Stress. It’s a word that gets used very frequently in our society, especially during the last year when we all experienced our first pandemic. Understanding cortisol and the testing options helps to explain your cortisol-related symptoms.

How Does Stress Affect the Body

According to the Merriam-Webster Dictionary, one of the definitions of stress is:

a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation

Stress can be classified as either eustress or distress. Eustress is viewed subjectively. Eustress is physiologically beneficial as it helps with adaptation and /or can be withstood without the result of disease. Distress, on the other hand, is viewed as subjective and is physiologically harmful.  It cannot be sustained and can contribute to disease. Physical stress is usually objective, and psychological stress is usually subjective. But with stress, the body can not completely differentiate between the type of stress it is experiencing. 

How Does Stress Affect Cortisol

Remember when I shared the 411 on the endocrine system?  (If you missed it, you can check out that blog post here). I shared how the hypothalamus is the command center, receiving internal and external messages and relaying that information to the pituitary gland. When stress is involved, the hormone released in response to the messaging is cortisol via the HPA axis (Hypothalamus-Pituitary-Adrenal). The hypothalamus receives a stress signal and sends a message to the pituitary. The pituitary releases ACTH, which signals to the adrenals to release cortisol. Until the hypothalamus no longer receives the signal of stress, cortisol will continue to be released in response.

Cortisol is classified as a glucocorticoid. Glucocorticoid receptors are present in almost all tissues in the body. Therefore, cortisol is able to affect nearly every organ system:

• Nervous
• Immune
• Cardiovascular 
• Respiratory 
• Reproductive
• Musculoskeletal
• Integumentary (1)

Since it affects every organ system, cortisol has some important roles, including:

• Manages how your body uses carbohydrates, fats, and proteins
• Keeps inflammation down
• Regulates your blood pressure
• Increases your blood sugar (glucose)
• Controls your sleep/wake cycle
• Boosts energy so you can handle stress and restores balance afterward

How Does Cortisol Affect the Body

When cortisol is released, the body is prepared to run and save you from the threat as the sympathetic nervous system is activated. Heart rate and blood pressure increase, blood is shunted away from your visceral vessels, functions of the digestive tract are inhibited, fat and protein are broken down, glucose is created by the liver to provide a quick energy source for the body, and insulin rises to shuttle that glucose out of the blood and into the cells. 

What an amazing process the body utilizes, so you have resources available to literally save your life!

While the body is incredibly smart and sophisticated, it also prefers to keep things simple as well as patterns. In its simplest form, the body chooses to respond to stress the same way every time. Whether it’s financial stress, the stress of a toxic relationship, under-fueling your body, not getting enough sleep, over-exercising, having an underlying gut issue like candida or other microbiome imbalance, or encountering a mountain lion while hiking, the hypothalamus is receiving an SOS message, and the adrenals pump out the cortisol in response. The amount of stress we put on our bodies due to our lifestyle can have a negative impact in the long run.

What About Adrenal Fatigue?

Technically, that is not a correct term? More accurate terms would be HPA (Hypothalamus- Pituitary- Adrenal) axis dysregulation or cortisol dysregulation.

When the body is continually receiving a message of stress, initially, the cortisol levels will be elevated. Along with that elevation, we begin to see symptoms of high cortisol (hypercortisol) arise, including

• Weight gain
• High blood pressure
• Fatigue
• Changes in mood
• Irritability
• Flushed face
• Thinning skin
• Difficulty concentrating
• Insulin resistance

But what happens when we are dealing with chronic stress? The body eventually gets to a point where it can no longer keep up with the demands of stress.  It will literally throw in the towel and surrender to the stress. So it’s not really “adrenal fatigue” but rather may be a resistance or failure of the receptor cells to send and receive signals appropriately. At this stage, we now see low cortisol (hypocortisol) symptoms arise, including:

• Decreased appetite and weight loss
• Fatigue
• Low blood sugar
• Salt cravings
• Dizziness
• Nausea, vomiting, or abdominal pain
• Muscle or bone pain

Occasionally, there are times when the adrenal glands fail to produce cortisol at all, resulting in adrenal insufficiency. This is known as Addison’s disease is typically the result of damage to the adrenal cortex.  Conversely, Cushing’s syndrome can occur when the pituitary gland produces too much ACTH and stimulates the adrenal glands to produce too much cortisol. Both of these instances are rare and uncommon.

Testing for Cortisol Dysregulation

Experiencing hypercortisol or hypocortisol is not a black-and-white, straightforward situation. Cortisol follows a diurnal pattern. It should be the highest when we wake up in the morning, and it should gradually decrease throughout the day. It should be the lowest at night between 11 p.m. and 1 a.m. Conversely, melatonin production should be at its highest between 9 p.m. and 11 p.m. to help optimize your sleep window. Through testing, we are able to take a snapshot of what cortisol levels look like throughout the day. Testing can be done through a blood serum lab draw, salivary testing, or urine testing.  

Advantages and Disadvantages of Cortisol Testing

Blood Serum Testing

Advantages:

• Set reference ranges used for the assessment of Addison’s disease and Cushing’s syndrome 
• Least expensive option

Disadvantages:

• Multiple lab draws throughout the day are required to obtain a diurnal pattern, which is not feasible for most people
• Free and protein-bound cortisol values are measured unless the free fraction is specified on the lab order

Salivary Testing

Advantages:

• Measured free/unbound cortisol only
• Multiple samples are easy to obtain with an at-home collection kit
• Information is easy to correlate with symptoms
• Provides dynamic information about cortisol output throughout the day

Disadvantages:

• Not always recognized by conventional medicine providers
• Tests are not often covered by insurance
• Can be influenced by DHEA supplements and steroid usage
• Cortisol metabolites are not measured

Dried Urine Test of Comprehensive Hormones (DUTCH test)

Advantages:

• Measures cortisol metabolites and cortisone 
• Multiple samples are easy to obtain with an at-home collection kit
• Information is easy to correlate with symptoms
• Provides dynamic information about cortisol output throughout the day
• When done as part of the DUTCH test, you also receive information on sex hormones and some organic acids

Disadvantages:

• Measures free cortisol only
• Collection cards need to dry for 24 hours
• Most expensive option

High or Low Cortisol Symptoms

If you’ve read about my journey with PCOS, you know that I have suffered from cortisol dysregulation. I was tired but wired every night, experienced menstrual irregularities, struggled to maintain a healthy weight despite my efforts, and had significant mid-afternoon fatigue. I chose to do the DUTCH test to also get that comprehensive view of my hormones and metabolites, and now actively work on how I respond to stress, prioritize sleep, and work on setting boundaries. If you’re curious and want to learn more, schedule a free consultation with me so we can discuss your testing options.