5 Supplements to Reduce Cortisol & Manage Stress

The United States is facing a mental health crisis. Since 2020, the American Psychological Association (APA) has published findings of growing self-reported stress levels in the United States. In 2022, 76% of adults reported symptoms related to stress, such as headache, fatigue, anxiety, and depression.

While stress is inevitable, we can change how we relate to and respond to stressors. Incorporating supplements into one's routine is one way to foster resilience to stress, reduce cortisol levels, and promote better health outcomes.

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Understanding Cortisol and Its Effects

Cortisol is a steroid hormone produced by the adrenal glands that mobilizes energy reserves, regulates the immune system, and heightens alertness. The body's circadian rhythm governs cortisol levels throughout the day, creating a pattern in which they peak in the morning and progressively decrease throughout the day.

Cortisol is often called the "stress hormone" because, during perceived physical, mental, and emotional stress, the hypothalamic-pituitary-adrenal (HPA) axis is activated to stimulate cortisol secretion. This primes the body to upregulate physiological pathways required for survival, such as increased heart rate and blood flow to muscles.

Prolonged exposure to stress creates an environment in which the HPA axis is always activated. Chronic stress and prolonged elevations in cortisol have detrimental effects on health that are associated with an increased risk of developing chronic health conditions.

Signs and Symptoms of Elevated Cortisol

Common signs and symptoms of elevated cortisol levels include:

Persistent fatigue (often described as a "tired but wired" sensation)
Insomnia or other disrupted sleep patterns
Weight gain, particularly around the abdomen
Increased irritability, anxiety, or depression
Digestive issues, such as bloating or indigestion
Difficulty concentrating or memory problems
Weakened immune function
Increased blood pressure

5 Scientifically-Backed Supplements to Lower Cortisol

Let's discuss five evidence-based supplements that can help manage the stress response and promote normal cortisol levels.

1. Ashwagandha (Withania somnifera)

Ashwagandha is a widely used medicinal herb that has been a mainstay in Ayurvedic medicine for over 3,000 years. Classified as an adaptogen, it supports the adrenal glands in regulating stress hormones to better manage stress. By lowering elevated cortisol levels, ashwagandha mitigates feelings and symptoms of stress, which include insomnia, poor memory, daytime fatigue, and infertility (1).

Ashwagandha is generally reported to be safe when taken in standard doses of 250-500 mg one to two times daily. Minor side effects, including diarrhea, nausea, and vomiting, have been reported with higher doses. (14, 57)

2. Phosphatidylserine

Phosphatidylserine (PS) is a fatty substance classified as a phospholipid. Phospholipids act as a building block of cell membranes, especially in the brain. PS helps maintain cell membrane integrity and fluidity, which is important for facilitating cell-to-cell communication, neurotransmitter production, and neuroplasticity. (31, 33)

Supplemental PS can preserve normal cortisol levels by reducing adrenocorticotropic hormone (ACTH), a hormone released by the pituitary gland that signals the adrenal glands to produce cortisol in response to stress (30).

Excessive cortisol can lead to muscle protein breakdown and insulin resistance, increasing muscle breakdown and reduced muscle growth (9, 36). Studies suggest that supplemental PS can lower elevated cortisol levels and perceived muscle soreness that results from overexercising.

Phosphatidylserine-rich foods include soybeans, sunflower seeds, eggs, fish, and organ meats. When dietary intake is insufficient, supplements (most commonly derived from soy or sunflower) can be taken. In clinical research, PS has been used safely and effectively in pediatric and adult populations in doses of 100-300 mg daily for up to six months (7, 34). PS is generally well tolerated but may cause mild gastrointestinal upset, headache, and insomnia in higher doses.

(23, 42)

3. Omega-3 Fatty Acids

Omega-3s, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are well-studied, healthy, anti-inflammatory fats highly concentrated in oily fish.

Lower omega-3 fatty acid plasma levels have been associated with accumulated biological stress, HPA axis dysregulation, and autonomic nervous system dysregulation.

