Category: Cortisol

The Paradox of Stress

4/6/2020

That which does not kill us, makes us stronger - (Friedrich Nietzsche)

...provided we get enough recovery - (Wellness Garage)

Chronic stress can play a central role in the development and progression chronic disease and ill health.

But stress is not all bad

Let’s consider the paradox of stress

Protection and damage are the two contrasting sides of physiological processes that defend our bodies against the challenges of daily life, whether or not we call them “stressors.”

We respond to stress in two ways:

The immediate physiological response that allows us to better cope with the situation at hand
The adaptation response that allows us to get stronger.

Our bodies are designed to respond to a challenge (or stress) by

turning ON a complex adaptive physiological response that allows the body to cope and
then turning OFF the response once the stress has passed

This process is called allostasis – the ability to achieve stability through change.

Your response to a stressor is determined by many factors:

Environmental stressors
Major life events
Trauma, abuse
Individual differences
Behavioral responses

ALL of which determine the extent of your physiological response.

Over time allostatic load can accumulate OR the individual can adapt.

The immediate stress response is mediated by two systems:

The sympathetic nervous system – which delivers the immediate response through adrenaline
The hypothalamic – pituitary axis – which delivers an intermediate response through the hormone cortisol

When a situation is perceived as stressful – the hypothalamus sends signals to activate both stress responses.

The hypothalamus signals the inner part of the adrenal gland to release adrenaline and which activates the sympathetic nervous system, resulting in:

Increased heart rate
Increased blood pressure
Redistributing blood to the muscles
Maximizing blood glucose by enhancing the release of glucose from glycogen in the liver
Increasing the release of free fatty acids from fat tissue

The effect is immediate and is experienced as the adrenaline rush.

The hypothalamus also releases a hormone CRH which activates the pituitary gland to secrete adrenocorticotropic hormone (ACTH) the hormone that stimulates the outer part of the adrenal gland to produce cortisol.

Cortisol enables the body to maintain steady supplies of blood sugar for a more prolonged stress.

Adequate and steady blood sugar levels help person to cope with prolonged stressor, and helps the body to return to normal.

Cortisol does this by:

Increasing production of glucose in the liver from the breakdown of glycogen
Promoting gluconeogenesis
A process that generates glucose from non-carbohydrate substrates - turning fats and proteins into glucose
Counteracting insulin’s effect
Increasing appetite
Increasing food seeking behaviour

Once the stress is over the body recovers by:

Turning down the sympathetic nervous system
Activating the parasympathetic nervous system
Turning off the cortisol response

Every system of the body responds to acute challenge with allostasis leading to adaptation.

When these acute responses are overused or inefficiently managed, allostatic overload results.

There are 4 patterns to the accumulation of allostatic load:

Repeated "hits" from multiple novel stressors
Lack of adaptation
Prolonged response due to delayed shut down
Inadequate response that leads to compensatory hyperactivity of other mediators: e.g., inadequate secretion of glucocorticoid, resulting in increased levels of cytokines that are normally counter-regulated by glucocorticoids.

Remember, three factors largely determine individual responses to potentially stressful situations:

The way a person perceives the situation
The degree of recovery from previous stress
The person's general ability to recover from stress – largely determined by their general state of physical health, which is in turn determined by lifestyle behaviors

So the key to avoiding the damaging effects of stress is to:

Decrease situations that are stressful
Change your perception of what situations are stressful
Enhance your ability to recover

This is why developing stress tolerance is one of our 6 pillars of health

Strategies like meditation, yoga, mindfulness, hobbies and anything that brings you into flow can help both the recovery and the perception of stress.

Other strategies like ‘stress audits’ can help you identify the areas of life within your control that are causing you stress. Decisions can then be made to alter or avoid these particular situations.

Changing your perception of a stressful situation is one of the most powerful ways to develop stress tolerance.

Katie Byron has a process called “The Work” in which she walks you through a process that has you answering 4 questions about the situation:

Developing a strategy to tolerate stress is a key part of maintaining health - what is your strategy?

