Is cortisol contributing to your metabolic problems?

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell, and this week’s topic we are discussing is cortisol contributing to your metabolic problems. So we are going to dig into this topic. So one, you can understand the connection between why managing your stress is so important and how it really impacts your metabolism when it comes to maintaining a healthy weight. And this can be for anyone, not just bariatric patients, but this is just normal physiology and the connections of what occurs when we are excessively stressed.

Dawn (00:51):

So I’m sure many of us have felt like that stress is really influencing our body in a negative way, but you maybe don’t really understand the impact and the connection between so many pieces of health and stress is kind of an element of life that we can’t avoid. We’re we’re not going to escape stress, but you’ve heard me say it before, that we can’t control the stress we are given, but we can control how we react.

Dawn (01:28):

And this is where this practice of stress management is a key piece in managing your metabolic health and correcting metabolic problems. Cortisol is just the body’s main stress hormone and it truly is essential for survival. And cortisol is something that your adrenal glands produce in response to stress along with adrenaline. So your adrenals produce cortisol and adrenaline. Cortisol is really just your body’s way of responding to danger. And when it recognizes a threat,

What is cortisol, and what does it do?

Dawn (02:12):

whether it’s real or just perceived, your body releases cortisol and it prepares your body for that fight or flight response. So how does cortisol connect to metabolism? When you’re under stressful conditions, your nervous system receives messages from the cortisol telling it to release glucose from your liver so that you have energy to fight off the threat or you have energy to run or you have energy to think and just energy to be prepared to survive this threat.

Dawn (02:56):

t also increases your heart rate to kind of support your organs with adequate blood supply, but anything not related to kind of survival is slowed down, which is like your digestion. So is cortisol good or bad? And if you think about it, we need cortisol to survive because we need our body to respond when there is a threat. So if we need to kick in our fight or flight response, then we need our body to respond appropriately. So it’s a necessary part of human existence. It’s not bad in that aspect.

Is cortisol good and bad?

Dawn (03:43):

It only turns to a bad response when it just chronically continues. So we’re not supposed to be chased by bears all the time, so that isn’t how our bodies are intended to survive. So how is cortisol connected to insulin and blood glucose in the body? Cortisol and insulin regulate your blood glucose levels.

Dawn (04:11):

Insulin is responsible for directing glucose into your cells, kind of unlocking your cells and allowing it to enter the cells. So without insulin, that’s why type one diabetics need insulin because they don’t have that ability to get energy into the cells or get glucose into the cells, then this glucose is converted into energy that the body can use to perform its necessary functions. So these are things that you want to do and then things that you don’t have to even think about,

Dawn (04:47):

hat’s like breathing your heart, beating your intestines to digest and metabolize all the foods and nutrients that you consume. So those types of things, that’s you need energy to exist. So if you can’t get the glucose into your cells, then you’re not going to have any energy and you’re going to feel super tired because insulin isn’t there to get it into the cells.

How is cortisol connected to insulin and blood glucose?

Dawn (05:14):

So then it’s just circulating, which is bad. Additionally, insulin also works to store glucose in the liver for later use. And when cortisol levels rise during stress, so a stressful event occurs, your body detects stress. So cortisol rises and this triggers the release of glucose from the liver. So that means your liver is dumping the glucose, which is, we call it glycogen because that’s your stored glucose. And what this does is it increases your blood sugar. So this is, so you have the energy, so your body is so intuitive, it knows that hey, A has occurred and we need energy.

Dawn (06:00):

So it’s going to now convert to the liver. It’s relying on the liver to send us a surge of glucose so that it prepares our body for fight or flight. And it does not take into account what’s already in the blood. So you could already have elevated blood glucose levels, so your blood sugar’s high already, and then you have this stress response whether again, real or perceived and more glucose is released into the blood.

Dawn (06:36):

So you can kind of see where this problem occurs. So your cortisol levels rise, this triggers your liver to release glucose, puts more glucose in your bloodstream so that you have immediate energy and this causes your blood sugar to increase. And in response, your pancreas produces more insulin. And this is to restore the levels to normal. So your insulin is supposed to take that extra glucose and put it into the cells because they work together. And this process is necessary to kind of prevent that hyperglycemia or high blood sugars because this essentially can then cause inflammation and other metabolic issues.

Too much stress causes metabolic havoc.

Dawn (07:29):

And these shifts aren’t overall bad when it’s a short term thing, it’s when it is chronically occurring and your body kind of lives in fight or flight or it maybe gets stuck in that response and now you have elevated blood glucose, you have elevated insulin, and then your insulin just quits responding to all that excess glucose that’s in the bloodstream and now you’re not getting energy into the cells and you feel super tired and you just don’t have energy to work all day, work out and do all the meal prepping you need.

