CORTISOL AND STRESS : WHAT IF THE CORTISOL WAS TOO LOW?

Cortisol is certainly the hormone which is more frequently associated to a condition of stress. Actually, high levels of this hormone are often found both in conditions of acute and chronic stress. Attention towards cortisol is above all present in the scientific approach connected to sports performance, since the cortisol/testosterone ratio or cortisol/DHEA ratio are fundamental parameters to monitor the condition of athletes. This means that when this ratio is particularly high, there is a condition of overtraining and muscular catabolism. High cortisol levels are not only harmful for athletes. Actually, also in normal people suffering from hypercortisolism there are metabolic changes which favour the insurgence of secondary hyperinsulinism with predisposition to the metabolic syndrome and to the increase in body fat. Often, weight increase, water retention, face or abdominal swelling which do not improve (and which even worsen in case of further calorie restriction and increase in physical activity) are correlated to high cortisol levels. However, today more and more often we experience an apparently opposite phenomenon, that is, the presence of low cortisol levels. When its causes are not iatrogenic, as in case of prolonged use of corticosteroids, they can be central causes (brain trauma, alteration in the susceptibility of hypothalamic and pituitary receptors, hippocampal dysfunction, etc.), peripheral causes (increase in Cortisol Binding Globulin, conversion of cortisol into other hormones responsible for cortisol production), or suprarenal causes (decrease in receptors, autoantibodies against suprarenal glands, lack of vitamin-mineral co-factors, lack of precursors such as pregnenolone and progesterone). Yet, they are more and more often linked to stress. This deficit in cortisol production is linked to a decrease in suprarenal functionality due to exhaustion or to the functional adjustment of the suprarenal glands as a result of the mechanism of negative feedback on part of the brain and the hippocampus which balance cortisol production to limit its detrimental action towards the brain in the hippocampus. Obviously, stress can be physical, emotional, psychological, environmental, due to diseases or it can be due to a combination of all these factors. The suprarenal glands react to all these types of stress in the same way: with cortisol hyperproduction. When the amount of stress goes beyond the capacity of the suprarenal glands to balance and recover, then the so-called “Adrenal Fatigue” or suprarenal insufficiency takes place. Actually, the words “suprarenal insufficiency” can be misleading: as we have seen, the exhaustion of suprarenal functionality is not necessarily implied. So, the correct term is “hypocortisolism”.

Hypocortisolism appears with various problems, the most frequent of which are hypoglycaemia due to the lack of the hyperglycemizing effect of cortisol and articular pain or fibromyalgia due to the lack of the anti-inflammatory effect of cortisol, allergies, autoimmune diseases and frequent respiratory infections due to alterations in the immune response. The most common symptoms are:

• difficulty in getting up in the morning
• constant fatigue not mitigated by sleep
• craving for savoury food
• lethargy
• decrease in libido
• decrease in the ability to cope with stress
• increase in the time needed for recovery and healing from diseases and wounds
• tendency to depression
• inability to experience fun
• hypoglycaemia on the occasion of salty meals and need to have snacks throughout the day in order not to faint
• difficulty in taking decisions
• memory problems
• decrease in tolerance towards other people
• feeling of strong apathy associated to lack of will until about 10 a.m. At about 3 p.m. there is often a fit of drowsiness. At 6 p.m. the subject feels better, as if he/she was a different person.

In order to diagnose “hypocortisolism”, as well as the symptoms, it is important to make use of proper laboratory tests. Unfortunately, the blood and urine tests which are generally used by the majority of doctors have been designed to identify evident diseases such as Addison’s Disease (when the levels of cortisol are below the range of reference) or Cushing’s Disease (when they are extremely high). Yet, today there is a new test measuring the level of hormonal values in the saliva rather than in blood or urine. The saliva test is also more indicated to measure the hormones at intracellular level, that is, where the hormones really work. The test is based on 4 samples a day: between 6 and 8 a.m. (about thirty minutes after getting up), between 11 and 12 a.m., between 4 and 6 p.m. and between 10 and 12 p.m. This shows that cortisol varies a lot during the day, so this test gives a more complete picture of suprarenal functionality. Once “Hypocortisolism” has been diagnoses, the treatment is based on interventions at various levels:

• lifestyle
• diet
• elimination of food causing allergies and food intolerance
• food integrators
• use of suprarenal cortex extracts
• hormonal substitutive therapy

Let us now consider the use of some supplements:

• liquorice extract, glycyrrhizic and glycyrrhetic acid inhibit the 11B HSD enzyme, which is responsible for cortisol inhibition. This inhibition causes an increase in cortisol levels.
• Rhodiola Rosea is an adaptogen plant which can positively influence physical and mental stress modulating cortisol production.
• Korean ginseng (panax ginseng) is a herb which can help increase cortisol levels. It must be used moderately since it can increase irritation.
• Eleutherococcus (Siberian ginseng) increases stress resistance and regulates neurotransmitters. In vitro tests have shown an increase in ACTH levels (hypophyseal hormone which stimulates cortisol production) after eleutherococcus intake. It fights mental fatigue and has anti-depressant properties. It also has anti-anxiety effect and helps sleep, giving a sensation of well-being.

• Withania Somnifera or Indian ginseng is another adaptogen plant and it is useful in case of anxiety and insomnia. It can reduce cortisol production when it is too high and increase it when it is too low.

• The vitamins of the B complex are fundamental for the correct functionality of suprarenal glands. Vitamin B1, or thiamine, is fundamental for the functionality of the nervous and cardiac system, and it is necessary for the metabolisation of carbohydrates. Vitamin B6 or pyridoxalphosphate is even more effective in protecting the system of response to stress. It is generally used by the body for the production of the various neurotransmitters. Moreover, it is a co-factor in many enzymatic routes used to produce suprarenal hormones. Recent studies have demonstrated that vitamin B6 helps the functioning and rhythmic control of the HPA (hypothalamic-pituitary-adrenal) axis. Finally, many studies have demonstrated that vitamin B5, or pantothenic acid, can balance cortisol. Pantothenic acid is turned into acetyl-CoA, a fundamental substance for the conversion of glucose into energy. It is contained in all the cells but there is a higher amount in the suprarenal ones since a lot of energy is necessary to produce suprarenal hormones.
• Vitamin C is absolutely essential not only to keep optimum levels of cortisol but also for the production of catecholamines (adrenaline-noradrenaline). The suprarenal glands have the highest concentration of vitamin C in our body and, in stressful periods, they release vitamin C from their deposit, favouring local vasodilation which allows higher cortisol production.

L’Accademia del Fitness – Wellness – Antiaging / july 2015