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Cortisoltoo low in the day, too high at night: Resetting you cycle of cortisol secretion

Many people spend their mornings trying to "get going" with coffee. But too many people I've consulted witheven after they had one, two, or three cups of coffee, which should rouse themare still as lethargic as the young lady to the right. An impatient middle-aged boss is likely to look at this young lady and reach a reflex conclusion: "She partied too late last night and blew off getting enough sleep. Tough for her! She's not going to get any slack from me today!" He may be right. But maybe not. We consult with many peopleincluding young ones! whose fatigue at work is caused not by neglected sleep, but by one or two fairly easy-to-fix problems: They make far too little cortisol, or they secrete so much at night that they have too little left during the day. For those who produce too little cortisol altogether, the fix is usually quickthat is, if they are assertive with their corrective care. A high enough dose of cortisol (but within the physiologic range) relieves some people's cortisol deficiency symptoms such as fatigue within the first week of care. For those who self treat,Isocort is the preferable product for a rapid relief. Fortunately, with what I call a "rehabilitative approach," many people need to use Isocort only for a month or two. But it's not people with low total cortisol output that I want to address here. Instead, it's those who produce enough cortisol overall, but secrete too much of it at the wrong time of their 24-hour cycle.

Most of you who've tested the free cortisol in your saliva have probably done it in the standard way: You took 4 saliva samples during the day: upon awaking, around noon, in the late afternoon, and just before bed. Having taken these 4 standard saliva samples, people who produce too little cortisol overall have 4 cortisol levels somewhat like those in Graph 1 (shown by the circles along the solid white line). It's not rare, however, for a person's 4th cortisol level to be like that in Graph 2 below. I call this 4th level "suspicious." This person's cortisol levels during the daytime are obviously too low. And the rise in the late evening raises my suspicion that he or she may be secreting too much cortisol at night, which can disrupt sleep. Symptoms consistent with high nighttime cortisol, for example, are waking up repeatedly during the night, or waking up feeling like sleep hasn't been deeply restful.

Long ago, I began asking people to do a cortisol test other than the standard one that includes 4 saliva samples during waking hours. The alternate test is an 8-saliva-sample test through a full 24-hour time. In doing the 8-sample 24-hour test, they take the customary 4 saliva samples during the day. In addition, though, they take 3 more samples through what should be their sleep time at night. They take the last saliva sample, the 8th, upon waking (or getting up for the day) the next morning. Often, the cortisol levels we find are like those in Graph 3 (in the right column). For most of these people, their low daytime and high nighttime cortisol levels correspond to their symptoms. For example, they are usually tired during the day and can't sleep, or can't sleep restfully, during the night. Fortunately, the fix I recommend for this abnormal circadian cortisol rhythm, Seriphos, is relatively inexpensive and usually works well. But I'm getting ahead of myself (more about Seriphos below). Taking Saliva Samples at Night. If you wake up repeatedly through the night, taking the 3 nighttime saliva samples may be no problem for you. You may wake up plenty enough times to take the samples. You should keep cold water close-at-hand. Before taking the nighttime saliva samples (just like during the day), you should hold the cold water in your mouth for a minute or two. Hopefully, you can then drift back off to sleep

In Graph 3 above, the person's nighttime cortisol levels are higher than her daytime levels. When factors such as shift-work don't interfere, Seriphos may lower the nightime levels. This will leave her with more cortisol in reserve to be secreted during the stresses of her days. Her 24-hour cortisol levels will then resemble those in Graph 4 below. at least for a while. If you don't wake up repeatedly through the night, having a caring loved one who'll gently wake you is optimal. However, you may have to set a soft cell-phone alarm that gently rouses you from sleep. Of course, you don't want to use a loud alarm that startles you out of sleep.

A potential criticism of the nighttime sample-taking is that artificially waking yourself may raise your cortisol level. That's true. But consider this: If your cortisol levels in your daytime samples are low (as in Graph 3 below), secreting an appropriateamount in response to an alarm at night shows us exactly what we want to know: That is, do you have an abnormal circadian secretion of cortisol? Do you make enough cortisol and hold it in reserve during the day, and for some reason secrete it readily at night? Or do you produce a normal amount of cortisol but have little left during the day after secreting too much too easily at night? Resetting Your Cycle of Cortisol Secretion. If you turn out to have high cortisol at night and too little left for the day, you may be able to reset your pattern of cortisol secretion. Your aim, of course, will be to bring about optimal cortisol levels during your whole 24-hour cycle. This optimal pattern is roughly shown in Graph 4 (below). In this pattern, cortisol is low enough during sleep so that it doesn't interfere with sleep. Then upon waking, cortisol secretion is at its highest point. The level should then decrease during the rest of the day and evening, with one exception. During stresses even late in the day, you want to have enough cortisol in reserve to provide an adaptive cortisol spike.

