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  1. This is awesome Judy! I hope they find the link or mutation.... because we already KNOW that this has a genetic component.
  2. <H1 class=main>DHEA and adrenal fatigue?</H1>by Marcelle Pick, OB/GYN NP Two months ago, Lisa, a 28-year-old mom, came to see me. She was so worn out from mothering two kids and working full-time she couldn?t get out of bed. Just driving to our practice took everything she had. Her tests revealed severe adrenal fatigue and, as so often occurs in these cases, very low levels of an important hormone called DHEA. DHEA is a natural steroid and precursor hormone produced by the adrenals. It?s also available at health food stores and on-line as an over-the-counter supplement. Manufacturers hype it as a magic cure-all for many things: muscle loss, weight loss, osteoporosis, and depression ? even menopause. Recently headlines have linked DHEA to athletes ?doping? with steroids, leading to a lot of confusion about DHEA, its role in the body, and how it should be used. Now DHEA is being labeled everything from ?fountain of youth drug? to fraud ? and the very real benefits of DHEA, particularly for women, are getting lost in all the controversy. The truth is that ? for the women who need it ? adrenal support with DHEA supplementation can make a big difference. I?ve seen it help patients get going again when they feel like they?ve hit rock bottom. But it?s never as simple as just popping a pill. When used appropriately ? in a therapeutic setting under medical supervision ? DHEA is a critical component to jumpstarting hormonal balance. Tips for Personal Program Success Clear out temptations. To jump-start your new eating plan, go through your kitchen and pantry and toss all the processed and unhealthy foods. At the least, rearrange your foods into different cabinets, so you can't reach for "bad" things so easily out of habit. Just ask Lisa. After two months of treatment that included lifestyle changes and adrenal support with low daily doses of DHEA, she feels like herself again. So let?s give you more information about DHEA and its role in hormonal balance. Then you can talk to your healthcare professional and make the best choice for your individual needs. What is DHEA? Dehydroepiandrosterone, or DHEA, is a steroid hormone synthesized from cholesterol and secreted by the adrenal glands. The adrenals are walnut-sized organs located right above your kidneys. The average adult makes about 25 mg of DHEA per day (some more, some less) with dwindling production as we get older. Men at all ages have more DHEA than women. Natural DHEA production is at its highest in your twenties: by the time we reach seventy we only make about 20% of the DHEA we had when we were young. A decline in DHEA with the passage of time is clearly what nature intended ? and as far as we know, a healthy process. This is only one of the major reasons we don?t recommend self-prescribing DHEA through over-the-counter products. Another reason is that DHEA is a very powerful precursor to all of your major sex hormones: estrogen, progesterone, and testosterone. (Its molecular structure is closely related to testosterone). We call it the ?mother hormone? ? the source that fuels the body?s metabolic pathway: Besides DHEA, your adrenals also make the stress hormones cortisol and adrenaline. Adrenal exhaustion from coping with chronic stress ? from (among other things) poor nutrition, yo-yo dieting, emotional turmoil, and job-related stress ? means your adrenals are bone-tired from pumping out cortisol and they simply can?t manufacture enough DHEA to support a healthy hormonal balance. The end result? You feel tapped out, overwhelmed and, often, depressed. It?s likely that DHEA and adrenal function are related to neurotransmitter-release rates, based on the mood elevation our patients report after just two weeks of adrenal support. But more research is needed to isolate the individual effects of DHEA from the hormones it gets metabolized into before we can know for sure what part it plays in all of this. One thing we do know is that adequate levels of DHEA are needed to ensure your body can produce the hormones it needs when it needs them. In that balanced state your mood is stable and you feel clear-headed, joyful and vigorous. DHEA is the best ?feel-good? hormone we know. And it works quickly and effectively when taken with the right combination of support. When DHEA levels are low, your body does not have enough working material for proper endocrine function. This throws off your hormone production and you feel a general sense of malaise, along with other symptoms of hormonal imbalance ? how severe depends on how many other demands are being made on your body at the same time. There is a growing body of evidence that healthy levels of DHEA may help stave off Alzheimer?s disease, cancer, osteoporosis, depression, heart disease and obesity, but there is still no clearcut consensus. There may be some increased risks associated with DHEA for women with a history of breast cancer ? all the more reason to take DHEA under medical supervision. At our practice we use DHEA where we?ve seen reliable proof of efficacy ? in cases of adrenal fatigue. DHEA and adrenal fatigue Your lifestyle, diet and stress levels all contribute to the amount of DHEA your body can produce in a given period. At our practice we look first and foremost at adrenal function, using DHEA levels as one of several diagnostic tools. Think of our exhausted mother, Lisa. Like her, your adrenals work tirelessly to meet the demands placed on them until they are utterly tapped. Without adequate support, they spiral downward into adrenal fatigue and eventually adrenal exhaustion. Most of the women we see at our practice ? and I mean 99% ? have some indication of adrenal fatigue, including symptoms of low DHEA levels, such as: Extreme fatigue Decrease in muscle mass Decrease in bone density Depression Aching joints Loss of libido Lowered immunity But simply adding more DHEA to the equation is not the answer ? despite what some of the popular products claim. DHEA alone can?t