Cortisol, Stress & Longevity: A Clinical Conversation on Healthy Aging (IFM 2025)

Introduction:
Dr. Angela Mazza, a board-certified integrative endocrinologist, has spent her career merging traditional endocrine science with holistic, preventive medicine. In a powerful presentation at IFM, sponsored by Vibrant Wellness (May 28-31, 2025, San Diego, CA) , Dr. Mazza explored the pivotal role of cortisol in our healthspan. She illuminated the connections between chronic stress, hormonal imbalances, immune dysfunction, and accelerated aging. Drawing from both her clinical experience and emerging research, her message was clear: managing cortisol is not simply about reducing stress, but about optimizing resilience, metabolic health, and cellular function. Her personal story, patient cases, and clinical pearls offered a roadmap for longevity that is rooted in precision, compassion, and intentional lifestyle design.

THE JOURNEY INTO INTEGRATIVE ENDOCRINOLOGY
by: Dr. Angela Mazza

When I first began practicing traditional endocrinology, something didn’t feel right. We were checking boxes, following guidelines, but missing the mark on patient outcomes. I saw too many thyroid patients who were underserved and misdiagnosed. That’s when I discovered integrative medicine. I founded the Metabolic Center for Wellness nearly ten years ago, and since then, my focus has expanded to include all hormonal imbalances, especially cortisol and stress.

Why Cortisol Matters
Every patient today is dealing with stress. It manifests differently for each person, but its long-term impact is universal. Cortisol, the primary stress hormone, influences metabolism, immunity, brain function, and even aging. When the hypothalamic-pituitary-adrenal (HPA) axis is activated by stress, the cascade begins: CRH from the hypothalamus prompts ACTH from the pituitary, which stimulates the adrenal cortex to produce cortisol, aldosterone, and DHEA.

Cortisol helps us respond to acute stress, but prolonged elevation suppresses immunity, impairs digestion, and disrupts sleep and sex hormones. It also wreaks havoc on thyroid function by inhibiting TSH, reducing conversion to T3, and increasing reverse T3.

From Hormone Pathways to Longevity Principles
Cortisol synthesis begins with cholesterol. Through the steroidogenic pathway, it converts to pregnenolone—our “mother hormone”—then branches to cortisol, aldosterone, or sex hormones. Cortisol is vital, but too much or too little becomes a problem.

What we need to remember is that longevity isn’t about living forever. It’s about quality. Healthspan. Being active, fulfilled, and independent in later years. Functional aging means preventing disease, optimizing vitality, and expanding what’s possible as we age. That’s where cortisol comes in.

The Evolution of Stress Models Hans Selye’s model of General Adaptation Syndrome still holds weight. There are three stages:· Alarm: acute response (think: almost in a car accident)
Alarm: acute response (think: almost in a car accident)
Resistance: chronic stress sets in, symptoms emerge
Exhaustion: fatigue, mood disorders, and disease follow 

·

Acute stress isn’t always bad. It’s anti-inflammatory and mobilizes energy. But chronic stress causes dysfunction. It flattens the cortisol curve and sets the stage for disease. The concept of allostatic load—the cumulative wear and tear from stress—explains why resilience varies. Every patient’s biography matters. Trauma, personality, and coping mechanisms determine their ability to return to balance.

Recognizing Adrenal Dysfunction
Too much cortisol? You’ll see fatigue, weight gain, anxiety, hypertension, menstrual issues, and low libido. Too little? Same fatigue, but also muscle loss, immune problems, and brain fog. Flattened cortisol curves are the worst: they correlate with higher mortality in cancer, diabetes, and cardiac patients.

Distinguishing HPA axis dysfunction from Cushing’s syndrome is essential. The latter involves tumors or exogenous steroids. HPA dysfunction is more subtle—an imbalance, not a disease.

[to be continued]

[Bootcamp #1] The Hormone Matrix: Mapping Adrenal, Sex, and Circadian Rhythm Markers Join Adair Anderson, Product and Marketing Educator at Vibrant Wellness, alongside Dr. Angela Mazza, a renowned triple board-certified endocrinologist, for Session 1 of the Hormone Zoomer Boot Camp—an in-depth training designed for clinicians, health practitioners, and functional medicine professionals seeking to elevate their hormone diagnostic skills. This foundational session introduces participants to the comprehensive "hormone matrix," a dynamic framework that maps out key hormonal systems, including adrenal hormones (such as cortisol and DHEA), sex hormones (like estrogen, progesterone, and testosterone), and circadian regulators that influence metabolic rhythm and overall well-being. Dr. Mazza expertly guides viewers through interpreting complex urinary metabolite data, using Vibrant Wellness' advanced hormone testing platform. She shares real-world clinical case scenarios that demonstrate how hormonal imbalances manifest in patient symptoms—and how proper analysis can lead to individualized, root-cause-driven care plans. Through a deeper understanding of hormone physiology and interrelationships, attendees will gain practical tools to decode patterns of dysfunction and fine-tune therapeutic interventions. Whether you’re managing patients with fatigue, mood disorders, infertility, or midlife hormone transitions, this session offers critical insights into testing strategies that bring clarity to complex cases. Discover how cutting-edge diagnostics can transform your clinical practice with precision and confidence.

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The Immune Connection
Chronic stress compromises immunity. Cortisol is catabolic to the gut and promotes intestinal permeability. This damages the epithelial lining and shifts immune balance from Th1 to Th2 dominance, increasing susceptibility to autoimmune diseases.

