Stress and the Cortisol Tightrope
Posted Jul 09, 2019
21st Century Stress and Health
A certain amount of stress can be healthy, and the body is equipped to handle it. However, the pervasive abundance of stress that most people live with during today’s economic recessions, political upheavals, environmental crises and high levels of crime and violence is undermining health, as well as happiness and peace of mind.
Despite huge changes in living conditions, human biology has remained much the same over the past hundred thousand years. The stress response system is designed for the kind of threats to survival that assaulted early man: arduous hunts, heavy physical work and exposure.
Overcoming or avoiding each of these stressors required a physical “fight or flight” reaction. It was important for the stress response system to be able to quickly shift metabolic processes from maintenance and repair to action stations, and then back to normal once the stressor had been dealt with. This is how the physiological balance that sustains life and health (homeostasis) is preserved.
In contrast, the complex 21st century stress overload from economic, environmental, social and psychological factors can rarely be resolved by physical action, yet the stress response still operates as if it can. It would probably be better for your health if you could hunt down debt or outrun a demanding job. Instead, the modern stress system is often in overdrive without physical relief, making it harder and harder to maintain optimum physiological balance in today’s world.
The Stress Response System
Every time your patients experience any kind of stress, whether internal, like a sore throat, or external, like an angry teenager, a chain reaction is triggered that prepares them to physically respond to the stressor. It starts when the hypothalamus is alerted to a threat to homeostasis. The hypothalamus then signals the pituitary gland to activate stress hormone production by the adrenal glands. Adrenal hormones, particularly cortisol, affect every cell and system in the body.
After the immediate stress passes, or if stress hormones get too high, this same system alerts the hypothalamus to decrease adrenal hormone production. As stress hormones decrease, other systems and metabolic functions return to normal. Known as the hypothalamic-pituitary-adrenal (HPA) axis, balanced functioning of this stress response regulator is essential to the body’s ability to cope with stress and maintain well-being during stressful times.
Stress and Inner Balance
The stress response system is able to influence the systems and metabolic processes that physically prepare for action and generate energy. Regulated by the HPA axis via adrenal hormones, the stress response intensifies cardiovascular function by increasing heart rate and blood pressure to enhance blood flow to the muscles; speeds up energy production by raising blood sugar and insulin levels; and heightens alertness and mental focus.
At the same time, it slows down digestion by decreasing stomach acid, digestive enzymes, peristalsis and nutrient absorption; shifts resources away from tissue building and repair; cuts back immune activity; and lowers libido. When stress is frequent or extreme and no physical action is taken, these HPA axis regulated adjustments can disrupt optimal physiological and metabolic balance over time, as well as lower stress tolerance.
Cortisol and Stress
Cortisol is the primary instigator of the physiological changes that prepare the body to react to a stressor. With each stress response, the adrenals have to produce the right amount of cortisol to shift into “fight or flight” mode. It is also one of the chief agents used to balance body chemistry, modulating blood sugar, energy production, immune function, inflammation, blood pressure, heart rate, muscle tone, sleep cycles, fluid balance, mental focus, mood and libido, and protecting every cell in the body.
The Cortisol Tightrope Walk
When the HPA axis is working overtime because of continuing stress, maintaining the physiological balance necessary for good health becomes a tightrope walk between two undesirable outcomes. The problems that result from either are largely related to the levels of cortisol being produced by the adrenals:
1. High Cortisol – Metabolic Syndrome
If adrenal response to chronic stress is normal, adrenal hormone output naturally remains high. High circulating cortisol raises blood sugar (glucose), which causes more insulin to be secreted by the pancreas. Without corresponding physical action, the excess glucose does not get burned up for energy. The cells, to protect themselves from the detrimental effects of taking in too much glucose, become more resistant to insulin.
This leaves high circulating glucose, insulin and cortisol, all of which can have adverse effects on health and disrupt normal sleep cycles, digestive function, and cell building and repair. As a way to reduce the excess glucose, cortisol causes it to be stored in fat cells around the abdomen. Over time, if adrenal function remains strong, the imbalances created by chronically high levels of cortisol and glucose can lead to metabolic syndrome, a symptom complex involving high blood sugar, insulin resistance, excess belly fat, elevated cholesterol and triglycerides, high blood pressure and inflammation that, unchecked, can develop into serious, long term health problems, such as diabetes and coronary heart disease.
2. Low Cortisol – Adrenal Fatigue
If adrenal resources become depleted by frequently triggered demands of stress, the adrenal glands can dysfunction, resulting in adrenal fatigue and reduced cortisol levels. This is common in stressful times, but if the adrenal glands do not keep pace with the demands and adrenal fatigue continues, the resulting sub-optimal output of adrenal hormones can have a number of adverse consequences for health, as well as exacerbate pre-existing acute illness and chronic health conditions such as hypoglycemia, allergies, asthma, autoimmune disorders, inflammation, hypothyroidism, PMS, difficult menopause and addiction.
