:                              So I guess if you go all the way back, well, my late teens, my early twenties, I got really sick. I had a chronic health condition. It was asthma that led to immunosuppression with all of the drugs that I had to take because of the asthma, which then led to all kinds of immune dysfunction that I got shingles. And my life, I just remember walking up a set of stairs when I was about 20 and feeling like I had an 80 year old’s body. And so it was at that point that I read Andrew Weil’s book, Spontaneous Healing.

Dr. Pratt:                              In that book, Andrew talked about naturopathic medicine and it was just my life’s mission to really find answers for people that were caught in a system that they weren’t finding the answers they were looking for, and making the progress they wanted to make. So I made a lot of changes in my diet. I started taking targeted supplements and I have not had an asthma attack since I was 24 years old. So it was Doctor, Heal Thyself, a little bit of that. And then this commitment to saying, “I want to find answers for people that can’t find answers.” So that’s what I do.

Dr. Maren:                          Yeah. I love that.

Dr. Carrasco:                      That book changed my life too.

Dr. Maren:                          I know I was going to say, I mean, all three of us have that in common. Andrew Weil was a such a huge influence in my career too. So thank you, Dr. Weil, because I’m sure you’re listening right now.

Dr. Pratt:                              It’d be great if he did.

Dr. Carrasco:                      I know.

Dr. Maren:                          I know. I don’t think he’s trying to get pregnant. He’s like-

Dr. Carrasco:                      Or trying to survive motherhood.

Dr. Maren:                          … done with. Yeah.

Dr. Carrasco:                      He’s not done.

Dr. Maren:                          Nonetheless. So let’s talk a little bit about stress and cortisol, and what that does to our bodies, and our hormones, especially when we’re kind of thinking of this in terms of reproductive health.

Dr. Pratt:                              Sure. So I mean, some of the first things I think about are the common ones, right. When we get really stressed, the first thing that happens is that we release cortisol and adrenaline, if we can, and we try to mount a response and this is a natural part of our body to do that. Well, over time, we also release, when we’re really stressed, we push a lot of enzymes in our body to reduce a lot of peroxide as well, and peroxide starts to age us. So that’s one of the ways in which, I mean, if you study genomics and methylation, you start to see [inaudible 00:03:51] becomes more and more of an issue and when we’re really highly stressed, because it’s aging us, it’s aging our body, it’s aging our skin, it’s aging our eggs, it’s aging all of us.

Dr. Pratt:                              And so how do we manage stress? A, to begin with. And then what happens with chronic cortisol and adrenaline over time is it starts to impact our metabolic rate? How we’re managing proteins, how we’re managing oxygen in ourselves, how we’re managing our glucose. Our glucose changes with high cortisol over time. And so all of these things, these ways in which our body tries to create something called homeostasis, which means we’re trying to keep everything in balance and our body does a really good job in the beginning, in acute stress, we can handle an acute stress with what all those changes that I just talked about.

Dr. Pratt:                              It’s chronic stress over time, not sleeping, not eating well. I mean, we can talk about all the things to do first to manage that before we ever take any supplements or herbs, but those are the ways in which it changes our hormones when we are stressed, and how we manage stress over time.

Dr. Maren:                          Yeah. I appreciate that. And the glucose piece, I mean, I’m sure you see this as well, but there’s so many patients in my practice who have really much higher than normal glucose. And it’s sort of surprising given maybe their family history and that they’re actually very thin, and they really don’t actually have insulin resistance. They’re just mobilizing glucose because of high cortisol, high glucose. And a lot of times these same patients will tell me, like they wake up every morning at like three or 4:00 AM and they’re just ready to go. Do you see that also?

Dr. Pratt:                              I do. And so there’s a couple of different things. You can kind of approach that at first. One is, are they eating a midday meal? Even though their glucose is high in the morning, but that’s also an inflammatory. So I think not only do I think high cortisol, but I think they’re very inflamed if they have a high morning cortisol. So it’s about regulating blood sugar. So what does that mean? Eating regular meals. A lot of people are doing intermittent fasting right now, and that’s not always working for women’s hormones. They’re pushing their cortisol too high, and they’re suppressing really their ability to get pregnant because their glucose and their hormones are off.

Dr. Pratt:                              So not everybody needs to do intermittent fasting. I really encourage people to, if you’re hungry in the morning, you probably should be eating, and eating those meals at strategic times in a day. So one of the things, to go back to my roots, is creating support for that circadian rhythm, for the cortisol to do exactly what it’s supposed to do, which is in the first thing in the morning when you wake up at six or seven, eight, whenever that is, it should be at its highest. And then throughout the day, it should kind of come down and be at its lowest when you go to bed. And so that’s kind of the curve that you want, is where you can wake up, you can, you can have energy through of the day and then it peters off at night.

