Labs/Situation Review & First Steps

KrunkChris

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Hi all, after my recent post regarding some of the things I am doing/taking to get back on track, I realized I was in the right place and should start spending some time here researching, absorbing and contributing. I realized that a lot of people here are chasing peak performance, both mentally and physically (or getting back on track), and I too am on that mission. However, I believe I fell trap to over working, and not focusing or working hard enough towards what matters most (myself) and took the path of "just keep working harder" thinking it would get me to the point of feeling and operating at my best. Lesson learned.

Below is a little background about me and my situation, but I am also posting my lab results from a few months back, and I wanted to see if you wouldn't mind providing insights on red flags and possible solutions to helping getting things in check, as I am sure a lot of it starts here.


32/M/5'11/190
Suffered lower back injury (2 herniated discs) about 4 years ago
Healed back naturally about 1.5 years ago
Continued ups and downs in the gym and with diet (although diet is never bad I eat relatively clean always)
~8 months ago I got vertigo and been managing that now, much better but not 100%, mostly just when my head is horizontal I get up feeling "woozy", planned MRI as next step after seeing a few specialist
Biggest concern is low energy and low drive which I would say are both physical and mental, along with mental focus.

My biggest takeaway based on my low energy (even right out of bed) was the cortisol level. Labs were taken at 8:45am after coffee (on accident). My main focus is to get energy back and feel healthy and my age again. If I could just get back on the train, that would be an enormous first step.

Thanks in advance for any help and guidance.

192847

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these were follow up labs ~3 months later
192852

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jrock645

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I’m not an expert with this stuff but a couple things struck me: high cortisol, high fasting insulin, high fasting blood sugar, low follicle stimulating hormone and vitamin D.

Vitamin D: start supplementing 5000iu per day with a meal containing some fat.

FSH- this probably just means you have low fertility. Not sure how much it has to do with anything else.

Insulin/Blood sugar: both of these are high and they kinda go together. How’s your weight/bw composition? What’s your waist measurement? You say you “eat clean” but I rarely see anyone say that and really be able to explain what they mean. But without knowing specifics, I’d say you should direct your efforts toward losing a few lbs, reducing overall carb intake(doesn’t mean you need to go keto!), and eating more fruits and vegetables(1kg per day combined weight). Doing these things should improve insulin sensitivity and improve these numbers.

Cortisol: how’s your stress level? Are you getting enough sleep? Combined with above, I would focus on strength training and a bare minimum of cardio(or none). Anything else that could contribute to stress level?

Again, I’m not an expert, but these are things that are apparent to me. What’d the dr say?
 
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HIT4ME

HIT4ME

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@jrock645 has some good insights.

When you said you had coffee before the teat by accident - we're you fasted otherwise? Any milk or cream in the coffee?

You look to be pretty healthy. Since this is a snapshot of one day, I wouldn't worry about stuff like the cortisol being barely low at all.

I am surprised to see such a complete workup. Wish my doctor would do this much.

The only thing Inwould say on disagreement with jrock is that reducing carbs won't help with potential insulin resistance, as much as reducing total caloric load and keeping fats reasonable.

Having said all of that, I would get your vitamin D levels up as he suggested and see how that effects everything.

As far as the vertigo - ever heard of the epley maneuver?
 

KrunkChris

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Thank you both.

Just answering a few questions and some thoughts.

I'll grab my BF % today, I have it on a print out and will track it down but I think its around 18%. Waist is 31. I could certainly lose a few pounds mostly around the stomach and working on that now.

Regarding diet, eating clean means I normally cook most my meals and things are generally organic and include meat, vegetables and sometimes a carb, and a fruit in the morning or snack, so almost nothing really comes out of a box except for the occasional snack. However, I certainly get your point and it stands out more now, that its probably more of a numbers thing, than just "eat clean" especially if my workouts are inconsistent.

Vitamin D was a big one, I started taking a 5000 daily and it didnt do much so I switched to injection weekly. Haven't gotten labs done again but I hope they are up. Now that I am working from home, I should sit outside for 20min daily to take advantage.

I was fasting outside the coffee for the 12 hrs prior. No cream or sugar.

Regarding cortisol - it was my understanding that my cortisol was so low that early in the morning because it is most likely is suppressed now after running at high stress for such a long time. This made sense to me, but I could have interpreted it wrong. Regarding the stress, there was a lot of chronic stress for a long time including: back injury for about 3yrs, consistent high pressure work environments, elderly family issues, and then my own day to day stress of wanting to be an over achiever. So this was a priority for me in terms of helping fix the chronic fatigue and loss of energy.

