What cortisol is really doing to you

[0:03] Welcome to Chasing Life. You know, we've all been there. Heart is pounding, your blood is pumping, [0:09] your breath starts to shake. Might sort of feel like a predator is chasing you, [0:14] except there is no predator. You're just late for work. You're just stuck in a traffic jam. [0:20] Okay, now think about that experience, that very intense feeling that's washing over you. [0:25] That is your cortisol at work. Cortisol. That's a so-called stress hormone, [0:31] maybe something that you've heard of. And if you go online, you'll see that it gets blamed for [0:37] just about everything nowadays. Weight gain, bad sleep, mood swings, hypertension, [0:43] infertility, even diabetes. But how much of that is really true? [0:50] Well, today's guest is going to help me navigate the reality of what may be [0:53] one of the most misunderstood hormones, Dr. Robert Sapolsky. He's a neuroscientist, [1:00] a biologist. He's a professor. [1:02] He's a professor at Stanford University. He's also spent more than three decades studying stress. [1:07] He has lived with baboons in Africa, and he also runs a neuroscience lab. He's author of [1:13] Why Zebras Don't Get Ulcers. Such a great title for a book. It's pretty much the book to read [1:19] on stress. Honestly, he's one of my favorite people to talk to. We've had him on the podcast [1:23] before. And let me tell you, you're in for a real treat. I'm Dr. Sanjay Gupta, [1:29] CNN's chief medical correspondent, and this... [1:32] Is Chasing Life. [1:37] Cortisol has sort of become a buzzword nowadays. People talk about stress, [1:42] and now people who are talking about stress often start talking about cortisol as well. [1:47] What is cortisol? How do you define it? [1:50] Okay. Well, first off, it's a hormone. What's a hormone? It's any chemical messenger that gets [1:56] released into the bloodstream that causes something or other to happen elsewhere in the body. [2:02] We've all heard of estrogen, progesterone, [2:06] like testosterone. Everybody knows about adrenaline coming out of your adrenal gland. [2:12] Cortisol is the other main stress messenger coming out of the same place. [2:18] So what happens in the body then when cortisol actually kicks in [2:22] during a threat or during a perceived threat, I'm going to say for now? [2:25] Well, if you're thinking like a normal vertebrate, everything it's doing is fantastic. [2:32] It's ancient, ancient stuff. Dinosaurs, when they were being, [2:36] you know, crossed by a predator were secreting something close to cortisol. [2:40] Fish have them, birds, amphibians, reptiles, all the mammals. And what it does is it lets you [2:48] survive a short-term physical crisis, like you're running for your life or you're running for a meal. [2:56] Is it by releasing glucose into the bloodstream? Is that its primary mechanism of action? [3:01] Well, that's kind of what it's most beloved for, [3:05] mobilizing glucose. [3:06] You know, you're running from storage sites and handing it to your muscles that are going to save your life. [3:11] They work in cooperation with adrenaline to increase your heart rate, your blood pressure. [3:18] They turn off all sorts of stuff in your body that you could do tonight if you survive long enough. [3:26] You turn off growth, you turn off tissue repair, you turn off reproduction, [3:32] you turn off aspects of your immune system, everything that's not essential. [3:36] How do you think of it? Is it sort of a frenemy in this regard? [3:41] Well, it all depends on what kind of organism you are and what's stressing you. [3:47] If somebody's trying to eat you and you're sprinting for your life and you manage not to [3:52] secrete this hormone, you're going to die. But then you get to us and yeah, we secrete cortisol [3:59] when we've got our own acute physical crises but what we mostly do is we secrete it because of taxes, [4:06] and traffic changes, and other things. But you know, I don't want to say who, but I'm going to use you for that. [4:06] traffic jams and unrequited whatevers for psychosocial reasons. And you get in trouble [4:13] for two reasons. One is you now secrete it chronically at elevated levels. And the other [4:20] is you shouldn't be secreting it at all because everything it does to your body is great for a [4:26] five-minute emergency