Cortisol is a steroid hormone that is produced by our adrenal glands which sit atop our kidneys. The normal levels of cortisol in people, who are not stressed, rarely exceed 15-20ug/dl and are only at these levels for a few hours at the most.
Back in 1971, Weitzmann and colleagues from USA described the normal pattern of cortisol secretion into blood over 24 hours through their study of 6 normal people. The 24 hour sleep-wake cycle can be divided into 4 distinct phases. An episode is where there is secretion of cortisol. There is a sharp rise in cortisol during each episode, followed by slow, smooth decline.
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a) Phase 1: Minimal secretion – 6 hour period (4 hours before and 2 hours after sleep) where there is negligible to no cortisol secreted.
b) Phase 2: Preliminary nocturnal secretory episode – 3 hour period from 3rd to 5th hour of sleep. Here there is only one episode of cortisol secretion.
c) Phase 3: Main secretory phase – 6th, 7th, 8th hours of sleep and 1st hour after waking up. Three to five secretory episodes occur during these 4 hours. Almost 50% of cortisol secretion for the day happens during this phase.
d) Phase 4: Intermittent waking secretory activity – 11 waking hours where there are several (4-9) episodes of cortisol secretion but where the levels of cortisol secreted are lower than in phase 3.
There are three conditions that trigger the release of cortisol:
This article will talk more about cortisol, its importance in our body and how it relates to candida infections.
Cortisol and the stress-response system
We share our world with various living and non-living things and environmental forces which we may or may not have control over. We sometimes feel threatened by any of these and we need to respond to these in a manner that ensures our survival. It is not a surprise, therefore, that our bodies come fitted with a central stress-response system.
Our stress response system is known as the hypothalamic-pituitary-adrenal (HPA) axis. The hypothalamus is a part of our brain that links our nervous system to the hormonal (endocrine) system via the pituitary gland which is a small pea-sized protrusion sitting at the bottom of hypothalamus. Adrenals are thumb sized glands on the top of the kidneys.
When we are stressed (or are fasting, or sleeping in the night), the hypothalamus produces a hormone called corticotrophin-releasing hormone (CRH). CRH goes to pituitary gland and asks it to produce another hormone – the adrenocorticotrophic hormone (ACTH). ACTH is released into the blood which then travels to the adrenal glands and tells them to produce cortisol apart from mineralocorticoids like aldosterone, and dehydroepiandrosterone (DHEA).
Things that can cause us stress (stressors) are majorly of two different types:
- Physical stressors – like very hot or cold temperatures, injury, pain, or starvation. When we have low blood sugar, cortisol stimulates the release of fatty acids which get converted into glucose.
- Psychological stressors which are related to perceiving a threat, for example, events, situations, comments etc.
When we are threatened or when we perceive a threat, our stress-response system kicks in and our bodies respond to the stressor– physical or psychological – in different ways to protect us. Once the threat is gone, the response returns back to normal.
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Two important functions of cortisol are energy regulation and mobilization.
- It regulates energy by choosing the right type and quantity of molecules (carbohydrate, fat, protein). When body needs energy and no food is available, it stimulates production of glucose. When glucose is in excess it stimulates conversion of glucose to glycogen which is stored in the liver for times of need.
- It mobilizes energy by using the body fat and providing it to hungry tissues. When we are stressed, cortisol provides the body with energy from non-glucose molecules like proteins and fats through a process called “gluconeogenesis” (Gluco= sugar, neo=new, genesis=production; which means production of new sugar) which takes place in the liver. It can also move fat from storage depots to the abdomen and help fat cells grow and mature.
Cortisol and candida
Cortisol allows candida colonization in a couple of ways.
1. Cortisol increases blood sugar: Cortisol stimulates gluconeogenesis – production of sugar. In a normal person, cortisol also balances this by triggering conversion of glucose to glycogen when glucose is in excess. However, when we are chronically stressed and there is chronic production of cortisol,
2. Cortisol impacts our immune system: Dhabhar and McEwen from USA showed that under acute stress that lasts for a short time, our immune system is boosted by cortisol and when the stress become chronic the immune system is suppressed by it. These researchers think that a boost in immune function during acute stress is body’s way to prepare it for any injuries sustained during the acute period of stress. On the other hand, suppressed immune system due to chronic stress makes a person susceptible to infections. Our immune system appears to behave a different way when there is constant secretion of cortisol. A glucocorticoid-resistance model proposed by Miller, Cohen and Ritchey in 2002 has since increasingly found evidence in other research studies. When we have a constant secretion of cortisol, our immune system becomes insensitive to cortisol.
