Written by Dr. Marlee Guy, ND
Chronic stress can have major detrimental consequences to our health, wellness and beauty. In fact, skin concerns, digestive complaints, immune dysfunction, mood disturbances, poor sleep, hair loss, hormonal imbalances, and weight management issues all share chronic stress as an underlying factor. As a consequence of chronic stress, our stress hormone, cortisol, becomes dysregulated, which has negative downstream effects on a wide array of other hormones responsible for our metabolic rate, our blood sugar levels, and our muscle building capacity.
If you always feel tense or anxious, your body remains in a constant state of heightened arousal, which many refer to as the “fight-or-flight” response. This “fight-or-flight” response becomes problematic when it isn’t turned off, which is the case for many individuals experiencing unrelenting chronic stress. Stress comes in many forms but our body and mind perceive all kinds of stress the same, whether physical or mental. For instance, any of the following will lead to the constant overproduction of cortisol and adrenaline and ultimately culminate in adrenal fatigue: constant multi-tasking, skipping meals, engaging in excessive calorie restriction, insufficient carbohydrate intake, too much protein consumption, lack of sleep, too much coffee, overexercising, and the list goes on!
In this state, your adrenal glands simply cannot keep up with the constant stimulation and outrageous demands for adrenaline and cortisol production, so they simply shut down. When your adrenal glands go on strike, cortisol and adrenaline levels plummet, which can result in many or all of the following symptoms:
• Chronic fatigue, lethargy (difficulties getting up in the morning, even with sufficient sleep hours)
• Sleep disturbances (not being able to fall asleep, or waking up between 2-4 am)
• Weight gain and increased belly fat
• Weight loss resistance – cannot lose weight despite healthy diet and exercise
• Difficulty concentrating or remembering (brain fog)
• Depression and Anxiety
• Hair loss
• Acne and other inflammatory and/or infectious skin concerns
• Weakened immunity, frequent infections or poor healing/recovery
• Increased inflammation
• Dependence on coffee or stimulants to get going in the morning
• Cravings for salty, fatty, and high protein food such as chips, meat and cheese
• Intolerance for exercise – may actually feel worse than better from exercise
• Reduced muscle strength
• Lowered blood pressure
• Blood sugar dysregulation
• Light-headedness (including dizziness and fainting), especially when rising from a seated or lying-down position
If this sounds like something you may be experiencing, it’s time to prioritize your self-care through identifying the underlying causes of your stress and evaluating the effects that chronic stress has had on your body and mind.
As a Naturopathic Doctor, taking the time to evaluate the complex ways in which chronic stress may be contributing to your health and wellness concerns is a critical factor in formulating an effective and sustainable treatment plan. Therefore, a thorough health history and lab assessment is required in order to establish which interventions are most indicated for each individual’s unique needs.
Below is a list of potential lab tests and assessments that are often investigated when there is a concern of underlying cortisol dysfunction.
Cortisol (Fasting AM Serum and/or Diurnal Salivary)
• Normally, cortisol follows a daily pattern in which cortisol rises rather rapidly in the first 10-30 minutes after waking (this is what’s known as the Cortisol Awakening Response) in order to help with energy, then gradually decreases throughout the day so that it is low at night for sleep. The cycle starts over the next morning. Reasons for low cortisol (low morning cortisol or low diurnal cortisol measurements) might include an underactive HPA axis, or excessive psychological burnout, whereas elevated cortisol can be a result of an overactive HPA axis, ongoing daily anticipatory stress, glycemic dysregulation, or even pain to name a few!
Fasting Blood Glucose & Fasting Insulin
• Cortisol has a very intricate relationship with insulin, which in turn, controls our blood sugar. When your body is healthy and your cortisol regulation is optimized, cortisol is released to help liberate glucose in order to maintain the functions of our brain, organs and cells when blood sugar levels decline between meals, as well as overnight during sleep. However, if your cortisol levels are elevated chronically, as is the case with chronic stress, the cells of your body can become resistant to insulin, leading to increases in blood sugar, weight gain and potentially increase the risk of developing a variety of metabolic and cardiovascular conditions. On the other hand, another common clinical problem that occurs with prolonged levels of chronic stress is that our adrenal glands shut down, resulting in low cortisol. During this situation of “adrenal fatigue”, individuals often experience hypoglycemia – or low blood sugar – especially between meals or while sleeping. Therefore, when cortisol is depleted, glucose levels tend to become too low, which ultimately causes lightheadedness, shakiness, irritability, headaches, and also explains why people with low blood sugar will commonly wake up during the night between 2–4 am.
