Get Your Cortisol Levels Under Control & Turn Down the Stress

March 21, 2018
Cortisol levels - Dr. Axe

Do you find yourself overly stressed, tired, and even notice weight gain despite not changing your diet or workout frequency? Your cortisol levels may be out of whack. More specifically, they may be too high.

Cortisol is often called the primary “stress hormone” because it’s one of the main hormones we release when we’re under any sort of pressure and our evolutionary-based “fight or flight response” kicks into gear. Although most think of cortisol as a bad thing — such as contributing to acne, weight gain or high blood pressure — there’s actually a lot more to cortisol levels than just our stress response and its unwanted symptoms. We need it to live.

While producing cortisol is a necessity for life and helps keep us motivated, awake and responsive to our environment, maintaining abnormally high circulating cortisol levels can become dangerous and contribute to long-term problems. Long-term use of corticosteroids and chronic stress are two of the biggest contributors to high cortisol. Chronic, high cortisol production is tied to symptoms and ailments including weight gain, anxiety, sleep disorders, hormonal imbalances and fertility problems, in addition to many other problems.

The good news is there are many natural ways to get your cortisol levels in check. For instance, some adaptogen herbs are known to lower cortisol, and that’s just the tip of the iceberg. Read on for more ways to lower high cortisol levels naturally.

How to Lower Cortisol Levels Naturally

You can greatly help manage cortisol levels and regain your health by changing your diet, exercise routine, sleep and stress levels. Assuming you haven’t been diagnosed with Cushing’s disease by your doctor, here are steps you can take to help lower high cortisol levels naturally:

1. Switch to a Whole Foods, Anti-inflammatory Diet

Poorly managed blood sugar levels (especially hypoglycemia, having low blood sugar) and high levels of inflammation can contribute to high cortisol levels and other hormonal imbalances. Following an anti-inflammatory diet low in processed foods and high in antioxidants, fiber and essential nutrients is key to balancing hormones, controlling your cravings and getting you on the right track. These same strategies can also help with adrenal support, allowing you to reach and maintain a healthy weight, boosting energy during the day and helping you sleep better at night.

Some of the most significant dietary contributors to inflammation and high cortisol levels include: (1)

  • high-sugar, high-glycemic diet (with many packaged foods, refined grain products, sugary drinks and snacks)
  • consuming high amounts of refined and trans fats
  • drinking too much caffeine and alcohol
  • experiencing insufficient intake of micronutrients and antioxidants
  • not consuming enough fiber (which makes it hard to balance blood sugar)
  • not consuming enough healthy fats or protein (which can lead to hunger, weight gain and high blood sugar)

Instead, switch to a low-glycemic diet, include healthy fats and proteins with every meal, and make sure to get enough fiber and phytonutrients by eating plenty fresh fruits and veggies. (2) Some of the most useful foods for lowering cortisol and stabilizing blood sugar include vegetables; fruits; coconut or olive oil; nuts; seeds; lean proteins like eggs, fish and grass-fed beef; and probiotic foods (like yogurt, kefir or cultured veggies).

2. Reduce and Manage Stress

Chronic stress is now linked with just about every health problem out there. Stress affects most people at least to some degree and impacts health by sending chemical signals around the body, including to the heart and blood vessels, immune system, lungs, digestive system, sensory organs, and brain. Stress has the power to increase breathing, heart rate, pain and muscle tension, your appetite (including overeating), and sleep-related problems.

Luckily, the natural stress relievers listed below are proven to help lower cortisol and decrease the negative impact stress has on your health:

  • Meditation or “mindfulness”: This practice has been shown to help train the brain and body to turn off the stress response and promote more relaxation. And these benefits are possible without impairing alertness, concentration or memory. Many studies show that daily mediation or even healing prayer for just 15 to 30 minutes can offer significant reductions in cortisol. Participating in a regular “mindfulness-based stress reduction” program also offers significant reductions in cortisol and stress-related symptoms or diseases. Using meditative methods can also improve brain and heart health while bolstering your immune system. (3)
  • Acupuncture: Trusted for thousands of years in Traditional Chinese Medicine, acupuncture treatments help naturally control stress and reduce symptoms like muscle or joint pain, headaches, fertility problems, troubling sleeping, and poor circulation.
  • Deep breathing exercises: Taking deep breaths helps turn down the sympathetic nervous system and kick in the body’s natural relaxation response by activating the parasympathetic nervous system. Diaphragmatic breathing is an easy technique to learn on your own and practice throughout the day to relieve muscle tension and anxiety. Controlled breathing techniques have been a staple in Eastern health practices for centuries and are becoming more popular in the West, too, thanks to emerging studies and books describing their benefits — such as Dr. Herbert Benson’s book “The Relaxation Response.” (4)
  • Spending time in nature/outdoors: Studies show that physical settings play a role in stress reduction, and being in nature is a well-documented way to promote relaxation. (5) Try going for walks or runs outside (especially barefoot running or walking, a practice called “earthing“), spending time at the ocean, walking through forests, gardening at home, or doing other things outdoors and away from technology to reduce anxiety.

