SOS: The Cortisol, Depression, Brain Fog, Autoimmune Disease Connection

Has feeling tired from the minute you wake up until you crash at night – maybe even living on caffeine and sugar between to keep you going – become your new norm? Are you living with brain fog, sugar cravings, a few extra pounds (or more) around your middle, or a laundry list of symptoms or diagnoses from digestive and sleep problems to fertility problems, depression and anxiety, even autoimmune disease and pre-diabetes symptoms or conditions – maybe even chalking them up to just normal? Aging? Or are you ignoring them because you’re too busy to deal? In fact, has overwhelm become your middle name?

While western medicine would have us believe that bad genes, aging, or bad luck are the cause of the myriad problems modern women are struggling with, this is simply not true. But that’s exactly how the medical and pharmaceutical systems make us lifelong customers. Our grandmothers’ generation did not struggle with all of these conditions. In fact, most didn’t even exist as common conditions 35 years ago, and our grandmothers certainly didn’t take on average, at least two medications by the time they were 50.

So why are we?

Survival Overdrive Syndrome – Too Much of a Good Thing

We’re facing new epidemics in women’s health, from diabetes to fertility challenges to autoimmune disease. One in 3 of us has a chronic disease of some kind – whether being overweight, having high cholesterol or blood pressure, or an autoimmune condition. On top of this, western medicine has no answers beyond pharmaceuticals which is why so many women are being over medicated for everything from hormone problems to depression and anxiety to high cholesterol, and often with medications that have serious unintended consequences as serious as the symptom or condition itself.

How does being stuck in survival mode contribute to these and what does it really mean for our health? I first began to connect the dots that answered this question about 10 years ago when I started studying a field of science called psychoneuroimmunology (PNI). It’s the hard-core science that connects the dots between what’s happening in the immune, endocrine, nervous, digestive, cardiovascular, and other body systems and what’s going on in the stress response system.

When I started to take a 30,000-foot view of what I was seeing in my women’s integrative medical practice, I discovered that the many seemingly disparate symptoms and even diagnosed medical conditions shared the mother of all Root Causes: disruption in what is called the Hypothalamic Pituitary Adrenal (HPA) Axis, more commonly called “the Stress Response System,”  or survival mode.

This was how I coined the term Survival Overdrive Syndrome, or SOS, to describe the complex array of problems for which women were seeking my medical help. And it partly arose from many of these women also saying things like:  

“Dr. Aviva, Please help me, I feel like I'm constantly in overdrive and I just can’t turn it off.”

“Dr. Romm, I feel like I'm stuck in survival mode, and it’s making me sick. I’m going from one thing to the next, and I can't turn off the stress. I'm constantly overwhelmed and I just don’t feel like myself.”

Here’s how it all happens: In nature, the stress response works with perfect elegance and leaves no lasting consequences to protect us from imminent danger. Imagine a National Geographic special where gazelles are comfortably gathering and drinking at a watering hole on a golden plain in Africa. Along comes a pride of hungry lions and the chase begins. The gazelles go into survival mode and run. They being to pump out adrenaline and their heart rates and blood pressure go up, they become hyper-alert. They pump out cortisol to mobilize blood sugar availability for energy, and their immune systems get activated all in order to give them energy to run, protection against injury and infection, and a super-focused ability to recognize the danger in their environment. They are in survival mode autopilot. The lions pursue, and eventually catch and subdue one of the older, sicker, or slower gazelles. But then what happens? The remaining gazelles go right back to the watering hole as if nothing’s wrong. They go from red alert back down to it’s all okay. This is called stress resolution. And it all happened in a matter of minutes.

This same reaction has served humanity well for millennia. We are perfectly hardwired to withstand a fairly high-level, short-lived stress lasting, say, for minutes to hours. Given that we’re pretty high up on the food chain, we haven’t had to spend too much evolutionary history running away from beasts. This ability to respond and adapt to stress and still stay healthy is known as allostasis, a term that means that we’re extremely resilient to stress. It’s really ingeniously orchestrated, if you think about it. So why, if it works so well to protect us, have I implicated it in pretty much every health problem you’re having?

Modern living causes us to get too much of a good thing. We keep withstanding high levels of stress day in and day out – bills to pay, traffic to sit in, bosses to contend with, families to care for – relentless demands, peppered with bad news in the news, world crises, and a whole lot of things to worry about. We experience chronic activation of the stress response without any or ample resolution – to the point that we get stuck in survival mode and the very system designed to protect us backfires and leads to a host of consequences, which I’ll explain to you below. At first these just usually manifest as common symptoms – but when we ignore these mayday signals, they eventually become full blown syndromes, conditions, and even diseases.

Constantly Outrunning a Lion?

