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Managing Type 2 Diabetes And Hormonal Imbalance

If you have type 2 diabetes, it's important to manage your hormone levels, as an imbalance can alter how your body responds to insulin. Lifestyle measures like reducing stressors and eating a balanced diet can help.

The body produces several powerful chemical messengers called hormones to regulate processes such as digestion, growth, and development. However, sometimes, the body produces too much or too little of a hormone, causing a hormonal imbalance. Even a slight imbalance can be problematic.

Here's what you need to know about the link between type 2 diabetes and hormonal imbalances.

It's not just an imbalance of insulin that can be problematic with diabetes. The hormone glucagon, which is produced in the pancreas, helps the liver turn stored sugar into energy. Normally, insulin and glucagon work together to regulate blood sugar levels. However, an imbalance of insulin can affect the production of glucagon.

If you develop an imbalance of other types of hormones, it can also affect your diabetes. For example, research suggests a link between diabetes and higher cortisol levels. Your body produces cortisol in response to stress and releases it into your bloodstream.

High cortisol levels can disrupt many systems in the body, but specifically, it can raise your blood sugar levels. It can make it harder for the insulin produced by your body to remove that sugar from your bloodstream.

Here are some strategies that may help you manage your diabetes and any other hormonal imbalances you may have.

Get the medical care you need

It's important to work closely with your healthcare team to manage all your health needs, including medication management. If you're taking diabetes medication, be sure to take it exactly as prescribed.

Make healthy lifestyle choices

Eating a balanced diet and maintaining a moderate weight can go a long way toward helping you manage your diabetes. A diabetes educator or a registered dietitian may be able to help you figure out what to eat to help you achieve your goals.

Reduce stress levels

Committing to activities that help you reduce your stress may help you balance your cortisol levels, which can, in turn, affect your blood sugar management.

In addition to other healthy lifestyle choices, consider mind-body exercises such as tai chi and yoga. Some research suggests that these may also help you sleep better.

There are several treatment methods available for type 2 diabetes, including lifestyle changes and medications.

Lifestyle changes

Many people with type 2 diabetes can manage their blood sugar levels with lifestyle changes, including exercise and nutrition, especially if they have overweight or obesity. For some people, losing just 5% to 10% of their body weight can make a difference. Plus, being active can make your body more sensitive to insulin again.

Non-insulin medications

The American Diabetes Association mentions that people with type 2 diabetes have several non-insulin options to help them manage their condition. Most people start by taking metformin, which helps in several ways. It reduces the amount of insulin the liver produces and the amount of glucose that the body absorbs from food. It also increases the body's response to insulin.

The other most commonly used medications for helping people with type 2 diabetes manage their blood sugar levels include:

  • Dipeptidyl peptidase 4 (DPP-4) inhibitors
  • Glucagon-like peptide 1 (GLP-1) and dual GLP-1/gastric inhibitory peptide (GIP) receptor agonists
  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors
  • Sulfonylureas
  • Thiazolidinediones (TZDs)
  • Some people may also need to use a combination of medications to help them keep their blood sugar levels within their target range.

    Insulin

    Some people with type 2 diabetes may need to use insulin. Usually, they need insulin because other medications do not work—or no longer work—to help them manage their blood sugar levels.

    There may also be occasions when they need to take insulin for a temporary amount of time, such as during a hospitalization or when pregnant.

    If you're finding it difficult to manage your blood sugar levels, consider speaking with a doctor. You may need to adjust your diabetes medication or try a different medication option. It's also possible that a doctor may need to adjust any treatments you're taking for other hormonally-related conditions.

    You can live a healthy, active life with a hormonal imbalance, including diabetes. Many treatment options exist that can help you manage your diabetes and any other hormonal condition that you may have so that you can carry out your daily activities.


    Should We Be Stressed About Our Cortisol Levels? I Got A Blood Stress Test To Find Out

    Cortisol is known as the "stress hormone," and ironically, online discussions and videos about cortisol imbalance seem to stress people out. That includes me: I have anxiety and, as a result, I've always wondered about how my stress is affecting my cortisol levels. I finally got the opportunity to find out when Quest, a diagnostic information services provider, offered me a complimentary Cortisol Blood Stress Hormone Test. 

