Optimal Hormone Balancing: Optimizing Adrenal Cortisol and DHEA

Check Adrenal Function with Testing:



Normally, your adrenal secretes cortisol in a daily rhythm


The best way to test your adrenal health is to measure your level of free key adrenal hormones such as cortisol and DHEA. 24 hour testing is the most time-consuming test, but is also an extremely accurate determination of adrenal and the levels of other hormones. Saliva testing is preferred over blood testing as it measures the amount of free and circulating hormones instead of the binded hormone commonly measured in blood test.

DHEA can be measured anytime during the day. Cortisol, on the other hand, is the highest in the morning and lowest in the evening before bedtime. If you are using saliva testing, you will take 4 samples of cortisol at 8 am, noon, 5 pm, and before bedtime.

The advantage of salivary testing is that with multiple samples taken throughout the day, we are able to map the daily diurnal curve of free cortisol in the body relative to DHEA level. This will give us a much clearer picture of adrenal function. If you are taking oral or applying topical supplemental hormone creams such as DHEA or pregnenolone, the saliva test results may be elevated immediately. Blood test results will also increase, but it will take about 3 months to show.

Stress can also affect the levels of adrenal hormones. Your cortisol level tested after a quiet and relaxing morning will be very different from that taken when you are under tremendous stress.

After testing, I discuss how your cortisol secretion is affected by meals, snacks, exercise, stress and other factors. Stress to the human body can include trauma, anxiety, infections, surgery, and even resistance training and aerobics.

I teach the danger of having cortisol levels that are too low, because of how important cortisol is for the massive inflammation that occurs with meals. Esther Steinburg of the NIH described cortisol as being vital for this protection, and that without the dampening effects of cortisol you can develop chronic inflammatory illness.

When your adrenal has secreted high levels of cortisol for a long time you may experience “Adrenal Exhaustion or Burnout” and your cortisol levels will be too low.  Many cases of this burnout can be treated with nutritional glandulars, vitamins and other natural products. Some individuals, however, may need a temporary support with cortisol, or “cortef.”

Low cortisol levels can lead to “cortisol steal,” a situation in which the precursor hormones are shunted to make more cortisol and your other hormones become depleted:




For low cortisol levels: Take adrenal support supplements in the AM When cortisol secretion is highest

1. To restore the normal adrenal rhythm and output:

A. Repair adrenals: Use adrenal glandular (lamb-based for highest safety), or bovine glandular from MediHerb/Standard Process, as well as Vitamins B5 and B6 for cortisol synthesis.

i. Take in the morning when the peaks of cortisol secretion are maximal

B. Ashwaganda: High-grade herbal (Adrenal Innate Response or MediHerb) supplement with that improves the action of cortisol at the cellular level.

C. Advocet give 3-4 months at a time for adrenal support

D. Understand the need for sufficient salt intake to support the adrenals

E. Adjust meals to daily cortisol peaks to dampen inflammation.

2. Optimize cortisol activity at the cellular level:

A. SeriPhos that acts as a cortisol receptor sensitizer.

B. Phosphatidylserine: See below

With aging, many individuals develop excessively high cortisol levels at night.

Higher cortisol levels may cause depression-type effects, high blood pressure, and loss of body potassium.  Too strenuous of an exercise regimen, or overtraining, can also cause high cortisol levels. If cortisol levels are too high later in the day or at night, there are supplements which will help this:

Phosphatidylserine is a well-known cortisol suppressor used in the evening. Dr. Alfred T. Sapse noted some of the other nutritional supplements to lower cortisol levels in the body that include gingko biloba, Vitamin A, Zinc, and acetyl l-carnitine.

Others have discussed the role of DHEA and its metabolites in helping to decrease cortisol levels.

One of the most significant stressors to remove is the exposure to high-glycemic-load diets of refined sugars and carbohydrates that create insulin fluctuations and shift the HPA axis toward sympathetic over-activity. A low-glycemic diet balanced in protein, healthy fats, and complex carbohydrates like vegetables, eaten as smaller meals more frequently (5-6 small meals/day), has a positive influence on hormones. Protein is important for the adrenals and requires adequate stomach acid (HCL) for digestion.

Individuals with adrenal fatigue are notoriously low in HCL, and HCL supplementation is therefore recommended for adrenal fatigue. Other adrenal stressors to avoid are caffeine, stimulating drugs, alcohol, allergenic foods, artificial sweeteners (aspartame), nicotine and partially hydrogenated oils.

It is important to note that the adrenals need cholesterol to make adrenal hormones. Avoiding fats (both saturated and unsaturated) and excessively lowering cholesterol levels, as with statin drugs, deprives the adrenals of adrenal hormone precursors, increasing the risk for such conditions as depression and impulsive behavior.

What about cortisol and exercising? Cortisol breaks down tissues, and exercise, of course, tends to break down tissues as it builds stronger tissues in response to the exrercise. The figure below shows that you must eat within three hours of exercise to avoid a “net” protein breakdown from these factors.  

Notice how timing plays such a crucial role in your post exercise food intake.

Just a three hour delay in getting your post-exercise nutrition can push you into a catabolic state.