I use the autoimmune triangle to explain this to patients:
- Genetics
- Environmental triggers (infections, toxins, stress)
- Gut dysbiosis

Stress plays into all three. It weakens the gut lining, reduces nutrient absorption, and exacerbates food sensitivities.

Immunometabolism & Disease
Metabolic and immune systems are intertwined. Stress alters immune cell behavior. During COVID-19, we saw how those with poor metabolic health had worse outcomes. Cortisol shifts immune metabolism, increases oxidative stress, and leads to chronic inflammation. This affects telomere length and epigenetic expression, both key drivers of aging.

Endocrine Disruptors & Cortisol
EDCs are everywhere—plastics, pesticides, cosmetics, even receipts. They disrupt the HPA axis, interfere with steroidogenesis, and alter cortisol metabolism. The result? Anxiety, metabolic disorders, mood dysregulation, and immune dysfunction.

I don’t overwhelm patients with this, but I educate them. Awareness leads to better choices.

The Blue Zones & the Cortisol Connection
Let’s take lessons from the Blue Zones—those five regions where people live long, vibrant lives. Their longevity comes from:
- Daily movement
- Strong social ties
- Plant-based, antioxidant-rich diets
- Spiritual grounding and purpose (Ikigai)
- Regular rest and downshifting

These habits manage stress, reduce allostatic load, and support hormonal balance. It’s not about perfection. It’s about lifestyle alignment.

Cellular Health & Aging The 12 hallmarks of aging include genomic instability, mitochondrial dysfunction, and cellular senescence. Cortisol negatively impacts all of them. It alters nutrient sensing, impairs proteostasis, and increases stem cell exhaustion.

Yet, hormesis—a little stress—can help. Intermittent fasting, sauna use, and exercise trigger autophagy, reduce mTOR, activate AMPK, and stimulate longevity genes. These tools clear out cellular debris and support healthy aging.

Testing & Personalization I rely on four-point cortisol tests (saliva or urine) for a complete curve. Serum tests only offer snapshots. I also measure DHEA, pregnenolone, estrogen, testosterone, melatonin, and cortisol metabolites. A low cortisol-to-cortisone ratio can signal inflammation. This personalized data shapes precise treatment.

So Where Do We Start?
Sleep is the cornerstone. Consistency, darkness, limiting blue light, and nighttime routines matter. I encourage exercise, but even gentle movement counts. Hobbies, mindfulness, and quiet time build resilience.

Diet must be anti-inflammatory and blood-sugar stable: high in fiber, resistant starch, omega-3s, and antioxidants. Avoid processed foods, reduce caffeine, and stay hydrated. Fermented foods support gut health.

Nutraceuticals: Useful but Not Magic
Adaptogens like ashwagandha, L-theanine, GABA, and cordyceps can help—but only in the context of foundational lifestyle work. Nutraceuticals are tools, not solutions.

Conclusion
Dr. Angela Mazza offers a timely reminder that cortisol is neither good nor bad—it is essential. But how we regulate it determines our trajectory. Chronic stress silently undermines immune defense, hormone signaling, gut function, and our very DNA. Yet the solutions are within reach. Through intentional living, precise testing, and personalized care, we can recalibrate the HPA axis and move toward true longevity. In Dr. Mazza’s practice, every patient’s story is honored and every protocol is tailored—because thriving isn’t about avoiding stress, but transforming how we respond to it.

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Check out Dr. Mazza's brand new website featuring her latest presentations, videos and educational  programs.  Also check out her latest reports on wellness and resilience topics at: www.DrAngelaMazza.com

LIFESTYLE REBOOT 2025: Dr. Angela Mazza’s Longevity Compass

 How One Functional Endocrinologist Embodies the Science of Living Better, Longer

By: Graciella Davi / Lennard Goetze, Ed.D  - Fact Checked by: Carmen Regallo

“Live what you teach”—that’s more than a motto for Dr. Angela Mazza. As a board-certified endocrinologist and respected leader in integrative hormone
health, Dr. Mazza embodies the same principles she shares with her patients. Rather than waiting for health crises to emerge, she focuses on proactive longevity—nurturing vitality from the inside out.

Through what she calls “Longevity Lifestyling,” Dr. Mazza integrates science-based strategies into her everyday life. She sees aging not as decline, but as an opportunity to optimize. Her daily routine revolves around four central health pillars: movement, nutrient-rich nourishment, mental clarity, and quality rest. And she approaches each with both intention and scientific insight.

Movement Over Medicine (The MOM Theory)

Physical activity isn’t an afterthought in Dr. Mazza’s life—it’s foundational. “Coming from a family with diabetes, I’ve seen how inactivity affects long-term health,” she shares. “Movement is how I stay ahead of it.”

Rather than focusing on long workout sessions alone, she emphasizes frequent, low-intensity movement throughout the day. These “movement snacks,” as she calls them, might include walking the dog, taking the stairs, or short stretches between appointments. “You don’t need an hour at the gym. You need consistency—small bursts of movement keep your circulation and energy flowing.”

This approach reflects emerging research showing that sedentary behavior—long periods of sitting or physical inactivity—contributes to metabolic and cognitive decline. Dr. Mazza counters this risk with a lifestyle that favors mobility, flexibility, and functional strength. “We’re not meant to be still all day. Every cell in our body benefits from motion.”

