WEBVTT - What's the deal with cortisol? 0:00:00.960 --> 0:00:04.240 Emily. We're talking about cortisol today, which people say is 0:00:04.280 --> 0:00:07.720 a stress hormone, and yeah, we'll get there. But I've 0:00:07.720 --> 0:00:10.360 been thinking a lot about stress this week, and one 0:00:10.360 --> 0:00:13.000 thing I wanted to tell you is that my fitness 0:00:13.320 --> 0:00:17.799 tracking watch, which is a Samsung watch, periodically pings me 0:00:17.920 --> 0:00:21.000 just to be like, hey, you're feeling very stressed right now, 0:00:21.680 --> 0:00:22.920 and this. 0:00:22.720 --> 0:00:24.560 Is that sounds so annoying. 0:00:24.560 --> 0:00:30.640 Not helpful, Samsung. I have no idea why. Like, it'll 0:00:30.680 --> 0:00:33.680 come up and I as a doctor, you know, I'll 0:00:33.720 --> 0:00:35.839 take my pulse and be like, it's something weird happening, 0:00:36.080 --> 0:00:38.880 and I think I feel fine, But then of course 0:00:38.880 --> 0:00:41.040 it gets in your head it's like, what, well am 0:00:41.080 --> 0:00:43.400 I stressed? And then I decide, well, I must be stressed, 0:00:43.400 --> 0:00:46.199 and then I'm stressed. Does this happened to you? 0:00:46.240 --> 0:00:48.599 No, because my fitness tracker, of which I have two, 0:00:49.320 --> 0:00:51.840 give me different kinds of inputs. But I will say 0:00:51.880 --> 0:00:53.760 at the end of the day, every day I get 0:00:53.920 --> 0:00:57.480 a message that's like, today you spent blah blah blah 0:00:57.520 --> 0:01:01.680 minutes in the high stress zone. And then it tells 0:01:01.720 --> 0:01:06.839 me whether those are like part of my actual exercise 0:01:06.920 --> 0:01:08.480 or other things sort of like today you spent two 0:01:08.520 --> 0:01:10.479 hours and nine minutes in the high stress zone, the 0:01:10.480 --> 0:01:14.360 majority of which came from activities outside of strain. And 0:01:14.400 --> 0:01:16.280 then it's like, oh, well, what else was I what 0:01:16.319 --> 0:01:18.360 else was I doing? And then it's usually like usually 0:01:18.400 --> 0:01:20.080 this came from sleep, and then I'll be like. 0:01:20.000 --> 0:01:21.200 Why did you drink alcohol? 0:01:21.319 --> 0:01:24.000 That's like it's like, so it gets a little more judgmental, 0:01:24.520 --> 0:01:27.720 but yeah, people don't like the judgment aspects of watches. 0:01:28.240 --> 0:01:30.120 It's like, I, do you ever do you run with 0:01:30.240 --> 0:01:30.679 a watch? 0:01:30.920 --> 0:01:34.200 I do exercise. Do you notice that when you start. 0:01:34.040 --> 0:01:38.440 Running it beeps a number like plus one, plus two, 0:01:38.520 --> 0:01:39.160 negative one? 0:01:39.200 --> 0:01:39.959 Does your watch do this? 0:01:40.240 --> 0:01:41.440 My watch doesn't do that. 0:01:41.520 --> 0:01:42.360 This is the worst thing. 0:01:42.400 --> 0:01:44.320 You're like running along and you're like I feel pretty 0:01:44.319 --> 0:01:46.680 good and then your watch beeps and it's like negative 0:01:46.800 --> 0:01:50.760 six and that you suck it, your bad And so 0:01:51.240 --> 0:01:53.320 I think they should dial down the amount of information 0:01:53.320 --> 0:01:54.680 our watches are pushing at us. 0:01:54.880 --> 0:01:58.640 I think telling someone, hey, you your stressed man is 0:01:59.160 --> 0:02:01.920 more or less the equivalent of me telling my sixteen 0:02:01.960 --> 0:02:04.600 year old daughter, like, you seem like you're in a 0:02:04.600 --> 0:02:07.680 bad mood, Like it's just just it's not going to 0:02:07.760 --> 0:02:08.240 go well. 0:02:08.360 --> 0:02:10.880 One step up from like are you getting your period? 0:02:11.040 --> 0:02:13.000 But like it still pretty bad? 0:02:13.360 --> 0:02:16.560 Okay, having three older sisters, I know not to ask 0:02:16.600 --> 0:02:19.800 that question. You'll learn that. You learn that maybe we 0:02:19.840 --> 0:02:22.840 need a more objective readout of stress. Maybe that objective 0:02:22.919 --> 0:02:26.480 readout is cortisol. Maybe not. Let's figure it out, find out. 0:02:29.200 --> 0:02:32.240 I'm Emily Aster, I'm an economist and a data expert. 