Dr. Pratt:                              And so to balance that circadian rhythm, that cortisol follows, you want to eat at the same time every day. You want to go to the bathroom around the same time every day. Like, you want to exercise around the same time every day. You want to go to sleep at the same time every day, and it sounds kind of restrictive, but it will set you up for a better circadian rhythm which helps your hormones immensely. So eating fiber and protein is very important for that midday meal and not to get too far into physiology, but if we don’t have enough glucose to store away in our liver, and if we don’t store it away very well and cortisol has to come up in the middle of the night. It wakes us up at three o’clock in the morning to say, “You ran out of glucose from your liver, and now it’s time for you to have cortisol to manage your blood sugar.”

Dr. Pratt:                              So sometimes just eating at strategic times, getting through three meals, which busy women, busy mothers tend to skip or snack all day, or eat what their kids leave behind. I’m a parent. I did it. But if you don’t get enough fiber and protein, that’s going to mess with your circadian rhythm. It’s going to mess with your cortisol and wake you up at night. It can. So that’s one of the things to look at. Also high stress. If your cortisol is running too high at a certain time of day, or it comes up and is too high at night, that’s going to wake you up to three, four, even five. When you could sleep a little bit longer. So it’s managing cortisol, it’s managing blood sugar to get back to your glucose comment.

Dr. Carrasco:                      Do you feel like, talking about meal patterning, because that’s something that I think a lot of my patients, probably your patients as well, Christine. Many are also desiring weight loss or dealing with weight loss resistance. And so the reason I think intermittent fasting feels appealing is because it might be a way to kind of support weight loss resistance. But how do you feel that the kind of diurnal pattern of cortisol plays a role with meal timing? Like what would you say like a good meal timing approach should be for people in general? Not knowing their specifics, I guess, for women with weight loss resistance.

Dr. Pratt:                              Well, for those women, I think there should be a fasting window where we end eating at night, and we fast until morning. If they have low cortisol in the morning, and let’s say they’ve been chronically stressed and they’re trying to get pregnant, we don’t want to continue to put that stress on the body by making them eat, making them fast through a window that they’re metabolically not stable enough to fast through. So those kind of patients, if they wake up and they’re hungry, we want to put them on a really wonderful, nutritious foods.

Dr. Pratt:                              It’s this kind of the same idea of the people in your practice that have, that their thyroid is off, and they’re not eating enough, and they’re trying to lose weight, and they actually would lose weight if they ate a little bit more, right. These cortisol is playing into that and adrenaline as well. And we’re going to talk about herbs that support the thyroid and the adrenals as well as the pancreas and all of this. That’s the beauty of these adaptogenic herbs. But I think meal patterning really needs to be specific to each individual based on where they’re at, and where their hormones are at, and how supported they are.

Dr. Pratt:                              If they’re running really high cortisol, it might be that they can fast a little bit longer, but we want to make sure their morning glucose isn’t too high to begin with because if they have high morning cortisol and high morning glucose, they’re too inflamed and that inflammation is working against their weight loss as well.

Dr. Carrasco:                      That’s fascinating.

Dr. Maren:                          And that’s good. I’m happy you brought up thyroid because that’s another kind of pattern we probably all see, is like this really high reverse T3. So for those listening if you’re seeing like a more conventional doctor, they probably haven’t checked reverse T3, and they might have some resistance around doing so, but the reason we check it is just so we can understand, sometimes when there are thyroid symptoms that are actually your thyroid’s fault. They’re a problem with not eating enough calories or having too much stress, where your body’s really like trying to slam on the brakes and increase your reverse T3. So sometimes it just helps us to explain some symptoms.

Dr. Maren:                          So let’s talk a little bit more about like other kind of lifestyle stuff that you would recommend before we talk about supplementation. Like what other key lifestyle factors are really important with managing stress and cortisol?

Dr. Pratt:                              So the Keystone, the very most important thing to talk about is sleep.

Dr. Maren:                          Yes, agreed.

Dr. Pratt:                              So I mean that’s the number one thing we need to prioritize for hormone health, immune health, neurological health. Really, our cornerstone to health is sleep, and prioritizing it from the moment we wake up in the morning from the time that we go through our day, all the way up to when we choose to go to bed. And I understand the population I’m sitting in front of, I understand what it’s like to have kids. And I know how hard it is, what I just said to say, to prioritize sleep, especially when you have little ones that wake you up.

