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Dr. Michael T. Murray
"PerformanceCheck is a valuable tool for maximizing performance, strength gains, and muscle mass."
Introduction
You should ALWAYS consult with a healthcare provider concerning
the attached results and before taking ANY supplement.
This Educational Guide was written by Dr. Michael T. Murray, N.D., a renowned expert in the natural health field and author of over 20 books on health. Information and recommendations provided by Dr. Murray are for informational purposes only and are not intended to be a substitute for consultation with a healthcare provider or other medical professional. Only your healthcare provider should diagnose any health problems you may be experiencing and prescribe treatment as necessary.
BodyBalance, Great Smokies Diagnostic Laboratory, and/or Dr. Michael T. Murray are not responsible or liable for any effects or consequences that may come about as a result of the recommendations contained in this Educational Guide, or BodyBalance health screens. None of the aforementioned parties makes any guarantee, expressed or implied, towards the claims, benefits, or safety of the recommendations and information included in this Educational Guide.
Recommendations from Dr. Murray
To gain the most from the hard work you are doing
during your exercise training sessions it is important that
certain hormones be in balance. PerformanceCheck is a
valuable tool in assessing this balance as it measures the levels
of the hormones cortisol, testosterone, and DHEA
(dehydroepiandrosterone); and the ratio of testosterone to
cortisol in saliva.
These measurements are extremely useful in managing your training intensity as well as assessing how you are responding to your training sessions. Saliva levels of these hormones are extremely accurate. In fact, it has been concluded by experts in hormonal assessments on athletes that the salivary measurements of cortisol, testosterone, and DHEA reflect the biologically active fractions of these hormones and that the corresponding testosterone:cortisol ratio obtained is a better measure than the one obtained from blood measurements.1
Cortisol
Cortisol is one of the
main hormones secreted by the adrenal gland--a small gland that sits on top of
each kidney. Cortisol is the main hormone responsible for responding to stress
including the stress of physical exercise. During the stress response and in
response to increased physical demands during exercise, the adrenal glands
release cortisol to stimulate the necessary changes in circulation and
metabolism. The immediate effect of exercise is stress on the body. However,
with a regular exercise program the body adapts. The body's response to this
regular stress is that it becomes stronger, functions more efficiently, and has
greater endurance. However, if a person is over-training or suffering from undue
stress, cortisol excess can lead to fatigue, loss of lean muscle mass, and
possibly, decreased physical performance.
Testosterone
Testosterone is well
known for its effects on enhancing physical performance, as well as its
masculinizing and anabolic (muscle growth promoting) effects. The majority of
testosterone in men is manufactured in the testes. Testosterone deficiency in
men is characterized by decreased sperm count, decreased libido, impotence,
fatigue, osteoporosis, and muscular atrophy. Testosterone excess is
characterized by acne, increased virilization (increased body hair and other
secondary sex characteristics of men), aggressive behavior, and is linked to
prostate cancer.
In the adult female, 50% of testosterone is manufactured from adrenal hormones like DHEA. The other 50% is made in the ovaries. In women, testosterone plays an important role in maintaining lean body mass, bone density, skin elasticity, and libido. Low testosterone levels have been linked to decreased lean body mass, increased risk for osteoporosis, and decreased libido, and may suggest insufficient ovarian and/or adrenal function. Elevated testosterone levels are linked to masculinization, increased body and facial hair, acne, and ovarian cysts.
DHEA
Produced by the adrenal
glands, the primary role of DHEA within the body is as a precursor (building
block) for steroid hormones, including testosterone, estrogen, and
corticosteroids. Like the other hormones in this health screen, salivary
measurement of DHEA correlates to levels of free hormones in blood, those
directly available to the cells in the body.
Studies in recent years have shown that decreasing levels of DHEA are linked to conditions such as obesity, diabetes, elevated cholesterol levels, heart disease, arthritis, and autoimmune diseases. Additionally, DHEA supplementation helps in enhancing memory, improving mental function, increasing muscle strength and lean body mass, immune function, and enhancing the quality of life in aging men and women. As DHEA levels tend to decrease with aging, it has been presumed that raising DHEA through supplementation may offer some protection against the effects of aging.
