Qualy #89 - Cortisol and healthy aging
Episode Stats
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Summary
In this bonus episode of The Qualies, Dr. Peter Atiyah and I discuss stress, hormones, and hyperthyroidism. Dr. Atiyah is an orthopaedic surgeon at the Mayo Clinic, and has been practicing for over 20 years. He is a regular contributor to the New York Times, and is one of the few people in the world with a PhD in hypo thyroidology. He is also the author of the book, Hyporoidism: The New Science of the Brain.
Transcript
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Welcome to a special bonus episode of the Peter Atiyah Qualies, a member exclusive podcast.
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The Qualies is just a shorthand slang for qualification round, which is something you
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do prior to the race, just much quicker. The Qualies highlight the best of the questions,
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topics, and tactics that are discussed in previous episodes of The Drive.
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So if you enjoy the Qualies, you can access dozens more of them through our membership
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program. Without further delay, I hope you enjoy today's Qualies.
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Talk to me a little bit about cortisol and your views on it. How does cortisol interact
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Yeah, well, I don't know. I see another one that I would love to work on. So it's just
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a weird observation. I don't know if you have this. I mean, I think maybe in our circles,
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we have a lot of kind of type A personalities who exercise vigorously. They wash their diet.
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But I always wonder if they're stressing themselves out by being so careful about everything.
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You know me, I am the opposite. You've seen me eat and drink.
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Yeah, but you're pretty fastidious with your exercise. You play soccer every day.
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No, I do. And I don't overeat. And I do time feedings, right? I still fast 12 to 15 hours.
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Most days closer to 15 hours. No, I do watch what I mean. But what I'm saying is I know people
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who get very, very regimented about these things. And it's like the marathon runners who,
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you know, the old line that they die, don't run marathons.
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Yeah, I was with a friend last night and he was joking about this exact concept. And he was
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talking about his, he's an orthopedic surgeon. He was talking about his partner or someone he
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knows. And he was like, the guy is so into yoga, but it's become, he's like, the way he described
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it was really funny. He's like, he's stuck in traffic and he's like, I got to get to my fucking
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And it's like, yeah, no, of course there's the irony to that.
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Right. So, you know, your insulin levels might be fine and everything's fine, but you know,
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what's your cortisol levels? So, I'm fascinated by cortisol. In fact, I'm fascinated by, I would
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love for you to basically develop a very simple test that you can sell at Walgreens where you
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take a prick of blood and you can do it as often as you want. And you tell me my thyroid and
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hormones, you tell me my insulin, my glucagon, my estrogen, my testosterone, my dopamine, serotonin,
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and obviously cortisol, right? These five or six, seven things that I just said, because it's
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about a lot of biology or physiology can be explained.
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Yeah, we're just, we're not going to be able to get it that way because cortisol is
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mostly bound to albumin and cortisol binding protein. So, it's the free cortisol that exerts
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its metabolic effects and its physiologic effects. And most of it's not free. So, you
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can only measure the free cortisol in saliva and urine and then the other, you know, of
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You know what I'm saying? Like, I would love to have those hormones at my disposal. You
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know, is my testosterone too low, my estrogen too high, this too high, insulin, you know
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what I mean? Just having that data points all the time. And then you could sort of modify
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your diet and your exercise. But I think the cortisol one is, I pay more attention today to
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stress than anything else. I'll be honest with you. I mean, I still exercise and I watch what
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I eat. Those things seem intuitive because I've done it for so long. But I've been wondering if
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myself and many of my colleagues, especially because, you know, we fly, give talks, you have
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grand pressures, a teenager daughter, she's lovely, lots of different pressures we all have, right? And
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if that somehow is being manifested metabolically through cortisol, to the mitochondria, just like
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we think about insulin, right? So, that's all. That's the only reason I want to talk about
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cortisol. No, I think I agree with that wholeheartedly. I think certainly in the last
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three years, as I've dug my heels into it, I think hypercortisolemia is a problem. And I think
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I wish people would think of these hormones through more broad endocrinologic terms. You know, it's
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very easy for people to think of hypo and hyperthyroidism. We accept those as states. You can be
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euthyroid or you can have too much or you can have too little. And yet people have such a hard time
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thinking of insulin in those terms. You can have too much, you can have too little. There's a range
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in which this hormone makes sense. And cortisol is probably equally important, if not more important,
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in terms of the damage that can be done, especially from too much with respect to everything from
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blood pressure, which would then impact the endothelium, what it does in terms of inhibiting
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melatonin secretion in the brain. And melatonin obviously plays an immediate role in terms of sleep,
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but also plays an indirect role in terms of neuro regeneration. So, and that says nothing about what
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we just talked about, which was the role that cortisol may even play in the mitochondria, which
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I'm just learning about, you know, literally in the past couple of months. So I don't disagree. I think
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the challenge in many ways for anyone listening to this, if we're going to be brutally honest, I think
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for many people, it's easier to control what they eat, how they exercise and exert discipline around
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taking medications, taking supplements. But in many ways, one of the hardest things to control
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is our response to stress. And I think that's an important distinction to make. I don't think
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there's anything that's particularly troubling with being in stressful situations. I think the
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difference is, is less about the situation you're in and more about the response you have to it.
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And that's probably where the greatest differences lie between people is there are some people who can
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be in relatively low stress situations. And yet they're sort of, they're not reacting well to it.
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They're not coping with it well. And there are others who can be in-
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They have different set points where they begin from.
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Maybe. I mean, I guess I just don't understand enough of this stuff. I mean, I think-
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But it's, I don't, you know, I don't hear too many people talk about it.
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No, no. People talk about stress, but, but sort of, like we talk about insulin all the time and
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glucose levels and for men, testosterone, women-
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You mean, you mean sort of in longevity circles?
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Yeah. In longevity circles, like, you know, is that a variable we're missing, you know?
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Well, part of it is we don't have a target for it, right? No one's thinking about
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pharmacologic ways to manipulate this. And we don't have great, obvious ways to curb our
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behaviors. Like meditation probably is the single most valuable thing I've ever found to help
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regulate this. But you also don't have the ability to measure cortisol levels that easily. Every
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time you want to do one of these tests, it's, you know, you're collecting urine over the course
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of a day and doing a bunch of other things. So it's just, it's involved. You don't have the-
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Yeah. You know, it's really funny. I mean, I think there was a paper that came out probably about
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three months ago that looked at, basically the punchline of the paper was, look, at any loss,
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But, you know, if you look at those events, it's like 950,000 to 954.
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The point of it is there's no dose of ethanol where the ethanol becomes valuable. But the
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toxicity takes a while to kick in. So, you know, for some people, a glass a day seems perfectly
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reasonable. There's no toxicity. But the flip side of it is, and this is where I kind of try to have
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this discussion with every patient is, look, I'm not going to tell somebody not to drink. I mean,
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I'm not going to tell myself not to drink. I probably have four drinks a week. And, you know,
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I pick and choose my shots. You know, I have this rule called don't drink on airplanes because the
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alcohol on airplanes sucks. So I'm not drinking alcohol just for the sake of drinking alcohol.
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But if you're sitting there and the alcohol is really great and it's something you really,
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the downside of the ethanol, the hepatic toxicity of the ethanol can be offset by the emotional
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benefit that could come from the enjoyment of having that glass of wine with your buddy.
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That brings me to another one of those things we should always measure. ALT, you know,
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How well your liver function. How's your ALT this morning, by the way?
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