How to Manage Your Cortisol
Stress and certain underlying conditions can increase your cortisol levels. High cortisol levels can cause a range of symptoms, including weight gain, acne, and fatigue.
Everyone has high cortisol from time to time, and levels vary throughout the day. It’s part of your body’s natural response to threats of harm or danger. But, if your body consistently makes too much cortisol, it usually indicates an underlying health problem. Doctors may refer to high cortisol as Cushing syndrome or hypercortisolism.
What is Cortisol?
The adrenal glands make this steroid hormone, but the hypothalamus-pituitary-adrenal axis controls how much your body releases. Think of cortisol as nature’s built-in alarm system. It’s your body’s main stress hormone. It works with certain parts of your brain to control your mood, motivation, and fear.
Your hypothalamus and pituitary gland -- both located in your brain -- can sense if your blood contains the right level of cortisol. If the level is too low, your brain adjusts the amount of hormones it makes. Your adrenal glands pick up on these signals. Then, they fine-tune the amount of cortisol they release.
Cortisol receptors -- which are in most cells in your body -- receive and use the hormone in different ways. Your needs will differ from day to day. For instance, when your body is on high alert, cortisol can alter or shut down functions that get in the way. These might include your digestive or reproductive systems, your immune system, or even your growth processes.
Cortisol plays an important role in a number of things your body does. For example, it:
Manages how your body uses carbohydrates, fats, and proteins
Keeps inflammation down
Regulates your blood pressure
Increases your blood sugar (glucose)
Controls your sleep/wake cycle
Boosts energy so you can handle stress and restores balance afterward
Cortisol is important for your health, but too much of it can harm your body and cause several unwanted symptoms.
What does Cortisol do to my Body?
Almost all tissues in your body have glucocorticoid receptors. Because of this, cortisol can affect nearly every organ system in your body, including:
Nervous system.
Immune system.
Cardiovascular system.
Respiratory system.
Reproductive systems (female and male).
Musculoskeletal system.
Integumentary system (skin, hair, nails, glands and nerves).
More specifically, cortisol affects your body in the following ways:
Regulating your body’s stress response: During times of stress, your body can release cortisol after releasing its “fight or flight” hormones, such as adrenaline, so you continue to stay on high alert. In addition, cortisol triggers the release of glucose (sugar) from your liver for fast energy during times of stress.
Regulating metabolism: Cortisol helps control how your body uses fats, proteins and carbohydrates for energy.
Suppressing inflammation: In short spurts, cortisol can boost your immunity by limiting inflammation. However, if you have consistently high levels of cortisol, your body can get used to having too much cortisol in your blood, which can lead to inflammation and a weakened immune system.
Regulating blood pressure: The exact way in which cortisol regulates blood pressure in humans is unclear. However, elevated levels of cortisol can cause high blood pressure, and lower-than-normal levels of cortisol can cause low blood pressure.
Increasing and regulating blood sugar: Under normal circumstances, cortisol counterbalances the effect of insulin, a hormone your pancreas makes, to regulate your blood sugar. Cortisol raises blood sugar by releasing stored glucose, while insulin lowers blood sugar. Having chronically high cortisol levels can lead to persistent high blood sugar (hyperglycemia). This can cause Type 2 diabetes.
Helping control your sleep-wake cycle: Under regular circumstances, you have lower cortisol levels in the evening when you go to sleep and peak levels in the morning right before you wake up. This suggests that cortisol plays a significant role in the initiation of wakefulness and plays a part in your body’s circadian rhythm.
Optimum cortisol levels are necessary for life and for maintaining several bodily functions. If you have consistently high or low cortisol levels, it can have negative impacts on your overall health.
What are Normal Cortisol Levels?
The level of cortisol in your blood, urine and saliva normally peaks in the early morning and declines throughout the day, reaching its lowest level around midnight. This pattern can change if you work a night shift and sleep at different times of the day.
