The Stress/Cortisol Belly Fat Connection

Reasons to Whittle Your Middle

Thoughts from some experts, Jillian Michaels and Sara Gottfried, M.D.stress-good-morning

I think we can all agree that “muffin tops” — the fat hanging over the waist of a too tight pair of pants — and beer bellies aren’t attractive. Still, when it comes to excess belly fat, the situation is more serious than how you look. Excess belly fat has been linked to diabetes, cardiovascular disease, some cancers and stress.When you have stress, your body releases certain “fight-or-flight” stress hormones that are produced in the adrenal glands: cortisol, norepinephrine and epinephrine. When you first get stressed, these hormones kick into gear. Norepinephrine tells your body to stop producing insulin so that you can have plenty of fast-acting blood glucose ready. Epinephrine will relax the muscles in your stomach and intestines and decrease blood flow to these organs. Once the stressor has passed, cortisol tells the body to stop producing these hormones and to go back to digesting regularly. It’s normal for your cortisol levels to go up and down throughout the day, but when you are chronically stressed your cortisol level goes up — and stays there.

When your stress and cortisol levels are high, the body actually resists weight loss. Your body thinks times are hard and you might starve, so it hoards the fat you eat or have present on your body. Cortisol tends to take fat from healthier areas, like your butt and hips, and move it to your abdomen which has more cortisol receptors. Hello ab flab! In the process, it turns once–healthy peripheral fat into unhealthy visceral fat (the fat in your abdomen that surrounds your organs) that increases inflammation and insulin resistance in the body. This belly fat then leads to more cortisol because it has higher concentrations of an enzyme that converts inactive cortisone to active cortisol. The more belly fat you have, the more active cortisol will be converted by these enzymes — yet another vicious cycle created by visceral fat.

So what if you have belly fat? Lose weight by following the best nutrition and lifestyle strategies that support you in times of stress, like the ones in my program. When you limit your caffeine to 200 milligrams a day, avoid simple carbs, processed foods, and refined grains, and get plenty of high-quality protein, in addition to de-stressing yourself, you’ll automatically help your body keep your stress hormones, especially cortisol, lower. It’s a day by day choice you’ll have to make, but the results will be worth it. Think how good it will be when you are as healthy on the inside as you look on the outside.

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What are the stress response pathways?
People can react to a stressor in different ways. For instance, if an individual perceives the stressor as a challenge to his/her control of a situation, norepinephrine, the “fight ” hormone is predominantly released. And, if the stress arousal increases and a possible loss of control is felt by the individual, then epinephrine, another “flight/anxiety” hormone is released. 

When the stress is prolonged and seen as hopeless, the individual becomes more distressed and feels defeated. This activates the hypothalamus in the brain. What follows is a cascade of hormonal pathways resulting in the final release of cortisol from the adrenal cortex (of the kidney).


The brain has the ability to selectively activate the fight, flight, or defeat responses (3). This usually occurs in day to day living when an individual perceives his/her hassles as a challenge to control or a loss of control. Although the stress pathways work together, they each can uniquely affect the function of bodily processes. For instance, the “fight” or “flight” stress responses cause the heart to beat faster and harder as well as release more free fatty acids (disassembled triglycerides) into the blood. The “defeat” response stress pathway can lead to enhanced lipogenesis (fat creation), visceral obesity (deep abdominal obesity), breakdown of tissues, and suppression of the immune system (1,2).

