If you are struggling with chronic health issues – the way I used to – you probably have piles of lab tests that can potentially tell you a lot about your health. Cortisol may be one of them. However, doctors never had enough time to explain it properly or connect the dots. Cortisol, for example, can impact your blood sugar, proteins, cholesterol, and inflammatory markers. Cortisol, when out of balance, may actually create a lot of health issues that at first seem unrelated.
What Increases and Decreases our Stress Response?
Since the stress response pathway is so critical to our health, it’s important to know what increases our stress response and what decreases it.
The problem comes when it’s activated too little, too much or it doesn’t have a good rhythm to it. In other words, HPA ‘dysregulation’ is bad.
This has nothing to do with the capacity or your adrenal glands themselves but is related to a bunch of other factors as you will see. (See the myth of adrenal fatigue).
The HPA axis also communicates with several regions of the brain, including the limbic system, which controls motivation and mood, with the amygdala, which generates fear in response to danger, and with the hippocampus, which plays an important part in memory formation as well as in mood and motivation. In addition, the HPA axis is also connected with brain regions that control body temperature, suppress appetite, and control pain .
Once activated, the stress response decreases growth, reproduction, metabolism, and immunity .
Most of these patients share psychological symptoms of too much HPA activation include sleep disturbances, loss of libido, and loss of appetite as well as physical problems such as an increased risk for accumulating abdominal fat [6, 7].
It’s a good idea to read my post on why stress is bad for a more detailed look.
Note that the HPA axis is not the only system that is part of the stress response. Your sympathetic nervous system (SNS) is a different arm of the stress response, and it can be slowed by beta 2-adrenoreceptor blockers like propranolol .
Psychological Stress and HPA Dysregulation
Stressors that are uncontrollable, threaten physical integrity or involve trauma tend to have a high, flat cortisol release, with lower-than-normal levels of cortisol in the morning and higher-than-normal levels in the evening. This results in a high overall level of daily cortisol release .
On the other hand, controllable stressors tend to produce higher-than-normal morning cortisol .
HPA Axis and Disease
People with too low or too high cortisol are at risk for various diseases, especially cognitive related.
Chronic stress response activation (HPA) is believed to be a causal factor of:
- Anxiety disorders (including anorexia , bulimia )
- Major depression  – A blunted ACTH response is common in depression
- Burnout, CFS , Fibromyalgia
- IBS 
- Bipolar 
- Insomnia 
- PTSD 
- Borderline personality 
- ADHD 
- Alcoholism and many other diseases .
- Rheumatoid arthritis  – There’s lower cortisol in RA, in some people.
Lack of the hormone CRH also results in the feelings of extreme tiredness common to people suffering from chronic fatigue syndrome. Lack of CRH is also central to seasonal affective disorder (SAD), the feelings of fatigue and depression that plague some patients during winter months.
Frequent insomnia is more than just having difficulty falling asleep. Researchers found that, when compared to a group of people who did not have difficulty falling asleep, the insomniacs had higher ACTH and cortisol levels, both in the evening and in the first half of the night. Moreover, the insomniacs with the highest cortisol levels tended to have the greatest difficulty in falling asleep .
Common diseases like diabetes are associated with too much HPA activation and high levels of CRH . People with Alzheimer’s have high levels of cortisol, but it’s believed to be a result and not a cause of the disease .
In PTSD, there’s a lower-than-normal cortisol release, and it is thought that a blunted hormonal response to stress may predispose a person to develop PTSD .
Circadian Rhythms and the HPA axis:
Many conditions such as Autism have a dysregulated cortisol rhythm .
Most breast and ovarian cancer patients have alterations in their cortisol rhythm .
Studies in humans and animal models have revealed that cancer development is closely associated with the loss of a circadian rhythm. This is because this rhythm controls energy balance, immune function, and other important functions – much of which is controlled by the HPA axis. These functions are involved in tumor suppression (including cell proliferation, apoptosis, and DNA damage response) .
This is why shift workers are at increased risk for so many chronic diseases .
Factors That Trigger Your Stress Response
Don’t be scared about everything that activates your stress pathway. It’s natural and healthy for it to be activated moderately.
Psychological/Social stress  Includes incomes insecurity and other occupational stress . Chronic stress increases CRH receptors in the PVN, which makes you even more susceptible to the harmful effects of stress . Everyone is affected differently by stress. In many conditions such as Autism psychological stress over-activates the stress response pathway and results in too much cortisol . In IBS, CRH causes significantly more ACTH when compared to people without IBS . So we see that with a given amount of HPA activation, some people are affected more.
