Natural Health Magazine: Interview on Low Libido

Thrilled to be interviewed in Natural Health, published in the April/May 2011 issue. Most of what I said about hormones and how they modulate libido got cut. My main point that libido is extremely complex (and that 70% of the time there's a hormonal component) but that there are many other factors including relationship connectivity - at least that made it in. Click here to read the article.

My long answer on how to manage adrenal dysregulation got distilled into a cliched soundbite: meditate and exercise. Excuse me? That is so not helpful. There's a much bigger story here, but still, it's a start. We gotta start somewhere.

BTW, does anyone know how to post a PDF on blogger? Haven't figured it out yet, so had to send you to my website, where I do know how to post PDFs.

Fried: Why You Burn Out by Joan Borysenko, PhD

I'm loving Joan Borysenko's new book, Fried... except I think I'm fried. I hate it when that happens. I immerse myself, write and teach what I most need to learn.

Joan refers to one symptom of burnout - the desire to take sabbaticals regularly - and that totally rings true for me, like an arrow to the chest. How can we move forward with our work, repair the world, heal others and not be desperate for a sabbatical every other minute?

Here's Joan in the early part of the book, when she was recognizing some of her symptoms of burnout:

I discovered that burnout is very poorly understood. None of the healers whom I consulted - either the traditional or the complementary - understood what the mechanics of burnout are and what is needed for recovery.


I realized that unless the condition is recognized and taken seriously, physicians will keep missing it and handing out antidepressants. While medication can affort temporary relief for some people, it may also short-circuit the process of self-reflection which is ultimately where healing comes from.

Plus we know that anti-depressants probably don't help mild to moderate depression - they are effective for severe depression but side effects (low libido, weight gain) may make them worse than placebo.

Here are some favorite questions she posits.

• In what ways do adverse experiences in childhood lead to learned helplessness that increases your chances of burning out as an adult?
• How can you learn to manage your energy and find a dynamic state of balance?
• Once you pinpoint your temperament, how can you match it to the right kind of work?

As you know, I am one-half physician/scientist and one-half yoga teacher. The former likes data, and turns out there are good outcomes measures of burnout, such as the Maslach Burnout Inventory, which queries 3 aspects of burnout:

1. emotional exhaustion - deep fatigue and feelings of being emotionally drained and overwhelmed;
2. depersonalization - a loss of self and a cynical disregard for the people you serve or live with;
3. diminished personal accomplishment - a progressive loss of confidence and competence.

I think burnout may be the new liminal space from which to most effectively prevent depression, addiction and degenerative disease.

Joan weaves an interesting new voice in her book - that of her Facebook Friends. Joan writes that one FB friend: "used to think that being burned out was an admission that something was wrong with her. Now she views burnout as an invitation to come into alignment with a more elegant expression of her gifts, relationships, and overall life energy."

More elegant expression of my gifts, relationships and energy? Yes, that is what I'm seeking too.

This is from Joan's Facebook Friend, Shannon Kennedy:

The body is where I would start to deal with burnout so that I wouldn't need to take long sabbaticals to collect my parts and return them to their original location. So often we intellectualize and go to the mind to think things through, jumping right past the physical discussion our body is having right under our nose. My perspective is this: getting to know where you feel contracted in body, thought and emotions and what it feels like to release that holding is the way out of burnout.


We are fluid, flowing beings, and when we are in nonstop mode, we are perpetually in a holding contraction, thinking that we are stabilizing. OUr body is actually working overtime to support our mind's directives, like a loyal canine companion. Because of this contraction, no blood/prana can flow.

Here's to releasing contraction in the way that serves you best, whether that is yoga, meditation, tai chi or some other contemplative practice.

Vacation: Rejuvenation Station

In my work as a hormone guide, I find the adrenals are the hardest to nurture and tonify. Our lives are so hectic, particularly in the Bay Area. But nothing nurtures and tonifies as much as a fabulous vacation.

