[Transcript] – Why Is My Cortisol High Even Though I’m Doing Everything Right? Hidden Causes Of High Cortisol, The DUTCH Test & More!

Affiliate Disclosure


Podcast from https://bengreenfieldfitness.com/2016/05/what-is-the-dutch-test/

[0:34]  Kimera Koffee

[1:45]   Nuts.com

[3:09]  Harry’s Razor

[4:32]  Introduction

[6:26]  An interesting weekend for Ben

[11:32] All about Chris Kellynour

[16:29] What Ben Does After Event Days

[17:30] Chris Says Thank You/Dr. Parsley

[18:51] The DUTCH Test

[24:41] What the DUTCH Measures

[26:30] DUTCH Test vs. Adrenal Stress Index

[32:00] Ben's DUTCH Test Results

[36:43] Free Cortisol vs. Total Cortisol

[39:39] Other Things The DUTCH Shows

[42:51] What Are Metabolites

[44:38] What To Do Regarding Metabolite Levels

[45:58] More on Ben's Results/Estrogen

[48:32] Dealing With Damaging Estrogens

[55:18] Chris' Thoughts on Ben's Results

[57:47] Why Zebras Don't Get Ulcers

[59:39] High Cortisol Effects

[1:04:35] What Can Elevate Cortisol Levels

[1:05:30] Crabs In The Bucket Story

[1:11:27] Heavy Training and Blood Glucose Mobilization

[1:18:23] Increasing Cortisol Levels

[1:22:59] Marijuana and Cortisol

[1:26:29] Supplements or Food That Decrease Cortisol

[1:32:15] Redoing The DUTCH

[1:33:47] When To Take These Tests

[1:35:17] How Chris Work as a Team 

Ben:  Hey folks, it's Ben Greenfield.  For the podcast you're about to hear, I had to pee on a bunch of pee strips to find out some really interesting things about my hormones. So you're gonna dig this one.

But before we jump in to today's episode, I wanna tell you about something else that might make you pee.  And that is coffee.  I'm not just talking about any type of coffee though, and no, don't worry coffee will not dehydrate you.  They've actually done studies on.  They found that the amount of water you get from coffee offsets any amount of dehydrating diuretic effect that it might have.   But the coffee that I drink is called Kimera Koffee.  K-i-m-e-r-a-k-o-f-f-e-e dot com.  And Kimera Koffee has a bunch of different nootropics in it.  Nootropics being things that actually improve your mental function and your cognitive performance.  I've talked about this stuff before but I wanna zero in on one particular nootropic called L-Theanine that's in this stuff.  Now L-Theanine when combined with caffeine that you find in coffee actually keeps coffee from disrupting your sleep patterns.

So, if you have coffee in the morning, and you wanna take an afternoon nap, or you have coffee in the afternoon and you want it not to disrupt your sleep, the L-Theanine actually makes that happen.  Now, that's just one of a host of different nootropic natural compound you'll find in Kimera Koffee.  And you get a 10% discount on this stuff.  All you need to do is go to kimerakoffee.com, that's k-i-m-e-r-a-k-o-f-f-e-e dot com and use discount code BEN to save 10% on L-Theanine infused coffee that has oh so much more than L-Theanine in it.

This podcast is also brought to you by Nuts.  Now, when I want nuts, I go to this website called nuts.com, frankly because they have way more than nuts.  They've got this huge Turkish figs, and I'm a big fan of the kinda figs that literally take up the entire space of the top of my smoothie.  They've got goji berries, they've got chia seeds, they've got organic quinoa, they've got dried organic mango, you name it.  So you can get things like English walnuts in the shell or roasted cashews, but you can get much, much more too.  And when you go to nuts.com they’ve got a special deal.  So here is the deal.  You get four free samples.

You get to choose from over 50 different options.  That's a $15 value.  When you go to nuts.com/fitness.  That's our special link.  That's nuts.com/fitness.  They arrive to your home almost immediately.  Really fast shipping.  And like I mentioned they have tons of sugar free items paleo friendly, certified organic, certified gluten-free, you name it.  So what would I recommend you get for starters? I'd say, Brazil nuts for the zinc and the selenium, some chia seeds for their gut healing properties, and then throw in some of those figs.  The figs are awesome, trust me.  So nuts.com/fitness, and you get four free samples with your order.

And then finally, this podcast is brought to you by Harry's.  Now Harry's makes just one razor with everything you need for a super close comfortable shave.  They have five German crafted blades, flexed hinge, lubricating strip you name it.  And last week I went travelling without my Harry's razor, I forgot it.  I called down to the hotel front desk and have them send up one of their free razors from the desk. And I swear it took me like 15 minutes to shave.  I had razor burn, I had 2 cuts and frankly compared to Harry's, which basically makes a razor that you don't even realize you're using until you look at your face, and it's completely free of hair or your legs, ladies.  You really cannot miss out when you use this razor.   It's the best shave you'll ever have period.  So here's how you get it.  You go to Harrys.com and you enter code BEN at checkout you get $5 off when you do that.  So that's H-A-R-R-Y-S dot com and enter code BEN.  I'd recommend you start with their Truman set where you get a razor handle, you get some moisturizing shave cream, and you get three of their five blade German-engineered razors.  So check it out Harrys.com with code BEN.

In this episode of the Ben Greenfield fitness show:

“The glycerin is the active extract in the creation and then caffeine, and then this amount of things.  What they do is they interfere with the action of that enzyme, and they slow the conversion from cortisol into cortisone.  So technically what you’re doing is you blunting the natural dropping cortisol”.  So what happens is you see no more TSA.  So TSA which is the main sickly hormone that comes from the brain, the thyroid glands, and then the active form of the hormone is T3 and the brain doesn’t recognize the reason enough.”

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:  (sound of soda can opening) Hey folks, it's Ben Greenfield, and yes that was the sound of me opening a cream soda Zevia. One of my favorite little (drinks) beverages of choice and I don't mess around I get the big old 16 ouncer from Whole Foods.  It's my little treat at the end of a good day.

It's been an interesting weekend.  I'm actually out of my element today recording for you from the Holiday Inn Hotel in downtown Seattle.  I'm actually in Seattle or have been in Seattle to race a 12-hour brutal crucible called The Hurricane Heat that's put on by Spartan, and so, I'm recording this podcast episode on a Sunday, but two nights ago, Friday night I spent 10pm until 10am doing all sorts of masochistic, ungodly events including sandbag carries and midnight calisthenics in the mud.  Different types of what they call a checkpoint adventure racing style, surges out into the wilderness to find different checkpoints, playing around on the Spartan obstacles, and just basically doing everything that the good folks at Spartan wanna throw at you for 12 hours.  So it was quite an interesting evening.

I'm working on a blog post about that, but I survived that and of course I get many questions also about what type of things I do to recover after an event like that.  And so, I've been  spending the day or spent the morning at the Turkish spas doing a little salt soaks, a little steam room, a little sauna, a little cold plunge just basically a circuit between all four, a little bit of Kundalini yoga today, trip to Whole Foods for a nice antioxidant rich salad.  I'll admit there were actually two trips to Whole Foods for two what I call big ass salads since that event.  A lot of topical magnesium lotion, and a lot of foam rolling using because I forgot my foam roller, a glass water bottle on the floor of my hotel room, and all sorts of little things I do for recovery along with a lot of sunshine and walking.

So, speaking of recovery and taking care of the body, I think that today's podcast episode is going to be really interesting.  For those of you who have any interest whatsoever in this mysterious hormone that we call cortisol, and no, don't worry this isn't going to be Cortisol 101.  I think we've probably talked about cortisol enough on the podcast where I don't need to do an entire podcast episode on what Cortisol is.  But I'd rather get in to the kinda confusing world of testing for cortisol and managing cortisol on whether you even need to worry about it in the first place.

So, frankly most popular tests for cortisol don't really tell you what you need to know.  They don't tell you things like how fast cortisol gets cleared by your body if it is being made, and what's truly causing high cortisol or low cortisol. And how cortisol and other crucial hormones that your body makes are getting created and broken down.  And you know, a lot more and in the past I recommended the adrenal stress index, the salivary measurement for measuring cortisol.  But recently, I've been looking into other ways to measure cortisol, because it turns out that that adrenal stress, that salivary index may not be the best method to use.

Now, why should you even care about this? Well, you probably know that low cortisol leaves you with low energy and low drive and brain fog and feeling over-trained and adrenalin fatigued.  And high cortisol, in the meantime which many of us get concerned whether or not we're making enough.  Well in fact, if you are making enough, you can still be making too much, and that can do a lot of the things you're gonna learn about in today's podcast episode like decreasing muscle protein synthesis, and amino acid uptake, and increasing bone degradation and suppressing your immune system, and increasing blood glucose.  So you feel pretty crappy when cortisol is low, and while you may feel good when cortisol is high, if cortisol is chronically high, there's some downsides to that too that you're also going to learn about in today's show.

So, recently I did a test called a urine hormone profile.  More appropriately it’s called a urine steroid hormone profile.  Also called a Dutch panel.  Now, I'm going to let my esteemed guest today actually fill you in on why I did this particular hormone profile. It's very new, it's very cutting edge, it's something that I've really been wanting to a look into.  And so I did this and I got the results, and I'm going to share the results with you today.  And I'm gonna share with you a whether or not you are someone who maybe should think about doing this particular test.  I certainly have gotten a ton of data out of it.  Free cortisol and creatinine and DHEA and the metabloids of cortisol breakdown, and all these very cool things you're going to learn about in today's show.

So my guest on the show has been a guest before.  He was with me on the podcast episode called The Little Known Test That Tells you Everything You Need to Know About your Metabolism, in which you learned all about this special test called an organic amino acids test.  He was also with me on the podcast episode 7 Signs Your Cortisol and Adrenals Are Broken.  In which we delve into issues that I know many of you face like adrenal fatigue for example.  And his name is Chris Kelly.  Chris quit his job at a hedge fund 2 years ago and completely pivoted to start this small functional medicine practice for athletes and for active individuals and hard charging folks called Nourish Balance Thrive.  He's not just a previous hedge fund manager, he's a computer scientist.  He's a pro-mountain biker and at Nourish Balance Thrive, because you may be scratching your head about how a computer scientist and pro-mountain biker could run a functional medicine practice.  He actually works with a couple of physicians.  One of whom is also a pro-mountain biker, and the other is Dr. Tommy Wood who is a biochemist and a PHD fellow, and Chris' wife, Julia is a food scientist.

So Chris is all over the place when it comes to delving into the latest cutting edge stuff in terms of functional medicine.  He's a, he's incredibly helpful resource for me especially with regards to the test that you're about to learn about and he's also got a podcast.  And I'll link to his podcast the previous episodes with Chris, Nourish Balance Thrive and my own cortisol testing results, everything that you are about to discover over at bengreenfieldfitness.com/dutch, that's bengreenfieldfitness.com/d-u-t-c-h. So Chris, with that incredibly long drawn out intro and one more sip of Zevia…

Chris:  (chuckles)

Ben:  Welcome to the Ben Greenfield Fitness Show!

