Stress is a ubiquitous word with all sorts of unhealthy connotations. So if you're wondering why do I always feel stressed out, I'm here to shed some light and ask have you ever heard of, or considered the cortisol stress connection?
Firstly, cortisol is a big deal. It's your life-saving hormone and has many critical roles:
- Managing how your body uses carbohydrates, fats, and proteins
- Limiting short-term inflammation through anti-inflammatory mechanisms (after you work out, for example)
- Regulating your blood pressure and immune function
- Increasing your blood sugar (glucose) in fight or flight scenarios, so you have enough energy to deal with immediate threats
- Controlling your sleep / wake cycle by counteracting the hormone melatonin that makes you sleepy, to help you wake up in the morning or stay awake during an emergency.
The cortisol stress connection. An explanation if you're always feeling stressed out
While cortisol is crucial for life, it's best reserved for reasons nature intended. With cortisol being essential for survival and your body’s main stress hormone, it's inevitable that cortisol will take priority over every other hormone in your body.
The cortisol stress connection can be problematic when too much, or too little cortisol is produced on an ongoing basis. It's very likely why you always feel stressed out, and it's therefore why stress management should be high on your priority list.
As a health coach, therapist and functional medicine practitioner I have daily conversations with people who are in a state of chronic stress, and as a consequence can be experiencing a number of symptoms related to the cortisol stress connection.
One of the biggest patterns I’ve noticed in the hundreds of people I’ve worked with is that they are either unaware of the cortisol stress connection, or they don’t realise the full extent stress and a cortisol imbalance can have on their overall health and wellbeing. If you have any questions about the cortisol stress connection or want to find out more about how I may be able to support you, then do get in touch.
In a balanced and healthy body, cortisol serves to provide negative feedback to the HPA-axis (hypothalamic-pituitary-adrenal), telling it the stress-responding chemical has been released and the body can go back to its regulatory, parasympathetic state.
In a “chronically stressed” body there is no shift from the “fight or flight” sympathetic mode back into the “rest and digest” parasympathetic mode. Instead it continues to trigger stress response chemicals while suppressing metabolism and immune regulatory functions.
What triggers a cortisol imbalance?
Stress is part of everyday life. Whether it’s mental or emotional, physical or biochemical the key thing to remember is that the body responds to ALL types of stress in a similar way.
Chronic stressors can show up in different shapes and sizes, and include but are not limited to:
- Emotional stress (e.g. from unhealthy relationships, suppressed emotions)
- Mental fatigue (e.g. from too much work, sleepless nights)
- Inflammation in the body (e.g. from chronic pain or excess weight)
- Biochemical imbalances - such as underlying gut infections, pathogens (like parasites, bacteria or yeast overgrowths), or a hormone imbalance, or a viral infection.
- Unhealthy lifestyle (e.g. poor diet, lack of sleep, lack of exercise) which can be behind or certainly contributing to all of the above stressors.
- Environmental or chemical exposure (e.g. pesticides, pollution, toxic cleaning and skin care products used)
Unhealthy consequences associated with the cortisol stress connection
Chronic stressors can lead to consistently high cortisol stress levels. If not addressed this can cause burnout, fatigue and even chronically low or dysregulated cortisol as time passes.
When cortisol stress levels become unbalanced, there’s no reserves or energy in the body for:
Digestion - too much cortisol can affect your liver function and it’s ability to eliminate toxins, your gut lining, nutrient absorption and gut microbiome balance. All, also contributing to reduced protection against keeping the bad bacteria from dominating your gut ecosystem.
Thyroid function – thyroid hormones ensure that every cell in your body has the energy it needs to function well. Prolonged stress can decrease or lower thyroid function, resulting in sluggish symptoms like fatigue, brain fog, memory loss, weight gain, constipation, hair loss, brittle nails, PMS, low mood, low libido.
Sex hormones – elevated cortisol can disrupt the metabolism of sexual hormones both directly and indirectly. First, by interfering with the way the liver excretes excess circulating hormone and second by interfering with the production and conversion of sexual hormones. All of which can affect fertility, a woman's menstrual cycle and libido.
For example, high cortisol levels can suppress the sex hormone, progesterone in women, which can contribute to estrogen dominance. This can result in PMS, bloating, breast tenderness, heavy/painful periods, and increased risk of fibroids, endometriosis and breast / ovarian cancer.
