Cortisol Balance: Find Out How It Affects Your Health

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by Karolina Zaremba


Have you ever wondered why you get a racing heartbeat, shortness of breath, or begin to sweat more when you’re anxious or nervous? These physical symptoms are a result of a hormone in your body known as cortisol. While this type of reaction feels uncomfortable, cortisol serves an important purpose. Cortisol is released when you encounter a physical or psychological stressor. A stressor can be anything from being cut off in traffic, to getting injured, to an argument with your coworker or spouse. For this reason, cortisol is commonly known as the “stress hormone”.

When your cortisol is in balance, it helps you to adapt well to stress. However, if your cortisol levels are too high or too low, it can be harmful to your organs or even fatal in extreme cases. (10) Read on to learn the effects of cortisol on your health, and what can happen with either insufficient or excess cortisol levels.

Woman relaxing on her couch at home

Cortisol is one of the main hormones that regulate your sleep-wake cycle.

What is cortisol?

Cortisol is a steroid hormone that is synthesized in your body from cholesterol. Although cholesterol may be obtained from the diet, it is also manufactured by your liver. It then follows one of several steroidogenic pathways in the adrenal glands, where it is eventually converted to cortisol, which is the active form of the hormone.

The adrenal glands are endocrine glands that produce hormones including cortisol, aldosterone, and adrenaline.

The production and release of cortisol, depends on the hypothalamus-pituitary-adrenal axis (HPA axis). These three endocrine glands work together to regulate cortisol and maintain homeostasis within your body. When you experience a stressor, it activates the parvocellular nuclei (PVN) in your hypothalamus gland. This leads to a release of corticotrophin-releasing hormone (CRH).

CRH acts on the anterior pituitary gland to promote the production and secretion of adrenocorticotrophic hormone (ACTH). ACTH is released into your veins and reaches the adrenal cortex, where it binds to the melanocyte type-2 receptor (MC2R) on cells and stimulates cortisol release into the bloodstream. This process is regulated by negative feedback inhibition, which means that cortisol can inhibit ACTH and CRH secretion to maintain homeostasis. (5)(10) In other words, as more cortisol is secreted by the adrenal glands, the negative feedback loop ensures ACTH and CRH secretion is decreased.

How does cortisol affect health?

When released into the bloodstream, cortisol has several physiologic effects, including:

  • Increasing heart rate
  • Raising blood pressure
  • Increasing blood glucose level
  • Adjusting respiration and muscle tension
  • Down-regulating digestive and reproductive functions (1)
  • Reducing inflammation (4)

The purpose of these effects is to allow your brain and body to respond and protect you from a stressor.

Man sitting at a desk holding his head, stressed

Cortisol is released when you encounter a real threat, such as injury, or a perceived threat, such as stress at work.

Beyond the stress response, cortisol also plays a role in your wake-sleep cycle and in maintaining serum glucose (blood sugar) levels. Cortisol levels should naturally peak in the morning between 6 am and 9 am, and be at their lowest from 11 pm and 1 am. As you are fasting overnight, cortisol levels begin to rise around 4 am in order to maintain blood glucose levels. (10)

While cortisol is essential to maintaining daily functions, chronic stress and other lifestyle factors can result in cortisol dysfunction. Dysfunction may involve depletion of cortisol, low free (or unbound) cortisol, issues with cortisol secretion or CRH function, glucocorticoid receptor resistance, or hypersensitivity of the negative feedback system. (4)

Insufficient cortisol

Since cortisol is made in the adrenal glands, sufficient adrenal function is necessary to produce the hormone. Adrenal insufficiency can come in several forms, including Addison’s disease, secondary adrenal insufficiency, and tertiary adrenal insufficiency. (13)

Some of the factors that contribute to adrenal insufficiency include:

  • Conditions that affect the pituitary gland, such as tumors, infections, or genetic diseases (secondary adrenal insufficiency)
  • Long-term use of corticosteroids followed by abruptly stopping the medication (tertiary adrenal insufficiency)
  • Autoimmune disease or infections such as tuberculosis (Addison’s disease) (13)

Addison’s disease, also known as adrenal insufficiency, is characterized by low cortisol levels. In Western countries, about 120 people per million suffer from this disease. The signs and symptoms include fatigue, weight loss, vomiting, diarrhea, abdominal pain, and behavioral changes. Corticosteroid and mineralocorticoid replacement therapies are used for the treatment of Addison’s disease. (14)

Woman sitting at her desk yawning

Addison’s disease can result in fatigue, behavioral changes, and digestive symptoms.

Another serious and potentially life-threatening condition related to insufficient cortisol is central adrenal insufficiency (CAI). CAI can be caused by either pituitary disease or impaired hypothalamic function, resulting in ACTH deficiency and other potential pituitary hormone deficiencies. When ACTH secretion decreases, cortisol secretion subsequently decreases as well resulting in several symptoms such as hypoglycemia, lethargy, apnea, jitteriness, and seizures. (9)

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Excess cortisol

Cortisol imbalance can also affect your health when levels are too high. While normal increases in cortisol levels occur as a result of moderate to intense exercise (6), prolonged cortisol exposure may lead to certain health conditions.

