July 2, 2016
[1:04 National Academy of Sports Medicine
[2:15] Organifi Green Juice
[3:29] A few things on today's podcast
[5:44] Where this all began with Cortisol
[6:48] All about Dr. Bryan Walsh
[8:05] About Dr. Brady Hurst and TrueHealthLabs
[9:33] Dr. Bryan's Morning Routine
[10:51] What's In Bryan's Morning Smoothie
[12:14] Dr. Brady's Morning Routine
[12:52] iSpring reverse osmosis filter/Apex Energetics supplements
[15:35] ACTH Testing when cortisol is high
[21:55] Oxidative Stress Protocol
[24:28] All about HDL
[27:05] Low Cortisol and Oxidative Stress
[27:46] Ben's Elevated Glucose, Hemoglobin A1c, and Insulin Levels
[28:59] Overview of Ben's Exercise Routine
[29:46] Stresses and Cortisol
[34:33] T4 and T3
[40:16] SHBG and Liver Enzymes
[43:04] Ben's Low Testosterone Levels
[48:26] Ben's Custom Panel Results
[1:01:35] Ben's Aldosterone Levels
[1:07:20] Ben’s Oxidative Stress Profile
[1:20:31] On Exercise
[1:25:14] Addendum to the Podcast
[1:32:15] End of Podcast
Ben: Hey, what's up! It's Ben Greenfield. This podcast episode you're about to listen to was actually a little bit difficult for me to, say, press “Publish” on. And the reason for that is because it shows a lot of things that are wrong with me, the guy who's supposed to be the ultimate health guru. Well, if I didn't delve into these type of things, if I didn't guinea pig my body, if I didn't go spend time in the trenches, if I didn't go, occasionally, put myself through the ringer from a fitness standpoint, so to speak, I probably wouldn't be able to dish out to you as much advice as I actually can about what works and what doesn't.
So, yeah, I'm putting myself out there and this was a little bit difficult for me to release. It's always hard for me to let you know when something is broken on me, but, frankly, I don't have my car parked in the garage. I'm out there driving it around so that I can teach you a little bit about how your own car works. Think about it that way. Alright. So, I wanna tell you about a couple of sponsors before we jump in.
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And now, let's jump into today's podcast, all about how you get high cortisol, what you can do about it, follow-up tests, et cetera, et cetera. And there will be, actually, a third part in this series I'm doing on high cortisol once I go give more blood to the labs to give you more information about what you can do about your own body. So, check it out. Here we go. Oh! One last thing. I actually have a pretty important announcement at the very, very end of this podcast. So if you're used to shutting down the podcast when we start to say our cheesy goodbyes, stick around. I think you might find the addendum interesting.
In this episode of The Ben Greenfield Fitness Show:
“There's been studies after studies that show that more than 50% of people who end up having cardiovascular disease end up having normal cholesterol levels. That's why something like an NMR cholesterol test here to show the size and the density of these cholesterol molecules are very important.” “What aldosterone does is it tells the kidneys to retain sodium and excrete potassium, but if aldosterone is low, it may tend to excrete sodium and retain potassium. And, with sodium, water will always follow it.”
He’s an expert in human performance and nutrition, voted America’s top personal trainer and one of the globe’s most influential people in health and fitness. His show provides you with everything you need to optimize physical and mental performance. He is Ben Greenfield. “Power, speed, mobility, balance – whatever it is for you that’s the natural movement, get out there! When you look at all the studies done… studies that have shown the greatest efficacy…” All the information you need in one place, right here, right now, on the Ben Greenfield Fitness podcast.
Ben: Hey, folks. It's Ben Greenfield, and last month, I released probably one of our more popular podcast episodes of the year entitled, “Why Is My Cortisol High Even Though I'm Doing Everything Right: Hitting Causes of High Cortisol and More.” And in that episode, I delved, with a couple of folks on the call, into the mystery of why cortisol can be so high in someone like me. You know, somebody who, who sleeps well, and does meditation, and yoga, and lives a relatively stress-free life, right, like out in the forest. And it was a fascinating, extremely popular episode, but the problem is that that episode created just as many questions as it answered about what really causes high cortisol in people, and whether high cortisol is even something that you really even need to worry about in the first place. So to delve into my own cortisol mystery even more after that episode, Chris Kelly, the guy I spoke with on that episode, he introduced me to Dr. Bryan Walsh.
And Dr. Bryan Walsh is a naturopathic physician from Maryland. He has this amazing series of WellnessFX lab testing interpretation-type of videos on YouTube, and I'll link to those in the show notes for this episode, but Dr. Walsh has an extremely sharp mind. He's got an extensive fitness background, which I really respect in a physician. He has a degree naturopathic medicine, and he has a host of other additional training and certifications, and alphabet letter soup after his name. And his wife is a naturopath too, so his kids are probably some of the healthiest kids on the face of the planet. But Dr. Walsh is a really good, kinda like forensic physiologist for looking at people's blood, and pulling out his microscope to analyze blood, and saliva, and urine, and lifestyle, and whatever else he has to in order to solve a medical mystery.
So what Dr. Walsh did was he ran this extensive series of follow-up lab tests on me, and he used this laboratory testing services, or service, called TrueHealthLabs. And this is a lab service that has a bunch of direct-to-consumer tests that aren't on traditional labs and can be just custom panels that a doctor orders for you, or that you order, and they even offer some of their functional lab testing over in Europe.
And the guy that runs TrueHealthLabs is Dr. Brady Hurst, and Dr. Brady Hurst is based out of Atlanta, he's another functional medicine practitioner who's really well-versed in geeking out on labs, and on today's show, which threatens to be, not to overuse the term geek, but threatens to be one of the geekiest shows that we've had yet, so you better be strapping on your propeller hats during this intro. I have both Dr. Bryan Walsh and Dr. Brady Hurst of TrueHealthLabs on the show, and we are going to dive into what type of mysterious things might cause high cortisol in people, we're gonna talk about oxidative stress, we're gonna talk about custom lab panels and some of the little things you can look at, hormones, a lot more. So, Dr. Bryan Walsh, Dr. Brady Hurst, welcome to the show.
Bryan: Thanks, Ben.
Brady: Hey. Thanks, Ben.
Ben: And so, just me and the rest of our audience can make sure we're able to tell you guys apart and to get to know you a little bit better, let's start with you, Dr. Bryan. You're obviously relatively geeked out on health, so I'm curious what your morning routine look like leading up to this call. It's 11 A.M. Pacific time. It's obviously a little bit later in the day Eastern time for you, but for you, what did your morning look like, Bryan, leading up to the call? Like your breakfast, or your fitness routine, or any special morning routines that you have.
Bryan: Yeah, I can say that, quickly, you see I have four kids under the age of eight, and another one on the way, so my routine, there's no such thing as a routine. Inevitably, one of the kids, and it varies based on the day, wakes me up at about 5:30, 6:00, we usually head outside, let the chickens out, turn the compost, check the garden, watch PBS until everybody else wakes up. I make breakfast for the kids, and then I make it for my wife and I, and that's about it, man. It's a few hours of just trying to corral the kids, and get 'em fed, and teeth brushed, and, you know, you know, the whole routine. I sometimes will get an exercise session in the morning. Sometimes if it doesn't fit my schedule, I'll do it in the afternoon, but I can go into more details, but that's about it. We feed the kids pretty healthy though. I will say that. They get a nice smoothie every morning with a bunch of good stuff in there and they eat pretty well. So, yeah, it's, I think that the routine is a lack of routine, but we're all doing pretty well.
Ben: Alright. Well, being someone that has to take care of chickens in the morning myself when my wife is gone, I know that turns into a routine all on its own, and perhaps you could call that a form of moving meditation perhaps, feeding chickens or collecting eggs, but, but not to poke too deeply into your life, but what are your kids drinking in that morning smoothie?
Bryan: Well, we have, one of our kids has an anaphylactic dairy allergy and he's pretty allergic to eggs also, so it really limits the breakfast options. So we usually do on the base of coconut cream or coconut milk. We have a couple of non-dairy protein powders that we'll use. I'm a big fan of choline, since they don't always eat eggs. So I put some choline in there, we usually toss some greens in there, digestive enzymes, maybe some probiotics, maybe some digestive resistant starches, some raw honey, usually to sweeten it up, and then some kind of fruit, usually we have some frozen berries around, maybe a banana. But I figure it's a pretty, if nothing else they have at least one decent meal, or shake, a day.
Ben: Geez. I was kind of proud of my kids doing like eggs, and cilantro, and parsley, with some sea salt for breakfast, and you just made their breakfast sound like freakin' corn nuts. That's crazy.
Bryan: Nah, I mean you know, like this morning we made some buckwheat pancakes with some dairy-free chocolate chips in there, and some bacon, and sausages, but, you know, how kids are. Sometimes they eat a lot, sometimes they don't, but as long as they get that shake, then I figured it's a pretty good start to the day.
