“We now live in a world where we are faced with 24-hour news cycles and phones that keep us connected at all times. Add to real world concerns about family and finances, many of us are living with chronic, prolonged stress that keeps cortisol levels elevated in ways our bodies were not designed to handle”

In my last post, we dug into the dangers of excess cortisol, a key hormone in the body responsible for managing key funtions, including stress response, metabolism, sleep cycles and immune health. Unhealthy excess amounts of cortisol can result in disrupted sleep, weight gain and abdominal fat, muscle loss, cognitive decline, and increases in anxiety and depression.

Let’s dig into the main causes of high cortisol levels in the body and how to get tested. In the next post, we’ll explore solutions, both in diet and supplements and in lifestyle changes.

Several factors can contribute to elevated cortisol levels, including chronic stress, poor sleep habits, unhealthy diet choices, lack of exercise, certain medical conditions, and medications. Reminder – your adrenal glands are responsible for releasing cortisol and adrenaline in your body. Every time you feel stress, your adrenals shoot out some cortisol. Our poor adrenals are overworked and tired, resulting in what is commonly known as adrenal fatigue. The good news is that many of the causes of excess cortisol and adrenal fatigue can be addressed.

Causes of High Cortisol

• Chronic Stress: When the body perceives a threat, it activates the fight-or-flight response, releasing cortisol to help cope with the situation. This response, known as the activation of the sympathetic nervous system, prepares the body to either fight or flee. It increases heart rate, diverts blood to muscles, and releases glucose for quick energy. While this is critically important in critical situations, we now live in a world where we are faced with 24-hour news cycles and phones that keep us connected at all times. Add to real world concerns about family and finances, many of us are living with chronic, prolonged stress that keeps cortisol levels elevated in ways our body was not designed to handle. Continuous activation of the sympathetic state can lead to chronic high cortisol levels, which may cause persistent anxiety, high blood pressure, and other health issues.

• Perimenopause and Menopause: Yes, in addition to everything else you’re dealing with during perimenopause and menopause, these life-changing hormonal shifts also affect cortisol levels. Estrogen helps regulate cortisol, so the decline in estrogen during these stages results in an imbalance. Progesterone, which has a calming effect on the brain, also drops, often leading to increased anxiety and stress, further elevating cortisol levels. Finally, testosterone levels also decline with age, which can lead to fatigue and decreased muscle mass. All of this can result in higher cortisol levels, making stress responses more intense and contributing to symptoms like weight gain, sleep disturbances, and mood swings. (This is one of the reasons I’m such a big proponent of hormone replacement therapy.)

• Poor Sleep Habits: Sleep is crucial for cortisol regulation. Ideally, cortisol peaks in the early morning and gradually decreases throughout the day. Poor sleep quality or insufficient sleep disrupts this rhythm, leading to elevated cortisol levels at inappropriate times. This can result in increased stress, anxiety, and difficulty concentrating. Chronic sleep deprivation can also lead to sustained high levels of cortisol, creating a vicious cycle where high cortisol further disrupts sleep. This cycle can contribute to various health issues, including weight gain, impaired immune function, and increased risk of chronic diseases like hypertension and diabetes.

• Unhealthy Diet Choices: Diet plays a crucial role in managing cortisol levels. High intake of sugar, caffeine, and processed foods can spike cortisol levels. For example, consuming large amounts of sugary snacks and drinks can lead to rapid spikes in blood sugar, which the body compensates for by releasing more cortisol. On the other hand, diets lacking in essential nutrients like omega-3 fatty acids, vitamins, and minerals can impair the body’s ability to regulate cortisol effectively. Ensuring a balanced diet rich in fruits, vegetables, lean proteins, and healthy fats can help maintain proper cortisol levels.

• Lack of Exercise: Regular physical activity helps regulate cortisol levels. A sedentary lifestyle can contribute to higher cortisol levels, while moderate exercise can help keep cortisol in check. For instance, activities like walking, yoga, and swimming can lower cortisol levels by reducing stress. However, excessive exercise without adequate rest can also lead to elevated cortisol, so balance is key. Overtraining can stress the body, leading to a chronic increase in cortisol, so it’s important to listen to your body and allow for recovery periods. Many of have been led to believe that intense cardio is crucial to burning calories for weight loss. For many of us, a more moderate approach will have a much more beneficial effect on our health. 

