Stress! Our world is riddled with it. Many of us face it head on nearly everyday. Job stress, commute stress, financial stress, job loss, the stress of raising children, intimate partner stress, divorce, stress of caring for (or worrying about) a sick or aging partner or family member and even social isolation and loneliness are considered stressful to the brain and the body. The list is infinite.
While some of life’s events are inevitable and we have very little control over it, other events or circumstances may not be as bad as we imagine. These might be phobias or simply an overreaction to something that hasn’t even occurred and likely may never occur. Yet our brain still perceives it as a potentially harmful threat to the body. The brain does not know the difference.
Subsequently, the body – that receives communication from the brain – does not know the difference either. Our bodies are naturally designed to survive acute and immediate stress. That’s one of the amazing miracles of the human body – it’s adapts quickly to protect you. Chronic stress – that’s a whole different scenario.
Here’s what happens when our brain senses fear or a threat of some kind.
That fear triggers the Amygdala, an area of the brain involved in emotional processing, to communicate with the hypothalamus. The hypothalamus, the major command center in the brain, then communicates with the Pituitary Gland in close proximity. The Pituitary Gland, the “master gland” that transmits precursor hormones to many hormones glands throughout the body communicates with the Adrenal Glands that sit on top of our kidneys. This is commonly known as the HPA Axis – the Hypothalamic-Pituitary-Adrenal Axis.
The sympathetic nervous system (think gas pedal to increase speed) has now been activated to prepare for a “Fight or Flight” response. The adrenal glands are signaled to produce Epinephrine (a.k.a Adrenaline) and Norepinephrine (a.k.a Noradrenaline) to help us get to “safety” as quickly as possible – whatever that might be. Respiratory airways open up, blood flow circulation increases to our muscles, heart rate increases, digestion slows, increased oxygen flows to the brain to increase alertness and focus, pupils in the eyes dilate to better see where we are going and blood is shunted away from non-critical organs. Our most important organs are treated with higher priority, while other organs like our skin, ovaries, testicles and thyroid gland are put on the secondary “back burner.” It’s a protective process designed to occur for a short duration.
Cortisol, a stress triggered steroid hormone, is also secreted from the adrenal glands to release stored glucose to provide a quick source of fuel for the “fight or flight” ahead. Additionally, it controls fluid and mineral balance and blood pressure through it’s effects on the kidneys. In a non-threatening environment, cortisol is positively essential for nourishment, growth, reproduction, survival, longevity and more.
If the stress is limited and the source of fear has resolved, the brain tells the body to resume to the more peaceful, relaxed parasympathetic nervous system (think brakes to slow down). In other words, Rest, Digest, Repair and Reproduce.
Chronic stress, that persists for weeks, months and even years is extremely detrimental to the body. Cortisol is released in overabundance – well beyond what the body needs and can tolerate. The body was certainly not designed to withstand the overwhelming exposure of stress hormones. Chronic stress is catabolic (breaking down or destructive) and leads to deterioration of the body’s organs, adverse changes in normal physiologic functioning and early death.
Listed below are some of the more common physiological responses to chronic stress:
Trouble falling or staying asleep
Gastro-Intestinal pain and ulcers
Irritable Bowel Syndrome
Malabsorption & Nutrient Deficiency
Intestinal Permeability (“Leaky Gut Syndrome”)
High Blood Pressure
Irritability and Impatience
Anxiety and/or Depression
Muscle Aches & Fibromyalgia
Carbohydrate & Sugar Cravings
Insulin Resistance (elevated glucose and insulin)
Premature Skin Aging
Eczema, Psoriasis & Acne Flare ups
Immune Suppression and/or Autoimmune Disorders
Getting Sick Frequently and/or Staying Sick (i.e. cold virus)
Increased Cell Dysfunction & Cell Changes (i.e. Cancer)
AND Hormone changes!
Chronic Stress and Thyroid Hormone
When our body is enduring chronic stress, our thyroid gland becomes less important, which is unfortunate because our thyroid is the main organ involved in regulating our metabolism. The thyroid gland plays a main role in body temperature, increasing energy, calorie burning, hair growth, skin moisture, gastro-intestinal regularity, mood, focus, exercise stamina, clearing excess cholesterol and triglycerides, hormone production, menstrual regularity and much more. With the brain’s perception of stress along with excess stress hormones circulating throughout the body, the hypothalamus and pituitary gland slow down production of their preliminary hormones to the thyroid gland, thus reducing the output of thyroid hormone coming from the thyroid gland. Normally T4 (inactive thyroid hormone) is converted into T3 (active thyroid hormone). Under chronic stress, T4 to T3 conversion is minimized and thyroid hormone becomes resistant to binding to cell receptors throughout the body. This results sluggish metabolism, weight gain, fatigue, hair and eyebrow loss, colder body temperature and extremities, irregular menstrual cycles, reduced levels of reproductive hormones like progesterone and testosterone, brain fog, trouble focusing, depression and much more.
