Cortisol is a steroid hormone that is essential for maintaining health and well-being and impacts several different bodily functions. It regulates blood pressure, controls sleep and wake cycle, helps your body respond to stress, and suppresses inflammation, among other functions. When cortisol levels are too high or too low, this can lead to significant health issues, like Cushing syndrome, Addison's disease, or, more commonly, Adrenal Fatigue Syndrome (AFS). However, if you are wondering how to fix cortisol imbalance, certain tests may give you direction, and there are several steps you can take to restore normal levels.
Cortisol is a steroid hormone that is synthesized from cholesterol in the zona fasciculate layer of the adrenal cortex. This hormone is produced in response to stress. As such, it’s often referred to as the body’s stress hormone. The hypothalamus-pituitary-adrenal axis regulates not only the production of cortisol but also its secretion.
If you have a cortisol imbalance, it can lead to a variety of health problems. However, before you can address a cortisol imbalance, you need to determine if you have one in the first place.
Normal cortisol levels vary depending on the time of day. In the morning, normal readings range from 10 to 20 micrograms per deciliter (mcg/dL). These levels decrease to about 3 to 10 (mcg/dL) in the evening.
There are a couple of ways to test cortisol levels, including saliva, urine, and blood tests. However, the best way to test cortisol levels throughout the day is with a saliva test or urine test, since cortisol levels vary during the day. If you are looking at how to fix cortisol imbalance, one of the following tests should be considered to determine if your cortisol levels are normal.
A blood test usually involves your healthcare provider using a small needle to take a blood sample from a vein in your arm. A small amount of blood is collected in a test tube or vial. This test typically lasts less than five minutes. Usually, patients have to give two blood samples during the day. The first sample is taken once in the morning, when your cortisol levels are at their peak, and again around 4 p.m., when cortisol levels are significantly lower. However, most providers usually only order the free cortisol level in the morning because it is hard for patients to go to the lab to get poked twice in one day.
A cortisol urine test typically involves your healthcare provider asking you to collect all your urine in a container over 24 hours. This is known as a "24-hour urine sample test." For this particular urine test, your healthcare provider gives you a special container and provides you with instructions detailing the correct collection and storage procedure for your urine sample. Also, you will be given information relevant to when to begin the test.
A cortisol urine test typically involves the following steps:
Begin by urinating in your toilet as normal. Make a note of the time you urinated. However, do not collect this urine to be used as a sample.This process is usually used to obtain cortisol samples over the course of a day, but in certain instances, a cortisol urine test may be done on a single sample of your urine that you collected in the morning.
This form of cortisol test is normally performed at home using a kit to collect a saliva sample. Your healthcare provider will inform you of the time to collect your sample. However, sample collection is often done four to five times throughout the day to get the best look at the cortisol curve.
Most cortisol saliva test kits include a swab and a storage container. Instructions usually come with the kit, and you should follow them carefully. The general instructions that typically accompany a cortisol saliva test may include the following:
These tests can help you understand how to fix your cortisol imbalance, but they have their advantages and disadvantages.
According to an article in Annals of Clinical Biochemistry, while the cortisol blood test measures total cortisol, their results can be misleading in patients whose serum protein concentrations are altered. Furthermore, the article added that a urine test can be used to screen for Cushing's syndrome, a condition caused by excess cortisol. Saliva test offers a reliable alternative to measuring free cortisol in serum, and is useful to be able to get multiple cortisol points throughout the day for the best way of looking at the adrenal function.
In general, you should also talk to a trusted medical professional with experience in cortisol imbalances who also takes a detailed medical history for help correctly identifying a cortisol imbalance. Cortisol levels fluctuate over the day, and incorrect testing can easily lead to incorrect interpretation.
Your body regulates the levels of cortisol hormone in your body via the action of the hypothalamic-pituitary-adrenal axis. When your cortisol levels are low, the hypothalamus springs into action, releasing the corticotrophin-releasing hormone (CRH). This action stimulates the anterior pituitary gland to release the adrenocorticotropic hormone (ACTH). Thus, causing your adrenal glands to produce and release more cortisol.
There are several reasons why your adrenal glands may release excess cortisol. These include:
Stress of any kind can trigger your adrenal glands to release hormones, including cortisol. Stressors can include work, relationships, financial issues, anxiety, environmental toxins, and even health conditions.
Your body goes into fight-or-flight mode as it prepares itself for whatever potentially dangerous stressor it perceives. Cortisol functions to help to limit and minimize any non-essential functions in a fight-or-flight situation. When the threat passes, cortisol levels return to normal. However, constant stress forces the body to produce more cortisol and keeps levels high.
Positioned at the base of your brain, the pituitary gland monitors and helps to regulate many bodily functions by releasing hormones. Pituitary gland issues can result in too much or too little hormone, like ACTH, which then stimulates your adrenal glands to release added cortisol.
Pituitary conditions that have the potential to cause high cortisol levels in your body include:
Sometimes adrenal gland tumors can be benign (noncancerous) or malignant (cancerous), and they often vary in size. Both types of adrenal gland tumors can produce high levels of cortisol hormone.
To figure out if you have an adrenal tumor, your healthcare provider will likely perform blood and urine tests to uncover the presence of particular substances. This will help to identify the kind of tumor that is present.
Some studies suggest that certain medications, like oral contraceptives, can increase cortisol levels. Also, medications like corticosteroids have been linked to causing elevated cortisol levels when taken in high doses or for a long period.
