Insomnia has reached epidemic proportions. It’s estimated to be the #1 health-related problem in America. More than 1/3 of Americans have trouble sleeping every night, and 51% of adults say they have problems sleeping at least a few nights each week. 43% of respondents report that daytime sleepiness interferes with their normal daytime activities.

These problems are getting worse, not better. The number of adults aged 20 to 44 using sleeping pills doubled from 2000 to 2004, and the number of kids ages 1-19 who take prescription sleep remedies jumped 85% during the same period. Prescriptions for sleeping pills topped 56 million in 2008 – up 54% from 2004 – with over $5 billion in sales in 2010.

This isn’t surprising in a culture that values productivity and activity above all else, and is almost scornful of rest and relaxation. “Resting” for many people means watching TV, browsing the internet or engaging with some other kind of electronic device that is anything but restful for the brain and the body. We have not only forgotten the value of rest, we have forgotten how to do it.

You cannot be healthy without adequate sleep. Period.

Unfortunately for us, the body hasn’t forgotten the importance of sleep. It’s absolutely essential for basic maintenance and repair of the neurological, endocrine, immune, musculoskeletal and digestive systems. The hormone melatonin naturally increases after sundown and during the night in a normal circadian rhythm, which increases immune cytokine function and helps protect us agains infection. (This is why you’re so likely to get a cold or flu after not sleeping well for a few nights.)

In fact, sleep is so important to our overall health that total sleep deprivation has been proven to be fatal: lab rats denied the chance to rest die within two to three weeks.

Among other things, a full night’s sleep:

• enhances memory and mental clarity
• improves athletic performance
• boosts mood and overall energy
• improves immune function
• increases stress tolerance

When things fall apart: how sleep deprivation destroys your health

Fewer than 6 hours of sleep per day is associated with low-grade chronic inflammation and worsening insulin resistance, as well as increased risk for obesity, type 2 diabetes and cardiovascular disease (CVD).

This is highly significant in light of a recent cross sectional study demonstrating that nearly one-third of US adults get less than 6 hours of sleep per 24 hour period.

Inadequate rest impairs our ability to think, to handle stress, to maintain a healthy immune system and to moderate our emotions. It’s associated with heart disease, hypertension, weight gain, diabetes and a wide range of psychiatric disorders including depression and anxiety.

The following is an abbreviated list of some of the more damaging effects of sleep deprivation:

• Impaired immune system: a study from the University of California found that even modest sleep loss weakens the immune systems response to disease and injury.
• Overweight and obesity: Recent studies have shown that even one night of poor sleep can result in dramatic changes in appetite and food intake. Others have shown that restricting sleep to 5 hours a night for just one week impairs carbohydrate tolerance and insulin sensitivity. Researchers now believe that sleep deprivation is the single best predictor of overweight and obesity in children – which has become an alarming problem. Finally, a brand-new study shows that not getting enough sleep causes fatty liver disease.
• Cognitive decline: sleep deprivation negatively impacts short-term and working memory, long-term memory and the generation of nerve cells – all of which effects our ability to think clearly and function well.
• Mood and mental health: anyone who has had a few nights of poor sleep can tell you that insomnia is associated with depression. Insufficient sleep shuts down the pre-frontal cortex and can cause or exacerbate a number of psychological conditions, ranging from anxiety to PTSD to depression.
• Systemic inflammation: as I already mentioned above, sleep deprivation causes chronic, low-grade inflammation. And we now know that inflammation is the root of all modern disease.
• Increased risk of death. Last, but certainly not least, not getting enough sleep reduces your lifespan.

Of course we could go on. There’s really no disease or medical condition that sleep deprivation doesn’t either contribute to directly or make worse.

I firmly believe that lack of sleep and stress are the two biggest health challenges we face today. If you’ve been reading this series (and this blog over time), you know how much value I place on proper nutrition. But it’s much easier for most people to make changes in their diet than it is for them to improve their sleep and manage their stress.

And here’s the thing: you can eat a perfect diet and take all the right supplements, but if you’re not sleeping well and managing your stress, all bets are off. I see this every day in my private practice.

How to get a good night’s sleep

Before we get into natural tips on improving sleep, I want to say a few words about sleep medications. In spite of their popularity, they are not without risk – including dependence, rebound insomnia, drowsiness, memory loss, bizarre sleep walking behavior, changes in brain chemistry, constipation and much more.

On the other hand, there is a point at which the harmful effects of sleep deprivation start to outweigh the potential adverse effects caused by sleeping pills. This is when I believe sleep meds should be used as a last resort, presuming all non-drug approaches have failed. Once you get into extreme sleep debt, it can be difficult to make it out without some biochemical assistance.

That said, there are many ways to prevent this from happening in the first place and to naturally improve the quality of your sleep if it’s poor.

Reduce your exposure to artificial light

Artificial light disrupts our circadian rhythm and throws off our sleep. Just a single ‘pulse’ of artificial light at night disrupts the circadian mode of cell division, which can not only impact our sleep, but also increase our risk of cancer. Another study showed that the blue light emitted from alarm clocks and other digital devices suppresses melatonin production in a dose-dependent manner.

Follow these tips to avoid light exposure:

• Don’t use a computer for 2 hours before going to bed. No staying up late on Facebook and Twitter!
• Use blackout shades to make your bedroom pitch black.
• Cover your digital alarm clock or get an analog clock.
• Turn off all digital devices that glow or give off any type of light.
• If you can’t do these things for some reason, use a sleep mask.

Don’t be too full – or too hungry

Some people sleep better after eating a light dinner. This is especially true for those with digestive issues. Others – like those with a tendency toward hypoglycemia – do better with a snack before bed (and possibly even during the night).

Go to bed earlier

You’ve all heard the saying “an hour before midnight is worth two hours after”. It turns out there is some truth to that. When you fall asleep, you go through a 90-minute cycle of non-REM sleep followed by REM sleep. But the ratio of non-REM to REM sleep within those 30 minute cycles changes across the night. In the early part of the night (11pm – 3am), the majority of those cycles are composed of deep non-REM sleep (stages 3 and 4) and very little REM sleep. In the second half of the night (i.e. 3am – 7am) this balance changes, such that the 90-minute cycles are comprised of more REM sleep (the stage associated with dreaming) as well as a lighter form of non-REM sleep (stage 2).

What’s important about this is that deep stage 3 and 4 sleep is where our body regenerates and repairs tissue and engages in other restorative processes. If we don’t get enough deep sleep, we can’t rejuvenate and heal.

So you say you’re a night owl?

Patients often tell me they’re “naturally” night owls, and they’ve always preferred to stay up late and sleep in. But in truth there’s nothing natural about this. For millions of years of human evolution sleep patterns remained in synch with the daily variation in light exposure. We rose with the sun, and went to be soon after sundown. This is what our bodies are adapted for.

In almost all cases, having a lot of energy late into the night is a sign of a disrupted circadian rhythm. Normally, cortisol should be high in the morning and taper off throughout the day and into the evening. This gives us the energy we need to wake up in the morning, and allows us to start winding down after dark so we’re ready to sleep. In people who’ve been exposed to significant chronic stress, this rhythm goes haywire. They have low cortisol in the morning (which makes it very hard for them to get going) and high cortisol at night, which gives them that late second wind. While drinking several cups of coffee in the morning mitigates the morning fatigue to some degree, it also perpetuates the pattern by revving them up in the afternoon and evening.