0:02:32.360 --> 0:02:34.440 And I'm Perry Wilson, I'm a medical doctor. 0:02:34.880 --> 0:02:39.320 It's Thursday, July ninth, twenty twenty six. And this is wellness. 0:02:38.680 --> 0:02:42.640 Actually, because you're getting a staggering amount of health and 0:02:42.680 --> 0:02:46.680 wellness information nowadays from every source imaginable, and some of 0:02:46.720 --> 0:02:48.640 it is awesome and some. 0:02:48.560 --> 0:02:53.720 Of it is well actually both Fortunately we are both 0:02:53.800 --> 0:02:56.320 people who know how to read studies, how to parse 0:02:56.360 --> 0:02:58.959 the data, and can tell you what's worth thinking about 0:02:59.120 --> 0:03:00.880 and what you can safely ignore. 0:03:01.200 --> 0:03:03.480 But before we dig in, a note that this podcast 0:03:03.600 --> 0:03:06.120 is for educational purposes and should not be construed as 0:03:06.160 --> 0:03:09.399 medical advice. We don't know your unique situation, so talk 0:03:09.400 --> 0:03:11.519 to your doctor for personal health decisions. 0:03:12.520 --> 0:03:15.600 This week we're asking what's the deal with cortisol? 0:03:15.919 --> 0:03:18.040 Perry and I will give the official smasher pass and 0:03:18.080 --> 0:03:19.960 then we'll get to your question of the week, but 0:03:20.040 --> 0:03:22.760 first let's do the health news roundup after the break. 0:03:34.760 --> 0:03:38.320 And we are back with the health news of the week, Emily. 0:03:38.720 --> 0:03:45.200 The FDA is allowing Zin pouches to market their relative 0:03:45.480 --> 0:03:51.880 health benefits compared to other tobacco products like cigarettes. What's 0:03:51.960 --> 0:03:53.200 going on here? What's up with zin? 0:03:54.080 --> 0:03:57.640 So Zin is a tobacco product. 0:03:57.880 --> 0:04:02.360 It is a nicotine product particular, and people like it 0:04:02.600 --> 0:04:05.600 a lot of people like it a lot. It's become 0:04:05.680 --> 0:04:09.040 very popular with like tech bros. Because there's this sense 0:04:09.080 --> 0:04:13.640 that nicotine increases your focus, and people like Andrew Huberman 0:04:13.720 --> 0:04:16.479 are kind of into the health benefits of nicotine, but 0:04:16.520 --> 0:04:18.680 they also understand this smoking is bad for you, and 0:04:18.760 --> 0:04:20.599 so this is like a way to get your nicotine 0:04:21.560 --> 0:04:27.039 without smoking. And Okay, so the FDA has now allowed 0:04:27.400 --> 0:04:31.040 Zin to make help what I would describe as health statements. 0:04:31.560 --> 0:04:34.760 So the claim things like using Zin instead of cigarettes 0:04:34.800 --> 0:04:36.840 puts you at a lower risk of mouth cancer, heart disease, 0:04:36.920 --> 0:04:41.440 lung cancer, stroke emphasem, and chronic broncholitis that statement is. 0:04:41.680 --> 0:04:42.880 I would say broadly true. 0:04:43.000 --> 0:04:46.200 So these products are definitely safer than cigarettes. I think 0:04:46.279 --> 0:04:50.720 what many people are concerned about is that children will 0:04:50.720 --> 0:04:54.599 see this and be like, hey, Zen's a health food 0:04:55.080 --> 0:04:56.800 and like I can do and this is like not 0:04:56.920 --> 0:04:59.720 bad for me at all. And on top of an 0:04:59.760 --> 0:05:02.479 app atmosphere in which you can also get as we 0:05:02.520 --> 0:05:05.600 talked about an earlier episode, like fruit flavored vapes, we're 0:05:05.680 --> 0:05:09.800 kind of entering a place where somehow we've come up 0:05:09.839 --> 0:05:13.280 with this idea that there's health benefit opportunities to things 0:05:13.320 --> 0:05:15.680 that are not cigarettes but still have this nicotine. And 0:05:15.720 --> 0:05:19.479 I think that's pretty dangerous in part because if you 0:05:19.480 --> 0:05:22.880 get addicted to nicotine and then there's no zin around, 0:05:23.560 --> 0:05:27.000 you got to move to something else, like cigarettes, which 0:05:27.000 --> 0:05:27.560 are bad for you. 0:05:28.200 --> 0:05:32.080 Yeah, or just zin, I mean this is or just zin. 0:05:32.080 --> 0:05:33.719 Is bad for you. We don't really. 