Coming to Terms with the Stress Hormone Using Dietary Modification as the Key

Too Much Stress Can Cause Distress in Life

Cortisol Levels Generally Rise after Exercise

For most, mornings are the busiest time of day and I feel today morning would have been no different. We are enveloped by stress and lack of time that’s become our daily routine almost every day. So, while all of us know about stress not many are aware of the science behind it. Our body releases cortisol, often known as the ‘stress hormone’ due to its connection to stress response, which helps in preparing the body for physical and mental stress by acting within the physiological processes. It also plays a critical role in the functioning of the body by affecting macronutrient metabolism, regulating water and electrolyte balance, blood pressure, body temperature and immune response. Your mood, behaviour, pain and appetite changes are the work of this hormone. All these functions make the cortisol hormone indispensable for good health and well-being. Maybe changes in the hormone levels can answer our lingering doubts why some people are always moody, anxious, stressed or even hungry!            

Cortisol is secreted in the body in the adrenal glands but is controlled/regulated by the hypothalamus, the pituitary gland and adrenal gland and their combination is often called the hypothalamus-pituitary-adrenal axis (HPA axis) which is involved in important functions such as regulating mood, sexuality, body temperature, digestion and energy use. The HPA axis is also one of the components of the fight-or-flight response.

Triggering Agents for Cortisol Production
Our food supplies us with the required nutrients and energy for proper functioning of the body but all this is possible only when we consume a well-balanced diet. Cholesterol helps in cortisol production through triple enzymatic hydroxylation. Liver is the primary source of cortisol metabolism and its secretion is affected by a variety of factors including circadian rhythm, negative external stimuli and feedback regulation.
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In times of stress the hypothalamus releases corticotropin-releasing hormone (CRH) and vasopressin (ADH, antidiuretic hormone). This in turn triggers the pituitary gland to produce the adrenocorticotropic hormone (ACTH). ACTH impacts StAR protein which helps in transporting cholesterol thereby encouraging cortisol formation in the adrenal cortex. Once cortisol is released its impact on the body and our response entirely depend on the concentration of the hormone, timing of cell cycle and presence of endocrine disorders.

Important Functions
Besides performing the above-mentioned functions cortisol also influences insulin resistance, dyslipidaemia, hypertension and obesity. Above all, it has a strong impact on appetite. A study by De Sa et al. showed that administering cortisol orally influenced the participants to be highly responsive to those foods presented with high glycemic index but the same response was not given when they were shown a couple of other normal non-food images. Presence of ghrelin, the hunger hormone, increased cortisol levels greatly. Abnormally high or low cortisol concentrations have been commonly linked to upper body fat leading to what’s known as Cushing Syndrome. This syndrome is characterized by rapid weight gain in the face, abdomen and chest besides causing a flushed face, high blood pressure and changes in the skin.

Collagen synthesis stimulated by cortisol is inhibited when an individual is under too much stress or performs vigorous physical activity due to interruption of bone mineralization. Cortisol might enhance sensitivity of tissues of blood vessels and heart to noradrenaline, vasopressin and angiotensin II thereby leading to higher blood pressure levels. It also affects immune system in the form of hydrocortisone-it shows anti-inflammatory and immunosuppressive effects by disrupting the production of inflammatory cytokines, migration of WBCs to inflammatory sites and inducting cell apoptosis. By doing this, cortisol protects our body in times of injury being especially useful in the case of athletes involved in sports. Studies have shown that athletes who are highly motivated and successful show higher presence of the cortisol hormones in their body. Likewise, levels of cortisol hormone also influence the emotional feelings experienced during the start of a competition and also the degree of burden that they carry around before, during and after the competition. After completion of an athletic event or exercise, the cortisol levels vary depending on the fitness of the individual, his/her training duration and compliance to regular training.

Effects of Dietary Intake on Cortisol Levels
Our diet talks about our health. The food we eat, the nutrients we consume and the quantity of these influence the functioning of the body which includes the endocrine system as well. The type of carbohydrates we eat and how much of it we eat actively affect the endocrine system. Hence, before, during and after exercise or sports training it is imperative for individuals to replenish energy stores by taking appropriate carbohydrates.

