Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
5 Jul

The Definitive Guide to Stress, Cortisol, and the Adrenals: When ‘Fight or Flight’ Meets the Modern World

One of my goals with this weekly column is to make significant human health issues easy to understand and discuss. I was pleased that last week’s piece, the Definitive Guide to Insulin, Blood Sugar & Type 2 Diabetes, garnered some rave reviews. The Case Against Cardio piqued some great conversation and interesting criticisms (one soul out there in the webosphere took issue with the fact that I positioned Cardio exclusively from my personal perspective as a runner rather than authoring a more scholarly article. Well wasn’t that spot on. It’s called my blog.) My opinions can’t please everyone, of course, but – based on my experiences and understanding – I am certain that contributing some insights on health in light of our (all together now) genetic blueprint is a worthwhile and timely endeavor.

Now to the topic at hand. Stress can make you gain weight, and it contributes to premature aging. Understanding how stress is related to your overall health and potentially even longevity is essential to achieving your health goals. But do not, repeat, do not go and buy yourself a bottle of Cortislim – just read this quick summary and you’ll know all you need to know.

Eerie, ain't it?

Ariel Amanda Flickr Photo (CC)

The adrenal glands are not unlike a walnut.

Understanding Stress

Most folks are aware that “fight or flight” is the body’s natural response to stress. When faced with a stressful situation, we either get aggressive or, in the words of a local surf instructor, we bail. This choice depends upon our perception of the circumstances and our corresponding judgment of the odds of success. The “fight or flight” response is, in terms of energy preservation, tremendously efficient. And it is very effective at ensuring greater odds of survival. This makes sense to everyone on a visceral level, but do you know the physiological mechanisms involved?

The fight or flight response begins in the brain. Various regions operate in concert to detect, sense, decode, and respond to a stimulus. Though there are a few different pathways for a given feeling (like fear) to travel, it is ultimately the hypothalamus that is responsible for triggering the fight or flight response. Once the hypothalamus goes to work, what I call your survival systems, i.e. the “gut”, kick into gear. They are the nervous system and the adrenal-cortical system.

Enter physical symptoms: sweating, heart palpitations, muscles tensing, hearing sharpening. You are now extraordinarily alert, but only on the issue at hand: concentration and awareness of anything else fly out the window. The nervous system has flooded your body with adrenaline (scientists often refer to this as epinephrine) and noradrenaline (norepinephrine). Meanwhile, the adrenal-cortical system (which produces these hormones) becomes activated by way of the pituitary gland. The pituitary gland secretes a hormone known as ACTH (adrenocorticotropic hormone…say that three times fast). ACTH journeys – via the bloodstream – to your adrenal cortex, where these small organs will pump out as many as 30 different hormones to address the stressful situation at hand (the adrenals are “fed” by cholesterol). And your immune system temporarily shuts down so your body can utilize all its resources to deal with the perceived threat.

The adrenal cortex produces cortisol, DHEA, estrogen and testosterone, among many other hormones. It’s a beautiful system. Unfortunately, what worked for our old friend Grok does not, I believe, work so well for us. Simply put, our modern lifestyle subjects us to a potentially enormous amount of stress on a daily basis that the body has simply not evolved to handle. To my mind it’s a bit like “deer in the headlights”. We have a big deer overpopulation problem in my area, and you always hear comments along the lines of how dumb the deer are around automobiles. Well, in my opinion they’re not so dumb – in evolutionary terms, after all, cars are very new on the scene. The deer simply haven’t adapted the appropriate stress response. Is it so different for humans?

Theoretically then, persistent, low-level stress – which the body unfortunately interprets as warranting a “fight or flight” response – is destructive to health. In other words, being stuck in traffic for two hours a day, every day, is the equivalent of a serious survival threat to your as-yet “primal” brain, and the adrenals pump accordingly. Cortisol serves many important functions, including the rapid release of glycogen stores for immediate energy. But persistent cortisol release requires that other vital mechanisms effectively shut down – immunity, digestion, healthy endocrine function, and so on. Among other stress-health associations, the link between elevated cortisol and weight gain has already been established.

At this point I hope you can begin to imagine the potential health ramifications of what is often called “adrenal fatigue”: daily compromised immunity, continuous stress hormone release, being “on edge” generally, exhausted sex hormones (remembering my admittedly pet theory of why male endurance athletes often suffer from diminishing testosterone production and consequent receding hair). Your body thinks it must survive at all costs – and is there ever a cost.

