What is cortisol?
Cortisol is a hormone produced by the adrenal glands in each kidney. Cortisol is released from the adrenal glands in a rhythmic pattern throughout the day as part of the body’s circadian rhythm. Cortisol generally is highest in the morning to help energize you for the day ahead, and lowest during the night when you should be resting, rejuvenating and enjoying the benefits of a restorative night’s sleep.
The release of cortisol is regulated by the pituitary gland in the brain and is activated during times of internal and external stress. Cortisol helps activate, protect and defend the body when the body is under attack e.g. internal inflammation and external stressors. The protective effects of cortisol however can also occur at the expense of other functions in the body, especially when cortisol levels remain elevated over prolonged periods e.g. as a result of chronic stress. Daily stress management can help protect against the adverse effects of prolonged elevated cortisol levels, but first …..
What are the beneficial effects of cortisol?
When it comes to internal inflammation, the effect of cortisol is to help “contain” and “control” inflammation, which is why cortisol-like drugs (corticosteroids) are often prescribed in the treatment of inflammatory conditions such as asthma, ulcerative colitis, lupus and some forms of arthritis.
Corticosteroids are also prescribed in the treatment or management of cancer – particularly cancers related to the immune system, such as leukaemia and lymphoma (to suppress an over-active immune system) and during organ transplants (to inhibit the body's immune response so that a transplanted organ is not rejected); and in the treatment of Addison's disease (an autoimmune disorder that stops the adrenal glands from making sufficient hormones, including cortisol).
Prolonged use of high dose inhaled corticosteroids and oral corticosteroids can however have the following effects:
- Immunosuppression and increased susceptibility to infections;
- Growth suppression;
- Hyperglycaemia (high blood sugar) and diabetes;
- Oedema (fluid retention), increased blood pressure and hypertension (high blood pressure);
- Osteoporosis (thinning of the bones) leading to bone fractures, particularly in the spine, kyphosis (hunching of upper back), loss of height and severe back pain;
- Build-up of fat around the face, chest and abdomen;
- Skin thinning, susceptibility to bruising and muscle wasting (including weakness of inspiratory breathing muscles, which is why inspiratory muscle training (IMT) can be beneficial for asthma patients on long-term corticosteroids).
Taking corticosteroids disrupts the body’s natural cortisol production. This can result in cortisol insufficiency when a person discontinues taking corticosteroids, especially if the dosage is high. Symptoms of cortisol insufficiency can include: fatigue, nausea, vomiting, hypotension (low blood pressure), hypoglycaemia (low blood sugar), shock and coma.
Cortisol insufficiency can also develop as a result of adrenal gland exhaustion due to chronic stress. So, let’s take a closer look at the stress response, the role of cortisol, and the effect of chronic stress.
What is the stress response?
The “stress response” in the human body is designed to protect us from an immediate physical threat by preparing our whole body (and mind) to “fight or flee” to save ourselves! It is a well-designed mechanism for that purpose however it can also be activated by a plethora of modern-day stressors ranging from work demands to health issues, family commitments, financial worries, relationship challenges and much more. Most modern day stressors do not necessitate that we fight or flee to save ourselves but they nonetheless activate the stress response, which gears up the body biochemically and physiologically to take physical action.
Stress response stage 1:
When the stress response is activated, the first stage is dominated by the stress hormone adrenalin. This has an immediate effect on, among other things, heart rate and breathing patterns by increasing heart rate and cardiac output, dilating the airways and increasing breathing volume/rate to increase ventilation of the lungs, in anticipation of increased metabolic demand arising from physical activity. The first problem is that when the stress response is activated in the absence of physical activity this creates a mis-match between the body’s biochemical and physiological response and the body’s actual needs. This can lead to symptoms of hyperventilation, which include:
- Short of breath/breathlessness, unable to breathe deeply/difficulty breathing;
- Muscle tension and tightness in the chest, numbness, pins and needles, tetany;
- Light-headedness, dizziness, confusion or a sense of losing normal contact with surroundings;
- Personality changes, feeling anxious, hyper-aroused, can’t calm down, anxiety;
- Reduced cognitive function, poor concentration and focus;
- Angina, heart palpitations, cardiac arrhythmias, tachycardia.