3. Exercise Regularly

According to research published by Harvard Medical School, regular exercise (about 30 to 60 minutes most days of the week, depending on the intensity) is one of the best ways to manage stress, balance hormones, sleep better and aid normal metabolic functions (like balancing blood sugar levels). (6) The key is to avoid overtraining and overexerting yourself, which can actually cause even more cortisol to be released.

Exercise benefits hormone levels because although it temporarily increases adrenaline and cortisol production, it generally helps bring cortisol back down to normal levels afterward. This cycle helps your body better handle stress and gives your autonomic nervous system (the one that controls your stress and relaxation responses) its own workout. This means the next time your stress hormones rise due to a perceived threat, you should be able to lower cortisol levels more easily, since your body becomes primed to this during physical activity.

4. Use Adaptogen Herbs and Superfoods

Adaptogen herbs help naturally lower high cortisol levels in several key ways. They help balance hormones, reduce inflammation due to their strong antioxidant, antiviral and antibacterial effects, have natural antidepressant effects, lower fatigue, and help balance blood pressure and blood sugar levels. Many adaptogens, such as reishi mushrooms and cocoa, have been safely used for thousands of years to promote better overall health with little to no side effects.

Some adaptogenic herbs that have been observed to directly regulate cortisol levels are:

  • ashwaganda
  • astragalus
  • licorice root
  • medicinal mushrooms, including resishi and cordyceps
  • rhodiola

While some adaptogenic herbs haven’t been found in scientific research to directly impact cortisol, they may help indirectly because of the way they function. See, adaptogens have “non-specific” impact throughout the whole body, resulting in an improved response to stress overall. Some of them lower corticosterone (another stress hormone), while others result in improved cognition, neurotransmitter function, immunity and antioxidant activity. Adaptogens that act without directly altering cortisol levels include Panax ginseng and holy basil, among others.

Interestingly, the herbs listed above may first act by giving you an extra bump in cortisol when presented with the fight-or-flight response. People who suffer from adrenal fatigue often aren’t able to produce proper amounts of cortisol when exposed to stress because their adrenal glands are taxed, so adaptogens that influence cortisol might provide the necessary boost. That way, your body is able to respond more efficiently to stress, resulting in lower circulating cortisol levels over time.

Many adaptogens are available in capsule or powder form. Some, such as holy basil, can be grown or bought in fresh plant form to use in beverages or foods.

5. Try Essential Oils to Promote Relaxation

Similarly to adaptogen herbs, essential oils are also helpful for fighting stress and balancing hormones. Essential oils, including lavender, clary sage, frankincense and bergamot, contain potent, active ingredients that have been shown to naturally lower cortisol, combat anxiety, reduce inflammation, improve immunity, and/or help with sleep and digestive functions. (7, 8, 9, 10)

Try inhaling some of the best essential oils for hormones, diffusing them in your home, making bath soaks or body washes using your favorite kinds, or rubbing them directly into your skin when mixed properly with a carrier oil (like coconut or jojoba oil). If you’re dealing with side effects of high cortisol, including acne, indigestion or bloated stomach, certain essential oils like lemon or peppermint can help with that, too.

6. Get Enough Sleep

Getting enough sleep helps us control cortisol production, but having high cortisol levels can make it hard to rest. In people with normal circadian rhythms, cortisol levels rise during the early morning hours and then drop very low at night prior to sleep and during sleep. People who develop high cortisol levels can wind up feeling the opposite: wired and anxious at night, but then fatigued during the day — thus, they can’t sleep well at the times they’re supposed to. On the reverse end, sleep deprivation results in higher levels of cortisol just the following evening. (11)

This overactivity of the adrenal glands is one of the biggest signs of Cushing’s disease or adrenal fatigue and is usually tied to stress and hormonal imbalances. By taking the steps listed above, you should be able to rest more easily. Ideally, you should aim for seven to nine hours of sleep per night to reset your circadian rhythms and bring hormones back to balance.

