Friday, February 19, 2010

Cortisol White Paper

Going through some of my older articles, I came across this White Paper that I wrote for a physician’s group when I was serving as Director of the University of Utah Nutrition Clinic. This must have been about 2004 or so - between the time of writing The Cortisol Connection and serving on the Nutrition Faculty at the University of Utah - and before I left the University to establish my own Nutrition R&D Lab (GLH Nutrition - “GLH” stands for “go like hell”). Although my thinking (and the research evidence) about chronic stress and cortisol overexposure has been refined a bit since 2004 (we now know that it is “metabolic balance” - or the balance between different biochemicals including cortisol and testosterone and dopamine and norepinephrine and insulin) - that is most important for optimal mental and physical functioning, the paper below is still very relevant for improving health in our over-stressed world. Enjoy!

The Cortisol Connection –

Why stress makes you fat and ruins your health… And what you can do about it

By Shawn M. Talbott, Ph.D., FACSM

Stress is the number-one reason for a trip to the doctor’s office. Stress is also cited in survey after survey as the primary lifestyle factor over which respondants would like to “gain control.”

Why is stress so detrimental to health? Largely because any kind of stress, whether emotional or physical, leads to an increased production of the body’s primary stress hormone – cortisol. Elevated levels of cortisol – as a result of our modern fast-paced, high-stress lifestyles – can predispose us to a wide variety of adverse health conditions.

Over the past decade or so, researchers around the world have been making closer and closer links between stress and a growing list of chronic diseases. Many of these conditions are what we might think of as the normal signs of “aging” – such as weight gain, low energy levels, a drop in sex drive, fuzzy memory, mood swings, and even wrinkling skin and thinning hair. Each of these conditions might appear to be completely unrelated to one another, but they all have a common link in being “set-off” and exacerbated by stress – and more precisely by the elevated cortisol levels that come with stress.

So, how can you tell if YOU (or your patients) have elevated cortisol levels? Answering three simple questions about lifestyle can provide a general gauge of overall stress and cortisol exposure:

Do you experience physical or emotional stress on a repeated basis (i.e. daily)?

Are you trying to lose weight or are you concerned about what you eat?

Do you get less than 8 hours of sleep each night?

If the answer is “Yes” to any of these three questions, then chances are good that you (opr your patients) are exposed to elevated levels of cortisol on a regular basis.

In the coming years, cortisol levels will be viewed by health professionals as at least as important to overall health as cholesterol levels, exercise patterns and dietary habits in the quest for optimal health.

When we consider stress and how it affects our health, a logical chain of events might look something like this:

1. Something causes stress

2. Your body releases cortisol

3. Cortisol leads to weight gain via:

a. increased appetite / increase in blood sugar levels

b. slowing of metabolic rate / loss of muscle mass

c. suppression of fat oxidation

4. You can control cortisol levels via:

stress management techniques



dietary supplementation

Even though the primary effect in the above scenario is weight gain – cortisol is at the root of numerous metabolic alterations – so a similar chain of events can be drawn for cortisol exposure to accelerate bone loss (increasing osteoporosis risk), suppress immune function (increasing risk of infection), and breakdown brain neurons (impairing memory and concentration).

Perhaps the biggest problem with chronic stress and elevated cortisol levels is the fact that the initial effects are so subtle—a few extra pounds of weight, a slight reduction in energy levels, a modest drop in sex drive, a bit of trouble with memory—that we simply brush them off as normal aspects of aging. According to some of the latest scientific and medical research, however, many of these effects are actually the earliest signs of obesity, diabetes, impotence, dementia, heart disease, cancer, and related conditions – and cortisol is emerging as a key factor in each and every one of these conditions.

Elevated cortisol levels have been associated with the following chronic conditions:

increased appetite and food cravings

increased body fat

decreased muscle mass

decreased bone density

increased anxiety

increased depression

mood swings (anger and irritability)

reduced libido (sex drive)

impaired immune response

memory and learning impairment

increased symptoms of PMS—premenstrual syndrome (cramps, appetite)

increased menopausal side effects (hot flashes, night sweats)

Exactly What Is Stress and What Does It Have to Do with Health?

Consider the typical scenario that we use to teach stress physiology…

There you are, a zebra strolling across the African savanna. You’re minding your own business, maybe looking for some tender young grasses to satisfy your appetite, when seemingly out of nowhere, A LION COMES CHARGING TOWARD YOU FROM THE BUSHES! This is the classic scenario used to describe the stress response—otherwise known as the “fight-or-flight” response. In reaction to that charging lion, your body quickly paces itself through a series of neurological, biochemical, hormonal, and physiological actions—each of which is designed to help you avoid that lion (run away or fight it off) and to survive for another day.

In the case of the zebra, the stress response runs its complete course, from start to finish, in a relatively short period of time. The stress occurs (the charging lion), which causes the zebra’s brain and hormone system to release a series of stress hormones (the stress response), that enable it to fight off the lion or run away from it (the fight-or-flight response). After getting away from the lion, the zebra’s stress hormones return to normal—end of story (Figure 1.1).

Unfortunately, we humans aren’t so lucky. The vast majority of our daily stressors come from factors that are much scarier than hungry lions (or at least are perceived as being very stressful)—things like monthly mortgage payments, credit card bills, project deadlines, traffic jams, family commitments – the list goes on and on. The major problem with our modern-day stressors is that they are not quite as easy to escape from as the charging lion. The things that cause us stress today are difficult to fight off and impossible to run away from—not to mention the fact that they also seem to keep coming back again and again. This unfortunate situation puts us in the position of begin “stuck” midway through our normal stress response—a position in which stress hormones are chronically elevated (Figure 1.2).