0:05:33.800 --> 0:05:37.440 I mean this is true that smoking, like lighting something 0:05:37.480 --> 0:05:39.480 on fire and inhaling the smoke that comes out of it, 0:05:39.520 --> 0:05:42.960 is worse for your lungs than sucking on a nicotine pouch. 0:05:43.080 --> 0:05:45.920 This is, Yes, you're at less risk of lung cancer, 0:05:46.200 --> 0:05:49.000 but nicotine is a highly addictive substance. It binds to 0:05:49.000 --> 0:05:52.359 a receptor in your brain called the NMDA receptor. It 0:05:52.400 --> 0:05:55.640 makes you feel certain good things and like all physically 0:05:55.640 --> 0:05:59.000 addictive substances. When it's taken away from you, you feel 0:05:59.200 --> 0:06:04.280 much worse you did at baseline. The psychological impact of 0:06:04.320 --> 0:06:08.320 that may be substantial. Certainly the economic impact is substantial 0:06:08.320 --> 0:06:10.919 because these things cost money. And being addicted to something 0:06:10.960 --> 0:06:12.800 that you need to take, even if it had like 0:06:12.960 --> 0:06:15.680 absolutely no ill health effects, if it's just like, oh man, 0:06:15.920 --> 0:06:18.359 I've got to buy this every day and keep sucking 0:06:18.440 --> 0:06:22.320 on it, imposes a cost. So it's an interesting shift 0:06:22.440 --> 0:06:24.920 at the FDA where they're kind of being accurate, but 0:06:24.960 --> 0:06:26.880 I think from a public health standpoint, they're not doing 0:06:26.880 --> 0:06:28.880 a great job telegraphing that, like this still isn't a 0:06:28.880 --> 0:06:29.360 good idea. 0:06:29.560 --> 0:06:32.280 Yeah, I also think we're we're actually in terms of 0:06:32.360 --> 0:06:35.960 the health benefits or costs of nicotine. You know, there's 0:06:36.000 --> 0:06:39.320 some research that nicotine kind of increases focus, but I 0:06:39.360 --> 0:06:43.080 don't know that we have anything that would tell us 0:06:43.120 --> 0:06:46.680 about the health potential health costs of consuming quite a 0:06:46.720 --> 0:06:49.040 lot of nicotine, which is effectively what people are doing 0:06:49.080 --> 0:06:51.479 when they're consuming many many zinn pouches in a day. 0:06:51.520 --> 0:06:53.479 So we're getting kind of a dose that's even a 0:06:53.480 --> 0:06:57.000 bit different probably than we've been tested and say mice. Yeah, Anyway, 0:06:58.200 --> 0:07:01.200 all right, something else that's going on is an outbreak 0:07:01.200 --> 0:07:07.440 of explosive diarrhea. Cyclospora outbreak is happening throughout the US, 0:07:07.640 --> 0:07:10.240 especially in places in the Midwest. 0:07:11.000 --> 0:07:12.960 Perry, what can you tell. 0:07:12.880 --> 0:07:16.360 Us about the explosive diarrhea and where it's coming next 0:07:16.400 --> 0:07:16.880 and why? 0:07:17.440 --> 0:07:24.360 Uh okay. Cyclospora is a parasitic amiba that causes a 0:07:24.400 --> 0:07:30.560 really bad gastro intestinal illness voluminous, watery, non bloody. For 0:07:30.560 --> 0:07:35.240 what it's worth, diarrhea people are going dozens of times 0:07:35.280 --> 0:07:38.680 per day, can lead to pretty severe dehydration, including the 0:07:38.720 --> 0:07:42.920 need for ivy fluids, et cetera. Current numbers, there are 0:07:42.920 --> 0:07:47.000 seven hundred reported cases. This is a one of the 0:07:48.080 --> 0:07:50.960 reportable outbreak, So like if you get a positive test, 0:07:50.960 --> 0:07:52.840 and if you run a clinical lab and a positive 0:07:52.840 --> 0:07:55.280 test comes through, you're required to report it, so we 0:07:55.360 --> 0:07:58.240 catch those, But there are likely people who are suffering 0:07:58.320 --> 0:08:01.400 in silence at home and their gatorade and not getting 0:08:01.400 --> 0:08:07.040 officially tested for this. It's predominantly in the Midwest. The 0:08:07.200 --> 0:08:10.600 concern is that