The Truth About Cortisol and Stress
Think cortisol is your enemy? Think again! Dr. Kerry Winge breaks down the surprising truth about your body's most misunderstood hormone. Like that helpful cousin who shows up uninvited, cortisol can be your best friend or your worst nightmare. Discover why this stress hormone might be hijacking your sleep, disrupting your gut health, and affecting your waistline – and why it's not the villain you think it is. Part one of this eye-opening series reveals the science behind cortisol's Jekyll and Hyde personality.
Transcript
Dr. Kerry Winge: Cortisol, the most misunderstood hormone in your body. It's not the villain. It's the cousin who shows up uninvited, fixes your Wi-Fi, and then eats all your leftovers. In small doses, this cousin is a lifesaver. But when they overstay their welcome, it's total chaos. Today, we're cracking why cortisol hijacks your sleep, your gut, and your waistline, and exactly how to boss it back into balance. Stick around because in the next episode, we drop the mic on fixing this mess. A quick reminder, this content is for educational purposes only. Always consult your healthcare provider before making health decisions. Now, hit play and let's stress less.
Let's talk about cortisol. It's often called the body's stress hormone, and it's produced by your adrenal glands, which are at the top of your kidneys. It gets a lot of bad press and for good reason. It's also referred to as the C word. I'm sure that you can all think of a few C words, but this one definitely invokes some negative feelings.
Nathaniel DeSantis: Many people might be thinking of a different C word. Mine's cousin. I have a cousin who has a lot of negative feelings when I think about him for a lot of various reasons that, you know, we could do a whole podcast episode just on why my cousin makes me think of those negative feelings when I think of a few C words.
Dr. Kerry Winge: Now, hold on. This is West Virginia, and we love our cousins here. Although, except when they show up uninvited and they refuse to leave. But cortisol is actually like that. The cousin that we all have, you know, the one who is actually helpful and fun in small doses. But if they overstay their welcome, things can always get a little messy. Now, cortisol, when it's working like it should, is like a helpful cousin that helps you move furniture. But those that hang around too long maybe eat all your food or hog the remote, creating stress, and you really start feeling overwhelmed. And then the helpful cousin turns into an overbearing presence, and we want him to leave because your sleep's disrupted, your metabolism slows down, and overall, your peace of mind is affected. So like any houseguest, boundaries need to be set, and cortisol is no different. We need to keep it in balance, and it'll support you, but if you let it run wild, you're going to end up cleaning up the mess.
Nathaniel DeSantis: A few things come to mind when you're talking about cortisol, because as someone who's not a doctor, who has no medical background besides biology in high school, I think of cortisol in a very negative way, right? It's stress. It's not good. Oh, this is spiking my cortisol, all that stuff you hear. So I'm a little bit surprised when you're saying that cortisol can work for you. Can you kind of explain to us what you mean by that and how it can work for us?
Dr. Kerry Winge: Absolutely. Let's think about three ways it can help you to wake up. So it naturally peaks in the morning so that you can wake up and feel alert. It's almost like an internal alarm clock. It can also help you handle a deadline at work. Cortisol will help to sharpen your focus, increase your energy, and really help you power through. And also, it can help you react in an emergency.
Nathaniel DeSantis: So like to keep with the cousin analogy, like when you almost get run over by a side-by-side, which you were just explaining to me what a side-by-side was, right? That's a thing in West Virginia.
Dr. Kerry Winge: Hey, wait, you are on my list now. Stop picking on West Virginia.
Nathaniel DeSantis: It's too easy. It's too easy. You guys don't have a whole lot going for you. So you make it simple.
Dr. Kerry Winge: Well, actually we do. According to Forbes, we're in the top 100 best places to live. And we have the best small places for business and careers as well as Morgantown is the greenest city in West Virginia. It's in the top 10 up-and-coming small cities.
Nathaniel DeSantis: Well, that's saying a lot for West Virginia, isn't it? But we got off topic.
Dr. Kerry Winge: Well, that's because you're raising my cortisol. Cortisol actually can help you fight off an illness like when you crush a cold. Cortisol can help you control inflammation so that your immune system can focus on actually fighting the infection without overreacting and causing unnecessary damage to your body. And it also helps you recover from exercise. So during a workout, cortisol helps to break down stored energy so that your muscles have the fuel that they need to perform. But afterwards, it can work with other hormones to reduce inflammation and repair some tissues.