For most tests that measure cortisol levels in your blood, the normal ranges are:
6 a.m. to 8 a.m.: 10 to 20 micrograms per deciliter (mcg/dL).
Around 4 p.m.: 3 to 10 mcg/dL.
Normal ranges can vary from lab to lab, time to time and person to person. If you need to get a cortisol level test, your healthcare provider will interpret your results and let you know if you need to get further testing. Testing can be conducted several ways:
Cortisol urine and blood tests. These tests measure the levels of cortisol in your blood and urine. The blood test uses a sample of blood drawn from your vein. The cortisol urine test is a 24-hours urinary-free cortisol excretion test that entails collecting urine over a 24-hour period. Blood and urine samples are then analyzed in a laboratory for cortisol levels.
Cortisol saliva test. This test checks for Cushing syndrome. A sample of saliva collected at night is analyzed to see if your cortisol levels are high. Cortisol levels rise and fall throughout the day and drop significantly at night in people without Cushing syndrome. High cortisol levels at night would indicate you may have Cushing syndrome.
Imaging tests. CT or MRI scans may be used to obtain images of your pituitary gland and adrenal glands to check for tumours or other abnormalities.
What are the Symptoms of High Cortisol?
High cortisol can cause several symptoms throughout your body. Symptoms can vary depending on what’s causing the increase in your cortisol levels.
General signs and symptoms of too much cortisol include:
weight gain, mostly around the midsection and upper back
weight gain and rounding of the face
acne
thinning skin
easy bruising
flushed face
slowed healing
muscle weakness
severe fatigue
irritability
difficulty concentrating
high blood pressure
headache
And on the flip side, If your body doesn’t make enough of this hormone, you have a condition doctors call Addison’s disease. Usually, the symptoms appear over time. They include:
Changes in your skin, like darkening on scars and in skin folds
Being tired all the time
Muscle weakness that grows worse
Diarrhea, nausea, and vomiting
Loss of appetite and weight
Low blood pressure
If your body isn’t making enough cortisol, your doctor may prescribe dexamethasone, hydrocortisone, or prednisone tablets.
Causes of High Cortisol Levels
The brain’s hypothalamus interacts with various glands in our body to regulate the levels of hormones. When it comes to cortisol, this is known as the hypothalamic-pituitary-adrenal axis.
When cortisol levels are low, the hypothalamus releases the corticotrophin-releasing hormone (CRH), which triggers the anterior pituitary gland to release the adrenocorticotropic hormone (ACTH). ACTH then causes the adrenal gland to create and release more cortisol.
There are different reasons why the adrenal gland may release too much cortisol.
Stress
Stress triggers a combination of signals within the body from both hormones and nerves. These signals cause your adrenal glands to release hormones, including adrenaline and cortisol. The result is an increased heart rate and energy as part of the fight-or-flight response. It’s your body’s way of preparing itself for potentially dangerous or harmful situations.
Cortisol also helps to limit any functions that aren’t essential in a fight-or-flight situation. Once the threat passes, your hormones return to their usual levels, and bodily functions return to typical levels. But when you’re under constant stress, this response doesn’t always turn off.
It’s also important to remember that, biologically speaking, there are multiple different kinds of stress, including:
Acute stress: Acute stress happens when you’re in sudden danger within a short period of time. For example, barely avoiding a car accident or being chased by an animal are situations that cause acute stress.
Chronic stress: Chronic (long-term) stress happens when you experience ongoing situations that cause frustration or anxiety. For example, having a difficult or frustrating job or having a chronic illness can cause chronic stress.
Traumatic stress: Traumatic stress happens when you experience a life-threatening event that induces fear and a feeling of helplessness. For example, experiencing an extreme weather event, such as a tornado, or experiencing war or sexual assault can cause traumatic stress. In some cases, these events can lead to post-traumatic stress disorder (PTSD).
Long-term exposure to cortisol and other stress hormones can negatively affect almost all of your body’s processes. This can increase your risk of health issues such as heart disease, lung issues, obesity, anxiety, depression, and more.