Ben: That's an impressive green smoothie for a kid. You're definitely giving their brains a step up in life with that. Dr. Brady, how about you? Did you have any special morning routine? Or do you have a special morning routine, or standby breakfast, or green smoothie that you yourself drink?
Brady: Yeah, in fact, well it's quite a bit opposite from Dr. Bryan. I don't have kids, so my morning routines are a bit more simplistic, and more of a routine. So, you know, the first thing I do when I wake up, I always drink a big glass of water and we live in Atlanta, so water quality isn't very high, but we have this really great seven stage reverse osmosis system to help purify, and also it adds in that and some magnesium potassium to keep the water, the pH a little more basic because reverse osmosis systems will tear out everything.
Ben: Which reverse osmosis system do you use, just out of curiosity?
Brady: Yeah, it's by company called iSpring, and they're actually based here out of Atlanta. So…
Ben: iSpring, as in like iWatch, except iSpring?
Brady: Yes. Exactly. iSpring.
Ben: So it's an iSpring reverse osmosis system, and you start off your day with a glass of water that.
Brady: Yep. Yep. Right when I wake up, glass water, and then I do make a shake also. What typically goes in there, I usually either do blueberries and, or a banana, and I do have this amino acid, and kind of a liver support powder that I use from Apex Energetics. That's really great. I usually exercise in the morning, so I will add in extra electrolytes to that, that is another product from Apex, and then I'll throw in some greens, some, usually arugula, spinach, and then kale off and on. Blend all that up, you know, we have a really powerful Vitamix, so I make sure it's blended, but not over blended because those, if you have a powerful blender like that, it can actually oxidize, it can mix in that oxygen with some of these antioxidant properties. So I keep the fruit frozen to minimize any heat that can promote oxidation of your shake, and then I only blend it for about 10 seconds or so. And so that's the usual breakfast there.
Ben: Yeah. That's interesting that you say that. We had an article, and I'll link to it in the show notes, about how to limit oxidation from a green smoothie, and there was actually a listener who did a study on the amount of oxidation that was occurring to his greens and found that the addition of ice and lemon juice significantly reduced oxidation when you put that in the bottom of the blender to start the morning green smoothie.
Brady: Wow. Yeah, that's very interesting. Yeah, definitely put that in the show notes. I would love to see it again…
Ben: Yeah. Cause you're basically controlling temperature. Yeah. I'll add this to the show notes. I'll also add, pretty much everything that we talk about. So, you know, Dr. Brady was just talking about like Apex Energetics, and the iSpring reverse osmosis filter, and Dr. Bryan was, you know, talking about the green smoothie he gives to his kids, and I mention that article on limiting oxidation of smoothie, this and everything we talk about, go to bengreenfieldfitness.com/cortisol2. That's bengreenfieldfitness.com/cortisol2, and I will link to pretty much everything that you are about to discover in the show. So, as much as I know, we could probably spend a great deal of time geeking out on morning routines, let's turn to the topic at hand.
And Dr. Bryan, I'd like to start here. When Chris Kelly, the guy who I interviewed on that first high cortisol podcast, sent me over to you to talk to you a little bit more deeply, the very first thing that you said was to test something called ACTH. You said the very first thing you should do is to get ACTH measured. Why did you make that your first recommendation for something to look at when someone's cortisol is high?
Bryan: Sure, sure. It's not run very often. Unfortunately, it's a little bit expensive, but it really should be run in anybody that has abnormal cortisol because, and I'll just take a step back to discuss the physiology of this, if there's a perceived or real stress to our brain and it needs to have a stress response that the brain can tell part of the brain called the pituitary gland to release a hormone called ACTH, or adrenocorticotropic hormone, also known as cortocotropin, which is, you can see why they abbreviated it as ACTH. But ACTH is, so if the brain perceives stress, either real or imagined, it tells the pituitary to release ACTH, and then ACTH circulates throughout the body, reaches the adrenal glands, and then when the adrenal glands receive this ACTH, they produce an accordant amount of cortisol as a response.
So the more ACTH, then the more cortisol. I will also say the less ACTH then, when the adrenal glands received the message from the brain of only a little bit of ACTH, then they only produce a little bit of cortisol, and one of the problems, well one of the things we do well, I will say, in the integrative medicine space is we run cortisol. Now most conventional doctors don't really run that very often and we do. The problem is is that when we see it high or low, then we just are, automatically jump to certain conclusions.
So in you, for example, without knowing any of your history, if you were sitting in front of a practitioner that ran this on you and your cortisol was high, they would say, “Well, you're obviously under a lot of stress,” and then to which you replied, “No. I sleep perfectly every night. I get, I meditate, I have a very chill constitution. I'm not a stressed guy,” to which they would probably respond, “No, no, no. You know, you have high cortisol. You have some kind of stress.” And so your cortisol on the DUTCH test was pretty elevated, also on, historically when Chris sent over your labs, or your history of labs, you cortisol has been on the high end, in blood, on the high end of normal, dating back to 2013.
And so my question was, and the first question that I think any practitioner should ask, “Well, why? Why is it high? Why does his body want high cortisol?” And there's really, ACTH will help narrow that down a little bit. So, by running ACTH, if ACTH is high, along with elevated cortisol, then physiologically that makes sense. That's your brain telling your adrenal glands to make more cortisol, and they're responding, and that's perfect. On the other hand, if ACTH was low, but your cortisol is high, then that's a totally different story, and that's indicating that something is going on, likely with your immune system, that is, I wouldn't say attacking, but telling your adrenal glands to make cortisol when the rest of your body and your brain doesn't want it.
And so those are two totally different things, and I would even say that they require two totally different treatments or protocols, if you will. And similarly, for listeners, if somebody has low cortisol, that the most important question is to ask why, and ACTH can be very helpful there as well. So, let's say you have two patients, patient A and patient B. They both have low cortisol. If Patient A has low ACTH, then, physiologically, that's a normal response. They have low cortisol because their brain is telling their adrenal glands not to make cortisol. In patient B, if they have low cortisol, but high ACTH, that's an indication that there, that person's brain is saying, “Please make more cortisol,” but the adrenal glands are not responding, and therefore the issue is with the adrenal glands. In patient A, the issue is higher up. It's with the brain or the pituitary not making ACTH in the first place. So it's an incredibly important marker that unfortunately is really not run very often, but can tell you a lot in terms of why somebody has high or low cortisol the first place.
Ben: That makes perfect sense. So, ultimately, what it comes down to is sometimes high cortisol can be caused by your brain actually churning out a lot of this ACTH that causes the cortisol release. But, other times, high cortisol might be caused by something else like, let's say, I don't know what it would be, like epinephrine or adrenaline perhaps, to mobilize liver glycogen stores or something along those lines. But, either way, you're, what you're saying is if your cortisol, if you test and you find out your cortisol is high, the very first thing that you should do is test your, your ACTH levels?
Bryan: I think that's the case and again, unfortunately, it's really, the less practitioners that run a marker, the more expensive that marker tends to be. And so ACTH, because conventional and alternative practitioners are not running it very often, tends to be a really expensive marker unfortunately, and therefore it's cost prohibitive for the average patient to be running them, and it's hard to actually find a doctor that will actually run it on you.
Ben: And that is tested via blood, not urine, correct?
Bryan: It is blood. Yes. Yeah, and so it's a really important one, and I will just kinda make a broad statement here that the job of a practitioner, so if a marker, any marker, is high or low, their job, there's a whole list of possibilities, which you guys covered in your last podcast, a whole list of possibilities that could cause that. But by running ACTH, what you're really doing is narrowing down that list of possibilities. So, whereas if somebody has high cortisol, let's just say be 15 different things, by knowing what the ACTH is, and that narrows down that list of 15 considerably, it that makes sense?
Ben: It makes perfect sense. Yeah. Yeah. So ACTH is one, I'm fearful that my alphabet letters might get a little bit jumbled during today's show because we have so many markers to discuss, but the other one that you mentioned testing was oxidative stress. After you told me that ACTH should be one critical parameter to test if cortisol was high, you mentioned testing oxidative stress. Now why would you recommend an oxidative stress profile when one's cortisol is high? And, kind of as a follow up to that, of course, what is an oxidative stress protocol?
Bryan: So, I will tell you, I don't run oxidative stress panels very often. The reasons behind it for you actually had less to do with, it was somewhat related to cortisol, but it was more so related to some of your other markers, which I'll cover. The correlation between oxidative stress and cortisol is basically this: to make steroid hormones, so it could be testosterone, estrogen, cortisol, to make steroids hormones actually generates a lot of free radicals in the process. And so, in somebody that's making a lot of cortisol, just by nature of that level of cortisol, they will be generating more than the average amount of free radicals as well within the adrenal gland. Now it's questionable of how much will those, will actually go systemic and maybe impact an oxidative stress panel like your own, but you have a history of high cortisol, and so, therefore, in the adrenal glands there is going to be more than the normal amount of oxidative stress.
