Ep. 216 The Science Behind Stress and How to Create Sustainable Change with Dr. Doni Wilson

Your trusted source for nutrition, wellness, and mindset for thriving health.

I am excited to have Dr. Doni Wilson back on the show today! She was with me once before in episode 142. Dr. Doni is a naturopathic doctor, certified professional midwife, and the bestselling author of Master Your Stress Reset Your Health. She has been in practice for the last twenty-two years.

Most people think that stress is all bad. However, it only becomes an issue when chronic, long-term, or debilitating. There are many benefits to having the right amount of stress at the right time.

In this episode, Dr. Doni and I take a deep dive into the role of stress and the impact of the stress response, including heart rate variability, the autonomic nervous system, and the role of the vagus nerve. We talk about what happens to our bodies with chronic exposure to stress- specifically around digestion, hormonal imbalances, neurotransmitter changes, and immune response. We discuss the impact of adverse childhood events and trauma, different types of stress, and recovery protocols. We also discuss measuring neurotransmitters and urine and speak about self-compassion and love- especially when dealing with stressful events.

I hope you enjoy today’s conversation! Stay tuned for more!


  • Dr. Doni defines the role of stress and talks about our built-in stress response system.
  • Some people are in a constant state of stress, so their stress-response system never turns off.
  • What does heart-rate variability represent?
  • The parasympathetic system is run mostly by the vagus nerve. Dr. Doni explains what the vagus nerve does in the body.
  • Constant stress causes overstimulation. That results in people not having enough time in the parasympathetic state, and that can cause chronic health issues.
  • The impact stress has on hormones and neurotransmitters.
  • The importance of testing hormone levels.
  •  Why can blood work appear normal, even when we are stressed or anxious?
  • When stressful things happen in middle age, it can overtax the adrenal glands and cause issues. Dr. Doni talks about the importance of testing adrenal levels when recovering from adrenal distress.
  • Dr. Doni explains what motivated her to write Master Your Stress Reset Your Health.
  • Why do adrenal and cortisol issues need to be addressed differently depending on the patterns?
  • The areas in the body that tend to be most affected by chronic stress.
  • Childhood stress and trauma can impact your long-term health and even affect future generations. Dr. Doni has created a system to address that.
  • Dr. Doni describes the different stress types and talks about the most common stress types she sees in women.
  • Dr. Doni says prioritizing self-care is vital for stress recovery.

“We have a built-in stress-response system that is meant to protect us.”

– Dr. Doni Wilson

Connect with Dr. Doni Wilson

On her website

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Connect with Cynthia Thurlow

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Check out Cynthia’s website


Presenter: This is Everyday Wellness, a podcast dedicated to helping you achieve your health, and wellness goals, and provide practical strategies that you can use in your real life. And now, here’s your host, Nurse Practitioner Cynthia Thurlow.

Cynthia: Today, I’m delighted and excited to have Dr. Doni Wilson. She’s a naturopathic doctor, certified professional midwife, I didn’t know that, and certified nutritional specialist. She graduated from Bastyr University in 2000, and she believes it is possible to be healthy even when we are stressed and we are in unprecedented times. She helps patients reverse challenging health conditions including fatigue, anxiety, autoimmunity, fertility, insomnia, as well as HPV and abnormal Pap smears, and we’ll talk about that later. She is frequently called upon to discuss her approach in the media as well as both public and professional events. She writes a blog. You can find at drdoni.com and her podcast which I have been grateful to been a part of is called How Humans Heal. So wonderful to connect with you this afternoon.

Dr. Doni: Oh, likewise, it is such an honor to be here. Thank you, Cynthia.

Cynthia: Absolutely. It was interesting, well, we follow one another on Instagram and there was a post you had up one day and I was like, “I have to get you on the podcast.” There’s so much that you’re talking about that is so incredibly relevant. But how did you get from undergrad, the decision to go to naturopathic medicine route as opposed to a more traditional allopathic medicine route? What was the impetus for making that shift?

Dr. Doni: I look back at that time in my life and I feel like, I’m so glad that I trusted my gut. So, to speak, I was doing a premed degree, completed a premed degree. So, I was heading that direction in my life and I decided one day, I’m so interested in nutrition. Maybe, I’ll take a nutrition course. So, I fell in love with nutrition and ended up also doing a degree in nutrition. I’m in my senior year of college, and I’m applying to medical schools, and I’m sitting there talking to my friends, and I’m thinking, “Is there a medical school that includes nutrition?” Because that’s what I was studying and that’s what I was passionate about. 

A friend said, “Well, there’s naturopathic medical school,” which I had never heard of, even though, I lived within 100 miles of two different naturopathic medical schools but I had never heard of it. This is way back before Google. So, I said, “Oh, that sounds interesting,” and ended up getting in my car and driving to the naturopathic medical school that that friend told me about, and I walked in and they said, “How are you? What are you looking for?” I’m like, “I’m looking for a medical school where I can also study nutrition or food as medicine.” They’re like, “Well, you’re in the right place.” [laughs] 

So, now, looking back, it seems so obvious, but at the time, I felt like I was discovering this perfect solution for what I was coming up with in my mind, which is that food, and nutrients, and healing is possible, and I wanted to be able to support people with that. I was also in my premed studies was doing a lot of interning with OB-GYNs. I was very interested in women’s health, and one of the doctors that I interned with introduced me to midwives. So, that’s what just opened up this whole world to me of not only food as medicine, but there’s a different way to approach women’s health that’s more in line with what we call midwifery. So, that’s how I got there. And then, once I found it, I’m like, “I just knew this is what I was passionate about and what I wanted to do.” 

Cynthia: Well, and I think being an advanced practice nurse myself, the midwives that I have had the opportunity to interact with over the years, I always say, it’s such a beautiful process when you can really, intrinsically hone in on the way our bodies work, and we’re not as focused on the pharmaceutical piece, although obviously very important. When you’re acutely ill or there are surgeries that are needed, but for so many of the well women care that we are going through or dealing with, I’m in a stage of life where I’m done having babies and my nurse midwife always talks about the fact that, she loves the fact that she can really just support women and support hormones in an entirely different way.

