In the times we live in, it can be difficult to manage stress. This same stress can affect cortisol levels and cause an imbalance.
“Cortisol is a hormone produced by the adrenal glands that helps regulate your metabolism, blood sugar, inflammation, blood pressure, and sleep-wake cycle,” says Dr. Mark Hyman, co-founder and chief marketing officer of Function Health, which offers a lab-based cortisol test. “It is best known for managing the body’s response to stress.”
But what are the signs that you might have high or low cortisol? For more information, we contacted doctors.
What is cortisol?
“Cortisol is a hormone produced by your adrenal glands in response to stress,” says Dr. Fady Hannah Shmouni, medical director at Eli Health, which sells an instant cortisol test. “When a stressful situation arises, cortisol can help your body prepare to respond by increasing its energy, focus, or alertness.”
Shmouni says that in the short term, your body’s cortisol response is necessary and helpful. However, chronic stress can lead to increased cortisol levels, which can negatively affect your organs, including your brain. For example, high cortisol levels can disrupt sleep, increase inflammation, or impair memory.
Dr. Andy Franklyn-Miller, a board-certified sports and exercise medicine physician, adds that cortisol is like your body’s built-in alarm system and is often called the “stress hormone.”
“Cortisol is a member of the glucocorticoid family and is released as part of the hypothalamic-pituitary-adrenal (HPA) axis, the seat of your body’s stress response,” says Franklyn-Miller. In the morning, your cortisol increases to help you move. At night, it dives to help you rest.
Where the adrenal glands are located.
Sebastian Kaulitzki/Scientific Photo Library/Getty ImagesSymptoms of cortisol imbalance
“Cortisol imbalances often go unnoticed until symptoms become disruptive,” says Hyman. “If you feel jittery at night, crash mid-afternoon, or have trouble getting restful sleep, your cortisol could be out of sync.”
Franklyn-Miller adds that it can be difficult to detect a cortisol imbalance because it can mimic other conditions. However, telltale signs include persistent fatigue, trouble sleeping, or unexplained weight changes. “Wearable devices that track heart rate variability, such as Whoop, Oura or Apple Watch, can also give indirect clues, as low HRV often correlates with cortisol dysregulation due to stress and reduced HRV,” he says.
Symptoms of high cortisol levels
“Under normal conditions, your cortisol levels peak in the morning to help you wake up, then gradually decline throughout the day,” says Shmouni. “But if you have chronic stress, your body can produce excess cortisol and one of the most common manifestations is disrupting energy patterns.”
According to Shmouni, some common symptoms of high cortisol include trouble sleeping at night, dips in energy caused by spikes and crashes in blood sugar, and feeling constantly tired. Hyman adds that chronically high cortisol levels can also lead to:
- Anxiety and irritability
- Common illnesses due to a weakened immune system
- High blood pressure
- Sleep problems, fatigue
- Weight gain
Over time, Hyman says, high cortisol levels can lead to more serious problems, like cardiovascular disease, insulin resistance and cognitive decline.
High cortisol levels are often linked to conditions like Cushing’s syndrome or chronic stress, said Franklyn-Miller, who adds that weight gain can be especially noticeable in the midsection and face (also known as “moon face”). You may suffer from osteoporosis and muscle loss because cortisol can destroy tissue over time or cause skin changes, such as thinning skin, easy bruising, or stretch marks.
Symptoms of low cortisol
Hyman says symptoms of low cortisol often include:
- Cravings for salt or sugar
- Dizziness when standing
- Fatigue that does not improve with rest
- Low blood pressure
- Mood swings or depression
“Low blood pressure, foggy feelings, weight loss, and muscle weakness can occur; any serious symptoms are a sign that you should see your doctor, as they could mean that a more serious adrenal problem (such as adrenal insufficiency) is at play,” says Shmouni.
Franklyn-Miller said low cortisol levels are often seen in Addison’s disease. People with Addison’s disease may notice darkening of the skin.
What causes a cortisol imbalance?
“There is no single cause of cortisol imbalance: it is the result of the accumulation of multiple stressors,” explains Hyman. “This can include: chronic psychological stress (work, relationships, trauma), poor sleep habits, blood sugar imbalances, overtraining without recovery, inflammation, infections and nutrient deficiencies, especially B vitamins and magnesium.”
Franklyn-Miller explains that the HPA axis is designed for short-term stress, so constant, long-term activation or suppression can lead to imbalance.
Stress
If you’re dealing with long periods of stress — caused by factors like a high-pressure job, financial struggles, or family responsibilities — Shmouni says cortisol may stay elevated in the body instead of fluctuating normally throughout the day.
“This can create a cycle in which high cortisol is not managed appropriately, leading to prolonged cortisol release,” he says. “If we don’t see a person’s cortisol levels decreasing throughout the day, with a normal response to waking up in the morning, this may be a sign that cortisol is dysregulated.”
