Dear Doctors: I'm a 64-year-old man with Type 1 diabetes and very high cortisol from stress at work. I can't lose weight despite lower calories, exercise and GLP-1 meds. I have a fatty liver and elevated bilirubin, which have never caused problems. I want to take ashwagandha for stress but read it can affect the liver. What is your opinion?
Dear Reader: It's understandable you might connect your elevated cortisol to your difficult work environment. Blood levels of the hormone can indeed rise in response to stress. It is also correct that elevated cortisol can interfere with weight loss. However, the health information you shared suggests the situation may be more complex than a simple cause-and-effect. To understand what may be going on, and to address the herb ashwagandha, we need to take a closer look at cortisol. We also want to talk about the role that lifestyle factors can play.
Stress triggers a chemical cascade in the body that includes the release of cortisol. It's part of the fight-or-flight response. This is why cortisol is known as the "stress hormone." Elevated cortisol is associated with increased fat storage, particularly in the abdomen. At the same time, it can trigger hunger and cravings. It may also slow the speed at which your body burns calories. This can obviously put the brakes on weight loss. These are also counter to how GLP-1 medications aid in weight loss. Such drugs slow stomach emptying, reduce appetite and signal a feeling of satiety to the brain. (Although these medications are not FDA-approved for Type 1 diabetes, they are sometimes used off-label.)
The blood sugar changes in diabetes, especially episodes of low blood sugar, can activate the body's stress response. This may contribute to elevated cortisol. Fatty liver indicates that the organ is under strain. This can influence the ways in which the body manages energy, including its response to stress and how it regulates cortisol. So, while stress is part of the picture, when it comes to your cortisol levels, it may not be the whole story.
Then there's your high-stress job. Luckily, this is a potential cortisol trigger you can address. You asked about the herb ashwagandha. It has a long history of being used for stress relief in traditional Indian medicine. However, it has been associated with liver injury. This is rare, but for someone with liver issues, it can pose a risk. The herb has also been shown to lower blood glucose levels. This presents another layer of risk for someone using insulin to manage Type 1 diabetes.
Instead, we urge you to consider a few lifestyle changes. These include yoga and tai chi, which have a proven track record of helping people relax. So do meditation and mindfulness practices, deep breathing, walking and spending time in nature. These can be done at home or in group classes. Good sleep habits, limiting alcohol, a healthy diet, and building and maintaining a meaningful social life are also buffers to stress. It's not an easy one-stop fix, but it is the framework of a more balanced life.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