Now, I want to make sure that we really touch on it. One of the reasons I wanted to have you on is really talking about the role of stress. As I mentioned, when I was interviewing you, we’re in unprecedented times, none of us have ever lived through a pandemic. What is the impact of stress on our bodies? Obviously, there is perceived stress, which for most of us we’ve had more stress than last year. How do you actually define stress and how do we mitigate the stress that we deal with acutely versus chronically? Because there’s no one listening that doesn’t have stress in their daily lives. It’s all how we react to it that has a large impact on how we respond.

Dr. Doni: Well, and actually, my interest in stress goes back to when I was studying to be a midwife. I also studied to be a doula. In that process, I decided to research how stress affects women in labor, specifically, women who have a history of abuse going through labor. Because there’s a high percentage of women who have fear of labor, let alone stress in labor. What we know from the studies then, and this was over 20 years ago, when I was researching this, is that for labor to happen efficiently and effectively, we need a certain amount of stress, we need a certain amount of stress hormones, cortisol and adrenaline in order for our bodies to get a baby out in labor. At the same time, if we have too much stress and not enough support in labor, it brings labor to a halt. So, really, if we look at labor as a normal natural process that our bodies go through and can do, it also requires that we have a certain amount of stress hormones, but not too much, and have enough support, and it’s about how we are in that process, that determines how well it proceeds and how the process goes.

So, when I then graduated, I was growing up and I was in [unintelligible [00:06:23] Medical School in Seattle in the Pacific Northwest, and when I graduated and finished my residency, I moved to the tri-state area, which happened to be right after 911, a very, very other very stressful time. So, I decided, “Hey, what I learned from women in labor, can I apply that to other people who are going through stressful situations and help them through it by helping them optimize their stress response?” Knowing that we can eliminate or avoid all stressors in our lives, stress is going to happen, but how do we support our bodies through stress so that we can maintain our health? So, I’ve been researching stress ever since and helping patients with it ever since. 

I’m so glad you’re asking about it and that’s what I’ve also written a lot about in my books, and my blogs, and so on. Because I think that as you’re asking, “What is first of all the definition of stress?” Because a lot of times when we talk about it, we think of psycho-emotional stresses, which is I definitely with this pandemic, that’s been an example of just psycho emotionally how do we deal with this much change and this many unknowns and this much fear? How do we deal with it on that psycho-emotional level? But there’re also stresses in the forms of, I would consider lack of sleep as stress for example or certain foods that can be a stress. Say sugar, too much sugar for example. We know it can be a stress on our immune system and toxins we’re exposed to, pesticides. 

We can look at research and we can look at our health and case studies and see that there’s certain things we’re exposed to on a physical level, even physical injury, or too much exercise. We know it can be a stress. So, it becomes again all about what we call this homeostasis, which I know you talk about a lot. Like, how do we maintain that homeostatic place where we know we’re going to have some stress. We might even purposely expose ourselves to small amounts of what we call stress, but as long as it’s within this zone, where our bodies can respond and recover effectively, that’s okay. It’s when things tip too far outside of that range. That’s when we start to see the negative effects of stress on our bodies and our health.

Cynthia: And I think it’s really important. I talk a lot about hormesis, hormetic stress as you’re talking about, and it’s the right amount of stress in the proper amounts that as you mentioned, it’s like Goldilocks. Not too little, not too much, stresses our body, makes us adapt and actually makes us stronger. Whether or not that is high intensity interval training, intermittent fasting, certain specific types of foods, obviously, avoiding the really inflammatory ones, getting good quality sleep, cold exposure. Any of us on the East Coast that thought we were heading earlier into spring we got a little bit of a surprise this morning with colder weather. So, all of those things in the right amounts can make us stronger. 

But what happens cumulatively over time, if we’re not dealing with stress over time and certainly if you were in the tri-state area post 9/11 you were in the thick of things. I’m sure you saw a lot of sequelae, a lot of complications related to what people experience. So, what happens in our bodies when we’ve had too much stress for too long a period of time, especially, in women? I feel like it goes without saying, it’s not to suggest that men aren’t susceptible to stress but women, our hormones are a little more delicate, we fluctuate throughout our menstrual cycle, and so, I kind of feel like women are in their own little special entity as I know you write a blog about quite a bit. 

Dr. Doni: Mm-hmm. Well, here’s the thing is, so when we ask what happens when we’re under stress all the time or too much outside of that zone of optimal? The way I tend to break it down is to first think about our stress response. So, our brain kind of has this constant, I call it like a stress radar system. Our brain is constantly picking up on stresses. Anything that our brain perceives as a stress, it’s going to send this stress signal. So, from the amygdala, it’s going to trigger the first of all what we call the autonomic nervous system, specifically, the sympathetic nervous system is where we get adrenaline happening. So, most people, you think of adrenaline, you think of heart racing, and sweating, and mind racing. If you’ve had a panic attack that feeling of like, your body’s going to try to help you survive the stress. And it does that from triggering the sympathetic nervous system. 

Now, the other part of the autonomic nervous system is called the parasympathetic nervous system, which is the opposite, the calming, what we call rest and digest version of our nervous system. So, you’ll hear about the sympathetic and we can look at what we’re really doing when we’re helping our bodies manage stress is, we’re helping to maintain an optimum balance of, yes, being able to respond with the sympathetic nervous system when necessary, but also being able to use our parasympathetic nervous system so that our body can do all of the activities it needs to do through at that time under rest and digest. So, there’s that part of it. But there’s also the other part of our stress response which is what we tend to call the HPA axis, which is when the hypothalamus and pituitary trigger the adrenal glands. Now, the adrenal glands are above our kidneys and they make a bunch of different hormones, but they make cortisol and also adrenaline.

