Cortisol is a hormone produced by the adrenal glands, which are located on top of the kidneys. It is normally released in response to events and circumstances such as waking up in the morning, exercising, and acute stress.
In the Dutch test there are 4 individual free cortisol readings that were measured at different times throughout one day:
- Cortisol A (Waking)
- Cortisol B (Morning)
- Cortisol C (Afternoon)
- Cortisol D (Night)
If you add those 4 free cortisol values together you get your 24hr Free Cortisol marker that is listed separately in your test report. Free cortisol results tell us how much cortisol is free to bind to receptors and allows for assessment of the circadian rhythm.
Cortisol levels naturally rise and fall throughout the day. They are usually highest in the morning and lowest around midnight, but there are also variations that depend on the person.
The 2nd free cortisol marker is called “Cortisol B (Morning)”. This marker is intended to represent the first cortisol level after waking.
It is really important to look at all 4 of these markers together and look at the free cortisol pattern throughout your day.
If all 4 levels are elevated you might have something called Cushing’s syndrome. Look at your 24hr Free Cortisol and Metabolized Cortisol levels to confirm this as they should also be elevated.
When you are looking at Cortisol B (Morning) it is essential to also look at Cortisol A (Waking). The difference between those 2 cortisol samples is called the cortisol awakening response (or CAR). An elevated CAR would mean that the difference between those 2 markers is really big. This can be a result of an overactive HPA axis, ongoing job-related stress (anticipatory stress for the day), glycemic dysregulation, pain (i.e. waking with painful joints or a migraine), and general depression (not SAD). Neither the waking nor post-waking cortisol results correlated to Major Depressive Disorder, but the CAR calculation (the change between the first two samples) does. So this means that if your morning free cortisol reading spikes up high first thing in the morning, there is something to look at. Is there an overactivity to stress? Are you anticipating a stressful day at work?
A low or blunted Cortisol Awakening Response can be a result of an underactive HPA axis, excessive psychological burnout, seasonal affective disorder (SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue and/or chronic pain. A decreased CAR has also been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases.
The Cortisol B (Morning) levels should spike (within the optimal ranges) and then gradually go down throughout the day.
Low levels of Cortisol B (Morning) alone do not give us enough insight into what the larger picture is looking like. You have to look at the other cortisol markers as well.
Here are a few different possible scenarios:
If your free cortisol levels throughout the day (Waking + Morning + Afternoon + Night) are all low, then it might be caused by an insufficient production of cortisol in the adrenal glands.
A low level of cortisol may indicate Addison’s disease, a disorder in which the adrenal glands do not produce sufficient steroid hormones.
Symptoms include: weight loss, fatigue, low blood pressure, abdominal pain, dark patches of skin.
You may also have hypopituitarism, which occurs when cortisol production by the adrenal glands is low because the pituitary gland is not sending proper signals.
If your Cortisol B (Morning) is low, but the other cortisol markers are in the normal ranges, you most likely have a flat Cortisol Awakening Response (CAR).
This can be a result of an under-active HPA axis, excessive psychological burnout, seasonal affective disorder (SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue and/or chronic pain. A decreased CAR has also been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases.
If your Cortisol B (Morning) is high, you have an elevated Cortisol Awakening Response (CAR). This can be a result of an overactive HPA axis (=stress response axis), ongoing job-related stress (anticipatory stress for the day), glucose dysregulation, pain (i.e. waking with painful joints or a migraine), and general depression (not "winter depression"). Neither the waking nor post-waking cortisol results correlated to Major Depressive Disorder, but the CAR calculation (the change between the first two samples) did.
It is really important to look at all four of these markers together (Waking + Morning + Afternoon + Night) and look at the free cortisol pattern throughout your day.
If all four levels are elevated you might have something called Cushing’s syndrome. Look at your 24hr Free Cortisol and Metabolized Cortisol levels to confirm this as they should also be elevated.
If your 24hr Free Cortisol and Metabolized Cortisol levels are also high:
High overall cortisol concentrations are typical of Cushing’s syndrome, but can also occur in severe depression and alcoholism and when cortisol or ACTH are given therapeutically. Some possible reasons:
a tumor of the adrenal gland
Pituitary gland issues (overactive gland / benign pituitary tumors, including adenomas / cancerous pituitary tumors)
the ingestion of substances that raise cortisol levels, such as alcohol or caffeine
Medication side effects
Elevated estrogen (estrogen therapy / pregnancy)
Why is too much cortisol a bad thing?
When chronically elevated, cortisol can have deleterious effects on weight, immune function, and chronic disease risk.
- Cardiovascular Disease. Cortisol constricts blood vessels and increases blood pressure to enhance the delivery of oxygenated blood. This is advantageous for fight-or-flight situations but not perpetually. Over time, such arterial constriction and high blood pressure can lead to vessel damage and plaque buildup—the perfect scenario for a heart attack.
- High glucose levels. Under stressful conditions, cortisol provides the body with glucose by tapping into protein stores via gluconeogenesis in the liver. This energy can help an individual fight or flee a stressor. However, elevated cortisol over the long term consistently produces glucose, leading to increased blood sugar levels.
- Weight gain. As your cells are crying out for energy, your body may send signals to the brain that you are hungry and need to eat. Studies have demonstrated a direct association between cortisol levels and calorie intake in populations of women. False hunger signals can lead you to crave high-calorie foods, overeat and thus gain weight. Unused glucose in the blood is eventually stored as body fat.
- Suppressed immune system. Cortisol’s positive action to reduce inflammation in the body can turn against you if your levels are too high for too long. The elevated levels may actually suppress your immune system. You could be more susceptible to colds and contagious illnesses. Your risk of cancer and autoimmune diseases increases and you may develop food allergies.
- Digestive problems. When your body reacts to a threat, it shuts down other less critical functions, such as digestion. If the high-stress level is constant, your digestive tract can’t digest or absorb food well. It’s no coincidence that ulcers occur during stressful times and people with colitis or irritable bowel syndrome report better symptom control when they get their stress under control.
- Fertility problems. Elevated cortisol relating to prolonged stress can lend itself to erectile dysfunction or the disruption of normal ovulation and menstrual cycles. Furthermore, the androgenic sex hormones are produced in the same glands as cortisol and epinephrine, so excess cortisol production may hamper optimal production of these sex hormones.
Potential ways to lower cortisol:
It's really important to first understand what the root cause for elevated cortisol is. Is it stress related? Is it due to a gland issue? depression? medication? Please talk to your health practitioner to get to the root cause and then address that root cause.
If you suspect that stress might be the root cause, be aware of your own stress levels and take steps to manage your stress.
Simple practices such as getting enough sleep, exercising, meditating, deep breathing techniques and a whole foods diet that decreases inflammation are first good steps.
Sleep is critical to the body as important healing and restoration to all cells happens during this time. Those who achieve less than the recommended 6-9 hours each night may experience fatigue, brain fog, lack of motivation, weight gain, trouble concentrating, mood swings, increased illness or inability to properly fight illness, and more.
Treatments are focused on addressing the cause but may also include cortisol calming agents if warranted such as L-theanine, Skullcap, Holy basil, Chamomile, and Magnesium before bed. Avoiding electronics, physical activity, sugar, and alcohol at night may help with sleep.
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