I've got to say, it's disappointing to have this analysis in Virology blog. There's no context, no discussion of the issues with cortisol testing (a single moment versus daily; the interplay between timing of collection and waking time and lifestyle in general; findings in ME/CFS that contradict this finding; the overlap in levels in Long Covid and healthy controls). The way the paragraph is written, it makes it sound like cortisol levels were lower in every person with Long Covid - there's no mention of 'average'. The rest of the article isn't bad though.
@dave30th, I don't think this is the first 'not quite right' article on Long Covid in Virology Blog (not yours, yours are fine of course). If we can't ensure good articles in Virology Blog, what hope do we have for doing that elsewhere? Perhaps there could be a policy that any author writing about ME/CFS or Long Covid is given the suggestion to come here to review content relevant to their article before finalising it? Who proofreads the articles? As I've said before, if researchers or journalists want private comment from members on articles/papers before they are published, the forum would be happy to facilitate that (a private forum, identifying one or two members with relevant expertise who are willing to put time to it).
Who is Gertrud Rey and why did she choose to write about this issue?
I haven’t read this as been too poorly for a while now.
but I’d like to make the point that if someone is looking at cortisol then:
1. it needs to have a synacthen test to check basal (which fir healthy people will definitely relate to time of day- issue fir us us the travel and doing it makes it big exertion) and vitally the ‘PEAK’ cortisol after the injection .
These people aren’t doing this for a reason - it’s appalling because they are potentially leaving in people whose peak is stunted and talking about their data as if that could ever change. You can’t treat and lump in busted adrenals or pituitary with those that aren’t. Or assume ‘the cause is trainable’ instead of making that assessment medically with medical staff - these MEDICAL findings aren’t for them or us to assume based on extrapolated papers done on people without this condition to disappear what actually needs to be properly ruled out the right way.
This needs to be done ‘within person’ and the difference between that ‘basal’ (in ill person it is actually‘how much are they using/needing just to be there for that test’ and annotating if it’s lying down, involved a commute etc) and the ‘max’ . The point being if there isn’t much difference that person has no spare ALL the cortisol they can get is just enough to do that test in that condition
it’s relevant because we have an illness/something wrong and there might well be some in that subgroup who actually have a condition that means their body CANT increase cortisol
2. so if what these people are thinking they are testing us the usual ‘training that works for well people’ which this sounds like they need to exclude those with a physical cortisol deficiency not by THEIR hypothesis but by the medical tests first. So they are polluting the rest with x% because doing so is convenient to do because tiny effects over bigger samples are accepted by crap oversight for journals. It’s
It’s like then being allowed to test behavioural things for blood sugar without excluding type 1duabetucs who can’t produce insulin first. And getting away with having 10% diabetic thrown in to drag down changes and create an effect they claim for the whole sample.
I cant emphasise enough how worrying it is that these standards of checking the max output of adrenals is - and that vs their baseline measure (which will include how ill and exerted we are just being there for test)
PARTICULARLY if they are using ‘change in cortisol’ as a measure
because max cortisol is literally someone’s ceiling ‘effect’ physiologically
CBT or anything else cannot heal a busted adrenal anymore than it can type 1duabetes.
the only way someone with this issue (basal cortisol = max cortisol) can avoid crisis is if the amount of cortisol their body needs eg to keep standing reduces to give spare beneath that max. Someone mightnt have low basal vs ‘norms’ but a problem here because they need more cortisol just to lie still - just due to how injured their body is
and no they can’t reduce that by CBT to think away the symptoms and no it’s not perception - that cortisol need is a measure if the physical stress that body is under and needing medical support to be treated for , definitely not exertion or any dangerous bps ‘exposure’ increases to exertion as if physically stressing the body more will lead to ‘fitness’ like a warped idea of HIT training principles but with ill people being harmed by the things that hurt their body instead of sprints fir well people. It doesn’t work like that where harm ‘fittens’ sick people. It just ends up with all their cortisol being used to keep them ‘alive’
I’m really worried we are letting them mix up two issues here.
these hypotheses should never be being tested on people with cortisol limitations - there will never be any more to give
and it’s very blinking dangerous someone would let teams of people who aren’t physiologists with expertise in adrenal and endocrine issues near these people. Adrenal crisis is life threatening.
the medical profession and any health system journal or institution are entirely irresponsible for signing off ethics or manifestos letting people put out nonsense a deficiency could be fobbed off and treated as if it could be resolved behaviourally
and that’s what these papers are targeting I think. Using the fact that some within these groups have real physical issues
then using tactics to temporarily increase their cortisol eg a shock or unpleasant temp at a time if day their cortisol is normally low to imply their health git ‘a boost’ gif a subjective answe. But that doesn’t train a busted adrenal system long term it just rigs the results short term. ?
