What To Do About High Cortisol

Do you wake up in the middle of the night or too early but you can’t fall back to sleep?

Do you get lightheaded upon standing and need caffeine to keep you awake?

Do you feel “wired” yet “tired” at the same time?

Do you crave carbs and possibly eat more than 50% of your calories after 5pm?

Do you suffer from depression, anxiety, nervousness, irritability, weight gain (specifically in the mid section), increased sugar cravings, increased blood pressure, and abnormal blood lipids (i.e. high LDL)?

Do you have difficulty recovering from exercise, easily get musculoskeletal injuries and seem to get sick often? 

If this describes some or all of your symptoms, you are likely stressed. Chronic stress and the resulting negative health issues is becoming a nationwide epidemic. 

Stress can result from psychological, physiological and/or physical reasons. The body responds by increasing cortisol (a stress hormone) output from the adrenal glands.

Normal cortisol levels are not detrimental and in fact beneficial and protective in controlling blood pressure, blood sugar levels, inflammation and strengthening cardiac muscle. A normal cortisol rhythm should peak in the morning hours (around 7-8am) and then steadily decline through the day with the lowest levels at night. However when the body experiences stress these levels increase above optimal range.

An acute rise in cortisol is not a bad thing, as it is the natural adrenal response to stress, (i.e. an acute illness, a stressful event, exercise etc.) however when the stress becomes chronic and cortisol is continuously elevated or not following a normal 24 hour rhythm the body enters what is known as the adrenal resistance phase.  

Chronically elevated cortisol levels are inflammatory and catabolic and can cause a myriad of disorders including: thyroid and metabolic dysfunction, cognitive decline, low serotonin levels resulting in depression, irritability, anxiety and carb cravings, immune suppression, altered glucose metabolism, elevated lipid levels, increased blood pressure, low melatonin levels resulting in altered sleep patterns, and musculoskeletal issues resulting in difficulty recovering from exercise and possible subsequent injuries.Cortisol levels are also related to mental acuity, and can factor into degenerative diseases such as dementia and Alzheimer’s.   

DHEA, a precursor to sex hormones or more easily remembered as the “fountain of youth” hormone, also relates to adrenal function and unfortunately can have an inverse relationship to cortisol. Thus, if you have chronically elevated cortisol you may have proportionately low DHEA resulting in further metabolic disturbances including weight gain, poor immune function and additional hormonal imbalances. (i, ii, iii, iv)

Stress itself is unavoidable, yet you can take steps to manage your cortisol levels and limit metabolic disturbances. Whether your personal goals are weight reduction, improved health, or sports performance you hold the power to make modifications to achieve your goals.  

The following nutrition, exercise and lifestyle recommendations can help you lower your cortisol to optimal levels.

Nutrition:  

A general rule in good nutrition is to focus on REAL food. Limit or avoid packaged, processed and non-organic foods as ingredients (additives, preservatives, GMO, dyes, food colorings etc), hormones, pesticides, herbicides and antibiotics increase the toxic load to the liver and cause additional stress (physical and physiological) to the body.

Cortisol causes gluconeogenesis (the production of sugar from non carb sources) thus it increases your blood sugar levels every time it is secreted. Eating a diet rich in carbohydrates (excluding non starchy vegetables and small amounts of fruit) further exacerbates blood glucose leading to increased visceral fat and weight gain.(v)

It is recommended that those with elevated cortisol levels avoid sugars (sugar, honey, agave nectar, fructose, dextrose, “ose’s”, syrups etc.) and limit carbohydrates categorized as starches. A low sugar/glycemic load diet is strongly encouraged.  

Non-starchy vegetables (specifically those in the cruciferous family due to their detoxifying ability) should be consumed three times as much as fruits and ideally be included at each meal. 

Protein, an integral macronutrient for healing, should be included at every meal to help with building lean body mass, improving metabolism, stabilizing blood sugar, and improving immune function.   Protein should also be consumed within 45-60 minutes post exercise to aid with muscle recovery.  Adding L-glutamine, an amino acid, post workouts also aids in muscle repair and improves the integrity of the gastrointestinal tract, which is directly linked to our immune function. Aim for organic proteins to limit hormones, antibiotics, and inflammatory fats that are often found in non-organic meats.