Dr. Pratt:                              But finding ways in order to encourage where you can during different phases of your life. I mean the basic sleep hygiene pieces should be there. There should be no technology in your room. You should keep your room cooler at night. You want to try to turn off any kind of Wi-Fi or routers if you can, that are near your bedrooms. So everyone sleeps better, including your children and we are going to have another talk about EMF and how that influences sleep. But just know the less you are influenced by EMF, whether it’s your phone, or your router, or your modem, or whatever it is.

Dr. Maren:                          Or your baby monitor.

Dr. Pratt:                              Or your baby monitor, beautiful, Christine. Those things matter. You can’t see them, but they are influencing sleep patterns. The basic things like I just talked about, setting up having meals at certain times of day to help you sleep at night, getting to bed before 11 if you can, in naturopathic medicine we say, the hours before midnight give you much more quality sleep than after. And now that I have an oura ring…

Dr. Maren:                          I know.

Dr. Pratt:                              … I’ve actually-

Dr. Maren:                          We all have it.

Dr. Pratt:                              We all have them because they’re so helpful at understanding circadian rhythm and health, we start to see patterns, and what I’m seeing, and you ladies can tell me if you see the same thing, is if I get to bed before eleven, I notice deep sleep increases and I see a lot more deep sleep, and the REM, actually can come up a little bit better in the early morning, if we’re getting to bed a little earlier and granted. There’s a lot more to talk about with sleep, but just knowing whatever you can do to support sleep is going to support your hormones, it’s going to support your neurological health and your immune health.

Dr. Pratt:                              So I don’t want to spend too much time talking about sleep, but it’s a really important one. Getting in touch with nature and creating a rhythm in your body. Again, getting back to the circadian rhythm, I cannot speak to it enough that just walking outside in the sun or even sitting on your porch in the morning hours to help your pituitary gland make the melatonin you need to make at night while you sleep. So it does matter if you get out and get a little bit of sun into your eyes. Again, don’t stare at the sun or…

Dr. Carrasco:                      And I would even add that if you’re someone that wears contacts or glasses, you need to not be wearing those, so that it can penetrate the eye and through the suprachiasmatic nucleus.

Dr. Pratt:                              Beautiful. Yes. So a lot of my people that don’t sleep well have a lot of hormone issues. I tell them the first thing to do when they wake up in the morning, if they can, is to go out and have a couple sips of their coffee, their tea, their water. Whatever they’re drinking or whatever they’re doing, first thing in the morning, just go out and spend a couple minutes outside, first thing in the morning, if you can. And another thing that if you can watch the sun go down, because if you are watching the sun go down, intuitively or internally, we want to think the day is ending. Now, is not the time we rev up.

Dr. Pratt:                              So this is another important lifestyle modification that the Western world doesn’t really support, but anything we can do to help our bodies understand that that matters when the light is in our… When the sun is out, we should really be awake more of that period, and when the sun is down, we should be sleeping a little bit more. So getting in touch with the seasons, the rhythm of the seasons and the sensitivity we have as humans, because we do to light. And when we use a lot of artificial lights, it’s not the same and it over stimulates us at night. So it’s just some of these basic things.

Dr. Pratt:                              Drinking plenty of water, staying really hydrated, that’s going to be so important for whether we have peroxides from stress or whether, just the way our cells work if we’re hydrated, we are less prone to stress and we are more resilient. So we want to take away anything internal or external stresswise. That’s the way I think about it. Exercise. And when you exercise is important as well. Exercise really helps us break down cortisol. It also helps us manage our stress and our… It helps increase circulation. It helps our brains work better. It bays our organs and our ovaries in new blood so that we can get nutrients there to make the best eggs possible. So exercise is really important, but not too much exercise. It’s the Goldilocks principle. It’s just the right amount.

Dr. Pratt:                              It’s better if you do it earlier in the day. It sets you up a little bit better because if you exercise late into the evening, if you exercise two hours before bed, it can boost your cortisol, and that would also make it harder for you to sleep, or if you do go to sleep, you might wake up. So finding a routine around exercise. Again, if the only time you can exercise is at 5:00 PM or 6:00 PM, that’s going to be fine as long as you go to bed. You give yourself at least three hours before you go to bed. So those are just kind of basic lifestyle hacks that I think are so important to make sure that people are in alignment with before trying to reach for a bottle.

Dr. Maren:                          Yep. Agreed, totally. And I think with the exercise, I see a lot of people who are under the impression that they shouldn’t exercise, because they’re stressed and they think they have adrenal problems. And so they shouldn’t exercise. But like you said, it’s this very good relaxing, like don’t train for a triathlon, that’s too much on your body right now, but pay attention to how you feel after exercise. It should make you feel better, if it makes you feel terrible, and you’re in bed the next day, and just totally wiped out, then that’s too much on your body.

