Introduction

Cortisol is made in the adrenal glands, two small glands that sit on top of the kidneys. It is one of our stress hormones, and works with adrenaline in the “fight or flight” response.



Cortisol allows glucose, fat, and protein to be mobilized into the bloodstream to be used for energy under stressful situations (physical or emotional). It suppresses inflammation and the immune system- because you don't want your immune system ramping up if you are running away from a tiger. It also helps control blood pressure and temperature.


The Stress Response:


Cortisol has its own daily rhythm in that it is highest in the morning, decreasing throughout the day until its lowest point at night.


Stressful events such as exercise, a work deadline, or a scare, raise cortisol temporarily to provide the energy you need to be alert to get through the event.



Chronic stress raises cortisol long-term which can lead to some undesirable symptoms. Eventually, if not being supported properly, adrenal glands can “burn out” and produce too little cortisol. The more severe end of this spectrum is thought to be connected with chronic fatigue syndrome and depression.


Additionally, even if you have not been stressed out for a long time, you can still suffer from low cortisol if you are not providing the adrenal glands with proper nutrition and support.


Symptoms of Cortisol Imbalance:


The symptoms of high or low cortisol can sometimes be overlapping and difficult to tease out but here's what we would expect to see in each situation:


Excess cortisol

  • Muscle wasting

  • Abdominal fat storage

  • High blood pressure

  • Sugar/carb cravings

  • Anxiety

  • IBS

  • Frequent illness, allergies, autoimmune disease

  • Insomnia

  • Low libido


Low cortisol

  • Low blood pressure

  • Hypoglycemia, dizziness

  • Depression/irritability/can’t cope with stress/overwhelmed

  • Fatigue, hard to get going in morning

  • Salt & fat cravings

  • Autoimmune disease, allergies

  • Non-refreshing sleep

  • Low libido


Cortisol and Other Hormones:


Insulin:


Cortisol raises blood sugar levels, again in an effort to provide energy for you to deal with your stressor. Additionally, cortisol inhibits the function of insulin which would normally rise with an increase in blood sugar to deliver the sugar to your cells and store the rest in the liver. This is to attempt to maintain sugar flowing in the bloodstream to be used for immediate energy and not stored.



Over the long-term, this can cause an insulin-resistant state, and if the glucose does not ever get used up (for example if you are constantly stressed at work and remain sedentary all day and don't allow your muscles to use the glucose for fuel) the excess glucose in the bloodstream will eventually get stored (as fat once the liver fills up), which may lead to weight gain.



As well, as the cells are chronically starved of energy, one may notice increased cravings for sugar or carbohydrate-rich foods which may lead to eating lower quality foods which further poorly affects energy, mental health, weight management, and many more aspects of your health.


Thyroid hormone:


There is an intimate functional relationship between the adrenal glands and the thyroid gland. The thyroid gland produces thyroid hormone, which has far-reaching effects on every cell in our body, and deserves a blog post of it's own to dive into more detail, but here is briefly how the adrenals and the thyroid gland are connected.



Low adrenal function is a major contributor to low thyroid disorder however cortisol must be balanced for proper thyroid function, i.e. not too high either. Stress itself, as well as increased cortisol due to stress, both down-regulate thyroid function.


Sex hormones:


Cortisol acts on both the brain and the ovaries to inhibit reproductive function by lowering hormones such as LH, FSH, estrogen, and progesterone. This is why some women lose their period when they are under a lot of stress, and may have difficulty getting pregnant.



Testosterone can also be suppressed which can have implications for sex drive, energy, and motivation.


During perimenopause, the ovaries of course produce less and less of the above sex hormones, which leaves only the small amount that the adrenal glands were making in addition. This is why supporting your adrenal glands is paramount to supporting an easy menopausal transition.


Cortisol and the Immune System:


Cortisol is anti-inflammatory in nature. So you might think that high cortisol would be good for those with inflammation but actually it acts as a sign that inflammation is high and cortisol is trying to put out the fire. This constant inflammation means that the immune system is not working at its best and this is where we often see frequent colds and flus, worsened or new allergies, and even autoimmune diseases.



Too low cortisol can be a problem here too, of course, if the immune system is left unchecked.


Can you Test for Cortisol Imbalances?


If symptoms are present that suggest that there might be a cortisol issue, there are a couple of ways that one can further investigate:


  1. Blood test- morning cortisol: This method of testing is extremely variable so it's not the preferred method but it can be good to see in addition to symptoms and other testing methods.

  2. 24-hour urine collection: This tests the total amount of cortisol produced in a 24-hour period and is used for diagnosing diseases of the adrenal glands or the brain such as Cushing's syndrome, Cushing's disease, and Addison disease. This test does not tell us anything about your daily cortisol rhythm.

  3. Temperature tracking
        1.Taking your temperature a few times a day at the same time each day for a few months and taking the averages may shed some light on adrenal (and thyroid) health.
        2. Unstable averages are thought to be connected to adrenal fatigue.

  4.  Saliva 4-point cortisol test
        1. Take-home kit with 4 tubes to collect saliva throughout the day.
        2. Saliva is the ideal way to test cortisol, and the 4-point test is useful for understanding what your daily cortisol rhythm looks like.


Treatment


Often, our sources of stress are unavoidable, and while the "root cause" treatment would be to remove the stressor, this is usually not an option. This is where stress management techniques are essential. These can include:

  • Breathing exercises

  • Physical exercise

  • Meditation

  • Ensuring adequate sleep

  • Physical therapies like massage, acupuncture

  • Talk therapy

  • Time management and setting boundaries


Nutritional counselling and supplementation are also often helpful in these cases and are best discussed with your naturopathic doctor to ensure you're getting the right nutrients for YOU with the best quality and appropriate dosages.



Wondering if your adrenals need help? Our naturopathic doctors would love to talk to you!