fix adrenal fatigue (don?t believe any product that says it will!), but it can be an important factor in a combination approach that includes hormonal and nutritional support, lifestyle changes, and proper rest. (For more information on adrenal function and adrenal exhaustion, see our article on adrenal fatigue.) Remember that DHEA is just one stop along the metabolic pathway ? it doesn?t work in a vacuum. How it gets converted comes down to your individual biochemistry ? some women may use it to make more estrogen, others may make more testosterone. Just throwing a pill into the mix without understanding the bigger picture is never a wise choice. Because having too much DHEA, or converting DHEA into too much of one hormone and not enough of another, can be as upsetting to your body as not having enough. A delicate hormonal balance So, you can?t look to DHEA supplementation as a stand-alone solution. It just doesn?t work that way. DHEA is one part of the whole concert of hormones at work every moment in your body. Before you tinker with that balance it?s a good idea to understand what is going on in your life on all levels ? physiologically and emotionally. After menopause or a hysterectomy, when your adrenals become the primary hormone factory, we see women in whom the ratio of DHEA that is converted into testosterone outweighs what?s converted into estrogen and progesterone. This can cause bouts of increased irritability and unusual body hair growth, especially when DHEA supplements are given without prior and follow-up testing of total and ?free? testosterone levels. ?Free? testosterone is the portion of the hormone that is biologically active in your bloodstream. After menopause, a woman may have volatile levels of free testosterone at work, which accounts for some of the annoying male-pattern facial hair that?s common during the transition. Most doctors only test total testosterone levels, not the combined amount. Adding DHEA to this scenario can tip the scale drastically. On the other hand, I?ve also seen patients who convert most of their DHEA into estrogen. In this case, DHEA supplements create a different kind of estrogen-progesterone imbalance with symptoms similar to PMS, including breast tenderness and mood swings. (See our article on estrogen dominance.) Even though we?ve been trained in our culture to expect a one-size-fits-all drug cure for every health issue, ingesting a powerful hormone like DHEA can be unpredictable ? and in some cases, risky. That?s why we advise our patients not to self-medicate. The trouble with over-the-counter DHEA supplements Nowadays you can buy DHEA over-the-counter as a matter of course in a confusing variety of doses and combinations. Most of these DHEA products are geared toward men, but I?m seeing more and more aimed at women. The labels claim DHEA will help us lose weight, rev up our libido, lift depression, and give us back the strength, immunity, and stamina we had when we were 20 ? the age at which our bodies naturally produced the most DHEA. While on the surface this is appealing (who wouldn?t want to feel 20 again?), it?s obviously not what nature intended. We also don?t know enough about DHEA to be conducting such a large, unregulated public experiment. DHEA is a potent steroid ? that?s why it?s been in the headlines and why it should be approached with due diligence. Without a comprehensive medical test it?s impossible to know what your DHEA levels are. Just because you?re getting older doesn?t automatically mean you?re deficient. Remember, this is a natural substance ? our bodies can produce more or less of it depending on our nutrient support, metabolism, hormonal balance, activity level and emotional state. In fact, there are many studies that show you can improve your DHEA levels naturally by maintaining a body mass index of 19-25, getting adequate rest and exposure to sunlight, exercising regularly (including sexual activity), and fostering more ?downtime? in your life ? but more on that in a moment. Also remember that any time you buy a supplement at a health food store you have no guarantee that what you are buying is the real deal. There are few regulations in place to police the manufacturing process or the product itself. (This is one reason we have our nutritional supplements made specifically for us by a manufacturer who tests every single batch.) Many of the DHEA supplements I see at my local store have very high dosages ? way too high for most women (often as much as 20 times what I start my patients on!). While there?s no way to tell how much of that you might actually absorb, I think it?s especially unwise to experiment with DHEA at these levels without medical supervision. Furthermore, taking DHEA alone won?t do any good if your adrenals are exhausted. There are too many other factors at work. You need to know the status of your adrenal function and your other hormones before you can even begin to know what kind of combination of support your body needs. That being said, if you?ve been taking a DHEA enhanced product ? don?t worry! Just call your doctor or medical practitioner and ask to get your hormones tested ? then you will know how to proceed. How we test for DHEA at our practice If I suspect adrenal fatigue, hormonal imbalance or a DHEA irregularity in a patient, the first test I order is a hormone panel. I check estradiol in the follicular phase (usually days 3?9 of a menstrual cycle); progesterone in the luteal phase (days 14?28); DHEA; and both free and total testosterone levels. I like to see estrogen, progesterone, and DHEA in the upper quadrant of normal. What many traditional medical practitioners consider normal is a little low in my opinion. I think there are many women who fall just shy of the bell curve in either direction, but still in the range of ?normal? by current standards, who have legitimate health problems. (When such women go to a conventional practitioner feeling awful they are told there?s nothing wrong.) But I don?t just go by the numbers. I always look at how a woman is feeling; what demands she?s placing on her body ? particularly her adrenals ? and her