and is bad news if you've been doing chronically for months and years. [4:32] So if cortisol is great, maybe even ideal for a real crisis, [4:39] why is it such a poor mismatch for most of the things that worry us today? [4:45] Well, once again, I'm probably not being inaccurate that if it was 120 million years ago [4:53] and a dinosaur was running for its life, it would have been secreting glucocorticoids. It's been [4:59] there the whole time. It's how vertebrates survive all sorts of mediums. It's how vertebrates survive [5:04] all sorts of mediums. It's how vertebrates survive all sorts of mediums. It's how vertebrates survive [5:04] emergencies. And what do we do? We turn it on anticipating a blind date. We turn it on [5:12] thinking about our heart's going to stop beating someday. We turn it on thinking about refugees on [5:17] the other side of the planet. We've come up with this bizarre thing that's unique to very smart [5:24] social primates and a few other species, elephants, cetaceans, where you can go turn it on for all the [5:31] reasons it didn't evolve for. [5:33] This would make no sense to any dinosaur. We've gotten smart enough that we are stressed by things [5:40] that this system simply didn't evolve for. And do it chronically, it's going to hammer away at your [5:45] body. [5:47] So is the only solution then to reframe how these things are actually being interpreted in our own [5:53] brains? I mean, we're not going to change our cortisol system, right? We need to change how [5:58] much we activate it, it sounds like. [6:01] How much we activate it and for what reasons? [6:05] You don't want to turn off the system when you want to react like a normal organism does, [6:11] but you sure want to have it not activated when you're being a psychosocially smart human. [6:16] And what you're left with is exactly, you could come up with some like wildly complicated system [6:23] that will shut down cortisol secretion only when you're being psychologically stressed and it's [6:29] good the rest of the time. The alternative that's infinitely easier is to, [6:34] figure out how to be less psychologically stressed in your everyday life. [6:38] There are these commercial at-home tests now. People who are listening to this may be curious about their cortisol [6:45] levels. Worth it, do you think? [6:47] Is this something you advocate? [6:49] Uh, no, no, because they're not necessarily particularly accurate ways of measuring the stuff. [6:57] They're not telling you the most important things, which is profiles over time. [7:02] Are your resting levels elevated? [7:04] When something stressful occurs, do you turn on the stress response fast enough and big enough? [7:10] Even more importantly, when it's over with, do you recover from it quickly? [7:15] And that's one of the vulnerable spots. So those are big problems. [7:19] And the biggest problem is the basic mindset is this is a hormone that is your enemy. [7:26] You know, it's interesting. Again, we're drawing these links between stress, cortisol, [7:30] and then a whole host of things, including hyperglycemia, [7:34] sugar in your blood, infertility, high blood pressure, all these things. [7:39] What about weight gain, metabolism, belly fat, that sort of bucket of things? [7:45] This is where cortisol comes screaming back with a whole new world of bad effects. [7:52] Cortisol, glucocorticoids, ones we talked about. [7:56] What does it do? [7:56] It mobilizes glucose from your stored sites because you're running for your life. [8:02] And when the stressor is gone, you're running for your life. [8:03] And when the stressor is gone, you're running for your life. [8:04] And when the stressor is gone, you're running for your life. [8:04] And when the stressor is gone, you're running for your life. [8:04] And when the stressor is over with, cortisol happens to stick around for a long time. [8:08] And in primates, it's got a half-life of about 90 minutes or so. [8:13] What's it doing sticking around long afterward? [8:17] Cortisol not only mobilizes your energetic stress response, [8:22] it then mediates your recovery from it. [8:25] During the recovery phase, it promotes putting glucose back in your storage sites. [8:31] It makes you hungrier. [8:33] It stimulates eating. [8:34] And what does it do? [8:37] It tries to reverse all that. [8:39] And if