Dr. Maren:                          So everybody has to just kind of tap into what’s right for them. But I do think exercise is a really, really important thing. And can help all these things, sleep and stress like it’s, if you put it all together, it helps with all the other sort of pillar of managing stress in your life. And I think when you don’t know what else to do, then lift some weights or do some yoga, right.

Dr. Carrasco:                      I think also though, if you haven’t exercised in a long time, you might actually not feel well when you start exercising. So you might not just say like, if you exercise and you feel bad the next day, that doesn’t mean the exercise isn’t for you, but if that’s the pattern, it might take a few weeks to kind of transition.

Dr. Maren:                          Yeah, totally, I would agree too.

Dr. Carrasco:                      If you haven’t exercised in a long time.

Dr. Pratt:                              And it’s the whole like ramping, right.

Dr. Carrasco:                      Microdose yourself up.

Dr. Pratt:                              Right. And sometimes it’s starting from maybe going for a walk every day, and that’s where you begin. But extreme exercise is probably going to be more stressful on your body. And that’s what I’m trying to also say, is there’s a lot of people that exercise a little too much, especially in the Boulder area where Christine and I are.

Dr. Maren:                          Yeah, especially.

Dr. Pratt:                              We sometimes have-

Dr. Maren:                          Someone [crosstalk 00:20:31] my husband.

Dr. Pratt:                              … to pull people back. But it is a great way for those of you that don’t exercise. I want to encourage you that it can be a great way to reduce your cortisol. So when you have high cortisol, one of the best things to do for it is exercise. Yeah, so those are-

Dr. Maren:                          Good points.

Dr. Pratt:                              Those are some of the places to begin.

Dr. Maren:                          The other thing you mentioned was just like the different kinds of stressors that people can have. And so I think it’s important for people to understand, like physical stress is a thing, not only from exercise but from chronic illness. And so at the same time we have to address these underlying issues with like chronic digestive issues or what, mold exposure, whatever it might be, creating this like external sort of stressor on our body.

Dr. Maren:                          I mean, of course we know, I think we think about stress in terms of the emotional aspects, in terms of relationships and work. But some people have the relationships and work piece pretty dialed in, and they’re still super stressed and super inflamed. And often I’ll look and I know you do all the time. We look for those kind of environmental triggers and kind of what else is going on.

Dr. Pratt:                              I mean, we have to look at all the different ways that physiologically can stress us, right. So that’s not just the mental, emotional picture. Looking at the environmental factors, looking at all the things, the illness, like you just said, so many people need adrenal support or cortisol support after getting through an illness. And they don’t think about that as a stressor, but it really takes a number on people’s adrenals when they have illness, whether it’s a flu, or a cold, or they had something bigger go on, or even they’re recovering from an injury, their adrenals had to manage that.

Dr. Pratt:                              And so how do we support not only the adrenals, but this whole, it’s called the hypothalamus-pituitary-adrenal axis. So it’s all part of it. And yes, it’s not just your job, your work, your family, your external emotional stress.

Dr. Maren:                          Yeah. So, okay, let’s talk a little bit about adaptogens. We’ve said this word a couple times, but I’m sure there are people who don’t know what that means. So let’s talk about like, what are they? How do they work? When can we use them? And then we’ll sort of dive into maybe some of your favorite in terms of like women who might be trying to conceive or in the postpartum timeframe, but what are adaptogens?

Dr. Pratt:                              Most research on adaptogens are from the Chinese medicine perspective, and what they are. They are herbs that help the neurological system, the immune system and the endocrine system, specifically by its influence on cortisol and adrenaline. And what adaptogens do and what the super cool part, and why we love them is because they create homeostasis, this whole idea of balance in the body. So these herbs can not only bring down cortisol if you need to bring down cortisol, but they can bring up cortisol for some people, or they can help you be more resilient to perceived stress, and decrease that perceived stress. They can create more, like I said, resilience and improved mental performance as well.

Dr. Pratt:                              Now, we’re starting to fall into, they’re called nootropics. That’s kind of a new hot topic in herbalism, but these adaptogens have always been there. So they help this mental piece in your cognition as well. But we’re seeing this also translate into, like I said, the nervous system, oxidative stress, a lot of these components that make up these adaptogens are also protective for the cells. So they have these constituents in them that are antioxidants, and also prevent tumor growth. So there’s this idea of there are safe herbs to use in most cases that can bring you into balance wherever you are in the spectrum with these hormones.

Dr. Maren:                          Awesome. So tell us about some of your favorites? I mean, I think a lot of people are familiar with ashwagandha and rhodiola. I mean, there are so many. So maybe outline some of the most common ones we see, and then why you might choose one over the other?

