welcome everyone I'm Noah Reed vice president of sales and marketing for precision analytical creators of the Dutch test thank you all for joining us in this January webinar and welcome to 2024 with our very own director of clinical education Dr Debbie rice in this month's presentation Dr Rice will explore the interconnection between stress cortisol and weight changes we all know that the holidays can lead to spikes in all of that so this discussion will bring to light how our body responds to these stressers and how you as providers can understand and best support these challenges there's even more to discover at Dutch test.com research the research team at Dutch recently published a new study that explored the same topic that we're discussing today they poured through thousands of patient results and found a clinically significant correlation between cortisol metabolites and BMI click the link in the chat to read the details of this study and learn more about other peer-reviewed research validating dad urine testing if you're ready to start using Dutch testing in your practice sign up as a registered provider today click the link that we've posted in the chat and complete our provider application form a member of our onboarding team will walk you through the steps to set up an account so that you can begin taking advantage of all of the education and resources that Dutch has to offer plus registered providers gain access to the mastering functional hormone testing course the Dutch interpretive guide and one-on-one consultations with Dutch clinical Educators this dedicated support and education is designed to help you become the hormone expert now let me introduce today's speaker Dr Rice is the director of clinical education for precision analytical and has focused Care on hormone thyroid and adrenal Health she has had experience working communities in need both in the United States and internationally her training is primarily in women's health Pediatric Care Midwifery hormone therapy and hormone function as well as complim complimentary adum Care Dr Rice prefers diet and lifestyle Botanical medicine and conventional approaches to maximize care for her patients and now without any further Ado welcome to 2024 and let's get started with today's webinar thank you Noah I am honored to be here thank you all for joining us today I'm going to turn off my camera so I'm not looking at myself but I have us all in presentation mode ready to start our adventure today so as Noah said we're going to be exploring cortisol and weight gain and the connection between so just as a reminder this information is presented for educational purposes only as always any questions that you have please reach out to your provider and work with them to get the best information possible for you so to start today we wanted to start up with a big bang and talk about how obesity has become a pandemic so pandemic means worldwide right this is an issue that has put stress on some of the medical systems we're looking at disease states that can affect our care the access that we have care to and quality of life in general so this map here is actually just for the United States and this was from 2022 a lot of the risk factors included in obesity include education poverty level race ethnicity and location but this is a pretty nice visual to see what we're looking at when we're looking at what obesity means for the United States and again this does not include the world numbers so the who states that this is an an epidemic across the world um of overweight and obesity naming it Glow obesity that is the World Health Organization there's a differentiation that males have higher risk of being overweight while females have higher risk of obesity this is not just for Western and developed countries this includes developing countries as well because of this we see the risk for diseases which include diabetes metabolic syndrome cardiovascular disease including stroke cancer and more so contributing factors and consideration so when evaluating like how did we get here what put us into this position we want to consider increased stress of a connected society and economy we are on 24 seven right we have access to everything anything all the time anywhere we have increased pressure to perform for work the other thing that I would also like to put in here is that with our like we're so connected but we're also not connected we don't have the same kind of like Village aspect of living with people and being close to people and having those social connections even though we are so interconnected so there is a little bit of Separation with social um like release being able to hang out with people so there's a like the the capacity for doing stuff online is fantastic but when we're in a remote Community it can be difficult to feel that connection and that can also be stressful when we have these types of stress it can deprioritize our healthy habits right whole food nutrition gets deprioritized we were looking at fast food instead we're looking at processed foods instead physical activi is deprioritized a lot of us when we're sedentary and they do say that sedentary is the new smoking doesn't sound great um an appropriate sleep habits so if we have work deadlines or family dynamics that can throw off our sleep patterns so when we think about increased stress we also want to think about cortisol cortisol is our main stress hormone so how does Cortisol tie into weight and obesity well folks sit back and relax I will be your tour guide through this awesomely complex yet straightforward discussion so we do want to look at cortisol and what C like where does Cortisol come from what does it do our adrenal glands are where cortisol is produced it is produced in the adrenal cortex and the Zona facula we do have some other hormones that are involved in our stress response but we're mainly going to talk about cortisol today touch a little bit on some catacol amines so cortisol is produced in the Zona facula in the adrenal cortex of the adrenal glands it is a glucocorticoid that means it is a steroid hormone that utilizes sugar and fats to mediate a response it can influence immune response and reduce inflammation cortisol is also released in response to stress it's released in the presence of low blood sugar as well which is also considered a stressor so because cortisol is a glucocorticoid