The Doctor Says I am Not Sick but I Know I am not Well

SymptomsSymptoms Excessive Fatigue Nervousness/Irritability Mental Depression Inability to Concentrate Apprehensions Weakness Feelings of frustration

Cravings Vertigo

Light headedness Insomnia PMS Headaches Muscle pains and

spasms Epigastric Pain Food and other

allergies Dyspepsia-indigestion Diarrhea-Constipation

OptionsOptions Order tests- FSH, Serum Thyroid, CBC,

SMA-7, cholesterol…….. Ultrasounds, CT scans, UGI, endoscopes,

laparoscopes Visitus Interuptus-Prescription

Popular Non-Diagnosis Chronic Fatigue Fibromyalgia Depression Attention Deficit Hyperactivity Disorder Irritable bowel Bipolar

Top 10 DrugsTop 10 Drugs Lipitor Premarin Synthroid Hydrocodone Prilosec

Norvasc Glucophage Albuterol Claratin Zoloft

Popular ThinkingPopular Thinking The problem with popular thinking is that

it doesn’t require you to think at all. Kevin Myers

It is easier to do what other people do and hope that they they thought it out.

John Maxwell “Thinking for a Change”

Definition of Stress

Definition Of Stress Any Disruption of Homeostasis

(Balance)

Whether internal or external in origin

The Impact of StressThe Impact of Stress 43% of all adults suffer stress related adverse health effects.

75-90% of all visits to primary care physicians are for stress-related

complaints or disorders.

Stress has been linked to all the leading causes of death:

CVD, cancer, lung ailments, accidents, cirrhosis and suicide.

An estimated 1 million workers are absent each day with stress related complaints.

Stress is responsible for more than 25 billion workdays lost annually because of

absenteeism.

The Impact of Stress

Fight

What a Zebra NeedsRun fast

Fight HardEnergy

LightweightThink quickly

Block Pain

What You Don’t Need If You What You Don’t Need If You are a Zebraare a Zebra

Reproduction Energy storage Metabolism Growth Water wasting

Sleep Immunity

Hormone disruption Insulin resistance Thyroid dysfunction Decreased GI absortion Decreased kidney

function, water retention Insomnia Altered Immunity

What a Human Doesn’tNeedsRun fast

Fight HardEnergy

LightweightThink quickly

Block Pain

Adrenal Glands

Can You Measure Stress

Wilson J. Adrenal Fatigue, The 21st

Century Stress Syndrome

Ann Clin Biochem. 1983 Nov;20 (Pt 6):329-35. Salivary cortisol: a better measure of adrenal cortical function than serum

cortisol.

Vining RF, McGinley RA, Maksvytis JJ, Ho KY.

Salivary cortisol concentration was found to be directly proportional to the serum unbound cortisol concentration both in normal men and women and in women with elevated cortisol-binding globulin (CBG). The correlation was excellent in dynamic tests of adrenal function (dexamethasone suppression, ACTH stimulation), in normals and patients with adrenal insufficiency, in tests of circadian variation and randomly collected samples. Women in the third trimester of normal pregnancy exhibited elevated salivary cortisol throughout the day. The relationship between salivary and serum total cortisol concentration was markedly non-linear with a more rapid increase in salivary concentration once the serum CBG was saturated. The rate of equilibrium of cortisol between blood and saliva was very fast, being much less than 5 minutes. These data, combined with a simple, stress-free, non-invasive collection procedure, lead us to suggest that salivary cortisol is a more appropriate measure for the clinical assessment of adrenocortical function than is serum cortisol.

PMID: 6316831 [PubMed - indexed for MEDLINE]

Clin Endocrinol (Oxf). 1982 Dec;17(6):583-92. Salivary cortisol assays for assessing pituitary-adrenal reserve. Peters JR, Walker RF, Riad-Fahmy D, Hall R.

