by Dr. Joseph Debé
Exercising regularly and making healthful dietary choices takes discipline and dedication. Some people do it for their appearance – they want to build muscle and/or lose body fat. Others are motivated to improve their health and vitality. And then there are the competitive athletes. No matter what your fitness goals are, one of the main determinants of whether you will reach them is your hormonal status.
Although many hormones have an influence, two of the most important are cortisol and DHEA. These are the long-lasting stress hormones secreted by the adrenal glands. Cortisol has a general catabolic effect on the body. Catabolism refers to the breakdown of complex living tissue into simpler components, some of which are used as metabolic fuel. DHEA has largely opposite effects of cortisol, being an anabolic hormone. Anabolism is the process whereby food is converted into living tissue. Anabolism and catabolism are both essential processes. In order to achieve your fitness goals, cortisol and DHEA must be produced in the proper balance. Chronic stress results in imbalance, with increased cortisol and decreased DHEA production. This causes the body to shift into a catabolic state.
It is critically important to understand that mental-emotional strain is only one of many different things the body perceives as stress. Two of cortisol’s main functions are to raise blood sugar levels and to reduce inflammation. Thus, cortisol levels increase in response to drops in blood sugar and the presence of inflammation. Other types of stress include: chronic pain, chronic illness, chronic/severe allergies, trauma/injury, temperature extremes, surgery, toxic exposure, chronic or severe infections, late hours/insufficient sleep, light cycle disruption (as in working night shifts), and excessive exercise. That’s right. Excessive exercise results in elevated cortisol to DHEA ratios. Over enthusiasm about exercise can easily produce cortisol-DHEA imbalance. In addition to overtraining, the three most common stressors to be concerned about are mental-emotional stress, dysglycemia (blood sugar fluctuation), and inflammation.
How exactly does an elevated cortisol to DHEA ratio interfere with fitness goals? One way is by producing cellular amino acid deprivation. Amino acids are the building blocks of proteins, which are responsible for most of the cellular structure, and for enzymes which catalyze biochemical reactions. Under the influence of stress, (a high cortisol to DHEA ratio), protein synthesis slows and protein breakdown accelerates. The end result is reduced muscle mass. Proteins from the heart, bones and gastrointestinal mucosa (lining) are also targeted for breakdown. The amino acids released by the catabolism of these proteins are oxidized to produce carbon skeletons to be used for making glucose. Importantly, aging proceeds by this very process of cell protein degradation. Stress also results in the replacement of insulin-sensitive, slow oxidative type I muscle fibers by fast glycolytic type II-B muscle fibers, which impairs muscular endurance. Elevated cortisol levels also interfere with energy production by decreasing glucose utilization. High cortisol to DHEA ratios result in fat deposition, especially around the midsection. It is possible to sometimes build muscle under stress (high cortisol: DHEA), but at the expense of the internal organs. What happens is that resistance exercise (weight training) makes the skeletal muscles the organ of demand so that protein is “stolen” from the internal organs to be used by the muscles. Bodybuilders in this condition have been found to have up to thirty percent shrinkage of the liver and catabolism of other organs, as their muscles grew. Obviously, this is detrimental to health. For those concerned about their appearance, stress strikes another blow. Elevated cortisol levels reduce skin regeneration and lead to accelerated wrinkling. The protein breakdown that occurs under stress can also accelerate osteoarthritis and bone loss, and prolong healing of injuries. Other conditions which people hope to prevent or improve by a healthy lifestyle are actually promoted by elevated cortisol to DHEA ratios. These include hypertension, ischemic heart disease, depression, and various cancers.
Elevated cortisol: DHEA further impedes fitness goals by altering the levels and activities of other hormones. Thyroid stimulating hormone and triiodothyronine levels are reduced and reverse triiodothyronine levels increase. In other words, thyroid activity is diminished. This results in a slowing of the metabolic rate. Body fat becomes easier to store, more difficult to lose. Stress lowers levels of growth hormone, testosterone, and insulin-like growth factor I, all of which are muscle-building, fat-burning hormones. Stress increases levels of estrogen released from the ovaries and also increases conversion by fat cells of DHEA, androstenedione and testosterone to estrogen. The more body fat a person has, the more these hormones get converted to estrogen. Estrogen stimulates fat deposition, particularly around the thighs and hips. Stress is feminizing in men and women. Stress produces insulin insensitivity with subsequent elevation in insulin levels. This produces increased hunger with craving for carbohydrates. Elevated insulin levels increase fat cell proliferation and fat deposition. To sum it up, under stress, muscle is replaced by fat.
So, how does one know if they have elevated cortisol: DHEA? The best way to measure these hormones is with the Adrenal Stress Index™. This is a simple test the person performs at home. Four saliva samples are collected over the course of one day by rolling cotton swabs under the tongue and then placing them into test tubes. The kit is then mailed to the laboratory and the hormones are measured from the saliva. The testing laboratory furnishes the test kit, with all supplies needed. The laboratory fee for the test is $99.
Test results are sent to the ordering doctor within about two week’s time. Analysis of the test results, in combination with evaluation of the individual’s lifestyle, leads to therapies to help restore any hormonal imbalance. Scientifically proven techniques for mental-emotional stress reduction can be used. Dietary and nutritional supplement recommendations to balance blood sugar levels are often needed. Women trying to lose weight often eat too much carbohydrate. Bodybuilders often eat too much protein. Both of these situations can result in elevated cortisol to DHEA ratios, as can simply not eating enough. Sources of inflammation must be sought out and dealt with appropriately to lower cortisol output. Thorough understanding of the individual’s lifestyle can identify other sources of stress.
A nutritional supplement called phosphorylated serine is often useful in lowering elevated cortisol levels. It appears to work at the level of the brain and pituitary gland. DHEA supplementation is usually called for when levels are found to be low. In some cases, sublingual administration is preferred; in other cases, micronized capsule form is best. In cases of sex hormone related problems such as prostate or breast cancer, DHEA should not be supplemented before performing an additional test called a DHEA challenge test. This test measures the increase in testosterone and estrogen levels after supplementing DHEA for just a week. For those individuals who convert a lot of DHEA to testosterone or estrogen and have certain health conditions, DHEA can be dangerous.
An additional therapy to help lower cortisol levels is aerobic exercise. However, as was previously mentioned, excessive exercise can stress the body. There is a way to help determine if a given duration and intensity of exercise is stressing or de-stressing the body. Another test of cortisol levels is performed in relation to exercise. A saliva sample is taken five minutes before beginning exercise, five minutes after, one and three hours after finishing the exercise session. It is acceptable for cortisol levels to rise immediately after exercise. However, they should decrease by one hour after exercise. Three hours after exercise, cortisol levels should be equal to or lower than starting values. If they are, then the level of exercise is beneficial. If they are not, then this level of exercise is a stress to the body and is sabotaging fitness goals and undermining health. In this case, the type, intensity, and/or duration of exercise need to be adjusted. This test is particularly well suited for women who cannot lose weight even though they exercise aerobically and – inappropriately – eat a high carbohydrate diet and avoid weight training.
