[Transcript] – Cortisol Decoded: The Myths & Truths About A Hormone Crucial To Your Health & Survival.

Affiliate Disclosure



[00:00:00] Introduction

[00:00:48] About This Podcast

[00:01:58] Podcast Sponsors

[00:04:01] Intro About This Podcast on Cortisol

[00:05:34] What is cortisol?

[00:13:37] How Cortisol Is Secreted

[00:20:12] How Cortisol Imbalances Affect Our Lives

[00:25:39] How Cortisol Gets Disrupted

[00:33:39] Podcast Sponsors

[00:36:30] cont. How Cortisol Gets Disrupted

[00:37:38] Why Cortisol Is Such A Hot Topic in Modern Society

[00:43:12] The Key Element Regarding Cortisol Missed by Conventional Medicine Practice

[00:49:31] How Cortisol Interacts with Other Hormones in The Body

[00:56:48] How to Effectively Modulate Cortisol

[01:14:53] Closing Thoughts

[01:18:31] End of Podcast

Ben:  On this episode of the Ben Greenfield Fitness Podcast.

Craig:  Try to figure out a way to engage your life so that you're more connected to that natural rhythm of the sun. That means wake up when the sun rises and go to bed when the sunsets. What you put attention on is what you're going to get in your life and you really have control over everything you put attention on. That's why understanding how cortisol works, why the rhythm of cortisol is so important can make a huge, huge difference in your life.

Ben:  Health, performance, nutrition, longevity, ancestral living, biohacking, and much more. My name is Ben Greenfield. Welcome to the show.

Hey, so this is one of those episodes where I got a super, super, duper smart cat who's been on the show before to record a topic that was something he got a lot of questions about after I interviewed him and that he wanted to riff on and fill you in on for a really, really comprehensive show. His name is Dr. Craig Koniver. He's one of my favorite physicians. He's down in Charleston, South Carolina. I talk to this guy almost every day. There's a small network of physicians who I interact with on a weekly basis and we've got guys you've probably heard of on the show before like Dr. Matt Cook and I talk about a lot of stuff, Dr. Mercola and I bounce things off each other all the time.

Dr. Koniver is another guy and he's the guest on today's show. Everything you hear on today's show, all the show notes are going to be at BenGreenfieldFitness.com/cortisolpodcast because it's about cortisol. So, BenGreenfieldFitness.com/cortisolpodcast. You're going to learn all the myths, all the truths, everything you need to know about this cool little hormone called cortisol. That's honestly unfairly vilified a lot of the time.

We also have some big parties coming up, if you haven't heard yet. Okay. We are launching the “Boundless” book parties. If you are near New York City or you want to go to New York City, or you're near L.A. or you want to go to L.A., we've got some big parties plan. So, New York City book party is on January 16th. Cool people, cool food, cool drinks, tickets still available. It's at the assemblage in New York City. And then in L.A. on the 29th of January and the 30th and the 31st, three parties in L.A. at the end of January. You can come to one of them, you can come to all of them. Total invite is open to you. All the details on these are at BenGreenfieldFitness.com/calendar. That's BenGreenfieldFitness.com/calendar. Navigate to January and you'll see where all the parties are happening. If you want to be with the cool kids, you better show up. And you can get the book at boundlessbook.com. So, come party with me in January in either New York City on the 16th or in L.A. on the 29th, the 30th, and the 31st.

And then when you are leading up to that party, you may want to actually clean out some of those holiday goodies that you munched on so intensively the past several days. And my team and I at Kion are hosting a free five-day fasting challenge. It starts on Monday, January 6th. So, you can start off your New Year with a whole bunch of longevity enhancing tactics. We've got tons of different fasting options for you from fasting-mimicking to intermittent fasting. You choose your own adventure, then you join tens of thousands of people who have already signed up for this fast. We're going to do it along with us. So, you have your instant community to keep you from robbing the refrigerator at midnight for those extra holiday cookies. So, you get in and you get our free awesome “Fasting Decoded” book if you go to getkion.com/fasting. That's getK-I-O-N.com/fasting. And yeah, I think that's everything I wanted to tell you about. So, let's go ahead and jump in with Dr. Craig Koniver.

Craig:  Hey, this is Dr. Craig Koniver from Koniver Wellness in Charleston, South Carolina. And we appreciate Ben Greenfield having us on again. Today, we're going to talk about cortisol, the circadian rhythm, hormones, the adrenal gland. This is actually a fascinating story, one story most people don't really know all the details. And I think you're going to enjoy learning about why you should respect cortisol and how cortisol literally impacts every facet of your life.

Today, we're going to review the history of cortisol, discuss the primitive effects of cortisol, the chronic modern-day effects of cortisol, and we'll review the biochemistry of cortisol secretion, we'll learn how cortisol affects every aspect of your life from exercise to having fun, longevity, to preventing disease, to sleeping. We'll talk about all the ways you can modulate cortisol from nutrients to meditation, to peptides, to hormones, to much, much more. We'll even go into why meditation may not be the best choice for you. We'll learn about wearables, how you can use data, your own data to help you modulate cortisol. And we'll certainly go into cutting-edge therapeutics and testing regimens that help you really master the cortisol in your life because when you do master cortisol, when you modulate cortisol really well, really good things happen.

So, cortisol, it is a hormone that's secreted by the adrenal glands. What are the adrenal glands? They are these triangular-shaped glands that sit on top of the kidneys in your back. It is really a big deal and I feel like I wanted to talk about this today because even in the integrative functional medicine world, I don't feel enough providers and doctors are giving cortisol enough respect, certainly not in the conventional medical world. So, this is a big deal to me. It provides a framework in context really for every patient and how that patient succeeds or fails in optimizing their health and performance.

So, let's talk about kind of long ago because this is where most people have heard of cortisol. It's called the stress hormone, and the classic example that people hear of is a fight-or-flight response. So, cortisol, we make cortisol or we put out cortisol in response to any perceived stress. And I highlight perceived. That'll come up a bunch as we talk about cortisol, stress management, things like that because it is the perception of stress, which leads to the release of cortisol. We are hardwired for a specific rhythm of cortisol. This means that all of us are wired to have high cortisol in the morning and low cortisol in the evening. This is just like the sun and this is how I want you to think about it. The sun rises in the morning and sets in the evening, so does cortisol. Escaping from this rhythm is really significant. And truly, everything that we deal with with cortisol is much more about the rhythm of cortisol versus the volume of cortisol.

So, going back to that fight-or-flight stress hormone, cortisol is an acute hormone. It literally saves our life. So, the classic example is someone being chased by a lion in the jungle. We secrete cortisol in that scenario because we need to save our life. So, what happens? So, biochemically, cortisol travels to our liver to make new blood sugar. We need fuel to survive the event. Cortisol turns off pain recognition, so even if we fall, we get bitten, we get stabbed, whatever, we can still fight on and survive. Cortisol is potently anti-inflammatory. Again, the goal in that scenario is to just survive. So, cortisol allows us to do that. Cortisol is also time-limited. Meaning, when we experience an acute stress, we have an elevation of cortisol, again to do all those physiologic processes. And then that cortisol should return to a baseline shortly after. Again, cortisol, in every sense of the word, is our stress hormone, is our life-threatening, life-saving, I should say, hormone.

So, cortisol serves as our catabolic hormone to get through our day. Catabolic means wear and tear. Primitively, again, think in terms of primitive examples, when we got up, we had to find our food, find our shelter. We literally had to survive each day. That's a catabolic process. So, if we go back, we think the sun rises. We want to do everything we can in as earliest time as possible so that we can survive. As the day goes on, we're settled in, we have our shelter, we have some food. We don't need to be as stressed. We don't need to have as much energy and we don't need to do as much. By the end of the day, the cortisol, just like the sun is setting, to allow us to go to sleep because then we need to recover so that we can do it all over again.

So, really important point here is if you think primitively, just like the sun, cortisol rises in the morning, we got to get all of our important stuff done. By the end of the day, we can settle down, go to sleep, just like the sun setting. What's happened over time, and we'll come back to this, is that we've changed cortisol from an acute hormone to a chronic hormone, and we've disconnected our sense of natural living with the sun. So, one of the big takeaways from this podcast that I want you to take is if you really want to improve upon your health, your performance, preventing disease, whatnot, try to figure out meaningful ways to live with the sun's rhythm. Wake up with the sun and go to bed with the sun. That is how our cortisol is hardwired within us.