So, now, we have this cortisol and adrenaline response. I think people often are hearing about cortisol. Most times when people say, when they recognize that they’re feeling stressed, often, they assume that they have high cortisol. Certainly, that’s what happens when we have, say the alarm goes off and you feel your body having a stress response. In that moment, your body is going to try to put out more cortisol because the cortisol is going to help get some glucose to your blood, and get your brain making decisions quickly, and getting your muscles to respond. So, the cortisol is going to help you respond to stress. The problem is when we’re under a constant stress signal, now, we have constant adrenaline and constant cortisol signaling, and see, normally, there’s a feedback mechanism to our brain. So, when the stress is done, it’s going to turn off these stress responses. But if we’re constantly triggering stress, then, the off switch stops working. It’s like our brain just keeps on triggering a stress response. 

So, sometimes, you’ll feel stressed even if you’re like sitting on your couch and you’re like, “I have no reason to be stressed.” But it’s because the nervous system is so used to being stressed, it keeps triggering it. That’s when things are getting outside of the zone. You’re not getting your sort of the anti-stress. You’re not getting some downtime. It’s a constant stress response. What I found and this is through my research and working with thousands of patients for over 20 years is that, it’s unique to each person what happens next. It’s not necessarily the same thing for everyone. In fact, I’ve outlined five different what I call stress types, which are different versions of what happens to you when you’re in a constant stress situation versus another person. Whether it has to do with some of your genetics, like there’s some genetic influence to this, how each person’s adrenaline and cortisol responds under stress. There’s also influence from earlier in your life, past exposures to stress, including exposures to stress in childhood and in the womb, and there’s even studies relating to stress exposure in generations prior to you. 

So, there’re all these variables that influence how I’m going to run respond to stress in this moment. So, that’s what I get really interested in helping my patients with. Because if a person comes to me and says, “I’m experiencing fatigue, or anxiety, or sleep issues,” let’s say, I’m very interested in what is their stress response, where did they get stuck, what is their stress mode look like? Are they stuck with high cortisol, are they stuck with high adrenaline or both, is their cortisol high, but the adrenaline’s low? Like, what’s happening there where there’s dysregulation in the sympathetic and the HPA axis? Because once I know where the dysregulation or imbalance is, then I can help that person rebalance it. I think that’s an important thing for people to really hear and understand is that it’s possible to help our body and our brain recover from stress. It’s not that it’s a done deal stuck that way. It’s just stuck that way for now and once we identify it then we can help our bodies recover them.

Cynthia: I love that you had to say and really focusing in on bio individuality that each one of us, if you took 10 women of a certain age and you put everyone together, there may be more people who can handle more stress or less stress and it could be things that are beyond our control. The genetics aspect, whether or not genes get turned on or off, or SNPs, these little snips has so much to do with our interaction with our environment. I was reading a book by David Sinclair that I’m sure you have already read, and he was saying that 80% of the way we age has to do with how we live our lives, that it’s not just written in stone per se that a baby is birthed and things are going to work out a particular way because that’s just the way things are. It’s 80% how we live our lives is how we age. I would imagine that the stress response is very aligned with that. 

Now, I want to just backtrack and I find the autonomic nervous system really, really fascinating. So, I’m being chased by a saber-toothed tiger, which is a sympathetic response. There’s the rest and repose, which is ideally the side of your autonomic nervous system you want to be in if you’re trying to digest food, relax, defecate, etc. What I find really interesting and I think particularly for women that are probably north of 35 or 40 is that, it’s really critically important as we get older that we are really managing and mitigating our stress. Because as one example, as I’m in the midst of writing my book, we have like I think it’s four times the amount of cortisol receptors in our bellies. So, when people say to me like, “Why am I gaining all this abdominal fat?” I’m like, “Oh, it’s because you’re stressed.” It’s because you have more receptors in your abdominal area and I think when people just start to realize like that’s a physical manifestation of something that’s going on internally. 

Like, your body doesn’t differentiate between being chased by a rabid animal as opposed to being frustrated because let’s insert anything that’s happened over the past year, you can’t go to a party, you’re not able to get on a plane and go wherever you want to, you have to wear a mask everywhere you go, your body doesn’t differentiate. So, it’s really, really important to understand how important it is to do everything you can to find balance. I know balance can be elusive, but balancing that sympathetic and most of us are sympathetic dominant, because we’re go, go, go, go, go all the time with that rest and repose side of our bodies. So, what are some of the ways that you like to suggest to your patients for how to get out of that fight or flight, that sympathetic dominant mode because I’m sure anyone that’s listening as I keep alluding to, we’ve had an unprecedented last year, things probably haven’t gone the way that we wanted them to ideally. So, what are some of the things that are best practices for you with your patients? 

Dr. Doni: Oh, it’s such a good question and again, I really believe that the more people understand this whole stress response and the point you made about epigenetics, which is that we have this ability to even reset our genetic expression based on helping our bodies. Usually, the terminology I’ll say is recover from stress or re-balance, re-optimize our stress response. So, knowing that it can motivate you to go, “Okay, what do I need to do here to help my body rebalance my stress response?” Interesting, because you’re mentioning like some of the ways that the pandemic is stressful, it’s so interesting to me speaking with patients now that it’s been this long into it that there’s actually some people who found during the pandemic, things that helped them that they would have probably chosen before. 

Like, prior to a year ago people were probably like, “Yeah, I wish someone would tell me to stay at home for a week. [laughs] I wish someone would tell me that I can’t go to a party,” because sometimes there’s a lot of obligation related to that. A lot of our stress was from commuting, on going to events that we didn’t really want to go to. So, it’s interesting to me to also see how that has shifted. But it has also given this opportunity, we’re more at home and we get to create our own schedule now. We can go and I encourage people to create a self-care schedule. So, now, that you’re maybe looking at your life again and saying, “Hey, how can I create a self-care schedule and structure?” That’s going to make a huge difference on your sympathetic-parasympathetic balance and your HPA axis. What I mean by self-care schedule would be, what are you doing from the minute you wake up in the morning instead of going straight to looking at your phone and checking messages? What if you start off with a meditation, or journaling, or gratitude session? What If you then get to spend some time like taking care of yourself and whatever that looks like in your schedule? Maybe that means for some people, that’s when they’re going to do their cold exposure, or that’s when they’re going to do, set their schedule for the day. 