    Following my cortisol blood test, I've spoken with several doctors to better understand my "high cortisol" results and answer the question: Should we all be concerned about cortisol? Or are all these videos on social media stressing us out for no reason?

    What is cortisol? Does it control stress?  From talking fridges to iPhones, our experts are here to help make the world a little less complicated.

    "Cortisol is an essential hormone produced and released by adrenal glands," said Dr. Sanjay Dixit, medical director of cardiometabolic endocrine and wellness solutions at Quest Diagnostics and medical expert for questhealth.Com, in an email. "Many people associate cortisol as being the 'stress hormone,' but it actually has many additional important functions."

    In addition to managing the body's response to stress, cortisol regulates blood sugar and blood pressure, the sleep-wake cycle and metabolism while suppressing inflammation. 

    "It is most commonly known as the 'stress hormone' because it's released in response to stress and works to prepare the body for 'fight-or-flight,'" added Dr. Sajad Zalzala, co-founder and chief medical officer of longevity platform AgelessRx, via email. "It increases glucose availability, which supplies energy and mobilizes stored fats and proteins to provide additional fuel."

    From talking fridges to iPhones, our experts are here to help make the world a little less complicated. Do you need a cortisol blood test? 

    Dr. Dixit explained that someone could get a cortisol test to see if they have a cortisol deficiency, also known as adrenal insufficiency. Symptoms of this can include:

  • Fatigue or being overly tired
  • Worsening muscle weakness
  • Skin changes (particularly darkening in folds and scars)
  • Loss of appetite
  • Unintentional weight loss
  • Low blood pressure
  • Another reason a cortisol test may be ordered is to see if a patient has excess cortisol, generally known as Cushing's syndrome. Potential symptoms for this include:

  • Bruising easily
  • Unintentional weight gain
  • Muscle weakness
  • Fatigue
  • Rounded and rosy face
  • Increased fat in the upper back
  • Impaired glucose tolerance
  • "[Impaired glucose tolerance is] something that can be particularly noticeable in type 2 diabetic patients who have trouble managing their glucose levels even with adherence to prescribed medication," said Dr. Dixit. 

    Westend61/Getty ImagesWhat happens during a cortisol blood test? 

    Before my blood was drawn for this test, I had my yearly physical with my primary care provider. I notified her that I would be getting this test and asked to have my other preventative blood tests taken simultaneously. I want to mention this because it's important to run any health-related tests by a doctor who knows you and your health history. 

    According to Quest, you must be at least age 18 to buy a test, which is unavailable in Alaska, Arizona or Hawaii. For select tests, you will be asked to answer relevant medical questions. Before a test order is submitted for processing, your purchase and answers will then be reviewed by a telemedicine doctor affiliated with the national clinician network PWNHealth to ensure this test is medically appropriate for you.

    You must also schedule the cortisol test between 7 a.M. And 9 a.M. "Cortisol levels naturally change throughout the day," Quest answered in an FAQ, stating that since cortisol levels usually peak in the morning, this particular level would be the best indicator of a cortisol problem.

    No fasting is required. But I had to fast for the other blood tests ordered by my doctor. 

    According to Dr. Dixit, it is also important to note that "a blood test for cortisol can be inaccurate in some cases." Inaccurate results, for example, can happen if a person is taking oral contraceptives or steroids, such as prednisone. 

    Once I bought the cortisol test on Quest's website -- it ordinarily costs $89 with a $6 physician service fee -- I was sent an email with my order number and a link to schedule an appointment at a nearby Quest location. I scheduled my appointment for 8:20 a.M. At the facility closest to me. 

    On the day of my appointment, I was texted a link to check in when I arrived and was admitted within 5 minutes. (I highly recommend scheduling beforehand so you don't have to wait.) I get particularly anxious about blood tests, so I notified my technician and asked if I could lie on an exam table. She assured me that many people get nervous about blood tests and, after I signed off on my tests, did a great job talking to me as a distraction while my blood was drawn. 

