The Role Cortisol Plays in Weight Gain

Did you know that cortisol, the steroid hormone produced by the adrenal gland, can cause us to heap on the kilos?

Prolonged stress makes our bodies produce more cortisol, which is great if we are cavewomen and need to escape from marauding tribes, but not so great if we have to deal with everyday work problems. Our bodies cannot tell the difference, and in this state of constant high alert, cortisol directs all our energies towards survival mode. That means, “Let’s put on weight in case we need it later”. 

Our cortisol levels are controlled by the hypothalamic-pituitary-adrenal (HPA) axis. Stress triggers the release of corticotropin-releasing factor (CRF) from the hypothalamus. CRF triggers the release of adrenocorticotropic hormone (ACTH) from the pituitary, which in turn triggers the release of cortisol from the adrenal glands.[1] Increased secretion of cortisol can eventually lead to hypertrophy of the adrenal cortex, adrenal exhaustion and immune suppression. 

Cortisol and weight gain

Does excess weight predispose to greater cortisol release? 

Or does excess cortisol increase weight gain? 

Studies have shown that women with high abdominal fat stores (HAF) or high waist to hip ratios (WHR) secrete significantly more cortisol in response to stress than women with a low WHR.[2] Additionally, obese women with a high abdominal fat distribution may have a hyperactive HPA axis leading them to over-secrete cortisol.[3] On the other side of the argument, women who are over-secretors of cortisol tend to consume more calories, with a preference to sweet foods.[4] And it’s long been known that people under chronic stress tend to gain weight over time.[5]
 
Which ever is the cause or the effect, from a clinical perspective, it seems reasonable to address both issues in unison as progress in one will influence the other, and vice versa. Where there is excess weight, the patient should be counselled towards a healthy weight; where there is excess cortisol secretion, a balance should be re-established. 

Cortisol testing

Patient cortisol levels may be assessed by testing samples of saliva. This method of cortisol testing is popular with patients as it is simple and non-invasive. Because salivary cortisol is stable at room temperature, samples can be conveniently mailed back to the testing facility for analysis. Four samples are required to be collected throughout the day to reflect the circadian fluctuation of cortisol. 

Cortisol levels are highest in the morning and gradually fall till about noon, after which levels stay steady until late evening.[6] The morning surge of cortisol is known as the cortisol awakening response (CAR).[7,8] This is an extremely important event when evaluating the HPA axis. Ensure that your patients take their first saliva sample 30 minutes after waking; this is the time it takes for peak CAR to reach the saliva. Optimal levels are generally around 25 in the morning, dropping to about 15 at midday and then below 5 by 10pm. 

Saliva testing kits for patients are offered by a wide variety of pathology testing labs. 

Cortisol balancing

To balance cortisol levels we must first look at balancing the HPA axis and enhancing the stress adaption response. 

Siberian ginseng (Eleutherococcus senticosus) works by altering the levels of HPA axis hormones involved in the stress response.[9] It also reduces stress-induced adrenal hypertrophy and adrenal ascorbic acid depletion.[10]

Korean ginseng (Panax ginseng) is thought to reduce the production of cortisol under stressful conditions.[11] Furthermore, Korean and Siberian ginseng may each inhibit the enzymes 11-beta-hydroxysteroid dehydrogenase and catechol-o-methyltransferase, respectively, to modify the binding of stress hormones to their receptors.[12]

Withania (Withania somnifera), also known as ashwagandha, is an ancient Ayurvedic herb that is used to support the stress response and nourish the adrenals.[13] Many steroidal compounds, withanolides, are found in the root.[10]

American ginseng (Panax quinquefolium) is proposed to calm a hyperactive HPA axis by regulation of stress mediators such as corticosterone, cytokines and brain monoamines.[14] It also reduces the duration, incidence and severity of symptoms of mild upper respiratory tract infections, and the common cold and flu.[15]