it uses glucose for its actions so we're going to talk about this a couple of times because we need to understand the effect that cortisol has with glucose so cortisol blocks insulin to keep glucose in the bloodstream when insulin is released it gathers up glucose from the bloodstream and puts it into cells where cells can use it um cortisol induces gluconeogenesis it's the breakdown of glucose from fat cells and liver it reduces protein uptake so it diverts to gluconeogenesis to keep that glucose and circulation so we can get fuel to do what we need to do it also suppresses the immune system to deal with whatever stress is happening right if you are running from a samber tooth tiger you do not have time to get sick this is also when people you know finally get a vacation and they finally relax and then they get sick right that's because cortisol is keeping you up and ready running from your saber-tooth fer cortisol increases blood pressure acutely and also chronically and it improves Focus mental and physical focus it improves your eyesight and hearing right you need to be able to see you need to be able to focus on what that stressor is as a glucocorticoid cortisol influences the metabolism of glucose fats and proteins the properties of cortisol as a glucocorticoid include being anti-inflammatory anti-allergic immunosuppressive and it does support metabolic optimization like when we think of cortisol as a glucocorticoid think about this when you are inflamed or when we have certain inflammatory um issues that come about some like C certain doctors might put you on a glucocorticoid right it has the same action as cortisol does so ol in that initial phase has that anti-inflammatory and immunosuppressive response so the goal of cortisol is to maintain homeostasis homeostasis is that balance make sure that we maintain balance cortisol creates a state of hyperglycemia keeping glucose and the bloodstream the stress induced need for glucose for critical organs so when we're looking at like how your brain gets to function how your skeletal muscles need to do what they need to do burst run um we need to have glucose available for that again cortisol blocks insulin action on the cells to keep glucose in the bloodstream so we have higher glucose in the bloodstream and it increases the enzymes responsible for that glycogenolysis and gluconeogenesis that we talked about previously it induces catabolism and peripheral muscle to mobilize amino acids for gluconeogenesis so this is utilizing all the things that we have to create quick energy fast energy and it activates hormone sensitive lipase to promote beta oxidation of free fatty acids for glucose what this what this means is it helps to break down fatty acids to create energy so the short-term effect of cortisol release is anti-inflammatory and to have the ability to have the energy to fight and deal with the stress this means we have increased Focus increased blood pressure and increased heart rate and blood flow to muscles right our systems open up we're ready to do stuff this activates that sympathetic nervous system it decreases your digestive effort we're not going to be sitting down for Thanksgiving dinner while running from our sabertooth tiger it decreases sex hormone response not time for sexy time we're running from a saber-tooth tiger and it decreases your immune response right so we don't get sick so that we can run from our saber-tooth tiger this part that decreased digestive effort means that we are reducing that parasympathetic nervous system support right as the sympathetic nervous system fires up it decreases the parasympathetic nervous system response so cortisol's short-term purpose is to keep you safe to enable you to run from your saber-tooth Tire whatever your saber-tooth tiger may look like this could be work stress relationship stress exercise is also a form of stress blood sugar disregulation not sleeping well there are many things that can show up as stressors to your body the long-term effect of cortisol so long-term effects of cortisol release include and this is where we're used to having that acute response right like when we were hunters and gatherers that would be what would Keep Us Alive right we would have that increased burst of cortisol Keep Us Safe what has happened now is we end up having that longer term effect of cortisol release right so we have blood sugar irregularities and dis glycemia this can lead to diabetes and Insulin disregulation you have weight gain specifically around the middle immune suppression and immune disregulation this means you can get sick easier or more difficult to recover chronic fatigue uh gastrointestinal isues or stomach issues uh this is parasympathetic nervous system suppression that we just talked about constipation diarrhea heartburn stomach upset like your gut is just not doing what it's supposed to do because why you're still fighting against that saber-tooth tiger cardiovascular concerns including blood vessel constriction this can lead to overcompensation of the cardiovascular system so high blood pressure and cardiovascular disease and then sex hormone imbalances we can see infertility irregular periods heavy periods low libido low sex drive and those are the things that can happen as your body continues to kind of build into that chronic cortisol response so for today we're really going to focus in on that blood sugar dis uh irregularity dysemia and weight gains specifically around the middle so just as a reminder when we look at how cortisol works we have a stressor that when we get this stressor our brain has to make a decision on what we're going to do and how we're going to respond to this stress this is part of that hypothalamic pituitary adrenal axis right so the hypothalamus signals our CR in the paraventricular nucleus the CR signals the pituitary gland to release act act then send signals to your adrenal glands to release cortisol the really final line here is the more act you have coming from the brain the more cortisol is released the less act the less Cor ol is released but this is also something that starts in the brain right so part of that stress response ends up being that fight or flight response and what I like about this presentation is we can see that hypothalamus activates the sympathetic nervous system so this is where we see um those catacol amines those catacol amines are epinephrine