Why Is My Cortisol High Even Though I'm Doing Everything Right? Hidden Causes Of High Cortisol, The DUTCH Test & More!

Hey folks, it's Ben Greenfield for the podcast you're about to hear. I had to pee on a bunch of pee strips to find out some really interesting things about my hormones. So you're gonna dig this one. In this episode of the Ben Greenfield Fitness Show.

So glycerin is the active extract in the licorice and then caffeine, and then there's some other things. What they do is they interfere with the action of that enzyme and they slow the conversion from cortisol into cortisone. So effectively what you're is you're blunting the natural drop in cortisol. So what happens is you see normal tsh. So TSH is the main signaling hormone that goes from the brain to the thyroid gland. And then the active form of the hormone is T3. And the brain doesn't recognize that there isn't enough.

He's an expert in human performance and nutrition, voted America's top personal trainer and one of the globe's most influential people in health and fitness. His show provides you with everything you need to optimize physical and mental performance, performance. He is Ben Greenfield. Power, speed, mobility, balance, whatever it is for you, that's a natural movement. Get out there. When you look at all the studies done, studies that have shown the greatest efficacy, all the information you need in one place right here, right now on the Ben Greenfield Fitness Podcast. Hey folks, it's Ben Greenfield. And yes, that was the sound of me opening a cream soda Zevia, one of my favorite little beverages of choice. And I don't mess around. I get the big old 16 ouncer from Whole Foods. It's my, my little treat at the end of a good day. It's been an interesting weekend. I'm actually out of my element today recording for you from the Holiday Inn Hotel in downtown Seattle. I'm actually in Seattle or have been in Seattle to race a 12 hour brutal crucible called the Hurricane Heat that's put on by Spartan. And so I am recording this podcast episode on a Sunday. But two nights ago, Friday night I spent 10pm until 10am doing all sorts of masochistic, ungodly events including sandbag carries and midnight calisthenics in the mud. Different types of what they call checkpoint adventure racing style surges out into the wilderness to find different checkpoints playing around on the Spartan obstacles and just basically doing everything that the good folks at Spartan want to throw at you for 12 hours. So it was quite an interesting evening. I'm working on a blog post about that, but I survived that and of course I get many questions also about what type of things I do to recover after an event like that. And so I've been spending the day or spent the morning at the Turkish baths doing a little salt soak, a little steam room, a little sauna and a little cold plunge. Just basically a circuit between all four. A little bit of kundalini yoga today, trip to Whole Foods for a nice antioxidant rich salad. I'll admit there were actually two trips to Whole Foods for two what I call big ass salads since that event. A lot of topical magnesium lotion, a lot of foam rolling using because I forgot my foam roller, a glass water bottle on the floor of my hotel room, and all sorts of little things I do for recovery along with a lot of sunshine and walking. So speaking of recovery and taking care of the body, I think that today's podcast episode is going to be really interest for those of you who have any interest whatsoever in this mysterious hormone that we call cortisol. And no, don't worry, this isn't going to be cortisol 101. I think we've probably talked about cortisol enough on the podcast to where I don't need to do an entire podcast episode on what cortisol is, but I'd rather get into the kind of the confusing world of testing for cortisol and managing cortisol and whether you even need to worry about it in the first place. So frankly, most popular tests for cortisol don't really tell you what you need to know. They don't tell you things like how fast cortisol gets cleared by your body, if it is being made and what's truly causing high cortisol or low cortisol and how cortisol and other crucial hormones that your body makes are getting created and broken down. And you know a lot more. And you know, in the past I've recommended the Adrenal Stress Index, this salivary measurement for measuring cortisol. But recently I've been looking into other ways to measure cortisol because it turns out that that adrenal stress, that salivary index may not be the best method to use. Now why should you even care about this? Well, you probably know that low cortisol leaves you with low energy and low libido and brain fog and feeling overtrained and adrenally fatigued and high cortisol in the meantime, which many of us get concerned whether or not we're making enough. Well, in fact, if you are making enough, you can still be making too much. And that can a lot of the things you're going to learn about in today's podcast episode, like decreasing muscle protein synthesis and amino acid uptake and increasing bone degradation and suppressing your immune system and increasing blood glucose. So you feel pretty crappy when cortisol is low. And while you may feel good when cortisol is high, if cortisol is chronically high, there's some downsides to that too, that you're also going to learn about in today's show. So recently I did a test called a urine hormone profile. More appropriately, it's called a urine steroid hormone profile, also called a Dutch panel. Now I'm going to let my esteemed guest today actually fill you in on why I did this particular hormone profile. It's very new, it's very cutting edge. It's something that I've really been wanting to look into. And so I did this and I got the results. And I'm going to share the results with you today and I'm going to share with you whether or not you are someone who maybe should think about doing this particular test. I certainly have gotten a ton of data out of it. Free cortisol and creatinine and DHEA and the metabolites of cortisol breakdown and all these very cool things you're going to learn about in today's show. So my guest on the show has been a guest before. He was with me on the podcast episode called the Little Known Test that tells you everything you need to know about your metabolism, in which you learned all about this special test called an organic amino acids test. He was also with me on the podcast episode 7 Signs yous Cortisol and Adrenals Are Broken, in which we delve into issues that I know many of you face, like adrenal fatigue, for example. And his name is Chris Kelly. Chris quit his job at a hedge fund two years ago and completely pivoted to start this small functional medicine practice for athletes and for active individuals and hard charging folks called Nourish Balance Thrive. He's not just a previous hedge fund manager, he's a computer scientist. He's a pro mountain biker and at Norrish Balance Thrive because you may be scratching your head about how a computer scientist and pro mountain biker could run a functional medicine practice. He actually works with a couple of physicians, one of whom is also a pro mountain biker. And the other is Dr. Tommy Wood, who is a biochemist and a PhD fellow. And Chris's wife Julia is a Food scientist. So Chris is all over the place when it comes to delving into the latest cutting edge stuff in terms of functional medicine. He's an incredibly helpful resource for me, especially with regards to the test that you're about to learn about. And he's also got a podcast and I'll link to his podcast the previous episodes with Chris Nourish, Balance, Thrive and my own cortisol testing results. Everything that you are about to discover over@BenGreenfieldFitness.com Dutch that's BenGreenfieldFitness.com Dutch so Chris, with that incredibly long drawn out intro and one more sip of Zevia, welcome to the Ben Greenfield Fitness Show.

Thank you so much. It's amazing to be here. Can I just point out how amazing it is that you can do a 12 hour race and then that intro. Are you reading from an auto prompt right now?

You know, when I've done videos, you know, because I, I did a course for Creative Live and, and then the, the website mindbody Green gave came to my home and did a video course and everybody always wants me to use the teleprompter and I always say no because I just feel, feel like it's cheesy, I feel like it's forced and you know, probably I, I don' shared this much on the podcast, but for three years in college I was on the speech and debate team and my particular method of speech that I competed in was extemporaneous or impromptu speaking in which you're given a topic, you're given about 15 minutes to prepare and then you go into a room with a panel of judges and you give anywhere from a 15 to a 30 minute speech on that particular topic. And so I think that I was just from an early age raised to in a way begrudge these teleprompters and reading off a page. So no, I didn't really read that one off a page.

However, another piece of the Ben Greenfield jigsaw puzzle falls into place right there. And I think that's kind of a lot of what this is about. Like everything you do is it's not just about your speed and performance in racing, but being able to do something like that or like this right after the race, isn't that incredible. I can remember a time where I could never have thought of that.

Well, get this, I finished the race, I finished the 12 hour event, came back to my hotel and went and got my big ass salad at Whole Foods. I just got lucky enough to wear one's four blocks from My hotel and I pile it high with all the Indian foods and the turmeric filled foods and the cumin, a ton of cruciferous vegetables, lots of kale, not a lot of proteins. As a matter of fact, I like to eat extremely alkalinic and extremely anti inflammatory after an event like this. And then I went back and crashed at my hotel room. Fell asleep at about 6pm and woke up at 8am and felt pretty good after about 14 hours of sleep like that. Threw in another nap this afternoon for another couple of hours. And so with about 14 hours of sleep under my belt, I feel just fine.

Oh, that's amazing. Whatever you're doing is obviously working. Whenever I do a really stressful event like that or a race, it always, I mean, presumably jacks up my cortisol. Right. That's what we're going to talk about. And then that stops me from getting the sleep that I need. So, yeah, the worst case situation.

Yeah. And as I've talked about on previous podcast episodes, and I think we may delve into sleep and cortisol a little bit on today's show, I have a few little choices, things that I'll take before I go to bed, particularly the one that I swear by is I take one to two packets of this sleep cocktail, which is designed by this Navy SEAL who works with a lot of Navy seals who would typically take Ambien or Valium or something like that after a stressful event. And he kind of formulated this cocktail to help calm them down after stress. And then I combine that with cannabidiol capsule, which is the nature CBD that my company makes, which is just magnesium and lemon balm and ashwagandha and cannabidiol, which is basically like, you know, weed without getting you high. So I take those, you know, about four capsules of the CBD and one to two packets of this sleep cocktail and it, it just knocks me out even after I've done something very hard like that.

So I know Doc Parsley. I've just interviewed him for my podcast and he says he's like you. There's been so many amazing people that have helped me launch this business and I should like take this opportunity to say thank you for you. It's a couple of years ago since I first appeared on the Ben Greenfield podcast and that show launched a business, a whole functional medicine practice of amazing people. Everyone that listens to this show, if you're listening to this right now, thank you. You are amazing. It's been so much fun to work with the listeners of the Ben Greenfield podcast and. And Doc Parsley, he spent two hours on Skype a couple of weeks ago talking to me about sleep, and I recorded about an hour of it for my podcast. But just such an amazing man. So many incredible experts out there that are willing to teach, and, yeah, you're all wonderful.