When I treat these so-called “night owls” for cortisol and melatonin rhythm dysregulation, one of the first things they report is feeling tired at night. And that’s a good thing! It takes them a while to adjust their lifestyle, but ultimately they’re better off for it.

For more good recommendations on improving sleep, read Mark Sisson’s Definitive Guide to Sleep.

When good sleep hygiene isn’t enough

I’m reluctant to make any recommendations about supplements and nutrients for sleep problems, because the decision about what to take depends on what the underlying cause of the problem is in the first place.

In general, though, magnesium is a good choice. Most people are deficient in it and it is not toxic at daily doses up to 800 mg. It’s also cheap and easy to find. I prefer the chelated forms of magnesium like glycinate and malate, but others like a product called Natural Calm which is mixed in warm water before bed. Be careful – it can have a laxative effect.

Melatonin is another commonly used sleep aid. But I don’t recommend it for anything more than emergency, short-term use. Why? Because melatonin is a hormone. Taking any supplemental hormone disrupts our natural regulatory mechanisms of that hormone and throws our internal production of it out of whack. This can create dependence over time and disrupt our circadian rhythm, which is crucial not only to sleep, but to overall health.

What I recommend instead to all of my patients with sleep issues – and what I use myself – is a program called Rest Assured. The premise behind the program, which I agree with completely, is that the most important factor in getting a good night’s sleep is managing stress during the day.

Most of us run around like chickens with their heads cut off all day, and then wonder why we can’t fall right asleep as soon as our head hits the pillow. If our nervous system has been in overdrive for 16 hours, it’s unrealistic to assume that it can switch into low gear in a matter of minutes simply because we want it to. Of course this is why sleeping pills are growing in popularity each year.

The Rest Assured program has simple, easy-to-follow breathing and movement exercises designed to promote daytime relaxation and a good night’s sleep. It helped me and my patients tremendously. You can try a sample exercise (audio and pictures) here.

Do you have trouble sleeping? What has worked for you? Leave a comment under the “Sleep More Deeply” post on my Facebook page.

There’s no question that regular exercise is essential to health. Our paleolithic ancestors had a different word for exercise: life. For the vast majority of our evolutionary history, humans had to exert ourselves – often quite strenuously – to get food. We naturally spent a lot of time outdoors in the sun, walking, hunting, gathering, and performing various other physically-oriented tasks. We had no concept of this as “exercise” or “working out”. It was just life.

Things are different today. 60% of American adults are not regularly active, and 25% are complete couch potatoes – they get no exercise at all, other than walking back and forth between the car, the cubicle and the refrigerator. This lack of physical activity has profound consequences. Regular movement protects us from disease in several ways, but most importantly it prevents oxidative damage and inflammation – the primary mechanisms underlying most modern, degenerative diseases. This explains why those who are completely sedentary have between 1.5 and 2.5 times the risk of developing heart disease and a higher risk for virtually all modern, degenerative disease.

On the other hand, we’ve got the exercise fanatics. Many Americans have been caught up in the fitness craze over the last 40 years, devoting countless hours to jogging, the Stairmaster or the treadmill in the hopes of slimming down, getting healthy and preventing disease. But while this type of activity may help with stress management, research suggests that it’s useless for weight loss and may in fact be detrimental to health.

If you doubt this, you’ll have to explain why Americans have continually gained weight over the last 40 years, in spite of increased leisure time exercise and increased energy expenditure.

Why “cardio” doesn’t work for weight loss

When I say “cardio”, I’m referring to steady-state, repetitive activity done at a moderate intensity like jogging outdoors, running on a treadmill or climbing the Stairmaster. [Side note: the idea that you have to perform this type of activity to benefit your heart and vascular system is false. Anything that places a demand on the muscles - including so-called anaerobic activities like weightlifting - will also condition the heart and vascular system.]

Most people are surprised to learn that cardio doesn’t work for weight loss. How could this be? There are three main reasons:

• caloric burn during exercise is generally small;
• people who exercise more also tend to eat more (which negates the weight regulating effect of exercise); and,
• increasing specific periods of exercise may cause people to become more sedentary otherwise.

In an example of the first reason, a study following women over a one-year period found that in order to lose one kilogram (2.2 pounds) of fat, they had to exercise for an average of 77 hours. That’s a lot of time on the treadmill just to lose 2 pounds!

In an example of the second reason, a study found that people who exercise tend to eat more afterwards, and that they tend to crave high-calorie foods. The title of this study says it all: “Acute compensatory eating following exercise is associated with implicit hedonic wanting for food.” I love it when researchers have a sense of humor.

In an example of the third reason, one study assigned 34 overweight and obese women to an exercise program for 8 weeks. Fat loss at the end of the study was an average of 0.0kg. Not very impressive. But the researchers noticed that some women did lose weight, while others actually gained. What was the difference? In the women that didn’t lose weight, the increase in specific periods of exercise corresponded with a decrease in overall energy expenditure. Translation: they were more likely to be couch potatoes when they weren’t exercising, which negated the calorie-burning effect of their workouts.

If you’re still not convinced, the Cochrane group did a review of 43 individual studies on exercise for weight loss. Study length ranged from 3 to 12 months, and exercise sessions lasted on average 45 minutes with a frequency of 3-5 times per week. The results? On average, the additional weight loss from exercise averaged about 1 kg (2.2 pounds). Meh. Assuming they worked out for 45 minutes 4x/wk over 6 months, that means they had to exercise 69 hours to lose that 1 kg.

Why cardio may be harmful

Too much cardio exercise has a number of harmful effects on the body:

• increases oxidative damage
• increases inflammation (the root of all disease)
• depresses the immune system
• decreases fat metabolism
• disrupts cortisol levels
• causes neurodegeneration

Overtraining is especially damaging because of its effects on cortisol. We discussed cortisol at length in Step 6: Manage Your Stress, but in this context what’s important to understand is that too much exercise can disrupt our natural cortisol rhythm and drive levels too high initially, and depress them over time. Cortisol dysregulation promotes abdominal fat gain and muscle loss, which in turn causes further weight gain.

There’s also some evidence that frequent endurance exercise may promote – rather than prevent – heart disease. Dr. Kurt Harris summarized a study performed on 102 active marathon runners and 102 age-matched controls to determine the effect of aerobic exercise on cardiovascular health.

The marathoners were between 50 and 72 years of age, and they ran an average of 35 miles per week. They had no known history of heart disease or diabetes. The control group was similarly aged and also had no history of cardiovascular or metabolic disease.

You might be surprised to learn that the marathon runners were three times more likely to have heart damage than the non-runners. Among the runners, there were 12 heart attacks vs. 4 attacks in the non-runners.

In another study by the same authors, the more marathoners ran, the higher their likelihood of heart disease. In fact, the number of marathons ran was an independent predictor of the likelihood of irreversible damage to the heart tissue.

No cardio? Then what should we do instead?

In short, we should move like our ancestors. They didn’t strap on a heart monitor and take off for a 45-minute jog, nor did they go down and swim laps for an hour in the local lake. Yet they were extremely fit and almost entirely free of the modern diseases that plague us today.