Stress now is a bit better since have took notice and I am taking some supplements to help. I have also been meditiating about every other day, working out pretty consistency (not hardcore yet), the back is healed and I have been mindful to try and not let everything bother me, however, I do still put a lot of pressure on myself to over achieve and get things done. Another thing I am going to start on is sleep quality and night time routines. (like to other post https://anabolicminds.com/community/threads/looking-for-review-and-recomendations.315948/ )

I also drink too much coffee, probably 3 cups a day and sometimes the last one is around 2-3pm. So I was thinking of cutting the second cup in the afternoon and just sticking to my morning espresso and coffee.

The vertigo I have mostly solved through the eply manouver (many times lol), but they think an infection may still be lingering so that is why they want to send me to get an MRI. I have noticed, when I drink it seems a bit worse. Will get the MRI when things hopefully return to normal outside.

I know that was a lot, but I appreciate the input. In summary it sounds like I can focus some things pretty quickly based on what stood out to you all

Vitamen D - keep injections ongoing until next set of labs and evaluate
Cortisol - Better manage stress through sleep routine, meditation and mindfulness
Coffee - possible reduce late afternoon coffee
Diet - get on a stricter diet more around numbers / intake (this will probably be my next question for help with)
Insulin/Blood sugar: further look into the insulin/BS levels and maybe address that in the above planned diet
Alcohol: I've thought about stopping for ~30 days, I've done it before and obviously felt a lot better. I don't drink much 2 drinks, 2-3x week. But I am sure it doesn't help much with everything going on
Workouts: I have been doing weights every other day, and my off days filling in with a Peloton ride or simple bike ride. Is this ok, or do I need a better focus here?

Thanks so much again!
 
HIT4ME

HIT4ME

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Thank you both.

Just answering a few questions and some thoughts.

I'll grab my BF % today, I have it on a print out and will track it down but I think its around 18%. Waist is 31. I could certainly lose a few pounds mostly around the stomach and working on that now.

Regarding diet, eating clean means I normally cook most my meals and things are generally organic and include meat, vegetables and sometimes a carb, and a fruit in the morning or snack, so almost nothing really comes out of a box except for the occasional snack. However, I certainly get your point and it stands out more now, that its probably more of a numbers thing, than just "eat clean" especially if my workouts are inconsistent.

Vitamin D was a big one, I started taking a 5000 daily and it didnt do much so I switched to injection weekly. Haven't gotten labs done again but I hope they are up. Now that I am working from home, I should sit outside for 20min daily to take advantage.

I was fasting outside the coffee for the 12 hrs prior. No cream or sugar.

Regarding cortisol - it was my understanding that my cortisol was so low that early in the morning because it is most likely is suppressed now after running at high stress for such a long time. This made sense to me, but I could have interpreted it wrong. Regarding the stress, there was a lot of chronic stress for a long time including: back injury for about 3yrs, consistent high pressure work environments, elderly family issues, and then my own day to day stress of wanting to be an over achiever. So this was a priority for me in terms of helping fix the chronic fatigue and loss of energy.

Stress now is a bit better since have took notice and I am taking some supplements to help. I have also been meditiating about every other day, working out pretty consistency (not hardcore yet), the back is healed and I have been mindful to try and not let everything bother me, however, I do still put a lot of pressure on myself to over achieve and get things done. Another thing I am going to start on is sleep quality and night time routines. (like to other post https://anabolicminds.com/community/threads/looking-for-review-and-recomendations.315948/ )

I also drink too much coffee, probably 3 cups a day and sometimes the last one is around 2-3pm. So I was thinking of cutting the second cup in the afternoon and just sticking to my morning espresso and coffee.

The vertigo I have mostly solved through the eply manouver (many times lol), but they think an infection may still be lingering so that is why they want to send me to get an MRI. I have noticed, when I drink it seems a bit worse. Will get the MRI when things hopefully return to normal outside.

I know that was a lot, but I appreciate the input. In summary it sounds like I can focus some things pretty quickly based on what stood out to you all

Vitamen D - keep injections ongoing until next set of labs and evaluate
Cortisol - Better manage stress through sleep routine, meditation and mindfulness
Coffee - possible reduce late afternoon coffee
Diet - get on a stricter diet more around numbers / intake (this will probably be my next question for help with)
Insulin/Blood sugar: further look into the insulin/BS levels and maybe address that in the above planned diet
Alcohol: I've thought about stopping for ~30 days, I've done it before and obviously felt a lot better. I don't drink much 2 drinks, 2-3x week. But I am sure it doesn't help much with everything going on
Workouts: I have been doing weights every other day, and my off days filling in with a Peloton ride or simple bike ride. Is this ok, or do I need a better focus here?