The common denominators in the health problems that arise from being in chronic survival mode, or Survival Overdrive Syndrome (SOS – your body’s mayday call!) are the constant high output of the neurotransmitter adrenaline and the adrenal hormone cortisol. Adrenaline, which is the first responder in the stress response, activates the ‘fight or flight’ response that we’re all familiar with from hearing a noise while walking alone in a parking garage at night or watching a scary movie and hearing a thud in your house. Heart rate accelerates as does your respiratory rate in order to get more oxygen to your brain, which become hypervigilant to danger; your blood vessels constrict to make this happen, and with it your blood pressure goes up.

After a few minutes, if the stressor is still present, or your brain senses (or imagines) that there’s danger, cortisol production and release kicks in, freeing up a load of blood sugar to provide extra and sustained fuel so you can run from or fight the danger, and insulin production also revs up to deal with that extra blood sugar so it doesn’t linger when the danger’s over and cause inflammatory damage as high blood sugar is apt to do. Cortisol also gets your immune system on the ready like the national guard, ready to protect your personal boundaries against infection that might occur if you’re injured, and it also changes the way your brain works so that you are reacting on automatic pilot rather than using your willpower and higher thinking capacities; you need to be instinctual during a crisis, not thinking about your taxes or to do list!

The problem is that when these responses are activated day in and day out, or are basically chronically activated if you’re always stressed out, your body pays the price. Blood pressure can stay high, so can blood sugar, your body starts to get tired of chronically producing insulin and you can become insulin resistant – and even diabetic. Cortisol causes you to pack weight around the middle and store extra energy as cholesterol in case you need it for more emergencies, it affects your mental focus making you unable to concentrate on focused tasks, while adrenaline keeps you hypervigilant – preventing you from falling asleep and causing a sense of chronic overstimulating and anxiety. Cortisol disruption leads to sugar, fat, carb, and salt cravings, affects your sleep wake cycle, and can impact your immune response enough to eventually land you in the realm of an autoimmune condition – particularly Hashimoto's, because cortisol directly impacts thyroid function. At first you might feel overstimulated and wired, but eventually, you might face fatigue or even profound exhaustion.

Further, it’s not just being stressed out all the time that can activate this response – though this is a huge trigger. So can inflammatory food triggers, poor sleep, chronic hidden infections (i.e., EBV), microbiome imbalances, and even environmental toxins. In fact, anything that leads to system overload or activates inflammation can lead to SOS. Past trauma can play a major role, too, by lowering the set point at which your stress response is activated, and making your more prone to see dangers in your world.

When I put it all together and began explaining Survival Overdrive Syndrome to my patients, most were like, “Oh, Dr. Romm, that sounds like me,” or “You’re describing my life exactly!” and the term was officially born. And when I explained SOS to a book agent and publishing team, they said,  “Wow, that sounds like every woman we know.” And that’s how my book The Adrenal Thyroid Revolution, which is all about SOS, was born!

Are you in SOS?

Here are some of the symptoms and conditions that could be telling you that you’re in SOS:

  • Weight gain, especially around the middle, and difficult or near impossible weight loss
  • Difficulty falling asleep, poor sleep, or waking up tired even after a full night of sleep
  • Poor immunity, getting sick a lot
  • Chronic exhaustion, overwhelm, poor emotional, mental, or physical resilience
  • Low stress tolerance
  • Irritability, anxiety, feeling tired and wired, depression, and hopelessness
  • Sugar, carb, fat, salt, or caffeine cravings
  • Episodes of low blood sugar
  • Insulin resistance, metabolic syndrome, high blood pressure, high cholesterol
  • Poor mental function, concentration, or memory problems
  • Hormonal problems from irregular periods to fibroids to infertility to PCOS to hypothyroidism

And if you feel like you’re constantly looking over your shoulder for lions – not ever just chilling at the watering hole – you’re also in SOS.

Take the Next Steps: Uncover Your SOS Pattern

The good news is that you can reset your stress response. The first step is to give yourself a minute to pause, and the next step is to uncover your SOS Pattern – Grab a copy of my book The Adrenal Thyroid Revolution today for the quiz that will help you do that, and the steps to get you out of SOS and take back your health. You so deserve it.  

And here are some articles on how to reset your stress response if you’re ready to get our of SOS starting today:

The Adrenal Thyroid Revolution

Best Selling Thyroid Book!

Want to learn how to support your own natural detoxification systems? Get Your Copy of My New Book to Learn How!


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Sternberg, E., Butts, C., & Tait, A. (2006). Neural immune interactions in health and disease: Relevance to women’s health. Gender Medicine, 3.
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Hi! I have been diagnosed with mono, low blood sugar, adrenal fatigue and endometriosis. Each one was diagnosed about a year after each other and by different doctors. I feel as though noone can help me. I am in constant endo pain and exhaustion. What can I do? PLEASE help me????!!!!

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    Aviva Romm

    Check out my article on EBV, and also: