An excerpt from the book, “Your Blood Never Lies: How to Read a Blood Test for a Longer, Healthier Life” by James B. LaValle, RPh, CCN, ND. Read additional excerpts or buy the whole book.
Over the past decade, cortisol has been at the forefront of research on health and well-being. The rise of diabetes complications and short-term memory erosion has resulted in more studies highlighting the importance of cortisol management. Made in the adrenal glands, cortisol is a steroid hormone that increases blood sugar, suppresses the immune system, fights inflammation, decreases bone formation, and helps metabolize fat, protein, and carbohydrates when it is released in appropriate amounts. It is most commonly known as the “stress hormone,” as it is released in response to both physical and psychological stress. While this reaction is normal and healthy in short bursts, chronic stress leads to the creation of too much cortisol, which results in a variety of imbalances in the body. Chronic elevation of cortisol can block the growth of nerve cells in the brain and damage the brain’s memory center (hippocampus), which may begin to shrink when high cortisol and low DHEA occur together.
Normal cortisol levels rise and fall cyclically throughout the day. Generally, they will be highest in the early morning (between 6:00 and 8:00 AM) and lowest at midnight. They usually drop around noon or midday, and then again in the evening around 4:00 to 6:00 PM. The table below lists the traditionally accepted ranges for cortisol production in the blood for adults.
| REFERENCE RANGES FOR CORTISOL | |
| Time of Day | Cortisol Normal Range (mcg/dL) |
| AM | 6.2 to 19.4* |
| PM | 2.3 to 11.9 |
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Target Range: AM: 10 to 14 mcg/dL; PM: Less than 7.0 mcg/dL
*Some labs place the normal upper limit at 22.24 mcg/dL
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Always check the reference ranges on your blood test, as they may vary slightly from the above. Cortisol may also be assessed using a four-point salivary cortisol test, which maps out cortisol output over the course of the day to determine if your body is releasing the appropriate amounts at specific times. These values are completely different from blood values and should not be confused with serum (blood) testing.
WHAT CAUSES HIGH CORTISOL?
Very high cortisol, also called hypercortisolism, has a number of potential causes, including:
- Adrenal tumors
- Anorexia or bulimia
- Chronic stress
- Cushing’s syndrome
- Oral contraceptives
- Physical activity
- Pituitary tumors
- Pregnancy
While physical activity brings about an increase in cortisol, this condition is temporary. A more troublesome issue is chronic stress, which does not allow the body to recover from moments of raised cortisol, setting the stage for bigger problems.
WHAT ARE THE SYMPTOMS OF HIGH CORTISOL?
Symptoms of chronic high cortisol may include anxiety, cravings for sweets and carbohydrate-rich foods, mood swings, sleep pattern disturbances, memory impairment, increased susceptibility to colds and flu, joint aches and pain, blood sugar imbalances, increased belly fat, and gastrointestinal disturbances such as gas, bloating, diarrhea, and constipation.
HOW CAN HIGH CORTISOL BE TREATED?
While there are many lifestyle adjustments that can be made to lower chronically high cortisol levels, sometimes the problem is beyond these solutions and requires pharmaceutical treatment. Typically, extremely high levels related to a disease may require surgery or medication. When cortisol is slightly elevated, treatment will likely depend on alleviating symptoms of conditions like insomnia, anxiety, or other mood disorders, whether through drugs or other means. There are also plenty of natural ways to correct slight elevations in cortisol or levels that trend high, as explained in further detail below.
SUPPLEMENTS TO REDUCE CORTISOL
Dietary supplements may be recommended to balance the production of cortisol.
| SUPPLEMENTS FOR HIGH CORTISOL | ||
| Supplement | Dosage | Considerations |
| Magnesium | 400 mg one to two times a day. | Use magnesium aspartate, citrate, taurate, glycinate, or any amino acid chelate. Supports bone building and balances calcium intake. The ratio of calcium to magnesium intake should be between 1 to 1 and 2 to 1. This supplement is reported to improve blood vessel function and insulin resistance, in addition to decreasing LDL cholesterol, total cholesterol, and triglycerides. Also essential for phase-I liver detoxification. If you experience loose stools after taking magnesium, cut your dose in half and gradually increase over the course of a few months. Consult your health-care provider for dosage advice. |
| Melatonin | 3 to 6 mg once a day, an hour before bedtime. | This is a natural hormone that improves sleep patterns and acts as an antioxidant in the body. It also resets the cortisol release pattern. Possible but rare side effects include dizziness and headache. People who are taking anticoagulants, immunosuppressants, oral contraceptives, or diabetes medication must use with caution and only under the supervision of a health professional. Doses higher than the recommended amount can be taken only under the advice and guidance of a doctor. |
| Relora | 250 mg two to three times a day. | This supplement helps alleviate stress by reducing the body’s physiological response. Since it may cause drowsiness, do not take before driving an automobile or working with or around heavy machinery. |
| L-theanine | 100 to 200 mg three times a day. | This supplement alleviates mental and physical stress, and decreases the level of phenethylamine (PEA) in the brain, a stimulatory neurotransmitter. Some medical sources say no side effects have been observed, but others warn that dizziness, headaches, and upset stomach are possible. Women who are pregnant or breastfeeding should avoid use. |
LIFESTYLE CHANGES
Because cortisol is produced in reaction to inflammation, reducing inflammation is a good way to lower cortisol levels. Eliminate inflammatory foods from your diet, including products made with refined sugar and flour, fried food, sweets, processed snacks, soft drinks, and fast food in general. Choose organic free-range meat and steer clear of chemical flavoring agents, artificial sweetener, preservatives, and dyes. Eat at regular intervals and take time to enjoy the meal. Foster relaxation by going for long walks, doing yoga, or meditating. Additionally, moderate exercise of thirty to sixty minutes a day can help reduce stress hormones and balance your blood sugar. Finally, try to drink at least 2 to 3 liters of filtered water every day.
