Cortisol and Stress: Exploring the Connection for Better Health

Cortisol, often termed the "stress hormone," plays a critical role in our body's response to stress. It mobilizes energy, increases hypervigilance, and fine-tunes our body's capacity to respond to various challenges. While beneficial in short bursts, prolonged elevation of cortisol due to chronic stress can have deleterious effects on health. 

This article aims to explore the nuanced relationship between cortisol and stress and examine how this interaction impacts our health, offering strategies to manage and mitigate these effects. By understanding the complex dynamics of cortisol and stress, readers can better navigate the stressors of daily life, aiming for a healthier, more balanced existence.

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Understanding Cortisol

Cortisol is a glucocorticoid steroid hormone released by the adrenal cortex and plays a critical role in the body’s stress response system as part of the hypothalamic-pituitary-adrenal axis. It works in concert with other stress hormones to prepare the body for a "fight or flight" response. As this response requires significant metabolic exertion, cortisol production is increased to provide the energy to respond accordingly and to maintain heightened alertness. Its main function during these periods is to break down proteins, fats, and sugars to quickly supply energy. 

Cortisol stimulates gluconeogenesis in the liver, enhances glucagon secretion to promote lipolysis, and breaks down muscle protein into amino acids (41). It also helps to moderate the immune response by reducing inflammation. Once cortisol levels peak, they initiate a negative feedback loop to regulate and maintain a balance within the system, ensuring the body does not remain in a state of stress indefinitely (34, 25).

In the absence of danger, cortisol has a natural diurnal release pattern as part of the circadian rhythm of the HPA axis that is further influenced by individual sleep-wake cycles and exposure to light-dark cycles (19). 

Cortisol rises in the morning, reaching a peak at around 30-45 minutes after waking to help prepare the body for the day, then slowly declines until it reaches its lowest levels at midnight. In the presence of chronic stress, this pattern can be disrupted. Common alterations include a blunted cortisol peak in the morning after waking, elevated cortisol levels throughout the day, and/or a rise in cortisol levels at night (30). 

The Impact of Stress on Cortisol Levels

The stress response system responds to all stressors similarly, no matter if you are running away from a tiger or scrambling to meet a deadline. With many of us dealing with persistent stressors in our day-to-day lives, this can lead to chronic stress responses and resultant cortisol imbalances. 

Acute Stress Response

In the presence of an acute stressor, increased cortisol release from the adrenal glands helps to provide quick fuel to the brain by encouraging the release of glucose into the bloodstream. This helps to increase energy and alertness, helping us respond to perceived threats quickly and effectively. After the acute stressor recedes, the SNS and the HPA axis are deactivated, allowing cortisol levels to regulate back to their normal baseline (31). 

Chronic Stress and Cortisol Imbalance

When acute stress turns into chronic stress, the regulatory mechanisms of cortisol release are negatively impacted. Chronic stress leads to sustained increases in cortisol, which in turn can damage neurons in the hippocampus that are involved in cortisol regulation, leading to long-term HPA axis and cortisol dysregulation (25).

The same catabolic actions (breakdown mechanisms) that help provide the body with the quick fuel needed for a physical response to acute danger can lead to negative consequences when experienced chronically during cortisol dysregulation. 

Cortisol’s role in increasing blood glucose can lead to insulin resistance and eventually diabetes when uncontrolled (18). Both diabetes and hypertension have been associated with blunted cortisol awakening responses (CAR) as well as nighttime cortisol elevations (30). Cortisol’s catabolic activity increases the risk for muscle loss, frailty in geriatric populations, and osteoporosis (18, 19).

 Its actions on the immune system can lead to poor immune system function in the long term. High cortisol can also have important implications for cognitive and behavioral health, including memory impairment, depression in adults, and increased emotional reactivity (18). 

Recognizing the Signs of High Cortisol

Because cortisol receptors are found throughout the body, sustained elevations in cortisol can potentially impact most organs and bodily systems (35). This leads to a wide variety of symptoms, including the following:

Physical Symptoms

• Weight gain, especially in the abdomen and face
• Fatigue
• Frequent illnesses
• Memory loss
• Muscle weakness
• Easy bruising
• High blood sugar
• High blood pressure
• Hirsutism (excess facial hair in cis women)

Psychological and Emotional Effects

When cortisol levels are present in balanced amounts, they aid central nervous system function by enhancing neuroplasticity and the healthy growth and differentiation of neurons in the brain. However, when the brain is exposed to high levels of cortisol for long periods, behavioral dysfunction can occur, leading to depression, irritability, and mood changes (18).

When cortisol levels do not drop at night as part of normal diurnal rhythm and instead remain elevated, sleep quality is reduced, leading to sleep disturbance issues (32).

Managing Cortisol Levels for Stress Reduction

With the reality of life presenting us with an onslaught of daily stressors, how are we supposed to manage our stress to best support HPA axis function and prevent dysregulation? 

Lifestyle Modifications

Daily exercise can play an important role in mitigating the impacts of stress. Routine physical activity modulates the nervous system’s response to stress by reducing cortisol levels. However, it is important to note that intense exercise such as high-intensity interval training can temporarily increase cortisol levels and should be balanced with sufficient rest and recovery time to allow levels to return to baseline. 

A diet rich in nutrients, fiber, protein, and healthy fats all support healthy HPA axis and SNS function. The Mediterranean diet is a helpful guideline that incorporates abundant amounts of fruits, vegetables, legumes, and whole grains and has been shown to have a positive effect on depression, blood glucose levels, and inflammation.

