Reducing Cortisol Improves Anxiety

by Nina

New Leaves in the Desert by Melina Meza

Have you noticed that whenever we talk about the dangers of chronic stress (see About Stress: Acute vs. Chronic), we always mention anxiety? That’s because anxiety is basically on every doctor’s list as one of the potential problems that can result from ongoing stress. And my personal experience has been that anxiety is the first problem I start to suffer from when I go through a period of chronic stress. That is why I personally value yoga’s stress management tools so much; I’ve learned how much better my life is if I can nip those stress levels in the bud before my emotions get out of control. 

But even though I knew that chronic stress could cause anxiety, I didn’t really know exactly why. You know me—I always want to know why—when it’s possible to know why—so I was very interested to read this paper about anxiety and cortisol levels Elevated cortisol in older adults with Generalized Anxiety Disorder is reduced by treatment: a placebo-controlled evaluation of escitalopram. Even though this paper had nothing to do with yoga (the scientists were using a drug to reduce cortisol levels in older people with anxiety), I was interested to learn that older adults with Generalized Anxiety Disorder have higher levels of the stress hormone cortisol. The paper put it this way:

“Generalized Anxiety Disorder (GAD) is a common and impairing anxiety disorder in older adults, and it has been associated with elevated cortisol in this age group.”

And the paper also said that the experiment they did with reducing cortisol levels in this group helped improve the anxiety!

"Compared with placebo-treated subjects, SSRI-treated subjects had a significantly greater reduction in both peak and total cortisol. This reduction in cortisol was limited to subjects with elevated (above the median) baseline cortisol, in whom SSRI-treated subjects showed substantially greater reduction in cortisol than did placebo-treated subjects. Reductions in cortisol were associated with improvements in anxiety."

In the past, we’ve talked about cortisol in the past in terms of inflammation and celluar stress (Reducing Cellular Stress with Yoga and Cortisol, Stress and Yoga) as well as stress eating (see Yoga, Stress and Weight Management and Stress Eating and the Healthy Eating Meditation Practice), but we’ve never addressed its effects on our emotions. In my post Stress and Your Thought-Behavior Repertoire, I talked about how while you’re in stress mode, your thoughts are restricted to Fight or Flight options. Now it seems possible elevated cortisol levels might be to blame for this and/or for raising levels of anxiety or worry in general.

The paper also said that older adults in general have a harder time with elevated cortisol as, “aging increases vulnerability to adverse effects of elevated cortisol, because compensatory mechanisms preventing its deleterious effects are diminished.” It also mentioned that that chronic over-activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis causes wear and tear to the brain and body via toxic effects of elevated cortisol levels.

So, the bottom line is that elevated cortisol levels in older adults is particularly dangerous, potentially causing Generalized Anxiety Disorder as well as other diseases and physical problems. But although the researchers of this paper used medication to lower cortisol levels, this may not be the only way to do lower them. If you’re feeling well enough to forgo medication (and your doctor agrees with you about this) or if you just want to practice to prevent future problems with anxiety, you can use yoga to lower your cortisol levels. 

Reducing Anxiety with Yoga

I’ve done several posts in the past about how to use yoga to reduce anxiety (see 10 Ways to Soothe Anxiety with Yoga and Yoga Solutions for Anxiety). But it’s worth emphasizing here that some of the techniques we recommend for stress management in general, including meditation and restorative yoga, might not work well for anxiety. That’s because it’s very hard for many anxious people to lie or sit still, as they tend to become even more anxious if they are alone with their thoughts. See When Relaxing Isn't Relaxing.

On the other hand, while an active yoga practice can engage your mind and distract you from your worries (a welcome relief!) it is not necessarily going to lower your cortisol levels. An active practice is generally more stimulating than relaxing, although it is useful for tiring you out (plus, everyone needs exercise).

So, if you’re someone who has trouble lying still due to anxious thoughts, who feels generally hyper (I know that feeling!), or who has been sitting all day for work and needs to move, I recommend starting with an active practice, such as Featured Sequence: Lower Body Strength or Upper Body Strength. Then, after you’ve released some of your excess energy, try practicing one or more supported inverted poses. Because the Relaxation response is triggered by your physical position, supported inverted poses don’t require a mental focus (see Why You Should Love Your Baroreceptors). So you can keep your eyes open and even listen to music while you are practicing them and you’ll still quiet your nervous system. Of course, as with any pose, if you feel bad in an inverted pose, come out of the pose immediately. See All About Supported Inverted Poses to find a supported inverted pose that's right for you.

