T Nation

Over Training Syndrome



This article appeared in Peak Performance magazine, Vol. II, No. 3

As an athlete you are used to stress. The pressure and tension of competition start the adrenalin flowing. But that very adrenal rush may be undermining your performance, cutting down your strength, speed and endurance.

We have all experienced stress but few are aware that stress must be countered by physiological responses in the body. The central components of this response are the steroid hormones cortisol and DHEA which are produced by the adrenal glands. The optimal ranges for these stress hormones are narrow; if they are either too high or too low, body functions suffer accordingly. For a runner this could mean fatigue, mental and physical, and seconds or minutes added to race times.

Cortisol and DHEA are in direct control of many body systems. Abnormal levels contribute to a greater likelihood of sports injuries and slower recovery times. With cortisol and DHEA imbalances, metabolism of carbohydrates and fats is compromised, leading to premature drops in blood sugar during workouts, which cut off the fuel supply to the brain and body at a critical moment. Under adrenal stress, blood sugar handling problems develop, causing a person to make poor food choices, with a tendency to eat too many sweets and high glycemic index carbohydrates that reduce performance level. Adrenal hormone imbalances interfere with muscle tissue repair and mineral levels are not adequately regulated, leading to a decrease in the ability of muscles to contract efficiently. Since the ratio of cortisol and DHEA controls mood, adrenal stress causes energy levels to drop, resulting in fatigue, depression and anxiety. Additionally, immune defense and even brain and nervous system tissue function suffer as our stress levels increase.

The results of many years of lab testing of adrenal stress hormone levels have shown that most people who are under persistent stress experience the physiological consequences of adrenal exhaustion. Complaints including fatigue, depression, headaches, weight gain, frequent colds and flu, digestive problems, female hormone imbalances and recurrent musculoskeletal injury, all result from a breakdown in our normal ability to adapt to stress.

After twenty years of research we now know how to measure and correct adrenal hormone imbalances, and we have devised the best treatment strategies available to reverse the damage caused by stress.

Our primary stress response starts in the brain with the hypothalamus signaling the pituitary gland to release the hormone ACTH (HPA axis refers to this hypothalamus-pituitary-adrenal gland communication system). ACTH activates the adrenal glands located just above the kidneys. Under ACTH stimulation the adrenal glands release cortisol. Once cortisol levels rise, the brain reads the increase of cortisol in the bloodstream and shuts down the release of ACTH, completing the feedback loop. The system then recalibrates and waits for the next stress attack to respond to. If the stress is ongoing and the release of cortisol continues for too long, the individual can lose the ability to shut off and reset this stress response. People can then become locked in the stress response, operating as if they are under stress constantly, regardless of what is going on around them. If these communication links between the brain and the adrenal glands malfunction due to chronic stress, cortisol levels remain high, even at night when we are asleep.

Under continual stress, the hormone production levels drop; this is referred to as adrenal exhaustion or adrenal burnout. Athletes know this as a psychological as well as a physical wipeout. Much of our present ability to handle stress is a result of how we have adapted to the stress in our past. In many cases when the signaling system between the HPA axis breaks down some people never truly recover, feeling thereafter not quite the same, permanently diminished. This kind of burnout can signal the end of an athlete's career.

The results of these tests can reveal several types of cortisol production problems. First, they let you
know the amount produced daily. The test also measures the daily flow of cortisol production. Variations in cortisol at specific times in our daily rhythm reflect different health problems. For example, abnormal afternoon cortisol indicates a glucose regulation problem. This demonstrates a need for examining what types of food a person is eating and what ratio of carbohydrate to protein to fat he or she is consuming. For runners it is especially important to know not only what to eat but when.

High nighttime cortisol levels reflect an inability to shut down our stress response before sleep. This often occurs in people who have trouble getting to sleep or staying asleep. Those with high nighttime cortisol often report having trouble shutting their minds off at night and ceasing to worry about tomorrow. Conversely, some people have low cortisol production. This is seen in those with significant fatigue, a poor immune response, and in athletes with unexplained performance problems. These might include, weak concentration, determination and other 'mental focus' problems.

The first step in a successful program is to identify and remove the original source of stress. This may involve changes in work habits, training programs or diet. The second step is to correct any hormone stress imbalances.

For each individual normal levels of cortisol and DHEA can be re-established through the use of specific nutritional treatment programs. While undergoing treatment, the circulating levels of cortisol and DHEA are balanced and the HPA axis gravitates back to normal.

The experiences of two athletes who undertook programs of stress elimination and hormone balancing might best illustrate the issues discussed above.


Allison M. is a 36-year-old professional athlete. Her chief complaints were bursitis of the left hip and low back pain, both negatively affecting her running and jumping ability. She was experiencing weight gain, low energy and cravings for sweets. She was sleeping poorly, waking two to three times a night with night sweats and hot flashes. Her initial adrenal stress test came back with a total production of cortisol at 35, close to the optimum of 38. While her total production of cortisol was normal, she suffered from a significant problem with the rhythm or timing of her cortisol production.


