Chasing Life

'Welcome to Chasing Life. You know, we've all been there. Heart is pounding, your blood is pumping, your breath starts to shake. Might sort of feel like a predator is chasing you, except there is no predator. You're just late for work. You're stuck in a traffic jam. Okay, now think about that experience, that very intense feeling that's washing over you. That is your cortisol at work. Cortisol. That's a so-called stress hormone. Maybe something that you've heard of, and if you go online, you'll see that it gets blamed for just about everything nowadays. Weight gain, bad sleep, mood swings, hypertension, infertility, even diabetes. But how much of that is really true? Well, today's guest is gonna help me navigate the reality of what may be one of the most misunderstood hormones, Dr. Robert Sapolsky. He's a neuroscientist, a biologist, he's a professor at Stanford University. He's also spent more than three decades studying stress. He has lived with baboons in Africa, and he also runs a neuroscience lab. He's author of "Why Zebras Don't Get Ulcers." Such a great title for a book. It's pretty much the book to read on stress. Honestly, he's one of my favorite people to talk to. We've had him on the podcast before, and let me tell ya, you're in for a real treat. I'm Dr. Sanjay Gupta. CNN's chief medical correspondent, and this is Chasing Life.

Cortisol has sort of become a buzzword nowadays. People talk about stress and now people who are talking about stress often start talking about cortisol as well. What is cortisol? How do you define it?

Okay. Well, first off, it's a hormone. What's a hormone? It's any chemical messenger that gets released into the bloodstream that causes something or other to happen elsewhere in the body. We've all heard of estrogen, progesterone, androgens like testosterone. Everybody knows about adrenaline coming out of your adrenal gland. Cortisol is the other main stress messenger coming out at the same place.

So what happens in the body then, when cortisol actually kicks in during a threat or during a perceived threat, I'm gonna say for now?

'Well, if you're thinking like a normal vertebrate, everything it's doing is fantastic. It's ancient, ancient stuff. Dinosaurs, when they were being stressed by a predator, were secreting something close to cortisol. Fish have them, birds, amphibians, reptiles, all the mammals. And what it does is it lets you survive a short-term physical crisis, like you're running for your life, or you're running for a meal.

Is it by releasing glucose into the bloodstream? Is that its primary mechanism of action?

'Well, that's kind of what it's most beloved for - mobilizing glucose from storage sites and handing it to your muscles that are going to save your life. They work in cooperation with adrenaline to increase your heart rate, your blood pressure. They turn off all sorts of stuff in your body that you could do tonight, if you survive long enough. You turn off growth, you turn off tissue repair, you turn off reproduction, you turn off aspects of your immune system, everything that's not essential.

How do you think of it? Is it sort of a frenemy, in this regard?

'Well, it all depends on what kind of organism you are and what's stressing you. If somebody's trying to eat you and you're sprinting for your life and you manage not to secrete this hormone, you're going to die. But then you get to us, and yeah, we secrete cortisol when we've got our own acute physical crises, but what we mostly do is we secrete it because of taxes and traffic jams and unrequited whatevers for psychosocial reasons. And you get in trouble for two reasons. One is you now secrete it chronically at elevated levels. And the other is you shouldn't be secreting it at all because everything it does to your body is great for a five-minute emergency, and is bad news if you've been doing it chronically for months and years.

So if cortisol is great, maybe even ideal for a real crisis, why is it such a poor mismatch for most of the things that worry us today?

Once again, probably not being inaccurate that if it was a hundred twenty million years ago and a dinosaur was running for its life, it would have been secreting glucocorticoids. It's been there the whole time. It's how vertebrates survive all sorts of immediate emergencies. And what do we do? We turn it on anticipating a blind date. We turn on thinking about our hearts going to stop beating someday. We turned it on thinking about refugees on the other side of the planet. We've come up with this bizarre thing that's unique to very smart social primates and a few other species, elephant cetaceans, where you can go turn it on for all the reasons it didn't evolve for. This would make no sense to any dinosaur. We have gotten smart enough that we are stressed by things that this system simply didn't evolve for. And do it chronically, it's going to hammer away at your body.

So is the only solution then to reframe how these things are actually being interpreted in our own brains? I mean, we're not gonna change our cortisol system, right? We need to change how much we activate it, it sounds like.

