Adrenal Stress Index Results

Here are my current cortisol lab results:
Hormone Test 3/23/2012 11/14/2012 6/30/2013   Units Range
DHEAS (saliva)
15.4
5.3 8   ng/ml 2-23 (Age Dependent)
Cortisol Morning (saliva) 9.6 7.6 5.8   ng/ml 3.7-9.5
Cortisol Noon (saliva) 1.3 1.3 1.5   ng/ml 1.2-3.0
Cortisol Evening (saliva) 0.9 1.3 1.4   ng/ml 0.6-1.9
Cortisol Night (saliva)
0.5
1.6
0.3
  ng/ml 0.4-1.0
Current results are in bold, and are shown compared to the last 2 times I had this test done (about a year ago and about 6 months ago).  According to Dr. Myhill, I’m recovering, as evidenced by normal DHEAS  and low cortisol.  Great.  Well, most things are in range – night time cortisol is a bit low, but I’m not sure I care about that, except that suggests overall low cortisol production.  I’d like morning and noon levels to be higher.  I guess I’ll be looking into adaptogens and supplements.  We’re all moved in to the new place.  I’m looking forward to things.  I have been sleeping well and don’t feel completely tired.  I think I just need to go to bed at a reasonable time.

Virgin Diet – Day 4

For the first time this week I really wanted carbs today.  I suspect this is related to drinking wine last night.  Didn’t give in though – still adhering closely to the rules of the Virgin Diet.  I have learned a couple of things about myself in the last few days.

I’ve always loved sushi – today I found out it’s not nearly as delicious when it’s not drenched in soy sauce (which is made of wheat and soy – 2 items banned by this diet).  Still good though, but not head-exploding good as it usually is for me.  Also, I learned that when I accidentally let my blood sugar get too low it takes me a long time to recover and for the next several hours – even after eating and after feeling relatively full – my appetite stays high.  A couple days ago it was 5 or 6 hours after breakfast – I was enjoying not thinking much about food and just sort of let it ride and skipped lunch.  Then around 3PM my blood sugar dropped quickly and I felt ravenous.  I was at a store and there was nothing on-plan to eat with me or in my car.  I was feeling pretty bad by the time I actually got to eat – my blood sugar had dropped further and I was really irritable.  I ate shrimp and vegetables and a broth-based soup – enough that I should have been full…but I just wanted to keep eating.  I ate probably the equivalent of another dinner over the next several hours – I just felt driven to keep eating.  It was like my body was programmed to stock up to avoid the inevitable next famine.   Anyway, I stayed on plan with everything I ate, and the next day the scale was the same.  If I had eaten even one piece of bread though, I know it would have all been stored as fat.

The scale today was down another pound – so that’s 2 pounds since I started this, and I’m not attempting to eat low carb/ketogenic/low salt – I’m just avoiding those 7 foods.  I’m eating rice and potatoes and drinking wine.  The loss today could be dehydration from drinking wine last night, so we’ll see what happens tomorrow.

So far it’s a tentative thumbs up for the Virgin Diet.

What I’ve eaten today:

Breakfast: Wild-caught salmon fillet sauteed in coconut oil and 1/2 of an avocado.

Lunch: 2 grass-fed hot dogs with dijon mustard

Snack: sushi (minus soy sauce but with rice and wasabi)

All I drink is water.  I do use caffeine pills – not the greatest thing ever if you have adrenal fatigue, but I don’t care.  I take in the equivalent most days of one cup of coffee.  I actually think my adrenal fatigue is getting better.  When I was in California and for the first few weeks after getting back here I had a very hard time getting out of bed in the morning.  Now it’s much easier – closer to how it was before we went West. I also get tired earlier at night.  This indicates to me that my cortisol is higher in the morning and lower at night again.  So things seem to be turning around for the better.

More Steps

Got my labs drawn yesterday.  I don’t know if they’ll be covered by insurance.  It doesn’t matter.  I don’t understand insurance.  If labs are drawn by the clinic I go to for my primary care but are ordered by a doctor who may or may not be covered, then are the labs covered?  I don’t know.  I figure I’ll be notified if I owe some dough.

Sorry for my extremely whiny post yesterday.  I have been feeling sick and run down this week.  I was diagnosed with Asthma 10 years ago and have had very few issues with it over the last 3 years or so…but this week I’m having a hard time breathing.  I thought I was getting sick but all it is is trouble breathing.  I brushed the dust off of my Albuterol inhaler yesterday and using it seemed to help, so I’m wondering if I’m having an allergic reaction to something.  I do live in farm country and we haven’t had much rain.  Could be lots of dust in the air.  All I know is if I can’t breathe nothing feels right.  I’ve arranged to take a day off work this week to get caught up on other things and to rest.

