Cortisol spikes are normal – so when is cortisol a real problem?

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You may have noticed a plethora of reels and posts on social media claiming cortisol “spikes” are harmful. Some warn against drinking coffee on an empty stomach or even doing certain exercises lest they “spike” your cortisol levels.

As an endocrinologist, I live and breathe hormones. I can reassure you cortisol spikes are not something healthy people need to fear.

In fact, cortisol rhythms – which involve some ups and some downs – are an essential part of what keeps your body well.

Remind me, what is cortisol?

Cortisol is an essential hormone that regulates our metabolism, immune system and cognitive/emotional processes.

Cortisol regulation is complex.

While cortisol release comes from your adrenal glands that sit just above your kidneys, it is under direct control by another hormone released by the pituitary gland, or “master gland” at the base of our brain.

Cortisol production follows a strong daily rhythm.

There is a sharp rise in cortisol levels in the first hour after waking up, called the “cortisol awakening response”.

This awakening response helps you feel alert. In fact, the higher this peak, the better you can cope with the physical and mental challenges for the day ahead.

A blunted cortisol awakening response (meaning they are not as high as would be ideal) is associated with poorer health.

Over the course of a day, cortisol levels fall gradually and are naturally very low in the evening, designed to bring on sleep.

Overlying this background rhythm there are regular cortisol pulses throughout the day, when your body is faced with challenges such as a tough workout, a stressful deadline or an infection.

These cortisol rises are protective. They help you stay focused, maintain your blood pressure and release more energy when needed.

So, what about coffee on an empty stomach?

Cortisol levels are affected by many factors including gender, age and genetics, as well as food, exercise, stress, light and illness.

Understanding the effect of a simple cup of coffee in the morning depends on the intricate and complex nature of these dynamics.

Importantly, there have been no randomised controlled studies comparing coffee consumption on an empty stomach to having it after food.

Certainly, coffee has been linked to a rise in cortisol levels, of up to 30% in one study, and in another even when drunk with breakfast.

However, particularly in regular coffee drinkers, the effect may be negligible.

Interestingly, it might be more about the timing of coffee drinking rather than whether it is consumed with or without food.

In the study of habitual coffee drinkers, morning caffeine intake was not shown to meaningfully disturb the cortisol rhythm, whereas drinking coffee later in the afternoon did seem to contribute to higher cortisol levels over the course of the day.

This also may have relevance to when we exercise – some studies have shown that people exercising earlier in the day have a steeper cortisol decline after waking and lower evening levels. This might mean it is easier to get to sleep.

Don’t worry about ‘spikes’

Rather than being concerned about cortisol “spikes”, it is sustained elevations over the course of a day that are linked to adverse health outcomes.

Chronic stress states (meaning persistent and extended period of exposure to one or more stressors, such as prolonged work stress or relationship difficulties) and long-term use of cortisol-like medications (such as the corticosteroid prednisone) might be problematic. They expose the body to high cortisol levels without the natural rise and fall over a 24-hour period.

Rare conditions like Cushing’s syndrome (a consequence of tumours of the pituitary or adrenal gland in most people) cause chronically elevated cortisol levels.

Although some smart watches can monitor your “stress” levels, this is done indirectly via measurement of heart rate variability – not by measurement of cortisol levels.

Measuring high cortisol levels requires sophisticated testing that might involve urine, saliva, as well as a variety of blood tests; so don’t be too worried about cortisol based on what your watch is telling you.

If you are concerned about cortisol, you should consult your doctor. If abnormalities arise, a referral to an endocrinologist may be needed.

Ann McCormack, Conjoint Associate Professor in Endocrinology, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Hearty Healthy Ukrainian Borscht

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    In the West, borscht is often thought of as Russian, but it is Ukrainian in origin and popular throughout much of Eastern Europe, with many local variations. Today’s borscht is a vegetarian (and vegan, depending on your choice of cooking fat) borscht from Kyiv, and it’s especially good for the gut, heart, and blood sugars.