In Ayurveda, they say that illness develops when you move to fast, when your body cannot catch up with your Being. This happens with trips that require airplanes or long car-rides. Solution? Bolinas!

I'm blessed to own my integrative medicine practice and to set up at the outset that I will be unavailable (the doctor is "out") for the month of August and for a month mid-December to mid-January. My adrenals demand it. It allows me to connect to my true Self, to reconnect to what is important, and to develop new ideas about to help you even more deeply and efficiently.

Here are some highlights of what was particularly helpful and healing on my August vacation.

First, one word: Bolinas. Ah, I just love to say it: Bolinas, Bolinas, Bolinas. We stayed in the house above for three days. It was so deeply relaxing, it felt like three weeks. Why? Soulful space.

We, as a family, did yoga daily, meditated, ate amazing local food from the Bolinas' People's Co-op, drank tea, had Big Thoughts, Big Conversations, Lingering Dialogues.

And then there was the Japanese soaking tub. OMG. Fantastic. I'm sitting there, chillin', or perhaps more accurately, sweatin', and in hops a little frog.

Hello, Sweet Frog. He hopped away before I could kiss him.

Darling Husband, David Gottfried, loved Bolinas because we were off the grid. He loves that in a vacation destination.

I just love getting re-energized about my path. Spent the month thinking about how aligned I am with my dharma or purpose. How can I make adrenal buoyancy more a daily part of my life for both me and my patients. Ideas? I'm reviewing Ayurveda and the wisdom it offers to us householders and forest dwellers. Stay tuned! Vacation ends Monday, August 30.

Memo to Your Thyroid: Role of Adrenals & Estrogen/Progesterone, etc

Somehow I made it through med school, residency and years of medical practice before I figured out a key epiphany: interdependence of the glandular systems of thyroid, adrenals and sex hormones (estrogen, progesterone, testosterone). Turns out I needed to teach it to myself - it's not in the medical textbooks or even conventional medical discourse. Once I got "it," meaning how all these crazy thryoid, adrenal and sex hormones fit together, much of my thryoid chaos fell away, for myself and more importantly, for my patients.

Here's the memo I never got.

1.   Got estrogen? Got too much estrogen? Estrogen dominance is common with hypothyroidism. Symptoms are: moodiness, cysts (ovarian, breast), weight gain, night sweats/hot flashes, irregular cycles. Too much estrogen raises thyroid-binding globulin, and this in turn can bind your free thyroid hormones, even if they are present in the right amounts. Think see-saw: if estrogen is high, free thyroid hormone is low. And vice-versa.

2.   Conversely, hypothyroidism causes sex-hormone binding globulin (SHBG) to decrease – this raises both free testosterone and estrogen. Note the significant overlap between estrogen dominance and hypothyroid symptoms – there is both redundancy in this system and crossover. Best fix: balance both systems simulataneously or sequentially. Most conventional docs will look at you like you’re nuts if you mention estrogen dominance – find an integrative doc here or test yourself.

3.   Adrenals operating properly? Adrenal function and thyroid function have a relationship also like a see-saw: when one is up, the other is down. Get both systems balanced so the see-saw is even.

4.   More on cortisol: correct amount of cortisol (not too much, not too little) helps the conversion from T4 (inactive thyroid hormone with 4 iodine atoms) to T3 (active form – 3-4 times more potent than T4, 3 iodines). You can check a questionnaire to assess for this, or even better, get it tested right here. Another benefit of balanced adrenal hormones is less thyroid inflammation.

