By Dan DeGryse
Sometimes it takes an issue hitting close to home to drive change.
That was the case with me a few years ago when I started researching the stress hormone cortisol and its effects on the body. Our bodies release adrenaline and cortisol when they’re stressed and in fight-or-flight mode, which firefighters experience regularly on runs or anytime the bell rings at the fire house.
My cortisol research is part of a larger study of physical and behavioral health involving the fire service. I initially looked into the suicide rate within the Chicago Fire Department and then delved into other main causes of death for our firefighters. Heart disease topped the list, and excessive stress can contribute to its risks, as I wrote earlier this year (“Stress, cortisol can complicate firefighting,” Feb. 20, 2015).
I worry about how our body absorbs cortisol, especially each time we get that jolt of energy when the bell rings and it’s a false alarm. That worry stems from my own 26-year fire service career in Chicago. To this day, I still feel shaky after a long shift and being up most of the night.
Signs and symptoms of low cortisol include memory loss, digestive issues, poor concentration, lethargy and depression. Those were all things I had been experiencing over a six-to-12-month period. To figure out what was wrong, I first had my testosterone tested, but it was fine. Then I had my heart checked, and it was fine, too. My blood work also was normal.
Based on my research, I opted to have my cortisol level tested. The test told me my cortisol was low in the morning and stayed the same throughout the day, which potentially indicated two things: One was the possibility of adrenal fatigue, and the other was that I was experiencing a continuous stress response during the day. (For reference, normal cortisol levels are highest in the morning to help get us up and going; cortisol drops throughout the day and is lowest at night.)
So where did I go from there? Continued exposure to a stressful environment and the stress response can cause the adrenal glands to shut down, requiring the use of medications to manage symptoms that might last forever. That’s why it’s imperative that cortisol issues are identified, diagnosed and treated. Treatment often includes lifestyle changes and/or career changes. As your typical stubborn firefighter, I opted for the former, which included a combination of diet change, vitamins and herbal remedies.
I focused more on eating foods that are rich in metabolism-boosting omega-3 fatty acids such as lean fish and dark, leafy greens, which are rich in vitamins. I take vitamin C and a methyl vitamin B-12, which supports the nervous system. I also take an herbal medicine called rhodiola rosea, which is commonly used in other parts of the world to cope with and adapt to stress.
I made this my routine for about six months and then had my cortisol tested again. My morning levels are more than triple what they were before and a bit lower during the evenings. Before I made those lifestyle changes, I sometimes wouldn’t feel fully awake until about noon. Now, I wake up and don’t feel like I have the sandman on my head. This regimen worked for me, but it might not be appropriate for everyone. Be sure to consult your doctor for advice.
In 2014, I worked with Rosecrance, a leading provider of substance use and mental health treatment services, to start the Florian Program. Florian is the first program in the country with dedicated inpatient space for firefighters and paramedics struggling with substance use and job-related post-traumatic stress disorder, anxiety and depression.
We’ve integrated some cortisol testing into the Florian Program under the monitoring of Dr. Raymond Garcia, medical director of the Rosecrance Harrison Campus, where Florian is housed. Dr. Garcia noted that we haven’t seen anyone with such high levels of cortisol that the person required medical intervention or referral to an endocrinologist. But we have seen cases where clients’ cortisol levels remained the same as the morning levels. Afternoon cortisol should decrease to about half of the morning level.
“A possible theory is that this is a warning sign of someone having enough stress that the adrenal system is starting to show signs of ‘wear and tear’ and that someone is maintaining a higher level of cortisol throughout the day in response to stress,” Dr. Garcia said.
Dr. Garcia went on to say that high cortisol levels and high stress have been correlated with higher risk of cardiovascular disease, as well as anxiety and depression. Cortisol isn’t something we regularly talk to our doctors about, but given the stressful nature of our profession, it warrants more attention. Lots of people get their cholesterol checked, but it’s just one indicator of health.
So is cortisol.