What is Cortisol?

Cortisol is a steroid hormone that is released by trusty adrenal glands ( a pair of endocrine glands that sit on top of our kidneys). It is otherwise commonly known as the stress hormone. 

Cortisol is released into the bloodstream and delivered to our muscles, organs and tissues. 

Cortisol often has a negative connotation to it, deemed as a ‘bad’ hormone, associated with weight gain, stress, inflammation etc. 

However, contrary to popular belief, cortisol is very much needed by our bodies! Without it, we cannot survive and carry out our daily activities. 

It is only when too much / too little cortisol is produced that it becomes an issue. 

Cortisol’s Role in our Bodies

• It regulates our body’s response to both internal and external stress (fight or flight mode)
• Reduces inflammation: 
• Regulates our blood sugar levels: An increase in cortisol levels will stimulate the release of glucose, raising our blood sugar levels – extra energy. 
• Regulates our blood pressure: Raised cortisol levels will increase blood pressure levels. 
• Controls your sleep-wake / circadian rhythm: Cortisol levels are low in the evening before sleeping and peak right before waking. 
• Regulates our immune system, keeping us healthy and happy

Stress can be 

1. Acute: ie a car coming towards you while crossing the road, a situation of sudden danger. 
2. Chronic: A taxing job, anxiety, stressful and frustrating situations ie family conflict, financial situation, heartbreak etc 
3. Traumatic: a life-threatening event that can induce fear and a sense of helplessness

Permanently Elevated Cortisol Levels 

Causes

1. Long-term use of glucocorticoids or corticosteroids. These medications are used to treat arthritis, asthma and some forms of cancer.
   1. Prednisone, Cortisone, Dexamethasone, Methylprednisolone. 
   2. Do consult your doctor if you notice side effects after taking these medications. Never stop taking your medications without first talking to your doctor! 

2. Medical condition- Cushing’s Syndrome 

• This can be due to: long-term use of glucocorticoids, or the body producing too much cortisol
• You may have Cushing’s Syndrome if you notice
  • Buffalo hump below your neck
  • Moon shaped face
  • Purple striae/stretch marks around your abdomen/belly
  • You bruise easily
  • Your wounds take a longer time to heal 
  • Have a large abdomen and thin limbs (lemon-on-stick appearance)

Important to seek treatment or visit your doctor if you notice any of these symptoms. 

People with Cushing’s Syndrome have a risk of developing Type 2 Diabetes Mellitus, osteoporosis (reduced bone density) and high blood pressure.

3. Chronic stress
4. Obesity
5. Cancer of the pituitary gland or adrenal gland

Signs of Permanently Raised Cortisol Levels

1. Weight gain, namely at the face and belly 
2. Acne
3. Fatigue 
4. Thinning of skin
5. Bruising easily
6. Slow healing wounds
7. Muscle weakness
8. High blood pressure
9. Poor concentration/ Brain fog 
10. Headache 
11. Getting irritated easily 
12. Getting sick easily 

Side Effects of Permanently Elevated Cortisol Levels 

1. Weight gain 
2. Heart diseases
3. Atherosclerosis (hardening of the blood arteries)
4. Immune suppression 
5. Osteoporosis 
6. Insulin resistance (Type 2 Diabetes mellitus) 
7. Psychiatric disorders – anxiety, depression

How Does Cortisol Cause Weight Gain?

Raised cortisol levels will increase appetite, and cause us to overeat. 

Testing Cortisol Levels 

Your doctor may run some tests to check your cortisol levels. 

• Saliva cortisol levels: your doctor may measure late-night salivary cortisol 
• Blood cortisol levels: your doctor may check for your blood cortisol levels early in the morning
• 24-hour urinary free cortisol test: 24-hour urinary free cortisol excretion test
• Imaging: CT/ MRI scans of the pituitary and adrenal glands for any tumours. 

What Can I Do to Reduce Cortisol Levels Naturally?

• Have a fixed sleep schedule

1. Good sleep hygiene – aim for 7-8 hours of sleep a night
2. Avoid caffeine after 3 pm
3. Put your phone/electronic gadgets away 1 hour before sleeping
4. Conducive environment to sleep – dim lights, optimum temperature 

• Sweat it out regularly!

1. Exercising works wonders for your body. 
2. Reduces the risk of developing chronic diseases ie T2DM, high blood pressure, and high cholesterol 
3. A great mood booster, and stress reliever (due to endorphins released)
4. Strength training – strengthens your bones and muscles 
5. HIIT/ cardio boosts your endurance
6. Improves overall health
7. The Ministry of Health recommends 150 minutes of moderately intense exercise a week. 