The following will increase your stress response:
- Try to control an outcome
- Try to change yourself
- Try to exert your willpower
- Try to increase your motivation
- Do something you don’t want to
- Make goals
- Have ambitions or try to get somewhere
- Have a strong attachment – to an idea, object, person, etc.
- Think about the past or future
- Take life too seriously
- Feel fear
- Feel anxiety
- Feel anger
- Feel frustrated
- Feel guilt
- Feel jealousy
- Feel hate
- Feel embarrassed
- Feel rejected
Bad quality sleep 
Staying up late  – cortisol is increased when we are awake during our normal sleep times.
Circadian Disruption – see how to keep to a circadian rhythm.
Physical trauma/Injuries/Surgery 
Dietary: Eating (esp men)  – mostly caused by VIP , Lectins (subjective), Protein restriction/Leucine deprivation , Excess sodium , Severe calorie restriction , Excess omega-6 , Intermittent Fasting or regular Fasting  – Modern Ramadan practices in Saudi Arabia are associated with excess evening cortisol (and increased insulin resistance.) Other kinds of fasting might decrease CRH .
Gut permeability  – when your gut is permeable, bacteria/endotoxins are capable of passing through your gut lymph node, liver, and spleen, which causes inflammation.
Nutritional: Vitamin A inadequacy [56, 57], Zinc inadequacy , Magnesium inadequacy [59, 60, 59]. Chromium (in-vitro) decreases cortisol at high doses . Potassium loading  – increases ACTH and cortisol in humans. This is probably the reason why potassium deficiency causes cortisol to decline (as mentioned) and causes a decrease in the conversion of 11-deoxycortisol to cortisol. This may also have a role in rheumatoid arthritis pain; cell potassium is always low in RA .
Excess Alcohol consumption . Continuous consumption of alcohol over an extended period of time has been shown to raise cortisol levels in the body . Marijuana/Pot/THC  – dose-dependently raises cortisol. Opioid withdrawal .
Hormones: CCK [72, 73], NPY , Estrogen (alpha, beta – CRH) , Pregnenolone, DHEA, GLP-1 , Leptin , VIP (raises CRH) , Sex hormones , Thyroid hormones , Vasopressin (releases CRH  and ACTH ), Ghrelin , AngiotensinII/ACE [83, 84], Insulin , Substance P (CRHR1) [84, 85], Low estrogen and melatonin supplementation increase cortisol levels in postmenopausal women . MSH (prevents a fasting-induced decrease in CRH) . Insulin can cause the release of vasopressin, which stimulates ACTH/cortisol .
Neurotransmitters: Noradrenaline , Glutamate , Dopamine (D1/D2) (CRH in PVN)  – contradictory , Serotonin (specifically 5-HT2CRs): Serotonin increased CRH and its neuronal activity and CRH (and corticosterone release) [92, 93]. Acetylcholine . Chronic SSRI usage increases CRH, but decreases ACTH and therefore cortisol , but fluoxetine decreases CRH .
Drugs/Supplements/Devices: LLLT (probably) , Potassium Chloride , 5-HTP , Finasteride , Naloxone  – Aspirin augments , Rehmannia, Lj100, Resveratrol (cortisol) , Forskolin [101, 102], Luteolin/PDE4 inhibitors , Curcumin (in goldfish, but my experience does not support this) , Valproate/Depakote .
Sexual stimuli increase cortisol in some women, while it’s decreased in most women .
Factors That Counteract Your Stress Response
Meditation , Yoga , Being physically active (lowers cortisol in longer term) , Massage therapy , Regular dancing , Music therapy , Glucose restriction/fasting (careful) , Chewing (CRH) , ‘High Power Postures’ 
Supplements/Drugs: Oxytocin , Endorphins , Probiotics , Phosphatidylserine , Magnesium (decreases CRH, ACTH response to CRH, Cortisol response ACTH) [59, 60, 113, 59], Selenium , Lysine , Vitamin C , Fish Oil/DHA (CRH) [30, 115], Curcumin , Aromatherapy (orange) , Bile (maybe – CRH) , Black Cumin Seed Oil , Rhodiola/Salidroside (CRH, enhances GR) , NSAIDs , Methylcobalamin (ACTH, CRH?) , SAM-e/Hydrogen Sulfide (in response to stressor, CRH), NAC/Hydrogen Sulfide (in response to stressor, CRH) , P5P/Hydrogen Sulfide (in response to stressor, CRH) , Lipoic Acid (CRH) , St John’s , Fluoxetine , Imipramine 
Hormones: GHRH (in men, but not women) , NPY – antagonizes CRH, even though it increases its release (Y1 receptor, lateral septum)[128, 129], Growth Hormone? [51?], Prolactin? [51?], Progesterone (lowers CRH), Allopregnanolone (progesterone metabolite) , Testosterone  – In people, testosterone increases ACTH and lowers cortisol in response to CRH . In male animals, DHT reduces corticosterone response to stressors. So finasteride can increase the stress response by reducing DHT . Cortisol inhibits CRH but not neuronal excitation . a-MSH lessens the stimulatory effects of IL-1b on the HPA axis .