Cortisol concentrations were determined in matched samples of plasma and saliva from patients and healthy volunteers throughout the course of standard tests of pituitary and adrenal reserve. During insulin tolerance tests the percentage incremental changes in cortisol concentrations in saliva were strictly comparable with those in plasma and showed less inter-subject variance. The clinical decision taken with regard to the integrity of the pituitary-adrenal axis was the same whether plasma or salivary cortisol was measured. In the short tetracosactrin test changes in salivary cortisol reflected those in plasma and patients with loss of adrenal responsiveness would have been diagnosed as such using either measurement. In normal subjects, the circadian rhythm in salivary cortisol concentrations exactly paralleled that in plasma. Absence of the circadian rhythm in cases of hypercortisolism was seen as well in saliva as in plasma. Assays for salivary cortisol therefore provide information which is as clinically useful as that of plasma determinations. Since salivary cortisol concentrations were shown to reflect the free, biologically active fraction in plasma, salivary assay may, in selected cases, provide results of greater diagnostic significance than plasma total concentrations. PMID: 6762264

[PubMed - indexed for MEDLINE]

Wired(ADHD)

Anxiety And Anxiety And DepressionDepression

An imbalance of adrenalin and serotonin not a Zoloft deficiency

AdrenalinSerotonin

Stress and Cardiovascular Disease

Hypertension Atherosclerosis Decreased blood flow to heart Heart Attack Heart Failure

Things You Do Need if you are Things You Do Need if you are a Humana Human

Reproduction Energy Utilization Metabolism Growth Fluid Balance Sleep Immunity

Hormone disruptionInsulin resistanceThyroid dysfunctionDecreased GI absorptionDecreased kidney functionInsomniaDecreased immune

function

Stress and Hormones

Stress

www.Endotext.com

Things You Do Need if you are Things You Do Need if you are a Humana Human

Reproduction Energy Utilization Metabolism Growth Fluid Balance Sleep Immunity

Hormone disruptionInsulin resistanceThyroid dysfunctionDecreased GI absorptionDecreased kidney functionInsomniaDecreased immune

function

Stress Glucose and Insulin

Central fat accumulationDecrease in muscle and bone massCardiovascular disease

Things You Do Need if you are Things You Do Need if you are a Humana Human

Reproduction Energy Utilization Metabolism Growth Fluid Balance Sleep Immunity

Hormone disruptionInsulin resistanceThyroid dysfunctionDecreased GI absorptionDecreased kidney functionInsomniaDecreased immune

function

Stress and the HPT axisHPT axis::• CRH inhibits TSH directly, and TRH secondarily.• Glucocorticoids inhibit TSH, and T4 to T3

conversion.

Stress and Thyroid Function

Activation of the HPA axis is associated with decreased production of thyroid stimulating hormone (TSH) and inhibition of conversion of the relatively inactive thyroxine to the more biologically active triiodothyronine in peripheral tissues (the "euthyroid sick" syndrome) (81, 82). Although the exact mechanism(s) for these phenomena is not known, both phenomena maybe caused by the increased levels of glucocorticoids and theoretically serve a desired energy conservation during stress. Inhibition of TSH secretion by CRH-induced increases in somatostatin might also participate in the central component of thyroid axis suppression during stress.

81. Benker G, Raida M, Olbricht T, et al (1990) TSH secretion in Cushing's syndrome: Relation to glucocorticoid excess, diabetes, goiter, and the "the sick euthyroid syndrome." Clin Endocrin 133:779-8682. Duick DS, Wahner HW (1979) Thyroid axis in patients with Cushing's syndrome. Arch Intern Med 139:767-72

Things You Do Need if you are Things You Do Need if you are a Humana Human

Reproduction Energy Utilization Metabolism Growth Fluid Balance Sleep Immunity

Hormone disruptionInsulin resistanceThyroid dysfunctionDecreased GI absorptionDecreased kidney functionInsomniaDecreased immune

function

Bloating and Diarrhea

The Digestion Process

Eating

Digestion

Absorption

Assimilation

Elimination of waste

Water

Digestive Process Where in the Body FunctionEating/food choices Mouth/mind Portal for all nutrients/

materials to enter the body

Digestion Stomach/small intestine; to a lesser degree, saliva in the mouth

Breaks down food into basic components for use by the bloodstream

Absorption Small intestine/ large intestine, bloodstream liver

Food comes through the intestinal wall into the bloodstream

Assimilation Cellular Nutrients enter cells and are used for energy, storage, and structure