They performed low-intensity movements like walking, gathering foods or working in other capacities on a regular basis. These periods of low-intensity activity were punctuated by brief periods of much higher-intensity activity – such as going on a hunt, running for a predator or fighting for survival.

This is the type of movement our bodies are adapted for, and thus this is what we should aim for in our daily lives. But how do we do that? As Mark Sisson suggests, we should:

1. Move frequently at a slow pace
2. Lift heavy things and sprint occasionally

Move frequently at a slow pace

Moving frequently at a slow pace means approximately 3-5 hours a week of low level activity like walking, cycling, gardening, hiking, performing manual labor, etc. This mimics our ancestral pattern of movement, helps maintain a healthy weight, promotes proper metabolic function and provides a foundation for more strenuous activity. Another benefit of this type of activity is that it’s often performed outdoors. Spending time outdoors reduces stress, increases vitamin D levels, and brings us pleasure, joy and a sense of connection with the world around us.

I think one of the best ways to do this type of movement is to integrate it into your daily life. This could include commuting to work and doing errands on foot or by bicycle, taking the stairs instead of the elevator, doing your own gardening and yard work, etc.

Lift heavy things and sprint occasionally

In contrast to cardio, this type of exercise involves performing movements at very high intensity for short periods of time – usually between 30 seconds and 2 minutes. This is sometimes referred to as high intensity interval training (HIIT).

Several studies have been done comparing HIIT to low-intensity, steady-state (“chronic cardio”, as Mark Sisson calls it) exercise, and HIIT has been shown to be superior in nearly every meaningful marker.

In this study, one group was assigned to “chronic cardio”, while the other was assigned to intervals of 8-second sprints. After 15 weeks, the researchers concluded:

Both exercise groups demonstrated a significant improvement (P less than 0.05) in cardiovascular fitness. However, only the HIIE group had a significant reduction in total body mass (TBM), fat mass (FM), trunk fat and fasting plasma insulin levels.

A pair of studies done at McMaster University found that “6-minutes of pure, hard exercise once a week could be just as effective as an hour of daily moderate activity“, according to the June 6, 2005 CNN article reporting on the study.

The study itself was published in the Journal of Applied Physiology, and it revealed that HIIT resulted in unique changes in skeletal muscle and endurance capacity that were previously believed to require hours of exercise each week.

A follow-up study confirmed the results. Despite the fact that the more conventional endurance exercise group spent 97.5 percent more time engaged in exercise, both groups of subjects improved to the same degree. The group that exercised 97.5 percent more received no additional benefit whatsoever from doing so. Considering the wear-and-tear and increased risk of injury associated with that much more exercise, there’s absolutely no point to doing “chronic cardio” when you can receive the same benefits with a fraction of the time and risk by doing HIIT.

The Cochrane study I linked to earlier in the article also found that high-intensity exercise was superior to “chronic cardio”. In particular, the researchers found that high-intensity exercise led to a greater decrease in fasting blood glucose levels than low-intensity exercise.

Why high-intensity exercise is better

In his excellent book on high-intensity strength training, Body By Science, Dr. Doug McGuff explains that high-intensity training is superior to chronic cardio because it produces a greater stimulus and thus more effectively empties the muscles and liver of glucose. This stimulus can last several days with HIIT, as opposed to just a few hours with low-intensity training.

HIIT also activates hormone-sensitive lipase (HSL), which mobilizes fatty acids for energy use. This means that during HIIT, both glucose and fatty acids will be burned, leading to greater fat loss and restoration of insulin sensitivity.

High-intensity strength training: best of all?

Both high-intensity running or bicycling sprints and high-intensity strength training are effective. But I believe high-intensity strength training is probably a better choice for most, simply because the wear-and-tear and risk of injury is lower – especially if the strength-training is performed using weight machines as described in Body By Science.

This is, in fact, the method of training I’ve been doing since April of last year. I admit I was somewhat skeptical about it all before I read Body By Science. But the research and the physiology was convincing, so I decided to give it a try.

The results have been incredible. My workout varies in length between 5 and 9 minutes a week. That’s right, I said minutes. With only a few exceptions, I’ve increased the amount of weight I can lift, the time I can lift it, or both, with each successive workout. My strength has increased and my physique is, if anything, better than it was when I was lifting 3x/week for much longer periods.

Where to learn more about HIIT

There are many books on the subject, but these are the two I’d recommend for most people:

• Body By Science, by Doug McGuff. The “bible” on high-intensity strength training. Goes into great detail on the physiological mechanisms and benefits behind this type of exercise, and explains how to put together a routine. Doug also has a great blog with an active community of people using the BBS approach. To see an example of what this type of workout looks like, check out this video on YouTube. For an in-depth video presentation about BBS, watch this video.
• The Power of 10: The Once-A-Week Slow Motion Fitness Revolution, by Adam Zickerman & Bill Schilley. This is more of a nuts-and-bolts book, with less theory than BBS and more focus on teaching you how to do this type of workout. It also has specific routines that can be performed at home, on the road and without access to a gym. The approach is slightly different than what’s advocated in BBS, but the basic idea is the same.

Of all the 9 steps, stress management is probably the most important. Why? Because no matter what diet you follow, how much you exercise and what supplements you take, if you’re not managing your stress you will still be at risk for modern degenerative conditions like heart disease, diabetes, hypothyroidism and autoimmunity.

I see this every day in my practice. I have a lot of patients that are following a “perfect” diet, and yet they are still sick. Stress is often the cause. (I’ll define stress more clearly in a moment.) Yet as pervasive as stress is, many people don’t do anything to mitigate its harmful effects. The truth is it’s a lot easier to make dietary changes and pop some pills (whether drugs or supplements) than it is to manage our stress. Stress management bumps us up against core patterns of belief and behavior that are difficult to change.

I suspect this is why all of the articles I’ve written about stress management are among the least shared on Facebook and Twitter and have elicited the fewest comments. I think many of you may feel defeated or overwhelmed by stress. I understand this. Stress management is hard. It asks a lot of us. It forces us to slow down, to step back, to disengage (if only for a brief time) from the electric current of modern life. It asks us to prioritize self-care in a culture that does not value it.

While I feel your pain, and still struggle with stress management myself, I’ve got to lay down some tough love here. If you’re not doing some form of regular stress management, you will sabotage all of your best efforts with diet, exercise and supplements. Stress management is absolutely crucial to optimal health and longevity. If most health conscious people spent even half the amount of time they spend focusing on nutrition and exercise on managing their stress, they’d be a lot better off.

I’m going to suggest several strategies for stress management at the end of the article, but first let’s define stress more explicitly and learn more about the harm it causes.

What is stress?

Hans Selye, the famous physiologist who coined the term “stress”, defined it this way:

…the nonspecific response of the body to any demand made upon it.

The prominent psychologist Richard Lazarus offers a similar definition:

…any event in which environmental demands, internal demands, or both tax or exceed the adaptive resources of an individual…

At the simplest level, then, stress is a disturbance of homeostasis. Homeostasis is the body’s ability to regulate its inner environment. When the body loses this ability, disease occurs.

The adrenals are two walnut-shaped glands that sit atop the kidneys. They secrete hormones – such as cortisol, epinephrine and norepinephrine – that regulate the stress response. Because of this, the adrenals are what determine our tolerance to stress and are also the system of our body most affected by stress.

