Sunscreen Safety

Sunscreen Safety

Sunscreen Safety

By: LouLou Piscatore
Sunscreen Blog - Yoga Love Magazine
Every summer we slather on sunscreen to protect ourselves from the negative effects of the sun (and the depleted ozone layer) But how safe is your sunscreen?

It’s important to get to know what’s in your sunscreen. For starters, sunscreens are either mineral or chemical based. Some sunscreens contain both. Mineral sunscreens, which often contain zinc oxide and/or titanium dioxide, sit on the skin’s surface to deflect the sun’s rays. Chemical sunscreens penetrate the skin and absorb the sun’s rays. This is where the problems start. Recent studies have shown that many of the chemicals used in chemical based sunscreen are absorbed into the body’s bloodstream at levels much higher than the FDA’s safety threshold. According to Yale Medicine (2021) at these levels, the chemicals have the potential to cause cancer, disrupt the hormone system and cause harm during reproduction and development.

As reported by the Environmental Working Group, “when the federal Food and Drug Administration proposed its most recent updates to sunscreen regulations, it found that only two ingredients, zinc oxide and titanium dioxide, could be classified as safe and effective.” Last year, the European Commission published opinions on the safety of three other common ingredients in chemical sunscreens, oxybenzone, homosalate and octocrylene. It found that hundreds of sunscreens manufactured in the U.S. use them at concentrations that far exceed safety levels. In addition, last May, benzene, a known carcinogen, was found in 78 sunscreen and after-sun care products, many from well known brands.

Chemicals in sunscreen may be harmful to other forms of life, too. According to the Coral Reef Alliance (2021) there are an estimated 14,000 tons of sunscreen deposited into the ocean annually. Studies have shown that chemical sunscreen is toxic and has “significant impacts to coral health and their reproduction.” And it can be harmful to other marine life too, like fish, dolphins, green algae, and sea urchins, causing problems like deformation, decreased fertility, and impaired growth.

So what do you do to protect yourself? And the environment? Use a mineral based sunscreen. Back in the day these used to turn your face white (remember putting Zinc on your nose?) but not anymore! Now there are plenty of safe, clean, and fun (glitter!) options. Here are some of our fav’s:

Sunscreens we Love

Sunscreen Blog product image - Yoga Love Magazine
SPF 30 powder sunscreen with a brush. Easy application. Reef safe and chemical free with resveratrol and green tea.
Sunscreen Blog product image - Yoga Love Magazine
Sea Star Sparkle SPF 50 Glitter sunscreen by Sunshine and Glitter
Made with biodegradable glitter! Reef safe, water resistant, paba and paraben free.
Sunscreen Blog product image - Yoga Love Magazine
Black Girl Sunscreen 

“Made by women of color for people of color because we get 

sunburned too.” Mineral sunscreen with no white residue! Ozybenzone and Octinoxate free, with avocado, jojoba, cacao and carrot juice to moisturize and heal skin

Sunscreen Blog product image - Yoga Love Magazine
Monat Sun Veil Daily Mineral Protection 


Sunscreen and serum in one with hyaluronic acid, niacinamide, arnica

Sunscreen Blog product image - Yoga Love Magazine
Salt and Stone 

SPF 30 

Face Stick and Lotion 

Zinc based with no white residue, water and sweat resistant and reef safe with vitamin E, hyaluronic acid and ashwagandha.

Sunscreen Blog product image - Yoga Love Magazine
Dune The Bod Guard and The Mug Guard

Reef friendly, paraben free, oxybenzone and octinoxate free, 72 hour hydration, inclusive – invisible on all skin tones.

Pacifica Coconut Probiotic Sport Sunscreen

SPF 50

Water resistant, oxybenzone and PABA free, no parabens or phthalates



MacMillan, C. (2021) Is my sunscreen safe? Yale Medicine.,sunscreen%20over%20time%2C%E2%80%9D%20Dr.

Sunscreen 101: Protecting your skin and coral reefs. (2021) The Coral Reef Alliance.