Wow. So you actually, when you came from hedge fund management into the world of functional medicine, from what I understand, you were actually a podcast listener to this show.

Yeah, that's right. You were part of the solution. It was all overwhelming at first. When I first started listening to the podcast, I was like, this guy's nuts. I can't do all this stuff. And now when I look back, I'm doing all of it. You know, like, it's not all happened at once, but gradually, bit by bit. I'm doing pretty much all of it. The saundering just started recently, and that's been incredible. And I'm like, why have I just started doing this? This is great. So, yeah, it's been a bit of a journey for me, sort of bit by bit.

Wow, that's really cool. That's really cool. I'm happy to hear it. And it seems like we run in a lot of similar circles. However, you, to tackle the topic for today, seem a little bit more immersed, more so than I am into testing what type of functional medicine tests, I guess you would call them, are out there and what you can get out of them. And there's this new test that you and a couple other people had mentioned it to me, and I decided to finally delve into it myself. But it's called the Dutch test, and obviously I alluded to it in the podcast intro. But tell me about this Dutch test exactly. Is it.

So the Dutch test is a urinary metabolite test, and it uses GC and LC tandem mass spectrometry. So this is this really fancy new technology. It's actually the same technology that the organic acids test that uses. And so previously we talked about the asi, and that was a saliva test. So in order to do that test, you would spit into a tube and then freeze those samples and then send them off to the lab. Well, now that's changed. Now you can pee onto a piece of filter paper. You know, it's just like coffee filter paper. And then you let those samples dry out, and then you send them back to the lab and they do this mass spectrometry on the paper itself, and then they tell you all of the hormones and their metabolites that are in the samples. So this is kind of. I think of this as the next generation of hormone testing. And it's the brainchild of an incredible analytical chemist who has also been on my podcast. His name is Mark Newman. And I owe him quite a lot of thanks, too, because he has also been extremely generous with his time to me.

Okay, so Mark Newman is an analytical chemist and an analytical chemist. What exactly do they do? They create tests like this, or they study tests like this?

Yeah, exactly. In this case, he has created a new test. So he's gone into the world of testing and say, okay, so this saliva testing is pretty good. The blood testing that came before it was not quite as good. How can I improve on this? And the Dutch test is. It's basically the manifestation of his life's work. And the reason I like it so much is it kind of reminds me of my former life. Right. So when I worked for a hedge fund, I was a computer programmer or a software engineer. And as any computer programmer knows, that the longer that you spend at a single company, the less you become of a software creator and more you become a software supporter. And so I would just spend most of my day debugging complex systems and trying to problem solve. And so this Dutch test kind of reminds me of that formal life. Like, it allows me to see inside of a person and find out what's going on with their hormones and then help diagnose a problem in a way that you just couldn't do before because the. You wouldn't be able to know what was going on inside of the person.

Now, mass spectrometry, you mentioned that that's the actual, you know, once you pee on these strips and you send them in. And by the way, that part of it was pretty easy. I just, you know, four times during the day, and it was kind of the option if you wake up in the middle of the night, to pee, which I did. So I think I wound up with five different urinary measurements. They, they use this, this mass spectrometry, which I believe that's all. That's also called liquid chromatography, correct?

Right. Yeah. I don't know that much about the.

Actual assay, so I, I actually, I, I do. I. Oh, do you? So another, another glimpse into my past is that when I was in college, I had two different internships in the. It was basically the microbiology lab at University of Idaho where we were. We were trying to find different bacteria that would be able to bioremediate pollutants such as iron, for example, from water. And basically that sounds very sexy. But what it really involved was me sitting in front of a mass spectrometer liquid chromatography machine for hours and hours running different bacterial samples through that machine and then matching them up and trying to analyze which bacteria was which. So I'm. I'm somewhat familiar with the test with. Not that great a memory of it, but from what I understand, it's a very, very prec. Sensitive way to identify chemicals and detect chemicals that one would not normally be able to detect using other types of chemistry techniques.

Right, right. Yeah. So to me, as the person just trying to figure out what's going on inside of another person, it's a black box. I don't really care how the mass spectrometry part works. All I know is I get this little dashboard with all the different hormone readings on. But, yeah, that's my understanding. So I've also interviewed a guy called Bill Shaw, who is another analytical chemist who does the organic acids test. And he refers to mass spectrometry as the truth machine. And the reason he calls it that is because it's so specific to the analyte that's being measured. So, for example, there are synthetic forms of cortisol that you can take either orally or topically, and there's really no chance of those showing up on the Dutch test because the mass spectrometry is so specific to the cortisol or cortisone that's being produced endogenously or inside of your body, really.

So if you were on like a hydrocortisone cream or some type of other cortisol analog supplement or a steroid or something like that, and you took this test, that would not skew the results.

It would, because that would affect your body's own ability to produce that. So your body produce things for fun.

But it wouldn't show the exogenous source. It would show what it done to your body.

That's my understanding, is that the chemicals are different enough to where it wouldn't show up on the Dutch.

Okay, interesting, interesting. Okay, so in terms of the Dutch panel, what exactly is it measuring?

Well, it's measuring sex hormones. It's measuring cortisol. It's measuring progesterone, estrogen, testosterone, and melatonin. And I think the place to focus today, the first thing it looks at is this most important of all hormones, I think cortisol.

Okay, got it. So. So it's. It's above and beyond cortisol, progesterone, estrogen, or as we say here in America, estrogen. Sorry, by the way. By the way, where were you born, Chris?

I'm British, so I was born in Lithium St. Anne's, which is up north in the uk. But my accent is quite neutral and I was living in London before I moved to the U.S. okay. I'm worried about losing my accent. I've been here for 13 years, and much of what I've learned about physiology and biochemistry has happened in the US So I think I'm quite confused about the way that you pronounce a lot of words. So please excuse that if you hear me pronounce anything incorrectly.

Oh, no, that's all right. I'm sure you get your accent back fast. We'll be talking about this later, but I know you and I are both going to be over in London at the Biohackers conference there. So, anyways, cortisol, progesterone, estrogen, testosterone, and melatonin. Those are the five that it measures. I know we're gonna talk a lot about cortisol today, but before we talk about cortisol, tell me how this is actually any different than the hormone test that I think a lot of people are familiar with and that a lot of physicians use as like, the gold standard for hormone testing, especially when it comes to cortisol, the adrenal stress index. How is this any different than that? And why somebody want to even look into something like a Dutch test instead of an adrenal stress index?

Right. Well, there was nothing wrong with that saliva test. And so when we first started Nourish, balance, thrive, we were running that panel on everyone, and we ran 550 odd saliva tests on athletes, specifically on athletes. And all we ever found was low cortisol. In fact, it got to the point where I actually stopped running that test because it didn't tell me anything. Like, everybody had low free cortisol, and so it wasn't really providing any useful information. Now, there were. There were a couple of exceptions, and usually those. Those were people who didn't ask to do the test. So my CEO, Jamie Bush, now Kendall Weed, she married, who was on that original podcast. She was one of the few people that had high free cortisol. And typically people don't complain about high free cortisol, and so they don't want to spend $300 on a test to find that out. Right? So we don't ever see it. Now, the way in which the Dutch is different is it doesn't just measure free cortisol, it measures both Free cortisol and total cortisol production. And the reason this is important is because free Cortisol represents only 1 to 3% of the total cortisol. And although the 1%, the free cortisol is the active fraction that axon cells, it's not the whole picture. And so when we started running the Dutch, and we've run about approaching 100 of these now, we're seeing all kinds of things all over the map. We're seeing high cortisol, we're seeing low cortisol, we're seeing people that produce a lot of cortisol. But clear it very well. The most common pattern that we see is that people don't produce a lot of cortisol. Like it's quite low total, but then they have sluggish metabolism of cortisol. And so overall the cortisol looks normal. So it's just giving me a much deeper picture and is allowing me to understand much better what's going on inside of the person versus the traditional saliva test.

Okay, gotcha. So when you do a saliva test, it's only showing part of the hormones that are available. So in the case of cortisol, you've got the, the free cortisol, but that's only a very, very small, small amount of the total cortisol that your adrenal glands are actually producing.

That's correct.

Okay, but, but when you do a urine test, it's like a combination of both the, the blood test and the saliva test in terms of telling you both the free and the total cortisol.

Yeah, that's right, exactly. So you were always able to measure the metabolites in urine, but then you lost the circadian rhythm part. Right, so, so when you go do a blood test, you only get one marker, Right? You go to Quest or you go to LabCorp and they draw your blood, you're only going to get one marker. So you're only going to know what's happened to cortisol first thing in the morning, probably. And so the saliva test was an improvement on that. Because you got four readings, it was easy for you to just spit into a tube four times during one day. And because cortisol follows the circadian rhythm, that was useful information. Now, the urine metabolites test, you were always able to measure some of these metabolites and see cortisone as well as cortisol. But the problem was it was a 24 hour urine collection. And so you would lose the circadian rhythm part. And so what the Dutch test does is it combines the best of all of those worlds into one test. That's super easy to do.

Okay, got it. So, basically, when I've tested before, like, I'll test through, say, Wellness fx, which is one of the testing services that I use for blood testing. I drive into the lab with my little requisition form, and I hand that in and they draw my blood. A couple of weeks later or a week later, I get a little printout and a dashboard where I can go and look through all my values. But when I see the cortisol, all that's showing me is whatever my cortisol was in the morning, not what it was the rest of the day. And so the saliva, the next level up, that tells you four different measurements. But the problem with that is it only tells you three, not total. And then you enter the urine test, where it just tells you everything.

