Chronic Stress and Weight Loss Resistance

by Clinical Consulting Team

This post was written by our guest author, Tonya Pasternak, ND.

In today’s world, stress is ubiquitous. Millions of Americans struggle with chronic stress in many forms, whether physical or emotional. In addition, Americans suffer from high rates of obesity, and difficulty losing weight. Both stress and weight loss resistance are linked by one important hormone, cortisol. Cortisol has powerful benefits for the body. When cortisol is too high or too low, those same benefits disappear, and health problems arise. The first step to understanding if cortisol is affecting your health, including your weight, is lab testing. Understanding how cortisol dysregulation might be affecting you and how to test is is an empowering step towards controlling the metabolic impact of life stress.

Types of Stress

When we think of stress, we typically think of lifestyle stressors: hectic work schedules, arguing with a spouse, financial strain, and the list goes on. While these stressors are typical, we are also bombarded by many other forms of stress as well. Other types of stress include environmental toxins, processed foods, certain medications, physical pain, and anticipatory stress, which is simply just worrying about something troubling. Our brains can’t distinguish between different types of stress; all it registers is a “danger” signal, which results in a stress response. The way the body responds to stress in most cases is to raise cortisol levels. Our bodies can be impacted by high cortisol levels even if we don’t feel stressed or believe we’re “handling” it well.

Adrenal Glands and Chronic Stress

Cortisol is produced by our adrenal glands, located on top of the kidneys. These glands also produce sex hormones such as DHEA. Cortisol serves many important functions, including regulating circadian rhythm and providing energy. Levels of this hormone change throughout the day, rising in the morning to help us wake up, then decreasing throughout the day until their lowest point in the evening. We also get surges of cortisol when the body is under stress. Acutely, this helps us act quickly in times of need, in instances such as hitting the brakes to avoid a collision. However, under chronic stress, we begin to develop imbalanced levels and rhythms of cortisol. Over time, this has numerous consequences on metabolism, including blood sugar dysregulation, insulin resistance, thyroid dysfunction, and impaired circadian rhythm.

Symptoms of Adrenal Dysfunction

How does one know if they are being affected by chronic stress and adrenal dysfunction? We will get to testing below; however, here are some signs and symptoms to look for:

• Difficulty waking up
• Fatigue throughout the day
• Hard time falling or staying asleep
• Burst of energy in the evening
• Anxiety, irritability, feeling on edge
• Depression
• Irregular menstrual cycles
• Infertility
• Lack of motivation
• Low libido
• Abdominal weight gain/obesity

Cortisol and Obesity

It's no surprise that Americans are struggling with an obesity epidemic. While the traditional “calories in vs. calories out” explanation may oversimplify things, recent medical research reveals that metabolism is far more complex. Cortisol, our body's primary stress hormone, has a strong correlation with obesity. This is linked to how cortisol increases blood sugar for energy, explained below. With the growing number of stressors in modern life, it’s no wonder that millions are finding it difficult to maintain a healthy weight due to elevated cortisol levels.

Cortisol and Metabolic Syndrome

Metabolic syndrome is a condition that occurs when someone has multiple risk factors for cardiovascular disease, including obesity and insulin resistance. Chronic stress and, therefore, chronically elevated cortisol levels significantly feed into this, independent of diet. That’s right, that means even when a person does “all the right things,” including healthy eating and regular exercise, stress can still wreak havoc on one’s metabolism. Cortisol leads to increased glucose or sugar in the bloodstream. While during small bursts of stress this can help us, over time, it can lead to insulin resistance and diabetes. These physiological responses also increase sugar cravings, lethargy, brain fog, headaches, irritability, and stubborn belly fat.

Cortisol and Thyroid Health

We have now seen how cortisol contributes to obesity through its effects on blood sugar and insulin resistance; however, it doesn’t end there. Cortisol produced from chronic stress can lead to lower levels of thyroid hormone.

The thyroid is a gland in the neck that acts like the body's engine. It regulates everything from energy, metabolism, cholesterol, blood sugar, hair growth, the menstrual cycle, body temperature, and blood pressure. When this gland is underactive (hypothyroidism), it decreases metabolism in many ways. One way it does so is by slowing down our basal metabolic rate (BMR), which is how much energy or calories our bodies burn at rest. When this is dialed down, metabolism slows, often leading to increased weight gain. Other symptoms of hypothyroidism include hair thinning, cold intolerance, constipation, depression, and dry skin. A simple blood test can be done to assess thyroid health.