5.   Polycystic ovaries? Another key aspect of interdependence is the dance between PCOS, your adrenals and your thyroid.  While the cause isn’t well-delineated, I believe most of PCOS begins with the stress cascade of overtaxed adrenals and too much cortisol in the fight-flight-collapse response, and leading to insulin resistance (typically defined as fasting insulin > 7), which is toxic to the ovary and makes progesterone levels drop. This leads to irregular cycles and imbalanced hormones (high androgens, high estrogens). One treatment is more progesterone, preferably the natural flavor as Chastetree Vitex, progesterone cream or prometrium. But that’s another blogpost for another day. Key point is that high cortisol when stressed can block your progesterone receptors, keeping the progesterone you make from doing its job. Another cause of high cortisol? HYPOTHYROIDISM! Oy, interdependence is a vicious cycle until you understand it. But know this: women with PCOS are four times more likely to have hypothyroidism due to autoimmune thyroiditis

6.   Speaking of inflamed thyroids, have you been tested for thyroid antibodies? Know your titers? Crucial, my friend. More often than not, your under-active or over-active thyroid is a result of autoimmune thyroiditis. What makes autoimmune thyroiditis worse? You guessed it, adrenal dysregulation and estrogen dominance. Oh, and digestive inflammation.

7.     Iodine, as the differentiator between thyroid hormones, is essential to the right balance of thyroid. I find most of my patients are deficient in the Bay Area of California, but too much can cause problems too. Best plan of action is to perform a iodine challenge test, available through Meridian Valley Labs in Washington among other places.

8.     Nutrition – what does that have to do with hormones? A ton. Just going gluten-free reduces estradiol (the key estrogen of our reproductive years and bioidentical hormone therapy in women 40+) by 30-40%. Big help if you’re estrogen-dominance.

9.     Got goitrogens? I’ve never heard a conventional doc talk to patients about foods (called goitrogens) that lower your thyroid function. Tell me your stories of docs who are sharing this info! Yet, as with most things, the info is easy to find online. Raw foods are lightly goitrogenic (cooking inactivates the goitrogenic compounds). Short version: strawberries, pears, peanuts, pine nuts, cassava (yucca), Brassica veggies such as broccoli, bok choy and brussel sprouts. I know, I know – they help your estrogen metabolism but recall the see-saw analogy.

10.  Polyendocrinopathy? Long word, key concept – refers to more than one endocrine gland malfunctioning at a time. Sometimes the thyroid is the first to manifest (or perhaps more commonly, the only one to be tested and/or recognized by your doc), yet one or more endocrine glands is on the wane. This can cause a more complex array of symptoms that are harder to treat. This is where a root cause analysis and step-wise or multi-system hormone treatments can be helpful.

You maybe wondering with all this complexity and interdependence, which is the chicken and which is the egg? Often we don’t know. That’s where balancing all three systems either simultaneously makes the most sense.

For more info, visit my website and like my Facebook page, all available right here.

Originally posted on the fantastic site for thyroidistas, Dear Thyroid.

Resolving Differences in Libido

Yesterday, I taught "Yoga for Restoring Energy & Libido" at Yoga Kula in Berkeley, and realized afterward that we didn't spend the 10-15 min I had prepared on how to resolve differences in desire, and sometimes, when needed, to compensate for both high and low libido when your libido is discordant than your partner's. Most partners have discordant libido, and how your find the middle path together is an essential part of a deepening, mature, mutually toe-curling sexual connection.

I mean "compensation" in the most loving, inclusive way -- such as how a kinesthetic learner would compensate for a class that requires visual learning, such as in Art History. I mean it with no judgment and no shame associated with it.

If you have low libido, I recommend a comprehensive medical exam, ideally with someone who is well-versed in hormones and their role in energy and libido. While causes for low libido such as adrenal dysregulation, fatigue, low testosterone, estrogen dominance, and underactive thyroid are described in previous blogs, as well as their natural solutions, I will focus here on the ways that have been shown to help bridge the divide if you have a partner with a higher or lower desire than yours, at least stronger than yours, and perhaps it's motivating you to do something about it.

