CHAPTER 19
Of all the problems I’ve seen in patients throughout my career, excess stress is the most common one. It typically triggers a multitude of signs and symptoms but at the same time is very elusive to detect and control. In our current health care environment, the focus on end-result complaints usually means the cause—some particular stress or combinations—remains untreated. As a consequence, most people are left unaware of the underlying stresses.
Stress is such an incredibly powerful influence on health and fitness that even if you are doing everything right in terms of exercise, diet, and nutrition, too much stress can make you feel old and run-down. Enough stress can contribute significantly and directly to inadequate fat burning, physical injury, aerobic deficiency, and poor brain function. And it can directly affect many health conditions, both as a cause and an aggravating factor, including cancer, heart disease, Alzheimer’s; and it can also contribute to fatigue, bacterial and viral infections, chronic inflammation, blood sugar problems, weight gain, intestinal distress, and headaches. Stress-related problems account for more than 75 percent of all visits to primary care physicians and are responsible each day for millions of people needing to take time off from work. So stress comes with a monetary price tag as well that far exceeds the cost of antianxiety drugs or antidepressants, which are readily prescribed and yet don’t address the causes of the problems.
Proper adaptation to stress first involves being as healthy and fit as possible and reducing unnecessary stresses—those that can be eliminated. This allows your body to better cope with the reality of life—that a certain amount of stress will always exist.
Adaptation is not always a conscious choice one makes. It involves the relationship between the brain and body and the specific hormones that help regulate stress. However, choosing to eat and exercise properly and deciding to better control stress is the major step in effectively adapting.
The mechanism by which you adapt to stress involves activity of the brain and nervous system with actions carried out by hormones. But dysfunction of the immune system, the balance of fats, blood sugar regulation, aerobic fitness, and all the health factors discussed in this book so far can lead to a maladaptive response to stress. In other words, you won’t easily cope with relatively minor stresses unless you’re healthy and fit. But as you can see, stress can easily become a vicious cycle in itself.
Stress is not without a remedy. In fact, you have a great coping mechanism for stress—it includes the brain and adrenal glands, important parts of what’s called the hypothalamic-pituitary-adrenal axis. However, when part or all of this mechanism is functioning poorly, bodywide problems can result.
There are effective ways to help protect oneself from harmful stress, and the first step is to better understand it. So let’s begin by addressing the three main types of stress: physical, chemical, and mental-emotional. These stresses can generate many different effects throughout the brain and body. Moreover, each person responds differently to various combinations of these stresses.
Physical stresses are strains or exertions on the body, something many people take for granted. Overworking your muscles is an example of physical stress. Slight physical stress is what makes exercise beneficial and is an example of good stress. However, too much physical stress, or that same good stress without adequate rest or recovery, can potentially result in a variety of problems. A common example of physical stress is exercising too much or too hard—beyond your body’s ability or threshold. This may result in sore muscles or joint inflammation that can then affect your lower back, knee, or hip, causing pain.
Likewise, dental problems can be a physical stress. It can affect more than your mouth, often causing stomach dysfunction, shoulder, neck, or head pain. Other physical stresses include irregular gait, poor posture, eyestrain, and even bad shoes.
THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS
The brain plays a major role in regulating hormones throughout the body. This impacts muscle function, energy production, water and mineral balance, as well as the glands that produce the hormones. In a small region of the brain called the hypothalamus, the important link between the nervous system and hormone control takes place. This part of the brain can provide information to the pituitary gland, housed in the middle of the brain, to produce a variety of hormones sent to the body. The pituitary is also influenced by memories and emotions stored in nearby regions of the brain.
The pituitary releases hormones that stimulate the body’s other glands, in particular those of the adrenal and thyroid, to control metabolism, muscle function, and sex hormones. Often referred to as the “master gland” of the body, the pituitary has significant control over one’s entire hormonal system and helps funnel information to it from the brain.
The pituitary also secretes growth hormone, which stimulates muscle development in men and women. Its production occurs during sleep. While the amount of growth hormone made is higher in childhood and is reduced as one ages, sufficient amounts are still secreted even in older, healthy individuals. Like other hormones naturally produced in the body, poor health may reduce the level of growth hormone. In rare cases, pituitary problems at any age, such as a tumor, might require the necessity of a patient to take a synthesized form of human growth hormone—HGH.
