Transcript excerpt from a Ben Greenfield podcast episode featuring Bryan Walsh discussing the physiology behind high cortisol. Walsh emphasizes measuring ACTH (adrenocorticotropic hormone) to determine why cortisol is elevated and explains the pituitary–adrenal signaling pathway and clinical implications for integrative medicine.
When Chris Kelly, the guy who I interviewed on that, on that first High Cortisol podcast, sent me over to you to talk to you a little bit more deeply, the very first thing that you said was to test something called acth. You said the very first thing you should do is to get ACTH measured. Why did you make that your first recommendation for something to look at when someone's cortisol is high?
Sure, sure. It's not run very often, unfortunately, it's a little bit expensive, but it really should be run in anybody that has abnormal cortisol, because. And I'll just take a step back to discuss the physiology of this. If there's a perceived or real stress to our brain and it needs to have a stress response, the brain can tell part of the brain called the pituitary gland to release a hormone called ACTH or adrenocorticotropic hormone, also known as corticotropin, which is, you can see why they abbreviate it as acth. ACTH is. So if the brain perceives stress, either real or imagined, it tells the pituitary to release acth. And then ACTH circulates throughout the body, reaches the adrenal glands, and then when the adrenal glands receive this acth, they produce an accordant amount of cortisol as a response. So the more acth, then the more cortisol, I will also say, the less acth, then when the adrenal glands receive the message from the brain of only a little bit of acth, then they only produce a little bit of cortisol. And one of the problems, well, one of the things we do well, I will say, in the integrative medicine space is we run cortisol. Now, most conventional doctors don't really run that very often, and we do. The problem is that when we see it high or low, then we just automatically jump to certain conclusions. So in you, for example, without knowing any of your history, if you were sitting in front of a practitioner that ran this on you and your cortisol was high, they would say, well, you're obviously under a lot of stress. And then to which you replied, no, I sleep perfectly every night, I meditate, I have a very chill constitution, I'm not a stressed guy. To which they would probably respond, no, no, no, you have high cortisol, you have some kind of stress. And so your cortisol on the Dutch test was pretty elevated. Also on historically, when Chris sent over your labs or your history of your labs, your cortisol's been on the high end in blood, on the high end of normal dating back to 2013. And so my question was, and the first question that I think any practitioner should ask, well, why? Why is it high? Why does his body want high cortisol? And there's.
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