Though I’m no Green, nor do I think moving to the woods to commune with the grubs is a viable (or desirable) solution to mitigating stress, the tremendous volume and scope of stressful stimuli present in the modern, fast-paced lifestyle may play a very critical role in the high rates of diabetes, metabolic syndrome, obesity, depression and anxiety we’re seeing (among many health problems). At any rate, I firmly believe this to be so. (Humorous note: apparently shopping is physically stressful for men. But then, planning holiday events and managing social obligations is stressful to women. At the risk of announcing my bah-humbugness to the world, the holidays are inordinately stressful to everyone.)

Managing Stress

Managing stress, then, is paramount to maximizing optimal health. To the extent that you can, reduce the “noise” in your life – from entertainment, from frivolous or excess obligations, from fractious relationships, from debt, and so on. Managing stress is a very big topic indeed, and we’ll be addressing it more in future posts. For now, here are the key factors I believe are necessary to reducing stress:

Consume antioxidant-rich foods such as fruits and vegetables. I also recommend a multivitamin that contains a comprehensive and potent antioxidant profile. Completely avoid processed, empty calories found in snacks, junk food and fast food.

Consume adequate beneficial fats to utilize antioxidants, vitamins, enzymes and co-factors. Wild Alaskan salmon, pure fish oil pills, olive oil, nuts and avocados are good places to start. I don’t go in for the Omega-enhanced Tropicana or miracle mayonnaise, personally.

Manage expectations: your own and others’. Ambition and motivation and generous support are all great traits to possess. But don’t over-promise to others or yourself. None of us knows the future.

Exercise daily. I cannot stress this enough. Exercise releases endorphins and helps to regulate the production of critical brain hormones.

Unhook daily. Most of us spend so much time on the input-output cycle, we don’t give adequate time to simply absorbing it all. Reflect, relax, restore. I personally like to spend a little time each day reflecting on what I am grateful for (I call this doing my “appreciations”.) Prayer, meditation, singing, cooking and other activities that get you out of your head and into the moment are vital to helping you manage the stress of constant stimuli and energy demands. “Think positive” is nice advice, but it’s tough to do if you are at your limit. It’s easier to find an action that naturally lends itself to positive thinking and feeling, rather than trying to control your thoughts. That in and of itself can become stressful. Find an immersing action that works for you and do it religiously. Fuming not recommended.

Further reading:

More Primal Health posts

Managing Stress: 10 Tips

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Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Hi Mark,
    I am so grateful for your newsletter… it makes perfect sense.
    I was diagnosed (finally) after several years of health problems and weight gain with cysts on my left kidney and adrenal gland… I have worked very hard to change my diet, no more chemicals, processed foods, organic as much as possible, no more wheat and very few starches (most of the time!). I am off all prescription meds, was even able to quit my high bp medication which was a biggie, since it tended to make me tired constantly. I have lost 75 pounds, and still would like to lose 75 more. When I went a month without losing weight, I began to work out daily, weights and treadmill. These last few weeks the weight loss has started again. My question is – I still feel the effect of the cyst on my adrenal glands, the jumpiness, heart palpitations, over-sensitive hearing… I sleep very little. I meditate, and have a gratitude time before I jump out of bed in the morning, and have cut nearly all caffeine out of my diet (except green tea in the morning). I no longer watch tv (had direct tv disconnected, only occasionally catch up on the news, am learning how to rephrase negativity in my life in positive ways…What else can I do?
    Thanks so much for any suggestions you can give me!
    I am now experiencing thinning hair (not great for a woman!)

    Betty wrote on November 22nd, 2008
    • I know this was posted about 3 years ago but would like to reply anyways.
      I’ve had heart palpitations my entire life. In fact, my heart would ache several times a year and mimic a heart attack. My entire left side of my upper body would be in so much pain I had to lift my left arm up to drain the blood.

      And I had all this while weighing 135 lbs at 5’10” (female).

      Finally by age 35 I had an allergy test done (outdoor stuff) and got allergy shots…which completely got rid of the heart palpitations but not the “mimicing” of heart attacks. Then I found MDA, started eating primal and upped my saturated fat intake. It’s been 1 year and I’ve had 2 of those little heart attack episodes (never actually went to a doctor to get it checked out, of fear they’d find something bad). Those 2 little “heart attacks” were not as severe and happened at the beginning of going primal…and have completely stopped now. No more heart pain, palpitations or mimicing heart attacks.