Unfortunately, it’s become too common for those seeking to restore youth, control weight, or enhance sports performance to also take HGH. However, the use of HGH does not actually guarantee more muscles or improved performance. It’s a banned substance in sports and its use is dangerous. Taking HGH can reduce the pituitary’s ability to produce growth hormone, creating an even more serious problem when HGH ingestion is stopped. Side effects of HGH include fatigue, muscle weakness, reduced sex hormones and sexual function, and blood-sugar irregularities. Don’t believe the extravagant claims by so-called anti-aging clinics that want you to believe that HGH is the “new fountain of youth” drug.
Many chemicals from our environment can adversely affect the body’s metabolism and cause stress. This can adversely affect your immune system, intestines, breathing, heart rate, and other areas. Dietary and nutritional imbalances such as too much sugar or too little vitamin D are examples of chemical stresses. In addition, drugs obviously influence body chemistry; examples of bad stress include excess caffeine or the side effects of prescription or over-the-counter drugs—virtually all have the potential for harm. Other sources of chemical stress include air pollution—secondhand smoke, indoor and outdoor toxins in the air. Reducing harmful chemicals from air, water, and food, and improving diet quality are key ways to reducing stress. Chemical stresses can also affect physical and mental-emotional problems.
The mental and emotional state includes the behavioral aspects of health. The mental state may be referred to as cognition—sensation, perception, learning, concept formation, and decision making. The emotional state typically describes pain, moods of anxiety or depression, and loss of enthusiasm or motivation. It’s usually difficult for most people to separate the two, and so I prefer to combine both.
A multitude of physical, chemical, and mental-emotional stresses can come from your job, family, strangers, infections, allergic reactions, and even the weather. Most people are affected by more than one form of stress and frequently by all three types. And, stress is cumulative; the response to a physical stress from the weekend’s 10K run may be amplified by Monday’s chemically related stress of too much coffee and poor eating, further compounded with a family-related mental stress on Tuesday and another with the boss on Wednesday. All of this may affect your brain and body by Saturday with symptoms of fatigue, headache, or intestinal distress.
The weather is a potential stressor too and can affect us physically, chemically, or mentally. Seasonal affective disorder (SAD) is a good example of how the weather at certain times of year, typically in the fall and winter in the Northern Hemisphere, can have a dramatic adverse effect on people. Cold temperatures, low barometric pressure, and reduced daylight can increase feelings of depression and trigger low metabolism, which causes weight and body fat gain.
Some people accumulate so much stress that they lose track of it. When I ask a patient to list their stresses, for example, they may recall three or four—but if I ask, “What about this or that?” they say, “Oh yes, that too.” When you’re ready to deal with stress, the first thing to do is make yourself aware of it. The best way to do this is write it all down as a stress list.
Reducing or eliminating individual stresses is easier if you write them down on paper. Here’s an example:
• On a page, make three columns, one each for physical, chemical, and mental-emotional stresses.
• In each category, write down what you think are your stresses. This may take several days to complete since you probably won’t think of all your different stresses right away.
• When you’re done, prioritize by placing the biggest stress of each category on top.
• Then work on reducing or eliminating one stress at a time. Or, if you can handle it, work on one stress at a time from each category.
Reducing or eliminating unnecessary stress from your life will give your body a better chance to cope with other stresses you may not be able to change right now.
As you make your list, put a check mark by the stresses over which you have some control. This may include unhealthy eating habits such as rushing or skipping your meals, drinking too much coffee, or not taking time to warm up or cool down properly during exercise.
Simply draw a line through those stresses that you can’t control. If there’s nothing you can do about them anyway, don’t worry about them for now. Many people expend lots of energy on stresses they can’t—or in most cases won’t—do anything about. This may include job stress or the weather, though in reality almost any stress can be modified or eliminated—it’s just a question of how far you’re willing to go for optimal health and fitness. As time goes on, you may want to reconsider some of the items you’ve crossed off. You’ll realize, for example, that changing jobs is a must, or moving to a more compatible climate will significantly improve your health.
