Latest / hol+ with Dr. Taz MD | The Future of Medicine is Holistic / The Hidden Cortisol-Gut Connection: Why Stress Can Block Weight Loss, Disrupt Blood Sugar, and Increase Belly Fat
Transcript
- [0:00] I meet people every single day who are so frustrated with their weight, with their metabolic health. They feel like they're doing everything, but they're [0:08] maybe not seeing the scale budge or they're not seeing their inches change or they just feel defeated. And this, by the way, is whether they are on or off [0:17] hormones, on or off a GLP-1 or a peptide or any of the big trends that are out there right now. I wanted to take a few [0:25] minutes to talk to you guys about one of the biggest metabolic and weight loss blocks that I see over and over again. [0:33] And it's probably a part of the reason why many people despite the best interventions do not lose weight or do [0:41] not see the scale change or their inches slowly go down. And that's rooted in the word cortisol. [0:51] Hi everyone, it's Dr. Taz. Before we get into today's episode, I just want to pause and say thank you. Your messages, [0:59] your shares, your stories are the reason we make Whole Plus. Every conversation here is about connecting the science, [1:06] the intuition, and everyday life together so you can feel more like yourself. Again, if you haven't already, [1:13] hit that subscribe or follow button. It helps us reach more people who need this. All right, let's begin. Today we're going to talk about cortisol as a [1:21] metabolic block, what it means for you, and how we can really maybe start to unwind it and be aware of it before it [1:29] sabotages our health and you see that visceral fat come back and you see all the different signs and symptoms of poor metabolic health start to show up in [1:37] you. Cortisol is something that is happening every single day, whether you're aware of it or not. I want you to [1:44] take a second to think back to a day where you were super stressed. Maybe the hits just kept coming. Maybe it was something with your children not getting [1:53] taken care of or dropped to the right place or you had a big work deadline or a family issue that really needed a lot [2:00] of attention and you felt that panic, right? That heart rate go up. Maybe you started to get sweaty or you started to [2:08] just ruminate, thinking and thinking and thinking over and over again trying to work through a solution. At first, it's [2:16] just a little bit of stress or maybe soft symptoms. But as time goes on, if you don't have the right outlets, that [2:23] cortisol loop turns into things like waking up at 2 and 3:00 in the morning. [2:29] And as that's happening, now we're seeing changes in your appetite and your blood sugar and even your mood. And [2:36] slowly the whole thing starts to unravel. So understanding what cortisol [2:43] is, how it's impacting you is very important when it comes to a conversation around metabolic health. [2:50] But we're going to start with the basics just in case everyone's confused about cortisol. Now, I know it's trending on Tik Tok and every other social media [2:58] channel out there, but cortisol is not just a simple onele thing that we look at. Cortisol is a hormone. It's produced [3:06] by the adrenal glands and it is in the right way at the right time. A little bit is released to get us out of bed, [3:13] make us do what we're supposed to do in the world and get us excited about whatever is going on in our lives. But when that is happening over and over [3:21] again or it gets exaggerated with chronic stress or chronic trauma, we end up in a cortisol loop where cortisol [3:29] stays elevated and continues to keep us feeling stressed out. than all the symptoms that follow. Now, as time goes [3:37] on, that elevation of cortisol starts to flip and we start to see high cortisol in the morning and then maybe just sort [3:44] of high cortisol all day long. It never actually ever goes down. Then the next phase of this is where cortisol starts [3:52] to switch what it does. Instead of being high in the morning, it starts to be high at night. So, you are tired all day, but you're up all night. And that [4:01] is one of the worst ways to feel. So all of these different stages of what cortisol is doing has to be caught by [4:08] not just looking at a single cortisol level, but actually looking at four different levels of cortisol throughout the day. This is why we like saliva [4:17] cortisol levels where we can check a fourpoint saliva test to see what your cortisol pattern is actually doing and [4:24] that's what we do at Whole Plus. So again, going back to your metabolism and how this connects. Now, if you are in [4:30] one of those stages of cortisol flipping or cortisol being in the wrong place, one of the things that gets impacted [4:38] over a period of time is your blood sugar and the levels of your blood sugar. So, as those levels of cortisol are shifting and changing depending on [4:47] what's going on with you, blood sugar is also shifting and changing and then the next thing you know, you're seeing the [4:54] rise in insulin. Many people don't realize that there are actually cortisol receptors on every organ of the body on your heart, on your belly, on your [5:03] hormonal organs, and so much more in your brain. So over time, what we see happen is that cortisol is directly [5:11] communicating with all the hormones around metabolic health. So that includes insulin, it includes things like norepinephrine and epinephrine, [5:20] which really regulates sort of your energy and your mood, and so many others as well. So again, for anybody suffering [5:27] from a metabolic block or getting super frustrated because they are doing every single thing that they think they're supposed to be doing, but they're not [5:35] seeing the needle budge in the way that they want to, even after medications and peptides and hormones, this may be where you really need to begin the [5:44] conversation, understanding where you personally are landing with cortisol. If you are in a mildly elevated cortisol [5:52] state or you're in a chronically elevated cortisol state, there is a huge difference in the biochemistry of each [5:59] state and how it's impacting your weight, your mood, and so much more. I want to pause here because I see this pattern all the time. People are doing [6:08] the research. They're listening to the podcast. They're trying to take better care of themselves, and they still feel so stuck, especially when it comes to [6:16] their health, their hormones, their stress, and even taking care of their families. That's why I created The Circle. The Circle is my private [6:24] membership where we go deeper into these topics with real guidance, demos, live sessions, and a supportive community. If [6:31] you want to try it, there's a one month trial available right now. You can learn more at wholeplus.co/circle. [6:39] That's holus.co/circle or just click the link in the description below and use the code [6:47] YouTube. Now, let's continue the conversation. I want to take a look for just a moment at some of the research because we have great research now on what cortisol means for your metabolism. [6:58] So, here are just a couple of studies that I find interesting. You know, this is a study in the Journal of Endocrinology. This is from 2024 and [7:06] it's finding that the glucose dependent regulation of cortisol is altered in people with both pre-diabetes and [7:13] diabetes. That means basically as your metabolic health is going down, your cortisol access is disregulated. So the [7:20] two are working kind of in conjunction with each other. Another journal, this is in the American Diabetes Association, [7:27] just put out a review about how high cortisol, hypercortisolism is what they call it, disrupts your circadian rhythm, [7:36] which then in turn causes insulin resistance, high insulin levels, which then in turn disrupts the HPA axis. So [7:43] now we're back to how cortisol is not only impacting blood sugar and insulin, but is also impacting your hormones and [7:51] your hormone regulation. And this is true for both men and for women as well. [7:56] We call this the reverberating cycle, meaning cortisol dysregulation is self-perpetuating. [8:02] I call it the cortisol loop where once you're in this cycle, it's very difficult to step off of it unless [8:09] you're very conscious and deliberate with how to reset not just cortisol, but your blood sugar, your hormones, and so [8:16] much more. That's why in our practices at Whole Plus, we really do take this holistic approach to looking at not just hormones, but cortisol and metabolism [8:25] and kind of again painting that triangle and trying to understand how those three corners of the triangle work together to really improve your metabolic health. [8:35] So, chronically elevated cortisol is metabolically destructive. It breaks muscle down. It promotes high blood sugar and high storage of visceral fat. [8:44] and it rewires our hormone feedback. [8:47] This is not a side story or a side issue. It's something that's affecting you every single day and it's definitely something that we see in practice over [8:56] and over again. Okay, let's move on now to talk a little bit more about the blood sugar cortisol connection. The [9:03] reason I keep coming back to blood sugar is your levels of blood sugar are directly impacting what your insulin is doing and how we're going to store fat. [9:13] So many of us notice, for example, that you'll eat a meal and you'll suddenly fall asleep, right? That's a sign that your blood sugar is rising very rapidly [9:22] with that meal and it's putting you in a state of hyperinsulinemia, which then means that meal is eventually getting stored. You're going to store [9:30] that as fat. So, it's very important again if we're bringing this back to real life and kind of what you're doing day in and day out in your living rooms [9:38] or your kitchens or your dining rooms or even eating out at a restaurant. The composition of what you're eating and what that does to your blood sugar is [9:47] very important in terms of understanding your tolerance to insulin to blood sugar and the right foods for you. But this is [9:56] again where cortisol comes into the picture because when cortisol is elevated and blood sugar stability is off, you're flipping all over the place. [10:04] You're high, you're low, you're all over the place when it comes to what your actual blood sugar levels are doing. And that means that your choices, your [10:13] cravings are going to be altered. Most people in a high cortisol state will crave things like high salty foods or [10:20] high sugary foods or fatty foods or those comfort foods that give you that quick hit of dopamine but only last for a very short period of time. So leave [10:29] you wanting for more very quickly. There is a direct correlation between cortisol levels and having some of these [10:37] different cravings where you choose foods that again give you that quick dopamine hit. So, this is again why when [10:44] blood sugar is regulated, when you're in a stressful state, you seem to do better when it comes to not gaining weight, not [10:51] storing fat, all the other metabolic markers that we talk about over and over again. I think, you know, it was interesting. I had a patient just [10:59] yesterday and she was telling me how she had been through such a stressful time since I saw her last, but her numbers looked fine. Like, all her metabolic [11:07] numbers looked okay. her hemoglobin A1C, her fasting insulin, her lipids, all of these things that we typically track in [11:14] terms of trying to assess your metabolic health looked great. And here's what she says. She goes, "Well, I've been super stressed, but I've been following the [11:23] protocol. I've been trying to take everything you said to take, eat consistently, and truly focus on my sleep and maybe a little bit of [11:30] self-care. So that even though we've had some major hits, you know, both personally and at work, I I feel like I can manage it. And that's what her [11:39] numbers said as well. And that was so gratifying, you know, to see that. So bottom line, you experience a stressor, the hypothalamus fires, we release [11:47] hormones. Those hormones then signal blood sugar to do many different things, including spiking, especially if you haven't eaten. Here's what the research [11:56] says, and this is always interesting. It shows that even a small elevation in morning cortisol blocks insulin [12:03] secretion and larger cortisol elevations were associated with insulin resistance within 4 to 6 hours and then persisted [12:12] over 16 hours. Think about this. This is from the American Journal of Physiology by the way. So if you have a stressful event that's actually staying with you [12:22] from a blood sugar perspective way into the evening, maybe even into the next day. And so that's why your blood sugar [12:30] is now altered and you're starting to store fat even though you might be eating healthy food. So, the cortisol, [12:37] stress, glucose, weight conversation is one that we've got to take into account if we're going to have a conversation around metabolic health and weight loss [12:46] and how these things connect. Let's do one more study on this because I find this so fascinating. And in a large population study of over a thousand [12:53] individuals, high serum cortisol levels were independently associated with decreased beta cell function. Meaning [13:01] your pancreas literally quits working in a high stress state. It stops producing insulin appropriately when cortisol is [13:09] chronically high. That is profound and it tells us that the place to start is to really bring cortisol down before you [13:16] start obsessing about everything else when it comes to weight. So bottom line, when we look at these two pieces of the puzzle, we understand that stress levels [13:26] and cortisol work together to determine what your body's going to do with weight and with blood sugar and with insulin. [13:34] And that at the end of the day, we need to know that there are cortisol receptors everywhere, especially on our belly. So if you have that accordion [13:42] belly that I myself am victim to then you know that that is not because you ate badly or you didn't exercise or you [13:51] forgot to take something. It is literally because your stress levels may be elevated at certain times and it's a [13:59] time to reflect back maybe calm down a little bit and put some self-care cortisol lowering strategies into [14:06] effect. Now cortisol can be the block for your metabolic health. Let's get a little bit deeper into this and talk [14:12] about another aspect of cortisol and its block on your metabolism which is rooted in inflammation. Okay, so we spent a [14:20] little bit of time talking about cortisol, how it's your metabolic block, how it impacts both blood sugar and your insulin levels and insulin secretion. [14:30] All of which are tied, we know directly to how we store fat, right? Whether we store visceral fat around our belly, our hips, wherever it may be. And this is [14:39] one of the patterns that I'm talking more and more about because it truly is the block to many of the patients that I see and and something that I even [14:46] personally have to deal with. Let's go a little bit deeper. There's another concept tied to cortisol that is also [14:54] acting as a metabolic block and that's around inflammation. And inflammation is again something that's gotten a lot of press. People are talking about it. [15:03] They're starting to understand that inflammation is the body reacting against itself, right? Not necessarily just a swollen joint or a rash or a [15:12] sickness or an illness, but the body saying, "Hey, I'm done. I can't do this anymore." But in an inflammatory cycle, there are lots of different symptoms. [15:21] Everything from brain fog to muscle weakness to joint pain, trouble sleeping, and so much more. But one of the symptoms of chronic inflammation is [15:30] also weight gain. Now, many people see this at the tail end, right? When the symptoms are intense, when they can't ignore it, when their clothes are a [15:38] couple sizes up, but there's a whole world of inflammation that's happening even before you get there. And that's [15:46] what I want you dialed into a little bit better. This is the relationship between cortisol and microinflammation [15:55] where the body is in this cortisol loop, right? There's this hum of higher cortisol levels. They're not really coming down like they're supposed to, [16:03] but it's triggering a lowgrade inflammatory hum. Something you may not even notice. Might start with you just [16:10] not feeling the way you normally do or your mood is a little bit off or your energy is a little bit lower. Those soft [16:19] signs are signs of microinflammation and they are warning signs that our body is in a loop that we may need to support to [16:27] kind of get out of that situation. So inflammation is important to understand as well. Cortisol, even a shortterm [16:36] spike actually helps inflammation. It stops it. It downregulates something called NFCappa beta which is the master [16:44] switch of the inflammatory cascade and it suppresses cytoines that we actually test from time to time like tumor [16:51] necrosis factor alpha, one beta, interlucan one beta and interlucan 6. [16:57] All of these are inflammatory cytoines that are associated with microinflammation, meaning they may be elevated first before we see the [17:06] conventional CRP and said rate that we're used to seeing in our labs in our exam room. And that microinflammation [17:14] in turn leads to some of the bigger inflammatory signals that eventually cause disease. But with chronic stress [17:22] and chronic cortisol elevation, we start to develop this resistance to cortisol, to blood sugar, and we stop listening to [17:32] anti-inflammatory signals. So those receptors start to go to sleep. They're like, "Okay, this is normal. You're always stressed. Cortisol is always [17:39] high. You know, I did what I could. I'm out." And they literally check out on you. And now you're left with high cortisol and high inflammation at the [17:48] same time. And that systemic inflammatory activation may not show up on your lab work, but it is really [17:55] laying the foundation for future disease. If we look at research around this critical point, it shows that this translation from acute stress to chronic [18:03] stress comes from issues with the receptor and what the receptor will and will not do. When cortisol is [18:11] chronically elevated, those receptors sort of downregulate, meaning they stop responding and then they become [18:18] metabolically destructive, even breaking down muscle mass, promoting fat storage and then rewiring our hormone feedback [18:26] loops. This is a part of the reason we are seeing the explosion of high androgens in women and low testosterone [18:35] in men because this chronically elevated cortisol that is then driving inflammation and insulin resistance is now in turn messing up hormones and [18:43] hormone imbalance. There was another research study that looked at uh inflammation and cortisol in a little bit more depth and talked about how when [18:52] the NFCappa beta pathway is shut down, right? The pathway that actually stops inflammation, when that pathway is shut [18:59] down, then the inflammatory pathway starts to go up. So, the two are very much linked together and a lot of [19:06] evolving research around how this is happening and what we can do to intervene earlier than we have in the past. All of this to say, when you are [19:15] thinking about your metabolism and trying to figure out why things may be working or why they're not, I have a lot of patients, for example, that have been [19:23] on GLP-1 and peptide medications, but they stop working. And when they stop working, even with dialing up that dose, [19:31] oftentimes it's due to things like chronic low-grade inflammation, high cortisol levels, higher blood sugar levels that are not responding to the [19:40] dose changes in medication. So you've got to look at these other factors as well. So inflammation is a concept to understand to really wrap your head [19:48] around when you're thinking about metabolic blocks even in the context of all that we have to offer today. Let's move on to one more idea around [19:57] cortisol. And that really sort of rounds out this conversation around cortisol acting as your metabolic block. And [20:05] that's gut health. Right? I've talked many times before about how your gut is ground zero for your health and it's true when it comes not only to [20:14] metabolism but to cortisol regulation as well. Here's what happens to your gut when you're stressed. A number of different things. There's something [20:22] called CRF or corticotropen releasing factor that triggers the whole stress cascade that has receptors throughout [20:30] your gut. That means when you're stressed, your gut is going to respond. [20:35] And it can respond in one of a number of different ways. You may run to the bathroom, right, and have episodes of going to the bathroom more frequently. [20:43] Or you may not go at all, or you may have bloating and stomach pain that you can't explain. And every lab test is [20:50] quote unquote normal. We understand now that the gut and cortisol are interconnected because the receptors [20:57] exist on the intestinal lining in a way that we never understood before. And so to manage the gut is a part of managing your cortisol response and vice versa. [21:09] Here's a study in the annual review of physiology, one of the highest impact journals in science, that shows exactly how corticore releasing factor is [21:17] signaling pathways that control gut motor function during stress. It shows that stress causes a very predictable [21:24] pattern. It slows gastric emptying, right? So, it slows down how things move through the gut. It stimulates motility [21:32] to a certain extent, meaning just pushing things suddenly through. And it makes us very hyper sensitive to how our [21:39] colon is moving. Hence bloating. You know translating that essentially. That is a s symptom cluster that I see over and over again in my patients especially [21:48] when they have IBS or constipation or unexplained diarrhea. And then that can move on if we bring the inflammatory [21:56] piece to it that can move on and become IBD, inflammatory bowel disease or colitis. So there's a very important [22:03] connection between cortisol and what it does to the gut. The other connection is in the microbiome and how cortisol and [22:11] those stress hormones and that cortisol releasing factor can influence the microbiome. Research has shown over and over again. This is a 2024 review in the [22:20] gut micro journal again that really looks at gut health over and over again that after stress the immune and the autonomic nervous systems bring stress [22:28] signals to the gut that favor the growth of bad bacteria and promote dispiosis. I would even say clinically what we've [22:36] seen aside from what this research study is saying, we've seen that it actually shifts towards a higher candida or a higher yeast state then in turn [22:44] triggering all the insulin resistance and and glucose issues. So bottom line, right, with all of this is that cortisol [22:52] through its actions and its signaling will impact the gut directly, change how often you go to the bathroom, change [23:00] things like bloating and digestion, slow things down or speed things up. Really important to understand, especially if you're on a medication like a GLP1 that [23:09] is known to slow the gut down as a part of its mechanism of action. So again the takeaway here is that stress is not just [23:18] the word stress in quotation marks and cortisol is not just the word cortisol and something that we talk about you [23:24] know in passing or lightly. It actually has very profound physiological implications for the body which in turn [23:32] are impacting metabolic health and we have to understand those those relationships to really change and move [23:40] things in a different direction. So, if you're stuck and if you're frustrated and you don't understand why you're doing all the things, but nothing's [23:48] working when it comes to your metabolism, your weight, however you are judging it, whether you are judging it by your body composition or by your [23:57] actual number on the scale, or you're actually looking at things like waist circumference, your lipids, your A1C, your fasting insulin, your blood [24:06] pressure, and so much more. If none of that is changing, I'm going to challenge you to actually look at cortisol and [24:13] maybe take a second to evaluate where your cortisol levels may be. Do a four-point cortisol test and maybe [24:21] evaluate what are the things that might be triggering an exaggerated cortisol response where everything else in your body may just simply want to shut down. [24:31] All right, cortisol is a big word. We're talking about it more. Metabolism is another one. The two are linked. The body is connected. That's the whole plus [24:38] way. And it's important to take some time and energy to get to the bottom of all of it. All right. Thank you for listening to this episode. I hope it was [24:47] helpful. And don't forget, we post new episodes every week. Before you go, remember, healing doesn't happen all at [24:54] once. It happens in moments. If today's episode gave you one of those moments, subscribe and keep learning with me. The [25:01] next video is right here and it picks up right where this one left