Causes of excess cortisol include:

  • Chronic stress, including shift work and intensive training in endurance athletes (5)(7)(12)
  • Children’s exposure to maternal postnatal depression (3)

Adapting methods to minimize or manage stress can help with cortisol dysfunction. Lifestyle changes such as cognitive-behavior stress management have been shown to help lower cortisol levels in patients experiencing high levels of stress, such as in cancer treatment. (2)

Some of the signs, symptoms, and outcomes of excess cortisol are:

  • A higher body mass index (BMI) or obesity (11)
  • Negative effects on cognition and can contribute to Alzheimer’s disease pathology (8)
  • An irregular inflammatory response when injured, resulting in impaired healing (4)
  • Inflammation, depression, and pain (4)

A condition called Cushing’s syndrome is characterized by elevated blood cortisol levels over an extended time. Some of the signs and symptoms of Cushing’s are obesity, hypertension, depression, decreased libido, and skin irregularities such as hirsutism or acne. The disorder can be caused by tumors on the pituitary gland or a benign adrenocortical adenoma. Interestingly, Cushing’s can also occur as a result of treatment with synthetic glucocorticoids. (10)

Key takeaways

  • Cortisol is a steroid hormone involved in managing your sleep-wake cycle and promoting adaptive physiological changes in the stress response.
  • Symptoms of cortisol dysregulation include fatigue, weight loss, digestive disturbances, hypertension, and decreased libido.
  • HPA axis dysfunction can result in unbalanced cortisol and conditions like Addison’s disease (adrenal insufficiency), central adrenal insufficiency, and Cushing’s syndrome.

Navigating cortisol levels can be complicated but is critical for optimal health. If you’re experiencing chronic stress or suspect you may have a cortisol imbalance, work with an integrative healthcare practitioner to evaluate your current status and learn how to regulate your stress response.

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  2. Cruess, D. G., Antoni, M. H., Mcgregor, B. A., Kilbourn, K. M., Boyers, A. E., Alferi, S. M., . . . Kumar, M. (2000). Cognitive-Behavioral Stress Management Reduces Serum Cortisol By Enhancing Benefit Finding Among Women Being Treated for Early Stage Breast Cancer. Psychosomatic Medicine, 62(3), 304-308. doi:10.1097/00006842-200005000-00002
  3. Halligan, S. L., Herbert, J., Goodyer, I. M., & Murray, L. (2004). Exposure to postnatal depression predicts elevated cortisol in adolescent offspring. Biological Psychiatry, 55(4), 376-381. doi:10.1016/j.biopsych.2003.09.013
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  7. Manenschijn, L., Rulanda G. P. M. Van Kruysbergen, G. P., De Jong, F. H., Koper, J. W., & Van Rossum, E. F. (2011). Shift Work at Young Age Is Associated with Elevated Long-Term Cortisol Levels and Body Mass Index. The Journal of Clinical Endocrinology & Metabolism, 96(11), E1862-E1865. doi:10.1210/jc.2011-1551
  8. Ouanes, S., Popp, J. (2019). High Cortisol and the Risk of Dementia and Alzheimer’s Disease: A Review of the Literature. Frontiers in Aging Neuroscience, 11(43), doi:10.3389/fnagi.2019.00043.
  9. Patti, G., Guzzeti, C., Di Iorgi, N., Maria Allegri, A.E., Napoli, F., Loche, S., Maghnie, M. (2018). Central adrenal insufficiency in children and adolescents. Best Practice & Research Clinical Endocrinology & Metabolism, 32(4), 425-444. doi: 10.1016/j.beem.2018.03.012
  10. Raff, H., Sharma, S. T., & Nieman, L. K. (2014). Physiological Basis for the Etiology, Diagnosis, and Treatment of Adrenal Disorders: Cushings Syndrome, Adrenal Insufficiency, and Congenital Adrenal Hyperplasia. Comprehensive Physiology, 4(2), 739-769. doi:10.1002/cphy.c130035
  11. Rask, E., Olsson, T., Soderberg, S., Andrew, R., Livingstone, D.E.W., Johnson, O., Walker, B.R. (2001). Tissue-Specific Dysregulation of Cortisol Metabolism in Human Obesity. The Journal of Clinical Endocrinology & Metabolism, 86(3), 1418–1421. doi:10.1210/jcem.86.3.7453
  12. Skoluda, N., Dettenborn, L., Stalder, T., & Kirschbaum, C. (2012). Elevated hair cortisol concentrations in endurance athletes. Psychoneuroendocrinology, 37(5), 611-617. doi:10.1016/j.psyneuen.2011.09.001
  13. Symptoms and Causes for Adrenal Insufficiency & Addison’s Disease. (2018, September 01). Retrieved May 13, 2019, from https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease/symptoms-causes
  14. Ten, S., New, M., Maclaren, N. (2001). Addison’s Disease 2001. The Journal of Clinical Endocrinology & Metabolism, 86(7), 2909–2922. doi: 10.1210/jcem.86.7.7636