We are going to talk about something that all of us deal with on a daily basis that can also affect our health and quality of life: CORTISOL. What is cortisol and why is it so important to our health and well being?

Cortisol is normally produced by the adrenal glands, located just above the kidneys. It belongs to a class of hormones called glucocorticoids, which affect almost every organ and tissue in the body. Scientists think that cortisol has possibly hundreds of effects in the body. Cortisol's most important job is to help the body respond to stress. Any of you ever deal with stress?

Cortisol has many functions. Some of which are actually very good and beneficial. Cortisol aids in the regulation of blood pressure and cardiovascular function as well as the regulation of the body's use of proteins, carbohydrates, and fats. Cortisol secretion increases in response to any stress to the body, whether physical such as illness, trauma, surgery, and temperature extremes, or even psychological stress.

Because cortisol is so vital to health, the amount of cortisol produced by the adrenals is precisely balanced. Imbalanced cortisol secretion leads to a negative cycle, which goes something like this: elevated cortisol secretion from physical or mental stress causes fat, protein and carbohydrates to be rapidly mobilized in order for you to take action against the stressor. This is sometimes referred to as the 'fight or flight' response. The mobilization of these nutrients in addition to epinephrine and a number of other endocrine hormones allows you to take quick action when presented with stress. During this mobilization, cortisol and adrenaline increase while DHEA (dehydroepiandrosterone) and testosterone decrease (and DHEA and testosterone are things we do not want decreased on a regular basis!) A chronic elevated cortisol level causes your body to enter a state of constant muscle breakdown and suppressed immune function, increasing your risk of illness and injury while reducing muscle.   I am sure none of us wants our immune system suppressed, our muscle being broken down or an increase in the risk of illness and injury. So, we've gotta control that stress and chronic release of cortisol! Did you know that for most people, cortisol levels are highest in the early morning around 6-8 am and are lowest around midnight?

Some of the other important things that cortisol does for us:

- Breaks down muscle protein, leading to the release of amino acids (which are the "building blocks" of protein) into the bloodstream.
     

- These amino acids are then used by the liver to synthesize glucose for energy, in a process called gluconeogenesis.
     

- This process raises the blood sugar level so the brain will have more glucose for energy.
     

- At the same time, the other tissues of the body decrease their use of glucose as fuel.
     

- Cortisol also leads to the release of so-called fatty acids, an energy source from fat cells, for use by the muscles.
     

- Taken together, these energy-directing processes prepare the individual to deal with stresses and ensure that the brain receives adequate energy sources
     

Cortisol also helps to:
- Maintain blood pressure and heart function
- Slow the immune system's inflammation response
- Balance the effects of insulin in breaking down sugar for energy
- Maintain proper arousal and sense of well-being

So,  cortisol is our friend. But, just like anything, too much is where we run into our problems when we have chronic stress and our bodies begin to deal with too much cortisol. I'll bet every one of us have experienced both the positive and negative impacts of cortisol.  You've been able to manage tough situations, or rise to the occasion due to the benefits of cortisol, but probably also felt some of the negative side effects of too much (chronic) cortisol release.

Physical Signs of Chronic Stress:
Joint pain
Muscle weakness
Chronic fatigue
Obesity
Digestive problems
Excess belly fat which is associated with a greater amount of other health problems than fat deposited in other areas of the body (like strokes, heart attacks, and metabolic syndrome)
High blood pressure
Elevated blood glucose which can lead to insulin resistance

Emotional Signs of Chronic Stress:
- Nervousness
- Anxiety
- Depression
- Feeling loss of control
- Irritability
- Craving carbohydrates
- Insomnia or difficulty falling asleep

When you are dealing with chronic stress and your body is over burdened with too much cortisol, it can lead to:
Emotional over-eating
Illness after a big race or completing a stressful project
Getting sick when you go on vacation
Mental preoccupation with a stressful event
(Source: Griffin J., Ojeda S. Textbook of endocrine physiology, 3rd ed. New York: Oxford University Press, 1996)

Now that we know that too much stress (and hence, too much cortisol in our systems) is creating all these problems, and because we want to be happy and healthy, how do we deal with all our stress?

