“I think stress is affecting my hormones.” And it’s so true. But not in the way many people may think. It’s not just your sex hormones like oestrogen, progesterone and testosterone that are causing reactions in your body but others such as insulin and the hormone we are looking at today, cortisol.
Introducing cortisol, the hormone that allows your body to deal with stress but may also slow your digestive system, and metabolism and suppress your immune system at the same time.
In this article, we will look at how Cortisol affects the body. I may launch into an unreferenced rant about adrenal fatigue. We’ll also look at some natural ways to harness cortisol, so it doesn’t harness you.
Cortisol is a good friend to all but an enemy to some.
Somewhat of a strange statement, so let me explain.
Like the other hormones in the endocrine system, Cortisol affects multiple sites within the body, such as the nervous, immune, digestive, respiratory, reproductive systems, often for reasons embedded within your survival.[1]
Cortisol is one of the most essential responsive hormones.
As we’ll see in this article, it does more than just manage your stress response. It covers your immune function inflammatory response and regulates your metabolism.[2]
Most of the time, its effects on these systems allow you to transcend an incoming threat and live to see another day. Unfortunately, in the modern-day, the body can have difficulty assessing when a stressor has dissipated and when it’s a direct threat to your life, such as an email from a colleague.
It’s times like this when cortisol remains elevated for too long when its effects can make you feel like it’s working against you.
For example, chemicals called catecholamines increase your heart and respiratory rate to help you physically respond to a stressful situation. Suppose the levels of these catecholamines stay high for a sustained period. In that case, the elevated heart and respiratory rate erode the cardiovascular system, eventually increasing your risk of stroke and cardiovascular illness.[3]
It is vital to see cortisol positively. Most of the time, it allows your body and brain to align for a common goal; to defend you from everything the big wide world can throw your way.
Let’s explore cortisol’s role in the stress response.
The brain, central nervous system and endocrine system interact when priming you to react to stress faultlessly.
One of the more compelling aspects of the cascade of physiology that follows stress is that the amygdala, the part of the brain that processes fear, arousal and emotional stimuli, [4] is the primary site to determine whether something is stressful or not.
Furthermore, research suggests that how your amygdala develops as a child influences how you respond to stress throughout your life.[5]
Conditions such as Post Traumatic Stress Disorder (PTSD) and traumatic brain injury (TBI) can contribute to a change in the amygdala, leading to a dysfunctional downstream response to stress.[6] [7]
It’s only when the amygdala says so that the hypothalamus gets the message to trigger a broader physiological reaction. Enter the sympathetic nervous system (SNS).
Once the hypothalamus is activated, the SNS stimulates the mobilisation of different energy sources, ensuring the body is up to the challenge of ‘present’ or ‘upcoming’ threats.[8]
The SNS triggers the catecholamines we mentioned earlier, responsible for increasing your heart and respiratory response. Epinephrine or adrenaline is an example of one of these catecholamines released from the adrenal glands.[9]
As the threat continues, the hypothalamic-pituitary-adrenocortical axis (HPA) axis is activated, releasing cortisol from the adrenal glands allowing the body to stay alert.[10]
In the more acute setting, cortisol sets off a metabolic process that carries on the release of energy ready to be used to continue responding.[11]
Cortisol sustains our response to stress by having a heavy influence on our metabolism
In short-term acute stress, glucose is released into the blood after the catecholamines start signalling the process of converting stored glycogen (the form your body stores glucose).[12] This conversion is mainly so that the energy-intensive brain can have uninhibited access to glucose whenever necessary.
If the stress continues, cortisol then sustains this glucose production process by initiating processes in the liver, muscle, fat tissue and pancreas.[13]
Whilst the adrenaline response kicks off the glucose manufacturing process, cortisol sustains it in two ways. The first is that it decreases glycogen synthesis or the operation of storing glucose in the muscle and fat tissue. After all, why are you going to deposit money in the bank when you need to buy something immediately?
It does this by influencing pancreatic cells that affect the actions of two hormones, glucagon and insulin.
In the liver, cortisol also upregulates a process called gluconeogenesis. This process involves taking amino acids from protein and other non-carbohydrate sources and turning them into glucose. Whilst this mainly happens in the liver, it’s lesser-known that the kidneys and intestines are contributory organs.[14]
Exposing the body to the effects of cortisol over a longer term leaves you at risk of developing stress-induced metabolic disorders such as metabolic syndrome.[15]
One of the things that I hope you are getting from this article is that cortisol’s action in the body allows a coordinated and sustained response to stress.