Hydration and Nutrition: Foundations of Energy and Repair 

Dr. Mazza begins each morning with a simple ritual: a glass of lemon water. It’s a reminder that hydration is the first form of self-care. “Water is the vehicle for every metabolic process. When you’re tired, foggy, or sluggish, dehydration is often the culprit.”

Throughout the day, she drinks steadily and eats meals that emphasize whole, nutrient-dense foods. Her plates are colorful, loaded with greens, clean proteins, and healthy fats. “I’m a big believer in the Mediterranean model of eating—it’s delicious, sustainable, and deeply healing.” One of her favorite practices? A daily shot of high-quality olive oil. “It’s rich in anti-inflammatory compounds and supports brain and heart health. For me, it’s a daily tonic.”

She also emphasizes balance over restriction. “I don’t count calories—I count nutrients. I look at how my meals support hormone balance, blood sugar, gut health, and brain function.”

Mental Balance: Crochet, Cortisol, and the Power of Purpose

Longevity isn’t only about what happens in the body—it’s also about how we support the mind. For Dr. Mazza, one of her most restorative daily practices is surprisingly tactile: crocheting.

“It sounds simple, but the repetitive rhythm relaxes my nervous system,” she says. “It becomes a form of active meditation.” Whether between patient visits or in the quiet hours of the evening, this practice grounds her emotionally and mentally.

Science supports her experience. Engaging in focused handwork like crocheting has been shown to lower stress hormones, enhance focus, and even improve mood by triggering the brain’s parasympathetic “relaxation” response.

She also practices short mindfulness breaks to reset during stressful days. Whether through breathing techniques or a walk in nature, these habits reflect her belief that mental recovery is just as important as physical rest.

Restorative Sleep: The Unsung Hormone Hero

By evening, Dr. Mazza prioritizes winding down—no emails, no devices, no stimulation. She embraces a screen-free wind-down routine that helps signal the body to transition into rest mode. “Sleep isn’t optional for health—it’s how we repair, regenerate, and reset our hormone systems,” she explains. “When you sleep poorly, everything from your thyroid to your insulin response suffers.”

Her nightly routine includes herbal tea, dim lighting, and often journaling—especially noting wins or gratitude. This sets the stage for deep, uninterrupted sleep, which she calls “the most underrated longevity strategy we have.”

Her Lifestyle, Her Message

What makes Dr. Mazza’s approach powerful isn’t just that it’s informed by science—it’s that it’s doable. Every element of her day—motion, meals, mindfulness, and rest—is within reach for patients and practitioners alike. She doesn’t promise quick fixes or fads. Instead, she advocates for small, consistent changes that add up to real transformation.

“I live this way not out of discipline, but out of love for life,” she says. “My message is simple: You have more power than you think to shape your future health.”

About Dr. Angela Mazza

Dr. Angela Mazza is a board-certified endocrinologist, functional medicine expert, and founder of the Metabolic Center for Wellness. Known for her integrative approach to thyroid disorders, midlife health, and metabolic resilience, she is a national educator and featured speaker at A4M, IFM, and other longevity-focused symposiums. Her work empowers patients to align lifestyle choices with science-backed wellness strategies.

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AFTERTHOUGHT 

By: Dr. Robert L. Bard [Diagnostic Imaging Specialist | Cancer Detective | BardDiagnostics]

In the world of medical diagnostics, I often see the effects of poor lifestyle choices long before symptoms appear. As a radiologist specializing in cancer imaging, I’ve spent decades identifying tumors, organ inflammation, and vascular damage—many of which are rooted in preventable conditions like obesity, chronic inflammation, and metabolic dysfunction. Patients who lead sedentary lives, carry excess weight, or ignore stress often find themselves facing serious disease without warning.

That’s why I believe the most powerful form of medicine is prevention. And prevention begins with education and lifestyle strategy.

Reading about Dr. Angela Mazza’s daily commitment to “Longevity Lifestyling” is more than inspiring—it’s a masterclass in functional health. Her “practice what you preach” philosophy isn’t just for show. It’s a model for how physicians—and anyone—can lead by example. Her focus on movement, nourishment, mental balance, and restorative rest mirrors the exact elements I wish more patients embraced before coming to my office with a serious diagnosis.

Functional medicine isn’t a trend—it’s the future. Dr. Mazza’s approach offers readers a clear path to reclaiming control over their health. Her day-to-day life demonstrates how small, intentional choices can yield profound long-term benefits.

This article isn’t just a peek into her routine—it’s a reminder that longevity is earned, one decision at a time.

DR. ROBERT L. BARD : Medical Director, BardDiagnostics

Fellow, American College of Radiology

Board-Certified in Diagnostic Imaging & Oncology Technologies

STAND UP FOR YOUR LIFE: How Movement Saves You from Early Decline

By: Dr. Angela Mazza

Introduction:
We are sitting more than ever—and it’s slowly killing us. With our lives built around desks, cars, and screens, the average adult spends the majority of their day immobile. This modern habit isn't just inconvenient—it’s a silent contributor to early death. If you want to add more years—and quality—to your life, the message is simple: get moving. A sedentary lifestyle is one of today’s most underestimated threats to longevity.

How Stillness Fuels Decline:
Extended inactivity wreaks havoc on the body. It increases your risk of major chronic diseases, such as diabetes, heart disease, and cancer. When you sit too long, your metabolism slows down. Fewer calories are burned, blood sugar levels climb, and unhealthy cholesterol begins to rise. All of this creates a perfect storm for disease and premature aging.