Adding protein and/or fiber to each meal and snack can help maintain healthy blood sugar levels, which prevents the release of cortisol in response to low levels of circulating glucose. 

Healthy sleep hygiene is also essential to a functioning stress response system. Getting 7 or more hours of quality sleep per night is ideal to help support healthy cortisol levels. Sleep helps to inhibit the HPA axis and thus keeps cortisol levels low as part of its natural diurnal rhythm. When sleep is routinely disrupted, it can lead to elevations in cortisol and increase the perception of stress. 

Stress Management Techniques

Stress management techniques can be effective in protecting the body from the detrimental consequences of chronic stress. These include mindfulness exercises such as therapeutic breathing, meditation, and relaxation exercises, all of which have been shown to reduce elevated cortisol levels in stress response (33).

Additionally, mindfulness activities can over time, lead to improved sleep quality, increased energy, and reduced symptoms of anxiety and depression (26).

Other mind-body therapies such as biofeedback, yoga, and cognitive behavioral therapy have also been shown to have a positive impact on cortisol levels (33). 

The Role of Nutrition in Cortisol Regulation

Certain foods can both help and hinder proper cortisol regulation. Incorporating foods that promote HPA axis regulation and limiting foods that increase cortisol are important tools for maintaining a healthy stress response system. 

Beneficial Foods and Supplements

Eating carbohydrates lowers cortisol levels in the body following acute stress events and protects against dysregulation of the HPA axis by enhancing cortisol’s feedback mechanisms. This is part of the reason why we reach for sugary snacks when we are overwhelmed by stress. Therefore, incorporating carbohydrates from whole foods such as fruit, vegetables, and whole grains into the diet can limit excess elevations in cortisol (36). 

Adding omega-3 fatty acid-rich foods to the diet can also help protect against chronic cortisol elevations. Omega 3 fatty acids are polyunsaturated fats found in abundance in seeds and nuts such as flaxseed oil, chia seeds, and walnuts, as well as certain fish such as salmon, herring, and sardines. High Omega-3 intake has been shown to reduce overall cortisol levels during stressful events and to aid in recovery. 

Herbal adaptogens are herbs and fungi that have shown modulatory activity on the HPA axis and help protect against harmful physiological stress responses. Adaptogens such as Schisandra, eleuthero, and Rhodiola have demonstrated neuroprotective effects as well as the ability to improve cognitive function, energy levels, and endurance. Ashwagandha, another notable adaptogen, can reduce cortisol levels and improve symptoms of stress and anxiety. 

Foods to Avoid

On the other end of the spectrum are foods that stimulate the release of cortisol. These include caffeine, high-fat diets, and high levels of sodium. Although a good cup of coffee can feed the soul, it can also increase cortisol levels. High intake of saturated fats has been shown to amplify the negative consequences of chronic stress on the nervous system and the cardiovascular system (22).

Finally, increased intake of dietary sodium can lead to elevations in cortisol throughout the day and overnight and is positively correlated with chronic stress markers (35). 

When to Seek Professional Help

Identifying the Need for Intervention

When chronic stress is not easily self-managed by adjustments made to lifestyle, nutrition, and stress mitigation practices, then it may be time for professional intervention. Healthcare providers can help pinpoint the degree of cortisol dysregulation through laboratory testing, which can aid in refining treatment plans.

As part of this workup, they can identify pathological disorders such as Cushing’s disease that are a rare cause of elevated cortisol. They can also identify alternative solutions and connect you with other practitioners such as therapists, nutritionists, and endocrinologists if needed for further support. 

Treatment Options

Treatment options primarily focus on reducing chronic stress and its impacts. The appropriate protocol varies based on root causes, individual needs, and health goals and often incorporates multiple modalities for greater effect and support.

In addition to the lifestyle, diet, and stress management practices already discussed, cognitive behavioral therapy and talk therapy can help identify stressors and mitigate the emotional effects of chronic stress. In some cases, medications such as anti-anxiety and anti-depressive pharmaceuticals may be used to help improve the associated impacts of chronic stress. 

Frequently Asked Questions (FAQ)

#1. How does high cortisol stress feel? 

High cortisol can commonly lead to feelings of overwhelm, fatigue, feeling “wired and tired” or on edge, irritability, depression and cause brain fog, mood swings, and result in poor sleep. 

#2. Is cortisol high or low when a person experiences stress?

For the most part, people will have higher cortisol levels when experiencing stress. This is due to the activation of the SNS and HPA axis which stimulates the release of cortisol and other stress hormones to respond to danger. When stress is chronic, low cortisol can also be experienced especially when HPA dysregulation causes a disturbance in the natural diurnal rhythm of cortisol, leading to deviations such as reduced CAR (31).

#3. What 4 foods raise cortisol?

Coffee and caffeinated energy drinks, high intake of saturated fats such as fried foods, and foods high in sodium such as cured meats can all elevate cortisol levels. 

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Key Takeaways

Cortisol, essential in our stress response, can harm health when levels remain high due to chronic stress.

Effective stress management is crucial for maintaining balanced cortisol levels and overall health.

Adopting a holistic approach—including lifestyle changes, regular exercise, a balanced diet, adequate sleep, and stress reduction techniques like mindfulness and meditation—is key.

For those struggling, professional support from healthcare providers or therapists can offer tailored guidance. By embracing comprehensive stress management strategies, individuals can improve their well-being and sustain a healthier, more balanced life.