and norepinephrine that is your really quick response to stress that's like if you touch a hot burner that sympathetic nervous system response is fast the other signaling happens with the hypothalamus is where we see that Cascade from the hypothalamus pituitary adrenal axis with the ACT to the cortisol so we see the hypothalamus sending signals to the sympathetic nervous system and through that HPA axis for that stress response so we all know that stress contributes to or exacerbates disease States we know that cortisols commonly or frequently referred to as the stress hormone we also know that our stress response involves our catacol Ames that's epinephrine and norepinephrine as well as dopamine therefore we can connect that cortisol and our catacol amines influence disease States we need to understand that the stress response begins in the brain not the adrenal glands it's not like the adrenal glands decide that they're going to be stress the the brain is what decides that we're going to have that stress response so the brain signals to the adrenal glands for a cortisol response the brain signals to the nervous system for a catacol immune response so the brain is making these decisions right and this is where your brain has that influence on how we intake stress right so is it a perceived stress and how we perceive that stress so there's a big difference between and and every person is a little bit different in how they respond to stress some people um their perception of stress is not huge so they're probably not going to have the same kind of stress response versus the other person who perceives stress as being very overwhelming that's going to have a different type of stress response there but again it's all about the brain and the brain deciding how we're going to respond to that stress so I actually really love this representation um when we look at this the stress picture here shows our perceived stress um and what that stress effect can have right that P and influences our disease state so we have perceived stress which can influence our mental emotional regulation we have blood sugar imbalance or that glycemic disregulation ultimately insulin resistance and obesity is what that end product is right we have inflammation we have inflammatory signals and ultimately this inflammation can lead to obesity we also have circadian disruption so when our HPA axis is not functioning as well as it could we can also see circadian rhythm disruption and that is important when we're looking at HPA balance or imbalance so to hone in here we can see like two of the big actually 50% of this presentation is looking at glyc IC disregulation so that's blood sugar disregulation and that's looking at dietary choices meal timing stress eating and the different things that can happen when we continue down that path right the end result can be obesity inflammatory signals these are um highlighted in the little black boxes there the il1 beta the il6 the tnf alpha so these inflammatory signals continue to compound and compound the more inflammation we have we can see disease states with cardiovascular disease um joint and Bone issues and then GI inflammation and what can happen there is when your body is not feeling good you don't want to move low physical activity that also means your metabolism slows down that can also lead to obesity so this is where we're highlighting that even 50% of this picture when we look at that that glycemic disregulation those inflammatory signals what is that overall overarching result we have obesity right low physical activity low physical activity and these are because of those two things right glycemic food diet choices meal timing and inflammatory diseases that can show up where your body is just not comfortable in moving as well as it could so the other part that we want to look at here is circadian disruption so our our body is very dependent on how the Circadian rhythm runs and when we don't have good circadian rhythm when we don't have good sleep and sleep patterns this can negatively affect how our body responds to sleep our capacity to deal with um with stress and we also know that during sleep hours is when our body is um repairing our sleepy time is repair time right our wakeful time is when our body just destroys all of its cells which it's supposed to do it's like anything that's functioning everything gets messy but then closing time everything gets cleaned that's the same thing when we're talking about sleep and circadian rhythm so cortisol responds to sunlight right all of our cells actually respond to sunlight it's a huge factor in supporting our circadian rhythm that wakefulness and sleepiness so that sunlight determines our wakefulness and sleepiness we should be wakeful during the light and sleepy during the night so hormones that regulate metabolism include growth hormone cortisol leptin gin thyroid estrad testosterone DHA progesterone there are more but this is a pretty good list that looks at hormones that can help regulate our metabolism the ones that we are going to look at today are going to be a little bit of growth hormone cortisol leptin grin and some other um cells that can influence our metabolism so these hormones also require a healthy sleep pattern to do their jobs appropriately when there's sleep deprivation these hormones are able to work as optimally as they could so sleep and Metabolism we know that sleep is an important contributor to overall health sleep is integral to our circadian modulation making sure that we have that sleepiness and wakefulness and when sleep loss occurs we are susceptible to increased disease States disrupted metabolism and Confused hormone signaling right so our our hormones may still signal but they might not signal appropriately they might not signal at the amplitude that they need to so you're still not getting a a good represent ation of how those hormones should be working so I did want to highlight here um sleep and sex differences so the key points of this little blur here show that females are at higher risk for inflammatory disease females are more likely to have sleep issues and they are more likely to develop higher levels of systemic inflammation associated with sleep loss we also see the higher levels of CRP which is an inflammatory marker and il6 um with females and inflammation so really what we see from this is that females have a