      Just recently I’ve read an article stating that the heart muscles energy comes EXCLUSIVELY from saturated fat.
      A light bulb came on….

      Donnersberg wrote on April 17th, 2011
      • Hi Donnersberg, I am happy to hear that the primal diet is working for you as well. I used to have the heart problems too; and no wonder, considering that I used to follow the “low-fat” diet that CW is preaching. Your post just reminded me that I also have stopped having these heart problems after I had been primal for about 6 months or so. Have been primal for about 12 months now but I am still trying to recover from the adrenal dysfuntion. A slow process but I am making progress. I am hoping to give Mark a success story by the end of this year :o)

        Kitty wrote on April 17th, 2011
      • I’ve had heart palpitations my entire life. In fact, my heart would ache several times a year and mimic a heart attack. My entire left side of my upper body would be in so much pain I had to lift my left arm up to drain the blood.

        I know this is an older thread but I have these exact same heart issues. In fact, last year I thought I was having a heart attack and went to the hospital. They did all the tests, even an angioplasty, but they said that it wasn’t a heart attack; although my left heart chamber had less than 10% blockage which they said was common. They put me on a low fat diet. My heart palpitations still persisted.

        Anyway, I discovered the whole Paleo/Primal scene in December and it has taken me about 6 months to digest it. I am one month into a paleo/primal diet and I am losing weight and feeling better but I still do get those heart palpitations from time to time.

        Has anyone else experienced this? If so, what helps to alleviate or eliminate this?


        Brian D wrote on June 7th, 2011
        • Hey, another thing that can cause this heart attack mimicking is the ‘coccidiosis virus’ and it can infect the heart. I had it, and my functional medicine doctor, who was formerly head of cardiology at a nearby hospital, cured me of it somehow without using antibiotics of any kind. Something to think about. You can Google more about it and find out more… Hope you are still around?

          Jacks wrote on April 6th, 2016
    • Hello you and I have a similar issue. I have a rare form of benign spinal tumor, likely caused from spinal trauma inflicted by an anesthesiologist. Up from the tumor runs a cyst as well. I also have pressure on adrenal nerves. The tumor is pressing on my leg nerves and they don’t work. No amount of wishing or therapy is going to change the fact that when the nerve is damaged or pressure is applied that it can cause problems and I see the same issue with the adrenals. That being said, I’d suggest following up with an endocrinologist or two. If the cyst is pressing the nerves, it can cause system disruption that no amount of positive thinking or diet changes will help (though I’d recommend both as well).

      You can start with an at home coritsol test, it should give you an idea of how coritsol is running. Other levels need to be serum tested in a lab, thyroid, glucose, etc.

      I have a perfect running body system and am young, so I’m a fairly good control. Perfect organs, bp, nutrients, etc. The low coritsol from the adrenal fatigue made it so I had no energy to even handle basic life issues. It’s something that has to be regulated. If you have trouble with docs, please don’t loose heart, it’s a complicated issue and will take time to resolve.

      Best wishes.

      Von wrote on November 9th, 2013
    • Dear Mark,

      I just want to applaud you on your blog and the amount of precious information you make available in a clear and structured way. Bravo!!
      I’m glad I came across your blog and have spent hours reading many of your posts in the last week. I’m a physician myself and will totally use these concepts when trying to help patients (almost all…) with metabolic issues.
      Thank you!!

      Daniel Leal wrote on February 7th, 2014
  2. Hi Mark,
    I have only just found you after doing extensive research on the internet to find ways to cure myself. I have been on the decline for years. First I was told that I was hypothyroid and I have sooo many health problems. Too numerous to mention. Now it also appears that I have adrenal fatigue. It has taken many visits to the doctor before he would even listen to me and do the tests. Now I have to work out how to get back on track. I have been trying to read as many articles of yours as possible. So far they have been very helpful :) I guess there is no quick way to solve all of my health problems, and reducing my stress levels would be almost impossible in the life situation I am in. I will try your primal diet and do the best I can. Hopefully it will not take too long before I can even do the simple things again (like get up the stairs to my house). I am a type O blood type and I love to do exercise (especially martial arts). The fact that I have been too weak and exhausted to do so has also caused a great deal of depression.
    Thank you for your newsletters.

