If you have pain in the ball of your foot you are not alone. Pain in the ball of the foot is a common complaint. When someone is referring to the ball of the foot they are usually referring to the location of the metatarsal heads. The long bones of the foot are called metatarsals. The metatarsal heads are the knobby ends of the metatarsals that form a joint with the toes. Thus the ball of the foot is the area where the toes form a joint with the long bones of the foot, the metatarsals.
Pain in the ball of the foot can come from a problem with the nerves as seen in conditions such as neuropathy or a neuroma, which will be discussed shortly. Often, pain in the ball of the foot can is the result of one or more of the metatarsals taking more than their share of the load. Metatarsalgia is a general term which simply means pain in the metatarsal bones. For this discussion I am going to be talking specifically about pain in the metatarsal heads.
There are several reasons why one or more of the metatarsal heads can become overloaded.
• Some people gradually lose the fat pad that cushions the area under the metatarsal heads as they age. If there is less cushion the bones feel more of the load and this causes pain.
• Some people were born with a deformity known as Morton’s toe in which the first metatarsal bone (long bone of the big toe) is short. As a result the second metatarsal or second toe is longer than the big toe. This causes most of the body weight to be put onto the second metatarsal head. This overloads this bone and causes pain.
• Some people with high arches have pain in the ball of the foot. In the person with the high arch we often see that they load the foot primarily at the heel and then again in the ball of the foot. The mid-foot does not take its share of the load. This again overloads the metatarsal heads at the ball of the foot.
• Another painful condition felt in the ball of the foot is Morton’s neuroma. This is usually felt between the 3rd and 4th toes. One quick way to tell if you may have this condition is to grab your foot around the metatarsal heads and squeeze your whole foot. If you have a neuroma this squeezing will causes pain at the site of the Morton’ Neuroma.
Although the cause of pain in the ball of the foot is varied, the treatment, at least the initial treatment, is the usually the same. We try to reduce load and if necessary movement of the metatarsal heads. This is accomplished by adding a metatarsal pad to an orthotic or arch support. The metatarsal pad fits in the ball of the foot just behind the metatarsal heads. This allows more of the weight to be taken up by the long shafts of the metatarsals and less on the metatarsal heads. The metatarsal pads can be added to a custom arch support. They can also be purchased over-the-counter from a pharmacy or specialty shoe store. The correct placement of the metatarsal pad is critical so follow directions or ask your physician or podiatrist for help.
For more information please visit Archatomics
Saturday, November 10, 2007
Monday, November 5, 2007
Flat Feet, Foot Pain and a Simple Solution
I love to see patients with flat-feet. In fact sometimes I feel that I should dedicate my medical career to educating people about flat-feet. Flat feet causes so much trouble for people and they just don’t realize that in most case it can be easily corrected with a good arch support. As a family doctor I spend a lot of time treating patients with chronic conditions they will have for the rest of their lives. Therefore I love it when patients come in with problems associated with flat-feet. This is one of the few problems I can actually fix and best of all it doesn’t require a medication to fix it.
Flat-feet in medical terms is known as hyperpronation, meaning over pronation. Pronation is the motion of flattening out of the arch as the foot rotates counter-clockwise (externally rotates). Pronation is important because it allows the foot to absorb shock. In addition, Pronation also allows all the bones of the mid-foot to unlock and become like a “bag of bones”. Being a loose “bag of bones” enables the foot to adapt to uneven surfaces (uphill, downhill, rocky surface, etc.). In moderation, pronation is a good thing. Hyperpronation is a bad thing.
The problem with flat feet or hyperpronation is that the foot remains pronated throughout the step. The foot does not supinate (soup-in-ate) as the foot moves into the later stages of the step. Supination is the opposite of pronation. In supination the foot internally rotates (rotates clock-wise). Supination re-locks the bones of the mid-foot and transforms the foot into a rigid lever arm to provide an efficient push-off and propel the body forward. If the foot cannot supinate it remains essentially a loose “bag of bones” and you are unable to use the foot as an efficient, firm lever arm for push off.
