(The Making Better Morning Series can be seen in its entirety here.)
Recently, I was on a health and wellness Facebook forum that my cousin hosts for thousands of women all over North America. I'm really proud of her for organizing and rallying such a large community in a very short period of time.
But some of the women post health tips and information that, frankly, have no grounding in biological plausibility or evidence. I am so tempted to get drawn into correcting them or debating them but I know that whatever they've learned fits with how they've framed their body in their mind. I am unlikely to be able to change anything.
I remember before medical school when I was health coaching, clients and I would discuss concepts like inflammation. I didn't really understand inflammation at the time but it was really popular in the nutrition literature to talk about it as the root of all disease. In the end, it likely does have something to do with most illness but certainly not in the way I thought and there is little to no evidence for many of the anti-inflammatory foods natural nutritionists recommend. I realize that there is a bias here in that institutions who fund this kind of research are more interested in pills than lifestyle interventions, but if classically anti-inflammatory foods like turmeric prevented illness then we would know something about it.
It concerns me more when people that don't wholly understand the physiological basis of our bodies insist to a large community of women that they should take some supplement, or some beauty products, or some new shake. They throw out words like 'inflammation' and 'adrenal fatigue' in ways that certainly don't make sense to me and don't really fit with the many hundreds of thousands of recent studies on the topic. This doesn't help people who really just want to live healthier lives.
One of the women insisted that working out before 3pm was essential because this is when cortisol levels peak and no one wants to work out when they're very stressed. This is untrue. Objectively, without a doubt, untrue. This is what cortisol patterns look like over a 24 hour period in a regular person. Cortisol levels peak just after rising and this is known as the Cortisol Awakening Response.
Here a few things that you can trust about what does happen with our stress hormone - cortisol - when we wake up in the morning.
1. Cortisol levels are very, very, very tightly regulated by several organs and glands in the body.
Having a really crappy day is not going to throw the whole system out of whack unless you have one of the rare conditions that actually affects these organ systems. People with these conditions are very ill and require hospitalization.
One rough night of sleep or one particularly stressful day won't lead you to organ dysfunction. Humans are very tough. You're very tough.
Cortisol levels go up in acute sicknesses, sleep deprivation, some eating disorders, really intense exercise and with some illicit drugs. But measuring just one cortisol level isn't useful because everyone is on their own 24-hour cortisol clock. So if you've been to a naturopath and your cortisol levels after one measurement have been considered higher than normal, know that the measurement is useless without seeing how much you've secreted over 24 hours. Most people don't need a 24-hour cortisol measurement for daily or even chronic stress unless they have some very severe symptoms. If you're concerned, talk to your doctor.
2. Cortisol is a really good thing.
At normal levels, cortisol makes sugar available to muscle for metabolism into energy, prevents overzealous immune response to foreign invaders in the body but promotes overall immunity, helps regulate sodium and potassium, helps with coping with stress and memory formation as well as helps the lungs of babies in utero develop properly.
At persistently high levels, cortisol can interfere with immune activity and wound healing, among other things. That's why people with autoimmune disorders, like lupus, are always on steroids (also known as glucocorticoids). These steroids work on one of the same receptors that cortisol works on so they share the ability to stop an overzealous immune reaction. These reactions form the basis of most autoimmune diseases.
3. Exhaustion does not cause 'adrenal fatigue.'
When a person's adrenal glands shut down or stop working close to normally, no amount of stimulation from the brain is going to force the adrenal glands (which sit on top of the kidneys) to release enough cortisol to allow the body to function. It's like the adrenals have been powered down. This is very dangerous and can result in death.
This is different than when 'adrenal fatigue' comes up to describe people experiencing fatigue and stress. When people are stressed out, cortisol levels increase meaning the adrenals gear up not power down. And there is no evidence that prolonged stress will cause the disease of adrenal insufficiency, or Addison's disease, nor a potentially-fatal adrenal crisis.
I have been to naturopathic doctors who have convinced me that my fatigue is a result of adrenal fatigue. This has an element of what Stephen Colbert calls "truthiness" in that it sort of makes sense so it sounds like it could be true. So I believed it.
In actual fact, if the adrenals shut down it's because the body has formed antibodies against them, there is a congenital deficiency of an essential hormone or enzyme in the cortisol pathway or there is a tumor somewhere along the axis.
Alas, I was just tired and underslept. Lifestyle changes were in order. I was in graduate school so the lifestyle change I needed was to just finish graduate school.
I have heard people talk about cortisol like it is some evil force within that we must destroy at all costs. Cortisol, in a fine balance, is necessary to sustain life.
In fact, if it's something that normally exists within your body - excluding the appendix and a few other bits and pieces - then it is probably best that we appreciate its fine work on behalf of our survival.