July 2, 2016
Click here for the full written transcript of this podcast episode.
Note: There is a special addendum at the end of this podcast episode in which Ben mentions the book “Ego Is The Enemy,” this sermon on Time & Resources by a man named Toby Sumpter and the practice of iridology.
Last month, I released the podcast episode entitled “Why Is My Cortisol High Even Though I’m Doing Everything Right? Hidden Causes Of High Cortisol, The DUTCH Test & More!“. In that episode with fellow podcaster and health consultant Chris Kelly, we delved into the mystery of why cortisol can be so high in someone such as myself who sleeps well, does meditation, yoga, and lives a relatively stress-free life. It was a fascinating, extremely popular episode, but created just as many questions as it answered about what really causes high cortisol in people, and whether it's something you even need to worry about in the first place!
To delve into the cortisol mystery more, after that episode, Chris Kelly introduced me to Dr. Bryan Walsh, a naturopathic doctor from Maryland, with an amazing series of WellnessFX lab testing interpretation videos on YouTube. Dr. Walsh has an extremely sharp mind, an extensive fitness background, a degree in naturopathic medicine, and a host of additional training and certifications. His wife is a naturopath too, so his children are probably some of the healthiest on the planet.
When tough cases or head-scratching lab results arise, Dr. Walsh turns from mild-mannered dad and husband into forensic physiologist, pulling out his microscope to analyze blood, saliva, urine, lifestyle and whatever else he has to, in order to solve the medical mystery.
Dr. Walsh ran an extensive series of follow-up lab tests on me, primarily through the laboratory testing services of another functional medicine practitioner – a chiropractor in Atlanta, Georgia named Dr. Brady Hurst. At his company, TrueHealthLabs, Dr. Hurst uses advanced laboratory tools to uncover hidden dysfunctions and uses primarily drugless treatment plans to restore those dysfunctions. TrueHealthLabs has a number of direct-to-consumer tests that are not traditional lab tests and can instead be custom panels that a doctor or patient can order. They even offer some functional lab testing in Europe.
In this episode, Dr. Brady Hurst, Dr. Bryan Walsh and I completely geek out on the high cortisol lab testing results and during our discussion, you'll discover:
-The secret ingredients the green morning smoothie that Dr. Bryan gives to his young children…
-How to keep your morning green smoothie from getting oxidized or damaged by the blender…
-The seven stage home filtration process Dr. Brady uses to filter his water…
-The very first additional hormone you should test for if you find out your cortisol is high…
-The best lab panel to look at whether or not your body is actually producing adequate antioxidants…
-When high HDL (commonly known as good cholesterol) can actually be a bad thing…
-How high cortisol down-regulates your metabolism and your insulin sensitivity and puts your body into fat storage mode…
-Why thyroid replacement medications or natural thyroid supplements rarely work to fix the thyroid…
-When you don't need to actually worry about high liver enzymes on a blood lab test…
-The hidden laboratory marker that can tell you if you need to be consuming more sea salt and minerals…
-How to tell if your body has excess oxidative stress, and what you can do about it…
-And much more!
Resources from this episode:
–iSpring Reverse Osmosis filter
–Apex Energetics supplements that Dr. Brady uses
-Article: How To Biohack Your Green Smoothie (And Can High Speed Blenders Really Damage Your Food?)
–DUTCH Urine Steroid Hormone Profile
–Ben Greenfield’s DUTCH test results
–TrueHealthLabs Oxidative Stress Profile
–Ben Greenfield's Oxidative Stress Profile results
–TrueHealthLabs Custom Lab Testing – Ben tested the following:
a. NMR Lipoprofile
b. Oxidized LDL
c. ACTH, cortisol, and aldosterone
d. LH, FSH
e. Free and total testosterone
–Ben Greenfield's TrueHealthLabs Custom Lab Testing results
After our call, in a flurry of e-mails, Dr. Walsh also recommended the following follow up tests:
- Lymphocyte subset panel (CD4/CD8) – Your lymphocytes are relatively low compared to your neutrophils, so I’m not sure it would show much, but this panel shows ratios of lymphocytes, regardless of their total levels, and could offer a little info.