See When Relaxing Isn't Relaxing for more suggestions for what to do when anxiety means that relaxing isn’t relaxing. Of course, if you’re not experiencing anxiety and are comfortable with other forms of stress management, continue to practice the way you enjoy it the most (see The Relaxation Response and Yoga). Keeping cortisol levels low may very well help prevent problems such as anxiety from occurring or re-occurring in your future.

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Reducing Cellular Stress with Yoga

by Ram

Blooming by Melina Meza

Cortisol is a steroid hormone synthesized by the adrenal cortex and is released in response to stress and low blood glucose concentration. It is involved in numerous physiological activities, including regulation of blood sugar, metabolism of fat, protein, and carbohydrate, suppression of inflammation, activation of anti-stress pathways and influence on behavior and moods. The hormone’s response to stress includes:

• metabolizing glucose as an energy source
• mobilizing fat and proteins as a stand-by fuel
• triggering the immune response
• increasing the heartbeat, blood pressure, and mental alertness, all of which help in warding off the stress

In a well-balanced individual, cortisol is part of an elegant system that helps cope with short-term stressful situations by providing fuel in the form of glucose, mobilizing fat and proteins as standby fuel systems, and modifying the immune response, heartbeat, blood pressure, brain alertness and the response of the nervous system to get us through the stressful situations (see Cortisol and Good Health). However any imbalance in the cortisol levels can be deleterious. Chronic elevated levels of cortisol result in several negative effects, including decreased cognitive function, disturbed thyroid function, excess sugar in the blood stream and more chance of developing diabetes, loss of immunity, increased risk of stomach ulcers, elevated blood pressure, increased risk of hypertension, heart disease and other vascular disorders, and decreased muscle mass and bone density. In contrast, chronically low levels of cortisol (this is typically associated with a condition called Adrenal Fatigue) can also be dangerous as it may trigger brain fog and depression, severe fatigue, low blood pressure, poor immune function, and inflammation.

After it is synthesized by the adrenals, cortisol is released into the blood stream where it gets bound to large proteins that facilitate its transport throughout the body. A small fraction of unbound free cortisol that is thought to be biologically active diffuses into cells and other bodily fluids. On a daily basis, a bit of cortisol is released in the early morning hours that help with the morning chores. The morning cortisol triggers the release of sugar into the blood stream and facilitates more blood to the brain and heart, all of which arouses us and puts us into action. In contrast, the level of cortisol gradually diminishes to its lowest levels around 10pm to coincide with the low physical activity in the night coupled with the sleep response. Salivary cortisol is perhaps the most reliable source for measuring the levels of cortisol. The concentration of cortisol in saliva accurately reflects the level of free cortisol in blood. Cortisol levels normally fluctuate throughout the day and night (diurnal variation), with a peak rise in levels at about 8 am and ebbing at around 4 am. To properly measure cortisol levels, saliva is collected four times in a day.

The adrenals secrete cortisol in response to a stressful situation, with the cortisol levels returning to normal following the stressful event. What is very important is that adrenals need time to recover after a stressful situation so they can do their job well if exposed to another stressful event. Unfortunately, in our present day high-stress environment, the body’s stress response is activated very frequently leaving very little recovery time for the adrenals. As a result, the adrenals are constantly under high alert and cortisol gets continuously released into the system. So cortisol levels remain high in the blood stream for greater periods of time, which can result in swelling of the adrenal gland itself, and an increased chance of all the negative effects as mentioned earlier (see Not So Sweet: Cortisol and the Problem with Sugar). The good news is that a regular yoga practice, including some restorative poses, guided meditations, and Savasana, regulates the cortisol levels so they are in balance, thereby keeping the adrenals healthy. 