For those with low libido:

1. Lean into your strength - Identify and fortify your sexual strengths. Even when desire is relatively low, often other aspects of your sexuality such as technique, variety, talking about sex, sensuality, romance, verbal intimacy or body image are areas where you are interested in putting more energy. For more info on this, and to perform a helpful survey to identify your sexual strengths and your partner's, read Pat Love's book, Hot Monogamy, esp pages 18-39, Mapping Your Sexual Relationship. 
2. Realize the power of receptivity. Recent thought leaders such as Rosemary Basson have recognized that spontaneous drive is common for men, and relatively uncommon for women. In fact, our most recent conceptual model shows that women do not need to have sexual desire or drive to have a satisfying sexual connection with their partner. Further, many women have difficulty distinguishing desire from arousal. Sometimes just a small opening in our receptivity to our partner's bid for sex can mean the difference between a mutually satisfying sexual connection and a connection that causes distress. 
3. Fan the fire when it strikes. Sometimes we have a small glimmer of interest in sex or sensuality, and the more we act on it, fan it, encourage it, the better. A crucial task here is to identify patterns in your life that are associated with greater libido: perhaps Friday or Saturday is a better day for you than during the week, maybe it's after your husband watched the kids while you went to a yoga or meditation workshop. Maybe it's day 9-14 of your menstrual cycle, when testosterone peaks.
   

For those with high libido:

1. Initiate sex out of love and desire, not habit. We often get locked into how sex needs to be, and breaking out of this habit will create more life and vitality in your connection. 
2. Improve technique. New expertise in love-making can go a long way in getting your less libidinous partner interested and receptive to your bid. We can always learn more and try new things. If you live in the Bay Area, attend a workshop at Good Vibes in Berkeley, or Celeste and Danielle's Become An Extraordinary Lover.  
3. Be respectful of your partner's parameters on sex. This requires verbal fluency in talking about sex, and how to optimize your partner's interest and openness to your bid. Ask your partner what some of their preconditions for sex are (kids are in bed and asleep, dishes are done, prefers sex in the mid-day), and do your best to satisfy them. 
4. Don't take your partner's lower libido personally. Many of us are just born with lower libidos - it's a bell-shaped curve. Find the way to negotiate a mutually satisfying plan for sex that honors your needs as well as those of your partners. Your partner's low libido is your issue as a couple - do not make your partner feel inadequate or that there is something wrong. 
5. Broaden your definition of sex. One brilliant sex therapist I love, Ruth Cohn, defines sex as "any erotic activity that is pleasurable, connecting, makes me feel good about me, good about you (my partner) and good about us." You can create your own list of what would now be defined as sexual activity, and it may include watching a romantic movie together while you hold hands and laugh together, or giving each other a massage and delighting in the pleasure of touch without it becoming sexual.

Yoga: Proven Benefits for Anxiety, Depression & Adrenal Dysregulation

If you practiced yoga daily, you wouldn’t need us doctors at the Gottfried Center to help you feel optimized. Yoga will change your life, for the good, but only if you commit deeply. You cannot proceed casually and expect transformation. Part of my job is to provide evidence to you – evidence that, in this case, yoga heals and transforms. What follows is the science supporting yoga for anxiety, depression and adrenal dysregulation, conditions that affect 100% of you. Please also keep in mind the wise words of BKS Iyengar:

“Words fail to convey the total value of yoga. It has to be experienced.”

Anxiety. There is 100% incidence of anxiety in our culture. There is a broad spectrum here from a little worry to the more debilitating problems such as obsessive thinking, insomnia, migraines, panic attacks, shortness of breath and palpitations. Excessive worry blocks healing. Simple tools such as deeper, belly breathing can help. Specifically, deep, slow breathing activates the Parasympathetic nervous system and releases the body’s own valium – GABA. Generally, we know that yoga increases our GABA levels. Other scientific evidence? Two studies show that yoga is as or more effective than tranquilizers such as Xanax or Ativan. In Germany, a group of 24 women with anxiety were randomized to two 90-minute yoga classes per week for 3 months or a waitlist. Significant reductions in both anxiety symptoms and salivary cortisol levels were found in the yoga group. Also interesting was that the women who reported headaches or back pain noted marked relief from pain.

