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Let’s Talk About Cortisol: The Highs, the Lows, the Adrenal Fatigue

Need to Know

  • Balanced cortisol affects nearly every system of the body and is vital for healthy functioning.

  • Temporary stress is a normal part of life; prolonged, chronic stress is the “bad” type that causes your cortisol levels to fluctuate.

  • High cortisol can result in inflammation and cause problems including swelling, weight gain, anxiety, depression, and skin issues.  

  • If your chronic stress lasts too long, your cortisol can plummet, resulting in a condition popularly known as adrenal fatigue in which you may experience exhaustion, sleep issues, low blood pressure, and other health problems.

Michelle Keldgord was 16 years old when she and her friend survived what could have been a fatal accident. While driving down a mountain on a cold winter night, they hit a patch of black ice and their car came inches away from plummeting over the mountain’s edge.

Thankfully, they were able to stop the vehicle just in time. But Keldgord, who today is the co-founder of BakingHow, says her life was irrevocably changed afterward. 

“At the time, I don’t think I came to terms with how scary the experience was,” she says. But in the month that followed, she started struggling with sleep. “That turned into an unimaginable amount of tiredness and fatigue. Even when I did get a good night’s sleep, I’d need caffeine to keep me going.”

Eventually, anxiety and tremors joined her extreme fatigue, and her quest for answers began. “I had to know what was going on with my body because nothing seemed to help,” she says.

It wasn’t until she stumbled upon information about adrenal fatigue that she felt she might finally be on the right track.

Cortisol Is Vital to Your Health

Dr. Tara Scott, chief medical officer and founder of Revitalize Medical Group, calls herself a “Hormone Guru,” and has committed her life to helping people achieve optimal health by finding the underlying causes of their symptoms. One hormone she regularly sees causing problems for her patients is cortisol, better known as the “stress hormone.”

Cortisol is made in your adrenal gland and is essential for life,” Scott says. This hormone interacts with and affects many different systems in your body, including your blood pressure, heart rate, digestion, reproductive system, sleep quality, and skin, among others.

When your cortisol is balanced, it helps these systems to work at their healthiest and most efficient. But when cortisol levels are either too high or too low, chaos in the body can ensue. The finger that flicks the first domino to start that chain reaction is stress.

In times of stress, the hypothalamus and pituitary glands in your brain release hormones that tell the adrenal gland that it’s time to increase its production of epinephrine and cortisol. This feedback loop is important: it’s at the center of the famous flight-or-fight response that helps us survive life or death situations, such as Keldgord’s near-death experience.

But just like exercise and foods high in fiber, your body can have too much of a good thing. The results of prolonged high stress, whether it is a ripple effect of a close call or a product of our busy modern lives, can be detrimental.

“When there is a lot of cortisol, it will send negative feedback to the brain saying ‘Hey, we don't need to you keep stimulating us! We have plenty of cortisol here,’” Scott says.

Sometimes that communication works a little too well, and cortisol levels plummet. Symptoms of too little cortisol include:

  • Extreme fatigue

  • Dizziness

  • Fainting

  • Reduced blood pressure

  • Muscle weakness

  • Unexplained weight loss

  • Skin coloration changes

  • Mood changes

  • Low blood sugar

On the flip side, sometimes the body doesn’t respond to the brain’s signals to put the breaks on production, and too much cortisol piles up. This results in high levels of cortisol, with symptoms that may include:

  • Swollen face, chest, and abdomen

  • Rapid wight gain

  • High blood pressure

  • Flushed cheeks

  • Unexplainable bruises

  • Osteoporosis

  • Stretch marks

  • Anxiety and depression

  • Irritability

  • Muscle weakness

  • Extreme thirst

  • Frequent urination

Scott added that decreased concentration, heart palpitations, and sleep disturbances can also result from high cortisol levels.

Not All Stress Is Bad, But Stress That Never Ends Is

Stress is a natural part of life. It’s something we all experience, even people who generally consider themselves to be calm and level-headed. Initially, the stress we experience is the same, no matter the situation that caused it.

“Your brain doesn't know the difference between you having a deadline at work or being attacked by a bear,” Scott explains. “The physiologic response is the same: increase your heart rate to make you more alert, increase your blood sugar to fuel your muscles so you can get ready to run.”