Certain medications or medical conditions
If you suffer from chronically high cortisol levels, Shmouni says it may be a side effect of medications like steroid inhalers, for example. On the other hand, Franklyn-Miller reports that long-term use of corticosteroids (e.g., prednisone) can shut down natural cortisol production, leading to low cortisol levels.
As Franklyn-Miller mentioned earlier, certain medical conditions, like Cushing’s syndrome, can also cause high cortisol levels. “Cushing’s syndrome, caused by tumors or excessive steroid use, floods the body with cortisol,” he says.
Low cortisol levels can be caused by adrenal insufficiency. “Conditions such as Addison’s disease damage the adrenal glands, reducing cortisol production,” says Franklyn-Miller. Autoimmune diseases can also cause low cortisol levels because the body attacks its own adrenal glands and reduces cortisol production.
Your lifestyle: sleep, exercise and nutrition
“Poor sleep, excessive physical activity, or a high-sugar diet can increase cortisol by stressing the body,” says Franklyn-Miller.
When planning your workout, consider your stress and sleep. If you had trouble sleeping last night and are dealing with high stress at work, now may not be the best time for an intense workout. If you find that a workout is making you tired or sick, you may be overdoing it.
In addition to a diet high in sugar, alcohol and caffeine can also affect cortisol levels. For most adults, the FDA recommends 400 milligrams of caffeine or two to three 12-fluid-ounce cups of coffee. However, certain medications or conditions may make a person more sensitive to caffeine, so be sure to consult your doctor if in doubt.
According to the American Heart Association, it is recommended to limit alcohol to two drinks per day for men and one drink per day for women. The National Institute on Alcohol Abuse and Alcoholism explains that in the United States, a standard drink contains 14 grams or approximately 0.6 fluid ounces of “pure” ethanol.
For sugar, the AHA states that men should consume no more than nine teaspoons of added sugar per day. For women, consumption should not exceed six teaspoons of sugar per day.
Make sure you eat a balanced diet rich in colorful fruits and vegetables, leafy greens, whole grains and protein. And of course, make sure you drink enough water.
How to regulate cortisol
“Regulating cortisol is like tuning an instrument: it requires careful adjustments to your lifestyle,” says Franklyn-Miller, who recommends the following strategies:
- Prioritize exposure to the sun after waking up: “Just 20 minutes can boost your circadian release of cortisol, helping with body balance.”
- Focus on sleep: “Stick to a consistent sleep schedule.” In general, 7 to 9 hours of sleep is recommended but this depends on your age.
- Managing stress: “Practices like mindfulness meditation, yoga, or diaphragmatic breathing can calm the HPA axis.”
- Exercise smartly: “Moderate exercise, like walking or yoga, balances cortisol, but overtraining can increase it. Aim for 30 minutes most days.”
- Eat balanced meals: “Avoid diets high in sugar, which can increase cortisol. Focus on whole foods, like vegetables, lean proteins and healthy fats. Omega-3s, found in fish, can reduce cortisol.” Hyman also recommends prioritizing fiber.
- Limit caffeine: “Too much coffee can mimic stress and increase cortisol. Try reducing your intake after midday.”
When should you see a doctor about cortisol levels?
“If you experience significant symptoms that interrupt your ability to participate in daily activities, or if you experience extreme changes in appetite, energy, mood, or sleep, talk to your doctor so they can work with you to manage symptoms and adjust your lifestyle,” says Shmouni.
Franklyn-Miller adds: “Also, if lifestyle changes (better sleep, stress management) don’t improve symptoms after a few months, or if you’re taking steroids long term, get checked.” He explains that the gold standard for checking cortisol is through lab tests for blood, saliva, or urine samples. For these, consult your doctor.
Shmouni says common signs of dysregulated cortisol include physical pain, a feeling of “mind control,” changes in appetite, chronic fatigue or lack of energy, difficulty concentrating or brain fog, increased alcohol or caffeine consumption, stretch marks, weight changes, mood swings or irritability, difficulty sleeping, or feeling exhausted even after a full night’s rest. Although each of these symptoms is not specific to cortisol deficiency, their combination may be more suggestive.
“That said, while these signs may indicate that your cortisol is working overtime, short-term changes do not necessarily equate to hormonal dysregulation,” says Shmouni. “To determine if you have chronic dysregulation, a more in-depth hormonal evaluation (either through an at-home test or a lab at your doctor’s office) may be necessary.”
Symptoms of excess cortisol include trouble sleeping at night, low energy, constant fatigue, anxiety and irritability, weight gain, high blood pressure, and frequent illnesses caused by a weakened immune system.
Adjusting your lifestyle can correct cortisol levels. Focus on sleep, stress management, a balanced diet, the right amount of exercise, and limiting caffeine.