    Later that night, I received the results of my cortisol test. As for the results from the tests ordered by my doctor, I received them five days later. Quest reports that processing times vary, but it generally takes up to eight business days to receive results. 

    My cortisol blood test results 

    Unsurprisingly, my cortisol blood test results came back as "high" at 33.2 mcg/dL. Quest reports that a normal range between 7 a.M. And 9 a.M. Is 4.0-22.0 mcg/dL. To be frank, this freaked me out. I had a feeling that my cortisol levels would be high because of my general anxiety and heightened nerves around blood tests, but actually seeing that "high" result and not fully understanding it ironically increased my stress levels even more. 

    Quest allows you to discuss your results with an independent physician, so I took advantage of this offer. I called Quest's customer service line and was emailed to schedule my appointment with a physician at PWNHealth via Everly Health Solutions, a digital health company that acquired PWNHealth in 2021. When scheduling my appointment, I provided context about my cortisol blood test. I was then told that a physician would call me within 4 hours during business hours. 

    Within 4 hours, a PWNHealth physician called. I asked the doctor if my cortisol level was in line with the fact that I have anxiety and was stressed about the blood test. She said that it could be why my cortisol was acutely high, but that chronically high cortisol levels could be concerning and caused by other conditions, certain medications or pregnancy. She added that it could be related to an adrenal gland condition. 

    I also asked about how high cortisol levels can go and she stated that there is no "highest point," especially since it varies from person to person, depending on the condition. She added that people with adrenal gland conditions typically show higher cortisol levels, but there isn't a specific cutoff. 

    Though the doctor stated that my high cortisol was likely due to anxiety, she recommended that I follow up with my primary care physician. Afterward, I was able to download my Quest results as a PDF and send them to my PCP. 

    mapodile/Getty ImagesWhat are 'normal' cortisol levels? Why do they change?

    "The 'normal' reference range varies slightly with the lab that's doing the testing," said Dr. Zalzala. "Quest reports a normal a.M. (7 to 9 a.M.) blood level of 4.0 to 22.0 mcg/dL, whereas Labcorp reports normal a.M. Blood level of 6.2 to 19.4 mcg/dL."

    As for why cortisol varies throughout the day: "Cortisol is very important in helping a person transition from sleep to wakefulness," Dr. Zalzala explained. "This triggers a 'morning cortisol surge' -- a rapid rise in cortisol levels within 20 to 30 minutes of waking, which jumpstarts alertness and prepares the body for the day."

    Over the course of the day, our bodies will also experience mini peaks in cortisol levels to help us maintain energy and alertness. These peaks typically occur around noon and in the early evening. "Interestingly, these peaks often align with standard meal times, playing a key role in supporting our body's ability to metabolize food and regulate energy levels," said Dr. Zalzala. 

    Dr. Betul Hatipoglu, MD, professor of medicine at Case Western Reserve University's School of Medicine and medical director of the Diabetes and Metabolic Center at the University Hospital Cleveland Medical Center, stated in an email that there is a "normal, what we call 'circadian rhythm' for cortisol." As the day goes on, cortisol levels will gradually decrease and become lowest closer to bedtime. 

    How high can cortisol levels go? 

    "Cortisol levels could go as high as or closer to 40 [mcg/dL] in individuals who are extremely ill, such as people in intensive care," Dr. Hatipoglu said. Dr. Zalzala added that a normal adult can generate cortisol levels up to 50 mcg/dL, which is about two to three times their morning surge level, during times of stress.

    Dr. Zalzala also mentioned Cushing's syndrome, a rare disorder in which "the adrenal gland starts making cortisol on its own (adrenal tumor) or in response to a pituitary gland tumor that makes too much ACTH [adrenocorticotropic hormone, which regulates cortisol] and ignores the feedback cycle." For those with this disorder, cortisol levels can go as high as 100 mcg/dL. 

    In cases where someone is extremely ill, such as with septic shock, Dr. Zalzala stated that levels can be as high as 1,000 mcg/dL.

    Maskot/Getty ImagesThe relationship between cortisol and anxiety 

    I shared my results with all the doctors I consulted to see if I could get a better understanding of how anxiety could affect my cortisol levels -- and any other factors that may be at play. 