In this scenario, our modern, fast-paced, high-stress lifestyles cause us to become stuck in what I refer to as the “Type C” personality – a victim of chronic stress and elevated cortisol levels (hence the “C”). As health professionals, most of us are well-aware of the classic “Type A” and “Type B” personalities: Type A’s are stereotyped as high-strung stress monsters, and Type B’s are cast as laid-back folks who always roll with the punches. It may be obvious to you that nobody has either a “pure” Type A or Type B personality, but rather, we are all a blend of the two—some with a bit more “A” and others with a bit more “B” thrown in.

Unfortunately, we can all succumb to stress and become the Type C personality if we aren’t careful to control either our exposure to stress or the way in which our bodies respond to stress. The “C” in the Type C designation also refers to the primary stress hormone—cortisol—which is elevated during periods of high stress. When we encounter something (anything) that causes us to feel stress, our cortisol levels go up. If we experience stressful events on a regular basis, and we are unable to effectively rid ourselves of the stressor, then our cortisol levels stay constantly elevated above normal levels.

Luckily, we have a great many cortisol-controlling options to offer our patients. The easiest choice of all is to do nothing (like most people) and let chronic stress and elevated cortisol levels slowly break down bodily defenses and increase risk for disease. The more difficult choices are to do something—about your stress levels, the way you handle stress, or how your body responds to stressful situations. There is certainly no shortage of self-help books and empowering seminars on the general topic of “stress management,” but from a purely practical point of view, most people can’t be bothered with traditional approaches to stress management. Many of our patients (and even many of us as health professionals) can’t even be bothered to exercise or eat the way we know we should—both of which could go a long way to reducing the detrimental effects of stress on our bodies.

My book, The Cortisol Connection – Why Stress Makes You Fat and Ruins Your Health (Hunter House, 2002), addresses many of the basic ways in which we can counteract the general effects of chronic stress and the specific effects of cortisol exposure. Each of my diet, exercise and supplement recommendations is pulled together into a tidy little plan called the SENSE program, which stands for the five key methods for dealing with stress:

Stress management





Why Supplements?

Why not supplements? For most of us, from a purely practical perspective, a balanced cortisol-control regimen that incorporates appropriate dietary supplements is a lot more doable than a complicated stress-management program, a time-consuming exercise regimen, or a restrictive diet. This does not imply that stress management is unimportant or that supplements can provide all of the same benefits delivered by regular exercise or a healthy diet. It simply means that supplements, for many people, represent something that they can realistically incorporate into their already busy daily lives and that can have a powerful beneficial impact on controlling stress and balancing cortisol levels.

For most people, a strategic regimen of carefully chosen dietary supplements can help control stress, reduce cortisol levels, provide relaxation and more restful sleep, help balance blood sugar, promote weight loss, and boost immune system fucntion. In no way should this imply that dietary supplements are the only solution to combating stress and controlling cortisol—but for many people they may be a powerful step in the right direction.


If the last decade of stress research has shown us anything, it is clearly that over the long term, chronic stress and excessive cortisol exposure can be as detrimental to overall health as elevated cholesterol is for heart disease or increased blood sugar is for diabetes. Aside from that, elevated cortisol levels make us fat, kill our sex drive, shrink our brain, squelch our immune system, and generally make us feel terrible. In the face of our modern, fast-paced lifestyles (which show no signs of becoming more relaxed), the solution is to help our bodies deal with their chronic exposure to stress in an appropriate way to promote long-term health. This means applying as many aspects of the SENSE program as possible (or practical) for a given patient in a given situation. By doing so, we teach our bodies to respond to stress with an appropriate stress response (and corresponding elevation in cortisol) rather than an over-active response – and over time, we reduce our overall cortisol exposure and thus reap the associated health benefits.

Works Consulted

1.Altemus M, et al. Stress-induced changes in skin barrier function in healthy women. J Invest Dermatol 2001;117(2):309-317.

2.Bjorntorp P, Rosmond R. Obesity and Cortisol. Nutrition 2000;16(10):924-36.

3.Epel ES, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med 2000;62(5):623-32.

4.Epel ES, et al. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology 2001;26:37-49.

5.Ganster DC, et al. Explaining employee’s health care costs: a prospective examination of stressful job demands, personal control, and physiological reactivity. J Appl Psychol 2001;86(5):954-64.

6.McLean JA, Barr SI, Prior JC. Cognitive dietary restraint is associated with higher urinary cortisol excretion in healthy premenopausal women. Am J Clin Nutr 2001;73:7-12.

7.Peeke PM, Chrousos GP. Hypercortisolism and obesity. Ann NY Acad Sci 1995;771:665-76.

8.Sephton SE, Kraemer HC, et al. Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst 2000;92(12):994-1000.


Shawn M. Talbott, Ph.D.

Nutritional Biochemist and Author

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-Killer at Large - an award-winning documentary exploring the causes and solutions underlying the American obesity epidemic (

-The Health Professionals Guide to Dietary Supplements (Lippincott, Williams & Wilkens) -

-Cortisol Control and the Beauty Connection - The All-Natural Inside-Out Approach to Reversing Wrinkles, Preventing Acne, And Improving Skin Tone (Hunter House) -

-Natural Solutions for Pain-Free Living (Chronicle Publishers - Currant Books)

-The Cortisol Connection - Why Stress Makes You Fat and Ruins Your Health (Hunter House) -

-The Cortisol Connection Diet - The Breakthrough Program to Control Stress and Lose Weight (Hunter House) -

-A Guide to Understanding Dietary Supplements - an Outstanding Academic Text of 2004 (Haworth Press) -

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