This post will not be offering the wellness industry’s version of “self care”, or admonish anyone for how they care for their health.
This is a post about taking integrated healthcare from a privilege to a right, mental health, and making the unfun choices that allow you to max out your potential and manage your stress.
What happened is simple. I tested my sex drive hormones with Base, and my results detected something else very wrong: my cortisol, the hormone that produces feelings of stress, was quite literally off the charts. My body was behaving as if I was under dangerous threat all day long.
Our stress response keeps us alive. Along with adrenaline, cortisol suppresses functions in our body that are not essential for fight-or-flight situations. It’s an ancient mammalian system that evolved to protect hunter-gatherers. A March 2019 report published by the Mayo Clinic explains its modern adaptation. Our nervous system goes absolutely nuts in response to things like a bursting inbox or a pandemic. This is occasional “life-or-death,” in 2021.
Given what I find life-or-death, my constant cortisol surges makes total sense.
I have chronic anxiety. It’s treatment-resistant and paralyzing. Here are two things you can try on, if you’d like to understand what I mean.
- I start work every day with this as my first thought: “Your past success was just luck. Why are you even trying?” It’s hard to square this with the fact that I absolutely love what I do.
- If I make a choice my friends disapprove of - even something that makes me happy - I am convinced they’re drifting away. Their opinion of me becomes the reason I make decisions. It can make me want to obscure things I think they’d judge me for. Anxiety convinces me I have two choices: do what makes me happy and lose people, or do what makes them happy and keep people around.
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Is that high cortisol? Is it my chemicals and neurotransmitters being out of whack, siphoning off my serotonin and other mood-regulating chemicals? Is it the 50 ounces of caffeine I drink a day?
I didn’t know. But neither do any of the doctors I’ve paid lots of money. Modern healthcare treats us in silos, if we’re privileged enough to have access to healthcare at all. An example: A GP prescribes sleeping medication. Since they don’t ask about your diet, they miss that you’re nutrient deficient. They also miss that you’ve been going on runs at night because it’s so hot. They don’t see how irregular your bedtimes are - an optimizer of many things. So, is that sleep medication treating the actual causes?
I’d likely have never known about my sky-high cortisol without this Base test. I wouldn’t have a data-driven reason to chill with the all-day-and-night coffee. I’d have spent more time and money on under-effective therapy.
I talked with Base’s founder Lola about all of this. We discussed how lab testing can unearth life-changing, life-saving, insights. We dug into how lab testing is filling a gap that big industries won’t. She explained the relationship between caffeine, cortisol, and anxiety. Here’s how it went.
In this article:
- How lab testing detected my extremely high cortisol by accident
- Why my cortisol level matters for my anxiety therapy
- The link between caffeine, hormones, and anxiety
- How high cortisol was ruining my sleep
- Changes I made to my daily routine to lower my anxiety
- How to test your cortisol levels at home and why it works
How lab testing detected my extremely high cortisol by accident
Grace: We detected my dangerously high stress because I tested sex drive hormones. Can you explain how that happened?
Lola: When I saw your sex drive test cortisol levels, I asked, “Grace, what was happening these days?” And you said, “oh, nothing. Maybe I went for a run in the morning?” Hearing that, I reached a new level of empathy. Many people say they are anxious, but your levels were telling the story that you’re in a very dangerous situation at all times.
Your body does believe there’s something serious going on in your environment. The link between your cortisol and your anxiety and, as we learned, your caffeine intake, is really, really interesting.
Grace: I hope people read this and understand that there is so much information your body wants to tell you. It just comes in the language of lab data, and it is possible to understand it. How does someone test sex drive hormones and end up learning about their stress?
Lola: There are several hormones that get tested for multiple things. Our bodies are efficient, so there are very few things that are single-purpose. When you want to improve your diet with a Base test, you’ll measure your thyroid. When you improve your energy levels, we test your thyroid hormones then, too. This can lead to all sorts of discoveries and surprises, some great and some not so happy.
Why my cortisol level matters for my anxiety therapy
Grace: I’ve had a therapy practice for almost two decades. No one’s integrated lab work into it. Why do you think this is?
Lola: It’s not my place to speak for other clinicians. I will say that I’ve been to medical school, and I know how much is in the mind of a doctor. The role of a psychiatrist is to keep your brain balanced. The faster route, and the way to make sure that happens in the easiest way for the patient, is often through prescription medication.
Grace: Do you think integrating lab work into more forms of care will become more common?
Lola: This is one of the reasons I’m so excited about Base. Have you heard of Dr Terry Wahls? She was diagnosed with multiple sclerosis, a disease that degrades your neurons. It has never been proven you can reverse it. Dr Wahl was already in a wheelchair when she began studying food and vitamins. This is in the first case where, through functional medicine and diet, she improved her symptoms. Neurons are covered by fat, so having more is an easier and better source of energy for neurons that are otherwise degrading. She adjusted her diet to be super-rich in omega-3 fats. She walks now. It is so cool to see this.
Back to psychiatry. Will therapists prompt their patients to share more about their lives holistically? We’re optimistic that healthcare will continue to trend toward this.
The link between caffeine, hormones, and anxiety
Grace: The first question you asked me after looking at my results wasn’t about stress. It was about caffeine. Explain that.