Dr. Pratt:                              So, I mean, the most talked about are ashwagandha, rhodiola panax ginseng, which is an Asian ginseng. Siberian ginseng, which is Eleutherococcus, and Seshendria. Those are kind of the most common to talk about. And then there’s things like licorice, but some holy basil is another really important one, which is [Tosi 00:25:46] out of India, that’s another ayurvedic like ashwagandha. So it just really depends on where people are in their journey within their relationship with cortisol, right. So I think of in my practice, and you ladies can tell me your relationship with these herbs.

Dr. Pratt:                              But somebody that’s coming in for balancing that cortisol, and a lot of times, I think I was going to mention this, is that sometimes it’s really nice if you’re getting confused about what your cortisol is doing. It’s really hard to know if you’re high or low. You can have symptoms. It’s kind of that same bell curve. You can have symptoms at the extremes that look exactly the same and you just don’t know. Are you high? Are you low? And there are tests out there that a functional medicine doctor or naturopathic doctor can run, that will tell you where you are.

Dr. Pratt:                              And that’s oftentimes really important to know when you use these adaptogens, because some of them work a little bit better at higher cortisol, and some of them work a little bit better at lower cortisol. So let’s talk about what that looks like. So in preconception, if you have a mom that’s really stressed and not sleeping so well, and she’s trying to get pregnant, I think a lot of times supporting her with either holy basil, ashwagandha and rhodiola, maybe a smidge again, I’ll make tinctures, and I’ll make them with different concentrations of each of these adaptogenic herbs and all. And that’s the kind of hardship about going and picking a formula with all of these in it.

Dr. Pratt:                              It’s really individualized, a lot of these should be given… You may do really well with just taking ashwagandha. And the cool part about ashwagandha is not only does it help with cortisol, it helps with food cravings, it helps with weight distribution and body weight, and your body mass, like I said. So ashwagandha has that piece built into it. What I will say is if you tend to be depressed and you take ashwagandha, it could make that worse. And not very many people experience that, but it can happen. And I think that’s something Christine and I talked about, which kind of spurred on this conversation today is helping people, that if they start to feel a little bit lower on ashwagandha, knowing yeah, you may want to back off of ashwagandha, you may do better with rhodiola.

Dr. Pratt:                              So rhodiola, I think of as more, it’s a nice herb to help people feel like they have a spring in their step again. What I want to be careful with rhodiola and panax ginseng, and even sometimes Eleuthero is that I don’t want a wired, but tired person to get more wired off of that panax, that rhodiola, because that can really bring back your feeling of energy. I mean, what’s really cool about panax and Eleuthero is again, this neurotropic, they can help dopamine you to feel your dopamine a little bit better, and it can change how you manage dopamine in your brain for focus and concentration. And what we just want to do, we don’t want to over stimulate you, right?

Dr. Pratt:                              And these herbs are great because they do help you if you’re low to be in the middle. But again, I would never tell anyone to take rhodiola or ashwagandha, or I would never tell anyone to take rhodiola or panax ginseng at night. We’d always use those in the morning, because they are a little bit more relational at helping you manage your cortisol and we wouldn’t want to bring up cortisol at night.

Dr. Maren:                          Do you ever find that they trigger anxiety?

Dr. Pratt:                              Yes. Panax ginseng can, rhodiola can, if they’re wired, but tired. Sometimes we have to bring up the fatigue. We have to help the fatigue by actually not stimulating, to bring down stimulation, which we have a… Oh, go on.

Dr. Carrasco:                      I’m sorry. I was going to say, I see a lot of patients with anxiety and also CMT mutations.

Dr. Pratt:                              Yep.

Dr. Carrasco:                      What would be a good adaptogen in that case?

Dr. Pratt:                              Probably a combination of holy basil and ashwagandha as long as it didn’t make them too tired and sometimes, or I do rhodiola with that

Dr. Carrasco:                      Just a smidge.

Dr. Pratt:                              Just a smidge of rhodiola, with ashwagandha for anxiety, the wired, but tired. And those people have typically had chronic stress for a long time. And so we’re trying to manage that. And so it’s understanding that. One of the things we were going to talk about is postpartum, and in postpartum you can use ashwagandha and holy basil to help with that kind of wired, but tired when you’re not sleeping so well, and you’re up with the baby. Those are two of the herbs that are kind of your friends and they’re pro galactogogues, which means a lot of them actually help you produce more milk, of those two herbs. So those would be good options to use.

Dr. Maren:                          What about if you’re postpartum and just exhausted like that? I find after like the first six weeks is kind of magical with your baby and then it really, like it’s-

Dr. Carrasco:                      And then it feels like [crosstalk 00:31:21].