Tips for Dealing With Stress
1. Don’t worry about things you can’t control, such as the weather or slow drivers in front of you.
2. Start with the little stuff.  Solve the little problems which can help you gain a feeling of control and build your confidence to tackle the bigger stuff.
3. Prepare to the best of your ability for events you know may be stressful, such as a job interview or a race, then relax and just enjoy the actual event.
4. Try to look at change as a positive challenge, not as a threat. I don't really like a lot of change, so for those of that struggle with this, I'm with you!
5. Find someone you can talk to about anything. It could be a trusted friend, family member or even your coach.  My husband is a very smart man and has learned to do lots of listening when the need arises.
6. Set realistic goals at home and at work.  Don't put unnecessary stress on yourself by creating unrealistic expectations (but realistic goals are super duper AWESOME!)
7. Avoid over-scheduling. 
8. Exercise on a regular basis.  You can't prioritize this out of your day. It is too valuable for every facet of your life. You know you love it and you know that it makes everything better, so do it!
9. Eat regular, well-balanced meals. Not only will it help you stay lean and strong, but it will help you manage stress.
10.Get enough sleep.  If you are not giving your body a chance to recover from all your crazy daily demands, it won't be able to manage what you're going to throw at it the next day- and the next, and the next!
(*Source: American Academy of Family Physicians)





A few additional notes for all endurance athletes... I found a really great article on TriFuel that covers a broader range of cortisol and its effects on athletes:

What is cortisol? Cortisol, known as the regulator of immune response, is a hormone controlled by the adrenal cortex. This powerful hormone is also known as an adrenalcorticol hormone, a glucocorticoid and hydrocortisone or simply cortisone. Cortisol has a catabolic (muscle breakdown) effect on tissue and is associated with a decrease in anabolic (muscle growth) hormones like IGF-1 and GH. Thus reducing levels of cortisol is ideal for an athlete to achieve tissue growth and positive adaptations to exercise training. Playing many different roles in your body, cortisol can have a negative impact on sleep, mood, sex drive, bone health, ligament health, cardiovascular health and athletic performance, potentially causing fatigue and inflammation. Its primary functions are to increase protein breakdown, inhibit glucose uptake and increase lipolysis (the breakdown of fats).

How do I know if my cortisol levels are high?
Mood swings, lack of motivation to train, loss of muscle and loss of appetite are all symptoms of an elevated cortisol level. Sound familiar? That's right, over-training syndrome. If you are not taking steps to modulate your cortisol, you are breaking down your muscle, storing fat and getting sick, all of which don't make for a fast racing season. A more scientific approach is to have your testosterone/cortisol or IGF-1/cortisol levels tested. A suppressed ratio of either IGF or testosterone over cortisol is a sure sign of decreased exercise capacity and over-training. There is also strong evidence that athletes exercising in a carbohydrate-depleted state experience greater increases in cortisol. Decreased frequency of menstrual periods in women (amenorrhea) has been linked to insufficient energy availability which triggers a stress hormone response and suppresses estrogen and progesterone (Loucks et al., 2004).

What affects cortisol secretion?
 Stress, which includes trauma, infection, disease and exercise, is the primary factor that dramatically raises cortisol levels. Wait a minute, exercise is a stressor? High intensity exercise and prolonged exercise both increase cortisol levels, which remain elevated for about 2 hours following the exercise bout. Repeated exercise without appropriate rest results in chronic elevated cortisol. Additionally, poor diet, inadequate supplementation and lack of rest also play key roles in cortisol secretion.

How does cortisol affect my endurance performance? 
It is only with chronic elevated cortisol levels that your performance will suffer, but the effect is dramatic. Excess cortisol suppresses your immune system, producing a greater risk of upper respiratory infections. On top of that, your body will be in a catabolic state -- breaking down muscle and storing fat. In addition to reducing your muscle and getting sick, suppressed testosterone means suppressed recovery. Aerobic and anaerobic muscle fibers need time to repair and recover from hard workouts to improve their capacity to exercise. Elevated cortisol and suppressed testosterone do not allow you to maximize your recovery, leading to slower performance gains. A Swiss study of elite male cyclists suggested that ratios of anabolic to catabolic hormones (ie. testosterone/cortisol or IGF-1/cortisol) may be useful markers for the detection of over-training (Hug et al. 2003). In fact, scientists use this Free Testosterone/Cortisol ratio to evaluate an athlete's training state. Daley et al. (2004) showed a strong relationship between elevated cortisol and decreased testosterone that was most dramatic 30 minutes after endurance exercise to exhaustion. A ratio where cortisol is elevated indicates over-training, so the modulation of this ratio can be key for those athletes who are susceptible to over-training. Additionally, amenorrhea in women and low testosterone in men may increase risk for stress fractures.

Now here's a few points from The Endurance Research Board...