Thanks so much again!
Honestly, it sounds like you're doing a really good job. I am in a really similar situation with a high stress job in commercial real estate, I've had issues for a couple years with my grandmother before she passed away in October. My dad had a stroke the October before that (that was a real sh1tshow), and I try to be aggressive and make things happen. I think now is a REALLY good time to take a step back with all the isolation that is going on and just focus on REST. Seriously, if you're feeling tired and run down, you'd be surprised. I have literally been forcing myself to sleep in until I am really, really ready to get up for the past 3 weeks, since no one is working full force right now. For 2 weeks I was sleeping until 8-830 easy, then slowly it started getting earlier and this week it's been about 7-730 and I am starting to feel much more motivated and ready. Still forcing myself to almost be lazy. Don't get me wrong, I've been working and doing things - but really taking some down time while it is hear. And after 3 weeks I feel better, but still not where I think I can be.

Also, a while back I cut out caffeine altogether. It was one of the best things I've ever done. I always thought people were crazy and it didn't effect me. I was so wrong. As soon as I did it, I actually started waking up earlier and having more energy. Because of a sudden increase in workload, over the past 4 months I've slowly let the caffeine creep back into my life because I needed it from being so exhausted. But now I am really aware that if I drink any caffeine after 12 in the day, I will feel like it had no effect on me until I go to sleep - then I will suddenly have these looping thoughts that become more and more negative, get me worked up and prevent me from relaxing and going to sleep. Something that during the day doesn't bother me at all or is a problem I can deal with, I will just start thinking about and looping over and over until my heart is literally pumping and I am tired but can't calm down. It just takes one cup of caffeinated coffee too late in the day.

It happened to me last night actually - I wound up awake until 3 AM and was up at 7:30 - so it totally ruined my rest and now I need the stimulants (actually had to use Thermagize) just to function today because I'm so tired. Caffeine is very deceptive.

How much vitamin D are you getting injected? That's pretty unusual. You could be taking a single oral dose of up to 100,000 iu per week pretty safely as well. I personally take 10,000 iu/day.

Get a glucose meter and track your blood sugar fasting and post-meal. It will give you some idea of how you are handling things. You seem pretty healthy and with an A1C of 5.1 I am not super concerned about the fasting blood glucose levels just yet. It could have just been a bad test on the insulin, etc. A single test doesn't mean much. If you get a follow up, you will know more.

Did you take BCAA's at all before the test? Also, I noticed in the other thread now that I'm aware of it - you are taking an adrenal calm product - ashwaghanda will lower cortisol. I would drop that for now. I would also avoid licorice extract.

If it were me, I would actually take some rest days where you don't do any work. Give it a month of really slowing down and focusing on recovery if you're that tired. Cut out the caffeine. Continue with the vitamin D injections and follow your doctor's guidance and get new blood work.
 

KrunkChris

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@HIT4ME Thank you for that response. I feel for you on the family issues and job stress so I hope things are on the up.

Crazy about the caffeine, today was my second day with none in the afternoon, and after reading your results I may give that a try especially now that things are a tad slower. I slept better last night (more below), and also have the same issues there the thoughts circle around forever, and the heart rate or awareness goes up, when you should be all but winding down.

Also, I took your advice and didnt set an alarm and got out of bed and onto work around 8am. I had one of my more productive mornings in a while! It's funny because the "normal" me had been setting my alarm at like 5:30 to wake up earlier work and and get personal stuff dont all before work started. The reality was that I would snooze till 6, hit a crappy workout and start work at 8 and then not be anywhere near peak productivity. So maybe youre on to something and I just need a deep reset to come out with more energy and more productivity. I also reach the point where I think (and do) have some many things I want to do that I dont do much lol. I am guessing that can be from being tired and overworked as well. So I am going to keep trying this new track out and hopefully it holds well.

No BCAA's before the test, but taking those now in the AM. I am going to try and do another set of labs in the next 3 weeks, so should be telling.

Vitamin D 0.5ml/week @ 100,000IU/ML

I thought the adrenal calm would help reduce the stress (and cortisol) so that my body can essentially come our of fatigue and produce more normal levels?