we actually don't know the source. So 0:08:10.760 --> 0:08:14.960 it's clear that you know where a cyclist bora usually 0:08:15.040 --> 0:08:20.920 lives is on produce and particularly like mint and parsley, 0:08:21.000 --> 0:08:23.520 like the sort of garnishy produce, as well as berries, 0:08:23.880 --> 0:08:26.240 which gets into my head because the berries are so 0:08:26.280 --> 0:08:28.680 good right now, and I like am getting blueberries and 0:08:28.680 --> 0:08:31.760 strawberries and raspberries and blackberries all the time at my 0:08:31.920 --> 0:08:35.280 grocery store. But so far testing has not revealed a 0:08:35.320 --> 0:08:38.000 particular source. It is certainly out there. 0:08:38.920 --> 0:08:41.400 It's I should say, it's actually a hard thing to 0:08:41.520 --> 0:08:44.720 test exact sources for because it takes The incubation period 0:08:44.840 --> 0:08:47.920 is not immediate. So if there's something which makes you 0:08:47.960 --> 0:08:50.920 sick in you know, three hours, it's actually quite easy 0:08:50.920 --> 0:08:53.200 to say, Okay, you know a group of people got 0:08:53.240 --> 0:08:55.120 sick within three hours, we know exactly what they ate 0:08:55.160 --> 0:08:58.000 three hours ago. Okay it was spinach or whatever. Here 0:08:58.320 --> 0:09:00.280 it takes a while. People don't remember what they eight. 0:09:00.480 --> 0:09:02.240 They ate a lot of different things. It's been hard 0:09:02.280 --> 0:09:02.800 to pinpoint. 0:09:03.040 --> 0:09:03.439 Yeah. 0:09:03.480 --> 0:09:05.360 One thing I was looking into about this because my 0:09:05.800 --> 0:09:07.960 daughter gave me a hard time the other day because 0:09:07.960 --> 0:09:09.400 I made her a hamburger and she said it was 0:09:09.520 --> 0:09:14.160 undercooked and she's very afraid of gastrointestinal illnesses. And you sure, 0:09:14.480 --> 0:09:16.600 but you know, yes, I guess you should cook your 0:09:16.679 --> 0:09:19.800 meat adequately, but like, come on, a rare hamburger is 0:09:19.880 --> 0:09:22.920 just the best thing in July. So I did dig 0:09:22.960 --> 0:09:26.520 into this to see, like gastro intestinal illnesses in the 0:09:26.640 --> 0:09:31.000 United States, what percent come from meat and poultry versus produce? 0:09:31.080 --> 0:09:33.920 And actually forty six percent of the food born illnesses 0:09:34.960 --> 0:09:37.640 come from produce and thirty one percent from meat and poultry, 0:09:37.640 --> 0:09:39.800 which leaves I don't know whatever percent. I'm not sure 0:09:39.840 --> 0:09:43.280 what else, but more often, more often from produce. Yeah, 0:09:43.320 --> 0:09:45.800 could be things like that, but produce is the most 0:09:45.800 --> 0:09:49.880 common source for food born illnesses in the US. You 0:09:49.920 --> 0:09:54.679 should wash your produce, and guys, it's watermelon season, like 0:09:54.720 --> 0:09:56.760 you should be washing the outside of your watermelon. I 0:09:56.760 --> 0:09:58.760 know you think that you're cutting into it, but you 0:09:58.800 --> 0:10:01.600 know you cut through the skin and it goes through. 0:10:02.280 --> 0:10:05.920 That's my own that you can suffer. 0:10:05.640 --> 0:10:08.480 Your safety perries here for ruining everything. 0:10:08.720 --> 0:10:11.400 Washa, I'm not ruining it. Just wash it and then 0:10:11.400 --> 0:10:17.920 it's delicious. All right. Let's talk about a new secret 0:10:18.040 --> 0:10:23.199 shopper study of these GLP one websites. So, as you know, 0:10:23.440 --> 0:10:28.280 there are multiple websites online that market GLP ones, and 0:10:28.360 --> 0:10:30.640 a new study actually out of Yale. Although I wasn't 0:10:30.679 --> 0:10:34.200 affiliated with it, set up a fake persona and called 0:10:34.440 --> 0:10:37.760 forty nine of these websites and was able to get 0:10:37.800 --> 0:10:40.760 a prescription from forty five of the forty nine, and 0:10:40.880 --> 0:10:45.559 two of them issued a prescription in under five minutes. Emily, 0:10:45.720 --> 0:10:50.040 problem or solution, I. 0:10:50.000 --> 0:10:54.760 Would say problem. I mean, look, we've talked about this before. 