by Dr Shawn Talbott
Cortisol, also known as cortisone and hydrocortisone, is a hormone which is produced by our adrenal glands when the body is under stress. The role of cortisol in the body is to ensure that our blood is signalling glucose, amino acids and fatty acids to flow out of our tissues and into circulation. A small amount of cortisol for a short period of time is not harmful, in fact it is the normal way that the body handles stressful situations - our heart rate increases, our energy levels rise and our blood pressure is maintained, resulting in emergency strength for us to literally run away from danger.
However, too much cortisol for too long is where we create health problems which include weight gain, osteoporosis, depression, cancer, diabetes and heart disease. Increasingly this is symptomatic of our modern lifestyles in which we have different forms of stress which are ongoing, triggering exactly the same response as in prehistoric times, but without our utilising the emergency strength physically. To make things more complicated, even if we excessively restrict our calorie intake in an effort to lose weight the body responds by increasing cortisol levels because it recognises this calorie restriction as a form of stress.
The best way to describe cortisol is to use cholesterol as an analogy because most people know about cholesterol. We know that our bodies make cholesterol in the liver and that it is used to make membrane structure and hormone metabolism. If you have too much cholesterol it leads to blood vessel and heart problems. The solution is to control it so that it keeps within normal ranges. This is also exactly how we should deal with cortisol.
The way we explain stress and stress response to our medical students is to get them to imagine that they are a zebra. I use this analogy after reading a very interesting book on stress called Why Zebras Don’t Get Ulcers which was written by one of my colleagues at Stanford. It is a terrific overview of what the body does when it is under stress. He has been to Africa to study what puts baboons under psychological stress. For a zebra, stress is created by a lion charging out of the undergrowth. When this happens it creates a stress response which manifests itself as a fight or flight reaction - you run away or you don't run away - but whatever happens your stress response ends after about 60 to 90 seconds.
Our stress comes from chronic situations such as bills, traffic, families and careers - all of these types of things can create the same physiological stress response in the body that the zebra experiences when running away from the lion. Whether we are sitting anxiously in traffic, tapping our foot while waiting in line at the post office or supermarket or mulling over things before we go to bed at night, these are all chronic stressors. It is this stress response which is killing us because this stress response continues and continues and continues unless we short-circuit it.
I call this the 'Type C' personality. Type A is this stereotypical anxious, often angry, executive who is on his way to his first heart attack (or second or third). Type B is the phlegmatic, 'laid-back' surfer type. Type C is pretty much everyone else (think 'C' for cortisol!). You're always frantic, your always running around trying to do several things at once - talking on the phone while you're working on the computer - those kinds of things. People who are not in their heads. The trick here is that we are not meant to harbour chronic stress. As humans who have existed for thousands of years, we are not meant to be undergoing this continual stress.
If you look at a graph showing normal cortisol levels you will see the highest peak as you get out of bed in the morning, getting ready to face the day, and this should drop slowly and steadily throughout the day reaching its lowest level in the middle of the night when we are supposed to be having our deepest sleep. However, when we examined people in the laboratory we found that they not only had the high level when they got up in the morning, but they also had another peak when they had their first crisis of the day, then the level would drop, then another peak - maybe caused by a problem at the office or a difficult meeting - and then the level would drop again. They were getting chronically high levels of cortisol without the steady drop which means that they could not sleep very well. They didn't sleep enough and missed out on sleep’s restorative powers all because their cortisol levels never had the opportunity of lowering sufficiently to allow proper sleep to occur.
The first major symposium on cortisol was held last year where researchers were able to see what could be done about it. This led to my writing my book, The Cortisol Connection: why stress makes you fat and ruins your health. Cortisol is one of the key factors in the international explosion of obesity that we have seen in recent years. It is synthesised in the adrenal glands and goes out into the bloodstream, affecting every single body tissue which has a blood supply - and that means every body tissue. We are now studying what long-term elevated cortisol levels are doing to our health. Cortisol is being talked about now as being one of the emerging health demons. In the 1980s it was cholesterol, in the 1990s it was free radicals and blood sugar. Cortisol is becoming the major health concern of the early 2000s.
The Stress Pandemic
There would not be a single person who would dispute the fact that stress is bad for us. The emerging data over the last five years is showing why and how long-term stress is so bad for us. It is caused by the chronic elevation of cortisol levels. I am going to concentrate on three things - cortisol, appetite and body weight. That is where my interest is particularly strong and which is supported by most of the data which is now emerging.
One of my major studies shows the specific relationship between cortisol secretion and high abdominal fat - it is highly associated with it. The fat that you carry in other parts of your body does not seem to be specifically related to cortisol levels. Also, the abdominal region contains a lot of subcutaneous fat. This is problematic, not only because nobody wants to have a pot belly, but also because it is associated with the cluster of conditions known as Syndrome X. People who show evidence of high cortisol secretion are people who have get more calories from sweets, have a negative self-image, suffer from chronic stress, have stressful things which happen to them throughout the day, or who are sleep deprived. It has been shown that we need eight and a half hours of sleep each night in order to reduce cortisol secretion to normal levels. Anything less will result in increasing levels proportionate to the lack of sleep.
One of the surprising outcomes of our research shows that anyone who is dieting, or who is restricting calories excessively, is also secreting more cortisol. Even if you are thinking excessively about your calorie intake you are also secreting high levels of cortisol. This is not an excuse to forget about diet and eat everything in sight. The moral of the story is that people should not be obsessed much by their diet. Do not restrict your diet - just take a holistic approach to it without inappropriate focus on food.
This makes a lot of evolutionary standpoint. If you starve yourself or you restrict your calories and do not eat as many calories as your body requires to lose weight, your body increases its secretion of cortisol which is a signal for it to do two very important things - eat more and store more. That is why people who have been on a diet gain weight so readily once they stop it. While they are getting calories their body is telling them to eat more and, when they give in to this, they will also store more. Cortisol secretion is a very potent signal to fat cells to store fat and to hold onto it at all costs.
