Understanding Suboptimal Cortisol

In modern culture, we are sadly all too familiar with chronic stress and the insidious symptoms of high cortisol: abdominal weight gain, insomnia, mood swings, headaches, high blood pressure and increased appetite. Stress was already a way of life long before the COVID-19 pandemic came along, completely flipping daily living upside down. According to the American Psychological Association, 78% of adults reported a significant increase in their stress levels 2020 onward. When you consider how chronic stress destroys a body, this number is even more frightening. 

Identifying and treating high cortisol early on is essential. It can prevent extended periods of sleep deprivation and secondary metabolic changes. So what happens when the period of high cortisol has passed, and you are still tired, gaining weight and anxious? This is often what we see by the time a patient comes in worried about high cortisol. The typical interventions don’t work, because the hormone imbalance has shifted. But don’t worry, it’s not too late to feel better. 

Why Does Cortisol “Crash?”

Causes of severe adrenal insufficiency like Addison’s Disease require immediate medical intervention with replacement adrenal hormone therapy. Addison’s is an autoimmune disease wherein your immune system attacks the adrenal glands, causing irreversible damage. Without the hormones, you can die. 

For patients with functional glands, but suboptimal cortisol production, the symptoms are very similar to the early stages of Addison’s Disease, but conventional medicine has little to offer. This is commonly referred to as “adrenal fatigue,” and usually arises after extended periods of high stress. Cortisol was likely high in the beginning, but over time nutritional deficiencies and constant demand on the glands caught up. 

Signs & Symptoms of Suboptimal Cortisol

It’s easy to mistake suboptimal cortisol symptoms for high cortisol, especially when they both impact mood, energy and metabolism. Even if you suspect high cortisol, you should talk to your physician about blood, urine or salivary testing to see where your levels fall.

Here are common signs & symptoms of suboptimal cortisol:

  • All day fatigue, decreased alertness or brain fog
  • Muscle weakness & decreased exercise endurance 
  • Lightheadedness, low blood pressure & salt cravings
  • Low blood sugar & appetite changes
  • Depression, anxiety & decreased stress tolerance 
  • Muscle aches & irritable bowel symptoms 

What Can Be Done?

With the right combination of lifestyle changes, nutritional and herbal support, the adrenals can recover. Suboptimal adrenal function is complex and usually requires an individualized treatment plan, but there are several interventions most will benefit from:

  • Lifestyle Changes: Avoiding intense exercise, stressful events (when possible), sleep schedule changes, and fasting are important when stress hormone production is below optimal. The adrenals simply can’t produce what you need, and keeping demand high limits their ability to reset and replenish their necessary nutrients like pantothenic acid.
  • Salt Supplementation: Adrenal hormones tell you body to hold onto salt, thereby keeping blood volume up. When your hormones drop down, so does your salt retention, blood volume and energy. Supplementing high quality salt (usually more than you find in a typical electrolyte powder) can help you to feel more “normal” while you recover. 
  • Adaptogens: Adaptogenic plant extracts provide a gentle intervention that can help to correct imbalances rather than shift hormonal production specifically one way or the other. Adrenal adaptogens are often used in both high and suboptimal cortisol production. Popular options include Ashwagandha, Maca root and Rhodiola. 
  • Targeted Nutrient Support: Nutritional deficiencies can directly inhibit your body’s ability to produce proper levels of cortisol and other stress hormones. In order to make their hormones, your adrenal glands need very specific nutrients. These include vitamin C, B-vitamins, magnesium, and more. 

If you are starting treatment for suboptimal cortisol levels, just remember, they are constantly working and it likely took many years to get to this point. Recovery is going to take time and a varied approach.