Stress (Cortisol) Test

Most of us know that cortisol is the primary stress hormone in our bodies that’s released when we experience moments of anxiety, fear, or other stressful events. While cortisol is often viewed as a stress hormone that contributes to weight gain, skin conditions, and other adverse symptoms, cortisol is an essential stress hormone that influences our body’s ability to metabolise glucose, control blood pressure, regulate inflammation, and respond to danger.

Cortisol is one of several steroid hormones that are produced by the adrenal glands, which are regulated by the pituitary gland. When released into the bloodstream, cortisol can influence many parts of the body, such as the liver, pancreas, muscle tissues, and insulin production, Cortisol is a necessary component to the fight or flight response – which is a natural reaction to perceived threats – but it’s also released in stressful situations that are less threatening.

Although it’s become trendy to discuss the health issues and prevalence of having high cortisol, the body can experience problems when cortisol levels are too low as well. Having the right balance of cortisol hormone is essential for optimal health, which is why testing your cortisol levels can be an important measure to know exactly where your body stands and what, if any, action you should take to better balance this important stress hormone.

Prolonged, chronic stress is one cause of cortisol imbalance. However, abnormally high cortisol levels can also manifest after traumatic events, such as in individuals who are experiencing post-traumatic stress disorder (PTSD)¹. Whether prolonged over an extended period or in the wake of a traumatic experience, the root cause of a cortisol imbalance can be stress.

Everyone encounters stressful events from time to time, and some individuals experience stress more frequently and intensely than others. But no matter how common you perceive stress signals like tension, trauma, pressure, and distress, it can reach a point when excess stress turns into a cortisol imbalance issue.

Not all cases of cortisol imbalance are the result of having too much of the stress hormone. Low cortisol levels can also cause an imbalance, which is often more deeply rooted in adrenal health problems. Chronically low cortisol levels (clinically referred to as “hypocortisolism”) are most commonly a form of adrenal insufficiency, which can occur at different degrees of severity. One cause  is primary adrenal insufficiency (or Addison’s disease), which is an autoimmune response where the immune system attacks the adrenal glands, thereby impairing their ability to produce sufficient levels of cortisol. Stress burnout is another cause of adrenal insufficiency that needs to be checked for.

One of the most commonly sought solutions to help influence cortisol imbalance and regulate levels is diet. Although diet and nutrition are just one factor among many natural ways to regulate cortisol (e.g. sleep, exercise, relationships, stress management, etc.), there is substantial science that supports certain dietary approaches to help control cortisol, including:

– Eating a diet high in refined carbohydrates, sugar, and saturated fat can lead to significantly higher cortisol levels compared with eating a diet high in fruits, vegetables, whole grains, and polyunsaturated fats.²

– Studies have shown a strong relationship between mental health and healthy gut bacteria.³ Consuming foods that help maintain a healthy gut microbiome – as well as supplementing with probiotics and prebiotics – can help reduce stress, anxiety, and support overall mental health.

– A diet high in healthy, unsaturated fats is linked to improved overall health and mental wellness. Omega-3 fatty acids, in particular, are the most potent types of fats linked with optimal brain health and reduced stress. A notable study indicated that those with high omega-3 levels were linked to having lower inflammation and cortisol levels.⁴

– Mild dehydration has been associated with heightened cortisol levels. Making sure to drink plenty of water throughout the day is a good habit.

These are just a few dietary considerations to help manage cortisol levels. Below we discuss more specific foods and supplements that can help in regulating high and low cortisol.

While diet is just one part of the stress management equation, there are several potential cortisol-lowering foods that are worth adopting into one’s diet.

– High vitamin C foods like citrus fruits, bell peppers, tomatoes, strawberries, and white potatoes.

– Potassium-rich foods like sweet potatoes, legumes, bananas, melons, squash, avocados, spinach, broccoli, and dried fruit can help

– Green tea, which contains polyphenols, has been postulated to regulate cortisol-producing enzymes.⁵ For someone with high cortisol, green tea might be helpful in reducing levels.

– Fermented foods like sauerkraut and kimchi contain probiotics that naturally occur in the human digestive tract.

– Dark chocolate, specifically types rich in polyphenols, has been shown, in a small study, to reduce cortisol levels⁶.

Stress reduction and lowering cortisol levels go hand in hand. So many foods that have “calming” properties are also potentially good for regulating cortisol levels.

There are certain types of food that may exacerbate stress and elevate cortisol levels. Below are some of the most common foods to avoid so that you’re better able to minimize increased cortisol.