Not all people experience symptoms of hyperventilation but if stress remains prolonged, the body nonetheless enters stage 2 of the stress response.
Stress response stage 2:
Stage 2 of the stress response is dominated by the stress hormone cortisol. Cortisol helps break down fat and protein for conversion into glucose. This is called gluconeogenesis and is designed to help fuel the body’s metabolic activities with the provision of glucose, which is also essential for brain function. Gluconeogenesis is perfectly natural and indeed essential during times of famine (when the body is being starved of nutrition) however in those extreme cases it can also lead to the breakdown of all structural tissue in the body including muscle, bone, skin, and brain tissue, causing accelerated aging. This occurs at the extreme end of the spectrum; so what are some of the more immediate effects of gluconeogenesis and cortisol?
Gluconeogenesis also inhibits protein synthesis to enable amino acids to be available for conversion to glucose. The inhibition of protein synthesis can compromise the immune system, which depends on proteins such as antibodies to protect the body. When stress is prolonged and cortisol levels remain high, the immune system becomes depressed (it does not work properly) and a person can become more vulnerable to infections and some forms of cancer.
Elevated cortisol levels can also lead to “hormone resistance”, which means cellular receptors in the body become less responsive to ALL hormones including insulin, thyroid, progesterone, oestrogen, testosterone and even cortisol itself. This can lead to elevated blood sugar levels, diabetes, weight gain, fertility problems and fatigue.
Cortisol also interferes with mineral absorption in the gut, including calcium and magnesium, which are required to build bones. Osteoporosis and bone fractures, especially of the spine, can occur as a result of prolonged elevated cortisol levels.
Taking supplementation to address hormonal and nutritional imbalances can be of limited assistance if cortisol levels remain elevated. This is because elevated cortisol levels inhibit nutrient absorption and create cellular resistance to hormones (including supplemental nutrients and hormones). This means you may be taking all of the right supplements but may not derive benefits from them if cortisol levels remain high. It is a known fact that medication and vaccines are also less effective during episodes of stress and elevated cortisol levels.
Elevated cortisol levels at night can also interfere with sleep patterns (causing insomnia). However, taking supplemental melatonin (to encourage better sleeping patterns) may be of limited benefit unless the underlying cause of stress and elevated cortisol levels is addressed as well.
If prolonged stress continues unabated, the adrenal cortex, which produces cortisol, eventually becomes exhausted and stops producing cortisol, leading symptoms of cortisol insufficiency, which include fatigue and exhaustion.
Cortisol plays an important role in the body’s 24-hour cycle and when defending the body during periods of acute stress (e.g. internal inflammation and external physical threats). This is normal and natural however when stress becomes chronic and cortisol levels remain elevated for prolonged periods, cortisol can compromise the optimal functionality of the body as a whole, inhibiting protein synthesis, suppressing the immune system, creating hormone resistance (including insulin-resistance and thyroid-resistance), diabetes, weight gain, insomnia, poor nutrient absorption, skin thinning, muscle wasting, osteoporosis, fatigue and exhaustion.
What can we do about stress?
Daily stress management helps attenuate the effects of stress. Research shows that certain breathing techniques, conscious relaxation, stretching, yoga and meditation techniques help manage stress and reduce stress hormones adrenalin and cortisol. This will be addressed in more detail in the next Newsletter from The Breathing Clinic.
Other lifestyle considerations include seeking counselling to explore psychological/emotional stressors; seeking advice on diet and nutrition to support your body’s metabolic needs; and enjoying moderate exercise, which also helps optimise lung capacity and improve the metabolic efficiency of the body as a whole. Exercise can be an excellent outlet for stress however it is important to bear in mind that physical exercise also stimulates the sympathetic nervous system (adrenalin and cortisol) therefore care should be taken to choose exercise that is beneficial for your body and does not promote or perpetuate adrenal exhaustion. The type/intensity/duration of exercise that may be appropriate for one person may not be appropriate for another, so honour your body.
Seeking advice from your GP regarding cortisol and other hormonal testing as well as the diagnosis and treatment of any co-existing medical conditions is recommended as part of a comprehensive stress management regime.
If you have any questions about this subject in general or the benefit of breathing techniques, stretching, relaxation, yoga and meditation to help manage stress, please ask! You can email me at The Breathing Clinic or call 0488 040 242.