Having a hormone imbalance, such as elevated cortisol, may be one piece of the puzzle impacting your overall health and wellbeing by presenting itself in various symptoms such as fatigue, low energy, insomnia, anxiety, and mood changes. Working with a functional practitioner will help to address the root causes of your symptoms.

What is cortisol?

Cortisol is most commonly known as “the body’s stress hormone.” Cortisol often gets a bad rep since we live in a system that is designed to constantly trigger our fight or flight state leading to elevated cortisol levels. Essentially, we need adequate cortisol levels to get up and going for the day. Your cortisol levels peak early in the morning about 30 minutes to an hour after waking and begin it’s downward descent towards the evening. The problem is when cortisol is either chronically elevated or chronically low. Many of us unknowingly live in a state of elevated cortisol levels leading to symptoms of chronic fatigue, burnout, trouble losing weight, GI symptoms, and mood changes. Chronically elevated cortisol levels may eventually lead to plummeting cortisol levels showing up as low cortisol on lab results. Your primary doctor may not order this specific biomarker for you during a routine checkup since it isn’t part of a comprehensive metabolic panel (CMP). It’s important to know what labs to ask your primary doctor to test for as well as interpreting those labs based on optimal ranges instead of the standard conventional ranges that isn’t optimally healthy for you and often miss beginning stages of overall health dysfunction.

The role of cortisol

Cortisol has a variety of effects on different functions in the body. It is the main glucocorticoid produced by the adrenal glands. Your adrenal glands are located on top of each kidney. A neat way to remember the definition of adrenal is to go back to the latin word ad meaning at or near and attach it to the latin word renal, or renes, meaning kidney. Glucocorticoid receptors are present in almost all tissues in the body. Therefore, cortisol is able to affect nearly every organ system:¹

• The Nervous System
• The Immune System
• The Cardiovascular System
• The Respiratory System
• The Reproductive System
• The Musculoskeletal System
• The Integumentary System

The hypothalamus-pituitary-adrenal (HPA) axis regulates both production and secretion of cortisol. The HPA-Axis refers to the communication and interaction between the hypothalamus (H) and pituitary (P) in the brain down to the adrenal glands (A) that sit on top of your kidneys. When cortisol is needed in the body, the hypothalamus releases cortisol releasing hormone (CRH) and the pituitary responds by releasing adrenocorticotropic releasing hormone (ACTH), which is the signal to the adrenal gland to release cortisol, DHEA and DHEA-S. It is these adrenal hormones that are assessed on the DUTCH test to understand the patient’s HPA axis.

Main functions of cortisol

1. Handles the stress response by releasing cortisol.
2. Regulates energy metabolism by way of gluconeogenesis and increasing blood sugar levels.
3. Helps maintain a balanced circadian rhythm: cortisol levels peak 30 minutes to an hour after waking up (think of it as your natural caffeine hit) then gradually decline as melatonin levels increase leading to a deep, restful sleep. Essentially, this is your sleep-wake cycle that allows for a good night’s rest.

Getting sunlight first thing in the morning allows your body to naturally regulate your circadian rhythm or the sleep-wake cycle partly by inhibiting melatonin production during the day due to sunlight exposure and increasing production of melatonin in response to darkness. Hence the recommendation to reducing your exposure to blue light exposure after dark which will disrupt the melatonin cycle by suppressing melatonin production leading to difficulty falling asleep or insomnia.

Common symptoms of elevated cortisol

• Chronic fatigue leading to persistent low energy levels
• Weight gain specifically around the face, or moon face, and the abdomen
• Insomnia or difficulty falling or staying asleep
• Mood changes such as anxiety or irritability
• Tired but wired feeling
• Digestive GI issues such as bloating, indigestion, and changes in appetite
• Acne due to hormonal imbalances
• Decreased muscle mass
• Irregular periods during the menstrual cycle

Root causes of elevated cortisol

• Chronic emotional, psychological, or physical stress from work, relationships, or situations
• Inadequate sleep
• Lack of physical activity
• Under consuming calories and nutrients which may lead to overall weight loss but may be at the cost of a hormonal imbalance specifically elevated cortisol levels
• Lack of a nutrient dense diet specifically high intake of refined sugars, refined carbohydrate intake, high caffeine intake, and majority of meals and nutrients coming from ultra processed foods

Labs

You may use DUTCH (Dried Urine Test for Comprehensive Hormones) testing linked here to view your cortisol production (DHEA production, free cortisol, and metabolized cortisol) graphed out through the day. The DUTCH test measures cortisol along with it’s metabolites to give you a more comprehensive story about how your stress hormone is functioning.

Above is shown your melatonin level in the upper left as well as your free cortisol levels throughout the day. If you are in a chronic state of elevated cortisol or constantly in fight or flight mode, the above graph will reflect that. Your functional practitioner will recommend dietary and lifestyle changes as well as targeted supplementation to help modulate cortisol levels.

Conventional Labs to review (specific biomarkers):

• HbA1c (elevated due to chronic stress and elevated cortisol)
• Fasting glucose (elevated due to chronic stress and elevated cortisol)

Functional Labs to review (specific biomarkers):

• DHEA production
• Free cortisol
• Metabolized cortisol

There is no continuous cortisol monitor yet on the market.