    You will need

    • 1 quart vegetable stock; ideally you made this yourself from vegetable offcuts you kept in the freezer, but failing that, your supermarket should have low-sodium stock cubes
    • 4 large beets, peeled and cut into matchsticks
    • 1 can white beans (cannellini beans are ideal), drained and rinsed
    • 1 cup sauerkraut
    • 1 large onion, finely chopped
    • 1 green bell pepper, roughly chopped
    • 1 large russet potato, peeled and cut into large chunks
    • 3 small carrots, tops removed and cut into large chunks
    • 1 tbsp tomato paste
    • ½ bulb garlic, finely chopped
    • 2 tsp black pepper, coarse ground
    • 1 bunch fresh dill, chopped. If you cannot get fresh, substitute with parsley (1 bunch fresh, chopped, or 1 tbsp dried). Do not use dried dill; it won’t work.
    • A little fat for cooking; this one’s a tricky and personal decision. Butter is traditional, but would make this recipe impossible to cook without going over the recommended limit for saturated fat. Avocado oil is healthy, relatively neutral in taste, and has a high smoke point, though that latter shouldn’t be necessary here if you are attentive with the stirring. Extra virgin olive oil is also a healthy choice, but not as neutral in flavor and does have a lower smoke point. Coconut oil has arguably too strong a taste and a low smoke point. Seed oils are very heart-unhealthy. All in all, avocado oil is a respectable choice from all angles except tradition.
    • On standby: a little vinegar (your preference what kind)

    Salt is conspicuous by its absence, but there should be enough already from the other ingredients, especially the sauerkraut.

    Method

    (we suggest you read everything at least once before doing anything)

    1) Heat some oil in a large sauté pan (cast iron is perfect if you have it), add the onion and pepper, and stir until the onion is becoming soft.

    2) Add the carrots and beets and stir until they are becoming soft. If you need to add a little more oil, that’s fine.

    3) Add the tomato paste, and stir in well.

    4) Add a little (about ½ cup) of the vegetable stock and stir in well until you get a consistent texture with the tomato paste.

    5) Add the sauerkraut and the rest of the broth, and cook for about 20 minutes.

    6) Add the potatoes and cook for another 10 minutes.

    7) Add the beans and cook for another 5 minutes.

    8) Add the garlic, black pepper, and herbs. Check that everything is cooked (poke a chunk of potato with a fork) and that the seasoning is to your liking. The taste should be moderately sour from the sauerkraut; if it is sweet, you can stir in a little vinegar now to correct that.

    9) Serve! Ukrainian borscht is most often served hot (unlike Lithuanian borscht, which is almost always served cold), but if the weather’s warm, it can certainly be enjoyed cold too:

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • Could not getting enough sleep increase your risk of type 2 diabetes?

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    Not getting enough sleep is a common affliction in the modern age. If you don’t always get as many hours of shut-eye as you’d like, perhaps you were concerned by news of a recent study that found people who sleep less than six hours a night are at higher risk of type 2 diabetes.

    So what can we make of these findings? It turns out the relationship between sleep and diabetes is complex.

    The study

    Researchers analysed data from the UK Biobank, a large biomedical database which serves as a global resource for health and medical research. They looked at information from 247,867 adults, following their health outcomes for more than a decade.

    The researchers wanted to understand the associations between sleep duration and type 2 diabetes, and whether a healthy diet reduced the effects of short sleep on diabetes risk.

    As part of their involvement in the UK Biobank, participants had been asked roughly how much sleep they get in 24 hours. Seven to eight hours was the average and considered normal sleep. Short sleep duration was broken up into three categories: mild (six hours), moderate (five hours) and extreme (three to four hours). The researchers analysed sleep data alongside information about people’s diets.

    Some 3.2% of participants were diagnosed with type 2 diabetes during the follow-up period. Although healthy eating habits were associated with a lower overall risk of diabetes, when people ate healthily but slept less than six hours a day, their risk of type 2 diabetes increased compared to people in the normal sleep category.

    The researchers found sleep duration of five hours was linked with a 16% higher risk of developing type 2 diabetes, while the risk for people who slept three to four hours was 41% higher, compared to people who slept seven to eight hours.

    One limitation is the study defined a healthy diet based on the number of servings of fruit, vegetables, red meat and fish a person consumed over a day or a week. In doing so, it didn’t consider how dietary patterns such as time-restricted eating or the Mediterranean diet may modify the risk of diabetes among those who slept less.

    Also, information on participants’ sleep quantity and diet was only captured at recruitment and may have changed over the course of the study. The authors acknowledge these limitations.

    Why might short sleep increase diabetes risk?

    In people with type 2 diabetes, the body becomes resistant to the effects of a hormone called insulin, and slowly loses the capacity to produce enough of it in the pancreas. Insulin is important because it regulates glucose (sugar) in our blood that comes from the food we eat by helping move it to cells throughout the body.

    We don’t know the precise reasons why people who sleep less may be at higher risk of type 2 diabetes. But previous research has shown sleep-deprived people often have increased inflammatory markers and free fatty acids in their blood, which impair insulin sensitivity, leading to insulin resistance. This means the body struggles to use insulin properly to regulate blood glucose levels, and therefore increases the risk of type 2 diabetes.