Nathaniel DeSantis: So on the flip side of... Like you were saying at the top, a lot of things have cortisol with the C word. That's not cousin and not cortisol. I think we can all figure out what we're thinking there. Because it can interfere with daily health and relationships. So can we maybe talk about how cortisol works against us? And I think this is probably going to be the more obvious one that people can think of. But maybe let's go into a little bit of details on that for us.
Dr. Kerry Winge: So it is. It is the one that is the most obvious because it's the more problematic side of cortisol. Some real-life examples, actually, on how cortisol can work against you is if you are struggling to sleep at night. If you have stressed all day, your cortisol can stay elevated. It should be dropping in the evening. But if it doesn't, then it can make it hard to fall asleep. It can also make it difficult to stay asleep. And then you're going to be exhausted all of the next day.
Nathaniel DeSantis: Okay. So interesting. So it's almost, this makes me kind of think of caffeine where it's like a raise and then a lowering, or maybe another example that I'm thinking of is insulin. You know, your insulin rises and then it drops and there's a natural cadence. So what's the natural cadence for cortisol?
Dr. Kerry Winge: So cortisol itself should drop in the evening and it should be at its lowest early night, about 8 to 10 p.m., and it helps to facilitate that relaxation and allow the melatonin, which is the sleep hormone, to elevate, and that promotes the restful sleep. So the melatonin and the cortisol are inversely proportionate.
Nathaniel DeSantis: So then I think a common thing people are running into these days is a modern problem is our blue lights, right? Like looking at your phone before sleep, how's that impacting? Is it just the blue light's bad for us? Is it spiking our cortisol? What's the relationship with those two things?
Dr. Kerry Winge: That is accurate. So the blue light does elevate the cortisol because it is creating an awareness in your system and your body wants to stay awake. So what you can do is you can set your phone around seven o'clock to have the amber light. But the best thing would be to not have any devices within an hour before bedtime. The other thing is if you don't sleep well, then you're going to end up feeling foggy and distracted. And the constant elevation of the cortisol levels can impair your memory and your concentration. So you can forget tasks and you can struggle to focus. And the other thing is so now you're not sleeping.
Dr. Kerry Winge: And then your immune system is down and you're going to be able to get sick more frequently, like colds and flus and infections. And elevated cortisol can also affect your moods. Like if you're snapping at your loved ones, you're going to be irritable. You're going to overreact, and small frustrations, like say your partner's tone of voice or a minor inconvenience, like in traffic, can really feel overwhelming and it can lead to conflict or maybe regret. And conflict or regret, I say, because you're not going to be able to respond because you're going to be so reactionary. And that's how you can kind of regret maybe some of the choices that you're making. But all of this could be explained as a hormonal imbalance, as an elevation of your cortisol levels. And what's really interesting is that cortisol can elevate and disrupt that gut. And it will cause something called gut dysbiosis.
Nathaniel DeSantis: Interesting. I'm generally pretty on top of a lot of health and health podcasts and know most things, but gut dysbiosis, that's a new one to me. Could you maybe explain that really quickly?
Dr. Kerry Winge: So gut dysbiosis is an imbalance in the gut bacteria. So fun fact, you actually have more bacteria in your gut than cells in your body. And gut bacteria also refers to as the gut microbiome. And the gut microbiome has a direct relationship with your cortisol levels. And the elevated cortisol affects the microbiome because the high cortisol increases the intestinal permeability, which you haven't probably heard of that, but you have heard of the buzzword leaky gut. And leaky gut allows harmful substances to enter the bloodstream and then further disrupt that microbiome. So the elevated cortisol levels actually favor the growth of bad bacteria and it decreases the beneficial strains of the good bacteria.
Dr. Kerry Winge: And what that does is it decreases the diversity of the types of bacteria in your gut. And the chronic cortisol levels can decrease the diversity by weakening the microbiome's resilience to stress and external changes. And this results in digestive issues, such as a slow digestion, reducing your stomach acid production, leading to bloating, indigestion, and constipation. But the problem is, it is actually a vicious cycle because that dysbiosis can trigger what's called the HPA axis activation, which increases your cortisol levels. So it's like you're going on a merry-go-round over and over again. One influences the other.