Further confirmation about the role of yoga in regulating the cortisol levels comes from a recent study on cancer patients Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. Breast cancer survivors are at risk for chronic stress-related mental issues that alter the activity of the Hypothalamic-Pituitary-Adrenal axis, resulting in aberrant regulation of cortisol secretion, increased risk of immune dysfunction, and accelerated cancer progression. To study the effect of a yoga practice on cortisol secretion in breast cancer patients, researchers enrolled two groups of breast cancer survivors: one group that consisted of 9 individuals who attended a yoga practice for 90 minutes twice weekly for 8 weeks and a second group of 9 waitlisted individuals that served as a control group. The outcome measures included self-perceived psychosocial function and diurnal salivary cortisol secretion. The practice involved asanas in the Iyengar tradition that progressively increased in difficulty as participants gained strength and flexibility. The tests were conducted at baseline and after the 8-week study. Both groups completed a self report to document various aspects of psychosocial and physical functioning, and also collected salivary samples for cortisol analysis four times during the day for two consecutive days. 

Not surprisingly, the yoga group had lower morning (8 am) and evening (5 pm) salivary cortisol and improved emotional wellbeing and fatigue scores compared to the control group, suggesting that a regular yoga practice may be a low risk, cost effective way to recover from physical and emotional stress, fatigue, and to regulate the levels of cortisol. The researchers postulate that yoga may impact the Hypothalamic-Pituitary-Adrenal (HPA) axis and the sympathetic nervous system (SNS) response to stress, possibly via direct vagal stimulation (see Vagal Tone and Yoga). In short, yoga may impact the endocrine and autonomic nervous systems together resulting in lowered cellular stress. Time to unroll the mat!

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Restorative Yoga Better Than Stretching for Reducing Subcutaneous Fat in Overweight Women

by Nina

Just a quick announcement today about some research findings I think you’ll all enjoy hearing about. Baxter and I read about a recent study, designed by Maria G. Araneta, PhD, MPH, of the University of California, San Diego, to determine whether obese women would see a loss of fat from less intense exercise instead of aerobic activity. Although not a huge study, the group sizes were larger than most of those we see in recent studies, with the yoga group of 88 having a mean age of 55 years with an average BMI of 36 kg/m2 and the stretch group of 83 having a mean age of 54 years with an average BMI of 32.5 kg/m2.

Along with her co-authors Matthew A. Allison, MD, MPH, Elizabeth Barrett-Connor, MD, and Alka M. Kanaya, MD, Dr. Araneta presented the results at the 73rd Scientific Sessions of the American Diabetes Association in Chicago (June 21-25). And their findings showed that the restorative yoga practitioners lost significantly more subcutaneous fat over the initial six months of the study period, and kept losing it during a maintenance period with less direct supervision! This is important because all the women participating in study had metabolic syndrome, which the Mayo Clinic defines as:

Metabolic syndrome is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes.

Metabolic syndrome affects 44% of the U.S. population older than age 50. And reducing abdominal fat may help reverse the syndrome.

Although the team is still reviewing the data, they’ve speculated that one explanation for the difference between the effects found with restorative yoga and stretching may be that restorative yoga reduces levels of cortisol. As Timothy wrote in his background post Stress, Your Health and Yoga, cortisol levels rise during times of stress and is known to increase abdominal fat. And in Baxter’s post Cortisol and Good Health Baxter wrote about the dangers of prolonged periods of stress and high levels of cortisol. I wrote specifically about the relationship between stress, cortisol and weight management in my post Yoga, Stress and Weight Management. So we'll be very interested to see the follow-up studies.

In Baxter's post on cortisol, he actually recommended restorative yoga along with yoga nidra as stress reduction—and cortisol-lowering—solutions. However, meditation (see Starting a Meditation Practice) and supported inversion poses (see All About Supported Inverted Poses) are also helpful. For a complete overview of how to use yoga to switch your nervous system from the Stress Response (Fight or Flight) to the Relaxation Response (Rest and Digest), see The Relaxation Response and Yoga.

In her presentation, Dr. Araneta did not recommend restorative yoga as a replacement for aerobic activity; instead, she said this “complementary” practice could provide a means of gentle movement for those severely obese patients for whom other activity is not practical. But as I wrote in Restorative Yoga: An Introduction, restorative yoga is a complementary practice that benefits all of us.