Chronic Stress and Insulin Resistance
Insulin is the hormone produced from the pancreas in response to a meal containing carbohydrates – fruits, vegetables, bread, potatoes, candy, desserts, etc. Once our bodies break down carbohydrates into the simplest form – glucose, insulin is the hormone that helps transport glucose from the bloodstream into our organs via cell receptors that surround our organs. Think of insulin as the courteous door man that lets you in the building. In this way, glucose as well as insulin levels decrease after a few hours of eating a carbohydrate meal. However, during a stressful experience and even worse during chronic stress, cortisol and epinephrine are released to help “support” our bodies during that time. With cortisol secreted by the adrenal glands, that tells the body to release stored glucose to provide extra fuel to the body for the “fight or flight.” If the stress is limiting, glucose and insulin levels eventually return to normal. If the stress is chronic with ongoing cortisol secretion and there doesn’t appear to be an end in sight, glucose levels remain elevated and so does insulin. What happens over time is the body’s attempt at survival and adaptation to the harmful stress. Instead of insulin binding to cell receptors and escorting glucose straight into the cells/organs, the insulin can no longer bind to cells or binds very poorly and inconsistently. This is known as “Insulin Resistance” – a dysfunctional metabolic disorder. This not only results in elevated glucose and insulin over a longer period of time, but leads to other health problems like weight gain, increased belly fat, fatigue after eating carbohydrates, low energy, sluggish metabolism, elevated triglycerides, LDL Cholesterol and increased risk for Diabetes and all of the unfortunate symptoms associated with that disease.
Chronic Stress and Estrogen, Progesterone
Estrogen and Progesterone are essential for creating life, producing a regular normal menstrual cycle, growth and development of female organs and secondary sexual characteristics, cognitive function, sleep, memory, strong bones, healthy cardiovascular system and normal lipid levels, clear vibrant skin and so much more. When chronic stress plagues the lives of women (as it often does), hormones are suppressed, imbalanced or sporadic leading to to a wide variety of unpleasant and uncomfortable symptoms. If you are still menstruating, these symptoms include: worsening PMS symptoms, irritability, tearfulness, headaches, heavier bleeding, uterine fibroids, fibrocystic breasts, reduced libido, shorter or longer cycles beyond 28 days, intermittent ovulation and therefore skipping some periods and in some severe cases, no menstrual periods at all for months or years. That latter symptom is also known as secondary amenorrhea. At various times throughout my life when I have been very stressed, my periods temporarily stopped for several months. Through the whole body approach to treatment – Naturopathic Medicine, as well as consulting with a Naturopathic Doctor, my periods fortunately returned to a monthly normal.
From a reproductive standpoint, a chronically stressful environment (the mother’s current situation and her stressed body) is not the ideal time to conceive and bring a baby into this world. So the body takes precaution and inhibits or reduces ovulation which then reduces progesterone release from the ovaries which is essential for conceiving and sustaining a healthy pregnancy.
If you are menopausal and recently past the point of monthly periods, such symptoms of chronic stress may include worsening and more frequent hot flashes, night sweats, severe sleep disruption, headaches, weight gain, irritability, vaginal dryness, low or non-existent libido, hair loss, drier, more wrinkled skin and more.
Chronic Stress and Testosterone
Testosterone is very important for both men and women. For men, testosterone is essential for male reproductive organ growth and development, secondary sexual characteristics, libido, stamina, muscle strength, confidence, ambition, mood, sharper cognitive function, stronger bones and cardiovascular system and so much more. In women, testosterone is also important for libido, muscle strength, energy, ambition, better mood, confidence, stronger bones and cardiovascular system and more. While men usually produce substantially greater amounts of testosterone compared to women, during chronic stress, both genders experience a drop in this important hormone. Since testosterone is an anabolic or building hormone and stressful reactions denote a catabolic or breaking down state, they work against one another. Testosterone insufficiency symptoms related to chronic stress may include (and will likely vary depending on gender) reduced sex drive and reduced sexual function, low energy, depression, irritability, brain fog, memory impairment, weight gain and more.
Diagnostic Tests to Evaluate Stress Effects on Hormones
DUTCH Hormone Test
The Dutch test, which stands for Dried Urine Test for Comprehensive Hormones, was created by the lab Precision Analytical. This excellent, detailed test evaluates hormones by way of collecting urine 4x per day over a 24 hour window. Essentially, urine is collected during the waking hours of the day – morning, midday, evening/dinner time and bedtime. Specifically this test measures the adrenal and sex hormones like several forms of estrogen, progesterone, testosterone, dhea, cortisol, cortisone and important hormone metabolites – the broken down version of those hormones. Such hormone metabolites provide us with greater and deeper insight into how well (or poorly) the hormones are absorbed and utilized in the body as well as how effectively (or not) they are excreted from the body. The more comprehensive Dutch Test – The Dutch Complete – further looks at other significant markers such as melatonin, nutritional organic acids (Vitamin B6/B12 markers) and neurotransmitter metabolites (i.e. epinephrine).
