In this Wednesdays With Will episode, Dr. Harden explains Cortisol Control and some of the common causes of headaches and how they can be prevented and treated.
Plus, in our listener question from Pete in Portland asks about the role of cortisol in the body and how it effects athletic performance and body weight.
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Transcript of This Episode
Will: Headaches come in many varieties. You certainly have known many people who’ve had chronic migraine headaches, stress headaches, sinus related headaches, jaw-joint-related headaches. And the truth is that’s just the tip of the iceberg, right? A headache can be caused by a brain tumor, an ocular or otomological problem, visual disturbances, eye strain or associated with computer use, on and on. And so the goal in part of any (inaudible 00:38) is to take a thorough history to try to find a connection between daily activities and headache or potential pathology in the headache.
As it turns out, 90% of headaches within the medical community are called stress headaches. Within the chiropractic community and to be a little more specific is to what a stress headache is we call that a cervicogenic headache. That is a headache made in the neck. Literally, cervicogenic means made in the cervical spine or the neck so between the base of the skull, called the occiput; and the top cervical vertebra, C1 or the atlas, on the right; and on the left are three suboccipital nerves. One goes to the base of the skull, essentially, in the back of the head. One goes to the parietal and temporal area. That means the top sides of the skull. And one of those suboccipital nerves goes to the frontal and periorbital region, In other words, the forehead and around the eye.
So some people might say “Oh my headache isn’t from my neck. It’s around my right eye or it’s in my right forehead.” And yet in nearly all cases, I can press on the base of the skull in the upper neck and reproduce to worsen that headache. And I can traction the neck at the base of the skull and ease or even eliminate that headache. And those are both really strong indicators that that headache is coming from the neck, not the head.
So as it turns out, one of the most common things for which people seek chiropractic care is headaches. And the truth is I really love a new patient with headaches because it’s surprisingly predictable that adjusting the upper cervical spine will get rid of that headache. And in many cases and a handful of adjustments someone that’s had 10 or more years of chronic headaches will see mark improvement or eradication of headaches.
So why would someone have a neck alignment problem that’s irritating suboccipital nerves and therefore inducing a headache? Right, ‘coz when push comes to shove, what really matters is how do you get to the root cause of the headache. And the answer is almost always postural. That is someone who sits at a computer 4, 6, 8 hours or more per day, and when not on the computer is texting or checking messages on a phone, or is goggling on their phone, and then at bedtime, they use an iPod or a laptop and read in bed and read the newspaper – all those things have one thing in common. They’re associated with chronic flexion of the neck or forward carriage of the head. And during one of our conversations, we had a discussion about a posture. And the idea that ideal posture is such that we have ears over shoulders which is indirect opposition to carrying the head forward.
Proper Neck Alignment
So therefore, to get to the root of headaches: one, we have to straighten out the alignment of the upper neck; two, we need to ease muscle tension at the base of the skull that’s downward traction and deep tissue work; And we have to address the fact that for most of the day, most of us are sitting with a head forward position. So the goal is to move the head back by essentially sliding it back on a horizontal plain. What I mean by that is don’t raise and tip your chin back. Don’t tuck your chin to get your head back instead you move your head and neck, I should say, your head and chin on a horizontal plain as if you’re sliding it along a kitchen counter to move the vertical line from your ears closer to your shoulders rather than having that plum line hit the chest of the lap, which is really common. If you doubt it, just look at your colleagues at work. Look at somebody driving a car and you’ll see that almost everyone is carrying the head forward. So headaches require addressing upper cervical spine and base of skull misalignment, doing everything you can to prevent the stress that causes the muscle over exertion of the base of the skull.
In fact, the most commonly dispensed tool that I have in my office is a little $20 foam triangular wedge that you lie on. You put it underneath the neck and ultimately what it’s doing is it is restoring the natural curve to the neck. If you were to look at an x-ray of the neck from the side, you would see that it’s concave toward the back. In other words, it’s curved. It’s not straight when viewed from the side. And yet, a lifetime of computer use, texting, reading, studying, forward head causes us to lose that natural curve. And therefore laying on your back, putting a curve in to your neck passively. In other words, it requires zero effort. You lay on this triangular wedge and you could somewhat accomplish this by making a small log out of a rolled up towel. Fold the towel in half lengthwise and then roll it up from one end until you make about a 4-5 inch diameter firmly rolled towel.
Glenn: Would be a foam roller be too large? Because I’ve done that before where I lay on my back with the foam roller under my neck.