Exactly.

Okay, gotcha. So I. I think probably the best way to go through what exactly, you know, a test like this actually looks like. At the. At the risk of opening myself up to extreme embarrassment, I actually have the results of my test. Like I mentioned, I peed five times on a strip. About a week later, you emailed me with the results, Chris, and they were a little bit shocking to me, frankly, when you sent them over. And I'm going to put them and make them available for anybody who wants to look at them or download them or stock my urine over@BenGreenfieldFitness.com Dutch that's BenGreenfieldFitness.com Dutch, if you want to download this or if you're listening and you're a visual person and you want kind of look at it as Chris walks me through it. But, Chris, I have these results pulled up in front of me in terms of everything that the Dutch test actually shows. And I'd love it if we could go ahead and, for the listeners, walk through these results as an example of how to interpret the test and how to use the test.

Sure. Yeah. Your case was very special. We'd not seen special. I say special. We'd not seen very many of these. Like I say, we've only seen between 75 and 100, I think, in is, and we'd never seen one like this. And so Dr. Tommy Wood is a medical doctor and a PhD fellow that I work with on an ongoing basis all the time. We chat all day long. And I also have some other doctors that I have access to, and Dr. Brian Walsh, who I hope is going to be on a future podcast because he is the neuroendocrine wizard that has to tell you about adrenal fatigue. He's an amazing guy. He helped me with your results as well, because we'd never seen anything quite like it. And one of the first things that we wanted to do was rule out a condition called Cushing's disease, where you see extremely high levels of cortisol, because that's the first observation that we made, was that your cortisol is really high.

Well, that's what shocked me. Was it not just really high, but like, off the charts? Like, there's a little ticker that shows cortisol levels, and there's like, low, low, normal, and normal and high. And then there's me, and I'm just like, breaking the thermometer.

Right. So Mark Newman has done a really. I would say this is one of his areas of strength, is his ability to visualize this data and define reference ranges. He told me on my podcast that he'd seen over a million saliva results, or at least it had access to those in the database. And he really knows how to define a reference range. And then not only that, the reference ranges on the Dutch, they're adjusted according to the supplements that you're taking, which I think is super cool.

So if you're doing now, what does that mean?

So, I mean, if you're on some sort of hormone replacement therapy, then he adjusts the reference ranges accordingly. And then on these little speedometers, they are, you know, there's an age adjusted reference range.

Okay, gotcha.

But the most important thing, I think, is that, that, you know, you don't just take just the average. So when they look at a blood chemistry, they just take, you know, 7,000 random results and then calculate the range as being two standard deviations either side of the mean. And of course, what kind of person goes to do a blood test? Ordinarily, it's not someone like you who's interested in performance and longevity. It's someone who's not feeling good. And so if you define your reference range around people who are not feeling good, you end up with a really weird reference range that's typically very wide. So Mark Newman has done a fantastic job of defining these reference ranges, and he's created this visual indicator that looks a bit like a speedometer. And you can see there's two yellow stars either side of the speedometer. And then the little red arrow indicates your level. And you can see for the total, the total cortisol production and the 24 hour free cortisol are Both extremely high. So not only are you making a lot of cortisol, it's also hanging around like you're not clearing it that well. So, you know, the overall picture is of a lot of cortisol.

Now. Now, in some cases, for example, from what I understand, you could not be making a lot of cortisol, but it wouldn't actually be getting cleared very quickly. And so you could show as having high cortisol even if you weren't producing that much cortisol. Is that correct?

That's right, yeah. So we see that quite a lot. So someone who's not making a lot of cortisol, so the total output from the adrenal glands is quite low, but then you still see high free cortisol. And that's usually because the. Either the liver is not clearing it very well, and that's because of hypothyroidism. And so that's a really, really common kind of pattern that we see amongst the athletes that we test.

And if that were the case, if someone went out and they got a blood test, they would test for. They would test and the test would show. What would it be? High cortisol. Even though their cortisol is actually low.

Yeah. Normally it's still within the normal range, but the total cortisol output, so you see where you're at 8,400, they would be much closer to the bottom of the range for the metabolized cortisol. So they'd be down at like, you know, 3,000 odd.

And they would. They would be under the impression that their adrenal glands were working just fine, when in fact, their adrenal glands were not producing much cortisol or as much cortisol as would be ideal, because cortisol is basically being, or not being cleared very quickly. So they're showing on their tests results as normal or slightly high cortisol, when in fact cortisol production is not that great.

Yeah, exactly. So you've got two problems that when you do the full accounting, they kind of net out to produce what looks like a normal result.

Okay, gotcha. So in terms of this whole, like free versus total cortisol, can you explain a little bit more with a hormone like this, you know, like cortisol, why that is, why there's free and why there's total and what it is about cortisol that makes some of it free and some of it total.

Sure. So when the adrenal glands make cortisol, they circulate, carried by a carrier protein which is Normally cortisol binding globulin and then, and then some albumin. And so that's kind of a protective measure. You know, like cortisol is extremely potent hormone, and so your body needs mechanisms by which to regulate the, the activity of cortisol. And so having this free and bound versions of the hormone is a way for your body to control that. And then in addition, there's these two forms, cortisol and cortisone. And cortisol is deactivated into cortisone primarily in the kidneys. And so that's a secondary way by which you can, your body can regulate the cortisol. And so the Dutch test is pretty cool because it looks not just at cortisol, which is the free and active fraction, it looks at cortisone, which is the inactive form. And so you get this kind of secondary look at cortisol. So you can think of cortisone as being like a shadow of the cortisol. And so, you know, with these two markers, you can kind of confirm what you thought you knew from the cortisol. And you can see that's very clearly the case for you. You have not just high cortisol, but also high cortisone. You can see that you're above the reference range for both of those hormones.

Okay. Okay, gotcha. So basically it all comes down to you can make up a bunch of total cortisol. And if it's bound to this, this carrier protein, then some of the cortisol would basically not be free.

Exactly.

So it's similar to testosterone. Like if you can make a certain amount of testosterone and then have, and that would be your total testosterone. And I see this a lot of times in folks, they'll have high sex hormone binding globulin. And so that will bind the total testosterone. And while their, their testosterone production is fine, there's very little of it that's actually free because it's bound to this sex hormone binding globulin.

Right, Exactly. So it's like the hormone is, is traveling on a bus, and if it's on the bus, then it can't go through the cellular membrane and get to the nucleus and actually make changes inside of the cell. It has to get off the bus first.

Okay, so only, only a free hormone is able to pass like through a cell membrane, is able to bind a receptor and is able to actually act on a system. Whereas if it's bound to a protein, like, you know, in the case of testosterone, sex hormone binding globulin or in the case of cortisol, you know, something like cortisol binding globulin, it's not really doing what itwhat it should be doing.

Exactly.

Okay, gotcha. In terms of other things that you see in my tests, I know we want to delve into cortisol a little bit more intensively because I really want to ask you a little bit about, you know, things that could cause high cortisol and talk to you a bit about that. What are some of the other things that this test shows? Because obviously the test tests for more than cortisol. Right?

Yeah, no, it gets really, it only gets more complicated from there. If we, if we've lost you already, it's, it's not going to get any better.

Our listeners are, our listeners are smart cookies though.

I know that already because I've been working with hundreds of them over the last couple of years there. Yeah, they're really great. I mean, that's kind of the reason I love them is you give them a little bit of information. Like I'll give someone one of these Dutch reports and then they'll come back and report back to me and teach me something new about it. That's just the way they are. They don't just awesome, awesome investigators, they're just so much fun to work with.

It's because so many of them exercise, they produce lots of brain derived neurotrophic factor.

That's awesome. Yeah. So if you scroll down to page three, there's a lot more of these knobs and dials. And so it looks like this big dashboard and what you're looking at is this steroid hormone hierarchy plotted out and then where the metabolites are measured. On the Dutch test you get a reading. So you can see that DHEA is on there and the metabolites of dhea, so that includes testosterone, the free testosterone, and then also etio, calanolone and androsterone. So those are the two most abundant metabolites of dha. And you can see that your total DHEA production is, is actually pretty good. So this is kind of a, you can think of this as being a, you know, anabolic versus catabolic ratio. Right. So cortisol, being a catabolic hormone that breaks things down and then DHEA eventually becomes things which are anabolic and build things up. And that's kind of a gross oversimplification, but it's broadly correct. And you can see your total DHA production is actually not bad. It's in the upper end of the reference Range. So it seems like you're adrenal glands are just. They're just really pumping out everything.

Yeah, I noticed that, like, you know, on a range of 1000 to 5000, for an ideal range of 1000 to 5000, my total DHEA, you know, these anabolic hormones, they're at 4100, between 1000 and 5500. Like we mentioned cortisol, you know, the ideal range tops out there around 7000, but I'm way up at 8400. So I'm, you know, like you, like you said, it seems that my adrenal glands are working. They're pumping out stuff, and possibly in the case of cortisol, too much of what they should be pumping out. What other things aside from these DHEA anabolic hormones and also the cortisol are we looking at on this test here?

Yeah, so as you go down and to the left on page three, you'll see these two metabolites of dha. And the reason these are interesting for both men and women because.

Oh, actually, could I. Could I interrupt you real quick?

Sure.

Just to make sure folks understand, when you say metabolites of a hormone, what exactly does that refer to?

