Wednesday, December 09, 2009

The Role of the stress hormone cortisol: in maintaining vitality and wellness

The Role of the stress hormone cortisol: in maintaining vitality and wellness

By Alex Berks  L. Ac
Director of Chinese Medicine Oncology

Cortisol is known as the "stress" hormone.  It is produced in the adrenal gland and controlled through a feedback mechanism (hypothalamic-pituitary-adrenal axis) between the brain and the adrenal gland located above the kidney. Research has shown that abnormal cortisol levels effect a broad array of physiologic changes from mood instability, to immuno-suppression, sugar cravings and even cancer development.(1) (2) (3). This can be caused by prolonged emotional and physical stress as well as infection, inflammation or oxidation.  Prescription steroids, for their anti-inflammatory and immunosuppresive properties, can also significantly impact cortisol (and a whole lot more!).  To treat a stress hormone imbalance, whether with a disease like cancer or in a condition like insomnia, the basic principles of lifestyle management, diet and appropriate activity and rest remain the same.  Depending on the severity and complexity of the condition additional supplementation may be needed.  Regulating cortisol levels is not only a way to get a better night's sleep but also a way to promote vitality and wellness. 

Normal Stress Responses

Elevated cortisol is a natural response to fear and emotional stress. Its purpose is to provide:

  • A quick burst of energy
  • Heightened memory functions
  • A burst of increased immunity
  • Lower sensitivity to pain
  • Helps maintain homeostasis in the body
  • Anti-inflammatory (4) 
This stress response has important survival functions. 
Diurnal Cortisol Rhythm

The red line represents cortisol or stress hormone release. The blue line represents melatonin and growth and repair hormones. (5)

Normal cortisol should be highest in the morning and taper off as the day progresses reaching its lowest level 3-5 hours after falling asleep. 

Dysregulated Cortisol
When cortisol levels chronically shift from a normal diurnal pattern symptoms begin.  If the pattern is low in the morning and getting lower throughout the day, the patient will present with chronic fatigue symptoms.  However before one gets to that severe level of energy deficiency one experiences more mild dysregulations of cortisol rhythmns.   For example, if breakfast is skipped, the brain needs to mobilize the stored form of sugar (glycogen) for its energy by elevating cortisol.   Some people are very sensitive to this hypoglycemic rise in cortisol.  Symptomatically, they often present with lack of focus, food cravings, and irritability.  This situation of hypoglycemia can also occur if one exercises too hard and does not replenish frquently.  Chronic psychological stress such as worry, fear and anger can also shift the normal pattern so that there are peaks of cortisol in the evening leading to insomnia, salt or sweet cravings and weight gain around the middle. 

The negative effects of chronically elevated cortisol are numerous: 
  • Impaired cognitive performance
  • Depression
  • Suppressed thyroid function
  • Blood sugar imbalances
  • Decreased bone density
  • Decrease in muscle tissue
  • Bloating and gas, possibly constipation
  • Higher blood pressure
  • Lowered immunity and inflammatory responses in the body, slowed wound healing
  • Increased abdominal fat, which is associated with a greater amount of health problems than fat deposited in other areas of the body. Some of the health problems associated with increased stomach fat are heart attacks, strokes(6), (7), (8)
Karen (not her real name) came to my office complaining of fatigue, inability to lose weight, muscle aches, bloating with meals, constipation and hair loss.  She had been on thyroid hormone replacement therapy for 4 years from a diagnosis of Hashimoto's Thyroiditis and was taking anti-depressants.   She is a 38 year old single female who exercises daily and intensely, works long hours and often sleeps about 6 hours per night, yet still gets up to work out hard daily. She is fastidious and educated about her diet, weighing her food and sticking to a low calorie diet.  She reports drinking 1 cup of coffee in the morning to help her go to the bathroom. 

Concerned that her hair was falling out,  she went to her MD who ran blood tests and thought she might have Cushing's Syndrome, an autoimmune failure of the adrenal gland. Two endocrinologists later she was eventually diagnosed as having exercise induced hormonal fluctuations.  After all the fear of a serious disease like Cushing's had passed and her MD increased the dosage of her thyroid medication, she still felt fatigued, constipated and that she couldn't lose weight.  Her thyroid was stable but her C-reactive Protein, a marker of inflammation, was elevated. 

Diagnosing her with Chronic elevated cortisol leading to adrenal fatigue,  I put her on a comprehensive supplement regimen to regulate her adrenal glands and control her insomnia as  away to restore her vitality and wellness.
Early Morning
Before Exercise Smoothie
After Exercise
Armour Thyroid
Rx. Medication
whey Proten
Wellbutrin RX. Medication (1:00)

Magnesium, potassium, Ca powder2

Adrenotone Plus™ 4

Armour Thyroid 
Rx. Medication (3:00)
Adrenotone Plus™ 

carbohydrate for energy ie... Orange Juice, or agave syrup
Adrenacalm cream™5


Detox Antiox™6

Adrenacalm cream™

Vitamin C

Larger Meal with some fat and protein

After 1 month on this regimen Karen reported that she was sleeping better and lost 6lbs. doing the same amount of activity, was eating more and her aches and pains bloating and constipation had resolved. 

The morning regimen is designed to give her a base of high quality protein (whey) with minerals and vitamins and phytonutrients in a green powder made into a smoothie with a small amount of a carbohydrate so that she will have energy to burn during her workout.  D-Ribose, can also be added to improve aerobic performance. 