    "High cortisol in a normal individual can be a sign of stress in your case," said Dr. Hatipoglu. "However, sometimes other hormones can affect the cortisol levels. For example, if someone is taking oral contraceptives or estrogen therapy, this can increase total cholesterol, which is what you have been tested for."

    Due to fasting, anxiety and being stressed about my blood draw, Dr. Zalzala said that combination could have caused my morning cortisol level to be higher than normal. He added, "Studies have shown that stress or acute anxiety can drive cortisol levels significantly higher, often to values similar to what you experienced."

    Do doctors recommend a cortisol blood test? What other cortisol tests are there?

    "I usually would check a random cortisol before 9 a.M. In the morning to make sure the level is not low," said Dr. Hatipoglu. "If we are concerned about high cortisol, it is usually recommended that we actually do different evaluations." 

    To understand whether elevated cortisol levels are a normal reaction or an abnormal increase, Dr. Hatipoglu may then want to do testing such as a milligram dexamethasone suppression test (which measures whether cortisol secretion by the adrenal gland can be suppressed) or a 24-hour urine cortisol test (which measures the amount of cortisol in a person's urine over a day). However, if a patient is on birth control, stopping it for a few months and then repeating the cortisol test may help show their body's actual cortisol levels. 

    Dr. Zalzala, on the other hand, stated that he rarely recommends a single morning cortisol test unless a patient is believed to have Addison's or Cushing's disease. Addison's is a rare endocrine disorder caused by damaged adrenal glands that can't produce enough hormones. 

    "For those people who want to use cortisol levels as a tool to make lifestyle adjustments and to monitor other interventions (like therapy or sleep medications), then the saliva cortisol level is the one I would recommend," stated Dr. Zalzala. "Studies indicate that salivary cortisol levels show a reasonably strong correlation with serum cortisol."

    For my "high" result specifically, Dr. Zalzala stated, "While this result aligns with the stress factors you've described, cortisol levels above 20–25 µg/dL [which is the same as mcg/dL] in the morning can sometimes prompt further evaluation, particularly if symptoms suggest additional hormonal imbalance." 

    If I were to take supplementary tests under less stressful conditions and my cortisol continues to be elevated, Dr. Zalzala said I should explore other factors with my healthcare provider. "They may consider repeating the test using alternative methods, like a 24-hour urinary free cortisol or late-night salivary cortisol test, which are less affected by immediate stress responses." 

    While this particular cortisol blood stress hormone test can be a good first step, Dr. Dixit acknowledges that it may not necessarily be the last one. He suggested that a person concerned about their health should talk to their doctor -- even if the test results don't show anything wrong. 

    AzmanJaka/Getty ImagesWhat happens if a cortisol blood test is abnormal?

    "I think the best way here would be to see a physician, a nurse practitioner or a healthcare provider to get an evaluation," Dr. Hatipoglu said. "[This is] done to understand if it is true [cortisol] elevation or is it stress-induced."

    Dr. Dixit specifically recommended that in addition to a primary healthcare provider, one could see an endocrinologist, a doctor specializing in diagnosing and treating health conditions that affect the endocrine system. "That's because testing for excess cortisol is not as straightforward as a single blood test," he said, adding that a healthcare provider could perform an evaluation, recommend additional tests and consider other potential causes.

    However, if additional tests remain abnormal, a trained clinician must be consulted for further diagnostic decisions. "Most conventionally trained physicians would initially evaluate for Cushing's or Addison's disease," Dr. Zalzala said. "If these are ruled out, a thorough clinician would then investigate other contributing factors affecting cortisol levels. Conversely, a less attentive approach might dismiss the patient without addressing the underlying issues." 

    If a doctor does determine that there are problems with excess cortisol or adrenal insufficiency, Dr. Dixit stated that the methods used to address the issue depend on the root cause. For example, with Cushing's syndrome, medication or surgery may be required since the disorder can be caused by a tumor on the adrenal or pituitary glands. 

    What can cause abnormal cortisol levels? 