Chris:  Thank you so much.  It's amazing to be here.  Can I just point out how amazing it is that you can do a 12-hour race and then that intro, are you reading from an auto prompter right now? (laughs)

Ben: (laughs) You know, yeah, when I've done videos ‘cause I did a course for Creative Live, and then the website Mind Body Green came to my home and did a video course, and everybody always wants me to use the teleprompter.  And I always say no because I just feel, feel like it's cheesy, I feel like it's forced.  I'd, I and you know, probably I don't think I've shared this much on the podcast, but for 3 years in college I was on the speech and debate team.  And my particular method of speech that I competed in was extemporaneous or impromptu speaking in which you're given a topic, you're given about 15 minutes to prepare, and then you go into a room with the panel of judges, and you give anywhere from a 15 to a 30 minute speech on that particular topic.  And so, I think that I was just from an early age raised to in a way uhm begrudge these teleprompters and reading of a page.  So now I didn't really read that one of a page.  However, it's a great question.

Chris:  Another piece of the Ben Greenfield jigsaw puzzle falls into place, I think right there.  And I think that's kind of a lot of what this is about, like everything you do is, it's not just about your speed and performance in racing, but being able to do something like that or like this right after the race.  Isn't that incredible?  Like, I couldn't remember a time where I could never have thought of that.

Ben:  Well, get this.  I finished the race, right?  I finished the 12 hour event, came back to my hotel, went and got my big-ass salad at Whole Foods, I just got lucky enough to where one's four blocks from my hotel, and I pile it high with all the Indian foods, and the turmeric-filled foods, and the cumin, a ton of cruciferous vegetables, lots of kale, and not a lot of proteins.  As a matter of fact, I like to eat extremely alkalinic and extremely anti-inflammatory after an event like this, and then I went back and crashed at my hotel room, fell asleep at about 6 PM, and woke up at 8 AM, and felt pretty good after about 14 hours of sleep like that.  Threw in another nap this afternoon for another couple of hours and so, with about 14 hours of sleep under my belt, I feel just fine.

Chris:  That's amazing.  Whatever you're doing is obviously working.  Whenever I do like a really stressful event like that or a race it always, I mean presumably jacks up my cortisol, right, that's what we're going to talk about, and then that stops me from getting the sleep that I need.  So, yeah, the worst case situation.

Ben:  Yeah, and as I've talked about on previous podcast episodes, and I think we may delve into sleep and cortisol a little bit on today's show, you know, I have a few little choice things that I'll take before I go to bed.  Particularly, my, the one that I swear by is I take one to two packets of this sleep cocktail which is designed by this Navy SEAL who works with a lot of Navy SEALs who would typically take Ambien, or Valium, or something like that after a stressful event, and he kinda formulated this cocktail to help calm them down after stress.  And then I combine that with a cannabidiol capsule, which is the Nature C.B.D. that my company makes which is just magnesium and lemon balm and ashwagandha and cannabidiol, which is basically like, you know, weed without getting you high.  So I take those, you know, about four capsules of the C.B.D. and one to two packets of this sleep cocktail, and it just knocks me out even after I've done something very hard like that.  So, seems to work.

Chris:  I know Doc Parsley.  I've just interviewed him for my podcast and he's just, he's like you.  There's been so many amazing people that have helped me launch this business and I should, like, take this opportunity to say thank you for you.  It's a couple years ago since I first appeared on The Ben Greenfield Podcast, and that show launched a business, a whole functional medicine practice of amazing people.  Everyone that listens to this show, if you're listening to this right now, thank you.  You are amazing.  It's been so much fun to work with the listeners of Ben Greenfield Podcast.  And Doc Parsley, he spent two hours on Skype a couple of weeks ago talking to me about sleep and I recorded about an hour of it for my podcast, but he's just such an amazing man.  So many incredible experts out there that are willing to teach and, yeah, you're all wonderful.

Ben:  Wow.  And, so, you actually, when you came from hedge fund management into the world of functional medicine, from what I understand, you were actually a podcast listener to this show?

Chris:  Yeah!  That's right!  You were part of the solution.  It was all overwhelming at first.  When I first started listening to the podcast, I was like, “This guy is nuts. I can't do all this stuff.”  And, now when I look back, I'm doing all of it, you know.  Like it's not all happened at once, but gradually, bit by bit, I'm doing pretty much all of it.  The soldering just started recently and that's been incredible.  And I'm like, “Why have I just started doing this?  This is great!”  So, yeah, it's been a bit of a journey for me, sort of bit by bit.

Ben:  Wow.  That's really cool.  That's really cool.  I'm happy to hear it and it seems like we've in run a lot of similar circles.  However, you to, to tackle the topic for today, seem a little bit more immersed, more so than I am into testing, you know, what type of functional medicine tests, I guess you would call them are out there, and what you can get out of them, and there's this new test that you and, a couple other people had mentioned it to me, and I decided to finally delve into it myself, but it's called the DUTCH test, and obviously I alluded to it in the podcast intro, but tell me about this DUTCH test.  What exactly is it?

Chris:  So the DUTCH test is a urinary metabolite test and it uses G.C. and L.C. tandem mass spectrometry.  So this is this really fancy, new technology.  It's actually the same technology that the organic acids test uses and, so previously we talked about the A.S.I. and that was a saliva test.

So, in order to do that test, you would spit into a tube, and then freeze those samples, and then send them off to the lab.  Well, now that's changed.  Now you can pee onto a piece of filter paper, you know.  It's just like coffee filter paper, and then you let those samples dry out, and then you send them back to the lab, and they do this mass spectrometry on the paper itself, and then they tell you all of the hormones and the metabolites that are in the samples.  So this is kind of, I think of this as the next generation of hormone testing, and it's the brainchild of an incredible analytical chemist who has also been in my podcast.  His name is Mark Newman, and I owe him quite a lot of thanks too because he has also been extremely generous with his time to me.

Ben:  Okay.  So, Mark Newman is an analytical chemist and an analytical chemist, what exactly do they do?  They create tests like this or they study tests like this?

Chris:  Yeah, exactly.  In this case, he has created a new test.  So he's gone into the world of testing and say, “Okay, so this saliva testing is pretty good, the blood testing that came before it was not quite as good, how can I improve on this?”

And the DUTCH test is, it's basically the manifestation of his life's work, and the reason I like it so much is it kind of reminds me of my former life, right.  So when I worked for hedge funds, I was a computer programmer or a software engineer, and, as any computer programmer knows that the longer that you spend at a single company, the less you become of a software creator and more you become a software supporter.  And so I would just spend most of my day debugging complex systems and trying to problem solve.  And so this DUTCH test kind of reminds me of that former life, like it allows me to see inside of a person, and find out what's going on with their hormones and then help diagnose the problem in a way that you just couldn't do before because the, you wouldn't be able to know what was going on inside of the person.

Ben:  Now, mass spectrometry, you mentioned that that's the actual, you know, once you pee on these strips, and you send them in, and, by the way, that part of it was pretty easy.  I just, you know, four times during the day and it was kind of the option if you wake up in the middle of the night to pee, which I did.  So I think I wound up with five different urinary measurements.  They use this mass spectrometry which I believe that's also called liquid chromatography, correct?

Chris:  Right.  Yeah.  I don't know that much about the actual assay…

Ben:  I, I actually, I do.

Chris:  Oh, do you?

Ben:  So, another glimpse into my past is that, when I was in college, I had two different internships in the, it was basically the microbiology lab at University of Idaho where we were trying to find different bacteria that would be able to bioremediate pollutants such as iron, for example, from water.  And basically that sounds very sexy, but what it really involved was me sitting in front of a mass spectrometer/liquid chromatography machine for hours and hours, running different bacterial samples through that machine, and then matching them up and trying to analyze which bacteria was which.  So I'm somewhat familiar with the test, with, not that great a memory of it, but it, from what I understand, it's a very, very precise, sensitive way to identify chemicals and detect chemicals that one would not normally be able to detect using other types of chemistry techniques.

Chris:  Right, right.  Yes, and to me, as the person, you know, just trying to figure out what's going on inside of another person, it's a black box.  Like I don't really care how the mass spectrometry part works, all I know is I get these, this little dashboard with all the different hormone readings on.  Yeah, that's my understanding.  So I've also interviewed a guy called Bill Shaw, who is another analytical chemist who does the organic acids test, and he refers to mass spectrometry as the truth machine, and the reason he calls it that is because it's so specific to the analyte that's being measured.  So, for example, there are synthetic forms of cortisol that you can take either orally or topically and there's really no chance of those showing up on the DUTCH test because the mass spectrometry is so specific to the cortisol or cortisone that's being produced endogenously or inside of your body.

Ben:  Really?  So, if you were on like a hydrocortisone cream, or some type of other cortisol analog supplement, or a steroid, or something like that and you took this test, that would not skew the results?

Chris:  It would because that would affect your body's own ability to produce that.  So your body doesn't produce things for fun.

Ben:  But it wouldn't show the exogenous source, it would show what it'd done to your body.

Chris:  That's my understanding is the chemicals are different enough to where it wouldn't show up on the DUTCH.

Ben:  Okay.  Interesting.  Interesting.  Okay, so in terms of the DUTCH panel, what exactly is it measuring?

Chris:  Well, it's measuring sex hormones.  It's measuring cortisol, it's measuring progesterone, estrogen, testosterone, and melatonin.  And I think the place to focus today, the first thing it looks at is this most important of all hormones I think, cortisol.

Ben:  Okay.  Got it.  So, it's above and beyond cortisol.  Progesterone, estrogen, or as we say here in America, estrogen.

Chris:  Sorry. (laughs)

Ben:  By the way, where were you born, Chris?

Chris:  I'm British.  So I was born in [0:25:24] ______ which is up north in the UK, but my accent is quite neutral, and I was living in London before I moved to the US, and I'm worried about losing my accent.  I've been here for 13 years and much of what I've learned about physiology and biochemistry has happened in the US, so I think I'm quite confused about the way the pronounce a lot of words so please excuse that, if you hear me pronounce anything incorrectly.

Ben:  Oh, no.  That's all right.  I'm sure you'll get your accent back fast.  We'll be talking about this later, but I know you and I are both gonna be over in London at the Biohackers Conference there.  So anyways, cortisol, progesterone, estrogen, testosterone, and melatonin.  Those are the five that it measures and I know we're gonna talk a lot about cortisol today, but before we talk about cortisol, tell me how this is actually any different than the hormone test that I think a lot of people are familiar with and that a lot of physicians use.  It's like the gold standard for hormone testing, especially when it comes to cortisol, the Adrenal Stress Index.  How is this any different than that and why would somebody wanna even look into something like a DUTCH test instead of an Adrenal Stress Index?

Chris:  Right.  Well, there was nothing wrong with that saliva test.  And so, when we first started Nourish Balance Thrive, we were running that panel on everyone and we ran 550 odd saliva tests on athletes, specifically on athletes, and all we ever found was low cortisol.  In fact it got to the point where I actually stopped running that test because it didn't tell me anything.  Like everybody had low free cortisol, and so it wasn't really providing any useful information.  Now there was, there were a couple of exceptions, and usually those were people who didn't ask to do the test.  So my C.E.O. Jamie Bush, now Kendall Weed, she married, who was on that original podcast, she was one of the few people that had high free cortisol.  And, typically, people who don't complain about high free cortisol.  And so they don't want to spend $300 on a test to find that out, right.  So we don't ever see it.

Now the way in which the DUTCH is different is, it doesn't just measure free cortisol, it measures both free cortisol and total cortisol production, and the reason this is important is because free cortisol represents only 1 to 3% of the total cortisol and, although the 1%, the free cortisol is the active fraction to acts on cells, it's not the whole picture.