Evidence that cortisol response to exercise can be modulated:  Although true resting levels of cortisol do not differ between trained athletes and sedentary controls, exercise and recovery periods are associated with elevated cortisol release. Even 15 minutes of submaximal cycling exercise has been shown to elevate post-exercise cortisol levels in the saliva (O'Conner et al. 1996). A study of marathoners (Cook et al., 1987) found salivary cortisol levels to be elevated during the race, but were maximal at 30 minutes after race completion. Cortisol release in response to exercise appears to be altered depending on the time of day that exercise takes place (Kanaley et al., 2001). Cortisol levels were much higher during and after exercise at 7am than at 7pm or midnight. Double sessions for one hour and fifteen minute bouts at 75% of VO2 max were found to elicit higher cortisol response if only separated by 3 hrs of rest versus 6 hrs rest between bouts (Ronsen et al., 2002). Carbohydrates consumed during exercise have been shown to decrease the immune and cortisol response within 30 minutes after 6 x 15min maximal running bouts when compared to a non-caloric, sweetened placebo (Bishop et al., 2002). There is strong evidence that athletes exercising in a carbohydrate-depleted state experience larger increases in circulating stress hormones (cortisol) and a greater suppression of immune function (Braun, 2004). An important take home message for athletes and coaches: the regulation of blood and body glucose levels is within the athlete's control and this can seriously impact their health and ability to enhance their exercise performance and training adaptations.

By Sally Warner, Ph.D.
How can I modulate Cortisol?


Cortisol can be modulated through rest, nutrition and supplementation. First, since repeated bouts of exercise cause chronic elevated cortisol, it is key to get plenty of rest between workouts. Double workouts in one day are detrimental if there is not sufficient rest between the workouts. Next, as mentioned earlier, depleted carbohydrates leads to higher levels of cortisol, so keep up your carb intake. Don't bonk! Finally, there are a number of supplements that are also helpful in modulating cortisol. A blend of high levels of B vitamins, branched chain amino acids, glutamine and key adaptogens like ginseng, rhodiola and ashwaganda all help you adapt to 'stress' by helping regulate the body's endocrine hormones also known as the 'fight or flight' response to stress.

Recommendation: Since the scope of this newsletter is nutrition, we will detail our nutrition and supplement recommendations and briefly list lifestyle changes which help modulate stress. The most important step is to reduce any unnecessary stress in your life. Although sometimes the most difficult thing to do, it is also the most effective, so make sure to manage the stress that you cannot eliminate. Time management, relaxation methods, yoga, and hobbies are some effective techniques. Complementary to managing stress, it is crucial to stick to a sensible diet. Poor nutrition -- including high fat or high protein diets -- can adversely affect cortisol control. In times of high stress many of us crave these types of meals which we know are detrimental to our health. It is also important to maintain carbohydrate intake that supports training hard and good health while doing so. A recent study by Green et al. (2003) supported carbohydrate intake during endurance exercise to reduce blood cortisol levels for up to 1 hour after exercise. A literature review of hormonal responses to exercise by Steinacker et al. (2003) suggested that with glycogen deficiency, cortisol levels are elevated and induce a "myopathy-like state" in skeletal muscle. And it's not only what you eat but when. Make absolutely certain you have breakfast, which will help regulate your blood sugar and your cortisol prior to workouts. A recent study showed that a carbohydrate drink consumed during exercise (500ml per hour of a 6.4%) can reduce symptoms of overreaching during a period of high intensity, high volume training (Halson et al., 2004). To ensure that you do not deplete your glycogen stores, be sure to take in carbohydrates while exercising along with a high quality recovery drink with high levels of carbohydrates immediately following exhaustive exercise. The bottom line: do not attempt endurance training on a high protein, low carbohydrate diet -- it's a kiss of death.

A high dose of B vitamins and calcium can help regulate the endocrine hormones necessary for proper cortisol control. Supplementing with 4+ grams of branched chain amino acids (BCAAs) and 6+ grams glutamine following exhaustive exercise can have a dramatic effect on cortisol. In fact, in a 25-week study of intercollegiate swimmers the group supplementing with BCAAs and glutamine showed a significant decrease in serum cortisol.

For added cortisol control, consider some herbal applications. Adaptogens are some of the more popular supplements that help with cortisol control, which include ashwaganda, rhodiola and ginseng. By definition, adaptogens help the body adapt to high levels of physical and mental stress. The result is a controlled 'fight or flight' response that helps modulate cortisol levels. Another class of herbs common in Traditional Chinese Medicine (TCM: magnolia bark, theanine (from green tea), epimedium and tyrosine) have shown promise in regulating cortisol. A recently released book titled The Cortisol Connection by Ironman triathlete, cyclist and Ph.D. Shawn Talbott, goes into detail on these and other TCM herbs.

Coach Keena is a regular contributor at TriEdge and has 16 years experience coaching and training hundreds of individuals. She is a USA Triathlon Certified Coach and holds additional certifications from the National association of Sports Medicine (NASM) and the American Council of Exercise (ACE) as a certified personal trainer. If you would like to contact Coach Keena go to: www.coachkeena.com