- Cytokine panel – I’m a little hesitant on the accuracy of these panels, but they are used in research, so I think they are accurate enough for our purposes. This might show a tendency for a Th1/Th2/Th17 shift, which could be interesting to know. High cortisol is often associated with a Th2 dominance, which this panel would theoretically show. If it were me, I’d be curious about the results of this panel.
- Neopterin – This is a huge stretch, but I personally love this marker. When neopterin is elevated, it suggests an Th1 response due to activated macrophages. If I had to bet money, I’d say this would come back normal for you but again, medicine attempts to rule out things first, and this would rule out any Th1 involvement.
- I don’t suspect any autoimmunity in you, but if you’re getting your blood drawn anyways, you could run something like ANA. This won’t identify all autoimmune conditions, but some. I’m on the fence about this marker.
- There’s one other marker you could run, but I would only run it for educational purposes for your listeners, and that is Glycomark, also known as 1,5 anhydroglucitol. This is one of my favorite markers of all time, because it measures postprandial glucose levels two weeks prior to the test, which is just awesome. I suspect that this marker, when abnormal, is the first of the glucose regulatory markers to show tendencies for glucose dysregulation, far before fasting glucose, c-peptide, or A1C.
- Cyrex panels – You mentioned this on the call. If you’re truly using yourself as an experiment for the benefit of listeners, you could run their antibody panel and/or their intestinal permeability panel. I know you’ve had some gut issues in the past, so the latter might be of interest. For the average patient, we usually use these when things aren’t resolving well, but for myself, if money weren’t an issue and I was truly doing an experiment, I’d run these panels to see what came up.
- If you’ve indeed had elevated cortisol for a few years now, and possibly elevated ACTH, it may be that you actually have enlarged adrenal glands capable of making more hormones. Here’s the thought process. ACTH is a “trophic” hormone, meaning it enlarges its target organ (adrenals). Not only that, the cells of the three layers of the adrenal glands can be repurposed for making different hormones than they were designed to. For example, cells in the outer-most layer of the cortex (glomerulosa) normally make aldosterone. But in the presence of sustained and elevated ACTH, the cells of the glomerulosa can morph into fasiculata cells, which normally make more cortisol. Thus, it may not only take less ACTH to stimulate cortisol release, but if the cells of the glomerulosa are repurposed, they will make less aldosterone, which is something you’re seeing on your lab as well. If you did want to ask a doc to humor you and get an ultrasound on your liver, you can see if they would be willing to do it on your adrenal glands as well. There are cash-based ultrasound clinics around and you wouldn’t even need a doctor’s recommendation.
Do you have questions, comments or feedback for Dr. Brady Hurst from TrueHealthLabs, Dr. Bryan Walsh or Ben Greenfield? Leave your thoughts below and one of us will reply!
46 thoughts on “High Cortisol Mysteries Unveiled, The Adrenal Fatigue Myth, Advanced Lab Blood Testing & More!”
Are Brian or Brady available for consultations? I’ve done a DUTCH test recently, and my results are pretty similar to Ben’s, albeit with somewhat lower testosterone levels.
I’ve worked with a couple different people in the past, but these guys seemed like they possessed next level knowledge of possible things to investigate. I’ve also got sky high free cortisol (higher than yours Ben), and middle of the range metabolised cortisol. I’ve had my thyroid and liver checked before, which seems to be the common suggestion to check, but they have only been tested by conventional endochrinologist biomarkers (i.e. FT4, TSH, and thyroid antibodies and I can’t remember what for the liver), perhaps the thyroid/liver checks could still be false negatives. Regarding the low testosterone, by 5beta andro path could be higher, but is a little off the bottom of the range, however my 5 alpha DHT path is almost non existent, seriously bottomed.
If Brian and Brady are not available to do this sort of thing, who else has a lot of experience that people can recommend?
They are, but…I'd be happy to help you via a personal one-on-one consult. Just go to https://bengreenfieldfitness.com/coaching. and then choose a 20 or 60 minute consult, whichever you'd prefer. I can schedule ASAP after you get that.
