Obesity and Cortisol:

While watching shoppers stroll through the malls during the Christmas holiday season, I was struck with just how serious obesity is becoming. Since 1994 when the Department of Agriculture issued the New Food Pyramid (a low fat, grain-based diet), the number of overweight and obese people in this country has continued to increase. Try as they might, the medical profession has yet to come up with a successful strategy for long-term weight loss. In fact, depending upon how one reads the medical literature, conventional medical diet strategies have a success rate of between 3 and 7%.

Doing the math, this means that conventional weight loss strategies have a FAILURE rate of between 93 and 97 percent. Surely, there is something more complex to
obesity than simply eating too much, or not exercising enough.

One clue to the obesity puzzle recently hit the medical news headlines. The September/October issue of Psychosomatic Medicine published a fascinating article that reported that stress might cause excess abdominal fat, even in otherwise slender women. There have been numerous studies that have examined the release of cortisol during acute and chronic stress, and the physiologic effects that this hormone has on the body. This is the first study to find that even in non-overweight women, this excess cortisol contributes to the deposition of visceral fat particularly in the abdominal region. Central obesity sets the stage for a host of health concerns such as heart disease and diabetes. This study was conducted on women, but as the studys author Dr. Epel states: These relationships are likely to apply to men as well.

Fight or Flight Response
It is important to understand that the stress response, or the fight-or-flight response, played a critical role in the evolution of man. The first descriptions of this response can be traced to the work of a Harvard physiologist, Walter Cannon, who described the human brain as hard-wired to protect us from bodily harm. This wiring exists in the hypothalamus, which, when stimulated, sets in motion a sequence of events that begins with nerve cell firings that result in the release of chemicals to prepare the body for running or fighting.

Lets say early man is suddenly confronted by a saber-tooth tiger. The fight-or-flight response activates and the body releases adrenaline, noradrenaline and cortisol. These hormones shunt blood away from the center of the body and toward muscles and limbs to prepare in the event this man is attacked. Additional physiologic responses ensure a rapid response to the threat: pupils dilate, awareness intensifies, and impulses quicken. When the perceived threat disappears the body reverts to its physiologic homeostasis, shutting down the release of the hormones, until the next threat appears.

This finely tuned mechanism was fine for our ancestors, and in fact they depended on it for their very survival. But in our modern world, this same stress response
kicks in rather indiscriminately, whether someone simply steals our parking space or we are facing true danger in the back alley of a city street with a mugger on our trail.

General Adaptation Syndrome
Numerous issues of this publication, most notably Dr. Ward Deans discussions of the Neuroendocrine Theory of Aging Part II, Adaptive Homeostat Dysfunction (April 1999 Vitamin Research News), have addressed the negative effects of this hyperadaptosis that has become part of the price we pay living in this stressful, fast-paced society.

What once was a critical component for survival in a hostile and volatile environment has become a source of many potential health problems. The bodys response to stress in the modern world has been characterized as the General Adaptation Syndrome (GAS). The GAS is a three-stage process.

The first GAS stage has already been described above. The second stage is that of resistance, where we learn (to our own detriment) to efficiently cope with the stressor. During this stage, hypothalamic cortisol receptors become less sensitive to feedback inhibition, resulting in increased cortisol production (Fig. 1.). Excess cortisol production is associated with a number of metabolic disorders of the Hypothalamic Pituitary Adrenal Axis (HPA) which include insulin resistance, central visceral obesity,
increased blood pressure, suppressed immune function and impaired wound healing. In fact, prolonged excessive cortisol elevation can lead to signs and symptoms resembling Cushings Disease. The third and final stage of the GAS is total adrenal exhaustion which involves a depletion of energy reserves and a loss of resilience leading to fatigue, immune system burnout, and a host of other systemic symptoms that may include brain pathologies such as Alzheimers disease and depression.

Although the stress response has been part of our genetic wiring since the beginning of time, this hyperadaptosis is a phenomenon that has only been recognized in the
last three decades. Since the syndrome described involves a complex interplay of hormones and neurotransmitters, there is not going to be one quick fix that will solve this problem for everyone.

One of the best known and most effective ways to lower excess cortisol levels is with the nutrient Phosphatidylserine (PS). Almost all readers are by now familiar with the benefits of PS in preventing short-term memory loss, age-related dementia, and Alzheimers Disease. The ability to blunt the effects of excess cortisol may be PSs most important function. A recent double-blind crossover study conducted at California State University by Thomas D. Fahey, Ed.D., established that serum cortisol levels were significantly lower in weight training athletes who took PS when compared to those who took the placebo. This is an important finding not only for weight training athletes who are trying to blunt the catabolic (or muscle breakdown) effects of the cortisol released during their vigorous workouts, but to all of us who suffer under the daily stressors of modern life. PS can be taken in dosages from one to three 100 mg capsules per day based, upon individual needs.