It just means there's a hierarchy of things. So imagine a waterfall. You know, like things that you put in this. It's pregnelanone at the top of the tree, right? So that's the water going into your. Into the top of the hierarchy. And then each time the metabolite, the water flows over a step, it converts into another steroid hormone. And so it's a downstream metabolite of pregnelanone, but it's just one further step away from the root of the tree or the top of the waterfall.

Okay, I got you. So a metabolite would just be almost like a breakdown byproduct of a certain hormone or a downstream product created after hormone is initially created.

Exactly, exactly.

Okay.

And then, so, so, you know, this conversion, it takes place using an enzyme, and there's two kind of categories of enzymes. And there's a five alpha pathway and a beta pathway. And the five alpha pathway is the most potent androgen. Right. So this is interesting for both men and women. So if you're a woman and you're taking what DHEA you have, and you're sending it down this really potent alpha pathway that can. And you can't. It's not black and white. You know, you have to consider the whole picture. But that can lead to things like thinning scalp hair, facial acne. Those types of problems. And then, you know, the same is true for men to a certain extent. You get the thinning scalp hair, but then also the, the five alpha, the dht, which of course has been talked about many times on the podcast. That's also a factor for prostate health health. So this is kind of a cool way for you to find out where your androgens are going.

Okay, so in my case, let's use an example. For example, it shows that in terms of androgen metabolism, the breakdown of all the different androgens I'm making, something like DHEA appears to be just fine within range. And then there are others like say androsterone, which is another byproduct of androgen metabolism that one shows at the low end of the range. Now in a case like that, is this something where you will simply talk to someone and give them recommendations in terms of what to do if certain metabolites are out of range? Or does this give you clues about what you need to do as far as the upstream metabolite? In this case, something like a DHEA product? Yeah.

So it's interesting to know in which direction you're headed because, you know, say you're a guy in your 50s and you're concerned about your prostate health and you were taking some sort of hormone replacement therapy, then you'd want to know where that testosterone is going because there's things you can do like this, there's supplements like saw, palmetto and even Zinc can block the 5 Alpha pathway and could send that testosterone down a less androgenic pathway, which could potentially be better for your long term health.

Okay, gotcha. Now, on my particular results, when you look at them, what would leap out to you as things that, you know, aside from the cortisol, which we're going to talk about, as things that you would remark upon or that you would find interesting so that people can kind of get an idea here of some of the things that you would actually make a recommendation on. When you look at some of these metabolites, some of these mortal, more detailed, you know, hormone byproducts.

Sure, yeah. So the estrogen metabolism is interesting for you because I think overall your estrogens are really quite low. And like most things in physiology, that.

Means I'm not going to get. That means I'm not going to get man boobs.

Chris, you're definitely not going to get man boobs. But you know, I can show you some studies that show estradiol improves insulin sensitivity. So lower is not always better. Right. It's very. The context matters, and so you don't want it to start. It'd be wrong to make a general recommendation that everybody should start taking DIM. So probably most people listening to this know that i3C and DIM are supplements you can take that lower.

Yeah, they are aromatase inhibitors.

Like aromatase inhibitors. Right. So that might. That you, you really need to know exactly where you, you stand before you start trying to fix things.

Okay, gotcha. So in a case like this, if someone were, say, taking an aromatase inhibitor, you would say, well, you may want to think twice about that because you're already showing that perhaps you're not producing enough estrogen or at least you don't have enough estrogen circulating. And that might not do you any favors, even though you've heard that you should take it if you don't want to keep testosterone from getting converted into estrogens or something like that.

Yeah, exactly. So I always think there's very few supplements that I would take without doing a test to, like, figure out whether or not they're right for you. You know, I mean, there's some good general recommendations, just a few, but for the most part, you want, you want to figure out where you are.

Yeah.

And, you know, obviously the estrogens are, are very interesting for the women. And, and actually for both genders, there's one metabolite that's measured on this test. It's called 4 hydroxy E1 and 4 hydroxy E1, it can actually bind and damage DNA. And so it's a cancer risk. It can be implicated in breast cancer and endometrial cancer. And so again, if you're a woman taking some sort of hormone replacement therapy, then you want to know where that estradiol is going. Like, is it going towards this dangerous for Methoxy E1? And the only way you can really know that is to do this test.

Now, let's say that a woman were taking some kind of a natural hormone replacement and she found out that some of it was going towards the. Or being converted into the type of estrogens that, and that would cause DNA damage. Are there things that you can do to keep some of the more damaging estrogens at bay, or is this something in which someone might be just genetically predisposed and so they may need to find a different solution than, say, like a natural hormone replacement therapy?

Yeah, I think so. For the most part, I think it's about dosing and there is a protective pathway here. So ideally you would send the, the E1, the estrone down this protective pathway towards two hydroxy E1. So that's also measured on, on the Dutch, and that's phase two live. So everything we've been talking about so far has been phase one metabolism. And then phase two would be methylation. That converts the two hydroxy E1 into two methoxy E1. And that's the protective pathway. That's where you want the estrogen to go. But the problem is that, that a lot of people, you and me included, stink at methylation. Right? So the cool thing about the Dutch test, and you can see how far beyond what the original saliva test, you know, this point, it's like it makes sense to kind of stop and look back and see how much more information we have versus the saliva test. But the Dutch test, on top of everything we've already been talking about, it also measures your methylation status, right? So your ability to convert the, the two hydroxy E1 into the two methoxy E1 shows how good you are at methylating. And as you can see from the dial on your result that the methylation activity is really low.

So when people are talking about being a poor methylator, this would be an example of that. Okay, exactly.

So we look at this on other, like the organic acids, for example. Like we would have other markers. We look like, look at, so formula glutamate is one, and then methylmalonic acid or other markers that can show methylation status. And then also just on a simple CBC on your blood chemistry, like we've seen that on yours, that the mean corpuscular volume, the mcv, is somewhat elevated. So that means your red blood cells are a little bit bigger than we would expect. And it's not a true pathology. Right. It's not something that's going to make you ill or anything, but it just hints that there may be a relative folate deficiency. And so that story has kind of been confirmed with what we've seen here on the Dutch. And so, you know, you might want to consider, I mean, I'm sure you've done the 23andMe genetic test. So look at some of the genetic variants, particular MTHFR and comt, and then think about increasing your consumption of some of the methyl donors. So that'd be things like Sami, the methylated B vitamins, folate, that type of thing.

So like the, like the tetra or the methyl tetrahydrofolate that you'd find in like a good multivitamin, like not, not the synthetic folic acid form, but, but something like MTHFR would be something that someone like me would want to think about taking.

Yeah, that's what I would do. That's the safest bet. I mean, I think you really have to dive into the genetics to know for sure whether you can handle folic acid. But, you know, I don't think the folic acid should be on the shelf at this point.

Right.

You just want to see the good stuff. And. And if you're taking a really good quality multivitamin like the Thorn Exos Multivitamin Elite, that includes the right type of folate that you're looking for.

Yeah. It's kind of interesting that leading up to this test, I actually quit taking multivitamins for a little while. But then I had just started into it recently going into the test, and so I'm curious whether or not that's gonna make an effect or not. After seeing these test results, I started right back onto that.

That.

But you said there were some other things like B vitamins and choline and Sami and something. You also mentioned something called tmg. What is this?

Yeah, trimethylglycine. So these are all just methyl donors, so something that can donate their methyl group.

Okay. And by the way, for those of you whose heads are spinning, don't worry, I'm putting information about all of this in the show notes. So I know that for those of you who might be out maybe swimming or biking or running or lifting right now, this one's kind of a head spinner. So, Chris, anything else in terms of. Before we delve into the cortisol issue that you would say leaps out on this particular test?

Sure. So this test measures melatonin, and obviously melatonin is interesting for anyone that's trying to get better sleep. And we saw that your melatonin was just off the charts high. So the range is 10 to 50. And yours is 760.

Yeah, I saw that it was enormously high.

So the reason for that is because you're taking oral melatonin. So there's a teeny, tiny little bit of melatonin in Doc Parsley sleep cocktails?

Yeah, very, very. It's like a microdose. And that would be enough to shove this way up, huh?

Yeah. So what's going on here? It's kind of interesting the way that this test work. It's not measuring melatonin per se, it's measuring this 6 hydroxy melatonin sulfate, which is a metabolite of melatonin. And what it represents, what the number represents is how much melatonin you made overnight. And when you take oral melatonin, it's conjugated and it excreted in the urine without ever being in circulation. So it doesn't matter how much melatonin, oral melatonin, you take, it just totally messes up the test. Like, it. The metabolite that's made in the gut that never enters circulation is very, very similar to the analyte that they're trying to measure on the test. And so if you're doing this test, I would wait as long as possible, maybe a week or so from taking oral melatonin, if you want to get a true picture of how much melatonin you're making overnight.

Right. And if you were having trouble sleeping, for example, and you weren't using melatonin, this test would give you a good example of whether or not your lack of proper sleep might be due to insufficient melatonin production.

Yeah, absolutely. So that's, you know, almost the first thing I start with when looking for solutions is with the sleep. Is there a disrupted circadian rhythm? Is the person not making a lot of melatonin because they're blocking it. Right. With the blue light or activity or something else?

Right. Okay, cool. Wow, this is so interesting. This is probably the most detailed we've ever delved into a lab test on a podcast.

It's a lot of knobs and dials, but I know people love it. Like, half the people listening to this are people like me who are practitioners and. And health coaches, and maybe there's even some endocrinologists that are thinking, well, crap, I'm running blood tests still. Maybe I need to look at this test.

