As with most things biology, there is a relatively tight range for optimal: insufficiency of compound X is a problem and excess of compound X is a problem as well, for a different, but related, set of mechanisms…. I have been particularly interested in this concept for the duration of my career, seeing this U curve relationship play out time and again in clinical laboratory data. Thus, when I popped open my Today’s Practitioner and read in the recent Lancet Diabetes & Endocrinology edition on cortisol and COVID, the U curve and mortality findings made good sense.
Called the koala stress syndrome, hypoadrenalism is a predictor of poor outcome in ICU patients. Additionally, what the NIHR researchers also found, looking at 3 London hospitals, is that very elevated cortisol (>744 nmol/L) is also a predictor of poor outcome. Those with this high level of cortisol had a median survival of 15 days, compared with those whose cortisol was less than or equal to 744 nmol/L and who had a median survival of 36 days. This cortisol measure was taken within 48 hours of hospital admission for suspected or diagnosed COVID-19.
“Kaplan-Meier plot of survival probability over time. The plot is categorised by baseline cortisol concentration above or equal to and below the cutoff of 744 nmol/L. Shading indicates 95% CI for each curve.” Lancet Diabetes Endocrinol. 2020 Aug;8(8):659-660. doi: 10.1016/S2213-8587(20)30216-3. Epub 2020 Jun 18.
Kara Fitzgerald, ND, received her doctor of naturopathic medicine degree from the National University of Natural Medicine in Portland, Oregon. She completed the first Counsel on Naturopathic Medicine-accredited post-doctorate position in nutritional biochemistry and laboratory science at Metametrix Clinical Laboratory under the direction of Richard Lord, PhD. Her residency was completed at Progressive Medical Center, a large, integrative medical practice in Atlanta, Georgia.
Dr. Fitzgerald is the lead author and editor of Case Studies in Integrative and Functional Medicine and is a contributing author to Laboratory Evaluations for Integrative and Functional Medicine and the Institute for Functional Medicine (IFM)’s Textbook for Functional Medicine. With the Helfgott Research Institute, Dr. Fitzgerald is actively engaged in clinical research on the DNA methylome using a diet and lifestyle intervention developed in her practice. The first publication from the study focuses on reversal of biological aging and was published 04-12-2021 in the journal Aging. She has published a consumer book titled Younger You as well as a companion cookbook, Better Broths and Healing Tonics and has an application-based Younger You Program, based on the study.
Dr. Fitzgerald is on the faculty at IFM, is an IFM Certified Practitioner and lectures globally on functional medicine. She runs a Functional Nutrition Residency program, and maintains a podcast series, New Frontiers in Functional Medicine and an active blog on her website, www.drkarafitzgerald.com. Her clinical practice is in Sandy Hook, Connecticut.
Additional publications
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