Ashlee Williams, MD: We all experience stress. But what happens inside our bodies when we're under pressure? At the center of it all is cortisol, often called the stress hormone. From regulating metabolism and blood pressure to influencing our sleep and even digestion, cortisol plays a critical role in our health. So what can we do to keep cortisol levels in check? And what does the latest research say about managing cortisol for better health?

 Welcome to the Healthier You podcast. I'm Dr. Ashlee Williams. And today I'm talking with Dr. Christina Lee, a Board Certified Psychiatrist here at Kaiser Permanente, to learn about how cortisol is released and regulated, how chronic stress affects the body and mind and practical ways to manage stress and keep cortisol levels in check. Dr. Lee, thanks so much for being here today.

Christina Lee, MD: Of course, thank you for having me.

Host: Yes, we're so excited about this important topic. It comes up in clinic so often. So can you talk a little bit about what exactly is cortisol and why is it called the stress hormone?

Christina Lee, MD: Yeah, cortisol is super critical for all organs in the body. It is a steroid hormone and it's produced by the adrenal glands and the adrenal glands sit right above the kidneys and it affects so many different things, right? So cortisol regulates the body's stress response. It manages your body's metabolism, It in terms of like the breakdown of fats, carbohydrates, proteins. It suppresses inflammation, so it's considered anti inflammatory. It manages your blood pressure because it controls salt and water balance and kind of that flow between salts and water in your arteries and veins and it increases the availability of blood glucose for your brain.

So it does so many different things, right? It also manages your sleep wake cycle and it increases glucagon and decreases insulin which ultimately basically modifies sugar and puts more sugar into your bloodstream.

Host: Wow, so much work for cortisol. So what does it mean to have high cortisol levels? And why is that a problem?

Christina Lee, MD: I want to emphasize the fight or flight response because most people are familiar with that and they've heard about that and so they know exactly what that means. So when your body, or when you're facing a stressful situation, we undergo what is known as the fight or flight response. And cortisol is a major steroid hormone that's involved in that entire response.

So it's helping you react to that stressful situation, for example. So you know, the notion of seeing a tiger, what do you do? Do you fight the tiger or do you run from the tiger? And what's needed to be able to fight or run? Your muscles need to be activated. You need to be getting more oxygen in general, breathing faster.

Your heart rate needs to go up. You start sweating. You know all of those things that your body needs to do to prepare, and your body has to replenish your energy stores too, so you don't tire out. So you get that like quick burst of energy and you can react. So during stressful times, cortisol is really important, right?

It does all of those things to help your body prepare. It even slows down your digestive system because you shouldn't be eating or relaxing while you're stressed out and needing to fight or flight. But the problem is, and so when you say why is cortisol, high cortisol a problem, is when you have high cortisol levels all the time, that can be really bad on the body. Because after that fight or flight response, your levels are supposed to return back to baseline, right, like your blood pressure is supposed to go back down, your sugar levels are supposed to normalize, you're not supposed to be so tense and ready to fight, your muscles are supposed to relax.

So, if you continuously have high cortisol, all of those things that your body is doing, right, in that high stress environment is staying like that, which can be really bad. So, high cortisol means your body maybe producing excess amounts. That could be like a medical problem. Some people have a disease called Cushing's syndrome, for example, but it could also mean that you're just stressed out all the time And you're kind of causing that fight or flight response to happen chronically in your body.

Host: And I think that's a important point, right? Cortisol fluctuates throughout the day. So sometimes it's good to have high cortisol levels, but it's supposed to go back to a lower level. And that's why we have specialists such as endocrinologists to evaluate if you do have elevated cortisol levels and it's consistently high and not appropriately responding, then how do we treat that?

Christina Lee, MD: Yeah. So there's certain lifestyle factors, like if we know that chronic stress plays a role in high cortisol, then there's things that you can do to reduce that stress. So certain lifestyle factors like diet, sleep, exercise, all the things that we know are healthy for us. Those are the things that will help drive that cortisol level down.

So, diet. What you eat will affect your cortisol level. That means like if you're eating a lot of processed foods, if you're eating a lot of refined sugar, those cause like sugar spikes and sugar crashes and those can like trigger, you know, changes in your cortisol level. If you drink too much caffeine or too much alcohol, in fact, those can also both interfere with your whole sleep wake cycle.

It could stimulate the stress response again from occurring, increase cortisol levels. Exercise. This is an interesting topic because most people think of exercise as just being great for you, right? And they say exercise, exercise, exercise. And it's true. You want to keep the body in motion and physical activity is good.