The trouble with ingredients in sunscreen. Environmental Working Group.


Common Chemicals Found  in Sunscreens 

The most worrisome sunscreen active ingredient is oxybenzone. It is readily absorbed through the skin (Matta 2019, Matta 2020) and the Centers for Disease Control and Prevention found it in nearly all Americans, with higher levels in those who report applying sunscreen (Zamoiski 2016). Oxybenzone behaves like an endocrine disruptor in many studies (Krause 2012, Ghazipura 2017) and is potentially of greater harm to children (FDA 2019). In an evaluation of CDC-collected exposure data for American children, researchers found that adolescent boys with higher oxybenzone measurements had significantly lower total testosterone levels (Scinicariello 2016). Female exposures to oxybenzone and related chemicals have been linked to an increased risk of endometriosis (Kunisue 2012).

Four studies published in 2020, support previous findings that oxybenzone can act as an endocrine disruptor and may increase the risk of breast cancer and endometriosis (Kariagina 2020, Peinado 2020, Rooney 2020, Santamaria 2020). In addition, the National Toxicology Program found equivocal evidence of carcinogenicity in rats after observing increases in thyroid tumors and uterine hyperplasia in females with high exposure to oxybenzone (NTP 2020). Recently, the European Commission found current human exposure levels to oxybenzone to be unsafe and proposed a concentration restriction of 2.2 percent (SCCS 2020) – lower than the limited amount allowed in U.S. sunscreens, which is up to 6 percent. Several countries ban the sale of sunscreens that contain this ingredient, because it may be harmful to aquatic life.

EWG recommends that consumers avoid sunscreens with oxybenzone.

Octinoxate (Octyl methoxycinnamate)
Octinoxate is an organic UV filter. It is readily absorbed into the skin and continues to be absorbed after the sunscreen has been applied. It has been found in blood 16 times above the proposed FDA safety threshold (Matta 2019, 2020). Animal studies have shown the chemical has hormone effects on the metabolic system and affects thyroid hormone production (Seidlova-Wuttke 2006), with some evidence for other endocrine targets, including androgen and progesterone signaling (Krause 2012). Several countries ban the sale of sunscreens made with octinoxate, because they may be harmful to aquatic life.

Homosalate is an organic UV filter widely used in U.S. sunscreens. Homosalate has been found to penetrate the skin, disrupt hormones and produce toxic breakdown byproducts over time (Krause 2012, Sarveiya 2004, SCCNFP 2006, Matta 2020). A recent opinion from the European Commission found that homosalate was not safe to use at concentrations up to 10 percent and recommended a maximum concentration of 1.4 percent, because of concerns for potential endocrine disruption (SCCS 2020). The FDA allows U.S. sunscreen manufacturers to use it in concentrations up to 15 percent.

Octisalate, an organic UV filter, readily absorbs through the skin at levels 10 times more than 0.5 nanograms per milliliter, the FDA’s cutoff for systemic exposure. This cutoff is the maximum concentration that may be found in blood before there are potential safety concerns. A case report showed that the chemical has been linked to allergic contact dermatitis (Singh 2007). Analysis of high throughput screening assays by the Environmental Protection Agency suggests octisalate may have endocrine effects, weakly binding to the estrogen receptor.

Octocrylene readily absorbs through the skin at levels about 14 times the FDA cutoff for systemic exposure (Hayden 2005, Matta 2020). Studies have found that octocrylene causes relatively high rates of skin allergies (Bryden 2006). It has been linked to aquatic toxicity, with the potential to harm coral health (Stein 2019), and it is often contaminated with the known carcinogen benzophenone. According to a recent study, its levels can increase when it is stored (Downs 2021). 

Avobenzone is a widely used organic filter that provides protection from UVA rays. Avobenzone can disrupt the endocrine system and has been shown to block the effects of testosterone in cellular studies (Klopcic 2017). In one study, avobenzone was detected in serum samples at levels nine times above the FDA’s cutoff for systemic exposure (Matta 2020).

