Qualy #89 - Cortisol and healthy aging

**Peter Attia** (0:11)
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Talk to me a little bit about cortisol and your views on it. How does cortisol interact with the mitochondria?

**Navdeep Chandel** (0:45)
Yeah, well, I don't know. I see another one that I would love to work on. So it's just a weird observation. I don't know if you have this.
I mean, I think maybe in our circles, we have a lot of kind of type A personalities who exercise vigorously, they watch their diet, they do all this sort of stuff.

**Peter Attia** (1:03)
I don't know anybody that does that.

**Navdeep Chandel** (1:05)
No, you don't know anybody.
But I always wonder if they're stressing themselves out by being so careful about everything. And you know me, I am the opposite. You've seen me eat and drink.

**Peter Attia** (1:18)
Yeah, but you're pretty fistidious with your exercise.

**Navdeep Chandel** (1:21)
And I don't overeat and I do time feedings. I still fast 12 to 15 hours. Most days closer to 15 hours. I do watch what I mean. But what I'm saying is I know people who get very, very regimented about these things.
And it's like the marathon runners who, the old line that they die don't run marathons.

**Peter Attia** (1:41)
Yeah, I was with a friend last night and he was joking about this exact concept. Then he was talking about his, he's an orthopedic surgeon. He was talking about his partner, or somebody he knows. And he was like, the guy is so into yoga, but it's become, he's like, the way he described it was really funny. He's like, he's stuck in traffic and he's like, I gotta get to my fucking yoga class.

**Navdeep Chandel** (2:01)
Yes, exactly.

**Peter Attia** (2:02)
And it's like, yeah, no, no, of course, there's the irony to that.

**Navdeep Chandel** (2:05)
So, your insulin levels might be fine and everything's fine, but what's your cortisol levels? So, I'm fascinated by cortisol. In fact, I'm fascinated by, I would love for you to basically develop a very simple test that you can sell at Walgreens, where you take a prick of blood and you can do it as often as you want, and you tell me my thyroid and hormones, you tell me my insulin, my glucagon, my estrogen, my testosterone, my dopamine, serotonin, and obviously cortisol, right? These five or six, seven things that I just said, because it's about, a lot of biology or physiology can be explained.

**Peter Attia** (2:42)
Yeah, we're just not gonna be able to get it that way, because cortisol is mostly bound to albumin and cortisol-binding proteins. So it's the free cortisol that exerts its metabolic effects and its physiologic effects, and most of it's not free. So you can only measure the free cortisol in saliva and urine.
And then the other, you know, of those other ones.

**Navdeep Chandel** (3:00)
But you know what I'm saying? Like, I would love to have those, those hormones at my disposal. You know, is my testosterone too low, my estrogen too high, this too high, insulin. You know what I mean? Just having that data points all the time, and then you could sort of modify your diet and your exercise.
But I think the cortisol one is, I paid more attention today to stress than anything else. I'll be honest with you. I mean, I still exercise and I watch what I eat. Those things seem intuitive, because I've done it for so long.
But I've been wondering if myself and many of my colleagues, especially because we fly, give talks, you have grand pressures. A teenager daughter, she's lovely.
Lots of different pressures we all have, right? And if that somehow is being manifested metabolically through cortisol, to the mitochondria, just like we think about insulin, right? So that's all. That's the only reason I want to talk about cortisol.

**Peter Attia** (3:55)
No, I think I agree with that wholeheartedly. I think certainly in the last three years, as I've dug my heels into it, I think hypercortisolemia is a problem. And I think, I wish people would think of these hormones through more broad endocrinologic terms.
It's very easy for people to think of hypo and hyperthyroidism. We accept those as states. You can be euthyroid, or you can have too much, or you can have too little. And yet people have such a hard time thinking of insulin in those terms. You can have too much, you can have too little. There's a range in which this hormone makes sense. And cortisol is probably equally important, if not more important, in terms of the damage that can be done, especially from too much, with respect to everything from blood pressure, which would then impact the endothelium.