We're going to talk about a common phenomenon today that happens to people who for one reason or another crash after they are put on steroids. You know, steroids, especially common names like hydrocortisone, Prednisone, trade names such as Lidex and other forms sort of retro packs, are commonly used in medical conditions to combat inflammation and if you, especially if you have a histamine released at the body is in the allergic state. When you have strained muscles or you have pain, injections of corticosteroids are usually given by the physician to help relieve the pain on the symptomatic basis because it does reduce inflammation. It does work in that sense, and many people find good relief. And in the last, I'd say two or three decades, there's also been a variety of different forms of steroids that have been advanced from short acting to medium to long acting. And so you have back pain, or you have strained muscles, or you have a sprained ankle, or you have allergic reactions and you go to the urgent care and you have rash and antihistamine doesn't work then usually steroids are prescribed. Steroids also prescribed if you have breathing problems such as asthma or if you have a lung infection to help the body heal. Without the antibiotic is on board so the use of antibiotic is widely prevalent and most of the time it works and you start out with a pretty high dose, usually for short term and then maybe you know, 20,40,50 milligrams and then slowly kind of titrate down. The use of steroids is well known and in the sports arena it is actually banned because it enhances performance. For normal daily use, people use it. Right, It's dispensed quite commonly now. You would think that something like this, which is so well received by most people, would have no problem. But in a small number of people, either acutely or afterwards, they complain that their body is never quite the same. They may get over the hump in terms of the rash, but a lot of people may complain of fatigue, anxiety, sleeplessness. Insomnia, both inability to fall asleep as well as waking up in the middle of the night. It's almost as if these symptoms that come from nowhere are triggered after the body is given the steroid, either by injection or by oral form. And it can be, as I said, immediate or soon after, or even months after. But you will find that a lot of people do complain that their body is never quite the same, and from that point on it's almost like the body is struggling to reestablish its own homeostasis and this journey here usually takes the sufferer through many, many doctors, endocrinologists, testing of various kinds. And then ultimately would be abandoned because there's really no explanation why the body would so to say, kind of quote, fall apart and never be the same. And the struggle will continue for years. And this is a classic picture, and many of them, when they present themselves, would have this type of weakness. Anxiety, brain fog, loss of vitality and loss of exercise capacity. The body's never quite the same multiple chemical sensitivities, Paradis tinnitus. It's just that the body feels off for some reason and it's never able to regain its footing. And no laboratory tests are positive usually it's always normal. And that is one of the biggest problems because when the laboratory tests are normal, the conclusion is that there's nothing wrong, and so the sufferers are kind of left as navigating on their own, and they complain enough. Then there's usually given antidepressants or sleeping pills or symptomatic treatment. But the problem never really goes away, and in extreme cases menstrual cycles in women can also be disrupted. So this is a problem and these are what we call the orphan child of medicine, where the sufferers are ultimately abandoned and there's no really help in sight. We don't know why it happens, but I see this quite often and my feeling is that it has to do with the cortisol feedback loop. You know the scientific literature on this is quite rare because there's just not enough cases to warrant that type of study. But if you have an intrinsic pre-existing weakness in your adrenals where cortisol is made and is supposed to be self-regulating. But if you are kind of marginal or you already have problems subclinically in that regulation even though laboratory numbers may be normal in terms of the cortisol and then when you give external cortisol in big doses, especially Prednisone, and impacts that start out at high doses, but you can actually upset the system. It's almost like you have an external bolus and given the body external cortisol. So in some people the body's adrenals may not feel it's a necessity to make it anymore. So when the feedback loop is offset then the body depends on the external cortisol. Of course, the longer you stay on cortisol, the harder it is to get off and this is oftentimes another problem. And when you get off, you can get withdrawals and you can get rebound reactions. But the concept at the higher level is that when external cortisol is given. The body may not feel a need to make its own endogenous cortisol and when that happens when you withdraw the external cortisol, let's say the five days is up, the seven days is up. The body is supposed to kick start itself and then to replenish. But if you have weak adrenals and this feedback loop has kind of been disregulated it may not be able to self-start. So when that happens the body becomes cortisol low subclinically even though interestingly the levels are by blood tests may be normal. The Saliva test is more important to see the entire rhythm because oftentimes you may not have caught it at the right time, but that's a separate issue altogether. The concept what I'm trying to allude to here is that the body goes into this loop where it is unable to self-regulate and self-drive itself to reset and then to rebound when the external steroid is taken away. So when this happens the person has low cortisol on a relative basis. It may not be an absolute basis. And the body feels more fatigue. The inflammation will come on because there's less inflammation suppression mechanism. Cortisol is the one that helps to drive sugar into the bloodstream as well for stress. So the body cannot handle stress when the cortisol is low. So there's a lot of these sequences that can happen that results in almost a very convoluted, kind of a very hard to understand basket of symptoms that defies conventional medical logic. So the way to look at this situation is to kind of step back and look at the whole body. We know that the stress control mechanism ultimately rests in the adrenal glands and regulated by insulin, regulated by adrenaline, and regulated by cortisol. So you know you can have this interplay of these three hormones that can cause problems to start even if you don't have adrenal issues or cortisol imbalances. And when you throw in the cortisol and then you take it away. This can upset the web of the feedback loop. So primarily it's very important to look at the history, try to see which of the six NeuroEndoMetabolic circuits that can regulate cortisol function, adrenal functions, as well as adrenaline and insulin plays into this stress regulation. So it's a rather complex, there's a lot of physiology involved, but a detailed history will tell you the answer. We know that there are six circuits, I said. So we find out with challenges which one is the weakest and we try to naturally support it and give the body the resetting of the cortisol if that is the main issue, or if it is an issue where it is driven by adrenaline from the cortisol withdrawal as sugar can be metabolically offset because your cortisol drives increasing sugar. So when you also have people who have sugar sensitivity, their sugar level may go down when the cortisol is withdrawn creating reactive hypoglycemia if they already have some weakness. On top of that if the cortisol is driving to reduce inflammation and the adrenaline level may also be high, medium or low as a compensatory response. So that's another kind of a wild card into the whole system. The bottom line is that we see this is a very uncomforting solution for the sufferer, but usually if you do a detailed history as we do and we give the challenges and figure out where the components are, we usually can come up to a pretty reasonable deduction. Whether it is an adrenal issue or whether it is a detoxification issue that drive these type of behavior. And with natural approaches with the NeuroEndoMetabolic therapy and then you can slowly help the body to reset and help the body to regain its composure. It's a process that takes time. You know, a few months is not unusual, you have to be very patient. But you know, there's really no good solutions. Some people would kind of go back on steroids and unfortunately most of the time. I found that it doesn't really work well eating those situations. So steroids may not be a solution. And of course, you can also use adaptogens like Ashwagandha, green tea, maca, rhodiola, ginseng that type of stuff to kind of stimulate and treat the body symptomatically. And you know you can also use testosterone growth hormone in extreme cases along with antidepressants and sleeping pills, but those tend to be quite symptomatic. A bandage and not really address the root and oftentimes they may have some short term relief but they don't last for a long time. So I urge everyone if you are indeed suffering from this type of kind of unknown condition that comes up from nowhere. Think backwards whether you have an association with a cortisol-driven event. If you do, find someone who knows what they're doing to really address this issue and investigate it from a functional perspective. If the conventional perspective has exhausted its weight. OK, thank you.