Dawn (08:18):

So it gets you in this vicious cycle of, okay, I sleep until the very last second, I get ready, go to work as quickly as I can, get to work barely on time, and then kind of drag yourself through the day. And your energy crashes really in the afternoon especially. And then you drag yourself home to not really feel like cooking. So you end up at the drive-through or popping in a pizza or ordering something and you get stuck. You get stuck in this cycle, which if you go back and you look at the big picture, it is the stress that is driving it or that elevated cortisol that just doesn’t ever lower long enough to recover anything do.

Elevated Cortisol Can Cause High Blood Glucose Levels (Hyperglycemia)

Dawn (09:14):

You can see that too much stress can create this metabolic havoc that can occur. And you have elevated cortisol which leads to a high blood glucose level, which then kind of shuffles through an elevated insulin that again, as it continues on for hours and days and weeks and months that you kind of stay in this response, that’s when you create insulin resistance and your cells just no longer are going to respond to all of that excess sugar.

Hyperglycemia and inflammation

Dawn (09:56):

And as a result of chronic exposure to cortisol, your cells are unable to utilize the glucose efficiently resulting in the insulin resistance. And as a result of cortisol and growth, hormone fat and muscle cells become less insulin sensitive, making the body less able to control glucose resulting in hyperglycemia. So now you have on your fasting blood work that your glucose is elevated and like I’ve talked about before, insulin probably has not been checked. Hopefully your doctor is on it. If not, request it, request a fasting insulin level so you kind of get a picture of where you are with your insulin. You definitely want it lower than 10.

Dawn (10:45):

Optimal levels are two to five, anything getting over that seven starts creeping into blood sugar issues. So you’re going to start noticing blood sugar issues once it gets in closer to that seven range. And for me personally, even in the six, I started noticing changes with my blood glucose in the 6’s. So again, it’s just a progression and I’ve talked about this before, how this is a natural process of menopause. So some of these things are occurring without you really changing a whole lot in your life.

Dawn (11:21):

So if you feel like, hey, I’m experiencing these problems and these symptoms and I really haven’t changed a lot, so what has happened? What is causing this? And you really could look at this whole cortisol insulin glucose connection and it being a contributor to why you are experiencing this. So now something to take note of is that high glucose levels can damage blood vessels and organs causing complications like heart disease, kidney disease, inflammation, and nerve damage, which all of you have probably heard this before.

Dawn (12:08):

mean you think about when, if you’ve ever been diagnosed with type two diabetes, they talk about diabetic neuropathy, they talk about kidney disease that could lead to dialysis or a kidney transplant. And heart disease is definitely something that ranks at the top that a lot of people are already aware and understand. The connection with a research study published in diabetes care stated that cortisol levels are significantly higher in people with type two diabetes than those without diabetes.

Elevated cortisol levels contribute to the development of insulin resistance and type two diabetes.

Dawn (12:44):

And the study suggests that chronic stress and elevated cortisol levels contribute to the development of insulin resistance and type two diabetes. So if you are already there and you’ve not evaluated your cortisol, this is something that you need to at least have a discussion with your physician and start the process in monitoring this. And you can do just morning fasting cortisol, it’s a snapshot, it’s not a perfect blood work, it’s not a perfect indicator, but it is information, it’s feedback into what you are experiencing that you may not even be aware of it.

Dawn (13:30):

And personally I can say that sometimes I have no awareness that my stress levels are elevated. I don’t feel those at times, but yet my blood work will tell me. And I know I’ve talked about my continuous glucose monitor, the cgm, and I can definitely tell you that is a big driver of some of my high and low blood sugars that are occurring. So that is definitely something that you have to kind of vet out. And a CGM is a really easy affordable way to evaluate that to find out what is your blood sugar doing all the time.

Dawn (14:17):

And if you’re like, okay, my food is not the problem. I’m not making poor food choices the majority of the time, but yet my blood sugar is staying elevated, I have pre-diabetes, what is driving this? One of these drivers could be your cortisol. So that’s why it’s important to consider like a CGM because that would allow you to rule that out. So a CGM could help you rule out a few different things because

Dawn (14:50):

you can notice things with sleep and then also with stress. So it kind of helps you highlight the areas that you need to work on first based on how your body is responding. Now what about a high blood sugar and inflammation? Inflammation is one of the mechanisms where high blood sugar damages organs and the immune system responds to infections, injuries, or foreign invaders during inflammation. And with chronic inflammation, however, can result in tissue damage and dysfunction.

