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. [email protected]
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. [email protected]
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. [email protected] 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. [email protected]
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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