Testing

The most important first step to understanding your cortisol is getting a good baseline of adrenal function. To understand the pros and cons of various types of tests, let’s first revisit the normal presentation of cortisol in more detail.

Cortisol levels follow our circadian rhythm. Levels need to be low at night for the body to be able to fall asleep easily. Typically, 2-3 hours after falling asleep, cortisol levels slowly start to increase until we wake up. For the next 30 to 60 minutes after waking up, cortisol levels reach the highest peak of the day, normally increasing by 50-160%. After this point, levels steadily drop throughout the day until they are low again at night, and the cycle restarts.

The cortisol spike in the morning is called the cortisol awakening response (CAR). Another name for the CAR is a mini-stress response. The CAR reflects the functioning of the stress response. When this spike happens normally, the brain and adrenal glands are in healthy communication, indicating no significant consequences from stress. If the CAR is higher-than-normal, it indicates the nervous system is on overdrive due to the examples we discussed previously. Burnout mode commonly causes a low CAR, which is often the result of a chronically overtaxed adrenal response. Other factors that feed into high or low bursts include sleep disorders, depression, chronic pain, and glucose dysregulation.

Now that we have a better understanding of normal cortisol patterns, we can dive into testing. Cortisol testing can be done in several ways. Blood tests are available; however, they only provide information on one specific point in time. By only assessing one marker, we would likely miss most dysfunctional cases. One can get serial serum draws, which requires staying in the lab and getting several stressful needle sticks. This is both impractical AND is less likely to get an accurate measurement of normal cortisol levels due to the stress of getting multiple blood draws. A superior method is salivary hormone testing, which can painlessly capture many samples throughout the day in your normal setting, at home or at work. This can give a more accurate view of our daily cortisol rhythm. Additionally, testing the cortisol awakening response (CAR) leads to even more understanding of adrenal function. The CAR is tested by measuring three specific points starting at waking to compare the relative increase of cortisol on waking. The DUTCH CAR test looks at 5 salivary samples, including the awakening response and samples throughout the span of the day to ensure adrenal imbalances are thoroughly assessed. The DUTCH CAR test uses an FDA-approved collection device called Salivettes, which is the preferred testing material recommended by experts in the field.

Knowledge as Power

Through advancements in testing, such as the DUTCH CAR test, we can assess if cortisol is a contributing factor in chronic stress and weight loss resistance. With knowledge comes power, as there are numerous treatments that can help mitigate stress and its implications on the body. Taking a deep dive into information gathering to know exactly what treatments are best can empower people to make informed health decisions. Not only can targeted treatment options help control blood sugar, insulin resistance, and obesity, but they can also drastically improve overall quality of life. Using the results from the most relevant tests to better align the most effective treatments is key.

Become a DUTCH Provider to learn more about how comprehensive hormone testing can profoundly change the lives of your patients.

This post was written by our guest author, Tonya Pasternak, ND.

Dr. Pasternak’s interest in Naturopathic Medicine was sparked at an early age and has been a long standing passion of hers ever since. She received her bachelor degree in cellular and molecular biology and her doctorate in naturopathic medicine from Bastyr University. During that time, she participated in various independent research projects with a primary focus on genetics. To help expand the availability of naturopathic care, Dr. Pasternak volunteered her time by providing medical services to the homeless population living in Seattle’s tent cities.

In addition to treating conditions related to the immune, endocrine, and digestive system, personal experiences lead Dr. Pasternak to dive deeply into the field of Lyme disease and other tick-borne illnesses. She studied the work of many renowned experts in the field, including Dr. Klinghardt, Dr. Ross, and Dr. Burrascano. She realizes the importance of treating the whole body, including clearing infections, restoring balance, nurturing damaged systems, and acknowledging the emotional hardships that come with disease.

Through clinical experience, Dr. Pasternak has also discovered a passion for women’s health. She has helped numerous women regain their vitality through addressing hormonal imbalances contributing to infertility, menopausal symptoms, PMS, PCOS, and endometriosis.

When working with patients, Dr. Pasternak always seeks to find the root cause of disease and values taking time to educate her patients. She creates customized treatment plans for each person, utilizing a blend of nutrition, botanical medicine, and craniosacral therapy. She is a member of naturopathic medical associations on both the state and national levels, and continues to expand her knowledge by staying up-to-date on current medical advancements.