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Sleep and Weight Loss (Gain)

1/20/2020

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(Part of our January series on S3 Weight Management - Systematic, Stratified and Sustainable)

There are multiple lines of evidence to support that getting a good night's sleep is important in order to be able to lose weight.

From an evolutionary perspective sleep and energy management are intricately linked.

Poor sleep dramatically alters the way the body responds to food.

When you do not get adequate sleep, your hunger hormones send signals to your brain to eat more.

Ghrelin - a hormone released from the stomach signals that you are hungry, and levels drop off when you are full. One study showed that those did not get enough sleep had 15% higher ghrelin levels than those that slept more than 7 hrs per night.
Leptin - is a hormone released from fat cells to suppress hunger and appetite. The same study showed a 15% decline in leptin for those who were poor sleepers

As a result studies have shown that people who have inadequate sleep consume more calories.

Compounding this, sleep deprived individuals have been shown to preferentially choose calorie dense foods rich in both fats and carbohydrates.

Inadequate sleep also increases the release of the stress hormone cortisol, which in turn signals the brain to increase appetite via the release of another hormone orexin. High levels of cortisol may explain why sleep deprivation appears to lead to loss of muscle mass and increased abdominal (visceral) fat.

Independent of its effect on appetite, cortisol also counters the actions of insulin, leading to insulin resistance the result of which can be high levels of insulin. Insulin is a storage hormone promoting the storage of prompt storage of glucose as glycogen and fats within adipose tissue.

With high enough levels of insulin, fat will be quickly stored and lipolysis (the breakdown of fat for energy) will be suppressed, resulting in one-way storage in other words "a moment on the lips, forever on the hips"

This cortisol induced insulin resistance can be demonstrated in as little as one week of sleep deprivation.

Other studies have shown that a lack of sleep can

decrease physical activity
increased fatigue with physical activity
decrease resting metabolic rate
decreased ability to resist temptations

As a result of these effects it is not surprising that inadequate sleep is associated with weight gain.

Large observational studies, like the Nurses Health Study, following 68,000 nurses, demonstrated that short sleep duration increased the likelihood of obesity by 15%. Of course, observational research can show associations it cannot prove causation, however shorter term sleep deprivation studies also show weight gain.

The recent PREDIMED Plus study showed that lack of sleep affects weight loss during a trial of the Mediterranean Diet , as overweight people who did not sleep well lost less weight that those without sleep issues.

Finally, sleep apnea one of the most devastating sleep disorders is both associated with and worsened by weight gain. This sets up a vicious cycle where poor sleep can lead to weight gain, and potentially sleep apnea and sleep apnea in turn leads to further weight gain.

So we can see from this

Lack of sleep leads to powerful physiological changes which leads to weight gain
Compounding this, weight gain also leads to powerful physiological changes resulting in decreased sleep

The resulting vicious cycle can set up a progressive deterioration of sleep with a corresponding weight gain.

The key to reversing this cycle is to prioritize sleep:

avoid substances that will alter hormones and affect your sleep - alcohol, caffeine, some medications
optimize your daytime activities - get outside and be active, but not too close to bedtime
optimize your environment for sleep - dark, cool, quiet and comfortable (no electronics)
optimize your sleep ritual - give yourself a 8-9 hour window to sleep, start your wind-down 60-90 min before bed

Along the way, pay close attention and investigate any warning signs:

Restless sleep
Awakening with choking, gasping, or smothering
Morning headaches, dry mouth, or sore throat
Waking up to urinate more than once per night
Feeling unrested and groggy in the morning - “brain fog”
Fatigue, low energy, memory challenges with difficulty concentrating

For more on this, see some of the previous blog posts on sleep

For other posts in our foundational behaviours for weight managemetn series:

On January 29th- we will launch a new group program - fully covered by MSP (for those with a BMI >30 or a BMI between 27 and 30 and a weight related diagnosis).

During the month of January - we will be posting about the foundational behaviours for sustainable weight management - stay tuned.

If you would like to learn more about the S3 program and whether you are eligible please check out our Sustainable Weight Management program page.

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The Paradox of Stress

Sleep and Weight Loss (Gain)

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