Why Understanding Cortisol is so Important

Why Understanding Cortisol is so Important

Many people have high total cortisol when experiencing what has commonly been called adrenal fatigue.

The term HPA axis (hypothalamus, pituitary, adrenal) dysfunction or maladaptation is a more accurate description due to the complex interdependence of glands, cells and the brain. Furthermore research and statistics show it is usually not a case of low output by the adrenals at all.

Why is this so important?

Cortisol has an impact on inflammatory response, thyroid function, glucose levels and the list goes on.  Studies show that early life events can set up a life long pattern that affects the HPA Axis and cortisol production.  This maladaptation also can occur when there is decreased output by the pituitary gland.  Receptor sensitivity is yet another way in which cortisol signalling can get disrupted. Lastly reduced bioavailability can happen at the tissue level by way of the binding globulin in the blood, conversion of cortisol to cortisone or cellular transcription.  The point is that the HPA axis is much more nuanced than the concept of adrenal fatigue lets on.

Research and Testing

Much of the research on cortisol has been done based on saliva tests which only show free cortisol.  Free cortisol levels can be very different, even opposite from total cortiso. Improper treatment can easily result.  Looking more closely can lead to early detection of thyroid disease, diabetes, leptin resistance and even certain cancers.

Pregnenolone and DHEA

Chronic stress leads to lowered DHEA, an important steroid hormone.  There is a common misconception that this is because cortisol is stealing from the precursor pregnenolone. Physiologically there is no evidence of this. Both pregnalone and DHEA are produced in mitochondria but in different tissues.  Cortisol is actually regulated outside of the adrenals. Also the amount of cortisol produced is significantly more than DHEA.  Location and function both debunk the myth that stress hormones ‘steal’ from sex hormones.   This is news to me as and not commonly understood in the medical community.   One way that this new theory can be proven is by looking at how supplementing pregnenolone will have no effect on DHEA.

Three ways of looking at Cortisol:

1. Is total cortisol low or high?  Looking into other factors that are present and that will be influenced by this.  Leptin and insulin resistance can be involved.

2. Is there a disrupted diurnal rhythm?  It is important testing is done properly because the morning cortisol curve happens in the first hour of waking.   Some tests are not specific enough by leaving a window of two hours. This creates misleading results.

3. Is there impaired cortisol metabolism?  When there is more cortisone present this could indicate thyroid involvement.

Evolutionary medicine reminds us that being human means that we are really good at adapting to our environment. This includes learning to ride the wave of positive stressors that move us forward in our lives. Noticing when we dip into too much stress and backing off is a skill that requires constant refinement. I teach a course on the HPA axis so please take advantage of this information. Stress is by far the number one factor influencing health today. The HPA axis is what allows us to regulate stress appropriately. We all have times when stress becomes too much. Knowing which tools to engage and how to recover is key to resiliency.

Mold and other Biotoxin Illness

Mold and other Biotoxin Illness

As you many of you know I’ve been going on meditation retreats for many years. Recently I was the health person on a retreat where mold illness was affecting three people. Another member of our community is literally debilitated from mold illness so it’s quite frightening for those who have been recently diagnosed.

I also have patients for whom mold is the number one issue affecting their health. It shows up in the lab work and correlates with the symptoms presenting. Most recently a young woman with high anxiety had mold exposure.

My son developed a chronic cough after moving into a home with water damage. We only stayed a few months but his symptoms have persisted for 3 years. This is how real mold exposure is. There was an article published by the Harvard Gazette last month which outlines the real costs of mold on productivity in the workplace. Framing it this way helps everyone take it seriously, because it is very serious.

What is mould and biotoxin illness? What can we do?

Dr. Shoemaker discovered a connection between a mysterious illness and a toxin produced called Pfiesteria found in the water of his patient population in the 90’s. He then linked similar illnesses to toxins from a variety of microorganisms and chemicals. Its now called CIRS (chronic inflammatory response syndrome).