higher risk of inflammation they have higher reactivity to sleep disturbances this does touch on ethnic differences too but there it needs more uh data collection here which is why I did not highlight that so sleep deprivation and inflammatory markers you guys this is just good information to have like if we I know that this is small and if you can see this this is actually pretty impressive and for those patients that try to kid themselves if we do and and providers I'll be guilty to this if we try to to pretend like we're getting enough sleep and we're doing all the right things we can test this in our blood right like there are markers that we can look at if we look at this so this is looking at sleep deprivation of 88 hours we're going to see increased levels of tnfr1 um so we see increased levels of is 6 we see increased levels of Il 10 we see Progressive increases in SE reactive protein if we have sleep deprivation of 34 hours we start to see increased levels of tnf but not the tnfr2 we also see il6 and CRP so we can see like based on your sleep deprivation we can see these inflammatory markers continue to increase right so let's see the sleep deprivation for seven nights we have increased levels of il6 in both sexes and increased of tnf in men but not women so this is a really great chart to kind of compare if if you decide to check in on your patients or yourself you can see hey if I were to test these levels what is that going to look like if I know that I'm getting good sleep these are the things that I would expect to not affect me right these are the things that should not negatively affect me but this is just great information to have to be able to check in on are you sleep deprived what does that look like based on your levels what is your body telling us right um sleep deprivation is also different per person right some people feel well rested after six hours of sleep most in general we look at sleep um patterns 7 to9 hours is optimal so there are some people that may have chronic sleep deprivation but don't know it because you're getting six hours of sleep a night so this is a good way to check in on that too so sleep and disease risk so when we look at your sleep needs appropriate sleep patterning that circadian rhythm when sleep deprivation is present we see difficulty losing weight easy to gain weight imbalanced signaling for grin and leptin inappropriate cortisol signaling right because cortisol is are daytime hormone cognitive aging biologic aging so brain aging and then body aging uh depression and mood shifts and poor metabolic resiliency meaning your body can't bounce back right so depending on how that sleep deprivation looks the Lesser your sleep dep deprivation the better your body can get back in sync with appropriate hormone signaling the longer you have that sleep deprivation the more difficult it is for your body to bounce back into that regular or optimal hormone signaling so hormones involved in weight management we have leptin gin adaptin and cortisol there are others but these are going to be our Focus for today so hormones released from fat cells we have fat cells that release hormones and I want to take a look at how these fat cells communicate so fat cells are also called adipocytes so we look at osy physiology previously we thought that fat or atopos sites the fat cells were an iner wow inert storage organ so we used to think it just didn't really do anything that it could be more of like a barrier protective but what we found out is that atopos tissue really is its own end endocrine organ this means it's capable of secreting biologically Active Components which are called adipokines so ocins are biologically active meaning they are metabolically active when we think of being metabolically act active that means they influence your metabolism these are called okines so an atoy plus a cyto equals an ocine so an ocine is a signaler a cell signaler that comes from your fat tissue ocin affect metabolic signaling and manage hormones affecting appetite satiety glucose metabolism lipid or fatty acid metabolism inflammation and immune function cyto kindes do um work through cellular activity so they signal cellular activity and these can include pro-inflammatory anti-inflammatory signals we have two major classes of adapost tissue we have white adapost tissue or wat and we have brown adapost tissue or bat W bat watb um so when we look at different fat cells in the body the white adapost tissue stores excess energy as triglycerides and the atpac generally released from white atopos tissue are atpenin leptin and I6 there there's actually a really huge list of what the white atos tissue um releases as but these are the major ones that we're going to kind of talk through today the brown atopos tissue actually stores energy a small lipid droplets it is metabolically active and it is thermogenic the ocin released from Brown atopos tissue are il6 il8 and I10 I is in our Lucan so the ocine is released by your white atopos tissue and your brown adapost tissue modulate thermogenesis energy expenditure glucose ostasis lipid metabolism insulin sensitivity angiogenesis and inflammation so let's talk about leptin um with leptin function or sorry when we look at leptin this is produced from our white atopos tissue Mass so any of the white atopos tissue that we have produ that's where our leptin comes from the function of leptin is to suppress hunger stimulate satiety so Reg Ates our appetite and increases energy expenditure through fatty acid oxidation that fatty acid oxidation is utilizing those fat cells to give us energy it results in decreased fat mass in the atoy and it strongly influences our immune cells more specifically that te- cell um t- helper 1 response and it is released in a dial and pulsatile fashion the levels of leptin are highest in the evening and early morning hours and circulating levels of leptin represent the amount of energy stored in fat so low levels of fat equal low levels of leptin and just as an aside here one of the things that I was looking at because I think this has been I don't know if you guys have had this question but I um come across this question just myself and with patients is when we look at fat cells right because these fat cells are are metabolically active and become kind of their own endocrine organ the question is does your body create more fat cells or do you have