    "I think it's useful to talk about the ways the normal cortisol cycle can be disrupted, that could show up on salivary testing if done at the right times of day," said Dr. Zalzala, who listed the following as common causes for a disrupted cortisol cycle:

  • For cortisol levels that remain low and flat throughout the day: chronic stress, adrenal fatigue, burnout and some chronic inflammatory conditions
  • For lower morning cortisol levels that then peak in the evening: chronic stress, sleep disorders, shift work and certain mental health conditions (for example, PTSD)
  • For normal morning cortisol levels that increase in the evening: anxiety, high-stress lifestyle, evening exposure to artificial light (such as from screens) and late-day caffeine or high-stress activities
  • For a lower or absent rise in cortisol upon waking, or Cortisol Awakening Response): chronic stress, depression, PTSD, burnout and shift work
  • Symptoms of high cortisol or cortisol deficiency can also be connected to non-cortisol-related conditions and health issues, according to Dr. Dixit. That is why consulting a doctor about your results and symptoms is essential. 

    Ekaterina Goncharova/Getty ImagesAbnormal cortisol health impacts 

    While social media may oversimplify all things cortisol as a means of clickbait, Dr. Zalzala said it should not be dismissed. That's because dysregulated cortisol has the following long-term health impacts: 

  • Mental health issues such as anxiety, depression and mood instability
  • Cognitive impairment such as memory problems and impaired executive function
  • Metabolic disorders that involve weight gain and obesity, insulin resistance, increased risk of metabolic syndrome and type 2 diabetes and blood sugar instability (such as hypoglycemia or hyperglycemia)
  • Cardiovascular issues like hypertension, arterial stiffness, inflammation and heart disease, raising the risk of heart attacks and stroke
  • Immune system impairment that can include increased susceptibility to infections and autoimmune conditions such as rheumatoid arthritis or lupus
  • Bone health issues and muscle wasting like osteoporosis and muscle loss
  • Sleep disruption and fatigue, including insomnia, chronic fatigue, low motivation and difficulty managing stress
  • Digestive issues such as gastrointestinal inflammation contributing to conditions like irritable bowel syndrome (IBS) and exacerbating symptoms of inflammatory bowel diseases like Crohn's disease, and gastric ulcers
  • Should people be concerned about their cortisol levels?

    The question that's on everyone's mind. After mentioning all of the social media videos circulating saying that people should be worried about their cortisol levels, I asked doctors if there is any legitimacy to these claims or if it's just fearmongering.  

    "I don't think it is fair to say people should be concerned about their cortisol levels -- as you can see, cortisol constantly fluctuates," said Dr. Hatipoglu. "The fluctuation occurs so many times that it is sometimes even difficult to know what is very normal or very abnormal." However, if you are concerned about your cortisol,  she recommends seeing a doctor to see if a test is needed first instead of having it tested randomly.

    While Dr. Zalzala acknowledges that there is some truth to the concept of "minding your cortisol levels," since there are medical conditions that can cause abnormal cortisol levels, he believes "social media often oversimplifies this, turning cortisol into a scapegoat for various health issues." He specifies that cortisol imbalances are typically caused by deeper issues such as poor sleep, unhealthy habits, unmanaged stress and substance abuse, in which case "cortisol is more of a symptom than the root cause."

    "Cortisol levels, as a tool, should be used in conjunction with other tools like a CGM sensor or a sleep monitor," concluded Dr. Zalzala. 

    How to naturally reduce cortisol with lifestyle changes

    "I usually recommend important, basic lifestyle management, [including] nutritious meals and good nutrition; movement exercise like yoga, walking and swimming; a good night's sleep, meditation and mindfulness; good vitamin D; and stress management for day-to-day stresses of life," said Dr. Hatipoglu. "And last, as much as possible, eliminating smoking and excess alcohol."

    "Minimize caffeine and sugar intake, especially later in the day," Dr. Zalzala recommended. "Both can elevate cortisol and disrupt the normal rhythm, making it harder to wind down at night." Excess sugar and starch can cause a spike in blood sugar followed by a crash. This can occur in the middle of the night, disrupting your sleep. 