• Nourish Your Body

1. A nutritious diet will help reduce cortisol levels 
2. A diet high in added sugar, refined grains, and saturated fat can raise cortisol levels 
3. Opt for a diet with whole grains, rich in fibre (fruits and vegetables) and lean protein. 
4. Dark chocolate (contains flavonoids which have antioxidant properties – reduce your risk of a heart attack or stroke)
5. Polyphenol-rich foods – extremely beneficial in lowering blood pressure, and blood sugar levels and improving heart health
   1. Green tea, berries, coffee, olives 
6. Probiotics and prebiotics – yoghurt, kombucha, kimchi. Improve gut health by increasing gut diversity, which is linked to improved mental health 
7. Magnesium-rich foods – stress has been linked to a greater loss of magnesium. Low magnesium has also been thought to increase one’s risk of stress. Avocados, dark chocolate, bananas, pumpkin seeds. 

• Practise mindful eating

1. Beyond a nutritious diet, mindful eating prevents overeating/ eating too fast. 
2. It encourages you to be aware of your hunger and fullness cues. 
3. A helpful tip: put away your phones at the dinner table and be fully immersed in conversations!

• Relax!

Our society is more stressed than ever. Bustling life, worries at work, family, relationships, financial stressors etc. 

Learn to cultivate and adopt helpful ways to combat stress and reduce cortisol levels. 

• Meditate
  1. Meditation helps you become aware of your body’s sensations, and calm your mind.
  2. Begin your day or end your day with meditation 
• Breathing exercises
  1. Diaphragmatic breathing helps to stimulate the parasympathetic nervous system (rest and digest system). 
  2. When you feel overwhelmed or stressed, take a few minutes to breathe deeply through your belly. Exhale and inhale as slowly as possible. 
  3. Some YouTube videos and smartwatches have a function to guide you. 
• Grounding/ Mindfulness practice
  1. Improves anxiety, stress and depression
• Therapy
  1. Process your thoughts with a professional 
  2. Reframe mindset and adopt healthier behaviours in combating stress

5. Cultivate strong and healthy friendships

1. No man is an island. We are built for deep and meaningful connections. 
2. Happy and healthy relationships can reduce cortisol levels. Having solid social support can help you weather the storms in life and combat stress.
3. WHO has declared loneliness has become a health crisis – as bad as smoking up to 15 cigarettes a day!

6. Let go, live and laugh!

1. Having an optimistic outlook towards life is key to overcoming stress. Not sweating the small things, being grateful and present. 
2. Laughing releases endorphins which lowers cortisol levels!
3. Better mood reduces blood pressure and even strengthens your immune system! 

However, if you have a medical condition, your doctor may prescribe you medications or suggest surgery depending on the cause. 

It is important to seek medical advice and not self-diagnose and treat!

References

1. Loneliness is a health crisis comparable to smoking up to 15 cigarettes a day. Here’s how to combat it https://fortune.com/well/2023/06/15/loneliness-comparable-to-smoking-up-to-15-cigarettes-a-day/#:~:text=Loneliness%20is%20a%20health%20crisis,to%2015%20cigarettes%20a%20day. [Last accessed 08 August 2024]
2. Lower Cortisol With Foods, Lifestyle Changes, or Medication https://www.verywellhealth.com/how-to-lower-cortisol-7971460#toc-mindfulness-and-relaxation-techniques [Last accessed 08 August 2024]
3. 11 Natural Ways to Lower Your Cortisol Levels https://www.healthline.com/nutrition/ways-to-lower-cortisol [Last accessed 08 August 2024]
4.  Healthy Foods High in Polyphenols https://www.webmd.com/diet/foods-high-in-polyphenols#:~:text=Research%20shows%20polyphenols%20can%20help,risk%20factor%20for%20heart%20disease.&text=Polyphenols%20can%20reduce%20and%20help%20control%20your%20blood%20sugar%20levels. [Last accessed 08 August 2024]
5. What Are the Symptoms and Causes of High Cortisol Levels? https://www.healthline.com/health/high-cortisol-symptoms#causes [Last accessed 08 August 2024]
6. Cortisol https://my.clevelandclinic.org/health/articles/22187-cortisol [Last accessed 09 August 2024]
7. Cushing’s Syndrome https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310 [Last accessed 09 August 2024]
8. Does Cortisol Affect Weight Gain? https://www.healthline.com/nutrition/cortisol-and-weight-gain#tips  [Last accessed 09 August 2024]