High cortisol

[ketoist]

Hello!
I keep reading how IF and keto/LCHF would lower cortisol, but I cannot say that that has been my experience. Au contraire. The symptoms of elevated cortisol have really been haunting me recently, with almost a very distinct onset, but I am unable to tie it to a specific cause. I added flaxseed (postmenopausal), and had a bit too much of it thanks to a delicious flaxseed cracker recipe. Another factor could be that in response to my latest NMR, I am trialing a lower saturated fat approach to see the effect on LDL. I suspect that I am running a bit of a caloric deficiency in response? There really does not appear to be a great substitute for dairy. I'm also a bit concerned about developing more food intolerances by repeating the same foods too frequently, especially with nuts and avocado.

I am in ketosis, although the depth has relaxed some, and my blood readings hover between 0.5 and 1. I have been feeling chronically hungry, jittery, less able to sleep well in response, but also seem to retain more fluid. Not liking it at all! I understand that fasting taxes the adrenals, but why are ketones not good enough fuel to prevent that stress response of elevated cortisol when fat reserves are high, and there is no immediate danger to survival? My weight loss has reversed, and I am packing on belly volume, my morning glucose is slightly elevated, and so is my BP and HR (all WNL, but higher than my own normal).

I would prefer to stay the course of IF with OMAD, or compromise to 16:8. I elevated my magnesium and vitamin C intake, as well as added ashwagandha, phosphatidylserine, and keep an eye on my B-vitamins.

Has anyone ever been there, and how have you managed? Thank you!

[TheresaB]

Cortisol, as you are probably aware, is often called the “stress hormone” although it is more nuanced than that. Just because you’re eating in a manner for ketosis, doesn’t necessarily mean you’re not eating something that your body is reacting to thus stressing your body or experiencing other factors affecting your cortisol levels. Specifically I’m thinking you maybe exposing yourself to too much artificial/blue light at wrong times of the day and messing up your circadium clock. We have a wiki on stress, https://wiki.apoe4.info/wiki/Stress maybe reading it will inspire you as to a direction to pursue in an effort address your high cortisol.

[ketoist]

Theresa, thank you for the link to the wiki. Interesting read, I must say, although the E4 not aiming for longevity does not bode too well with me. : ( The struggle with inflammation is all too real for me. If you think you have it all figured out, just another food intolerance (probably from eating the same foods way too often) sneaks up on you. I just discovered that psyllium husk is not my friend any longer. But there are several other stressors at work for me, Tackling them successfully is my only chance of losing the weight. But thanks to my Hashimoto's and adrenal weakness, my body also has limited tolerance for reduced caloric intake. Gosh, isn't there anything GOOD that comes from being E4???

[circular]

I’m wondering how adrenal weakness and high cortisol go hand in hand. In true medical adrenal insufficiency the adrenals stop producing cortisol altogether. It can be life threatening in certain scenarios of physiological stress. If you’re concluding you have some adrenal weakness of some kind based on low stress tolerance and chronic fatigue type issues, I’d personally look elsewhere ... mold, viruses, spiritual and or emotional depletion, food intolerance, elevated histamine ... Since I’m familiar with true hypoadrenalism, I’m leery of the ‘adrenal fatigue’ notion that’s so often seen given as a diagnosis of sorts. How is it determined?

[aphorist]

I’m wondering how adrenal weakness and high cortisol go hand in hand. In true medical adrenal insufficiency the adrenals stop producing cortisol altogether. It can be life threatening in certain scenarios of physiological stress. If you’re concluding you have some adrenal weakness of some kind based on low stress tolerance and chronic fatigue type issues, I’d personally look elsewhere ... mold, viruses, spiritual and or emotional depletion, food intolerance, elevated histamine ... Since I’m familiar with true hypoadrenalism, I’m leery of the ‘adrenal fatigue’ notion that’s so often seen given as a diagnosis of sorts. How is it determined?

I agree w/ this viewpoint.

The first question I would have is if you are experiencing 'adrenal fatigue' or whatever that is -- then what is your creatinine and eGFR values? Are your kidneys actually failing? It defies biology to have both high cortisol values and 'adrenal weakness'.

The second question I would have is what cortisol values are you looking at exactly that describes them as being high? Cortisol fluctuates throughout the day. Are these AM fasting values? Are these 24 hour urine test values? You would need to do something like a Dutch test to really dig into what is going on with these values over the course of a day. Having a high fasting cortisol value, is not the end or be all of a problem. If you really have persistently elevated cortisol values (i.e. Cushing Syndrome), that's a different situation.