Yeah, no, I'll be sending this to some physicians I know for sure. So here's the deal, Chris. I feel freaking awesome. I sleep amazingly and I feel good during the day, and I have great relationships, and my life is relatively low stress. I mean, even though I do work a fair amount, I'm spinning a lot of plates. I start my day with. With deep breathing and yoga and a little bit of sauna. Like I mentioned today, I spent an hour in a Turkish bath just breathing. And I've got friends and a good lack of loneliness in my life. And generally, when it comes to everything from gratitude practice to deep breathing to good spiritual connections to frequent sex to just everything that. That you'd expect in someone if you expected them to have normal cortisol, that's me. However, my cortisol is, as we've outlined off the charts. So in terms of cortisol being off the charts in someone who's maybe not a glaringly super high stress individual. First of all, I'd like to hear just your general thoughts on this.

Yeah, so there's a very interesting philosophical question to be asked here, and that's if, you know, if you're feeling okay, are you okay? Do you want to, like, try and create some artificial illness just because you ran a test? Like, I'm not sure I have the answer to that. For me personally, it's a really personal question you have to ask yourself, I think. And for me personally, I've gotten great results by chasing after these things on the test results, even though I feel good.

Well, yeah, and we talked about that in a previous podcast episode with you, you know, and folks, go back and listen to the podcast episode with Chris if you want to hear his whole story. But he had some really, really serious adrenal issues that he wound up fixing by doing lots of testing and lots of targeted, you know, nutrient and supplementation and lifestyle changes due to that testing. So, you know, I know we probably don't even have time to delve into your entire backstory, Chris, but.

But.

I think one thing you explained to me before we got on this podcast was even though I feel like a million bucks with my cortisol high, there are some issues if I allow that to remain to be high. Right?

Yeah, exactly. So we know that long term exposure to cortisol damages the cells in the hippocampus, so you may have trouble forming long term memories. So this is super interesting and I'd really highly recommend the book why Zebras Don't Get Ulcers by Robert Sapolsky, who is a professor of biology and neurology at Stanford University. It's one of the coolest books I've ever read. And yeah, he goes into the details.

Why zebras don't get ulcers.

Why zebras? Sorry, I said zebras, didn't you?

Oh, you did say zebras. I wasn't even going to say anything. I figured our UK listeners would get annoyed at me if I brought up it up again, but okay, so why zebras don't get ulcers.

Yeah, exactly. So I think in this instance, it makes sense. So one of the things I really hate our mysteries. It was kind of like our motto or one of the things. One of the rules by which we live by at the hedge fund is we just don't have mysteries, right? So if something goes wrong, and this happens all the time with computers, a lot of people listening to this will relate to this that, you know, you get a hiccup and something goes wrong with your computer, and then two seconds later it's fine again. But in the world of hedge funds and trading, like, that could mean you could lose a million dollars in a minute. Right. And if you don't understand what went wrong, then there's a really good chance that's going to come back and bite you even harder in the future. And so we just don't have mysteries. Right. Nothing is left to be unknown. And so certainly if this was my result, I would want to keep digging because it doesn't make like, it just doesn't make any sense. Like what you've told me. You've. You're implementing all of the diet and lifestyle factors that control the output of cortisol, and yet still it's high. And so you have to ask this question, you know, why we know it's not good. High cortisol decreases protein synthesis.

Okay.

And proteolysis and bone degradation. So it's really not good. You need to figure this out.

Okay? Now, what else can high cortisol do if chronically high?

Well, you know, so one of the things I'm worried about is it may increase your chances of getting diabetes in the future. Right. So you think, what does cortisol do? It's a glucocorticoid, so its primary purpose is to raise blood glucose. And so we've seen that a little bit on your blood chemistry.

Yeah.

Eating, you know, a really good high fat, low carb diet, and still you have somewhat elevated fasting glucose. And so you have to ask this question, is that because of the cortisol, Is that what's happening? And so maybe that could be causing some degree of insulin resistance that could increase your chances of getting type 2 diabetes in the future. And it's all because the root of the problem was this cortisol thing, which.

Is concerning to me because I've done genetic testing and I do carry the gene that puts me at higher risk for type 2 diabetes. And I've always wondered, because when I get my blood test, they've always shown like, like slightly high cortisol, but also much higher glucose than you would expect to see. Now we're talking, when I say high glucose, we're talking like 90, 95. Right. Not, not off the charts. Yeah. But high enough to show that there's, you know, like you alluded to, perhaps the liver is breaking down glycogen and shoving it as glucose into the bloodstream due to a Cortisol response. So, yeah, that's certainly concerning to me. What else, what else can can chronically high cortisol do?

Well, there's a big factor with the thyroid here, right? So with high cortisol less T3. So T3 is the active form of thyroid hormone. Less T3 is made peripherally, but more is made centrally. So the brain doesn't know that the tissues aren't getting T3. So that makes sense. So what happens is you see normal tsh. So TSH is the main signaling hormone that goes from the brain to the thyroid gland. And then the active form of the hormone is T3. And the brain doesn't recognize that there isn't enough. And so you see low levels of free T3 and normal TSH. And then in addition to that, your brain can also make reverse T3, which is like putting on the brakes on your thyroid. So you might see, you know, I mean, thyroid does everything right, that controls the rate of cellular metabolism and pretty much everything inside your body, super important hormone. And so the cortisol can mess that up too. And, you know, I know that you've had issues with that in the past. And so that's another concern that may be downstream of the cortisol.

I've also heard that hypercortisolism, due to the body being under the impression that it's stressed and almost due to like this ancestral mechanism to have us not want to make babies when we're stressed, can also potentially bind up, up some total testosterone and keep it from being converted into free testosterone. Almost like a link between hypercortisolism and this, this sex hormone binding globulin. Are you familiar with that at all or do you know if that could also be an issue? Just overall, you know, fertility or libido if left chronically high?

Yeah, I've not heard of that exact mechanism, but it totally makes sense when you think about this thing in terms of long term building projects. Projects, Right. So cortisol is the most important stress hormone. And so as far as your brain is concerned, you're, you know, you're being chased by a tiger or the house is on fire. So you're producing a lot of this stress hormone, cortisol. And so any kind of long term building project goes on hold. And that includes digestion, includes immunity, includes making new memories, includes making babies. Like, why would your body do that, that if you're being chased by a tiger? Like, it just doesn't make sense. So, you know, that's why I think the cortisol is really good to try and pin down and understand.

Yeah. And it's really strange for me because, you know, like I mentioned, my blood pressure is low. And most people that hang out with me don't, you know, they find me to be one of those guys who would rather charge up into the mountains with a heavy backpack and an elevation training mask on than sit around on the back porch and just chill. But at the same time, I've got low blood pressure, I've got high libido, low resting heart rate, fantastic sleep rhythm, et cetera. So I'm curious, based on my lifestyle, at least some of the glaringly obvious things that may elevate cortisol based on my lifestyle, what are some things that you think in a case where somebody, listener or someone like me has high cortisol, chronically high cortisol, but is doing everything right?

Right.

You know, as far as, like stress control and sleep and, you know, good recovery and Turkish baths and stevia flavored soda and all these big ass salads from Whole Foods. What are some things that could elevate cortisol if somebody is already doing everything right?

You know, so this is where Phil Maffetone has been so helpful for me in understanding this stuff is. I mean, you have to question whether you're doing it right or not. Like, you think about what we've just been talking about, a 12 hour obstacle race, and it's an amazing feat and it demands absolute respect that you were able to do that. But does it? Is it really doing everything right? You know, and I know that, you know, you take an approach to your training, which is less volume and lots of intensity. Well, we know that that's the sort of thing that would raise cortisol too. And then I was listening to your podcast this morning and there's the fantastic. I've totally forgotten the person you've interviewing. I'm sorry about that. But the crabs in the bucket is just so memorable. You know, just the idea of you being out there in front of everybody, this huge audience.

My interview with Craig Ballantyne.

Craig Ballantine, the crabs in the bucket. So you better tell the crabs in the bucket story as no one's gonna know what I'm talking about.

Okay, so you do need to go listen to the podcast episode. That was a great episode with Craig. It's basically his perfect day. Like how to put together the perfect day. And there's this trying to remember the exact way the story goes, but it's basically more or less this guy and he's Walking on the beach, and he finds this other guy fishing with a bait bucket. And he comes up and he sees the bait bucket doesn't have a lid, but it has a bunch of crabs inside. And he asked the guy, why doesn't he cover the bucket so the crabs won't escape? And the guy tells him, well, if there's one crab in the bucket, it would crawl out and escape. But when there's a whole bunch in the bucket, it. If one of them tries to crawl and escape, the other crabs grab a hold of it and pull it back down. So it'll kind of like share the same fate as the rest of the crabs. And the idea behind it was that it's the same with people. If you try to do something different, like get better grades or better job or improve yourself or escape your environment or dream big dreams or whatever, the other people might try to drag you back down to share their fate. And that was kind of the. The basics of the story.

Yeah. So my point here is that, you know, Ben Greenfield, you're kind of on a pedestal here, right? You're that crab trying to get out of the bucket. And maybe were your audience, like, kind of a little bit resentful of that, and, you know, we're pulling you back and. And there's this pressure on you to constantly be perfect. And another example of that I hear you talking about on the podcast is, you know, somebody asked a question like, what can I do when I'm going to spend a lot of times in a seated position in a car when I commute? And you talk about all the things that you do, and I wonder, blimey, that is a lot of stuff for you all, you know, to be remembering and doing all the time.

