Earlier this week I read an article in the WSJ’s health section about how to balance cortisol levels. It barely skimmed the surface of what you need to know about the vital hormone that plays a role in everything from your energy to your ability to lose weight.
I treat patients with cortisol-related health issues all the time with a lot of success. So, I’m diving in.
Why cortisol?
Your cortisol levels have a profound impact on your metabolism and your energy levels. I just saw a patient this week who finally lost the proverbial last 10 pounds because we were able to address the way cortisol was impacting his metabolism. Another patient of mine finally got her fasting blood sugar down to 80 when it had been firmly stuck at 95 after she was finally able to balance cortisol levels. Another patient got pregnant after balancing her chronically high cortisol, which was reducing her progesterone levels and impacting her fertility.
Balancing cortisol levels was the key for all three patients.
My cortisol
I got interested in cortisol in med school when I read a study about how stress impacts the immune system. The researchers gave medical students paper cuts and showed that they took longer to heal when the students were stressed around exams, than when they weren’t stressed over a holiday. Maybe I just took the article personally since they were experimenting on people who could have been my classmates, but I loved understanding the interplay between stress, cortisol, and our immune system’s ability to heal injury.
Also around that time I (unintentionally) ran my own experiment on my cortisol patterns. I was running a lot and doing tons of cardio at the gym, while also studying a lot and being chronically stressed. I was always hungry, always craving carbs, and almost always cranky and irritable.
Burned out, I started doing more yoga. It was hard in a different way than running but also calming to my nervous system. Over time, I found myself with fewer cravings, more energy and oddly, I didn’t have to work so hard to stay in shape. In fact the weight I always felt I was in a bit of a war with just went away—even though I’d cut my cardio by 80%. This was a huge lesson in the way that stress literally packs on the pounds.
When I trained later in functional medicine, I learned how cortisol was causing that phenomenon and how by switching from intense cardio-focused workouts to yoga-focused workouts, I’d unintentionally hacked my own cortisol for increased energy, improved mood, and healthier body weight.
Today, I balance cortisol levels in a different way. If I stay up too late I get that “second wind” or “witching hour” energy spike, which is really a flood of cortisol that comes for most people between 11 p.m. and 1 a.m. if they’re still awake. When I do that, my sleep is terrible, so I’m motivated to get to bed before 10:30 p.m.
The Research:
Cortisol is a hormone produced by the adrenals, two glands that sit one atop each kidney. They respond to signals in the brain in response to stress—both physical stress, like being sick or injured, and mental stress.
Cortisol (along with neurotransmitters norepinephrine and epinephrine, also produced by the adrenals) increases the amount of glucose, or blood sugar, released into the bloodstream to support muscles and brain function in response to stress. These hormones also increase blood pressure, heart rate, and breathing rate.
This is an adaptive response—we need cortisol to be able to fight an attacker, or run from a predator. But when cortisol is high all the time, due to chronic stress, downstream effects start to become negative.
- Weight gain: Overproduction of cortisol and the corresponding blood sugar elevation increase insulin levels. (Insulin’s function is to move sugar out of the blood back into the cells.) When this happens constantly, you store more fat—particularly abdominal fat.
- Increased risk of diabetes: Chronically high insulin levels can cause insulin resistance, the precursor to diabetes.
- Decreased immune function: High cortisol suppresses the immune system, making you more likely to get sick.
The truth about cortisol
In my practice, I often see cortisol high when it should be low and low when it should be high—fluctuations caused by chronic stress, poor sleep, and chronic conditions like diabetes.
These cortisol pattern disruptions show up as:
- Fatigue
- Mood disturbances like anxiety and depression
- Insomnia
- Stubborn weight gain or inability to lose weight
- In some cases, even infertility
The good news is that, in most cases, we have can balance cortisol levels.
That’s why the advice from a prominent endocrinologist in this WSJ article on the topic who effectively said not to take supplements for adrenal health because they might have the wrong ingredients in them actually made me laugh out loud. If you’re working with a doctor, isn’t it their responsibility to be supplement literate, know which supplements impact cortisol for the better, and to prescribe safe tested supplements? It is at Parsley. But, moving on.
The article also cites a literature review that says “Adrenal fatigue does not exist!” As a rule, if you ever see the medical community insisting to patients that a condition doesn’t exist, we are usually about 10 years out from an apology and further reviews of the literature showing that the condition is in fact real. I’ll wait!
The following is how I approach how to balance cortisol levels for my patients if I see signs of mood, energy, weight, or hormone imbalances that cortisol may impact.
How to balance cortisol levels
Step 1: Test cortisol the right way.
Testing cortisol the right way is key. I recommend a 5-point saliva or urine test that maps your daily cortisol pattern along with testing related hormones (like those produced by the thyroid and progesterone), and blood sugar markers.
Skip one-off blood tests which don’t give you a view of your cortisol pattern throughout the day.
Cortisol should be high on waking and slowly come down mid day, being lowest at night.
If your cortisol is:
Low in the morning—it could be why you’re tired.
High in the evening—it could be why you can’t fall asleep.
High all day—it might be why you are dealing with stubborn belly fat.
I also recommend testing related hormones including:
- Thyroid levels
- Progesterone
- Testosterone (free and total)
- SHBG (sex hormone binding globulin)
- DHEA-S
You should also test fasting blood sugar, fasting insulin, and HgbA1C along with key nutrients like iodine, iron, zinc, selenium, and Vitamin D3.
At Parsley we use either the ZRT or the Genova Adrenocortex with CAR test (if we just want to look at cortisol levels) or the DUTCH Complete urine hormone test if we also want to look at sex hormones.
Step 2: Eat to balance your cortisol curve.
Time your carb intake. Cortisol should be elevated from waking to midday. If you’re experiencing weight gain, avoid carbs and sugar in the morning (when cortisol is high) to avoid storing these easily accessible calories as fat. Save your carbs for midday when cortisol is lower.
Eat adrenal happy foods. The adrenals like water, protein, healthy fats, and fiber. Eat lots of vegetables, stay hydrated, and add electrolytes to your water (I love Endura from Metagenics or just a pinch of pink sea salt). I also find a way to get EVOO in every day.
Step 3: Use safe, trusted, and personalized supplements to balance cortisol.
Do not go pull supplements off the shelf or on Amazon. To the WSJ’s point, there are too many supplements for “adrenal health” that have actual steroid hormones or thyroid hormones in them. Supplements can be mislabeled or not labeled at all.
Even with vetted supplements, if you haven’t tested and don’t know if your cortisol is high or low, you don’t know what you’re treating and can actually make the problem worse.
That said, here is what I recommend:
- For low cortisol: Adaptogens like Panax Ginseng may help balance cortisol by regulating the hypothalamic–pituitary–adrenal axis and the sympathetic nervous system. For very low cortisol, we prescribe licorice (but be careful if you have high blood pressure).
- For high cortisol: Calming adaptogens like ashwagandha have been shown in some studies to reduce cortisol levels (and may also help treat anxiety).
You can also take phosphatidylserine in the evening to reduce high evening cortisol and support sleep. And add magnesium glycinate or threonate for calming the nervous system day or night.
Finally, take 2 grams of Omega-3s daily. Studies show omega-3 supplementation can lower cortisol levels and blunt cardiovascular and sympathetic stress reactivity.
If you’d like to get your hormones tested and develop a personalized treatment plan to address cortisol, thyroid, sex hormones or other health issues, work with us at Parsley Health. Learn more with a free call.