Stress

And The Cycle of High Cortisol and its Impact on

Weight, Eating Patterns, low Serotonin and Low Dopamine, liver, Thyroid, fatigue, hormones, Immune and Gut Health

We all have stress from time to time, but the issue is when you not only have chronic stress but how you are coping and managing the stress.

For me personally, I have been under a great deal of stress with recent deaths, aging parents and yes, COVID/mass forced quarantine stress. Because I am aware of the stress, I have been doing more work to support my body. I think the key here is be aware and support your body.

What is all this stress doing to us? A lot! In fact, stress is often an underlying root cause to many modern-day health issues.

And in Medscape they just reported on a study that shows those with elevated cortisol have greater risk of death from COVID 19.

Before I dive into what cortisol is and the stress response, I want you to keep these things in mind.

  • It is important to recognize that you are under chronic stress.
  • Then identify what is causing stress for you (it may be more than one stressor)
  • Ask yourself, is there is way to remove the stress or address it (such as a toxic friendship, or an endogenous stressor such as a gut pathogen) or is it a stressor you cannot avoid dealing with such as caring for an aging parent or a disabled child (maybe respite would be helpful in these circumstances)
  • When under chronic stress, identify your weak areas? For instance, when I am under chronic stress, I know I am more susceptible to colds and migraines.
  • Have tools at hand to address the stress. It is different of everyone-maybe for you it is going out with friends, or gardening or reading a novel, going for a walk in the woods, or doing yoga. Find what helps you relax and make sure to take time for it

What is Cortisol?

Cortisol is not a bad thing. We need it during times of stress, and it helps us to cope with a stressful situation. Cortisol is produced from the adrenal glands. Your adrenal glands balance ALL of your other hormones so in order to have balance, the adrenals must be nurtured. This means that if there is adrenal dysfunction, you can have imbalances not only in cortisol but in blood sugar, sex hormones, thyroid hormones, and your neurotransmitters as well.

Therefore, when someone has a mood disorder or has hypothyroidism, for example, we do not just look at the brain or the thryoid gland. If you are working with someone who is just focusing on the one body part, you need to reevaluate if this professional is helping you. A holistic approach looks at how everything in the body is connected and how one system impacts another-instead of piecemealing your health issues.

One of the functions of the adrenal glands is to produce cortisol in response to stress. These small yet mighty glands sit on top of your kidneys. Cortisol is anti-inflammatory and controls body inflammation. It also follows a circadian rhythm-it is highest an hour after you get out of bed and lowest at night during sleep. It helps you to get up and go in the morning and helps you to wind down and sleep at night.

But problems can arise, and you may have low cortisol at night and highs and lows of it all throughout the day. For some, cortisol levels have reversed so that it is at its lowest in the morning and at its peak at night. This can lead to fatigue and sleep disturbances.

How does Dysregulated/Imbalances in Cortisol Happen?

The brain and the pituitary gland respond to stress by releasing adrenocorticotropic hormone (ACTH). This stimulates the adrenals to increase production of your hormones, norepinephrine, epinephrine, and cortisol. Epinephrine and Norepinephrine are the main stimuli in response to stress and are also known as catecholamines.

These hormones will them stimulate the heart and blood pressure causing increase in blood pressure, increase in heart rate. They will divert energy away from digestion increasing blood flow to the muscles and brain and decrease blood flow to the digestive tract and other organs.

During stress adrenaline will also raise blood sugar, as it stimulates the liver to produce and release more glucose and cholesterol into the blood so that our cells will have the energy they need. All of this results in increased rate of metabolism.

Thus, the body is also using up nutrients faster and requires nutrients in larger amounts.

This is a good thing during a critical stressful moment. But what if the stress is chronic, what is the rise in blood sugar, reduced digestion and so forth doing to your health over time?

Think of the stress response in this way: In prehistoric times, if you were running from a saber tooth tiger, cortisol, catecholamines and adrenaline surges helped in the flight or fight situation. When the situation ended these hormones returned to normal levels.

But we are not running from tigers any longer and our stressors are different such as work and family issues. When running from the tiger you needed extra fuel, extra energy which you do not need when the stressor comes from sitting in front of a computer all day long.