Elimination Colon, kidneys, skin, lymph system, cells and bloodstream

Wastes are excreted

Brain and Digestion Food choices

Herbivores Cravings

○ Low serotonin-carbs○ Low adrenal function- salt

Prepare for consumption of food

( enzymes, hormones)Relaxation

The GI Experiment Industrial Revolution

Refined sugar and flour became affordable

Frozen, packaged, microwavable, globally

shipped

Additives: preservatives, dyes, artificial

flavors and sweeteners

Stress, poor air and water quality

What You Are Eating 638 cans of carbonated drinks (age 12-29) 134 pounds of refined sugar 90 pounds of fats and oils 63 dozen donuts 60 pounds of cakes and cookies 23 gallons of ice cream 22 pounds of candy 8 pounds of corn chips, popcorn and

pretzels 7 pounds of potatochips

Why Are We Surprised That: Americans are fatter than ever More violent than ever Infertility rates are higher than ever New conditions are recognized i.e.

ADDADHD Chronic fatigueChildren committing suicide

Diabetes and Metabolic Syndrome in young children

The Liver and GI System Protects us from the environment and what we

eat

The liver has a finite functioning capacity

When the GI system is abused, our protection

from the environment is compromised

This allows the GI system to be an ideal point

of entry for disease causing antigens

Brain Digestive juices

Saliva

Enzymes

Digestive hormones

Receives satiety

signals

Digestive Process Where in the Body FunctionEating/food choices Mouth/mind Portal for all nutrients/

materials to enter the body

Digestion Stomach/small intestine; to a lesser degree, saliva in the mouth

Breaks down food into basic components for use by the bloodstream

Absorption Small intestine/ large intestine, bloodstream liver

Food comes through the intestinal wall into the bloodstream

Assimilation Cellular Nutrients enter cells and are used for energy, storage, and structure

Elimination Colon, kidneys, skin, lymph system, cells and bloodstream

Wastes are excreted

Stomach Begins protein digestion (pepsin and HCL) HCL

Break down proteins to amino acidsKills microbes

Lining protected by mucous produced by prostaglandins

Low acid = low B 12

Pancreas Digestive Enzymes

Lipase AmylaseProtease

Insulin Bicarbonate

Digestive Process Where in the Body FunctionEating/food choices Mouth/mind Portal for all nutrients/

materials to enter the body

Digestion Stomach/small intestine; to a lesser degree, saliva in the mouth

Breaks down food into basic components for use by the bloodstream

Absorption Small intestine/ large intestine, bloodstream liver

Food comes through the intestinal wall into the bloodstream

Assimilation Cellular Nutrients enter cells and are used for energy, storage, and structure

Elimination Colon, kidneys, skin, lymph system, cells and bloodstream

Wastes are excreted

Small Intestines

MicrovilliProduces digestive enzymesAbsorbs nutrientsBlock the absorption of non-

nutrients

Gut Associated Lymphatic Tissue (GALT)

Seventy percent of the immune system

Digestive Process Where in the Body FunctionEating/food choices Mouth/mind Portal for all nutrients/

materials to enter the body

Digestion Stomach/small intestine; to a lesser degree, saliva in the mouth

Breaks down food into basic components for use by the bloodstream

Absorption Small intestine/ large intestine, bloodstream liver

Food comes through the intestinal wall into the bloodstream

Assimilation Cellular Nutrients enter cells and are used for energy, storage, and structure

Elimination Colon, kidneys, skin, lymph system, cells and bloodstream

Wastes are excreted

Liver Manufactures and

MetabolizesCholesterolHormones

Regulates blood sugar

Processes all food, nutrients, alcohol, drugs etc

Liver Environmental toxins are an increasing

problem300,000 new chemicals are listed each yearWe consume 14 lbs of food additives each year70,000 are used in foods, drugs and pesticides

If the liver cannot detoxify the chemicals the chemicals are stored in tissues throughout the body