0:10:54.920 --> 0:10:58.120 I'm a smashed broadly on GLP ones as a treatment 0:10:58.160 --> 0:11:01.880 for many things, and I think this is an incredible technology. However, 0:11:02.160 --> 0:11:05.840 it is a medication, injectable, medication or now oral, but 0:11:05.880 --> 0:11:10.240 like it's a medication that has significant effects on people 0:11:10.400 --> 0:11:14.160 and should ideally be prescribed by a doctor who has 0:11:14.160 --> 0:11:19.160 had some interaction with the patient. And I do worry 0:11:19.200 --> 0:11:22.640 about people who are really don't need this or for 0:11:22.720 --> 0:11:26.400 whom maybe it's even kind of damaging in the sense that, 0:11:26.480 --> 0:11:30.880 you know, we have seen some concerning at least anecdotal 0:11:30.920 --> 0:11:33.240 evidence about me people have suffered from meeting disorders in 0:11:33.240 --> 0:11:35.920 the past, this kind of this environment reupping those and 0:11:36.000 --> 0:11:38.719 I would worry about people in that category calling an 0:11:38.720 --> 0:11:40.600 online pharmacy and saying, hey, I feel like I need 0:11:40.600 --> 0:11:44.360 a JLP one similar to an article I saw come 0:11:44.400 --> 0:11:48.000 across my Instagram feeds. Just a clip of someone saying 0:11:48.080 --> 0:11:50.040 that the way that she got a JLP one was 0:11:50.080 --> 0:11:55.200 by wearing twenty pound ankle weights to the doctor so 0:11:55.240 --> 0:12:00.360 she could weigh the like required one hundred and sixtys 0:12:00.440 --> 0:12:03.120 to get on a GLP one, even though she was 0:12:03.160 --> 0:12:06.160 only one hundred and twenty pounds, which probably does not 0:12:06.400 --> 0:12:08.160 necesssitate needing a JLP one. 0:12:08.240 --> 0:12:10.360 So that feels bad to. 0:12:10.360 --> 0:12:13.839 Me, Yeah, that should feel bad. Just over fifty percent 0:12:13.880 --> 0:12:16.760 of the sites asked about eating disorders at all in 0:12:16.800 --> 0:12:21.400 their intake surveys, so there is some potential missed opportunities there. 0:12:21.400 --> 0:12:23.079 And I should say that almost all the sites are 0:12:23.200 --> 0:12:28.280 selling compounded GLP ones. They do this by making custom preparations. 0:12:28.440 --> 0:12:32.800 They take bulk amounts of like ozembic or munjaro, dissolve 0:12:32.840 --> 0:12:34.640 them in their own water, and then you have to 0:12:34.640 --> 0:12:36.840 add something to personalize it to the patients. They usually 0:12:36.840 --> 0:12:39.160 add like some B twelve or something so that it's 0:12:39.200 --> 0:12:41.520 not exactly the same as the branded pharmaceutical. So it's 0:12:41.520 --> 0:12:44.280 in this very regulatory gray zone. You got to be careful. 0:12:44.480 --> 0:12:47.960 I mean, you know. Again, there's a flip side of this, 0:12:48.600 --> 0:12:50.560 and I actually wrote about this this week, which is like, 0:12:50.800 --> 0:12:55.200 if it's this easy, then should there be prescriptions at all? 0:12:55.400 --> 0:12:58.480 Like this middle road of oh yeah, there are prescriptions, 0:12:58.480 --> 0:13:01.040 but everyone can fake it seem sort of dumb. So 0:13:01.120 --> 0:13:03.599 you either close these loopholes and you actually have to 0:13:03.600 --> 0:13:06.120 see a doctor and discuss it, or you don't and 0:13:06.160 --> 0:13:09.319 you just let people buy the things and the libertarians win. 0:13:09.840 --> 0:13:11.400 Right, Yeah, and I think we have either. 0:13:11.559 --> 0:13:14.080 Yeah, we haven't made that choice with most other medications. 0:13:14.080 --> 0:13:15.880 And I think most people would not make the argument 0:13:15.880 --> 0:13:18.560 that we should be allowing people to you know, take 0:13:18.800 --> 0:13:22.760 statins whenever or you know, just get on different But 0:13:22.840 --> 0:13:24.480 maybe maybe people would argue that. 0:13:26.320 --> 0:13:27.800 All right, that's in for the health news of the 0:13:27.840 --> 0:13:31.280 week after the break. What's the deal with cortisol? 0:13:36.640 --> 0:13:40.640 All right, Perry, I am delighted to talk about cortisol, 0:13:40.800 --> 0:13:42.480 something I've heard a lot about. 0:13:42.960 --> 0:13:46.840 As a woman in her let's say, mid to late forties. 0:13:47.080 --> 0:13:50.200 I'm aware that raising my cortisol too high will lead 0:13:50.240 --> 0:13:54.200 to the dreaded belly fat. And I'm sure we'll get 0:13:54.280 --> 0:13:56.800 later to the many ways in which my bones are 0:13:56.800 --> 0:13:59.920 attorney to dust due to my high cortisol. Belly fat combo. 0:14:00.000 --> 0:14:04.280 Oh it's terrible. But before we get into this just 0:14:04.360 --> 0:14:07.000 for people who are getting all their information about cortisol 0:14:07.080 --> 0:14:09.960 from the same Instagram that I'm getting it from. Let's 0:14:10.040 --> 0:14:16.160 start by defining what is cortisol and what are we 0:14:16.400 --> 0:14:19.360 actually talking about here overall. 0:14:19.440 --> 0:14:20.920 So you're a doctor, tell. 0:14:20.760 --> 0:14:25.000 Me, yeah, oh man, cortisol gets such a bad rap 0:14:25.200 --> 0:14:28.040 online and it's such a critical hormone, it's so important. 0:14:28.120 --> 0:14:30.880 So cortisol is a steroid hormone. We've talked about these 0:14:30.880 --> 0:14:35.680 several times before and wellness. Actually, steroid hormones are really 0:14:35.760 --> 0:14:38.840 interesting because the site that they act on is in 0:14:38.880 --> 0:14:41.320 the nucleus, is with the DNA of a cell. So 0:14:41.720 --> 0:14:45.640 all the steroid hormones, including things like testosterone and estrogen, 0:14:45.880 --> 0:14:49.360 get into the nucleus and change how DNA is transcribed, 0:14:49.400 --> 0:14:52.440 so it can fundamentally change what cells are doing, which 0:14:52.480 --> 0:14:56.120 means all these things can do a million different things. 0:14:56.320 --> 0:14:59.640 It's not like you know this one protein is responsible 0:14:59.760 --> 0:15:02.880 for or you know, increasing your sugar level or decreasing 0:15:02.880 --> 0:15:04.880 your sugar level. It does a million things. And I 0:15:04.960 --> 0:15:08.120 think the best way to sort of think about cortisol 0:15:08.440 --> 0:15:12.600 is that it is there primarily to save your life 0:15:13.280 --> 0:15:16.760 in the next ten minutes at the expense of the 0:15:16.800 --> 0:15:22.480 next ten years. So cortisol is a hormone that's present 0:15:22.560 --> 0:15:26.400 to keep you moving and alive after something really bad 0:15:26.480 --> 0:15:28.800 has happened to you, like you got mauled by a 0:15:28.800 --> 0:15:32.640 saber toothed tiger, or you are, you know, running from 0:15:32.680 --> 0:15:34.360 something that is trying to eat. 0:15:34.160 --> 0:15:37.760 You can I'm gonna pause you there because I think 0:15:38.040 --> 0:15:41.240 for most people the thing they think is driving that 0:15:41.400 --> 0:15:42.040 is adrenaline. 0:15:42.440 --> 0:15:44.800 So when you tell me you were chasing by a tiger, 0:15:44.920 --> 0:15:47.520 I think adrenaline. Yeah, they're not the same. 0:15:48.160 --> 0:15:51.400 They're not the same. And cortisol is secreted by the 0:15:51.440 --> 0:15:55.000 adrenal glands, which is where adrenaline comes from. Two and 0:15:55.680 --> 0:15:59.240 they are by all means related and evolutionarily followed kind 0:15:59.280 --> 0:16:04.560 of similar. But adrenaline is much more cardiovascularly active in 0:16:04.680 --> 0:16:09.080 terms of like flogging your heart and whatnot, whereas cortisol 0:16:10.320 --> 0:16:14.080 is more focused on sugar levels. So when you're being 0:16:14.160 --> 0:16:16.840 chased by a tiger, you want there to be plenty 0:16:16.840 --> 0:16:19.320 of sugar in your blood for your muscles to use 0:16:19.440 --> 0:16:21.640 and for your brain to use. And you really don't 0:16:21.680 --> 0:16:26.120 care about whether there's energy