Biotoxins that cause CIRS are encountered in water-damaged buildings and other places. They include (1):

  • Fungi
  • Bacteria (possibly including BorreliaBabesia, and other organisms transmitted by tick bites)
  • Actinomycetes (gram-positive bacteria from the order Actinomycetales)
  • Mycobacteria
  • Mould
  • Mould spores
  • Endotoxins (aka lipopolysaccharides, or LPS; cell wall components of gram-negative bacteria)
  • Inflammagens (irritants that cause inflammation and edema)
  • Beta-glucans (diverse group of polysaccharides)
  • Hemolysins (exotoxins produced by bacteria capable of destroying cells)
  • Microbial volatile organic compounds (mVOCs; organic compounds released by microorganisms when there is adequate food supply for such “secondary metabolite production”)

Most people become ill when exposed to sufficient levels of these biotoxins.  Many recover once they are removed from exposure. Our detoxification system recognize theses toxins and eliminate them via the normal mechanisms.

How Common is Biotoxin Exposure?

43% of buildings examined had active water damage and 85% had past water damage. Mold grows in a day or two after water damage.

Mold and other biotoxins can develop in buildings that are not water-damaged but have indoor humidity levels above 50 to 60 percent. Experts recommend maintaining indoor humidity levels between 30 and 50%.

Some people do not recover.  Many of these have HLA (human leukocyte antigen) genes that prevents their bodies from recognizing and thus eliminate biotoxins. So the biotoxins remain in the body triggering a chronic, systemic inflammatory response. Roughly 25% of people have this genetic tendency. When there is a sufficient exposure and a triggering event then CIRS will develop. This event could be as simple as a cold or as complex as a Lyme disease. Dr. Shoemaker also estimates that 2% of the population are highly susceptible genetically to developing a multi-system, multi-symptom illness after prolonged or repeated exposure to biotoxins.

Here’s how to improve indoor air quality (1):

  • Fix plumbing leaks and other water problems as soon as possible. Dry all items completely.
  • Scrub mold off hard surfaces with detergent and water and dry completely.
  • Discard absorbent or porous materials, such as ceiling tiles and carpet, if they become moldy. Don’t paint or caulk moldy surfaces.
  • Clean and repair roof gutters regularly.
  • Keep air conditioning drip pans clean and the drain lines unobstructed and flowing properly.
  • Make sure the ground slopes away from the building foundation, so that water does not enter or collect around the foundation.
  • Keep indoor humidity between 30 and 50 percent. Measure it with a moisture meter available at most hardware stores. Venting bathrooms, dryers, and kitchens to the outside is important. Using air conditioners and de-humidifiers where needed and increasing ventilation including exhaust fans for cooking can help.
  • Do not install carpeting in areas where moisture problems may develop (i.e., in a bathroom).

Air Filters can also be helpful. A HEPA filter that is capable of removing ultrafine particles like mold, dust, pet dander, VOCs, and even viruses from the air. These ultrafine particles represent 90 percent of all airborne pollution that you breathe. An air sanitizer can eliminate allergens, odors, mould, and germs.

CIRS commonly misdiagnosed as:

  • Fatigue, weakness
  • Post-exertional malaise
  • Memory problems, difficulties with concentration
  • Disorientation, confusion
  • Headaches
  • Vertigo, lightheadedness
  • Muscle aches, cramping, joint pains without arthritis
  • Hypersensitivity to bright light, blurred vision, burning or red eyes and tearing
  • Cough, asthma-like illness, shortness of breath, chronic sinus congestion
  • Unusual shortness of breath at rest
  • Chronic abdominal problems including nausea, cramping, diarrhea

Removal From Exposure is often the hardest step

Mold inspectors are not using comprehensive, accurate testing methods. A visual inspection and air samples is not enough. Both of these methods can yield useful information, but more is required.

The first VCS test is available at Dr. Shoemaker’s website, Surviving Mold, at a cost of $15 USD. This is a Functional Visual Acuity Test (FACT) that uses a scoring algorithm to determine the likelihood that a patient is being adversely affected by biotoxin exposure. If it is positive, there is a 92 percent chance that the patient has CIRS. This test cannot be used to rule CIRS in or out on its own. A clinician trained by Dr. Shoemaker needs to be involved in the diagnosis and treatment of CIRS. He has a number of valuable resources on his website so please have a look.  Another physician named Dr. Keith Berndston, has written a summary of CIRS.