But now, you have a different frame where you’re looking at your day from a perspective of, what’s going to be the best way of managing my health? Maybe I want to change my eating window, maybe I want to make sure I have the right foods available for me, do I need to go shopping? What am I going to do to set myself up in the evening so that I can get my best sleep? So, by the time you’re really taking care of your– when I talk about care, I think of clean eating, setting up your diet, adequate sleep, stress recovery techniques, some that I mentioned like meditation and so on, we can talk about more, and ‘E’ for exercise. So, when you can set up your daily routine to make space for those things is going to really help you to manage and master your stress in the long term.

Cynthia: No, I think that it’s really critically important and I always say, I prefer to look at the past year as what are the gifts that we learned, and as someone that is up until five years ago was in the hospital rounding early and clinic rounding early, the very first business coach I had when I transitioned to being an entrepreneur used to say to me, “Cynthia, put nothing on your schedule before 11 AM.” Now, coming from a traditional allopathic medicine background, I was used to being in the hospital early 6:30, 7:00, 7:30, 8:00 AM, and the first year or two, I was an entrepreneur. I still was packing my schedule like that and it finally dawned on me. Finally, after four years to being an entrepreneur took me that long to figure this out. I was like, “Oh, I can be my best for my clients, for my patients, for all my business relationships.” 

So, I don’t put anything on my schedule unless I have to before 11 AM. I’ve come to find out that has made my life so much better. Like, I’m not yelling at my kids, [laughs] not yelling at my husband or the dogs. I can get up, exercise, take care of myself, meditate, maybe, I break my fast right before 11 AM and I have the opportunity to eat. I encourage other people to, if you’re listening, what are things you can do in your days that you don’t feel like you are full speed ahead from the moment you get out of bed? One of the things that I’ve come to find out, social media is a blessing and a curse. A blessing because it allows you to be connected with your community and hopefully, a lot of really interesting individuals with similar backgrounds or people maybe that you get to learn from. But also, detrimental because we feel the sense of obligation to always be connected. So, I made a very purposeful decision this year that I was going to cut my social media time in half. I’ve come to find out I’m far more productive when I’m not focused on getting up in the morning and looking at Facebook, and Twitter, and Instagram, and whatever else I’ve gotten notifications for. So, I love that you are encouraging people to really invest in themselves, because investing with into yourself first is really important. 

Now, I know there are probably people listening who have younger children, I have teenagers, I know that I believe your children are a little bit closer in age to mine. But I know when you are caught up in the yumminess of having infants, and toddlers, and they’re very dependent on you, and then, you get the ability in the evenings, maybe, the evening timeframe is when you can reinvest in yourself, read a book, etc. But making sure you’re carving out time every day to get yourself out of that fight or flight mode, I feel like meditation was something that took quite a bit of effort to get interested in. I kept saying, “Oh, I can’t like quiet my mind.” I found a device that I wear when I meditate and it has been life altering. I tell people everyone has time for three minutes to meditate. I started with three minutes every day for a month, and then, went to five, and then, went to 10 minutes. Now my husband meditating, too, I’m sure he probably would be stunned if he knew I shared that. But I really think it puts us in the best frame of mind to get out of that fight or flight response.

Dr. Doni: Oh, it’s so true. There’s a lot of research. I mean, meditation itself has so many studies showing the benefits. So, even though, it’s essentially, you’re doing nothing, you’re basically saying, “Okay, I’m going to do nothing for three minutes, or 10 minutes, or an hour, and at first,” it feels really wrong. Because we’re so used to this message that we’re supposed to be super-efficient, we’re supposed to get something done every minute. So, it feels like, “What do you mean, I’m supposed to do nothing?” I don’t know how to do that. So, it’s a really good, I love how you’re saying to start with a small amount of time because first three minutes is going to feel like all long. [laughs] We’re just sitting and being in the nothingness. And yet, there’s the studies we can argue with are so showing us that allowing ourselves that nothing this time actually helps our brains recover and heal from all that stress, what we call neuroplasticity, which is developing new neural pathways. 

It’s also helping to correct this cortisol and adrenaline that we talked about getting out of balance, and it’s interesting to me, see, because I’m looking at both high and low cortisol and adrenaline. So, I’m always looking for studies that can show me that it’s good for people who have high cortisol and people who have low cortisol. It’s going to bring it to optimal. It’s so amazing how our bodies know where that optimal middle range is and when we choose activities like meditation that can actually help our bodies, give our bodies the space to find that middle perfect zone again. So, whether you are high cortisol or low cortisol, or high adrenaline or low adrenaline, it is going to help you come back to optimal. By practicing it on a regular basis, that you give your body that chance to keep coming back to center. So, you can think of it that way, just letting yourself recenter and actually what we end up seeing is that, you end up becoming more productive because we falsely think that we have to keep– we can work all day, and we end up not taking care of ourselves that whole time, we can focus, focus, focus. But actually, if you take breaks even little one three-minute breaks to take a couple of deep breaths, it actually helps us to become more productive when we go back to focusing and working. 

So, just knowing that, I feel like the more we can understand our human physiology and understand the need for stress recovery and find ways to integrate it because it’s not the same for everyone. You want to really just take it on with curiosity and play with it like you did. Like, let me just try it out a little bit and see what works best for one person is going to be different for another person. Maybe, even with meditation, there’s sitting meditation, there’s laying down meditation, there’s walking meditation, there’s standing meditation, so you don’t have to be in any particular posture. You can really individualize even meditation.