Dear Ben, listened to this whole series. Due to progression from college athlete to military training to career in a very busy high stress law enforcement environment I too seem to be stuck in some sort of rut between blood sugar issues regardless of how strict the diet is. Based on this series I decided to try to stop fasting and increase the macro balance in an attempt to lower cortisol response while fasting and increasing fat. Also decided to devolve the intensity training for 3 weeks and start a rebuild on programming. Although I’m not in the realm of pre-diabetic yet I’m super freaked out by that slippery slope. What are your thoughts on ‘group norm’ vs ‘subject norm’ in terms of blood sugar results especially in former endurance athletes or athletes experiencing high stress careers? Is it possible to be in the realm of ‘group norm’ pre-diabetic and have no issues?
Loaded question but I'd say if you are high stress, it is likely glocygenolysis due to cortisol and if that is the case, the sugar is still ending up in your bloodstream so it's still just as much a concern!
Hi Ben, Thank you for all of the great content and disseminating all of the amazing knowledge to the community. I was wondering, if your cortisol is jacked up (scientific for elevated). How come your HRV reading still show healthy signs to train. I thought HRV was supposed to be the reading that lets us know if we should train or not. I’e seen your published HRV readings in prior posts and they looked good I thought. Yet your cortisol is telling a different story. Any light you can shed on that or perhaps one of the Doctors..
Because my nervous system is just fine. I just happen to be churning out lots of hormones adrenally.
Loved this podcast, particularly the addendum. I know 58 year old women are not your key demographic, but I have learned so much. It’s been fun to see you show more interest in aging well, being a great Dad and husband, and having fun – and less about setting world records in extreme sports (although that’s pretty cool too). Thanks for everything you do, for being open about your faith, and sharing your curiosity about all things health.
Why cannot I listen to the podcast from my android tablet please?
Have you tried it in a different browser?
Ben this one is pure gold!!
Between the one with Dr Minkoff, Dr Chopra, and this one you’re on a roll!!
Thank you Ben! I just discovered podcasts in 2015. I have a few favorites in fitness health biohacking entrepreneurship and spirituality. I have been pretty dedicated to listen to all your new episodes now for the past year. I love your style. You got a great voice. I appreciate your level of intelligence and knowledge on the topics you discuss. I love that you are open to exploring the woo woo and more esoteric side of reality. And you make me laugh. This is the first time ive chimed in or left a review. And your most recent episode called cortisol2 moved me deeply. Especially your sharing at the end of the episode. I appreciate your vulnerability and authenticity around a subject that would obviously be very humbling for most of us. I found it very moving and i was grateful to see another side of you my friend. Thanks again for all that you do. Staying tuned and looking forward to cortisol3 and so many more of your shares. Hope someday to meet you and return the favor to share something of value with you. Aloha! Mahalo! Best regards, Luke
Thank you, Ben, for your open and honest Podcast. I understand how hard it must have been to admit to imperfection. As I posted on your first podcast on this topic…I recognized you from the beginning as a fellow cortisol junkie. Funny, whenever I want to talk to anyone about a “perfect body,” I use you as an example. But I usually add…”at what cost.” Perfection is a difficult Monkey to shake off your back. I wish you all the best and hope it does not take you as long as it took me to come to terms with it. Ha…who am I kidding…still working on it at 71. :)
Been drinking Hunza water now for a few months instead of adding sea salt which has really helped to replenish minerals and leave me feeling much more hydrated as well as less of a need for electrolyte consumption during and after long endurance sessions.
Great Podcast Ben!! I have been into this paleo/alternative health way of life for 4 years now and I keep wanting to learn more, this podcast provided a bunch more!
Curious Ben, how is this analysis of your physiology align with some of the data you received from Wendy Myers?
Most of it agrees: low minerals, slight amounts of metal toxicity here and there, etc.
Hey Ben, awesome podcast! I have basically the same issues…what modifications are you personally going to make to boost glutiathione and stop excess excretion of water?
I'll be using sublingual glutathione, higher mineral intake, more testing to look at potential immune factors, etc. Stay tuned!
I’d say we live in a world that’s full of people running around on high cortisol these days. Learning how to manage this issue is HUGE for personal health and well being.