DHEA can offer significant benefits when used appropriately. However, one of the concerns I have with DHEA (and melatonin) is that many people use it without consulting with their healthcare provider. DHEA is not like vitamin C or other nutrients that have virtually no toxicity. There is relatively little available information on the long-term safety of this hormone. It is safe if used appropriately, but a big gamble if abused.
I recommend that people using DHEA base the dosage on saliva levels of DHEA and testosterone. If saliva levels of either DHEA or testosterone rest on the high end of normal, I recommend reducing the DHEA dosage and rechecking levels in 60 days. If saliva levels of either DHEA or testosterone are low, increase DHEA dosage and recheck in 60 days. When you find the right dosage, I recommend rechecking every 6 months.
Testosterone to Cortisol Ratio
A decreased ratio of
testosterone to cortisol is an important indicator for over-training in the
endurance athlete. It also is an indicator of a potential disturbance in the
anabolic-catabolic balance that may reflect that muscles are being broken down
too excessively. These disturbances may ultimately express themselves in
decreased physical performance.
Interpreting the results of
PerformanceCheck
Assessments of cortisol,
testosterone, and DHEA levels and the testosterone to cortisol ratio are subject
to many variables.
We have controlled for the major variables such as time of day the saliva was collected, gender, and age. One thing we do not control for is your level of fitness and your workout history. The interpretations below assume that you have been training consistently for at least a month and your body has adapted to regular physical exercise.
Cortisol
Normal cortisol: Normal
cortisol levels usually indicate that your training routine is not overstressing
your body.
Low cortisol: Low cortisol levels often indicate severe over-training or adrenal exhaustion. Panax ginseng (100 mg three times daily of the extract standardized to contain 5% ginsenosides) can be considered when an increase in cortisol is desired. Repeat PerformanceCheck in two months. If the ginseng was not effective, I recommend switching to oral pregnenolone therapy. Begin with 5-10 mg daily.
High cortisol: Elevated cortisol levels are a classic indication of over-training, prolonged stress, and/or inadequate support of the adrenal glands--the main glands controlling stress response! High cortisol levels are indicative of a catabolic state, meaning that muscle tissue is breaking down at a greater rate than it is being built. Follow the recommendations suggested in the "How can I reduce my cortisol levels?" section. Also, glutamine (2-3 grams daily) can help recover from over-training (see below).
Testosterone
Normal testosterone: Normal
testosterone levels usually indicate that your training routine is not
overstressing your body.
Low testosterone: A low testosterone level may signify over-training, specifically, an insufficient recovery between training sessions.3-6 Supplementation with DHEA may be helpful, especially if the testosterone-to-cortisol ratio is also reduced. For men under 50, start with a dosage of 15-25 mg of DHEA daily. If you are over 50, start with 25 to 50 mg. Repeat this health screen or use MaleCheck after 60 days to monitor dosage.
In severe cases of testosterone deficiency, androstenedione may be of benefit. For women under 50, start with a dosage of 5-10 mg of DHEA daily and 10 mg to 15 mg if you are above age 50. Repeat this health screen or use FemaleCheck after 60 days to monitor dosage.
High testosterone: It is important to avoid further amplification of testosterone levels. Do not take pregnenolone, DHEA, androstenedione, or any other androgenic agent if you have high testosterone levels unless under direct supervision of a qualified healthcare professional.
DHEA
Normal DHEA: If
you have low testosterone levels, a low dosage of DHEA (less than 10 mg) can be
used if desired. Be sure to recheck levels in 60 days as you may be very
sensitive to even low dosages of DHEA raising testosterone levels.
Low DHEA: Most likely, DHEA supplementation is appropriate here. However, if you have high testosterone levels, I strongly discourage you from using a DHEA supplement. If testosterone levels are low, and you are between the ages of 40 and 50 years, start with a dosage of 15-25 mg of DHEA daily. If you are over 50, start with 25-50 mg daily. If you desire the positive benefits of DHEA without the testosterone-raising effects, there is a new form of DHEA, 7-Keto-DHEA, which may be helpful. Repeat PerformanceCheck in 60 days to determine if dosage levels are appropriate.
High DHEA: Do not supplement with DHEA.
Testosterone to Cortisol Ratio
Normal
testosterone:cortisol ratio: This pattern reflects good balance in the
anabolic-catabolic state and reflects good training practices.