What Is Cortisol?

The adrenal gland, following signals from the hypothalamus and pituitary gland, is responsible for the secretion of cortisol, a type of essential glucocorticoid steroid hormone. Cortisol levels are highest in the morning around 7 a.m. and lowest at night (called a diurnal rhythm). Cortisol is also present in both chronically stressed individuals and those who are perfectly healthy. (12) This vital hormone possesses dozens of different purposes within the body and makes numerous chemical interactions every single day.

What does cortisol do exactly? Cortisol receptors are scattered throughout the entire body, found in nearly every cell, and serve different essential functions, including: (13)

  • helping to keep us awake and alert
  • preventing fatigue or brain fog
  • keeping our metabolisms running (it helps us burn fat for energy)
  • balancing blood sugar levels (since it allows cells to take up and use glucose for energy)
  • reducing inflammation and helping with healing
  • balancing fluid levels based on salt and water intake
  • contributing to control over blood pressure
  • helping with many cognitive processes like learning and memory formulation
  • allowing us to respond to and escape perceived dangers
  • helping to develop the fetus during pregnancy

Levels of cortisol rise when the pituitary gland releases another hormone called adrenocorticotropic hormone (ACTH). ACTH signals the adrenals to pump out more cortisol. Why does this happen? Many different things trigger this release, including various forms of physical or emotional stress, a poor lifestyle, too little sleep, or illnesses and infections.


Symptoms of high cortisol levels - Dr. Axe


High Cortisol Levels, Cushing’s, Addison’s and Adrenal Fatigue: What’s the Difference?

Cushing’s Disease/Syndrome

When the pituitary or adrenal glands produce abnormally high levels of cortisol for a duration of time, a doctor may diagnose a serious, chronic disorder called Cushing’s disease. Cushing’s disease is usually caused by tumors on the adrenal or pituitary glands and often causes symptoms like rapid weight gain, a swollen face, fatigue, and water retention/swelling around the abdomen and upper back. It impacts women between the ages of 25 to 40 most often, although people of any age and gender can develop this condition. (14)

Diagnosable Cushing’s disease caused by an overactive adrenal gland is considered much rarer than just having generally high cortisol levels. In other words, you have a much greater chance of experiencing high cortisol at certain times due to increased stress in your life than you do of ever being diagnosed with Cushing’s disease. While people experience at least somewhat high levels of cortisol at one time or another during very stressful episodes (such as a job loss, family crisis or major change), rates of Cushing’s disease diagnoses are still very low compared to other hormonal/endocrine conditions like thyroid disorders or diabetes, for example.

It’s estimated that Cushing’s disease impacts between 10 to 15 people per million, but comparatively high cortisol levels above what are considered normal affect millions of people and most adults. While symptoms of Cushing’s disease and high cortisol tend to be similar, those caused by Cushing’s disease are usually more severe, last longer and more often cause other complications.

To clear up confusion about terminology, Cushing’s syndrome is not the same as Cushing’s disease. They’re similar but also different conditions: Cushing’s syndrome is less serious and refers to “the general state characterized by excessive levels of cortisol in the blood,” while Cushing’s disease is the condition caused by a pituitary tumor that secretes the hormone ACTH, which causes excess cortisol. (15)

Adrenal Insufficiency and Addison’s Disease

On the other hand, the opposite of having Cushing’s disease — experiencing abnormally low cortisol levels — can result in a condition known as Addison’s disease or adrenal insufficiency. Addison’s disease is also rare and is considered a type of autoimmune disease, since it causes the immune system to attack the body’s own healthy tissue. In this case, tissues within the adrenal glands themselves becomes damaged and inflamed due to some sort of trauma, which alters how the adrenals produce hormones.

Certain symptoms of Addison’s disease are essentially the opposite of symptoms of Cushing’s disease, since they’re caused by a deficit in cortisol rather than an excess. Addison’s symptoms can include fatigue, weight loss, muscle wasting, mood swings and changes to the skin.

Adrenal Fatigue

Finally, you have adrenal fatigue. A diagnosis of adrenal fatigue is still very controversial and many health professionals and scientists think it’s a completely fabricated disorder.