Depression. Don’t co-opt the message from your conventional doctor that the answer to your sluggish mood and lack of joy can be found in a pill. Here’s the science: (1) A randomized trial from UCLA of 28 women with mild depression were treated with yoga twice/week compared to a control group placed on a waitlist. The yoga group had significant improvements in mood and anxiety, after only 2.5 weeks in class. (2) Another study of 80 people found that yoga for 3 to 6 months was as effective as a older treatment for depression – a tricyclic antidepressant (TCA), imiprimaine. Both yoga and the TCA raised serotonin and resolved symptoms, and while yoga took a little longer to have a significant effect, the effect lasted longer when patients stopped the therapies. Another randomized trial of Mindfulness-Based Stress Reduction showed it cut the recurrence rate for depression in half.

Adrenal dysregulation. If you have high cortisol levels, yoga has been shown to lower cortisol. High cortisol can cause depression, bone loss, poor memory and thick waistlines. Yoga activates the parasympathetic nervous system, which balances our chronically-activated sympathetic nervous system, or “fight or flight.”

Many of us look for a quick fix for depression, anxiety, fear, insecurity, stress, relationship problems, feeling numb, and emotional immaturity. Go with the long view: figure out what's not working for you and slowly manifest what would suit you better. Yoga helps you cultivate joy, peace, radical self-acceptance and vibrant health. It's proven.

Adrenals Burned Out?

Adrenal fatigue or dyregulation is the change in the ability of the adrenal glands to carry out their normal job. The main symptoms is fatigue, or in the case of hyperadrenalism, feeling tired but wired.

In response to chronic stress, many folks suffer from adrenal dysregulation, which can be either low production of adrenal hormones (hypoadrenalism) or high production, or a combo of the two. Many of my patients wake up in the morning with low cortisol, drink a cup of coffee to wake up, and then have high cortisol (coffee raises cortisol) and feel wired. Then they’re exhausted when the caffeine wears off by 2-4pm.

What causes adrenal fatigue? At Gottfried Center for Integrative Medicine, every case is individualized, but there are four common causes as identified by Dr. James Wilson:

• Disease that overwhelm the body such as auto-immune conditions or cancer;
• Physical stress such as poor nutrition, addiction (especially to sugar and/or flour), injury, exhaustion;
• Environmental stress, e.g., toxic chemicals in air, water, clothing or food;
• Emotional stress – usually arising from relationship, work or psychological sources.
  

Overlap with other hormone systems
Over 80% of people with adrenal dysregulation suffer from some type of decreased thyroid function. We often find that people who have both adrenal dysregulation and hypothyroidism do not get relief from thyroid replacement alone, and need adrenal support to get better. Dr. Marsha Nunley, MD, and Dr. Charlotte Massey, ND, L.Ac., are especially good at addressing both simultaneously. Dr. Nunley is available to coach patients who live outside of California, but you must visit her in Oakland to receive prescriptions.

Testing
We recommend saliva or blood testing to check your adrenal function. For your adrenal home test, order a diurnal cortisol test. Alternatively, ask your doctor to order a morning cortisol level in your blood. For your thyroid, we recommend TSH, free T3 and free T4 tests.

Adrenal Dysregulation Syndrome

This is a fantastic review of Adrenal Dysregulation (aka "Adrenal Burn Out" or "Adrenal Fatigue" in other circles) by our Portland neighbor and wise doc, Tori Hudson, ND. Stop that coffee, People! Drink yerba mate or green or white tea!

ADRENAL DYSREGULATION SYNDROME and ELEVATED SALIVARY CORTISOL LEVELS

Tori Hudson, N.D.

First things first: A bit about the naming of adrenal fatigue and adrenal failure. Most practitioners of alternative medicine often use the term adrenal fatigue or adrenal failure to name the complex array of symptoms their patient is having, presumably related to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. I would assert that the term adrenal failure should be reserved for Addison's disease. What we are looking to name, is not adrenal failure, or even adrenal fatigue necessarily, but a syndrome with several phases and many different manifestations, caused by dysregulation/dysfunction of the HPA axis. As such, I would propose we avoid the terms adrenal failure or adrenal fatigue, and rather use the term adrenal dysregulation syndrome.