    Further, people who don’t sleep enough, as well as people who sleep in irregular patterns (such as shift workers), experience disruptions to their body’s natural rhythm, known as the circadian rhythm.

    This can interfere with the release of hormones like cortisol, glucagon and growth hormones. These hormones are released through the day to meet the body’s changing energy needs, and normally keep blood glucose levels nicely balanced. If they’re compromised, this may reduce the body’s ability to handle glucose as the day progresses.

    These factors, and others, may contribute to the increased risk of type 2 diabetes seen among people sleeping less than six hours.

    A man checking the glucose monitor on his arm.
    Millions of people around the world have diabetes. WESTOCK PRODUCTIONS/Shutterstock

    While this study primarily focused on people who sleep eight hours or less, it’s possible longer sleepers may also face an increased risk of type 2 diabetes.

    Research has previously shown a U-shaped correlation between sleep duration and type 2 diabetes risk. A review of multiple studies found getting between seven to eight hours of sleep daily was associated with the lowest risk. When people got less than seven hours sleep, or more than eight hours, the risk began to increase.

    The reason sleeping longer is associated with increased risk of type 2 diabetes may be linked to weight gain, which is also correlated with longer sleep. Likewise, people who don’t sleep enough are more likely to be overweight or obese.

    Good sleep, healthy diet

    Getting enough sleep is an important part of a healthy lifestyle and may reduce the risk of type 2 diabetes.

    Based on this study and other evidence, it seems that when it comes to diabetes risk, seven to eight hours of sleep may be the sweet spot. However, other factors could influence the relationship between sleep duration and diabetes risk, such as individual differences in sleep quality and lifestyle.

    While this study’s findings question whether a healthy diet can mitigate the effects of a lack of sleep on diabetes risk, a wide range of evidence points to the benefits of healthy eating for overall health.

    The authors of the study acknowledge it’s not always possible to get enough sleep, and suggest doing high-intensity interval exercise during the day may offset some of the potential effects of short sleep on diabetes risk.

    In fact, exercise at any intensity can improve blood glucose levels.

    Giuliana Murfet, Casual Academic, Faculty of Health, University of Technology Sydney and ShanShan Lin, Senior Lecturer, School of Public Health, University of Technology Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • JoyFull – by Radhi Devlukia-Shetty

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    We haven’t done a recipe book in a little while, so here’s a good one!

    The focus of this book is getting more plants and spices into your diet, and doing it deliciously.

    Healthwise, there is nothing controversial here: the recipes are all plant-based, mostly whole-foods, and the items that aren’t whole foods are things like “vanilla extract”.

    The recipes themselves (of which there are 125) are presented clearly and simply, one to a double-page (although sometimes there will be a suggested variation on the same double-page), ideal for use in a kitchen bookstand. For each recipe, there’s a clear photo of the end result, so you know what you’re working towards.

    The ingredients are not too obscure, and can be acquired from more or less any large supermarket.

    Bottom line: if you’re looking to expand your plant-based cooking repertoire in a way that’s not just substitutions, then this book provides an excellent variety.

    Click here to check out JoyFull, and get a taste of Ayurvedic cooking!

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  • Want to sleep longer? Adding mini-bursts of exercise to your evening routine can help – new study

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    Exercising before bed has long been discouraged as the body doesn’t have time to wind down before the lights go out.

    But new research has found breaking up a quiet, sedentary evening of watching television with short bursts of resistance exercise can lead to longer periods of sleep.

    Adults spend almost one third of the 24-hour day sleeping. But the quality and length of sleep can affect long-term health. Sleeping too little or waking often in the night is associated with an increased risk of heart disease and diabetes.

    Physical activity during the day can help improve sleep. However, current recommendations discourage intense exercise before going to bed as it can increase a person’s heart rate and core temperature, which can ultimately disrupt sleep.

    Nighttime habits

    For many, the longest period of uninterrupted sitting happens at home in the evening. People also usually consume their largest meal during this time (or snack throughout the evening).

    Insulin (the hormone that helps to remove sugar from the blood stream) tends to be at a lower level in the evening than in the morning.

    Together these factors promote elevated blood sugar levels, which over the long term can be bad for a person’s health.

    Our previous research found interrupting evening sitting every 30 minutes with three minutes of resistance exercise reduces the amount of sugar in the bloodstream after eating a meal.

    But because sleep guidelines currently discourage exercising in the hours before going to sleep, we wanted to know if frequently performing these short bursts of light activity in the evening would affect sleep.

    Activity breaks for better sleep

    In our latest research, we asked 30 adults to complete two sessions based in a laboratory.