for your gut or your 0:16:26.240 --> 0:16:31.640 liver or like your bones, or for your immune system even, 0:16:31.760 --> 0:16:34.440 which is a very energetic, energy intensive thing. So you're 0:16:34.520 --> 0:16:38.240 kind of like shutting everything down and focusing all that 0:16:38.320 --> 0:16:42.080 glucose into muscle and brain. And so when you give 0:16:42.160 --> 0:16:45.120 someone cortisol or when they're indogenous, when their own cortisol 0:16:45.320 --> 0:16:48.840 goes up, their blood sugar goes up, their immune system 0:16:49.040 --> 0:16:57.200 ramps down. That's why glucocorticoids, which are cortisol derivatives, are immunosuppressants, 0:16:57.520 --> 0:17:01.480 things like prednozone. Many people have used hydro cortizone cream 0:17:01.600 --> 0:17:04.560 like for itches and stuff like that. So hydro cortizone 0:17:05.160 --> 0:17:08.680 is cortisol, the exact same molecule. There's no difference between 0:17:08.800 --> 0:17:12.640 hydro cortizone and the cortisol that you're adrenal land secretes. 0:17:12.640 --> 0:17:14.480 I mean they put it in a cream obviously, But 0:17:15.560 --> 0:17:19.680 that's what it is. The problem that people attribute to cortisol, 0:17:20.359 --> 0:17:23.639 and sometimes incorrectly, as we'll go into, is like, what 0:17:23.800 --> 0:17:27.960 if that stressor lasts longer than twenty minutes, Right, you're 0:17:28.040 --> 0:17:29.600 running away from the tiger. Oh, you made it away 0:17:29.640 --> 0:17:31.879 from the tiger. Great, you're good, everything's safe, everything can 0:17:31.920 --> 0:17:34.119 go back to normal. What if your whole what if 0:17:34.119 --> 0:17:37.639 your whole life is stressor what if you're constantly feeling 0:17:37.760 --> 0:17:40.440 like you're being chased by a tiger and your cortisol 0:17:40.560 --> 0:17:44.600 levels are high all the time, and it tells a 0:17:44.640 --> 0:17:46.760 really nice story that like, ooh, that would do a 0:17:46.800 --> 0:17:50.120 lot of bad things. But as I said, cortisol gets 0:17:50.480 --> 0:17:53.679 a bad rap, and it might not be as bad 0:17:53.720 --> 0:17:54.120 as you think. 0:17:55.040 --> 0:17:57.800 So in terms of just sort of people thinking about 0:17:57.920 --> 0:18:02.280 like the way that their quarter so moves throughout the day, 0:18:02.320 --> 0:18:04.639 because cortisol is a it is a hormone, and it 0:18:05.160 --> 0:18:07.159 would be a mistake to think of it as just 0:18:07.280 --> 0:18:10.000 always flat except when you're chased by a tiger. It 0:18:10.200 --> 0:18:14.920 is something which is fluctuating through the day. It's highest 0:18:14.960 --> 0:18:16.680 in the morning, so when you sort of first wake 0:18:16.800 --> 0:18:19.879 up in the morning, your cortisol tends to be tends 0:18:19.920 --> 0:18:22.080 to be higher, and it's lowest sort of in the 0:18:22.119 --> 0:18:24.840 middle of when you are asleep, is my sense, like 0:18:24.960 --> 0:18:28.320 on average for most people, and then it will spike 0:18:28.400 --> 0:18:31.080 at times during the day. This is something that's quite 0:18:31.119 --> 0:18:33.200 hard to measure, but in principle it would spike when 0:18:33.240 --> 0:18:37.440 you are doing either physically or emotionally stressful activities like 0:18:37.560 --> 0:18:38.880 running from a tiger is that true. 0:18:39.320 --> 0:18:43.879 Yeah, yeah, yeah. The morning cortisol spike is well described. 0:18:44.520 --> 0:18:47.760 It is one of the reasons why heart attacks are 0:18:47.800 --> 0:18:50.399 more common in the early hours of the morning, for example, 0:18:50.440 --> 0:18:53.119 because your body's sort of revving up to get ready 0:18:53.200 --> 0:18:57.440 to wake up the day. And we will get to 0:18:57.720 --> 0:19:01.200 this is a circadian rhythm, like one of our fundamental 0:19:01.280 --> 0:19:04.000 circadian rhythms. It's about five times higher in the morning 0:19:04.080 --> 0:19:05.880 than it is at night. I mean, it's a real 0:19:06.160 --> 0:19:09.800 it's a real shift over time. And if you really 0:19:09.880 --> 0:19:14.159 dig into the data, you'll find that the level of 0:19:14.280 --> 0:19:18.280 cortisol might not be as important as the circadian rhythm 0:19:18.400 --> 0:19:20.680 of cortisol. So one of the things we see in 0:19:20.880 --> 0:19:24.399 the truly chronically stressed are actually not high cortisol levels. 