Do I need to test my cortisol?
Do I need to test my cortisol? Understanding our stress response and when we test our stress hormone
Written by Dr. Fiona Callender, ND
It is not uncommon for a patient to land in my office with questions about their cortisol levels. With so much information about cortisol on social media, many have fears that it has to be high cortisol causing all of their concerns - especially as they are experiencing a ton of stress. The thing is, cortisol may be contributing… but do we need to test it to find out? That’s a longer conversation!
But first, what is cortisol?
To start our conversation, let’s begin to understand what cortisol is and what it does. Though we often think of cortisol as our “stress hormone”, it actually plays a number of roles in our bodies. We have receptors for cortisol in almost every tissue throughout our bodies, which means that it has the ability to impact most of our systems including nervous, immune, cardiovascular, respiratory, reproductive, musculoskeletal, and skin/connective tissue systems. Not only does it mediate our stress response, it also plays a role in regulating metabolism, inflammation and immune function. We need a certain amount of cortisol for balanced body responses, but chronically high cortisol can lead to issues.
Cortisol is released in a diurnal fashion - meaning it’s levels peak in the early morning to help us rise and feel alert, and declines steadily after this. Levels are lowest around midnight - working opposite melatonin and allowing us to stay asleep. During the day when levels are higher, cortisol helps maintain blood sugar and manages energy by suppressing non-vital organ systems.
Importantly, as mentioned above, cortisol also helps us mount a stress response when needed. This is really important when we have short-term stressors, but excessive or prolonged high levels of cortisol can have negative impacts on our physical and mental wellbeing.
What is the stress response?
Our bodies are constantly responding to stressors - both internal and external. In an ideal world, we process information from our surroundings (and our bodies) and elicit a response that should be in accordance with the degree of threat. The thing is, a stressor may be anything that causes a physical or psychological threat to our safety or well being, a significant shift in our environment, or inconsistency between our expectations and reality. The perception of threat or fear will vary between people - we don’t all have the same response to the same triggers or stressors. Our amygdala is an area of our brain that is responsible for this perception of fear or danger.
Neurologically, our stress response exists on a continuum of parasympathetic, “rest & digest” to sympathetic, “fight or flight”. Our sympathetic nervous system is responsible for breakdown of tissues and metabolism of fat to mobilize sugar for energy. It also promotes alertness and helps with goal-directed behaviour. On the other hand, the parasympathetic nervous system promotes repair, immunity, healing and growth. We need a balance between the two for overall health.
When a threat is experienced, our amygdala helps determine what kind of response is needed. If necessary, signals are sent to other regions to activate the sympathetic nervous system and signal the adrenal glands to release epinephrine - which increases our heart rate and respiratory rate. If the threat continues, our hypothalamic-pituitary- adrenal (HPA) axis is activated and cortisol is released from the adrenal glands. In the short term, this is really helpful as cortisol helps us have quick access to fuel and helps us stay alert.
But what happens when that stress is not acute? What happens when it’s our job, or financial security, or our relationships that are causing the stress? Long-term or chronic activation of our stress response can lead to repeated surges of cortisol and, eventually, cortisol dysfunction. It’s unclear exactly what the mechanism is, but it’s possible our receptors become less sensitive to the increased cortisol (similar to what we know happens with insulin and type 2 diabetes). This leads to less effective function of cortisol - even though levels are high. Your adrenal glands are still able to produce cortisol, this chronic high level just might be impacting how you feel. Stressful events in life are inevitable - in fact, overcoming hurdles and difficult situations is part of what helps us adapt! To some degree, we may have the capacity to control what our body and brain perceive as stressful and how we respond to it.
Do we need to test my cortisol?
For most people, testing cortisol levels won’t actually tell us much and might actually lead to more confusion when we see that the test doesn’t line up with your experience. For most people, understanding their stress and burnout symptoms is far more important in terms of how we will support them. Testing is useful when we are determining if a person has a high or low cortisol condition such as Cushing’s syndrome (a disease of cortisol excess due to either a tumour or medication) or Addison’s disease (a condition of low cortisol, most often caused by autoimmune factors). These conditions come with specific symptoms such as:
High cortisol:
Weight gain (especially in the face and abdomen)
Diabetes
High Blood Pressure
Hirsutism (facial hair or acne) in women
Muscle weakness
Osteoporosis
Low cortisol:
Fatigue
Weight loss
Low Blood Pressure
Hyperpigmentation of the skin
These are medical conditions that require interventions that may include surgery and medications.
We always ask a number of questions and may run lab tests to rule out other conditions that present with similar symptoms - think, hypothyroidism, low iron, symptoms of perimenopause, depression/anxiety, sleep disorders such as sleep apnea. I often ask about pain and digestion too because, as we’ll discuss, chronic stress can deeply impact these other areas of our health.
Stress and Chronic Pain
I always talk about stress with my patients who are experiencing any kind of pain - whether that’s menstrual, pelvic, digestive, back pain, migraines, you name it. We know that pain is impacted by a variety of cognitive, emotional and social factors. Long-term, recurrent stress that involves a negative outlook, rumination or worry, or catastrophization about pain, may prolong cortisol secretion. There’s a questionnaire that I often do with my pelvic pain patients that gives us some clues about how this is impacting you. This is, of course, just one piece of the pain puzzle - but it’s an important piece. Chronic stress and cortisol may impact pain in a number of (likely overlapping) ways including inflammation and nervous system sensitization/feedback.
Managing stress and calming our system
A huge part of what we work on in my office is combating stress. Of course, I can’t give you a magic pill to erase your job stress, or help you cope with being a caretaker, or improve your finances, but we can work on making changes to support how your body perceives these stressors. Reducing other forms of stress - nourishing yourself with enough food and getting good quality sleep - are a huge part of the process. We also lean on mindfulness - which has been studied and shown to help decrease cortisol levels. It is also helpful in chronic pain and digestive concerns. The research is continuing to emerge: mindfulness and breathing exercises are paramount to treating these conditions. I often refer to our psychotherapist, Nicole Armstrong RP to support alongside the work we are doing. Shifting our attitudes and perceptions around stressors and pain can also be helpful.
Will you leave my office with homework? Probably! But I also know that we need to take a stepwise approach to managing stress. Adding an hour of meditation to your day isn’t going to help if that time commitment is an added stress. We work together to start a plan that feels sustainable and approachable to you and we build from there.
Curious about how we can help support you? I welcome you to book a meet & greet appointment!