How much we activate it and for what reasons. You don't want to turn off the system when you want to react like a normal organism does, but you sure want to have it not activated when you're being a psychosocially smart human. And what you're left with is exactly, you could come up with some like wildly complicated system that will shut down cortisol secretion only when you are being psychologically stressed, and it's good the rest of the time. The alternative that's infinitely easier is to figure out how to be less psychologically stressed in your everyday life.

'There are these commercial at-home tests now. People who are listening to this may be curious about their cortisol levels. Worth it, you think? Is this something you advocate?

Uh, no, no, because they're not necessarily particularly accurate ways of measuring the stuff. They're not telling you the most important things, which is profiles over time. Are your resting levels elevated when something stressful occurs? Do you turn on the stress response fast enough and big enough? Even more importantly, when it's over with, do you recover from it quickly? And that's one of the vulnerable spots. So those are big problems, and the biggest problem is the basic mindset is this is a hormone that is your enemy.

'You know, it's interesting. Again, we're drawing these links between stress, cortisol, and then a whole host of things, including hyperglycemia - sugar in your blood - infertility, high blood pressure, all these things. What about weight gain, metabolism, belly fat, that sort of bucket of things?

'This is where cortisol comes screaming back with a whole new world of bad effects. Cortisol, glucocorticoids, as we talked about, what does it do? It mobilizes glucose from your stored sites because you're running for your life. And when the stressor is over with, cortisol happens to stick around for a long time. In primates, it's got a half-life of about 90 minutes or so. What's it doing? Sticking around long afterward, cortisol not only mobilizes your energetic stress response, it then mediates your recovery from it. During the recovery phase, it promotes putting glucose back in your storage sites. It makes you hungrier. It stimulates eating. And what does it do? It tries to reverse all that. And if you're secreting a whole lot of it, the net result is it's increasing fat deposition. You get especially in trouble because there's two types of fat in the body. Broad dichotomy, fat that winds up in your gut, truncal fat, and fat that winds up in the rear end, gluteal fat. And what you see is fat in your gut is much more sensitive to glucocorticoids than fat on your rear end. So not only are you preferentially storing fat if you're chronically being psychologically stressed, you're putting it in the worst place in your body, right around all your organs there. That's where you don't want to be doing it. That promotes inflammation. That's another major downside of chronic stress because if you are chronically stressed, you're chronically going to have to be going through the process of recovering from the stress response. And that's where a lot of the damage occurs.

This is unique to primates? I mean, I know you say other animals have, obviously they have cortisol, they need it, but in terms of the recovery or the sustained effects of cortisol, is that... I mean, "Zebras Don't Get Ulcers," that's the title of the book. So what are we to infer from that in terms of how zebras are different than humans, then?

Well, if you're a zebra, and I've had the luxury of seeing this many times, you're some zebra out in the savanna, and you're eating some grass, and some lion appears, and you run for your life, and you get away from it. And as far as I can tell, 30 seconds after it's over, with all the zebra's thinking about is, 'Hmm, maybe I'll eat this piece of grass... Oh, though that one looks good.' It's gone. It's over with. You take a primate, a baboon, or us, and what it's thinking is, 'How did I step into the wrong end of the field? Why wasn't I more attuned? Oh my god, mortality, what could have happened to me? What could have happened to my loved ones?' I don't know if a baboon is quite this sophisticated, but they sure are capable of being anxious. Zebras don't get anxious, primates get anxious, which is, you see threats that are not necessarily there.

Coming up! Practical tips if your cortisol is working overtime. That's after the break.

Cortisol often gets blamed for sleepless nights, difficulty sleeping. Is that a real connection between cortisol and sleep issues?

Yeah, everything about that is bad. Stress, by way of cortisol, makes it hard to sleep. Disrupted sleep elevates your cortisol levels. Oh no, we've got a vicious cycle. And when you look at the ways in which cortisol is disrupting sleep, it's particularly hitting the type of sleep, deep wave sleep, where you're building energy back up in your brain or restorative stuff. So separate of it waking you up in the middle of the night, because it sets off all sorts of alarms. Even if you stay asleep, you're doing a less efficient job at rebuilding your energy stores.

Interesting.

So you're getting in trouble in lots of ways there. And it's one of those stress disrupts normal function, which triggers stress, which disrupts normal function, and off you go.

