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Wednesday
May232012

Q & A: High Cortisol and Exercise

Written by Jim LaValle, R.Ph., CCN

Question:

For those with chronically elevated cortisol levels, how should high-intensity training be incorporated into a training program?

This is such an important question.  Many people may not realize that when you exercise with some intensity it elevates cortisol in your body, because basically you have placed your body under a physical stress to achieve fitness.  Normally, that is OK.  When you rest after exercise, cortisol levels will return to normal as your muscles go to work repairing and rebuilding.  That is how we get fit. 

But in a person with chronically elevated cortisol, the additional physical stress from a hard workout can be too much.  It is extremely important for anyone with high cortisol levels to address the issue because of the long-term negative effects chronically elevated cortisol can have. 

To answer this question thoroughly, I really need to address the problem from two perspectives:  for people who are not currently exercising or who are just endeavoring on a weight loss and fitness program, as well as in those who are already training intensely.  It helps to understand a little more about cortisol, its actions and how it affects us so dramatically.

Background

Cortisol’s actions in the body are lifesaving  when there are threats to our existence, like when we are injured or fighting for our lives.  However, it works against us when these conditions aren’t present and levels stay elevated over time. 

Cortisol does things like decrease production of certain immune cells, In this way, it is anti-inflammatory.  But it also increases blood pressure and slows digestive processes.  Over time it can cause suppressed growth hormone, lowered sex hormone production, and can even cause bone loss.  In fact, almost every system of the body can be affected.  High cortisol lowers production of T3 thyroid hormone and affects mood by disrupting serotonin production.

Symptoms of elevated cortisol will be things like reduced ability to fight off colds and flu.  (Ever notice that you get sick more often during times of high stress?)  This may seem harmless enough, but over time the lowered immunity even translates to increased risk of cancer.  You may also notice stomach upset or develop irritable bowel-type symptoms.  You may notice a more depressed mood and lower energy overall, especially a noticeable midday slump.   Increased cortisol is also a well-known cause of disrupted ability to sleep, and that may be part of the reason growth hormone production goes down. When growth hormone is reduced a person will notice that they are starting to lose their muscle, or in a person who trains, they may notice their body is not building and maintaining muscle like it should.

Studies have shown very clearly that when people exercise it raises adiponectin and testosterone levels, and that is great for weight management and fitness, but intense exercise also raises cortisol levels.  Part of the purpose of recovery time is to allow cortisol to return to normal while muscles repair and build.  

When people have repeated incidents of high stress at first, the cortisol will spike and then drop, and spike and then drop with each incident.  Eventually, with too many “incidents” the cortisol stops spiking quite so high, but in time the body “adapts” and the cortisol levels just stay high.  And eventually, even that wears out as the cortisol-making ability of the adrenal glands wears out, and cortisol is chronically too low. 

This scenario can happen regardless of whether the incidents causing spiked cortisol are from emotional stress or physical stress, such as occurs with intense training.  A person with low cortisol levels will have very low energy and, according to the CARDIA study from 2006,  is actually more prone to plaquing of the arteries and heart attacks.

When a person who trains intensely starts to develop some of the symptoms of elevated cortisol described above (getting more colds, not sleeping well, digestive symptoms, low mood, not recovering as quickly from workouts, not getting the same response to workouts), that is how we evaluate if they are overtraining.   Because athletes are very determined people, the response may be to “just push through it” and keep working out anyway.   Do I need to emphasize how incredibly unhealthy this is?

When cortisol levels increase, sex hormone levels decrease.  This is because since these are all steroid hormones, they are all made from the same raw material, called pregnenolone.  Because there is only so much raw material, when one biochemical pathway in the body is dominating how it is used, the other substances just don’t get made.

So another sign of overtraining is a lowered production of sex hormones, estrogen and progesterone in women, and testosterone in men, with an increased cortisol level.  So yet another sign of chronic stress and elevated cortisol can be reduced sex drive.

So what should you do about workouts if you have high cortisol, since intense workouts can increase cortisol? 