emotional state. Sometimes a woman can test normal by conventional standards and still need a slight, temporary boost. What if you need DHEA? If tests indicate the need for DHEA supplementation, I start patients off with as little as 5 mg, two times per day. It?s possible to slowly up the dosage if further tests warrant it, but I find I rarely need to use more than 10?12 mg per day ? almost a homeopathic dose. I use only pharmaceutical-grade DHEA compounded by a reputable pharmacy. That way I can be confident that what I?m prescribing is actually what the patient will get. The kind I use comes in liquid drops - I prefer them to tablets. If your doctor is unaware of a reliable compounding pharmacy in your area, log in to the International Academy of Compounding Pharmacists? website to access their referral service. Once a patient is taking DHEA, I closely monitor how she is metabolizing the hormone through regular tests and face-to-face check-ups. Many women don?t need to take DHEA for an extended period of time ? once our bodies return to balance we?re usually more than capable of making what we need. Many of my patients in menopause who are taking bioidentical hormones also take DHEA to promote a good overall balance and vice-versa. DHEA can be a great bridge through menopause. Again, once balance has been restored and symptoms even out, most women produce enough DHEA on their own. Which brings me to the point I most want to make about DHEA ? its connection to joy. The best way to make more DHEA: cultivate joy As I said before, DHEA is just one small part of a much larger picture ? one that you can exert considerable influence over. Our bodies produce DHEA all the time. And it?s possible to measurably boost your body?s own production of DHEA naturally. Some studies show that people with a positive outlook actually create a self-sustaining cycle of DHEA production: they produce more DHEA, which may affect their levels of serotonin (the happy neurotransmitter; for more see our article on anti-depressants), which in turn gives them a better outlook ? which ups DHEA and so on. One proven way to boost levels of DHEA naturally is to find ways to cultivate joy in your life. This can mean different things to different people but overall there are some common threads when weaving this web of joy: Connection: Human beings are social creatures ? we like companionship. Connecting with family and friends in a healthy, loving way is one of the best joy-makers around. Or think long and hard about what you like to do for pleasure and reach out. Join a local class or group that shares your interest. Exercise: Moving your body, even through deep breathing and mild stretching, reduces stress, oxygenates your cells, and boosts mood-elevating substances in your bloodstream called endorphins. This process can actually change your body chemistry for the better. Meditation is also useful in this way. Spirituality: The ability to entertain the idea of some sort of larger power, be it natural or divine, is a powerful component of joy. Rituals of worship and contemplation, from a walk in the woods to yoga to prayer, helps us make space in our busy lives to focus on what is truly meaningful to us and who we really are. Play: Is it a coincidence that our levels of DHEA decline as we enter the grown-up world of work and responsibility? Who knows? It would be interesting to find out. But one thing is certain: playtime shouldn?t be just for kids. Sometimes I actually have to write out a prescription that reads PLAY so a patient can have fun without guilt. You too have my medical permission: go out and play. Kick up your heels ? it?s good for your health! I know none of this is easy to do in today?s non-stop world. Everything around us pushes us to have more, do more, be more ? is it any wonder our bodies eventually throw up a huge stop sign? The best time to foster hormonal balance, adequate DHEA levels, and healthy adrenals is before you hit that stop sign. So give yourself a time-out and check-in. You may find, with a little help, your body and mind are more than capable of taking care of themselves. The evolving wheel Feelings of health and well-being are never static. Like all things natural, they depend on a kaleidoscope of moving parts ? always changing, always unique. DHEA is just one part of this evolving pattern, one you can influence to create a better picture by changing your lifestyle and taking care of your adrenals(for more on this, read our article on adrenal fatigue). As with all things concerning your body, your mind, and your health, I hope you?ll learn as much as you can about yourself and find a medical practitioner you can talk openly with. DHEA should never be taken casually or unsupervised, but its benefits are real for the women who need it ? as are the physiological benefits of cultivating joy. I encourage you to embrace the possibilities inherent in both! Our Personal Program is a great place to start The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse?Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic. To learn more about the Program, go to How the Personal Program works. To select the Program that's right for your symptoms, go to Choose the plan that works for you. To assess your symptoms, take our on-line Hormonal Health Profile. If you're ready to get started, learn about our risk-free trial. If you have questions, don't hesitate to call us toll-free at 1-800-798-7902. We're here to listen and help. We?re always happy to welcome new patients to our medical clinic in Yarmouth, Maine, for those who can make the trip. Click here for information about making an appointment
  3. Some doctors are predicting that SOM 230 will be the new conventional treatment for Cushing's Disease. The trial has only included patients who achieved high ufc's on several occasions (untainted by any normal tests) Do you believe it will be an effective treatment for cyclical or intermittent Cushing's as well?
  4. This is the drug I am holding out for... My Dr. speculates this to become the new standard treatment in Cushing's Disease... we are inside of 2 years on its approval!