If the foot does not supinate it cannot form an efficient lever arm. As a result, the calf muscles have to work all that much harder in order to propel the body forward. This causes fatigue and ache in the muscles of the lower legs at the end of the day. In addition if the calf muscles are working harder they become very strong and bulky. This sometimes leads to a condition known as shin splints. The term "shin splints" usually refers to pain along the inside-front part of the lower leg. Shin splints is usually caused by an imbalance between the calf muscles on the back of the lower leg (posterior muscles) and the anterior muscles or muscles on the front part of the lower leg. The more powerful posterior muscles overwork the less powerful anterior muscles as the anterior muscles try to decelerate the body at heel strike. This causes excess strain, inflammation and pain where the anterior muscles attach to the shin bone.
Hyperpronation can cause the heel pain known as plantar fasciitis. The typical symptom of plantar fasciitis is severe heel pain when taking the first few steps in the morning or during the first few steps after sitting for a few minutes. Hyperpronation causes excessive flattening of the arch. This causes the ligament called the plantar fascia on the bottom of the foot to stretch out too much. The excessive pulling on the plantar fascia causes inflammation where the plantar fascia inserts into the heel.
In conclusion, someone with flat feet has very inefficient foot function and this can lead to heel pain, muscle fatigue and shin splints. By adding an arch support the foot is prevented from hyper-pronating and this improves the over-all efficiency of the foot function. Occasionally you can buy an arch support off-the-shelf that provides support. In most cases, however, the off-the-shelf insoles only provide cushioning and do not correct the hyper-pronation. Life is too short to suffer in pain, especially when the problem can be easily corrected. If someone is having pain as the result of flat-feet it makes sense to spend the extra money to purchase a custom arch support that will correct the problem once and for all.
For more information please visit Archatomics
Flat-feet in medical terms is known as hyperpronation, meaning over pronation. Pronation is the motion of flattening out of the arch as the foot rotates counter-clockwise (externally rotates). Pronation is important because it allows the foot to absorb shock. In addition, Pronation also allows all the bones of the mid-foot to unlock and become like a “bag of bones”. Being a loose “bag of bones” enables the foot to adapt to uneven surfaces (uphill, downhill, rocky surface, etc.). In moderation, pronation is a good thing. Hyperpronation is a bad thing.
The problem with flat feet or hyperpronation is that the foot remains pronated throughout the step. The foot does not supinate (soup-in-ate) as the foot moves into the later stages of the step. Supination is the opposite of pronation. In supination the foot internally rotates (rotates clock-wise). Supination re-locks the bones of the mid-foot and transforms the foot into a rigid lever arm to provide an efficient push-off and propel the body forward. If the foot cannot supinate it remains essentially a loose “bag of bones” and you are unable to use the foot as an efficient, firm lever arm for push off.
If the foot does not supinate it cannot form an efficient lever arm. As a result, the calf muscles have to work all that much harder in order to propel the body forward. This causes fatigue and ache in the muscles of the lower legs at the end of the day. In addition if the calf muscles are working harder they become very strong and bulky. This sometimes leads to a condition known as shin splints. The term "shin splints" usually refers to pain along the inside-front part of the lower leg. Shin splints is usually caused by an imbalance between the calf muscles on the back of the lower leg (posterior muscles) and the anterior muscles or muscles on the front part of the lower leg. The more powerful posterior muscles overwork the less powerful anterior muscles as the anterior muscles try to decelerate the body at heel strike. This causes excess strain, inflammation and pain where the anterior muscles attach to the shin bone.
Hyperpronation can cause the heel pain known as plantar fasciitis. The typical symptom of plantar fasciitis is severe heel pain when taking the first few steps in the morning or during the first few steps after sitting for a few minutes. Hyperpronation causes excessive flattening of the arch. This causes the ligament called the plantar fascia on the bottom of the foot to stretch out too much. The excessive pulling on the plantar fascia causes inflammation where the plantar fascia inserts into the heel.
In conclusion, someone with flat feet has very inefficient foot function and this can lead to heel pain, muscle fatigue and shin splints. By adding an arch support the foot is prevented from hyper-pronating and this improves the over-all efficiency of the foot function. Occasionally you can buy an arch support off-the-shelf that provides support. In most cases, however, the off-the-shelf insoles only provide cushioning and do not correct the hyper-pronation. Life is too short to suffer in pain, especially when the problem can be easily corrected. If someone is having pain as the result of flat-feet it makes sense to spend the extra money to purchase a custom arch support that will correct the problem once and for all.