Once you can “see” your stress listed on paper, it will be easier to manage. Start with your checkmarked stresses first, because you have more control over them—not that it’s always easy. Circle the three biggest stresses from this list and begin to work on them. You may be able to improve on some and totally eliminate others. Some will require habit changes. It’s a big task, but one that will return great benefits. When you’ve succeeded in eliminating or modifying each one, remove it from your list and circle the three next most stressful ones, so you always have three to work on.
What’s most important about stress is that too much of it interferes with rest. Or more accurately, recovering from excess stress requires more downtime. If you don’t get enough rest, usually in the form of sleep, the effects of stress will continue to accumulate. One of the questions to ask yourself is whether you’re getting enough sleep, considering the amount of stress you have. As you will see, one of the symptoms of excess stress is insomnia. In fact, too much of the stress hormone cortisol can interfere with sleep, waking you in the middle of the night and causing difficulty returning to sleep. A disturbed night’s sleep is not only a stress but also reduces recovery for everyday activities.
Stress—Just Say No!
In addition to self-managing your stress list, here’s some other strategies for dealing with stress:
• Learn to say no when asked to do something you really don’t want to do.
• Decide not to waste your time worrying about the past or the future. That’s not to say you should ignore the past or not plan for the future, but live in the present.
• Learn some relaxation techniques, and perform them regularly. This also includes listening to or even playing music.
• When you’re concerned about something, talk it over with someone you trust.
• Simplify your life. Start by eliminating trivia. Ask yourself, “Is this really important?”
• Prioritize your busy schedule: Do the most important things first, but don’t neglect the enjoyable things. Before getting out of bed in the morning, ask yourself, “What fun things do I have planned for today?”
• Know your passion and pursue it.
By learning to take control of the various types of stress in your life, you can literally improve the quality of your life. This will also help your brain and adrenal glands regulate other stresses better.
No matter what type of stress you encounter—whether it’s physical, chemical, or mental and emotional—your body has an efficient mechanism for coping. This is the important job of the adrenal glands. On the top of each kidney, these small glands work with the brain and nervous system to regulate important coping mechanisms, including the fight-or-flight reaction. The adrenal glands accomplish their work through the production of certain hormones, making them not only essential for stress coping but also for life itself. In addition to the regulation of stress, these hormones also help with sexual activity and reproduction, growth, aging, cellular repair, electrolyte balance, muscle function, and blood sugar control. This is why stress can affect so many different aspects of health and fitness—when the adrenals become overwhelmed with stress regulation, they may have to reduce their work with all other tasks.
THE “RUNNER’S” HIGH—NOT JUST FOR RUNNERS
Many people believe that working out is one of the best ways to reduce stress. The so-called runner’s high—a feeling of euphoria during or right after exercise—is often perceived as a way for a runner, hiker, cyclist, or other active person to feel great. But what really is this “high”?
We don’t really know exactly what the runner’s high is or why it occurs. In past decades, research has associated this state with natural opiates in the brain, or a cognitive state of dissociation. This usually centers on a discussion of endorphins—different types of hormonelike chemicals produced in the brain; some may even be produced in the skin, associated with sun exposure and vitamin D.
More recently, the so-called runner’s high has been associated with the same brain receptors for substances like marijuana. While these receptors in the brain are still being studied in the lab, and undoubtedly other chemicals will be discovered that might better explain that elusive feeling gained from working out, the brain is far too complex to pinpoint just one cause for an “elevated state.”
I believe the runner’s high phenomenon is an important state of consciousness. Normally, when one is sleeping, in a business meeting, or in the middle of a good workout, the brain produces certain brain waves. When you’re mentally relaxed, unstressed, and doing something that takes you into your own private world, the brain produces alpha waves. This state also can be promoted by listening to music, mediating, prayer, and other activities. Unfortunately, not all people experience the high because, for some, stress can overpower the enjoyment of the workout, impairing the ability to produce alpha waves.