In addition to this, in the past, the stress was there and then it was not, so cortisol and other stress hormones could return to baseline. Now, the stressor may be constant with some highs and lows but never really goes away, hence, your cortisol never returns to baseline and before you know it your baseline is higher and higher each time until it ends up burning out.

We all have stress in our lives. The key point is not only how much stress but how are you managing the stress. Are you responding to the stress or reacting to the stress? Some people are much better at dealing with stress than others. Which one are you? Do you react or respond to stress?

We know that chronic stress can impact our physical and mental health and there is a whole field of medicine called psychoneuroimmunology that looks in depth at stress and disease. However, most doctors are not trained in stress related conditions and instead will just write you a script for your IBS, or your migraines or your sleep issues instead of addressing the chronic stress.

Causes of too Much cortisol (hypercortisolemia)

  • Stress, any kind! (what your body perceives as stress!) This can be anything from cancer, surgery, injury to work and family stress to endogenous stress such as a food sensitivity.
  • Low carb intake (yes, that goes for all you long term keto dieters)
  • Skipping meals (not doing intermittent fasting properly)
  • Alcohol
  • Standard American diet
  • Excessive exercise
  • Inflammatory cytokines (think the cytokine storm in some with COVID 19)
  • Gut pathogens
  • Food sensitivities

What Happens When Your Cortisol Stays Elevated

  • Reduces BDNF (brain derived neurotropic factor)
  • Damages the hippocampus (impact to your short- term memory)
  • Poor STM, forgetful
  • Lowers DHEA
  • Increase risk of depression
  • Increase risk of diabetes
  • Increase weight gain
  • Decrease bone density-interrupts bone formation
  • High BP
  • Increase risk of gut infection/damages mucosal gut barrier
  • PMS: cortisol and stress is almost always involved in PMS symptoms

Signs and Symptoms that Your Cortisol is out of Balance

  • Tired even after good night sleep-depleting adrenal glands
  • Gaining weight-especially around your middle (even if eating right)
  • Catch colds, upper respiratory/flu easily. Cortisol deactivates self- repair mechanisms
  • Crave unhealthy foods-cortisol raises BS-causes imbalances which lead to cravings
  • Backaches/headaches-raised prolactin (hormone) levels increasing sensitivity to pain
  • Low sex drive-testosterone drops
  • Gut issues-gut is sensitive to excess cortisol (gut issues, gut tightens up)
  • Anxiety-increases epinephrine
  • Depression-decreases serotonin and dopamine production
  • Acne
  • High BP
  • High glucose levels

 

Testing

The best test is the Adrenal Salivary Index that will measure your cortisol levels several times throughout a day to see if it is following a circadian rhythm or not. Typically, this test will want you to put your saliva into a tube 30 minutes after you wake, again around noon, mid-day, evening and/or at night. You can get an adrenal saliva test via your health professional and out of pocket it typically costs around $200. There are some restrictions on the day of testing such as no caffeine, no alcohol and no strenuous exercise.

If you are suffering from fatigue, highs and lows with energy, chronic stress, difficulty coping, mental health issues, I think the test is worthwhile.

How Cortisol Imbalances and Chronic Stress Impacts Your Health

Depression: Constant cortisol output increases systemic inflammation in the body. Inflammation is at the root cause of all disease including mental health issues. In addition to this, it contributes to low production of serotonin, your feel -good hormone. Another neurotransmitter that elevated cortisol impacts is dopamine and this is your NT responsible for motivation, finishing projects and pursuing activities.

Indirectly, it impacts your gut and leads to intestinal permeability. This indirectly impacts mental health because your gut health is tied to your mental health via the vagus nerve and much of your serotonin is produced in the gut. By impacting the gut, it can lead to systemic inflammation including brain inflammation. Also, gut impact can lead to nutrient deficiencies which will also impact brain function and health.

Thus, elevated chronic cortisol can directly and indirectly impact your mental well-being.

Weight Gain: Not only does the inflammatory response it causes contribute to weight gain but it can increase your appetite. Think about that extra fuel that is required when you are running from that tiger. But now your stressor isn’t the tiger and your body doesn’t need all those extra calories but your body does not know this-it just knows you are under stress. The elevated cortisol can lead to over- eating, binge eating and bulimia. In addition to this the low serotonin can also cause cravings and binges. Elevated cortisol also impacts your dopamine levels, which can also contribute to obesity, fatigue, and addiction.