Many individuals these days take dietary supplements alongside a well-balanced diet to maintain the nutritional requirements of the body. We can see an increasing number of elderly people, athletes and heavy workload people using nutritional supplements to improve their overall efficiency and functioning.  These are one of the groups of people who are highly susceptible to increased secretion and metabolism of hormones including cortisol. So, consuming dietary supplements helps them in stabilizing the effect of these hormones. For instance, cortisol levels might increase after exercising and supplementing the body with certain amino acids such as tryptophan decreases cortisol levels. One should carefully choose the supplements with the help of physician’s guidance-supplementing with amino acids such as glutamine and arginine have no impact on cortisol concentration.
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Phospholipids too regulate cortisol levels and the best of them include phosphatidylserine and phosphatidic acid. But studies have shown that supplement dosage plays a great role in bringing about changes- a 400mg/day dose administered for 6 weeks reduced cortisol levels incremented due to exercising while consuming a 200mg/day dose had no significant effects. Protein-enriched products such as egg yolk are great sources of these phospholipids, yet another reason why we are always suggested to consume a protein-enriched diet. Fermented milk products, sprouts of brown rice, barley and beans can be consumed generously as these help in controlling cortisol release with the help of a chemical compound called GABA (gama aminobutyric acid) present in each of them. Besides foods, yoga has been proclaimed as one of the best ways to increase GABA concentration in brain.

Studies Supporting Supplement Intake
We have had numerous studies trying to understand the effect of ascorbic acid (vitamin C) intake on cortisol synthesis. A study by Brody et al. showed that consuming 3000 mg of vitamin C daily helps in cortisol recovery after psychological stress but does not contribute towards lowering cortisol levels. We have other studies showing that consuming high dosages of ascorbic acid (1000-1500 mg/day) before the start of an athletic session helps in restricting increasing cortisol levels, decreases muscle pain and facilitates efficient regenerative processes. Similar effects were observed for supplementing the body with vitamin B1, B2 and niacin. Vitamin D has always been mysteries and in the case of cortisol too the results have been controversial.

It has been well-known that exercise increases cortisol levels but a study by Golf et al. showed that supplementing our diet with magnesium inhibits exercise-induced increase in cortisol levels. But another study by Cinar et al. showed that magnesium supplements in combination with physical activity increased cortisol concentrations. Even vitamin E and omega-3 are proposed to be cortisol-lowering supplement aids but we don’t have authentic scientific evidence to support this. But a 3-week supplementation of fish oil helps in reducing cortisol and stress levels.

Coffee and tea have been always consumed in times of energy needs. A study by Arent et al. showed that consumption of black tea extract enriched with theaflavin helps reducing cortisol levels caused by stress and so does oolong tea. Contrarily, black coffee stimulates hydrocortisone secretion. The presence of caffeine in coffee prevents decrease in cortisol levels. Having caffeine before a workout leads to dose-dependent increase in cortisol and testosterone concentrations. Studies on individuals who consume drinks containing carbohydrates and caffeine during workout shows that maximum increase in cortisol levels was seen in the group supplemented with caffeine without carbohydrates. Study by Miyake et al. showed that supplementation with L-ornithine reduced serum cholesterol levels besides reducing anger and improving sleep quality. A 4-week supplementation of extracts found in the roots of Eurycoma longifolia (Malaysia ginseng) helped in reducing cortisol levels by 16% and increasing testosterone levels by 37%. Intake of enzyme-treated asparagus extract prevents cortisol increase and also raises sleep quality.

Vitamin D’s Impact on Cortisol Levels
Vitamin D deficiency is prevalent worldwide right from youngsters to elderly people. Chronic stress prevents the body from accepting stress challenges and this is termed as allostatic load which impairs normal levels of stress mediators such as cortisol (CORT). Changes in cortisol levels have been associated with a number of factors and the recent has been links between vitamin D deficiency (VDD) and lifestyle stressors. There has been an inverse association noticed between serum 25 (OH) D and postpartum allostatic stress and another similar one seen in preeclampsia patients too. Studies dealing with VDD’s link with stress has been inconsistent. Vitamin D3 supplements suppressed HPA-axis activity. While it was positively linked to coffee consumption in Koran participants another study in Saudi Arabia excluded coffee consumption as a contributing factor for VDD. Though we have a few studies linking VDD with obesity biomarkers such as hip, waist, weight and BMI we don’t have definite results relating VDD to lifestyle stressors. A study tried to analyse the relationship between VDD and lifestyle stressors in healthy Jordanians.