Titanium dioxide and zinc oxide
Mineral sunscreens are made with titanium dioxide and zinc oxide, usually in the form of nanoparticles. The FDA proposed that both titanium dioxide and zinc oxide be classified as safe and effective. Evidence suggests that few if any zinc or titanium particles penetrate the skin to reach living tissues (Gulson, 2012, Sadrieh 2010).

Titanium dioxide is classified as a possible human carcinogen by the International Agency for Research on Cancer, because of the potential of exposure through inhalation. For this reason, powdered or spray formulations containing titanium dioxide are of concern. In general, mineral sunscreens tend to rate better than chemical sunscreens in the EWG sunscreen database. 

The trouble with ingredients in sunscreen. Environmental Working Group.

Keeping Abreast of It

Keeping Abreast of It

Keeping Abreast of It

By: LouLou Piscatore
Photos: Sari Goodfriend


Breast care - Boob balm
Are your breasts getting enough attention? I mean, apart from your yearly mammogram and the occasional exam, how are you caring for them? We massage lotions and potions into just about every body part, but our breasts are often left out of the wellness routine…and they deserve our attention.

For starters, the body’s lymphatic system is highly concentrated near the breast and underarm. The lymphatic system is a network of tissues and organs that help rid the body of toxins, waste and other unwanted materials. It also transports lymph — a fluid containing white blood cells — throughout the body, and is an important part of our immune system.1 Wearing a bra (especially underwire) can cause stagnation in the area and interfere with lymph circulation. Taking off your bra and massaging your breasts at the end of the day can help drain the stagnant lymph fluid and support detox and circulation to the tissue.

Breast massage can reduce hormonal tenderness and reduce swelling, Not to mention, the skin on our breasts and chest is thinner than the rest of our body and needs moisturizer (and natural sunscreen!) to prevent signs of aging. Perhaps most important of all, it is an effective preventative care measure. Regular breast massage will keep you familiar with your own body, so you’ll be the first one to notice any changes. Courtney Kinnare of Noniko Natural Skincare recommends using a breast specific product, and making it part of your self-care routine. “You are not only moisturizing your décolletage, but you are also familiarizing yourself with your ‘normal.’ Early detection is one of the keys to beating breast cancer and by getting to know your body, you are increasing your chances of noticing any differences.”

Some other tips for breast wellness? Rethink your underwire bra. Ideally you want a bra that offers support without cutting off circulation. And use natural deodorant. Your underarms are right next to your breasts and packed with lymph nodes. Standard deodorants contain aluminum and hormone-disrupting preservatives like parabens, both of which pose health concerns.

Need some inspiration? Try one of these multi-tasking, non-toxic, breast-positive products, and add some breast care to your self-care.

1 – When Beauty and the Breast Bio Cellulose Breast Mask

2 – Hatch — Nipple and Lip Rescue Balm

3 – Noniko — Boob Balm

4 -Mega Babe — Bust Dust

5 – Dirty Girl Farm — Boobie Butter

6 – Aroms Natur — Love Your Breasts daily firming massage oil

7 – Banyan Botanicals — Breast Care Balm

8 – Lansinoh — Organic Nipple Balm

9 – Simply Divine Botanicals — Keeping Abreast Of It

Breast care - Boob balm
Head to Toe

Head to Toe

Head to Toe



Head To Toe Beauty products

Your skin is a living, breathing organ. It is your largest organ, and it needs the same level of care as other organs. It needs nourishment, hydration, sleep, oxygen and apparently lots of moisturizer. For thousands of years, Ayurveda has associated aging with “drying out.” Now western science is catching up. According to recent research, some of the systemic inflammation associated with chronic diseases of aging has been linked to — dry skin!

In a recent article, Mariana Lenharo documents the research going on at the University of California, San Francisco, and the links between dry skin and inflammation.The inflammation response is part of the body’s immune system and plays an important part in healing tissue damage and fighting viruses and bacteria. But chronic, low-level inflammation has been linked to common age-related degenerative conditions (like Alzheimer’s, arthritis, and cardiovascular disease). As you age, the skin barrier deteriorates, and is unable to keep the skin hydrated. So the skin sends out signals to the immune system to try and repair itself. Those signals, and the immune system’s response, creates systemic inflammation, which can lead to chronic disease.

