Cortisol – More Than Just "the Stress Hormone"

Ever wonder how stress affects your body? Learn how hormones like cortisol and adrenaline work, why too much can be harmful, and discover simple ways to keep your stress—and your health—in check.

When you face a perceived threat—like a car swerving into your lane or an aggressive dog, the hypothalamus in your brain triggers the “fight or flight” response. It signals the pituitary gland, which then tells the adrenal glands on top of your kidneys to release adrenaline and cortisol. Together, these hormones prepare your body to respond to stress and danger.

Adrenaline is the immediate responder – the “get going” hormone. It prepares your body for rapid action by increasing heart rate and blood pressure, speeding breathing to oxygenate muscles, releasing glucose for quick energy, sharpening focus, and speeding reaction time.

Cortisol is the sustained responder—the “keep going” hormone. It helps your body cope with ongoing stress by keeping blood sugar steady, suppressing non-essential systems like digestion and immune responses, maintaining alertness, and supporting memory formation.

Metabolic Regulation

Both adrenaline and cortisol have functions beyond the fight or flight response. Adrenaline helps raise blood sugar and metabolize stored fat when the body needs more energy, such as during physical activity. Cortisol helps regulate blood pressure, metabolism of carbohydrates, fats, and proteins, insulin effects, inflammation, and the sleep-wake cycle.

Too Much of a Good Thing

Clearly, cortisol helps us maintain a healthy metabolism. So why does it get a bad rap? It’s normal for cortisol levels to fluctuate throughout the day in response to minor stressors, such as a difficult commute or a conflict at work. These spikes are temporary and quickly resolved. However, prolonged exposure to high cortisol levels can cause a myriad of issues, such as:

• Weight gain
• Fatigue
• Acne
• Hair loss
• Bruising and slow wound healing
• Muscle weakness
• Elevated glucose levels
• Sleep problems
• Difficulty concentrating
• Anxiety and depression
• High blood pressure
• Menstrual irregularity, fertility problems, facial hair growth, and an increased risk of polycystic ovarian syndrome in women
• Decreased testosterone, poor sperm quality, lower libido, and erectile dysfunction in men

When Cortisol Levels Are Out of Balance

Consistently high cortisol levels can even lead to a condition known as hypothalamic–pituitary–adrenal (HPA) dysfunction, which increases your risk for heart disease, osteoporosis, diabetes, and depression. Another condition caused by abnormally high cortisol levels is Cushing’s syndrome. However, in Cushing’s, the elevated cortisol levels are not stress related. Rather, they are caused by tumors of the pituitary or adrenal glands, rare genetic conditions, or prolonged and/or high doses of steroid or glucocorticoid medications. People with Cushing syndrome tend to accumulate fat on their belly, behind the neck, and in the face, a symptom sometimes referred to as “moon face”. Their arms and legs may appear very thin in relation to their torso.

Consistently low cortisol is also a serious problem, known as “adrenal insufficiency.” There are three main types of adrenal insufficiency:

• Primary adrenal insufficiency is caused by damage to the adrenal glands themselves.
• Secondary adrenal insufficiency is when the pituitary glands don’t make enough aldosterone, an adrenal hormone that helps maintain your fluid/electrolyte balance and control blood pressure.
• Tertiary adrenal insufficiency stems from the hypothalamus failing to signal properly.
• Addison’s disease, most often caused by an autoimmune attack on the adrenal glands, leads to low cortisol and aldosterone. Symptoms include fatigue, low blood pressure, salt cravings, dizziness, muscle weakness, mood changes, skin darkening, and weight loss. Severe cortisol deficiency can trigger an Addisonian crisis, a medical emergency.

Managing Your Cortisol

A blood test can easily determine if your cortisol levels are elevated or not. It’s often included in the standard blood tests ordered as part of your annual physical but be sure to ask your doctor if you are concerned or have symptoms. If you do have high cortisol, managing stress is typically the first step. We know that’s easier said than done but focusing on some of these basic habits and lifestyle factors can certainly help.

• Make sleep a priority. Chronic sleep issues raise cortisol levels. Go to bed at the same time every night and try to keep regular hours. Stay away from screens at least an hour before bed: the blue light interferes with your sleep/wake cycle.
• Try to get 30 minutes of exercise in at least 5 days a week. Regular exercise is one of the very best ways to reduce stress – which is also good for your heart and general health. Moderate exercise is great, but just an evening walk after dinner is also helpful.
• Explore mind/body modalities such as yoga, meditation and practice deep breathing exercises. Controlled breathing stimulates the parasympathetic nervous system which helps lower cortisol levels.
• Try keeping a journal. Research has consistently shown that writing down your thoughts helps you process them and let go of negative patterns and emotionally-charged behaviors.
• Eat healthily. You know the drill – eat more fruits, vegetables and whole grains and less red meat. Stay away from processed foods, cut down on sugar and salt, and avoid anything that might give you heartburn or gas.
• Seek distraction. Find a hobby. Learn an instrument. Garden. Restore an old piece of furniture. Read, listen to music, or watch a favorite film. Volunteer in your community.
• Get out of the house. Take a walk or go somewhere beautiful and be in nature. Being among the trees has a calming effect on the mind.
• Avoid unhealthy ways of managing your stress, such as overeating or using alcohol, tobacco, or drugs. Talk to your healthcare provider if you feel you’ve indulging in unhealthy activities due to stress.
• Enjoy yourself and laugh. Laughter suppresses cortisol and promotes the release of endorphins. Tend to your relationships and distance yourself from people who stress you out.
• Don’t let others overburden you by asking for help or favors when you are too busy. Learn to say no and mean it. Organize and focus on what you need to get done at home and work and delete anything on your to-do list that doesn’t really need to get done now.

This article first appeared in the January 2025 edition of the HealthPerks newsletter.