The study included male and female Jordanian Applied Science University students and their Anthropometric and lifestyle habits were noted with the help of a questionnaire. There were 371 participants who were eligible for analyses. Their serum 25(OH)D levels, serum CORT levels and serum PTH levels were measured using different techniques. All the participant were between 17 and 52 years of age and their mean serum 25(OH) levels was 12.2 ng/mL and this is classifiable under vitamin D deficiency. PTH, ionized calcium and phosphate besides serum morning cortisol were within physiological limits. 72% participants were females and some of the common positive traits observed among most of the participants in the study includes adequate sleeping hours during night, morning sun exposure, non-smokers and living with their family.

Anthropometric parameters showed very weak positive correlation with VDD, a poor correlation was seen between vitamin D levels and exposure to sunlight, larger number of family members implied severe VDD levels, LDL-C and TC showed a weak correlation with VDD severity.

Cortisol & Weight Changes
Stress rules the world, it rules our actions and even the choice of our foods. Effect of stress varies depending on the type and duration of stressors. Acute stress (developed as a result of exposure to some traumatic event) supresses appetite while chronic stress increases hunger and intake of high-fat and energy-dense foods. Chronic stress has been linked with obesity/overweight issues in a number of studies. Effects of chronic stress has been linked to disturbances in the HPA axis due to which cortisol hormones are secreted. This secretion triggers hunger hormones and increases intake of high-fat foods. The clear link between food cravings, stress, cortisol and appetite-inducing hormones are not understood until now.

A group of researchers tried to understand whether increased chronic stress, cortisol and appetite-related hormones triggered food cravings and weight gain. 339 participants aged between 18 and 50 years who were not pregnant, taking meds for any psychiatric disorders or suffering from chronic medical conditions were involved in the study. All of them underwent a biochemical evaluation after overnight fasting, psychological measures and a self-report questionnaire. Height and weight were measured at baseline.

Chronic stress was measured using a 62-item questionnaire in which items were rated as not true, some to very true. Questions included those on relationship with family, difficulties in work and home environment, etc. Food cravings were measured using a 28-item questionnaire rating each food on a scale of 1 (never) to 5 (always/almost every day). Items were split into four sub-categories-sweets, high fats, carbohydrates/starches and fast-food fats.

Results
Among the 339 participants almost 57% were females. Males had increased cravings for high fats and had high glucose levels. Females had higher ghrelin, leptin, cortisol and chronic stress besides cravings for sweets. Baseline BMI was positively associated with total and specific food cravings. Total food cravings were positively associated with leptin, insulin and glucose. Morning cortisol was inversely linked to chronic stress, cravings for high-fat foods, leptin and insulin. Leptin was positively associated with total food cravings. Cross-sectional model did not show any association between cortisol, chronic stress and weight. But cortisol, leptin, insulin and stress did not predict changes in food cravings over time.

Of the total participants almost 50% of them gained weight over the 3-month study period. Individuals with higher baseline cortisol gained an average of 1.12±0.33 kgs while those with a lower baseline cortisol gained 0.530.37 kgs. It was observed that higher baseline cortisol, insulin and chronic stress implied greater weight gain from baseline to 6 months.
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Hence, it is imperative that each of take care and eat well to optimize cortisol levels in the body. It is an essential hormone which works wonders when the levels are balanced but which also has the ability to create tremors when the levels go too low or high.

References
The Effect of Diet Components on the Level of Cortisol: https://link.springer.com/article/10.1007/s00217-016-2772-3
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Correlation of Selected Stress Associated Factors with Vitamin D Deficiency in Jordanian Men & Women: https://www.dovepress.com/correlation-of-selected-stress-associated-factors-with-vitamin-d-defic-peer-reviewed-fulltext-article-IJGM

Stress, Cortisol and Other Appetite-related Hormones: Prospective Prediction of 6-Month Changes in Food Cravings & Weight: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373497/

What is Cortisol? https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/cortisol

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