Stop Demonizing Cortisol!

This one fires me up!

The Monologue

Like many of you, my head spins with the mountain of information about anything and everything on the internet - and women’s health is no exception. Having some expertise in women’s health, fitness, and hormone health, I take very seriously the responsibility of bringing objective and accurate information to my patients, clients, and subscribers of my publications, and followers on social media. This is quite a task when you have so many outlets of information with no single source that is universally complete or, in some cases, even reliable.

In my quest for objectivity and accuracy, I evaluate the medical literature for its strengths and limitations and look for consistency and evidence-based information in those whom I follow on social and mainstream media. Then I check this information against more than 20 years of training and experience as a women’s health physician, scientist, athlete, and fitness professional.

A very disturbing trend that I have noticed is the demonization of many naturally-occurring things that are essential for our health and well-being. Let’s start with the sun. Media culture stoked the fear of the All Mighty within us if we didn’t wear 50+ sunblock from dawn until dusk - until we realized that this was increasing the rate of vitamin D deficiency. Shocker. Fat and “cholesterol” were demonized as the nail in the coffin for developing cardiovascular disease, strokes, and heart attacks - until we learned that this may just be a small piece of a much bigger puzzle and that refined sugar may actually be a bigger culprit. Then if it wasn’t enough to demonize refined sugar, the cultural think tank decided to demonize all carbohydrates - feeding into the toxic diet culture that sadly pervades society today.

But the latest in these destructive narratives is the demonization of cortisol - a hormone necessary for Human life - and this notion that mid-life women should avoid physical intensity because “cortisol is bad” is one of the most misguided and destructive narratives polluting our media outlets. Today’s post is going to make the case against this narrative.

What is Cortisol?

Cortisol is a steroid hormone that is produced by two glands that sit atop the kidneys called the adrenal glands. These glands produce many different hormones that control physiologic hemostasis (balance) and are essential for life. Cortisol is one such hormone produced during the stress response, a.k.a the “fight-or-flight” response, which is orchestrated by the Sympathetic Nervous System (SNS).

The SNS response was designed by nature to fight against threats to our survival. This could be a bear in the woods, a famine, or threats to our personal well-being. In a more civilized society, this system is also activated during an athletic event, saving a victim from a burning building, or the classic CrossFit workout “Murph” on Memorial Day. This response has been conserved through evolution from our earliest primate ancestors and is a key player in the continued survival of our species.

If you want to learn more about the stress response, check out these two video excerpts: Stress Response Part 1 and Stress Response Part 2 taken from my course, Menopause Health and Fitness Specialist.

Myth-Buster Alert: Excess cortisol is NOT stored as fat! This is a biochemical impossibility.

It doesn’t take a chemistry degree to see that these structures are not much alike, and thus conversion from one to the other is like making gravity go sideways.

Cortisol and Fitness

The activation of the SNS, and thus the cortisol response, is essential for maintaining and improving physical fitness. There is no way around this. Gains in fitness are had beyond the margins of our experience, and that requires working hard and pushing limits which cannot occur without activation of the SNS and transient increases in cortisol. For a deep dive into this concept, check out this previous post in Athletic Aging: Neuroendocrine Adaptation - Your “End-Run” Around the Menopause Transition

Mid-life is the time when the contribution of estrogen to maintaining muscle and bone mass declines and thus impacts overall metabolic health, fracture risk, and longevity. The need for physical fitness is thus of critical importance as a woman enters this stage of life to stave off the physical decline that inevitably accompanies these hormonal changes.

Navigating the Female Stress Response

The SNS response in females is directly linked to the reproductive system and her overall physiology as part of arguably THE most powerful evolutionarily conserved pathway to promote the survival of the female and her offspring. Because of this link between the stress response and female physiology, this interplay needs to be carefully navigated.

The notion that mid-life women are singularly sensitive to stress is flawed based on biological fact because an “unchecked” stress response can wreak havoc at every stage of a woman’s life.

At the start of puberty, when the stress response goes unchecked, menstrual cycle onset can be delayed and lack of menses impacts the development of peak bone mineral density -one of the single, greatest risk factors for osteoporosis and fracture later in life.

During reproductive age, the unchecked stress response can lead to menstrual cycle dysregulation, impaired bone mineral density development, and the ability to conceive. Given that there is a finite period in a woman’s life for child-bearing, infertility can be a big deal.

Lastly, in perimenopause and menopause, the unchecked stress response can result in elevated blood sugar, high blood pressure, low bone mass, decreased cognitive function, body composition changes, and accelerated aging. Check out this post from March 2022: “Just Deal With It” is Not an Option which is a review of a research study showing the benefits of managing menopausal symptoms for its effect on lowering cortisol levels.

Reconciling the Narrative

One could argue that the points made in the last section “Navigating the Female Stress Response” proves the point that “cortisol and stress are bad”. On the contrary. The fact that the cortisol response is apparent in every stage of a woman’s life is a testament to its necessity. What’s “bad” is letting this response go “unchecked” - not just in mid-life, but in every stage of a woman’s life.

The goal, is that we, as educated women, athletes, health care providers and fitness professionals should focus not on avoiding this powerful hormonal pathway integral to our fitness and survivial, but rather managing it.

This starts with awareness and identifying the variables that prevent the return of the stress response to baseline after a life or physical stressor. Transient stress is what builds fitness. Chronic stress - when the system does not return to baseline - it what is meant by an “unchecked” stress response.

Once we identify the variables, we focus on nutrition, breathwork, meditation, yoga, tissue care, appropriate warm-up and cool-down, balancing training and fueling, to name just a few. I highly recommend this blog post from my friend and rock star writer, Selene Yeager “Are You Overtraining?” which beautifully illustrates this point.

The resources for managing the stress response are readily available. We just need to make a point of prioritizing them as part of our daily rituals and fitness strategies. This is critical not just for women in mid-life, but for maximizing women’s health and performance during every stage of their lives.

So rather than running from a physical response that is integral to our very existence, let’s instead learn about it, embrace it, and work within it rather than against it. That, my friends, in my humble opinion, is one of the greatest keys to achieving your peak performance potential and your healthiest, most vital self!

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Housekeeping…….

I had the privilege of being a guest on two amazing podcast episodes that dropped last week. Enjoy!

Inside Sports Nutrition Podcast: Hormones and Female Physiology with Dr. Carla DiGirolamo - Ep. #69 – Dina Griffin/Bob Seebohar

Fit Womens Weekly Podcast: Should Workouts Change As You Get Older? Dr. Carla DiGirolamo Breaks It All Down - Kindal Boyle