It occurs to me that if I start hormone therapy I won’t be able to do CT for quite a while.  The PA will be monitoring my hormone levels for 2-3 months at least, and it’s going to cloud the picture if I’m releasing extra estrogen into my system via CT.  Well, that’s ok I guess.  I miss doing it but also I suspect my cold tolerance will be better when my hormones are optimal.

In the interest of adrenal recovery, I borrowed an emWave from a friend so I can try out biofeedback.  I’ve experimented with it just a little in past years, but never with any real intention or motivation behind it.  Now that I know what my health issues are I feel very motivated to fix them.  Stress and cortisol management are clearly among them.

I’ve been reading lately that hormonal problems can lead to fatigue, as can adrenal/cortisol issues.  My energy picked up quite a bit just by doing the Leptin Reset.  Before I could barely scrape myself off the couch after work, and always needed a nap.  If I couldn’t take a nap for whatever reason I would just cry with frustration.  Now it’s better but I still wish I could just lie around a lot more than I do.  My husband thinks it’s normal to feel that way when you have  2-year old and a job.  I think it might be typical, but that doesn’t mean it’s normal.  Previous generations were busy all day long finding food, cooking, cleaning, and teaching and raising their kids instead of plopping them in front of the TV.  There’s a certain level of energy that human beings should have but don’t, and we don’t even question it.  I want to have energy all day long and feel lit up about life. I don’t want to need caffeine to function.

The PA emailed me yesterday to let me know she’ll contact me after she receives my labs.  I appreciated that, and I’m very glad she’s open to communicating via email.  I was so busy complaining yesterday that I forgot to mention, I did really like the PA.  She seems to be confident she can help me, and in fact was in the same situation when she was my age, about 5 years ago.  I’m looking forward to working with her.

Need a Break

I’m tired of being tired.  Now that I’ve pressed the pause button on CT you would think I’d be getting more done…you know, with that extra time I’ve freed up.  Nope…I’m just going to bed earlier and waking up earlier and it feels like nothing’s changed.  I think I’m down a bit because I’m feeling under the weather.  I have a cough that seems to be getting worse.  I just want to take a day off from everything.  But life keeps on rolling in like a tireless ocean of crap to do.

I was thinking it would be cool to attend the Ancestral Health Symposium coming up next month in Boston.  It’s sold out but I got a notification yesterday that my turn on the waiting list had come up and I could buy tickets if I wanted to.  I thought about it…it would mean 3 days away from babykins and 2 days away from work…and it wouldn’t even be relaxing.  It would be running around learning stuff.  And expensive.  So I decided not to.  If I’m going to be away from my little one for that long it needs to be to a spa or something…I just desperately need a break.

I notice I start talking about needing a break around the time I feel I’m getting behind on things in my life.  Things are nagging at me, nagging at me…I think I need a break from nagging myself.  In the future when I take consulting work (over and above my full-time job) I’m just going to have to get the paperwork end of it done the same day.  Otherwise it just hangs on and burns out my adrenal glands with stress.

Lifestyle changes that I will make RIGHT NOW to fix my adrenal glands:

  • Get sleep.  Go to sleep when I’m tired.  Yes, it’s boring.  Do it anyway.
  • Finish paperwork for consulting jobs on same day of consultation so it’s not nagging me.
  • Look into emWave and/or other biofeedback systems to learn to manage stress better.
  • Start doing some kind of yoga – even just a little every day, like a few sun salutations.
  • Take a break once a month (omg…it’s hard for me to even write this! What the hell is wrong with me that I can’t take a break?!?!  Geez, can’t imagine why I have adrenal fatigue…).  This may involve taking a half day off work and going somewhere relaxing outside or going to a movie alone…or something.  Or maybe even a full day!  Yeah!  That’s it…I’m scheduling it NOW.  Wait, I don’t have my calendar in front of me.  I’m scheduling it TOMORROW.  For real.

Here’s a decent article on Cortisol a friend passed on to me.  It answered some of my questions about why cortisol is good when managed well and bad when it’s abused.

My name is Lanie and I’m a cortisol abuser.

Studying the Adrenals

The PA got back to me and yes, she does prescribe BHRT for women who are still menstruating.  Yay!