And as we'll go through this talk and this podcast, you'll learn why that's important to do. So, again, you've heard the terms catabolic, anabolic. We are catabolic during the day, or at least we should be, and we should be anabolic at night. Catabolic means wear and tear, get stuff done. Anabolic, growth, healing, mending, rejuvenation, repair, that occurs when we go to bed. The hormone flow, the hormone balance within us is really dictated by this catabolic, anabolic balance.

So, let's look at this hardwired rhythm. Right, the sun rises in the morning. This is when cortisol starts to peak around 6:00 a.m. And again, as the day goes on, that cortisol lowers in our body. The lowest point, of course, was around 10:00 p.m. This is around when we should be going to sleep, the sun has set. When cortisol is at its lowest, that allows the three most anabolic hormones, testosterone, growth hormone, and melatonin to take off. Those three anabolic hormones are potently anti-inflammatory. And one point I'll make here is that when you have an elevated cortisol in the evening, you blunt the response or the output of those three anabolic hormones, testosterone, growth hormone, melatonin. Doing so over time will impair your ability to sleep, recover, mend, repair all those good things you need to do to lead a quality life.

You've probably heard that the most critical hours of sleep are between the hours of 10:00 p.m. and 2:00 a.m. Why is this? Well, this is when we pose growth hormone. It's debatable what's more of an anabolic hormone, growth hormone, or testosterone. But the largest pulse of growth hormone by our pituitary gland is between the hours of 10:00 p.m. and 2:00 a.m. Again, that falls in line with the cortisol first being at its lowest point around 10:00 p.m. A point about melatonin, another anti-inflammatory hormone, a very strong antioxidant, it takes melatonin about 12 hours to reset.

So, if you get out of bed at 10:00 a.m. and don't get sunlight, and the way melatonin resets is to get sun exposure, light exposure into your pineal gland, so if you get sun exposure at 10:00 a.m., it's going to take 12 hours to reset melatonin. Your melatonin won't start being secreted until at least 10:00 p.m., 11:00 p.m. Well, that's getting late. You're not going to feel as tired as such you're not going to sleep as well. That's very different than if you get early morning sun at 7:00 a.m., well, now your melatonin is starting to secrete at 7:00 p.m., 8:00 p.m., which is much more in line with having a low point of cortisol around 10:00 p.m., and then the peak of growth hormone between the hours of 10:00 p.m. and 2:00 a.m. We'll go back more into this, but it's a good way to categorize being catabolic during the day. Again, lots of cortisol in the morning as the day goes on, and we don't need as much cortisol. And then lots of anabolic hormones while we sleep at night to repair, again the three big ones, growth hormone, testosterone, melatonin.

Before we get into how cortisol gets disrupted and what we can do about it, let's review specifically how cortisol is secreted. So, again, I mentioned that cortisol is secreted from any perceived stress. This can be over such as witnessing or being around the lion in the jungle, but this can also be subtle, which is really what's happened in modern times. Eating the wrong food, pain in your body, blood sugar changes, emotional thoughts, overthinking things, worried about a deadline, all of these things we think about are perceived stressors. And what happens is when we perceive a stress, we're going to trigger this cortisol release. And let's review how to do this because this is a really important aspect.

When we perceive a stress, that stress is perceived at a primitive part of our brain, part of our midbrain, which is above the brainstem. So, when we look at the brain anatomically, we have the higher processing brain, which most of us are used to, the frontal lobe, all of those things that people see when they think of a brain. But below that, we have something called the midbrain and then the brainstem that connects to the spinal cord. In the midbrain, there's a part of that area called the reticular activating system. We call that RAS. And the reticular activating system is where we initiate the signal for stress or for cortisol release. Again, a perceived stress.

So, let's go through. We perceive a stress, we think about something, we have some emotional thought. Once we perceive that stress, the reticular activating system lights up and sends a signal to the next part of this chain, a higher up part of the brain called the locus coeruleus. The locus coeruleus is actually one of the smallest anatomical parts of the brain, but is literally one of the most connected aspects of the brain. So, when that locus coeruleus gets fired upon, again we send a signal from the reticular activating system, the locus coeruleus sends a message from there to the hypothalamus saying it's time to release cortisol. So, again, the chain of events is perceive stress, reticular activating system to locus coeruleus, locus coeruleus to the hypothalamus, and then the hypothalamus sending a signal to the pituitary, and then the pituitary to the adrenal glands. You're likely familiar with the HPA axis. That's the hypothalamus-pituitary adrenal access.

The other part about the locus coeruleus that's interesting is that when locus coeruleus is fired, it starts to put out norepinephrine in the brain. We'll come back to this, but norepinephrine and cortisol are essentially partners in crime. Anytime we release cortisol, we also release norepinephrine. And we'll talk about why that's important. Actually, it's a very important part of this process. So, again, perceive stress, reticular activating system goes to the locus coeruleus, locus coeruleus puts out some norepinephrine. We then trigger a signal to the hypothalamus, which signals the pituitary. Now, the pituitary is an interesting part of the brain because it's in charge of all the signaling molecules.

So, you may be familiar with hormones like TSH, LH, FSH, growth hormone. And then for the adrenals, something called ACTH. So, the anterior or the front part of the pituitary puts out something called ACTH, which travels through the bloodstream to the adrenals and says, “Put out cortisol and even more norepinephrine.” So, that's the chain of events that happen. And why that's important is because we can modulate those different pathways. We can modulate in different arenas to help improve how we put out cortisol. And again, we're going to go into all those specifics, but I want you to remember, perceive stress, reticular activating system, locus coeruleus, through the hypothalamus, pituitary adrenals, and then comes out cortisol.

And one interesting thing is that norepinephrine. So, again, locus coeruleus will secrete some norepinephrine, then the adrenals will secrete some norepinephrine with cortisol. And as I said, they're kind of partners in crime. What happens though over time, and we'll get into chronic stress and how it wears down our adrenals, what happens to a lot of people in the modern-day world is we stop our ability of putting out enough cortisol, and what we end up having is unopposed norepinephrine. And that is significant because people who are anxious or feeling stressed, they're literally feeling the effects of unopposed norepinephrine. So, again, this is a really important process to understand. That's why it's worth reviewing.

I also want to mention, on average, we put out about 35 milligrams of cortisol each day. So, that's an average per person, per adult. We'll come back into that number and why that's significant when we discuss cortisol replacement. But again, one of the key points here is that we are hardwired for this cortisol rhythm. Meaning, highest in the morning, lowest at night. And disease and pathology occurs when this rhythm is disrupted. We're all familiar with this because we've heard of these stories, but the classic example is nightshift workers, people who are working from 11:00 p.m. to 7:00 a.m.

What we know is that when people maintain that type of work schedule, they die younger and they have more disease. Why is that? Well, they've disrupted that cortisol rhythm. It's 2:00 a.m. and they're shining light on their eyes, they're wide awake, then they're telling their body they should be wide awake when in a hardwired biochemical sense, they really should be sound asleep. If you do that enough, it will catch up with you. I remember years ago, I had a patient with MS, actually two patients, it was interesting, with MS. Both of whom, interestingly enough, would not go to bed until about 3:00 to 4:00 a.m. They just said that this is just how they've done it their whole life is they like to stay up late. I think there's definitely a connection with people who do not sleep in a normal sleep rhythm and having a hormonal disruption of cortisol, which catches up with you. And we'll get into what that means in a very meaningful way.

So, again, cortisol is secreted from any perceived stress. Our brains do not know the difference between real or perceived stress. There was a study I think of long ago, they have people come and run around the track. And after they ran around the track, they got them in a functional MRI scanner to look at what was going on in their brain, what patterns of neurochemicals were released, and whatnot. One month later, they had the participants come back, and this time, they didn't run around the track, they just told the participants, “Get in the MRI scanner and think about running around the track.” Well, guess what, same exact areas of their brain were stimulated. What this means is that our brains do not know the difference between perceived reality or what we can imagine and what is actually true.

We've heard of examples of this especially in sports. I always heard the story of Michael Jordan, how he always imagined he would make the basket before he took the shot. Well, that's very real, right, because he's telling his brain, “Here's what's going to happen,” before it happens. And if you train yourself, and a lot of people are waking up to this about how to train your brain to focus in a very intentional way, if you can imagine what you want to happen in your life, it will show up and happen to you. This is why I tell my patients and clients, in life, you always get what you focus on, always. You cannot separate from that.