And so when we started running the DUTCH, and we've run about, approaching a hundred of these now, we're seeing all kinds of things all over the map.  We're seeing high cortisol, we're seeing low cortisol, we're seeing people that produce a lot of cortisol but clear it very well.  The most common pattern that we see is that people don't produce a lot of cortisol, like it's quite low total, but then they have sluggish metabolism of cortisol, and so, overall the cortisol looks normal.  So, it's just giving me a much deeper picture and is allowing me to understand much better what's going on inside of the person versus the traditional saliva test.

Ben:  Okay.  Gotcha.  So when you do a saliva test, it's only showing part of the hormones that are available.  So in the case of cortisol, you've got the free cortisol, but that's only a very, very, small, small, amount of the total amount of cortisol that your adrenal glands are actually producing?

Chris:  That's correct.

Ben:  Okay.  But when you do a urine test, it's like a combination of both the blood test and the saliva test in terms of telling you both the free and the total cortisol?

Chris:  Yeah.  That's right.  Exactly.  So you were always able to measure the metabolites in urine, but then you lost the circadian rhythm part, right.  So when you go do a blood test, the only, you only get one marker, right?  You go to Quest, or you go LabCorp, and they [0:29:32] ______ , you're only gonna get one marker.  So you're only gonna know what's happened to cortisol first thing in the morning, probably.

And so the saliva test was an improvement on that because you've got four readings.  It was easy for you to spit into a tube four times during one day, and because cortisol follows the circadian rhythm, that was useful information.  Now the urinary metabolites test, you were always able to measure some of these metabolites and see cortisone as well as cortisol, but the problem was it was a 24 hour urine collection, and so you would lose the circadian rhythm part.  And so what the DUTCH test does is it combines the best of all of those worlds into one test that's super easy to do.

Ben:  Okay.  Got it.  So basically when I've, when I've tested before, like all tests through, say, WellnessFX, which is one of the testing services that I use for blood testing, I drive into the lab with my little requisition form, and I hand that in, and they draw my blood, couple of weeks later, or a week later, I get a little printout and a dashboard where I can go and look through all my values.  But when I see the cortisol, all that's showing me is whatever my cortisol was in the morning, not what it was the rest of the day.  And so the saliva, the next level up, that tells you four different measurements, but the problem with that is it only tells you free, not total, and then you enter the urine test where it just tells you everything. 

Chris:  Exactly.

Ben:  Okay.  Gotcha.  So, I think probably the best way to go through what exactly, you know, a test like this actually looks like, at the risk of opening myself up to extreme embarrassment, I actually have the results of my tests.  Like I mentioned, I peed five times on a strip, about a week later, you emailed me with the results, Chris, and they were a little bit shocking to me, frankly, when you sent them over, and I'm going to put them and make them available for anybody who wants to look at them, or download them, or stock my urine over at bengreenfieldfitness.com/dutch. That's bengreenfieldfitness.com slash D-U-T-C-H, if you wanna download this, or if you're listening and you're a visual person, and you want to kind of look at it as Chris walks me through it, but Chris I have these results pulled up in front of me in terms of everything that the DUTCH test actually shows and I'd love it if we could go ahead and, for the listeners, walk through these results as an example of how to interpret the tests and how to use the test.

Chris:  Sure.  Yeah, your case was very special.  We've not seen…

Ben:  Special?

Chris:  So I say special, we'd not seen very many of these, like I say, we've only seen, you know, between 75 to 100, I think it is, and we'd never seen one like this.  And so Dr. Tommy Wood is a medical doctor and a PhD. fellow that I work with on an ongoing basis all the time where we chat all day long, and I also have some other doctors that have I access to and Dr. Brian Walsh, who I hope is gonna be on a future podcast, 'cause he is the neuroendocrine wizard that has to tell you about adrenal fatigue.  He's an amazing guy.  He helps me with your results as well because we've never seen anything quite like it, and one of the first things that we wanted to do was rule out a condition called Cushing's disease where you see extremely high levels of cortisol because that's the first observation that we made, was that your cortisol was really high.

Ben:  Well that's what shocked me, was it not just really high, but like off the charts.  Like there's a little ticker that shows cortisol levels and there's like low, low normal, and normal, and high, and then there's me and I'm just like, you know, breaking the thermometer.

Chris:  Right.  So Martin Newman has done a really, I would say this is one of his areas of strength, is his ability to visualize this data in defined reference ranges, you know.  He told me in my podcast that he'd seen over a million saliva results released.  He had access to those in the database and he really knows how to define a reference range.  And then not only that, the reference ranges on the DUTCH, they're adjusted according to the supplements that you're taking, which I think is super cool.  So if you're doing…

Ben:  Now what does that mean?

Chris:  I'm sorry.  I mean if you're on some sort of hormone replacement therapy, then he adjusts the reference ranges accordingly.  And then on these little speedometers, they are, you know, there's an age-adjusted reference range.

Ben:  Okay.  Gotcha.

Chris:  But the most important thing, I think, is the, you know, you don't just take just the average.  So when they took at a blood chemistry, they just take, you know, 7,000 random results, and then calculate their ranges being two standard deviations either side of the mean.  And, of course, what kind of person goes to do a blood test ordinarily?  It's not someone like you, who's interested in performance and longevity, it's someone who's not feeling good.  And so if you define your reference range around people who are not feeling good, you end up with a really weird reference range.  That's typically very wide.  So Martin Newman has done a fantastic job of defining these reference ranges and he's created this visual indicator that looks a bit like a speedometer.  And you can see there's two yellow stars either side of the speedometer, and then the little red arrow indicates your level, and you can see for the total cortisol production, and the 24 hour free cortisol are both extremely high.  So not only are you making a lot of cortisol, it's also hanging around.  Like you're not clearing it that well.  So, you know, the overall picture is of a lot of cortisol. 

Ben:  Now in some cases, for example, from what I understand, you could not be making a lot of cortisol, but it wouldn't actually be getting cleared very quickly, and so you could show as having high cortisol even if you weren't producing that much cortisol.  Is that correct?

Chris:  That's right.  Yes.  And we see that quite a lot.  So someone who's not making a lot of cortisol, so the total output from adrenal glands is quite low, but then you still see high free cortisol and that's usually because the, either the liver is not clearing it very well and that's because of hypothyroidism, and so that's a really, really common kind of pattern that we see amongst the athletes that we test.

Ben:  And if that were the case, if someone went out and then got a blood test, they would test for, they would test and it would, the test would show, what would it be?  High cortisol even though their cortisol is actually low?

Chris:  Yeah.  Normally, it's still within the normal range, but the total cortisol output, so you see where you're a, you know, 8,400s, that would be much closer to the bottom of the range for the metabolized cortisol.  So they'd be down at like, you know, 3,000 down.

Ben:  And they would be under the impression that their adrenal glands were working just fine, when in fact their adrenal glands were not producing much cortisol, or as much cortisol as would be ideal, because cortisol is basically being, or not being cleared very quickly.  So they're showing on their test results as normal or slightly high cortisol, when in fact cortisol production is not that great?

Chris:  Yeah.  Exactly.  So you've got two problems that when you do the full accounting, and they kinda net out to produce what looks like a normal result.

Ben:  Okay.  Gotcha.  So in terms of this whole like free versus total cortisol, can you explain a little bit more, with a hormone like this, you know, like cortisol why that is?  Why there's free, and why there's total, and what it is about cortisol that makes some of it free and some of it total?

Chris:  I’m sure.  So when adrenal glands make cortisol, they circulate, carried by a carrier protein which is the only cortisol-binding globulin and then [0:37:12] ______ .  And so that's kind of a protective measure, you know.  Like cortisol is an extremely potent hormone, and so your body needs mechanisms by which to regulate the activity of cortisol, and so having this free and bound versions of the hormone is a way for your body to control that.  And then, in addition, there's these two forms: cortisol and cortisone, and cortisol is deactivated into cortisone primarily in the kidneys, and so that's the secondary way by which you can, your body can regulate the cortisol.

And so the DUTCH test is pretty cool because it looks not just at cortisol which is the free and active fraction, it looks at cortisone which is the, the, the inactive form, and so you get this kind of secondary look at cortisol.  So you can think of cortisone as being like a shadow of the cortisol, and so, you know, with these two markers, you can kind of confirm what you thought you knew from the cortisol and you can see that's very clearly the case.  You have not just high cortisol, but also high cortisone.  You can see that you're above the reference range for both of those hormones.

Ben:  Okay, okay.  Gotcha.  So, basically, it all comes down to: you can make up a bunch of total cortisol and if it's bound to this carrier protein, then some of the cortisol would basically not be free.

Chris:  Exactly.

Ben:  So it's similar to testosterone?  Like if you can make a certain amount of testosterone and then, how, and that would be your total testosterone, and I see this a lot of times in folks, they'll have high sex hormone-binding globulin, and so that will bind the total testosterone, and while their testosterone production is fine, there's very little of it that's actually free because it's bound to this sex hormone- binding globulin.

Chris:  Right.  Exactly.  So it's like the hormone is traveling on a bus, and if it's on the bus, then it can't go through the cellular membrane and get to the nucleus and actually make changes inside of the cell.  It has to get off the bus first.

Ben:  Okay.  So only a free hormone is able to pass like through a cell membrane, is able to bind to a receptor, and is able to actually act on a system.  Whereas if it's bound to a protein, like, you know, in the case of testosterone, sex hormone-binding globulin, or in the case of cortisol, you know, something like cortisol-binding globulin, it's not really doing what it should be doing. 

Chris:  Exactly.

Ben:  Okay.  Gotcha.  In terms of other things that you see in my test, I know we wanna delve into cortisol a little bit more intensively because I really wanna ask you a little bit about, you know, things that could cause high cortisol and talk to you a bit about that, what are some of the other things that this test shows?  ‘Cause obviously the test tests for more than cortisol.

Chris:  Right, yeah.  No, it gets really good, it only gets more complicated from there.  If we, if we've lost you already, it's not gonna get any better.

Ben:  Oh, our listeners are smart cookies.  They’ll get it.  Yeah.

Chris:  I know that already ‘cause I've been working with hundreds of them over the last couple of years.  Yeah, they're really great.  I mean, that's kind of, the reason I love them is you give them a little bit of information, like I'll give someone one of these DUTCH reports, and then they'll come back and report back to me and teach me something new about it.  That's just the way they are.  They're just awesome, awesome investigators.  They're just so much fun to work with.

Ben:  It's because so many of them exercise.  They produce lots of brain-derived nootrophic factor.

Chris:  That's awesome.  Yes, if you scroll down to page three, there's a lot more of these knobs and dials, and so it looks like this big dashboard, and what you're looking at is this steroids hormone hierarchy plotted out and then where the metabolites are measured on the DUTCH tests, you get a reading.  So you can see that DHEA is on there and the metabolites of DHEA.  So that includes testosterone, the free testosterone, and then also etiocholanolone, and androsterone.

So those are the two most abundant metabolites of DHA, and you can see the, your total DHEA production is actually pretty good.  So this is kind of uh, you can think if this as being uh, you know, anabolic vs. catabolic ratio, right.  So cortisol being a catabolic hormone that breaks things down and then DHEA eventually becomes things which are anabolic and build things up, and that's kind of a gross oversimplification, but it's broadly correct.  And you can see your total DHA production is actually not bad, it's in the upper end of the reference range.  So it seems like your adrenal glands are just, they're just really pump out everything, you know.