Nutrition/Diet

Add:

• Include magnesium-rich foods such as dark, leafy greens, nuts, and whole grains.
• Include prebiotic-rich sources such as garlic and onion. Check with your practitioner first to see if you have a GI condition such as SIBO or SIFO.
• Include various fermented foods for gut microbiome diversity such as kimchi, kefir, fermented veggies, homemade pickles with the brine, and probiotic rich yogurt. Check with your practitioner first to see if you have a GI condition such as SIBO or SIFO.
• Include Vitamin-C rich foods: oranges, strawberries

Subtract:

• Remove or reduce refined sugars such as white sugar, brown sugar, high fructose corn syrup, cane sugar, corn syrup, etc
• Remove or reduce refined grains such as white processed bread, white rice, white pasta made with refined flour, pastries made with refined white flour and refined sugar, etc
• Limit caffeine intake or have after meals with protein and fiber to cushion the caffeine intake during digestion and absorption.

Probiotic strains

Discuss supplements with your dietitian to determine which will be the best fit for you. Always consult your healthcare provider prior to beginning a new supplement. 

Gut health and hormone health are connected. You are living in one body meaning all systems must work together to achieve optimal health so when one system is imbalanced, in this case a hormone imbalance or an imbalance in the endocrine system, the other systems (organs) are affected as well. An example of this is the gut which is part of the digestive system affecting the nervous system leading to a change in mental health, emotional health, and overall wellbeing. Having optimal health is simply focusing on the importance of the interconnected system of organs within the human body working together and properly in balance and harmony.

• Supplement with various probiotic strains that are associated with lowering elevated cortisol levels or supplement with a basic helpful probiotic strain such as Saccharomyces boulardii or S. Boulardii to help with general gut microbiome balance.

Adding various or specific probiotic strains to ferment in yogurt allows them to multiply and digest easier as well survive intestinal transit ensuring optimal nutrition.  I recommend making your own probiotic rich yogurt to experiment with different probiotic strains! I have the recipe linked here!

Medicinal herbs & adaptogens

Discuss supplements with your dietitian to determine which will be the best fit for you. Always consult your healthcare provider prior to beginning a new supplement. 

Adaptogens are herbs that help the body adapt to stress, regulate cortisol levels, maintain a healthy nervous system, promote relaxation leading to overall health and wellbeing.

• Ashwagandha (Withania somnifera)
• Lemon balm (Melissa officinalis)
• Kava (Piper methysticum)
• Sage (Salvia officinalis)
• Chamomile (Matricaria chamomilla)
• Rhodiola Rosea

Supplements

Discuss supplements with your dietitian to determine which will be the best fit for you. Always consult your healthcare provider prior to beginning a new supplement. 

Targeted Supplements to help with managing stress.

• Phosphatidylserine: recommended dosage is 100-200 mg daily or during times when cortisol peaks in the evening to help reduce levels. You can view your cortisol patterns mapped out throughout the day by viewing your DUTCH test results. To learn more about DUTCH testing for hormones click here.
  Cortisol Manager: contains Ashwagandha and Phosphatidylserine.
  Magnesium Glycinate: in the evening to support relaxation and optimal deep sleep.
  Cortisol Calm: contains Ashwagandha (adaptogen for stress) and L-theanine.
  L-Theanine: to support relaxation and restful sleep.
• B-Complex with Methylfolate:
• Liposomal Vitamin C: to help support the adrenal glands.
• Apigenin: medicinal compound found in chamomile.

You may order from my supplement dispensary below through Fullscript’s catalog where each brand and product meets strict top quality standards. You can learn more about third party testing here. My supplement dispensary is linked here and you do not need to be a client to place an order.

Stress

Stress management tools are listed here that will slowly help regulate cortisol levels.

Sleep

• Aim for 7-9 hours of quality, deep sleep. (there’s a difference between getting 8 hours of poor sleep versus 6 hours of deep restful sleep looking specifically at the REM and non-REM duration of your sleep for that night using wearable data (oura ring and whoop band).

Duration of sleep varies for females since hormones are always fluctuating and run on a monthly cycle. In the days leading up to the menstruation phase of your menstrual cycle, you may find that you have trouble falling asleep due to the decrease in estrogen and progesterone levels.

• Look at sleep routine: reduce blue light towards the evening to regulate proper circadian rhythm and melatonin levels, limit caffeine intake prior to bedtime (depends on multiple factors such as absorption rate of the caffeine, amount of caffeine intake per drink (milligrams of caffeine), meal intake for that day, meal timing and density prior to caffeine intake, hydration status, and in general your genetics or nutrigenomics & how well you process caffeine), sunlight in the morning for 10-15 minutes to regulate internal circadian rhythm, natural cortisol spike in the morning (to wake us up) as well it’s natural decline in the evening (to wind down) as melatonin secretion increases. You can test your *waking* melatonin levels using DUTCH hormone testing.

References

1. Kadmiel M, Cidlowski JA. Glucocorticoid receptor signaling in health and disease. Trends Pharmacol Sci. 2013 Sep;34(9):518-30. ↩︎