So, always focus on what you want. And I think people struggle with that a little bit because we're so negatively wired. We have a lot of fear-based, especially in Madison, a lot of it is fear-based, if you don't do this, then this bad stuff will happen, if you do this, if you eat a certain way, you'll gain weight, if you eat certain foods, you'll get fat. A lot of it is fear-based, and that fear is very real because it puts that thought, that emotion in people's brains, and then that's what they focus on. So, what I strive to do with my patients is really to undo that, to kind of rewire that programming because it is true and you can look back on your life. You always get what you focus on.

So, what I tell people, the classic way of describing this, because a lot of people are interested in losing weight, again his weight gets screwed up, instead of focusing on, “Oh, I want to lose weight, I'm excited to lose weight, I can't wait to lose weight,” what's much better and more effective is, “I can't wait to wear those clothes. I can't wait to wear that bathing suit.” Change happens much faster when we run towards something than away from something. And that's very true when we get into perception versus reality. And so another takeaway is always focus on what you want and make it positive, right, because your brain doesn't know the difference.

So, we can use this to our advantage, right? You can intend what you want to happen in your life and a lot of this is happening in this whole mixture of how cortisol is modulated, and it's happening in this modulation of that reticular activating system. I want to digress a minute and talk about that reticular activating system in our perceived reality because this is also involved in how we focus. Attention, what is attention? Well, attention is simply what is important in our world. And our reticular activating system helps us distinguish background and foreground in our world.

I think an easy way of understanding this is look at people with attention deficit disorder. What they have trouble doing is distinguishing between background and foreground in their world. So, for example, they'll be working at something at their desk, they'll look up and they'll say, “Oh, I need to go water that plant.” Well, watering that plant becomes just as important as what was in front of them. And then they water their plant, and they look over and they say, “Oh, I need to fold some laundry.” Now, folding their laundry is just as important as watering their plant, right? The background becomes equally as important as the foreground.

And we all have some degree of ADD, but people who don't struggle with this can really distinguish and say, “Yeah. I see the plant, I see the laundry, but I also need to focus right here.” And that is an important aspect in their life. This is also the same system which allows us to see things in our world. So, classically, if your neighbor got eaten by a lion in the jungle, you're going to be hyperaware of lions in your world. The way I think about this, and I think you can agree, if you buy a red pickup truck, all of a sudden, you see a lot more red pickup trucks in your world. Things have more meaning because we place that more meaning. Again, a lot of that happens between that reticular activating system and how we perceive our own reality. This is really important to what we put attention on, okay, because a lot of people go through life, one, negatively base, and two, feeling like life happens to them.

And what I want to stress to you and ties into this whole cortisol stress hormone is what you put attention on is what you're going to get in your life. You really have control over everything you put attention on. So, understand that your brain doesn't know the difference between perceived reality and actual reality. It is the same. And also, remember that what you focus on, what you put attention on your life is always what you get. So, use that to your advantage. Don't let life happen to you. And we'll talk more about that.

So, let's get back to how cortisol gets disrupted. I want to make a point that as humans, we are super adapters, and females are even better. They are super, super adapters. We are the only species to live anywhere on the planet. We can adapt to any climate, to any stressor, and use it to our advantage really. As such, we can tolerate a lot of fluctuations and stress over long periods of times. One of the major challenges to our cortisol flow or rhythm that you will easily understand is the whole electronics and digital world we live in. That totally disconnects us from the sun, that totally takes us out of that natural living.

Now, it's not all bad. I think pretty much all of us would agree we rely on our cell phone, we rely on our laptops, we rely on air travel and in cars to get around. So, this is not all bad, but we do need to recognize from a cortisol hormonal point of view, when you have so much digital information coming in, when you're so disconnected from the sun, that is going to change how cortisol operates in your world. And the easiest way to explain this is that we see those changing happening to the evening cortisol first. This is where it hits us first.

So, again, cortisol is like the sun, rises in the morning, sets in the evening. If we look at evening or nighttime cortisols, what we'll see for people is one of the first complaints that most of us are familiar with is we don't sleep well. Well, why don't we sleep well? From a very strict biochemical point of view, most of us put out some cortisol at nighttime when we shouldn't be, and it makes sense. We get home, we finish work, we finish school, we're done all the things and chores we need to do and we just want to relax. So, what do we do? We sit on the couch, we watch TV, we get on our phones, we get on social media, we start stimulating our brains again. Again, we are hardwired for that cortisol to be as low as possible.

When you start turning on the lights, electronics, digital things, you're stimulating your brain, telling your brain you're supposed to be awake. So, guess what you do, you're going to put out some cortisol. Again, that's not bad. You're an adapter. You can adapt to that stress not just for years, but for decades. And so we see people really not having a problem. We see people, especially coming to my office, they've adapted to six hours of sleep. They've adapted they're not sleeping well for decades of their life and they're fine. They can still do their job, they can still perform in school, they can still exercise, do potentially everything they wanted to do, but they're not doing it as well. But at some point, it catches up with them and they come in and they say, “I'm just not sleeping well. I cannot catch up. I can't get quality sleep, and now I don't have as much energy when I wake up, or now I've got this joint pain that won't go away, or now I've got this rash, now I've got headaches.” A lot of disease manifestation is just from this process. And what's really interesting and I think exciting is that now that we can understand how this whole cortisol rhythm works, we can work backwards, reverse engineer, and modulate the whole system.

So, again, we tolerate these stressors, we tolerate what happens not only for years, but for decades. Using the example of having a high cortisol at night, it doesn't have to be very high. If we talk in numbers, for example, we do a lot of salivary cortisol testing, and we'll get into the details of that, which measures a free salivary cortisol throughout the day. Well, at nighttime at 10:00 p.m., that salivary cortisol really should be one. It should be as low as possible. When we do testing, a lot of people are four, six, eight. Again, it's not terribly high, but it's high enough that it's going to blunt the output of the anabolic hormones.

So, again, looking at this whole cortisol rhythm, the circadian rhythm, where we see this happening first for most people is an elevated cortisol at night. That elevated cortisol at night then blunts the anabolic output of hormones such as testosterone, growth hormone, melatonin, and we don't sleep as well. When we don't sleep as well, we don't recover easily, we don't repair our tissue in our cells. And therefore, over time, our cells slow down, we have more debris. We're not as efficient in all the things we want to do.

This leads to decline in healing, in mending, and repair of the tissue, and we will start to feel this. We don't sleep well, injuries take longer to heal, workouts become more challenging. We can't recover from our workout. Very classically, people say, “Hey.” I mean, I just saw a patient last week and she said, “If I go and work out, it takes me three to four days to literally get back on my feet. I am wiped out.” Well, that wiping out is because you're not repairing at night. You're not repairing at night because you have lost this cortisol rhythm.

So, as we sleep more poorly and elevate cortisol at night, this takes a toll than on the morning cortisol. And again, the way I know this is because we do a lot of testing of these hormones. And the classic or the gold standard to test adrenal function is going to be a salivary cortisol test. And the way that works is we check your cortisol when you first wake up, midday, mid-afternoon, and then bedtime. We can also throw another one in there if you're waking up in the middle of the night. But doing so, number one, well-confirmed and validated that saliva is a good medium to check cortisol levels. And what's nice is it's not stressful to do so.

So, if you think about a blood draw, yeah, it's a little stressful to having a needle in your arm. When you're collecting saliva, which simply means you're taking the cotton swab and putting it underneath your tongue for five or six minutes, that's not stressful at all. So, we can get really valid results from that test that look at that rhythm. And so I know that a lot of people struggle with maintaining this cortisol rhythm because we've measured for years and years and years, and we can look and say, “Hey, your morning cortisol should be high. It should be 18. It should be 16. Yours is 6. That's a problem. And your nighttime cortisol, like I said should be 1. Yours is 8. That's a problem.”

So, again, a lot of these cortisol problems start at nighttime because of the digital world we live in, but then they bleed into that morning cortisol. And when they bleed into that morning cortisol, what happens is again, think about it, think about the sun rising but only rising 50%. You think it's the afternoon when it's the morning. You don't have that energy that get up and go because you don't have that, literally, that cortisol fighting for you. So, when your cortisol is low in the morning, it's like you're walking in quicksand. It's like you can't ever get going. It's like you are struggling to get any bit of momentum. So, what do we do? We drink coffee, we stimulate, we take Adderall. We got stuff to do, right? We got our jobs to complete and we have school to complete. There's a lot we want to get done in our day. Well, if you're sluggish and it takes you two to three hours to get going but you don't really ever get that momentum, that just doesn't feel good. Over time, again you can adapt to it, but it's not really enough, and this causes a huge problem for people, and it causes them to do things they probably shouldn't be doing, which is reaching for stimulants, drinking too much coffee, trying to wake their system up. And again, over time, that catches up to people, and we'll get into that.

