by Pauline N. Harding, MD
Article from NOHA NEWS, Vol. XXVII, No. 1, Winter 2002, pages 3-6.
Nutrition for Optimal Health Association, Inc
Let's take a look at a major contributor to the aging process and what it can tell us about slowing the ravages of time on our health. The factor we will explore is cortisol, a hormone that controls dozens of vital functions in the body. When cortisol levels are too high or too low, rapid-aging processes accelerate.
The Adrenal Gland
Cortisol is secreted by the adrenal glands, which are located above the kidneys. The adrenals have one of the highest rates of blood flow of any tissue in the body, and the adrenals have the highest concentration of vitamin C of any tissue in the body.
Each adrenal gland is composed of two separate functional components. The outer zone, called the cortex, which secretes adrenal steroids such as cortisol, DHEA, and aldosterone, and the inner zone, called the medulla, which secretes adrenalin and norepinephrine. These latter two hormones, the catecholamines, are known colloquially as the "fight-or-flight" hormones.
The Adrenal Circadian Rhythm and Its Significance
The adrenal glands do not secrete their steroid hormones at a constant rate throughout the day. The hormones are released in a cyclic fashion with the highest levels being released in the morning and the lowest at night. This 24-hour cycle is called the circadian rhythm, and an abnormal circadian rhythm of adrenal hormones can adversely affect multiple critical functions in the body including energy production and immune surveillance.
Abnormal adrenal function can affect the ability of cells to produce energy for the activities of daily living. Individuals who drag out of bed in the morning, those who have energy slumps at various times during the day, and those who are tired all of the time often have abnormal adrenal hormone rhythms.
Muscle and Joint Function
Abnormal adrenal hormone levels and rhythms retard tissue healing. Reduced tissue repair and increased tissue breakdown lead to muscle and joint injury and chronic pain. In particular, it has long been noted that excess steroids cause weak hip and shoulder girdle muscles. What is not as obvious is that the converse is true: postures (such as excessive sitting), which lead to weak hip and shoulder muscles, promote the excess secretion of catecholamines and cortisol. The reason? This "Neanderthal" posture, in which the shoulders and hips are flexed, mimics the "flight-or-flight" posture the body assumes when it is running or fighting. The flexion posture is an immediate invitation to the body to secrete "fight-or-flight" hormones. Note the emphasis in the martial arts on maintaining a straight spine, thus avoiding the artificial boost in energy that a release of catecholamines would provide. .
As an aside in the discussion of rapid aging: note that the "chin forward" posture also invites rapid aging, especially of cognitive functions. When the chin is jutted forward or the head tilted down, signals from the spinal cord terminate in the midbrain; this short-circuiting (which leaves out the cortex, or "thinking" part of the brain) allows the lightning-fast responses needed for fight-or-flight.
On the other hand, when the head is erect, spinal cord impulses proceed to the cortex and stimulate the formation of protein within the cells of the gray matter. If signals do not reach the cortex such that this stimulation does not take place, then the protein in the brain cells dissipates, and with it the negative charge carried by the protein. As negative charge is lost, the cell comes closer and closer to its action potential and may start to fire indiscriminately. This uncontrolled firing can lead to tics, seizures, spasms, and unremitting pain.
. . . the "chin forward" posture also invites rapid aging, especially of cognitive functions.
As the brain cells lose protein, they atrophy or "shrink." This shrinkage occurs each day that they do not receive stimulus from the spinal cord. Hence, the wisdom of the expression "use it or lose it," and the wisdom of the exercise routines in the martial arts in which one "moves every joint in every direction every day." Failure to move a particular joint or muscle causes the brain cell that controls that muscle or joint to lose its cellular protein and thus lose its ability to function. This also underscores the osteopathic and chiropractic disciplines' insistence on mobilizing the vertebra so that they can move freely.
The adrenal rhythm determines how well an individual builds bone. If the night cortisol level is elevated and the morning level does not return to normal, bones do not rebuild well, and the osteoporotic process occurs despite such efforts as increased calcium intake. Indeed, elevated cortisol causes calcium to leach from bone and leads to demineralization of bone. Taking calcium supplements while the cortisol rhythms are abnormal is often pointless and, perhaps, even detrimental if the calcium leached from bone is deposited in an undesired location.