The process of collecting urine 4x/day can also better evaluate the person’s circadian rhythm, an internal 24 hour clock controlled by our hypothalamus in our brain as well as by the light and darkness of each day. In a healthy person with a normal circadian rhythm collecting urine 4x/day, you would expect to see cortisol highest in the morning and lowest in the evening and at bedtime. Conversely, in a person with an opposing or “out of balance” circadian rhythm, cortisol would show lowest in the morning and highest at bedtime. In which case, that might explain their chronic morning or daytime fatigue and difficulty falling or staying asleep at night.
The Dutch method of testing can more accurately detect the amount of stress hormones being produced by the adrenal glands and excreted in the urine. This test also shows how chronic stress (excess hormones) or adrenal fatigue (insufficient hormones) is adversely affecting the sex hormones. Furthermore, this test can help monitor and tailor individualized hormone supportive treatments such as bio-identical hormone replacement and botanical/nutritional therapies aimed at balancing hormone levels.
Here’s a sample report of what you can expect to see if you have the Dutch Complete ordered for you: https://dutchtest.com/wp-content/uploads/2016/02/DUTCH-Complete-Female-Sample-Report-01_24_19.pdf
Serum/Blood Testing for Hormones
Serum or blood testing for hormones has been the universally accepted “gold standard” of testing hormones for many years. This method of testing is the most convenient, least expensive and commonly covered by most health insurance plans. Blood draws are routinely done in the morning as a one time collection requiring the patient to fast for 10-12 hours. As with any diagnostic lab test, there are limitations to serum testing of the sex and adrenal hormones. Hormone levels tend to be higher at certain times of the day and can also fluctuate throughout the day and evening. For example, cortisol and testosterone are usually highest in the morning and therefore a morning collection will show a higher level compared to a 4pm collection.
Saliva Testing for Hormones
Salivary testing of the adrenal and reproductive hormones has been commonly used over the years by many health care practitioners. Usually collected 4x/day similar to the Dutch Test, it is relatively inexpensive, convenient, time saving and non-invasive (no needles involved). Testing for salivary free cortisol 4x/day has its clinical advantages in some cases. However, cortisol metabolites are missing in a salivary collection and therefore it’s difficult to fully assess the full cortisol status from brain to adrenal glands (remember the HPA Axis?). Furthermore, salivary testing of the sex hormones does not show hormone metabolites, hinders the complete analysis of hormones and makes hormone replacement therapy more challenging.
From my clinical perspective in testing and treating patients over the years, salivary testing of hormones tends to show much lower levels (or higher levels) compared to serum/blood and urine levels in the same patient. For example, if a salivary test (ordered by another doctor or practitioner) for a female shows low progesterone and low testosterone and yet blood and/or urine shows that they are within the normal reference range, often patients are inappropriately treated with hormones when it may not be necessary. Then patients are getting too high of a dose of hormones with subsequent adverse side effects. Additionally, patients that are using bio-identical hormones and then complete a salivary hormone test, often their levels show substantially higher outside of the reference ranges. Their hormone doses are often times reduced or they are told to discontinue hormones altogether. And this can cause hormone deficiency symptoms to return, making the patient unhappy and frustrated.
Blood/Serum Testing for Thyroid
The best way to evaluate for thyroid hormones is through blood or serum. It is by far the Gold Standard of testing. I routinely order the complete thyroid panel for my patients. That usually includes TSH, Free T3, Free T4, Reverse T3, Anti-Thyroglobulin Antibodies, Anti-Thyroperoxidase Antibodies. The latter two evaluates for autoimmune thyroiditis such as Hashimoto’s Disease. This comprehensive test is so beneficial for proper diagnosis and to better monitor thyroid dosages. There are many labs that I use that offer this detailed panel.
Blood/Serum Testing for Insulin and Glucose (& More!)
Glucose is regularly monitored by blood as a mainstream test usually included in a Metabolic Panel with many other markers. By itself, it is helpful yet incomplete. Add in insulin, hemoglobin A1c, cholesterol, important lipoprotein markers, leptin, adiponectin, C-Reactive Protein and much more (i.e. Cardiometabolic Panel), and you have a much better diagnosis of insulin resistance, metabolic syndrome, diabetes and cardiovascular disease.
Dealing with life’s stressful events and interested in finding out what your hormone levels are? Or maybe you are not chronically stressed but still curious about your hormones. With the right hormone test (i.e. The Dutch Complete), a complete thyroid evaluation, a cardiometabolic panel and detailed and educational interpretation of such test results, the right treatment recommendations can be tailored specifically to you. Such treatments may include:
Lab Test Ordering and Interpretation
Supportive Stress Management Techniques
Diet and Nutrient Therapies Specifically for You
Evidence Based Botanical & Nutritional Supplements
Individually Customized Bio-identical Hormone Prescriptions