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Craig:  So, think about it. If you're settling down for the night, maybe you put your kids to bed or maybe you've had a long day at work, you just want to relax, you just want to face out, watch TV. Well, now it's 8:00 p.m., you turn the TV, get on your phone, and there goes three hours. Now it's 11:00 p.m., you've stimulated your brain, you're going to have a harder time going to sleep. You do that over and over. You just don't have that cortisol where it should be. That bleeds over to the morning and now you're tired, you didn't sleep well. You didn't sleep well because you didn't put out enough growth hormone, you didn't put out enough testosterone, you didn't put out enough melatonin because you had too much cortisol at night, right?

So, too much cortisol at night means you're not going to put out those anabolic hormones. It means you're not going to be able to repair during the nighttime. Well, if you can't repair at night, you're going to wake up tired. When you wake up tired, you're going to have to caffeinate, stimulate just to try to get it going. That's a challenge. Most people can relate to that. Most people would be able to tell you, yeah, part of that story is true for them. And again, I like to review all this biochemistry and explain how it happens so that you can then work backwards to fix it.

Let's go into some more depth about what's going on physiologically with this release of cortisol and how to modulate it. Remember I told you that cortisol is a primitive hormone. It's designed to be a savior life type of hormone. We call it fight-or-flight. And that means that when there's an acute stress, we're going to put out cortisol because we have to do things like make new blood sugar, turn off pain receptors, fight fires. Unfortunately, over time, and by time I mean thousands of years, we've changed cortisol from an acute hormone to a chronic one. What that means is we're no longer–I mean, most of us are never in a life-threatening scenario. Most of us will never be chased by a lion in the jungle. But most of us are late for a meeting, most of us do get stuck in traffic, most of us eat the wrong foods and deliberate over that.

And what we do when we deliberate and we have these negative thoughts and we worry and we stress, we're triggering that same cortisol response. Now, it's not as acute. You don't feel like you're being chased by a lion in the jungle, but your cortisol is responding the same way. Again, that perceived stress is the exact same as a real stress. And so we've changed the characteristics of cortisol from an acute hormone to a chronic one over time. And so over time, we are chipping away at our cortisol release. And what we speculate, probably more than speculate at this point because we have so much data from testing people, is we just cannot keep up with cortisol demands. And if you cannot keep up with cortisol demands, over time, you cannot put out as much cortisol. If you can't put out as much cortisol, you'll lose that cortisol reserve.

Again, to reiterate, we see that at the nighttime cortisol and the morning cortisol. Those are the bookends, those are where we see people not feeling well, and those are what we want to hone in on. So, again another important takeaway is we've changed cortisol from an acute hormone to a chronic one. And by doing so, because we are silently chipping away at our cortisol secretion, we lose that cortisol reserve. Now, we're adaptable, we're humans. We can maintain that. We can maintain that pretty well, not only for years, but for decades. But at some point, it catches up with us and it doesn't feel good.

Now, sometimes it catches up with us before we don't feel good, and this is the major concern, because what happens if we do experience a major stress? And a major stress would be death of a loved one, loss of a job. There's lots of examples like that. And the analogy I use is like we want to be a rubber band. We want to be flexible. We want to be able to stretch that rubber band and it comes back to position. When you lose that cortisol reserve over time, and then you have a major stressor, that rubber band, now when you stretch it, it breaks. This is when we see the context or the beginnings of cancer, heart disease, autoimmune disease. And this is why we have so much disease as we get older in our life, I think, right? Because we lose that cortisol reserve.

We don't think it's a big deal to weary or be stuck in traffic. We don't think it's a big deal to deliberate over the food we eat. We can tolerate it. We don't think it's a big deal to go to bed late and not sleep well. It just isn't, and it isn't because we can adapt to that for not only years, but decades. But the context or the setting up of degenerative diseases, cancer, heart disease, neurodegenerative process, I feel happened in the context of losing that cortisol reserve. This is a huge, huge deal because most people, obviously from a positive standpoint, want to be able to perform their best, optimize their health and performance. But most people have great fears about developing cancer, great fears about developing neurodegenerative diseases like dementia, Parkinson's, MS, things that we just don't want to happen.

The very best way to ensure that you don't develop those big bad diseases, take care of your cortisol, absolutely take care of it. That's why understanding how cortisol works, how the secretion of cortisol works, why the rhythm of cortisol is so important can make a huge, huge difference in your life. So, again, we're super adapters. We can adapt to these changes to these stressors for long periods of time, but we can adapt until we can't. Usually, that shows up when someone develop–again, a big stressor happens in their life and then you can't keep up, and we don't want that to happen.

Now, commonly, what can happen as well is we start to feel those changes, we start to slow down, we start to impair cognition, our work suffers, our exercise suffers, we start to feel poorly. That's when people come in asking for help and we can figure these things out. I actually like for my clients to be proactive and for us to measure this cortisol rhythm before we get to that point. Let's measure and see what that cortisol is doing because cortisol has such a huge impact on not only the rest of our hormones, but really all the big bad things that can happen in our world.

I do want to point out because in conventional medicine, there's this–well, not in conventional medicine, in the world I operated and the colleagues I interact with, we have this concept of adrenal fatigue, adrenal insufficiency. In conventional traditional medicine, that does not exist. So, in the conventional medical world, there are two extremes. There's Cushing's disease and there's Addison's disease. Cushing's is when we hypersecrete cortisol. We have too much cortisol secretion. And Addison's, that's what President Kennedy had, is when we can't make enough cortisol.

In the conventional medical world, it's black or white. You either have Cushing's, Addison's, or your adrenals are great. But we know that's not true. We know there's a gray area, which is all the in-between. When you can have a less than functioning adrenal gland, then you can have different degrees of adrenal fatigue. That's important to point out because if you go to your doctor, most doctors would say, “Oh, it doesn't exist.” They'd say, “You don't have Cushing's. You don't have Addison's. Your adrenals are totally fine.” I'm here to tell you that that's not true. Adrenal fatigue and degrees of adrenal fatigue or degrees of adrenal insufficiency is 100% true. I know it because for years and years and years, I've been testing patients and helping patients rework their cortisol rhythms.

I want to talk to you about norepinephrine because I think that's a really important point to make here. So, if you remember, here's the chain of events. We perceive stress, that stress is perceived at the midbrain, the reticular activating system, sends a signal to the locus coeruleus, which is in the higher up center of our brain. That locus coeruleus does a couple things. One, it secretes norepinephrine, and also then sends a signal to the hypothalamus, which will send a signal to the pituitary and eventually the adrenals to put out cortisol. What seems to happen is as we chip away at cortisol and not being able to keep up with cortisol demands, we lose the cortisol fire-fighting effect. Cortisol is our buffer. Cortisol is our firefighter.

Well, let me tell you what norepinephrine does. So, norepinephrine does many things in the body, but it does two main things you're familiar with. Number one, it increases your heart rate, and number two, it increases your blood pressure. Well, what does increasing your heart rate and increasing your blood pressure feel like? It feels like something's wrong. It feels like anxiety. And this is what happens. When you lose that cortisol buffer, you have unopposed, or not 100% unopposed, but you have more norepinephrine secretion than cortisol. With more norepinephrine secretion, you're going to increase your heart rate, increase your blood pressure, and you're going to feel anxious. It's very real. You feel stressed.

And that stress comes from this biochemical release of norepinephrine without cortisol. So, many of you have experienced this, right? Many people say, “I have no idea why I'm feeling anxious. I'm just sitting there at work or I'm sitting in my car and all of a sudden I feel anxious.” Well, there's some perceived stress there and you've no longer are able to keep up with cortisol. So, you're putting out norepinephrine, and now that norepinephrine is doing its job increasing your heart rate, increasing your blood pressure that literally feels like anxiety. So, if you start to feel those things, which a lot of us do, it's worth going to see your doctor or finding a doctor who's familiar with these things so that you can understand what happened to your cortisol. So, a good takeaway here is if you're feeling any bit of anxiety, it is likely because you lost control of the cortisol buffer. Again, cortisol is our buffer.