What is the indication, aside from measuring this through blood or urine or saliva or whatever... How would you know that maybe you're an individual that's making too much cortisol?

Well, rather than somebody taking your blood or making you do unpleasant things with your urine or whatever, you know, how do you tell when you're stressed into a pathological range? You feel miserable. Your sleep is disrupted. You're exhausted all the time, even if you've gotten good sleep. Your sex life is thrown out of whack. You're getting a lot of colds. Your concentration is thrown out the window. That's like a pretty good assay, rather than paying somebody to measure something in your bloodstream. If all those things are happening, that's a pretty good marker that either you're secreting too much cortisol, or your body is listening to cortisol way too much. Things go wrong in this big global kind of way. Hypertension, heart rate increase. If you've got diabetes, it suddenly becomes harder to keep it under control. Everything goes either a little bit wrong or eventually a lot wrong, very global pathologies, that's your surest sign.

And at that point, instead of seeing an endocrinologist, a doctor who does hormones, maybe seeing a psychologist would be better?

'Exactly. And that's where you run into every dead white male bias in the field, which is, if there's a problem, fix it when it's already become a problem rather than preventatively. And when you're fixing a problem after the fact, if you could do it when you've got a lab coat on, and you're using gazillion-dollar machines versus trying to get somebody to shift their priorities in life. The bias of medicine is high-tech after-the-fact interventions. When you come to this system, overwhelmingly, the better solutions are: get less stressed in circumstances where it would make no sense at all to a zebra.

Do people with higher cortisol, do they... I wanna phrase this question in a proper way, but are they more successful?

'Well, this puts us into tricky domain. Depends how you're defining more successful, who, obviously, it depends on what exactly the excess cortisol is about. You're going to be much more successful at remembering strings of digits backwards and stuff like that, for the first couple of days that you're super stressed. As we saw chronically, you begin to have downsides to all of it. That, of course, leads us to sort of industrial psychology-type questions. So you look at big faceless corporations and who's got the elevated cortisol levels, who gets the most stress-related diseases? The bias forever was the people on top, and it even had a term, 'executive stress syndrome.' And it turned out the research studies that sort of broadcast that to the world were done wrong in the late 1950s, but everybody learned, 'Ooh, those poor executives sitting in that....' You look at big corporations, and it's middle management who gets the stress-related diseases. Why? They've got the double whammy. They've responsibility, but they don't have control. They don't have autonomy, and that's a killer combination.

Was that the Whitehall experiment?

'Exactly. Whitehall. Which was showing British civil servants, every step you go down in the British civil service browning point sort of scale, your health is worse, your life expectancy is worse. You're more subject to stress-related diseases. And what was great was, this was controlled. These were people at the bottom of the ladder who were not in poverty. They were just poorly paid civil servants. These were people who all got vaccinations. These were people... None of them were getting malaria. So lots of controls in there. Wonderful work by this guy, Sir Michael Marmot, showing this, showing that your place in that hierarchy is hugely influential.

So the people who were sort of middle management, they were worse off than people who may have been lower down the ladder, as well as people who were higher on the ladder?

'Well, no, there you get the comparison of middle with top, and that big lesson was middle management is more stressed. Look at the people down at the bottom, they're doing the worst of all. So the big surprise was middle-management versus executives, but go down the hierarchy there and, as seen in every westernized country, doesn't matter if you've got socialized medicine or you've got the American nightmare system, and you know, all sorts of different cultures, you go down the socioeconomic ladder and every step going down, on the average, health is worse, life expectancy is shorter, and it's not due to obvious stuff. 'Oh, poor people can't afford to go to a doctor.' They go to doctors in places with socialized medicine. 'Ooh, poor people, as is known, are more likely to drink or smoke to excess.' Control for that is because you were being psychologically pummeled all the time with being a very low-ranking primate. And that's the price you pay.

If you're thinking about this now and listening to this podcast, is one of the objectives when thinking about stress and cortisol, would the goal be more to become more resilient to it or try and reduce your stress in the first place? Obviously, you'd like to do both, but where would you focus your attention?