Third, elevated cortisol stimulates gluconeogenesis and causes the body to catabolize for generation of glucose when being fuel deprived. It's an immediate response in the first day or two of fasting, particularly in the morning when the cortisol awakening response occurs at its highest level. Food deprivation is a stress. Eventually the body transitions more to burning fat and ketosis kicks in at higher levels 2 days after a fast begins.

[ketoist]

I’m wondering how adrenal weakness and high cortisol go hand in hand. In true medical adrenal insufficiency the adrenals stop producing cortisol altogether. It can be life threatening in certain scenarios of physiological stress. If you’re concluding you have some adrenal weakness of some kind based on low stress tolerance and chronic fatigue type issues, I’d personally look elsewhere ... mold, viruses, spiritual and or emotional depletion, food intolerance, elevated histamine ... Since I’m familiar with true hypoadrenalism, I’m leery of the ‘adrenal fatigue’ notion that’s so often seen given as a diagnosis of sorts. How is it determined?

Like with most diseases, there is a gray zone prior to meeting the currently established diagnostic criteria. This doesn't mean that if you fall just short of the cut-off, you're healthy. For my personal situation, the "diagnosis" came with just marginally passing a cosyntropin stim test three years ago, along with almost a flatline of diurnal salivary cortisol. The result: I was bedridden three years ago. What got me there in the first place was chronic stress, and a determined effort of getting my elevated lipid profile under control with a low-fat, low carb diet. I succeeded in the latter, at the expense of depleting substrate for hormone production. Once I changed my diet, I very, very slowly recovered, but never back to baseline. The years leading up to this were characterized by elevated BP, anxiety, poor coping mechanisms, poor social support, and other significant stressors. I developed a fat ring around my stomach. Around the crash, I lost weight faster than I ever had before, without even trying, and my electrolytes were a hot mess. So, I really do not care too much about what label people choose to stick on the symptoms, but they exist, and they impact those who seek out help from their doctors, but are often left hanging. And...isn't what we try to accomplish here, at least in part, busting the current lipid hypothesis, the same thing: seeking out treatment/guidance outside the realm of ICD10 codes, because the mainstream medical field has not caught on just yet?

[ketoist]

I’m wondering how adrenal weakness and high cortisol go hand in hand. In true medical adrenal insufficiency the adrenals stop producing cortisol altogether. It can be life threatening in certain scenarios of physiological stress. If you’re concluding you have some adrenal weakness of some kind based on low stress tolerance and chronic fatigue type issues, I’d personally look elsewhere ... mold, viruses, spiritual and or emotional depletion, food intolerance, elevated histamine ... Since I’m familiar with true hypoadrenalism, I’m leery of the ‘adrenal fatigue’ notion that’s so often seen given as a diagnosis of sorts. How is it determined?

I agree w/ this viewpoint.

The first question I would have is if you are experiencing 'adrenal fatigue' or whatever that is -- then what is your creatinine and eGFR values? Are your kidneys actually failing? It defies biology to have both high cortisol values and 'adrenal weakness'.

The second question I would have is what cortisol values are you looking at exactly that describes them as being high? Cortisol fluctuates throughout the day. Are these AM fasting values? Are these 24 hour urine test values? You would need to do something like a Dutch test to really dig into what is going on with these values over the course of a day. Having a high fasting cortisol value, is not the end or be all of a problem. If you really have persistently elevated cortisol values (i.e. Cushing Syndrome), that's a different situation.

Third, elevated cortisol stimulates gluconeogenesis and causes the body to catabolize for generation of glucose when being fuel deprived. It's an immediate response in the first day or two of fasting, particularly in the morning when the cortisol awakening response occurs at its highest level. Food deprivation is a stress. Eventually the body transitions more to burning fat and ketosis kicks in at higher levels 2 days after a fast begins.

I have done a DUTCH Complete last year, and have another one waiting for me this weekend. This test is the only test that showed super-elevated urine cortisol getting metabolized to cortisone. It is conflicting with the saliva and blood tests. But I have not received any information as to why I would metabolize cortisol like crazy.

[ketoist]

I am really just asking if anyone had been there, and how they managed. I would love to stay in keto, but feel like my body needs more carbs.

