The Cortisol Debate


For years no one paid any attention to the hormone cortisol. Now everything seems to be about cortisol, with people lining up to get saliva testing or to buy the latest book on cortisol as the secret to weight issues. What’s the real story? First let’s understand what a hormone is. When we talk about the adrenals, we are talking about glands. Just as the nervous system uses impulses that can produce an effect within a millisecond, the endocrine system uses chemicals known as hormones that can produce a rapid response as well, such as adrenaline. But unlike the nervous system, the glands can also be slow and persistent in their response. This second type of response is the more common since it provides day-to-day maintenance and growth such as the thyroid hormone thyroxine. So glands are what either begin a process or prevent a process... all through the action of hormones.

Hormones are different from enzymes, which act as a catalyst that speed up chemical reactions (think of your digestive enzymes). Hormones are inactive while carried to their destination. Once they reach their target tissues, they bring about a chemical reaction making the hormone metabolically active. The Endocrine system consists of various glands and glandular tissues that maintain a constant balance of physiological functions within the body despite fluctuations in the outside environment including metabolism, nutrient levels and energy balance. All the glands in the system are interrelated and have an effect on every other gland. So if one is a problem, others will step up to carry the load. For this reason, adrenal fatigue can actually be compensation for low thyroid function, cysts on the ovaries, fibroids in the uterus or sugar issues with the pancreas. This also means that hormones balance eachother out. If there is a hormone to start a process, there is another one to shut it down. Interestingly, this is the very basis of medicine in nature, because a plant that will produce a symptom will grow near to a plant that offers the cure.

And just to make it clear how much your body values hormones, when you have a LOT of a particular hormone, your body will create extra receptors so it can be used, while if you have too little of a particular hormone, the number of appropriate receptors will decrease. This is one way of the body regulating hormone activity to keep your body balanced.

Sometimes an underactive gland, such as the thyroid, really isn’t underactive, but simply has overproduced, causing receptors to lessen. This can happen especially during periods of stress. In fact, stress is the most crucial determinant of glandular function. Severe stress can even cause the adrenal glands to wear out their reserves of hormones, causing fatigue, body pain, emotional instability and fluid retention.

Many hormones must circulate through the blood for long distances to reach their target tissues. If they are fat-based such as cortisol from the adrenal glands, they rely on transporter proteins synthesized by the liver to make them temporarily water-soluble. If blood flow is compromised because of stress, muscle tension or other imbalances, then many hormones will have no mode of transportation to target tissues. Or if your essential fatty acid levels in your diet are too low, then you may not even be making hormones. Or perhaps you follow a vegan lifestyle. If your protein levels are not sufficient, then there won’t be transporter proteins for hormones to travel to their target tissues.

But to get a sense of cortisol, you have to understand where it comes from... the adrenal glands. These are the very essence of our coping mechanisms for day to day stress. They adapt to our environment and our sensory awareness, assessing your world from atop your kidneys. There are two areas of the adrenal, the cortex on the outside and the medulla within. The adrenal cortex releases a group of hormones known as Mineralocorticoids, which include aldosterone. Aldosterone controls the balance between intra and extra-cellular fluid, increasing blood levels of sodium and water and decreasing blood levels of potassium. This action can help to prevent acidosis and low blood pressure. But it can also cause edema, swelling of the hands and feet and headaches.

The cortex also releases a second group of hormones known as the Glucococorticoids, the most important of which is Cortisol. These act to increase the rate at which protein is broken down, stimulate synthesis of glucose and the breakdown of essential fats. In this way, they provide tissues with a ready source of energy to combat a range of stresses.

So you should understand that no hormone including cortisol is inherently bad. In fact, every single hormone has a positive purpose. But just like anything in life, when you overdo, there can be negative effects to what would normally be a positive experience. In the case of cortisol, we should take stock of what cortisol actually does...