There is also a direct relationship between elevated cortisol levels and inflammation of the blood vessels leading to heart disease. We now know that is one of the contributing factors, along with cholesterol and homocysteine levels in the blood.
What is the solution? Cortisol itself is an energy mechanism which is important, but it needs to be under control - and there is not one single solution for achieving this. It is better for people to choose a regimen of diet, exercise and/or stress control which suits them personally. For instance, stress management in the form of meditation does not suit me. I know that it would be beneficial, but I find it too difficult. Even sitting on a beach on Hamilton Island recently I could not stop myself from thinking, writing and reading. Even though I know that stress management would help me I find it personally easier to simply go for a run, lift some weights or eat a certain way. In my book I encourage people to create their own cortisol-lowering program by choosing from various options. Stress management, exercise and diet are all components of an effective programme. For exercise it should be daily moderate exercise - running, walking or stair-climbing - there are no strict guidelines as to what exercise is involved. The essential thing is that you do it on a regular basis.
Research from the University of Connecticut shows that people who go to any extreme when it comes to dieting, either completely restricting their fat or carbohydrate intake, will increase their cortisol levels. They may lose weight temporarily while they are on the restricted diet, but in the long-term their cortisol levels will rise and they will gain weight slowly over time - and they will gain it around the mid section. I am not advocating calibrated levels of protein or carbohydrates but am advocating a return to a balanced approach to our diet which will bring cortisol levels down to normal ranges. Elevated cortisol levels are a signal to the body to maintain water. Anything more than two cups of coffee a day will push your cortisol levels over the limit by stimulating the central nervous system. The same applies to substances like yohimbe and guarana. In the US they sell substances designed to control appetite in the short term, but these have the long-term effect of stimulating cortisol levels. While there is a short-term weight loss made by people when they start taking them, over time their cortisol levels ensure that they gain weight again. The result is that they rush out and buy another lot of appetite suppressants and the cycle continues.
Another study which was done at the University of Connecticut took a group of people who were told that they were going to be put under a very intense stressful situation. One group was given cortisol control supplements while the other was given a placebo. We looked at their cortisol levels before, during and also measured how fast they recovered after, the stressful situation. We were able to show that anticipatory stress was lower in people taking supplements than in the control group. During the stressful incident the levels of cortisol in the group taking supplements did rise, but not as high as the control group which was taking the placebo. Also the recovery rates were much faster in the supplemented group.
The Main Cortisol Controllers
The most effective nutritional cortisol controllers which I have found in my research are theanine, magnolia bark (from Magnolia officinalis), epimedium (Epimedium brevicornum) and phosphatidylserine (enriched soy lecithin powder).
Theanine is a totally natural substance which is extracted from green tea (Camellia sinensis). When you drink a cup of coffee you get jittery because of the effect of the caffeine. However, when you drink tea the stimulating effect of the caffeine is balanced by the calming effect of the theanine so it has a different effect on your body. You feel energised without feeling jittery. Also you get the benefit of the antioxidant catechins in the tea.
I do not know why substances such as theanine are not used more widely in the West. In Asia you find theanine in everything - in drinks, in chewing gum and so on. People take it all the time. Studies have proved that it is harmless. Even with large doses, the body uses what it needs and discards the rest without causing harm. It does not suppress the body’s reduction of cortisol, which would be a problem if you took too much of it, but sensitises it to the effects of cortisol. This is better than trying to suppress cortisol synthesis altogether. To get an effective dose of theanine (between 50 and 70 g) you would need to drink four cups of green tea per day.
Magnolia bark is a traditional Chinese medicine used since 100 AD. It contains the active compounds, magnolol and honokiol, which are strong cortisol controllers. Epimedium is a medicinal herb whose use dates back to 400 AD. Its active ingredient is icariin. Phosphatidylserine is a phospholipid which is a basic structural component of human cell membranes. It is thought to play roles in muscle metabolism and immune system functions, as well as being involved in brain activity. Phosphatidylserine is concentrated in the brain cells and is thought to be related to brain cell function. It has been shown to effectively modulate levels of cortisol secretion.
While valerian, melatonin and tyrosine are also excellent relaxants which can be used safely, none is as effective in controlling cortisol secretions as theanine, magnolia bark, epimedium and phosphatidylserine.
Cortisol and Stress Management
I am a nutritional biochemist. When I look at cortisol I look at the biochemical effects of cortisol and the biochemical ways of containing it. This is why I confine my research to the benefits of exercise, nutrition and supplementation. A good friend of mine, Alyssa Eppel, who is a psychologist has taken a different approach by treating elevated cortisol through stress management. She had the idea that, if cortisol increases abdominal fat as a result of stress, could stress management alone lower cortisol and therefore body fat levels? This is exactly what she showed in her study. With her purely stress management approach, which does not include either diet or exercise, she was able to show a reduction of one and a half percent in abdominal fat over a three month period. While this may not sound much, it is really a significant reduction in so far as abdominal fat is concerned. It could mean the difference between being on medicine for high blood pressure, insulin and/or hypoglycaemic medication, or not. This was sufficient proof to show that the mind and body do interact and that they are not separate entities as is commonly believed.
Cortisol is a major health concern, but as we gain more understanding of how to control it, it will lead to a society better able to deal with the ongoing stresses of modern life.
Cortitirol, produced by Pharmanex.
Dr Shawn Talbott, PhD, is an adjunct assistant in the Department of Nutrition at the University of Utah, USA. He is the author of the book, The Cortisol Connection.
Copyright © by The Australian Vegetarian Society All Right Reserved.