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Stress is increasing in American society at an alarming rate. Almost every patient who comes to see me is experiencing some kind of stress. The body's ability to react to stress is governed by the hypothalamic-pituitary-adrenal axis (HPA axis) in which the hypothalamus makes the hormone called a corticotropin-releasing hormone (CRH), which goes to the pituitary to make the hormone ACTH, which goes to the adrenal glands to make cortisol.
Importantly, the cortisol then feeds back and inhibits both CRH and ACTH secretion. This axis is increased when someone is under stress and most importantly, the feedback is necessary to shut down the axis when the stress is over. In general, the desire is to have short-term response to stress is
beneficial. For example, when a primitive man was being chased by a saber-toothed tiger, the body wanted to increase the cortisol production to have the primitive man run faster and escape from the saber-toothed tiger. If he was bitten by the saber-toothed tiger, he wanted to have his heart rate go up and his blood vessels constrict to have more blood go to his brain and muscles
and away from, for example, his reproductive organs or his thyroid.
However, chronic stress is detrimental to the body. For example, the activation of cortisol with chronic stress may lead to diabetes, osteoporosis, and problems with immune system. However, stress is very misunderstood, especially by some antiaging or alternative doctors who believe stress causes a decrease in cortisol. There is no evidence that the adrenals “peter out”
with chronic stress, as postulated by some anti-aging or alternative doctors.
In fact, stress causes an increase in cortisol. Therefore, it makes no sense to give cortisol to somebody with normal adrenal glands who is under stress. Although cortisol is a “feel good” hormone, giving cortisol to someone who doesn’t need it suppresses the body’s own cortisol production from the adrenal gland that is exquisitely capable of secreting the correct amount of cortisol at the correct time.