Dr. Kerry Winge: So the cycle continues and it contributes to chronic stress, inflammation, and poor gut health. So in addition, the cortisol itself can affect that gut-brain connection, and it can exacerbate conditions even like IBS. And then worse, we also can have some slow recovery from workouts or injuries. So we have overtraining or chronic stress can also lead to persistently high cortisol levels, and that's going to interfere with your muscle repair and your healing. You might feel sore longer or struggle to make progress with your fitness goals. I know you've heard of second-day soreness, but soreness can progress or last longer than that. If that is the case, you are probably overtraining.
Nathaniel DeSantis: Workouts are interesting because that's something I care really passionately about is working out. And I do know when you work out, you're purposely putting stress on your body. Because it'll repair itself and it'll become better as a result of that. But I guess, how many intense workouts a week should I be doing? Like, is there too much? Is there a limit where I'm just actually making it worse and going too deep into it? Or is it just as many as I want? Is it like one a week? What's the consensus on that?
Dr. Kerry Winge: Well, it does depend on your fitness levels. However, on average, research suggests that performing three HIIT workouts, which is a high-intensity workout per week, lasting about 30 to 45 minutes, combined with other moderate activities and low-impact exercise like walking, yoga, rowing, biking, or swimming is actually ideal for most people. But however, athletes or those with advanced fitness levels may tolerate up to four high-intensity workouts per week. They have to make sure that they are prioritizing recovery and proper nutrition to sustain this level of activity. And usually athletes have somebody who is watching their nutrition and making sure that they are recovering so that they do have balanced workouts.
Nathaniel DeSantis: Let's say I'm not an athlete and I decide I'm going to be crazy and do six HIIT workouts a week. What happens? What's going on in my body when I'm overdoing it like that?
Dr. Kerry Winge: Okay. Well, the number one is that your inflammation is going to drive up quickly because the cortisol is elevated and you're going to be exhausting your adrenal glands. This is going to leave you actually feeling fatigued and unmotivated and emotionally drained, even after minor tasks. So when you work out too much, then you're not able to fulfill what your requirements are for your daily life and you're exhausted. So the whole point of working out is so that you can feel motivated and you can feel good and it can benefit your health. You really don't want to work against yourself.
Nathaniel DeSantis: That's interesting that working out too much can cause inflammation because we've talked about this off mic before, but inflammation is really scary because I'm reading a book called The End of Alzheimer's. And one of the biggest factors is high inflammation. And I think a lot of people, when they think of how can I prevent having Alzheimer's, dementia, something like that, they think of, oh, I had to be healthy and I had to be low inflammation. And for many people, it's like, I'm going to work out. But conversely, if you overdo it, you're just contributing to that inflammation. It ties in with stress. It ties in with everything. But maybe this is more like a PSA, just be careful about inflammation. It really is not something that you want. We're not meant to constantly be inflamed. We're meant to have inflammation if our body's fighting something, but we shouldn't be the reason we have inflammation and our food shouldn't be and our stress shouldn't be the reason for that. So just something to be aware of for everyone listening. Inflammation, no good. We don't like that.
Dr. Kerry Winge: No, we don't. Like you said, unless it's used for something that the body needs in order to heal and move. But that whole rest and digest is extremely important. And we have to make sure that we continue the balance and that everything has to be done in moderation. So your workouts, your fitness level, your way. If you realize that things aren't working for you afterwards and you're too tired and you're too exhausted and you're not hydrating well and you don't feel good, then you need to turn around and look at what you did and make some changes.
Nathaniel DeSantis: Yeah. Well, since we're on the topic of being inflamed, as I was doing research for this episode, I found something really interesting. But the number one factor that people complain about regarding chronically elevated cortisol levels is gaining weight without explanation. Could you explain that to us? What's that about?
Dr. Kerry Winge: Well, yeah, because chronic stress, actually, when your cortisol levels are elevated, it leads to fat storage, but it leads to fat storage around your abdomen. And the reason for that is because the fat cells in the abdominal area actually have more cortisol receptors compared to fat cells in other parts of your body. But if you're thinking about the cortisol levels from more or less of an evolutionary perspective, storing the fat around the abdomen was important because it allowed the body to keep those energy reserves near your vital organs. And they utilize them during periods of stress or food scarcity, which obviously we don't have in the United States.
Nathaniel DeSantis: Cortisol being too high is a problem, but what about when it's too low for too long? What problems does that introduce?
