Understanding High Cortisol Levels: Symptoms, Causes, and Regulation

November 17, 2022 • Kathi Head, ND

What is cortisol hormone?

What do you know about cortisol – the stress hormone? It’s called the stress hormone because it’s one of the primary hormones secreted by the adrenal glands in response to stress. Cortisol is often referred to as the fight-or-flight hormone. When your adrenal glands function optimally, they produce an adequate amount of cortisol. Cortisol helps you cope with stress, and it helps power you through the day. Whether stress comes in the form of an external threat – such as a natural disaster – or an internal one – like the stress you experience before public speaking – cortisol helps you adapt to the situation.

But cortisol is more than a stress hormone; it has wide-ranging effects in the body because it interacts with the reproductive, immune, and endocrine systems. As a result, stressors, such as those in your work or home life, can trigger a release of cortisol, either acutely or persistently. Elevated cortisol levels impact your health in a variety of ways. Cortisol raises blood sugar, suppresses immune responses to inflammation, and is involved with the metabolism of protein, fats, and carbs. In the right amounts, cortisol provides balance, helping to prevent an overactive immune response or providing glucose to help you combat a stressful situation. But when too much cortisol is present, it can be harmful.

High cortisol levels: symptoms and signs

Although cortisol is an important hormone for keeping your body in balance, you can have too much of a good thing. The symptoms of high cortisol can either be persistent or transitory depending on the cause, and high cortisol level symptoms can also vary depending on how high cortisol is and how long it’s been elevated.

High cortisol symptoms (symptoms are things you feel)

1. anxiousness

2. fatigue

3. irritability

4. difficulty concentrating

5. difficulty sleeping

6. muscle tension, discomfort, or weakness

7. digestive issues

Signs of high cortisol (things you and others can see or your health professional can detect with a test or instrument)

1. weight gain – especially around the midsection

2. erratic blood pressure

3. thinning skin

4. easy bruising/slow wound healing/purple stretch marks

5. round, flushed face

6. development of a fat pad between the shoulder blades

7. bone loss

What causes high cortisol levels

Some of the high cortisol level symptoms and signs listed above (particularly the signs of bodily changes) can be indicative of a condition called Cushing’s syndrome that requires medical intervention. The most common cause of Cushing’s is long-term use of corticosteroid medications, such as prednisone. But it can also be caused by too much cortisol being secreted from the adrenals or too much of the hormone ACTH from the pituitary gland, which tells the adrenals to secrete cortisol. If you are experiencing signs and symptoms, then you should consult with your health-care professional to have a complete workup, which includes several different testing procedures, including checking your blood cortisol level.

The remainder of this article addresses the effects of stress-induced transitory high cortisol levels or abnormal cortisol fluctuations throughout the day – it does not apply to a clinically high cortisol disease or condition.

Normally, your cortisol level follows a 24-hour circadian rhythm, with higher levels occurring in the morning when it’s time to wake up, and lower levels in the evening when it’s time to go to sleep. This is the opposite of melatonin’s circadian rhythm, which is higher in the evening when it’s time to go to sleep, and lower during the daytime when you want to be awake. But stress can throw this whole system out of balance – especially chronic stress. When cortisol is continuously elevated, such as when you are chronically stressed, your body behaves as if it’s constantly faced with an emergency.

Inflammation, either acute from an injury or other trauma, or from a chronic inflammatory condition, can also cause high cortisol. Although cortisol is secreted to help tamp down the inflammation, if you have a source of chronic inflammation, then cortisol can be chronically elevated, too.

Rather than having abnormally elevated cortisol throughout the day, you can develop an irregular cortisol pattern. Normally, cortisol peaks at waking and then gradually falls throughout the day. When you have a healthy level of cortisol, it helps you wake up in the morning, regulates your energy and hunger, and modulates your normal response to physical and emotional stress throughout the day. Chronic stress can result in cortisol not going down normally throughout the day; your normally lower cortisol level in the evening can remain elevated. Other causes of irregular fluctuations include working a swing or night shift or traveling at irregular hours, causing jet lag.

When cortisol is chronically elevated, blood sugar levels might rise along with insulin levels and cause your appetite to increase. This can lead to over-eating and unnecessary weight gain – one reason stress is associated with weight gain. Another adrenal hormone, adrenaline (also called epinephrine) plays a role too – increasing heart rate, blood pressure, and energy production. All of this can wreak havoc on your body, increase your risk for cardiovascular problems, and weaken your immune function, leaving you more vulnerable to getting sick. Elevated cortisol can also negatively impact the hippocampus – a major learning and memory center in the brain.