For more information please visit Archatomics
Saturday, November 3, 2007
Knee pain? Maybe It Your Feet
There are several painful conditions of the knee that may be caused by problems with your feet. The knee joint is one of the most complex joints in the body. It is a hinge joint, a sliding joint and a rotating joint all at the same time. The proper and pain-free functioning of the knee requires near perfect alignment of the bones, ligaments and tendons that make up the knee joint. Pain in the knee is usually an early warning sign that something is wrong with the alignment. It is important to address these problems early to avoid serious, long term problems such as severe arthritis.
The improper alignment that causes knee pain is often the result of improper alignment of the joints of the foot and ankle. Let me give some examples.
Pain on the inside part of the knee may be caused by bursitis at the location where three of the tendons from the thigh muscles (sartorius, gracilis and semitendinosus) come together and insert into the upper/inner part of the tibia (bone of the lower leg). This condition is known as Pes Anserine bursitis. Pes Anserine is Latin for “goose foot”. I suppose it is called goose foot because these three tendons coming together look somewhat like a goose’s foot. The pain is caused by inflammation of the bursa beneath these three tendons. A bursa is a fluid-filled sac that is found where tendons and ligaments rub against bone. The bursa is designed to prevent the bone from irritating and damaging these tendons and ligaments as the rub back and forth over the bone. When these bursa become inflamed this is known as bursitis. Pes anserine bursitis is inflammation of the bursa beneath the three tendons that form the goose foot. Pes Anserine bursitis can be caused by excessive pronation of the foot. The excessive pronation (see article on normal foot motion) causes excessive stretching of these tendons which over time results in inflammation. The treatment and prevention of this condition involves an arch support to prevent excessive foot pronation.
Pain on the outside of the knee is sometimes caused by a condition known as iliotibial band syndrome. The iliotibial band runs from the pelvis down the outside of the leg and attaches to the outside part of the knee. Problems with the foot together with overuse (such as running or bicycling) can lead to inflammation where the iliotibial band inserts into the outer knee. There are several different foot problems that can cause this inflammation. If the person is flat-footed (over-pronatnor) this causes the tibia (lower leg bone) to excessively internally rotate. This increases the stretch on the iliotibial band and causes inflammation. On the other hand if someone has a high-arched foot, the foot is in a supinated position (see normal foot motion) and this too can cause excessive stretch on the iliotibial band and inflammation. These two very different types of foot problems result in the same painful condition (iliotibial band syndrome). However the two problems require very different treatments. In order to correct the problem it is essential to determine what exactly is causing the problem.
Knee arthritis can be caused or exacerbated by problems with the foot. Someone that has arthritis pain on the part of knee closest to the midline (medial compartment) may have a supinated foot that contributes to a bow-legged type of stance. Someone with pain in the lateral compartment (the outer part of the knee furthest from the midline) may be flat-footed, a hyper-pronator, which leads to a knock-kneed type of stance. Through the proper use of a foot orthotic I believe that we can, over time, reduce the load on the painful knee compartment, reduce the pain and at least slow down the degeneration of the cartilage.
Pain in the center of the knee is often cause by chondromalacia patella, also known as retropatellar (behind the kneecap) pain syndrome. This is often seen in someone with excessive pronation (flat-feet). As the knee straightens and bends the kneecap is supposed to ride smoothly in a cartilage-lined groove on the lower end of the femur (thigh bone). Someone that is a hyper-pronator has excessive internal rotation of the tibia. This excessive internal rotation changes the angle that the kneecap rides up and down in this groove (known as the Q angle or Quadriceps angle). Over time this leads to irritation behind the kneecap and the retropatellar pain syndrome. An arch support or orthotic can be very helpful in treating this condition.
In conclusion I have discussed a few of the common causes of knee pain that can be relieved or at least improved through the use of a simple foot orthotic. The key to treatment however is knowing what is causing the problem in the first place. The techniques we use for diagnosing the problem will be discussed in an upcoming article.
For More Information Visit www.Archatomics.com
The improper alignment that causes knee pain is often the result of improper alignment of the joints of the foot and ankle. Let me give some examples.