So that was part of it. The other piece of this, however, and this, you can stop me if you don't wanna cover this just now, but had to do with your lipid panel. Your lipid panel, your total cholesterol, by my standards, is fine. It was, I think in the 230s. Conventional medicine wouldn't like that too much. Your LDL was fine, I think it was low 100s, but your HDL was quite high, in my opinion.
Ben: Yeah. Always has been. Like above a hundred.
Bryan: Yeah. And, in fact, your, I think the last one, we ran it twice, but it was about the same level as LDL. And, by the way, that's really common in somebody following a low carb, high fat diet. It's really, really common. In an average person who's not following that type of diet, however, anytime I see an elevated HDL, it usually, and I don't like the word inflammation, but that's the first thing that comes to mind, is some kind of inflammation, a better phrase would be immune activation. Also, other things that can cause that, however, are liver dysfunction. That's also seen in cancer, not to say that you have cancer, but the point being in all these things, inflammation, immune activation, liver dysfunction, cancer, a significantly elevated HDL is not necessarily a great thing in my opinion.
HDL, considered the good cholesterol, which is not entirely correct, can act as an antioxidant, but it can also act as a pro-oxidant. And there was a study that showed that elevated neutrophils, of which yours were slightly elevated, elevated neutrophils were an independent predictor of HDL acting as a pro-oxidant, if you follow that. So, because of that, because of the elevated HDL, because of the elevated neutrophils, and suggesting that maybe the HDL was acting as a pro-oxidant, I was really curious about your oxidative stress profile.
And you asked about what that was, there's a number of different labs that can offer this, well I should say there's a number of different types of oxidative stress, and therefore there's a number of different markers that can look at oxidative stress potentially. The one that TrueHealthLabs offered was a profile by Genova Diagnostics that has a number of different markers within this single panel to evaluate oxidative stress. So that was the rationale behind it.
I will tell you, a lot of people have oxidative stress to varying degrees. I think it's a general clinical assumption that most people probably have a little bit more going on if they're not following a great diet, not following a great lifestyle, and therefore, I typically don't run that panel. But there were some very distinct things on your panel that made me very curious about what was going on with oxidative stress in you, which is why I suggested we run that panel.
Ben: Okay. So, a couple of things there. The first is that if someone's HDL is very high, what you're suggesting is that they look at their neutrophil count, and if that neutrophil count, which, correct me if I'm wrong, should appear on the white blood cell part of someone's labs, if that is also high, then that one-two combo might be impetus for someone to perhaps go and look at whether or not their body has a high amount of oxidative stress because, in that type of situation, high HDL could be a sign, not that you just have lots of good cholesterol, but could instead be a sign that you have high amounts of inflammation or oxidative stress.
Bryan: Yeah. Yeah, not inflammation, but oxidative stress. They're two separate things. Interestingly, high cortisol tends to increase neutrophils also. So, to see slightly elevated neutrophils in you wasn't necessarily surprising because of the elevated cortisol, but because of that one study that suggested that elevated neutrophils were a predictive, independent predictive factor of pro-oxidant HDL. It was just a, it was a big question mark in my head in terms of what's going on with oxidative stress in you.
Now I will say, conversely, low cortisol, you would very often see low cortisol correlate with high oxidative stress as well, but back to the other cortisol piece, when you're making too much cortisol, that drives a lot of oxidative stress. However, it's relegated to the adrenal glands, and so, systemically, it probably wouldn't change your oxidative stress profile if it was just within the adrenal glands.
Bryan: Because the neutrophils, the HDL, I just had a big curiosity about that.
Ben: Right. Gotcha. Now, Brady, I would imagine at this point you're probably well into your second green smoothie, sitting on your hands, waiting for me to ask you a question, but I actually do have a question now for you. One of the things that was noted by several practitioners on my lab tests that showed high cortisol was that, for someone who follows, like me, a high fat, low carb, you know, relatively healthy, kinda like a plant based diet, mixed with a little bit of meat and plenty of oils, my glucose, and my hemoglobin A1c, you know, the three month snapshot of my fasted glucose levels, and even my insulin were a little bit higher than one might expect. Now I know you look at a lot of lab panels there at TrueHealthLabs, and I'm curious if that cluster, high glucose, high hemoglobin A1c, relatively high insulin in someone who's not necessarily eating a lot of sugars is something that you tend to see on, in the case of elevated cortisol.
Brady: Yeah, you know, and I know you and Dr. Bryan have worked really close with each other, and, you know, I don't have a lot of your health background, but, yeah. I mean, you do lead a healthy lifestyle. Your exercise, you know, how would you describe your exercise? What's your exercise routine like?
Ben: My exercise routine is comprised of basically low level physical activity, all day long. Meaning that I try and simulate a hunter/gatherer-esque lifestyle by slowly walking on a treadmill while talking on the phone, or by stopping every hour to do a few pull ups, or to go pick up a heavy deadlift bar over in the gym next to my office. And then, at the very end of the day, I typically do what most people would be, would consider to be an extremely hard workout, 45 to 75 minutes of obstacle course training, or high intensity interval training, or weight training, or something like that, with the exception that there is one day of the week that's light, and easy, and more yoga-esque.
Brady: Yeah, so you know, just based on what you told me there, a few things could be going on here. You know, cortisol is a stress hormone. It gets released, like Dr. Brian said, either with biochemical stresses, physical stresses, or even imagined type of stresses. So, cortisol is a stress hormone, so it ultimately, basically it wants to help conserve energy. It also, it allows the body to have access to different sugars, but it also wants to shut down metabolism in a way to help conserve energy. You can think of it, the whole, the tiger jumping out of, at you, 2000 years ago and you have to have this burst of energy to get away, but then your body needs to shut down, conserve energy, and that's one of the processes for it, and cortisol really works in many hundreds of different metabolic pathways. Some of it is actually to promote insulin resistance and from the resistance will actually help fat storages, and that means you have energy storages for the time you need to heal, recover, you know, a lot of people who are in chronic health issues, their body goes into that state that may produce excess cortisol in order to get their body in that state of “We need to retain.”
And so exercise is one of those things too. You know, I'm really glad to hear, the hunter/gathering type of exercise that during the day, that kinda goes against our conditioned aspect of “You need to hit the gym, work hard for two, two and a half hours a day,” and that's our version of healthy exercise. So, not to get too far off track, your glucose, your hemoglobin A1c, which again is a kind of a three month average of blood sugar, so they were a little higher than you would expect. But you also stick to a pretty strict diet of the high fat, low carbs, so, you know, it's difficult to say whether that, those levels are good for your lifestyle and your genetic make-up. It's really difficult.
When I used to take on patients, we used to run very extensive panels so we can look at all these things together, really take in the environment, and look at all these numbers and say, “Hey, what patterns are we looking at here? What are the big issues?” And, instead of nit picking everything, we can kinda look back, see the big picture, and I like to use the metaphor of dominoes, you know.
Some of the dominoes at the beginning of the line are really big and they could knock down all the rest. What are those few big ones? And do we need to mess with those or do we not?
Brady: Again, it's really, really difficult to tell.
Ben: Yeah, that makes sense. And one thing that I wanna highlight, that you just mentioned that I think some people might not know is this issue with high cortisol causing insulin resistance, you know, potentially even if you're eating, let's say, a low carb, low sugar, low starch type of diet.
So, if I understand correctly, what you're saying is that when your body feels as though it's constantly stressed out, whether from exercise or some other stressor, what can happen is that it switches on pathways to develop insulin resistance so that, rather than putting food stuff into, say, muscle storage or liver storage, you might actually create new fat cells or put glucose, you know, that has been converted into triglycerides, et cetera, into fat cells so that your body has storage to rely upon in times of need even though you're not necessarily in a time of need. That’s almost like an ancestral mechanism in the presence of high cortisol?
Brady: Exactly. Well put.
Ben: Okay. Interesting. And that's also interesting because you'll hear a lot of personal trainers say, “Oh, high cortisol makes you look bloated, makes you retain water, gives you that skinny fat soft look,” but it sounds, like based on what you're saying, it's not only that you're, say, retaining water, or experiencing some type of mineral deficiency or excess from high cortisol, but also, literally, creating new fat.
Brady: Yeah. Exactly. Yep.
Ben: Interesting. Interesting. Okay. So, that's another thing that one might expect to see, even if they're eating, let's say, a high fat diet, would be potentially higher glucose, higher hemoglobin A1c, and higher insulin, and one thing to look for would be hypercortisolemia on a test like that.
Bryan, you also noted that thyroid on this test that showed high cortisol, that free thyroid, or free T3, and total T3, that active thyroid hormone, you noted that that was low, suggesting some kind of a conversion issue. Now does cortisol, and elevated cortisol particularly, and/or oxidative stress cause this type of issue as well?
Bryan: Yeah. Absolutely. So, when the thyroid makes thyroid hormone, it makes it, the majority is T4, also known as thyroxine, and then, really in a number of different tissues in the body, the liver and the kidney, well, I'll say this, T4 is converted to T3 in just about every cell of the body. That said, the liver and the kidneys contain an enzyme that, when they convert it, contribute to plasma T3 levels.