And when we lose cortisol, when we lose that cortisol reserve, we are setting ourselves up for cancer, heart disease, autoimmune disease. This is the major concern. There was a study I like to tell my clients. It's probably 10 years old now. I'm not sure. It was in the Netherlands they conducted it. They looked at men over the age of 50 who ran marathons and compared some data to men over the age of 50 who did not run marathons. And the men over the age of 50 who ran marathons had better numbers, better cholesterol, better blood pressure, but they also had many more heart attacks. Now, why is that?

Well, training for a marathon is very stressful to the body. In fact, the most stressful type of exercise that one can endure is endurance exercise. We see the most cognitive changes or most cognitive impairment over time in endurance athletes. And this is because in part, they're not modulating that cortisol anymore. So, even exercise, which can be a positive stressor, is still a stressor. And in this day and age, when our society is way more interested in being physically fit, we have many more people exercising. It's important to know there's some really healthy ways to exercise and some ways that aren't so healthy.

We actually do a test where we can help athletes figure out if they're overtraining. It involves that same salivary cortisol test. And what we do is we measure a baseline cortisol level before exercise, then we do that same saliva test 30 minutes, one hour and two hours into their exercise or after their exercise to see how their cortisol responds and how that cortisol recovers after the exercise. And if you're an athlete who's overdoing it, number one, you won't have very high of a cortisol reserve. And then two, it will take that cortisol a long time to come back to normal. That's not a good thing. And from there, we can make specific recommendations about fitness and training. So, that's a really important point. I know a lot of people who listen to this podcast are really into exercise physical fitness. A lot of people think, “Oh, if I do two a day, I can crush my goals even faster.” The whole concept of being an elite athlete, as a lot of you know, has to do with recovery. And a lot of recovery has to do with cortisol and cortisol modulation. So, that's an important test to keep in mind.

I want to switch gears a little bit and talk about other hormones and how cortisol interacts or interplays with the other hormones. Cortisol, or let me back up, when I look at hormones or my view of hormones, it's like they're kids on a playground with different personalities. As opposed to looking at a hormone as a totality, it's best to look at hormones as interacting with other kids. So, there's the social, fun, happy-go-lucky kid. That's testosterone. Then there's the big, bad, bully. That's cortisol. And there's actually three main bullies in the hormone world. Number one is cortisol, number two is insulin, number three is estrogen. All three hormones have a negative influence or impact on all the rest of the hormones when they're not modulated appropriately.

Let me take a quick diversion and tell you about insulin and the interaction between insulin and cortisol. A lot of people struggle with fat loss. They struggle with weight for a variety of reasons. And one way that you can quickly modify this is to stop eating carbohydrates in the morning. So, to go through the biochemistry, our cortisol should be the highest in the morning, especially between 6:00 a.m. and noon. And if you're eating a high-carb breakfast, so the classic example is you're eating donuts, coffee with sugar, you're triggering a huge insulin response. Well, that addition of high insulin and high cortisol, guess what that leads to, that leads to fat gain. Your body doesn't know what to do with that fuel, so you're going to store it as fat.

So, a very quick and relatively easy way to burn fat or to lose fat is to not eat any carbs before noon. A lot of people are into intermittent fasting. They're doing this anyway, but it's worth pointing out because a lot of people don't understand how that cortisol and insulin work together. But again, high-carbs intake leads to high insulin output. High insulin plus high cortisol leads to fat gain. So, either don't eat breakfast or don't eat high-carb. Probably most of the people listening to this podcast aren't doing that, but just in case, that's a good way to do that.

Let's go back to the cortisol and the negative effects on other hormones. Well, the three other hormones I think that cortisol negatively impacts the most are thyroid hormone, testosterone, and growth hormone. Let's start with thyroid, and thyroid is super important for women because probably in this day and age, we have the most important hormone for women is thyroid hormone. There seems to be, really in the last five years, an epidemic occurring where women, as they get older, are losing their ability to secrete thyroid hormone appropriately, and that becomes a big deal because thyroid is involved with so many things relating to metabolism. And for a lot of women, as they hit their 30s, 40s, and 50s, they start to slow down, brain fog, gain weight, feeling cold, feeling constipated. A lot of that goes back to thyroid.

The analogy I use with my clients is if you picture yourself as a cart being pulled by two horses, one of the horses is a small speedy horse, the other horse is a large big horse. The small speedy horse is the thyroid. It sets the pace. The large big horse is the adrenals. It does the work. And so what often happens is you're going to have a slowing down of one or both of these horses at the same time. So, if you're trying to set the pace, but you can't do the work to keep up, you won't go anywhere. If you're a female and you're on thyroid hormone replacement, but you're doing nothing for your adrenals, at some point you will probably burn out because you're setting that pace a little bit too fast for you to do the work. So, it's really important because that cortisol and those thyroid hormones really specifically work together.

What happens is very specifically, not to get too technically detailed, is when we make thyroid hormone in our thyroid, we make both T4 and T3. That T4 leaves the thyroid and makes travels in your bloodstream where you make T3. You take off an iodine to make from T4 to T3, and you also make reverse T3. Well, what we know from studies done in the intensive care unit, when we have an inappropriate modulation of cortisol, we make way more reverse T3 than T3. Well, because that reverse T3 is essentially putting the brakes on, that causes us to slow down, and that doesn't feel good. And again, that's specific to an abnormal cortisol modulation. So, again, thyroid and cortisol go hand in hand. And if you're a female and you're on thyroid hormone replacement, it is imperative to know what your adrenal status is. You have to be secreting cortisol appropriately or that will absolutely interfere how your thyroid is metabolized as well.

The next I want to talk about is testosterone. Cortisol has a very negative effect on testosterone in regards to building muscle. I alluded to this before about endurance exercise. And so what we know is if you're an endurance athlete, and most endurance exercise we regard is exercising for more than an hour, what happens at that point is you're putting out way more cortisol than testosterone. If you're putting out way more cortisol than testosterone, it becomes almost impossible to build muscle.

And it's easy to see this if we compare a sprinter's body to the body of a long-distance runner. The long-distance runner is lanky. They may be lean, but they certainly don't look muscular and in great physical shape. If you look at a sprinter, they're ripped, they're cut, and that is because they're not putting out more cortisol than testosterone. So, again, cortisol can have a very negative impact on testosterone. I tell people if you are doing endurance races, if you're training for endurance–any competition, you absolutely need to lift weights, you need to respect and honor that testosterone, or you're going to do more harm than good.

The last hormone that I'll talk about that cortisol has a negative impact on is growth hormone. We talked about this in the beginning, but again, cortisol being low at bedtime allows growth hormone to be secreted appropriately. If you have a high cortisol at bedtime or at night, you can't put out as much growth hormone. If you can't put out as much growth hormone, you don't get exposure to that hormone, which means over time, you won't sleep as well, you won't repair your tissue as easily, you won't be able to rejuvenate your cells, and that will catch up with you. You'll gain weight, you'll get tired, you'll have brain fog, constellation of things going back to, too much cortisol at night, not enough growth hormone.

So, let's start talking about how do we treat or modulate cortisol. I'm not going to go into specific recipes per se, but I'm going to give you some broad strokes, things to think about, things to go back to your doctor, things to contact us about for sure because we have a lot of experience doing this. So, what we start to do is number one, we test. Sometimes we'll start with blood tests in the morning as a screen to see what a cortisol level is. In general, we can learn a lot by how someone's feeling, but if they've got an elevated or even normal morning cortisol in a zone anywhere from really 14 to 18 on the blood test and they're sleeping well, they're probably doing pretty good. Most people don't have this.

So, most people, their morning cortisol will be less than 14 and they will complain of not sleeping well. When that happens, we'd like to do a salivary cortisol test. And we can do a salivary cortisol test anyway. That salivary cortisol test checks four cortisols throughout the day, and it also checks some other adrenal hormones, which we haven't talked about, DHA, DHEA, and pregnenolone. So, the way I like to think about cortisol is that the adrenal gland is like a factory making cortisol. Cortisol is the main goal. So, think of it like a plant making cars or vehicles. The end goal is the car, but along the way, they can create some other products as well, and those other products will be something like DHEA. That DHEA is then further converted into other hormones in the adrenal glands such as testosterone and estrogen.