Digestive Process Where in the Body FunctionEating/food choices Mouth/mind Portal for all nutrients/

materials to enter the body

Digestion Stomach/small intestine; to a lesser degree, saliva in the mouth

Breaks down food into basic components for use by the bloodstream

Absorption Small intestine/ large intestine, bloodstream liver

Food comes through the intestinal wall into the bloodstream

Assimilation Cellular Nutrients enter cells and are used for energy, storage, and structure

Elimination Colon, kidneys, skin, lymph system, cells and bloodstream

Wastes are excreted

Large Intestine Function:

absorb water and remaining nutrients

Form stool○ Two thirds water○ Fiber and undigested food○ Living and dead bacteria

Intestinal bacteria Lower pH Produce vitamins A, B and K Produce short chain FA

(butyric acid) deficiency associated with colon cancer and IBD

Large Intestine Western diet produces 5 oz. of stool a day

Africans eating traditional diet produce 16 oz.

of stool

Normal bowel movements should be 2-3/day

The longer stool is in the bowel the more

reabsorption

Probiotic BenefitsNutritional Digestive Immune MetabolismManufacture vitamins in our foods and bodies

Digest Lactose Produce antibiotics and antifungals, breakdown bile acids

Breakdown and rebuild hormones

B3,B5,B6, B12, A and K

Regulate peristalsis

Manufacture EFADecrease pH

Promote healthy metabolism

Digest protein to release amino acids

Increase number of immune system cells

Convert flavonoids into useful forms

Establish good digestion in infants

Breakdown bacterial toxins reducing colitis

Normalizes serum cholesterol and triglycerides

Protect against xenobiotics and pollutants

Dysbiosis Caused by

Constant high levels of stress

Exposure to manufactured chemicals

Poor food choices

Oral contraceptives

Surgery

Use of antibiotics- Most common

Dysbiosis NSAIDS

Block prostaglandin induced repair of the intestinal lining

Poor diet-not enough nutrients to provide the building blocks for GI repair

Low stomach acid

Leaky Gut Syndrome Increased Intestinal

PermeabilityNot a disease,

however it can be manifested by an enormous variety of symptoms depending upon genes and ecology

This is a dysfunction of the “barrier function” the brush border

Leaky Gut Undigested food is

exposed to the immune system, IgG antibody production is stimulated

This leads to food sensitivities that have a delayed reaction

Symptoms Associated with Leaky Gut

Abdominal pain Asthma Chronic joint pain Muscle pain Fuzzy thinking Gas Indigestion Mood swings Poor immunity Recurrent vaginal

infections Skin rashes

Diarrhea Recurrent bladder

infections Fevers of unknown origin Poor memory Shortness of breath Constipation Bloating Aggressive behavior Anxiety Primary biliary cirrhosis Fatigue and malaise Toxic feelings

Things You Do Need if you are Things You Do Need if you are a Humana Human

Reproduction Energy Utilization Metabolism Growth Fluid Balance Sleep Immunity

Hormone disruptionInsulin resistanceThyroid dysfunctionDecreased GI absorptionDecreased kidney functionInsomniaDecreased immune

function

Stress

Things You Do Need if you are Things You Do Need if you are a Humana Human

Reproduction Energy Utilization Metabolism Growth Fluid Balance Sleep Immunity

Hormone disruptionInsulin resistanceThyroid dysfunctionDecreased GI absorptionDecreased kidney functionInsomniaDecreased immune

function

Tired then Wired

Psychoneuroendocrinology. 2005 Jul;30(6):568-76.Related Articles, Links  

Decreased cortisol awakening response after early loss experience.Meinlschmidt G, Heim C.

Division of Clinical and Theoretical Psychobiology, Department of Psychobiology, University of Trier, 54286 Trier, Germany.

