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Hormone series Part 1: What is cortisol?

Bits of Wisdom

“My goal is to offer insight into your symptoms, help you make connections and give you some action steps to find your own optimal hormone balance and total body wellness.”


“Since our modern lives are incredibly stressful, understanding cortisol – and how to support a healthy cortisol rhythm – is critical for vitality and disease prevention.”


“Not only do we want the right amount of cortisol, not too much or too little, but we want our cortisol to follow a natural daily pattern of spiking first thing in the morning and gradually declining throughout the rest of the day. This supports daytime wakefulness and night time sleepiness, among many other benefits to our energy, metabolism, mental health and longevity.”



Hormone Series Part 1: What Is Cortisol? Cortisol Function


Most of the women, and men, who come to my functional medicine practice, have questions or concerns about their hormones. And with good reason: hormone balance creates a healthy and well-functioning body. When hormones are out of balance, however, we begin to experience symptoms. If you are gaining weight, experiencing inflammation, having fertility challenges or are tired all the time, it’s time to take a look at what your hormones are doing. 


A hormone is a substance, a protein (peptide) or steroid, made in one part of the body that has an effect on cells elsewhere in the body. Hormones include those that regulate blood sugar, hunger, metabolism, reproduction, digestion, gene expression and so much more. Because the topic of hormones is so broad, I’m writing a series of articles highlighting the most important hormones – and hormonal imbalances – that I see in my practice. My goal is to offer insight into your symptoms, help you make connections and give you some action steps to find your own optimal hormone balance and total body wellness.


In this article, I’m going to focus on the hormone cortisol. Cortisol is such an important hormone and one that I’m always testing in patients to help them uncover the root of the symptoms they are experiencing. Since our modern lives are incredibly stressful, understanding cortisol – and how to support a healthy cortisol rhythm – is critical for vitality and disease prevention. 


Keep reading to get the answers to these questions about cortisol:


Let’s dive in to this fascinating topic!


What Is Cortisol?


Cortisol is a hormone that you might already be familiar with as it is frequently discussed in terms of stress hormones. Cortisol is a glucocorticoid hormone, or a steroid hormone, made in the body from cholesterol. Whereas the majority of hormones are made from protein, steroid hormones are more similar to fat. Other examples of steroid hormones include the sex hormones such as DHEA, testosterone, estrogen and progesterone. 


Cortisol is a primary product of the HPA-axis, the hypothalamic-pituitary-adrenal axis, which is part of the body’s main stress response system. In other words, cortisol doesn’t act alone, but instead is part of a complex relationship between the brain and the adrenal glands. 


Here is the pattern: the hypothalamus in the brain produces corticotropin-releasing hormone (CRH), which signals the pituitary gland in the brain to produce adrenocorticotropin hormone (ACTC). It’s the ACTH that signals for the release of cortisol. 


I wrote about the HPA-axis extensively in my previous article: Adrenal Support During a Pandemic. Take a look at this article to learn more about what HPA-dysfunction looks and feels like in the body, what symptoms you might experience when cortisol levels are out of balance and important lifestyle and supplement support for your body’s stress response. 


Where Is Cortisol Produced?


Now that we’ve covered the basics of what cortisol is, the next question is: where is cortisol produced? If you guessed the adrenal glands, you are correct!


The adrenal glands are small triangular glands that sit on top of the kidneys like a baseball cap. Each adrenal is composed of the inner medulla and the outer cortex. It’s the cortex, and specifically the zone called the zona fasciculata, that produces cortisol. The medulla produces the other fight-or-flight stress hormones including epinephrine (adrenaline) and norepinephrine (noradrenaline). The adrenal glands also produce DHEA, a precursor to testosterone and aldosterone that helps to regulate blood pressure. 


Although small, the adrenals are very important!


What Does Cortisol Do In The Body? 


To understand cortisol function, we need to look at the natural diurnal cycle of cortisol. Cortisol follows a daily rhythm where it is high in the morning and then declines throughout the day, reaching its lowest point around bedtime. Upon waking, cortisol levels will surge an average of 50 to 60 percent in the first 30 to 45 minutes of the day. This is called the cortisol awakening response, or CAR. This surge is normal and healthy and helps you to feel awake, alert and ready to start your day. 


The cortisol decline throughout the day is called the diurnal cortisol slope, or DCS, and meant to follow a typical pattern where it decreases gradually to make you feel sleepier at night. Here is a visual of what a normal CAR and DCS looks like throughout the day:


I will circle back to this pattern in a moment because it’s very important when we talk about testing cortisol levels. But, back to the question at hand: What does cortisol do in the body? 


Here are some important functions of cortisol:


  1. Plays a role in metabolism and affects the body’s use of fats, proteins and carbohydrates.


  1. Raises blood sugar. When stress increases cortisol, cortisol mobilizes sugar to be used as energy in the “fight or flight” response. 


  1. Anti-inflammatory. Think of hydrocortisone cream or cortisone injections that are used medically to decrease inflammation. Your natural cortisol does the same thing making it important for the immune system. 