Most people are aware of the obvious forms of stress that affect the adrenal glands: impossibly full schedules, driving in traffic, financial problems, arguments with a spouse, losing a job and the many other emotional and psychological challenges of modern life.

But other factors not commonly considered when people think of “stress” place just as much of a burden on the adrenal glands. These include blood sugar swings, gut dysfunction, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems, inflammation and overtraining. All of these conditions sound the alarm bells and cause the adrenals to pump out more stress hormones.

Adrenal stress is probably the most common problem we encounter in functional medicine, because nearly everyone is dealing with at least one of the factors listed above. Symptoms of adrenal stress are diverse and nonspecific, because the adrenals affect every system in the body. But some of the more common symptoms are:

• Fatigue
• Headaches
• Decreased immunity
• Difficulty falling asleep, staying asleep and waking up
• Mood swings
• Sugar and caffeine cravings
• Irritability or lightheadedness between meals
• Eating to relieve fatigue
• Dizziness when moving from sitting or lying to standing
• Digestive distress

How does stress harm the body?

The short answer is “in every way imaginable.” It would take books to explain the full effects of stress. And those books have been written. Check out Why Zebras Don’t Get Ulcers by Robert Sapolsky and When the Body Says No: Exploring the Stress-Disease Connection by Gabor Mate for a more thorough investigation. I’m just going to summarize here.

When stress becomes chronic and prolonged, the hypothalamus is activated and triggers the adrenal glands to release a hormone called cortisol. Cortisol is normally released in a specific rhythm throughout the day. It should be high in the mornings when you wake up (this is what helps you get out of bed and start your day), and gradually taper off throughout the day (so you feel tired at bedtime and can fall asleep).

Recent research shows that chronic stress can not only increase absolute cortisol levels, but more importantly it disrupts the natural cortisol rhythm. And it’s this broken cortisol rhythm that wreaks so much havoc on your body. Among other effects, it:

• raises your blood sugar
• weakens your immune system
• makes your gut leaky
• makes you hungry and crave sugar
• reduces your ability to burn fat
• suppresses your HPA-axis, which causes hormonal imbalances
• reduces your DHEA, testosterone, growth hormone and TSH levels
• increases your belly fat and makes your liver fatty
• causes depression, anxiety and mood imbalances
• contributes to cardiovascular disease

These are all well-documented in the scientific literature, and the list of health problems caused by stress goes on. And on. In fact it’s not a stretch to suggest that stress contributes to all modern, chronic disease.

But most people don’t need much convincing of this. You’ve witnessed the negative effects of stress firsthand, every day of your life. So the question is, what do you do about it?

How to reduce the impact of stress

There are two different approaches to reducing the impact of stress, and both are important:

1. Reduce the amount of stress you experience.
2. Mitigate the harmful effects of stress you can’t avoid.

Reducing the amount of stress you experience

Reducing stress means just what it sounds like: reducing your total exposure to all forms of stress, whether psychological or physiological. Of course it’s never possible to completely remove stress from our lives. But even in the most stressful of circumstances, it’s still possible to reduce stress.

The first step is to avoid unnecessary stress. This often seems obvious, but it isn’t. It’s easy to overlook habitual patterns of thought and behavior that cause unnecessary stress above and beyond the stress we can’t avoid. Here are a few guidelines for how to avoid this kind of stress:

• Learn to say “no”. Know your limits, and don’t take on projects or commitments you can’t handle.
• Avoid people who stress you out. You know the kind of person I’m talking about. Drama kings and queens. People who are constantly taking and never giving. Limit your time with these people or avoid them entirely.
• Turn off the news (or at least limit your exposure to it). If watching the world go up in flames stresses you out, limit your exposure to the news. You’ll still find out what’s going on, and still be able to act as a concerned citizen. But you’ll have more time for yourself. I stopped getting the paper years ago, and don’t even have TV. And believe it or not I’m still well-informed. The difference is I get to choose what I’m exposed to.
• Give up pointless arguments. This is especially true for useless internet debating. There is obviously a place for discussion and debate, and working towards change. But have you noticed that most arguments don’t lead to change? In fact, they tend to have the opposite effect – each side becomes more defended and entrenched in their worldview. Find other ways to get your point across, learn to listen with empathy, and don’t waste precious time and energy trying to convert fundamentalists to your religion.
• Escape the tyranny of your to-do list. Each day spend some time in the morning really considering what needs to be done that day. Drop unimportant tasks to the bottom of the list. Better yet, cross them off entirely. The world will go on.

The second step in reducing the amount of stress you experience is to address any physiological problems that are taxing your adrenals. These causes include anemia, blood sugar swings, gut inflammation, food intolerances (especially gluten), essential fatty acid deficiencies and environmental toxins. If you have one or more of these conditions, it’s probably best to get help from a skilled practitioner.

Mitigating the harmful effects of stress you can’t avoid

Obviously there are times when we just can’t avoid stress. Maybe we have a high-stress job, or we’re caring for an ailing parent, or we’re having difficulty with our partner or spouse. In these situations it’s not about reducing stress itself, but about reducing its harmful effects.

How do you do that? There are several different strategies:

• Reframe the situation. We experience stress because of the meaning we assign to certain events or situations. Sometimes changing our perspective is enough to relieve the stress. For example, being stuck in traffic can be a “disaster” or it could be an opportunity for contemplation and solitude.
• Lower your standards. This is especially important for you perfectionists out there. Don’t let the perfect be the enemy of the good. Let good enough be good enough.
• Practice acceptance. One of my meditation teachers used to say “All suffering is caused by wishing the moment to be other than it is.” Many things in life are beyond our control. Learn to accept the things you can’t change.
• Be grateful. Simply shifting your focus from what is not okay or not enough, to what you’re grateful for or appreciative of can completely change your perspective – and relieve stress.
• Cultivate empathy. When you’re in a conflict with another person, make an effort to connect with their feelings and needs. If you understand where they’re coming from, you’ll be less likely to react and take it personally.
• Manage your time. Poor time management is a major cause of stress. When you’re overwhelmed with commitments and stretched too thin, it’s difficult to stay present and relaxed. Careful planning and establishing boundaries with your time can help.

In addition to everything I’ve listed above, one of the most important things you can do to manage stress is to bring more pleasure, joy and fun into your life. This is the subject of Step 9, so I’ll just mention it briefly here.

Stress management practices and techniques

All of the stress management tips above are important, and can make a huge difference in your health and well-being. However, there’s a certain amount of stress in modern life that is simply unavoidable for most of us. That’s why it’s so crucial to have a regular stress management practice.

There are a lot of options here, of course. Things like exercise, yoga, tai qi, qi gong, a walk on the beach, etc. can all relieve stress. I’ll just share the practices I’ve found to be most helpful for myself and my patients over the years.

Meditation

In spite of the fact that I’m listing it here, I don’t consider meditation as a “stress management” technique – although it can certainly have that effect. Meditation is an awareness practice. Through meditation we learn to witness our thoughts, feelings and sensations and dis-identify with the story we tell ourselves about them. We learn to stay present to our lives even in the face of great difficulty or pain.

