One of the things I deeply enjoy my work is that it gives me the opportunity to constantly learn. It is my goal to look back on my treatment plans from 1-2 years ago and shake my head at how ignorant I was back then.
A student recently asked me how much time I spend studying and my answer was about an hour a day – between researching specific topics for patients, diving into subjects that have caught my attention, finding an area I’m weak on, reading a handful of blogs, books, and videos by experts, etc.
So in the vein of continuous learning, here’s a little something I recently uncovered while studying more about cortisol.
If you’re not up on cortisol, it’s one of our primary stress hormones secreted by our adrenals.
It’s definitely a Goldilocks hormone, too little is bad, and too much is also bad.
Chronic stress tends to derange the adrenal glands and disturb our cortisol leading to what is commonly called “adrenal fatigue”.
But, as with most things, it’s more complicated than that. Now we understand that it’s not just the cortisol produced by our adrenals, but certain tissues like fat, the liver, and other tissues have enzymes that can actually recycle cortisol and keep their cortisol levels up independent of what’s in the blood.
Whoa! That certainly complicates things…
“…intracellular cortisol levels within target tissues can be controlled by local enzymes. …thereby amplifying cortisol levels and glucocorticoid receptor activation in adipose tissue, liver and other tissues…there is evidence that it adjusts local cortisol concentrations independently of the plasma cortisol concentrations…[in mice] these data support the use of 11beta-HSD1 inhibitors [enzyme blockers] to lower intracellular glucocorticoid levels and treat both obesity and its metabolic complications….in human subjects…[inhibiting these enzymes and lower cortisol] enhances insulin sensitivity.”
“Obesity is closely associated with the Metabolic Syndrome, which includes insulin resistance, glucose intolerance, dyslipidemia and hypertension. The best predictor of these morbidities is not the total body fat mass but the quantity of visceral…fat [belly fat]. Glucocorticoids play a pivotal role in regulating fat metabolism, function and distribution… The role of glucocorticoids in prevalent forms of human obesity, however, has remained obscure, because circulating glucocorticoid concentrations are not elevated in the majority of obese subjects. Glucocorticoid action on target tissue depends not only on circulating levels but also on intracellular concentration…[cortisol in the fat tissue] is commonly elevated in fat depots from obese individuals. This suggests [that tissue cortisol is an important factor] in obesity and the Metabolic Syndrome…In adipocytes [fat cells], both antidiabetic PPARgamma agonists and LXRalpha agonists [diabetic drugs] significantly reduce 11beta-HSD1 mRNA and enzyme activity [the enzyme that is primarily responsible for recycling cortisol], suggesting that suppression of 11beta-HSD1 in adipose tissue may be one of the mechanisms by which these drugs exert beneficial metabolic effects.”
Measuring cortisol in the blood doesn’t necessarily tell you about how much is in the tissues because some tissues, particularly fat can recycle their cortisol and may have high levels inside the tissue even though it’s low in the blood.
High cortisol in the fat tissues seems to play an important role in the complications of obesity like high blood pressure, insulin resistance, and messed up cholesterol levels.
Diabetic drugs seem to, at least partly, block the enzyme that primarily recycles cortisol, lowering the amount of cortisol in the cells and lessening the bad things.
UPDATE: Many other great docs out there have talked about how our idea of “adrenal fatigue” has evolved over the years, and while I still use the term, we recognize now that for many people it’s not really “low cortisol” that’s the issue, it’s a deranged “stress response”.
Most people don’t need more cortisol (although some do!), they just need to get everything balanced out.
I also rarely do cortisol saliva tests any longer, as for most people, I generally find they don’t provide valuable, actionable information that can’t be gathered elsewhere.
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