Ben:  Yeah!  I noticed that!  Like, you know, on a range of 1,000 to 5,000, you know, for an ideal range of 1,000 to 5,000, my total DHEA, you know, these anabolic hormones, they're at 4,100, between 1,000 and 5,500.  Like we mentioned, cortisol, you know, the ideal range tops out there at around 7,000, but I'm way up at 8,400, so I'm, like you said it, seems that my adrenal glands are working, they're pumping out stuff and possibly, in the case of cortisol, too much of what they should be pumping out.  What other things, aside from these DHEA anabolic hormones and also the cortisol, are we looking at on this test here?

Chris:  Yes.  So as you go down and to the left on page three, you'll see these two metabolites of DHA and the reason, these are interesting for both men and women because…

Ben:  Oh, actually, could I interrupt you real quick?

Chris:  Sure.

Ben:  Just to make sure folks understand, when you say metabolites of a hormone, what exactly does that refer to?

Chris:  It just means there's a hierarchy of things.  So imagine a waterfall, you know, like things that you put in this, it's pregnenolone at the top of the tree, right.  So that's the water going into your, into the top of the hierarchy.  And then each time the metabolite, the water flows over a step, it converts into another steroid hormone.  And so it's a downstream metabolite of pregnenolone, it's just one further step away from the root of the tree or the top of the waterfall.

Ben:  Okay, I get you.  So a metabolite would just be almost like a breakdown byproduct of a certain hormone, or a downstream product created after a hormone is initially created?

Chris:  Exactly.  Exactly.

Ben:  Okay.  Gotcha.

Chris: And then, so, you know, this conversion, it takes place using an enzyme and there's two kind of categories of enzymes, and there's a 5-alpha pathway and a beta pathway, and 5-alpha pathway is the most potent androgen, right.  So this is interesting for both men and women.  So if you're a woman and you're taking what DHA you have and you're sending it down this really potent alpha pathway, that can, and you can, it's not black and white, you know.  You have to consider the whole picture, but that can lead to things like thinning scalp hair, your facial acne, those types of problems.  And then, you know, the same is true for men to a certain extent.  You get the thinning scalp hair, but then also the 5-alpha, the DHT, which of course has been talked about many times in the podcast, that's also a factor for prostate health.  So this is kind of a cool way for you to, like find out where your androgens are going.

Ben:  Okay.  So, so in my case, let's use an example.  For example, it shows that, you know, in terms of androgen metabolism, the breakdown of all the different androgens I'm making, something like DHEA appears to be just fine, within range, and then there's, there are others like, say, androsterone which is another byproduct of androgen metabolism, that one shows at the low end of the range.  Now in a case like that, is this something where you will simply talk to someone and give them like recommendations in terms of what to do if certain metabolites are out of range? Or does this give you clues about what you need to do as far as the upstream metabolite?  You know, in this case something like DHEA production.

Chris:  Yes.  So it's interesting to know in which direction you're headed because, let's say you're a guy in your 50s and you're concerned about your prostate health and you were taking some sort of hormone replacement therapy, then you'd want to know where that testosterone is going because there's things you can do, like there's supplements like saw palmetto, and even zinc, can block the 5-alpha pathway, and could send that testosterone down a less androgenic pathway, which could potentially be better for your long term health.

Ben:  Okay.  Gotcha.  Now in my particular results, when you look at them, what would leap out to you as things that, you know, aside from the cortisol which we're gonna talk about, as things that you would remark upon or that you would find interesting?  So that people can kind of get an idea here of some of the things that you would actually make a recommendation on when you look at some of these metabolites, some of these more detailed, you know, hormone byproducts?

Chris:  Sure!  Yes.  So the estrogen metabolism is interesting for you because, I think overall, your estrogens are really quite low and, like most things in physiology, less it not always better.

Ben:  That means I'm not gonna get man boobs, Chris.

Chris:  (laughs) You're definitely not gonna get man boobs, but, you know, I can show you some studies that show estradiol improves insulin sensitivity.  So lower is not always better, right.  It's very, the context matters and so you don't want to just, it'd be wrong to make a general recommendation that everybody should start taking DIMs.  So probably most people listen to this know that I3C and DIM are supplements that you can take that lower estrogen.

Ben:  Yeah.  They are aromatase inhibitors.

Chris:  Aromatase inhibitors!  Right.  So that might, that, you really need to know exactly where you stand before you start trying to fix things.

Ben:  Okay.  Gotcha.  So in a case like this, if someone were, say, taking an aromatase inhibitor, you would say, “Well, you may want to think twice about that because, you know, you're already showing that, perhaps, you're not producing enough estrogen, or at least you don't have enough estrogen circulating, and that might not do you any favors even though you've heard that, you know, you should take it if you don't want to keep testosterone from getting converted into estrogens,” or something like that?

Chris:  Yeah.  Exactly.  So I always think, you know there's very few supplements that I would take without doing a test to like figure out whether or not they're right for you, you know.  We missed some good general recommendations, just a few, but for the most part, you want to, you want to figure out where you are and, you know, obviously the estrogens are very interesting for the women and, actually for both genders, there's one metabolite that's measured on this test.  It's called 4-hydroxy-E1, and 4-hydroxy-E1, it can actually bind and damage DNA and so it's a cancer risk.  It can be implicated in breast cancer and endometrial cancer and so, again if you're a woman taking some sort of human replacement therapy, then you want to know where that estradiol is going.  Like is it going towards this dangerous 4-methoxy-E1?  And the only way you can really know that is to do this test.

Ben:  Now, let's say that a woman were taking some kind of a natural hormone replacement and she found out that some of it was going towards the, or being converted into the type of estrogens that would cause DNA damage.  Are there things that you can do to keep some of the more damaging estrogens at bay?  Or is this something in which someone might be just genetically predisposed, and so they may need to find a different solution than, say, like a natural hormone replacement therapy?

Chris:  Yeah. I think so for the most part, I think it's about dosing and there is a protective pathway here.  So ideally, you would send the E1, the estrone, down this protective pathway towards 2-hydroxy-E1.  So that's also measured on the DUTCH and that's Phase Two, so everything we've been talking about so far has been Phase One metabolism, and then Phase Two would be methylation that converts the 2-hydroxy-E1 into 2-methoxy-E1, and that's the protective pathway.

That's what you want the estrogen to go, but the problem is that a lot of people who, you and me included, stink at methylation, right.  So the cool thing about the DUTCH test, and you can see how far beyond what the original saliva test, you know, this point, it's like it makes sense to kind of stop and look back and see how much more information we have versus the saliva test, but the DUTCH test, on top of everything we've already been talking about, it also measures your methylation status, right.  So your ability to convert the 2-hydroxy-E1 into 2-methoxy-E1 shows how good you are at methylating, and as you can see from the dial on your result that the methylation activity is really low.

Ben:  So when people are talking about being a poor methylator, this would be an example of that?

Chris:  Uhmm.

Ben:  Okay.

Chris:  It's actually, so we look at this on other, like the organic acids, for example.  Like we would have other markers we look like at [0:50:27] ______so formerly glutamate is one, and then methylmalonic acid are other markers that can show methylation status.  And then also just on a simple CBC. on your blood chemistry, like we've seen on yours, that the mean corpuscular volume, the MCV, is somewhat elevated.

So that means your red blood cells are a little bit bigger than we would expect and it's not a true pathology, right.  It's not something that's gonna make you ill or anything, but it just hints that there may be a relative folate deficiency.  And so that story has is kind of been confirmed with what we've seen here on the DUTCH and so, you know, you might want to consider.  I mean, I'm sure you've done the 23andMe genetic test, so look at some of the genetic variants, particular MTHFR and COMT, and then think about increasing your consumption of some of the metal donors, so that'd be things like SAM-e , the methylated B vitamins, folate, that type of thing.

Ben:  So like the tetra, or the methytetrahydofolate that you'd find in a, like a good multi-vitamin, like not the synthetic folic acid form, but something like MTHFR would be something that someone like me would want to think about taking?

Chris: Yeah, that's what I would do.  That's the safest bet.  I mean, I think you really have to dive into the genetics to know for sure whether you can handle folic acid, but, you know, I don't think the folic acid should be on the shelf at this point, right.  You just wanna see the good stuff and, if you're taking a really good quality multivitamin like the Thorne Thorne Multivitamin Elite, that includes the right type of folate that you're looking for.

Ben:  Yeah.  It's kinda interesting that leading up 'til this, to this test, I actually quit taking multivitamins for a little while, but then I had just started into it recently, going into the test, and so I'm curious whether or not that's gonna make an effect or not.  After seeing these test results I started right back on to that, but you said there were some other things like B vitamins, and choline, and SAM-e, and something, you also mentioned something called TMG. What is this?

Chris:  Yeah.  Trimethylglycine.  So these are all just methyl donors.  So something that can donate the methyl group.

Ben:  By the way, for those of you whose heads are spinning, don't worry I'm putting information about all of this in the show notes.  So, I know that for those who might be out, maybe swimming, or biking, or running, or lifting right now, this one's kind of a head spinner.

So, Chris, anything else in terms of, before we delve into like the cortisol issue, that you would say leaps out on this particular test?

Chris:  Sure.  So this test measures melatonin and, obviously, melatonin is interesting for anyone that's trying to get better sleep and we saw the, your melatonin was just off the charts high.  So the range is 10 to 50, and yours is 764.

Ben:  Yeah.  I saw that.  It was enormously high.

Chris:  So the reason for that is because you're taking oral melatonin, so there's a teeny, tiny little bit of melatonin in Doc Parsley's sleep cocktail.

Ben:  Yeah.  Very, very, it's like a micro dose and that would be enough to shove this way up, huh?

Chris:  Yeah.  So what's going on here, it's kind of interesting the way that this test work, it's not measuring melatonin per se, it's measuring this 6-hydroxymelatonin sulfate, which is a metabolite of melatonin.  And what it represents, what the number represents is how much melatonin you made overnight and when you take oral melatonin, it's conjugated and then excreted in the urine without ever being in circulation.  So it doesn't matter how much melatonin, oral melatonin you take, it just totally messes up the test.  Like it's, the metabolite that's made in the gut that never enters circulation is very, very similar to the analyte that they're trying to measure on the test.  And so, you know, if you're doing this test, I would, you know, wait as long as possible, maybe a week or so, from taking oral melatonin if you want to get a true picture of how much melatonin you're making overnight.

Ben:  Right.  And if you're having trouble sleeping, for example, and you weren't using melatonin, this test would give you a good example of whether or not your lack of proper sleep might be due to insufficient melatonin production?

Chris:  Yeah.  Absolutely.  So that's, you know, always the first thing I start with when looking for solutions is with the sleep.  Is there a disrupted circadian rhythm?  Is the person not making a lot of melatonin because they're blocking it, right, with the blue light, or activity, or something else.

Ben:  Right.  Okay.  Cool.  This is so interesting.  This is probably the most detailed we've ever delved into a lab test on a podcast.

Chris:  It's a lot of ups and downs, but I know people love it.  Like half the people listening to this are people like me who are practitioners, and health coaches, and maybe there's even some endocrinologists that are I thinking, “Well, crap. I'm running blood tests, still.  Maybe I need to look at this test.”   

Ben:  Yeah.  I'll be sending this to some physicians I know for sure.  So here's the deal, Chris. I feel freaking awesome.  I sleep amazingly, and I feel good during the day, and I have great relationships, and my life is relatively low-stress.  I mean, even though I do, you know, work a fair amount, I'm spinning a lot of plates, you know, I start my day with deep breathing, and yoga, and a little bit of sauna.  You know, like I mentioned, you know, today I spent, you know, an hour in a Turkish bath just breathing, and, you know, I've got, friends and a good lack of loneliness in my life, and, generally, when it comes to everything from gratitude practice, to deep breathing, to good spiritual connections, to, you know, frequent sex, to just like everything that you'd expect in someone if you expected them to have normal cortisol, that's me.

