About Our Guest- Dr. David Borenstein – Treating Adrenal Fatigue
Dr. David Borenstein is New York’s leading integrative and functional medicine physician.
Board certified by multiple medical associations, including American College for Advancement in Medicine and American Academy of Anti-Aging Medicine, Dr. David Borenstein combines the best of traditional and holistic medicine.
David Borenstein, MD is the founder of Manhattan Integrative Medicine. He obtained his medical degree from the Technion Faculty of Medicine in Haifa, Israel and completed his internship at Staten Island University Hospital. During the course of his career, he has attended numerous specialized training courses in order to expand the scope of his medical expertise. He is board certified in Physical Medicine and Rehabilitation, certified in Medical Acupuncture, and is a member of numerous professional societies.
Dr. Borenstein has held many prestigious clinical appointments and positions in leading medical facilities. He has been published in the European Journal of Ultrasound and has been the Chief Investigator on a research project on Spinal Cord Injuries.
Full Podcast Transcription
Dr. David Borenstein 00:05
The human body is made to handle stress in bursts. But our society today is a constant
stress 24/7 and we weren\’t designed that way. We were designed to have bursts of stress
rather than constant stress. Many times patients with chronic illness for example you
quietly sick your adrenals tend to be low. So as many different contributing factors to this,
but our society today generally stress, lack of sleep, poor diet and too much caffeine.
Diva Nagula 02:02
Hello, this is Dr. Diva Nagula. Welcome to From Doctor To Patient, where our goal is to bring you topics of discussion that will educate you on the various healing modalities to help balance the mind, body and spirit. Hello everyone and welcome to another episode of From Doctor to Patient. Today I\’m joined with Dr. David Borenstein. He is New York\’s leading integrative and functional medicine physician, board certified by multiple medical associations including American college for advancement in medicine and American Academy of anti aging medicine. Dr. Borenstein combines the best of traditional and holistic medicine. He\’s the founder of Manhattan integrative medicine. He obtained his medical degree from Technion in Haifa, Israel and completed his internship at Staten Island University Hospital during the course of his career, he\’s attended numerous specialized training courses in order to expand the scope of his medical expertise, is board certified in physical medicine and rehabilitation, certified in medical acupuncture, and is a member of numerous professional societies. He has held many procedures, clinical appointments and positions in leading medical facilities. He has been published in the European Journal of ultrasound, and has been the chief investigator on a research project on spinal cord injuries. You know, it\’s it\’s funny, as I was reading your bio, I didn\’t realize this until as I was reading and I was like you\’re also a seminar specialist. And it\’s very rare to find PNR specialists who go into the path of integrative medicine, functional medicine and so forth. And I went into p m&r, and then went and did a fellowship in interventional pain. And that\’s how I entered into my path of integrative medicine. But curious, how did you start specializing and getting into integrative medicine?
Dr. David Borenstein 04:07
Sure, I\’ve always had the interest of integrative medicine and functional medicine. I think Unfortunately, when you\’re in medical school and residency, the concept and the idea of integrative medicine is quite downplayed, but I always had an interest in it. And I was lucky in my residency, I had a attending and Chairman who is actually quite supportive of my interest in integrative medicine. When I left my residency, before I started my private practice, I got several jobs working in different clinics, and one of them was in integrative medical clinics. And I worked here initially once a week than twice a week. I loved it. I went into courses, got many certifications, and then I said, you know, let me know but my own practice and that\’s exactly what I did. So I did more and more of it. And now my practice is primarily functional medicine and integrative medicine. That\’s excellent. A lot of people have had personal ailments and whether it\’s dealing with them or their family. And I\’ve detailed on my show how, you know, much of the reason why I got into integrative medicine was through by accident because I was researching on why I developed and had Non-Hodgkins Lymphoma. And it just, you know, made sense that it was all related to lifestyle choices. It was at any part of your choice into really specializing in getting into integrative medicine, or was it purely the science that at all that made sense to you? Actually, you have a very interesting experience, because before I did physical medicine rehabilitation, I did one year of radiation oncology, which is exactly what you do for what you had. And I always had an interest in, I guess, non traditional approaches to oncology know, in medicine, you know, what do we do we do chemo radiation in your particular what you had, and of course, surgery, and I always thought there\’s other options you can do, and even doing my term working radiation oncology, that was very poo pooed. You can\’t say the word alternative, or integrative oncology is a field that does not like that word and does not like anything in that direction. So I left it, I wasn\’t I wasn\’t happy with what I saw. And I went into rehab and I was much happier. But it only increased my interest in looking at integrative functional and alternative ways of treating disease. And now I do a lot of repurposing of drugs for oncology and a lot of integrative oncology. So I kind of went the direction you did. Yeah, that\’s awesome. And it\’s funny, I, what\’s coming to mind is that, as I was talking to my oncologist, and I was also asking my oncologist, you know, and try to be