Contrary to popular belief, you don’t have to be able to “relax” to meditate. Sometimes we are relaxed during meditation, sometimes we are quite agitated. We don’t meditate to manipulate our feelings, but to learn to observe them without reacting to or “becoming” them.

One of the books I often recommend to people who’d like to learn more about meditation practice is Opening the Hand of Thought, by Kosho Uchiyama. You may also want to check out Don Matesz’s recent article, 10 Reasons Why I Practice Mindfulness Meditation, for more on the benefits of meditation practice.

Mindfulness-based Stress Reduction

Mindfulness-Based Stress Reduction (MBSR) combines mindfulness meditation and yoga to cultivate greater awareness of the unity of mind and body, as well as of the ways the unconscious thoughts, feelings, and behaviors can undermine emotional, physical, and spiritual health. It was developed by Jon Kabat-Zinn at the Stress Reduction Clinic at the University of Massachusetts Medical Center in 1979.

Through clinical research at the University of Massachusetts and elsewhere, MBSR has been shown to positively effect a range of autonomic physiological processes, such as lowering blood pressure and reducing overall arousal and emotional reactivity. MBSR is offered as an 8-week intensive training in hospitals and medical centers around the world. It is also offered as an online course, and can be done via home study with books and audio recordings. MBSR is particularly effective for anyone struggling with chronic illness or pain.

Rest Assured

Rest Assured is a program for healing insomnia naturally. However, the way this is accomplished is by maintaining a greater state of relaxation and ease throughout the day. We can’t run around all day in a state of constant hyper-arousal and expect to fall into a deep and peaceful sleep at night. The body doesn’t turn on and off like a light switch. This is why sleep medications have become ubiquitous. They’re the equivalent of hitting yourself over the head with a sledgehammer so you can fall asleep.

The Rest Assured program contains simple exercises that coordinate breath and movement. Many of the exercises can be performed in as little as 3-4 minute throughout the day, while some take 20-30 minutes and can be done when you have a little more time – or while you’re laying in bed before sleep. I’ve found these to be incredibly helpful myself, and my patients have as well.

So here’s my request. If you found this article to be helpful, please share it on Facebook and Twitter (you can use the FB & Twitter icons at the top of the post), or email it to someone you care about. Stress management is one of the most important things we can to do protect our health, yet it’s often the first thing that slips through the cracks in a busy life.

Let me start by saying that I’m a fan of intermittent fasting. I think going for extended periods without eating was probably normal for humans throughout most of our evolution, and I’ve seen enough evidence to convince me that it can help with everything from weight loss to improving insulin sensitivity to boosting the immune system.

Martin Berkhan at Leangains and Paul Jaminet at Perfect Health Diet both write extensively about the benefits of intermittent fasting, so I’m not going to cover that here.

Instead, I want to talk briefly about when intermittent fasting might not be a good idea. I haven’t arrived at this notion through combing the research literature, but through direct experience with patients in my clinical practice.

In the last few months I’ve had a few patients come to me with several months of low-carb, paleo nutrition and intermittent fasting experience behind them. When I had them test their blood sugar with a glucometer, we discovered some very erratic patterns. They didn’t just have high fasting blood sugar in the morning, as is typical with low-carb dieters, but they had high levels or a “yo yo” pattern throughout the day.

I tested the cortisol/melatonin rhythm in two of these patients, and it was off in both of them. Why would this be? It’s possible that the blood sugar ups and downs they’re experiencing are exhausting their adrenals. Or, that their adrenals were already under stress and the repeated cortisol secretions necessary to bring their blood sugar back up when it drops created further stress.

As an experiment we decided to have them try eating regular meals, and even more frequently than normal (i.e. every 2-3 hours). Guess what? Their blood sugar normalized within a few days, they started sleeping better and other symptoms improved. I’ve only re-tested cortisol rhythm in one of these patients, but it was back in the normal range after three weeks of eating more regularly.

So how could intermittent fasting normalize blood sugar in some people, but throw it off in others? I’m not sure, but as I said above, my guess is that it has a lot to do with their adrenal status when they begin fasting. There’s a complex relationship between blood sugar and hormones like cortisol, glucagon, epinephrine, norepinephrine and growth hormone. While it’s true that balancing blood sugar can bring the hormones back into line, it’s also true that hormonal imbalances can throw blood sugar out of whack.

I’ve heard anecdotal reports from some that intermittent fasting was rough on them when they first started, but after sticking with it for quite a while it had the desired effect. It’s possible, of course, that if these patients of mine had simply kept going their blood sugar and insulin sensitivity would have normalized. But three of them, at least, had been doing it for six months or longer before they came to me – so I think it’s unlikely that another few months would have made the difference.

As usual, I’d love to hear your thoughts on this.

I hope you all had happy holidays and are off to a great start this year. I thought I’d share a few thoughts that have been bouncing around my head lately, stimulated most recently by two articles written by fellow health bloggers.

Don Matesz over at Primal Wisdom wrote a thought-provoking piece on the hormone composition of grass-fed and factory-farmed meat. In it he argues (convincingly, I might add) that meat from CAFO (confined animal feeding operations) does not have dangerously high levels of hormones, in spite of claims to the contrary made by advocates of eating grass-fed meat.

Got testicles?

I recommend reading the entire article, I’ll summarize it briefly here. Before CAFO came into being, humans predominantly ate bulls, since eating female animals (cows) was taboo. The taboo made perfect sense in a hunter-gatherer culture, since killing the female could eliminate potential offspring, while killing a few bulls would have no effect on the fecundity of the herd.

Today, CAFO use steer, which are neutered bulls. One reason for this is that steer are a lot easier to manage than bulls. Why? Because hormone levels in bulls (with intact sex organs) are significantly higher than in steer. In fact, bull meat has between 34 and 105 times more testosterone than steer meat. No wonder bulls are harder to manage!

Even when hormones are added to steer in CAFO, the levels are nowhere close to what they are in intact bulls. In fact, studies have found no significant difference in hormone levels between meat from hormone-treated and untreated animals.

This means that Paleo Pete was eating meat with a lot more hormones in it a million years ago than American Andy is when he gets a cheeseburger at McDonalds today.

Hormones in meat are bad – if you eat 200 pounds of meat a day

Studies have also shown that the hormones ingested from food, including CAFO meat, have a negligible effect on human health. From Don’s article:

For example, a prepubertal boy, most vulnerable to adverse effects of excess dietary estrogens, produces about 100 micrograms of estrogen daily. Beef muscle meat contains less than 0.02 micrograms of estrogens per kilogram. To get from beef an intake of estrogens equal to just one percent of his endogenous estrogen production, i.e. 1 microgram, he would have to consume 50 kilograms–110 pounds– of beef in a day!

Another common claim is that adding hormones to meat has increased the rates of cancer and other modern, degenerative diseases. But if that were true, we would have seen these diseases in hunter-gatherer populations that were eating large amounts of bull meat, which has on average 50 times more hormones than the CAFO steer meat eaten today.

So it would seem that there isn’t much difference between grass-fed and CAFO meat when it comes to hormones. So should we all just save some money and eat conventional meat?

It’s not all about hormones. Don’t forget omega-3s!

Not so fast. Mark Sisson published an article earlier this week reporting on a study comparing the effects of eating grass-fed and CAFO meat on omega-3 and omega-6 concentration in human plasma and platelets.