you're secreting a whole lot of it, the net result is it's increasing fat deposition. [8:45] You get especially in trouble because there's two types of fat in the body. [8:51] Broad dichotomy, fat that winds up in your gut, truncal fat, [8:57] and fat that winds up in your rear end, gluteal fat. [9:00] And what you see is fat in your... [9:04] Your gut is much more sensitive to glucocorticoids than is fat in your rear end. [9:10] So not only are you preferentially storing fat if you're chronically being psychologically stressed, [9:15] you're putting it into the worst place in your body, right around all your organs there. [9:21] That's where you don't want to be doing it. [9:23] That promotes inflammation. [9:25] That's another major downside of chronic stress. [9:28] Because if you're chronically stressed, [9:30] you're chronically going to have to be going through the process of recovery. [9:34] You're recovering from the stress response. [9:36] And that's where a lot of the damage occurs. [9:38] This is unique to primates? [9:41] I mean, I know you say other animals have... [9:43] Obviously, they have cortisol. [9:45] They need it. [9:47] But in terms of the recovery or the sustained effects of cortisol, is that... [9:51] I mean, zebras don't get ulcers. [9:53] That's the title of the book. [9:55] So what are we to infer from that in terms of how zebras are different than humans then? [9:59] Well, if you're a zebra and... [10:03] I've had the luxury of seeing zebras. [10:05] I've said this many times. [10:07] You're some zebra out in the savannah. [10:09] And you're eating some grass. [10:11] And some lion appears. [10:13] And you run for your life. [10:15] And you get away from it. [10:17] And as far as I can tell, [10:19] 30 seconds after it's over with, [10:21] all the zebras thinking about is, [10:23] hmm, maybe I'll eat this piece of grass. [10:25] Oh, that one looks good. [10:27] It's gone. It's over with. [10:29] You take a primate, a baboon, or us. [10:31] And what it's thinking is, [10:33] how did I step into the wrong end of the field? [10:35] Why wasn't I more attuned? [10:37] Oh my God, mortality. [10:39] What could have happened to me? [10:41] What could have happened to my loved ones? [10:43] I don't know if a baboon is quite this sophisticated, [10:45] but they sure are capable of being anxious. [10:49] Zebras don't get anxious. [10:51] Primates get anxious. [10:53] Which is, you see threats that are not necessarily there. [10:57] Cortisol often gets blamed for sleepless nights. [11:01] Difficulty sleeping. [11:03] Is that a real connection [11:05] between cortisol and sleep issues? [11:07] Yeah. [11:10] Everything about that is bad. [11:12] Stress, by way of cortisol, [11:14] makes it hard to sleep. [11:16] Disrupted sleep [11:18] elevates your cortisol levels. [11:20] Oh no, we've got a vicious cycle. [11:22] And when you look at [11:24] the ways in which cortisol is [11:26] disrupting sleep, it's particularly [11:28] hitting the type of [11:30] sleep, deep way of sleep, where [11:32] you're building energy [11:34] back up in your brain. [11:36] Restorative stuff. [11:38] So separate of it waking you up in the [11:40] middle of the night, because it sets off [11:42] all sorts of alarms, even if you stay asleep, [11:44] you're doing a less efficient [11:46] job at [11:49] rebuilding your energy stores. [11:51] So you're getting in trouble [11:53] in lots of ways there, and [11:55] it's one of those [11:57] stress disrupts normal function, [11:59] which triggers stress, which disrupts [12:01] normal function, and off you go. [12:03] What is the indication, [12:05] aside from measuring this through blood or urine [12:07] or saliva, whatever, [12:09] how would you know that maybe you're [12:11] an individual that's making too much cortisol? [12:13] Well, rather than [12:15] somebody taking your [12:17] blood or making you do [12:19] unpleasant things with your urine [12:21] or whatever, you know, how do you [12:23] tell when you're stressed into a [12:25] pathological range? [12:27] You feel miserable. [12:29] Your sleep is disrupted. [12:31] You're exhausted all the time, even if [12:33] you've gotten good sleep. [12:35] Sex life is thrown out of whack. [12:37] You're getting a lot of colds. [12:39] Your concentration [12:41] is thrown out the window. [12:43] That's like a pretty good [12:45] assay, rather than paying somebody to measure [12:47] something in your bloodstream. [12:49] If all those things are happening, that's a [12:51] pretty good marker that [12:53] either you're secreting too [12:55] much cortisol, or your body [12:57] is listening to cortisol way [12:59] too much. [13:02] Things go wrong in this big global [13:04] kind of way. Hypertension, [13:06] heart rate increase, [13:08] if you've got diabetes, [13:10] it suddenly becomes harder to [13:12] keep it under control. [13:14] Just everything goes [13:16] either a little bit wrong [13:18] or eventually a lot wrong. [13:20] Very global pathologies. [13:22] That's your surest sign. [13:24] And at that point, instead of [13:27] seeing an endocrinologist, a [13:29] doctor who does hormones, maybe seeing [13:31] a psychologist would be better? [13:33] Exactly. And that's where you run [13:35] into, you know, [13:37] every dead white male [13:39] bias in the field, which [13:41] is if there's a problem, fix [13:43] it when it's already become a problem, [13:45] rather than preventatively. [13:47] And when you're fixing a problem after the [13:49] fact, if you could do it when you've got a [13:51] lab coat on and you're using [13:53] gazillion dollar machines [13:55] versus trying to get somebody [13:57] to shift their priorities in life, [13:59] the bias of medicine is [14:01] high-tech, after-the-fact interventions. [14:03] When you come to this [14:05] system, overwhelmingly, [14:07] the better solutions [14:09] are get less stressed [14:11] in circumstances where it would make [14:13] no sense at all to a zebra. [14:15] Do people with higher [14:18] cortisol, do they... [14:21] I want to phrase this question [14:23] in a proper way, but [14:25] are they more successful? [14:28] Well, this puts us into [14:30] tricky domain. [14:32] Depends how you're defining more successful. [14:34] Obviously, it [14:36] depends on what exactly the excess cortisol [14:38] is about. You're going to be [14:40] much more successful [14:42] at remembering strings of [14:44] digits backwards and [14:46] stuff like that [14:48] for the first couple of days that you're super [14:50] stressed. As we saw, chronically, [14:52] you begin to have [14:55] downsides to all of it. That, of course, [14:57] leads us to sort of [14:59] industrial psychology-type [15:01] questions. So you look at big [15:03] faceless corporations [15:05] and who's got the elevated cortisol [15:07] levels, who gets the most stress-related [15:09] diseases, the bias for [15:11] whatever it was, the people on top, [15:13] and it even had a term [15:15] executive stress syndrome, [15:17] and it turned out the research studies [15:19] that sort of broadcast that to [15:21] the world were done wrong [15:23] in the late 1950s, but everybody [15:25] learned, ooh, those poor [15:27] executives sitting in the... You look [15:29] at big corporations and [15:31] it's middle management who gets the stress-related [15:33] diseases. Why? [15:35] They've got the double whammy, [15:37] they've got responsibility, [15:39] but they don't have control. [15:41] They don't have autonomy, [15:43] and that's a killer combination. [15:45] Was that the Whitehall [15:48] experiment? Exactly. Whitehall, [15:50] which was showing [15:52] British civil servants [15:54] every step [15:56] you go down in the [15:58] British civil service browning [16:00] point sort of scale, your health [16:02] is worse, your life expectancy [16:04] is worse, you're more subject [16:06] to stress-related diseases, [16:08] and what was great was this was [16:10] controlled. These were people [16:12] at the bottom of the ladder who [16:14] were not in poverty. They were just [16:16] poorly paid civil servants. [16:18] These were people who all got [16:20] vaccinations. These were people [16:22] none of them were getting malaria. [16:24] So lots of controls in [16:26] there. Wonderful work by this [16:28] guy, Sir Michael Marmot, [16:30] showing [16:33] this, showing that [16:35] your place in that hierarchy is [16:37] hugely influential. [16:39] So the people who are sort [16:41] of middle management [16:43] they were worse off than people who [16:45] may have been lower down the ladder [16:47] as well as people who were higher on the ladder. [16:49] Well, no. There you [16:51] get the comparison of middle with [16:53] top, and