Dr. Pratt:                              … people get so tired. Yeah You’re like, it’s a train wreck. I mean, obviously yeah. We’re going to check all these other things, make sure postpartum depletion, and thyroid and all that is taken care of, but how do we help that woman who’s postpartum? Who’s baby is maybe colicky up all the time. She’s not getting enough sleep.

Dr. Carrasco:                      Her body hurts.

Dr. Maren:                          And just her body hurts and she’s exhausted. What adaptogen might you reach for?

Dr. Pratt:                              I mean, ashwagandha is still pretty good with that, and it helps with postpartum depression as well, it can. And it might be, it just depends on what? It depends on the individual.

Dr. Maren:                          Yeah. [crosstalk 00:32:01] Cortisol is doing?

Dr. Pratt:                              You got to be careful about stimulating if they’re not sleeping, right?

Dr. Maren:                          But sometimes-

Dr. Pratt:                              [crosstalk 00:32:09] the anxiety even worse. Some people take rhodiola and they’re like, “Whoa, that was too much.” But it’s the ginsengs that work more with those. There’s these certain chemical constituents that actually help, they’re called caracole, it means excitatory neurotransmitters. If they’re already [inaudible 00:32:32] plus plus, meaning they have mutations on both genes, they’re going to be more sensitive in your population to ginseng then say maybe some of these other adaptogens.

Dr. Maren:                          Yeah. It’s such a puzzle.

Dr. Carrasco:                      What about-

Dr. Pratt:                              It is a puzzle.

Dr. Carrasco:                      I mean, I think that’s where like your good old magnesium and vitamin C or just your good old strongholds. What about reishi? Mushrooms have become such a hot topic. [crosstalk 00:33:01].

Dr. Pratt:                              Reishi. I mean, these are not considered like traditional adaptogens. These are kind of new to the scene. Chaga, Shiitake, reishi but they have these same, reishi can do that same thing with catecholamines.

Dr. Carrasco:                      Same as the panax ginseng.

Dr. Pratt:                              A little bit, but they help blood sugar balance and they help how you break down your sugars, how you store it in your liver. And reishi is a different, they’re mushrooms, right, like Cordyceps. I might say Cordyceps would be a little bit more, I’d go to Cordyceps before reishi, because they’re also great antioxidants. They help glutathione production, which is your master antioxidant. I think of it like superman in your body.

Dr. Pratt:                              They decrease inflammation. So there’s a lot that these mushrooms have to offer as well, but it’s tricky. A lot of Christine’s patients have molds exposure. So some of them can’t tolerate even a little bit of mushroom. If you still have an immune system that’s kind of-

Dr. Carrasco:                      Depleted.

Dr. Pratt:                              Depleted and-

Dr. Maren:                          Confused about fungus.

Dr. Pratt:                              Confused-

Dr. Carrasco:                      Confused.

Dr. Pratt:                              … about fungus. But they are wonderful to use. And we are seeing them in lots of different ways show up in our natural grocery stores, coffee replacements and things like that.

Dr. Carrasco:                      What about… I’m sorry to interrupt.

Dr. Pratt:                              That’s okay.

Dr. Carrasco:                      What about adaptogens for hair loss? So in our population, of course you’re going to have a telogen effluvium postpartum, but it’s very distressing to a lot of women, especially the first time it happens. And then sometimes you can get into a chronic telogen effluvium pattern. Yes, there’s nutrients involved in thyroid, but I think there’s also a case you made for adaptogens to support, to decrease that shedding.

Dr. Pratt:                              Well, let’s also just have a moment where cortisol is one of the hormones in the whole web of hormones that all influence each other. So a lot of times when I talk to my patients, I like you to have this visual picture of a spider web. And if you have your ovaries and your sex hormones over here and you have your blood, your cortisol and your adrenal hormones here, and you have your blood sugar hormones up here, and you have your neurotransmitters, which are all influenced. They’re all pulling off of each other. And so postpartum is a time that so many, so much of your endocrine system is kind of trying to find equilibrium again.

Dr. Pratt:                              So by supporting the adrenals, a lot of times you’ll support all the other endocrine systems, and these adaptogens can do that. So again, coming back to a holy basil or ashwagandha some of these, they can help support the adrenals, but it’s kind of in the best case scenario, you go and you have a practitioner that knows where your cortisol was at before you got pregnant. That kind of gives you an idea of where you are after, and postpartum. That gives you a key on is happening with that hair, right? But by supporting the adrenals, you’re supporting the thyroid too, which is going to help with hair loss as well as blood sugar, which helps with hair loss and your neurochemistry.