Over time, the lack of motion weakens both muscle and bone. Muscle atrophy and decreasing bone density (known as sarcopenia and osteopenia) lead to frailty and increased injury risk, especially as we age. The very structure of your body begins to erode from the inside out.

The Truth About Sitting:
Being seated for long periods is now considered its own health risk. Nicknamed “sitting disease,” this condition can trigger everything from poor circulation and back pain to impaired lung and brain function. The joints, deprived of regular movement, lose lubrication, which may pave the way for arthritis and mobility disorders. As posture worsens and muscles disengage, we begin to feel—and function—like we’re decades older than we are.

Weight Gain, Toxic Fat, and Metabolic Trouble:
Physical inactivity contributes directly to weight gain, but more concerning is the rise in visceral fat—fat stored around internal organs. This type of fat is hormonally active and inflames the body, increasing the likelihood of insulin resistance, high blood pressure, and cardiovascular events. Even individuals who appear lean can be metabolically unhealthy if they spend too much time sitting—a phenomenon known as “skinny fat.”

Why Movement is Medicine:
The human body is designed to move. Movement stimulates circulation, boosts immune function, and helps regulate critical systems like digestion and hormone balance. Incorporating light movement throughout the day—short walks, stretching, even standing periodically—can undo some of the damage of prolonged sitting.

Exercise doesn’t have to be intense to be beneficial. Daily physical activity strengthens the heart, improves mood, supports bone and joint health, and enhances metabolism. Weight-bearing exercises like walking, light resistance, or squats can slow age-related decline and help preserve independence.

Mobility Restores Vitality:
When you keep your joints and muscles active, you protect your body from premature breakdown. Moving improves lymphatic flow, reduces inflammation, and helps the body manage stress more effectively. It also keeps your brain sharp and your mood stable—crucial benefits for mental health and cognitive longevity.

Conclusion:
A sedentary lifestyle quietly chips away at your health, but the solution is within reach. You don’t need a fitness subscription or marathon goals—just a commitment to stay in motion. Take walking breaks, stretch at your desk, or find joyful ways to stay physically engaged throughout your day. Your joints, muscles, brain, and heart will thank you. Choose motion over stillness, and give yourself the gift of a longer, stronger, healthier life.

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1) Sitting Time and All-Cause Mortality - Source: Patel, A. V., et al. (2010). Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults. American Journal of Epidemiology, 172(4), 419–429. Link: https://doi.org/10.1093/aje/kwq155

2) Health Risks of Sedentary Behavior - Source: Owen, N., Healy, G. N., Matthews, C. E., & Dunstan, D. W. (2010). Too much sitting: the population health science of sedentary behavior. Exercise and Sport Sciences Reviews, 38(3), 105–113. Link: https://doi.org/10.1097/JES.0b013e3181e373a2

3) Physical Activity Guidelines Advisory Committee Report - Source: U.S. Department of Health and Human Services (2018). Physical Activity Guidelines for Americans, 2nd Edition. Link: https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

4) Visceral Fat and Metabolic Health Source: Britton, K. A., et al. (2013). Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. Journal of the American College of Cardiology, 62(10), 921–925. Link: https://doi.org/10.1016/j.jacc.2013.06.027

THYROID NODULES 101: A MODERN APPROACH TO MANAGEMENT

Originally published in BALANCE & LONGEVITY Issue #537 (May, 2025) 

Insights from Dr. Angela Mazza

In recent years, thyroid nodules have become an increasingly common clinical finding, often detected incidentally during imaging for unrelated conditions. Dr. Angela Mazza, a board-certified endocrinologist and founder of the Metabolic Center for Wellness, has dedicated much of her integrative endocrinology practice to understanding and managing thyroid nodules using the latest technologies and non-surgical interventions.

The Prevalence and Nature of Thyroid Nodules
Thyroid nodules, which are masses located within the thyroid gland itself, are remarkably prevalent. “If we ultrasound everyone walking down the street,” Dr. Mazza notes, “one in three people will have some sort of nodule.” Fortunately, the vast majority are benign and asymptomatic. Ultrasound imaging has become the frontline tool in classifying nodules based on characteristics such as size, echogenicity, vascularity, and the presence of microcalcifications — all features that help clinicians stratify risk and determine the need for biopsy or intervention.

Particularly common in patients with autoimmune thyroid conditions like Hashimoto’s thyroiditis, nodules can range from true growths to pseudo-nodules — regions of altered tissue responding to autoimmune activity. “I’d estimate that more than 50% of my Hashimoto’s patients have some form of abnormality, whether it’s small, inconsequential, or something more concerning,” Dr. Mazza explains.

Understanding the Causes and Risks
For decades, iodine deficiency or excess was blamed for most thyroid nodule development. However, Dr. Mazza emphasizes that current research points to multiple contributing factors. “Inflammation plays a big role. Obesity, estrogen dominance, and even certain infections like H. pylori have been implicated.” While viruses such as Epstein-Barr have been studied, causality remains unconfirmed.

A subset of nodules, known as toxic nodules, function independently of the thyroid’s regulatory mechanisms, leading to localized overproduction of thyroid hormone and hyperthyroid symptoms. Historically, these were identified via radioactive iodine uptake scans, but Dr. Mazza now relies exclusively on ultrasound and lab testing for diagnosis, noting the inefficiency and radiation exposure of the older method.

