Elevated Cortisol: Addressing the Causes

Cortisol is also known as the 'stress hormone' because it is released by the adrenal glands during stressful situations. This hormone is also important to help regulate several physiological processes in the body, including metabolism, immune response, inflammation, blood pressure, and the sleep-wake cycle, among others. A long-term elevated cortisol level is related to a condition known as Cushing's syndrome and may also lead to several health problems, including weight gain, heart disease, diabetes, and mental health disorders.

In this article, we will discuss the causes, implications, and possible ways to deal with elevated cortisol levels.

What is cortisol?

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Cortisol is often referred to as the 'stress hormone' since it gets released during stressful situations. The production of cortisol is regulated by the endocrine system (hormone system), specifically by a circuit known as the hypothalamus-pituitary-adrenal (HPA) axis. When a person is in a stressful situation, the hypothalamus — an area of the brain — releases corticotropin-releasing hormone (CRH).

CRH then stimulates the pituitary gland, a small, pea-sized gland located at the base of the brain, to secrete adrenocorticotropic hormone (ACTH). In turn, ACTH stimulates the adrenal glands (suprarenal glands) to produce and release cortisol into the bloodstream. There are two adrenal glands, each located on top of one kidney.

When cortisol levels in the blood are high enough, and the stressful situation no longer exists, the release of both CRH and ACTH is inhibited. So, if any part of the HPA axis fails, the levels of cortisol in the body can get imbalanced.

Persistently high cortisol levels may lead to various health issues, such as heart disease, obesity, diabetes, fertility problems, and mental health disorders.

What does cortisol do in our body?

Besides regulating the response to stress and allowing the body to stay alert, cortisol plays many other important functions and exerts its effects on almost all systems of the body.

The main effects of cortisol include:

  • Metabolism regulation. Cortisol promotes the catabolism (breakdown) of fats and proteins in the tissues to provide energy for the body when necessary.
  • Blood sugar regulation. Cortisol increases blood glucose (sugar) levels by decreasing the levels of a hormone called insulin and increasing the action of another hormone called glucagon.
  • Blood pressure control. Since cortisol is involved in the regulation of water and electrolytes in the body, an imbalance of this hormone may promote fluid retention, which may lead to high blood pressure levels.
  • Inflammation suppression. Cortisol promotes an anti-inflammatory effect by suppressing the production of pro-inflammatory substances and inhibiting the activation of some immune cells. Over time, sustained inhibition of immune cells could lead to a higher prevalence of infections.
  • Sleep-wake cycle regulation. Since the HPA axis follows the circadian rhythm (the internal clock of the body), cortisol levels are naturally high in the morning and low during the night.
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Overall, cortisol is essential to enable a proper response to stress and maintain an adequate balance between various systems of the body.

Why is it bad to have constantly elevated cortisol levels?

Short bursts of cortisol are normal and part of the natural process designated to keep the body on alert during the 'fight or flight' response before perceived or real threats.

However, having chronic (long-term) high cortisol levels (hypercortisolism) can be detrimental to a person’s health because the body will always be on alert, even when it is not necessary.

Furthermore, since cortisol affects several processes in the body, prolonged exposure to elevated levels of this hormone causes a condition known as Cushing's syndrome.

Cushing’s syndrome can have numerous negative effects on the body and mind, including:

  • Weight gain, especially in the trunk — the legs and arms are thin compared to the rest of the body
  • Rounded, puffy face, often referred to as a 'moon face'
  • A fatty lump on the back, neck, and shoulders, also known as a 'buffalo hump'
  • Fragile and easily bruised skin
  • Muscle weakness
  • Slow wound healing
  • Large pink or purple stretch marks
  • Fertility problems
  • Mood swings, anxiety, and depression
  • Memory problems
  • Increased risk of type 2 diabetes
  • Increased risk of high blood pressure (hypertension) and heart disease
  • Increased risk of osteoporosis and fractures

If left untreated, hypercortisolism may even result in death.

The root causes of chronically elevated cortisol

Hypercortisolism may happen as a result of the chronic use of medications called glucocorticoids at high doses.

Glucocorticoids include drugs like prednisone, dexamethasone, prednisolone, and triamcinolone, among others. These drugs are often used to treat several chronic conditions like rheumatoid arthritis, asthma, and some autoimmune diseases like lupus.

Other less frequent causes of hypercortisolism include tumors in the pituitary gland or adrenal glands or, more rarely, an ACTH-producing tumor in any organ of the body (e.g., lungs, thyroid gland, or pancreas).

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On the other hand, chronic psychological or physical stress can lead to continuous activation of the HPA axis and sustained cortisol release.

So, people with ongoing work-related stress, financial issues, personal problems, chronic pain, chronic illness, or extreme physical exertion may have continuously elevated cortisol levels.

Other causes of dysregulation of cortisol secretion include chronic sleep deprivation or disrupted sleep patterns (e.g., shift work or sleep apnea).

The same happens with exposure to artificial light or excessive noise at night, which can disrupt the circadian rhythm and affect cortisol secretion.