Pituitary gland issues
The pituitary gland is located at the base of your brain. People sometimes refer to it as the “master gland” because it monitors and helps control many of the body’s functions by releasing hormones.
Issues with the pituitary gland can cause it to under or over-produce hormones, including ACTH, which then triggers the adrenal glands to release more cortisol.
Pituitary conditions that can cause high cortisol levels include:
hyperpituitarism (overactive pituitary gland)
benign pituitary tumours, including adenomas
cancerous pituitary tumours
Adrenal gland tumours
Your adrenal glands sit above each kidney. Adrenal gland tumours can be benign (noncancerous) or malignant (cancerous) and range in size. Both types can secrete high levels of hormones, including cortisol.
In addition, if the tumour is large enough to pressure nearby organs, you might notice pain or a feeling of fullness in your abdomen.
Adrenal tumours are usually benign and found in approximately 1 in 10 people having an imaging test of the adrenal gland. Adrenal cancers are much rarer.
Medication side effects
Certain medications can cause an increase in cortisol levels. For example, some studies note a link between oral contraceptives and blood cortisol levels.
Corticosteroid medications used to treat asthma, arthritis, certain cancers, and other conditions can also cause high cortisol levels when taken in high doses or for a long period of time.
Commonly prescribed corticosteroids include:
prednisone (Deltasone, Prednicot, Rayos)
cortisone (Cortone Acetate)
methylprednisolone (Medrol, Methylprednisolone dose pack)
dexamethasone (Dexamethasone Intensol, DexPak, Baycadron)
Finding the right dose and taking corticosteroids as prescribed may help reduce the risk of developing high cortisol levels.
You should never stop steroid medications without gradual tapering or talking with a doctor first. Abruptly stopping can cause low levels of cortisol. This can cause low blood pressure or blood sugar, coma, and death.
What Causes Low Levels of Cortisol?
Having lower-than-normal cortisol levels (hypocortisolism) is considered adrenal insufficiency. There are two types of adrenal insufficiency: primary and secondary. The causes of adrenal insufficiency include:
Primary adrenal insufficiency: Primary adrenal insufficiency is most commonly caused by an autoimmune reaction in which your immune system attacks healthy cells in your adrenal glands for no known reason. This is called Addison’s disease. Your adrenal glands can also become damaged from an infection or blood loss to the tissues (adrenal hemorrhage). All of these situations limit cortisol production.
Secondary adrenal insufficiency: If you have an underactive pituitary gland (hypopituitarism) or a pituitary tumour, it can limit ACTH production. ACTH signals your adrenal glands to make cortisol, so limited ACTH results in limited cortisol production.
You can also have lower-than-normal cortisol levels after stopping treatment with corticosteroid medications, especially if you stop taking them very quickly after a long period of use.
How can I Reduce my Cortisol Levels?
If you have Cushing’s syndrome (very high levels of cortisol) you’ll need medical treatment to lower your cortisol levels. Treatment usually involves medication and/or surgery. You’ll also need medical treatment if you have lower-than-normal cortisol levels.
In general, though, there are several everyday things you can do to try to lower your cortisol levels and keep them at optimal ranges, including:
Get quality sleep: Chronic sleep issues, such as obstructive sleep apnea, insomnia or working a night shift, are associated with higher cortisol levels. Prioritizing sleep may help reduce cortisol levels. Practicing good sleep hygiene can help to keep cortisol in a normal rhythm. Keeping a consistent sleep schedule, avoiding caffeine 6 hours before bed, and staying off your cell phone right before bed are effective strategies.
Exercise regularly: Several studies have shown that regular exercise helps improve sleep quality and reduce stress, which can help lower cortisol levels over time. Exercise can increase or decrease cortisol depending on the intensity. Intense exercise increases cortisol shortly afterward but decreases it a few hours later. This short-term increase helps coordinate the growth of the body to meet the challenge. Additionally, the size of the cortisol response lessens with routine training.