Dr. Kerry Winge: Well, a lot of problems. It's just like if you're looking at a number line, you want to be in the middle ranges. So you don't want to be too high and you don't want to be too low, kind of like Goldilocks, right? Goldilocks and the three bears. We have to have something that is just right. Now, when things are too low for too long, it can occur from also chronic stress, autoimmune conditions like Addison's disease, chronic fatigue syndrome, and POTS, which is postural orthostatic tachycardia syndrome or dysfunction, any type of dysfunction in that HPA axis, which is hypothalamic pituitary adrenal axis. And it's important to know that that hormone requires balance. We talk about it needing homeostasis. So sustained high and low levels can disrupt functionally every single organ system in our body.
Nathaniel DeSantis: You know, we're going to do a part two about ways to address cortisol, right? But just as we're talking about it, I think what's really blowing me away is like, this is all kind of controlled by our mind, right? Like I'm the only one stressing me out, right? I'm causing this to myself. It's my brain thinking. It's not really anything else, especially in modern times, like what you're saying. Like I can go to the grocery store and get enough food to last me the rest of my life. It's not food scarcity that's causing anything. It's just my brain being kind of a prick to itself, like it's causing all these terrible things. And for me now, I'm freaking out and it's stressing me hearing all of these terrible things that are coming along with it. So I'm wondering, can I go get a test? Is there anything I can do? Like does that exist for cortisol, like a cortisol test, blood tests? I don't even know how that would work.
Dr. Kerry Winge: There are ways that we can test our cortisol levels. And kind of backtracking a little bit to what you said, you're absolutely correct. It's how you are interpreting your environment. So it's how you are responding to your environment. So you can be in traffic and you can have somebody in front of you and they're going 15 miles an hour and say you're 15 minutes late and it can stress you out. Or you can look at that in a different direction, have the time to do some deep breathing, relaxation, feel that, hey, maybe this is a pace car. I need to slow myself down a little bit. Maybe instead of having road rage, I need to back up another few car lengths and just relax and be able to be present in the moment. And we are going to deal and discuss a lot of these techniques in part two of this.
But to answer your question about testing the cortisol levels, you really don't need to test your cortisol levels if you are managing stress well. So that's the question you should ask yourself, and also if you're not experiencing symptoms. However, you might consider testing your cortisol levels if you are experiencing things like persistent weight gain, anxiety, irritability, mood swings, persistent insomnia, poor quality of sleep, high blood pressure, muscle weakness, fatigue, or thinning skin. If you've been on long-term use of corticosteroid medications like prednisone, if you end up with frequent infections, slow wound healing, dizziness, fainting, low blood pressure. Say that fast, low blood pressure, low blood pressure. That's not easy, low blood pressure.
Unexplained weight loss, salt cravings or electrolyte imbalances, if you have a really low tolerance to stress, or symptoms of adrenal insufficiency or an adrenal crisis, or some unexplained health issues, like if you have persistent digestive problems, mood disorders, irregular menstrual cycles without a clear cause. And we will also get into that in the next episode on how the cortisol affects menopause and pregnancy.
But if you have any of these conditions that are chronic. Probably everybody has at least a couple of those conditions. Doesn't mean you need to run out and get your cortisol levels checked. It's probably talking about the whole entire United States. But if you do want to, it's a very simple test. There's your option of a blood test, which you're going to measure your cortisol levels at specific times of the day, usually in the morning or the afternoon. You can also do a saliva test. So the saliva test is also going to track those cortisol fluctuations. You can do a urine test over a 24-hour period. It's just called a 24-hour urine. And you can do a dexamethasone suppression test. Dexamethasone is a steroid. The suppression test is used to diagnose conditions like Cushing syndrome by evaluating how your cortisol levels are responding to the suppression itself.
Nathaniel DeSantis: Can you have high cortisol without feeling stressed? Does that make sense? You know what I'm trying to ask is that like, do I have to feel stressed to have high cortisol? Or could I have, like what you're saying, intellectually imbalanced and my cortisol is high but I don't know and I'm maybe stressed physically but I don't feel stressed mentally? Is that a way it can surface?
Dr. Kerry Winge: Well, I think it all depends on what your normal ends up being. So some people that have had chronic conditions over a period of time, it's their normal to feel like that and have those symptoms.
Nathaniel DeSantis: Don't even know that they're stressed. They don't.
Dr. Kerry Winge: And that's where your physician comes in. If you go for your yearly examination and they'll go over a list of questions. And sometimes the questionnaires are really good, thought-provoking types of questions in order to really get you thinking, well, maybe this might be me. But a lot of times when you have a chronic condition, people don't really know what it's like to feel good.