Low testosterone:cortisol ratio: This pattern usually reflects over-training and signifies a catabolic state. Repeated bouts of heavy endurance or resistant exercise without sufficient periods of recovery can create this ratio.3-6 As a result, physical performance may suffer especially if this pattern is maintained for any extended period of time. Supplementation with glutamine (2-3 grams daily) or DHEA may be helpful. For men, start with a dosage of 15 to 25 mg of DHEA daily if you are under 50 years of age. If you are over 50, start with 25 to 50 mg. Repeat this health screen or use MaleCheck after 60 days to monitor dosage. In severe cases of testosterone deficiency, androstenedione may be of benefit. For women, start with a dosage of 5 to 10 mg of DHEA daily if you are under age 50 and 10 mg to 15 mg if you are above age 50. Repeat this health screen or use FemaleCheck after 60 days to monitor dosage.
Elevated testosterone:cortisol ratio: This ratio is rare in the highly trained endurance athlete and may signify that your training sessions could be more intense. Balance this result with the post-training assessment. Strength-training athletes will find this ratio quite beneficial as it usually signifies increased anabolic effects.
Common Questions and Answers
Why do you recommend
glutamine when there are signs of over-training?
There is evidence that
over-training results in low glutamine levels and that glutamine supplementation
can help prevent over-training as well as help an athlete recover from
over-training.9 Glutamine is the most abundant amino acid in the blood and in
the free amino acid pool of skeletal muscle. Glutamine stimulates the synthesis
and inhibits the degradation of proteins and is an energy source for muscle cell
division. Glutamine is also a precursor for the synthesis of amino acids,
proteins, nucleotides, glutathione, and other biologically important molecules.
Glutamine has an anabolic effect on skeletal muscle and may also help blunt
increases in cortisol with exercise.10
Plasma glutamine concentrations increase during exercise. However, during the post-exercise recovery period, plasma concentrations decrease significantly. Several hours of recovery are required before plasma levels are restored to pre-exercise levels. If recovery between exercise bouts is inadequate, the acute effects of exercise on plasma glutamine concentrations can be cumulative. In other words, it can lead to very low levels of glutamine. This situation can have extremely detrimental effects on athletic performance and muscle growth. Nutritional support with either glutamine or its carbon skeleton, alpha-ketoglutarate, has been shown to boost muscle levels of glutamine and promote muscle protein synthesis.9
One of the best sources of glutamine is whey protein. A post-exercise routine of 40 grams of whey protein provides ample glutamine levels in most cases. For the athlete who is showing signs of over-training, I would recommend an additional 2-3 grams of glutamine after exercising.
How can I reduce my cortisol
levels?
Elevated cortisol levels
may be a sign of stress. Learning to calm the mind is extremely important in
relieving stress. Some of the popular techniques are meditation, prayer,
progressive relaxation, self hypnosis, and biofeedback. The type of relaxation
technique best for each person is totally up to you. The important thing is that
at least 5 to 10 minutes be set aside each day for the performance of a
relaxation technique. It is also important to follow some dietary guidelines:
1. Eliminate or restrict
the intake of caffeine.
2. Eliminate or restrict
the intake of alcohol.
3. Eliminate refined
carbohydrates from the diet.
4. Increase the intake
of high potassium, low sodium foods like vegetables, fruit, whole grains, and
fruit.
5. Take a high potency
multiple vitamin and mineral formula.
If post-exercise cortisol levels are increased, the combination of arginine and glutamine, two amino acids, may help lower cortisol levels. In one double-blind study, a salt of arginine and glutamine at a dosage 20 grams in the morning significantly reduced exercise-induced elevations in cortisol.10 An alternative to this recommendation may be 40 grams of whey protein at breakfast. Whey protein is rich in virtually all amino acids especially glutamine.
What about
phosphatidylserine?
Phosphatidylserine is
the major fatty substance in brain tissue. It is becoming widely used by body
builders due to its presumed ability to prevent muscle tissue degradation. There
is little evidence to support this use. The evidence that is available is that
phosphatidylserine reduces the exercise-induced increase in cortisol The dosage
required to produce this effect was 800 mg per day. While the
results of this preliminary work appear promising, to date, no trials have
reported an increase in strength or an improvement in body composition after
phosphatidylserine supplementation. Until these results are determined, claims
of phosphatidylserine's ability to decrease muscle tissue catabolism should be
considered unsubstantiated. Given the expense of phosphatidylserine, I would opt
for substances that may provide the same sort of benefit (as well as other
beneficial effects) but are less expensive, such as vitamin C (1-3 grams daily)
and Panax ginseng (100-300 mg per day of an extract standardized to contain 5%
ginsenosides).13-15
Does creatine monohydrate impact
PerformanceCheck?