Immune System Health and High Cortisol
Elevated cortisol levels suppress the immune system including the immune response of the mucous membranes throughout the body. High cortisol reduces the mucous membrane surface antibody, called secretory IgA (SIgA). SIgA helps provide immune exclusion of bacteria, viruses, plasmids and toxins. When high cortisol weakens the immune defense of mucosal and serosal membranes, individuals are more prone to "pink eye," sinus infections, earaches, bronchitis, chronic cough, pleurisy, sore throats, reflux esophagitis, stomach (peptic) and duodenal ulcers, gallbladder inflammation, colitis, vaginal infections, and kidney and bladder infections.
Case Study: "Cynthia" had seen 6 physicians in the previous month. She had filled prescriptions from her ophthalmologist for antibacterial eye drops, from her gynecologist for a vaginal cream for vaginal itching and burning, from her family doctor for a cough medication, from her gastroenterologist for a H-2 blocker medication for her heartburn, from the ear, nose, and throat specialist for an antibiotic for her persistent sinus infection, and from the Urgent Care physician for an antibiotic for her urinary frequency and burning on urination. We pointed out to Cynthia that all of her symptoms could be lumped under the general category of "mucous membrane irritation." Within 4 weeks of taking measures to correct her cortisol rhythm and levels with diet and herbs, Cynthia reported no further problems with any mucous membrane in the body.
Immune System Health and Low Cortisol
Just as a high cortisol suppresses the immune system, a low cortisol can result in unbridled immune system action. The immune defenses become overly aggressive and not only attack invading organisms, but mount allergic reactions against many environmental agents. "Allergic reactions" can also be directed against endogenous antigens, the components of our own bodies. Autoimmune conditions such as lupus, Rheumatoid arthritis and Sjogrens syndrome can activate during periods when cortisol levels are low.
The ability to enter REM (rapid eye movements) sleep cycles requires normal cortisol levels at night. High nighttime cortisol disrupts REM sleep (restorative and refreshing sleep) and leaves one feeling groggy and fatigued in the morning. This morning fatigue can be easily mistaken by the patient and physician for endogenous depression. If "depression" does not respond to medications directed at serotonin and norepinephrine metabolism, consider evaluation of nighttime cortisol levels.
The ability to enter REM (rapid eye movements) sleep cycles requires normal cortisol levels at night. High nighttime cortisol disrupts REM sleep (restorative and refreshing sleep) and leaves one feeling groggy and fatigued in the morning.
Case study: A dramatic example of what a derangement in the circadian rhythm of cortisol can cause is illustrated by "Melissa." Melissa was a child who perplexed teachers and parents by unpredictable extremes of behavior and extremes of performance as reflected by grades that ranged from "A" to "F"—in the same subject. Lack of motivation was suspected, but psychological testing indicated that the child was highly motivated. Attempts to relate the pattern of failing and passing grades to subject matter, style or personality of teacher, gender of instructor, or rebellion against authority failed to establish a correlation. The situation worsened Melissa's freshman year of high school. Her parents reported that it was a tremendous struggle to arouse her from bed in the morning at which time she acted highly irritable and "drugged." Her first semester report card for math indicated that she came late for class, did not bring her supplies, did not participate in class, and did not complete her homework. However, within the first two weeks into second semester, the teacher reported that Melissa was "one of the brightest math students they had ever seen, that she caught on instantaneously, and that she spontaneously helped other students who struggled with math." Had the student been transferred to a remedial math class? No. The textbook and teacher were the same. What had changed was the time of the class. The first semester the class had been held at 7:20 a.m. Second semester the math class was held at 1:20 p.m. Melissa now had gym class at 7:20 a.m. and was "not bringing her gym suit to class, not participating in class, etc." A test of cortisol levels revealed that Melissa's morning cortisol was half the value needed to function even marginally at that time of day. (Most adults with levels in her range apply for a disability because they cannot function at work.) For Melissa, being aroused and asked to dress for school was tantamount to waking someone from sleep at 2 a.m. and expecting them to function at full capacity. Melissa's noon cortisol level was in the middle of the normal range (note her stellar function at this time of day), and her midnight level was markedly elevated and was, indeed, higher than her morning level. Correcting the cortisol levels so that the highest level was in the morning and the lowest level was at midnight resulted in dramatic changes in "personality, energy, and performance." Indeed, by her sophomore year, Melissa was happily attending student council meetings that started at 6:30 a.m.