Dawn (15:28):

So the key is that you don’t have these elevated blood glucose levels for extended periods of time because it creates inflammation and tissue damage where it has to do with your kidneys and your nerve endings and just that whole picture of your cardiac health, your renal health, and then your nerve endings. Studies have shown that high blood glucose levels can activate various inflammatory pathways in the body such as the NF kappa B, the advanced glycation in products or AGES, and the oxidative stress pathway.

Stress Can Trigger Overeating, Especially for High Sugar & Carb Snacks

Dawn (16:17):

These pathways can produce pro-inflammatory cytokines. When these cytokines are released, they attract immune cells to the site of the inflammation only amplifying the inflammatory response. Now how can stress trigger overeating, especially for those high sugary car snacks? Stress can cause overeating especially of those high sugar, high carb snacks, which then further compounds the problem of a high blood glucose level One study found that women who experience stress tend to eat more high fat, high sugar foods.

Dawn (16:57):

Additionally, they find that eating sugary foods can cause a dysregulated cortisol response making it harder for individuals to handle stress. Another study published in diabetes titled Metabolic syndrome and obesity targets in therapy found that chronic stress can lead to dysregulated cortisol response, which can cause an increase in appetite for high sugar and high carb snacks. In turn, this leads to high glucose spikes and dips causing overeating and metabolic problems.

Dawn (17:33):

Now, there are several reasons why stress can lead to overeating of the high sugary carby snacks. One, it can lead to emotional eating where individuals can turn to food to cope with or to feel better after dealing with negative emotions or for some people even positive emotions. And these high sugar and carb snacks can provide a temporary sense of comfort and pleasure leading to a desire to consume more of these foods. Then secondly, the stress can affect appetite hormones such as graylin and leptin, which can increase hunger and decrease satiety.

Reasons how stress causes sugary foods overeating

Dawn (18:17):

And this can result in individuals feeling more hungry and less satisfied after eating, leading to a desire to consume more food, especially the higher sugar and carb snacks. And lastly, the stress can also affect the brain’s reward centers leading to an increased desire for highly palatable foods such as the high sugar and high carbohydrate foods.

Dawn (18:40):

And these foods provide a sense of pleasure and reward. This is where dopamine is kicking in. You get that dopamine response and that reward that you ate that food. And so your brain likes patterns and it likes to remember and be efficient. And when you do that enough times, especially in a routine, so maybe in the afternoon you get a snack and it’s something sweet, then it kind of triggers this habit that because your body wants that dopamine fix or

Dawn (19:21):

that dopamine hit to kind of boost maybe a low mood or a low energy because of everything that’s occurring metabolically. Now what about stress and sleep? We have talked about how big of a deal that two to 4:00 AM wake up can be and that your blood sugar and cortisol are a piece of this. And it could be that you’re just having issues with your cortisol levels or blood sugar or both.

Dawn (19:56):

So that’s where a CGM really does help with this because it can help you identify any low blood sugars that you maybe were not aware of. But if it’s cortisol, usually when it wakes you up, you just cannot fall back asleep. And remember, menopause increases cortisol. So again, you’ve you transition into this and it gets you in this phase where you are finding yourself wide awake and you can’t go back to sleep.

Stress Can Disrupt Sleep, Causing That 2-4:00 AM Wake-Up

Dawn (20:27):

So that’s where you have to kind of enlist different strategies and different ways to help support your blood sugar balance so that you are eating appropriately during the day, maybe adding a bedtime snack if necessary so that you can help maintain stable blood sugars all day long, which is super important to do. And according to the National Sleep Foundation, stress related insomnia can occur due to the release of cortisol during the body stress response.

Dawn (20:59):

And this may lead to a person waking up at night and having difficulty falling back asleep again. So let’s kind of just take a closer look at kind of this process with your sleep wake cycles or your circadian rhythm and how cortisol plays a role in this. You have increased corti cortisol levels. So stress you have the stress activates the body stress response, which includes the release of cortisol. Then an elevated cortisol level can disrupt sleep patterns and interfere with your sleep wake cycle.

Dawn (21:33):

Specifically cortisol levels naturally rise early mornings and which can cause individuals to wake up between the two and 4:00 AM and having difficulty to fall back asleep. So you don’t want that cortisol to rise at two to 4:00 AM you want it to be more at a more natural time depending on your lifestyle. And your work or your tasks that you have to do for the day. Would be dependent on maybe 5:00 AM or 6:00 AM or seven.

Dawn (22:06):

It just depends on your schedule as to when you need to wake up. But definitely two to 4:00 AM is not ideal for most people to wake up and be awake for the day. One study found that stress can increase the activity of the HPA access leading. Which is your hypothalamus pituitary adrenals and leading to increased cortisol levels. And this can disrupt the normal sleep wake cycle causing the two to 4:00 AM wake up. Next is your sympathetic nervous system activity.