Some commonly prescribed corticosteroids that are implicated include:
However, be sure to talk to your doctor first before you stop taking steroid medications. Suddenly stopping them could cause low levels of cortisol and lead to serious health complications like low blood pressure or blood sugar, coma, and even death.
Low cortisol levels, also referred to as hypocortisolism, are a type of adrenal insufficiency, where the adrenal glands do not make enough cortisol. This insufficiency can stem from various issues. Some of the causes of low cortisol levels include:
This is an autoimmune disorder that attacks the adrenal glands, disrupting cortisol production.
The pituitary gland fails to produce and release enough ACTH, which signals to the adrenal glands the amount of cortisol that’s needed.
Adrenal Fatigue Syndrome (AFS), is the non-Addison's form of adrenal dysfunction, where the body's stress response cannot keep up with life's chronic stressors. Adrenal fatigue brings with it imbalances in cortisol production. Cortisol levels can be significantly disrupted if you have AFS.
At first, cortisol levels increase to meet the growing demand; however, eventually the adrenals become unable to meet the ongoing demand and production declines. The Hormone Circuit of the NeuroEndoMetabolic (NEM) Stress Response comprises the adrenal glands, thyroid glands, and reproductive organs and helps with regulating hormones. An imbalance in the Hormone circuit has the potential to impact the pituitary hormones, including ACTH, which can impact cortisol levels.
Restoring balance to your Hormone Circuit can ease adrenal fatigue symptoms. Talk with your doctor if you suspect that you are experiencing hormonal imbalance and want more personalized suggestions of how to fix cortisol imbalance.
There are several strategies you can use to fix cortisol imbalance. These include:
An imbalance in cortisol levels, especially if it's high at night, can disrupt your sleep. Prioritize getting adequate sleep to effectively reduce cortisol levels. Some simple things that you can do to sleep better include:
Creating a consistent bedtime routine can serve to signal to your brain and body to begin winding down for the night.Exercise has been linked with a decrease in cortisol levels and reactivity to stress.
However, you don’t want to overdo it. It’s best to have an exercise routine that focuses on gentle exercises in the beginning. Intense exercises can increase cortisol shortly afterward, which can worsen adrenal fatigue in some cases.
Some of the kinds of gentle exercise to consider are yoga, pilates, tai chi, and walking. Additionally, the level of exercise that you’ll be able to perform will depend on your stage of adrenal fatigue. Talk with your healthcare practitioner before you begin a new exercise program.
One of the best ways to address adrenal fatigue and cortisol imbalances is to identify and reduce your stressors. Stressors can include work, relationships, financial issues, anxiety, environmental toxins, and even health conditions. Reducing or removing stress is ideal.
Many of these stressors are not easy to avoid, however. In this case, it may help to learn more strategies to manage stress, including meditation, yoga, exercise, journaling, maintaining a positive attitude, gratitude, and picking up a hobby. Counseling may also help.
Before starting supplements, always try to find the root cause and figure out what’s the best way of supporting the adrenals through a personalized program. Those with adrenal fatigue might have to adjust dosing based on their sensitivities and tolerances. Supplements to support healthy cortisol levels include:
These herbs can help to restore your body to a state of balance. They are non-toxic and aid the body in coping with and adapting to stress. Adaptogens can help balance cortisol by increasing it when it is low and helping your body lower levels when it is too high.
Many herbs and supplements may help you better deal with stress. Herbs that provide adrenal support include:
Cortisol imbalance can significantly impact your health, and both too much and too little cortisol can be problematic. However, knowing how to fix cortisol imbalance is not a one-size-fits-all situation. You may need to try different strategies to see what works for you.
Some possible ways to fix cortisol imbalance include gentle exercise, stress management, the right vitamins and supplements, and getting adequate sleep.
Balancing cortisol levels is essential for overall health, yet finding the right approach can be complex and individualized. From managing stress to incorporating suitable exercise and supplements, there are various strategies to address cortisol imbalance effectively.
Dr. Lam's Nutritional Adrenal Fatigue Recovery Program offers comprehensive support in addressing cortisol imbalance and adrenal health. Our program integrates targeted exercises, strategic supplementation, and personalized guidance to help you reclaim balance and vitality.
Contact us today at +1 (626) 571-1234 to schedule a free initial consultation and take the first step towards optimized health and well-being. You can also click here to access out Ask the Doctor System. Let us guide you towards holistic wellness and resilience.
El-Farhan, Nadia, et al. "Measuring Cortisol in Serum, Urine and Saliva - Are Our Assays Good Enough?" Annals of Clinical Biochemistry, vol. 54, no. 3, 2017, pp. 308-322. SAGE Journals, doi:10.1177/0004563216687335.
Thau, L., Gandhi, J., Sharma, S. "Physiology, Cortisol." StatPearls [Internet]. Treasure Island: StatPearls Publishing, January 2023. Updated 28 August 2023. NCBI.
Todorova, Vellislava, et al. "Plant Adaptogens-History and Future Perspectives." Nutrients, vol. 13, no. 8, 2021, 2861. MDPI, doi:10.3390/nu13082861.
Knowing how to fix cortisol imbalance involves supporting your adrenals by minimizing stress, doing gentle exercises, getting enough sleep, and taking the right supplements and vitamins that will support cortisol balance.