How long had Melissa's cortisol rhythm been essentially reversed? Her parents reported that she had been "a wonderful baby. She could stay out late without getting grumpy and without wanting to go to bed at 8:30 p.m. like the other children, and she wouldn't wake the household up early the next morning like her younger sister did." For the record, Melissa's mother worked "graveyard" shift in a highly stressful job while she was pregnant with Melissa. It is quite likely that Melissa was born with a reversal in her circadian cortisol rhythm.
Skin regenerates mostly during the night. Elevated cortisol reduces skin regeneration. Normal cortisol rhythm is essential for skin health, especially conditions such as "adult acne."
Individuals with skin problems often have low zinc and high copper levels. The connection with cortisol is that excess copper speeds the conversion of dopamine to norepinephrine and adrenalin. The excess adrenalin tends to increase cortisol. Meanwhile, the lower dopamine increases the risk for Parkinson's and early Alzheimer's.
Also, skin problems such as eczema are associated with gliaden intolerance. Gliaden is a component of gluten grains. Gliaden intolerance is also exacerbated by high copper.
Thyroid Function and Cortisol
The level of cortisol at the cell level controls thyroid hormone activation. Often, symptoms of hypothyroidism such as fatigue, difficulty losing weight, and low body temperature are due to adrenal hormone imbalances. If a trial of thyroid hormone resulted in significant but temporary relief of symptoms of hypothyroidism, check the cortisol levels and rhythm.
Gluten Grain Intolerance and Stress
In many individuals, the gut becomes inflamed within 30 minutes after consuming gluten-containing grains such as wheat, oats, rye, barley, and spelt. This inflammatory response in the intestinal tract is tantamount to having a "30-foot-long sore throat." In infants we call it colic. We assume the child "outgrows" the food allergy. In fact, the body merely learns to respond to this inflammation by secreting cortisol and, in many cases, an endogenous morphine-like substance to "cover up" the pain and suppress the inflammation. This narcotic substance absorbs into the bloodstream and travels to the brain where it stimulates morphine receptors, and the individual becomes physiologically addicted to the grain or dairy product that induced the inflammation. Observe the symptoms and behavior patterns of individuals consuming grain and dairy products, and note the striking similarities with the "upper" and "downer" phases of drug intake and withdrawal. The similarities with drug addiction become even more striking when the individuals attempt to stop eating dairy and grain products.
Excess Cortisol and Loss of Libido
Conditions which require large amounts of cortisol create a drain on our capacity to produce adequate hormones. To provide the excess cortisol needed to respond to conditions such as pain and inflammation, the body diverts the production of our sex hormones into the production of cortisol. In particular, the body "cannibalizes" our sex hormone progesterone to make additional cortisol.
Observe the symptoms and behavior patterns of individuals consuming grain and dairy products, and note the striking similarities with the "upper" and "downer" phases of drug intake and withdrawal.
This decrease in our progesterone often leaves us with low progesterone in comparison to our estrogen or testosterone and leads to conditions of "estrogen dominance" and "testosterone dominance." Both estrogen and testosterone dominance are associated with an increase in irritability, aggressive behavior and even violence. Estrogen dominance also leads to PMS, uterine fibroids, increase risk of uterine and breast cancer, heavy menstrual periods and clots. The progesterone deficiency leads to a tendency to miscarriage.
Progesterone is also needed to keep in check the conversion of testosterone into dihydrotestosterone (DHT). Low progesterone ultimately leads to low testosterone, high DHT, balding, prostatic enlargement and low libido.
Lowered cortisol and lowered testosterone also lowers the threshold for migraine headaches.
The Causes of Cortisol Imbalance
Activities and other factors that lead to excess cortisol levels include:
1. Skipping breakfast.
2. Skipping any meal.
3. Eating more carbohydrate than protein in any five-hour period.
4. Assuming a slouched or a flexed posture (e.g., sitting posture) with the chin jutted forward.
5. Staying up past 10 p.m.
6. Being emotionally stressed.
7. Being in pain.
The "fight-or-flight" response and the elevated cortisol response are good adaptations if stress is infrequent or short-term. However, if stress becomes chronic and the cortisol becomes elevated frequently or for prolonged periods of time, then the precursors for making cortisol can become depleted. Eventually, a low cortisol output can result. Low cortisol is Mother Nature's way of slowing us down. Conveniently, low cortisol also slows some of the rapid-aging processes that are seen with high cortisol. Unfortunately, low cortisol results in a different set of rapid-aging processes such as the autoimmune diseases.