Will: It would be too large because a foam roll with a 6-inch diameter is putting a really gradual curve in to your neck. But a rolled up towel of 4-5 inches diameter, better yet a triangle, a firm foam triangle is more forcibly putting a natural curve into the neck. And that curve within neck is called the cervical lordosis and it actually first develops as an infant first learns to carry his or her head. The weight of one’s own head, that’s when the cervical lordosis begins to develop. In fact, if you look up at the side view of the entire spine, you would see that the cervical spine is concaved toward the back. The upper and middle back called the thoracic spine is convex toward the back and the lumbar spine or the low back is concave toward the back, the same as the neck. And that big S shape is a perfect shock observer. It’s a big spring. So that when you walk, run, go down the stairs, hopped or jumped, you have an inbuilt shock observer or spring.
And when you lose that curve, those curves, for example, when your neck is lost in its natural lordosis or curves that leads to premature arthritic change. It will have huge implications because I see arthritic changes within necks and low backs in, particularly, literally, all day long. And it’s not uncommon in this day and age.
In fact the last 3-5 decades of the excessive use of the computers that I see arthritis in 30 and 35-year-old necks all the time leading to chronic neck pain, chronic headaches. So getting that curve back into the neck and preventing daily overuse that promotes its lost is extremely beneficial for neck pain and headaches.
Glenn: Well, I have a question from a listener. It’s Pete from Portland. He says:
“I hear a lot about cortisol. Well, most sources say it’s bad and causes belly fat. I’ve also heard that it’s necessary and important. As an athlete, what should I know about it and how can I improve my performance?”
Will: Don’t all athletes wanna know about performance enhancement?
What is Cortisol?
Will: So cortisol. Wow. What a neat topic. You have two glands that sit on top of your kidneys, one over each kidney. And it’s your adrenal gland. Your adrenal gland is responsible for manufacturing a few hormones. The two main hormones that the adrenals manufacture and release are adrenaline and cortisol. Adrenaline is we might call it an acute stress hormone. So if you’re driving along and you have a near-miss car accident, you slam on your breaks and your heart is raising. That’s a result of your adrenals having released adrenaline. Adrenaline makes your reactions faster. It literally activates your muscles to contract more quickly and forcibly. You’ve heard stories about moms lifting a car off of their baby that’s about to be crushed. And it is understood that that’s a result of the release of adrenaline.
But I would say that more importantly, the adrenal glands release cortisol. Cortisol is your body’s main ongoing stress hormone. So when you wake up in the morning, your adrenals surge in their release of cortisol. And cortisol is released throughout the beginning and I would say the first half to two-thirds of a day. So cortisol keeps your heart rate, blood pressure, respiratory rate and energy level on a nice even uphill during the day. By evening time, your adrenals stopped releasing cortisol and you burn up what cortisol exist within the blood stream. And then sure enough as your cortisol levels dropped, you feel tired. You go to bed. And through the night, you release no cortisol. You wake up in the morning and boom! Your cortisol begins to surge again which allows you to maintain a nice wakeful day.
Cortisol and Stress
In truth, many people get confused, if you will, in their cortisol releases. And it is believed that this happens as a result of prolonged and excessive stress. And I submit to you this easily could happen confusion in your normal diurnal release of cortisol. Diurnal meaning dark and light 24 hour rhythm. As a result of having a job in which let’s say for 6 months or 6 years, you worked night shift. In that case, you were forced overtime to switch on your cortisol releases and release it at night and then not in the day. And some people never really recover from that confusion of cortisol release. That is not the norm.
Most people as a result of excessive stress overtime, who developed a cortisol imbalanced have it manifest as insomnia. And then in the day, they’re tired all the time. But I want to emphasize that that has no real direct implications to your athletic performance. That has more or less direct implications to all aspects of your life namely your energy level in the day and your ability to sleep well at night. The most common manifestation of a cortisol imbalance is that whether or not you fall to sleep at night, you tend to wake up in the middle of the night between 2 and 4 AM feeling more or less wide awake. In other words, you wake up in the middle of the night and you could read a book or watch TV or get up and study something, or do some work and check emails, and for the life of you, you can’t get back to sleep but you may 2-3 hours later. And that is extremely common.
So I need to back up a little bit. So if you are tired during the day, that’s a direct indicator that either a cortisol imbalance or outright what’s called adrenal fatigue. And I know that we did previously discussed DSF, De-Stress Formula, which is an adrenal supplement used to improve adrenal function. And what that is ultimately is an adrenal glandular extract of bovine source. In other words, during the slaughtering of a cow, we don’t just use the beef. It’s also very common that glandular extracts are produced. A glandular extract, it is when you remove the gland of another mammal, another animal and you remove all hormonal constituents leaving only cellular constituents. And when we take that orally, when we ingest that, it goes to that particular gland where it increases cellular function and nourishment.
So the most common supplement that I dispensed is called DSF or De-Stress Formula. It’s a daytime adrenal fortifying supplement that typically in 2-4 week’s use results in a person saying that their energy levels have dramatically improved during the day. Some people go so far as to say “I feel like I’ve come out of a fog.”