Adrenal functions and stress adaptation mechanisms are among the most far reaching network of endocrine, nervous and immune system interactions regulating our life. The HPA glands and their interactions are responsible for the secretion of critical hormones vital to the control of carefully orchestrated production, synthesis and communication of these hormones. In response to stress, the hypothalamus secretes corticotropin-releasing hormone (CRH) that then stimulates the anterior lobe of the pituitary gland to secrete adrenocorticotropic hormone (ACTH). ACTH then reaches the adrenal cortex and cortisol is synthesized and secreted into the bloodstream. This hormone, cortisol, is the major glucocorticoid that acts as both mediator and inhibitor of the stress response. Cortisol is an insulin antagonist and maintains blood glucose levels by inhibiting glucose uptake and oxidation.[i] Its enhancement of catecholamine release leads to improved cardiac function and blood flow. Cortisol also suppresses collagen synthesis, osteoblast activity, hematopoiesis, protein synthesis, immune responses and kidney function.

Under usual circumstances, our stress response, and the acute/alarm phase is temporary. The HPA axis is under negative feedback control from cortisol. Cortisol then is the primary regulator of the HPA axis with negative feedback on ACTH and CRH, exerting its control of both the hypothalamus and the pituitary gland. Under prolonged stress or increasing intensity of the stress, the HPA axis no longer responds to this negative feedback. This prolonged stress response can then cause continuous cortisol synthesis and chronically elevated cortisol levels. In this state of prolonged stress, increased cortisol levels are linked to metabolic syndrome, overweight and obesity, chronic fatigue syndrome, chronic inflammatory states, coronary artery disease, anxiety, insomnia, depression, and more. This is referred to as the resistance phase of the stress adaptation syndrome. If allowed to persist, there is a significant increase in risk of these diseases. This can also lead to the final stage of the stress adaptation syndrome, i.e. exhaustion. This exhaustion phase may manifest as more acute and serious collapse of vital organ systems and functions.

A comprehensive medical and social history will be the primary tool that will help to identify our patients' phase of stress. Physical exams and select laboratory testing will help to determine not only underlying causes of stress, but also help to diagnose current diseases and to evaluate for risk factors for other significant concerns. This in turn will help with prioritizing treatments and strategizing risk reduction with the goal of restoring hypothalamic-pituitary-adrenal balance.

Many, if not most of the manifestations of chronically elevated cortisol, are more common in women. For example, chronic fatigue syndrome (CFS) occurs more frequently in women than in men. Most commonly, the onset is between 20 and 40 years of age. The majority of patients are middle class and in the helping professions such as nurses, doctors and teachers. Overweight, obesity, insomnia, depression, anxiety and metabolic syndrome, all associated with chronically elevated cortisol levels, are also among the health disorders more common in women. In addition, the hormonal influences of premenstrual syndrome, postpartum, perimenopause and menopause add another layer of complexity and interaction unique to women and adrenal regulation.

It is this chronically elevated cortisol state, most easily identified with salivary cortisol testing, that I wish to address in the rest of this article.

The most effective way to manage chronically elevated cortisol levels is to ensure that the adrenal glands are supported with the proper nutrients. Vitamin B6, pantothenic acid, and vitamin C, often become depleted when the demands on adrenal gland cortisol production are continuous. An abnormal adrenal response, whether it is deficient or excessive hormone release, can be in large part addressed with these key nutrients. These nutrients play a critical role in the optimal function of the adrenal gland and in the optimal manufacture of adrenal hormones. Levels of these nutrients can be diminished during times of stress. Urinary excretion of vitamin C is increased during stress. A deficiency of pantothenic acid results in fatigue, headaches, insomnia and more. L-tyrosine and L-theanine support the adrenal glands by combating fatigue and anxiety related to stress. In addition, the cortisol feedback control mechanism is dependent on adequate amounts of calcium, magnesium, potassium, manganese and zinc.