Where does cortisol come from and what is its purpose in the body?
Cortisol has become a ‘prime’ hormone of fascination, discussion and confusion within the consumer and fitness industry, due to misleading television commercials and advertisements. It is a steroid (compound based from a steroid nucleus) hormone that is produced in the cortex of the adrenal glands located on top of each kidney. Fasting, food intake, exercising, awakening, and psychosocial stressors cause the body to release cortisol (3,4,6,7). Cortisol is released in a highly irregular manner with peak secretion in the early morning, which then tapers out in the late afternoon and evening. Energy regulation and mobilization are two critical functions of cortisol (4). Cortisol regulates energy by selecting the right type and amount of substrate (carbohydrate, fat or protein) that is needed by the body to meet the physiological demands that is placed upon it. Cortisol mobilizes energy by tapping into the body’s fat stores (in the form of triglycerides) and moving it from one location to another, or delivering it to hungry tissues such as working muscle. Under stressful conditions, cortisol can provide the body with protein for energy production through gluconeogenesis, the process of converting amino acids into useable carbohydrate (glucose) in the liver. Additionally, it can move fat from storage depots and relocate it to fat cell deposits deep in the abdomen (8). Cortisol also aids adipocytes (baby fat cells) to grow up into mature fat cells (9). Finally, cortisol may act as an anti-inflammatory agent, suppressing the immune system during times of physical and psychological stress.

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Cortisol Switcharoo: How the Main Stress Hormone Makes You Fat and Angry

Have you heard of the “cortisol switch”?

The Good

Here’s the scenario. When you’re stressed, you feel the positive vibe of cortisol — the rise of energy, the focus, the charge, the ascent. Cortisol is the main stress hormone made in your adrenal glands and it’s designed to get you out of danger. Cortisol has three main jobs: raise blood sugar (to feed muscles so you can run or fight), raise blood pressure, and modulate immune function.

The Bad (aka, the Switch)

But here’s the rub (as Shakespeare puts it)… “the cortisol switch.” Your body ceases to register the positive aspects of cortisol, and you switch to the negative aspects of cortisol. It takes about 18 minutes.

It’s like when you drink regular coffee and feel like a rockstar, for 18 minutes to be precise. Then you get hit the wall, get all jittery and anxious. Thoughts erode. Blood sugar rises, then precipitously drops. Acidity increases. You get heavy and dumb.

The Long-Term Badness: From Muffin Top to Insomnia

Over time, high cortisol, when sustained, is linked to high blood pressure, prediabetes and diabetes, increased belly fat, brain changes such as atrophy of the hippocampus (where memory is synthesized), depression, suicide, insomnia, and poor wound healing. In fact, fat cells in the belly have four times more cortisol receptors compared to fat cells elsewhere, so you just keep reinforcing the muffin top as your cortisol climbs and stays high. It’s not pretty.

The best end game? Prevent the cortisol switch.

Cortisol is like that. It’s an impulsive little hormone that makes you feel smart and on your game one moment, and then turns on you. And the positive side of cortisol, prior to the switch, can be addictive.

My Own Path With the Cortisol Switch.

I know about such things. I’m a Harvard-trained physician scientist and yoga teacher. I struggled for 10 years ago with high cortisol, sugar cravings, unstable blood sugar, irritability, pre-diabetes, and a spare beach floatie around my waist (though I was otherwise lean and didn’t look the part of a person with high blood sugar). It felt like I looked at a piece of chocolate cake and gained weight. Overall, I gained about 20 pounds over a few years, despite eating moderately and running four days per week. I was cranky and tired. I barked at my kids and ran low on feel-good brain chemicals such as serotonin and dopamine, neurotransmitters that are depleted by excess cortisol over time. I’d get home from a long day of seeing 30 patients as a board-certified obstetrician and gynecologist, and do the worst possible thing: pour a glass of wine.

Turns out that alcohol raises cortisol.

Similar to others who struggle with a stress-crazed life and the downstream effects of the cortisol switch, conventional medicine had no answers for me. I went to the doctor and was told to exercise more. That might be the worst advice a clinician could give to someone with high cortisol.

Time for a Little Hypothesis-Testing…

I did what Harvard taught me well: I formulated a hypothesis. Perhaps my hormones were out of whack. I read a ton, beyond the mainstream textbooks that I had on my bookshelf. I learned that for thousands of years, Ayurveda and Traditional Chinese Medicine dealt with such problems.

I Went Rogue. I Channelled Tim Ferris.

I turned myself into a guinea pig. Biohacker, but of the female persuasion. It took me years, but I fixed my cortisol, changed what I ate, lost weight, and filled my tank with energy again. It took me years, but my cortisol is now normal. And (bonus prize!) the downstream effects are much more flexibility, emotional intelligence and dexterity, and sex drive! No more fat and angry!

