Holistic Approaches to Optimize Cortisol Levels

What is cortisol?

Cortisol is a steroid hormone that is made by the adrenal glands, which are located above the kidneys.

Hormones (like cortisol) are essentially messenger chemicals that coordinate different functions in the body. Cortisol is responsible for stimulating the body’s fight-or-flight response, which occurs when a threat or stress is present.  

There are different types of stress, such as:

·       Acute stress (sudden danger)

·       Chronic stress (long-term frustration or anxiety)

·       Traumatic stress

The body will release cortisol in response to any type of stress.

Why is cortisol important?

In addition to being the body’s primary stress hormone, cortisol plays an important role in many body systems, including:

·       Blood pressure regulation

·       Blood sugar control

·       Reducing inflammation in the body

·       Energy levels and metabolism regulation

·       Assisting with memory & the sleep-wake cycle.

There are many factors that influence cortisol levels, including elements of the central nervous system and the adrenal system.

Note cortisol is not a “bad guy.” It is “good guy;” but when working in overdrive for too long, negative health effects can occur when cortisol regulation becomes dysregulated.

What is cortisol dysregulation?

Cortisol dysregulation, or often seen as HPA axis dysfunction in medical literature, often occurs when someone is under significant stress.

*Note, this is different from Addison’s Disease or Cushing’s Syndrome, which are both medical diagnoses that result from either “flat lined” very low or very high cortisol levels. Addison’s Disease & Cushing’s also have different etiology.

Cortisol dysregulation occurs in that “middle area” where levels are hanging onto normal reference ranges but can still trickle-down to other health issues. Consistently higher or lower cortisol (not meeting an ICD-10 code diagnosis) levels can negatively impact health.

Let’s dissect this. Over time, higher cortisol levels can result in lower cortisol levels. People can progress from phase 1 down to phase 4 and I would succinctly describe it as

• Phase 1: “alarmed and alert”
• Phase 2: “wired yet tired”
• Phase 3: resistance and adaptation
• Phase 4: exhausation

Higher cortisol levels:

Think more of the phase 1 as shown above. When the body is under stress, it prioritizes “fighting” off the stressor. This is helpful compensatory mechanism so we can “fight or flight.”

But if the stressor is ongoing or lingers, the consequences of this can be long term as not just an initial safety blanket. Long term, the body continuing to dump out cortisol can alter other normal bodily processes even if there isn’t a diagnosis for it:

• Increasing androgens too much
• Impaired thyroid conversion
• Slower digestion
• Decreased release of digestive enzymes
• Decreased insulin’s ability to work well
• Decreased immune function
• Reduced sleep quality
• Increased risk of autoimmune conditions
• Increased inflammation,
• In females can inhibit ovulation – which means pregnancy is not possible

Possible symptoms of chronically higher cortisol levels include:

·       Anxiety, depression, or panic attacks

·       Insomnia

·       Weight gain, specifically in the abdominal region

·       Brain fog

·       Inflammation or pain

·       Insulin or blood sugar dysregulation

·       Cravings for salty foods

·       Hair loss

Lower cortisol levels:

As time passes and a person has been in “fight or flight” for far too longer, cortisol levels can lower. This can result in downregulated sex hormone production (and decreased fertility), electrolyte imbalances cascading to water retention, decrease immunity, worsened fatigue, disrupted sleep, and heightened stress.

Symptoms of lower cortisol include:

·       Fatigue or burnout

·       Low mood or limited motivation

·       Decreased libido

·       Orthostatic hypotension (feeling dizzy or weak when standing)

Of course, any of these symptoms can be due to many other root causes, other than just abnormal cortisol levels. This is another reason why getting a medical evaluation is so important. “Test and don’t guess” is an expression I say all the time.

The DUTCH test is one common test and one stone to overturn to gather data on cortisol production and clearance in the body; this test is ordered by many functional nutrition registered dietitians and functional medicine physicians throughout the country.

Additionally, I want to stress that cortisol dysregulation is not “adrenal fatigue,” which many health experts state does not exist.

