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Stress and Cortisol: Whats the Connection?

Stress and Cortisol

Recently we have noticed patients coming to our practice with stress related symptoms and complaints has nearly doubled. They are stuck in the Alarm stage or "fight or flight" which was first introduced in the 1930's by the scientist Hans Selye.  He discovered the importance of the adrenal glands in mediating the biological effects of stress.

What are adrenal glands and why are they important?

The adrenal glands are two tiny pyramid-shaped pieces of tissue situated right above each kidney. Their job is to produce and release, when appropriate, certain regulatory hormones and chemical messengers.

Adrenaline (epinephrine) and noradrenalin (norepinephrine) are manufactured in the interior of the adrenal gland, called the adrenal medulla. Cortisol, the other hormone from the adrenal gland, is made in the exterior portion of the gland, called the adrenal cortex. Cortisol, commonly called hydrocortisone, is the most abundant -- and one of the most important -- of many adrenal cortex hormones. Cortisol helps you handle longer-term stress situations. The adrenal cortex also secretes androgens, estrogens, progesterone and DHEA.

What is the link between stress and cortisol levels?


The HPA (hypothalamus-pituitary-adrenal) axis a major part of the neuroendocrine system that controls reactions to stress. It also regulates other body processes such as digestion, immune response, energy usage, mood and sexuality. The limbic system of the brain triggers the hypothalamus to secrete CRH (corticotropin-releasing hormone) in response to a physical, emotional, or environmental stressor. CRH and vasopressin trigger the pituitary gland to secrete ACTH (adrenocorticotropic hormone), which activates the adrenal glands to produce cortisol which is then released into the bloodstream.


When cortisol blood levels become excessive, the HPA axis feedback mechanism turns off the corticotropin-releasing hormone which tells the brain and adrenal glands to cut down on cortisol excretion. Continued stress overrides this feedback system leading to continued production of cortisol.

If stress goes on too long and cortisol levels have stayed too high for too long this can lead to eventual adrenal fatigue and burn-out.

The Downside of cortisol

Some cortisol is essential for life. Cortisol is necessary for normal brain, immune, muscle, blood sugar function, and blood circulation.  In the beginning stages of adrenal fatigue cortisol levels are elevated. As the stress continues and the adrenal glands further deteriorate cortisol levels begin to decline. Having too little cortisol contributes to a new set of problems. Some know this as adrenal exhaustion or adrenal burn-out. Serious cortisol deficiency such as Addison's disease, is a potentially fatal illness.

Excessive cortisol is equally damaging and some of the symptoms can be the same.


How can I tell if my cortisol level is too high or too low?

 A saliva test called the Adrenal Stress Index can determine if your cortisol levels are too high or too low. All patients we consult with complaining of anxiety, panic, insomnia or other related symptoms get recommendations for a adrenal fatigue test. This consists of a saliva collection at four points during the day to determine diurnal cortisol rhythm. An adrenal fatigue test can also help pinpoint if you are in the beginning or advanced stages of adrenal fatigue. The sooner adrenal fatigue is discovered and treated the better the chances of preventing more serious health consequences.



Too much cortisol causes:

Abdominal obesity

High blood sugar ("adrenal diabetes")

Muscle wasting

Bone loss

Immune shutdown

Brain (hippocampus) atrophy

Poor wound healing

Thin wrinkled skin

Fluid retention



Excessive cortisol frequently causes increased:

Fatigue/decreased energy


Impaired memory

Depressed mood, decreased libido



Impaired concentration



Social withdrawal

Feelings of hopelessness

Chronically excess cortisol may contribute to many diseases, including cancer, ulcers, heart attacks, diabetes, infections, alcoholism, strokes, skin diseases, psychosis, and possibly Parkinson's and Alzheimer's disease, multiple sclerosis and myasthenia gravis. Cortisol excess may contribute to obesity not only because of the metabolic derangements (including insulin resistance) that it promotes, but also because it induces "stress overeating," especially (but not only) in women.


Ways to Reduce your Cortisol:


1. Use cortisol reducing supplement: There are a variety of herbs to reduce cortisol at peak times. Some of my favorites include: Seriphos, and Calm-PRT.

2.Adrenal Fatigue Supplements should be used in addition to the above to nourish and strengthen the gland. An adrenal supplement will also prevent the progression  towards low cortisol levels. Two of our favorites are Adrenal Fatigue Formula or Dr. Wilson's Dynamite Adrenal. This was formulated by Dr. James Wilson author of the book "Adrenal Fatigue" The 21st Century Stress Syndrome.

3. Eat at regular intervals throughout the day: Avoid skipping meals, as this will create a cortisol release.

4. Excessive carbohydrate intake creates cortisol release in response to constantly elevated insulin levels. Eat complex carbohydrates instead.

5. Utilize stress reduction techniques at peak cortisol times: meditation, self-hypnosis, or simply lying on the floor doing belly breathing for 10-15 minutes can work wonders at reducing stress and thus cortisol levels.

6. Get to bed on time. Get at least 8 hours of sleep nightly.

7. Avoid stimulants: Stay away from energy drinks that contain ephedra-like compounds and caffeine. Stimulants shift the body into sympathetic dominance, i.e. "fight or flight". Stimulants can also disrupt your sleeping patterns. If you must drink coffee, be sure that you do not drink any after 12 noon.

8. Keep your workouts under 1 hour: At the 1 hour mark, your testosterone levels begin to decline and cortisol levels rise. Yoga and Tai Chi have been shown to help reset the HPA axis and are great as part of your stress management plan.

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