MEASURES TO SLOW THE AGING PROCESS
Eat Protein by 8 a.m. Each Morning and Every 5 Hours While Awake
Cortisol levels start to rise whenever one does not eat for 5 hours. During our daily overnight fast, cortisol levels rise to the level needed for us to "bounce out of bed." If one eats later than 8 p.m., then the peak cortisol elevation needed for easy wakening may be delayed, and one is likely to feel tired in the morning and not experience adequate energy to function properly until later in the day.
Likewise, if one does not eat by 7 or 8 a.m., then the morning cortisol level continues to rise and may overshoot the normal range. When the cortisol level overshoots its goal any time during the day, it is often difficult to bring the cortisol level back down in time to achieve the lower range needed in the evening for REM sleep. Thus, the fatigue problem perpetuates itself.
Some individuals who tend to skip breakfast do so unwittingly in order to use short-term starvation as a stimulus to secrete cortisol and thus bring subnormal morning cortisol levels up to normal. This approach has the disadvantage of stimulating adrenalin which itself is a "wear-and-tear" stress hormone.
Note that sleep will be interrupted if we have inadequate glycogen stores to provide the brain with energy throughout the entire night. Glycogen stores are replenished each time we eat protein (or eat a low glycemic meal) every 5 hours during the day. Glycogen stores in the liver are depleted a little each time we skip a meal or if we eat more carbohydrate than protein within any 5-hour period. If we skip meals habitually or eat excess starches and sugars, sleep disruption is predictable. For individuals who have depleted their glycogen stores in this fashion, a bedtime snack of 2 bites of protein may be required for several days or even weeks until the glycogen stores in the liver are replenished enough to sustain the brain throughout the night.
Much confusion about which foods raised glycogen stores arose in the 1970's when it was common for coaches to encourage athletes to "carbohydrate load" before major sporting events. Indeed, one of the popular diets of the era encouraged individuals to eat only fruit before noon. These practices of eating inadequate protein actually led to glycogen depletion, not to mention derangements in cortisol rhythm. The assumption that high glycemic foods increase glycogen stores was erroneous, and a generation of athletes and diet enthusiasts suffered fatigue and adrenal exhaustion as a consequence. We still find a carryover of this notion adversely affecting patients and athletes today.
Control Pain Promptly
Pain is the single most impressive factor in terms of sharply elevating cortisol levels. A single migraine headache can cause secretory cortisol levels to elevate to multiples of the baseline values. It is no wonder that individuals with chronic pain soon display the signs and symptoms of cortisol excess: physical and mental fatigue, weight gain around the middle, muscle weakness (in excess of the weakness expected from lack of exercise alone), abdominal bloating, easy bruising, sleep disturbance, digestive abnormalities, and increase in mucous membrane infections (sinusitis, bladder infection, bronchitis, etc.). They cannot expect these symptoms to resolve until their pain is controlled.
Go to Sleep by 10 p.m.
Benjamin Franklin understood the need for honoring the circadian rhythm when he intoned, "Early to bed, early to rise, makes a man healthy, wealthy and wise." One is likely to feel more refreshed with 5 hours of sleep between 10 p.m. and 3 a.m. than with 5 (or more) hours sleep that do not begin until 3 a.m.
Note, also, that some immune system protective functions do not even engage until one has had 7 or more hours of continuous sleep. Chronic sleep deprivation takes a toll on immune surveillance.
Correct the Circadian Rhythm
Once it has been determined that the circadian rhythm is abnormal, multiple therapeutic approaches are available. The treatment regimen is aimed at correcting the depressions or elevations in cortisol at each particular time of day. Herbs can be useful, but must be used carefully and precisely. For example, deglycerinized licorice (DGL) lowers cortisol while whole licorice root extract raises cortisol. Phosphorylated serine helps to elevate low secretory IgA to normal, probably by lowering elevated cortisol, which suppresses SIgA. Use of phosphorylated serine at 6 p.m. to lower an elevated midnight cortisol can be the secret to a good's night rest replete with REM sleep.