Cynthia: Inevitably, someone will ask, what device it is that I wear when I meditate? It’s called Muse, M-U-S-E. I have no affiliation with them. I just really believe in the product and recommend it to my clients, when they tell me they can’t get into the right frame of mind and I said, “This will actually tell you if you’re in the right frame of mind while you’re meditating,” and it can be a really powerful way. But I love that you’re suggesting that, you don’t have to just sit cross legged in a quiet room. There’re so many different ways that you can practice those. Now, do you have specific adaptogenic herbs or supplements that you like to use with your patients, whether their stress response is like overactive or underactive? 

I know that, this is a question I get asked quite a bit and I definitely have adaptogens. In fact, I’m always experimenting with different protein powders because people always ask me lots of questions about nutrition. So, I just purchased a new ashwagandha powder, which is one of the adaptogens that can be both stimulating and calming depending on how you’re using it. So, I use some in a shake this morning just to experiment with it because ashwagandha powder can actually be a little bit bitter. I think people find that surprising. So, start small. Don’t put a tablespoon in a shake. You might not be able to get through it. But what are some of your favorites to use?

Dr. Doni: Well, and what I like to do first of all is, I’ve developed an assessment by the way to help understand your stress type. To be able to understand, you have a high or low cortisol, high or low adrenaline, and then, whenever possible I encourage you to actually measure your levels. Because these levels can be tested in urine– Cortisol, you can measure in urine or saliva at different times a day. Because you might have too high cortisol in the morning and too low at a different time of day. So, you want to measure morning, midday, evening, and bedtime. So, you’re dosing your adaptogen, the right adaptogen at the right time of day. And same with the adrenaline. You want to see, is it too low, is it too high? Because we’re going to use different treatments. Well, if it’s too high versus if it’s too low. 

So, first of all, I like to first know, what is your stress type, what is your body doing under stress? So that we can really more specify the treatments. This is what I write about in my newest book, too by the way, so I’m so excited about it. So, from there we can look at the studies and we can go, “Okay” Like, ashwagandha that you mentioned, ashwagandha is considered adaptogen. Now, for those who may not be familiar, adaptogen is a term that’s used to basically say, any substance that helps us bring, come back to this homeostatic middle balance point. The thing is that a lot of studies on ashwagandha show it’s really good at decreasing cortisol when it’s too high. So, I’m much more likely to recommend ashwagandha to someone who has cortisol that’s too high and then, for them to take it at the time of day when their cortisol is too high. So, if your cortisol is too high at night, it may not help much to take it in the morning. You want to take the ashwagandha, then, in the evening, when you want that effect to happen. 

I just like to clarify that because some people feel like, “Well, is it just like a temporary quick fix or something.” But I’d like to clarify that yes, while these adaptogenic herbs and different things we can do can help bring our cortisol and adrenaline back to more of an optimal level. My goal is always to fully help your body recover from stress. So, hopefully, your body is able to maintain those healthier levels over time. I’m usually using adaptogenic approaches as a part of a stress recovery program, and then, once you get back to optimal levels then we’re doing more of a maintenance plan to maintain that over time, even though, you’re going to be continually exposed to stress we want to– then, you’ll know, “Oh, if I had a really stressful day and I’m really wired at night, I probably need my ashwagandha to turn down my cortisol.” But other days, you might not need it. So, that’s the goal is to get to that point where you’re really able to respond to your body’s needs in the moment. But at first, there is usually a stress recovery process. We’re using these herbs and nutrients to get the body back to balance. 

Another example would be with adrenaline. If adrenaline is too high, it has to go through different metabolic processes to get out of our body. And again, there’s genetics that influence this like COMT, I’m thinking of is the enzyme and gene that influences that enzyme and pathway to metabolize adrenaline, or norepinephrine, and epinephrine. We know that magnesium is a nutrient that facilitates that process. So, if I see that on urine testing, a person has high adrenaline levels or even if they have symptoms of high adrenaline levels, then, using magnesium can help the body move that magnesium out, and it’s going to help them feel better. So, again, by understanding physiology and understanding the person’s body’s response to stress, we can give specific approaches to help.

Cynthia: Well, one of the things that I want to make sure we touch on because you’ve alluded to it is the whole circadian rhythm, because when you’re talking about monitoring the cortisol levels in the morning, midday, afternoon, and evening, that’s really what we’re looking for. So, when that circadian rhythm which is the secretion of cortisol, when that gets dysregulated, and it could just be just, “I’m super stressed, maybe I’m getting married, or I’m getting ready to have a baby.” It’s like it could be good beneficial stress. But you can get a dysregulation in that pattern. But I’d love for you to touch on that. 

One of the things that I want to make sure I mentioned, we’re talking about things that are very important for the body, especially, when we’re trying to mitigate stress, deal with stress is even connecting with nature, like, as easy as 10 or 15 minutes outside in the morning, it can be very beneficial for that circadian rhythm, our retinas will actually kind of take in that information, it’s very light and bright, I’m going to suppress melatonin, which is one of our sleep hormones, and I’m going to tell the body, “Okay, let’s get this cortisol going” because at the start of our day, we need plenty of energy, let’s get moving.

Dr. Doni: Absolutely. Like, I was mentioning care, the clean eating, adequate sleep, recovering from stress, and exercise, and in the recovering-from-stress category, there’re so many things we mentioned meditation but spending time in nature is huge. I love how you’re mentioning that it’s even what time of day we spend time in nature. Like, being able to, I guess, recognize that we’re human beings on earth, and part of the reason that we are able to survive and live on earth is because of the whole way that the earth is orbiting the sun, and the moon is orbiting the Earth. By recognizing that and going, “Oh, wait a minute, as a human being if I give my body these purposely, give my body the signals of light in the morning,” it’s going to signal a whole cascade of hormones that we want that are going to give us energy and help our bodies function. Then, at night, we want to signal darkness so we can turn on the melatonin that you’re mentioning. So, to just recognize that our bodies are so responsive to light exposure, to different sounds, and noise exposure, these are all potential actually, stress signals if we get thrown off. That’s why even when we have daylight savings time or change time zones it throws you off. You can feel right away like, we know from daylight saving times that people have more accidents, they have change in energy mood and it’s because that even in our shift in light exposure affects us.