However, most natural health professionals agree that the science supports the concept of adrenal fatigue as what may be considered a “subclinical” (not severe enough for a diagnosis of illness/disease) condition that can benefit from following an adrenal fatigue diet, taking supplements and herbs known to improve stress responses and reduce stressors in your life.

Adrenal fatigue symptoms result from overstimulation of the adrenal glands, which results in inconsistent cortisol production. Sometimes, cortisol levels are far too high, and other times, not enough cortisol is produced to allow you to deal with stressful stimuli. These symptoms range from chronic fatigue, autoimmune reactions and brain fog to decreased libido, depression, sleep disturbances and (often) weight gain. (16)

Symptoms of Low or High Cortisol Levels

According to research done by the Genetics Learning Science Center, the long-term danger of having perpetually high cortisol is that it activates the fight or flight response, which temporarily shuts down normal reproductive, digestive and immune functions. The body targets these systems for shutdown because it doesn’t need them for immediate survival.

Sensory nerve cells pass the perception of a threat, or stress, from the environment to the hypothalamus in the brain. This signals the pituitary and adrenal glands to produce more cortisol. If this cycle goes on for too long, someone becomes more susceptible to all sorts of illnesses, infections and hormonal problems. (17)

Some clues that may signal you’re living with high cortisol levels, specifically in the form of Cushing’s disease, include: (18)

  • weight gain, especially around the abdomen/stomach (this can happen despite not changing your diet or exercise routine)
  • a puffy, flushed face
  • mood swings and increased anxiety
  • fatigue (including feeling “tired but wired”)
  • trouble sleeping normally
  • irregular periods and fertility problems (Chronic stress drives pregnenolone/progesterone into conversion to cortisol, which competes for precursors available for synthesizing of other important hormones, like DHEA, estrogen and estradiol. This is known as “The Progesterone/Pregnenolone Steal Effect”) (19)
  • high blood pressure levels (cortisol narrows the arteries while the epinephrine increases heart rate)
  • acne or other changes in the skin
  • higher rates for bone fractures and osteoporosis (cortisol can lower hormones like estrogen, which are important for bone health)
  • muscle aches and pains
  • changes in libido due to changes in estrogen or decreased testosterone
  • excessive thirst
  • increased urination
  • higher susceptibility to infections (the stress response can lower immune system functions)

If you’re not making enough cortisol, you will have symptoms of Addison’s disease and/or adrenal fatigue. These are symptoms like: (20)

  • skin changes (such as scar darkening)
  • fatigue
  • worsening muscle weakness
  • diarrhea
  • vomiting
  • nausea
  • weight loss
  • loss of appetite
  • low blood pressure

Don’t try to diagnose yourself when you have these symptoms, especially if they persist for more than a few days to weeks. Your health care provider can help determine if your symptoms are caused by poor cortisol levels or another underlying condition.

Causes of Abnormal Cortisol Levels

Wondering what underlying conditions could be contributing to your high cortisol levels? Cortisol tends to go up as perceived stress goes up, so anything that triggers a negative mind states — things like anxiety, worry, anger or frustration — contributes to high cortisol levels. Medication use, inflammation, poor sleep and a poor diet can also trigger high cortisol levels by altering hormonal balances and negatively affecting the immune system.

Corticosteroid medications like hydrocortisone, prednisone pills or other medications used to treat inflammatory-related diseases or symptoms are common causes of high cortisol levels. Aside from corticosteroids, other major factors associated with poor cortisol production may include:

  • depression (21)
  • over-exercising or overtraining (22)
  • addiction (alcohol or drug abuse) (23)
  • malnourishment and eating disorders (24)
  • severe kidney or liver disease (25)
  • hyperthyroidism (26)
  • obesity (27)
  • pregnancy or birth control pills (28, 29)
  • inflammation (30)
  • a tumor (A pituitary adenoma (benign tumor on the pituitary gland) or an ectopic ACTH-secreting tumor can result in high cortisol levels seen in Cushing’s.)
  • familial Cushing syndrome (There is a rare inherited genetic trait that is linked to the development of tumors on the endocrine gland, leading to Cushing’s syndrome.) (31)

Cortisol Testing and Diagnoses

Your doctor can order a number of tests to determine if you have abnormally low or high cortisol levels. Both blood and urine testing help reveal a problem, but a 24-hour urine test is used more often than a cortisol blood test to diagnose Cushing’s disease or syndrome.