Dr. Carrasco:                      There was a Harvard Study that came out last year on mice. I don’t know if you saw it, but it was like, they basically took out the adrenal glands of the mice and then, and they were bald. They had made them lose all their hair, they took out the adrenal glands and then they wouldn’t stop growing hair.

Dr. Pratt:                              Wow.

Dr. Maren:                          Interesting.

Dr. Carrasco:                      And so-

Dr. Maren:                          So there was some mechanism.

Dr. Carrasco:                      So just making sure on how cortisol really plays a big role with hair growth and it’s actually found in the follicle as well.

Dr. Pratt:                              Right. Well, [crosstalk 00:37:23] there’s more to endocrine system than just those glands, right. There’s a mitochondrial piece as well, which gets really complicated.

Dr. Carrasco:                      It’s also so complex.

Dr. Pratt:                              And that’s what the beauty of medicine is we learn more every year.

Dr. Carrasco:                      Absolutely.

Dr. Maren:                          Yeah. The [morino 00:37:43] are the less.

Dr. Carrasco:                      Totally.

Dr. Maren:                          I thought you all know that [crosstalk 00:37:45].

Dr. Carrasco:                      Yeah. My husband and I were talking about the other day, we were like, the more we know, the less we know. We should know-

Dr. Maren:                          Because your- [Crosstalk 00:37:52]. Yeah, I don’t think she knows this about you, but Alex’s husband is a dermatologist. So does he have any, like have you guys found anything about certain adaptogens around hair loss and telogen effluvium?

Dr. Carrasco:                      I think that what I’ve seen from the kind of more mainstream during communities that they’re all, many are embracing the neutrophil products and they have an adaptogenic plan. And I think ashwagandha is one of the Mainstays Essential kind of trademark brand, and so they’re seeing… With micronutrient repletion and with adaptogens, a lot of people are getting some response.

Dr. Pratt:                              Well, sure, adaptogens can work a lot better if you have the B vitamins and the minerals, like magnesium is a huge one, which are diets. Unfortunately, even in the best organic food, our magnesium is just not there anymore in those dark leafy green vegetables. So taking magnesium is often times essential to getting these adaptogens to work the way we want them to as well.

Dr. Maren:                          Yeah. That’s interesting. Any other kind of favorite adaptogens that you like to use in your practice a lot?

Dr. Pratt:                              Well, I also like licorice if they don’t have hypertension. Of course, if you have high blood pressure, you cannot use licorice, but licorice has-

Dr. Maren:                          Is ginseng in that same category?

Dr. Pratt:                              Ginseng was it in the same category as like-

Dr. Maren:                          Meaning like if you have hypertension, you want to kind of avoid it.

Dr. Pratt:                              Ginseng doesn’t have the direct effect like licorice does, but I’d say work with a doctor if you have high blood pressure with taking any herbs, like you really should be seeing somebody. But some of my favorite, I mean, it just depends on the person, but eleuthero. I love-

Dr. Maren:                          Yeah. So tell us, who do you give eleuthero to?

Dr. Pratt:                              I give eleuthero to kind of the person that just has chronic stress and needs, just that little bit, I’ll just give eleuthero by itself to somebody that needs just that hammock for their nervous system and their endocrine system to kind of just fall into if they’ve just been under chronic stress for a long time. And I may add in, like we talked about just depending on the person, I may create a tincture that has some rhodiola in it to go with that. And if they want really good mental and cognitive support, I may give a little bit of that panax ginseng too.

Dr. Pratt:                              But the people that come into my practice that are just but exhausted but wired, meaning they just can’t put things down. They’re up in the middle of the night. They can’t stop their brain from kind of circling, that would be somebody that needs to manage cortisol for sure. I try to get them on those lifestyle pieces. I try to manage cortisol with something like holy basil and I may add in ashwagandha and magnesium, magnesium is so important. If you’re not breastfeeding, you can also do [elthioning 00:41:13] which, that’s not an adaptogen, that’s just a part of a green tea extract that helps bring down glutamate.

Dr. Pratt:                              That’s the mechanism of action of elthioning. So that can also help kind of manage this overthinking where your brain won’t stop. But I think those are kind of my go-to’s, there’s eleuthero is one of my favorites in rhodiola. I use a lot of awshagandha and I try to use holy basil in my population, especially that’s nursing.

Dr. Maren:                          Yeah. Awesome. I love that. And let’s just quickly address pregnancy. I think we’re all on the same page with that, but what do we have to say about pregnancy and adaptogens?