It releases endorphins. It helps drive down stress level. But there's also a thing where you need to find the right balance. If you over stress and over exert your body and you don't give yourself rest days, that actually can still drive cortisol levels up and keep them high. So you need to make sure that you're keeping that in account when you are training for something like a marathon, for example.

You need to give yourself rest days and if you start an exercise routine, give yourself some rest days and do everything in moderation. And then last, sleep. I mean that is really the ultimate cortisol regulator. Cortisol, like you, mentioned, it follows this natural circadian rhythm. So it peaks in the morning and then it goes down at night as your body is resting and your body's kind of recovering from the day.

 So anytime you have poor sleep or you stay up at night or you pull an all nighter, that will disrupt that cycle and it will keep your cortisol levels then high. It doesn't allow it to go down naturally. So getting seven to nine hours of sleep every night is really crucial for stress.

Host: And sometimes getting good sleep is sometimes easier said than done, but we definitely have some good tips on how to get a good night's sleep on one of our prior podcasts, but also on kp.org that people can check out if they're listening. Okay, so if you have, you think you have high cortisol levels, what can you do about it? Or how can you prevent the cortisol levels from staying elevated?

Christina Lee, MD: So I already mentioned a couple of lifestyle changes that you can make, right, with sleep, exercise, diet, but the key is, like focus on managing your stress and focus on self-care. So I feel like self-care is a buzzword that people throw around, but they don't actually prioritize that. They don't make that the number one thing that they should be doing. Just like, people know, I gotta brush my teeth every day, I gotta go to the bathroom, you know, take a shower, but they don't prioritize self-care as being one of those, like, I need to do, and that's what you need to do.

So, things that you can do, is practice mindfulness and meditation. Even just five to ten minutes a day of practicing some deep breathing, meditation where you are trying to be in the moment, can really reduce your stress and lower your cortisol levels. And I just want to let you know that if you're interested in a free online stress reduction course, like a mindfulness meditation stress reduction course, you can go to palousemindfulness.com. It's free and it's an eight week session that's taught by someone who's certified to do this.

And then try progressive muscle relaxation. That technique can again help relax the body, calm the nervous system. I say try to find some enjoyable activities that you enjoy doing because if you're having fun and you're relaxing, that's going to shift your brain out of stress mode, right?

If you like listening to music or playing or reading or hanging out with your family. And then the things that I mentioned already before, like make sure you're prioritizing a good sleep routine. Make sure you're exercising, but not too much. Make sure you're eating a balanced diet. So that's also like making sure you're getting nutrient dense foods in you, like things like omega 3s, magnesium rich foods, things like salmon, flax seeds, nuts.

You know, people talk about those as being the really good oils to have. Dark leafy greens, avocados, all of those things which contain magnesium, which is also really good in helping you sleep and then finally stay hydrated. So, even mild dehydration can trigger cortisol.

Host: Yeah, love the tip about prioritizing our self-care just like we prioritize going to the bathroom and brushing our teeth. It's something, even if you take five minutes out of your day to do before you brush your teeth. And thanks for the information about the free mindfulness activities. There's also lots of apps out there, such as the Calm app that we provide free for all of our Kaiser Permanente members.

So definitely something else to check out. Well, thank you so much for this great information, Dr. Lee. We learned a lot about stress cortisol and what we can do to keep our levels in check. Here are the top takeaways.

One, everyone has cortisol in their bodies. Cortisol is a hormone that helps the body produce the fight or flight response. That helps us react to stressful situations.

Two, chronic stress, overexerting yourself and certain medical conditions can cause cortisol levels to stay elevated, which can lead to problems including digestive issues, headaches, anxiety, sleep problems, weight gain, memory and concentration issues, and even high blood pressure.

 Three, balancing diet, sleep, and exercise is key to maintaining healthy cortisol levels. The goal is to support your body's natural rhythm, fueling it with nourishing foods, prioritizing rest, and engaging in a healthy amount of movement.

Four, though it's easier said than done, the best way to manage cortisol is to try to have a balanced life. Make times to do the things that you enjoy. Find time to disconnect from work, take a break from social media. Finding a healthy balance improves cortisol levels because it improves overall happiness and lowers stress.

 For more information from our experts, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, be sure to subscribe and share it with others who may find it helpful.

Thank you. And from all of us at Kaiser Permanente, be well.