So, when you're looking at T3 in the blood, what you're really looking at is the ability of the liver and/or kidneys to convert T4 to T3. Whereas, it is being converted in other, sort of selfish cells that don't release it back into the plasma and, yeah, you know, it's funny is, so in the, first of all, in the conventional space, they really don't even care about conversion. In fact, I have a lot of patients that have talked to an endocrinologist that ask for T3, and the doctor will say, “Well, why? It's not important. All that matters is TSH and T4,” which is really kind of a sad state of affairs in the conventional world.
But the problem in the alternative world, a lot of times what you'll hear is that that can indicate a selenium deficiency, which is technically true. The enzyme that converts T4 to T3 is a selenium-dependent enzyme, meaning that if selenium is not present, then this enzyme cannot do what this enzyme is supposed to do which is the pop off one of the iodines to turn T4 into T3. But the reality is is it's a really long list of things, according to the scientific literature, that can decrease conversion of T4 to T3 beyond selenium. Iron deficiency has been shown to decrease T4 to T3 conversion.
You mentioned cortisol. Both, cortisol will do it. Now, a question that I have is how high does endogenous, or your own made cortisol have to be in order to downregulate conversion of T4 to T3? What's well known is that glucocorticoids, from like a cortisone drug perspective, so somebody is taking steroids, for example, to suppress their immune system, or for asthma, or for whatever reason, that can definitely do it. So, cortisol, yes. It can definitely downregulate the conversion. At the same time, a low calorie diet, I'm sure you're probably aware, can also do that quite a bit. A number of pro-inflammatory cytokines have been very well shown to do this.
A number of chemical toxins like Bisphenol A for example, have been shown to do this. Mercury, flame retardants. Low growth hormone is associated with a decrease of T4 to T3 conversion. And there was a case report, a single case study, a published case study that I found which I thought was really interesting. This doctor was tracking his patient, a female patient's conversion of T4 to T3 while she was experiencing pain and what he found was is the more pain she was experiencing, the less conversion she was doing, and as her pain went away, then she converted more now. That might be speaking more to some of these inflammatory cytokines, but it definitely begs the question if something like perceived pain can decrease conversion as well.
So I say all that because, you know I saw that, and your T3 was actually pretty low. Whereas your TSH and your T4 were fine. I would have no issues with those. But your, one of your labs, your total T3 was 59 and the range that I would like to see that in is about 100 to 180. Your free T3 was equally low. So there's definitely a poor conversion going on. The question is why and where, and I have some insights possibly as to where which we can talk about.
But you can see with that long list that it's not really just about taking a conversion supplement, which there are companies that make this, but I will tell you that nine out of ten times, they will fail miserably. Because when you look at that long list of things that are involved in conversion, you know, what is it is it? Is it cortisol? Is it oxidative stress? Is it inflammation? Is it toxic chemicals? Is it low growth hormone? Is it deficiency of certain nutrients? So it's really a very tricky thing to try to fix and I would say if there's any listeners out there that have poor conversion of T4 to T3, it's really about correcting their overall system. It's about, you know, getting rid of toxins, making sure that they have nutrient sufficiency, taking a look at cortisol, taking a look at, you know, possible inflammation that might be going on. And when those are resolved, then and only then, I think, will that conversion of T4 to T3 increase.
Ben: Right, right. And so what you're saying is that if someone gets a thyroid panel and they find out that their thyroid hormone is low, many doctors will put them on synthroid, or perhaps like a natural thyroid replacement like armor thyroid, or something like that. But what you're saying is that, in many cases, it could be a selenium deficiency, or it could be oxidative stress, or it could be hypercortisolism, and just doing something like a like a thyroid supplement, or a thyroid replacement could indeed just be a Band-Aid over a bigger issue.
Bryan: If it even corrected it at all. I've tried. I mean, I will admit, I've seen that conversion issue, I've tried over the years a number of different supplements and I've never seen that conversion improve, and it would only tend to improve when other metabolic processes in that person improve.
Ben: Got it. Okay, now before we delve into, obviously, you guys ran tests on me, and I wanna talk about those tests in a moment, but there was one other question that I have that really either one of you I suppose could answer this question, but Bryan suggested that my sex hormone binding globulin, SHBG, which binds to your sex hormones and kinda keeps them from being biologically active, and also my liver enzymes appear to be slightly elevated as well. Now, in your guys' experience, and either one of you again could answer, did these type of parameters, SHBG and liver enzymes, also appear when someone's cortisol is high?
Bryan: I could take that, or Brady, you wanna…
Brady: Yeah, sure. Bryan, go ahead first, and then I'll follow.
Bryan: Yeah. So, AST, ALT, there's other ones like ALK PHOS, LDH, GGT, these are all enzymes. They're intracellular enzymes. And so, as something that's normally found huddled inside, protected inside of a cell, you'll only tend to see those go up when there's cell damage, meaning the insides of these cells aren't going to show up on the blood unless these cells are breaking down. So they're typically markers of tissue breakdown and each of these enzymes are found in differing amounts in different tissues, and therefore can indicate what tissue was being broken down versus other ones.
So we're not gonna talk about it here, but something like LDH, lactate dehydrogenase, that's found in just about everything single blood cell. So if that's high, all it says is that tissue's breaking down, but you really don't know why. ALT, on the other hand, is typically found in greatest quantities, but not exclusively, in the liver. So if somebody's ALT was the only thing elevated, then it probably means the liver is, the liver cells are being broken down and destroyed for some reason.
In terms of the tie-in between cortisol, what you mentioned, sex hormone binding globulin, AST, and ALT, which in you are all elevated, there's not a real direct correlation that I would personally say. Sex hormone binding globulin, most common cause of it to be elevated in both men and women is excess estrogen. That sex hormone binding globulin is a protein made in the liver and, in the presence of excess estrogens, the liver tends to make more binding globulins. Conversely, in the presence of high androgens, like testosterone, then the liver will tend to make less. So, just as a take home, women by nature, they're estrogen dominant, tend to make more of these binding globulins than men do, who are androgen or testosterone dominant.
Now, in you, the other thing that came up, both on the DUTCH test and previous tests was you tend to have low total and free testosterone. Not totally bottomed out like your T3 levels, but pretty low for a young, healthy guy like yourself. And because of that, your estrogen level was, I'd say it was okay, but what you're looking then at is a relative testosterone deficiency to estrogen, if that makes sense. That your estrogen levels are fine, but when you compare them to your testosterone levels, your testosterone might be a little bit low and therefore, that may be causing a slight increase in the sex hormone binding globulin levels. But, another thing, so your AST was higher than your ALT, but they're both high. The AST, I think, was 60…
Ben: Those being the liver enzymes.
Bryan: Yeah. Yeah. It was 60. You know, a healthy range is about anywhere between 10 to, let's say, 35. AST has the same range, but your AST, I think, was in the 130's, if I remember correctly. So those are both elevated, which again, it could be caused, I will say, it could be caused by exercise, especially strenuous exercise, the type that you do. But, the thing is, I've seen a lot of labs in a lot of fitness people, that tends to be the majority the patients that I see, is relatively healthy people who are exercising, who are eating well, who are on supplements, you know, not type 2 diabetics who have congestive heart failure, patients, and I don't always see elevated enzymes like with yours. So, I think exercise can do this, but that doesn't mean that exercise does do this, if that makes sense.
Ben: Right, right. One thing I should throw in there for people listening in is, is that I personally, you know, also tend to look at a lot of blood and biomarkers because I do some work with WellnessFX as I know you do, Dr. Bryan, and you'll see often in someone who has exercised in the past 48 hours leading up to the test elevated liver enzymes because they tend to be elevated in response to a moderate to difficult exercise session, correct?
Bryan: Yeah, yeah. And I'll tell you, that's a great question. So if I have somebody who's into fitness, maybe an athlete and we get back, it's not a technical term, but sort of wonky enzymes, wonky creatinine, or some of these things, I'll ask them, you know, when was the last, when did you exercise prior to this test, and if they say that they had a tough session the day before, then you have to take that into consideration. The nice thing I will say, however, is that when one does serial testing, then you can start to see patterns.
So, if, for example, somebody has relatively normal enzymes, AST, ALT, but then they elevated quickly, that might have been because of their training session the day before the last test. So, you know, in someone like you, I'd be curious to see if this was a trend or a tendency because, generally speaking, people that exercise, and if they exercise hard, they can go up, but they don't always so that doesn't mean that's the case.
And I will tell you that because of your elevated sex hormone binding globulin, AST, ALT, and the HDL that we talked about, that I, which is, it's strange, but in a healthy guy like you, I seriously wonder if maybe something, and I always look at this as with myself, which I'll just say that, I would seriously wonder if something was going on with my liver because liver dysfunction can create an elevation in those enzymes. Liver dysfunction can create an elevation in sex hormone binding globulin, as well as can be, it doesn't cause the elevated HDL, but it's associated with high HDL.
Ben: Right. And liver enzymes, if not sparked by something like a hard exercise session, those could be caused by everything from a poor diet, low magnesium, low antioxidant intake, alcohol intake, or excessive alcohol intake, things of that nature, right?