Testing cortisol levels

Testing for stress-related cortisol abnormalities involves taking a saliva sample four times during the day to assess its fluctuations. Typically, a saliva sample is taken at waking, at midday, in the late afternoon, and in the evening before bed. Thorne’s at-home Stress Test measures cortisol levels at these four points during the day, as well as assessing your dehydroepiandrosterone (DHEA) level. DHEA is another hormone secreted by the adrenal glands that helps balance cortisol, especially when cortisol gets too high. DHEA is also a precursor to reproductive hormones, like estrogen and testosterone.

Diet and lifestyle measures to regulate cortisol

We’ve talked about what causes high cortisol levels. But what can you do about it? Clearly, if you appear to have a high cortisol clinical condition, then it is essential to consult with a health professional. But as you might have guessed, addressing stress can benefit abnormal cortisol fluctuations. Here are some measures you can take:

Mediterranean diet. Eat an anti-inflammatory diet. If you take steps to calm inflammation with your diet, then cortisol doesn’t have to work so hard to dampen it. The Mediterranean diet is an anti-inflammatory diet that has been shown to help normalize the level of cortisol throughout the day.1 The Mediterranean diet consists of consuming large amounts of vegetables and moderate amounts of fruit, in addition to whole grains, beans, nuts, and seeds. Fish and poultry are eaten in moderation. Fresh fruit is the typical daily dessert and olive oil is the primary source of fat.

Healthy fats. Studies show that eating healthy fats, such as monounsaturated fats (MUFAs) from olive oil, has a positive effect on cortisol levels. On the other hand, eating large amounts of trans fats or high-fat diets in the absence of long-chain omega-3 fatty acids (such as those found in fish) can result in abnormal cortisol fluctuations. In a study of 41 women in the Mediterranean region, high MUFA intake was associated with normal cortisol fluctuations.2

Probiotic foods. A healthy gut equals a healthy mental outlook – at least it certainly helps. For example, maintaining a healthy gut microbiome helps modulate cortisol spikes in response to stress. In a study of 48 medical students, half consumed a probiotic in the form of fermented milk with Lactobacillus casei and half were given an unfermented milk without probiotic activity for eight weeks daily prior to taking exams. The study showed that the group who consumed the fermented milk containing L. casei had lower cortisol levels, less anxious feelings, and experienced fewer cold and intestinal symptoms.3

Probiotic foods include yogurt or kefir (fermented milk), miso (fermented soybeans), sauerkraut (fermented cabbage), kombucha (fermented black or green tea), and kimchi (salted, fermented radishes, and Napa cabbage).

Limit caffeine. A study of caffeine’s immediate effect in healthy men found caffeine adversely affects cortisol levels. Sixteen men (ages 21-39) received 200 mL caffeinated coffee, 200 mL of decaf coffee, or 200 mL of water. Cortisol levels were higher in the caffeinated coffee group, but not the other two groups, after 60, 90, 120, 150, and 180 minutes.4 Thus, caffeine interferes with maintaining normal cortisol fluctuations.

Avoid HFCS. High-fructose corn syrup (HFCS), in addition to contributing to inflammation and increasing your risk for fatty liver, is associated with abnormally elevated cortisol levels. In a study of 17 healthy adults, over-consumption of HFCS resulted in increased sleeping metabolic rate and elevated urinary cortisol levels.5

Avoid smoking. In one study, salivary cortisol in current smokers compared with non-smokers was elevated. However, there was no observed difference between ex-smokers and individuals who never smoked.6 So, if you smoke, then you can normalize your cortisol levels when you stop.

Yoga/meditation. Although cortisol normally spikes in the morning, if it spikes too high or too early, then it can result in early waking with anxiousness. One study found that the practice of yoga asanas, with or without mindfulness meditation, helped reduce both evening and waking cortisol levels.7 In addition, yoga increases GABA levels – an important brain neurotransmitter that helps alleviate stress.8

Exercise. Engaging in regular exercise is a good way to reduce stress and can even lower cortisol levels.9 Heavy exercise too close to bedtime can be stimulating, however. So, especially if you find you have elevated cortisol in the evening and have trouble falling asleep, it’s best to exercise earlier in the day.

Which Thorne supplements support healthy cortisol levels?

Several nutrients can help dampen elevated cortisol levels. Let’s look at which ones and when you might choose one over another.