proactive when I was diagnosed. And I didn\’t know anything about integrative medicine or anything like that, just from the little bit of red at the time diagnosis. And I was like, What about diet and lifestyle modifications? And, you know, what can I do, and he\’s like, you know, I\’ve had people who change their diets, I\’ve had people do this and do that, and nothing seems to help except for the chemo. And looking back at that now, it\’s like, wow, if only had if he had known, and if only I had actually taken advantage of some of the lifestyle strategies way ahead of time. So that\’s kind of why I\’m here is really to really help educate people and bring people on like yourself to talk about lifestyle changes, and I could actually make a difference in people\’s lives and prevent them from ultimately having some sort of chronic condition that can play them forever. So I appreciate the work that you do and all of the practitioners that are out there, but what really interests me specifically is, you know, often as we get older and under a lot of chronic stress, sometimes we get this diagnosis of issues with a poorly functioning adrenal gland. And I\’d like to go into our show more and talk about adrenal insufficiency and adrenal fatigue. But this particular gland is something that most listeners or most people don\’t know that exists, because it\’s not something that we talked about. So can you kind of go into a little bit of detail as to what the adrenal gland is and and why we have one? Well, that\’s a great question. And let\’s talk about what is adrenal fatigue, basically, adrenal fatigue, it\’s a group of signs and symptoms that result when your adrenal function is suboptimal, below the level necessary to deal with stress. Now, remember, when in that many, many years ago, and I mean, many, many years ago, when we were cavemen, we generally had a very quiet life with areas of bursts, you know, the tiger would come attack us and then we have a burst of energy fighting, the tiger would go back to the regular low level of stress. But as time goes on, and our society has changed, we went from a society we had burst of stress, to constant stress. remember years ago, we didn\’t have all the great communication, things were slower things were quieter, we slept more. We, you know, a great grandparents slept nine hours and our grandparents that data is and now we are lucky if we sleep six to seven hours a night. So a lot of the things we do have changed, and now we have a situation of chronic stress. This leads us to a situation where we don\’t have enough adrenal hormone cortisol to deal with your daily life. And then you become tired, you can\’t get out of bed, you crash. And then later you get a spike of energy at night you get dizzy, low blood pressure. So these are some of the things that we find in people who have chronic stress and develop what we call collectively as adrenal fatigue. And adrenal fatigue, as we\’re discussing really isn\’t something that\’s recognized by Western medicine. Am I correct? 1,000% correct. In Western medicine, we recognize extremes. Too much cortisol, we know we call it Cushing\’s syndrome. Too little cortisol is called Addison\’s, we don\’t recognize that there is a spectrum, we have a diagnosis, I just give you an example. If your cortisol level in the morning is 4.9, that\’s considered low, if it\’s 5.1 is considered normal. Now, it\’s not a huge difference. But we have a low cutoff. And we don\’t treat a recognized adrenal fatigue as a spectrum that people can still have a normal cortisol level, what is defined is normal in your lab work, and still have all of the symptoms of low adrenals. Now, is it just a specific low levels in the morning, are you also taking levels throughout the day, and comparing that to what a baseline person should have in order to diagnose adrenal fatigue? There\’s another way to diagnose it, the initial way you can do it is, is by checking a morning cortisol. Now, cortisol levels are supposed to be very, relatively high in the morning, let\’s say 8am. So you can get through the day, and at 8pm is supposed to go down to a low level. So you can go to sleep at night. So there\’s a really high in the morning, low in the evening. in patients with adrenal fatigue, they may have the opposite syndrome, they may be usually the very low in the morning, they can\’t get out of bed and they crash during the day. And then in the evening, they get this second burst of cortisol, and they can\’t go to bed, they stay awake. So yeah, they still have adrenal fatigue. But their cortisol levels are higher in the evening, when they should be lower, and they can\’t fall asleep. And that even contributes to it because one of the contributing factors to Adrenal Fatigue is sleep issues. So yeah, the rhythms change, the levels change. And it\’s unfortunately, as you mentioned earlier, not recognized as much in western medicine. What is the cause for these abnormal fluctuations of cortisol levels? In why he deviates from the standard? Is it just because of, you know, like we\’re talking about earlier the burst of fight or flight that\’s in our lives? Well, yes, well, the like I said earlier, the human body is made to handle stress in bursts. But our society today is a constant stress, 24 seven. And we weren\’t designed that way. Humans are not designed to be that we were designed to have bursts of stress rather than constant stress. So what happens you have constant stress, your cortisol levels constantly are high. Now initially, as a young person, you\’re nice and high, but eventually you\’re not going to be able to handle it and it\’s going to drop. As you get older and the stress increases. We don\’t sleep as much. We drink five cups of coffee a day. We have a lot of gluten and dairy and high fructose corn syrup and simple sugars, which are not very good for the diet. So many times patients with chronic illness, for example, you quietly sick, your adrenals tend to be low. So as many different contributing factors to this, but our society today generally stress, lack of sleep, poor diet, and too much caffeine.