  5. What a great interview! Thanks for spreading the word
  6. Great work Debra! I told Dh last night I was going to make it a priority to find out who this guy was mess up his life by writinhg to everyone in his practice... hospital... every ethic board created for physicians. thanks dear, looks like he's messed up his own life. lol
  7. Robin, thanks again. I think this has the potential to change someone's life-- we were noticed
  8. Thanks Mary for the reminder-- I love these chats... Thank YOU!!! Hugs, Carrin
  9. I think the "smart" refers to the type of drug that GHB is... it is a said to enhance cognitive abilities. smart drugs
  10. Mellie, I am so sorry to hear about what your brother and sister has gone through. I imagine that this is a very touchy subject for you to talk about, I don't know that we ever really heal from these tragedies-- how can we? Thank you everyone for sharing your history, this thread will most definitely help others. I remember right before I became physically ill, I was struggling with huge amounts of depression,anxiety and experiencing panic attacks daily. I finally went to the dr. after several episodes of paralyzing despair. One of these epsidodes 6 years ago left me motionless on the kitchen floor crying for hours. I don't know how long because I actually "lost time" during that one. I felt like someone laid a blanket of despair over me. I wasn't crying over anything, I was just overwhelmed... completely and hopelessly overwhelmed. At this point in my life I wasn't thinking about suicide, but I was certainly picturing the world without me in it. Infinite sleep. I got myself to the dr. and cried and cried in his office-- I told him I thought I was going crazy. He replied that crazy people don't know they are crazy. It didn't make me feel better. He asked if I was suicidal, I told him I didn't think so. I did tell him, however, that I did picture the world without me in it a lot. I thought about going into a peaceful sleep and never waking up. He sent me home with a prescription for zoloft. No follow up necessary. My husband and I have talked about this a length and we feel that he did a huge disservice to me and my family. I was obviously not stable, this situation should have at least been referred on for psychiatric care and possibly even a hospital stay would have been warranted. I know that feeling hopeless and picturing life without you in it are different than suicidal thoughts & devising a plan, but I don't believe it is that far of a stretch. I did refer myself to get psychiatric care and I started seeing a counselor to help me keep these thoughts in check. Eventually, the mental illness aspect of my disease faded out and I haven't been on anything other than ativan prn for anxiety for a couple years. But, even though I feel I am "mentally" together right now it is always looming. I liken it to walking around with a bomb strapped to your chest-- you know the bomb is there, you know what the bomb can do, you just pray that today isn't the day it is going to go off. I have handed over the keys to husband, and I would suggest that everyone have someone they trust take the wheel in this area. Sign a contract with them before hand stating that if they notice these behaviors/emotions in you they will tell you and help you get the help you need. During a time of my lucidity I told him all the precursors and signs to look for and he is to sit me down and tell me if he feels we are treading in dangerous waters. I am so afraid that I will not recognize them, or worse ignore them until it is too late. Judy, I commend you for taking a wide-eyed interest in your children. Many parents choose not to "see" what is right in front of them, you are right to be concerned-- these are dangerous times for us especially-- the mental and physical illness combined are tortured. Cushing's Syndrome/Disease is direct violation of the Geneva Convention. It is not humane. To make a complex situation more confusing we are so afraid being labeled at "crazy" or "depressed" that we actually FEAR telling any medical professional about it because we know that it will only serve to muddy the water. Shame on them. I know that someday Cushing's will be a household name. In the last several years we have seen the once taboo "bipolar disorder" being paid attention to. People listened to those desperate people and they will hear us very soon. I just know it. I guess this is long enough, many hugs to you all! Carrin
  11. Lyndsey, this is exactly the place to discuss these things. I was discussing suicide and self-mutilation with another member... In myself I know that these tendencies are two entirely different things driven by different emotions, although many docs see them as one and the same. Right now I don't have either of these symptoms, however I have had them both in the past. My self-mutilation presents itsself as almost a compulsive behavior-- if there is something sharp I cut. If there is a small lesion I compulsively pick-- I cannot help myself. I have linked this behavior to sleep deprivation. Now, when I feel myself get to that point I have to medicate to sleep at night... you know so I don't completely lose my mind. I haven't been suicidal in my adult life (more when I was a teenager), however I imagine if my situation were different I really see how that could be an issue. If I didn't feel I had any hope, or support, or money to get help-- that would certainly create a sense of desperation that could cloud a mind that is already plagued with anxiety, panic, depression on top of constant pain-- and could definitely lead to those toughts. I just want to let you know that this is a safe place to vent freely and discuss these issues. If you ever need to talk, please feel free to call me-- really anytime. I get it-- it sucks, there is no way to sugar coat those feelings. sending hugs! Carrin
  12. Jules what that woman said is just horrible! I guess I understand where she is coming from, but it is still not something that you suggest to anyone... what was she thinking? Obviously this shows the correlation to the mental instability that Cushing's (diagnosed or diagnosed) creates in a victim. It is very sad.
  13. I was on the phone with a board member and we were talking about suicidal tendencies... so I thought this was relevant. Of course it isn't the whole article, just the abstract. Pituitary Tumors and Suicide Abstract Background: Current data suggest an influence of the hypothalamic-pituitary-adrenal axis on suicidal behavior. The frequency of pituitary adenomas in suicide victims has not yet been investigated. Objectives: The aim of this study was to assess whether the incidence of pituitary adenomas is correlated with suicide. Methods: Serial sections of 151 human pituitary glands obtained upon autopsy were examined microscopically. The glands were collected from 70 suicide victims and 81 subjects whose deaths were classified as unexpected or accidental (nonsuicidal group). The sections were stained with hematoxylin-eosin and the presence of adenoma was confirmed by immunostaining for collagen III. Results: In the suicidal group, pituitary microadenomas were found in 32 cases (47.7%), while in the nonsuicidal group microadenomas were detected in 15 cases (18.3%). The observed difference was statistically significant (p = 0.0003). The relative risk ratio of suicide in persons with pituitary adenomas was estimated at 1.9. Logistic regression analysis in a model controlled for age and sex showed that microadenomas constituted a unique risk factor in this model. The immunohistochemical phenotyping revealed a higher percentage of immunopositive (secreting) microadenomas in the nonsuicidal group as compared to the suicidal group (80.0 vs. 59.38%) and a predominance of growth hormone-secreting microadenomas in both groups. However, these differences as well as differences in the hormonal profiles of microadenomas between the groups were not significant. Conclusions: These results suggest that pituitary adenomas belong to suicide risk factors. Copyright ? 2007 S. Karger AG, Basel
  14. This is why no one will thoughouly test for cushing's and even dismiss patients with normal and abnormal results... they know that there is no legal responsibility on their part. Who, if not the doctors, should be held accountable for the delay of diagnosis and subsequent health complications?