This creates exciting possibilities. They found that if you improve skin function, you can reduce inflammation. Basically If you moisturize your skin, you can improve your health. And one of the most exciting findings is that treating even part of the skin has enough of an impact to make a difference.

So skin care is health care, and Ayurveda was right all along. Stay moisturized. Pick a body part and start with any of these great products:


Belly Mask, Belly Oil

Lip Serum, Lip Mask, Citrus Hand Cream

Smooth Operator Intimate Serum

Line-filling Eye Balm

Ad Astra Nighttime Eye Cream Emulsion

Precious Sea Hand Saviour

Thigh Rescue

Happy Pits

Stretch Mark Cream, Stretch Mark Serum,

Founders Blend Scalp and Hair Treatment

Foot Treatment

Lip Patch, Eye Patch, Foot Mask

Butt Masks

Himalayan Body Buff

Barrier+Triple Lipid-Peptide Cream

Body Cream

Body Butter

Stone Crop Body Oil



Body Salve



Creme No. 3



Ceramide Refuel Soap Jel

Head To Toe Beauty products
Head To Toe Beauty products
Head To Toe Beauty products



By LouLou Piscatore


HEX brand Fermented Sauerkraut
Fermented foods have shown up for thousands of years in almost every culture in the world.  Historically they have been a way to preserve the harvest and make foods more digestible. We now understand that fermentation transforms food —enhancing nutrients, while adding naturally occurring probiotics (healthy bacteria) to the diet. In recent years, naturally fermented foods have been getting a lot of attention because they help strengthen the gut microbiome —the “good bacteria,” or “gut bacteria,” that live in your digestive tract. These healthy bacteria impact our digestion, immune system, heart health and even our mental health.

To learn more I chatted with my friend Meaghan Carpenter, an honest to goodness “Food Alchemist,” and co-founder of Hex Ferments.

What are fermented foods?

Fermentation is a process of microbial transformation that can be achieved using sea salt for vegetable ferments, a culture (like kombucha and kefir), an active starter like sourdough or yogurt, or inoculated and left to grow like koji spores on rice for miso.” What is created is a “living food,” which contains live, healthy bacteria or probiotics.

The fermentation process for veggies involves cutting or shredding to create surface area, and adding salt, “which releases water and exposes the sugars and nutrients that the lactobacillus bacteria need to grow and thrive. In a short time the vegetables transform into tangy, nutrient-dense and probiotic-rich sauerkraut, kimchi or pickles.

Why are fermented foods important?

They make anything you are eating instantly more bioavailable. There is a reason why you get a pickle with your sandwich or kraut on a hot dog. Fermented vegetables help our bodies to break down fats, nutrients and coat our digestive organs with beneficial bacteria that will make digestion and assimilation quicker and more efficient.

They are important for healthy gut bacteria, which is important for a healthy immune system, and even impacts mood. “90% of our immune system and serotonin is produced in our gut. Both are impacted by our gut bacteria. The more of a diverse bacterial environment you have in your body, the stronger your immune system. And it will help keep you happy! (Serotonin is the ‘feel good’ brain chemical.)

And they add fiber, vitamins and minerals that are already pre-digested. Think of your gut as a lush rainforest that you need to keep in balance with daily doses of delicious sauerkrauts, kimchi and kombucha tea. The more lush your forest the better you feel. So when you are feeling over-indulged, bloated, hungover etc. reach for a bite of sauerkraut or kombucha.

Not all fermented foods are created equal

To get the benefits of “living food” look for fermented vegetables that have been made using just sea salt and left unpasteurized. This ensures that the process has been done traditionally and not using a shortcut like vinegar. Look for the words “naturally fermented” on the label, and for telltale bubbles in the liquid when you open the jar.