– Refined sugar may contribute to raising cortisol levels. Any form of sugar can quickly elevate blood sugar levels, only to plummet shortly after. it’s important to keep sugar consumption in check.

– Trans fats are associated with a variety of diseases and it’s widely recommended to avoid trans fats in all forms.

– Alcohol, while not technically a food in the nutritional sense, is a toxin that the liver cannot break down. In turn, this creates internal stress that can raise cortisol.

– Refined grains should be replaced with 100% whole grain. It’s best to consume these foods mindfully.

– Caffeine consumption can still be enjoyed at healthy cortisol levels, however, individuals who are prone to high-stress lifestyles can benefit from minimizing caffeine. Low tolerance caffeine users may experience jumps in cortisol that linger throughout the day.

– Saturated fats from animal-based sources, such as meta, whole milk, eggs, and butter, can have the same effect on cortisol levels as trans fats. Whenever possible, consume lean options of fish, poultry, and plant-based fat alternatives, like coconut oil and olive oil.

Learning to avoid cortisol trigger foods can not only have a positive effect on your stress levels, but may also help in reducing other emotional and hormonal issues that have been associated with anxiety, depression, and obsessive-compulsive tendencies.

Testing cortisol levels is important to gauge adrenocortical function, which can have numerous health implications, especially in individuals who are susceptible to stress. Determining abnormal cortisol levels is essential in the diagnosis of Cushing’s syndrome and Addison’s disease, hypopituitarism and adrenal hyperplasia, and carcinoma.

Cortisol is usually at its highest early in the morning and at its lowest near the midnight hour. Normal cortisol levels can vary depending on the type of test, the individual, and when the test is taken. It’s generally recommended to test cortisol levels in the morning.

Elevated cortisol levels can occur as a result of a number of factors, ranging from emotional and psychological (e.g. stress) to physical and biological triggers, including:

– Stress response in the body, either caused by physical or emotional stressors, can cause cortisol levels to increase. This response can be triggered from many occurrences, such as trying to meet a tight work deadline or catching a cold or illness.

– Malnutrition, such as consuming an unhealthy diet filled with animal-based fats, refined sugar, and alcohol, can contribute to elevated cortisol. Similar, certain eating disorders can result in cortisol imbalances.

– Pituitary gland problems, for example an overactive pituitary gland or pituitary tumour, may stimulate your adrenal glands and result in too much cortisol production.

– Medications like corticosteroids used to treat asthma, arthritis, certain cancers can, mimic cortisol as they are similar in structure and action.

– Adrenal gland tumours can disrupt normal cortisol production, thereby causing either too much or too little. Most often, such tumours can contribute to high cortisol levels.

There are also several different conditions that can influence increased cortisol, such as depression and psychological disorders, diabetes, and alcoholism.

Just as high cortisol can be the result of many different factors, the symptoms can be equally vast. Some of the most commonly reported symptoms of high stress are:

– Low sex drive or low libido

– Insomnia or inability to fall asleep

– Irritable Bowel Syndrome (IBS) and ulcers of the stomach

– Frequent colds, illness, and immune system issues

– Excess belly fat and prone to weight gain

– Menstrual cycle imbalance in women

– Testosterone imbalance in men

– No symptoms at all

If you’re feeling one or more of these symptoms, or it may be that you don’t have any symptoms but are still worried about what might be happening in your body, then you may want to have your cortisol levels checked for high values.

Although high cortisol is more widely discussed, experiencing low cortisol levels is equally concerning for one’s health. One cause of reduced cortisol may occur when there are issues with the pituitary gland preventing its ability to produce enough adrenocorticotropic hormone (ACTH). Addison’s disease can develop when your adrenal glands are damaged, reducing the levels of hormones it produces. Stress burnout can cause adrenal insufficiency and low levels of cortisol.

Symptoms of low cortisol levels can develop slowly, oftentimes taking several weeks to several months to notice changes. Some of the most common symptoms and reporting feelings of below-average cortisol include:

– Chronic fatigue

– Decreased appetite and weight loss

– Hypoglycemia or low blood sugar levels

– Muscle soreness, joint pain, and abdominal pain

– Gastrointestinal distress, including nausea, diarrhea, or vomiting

– Low blood pressure

– Depression, irritability, and behavioral symptoms

Low cortisol symptoms can be very subtle at first and progressively get worse over time. If you start to feel one or more of these symptoms, it’s important to catch problems related to disrupted pituitary glands and adrenal glands as soon as possible.