However, my cortisol is, as we've outlined, off the charts.  So, in terms of cortisol being off the charts, you know, in someone who's, maybe not a, you know, a glaringly super high-stress individual, first of all, I'd like to hear just your general thoughts on this.

Chris:  Yes.  So there's a very interesting philosophical question to be asked here and that's, you know, if you're feeling okay, are you okay?  Do you want to like try and create some artificial illness just because you ran a test?  Like I'm not sure I have the answer to that, but for me personally, it's a really personal question you have to ask yourself, I think.  And, for me personally, I've gotten great results by chasing after these things on the test results, even though I feel good.  You know, something must still be…

Ben:  Well, yeah.  And we, we talked about that in the previous podcast episode with you, you know, and folks, go back and listen to podcasts with Chris if you wanna hear his whole story, but he had some really, really serious adrenal issues that he wound up fixing by doing lots of testing and lots of targeted, you know, nutrient, and supplementation, and lifestyle changes due to that testing.  So, you know, I know we probably don't even have time to delve into your entire back story, Chris, but, you know, I think one thing you explained to me before we got on this podcast was, even though I feel like a million bucks with my cortisol high, there are some issues if I allow that to remain to be high, right?

Chris:  Yeah, exactly.  So we know the long term exposure to cortisol damages the cells in the hippocampus, so you may have trouble forming the long term memories.  So this is super interesting and I'd really highly recommend the book “Why Zebras Don't Get Ulcers” by Robert Sapolsky, who is a professor of biology and neurology at Stanford University.  It's one of the coolest books I’ve ever read and, yeah, he goes into the details….

Ben:  Why Zebras Don't Get Ulcers?

Chris:  Why Zebras, sorry.  I said Zebras, didn't I?

Ben:  Oh, you did says Zebras.  I wasn't even gonna say anything, I was, I figured our UK listeners would get annoyed at me if I brought it up again, but.  Okay, so “Why Zebras Don't Get Ulcers.”

Chris:  Yeah.  Exactly.  So, I think in this instance, it makes sense.  So one of the things I really hate are mysteries.  It was kind of like our motto, or one of the things, one of the rules by which we live by at the hedge fund is we just don't have mysteries, right.  So if something goes wrong, and this happens all the time with computers, a lot people listen to this will relate to this, that, you know, you get a hiccup, when something goes wrong with your computer, and then, two seconds later, it's fine again.

But in the world of hedge funds and trading, right, that could mean you could lose a million Dollars in a minute, right, and if you don't understand what went wrong then, there's a really good chance that's gonna come back and bite you even harder in the future.  And so we just don't have mysteries, right.  Nothing is left to be unknown and so, certainly, if this was my result, I would want to keep digging because it doesn't make any sense, like what you've told me.  You're implementing all of the diet and lifestyle factors, the control, the output of cortisol, and yet still it's high.  And so you have to ask this question, you know, why?  We know it's not good.  High cortisol decreases protein synthesis, and proteolysis, and bone degradation.  So it's really not good.  You need to figure this out.

Ben:  Okay.  Now what else can high cortisol do if chronically high?

Chris:  Well, you know, so one of the things I'm worried about is it may increase your chances of getting diabetes in the future, right.  So you think what does cortisol do?  It's a glucocorticoid that's primary purpose is to raise blood glucose, and so we've seen a little bit on your blood chemistry, [1:00:03] ______ , you know, a really good high fat, low carb diet, and still you have some more elevated fasting glucose, and so, you have to ask this question, is that because of the cortisol, you know, is that what's happening?  And so, you know, maybe that could be causing some degree of insulin resistance that could increase your chances of getting type II diabetes in the future and it's all because, the root of the problem was this cortisol thing.

Ben:  Which is concerning to me because I've done genetic testing and I do carry the gene that puts me at higher risk for type II diabetes, and I've always wondered, because when I get my blood tests, they've always shown like slightly high cortisol, but also much higher glucose than you would expect to see.  Now, now we're talking, when I say high glucose, we're talking like 90, 95 right.  Not off the charts, but…

Chris:  A smidge high.

Ben:  Yeah, but high enough to show that there is, you know, like you alluded to, perhaps the liver is breaking down glycogen and shoving it as glucose into the bloodstream due to a cortisol response.  So, yeah, that's certainly concerning to me.  What else?  What else can chronically high cortisol do?

Chris:  Well, there is a big factor with the thyroid here, right.  So with high cortisol, less T3.  So T3 is the active form of thyroid hormone.  Less T3 is made peripherally, but more is made centrally.  So the brain doesn't know that the tissues aren't getting T3.  Does that makes sense?  So what happens is you see normal TSH, so TSH is the main signaling hormone that goes from the brain to the thyroid glands, and then the active form of the hormone is T3, and the brain doesn't recognize, there isn't enough.  And so you see low levels of free T3, and normal TSH, and then in addition to that, your brain can also make reverse T3, which is like putting on the brakes on your thyroid.  So you might see, you know, I mean thyroid does everything, right, that controls the rate of cellular metabolism, and pretty much everything inside your body.  Super important hormone, and so the cortisone can mess that up too, and, you know, I know that you've had issues with that in the past, and so that's another concern that, that may be downstream of the cortisol.

Ben:  I've also heard that hypercortisolism due to the body being under the impression that it stressed and almost due to like this ancestral mechanism to have us not want to make babies when or stressed can also potentially bind up some total testosterone, and keep it from being converted into free testosterone, almost like a link between hypercortisolism and this, this sex hormone-binding globulin.  Are you familiar with that at all?  Or do you know if that could also be an issue, just overall, you know, fertility or drive if left chronically high?

Chris:  Yeah, I've not heard of that exact mechanism, but it totally makes sense when you think about this thing in terms of long term building projects, right.  So cortisol is the most important stress hormone and so in, as far as your brain is concerned, you're, you know, you're being chased by a tiger or the house is on fire, so you're producing a lot of the stress hormone cortisol, and so any kind of long term building projects goes on hold, and that includes digestion, includes immunity, includes making new memories, includes making babies.  Like why would your body do that if you're being chased by a tiger?  Like it just doesn't make sense.  So, you know, that's why I think the cortisol is really good to try and pin down and understand.

Ben:  Yeah.  Yeah, and it's really strange for me because, you know, like I mentioned, my blood pressure is low and most people that hang out with me don't, you know, they find me to be one of those guys who'd rather charge up in the mountains with a heavy backpack and an elevation training mask on, than sit around on the back porch and just chill, but at the same time I've got low blood pressure, I've got high drive, you know, low resting heart rate, fantastic sleep rhythm, etcetera.  So, I'm curious.

Based on my lifestyle, you know, at least some of the glaringly obvious things that may elevate cortisol based on my lifestyle, what are some things that you think, you know, in a case where somebody, a listener or someone like me, has high cortisol, chronically high cortisol, but is doing everything right, you know, as far as like stress control, and sleep, and good recovery, and Turkish baths, and stevia-flavored soda, and all these big ass salads from Whole Foods, what are some things that could elevate cortisol if somebody is already doing everything right?

Chris:  So, this is where Phil Maffetone has been so helpful for me in understanding this stuff is, and then you have to question whether you're doing it right or not.  Like you think about what we've just been talking about, a 12 hour obstacle race, and it's an amazing feat, and it demands absolute respect that you were able to do that, but does it, is it really doing everything right, you know?  And I know the, you know, you take an approach to your training which is less volume and lots of intensity.  Well, we know that that is the sort of thing that would raise cortisol too.  And then I was listening to your podcast this morning, and there's the, I've totally forgotten the person you were interviewing, I'm sorry about that, but the crabs in the bucket is just so memorable, you know.  Just the idea of you being out there, in front of everybody, this huge audience.

Ben:  My interview with Craig Ballantyne.

Chris:  Craig Ballantyne!  The crabs in the bucket!  So you'd better tell the crabs in the bucket story else no one's gonna know what I'm talking about.

Ben:  Okay.  So you do need to go listen to the podcast episode…

Chris:  That was a great episode.

Ben:  …with Craig.  It's basically his perfect day.  Like how to put together the perfect day, and there's this, I'm trying to remember the exact way the story goes, but it's basically more or less this guy, and he is, he's walking on the beach and he finds us other guy fishing with a bait bucket, and he comes up and he sees that the bait bucket doesn't have a lid, but it has a bunch of crabs inside, and he asked the guy why doesn't he cover the bucket so the crabs won't escape.  And the guy tells him, “Well, if there's one crab in the bucket, it would crawl out and escape, but when there's a whole bunch in the bucket, if one of them tries to crawl and escape, the other crabs grab a hold of it and pull it back down,” so it'll kinda like share the same fate as the rest of the crabs.  And the idea behind it was that it's the same with people, if you try to do something different, like, you know, get better grades, or a better job, or improve yourself, or escape your environment or, you know, dream big dreams, or whatever the other people might try to drag you back down to share their fate, and that was kind of the basics of the story.

Chris:  Yeah.  So my point here is the, you know, Ben Greenfield, you're kind of on a pedestal here, right.  You're that crab trying to get out of the bucket and, maybe, we're, your audience, like kind of a little bit resentful of that and, you know, we're pulling you back and, and there's this pressure on you to constantly be perfect, and another example of that, I hear you talking about on the podcast, is, you know, somebody asks question like, “What can I do when I'm gonna spend a lot of times in a seated position in a car when I commute?”  And you talk about all the things that you do, and I wonder, “Blimey.  That is a lot stuff for you, you know, to be remembering and doing all the time…”

Ben:  See, see, for me though, to have like a hand grip strengthening device, and a little power lung, and some rows, and like hypoxia, to do all that while I'm driving, it's all habit.  It's totally like nothing about that feels like I'm running from a lion when I'm just like making a drive more interesting and better for my body, and I see where you're going with this, you know, in terms of their potentially being like hidden, or something I'm not aware of driving cortisol, and I mentioned this to my wife, I was talking about this test with her and I'm like, “Maybe I don't, I've never known what it is to be truly relaxed,” or to truly have low cortisol because I'll be, and again, like opening the kimono here, you know, I took 25 credits per semester for four years in college while working three jobs simultaneously, and I was just how I lived, and that was, you know, what I enjoyed.  I worked at the pub at night, I worked at the bakery in the morning, worked as a personal trainer during the day, and then took classes in between all those times.  You know, and I obviously, you know, run multiple businesses now and do podcasting, and write books and, you know, mess around with a lot of other hobbies while still spending time with my kids.  It's, I feel like I do fill every day quite full, but that's something I've always done.  I don't have anything to compare that to, really, like not being driven.  So, you know, part of it is that I feel like I'm a little bit hard wired to be driven, but, you know, like I keep mentioning at the same time, I just feel so relaxed and so good and so I'm curious, you know, not to kick this horse too much to death, I'm curious if we move on and look at a few other lifestyle factors, there are other things I've wondered about, you know.

For example, I've heard a little bit about ketosis, and how there is some sort of biochemical mechanism with ketosis that may show that you have high cortisol even if, what it really is is that ketosis keeps cortisol from being broken down quickly.  There's something about a lack of blood glucose that keeps cortisol from being broken down quickly.  Do you know what I'm alluding to here?