Pain on the inside part of the knee may be caused by bursitis at the location where three of the tendons from the thigh muscles (sartorius, gracilis and semitendinosus) come together and insert into the upper/inner part of the tibia (bone of the lower leg). This condition is known as Pes Anserine bursitis. Pes Anserine is Latin for “goose foot”. I suppose it is called goose foot because these three tendons coming together look somewhat like a goose’s foot. The pain is caused by inflammation of the bursa beneath these three tendons. A bursa is a fluid-filled sac that is found where tendons and ligaments rub against bone. The bursa is designed to prevent the bone from irritating and damaging these tendons and ligaments as the rub back and forth over the bone. When these bursa become inflamed this is known as bursitis. Pes anserine bursitis is inflammation of the bursa beneath the three tendons that form the goose foot. Pes Anserine bursitis can be caused by excessive pronation of the foot. The excessive pronation (see article on normal foot motion) causes excessive stretching of these tendons which over time results in inflammation. The treatment and prevention of this condition involves an arch support to prevent excessive foot pronation.
Pain on the outside of the knee is sometimes caused by a condition known as iliotibial band syndrome. The iliotibial band runs from the pelvis down the outside of the leg and attaches to the outside part of the knee. Problems with the foot together with overuse (such as running or bicycling) can lead to inflammation where the iliotibial band inserts into the outer knee. There are several different foot problems that can cause this inflammation. If the person is flat-footed (over-pronatnor) this causes the tibia (lower leg bone) to excessively internally rotate. This increases the stretch on the iliotibial band and causes inflammation. On the other hand if someone has a high-arched foot, the foot is in a supinated position (see normal foot motion) and this too can cause excessive stretch on the iliotibial band and inflammation. These two very different types of foot problems result in the same painful condition (iliotibial band syndrome). However the two problems require very different treatments. In order to correct the problem it is essential to determine what exactly is causing the problem.
Knee arthritis can be caused or exacerbated by problems with the foot. Someone that has arthritis pain on the part of knee closest to the midline (medial compartment) may have a supinated foot that contributes to a bow-legged type of stance. Someone with pain in the lateral compartment (the outer part of the knee furthest from the midline) may be flat-footed, a hyper-pronator, which leads to a knock-kneed type of stance. Through the proper use of a foot orthotic I believe that we can, over time, reduce the load on the painful knee compartment, reduce the pain and at least slow down the degeneration of the cartilage.
Pain in the center of the knee is often cause by chondromalacia patella, also known as retropatellar (behind the kneecap) pain syndrome. This is often seen in someone with excessive pronation (flat-feet). As the knee straightens and bends the kneecap is supposed to ride smoothly in a cartilage-lined groove on the lower end of the femur (thigh bone). Someone that is a hyper-pronator has excessive internal rotation of the tibia. This excessive internal rotation changes the angle that the kneecap rides up and down in this groove (known as the Q angle or Quadriceps angle). Over time this leads to irritation behind the kneecap and the retropatellar pain syndrome. An arch support or orthotic can be very helpful in treating this condition.
In conclusion I have discussed a few of the common causes of knee pain that can be relieved or at least improved through the use of a simple foot orthotic. The key to treatment however is knowing what is causing the problem in the first place. The techniques we use for diagnosing the problem will be discussed in an upcoming article.
For More Information Visit www.Archatomics.com
Friday, November 2, 2007
Leaky Gut Syndrome
The digestive tract is lined with very specialized cells that control the absorption of nutrients. Under ideal circumstances these cells should let in the all the good nutrients and keep out all unwanted substances. For the digestive system to work properly is it critical that there is a “tight junction” between the cells of the intestinal wall to prevent unwanted particles from sneaking in between the specialized barrier cells. Some researchers have described the tight junctions to be like the concrete mortar that holds the bricks of a wall together. If these tight junctions become damaged then large particles of food are able to pass from the digestive tract and enter the blood stream. This is known as the “leaky gut” syndrome.
When large particles sneak through the junctions between the specialized intestinal cells and enter the blood stream they are immediately identified as foreign intruders. Fortunately, your body is equipped with an elaborate defense mechanism known as the immune system to guard against these invaders. There are chemical messengers residing in the blood and in the surrounding tissues that act as sentries patrolling for foreign invaders. When an invader is detected these specialized sentry cells send out signals to call in the cavalry. The cavalry consists of cells that kill and/or engulf the intruder.