Hormones are either increased or decreased, multiple organs are activated, and having an endless supply of glucose becomes a high priority.
When my patients think of stress, the connection between the way stress feels in the body and dysfunction in the metabolism isn’t always straightforward.
We often make the connection between stress being an excitatory or sustaining factor. Still, as cortisol’s effect on the body becomes more apparent, maybe it’s easier to see how things can go wrong when the cortisol isn’t allowed to decrease?
From as early as 2003, studies have been looking at stress-induced causes of type-2 diabetes, with elevated cortisol levels playing a central role.[16]
This connection seems to have developed into building relationships between the stress response and metabolic syndrome in the modern-day. A condition that affects up to 25% of the world’s population.[17]
Metabolic syndrome presents with three out of the following five markers appear in a blood test:[18]
- elevated fasting glucose
- elevated triglyceride levels
- low high-density cholesterol (HDL)
- high blood pressure (hypertension)
- waist circumference (as it relates to BMI)
A common trend in the clinic is patients of both genders presenting with these markers at younger intervals. Still, a clearer common denominator, especially in the financial centres such as Hong Kong, New York and London, is a higher sustained level of stress.
But wait, there’s more.
We’ve linked metabolic syndrome and cortisol, as have multiple studies,[19] but another component makes this a more dynamic triad, obesity.
Once again, as this comes together, it’s more evident that the relationship between prolonged high cortisol from stress, obesity and metabolic syndrome is a chicken and egg scenario.[20]
As research unfolds, one of the more interesting ideas around how cortisol influences our metabolisms and obesity, especially central obesity, is its metabolism. Specifically, an enzyme that activates or inactivates it 11ß-hydroxysteroid dehydrogenase type 1. Let’s just call it 11ß-HSD-1.
Whilst more clarity on exactly how this enzyme plays a role, its overexpression leads to higher levels of diabetes type-2 [21] (a progression of metabolic syndrome) and visceral fat (the type of fat that covers your organs).[22]
This enzyme-based connection clears the way to a better understanding of why people with higher cortisol levels have higher levels of central obesity; 11ß-hsd-1 simply keeps the cortisol active, amplifying the metabolic changes we’ve touched on above.
It seems scientists feel that this is just as important with new drugs looking to inhibit the action of this enzyme being researched to influence metabolic syndrome and obesity.[23]
But this isn’t all cortisol does in your body. It also has a significant effect on your immune system.
Cortisol affects your immune system
Most of my patients are familiar with glucocorticoid drugs like cortisone and its use as an anti-inflammatory drug. But if you’re not, then commonly, it’s used to assist people living with allergies, autoimmunity and chronic inflammatory conditions.[24]
One of the ways they help people manage their inflammation is by limiting the access immune cells can have to inflammatory sites.[25]
For those experiencing either an acute or more longstanding inflammatory event, the efficacy of glucocorticoid drugs can be life-changing.
But what if you weren’t looking for that immune suppression?
The strength of immune suppression we get from cortisone as a drug is mimicked by cortisol in the body, often in an unwanted fashion.
Here we find another example of how cortisol can be a friend to most but an enemy in the wrong circumstances.
Suppose you’re living through an unprecedented global pandemic and looking to protect and nurture the effectiveness of your immune system as best as possible. Having elevated levels of cortisol may not help.
In fact, cortisol suppresses nearly all your critical immune cells making it difficult to mount a response when needed.[26]
This dampening of the immune system can hinder your ability to respond to an infection but may also reactivate previous viral infections such as herpes simplex.[27]
Elevated cortisol can slow down your metabolism and immunity and divert energy from your digestive system.
I’ve touched on this before in other articles. It is vital to understand how stress can radiate symptoms into your body, and cortisol is a central figure, even more so if you suffer from irritable bowel syndrome (IBS).
We’ve mentioned one of the beneficial roles that cortisol plays are initiating a process that diverts energy in a way that frees up glucose for the brain. Once again, another place where this can work against us is within the digestive system.
I’ve offered to patients to try and imagine what trying to eat a sandwich would feel like if someone was chasing you with a knife, when your body is in mortal danger, eating, appetite, and digesting fall quickly down the list of priorities.
This change in priorities better represents how elevated cortisol impairs digestive function by simply choosing the send the energy source somewhere.
The cortisol response and epinephrine dry up the saliva in the mouth, dilute the gastric juice (think the hydrochloric acid in your stomach), and inhibit your pancreatic enzyme secretions.[28]
These components are part of the critical north to south journey your food takes through the body. It’s any wonder then that if you are stressed whilst eating that your nutrients can feel as if they aren’t getting to the right place.[29]
In conclusion, cortisol is a perfect example of when relying too much on a good thing ends up working against you.
