What Causes High Cortisol?

It seems like high cortisol is being blamed for everything these days.

I can understand why it’s tempting to do so.  Cortisol is, after all, a chronic stress hormone, and folks have plenty of reasons to be stressed.

And as a Functional Medicine doctor who has helped hundreds of people discover how their stress-response system might be making them feel sick, I’ve seen lots and lots of symptoms related to cortisol imbalances - from panic attacks to hives to IBS, elevated cortisol can create some serious issues.

And most conventional doctors aren’t paying it enough attention.

Here are a few more symptoms of elevated cortisol:

• hot flashes and night sweats
• heart palpitations
• dizziness and vertigo
• constipation or diarrhea
• cramping and bloating
• poor circulation in the hands and feet
• sleep problems (especially waking up in the middle of the night)
• fatigue, anxiety and depression,
• weight gain - especially in the belly area
• memory problems

…and I could keep going, believe it or not. Your stress-response system is very powerful and very influential. It impacts pretty much every body system you’ve got, and not always in a friendly or helpful way.

So, what is cortisol? And what exactly does it do in the body to create such a mess when it’s high?

Cortisol is one of the hormones produced by the Hypothalamus, Pituitary, Adrenal Axis or HPA-Axis in response to stressors.

You might be thinking "Ok, Dr. Kate, if cortisol is a stress hormone, then high levels are caused by too much stress!"

And you’d be correct - but it’s important to remember that the body treats all stress the same, which means we have to consider mental, emotional, and physical stressors. 

I’ve found that the physical stressors - the ones that don’t involve our thoughts and feelings, but instead involve our neurology, immune system, hormones, and gut - these guys aren’t always given their due.

And it’s also important to note that the body interprets stress as a threat to survival - which is why another part of the stress response system involves adrenaline, which kicks your system into fight/flight/freeze mode. It’s trying to keep you safe and alive, which is great!

The problem is that most of us live a huge percentage of our lives in a stressed state - mentally, emotionally, and/or physically - which means we never come back to baseline.

This is when the HPA Axis starts kicking out cortisol, our chronic stress hormone.

So, let’s say your body is facing a chronic stressor - whether that’s raising teenagers or juggling lots of tasks at work or enjoying too many sugary coffee drinks - the longer that stress goes on, the more likely it is that your body will crank up it’s output of cortisol in response.

Cortisol does a lot of helpful things to keep you alive, too, but over time it can be very inflammatory and degenerative. It suppresses the immune system - making it harder to heal, raises blood glucose - which can lead to insulin resistance and type 2 diabetes, it can even cause depression independent of serotonin levels, and can seriously shift your sleep cycle - causing insomnia and fatigue.

And these are only a few of the ways that high cortisol can create chaos.

The good news is that we can measure cortisol levels using both saliva and urine.

While you can also measure cortisol in the blood, it’s not the best way to test for two reasons.

1. Cortisol levels are supposed to rise and fall significantly over the course of the day and night, so measuring cortisol at several points throughout the day gives you a much better picture of what’s happening.
2. The “normal” range for cortisol levels in the blood is big enough to drive a bus through so you’ll miss the more subtle changes that most of us deal with.

I prefer using urine levels because you can measure both free and total cortisol production - there’s a handy at-home test kit you can use for this called the DUTCH Adrenal test. You might be able to order it through my website - and I’ll even help you interpret the results! 

Click HERE if you’re interested in ordering this testing.

While there are many, many root causes of high cortisol, in this post I’m going to cover 3 cortisol triggers that don’t get talked about enough - and I’ll also share some tips about how to address each cause.

The first is blood sugar fluctuations.

When you eat, your body extracts the fuel from your food and transports it to your cells via the bloodstream. Insulin is needed to signal to the cells to accept this fuel, or take it up into the cell.

But this process takes time, and there are lots of variables that cause blood sugar to raise and lower, including the makeup of our food, meal timing, the microbiome, genetics, and other factors.

Sharp spikes and crashes in our blood sugar triggers the HPA Axis, releasing cortisol, which can then trigger our fight-or-flight response causing shakiness, brain fog, trouble focusing, anxiety, and eventually fat gain.

How can you prevent blood sugar fluctuations and sensitize your insulin receptors?

By eating meals and snacks with protein, healthy fats, and fiber - and avoiding sweets, sweetened beverages, and empty carbs.

It can also be useful to eat every 3-4 hours - especially when under acute stress.

I’ve got some additional strategies for how to eat when your cortisol is high in my Free Stress Smarter Starter Kit - get your copy HERE.

The second stress trigger that nobody talks about is dysbiosis.

This term has to do with the microbiome, which is the bacteria and yeasts and other “bugs” that live in and on our bodies - especially in the digestive tract, or gut.

When the microbiome is unbalanced or dysfunctional, we call it dysbiosis.

Dysbiosis is different than having a bacterial infection in your digestive tract, but in some ways it’s equally damaging.

When inflammation or irritation is present in the lining of the digestive tract, perhaps because of less-than-optimal microbial balance, the cells on the inside of the gut can pull apart slightly, leaving an opening or gap for particles or microbes to enter the bloodstream.

The scientific term for this is gut hyper-permeability, or loss of gut barrier integrity, but I find the term “leaky gut” to be easiest to understand.

This causes a chain reaction of inflammation that easily spreads to the brain.

What’s the result of this leakiness? Any number of brain-related symptoms including anxiety, depression, loss of focus, brain fog, and sleep problems.

Sounds like high cortisol, doesn’t it?

One of my favorite ways to protect the gut against too much permeability is with a very special bacteria called Akkermansia muciniphila.

This keystone microbe also helps balance blood sugar and reduce body fat, so it helps lower cortisol on multiple levels.

Click HERE for my favorite Akkermansia probiotic - it’s a tricky bug to grow and package up, so quality is really key for this one.

The third stress trigger that doesn’t get enough attention is micronutrient deficiency.

Not having optimal levels of vitamins and minerals forces the body to take biochemical “backroads” and detours in order to get stuff done.

It makes sense - if your body doesn’t have enough ingredients to do the daily functions that keep you going, eventually those biochemical processes like metabolism, detoxification, and regeneration stop working properly, usually very gradually, triggering chronic stress and raising cortisol.

In addition, lack of compounds called antioxidants can cause a build up of free radicals in the body, which break down and damage tissues, creating long-term inflammation, which again raises cortisol.

The trouble is that your doctor probably isn’t monitoring your micronutrient status - routine bloodwork rarely checks for common insufficiencies like Vitamin B12, Folate, Magnesium, Ferritin, Zinc, and Vitamin D.

Even if you’re eating lots of fruits and veggies, the unfortunate reality is that the micronutrient density of our food supply just isn’t as good as it was one hundred years ago.

And if you’re relying on supplementation, most health store multivitamins don’t meet label claims, meaning that what you see on the ingredients list isn’t actually in the capsules.

The good news is that you may be able to order your own micronutrient blood testing through my website - and I’ll even send you a handy chart so you can tell if your levels are in the optimal range. Click HERE for more info about micronutrient lab testing.