  15. Even though this is geared toward body builders and not cushing's patients, I found it to be one of the most comprehensive explanations of what excess cortisol is doing to our bodies and why. -Carrin http://www.thinkmuscle.com/ARTICLES/jalali/cortisol.htm Muscle Breakdown: Is Cortisol Leading You Down the Catabolic Pathway? by Rehan Jalali Please send us your feedback on this article. Walk into any so-called "hardcore" gym these days, and you'll likely see 'em by the dozens. They're easy to spot? they're the guys who spend hours on end pushing up plates, searching for supreme physical perfection, yet rarely finding it. They are the hopelessly overtrained, and they're afflicted with that old Protestant work ethic: a little training is good, so a whole lot must be better. The very idea of producing a peak physique leads to a perverse temptation among these fellows to do all but pitch tent in the weight room and camp out there 24/7. "There's no such thing as overtraining," they declare. Indeed, they know a lot of clich?s and can spout them off with machine-gun repetition?No Pain, No Gain? If the Bar Ain't a Bendin', You're Just Pretendin'? Go Heavy or Go Home. But ask them anything specific about exercise physiology or the dynamics of muscle-fiber hypertrophy and repair, and they're as quiet as Tori Spelling playing Trivial Pursuit. The bottom line is, if you're among the band of hard-and-heavy lifters, cortisol may be literally eating away at your muscle-building potential. Weight training enthusiasts must declare all-out war on this catabolic hormone if they have any aspirations of building muscle. But before we attack all of your cortisol problems, some background on this intriguing subject is in order. After all, understanding leads to solutions (or was it madness?). Anyways, here goes?. Cortisol is the primary glucocorticoid. It is a natural hormone of the adrenal glands. Although cortisol's precise actions are not completely understood, we know that it is essential for life. Cortisol is necessary to maintain important processes in times of prolonged stress. Most of its effects are not directly responsible for the initiation of metabolic or circulatory processes, but it is necessary for their full response. Cortisol Synthesis: Cholesterol--> Pregnenolone--> Progesterone --> 17-Hydroxyprogesterone-->11-Deoxycortisol --> Cortisol. Cortisol can exert its effects on peripheral tissue. Once in circulation, cortisol is typically bound to a specific glucocorticoid-binding alpha2-globulin called transcortin. About 75% of cortisol is bound to transcortin, 15% to 20% bound less tightly to albumin, and 5% of circulating cortisol is unbound (1). This is an important factor to take into consideration when measuring cortisol levels. The 24-hour urinary excretion of unmetabolized cortisol is one of the best ways to accurately gauge cortisol levels. This helps take into account bound and free cortisol. Exogenous cortisol has a half-life of about 70 to 90 minutes. Cortisol can be converted to its 11-keto analogue cortisone (you know, the stuff you take when you have some bad swelling or inflammation). The major catabolic effects of cortisol involve its facilitating the conversion of protein in muscles and connective tissue into glucose and glycogen (cortisol may increase liver glycogen). Gluconeogenesis involves both the increased degradation of protein already formed and the decreased synthesis of new protein. Cortisol can also decrease the utilization of glucose by cells by directly inhibiting glucose transport into the cells (1). A cortisol excess can also lead to a decrease in insulin sensitivity. Cortisol also reduces the utilization of amino acids for protein formation in muscle cells. A cortisol excess can lead to a progressive loss of protein, muscle weakness and atrophy, and loss of bone mass through increased calcium excretion and less calcium absorption. That is one of the reasons long-distance runners tend to have skinny physiques. With the amount of stress that runners place on their bodies, they have high levels of free radicals as well as cortisol. Excess cortisol can also adversely affect tendon health. Cortisol causes a redistribution of bodyfat to occur through an unknown mechanism. Basically, the extremities lose fat and muscle while the trunk and face become fatter. Some of the signs of overtraining include higher cortisol levels, which may cause depression-type effects. Cortisol excess can also lead to hypertension because it causes sodium retention (which can make you appear bloated) and potassium excretion. In other words, excessively high cortisol levels may turn you into a girly man! So the real challenge becomes how can cortisol levels be controlled but not inhibited completely because of cortisol's necessary anti-inflammatory effects? One way is to take anti-cortisol supplements in the morning upon rising and then before bedtime, as these are two times that cortisol levels seem to be raised. Timed release would not be an option here because this may suppress cortisol levels over too long of an extended period. The key is to suppress elevated levels of cortisol, not decrease normal physiological levels of this hormone because as I mentioned earlier, a small amount is needed for it's anti-inflammatory and other effects. Another one of cortisol's undesirable effects for athletes is it causes insulin resistance by decreasing the rate at which insulin activates the glucose uptake system, likely because of a post-insulin receptor block (2). Any type of stress that occurs to the body signals the nervous system to relay this to the hypothalamus. The hypothalamus then responds by initiating the stress-hormone cascade starting with CRF (corticotrophin releasing hormone) followed by ACTH (adrenocorticotropic hormone) release, and finally glucocorticoid