Cortisol is a key adrenal stress hormone and commonly measured by simple blood or saliva tests that can be performed like other tests from your health care practitioner. Saliva is a better way to measure cortisol in most instances because having a needle thrust into a vein in your arm evokes stress—and cortisol production—sometimes making the blood test quite inaccurate. A saliva test only requires a small sample of your saliva in a little test tube during the normal course of your day. And since cortisol fluctuates throughout the day and night, a saliva test can easily be taken four different times throughout the day for a more accurate evaluation. (Most research studies on stress also rely on measurements of salivary cortisol rather than blood tests.)
When your body is under high stress, cortisol level can increase dramatically, and when the stress passes, the level returns to normal. In chronic stress states—the continuation of stress without relief—high cortisol levels can become prolonged and dangerous. This can adversely affect the brain, including the pituitary gland, and especially reduce memory, impair aerobic function, create blood sugar problems, reduce fat burning, suppress immune function, lower the body’s defense against not just cold and flu but any infection, and cause intestinal distress. Long-standing stress can result in the “burning out” of adrenal function, with a serious loss of normal hormone production. In this state, cortisol levels become dangerously low, along with other hormones made by the adrenals.
Sex hormones, including estrogens and testosterone, are also important adrenal hormones that help both males and females to maintain proper sexual function and reproductive health and strong muscles and bones. In addition to production of both estrogens and testosterone by the testicles in men and ovaries in women, significant amounts of these sex hormones come from another important adrenal hormone, DHEA. When stress raises cortisol, DHEA is often reduced. The end result may be lowered sex hormones, which cause poor sexual function and loss of desire.
Our knowledge about stress and adrenal function began in the 1920s, when famous stress-research pioneer Hans Selye began to piece together the common problems resulting from excessive adrenal output. These include poor immunity and intestinal dysfunction, which in turn can trigger many other problems—like a domino effect. Selye developed what is called the general adaptation syndrome, which has three distinct stages:
• Stage 1: The first stage begins with the alarm reaction, when you’re initially hit with stress. This could be job or family related. This increases the adrenal hormone production of cortisol to help the body cope. The purpose of this first stage by the adrenal glands is an attempt to battle and adapt to the increased stress. If it is successful, and the stress is reduced, you recover; adrenal function returns to normal, especially with sufficient rest. If this stage takes a bit longer to complete, a variety of mild symptoms may occur: noticeable tiredness during the day, mild allergies, or even some nagging back, knee, or foot pain. If over time—a few weeks or months—the adrenals fail to meet the needs of the body to combat the stress, they enter the second stage.
• Stage 2: During this period, also called the resistance stage, the adrenal glands themselves get larger through a process called hypertrophy. Since the increased hormone production of the first stage couldn’t counter the stress, the glands enlarge in an attempt make even more cortisol to do the same. During this stage, more advanced symptoms may occur, including fatigue, insomnia, and more serious back, knee, or foot pain, or poor recovery. Many people with chronic stress problems are stuck in this stage, often for months or years. They usually no longer function at their best—physically or mentally, are frequently ill, injured, or have other chronic health problems. If people in this stage continue to push themselves, thereby maintaining high levels of stress, the adrenals eventually can enter the third stage, called exhaustion.
• Stage 3: People who enter this stage are exhausted, often with chronic illness, and most likely are not able to function in life near the same level of effectiveness. Getting through the day—and night—is usually difficult. The adrenal glands are unable to adapt to any stress and are unable to produce adequate levels of hormones, including cortisol. The person is usually more seriously ill—physically, chemically, or mentally.
This discussion is not about adrenal disease; rather, it concerns the gray area between normal adrenal function and disease. Addison’s disease occurs when the adrenal glands are unable to produce sufficient cortisol to sustain life. It can occur in men and women of all age-groups; symptoms include severe weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin. The disease is also called adrenal insufficiency or hypocortisolism.
Adrenal stress can be caused or aggravated by the consumption of refined carbohydrates and sugar. This includes hidden sugars in many foods. How much is too much? Less is best.
