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Ask Dr. Mike: New Sugar Test & What's Causing My High Anxiety?

Here you'll find the answers to a wealth of health and wellness questions posed by Healthy Talk fans. Listen in because what you know helps ensure healthy choices you can live with. Today on Healthy Talk, you wanted to know:

My anxiety level is very high, and I feel stressed out all the time. My NP checked a morning and evening cortisol level and both were low. Any thoughts before I go see her?

Cortisol is a stress hormone produced in the adrenal glands that sit atop your kidneys. Cortisol levels usually peak in the morning to prepare you to get moving. Once cortisol levels drop, serotonin and melatonin levels increase.

However, you can still have low levels of cortisol and still have anxiety. In fact, anxiety has multifactorial causes.

You might want to ask your doctor about testing your urine throughout the day. This allows your doctor to take an in-depth look at your cortisol levels, to see how they fluctuate throughout your day. You may also want to consider liquorice extract, DHEA, CoQ10, and American ginseng to help ease your anxiety symptoms.

I understand there's a better test for sugar problems than hemoglobin A1C. Do you know what it's called?

There is a new sugar test, which tests 15EG. This is a glucose-like sugar, and the test gives doctors a better understanding of sugar spikes.

If you have a health question or concern, Dr. Mike encourages you to write him at This email address is being protected from spambots. You need JavaScript enabled to view it. or call in, toll-free, to the LIVE radio show (1.844.305.7800) so he can provide you with support and helpful advice.

RadioMD Presents:Healthy Talk | Original Air Date: May 1, 2015
Host: Michael Smith, MD

It's time to ask Dr. Mike do you have a question about your health? Dr. Mike can answer
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DR MIKE: So, remember you can send detailed questions, big questions. You can tell me your name or not. Tell me not to say your name or whatever. You can even ask me to read your question and answer it on a certain day and I will do my best to do that, This email address is being protected from spambots. You need JavaScript enabled to view it. .

Here's a question from Diane. My anxiety level is very high. I feel stressed out all the time. My N.P.," and probably that's means natural path a doctor, "checked a morning and evening cortisol level and both were low. Any thoughts before I go to see her?"

So, okay. So, cortisol, is the stress hormone. It comes from the adrenal gland and it peaks in the morning. There's a substantial peak of cortisol in your blood around sun up. I mean, that makes sense, right? Cortisol kind of prepares you to get moving, is what it does. You know, we think whenever we say stress hormone most people think bad things. No, stress is good and waking up from a nice, peaceful sleep is stressful but it's good. You're getting up. Cortisol peaks and it helps to mobilize sugar for energy and it releases the catecholamines, the epinephrine, the norepinephrines so you can...It just gives you this what's known as a sympathetic drive, so you're just getting your day ready. Some of us need some coffee help, too, but that's what cortisol supposed to do for us.

So, it peaks in the morning and then it should trail off, should come down kind of fine like a valley from most of the day and then there is usually, for most people, a slight little peak, maybe half what you see in the morning around evening time and then it drops off fairly quickly. Once cortisol drops, things like melatonin and serotonin increase. Those are the feel good and calm you down hormones. I just threw my pen. Maybe I need some serotonin. Anyway, I get excited when I talk. It's the Greek in me and I can't help but use my hands.

So, cortisol drops in the in the PM, the calm you down hormones go up because, you know, it's time to go to bed. So, that's how it supposed to be. There should be a morning peak and maybe a slight evening peak and, apparently, for Diane that didn't happen.

Her doctor, rightfully so, checked the AM and PM cortisol and they're both just low, which, by the way, before I go on here, Diane, your doctor did a great job. It is better to do cortisol twice, an AM and PM blood draw. I mean, I know that's harder and it may make your day tough, I guess. But to take just a random cortisol, you know, most people, I guess, when they do blood work, they usually go in the morning but just to check a random cortisol level is not going to tell you much.

