Chronic stress doesn't just feel exhausting - it can physically change your hormones. Understanding cortisol can help explain why you feel wired but tired.
The Stress Response
Cortisol is your primary stress hormone. In acute stress, it can spike to help you respond. But chronic stress can keep cortisol elevated, which may eventually deplete your reserves.
The Cortisol Curve
Healthy cortisol can follow a daily rhythm:
- Morning: Highest (can help you wake up)
- Midday: Gradual decline
- Evening: Lowest (can allow sleep)
Chronic stress can disrupt this pattern.
Symptoms Cortisol Dysfunction Can Cause
High Cortisol
- Anxiety and racing thoughts
- Weight gain (especially belly)
- Difficulty sleeping
- High blood pressure
- Sugar cravings
Low Cortisol (Adrenal Fatigue)
- Difficulty waking up
- Afternoon energy crashes
- Need caffeine to function
- Salt cravings
- Low blood pressure
Testing Cortisol
Morning Blood Cortisol
Should be tested before 9am. Normal may be 10-20 mcg/dL.
4-Point Salivary Cortisol
Tests cortisol at multiple times to assess the daily rhythm. EllaDx doesn't offer salivary cortisol testing. You can order morning cortisol as a blood test, drawn at Quest.
DHEA-S
Often tested alongside cortisol as another adrenal marker.
Beyond Testing
While tests provide data, your symptoms matter too. Many people with "normal" cortisol can still experience stress-related health issues.
References
- Chrousos, G. P. (2009). Stress and disorders of the stress system. Nature Reviews Endocrinology, 5(7), 374-381. PMID 19488073
- McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171-179. PMID 9428819
- Nicolaides, N. C., et al. (2015). Stress, the stress system and the role of glucocorticoids. Neuroimmunomodulation, 22(1-2), 6-19. PMID 25227402