Caffeine is a common source of adrenal stimulation, and one of the main reasons people depend on it to get through the day. Coffee, tea, and cola are the main sources. If you have an adrenal problem, assess your caffeine intake. For many, no caffeine is best; for others, a single cup or two of coffee or tea may be tolerable. You must determine this, as objectively as possible, by listening to your body to see how much caffeine you can tolerate. Feeling jittery and high-strung, a rapidly rising heart rate, or queasiness in your stomach may indicate you’ve consumed too much caffeine.
Breakfast is always the most important meal of the day, but most especially for those with adrenal dysfunction. A healthy breakfast includes protein but is void of refined carbohydrates. An egg-based meal can be the cornerstone of an ideal breakfast.
People with adrenal stress often need to snack between the three main meals, as much as every two hours, in the early stages of recovery. Healthy snacking means eating healthy food in small portions.
ADRENAL STRESS CHECKLIST
Ten common symptoms of adrenal dysfunction are listed below. Note those that pertain to you. While any of these can be caused by other imbalances in the body, together they make up the most common complaints experienced by those with adrenal dysfunction:
• Low energy. This is common especially in the afternoon, but could happen anytime or all the time. The fatigue can be physical, mental, or both. When the adrenals are too stressed, the body uses more sugar for energy but can’t access fat very well for energy use. This can significantly limit one’s energy for daily activities and even sleep.
• Dizziness upon standing. Standing up from a seated or lying position, or just bending over to pick up something from the floor, can make you dizzy because not enough blood is getting to the head quickly enough. Check your blood pressure while lying down and then immediately after you stand. If you suffer from adrenal dysfunction, you will often notice the systolic blood pressure (the first number) doesn’t rise normally—it should be higher when you’re standing by about six to eight millimeters.
• Eyes sensitive to bright light. Adrenal stress often causes light sensitivity in your eyes. You may feel the need to wear sunglasses even on cloudy days or have difficulty with night driving because of the oncoming headlights (often misinterpreted as bad night vision). Some people find that their nearsightedness (ability to see distances) worsens with adrenal stress.
• Asthma and allergies. Whether you call it exercise-induced asthma, food allergies, or seasonal allergies, they are all similar symptoms of adrenal dysfunction.
• Physical imbalance. Problems in the low back, knee, foot, and ankle are particularly associated with adrenal problems. They can produce symptoms such as low-back pain, sciatica, and excess pronation in the foot, leading to foot and ankle problems.
• Stress-related syndromes. Emotional despair and depression can often be the result of adrenal exhaustion. While both these problems can become serious enough to warrant medication or hospitalization, adrenal dysfunction occurs long before this point.
• Blood sugar stress. With adrenal dysfunction, the body is unable to properly regulate blood sugar. Symptoms include constantly feeling hungry, being irritable before meals, especially if meals are delayed, and having strong cravings for sweets or caffeine.
• Insomnia. Many people with adrenal dysfunction fall asleep easily (from fatigue) but wake in the middle of the night with difficulty getting back to sleep. This may be due to high levels of cortisol occurring at the wrong time (levels should be low during sleeping hours). Many people say they wake up in the night to urinate, but it’s usually the adrenal problem that awakens them, and then they get the urge to urinate. Rest is a key factor in recovering from adrenal dysfunction. Are you getting at least seven to eight hours each night? If not, you may need more sleep. Adrenal stress increases the need for recovery.
• Diminished sex drive. This is a common symptom of adrenal dysfunction due to low levels of the hormone DHEA, which makes estrogen and testosterone.
• Seasonal affective disorder (SAD). This usually occurs during the colder months. As the hours of daylight lessen and the temperature drops, many people go into a mild state of hibernation. The metabolism slows and the body and mind become sluggish, sometimes resulting in a mild or moderate depression. (This corresponds with a combination of stresses: the weather, lack of sunlight and vitamin D, and even the start of the holiday season—people don’t eat well, are less active, and weight gain is typical.)
In addition to these signs and symptoms, excess abdominal fat is common in those with high levels of stress. Because high cortisol level encourages sugar burning and reduces fat burning, belly fat tends to accumulate for many stressed-out people.
Recognizing the symptoms of adrenal dysfunction can be useful in your own self-assessment. You may also want to test some of your adrenal-hormone levels with the help of a health care professional. The best initial test for adrenal function measures cortisol and DHEA in saliva and is performed with four samples of saliva over the course of a typical day and evening, rather than just a single test.