Nathaniel DeSantis: Yeah. Well, I, so I'll tie that into myself before we talk about levels and what it should be at, but I recently started doing keto around two years ago, completely transformed my life. I did not realize how stressed my body physically was until I got rid of the stress, but I didn't even know it was there. Like I didn't know that certain foods were making me feel so bad until I stopped and I tried eating them again and I was like, oh my god, like this is how I felt all the time. It's something I talk about with my sister a lot too because she's the same way. We think it's something in our family with gluten and carbs just does not work well.
We didn't realize how stressed our body felt until we tried something that worked really well for us and lowered inflammation, probably really lowered our cortisol levels among other things, right? It's the ecosystem. So it's not just cortisol that was lower. It's probably so many different factors, but it makes me wonder how many people don't even realize that they feel bad because it's what you've done your whole life and it's how you felt your whole life. And you don't know that another one, it's almost like Plato's allegory, like the cave, right? How are you supposed to know what exists out there if you've never experienced it? So to make it a little bit philosophical.
Dr. Kerry Winge: It's like somebody opens the curtains for you and all of a sudden lets light in.
Nathaniel DeSantis: Yeah and...
Dr. Kerry Winge: You didn't really know to ask yourself the questions about how you were feeling or even tied an emotion to your food, which is probably a whole other podcast.
Nathaniel DeSantis: It's just crazy like, you know, I think when people think of stress they really do think like up here mentally the stress but it really like the body stress it's completely different and it feels different and it can tie into your mental stress. It doesn't have to but it's just so interesting how it works like that. But that's a tangent. I want to know, let's say I feel really stressed and I decide I'm going to get tested and I'm getting my blood drawn. I get a result back and it says, my morning stress is 5 mcg/dL. Is that good? Is that bad? What do my levels need to be at? What's good? What's bad? Explain.
Dr. Kerry Winge: Okay. So your morning levels are tested around seven to nine in the morning, and you should be 10 to 20 micrograms per deciliter. And the average in the afternoon, about three to 4 PM is three to 10 micrograms per deciliter. And then in the evening, it's around 8 PM. It's less than three micrograms per deciliter. So when you get those test levels back, it's important to bring them to a practitioner who is good at interpreting the levels. Because not only the cortisol test, they'll probably want to run a couple other tests because it's not one snapshot. It's how all of your tests are correlated together. When a good practitioner is able to look at and see the picture for you, and that is their job, they're detectives, figure out how you're feeling, run the appropriate tests, make the correct diagnosis in order to get you better.
Nathaniel DeSantis: Another question. This has me thinking something I want to do. I just turned 28 around a month ago, a little over a month ago.
Dr. Kerry Winge: Happy birthday.
Nathaniel DeSantis: Thank you. I appreciate that. But I'm getting to that point where I have to accept that in a few years, not yet, but in a few years, my testosterone levels are going to drop. That's a real reality for me. So I'm thinking about getting a test to see where my baseline is so that when I'm 35, 40, 50, I can kind of track and see my testosterone really took a plummet when I hit 38. Like what's going on? Do I need to go on TRT? Do I need to do something? And maybe this shows you how stressful of a person I am that I've been thinking of this, do I need to do the same with cortisol where I have like a baseline and I know for me at 28 when I'm not stressed, I'm at a 30 mcg in the morning, 15 in the afternoon, two at night. Is that worth knowing like a base level? Is it worth even doing that? Or if I feel good, I feel good. Don't worry about it.
Dr. Kerry Winge: If you feel good, don't worry about it. If you're interested in it, then what you want to do is you want to watch your cortisol levels over a period of time. Because when you get blood results, it's only a snapshot in what was going on with your body at that period of time. Just like your testosterone levels, they can change and they can fluctuate.
Nathaniel DeSantis: Okay, so I have a lot more questions for you, Kerry. But I'll tell you what, let's save them for next episode. Because from my understanding, the next episode we will be talking about ways to address cortisol imbalance, whether it's too high or too low. We're going to be talking about some other things too with weight gain and cortisol, which we've touched on a little bit. But next week's episode or the next episode we publish will be a little bit more like, let's get into the nitty-gritty. And I can tell you I'm a stressed person, so I need that episode and it's going to be good. But in the meantime, I think this is a really great understanding and primer for what is cortisol, what are good levels, what are bad levels, what's the good, what's the bad, what's the ugly of cortisol. And to any of my cousins listening to this, I apologize.
Dr. Kerry Winge: Fantastic.