Fats, more specifically omega 3 fatty acids, are anti-inflammatory and help to counter the inflammatory effects of cortisol. The research on omega 3 fatty acids and their anti-inflammatory effects on the central nervous, cardiovascular, gastrointestinal and endocrine systems is extensive.  Take omega 3 fish oils rich in EPA and DHA, and incorporate omega 3 rich foods into your daily diet. (i.e. salmon, flax and chia seeds).  (vi)

Water appropriately labeled “the liquid of life” is encouraged for those with elevated cortisol levels as it will help hydrate cells and detoxify, while limiting caffeine, as it is an adrenal stressor, is strongly recommended.  

Foundational supplements for optimal health include a good quality multivitamin*, omega 3 fish oils* and probiotics (*assuming normal renal function and no allergies).  Additional supplementation such as specific B vitamins, Vitamin C, Relora ™ and others specific to a clients medical, nutrition and lifestyle history can be added to help decrease elevated cortisol.

Exercise: 

While exercise is recommended as one of the best forms of medicine, cardiovascular activity can be more inflammatory and further exacerbate cortisol levels in those that have already elevated values.   

While many individuals may not be happy with the following recommendation…. less many be better right now with respect to cardio.  

First, it is best to exercise when your cortisol is closest to normal range. Cortisol also normally peaks about 40 minutes into exercise, therefore recommendations would be to limit aerobic activating to less than 40 minutes in duration and limit frequency to 2-3 times per week. 

As for resistance training, a progressive and periodized program is recommended. 

Don’t forget to include protein and l-glutamine post workout to aid with recovery, repair, and resilience. 

Lastly implement recovery based exercise, such as yoga, Pilates, stretching, etc. as these exercises help to regulate optimal cortisol output.

Lifestyle:

Your sleep patterns are likely altered with high cortisol values, therefore it is important for you to try to maximize your sleep, as it is the time for our bodies to heal and restore. 

Work towards 7-8 hours of uninterrupted sleep and optimally between 10pm and 6am. Turn off any artificial light.That means put the iPad, kindle, laptop, iPhone etc. away! No television either and aim for the lights off! Artificial light tricks the body into releasing more cortisol and thus suppressing melatonin. vii

Avoid cooking in plastic and Teflon coated pots and pans as toxins are often released into the food subsequently increasing the stress load on our body. Instead use glass, stainless steel and ceramic. 

Look to meditation, deep breathing, tai chi, and restorative type exercise such as yoga, Pilates and stretching to manage stress. Dry sauna several times a week has also shown to reduce toxins.

Lastly massage has also shown to directly decrease cortisol while subsequently increasing serotonin and dopamine. (viii)

Know Your Cortisol Values:

If you suspect you have chronically elevated cortisol levels, get your values tested via a 4-point salivary cortisol test before implementing any changes, specifically supplementation.

Stress cannot be avoided, but as you see it can be effectively managed!

i. Black PH. Med Hypotheses. 2006;67(4):879-91. Epub 2006 Jun 15. The inflammatory consequences of psychologic stress: Relationship to insulin resistance, obesity, atherosclerosis and diabetes mellitus Type II

ii. Epel ES, McEwen B, Seeman T, et al. Stress and body shape: Stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med. 2000;62(5):623-632

iii. Andrews RC, Herlihy O, Livingstone DEW, Andrew R, Walker BR. Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance. J Clin Endocrinol Metab. 2002;87(12):5587-5593.

iv. Young AH, Gallagher, Porter RJ Elevation of cortisol- DHEA ration in drug free patients Am J Psychiatry 2002 July:159(7) 1237.9

v. Al-Dujaili E, Ashmore S. Effect of glycaemic index of the diet on salivary cortisol and testosterone levels in females. Society for Endocrinology, 2007; Endocrine Abstracts;13:286.

vi. Delarue J, Matzinger O, Binnert C, Schneiter P, Chiolero R, Tappy L. Fish oil prevents the adrenal activation elicited by mental stress in healthy men. Diabetes Metabolism, June 2003;29(3):289-95.

vii. Spiegel K., Leproult R. Van Cauter E., Impact of sleep on metabolic and endrocrine function. Lancet. 1999 Oct 23;354(9188):1435-9

viii. Field T, Hernandez-Reif M, Diego M, et al. Cortisol decreases and serotonin and dopamine increase following massage therapy. Int J Neurosci. 2005;115:1397-1413.

The article is for nutrition education only and is not intended for the treatment or prevention of disease, nor should it be used as a replacement for seeking medical treatment.