I’m taking up kundalini yoga thanks to your inspiration on the biohacker summit Ben.
Very interesting episode, Ben, and thanks for being so open! Strangely enough, I have had some results very similar to yours, amongst them depressed testosterone, high FSH, and my glutathione is also low. I’m still struggling to get my head round it all, however, in my case, I think these stem from having a high toxic burden (heavy-metals), which has also lead to low cortisol. I’ve been dealing with this as one would normally treat adrenal fatigue, and have seen some improvement, but it still feels like some pieces of the puzzle are missing. Anyway, I look forward to hearing more about how you correct these issues!
Great podcast!! One of my favorites. I have low TSH, low Free T3 like you but I also have low T4. I also have low Estrogen and low Testosterone. I have been struggling to stay asleep for 2 years – really bad sleep 5-6 hours a night. I know that the more I lost sleep, the harder it is to get good sleep, but I don’t know how to break this trend. I did the dutch test which showed high cortisol but I metabolize it fast so it would show very low cortisol on the standard salivary panel. Sometimes I think I have slept only to wake as if I didn’t get any sleep at all. Which tests should I get to figure out what is going on?
I would suggest booking a consult at <a href="https://greenfieldfitnesssystems.com/ben” target=”_blank”>www.greenfieldfitnesssystems.com/ben and choose 20 or 60 mins and we'll go over everything in detail there.
Phenomenal conversation, and rather timely. Very much looking forward to the next. I recently got some blood chemistry results back that showed many of the same trends. Now I’m even more convinced to dig deeper.
And Ben, I can’t thank you enough for the addendum… Opened my eyes to some of my own lifestyle factors that might need some reconsidering in a hard-charging life. Perhaps in the pursuit of health, we sometimes forget to slow down.
Great podcast, Ben! Your candor and honesty are perfect! I am a certified health coach who is in training to become a nutritionist. My HDL is a whopping 172 (Gasp! It’s always been very high.) 112 triglicderides, 88 LDL. I eat ketogenic for the most part and don’t consume any grains or dairy, constant movement throughout the day, walking and light body weight strength exercise, meditation, pretty good sleep. What really made sense to me today as I listened was the connection between the high HDL and autoimmune disease. I was diagnosed a couple years ago with Undifferentiated Connective Tissue Disease, so this makes sense! I plan to have further testing after listening to your podcast. Keep up the excellent work…but please take care and rest too. ;)
After listening to this podcast, it occurred to me that the reason Ben’s tests indicate possible liver problems could be related to his consumption of cinnamon. I have been enjoying a morning smoothie recipe contributed by Ben to Yuri Elkaim’s “Community Cookbook” and the recipe includes cinnamon – without specifying which type – Ceylon or Cassia. Cinnamon use (especially Cassia) in sensitive people can cause liver damage. See sites below or google liver damage cinnamon. Could explain some of Ben’s test results. Or not. But worth a look.
I do believe Ben uses “Frontier Co-op Ground Ceylon Cinnamon” I have started using it based on his recommendation.
I can’t get enough of these technical podcasts! Thank you Ben for being so generous with your data and to the doctors for showcasing the best of functional medicine.
Ben-A Colonoscopy! Welcome to my world! I get one every 3-5 years due to the fact that my father had colon cancer. The prep has improved a lot over the years. I used to have to drink a gallon of grease, but now it is much better. The best part about a Colonoscopy is the drugs they give you.
However, I never have had the doctor tell me anything about my large intestine. I know I have colitis (always have) and internal hemorrhoids, but that’s it.
Your work, work, work, ethos puts me to shame. Kudos for building the Ben Greenfield Empire. December is a great month to kick back do nothing. Just read, write some fiction, maybe go to some relaxing destination with the wife (if you can get Grandma, sister, brother or somebody to watch the kids). Whatever you do have fun and chill!
Reviewing all of Ben’s blood work I missed his glucose results. It has to be there I’m at a loss to find it.