As I write these articles every week, I’m grateful that I see common themes amongst them.
For example, one of the key themes I hope you’ve picked up in this article is maintaining balance. The way cortisol, and the catecholamines preceding its release in the body, is that they are a terrible thing. But their presence has saved you from hurting yourself or, worse, more times than you can count.
This negative narrative can lead us to believe that we always have problems with cortisol and that the issues of elevated cortisol are always at the heart of our problems. After completing many cortisol exams over the years, I can tell you that it isn’t as frequent as you think.
The cortisol parameters over the day can fluctuate, something that can affect sleep and your insulin response. You rarely see someone with ultra-high levels or ultra-low levels across a whole day (yep, just a morning reading in your blood is not very indicative).
Therefore, if you’ve read this article and want to get started on your cortisol levels, I would look for a practitioner who can help you.
Try looking for a test that can measure urinary cortisol metabolites to understand how your cortisol and cortisone levels are placed.
Remember 11ß-hsd-1? Oh, don’t tell me you’ve forgotten already!
Getting to the core of why your cortisol levels are a problem can be explicitly helped with herbal medicine, but a meditation practice will prove to be a longer-term fix.
Boring!
The easy road lies within pills and potions. Suppose, though, you have caught another theme in this article. In that case, you’ll remember that the amygdala, your brain’s emotional decision-maker, decides on how your body reacts before the cortisol response is activated.
Now there is an evidence base to how meditation can help.
One study trained a small group of people in a Buddhist form of meditation and measured amygdala activity. Over time, the meditation group saw neuroplastic changes in the amygdala structure, which allowed for better processing of negative stimuli than the control group.
The key thing I picked up from this study is that the structural changes they saw in the amygdala allowed for clear improvements in stress reduction in a non-meditative state.[30]
Researchers in the US have built on these studies using functional MRIs measuring changes in amygdala activity and have concluded that eight weeks is the best length of time to see a change for the better.[31]
So there you have it, cortisol is a friend to all but an enemy to some. Now we know that the ferociousness of cortisol’s action in the body can be managed via changing the part of the brain that deems its presence to be an appropriate reaction in the first place.
This action is a real example of treating the cause in its purest form.
Hope it helps!
References
[1] Thau L, Gandhi J, Sharma S. Physiology, Cortisol. [Updated 2021 Sep 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538239/
[2] Kumari M, Badrick E, Chandola T, et al. Cortisol secretion and fatigue: associations in a community based cohort. Psychoneuroendocrinology. 2009;34(10):1476-1485. doi:10.1016/j.psyneuen.2009.05.001
[3] McEwen BS. Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008;583(2-3):174-185. doi:10.1016/j.ejphar.2007.11.071
[4] Rasia-Filho AA, Londero RG, Achaval M. Functional activities of the amygdala: an overview. J Psychiatry Neurosci. 2000;25(1):14-23.
[5] Fowler CH, Bogdan R, Gaffrey MS. Stress-induced cortisol response is associated with right amygdala volume in early childhood. Neurobiol Stress. 2021;14:100329. Published 2021 Apr 22. doi:10.1016/j.ynstr.2021.100329
[6] Rosenkranz JA, Venheim ER, Padival M. Chronic stress causes amygdala hyperexcitability in rodents. Biol Psychiatry. 2010;67(12):1128-1136. doi:10.1016/j.biopsych.2010.02.008
[7] Palmer CP, Metheny HE, Elkind JA, Cohen AS. Diminished amygdala activation and behavioral threat response following traumatic brain injury. Exp Neurol. 2016;277:215-226. doi:10.1016/j.expneurol.2016.01.004
[8] Herman JP, McKlveen JM, Ghosal S, et al. Regulation of the Hypothalamic-Pituitary-Adrenocortical Stress Response. Compr Physiol. 2016;6(2):603-621. Published 2016 Mar 15. doi:10.1002/cphy.c150015
[9] Dalal R, Grujic D. Epinephrine. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 7, 2021.
