Max Nieuwdorp, endocrinologist: “Chronic exposure of our body and brain to cortisol can cause depression” | Health & Wellbeing

To what extent do hormones control what happens in our bodies and minds? Max Nieuwdorp (Brunssum, Netherlands, 47), internist and endocrinologist, reminds us in The Unknown Power of Hormones (Salamandra Miradas), that we are not necessarily slaves to our hormones, but the truth is that they also recognize the leading role they play in our health, our character and the quality of our lives. Because hormones shape us at every stage. Little by little, like a drop falling from a badly turned tap. Because the effect they cause is not instantaneous, as he says in this interview, but is formed slowly, influencing the various processes that mark us.

To maintain hormonal balance, Nieuwdorp, who is also a professor and head of the department of experimental vascular medicine at UMC Amsterdam, insists on the Holy Trinity for a healthy body: rest, nutrition and exercise. So powerful that it allows us to achieve significant control over our physical and mental health and alleviate hormonal imbalance issues that can profoundly affect our quality of life.

Ask. He says he doesn’t mean to suggest that we are slaves to our hormones, because there is always an interaction between the environment, body and mind. “Hormones may cloud our ability to make decisions, but they don’t absolve us of responsibility for our actions,” he writes. Reading the book, it seems like such a complex network that there’s little we can do when it becomes unbalanced…

Reply. It is true that hormones can help guide the body and mind slowly in one direction or another, just as an oil tanker moves quite slowly. The effects they produce are not immediate, but happen slowly, affecting processes such as metabolism, growth and development, sexual function, or mood. But we can do something about them when they get out of balance. For example, by getting enough sleep, eating well, and exercising properly, we can keep our bodies in shape, and therefore our hormones more balanced.

TO. And when does this imbalance require something more?

R. For most hormone-related conditions, we can identify and effectively treat the underlying cause. However, treatment for hormone deficiency, as with thyroid disease, although biochemically effective, is still associated with side effects such as fatigue and weight gain. This is because our body’s natural hormonal function typically peaks and valleys, whereas hormonal pills and injections cannot accurately reproduce this pattern, leading to ongoing discomfort.

TO. From 12 weeks of intrauterine life until old age, our body does not stop producing hormones. There are external factors that affect the production of hormones and this balance. Is it possible, given today’s lifestyle, to avoid hormonal imbalance throughout life?

R. This is a complex topic. Even in the womb, the fetus is exposed to external factors such as diet, exercise, and stress experienced by the mother. These factors can cause epigenetic changes in the baby’s genes involved in hormonal function. But I return to the first point: these effects can still be reversed through healthy habits such as adequate sleep, a balanced diet, and regular exercise. While exposure to these factors during fetal development can have a significant impact, adopting these healthy habits later can help restore and maintain hormonal balance throughout life.

TO. What hormonal changes occur during pregnancy and how do these changes affect the baby’s development and the mother’s health?

R. During pregnancy, the mother’s body produces high levels of the pregnancy hormone hCG, but later, during labor, also prolactin and oxytocin. This hormonal increase can also cause changes in the mother’s mood and body. And don’t forget that the baby is also producing hormones, such as testosterone in a male fetus, which can affect the mother’s hormonal balance.

TO. When your wife was pregnant with your third child and you were just starting out as an endocrinologist, your young son became ill with a very serious cancer, which caused a family tsunami in which cortisol won. What role do hormones play in the body’s adaptation to situations of acute or chronic stress?

R. Stress in our bodies is transmitted through the nervous system and through the release of (nor)adrenaline (norepinephrine and adrenaline) by our adrenal glands. These hormones trigger an acute stress response, causing an increase in heart rate, dilation of the pupils, and other immediate physical changes. Cortisol, on the other hand, is a stress hormone that acts over the long term and transmits stress to the body in a slower, more steadfast manner. It is important that the levels of stress hormones in our bodies rise and fall in a balanced manner. But during periods of chronic stress, the levels of these hormones remain constantly elevated. This can have long-term effects on the body, including epigenetic modifications, which are changes in gene expression without changing the DNA sequence.

TO. What is the connection between hormones and disorders such as depression and anxiety, and how does this affect the immune system?

R. Chronic exposure of our body and brain to cortisol can lead to depression by affecting the dopamine/serotonin balance in our brain. Additionally, cortisol and insulin can affect our immune system. When chronically elevated, they can increase the risk of infections as well as cardiovascular disease.

TO. Can some medications disrupt our hormone balance?

R. Yes, in fact, some medications, such as exogenous cortisol pills or creams, can alter the body’s own cortisol production and lead to a deterioration in the functioning of the adrenal glands. In addition, testosterone injections can negatively affect a man’s own testosterone production.

TO. When will this happen, how long will it take them to adjust again and how? If they come back…

R. It usually takes several weeks or months for the body’s own hormone production to return to normal. However, in some people, endogenous hormone production may remain impaired even after the medication is discontinued.

TO. In the book, he says that, like other stages of life, the onset of old age is accompanied by profound hormonal changes. What are the main hormonal changes that occur at the onset of old age, and how do these changes affect physical and mental health?

R. In old age, insulin resistance (increased insulin levels) is common, as is a slight increase in testosterone (a male hormone) in older women and more estrogen (a female hormone) in older obese men. This affects both the body’s function and mood.

TO. And these changes in sex hormones, by affecting the body and mood, therefore affect the quality of life of older people.

R. Yes, but it happens differently between women and men. In women, menopause is a sudden drop in estrogen levels in the body, which affects functions and causes hot flashes, hair loss, weight gain, etc. All of this affects the quality of life of women. In men, testosterone levels decline slowly, starting in middle age, with andropause, and therefore is accompanied by fewer consequences and is more tolerable.

TO. Can we anticipate hormonal changes and adapt to them better? I think of menopause, for example, in the case of women.

R. The experience of menopause varies across cultures. In Asian societies, menopause is considered a positive phase and is known as the “golden years” for women. In contrast, some Aboriginal people do not even have a word to describe menopause. Hormone therapy can help ease the symptoms of menopause, although it does have certain side effects, such as a slight increase in the risk of cancer and cardiovascular problems. If this type of treatment is not preferred, maintaining a regular sleep schedule, eating a balanced diet, avoiding certain foods that can trigger hot flashes, such as alcohol, and getting enough exercise can help women better adjust to this stage of their lives.

TO. How should they be addressed in medical treatment? Is there also a medical bias in studying men and women?

R. Yes, indeed, there is a bias in medical science towards studying the male body in the treatment of endocrine diseases. We know that women have a different body composition, shorter intestines, and all this affects the effectiveness of treatment with exogenous hormones. This is now being taken into account more in new studies.

TO. What recent advances in hormonal research may change our understanding and treatment of hormonal disorders in the near future?

R. We can now better simulate the ups and downs of hormones using self-learning AI technology, for example, thinking about insulin pumps. Hopefully, the same can soon be done for other hormones, such as cortisol and thyroid hormone treatments.

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