It is in my last wellnessfx results blog post. Here: https://bengreenfieldfitness.com/2015/11/ben-gree…
Ben- I respect you more for being honest with yourself and with us as well. Thank you for putting your ego in check and exposing yourself as a sojourner along with the rest of us. No one has it all figured out and we are continually learning to deal with ourselves despite the monumental efforts we put in to trying to understand what is going on.
I am a psychotherapist who often helps remind my patients that this is the first time you have ever been here in this place, in this present, in this predicament, give yourself some grace and some time to catch up with what has transpired to have you land here. Assume you are here for a reason, and this is exactly where you need to be. At our best we can be an expert in where we have been, have a foggy notion as to where we are headed, and listen to the clues or messages that we are being directed towards in the present to get us to where we need to be.
All that to say that although I wouldn’t come close to claiming to be an expert in terms of a majority of the labs mentioned in this podcast, one element that came to mind during the last podcast concerning the dutch test, and this one is that many people don’t consider in terms of cortisol is the impact of change. Change is hard, especially when we are speeding at the rate that our culture asks us to keep up with these days. We vastly underestimate the difficulty that is a part of our everyday lives in regards to change. (Although when we lose an hour of sleep because of the scourge on humanity that is daylight savings time we are more aware of how hard change really is)
I have followed your podcast for some time and I along with people that I am in contact with are stunned by the amount of change that I have undertaken in the past several years. Much of which I will attribute to you Ben (i.e. to list a few I now have a huge infrared sauna in my garage, take pond scum a.k.a. algae daily, smell like a sweet marinara sauce from skin serum I got from listening to this podcast, have totally rekindled my love for coffee, have a cool fat burner vest which I put on (often after a cold shower), etc.) The change is dizzying and hard to keep up with and it is extremely important that we remember that although the changes are good our bodies just don’t adjust that fast and we have to allow adequate time for us (as well as our wallets) to metabolize those changes.
I loved the addendum and love the growth and maturity towards health on all levels physical mental emotional relational and spiritual. Keep up the good work! Look forward to hearing round 3 on this topic as well.
I have high HDL and low trig as you. But unlike you, I also have high LDL (bad in numbers and in size). I always thought having high HDL and low trig is a good thing, but now I am not sure.
I also have high HDL and low Trigs… and I thought this was a ‘good’ thing… at least from what I read on some primal/paleo blogs. My twin sister has the same and her doc told her to go home and enjoy a glass of wine! My doc berated me and tried to put me on a high carb diet with no red meat! I took my sister’s doc’s advice instead!! :)
My neutrophils have been very low for years, but no MD or ND has ever bothered to even investigate it further despite the labs stating that neutropenia should be investigated.
A question about TSH reference ranges . The functional doctors who do podcasts are saying these reference ranges are too high , and a healthy TSH should register below 2. Tegular docs still stick to the current ranges as being correct . Who is right ?
I personally think that a TSH between 0.5 and two is most appropriate
Why would you say that? What qualifies you to have such an opinion?
Being a person qualifies one to provide a personal opinion.
This is great because now we’ll be able to see if Ben’s upcoming testosterone boosting formula works as I’m sure he’ll be testing it on himself. None seem to work well enough to be honest. Men are bombarded by things causing estrogen to be high and this is troubling as testosterone levels are dropping and nobody seems to know why. Is it evolution? Plastic water bottles? Pollution? Would love to hear more podcasts that address this.
Great podcast Ben. I listen to them Sat mornings as part of my continual education. It would be great if there was an EASY way to review them on Stitcher. I’n an Android guy much to my son’s dismay.
Great podcast Ben and nicely concluded too. Great insight and I too think that you should have a few more R & R days!
What is the best way to decrease (bad) cholesterol of 7.4 and thyroid TPO antibodies at 154 in a person with several auto-immune diseases? I understand that TSH is related to high cholesterol in some way.