Increased cortisol levels

Dawn (22:40):

Stressful situations can activate your sympathetic nervous system, so you’ve got to think about fight or flight and rest and digest. So those are the nervous system activities we’re talking about. So sympathetic is your fight or flight, and parasympathetic is rest in digest. The sympathetic is kind of the cortisol spiking and glucose increasing nervous system activity, and it just prepares your body for action.

Dawn (23:14):

It re prepares your body for to be able to respond. A study published in a journal of sleep found that stress can increase the activity of the sympathetic nervous system. Or fight or flight resulting in an increase in your heart rate, blood pressure and arousal. And this can interfere again with your sleep and how early you wake up in the morning. So let’s wrap this up. Cortisol is a vital hormone for survival and it keeps us energetic and helps us manage our stress. So it’s a necessary part of a healthy body. So not all cortisol is bad. It’s when your cortisol is responding at inappropriate times or excessively.

Increased sympathetic nervous system activity:

Dawn (24:03):

And when you have prolonged elevated cortisol levels. This is where it leads to the metabolic problems that lead to high blood sugars, high insulin, insulin resistance and inflammation. And this leads to difficulties in losing weight and maintaining a healthy weight. So say you have bariatric surgery and you get the weight off, you hit your goals. You get the weight off, and then all of a sudden the weight starts creeping back up and. You really don’t feel like you’ve changed anything and you’re like, what is happening?

Dawn (24:49):

I would say for a lot of people that insulin piece is part of the picture. Is it driven from you’re just having high blood sugar levels from food choices. And you’re not moving your body enough to utilize the carbohydrates and the sugars that you are eating? That could be a piece of it. Or is it that your cortisol is spiking and creating this kind of domino effect where your liver than releases more glucose. Then your pancreas releases more insulin. And then as it continues to stay up there. Your insulin quits responding and is no longer sensitive to the facts that. There’s still glucose in the blood, too much of it in the blood.

Increased likelihood of nightmares and other sleep disturbances

Dawn (25:38):

So now you’re stuck with type two diabetes and heart disease and maybe kidney disease and neuropathy and. All of those side effects that occur when it may be started with poor stress management. And that cortisol was just not properly addressed long enough or adequately. So if you think about for a bariatric patient. Maybe you never dealt with your stress management behaviors and the surgery shifted everything metabolically. But you didn’t shift your behaviors. So now you’ve got the surgery working for you and correcting everything. Then you didn’t work on changing those behaviors of how you interact in life and. How you deal and cope with things. And now it’s creeping back up because it wasn’t dealt with appropriately. So bariatric surgery is a great tool in helping shift everything.

Dawn (26:58):

I don’t want, I don’t, maybe magically, but it doesn’t solve it permanently without you making changes. So that’s where you have to evaluate, stop and evaluate and say, okay, where is the missing link? What is occurring that is contributing to my blood glucose rising and my insulin rising. But yet my food choices are not bad. I am moving my body and. I should be able to manage some of these a little bit better with what I’m doing.

Dawn (27:35):

It literally could be just that cortisol level. So I would encourage you to check out your cortisol level. Just a fasting cortisol level, which means it has to be done before 10:00 AM. It’s just a blood test. It is truly just a snapshot. It is not truly the best way to evaluate cortisol. You can do a urine or saliva test that’s more accurate. But not every practitioner’s going to do that for you.

Dawn (28:09):

o at least you can easily ask for a fasting morning cortisol, and it’s a snapshot into what’s happening. If it’s elevated, ideally it should be around 10, so you don’t want it zero because. It’s supposed to be rising in the morning because of our circadian rhythm to help us be awake and energized. And then as the day progresses, it lowers. So that morning time should be higher but not high, not elevated. So if you’re in the twenties or thirties, that’s not a great thing. Tzhat’s where you can at least get a snapshot of. What’s occurring naturally for you that you maybe weren’t aware of. So I hope that makes sense.

Conclusion

Dawn (28:58):

I know I’ve talked about cortisol. I know I talk a lot about stress, and I want you to truly understand this metabolic piece of maybe. What’s getting you hung up that you never would’ve thought of. You wouldn’t have put this cortisol piece together with your insulin and your glucose without hearing this. So I truly hope this gets you looking at the big picture. Really evaluating what your body is doing, and it gives you the tools to ask the right question. When you go to your providers and not being afraid to ask for a fasting cortisol, or if they

Dawn (29:40):

Do like a saliva or urine test for your stress hormones, that would be fabulous. Pursue that and learn more about what your body is doing and how it’s responding. So I hope this has helped. And check out our gastric health membership. I promise you it’s something that is a great value and offers you great insight. And tools and resources to grow and learn. So I hope you guys have a great week and we will see you next time. Bye-bye.\

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