I’m researching this largely due to my son’s presentation of chronic rhinitis and asthma. Luckily he has improved a lot these past few months. I changed his mattress and have him sleeping by a open window. These interventions may have been more important than the steroids offered by the specialist which I used in small amounts when he was in an acute stage and unable to breathe.

A CIRS diagnosis, like any diagnosis, is helpful if it changes treatment strategies. In this case finding a qualified practitioner is important. I do preliminary testing in my practice.  for patients who have been exposed and are not responsive to other treatments further steps need to be taken. Opening detox pathways, looking into a genetic predisposition and removing people from exposure are always the first steps.






The Real Goods on Meditation

The Real Goods on Meditation

Self-care and stress management can feel like just one more item to add to our to-do list.  How can we talk about meditation without making it one more thing that stresses us out?

Anyone can meditate. There are many approaches and none are wrong.  All of them have been studied in depth and show excellent health outcomes often outweighing other interventions including pharmaceuticals. When it comes to health and happiness this is the magic bullet.  A solo practice can nurture introverts who require more time alone. Group retreat can provide a new kind of social contact to unwind trauma.

I hear people say they can’t meditate.  “My mind never gets quiet.”  A different view or understanding is needed regarding what meditation actually is.  Fundamentally it is the opposite of doing anything including judging what is happening.  The point is to stop, step away from everything external and just see what’s there.  At first what we discover includes the full range of human experience. Then we may start to feel a bit of space emerging.  What is in this space after we settle into our body a little?  All that is good about being human including wisdom and joy.

The Science Backing Meditation

A recent meta analysis done by the Journal of American Medicine reviewed nearly 19 000 research studies on meditation.  The results were stunning across the board.  In just 8 weeks anxiety was reduced in the majority of people.  After 3 to 6 months of practice, 78% of those suffering from anxiety enjoyed significant benefits. This meta analysis concluded that meditation lowers depression in 70% of people and reduces pain in 67%.  This may be related to its ability to increase serotonin and dopamine levels in the brain.  So let’s talk more about the brain and then we’ll get into the stress response.

A study done in 2004 at the University of Wisconsin by Richard Davidson looked at long time meditators.  Using an EEG it was determined that not just brain waves changed during meditation but there were also permanent structural changes. Meditators have a thicker brain and more folds on the surface. They are also able to induce gamma waves at levels not seen in the rest of the population.

Changing the Brain

The control tower for the endocrine or hormone system is in the brain.  The amygdala interprets stress and is responsible for emotions, instincts and memory.  It also has a role in libido.  Psychological stressors like to-do lists and deadlines create the same physiological stress response as being in immediate danger.  We know that women are more at risk for having a dysregulated stress response. The #me too phenomenon explains in part why this is and I’ll be addressing this more in another article.  Chronic issues with gut, thyroid and HPA (hypothalamus, pituitary, adrenal) function are all too common these days.  Shiny, new, high tech interventions are not where we are finding answers.

When my health issues began, my gut instinct was to move away from conventional medicine. I literally relocated to the mountains and learned to meditate.  I found my doctor there.  Gradually returning to dance and martial arts training was part of the answer.  Movement and strength training is important as long as it is enjoyable.  It triggers human growth hormone and stimulates a cascade of changes that makes us feel safe on a fundamental, somatic level.

Neuroplasticity or the brain’s ability to change goes on throughout our lives. It is not limited to just babies as we once thought so we can always begin wherever we are.  You may recognize these words from the title of a popular book written by the Buddhist teacher Pema Chodron.

Focus, Attention and Addiction

ADD is a common diagnosis in children whereas it seems under diagnosed in women. This is another area where pharmaceuticals are the primary intervention. However, the long-term evidence is not convincing.  Young people are being exposed to meditation more and more because of how effective it is.  In terms of substance use, meditation, cognitive behavioural therapy and acupuncture are some of the best tools for building resiliency.

A wave of research on meditation occurred after a conference where the Dalai Lama urged scientists to go in this direction.  Research is currently being done at the University of Victoria by a professor who is part of the meditation community I practice with.