Thank you SO much for this podcast Ben! And to your initial intro, I really appreciate how transparent and real you are, and far from discrediting you, it makes me respect and relate to you more, not to mention hugely helpful as I am currently going through similar things (very “clean” lifestyle, but some labs not optimal). As for the addendum and “random ramblings”, again, thank you so much for allowing us to be part of your discoveries, and allowing us to follow along – looking forward to the updates, and I hope you figure out and get your levels in the optimum :=)
There is this misnomer that there is good and bad cholesterol. Cholesterol is being made in most cases to support repair. Cholesterol is a problem when it becomes damaged/oxidized. But, the cholesterol isn’t the problem, it’s 1.what is causing the increased demand/production 2. what is causing the cholesterol to become oxidized. These things both go back to primarily what is causing inflammation. There are lots of ways to lower cholesterol and make your number look “normal” very few of them address the root cause. Review my previous comment to you and address those things first.
If you lower cholesterol whether it is supplement or medicine without addressing cause, it’s like unplugging the smoke alarm so you don’t have to listen to noise but never addressing the fire that is causing the smoke.
Ottima Intervista! Thank you Ben
Dr. Walsh is a smart guy. What he is referring to regarding the reduced thyroid conversion is a very common and normal finding secondary to stress response. If you search “Cell Danger Response”, http://www.ncbi.nlm.nih.gov/pubmed/23981537 you will find an amazing paper that explains the CDR.
Essentially under stress response thyroid hormone conversion is going to be down regulated to peripheral tissues. This is a normal response to threat. It should only be short lived. When the stress response becomes chronic is where we see more challenges.
Low thyroid symptoms are the result of reduced peripheral cellular thyroid hormone levels. If there is a threat to the cells (physical, chemical, emotional, or microbial), the transport of thyroid hormone and conversion of T4 to T3 will be down regulated in peripheral cells. If you think about it like a virus infection. You wouldn’t want to increase metabolism of a cell that has a virus in it. You would want to slow metabolism and actually make the cell sick enough to kill off the virus.
When the stress does not go away and becomes chronic we see more dysfunction in the body leading to symptoms, autoimmunity, disorders, and disease (S.A.D.D).
These are the people that show up in a doctors office. In the beginning, they will have symptoms but normal TSH and T4. They will be told there is nothing wrong with thyroid physiology since those values are normal. But, TSH does not represent the thyroid hormone status of all the peripheral cells, it represents T3 in the pituitary. In stress situations T3 is upregulated to pituitary and downregulated to peripheral cells.
This person will struggle with symptoms, likely be told by their doctor to eat less and exercise more which actually increase the stress response/CDR. They will struggle for years before phase 2 happens and they start to develop autoimmune attack on their thyroid. Most doctors don’t test thyroid antibodies so they will not see this developing since TSH and T4 will still be normal. They will be told the same thing to eat less, exercise more, and maybe take a medication for their stress.
Eventually phase 3 kicks in. This is when the autoimmune / immune response creates so much damage of the thyroid that the gland can no longer make enough hormone to support the even the pituitary gland and the TSH will rise and T4 will drop below lab range.
Now the doctor after years of patient struggle will announce that although you had symptoms for years and you didn’t have a thyroid problem than, you do now. What the doctor is seeing is not the beginning of a thyroid problem but the end stage. This is the problem with the current model of thyroid evaluation and treatment.
Sorry, for the long comment.
Eric Balcavage thanks for the great explanation and the link to the CD-R paper. But what now for the many people at the beginning or the middle of the end stage?
Great Question Mel. This is where you need to take a look at your life. Look at the four main forms of stress: physical, chemical, emotional, and microbial. Look at each of these areas and do what you can to reduce these. Let me give you some examples:
– you sit most of the day do very little movement, activity or exercise. Start improving this each day. If you are too debilitated to move, increase the amount of activity you do than you will need to work with someone to get started.
– you stay up late watching tv or reading facebook and than get up early because you have work. You are exhausted. Change your sleep habits.
With my patients I work on 9 key fitness factors I call “You.Optimized”. The factors are: physical fitness, emotional fitness, dietary fitness, sleep fitness, respiratory fitness, neurologic fitness, habitual fitness, spiritual fitness, and metabolic fitness.
Only one of these fitness factors may really require advanced help. Metabolic fitness often requires a functional medicine or what I call a strategic medicine specialist to help repair damage to metabolic systems due to years of poor fitness in the other areas. But, I think that if most people hired a health coach or coaches to guide them through these areas they would get to their desired result faster.
Hope this helps!