This leads to a vicious cycle because you are craving more carbs as your body perceives that you need carbs and sugar for quick fuel to address the stress, so you end up not only over eating but eating processed foods rich in sugar and simple carbs. This leads to nutrient deficiencies which places even more stress on the body. These nutrient deficiencies will also contribute to fatigue from not nourishing your body.

In addition to this, as if that were not bad enough, the stress response keeps glucose levels high and leads to insulin resistance which can then lead to diabetes type 2. It also induces leptin resistance, meaning your hormone that tells you your full and satiated is now not working properly and you feel hungrier.

Thyroid: The stress puts the breaks on producing thyroid hormone to save energy. The thryoid determines metabolism speed and thus now all bodily processes slow down. Thus, you gain more weight, experience more anxiety, more depression, digestion slows down, and much more. In addition to this, liver detox is also dependent upon thryoid function. The liver detox process slows down so now toxins that do not get released get dumped into the gut instead. The thyroid is also dependent upon the liver. Now the liver is sluggish, not doing its job as it should, and part of that involves converting your T4 thyroid hormone into its active T3 from.

As mentioned below under the immune system heading, elevated chronic cortisol levels can lead to suppressed secretory IgA, which is part of the mucosal immune barrier. When this is suppressed it can over time lead to intestinal permeability and a downstream effect of this can be autoimmune diseases for those who are more susceptible such as Hashimoto’s thyroiditis.

Fatigue: Eventually if the stress and the elevated cortisol is not dealt with, it will lead to fatigue. This is the end stage of cortisol disruption.

Your body may adapt to the chronic state of elevated cortisol and you may stay in this stage if you started out with healthy adrenals and a good diet. For many with chronic stress, if it doesn’t go away, you don’t do anything about it and don’t support your body, you may end up in the exhaustion phase in which your adrenals basically wear out.

Testing would show low cortisol all day long. Testes may also show low epinephrine and low DHEA. Norepinephrine may help the body to continue to function but if the norepinephrine is also very low on testing, you may feel burned out with constant fatigue.

Immune Function: Elevated cortisol can suppress SigA (secretory IgA) which is the first line of defense of protection on the mucosal surfaces on your body. Sig A plays a role in defending your body against pathogens. It is important for barrier function and not allowing pathogens to enter the body. Thus, a depressed SigA is a good indication of a compromised immune system. Once your immune barrier is suppressed, it also leads to intestinal permeability, opening you up to a host of other health conditions such as food sensitivities and autoimmune conditions which will only further suppress the immune system The body sees all of this as more stress on the body and thus more output of cortisol and you end up in a vicious cycle.

Gut Function: As already stated, stress can cause intestinal permeability which will have down stream effects such as food sensitivities and autoimmune conditions. Other ways stress impacts gut function includes slowing down the digestions process and reducing your stomach acid levels. In times of stress, the energy will move away from digestion to deal with the stress at hand. Therefore, you don’t breakdown your food. This can lead to discomfort, such as gas, bloat, and constipation. Stomach acid will originally increase in production in response to the stress, which can cause GERD, indigestion and so forth. With the increased levels, over time, the pancreas is stimulated to release alkaline enzymes to help balance the acidity. With chronic stress, this can lead to low stomach acid and reduced pancreatic function resulting in poor assimilation of nutrients and thus deficiencies as well as resulting over time in food sensitivities because of the improper breakdown of your food which then lead to absorption of large food molecules which can be immunogenic.

COVID 19 and the Impact of High Cortisol

It comes as no surprise that those with elevated cortisol levels are at greater risk of COVID 19.  This is not a surprise because we know that the high cortisol weakens immune and gut health.

But nonetheless, UK researches have discovered that those with high cortisol levels on admission to the hospital for COVID 19 symptoms have a substantially increased risk of dying.  They studied 535 patients admitted to London hospitals. They are suggesting that they measure cortisol levels and use this as a measure to determine who needs immediate medical attention.

The mean age of these patients was 66.3 years and those with higher levels survived on average 15 days after admission.

While their cortisol was elevated and may have been prior, it is important to note that fear and worry of COVID is stress on the body and also can increase cortisol levels.