Optimizing plasma levels with omega-3 supplementation may reduce cortisol levels. One study found that supplementing with 1.25-2.5 grams of omega-3 fatty acids daily for four months led to lower cortisol and inflammation levels during stress and boosted repair mechanisms during recovery.

Researchers have found that supplements containing 2.5 grams of omega-3 fatty acids are best at improving stress resiliency.

4. Magnesium

68% of Americans don't meet dietary intake requirements for magnesium, which is associated with subjective stress and anxiety. Additionally, high levels of physical and emotional stress can lead to magnesium depletion by enhancing the urinary excretion of magnesium, perpetuating a vicious cycle.

Magnesium supplementation modulates the HPA axis by reducing ACTH and cortisol secretion in response to stressors (6). Magnesium is involved in the synthesis and function of serotonin and gamma-aminobutyric acid (GABA), neurotransmitters that play a role in stress regulation and emotions.

Magnesium supplements come in various forms, each with unique properties and affinities for different body systems. Magnesium citrate and magnesium glycinate are commonly preferred for their high absorption rates, making them suitable for raising low magnesium levels and addressing stress and anxiety symptoms (20). Magnesium threonate is gaining attention for its ability to penetrate the blood-brain barrier, making it a popular option for supporting mood and cognitive function (16).

Loose stools and abdominal cramping are magnesium supplements' most common side effects. When starting a magnesium supplement, it is recommended to start at a low dose and gradually increase to bowel tolerance. If diarrhea occurs, it is reversible by lowering the dose. Typical doses range from 200-500 mg one to two times daily. (39)

5. Rhodiola rosea

Rhodiola root contains adaptogenic compounds, including salidroside and rosavin, responsible for its stress-relieving therapeutic benefits. Many clinical trials have used a standardized rhodiola root extract called SHR-5 to study its effects. These trials have shown that study participants experience improved energy levels, cognitive function, and stress levels when taking supplemental rhodiola during stressful situations. (24, 48)

Supplemental rhodiola extracts are standardized to rosavin and salidroside content. A standard therapeutic dose ranges from 100-600 mg daily for up to 12 weeks. Side effects, although rare, may include dizziness, dry mouth, or excessive saliva production. (18)

Best Practices for Supplement Use

Selecting high-quality supplements ensures safety and efficacy. Look for reputable brands that adhere to good manufacturing practices (GMP) and have undergone third-party testing for purity and potency. Choose supplements with minimal additives, fillers, and allergens, and opt for forms easily absorbed and utilized by the body.

Before starting any new supplement, you should always consult with a healthcare provider, especially if you have underlying health conditions or are taking other medications or supplements.

Monitoring supplement effectiveness can be done by tracking symptom changes or health outcomes over time. It can often take several weeks or months to notice significant improvements, so it is important to give the supplement adequate time before determining if it is effective. To monitor progress, doctors may also suggest measuring objective markers, such as salivary cortisol, inflammatory markers, or micronutrient levels.

Lifestyle and Dietary Considerations

Integrating supplements into a holistic stress management plan can provide valuable support for the body and mind, complementing (not taking the place of) other lifestyle interventions such as a healthy diet, exercise, mindfulness practices, and adequate sleep.

Understanding Side Effects and Interactions

One common mechanism of herb-drug interactions is interference with drug metabolism, particularly through inhibiting or inducing drug-metabolizing enzymes in the liver, such as cytochrome P450 (CYP). Many herbs can modulate the activity of these enzymes, either inhibiting or inducing their function.

For example, some studies have suggested that rhodiola may increase the levels of drugs metabolized by CYP3A4, thereby increasing the risk of toxicity by inhibiting the enzyme.

The Importance of Professional Guidance

Effective medical care deviates from the one-size-fits-all care model, recognizing that individuals have unique health needs and responses to treatment. What works for one person may not be suitable for another due to variations in genetics, physiology, lifestyle, and underlying health conditions.

Healthcare providers can help patients navigate the complexities of supplement quality, efficacy, and safety by recommending reputable brands, appropriate dosages, and evidence-based formulations. They can assess individual health status, medication regimens, and potential risk factors to provide personalized recommendations for supplement use. They can also monitor adverse reactions or interactions and adjust supplement doses.