Proper testing is the best way to measure cortisol levels and pinpoint whether there’s a deficiency or excess of hormones present. While cortisol testing can be done with blood, urine, or saliva tests, a blood cortisol test is the most common and accurate method. Conducted in a laboratory setting or with a simple finger-prick blood sample taken at home using a blood collection kit, a blood sample (best when taken in the resting morning hours of the day) can help you determine if your cortisol levels fall in the normal range. Urine tests are not helpful unless you collect your urine for 24 hours and then test a sample of the whole collection. This isn’t very practical, and a blood test is much more useful to determine what your cortisol level is.

A cortisol test is conducted to accurately measure an individual’s levels of cortisol hormone. There are several different types of cortisol test. The most accurate and popular type is a cortisol blood test, which can effectively measure cortisol levels and determine whether they’re high, low, or at a normal value.

A cortisol test can help pinpoint problems associated with both the pituitary gland and adrenal glands. While cortisol is produced by the adrenal glands, the root cause of elevated or reduced cortisol levels may sometimes be attributed to the pituitary gland, which releases adrenocorticotropic hormone (ACTH), an essential hormone that’s responsible for stimulating cortisol production in the adrenal gland.

The timing of the cortisol test is critically important because of the way cortisol levels vary throughout the day. In most cases, it’s recommended to do a cortisol blood test in the morning hours. Your morning cortisol level is the best indication of whether or not you have a normal cortisol level. Morning cortisol levels are typically the highest point in the day, and then fall over the course of the day.

There are some at home cortisol tests that allow you to measure your cortisol levels from the comfort of your home. When using an at-home cortisol test kit, it’s recommended to choose a cortisol blood sample via finger prick over a cortisol saliva test or urine test. Cortisol blood tests are the most accurate and can provide a reliable measurement of your levels, and are always advised over a cortisol saliva test. YorkTest offers a simple finger prick at home cortisol blood test sample test to measure cortisol levels and results are provided in an easy-to-review report within 7 days. Our results will provide detailed guidance on your results to show if you have normal cortisol levels, and advice going forward.

Our at home cortisol test can indicate whether an individual has elevated or low levels of cortisol hormone, which may point to an adrenal or pituitary gland disorder. Usually taken in the morning hours, a cortisol test will show whether or not levels fall between the normal values set by the laboratory that is used. However, results from cortisol testing can vary widely depending on the time of day the test was taken as well as the other factors that influence cortisol levels.

The cost of a cortisol test can vary widely depending on the testing type (e.g. urine, saliva, or blood test) and whether you opt for an at-home test kit or have the test administered in a clinical or laboratory setting. In general the at-home cortisol test kits are often more affordable and are more reasonably priced.

¹ Elzinga, B., Schmahl, C., Vermetten, E. et al. Higher Cortisol Levels Following Exposure to Traumatic Reminders in Abuse-Related PTSD. Neuropsychopharmacol 28, 1656–1665 (2003). https://doi.org/10.1038/sj.npp.1300226

² Soltani, Hoda et al. “Increasing Dietary Carbohydrate as Part of a Healthy Whole Food Diet Intervention Dampens Eight Week Changes in Salivary Cortisol and Cortisol Responsiveness.” Nutrients vol. 11,11 2563. 24 Oct. 2019, doi:10.3390/nu11112563

³ Adan, Roger A H et al. “Nutritional psychiatry: Towards improving mental health by what you eat.” European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology vol. 29,12 (2019): 1321-1332. doi:10.1016/j.euroneuro.2019.10.011

⁴ Thesing, Carisha S et al. “Omega-3 polyunsaturated fatty acid levels and dysregulations in biological stress systems.” Psychoneuroendocrinology vol. 97 (2018): 206-215. doi:10.1016/j.psyneuen.2018.07.002

⁵ Hintzpeter, Jan et al. “Green tea and one of its constituents, Epigallocatechine-3-gallate, are potent inhibitors of human 11β-hydroxysteroid dehydrogenase type 1.” PloS one vol. 9,1 e84468. 3 Jan. 2014, doi:10.1371/journal.pone.0084468

⁶ Tsang, Catherine et al. “Effect of Polyphenol-Rich Dark Chocolate on Salivary Cortisol and Mood in Adults.” Antioxidants (Basel, Switzerland) vol. 8,6 149. 29 May. 2019, doi:10.3390/antiox8060149