In a person who is trying to get into shape and lose weight, I usually recommend trying more gentle exercise, like yoga.  Yoga is particularly helpful in these scenarios because it involves deep breathing and is done in a calm meditative state.  This is tremendously helpful for lowering cortisol, and it does tone and strengthen the muscles.

Another option is to do resistance training only versus endurance exercises like cycling and running. A study in untrained males found that resistance training leads to increases in testosterone, while not causing spikes in cortisol.  Endurance exercises like running and cycling, which work to achieve calorie burning and cardiovascular fitness, did just the opposite – increased cortisol[i] and lowered testosterone. 

The study also looked at the effects of concurrent training — that is,doing some resistance training along with endurance exercise — and found that it protected against the lowered testosterone somewhat. However, you do still get some increases in cortisol.[ii]  

I’m not aware of any studies on the effects of endurance versus resistance training in a person whose cortisol levels are already elevated.   However, in my experience, you can tell your tolerance of an activity and its intensity by how you respond to the exercise. 

If resistance training or whatever workout you are doing makes you inordinately tired, you don’t recuperate very quickly, or you notice you get sick or get a cold after workouts, you are doing too much.  Choose lighter intensity activity. Walking may also be a good first option, though you may want to also do some light resistance training along with it for better fitness results.

For Athletes

In an athlete or someone who trains heavily, I highly recommend monitoring your hormone and cortisol levels regularly.  A free testosterone (T) to cortisol ratio is a predictor of a person’s ability to build muscle with training.  In other words, it is considered a very reliable marker of a person’s anabolic or catabolic state.  Higher numbers are anabolic; low numbers are catabolic.  Therefore, if you have a low free T to cortisol ratio, you get very little out of your workouts anyway, so the best thing to do is to rest.

For a person who wants to train, a high cortisol level presents a challenge.  You don’t want to stop training altogether, but you need to not add insult to injury by continuing to train too heavily.  There may be ways to help protect against this effect and still maintain a fairly intense level of training.  For example, based on studies that show endurance training is the worst for elevating cortisol levels, it may be better to switch over to more resistance exercise for a time, but be aware that even an intense resistance training session could be more than your body can handle. 

Also, for both athletes and people who are still trying to get into shape, there are other measures you can take to help reduce cortisol.  Here are some suggestions:

Diet

  1. Lower your intake of refined sugars.  High-sugar foods can cause a stress response and make cortisol elevate.  You don’t need to give the body more reasons for cortisol to elevate. Besides, if you are trying to lose weight, eating lower glycemic-index and -load carbohydrates has been shown to help muscle retention and fat loss.[iii] 
  2. Get tested for food allergies and sensitivities.  When cortisol elevates it reduces the production of some immune cells, but increases production of some antibodies that make us more prone to food allergies.  This is a chicken-or-the-egg question, however, because food allergies can a primary contributor to elevated cortisol so theallergies could have been happening first.  Either way, they are a stress to the body, and removing foods that are a problem for you can go a long way to helping improve cortisol levels.
  3. If trying to lose weight, follow a specific low-carb eating plan. Believe it or not, I recently saw a study done in men that showed eating no carbs during the day, but including them in only the evening meal, led to more weight loss and reduced appetite compared to a regular low-calorie weight loss diet.[iv]  Another study in women found they lost more weight if they ate carbs at breakfast along with protein, and then ate low carb the rest of the day.  Experiment!  See what works best for you.

Supplements

I have used supplements for a variety of health issues over the years and when it comes to supplements for stress, I have to say, this is one area where people notice a big difference with the supplements. Because these supplements have been discussed in other articles on this site, I will just give a quick rundown of supplements available at Life Time Fitness centers.

  • Relora Plus - Dampens stress response
  • Adreno-Mend -  Contains adaptogens that reduce the stress response
  • DHEA - this is an important hormone precursor that also drops under stress.  It is neuroprotective under sustained stress.
  • L Theanine - calms stress response and reduces feelings of anxiety
  • LeanSource  - supports thyroid hormones, improves alpha keto levels, improves fatty acid oxidation blocked by cortisol-insulin resistance
  • Cortrex  - helps rebuild adrenal gland, especially good during training for support and improves cortisol levels in those with low cortisol.