Like, see, see, for me, though, to have like a hand grip strengthening device and a little power lung and some rows and like, hypoxia, like to do all that while I'm driving. It's all habit. It's totally like, nothing about that feels like I'm running from a lion when I'm just like, making a drive more interesting and better for my body. And I see where you're going with this, you know, in terms of there potentially being like a hidden or. Or something I'm not aware of driving cortisol. And, and I mentioned this to my wife. I was talking about this test with her, and I'm like, maybe I don't. I've never known what it is to be truly relaxed or to truly have low cortisol, because I'll be. And again, like opening the kimono here. I took 25 credits per semester for four years in college while working three jobs simultaneously. And that was just how I lived, and that was what I enjoyed. I worked at the pub at night, I worked at the bakery in the morning, worked as a personal trainer during the day, and then took classes in between all those times. And I obviously run multiple businesses now and do do podcasting and write books and mess around with a lot of other hobbies while still spending time with my kids, et cetera. I feel like I do fill every day quite full, but that's something I've always done. I don't have anything to compare that to, really, like not being driven. So part of it is that I feel like I'm a little bit hardwired to be driven. But like I keep mentioning, at the same time, I just feel so relaxed and so good. And so I'm curious, you know, not to kick this horse too much to death. I'm curious if we move on and look at a few other lifestyle factors. There are other things I've wondered about. You know, for example, I've heard a little bit about ketosis and how there is some sort of biochemical mechanism with ketosis that may show that you have high cortisol. Even if. If what it really is is that ketosis keeps cortisol from being broken down quickly. There's something about a lack of blood glucose that keeps cortisol from being broken down quickly. Do you know what I'm alluding to here?

Yeah, I do. So, you know, insulin is one of the things that tips the balance more towards cortisol, which, remember, we said was the active fraction of the hormone and away from cortisone.

Right.

But in most cases, I think this is reversing a pathology. Right. So when you've got someone who's severely insulin resistant, they've got tons of insulin floating around, they have massively upregulated cortisol clearance that paradoxically outweighs the additional cortisol production. And so what you end up with is low free cortisol on one of these tests. So the ketosis thing, I think if anything, it's actually reversing a pathology by reducing the amount of insulin that's going around rather than causing a problem. But there are some, you know, so there's some other studies that have been kicking around that show that the ketogenic diet increases cortisol, but when you look at them, they're all junk. Like, we took, you know, eight obese Untrained men and who were eating a high carb diet. And then we just took away the, the carbs and gave them tons of fat. And it wasn't even tons of fat, it was 60% or, sorry, 40% protein. I'm so just a terrible diet. And then we saw an increase in cortisol and so the studies are just really awful. So if anyone's listening to this that knows of a study that ketosis or a ketogenic diet can somehow now increase cortisol production, then we'd love to see it. Because, you know, Tommy, as I said, is does peer review for a living and spent a lot of time looking for something that would answer this question and we can't find anything at all interesting.

Okay, so. So it's basically bunk that, that an extremely low carbohydrate, high fat diet might, through some sort of biochemical mechanism, directly decrease the rate at which cortisol breaks down or increase cortisol production, it would appear. But what about this idea that your body, if you were doing heavy and hard training, might want to actually mobilize more blood glucose because there isn't a lot of, say, like endogenous glycogen or glucose availability. And do so by churning out a bunch of cortisol to get the liver to release glycogen? Because you have a combination of a low carb diet and high intensity training, which would actually define me.

Right. So I mean, this is just the normal physiological response to high intensity exercise, is it not? It's not really to do with carbohydrate availability. I mean, so cortisol liberates free fatty acids as well as the glycogen. And so if you do high intensity exercise, you're going to see raise cortisol, but that should return to normal once you return to a normal energy.

I was gonna say on, on a test like this where you have like a multiple measurements throughout the day, you wouldn't see it high all day as it is on mine. Correct?

Yeah, no, exactly. So you're cranking out a ton of cortisol and the cortisone is high, so the shadow of cortisol size. So it's not like a single re. So I have seen that before. You know, I've done not quite a split test, but I've done two saliva tests on the same person on two subsequent days. And on the second day they went and did a crossfit workout in the afternoon and you can see a clear spike in the free cortisol. But that's not what we're seeing here. It's not like a spike. It's like every single value is high. So it doesn't make a lot of sense.

Yeah. Especially in light of the fact that I do cyclic ketosis, meaning that at the end of just about every day, I typically am consuming 100 to 200 grams of carbohydrate from red wine. And just a glass of red wine, by the way, lest you suspect that alcohol might be driving cortisol production. A little bit of rice or quinoa or amaranth or millet, a little sweet potato, a little yam, these type of things. And so I am restoring much of my muscle and liver glycogen levels to the point where I wouldn't, I wouldn't say that I'm one of those people who's in like a state of constant glycogen depletion, for example. Now, one other question I wanted to ask you before turning to, you know, the potential for supplements or herbs or something like that to increase cortisol. Since sleep is good, I know that sleep can cause high cortisol, but my sleep, and I recently wrote a post on this, my sleep is fantastic. You know, eight to nine hours of sleep per 24 hour sleep cycle. And I've, you know, I've measured it and it actually is true sleep. It's not just lying in bed, it's not just light sleep. It's like a good cycle of non rapid eye movement to rapid eye movement sleep. Using this ring that I'm actually using now to measure my sleep cycles. What about infections? Are there things? Because we hear these days about everything from staph to Lyme to all these things that can be like, like hiding in your bloodstream or you know, even parasites, things like that. Can those potentially cause high cortisol levels even if you feel good?

Yeah, absolutely. And so we know that this was a potential reason the investigation that we did, we were like kind of playing tennis with test results. You sending me more and more stuff from like the ancient past. And we were trying to figure out what might be causing this. And you sent me an old gut test that showed a parasitic infection called Blastocystominas.

Yeah, I came back from Thailand with that little gift one year, year, actually two years, because I started to test my gut every time I'd come back from travel and swimming in nasty water, doing triathlons and things like that. And twice I came back as recently as a couple years ago with some nasty things living in my gut. Some Nasty critters on board.

Right. So in theory, that could be a possibility, but when you talk to someone who is really experienced with this. So Dr. Brian Walsh, who has, like I say, just been so helpful to me in teaching me over the last couple of years, he was not buying that at all. So blastocyst is hominis. I mean, I think it does cause people problems, but it's one of the more controversial parasites that you see on a stool test. And there are actually researchers that are looking at this parasite in its role of promoting health. Health. So it's a, it's a really kind of wishy washy one. And I think the kind of, the stance on it should be like, treat if you see symptoms, and then if not, then you probably, you're not going to get any benefit from treating it. And so that's certainly the case for you. Right. Like you don't have any symptoms. So even if you were to do another stool test, it came back and you found the blasto again. Is this going to be the high of the cause of the high cortisol? It seems unlikely.

But for people listening in, whom who may be, do have high cortisol and are kind of trying to solve these mysteries, it is possible that something like a gut test would be prudent to see if there's any, like, hidden parasites or yeast or fungus or bacterial imbalances that could potentially be causing high cortisol. Because what I understand is that gut issues can directly cause the HPA axis to actually be producing more cortisol, like cytokines and inflammation and things like that can actually cause high cortisol. Correct?

Yeah, exactly. So, you know, Brian is the man on this one, and I don't want to go too deep into his story because he's going to be able to tell it a lot.

Yeah, I have him scheduled to be a podcast guest to talk about, to talk about some of these things.

I'm really, really excited about that. But yeah, so basically, some of these protein messengers, cytokines, they can stimulate the HPA access into producing more cortisol, but typically that's more of an acute response. Right. So acutely, cortisol helps stimulate the immune system, but chronically, it's immunosuppressive. So there's this very, very delicate and complicated feedback loop that exists between the immune system and cortisol or glucocorticoids to stop the immune system from just, you know, frying your body. Right. You can turn up the cortisol, turn down the immune system, but it's so complicated. And it's really, really interesting because for me, I think it's the true cause of these cortisol dysregulation issues that we see on these tests. It's the immune system dummy. Like, it's not the word adrenal fatigue or the term adrenal fatigue is just a gross opal of simplification and probably not a term that we should be using anymore. And so, yeah, it's definitely something I'll be looking forward to hearing from Brian.

Yeah, that'll be interesting. And I know that there are also some other things that can affect cortisol. You know, for example, on the podcast before, I've talked about, like, how licorice has, like, components in it that can decrease the half life of cortisol or cause it to stick around in the bloodstream longer. And that's actually something that, you know, I'll sometimes recommend to folks who have adrenal fatigue. Like, true adrenal fatigue aren't producing a lot of cortisol. You know, sometimes I've recommended red ginseng is another herb that can be used to increase cortisol if cortisol is too low or even the use of adaptogenic Chinese herb complexes. But when it comes to supplements or herbs that could be increasing cortisol, and I don't take licorice, I don't take red ginseng, I don't use any of these things I'd recommend to folks who produce low amounts of cortisol to increase their cortisol. Are there other things that could increase cortisol? Like, you know, I had mentioned alcohol, and I'm certainly very, very low on the alcohol intake, but one I wanted to ask you about was coffee. I know that coffee is a natural source of cortisol, and my dad was a gourmet coffee roaster starting from when I was 15 years old. I've been a coffee aficionado since I was a teenager. And I'm one of those guys who will, you know, drink a good two to three cups of coffee in the morning and, you know, then I'll switch to decaf and sometimes even throw in another 1 to 2 cups of decaf at some point during the day, drinking it like tea. Is there any link between coffee and especially caffeine and the potential to increase cortisol?