Karen was exercising too hard and not getting enough rest.  Her adrenal glands, I reasoned, were in a chronic alarm state.  To rebalance her I focused on reducing her elevated cortisol after exercise and in the evening. Post exercise, cortisol can remain elevated for an extended time especially if one exercises hard or does not eat sufficiently for the level of activity.  Additionally, exercising  causes oxidation as it is an increase in cellular activity.   This is why I recommended the formula Detox Antiox™.  The post-exercise supplementation and meal allowed Karen to reduce hypoglycemic inducement of cortisol.  Inflammatone™ is a natural anti-inflammatory containing herbs and proteolytic enzymes.  Her CRP being elevated is a sign of the oxidative and inflammatory pressure she is under.  Vitamin C, Magnesium and potassium are all excreted by elevated cortisol levels and are useful to replenish a stressed adrenal gland. (9)

I treated the insomnia as elevated evening cortisol due to the fact that she works late and was probably over-stimulated in the evening.  Karen was on her way to chronic fatigue if she did not do something about it.  Now she is able to restore herself better and get a good night's sleep. 

It is important to understand that elevated cortisol levels are not Karen's primary problem.  Elevated cortisol is always secondary to another process - unsustaining lifestyle habits or physiological problems. Therefore to treat the cortisol problem one must get at the root to rebalance the body and mind.  Then with the proper lifestyle changes and supplementation the body can restore itself.  Each person is unique.  Some people will present with more hyperactivity and others with more fatigue.  Others will combine an energy imbalance with digestive disturbances such as sugar/saltcravings, bloating, gas and constipation others will present with more anxiety, depression and insomnia, still others will have frequent colds.   They can all have the same root.

Nearly all of us have stress hormone imbalances caused by age-related hormone changes starting in our mid 30's or younger if significantly out of balance.  Lifestyle stresses, inflammation, infections and oxidation also contribute to the aging process.  In other words if we do not attend to our cortisol balance than the aging process can be accelerated. 

Asking The Right Question To Get On Track

What part of your life do you need to modify to maintain a grounded connection to your needs?
  • Do you eat sugary or "comfort foods" to calm yourself down?
  • Do you skip meals in an effort to lose weight?
  • What is the role of coffee and other stimulating drinks and foods?
  • What is the role that anxiety plays in your life?
  • Is there a emotional cause to your insomnia?
  • Are you too tired to exercise?  or do you feel excessively depleted after exercise?
  • Does stress affect your digestion?
In a future article I will discuss the literature on cortisol as it relates to cancer. 

1 -  Sephton et. al. oxfourd journals Journal of the National Cancer Institute 2000 92(12):994-1000 Diurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival
2 -  Cortisol and Stress: How to Stay Healthy
3 -  How Sleep Affects Cancer Poor Sleep Alters Hormones That Influence Cancer Cells
5 -  Sleep and Your Circadian Rhythm
6 -  Adrenal Weakness
7 -  Cortisol and Stress: How to Stay Healthy
8 -  How Sleep Affects Cancer Poor Sleep Alters Hormones That Influence Cancer Cells
9 -  Adrenal Weakness

The information contained in this article is for informational purposes.  it is not intended to diagnose, cure or prevent disease.  If you are having a medical problem please consult a qualified health care practitioner for your needs. 

For more information about Alex Berks L. Ac., FABORM go to


1 Inflammatone is a combination of herbs, nutrients and proteolytic enzymes for promoting the breakdown of inflammatory proteins like kinins and fibrin and for healing damaged tissue. The herbs in Inflammatone provide protection from free radicals and are safe to use in high doses. This formula is extremely effective, as a natural antiinflammatory and alternative to NSAID medication.

2 A magnesium-potassium- calcium formulation. formulated with 3 parts magnesium to 2 parts calcium, which will prevent a surplus of calcium robbing the body's vital magnesium supply and avoid the symptoms associated with depleted levels of magnesium. This superior formulation includes potassium, boron and vitamin D for better absorption of these key minerals, building strong bones, regulating hormones 

3 PaleoGreens is a greens food powder made with over 85% organic ingredients. The vegetable, fruit, and berry ingredients are brightly colored and non-oxidized, as the powders are protected from heat, UV light and moisture from start to finish. These greens have a paleo profile; they contain no grains, legumes, alfalfa, corn, gluten, fructose or artifi cial sweeteners.

4 Adrenotone Plus is a combination of standardized herbs and nutrients which are known for rejuvenating the adrenals. This product is designed to balance cortisol levels, promote healthy hypothalamic and pituitary function (HPTA axis), and replenish depleted catecholamines (dopamine, norepinephrine, and epinephrine). This product does not contain glandulars.

5 AdrenaCalm is a gentle, soothing cream that contains herbs and nutrients to support the management of adrenals. This broad spectrum cream contains phosphatidyserine and key B vitamins.

phosphatidylserine modulates and blunts the neuroendocrine response to stress.

6 Detox Antiox synergistically combines many nutrients that have a positive effect on the immune system. This formula contains multiple ingredients known to raise glutathione levels making it helpful for supporting phase II liver detoxification. It also combats free radicals and helps detoxify harmful chemicals including heavy metals. L-Leucine when taken with NAC prevents mercury from being reabsorbed into the central nervous system. It is designed to aid the production of metallothionein. The vitamin E is 60% gamma, mixed tocopherols. Lipoic acid regenerates vitamins E and C and supplies sulfur for detoxification. Two capsules daily of this powerful formula also provides the well-researched antioxidants green tea, grape seed extract and curcumin.