Just Breathe
How stress (specifically chronically elevated cortisol levels) can affect weight management
Earlier this year, I was asked a question about stress and its relation to weight management. A lady in one of the fitness communities that I help moderate had noticed that when she experienced high levels of stress, she gained weight. When she was relaxed and not stressed, she lost weight. Seemingly regardless of what she ate, and regardless of how much or little she worked out. To her mind, when stressed, she could eat “under her BMR, while working out 3-6x/week and still gain weight”, whereas when she took a long holiday and ate whatever she wanted, didn’t exercise even once, she lost a bunch of pounds like whoa. Last week, one of you reached out to ask about cortisol, so I figured I’d share what I had read up about.
Stress — and chronic stress, in particular — is not an uncommon condition by any means, regardless of the specifics, so hopefully some of you find this information useful. (Well…with any luck NONE of you do, since chronically elevated cortisol is something I hope none of you have to deal with, but in the event that you do, maybe this might shed some light.)
As always, all my usual disclaimers apply, and, in case it bears repeating: if you suffer from any emotional or physiological distress (no matter how “severe” — or not! — it may seem to you), do consider seeking professional help, probably before you embark on any rigorous or new dietary or exercise regimen.
Ass, cover thyself.
Okay, I know I linked up my disclaimers above, but…once more for the people in the back: I’m not a professional. I’m not trained in any way, shape, or form. I’ve done a little reading, but I’m about 99% sure that anything I have to offer is nothing more than an incredibly shallow understanding of an incredibly small part of an incredibly complex system. Add to that: while (good) studies, evidence, and science are wonderful tools that we can and should use to guide our actions, the human body is also a ridiculously complex and highly variable combination of systems, and at the end of the day said evidence-based study has to be individualised towards the person in question and any peculiarities of their experience. Also, if you’re sure that you’re eating much fewer calories than your body “should” require, but experiencing misaligned results, it’s probably a good idea to get some medical tests done to rule out other physiological disorders (such as Graves’, thyroid dysfunction etc) too. We cool? Cool.
Glossary (lulz)
Also, I’ll probably be using the following acronyms a lot, so for those of you who need to be refreshed —
TDEE: total daily energy expenditure
BMR: basal metabolic rate
EAT: exercise activity thermogenesis
NEAT: non-exercise activity thermogenesis
BP: blood pressure
Let’s start here: chronically elevated stress is very strongly correlated to weight gain. So if this is something you’ve struggled with or experienced, know that you’re not imagining things! Which means that addressing emotional and psychological well-being is in fact a valid strategy for weight management.
On the most basic level, I’m sure many of you have experienced that in times of high stress, your appetite and eating levels are often affected. Different people will respond in different ways — some ‘stress eat’, some lose their appetites. Suffice it to say, high stress will likely have an effect on your weight and/or body composition. But what effect does it have on your hormone (dys)function, and what happens when this stress is a chronic situation?
What happens when you get stressed?
When stress levels increase, cortisol levels rise. Cortisol is a catabolic stress hormone. Acute increases in cortisol trigger increased metabolic activity (as part of the fight/flight stress response), which increases blood sugar levels via gluconeogenesis (creation of new blood sugar, usually from existing fat and protein stores), which in turn raises blood insulin levels, and also results in an increased appetite (particularly for sugary and fatty foods).
Now, nothing problematic with this physiological response so far, especially if this stress response is due to threat of imminent physical danger (e.g. a ’gator attack! — I onno don’t look at me I’m a city kid but it’s a big bad world out there) where you may actually need those increased blood glucose levels in order to be able to sprint to safety. However, in the case of non-physical stress, elevated blood glucose (both from the catabolised fat and muscle, as well as any other food you may have ingested) is not utilised, and ends up stored as fat.
What happens when that’s a long-term issue?
Now, in the case of chronically elevated cortisol, the same system described above applies, but elevated cortisol levels can also lead to depressed testosterone production (which makes it harder to build muscle). This, in conjunction with the continued catabolising of lean mass via gluconeogenesis, means that you’re likely to observe a negative change in your body composition (i.e. less muscle, more fat) even if you remain the same weight. These changes in fat storage patterns and body composition (even if overall mass remains constant), include increased belly fat (which has approximately four times the number of cortisol receptors than other fat cells do), and increased visceral fat (which is linked to estrogen dominance and an increase in the amount of circulating free fatty acids in your bloodstream, which can then inhibit liver function, which includes the ability to remove excess cortisol and estrogen). Increased estrogen, increased levels of estrogen metabolites, and increased insulin all contribute towards insulin resistance.
Suboptimal eating patterns that may develop during acutely stressful periods will likely be reinforced over time, willpower to fight those urges will diminish, and the related disruption of digestive systems (including but not limited to: lack of appetite, increased appetite for less satiating and nutrient-dense foods, indigestion, halitosis, nutritional malabsorption, acid reflux, reduced blood flow to the gut, chronic inflammation, poor gut health…I mean. This list goes ON like Donkey Kong) will probably make you feel pretty damn crappy about yourself, and guess what that’ll lead to? [Spoiler: more stress.]
