David, I would like to ask for your advice in the case of a 22 year old female patient with chronically high cortisol levels. This girl has been through the ringer...engineering degree through COVID, and first engineering job! In short, chronic stress. Morning AM cortisol high at 25. Top of range is 19.4. High anxiety, panic attacks, impaired digestion, swings between constipation/diarrhea, and heart palpitations. Very thin and small in stature. Currently taking Calm Adapt, GABA, and multi vitamin with added extra B-12 due to low levels. She has taken the infamous "Cortisol Manager", but has somehow connected heart palpitations with it, so has stopped. Dealing also with recurrent Epstein Barr...all verified through bloodwork, so I'm assuming lowered immune response due to high cortisol issues. Poor thing! I feel like her liver needs help...with digestion as well as the metabolism of cortisol. I also think she would benefit, in addition to the Calm Adapt, from an added adaptogen/nootropic/nervine. There are so many! She is easily stimulated. Can you point me in the right direction in the area of liver help and added herbs? Jami

If this was my case, I would not be focusing on her liver unless she had some abnormal liver enzymes, clay colored stools or other markers of liver dysfunction. The high level of stress and elevated cortisone can explain her anxiety, digestive issues) although Gi issues can also cause anxiety), immune depletion and cardiac palpitations. Have you done tongue, pulse, facial and blood analysis to try to determine underlying dysfunction or problems ? Some of the herbs I use for chronic stress that causes GI issues, palpitations and anxiety might include Hops, Motherwort, Chamomile, Catnip. Also consider Bacopa, Gotu Kola, Skullcap or Chinese Polygala. One herb that benefits the liver, and reduces GI inflammation and anxiety and depressions Turmeric.

David, She sees a practitioner who has a Doctorate in Chinese Medicine, and I know Dr West has evaluated her tongue, pulse, and face. I'll take another look too, although I am hardly skilled. Other than some underlying thyroid dysfunction due to elevated cortisol, and the high cortisol, her bloodwork is good. She routinely checks on her EBV antibodies. She is a patient who also has a basal ganglia disorder/ie possible Tourette's. It is my understanding that individuals with this condition can oftentimes have an overly sensitive stress response which drives the chronically high cortisol. Thank you for your much appreciated advice on the matter, and if you have any more insight regarding how to help this young woman now that you know she has Tourette's, I will hang on every word!

Update!! My little "patient" has had a flare up of EBV, complete with white "strep like" patches in the back of her throat. I have chosen to give her a tincture of equal parts of Isatis Tinctora, Baikal Skullcap, and Ginger. Her throat cleared within 24 hours.! This is in addition to the Adaptogenic Blend of Calm Adapt, and various immune supplementation. Once the EBV infection has totally cleared, I will be replacing the anti-viral tincture with a blend of Gotu Kola and Scullcap lateriflora. May keep the Ginger as a digestive aid. I hope I'm on the right track! Trying to treat the person instead of the disease;) If there is something above that I shouldn't be doing, please let me know.

not knowing more about the case it is difficult to make definitive statements as to what will help or not. Based on her symptoms picture the Gotu Kola and Skullcap seem fine, I might do more for her anxiety perhaps a tea of Linden flower, Chamomile, Catnip and Passionflower, the first 3 will also help the GI issues. Once the EBV is no longer active taking immune amphoterics such as Astragalus, Cats Claw, Licorice (as long as her BP is normal) may also be helpful.

David, Thank you:)