Suggestions for Intense Training to Moderate the Stress Response to Exercise:

  • Pre/post workout nutrition 15-30g glucose +5gm BCAAs or 10gm of protein every 30 minutes and within 30 minutes after stopping exercise.
  • Moducare - modulates cortisol and supports immune balance. Dosage 20-40mg, two times a day.
  • Adaptogens:
  • Cordyceps - helps improve oxygenation of blood and supports kidney function, which improves endurance and recovery.  Dosage: 1000mg two times a day.
  • Rhodiola ( with 5% rosavins) - improves the body’s ability to deal with stressors, reduces cortisol.  Dosage 100-200mg two times a day.
  • Cortrex - supports adrenals. Dosage: 1 capsule three times a day.

 This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader


[i] Skolud,N, Dettenborn, L, et al. Elevated hair cortisol concentrations in endurance athletes. Psychoneuroendocrinology May 2012 (37) 5; 611-617.

[ii] Shakeri, Nader, et al.  The effect of different types of exercise on the testosterone/ cortisol ratio in untrained male adults. Annals of Biological Research, 2012, 3 (3):1452-1460

[iii] Das SK, Gilhooly CH, et al. Long-term effects of energy-restricted diets differing in glycemic load on metabolic adaptation and body composition. Open Nutr J. 2007 Apr 1;85(4):1023-1030.

[iv] Sofer, S., Eliraz, A., Kaplan, S., etal; Obesity 19, 2006-2014 (October 2011) doi:10.1038/oby.2011.48

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Reader Comments (4)

I appreciate the clear explanation in this post. I'm an endurance athlete, but beginning a job with a much higher stress level 4 years ago has really affected my training and performance (as well as sleep, energy, mood, body composition). Are there specific tests I can ask my doctor to order to determine if my cortisol and related hormones are imbalanced?

May 26, 2012 | Unregistered CommenterRunning_Fatigued

When cortisol rhythms are out of optimal, it's best to assess the salivary 4-point cortisol & DHEA. However, other systems in the body can also suffer such as glucose control through insulin function, thyroid & metabolic hormones, as well as lower testosterone in males (typically lowered progesterone in females).

If you're a member of Life Time, you could take a complimentary questionnaire on www.mylt.com as part of the "myPlan" feature. The questionnaire is designed to take subjective feedback to determine which of the above areas (and more) are challenges for your body beyond calorie in & calories out.

You may use HSA or FSA funds to thoroughly assess all of the systems mentioned above at www.lifetimelabtesting.com. Ask a Fitness Professional how you may get a discount and thorough review of your results as well.

May 28, 2012 | Unregistered CommenterPaul Kriegler, RD/LD

Thank you for the helpful article. Is any of this information applicable to someone who has been diagnosed with adrenal fatigue? Specifically, relating to exercise .....

June 2, 2012 | Unregistered CommenterAdrenally Fatigued

@Running Fatigued: If you have a more progressive doctor, you could ask to have your sex hormones, complete thyroid profile and blood cortisol measured. It's unlikely he or she would have it, but a salivary 4-point cortisol test would also be super beneficial. You can also order them yourself if you hover over the "products" link at the top of the page and click on "personal assessments." The Stress & Resilience test is the 4-point cortisol test, which you can order online by following the links, or you can buy it at any of our Life Time centers. You can also order the sex hormone blood tests through this site as well if your doctor won't or can't do it.

@Adrenally Fatigued: The best exercise for you depends on the stage of adrenal fatigue your in. Those who at an early stage and are still producing high levels of cortisol from being under chronic stress can benefit from lower intensity exercise like walking or leisure bike rides. Yoga and other mind/body exercise is beneficial as well, as it trains the parasympathetic nervous system. If you are at later stages, where you may not even be producing much cortisol anymore, exercise may need to be avoided for a period of time. The best way to understand what stage you're in is through the 4-point salivary cortisol test I mentioned in the previous paragraph (at Life Time, it's called the Stress & Resilience Test).

June 2, 2012 | Unregistered CommenterTom Nikkola

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