Chris:  Yeah, I do.  So, you know, insulin is one of the things that tips the balance more towards cortisol which, remember, we said was the active fraction of the hormone and away from cortisone.  Right?  But in most cases, I think this is reversing a pathology, right.  So when you've got someone who's severely insulin resistant, they've got tons of insulin flying around, they have massively upregulated cortisol clearance, that paradoxically outweighs the additional cortisol production, and so, what you end up with is low free cortisol on one of these tests.

So the ketosis thing, I think if anything, it's actually reversing a pathology by reducing the amount of insulin that's going around rather than causing a problem, but there are some, you know, so there's some other studies that have been kicking around that show that the ketogenic diet increases cortisol, but when you look at them, they're all junk.  Like we took, you know, 8 obese, untrained men and who were eating a high carb diet, and then we just took away the carbs and gave them tons of fat, and it wasn't even tons of fat, it was 60% or, sorry, 40% protein, so it was a terrible diet, and then we saw an increase in cortisol.  And so the studies are just really awful.

So if anyone's listening to this that knows of a study, the ketosis or a ketogenic diet can somehow increase cortisol production, then we'd love to see it because, you know, Tommy, as I said is, does peer review for a living and spent a lot of time looking for something that would answer this question, and we can't find anything at all.

Ben:  Interesting.  Okay.  So, it's basically bunk that an extremely low carbohydrate, high fat diet might, through some sort of biochemical mechanism, directly decrease the rate at which cortisol breaks down or increase cortisol production, it would appear.  But what about this idea that your body, if you were doing heavy and hard training, might want to actually mobilize more blood glucose because there isn't a lot of, say, like endogenous glycogen, or glucose availability, and do so by churning out a bunch of cortisol to get the liver to release glycogen because you have a combination of a low carb diet and high intensity training, which would actually define me.

Chris:  Right.  So, I mean this is just the normal physiological response to high intensity exercise, is it not?  It's not really to do with carbohydrate availability.  I mean, so cortisol liberates free fatty acids as well as the glycogen.  And so, if you do high intensity exercise, you're gonna see raised cortisol, but that should return to normal once you return to a normal energy…

Ben:  I was gonna say, on a test like this where you have like multiple measurements throughout the day, you wouldn't see it high all day as it is on mine, correct?

Chris:  Yeah.  No, exactly.  So you're cranking out a ton of cortisol and the cortisone is high, so the shadow of cortisol is high.  So it's not like a single week, so I have seen that before, you know, I've done, not quite split test, but I've done two saliva tests on the same person on two subsequent days, and on the second day, they went into the crossfit workout in the afternoon, and you can see a clear spike in the free cortisol, but that's not what we're seeing here, it's not like a spike.  It's like every single value is high.  So it doesn't make a lot sense.

Ben:  Yeah.  Especially in light of the fact that I do cyclic ketosis, meaning that at the end of just about every day, I typically am consuming 100 to 200 grams of carbohydrate from red wine and, just a glass of red wine, by the way, should, lest you suspect that alcohol might be driving cortisol production.  You know, a little bit of rice, or quinoa, or amaranth, or millet, a little sweet potato, a little yam, you know, these type of things and so, you know, I am restoring much of my muscle and liver glycogen levels to the point where I wouldn't say that I'm one of those people who's in like a state of constant glycogen depletion, for example.

Chris:  Right, right.

Ben:  Now one other question I wanted to ask you before turning to, you know, the potential for supplements, or herbs, or something like that to increase cortisol, since sleep is good, I know that sleep can cause a high cortisol, but my sleep, and I recently wrote a post on this, my sleep is fantastic, you know.  Eight to nine hours of sleep per 24 hour sleep cycle and I've, you know, I've measured it and it actually is true sleep, it's not just lying in bed, it's not just light sleep, it's like a, you know, a good cycle of non-rapid eye movement to rapid eye movement sleep using this ring that I'm actually using now to measure my sleep cycles.

What about infections?  Like are there things, 'cause we hear these days about everything from staph, to lyme, to all these things that can be like hiding in your bloodstream, well, you know, even parasites, things like that, can those potentially cause high cortisol levels even if you feel good?

Chris:  Yeah, absolutely.  And so we know that this was a potential reason, the investigation that we did, we were like kind of playing tennis with test results, you sending me more and more stuff from the ancient past and we were trying to figure out what might be causing this and, you sent me an old gut test that showed a parasitic infection called blastocystis hominis.

Ben:  Yeah, I came back from Thailand with that little gift one year, actually two years because I started to test my gut every time I'd come back from travel and swimming in nasty water doing triathlons and things like that, and twice I came back, you know, as recently as a couple years ago, with some nasty thing as living in my gut.  Some nasty critters on board.

Chris:  Right.  So, in theory, that could be a possibility, but when you talk to someone who is really experienced with this, so Dr. Brian Walsh who has, like I say, just been so helpful to me in teaching me over the last couple of years, he was not buying that at all. So blastocystis hominis, I mean, I think it does cause people problems, but it's one of the more controversial parasites that you see on a stool test, and there are actually researchers that are looking at this parasite and its role of promoting health.  So it's a, it's a really kind of wishy washy one, and I think the kind of, the stance on it should be like treat if you see symptoms and then if not, then you probably, you're not gonna get any benefit from treating it, and so that's certainly the case for you, right, like you don't have any symptoms.  So even if you were to do another stool test, it came back, and you found the blasto again, is this gonna be the, the cause of the high cortisol?  It seems unlikely.

Ben:  But for people listening in who maybe do have high cortisol and are kinda trying to solve these mysteries, it is possible that something like a gut test would be prudent to see if there's any like hidden parasites, or yeast, or fungus, or bacterial imbalances that could potentially be causing high cortisol because, what I understand, is that gut issues can directly cause the HPA axis to actually be producing more cortisol, like cytokines, and inflammation, and things like that can actually cause high cortisol, correct?

Chris:  Yeah, exactly.  So, you know, Brian is the man on this one and I don't want to go too deep into his story because he's gonna be able to tell it a lot better than I can.

Ben:  Yeah.  I have him scheduled to be a podcast guest to talk about some of these things.

Chris:  Yes!  I'm really, really excited about that.  But, yeah, so basically, some of these protein messengers, cytokines, they can stimulate the HPA axis into producing more cortisol, but typically that's more of an acute response, right.  So acutely, cortisol helps stimulate the immune system, but chronically it's immunosuppressive.  So there's this very, very delicate and complicated feedback loop that exists between the immune system and cortisol, or glucocorticoids, to stop the immune system from just, you know, frying your body, right.  You can turn up the cortisol, turn down the immune system, but it's so complicated and it's really, really interesting because, for me, I think it's the true cause of these cortisol dysregulation issues that we see on these tests, it's the immune system dummy.  Like it's not, the word adrenal fatigue, or the term adrenal fatigue, is just a gross oversimplification and I'm probably not a term that we should be using anymore, and so, yeah, it's definitely something I'll be looking forward to hearing from Brian.

Ben:  Yeah.  That'll be interesting and, you know, I know that there are also some other things that can affect cortisol.  You know, for example, on the podcast before, I've talked about like how licorice has like components in it that can decrease the half-life of cortisol, or cause it to stick around in the bloodstream longer, and that's actually something that, you know, I'll sometimes recommend to folks who have adrenal fatigue, like true adrenal fatigue, who aren't producing a lot of cortisol, you know.  Sometimes I've recommended red ginseng as another herb that can be used to increase cortisol if cortisol is too low, or even the use of like adaptogenic, like, Chinese herb complexes, but when it comes to supplements or herbs that could be increasing cortisol, you know, and I don't take licorice, I don't take red ginseng, I don't use any of these things I'd recommend to folks who produce low amounts of cortisol to increase their cortisol.

Are there other things that can increase cortisol?  Like, you know, I had mentioned alcohol and I'm certainly very, very low on the alcohol intake, but what I wanted to ask you about was coffee.  I know that coffee is a natural source of cortisol and, my dad was a gourmet coffee roaster starting from when I was 15 years old.  I've been a coffee aficionado since I was a teenager, you know, and I'm one of those guys who will, you know drink a good, you know, two to three cups of coffee in the morning and, you know, then I'll switch to decaf, and sometimes even throw in another one to two cups of decaf at some point during the day, drinking it like tea.  Well is there any link between coffee, and especially caffeine, and the potential to increase cortisol?

Chris:  Yes.  So it seems like most of the things, most of the supplements, or at least all of the ones that I know, they're not truly leading to a production, an increase in the production of cortisol, right.  So on the DUTCH test, you wouldn't see the total metabolized cortisol go up as a result of taking a supplement, unless you are sensitive to it, or something like that, you know, it's causing some sort of allergic reaction.  Like no supplements really do that.  All they do is interfere with the action of this enzyme which converts the active cortisol into the inactive cortisone.  So that enzyme is 11-beta hydroxysteroid dehydrigenase.  I love that.  It's a variable name what it is, what it is.  If you're a computer programmer like me, you'll appreciate that's a pretty good variable name that when you do a Google search for it, you'll find lots of information, and so that's how all of these things work.

So, glycerin is the active extract in the licorice, and then caffeine, and then there's some other things, what they do is they interfere with the action of that enzyme and they slow the conversion from cortisol into cortisones.  So, effectively, what you're doing is you're blunting the drop in the natural dropping in cortisol, right.  So first thing in the morning, you produce a lot of cortisol and that's supposed to naturally decline as the day goes on.  And so if you take caffeine, or licorice, or something else, you just inhibit that enzyme, and so the cortisol that you do make, it just ends up hanging around longer.

Ben:  Okay.  Gotcha.  So, a lot of these things are just causing cortisol not to break down quite as quickly.  Would that include caffeine?

Chris:  That includes caffeine.

Ben:  Okay.  So caffeine doesn't have some kind of natural cortisol analog in it, it's just causing the cortisol that you'd naturally be making anyway to not get broken down quite as quickly.

Chris:  That is my understanding.  Unless you have a sensitivity and then it could be, so then, if you have a sensitivity, if you have some kind of reaction to something, that's a stress, right?  As far as your brain is concerned, you're being chased by a tiger, and so that would lead to an increase in cortisol.  But my understanding with caffeine is it slows the breakdown of cortisol.

Ben:  So when we look at these studies, you even sent one over to me that shows that caffeinated coffee could prevent serum cortisol concentrations from falling, you know, when you look at that study at first glance, it would appear to be synonymous with saying that coffee increases cortisol production, but, in fact, all it's doing is taking the cortisol that you're making anyways, and just keeping it from getting broken down as quickly.

Chris:  Yeah, that's, and it's a really important distinction, you know, it's not, you're not making more cortisol, you're just slowing the production, the breakdown.

Ben:  And what this DUTCH test shows is that the coffee couldn't be an issue because I'm not just hanging out with a lot of free cortisol, but I'm churning out a bunch of cortisol naturally, like endogenously.

Chris:  Yeah.  Exactly.  So both markers are high.

Ben:  Right.  Okay.  Gotcha.  Another one that I wanted to ask you about, because I've seen links between it in cortisol, but typically the research that I've seen has shown a decrease in cortisol, especially when it comes to the cannabidiol component, would be marijuana or cannabidiol.  Now, like I mentioned, I take CBD almost every night, I swear by it, to help with sleep and I've, you know, I've written full articles and done podcasts about it and why and it's, you know, it's full legality around the world, etcetera.  So I won't kick this horse to death too much, but I want to dwell upon a little bit when it comes cortisol.  Do you know anything about the link between either CBD, or THC, and cortisol because I don't just take THC, and I'll occasionally, sometimes as much as like three to four nights per week, especially when I'm playing music, or I'm writing, I'll microdose with THC, meaning that, you know, some of these edibles will contain massive amounts of THC, but I'll use like two and a half to five milligrams of like a THC tincture that I make at home.  Would something like this affect cortisol, do you think?  Basically weed.