• Medical Conditions & Medications: Certain medical conditions, such as Cushing’s syndrome, can lead to abnormally high levels of cortisol. This condition is rare but highlights the importance of understanding underlying health issues that might contribute to hormonal imbalances and why it’s essential to get bloodwork and talk to a qualified health professional. Some medications, especially corticosteroids prescribed for conditions like asthma or arthritis, can increase cortisol levels in the body. If you are on these medications, work with your healthcare provider to monitor and manage your cortisol levels.

• Psychological Factors: Mental health conditions such as depression and anxiety can also influence cortisol levels. Psychological stress and mood disorders often lead to elevated cortisol, creating a complex interplay between mental and physical health. For example, chronic anxiety can keep the body in a constant state of alertness, maintaining high cortisol levels. This is why we’ll talk about the importance of stress-reducing techniques such as mindfulness, therapy, and relaxation exercises to help manage cortisol levels.

How to Test Cortisol Levels

So now we know what causes high cortisol. Let’s talk about getting tested. If your health practitioner is dismissive of your concerns about cortisol, get a new one. In my experience, people are dismissive when they lack adequate knowledge on a topic, and you deserve a health partner that is on the same page. (I said what I said 🎤)

If you suspect that your cortisol levels are too high, several tests can help determine your levels:

Blood Tests: The easiest, most affordable, and most widely accessible is a blood test to measure the amount of cortisol in your blood. They are usually done in the morning when cortisol levels are at their peak. You typically need a prescription from your doctor for this test, especially if you want it covered by insurance, and it may require fasting beforehand. Blood tests provide a snapshot of cortisol levels at a specific time.

Saliva Tests: Saliva tests can measure cortisol levels at different times of the day, providing a more comprehensive picture of your daily cortisol fluctuations. The most common of these tests is called the DUTCH test. They are non-invasive and can be done at home using a kit provided by a healthcare provider or a testing service. Saliva samples are collected at multiple points during the day (e.g., morning, afternoon, evening, and night) and sent to a lab for analysis. No prescription is usually needed, but you will pay out of pocket anywhere from $300-$500. It’s best to work with a health provider to properly analyze results.

Urine Tests: A 24-hour urine test measures the total amount of cortisol excreted in your urine over a day, giving an overall picture of cortisol production. Again, the “DUTCH Plus” test will test both salive and urine (this is the one that’ll run around $500). This test involves collecting all urine produced in a 24-hour period, which is then analyzed in a lab. This method is useful for detecting conditions that cause excessive cortisol production, such as Cushing’s syndrome. You typically need a prescription for this test, and it may require specific collection instructions to ensure accuracy.

Dexamethasone Suppression Test: This test involves taking a dose of dexamethasone, a synthetic steroid, and then measuring cortisol levels in the blood. It helps determine how well your adrenal glands respond to the synthetic steroid and is often used to diagnose conditions like Cushing’s syndrome. A prescription from your doctor is required for this test.

ACTH Stimulation Test: The adrenocorticotropic hormone (ACTH) stimulation test evaluates how well your adrenal glands respond to ACTH, a hormone that stimulates cortisol production. This test involves an injection of synthetic ACTH and subsequent measurement of cortisol levels in the blood. It’s used to diagnose conditions such as adrenal insufficiency or Addison’s disease. A prescription is needed, and the test is conducted under medical supervision.

Estrogen and Progesterone Tests: Given the role of these hormones in regulating cortisol, and you are over the age of 35, it’s also a very smart idea to test estrogen and progesterone levels. (Average age of perimenopause is 35-45 and menopause is 45-55.) These tests usually involve blood samples taken at specific times in your menstrual cycle (if applicable) or at any time if you are postmenopausal.

Things to Consider:

• Prescription: Most cortisol tests require a prescription from a healthcare provider. Consult with your doctor to determine which test is appropriate for you.
• Preparation: Depending on the test, you may need to fast, avoid certain medications, or follow specific instructions for sample collection.
• Insurance: Check with your insurance provider to understand coverage and potential out-of-pocket costs for cortisol testing.
• Interpreting Results: It’s important to have your test results interpreted by a qualified healthcare provider, as cortisol levels can vary based on numerous factors, including time of day, stress levels, and underlying health conditions.

In the next sections, we’ll delve into practical solutions, focusing on dietary adjustments, supplements, and lifestyle changes that can help keep cortisol levels in balance.

xo Tracey

P.S. Reminder – I’m a wellness coach, not a health practitioner, and I share what I’ve learned in the hopes that you’ll be empowered to find a great functional health practitioner as a partner on your health journey. If you are struggling to find one in your area, I suggest reaching out to my dear friends at Follaine Health who do telemedicine and can get you a DUTCH test quickly.

Read Part 1 of the Cortisol series 

Read Part 3 of the Cortisol series