Or make your own! Here’s a recipe from Hex Ferments for a quick Local Winter Kraut:


  • 5 pounds green cabbage
  • 2 pounds napa cabbage
  • 3 medium carrots
  • 5 small red turnips
  • 1 small onion
  • 1 Bosc pear or apple
  • 5 cloves garlic, minced
  • 2 tablespoons grated ginger with skin
  • 1 orange juiced, approximately ¼ cup
  • 1 to 2 teaspoons dried pepper or to taste (Espelette, cayenne, or jalapeño)
  • 4 to 6 tablespoons coarse sea salt (taste after 4, then salt to taste)



  1. Wash produce well, and remove any bad parts. Reserve 5 to 6 outer cabbage leaves, set aside. Cut cabbage into 4 sections, and remove the core. Slice produce into thin, bite-sized pieces.
  2. Place everything in a large bowl, add salt, spices (wear gloves if adding hot pepper!) and orange juice. Mix and massage with your hands. Squeeze! Work those veggies! Work salt into the produce well to release the water and create a brine.
  3. Once a nice pool of brine has collected in the bottom of the bowl, approximately 2 to 3 cups, pack vegetables into a clean, 2-gallon crock or wide-mouth glass container. Be sure to push down with your hands to remove air pockets. After all vegetables are packed in to the jar, press down well so that the brine covers the surface, creating an anaerobic environment. Layer reserved cabbage leaves onto the surface of the kraut. Place a weight (a plate topped with a jar filled with water works well) over the surface, cover the top of the vessel with a clean towel and secure with a rubber band. Kraut should be covered in its brine with room at the top of the vessel to allow for expansion over the first few days of active fermentation.
  4. Date outside of the vessel and place in a location that is away from direct sunlight, and maintains a relatively even temperature; 64-72 degrees is ideal, higher temperatures will speed up fermentation, cooler temperatures will slow it down.
  5. After 5 to 10 days, active fermentation will slow as lactic acid bacteria begin to take up residence. Kraut will continue to ferment vegetables into sour, tangy Winter Kraut. At this point, jar up kraut into smaller portions and refrigerate or take what you want from crock and enjoy its flavorful changes until it’s all gone.


Different types of fermented foods

Kombucha: a fermented sweetened black or green tea drink

Kvass: fermented sauerkraut or beet juice.  In slavic cultures it is made from rye bread.

Yogurt/Kefir: milk fermented by added bacterias

Kimchi: Korean salted and fermented vegetables (usually napa cabbage and Korean radish)

Sauerkraut: finely-cut raw cabbage fermented by lactic acid bacteria.

Miso/Tempeh/Natt: fermented soybean products

Sourdough: bread made with fermented dough using naturally occurring lactobacilli and yeast

Olives: brine cured and naturally fermented

Pickles: vegetables fermented in brine (not vinegar)

Meaghan Carpenter is a “Food Alchemist” and Co-Founder of HEX Ferments, an award-winning, Baltimore-based fermented foods company. HEX Ferments specializes in creating living foods (sauerkrauts, kimchi, pickles and Kombucha) from local-organic and sustainably grown ingredients. HEX Ferments was born from a performance art piece that was a collaboration with her photographer husband. The concept of the art-piece touched on her pursuits of (re)creating gut-healthy communities centered on local food and delicious edible art. HEX Ferments has been nationally and internationally recognized for its creations, sustainability practices, fermentation education and advancing the frontier of the fermented arts.

Find them at

Functional Medicine and Adrenal Fatigue

Functional Medicine and Adrenal Fatigue

Functional Medicine and Adrenal Fatigue

By LouLou Piscatore
photo credit: Chas Kimbrell


Yoga Plus Magazine - adrenal fatigue - Photo by-Chas Kimbrell
Adrenal fatigue is a phrase we hear often in the wellness world, but what is it? As a licensed  acupuncturist, I can say that the majority of what I treat can be described as stress related health issues; imbalances in the body created or exacerbated by prolonged and repetitive stress. Everyday I see how almost every bodily function is affected – digestion, sleep, immune function, blood pressure, pain, fertility, mood, hormone health and more. Recently the World Health Organization recognized “burn out” as a diagnosable condition (1), perhaps opening the door to more exploration on how stress impacts our health. But how are the adrenals involved? And what happens when they get “fatigued?” I reached out Dr Miriam Rahav, a dual certified physician of internal medicine and functional medicine doctor, for some answers.