There's some other intermediary hormones such as androstenedione, as well as even progesterone. So, the adrenal gland is like a factory making all these hormones. Cortisol is the goal, but we still need to make all those other hormones. That's an important point because when we start to lose our ability to make cortisol because of stress, we're going to steal from these other hormones. And this is what we see on these tests is we have lower DHEA or lower pregnenolone. And that's because we're trying to make up for a depleted cortisol. Those hormones are important. DHEA is an anabolic hormone just like testosterone, just like growth hormone. Pregnenolone is a significant hormone that really is needed in order to make cortisol. So, while cortisol is the main goal, those intermediary hormones are really important, too.

As a side note, pregnenolone is actually made from cholesterol. And if you can think about it, we have at least one generation of adults now have been put on cholesterol-lowering drugs, statin drugs. So, here's what happens. If you lower someone's cholesterol, say they're in their 40s or 50s, and you do a blood test and say, “Oh my goodness, your cholesterol is elevated, now we've got a problem,” and they are put on a cholesterol-lowering medication like a statin, well, now they can't make enough cortisol. If you don't have cholesterol to be turned into pregnenolone, to be turned in cortisol, you can't make enough cortisol. As we've discussed, if you can't make enough cortisol, you can certainly not do all the things you need to do in your life, and it will catch up with you.

So, there is a myth that has been circulating for years, if not longer, that the number one leading cause of heart disease is elevated cholesterol, and that's just not true, it's much more complicated than that. Especially for a man, the number one risk factor for a heart attack for men is low testosterone. So, if you're out there and you're on some statin drug like Lipitor, you need to be careful because, and you certainly need to measure your cortisol levels, because again, cortisol is this master hormone. Cortisol is what's going to help prevent you from getting big bad diseases. Cortisol is going to help you optimize your health. And if you lose control of that because you've chipped away your cholesterol production through taking a pharmaceutical, you're going to suffer.

So, again, that's just a side note, but we really want to focus on being able to maintain and build that cortisol reserve. Having that reserve allows you to handle a stress. That stress, we're all going to encounter at some point. We're all going to encounter major stress. We want to ensure that we have that cortisol reserve to help us prevent things like cancer and heart disease and autoimmune disease, right? So, how do we do this? Well, actually, the best approach is behaviorally. It's not with taking anything, it's with how you change your behavior. It's what I call deliberate, contemplative exercise. So, let's talk about what that is. Contemplative exercise can certainly be meditation, but also it's things like prayer, listening to music, fictional reading and journaling. It is anything that is outside of an external influence. It is introspective and it is a way to tap back into our parasympathetic nervous system and turn off that sympathetic nervous system.

In the beginning of this talk, I started talking about, or I mentioned how meditation might not be the best way for us to do that. It's certainly a good way, but with my clients, I certainly make the point not all of us are able to meditate. And I think there's a lot of pressure now for people to feel like you have to figure out the only way to be successful in training your brain and your hormones is to meditate. And that's just not true, right? Prayer is a very great way to tap into the parasympathetic nervous system, listening to music, journaling. For me, I like to shoot baskets. I've done that since I was a young kid. For a lot of men, it's something with a ball and playing sports, some repetitive action, and we get into that zone.

I don't want people to feel like you have to sit there and be silent and work really hard to meditate. I think that if you're good at that and that works for you, that's great, but there's lots of other ways for you to again be introspective. And the key is being deliberate. So, the key is doing it on a regular basis. It's not saying, “I'll get through my day. And then if I happen to have time, I'll do this.” You got to be deliberate. You got to be proactive so that you can build and maintain this cortisol reserve. So, again, contemplative exercise, prayer, meditation, listening to music, fictional reading, journaling, nothing with your phone, nothing that involves a computer, something that you can just go inward and be with yourself. That's the best way to work on building that cortisol reserve.

Another great way we're going to go over several here, most of you are familiar with these adaptogenic herbs, and there's a host of them. So, adaptogenic herbs have a long history of really helping to support cortisol. I'm going to name five of them that we use routinely and go into how they work. Number one is licorice root. Licorice root delays the conversion of cortisol to cortisone. It has to do with slowing down the enzyme that converts cortisol to cortisone. So, you can take licorice root by itself, a dose. You don't want to do really more than about 20 milligrams.

If you look at supplements over-the-counter, a lot of those supplements have way too high quantities of licorice root. You'll see quantities 100, 200, 500 milligrams of licorice root. That's way too high and that will actually stimulate other hormones like aldosterone from your adrenal gland, which will increase your blood pressure. You may have heard of people taking too much licorice root. So, you want a very low dose of licorice root. What we found to be successful, and then we'll get into it in a second when we talk about cortisol replacement, but we actually compound licorice root with hydrocortisone and a liquid tincture. And we do so because again there's synergy. So, licorice root is a really good tool. Take it in the morning.

Another one we like is holy basil, and a dose of about 500 milligrams in the morning. Holy basil has a long history, meaning, thousands of years where people would take this botanical herb and they would get a sense of the divine in their world. Any of these botanical herbs you want to take their flavor, their personality and make them your own. Another great one that we use a lot of is cordyceps, which is a mushroom. Cordyceps, we usually like it as a powder. You can put it into coffee you can put into a shake, you can certainly take it as capsules, but cordyceps is a great adrenal strengthening herb. Rhodiola is another one we like. Rhodiola grows in very harsh conditions, so it's very durable as a botanical herb. With that durability, we want to apply that same durability to our adrenal gland. And then lastly, schisandra berry. Schisandra berry has more of a history in kind of traditional Chinese medicine, has more of a fun, happy component to schisandra berry, but you again can take that in the morning.

What I like people to do is don't take these herbs for more than six weeks at a time. You can rotate them, you can take breaks from them, but they are very tonifying and strengthening the adrenals. And frankly, probably as we go through this list, we should all be doing some of each of these just because we have so much stress in our world, especially in this modern time. There's some critical nutrients we think of that help supply the adrenal gland with the necessary nutrients. The three big ones are vitamin A, vitamin B5 or pantothenic acid, and vitamin C. Vitamin A you can get from–I like people to get it from like sources such as cod liver oil. Vitamin B5 you can get from a B complex or vitamin B5 itself. Vitamin C, an essential vitamin, we cannot synthesize it as in the guinea pigs. We don't make it, so we need to get it. A good dose is at least 3,000 milligrams in a day that you're going to need to sustain just kind of normal healthy adrenal function.

And then lastly, the nutrient we use a lot of here is intravenous NAD+. NAD is, it's really a coenzyme, but what NAD does is it helps the mitochondria make more ATP energy. So, without enough NAD, we can't make ATP. Why this is important is for most of us as we're adults, we're in some sort of healing phase. We're working on stuff or stressed out and supplying our cells with as much ATP as possible. It's a really positive aspect or a really positive tool. So, we use a lot of intravenous NAD to do just that. NAD is wonderful for the nervous system, but really when we're talking specifically about adrenal health, it's about supplying the ATP energy.

We use a lot of peptides in our practice. And in the morning, what we like to use, there's one peptide called hexarelin, which really is an energy producer. It is a growth hormone-releasing peptide. So, you take it first thing in the morning on an empty stomach. It is injectable. That's the one I like for helping the adrenals. I'll talk about a couple others that we can take at bedtime. There are glandular therapies. So, taking just like one would take Armour Thyroid or Nature-Throid for thyroid support. We can do an adrenal glandular that is usually processed from a bovine or porcine source to give us the kind of the tools for our adrenals to work better.

We also can use some RNA therapy. This is more cutting-edge RNA therapy. We can get specifically for the adrenals, for the pituitary, for the hypothalamus. And again, this helps to supply those cell lines with the, for lack of a better term, nutrients to help revitalize them. We also can use intranasal stem cells. Intranasal stem cells seem to have more of an impact on that hypothalamus. And again, we want that hypothalamus functioning as efficiently as possible because that's one of the parts of the brain that sends a signal to the pituitary. So, intranasal stem cells, as well as intravenous stem cells work well here, too.

I also want to talk about hydrocortisone or cortisol replacement. They are synonymous. So, when we think of cortisol, when we give people cortisol, we're actually giving them hydrocortisone. If you remember I talked about there's a dose we want to stick to. That's 35 milligrams. We, on average as adults, whip out 35 milligrams of cortisol in a day. So, when we give people cortisol replacement, just like we would for thyroid, just like we would for testosterone, growth hormone, we're giving them hydrocortisone. We don't ever want to exceed 35 milligrams in a day. As long as we don't do that, we're not going to suppress their adrenal function. The reason we would choose hydrocortisone over any other therapy is when their adrenal function is really, really poor. They're in a true adrenal fatigue. We've measured their morning cortisol and it's bottoming out. Those people cannot respond to botanical herbs, they cannot respond to other treatments, and they absolutely need cortisol. And so we'll give them hydrocortisone either as a capsule or will compound it with licorice root as a liquid tincture and we'll have them do that throughout the day, and that can work phenomenally.