that same number of fat cells through most of your life and what we have found is that your body essentially creates all of its fat cells in your adolescence so by the time you are in your 20s you have the amount of fat cells that you are going to have now the difference with fat cells is how big they are or how little they are so when we look at the fat cell volume like when we're looking at this um letin results in decrease fat mass of the adopite so you still have the same number of fat cells but it can reduce how big or what their Mass looks like so that's an important component of leptin um adaptin so when we look at adaptin function this is also produced by white adapost tissue it increases fatty acid oxidation so it burns fat for energy and it sensitizes our insulin so the important thing about adenon is it really helps insulin stay sensitized so that we can have appropriate blood sugar management it is strongly anti-inflammatory and when we look at this high levels of adoptin are generally better so in the graphic here we're looking at the functions of adoptin and the atopos sites in the liver in the pancreas in the muscle and in the atopos sites so we can see that higher levels of atopos sites sorry high levels of adoptin and atopos sites can help in consumption of glucose and help to metabolize your triglycerides and help um send out fat storage function for the ocytes so other component of function for adaptin is it's anti atherosclerotic which is really exciting um we think about that so um that helps with our blood vessels right so how much inflammation can develop when we're looking at blood vessel Health it is anti- prolif proliferative and it can suppress carcin so Adena not only influences our metabolism of fats and fatty acids and energy balance but it also has some pretty significant effects when we talk about blood vessel Health when we talk about proliferation of cells and suppressing carcinogens right so this is also where we're looking at cancer cancer development what those signals mean so um out of conect and function is is actually really important when we look at immune function too it does help modulate immune function by affecting both B and te- cells so it's got a pretty heavy uh immune hit here and adpen levels are decreased in disease States like like type 2 diabetes insulin resistance obesity metabolic syndrome and cardiovascular disease so remember high levels of adaptin are better the more adaptin we have the more protective it is the more it can help support insulin um signaling and sensitization the lower levels of adenon are where we have more risk for disease so gin is another one of our ad adipokines and this is actually one of the adipokines that comes from our gut and it um I like to call gremin the gremlin hormone you about Gremlins you guys have ever watched Gremlins um you know they're all about eating especially after midnight right like all the bad things that you're not supposed to do with eating so gin to me is a gremlin hormone that's how I remember it um gin stimulates appetite it stimulates fat deposition it stimulates the release of growth hormone so this is where we're building right like we're trying to pile on some things we're trying to get more food we're trying to get more calories we want to get that fat deposition it inhibits insulin secretion so it keeps that glucose in your bloodstream it regulates hepatic or liver glucose output it decreases energy expenditure so it makes your body less um less desire to move it reduces thermogenesis so it reduces heat right and heat can help burn energy when we reduce that thermogenesis um you have more of a sedentary presentation grin is often called the hunger hormone and it's necessary for blood glucose balance so when we're looking at grin this is one of the things that can really come up in like malnutrition and fasting States for too long so gin is there to protect you actually um because it wants to make sure that you're getting all the calories that you need that you're getting your fat deposition for energy you're getting your fat deposition so that you have thermogenesis and Thermo regulation and it is that balancer of just like the adenon and the Lenton help to keep those um blood sugar levels low grin can help balance that to make sure that you don't drop too low um the other parts of gin are that it reduces sympathetic nerve activity and prevents muscle atrophy so the reason I put these in here is because grin in the research is also actually pretty cool in that uh because it can help prevent muscle atrophy gin actually comes in in certain disease States like myocardial infection or a heart attack um if that happens gin actually kicks in it reduces sympathetic nerve activity so that you're not having that sympath athetic reaction in those cells and it prevents muscle atrophy meaning your muscle can stay strong and healthy so grin is pretty awesome I feel like a lot of people think that grin is bad because it is the hunger hormone but it's actually really protective it really it's it's it's important factors are that it helps to balance that blood sugar for you so you're not becoming malnourished you're not losing muscle when you are having reduced appetite and trying to balance that blood sugar for you it can contribute to obesity and insulin resistance if there's too much of it right again all of these are like Goldy lofs hormones right we don't want too little we don't want too much we want just the right amount and that's the important thing because every person has an individual metabolism every person has an individual stress response every person is individual and we need to remember that when we're looking at what's happening with their out of connective what's happening with our leptin what's happening with their gin um it's involved in bone metabolism and formation and it may be indicated in cancer it can have proliferative properties so because gin is really in that like we're going to build stuff we're going to pile stuff on it can maybe get excited where it shouldn't um the one of the big things that's involved in cancer development is um the the veg F the VF and this is one of the this is like a whole other lecture for another time but this can be contributory because it's proliferative and gin is one the main drivers for that as well so again all in Balance so the ADP the adipocyte effect on the body