High Cortisol Levels Now Lead to Depleted Cortisol Later
The general pattern that leads to cortisol imbalance is that the individual's lifestyle initially causes periodic or prolonged elevations of cortisol. Eventually, the "spending (of cortisol) above budget" leads to "pregnenolone steal." Pregnenolone is the "grandmother" hormone from which the sex hormones and cortisol are made. If the body makes excess cortisol, then, in effect, the body has to divert or "steal" pregnenolone from its use in making DHEA, estrogen and testosterone.
Each moment of our life, we decide by our food choices, our bedtime, our posture, our response to stress, and our pain control whether to make sex hormones (which are the anti-aging hormones) or stress hormones (which cause rapid aging).
Cortisol, when secreted in excess, increases catabolism. Catabolism is a process that weakens tissues in virtually every part of the body, and, in effect, causes rapid aging. Catabolic processes weaken ligaments, muscle, blood vessels, and bone. Thus, catabolic processes contribute to hunched posture, osteoporosis and hemorrhagic tendencies. Excess cortisol contributes to cataracts and glaucoma and can cause high blood sugar, high blood pressure, and high intraocular pressure (glaucoma). Excess cortisol weakens the skin leading to stretch marks, easy bruising, and "see-through" skin. High nighttime cortisol disrupts REM sleep (restorative and refreshing sleep) and leaves us groggy and fatigued in the morning.
Low cortisol also exacts a toll. Low cortisol in the morning makes it hard for us to get out of bed. If cortisol drops below normal at any time of the day, it can create an energy slump.
Each moment of our life, we decide by our food choices, our bedtime, our posture, our response to stress, and our pain control whether to make sex hormones (which are the anti-aging hormones) or stress hormones (which cause rapid aging).
It is not unusual for individuals to consciously, or more often, unconsciously, seek to boost energy by engaging in cortisol raising activities. These activities include skipping a meal, eating a carbohydrate (sugar or starch) snack, or engaging in stress-hormone inducing or physically risky behavior. How often is dysfunctional behavior simply an adaptive ploy to boost cortisol levels up to normal or to compensate for low cortisol by stimulating adrenalin release?
Unfortunately, many cortisol-raising tactics lead to an overshoot in cortisol and perpetuate the cortisol imbalance.
Measures to normalize cortisol rhythm and levels are remarkably effective
Individuals are pleased to find that stretch marks, "love handles," and energy slumps can all disappear when cortisol rhythm is corrected. Infection and/or irritation of mucous membrane resolve often without use of antibiotics or corticosteroids upon following these lifestyle guidelines:
1. Go to bed by 10 p.m.
2. Eat breakfast by 7 a.m.
3. Avoid excess sugar and starch.
4. Eat low glycemic index meals every 5 hours, i.e., meals in which the rapid-to- digest sugars and starches do not exceed by weight the slow-to-digest meats, fish, poultry and eggs. Better yet, skip the sugars and starches (including the inflammation-inducing grains) in favor of not-overcooked vegetables.
5. Avoid gluten grains if you have a grain intolerance. Feed children sprouted grains to avoid or delay gliaden-intolerance.
6. Maintain erect posture and avoid prolonged periods of sitting or flexion posture (such as fetal position during the night).
7. Control pain.
8. Manage emotional stress. (Following the first 7 guidelines provides a good foundation for accomplishing guideline number 8.)
Preservation of a normal circadian rhythm and preservation of adrenal hormone precursors will delay many of the so-called aging processes. Restoration of circadian rhythm and replenishing adrenal reserves will result in reversal of many of the processes that one assumes are irreversible ravages of time and aging.
About the author:
Pauline N. Harding, MD, is residency trained in Internal Medicine, Board Certified in Family Practice, and licensed as a Nutrition Counselor. She is an instructor in the Department of Family Practice at the University of Illinois College of Medicine in Chicago. She has been on the speakers' forum for the Rush Presbyterian St. Luke's Medical Center Conference for Body-Mind Healing and the Wilson Foundation Conference on Ethics for High School Science Teachers, and she has acted as panel discussant for the American Psychological Association. Dr. Harding is Medical Director at Prairie Trail Family Medicine in Winfield, Illinois. Her medical practice embraces a potpourri of natural healing techniques, especially as they apply to problems associated with environmental sensitivity and other allergies, fibromyalgia, chronic fatigue, colitis, sleep disturbances, and menopause.