Early loss experience (ELE) due to death or separation is a major risk factor for the development of several psychiatric and physical disorders in adulthood. Few studies have focused on the effects of ELE on neuroendocrine systems, which might mediate this risk in part. The goal of this study was to evaluate salivary cortisol responses to awakening in individuals with and without ELE. A total of 95 healthy college students (29 men, 66 women) completed a questionnaire on ELE and were instructed to collect saliva immediately after awakening and 30 min later. Fifty-five of the 95 subjects reported having experienced the separation or divorce of their parents and/or the death of a close relative before the age of 14 years. Subjects with such ELE exhibited decreased salivary cortisol responses to awakening compared to subjects without ELE (net increase: 4.78 nmol/l versus 9.83 nmol/l; t93 = 2.88, p = 0.005). The effect was most pronounced in individuals who experienced multiple types of ELE, while there were no sex differences. In conclusion, ELE appears to be associated with decreased salivary cortisol responses to awakening. Low cortisol awakening responses are believed to reflect altered dynamics of the hypothalamic-pituitary-adrenal (HPA) axis, possibly conferring risk for certain stress-related disorders.

Sleep Duration and Breast Cancer: A Prospective Cohort Study

Cancer Research 65, 9595-9600, October 15, 2005]

© 2005 American Association for Cancer Research Epidemiology and PreventionPia K. Verkasalo1, Kirsi Lillberg2, Richard G. Stevens7, Christer Hublin3, Markku Partinen6, Markku Koskenvuo4 and Jaakko Kaprio4,5

. Breast cancer incidence has increased during recent decades for reasons that are only partly understood. Prevalence of sleeping difficulties and sleepiness has increased, whereas sleeping duration per night has decreased. We hypothesized that there is an inverse association between sleep duration and breast cancer risk, possibly due to greater overall melatonin production in longer sleepers. This population-based study includes information from

women born in Finland before 1958. Sleep duration, other sleep variables, and breast cancer risk factors were assessed by self-administered questionnaires given in 1975 and in 1981. Breast cancer incidence data for 1976 to 1996 was obtained from the Finnish Cancer Registry. Hazard ratios (HR) and 95% confidence intervals (CI) were obtained from Cox proportional hazards models adjusting for potential confounders. Altogether, 242 cases of breast cancer occurred over the study period among the 12,222 women with sleep duration data in 1975. For these

women, the HRs for breast cancer in the short ( 6 hours), average (7-8 hours), and long sleep ( 9 hours) duration groups were 0.85 (CI, 0.54-1.34), 1.0 (referent), and 0.69 (CI, 0.45-1.06), respectively. Analysis restricted to the 7,396 women (146 cases) whose sleep duration in 1975 and 1981 were in the same duration group (stable sleepers) yielded HRs of 1.10 (CI, 0.59-2.05), 1.0, and 0.28 (CI, 0.09-0.88), with a decreasing trend (P = 0.03). This study provides some support for a decreased risk of breast cancer in long sleepers.

The Impact of Stress

Things You Do Need if you are Things You Do Need if you are a Humana Human

Reproduction Energy Utilization Metabolism Growth Fluid Balance Sleep Immunity

Hormone disruptionInsulin resistanceThyroid dysfunctionDecreased GI absorptionDecreased kidney functionInsomniaDecreased immune

function

J Natl Cancer Inst. 2000 Jun 21;92(12):994-1000.Related Articles, Links

Comment in: J Natl Cancer Inst. 2002 Apr 3;94(7):530; author reply 532-3.

 Diurnal cortisol rhythm as a predictor of breast cancer survival.

Sephton SE, Sapolsky RM, Kraemer HC, Spiegel D.

Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, KY 40292-0001, USA. sephton@louisville.edu

