3 Ways that Stress Throws Your Hormones Out of Balance

If you are reading this and are not a physician, please keep in mind: this stuff is complex, especially if you are not trained in scientific language and the specific way doctors think about medical issues. Scientific proof is not nearly as black and white as people think, and in order to make treatment decisions for individual people sometimes we have to consider evidence that is not nearly as absolute as we would like. This is where experience, advanced medical training, and consideration of the relative benefit versus risk comes into treatment recommendations. This is not meant to be medical advice, and you should consult your own physician for any medical issues or diagnoses you may have.

Stress

Last week we talked about the fact that stress can cause our thyroid function to be suppressed, or even blocked. Today I want to dig onto that a bit more, and then look at two more ways that stress throws your hormones out of balance. 

But first, let’s talk about what’s happening with stress and why. If you’re like most people, when you have had a super stressful day, it takes a couple of hours (and maybe a couple of drinks) to unwind enough to even interact with your family in a reasonable way, And even though you’re exhausted, you can’t sleep because your mind is just going 90 miles a minute, thinking about that big presentation that’s coming up, or conflict with your boss, or your overflowing inbox. 

This is because of the way your body and your hormones react to stress. And the more prolonged the stress is, the more pronounced and persistent that reaction gets.

Our bodies evolved to handle stress. There’s acute stress, “running from the tiger” is the cliche typically discussed example. But there was also chronic stress. War, famine, and slavery are historical examples of chronic stress that our bodies evolved to handle! And the hormone changes that happen during stress actually do help us survive all these things better! We call that adaptive. But what passes for stress in our modern world has changed, and our bodies and primitive brains, not so much. Stress is anything our primitive brain sees as a threat to our survival! 

Stress can be internal, like pain; external, caused by circumstances, or anticipatory: when we worry about things that haven’t even happened yet! or have little control over. And our brains react to these stressors in exactly the same way!

But the stress reaction doesn’t stay in the brain. Our body reacts to stress in a predictable, and mostly in our modern context, a maladaptive way. Maladaptive means they are natural and normal, but make us sick. So what’s happening here? We doctors Learn about the chemical signals of stress in medical school, and we refer to this system of brain chemicals  (neurotransmitters) stimulating/regulating the pituitary hormones stimulating/regulating the adrenals and other hormone-producing glands such as ovaries/testes, as the Hypothalamo Pituitary Axis, or HPA Axis. 

The Adrenals

The hormones of stress come primarily from the Adrenal glands. These are a pair of small fatty glands that sit like caps on top of our kidneys, where they have an excellent blood supply. The 2 layers of the Adrenal glands produce neurotransmitters, like Adrenaline, and hormones. The most important hormone the adrenal gland makes is Cortisol, but not the only one. Its hormones are made from cholesterol, so they are called sterol or steroid hormones.

So what does a stress reaction look like?
Say you start to pull out into traffic and all of a sudden another car runs the stop sign and is barrelling down on you! That instantaneous electric charge you get, when your senses are all of a sudden twice as sharp, your heart is racing, and time seems to slow down, and you’re just “amped up” when something startles or frightens you? That’s adrenaline - it is released and starts acting in your body in less than a second! It mobilizes the entire body to metabolic “high alert.” And this is a good thing! It helps you react fast in an emergency. But it’s not good when you’re at the podium about to give the valedictory address at your alma mater! 

Cortisol

The second part of an acute stress reaction is the release of Cortisol from the adrenals. The brain signals that trigger this start within 2 seconds after the trigger and within 30 seconds the cortisol levels in the bloodstream are rising. And once again, in a situation where we are in actual danger, this is a really helpful thing!  

Cortisol increases blood flow and oxygen delivered preferentially to muscles, so we can fight or run! It also raises blood glucose: by rapid release from the liver and other ways provides energy to our brain and muscles. It enables us to be focused and alert to danger. Cortisol is necessary for life! People who don’t make it or have Cortisol will drop dead running to catch a flight. Even in ordinary day-to-day life, cortisol helps us be alert during waking hours, regulates metabolism, and cortisol helps reduce inflammation and swelling in our bodies. 

Our adrenals make other hormones as well, including aldosterone which helps keep our blood pressure up in the normal range, and sex hormones too (yes, in addition to testes and ovaries). The importance of this is something we will discuss again in a minute.

Sympathetic Tone

Another result of the body's response when Cortisol is released is the Elevated Sympathetic tone. In case you don’t recall - it has nothing to do with sympathy. This refers to the 2 different and opposite parts of the involuntary nervous system, Sympathetic, and Parasympathetic – the sympathetic nervous system revs us up, for fighting or running away, and makes us vigilant for danger. Fight or flight. Parasympathetic is the opposite of that, rest, digest, and heal. So sympathetic tone is a baseline state that keeps your body ready for action even when you're not consciously aware of any threats. Elevation results in anxiety, hyperalertness, high blood pressure, and difficulty sleeping. A modern example would be like how you don’t sleep well when your child is sick, or when you are on call.