I’ve been reading more about adrenal fatigue around the interwebs.  I’m starting to understand the role of physiological stress (not just psychological stress) in adrenal burnout.  I’ve been sort of blaming my pedal-to-the-metal approach to life for my current adrenal/cortisol issues…but it really looks like a life of food intolerance made things a lot worse too.  Apparently (and keep in mind this information is from “the internet” so I’m not sure of it’s credibility), cortisol is an anti-inflammatory.  So whenever you do something that causes inflammation (eating grains or dairy, for example, or depriving yourself of sleep), the adrenals have to put out cortisol to deal with it and quell the inflammation.  Years and years of this and you get adrenal fatigue.  I was reading about adrenal fatigue instead of taking a nap yesterday, while the little one was napping.  I just didn’t want to nap – I wanted to read.  Then I got to a website that said,

When we force ourselves to push through that groggy afternoon slump time, it triggers a stress response from our adrenals, forcing them to produce more cortisol when what they are trying to tell us is that they need a break!

So I put the iPad down and took a nap.

Same thing last night – I had a lot to do but instead listened to my body at 9:30PM and went to bed.  I think that’s just what I have to do now.  Stop pushing so hard, start listening to my body, and start learning to say no.  I like this website about Adrenal Fatigue, by the way…lots of interesting information that seems to support other things I’ve been reading.

My body seems to have stopped with the poor temperature regulation and weird hormonal surges/dips.  It’s been about 6 days off CT.  I was listening to Dr. Kruse’s webinar on hormones.  It’s very densely packed with information – it’s literally an hour and a half of him talking very fast.  At least I think it is – I only made it 30 minutes so far.  He did say, regarding the adrenals, that CT increases CRH and ACTH, which lead to more cortisol output.

The hypothalamus sends CRH to the pituitary, which responds by secreting ACTH. ACTH then causes the adrenal glands to release cortisol into the bloodstream

So lots of reasons to get back into the water.  I think when I resume CT in a week or two I’m going to try something different.  I notice when I was just doing the Leptin Rx with no CT my sleep got very regular – I didn’t even need an alarm to wake up.  I think I started feeling stressed and drained after starting CT because I was doing the baths at night.  They increased cortisol and made me feel very productive and not much like sleeping.  Instead I’m going to try to take them in the morning.  I’m not extremely excited about a 50 degree bath first thing in the morning (well, second thing…after the BAB), but I seriously need to start honoring  my sleep at night. So that’s what I’m looking at.  The baths may be shorter on days I have to be at work very early.  This will no doubt cut into my blogging time, most of which is in the morning.  I’ll have to work it all out.  I really just need to learn to prioritize.

One thing I’m not clear about though…I have heard that cortisol overproduction causes increased belly-fat.  I think it is the case then that it’s the overproduction that precedes adrenal exhaustion, and that overproduction leads to belly fat.  If you keep on pushing through you get to where I am now – adrenals are fatigued (but not dead yet!) and now under-producing cortisol.  So how come my belly fat doesn’t go away now that I don’t have so much cortisol?  Maybe I’ll go back and read Dr. K’s blog on this matter.  Usually I start to understand him after reading for the 4th or 5th time.

Currently my social needs and my me-time is out prioritizing my health.  That’s just not right.  I need to have a real heart-to-heart with myself about this.

Oh well…don’t have time. 🙂

______________________

Citation: http://www.daviddarling.info/encyclopedia/A/adrenocorticotropic_hormone.html

Frustrated

I noticed in the last couple weeks I catch myself saying “Fuck it.”  and just eating even though it’s not meal time.  It’s always in keeping with ketogenic Paleo, but twice in the last week I’ve been hungry/hypoglycemia outside mealtimes and ate a snack anyway, whereas a couple months ago I would have white knuckled it until the next meal.  I just hate being hungry.  I’m not sure if the hunger/hypoglycemia has gotten worse or if my tolerance for it has gotten worse.

It pisses me off that I’m experiencing hunger almost every day and yet I’m not losing weight.  I never eat till full – always just till satisfied, and I’m always hungry before meals (except, ironically, before breakfast, the most humongous meal of the day).  I just don’t understand why I’m not losing weight.  I am not going to count calories.  When I count and restrict calories it smacks of the conventional wisdom of dieting which has NEVER worked for me long-term, and which makes me feel terrible about myself – as if I need to pay for my imperfection by being hungry.  Fuck that.  It doesn’t make sense to me.

All of this makes me wonder if I’m missing something.  Maybe I’m eating something that I’m intolerant to…?  Some people have to give up coconut oil completely to end a stall. Maybe I should try that.

