Cortisol Testing & Adrenal Health

Cortisol Testing & Adrenal Health

What are the adrenal glands?

Each of us has a pyramid-shaped adrenal gland that sits on top of each kidney. The adrenal glands are part of the neuroendocrine system – they are made up of the cortex (outer part) and medulla (inner part) – each of which produces its own hormones – the adrenal cortex produces steroid hormones, including cortisol, aldosterone, and DHEA, and the adrenal medulla produces catecholamines, including epinephrine and norepinephrine (AKA adrenaline.)

What does it mean to have high cortisol?


This blog will focus on cortisol, as it is the primary hormone released by the adrenal glands. It is notoriously referred to as the stress-hormone or the wear-and-tear hormone because it is catabolic (breaks down tissues) and involved in the stress response. Cortisol is classified as a glucocorticoid hormone (gluco- for glucose, corti- for cortex, and -oid for steroid). This means it increases blood sugar levels; it does this by breaking down muscle tissue to release amino acids that get converted into sugar by the liver.


It also increases fatty acids, blood pressure, and heart rate. All these functions give us the energy and alertness to carry out various functions and handle stressful situations. Cortisol is released at varying extents depending on the level of stimulus – from normal daily functioning to coping with emotions to running from a threat. It taps into our reserves to supply us with the fuel we need to respond to internal and external events. Note that stress comes in many forms; mental, emotional, physical, spiritual. 


What are the symptoms of high cortisol?


If cortisol is too high or remains high, you now understand why it may lead to chronically elevated blood sugar and blood pressure, putting us at risk of developing type II diabetes, hypertension and other heart and metabolic problems. Cortisol also assists the immune system in responding to infection and inflammation; it is part of our circadian rhythm that maintains our sleep and wake cycles; it promotes our sympathetic (fight or flight) system; and it is highly integrated with other hormones like sex and thyroid hormones. 


This means that if out of balance, cortisol can impair immunity, sleep, stress, hormones/menstrual cycles/fertility, and more. Cortisol in healthy levels has many positive effects and is required for survival as well as optimal functioning. Cortisol in unhealthy levels has many negative effects and may cause or contribute to a host of dysfunctions and diseases. 


It may be the reason you feel like your body is breaking down, gaining weight in all the wrong places, fluctuating from anxiety to depression, having trouble waking and crashing in energy, thinking unclearly and becoming overwhelmed, craving fat, sugar, and salt, becoming ill too often, lacking sexual desire, dependent on stimulants, experiencing brain fog, etc.



The production of hormones is directed by the hypothalamic-pituitary-adrenal axis, which is a cascade of hormone production from the brain to the adrenals, or more specifically from the hypothalamus to the pituitary to the adrenals. This hormone pathway naturally follows the circadian rhythm (24-hour internal clock). For normal functioning, it is important that communication between these organs is working properly.


With excessive stress, the adrenals release excessive amounts of cortisol and, over time, become blocked and release insufficient amounts of cortisol. There are many factors that can tax the HPA axis and alter cortisol levels, including chronic stress, over-exercise, artificial lighting, malnutrition, poor sleep, specific diseases, and certain medications (such as corticosteroids).

How do you test cortisol levels?


So, how do we know for sure that our cortisol levels are out of rhythm? We can test them! The best ways to test cortisol is by measuring levels in saliva at different points throughout the day – this is because cortisol production normally follows a diurnal rhythm (synchronized with the day and night cycle). In this way, we can see where your cortisol levels fall over the course of an entire day, which reflect how they fall on the other days as well. 


Normally, cortisol is highest when the sun rises and progressively decreases as the day goes on with lowest levels seen when the sun sets. However, modern-day living can throw off our internal hormonal rhythms, and therefore it is extremely common for cortisol levels to be out of alignment with its diurnal pattern. Let’s face it, most of us are over-worked and over-stressed, all the time.


Here is a brief explanation of common patterns of cortisol imbalance:

  • Chronically elevated cortisol (points high across the board) – this pattern is often a result of prolonged stress demands and is characterized by the feeling of being “wired and tired”
  • Elevated evening cortisol (points high in the evening) – this pattern is often a result of artificial lighting or short-term stressors and is characterized by difficulty falling asleep and/or staying asleep 
  • Chronically depressed cortisol (points low across the board) – this pattern is often a result of adrenal exhaustion and is characterized by feeling tired and burnt out throughout the day 


Note: there are several other patterns of dysregulated cortisol not included here.  

How do you balance cortisol levels?


As you can tell, keeping cortisol levels in check is a very important part of your health. The best way to do this is intentionally by living a healthy, balanced, low-stress lifestyle. The more we can maintain normal cortisol levels, the more able we are to conquer the [excessive] stresses of modern life without sacrificing our health. Remember, how we take care of ourselves on a daily basis will determine our health and quality of life in the long run. 


Stress is a major culprit of disease and disorder, which is why stress management is part of the foundations for health in naturopathic medicine. NDs understand the profound connection between our mental/emotional health and our physical health. Many times stress is unavoidable and there are difficult times in life that we must endure. However, there are always ways to support yourself as you move through these times and to lessen the amount of unnecessary stress in everyday life.  


We encourage you to visit a naturopathic doctor (ND) at LIVV to complete your cortisol test – they can interpret your results for you and offer an individualized plan with targeted treatments to get you back into normal rhythm. People with diagnosed or suspected adrenal diseases, such as Cushing’s disease or Addison’s disease, will need specific evaluation and treatment outside of the scope of this blog. 


Here are the top 7 tips for supporting adrenal health and cortisol levels:

  1. Maintain low stress levels
  2. Balance your blood sugar 
  3. Limit caffeine and stimulants
  4. Get quality sleep at night 
  5. Fill up in vitamin C and B vitamins
  6. Supplement with adaptogens
  7. LIVV IV’s (Energy, Immune, Anti-Inflammatory)


Talk to your ND about more details on each of these tips and how to implement them into your lifestyle!


Written by Jordan Valdez, RDN



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