So, I have many patients on hydrocortisone and we're doing super well. The caveat being when we place someone in hydrocortisone, they're going to be on it for a while. It usually takes one to two years minimum to rejuvenate the adrenals. And the challenge there is that it only takes a month or two for people to start feeling better. So, we give them hydrocortisone. Now, they have more energy when they wake up. They're able to do more, handle stress better. Now, they want to go exercise again. Well, they're not caught up, and so it can be a back-and-forth ebb and flow type of arena until we really reach that point where their adrenals have taken over again. I have a patient who's been on hydrocortisone for a year. We just did his salivary cortisol test and his looks perfect. And so what we're going to do is we're going to try to back him off his hydrocortisone. I think he'll respond pretty well. And within a month or so, will be off the hydrocortisone, meaning, his adrenals have caught up, his adrenals have recovered and he can make all that cortisol on his own.

So, those are the main things we'll do for morning to help people rejuvenate that morning cortisol that needs to be put out. In the evening, there's several things we do as well, and sometimes we'll do this simultaneously. Again, we're going to base this on how the client feels, base this on cortisol testing, and there's a handful of therapies I like to use. The first is something called phosphatidylserine. Phosphatidylserine is, it's an amino acid serine, which we [01:12:12] ______ a phosphate group on. And what that does is that allows the pituitary to be more sensitive to cortisol.

For all of these hormones, there's feedback loops. And so when that cortisol is secreted in the bloodstream, it also travels up to the blood. If there's sufficient cortisol, the pituitary won't put out ACTH telling the adrenals to make more cortisol. We can enhance or amplify the sensitivity of the pituitary to cortisol with phosphatidylserine. So, I like people to take it at night, and over time, it will lower the amount of cortisol they need in their world. So, it's a great way to lower the nighttime cortisol.

Another great way is using the botanical herb ashwagandha. A lot of people use ashwagandha in the morning. They really should be using it at bedtime because what ashwagandha seems to do is clean out the cortisol from the cortisol receptors. So, if you use it over time again, by cleaning out those receptors, you just don't need as much cortisol in your world. So, you can take it at bedtime. The dose there, well, let me back up this for phosphatidylserine, anywhere from 100 to 300 milligrams. Ashwagandha, you can take big dosages. So, 300 to 3,000 milligrams.

On the same token, we use a lot of glycine. Glycine is the smallest amino acid. Great for the liver, but also calms down the nervous system, as such helps us tap back into that parasympathetic nervous systems, helps us relax, be calm, helps us not need as much cortisol. Thus, there is anywhere from 1,000 to–I mean, very high doses, but 1,000 to 5,000 milligrams at bedtime. We also use a lot of CBD. CBD is again the endocannabinoid system taps directly into the adrenal system. So, if you're looking for a kind of a direct connection, CBD is one of those fools that will allow your adrenals to settle down. So, CBD is great. You can take it throughout the day, but certainly at bedtime for someone who is over-excretor or secretor of cortisol at night. CBD is calming, for a lot of people a little bit sedating, helps people relax, helps people with anxiety. So, we like to use CBD. We can use combination of all these things as long as they're not too sedating.

In terms of peptides, three main ones we use, we use Epitalon, which does help to reset the circadian rhythm. We'll use nylon, which helps us put out more melatonin. And then we'll use some of the growth hormone-releasing peptides such as Ipamorelin, GHRP-6, GHRP-2, again at bedtime so we can put out more growth hormone. Again, there's that interplay with cortisol, growth hormone, and we want growth hormone at night and we want cortisol during the day.

So, that was a lot of information about cortisol, the circadian rhythm. I didn't mention a couple things that I'll mention now. One thing that we would ideally like to have is a very quick and easy way to kind of say, “What is my cortisol doing?” There seems to be pretty good correlation between heart rate variability and cortisol, but you don't want data all the time. So, the point there is you want to collect morning heart rate variability and nighttime before you go to bed.

And look at those over time, but they correlate pretty well. Meaning, if you've got a good heart rate variability, that means you are supporting your cortisol well. If your heart rate variability is lower than you want it to be and your–and again, you have to do this over time. I think the mistake people make with the wearable devices, they're looking for day-to-day stuff. It doesn't work that way, there's too much variation, but over time, meaning weeks to months if you're seeing that your heart rate variability is suffering, that is a really good indicator that your cortisol is not optimized. So, that's a really good tool, an up-and-coming tool.

But overall, I think you've gotten the point that cortisol is a really, really big deal. It's a big deal for day-to-day stuff, helping you cognitively be your best, helping you perform your best, helping you exercise as intensely as possible, and then being able to recover well. If you're any bit tired like most of us, if you're any bit feeling stressed like most of us, we're not modulating cortisol appropriately. We're not treating cortisol with the respect it really is owed. Cortisol is a primitive hormone. We are hardwired for specific cortisol rhythm. Once we get out of that rhythm, bad things start to happen, and they start to happen in how we feel, and then they show up in big bad diseases that we don't want to get. And all of us now have the opportunity to really learn about our own specific cortisol rhythms. Pay attention to it.

And then there's a variety of tools from contemplative exercises, adaptogenic herbs, certain nutrients, intravenous nutrients such as NAD, peptide, stem cells, a whole host of tools that we now have available. The key with those is making sure you're taking them at the right time. Again, the two big bookends for cortisol is the morning cortisol and the nighttime cortisol. Sometimes we do take care of the noon and afternoon cortisol, but not a lot. We mostly see people being affected by cortisol fluctuation first thing in the morning and right before bed.

So, you can find us on Instagram at Koniver Wellness. Our website is koniverwellness.com. We work with people from all over the country, professional athletes. We train doctors in all the programs that we engage in. We like to do a lot of cutting-edge therapies. But one of the mainstays is cortisol, the circadian rhythm having respect for it, and then using that to drive strategically and contextually, how to create specific programs for our individual clients. That is really a key point, right? You hear a lot of information about taking this new trainer, engaging in this exercise. I can tell you that that gets a whole lot easier and a lot more efficient when you work that in into the cortisol rhythm. So, from whatever you take from this talk, this podcast, understand your cortisol rhythm, respect it, and then work everything in your life back into that rhythm. Live like the sun, rise in the morning, set in the evening, and that is how you lead the most optimal life. Thank you.

Ben:  Well, thanks for listening to today's show. You can grab all the shownotes, the resources, pretty much everything that I mentioned over at BenGreenfieldFitness.com, along with plenty of other goodies from me, including the highly helpful “Ben Recommends” page, which is a list of pretty much everything that I've ever recommended for hormone, sleep, digestion, fat loss, performance, and plenty more. Please, also, know that all the links, all the promo codes, that I mentioned during this and every episode, helped to make this podcast happen and to generate income that enables me to keep bringing you this content every single week. When you listen in, be sure to use the links in the shownotes, use the promo codes that I generate, because that helps to float this thing and keep it coming to you each and every week.



Let's face it: cortisol gets a bad rap these days.

“I have high cortisol.”

“I have low cortisol.”

“My cortisol it out-of-whack.”

You've no doubt heard this all before or said it yourself. So in an effort to decode cortisol once and for all, I decided to feature a wildly popular previous guest of mine—the guy who personally helps me and my wife manage our own hormones and has helped countless listeners of mine with their own anti-aging and natural hormone management protocols.

His name is Dr. Craig Koniver.

Dr. Koniver was a guest on the episode “How To Get Your Own Vitamin and NAD IVs, The Truth About Umbilical Stem Cells, Peptide Injections & Much More With Dr. Craig Koniver.

He has been practicing performance medicine for over 18 years and is the founder of Koniver Wellness in Charleston, South Carolina. Not satisfied with the disease-based model of modern medicine, Dr. Koniver seeks to help his clients optimize their health and performance through time-tested, nutrient and science-driven protocols that are the cutting-edge of medicine. He is the founder and creator of the patent-pending FastVitaminIV® as well as re-engineering the NAD+ IV protocols, now called Brain Refuel™.