I know Dr. K. says it can take “longer” when you have hormonal issues, whatever the hell that means.  So ok…maybe I have hormonal issues.  But which hormones are having issues?  I’ve suspected cortisol, and I definitely have a body shape that suggests cortisol is an issue (excess fat around the middle).  I have some of the symptoms of adrenal fatigue (like needing caffeine to get through the day, fatigue) but I don’t have others (like problems sleeping, difficulty getting up in the morning, slow recovery from illness, frequent illness).  Plus my cortisol labs looked relatively normal – no shortage of cortisol in the AM, which can be a major sign of adrenal fatigue.

I don’t know what my sex hormones look like because I was taking DHEA during my last set of labs, which I think screwed things up.  Maybe in another month or so I’ll get another hormone panel done.

In the interest of trying one thing at a time to isolate variables, I’m going to avoid the coconut for a week or so.  This should be easy as I’ll be out of town at a conference starting on May 24th, and coconut oil won’t be easily accessible.  We’ll see if that makes any difference.

Just now I was crying out of frustration, and also because I’m not feeling much energy today and my 2-year old daughter wants to play.  Just general frustration.  My daughter saw me with tears on my face and asked me if I wanted a blankie.  I said yes.  She brought me one.  I love that child.

ETA:  CB #21 yesterday.  30 minutes at 64 deg F.  Definitely like it colder than that in the water, but it made me feel nice and cool for the rest of the 93 degree day.

Adrenal Stress Index – A Closer Look

The salivary test I took to evaluate adrenal function is known as a Adrenal Stress Index (ASI). You spit into a cup 4 times in one day – upon waking, at noon, at 5:00PM, and then before bed.  The purpose is to evaluate the amount of cortisol in the system at various points in the day, as well as the level of DHEA.  A normal cortisol pattern looks like this:

Relatively high in the morning, and falling over the course of the day.  The finely dotted line in the diagram is what’s ideal and represents “normal” adrenal function.  Notice how nicely it falls right in the middle of the “acceptable” range throughout the day?

Mine looks like this:

Mine follows the right basic structure…high in the morning and lower the rest of the day, but upon looking at it carefully it’s clear that my cortisol levels during the day (the 2nd and 3rd test at Noon and 5:00PM) are barely higher than my nighttime cortisol level, just before I fall asleep at night.  It’s good that it’s not too high, but too low is no party either.  No wonder I struggle to get through the day if I don’t have caffeine (I had no caffeine the day of the test).  So what does this all mean?

My current doc doesn’t practice this kind of medicine.  She didn’t even feel comfortable ordering tests, let alone interpreting them.  She referred me to a gynecologist.  I made an appointment (it’s not till May) but I may cancel before then because I don’t see how that will be useful. I could look for a naturopathic doctor, but I suspect a lot of them are quacks.  I don’t mind spending a lot of money out of pocket for lab tests, even though I’d be lying if I said it wasn’t difficult laying out hundreds and hundreds of dollars on lab testing…but the result is hard evidence…verifiable scientific data.  I can’t bring myself to call up someone with N.D. after their name and go pay them $300-400 to look at my labs and advise me.  Plus, I suspect they’ll want to set up a whole treatment plan including an expensive intake session, several consultations…all of which would be out of pocket and about 90 miles away.  No thanks.  I’ll use the internet.  If I’m wrong, I’m still likely to be better off than if I had done nothing.  Maybe at some point I’ll pay for a consult with Dr. Kruse himself.  Considering the options out there he’s actually fairly cost-effective ($250).

Anyway, onward with my research and self-diagnostics.

I’m aware of Dr. Sarah Myhill from the Livin La Vida Low Carb podcast.  I’ve heard her speak and liked her.  On her website she discusses some possible interpretations for the results of your Adrenal Stress Index.  Before I get into that though, here are my ASI test results, once again:

DHEAS 15.4 2 – 23
Cortisol – Morning 9.6 H 3.7 – 9.5
Cortisol – Noon 1.3 1.2 – 3.0
Cortisol – Evening 0.9 0.6 – 1.9
Cortisol – Night 0.5 0.4 – 1

DHEAS is actually on the high side for someone my age – probably because I’ve been taking a DHEA supplement.  Here’s a graph:

Unfortunately I started taking the supplement before getting a baseline, so I don’t know what my DHEA level was at the start of my Leptin Reset.  Too bad.  I had no idea what I was doing (still don’t really, but now at least I understand the importance of testing).