Yeah. So it seems like most of the things, most of the supplements, or at least all of the ones that I know, they're not truly leading to a production, an increase in the production of cortisol Right. So on the Dutch test, you wouldn't see the total metabolized cortisol go up as a result of taking a supplement unless you were sensitive to it or something like that. You know it's causing some sort of allergic reaction. Like, no supplements really do that. All they do is interfere with the action of this enzyme, which converts the active cortisol into the inactive cortisone. So that enzyme is 11 beta hydroxy steroid dehydrogenase. I love that. It's kind of. It's a variable name. What if it is what it is? If you're a computer programmer like me, you'll appreciate that's a pretty good variable name. That when you do a Google search for it, you'll find lots of information. And so that's how all of these things work. So glycerin is the active extract in the licorice and then caffeine. And then there's some other things. What they do is they interfere with the action of that enzyme and they slow the conversion from cortisol into cortisone. So effectively what you're doing is you're blunting the drop in the natural drop in cortisol. Right? So first thing in the morning, you produce a lot of cortisol, and that's supposed to naturally decline as the day goes on. And so if you take caffeine or licorice or something else, you just inhibit that enzyme. And so the cortisol that you do make, it just ends up hanging around longer.

Okay, gotcha. So. So a lot of these things are just causing cortisol not to break down quite as quickly. And would that include caffe?

That includes caffeine.

Okay, so caffeine doesn't have some kind of natural cortisol analog in it. It's just causing the cortisol that you'd naturally be making anyway to not get broken down quite as quickly.

That is my understanding.

Okay.

Unless you have a sensitivity, and then it could be. So then if you have a sensitivity, if you have some kind of reaction to something, that's a stress, right. As far as your brain is concerned, you're being chased by a tiger. And so that would lead to an increase in cortisol. But my understanding with caffeine is it slows the breakdown of cortisol.

So when we look at these studies, you even sent one over to me that shows that caffeinated coffee could prevent serum cortisol concentrations from falling. You know that when you. When you look at that study, at first glance, it would appear to be synonymous with saying that coffee increases cortisol production. But in fact, all it's doing is taking the cortisol that you're making anyways and just keeping it from getting broken down as quickly.

Yeah. And so it's a really important distinction that, you know, you're not making more cortisol, you're just slowing the production, the breakdown.

And what this Dutch test shows is that the coffee couldn't be an issue because I'm not just hanging out with a lot of free cortisol, but I'm churning out a bunch of cortisol naturally. Like endogenously.

Yeah, exactly. So both markers are high.

Right. Okay, gotcha. Another one that I wanted to ask you about, because I've seen links between it and cortisol. But typically the. The research that I've seen has shown a decrease in cortisol, especially when it comes to the cannabidiol component would be marijuana or cannabidiol. Now, like I mentioned, I take CBD almost every night. I swear by it to help with sleep, and I've written full articles and done podcasts about it and why, and it's full legality around the world, et cetera. So I won't kick this horse to death too much, but I want to dwell upon it a little bit when it comes to cortisol. Do you know anything about the link between either CBD or THC and cortisol? Because I don't just take thc. I'll occasionally, sometimes as much as three to four nights per week, especially when I'm playing music or I'm writing. I'll microdose with thc, meaning some of these edibles will contain massive amounts of THC. But I'll use 2 1/2 to 5 milligrams of a THC tincture that I make at home. Would something like this affect cortisol, do you think? Basically, yes.

That's the same mechanism. It's the same as the licorice root. So we've got at least one study here that shows that both CBD and THC prevent that daytime drop in cortisol. But then we have another study that said the opposite. Right. It was kind of. It didn't see any difference in cortisol with the administration of cbd. So it's contentious. And I wonder whether there's going to be, like, a lot of individual variability there, and maybe that's what's going on on. But it certainly seems to be working for you, like, in terms. I mean, if that's what's giving you great sleep, then, you know, I would have thought that sleep is the highest priority.

Oh, yeah. Sleep, creativity, you know, good ukulele songs, that type of thing. So. So there's really not much of a link between marijuana or cannabidiol and cortisol when it comes to anything beyond simply either decreasing the rate at which cortisol is broken down. And I. Because I have seen a. A couple of studies that shows that. That THC all by itself might actually increase cortisol. But it's the same as coffee. Correct?

Right, Right.

Okay.

And then so Mark Newman, like, obviously he pulled up a lot of research when he was developing this test, and included with each test result is this roadmap of the steroid hormone hierarchy. And he lists a whole bunch of things which affect the action of these enzymes that convert one hormone into another. And he's got chronic marijuana use listed under the decreased cortisol section. And I asked him for a reference for this, and he didn't get back to me in time for this interview, but I'm sure he has one. I'd be very surprised if he's made a mistake there.

So, okay.

According to Mark Newman, the analytical chemist that developed this assay, he thinks that chronic marijuana use decreases cortisol.

Right, right. And that's actually what some of the research that I've seen shows as well. Where. Whereas, like, like, you know, obviously overdosing with THC can really put your adrenal glands for a spin when it comes to raising cortisol. Small amounts here and there could actually relax you and decrease cortisol.

Right.

Yeah. Okay, gotcha. Anything else when it comes to supplements or foods or anything like that that would cause an increase in cortisol? Before I ask you about, of course, another very important point here is what can decrease cortisol? Cortisol.

I think. I think we covered it. I think we covered it. We talked about glycerin, which is the active component in licorice. I think that's about it.

Okay, so what kind of supplements or foods or, you know, even, like, you know, I know there's a lot of essential oils out there. What, what kind of things can decrease cortisol? And actually, before I ask you about this, I. I do want to let you know, and I. I've talked about this on the podcast before. I keep a cold air diffuser next to my bed stand, and I diffuse when I sleep at night, things that can help to decrease your sympathetic nervous system stimulation, particularly what I put in that Cold air diffuser is a few drops of lavender oil and a few drops of rose oil. And so it's nice because it humidifies the air a little bit and helps you to sleep. And I know that essential oils have some research behind them when it comes to decreasing cortisol, but I'm curious to hear your thoughts on, on supplements, foods, essential oils, how they could decrease cortisol if they actually do decrease cortisol or if they're just acting similarly to perhaps decrease the actual, or I suppose increase the breakdown of the cortisol that you are making rather than directly decreasing your cortisol production. But fill me in on this if that was a long enough question.

Yes, so there is the essential oils are an evidence based approach and Tommy was able to find some good quality science that shows that lavender does indeed reduce cortisol. So that seems like a good idea. So what they had people do was either sniff an artificial fragrance or the lavender and they showed a reduction in cortisol with the essential oil versus the, the artificial fragrance. So that seems like a good approach to me. It's not what I have to say. We don't have a lot of experience of recommending supplements based on your situation because like I say, we never see it. We never see it. So the hundreds, literally 550 odd people, we never see the high cortisol, but we know that phosphatidylserine. So one of the training courses I did, so when I bumped into the system, did a whole ton of training courses and one of them was the, the Kalish Institute training, which I found tremendously helpful. And I was turned on to a supplement called phosphatidylseri during that training course. And that again is a very evidence based approach to lowering cortisol. And the way that phosphatidyroserine works is it, it blunts acth. So this is act. ACTH is the messenger that goes from the brain to the adrenal glands. So that's what it's doing. It's not acting on cortisol at all. It's acting on the signaling hormone that comes before it that goes from the brain, brain. And again, very evidence driven approach. But the problem is that most of the studies that have been done have been done on bovine phosphatidylserine. And then there was the, the mad cow disease fiasco in the uk and so people stopped making phosphatidylserine out of cow brains. And now what you see are products that are made with soy and those have also been shown to work. Work. But it would appear that there's a U shaped curve. So 6 to 800 milligrams of phosphatidylserin as soy only worked as well as the placebo. So it's like kind of really hard to figure out the dose. It seems it's lower than that. And again, I bet this is another one of those things that's very variable according to the person. Right. So you might have to experiment with this as well. So really interesting.

So when it comes to phosphatidylserine, that would be something, it sounds like you're saying would actually modulate cortisol levels directly, the actual production by the adrenal glands, because it's not working on the cortisol that's in the bloodstream. Unlike some of these other things that we've talked about, it's actually acting directly on the brain and the signal that the brain is sending to the adrenal glands.

Yeah, exactly. So this is working on the brain to block the production of acth. Now the problem is, what if there's something else in your body that's producing the acth? Like there could be some other tissue, some rogue tissue tissue that's producing the acth, and that's what's triggering the adrenal glands to produce the cortisol. And so if the phosphatidylserine only works on the brain, you're kind of dependent on the brain working properly in order for the phosphatidylserine to work. But we do think that that is the case for you because you still have a normal circadian rhythm. So in someone with Cushing's disease, for example, where there's like unregulated acth, you'd lose that circadian rhythm and all you see is just high cortisol all of the time. Time. And that's not the case for you. You have a normal circadian rhythm. So we have good confidence that the phosphatidylserine would work.

Interesting. Okay, so in a case like mine, you would recommend definitely continuing with essential oils, but also perhaps experimenting with the use of something like phosphatidylserine.

Yeah, I mean, so, you know, I've put in my notes here, highlighted with two question marks. Why? So that's what I'm always thinking as both a computer programmer and as somebody that looks at these dust test results. Why, why is this person making a lot of cortisol? Why are they not making a lot of testosterone? There's a reason. And this is what I want to implore people to do. Like, if you're currently taking hormones that have been prescribed to you by an endocrinologist, why do you need them? It's not a genetic deficiency. Probably like there's something going on and people just write prescriptions without even. Or take prescriptions without really understanding why they need them. And so that's really what you need to do is figure out what the heck's going on here. Is it the ketogenic diet? Is it the high intensity intervals? What the heck's going on? Like, we need to know the answer to this. And the only way that you can find out is to do some more testing, do some more experimentation and then redo the Dutch test and find out if anything has changed.