Diagnostic and Molecular Advances
When nodules present features such as irregular borders, rapid growth, or microcalcifications, ultrasound-guided fine-needle aspiration (FNA) biopsy is the gold standard for assessment. These procedures, particularly when performed by experienced specialists, yield a sensitivity and specificity approaching 98-99%.

Dr. Mazza also stresses the importance of molecular testing for indeterminate cases. “If biopsy results aren’t clearly benign or malignant, we can analyze gene mutations associated with thyroid cancer to better predict future risk,” she explains. This stratification can guide decisions on surveillance versus intervention and has significantly improved management pathways.

Radiofrequency Ablation: A Game-Changing Treatment
Among the most exciting developments in thyroid care is radiofrequency ablation (RFA). Though used globally for over two decades, it wasn’t FDA-approved in the U.S. until late 2018. RFA employs targeted electromagnetic energy to destroy thyroid nodules while preserving the surrounding gland, offering a minimally invasive alternative to surgery.

“Patients love that we can treat a problem nodule and leave their thyroid intact,” says Dr. Mazza. Performed in-office with local anesthesia, the outpatient procedure typically takes under two hours, with most patients returning to work within a day or two. Side effects are minor, limited to tenderness or transient discomfort, with rare complications like voice changes being far less frequent than with traditional surgery.

Dr. Mazza also notes RFA’s emerging role in treating small papillary thyroid cancers — the most common type of thyroid malignancy. “For select cases under 1.5 centimeters, where the cancer is slow-growing and well-positioned, RFA offers a safe, effective alternative to surgery.”

Complementary Treatments and Cautions
While RFA dominates discussions, Dr. Mazza also performs percutaneous ethanol injection (PEI) for cystic nodules — draining fluid-filled growths and instilling sterile alcohol to prevent recurrence. Other thermal ablation modalities like laser and microwave ablation exist but are currently less common in practice.

On the subject of iodine, Dr. Mazza remains cautious. While deficiency can contribute to nodule development, excess iodine, particularly from supplements, poses risks for those with autoimmune thyroid disorders. “I routinely test iodine levels before recommending supplementation. Many people already get enough iodine through diet, and more isn’t always better.”

Barriers to Adoption and Patient Advocacy
Despite clear clinical advantages, insurance coverage for RFA remains limited, as no dedicated procedural code has been approved in the U.S. “Patients are often paying out-of-pocket and submitting for reimbursement themselves,” says Dr. Mazza, who actively advocates for broader coverage and physician education. She notes that patient-driven demand is accelerating change as individuals increasingly educate their doctors about alternatives to surgery.

A Vision for Integrative, Patient-Centered Care
Dr. Mazza’s integrative approach to endocrinology blends conventional diagnostics with patient-centered, minimally invasive interventions. Her mission is to empower patients with evidence-based options that preserve quality of life. “Medicine moves slowly, but awareness is growing. Treatments like RFA are a great example of how we can modernize care while respecting patient preferences.”

For those seeking more information, Dr. Mazza invites readers to visit metaboliccenterforwellness.com and explore her published works detailing her journey into integrative endocrinology.

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A VOICE FROM THE COMMUNITY

Kudos to Dr. Bard for his groundbreaking work with MenoScan, a diagnostic innovation that is transforming how menopause is understood, diagnosed, and managed. By addressing the intricate interplay of hormonal balance, bone density, cardiovascular function, neurological health, and overall metabolic stability, MenoScan empowers both patients and physicians to make informed, personalized decisions around prevention and care.

In collaboration with Dr. Angela Mazza—a triple board-certified endocrinologist and founder of the Metabolic Center for Wellness—Dr. Bard has assembled a team of leading medical experts dedicated to a comprehensive, individualized approach to women’s health during midlife and beyond. Dr. Mazza’s work highlights the importance of personalized thyroid care, particularly during the menopausal transition. As the accompanying graphic illustrates so clearly, menopause impacts all women. Understanding it fully is essential to improving care and outcomes.

- ROBERTA MORRIS, Menopause Educator l Neuro-Nutrition Specialist

The Cortisol Equation: How Stress Shapes Longevity and the Aging Body

 By Dr. Angela Mazza

Introduction: Stress, Hormones, and the Hidden Clock of Aging

In our fast-paced, chronically stimulated world, stress has become more than just a passing feeling—it’s a physiological force that influences how we age. At the heart of this connection is cortisol, often called the “stress hormone.” More than just a response to deadlines or emotional strain, cortisol plays a key role in regulating metabolism, immune responses, and cellular aging. When produced in the right amounts, it’s essential for survival. But when stress becomes chronic, cortisol turns from a helper to a harmful driver of disease and accelerated aging. Understanding the cortisol connection can unlock new strategies for achieving resilience, health, and longevity.

The HPA Axis: Your Body’s Stress Command Center

The hypothalamic-pituitary-adrenal (HPA) axis is the body’s central stress response system. It starts in the brain, where the hypothalamus signals the pituitary to release ACTH (adrenocorticotropic hormone), which in turn stimulates the adrenal glands to produce cortisol. This cascade helps you respond to physical, emotional, or psychological stress by mobilizing energy and sharpening focus. In a balanced state, cortisol rises in the morning to wake you up and declines at night to prepare the body for rest. But when stress is prolonged, the HPA axis becomes dysregulated, leading to serious health consequences.