  1. Blood pressure regulation. Although the other adrenal hormone aldosterone plays a major role in blood pressure, cortisol also contributes. 


  1. Maintaining bone density. Normal cortisol levels support bone health. 


  1. Supports a healthy sleep-wake cycle. Cortisol works opposite of melatonin and helps you to feel alert and awake, whereas melatonin helps you to feel sleepy.


  1. Impacts mental health. Cortisol is important for behavior, cognition and mood. 


In short, cortisol impacts all body systems, affecting mental and physical health both in the short - and long-terms. If you started reading this article with the thought that “cortisol is bad” because it’s a stress hormone, now you can see just how vital cortisol is, when it is in the optimal daily pattern. 


Cortisol Testing


Since deviations from the typical cortisol pattern are associated with HPA-axis dysfunction, fatigue, heart disease, diabetes, depression and mortality and more, testing cortisol levels is an important functional medicine test for many of my patients. Understanding cortisol helps us to see why stress is an important, and often overlooked, root cause. 


Cortisol levels fluctuate during the day because of the diurnal pattern that we discussed, as well as the fact that both acute and chronic stress influence cortisol levels. Everything from a bad night’s sleep, sitting in traffic to hearing some bad news or other common every day events influence cortisol levels in the moment, and over time. 


This is why we can’t rely on a single cortisol test when looking for normal cortisol levels. Instead, I recommend a 4-point cortisol test that looks at 4 samples throughout the day to assess both cortisol levels and the daily pattern. 


Where some people follow a typical cortisol curve with this four-point test, more often than not, I do see some deviation from the optimal curve. I see patients with high cortisol levels throughout the day, low cortisol or a pattern where levels are low when they should be high or high when they should be low. 


Each of these cases present issues and may require different interventions, different supplements and different timing of habits throughout the day. In order to receive personalized care, we must test instead of guess. 


What Causes High Cortisol Levels?


The next question to explore is: what causes high cortisol levels and cortisol dysregulation. We’ve already touched on the main contributor: stress. 


At the extreme level of high cortisol is Cushing’s disease where cortisol and other adrenal hormones are excessively produced. This might be a result of a nodule on the adrenal gland or a tumor on the pituitary. High cortisol symptoms, in this case, are weight gain in the belly and upper back, rounding of the face, thinning of arms and legs, stretch marks, weak skin and weak bones. 


On the other extreme is Addison’s disease, which is adrenal insufficiency or extremely low levels of cortisol and other adrenal hormones. Symptoms tend to be fatigue, weight loss and weakness and Addison’s needs to be treated with hormone replacement. 


Most people I work with fall somewhere in between these extremes and experience some of the symptoms of HPA-axis dysfunction such as elevated blood sugar, weight gain around the midsection and other hormone imbalances


Anything that stresses the body contributes to cortisol imbalance, including:



When we typically think of stress, we think of the problems we have with our job or worry about money, but the body perceives stress on a much broader scale and we must consider all factors. 


Bottom Line


When it comes to cortisol, we want to be in the sweet spot. Not only do we want the right amount of cortisol, not too much or too little, but we also want our cortisol to follow a natural daily pattern of spiking first thing in the morning and gradually declining throughout the rest of the day. This supports daytime wakefulness and nighttime sleepiness, among many other benefits to our energy, metabolism, mental health and longevity.  


We all have stress in our lives, whether it’s obvious or not-so-obvious, as might be the case with toxins or infections. All of the daily stresses add up over time and negatively impact our cortisol rhythm. It doesn’t happen overnight and reversing changes often takes a deep look at your relationship to stress and developing new tools for self-care. 


If you are looking for action steps, check out my article on HPA-axis dysfunction for some simple strategies that you can begin implementing today. If you are ready for testing, and developing your personalized plan, please contact my office as I’d love to work with you. Balancing cortisol is deeply personal and leads to profound healing that most everyone can benefit from! 


References


  1. Adam, E. K., Quinn, M. E., Tavernier, R., McQuillan, M. T., Dahlke, K. A., & Gilbert, K. E. (2017). Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology, 83, 25–41. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568897/ 
  2. Kumari, M., Shipley, M., Stafford, M., Kivimaki, M. (2011). Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II study. J Clin Endocrinol Metab. 2011;96(5):1478-1485. Full text: https://academic.oup.com/jcem/article/96/5/1478/2833765 
  3. Joseph, J.J., Golden, S.H. Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes mellitus. Ann N Y Acad Sci. 2017;1391(1):20-34. Full text: https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1111/nyas.13217 
  4. Sephton, S.E., Lush, E., Dedert, E.A., Floyd, A.R., Rebholz, W.N., Dhabhar, F.S., Spiegel, D., Salmon, P. (2013). Diurnal cortisol rhythm as a predictor of lung cancer survival. Brain Behav Immun. 30(Suppl):S163-S170. Abstract: https://www.sciencedirect.com/science/article/abs/pii/S0889159112002024?via%3Dihub 


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The Fork Functional Medicine
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Phone: (615) 721-8008
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