The cortisol values listed below, which can be obtained from a blood test, serve as a reference range for what’s considered normal. Cortisol levels above this normal range are considered high and can be risky or problematic. But keep in mind that values differ depending on time of day, age and the type of cortisol test preformed. Because of this, your doctor will always need to evaluate your results in light of your specific symptoms and medical history.

  • Normal cortisol ranges for adults and children in the morning are between five to 23 micrograms per deciliter (mcg/dL) or 138 to 635 nanomoles per liter (nmol/L) (32)
  • Normal cortisol ranges for adults and children in the afternoon are between three to 16 mcg/dL or 83 to 441 nmol/L
  • Normal cortisol for a newborn baby is between two to 11 mcg/dL or 55 to 304 nmol/L

If your test results reveal that you’re at risk for Cushing’s disease or Cushing’s syndrome, you’ll be treated dependent on what’s causing cortisol levels to rise in the first place. Cushing’s syndrome and Cushing’s disease are often caused by benign tumor growth on the pituitary gland (called a pituitary adenoma), cortisol-like synthetic medication use and the cortisol-increasing lifestyle factors mentioned above, so all of these will be addressed by your doctor if they’re contributing to your symptoms.

A high percentage of people with either Cushing’s disease or syndrome display at least small tumor growths on their pituitary glands and need to have these removed with surgery or reduced with medications and lifestyle changes in order to resolve cortisol-related symptoms.

It’s important to talk to your doctor if you suspect you might have Cushing’s disease or syndrome to assess whether or not you need to discontinue or lower use of medications that increase cortisol (such as steroids), undergo life-saving surgery to remove the tumor, or use radiation and/or medications to shrink the tumor. However, keep in mind these are very rarely needed interventions, and most people with high cortisol levels are able to manage their conditions naturally without surgery or medication.

If your healthcare provider is concerned you may have low cortisol to the point of adrenal insufficiency, they will likely administer an ACTH stimulation test, which involves getting an injection of synthetic ACTH along with testing reactions in the blood and urine for changes in cortisol levels. People with adrenal insufficiency won’t have a significant increase in cortisol, which should occur in a healthy person who receives ACTH.

Final Thoughts on Cortisol Levels

Although cortisol is often viewed as a bad actor, we need it to live. There are many causes for too-low or too-high cortisol levels, but many of them are environmental or lifestyle-related. In rare cases, a (usually benign) tumor could be the root cause of abnormal cortisol levels. Your doctor can order routine tests to determine your cortisol levels and suggest ways to lower it.

Regardless, we could all probably tap in to natural cortisol-lowering techniques like mindfulness, exercise, and a diet rich in fresh vegetables, clean protein and fruit. So in order to keep your cortisol levels in check, remember the following:

  • Here are some steps you can take to manage your cortisol levels: switch to a whole foods, anti-inflammatory diet; reduce and manage stress; exercise regularly; use adaptogen herbs and superfoods; use essential oils to promote relaxation; and get enough sleep.
  • You have a much greater chance of experiencing high cortisol at certain times due to increased stress in your life than you do of ever being diagnosed with Cushing’s disease, though Cushing’s disease is usually caused by tumors on the adrenal or pituitary glands and often causes symptoms like rapid weight gain, a swollen face, fatigue, and water retention/swelling around the abdomen and upper back. It impacts women between the ages of 25 to 40 most often, although people of any age and gender can develop this condition. While symptoms of Cushing’s disease and high cortisol tend to be similar, those caused by Cushing’s disease are usually more severe, last longer and more often cause other complications.
  • Symptoms of high cortisol levels include weight gain, a puffy, flushed face, mood swings and increased anxiety, fatigue, trouble sleeping, irregular periods and fertility problems, high blood pressure, acne or other changes in the skin, higher rates for bone fractures and osteoporosis, muscle aches and pains, changes in libido due to changes in estrogen or decreased testosterone, excessive thirst, increased urination and higher susceptibility to infections.
  • Symptoms of low cortisol levels include skin changes, fatigue, weight loss, muscle weakness, diarrhea, vomiting, nausea, loss of appetite and low blood pressure.
  • Corticosteroids, depression, over-exercising or overtraining, malnourishment and eating disorders, sever kidney or liver disease, hyperthyroidism, obesity, pregnancy or birth control pills and inflammation can all cause abnormal cortisol production.

Read Next: 7 Adaptogen Herbs to Lower Cortisol

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