Diva Nagula 13:11
So those are the common causative factors. So what about symptoms, the constellation of symptoms of adrenal fatigue?
Dr. David Borenstein 13:17
There are a lot – difficulty getting out of bed in the morning, crashing during the day, a spike of energy at night, dizziness, low blood pressure, excessive urination, craving for salt, dark circles under the eyes, episodes of hypoglycemia, low blood sugar. These are one of the many symptoms of adrenal fatigue and surely the most common To my memory. I was diagnosed in a stage I had stage-four adrenal fatigue. What are the categories of adrenal fatigue? in workplaces? Someone in the category of one or two or even four? Is it a specific level of cortisol that\’s deficient in their system or overproduced? Well, there are many, you know, you can you can describe it as mild, moderate, severe. Some of the companies that test it have four different levels. I mean, one of the things with adrenal fatigue, and I find is, is that sometimes the testing does not correlate well with the physical findings. So I patients have every possible scenario of adrenal fatigue and in the numbers, I mean, it\’s there, but it\’s not so severe. And I have the opposite I patients who, usually younger, who can, you know, go party all night and they have plenty of a good amount of energy, but they still have significant adrenal fatigue because eventually, they\’re young, they can handle it, but eventually they\’re going to crash. But I think the best way to define it is you know, it either a mild, moderate, severe, and it\’s quite arbitrary how you can do that. There are several different parameters that one can do. There\’s no really official accepted guideline. But the issue is, is that if you have the symptoms of low adrenals, the symptoms that I mentioned earlier, whether it\’s an early middle or late stage, you know, it has to be addressed and it has to be, you know, corrected for Or else, it\’s just going to get worse and worse and worse. The symptoms that you\’ve described, that comprise of adrenal fatigue can really overlap with a lot of other conditions that are out there specifically mental health issues like depression, do they go hand in hand? Are they completely? Two different types of issues? Oh, they do. They do. There\’s a lot of overlap. I should have mentioned earlier vitamin and mineral deficiencies, hormones. I mean, there\’s so much overlap. And that\’s why in many conditions such as renal fatigue, they don\’t exist in isolation, one has to look outside the box and test many different parameters, not just the adrenal gland. For example, every patient that comes to me, I do extensive adrenal testing, we can test the adrenal several different ways. You can do it by blood, you can do it by saliva, you can do it by urine, each has its advantages and disadvantages and its costs. I also check thyroid is very important to check thyroid function, vitamin and mineral deficiencies, hormones, male and female hormones. virus is just so much you have to check out because as you mentioned, there\’s a lot of overlap. So one can have adrenal fatigue and one can have thyroid issues. And usually they go hand in hand. It\’s very rare that I see a patient with comes into me, they think everything is thyroid, thyroid, and then you look, yeah, there\’s some thyroid issue, but it\’s mostly adrenal and vice versa. So nothing is looked at in isolation, you have to look at the entire picture. Thank you for that. And yeah, I guess as we physicians, we call that as a differential diagnosis. And, yeah, it seems to be very widespread. And it\’s interesting how a lot of people are just mis diagnosed, and then they\’re labeled as something having Fibromyalgia or depression. You know, these are types of patients that I saw when I was practicing medicine. And I kind of wish at the time that I was able to identify if they were indeed suffering from adrenal fatigue, because I\’m pretty confident that it would have gotten a lot better. In terms of your approach to treating patients with adrenal fatigue. I\’m sure you have a multi pronged layered approach. So I\’d love to hear your way you treat? Sure, as you said, it\’s definitely multi- prong approach. First of all, we talk about relaxation techniques. And there\’s several that we can go through dietary changes, reduction in caffeine, improving your sleep, and we work on different ways on improving sleep hygiene. Then we talk about using adrenal extracts, adrenal granulars things like adaptogens at balance it some s we use licorice root high dose vitamin C, these supplements, okay, so this is the way we treat the drills. And sometimes in severe patients, we actually give the patient some hydrocortisone to make up for the balance until the treadles can improve on their own. Let\’s go back to the glandular – this thing is really interesting. I didn\’t know this was even something