so what we see here and this doesn't include all of those ocins that we have talked about but we can see the the different effects and the systems of the body right we're looking at appetite so we're looking at leptin and adaptin those are the ones we've talked about so far insulin secretion so how much insulin is secreted we want to be able to manage are we getting too much insulin out there or are we holding insulin back and that's also looking at leptin and adaptin um steatosis or liver function so the liver is going to be um important when we're looking at overall metabolism of our fats and sugars and our atpa sites the atpa kindes influence that signaling and when we have too much inflammation happening with the liver we can see a compromise in how well the liver is able to support metabolism and it can fact how well those atpo Kines can signal all of what they're supposed to be doing right are we supporting inflammation are we going pro-inflammatory or are we anti-inflammatory um atherogenesis so this is looking at blood vessel health and inflammation so we already talked a little bit about that with leptin and out of pektin um and how this can affect your blood vessel health and where those you know fats are deposited and how our body signals our fat release and use of that energy we also see insulin sensitivity so not just insulin secretion but how well our body is responding to insulin right so we look at other peripheral tissues like muscle are they sensitive enough to insulin are they getting the glucose that they need we want to make sure that we are having appropriate uh receptor sensitivity so that our bodies are signaling appropriately and then ataides and ocins effect on the body so I really like this representation because we can see the anti-inflammatory effect and pro-inflammatory effect of these different um atpo so when we have um better functioning ocay we have leaner fat cells or lower Mass uh fat cells and this leads to lower probability of pathogenesis meaning lower risk of metabolic and cardiovascular disease when that's flipped and we have lower levels of anti-inflammatory and higher levels of pro-inflammatory this means those fat cells can increase their Mass when we have increased ined fat cells we have more signaling that can increase inflammation and we have a higher probability of pathogenesis meaning we have higher chance for metabolic and cardiovascular disease okay so ocins in general their goal is to maintain metabolic Integrity or homeostasis through sensitization or resistance to insulin or essentially regulating blood glucose levels right like that's their goal um in general they influence immune function they influence inflammation but it's all because they want to help regulate that blood glucose level so um this is a quote taken from a study uh atos tissue inflammation is initiated and sustained over time by adant adipocytes so bad adipocytes that secrete inflammatory adipokines and by the invasion of immune cells formed in the bone marrow that communicate via the production of cyto and chemokines low grade inflammation of adapost tissue has a detrimental effect on distant organ function and is believed to be the core cause of obesity complications among them visceral obesity plays an essential role in the development of metabolic syndrome so this is a pretty big statement right so when we're looking at atopus tissue inflammation that's because it's initiated and sustained because those adipocytes were not doing what they were supposed to do and this can come from many different uh reasons sometimes illness sometimes stress but that tells us that the adipocytes end up getting a little wonky right so that wonky ocy um signaling ends up sustaining inflammatory response and because of that that's where we start to see the complications in obesity so why is this all important let's try to pull all of this together now so key points when we're looking at at cortisol cortisol is released in response to a stress cortisol is meant to be acutely protective right where we were not meant to be running from a saber to Tiger all the time every day forever and ever and ever it is not meant to maintain chronically high levels when your body is in fight ORF flight mode your appetite decreases tissue repair stops reproduction processes slow hormones slow down and your immune system pauses when your cortisol levels remain consistently High the body craves carbohydrates and sugars for energy and high fats your sleep is not optimal even if you're sleeping in like the same amount of time like you're still going to bed at the same time you're still waking up at the same time there are studies that show that even with that the Sleep Quality is less so you're not getting as good quality of sleep with this when cortisol levels remain consistently High your energy expenditure expenditure becomes less and your appetite changes meaning the timing of eating and the type of food eaten so we have sustained high levels of cortisol we have that need for comfort food so a lot of times we see this um your body starts to Crave High fats foods with high glycemic index the reason for that is because your brain runs better on glucose and sucrose for energy the other thing um that our body kind of protectively does is when we have higher levels of carbohydrates our body has to release insulin and so your body knows that when it's in a high stress situation for a longer amount of time if you feed at carbohydrates it's going to release insulin and the hope with that is it will um reduce cortisol so these should have that balancing effect on each other and that's what the body's trying to do right it it gives you that cating for high fats and high glycemic foods so that you can increase your appetite release that insulin and then lower that cortisol that's what's supposed to happen in balanced signaling with poor dial regulation hormone signal becomes imbalanced right so gin leptin and adaptin may not be signaling appropriately and the timing of food intake is different your body distributes these calories differently this combination causes your white adapost tissue to redistribute to the abdominal region of the body and you know have increased ocine activity from your white adapost tissue this abdominal white adapost tissue actually decreases the activity of your brown atopos tissue so that means we have decreased thermogenesis