Cortisol: Essential and Dangerous

Cortisol’s role is dual-edged. In acute situations, it suppresses non-essential systems (like digestion and reproduction) so the body can focus on immediate survival. It increases blood sugar for quick energy and modulates inflammation. However, chronic elevation or suppression of cortisol—as seen in HPA dysfunction—can disrupt nearly every body system. Symptoms can include fatigue, poor stress tolerance, weight gain, mood swings, insomnia, hormonal imbalances, and immune dysregulation. Over time, these disturbances contribute to metabolic syndrome, autoimmune disease, and cognitive decline.

We can analyze stress stages and the wear-and-tear of aging.  Hans Selye’s General Adaptation Syndrome (GAS) model outlines three stages of stress response:

1. Alarm Phase: Fight-or-flight response with high cortisol and adrenaline.

2. Resistance Phase: Adaptation attempts; cortisol remains elevated but symptoms may dull.

3. Exhaustion Phase: Adrenal fatigue or burnout with low cortisol and loss of resilience.

This model helps explain how chronic stress silently drives aging. The term allostatic load captures this cumulative toll—the wear and tear from repeated or inefficient responses to stress.

 

From the perspective of DNA to Digestion, we can review how cortisol alters health. Cortisol touches nearly every system in the body. Its chronic dysregulation contributes to:

• Metabolic disease: Insulin resistance, fat accumulation, and increased risk for diabetes.

• Cardiovascular stress: High blood pressure, vascular inflammation, and cholesterol changes.

• Brain function decline: Memory loss, depression, and disrupted sleep from hippocampal damage.

• Immune dysfunction: Reduced defense against infections and increased risk of autoimmunity.

• Gut health: Increased intestinal permeability ("leaky gut"), microbiome imbalance, and digestive disorders.

• Hormonal imbalance: Disrupted sex hormones leading to fertility issues, PMS, and libido loss.

• Cellular aging: Accelerated telomere shortening, oxidative stress, and reduced autophagy (the cell's self-cleaning mechanism).

Environmental Disruptors and Cortisol Chaos

Beyond psychological stress, environmental endocrine-disrupting chemicals (EDCs)—like BPA, phthalates, and certain pesticides—can mimic or block hormone activity. These toxins can impair cortisol regulation by altering enzyme activity, adrenal steroidogenesis, and even programming stress vulnerability in utero. The result? A new layer of invisible stress contributing to fatigue, metabolic disease, and cognitive dysfunction.

Interestingly, communities known for exceptional longevity—like the “Blue Zones” of Sardinia, Okinawa, and Nicoya—share common habits that naturally modulate stress and cortisol levels. These include:

• Strong social bonds

• Regular movement

• Whole-food diets rich in antioxidants (like the Mediterranean diet)

• Adequate sleep and sunlight

• A strong sense of purpose (“Ikigai”)

These lifestyle factors lower allostatic load, improve resilience, and slow the biological clock.

The Cortisol Curve and Circadian Harmony

Cortisol and melatonin operate in a delicate circadian rhythm. Cortisol peaks in the early morning to promote alertness, while melatonin rises at night to encourage sleep. Disruption to this rhythm—from shift work, blue light exposure, or irregular sleep—can disturb both hormones. Rebalancing requires morning sunlight exposure, limiting blue light at night, and using nutritional and lifestyle tools like magnesium, adaptogens (e.g., ashwagandha), and breathwork to recalibrate this internal clock.

There are tools for rebalancing cortisol towards the promotion of better health and longevity.  Managing cortisol is not about elimination—it’s about regulation. Functional strategies include:

• Targeted testing: Salivary or urine cortisol panels to track patterns.

• Anti-inflammatory nutrition: Fiber-rich foods, omega-3s, fermented options, and antioxidant-rich plants.

• Mind-body practices: Meditation, yoga, deep breathing, and mindfulness help buffer cortisol surges.

• Smart supplementation: Adaptogens (rhodiola, holy basil), amino acids (GABA, L-theanine), and adrenal-support blends.

• Physical activity: Regular movement—especially resistance training—supports stress resilience without overtaxing the system.

• Sleep optimization: Consistent sleep-wake times and good sleep hygiene reinforce hormonal balance.

• Purpose and connection: Social support and meaning in life directly reduce cortisol and buffer against disease.

Conclusion: Stress as a Lifelong Signal

Cortisol isn’t the enemy—it’s the messenger. It tells your body when to fight, when to rest, and when it’s under threat. But chronic, unrelenting activation of this system rewrites your biology, ages your cells, and steals years from your life. By understanding the nuances of cortisol, and applying the lessons of resilience, we can shift from stress overload to longevity. Functional medicine offers a blueprint for reclaiming this balance—through testing, lifestyle design, and integrative therapies—so we not only live longer, but thrive longer.

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About the Author

Dr. Angela Mazza, DO, ABAARM, ECNU is an integrative endocrinologist, bestselling author of Thyroid Talk, and founder of the Metabolic Center for Wellness. She is a respected speaker on the national circuit including the A4M, IFM, and Integrative Health Symposiums, where she advocates for the connection between hormonal health, resilience, and longevity. Her work bridges advanced endocrine diagnostics with personalized functional medicine strategies to empower healthier aging, especially for women in midlife.

"Living Better, Longer: A Smarter Approach to Longevity from the Inside Out"

 By Dr. Angela Mazza

Introduction: The New Meaning of Longevity

When we hear the word longevity, we often think about extending life. But in modern health circles, longevity means something deeper—it’s not about the number of birthdays we celebrate, but the quality of life we live along the way. More than just delaying disease, it’s about expanding our healthspan: the years we spend active, independent, and well.