I like your advice and will defiantly consider and impliment a lot of it, especially the caffeine, but also the rest. It's a good opportunity to get the rest that will probably not come around again anytime soon (hopefully). Also looking to get my follow up labs and I got back on the phone with the doctor today to do another evaluation of everything I am doing.

Thanks again for the help and insights!
 

SweetLou321

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The most relevant marker on your labs as it pertains to your energy and motivation is your cortisol reading.

Cortisol levels tend to peak about 30min after waking for most, if you are tolerant to caffeine then the likelihood it would really affect this is pretty minimal. I wrote this information for something else, it may not pertain directly to you but it should help give some direction:

1. The Perception of Stress

When it comes to addressing an overloaded “high” stress lifestyle the first place to start is perception. As humans we have an amazing ability alter our physiological stress response by altering our psychological stress response. What this means is we don’t have alter the load on us to improve but simply alter our perception of that load (1). This is of course easier said than done but this is clearly the biggest factor needing to be addressed. One option is altering the environment of the stress, like changing ones job. This is a short term fix to a long term problem as with our current first world lifestyle the probability is high that one will eventually end back up where they started if their perception of stress is never addressed. Giving the body what it needs to react to the level of perceived stress gets all the attention however this is more along the lines of a western medicinal view of treating disease. It will just prolong the inevitable and the probability of ending up back at square one is high. We see this in research where they will take a group of librarians and nurses and put them into a high and low perceived stress group. The groups each had nurses, meaning some reported low perceived stress, and each group had librarians, which means some reported a high perceived stress response. They used hair analyses for cortisol to determine their physiological stress load. The high cortisol group was indeed the high perceived stress group and the normal cortisol group was the low perceived stress group, which again had some nurses in it (2). Also if you perceive your stress level as high regardless of what it may actually be you are more likely to have reduced mortality due to stress (3).



How to Address*

-Meditation/Yoga and working ones stress response; also lowers inflammation of the brain like IL-6 (4,5)

-Writing a grateful for list allowing us to appreciate more instead of complain more

-Recognizing when under stress and stepping back internally and assessing what is happening, viewing one’s self in third person

-Recognizing when we say negative thoughts, setting aside time to come back to those thoughts and find positive thoughts to replace them, example 1-I am tired, write or say I am more energy, example 2-I am depressed, write or say I am happier due to X reason and today was a great day because of it, example 3-I am not sure I can do all this work, write or say I can handle more work and this will be easy
 

SweetLou321

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Dysfunction in the HPA: Inflammation, Orexin, Glucocorticoid Receptor Density, and Glucocorticoid Receptor Resistance



Chronic stress exposure can lead to a dysfunctional pattern of the HPA (1). The response seen above in the labs indicates there is adrenal function since DHEA is normal but the cortisol pattern itself is altered. This is characteristic of hypoadrenalism in absence of Addison’s disease and usually caused by an extreme stressor or chronic high perceived stress load (1,6) There are a few reasons this could be seen but usually there is an issue with ACTH, orexin, and cortisol release. CRH is likely to being produced at a high rate as the DHEA is normal and CRH can directly stimulate DHEA levels (7). This DHEA production could be driving down cortisol since they have an inverse relationship. There could also be low levels of CoQ10 and glutathione needed to fight the oxidative stress produced by CRH which can negatively impact the production of ACTH (8). We see those with adrenal issues tend to have low CoQ10 blood levels and these blood levels correlate with cortisol production. The level in this model was that of around 0.57 mcg/mL (9,10). This is unsurprising as lack of mitochondrial based nutrients like CoQ10 are linked with treatment resistance depression, CFS, and fibromyalgia; all diseases that usually also show altered HPA function with CoQ10 levels at <0.49 mcg/mL (11,12, 13,14). Orexin is also a factor as it directly stimulates cortisol release and this effect may not be regulated by ACTH (15). Orexin is a part of wakefulness response and one the main systems regulating that (80).Inflammation, like IL-6, and mitochondrial dysfunction, which impacts glucose suppression of orexin, impact the secretion and activity of orexin so having either of these in areas like the hypothalamus will impact energy levels and cortisol levels (16,17). There is also the issue of having high amount of glucocorticoid receptor density which will make someone more sensitive to the presence of cortisol, this is not a bad thing overall as in this case we have normal function just altered blood levels (18). There is also glucocorticoid receptor resistance which is similar to insulin resistance. This would be seen if we have a high cortisol level, make more GR to compensate, then the cortisol levels stay high, and finally the GR start resisting the presence of cortisol (1). This can also lead to low cortisol levels as we stop getting the activity of cortisol to signal lowering of CRH, so normal DHEA, but we no longer have the anti-inflammatory effects of cortisol to stop the inflammation that will lower orexin (17). We still have cortisol effects but they will more likely impact the mineralocorticoid receptors which now makes cortisol pro-inflammatory leading to a worsening of the disease state (1). Inflammation carries additional issues as cytokines can also impact glucocorticoid receptor sensitivity (59). Then the glucocorticoid receptor resistance leads to a regulation issue of the cytokines allowing the issues to continue to worsen as a whole (60). Some people start to report a tired but wired effect but yet they likely have low orexin and have low cortisol most of the time, this can be explained by CRH. CRH is involved in several parts of the brain that regulate various aspects of our mood and appears to have actions independent of cortisol in many disease states like depression and anxiety (19).