“Every day, think as you wake up, today I am fortunate to be alive, I have a precious human life, I am not going to waste it. I am going to use all my energies to develop myself, to expand my heart out to others; to achieve enlightenment for the benefit of all beings. I am going to have kind thoughts towards others, I am not going to get angry or think badly about others. I am going to benefit others as much as I can.”
-H.H. The 14th Dalai Lama






15 Sleep Solutions You Can Do

15 Sleep Solutions You Can Do

Sleep is a big deal  

Especially when two-thirds of adults don’t get the minimum required to meet basic physiological requirements.  In fact, less than 7 hours per night can shorten lifespan significantly.  Inflammation increases when we miss a night of good sleep.  Other sleep research shows up to 29% lower sperm count in men who sleep poorly vs those who regularly get enough rest.  Athletes performance drops 10-30%.

Why Parents are Crazy

As a parent of a young child I can vouch for how difficult it can be to get enough sleep.  When your infant finally starts sleeping through the night your cortisol and melatonin production is so confused insomnia becomes a thing. Catching up is not actually possible especially as a single parent.  Through trial and error I’ve discovered the ridiculous reality of living in a state of constant sleep deprivation.  Caffeine stops working.  You think everyone hates you and life is out to get you.  This is the real reason parents are crazy a lot of the time!  Anyone doing shift work or work late at night can be included in those who suffer the most.

Adults really do require 7-9 hours of sleep

  • Newborns (0-3 months): 14-17 hrs
  • Infants (4-11 months): 12-15 hrs
  • Toddlers (1-2 years): 11-14 hr
  • Preschoolers (3-5): 10-13 hours
  • Elementary school age (6-13): 9-11 hrs
  • Teens (14-17): 8-10 hrs
  • Adults (18-64): 7-9 hrs
  • Older adults (65+): 7-8 hrs


Sleep Hygiene: Focus on What to Do

1. Be consistent with your sleep schedule 

Set a realistic bedtime.  Train your brain to develop a regular circadian rhythm by going to bed at the same time most of the time.  

2.  Establish a bedtime routine

This can include a warm but not hot bath or shower.  Journaling in a book, meditating, stretching gently or reading are all appropriate activities.  Dim your lights and listen to relaxing music to unwind from your day.  

3.  Your bedroom needs to be quiet, cool and comfortable

Sleep is better when your room is cool rather than warm. You can keep a door or window cracked for circulation and to avoid stuffiness. Keep all lights off, including night lights, and lights from electronic devices. Sleep on a comfortable mattress.  Turn off the extraneous noise. A white noise machine is fine. If your pets wake you up, keep them in another part of the house. 

4. Turn off electronic devices in the evening

This allows for more connection, better digestion and a general parasympathetic or relaxed environment where you can reconnect and let go of the day.  Electronic devices emit blue light which stimulates the brain.  Cortisol and melatonin get confused and these hormones play a huge role in insomnia.

5. Exercise during the day

Exercise promotes continuous sleep.  Its also great stress relief.  Avoid intense exercise in the evening as this can interfere with deep sleep.  Stress management is crucial to sleeping well.

6.  Eat enough during the day

Blood sugar dysregulation causes spikes in cortisol and makes it more difficult to rest later on.  In fact, having enough carbohydrates during your evening meal has been shown to support better sleep.  Choose root veggies and unprocessed, gluten free options.  Often times food reactions cause an internal stress response that we aren’t aware of.

7. Use caffeine with caution

We know that 50% of people don’t metabolize caffeine.  This means it stays in the body for much longer and therefore amount matters.  Cut down on caffeine and avoid it after noon entirely.  This includes chocolate. Uncooked cacoa is easier on you.  Matcha has a longer burn than coffee and many health benefits.  Find alternatives like peppermint or dandelion tea. Golden tea is a delicious alternative as well.  I know its not easy to change this habit especially when you are sleep deprived but it can be done.  It may be the most important change you can make.

8. Get out of bed if you aren’t sleeping

Do a guided meditation or find another relaxing activity until you feel sleepy.  This is part of training your body that bed is for sleep.  Have a comfortable chair in your room and make a cup of sleepy tea.  Simple rituals like this work.