How to deal with chronically elevated cortisol?

While you might not be able to prevent or treat some causes of hypercortisolism — like tumors — without medical assistance, there are some things you may be able to do to try and reduce the constant release of cortisol in your body:

Dietary changes

A diet that may aid in regulating elevated cortisol levels should focus on balanced nutrition and ingesting foods that may aid in reducing blood sugar levels and have anti-inflammatory effects.

For instance, an ideal diet should include complex carbohydrates like whole grains, vegetables, fruits, and legumes that may help in blood sugar level control. Examples include oats, quinoa, lentils, beans, chickpeas, sweet potatoes, brown rice, leafy greens, strawberries, blueberries, and blackberries, among others.

Lean proteins may also help control blood sugar levels and may promote satiety. These include chicken, lean beef, turkey, fish, eggs, and tofu.

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Foods rich in healthy fats may potentially have anti-inflammatory properties and may also help regulate cortisol levels. Good sources include avocados, nuts, olive oil, and fatty fish like salmon, herring, or mackerel.

Some supplements may also help decrease cortisol levels in the blood.

On the other hand, refined sugar, processed foods, alcohol, and caffeine should be avoided, as these foods and beverages might potentially alter cortisol levels.

Mind-body practices

Mind-body practices may be effective in reducing cortisol levels and managing stress.

These practices may help calm the nervous system, promote relaxation, and improve overall mental and physical well-being. Several options are available, including:

Mind-body practiceDescriptionUsefulnessHow to
Mindfulness meditationFocuses on being present in the moment, aware of all thoughts and feelings, and letting go of all negativity and self-judgment.
Might help reduce stress, anxiety, and depression. Has the potential to improve emotional control.It must be done in a calm and safe space using guided meditations or mindfulness apps, starting with 5-minute sessions and gradually increasing their duration.
Deep breathing exercisesRequires being aware of breathing patterns while inhaling and exhaling deeply and slowly in a controlled manner.
Reduces the heart rate and contribute to muscular and mental relaxation.
Several deep breathing exercises and techniques are available online. Find the one you feel more comfortable with and practice it every day.
Progressive muscle relaxationThis technique is based on tensing and then relaxing different muscle groups in the body in a controlled manner.
Helps reduce muscular tension and promotes physical relaxation.
Beginning from the toes, start tensing each muscle group for 5–10 seconds and then relax them for 20–30 seconds at a time.
JournalingRequires writing down all your thoughts and feelings.
Helps process emotions, clarify thoughts, and might help reduce stress.Use a journal to write down everything that happened during the day, focusing on both positive and stressful experiences.
YogaInvolves the use of physical postures, breathing techniques, and meditation combined into a single discipline.
Promotes relaxation. Improves flexibility, balance, and strength.Enroll in a yoga class or do the exercises at home while watching online videos.
Tai chiUses a combination of slow, deliberate movements, meditation, and breathing exercises.Improves balance, and flexibility. It may help reduce stress.Join a class or follow online tai chi tutorials.

You can choose one or more techniques and practice them every day in order to start seeing beneficial results.

Lifestyle modifications

Although stress may be unavoidable in modern life, every person has the potential to modify what they perceive as stressful, how it affects them, and how they react to it.

In this sense, several lifestyle modifications may help regulate cortisol levels in the body, including:

  • Start doing moderate exercise — like walking, cycling, or swimming — every day for at least 150 minutes per week.
  • If you perform strenuous exercises, make sure to have adequate recovery periods in between sessions.
  • Adhere to a sleep schedule. Aim to go to bed and wake up at roughly the same hour each day.
  • Limit screen time before bed. Turn off all electronic devices at least 1 hour before your bedtime.
  • Make sure to drink enough water and stay hydrated throughout the day.
  • Schedule regular breaks during work. This will help you clear your mind and stretch your body.
  • Learn to say no and set boundaries to avoid overstraining yourself.
  • Prioritize tasks and learn how to manage time effectively and delegate when necessary. Use tools like to-do lists and planners.
  • Make sure to have a support network. Visit friends, family, or professional counselors during stressful times.
  • Get involved in fun hobbies and activities that you enjoy.
  • Minimize noise pollution in your living space.
  • Keep a clutter-free working and living environment.
  • Take breaks from social media and digital devices every once in a while.

If you still find it difficult to keep your stress levels under control, consider seeking help from a healthcare professional and getting counseling to develop coping strategies for managing stress and addressing underlying issues.

Bottom line

In conclusion, constantly elevated cortisol levels can have deleterious effects on multiple systems of your body, contributing to various physical and mental health issues and increasing the risk of several diseases and conditions.

Learning how to manage stress effectively and making some lifestyle improvements are crucial for maintaining cortisol levels under control and improving your overall well-being.

However, you need to keep in mind that medical treatment may be necessary in some cases.

So, besides trying holistic approaches to try to get your cortisol levels 'under control,' always seek assistance from your healthcare practitioner to make sure your health is on point.

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