that you could use, but it\’s a very interesting concept of how to treat this. I mean, right? It\’s actually pure. It is an adrenal gland. No, of an animal. I think it\’s a it\’s a cow or of some sort. But yeah. Talk to us a little bit about that. Yeah, basically, they take the adrenal glands from cows and they put it in a capsule through a whole process. And you take that extract and it can help with adrenal function by giving nourishment to the adrenal gland. And I\’m assuming that the reason why you\’re using high dose vitamin C\’s because of the antioxidants or is there another rationale as to how this affects adrenal fatigue? That\’s one of the ways vitamin C can help. And we do know that vitamin C is very important to cofactor in many metabolic processes, but the adrenal gland loves vitamin C. So I like to give us, you know, as much as patients can, can take. That being said, you know, it\’s only one part of a very comprehensive program, and we work very hard to stress that to our patients that, you know, it\’s not just taking the grain, Liz, you got to do some of the lifestyle changes, you got to, you know, reduce some of that stress, which is, look, that\’s extremely hard today. It\’s like, it\’s like, you know, telling someone, you know, go lose 50 pounds, it doesn\’t happen overnight, it doesn\’t, it\’s an easy thing to do. And having, you know, COVID. And, you know, the situation around COVID doesn\’t exactly take away from our stress. It only made it worse. But you know, it\’s certainly I want to tell people that this is certainly something that can be addressed and treated. And also, I would imagine, you use a lot of adaptogens, you know, in treating adrenal fatigue, can you talk a little bit about what an adaptogen is, and what types that you\’d like to use for your patients? Basically, adaptogen is, is something that\’s going to help regulate cortisol levels, keep them where they should be. Things like ashwagandha, and ginseng, work very, very well, I have them all in one formula, and they work really well. You know, and I\’m a big fan of, of ginseng, and ashwagandha. Those are my two favorites, licorice. licorice root, liquid also works very well. So those are some of the adaptogens that we use, but they\’re all they\’re all in one, it works easy. And I guess with lifestyle changes, I mean, this all goes with it, right. And that\’s probably everything that you see in your office, and you diagnose and treat. And then you can give them the supplements, you can give them things to help. But in the end, it\’s really about a patient being very proactive, but their approach to life and making these changes, like if they\’re really stressed, then you have to obviously implement, you know, relaxation techniques, whether it\’s breathing exercises, meditation, any of those types of things that can help the patient not only now, but in the long run, what are your favorite types of relaxation and meditations as you like to utilize for your clients, or patients? Deep breathing exercises, yoga, anything. I think I think that deep breathing is among the easiest things that people can do. And you know, yoga is a technique known as tapping. And you can go on YouTube and see that meditation works beautiful. Thomas was so busy in our lives, everything\’s just busy rush, rush, rush, rush, rush square, especially here, I live in New York, and this is a rat race here in New York, this is not, you know, a quiet, you know, rural area where things are a little bit slower in the New York. So rat race, and we see more, you know, fatigue, hear that anywhere, probably in the United States, it\’s really, really a, you know, symbol of you know what Adrenal Fatigue is, but a lot of the times, you know, it\’s very hard for a patient to control their stress. Many times, they can\’t deal with the fact they don\’t have a job. These are common things, you know that one of my patients state, they\’re in a job that they just can\’t, they just hate, but they can\’t get out of because they have to pay the bills. I have patients whose parents are like in their 90s. And they spent all their time taking care of elderly parents. And if you\’ve ever done that, it\’s a very, very difficult thing to do. So it means a lot of stressors. And sometimes you just can\’t take those stresses out of your life, even if you want to. So that makes it all the more difficult to treat. And for your patients who are starting this treatment algorithm that\’s given by you, what\’s the average like turn around where they start to feel better, and start to be able to modulate their stress levels and come out of this adrenal fatigue? Well, most of the patients after several months are going to start getting a response. But adrenal fatigue can take sometimes more than a year, even a year and a half to heal. It takes a very long time, especially if you had it for for a long period of time. It does