BACKGROUND:: Abnormal circadian rhythms have been observed in patients with cancer, but the prognostic value of such alterations has not been confirmed. We examined the association between diurnal variation of salivary cortisol in patients with metastatic breast cancer and subsequent survival. We explored relationships between cortisol rhythms, circulating natural killer (NK) cell counts and activity, prognostic indicators, medical treatment, and psychosocial variables. METHODS: Salivary cortisol levels of 104 patients with metastatic breast cancer were assessed at study entry at 0800, 1200, 1700, and 2100 hours on each of 3 consecutive days, and the slope of diurnal cortisol variation was calculated using a regression of log-transformed cortisol concentrations on sample collection time. NK cell numbers were measured by flow cytometry, and NK cell activity was measured by the chromium release assay. The survival analysis was conducted by the Cox proportional hazards regression model with two-sided statistical testing. RESULTS: Cortisol slope predicted subsequent survival up to 7 years later. Earlier mortality occurred among patients with relatively "flat" rhythms, indicating a lack of normal diurnal variation (Cox proportional hazards, P =. 0036). Patients with chest metastases, as opposed to those with visceral or bone metastases, had more rhythmic cortisol profiles. Flattened profiles were linked with low counts and suppressed activity of NK cells. After adjustment for each of these and other factors, the cortisol slope remained a statistically significant, independent predictor of survival time. NK cell count emerged as a secondary predictor of survival. CONCLUSIONS: Patients with metastatic breast cancer whose diurnal cortisol rhythms were flattened or abnormal had earlier mortality. Suppression of NK cell count and NK function may be a mediator or a marker of more rapid disease progression.

PMID: 10861311 [PubMed - indexed for MEDLINE]

CONCLUSIONS: Patients with metastatic breast cancer

whose diurnal cortisol rhythms were flattened or abnormal

had earlier mortality. Suppression of NK cell count and NK

function may be a mediator or a marker of more rapid

disease progression.

Chronic Fatigue

ADHD

Depression

Insulin Resistance

Fibromyalgia

3 Ways To Cope With Stress1. Eliminate the Stress

2. Change Your Response to the Stress

3. Prepare Your Body for the Stress

Popular Non-Diagnosis Chronic Fatigue Fibromyalgia Depression Attention Deficit Hyperactivity Disorder Irritable bowel Bipolar

J Clin Endocrinol Metab. 2001 Aug;86(8):3545-54.Related Articles, Links  

Hypothalamo-pituitary-adrenal axis dysfunction in chronic fatigue syndrome, and the effects of low-dose hydrocortisone therapy.

Cleare AJ, Miell J, Heap E, Sookdeo S, Young L, Malhi GS, O'Keane V.

Department of Psychological Medicine, Institute of Psychiatry and Guy's, King's and St Thomas' School of Medicine, London SE5 8AZ, United Kingdom. a.cleare@iop.kcl.ac.uk

These neuroendocrine studies were part of a series of studies testing the hypotheses that 1) there may be reduced activity of the hypothalamic-pituitary-adrenal axis in chronic fatigue syndrome and 2) low-dose augmentation with hydrocortisone therapy would improve the core symptoms. We measured ACTH and cortisol responses to human CRH, the insulin stress test, and D-fenfluramine in 37 medication-free patients with CDC-defined chronic fatigue syndrome but no comorbid psychiatric disorders and 28 healthy controls. We also measured 24-h urinary free cortisol in both groups. All patients (n = 37) had a pituitary challenge test (human CRH) and a hypothalamic challenge test [either the insulin stress test (n = 16) or D-fenfluramine (n = 21)]. Baseline cortisol concentrations were significantly raised in the chronic fatigue syndrome group for the human CRH test only. Baseline ACTH concentrations did not differ between groups for any test. ACTH responses to human CRH, the insulin stress test, and D- fenfluramine were similar for patient and control groups. Cortisol responses to the insulin stress test did not differ between groups, but there was a trend for cortisol responses both to human CRH and D-fenfluramine to be lower in the chronic fatigue syndrome group. These differences were significant when ACTH responses were controlled. Urinary free cortisol levels were lower in the chronic fatigue syndrome group compared with the healthy group. These results indicate that ACTH responses to pituitary and hypothalamic challenges are intact in chronic fatigue syndrome and do not support previous findings of reduced central responses in hypothalamic-pituitary-adrenal axis function or the hypothesis of abnormal CRH secretion in chronic fatigue syndrome. These data further suggest that the hypocortisolism found in chronic fatigue syndrome may be secondary to reduced adrenal gland output. Thirty-two patients were treated with a low-dose hydrocortisone regime in a double-blind, placebo-controlled cross-over design, with 28 days on each treatment. They underwent repeated 24-h urinary free cortisol collections, a human CRH test, and an insulin stress test after both active and placebo arms of treatment. Looking at all subjects, 24-h urinary free cortisol was higher after active compared with placebo treatments, but 0900-h cortisol levels and the ACTH and cortisol responses to human CRH and the insulin stress test did not differ. However, a differential effect was seen in those patients who responded to active treatment (defined as a reduction in fatigue score to the median population level or less). In this group, there was a significant increase in the cortisol response to human CRH, which reversed the previously observed blunted responses seen in these patients. We conclude that the improvement in fatigue seen in some patients with chronic fatigue syndrome during hydrocortisone treatment is accompanied by a reversal of the blunted cortisol responses to human CRH.

