Cortisol is a hormone produced by the adrenal glands that helps regulate metabolism, blood sugar, inflammation, blood pressure and sleep-wake cycles. When stress is chronic, cortisol can remain elevated or drop too low, leading to a range of physical and emotional problems.
At a Glance
- Elevated cortisol can cause sleep disruptions, anxiety, weight gain, and a weakened immune system.
- Low cortisol may lead to fatigue, dizziness, low blood pressure, and mood swings.
- Lifestyle changes-sleep, stress management, balanced diet, and moderate exercise-are the first line of defense.
Why it matters: Understanding cortisol’s signals can help you spot imbalance early and take steps to restore balance before serious health issues arise.
What Is Cortisol?
“Cortisol is a hormone produced by your adrenal glands in response to stress,” says Dr. Fady Hannah Shmouni, medical director at Eli Health. “When a stressful situation arises, cortisol can help your body prepare to respond by increasing energy, focus or alertness.” The hormone follows a natural rhythm: it spikes in the morning to help you wake up and dips at night to aid rest.
Dr. Mark Hyman, co-founder and CMO of Function Health, adds that cortisol is often called the body’s built-in alarm system and is part of the glucocorticoid family released through the hypothalamic-pituitary-adrenal (HPA) axis. “It’s most known for managing the body’s response to stress,” he explains.
Symptoms of an Imbalance
High Cortisol
Common signs include:
- Nighttime sleep disturbances
- Energy dips from blood-sugar spikes
- Constant fatigue
- Anxiety and irritability
- Frequent illnesses
- High blood pressure
- Weight gain, especially in the midsection and face (“moon face”)
“Elevated cortisol can disrupt sleep, increase inflammation or impair memory,” notes Dr. Shmouni. “Over time, it can lead to cardiovascular disease, insulin resistance and cognitive decline,” says Dr. Hyman.
Low Cortisol
Typical symptoms are:
- Cravings for salt or sugar
- Dizziness upon standing
- Fatigue that doesn’t improve with rest
- Low blood pressure
- Mood swings or depression
- Weight loss and muscle weakness
Dr. Shmouni warns that serious symptoms could signal adrenal insufficiency, such as Addison’s disease, which may also cause darkening of the skin.
Causes of Cortisol Imbalance
There is no single cause; it usually results from multiple stressors piling up:
- Chronic psychological stress (work, relationships, trauma)
- Poor sleep habits
- Blood-sugar imbalances
- Overtraining without recovery
- Inflammation and infections
- Nutrient deficiencies, especially B vitamins and magnesium
Medications also play a role. Long-term use of corticosteroids (e.g., prednisone) can shut down natural production, leading to low cortisol, while steroid inhalers may elevate it.
Certain medical conditions such as Cushing’s syndrome or Addison’s disease directly alter cortisol levels. “Cushing’s syndrome, caused by tumors or excessive steroid use, floods the body with cortisol,” explains Dr. Franklyn-Miller.
Lifestyle Factors That Influence Cortisol
| Factor | Effect on Cortisol |
|---|---|
| Sleep | Poor sleep spikes cortisol; adequate sleep lowers it |
| Exercise | Moderate activity balances cortisol; overtraining spikes it |
| Diet | High-sugar meals raise cortisol; balanced meals keep it steady |
| Caffeine | “Too much coffee can mimic stress, raising cortisol,” says Dr. Franklyn-Miller |
| Alcohol | Excessive drinking disrupts cortisol rhythm |
The American Heart Association recommends limiting alcohol to two drinks per day for men and one drink for women. A standard drink contains 14 grams of pure ethanol. For caffeine, the FDA suggests no more than 400 milligrams per day, or two to three 12-fluid-ounce cups of coffee. Men should not consume more than 9 teaspoons of added sugar daily; women should stay under six teaspoons.
How to Regulate Cortisol
- Prioritize Sunlight – 20 minutes after waking stimulates circadian cortisol release.
- Maintain Consistent Sleep – Aim for 7 to 9 hours per night, depending on age.
- Manage Stress – Mindfulness meditation, yoga, or diaphragmatic breathing calm the HPA axis.
- Exercise Wisely – 30 minutes of moderate activity most days; avoid overtraining.
- Eat Balanced Meals – Focus on whole foods, lean proteins, healthy fats, and omega-3s.
- Increase Fiber – Dr. Hyman recommends high-fiber foods to support adrenal health.
- Limit Caffeine After Noon – Reduces cortisol spikes later in the day.
Home wearables that track heart-rate variability, such as Whoop, Oura, or Apple Watch, can provide indirect clues; low HRV often correlates with cortisol dysregulation.
When to See a Doctor
If you experience:
- Significant changes in appetite, energy, mood, or sleep that interfere with daily life
- Persistent symptoms after a few months of lifestyle changes
- Long-term steroid use
Consult a healthcare provider. The gold standard for measuring cortisol is a lab test of blood, saliva, or urine. Symptoms that may warrant testing include chronic fatigue, brain fog, weight changes, mood swings, and sleep problems.
“If lifestyle changes don’t improve symptoms after a few months, or if you’re on long-term steroids, get checked,” says Dr. Franklyn-Miller.
Key Takeaways
- Cortisol imbalance can manifest as sleep issues, mood swings, weight changes, and immune problems.
- Causes include chronic stress, poor sleep, overtraining, nutrient deficiencies, and certain medications.
- Lifestyle adjustments-adequate sleep, balanced diet, moderate exercise, stress reduction, and limiting caffeine and alcohol-are effective first-line interventions.
- Persistent or severe symptoms should prompt medical evaluation and possible laboratory testing.
By paying attention to the body’s signals and making thoughtful changes, you can keep your stress hormone in healthy balance and protect long-term health.