Lola: Our doctor can take credit for that. When he saw your results, he asked, “does she drink coffee?” When I told him how much you drink on a regular day, he said, “Maybe she’d want to consider replacing that with something caffeine free pretty immediately.”
Grace: How do you explain the interaction between anxiety, caffeine, and hormones?
Lola: What we understand today is that anxiety and hormones are two separate things. They directly affect each other, and caffeine affects both.
When we’re stressed, our brain responds by producing a hormone that tells our adrenal glands to start cranking out cortisol. When we drink caffeine, it does the same thing.
Grace: So which comes first - higher cortisol, or anxiety? Does anxiety produce cortisol?
Lola: Generally speaking, stress stimulates the release of cortisol. If you had to simplify it, anxiety produces cortisol.
Grace: And does caffeine produce cortisol too?
Lola: As our doctor explains it, “caffeine → cortisol” is the best way to think about it. While there might be some intermediate cofactors, it’s not major biomarkers or hormones such as estrogen. It’s a pretty direct line from ingesting caffeine to an increase in cortisol.
Grace: How would drinking 40+ ounces of coffee all day long spike my cortisol?
Lola: There’s a simple chain of command: caffeine goes to work in your body through your bloodstream. That’s how it accesses your brain, and tells it to release cortisol.
Grace: And now for a therapy question: does caffeine interact with SSRIs?
Lola: Not heavily, as our doctor explains it. What it does affect is the anxiety the SSRI is aiming to treat.
You’re giving that medication even more work to do. There is one specific SSRI, fluvoxamine, that is known to potentiate the effects of caffeine, meaning it increases the effects and makes it last longer.
Grace: When is cortisol helpful?
Lola: Any time we need to do above-average activity. Think about setting fake deadlines, or your muscles during a strenuous workout. Cortisol, plus adrenaline, let you push in temporary bursts. You can’t and should not sustain that.
Grace: That’s part of my issue - not just that my levels are high but that they are always high.
Lola: Yes. You collected samples on different days in the morning, afternoon, and evening. At every measurement, it looked like your body thought it had to power through something very big and difficult.
Grace: Yes, I believe I call that “waking up and going about my day.” But in all seriousness, what do we want to see next time?
Lola: In the simplest terms, cortisol highest in the morning, lowest at night, and always within range.
How high cortisol was ruining my sleep
Grace: Talk to me about cortisol and melatonin. They seem related.
Lola: More than related! Cortisol blocks the production of melatonin. It keeps you from falling asleep. If your cortisol is high at night, you produce less melatonin. You can supplement it if your body isn’t producing it but the better approach is to get your cortisol levels in place so you sleep better naturally.
Grace: Your body can become trained that it doesn’t need to produce melatonin on its own?
Lola: I know that there are some people that like to cycle off melatonin supplements every once in a while just in case. We recently wrote a whole article about picking the right melatonin supplement.
Other changes I made to my daily routine
Grace: The easiest, or simplest thing rather, was to cut caffeine immediately.
Lola: I bet you didn’t feel great doing it. There is a bit of withdrawal.
Grace: Didn’t feel great at all. I started drinking MUD\WTR instead of coffee, and probiotic no-caffeine soda instead of Diet Coke.
I started mixing ashwagandha powder into my smoothie.
I committed to an earlier bedtime. At 9:45pm no matter what, I started a wind-down routine, physically in bed by 10pm, and lights out by 11pm. Sleep consistency’s always eluded me, but Matthew Walker’s Book Why We Sleep convinced me I can’t not optimize this simple thing any longer. My phone’s relegated to my kitchen, and the Loftie clock wakes me up.
I was able to get up way earlier too, and that opened up room for something else: morning workouts. Game changer.
I started box breathing for 30 seconds before certain meetings. Some people have recommended drinking cold water to signal the body that it’s okay to calm down.
Last, I committed to practicing a different mindset. My coach reminds me our brains are SQL databases. We think something - “I’m so not good at this thing” - and it queries our brain which goes around to find examples of that being true. Our brain is just doing what it should. Wonderfully, the exact same thing happens when we think a more resourceful, positive thought.
Embracing uncomfortable situations too. They’ll never stop, right? So I view each one now as a chance to practice a more effective way to “be.” Eventually, uncomfortable situations will feel normal, or even safe.
Staying up late and procrastinating are not more important than being relentless about feeling and being better.
How to test your cortisol levels at home and why it works
Grace: How can someone figure out if they are dealing with cortisol that’s too high or too low?
Lola: Lab testing is the simple answer, whether it’s at a doctor’s office or at home.\
Grace: When you measure your cortisol, is it testing just the day you collect that sample?
Lola: Yes, any cortisol test tells you levels at that moment you collected that sample. That’s why our stress test asks you to measure at several points throughout the day to see how it fluctuates.
Grace: How often does someone have to test to really understand their cortisol level?
Lola: If you’re really determined to get to the bottom of something, monthly testing tells you the most, the fastest. Once you’ve figured out a root cause and managed it, quarterly testing might make sense. We have members who do a mix of both for different things they want to measure.
Grace: This should be basic preventative care, but in a recent poll, 25% of Americans are being denied care because of finances.
Lola: This is one of the reasons I’m excited about Base, and the future of healthcare. Making your health data easy, and even fun to follow along, can improve life so much whether it’s early detection of a chronic condition or that aging doesn’t have to mean pain or loss of energy. It’s just the beginning for this type of care.
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