High cortisol isn’t always the culprit, but if you’re dealing with these three symptoms, it may be higher than it should be.
Reviewed by Dietitian Jessica Ball, M.S., RD
If you’ve spent any time on social media lately, you’ve probably seen cortisol blamed for everything from visceral fat to burnout and sleepless nights. While it’s true that this stress hormone plays a role in how you feel, cortisol is essential for many everyday functions. “It helps regulate your body’s stress response, blood sugar, metabolism, inflammation and even your sleep-wake cycle,” says Erica Armstrong, M.D., IFMCP.
The key is to keep cortisol in a healthy range—which is managed by the adrenal glands when they’re healthy. But if cortisol levels become too high for too long, you may start to notice some unpleasant side effects, and your health could be at risk. To untangle fact from fiction when it comes to cortisol, we spoke with a physician to understand what this stress hormone does, how to spot when it might be out of balance and steps you can take to manage inflammation and feel your best.
“Cortisol is a hormone produced by your adrenal glands that plays an essential role in your health,” says Armstrong. This hormone naturally follows a 24-hour cycle, peaking 30 minutes after waking up, and declining during the day, with the lowest levels occurring during the early phases of sleep.
As a stress hormone, cortisol is regulated by the hypothalamic–pituitary–adrenal axis (HPA axis) and surges during times of high stress. A burst of cortisol leads to high amounts of sugar being released into the bloodstream for extra energy, vasoconstriction and increased heart rate to get your body ready for the “fight or flight” response. This response is useful in a situation when you need to move or act quickly, but can create problems when it occurs too frequently, and without the follow-up of physical action.
Most cells in the body have cortisol receptors, meaning that this stress hormone impacts everything from your heart to your brain, metabolism, immune system and more. Chronically high cortisol levels are a biomarker for a number of diseases, including heart disease, stroke, type 2 diabetes and other metabolic and inflammatory conditions. Some of the most common conditions to elevated cortisol include chronic stress, insulin resistance, autoimmune diseases and Cushing’s syndrome, explains Armstrong.
The only way to know if you have high cortisol levels is to see a medical professional. “We always combine symptoms with lab testing (like a 4-point saliva cortisol test) and a full clinical picture before concluding whether cortisol is truly out of balance,” says Armstrong.
That said, these are some of the most common signs of high cortisol.
If you have trouble falling asleep at night or tend to wake up in the middle of the night and can’t fall back asleep, it could have something to do with your stress hormones. “Cortisol should be low at night, but if it’s spiking due to stress or blood sugar dips, it can wake you up in the middle of the night,” says Armstrong.
One study of healthy individuals found that higher pre-sleep cortisol levels were associated with shorter and poorer sleep quality than lower presleep cortisol levels. A similar connection was also found among people with type 2 diabetes. Left unaddressed, poor sleep quality and short duration can lead to a number of health concerns, including an increased risk of heart disease and all-cause mortality.
If you find yourself holding onto extra weight around your midsection, despite no changes in your diet or exercise routines, it could be a sign of high cortisol levels. In one study of middle-aged and older adults, those with higher levels of hair cortisol were more likely to have a higher body weight and waist circumference than those with lower levels.
“Cortisol promotes fat storage, especially around the midsection, as a survival mechanism,” says Armstrong.
It’s important to note that “general obesity” does not necessarily equate to “abdominal obesity”—high levels of visceral fat. One large study found that people with abdominal obesity, but not necessarily general obesity, were at a higher risk of having abnormal liver enzymes.
As a stress hormone, cortisol helps your brain stay ready for impending danger—even if the danger is perceived and not real—which can feel downright exhausting when you’re stuck in that state for too long. “Elevated cortisol can make you feel mentally alert even when you’re physically exhausted,” says Armstrong.
However, even if you’re feeling mentally wired, chances are your brain isn’t operating at its best. High levels of cortisol, maintained over long periods, are associated with reduced cognitive function and impaired sleep, which can further impair mental functions such as memory and attention.
Working to lower elevated cortisol levels can help reduce chronic inflammation and the risk of inflammatory diseases. Here are other expert-approved ways to manage inflammation:
When operating correctly, your body has systems in place to regulate cortisol production and release for an appropriate stress response. So while some people do not have to worry about elevated cortisol, chronically high levels can cause unwanted side effects and increase the risk of inflammatory and metabolic health conditions. Difficulty sleeping, abdominal weight gain and feeling mentally wired but physically tired can indicate elevated cortisol levels; however, these symptoms could also be caused by a variety of other health conditions or imbalances. The best way to know for sure is to speak with a health care provider.