How to Address*

-Inflammation-We need items that can cross the BBB to impact areas like the hypothalamus. Only take these item earlier in the day as to not impact sleep (17).

*Curcumin can inhibit the inflammation response that leads to resistance to glucocorticoids (67).

*Resveratrol can inhibit the inflammation response that leads to resistance to glucocorticoids (67).

*Green tea polyphenols can lower inflammation in the microglial cells, hypothalamus, and inhibit the inflammation caused by LPS, would take 725-1450mg of a 98% extract as well as use this for a caffeine source if needed (24,25,26,27).

*Tart cherry polyphenols can enhance sleep quality and efficiency while lowering inflammation like IL-6 in the hypothalamus and microglial cells, would take 480-960mg of CherryPURE (29,30,31,32,33).

* PQQ can lower IL-6 and CRP, would take 20mg (28).

-Mitochondrial Function-This can be a little more tricky as its hard to know which factor is the one of concern between CoQ10, carnitine, glutathione, SOD, or NAD+.

*CoQ10 (ubiquinol) 100-400mg but base preferably on blood levels and a blood could help indicate the need to start supplementation.

*Acetyl-L-Carnitine or L-Carnitine-L-Tartrate at 1000-2000mg a day in divided dosing. Acetyl-L-Carnitine can impact acetylcholine levels and some may not respond well to that so use L-Carnitine-L-Tartrate instead.

*NAC at 600-1800mg or liposomal glutathione at 500-1000mg.

*SOD can be supported with melon extract at 10mg or tart cherry at 480-960mg (56,57)

*Nicotinamide riboside to promote NAD+ levels at 100-250mg.

*PQQ 20mg(28).

*Gynostemma can promote mitochondrial through several factors like AMPK and preventing apoptosis (35,36,37,38).

-Orexin-Being a vast system we don’t want to drive this up to much and addressing inflammation and mitochondria function should even this out in most cases.

*Sunlight, dopamine, and acetylcholine can also stimulate orexin (62,65,66).

*Glucose lowers orexin so walking for 10min after glucose containing meals can be a great way to maintain orexin levels post meal esp if mitochondrial dysfunction is believed to exist (64).

*Have protein with each meal as amino acids can compete with glucose to inhibit the effect glucose can have on orexin (63).

*NAD+ activates Sirt1 which enhances the function of the orexin receptors (61).

-Glucocorticoid Receptor Density-Not much can be done here except understand it could be there and if one feels great yet they don’t have optimal cortisol levels this is likely present. However exercise can increase this and B6 can inhibit this from increasing (34,58).

-Glucocorticoid Receptor Resistance-We don’t have to by hypersensitive or overly resistant in this case.

*Exercise has a modulatory effect on receptor activity so this can be a good thing however start very low and do not pass threshold as pushing past threshold could drive someone heavily into a resistance state as seen in those with CFS, one theory, and how exercise can make them more tired (58).

*Ginsenosides can increase receptor sensitivity so panax ginseng or gynostemma can be great options depending on how someone reacts to either (23).
 

SweetLou321

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Altered Circadian Rhythm

In this altered HPA function there is usually a circadian rhythm issue. Since cortisol releases on a circadian rhythm focusing on this aspect can be a great way to help regulate its function. Ideally cortisol is highest in the A.M. and trends downward being lowest at night which allows melatonin to be released to signal it is time for sleep (1). There is usually a trend toward sleep issues in those with altered circadian rhythms which will impact cortisol awakening response (20).



How to Address*

-Bright light therapy can help signal it is time to release cortisol, this can also done by getting out into the sun in the morning. However, best effects are seen in the first 30min of being awake or around 6-8A.M. (21).

