Cortisol: Is it only about stress?

Cortisol is a hormone that most people have heard of, yet few are able to explain its function other than it being a "stress hormone." Today I will explain a bit about the hormone, its functions and why it's not completely bad to have circulating around the body.

Cortisol is the primary glucocorticoid involved in both glucose metabolism and in response to stress. During periods of stress (particularly new stressors on the body), Cortisol helps the body adapt and maintain normal body functions and metabolism until the stress-induced physiology is exhausted or the stressor is removed. Studies have repeatedly shown that animals can survive without the organs that produce Cortisol and the other adaptation hormones when given doses of these hormones, but they are unable to survive without the hormones themselves.

Levels of Cortisol also fluctuate with the sleep-wake cycle. Normally, there is a sharp increase in Cortisol in the morning which peaks by 8:00 am followed by gradual lowering until midnight. Any physical, mental, environmental, or chemical stress can affect the output levels and timing of Cortisol.

Since the multiple roles of the hormone act on many types of cells (immune, liver, fat, bone and others), the effects of imbalance are many.

Symptoms of Cortisol Excess include: sugar craving, trunk obesity, insulin resistance, weakness, shakiness between meals, irritability, high blood pressure, bruising easily, impotence, oily skin, trouble sleeping and headaches.

Symptoms of Cortisol Deficiency include: chronic weakness and fatigue, weight loss, stress intolerance, alternating diarrhea and constipation, salt craving, dizziness, joint and muscle pain, low blood pressure, and anemia.

Not only can these symptoms prevent you from feeling good, but chronic altered levels of Cortisol can lead to other problems that decrease Calcium absorption, and depletions of B-Vitamins, Vitamin E and Vitamin C.

Does one of those categories sound like you? Don't let your bad-days linger, consider consulting a qualified physician who can test your adrenal hormones and help you with the treatment of these conditions.

Dr. Behnke


References:
1. Lord and Bralley. Laboratory Evaluations for Integrative and Functional Medicine. 2nd Edition. 2008. Duluth, GA.

2. Lee Scung hye, Shin Dong-won and Mark A Stein. Increased Cortisol after Stress is Associated with Variability in Response Time in ADHD Children. Yonsei Med J. 2010;51(2):206-11.

Grave's Disease

Grave's Disease is one form of hyperthyroidism (over-active thryoid gland). This disease affects women much more than men, at a rate of 7-10:1. It is actually an autoimmune condition, and the affected patient will have autoantibodies to Thyroid Stimulating Hormone receptors on the thyroid gland. The antibodies stimulate or attack the receptors causing increased production of thyroid hormone T4, and therefore results in overactivity of the gland. Current medical treatments for Grave's Disease are antithyroid medications, surgery and radioactive iodine.

Grave's Disease is often triggered by a very stressful event, and it does have some genetic influence. Other things that increase the risk are smoking, excess iodine, Cadmium and Mercury exposure, and toxic reactions to medications. Diagnosis is usually made based on lab testing for thyroid hormones. Classic presentation are increased thyroid hormones and decreased Thyroid Stimulating Hormone, as well as the presence of thryoid receptor antibodies. Symptoms of Grave's Disease include: increased heart rate, weakness, sweating, weight loss, nervousness, loose stools, intolerance to heat, fatigue, irritability, warm or thin moist skin, tremors, goiter, and exopthalamus (classic bulging eyes of hyperthyroidism).

A condition like this should not be self-treated and a physician should be consulted when beginning new treatments. Following are some suggestions for natural, non-invasive ways to control hyperthyroid symptoms.

• Reduce risk factors (stress, smoking, excess iodine intake, avoid toxins)
• Avoid situations that cause excitation or anger
• Stress counceling or meditation
• Dietary changes: consume organinc, whole foods, increase calorie intake through small frequent meals
• Avoid caffeine and other stimulants
• Avoid refined sugars and foods made with white flour and white sugar
• May increase consumption of cabbage to 1/2 raw head of cabbage per day
• Increasing goitrogens is controversial, but may help. (turnips, broccoli, brussels sprouts, kale, cauliflower, soybeans, peanuts, pine nuts, millet)
• Maintain gut health with fiber intake, probiotic use and get tested for food sensitivities
• Supplement the following: Vitamin A, Vitamin C, Vitamin E, Selenium, Calcium, Zinc, L-Carnitine, CoQ10, EPA/DHA. Amounts are specific to patients, to avoid mis-use of supplements, I will not give dosage amounts here.

References:
1. Brent GA. Graves’ Disease. N Engl J Med. 2008;358:2594–2605.
2. Streetman DD and U Khanderia. Diagnosis and Treatment of Grave's Disease. Ann Pharmacother. 2003;37(7-8):1100-9.

How important is Fiber consumption?