Chris:  Yes.  So it's the same mechanism, it's the same as the licorice route.  So we've got at least one study here that shows that both CBD and THC prevent that daytime drop in cortisol, but then we have another study that said the opposite, right.  It was kind of, it didn't see any difference in cortisol with the administration of CBD, so it's contentious and I wonder whether there's going to be like a lot of individual variability there, and maybe that's what's going on.  But it certainly seems to be working for you, like in terms of, I mean if that's what's giving you great sleep, then, you know, I would have thought that sleep is the highest priority.

Ben:  Oh, yeah.  Sleep, creativity, you know, good ukulele songs.  So there's really not much of a link between marijuana, or cannabidiol, and cortisol when it comes to anything beyond simply either decreasing the rate at which cortisol is broken down, because I have seen a couple of studies that shows that THC all by itself might actually increase cortisol, but it's the same as coffee, correct?

Chris:  Right, right.  And then, so Martin Newman, like, obviously, he pulled up a lot of research when he was developing this test, and included with each test result is this road map of the steroid hormone hierarchy, and he lists a whole bunch of things which affect the action of these enzymes that convert one hormone into another, and he's got chronic marijuana use listed under the decreased cortisol section.  And I asked him for a reference for this, and he didn't get back to me in time for this interview, but I'm sure he has one.  I'd be very surprised if he's made a mistake there.  So, according to Martin Newman, the analytical chemist that developed this assay, he thinks that chronic marijuana use decreases cortisol.

Ben:  Right.  Right.  And that's actually what some of the research that I've seen shows as well, whereas, like, you know, obviously overdosing with THC can really put your adrenal glands for a spin when it comes to raising cortisol.  Small amounts here and there could actually relax you and decrease cortisol.

Chris:  Right.

Ben:  Yeah.  Okay.  Gotcha.  Anything else when it comes to supplements, or foods, or anything like that that would cause an increase in cortisol, before I ask you about, of course, another very important point here is what can decrease cortisol.

Chris:  I think we covered it.  I think we covered it.  We talked about glycerin, which is the active component in licorice.  I think that's about it.

Ben:  Okay.  So what kind of supplements, or foods, or, you know, even like, you know, I know there's a lot of essential oils out there, what kind of things can decrease cortisol?  And actually, before I ask about this, I do want to let you know, and I've talked about this on the podcast before, I keep a cold air diffuser next to my bed stand and I diffuse, when I sleep at night, things that can help to decrease your sympathetic nervous system stimulation.  Particularly, what I put in that cold air diffuser is a few drops of lavender oil and a few drops of rose oil, and so it's nice 'cause it humidifies the air a little bit in and helps you to sleep, and I know that essential oils have some research behind them when it comes to decreasing cortisol, but I'm curious to hear your thoughts on supplements, foods, essential oils, how they could decrease cortisol, if they actually do decrease cortisol, or if they're just acting similarly to, perhaps, you know, decrease the actual, or I suppose increase the breakdown of the cortisol that you are making, rather than directly decreasing your cortisol production.  But fill me in on this, if that was long-ass question.

Chris:  Yes.  So there is, the essential oils are an evidence-based approach and Tommy was able to find some good quality science that shows that lavender does indeed reduce cortisol.  So that seems like a good idea.  So what they had people do was either sniff an artificial fragrance, or the lavender, and they showed a reduction in cortisol with the essential oil versus the artificial fragrance.  So that seems like a good approach to me.  It's not what, I have to say, we don't have a lot of experience of recommending supplements based on your situation because, like I said, we never see it, we never see it.

Ben:  I'm special.

Chris:  So if the hundreds, literally 550-odd people, we never see the high cortisol, but we know the phosphatidylserine, so one of the training courses I did, so when, I bumped into the system, did a whole ton of training courses, and one of them was the Kalish Institute Training, which I found tremendously helpful, and I was turned on to a supplement called phosphatidylserine during that training course, and that again is a very evidence-based approach to lowering cortisol.  And the way that phosphatidylserine works is it, it blunts ACTH, so this is ACC, ACTH is the messenger that goes from the brain to the adrenal glands.  So that's what it's doing, it's not acting on cortisol at all.  It's acting on the signaling hormone that comes before it that goes from the brain and, again very evidence-driven approach, but the problem is that most of the studies that have been done, have been done on bovine phosphatidylserine.  And then there was the mad cow disease fiasco in the UK, and so people stopped making phosphatidylserine out of cow brains, and now what you see are products that are made with soy, and those have also been shown to work, but it would appear that there's a u-shaped curve.  So six to eight hundred milligrams of phosphatidylserine of soy only worked as well as the placebos.  So it's like kind of really hard to figure out, but it seems it's lower than that.  And again, I bet this is another one of those things that's very variable according to the person, right.  So you might have to experiment with this as well.  So the phosphatidylserine…

Ben:  Really interesting.  So when it comes to phosphatidylserine, that would be something, it sounds like you're saying, would actually modulate cortisol levels directly, the actual production by the adrenal glands, because it's not working on the cortisol that's in the bloodstream, unlike some of these other things we've talked about.  It's actually acting directly on the brain and the signal that the brain is sending to the adrenal glands.

Chris:  Yeah, exactly.  So this is working on the brain to block the production of ACTH. Now the problem is what if there's something else in your body that's producing the ACTH, like there could be some other tissue, some rogue tissue, that's producing the ACTH, and that's what's triggering the adrenal glands to produce the cortisol.  And so if the phosphatidylserine only works on the brain, you're kinda dependent on the brain working properly in order for the phophatidylserine to work.  But we do think that that is the case for you because you still have a normal circadian rhythm.  So in someone with Cushing's disease, for example, where there's like unregulated ACTH, you lose that circadian rhythm and all you see is just high cortisol all the time, and that's not the case for you.  You have a normal circadian rhythm, so we have good confidence that the phosphatidylserine would work. 

Ben:  Interesting.  Okay.  So, in a case like mine, you would recommend definitely continuing with essential oils, but also perhaps experimenting with the use of something like phophatidylserine.

Chris:  Yeah.  I mean, so, you know, I've put in my notes here, you know, highlighted with two question marks “Why.”  So that's what I'm always thinking as both a computer programmer and as somebody that looks at these DUTCH test results.  Why?  Why is this person making a lot of cortisol?  Why're they not making a lot of testosterone?  There's a reason, and this is what I want to implore people to do, like if you're currently taking hormones that have been prescribed by an endocrinologist, why do you need them?  It's not a genetic deficiency, probably.  Like there's something going on, and people just write prescriptions without even, or take prescriptions without really understanding why they need them, and so that's really what you need to do, is figure out what the heck's going on here.  Is it the ketogenic diet?  Is it the high intensity intervals?  What the heck's going on?  Like we need to know the answer to this, and the only way that you can find out is to do some more testing, do some more experimentation, and then redo the DUTCH test and find out if anything has changed.

Ben:  Yeah.  And so in the case of testing, what you would recommend then would be, for example, a gut test to rule out any underlying infection, and then potentially experimenting with some of these other recommendations that you've made, such as the use of you know, something like a little bit lower exercise, maybe a little bit higher carbohydrate intake, possibly just really focusing on, you know, maybe a week of absolutely taking things off from a work standpoint and just see if, perhaps, I'm more stressed out than I actually think I am, and then redoing the test.

Chris:  Yeah.  That makes sense. Just go on holiday.  Wait until you're gonna go on holiday and you know you're gonna have a super chill week with your family and not really do any working out.  You know, maybe just a bit of walking or something, then keep up your yoga, or meditation, and all that, and then redo the test and see if the cortisol's still high.  That seems like a pretty good strategy to me.

Ben:  Yeah. I have a little digital detox coming up in December.  I've talked about this very briefly on the podcast.  It's called Runga, down in Costa Rica, and it's kinda like an eight day yoga retreat-slash-digital detox and so, perhaps that'd be a perfect one for me to bring some pee strips to and run the test right after I finish something like that just to, just to see, just out of curiosity.  So, even though, you know, I am definitely one of those cases, you know, and, you know, as you would know if you clicked on the title to this podcast, where I'm wondering, why is my cortisol high even though I'm doing everything right.

So this is super interesting stuff, Chris, and I wanna now ask you a little bit about kinda  how people can get this test, you know, use you for interpretation, etcetera.  So can you go ahead and delve into your method with me, and how this actually works, and how somebody can get started if they want to do it a test like this?

Chris:  Sure.  So I think it's really important to make it clear that hormone test is the beginning of an investigation and not the end of one, right.  Like if you run this test and you find high cortisol, or low testosterone, or high estrogen, that's the beginning of an investigation, right.  Like it only raises more questions than it does create answers, like that's important to point out, but at the same time, I think this is a totally awesome test to use as a barometer, like what's going on for you right now.  Like if you're headed into a hard race season, like it's really interesting to establish a baseline to see how your body responds over this stressful race periods.  And then another good reason to do this test is, if you're feeling really good right now, do the test and find out what your free testosterone is, and then, if next year, or in two years' time, or in ten years' time, suddenly you start feeling like crap and somebody runs a test on you, and says, “Hey, you have low free testosterone,”, then there's a good chance you might be able to say, “Well, hey, 10 years ago, I also had free testosterone and I felt great then.”  So, you know, probably not that.

It can make an investigation in the future much, much easier, but the way we work, and I say we, it's not the royal we, as you pointed out in the start, I work with my wife who's a food scientist and a registered nurse who's also done the Kalish Training, and then Tommy is a medical doctor and our chief medical officer, and the way we work together as a team is I think, pretty cool, pretty noble, and it's something I was turned on to through software engineering.

There's this method of project management in software engineering called Agile, and then there's a really, really common, or the most frequently used method of Agile project management, is called a Scrum, and what the Scrum is is you get a bunch of people together, so a bunch of interested parties are trying to produce some product, some end result, some end goal, maybe some big, hairy aspirational goal like: as a runner, I wanna qualify for Boston.  Right?  That's your big, hairy aspirational goal.  And then, maybe you're listened to 350, or maybe even 800 episodes of The Ben Greenfield Podcast.  So, for the most part, everybody knows what tasks need to get done in order for you to achieve that big hairy aspirational goal.  So what you really need is someone to break that down into smaller subtasks that you can easily get done.

So that's the way that we work now.  We take someone, you know, we run some labs on them, the DUTCH is one of those labs, they have some goals that they're trying to achieve, and then we take from our big deck of tasks the things which are most important for that person right now, and then we put them on to a board that we call a kanban board and, everybody knows what kanban is because you've been into a busy coffee shop, right.  When they write your name on a coffee cup and put it down on the counter, that's a kanban.

Ben:  Is that similar to the, to like the online project management service, Trello?

Chris:  Yeah.  Exactly.  So Trello is a flexible tool that can be used for a number of different things, and so for this instance, we're using it as a kanban board because it's super flexible and really easy to use.  So we get the, we take these tasks, so, let's say, get to bed by 10 PM, and install some orange light bulbs in your house, and eat dinner earlier in the day, like maybe those are the most important tasks for you to do in order to improve your cortisol situation.  So we would create sticky notes and we put those on the Trello board, the kanban board as we call it, in the To Do column and then we work two week sprints.