-Methylcobalamin at 1g TID has been shown to enhance the effects of bright light therapy and sunlight on regulating circadian rhythm. It does not impact the total levels of cortisol just simply when it is released and people wake up feeling more refreshed (21).

-PQQ at 20mg a day was shown to improve sleep quality, stress response, and cortisol awakening response (20).

-Nobiletin has been shown to help with metabolic issues while also supporting the activity of the clock genes that regulate circadian rhythm (22).



4. Nutrients and Herbs in Cortisol Production

Everything mentioned so far goes over the underlying issues presenting in HPA dysfunction however some nutrients may be useful at doses beyond their RDA to give the body what it needs to regulate itself in time. Herbs can also be used which full under the adaptogen class.



Nutrients of Interest:

-B5-In animal models they have seen when they provide extra B5 the animals can make more cortisol to compensate to a stressor (39). They have also seen in humans that when given B5 they have less of a cortisol spike in relation to stress hinting that B5 has a modulatory effect on the adrenal gland (43).

-Vitamin C-Vitamin C has been shown to help cortisol levels recover after being exposed to stress but not impacting the magnitude of the stress response on the cortisol levels, but the people felt less stressed overall (42). Vitamin C also has a huge concentration in the adrenal glands and seems to have a direct regulation on cortisol release (40, 41).

-Vitamin E-Vitamin E is needed in animal models to help reduce stress response in acute settings while helping to maintain stress response in a chronic setting (44).

-Zinc-Zinc is needed in animal models to respond accurately to a stressor and not over or under produce cortisol when needed (45).

-Sodium-Getting to much or too little salt can increase cortisol (72). Having to little or to much salt can also increase CVD risk (71). Salt is needed to help regulate aldosterone which ACTH is promotes production of.

-Potassium-Potassium intake greater then 3000mg a day carries the lowest risk of CVD risk (71). Potassium should balance out with sodium.

-Magnesium-Magnesium can help control cortisol response from exercise (73,74). We also excrete more magnesium while we are under stress (75). Lack of magnesium can lead to chronically elevated ACTH and a higher set point when we respond to stress (76).

-Calcium-Calcium excretion is elevated when under stress (75). Calcium has a role in regulation aldosterone levels and could have a role in regulating cortisol levels as ACTH is a precursor to both. (77,78,79).

-Ornithine-Has been shown to support adrenal gland function under stress by inhibiting cortisol release and supporting dhea production and support sleep quality (68).



How to Address*

-Multivitamin supplement would be a great addition here to ensure at least adequate amounts of vitamin c, B5, vitamin e, B6, and zinc. Multis and a b-complex, which you would get with a multi, also have shown to improve mood and stress perception at work (46,47,48,49,50,51)

-B5-500mg TID

-Vitamin C-1000mg TID

-Sodium-4000-6000mg

-Potassium->3000mg

-Magnesium-400-500mg minimum

-Calcium-1000-1200mg

-Ornithine-400mg



Herbs of Interest/How to Address*


-Siberian Ginseng-Siberian ginseng is one of the few adaptogens that has been shown in humans to truly have a modulatory effect on stress response and even raising cortisol levels if they were too low to properly respond and adapt the stressor at hand (54).

-Schisandra-Schisandra has also been shown to have a modulatory effect altering cortisol release as needed to allow the person to respond the stressor at hand, in some cases raising cortisol (55).

-Gynostemma-Gynostemma has adaptogenic properties impacting anxiety after stress and fatigue while under stress (52,53). It also impacts GR sensitivity (23).

-Cocoa-Cocoa has been shown to reduce perceived stress and modulate cortisol release in relation to stress. It also has been shown to normalize microbiome and energy markers when under stress (69,70). 10g of powder or 40g of dark chocolate would achieve these effects.
 