Reiishi mushroom (Ganoderma lucidum), also spelled as reishi mushroom, has adaptogenic qualities and is a strong immune stimulant with the ability to restore organs to homeostasis.[16,17]

B vitamins (particularly, B3, B5, B6, folic acid, B12) are essential for normal healthy adrenal and nervous system function, while phenylalanine and tyrosine are important amino acids for adrenal hormone production.[9,18,19]

References

1. Ulrich-Lai YM, Figueiredo HF, Ostrander MM, et al. Chronic stress induces adrenal hyperplasia and hypertrophy in a subregion-specific manner. Am J Physiol Endocrinol Metab 2006;291(5):E965-E973. [Full Text]
    
2. Epel ES, McEwen B, Seeman T, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med 2000;62(5):623-632. [Full Text] 
    
3. Pasquali R, Cantobelli S, Casimirri F, et al.The hypothalamic-pituitary-adrenal axis in obese women with different patterns of body fat distribution. J Clin Endocrinol Metab 1993;77(2):341-6. [Abstract] 
    
4. Epel E, Lapidus R, McEwen B, et al. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology 2001;26(1):37-49. [Abstract] 
    
5. Greeno C, Wing R, Matthews K, et al. Stress predicts overeating and weight gain outside of the laboratory: data from multiple studies. Ann Behavioral Med 1998;20:S032.
    
6. Guilliams T, Edwards L. Chronic stress and the HPA axis: clinical assessment and therapeutic considerations. The Standard 2010;9(2):1-12. [Full Text] 
    
7. Fries E, Dettenborn L, Kirschbaum C. The cortisol awakening response (CAR): facts and future directions. Int J Psychophysiol 2009;72(1):67-73. [Abstract] 
    
8. Chida Y, Steptoe A. Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biol Psychol 2009;80(3):265-278. [Abstract] 
    
9. Braun L, Cohen M. Herbs and Natural Supplements: an evidence-based guide, 3rd ed. Sydney: Churchill Livingstone Elsevier, 2010.
    
10. Mills S, Bone K. Principles and Practice of Phytotherapy. Edinburgh: Churchill Livingstone, 2000.  
       
11. Tachikawa E, Kudo K. Proof of the mysterious efficacy of ginseng: basic and clinical trials: suppression of adrenal medullary function in vitro by ginseng. J Pharmacol Sci 2004;95(2):140-4. [Full Text] 
     
12. Gaffney BT, Hügel HM, Rich PA. Panax ginseng and Eleutherococcus senticosus may exaggerate an already existing biphasic response to stress via inhibition of enzymes which limit the binding of stress hormones to their receptors. Med Hypotheses 2001;56(5):567-72. [Abstract] 
     
13. Upton R (Ed). Ashwagandha root - Withania somnifera: analytical, quality control and therapeutic monograph. Scotts Valley: American Herbal Pharmacopoeia, 2000.
     
14. Rasheed N, Tyagi E, Ahmad A, et al. Involvement of monoamines and proinflammatory cytokines in mediating the anti-stress effects of Panax quinquefolium. J Ethnopharmacol 2008;117(2):257-262. [Abstract] 
     
15. Predy GN, Goel V, Lovlin R, et al. Efficacy of an extract of North American ginseng containing poly-furanosyl-pyranosyl-saccharides for preventing upper respiratory tract infections: a randomized controlled trial. CMAJ 2005;173(9):1043-1048. [Full Text] 
     
16. Rouse J, Spoerke D, Rountree B. Reishi mushroom. Micromedex monograph. [Link] 
     
17. Upton R (Ed). Reishi mushroom - Ganoderma lucidum: standards of analysis, quality control, and therapeutics. Scotts Valley: American Herbal Pharmacopoeia, 2006.
     
18. Shils ME, Shike M, Ross AC, et al (Eds). Modern nutrition in health and disease, 10th ed. Baltimore: Lippincott Williams & Wilkins, 2006.
     
19. Higdon J. An evidence-based approach to vitamins and minerals. New York: Thieme Medical Publishers Inc, 2003.

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