and um decreased protective uh properties right it's less um anti-inflamm so now you're pro-inflammatory cortisol reduces the ability to focus and think clearly when this occurs we do not make smart food choices rather we follow our cravings for high glycemic carbohydrates of fats now part of that is your body trying to get you back into balance but the other part of that depending on how long this has been happening for is your diol Rhythm your dial curve may also be off when we're when we're eating well we tend to have less Cravings right so we may not consider the timing of when we eat either when we're stressed right like if you are stressed something is happening you realize Good Golly it's 5 o'clock in the evening and I haven't eaten anything so now your body has been in a type of State sometimes fasting sometimes too long and then you end up eating or overeating and because you're all of a sudden hungry again smart to smart food choices may not be happening um when we are stressed we don't create space for physical activity which also creates metabolic imbalance right so when you're stressed you're working on a deadline you are traveling you are dealing with family Dynamics uh you're not going to pause and say I'm just gonna go do some yoga really quick or I'm just going to go to my Orange Theory right when you are thrown out of routine your body doesn't have a good routine and so then you end up just doing things randomly or when you can or however you're able to um our body bodies really like routine I know I've said this before um if you've been a patient of mine you've heard this if you've listened to me speak before you hear me say this our bodies like routine our bodies and our adrenal glands too I think cortisol are like a puppy what we know about puppies is that they do awesome with routine right like they know when it's bedtime they know when it's time to wake up they know it's time to go for their walk they know when it's dinner time they like routine they do better on routine same thing same thing our adrenal glands like a puppy um it's not just about calories in equals calories out right that is no longer it multiple studies show that sustained high levels of cortisol correlate with a high BMI elevated cortisol metabolites that's our thf and our th correlate with high BMI and when we're looking at BMI even though there could be some discussion about how BMI is measured BMI is highly correlated with higher BMI is correlated with obes obesity still other Studies have shown that sustained high levels of cortisol predict obesity in multiple population so they can see this in children and adults multiple ethnicities when they look at high levels of cortisol they can predict obesity um and cortisol can further metabolize from fat cells via cortisol conversion enzyme so the more white adapost tissue you have and the more stress it's happening you end up getting this kind of buildup like this vicious cycle where cortisol continues to convert to more cortisol to more cortisol so then you get this higher cortisol and you're just feeding that cortisol Loop right and in this I want to be sure to highlight that the elevated cortisol metabolites show that this is about how your body metabolizes cortisol not how your body produces cortisol so that is a big distinction when we're looking at cortisol being Mi and obesity and as Noah said at the beginning of the presentation we do have information on this um we just recently uh publish this in December this has a um pretty extensive review of cortisol metabolites and the correlation with higher BMI so please check that out this I think is a wonderful uh picture or representation of that vicious cycle that can happen because sometimes it's not about you started out obese and then these things happen sometimes it starts out that you are stressed and these things happen so this is that Circle of stress obesity and glucocorticoid reactivity that GC is glucocorticoid so the other thing that I want to highlight here is that glucocorticoid reactivity is dependent on receptor sensitivity so they have acknowledged in studies that different people have different reactivity so certain disease States and even um mental states can influence how sensitized your gluc IID receptors are so the more highly sensitized they are the more reactive they can be and vice versa the less sensitized they are the less reactive they can be so we look at this and we can see like what the different colors and the um how dark the colors are and we're looking at this relationship so if we have chronic stress and we look at that outside Circle chronic stress can lead to obesity which can lead to increased glucocorticoid reaction when we have increased glucocorticoid reaction that can increase stress and vice versa right if we have chronic stress really what ends up happening is we have increased sensitization of our glucocorticoid reactions or receptors and that can stimulate that obesity response and then that obesity ends up causing stress to the system so you have this ongoing vicious cycle and what I love about this is it also shows us individual characteristics right so we want to take into consideration your genetics right like there we can certainly tip our hat to genetics and how our body um signals different things either infl pro-inflammatory or anti-inflammatory and even immunomodulating um so we also have genes that are obesity related some people have have this gift and some people do not uh we have physical disorders right chronic pain endocrine diseases cardiovascular disease um obstructive sleep apnea we have certain intoxications so excessive alcohol use smoking that's that can be really stressful on our cells and our cellular function um unhealthy LIF Styles sleep deprivation shift work unhealthy food choices lack of exercise um mental distress mood and anxiety disorders um I would say that a lot of the studies and looking at this did a pretty good um review of mental health and what they really focused in in on was mood and anxiety disorders um and weight discrimination this actually comes up pretty significantly for how that affects your stress response and then medication use so corticosteroids are a big one antiy P otics anti-depressants and beta blockers can also influence how well your body has that glucocorticoid reactivity and what that means for stress on your body so this is