Others have looked at cortisol levels as a way to discriminate proper training intensity from “overtraining.” Cortisol increases with increasing time of intense exercise. Proper training intensity appears to result in a  lower cortisol to cortisone ratio.

In overtrained individuals, cortisol levels increase while testosterone levels decrease.

That is why one measure of overtraining is the testosterone: cortisol ratio.

Some have suggested that one way to reduce cortisol after training is to spike insulin levels after a workout. Insulin actually interferes with cortisol and may enhance cortisol clearance from the body. Spiking insulin levels after a workout (by consuming a high-glycemic index carbohydrate) may help minimize excessive cortisol levels since cortisol levels are elevated significantly after resistance training.

See below for supplements that may help control increased cortisol levels secondary to intense exercise.

Phosphatidylserine (PS):This phospholipid, which has been known mainly for its cognitive effects, seems to have cortisol-suppressive properties. Recent research shows that 800 mg Phosphatidylserine given in two divided oral doses helps suppress cortisol secondary to intense weight training. (11) In fact, in this same study, the individuals using PS experienced less muscle soreness as well. Earlier research by Monteleone confirms these results. By decreasing cortisol levels, the testosterone: cortisol ratio can increase possibly relating to anabolic effects. PS seems to only decrease cortisol levels when they are elevated and does not seem to decrease cortisol levels below normal. Decreasing cortisol levels or suppression of cortisol production is not desired in many instances as it may cause adverse effects such as a decrease in reaction time to wounds and healing mechanisms in the body. There are two forms of PS available: a brain cortex derivative and a soy lecithin derivative. The brain cortex PS has been used in most of the studies and shown to be effective.

Acetyl-L-carnitine: This is basically the acetylated ester of L-carnitine. This supplement may help prevent the decline in testosterone that occurs during and after an intense resistance training session. It seems to lessen the response to stress.

L-Glutamine: This is the most abundant free amino acid in muscle tissue. (12) It seems to play a very important role in protein synthesis and is very important to weight-training athletes. Some research suggests that glutamine levels may be a good indicator of overtraining or overreaching. (12) In other words, athletes who were overtrained generally had low levels of glutamine along with high levels of cortisol. One study actually showed that glutamine directly prevents the cortisol-induced degradation of muscle contractile proteins.(13) Some of its positive effects include enhancing protein synthesis; increasing GH levels, which can counteract some of the catabolic effects of cortisol; potent cell-volumizing effects, which can create an anabolic environment in muscle cells; and partially determining the rate of protein turnover in the muscle. An oral glutamine supplement can help athletes prevent some of the symptoms of overtraining. It may also enhance glycogen synthesis through an unknown mechanism. It also helps provide a source of fuel for the small intestine and may enhance anti-inflammatory function. It has been shown to boost immune function. I hope you get the point -Glutamine is a vital nutrient for weight-training athletes.

Vitamin C: This vitamin, mainly known for it’s anti-oxidant properties, may also have some anti-cortisol effects. A study done by Stone entitled “Effects of Vitamin C on Cortisol and the Testosterone: Cortisol Ratio” showed a decrease in cortisol levels in 17 junior elite weight lifters. This study also showed that the individuals taking Vitamin C (an extra gram a day) improved their testosterone:cortisol ratio by over 20%. This type of decrease in cortisol can lead to increased muscle and connective-tissue hypertrophy and enhanced recovery from training. Since Vitamin C also decreases your chances of suffering from a cold or flu infection by 30% (14) and may aid in collagen synthesis, it would be wise to take some extra vitamin C when involved in an intense weight-training program.

Zinc: A mineral that is an essential cofactor in over 300 enzymatic reactions in the body including testosterone synthesis and steroid hormone production. Getting enough zinc may make the difference between making great gains and only making average gains in a weight training program.

Vitamin A: This vitamin, which is often times used for healthy skin function, may also minimize cortisol levels according to Dr. Sapse. He suggested this in an abstract he presented at the 1997 conference on cortisol and anti-cortisols. (8)

Gingko Biloba: This herb is mainly used for its excellent cognitive effects by increasing blood flow and oxygen to the brain, which can lead to greater mental focus and concentration. It may also have additional benefits of decreasing cortisol levels according to an abstract presented at the 1997 conference on cortisol and anti-cortisols. (15) The anti-stress and neuroprotective effects of ginkgo biloba in this study were due to its effect on glucocorticoid biosynthesis. The EGb 761 standardized gingko biloba extract was used in this study and many of the studies showing that it enhances cognition.

DHEA: This natural hormone of the adrenal glands that declines after the age of 30 seems to have some powerful anti-cortisol effects. Many abstracts presented at the 1997 conference on cortisol and anti-cortisols discussed DHEA’s role in decreasing cortisol levels. DHEA is fat soluble so it can cross the blood-brain barrier and have some effects on cognition as well.

Androstenedione: This prohormone is a direct precursor to testosterone, which may explain its anti-cortisol effects since increases in testosterone can blunt elevated cortisol levels secondary to intense weight training. Different metabolites of androstenedione and testosterone, such as 4-androstenediol, 5-androstendiol, and nornadrostenediol, may also exert some anti-cortisol effects. However, more research needs to be done in this area to make this clear!

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