    During one session the adults sat continuously for a four-hour period while watching streaming services. During the other session, they interrupted sitting by performing three minutes of body-weight resistance exercises (squats, calf raises and hip extensions) every 30 minutes.

    After these sessions, participants went home to their normal life routines. Their sleep that evening was measured using a wrist monitor.

    Our research found the quality of sleep (measured by how many times they woke in the night and the length of these awakenings) was the same after the two sessions. But the night after the participants did the exercise “activity breaks” they slept for almost 30 minutes longer.

    Identifying the biological reasons for the extended sleep in our study requires further research.

    But regardless of the reason, if activity breaks can extend sleep duration, then getting up and moving at regular intervals in the evening is likely to have clear health benefits.

    Time to revisit guidelines

    These results add to earlier work suggesting current sleep guidelines, which discourage evening exercise before bed, may need to be reviewed.

    As the activity breaks were performed in a highly controlled laboratory environment, future research should explore how activity breaks performed in real life affect peoples sleep.

    We selected simple, body-weight exercises to use in this study as they don’t require people to interrupt the show they may be watching, and don’t require a large space or equipment.

    If people wanted to incorporate activity breaks in their own evening routines, they could probably get the same benefit from other types of exercise. For example, marching on the spot, walking up and down stairs, or even dancing in the living room.

    The key is to frequently interrupt evening sitting time, with a little bit of whole-body movement at regular intervals.

    In the long run, performing activity breaks may improve health by improving sleep and post-meal blood sugar levels. The most important thing is to get up frequently and move the body, in a way the works best for a person’s individual household.

    Jennifer Gale, PhD candidate, Department of Human Nutrition, University of Otago and Meredith Peddie, Senior Lecturer, Department of Human Nutrition, University of Otago

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Macadamia Nuts vs Brazil Nuts – Which is Healthier?

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    Our Verdict

    When comparing macadamia nuts to Brazil nuts, we picked the Brazil nuts.

    Why?

    They’re a lot more nutrient dense! But watch out…

    First, to do due diligence in terms of macros: Brazil nuts have twice as much protein and less fat, as well as being a little higher in fiber and slightly lower in carbs.

    In terms of vitamins, Brazil nuts are about 10x higher in vitamin E, while macadamias are somewhat higher in several B-vitamins.

    The category of minerals is where it gets interesting. Macadamia nuts are a little higher in iron and considerably higher in Manganese. But… Brazil nuts are a lot higher in calcium, copper, magnesium, phosphorus, potassium, selenium, and zinc.

    About that selenium… Specifically, it’s more than 5,000x higher, and a cup of Brazil nuts would give nearly 10,000x the recommended daily amount of selenium. Now, selenium is an essential mineral (needed for thyroid hormone production, for example), and at the RDA it’s good for good health. Your hair will be luscious and shiny. However, go much above that, and selenium toxicity becomes a thing, you may get sick, and it can cause your (luscious and shiny) hair to fall out. For this reason, it’s recommended to eat no more than 3–4 Brazil nuts per day.

    In short… Brazil nuts are much more nutrient dense in general, and thus come out on top here. But, they’re so nutrient dense in the case of selenium, that careful moderation is advised.

    Want to learn more?

    You might like to read:

    Why You Should Diversify Your Nuts

    Take care!

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  • Avocado vs Eggplant – Which is Healthier?

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    Our Verdict

    When comparing avocado to eggplant, we picked the avocado.

    Why?

    In the battle of “fleshy plants that can be enjoyed on toast or in warm salads”, there was a clear winner:

    In terms of macros, avocado has more than 2x the fiber, a lot more fat (famously, healthy fats, including omega-3 fatty acids), just a tiny bit more carbs, and more than 2x the protein, winning easily in this category.

    In the category of vitamins, avocado has a lot more of vitamins A, B1, B2, B3, B5, B6, B7, B9, C, E, and K, while eggplant is not higher in any vitamins. A total win for avocado in this round!

    Looking at minerals, avocado has more calcium, copper, iron, magnesium, phosphorus, potassium, selenium, and zinc, while eggplant has more manganese. Another easy win for avocado.

    In other considerations, neither are particularly a good source of polyphenols. Despite the rich purple color, the skin of an eggplant is so thin that unless one is eating only the skin, the polyphenol-per-100g scores are negligible.

    Adding up the sections makes for a very clear overall win for avocado, but by all means enjoy either or both, as diversity is good!

    Want to learn more?

    You might like:

    What Omega-3 Fatty Acids Really Do For Us

    Enjoy!

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