production (pretty intense, huh?). Stress to the human body can include trauma, anxiety, infections, surgery, and even resistance training and aerobics. Recent research has shown that increased cortisol levels also increased protein breakdown by 5% to 20%. (3) Even mild elevations in serum cortisol can increase plasma glucose concentration and protein catabolism within a few hours in healthy individuals. (4) Cortisol increases with increasing time of intense exercise. In overtrained individuals, cortisol levels increase while testosterone levels decrease. That is why one measure of overtraining is the testosterone: cortisol ratio. By the way, overtraining is defined as an increase in training volume and/or intensity of exercise leading to a decrease in performance. Cortisol can increase bodyfat levels especially when it's increased dramatically in the body. Increased cortisol levels have an adverse effect on testosterone levels. In fact, one of the primary anti-catabolic effects of testosterone and anabolic steroids is it's decreasing muscle cortisol metabolism. (5) That is one reason why many athletes can completely overtrain when taking anabolic steroids and still increase lean body mass and strength. Some research indicates that cortisol response to resistance training normalizes after about five weeks and that the testosterone: cortisol ratio is not adversely affected after long periods of resistance training. (6) This suggests that the body has an adaptive response. Cortisol can inhibit growth-hormone levels by stimulating the release of somatostatin (a growth-hormone antagonist). It may also reduce IGF-1 expression (IGF-1 is one of the most anabolic agents in the body and is the substance that is responsible for most of growth hormone's positive effects because GH converts into IGF-1 in the liver). Cortisol has other hormone-modifying effects. Cortisol can directly inhibit pituitary gonadotropin and TSH (thyroid stimulating hormone). (7) By doing so, it can make the target tissues of sex steroids and growth factors resistant to these substances. It may also suppress an enyme known as 5' deiodinase, which converts the relatively inactive thyroid hormone T4 to the active one known as T3 or triiodothyronine. This can decrease metabolic rate and make it harder to lose bodyfat (it's already hard enough for people and anything making it harder definitely needs to be kicked to the curb). There are different stages in sleep and during one stage, cortisol levels are elevated because protein is being re-cycled. This is one reason that cortisol-suppressing supplements should be taken before bedtime to help minimize excess cortisol production during sleep. Cortisol also seems to play a role in various disease states. It is found in higher-than-normal levels in diseases ranging from AIDS and multiple sclerosis to Alzheimer's. Prolonged high levels of cortisol can throw the immune system into chaos and ravage the human body. A growing number of researchers believe that many of the worst, and least-understood, diseases will soon be identified as caused by high cortisol, and subsequently treated with cortisol- reducing drugs or supplements. There was an anti-cortisol conference (the second one ever conducted) held in Las Vegas in 1997 and headed up by Steroidogenesis Inhibitors Inc. and Dr. Alfred T. Sapse. This conference had many researchers involved in anti-cortisol research. Abstracts were presented on various supplemental and drug therapies for decreasing cortisol levels, especially in excessive cortisol-production disorders. In particular, there was an abstract presented by Dr. Sapse that mentioned some nutritional supplements to lower cortisol levels in the body. These included gingko biloba, Vitamin A, Zinc, and acetyl l-carnitine (8). Other abstracts presented there discussed the role of DHEA and its metabolites in helping to decrease cortisol levels. (9) Some abstracts presented looked at the progression of cortisol-induced diseases. Overall, the conference was very informative and helped researchers answer many questions on cortisol and anti-cortisol therapies as well as opened the door for further anti-cortisol research. Cortisol suppression may be an essential part in the recovery process for athletes involved in a rigorous training program. In fact, one of the signs of overtraining syndrome is high cortisol levels. Moderating (not completely diminishing) cortisol levels is an essential factor in allowing weight-training individuals to completely recover from their exercise session and maximize results (something we would all like to do). It may be a very good idea to get cortisol levels tested by a qualified physician (when I say qualified, I mean one who has done this sort of thing before and has been to medical school) on a regular basis. One of the best times to test cortisol levels is first thing in the morning on an empty stomach. This reference value or proper range for cortisol first thing in the morning should be between 4 mcg/dl and 19 mcg/dl with the sample being taken from blood. The normal range for free cortisol levels measured from urine is between 10 pg/ml and 110 pg/ml. There is also another way to measure cortisol through a salivary cortisol screening. The normal range for cortisol with this test first thing in the morning is between 100nmol/L and 300nmol/L. These tests may not have the final say in determining high cortisol levels but, it will certainly give you an idea about where your cortisol levels stand. Controlling Cortisol Levels Here are some solid tips to help control cortisol levels: 1) Diet: Make sure you are supplying your body with all the essential nutrients you need to prevent deficiencies and for optimal function. This includes plenty of high-quality protein, complex carbohydrates, essential fatty acids, and vitamins and minerals. Try not to restrict calories continuously as some research suggests that restricting normal caloric intake by 50% can lead to a subsequent increase in cortisol levels by 38%. (10) 2) Do not overtrain: Try not to work out three or more days in a row without taking a day off. Keep workouts to under an hour at the most and train efficiently and intensely. I know this phrase has been beaten to death but LISTEN TO YOUR BODY! Take enough rest days between workouts - If you are really sore, then wait an extra day to train until your body fully recovers from your previous workout. Remember, less may be more in this case. 4) Relax and try not to get stressed out easily: Take an evening walk with a loved one or take a nap when you get a chance. 