More info on this study can be found at https://www.medsape.com/viewarticle/932705

What to Do For Elevated or Dysregulated Cortisol

  • Get tested. Often times a health professional can tell if your cortisol is dysregulated just by listening to you and asking the right questions, but if you can afford it, a salivary test done several times in a day is helpful to see where the highs and lows are. However, many choose not to test, and we still address dysregulated levels, if need be.
  • Balance blood sugar: Since the chronic stress is going to stimulate the release of glucose it is important to eat a whole food, balanced diet with protein, healthy fat and whole food carbs, not processed carbs. Make sure you consume adequate amounts of protein and fat at each meal and make the carbs such as rice and quinoa or potatoes a smaller portion of your plate.
  • Swap the percentages in the diet: By this I mean that most people say they eat a healthy diet but in reality they eat a home cooked dinner, which is great but the fast food breakfast and lunch is not so great. Reverse this by making 80-90% of your daily food intake whole foods and allow some wiggle room for processed foods.
  • Figure out what relaxes you and make time for it, every day even if for a few minutes.
  • Add in Adaptogenic herbs: see these posts for more information: http://trufoodsnutrition.com/4783-2/  and this one  http://trufoodsnutrition.com/rhodiola-rosea-for-stress-anxiety-depression-fatigue-and-add/  and this one http://trufoodsnutrition.com/anxiety-and-stress-adaptogens-vs-medication-for-relief/
  • Add in supportive foods such as whole foods not processed foods with  chemicals, sugar, fake sugar or additives. When under stress, it is even more critical to consume a nutrient dense diet because stress increases cellular activity which leads to increased nutrient usage. Thus, without a whole foods diet, you may aggravate the already damaging effects from stress.
  • Address hidden stressors such as Lyme disease, food sensitivities, mycotoxin, gut pathogens, and so forth as these are added stressors on the body that you may not even be aware of.
  • Support neurotransmitters: if you are having increases or new anxiety or depression you may want to add in supportive supplements if not on SSRI meds such as 5-HTP or saffron or L dopa or Pharma GABA as examples. It is best when using these products to work with a professional.
  • Support gut health: Add in fermented foods, probiotics, pre-biotics and gut supportive foods such as bone broth. You may need additional support such as digestive enzymes, HCL support and more so again this is an area that is best to seek the guidance of a nutritional professional.  http://trufoodsnutrition.com/microbiome-diversity-and-impact-on-your-immune-physical-and-mental-health/
  • Supplement with B complex, vitamin C and magnesium. These nutrients are the first to get depleted when under stress. Others that get depleted faster when under stress include A, E, zinc, selenium, iron, calcium, potassium, sulfur and molybdenum.
  • Do not eat in a stressed state! If eating when stressed, energy will be diverted from the digestive process to handling the stressor. Thus, you may end up with gas, bloat, GI pain and decreased absorption of nutrients which long term can then lead to nutrient deficiencies.
  • Have a bedtime routine and stick to it. Turn off all blue light one to two hours prior to bedtime. Do not work right before bed, instead do something relaxing for you such as a warm bath, soothing music or reading a novel. Try relaxing herbs in tea or supplement form to help you unwind or relax such as chamomile, hops, and lavender. Add in a product called Seriphos, original formula to help support balanced cortisol as it may be beneficial if you know your cortisol is elevated at bedtime.

Bottom Line: Chronic stress will impact every aspect of your health is you do not address it. Part of the stress response and how your body responds is how you look at the stressful situation. Again, do you react, or do you respond? One is obviously going to be better for your health than the other. If you are a person who gets stressed easily or who has been under a great deal of stress and find that you are not coping, it is best to work with a professional who can help you get your body back to a place of balance where it can handle the stress in a proper manner.

Sources

Bauman, E. & Friedlander, J. (2104) Therapeutic Nutrition. CA: Bauman College

Gaby, A. (2011), Nutritional Medicine. NH: Fritz Perlberg Publishing.

Haas, E. (2006) Staying Healthy With Nutrition. The Complete Guide to Diet and Nutritional Medicine. CA: Celestial Arts

Pizzorno, J., Murray, M., & Joiner-Bey, H. (2008) The Clinician’s Handbook of Natural Medicine. Second Edition. USA: Churchill Livingstone.