What can be done about the problem of cortisol, and the shadow side of this important stress hormone? I’ve got five practices for you. (These are not tips, because tips are things you do once and then they fall by the wayside. Practices are different. You take them on more fully, and integrate them into your day — ultimately becoming a habit.)

5 Practices to “Right-Size” Your Cortisol (and Prevent Cortisol Switch)

    1. Eat nutrient-dense food. Avoid refined carbs and sugar like the plague. Jonesin’ for sugar or alcohol? It could be a symptom of high cortisol. Don’t go there. It just keeps spiraling downward and doesn’t make you feel better. Eyes on the prize, which is cortisol in its sweet spot, not too high and not too low.
    1. Take that fish oil. You know it’s a good idea. Yes, it’s more proven than any other supplement at the health food store. So why don’t you take it? Just 2,000 mg per day lowers your cortisol level.
    1. Contempletive practice is nonnegotiable. This is especially true if you are struggling with your weight. A recent study from my ‘hood, the University of California at San Francisco, showed that obese women who began a mindfulness program and stuck with it for four months lost belly fat. That is radical. Just radical.
    1. Adaptive exercise. Running raises cortisol. Switching to adaptive exercise where maximal heart rate (and VO2 max) are not king really worked for me. In fact, yoga and Pilates made all the difference in my weight. (Note to the running addicts: Are you a cortisol junkie? Perhaps. Fortunately, vitamin C may buffer the rise in cortisol associated with maximal exercise.)
    1. Rhodiola is queen when cortisol is high. Rhodiola is an herb and one of the forms of ginseng, and it’s the best proven botanical treatment for lowering cortisol. I just took mine, so I’m on the happy side of the mountain, of the “cortisol switch.”

And if you need to go deeper, if you know from that still point within that you have a problem with the cortisol switch, and if you know that you need external accountability and a daily reminder… I’ve got a few more practices to share with you in a few days. I want to shorten the learning curve for you, and prevent for you the years it took me to get on the cortisol repair train. I want to shorten your learning curve. Tune in next time and ride the train further.

Choose: Virtuous or Vicious?

Your stress response is tightly connected to your sugar response, and you choose with your fork either a virtuous cycle or a vicious cycle.

This isn’t just an epidemic; it’s an undiagnosed epidemic.

Dr. Hyman: “Ninety percent of people have this are not diagnosed and it affects one out of two people.”

Meet Your Charlie’s Angels

Most likely, you have either estrogen dominance or low estrogen, but it’s also possible your bad boy hormone, cortisol, is off. We know that 20 percent of people with poor mood and depression have a problem with the third angel, thyroid.[1],[2] (For men, I call them your Three Amigos: testosterone, cortisol, and thyroid.)

My main point: if you’re cranky, tired but wired or just plain tired, think biology first before you start blaming yourself and signing up for therapy. Most likely, your hormonal Charlie’s Angels need a few small tweaks, such as the one I have for you today. (Of course, you want to get this problem checked out with your local clinician if it’s been going on for more than two weeks or it’s severe.)

Low estrogen causes your mood and libido to tank. This is not just a problem of women in the later years of menopause, but younger women may experience a drop in estrogen as early as 28, especially if they go on the pill. Low estrogen makes your vagina as dry as the kitchen floor, your joints less flexible, your mental state less focused and alive. So in the interest of general juiciness — make a smoothie!

Cortisol Switcharoo: How the Main Stress Hormone Robs Your Brain of Happy Chemicals and Sleep

 Today I want to dish on my Achilles’ heel, which is the wayward, dysregulated hormone called cortisol. I wrote last time about the “cortisol switch” (described in part one — click here for the definition), and now let’s talk about how cortisol, the main stress hormone produced by your adrenal glands in your mid-back, brings you down and ramps up your risk of serious disease — and more importantly, what you can do about it.