'You know, resilience is how you were responding to an environmental kick in the rear end, how long it takes you to re-equilibrate, to get back up on your feet. Changing your life so that there's fewer of those challenges, and our resilience is probably the way to go. If you can get a less stressful job, if you can get a boss who's not a jerk, if you can figure out your abusive relationship. Any of these things, that's great. Decreasing the legitimate psychosocial stressors going on in the world around you. Resilience perceptual changes are probably stronger. And that is not to sit there and say to somebody, 'Oh, all you have to do is just get the right attitude about your appallingly unpredictable, unempowered life.' This is mostly for dealing with middle-class neuroses.

You know, I don't wanna be pollyannaish about this at all because I think for a lot of people, they think so much of this is out of my control. There are people who live in places with incredible socioeconomic disparities. That's just their reality. A few months ago now, we had two headlines in the news at the same time. One was about the world's first potential trillionaire, and one was about the fact that 600,000 people, 400,000 of whom are children, may die as a result of cuts to USAID. And that was in the same week. And I remember thinking, what the blank is happening here? Yep. Those types of disparities are toxic. And it seems like they're toxic no matter where you lie on the socioeconomic spectrum, have or have not, or wherever you may be. That's just stressful, it seems.

'Absolutely. And what you see is, when you look closely, and wonderfully subtle work by all sorts of health psychologists, what you see is being poor is a pretty good way to elevate stress hormone levels, and it's a pretty good way to be more at risk for stress-related disease. Being poor amid plenty, that's the route. Inequality, being surrounded by having your nose rubbed in it over and over each day. 'Oh, a baboon gets trounced by a higher-ranking guy.' He's reminded that he's low ranking. Drive down the freeway, and somebody in some expensive Tesla blasts past you. You never even see that primate's face! And you have been subordinated in the hierarchy there. What surprises people the most is exactly what you mentioned. Everybody suffers with increased inequality. The poor, because they have less psychological control and they're dumped on, and all this stuff, the wealthy get less healthy as well. Why? Because they have to put more resources into keeping all the stressful stuff outside the gates of the mansion. Private schools, security stuff, bottled water, because who knows what's in the real water supply. What you see is, ironically, for the privileged, it could be very stressful to try to make a life in which something stressful never occurs.

'My guess is, because of who you are and your notoriety in this field, you must have a lot of people, including students, and young clinicians, and people coming to you who feel overwhelmed by the systemic stressors - the system - things that they can't directly control. What do you say to them to try and help them?

Well, in terms of the psychological things that go into coping, don't try to control things you really have no control over. Don't try to predict stuff where knowing it in advance is just going to make stuff worse. Don't look for outlets where your doing so makes everybody around you more miserable. Don't mistake superficial relationships at a club on Friday night for a real, supportive social relationship. It's a very narrow range in which these psychological manipulations work. You don't wanna make somebody feel like they had more control when the outcome was a disaster. You wanna make them feel that way when the outcomes was pretty good. 'Thank God I had some control. Look how much worse it could have been.' As opposed to: look how much better it could've been. You know, I've been on a bandwagon in recent years about how when you look closely, we really have no free will. There's no such thing as free will. We're biological machines, that's all I've been obsessing over. And that gets a whole lot of people really upset. If you're on the bottom of a hierarchy and you were living in a culture which has system justification telling you over and over, it's your own damn fault, you could have been other... Anybody could wind to being that first trillionaire. All you're doing is telling somebody, it's your own fault for stuff you had no control over. And when you recognize the extent to which you have no control over your bad luck in life, all doing that does is prove liberating. That's wonderful news.

I read your book, and I decided I wanted to be more like a zebra. I always learned so much from you. I really appreciate it. And whenever I get a little stressed, I imagine being at Professor Robert Sapolsky's house, walking out his front door, taking a few steps to the right, not even that far, and suddenly being in the middle of just that unbelievable sort of splash of nature. It was just so gorgeous. To say what you want, anybody who's listening, and I don't, again, I'm very careful not to sound too pollyannaish, but be outside for 15 minutes in nature, and it does a pretty good job of regulating many of the things we've just talked about.

Probably the most impactful way that it does that is if it's beautiful enough out there, you get a sense of awe. And if you get a sense awe, you get a sense of gratitude. And you get a sense that your problems are pretty small potatoes compared to how big the sky is.

Well, that was my conversation with neuroscientist Dr. Robert Sapolsky. Thanks for listening.