Stress: If you don’t have it, you’ve apparently found the pot of gold at the end of the unicorns’ rainbow. If you do—like most Americans—the phrase “cortisol levels” might have come up during one of your visits to your doctor’s office.
Cortisol is best known as “the stress hormone,” a chemical messenger the body produces when we’re feeling like we’re at the end of our rapidly fraying rope. It’s produced and secreted by a part of the body known by doctors as the HPA axis—a combination of the hypothalamus, pituitary gland, and adrenal gland that sends varying amounts of cortisol out to other parts of the body.
Linking cortisol to stress gives it a negative connotation, but in truth this hormone is not all bad, says David Cutler, MD, a family medicine physician at Providence Saint John’s Health Center in Santa Monica, California. In fact, Culter says cortisol is “essential in controlling our growth, organ development, immune functions, inflammatory response, and many other cellular activities.”
And while our cortisol levels do tend to spike when we’re stressed, cortisol production is part of the body’s functioning even when we’re having nice, normal, calm days (hey, they do exist!). Unfortunately, when your cortisol levels get out of whack, so can your body. Cortisol levels that are too high or too low can cause everything from extreme fatigue to blood pressure issues.
So how do you know if your cortisol levels are too high, too low, or just right? And is there really anything you can do about all that stress?
Sit down, chill out, and let’s do this.
What is cortisol, anyway?
Despite its colloquial name as the body’s stress hormone, cortisol is more aptly described by doctors as a steroid hormone, Cutler says—a complex molecule that has a variety of metabolic functions throughout the body.
“Its structure of carbon-containing rings is typical of steroid molecules,” Cutler explains, “And its functions can be mimicked by the synthetic cortisol hydrocortisone or other steroids.”
Yes, hydrocortisone, the tube of cream you grab at the drugstore when you’ve got an itchy rash, is related to cortisol. In the case of an allergic rash, smearing on a few dabs of hydrocortisone can tell the body to chill out and stop reacting to the allergen so you can get a little relief from all that itching. In the body, on the other hand, naturally produced cortisol helps to keep our systems in check, whether it’s maintaining the right levels of blood glucose or maintaining a healthy blood pressure. Basically, cortisol gives the body a little relief…from itching, and a whole lot more.
Much of what doctors know now about stress and the role cortisol levels play in the body’s response goes back to the 1930s and 1940s, when Hungarian endocrinologist Hans Selye explained the role the HPA axis plays in our fight-or-flight response to a problem. Selye found that corticoid hormones like cortisol were “indispensable for the maintenance of life and especially for the acquisition of adaptation to changes in the external or internal environment of the body.”
Cortisol Levels and Your Body
For the body to keep adapting to changes in its external and internal environment, cortisol levels have to change, Cutler says, and that’s usually normal. For example, cortisol may kick in as a response to any sort of stressor on the body,
Of course, this doesn’t just refer to “stress” as we’ve come to know it. Stress isn’t just your boss yelling at you or your child darting into traffic.
Stress can be getting extra busy in between the sheets, sending a message to your heart that it needs to increase the amount of blood it’s pumping to your heart, STAT! Stress can also come from that snacking on a pile of what you thought were gluten-free pretzels, only to find out you just “got glutened,” and knowing your celiac allergies are going to kick in, triggering an immune response.
“The transient rise or lowering of cortisol level is normal and in fact happens on a daily basis as cortisol levels peak upon awakening and bottom out shortly after bedtime,” Cutler explains. “They can also be affected by physical illness, fever, sleep deprivation, inflammation, pregnancy and emotional factors. In addition to internal factors, external factors such as diet, alcohol, caffeine, prescription medication, and nutritional supplements can also affect cortisol levels.”
You’ll notice some of these issues, including emotional factors, lack of sleep, and alcohol and caffeine usage can all be linked to what we traditionally think of as stress, while other factors are stressing the body in a more medical sense.
Semantics aside, when your body encounters stressors, cortisol comes out to play, helping the body keep its systems in check, and keeping your body healthy even in the face of an attack on the immune system. When everything seems okay, cortisol levels are then supposed to drop, increasing again only when they’re needed.
“Chronic stress is a contributing factor in elevated cortisol,” Lourie says. Other medical conditions that can increase cortisol levels are pregnancy, Cushing’s syndrome, Addison’s disease, pituitary or adrenal tumors, high blood pressure, obesity, and metabolic syndrome. Prolonged use of certain medical steroids such as prednisone or cortisone can also affect a person’s cortisol levels.
If you have Addison’s disease, for example, your body may not produce enough cortisol and aldosterone (another steroid hormone), says Joseph Geskey, DO, an internal medicine specialist and vice president of medical affairs at OhioHealth Doctors Hospital in Columbus, Ohio. That lack of cortisol can result in a variety of gastrointestinal issues including nausea, vomiting, abdominal pain, diarrhea, muscle weakness, and weight loss.
When managed well, Addison’s sufferers can live a fairly normal life—in fact the most famous Addison’s patient might be President John F. Kennedy, whose disease was kept relatively secret until after his assassination, when an autopsy revealed his adrenal glands were almost nonexistent.
Patients who have Cushing’s syndrome are also affected by cortisol levels that are different from their peers’, but in their case, the cortisol levels are too high instead of too low.