    If you maintain a consistent sleep schedule and evening routine without screen time or intense exercise (which can elevate cortisol and disrupt sleep) but still struggle to fall asleep, Dr. Zalzala recommends mild sleep aids like melatonin or L-theanine before moving on to strong options like passionflower or California poppy. "If these aren't effective, consult a doctor about medications like trazodone or doxepin and rule out conditions like sleep apnea," he said. "Always discuss sleep therapies, including OTC supplements, with a doctor."

    The takeaway 

    While the results of my cortisol blood test did stress me out, I'm glad I tried it because it helped me learn more about cortisol. It also gives me even more of an incentive to increase my stress and anxiety management. While I've always prioritized my health and wellness, since getting the cortisol blood test, I've started exercising more than before, going to bed earlier, thinking up new ways to lower my stress levels and paying closer attention to having a well-balanced diet.

    As for ordering the test through Quest, I thought the process was smooth, and it's nice to have control over the health tests you can get done (if approved, of course). I also appreciated having the option to speak with an independent physician about my results. However, as both Quest and the doctors I consulted advised, it is best to do any health tests under the supervision of a healthcare provider, who can then help with diagnosis and potential treatment. I'm glad I told my doctor about the test and that it was easy to send her my results. And now, I'm way more informed about what the next steps could be if further testing is needed. 


    Is Stress Affecting Your Blood Sugar? Here's How Cortisol Plays A Key Role

    Feeling overwhelmed by stress? Maybe you're tossing and turning at night, or perhaps you're sleeping too much. Your irritability is through the roof - every little thing sets you off. You're bloated, frozen in stressful situations, and staring at your screen feels like trying to see through fog. Your shoulders are tense, and nothing seems to ease the discomfort.

    Sounds familiar? If you've turned to online searches to explain these symptoms, you might likely have stumbled across cortisol - the infamous stress hormone. But here's a twist: Cortisol isn't the villain it's often portrayed to be. In fact, it's one of your body's most vital allies, connecting your mind and body in ways that keep you balanced. With receptors in nearly every organ, cortisol helps regulate blood pressure, control inflammation, and keep you functioning smoothly. The real issue arises when cortisol stays elevated for too long.

    So what exactly is cortisol, and why does it have such a profound impact on your body and mind? To understand why this hormone is both a friend and a foe, it's important to uncover how it works and how it shapes everything from your mood to your physical health.

    Cortisol is your friend - until it overstays its welcome.

    As Dubai-based physicians Susan Thomas and Manjiri Singh explain, produced by the adrenal glands above your kidneys, this steroid hormone belongs to the glucocorticoid family, which plays a crucial role in regulating metabolism and immune responses. While cortisol is best known for its role in managing the body's stress response, its impact stretches far beyond that. It helps regulate metabolism, control inflammation, and oversees numerous vital functions, making it an essential hormone in keeping your body balanced.

    However, like any good ally, it's only truly helpful when it knows when to step back.

    Cortisol is released through the complex hypothalamic-pituitary-adrenal (HPA) axis, a feedback system connecting your brain to your adrenal glands. When your brain senses stress - whether physical, emotional, or environmental - it triggers the hypothalamus to start the process, explains Singh. "This sends signals to the pituitary gland, which then prompts the adrenal glands to release cortisol into the bloodstream. Once released, cortisol moves throughout your body, helping organs respond to stress and meet immediate needs. Cortisol follows a natural rhythm, peaking in the morning and declining in the evening, supporting your Circadian [day-night] rhythm."

    'A true multi-tasker'

    Cortisol is a true multi-tasker, as Thomas puts it. It helps convert food into energy and manages how the body uses it, playing a crucial role when extra energy is needed, especially during stress or fasting. "Additionally, it signals fat cells to release fatty acids into the bloodstream for energy, which is vital during exercise or physical stress when the body requires immediate fuel," she explains. But it doesn't stop there - cortisol also breaks down muscle proteins into amino acids, which are then used for energy or tissue repair.

    Furthermore, cortisol regulates the immune system by suppressing the release of pro-inflammatory molecules like cytokines, ensuring that inflammation stays in check and preventing excessive immune responses. This balancing act is why synthetic cortisol, such as corticosteroids, is often used to treat autoimmune and inflammatory conditions. Moreover, cortisol enhances focus during stressful situations, preparing both the body and brain for the 'fight-or-flight' response. It also supports memory and learning, especially in short-term situations.