9. Avoid large meals later at night

A small protein rich snack before bed can help with night hunger but large meals late at night create a burden for the liver.  Finish meals a few hours before bedtime.  The liver kicks into gear at 11pm so being asleep by then is ideal.

10. Reduce fluids before bedtime

I’m training my son to drink more during the day so he won’t need pull-ups at night.  Just pretend you are 5 years old!  My mom has sage advice for parents.  Ask yourself if getting your kid up to pee in the night is more of a priority than your sleep.

11.  Nap or no nap?

I teach meditation to my patients.  I find if someone calms their nervous system for 5-20min during the afternoon it can support a deeper sleep later.  People may or may not nap as part of the practice. I don’t see any problem with this however long naps may inhibit sleep later on.

12. Avoid these because we know they interfere with sleep

Alcohol raises our body temperature and requires that the liver clear it.  Ever wake up between 1am and 3am after having a drink?  Cigarettes and some medications also make sleep more elusive.

13. Black out your room, hide the clock and wake naturally if possible

This is basic but an incredibly important game-changer.  Buy black-out curtains.  Don’t use night-lights except in the bathroom.  Turn your digital clock away from your bed while you sleep.  Don’t wake to an alarm as much as possible.

14. Creat an extended sleep schedule

For anyone who has suffered from sleep problems an extended sleep schedule can support getting more sleep.  Research shows that allowing a longer period of time in bed does increase the amount of sleep people get.

15. Only use your bedroom for sleep and sex

Train your body to expect only rest and pleasure in this space by creating this.  Bedrooms ought to be a place of sanctuary from the world.


An Important Ally: Your Morning Awakening Response

Its best to get up when you first wake up.  By exposing your eyes to bright full-spectrum light you are stimulating the cortisol awakening response (CAR).  This accounts for half or more of our daily cortisol secretion.  Remember the cortisol is anti-inflammatory and an important hormone that works synergistically with melatonin. Doing any kind of movement first thing supports morning cortisol.  This could be carrying a child, going upstairs, walking your dog or going for a run. Daylight stimulates cortisol release, and darkness stimulates melatonin.

Blue light boxes improve sleep and depression simply by stimulating this early morning response during the winter for those who have to get up before dawn or who can’t go outside first thing in the morning.  Beginning to notice this response and working with it can help repair your sleep-wake cycle if its been disrupted.

HPA-D is not Adrenal Fatigue

I’ve written extensively on this topic and the reason I bring it up is because you’ll see a bunch of recommended supplements for adrenal fatigue.  Insomnia is a symptom of a much more complex disorder called HPA-D.  (hypothalamus pituitary adrenal dysregulation).  By testing cortisol thoroughly we can see that pattern of dysfunction and supplement accordingly.  Giving adaptogens to everyone is not the answer.  Nervine herbs on the other hand are safe and interestingly ashwaghandha is both an adaptogen and a nervine.  Some of my other favourites include skullcap, passion flower and camomile.  Anything that makes you feel groggy upon awakening is inhibiting the cortisol awakening response so avoid this. Be careful using licorice as this potent herb increases cortisol.  L-theanine is an amino acid that is safe to use for anyone.

Certain patterns of HPA-D require increasing cortisol at certain times of day or decreasing it. Often there’s an issue with hormone clearance pointing to excess inflammation, inhibited liver function or thyroid issues.  The testing I do looks at both free circulating cortisol and total metabolized cortisol.  These are not always the same.  In many cases only free cortisol is tested resulting in treatment that is not neccessarily exact.

CBD is both anti-inflammatory and promotes sleep.  This is why standardized extracts need to made available.  For those experiencing recalitrant pain CBD can bring down the pain where other pain medications won’t.  A patient of mine with insomnia and endometreosis began using CBD.  Once her pain came down she was able to sleep and could start making decisions about her health.  She had been unable to work for many months.  I’ve seen this with backpain as well.

Thorough blood work including iron, blood sugar, thyroid and inflammatory markers is required to see a full picture and get a sense of what is going on.  A gut work-up is also important. Neurotransmitters play a role in HPA-D through the gut-brain axis.  Healing the gut so its producing neurotransmitters again and absorbing nutrients is the key in some patients. Supplementing with precursors like 5HTP are helpful in these patterns during treatment.  You may be noticing that it can take time to get to the root cause of insomnia.  Often we are also addressing trauma during treatment.  When we find out what works and are sleeping more, people report feeling that they got their life back.