Turns out those that ate the grass-fed meat had significantly higher levels of omega-3 in their plasma and platelets than those that ate CAFO meat, despite the fact that the amount of omega-3 fatty acids in the two types of meat were not hugely different.

The folks consuming grass-finished meat ate, on average, 65 mg/d of long chain omega-3s, while those eating concentrate-finished meat ate about 44 mg/d of long chain omega-6s, yet the lab results – the big improvements in plasma and platelet fatty acid numbers – were lopsided.

What’s happening here? I suspect the answer lies with the difference in omega-6 content in the diets of both groups. Those who ate the CAFO meat had an average intake of 8.5g/d of omega-6 fats, while those that ate grass-fed meat had an average intake of 5.5g/d. In a previous article about how too much omega-6 is making us sick, I explained that omega-6 and omega-3 fatty acids compete for the same conversion enzymes.

Several studies have shown that the biological availability and activity of n-6 fatty acids are inversely related to the concentration of of n-3 fatty acids in tissue. Studies have also shown that greater composition of EPA & DHA in membranes reduces the availability of AA for eicosanoid production.

This works the other way, too. The more omega-6 is consumed, the less omega-3 is available to the tissues. So if two people eat a diet identical in omega-3 content, but one person’s diet is high in omega-6, and the other person’s is low, guess who will end up with more omega-3 in their tissues? That’s right – the one with a low omega-6 intake. This is why I constantly tell people that the most important step they can take in normalizing their omega-3:omega-6 ratio is not boosting omega-3 intake, but reducing omega-6. And this is likely what explains the higher levels of omega-3 in the grass-fed meat eaters in the study, even though grass-fed meat doesn’t have a lot more omega-3 than CAFO meat.

This is important, because the ratio of omega-3 to omega-6 in our tissue is crucial to health. Too much omega-6 in relation to omega-3 has been shown to be a factor in everything from depression and arthritis to heart disease and diabetes. There isn’t a modern disease out there that isn’t influenced by this ratio.

Black, white & shades of grey

So here we have one study suggesting there isn’t much difference between CAFO and grass-fed meat, and another suggesting the opposite. What do we make of this?

As much as we’d all like things to be simple when it comes to food and health, they often aren’t. We have to use our brains to sift through the available information and make intelligent choices based on several different factors.

In the case of grass-fed vs. CAFO meat, there’s a lot more to consider than hormones and fatty acids. There’s also antibiotic use in CAFO cattle and the increased risk of foodborne illness in CAFO meat, and there are several economic and social issues as well. Grass-fed animals are generally treated in a more humane way than CAFO animals. If you’ve ever visited a CAFO you will know what I mean. It’s shocking and disgusting. I personally prefer to support local farmers that use traditional methods of animal husbandry, that pay attention to how the animals are treated and slaughtered, and who care about every phase of the process. I like the money I spend on food to stay in my local community whenever possible.

Clearly this is not a black and white issue, and there’s a lot to take into account when choosing between grass-fed and CAFO meat. As usual, I’d love to hear your thoughts.

Over the last several years I’ve come to believe that chronic stress – and the cascade of changes it causes in the body – is second only to diet as the primary cause of modern disease. This isn’t just my opinion. It’s supported by mountains of scientific evidence as well as a basic understanding of evolutionary biology and human physiology.

The problem is, nobody wants to hear this. I think it, um, stresses us out to know that stress is so harmful. It’s interesting to note that whenever I write an article about stress, like this one about how stress makes you fat and diabetic, the response is decidedly lukewarm – especially compared to the popularity of articles about diet.

Diet is important. I think you all know how I feel about that. But here’s the thing: it’s not enough. Even if your diet is perfect, stress can still destroy your health.

In fact, I see this in almost all of my patients. Most people I work with already have pretty good diets. Sure, there’s almost always room for some tweaks, but overall they’re doing better than 99% of the population. Yet they are still struggling with chronic health problems – some of them quite severe.

Without exception, these folks have cortisol problems. Either their cortisol is high, low, or the rhythm is out of whack. Remember that cortisol is a hormone that is released during the stress response. Like insulin, we need it in small amounts to function properly, but too much of it can wreak havoc on the body.

Why? Because our bodies aren’t set up for chronic stress. We evolved to deal with a series of acute, short-term stressors. Stress causes the release of cortisol and other hormones. The purpose of these hormones is to prepare our bodies for either fight, or flight. This involves mobilizing stores of fat, protein and glucose to give us the energy we need to deal with the threat.

This all works well if we actually do fight, or run away, because these activities discharge the hormones and the extra energy produced by the stress response.

But these days, we don’t have the chance to do that. The stress we experience is chronic, not acute, and more often than not it’s not something we can fight or run away from. One of the disadvantages of our big brains is that we’ve developed the capacity to stress ourselves out simply by imagining potential threats. Worrying about our financial future or driving in traffic produce a similar hormonal response to what getting chased by a lion would have triggered for our ancestors.

But in our case, those hormones just keep pumping out and building up, and fat, protein and glucose keep getting mobilized without any discharge. And what happens when cortisol builds up and fat and sugar are too abundant? Modern disease happens. Obesity, diabetes, heart disease, depression, anxiety, insomnia, gut disorders, autoimmune diseases, allergies and nearly every chronic, modern health problem is directly related to the changes in our body caused by stress.

I’m sure you don’t need me to tell you that stress is harmful. Duh. The question you’re probably more interested in is, “what can I do about it?”

It’s pretty clear that for most of us, reducing stress isn’t a viable option. At the simplest level, stress is what happens when the demands of life exceed our ability to deal with them. Those demands can be physical, emotional or psychological.

Raise your hand if you ever feel the demands of modern life exceed your capacity to deal with them. Yeah, that’s what I thought. That’s probably why people feel disempowered when they read articles like this. But that doesn’t mean we can’t take steps to mitigate the harmful effects of stress. Stress management – not stress reduction – is where we need to focus.

Stress management may very well be the most important thing you can do to improve your health and prevent disease. Yet most of us don’t do it anything about it.

When I talk to people about the importance of stress management, I usually get a nod of the head and an answer like “yeah, I know I’m really stressed out and I need to relax more.” But I can tell they’re not taking it seriously. It’s almost like I suggested they put up their Christmas decorations a little earlier, or they wash their car more often, or something like that. “Yeah, I know I should, but…”

Yet these are the same people that are taking 23 different supplements, following a strict diet and exercising every day at 6:00am. Clearly lack of motivation isn’t the issue.

So why are we so resistant to managing stress? Because the truth is, it’s far easier to change our diet and take some pills than it is to manage stress and transform the way we live.

If stress is what happens when life’s demands exceed our body’s capacity to deal with them, then we have two options. The first is to reduce the demands. In today’s world, this just isn’t practical for most people. The second option is to increase our body’s ability to deal with the stressors we face. Everyone can – and should – do this.

How? There are two ways, both important. First, we can learn stress management techniques and make lifestyle changes that increase our buffer against stress. Second, we can use supplements and herbs to support the hypothalamic-pituitary axis (HPA), which governs our stress response. I’ll discuss specific strategies for both in a future article.