    Angelina wrote on January 17th, 2010
    • Hi Angelina,
      Reading your comment was like having you talk about my life this past year. I’m a long distance trail runner, and now I can’t even hike. The diagnosis started with autoimmune hypothyroidism, then adrenal stress, now autoimmune diabetes. I’m seeing integrative doctors and they put me on all sorts of supplements as well as Armour and Cortisol, but my energy level is still extremely low. And not being able to run is causing me severe depression. I eat very healthy – mostly organic greens, a little fruit and organic meat…no carbs since my body can’t handle it. Please let me know if anyone has any suggestions. I need help to get out of this. Thank you. Anny

      Anny wrote on June 12th, 2011
      • Hi Anny, I WILL get back to you after my exams :o) I have kept with the primal diet and I am seeing some improvements. It is a slow process though…and I have kept the carbs really low, stayed very strict, and increased fats. I have also been taking herbs and vitamins that provide adrenal support and taken lots of rest. One of the important things is also to remove some of the things in your life that might be causing you stress and also don’t over-exericse…and get lots of sleep. I also gave up fruit because of the fructose..For the first time in two years I was able to do 3 miles on my exercise bike…but would still be no good at running up and down hills etc. I did start reading a book a couple of weeks ago that might be of interest to you called Chi Running by Danny Dreyer. If you get the 2009 edition from it is a full revised edition that starts with Chi Walking and will guide you on how to run effortlessly without strain or injuries…
        Will get back to you after my exam..
        Best Wishes.

        Angelina wrote on June 12th, 2011
      • You may have Lyme Disease. I got bit about 6 years ago by those large animal-biting flies you see on dairy farms. The Lyme is very hard to detect. You need a doctor who believes Lyme exists.
        My fatigue was awful along with serious depression. I could barely function. I also had headaches and involuntary tremors and pain in my arms and legs. Lyme is very tenacious and difficult to treat. It mimics other sickness and disorders. You really need to find a good lyme doctor if you want to check that out.

        NELLIE MARTIN wrote on October 24th, 2011
        • I was diagnosed 3 years ago with late Stage Lyme Disease. As near as I can figure, I was probably bitten somewhere between 1985-88. There came a point when I could no longer go camping or walk long distances, so that’s aprt of how I know, plus remembering a tick bite that my MD ignored. Since I was in school and working full time I thought my problems were due to stress. My MD said I was just getting older. (40?) Finally, after 9 years of watching pain and neuropathy creep up both legs, I got scared when it started in my arms. I complained to my sympathetic gyn and she did tests, which showed Lyme and Epstein-Barr. My CD 57 was 22, which showed how sick I was. My Vitamin D level was 9. She said I was barely a carbon-based life form…lol! After 3 years of antibiotics, my asthma has gone away. I’m hoping my Hashimoto’s and insulin resistance will go away, too. For 16 years I was an EMT, working in the E.R. and pretty strong. Now I feel lucky to have escaped with my life and most of my mind. I take Paracetim for memory loss, and supplements to help with Lyme neuropathy. I hope you are feeling better now.

          Becky wrote on October 25th, 2011
  3. Mark, someone commenting on another blog has been saying that too much protein raises cortisol (I get that it can raise insulin, but cortisol?) and gives this as a reason low-carb is supposedly bad for the metabolism. She also claims that insulin is anabolic and so needs to be balanced with cortisol, which is catabolic. It sounds off to me, but hey, I’m no endocrinologist. This all came up in the context of Jimmy Moore announcing he’s eating just eggs, butter and cheese for the time being to reverse his recent weight gain. Apparently his metabolism is so broken that even limiting himself to 30 or so grams of carbohydrates a day is not enough to stop weight regain. He also says he’s breaking his diet soda habit at long last.

    So my question, is there any truth to the assertion (by Matt Stone and others) that low carb could actually damage your metabolism? Even if you’re eating moderate protein, high fat? Thanks for any light you can shed on this.

    Jeanmarie wrote on March 31st, 2010
  4. I believe a diet that is too low in carbs would certainly lead to an increased cortisol level and maybe weight gain. This would be especially true with females. My female friends who do low carb always complain about this. As soon as they add 10 to 20 more carbs everyday the weight starts coming off and they feel better. Then again some people feel fine on an all meat diet. I know that I do better with almost no carbs.

    Marc wrote on April 1st, 2010
  5. So “too low in carbs” is still an individual thing, only to be established by trial and error?