[10] Thau L, Gandhi J, Sharma S. Physiology, Cortisol. [Updated 2021 Sep 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538239/
[11] Lee DY, Kim E, Choi MH. Technical and clinical aspects of cortisol as a biochemical marker of chronic stress. BMB Rep. 2015;48(4):209-216. doi:10.5483/bmbrep.2015.48.4.275
[12] Lee DY, Kim E, Choi MH. Technical and clinical aspects of cortisol as a biochemical marker of chronic stress. BMB Rep. 2015;48(4):209-216. doi:10.5483/bmbrep.2015.48.4.275
[13] Kuo T, McQueen A, Chen TC, Wang JC. Regulation of Glucose Homeostasis by Glucocorticoids. Adv Exp Med Biol. 2015;872:99-126. doi:10.1007/978-1-4939-2895-8_5
[14] Mithieux G, Gautier-Stein A, Rajas F, Zitoun C. Contribution of intestine and kidney to glucose fluxes in different nutritional states in rat. Comp Biochem Physiol B Biochem Mol Biol. 2006;143(2):195-200. doi:10.1016/j.cbpb.2005.11.007
[15] van der Kooij MA. The impact of chronic stress on energy metabolism. Mol Cell Neurosci. 2020;107:103525. doi:10.1016/j.mcn.2020.103525
[16] Rosmond R. Stress induced disturbances of the HPA axis: a pathway to Type 2 diabetes?. Med Sci Monit. 2003;9(2):RA35-RA39.
[17] Belete, R., Ataro, Z., Abdu, A. et al. Global prevalence of metabolic syndrome among patients with type I diabetes mellitus: a systematic review and meta-analysis. Diabetol Metab Syndr 13, 25 (2021). https://doi.org/10.1186/s13098-021-00641-8
[18] Fahed G, Aoun L, Bou Zerdan M, et al. Metabolic Syndrome: Updates on Pathophysiology and Management in 2021. Int J Mol Sci. 2022;23(2):786. Published 2022 Jan 12. doi:10.3390/ijms23020786
[19] Walker BR. Cortisol–cause and cure for metabolic syndrome?. Diabet Med. 2006;23(12):1281-1288. doi:10.1111/j.1464-5491.2006.01998.x
[20] Cameron AJ, Boyko EJ, Sicree RA, et al. Central obesity as a precursor to the metabolic syndrome in the AusDiab study and Mauritius. Obesity (Silver Spring). 2008;16(12):2707-2716. doi:10.1038/oby.2008.412
[21] Dube S, Norby BJ, Pattan V, Carter RE, Basu A, Basu R. 11β-hydroxysteroid dehydrogenase types 1 and 2 activity in subcutaneous adipose tissue in humans: implications in obesity and diabetes. J Clin Endocrinol Metab. 2015;100(1):E70-E76. doi:10.1210/jc.2014-3017
[22] Li H, Sheng J, Wang J, et al. Selective Inhibition of 11β-Hydroxysteroid Dehydrogenase Type 1 Attenuates High-Fat Diet-Induced Hepatic Steatosis in Mice. Drug Des Devel Ther. 2021;15:2309-2324. Published 2021 May 31. doi:10.2147/DDDT.S285828
[23] Morton, N.M., Obesity and Corticosteroids: 11- Hydroxysteroid Type 1 as a Cause and Therapeutic Target in Metabolic Disease, Molecular and Cellular Endocrinology (2008), doi:10.1016/j.mce.2009.09.024
[24] Kehrl JH, Fauci AS. The clinical use of glucocorticoids. Ann Allergy. 1983;50(1):2-8.
[25] Kehrl JH, Fauci AS. The clinical use of glucocorticoids. Ann Allergy. 1983;50(1):2-8.
[26] Webster Marketon JI, Glaser R. Stress hormones and immune function. Cell Immunol. 2008;252(1-2):16-26. doi:10.1016/j.cellimm.2007.09.006
[27] Ives AM, Bertke AS. Stress Hormones Epinephrine and Corticosterone Selectively Modulate Herpes Simplex Virus 1 (HSV-1) and HSV-2 Productive Infections in Adult Sympathetic, but Not Sensory, Neurons. J Virol. 2017;91(13):e00582-17. Published 2017 Jun 9. doi:10.1128/JVI.00582-17
[28] Cherpak CE. Mindful Eating: A Review Of How The Stress-Digestion-Mindfulness Triad May Modulate And Improve Gastrointestinal And Digestive Function. Integr Med (Encinitas). 2019;18(4):48-53.
[29] Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011;62(6):591-599.
[30] Leung MK, Lau WKW, Chan CCH, Wong SSY, Fung ALC, Lee TMC. Meditation-induced neuroplastic changes in amygdala activity during negative affective processing. Soc Neurosci. 2018;13(3):277-288. doi:10.1080/17470919.2017.1311939
[31] https://news.harvard.edu/gazette/story/2018/04/harvard-researchers-study-how-mindfulness-may-change-the-brain-in-depressed-patients/, viewed 26th March 2022.