    As specialists explain, while cortisol's role in stress and metabolism is well-known, its impact on blood sugar regulation is just as critical. By raising blood sugar levels during stress, cortisol ensures that the body has enough fuel to meet its immediate needs. However, this vital function can turn problematic when cortisol stays elevated over prolonged periods.

    While we often think of cortisol in the context of stress and metabolism, its influence on blood sugar regulation is just as critical. Here's how: When the body experiences stress - whether physical, emotional, or environmental - cortisol's primary job is to increase blood sugar levels.

    As Nupur Shastri, a Dubai-based physician, explains, cortisol does this by triggering gluconeogenesis: A process where the liver releases stored glucose (glycogen) into the bloodstream. This gives your muscles and brain an immediate source of energy, ensuring your body performs at its peak under pressure.

    In a delicate balancing act, cortisol works alongside insulin, another key hormone that regulates blood sugar. While cortisol raises blood sugar to fuel your body, insulin ensures it doesn't go too high by helping cells absorb glucose for energy or storage. The harmony between these two hormones is essential for maintaining stable blood sugar levels.

    When cortisol levels remain high

    The consequences compound when cortisol levels stay high. Prolonged high cortisol can disrupt blood sugar regulation, causing a cascade of health issues. Chronic stress, illness, or sleep deprivation can keep cortisol levels soaring, leading to insulin resistance. "When cortisol levels stay high for extended periods, the body's cells can become less responsive to insulin, which may result in insulin resistance - a precursor to type 2 diabetes," explains Thomas.

    But that's not all. Persistent cortisol elevation also triggers fat storage, especially around the abdomen. "Abdominal fat is closely linked to a higher risk of metabolic disorders and cardiovascular diseases," says Shastri. Additionally, this hormonal imbalance causes blood sugar fluctuations, leading to energy surges followed by crashes - resulting in fatigue, irritability, and a cycle that's hard to break.

    The ripple effects don't stop there:

    Arvind Gaddameedi, Specialist Endocrinology, Aster Clinic, Al Muteena, Deira explains: 

    • Increased risk of metabolic disorders: As cortisol disrupts the balance between blood sugar regulation and insulin function, it increases the risk of developing conditions like type 2 diabetes and metabolic syndrome.

    • Cardiovascular risks: Chronic high cortisol levels are linked to increased abdominal fat, which contributes to a higher risk of heart disease, high blood pressure, and stroke.

    • Cognitive impairment: Prolonged exposure to elevated cortisol can also impact brain function, particularly memory and learning. Over time, it may affect the hippocampus, the brain region responsible for long-term memory, leading to difficulties with focus and recall.

    • Elevated cortisol breaks down protein, leading to muscle weakness and reduced bone density, increasing the risk of osteoporosis over time.

    • Chronic stress affects gut health by altering the balance of gut bacteria and slowing digestion, leading to issues like bloating, indigestion, and irritable bowel syndrome (IBS).

    What is Irritable bowel syndrome?

    Irritable bowel syndrome is a functional gastrointestinal disorder characterised by a group of symptoms that commonly include abdominal pain, abdominal bloating, and changes in the consistency of bowel movements. (Source Mayo Clinic)

    • High cortisol levels can keep the body in a constant state of 'fight or flight,' causing persistently elevated blood pressure. Over time, this can damage blood vessels, leading to cardiovascular complications.

    • Cortisol prompts the kidneys to retain sodium, which raises blood volume and, consequently, blood pressure. Chronically elevated blood pressure, or hypertension, is a leading risk factor for stroke and heart attack.

    Research speaks volumes too: A 2018 review published in the US-based academic journal Diabetes Metabolism Research and Reviews highlighted the role of cortisol and enzymes in modulating insulin resistance. It noted that chronic stress and elevated cortisol are linked to visceral fat accumulation and impaired insulin sensitivity, particularly in those with metabolic risk factors.

