One of my earliest clinical mentors used to tell me, “Who we are and how we practice once we are three years out of school/training is who we will be for the rest of our clinical practice.”

That should serve as a warning to those of us who have lingered in a space while everything about clinical practice has changed with lightning speed in the past decade and promises to change even faster in the next decade. From our payer system and electronic medical systems technology, to the patient’s access to information and even to our clinical understanding, healthcare is changing exponentially. If we don’t continue to learn and incorporate what we learn, we will become irrelevant – overnight!

And for those of us who belong to the tribe of Functional Medicine, we have an even greater burden to keep current as our message of health promotion and not merely disease management must be rooted in the highest level of science if we are to be excellent clinicians as well as effective evangelists.

To this end, I propose changes to our clinical thinking in two areas that concern stress-related conditions and restoration of the normal stress response, that is, the Hypothalamic-Pituitary-Adrenal (HPA) axis function. The first is to move away from, even abandon, the notion of pregnenolone steal or cortisol escape. The idea that pregnenolone substrate sequestered in the mitochondria of one cell layer of the adrenal gland is available to other cell layers to be used in the manufacture of various hormones may not be physiologically possible. And the fact that DHEA is a hundred-fold more abundant in the human body than is cortisol would make such a concept irrelevant when diagnosing and addressing HPA axis dysfunction. It is time to change the paradigm and drop the term pregnenolone steal. Holding to this notion prevents any positive dialogue with the established medical paradigm (i.e., endocrinologists) and further separates us from the rest of the clinical research community.
A second area to consider change is the relatively new understanding within clinical research of the HPA axis known as the Cortisol Awakening Response or CAR. Though CAR was studied and researched before the year 2000, it has been an ever-increasing focus since 2003 among the clinical research community, and numerous papers and studies have been published on the topic. The CAR is a measurable rise in cortisol within 30-40 minutes of awakening that adds between 40-75% to the circadian baseline and is indicative of the reactive capacity of the HPA axis. It may be the most important biomarker when assessing HPA axis function and yet it is not well understood among clinicians and there are few, if any, labs offering assessments of this biomarker. 



Christopher Mote, DO, DC, IFMCP

Christopher Mote, DO, DC, IFMCP, earned his doctorate in osteopathy from the Chicago College of Osteopathic Medicine at Midwestern University. He earned his doctorate in chiropractic and Bachelor of Science in human biology from the National University of Health Sciences (NUHS) in Lombard, Illinois, and is certified in Functional Diagnostic Medicine. With a focus on addressing the root cause of health concerns, Dr. Mote specializes in the diagnosis and treatment of chronic health disorders.


Read more on both of these topics, as well as a thorough understanding of the stress response, by obtaining a copy of Dr. Thomas G. Guilliams’s reference guidebook,The Role of Stress and the HPA Axis in Chronic Disease Management .


Webinar: Moving Beyond Adrenal Fatigue

Over the past decade, terms like “adrenal fatigue” and “adrenal exhaustion” have been used to summarize the complex dysfunction related to the stress response system. Although this terminology has been useful in dismissing the perception that only extreme issues related to adrenal function (Addison’s or Cushing’s Disease) are of clinical importance, it has done little to help, and in some cases hindered, clinicians‘ understanding of the important mechanisms and solutions related to patients’ chronic illnesses.

Join Dr. Christopher Mote, ARK Stress Recovery Program Clinical Expert, as he discusses:

  • The Pathophysiology Caused by Stress and the Stress Response System
  • Current Limitations in Testing and How to Use It Effectively
  • Using More Accurate and Medically Appropriate Terms to Describe Stress