Optimum Levels

Allison's levels
Morning 22 pcg/ml 12 (low)
Noon 7 pcg/ml 3 (low)
Afternoon 6 pcg/ml 2 (low)
Evening 3 pcg/ml 18 (high)

DHEA 6-8 1.9
Her afternoon fatigue was reflected in the low noon and afternoon cortisol levels. Her abnormal daytime cortisol was also leading to an inability to maintain adequate blood sugar, which resulted in cravings for sweets. What was of great interest in terms of her evening levels was the notably elevated cortisol level at bedtime. Just when her body was supposed to be slowing down for the immune system to engage in repair, she was revving up her stress response. This high nighttime cortisol correlated with her emotional state at night, as she tended to worry in bed, unable to shut down her mind. Normally, the lowering of cortisol at night signals human growth hormone levels to rise. This then leads to mobilization of proteins into the tissues for the cellular repair processes that are such a critical component of athletic performance. Rest and rejuvenation of knee and foot tendons, for example, are vitally important for runners.

The initial three months of treatment included a complete nutritional program. The key nutrients required to handle stress and stress hormone production were used, including pantothenic acid, magnesium, calcium, zinc and vitamin C with bioflavinoids.

Phosphotidyl serine was recommended at night to lower the evening cortisol. This almost immediately stopped her night sweats and hot flashes and improved Allison's sleep. If we had used phosphotidyl serine at the wrong time of day when she was already low in cortisol, we would have made her condition worse. Timing, in life as in sports, is everything. Phosphotidyl serine, taken several hours before a lab value demonstrating high cortisol, will lower the cortisol into normal range. Phosphotidyl serine acts by breaking the signal system, or feedback loop, that tells the body to overproduce cortisol thereby re-establishing normal levels.

Allison's low daytime cortisol was raised using pregnenolone and whole licorice root extract, taken several hours prior to her low cortisol levels. Pregnenolone is a direct precursor to cortisol, and licorice root extract prevents the breakdown of cortisol in peripheral tissue that results in higher circulating levels.DHEA was prescribed in a very low dose, 6 mg per day. This helped take the burden off the adrenal gland's DHEA production requirements by supplying what is known as a physiological dose, or a dose that mimics the amount of DHEA that would typically be produced by the body naturally. This low dose allows the adrenal glands to rest and undergo the natural repair processes that are necessary for healing. DHEA taken in too high a dose will actually lower cortisol and impede adrenal hormone balancing.

After three months of treatment Allison was retested. She was now normal in her evening cortisol, but was still low during the day. At her six-month retest, her levels were all in the optimum range. During the course of the six months her musculoskeletal complaints diminished as her body's ability to heal improved.

Allison's midsection fat disappeared as her metabolism improved from the adrenal support program. Her cravings for sweets and afternoon fatigue also tailed off as her cortisol levels rebounded. Of interest in Allison's case was the abnormal rhythm of cortisol production with the low levels during the day and high cortisol at night. Upon her initial test, her total production in 24 hours was close to normal, and reviewing any single lab value on her test would not have accurately depicted her most significant problem, which was the timing throughout the day of her cortisol production. We all function on a 24-hour clock and if this circadian rhythm is disturbed our health inevitably suffers.

When asked how the program had affected her athletic performance, Allison reported, "I handle the pressure during competition better now; it's like I have a reserve built up which didn't used to be there. My endurance has improved to the point it often feels like my workouts are almost too easy."


David K. is a recreational athlete. His chief complaint, along with abdominal bloating after meals and excessive gas, was not improving his run times despite consistent training. He also experienced fatigue and occasional headaches in the late afternoon, making it difficult for him to concentrate at work. David ran five days a week, usually five to six miles per day, and usually fit in longer runs or races on weekends. His initial cortisol levels were low during his average workday.


Optimum Levels

Allison's levels
Morning 22 pcg/ml 18 (normal)
Noon 7 pcg/ml 2.5 (low)
Afternoon 6 pcg/ml 1.4(low)
Evening 3 pcg/ml 2 (normal)

DHEA 6-9 1.1
These low cortisol levels reflected the chronic nature of his typical workday stress. His therapeutic nutritional program included DHEA, pregnenolone, B complex, vitamin C with bioflavinoids and a multi-mineral. His digestion was found to be poor due to his stress levels and he was supplemented with digestive enzymes to help his bloating and gas. He was also instructed to re-arrange his exercise schedule based on the lab test results. Since David's cortisol was most out of range during the day, we had him extend his workday and create a two-hour lunch. Rather than run in the evening after work, he exercised primarily at midday to help reduce his afternoon stress response. Saturday was made an exercise day off to allow for adequate rest after his challenging work week, and Sundays were reserved for his longer runs when his stress levels were lowest and the exercise would be best tolerated.

At his three-month re-evaluation, his cortisol levels were normal and he was instructed to stop the initial nutrients and shift to a maintenance program. David's digestive problems disappeared within the few weeks of digestive support. The longer lunch break and midday exercise had several consequences. It forced him to take a lunch break every day, which he had often skipped in the past. This new routine also got him out of the office, got his mind off work and onto exercise, which relieved and energized him. His afternoon work hours became more productive and less draining. "I have a feeling of strength during runs, like I'm not just going through the motions, but really have some power behind my legs now that's been missing for too many years." he reported. "This program restored my sense of energy and mental focus that's been missing for too many years."

Dr. Kalish works with people nationwide through phone consultations. He has designed lab-based nutritional programs to help a wide variety of athletes overcome health problems and achieve optimum performance. Dr. Kalish teaches seminars for health professionals and the public on stress, healthy weight loss and natural female hormone balancing. For more information visit has website at drkalish.com or call 800-616-7708.