Dr. Koniver’s client list includes Navy SEALs, NFL players, PGA golfers, Hall of Fame NHL players, world-class professional athletes, Fortune 100 Executives, and well-known celebrities and TV personalities. In addition, Dr. Koniver offers a comprehensive training program of the Koniver Wellness Model to physician practices across the country.

In this episode, you'll discover:

-What is cortisol? 5:32

  • Hormone secreted by adrenal glands
  • Not enough attention is given to cortisol in the medical field
  • “Stress hormone” — fight or flight response
    • It is secreted in response to any real or perceived threat or stressor
  • We're hard-wired to have high cortisol in the am, and low in the evening
  • Rhythm vs. volume is key
  • Acute hormone; ex. being chased by a lion
    • Turns off pain recognition
    • Anti-inflammatory
  • Catabolic hormone — wear and tear
  • We've changed cortisol from an acute to a chronic hormone
  • Key takeaway: try to find meaningful ways to live w/ the sun's rhythm
  • Lowest levels are at around 10 pm; allows anabolic hormones testosterone, growth hormone, and melatonin to elevate
  • Most critical hours of sleep are 10 pm – 2 am
    • It takes melatonin 12 hours to reset
    • Later (or no) sun exposure means melatonin levels peak later, leading to loss of sleep quality

-How cortisol is secreted…13:37

  • Perceived stressors (most often subtle in modern times)
  • Primitive part of the mid-brain, above the spinal cord
  • Reticular Activating System (RAS) triggers release of cortisol
  • Signal sent to locus ceruleus (one of the most connected parts of the brain)
  • Signal sent to hypothalamus, to pituitary, then to adrenal glands
  • Norepinephrine and cortisol are “partners in crime”; released along w/ cortisol
  • Pituitary responsible for all signaling molecules
  • We stop releasing cortisol, and have surplus of norepinephrine
  • We release an average of 35 g of cortisol per day
  • Irregular sleep patterns (night shift workers) lead to chronic health problems later in life

-How cortisol imbalances affect our lives…20:12

  • Our brains cannot differentiate between perceived and real stressors
  • Visualizing a success (or a failure) will trigger cortisol secretion
  • “I can't wait to wear that outfit” is much more effective than “I'm way too big…”
  • RAS helps distinguish background and foreground in our world
  • Buy a red truck, all of a sudden you see a bunch of red trucks on the roads
  • What you put your attention is what you're going to get in your life

-How cortisol gets disrupted…25:40

  • Humans are “super-adaptors”; we can tolerate stressors over a long period of time
  • Modern tech can disconnect us from the sun, circadian rhythm, and cortisol flow
    • We release cortisol at night when we look at TV, phones, etc. at night
  • We tolerate stressors for years and decades, but it eventually catches up with us
    • It will eventually blunt the anabolic hormones (testosterone, growth hormone, melatonin)
  • We lose sleep quality, take longer to heal injuries, workouts are more challenging, etc.
  • Gold standard to test adrenal function: salivary cortisol test
    • Salivary is far less stressful than a blood draw (hence more accurate results)
  • We rely on stimulants such as coffee and prescription drugs, rather than address the issue of disrupted cortisol flow

-Why cortisol is such a hot topic in modern society…37:40

  • Acute stressor triggers cortisol
  • Over time, cortisol has become a chronic hormone, rather than an acute hormone
    • We'll never be chased by a lion in the jungle
    • We trigger cortisol response w/ everyday stressors
    • Chipping away at cortisol release over time
    • We can't keep up w/ cortisol demands; lose cortisol reserve
  • Major stressor (loss of job, death in the family, etc.) causes a breakdown when cortisol levels have been chronically disrupted
    • Cancer, autoimmune disease, etc. occur with this breakdown
    • Many fear cancer, other serious illnesses
    • Best way to prevent disease: take care of cortisol levels
  • Be aware of indicators of low cortisol levels: poor sleep, longer than usual recovery times, etc.

-The key element regarding cortisol missed by conventional medicine practice…43:13

  • Adrenal fatigue and insufficiency doesn't exist in conventional medicine
  • Two extremes in conventional medicine: Cushing's disease, and Addison's disease
    • Cushings: too much cortisol secretion
    • Addisons: not enough cortisol is produced
    • There's a gray area; it's not simply black and white
  • As cortisol levels are disrupted, norepinephrine levels increase
    • Increased heart rate
    • Increased blood pressure
    • This feels like anxiety
    • Consider visiting a doctor knowledgeable in this as you may have lost control of the cortisol buffer
  • Study in the Netherlands on men over 50 who ran marathons vs. men who didn't run marathons
    • Men who ran marathons suffered more heart attacks (due to overtraining)
    • Positive exercise can still be a stressor, releasing cortisol
  • Recovery is key to being an elite athlete

-How cortisol interacts with other hormones in the body…49:30

  • Hormones are like kids w/ differing personalities
    • Cortisol is the neighborhood bully
    • High insulin levels and cortisol lead to weight gain (cut carbs in the morning)
  • Abnormal cortisol modulation affects thyroid levels deleteriously
    • Be aware of your adrenal status if you're on thyroid hormone replacement
  • An imbalance of cortisol and testosterone inhibits muscle production
  • Growth hormone depletion leads to brain fog, weight gain, etc.

-How to effectively modulate cortisol…56:52

  • Tests:
  • Adrenal glands are like a factory producing hormones: cortisol is the goal, but we need to make the other hormones
    • Cortisol imbalances lead to depletion of other hormones
  • Pregnenolone is made from cholesterol; low cholesterol levels affects cortisol production
  • Number 1 risk factor for cancer for men is low testosterone; cortisol will help optimize health
  • Having a cortisol reserve enables us to handle and tolerate stress, thus preventing cancer, autoimmune disease
  • Behaviors to normalize cortisol levels (deliberate contemplative exercise)
    • Meditation, prayer, reading
    • Activate parasympathetic system, turn off sympathetic system
    • Meditation is not the only means of managing stress
  • Adaptogenic herbs:
  • Critical nutrients:
  • Peptides: (use code: BEN2020 at check-out to get a 15% off of products and phone consult)
    • Hexarelin
    • Epithalon
    • Ipamorelin
    • GHRP 6 and GHRP 2
  • Intranasal and intravenous stem cells
  • Hydrocortisone replacement (don't surpass 35 mg per day)
  • Phosphatidylserine (100-300 mg)
  • Ashwagandha (use at bedtime – 300 – 3000mg)
  • Glycine (great for the liver, 1000-5000 mg at bedtime)
  • CBD (bedtime)

-Closing thoughts…1:14:42

  • Good correlation between HRV and cortisol; collect morning and evening times
  • Cortisol helps be your best cognitively
  • If you're feeling tired, stressed and anxious, check your cortisol levels

-And much more…

Resources from this episode:

Koniver Wellness ( use code: BEN2020 at check-out to get a 15% off of products and phone consult)

Episode sponsors:

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Ask Ben a Podcast Question

6 thoughts on “[Transcript] – Cortisol Decoded: The Myths & Truths About A Hormone Crucial To Your Health & Survival.

  1. Gabrielle Malo-Bibeau says:

    Can we use hydrocortisone during the day and phosphadylserine at night?

  2. Kristi says:

    This was a fantastic podcast. Thank you!

  3. Vinny U says:

    You mentioned some ranges for Cortisol saliva test. When I had mine done, here’s what I got as results. The numbers you mentioned were like 18 in the morning? Does this mean adrenal fatigue since the night time reading is low?

    Test Name Result Range

    Cortisol 7.8 (3.7-9.5 ng/mL) (morning)

    Cortisol 1.7 (1.2-3.0 ng/mL) (noon)

    Cortisol 1.4 (0.6-1.9 ng/mL) (evening)

    Cortisol 0.3 (0.4-1.0 ng/mL) (night)

    1. I'd be happy to go over your test results in a one on one consult, just go here: https://bengreenfieldfitness.com/coaching

  4. Chris says:

    How are you supposed to sleep and wake with the sun in the North? It’s only light out where I live from 8am till about 4pm…

  5. Rebecca says:

    Best presentation on cortisol I’ve heard, and I’ve listened to countless in pursuit of big fat belly reduction. Truly appreciate the actionable suggestions and mix of high tech (more expensive) suggestions with attainable today suggestions.
    I purchase bulk herbs/supplements and encapsulate myself or make tea as this is more affordable which allows me to try more for longer. Any suggestions on dosage using 00 caps size or making tea for the adaptogenic herbs listed above?
    Actually enjoyed listening to Craig, thank you so much for this segment.

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