But we also want to shut off the adrenals at night to restore normal cortisol rhythm. And that is accomplished with a supplement called phosphatidylserine, which is essentially an amino acid that tells the adrenal gland to stop releasing cortisol. So to use for insomnia, for someone who wakes up consistently between 2 and 4 am, feeling relatively wide awake. It’s taken before dinner and before bed. And in most cases, within anywhere from days to weeks, people will say they’re sleeping through the night not requiring any sleep meds and their far more energetic in the day.
So yes, it is true that having this cortisol imbalance, whereby we release it at night and not in the day, does overtime change the way that we process calories and deposit fats. In other words, releasing cortisol at night and not in the day, overtime will promote abdominal fatty tissue deposition. Not that we will see that by taking phosphatidylserine that in a month, somebody’s belly is flatter. But overtime if you normalize cortisol diurnal rhythm, it is expected that you will see a reduction in belly fat.
Glenn: Interesting. Very interesting. And one of the reasons I wanted to ask you that question was because I’ve seen commercials on TV for… I forget what it’s called but it’s supposed to block cortisol and that supposed to help remove or stop the formation of belly fat.
Will: Totally make sense. And yet that is promoted in a way that by taking that, you’re gonna see flattening of your belly over the course of one or 2 months and I strongly debate that.
Glenn: Yeah, I doubt most weight loss drugs. I have never seen one that worked and didn’t damaged the body. So either they—
Glenn: –don’t work or it’s a waste of money or it’s harmful.
Will: And nearly all of those are some type of stimulant that will reduce appetite. And in the process is probably gonna elevate heart rate, possibly blood pressure and is not likely something you’re gonna sustain for the rest of your life which harks us back to a discussion we’ve had about weight loss which has to do with regulation of insulin release and blood sugar levels. And by given an appetite suppressant, were kind of going against that whole philosophy that is you take an appetite suppressant so you don’t eat for 4-6, 8 or 10 hours by which point your blood sugar’s really low. You’re gonna crave something that’s gonna make it elevate, which is gonna raise your blood sugar. Therefore, make a significance insulin occur which is then gonna make you promote weight gain.
Glenn: Well, yes, that too plus you’re gonna be eating more to make up for what you didn’t eat because now you’re (inaudible 18:25).
Will: Almost certainly. Agreed.
Glenn: So are there any… Is there anything besides taking a supplement that somebody can do to regulate their cortisol level is it’s out of whack?
Will: I could say that the way to naturally do it which is kind of an oxymoron because if you have insomnia, you can’t pull this off. It’s to go to bed at a really reasonable hour. I’m gonna say 9:30 or 10:00 and get up at an 8-hour point later and to regulate and literally be adamant about keeping that schedule for 1 or 2 or 3-month period at which point, you should reestablish normal cortisol diurnal releases. However, if you have insomnia and you go to bed at 9:30 or 10:00, you’re only gonna be more frustrated because there’s a significance chance that a lot of that time is gonna be spent wakeful.
Glenn: That’s gonna create stress.
Will: Which is gonna create stress, which is gonna cause you to release more cortisol, et cetera, et cetera.
Glenn: Well then, what are the names of the supplements again?
Will: Of the one that shuts off cortisol used… If you have mild insomnia and I think taking this is actually really healthy because of the unavoidability of stress in our lives is phosphatidylserine. And if you do not have that tendency to wake up in the middle of the night and stay up, then I’d like to just take one of those half an hour before bed. If you do in fact wake in the middle of the night, then you take one half an hour before dinner and then half an hour before bed for one month. And then you would back off to just one before bed for another month and then you discontinue its use and see if you’ve regulated.
Glenn: And do you need the other one in conjunction with it or do they work independently?
Will: I think it depends on how severe the daytime fatigue is. If daytime fatigue is significant, in other words, if you’re tired all the time; then yes, you do both. You take the DSF, one in the morning, one by 2 or 3 in the afternoon. And then you take the phosphatidylserine in the evening at bedtime. If the day time fatigue does not tend to exist or is not any way overwhelming, then you would for a period of time, take only the phosphatidylserine in which case you would have more cortisol in the day. And therefore the daytime fatigue, be it mild would probably take care of itself.
Glenn: Great. Thank you, Will.
Links and Resources for This Episode
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Ask Will A Question
These special Wednesdays With Will episodes are a series with Dr. Will Harden, chiropractor, creator of the Dr. Will Bar, and health and fitness guru. He will discuss health, fitness, nutrition, and chiropractic issues that have the potential to improve your health and life. Dr. Will Harden has been a chiropractor for 26 years. He graduated first in his class from National College of Chiropractic in Chicago, IL and moved to Portland, OR in 1989 and owns a practice called the Corbett Hill Wellness Center.
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