Adaptogens
An entire category of herbs called adaptogens assist the body in coping with stress by restoring hypothalamic cortisol receptor sensitivity. Increased cortisol receptor
sensitivity to negative feedback inhibition results in a rapid restoration of the stress response to normal, with a reduction in cortisol levels. AdaptaPhase I is one such blend of adaptogenic herbs. It is a combination of Siberian ginseng, Manchurian Thorn Tree extract, Hawthorn extract, Echinopanax elatum and Schisandra. This blend of adaptogenic herbs was developed for people under increased stress. Some people will get relief from one ml per day, while others will benefit from as many as four mls. AdaptaPhase I may work alone or in conjunction with its anti-catabolic counterpart, AdaptaPhase II.

Daily the body engages in a tug of war between two types of metabolism, anabolic metabolism and catabolic metabolism. During the anabolic phase the body accumulates
energy to build up new cells and lean muscle. Catabolism occurs when the body exhausts its energy reserves and breaks down lean muscle tissue. This often occurs when the body is subjected to extreme stress, such as the intense physical demands faced by athletes, the high pressure experienced by dot com executives as the NASDAQ loses 50% of its value, or a personal trauma such as the death of a loved one. AdaptaPhase II is synergistic blend of ingredients designed to help the body overcome that exhausted or tired feeling that is experienced by people under such extreme stress. The formula includes soy protein isolate, Rhaponticum carthinoides, Tribulus
Terrestris, and Adjuga turkistanica. These ingredients exert profound energizing, anabolic, muscle-building effects. This product is best used in cycles, with each cycle lasting 10 days with a break of two to three weeks between each 10 day cycle. Dosages range from 4-10 capsules per day depending upon the individuals weight and the amount of physical or psychological stress that individual is undergoing.

Adrenal Exhaustion
The third stage of the GAS, adrenal exhaustion, is often more difficult to resolve. Adrenal exhaustion involves a depletion of energy reserves and a loss of resilience. Symptomatic signs of adrenal exhaustion can be as diverse as fatigue, nervousness, anxiety, severe PMS, depression, brain fog, carbohydrate cravings, allergies, muscular pain and tenderness, joint pain and irritable bowel syndrome. The goal of nutritional therapy in this situation is to restore the natural, diurnal release of normal levels of cortisol. The theory is if you provide the body with a small amount of a cortisol-like substance, the adrenal glands can take a rest and have an opportunity to regenerate. Then normal cortisol production will be restored.

CortiTrophin is a combination of adrenal concentrate and glycyrrhizinate. Glycyrrhizinate is a natural cortisol-mimicking extract from licorice. Taking a small amount
of CortiTrophin 25-100 mgs/day can be beneficial in treating symptoms of adrenal exhaustion and can provide significant relief from the symptoms of chronic fatigue and fibromyalgia. To best mimic the bodys own physiology, CortiTrophin should be taken on an empty stomach, first thing in the morning. If a second dose is required, it should be taken before lunch. Since CortiTrophin mimics the action of cortisol, one should be very judicious in using it. It should only be used intermittently and if any adverse effects occur, such as water retention or elevated blood pressure, use should be discontinued imwww.ely.

DHEA
As cortisol rises with age, another adrenal hormone, DHEA, drops precipitously. Convenient salivary testing of both DHEA and cortisol can provide a road map for balancing these two critical hormones. However, DHEA can also be used empirically to alleviate the symptoms of excess cortisol or hyperadaptosis. DHEA can improve glucose tolerance, convert excess body fat to lean muscle mass, alleviate depression, increase energy and decrease pain in chronic fatigue and fibromyalgia patients, decrease joint pain and fatigue in inflammatory and autoimmune diseases, improve mental clarity and enhance overall immune function.

Nutritional strategies are only one component, albeit an important one, of a rational approach to attack the problem of excess cortisol. This discussion would be incomplete
without mentioning an optimal integrative approach to reducing excess cortisol levels which would include nutritional supplement strategies, stress reduction through exercise, and stress reduction through meditation. In a study published in the Journal of Sport and Exercise Psychology, Edward McAuley, a professor of kinesiology at
the University of Illinois, found that aerobic exercise had a significant impact on anxiety as compared with subjects asked merely to sit still. Herbert Benson, MD, author of the Relaxation Response has dedicated a lifetime to the notion that the regular practice of meditation can reduce the negative effects of stress and reduce cortisol levels.
Another dedicated researcher in this field has been Jon Kabat-Zinn, Ph.D., of the University of Massachusetts. He is the author of Full Catastrophe Living, which provides an excellent guide to those of you who want to include the meditation approach in your plan for optimal health. When it comes to stress, I learned long ago not to sweat the
small stuff. And in the end, its all small stuff.

References:
1. Bjorntorp P, Rosmond R, Neuroendocrine abnormalities in visceral obesity. Int J Obes Relat Metab Disord 2000 Jun; 24 Suppl 2:S80-5.

2. Pasquali R, Vicennati V, Activity of the hypothalamic-pituitary-adrenal axis in different phenotypes. Int J Obes Relat Metab Disord 2000 Jun;24 Suppl 2:S47-9.

3. Bjorntorp P, Rosmond R, The metabolic syndrome: a neuroendocrine disorder? Br J Nutr 2000 Mar;83 Suppl 1:S49-57.

4. Raber J, Detrimental effects of chronic hypothalamic-pituitary-adrenal axis activation. From obesity to memory deficits. Mol Neurobiol 1998 Aug;(1):1-22.