This week I am inspired to open your hearts to the wonderful world of Fiber. Fiber consumption could be argued to be one of the most important ways to feed our bodies, but it is far too low, and sometimes even completely missing from the Standard American Diet (SAD). Fiber is derived from the cellular residues of the foods we eat, and it not actually digested like the fat, protein and carbohydrate parts of the foods. The fibrous portions of foods get all the way to the large intestine virtually unchanged from when they are put into the mouth. The role of fiber in your gut is critical for the biological processes to happen, and therefore to keep you healthy.
Fiber deficiency is liked to many diseases including: appendicitis, breast cancer, colon and prostate cancer, colitis, diverticular disease, gallstones, hemorrhoids, hiatal hernia, ulcers and other gastrointestinal disorders.

The health benefits are many:

• reduces colon transit time
• binds bile acids
• increases fecal bulk
• causes fermentation in the large bowel
• increases water content in the bowels

Because of these great functions of fiber and the digestive system, increasing fiber intake has a benefit on many diseases. Soluble fibers function to lower cholesterol, reduce heart disease, regulate blood sugar, lower blood pressure and promote the life of beneficial bacteria. Insoluble fibers aid digestion and elimination and help decrease the toxicity of irregular bowels.

The recommended daily fiber intake is 35 grams! Are you getting enough?

When cooking or purchasing foods, look at the labels for fiber content per serving. Try to estimate your current fiber intake and consider making changes in your diet to increase your fiber to 35 grams per day. It may sound like a daunting task at first, but you will notice benefits quite rapidly. Ask your doctor for help!

The best way to get fiber working for your health is to consume fiber of all kinds, mixing soluble and insoluble fiber sources. Good sources of fibers include: whole grains (wheat, rice, corn, barley, millet, oats), legumes, nuts, fruits, leafy green vegetables, and seeds.

Enjoy!

Dr. Behnke

Reference: Kamen, Betty. New Facts About Fiber. 1997. Nutrition Encounter Inc. Novato, CA.

Type 1 Diabetes

This past weekend, a very large event was held at the Mall of America. It's goal was to raise money for research and awareness of Type 1 Diabetes, or Juvenile Diabetes. Friday morning I had a local news station on while I was getting ready for the day, and I overheard and interview with someone involved in the planning of this great event. I'm not sure if I'm breaking rules by naming the source/channel, so I will leave those details to myself.

Part of this interview was explaining bits and pieces of this disease, and I found myself questioning the content of their conversation when the interviewee told the audience that the difference between Type 1 and Type 2 Diabetes is that Type 1 is not responsive to exercise and activity levels have no bearing on the severity or treatment of Type 1 Diabetes. In my opinion, because of the strong trend for Americans to get little to no physical activity, people should not be told that there is no benefit of exercise regardless of what disease is being discussed.

Type 1 Diabetes affects only 5-10% of diabetic patients, and is usually diagnosed in childhood or before young adulthood. Many factors are involved in the risk of having Type 1 Diabetes: Gut infections, mother's Vitamin D deficiency, poor protein digestion, genetic predisposition, auto immune destruction of pancreatic cells, viral or environmental triggers. To diagnosis of Type 1 Diabetes is usually due to high C-Peptide levels, autoantibody presence, glucose and ketones in urine, and random blood glucose above 200 mg/dL. Signs and symptoms of the disease include: increased hunger and thirst, excess fatigue, increased urination, weight loss, blurred vision, numbness in hands or feet, rapid breathing, dry skin and mouth, sweet odor of breath, and vomiting.

Because the pathogenesis of Type 1 Diabetes is destruction of the insulin-releasing cells of the pancreas, medical treatment consists of insulin injections and daily monitoring of blood glucose levels. Severe cases are treated with pancreas transplants.

My diet and other recommendations:

• Eat several meals at the same time each day, using portion size control.
• Choose low glycemic foods, non-starch vegetables, reduce sugary snacks and desserts.
• Increase fruits and vegetables.
• Use lean meats, dried beans, fish, non-fat dairy, whole grains and water.
• No-flush Niacinamide to reduce immune-mediated cell destruction. Dosage should be given by a healthcare professional.
• Epicatechin to save beta-cells.
• Vitamin D
• Exercise and physical activity

The benefits of exercise are numerous:

Reduce blood pressure and blood sugar levels
Raise good cholesterol levels, lower the bad ones
Improve how your body uses insulin
Reduce the odds of having a stroke or developing heart disease
Promote a strong heart and strong bones
Reduce your odds of falling
Help you shed pounds
Provide more energy
Reduce stress levels

Make sure to balance stretching, aerobic and strengthening exercises. Be careful to avoid exercising in a dangerous way, particularly to diabetics, heavy weight training and high impact aerobics should be avoided due to the side effects of diabetes. Always tell your doctor your activity levels and know your ketone levels, the signs for too low blood sugar, and do not exercise alone if you have numbness in your feet or other conditions that would make exercise dangerous to you.

References:

Riddell M and BA Perkins. Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring. J Diabetes Sci Technol. 2009;3(4):914-23.

Man CD, Breton MD and C Cobelli. Physical activity into the meal glucose-insulin model of type 1 diabetes: in silico studies. J Diabetes Sci Technol. 2009;3(1):56-7.

Rachimiel M, Buccino J and D Daneman. Exercise and type 1 diabetes mellitus in youth; review and recommendations. Pediatr Endocrinol Rev. 2007;5(2):656-65.

Enjoy,

Dr. Behnke