WHAT CAUSES LOW CORTISOL?
Although chronic stress causes cortisol levels to rise in the body, it may lead to cortisol deficiency if it persists long enough. When the adrenal glands constantly produce large amounts of cortisol, they can eventually begin to wear out and lose their ability to produce and regulate cortisol. This condition is commonly referred to as adrenal fatigue, but the term is not entirely accurate. Most of the time, the adrenal glands are not the problem, but rather the regulation of the adrenal glands by the brain’s hypothalamus and pituitary glands. Stress alters the circuitry of brain signaling, and the net result is what is called maladaptive stress syndrome. In other words, the term “adrenal fatigue” is misleading and poorly chosen.
Although this scenario is the most common reason for altered patterns of cortisol production, the condition can also be caused by underlying medical disorders such as:
- Addison’s disease
- Hypopituitarism
- Post-traumatic stress disorder (PTSD)
If you experience symptoms of low cortisol, make an appointment with your doctor for a blood test.
WHAT ARE THE SYMPTOMS OF LOW CORTISOL?
If low cortisol stems from chronic stress, you may experience many of the symptoms of high cortisol before you notice the effects of a drop in the hormone. Signs of low cortisol include chronic fatigue, muscle weakness, darkening of the skin, loss of appetite, unexplained weight loss, depression, irregular menstrual periods, low blood pressure, and low blood sugar. If traumatic stress or post-traumatic stress disorder (PTSD) is the cause of low levels, panic and anxiety may ensue when the brain begins to release cortisol again.
HOW TO TREAT LOW CORTISOL?
Cortisol management is becoming increasingly important in treating chronic illness, as well as for maintaining good health in general. Although it is relatively rare to have a disease that causes a dramatic change in cortisol output, many people experience chronic health-related issues due to inappropriate cortisol release. It’s critical for you to monitor your levels carefully. If Addison’s disease or hypopituitarism is responsible for low cortisol levels, your doctor will treat these underlying conditions appropriately with medications such as corticosteroids. Otherwise, there are a few options for managing cortisol levels naturally.
CORTISOL MANAGEMENT SUPPLEMENTS
The following dietary supplements may help normalize cortisol levels.
| SUPPLEMENTS FOR LOW CORTISOL | ||
| Supplement | Dosage | Considerations |
| Adrenal glandular supplement | 100 to 200 mg one to three times a day. | Whole-gland extract may cause anxiety in individuals who have PTSD or artificially suppressed cortisol levels. To avoid health risks associated with Bovine Spongiform Encephalitis, buy supplements made from cattle in New Zealand, not Europe, where BSE infection rates are higher. |
| Ashwagandha (standardized to 1.5-percent withanolides and 1-percent alkaloids) | 450 to 900 mg once a day. | Use with caution when taking sedatives and hypnotics such as barbiturates, as their effects may be increased. May also alter thyroid hormone levels, so check with your doctor before using if you have a thyroid disorder. Consult your doctor before taking if you are on blood thinners or antiplatelet drugs. Substances similar to ashwagandha (adaptogens) that may also be beneficial include Rhodiola, American ginseng, and Manchurian ginseng. |
| Licorice root (standardized to contain 20-percent glycyrrhizinic acid) | 250 to 500 mg three times a day. | Do not take if you have heart disease, congestive heart failure, high blood pressure, fluid retention, diabetes, kidney disease, or liver disease. Women who are pregnant or breastfeeding should not take licorice. This supplement should not be used by anyone who is currently taking ACE inhibitors, diuretics, digoxin, or oral contraceptives, among other medications. Talk to your doctor before using. |
LIFESTYLE CHANGES
If you suspect you are suffering from consistently elevated amounts of cortisol and wish to avoid the symptoms of adrenal burnout, follow the suggestions made earlier in connection with the treatment of high cortisol, such as cutting out refined carbohydrates and trying meditation. The goal is to bring your body back into balance before the circuitry between the hypothalamus, pituitary glands, and adrenal glands misfires and alters cortisol output.
Last Updated: June 21, 2021
Originally Published: August 1, 2016