  • It redirects blood to somatic muscles for the fight or flight response
  • It inhibits the thyroid by increasing thyroid-binding proteins made in the liver.
  • It influences the activity of DHEA and testosterone.
  • If the adrenals are healthy, then it enables the body to produce endogenous progesterone after menopause.
  • Cortisol also cycles numerous times through the blood instead of being removed, so its effects can be carried on for lengthy periods of time.
  • In reproductive age women, it competes with progesterone, making progesterone deficiency common in Phase 2 Adrenal Fatigue. Progesterone also provides a calming influence, which means that progesterone deficiency can cause anxiety.
  • Cortisol also affects female hormonal balance by preventing ovulation when cortisol levels are elevated. This prevents the additional stress of pregnancy from overloading the body’s stress-handling system.
  • Cortisol is anti-inflammatory
  • It is immuno-suppressive
  • It helps to regulate glucose production.

Cortisol has a number of daily cycles that are important in keeping your energy and metabolism balanced. Cortisol should be highest in the early morning at around 6-8 AM and lowest around midnight. In addition, it may be a bit higher after meals. Normal levels should be 6-23mcg/dl of blood. When the immuno-suppresive effects of cortisol reduce as cortisol levels drop, histamine levels can rise and so allergies may develop that are a direct result of adrenal fatigue.

A balancing aspect to cortisol is found in the final group of hormones from the adrenal cortex. These are the Androgens such as DHEA. In females DHEA is thought to increase sex drive and libido. DHEA is anabolic and androgenic, an anti-atherogenic which increases bone deposition and remodeling to prevent osteoporosis. It improves cardiovascular status by lowering total cholesterol and LDL levels. It also has a tremendous effect on our sex hormones as a precursor to testosterone in men and to estrogen in women. Recently DHEA has become sought after for its ability to increase muscle mass and decrease the percentage of body fat. It also is involved in the conversion of T4 to T3 in the thyroid.

When we first experience adrenal fatigue, as the cortisol elevates, the body will self-medicate by increasing DHEA levels as well to offset the negative effects of the high cortisol. This will create temporary improvements in energy, vitality, sleep, PMS and mental clarity. But don’t be fooled, this phase won’t last long and the surges in insulin that will occur will cause cravings for sugar, carbohydrates and hydrogenated oils.

Once we move into phase 2, cortisol will remain high, but its balancing partner DHEA will decrease and this is when symptoms will really begin. A nxiety attacks, mood swings, onset insomnia, restless leg syndrome and a generally "stressed" feeling become common. Due to the higher cortisol levels, many people experience "epic" dreaming, which is very exhausting. Increased cortisol levels extend the length of REM cycle sleep, allowing less time for Delta Wave sleep, which is the period of healing, repair and growth. Because of this, healing capacity diminishes and immunity weakens.

Increased levels of cortisol require additional calcium to sustain higher cortisol production. If there is insufficient calcium that is bioavailable, the body will cannibalize bones and other structures moving towards osteopenia. Higher levels of cortisol will increase prolactin which can cause a lack of ovulation and increases the removal of calcium from bones into the blood, which supports sympathetic dominance. High cortisol increases obesity by increasing fat deposition and the loss of lean muscle mass (due to the reduced effect of DHEA). It also has an antagonistic effect upon insulin production. High cortisol will cause headaches from vasoconstriction and inhibit the conversion of T4 to T3 for thyroid function. It will even shrink and kills off hippocampus cells depleting emotional memory.

During this phase, higher protein intake can cause an elevation in cortisol potentially making symptoms more severe. As the DHEA decreases, depression will begin. It is common for potassium levels to be low compared to sodium levels during this phase.

Once the exhaustion phase is reached, cortisol and DHEA both become depleted. The body will now enter a conservation mode with chronic fatigue, depression, maintenance insomnia and exhaustion, all of which can bring on fibromyalgia symptoms, impotence in men, panic disorders, infertility, anorexia nervosa, low white blood cell levels and low blood pressure. Sleep will be disturbed by waking up and not returning to sleep, a result of cortisol surges from the adrenals having lost their proper timed response. These surges can be worsened by hypoglycemia issues. Low levels of DHEA can cause recurring infections, arthritis, obesity and early menopause.

So simply reducing cortisol is not the answer. Cortisol levels are part of a well-timed and balanced system of body homeostasis. Don’t make the mistake of only addressing cortisol instead of paying attention to the adrenal glands as a whole. You make create more problems than solutions.