Your nutritional needs may vary with adrenal stress. These include factors to help the immune system, intestines, and the adrenal glands themselves. Most, if not all, nutrients should come from an optimal diet. Below are some possible supplemental nutrient needs:
• For many types of adrenal stress, especially those that cause insomnia, additional zinc may be useful. Studies show this important mineral can help lower high cortisol levels that accompany adrenal stress. Taken right before bed, for example, zinc may improve sleep patterns associated with high cortisol.
• Choline is a nutrient commonly needed by some people with adrenal stress, in part due to the relationship of choline with the brain and nervous system. Individuals who are always on the go, overworked, and trying to do too much are examples of those who may benefit from additional choline. A smaller dose several times a day, rather than one or two higher doses, may be most helpful. Those with asthma (exercise-induced or not) may need higher doses. The best source of choline in the diet is egg yolks.
Building a great aerobic base can be a significant strategy for improving adrenal function. Anaerobic training, including any type of weight lifting, can worsen existing adrenal problems. Once adrenal function is improved, anaerobic exercise can be resumed, though the balance of aerobic and anaerobic exercise must be maintained.
All hormones play a major role in one’s physical, chemical, and mental well-being. Three important hormones, produced by both men and women, include a group of estrogens, testosterone, and progesterone. As one ages, and with increased stress, the production of these hormones is diminished. This occurs especially when cortisol rises, reducing the production of DHEA, and subsequently diminishing the estrogens and testosterone.
EXERCISE AND STRESS: WELCOME TO THE RAT RACE
The following is excerpted from my good friend Bill Katovsky’s latest book, Return to Fitness: Getting Back in Shape after Injury, Illness, or Prolonged Inactivity:
Research scientists love tormenting lab rats. The furry little rodents are starved, shocked, bullied, and even water-boarded. Their torture is encouraged under the rational aegis of science—to find out how stress affects the brain. Because rats provide a fairly reliable indicator of human behavior, scientists use them to examine how stress affects overall health, including blood pressure, immune system, and depression.
In 2009, scientists at the University of Minho in Portugal discovered that chronically stressed rats acted rather un-ratlike. They’d continually press a bar for food pellets even when they had no intention of eating. The rats were stuck in a habit-forming groove of futile, nonproductive behavior. It’s as if their stressed brains were unable to make intelligent decisions like, “Hey, no food, so why don’t I do something else with my time?”
Speaking with The New York Times, Robert Sapolsky, a neurobiologist at Stanford University School of Medicine, called the Portuguese study “a great model for understanding why we end up in a rut, and then dig ourselves deeper and deeper into that rut. We’re lousy at recognizing when our normal coping mechanisms aren’t working. Our response is usually to do it five times more, instead of thinking, maybe it’s time to try something new.”
Stress had an important evolutionary role in keeping our ancestors alive. Survival in the forest or on the savanna demanded quick action when danger lurked. Stress hormones like cortisol and adrenaline would suddenly flood into the bloodstream, causing the heart to beat faster, which increased blood flow to the muscles. But after the danger passed, the flight-or-fight hormones would settle down and the body would return to its normal physiological state.
But in today’s modern world, stress receptors often get stuck open in a locked position. Since the body can’t function all the time like this, stress hormone production is ultimately affected. Natural defense mechanisms weaken. The overloaded brain shuts down critical areas such as the hippocampus and prefrontal cortex, which affect learning, memory, and rational thought. A stressed-out person will end up engaging in harmful, counterproductive behavior, like having three beers after work, or eating junk food when not hungry.
Given identical stressful conditions, such as losing a job or breaking up, some people are better able to cope, while others will emotionally fall apart—and remain depressed for a long time. In a 2009, Newsweek cover story titled “Who Says Stress Is Bad for You?” science reporter Mary Carmichael cited several studies that pointed to genetic differences in determining the individual outcome to stressful situations. But which specific genes are responsible? No one knows. “The science is still young,” she writes.