The immune system is essential to keep the body healthy and to fight off infection. In general, the immune system works for the benefit of the body as a whole. However, the immune system is very aggressive in its effort to destroy intruders. When the immune system is continually set into action by large particles sneaking thought the junctions between the intestinal cells the immune system is continually in a state of high-alert. As an example, suppose there was a small rural town that had six fires a day. I’m not talking about false alarms I am talking about six real fires each day. The local fire department would be on high alert at all times. After awhile they would get so jumpy that they would hose down a house even if it was a false alarm.
When someone has a leaky gut there immune system is constantly being set off. The immune system is always on high-alert. The immune system may start to set up an immune response against its own, normal tissues. When the body starts to believe that its own, normal tissues are foreign invaders this is know as an auto-immune disease. The leaky gut syndrome has been blamed for causing or worsening of some autoimmune diseases including fibromyalgia, lupus and arthritis.
The best way to prevent leaky gut syndrome is to ensure that specialized intestinal cells of the digestive tract are healthy, the tight-junctions are maintained, the intestinal bacteria (flora) are alive and well and all the food is properly digested.
These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure or prevent any disease. The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on or in any product label or packaging. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. You should not stop taking any medication without first consulting your physician.
When large particles sneak through the junctions between the specialized intestinal cells and enter the blood stream they are immediately identified as foreign intruders. Fortunately, your body is equipped with an elaborate defense mechanism known as the immune system to guard against these invaders. There are chemical messengers residing in the blood and in the surrounding tissues that act as sentries patrolling for foreign invaders. When an invader is detected these specialized sentry cells send out signals to call in the cavalry. The cavalry consists of cells that kill and/or engulf the intruder.
The immune system is essential to keep the body healthy and to fight off infection. In general, the immune system works for the benefit of the body as a whole. However, the immune system is very aggressive in its effort to destroy intruders. When the immune system is continually set into action by large particles sneaking thought the junctions between the intestinal cells the immune system is continually in a state of high-alert. As an example, suppose there was a small rural town that had six fires a day. I’m not talking about false alarms I am talking about six real fires each day. The local fire department would be on high alert at all times. After awhile they would get so jumpy that they would hose down a house even if it was a false alarm.
When someone has a leaky gut there immune system is constantly being set off. The immune system is always on high-alert. The immune system may start to set up an immune response against its own, normal tissues. When the body starts to believe that its own, normal tissues are foreign invaders this is know as an auto-immune disease. The leaky gut syndrome has been blamed for causing or worsening of some autoimmune diseases including fibromyalgia, lupus and arthritis.
The best way to prevent leaky gut syndrome is to ensure that specialized intestinal cells of the digestive tract are healthy, the tight-junctions are maintained, the intestinal bacteria (flora) are alive and well and all the food is properly digested.
These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure or prevent any disease. The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on or in any product label or packaging. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. You should not stop taking any medication without first consulting your physician.
Thursday, November 1, 2007
Cortisol is the Stress Hormone
Technorati Profile
When the body is under stress, excess cortisol is produced. Cortisol is part of the "fight or flight" response. If we are threatened we have to immediately prepare our bodies either to face the threat or run for our lives. In order to prepare ourselves, the adrenal gland secrets cortisol to increase our blood sugar for extra energy and increase our heart rate and blood pressure in order to pump more blood to the muscles and brain to prepare us for battle. This stress response or "flight or fight" response is meant to only last for the brief time necessary to get us to safety.
The "flight or fight" response was great for our ancestors when they needed the extra cortisol to protect themselves from the occasional threat of the saber-toothed-tiger. It is also essential today if we have to jam on the brakes if someone runs a STOP sign. If this is only a once-in-a-while event the brief elevation in cortisol does not cause health problems.
In our everyday lives we are facing saber-toothed tigers (real or imagined) all day long. Many of us are over-worked, don't get enough sleep, have demanding bosses, relationship problems, and financial worries. We may also have feelings of guilt or pain from past emotional injuries. All of these issues put us in a constant state of stress. Constant stress, in turn, leads to chronically elevated cortisol levels. Chronically elevated cortisol can lead to adrenal dysfunction.