require you to be on supplements and all this and even after the adrenal fatigue is here, you don\’t want it to come back, you still have to make the lifestyle changes. But most of the patients do respond after relatively, you know, after a month or two of being on supplements, they say, Hey, you know, I get a little more energy of sleeping a little better. But for long term, we\’re talking probably over a year. Wow. Okay. I mean, the goal is, is to help these patients of yours in the short term, you know, to do what you can do to in order to have them feel better get some sleep and allow them to improve in an acute stage. But over time, do you find that they need the supplements or typically the relaxation techniques and other mindfulness strategies and dietary changes does that typically take over where they don\’t have to use these supplements anymore? Well, there\’s a point where we will try to taper the patients off the supplements. But here\’s the problem. It\’s hard for a lot of people to just get that stress out of their life. It\’s hard to just can\’t you know if they, if their parents are around and elderly parents, you know, they still going to have Issue, if people were in a situation where they hate their job, and they still hate it, it\’s gonna be hard. We\’ve gotten, we\’ve gotten patients off the supplements, but sometimes they need to come back on it because the stress just comes back. The best thing people can do is, is just move to a desert island and not be, you know, stressed out, move to a place where there\’s very little stress. But that\’s, that\’s hard to do. Yeah. And a lot of the times you just can\’t, you can\’t change that. It\’s just the way it is. So you do your best but you know, every Every patient\’s going to be different, some can get off the supplements, some need to be out for a prolonged period of time before they can even consider getting off. When I have practitioners like yourself, come on I to see if you can come up with a nice case study of yours where patient came in with, you know, really horrible adrenal fatigue. And, you know, I love to hear success stories with what their outcomes, you have one in mind. Oh, I do. And this patient was complicated because not only you have adrenal fatigue, she had thyroid issues, hormonal issues, chemical sensitivity, illos danlos syndrome, you name it, she had no pots, you name it, she had it very sweet lady, and took us about a year and a half. But she was very, very happy. We just started off with the basics. I did all the blood work, we can and we put her not only on the adrenal extracts, but she was put on the hydrocortisone. She was put on a drug called florinef to him, because she was using losing a lot of a lot of water. So we put on a drug to help prevent that. We\’ve found some of the thyroid issues that she had, and we addressed those issues. It was rough going for about six months, it was very rough going in and all of a sudden, she started to do slightly better and better. And now her Adrenal Fatigue is certainly manageable, she will need to be on the adrenal supplements, probably for a prolonged period of time, she\’s still taking adrenal medications, the hydrocortisone and the florinef, which are medications for medication for increasing aldosterone. But, you know, she is probably the poster child of my success. And she went to a number of different doctors, and they all waved her off. That\’s what I was going to ask. How many years of doctors that she actually go through before she found you? You know, it\’s just….I\’m sure you get that a lot. I get that all the time. And, you know, unfortunately, the way the medical system is today, we practice what I call assembly line medicine. And I think that\’s unfortunate. And that came about for several reasons. Number one, because of the insurance situation, you know, the doctor can only spend seven, eight minutes with you, and then he or she is on to the next patient. They\’re not going to sit there and give you the time that you need to deal with the with the problem. They\’ll tell you that, oh, it\’s probably in your head or your it\’s too much stress and say goodbye. And they won\’t sit down and literally do the detective work to find out Hey, what\’s going on here? And it\’s a shame because there\’s probably you know, 1000s of 1000s of people maybe in the millions who are feeling this way and we cannot get to every one of them who needs to care. Right. Right. Well, Dr. Borenstein for my listeners, for anyone else who wants to find more information about you what\’s the best way to find out? Sure, you can go directly to my website, which is www.DavidBorensteinMD.com. That\’s the website of Manhattan integrative medicine here in New York. Well, thank you so much for taking the time out of your busy schedule to join me today and talk about a really important topic, adrenal fatigue and yeah, thanks so much.