Adrenal fatigue leaves people tired (especially in the morning and mid-afternoon) foggy headed, and often trying to keep going with caffeine and salty/high fat/sweet snacks. It becomes harder to mount an adequate stress response or raise blood sugar to generate energy. Stamina, quality of sleep, immunity, mood and libido can all decline.
Balancing on the Cortisol Tightrope
It is essential to overall health and ability to handle stress that the HPA axis and adrenal glands function soundly and stay in balance. Many of the same principles for promoting and maintaining this healthy balance apply to both sides of the cortisol tightrope. Here are a few:
Lifestyle and Stress Management Tips for Your Patients
Lifestyle tips for high and low cortisol:
- Eliminate as many sources of stress as possible and limit contact with energy robbers (people, environments and activities that leave you feeling drained)
- See the stressors you can’t get rid of in a more positive light (reframing)
- Laugh more (it may seem silly but laughter can help reduce stress levels)
- Make time daily to just relax (even if it’s only for 10 minutes)
- Practice some simple breathing and meditation techniques daily
- Prioritize (not everything is an emergency and must be done now)
- Learn to say no (know your limits – saying no is not a sign of weakness)
Additional lifestyle tips for low cortisol:
Lie down during work breaks, go to bed by 9-9:30, and sleep in as long as possible.
Dietary Guidelines for Stress
- Eat only low carbohydrate (low glycemic index), whole, fresh, natural foods, oils high in Omega 3 and plenty of vegetables
- Avoid hydrogenated and partially hydrogenated fats (most crackers, baked goods and peanut butter – read labels) and refined carbohydrates (sugar, concentrated sweeteners and white flour) that disrupt blood sugar and insulin balance
- Eat regular meals (no skipping meals, include snacks between meals if you’re still hungry)
- Don’t do anything else while eating (TV, work, texting)
- Chew every mouthful 30 times
Dietary tips for high cortisol:
- Eat less and only when hungry
- Have small regular meals with plenty of fresh vegetables and fruit
- Avoid substances that stimulate cortisol (caffeine) and insulin (sugar and refined carbohydrates)
- Reduce fat and overall calorie intake
- For protein eat white meat, fish and vegetable sources (legumes, nuts and seeds)
- Reduce sodium and increase potassium intake (clams, avocados, bananas, dates, figs and other fruits)
Dietary tips for low cortisol:
- Eat before 10 AM and again before noon
- Avoid fruit in morning
- Eat at regular intervals and don’t skip meals
- At every meal and snack combine good quality protein, oil/fat and unrefined carbohydrates (whole grains, vegetables, fruit)
- Increase protein intake with red meat and other animal protein (eggs, cheese, organ meat) and oil (cold pressed vegetable and some animal fat)
- Include sodium (sea salt, kelp powder, sea food, seaweed, olives) and reduce potassium intake (not too much fruit)
Exercise for Stress
Exercise tips for high cortisol:
When the stress response system is in overdrive, exercise helps to normalize (reduce) cortisol, insulin, blood sugar and belly fat. Combine aerobic (vigorous walking, jogging, swimming, dancing, Zoomba), anaerobic (weights, isotonic, pilates) and flexibility (yoga, stretching, tai chi), and exercise 30-40 minutes/day to comfortable capacity.
Exercise tips for low cortisol:
When the adrenals are depleted, moderate (less vigorous than for metabolic syndrome) exercise tends to normalize (raise) cortisol, blood sugar, and sodium/potassium balance. Combine aerobic (walking, swimming, dancing), anaerobic (weights, isotonic, Pilates) and flexibility (yoga, stretching, tai chi), and exercise daily just to comfortable capacity. If you feel more tired 90 minutes after exercise or the next day, cut back. Avoid competing with yourself or others or pushing to do more – keep it fun.
Dietary Supplements for Stress Support
There are several reasons why properly formulated dietary supplements designed specifically for stress and adrenal support can make a significant difference for those walking the cortisol tightrope. Stress burns up many nutrients at an accelerated rate because the production of cortisol and other adrenal hormones, generating energy, and the shift into “fight or flight” mode to ready the body for action are all nutrient intensive processes. The adrenal glands use more vitamin C than any other part of the body, so this antioxidant is in particularly high demand. Providing the right kind of supplemental nutritional support can significantly enhance the body’s ability to handle stress and rebound from adrenal fatigue.
Supplement support during high cortisol:
This should naturally promote balanced HPA axis function and blood sugar metabolism; help replenish the nutrients used up by stress and adrenal hormone production; and provide antioxidants and additional vitamin C.
Supplement support during low cortisol:
This should deeply support adrenal structure and function; enhance cortisol activity; replenish the nutrients used up by stress and adrenal hormone production; provide additional antioxidant vitamin C in a non-acidic form; and help sensitize HPA axis function.