Regular exercise can help reduce your risk of chronic disease, reduce stress, and improve overall health, according to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). This can help lower cortisol over time. Regular exercise may lead to greater resilience to acute stress and may lower adverse health effects associated with stress, such as high cortisol.
Learn to limit stress and stressful thinking patterns: Being aware of your thinking pattern, breathing, heart rate and other signs of tension helps you recognize stress when it begins and can help you prevent it from becoming worse. Adding a mindfulness-based practice to your daily routine may help you manage stress and reduce cortisol levels. Mindfulness-based stress reduction is a strategy that involves becoming more self-aware of stress-provoking thoughts, accepting them without judgment or resistance, and allowing yourself to process them. Training yourself to be aware of your thoughts, breathing, heart rate, and other signs of tension helps you recognize stress when it begins. By focusing on awareness of your mental and physical state, you can become an objective observer of your stressful thoughts without judging.
Practice deep breathing exercises: Controlled breathing helps stimulate your parasympathetic nervous system, your “rest and digest” system, which is responsible for relaxation and lower cortisol levels. Meditation, yoga, tai chi, and qi gong can help.
Enjoy yourself and laugh: Laughing promotes the release of endorphins and suppresses cortisol. Participating in hobbies and fun activities can also promote feelings of well-being, which may lower your cortisol levels.
Maintain healthy relationships: Relationships are a significant aspect of our lives. Having tense and unhealthy relationships with loved ones or coworkers can cause frequent stress and raise your cortisol levels.
Eat a nutritious diet. While all foods can be enjoyed in moderation, being mindful of the foods you eat may relieve symptoms of stress and help you better manage your cortisol levels. Regular high added sugar intake may result in elevated cortisol levels. Interestingly, a diet high in sugar may also suppress cortisol release during stressful events, making it more difficult for your body to handle stressful situations.
A recent study found that a diet high in added sugar, refined grains, and saturated fat led to significantly higher cortisol levels than a diet high in whole grains, fruits, vegetables, and polyunsaturated fats. Research has shown a strong relationship between a healthy gut microbiome — all the microbes living in your gut — and improved mental health. Therefore, consuming foods to support a healthy gut may help reduce stress and anxiety and improve overall health.
Other foods that help manage cortisol include:
Dark chocolate: Dark chocolate contains many flavonoids, which may buffer stress reactivity in the adrenal glands, resulting in lower cortisol release.
Whole grains: Unlike refined grains, whole grains are rich in plant-based polyphenols and fiber, which may support stress levels and gut health.
Whole fruits and vegetables: Whole fruits and vegetables contain many antioxidants and polyphenolic compounds that fight cell-damaging free radicals and may help reduce cortisol levels.
Legumes and lentils: High in fiber, they support a healthy gut while managing blood sugar levels.
Green tea: Green tea contains catechins, other polyphenols, and a calming compound known as L-theanine, which has been linked to reduced stress and increased mental alertness.
Probiotics and prebiotics: Probiotics are friendly, symbiotic bacteria in foods such as yogurt, sauerkraut, and kimchi. Prebiotics, such as soluble fiber, provide food for these bacteria. Both probiotics and prebiotics are linked to better gut and mental health.
Healthy fats: A diet high in unsaturated fat and low in saturated fat is associated with better overall health and mental well-being. In particular, omega-3 fatty acids are best linked with brain health and reduced stress. Good sources include fatty fish, nuts, and seeds.
Water: Dehydration can temporarily increase cortisol levels, making drinking water throughout the day even more important.
The Bottom Line
Cortisol is a hormone that is released during times of stress. While important for reacting to physiological and psychological stressors, chronically high cortisol can lead to poor health. Along with speaking with a healthcare professional, healthier lifestyle habits can help naturally reduce cortisol levels. If you’re looking for a natural way to reduce your cortisol levels and overall stress, try the simple lifestyle tips above.