So, the AM and PM is better but in this case for Diane, she's anxious, she stressed out. You know, you might get the idea, you might think yourself, "Oh, my gosh. Cortisol's just going to be sky high in her all the time," right? But in this case, it's low. Well, here's what happens. I mean remember cortisol is considered the stress hormone but that doesn't necessarily mean bad stress like anxiety. It means that it cortisol is the hormone that prepares your body to deal with a stressor. So, you can still have low cortisol and be anxious because anxiety and stuff like that have many different causes, multi-factorial. It's not just cortisol linked.

As a matter of fact, if you've been living most of your adult life stressed out and anxious, not sleeping well and day in and day out, you know, one year to the next, your adrenal glands get wiped out. I mean, in the alternative medicine arena we call that "adrenal fatigue". You know, it's not total dysfunctional adrenal gland like you see in Cushing's disease. That's different. I mean, that's a total knock out of the of the adrenal, but in this case this constant day in and day out, week to week, month to month, year to year stress just causes your adrenal gland to dysfunctional a little bit and they become fatigued. So, they're not regulating. Not only is cortisol kind of being mismanaged.

So, you're not peaking cortisol the way you should, you're also probably not dealing with the catecholamines. Maybe they're just getting released too much. Maybe that's driving some of the anxiety. The adrenal glands, basically, just lose the ability to control all these hormones that they're making and that's not good because these hormones and neurotransmitters that come from the adrenal glands are quite powerful.

So, if your adrenal glands are a little fatigued, Diane, yes. All these hormones can get a little wacky. Cortisol drops. Epinephrine's up all the time. Yes. I mean, those are consistent signs of adrenal fatigue. I'm pretty sure your naturopathic doctor is most likely really on top of adrenal fatigue. Diane, she's going to look at those numbers and know exactly what to do for you but you might consider a 24-hour urine cortisol test. That's more detailed so the best way to check cortisol. The bad way is just to do cortisol in the morning. That's the best way. The second best way would be what you did. Cortisol in the morning cortisol in the evening. The best way is a 24-hour urine collection looking for cortisol. That really tells you what you're doing throughout the day.

So, you might want to do that I might suggest that but licorice extract is good for adrenal fatigue. DHEA, which is a hormone; Vitamin B5. Pantothenic acid is good. CoQ10. Even some adaptogenic herbs like rhodiola, American ginseng. Pretty good for adrenal issues so I'm sure you're naturopathic doctor will be ready to set you up on a good adrenal support program but, so, the cortisol levels are low and you're still anxious. That's adrenal fatigue in a nutshell. Great question. Thank you, Diane. I hope you feel better soon.

Alright. Moving on.

"I understand there's a better test for sugar problems than hemoglobin A1C. Do you know what it's called?"

You know, they change these things all the time. There's new inventions and new tests and so I had to look this one up and I did find one here. There is a new sugar test. It tests for something called 15AG and "AG" stands for anhydroglusitol. 15AG. It's a glucose like sugar, okay? And, it gives us a better understanding specifically of sugar spikes. You know, that's, if you really think about it, the post-meal--the official terminology for that is postprandial--but the post-meal sugar spike. So, you eat. Let's just say a donut.

Okay? You eat a donut. Within like thirty minutes or so, once you've digested the donut, the sugars are in your blood stream, your blood sugar levels just spike, big time. And when your blood sugar level spikes, say, over a level of about 200, that causes some issues especially, if you're doing that day in and day out.

Right? You're spiking blood sugar levels at a high number every single meal day in and day out that causes insulin spiking. Insulin spiking, eventually, is going to cause something called "insulin resistance" which is the hallmark of Type 2 diabetes. So, knowing really how you're doing meal to meal is important and apparently, this is what this new test does. I don't think this replaces hemoglobin A1C. That gives you an idea of how much sugar is in your blood for about a three month period because sugar glycosylates the hemoglobin. So, we can measure that.

It's a sign of not controlling it very well for months down the line. This is more about blood sugar spiking per meal and you want the number to be higher, actually. Fourteen is ideal. Less than ten tells us you're having too many sugar spikes. So, yes. There is a new test 15AG for sugar spikes.

This is Healthy Talk on RadioMD.

I'm Dr. Mike. Stay well.