Tired? Stressed?  Find out what is going on and why is it not adrenal fatigue

Tired? Stressed? Find out what is going on and why is it not adrenal fatigue

Stress is a major contributor to nearly all disease but what is it exactly and how can you recover? Most people understand stress in the form of a time pressure, moving homes or financial worries but there are some physiological stressors that can outweigh these perceived stressors.

Anything that interferes with the body’s ability to maintain homeostasis can be a chronic stressor and will lead to an HPA Axis dysregulation. The major ones I see in clinic are:

Blood sugar issues leading to insulin resistance and metabolic disorders. Missing meals, under/overeating. Circadian rhythm disruption from improper light exposure, lack of real rest, play and sleep. Chronic inflammation from hidden gut infections, an elevated immune response, overwork and allergies.

Why is this not Adrenal Fatigue?

In the scientific literature adrenal fatigue is represented with just a few publications whereas the more accurate term HPA axis dysregulation has over 18 000 research papers. The reason is that this isn’t a case where the adrenal glands are tired and unable to function. In fact often cortisol is normal or high and the imbalance is occurring in how the brain and cells are responding to it. Cellular resistance to cortisol is one way the body responds to chronic stress. This is similar to insulin resistance which many people are familiar with.

Testing for Stress

The brain is the control tower for the HPA axis which stands for the hypothalamus, pituatary and adrenal axis. These glands work together in a series of negative feedback loops which maintain homestasis. When there is a disruption it can be tricky to see what went off track. This is where the right lab work can be helpful. Saliva tests for free cortisol which is the most potent form and has been used to diagnose “adrenal fatigue”. The problem with this test is that 85% of those with low free cortisol have normal or high overall cortisol. This is where the replacement model of supplementing creates more problems. I use a urine lab that looks at the cortisol levels throughout the day. It also shows all the sex hormones and their metabolites which gives important information for treatment.

Chronic stress of any kind creates physiological changes ranging in severity depending on how long its been going on. An important part in recovering health requires long-term stress management. When we are in a heightened level of stress we respond to world differently and can create a cycle of more stress. I promote gradual change because this is what lasts. Shift tracks gradually instead of trying to stop the train and begine making these changes before it derails itself.

Am I going NUTS?

The NUTS acronym can be helpful in understanding stress. Stress usually includes these components:

Novelty: a feeling of a new situation

Unpredictability: a sense of touching something unknown

Threat or perceived threat to either the body or ego: as in chronic illness or the end of a marriage

Sense of loss of control: we actually have little control but we can, at times, control our response

These components exist in activities that are positive stressors as well like: applying for school, going on a date or starting a new job. Recognizing that not all stress is harmful is important. Increase your sense of control by gathering information and making informed decisions. Expand your time horizon or put it in perspective by looking at what’s happening within the context of your whole life. For example having a new baby can mean a lot less sleep but only for a few years. And finally remember to question your thoughts. Say an social event goes poorly and by the end of it your internal dialogue is something like “I said dumb things and I always do…I’m a failure…am doomed to always be alone…etc etc”.

This is an excellent time to check your head, sit down on a cushion and watch your thoughts. Meditation is by far the fastest, yes the fastest, way to transform belief systems and calm the nervous system so new habits and neuro pathways can form.

Symptoms that point to an HPA Axis dysregulation

There isn’t one set of symptoms or stressors that define this kind of imbalance. That being said here is a list of possible symptoms:

poor memory

weight gain or loss

brain fog


cold hands and feet

low libido

frequent illness

hunger that comes quickly with agitation


waking with a rapidly beating heart

trouble falling or staying asleep

postural hypotension

Living a long life with Optimal Health and Vitality

In order to do this we must address the HPA axis and understand our own stress response. I know personally that the more joy and purpose I discover, the more I must look at how I manage my stress.

There will be times when stress becomes unmanagable. When this happens the best action we can take is allow for a period to recover. Listening deeply to the body for guidance is the most important resource. If accessing it on your own is difficult then reach out for support.


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