Chronic Stress

But then what about chronic stress: Work pressure, family stress, and just the “always on” nature of our current society? Unfortunately, Studies show your body can’t tell the difference - it reacts exactly the same! Except, because we aren’t actually running from danger, all that quickly released energy isn’t needed by our muscles, so it's now available to be packed on as fat. Sometimes we can even in a way be addicted to stress, because of the quick energy boost we get from it - think over scheduling, procrastination, and being habitually late! The other thing is, that we humans are the only species that have evolved the ability to create our own stress by worrying about things BEFORE they happen! Chronic thoughts about What if I get cancer? What if I get robbed? What if I can’t pay my bills? Why me? Worry results in just as much stress as if the bad situation was actually happening.

Thyroid 

1. Elevated ACTH (the pituitary chemical that signals your body to make more stress hormones), suppresses TSH (the pituitary chemical that signals the production of thyroid hormone) and therefore suppresses all thyroid hormone production. 
   
   
2. Suppresses thyroid function by increasing Reverse T3, which slows your metabolism. This is because your body can’t tell the difference between a calorie-restricted diet and actual starvation; or between being stressed out because of a stressful job or home life, and an extreme illness or injury where it needs to conserve energy or die. Which, if you aren’t actually sick or injured or starving, makes it even harder to manage your life, because it adds chronic exhaustion and the other hypothyroid symptoms to the list of things causing you to be stressed out. The way it does this is by triggering the production of more reverse T3, which we discussed last week. It’s a blocker of T3, the active thyroid hormone. Most doctors do not realize the value of measuring this marker, as we discussed previously.

Insulin 

Insulin sensitivity decreases with high Cortisol and stress  - again, helpful in the immediate term if we actually need to run! The reason this works is that active muscle doesn’t need insulin to take up blood sugar. The other tissues of the body use insulin. Decreasing the sensitivity of insulin allows more blood sugar to be available to muscle tissue. If you aren’t using your muscles, lower Insulin sensitivity means insulin levels increase and eventually blood sugar increases, with all the problems that causes. 

High insulin does several unhelpful things to your body, even before you end up with a diagnosis of diabetes, but I’ll just name a few:

• It makes you hungry! So you eat even more.
• Causes Chronic anxiety or depression
• Promotes growth - of fat cells.
• Promotes growth of cancer cells.
• Messes up sex hormones: testosterone can either drop, causing all kinds of problems,
• Or rise, triggering PCOS
• Promotes heart disease.
• It also feeds forward to force cortisol up even higher!

How does stress do all these things?

Let’s use a factory as an analogy for what’s going on -the adrenals are the factory -  on orders from the brain, The pituitary chemical ACTH signals increased production of Cortisol. Think of ACTH  as orders to a car factory that also makes tanks. As the government (brain) orders more and more tanks, the factory no longer has the excess capacity to make convertibles, station wagons, or even sedans. 

So the other orders get canceled: Like TSH, we just talked about that one, Growth hormone -  I’m sure you can guess what that does. Gonadotropins - FSH and LH -  are what stimulate your ovaries (and Adrenals) to make the sex steroid hormones. So all the other hormones get knocked off the assembly line, so to speak, in favor of keeping the tanks (Cortisol) coming.

Another way this happens is that the adrenals and other glands start running out of raw materials to make the steroid hormones and start rationing in favor of Cortisol. The result is that the production of sex steroid hormones slows or stops, and eventually aldosterone too, that’s when you can get low blood pressure and fainting spells.

And when the raw material supply to make even Cortisol runs low, the result is chronically elevated sympathetic tone:  adrenaline is now used all the time to help you react to stress -   this produces anxiety! Due to repeated and chronic overstimulation, this elevated level of anxiety becomes chronic. This results in hypertension,  anxiety, and eventual heart failure.

Interestingly - when a chronically stressed mom carries a pregnancy, the baby is born with a larger Amygdala - the part of the brain that sees threats everywhere. So the baby will be chronically anxious too!

The more stress we endure, the more we overuse our adrenals. The longer and harder the adrenals work, the more tired and depleted they may become. When the adrenals cannot produce enough cortisol to meet our needs, we also get problems like these: 

Chronic Fatigue Syndrome, Fibromyalgia Syndrome, PTSD.

So what symptoms occur when we can’t make enough cortisol? Interestingly, both HIGH and LOW cortisol can produce many of the SAME symptoms! But the main overarching theme is the loss of ability to handle stress. 

• Fatigue, low energy even after rest
• Exhaustion after even mild exertion
• Weakness, joint and muscle pain
• Loss of appetite
• Low blood pressure, dizziness, lightheadedness, fainting
• Salt craving
• Inability to handle stress
• Mood changes and emotional disturbances, anxiety, depression
• Increased perception of pain 

And many of these symptoms are the hallmarks of burnout!

If you’re a physician reading this and you need to discuss a patient with me, I do also offer consultations.  Email me at [email protected] 

If you’re a thyroid or chronic fatigue sufferer in North Texas and you want a caring doctor to help you finally resolve your exhaustion, frequent illness, joint and muscle aches, menstrual irregularity, and poor sleep issues, come sign up for a new patient appointment with me now at www.danagibbsmd.com.

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