Bryan: Yeah, anything to break cells down.
Ben: Right, right. Gotcha. And, Bryan, did you want to jump in?
Ben: Oh, Brady.
Brady: Oh yeah, you know, just something to add on to that, even the intestinal environment is very important for liver function also. So, if there's any sort of intestinal malfunctions with digestion, absorption, even what I typically see with a lot of stool tests that come back is, you know, we highly recommend the stool tests that tests for good bacteria too. So, a lot of times, I'll see imbalances in the good bacteria, which can produce byproducts that the liver doesn't like, can also increase liver enzymes, things like that, and be part of that domino effect of changing sex hormone binding globulins, and conversion issues with thyroid, things like that. So the intestinal tract is a huge piece there too.
Ben: Got it. So, like leaky gut, gut dysfunction, bacterial dysbiosis, all these type of things, if someone's liver enzymes are elevated, they might also want to consider looking at that type of thing.
Brady: Yeah, and this is human physiology, so everything works with everything else. So it's really, it's looking back and saying, “Okay, where are these changes happening? What are the big things that are happening that we can actually do something to make this domino effect of good change that happens,” and be able to do serial testing to find out, to see if these things are headed in the right direction.
Ben: Yeah. Okay, cool. So, for those you listening in, just to kinda bring this full circle here briefly, high cortisol, in the case of high cortisol, one of the things that Dr. Bryan recommended was to look at things like your cholesterol particles and your HDL, to look at things like your testosterone, to look at things like the ACTH that we talked about, and some of these other variables that can affect ACTH, and then of course, something like an oxidative stress panel.
And so, I, being the good little boy, the good little obedient boy that I am, decided that I would just go ahead and get all of these tests that Dr. Bryan recommended. I actually went through Dr. Brady's TrueHealthLabs which, again, puts together these custom panels that you can run, and Dr. Bryan just kinda sent over everything to test, and we ran these labs.
Now I have, for those you who wanna to follow along, I have all of my lab reports published over at bengreenfieldfitness.com/cortisol2, cortisol, the number two, and this is going to be incredibly insightful for you, if listening in, because we are going to delve into how some of these things that we tested actually give insight into cortisol, and into stress, and, full disclosure, I have not actually looked over these results at all with either Dr. Brady or Dr. Bryan, so this will be a bit interesting for me too, and you will get to witness it in real time. So, what you think guys? Do you wanna jump into my results here?
Bryan: Yeah, we totally can. Actually, if I could just quickly jump in, I love what Dr. Brady just said about the, the gut health. The, certain bacteria, the unhealthy ones, if you will, gram negative bacteria, in the gut produce what's called an endotoxin. Endo being from within, the toxin called a lipopolysaccharides, LPS, and, it turns out, that lipopolysaccharides are a major cause of fatty liver, and the reason why is if somebody has intestinal permeability, or leaky gut, and they have dysbiosis, so these gram negative bacteria, and they're making these lipopolysaccharides, the first place in the body that these things leak out into is the liver. And so I'm really glad that he brought up that point because liver dysfunction, fatty liver, whatever you wanna call it, which, again, when you look at yours Ben, you know, when you consider that the low T3, the conversion as well, that also is likely happening in the liver. That's why I was really curious about your liver.
He brought up a really important point that somebody may be experiencing thyroid symptoms, somebody may be experiencing high cortisol, but in fact may be emanating from the gut in the first place, driving some of those liver dysfunction that can contribute to some of the things that we potentially are seeing that are liver derived on your panel. So I just wanted to point out that he brought up a really great point when saying that.
Ben: Yeah. Okay. Cool. Got it. That is an excellent point. Okay, so there's two different panels here. There's one that's this custom panel of random things that you wanted to test to give insight into high cortisol, Dr. Bryan, and this one is a LabCorp panel that I have, I actually have it pulled up in front of me right now. Do you wanna walk through this one?
Ben: Okay. Well, I will turn things over to you and Dr. Bryan to perhaps bounce things off, and then I will keep my mouth shut unless I need to pipe in here with dumb questions.
Bryan: Sure, and Dr. Brady, feel free to interrupt me as we're going along here.
Brady: Sure. Absolutely again.
Bryan: So page one of your report here is the NMR lipid profile and that's really looking at lipid, the cholesterol, not the, but the lipoprotein particle size and count, or number, and some of the sub fractions of some of those things, which I'm not gonna really spend any time on. We actually already talked about this. Your cholesterol, according to the lab, is high but at 223, I have no problem with that. Your particle number, up at the top there, 909, that's fine. Your LDL cholesterol is, again, showing up as high, but with the total cholesterol of 223, I think an LDL of 109 is to be expected. The only issues that have come up here for me is that the HDL level of 105, which we already talked about, and the other bit too is your triglycerides, if anything, I would say are on the low side. Now that might be because of your diet.
I will say though, in the average person, if I were to see an elevated HDL and low triglycerides, that's a really common pattern that you see with immune activation. Again, you call it inflammation or immune activation, but it's a really common pattern, especially in people that have autoimmune conditions. Now, again, not suggesting that that's what you have, I'm just saying what I see most frequently. But, so it's…
Ben: Now, that's very interesting. If I could jump in, because, most of the time, you'll see popular medical literature saying that a high HDL to triglyceride ratio, right, like high HDL and low triglycerides, is a potent marker that you've got a healthy ticker. That you're not gonna die of cardiovascular disease, or at least you're not showing one of the biggest risk factors for cardiovascular disease which should be low HDL and high triglycerides. But what you're saying is that, in some cases, especially in folks who might be symptomatic, or who might have high cortisol, that high HDL, very high HDL, and relatively low triglycerides could in fact be an indicator that you have some type of autoimmune issue going on.
Bryan: Yeah, and I hate to use that word autoimmune because it freaks people out. So that's why I just say immune activation, or maybe inflammation, which is really, inflammation is too ubiquitous of a word, really. People don't know what it really means, I mean, including anybody. But, yeah, and I love the word that you said as indicator. It doesn't mean that it is the problem itself, its meaning that it's indicating something else that may be going on. So, anyhow, I saw that and that I just had a curiosity about it. Nothing to really talk about. The next page is really just a kind of a summary of that lipid profile.
Ben: All the different particles on the cholesterol panel.
Bryan: Yeah. And again, I don't think there's a reason to really nitpick all that. Big, so, and again, when you're looking at this stuff, you wanna look at the smoking gun. You want to try to find out the thing that's really going to help explain things, and none of it really does here. So, I just, I really move pretty quickly from there.
Brady: Well, if I could jump in just were just one second, since some viewers may have some lipid-type of concerns and confused or wondering about the sizes, and the densities, and things here is, is the, when it comes to lipids, and it's a much better indication of cardiovascular health or risk factors of cardiovascular disease, is the size and the density of cholesterol molecules. So you can think of it as having a golf ball and a basketball floating through the bloodstream. And, over time as we just live our lives, our arteries and our blood vessels, they develop little cracks in them. They get damaged like all the tissues in our bodies do, but they need to be patched up, and so the part, one job of cholesterol is to patch up these cracks.
Now, if you have a large, big, light type of cholesterol molecule, like a basketball, these things don't get into those cracks very much and that actually lowers the risk of developing plaques, and strokes, and potentials like that. Now, if your cholesterol molecules are really small and dense, they can get in there, they can build up, and they can increase your risk of developing heart issues even if you have normal cholesterol readings here.
And so, there's been studies after studies to show that more than 50% of people who end up having cardiovascular disease, end having normal cholesterol levels. That's why something like an NMR cholesterol test here to show the size and the density of these cholesterol molecules are very important because that could help avoid getting on these stance 'cause you got remember, you take something like this to your doc in the box down the street, and they see that you have a high cholesterol level, you know, they might take your triglycerides into account, and that's it, a lifelong supply of Lipitor, and that has its tremendous, you know, downfalls too. So…
Ben: Yeah. I think most of our listeners are probably well aware that statins are bad news bears, but yeah. It is quite interesting that these particles are definitely something to take into account when getting a lipid panel for sure. You know, anybody who gets just LDL, and HDL, and triglycerides is not getting the full picture.
Ben: There are other things on here, you know, testosterone, cortisol, luteinizing hormone, et cetera. So, when you talk about smoking gun, you know, in the interest of course, that we don't have four hours for a podcast, what, are there other things on here that you think leap out, as far as things that influence high cortisol, or things that you specifically ordered on this custom panel that you really wanna highlight?
Bryan: Yeah. So, if you remember from that e-mail, I guess it was a couple months ago now, I listed out a number of different panels that you could theoretically run from a top tier priority down to a lower tier, and you chose the ones that you wanted to do. In terms of the smoking gun, so if you look at, I'm on page three here, your testosterone at 496 is not bad, but it's, you know, depending on if you look at an optimal reference range for testosterone, it's maybe a little bit on the low side. Your serum cortisol is elevated above the lab range here, which is great because that just justify, or validates, the DUTCH test that you had. So you have high cortisol in the urine test, you have it on a blood test, and that's just telling you that you actually do have high cortisol. What I find really interesting, if you look at luteinizing hormone at 1.8, that's just one-tenth of a point above the low end of the reference range here.