Ashwaganda (Withania somnifera), also known as Indian ginseng, has been in historical use in the Ayurvedic medical system for over 3,000 years. Ashwagandha has been shown to reduce corticosterone, a glucocorticoid hormone structurally similar to cortisol., An array of clinical trials and laboratory research also support the use of ashwaganda in enhancing mood, reducing anxiety and increasing energy. , , 10 ,

Magnolia (Magnolia officinalis), also known as Holly Bay and White Laurel, has been historically used for weight loss, obesity, anxiety, stress, depression and inflammation. A randomized, parallel, placebo controlled study in overweight premenopausal women resulted in a decrease in transitory anxiety, although salivary cortisol levels were not significantly reduced. Through some of its reported antidepressant and anxiolytic effects, magnolia can improve mood, increase relaxation, induce a restful sleep and enhance stress reduction.

A proprietary blend of two plant extracts, one from Magnolia officinalis and the other from Phellodendron amurense has shown promise in lowering cortisol. In initial evaluations, by the research and development company behind this proprietary product, they found that eight out of 10 stressed individuals felt more relaxed, seven out of 10 enjoyed more restful sleep, and nine out of 10 said it was gentle on the stomach.

In a study conducted at the Living Longer clinic, in Cincinnati, Ohio by Dr. LaValle, (unpublished), the same proprietary blend was shown clinically to normalize the hormone levels associated with stress-induced obesity. It was demonstrated that this combination lowered cortisol levels by 37 per cent and increased DHEA by 227 per cent.

Phosphatidylserine (PS), also known as lecithin phosphatidylserine, is a fat-soluble phospholipid that is the most abundant phospholipids in the human brain. PS is a component of the mitochondrial membrane where it serves as a reservoir for other phospholipids. It is vital in neuronal membrane functions, signal transduction, cell-to-cell communication, cell growth regulation and secretory vesicle release. We obtain most of our PS from dietary sources, although we do synthesize PS as well. PS is known to blunt the rise in cortisol and ACTH following strenuous training, and significantly reduce both ACTH and cortisol levels after exposure to physical stress. Phosphatidylserine also has been shown to improve mood.

Combinations of the above mentioned ingredients can be used together and in multiple ingredient formulations as part of a whole system approach to correcting adrenal dysregulation with elevated cortisol levels. In a recent unpublished study of another proprietary formula, study subjects took a product containing ashwagandha, phosphatidylserine, magnolia and L-theanine. The nutritional/botanical supplement consistently decreased salivary cortisol levels in relation to baseline levels. In addition, participants reported increased relaxation, improved sleep, deeper sleep, and reduced stress levels.

Numerous other adaptogens may be considered in cases of adrenal dysregulation. Traditional herbal definitions of an adaptogen states that an adaptogen is an agent that produces a nonspecific response to counter physical, chemical or biological stressors, thus allowing the body to "adapt" to the stressful circumstance. This normalizing influence on physiology is irrespective of hyperfunction or hypofunction of an organ or organ system. Western botanical researchers look at the effect of adaptogens on regulating the hypothalamic-pituitary-adrenal axis and use them to regulate the neuroendocrine and immune systems. Adaptogenic herbs support the entire neuroendocrine system, in particular the adrenal function and the stress response, which results in a modulating and regulating effect on the use of cortisol. Adaptogens known for their anti-stress qualities and stabilizing effect on the HPA axis include American ginseng, ashwagandha, Asian ginseng, astragalus, cordyceps, reishi, eleutherococcus, holy basil, rhodiola, schisandra, and licorice. Again, combination/multi-ingredient formulations are common in a whole system approach to restoring adrenal regulation.

Reducing cortisol levels and restoring adrenal regulation can be a very effective management approach to addressing stress management, chronic fatigue, sleep disturbances and anxiety, while also reducing the long term risks associated with elevated cortisol levels.
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