Yet there’s good news for the stressed-out population. The Portuguese scientists found that stress-caused behavior is indeed reversible. Once removed from a stressful environment, the rats resumed acting like normal rats. No more pressing the food bar when there wasn’t any food. Their brain circuitry had somehow rewired itself.
“The brain can grow new cells and reshape itself,” says Carmichael. Furthermore, “meditation appears to encourage this process. Monks who have trained for years in meditation have greater brain activity in regions linked to learning and happiness.” The monks grew new brain cells.
Carmichael brought up another classic rat study: “Something that should lower stress can actually cause stress if it’s done in the wrong spirit. Scientists put two rats in a cage, each of them locked inside a running wheel. The first rat could exercise whenever it liked. The second rat was forced to run whenever its counterpart did. Exercise, like meditation, usually tamps down stress and encourages neuron growth. The second rat, however, lost brain cells. It was doing something that should have been good for its brain, but it lacked one crucial factor: control. It could not determine its own ‘workout’ schedule, so it didn’t perceive it as exercise. Instead, it experienced it as a literal rat race.”
So even too much of a good thing like exercise can turn harmful if it’s controlling you rather than vice versa. It’s a primary reason why many athletes get injured or sick if they train or race too hard and don’t take time off. The stress switch can’t indefinitely remain open.
In many, if not most, cases, improving health and fitness will also correct hormone imbalance. This is especially true when adrenal hormone problems exist. In difficult cases, since the hormonal system is complex, it’s recommended that you seek the input of a health care professional to assess and treat the problem. In some stubborn cases, natural hormone supplements may be an option.
This most well-known of hormones is actually a group of about twenty compounds. The most important estrogens are estrone, estradiol, and estriol. The different estrogens have unique roles in the body. For example, estradiol is the most stimulating to the breast, potentially increasing the risk of breast cancer. Estriol protects against breast cancer. Normal production of both by the body is the right balance. A variety of benefits are attributed to the effects of natural estrogens, including prevention of hot flashes, better memory and concentration, slowing of the aging process, and reduced depression and anxiety.
BIOIDENTICAL HORMONES
What are bioidentical hormones and are they safe? The answer is not what you’d expect. Any hormone, synthetic or natural, must be identical to the ones your body make; otherwise it would not work (some are only similar and the body may convert them to the identical type). For the past dozen years or so, the FDA literature—those difficult-to-read tiny-print inserts that accompany prescription drugs—have been using the marketing term “bioidentical.” While this term sounds safe, it may not be—it’s simply a consumer-friendly term. Bioidentical hormones may or may not be natural—some are even synthetic.
But bioidentical hormones can be deadly if taken improperly. Estrogen’s commonly known risk of breast cancer is one example. A healthy body normally orchestrates the production of a whole range of hormones that are produced, do their work, then disappear. It’s the liver that breaks them down, through a process called detoxification, and eliminates them through the gut. When this does not happen, it may be due to poor liver function or an imbalance in hormone production.
But if you do have an imbalance, hormonal therapy may be an option, but you first need to consider all the potential risks. Before taking any additional hormone, the question about why you’re not making enough of your own must be answered. This involves a proper assessment by a health care professional. Good liver and gut function becomes even more important during any hormone therapy. So make sure your liver is working well so it can properly control the hormones. To do this, the body needs the active (natural) B vitamins, listed in chapter 9, and a proper detoxification system discussed in chapter 22.
For most people, hormone therapy is not necessary. Why? Because by being healthy and fit, hormone activity usually remains in balance, at any age. An example is when a woman’s ovaries no longer produce adequate amounts of estrogens. After menopause, the adrenals normally adapt by making more of this hormone. But without healthy adrenal function, this may not happen, triggering common menopausal symptoms with health care professionals recommending hormone therapy instead of improving adrenal function.
Bioidentical or not, hormone therapy is tricky as exemplified by the use of estradiol, one of the estrogens. It’s the most common hormone prescribed to women and the one that’s responsible for the alarming rates of breast and uterine cancer. Estradiol is normally not produced by itself but with other estrogens and, along with progesterone and other hormones, provides the body’s natural “checks and balances” that avoid the increased risk of cancer.
There are times, however, when natural hormone therapy is warranted—this is an individual issue.