Effects of adrenal dysfunction " fatigue " suppressed immune system " muscle and bone loss" depression " autoimmune disorders " thyroid dysfunction" weight loss resistance
However if you feel that things are going well in your life, your are spiritually healthy, you eat well, get enough sleep, exercise regularly and maintain a healthy weight (without dieting!) then your adrenal glands are probably functioning as they should.
If you feel anxious most of the time, you feel fatigued, sleep poorly, can't lose weight (even if you diet and exercise), use caffeine and carbohydrates to give you a boost during the day, then your adrenal glands are likely dysfunctional.
In order to reduce your cortisol level you have to reduce your stress. Stress reduction is a critical part of any weight loss program.
In the early stages of adrenal dysfunction the cortisol level continues to rise throughout the day. In the late stages of adrenal dysfunction the adrenal glands actually become exhausted from having to continually pump out all the excess cortisol. In late adrenal dysfunction the cortisol levels may actually be below chronically low resulting in chronic fatigue.
Conventional medicine recognizes only the extremes of either cortisol excess (Cushing' Syndrome ( http://www.niddk.nih.gov/health/endo/pubs/cushings/cushings.htm )) or extremely low cortisol (Addison's Disease ( http://www.niddk.nih.gov/health/endo/pubs/addison/addison.htm )
Conventional medicine does not look for less extreme fluctuations of cortisol as a source for poor health. In the conventional standard of care, any cortisol level within a very broad range is considered normal, and anything outside that range indicates disease.
When the body is under stress, excess cortisol is produced. Cortisol is part of the "fight or flight" response. If we are threatened we have to immediately prepare our bodies either to face the threat or run for our lives. In order to prepare ourselves, the adrenal gland secrets cortisol to increase our blood sugar for extra energy and increase our heart rate and blood pressure in order to pump more blood to the muscles and brain to prepare us for battle. This stress response or "flight or fight" response is meant to only last for the brief time necessary to get us to safety.
The "flight or fight" response was great for our ancestors when they needed the extra cortisol to protect themselves from the occasional threat of the saber-toothed-tiger. It is also essential today if we have to jam on the brakes if someone runs a STOP sign. If this is only a once-in-a-while event the brief elevation in cortisol does not cause health problems.
In our everyday lives we are facing saber-toothed tigers (real or imagined) all day long. Many of us are over-worked, don't get enough sleep, have demanding bosses, relationship problems, and financial worries. We may also have feelings of guilt or pain from past emotional injuries. All of these issues put us in a constant state of stress. Constant stress, in turn, leads to chronically elevated cortisol levels. Chronically elevated cortisol can lead to adrenal dysfunction.
Effects of adrenal dysfunction " fatigue " suppressed immune system " muscle and bone loss" depression " autoimmune disorders " thyroid dysfunction" weight loss resistance
However if you feel that things are going well in your life, your are spiritually healthy, you eat well, get enough sleep, exercise regularly and maintain a healthy weight (without dieting!) then your adrenal glands are probably functioning as they should.
If you feel anxious most of the time, you feel fatigued, sleep poorly, can't lose weight (even if you diet and exercise), use caffeine and carbohydrates to give you a boost during the day, then your adrenal glands are likely dysfunctional.
In order to reduce your cortisol level you have to reduce your stress. Stress reduction is a critical part of any weight loss program.
In the early stages of adrenal dysfunction the cortisol level continues to rise throughout the day. In the late stages of adrenal dysfunction the adrenal glands actually become exhausted from having to continually pump out all the excess cortisol. In late adrenal dysfunction the cortisol levels may actually be below chronically low resulting in chronic fatigue.
Conventional medicine recognizes only the extremes of either cortisol excess (Cushing' Syndrome ( http://www.niddk.nih.gov/health/endo/pubs/cushings/cushings.htm )) or extremely low cortisol (Addison's Disease ( http://www.niddk.nih.gov/health/endo/pubs/addison/addison.htm )
Conventional medicine does not look for less extreme fluctuations of cortisol as a source for poor health. In the conventional standard of care, any cortisol level within a very broad range is considered normal, and anything outside that range indicates disease.
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