GABAergics supplements include Progesterone , Hi-Maize/Butyrate, Ketogenic diets, Honokiol , Theanine , Hops , Chinese Skullcap , Kava , Valerian , Ginkgo , Taurine (high dosage), Ashwagandha (weak), Bacopa (weak), Astragalus (weak), etc..
My favorite way to decrease the stress response is by putting a device called ICES on my head, which also decreases inflammation.
PEMF (higher AM, lower PM) – depends on device used , tDCS , TMS (CRH production and release) [141, 142], Electroacupuncture , Schisandra (Cortisol), Anti-depressants (‘regulate’) , Aspirin (ACTH/cortisol levels after awakening, increased WM) [146, 33], Nrf2 , Mucuna, CES, Uridine, Chayawanprash, Ursolic acid, Tribulus, Ginseng, Cordyceps, Ginkgo,
Adrenal glandular has cortisol and Licorice and Grapefruit Juice increase cortisol, which inhibits CRH, the first part of the stress response. So the effects are variable.
Separation of monkeys from their mother causes long-lasting changes in the HPA axis, resulting in lower cortisol levels overall and a lack of a circadian cortisol rhythm (all bad) .
Cortisol Circadian Rhythm
Here’s a simple way to think about the circadian rhythm. The body has thousands of processes going on at any given moment. Many of these processes function better in concert with other processes – just like in a symphony, where different sounds work better with other sounds.
These processes have a certain rhythm or flow. The body conducts this orchestra with ‘clock genes’. When they get expressed, it happens all over the body, in a synchronous way.
Since our HPA axis (includes CRH, ACTH, Cortisol) is involved in so many bodily functions, it’s important that it has a good rhythm to it.
In humans, cortisol levels peak in the early morning (approximately 8 a.m.) and reach their lowest level at about midnight-4 a.m., or three to five hours after the onset of sleep. Information about the light/dark cycle is transmitted from the retina to the suprachiasmatic nuclei in the hypothalamus .
While people differ in their cortisol rhythms, a given person tends to have consistent rhythms .
It’s also important to realize that the ratio of cortisol to DHEA has various effects.
Prenatal/Childhood Stress and the HPA Axis
Stress Before Birth
There is evidence that prenatal stress can influence HPA regulation.
In animal experiments, exposure to prenatal stress has been shown to cause a hyper-reactive HPA stress response .
Rats that have been prenatally stressed have elevated baseline levels and abnormal circadian rhythm of corticosterone as adults .
Additionally, they require a longer time for their stress hormone levels to return to baseline following exposure to both acute and prolonged stressors .
In humans, prolonged maternal stress during gestation is associated with mild impairment of intellectual activity and language development in their children, and with behavior disorders such as attention deficits, schizophrenia, anxiety, and depression; self-reported maternal stress is associated with higher irritability, emotional and attentional problems .
Prenatal stress has also been implicated in a tendency toward depression and short attention span in childhood .
Exposure to mild or moderate stressors early in life has been shown to enhance HPA regulation and promote a lifelong resilience to stress. In contrast, early-life exposure to extreme or prolonged stress can induce a hyper-reactive HPA Axis and may contribute to lifelong vulnerability to stress .
Mothering may enhance HPA functioning in at least two ways.
First, maternal care is crucial in maintaining normal stress in a period where the HPA doesn’t activate much in childhood. The extreme stress of maternal separation may lead to permanent HPA dysregulation .
Second, increased maternal handling (hugging, kissing) has been shown to alter the expression of the glucocorticoid receptor gene implicated in adaptive stress response (in animals) .
Adult victims of childhood abuse show increased ACTH concentrations in response to CRH/stress, compared to healthy controls and people with depression but not childhood abuse .
Early life stress causes heightened neuronal activity in response to stress-induced CRH release. With repeated exposure to stress, you’ll continue to hyper-secrete CRH. Over time, CRH receptors in the anterior pituitary will become down-regulated, producing depression and anxiety symptoms .
- Higher levels of BDNF (See BDNF genes) increases the stress response by increasing CRH.
- Low levels of COMT (see COMT genes) increases the stress response by increasing dopamine.
- Lower levels of MAOA (see MAOA genes) can increase the stress response by increasing some catecholamines like noradrenaline, adrenaline, and dopamine.
- Having certain Oxytocin genes can counteract the stress response.
Irregular Cortisol Levels?
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