So, we realize, “Oh, my gosh, I’m not a robot, I’m not a machine. I’m a human being that’s very responsive to my environment. If I’m intentional about my exposures in my environment that’s going to influence my health.” I also usually like to emphasize that how much cortisol affects all of our different body systems. The four main systems that we read about in the research is the digestion is definitely affected by cortisol, also all the hormones you alluded to that before too, how cortisol affects digestion and hormones, and also, cortisol affects our nervous system. So, all of our neurotransmitters, serotonin, and dopamine, and GABA, and so on. And also, cortisol affects our immune system. When you think about it, if we get thrown off of our circadian rhythm, either accidentally or on purpose, [giggles] we’re potentially affecting our digestion, our immune system, our hormones, and our nervous system. Some people might notice it in one area more than another. Like, some people might be like, “Oh, my heartburn is worse or I feel bloated, or another person it might be more in their immune system.” Maybe, when they’re stressed, they are more likely to catch a cold or get some other infection or autoimmunity flaring up. 

Some people have all four systems activating on there. Basically, I look at it, those are signals from your body telling you that it’s too stressed, it’s out of balance, and it starts sending signals or symptoms through these different systems in our bodies. So, that also means that, as we get back into our self-care routine with our circadian rhythm, and taking good care of ourselves, and giving our bodies what they need, then these systems sync back up again. Now, the digestion improves, the immune system, the nervous system, and the hormones, they can come back in line again. So, it means that we have a lot of control actually based on our choices. Sometimes that feels overwhelming because it’s like, “Oh, my gosh, where do I start?” But that’s where I think just having that awareness, and then, you can start down this path, you can start any day down this path of recognizing and paying more attention to what your body signals are, and what your body needs, and really, then, recalibrating along the way.

Cynthia: I think that’s really important, talking about the downward effects of what happens when there’s too much cortisol over a period of time. And I also like to talk to patients about the influence of blood sugar and how cortisol will make it much harder for you to maintain your blood sugar properly, it will make it harder for you to ensure that your insulin is working properly. So, you talk about the cortisol belly, we talk about a lot of these other side effects when cortisol is not properly regulated. Now, do you like to use the DUTCH, the dried urine and saliva test in your practice?

Dr. Doni: I do use the dried urine and saliva or dried urine test for cortisol levels, but also for estrogen progesterone, so, we can really see how those hormones are being affected. I also will sometimes check cortisol levels and saliva. Again, multiple times a day because you can do a blood test for cortisol, then, it’s only giving you that one moment in time that you had your blood drawn, which also might have been a stressful moment. [laughs] So, it’s better to really get as much information as we can. And then I measure epinephrine and norepinephrine or adrenaline in the urine as well as the other neurotransmitters. Serotonin, and dopamine, and GABA, we can measure in urine. So, we can really learn a lot about what these different signals are in your body. I always look at it because sometimes people feel afraid like, “Oh, my gosh, what am I going to find? But on the other hand, a lot of times, you’re not feeling well and you just want to understand what’s out of balance, because once we see what’s out of balance, then, we can help rebalance it. We can help– you mentioned insulin as a hormone that gets thrown off by cortisol.

Of course, again, it’s because the cortisol is trying to help us with stress. So, it’s trying to get sugar to our bloodstream. But if that’s happening constantly or especially, as you mentioned with women who are perimenopausal insulin function decreases, so that means if you combine lower insulin function and higher cortisol, you’re definitely going to end up with higher blood sugar levels, which then, what happens is when there’s a lot of glucose in the blood and it can’t get into our cells, the liver, the way I think about it is the liver then has to decide. The liver has only a few options. The liver can turn it into cortisol or triglycerides, so it can raise your cholesterol levels, or the liver can put it in fatty storage in the liver, what we call a fatty liver, or the liver can basically turn it into fat storage around your waist. You really don’t want any of those three. You don’t want your waist growing, you don’t want your cholesterol going up, and you don’t want your liver having fatty storage either. So, it becomes this impetus to say, “What do I have to do to manage my cortisol and optimize my insulin?” So, your liver never has to deal with too much glucose. 

Cynthia: It’s so very important, especially, as we see more and more metabolic diseases here in the United States and abroad, and I’m sure this past year– I’ll just keep saying it. This past year with unprecedented times, I think a lot of people jokingly, patients have called with COVID-19 but I always remind them, I’m like, “We can always work on taking this back off. We’re not going to embrace limiting beliefs. This is the way things are going to be forever.” But one of the things I want to touch on and I want to pivot just a little bit, when I was asking my social media following what kinds of questions they had for you, and they know that you’ve got this focus in HPV education and research. There was a lot of discussion about HPV. I think many of us think of it as a younger person’s issue. So, let’s talk about how this is not just a virus that impacts young people, it also impacts middle age people as well. So, in terms of the differences of virility, I don’t know if it’s any more virulent with age. You mentioned the cortisol, the stress response, the impact on the immune system, I’m presuming you can probably reactivate viruses that have been dormant in the body and HPV is probably no different.

Dr. Doni: One, I’m definitely seeing after this extremely stressful time with the pandemic that we’re seeing more and more positive HPV results coming back. So, I do think we’re seeing that stress turning on HPV. As you mentioned, there’re other viruses that can be activated also under stress like Epstein–Barr virus, and even herpes virus. So, if people are noticing, “Oh, my gosh, why all of a sudden am I having these other viral symptoms or situations coming up?” It’s because the stress is affecting your immune system and leaving you vulnerable. And that’s the way that I really have found best to think about HPV. I’ve been helping women with HPV for over 20 years. So, I’ve seen a lot of cases and I’ve learned from them. They really inspired me, these women, because they’ve come to me asking for help saying, “Hey, I have this positive HPV. Maybe, they also are having abnormal Pap smears.” They’re saying, “Listen, it’s not okay with me to just watch and wait.” Because a lot of times if you get a positive HPV on a Pap smear, oftentimes, doctors will say, “Well just come back in a year and see if anything abnormal has occurred.” 