So, going back to that conversation we had about the pituitary and the adrenal glands, it's the same conversation about the pituitary and the testes. So what you see here is that your pituitary is not trying really hard to get your testes the make more testosterone. So is the defect in your testes' ability to make testosterone, or are they merely responding to the very quiet whisper of the pituitary gland?
And so, when I, it's not a smoking gun. This doesn't relate to cortisol per se, but as I said in an email to you before, I think there's a bigger picture going on. There's something that's driving up your cortisol, I wouldn't be surprised if it's the same thing that is decreasing your T4 to T3 conversion, and now, I would say, that it's suppressing your pituitary's ability to make luteinizing hormone, and that's why you don't see higher levels of testosterone, if that makes sense. I feel like that the smoking gun isn't on this panel, but I feel like that what you're seeing is indicators of some higher order thing, whether it be inflammation, or something going on immune related, that is, again, elevating cortisol, suppressing luteinizing hormone, decreasing conversion of T4 to T3. That make sense?
Ben: Got it, and that all makes sense. So one thing that I wanna highlight to folks who are listening in is if your testosterone tests lower than what would be ideal, and in my case, you know, like Dr. Bryan highlighted, my testosterone is not hypogonadal. And, to be frank and realistic, I, you know, I have high motivation, high drive, great sex, et cetera, but it's still, testosterone is lower than what you would expect in like a young healthy male.
So, in this case, if you look at luteinizing hormone, luteinizing hormone is your brain's signal to tell your testes to make more testosterone, and if you have low testosterone, you may want to consider as I did on this panel, testing luteinizing hormone because that can show whether it's an issue with the testes, or whether it's an issue with the brain, and it looks like what you're saying, Dr. Bryan, is that in my case, I'm showing low luteinizing hormone, which suggests that these issues with, for example, low testosterone, or cortisol, might be occurring potentially, you know, higher up and, you know, from a brain signaling level.
Bryan: Yeah. No, that's perfectly said. I would expect your pituitary to be trying a little bit harder to get your testes to make more testosterone. And, when you said, to have, if you have low testosterone to consider testing luteinizing hormone, I would say absolutely test luteinizing hormone. Because, again, if somebody has, if you have two people, two men that both have low testosterone, it could be the same level, let's say it's your level, and one guy has luteinizing hormone that's really high, that means that the body, his brain is trying to tell his testes, “Please make testosterone,” but they're not, then the issue, the defect is in the testes. But in this case, where you have low-ish luteinizing hormone and low-ish testosterone, the testes may be working perfectly, they're just not being asked very hard to make more testosterone. So, I think it's an incredibly important test run if somebody has low testosterone.
Ben: Got it. Okay. Cool. So, we see some clues here that there are things going on that are perhaps affecting the brain's signaling to the adrenal glands, or to the testes on this first custom panel in which we tested ACTH, luteinizing hormone, like you just mentioned along with some of these other variables that are on this panel. Now, in addition to that, unless there was anything else that you want to discuss on that custom panel, we also have this oxidative stress panel. Do you want to delve into that?
Bryan: Yeah, yeah. Well there's actually one more page, real quickly, I could do it in 30 seconds if you want.
Ben: Oh, yeah. Sure.
Bryan: So, on that last page, or the fourth page you have FSH on there, and here's the thing, so FSH is another pituitary hormone in men. It stimulates spermatogenesis, or sperm production. And, if you notice that if you look at that reference range, and where you are, then that one's fine. It's, you know, it's kind of in the middle. So it's interesting because of all your pituitary hormones, it's like there's certain hormones that are being selected to not be produced. FSH is fine here. If you jump down to markers, you have ACTH on there. It's about 48. So, this is an indication that your pituitary is trying to get your adrenal glands to make cortisol, unlike which is one of the things we're trying to rule out.
I ran prolactin because high prolactin in a man is a great way to bottom out testosterone and I was just trying to rule out one potential cause for low testosterone in you. C-peptide is a surrogate marker for insulin, and this was interesting because your insulin, I think, was a little bit on the higher side, but your C-peptide is totally fine. It's on the low side, which is to be expected in you. Your free testosterone is low, if you noticed, and that’s because your total testosterone is low-normal, I would say. This is laboratory low, but that's a consequence of that elevated sex hormone binding globulin. So it's holding on to most of your testosterone.
And in the last marker, I just want to point out to you that aldosterone there, that’s like a marker down, I read that one, it was really interesting because your blood chemistry, or a previous one, showed an alteration in sodium and potassium, I won't get to the details unless you want me to, but you usually see that pattern in sodium and potassium on you if you have low cortisol, low cortisol, low aldosterone. And so, it turns out that you notice that your aldosterone level here is on the low side. Your cortisol, however, these are both adrenally produced hormones, your cortisol is high, but your aldosterone is a little bit low, which is really curious and paints kind of a larger picture as to possibly what's going on with this.
But with low aldosterone, I will tell you, you have a hard time holding on to your water. What aldosterone does is it tells the kidneys to retain sodium and excrete potassium, but if aldosterone is low, then they tend to excrete sodium and retain potassium, and with sodium will always follow, water will always follow it. So, I would suspect that you drink a normal amount of water, being a healthy guy, but that you probably urinate quite a bit, and you're not actually holding on to that water because your aldosterone's low and you're losing sodium.
Ben: That's very interesting, and it's an interesting observation for two reasons. I drink copious amounts of water, but I also tend to urinate very frequently, you know, like every 30 to 60 minutes, often. And so what you're saying is that that could be a function of that low aldosterone causing me to shed water because I'm shedding sodium, and in this case, whatever is causing high cortisol or low luteinizing hormone/low free testosterone might also be suppressing aldosterone.
Bryan: Yeah. That's actually a different conversation, maybe that's a cortisol talk part three, but no, that's, I would actually suggest not the suppressed aldosterone.
Ben: Okay. Gotcha. Gotcha. Now one quick question before we get into the oxidative stress panel. This, you know, if aldosterone is low, it seemed to indicate that one might have some hydration worries. Is there a solution for doing something like increasing aldosterone, or is it a matter of going after the high cortisol?
Bryan: No, no. I would say, if somebody doesn't have high blood pressure, to start adding some sea salt to your water.
Ben: Interesting. So some more minerals in the water?
Bryan: Yup, and usually the pattern is that when they have low aldosterone like that, their pattern tends to be towards low blood pressure, they tend to have what's called orthostatic hypotension, which means they get dizzy if they stand up too quickly, and they urinate a lot, and their blood chemistry will typically show patterns of dehydration, but by adding sea salt, what typically happens is it's great. You increase your blood pressure a little bit, you don't get dizzy as much when you stand up, and you stop urinating as much, and by nature, you end up hydrating yourself more.
Ben: Got it.
Brady: And the beautiful thing about the sea salt is that it has minerals in it, and because of that you're not gonna have a dramatic increase in blood pressure like you would normally have with table salt. So it's important to stay with the salts with minerals, since that is the only salts that actually are available on Earth, you know, your table salt is manufactured, that doesn't really occur in nature. So, yeah, the sea salt has a really great importance there too.
Ben: Makes perfect sense. Okay. So, add minerals to the water, drink more water, get more sea salt into the system, but ultimately that's kind of an aside in terms of the high cortisol. It's just something that we kind of stumbled across, basically.
Ben: Okay. So we have this oxidative stress panel, and by the way also at bengreenfieldfitness.com/cortisol2, cortisol, the number two, I'll link to this if you wanna pull it up and see what an oxidative stress profile looks like, if you're listening in, 'cause this one's pretty fascinating. You guys wanna walk through this one?
Bryan: Sure. Brady, do you want it? Or do you want me to take it?
Brady: Yeah. Go ahead and I'll fill anything in.
Bryan: Alright. Cool. I'll go through it quickly, I know we've been on the call here for a while. So this oxidative stress profile…
Ben: No, no rush. Remember, people put on their propeller hats.
Bryan: Alright, alright.
Ben: They're ready.
Bryan: The first table that you see there, it has a subtitle of protection, and these are generally things that are going to provide either the substrate for an antioxidant to protect against oxidative stress or has an antioxidant itself, and again, I won't go through a great deal a lot of this, but if you notice the first one is glutathione.
Glutathione is arguably the most potent intracellular antioxidant that our body makes, and that's the nice thing is our body makes it. It's a tripeptide made up of three different amino acids. The body is pretty adept at making this. One of the, the rate limiting amino acid for glutathione synthesis, if you go down to, there to cystine, they sound pretty similar, there's cystine and cysteine, but the cysteine is the rate limiting amino acid for glutathione synthesis. Meaning you can have the other two amino acids, which are glycine and glutamate, but if you lack that cysteine, then your body will have a hard time making glutathione. It's a pretty, I wouldn't say it's an easy process, but the body is really adept at making glutathione.