Dr. Pratt:                              So pregnancy is not, we just don’t have enough research and data to support that it’s safe. And so really, we don’t use adaptogens during pregnancy, we use lifestyle, right. We try to get you to meditate, lot of mindfulness, moderate exercise, diet, eating the things. Most people don’t know this, but oats avena is actually a nerve vine. So it can actually help you sleep a little bit better during pregnancy to take in and have a Bowl of oatmeal in the evening, just to also manage some of your stress, just to support the nervous system. So food, rest, lifestyle, mindfulness exercises, that’s where we go for pregnancy.

Dr. Maren:                          Yeah. We’re on the same page. I mean, both Alex and I work with a lot of women who are trying to conceive and a lot of times there’s a lot of stress. And so we have them on adaptogenic herbs. And I just tell them when you’re pregnant, just stop it. Like, you can take it until you have a positive pregnancy test, but once you have that positive pregnancy test, you should stop it. Like you said, it’s just not studied, but one thing I think both of us use a lot of is magnesium and vitamin C, when people are pregnant, because those are totally safe and will help in other ways as well.

Dr. Pratt:                              Yes.

Dr. Maren:                          Anything else to add on that, Alex?

Dr. Carrasco:                      No. Yeah, I think adaptogens are really useful postpartum, but I agree.

Dr. Maren:                          Yeah, totally. They’re so great postpartum. I mean, I feel like that’s the other thing I always tee people up for, is like after you have your baby, you’re going to start an adaptogen because I promise you, it just is like if we go back to that sleep piece, I mean, if you’re a mom, especially if you’re a new mom, we know you’re not going to have great sleep and that’s okay, as long as it’s a short-term problem, kind of like stress, we can handle that stuff when it’s short-term. It’s when it becomes a long-term chronic issue that we have problems, and it depends on how much we can tolerate in our threshold for things like that. But definitely have that ready in your postpartum arsenal and start it up.

Dr. Pratt:                              And the other cool part is that these adaptogens, you can work with your doctor even if you are on medications to take these with them. They don’t influence directly certain neurotransmitters, which-

Dr. Maren:                          Oh, some people [crosstalk 00:44:28].

Dr. Pratt:                              … some other herbs are-

Dr. Maren:                          An antidepressant or something like that.

Dr. Pratt:                              Yes.

Dr. Maren:                          Yeah, totally. Yeah, that’s a great point because there are a lot of other sorts of supplements that we wouldn’t use for some people who are on Zoloft, or effects, or any of those kind of psychiatric kind of meds to support depression and anxiety, like 5 HCP and a lot of those others that just aren’t super safe.

Dr. Pratt:                              But I will put in a note about just being cautious, if you have bipolar with some of these adaptogenic herbs. If you overstimulate your cortisol, that can throw your bipolar. I’ve only had that happen once in my practice with using pretty stimulating adaptogens. It’s just something to keep in mind.

Dr. Maren:                          Yeah. I think it seems like a good thing to start on its own. And sometimes I kind of steer away from the blends at this point, not always, but sometimes just because it’s hard to know like what maybe you reacted to. And so maybe just using ashwagandha, I mean, that’s not a hard [inaudible 00:45:31], there are a lot of times when I’ll do a blend, but I do sometimes just appreciate, like let’s just try some ashwagandha to see how you feel. Rhodiola is the one where I have seen a couple people who have worsening anxiety, and I think I actually had some sleep disturbance with rhodiola.

Dr. Pratt:                              What’s interesting is one of the criteria to meet an adaptogen is that it doesn’t disrupt your sleep.

Dr. Maren:                          Totally.

Dr. Pratt:                              But everybody’s an individual and we all have these genetic variations. And I think some people are more sensitive to some of these herbs than others. And so if you didn’t do well with rhodiola, you might do fine with eleuthero, right. So it’s finding what’s right, individually for each person.

Dr. Maren:                          Yeah, for sure. Well, awesome. Thank you so much for your wisdom. Can you tell patients, or I’m sorry, listeners rather where they might find you?

Dr. Pratt:                              So my website is theprattclinics with an S .com or you can find me on Facebook @theprattclinics or on Instagram @theprattclinics. So those are the easiest ways to go find me on the Ether Web.

Dr. Maren:                          On the World Wide Web.

Dr. Carrasco:                      On The interwebs.

Dr. Pratt:                              Yes.

Dr. Maren:                          Awesome. Well, thank you so much. Hopefully we’ll see each other very soon for a coffee date.

Alejandra Carrasco M.D. and Christine Maren D.O.

Hello! We are Alejandra Carrasco M.D. and Christine Maren D.O. We founded Hey Mami because we felt a lack of support for fellow mamis. As physicians, we see women every day who struggle with fertility, are forgotten about postpartum, and have put their health on hold for years while they raise a family. We’re here to change that.

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