The Cortisol Diaries

Cortisol isn’t a bad hormone, it just has a bad case of impulse control issues when your life is stress-crazed. When stress is not managed skillfully, and it becomes a chronic and repetitive part of your personal narrative, cortisol rises too high. Cortisol has three main jobs in your body: raise blood sugar (as fuel), raise blood pressure (so you can run from the tiger your body thinks is chasing you), and modulate your immune system.

Here are some of the problems linked with excess cortisol.

    • Diabetes/pre-diabetes. Cortisol’s main job is to raise glucose levels, and even small bumps in cortisol, such as when drinking a cup of regular coffee, can raise blood sugar and increase insulin resistance (another major topic I’ll tackle soon for you, and I promise to make it stunningly simple).
    • Sucky mood. Persistent stress causes your body to increase the production of brain chemicals, and initially you make too many “excitatory” neurotransmitters, such as epinephrine and norepinephrine. Over time your supply runs dry on feel-good brain chemicals such as serotonin, which regulate mood, sleep, and appetite. Then you find yourself mildly depressed, unable to focus, and wondering what happened to your battery charge. Maybe sleep and motivation start to worsen. Not pretty, but also not a good time to start a prescription antidepressant (unless, of course, symptoms are severe and you together with your doctor decide it’s needed) — you need to work on more effective stress management and correcting your cortisol (see prescriptions below), not crank up your serotonin with a happy pill! By the way, the “happy” pill was recently shown to increase breast and ovarian cancer by 11 percent, which you can now add to the list of side effects including weight gain, stroke, and libido hijack.[1]
    • More body fat. Too much cortisol makes you fat, especially at your belly. Hello, spare beach floaty? Unfortunately, the belly fat has four times the number of cortisol receptors, so you get into a vicious cycle of excess cortisol creating more body fat, which gets stimulated by persistently high cortisol levels.
    • Slow wound healing. When cortisol is high, it takes you longer to recover from injury, like a cut or even a sports injury. Your immune system is too jacked up to work effectively.
    • Lousy sleep. If you measure the cortisol levels of insomniacs, they are increased. High cortisol at night inhibits melatonin and disrupts your circadian clock
    • Liver injury. Up to 20 percent of people with Cushing’s syndrome, the clinical diagnosis conventional doctors make in people with cortisol levels that are inappropriately high and cause a particular batch of signs and symptoms, also have liver problems such as non -alcoholic fatty liver disease (NAFLD). Recently, the reverse was also found to be true: People with NAFLD show a switch in how the liver processes cortisol, leading to increased cortisol metabolism and clearance, perhaps to protect the liver from further damage from cortisol.[2]

Okay, Okay… Enough of the doom and gloom. Let’s turn this ship around before it hits the iceberg.

Now, for your prescriptions
I have 250 prescriptions for right-sizing your cortisol. Here are three more.

1Get a massage. You’re probably thinking, “Duh!” but there was just a small randomized studysuggesting that massage may lower your cortisol. Now if we could just get our insurance to pay for it!

2. Alternate nostril breathing. I do this three times per day. The Sanskrit term is “Nadi Shodhana,” or channel-clearing breath. This is not woo woo — there’s is science showing that when you breath in this way, your breath crosses the center line, builds synapses, leverages neuroplasticity, helps you see the bigger picture, and increases problem solving. And, by the way, it’s shown in a randomized trial to lower blood pressure and heart rate, which means it reverses signs of stress.

3. L-Theanine. Shown to calm down the sympathetic nervous system (“fight or flight”). The idea is that we need sacred balance between the sympathetic nervous system and parasympathetic nervous system (“rest and digest”). Dose of L-theanine is 250 to 400 mg per day.

Now I’d like to hear from you…

What are your favorite ways to lower cortisol when it’s crazy high? Another prescription of mine is to leverage oxytocin with lingering touch (and orgasm), but that’s a conversation for another time.belly-fat-hormone-cortisol-adrenal-ovary-thyroid-liver

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3 thoughts on “The Stress/Cortisol Belly Fat Connection

  1. I really enjoyed reading this and have taken some of your points on board. I’ve found over the years that I’m easily prone to stress, even in school and I’ve never quite managed to learn effective ways to control it so I hope this works!

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