that big [16:56] lesson was middle management is more [16:58] stressed. Look at the people down [17:00] at the bottom. They're doing [17:02] the worst of all. So the big [17:04] surprise was middle management versus [17:06] executives, but go down [17:08] the hierarchy there, [17:10] and as seen in every [17:12] westernized country [17:14] it doesn't matter if you've got socialized [17:16] medicine or you've got the American [17:18] nightmare system and [17:20] you know, all sorts of different [17:22] cultures. You go [17:24] down the socioeconomic ladder [17:26] and every step going down [17:28] on the average, health [17:30] is worse, life expectancy is [17:32] shorter, and it's not due to [17:34] obvious stuff. Oh, [17:36] poor people can't afford to go to a doctor. [17:38] They go to doctors in places with [17:40] socialized medicine. Ooh, [17:42] poor people, as is known, [17:44] are more likely to [17:46] drink or smoke to exit. [17:48] Control for that is because you [17:50] are being psychologically [17:52] pummeled all the time [17:54] with being a very low-ranking primate, [17:56] and that's the price [17:58] you pay. If you're thinking about this [18:01] now and listening to this podcast, is [18:03] one of the objectives when thinking about [18:05] stress and cortisol, would the goal [18:07] be more to become more resilient [18:09] to it or try and reduce [18:11] your stress in the first place? Obviously, [18:13] you'd like to do both, but where would you [18:15] focus your attention? You know, resilience [18:17] is how [18:19] you were responding to [18:21] an environmental kick in the rear [18:23] end, how long it takes you to [18:25] re-equilibrate to get back up on your [18:27] feet, changing [18:29] your life so that there's fewer [18:31] of those challenges. [18:33] Oh, resilience [18:35] is probably the way to go. [18:37] If you can get a less stressful job, [18:39] if you can get a boss who's not [18:41] a jerk, if you can [18:43] figure out your abusive relations [18:46] relationship, any of these things, that's great. [18:48] Decreasing the [18:50] legitimate psychosocial stressors [18:52] going on in the world around you, [18:54] resilience, perceptual [18:56] changes are probably stronger. [18:58] And that is not [19:00] to sit there and say to somebody, [19:02] oh, all you have to do is just get [19:04] the right attitude about your [19:06] appallingly unpredictable, [19:08] unempowered life. [19:10] This is mostly for [19:12] dealing with middle-class neuroses. [19:14] You know, I don't want to be [19:16] pollyannish about this at all, because [19:18] I think for a lot of people, they think so [19:20] much of this is out of my control. [19:22] There are people who live in places with [19:24] incredible socioeconomic [19:26] disparities. That's just [19:28] their reality. [19:30] A few months ago now, we had two [19:32] headlines in the news at the same time. [19:34] One was about the world's [19:36] first potential trillionaire, [19:38] and one was about the fact [19:41] that 600,000 people, [19:43] 400,000 of whom are children, [19:45] may die as a result of [19:47] cuts to USAID. [19:49] And that was in the same week, and I remember [19:51] thinking, what the blank [19:54] is happening here? [19:56] Those types of disparities [19:58] are toxic. [20:00] And it seems like they're toxic no matter [20:02] where you lie on the socioeconomic spectrum, [20:04] have or have not, or, you know, [20:06] wherever you may be. That's just [20:08] stressful, it seems. Absolutely. [20:10] And what you see is [20:12] when you look closely at [20:14] wonderfully subtle work by [20:16] all sorts of health psychologists, [20:18] what you see is being poor [20:20] is a pretty good way to [20:22] elevate stress hormone levels, and it's a [20:24] pretty good way to be more at risk for stress-related [20:26] disease. Being poor [20:28] amid plenty, [20:30] that's the route. [20:32] Inequality, being [20:34] surrounded by it, having your [20:36] nose rubbed in it over and over [20:38] each day. A baboon [20:40] gets trounced by a higher-ranking [20:42] guy, he's reminded that he's [20:44] low-ranking. Drive down the [20:46] freeway, and somebody in [20:48] some expensive Tesla [20:50] blasts past you. You never [20:52] even see that primate's face. [20:54] Right. And you have been subordinated [20:56] in the hierarchy [20:58] there. What surprises people the [21:00] most is exactly what you mentioned. [21:02] Everybody suffers [21:04] with increased [21:06] inequality. The poorer [21:08] because they have less psychological control [21:10] and they're dumped on and all this stuff, [21:12] the wealthy get less healthy [21:14] as well. Why? Because [21:16] they have to put more resources in [21:18] to keeping all the stressful [21:20] stuff outside the gates of [21:22] the mansion. Private schools, [21:25] security stuff, [21:27] bottled water, because who knows [21:29] what's in the real water supply. [21:31] What you see is, ironically, [21:33] for the privileged, [21:35] it could be very stressful [21:37] to try to make a life in which [21:39] something stressful never occurs. [21:41] My guess is, because of [21:43] who you are and your notoriety [21:45] in this field, you must have a lot of [21:47] people, including students and young [21:49] clinicians and people coming to you who [21:51] feel overwhelmed [21:53] by the systemic stressors, [21:55] the system, things that they can't [21:58] directly control. [22:00] What do you say to them to try and help them? [22:02] Well, in terms of the [22:06] psychological things that go into coping, [22:08] don't try to control [22:10] things you really have no control over. [22:12] Don't try to predict stuff [22:14] where knowing it in advance is [22:16] just going to make stuff worse. [22:19] Don't look for outlets [22:21] where you're doing so [22:23] that makes everybody around you [22:25] more miserable. [22:27] Don't mistake superficial relationships [22:29] at a club on Friday night [22:31] for a real supportive [22:33] social relationship. [22:35] It's a very narrow range in which [22:37] these psychological manipulations [22:39] work. You don't want to make somebody [22:41] feel like they had more control [22:43] when the outcome was a disaster. [22:45] You want to make them feel that way [22:47] when the outcome was pretty good. [22:49] Thank God I had some control. [22:51] Look how much worse it could have been. [22:53] Look how much better it could have been. [22:55] You know, I've been on a bandwagon [22:57] in recent years about how when you [22:59] look closely, we really [23:01] have no free will. There's no such thing [23:03] as free will. We're biological machines. [23:05] That's all I've been obsessing over. [23:07] And that gets a whole lot of people [23:09] really upset. [23:11] If you're on the bottom of a hierarchy [23:13] and you are living in [23:15] a culture which has system [23:17] justification telling you over and over [23:19] it's your own damn fault, [23:21] you could have been other. [23:23] Anybody could wind up being that [23:25] first trillionaire. All you're doing [23:27] is telling somebody it's your own [23:29] fault for stuff you had no [23:31] control over. And when [23:33] you recognize the extent [23:35] to which you have no control [23:37] over your bad luck in life, [23:39] all doing that does is prove [23:41] liberating. That's wonderful [23:43] news. I [23:48] read your book and I decided I wanted to be more like a [23:50] zebra. I always learn [23:52] so much from you. I [23:54] really appreciate it. And whenever I [23:56] get a little stressed, I imagine being at [23:58] Professor Robert Sapolsky's [24:00] house, walking out his front [24:02] door, taking a few steps to the [24:04] right, not even that far, and [24:06] suddenly being in the middle of just that [24:08] unbelievable sort of splash [24:10] of nature. It was just so gorgeous. [24:12] I mean, say what you want, [24:14] anybody who's listening. And I don't, again, [24:16] I'm very careful not to sound too Pollyannish, [24:18] but be outside for 15 minutes [24:20] in nature. And it does a pretty [24:22] good job of regulating [24:24] many of the things we've just talked about. [24:26] And probably [24:29] the most impactful way that it [24:31] does that is if it's beautiful [24:33] enough out there, you get a [24:35] sense of awe. And if you get [24:38] a sense of awe, you get a sense [24:40] of gratitude. And you get a [24:42] sense that your problems are [24:44] pretty small potatoes [24:46] compared to how big the sky [24:48] is. Yeah. Well, that was my conversation [24:53] with neuroscientist Dr. [24:55] Robert Sapolsky. Thanks for listening.