Stress and aging. Phosphatidylserine (PS), found in Thorne’s Iso-Phos, is a phospholipid found in high concentrations in brain and nerve cell membranes. It has been shown to down-regulate cortisol during times of stress.* Clinical research also shows PS is important in promoting cognitive function, particularly in the aging brain.*10

Stress and athletes. Moducare® is a blend of plant sterols and sterolins that promote a balanced response to stress – helping bring both cortisol and DHEA levels into balance.* Supplementation of Moducare prior to a marathon dampened the typical rise in cortisol levels and subsequent immune function suppression brought on by an intense physical event.*11

Stress eating. If you find yourself mindlessly eating when you are stressed – and you don’t notice you’re stuffing food in your mouth – then consider Relora Plus. Several studies have found the botanical combination – Relora® (Magnolia officinalis and Phellodendron amurense) – help modulate elevated cortisol, decrease stress eating, decrease anxious feelings, and improve mood.*12-14

Stress at bedtime. If your cortisol level is elevated at bedtime, then you might have trouble winding down and falling asleep. PharmaGABA, which contains the relaxing neurotransmitter GABA, has also been shown to decrease cortisol levels in healthy individuals in stressful situations.* Research has shown it can also promote restful sleep.*15

Still having trouble deciding which supplements might be best for you? Then take this Stress Support Quiz – or for a more in-depth approach, take Thorne’s at-home Stress Test, which assesses salivary cortisol and DHEA and provides extensive diet, lifestyle, and supplement recommendations based on your results.

References

1. Romagnolo D, Selmin O. Mediterranean diet and prevention of chronic diseases. Nutr Today 2017;52(5):208-222.

2. García-Prieto M, Tébar F, Nicolás F, et al. Cortisol secretory pattern and glucocorticoid feedback sensitivity in women from a Mediterranean area: relationship with anthropometric characteristics, dietary intake and plasma fatty acid profile. Clin Endocrinol (Oxf) 2007;66(2):185-191.

3. Kato-Kataoka A, Nishida K, Takada M, et al. Fermented milk containing Lactobacillus casei strain Shirota prevents the onset of physical symptoms in medical students under academic examination stress. Benef Microbes 2016;7(2):153-156.

4. Gavrieli A, Yannakoulia M, Fragopoulou E, et al. Caffeinated coffee does not acutely affect energy intake, appetite, or inflammation but prevents serum cortisol concentrations from falling in healthy men. J Nutr 2011;141(4):703-707.

5. Ibrahim M, Bonfiglio S, Schlögl M, et al. Energy expenditure and hormone responses in humans after overeating high-fructose corn syrup versus whole-wheat foods. Obesity (Silver Spring) 2018 Jan;26(1):141-149. doi: 10.1002/oby.22068.

6. Badrick E, Kirschbaum C, Kumari M. The relationship between smoking status and cortisol secretion. J Clin Endocrinol Metab. 2007;92:3:819-824.

7. Pascoe M, Thompson D, Ski C. Yoga, mindfulness-based stress reduction and stress-related physiological measures: A meta-analysis. Psychoneuroendocrinology 2017;86:152-168.

8. Streeter C, Jensen J, Perlmutter R, et al. Yoga asana sessions increase brain GABA levels: a pilot study. J Altern Complement Med 2007;13:419-426.

9. Beserra AHN, Kameda P, Deslandes AC, et al. Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis. Trends Psychiatry Psychother 2018;40(4):360-368. doi: 10.1590/2237-6089-2017-0155.

10. Monteleone P, Beinat L, Tanzillo C, et al. Effects of phosphatidylserine on the neuroendocrine response to physical stress in humans. Neuroendocrinology 1990;52(3):243-248.

11. Bouic P, Clark A, Lamprecht J, et al. The effects of β-sitosterol (BSS) and β-sitosterol glucoside (BSSG) mixture on selected immune parameters of marathon runners: inhibition of post marathon immune suppression and inflammation. Int J Sports Med 1999;20(4):258-262.

12. Talbott SM, Talbott JA, Pugh M. Effect of Magnolia officinalis and Phellodendron amurense (Relora®) on cortisol and psychological mood state in moderately stressed subjects. J Int Soc Sports Nutr 2013;10(1):37. doi: 10.1186/1550-2783-10-37.

13. Garrison R, Chambliss WG. Effect of a proprietary Magnolia and Phellodendron extract on weight management: a pilot, double-blind, placebo-controlled clinical trial. Altern Ther Health Med 2006;12(1):50-54.

14. Kalman DS, Feldman S, Feldman R, et al. Effect of a proprietary Magnolia and Phellodendron extract on stress levels in healthy women: a pilot, double-blind, placebo-controlled clinical trial. Nutr J 2008;7:11. doi: 10.1186/1475-2891-7-11.

15. Yamatsu A, Yamashita Y, Pandharipande T, et al. Effect of oral γ-aminobutyric acid (GABA) administration on sleep and its absorption in humans. Food Sci Biotechnol 2016;25(2):547-551. doi: 10.1007/s10068-016-0076-9.