What does Dr. Myhill have to say about all this?

Cortisol levels low, DHEA borderline or normal. This probably represents the gland beginning to recover after a long rest. DHEA may be used to help patients feel better whilst they continue their programme of rest and rehabilitation.

So according to her, perhaps my adrenals have been taxed but are now on the mend.  She doesn’t really address the situation of high AM cortisol and low subsequent levels.

ZRT Labs, who did the testing, returned the following comments with my lab results:

Morning cortisol is high, but levels drop to normal the remainder of the day. The high morning cortisol seen in these test results may indicate a situational stressor (emotional, physical) or low blood sugar level (hypoglycemia), which often occurs in the morning after overnight fasting. Acute situational stressors (e.g., anxiety over unresolved situations, travel, work-related problems, wedding, holiday season, etc.) can raise cortisol levels, which is a normal response to the stressor. Symptoms commonly associated with high cortisol include sugar craving, fatigue, sleep disturbances, anxiety, and depression. If cortisol remains elevated throughout the day (usually associated with a high night cortisol) and over a prolonged period of time (months/years) excessive breakdown of normal tissues (muscle wasting, thinning of skin, bone loss) and immune suppression can eventually result.

They also say this about my testosterone level (a bit off topic here, but I think it’s interesting):

Testosterone is high-normal, which likely is due to the use of oral DHEA therapy. DHEA therapy increases the level of both DHEAS and testosterone. Elevated testosterone may be associated with symptoms of androgen excess (increased facial/body hair, acne, loss of scalp hair). If these symptoms are/become problematic lowering of DHEA dosage is worth considering.

Haven’t seen any of that yet…so steady as she goes, I suppose.  Dr. Kruse says that with his patients he aims for hormone levels that are normal-high for people in their 20s.  Well, that’s where my DHEA and testosterone are right now…so I’ll keep going with the current supplement.

What I would like to know is what it means to have somewhat high cortisol in the AM and lowish cortisol the rest of the day….and if there’s any way to correct this.  I’ll have to keep researching.

Adrenal Fatigue

I’ve been trying to learn more about Adrenal Fatigue (AF) and the effects on the body.  There’s a lot of information out there, as this appears to be a pretty common problem, often misdiagnosed as depression and treated with antidepressants.  I was taking antidepressants up till a couple months ago, when I decided that was dumb.  I didn’t feel depressed, I just felt tired and irritable. Makes me wonder why my doctor didn’t ask more questions.  I mean, she’s a flippin doctor!  Isn’t she supposed to know more about this than me?  If I were a medical professional and a woman walked into my office, 40-50 pounds overweight with a significant amount of belly fat, and complained about fatigue, I think I might now suspect a cortisol/adrenal problem.  I guess that’s not how doctors are trained.

I came across a questionnaire that helped me get a sense of how much AF might be playing a role in my life.  I scored in the “Mild Adrenal Fatigue” range.  I’m not sure how scientific this is, but considering I have nothing else to go by, I’m declaring this a good starting point.   Here’s a description of the various stages of adrenal fatigue from the Adrenal Fatigue Center – a website created by a medical doctor, Dr. Michael Lam.  Again, I don’t know anything about him or his medical practice, but he seems to know much more about this than me.  According to him, I’m around stage 1 of adrenal exhaustion (4 being the worst, where you’re bedridden, vomiting, and almost dead), but prior to starting the Leptin Reset I was much more around Stage 2.  Since starting the reset, I’ve had much less fatigue and more mental clarity.  Erin over at Pretty in Primal has some recommendations for recovering from mild AF, including:

  1. getting more sleep (check)
  2. going to bed before the 11:00PM cortisol burst or “second wind” (check)
  3. eat a diet that’s easy on the blood sugar (check)
  4. don’t exercise too hard (no problem there…I mean “check”)
  5. add unrefined salt to water to make up for the fact that you’re not making much aldosterone if your cortisol is stealing all the pregnenalone.  Hm…I don’t know about this one…may require more research.
  6. stop being a perfectionist and be nice to yourself (check)
  7. take L-Theanine, an amino acid that helps the brain make alpha waves to keep you in a calmer state.  I may need to try this one!  I sure do love popping pills.
  8. deep breathing/meditation.  I need to do more of this.
  9. take Himalaya Stress Care – an antioxidant that supposedly reduces cortisol.  Maybe, depending on upcoming labs.

I have ordered cortisol testing from ZRT Labs.  I’ll be ordering more testing after I find out what my doctor is willing to authorize for me.