5) Try to get at least eight hours of sleep per night: Sleep is crucial to the recovery and recuperation process. 6) Spike Insulin levels after a workout: Insulin actually interferes with cortisol and may enhance cortisol clearance from the body. Spiking insulin levels after a workout (by consuming a high-glycemic index carbohydrate) may help minimize excessive cortisol levels since cortisol levels are elevated significantly post resistance training. Supplements that may help control increased cortisol levels secondary to intense exercise Phosphatidylserine (PS):This phospholipid, which has been known mainly for its cognitive effects, seems to have cortisol-suppressive properties. Recent research shows that 800 mg Phosphatidylserine given in two divided oral doses helps suppress cortisol secondary to intense weight training. (11) In fact, in this same study, the individuals using PS experienced less muscle soreness as well. Earlier research by Monteleone confirms these results. By decreasing cortisol levels, the testosterone: cortisol ratio can increase possibly relating to anabolic effects. PS seems to only decrease cortisol levels when they are elevated and does not seem to decrease cortisol levels below normal. Decreasing cortisol levels or suppression of cortisol production is not desired in many instances as it may cause adverse effects such as a decrease in reaction time to wounds and healing mechanisms in the body. There are two forms of PS available: a brain cortex derivative and a soy lecithin derivative. The brain cortex PS has been used in most of the studies and shown to be effective. Acetyl-L-carnitine: This is basically the acetylated ester of L-carnitine. This supplement may help prevent the decline in testosterone that occurs during and after an intense resistance training session. It seems to lessen the response to stress. L-Glutamine: This is the most abundant free amino acid in muscle tissue. (12) It seems to play a very important role in protein synthesis and is very important to weight-training athletes. Some research suggests that glutamine levels may be a good indicator of overtraining or overreaching. (12) In other words, athletes who were overtrained generally had low levels of glutamine along with high levels of cortisol. One study actually showed that glutamine directly prevents the cortisol-induced degradation of muscle contractile proteins.(13) Some of its positive effects include enhancing protein synthesis; increasing GH levels, which can counteract some of the catabolic effects of cortisol; potent cell-volumizing effects, which can create an anabolic environment in muscle cells; and partially determining the rate of protein turnover in the muscle. An oral glutamine supplement can help athletes prevent some of the symptoms of overtraining. It may also enhance glycogen synthesis through an unknown mechanism. It also helps provide a source of fuel for the small intestine and may enhance anti-inflammatory function. It has been shown to boost immune function. I hope you get the point -Glutamine is a vital nutrient for weight-training athletes. Vitamin C: This vitamin, mainly known for it's anti-oxidant properties, may also have some anti-cortisol effects. A study done by Stone entitled "Effects of Vitamin C on Cortisol and the Testosterone: Cortisol Ratio" showed a decrease in cortisol levels in 17 junior elite weight lifters. This study also showed that the individuals taking Vitamin C (an extra gram a day) improved their testosterone:cortisol ratio by over 20%. This type of decrease in cortisol can lead to increased muscle and connective-tissue hypertrophy and enhanced recovery from training. Since Vitamin C also decreases your chances of suffering from a cold or flu infection by 30% (14) and may aid in collagen synthesis, it would be wise to take some extra vitamin C when involved in an intense weight-training program. Zinc: A mineral that is an essential cofactor in over 300 enzymatic reactions in the body including testosterone synthesis and steroid hormone production. Getting enough zinc may make the difference between making great gains and only making average gains in a weight training program. Vitamin A: This vitamin, which is often times used for healthy skin function, may also minimize cortisol levels according to Dr. Sapse. He suggested this in an abstract he presented at the 1997 conference on cortisol and anti-cortisols. (8) Gingko Biloba: This herb is mainly used for its excellent cognitive effects by increasing blood flow and oxygen to the brain, which can lead to greater mental focus and concentration. It may also have additional benefits of decreasing cortisol levels according to an abstract presented at the 1997 conference on cortisol and anti-cortisols. (15) The anti-stress and neuroprotective effects of ginkgo biloba in this study were due to its effect on glucocorticoid biosynthesis. The EGb 761 standardized gingko biloba extract was used in this study and many of the studies showing that it enhances cognition. DHEA: This natural hormone of the adrenal glands that declines after