So what you notice in that first protection panel or profile, is that your glutathione's low. So what that means is that you don't have enough glutathione, for some reason. Glutathione is, again, a really important antioxidant, and then the question arises why. And if something's low, then it's either it's being used up or you're not making it sufficiently, if that makes sense. So, but again, you don't take anything, you don't look at just one marker and make decisions, you have to look at the whole thing. So let's, we'll just leave it at that. So the total antioxidant capacity might be on the low end, but it's in the green and their reference ranges are pretty tight, I will tell you. And then some of those other amino acids in the ratios, those all look pretty good, but glutathione's a little bit low.
Ben: Right, but that's, so that's important because glutathione is such a potent antioxidant.
Bryan: Oh. Totally. It is, but like I said, we, you know, you never wanna look at just one thing and say, well, because you don't know if you're not making it, or if you're using it up, and so by looking at the rest of the panel, we might be able to kinda figure this out a little bit. So then the next subsection has two markers in it, or enzymes, and it's called enzymes, and this is glutathione peroxidase and superoxide dismutase. So glutathione peroxidase is the enzyme, well, how do I, I don't know how deep you wanna go.
Glutathione, as an antioxidant usually holds hands with another glutathione molecule. So they tend to go around, two of them connected. Glutathione peroxidase then is the enzyme that says, “Listen. I have some free radical damage, or some free radicals over here. Can I get a couple of electrons off you guys and donate them to the free radical to make it happy?” So glutathione peroxidase is the enzyme that helps take the electrons off of glutathione itself and hand it off to a free radical or reactive oxygen species. And then similarly, superoxide dismutase is the enzyme that a…
Ben: An enzyme with a great name, by the way.
Bryan: Oh my gosh…
Ben: Sounds like a super hero.
Bryan: No. You know, it take, that takes an electron off of superoxide radical, which I think is probably one of the coolest heavy metal names for a band, if I were to name one. But so what happens is inside the mitochondria, the little energy producing cells of the body, we use oxygen to help make ATP. The problem is that, and it's not a problem, it's considered to be healthy in the right amounts, is that oxygen, when it gets an extra electron, becomes something called a superoxide radical. And as the name would suggest, that can cause, it's a free radical. It can cause damage to the mitochondria, or any number of things. Superoxide dismutase hands superoxide radical an electron, and it turns it into hydrogen peroxide. So now, no more superoxide radical. So that's the role of superoxide dismutase, and then glutathione peroxidase takes two electrons off of glutathione and turns hydrogen peroxide into water. So, hopefully you followed all that.
Ben: Yup. Yup.
Bryan: So when looking at these enzymes, what you notice is superoxide dismutase is really quite high, according to their reference range. Glutathione peroxidase is a little bit on the low side. Now, with these panels, it turns out that the higher the enzyme function, or the higher the enzyme amount, like what you see, means there's oxidative stress that, when it's low, it's a different story, but when it's high that indicates there's oxidative stress. So this piece right here, that high superoxide dismutase is indicating that you are under oxidative stress. And, if you follow that sort of progression that I just mentioned, if you have functioning superoxide dismutase, but not glutathione or glutathione peroxidase, then you're stuck with too much hydrogen peroxide, and hydrogen peroxide is one electron away from being another free radical.
Bryan: So, you, it seems that you do have excess oxidative stress because of this excess superoxide dismutase, the amount of it, and but, and you're probably turning that superoxide radical into hydrogen peroxide, fine, but you're not turning that hydrogen peroxide into water, leaving yourself, maybe with excess free radicals.
Now the last important piece of this panel, however, is that last one saying, with the subheading of damage, where it says lipid peroxides. So lipid peroxides are essentially damaged fatty acids that have been oxidized, let's just put it that way. And if you notice that you're in the green, which is good, but you're on the high-normal range, you could say. So taken all together, what I would say is you are under more oxidative stress than normal, that, because the lipid peroxides are still within the green, that you're hanging on, you're holding tight. Your antioxidants are doing their job, but with a low glutathione, and sort of low-ish glutathione peroxidase activity, that if this were to continue for, I don't know, I can't even say, a period of maybe months, maybe even years, that if all things stayed as they were, that your lipid peroxides might start to creep up a little bit.
Ben: I gotcha. Okay. So, obviously, exercise creates oxidative stress and, you know, it's no secret that I do things like Spartan triathlons, and often, you know, during any given month, I might have some masochistic two or three day event thrown in. Do you think that that would be enough oxidative stress to produce some of these things that we're seeing, extremely high cortisol, low thyroid, low luteinizing hormone, high levels of superoxide dismutase, and low levels of glutathione? Or, as you indicated when talking about triglycerides and HDL, do you think that another factor here could be some sort of, as you mentioned, autoimmune condition, or other issue, other hidden issue causing high cortisol?
Bryan: Yeah. I think it could be both, and I think what you're seeing is, and at least what I think I'm seeing here, is a really fit guy who follows a really killer lifestyle, eats fantastically, very low stress, doing all the right things, taking the right supplements, and seeing an element of oxidative stress that based on your exercise, is not surprising. And the only thing I think missing from this is a little bit more glutathione, if you will. That, I'm not surprised to see some of this oxidative stress, but if you look at the lipid peroxides, you're handling it. So, the level, I think the intense level of your awesome diet and lifestyle is matching your intense level of exercise, and like I said, you're hanging in there, and the only thing that's missing is the glutathione component. So, if that were to be increased a little bit, what I would suspect is that that lipid peroxides would actually go more into the green.
Ben: Uhm, gotcha.
Bryan: And, I will add…
Ben: You mean using like a glutathione supplement, like a liposomal glutathione or something like that.
Bryan: Yeah, or the precursors, you know, like N-acetylcysteine is a very potent precursor, maybe a little extra vitamin C, a gram or two a day possibly. Yeah, I think, but then to speak to the other part of your question, I still think that there may be something going on with the immune system that your body wants high cortisol, and it wants suppression of some of these things like luteinizing hormone, and possibly conversion that is totally unrelated to oxidative stress.
Ben: Gotcha. And for something like that, are you suggesting that there is a test to look at autoimmune disorders? Like a Cyrex laboratory panel for food allergies, or something along those lines?
Ben: Or are you suggesting something else?
Bryan: That's not what I would personally run, and I've mentioned this before, but it's the lymphocyte subset panel which sort of dissects your lymphocytes, which is one type of white blood cell, a little bit deeper. And you can look at, it's kinda theoretical, but you could at if there is sort of a TH1 dominance, TH2 dominance, what your natural killer cells are doing, just to give you a little bit more insight into what is actually going on with your white blood cells, I think. It may come back totally clean, and doesn't give any answers, but I always look at these if they were me, and if this was my panel, that's I would, the next thing I would do is not a Cyrex panel, but instead I would do a lymphocyte subset panel.
Ben: A lymphocyte subset panel.
Brady: Yeah, and that's also called a CD4/CD8 ratio panel. A commonly searched for term for that.
Ben: Interesting. So, you know ultimately, I want to make our listeners aware that I wanna highlight something that Dr. Bryan said. Basically, the fact that my clean lifestyle, good air, water, light, electricity, food, movement, recovery, not overtraining, you know, attention to heart rate variability, et cetera, is allowing me to control lots of oxidative stress. It's allowing me to control lots of cortisol, even though it's not necessarily an ideal scenario, and I wanna highlight the fact that I have never preached that doing the Spartan triathlons all the time, and subjecting the body to masochistic feats of endurance, or climbing your own personal Mt. Everest is something healthy, but I think that one cool thing, if you can pull it off, and what's kinda leading to this discussion in the first place is, if you can keep yourself healthy, or as healthy as possible while living life as full as you want to live it, then I think that you can potentially tap into the best of both worlds.
And that's really, you know, what led to this little quest of podcast series on hidden causes of high cortisol and what you can do about it is the fact that, perhaps, you don't necessarily want to just do yoga, and meditation on a Himalayan mountaintop, and a few easy walks in the sunshine, and, you know, tiny bits of exercise here and there. Perhaps you want to do an Ironman, or you want to do a Spartan race, you want to do something else that's going to subject your body to high amounts of stress. How do you mitigate that? And I'm hoping that by using myself as a bit of a testing guinea pig, I can help to give you, the listener insight into that, and what you just heard Dr. Bryan, and Dr. Brady, and I go over were, as a reminder, a test of the brain's function, and whether or not that's causing cortisol issues, and again I will link to this custom lab panel that Dr. Bryan ran that goes into everything from the prolactin, to the LH, to the ACTH, to the triglycerides and HDL. And then also, I'll link to this oxidative stress profile, which shows whether or not you're actually doing a good job controlling the oxidation that is occurring.
And so, I would highly recommend that if you yourself are concerned about high cortisol, you listen to the previous podcast episode in which we went over how to test for high cortisol, and then you also go check out the show notes for this episode at bengreenfieldfitness.com/cortisol2.