Please don't forget that we are as diverse as our genetic make-ups. When I started this journey on keto and IF, I felt like I was given a new lease on life. Now I feel like the ghosts of the past have come back to haunt me. There is nothing worse than being told there's nothing wrong with you because your labs are WNL. But, you can't even lift your feet off the ground to walk. In response to all that, I went through a battery of tests and labs, including the Dutch, Genova ION panel, Cyrex, several salivary tests, blood work, cardio tests, psych evals (how humiliating). I never managed to get my endocrinologist to evaluate my low ACTH of 6. I had hoped that this being a community of forward-thinking individuals, someone may have had a similar experience, and perhaps a success story to share.

[TheresaB]

I assume from your insistence that it is being ketogenic that is driving your cortisol levels high, that you are doing everything else that influences cortisol perfectly (and there are MANY). So my recommendation regards your sodium intake. Dr Stephen Phinney, who's been studying diet for 35+ years and is an internationally recognized expert on the ketogenic diet emphasizes that folks who are in nutritional ketosis should consume 5 grams a sodium a day. Try that and see if it helps your cortisol levels.

I'm curious as to why you feel your body needs more carbs? If it's an energy thing, that points more toward adrenal fatigue raising your cortisol levels.

Strictly speaking, no one needs carbohydrates, there are no essential carbs. There are essential amino acids (protein) and essential fatty acids, but not carbohydrates. That's not to say we shouldn't eat carbs, I'm not a zero carb advocate especially when it comes to APOEe4s. There are many vegetables, some nuts, fruit (in moderation) that offer wonderful health benefits, but not all plant based foods react well within our bodies and some folks are far more sensitive than others. Food sensitivities can raise cortisol levels, and the problem with sensitivities is they're more subtle and we live with them everyday, so we often don't know we're reacting. I know I was personally shocked to learn from blood tests how sensitive I was to lectin heavy foods. So if you are experiencing high cortisol levels, just be careful and do your research, maybe add one food at a time, and pay close attention to reactions. Do recognize I understand it can take 2 weeks before a reaction.

[ketoist]

Thanks, Theresa! I have been suspecting an unknown food intolerance to be a part of my current state, but I have also noticed that I fare a lot better both mentally and physically when I slightly increase my carb intake, reason being what it may. It just is. The food intolerance is on my current to-do list, as I do feel inflamed, not terribly bad, but a lot more than when I started IF and keto/LC. And that feeling came prior to raising my carb intake slightly. Still in mild ketosis, though. Which in my mind equates to fat-burning, and therefore I find it confusing why that source of energy does not seem to be sufficient to sustain me.

Here is the timeline of events:
Started keto/IF (going in already sugar-, gluten-, legume-, soy-, processed-food-free), and feeling REALLY good (increased energy, increased mental clarity, increased exercise tolerance, but had a terrible time sleeping initially, which improved after a while).

Two months in, I suddenly felt weak, teeth shattering mildly at night, then also felt this trembling sensation throughout the day, difficulty even climbing stairs, lethargy, fatigue (started napping, which I NEVER do), mental clarity settling back to baseline, sleep disruptions, increased abdominal girth (fatty, not bloated), poor stress tolerance, raised morning glucose (I am not IR), etc.). A few weeks prior to this, some mild inflammation set in (knees, my left toe, and elbows). Usually, curcumin has been taking care of this, but not so this time. I was completely symptom-free for a while, even without fishoil or curcumin.

Then, a few days ago, I increased my carb intake slightly to the effect that the teeth shattering is gone, mood and energy have improved, and I'm climbing stairs with a lot more gusto than before. I am still way below 100 grams of total carbs per day. The symptoms of inflammation are still present, though.

Typing things out like this is helpful for me to process and analyze the situation. I started journal to keep track of things, in hopes of identifying the perpetrator. Somewhere, I read that vitamin E supplementation may be a detriment for some of us, by means of adversely impacting the immune system, causing inflammation. I am holding it now, and observe. There are other antioxidants in my regimen to help cover.

My salt intake is pretty decent, not sure it's amounting to 5 grams daily, though. I do the electrolyte powder, and am rather generous with sea salt in my food. Since my BP has come down to normal to low levels, I feel a lot more comfortable with added salt. Thank you for pointing out this nugget. I will check out Dr. Phinney's research.