If you haven't already, check out Baxter's video of the classic restorative pose, Reclined Cobbler's pose! 

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Cortisol and Good Health

by Baxter

Fallen Tree by Brad Gibson

We have mentioned one of the body’s important hormones, cortisol, on these pages a few times in the recent past, but always with the slant of it somehow being a problem child, a bad actor, a rotten apple, as it were. But cortisol, when it is working in harmony with a well-balanced body and mind, is part of a elegant system that tries to help us respond in the best way possible to short term stressful situations that are bound to arise in our daily lives. So on a daily basis, during the early morning hours - around 4-5 am, the body releases a bit of cortisol to get your inner furnace ready for the first foot hitting the floor in the morning. It releases a bit of sugar into the blood stream, sends a bit more blood to the brain and heart, and really gets us ready for action, however mellow or intense our morning will be. Then, if the day is relatively uneventful, the level of cortisol gradually diminishes to its lowest levels around 10pm.

When released in response to unexpected stressful events, it has many more helpful roles to play. It has a strong anti-inflammatory effect, which is helpful with acute injury, so it can act like a fire truck when the body’s immune response to infection is too strong by decreasing the life span and production of one of our white blood cells known as lymphocytes. Basically, it tries to keep a balanced approach to infections.

Cortisol has an effect on the cardio-vascular (CV) system by controlling the smooth muscles in the walls of our arteries. In normal circumstances, this allows cortisol to help boost our blood pressure in the short run when we need extra work from the CV system. It has effects on the central nervous system (CNS), too, influencing behavior, mood, excitability, and the electrical activity of neurons. When we put all that together, cortisol is designed to respond to stress by providing fuel in the form of glucose, mobilizing fat and proteins for back-up fuel supply, modifying the immune response, heartbeat, blood pressure, brain alertness and the response of the nervous system to get us through the rough spots.

The cool thing about cortisol is that is has evolved to enhance the body’s response to stress while also protecting from excessive response to stress. The key thing about the place that produces cortisol, the adrenal glands, is that they need time to recover after stressful events have passed. And herein lies the rub!  If we give the body some time to recover between stressful events, the adrenal glands can do their job well, cortisol levels are adequate to the demands of the body, and you stay healthy and ready for the next stressful event.

But if you are either under constant stress, or your mind is prone to brooding about the past or anxious musings about the future or even negative assessments about the present moment, your adrenals interpret this as an actual stressful event occurring right now, and cortisol gets released into your system. So cortisol levels remain high in the blood stream for greater periods of time, which can result in swelling of the gland itself, and an increased chance of the following negative effects: loss of immunity secondary to shrinkage of lymph glands, increased risk of stomach ulcers, increased risk of hypertension, heart disease and other vascular disorders, excess sugar in the blood stream and more chance of developing diabetes. Not a good outlook! 

And as I mentioned last week, chronic stress depletes your supply of cortisol and can steal the building blocks of your sex hormones (see Yoga and Male Menopause), thus negatively impacting your sexual function and your reproductive capacity. What’s a yogi to do? 

Supta Baddha Konasana (Reclined Cobbler's Pose)

The good news is that your regular yoga practice, if it includes those much needed restorative poses (see Restorative Yoga), yoga nidra (see Yoga Nidra and Deep Relaxation), long guided meditations and generous Savasana (see Savasana Variations), should be the perfect balancing act for keeping the adrenals healthy and the cortisol cycle in synch with your changing needs. One fact that might influence your asana and even your exercise regimen is that aerobic or effort-full exercise (and some forms of yoga definitely fit the bill) can cause a release of cortisol to deal with the short term “stress” of the increased physical effort. If you work out or do asana in the morning, when there is still a bit of cortisol around from the 4 am release, the effects of the brief elevation are minimal. However, a late day work out could be theoretically more problematic, with a negative effect on sleep patterns as one possible side effect. So I would recommend active workouts and asana for the morning, and restorative practices in the evening if you want or need to do something later in the day.

So remember, cortisol is a good guy just trying to do its job. It’s the stress and our reactions to it that are really the culprits. Fortunately, we have the technology to neutralize this threat to our healthy aging! 

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