The more appropriate terminology is cortisol dysregulation which results from communication difficulty along the Hypothalamus-Pituitary-Adrenal (HPA) Axis typically in periods of prolonged stress. Chronic stress keeps your HPA axis constantly engaged.

The HPA Axis is complex and dynamic. To explain further, cortisol is produced in the adrenal glands, which are located on top of the kidneys. However, the hypothalamus and pituitary gland (which are located in the brain) are responsible for managing cortisol levels by instructing the adrenal system to adjust cortisol production as needed in the body.

Been stressed? First, I want to empathize with you. Secondly, what can you do about this:

Tips for naturally improving cortisol regulation in the absence of diagnoses

Medications are not typically prescribed for cortisol dysregulation, but there are plenty of lifestyle changes that CAN help:

• Stress management is the cornerstone for improving cortisol regulation. I like to recommend singing to loud music, which stimulates the Vagus nerve. Other relaxation techniques include deep breathing, taking a hot bath, or castor oil abdominal massage.
• Reduce caffeine intake! Remember that cortisol helps signal to the body that it is time to be awake and responsive. Too much caffeine can interfere with normal morning cortisol production, and potentially add more stress to the adrenal glands.
• Remediate toxic indoor mold. Test, don’t guess. Get an ERMI Kit (buy ERMI Kit 1 under “shop”) which is an at home dust collection kit to see what mold and “how much.” It is the medically recognized way to screen your home for clinically significant levels of toxic indoor mold that harm the human body. If score is above a 5, hire a certified mold inspector.
  • Mold is a big topic – check out my Healing from Mold Online Program if you need a step by step roadmap to follow that divulges it all!
• Get optimal sleep. Not getting enough sleep, poor sleep quality, and inconsistent sleep schedules (i.e. night shift) can all increase cortisol production and impact the HPA axis. This can lead to a vicious cycle of more stress and trouble sleeping. The American Academy of Sleep Medicine recommends that adults get at least 7 hours of sleep every night.   
• Move your body. The Physical Activity Guidelines for Americans recommend 150-300 minutes a week of moderate-intensity exercise. But any physical activity is better than none! Brisk walking is one of my favorite ways to move my body while also checking in on my stress and mental health. Additionally, spending time outside can provide additional calming benefits. If cortisol is lower, restorative exercises are best (like yoga) instead of HIIT work outs which can add additional strain.
• Write in a journal. Sometimes it can be helpful to just get stressful thoughts out of your head and onto paper.
• Obtain adequate nutrients and work with a registered dietitian to screen for nutrient deficiences and correct when needed. Certain nutrients deplete faster, like zinc and magnesium, when the body is under stress.
• Use adaptogens smartly!

General nutrient recommendations for supplements to support adrenal health:

• A morning “adrenal cocktail”
• A quality multivitamin with B- vitamins
• Magnesium glycinate around 300 to 400mg before bedtime
• Omega 3 Fatty acids at 1000-2000mg per day
• Vitamin D3/K2 between 1000-5000IU per day (depending upon labwork)
• Reishi Mushrooms 500-1000mg per day

Adaptogenic herbs or “adaptogens” are a class of herbs that help the body “adapt” to stress by modulating cellular sensitivity to stress hormone. Adaptogens such as ashwagandha, ginseng, and rhodiola have a long history of use in traditional Chinese and Ayurvedic medicine. Adaptogen supplements that help both ends of the cortisol dysregulation spectrum. As always, check with your healthcare team before starting anything as contraindications for you may exist.

• Rhodiola from 200-1000mg per day
• Ashwagandha 500 to 1000mg/day

Get my adrenal support protocol (with 15% off an free shipping) with dosing, instructions and general education handouts.

Looking for individualized nutrition guidance?

If you are questioning that you have a problem with cortisol dysregulation and want help navigating it, there are things you can do to feel better.

I heavily support (and utilize) functional nutrition in my practice. Sometimes, medical management and/or behavioral health experts are essential and I refer out when needed.

If you are interested in an individualized nutrition consultation, I offer telehealth nutrition packages. I often utilize the DUTCH test as part of my nutrition assessment. 

Ready to get started? Then go ahead, schedule your package now!

Warmly,

Katie Driessens, RD,LDN, CDCES, CGN

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