But more women now are saying, “I’m not okay with just waiting to see if it causes abnormal cells or cancer. I want to do something about it.” I’m so happy that women are thinking that way and starting to ask those questions and say, “Hey, what can I do to help fend off this virus and prevent it from causing?” Because what we know is that, HPV is associated with cancers. Most often we hear about cervical cancer. So, cancer on the cervix, but it can also cause cancer in the vaginal tissue, it can also cause cancer for men, anal cancer, oral cancer, and penile cancer. So, this is a virus that can lead to abnormal cells, and then, makes us have to sit here and think, “Well, what can I do to prevent that from happening to me?” That’s what women are saying to me when they call me. “What can I do to prevent that virus from being able to cause cancer in my body?” 

There’s so much we can do. There really is and my patients have proven it over and over. So, now, yes, I’m very motivated to share more about it. Even to know that we say, HPV as if it’s one virus, but there’s actually over hundred different types of HPV. Some of them are known to cause genital warts. So, some people know of the virus that way. But that’s the thing is most times it doesn’t cause genital warts. Most times it actually doesn’t cause any symptoms. So, people don’t realize they even have the virus including men have no idea that they have the virus because most times they don’t have any symptoms. The only way we end up knowing that exists is when it’s tested with a Pap smear. Using the Pap smear is really just looking for the types of cells on the cervix to see if there’s any abnormality in the cells. Alongside the Pap smear, the doctor can order an HPV test. For many years that wasn’t even done all the time. You would get a Pap and you weren’t necessarily tested for HPV. But more recently, it’s the HPV test is being done, the CDC even recommends it for anyone over age 30. 

And around the world I’m hearing from women who are now being tested for HPV and finding out they have it. So, now, they have this piece of information and they’re like, “What do I do about this now?”  Because here’s the thing is that, 50% of people who are diagnosed with HPV, who find it on their Pap smear, 50% of them, it will go away and go to negative within eight months. So, if 50% of people it goes to negative in eight months, and 90% of people, it goes to negative within two years without doing anything. So, it’s a very common virus too, by the way. All of us are going to be exposed to HPV at some point in our lives. So, these are some of the myths. We would think, “Oh, this is a rare virus, oh, it’s only from being promiscuous or something.” A lot of women call me feeling very ashamed, and afraid, and not having enough information because it’s just these misconceptions about it. 

So, I really like to encourage people to know that it’s very common HPV, and it’s only tested in women, it’s not tested in men. And 90% of the time, your body will clear it on its own. So, you really want to be in the 90%. You want to be the 90% where it doesn’t cause an issue and it leaves you alone. The issue is the 10% of people where it doesn’t leave you alone. It does end up causing abnormal cells. That’s where, women are wanting to stay out of that 10% or once it does cause abnormal cells, what can we do to help the body get rid of those abnormal cells and get the cervix back to healthy?

Cynthia: It’s such helpful information because I know that when I trained in the university that was when the HPV vaccines were being developed and actually, my GYN, Connie Trimble, who is this revered respective gynecologist. She kept saying, “We’re making this vaccine so that women don’t die of cervical cancer.” Obviously, we reduce the transmission of this virus between same sex partners, opposite gender partners, etc. So, what’s been your experience when you’re looking at– My understanding is that, teenagers are older children, pre-teens are the ones that are usually being targeted for the vaccine so that they’re getting it before they become sexually active. Do you have any data on the efficacy of the vaccine or some of the concerns that go along with it?

Dr. Doni: Well, one thing I was like to really clarify is that the vaccine, the Gardasil vaccine, first of all, it was covering four of the types of HPV. And now it covers nine. So, that’s why they call it Gardasil 9. It is because it’s covering nine of the different types. Now, these are the types that tend to cause genital warts and are the higher risk for abnormal cells and cancer development. But it’s important to recognize that there’s hundreds of types of HPV. So, it doesn’t cover all of them. Just knowing that going in, because I hear from a lot of women who had the vaccine and still got HPV of a different type or even sometimes, one of the types that’s covered by the vaccine. So, it’s important to know that it’s a not 100%. It still means you still need to get a Pap smear, you still need to be monitoring for HPV because it’s not a complete solution. We’d like to be able to just have a vaccine and then, cross it off our list forever but it’s not the case, so it’s important to know that. It’s also important to know that there are some reported side effects to the vaccine. So, I always encourage people to really learn, and research, and read about especially this particular vaccine so that you’re aware of the risks of the vaccine. 

On the other side, as we’ve been talking about the risks of HPV, and then, you have to decide, “Okay, do I–” It’s tough when you’re a parent having to choose for your child. It’s always one of the hardest decisions as a parent to make because here we are making a choice that could influence our child’s health for the rest of their lives. I would say sit down and look at both sides. What are the risks with the virus exposure, which again most all of us are going to be exposed to this virus at some point in our lives versus the risks of the vaccine, and then deciding what you want to do and what you want to choose whether you have a daughter or a son? Because it is suggested for both men and women, for girls and boys. Again, I mean, men can have HPV virus and not know it and they can also get cancer from the virus at some point in their life, and then, they are in a situation of thinking, “Oh, my gosh, I wish I would have known I had this virus, I would have done something about it.” So, I hope that helps answer a vaccine question.

Cynthia: No, it definitely does. Some of the other questions I received about the vaccine in particular were, if I’ve recently been divorced, was monogamous for 20 plus years, is there value as a middle-aged person getting the vaccine? I didn’t see any specific research in that area, but I figured you would probably know.