“Cushing’s disease is caused by a tumor in the pituitary gland (located in the brain) that produces a chemical called ACTH (adrenocorticotropic hormone) that stimulates the adrenal gland to produce too much cortisol,” Geskey explains.
Cushing’s sufferers typically have round faces, extra fat on the back of the neck, stretch marks on the abdomen, easy bruising, and extra hair growth on face, neck, chest, and abdomen. If the tumor grows large in the pituitary gland, it can also cause vision loss, Geskey warns. Other complications of too much cortisol can be cataracts, diabetes, hypertension, depression, and osteoporosis.
Signs Your Cortisol Levels Are Out of Whack
Despite the rather long list of conditions that might affect the body’s cortisol levels, there is some good news: Cortisol abnormalities are unusual according to Cutler. On the other hand, that also means doctors rarely test cortisol levels as part of an average physical or doctor’s visit.
“Because there is a very wide range of ‘normal’ levels of cortisol, as well as a certain degree of variability in these results, cortisol levels are generally not checked as part of a routine exam, but rather only if there is a high degree of suspicion of there being a cortisol abnormality,” Cutler explains.
So what sort of symptoms might prompt legitimate suspicion in you or your doctor? Lourie says it’s good to mention your concerns to your doctor if you have any of the following symptoms:
- Feeling you are overreacting to certain situations, have a very short fuse, or are easily angered
- Feeling anxious frequently for no apparent reason
- Feeling tired all the time no matter how much sleep you get
- Inability to relax and calm down, even during a restful moment
- Inability to sleep or waking up feeling unrefreshed
- Unexplained weight gain (without changing diet or exercise routine)
- Inability to lose weight (despite exercise and dedicated diet change)
- Unexplained acne
- High blood pressure
- Hormonal problems such as irregular menses or extreme cramping during menses
Many symptoms that would seem to indicate cortisol level abnormalities can be explained by other issues and will go away with treatment of said issues, but there are blood tests that can be done for cortisol levels to get to the bottom of the issue if other treatments don’t address the problem.
“Levels may seem abnormal when, in fact, there is no disease. And subtle symptoms may be found to be the result of cortisol abnormalities after more common causes have been excluded,” Cutler notes.
Managing Cortisol Levels
If a cortisol level abnormality is suspected, a primary care doctor will typically refer a patient to an endocrinologist, says Muneer Imam, MD, lead physician at the CIIT Medical Center, Long Island. The endocrinologist will call for blood tests, typically performed early in the morning and later again in the day to address the fact that cortisol levels fluctuate through the day.
Imam says a normal cortisol level is 6.2 to 19.4 micrograms per deciliter. “Anything below or above is out of normal range.”
If the numbers aren’t in range, the next step is determining why levels are too high or too low.
In cases of Addison’s disease, medicine is typically required. Doctors will turn to a class of pharmaceuticals known as glucocorticoids to replace the cortisol and mineralocorticoids to replace aldosterone, Geskey says. If an Addison’s patient gets sick, they can suffer an adrenal crisis, in which case doctors may administer cortisol via an injection.
For Cushing’s syndrome patients, on the other hand, treatment can involve surgery, medication, and radiation therapy. Surgical removal of the tumor that causes the condition offers the only long-term cure, Geskey says.
Diet changes may also be recommended by your healthcare provider, as food can have an effect on cortisol levels for some people.
Addison’s patients are often directed to increase their calcium and vitamin D levels, as well as salt intake, Geskey says, while Cushing’s patients may be told to eat a diet with foods rich in calcium and protein, which can possibly prevent muscle and bone loss associated with having too much cortisol.
Even those who are otherwise healthy and whose levels are not severely off track may benefit from dietary changes. For example, Lourie says, “Fast food choices and chronic stress add up to elevated cortisol levels.”
She starts patients off with an anti-inflammatory diet, eliminating sugars, processed foods, alcohol, and coffee. “The focus is on lots of fresh vegetables, healthy fats, gluten-free whole grains, small amounts of organic chicken, meat, and fish, as well as fruits.”
If upending your entire diet isn’t in the cards, it’s still a good idea to simply increase the amount of healthy foods in your diet, Lourie says, as that can put your entire body on a track to better health.
For other people with cortisol level issues that aren’t directly related to a medical condition that needs to be treated, diet, exercise, and other lifestyle changes are all on the table. Stress in life, after all, is part of what can make your cortisol skyrocket, and with it the side effects of cortisol levels that are too high.
“Although they are different, one of the common denominators is they all lower the body’s sympathetic nervous system, the fight or flight response, and activate the parasympathetic nervous system,” Lourie explains. “This is the part of the body’s nervous system which is calming and encourages relaxation and joy.”
Even focusing on something calming such as an art class to take your mind off your day-to-day could have benefits. In one small study performed by researchers at Philadelphia’s Drexel University, cortisol levels were tested on a group of 39 healthy adults before and after a 45-minute art class. The results? Three quarters of the group saw a drop in cortisol after letting their creative juices flow.
Of course, any treatment approach should be discussed with your medical practitioner, but if lifestyle changes can reduce your stress, you may just kill two birds with one stone.