Our immune cells which normally express receptors to cortisol – when the receptors bind cortisol it is a signal that the immune function, especially functions that cause inflammation should be reduced. So what do these cells do in chronic cortisol condition? They need to protect the body in some way. So they stop/reduce the production of these receptors. This results in constant low-grade inflammation. Candida can easily take advantage of this low grade inflammation – it can use the slight tissue damage and slowing down of tissue repair to its advantage. A study published in 2008 by Jawhara and colleagues from France showed that inflammation of the gut promotes candida colonization.
A telltale sign of chronic stress is a lower than normal morning levels of cortisol in the saliva. After a long time of chronic stress and cortisol secreted continuously, our body’s reaction to external stress fails – our cortisol secretion reduces to normal or below normal levels. This is called as “blunting of cortisol response”. So our body at this stage refuses to react to a threat, for example, an infection. This gives a chance to opportunistic organism like candida to gain access to our tissues to establish. Ehrstrom and colleagues from Sweden showed in 2005 that women with chronic vaginal candida infection had lower than normal morning levels of salivary cortisol.
3. Cortisol affects our gut microbes: Cortisol can alter gut-permeability and barrier function. This way it can contribute to change in gut microbe composition. Change in gut microbes can lead to increased colonization by opportunistic pathogens like candida.
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What can be done to maintain healthy cortisol levels?
Stress is a part of life and we cannot avoid it. What we can do is to avoid becoming chronically stressed. This we can do only if we are consciously aware of being stressed. This can only happen if we give ourselves some time. You cannot work towards solving a problem if you are unaware of the problem. So a good start is to find out if you are on a problem path. Once you have realized this, you can make small changes in your lifestyle that will increase the quality of your life, reduce stress and avoid the dangers of high cortisol running in your blood. Here are a few tips:
- Relax: While small amounts of stress can be beneficial, you need to give yourself time to recover from the stress and the increased cortisol levels. Spanish researchers Cea Ugarte and colleagues showed in 2010 the beneficial impact of controlled breathing exercise on cortisol levels. You can do some breathing exercises that can relieve your stress. Also, Tai-chi has been shown to have cortisol lowering effect. Compared to physical exercises, mind-body exercises like tai-chi or yoga are more effective in handling stress.
- Get good quality sleep: Poor sleep has been shown to result in much increased cortisol response to psychological stressors and physiological stressors. Worse your sleep worse will be your problems with cortisol, higher the risk of candida infections and lower the chances of recovery from any existing candida infection.
- Exercise regularly: A 2008 research study by Hill and colleagues from USA showed that while low-intensity exercises caused a reduction in circulating cortisol levels, medium and high intensity exercise actually increased them! So beware, light exercise is good for you to reduce cortisol due to daily stresses, but if you overdo it, you may actually increase your problems instead of reducing them.
- Stop your caffeine intake: There is evidence that caffeine intake can increase the cortisol levels in blood. Lovallo and colleagues from USA showed in 1996 that the response to caffeine was very much stress-like. So, if you are already stressed, coffee is not going to help in any way.
- Stop alcohol: Although alcohol is known to relieve anxiety, there is a strong association between alcohol use and increased cortisol levels. So, if you are looking to reduce/prevent your stress and cortisol related issues, you really need to give up on alcohol.
- Stop smoking: Smoking tobacco also increases the blood cortisol levels acutely and so it follows that you must stop smoking.
- Good balanced diet: There is some evidence that caloric dieting (dieting to reduce calories) actually increases the cortisol levels. US researchers Tomiyama and colleagues showed in 2010 that dieting may be deleterious to psychological well-being and biological functioning due to increased outputs of cortisol. High and low zinc intake in food has been reported to cause changes in adrenal secretions. Zinc seems to acutely and temporarily inhibit cortisol production as was showed by a preliminary study by Brandao-Neto and colleagues from Brazil in 1990. So, a deficiency of zinc can cause your cortisol to stay high. Additionally, poor nutrition can cause hormonal imbalance through various mechanisms. So, it is important to have a good and balanced diet in order to make sure that your hormones, including cortisol, stay in balance.
- Probiotics/prebiotics usage: Microbes also exert an effect on the circulating cortisol levels. A study by Schmidt and colleagues from UK which was published in 2014 described the effects of prebiotics, which increase the population of good-bacteria in the gut, on circulating cortisol levels in healthy volunteers. The study found that the prebiotic Bimuno-galacto-oligosaccharide reduced the salivary cortisol awakening response and also changed the emotional processing to positive. CanXidaRestore is one of the best probiotic+enzyme blend out there that you can incorporate in your diet.