"Low cortisol levels have been observed in patients with different stress-related disorders such as chronic fatigue syndrome, fibromyalgia, and post-traumatic stress disorder. Data suggest that these disorders are characterized by a symptom triad of enhanced stress sensitivity, pain, and fatigue" - Fries

    "Low cortisol is of clinical relevance in CFS, as it is associated with a poorer response to CBT. Hypocortisolism could be one of several maintaining factors that interact in the persistence of CFS." -Roberts

Hypocortisolism means low levels of important stress hormone cortisol. Cortisol is produced by the adrenal glands (little dunce hats that sit on top the kidneys) it helps us cope better with stressors; reduces inflammation; helps regulate blood sugar levels and more.

Hypocortisolism affects 1 in 4 people with Sensitivity Related Illnesses related to multiple chemical sensitivity according to Fries and results in a very nasty triad of heightened pain; fatigue and hypersensitivity to stimuli and stress.

This figure is thought to be higher in people with multiple chemical sensitivity (MCS), and according to Yanick is one of the reasons why a number of people with multiple chemical sensitivity do no respond well to most standard treatments (e.g. medicines; supplements; detoxification; and psychological interventions) without modification (low and slow). Roberts says that hypocortisolism seems to be one of the reasons why therapies such as Cognitive Behavioural Therapy (CBT) is ineffective in the treatment of Chronic Fatigue Syndrome CFS) (many people with MCS also have CFS). It may also contribute to the exercise intolerance experienced by people with CFS according to Dr Sarah Myhill.

If you get your cortisol levels measured by your doctor and they are very low (hypocortisolism), your doctor is unlikely to do anything unless you have the adrenal insufficiency illness Addison Disease, however, it is very important that you do something as this is not good. To help replenish your cortisol levels you will need to take time away from work (assuming you have somehow managed to hold onto your job being as ill as you are); get plenty of rest, practise the stress management technique MINDFULNESS a lot and reduce all stressors and stimuli for a period of time - however slowly at a PACE that is right for you, otherwise you are likely to experience some very nasty symptom flare-ups and set backs.

For some people cortisol replenishment may occur quite quickly if the stressor (s) causing the depletion is an underlying illness that has been identified and treated appropriately, however for most, this can take some time. To help guide overall stress reduction I found creating a Wellness Plan essential. To help modify MCS treatment to my level of severity (which was quite extreme), I found it essential to get a really good understanding of MCS, the different treatment approaches and the possible pitfalls. I also found it important to keep an activity and symptom journal. Whilst this could be a bit of a hassle, it helped me work out what was helping and what was causing flares and ways to modify treatment for the best results.