SweetLou321

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Resources:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/
  2. https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-014-0030-7
  3. https://www.ncbi.nlm.nih.gov/pubmed/22201278
  4. https://www.sciencedaily.com/releases/2017/08/170822104855.htm
  5. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1809754
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829297/
  7. https://www.ncbi.nlm.nih.gov/pubmed/10523022
  8. https://www.ncbi.nlm.nih.gov/pubmed/25649650
  9. https://www.ncbi.nlm.nih.gov/pubmed/16873946
  10. https://www.researchgate.net/publication/221772607_Hormonal_Influence_on_Coenzyme_Q10_Levels_in_Blood_Plasma
  11. https://www.researchgate.net/publication/40688043_Lower_plasma_Coenzyme_Q10_in_depression_A_marker_for_treatment_resistance_and_chronic_fatigue_in_depression_and_a_risk_factor_to_cardiovascular_disorder_in_that_illness
  12. https://www.ncbi.nlm.nih.gov/pubmed/20010505
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680051/
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4136529/
  15. https://www.ncbi.nlm.nih.gov/pubmed/11158046
  16. https://www.ncbi.nlm.nih.gov/pubmed/22005675
  17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994460/#B29
  18. https://academic.oup.com/endo/article/152/12/4496/2457286
  19. https://www.ncbi.nlm.nih.gov/pubmed/23800343
  20. http://functionalfoodscenter.net/files/56592277.pdf
  21. http://archive.foundationalmedicinereview.com/publications/4/4/249.pdf
  22. https://www.ncbi.nlm.nih.gov/pubmed/27076076
  23. https://www.ncbi.nlm.nih.gov/pubmed/16529692
  24. https://www.ncbi.nlm.nih.gov/pubmed/25086779
  25. https://www.hindawi.com/journals/ecam/2012/163106/
  26. https://www.ncbi.nlm.nih.gov/pubmed/27144449
  27. https://academic.oup.com/abbs/article/46/1/31/1447
  28. https://www.sciencedirect.com/science/article/pii/S0955286313001599
  29. https://www.ncbi.nlm.nih.gov/pubmed/26482148
  30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266225/
  31. https://www.ncbi.nlm.nih.gov/pubmed/22038497
  32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187531/
  33. https://www.ncbi.nlm.nih.gov/pubmed/19857054
  34. https://www.ncbi.nlm.nih.gov/pubmed/2192624
  35. https://www.ncbi.nlm.nih.gov/pubmed/22576281
  36. https://www.ncbi.nlm.nih.gov/pubmed/25817647
  37. https://www.ncbi.nlm.nih.gov/pubmed/24726523
  38. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429198/
  39. https://www.jstage.jst.go.jp/article/bpb/31/6/31_6_1205/_article
  40. https://www.ncbi.nlm.nih.gov/pubmed/15666839?dopt=Abstract
 

SweetLou321

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  1. https://www.ncbi.nlm.nih.gov/pubmed/17616774?dopt=Abstract
  2. https://www.ncbi.nlm.nih.gov/pubmed/11862365
  3. Onuki M, Suzawa A. Effect of pantethine on the function of the adrenal cortex. 2. Clinical experience using pantethine in cases under steroid hormone treatment. Horumon To Rinsho 1970;18:937-940.
  4. https://www.ncbi.nlm.nih.gov/pubmed/1788878?dopt=Abstract
  5. https://www.ncbi.nlm.nih.gov/pubmed/19931332
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885294/
  7. https://www.ncbi.nlm.nih.gov/pubmed/23727255
  8. https://www.ncbi.nlm.nih.gov/pubmed/21905094
  9. https://www.ncbi.nlm.nih.gov/pubmed/23362497/
  10. https://www.ncbi.nlm.nih.gov/pubmed/11234653
  11. https://www.ncbi.nlm.nih.gov/pubmed/10468649
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202428/
  13. https://www.ncbi.nlm.nih.gov/m/pubmed/23584055/
  14. https://www.ncbi.nlm.nih.gov/pubmed/11798012
  15. https://www.researchgate.net/publication/13069175_Effects_of_heavy_physical_exercise_and_adaptogens_on_nitric_oxide_content_in_human_saliva
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757026/
  17. https://www.ncbi.nlm.nih.gov/pubmed/19763832
  18. https://www.physiology.org/doi/pdf/10.1152/japplphysiol.00108.2002
  19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399249/
  20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341031/
  21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104082/
  22. https://www.ncbi.nlm.nih.gov/pubmed/24813431
  23. https://www.sciencedirect.com/science/article/pii/S0896627311007823
  24. https://physoc.onlinelibrary.wiley.com/doi/abs/10.1113/jphysiol.2011.217000
  25. https://deepblue.lib.umich.edu/bitstream/handle/2027.42/71513/j.1460-9568.2005.04121.x.pdf?sequence=1
  26. https://www.sciencedirect.com/science/article/abs/pii/S030645220401019X
  27. https://link.springer.com/article/10.1007/s00217-016-2772-3
  28. https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-13-53
  29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350893/
  30. https://www.ncbi.nlm.nih.gov/pubmed/19810704
  31. https://www.ncbi.nlm.nih.gov/pubmed/22110105
  32. https://www.ncbi.nlm.nih.gov/pubmed/3020116
  33. https://www.degruyter.com/view/j/cclm.1984.22.issue-11/cclm.1984.22.11.717/cclm.1984.22.11.717.xml
  34. https://link.springer.com/article/10.1023%2FA%3A1007708918683
  35. http://www.jle.com/fr/revues/mrh/e-docs/anxiety_and_stress_among_science_students._study_of_calcium_and_magnesium_alterations_269595/article.phtml?tab=texte
  36. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198864/
  37. https://www.ncbi.nlm.nih.gov/m/pubmed/24095631/
  38. https://www.ncbi.nlm.nih.gov/pubmed/1786581
  39. https://www.ncbi.nlm.nih.gov/m/pubmed/22334595/
  40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589707/
These should be 41-80 in that order for the above writing.
 