    Furthermore, as Singh cites, studies from the scientific journal Endocrinology and Metabolism have shown how elevated cortisol can influence glucose metabolism directly by increasing gluconeogenesis, which is the production of glucose from non-carbohydrate sources, in the liver. This could explain why people under chronic stress or those with high cortisol levels tend to experience blood sugar fluctuations, leading to a higher risk of developing type 2 diabetes.

    Imagine you're at work, up against a tight deadline. Your heart rate speeds up, your muscles tense, and a burst of energy floods your system. That's cortisol helping you rise to the challenge. You push through, complete the task, and for a moment, everything seems fine - until the next wave of stress hits. Suddenly, the energy boost doesn't seem to work. Instead, you feel jittery, overwhelmed, and short-tempered.

    The more this cycle repeats, the more cortisol floods your system, leaving you emotionally drained and mentally exhausted.

    Cortisol has a significant impact on mood and emotional regulation. In short bursts, it helps individuals respond to stress effectively. However, chronic elevation of cortisol, often due to prolonged stress, can negatively impact mood. It has been associated with anxiety, depression, and irritability. High cortisol levels can disrupt the balance of neurotransmitters like serotonin and dopamine, which are critical for maintaining emotional well-being.

    Manjith Singh, physician, DubaiSupplied

    Arvind Gaddameedi Specialist Endocrinology

    Here's the science behind it. Shastri explains, "When the cortisol levels are constantly at a peak, it disrupts the delicate balance of other hormones that regulate mood, like serotonin and dopamine. These 'feel-good' neurotransmitters play a vital role in stabilising your emotions, and when cortisol overrides them, you may find yourself feeling more anxious, stressed, or low than usual."

    While cortisol isn't inherently harmful, balance is key. "A surge in cortisol during stress is natural, but prolonged high levels can trigger a 'downward spiral' of emotional instability," adds Thomas. "You might feel more irritable, short-tempered, or emotionally drained."

    This imbalance fractures your sleep, leading to mood swings and more stress. "It's a vicious cycle - cortisol spikes, causing anxiety and emotional exhaustion, which disrupts sleep, triggering more cortisol production." Over time, sustained high cortisol levels may increase the risk of more serious mental health conditions like depression and anxiety. "Persistent cortisol elevation impacts the hippocampus, which regulates mood, memory, and emotional responses," Singh explains. When cortisol levels stay high, the hippocampus becomes less responsive, leading to difficulty processing emotions or coping with stress.

    How to keep your cortisol levels under control

    Keeping your cortisol levels in check is key to feeling your best. When stress takes over and cortisol runs high, it can lead to a range of health issues. But don't worry - by implementing a few simple strategies, you can regain control and keep this powerful hormone in balance for better physical and mental well-being.

    For starters, as Thomas says, manage your stress. Practices like deep breathing and meditation activate the parasympathetic nervous system, lowering cortisol. Get your sleep patterns fixed: Aim for 7 to 9 hours of quality sleep. Avoid caffeine and screens before sleeping too. "Activities like walking and swimming can help reduce cortisol," she adds.

    What is parasympathetic nervous system?

    The parasympathetic nervous system (PNS) is a division of the autonomic nervous system, which controls involuntary bodily functions. Often referred to as the 'rest-and-digest' system, the PNS is responsible for promoting relaxation and recovery in the body. It helps to counterbalance the effects of the sympathetic nervous system, which activates the 'fight-or-flight' response during stress.

    The specialists also advise, maintaining a healthy diet:

    Balanced meals: Include whole foods like lean proteins, healthy fats, and vegetables to maintain steady energy, which will avoid the spike in cortisol.

    Stay hydrated: Dehydration can raise cortisol levels, so drink plenty of water.

    Diet tips for managing cortisol:

    Whole foods: Focus on complex carbs (oats, quinoa), healthy fats (Omega-3s from fish, flaxseeds), and lean proteins to stabilise blood sugar.

    Limit sugar: Avoid processed foods and refined sugars that cause blood sugar fluctuations.

    Magnesium and vitamin C: Foods like leafy greens, nuts, citrus, and berries help reduce stress and lower cortisol.

    By integrating these practices into your lifestyle, you can maintain balanced cortisol levels, improve your health, and manage stress more effectively.






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