We conclude that the improvement in fatigue seen in some

patients with chronic fatigue syndrome during

hydrocortisone treatment is accompanied by a reversal of the

blunted cortisol responses to human CRH.

J Psychosom Res. 2000 Nov;49(5):335-42. Salivary cortisol patterns in vital exhaustion. Nicolson NA, van Diest R. Department of Psychiatry and Neuropsychology -

PAR 45, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. n.nicolson@sp.unimaas.nl OBJECTIVE: The syndrome of vital exhaustion (VE), a risk indicator for myocardial infarction, is characterized by excessive fatigue, irritability, and demoralization. Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis is a potential pathogenic mechanism in fatigue syndromes, but little is known about HPA function in syndromal VE. METHOD: We assessed basal free cortisol levels and responses to a speech task and to morning awakening by collecting multiple saliva samples over 2 days from 29 VE men and 30 controls. RESULTS: VE subjects reported higher perceived stress, poorer sleep, and greater fatigue than controls. Basal cortisol levels were lower in VE subjects, especially in the evening, and were negatively associated with fatigue. Overall cortisol responses to the speech task were similar in VE and control groups, although VE subjects were less likely to show large (> or =2.76 nmol/l) responses. The cortisol response to awakening was associated with concurrent fatigue and poor sleep quality. CONCLUSION: These findings suggest a subtle HPA hypoactivity in VE, which may arise

through chronic stress and associated sleep disturbances.

The cortisol response to awakening was associated with concurrent fatigue and poor sleep quality. CONCLUSION: These findings suggest a subtle HPA hypoactivity in VE, which may arise through chronic stress and associated sleep

disturbances.

Psychoneuroendocrinology. 2004 Oct;29(9):1184-91.Related Articles, Links  

Sleep disturbances are correlated with decreased morning awakening salivary cortisol.

Backhaus J, Junghanns K, Hohagen F.

Department of Psychiatry and Psychotherapy, University of Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany. backhaus.j@gmx.de

Morning and evening salivary cortisol levels were correlated with sleep parameters in 14 patients with primary insomnia and 15 healthy controls. Salivary cortisol was sampled immediately after awakening (T1), 15 min later (T2), and immediately before going to bed (T3) for 1 week at home. In parallel with this, subjects estimated parameters of sleep in a daily sleep log. Patients and controls were all non-smokers who did not differ regarding morning awakening time or bedtime. Cortisol after awakening was significantly decreased in primary insomnia. Salivary cortisol at the time of awakening correlated negatively with the subjective estimation of sleep quality, i.e. a low salivary cortisol level directly after awakening correlated with a higher frequency of nightly awakenings (r = -0.50), a diminished sleep quality (r = -0.34) and a decreased feeling of recovery after awakening (r = -0.35; all p < 0.05). Furthermore, awakening cortisol was negatively correlated with the Pittsburgh Sleep Quality Index (r = -0.43) and with a questionnaire on sleep-related cognitions with the subscales rumination in bed (r = -0.56 ) and focusing on sleep-related thoughts (r = -0.46; all p < 0.05).

Cortisol after awakening was significantly decreased in

primary insomnia. Salivary cortisol at the time of awakening

correlated negatively with the subjective estimation of sleep

quality, i.e. a low salivary cortisol level directly after

awakening correlated with a higher frequency of nightly

awakenings (r = -0.50),

Ginseng improved fatigue in 25% of cancer patients Compared to 10% on placebo

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