Yeah. And so in the case of testing, what you would recommend then would be, for example, a gut test to rule out any underlying infection and then potentially experimenting with some of these other recommendations that you've made, such as the use of something like a little bit lower exercise, maybe a little bit higher carbohydrate intake, possibly just really focusing on, you know, maybe a week of absolutely taking things off from a work standpoint and just see if perhaps I'm more stressed out than I actually think I am and then redoing the test.

Yeah, that makes sense. Just go on holiday. Wait until you're going to go on holiday and you know, you're going to have a super chill week with your family and not really do any working out, you know, maybe just a bit of walking or something and keep up your yoga and meditation, all of that. And then redo the test and see if the cortisol is still high. That seems like a pretty good strategy to me.

Yeah, I have a little digital detox coming up in December. I've talked about that this very briefly on the podcast. It's called Runga down in Costa Rica and it's kind of like an eight day yoga retreat digital detox. And so perhaps that'd be a perfect one for me to bring some pee strips to and run the test right after I finish something like that, just to see, just out of curiosity. So even though I am definitely one of those cases, and as you would know if you clicked on the title to this podcast, where I'm wondering, why is my cortisol hotel even though I'm doing everything right? So this is super interesting stuff, Chris. And I want to now ask you a little bit about kind of how people can get this test, use you for interpretation, etcetera so can you go ahead and delve into your method with me and how this actually works and how somebody can get started if they wanted to do a test like this?

Sure. So I think it's really important to make it clear that. That a hormone test is the beginning of an investigation and not the end of one.

Right.

Like, if you run this test and you find high cortisol or low testosterone or high estrogen, that's the beginning of an investigation. Right. Like, it only raises more questions than it does create answers. Like, that's important to. To point out, but at the same time, I think this is a totally awesome test to use as a barometer. Like. Like, what's going on for you right now? Like, if you're headed into a hard race season, like, it's really interesting to establish a baseline to see how your body responds over this stressful race period. And then another good reason to do this test is if you're feeling really good right now, do the test and find out what your free testosterone is. And then if next year, or in two years time, or in 10 years time, sudden you start feeling like crap, crap, and somebody runs a test on you and says, hey, you have low free testosterone, then there's a good chance you might be able to say, well, hey, 10 years ago, I also had free testosterone, and I felt great then. So, you know, probably not that it can make an investigation in the future much, much easier, but the way we work, and I say we, it's not the royal we, as you pointed out at the start. I work with my wife, who's a food scientist and a registered nurse, who's also done the Khaleesi training. And then Tommy is our medical doctor and our chief medical officer. Excuse me. And the way we work together as a team is, I think, pretty cool, pretty novel. And it's something I was turned onto through software engineering. There's this method of project management in software engineering called Agile. And then there's a really, really common or the most frequently used method of agile project management is called a scrum. And what the scrum is, is, is you get a bunch of people together so a bunch of interested parties that are trying to produce some product, some end result, some end goal, maybe some big, hairy, aspirational goal, like, as a runner, I want to qualify for Boston. Right. That's your big, hairy, aspirational goal. And then maybe you've listened to 350 or maybe even 800 episodes of the Ben Greenfield podcast. So for the most part, everybody knows what tasks need to get done in order for you to achieve that big hairy aspirational goal? Goal. So what you really need is someone to break that down into smaller subtasks that you can easily get done. So that's the way that we work now. We take someone, you know, we run some labs on them. The Dutch is one of those labs. They have some goals that they're trying to achieve and then we take from our big deck of tasks the things which are most important for that person right now and then we put them them onto a board that we call a Kanban board. And everybody knows what a Kanban is because you've been into a busy coffee shop, right? When they write your name on a coffee cup and put it down on the counter, that's a Kanban.

Is that similar to the online project management service Trello?

Yeah, exactly. So Trello is a flexible tool that can be used for a number of different things. And so for this instance, we're using it as a Kanban board because it's super flexible and really easy to use. So we take these tasks. So let's say get to bed by 10pm and install some orange light bulbs in your house and eat dinner earlier in the day. Like maybe those are the most important tasks for you to do in order to improve your cortisol situation. So we would create sticky notes and we put those on the Trello board, the Kanban board, as we call it, it in the to do column and then we work in two week sprints. So the idea is you take those sticky notes and you move them from the to do column into the done column and then that way the whole thing becomes manageable. Because what I found in the past, you know, two years in is my list of things, my deck of possible cards that I could put on your board has gotten bigger and bigger and bigger. And if I try and get everybody to do everything all at once, they do nothing. And so, so breaking it down and doing the proper project management becomes really, really important. And we have been getting fantastic results, like 100% success with people by using this special agile method of health coaching.

Interesting. So it sounds very, very formulaic, very scientific. Rather than just like throwing a bunch of supplements and lifestyle changes at an issue. You're systematically ruling out what's working and what's not as you walk someone through the results of a test like this, kind of like we've very briefly done in this episode. But basically what you're doing is a little bit more almost like systematic detective work. With food supplements, self quantification, et cetera.

Yeah, exactly. And it makes the follow up so fun. So normally in a follow up call, I would spend the whole call saying to the person, did you do headspace? Did you check your blood glucose? Did you check your blood ketones? Did you stop eating oatmeal? And it would be a really boring call. Whereas now with the Kanban board board, the person has just dragged all of the cards from the to do column into the done column. And so it's really, really obvious exactly what they've done and what they haven't done and what we need to focus on on the next iteration. And then in addition, it makes it really easy for me to collaborate with other people on my team. Right. Like, I don't need to tell my wife what I've already told you because she can see it on the board. And then if we get stuck for any reason, which hardly ever happens, but occasionally does, then I can helicopter in Tommy from the other side of the world, literally, and he can look at your board and say, and know exactly what I've asked you to do. And it just keeps the state of the system really clear at all times. So it's a really cool system.

Awesome. I love it. And obviously your wealth of knowledge on this stuff, you've been enormously helpful to me when it comes to kind of walking through some of these results. And by the way, for those of you listening in, I've been taking notes quite furiously on everything from this test to all the studies that Chris mentioned. I'm gonna link to those in the show notes for you. And then finally, the other podcast that I've done with Chris on the organic amino acids test, which is a different test altogether, but also very helpful for things like micronutrient deficiencies, et cetera. And Chris's podcast with me called the seven signs that your adrenals or your cortisol is broken and plenty more. So that's all over@BenGreenfieldFitness.com Dutch that's BenGreenfieldFitness.com Dutch along with my own test results, if you care to look over those or download those or kind of glance through them as you listen to this again, which you may need to. But then also Chris is offering a discount on the testing service that he just described. The consulting combined with the systematic fixing of issues. Issues. So what you do is you go to his website and I'll put a link to it in the show notes, or you can just go to norrishbalancethrive.com and you use code BEN10 to get a 10% discount on the testing and consulting that we just talked about. It's called Ben 10. That's the correct discount code, right, Chris?

Yeah, that's right. So we're doing it as a challenge. I'm calling you to action, right? You've listened to 350 episodes of the Ben Greenfield podcast. Podcast. What have you done about it? Do two Dutches. So that's what this program consists of. You're going to do a baseline test and then I'm going to do some health coaching with you. We're going to figure out what the most important tasks are for you to do right now and then you're going to go do something and then the follow up test is included in the purchase price. Right? So I'm going to send you two test kits. And the beauty of this thing is because it's done on these filter paper, it doesn't matter where you are in the world. Like you can pee on the filter paper and send it back in the regular mail, right? You don't have to send it by USPS or sorry, by UPS or FedEx. It's super light. So you can do this from anywhere in the world and get the baseline and then the follow up. And then I've kind of. It's playing on the back of my mind that Tommy is a research scientist and he knows how to do peer reviewed science and has had several papers published in the last couple of weeks. And so if we get enough people do this, then we've got the data for a study. This could get interesting, but we'll see how many people sign up for it first.

That's awesome. So you can pee not just four to five times, but eight to ten times by.

Exactly. It's actually quite fun. Compared to the spitting in tubes, which wasn't much fun, the peeing on paper is much more fun.

Well, my trick for dripping saliva into tubes is always to sniff a jar of peanut butter. That always makes me salivate. Speaking of which, it's high time for me to walk back down to Whole Foods one more time time before I leave Seattle to go pile myself up another big ass salad. And I'm working on a blog post, by the way, on all these things I mentioned in the intro, from recovery from a 12 hour event to how I hack the issue with the canola oil at Whole Foods and much more. So stay tuned for that.

I'm looking forward to that.

Yeah. But in the meantime, BenGreenfieldFitness.com that's BenGreenfieldFitness.com Dutch and also, when you go there to the show notes, feel free to leave your comments, leave your questions there, and either Chris or myself will be happy to hop in and reply. So Chris, thanks so much for coming on the show and sharing all this with us, man.

No, thank you, Ben. It's been an absolute pleasure and a privilege. Thank you again.

Awesome. Well, folks, this is Ben Greenfield and Chris Kelly from Nourish Balance Thrive signing out from BenGreenfieldFitness.com have a healthy week. You've been listening to the Ben Greenfield Fitness podcast. Go to BenGreenfieldFitness.com for even more cutting edge fitness and performance advice.

Sam.