When our bodies perceive a crisis, they begin to suppress systems that are not immediately vital (like reproduction and digestion) and send all available resources to things that are, like increasing cortisol production to give you a surge of energy, pumping extra blood to your muscles, and upping the oxygen flow in your lungs. This is all part of the fight or flight response, which is supposed to end with the activation of the rest and digest parasympathetic system, which helps your body calm down once it is safe. But this two-part system was designed for momentary stresses (like a bear attack), not ongoing stressors (like our current pandemic or modern 24/7 work habits).

It’s when your body doesn’t get a break that the label of “bad stress” applies. At some point, this can cause one of two results. The first is that your cortisol levels can remain way too high.

“Persistently high cortisol causes inflammation which is associated with many chronic diseases,” Scott says. “It increases the risk of heart attack, diabetes, and has been associated with a poor prognosis after cancer diagnosis. It can disrupt your hormones such as thyroid, your menstrual cycle, and deplete your testosterone.”

But if your body stops responding to stress altogether, your cortisol may go the second route and dip way too low, which carries its own health problems.

How Chronic Stress Can Lead to “Adrenal Fatigue”

Adrenal fatigue has become a buzz word for chronic stress that sends your cortisol plummeting. But Scott says calling this condition “adrenal fatigue” isn’t exactly accurate.

“The adrenal gland doesn't really get tired,” she explains. Instead, she says hypothalamic-pituitary-adrenal (HPA) dysfunction is a better description for what’s going on.

“Chronically high cortisol levels feed back to the brain that we don't need any more cortisol. So now the brain thinks it doesn't need to produce corticotropin-releasing hormone (CRH) or adrenocorticotropic hormone (ACTH) anymore to stimulate cortisol production,” Scott says.

Over time, this results in the exhaustion phase many people who think they have adrenal fatigue experience.

“People in this phase are tired, morning is the worst time of day for them,” Scott says. “Some feel better after coffee in the morning then have a 3 p.m. crash where they have to drink more coffee or eat sugar. At night, they are usually tired but wired.”

Chronic Stress Can Also Impact Your Skin

Among its many health consequences, chronic stress can also have on effect on your outward appearance.

“High cortisol can suppress the pituitary release of other hormones, such as TSH and FSH,” Scott explained. This can result in rapid aging (the body actually breaking down) and acne (sometimes the result of testosterone increasing in response to other hormone fluctuations).

“Cortisol can cause hair loss as well,” Scott says. “During times of stress, cortisol breaks down your body to get nutrients to fuel your muscles. It is called catabolism. High cortisol can also irritate the lining of the gut, cause inflammation, and prevent absorption of nutrients needed for hair and nail growth.”

Given the wide-ranging impacts of cortisol imbalance, it’s no surprise that those struggling with the results of chronic stress find themselves desperate for ways to feel better, just as Keldgord once did.

Treating Chronic Stress

To treat chronic stress, first determine if your cortisol is high or low by taking a hormone test like Veracity’s Skin + Health Test. Then:

  • For high cortisol: Focus on eliminating stress through activities like yoga, meditation, breathing exercises, light exercise, and including adaptogens (like holy basil, ashwagandha, maca, and reishi mushrooms) in your diet and skincare.

  • For low cortisol: Explore supplementing your diet with vitamins, eat balanced meals to improve your blood sugar levels, prioritize sleep and develop a healthy sleep routine, and begin to exercise regularly.

While the term “adrenal fatigue” may not be medically accurate, it was in learning about this condition that Keldgord started down her own path to relief.

“I had a lot of the symptoms,” she says, so she researched possible at-home treatments. The plan she put together included, “a multivitamin, a B complex vitamin that went under the tongue, and a magnesium drink before bed. I also tried to reduce stress levels through exercise.”

Over time, her symptoms disappeared.

Keldgord was lucky. She was able to find relief on her own. Other people struggling with chronic stress end up seeking the help of professionals like Scott to develop a treatment plan.

When it comes to high cortisol, Scott suggests learning deep breathing and meditation techniques, as well as adding yoga to your daily routine. “Ideally, identifying stress and reducing it works,” she says, adding that it can also be helpful to include adaptogens, which are “herbs that protect your body against the harmful effects of the high inflammatory cortisol,” in your diet.  

If it’s low cortisol you’re struggling with, “Treatment may include things for nutrient deficiencies, energy, sleep, and blood sugar regulation,” Scott says. “If [your] DHEA is low, we may suggest replacing that.”

Ultimately, no one is immune to toxic stress, and Scott says we should all be more proactive when it comes to dealing with is and the effects it can have on the body. Far better than having to treat the effects of chronic stress is protecting yourself against those effects before they ever begin.

Our Experts

Tara Scott, MD

Chief medical officer and founder of Revitalize Medical Group

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