What is functional medicine? How is it different than standard care? And what are the kinds of things that you treat? 

In functional medicine, we say that we want to work on root cause resolution. This depends wildly on the human sitting in front of me asking for help and the entire constellation of their being. 

My formal training is as a general practitioner. If someone came in with high blood pressure, there are specific definitions…there is a bit of nutrition counseling, and of course, a lot of medications. We had tools, but we also had a certain time allotment in which to use those tools. And what I saw happening, which made me incredibly sad, was that if the tools weren’t working, there started to be almost a dread of that patient – you wanted to solve that problem, but you didn’t want to be in the room with a patient who had a problem you could not solve within five or ten minutes. I watched kind of the unraveling of the sacredness, the beauty, or the joy that could be in a provider-patient relationship.

That’s standard care.

Yes, that is the standard of care and it’s incredible that we know what we know. It comes from a depth of study and understanding of the body. But sometimes someone would come into my office and they would have diabetes, hypertension, high cholesterol, but they would also not feel well and not feel themselves. I could give them the medications and they’d say, “But Doc, I still don’t feel well…is there anything I can do other than the medications you have prescribed?” I wanted to be able to meet the requests of these humans who were not feeling well, who were vulnerable and who were asking me for help.

It’s more intuitive to explain functional medicine through the lens of a human being and the problem, and what I call a 360-degree wraparound plan of care. But it wouldn’t just be a laundry list of things that might just be good for you to do. It would be based on that person’s biology.

For example, during my residency in the Bronx, there was a lack of access to fresh foods. And so sometimes my therapeutic plan of care would be sussing out the farmers market schedule, how they would get there, did they have transportation, etc. And then if they were able to buy those fresh foods, how would they cook them and I would Google recipes and print them out. 

So it is a 360-degree approach to the entire person. What is going on in their life, what their lifestyle choices are, what they are eating, what their stress levels are, And personalizing care for that person?

Right, what their genetics are, what their environmental exposures are, and every human who is struggling with a health imbalance will have antecedents -–those could be myriad. We think of it as the functional medicine matrix. We look at all of the factors influencing a person’s health, including social, cultural, life circumstances, everything.

For example, not being able to get fresh produce in the Bronx…

Right. That might be an antecedent because it puts you at risk for vitamin and mineral imbalances, or blood sugar imbalances. And then there are triggers – where your body is maintaining a certain balance and then something pushes you over the edge. Maybe it’s a big life stressor, maybe it’s getting an acute illness, or taking a course of antibiotics, which can begin a kind of a snowball. Maybe someone says, “Well, my digestion wasn’t good but then my husband filed for divorce and ever since then I’m so bloated, and I look like I’m pregnant.” So, there might have been an antecedent, but there’s also a trigger. And then there are certain things that might perpetuate that imbalance. Once that imbalance is in place, certain foods might be feeding the wrong population of gut flora that are perpetuating bacterial overgrowth, or yeast overgrowth, which could manifest in fatigue, joint pain, and headaches. It might be a seemingly unrelated constellation of symptoms that come from a similar root cause. so, we would think about it in terms of the functional medicine matrix – what is contributing to that health imbalance, what was the trigger, what were the vulnerabilities that allowed that trigger to push them over the edge,and we address as many or all of those pieces of the puzzle as we can to bring the person back into optimal balance. 

You take the time to figure all of that out, which separates you from standard care.

When humans come to me, who I call in my mind and in my heart, “partners in healing,” because it really is a healing partnership, they’ve gone to other physicians, sometimes many, who have done their utmost within the scope of their training to advocate, to investigate, and to treat my partner in healing.  

But their tools are limited.