As chronic illness, cognitive decline, and stress-related burnout rise, we now understand that living well into older age requires intentional strategies. Rooted in the latest research and modeled after long-living “Blue Zone” populations, longevity medicine focuses on preventing cellular damage, boosting resilience, and empowering personalized wellness.

This guide presents the essentials of a clinical-yet-practical roadmap to optimizing your long-term health.

1. Eat to Thrive: Fueling Your Body for the Long Game

Nutrition is the foundation of longevity. Studies show that diets rich in plant-based foods, healthy fats, and anti-inflammatory ingredients promote a longer, healthier life. The Mediterranean diet consistently ranks highest in this regard.

Incorporating fasting strategies—like intermittent fasting or fasting-mimicking diets—can trigger autophagy, a powerful cellular “clean-up” process that reduces damage and boosts efficiency. Adding targeted supplementation based on micronutrient testing (such as omega-3s or multivitamins) also helps fill nutritional gaps.

Longevity tip: Eat more whole, organic foods. Avoid ultra-processed items. Consider periodic fasting under professional guidance to activate your body’s natural repair mode.

2. Sleep: The Underestimated Anti-Aging Tool

Restorative sleep isn’t just about feeling refreshed—it actively helps prevent diseases like diabetes, obesity, and heart conditions. Even short-term sleep deprivation can disrupt metabolism and hormones.

Improving “sleep hygiene” (like limiting screens before bed, reducing caffeine, and creating a calming bedtime routine) can add years to your life. Supplements like magnesium, melatonin, and calming herbs may help support better sleep naturally.

Longevity tip: Track your sleep patterns. If fatigue persists, a sleep study or hormone testing may reveal underlying imbalances.

3. Move More, Live Longer

Exercise remains one of the strongest predictors of healthy aging. It boosts cardiovascular health, improves brain function, and reduces stress. But balance is key—excessive high-intensity training can backfire.

Aim for moderate activity five or six days a week, mixing aerobic movement, strength training, yoga, and flexibility work. Even short bursts of high-intensity movement throughout the day (like 10-second intervals) can deliver benefits.

Longevity tip: Don’t just exercise—move throughout your day. Take walking meetings, stretch regularly, and avoid prolonged sitting.

4. Master Stress Before It Masters You

Chronic stress disrupts hormones, impairs immunity, and accelerates aging. While short-term stress is natural, ongoing mental pressure harms long-term health—especially if it dysregulates cortisol, the body’s primary stress hormone.

Simple daily rituals like meditation, breathing exercises, or engaging in creative hobbies can recalibrate the body’s stress response. Adaptogenic herbs (like ashwagandha or rhodiola) and amino acids like GABA can provide added support.

Longevity tip: Enjoyment is medicine. Encourage social connection, relaxation, and joy as part of your health routine.

5. Gut Health: Your Immune and Longevity Gateway

The gut is where 70% of your immune system resides. A leaky or inflamed gut contributes to systemic issues—from autoimmune disorders to mood imbalances. Identifying and removing food sensitivities, treating infections, and supplementing with probiotics or gut-healing nutrients (like glutamine and quercetin) helps restore balance.

Longevity tip: Listen to your gut—literally. Bloating, fatigue, and frequent illness can signal imbalance. Consider functional gut testing if symptoms persist.

6. Hormones: The Longevity Messengers

Hormones regulate everything from metabolism to mood. For longevity, it’s critical to maintain thyroid, adrenal, and sex hormone balance. This is especially important in midlife, when shifts in estrogen, testosterone, or cortisol can accelerate aging symptoms.

Regular hormone testing—along with guided replacement or herbal support when appropriate—can restore equilibrium and improve energy, cognition, and resilience.

Longevity tip: Feeling "off"? Fatigue, weight changes, and mood swings may be signs of hormonal imbalance worth exploring.

7. Detox Daily: The Hidden Burden of Modern Life

We are exposed to tens of thousands of toxins—from plastics and pesticides to heavy metals and air pollution. Many act as hormone disruptors or carcinogens.

While we can’t live in a bubble, we can reduce our toxic load. Drinking filtered water, choosing organic foods, and supporting liver detox pathways through hydration, sauna use, or nutrients like glutathione, milk thistle, and vitamin C are critical steps.

Longevity tip: Sweat daily, poop daily, hydrate deeply. Your detox organs need constant support.

8. Insulin Resistance & Mitochondrial Health: The Cellular Core

Insulin resistance is a silent saboteur. It raises the risk of heart disease, dementia, and cancer. It also signals mitochondrial dysfunction—the cellular energy crisis at the root of many chronic conditions.

Managing blood sugar through continuous glucose monitoring, strategic fasting, and mitochondrial-targeted nutrients (like CoQ10 and NAD+ boosters) can help restore optimal energy and reduce inflammation.

Longevity tip: Waist gain, brain fog, and afternoon fatigue can all be signs of insulin resistance. Test early. Act early.

9. The Power of Purpose & Connection

Science supports what many have long felt: people who feel connected, purposeful, and supported live longer. Social isolation increases the risk of chronic disease and mortality, while regular interaction improves immune strength, mental health, and resilience.

Longevity tip: Invest in community. Volunteer, join a class, or reconnect with old friends—your cells will thank you.

Conclusion: A New Era of Longevity is Here

Longevity is no longer a passive hope—it’s an active practice. By addressing core areas like nutrition, stress, sleep, gut health, and insulin balance, we can reshape our aging trajectory. Best of all, these strategies don’t just add years to your life—they make those years vibrant, energized, and meaningful.