Estradiol (Premarin) is a commonly prescribed estrogen that places woman at high risk for breast cancer. This is due to the fact that it’s not broken down in the liver as quickly as your own natural estrogens (affecting the cells for a longer time). Premarin, made from the urine of pregnant horses, simply doesn’t function exactly like the estrogens made in the human body.
One of the common risks of taking an estrogen replacement drug is the higher dosage compared to what the female body would normally produce. The most common symptom of too much estrogen is water retention. This can lead to breast tenderness and swelling, weight gain, and headaches. Excess estrogen can also lower blood sugar and increase your cravings for sweets. Too much estrogen also increases a woman’s risk of uterine cancer and gallbladder disease.
While the idea of estrogen replacement is often “sold” to female patients by touting the benefits of building strong bones, estrogen doesn’t actually do this. Rather, it decreases the rate of bone loss that occurs naturally throughout life. The hormones that have the greatest impact on new bone growth—something the body is always doing—are progesterone and testosterone.
Unlike estrogen, which is a group of hormones, progesterone is the only hormone in its class. It improves sleep, builds bone mass, protects against breast and uterine cancer, improves carbohydrate tolerance, helps burn fat, prevents water retention, increases sex drive, and in many women has a calming effect on the nervous system. (Men also produce progesterone, which has similar health effects.)
Provera is a commonly used synthetic version of progesterone. However, it doesn’t have the same functions as the natural hormone your body produces. While natural progesterone acts like a diuretic, Provera can increase salt and water retention and body fat. Too much of this synthetic hormone can cause bloating, depression, fatigue, increased hair growth on the body, and increased weight gain. Provera can also cause your body to diminish its own production of natural progesterone, forcing you to rely more on outside sources. Other synthetics can cause birth defects, epilepsy, asthma, and heart problems.
It’s important to note that both estrogen and progesterone work together. In a real sense, they balance each other when in their natural state. Taking one prescription hormone without the balance of the other often creates the side effects noted above.
Testosterone is also a naturally occurring hormone made by both men and women. It’s important for healing, helps build and maintain muscles and bones, increases sex drive and overall energy, and is a very important hormone for healthy metabolism. There are a variety of synthetic testosterones, such as fluoxymesterone and methyltestosterone, with side effects including hormonal imbalance, intestinal distress, increased cholesterol, hair loss, depression, and anxiety.
Outside sources of testosterone are sometimes used to enhance strength performance—not just for athletes but those who work out very little. The use of this hormone and its potential to help “restore youth” may go back thousands of years with the consumption of animal parts containing this hormone, namely, the adrenal glands and testicles. Today, it’s produced in drug-company labs and is classified as an anabolic steroid and is the most commonly detected drug in athletes who are tested, often causing a fine or banning from competition (depending on the particular sport’s rules). Androgen abuse in men is associated with reduced size of the testicles and low sperm counts, and low production of natural testosterone; symptoms can include violent mood swings, acne, and excessive muscularity.
Taking synthetic testosterone can cause the pituitary gland to shut down the supply from the testicles—a chemical castration. The inappropriate and dangerous use of testosterone is not only a problem with some athletes and bodybuilders but is also becoming more popular among older men, with a side effect of increasing the risk of prostate cancer.
Like all hormones made by the body, the sex hormones are important for optimal health and fitness. The ideal scenario is to have your body make the types and amounts of hormones necessary for you. That amount varies from day to day and year to year (even from minute to minute). If reduced health interferes with this delicate mechanism, imbalances can occur.
If you have signs and symptoms related to hormone imbalance, measuring your hormone levels, such as by testing the blood or saliva, is an important part of a complete assessment process. A reevaluation of the same tests will help you know whether improved lifestyle habits or any replacement therapy is successful.
For menopause, premenstrual syndrome, muscle or bone loss, or other hormone-related imbalances, the use of hormones can improve your quality of life. What’s most important is to understand that no one has to live with the pain, displeasure, and discomfort that too many doctors (along with the media and pharmaceutical companies) have told us are normal with aging. But I can’t emphasize enough that preventing and correcting hormone imbalance by improving adrenal function and overall health and fitness is the most effective and best first option.