Now guys, it sounds like, right now, the recommendations that you're making would be to follow up this series of tests with yet another test, a lymphocyte subset panel, and then also look into something like enhancing my body's intake of glutathione or glutathione precursors along with, perhaps for this aldosterone side issue, adding in some sea salts and some trace minerals.
Bryan: Yeah. Yeah. No, there's a couple other markers that I could, we don't even talk about now, but I could, come to mind, but that's absolutely right. And anything Dr. Brady can speak to this also, but another layer of testing to try to, now that you have this, decipher what's going on, you know, glutathione like you to talked about, some sea salt to your water, I think that's a really solid place to start.
Ben: Interesting, interesting. Anything else that you guys want to, in the few minutes that we have left here, anything else you wanted to throw in, comment on, or tell the folks who are listening in?
Brady: Yeah. I mean, I have something that came up a little earlier when you were talking about exercise, and I just wanted to give the other side of the coin to, you know, in your case, you're doing things to mitigate, or buffer your body's response to exercise because, as a society, we're conditioned. We say exercise equals good, and I see it when I go through my walks in the woods, and I run and, you know, see the guys who run, 15 miles a day and Dr. Bryan, I know you said you work with a lot of fitness folks. You've probably seen this, these chronic runners and they look emaciated, and they have, not only no fat, but no muscle tissues either. Their body is basically eating itself in order to make sure the brain and other organs stay alive.
And so, what we've been going over here is, and the whole idea of this is to say, “Yeah, there's, our environment tries to break our body down, we have the ability to buffer, counteract that, and we want it to be in a good balance,” and that's the beauty about laboratory tests because you can see that, and you can make the changes in your life to help get that balance without just being simplistic and saying exercise equals good.
Ben: Yeah. Good point, good point.
Bryan: Yeah. In fact, I'll do a quick plug for TrueHealthLabs. Yeah, I think the link's in the show notes, but they offered, for listeners, a tremendous, tremendous resource in terms of many, and even in Europe, but even just so many different lab tests that honestly doctors are not running, and it offers, and I know I'm stealing your thunder, I know if, Brady, if you were to do your own plug, it sounds like you might be a little biased, so I'm gonna do it for you, but it's an incredible resource. It's where we send most of our patients if we can't get lab testing for them, the, just the basic blood panels that are available on that website are so cost effective and give so much more information than what most people could even dream about getting from their doctor. So for 199 bucks, you can get a better panel than your doctor would probably ever run, and it's just an incredible resource, and the thing I wanted…
Ben: And some of these are available in Europe too as well.
Bryan: Yeah, yeah, yeah! The thing I want to point out about you, Ben, is TrueHealthLabs only offers certain panels and certain tests on their website, but in the case of you, Ben, we asked them and said, “Can you get this run for us,” and they can get almost anything run. It may not be on the website for reasons of just not over confusing the customer, which makes sense, but that's how we got this done. I mean, they were able to pull through and run some pretty awesome markers for you.
Ben: Yeah. Like random stuff that we would have a hard time hunting down otherwise.
Bryan: You could ask a doctor for and they never would have run it on you.
Ben: Yeah. Yeah. So custom lab panels, basically. And I'll link to TrueHealthLabs in the show notes for people, like if you wanna go over there, ask your doctor about custom labs that they might be able to order for you, or go compare that to what's available over at TrueHealthLabs, go for it 'cause I'm pretty impressed with the range of testing services that they actually have over there, and don't get me wrong, I'm a huge fan of WellnessFX, right. Like I use that all the time, but at the same time, sometimes you gotta go delve into this hidden stuff that you're not gonna to find in other places.
So, I'll put a link to that in the show notes, and then of course, I know that a lot of you listening in, you're practitioners, you're functional medicine practitioners, chiropractic docs, physical therapists, you look at blood and biomarkers, and you might have something valuable to add to the conversation. So feel free to comment, if you're just the average, everyday listener whose head hurts after listening to this one, that's fine too. Comment. Ask your questions over there, and either Dr. Brady, or Dr. Bryan, or myself will jump in or reply, and all that is over at bengreenfieldfitness.com/cortisol2, that's bengreenfieldfitness.com/cortisol2.
You guys, Dr. Bryan, Dr. Brady, thanks so much for your time, and for going over all this stuff with us. This has been an invaluable dump of info.
Brady: Yes. I'm sure heads are spinning but it's uh… thanks. Thanks a lot, Ben.
Bryan: Yeah. Thanks, Ben. It was great.
Ben: Awesome. Well, thank you, you guys. And folks, until next time, I'm Ben Greenfield along with Dr. Bryan Walsh and Dr. Brady Hurst, signing out from bengreenfieldfitness.com. Have a healthy week.
Ben: Hey, it's Ben Greenfield. Back here very quickly for that addendum to the podcast that I promised you. I want to, for just a moment, delve into both the woo-woo and the practical, and share something with you that has been on my heart as I dig into these type of health issues that many of us hard-charging, high achievers need to think about.
Recently, I have had a flurry of, shall we say, messages or signals coming my direction. After I finished the podcast that you just listened to, I was approached by a respected friend who does iridology. If you looked up iridology, it's fascinating science. We're going to do a podcast on it, but it is, basically high resolution photographs of the eyes to get insight into things that may be going on with the body's organs.
I also, in the past several months, have gotten, don't laugh, a colonoscopy to see what's going on also with the large intestine because that's probably, of all the areas of my entire body that I've ever struggled with, it has been that. Again, possibly a TMI, but this might be interesting for those of you listening in because it's all about health detective work so that we can live, long healthy lives, be there to play with our grandkids, be stand-up paddle boarding, and throwing the football, and playing tennis when we're old, and feeling like a million bucks for as long as possible.
So, anyways, I drone on, I rabbit hole. I digress. So, those two studies, the iridology and the colonoscopy, both revealed that there are some serious large intestine issues. Basically, lack of mineral absorption, lack of muscle tone, what is called a spastic colon, and issues with the digestive system that indicated the need for, shall we say, a bit of an overhaul combined with a bit of time off from the hard chargedness of my life.
Later on, this December, I've already programmed in a little bit of time to step away, but, in addition, I've been drawn. I'm all about listening to the messages that your body has been sending you. I've been drawn to a lot of healing things lately, healing sounds, healing frequencies, infrared sauna, meditation, breath work, really good deep tissue work, and, you know, I was speaking with my wife about a week ago and she commented on the fact that in the thirteen years that we've been married, when she met me, I was a bodybuilder and a spin instructor, she doesn't think she's ever seen me take any more than, perhaps, a couple of days off of an extremely hard charging life, in which I'm replying to literally hundreds of emails a day, squeezing in the type of exercise sessions that allow me to do masochistic things, volunteering, jetting around the globe, you name it. So, basically messages. Listen to messages that your body is sending you, and I'll share many of these discoveries that I make along the journey.
I'm also doing a follow-up podcast with the gentlemen who you just listened to, the two physicians, because we made some other discoveries such as Cyrex food allergy testing that gave, or is going to be giving you some insight, as well as testing of things like cortisol precursors, lymphocytes, some of things that we discussed in today's podcast.
And then, finally, if some of that iridology chat wasn't woo-woo enough for you, there have been other messages coming my way. “Ego Is The Enemy”, a great book by Ryan Holiday, in which I've been more and more discovering things that suggest that perhaps a big part of a lot of what I do is based on me wanting to achieve a lot of things in life and that's great, if it's about affecting change in other people's lives, but I think that there may also be, potentially, a little bit of an unhealthy obsession with being great. A little bit too much ego, perhaps, in my life.
I also listened to a fascinating sermon by a friend of mine named Toby Sumpter that highlights the fact that all of us need a day off, preferably every week. And on that day off, we should go out of our way to help others, to volunteer, to do mission work, to even take care of our own bodies and give our own bodies a little bit of recovery and R&R. And so that was yet another sign, another signal, and correlated quite well to a lot of volunteer work I've been doing locally to help feed local poor elementary children, and I've been quite frustrated when I run into weeks where I'm able to make zero progress with that because I'm getting ready for a Spartan race, or I'm podcasting, or replying to emails, or building the fitness empire.
So anyways, lots of little things to think about, but you are my friends, you're my listeners, you're the people who I care deeply about, and so I wanted to at least take a moment to share some of my random ramblings with you because what I do is based on a quest, not only for me to be able to live a limitless life, but also to teach you how to live a bold, edgy, limitless, exciting life, and I want all of us to be able to stay as healthy as possible doing it, to be as happy as possible doing it, and also to change as many other lives as possible doing it. So, thank you for listening to my brain dump, and now, I promise the podcast actually is over. Alright. Have a great week.
You’ve been listening to the Ben Greenfield fitness podcast. Go to bengreenfieldfitness.com for even more cutting-edge fitness and performance advice.
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:
–TrueHealthLabs Custom Lab Testing – Ben tested the following:
- NMR Lipoprofile
b. Oxidized LDL
c. ACTH, cortisol, and aldosterone
d. LH, FSH
e. Free and total testosterone
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.