So the idea is you take those sticky notes and you move them from the To Do column into the Done column, and then that way, the whole thing becomes manageable because what I found in the past, you know, two years in, is my list of things, my deck of possible cards I could put on your board, has gotten bigger and bigger and bigger, and if I try and get everybody to do everything all at once, they do nothing.  And so, breaking it down and doing the proper project management becomes really, really important, and we have been getting fantastic results, like 100% success with people, by using this special Agile method of health coaching.

Ben:  Interesting.  So it sounds very, very formulaic, very scientific.  Rather than just like throwing a bunch of supplements and lifestyle changes at an issue, you're systematically ruling out what's working and what's not as you walk someone through the results of a test like this.  You know, kinda like we've very briefly done in this episode, but basically what you're doing is a little bit more, almost like systematic detective work with food supplements, self-qualification, etcetera.

Chris:  Yeah, exactly!  And it makes the follow-up so fun!  So, normally in a follow-up call, I would spend the whole call saying to the person, “Did you do head space?  Did you check your blood glucose?  Did you check your blood ketones?  Did you stop eating oatmeal?”  And it would be a really, really boring call, whereas, now with the kanban board, the person has dragged all of the cards from the To Do column into the Done column, and so it's really, really obvious exactly what they've done, and what they haven't done, and what we need to focus on on the next iteration.  And then, in addition, it makes it really easy for me to collaborate with other people on my team, right.  Like I don't need to tell my wife what I've already told you because you can see it on the board, and then if we get stuck for any reason, which hardly ever happens but occasionally does, then I can helicopter in Tommy from the other side of the world, literally, and he can look at your board and say, and know exactly what I've asked you to do, and it just keeps the state of the system really clear at all times.  So it's a really cool system.

Ben:  Awesome. I love it, and obviously you're a wealth of knowledge on this stuff.  You've been enormously helpful to me when it comes to kinda walking through some of these results and, by the way, for those of you listening in, I've been taking notes quite fiercely on everything from this test to all the studies that Chris mentioned.  I'm gonna link to those in the show notes for you.

And then, finally the other podcast that I've done with Chris on the organic amino acids test, which is a different test altogether, but also very helpful for things like micronutrient deficiencies, etcetera, and Chris's podcast with me called “The Seven Signs That Your Adrenals Or Your Cortisol Is Broken” and plenty more.  So that's all over at bengreenfieldfitness.com/dutch, that's bengreenfieldfitness.com slash D-U-T-C-H, along with my own test results, if you care to look over those, or download those, or kinda glance through 'em as you listen to this, again, which you may need to.  But then also, Chris is offering a discount on the testing service that he just described, the consulting combined with the systematic fixing of issues.  So what you do is you go to his website, and I'll put a link to in the show notes, or you can just go to nourishbalancethrive.com and you use code Ben10 to get a 10% discount on the testing and consulting that we just talked about.  It's code Ben10.  That's the correct discount code right, Chris?

Chris:  Yeah, that's right.  So do it as a challenge.  I'm calling you to action, right.  You've listened to 350 episodes of The Ben Greenfield Podcast, what have you done about it?  Do two DUTCHs.  So that's what this program consists of: you're gonna do a baseline test and then I'm gonna do some health coaching with you.  We're gonna figure out what the most important tasks are for you to do right now, and then you gonna go do something, and then the follow up test is included in the purchase price, right.  So I'm gonna send you two test kits.  And the beauty of this thing is because it's done on these filter paper, it doesn't matter where you are in the world.  Like you can pee on the filter paper and send it back in the regular mail, right.  You don't have to send it by USPS or, sorry by UPS or FedEx, it's super light.  So you can do this from anywhere in the world, and get the baseline, and then the follow up, and then, I've kind of, it's playing on the back of my mind, that Tommy is a research scientist, and he knows how to do peer reviewed science, and has had several papers published in the last couple of weeks, and so, if we get enough people to do this, then we've got the data for a study.  Like this could get interesting, but we'll see how many people sign up for it first.

Ben:  That's awesome.  So you can pee, not just four to five times, but eight to ten times by [1:42:34] ______ .

Chris:  Exactly!  It's actually quite fun compared to the spitting in tubes, which wasn't much fun.  The peeing on paper is much more fun.

Ben:  Well, my trick for the dripping saliva into tubes is always to sniff a jar of peanut butter.  That always makes me salivate.  Speaking of which, it's high time for me to walk back down to Whole Foods one more time before I leave Seattle to go pile myself up another big-ass salad.  And I'm working on a blog post, by the way, on all these things I mentioned in the intro. from recovery from a 12 hour event, to how I hack the issue with the canola oil at Whole Foods, and much more.  So stay tuned for that.

Chris:  I'm looking forward to that!

Ben:  Yeah.  But in the meantime, bengreenfieldfitness.com slash D-U-T-C-H. That's bengreenfieldfitness.com/dutch, and also when you go there to the show notes, feel free to leave your comments, leave your questions there, and either Chris or myself will be happy to hop in and reply.  So, Chris, thanks so much for coming on the show and sharing all this with us man.

Chris:  No.  Thank you, Ben.  It's been an absolute pleasure and a privilege.  Thank you again.

Ben:  Awesome.  Well, folks, this is Ben Greenfield and Chris Kelly from Nourish Balance Thrive signing out from BenGreenfieldFitness.com.  Have a healthy week.

You’ve been listening to the Ben Greenfield fitness podcast.  Go to bengreenfieldfitness.com for even more cutting-edge fitness and performance advice.


Cortisol can be confusing.

And frankly, most popular tests for cortisol don’t tell you what really need to know…

…things like how fast cortisol gets cleared by your body, what’s truly causing high cortisol or low cortisol, how cortisol (and other crucial hormones) are getting created and broken down, and much more…

And this is important, because low cortisol leaves you with zero energy, low drive, brain fog, and feeling overtrained and adrenally fatigued, while high cortisol decreases protein synthesis and amino acid uptake, increases proteolysis (protein breakdown) and bone degradation, suppresses parts of the immune system, and increases serum glucose. So you feel pretty crappy when cortisol is low, and while you may feel good when cortisol is high, if cortisol is chronically high, there are some downsides to that too.

Enter the DUTCH test – which is a new way to measure cortisol and much more.

So what is the DUTCH test?

The DUTCH test is a urine steroid hormone profile that measures hormones and hormone metabolites (called conjugates) in a dried urine sample, and is performed from the comfort of your home. It is the most cutting-edge way to truly see what’s going on when it comes to your hormones, because it doesn’t just measure hormones, but also something called “metabolites”, which are a measurement of hormone production and hormone breakdown.

Measuring both hormones and their metabolites can give you or your health care practitioner a much better overall picture of hormone production. For example, a DUTCH urine steroid hormone profile on someone with low salivary cortisol could show normal cortisol production, but high levels of metabolites. In other words, this would indicate that you are producing enough cortisol, but it’s just getting broken down into its metabolites very quickly. There are also some metabolites that are important markers for cancer risk that can only be measured in urine.

With serum (blood) and saliva hormone spot-testing, it’s possible to track variations in hormone release throughout the day – and this is a great way to measure how your hormones change during a 24-hour period (your circadian rhythm). In contrast, a standard 24-hour urine collection many physicians use reflects your total hormone output in a 24-hour period.

But by using the DUTCH urine steroid test, you get the best of all worlds: blood, saliva and urinary results with just a urine collection.

The DUTCH test measures the following:

-Free cortisol
-Free cortisone
-Progesterone metabolites (a-pregnanediol, b-pregnanediol)
-Androgen metabolites (DHEAS, etiocholanolone, androsterone, testosterone, 5a-DHT, 5a-androstanediol, 5b-androstanediol, epi-testosterone)
-Estrogen metabolites (estrone, estradiol, estriol, 2-OH-estrone, 4-OH-estrone, 16-OH-estrone, 2-Methoxy-estrone, 2-OH-estradiol)

My guest on today’s podcast, Chris Kelly, is an expert when to the DUTCH test. Two years ago Christopher Kelly quit his job at a hedge fund to start Nourish Balance Thrive, a small functional medicine practice for athletes. Chris is a computer scientist and pro mountain biker and he works with two medical doctors, one of whom is also a pro mountain biker, and the other is Dr. Tommy Wood, a biochemist and Ph.D. fellow. He employs a registered nurse, and works with his wife Julia, who is a food scientist.

During our discussion, you’ll discover:

-What the DUTCH test is and why it is far different than an Adrenal Stress Index…

-My own shocking results on the DUTCH test… 

-The difference between free and total cortisol, and why you may think that your cortisol is normal when it is actually quite low…

-Why some women should not use estrogen natural hormone replacement therapy…

-How to know if you should be using a multivitamin…

-How chronically high cortisol can cause high blood glucose, brain damage, and muscle wasting (even if you feel great short-term!)…

-Things that can elevate cortisol if you are already doing everything “right” in terms of stress control, sleep, proper training recovery, etc…

-Whether it’s true that high ketosis can cause high cortisol…

-What type of hidden infections in your gut or blood can cause high cortisol…

-Supplements and herbs you may be taking can increase cortisol dramatically…

-Whether there is a link between cannabis, CBD, THC and cortisol…

-The most potent supplements or foods or essential oils for decreasing cortisol…

-And much more!

Resources from this episode:

-Book: Why Zebras Don’t Get Ulcers

A sleep article that includes the one-two Sleep Remedy/CBD combo Ben swears by for sleep, along with the essential oils we discuss

Phosphatidylserine for lowering cortisol

The London Biohacker Summit – click here to register and use 10% code “ben”.

The RUNGA “digital detox” Costa Rica retreat Ben is going to in December (mention this show for $75 gift upon registration).

Click here to visit NourishBalanceThrive and use code BEN10 for a 10% discount on the testing and consulting Chris and I discuss in this episode.

The Little Know Test That Tells You Everything You Need To Know About Your Metabolism podcast with Chris Kelly

-“7 Signs Your Cortisol & Adrenals Are Broken” podcast with Chris Kelly

The Underground Test That Shows You How To Legally Upgrade Your EPO, Increase Your Oxygen Levels, Boost Your Red Blood Cells & Build Double-Digit Percentages In Power And Endurance podcast with Chris Kelly

-Article: “The Ketogenic Diet’s Effect On Cortisol

Caffeine may increase cortisol levels.

CBD increases cortisol release in healthy volunteers

Safety and pharmacokinetics of oral cannabidiol when administered concomitantly with intravenous fentanyl in humans.

Essential Oil Inhalation on Blood Pressure and Salivary Cortisol Levels in Prehypertensive and Hypertensive Subjects

Blunting by chronic phosphatidylserine administration of the stress-induced activation of the hypothalamo-pituitary-adrenal axis in healthy men

Ben Greenfield’s DUTCH test results

Read more https://bengreenfieldfitness.com/2016/05/what-is-the-dutch-test/





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2 thoughts on “[Transcript] – Why Is My Cortisol High Even Though I’m Doing Everything Right? Hidden Causes Of High Cortisol, The DUTCH Test & More!

  1. CSue says:

    It isn’t clear to me how useful the DUTCH test is for a menopausal woman on bioidentical hormone cremes. Their charts show it is not very useful, except for “metabolism”. But what does this mean? Is it still worth doing? Does it mean you won’t know the exact amount of estrogen and progesterone but you’ll know how the amount you do have breaks down? I also take DHEA pills, is that going to skew the results?

    1. Yes, in my opinion it is still worth doing and you know how the amount you have breaks down indeed. I would STOP taking DHEA, etc. before you do it for sure.That will skew results.

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