It’s no secret that I have not been feeling great over the last few months. At a recent appointment with my functional med doctor, we decided to go ahead and pull a 4-point cortisol test just to see what was going on. [Full report here]
As the green in the graph demonstrates, cortisol should increase in the morning and decrease over the course of the day. The blue line- my cortisol rhythm- is not exactly ideal. No wonder my energy levels are super inconsistent over the course of the day. While the majority of my values are within the normal limits, the overall rhythm is totally wonky. And no wonder for so long I was dependent on caffeine in the morning to feel like a person. And no wonder I feel like I’m crashing in the afternoon. The interesting one is the midnight reading- which I took closer to 10pm when I go to sleep. I feel like this trend back upward likely has a lot to do with my frequent waking up during the night.
FACTORS EFFECTING CORTISOL
I definitely have had a TON of emotional/ mental stress over the last 6 months- and I think this test is a demonstration of how stress has a very direct impact on our physiology. I have written a lot about how I continued to push and push and push in the gym despite my joints feeling inflamed and battling multiple nagging injuries- I was dealing with complicated relationship dynamics- transitioning into a career as a PT- and then within a year, transitioning out and jumping into full time coaching. My bod was like- “yo T, we need some down time.” And I was like ignore ignore ignore. Until I literally couldn’t do anything, then I started to listen.
MACRONUTRIENTS TRENDS UP UNTIL DATA COLLECTION DAY
My food diary from Cronometer is above so you can see exactly what I ate on that day. The timing of this test was super interesting. The day I collected the data for this test was 1/26/19 – so approximately 10 days after I started changing my diet. I do not think that this test is an indication that my dietary changes were not beneficial. I do not think that my adrenal hormones would change that quickly- considering the months (or years really) that I have been beating my body into the ground.
Signs and symptoms of low DHEA
-Fatigue and/ or depression (hello)
-Brain fog (yep)
-Decreased immune function
-Decreased sexual desire (yep)
-Decreased exercise tolerance and loss of muscle tone (yep)
-Dry skin and eyes (omg- my eyes get super super dry)
-Aching joints (yes- all of them)
Holy low DHEA. That little red box is my DHEA. DHEA is another adrenal hormone- it has immune functions independently and also converts into hormones including estrogen and testosterone. DHEA can become deficient during chronic stress- and thats definitely me. Lols. Elevated blood glucose and elevated insulin levels can also cause a decrease in the production of DHEA. With my long eating disorder history, intense exercise habits, and 6 uber stressful years in graduate school- pretty sure my bod has just been pumping out cortisol constantly. Additionally, for the majority of 2018 I was leaning HEAVY on oatmeal, parboiled rice, fruit, and protein bars for my 400-500g carbs/ day. Even though I was training a lot- I don’t think there was any amount of food that was going to support my HPA axis dysregulation. I think that high glycemic load combined with high levels of stress really got me into trouble. The other concept relevant here is the pregnenolone steal. This refers to pregnenolone (one of our precursor hormones) getting shuttled toward cortisol production, rather than toward DHEA production under chronically elevated stress levels (see DUTCH test hormone metabolism image below for a visual of those hormone pathways). Sara Gottfried discusses in her book that she often sees low DHEA as a precursor to low cortisol. I’m pretty sure that if I would have made zero changes to my stress levels, lifestyle etc. that my cortisol rhythm would continue to get worse.
Not too surprising these are low considering my food intake leading up to and on the day of data collection. Really would have loved to see what this would have looked like about in mid-December when my blood glucose was all over during the course of the day. Good news is that I think dietary changes have been effective at reducing my insulin (assuming it was every elevated in the first place).
Another normal value! Woo hoo! This is often used as a screen for adult-onset congenital adrenal hyperplasia (CAH)- the most common type occurs as a result of a deficiency in the enzyme that creates cortisol from 17-OH progesterone… thus we would see elevated levels of 17-OH progesterone because it can’t make it any further down the chain. If we refer back to the DUTCH hormone metabolism graphic, we see the pathway visually.
Today (02/19/19) is day 4 of my current cycle- I will start collecting data for the DUTCH cycle mapping test in 3 days and collect over the course of the next 30 days. I am super super curious to get a more complete picture of what all my hormones are doing based on this glimpse into things! If I had to guess, I’d say my testosterone and estrogen will both be low due to DHEA being so low. If you are interested in a full analysis of my DUTCH test once I get it back, DM me and let me know!
CHANGES I PLAN ON MAKING
- Continue with ketogenic diet for another 4 weeks- in mid March, begin reintroducing carbs SLOWLY (mainly in the form of vegetables at first). Will likely do some carb cycling with keto and closely monitor blood glucose to make sure regulation is improved.
- Continue to keep training volume super super low. Currently, I am working with my functional med doctor on treating what we think is candida, so I’m guessing that is why my knee inflammation is flaring back up right now. I am focusing on body weight movements, cardio, and some light weightlifting (mostly power stuff to avoid end range flexion on my knee while its puffy).
- Continue to prioritize sleep. 8-9 hours/ night. Every night.
- Consider creating some different boundaries around work to help with stress management. I am not sure what this needs to look like at this point- but definitely something I’ll be thinking about.
Please feel free to DM me with any questions you have! xoxo
For further reading on all things hormones, check out:
DUTCH test (Dried Urine Test for Comprehensive Hormones)