vvs1

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I would definitely get your vitamin D and magnesium up. Possibly through liposomal vitamin D/transdermal magnesium. Low vit D can cause vertigo. Stay away from fillers/Stevia in supplements.

Low cortisol is a huge issue. I’ve never seen a serum blood lab below range, although just below. Low cortisol is dangerous and you may want to look into cortisol treatment from a doctor or possibly pregnenolone.

Best to check every supplement to see if it reduces cortisol. I have lower salivary cortisol and feel awful if I take something that lowers cortisol like phosphatidylserine. Or ginkgo if I take it too many days in a row.
 
HIT4ME

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@HIT4ME Thank you for that response. I feel for you on the family issues and job stress so I hope things are on the up.

Crazy about the caffeine, today was my second day with none in the afternoon, and after reading your results I may give that a try especially now that things are a tad slower. I slept better last night (more below), and also have the same issues there the thoughts circle around forever, and the heart rate or awareness goes up, when you should be all but winding down.

Also, I took your advice and didnt set an alarm and got out of bed and onto work around 8am. I had one of my more productive mornings in a while! It's funny because the "normal" me had been setting my alarm at like 5:30 to wake up earlier work and and get personal stuff dont all before work started. The reality was that I would snooze till 6, hit a crappy workout and start work at 8 and then not be anywhere near peak productivity. So maybe youre on to something and I just need a deep reset to come out with more energy and more productivity. I also reach the point where I think (and do) have some many things I want to do that I dont do much lol. I am guessing that can be from being tired and overworked as well. So I am going to keep trying this new track out and hopefully it holds well.

No BCAA's before the test, but taking those now in the AM. I am going to try and do another set of labs in the next 3 weeks, so should be telling.

Vitamin D 0.5ml/week @ 100,000IU/ML

I thought the adrenal calm would help reduce the stress (and cortisol) so that my body can essentially come our of fatigue and produce more normal levels?

I like your advice and will defiantly consider and impliment a lot of it, especially the caffeine, but also the rest. It's a good opportunity to get the rest that will probably not come around again anytime soon (hopefully). Also looking to get my follow up labs and I got back on the phone with the doctor today to do another evaluation of everything I am doing.

Thanks again for the help and insights!
Hey @KrunkChris , sorry I missed your response here - sometimes the notifications don't work out.

I get why you were using the adrenal calm. It makes a lot of sense when you list symptoms and they match up with HIGH cortisol too - but if your cortisol is low I'm not really sure it is helping anything.

Still, it would be good to get a doctor to dig a little deeper and try to figure out WHY you have low cortisol. It could be a number of things...I know finding a doctor who will listen can be hard, but you have a test now that provides some starting evidence so it's not like they are shooting in the dark with more tests. They can run their own test and confirm or deny your results if they like.

I hope with some rest and less caffeine you are feeling a bit better! Would like to hear your results.
 

KrunkChris

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The most relevant marker on your labs as it pertains to your energy and motivation is your cortisol reading.

Cortisol levels tend to peak about 30min after waking for most, if you are tolerant to caffeine then the likelihood it would really affect this is pretty minimal. I wrote this information for something else, it may not pertain directly to you but it should help give some direction:
Thank you for all this info, it is greatly appreciated! The perception of stress makes a lot of sense and I can see that a good portion of my stress actually falls into that category. Beyond that, it was a lot of info to absorb but I was able to take a few pieces away and will incorporate that (I am still new to all of this). It seems like I need to address this one issue head on with a doctor, sooner. Thanks again!
 

KrunkChris

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Apologies for missing these responses, I have still been working on this but not there yet. I am getting blood work done again this coming week and will circle back with results. Thanks all for the advice and support.
 
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