    Jeanmarie wrote on April 1st, 2010
    • I agree that it is still an individual thing too. I have also heard that females do better with a little more carbs than the men. But I have always thought my system ran more like a males, and it appears that I was right. I also had some tests done not long ago and my doctor, to my surprise, said “your more like a male”. I tried to eat just a little extra carbs and it was doing me no good at all. I cut them out almost entirely and now I am starting to slowly get better from all of my above health problems. We are certainly all individuals!

      Angelina wrote on April 1st, 2010
      • New reply to old post.
        I have thought for awhile that females needing somewhat more carbs may be due to the hunter-gatherer lifestyle itself. I am sure that Grokka ate some of the plants as she gathered them so she didn’t need to develop the means to turn protein into carbs as much as the hunting males did. I need SOME carbs but the slower the better; cut them back too much and I am fighting w/hypoglycemia. If I eat fruit for/with breakfast I have cravings all day; can’t get satisfied by whatever I eat.
        Looking forward to finding out more about the effects of cortisol.

        shrimp4me wrote on October 14th, 2013
        • I had similar issues with eating fruit & making me extra hungry after. No matter how I balanced my meals/snacks with protein/carb/fat the fruit set off my appetite! I’m studying to be a Registered Dietitian and currently specialize in IBS/thyroid/adrenal related issues. I wanted to let you know what I found after tons of self study into my imbalances that caused chronic hunger & hypoglycemia. By way of speciality testing: spectracell (nutrients intracellular), MRT Leap 150 (food sensitivities/chemicals), & comprehensive stool analysis test (gut flora balance) I saw inside what was out of balance do I could rebalance.
          I had a candida/yeast/wheat/dairy/and a fair amount of other offending foods, a severe imbalance in my gut flora, even after being primal/gluten free/dairy free I had some major nutrient deficiencies due to gut flora effecting my enzymes & ability to absorb nutrients, chromium was very low (hypoglycemia & sugar cravings, calcium, vitamin D (even after 2 years, of supplementing with 2,000 iu, now I take 5,000), a couple amino acids, zinc, so my adrenals were off= thyroid off (hypothyroid), digestion was off (Candida albicans) but after a month of avoiding candida feeding foods (only very small portions of low sugar fruits), digestive enzymes/probiotics/cultured veggies/vitamins where I tested extremely low/fresh real food cooked daily/avoidance of moldy foods/adrenal supplement/modified daily exercise/and stress reduction BALANCE is coming back & I can eat potatoes/fruit with my main meals and feel energized/satisfied/stable. It takes self discovery, & maybe some special antifungal a if candida or parasites are wrecking your gut flora
          “Food is Medicine”

          Anon wrote on December 29th, 2013
  6. This blog has excellent information and confirms much of what I was clued. Please continue to post great information as I am a reader who values it, because I’m trying to lose weight (I use to lose easily) and get healthy again. 30 lbs. to go….off and away.

    Lena wrote on April 12th, 2010
  7. Thanks for writing this.

    1) You recc. exercising daily. However, didn’t we also agree that you shouldn’t exercise daily (overtraining article)?

    2) Isn’t baldness caused by DHT, which is related to testosterone? ie: Wouldn’t it be: HIGH stress -> low testosterone -> less DHT -> LESS bald ?

    LooksYoungerThanHeIs wrote on May 7th, 2010
    • I think by ‘exercise’ he means just moving the bones in general…not actually sweating your armpits off doing cardio.

      Means don’t get up in the morning and schlepp yourself to the couch where you remain watching TV until bedtime.

      Taking the dog for a walk, go to the park, walk around the mall and check out the newest silly outfits, play ball, rollerskate, go swimming, even going to the library and read a couple pages of books of interest without sitting down.
      I personally love going to the outdoor hot tubs, the smell of sulfur and slimey mineral water on my skin is so refreshing :-)

      Donnersberg wrote on April 17th, 2011
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    px90 exercise program wrote on July 13th, 2010
  9. I am interesting in following your exercise recommendations, but for someone who already has adrenal fatigue, what is the best approach? Intense exercise (such as lifting heavy weights or sprints) really whacks me, and it seems like it would just put more stress on the adrenals? Would you tweak your recommendations in this case?

    Sydney wrote on August 29th, 2010
  10. One of our personal trainers just wrote a blog post on the effects of Cortisol.

    The Foundry wrote on September 14th, 2010

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