Recovering reasonably normal cortisol levels during the day and night isn't easy for someone troubled by high nighttime cortisol. For example, a person's cortisol can be high too much of the night because of low blood sugar levels at night. Seriphos might help this person sleep better, but the proper solution in her high nighttime cortisol is to arrange to have normal blood sugar levels through the night. The scenario I've presented in this article, then, is "cleaner" than some people's effort to lower their cortisol levels at night. But many people's cases have been as clean as this scenario. It is from those people's successes withSeriphos (sometimes used in conjunction with Isocort) that I composed this article.

Seriphos or Phosphatidyl Serine. The product I recommend for resetting one's cycle of cortisol secretion, as I mentioned above, is "Seriphos." This product contains the amino acid "serine" bound to pure phosphorus. (Seriphos is technically called phosphorylated serine. The term "phosphorylated" is pronounced fos' fr' i lted.) The product also contains a synergistic compound called "ethanolamine." Seriphos usually isn't sold at health food stores and most pharmacies. At those outlets, you'll usually find a related product called "phosphatidyl serine." (Phosphatidyl is pronounced fos' f tid' l.) This product works as well as Seriphos, but I recommend Seriphos for several reasons. Cost & Composition. My first reason for preferring Seriphos over phosphatidyl serine is one of great importance to steadily more people todaythat is, cost. In general, Seriphos is substantially less expensive than phosphatidyl serine.

The serine in Seriphos is from vegetables and the phosphate is pure. In contrast, the phosphorus in phosphatidyl serine is typically derived from soy. Many of the people we consult with have sensitivities to soy or actual soy antibodies. In avoiding soy-containing products, these people avoid phosphatidyl serine. Work Load. Phosphatidyl serine is actually a precursor of the active compound in Seriphos, phosphorylated serine. Before being absorbed into the blood from the GI tract, phosphatidyl serine has to be partially digested to phosphorylated serine. It's helpful to consider that 100 mg of phosphatidyl serine yields about 20 mg of phosphorylated serine. To convert phosphatidyl serine to the phosphorylated form, pancreatic and intestinal brush-border enzymes have to partially decompose phosphatidyl serine. The activity of those enzymes expends energy, energy that isn't required to absorb the ingredients in Seriphos. Moreover, the phosphorylated serine in Seriphos absorbs more easily because it's chelated to calcium and magnesium. In breaking down phosphatidyl serine in the GI tract, enzymes cleave from phosphatidyl serine two fatty acids and a molecule of glycerol. What remains to be absorbed is the phosphorylated serine, as in Seriphos. The phosphorylated serine absorbs into the blood and then enters cells. Inside cells, glycerol and two more fatty acids are added back to the molecule. The fatty acids, however, are usually different from those that were broken off in the GI tract. The fatty acids that attach to phosophorylated serine are ones that are appropriate to the particular type of cell. Dose. In working to reset their cycle of cortisol secretion, we recommend that most people start with 2 capsules of Seriphos. If this dose doesn't improve sleep, we suggest an increase to 3 capsules, and if necessary, 4 capsules. The most capsules anyone has told us he needed to sleep well and recover a normal cortisol secretion pattern was 6 per night. Unfortunately, we don't have research data that tells us the time needed for Seriphos or phosphatidyl serine to reset the day time and night time cortisol secretion pattern. However, Seriphos works well for most people with high night time cortisol, and follow-up tests have shown that the product can help bring about a cortisol secretion pattern like that in Graph #4. If you reduce your cortisol secretion enough through the night, you may have enough cortisol in reserve to meet your needs through the day. If so, you won't need to take Isocort during the daytime. You may have a clinician who is experienced in using Seriphos and Isocort. If so, you may feel most comfortable consulting him or her before beginning your regimen of self-care. If you don't have a suitable local clinician, then I strongly recommend the soundly rational approach for all of us who are involved in self care: read, read, read, and continue reading, and while doing so, question the accuracy of everything any writer expounds upon, especially if he or she is a doctor. (You can start, as you should, by questioning the veracity of my views in this article.) You'll find many conflicting viewpoints, but don't let that discourage you. Instead, let it muster your resolve to keep on reading, questioning, and exercising your very best discretion to decide what to youbest corresponds to the facts and makes the most sense. Tammy and I wish you the very best.

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