In the first part of this series on diabesity, we “got under the hood” to look at the underlying mechanisms of both obesity and diabetes. We’ve now moved on to discussing the environmental and lifestyle risk factors that drive these conditions. In the last article we learned about the top 3 dietary causes of diabesity. In this article, we’re going to see how stress can independently cause both obesity and diabetes.

A huge – and I mean huge – amount of research over the past two decades shows that stress causes both obesity and diabetes in a variety of ways. Studies also show that stress makes it hard to lose weight. This is one reason why some people just can’t seem to lose weight no matter how well they eat or how much they exercise. I believe stress is one of the most important – yet most often ignored – factors driving the diabesity epidemic.

Stress is a bigger problem than you think

Hans Selye, the famous physiologist who coined the term “stress”, defined it this way:

…the nonspecific response of the body to any demand made upon it.

The prominent psychologist Richard Lazarus offers a similar definition:

…any event in which environmental demands, internal demands, or both tax or exceed the adaptive resources of an individual…

Most people only think of psychological stress when they hear the term “stress”. When asked what causes stress, they might say things like losing a job, having a fight with your spouse, driving in traffic or getting audited by the IRS.

While it’s true that psychological challenges like this are major stressors, what many people don’t realize is that stress is also caused by physiological challenges, such as:

• insomnia
• chronic infections
• inflammation
• autoimmune disease
• environmental toxins
• dieting
• too much exercise

Even if your levels of psychological stress are pretty low, any of the conditions listed above can provoke a chronic stress reaction in your body. And as we’ll see in the next section, chronic stress can make you both fat and diabetic.

10 ways stress makes you fat and diabetic

When stress becomes chronic and prolonged, the hypothalamus is activated and triggers the adrenal glands to release a hormone called cortisol. Cortisol is normally released in a specific rhythm throughout the day. It should be high in the mornings when you wake up (this is what helps you get out of bed and start your day), and gradually taper off throughout the day (so you feel tired at bedtime and can fall asleep).

Recent research shows that chronic stress can not only increase absolute cortisol levels, but more importantly it disrupts the natural cortisol rhythm. And it’s this broken cortisol rhythm that wreaks so much havoc on your body. Among other effects, it:

• raises your blood sugar
• makes it harder for glucose to get into your cells ¹
• makes you hungry and crave sugar
• reduces your ability to burn fat
• suppresses your HPA-axis, which causes hormonal imbalances
• reduces your DHEA, testosterone, growth hormone and TSH levels ²
• makes your cells less sensitive to insulin
• increases your belly fat and makes your liver fatty
• increases the rate at which you store fat
• raises the level of fatty acids and triglycerides in your blood

Each one of these consequences alone could make you fat and diabetic, but when added together they’re almost a perfect recipe for diabesity.

Our bodies aren’t made for chronic stress

One of the reasons chronic stress is so destructive is that our bodies didn’t evolve to deal with it. We’re set up to handle short-term, acute stress fairly well. In paleolithic times, this might have been caused by getting chased by a lion or hunting for our next meal. In fact, this type of stress may even be beneficial for our bodies because it improves our ability to react to the challenges of life.

What we’re not adapted for, however, is the chronic, unrelenting stress that has become so common in modern life. This type of stress provokes feelings of hopelessness and helplessness – what psychologists call a “defeat response”. And it’s the defeat response that leads to increased fat storage, abdominal obesity, tissue breakdown, suppression of the immune system, and all of the other effects I listed above that directly cause obesity and diabetes.

A closer look at insomnia, dieting and exercise

I’d like to take a closer look at three often stressors that can make us fat and diabetic: insomnia, dieting and exercise.

More than a third of American suffer from insomnia, with 42 million prescriptions for sleeping medications filled in 2007. Several studies show that sleep deprivation elevates cortisol and makes it more likely that you’ll get fat and develop diabetes.

A very recent paper showed that restricting sleep to 5 hours a night for just one week significantly reduces insulin sensitivity. Another study earlier this year showed that even one night of sleep loss increased appetite in young, healthy adults. Sleep restriction is associated with impairment of carbohydrate tolerance, and research has shown that a loss of 3 hours of sleep each night causes a weight gain of 4-5%.

It’s estimated that between 50-60% of Americans are dieting at any given time. That’s a huge number. And while it may seem counter-intuitive that dieting contributes to obesity and diabetes, it makes perfect sense when you understand that dieting is a stressor that disrupts our cortisol rhythm.

A 2001 study showed that “cognitive dietary restraint” (translation: stressing about food or doing overly restrictive diets) raises your cortisol levels. Studies have also shown that caloric restriction – as is common in low-fat diets – increases cortisol levels. And a recent study reported on by Stephan Guyenet at Whole Health Source found that caloric restriction is especially harmful when combined with sleep deprivation.

Finally, although not common in the general population, too much exercise can also predispose you to weight gain and diabetes by raising cortisol levels, breaking down muscle tissue and increasing fat storage. This is especially true if cortisol levels are already elevated or disrupted by other stressors like gut infections, insomnia, food toxins or psychological factors.

It’s not uncommon (in the paleo/fitness subculture, at least) to encounter someone who eats well and exercises their brains out, but cannot lose weight. In fact, several of my patients fall into this category. They are often surprised when I tell them they need to exercise less if they want to lose weight and recover their health. What they may not realize is that cortisol is a catabolic hormone. It breaks the body down.

While this might sound like a good thing for those trying to lose weight, it’s not. Muscle tissue is metabolically active and actually helps us lose weight. A reduction of lean muscle tissue may drop a few pounds in the short-term, but it will predispose you to weight gain in the future by impairing your metabolism. (This is another reason why caloric restricted diets, which break down muscle tissue, don’t work in the long-term and even make things worse.)

So if you’re struggling with weight or blood sugar control, don’t diet, get plenty of sleep and take it easy with exercise. You’ll be a lot better off.

We’ve already talked about how blood sugar imbalances and poor gut health can lead to hypothyroidism and Hashimoto’s. The harmful effects of adrenal stress complete the triad.

The adrenals are two walnut-shaped glands that sit atop the kidneys. They secrete hormones – such as cortisol, epinephrine and norepinephrine – that regulate the stress response. But these hormones play other crucial roles, many of which are directly related to thyroid health. In fact, as we’ll see in this article, proper thyroid function depends on healthy adrenal glands.

Most people are aware of the obvious forms of stress that affect the adrenal glands: impossibly full schedules, driving in traffic, financial problems, arguments with a spouse, losing a job and the many other emotional and psychological challenges of modern life.

But other factors not commonly considered when people think of “stress” place just as much of a burden on the adrenal glands. These include blood sugar swings, gut dysfunction, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems and inflammation. All of these conditions sound the alarm bells and cause the adrenals to pump out more stress hormones. In this context, stress is broadly defined as anything that disturbs the body’s natural balance (homeostasis).

Adrenal stress is probably the most common problem we encounter in functional medicine, because nearly everyone is dealing with at least one of the factors listed above. Symptoms of adrenal stress are diverse and nonspecific, because the adrenals affect every system in the body. But some of the more common symptoms are:

• Fatigue
• Headaches
• Decreased immunity
• Difficulty falling asleep, staying asleep and waking up
• Mood swings
• Sugar and caffeine cravings
• Irritability or lightheadedness between meals
• Eating to relieve fatigue
• Dizziness when moving from sitting or lying to standing
• Gastric ulcers

Weak adrenals can cause hypothyroid symptoms without any problem in the thyroid gland itself. In such cases, treating the thyroid is both unnecessary and ineffective, and addressing the adrenals themselves is the key to improving thyroid function.