complicated but not right like when we look at it like we've read through all the things it makes sense so cortisol and weight gain considerations not all cases of weight gain have high cortisol levels so we have normal cortisol listic obesity which means you have normal metabolic levels of cortisol so that metabolize cortisol is within the normal range this means there are likely other factors influencing your metabolism and it's not just about cortisol this that we're talking about today is more of that hypercortisol listic obesity so these are elevated cortisol levels in that metabolized cortisol so many times this is also associated with abnormal body composition oral pattern insulin disregulation and inflammatory States so other considerations people who are overweight or obese and are mentally stressed about weight discrimination show higher cortisol levels so the people that are overweight and obese but are not stressed about it show lower cortisol levels interestingly enough and this correlates to ongoing elevated cortisol levels that perpetuate cortisol with weight gain right so this is really kind of like feeding on itself essentially when you are overweight and obese and are mentally stressed about it you continue to create that higher cortisol cycle so when we look at treatment consider so when elevated cortisol is involved it's important to consider and really what we're looking at and considering these are those foundational lifestyle things Stress Management I know it's easy to say we'll throw it out there like fairy dust um but yes even the studies say it mindfulness mindfulness prayer um studies show that it makes a huge difference a lot easier said than done but the proof is in the pudding Stress Management mindfulness breath work um and adop adting an appropriate sleep routine so making sure that you have an appropriate circadian rhythm right that you're going to bed around the same time every night you're waking up around the same time every morning that's going to be huge in supporting your sleep um the sleep cycle and that sleep architecture that supports better hormone signaling right making sure that your growth hormone can do what it's supposed to do make sure your leptin is signaling appropriately and then stabilizing blood sugar so timing and quality of nutrients is key it's not just about what you eat it's also about when you eat so when the body has higher elevated cortisol protein and balanced foods every two to four hours when stressed can help to maintain stable blood sugar and reduce cravings for those high glycemic foods and this is something where you just have to kind of proactively get into that pattern um when elevated corol is involved we also want to look at physical activity so walking walking cardiovascular you know movement getting the blood pumping walking for 20 minutes especially post meal so there's a lot of research that um is supportive of going for a walk 20 minutes after you eat um or for 20 minutes after you eat that can also help to lower your blood sugar weightlifting to support healthy muscle metabolism the more muscle mass you have the better metabolism you have right like muscles are also essentially their own endocrine organ and the lack of muscle or lack of protein can also create increased fatness so we want to be aware of that and then food planning I know like when you are stressed out the last thing you want to do is plan out your food but honestly it is the best way to get ahead of falling into those really bad patterns so this reduces the stress of having to decide on Foods in the moment of stress because if you're me I'm gonna have cheesecake can I have dairy no I don't care I want cheesecake right but if I plan ahead I'm going to make better decisions this is proven to reduce snacking or food choices and craving frenzies so we also want to make sure that we're addressing the root cause right like are there mood um issues that need to be addressed when we're looking at anxiety and depression um are there immune issues that need to be addressed are there viral issues microbial issues there's a lot of connection with our gut health and overall immune function and disease States in general but we want to evaluate immune function in general and inflammation in general right do we have environmental exposures are there foods that we shouldn't be eating are there um is there mold in the house have we been you know with other viral things too have we been exposed to Lime like we want to be able to take the whole get Kaboodle out and look at it and say like okay this is good this is good this is not good we need to work on this right being able to address the root CA is going to be important and test don't guess it's important to have information to approach your treatment appropriately you can do serum testing for letin Adam pektin and other inflammatory markers you guys saw that fun little sheet guys I can't wait to do that test on me actually um but you can do that in the blood and then Dutch testing of course right we want to look at metabolized cortisol so how is our body metabolizing cortisol not producing cortisol but metabolizing cortisol we want to look at those cortisol metabolites that thf and the th we want to be able to see our dial pattern of free cortisol to evaluate appropriate circadian rhythm are we on par with that circadian rhythm do we have the Daytime Nighttime balance the eight hydroxy marker looks at um oxidative stress so this is looking at cellular stress or DNA damage and we can also look at inflammatory markers in our churate the xanthate and the quinolinate so these give us a really good idea of like where we're at do we have good metabolized cortisol do we have a good dial pattern what does that inflammation look like okay and I don't know if we have time for questions but thank you for joining me in our adventure today yes we don't have time for questions however uh we do want to thank everybody for joining us today for the webinar uh and check your inboxes tomorrow for a link to the recording uh and to access all the resources that we shared today you can learn more about the research behind Dutch test at Dutch test.com resesarch and make sure to visit the become a provider tab at dutch.com to register for an account so that you can gain access to even more hor Education and Research again thanks for coming have a great rest of your day