the age of 30 seems to have some powerful anti-cortisol effects. Many abstracts presented at the 1997 conference on cortisol and anti-cortisols discussed DHEA's role in decreasing cortisol levels. DHEA is fat soluble so it can cross the blood-brain barrier and have some effects on cognition as well. Androstenedione: This prohormone is a direct precursor to testosterone, which may explain its anti-cortisol effects since increases in testosterone can blunt elevated cortisol levels secondary to intense weight training. Different metabolites of androstenedione and testosterone, such as 4-androstenediol, 5-androstendiol, and nornadrostenediol, may also exert some anti-cortisol effects. However, more research needs to be done in this area to make this clear! Androstenetriol: This steroid metabolite, which is chemically known as Delta 5-androstene-3b,7b,17b,triol, was shown in an abstract presented at the 1997 conference on cortisol and anti-cortisols to counteract the immunological effects of glucocorticoids. (16) This is an interesting compound that definitely needs to be looked at further. Conclusion This is a subject that will be studied thoroughly in the future. Studies investigating supplemental strategies against cortisol may help weight trainers get the most out of their workouts and help enhance the recovery and recuperation process. Now before you think suppressing cortisol levels can make you Hercules, remember, cortisol levels are one piece to a large and complex puzzle. It takes a combination of proper training, nutrition, and supplementation to achieve your true muscle-building potential. However, getting cortisol levels checked by your doctor and implementing strategies against cortisol may be a good idea, especially during a calorie-restrictive dieting phase. So, the next time you feel tired, sluggish, or sore for an abnormally long time in your weight-training program, and you don't know why, look into cortisol levels, and you might find the answer. References 1. Griffin J, Ojeda S. Textbook of endocrine physiology, 3rd ed. New York: Oxford University Press, 1996. 2. Rizza, et al., "Cortisol-induced insulin resistance in man. Impaired suppression of glucose production and stimulation of glucose utilization due to a post receptor defect of insulin action," J Clin Endocrinol Metab 54 (1982) : 131-138. 3. Brillon, et al., "Effect of cortisol on energy expenditure and amino acid metabolism in humans," Am J Physiol 268 (1995) : E501-13. 4. Simmons, et al., "Increased proteolysis: an effect of increases in plasma cortisol within the physiological range," J Clin Invest 73 (1984) : 412-420. 5. Hickson, et al., "Glucocorticoid antagonism by exercise and androgenic- anabolic steroids," Med Sci Sports Exerc 22 (1990) : 331-340. 6. Fry, et al., "Resistance exercise overtraining and overreaching. Neuroendocrine responses," Sports Med 23.2 (1997) : 106-129. 7. Chrousos, et al., CRH, Stress and Depression: An Etiological Approach (Las Vegas, NV: Conference on Cortisol and Anti-Cortisols, 1997) 8. Sapse, et al., Anticortisols in the Treatment of Retinitis Pigmentosa (Las Vegas, NV: Conference on Cortisol and Anti-Cortisols, 1997) 9. Baulieu, et al., Anticortisols: Their Potential Usefulness (Las Vegas, NV: Conference on Cortisol and Anti-Cortisols, 1997) 10. Kelley, et al., "Energy restriction and immunocompetence in overweight women," Nutrition Research 18.2 (1998) : 159-169. 11. Fahey, et al., Hormonal Effects of Phosphatidylserine (PS) during two weeks of intense weight training (Orlando, Fl : ACSM Conference, 1998) 12. Rowbottom, et al., "The emerging role of glutamine as an indicator of exercise stress and overtraining," Sports Med 21.2 (1996) : 80-97. 13. Hickson, et al., "Glutamine prevents down regulation of myosin heavy chain synthesis and muscle atrophy from glucocorticoids," Am J Physiol 268 (1995) : E730-E734. 14. Anderson, et al., "Vitamin C and the common cold: A double-blind trial," J Canadian Med Assoc 107 (1972) : 503-508. 15. Papadopoulos, et al., Regulation of Glucocorticoid Synthesis by the Ginkgo Biloba Extract EGb 761 and isolated Ginkgolides (Las Vegas, NV: Conference on Cortisol and Anti-Cortisols, 1997) 16. Norbiato, et al., In Vitro Immunomodulatory Effects of Delta 5-Androstene-3b,7b,17b Triol (AET) in Hypercortisolemic Patients (Las Vegas, NV: Conference on Cortisol and Anti-Cortisols, 1997)
  16. Wow, sounds like he would be considered a friend to cushies.... I would be curious to see if anyone has used him or if someone local would be willing to see him to find out how "open" he truly is.
  17. I get mine free at the hospital lab and at quest lab when I pick up jugs. I did purchase one at a medical supply store for 50 cents before I knew they were giving freebies
  18. huh... am I the only person who can make little sense out of these journal articles? lol Thanks for sharing though My brain simply isn't working the way it should.
  19. http://www.cbsnews.com/stories/2007/05/23/...in2842951.shtml I saw this piece this morning and thought it was worth sharing.
  20. I know a person who is rep-- a few months back they got an email that they needed to use $1500 in food expense during the next week. They HAVE to buy food for the dr's and offices. These are often full catered meals. I have family in the medical profession and they talk about "subway day" - "mexican day" etc. The office staff have standing orders... so the rep knows what they want on their sandwich. Obviously... I know this is life and sales. Afterall the reps get commission for every script the dr. writes-- and they have to make a living too, and they do work hard for their paycheck. I also should add that I am very very appreciative of the occasional "free" sample. But it seems there should be a balance to all of this-- ???
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