Immune health markers (CBC, Zinc, Ascorbic acid, 25-Hydroxy Vitamin D3, hs-CRP etc.)
• When under chronic stress, the immune system is also sent into chronic overdrive and eventually will become compromised, leading to increased susceptibility to a variety of illnesses and infections. Individuals who are suffering from chronic stress and burnout often experience recurrent infections and/or display difficulty with recovery and healing in general. Therefore, it is no surprise that these clinical signs are often further confirmed by abnormalities in such patient’s lab results, with immune markers and nutrients being abnormal or suboptimal. With the insights gathered through lab testing, we can then address the negative effects of chronic stress by ensuring that your immune system is being supported and optimized through targeted supplementation as well as diet and lifestyle modifications.
Thyroid Panel (TSH, Free T4, Free T3, Anti-TPO, Reverse T3)
• Healthy adrenal function and cortisol regulation is critical for promoting optimal hormone production from our thyroid gland. Optimal thyroid function helps with the maintenance of a healthy metabolism, yet both high and low cortisol levels can impair the conversion of thyroid hormone from its inactive form to its active form. This can ultimately result in a low thyroid hormone situation, causing weight gain, slow metabolism as well as a wide array of other hypothyroidism symptoms.
Sex hormones Panel (Estradiol, Progesterone, LH, FSH, Testosterone, DHEAs)
• I would additionally suggest any patient experiencing chronic stress to investigate the potential impact that cortisol dysregulation has had on their sex hormones as the downstream hormonal consequences can be significant. Cortisol—along with testosterone, estrogen, progesterone, DHEAs and various other hormones—are synthesized from a precursor molecule called pregnenolone. Depending on the body’s overall status and the level of hormones in the body at a particular time, pregnenolone can be shunted down different pathways and converted into a variety of different hormones, in order to meet the body’s needs for survival. The general idea is that under chronic stress conditions, the cortisol pathway ‘steals’ the pregnenolone from the other sex hormone pathways, in reaction to the stress response. Although the idea of this “pregnenolone steal” is an oversimplification, and the actual mechanisms involved are quite complex, the main message is that chronic stress obscures the normal hormonal homeostasis in the body and can cause complications in nearly all body systems as a result of the wide array of hormonal pathways affected.
Ultimately, understanding the relationship between all of your hormones, of which include, but are not limited to, your stress hormones (such as cortisol), your thyroid hormones, and your sex hormones, is critical in resolving the negative health and wellness consequences of chronic stress.
Bioelectrical Impedance Analysis (BIA)
• Bioelectrical impedance analysis (BIA) measures body composition based on the rate at which an electrical current travels through the body. Body fat causes greater resistance than lean body mass and slows the rate at which the current travels. By using a BIA machine we are able to accurately measure the body’s lean muscle mass, which is essential for us to retain, yet is often compromised under periods of chronic stress.
Orthostatic Blood Pressure
• Patients suffering from adrenal fatigue may experience low blood pressure when standing or getting up from a sitting or lying down position. Regular blood pressure monitoring as well as orthostatic blood pressure measurements may act as important markers of adrenal function. Additionally, as part of your comprehensive assessment, it’s important that we spend time exploring dietary patterns, sleep habits, as well as exercise regimens that you are currently implementing into your daily life as each of these lifestyle factors often provide insight into the underlying causes of your cortisol dysfunction as well as help inform how we can best restore your
Additionally, as part of your comprehensive assessment, it’s important that we spend time exploring dietary patterns, sleep habits, as well as exercise regimens that you are currently implementing into your daily life as each of these lifestyle factors often provides insight into the underlying causes of your cortisol dysfunction as well as help inform how we can best restore your optimal health and wellness.
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