Whether you're a patient ready to reclaim your vitality or a clinician guiding others, this protocol reminds us: the path to longevity begins today, with daily choices that build a healthier tomorrow.

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About the Author

Dr. Angela Mazza is an endocrinologist and functional medicine expert dedicated to helping individuals thrive through midlife and beyond. Founder of the Metabolic Center for Wellness and host of the podcast "Thyroid Talk", Dr. Mazza is a nationally recognized speaker on longevity, hormone health, and resilient aging.

The Fasting Mimicking Diet Revolution: A Science-Backed Strategy for Longevity in Midlife Women

Source: Balance & Longevity editorial team (6/4/2025)

INTRODUCTION

As women approach midlife, many seek answers to the biological shifts that come with aging—weight gain, sluggish metabolism, chronic inflammation, and hormonal imbalance. But what if the key to turning back the biological clock wasn’t found in a prescription bottle, but in how we eat—specifically, when and how we don’t eat? Enter the Fasting Mimicking Diet (FMD): a cutting-edge nutritional protocol backed by science, shown to promote cellular rejuvenation, metabolic health, and longevity. Popularized by longevity researcher Dr. Valter Longo, and now reimagined by endocrinologist Dr. Angela Mazza, FMD represents a growing trend toward accessible, evidence-based dietary interventions that help women take control of their aging process—on their own terms.

THE SCIENCE BEHIND THE FMD

The Fasting Mimicking Diet is not just another trend—it’s a clinically researched, biologically strategic regimen that simulates the effects of fasting while allowing limited food intake. Developed at the University of Southern California by Dr. Longo and his team, the FMD was designed to trigger the body’s fasting-response pathways without requiring complete food deprivation.

This is achieved through a carefully structured five-day eating plan that reduces calories while maintaining specific macronutrient ratios—higher healthy fats, low protein, and minimal carbohydrates. Day one typically allows for around 1,100 calories, tapering to 750 calories from day two through five. The nutritional design tricks the body into thinking it’s fasting, initiating a cascade of physiological processes such as autophagy (cellular cleanup), ketogenesis, and hormone regulation—without the burden of prolonged water fasting.

Fasting, and particularly FMD, influences a wide array of molecular mechanisms linked to aging. It has been shown to suppress IGF-1 (a growth factor associated with aging and cancer), enhance stress resistance, and promote stem cell-based regeneration. These are the underpinnings of its promise in extending healthspan—the number of years a person lives in good health.

HEALTH BENEFITS FOR MIDLIFE WOMEN

Midlife is a time when women are especially vulnerable to metabolic decline, insulin resistance, inflammation, and the hormonal upheaval of menopause. FMD offers a unique, non-pharmaceutical intervention to support these challenges:

• Cellular Rejuvenation: FMD stimulates autophagy, helping cells detox and repair damage, which is vital in reducing aging and cancer risk.

• Reduced Inflammation: Cycles of FMD can reduce systemic inflammation—a common root cause of chronic diseases including heart disease and autoimmune conditions.

• Improved Metabolic Health: Regular FMD use has been associated with improved insulin sensitivity, lowered glucose levels, and better cholesterol markers.

• Weight Management and Body Composition: By resetting hunger hormones and reducing visceral fat, FMD can aid in sustainable weight loss.

• Hormonal Balance: Though still being studied, fasting can influence estrogen metabolism, cortisol response, and even thyroid function—all areas of concern in perimenopause and menopause.

For midlife women, these benefits are more than superficial—they represent autonomy over one’s health trajectory and a reduction in future disease burden.

ACCESSIBILITY & THE NEXT GENERATION OF FMD KITS

Despite its promising outcomes, FMD hasn’t been widely adopted in daily life. One major barrier is cost: current FMD kits range between $185–$220 per cycle and are often distributed only through healthcare providers. Dr. Mazza’s proposal seeks to change this by developing a more affordable, delicious, and accessible version under a health science brand—bringing the protocol to retail shelves and digital storefronts.

Removing the practitioner-only barrier also democratizes the practice. With improved flavors, supplemental support, and clearer educational materials, more health-conscious women can embrace the benefits of FMD without institutional hurdles.

THE TREND TOWARD LONGEVITY LIFESTYLES

Longevity isn’t just about extending life—it’s about extending quality of life. In the post-pandemic wellness era, women are not only becoming more informed about their health but are demanding science-backed, proactive solutions. This is why FMD is at the center of the longevity conversation. It aligns with other rising practices like intermittent fasting, circadian eating, and time-restricted feeding—but with more structure, safety, and clinical validation.

Moreover, FMD fits seamlessly into the expanding narrative of precision nutrition and functional medicine. It represents a personalized lifestyle tool that intersects endocrinology, immunology, and aging science—especially important for women who have long been underserved by generalized dietary advice.

CONCLUSION

For midlife women navigating a whirlwind of biological change, the Fasting Mimicking Diet offers more than just a diet—it offers a scientifically grounded reboot. By providing cellular rejuvenation, hormone balancing, and metabolic clarity, FMD becomes a cornerstone for those looking to enhance their resilience and longevity.

Thanks to experts like Dr. Angela Mazza, the vision for a more inclusive, affordable, and empowering future for FMD is taking shape. As access grows, so too does the opportunity for millions of women to reclaim their vitality—not through restriction, but through renewal.