Immunity – high levels of cortisol can disrupt the body's inflammatory response reducing your defence against dis-ease and infection. A suppressed immune system can lead to more frequent infections, reactivation of old viruses, allergies, inflammation, and even autoimmune conditions.
Brain function – chronic stress can increase brain fog, memory loss, focus, concentration and creativity.
Balancing cortisol levels is further complicated by the fact that cortisol is affected by hypothyroidism, obesity, high estrogen levels, and type 2 diabetes.
Insulin resistance - the stress hormone cortisol is a glucocorticoid, a hormone that produces blood sugar from the liver and reduces sensitivity on insulin receptors. Therefore, cortisol increases blood sugar levels, insulin resistance, and drives body fat storage.
When cortisol stress is chronically elevated, it can drive blood sugar imbalance and weight gain.
Physically, cortisol increases insulin release, which stimulates appetite, especially for carbohydrates or fatty foods, and most commonly affects your abdomen, as those fat cells tend to be more sensitive to cortisol.
These cycles feed each other as increased weight, for example, can raise estrogen, and elevated estrogen can lead to increased weight gain due to binding up thyroid hormone, increasing insulin secretion, loosening gut tight junctions, and decreasing sensitivity to leptin (a hormone that tells us we're satiated after eating).
The resolve - what can you do if you're always feeling stressed out?
Yes, the cortisol stress connection has a lot to answer for. But what can you do if you're always feeling stressed out and concerned that it's impacting your health?
Testing can be done to identify where your cortisol stress levels are, and therefore how to best get them back in to balance.
Tests can most definitely be a helpful way to also evaluate the severity and cause of a cortisol, or other hormone imbalance.
The Cortisol graph
Cortisol is highest from about 6 a.m. to 8 a.m. to help us wake up, and then it declines throughout the day.
As cortisol falls during the evening, melatonin your most potent endogenous antioxidant and sleep hormone rises at a similar rate. The two hormones work inversely, creating a natural sleep-wake rhythm for optimal function.
Both cortisol and melatonin can be tested at different times throughout the day. This provides a more accurate picture of someone's stress response and how it relates to an optimal cortisol curve of highest in the morning and lowest in the evening.
Above is an example result graph to show you how it works in practice. As you can see this person's cortisol stress levels are low on waking, shoot up too high at the 30 - 60 minutes after waking points, and then fall too low in the afternoon, before climbing a bit too much in the evening before bedtime.
This information was of real value to the individual concerned. Not only did it help us evaluate how well their adrenals were functioning, but it also provided other clues to what else might be happening in the body, and additional information to their overall health picture which forms the basis for bespoke nutrition, diet and lifestyle recommendations.
How to test?
We can do adrenal function tests which involve a saliva collection and evaluate measurements of cortisol, DHEA and other adrenal metabolites. This gives a good indication of how your adrenals are functioning, and where they may need some support. Your adrenal glands are where cortisol is produced in the body.
The other popular test is a Dried Urine Test for Comprehensive Hormones (DUTCH) which includes as well as cortisol, DHEA, other adrenal and neurotransmitter metabolites, key hormones like, estrogens, progesterone, testosterone, melatonin and more... The example cortisol graph above was part of a DUTCH test.
Stress management is key
When trying to improve your stress response and lower your cortisol levels, it's imperative to recognise what's making you stressed in the first place and try to get that under control. As already mentioned that could be mental, emotional, physical or biochemical, or a likely combination of more than one of these stressors which is why functional testing can be so helpful.
By far the best thing you can do to prevent the negative effects associated with chronic stress is to actively engage in stress management practices.
There's lots you can do to nip stress in the bud before it takes hold, like eating healthy, taking relaxing baths and getting regular massages. You may also like to check out this breathing technique - The anti-inflammatory breathing technique that reduces stress instantly.
The important thing is to make sure whatever you do works for you.
For information on the effect of stress on sex hormones, go to female hormone health
Hi, I'm an Integrative Nutrition Health Coach, Pain & Stress Management Therapist, and Certified Functional Medicine Practitioner.
I help people elevate their mind and body health by addressing diet, nutrition and lifestyle symptoms. Let's work together to optimize how you feel and function.
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