The tools are limited. And also the system is limited. What I started seeing happening in my early training and residency, within the time allotment and with the tools we had, we started to experience failure. And I really love and respect my colleagues. However, if all the tools that I acquired with the intention of being of service have not been able to answer the need of a patient, what functional medicine does, is it expands the menu. It’s evidence-based medicine the way I was trained, but expanding the toolkit.  

Let’s talk about adrenal fatigue or “burnout” 

Our adrenals are little glands that sit like little snow caps on top of our kidneys. Our adrenals are chiefly responsible for making cortisol. And the reason I say chiefly, is because the adrenals also make other wonderful hormones. In medical training, we had a mnemonic for the function of the adrenals; it was sugar, salt, and sex. Sugar is cortisol – cortisol raises blood sugar, and that’s the stress response. We have evolved over millennia to be able to escape from the bear who’s chasing us. We survived because we mounted a stress response, which either gives the energy to climb up a tree or run really fast, or fight. To be standing here today, we had to be able to mount a massive stress response – that is tied to our survival. And that’s cortisol. But there are all these other interesting hormones that the adrenals make. There’s one called aldosterone, which helps us with salt balance, and is part of regulating our blood pressure. And sex hormones. We think of the ovaries or the testes as making our hormones, and that’s true, but the adrenals can also make those hormones. The adrenals make estrogen and progesterone and testosterone. So, if there is something that is causing stress in our body, it affects our adrenals, which essentially affects everything. 

This is always an interesting conversation that I have with people, sometimes they say, “But I’m totally relaxed, my life is great, my kids are doing well, I love my job, my partner is supportive.” But that is only one level of stress – there are others. What if your drinking water has lead and you’re amassing a load? That’s stress on your body, You don’t feel it as an emotion, but that’s a huge stress. 

So, stress can be physical OR emotional… 

We are complex. Every human being is a universe, and is as complex as the universe itself. And in that universe, we have any number of stimuli. It could be light exposure, or exhaust from cars, or a check bouncing and not being able to make rent, or your boss yelling at you, or a food sensitivity. Anything that the body could experience as stress, whether you experience it as an emotion or not, the body will need to respond to with a stress response. Infinite possibilities of stimuli and one response. The body has a finite number of responses. What can the adrenals do? They can make cortisol, or they can make cortisol. Therefore, we have to look at the adrenals with that same 360-degree approach. How will overworked adrenals manifest? When we have a stressor and the adrenals respond, they make more cortisol. But that’s a process and it requires resources. We need our B vitamins, vitamin C, amino acids. If one of our stressors is that we have a chronic gut infection that is starting to affect our ability to assimilate those nutrients, we may be revving up the adrenals, but we’re not able to assimilate the ingredients they need to replenish themselves. 

Another way the adrenals replenish themselves is while we rest. Sleep is a huge way that we replenish the adrenals. What if we’re running on empty, and we also have insomnia? We can start to understand how, over time, the adrenals get taxed, and can lose their ability to compensate. That’s usually when people walk through my door. 

At first, cortisol is anti-inflammatory. In a stress response, we don’t feel pain – it’s a survival technique. That’s what allows us to fight the bear even if the bear tears open a flesh wound.  That’s part of how we survive. But the converse is also true. When we can no longer mount a cortisol response, we’re going to have pain. An extreme version of this is fibromyalgia, which is just total body pain. Or the adrenals are involved in blood pressure regulation. So, someone  who says, “when I change positions from sitting to standing, I start getting lightheaded.” That’s the inability of the body to maintain the blood pressure related to aldosterone (adrenal) deficiency. These are all signs, symptoms that our adrenals are depleted.

 The symptoms I would associate with adrenal fatigue are fatigue, first of all, weight gain, hair loss, and depression. 

You’re actually naming a lot of the classic signs and symptoms for hypothyroidism. They are related. One of the interesting things that goes beyond laboratory evidence is that when your cortisol is high, it can actually block the function of the thyroid on a cell level. You can have thyroid levels that look kind of within normal range, but you can still have functional hypothyroidism. If you have adrenal imbalances over time, it will affect the thyroid. And of course sex hormones. Sex hormones are the last priority. So, if sex goes, it’s one of the signs that hormones are off, that the body is under stress. When sex comes back it’s a sign that your hormones are reconstituting. There’s a pyramid (for hormones) and the base, the foundation, is adrenals  (then thyroid, and then sex on top). 