No. Although creatine
supplementation has been shown to improve performance in very high-intensity
exercise, especially where repeated bursts of energy are required with short
recovery periods, it does not accomplish this effect by directly impacting
testosterone or cortisol levels. Instead, it works by increasing the levels of
creatine phosphate within skeletal muscle--a substance that can be utilized as
a temporary energy source for quick bursts of activity. While creatine
supplementation increases performance in strength-training or high intensity
anaerobic activities, it does not appear to improve endurance
performance.16,17
In fact, evidence suggests it may actual1y impair
performance in endurance athletes. I recommend that endurance athletes avoid
creatine supplementation until this issue is better clarified. Creatine appears
to be best-suited for strength-training, anaerobic activity.
Several studies have also documented creatine's effect on muscle size and strength.18 Typically, after a 5-7 day loading dose, there is an increase in the amount of work done in repeated bouts of maximal exercise and a gain in body mass of between 1-2 pounds. During the loading period, 5 g are taken four times daily. The maintenance dose is usually 3-5 grams per day. Larger doses are probably not of any greater benefit since the capability of muscle to take in and store creatine is limited.
What nutritional supplements
would you recommend to a body builder?
Based upon what I have
seen in the medical literature, body builders and strength-training athletes are
most likely to obtain improved results by following a supplementation routine
that includes:
• Creatine monohydrate
(dosage given above)
• A post-workout
protein shake providing 40 g of protein (whey protein appears to be the most
beneficial)
• Vitamin C (1-3 g/d)
• Vitamin E (400-800
IU per day)
• A high potency
multivitamin/mineral formulation
What would you recommend
specifically for the endurance athlete?
The endurance athlete
should take a high potency multivitamin/mineral formulation and additional
antioxidants like vitamin C (1-3 g per day) and vitamin E (400-800 IU per day)
to protect against the tremendous burden of free radicals produced by
exercise.19
In addition, consuming a beverage high in carbohydrates and
electrolytes (such as the various sports drinks on the market as well as fruit
and vegetable juices) within 1 hour after exercise can help restore muscle
glycogen levels which can be rapidly restored by glucose ingestion.20
Don't drink
such a drink before exercise, however, because it can impair performance.
Glossary
Adrenal Gland--Hormones, such as cortisol, are produced by the adrenal glands, which are located on top of each kidney. These hormones, as well as adrenaline, aid your body in times of stress, physiologically helping your body adjust to the stressful period until it has passed.
Anabolic--A building up of proteins that results in increased lean muscle mass, stronger bones and a greater energy supply. Anabolic hormones include DHEA, testosterone, and growth hormones.
Androstenedione--A steroid sex hormone that is secreted by the testes, ovary, and adrenal cortex and acts more strongly in the production of male characteristics than testosterone.
Biofeedback--A training technique designed to allow an individual to gain some semblance of voluntary control over body functions that occur involuntarily.
Catabolic--A breaking down of proteins that results in a weakening of bone and muscle tissue and a general decline in other important body functions. The physical degeneration that often occurs with aging is a catabolic process. Cortisol is a catabolic hormone.
Electrolytes--A non-metallic electric conductor where current is carried by the motion of ions, which are electrically-charged elements.
Glutamine--An amino acid found both freely and in proteins in the body. As an important amino acid, glutamine provides energy to muscle cells.
Metabolism--The vast range of cellular and biochemical processes the body uses to create and convert the substances necessary for its existence.
Mono-unsaturated fats--Can be found in peanut, olive and canola oils and are recommended over other fats to lower blood cholesterol.
Nucleotides--One of the basic structural units of RNA and DNA, nucleotides are assisted by glutamine for their synthesis.
Osteoporosis--A thinning of bone tissue caused by gradual bone loss over a long period of time. Osteoporosis produces dry, brittle bones that may easily crack or collapse.
Pregnenolone--A steroid that serves as a go-between in the synthesis of various hormones-such as progesterone.
References:
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