0:19:24.560 --> 0:19:28.680 It's a loss of that fluctuation. It's flat cortisol levels. Yeah. 0:19:28.720 --> 0:19:30.600 So I think that's a good that's a good pivot 0:19:30.680 --> 0:19:34.680 into what I the first piece of what's tough about 0:19:34.720 --> 0:19:37.320 this entire discussion is going to be really hard about 0:19:37.320 --> 0:19:39.760 the data, which is like what are we measuring and 0:19:39.880 --> 0:19:40.760 when are we measuring? 0:19:40.840 --> 0:19:43.040 So this is not there are some things we measure in. 0:19:43.080 --> 0:19:45.480 People where I think we can say, you know, maybe 0:19:45.520 --> 0:19:47.399 you want to do some repeat measurements, but like we 0:19:47.520 --> 0:19:49.800 have a good sense like something like you know like 0:19:49.880 --> 0:19:52.200 a one C levels for like a diabetic. You know 0:19:52.280 --> 0:19:54.399 you test me we you test it fasting not fasting. 0:19:54.520 --> 0:19:57.760 But we have a good sense, we have a stable 0:19:57.840 --> 0:19:59.680 sense of like how we test that, and we could 0:19:59.760 --> 0:20:01.760 use to say, you know you're a diabetic, you're not 0:20:01.800 --> 0:20:06.359 a diabetic. Measurements of cortisol which are done typically through 0:20:06.760 --> 0:20:09.280 your blood, although actually they can also do saliva, you 0:20:09.320 --> 0:20:11.879 can also do hair. You have many different ways to 0:20:12.040 --> 0:20:14.240 test this. They don't all test the same thing. 0:20:14.760 --> 0:20:18.400 And because there's this fluctuation, it's actually a really really 0:20:18.480 --> 0:20:20.160 hard thing to hit. 0:20:20.640 --> 0:20:22.560 If you wanted to say, what's the number that's going 0:20:22.640 --> 0:20:25.040 to tell me I'm chronically stressed in some dangerous way, 0:20:25.600 --> 0:20:26.840 there's sort of no number like that. 0:20:27.560 --> 0:20:30.440 Yeah, and actually it's a lab test that's pretty bad. 0:20:30.920 --> 0:20:33.840 So there's some lab tests like sodium level that's just 0:20:34.080 --> 0:20:36.280 it's been figured out and we can do it really 0:20:36.359 --> 0:20:38.360 quickly and it's highly accurate, and you test the same 0:20:38.359 --> 0:20:40.159 blood sample twice and you get the same number, and 0:20:40.240 --> 0:20:42.280 like it's really nice, and cortisol just isn't one of 0:20:42.320 --> 0:20:44.879 those things. I mean One of the major issues is 0:20:44.960 --> 0:20:47.680 that ninety five percent of cortisol in your blood is 0:20:47.840 --> 0:20:53.200 bound to proteins and is inactive, so these are just 0:20:53.359 --> 0:20:56.000 chaperone proteins that carry it around. And then the free fraction, 0:20:56.119 --> 0:20:58.080 the five percent, is the thing that does stuff in 0:20:58.160 --> 0:21:00.919 your cells. But almost all the lab tests out there 0:21:01.000 --> 0:21:04.920 are measuring the total, so you know that's is it 0:21:05.000 --> 0:21:08.720 correlated with the free Yeah, but not great and it's 0:21:09.000 --> 0:21:13.200 hard to know. There's obviously the timing of measurement that's 0:21:13.240 --> 0:21:15.560 really important, so you know, you really want to get 0:21:15.560 --> 0:21:18.000 if you actually needed to measure cortisol, for example, to 0:21:18.440 --> 0:21:21.600 tell if you have a disease of excessive cortisol production. 0:21:21.720 --> 0:21:25.480 And these diseases exists called Cushing syndrome or Cushing's disease, 0:21:26.160 --> 0:21:28.880 you get a test early in the morning when you've 0:21:28.920 --> 0:21:32.200 got the best chance of capturing things high. The assays 0:21:32.280 --> 0:21:35.320