As if that’s not enough, elevated cortisol is also correlated with inhibited serotonin production and transport. Serotonin, by the way, is a mood regulator that helps to promote emotional stability and reduces anxiety and cortisol. Increased serotonin levels decrease the effect of stress on sleep (which means you’re likely to experience increased focus and energy) and increase feelings of satiety (hence potentially functioning as an appetite suppressant). Serotonin is also much more easily produced after carbohydrates are consumed: the insulin response conducts amino acids to various organs, which increases the relative proportion of tryptophan — the key ingredient in serotonin synthesis — in the blood, which then allows more tryptophan to cross the blood-brain barrier, where serotonin gets made.
Another (non-cortisol) thing that increases in times of chronic stress is aldosterone, which is responsible for regulation of water, electrolyte levels, and BP. It signals sodium (and therefore fluid) retention (as a stress/survival response/strategy), which subsequently results in weight (note: not fat) gain. But…guess which stress-addled brains are unlikely to be able to Spock their way out of that mindfuck?
What does this all mean?
Especially in cases of chronically elevated cortisol levels, stress (and its related physiological adaptations) can definitely play a part in weight gain. It’ll often even seem as though your body is defying the laws of thermodynamics, e.g. if you “know” that your TDEE is around 2000 cal, but you’re meticulously tracking and only consuming 1200 cal, yet still gaining weight, does that mean Starvation Mode exists after all??!?! [Spoiler: no.] Instead, what’s most likely to be the case is that your BMR (and therefore your TDEE) has been negatively impacted by hormone dysfunction, and, beyond that, changes to your body composition are also happening to cyclically compound this issue. Stress can also result in higher levels of fatigue, which will likely affect both your NEAT and EAT, further driving your TDEE down. And, while it may not be a strictly related issue, often individuals with chronic stress and/or PTSD-type issues probably have a higher likelihood of having previous experience with chronic severe/extended caloric restriction (and the related metabolic adaptations), which is what makes it seem as though you are “eating under your BMR” but failing to lose weight. (Translation: you’re not eating under your BMR, your TDEE is just a lot lower than it probably ‘should’ be.)
So…wat do?
If this is something you’re struggling with, I would:
seek relevant professional help, where applicable, and
stop trying to diet/lean down.
The most important thing to do when dealing with (chronically) elevated cortisol is to manage your stress, and to remove as many stressors as you have control over. Addressing the underlying psychological and emotional issues will help to treat the cause (instead of just pasting a Band-Aid on the symptoms) and is probably going to be crucial for long-term mental (and therefore physical) well-being, so — and I can’t stress this enough — talk to someone. A therapist if that’s what you need and can afford, a supportive loved one if not. Unfortunately, there is still a (ridiculous) stigma about mental health even in 2018, but in case it helps you to hear it: you don’t have to be clinically diagnosed in order to seek professional help, and there’s absolutely nothing wrong with getting help in whatever way it may be available to you. Practicing mindfulness and/or various forms of meditation may also be an alternative (or additional) option that could help.
Now, chances are, a bunch of those stressors may be outside of your control (a horribly taxing period at work, periods of financial or emotional instability, big changes in your life, natural disasters, loss), but dieting probably isn’t one of them. Caloric deficits (even when fairly shallow) are physiologically taxing, and extended (>21 days) caloric deficits often result in metabolic adaptations and changes to thyroid function (both stress adaptations). If you’re doggedly trying to lose fat, you’re probably also engaging in some intense cardiovascular training and/or heavy resistance training in an effort to drive your EAT (and thereby TDEE) up, which is also physically stressful. It’ll probably make sense to ease up on most, or all, of that.
Two other things that would probably make sense to avoid or cut down on are (large quantities of) simple and non-satiating carbohydrates and intake of stimulants such as caffeine. Simple carbohydrates can cause blood sugar to spike, which will affect insulin sensitivity and management systems, and reducing intake of stimulants will reduce demand on cellular function and help to mitigate contributing factors to elevated BP and cortisol levels.
Reverse dieting to increase your caloric intake may also be worth considering, for two reasons:
Higher intake (within reason) over time may help to return your metabolic function to a healthier level, and will cause less stress on your body
The gradual increase in intake is less likely to cause any sharp scale weight spikes (that can cause anxiety)
NB: It may be worthwhile to consider hiring a nutrition coach or registered dietician to help you with this.
Other interventions which should be considered:
two or three sessions of low-impact and low-intensity exercises per week, such as 20 to 25 minute walks (particularly outdoors and in the sun, where possible, since there is a positive correlation between serotonin synthesis and hours of sunlight in the day), yoga, Pilates, stretching and mobility work
some complex carbohydrates in your diet (severe restriction of carbs can cause stress adaptations; adequate carbohydrates may be helpful for energy production in individuals with adrenal and cortisol issues, and are useful for up-regulating serotonin production)
nutrient-dense foods (which will increase satiety and good health, and hopefully help to make it easier to resist any cravings for sugar, fat, and alcohol)
fish oil supplementation or increased intake of fatty fish (there are some tentatively promising links between fish oils and blunting the production of cortisol)
I do realise that a bunch of these things sound like recommendations that could get me smacked — “I’M ALREADY STRESSED OUT BECAUSE I DON’T HAVE ENOUGH TIME, DON’T TELL ME TO GET MORE SLEEP” — but, you know. Do what you can. Every little counts and all.