On that note, let’s talk about the importance of rest.

Cortisol follows a circadian rhythm. If cortisol is in balance it should peak within 20 minutes of waking. In fact, in a normal sleep and wake cycle, cortisol should rise as light hits the back of your eyelids. If we’re not mounting that peak, we don’t feel like we’re awake, we don’t feel like we can get out of bed. That’s a cardinal sign of the adrenals burning out. Or someone telling me, “I have a really hard time getting up in the morning, can’t open my eyes until that first cup of coffee.” Some people need a nap at 4pm, but then get a second wind, and are up all night. That’s adrenal imbalance. It’s like waves. The top of the wave should be in the morning and then you have this gradual going down, down, down, and then the bottom of the wave should be the feeling of, I’m ready for bed, I’m going to call it a night. Ideally, we’re hitting that before midnight, and we’re going to lie down, to get that deep, restful sleep, that replenishment. It’s the time when our brain detoxes, our liver detoxes. If instead, we started low in the morning, and we go from low to high instead of high to low, we’re not going to get restful sleep, and that can create a vicious cycle where we’re not getting the rest we need — we’re not replenishing.

Let’s talk about that, because the modern lifestyle changes makes that kind of natural rhythm nearly impossible for most people…people are working 24 hours a day.

Well, now we have technology. I’ll share something that I love from a brilliant functional medicine gynecologist named Bethany Hayes. She asked this question: “How many of you go to sleep when sleepy arrives?” It’s such a simple question. And the answer is we don’t, we push back sleepy, because we have a deadline, or read stories to your kids so that they can go to sleep, and then get things done for tomorrow, and place orders on Amazon Fresh. Oftentimes it involves blue light and the screen,which blocks melatonin. So we are not getting that sleep, we’re not restoring our adrenals. We’re living in that perpetual state of yin deficiency, or parasympathetic deficiency and sympathetic drive, which burns the adrenals out over time. Even if there isn’t something specifically stressing out your system, just the lack of downtime, the lack of rest, of deep, nourishing rest is going to affect your health.

Recently, the World Health Organization recognized burnout as a diagnosable condition. How do you feel about that? 

Breaking the silence on burnout is a huge conversation. For example physicians and nurses. There is a great opinion piece, by a physician named Danielle Ofri in the New York Times about the exploitation of doctors and nurses in a system where we have a ratio of 10 administrators to one healthcare provider, and how there’s no more operational efficiency that can be optimized. It’s impossible for a doctor to do the right thing within the 10 or 15 minutes that we’re allotted, so we give of our own time. And so there is burnout. In the physician population, we have the highest rate of suicide of any profession. I’m deeply committed to speaking out about this. I’m very involved in a wonderful organization called the Gold Humanism Honor Society which is trying to cultivate values of humanism in medicine for the humans we are caring for and the humans we are. My antidote to that is the practice of functional medicine, where I get to practice what I signed up for. I get to hold humans in their entirety and care for them in their entirety. There’s a profound insight that grows out of that work. And there is a profound exchange. And we’re able to do impactful work that helps people truly feel better, and function better. It changes your entire, not just health trajectory, but life trajectory. Functional medicine is my antidote to burn-out because it’s about becoming the change we want to see. First, as a human and then as a practitioner practicing the way I believe medicine should be practiced, and caring for others the way I wish I would be cared for. And in fulfilling those things, I have joy, and the wonderful humans I’m so honored to work with have joy, too.

Miriam Rahav, M.D. is a dual board certified physician in the fields of internal medicine and hospice and palliative medicine. Dr. Rahav also has many years of training and clinical experience in integrative medicine and functional medicine. She currently practices medicine in New York City where she is the founder and owner of Rahav Wellness,