The most significant indirect effect the adrenals have on thyroid function is via their influence on blood sugar. High or low cortisol – caused by any of the chronic stressors listed above – can cause hypoglycemica, hyperglycemia or both. And as we saw in a previous article, blood sugar imbalances cause hypothyroid symptoms in a variety of ways.

But adrenal stress also has more direct impacts on thyroid function. The following five mechanisms are the most important.

1) Adrenal stress disrupts the HPA axis

By now many people have heard of the hypothalamic-pituitary-adrenal (HPA) axis. It’s a complex network of interactions between the hypothalamus, the pituitary and the adrenal glands that regulates things such as temperature, digestion, immune system, mood, sexuality and energy usage – in addition to controlling the body’s reaction to stress and trauma.

Countless studies show that chronic adrenal stress depresses hypothalamic and pituitary function. And since these two organs direct thyroid hormone production, anything that disrupts the HPA axis will also suppress thyroid function.

Studies have shown that the inflammatory cytokines IL-1 beta, IL-6 and TNF-alpha, which are released during the stress response, down-regulate the HPA axis and reduce levels of thyroid stimulating hormone (TSH). Another study showed that one single injection of tumor necrosis factor alpha (TNF-alpha), an inflammatory peptide, reduced serum TSH, T3, free T4, free T3 and hypothalamic TRH for 5 days. TNF-alpha was also found to decrease the conversion of T4 to T3, reduce thyroid hormone uptake, and decrease the sensitivity of the thyroid to TSH.

2) Adrenal stress reduces conversion of T4 to T3

We discussed under-conversion of T4 to T3 in a prior article. Remember that although 93% of the hormone produced by the thyroid gland is T4, it is inactive in that form and must be converted into T3 before it can be used by the cells. The inflammatory cytokines I listed above not only disrupt the HPA axis, they also interfere with the conversion of T4 to T3.

The enzyme 5′-deiodinase catalyzes the conversion of T4 into T3 in peripheral tissues such as the liver and the gut. Both Th1 and Th2 inflammatory cytokines – IL-6, TNF-alpha, IFN-gamma and IL-1 beta – have been shown to suppress the conversion of T4 to T3. In patients without thyroid illness, as levels of IL-6 (a marker for inflammation) rise, levels of serum T3 fall. And injections of inflammatory cytokines into healthy human subjects resulted in a rapid reduction of serum T3 and TSH levels, and an increase in the inactive reverse T3 (rT3) form, while T4 and free T4 levels were only minimally changed.

3) Adrenal stress promotes autoimmunity by weakening immune barriers

The GI tract, lungs and the blood-brain barrier are the primary immune barriers in the body. They prevent foreign substances from entering the bloodstream and the brain. Adrenal stress weakens these barriers, weakens the immune system in general, and promotes poor immune system regulation.

As we discussed in my previous article on the gut-thyroid connection, when these immune barriers are breached large proteins and other antigens are able to pass into the bloodstream or brain where they don’t belong. If this happens repeatedly, the immune system gets thrown out of whack and we become more prone to autoimmune diseases – such as Hashimoto’s.

4) Adrenal stress causes thyroid hormone resistance

In order for thyroid hormone circulating in blood to have a physiological effect, it must first activate receptors on cells. Inflammatory cytokines have been shown to suppress thyroid receptor site sensitivity.

If you’re familiar with insulin resistance, where the cells gradually lose their sensitivity to insulin, this is a similar pattern. It’s as if the thyroid hormone is knocking on the cell’s door, but the cells don’t answer.

While there’s no practical way to measure receptor site sensitivity in a clinical setting, the research above suggests it is decreased in autoimmune and other inflammatory conditions. A perfect example of this in practice is the Hashimoto’s patient who is taking replacement hormones but still suffers from hypothyroid symptoms – often in spite of repeated changes in the dose and type of medication. In these patients, inflammation is depressing thyroid receptor site sensitivity and producing hypothyroid symptoms, even though lab markers like TSH, T4 and T3 may be normal.

5) Adrenal stress causes hormonal imbalances

Cortisol is one of the hormones released by the adrenals during the stress response. Prolonged cortisol elevations, caused by chronic stress, decrease the liver’s ability to clear excess estrogens from the blood. Excess estrogen increases levels of thyroid binding globulin (TBG), the proteins that thyroid hormone is attached to as it’s transported through the body.

When thyroid hormone is bound to TBG, it is inactive. It must be cleaved from TBG to become “free-fraction” before it can activate cellular receptors. (These free-fraction thyroid hormones are represented on lab tests as “free T4 [FT4]” and “free T3 [FT3]“.)

When TBG levels are high, the percentage of free thyroid hormones drops. This shows up on labs as low T3 uptake and low free T4/T3.

Aside from adrenal stress, the most common causes of elevated TBG secondary to excess estrogen are birth control pills and estrogen replacement (i.e. Premarin).

Balancing the adrenals

Here’s the tricky thing about adrenal stress: it’s almost always caused – at least in part – by something else. These causes include anemia, blood sugar swings, gut inflammation, food intolerances (especially gluten), essential fatty acid deficiencies, environmental toxins, and of course, chronic emotional and psychological stress.

When they exist, these conditions must be addressed or any attempt to support the adrenals directly will either fail or be only partially successful. With that in mind, here are some general guidelines for adrenal health:

• Avoid or at least greatly minimize stimulants
• Stabilize blood sugar (via a moderate or low-carb diet)
• Practice stress management and relaxation techniques
• Have fun, laugh and make pleasure a regular part of your life
• Avoid dietary causes of inflammation (refined flours, high-fructose corn syrup and industrial seed oils in particular)
• Ensure adequate intake of DHA & EPA

Specific nutrients such as phosphatidyl serine and adaptogenic botanicals like Panax ginseng, Siberian ginseng, Ashwagandha and Holy basil leaf extract are also helpful in modulating the stress response and supporting the adrenals. However, these are potent medicines and should be taken under the supervision of a trained practitioner.

Excerpted from Sciencedaily.com, 9/4/08

In an effort to better understand how chronic stress affects the human body, researchers at the Yerkes National Primate Research Center and the Department of Psychiatry and Behavioral Sciences, Emory University, have created an animal model that shows how chronic stress affects behavior, physiology and reproduction.

According to lead researcher Mark Wilson, PhD, chief of the Division of Psychobiology at Yerkes, “Chronic stress can lead to a number of behavioral changes and physical health problems, including anxiety, depression and infertility.”

Via the animal model, the researchers found corticotropin releasing factor (CRF) is a key neurohormone involved in stress response. Wilson explains, “CRF is located in several different brain regions, serving different functions. Its release is important for our ability to adapt to every day stressors and to maintain our physical and emotional health.”

In response to stress, CRF levels rise; CRF levels decrease when the stressor no longer is present. Chronic stress, however, increases the length and volume of expression of CRF in areas of the brain associated with fear and emotion, including the amygdala. Such chronic stress changes the body’s response, and the resulting increased expression of CRF is thought to be the cause of such health-related stress problems including anxiety, depression and infertility.