Dr. Doni: Well, and this is the thing, it is a great question because the thing about HPV is that the virus can activate at any point. So even if you had been exposed to HPV, maybe, you were exposed to HPV 20 years ago, but you never knew it because it wasn’t showing on a test or maybe you weren’t tested. But 20 years later, it could activate. You mentioned middle-aged women. A lot of times, I speak to middle-aged women say, 55 or 60 years old, and they just now got a positive HPV test. And they’re thinking, “Well, was this a recent exposure? Were they in a new relationship or did somehow come from their partner?” Women can be very distraught trying to figure out, “How did I get exposed to this virus at this time in my life.” But what’s important to remember is that, that virus might have been in your body for 20 years and it’s only the stress you’ve been under recently that turned it on, that activated it. So, even if at that point in your life you decide to have a vaccine, you still don’t know whether that virus might already be in your system. So, you might have the vaccine, you might choose to do it just in case, but you still might have HPV activate. 

So, again, it’s not a failsafe solution. I encourage you to just think it through for yourself. I think a lot of it is– see from my perspective, I’ve been helping women who already got the virus and maybe had the abnormal Pap smear, and I’ve been helping them for over 20 years to reverse the abnormal Pap, and get the HPV to negative by the way. We’ve been able to actually get their follow-up Pap smears to show a negative HPV and that maintains over time. So, I’m coming from the perspective of someone who sees that we can address this virus and get it to negative, we can get the cells on the cervix to go to healthy using natural approaches and by the way, that includes the stress recovery. Because we know that HPV tends to activate when we’re under stress. It also activates when we’re exposed to things that are stressful to our bodies. Like, we know HPV is more likely to turn on when we on a birth control pill, which are synthetic hormones. We know it’s more likely when people are smoking, which it has toxin exposure. So, we know that toxins, chemicals, stress are what turn on the virus. If we can eliminate these stresses or help the body recover from stress, then, the body can fend off the virus. 

I’m coming from a perspective of empowerment. Like, I can see that we can protect ourselves from this virus and just having that information, I’m hoping that helps you then when you’re making that decision about do I get a vaccine or not to be able to realize, okay, if this virus does turn up for you or if you do catch some abnormal cells on your Pap smear, know that there’re things we can do, protocol we can follow to help prevent that from causing cancer. So, then that maybe weighs in with your decision making.

Cynthia: Yeah, that’s really helpful. I think for anyone that’s listening that’s not familiar with this virus or you’ve heard about the virus, but you’re not sure what the traditional approaches for many, many people, if they have significant enough HPV found on a Pap smear, they sometimes will go on for a colposcopy, which is when the gynecologist or the midwife will be looking with a– and to correct me if I’m wrong, if I’m not using the proper terminology. But looking with essentially like a microscope to you know, they’ll use acetic acid on the cervix to be looking to see if they can visualize any of these abnormal cells. If they see something of significance, they can actually go in and biopsy it. And then, from there make a decision if someone needs surgery or if they can just watch and wait. 

So, I love hearing that whether you get the vaccine or not, there are ways to address lifestyle, nutrition, stress management, etc., that can mitigate this developing into a full-blown problem. Are you in a position where you can share some of those strategies or is that proprietary? Out of utter curiosity, I just find this really interesting. Let the body heal itself is really the message that we’re sharing, a message of hope, and as you mentioned, empowerment, which I think will resonate with a lot of people.

Dr. Doni: Well, this is the thing, is you can find when you say you start searching. Because this is when women contacted me, they’ve usually started searching on their own and saying, “Hey, is there something I can do?” Which I think is a great question. You’ll find like even some simple things that we probably would already think of like vitamin C. We know vitamin C helps us fend off cold and flu viruses. Yes, it’s going to help you fend off HPV virus, too. So, we can look at nutrients, we know about even say mushroom extract is one that’s well established as helping the immune system to fend off viruses including HPV virus. The key thing is that there’re a lot of questions in terms of, well, what’s the right dose, what’s the right timeframe, how am I going to implement this? This is where, because I’ve worked with thousands of cases over so many years, I’ve been able to figure out, here’s the doses that are most effective for most people, and here’s the systematic way we can implement that in terms of supplements, in terms of dietary changes. 

I also see that food as medicine. So, you would kind of think, “Okay, we want to avoid inflammatory foods and avoid sugar.” But what I’ve been able to see is that, actually, there’s such a huge connection between leaky gut or intestinal permeability, and the things that cause leaky gut like, again, toxins and gluten. The more these things are causing leaky gut and the more leaky gut is present, it pre-disposes women to HPV activating and abnormal cells developing on the cervix. So, I really like to, again encourage people to take a bigger approach to it. Like, we need to help your body get as healthy as can be. Get your digestion recovered, get your hormones balanced, get your nervous system and your immune system optimized. Because then what we’re really doing is we’re helping your body fend off this virus. We’re getting you from the 10% that we’re susceptible into the 90% they were able to clear this virus.

Cynthia: Well, it is so incredibly valuable and I’m so glad that we were able to connect today because these two big topics, HPV, I’m talking about stress and cortisol are things that I know all of my listeners can benefit from. So, you mentioned that you have a new book and I’d love for you to share a little bit about your new book, how best to connect with you, share your podcast so that my listeners can connect with you outside of this episode. 

Dr. Doni: Oh, thank you so much. My website is drdoni.com, Doni is spelled D-O-N-I, so, it’s either D-R-D-O-N-I or spelled out drdoni.com. And there you can find my blogs and I have a guide to HPV. So, I’m happy for people to grab that and it’s a free guide. So, you can learn more about the approach and what your next steps might be. I’m also always happy to talk to people who are in that HPV decision making and help give a little input into what are your options. Because I feel so passionate. There’s so much confusion. I just would want women to be able to connect with someone who can say, “What are my options, what is my best decision from here?” So, I’m happy to offer that as a resource as well. 

My prior books are The Stress Remedy, and Stress Warrior, and the newest book is Master Your Stress, Reset Your Health. And that’ll be out soon. So, that’s going to be coming including being able to help you assess for your stress type, and really I want to encourage you to get empowered around getting that homeostasis with your stress response, and really learning your body and what it needs. And that’s what that book does is to really empower you about how to be your healthiest self, get that epigenetics working for you instead of against you, and to be able to just have your best quality of life.

Cynthia: Great. Thank you so much for your time.

Dr. Doni: Thank you. Oh, my goodness, that was great.

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