Cortisol high level how to lower, how to reduce, risks and danger by Ray Sahelian, M.D.
April 3 2014

Cortisol side effects, safety, risks and danger
A high cortisol level for prolonged periods can increase the risk of infection, high blood pressure, peptic ulcers, diabetes mellitus, osteoporosis, and depression. Recent findings show that treatment in the form of prednisone or another form of corticosteroid increases the risk for atrial fibrillation. This treatment influenced this arrhythmia no matter what the underlying reason of the cortisol treatment.

Definition: Cortisol is a natural steroid hormone produced by the adrenal gland cortex. It has a strong diurnal variation, generally high early in the morning and falling during the day. Cortisol level typically increases over the first few minutes of the day, reaching a peak 20-30 minutes after waking. Also called the stress hormone, it is available synthetically under various names including dexamethasone, prednisone, triamcinolone, fluocinolone, and others.
   Cortisol, the active form of cortisone, is a hormone involved in a variety of different bodily functions, from the immune system to the regulation of blood sugar and liver function. Those with a medical condition known as Addison's disease have very low levels.
   Some companies sell "cortisol blocking" herbal products and claim these users will benefit with weight loss. I doubt these claims.

The daily cortisol cycle
The awakening cortisol response (ACR) is a discrete and distinctive part of the cortisol circadian cycle. In healthy adults salivary free cortisol concentrations increase by between 50 and 160% in the first 30 min immediately post-awakening. This increase does not occur appropriately in those with Asperger syndrome.

Diabetes
The cognitive impairment that can occur in people with diabetes appears to result from high levels of the stress hormone cortisol.

Cortisol blockers - diet supplement
Some products are being marketed that claim to block cortisol. Unless a person has a medical condition such as Cushing's disease, blocking is not going to be of any benefit. Plus, there is no proof that these products block production. It would be best at this time to avoid a product that claims to be a cortisol blocker.

Low cortisol level - hypocortisolism - deficiency
These have been observed in patients with different stress-related disorders such as chronic fatigue syndrome, fibromyalgia, and post-traumatic stress disorder. Low cortisol symptom leads to enhanced stress sensitivity, pain, and fatigue. The phenomenon of hypocortisolism may occur after a prolonged period of hyperactivity of the hypothalamic-pituitary-adrenal axis due to chronic stress. Despite symptoms such as pain, fatigue and high stress sensitivity, low cortisol level may also have beneficial effects on the organism.

I was curious to know if taking licorice while on the antidepressant paroxetine would be safe. I feel tired during the day and I had an adrenal test showing that my adrenals were exhausted and i was producing low cortisol throughout most of the day. Would there be a better alternative to licorice to raise cortisol level during the day?
   Small amounts of licorice used a few days a week appears to be safe. There are many causes for low energy and I prefer not to focus exclusively on trying to elevate levels of one hormone.

High cortisol level - excess symptom
Elevated cortisol level is found in many diseases, including infectious, aging-related, depression and depression -associated conditions; even in some with no known origin. While it was initially thought that a high level is the result of these diseases, there is mounting evidence to the contrary, namely, that high cortisol actually plays a major role in inducing them, opening the possibility that anti cortisol drugs might represent a new beneficial therapy. High levels for prolonged periods leads to fat deposition and often belly fat. Hair analysis can reveal if seniors have elevated stress hormone levels that may put them at increased risk for heart disease and stroke. Unlike a blood test that provides information about stress hormone levels at a single point in time, analysis of a strand of hair can reveal trends in levels of the stress hormone cortisol over several months, higher long-term levels are more likely to cause heart disease.

I have repeatedly tested high on cortisol screenings. I am considering beginning supplementation for adrenal support - one containing adaptogenic herbs and one containing vitamins plus porcine adrenal gland concentrate. Will supplementing with the adrenal gland concentrate increase levels of cortisol though - since I'm already high I don't want to do that. Is it best if one has high cortisol levels only to take the adrenal support (ie, the herbs) rather than supplementing with the glandular products?
   There are different porcine adrenal gland products on the market and each may provide different results and effects, and I have not seen any research regarding their influence on cortisol levels. I personally do not treat patients solely on the results of a blood study but look at the whole person, their symptoms, their full history, medical exam and evaluation of basic blood studies or other tests. Focusing on treating a person based solely on one blood study can lead to the wrong diagnosis and treatment.

Reduce cortisol - how to lower level
A reliable way to reducing colesterol level is by leading a low stress life, talking walks, eating and drinking in moderation, getting a deep sleep, and getting a massage, praying, meditating, or doing yoga. By taking all these steps you have control over levels and you can maintain a normal level or reduce it if it happens to be in excess.

Caffeine can activate important components of the pituitary-adrenocortical response in humans during the resting state. Caffeine's known ability to increase cortisol production appears at least partly due to an increase in ACTH release from the pituitary gland. Therefore, consider decreasing your coffee or caffeine intake.

Stress reduction
Cortisol has been called the stress hormone.  It is a steroid hormone produced in the adrenal gland in response to stress. In the body, cortisol is needed to maintain normal physiological processes during times of stress - without it, the body would not be able to respond effectively to stress.

Vitamin C benefit
A randomized controlled trial of high dose ascorbic acid for reduction of blood pressure, cortisol, and subjective responses to psychological stress.
Psychopharmacology. 2002.
High-dose ascorbic acid has reduced indices of stress in laboratory animals. We conducted a randomized double-blind, placebo-controlled 14-day trial of sustained-release ascorbic acid (60 healthy young adults; 3 x1000 mg/day Cetebe) and placebo (60 healthy young adults) for reduction of blood pressure, cortisol, and subjective response to acute psychological stress (Trier Social Stress Test, TSST, consisting of public speaking and mental arithmetic). Six subjects from each group were excluded. Compared to the placebo group, the ascorbic acid group had less systolic blood pressure (an increase of 23 versus 31 mmHg), diastolic blood pressure, and subjective stress responses to the TSST; and also had faster salivary cortisol recovery (but not smaller overall cortisol response). Cortisol response to 1 microg ACTH, and reported side-effects during the trial did not differ between groups. Plasma ascorbic acid level at the end of the trial but not pre-trial was associated with reduced stress reactivity of systolic blood pressure, diastolic blood pressure, and subjective stress, and with greater salivary cortisol recovery. Treatment with high-dose sustained-release ascorbic acid palliates blood pressure, cortisol, and subjective response to acute psychological stress. These effects are not attributable to modification of adrenal responsiveness.

Cortisol and weight loss - diet pill
A high cortisol level, such as in Cushing's disease, can lead to weight gain. It is simplistic to suggest that lowering cortisol levels leads to weight loss, as some television ads claim. Cortisol isn't the major factor involved in weight gain and fat distribution, and might actually come into play at a secondary level. When treating inflammations such as asthma, patients might have to take high doses of cortisone, which can lead to weight gain. On the flip side, obese people usually have elevated cortisol blood levels. Because of this, some lay people have the misunderstanding that cortisol is responsible for obesity and should be lowered to lose weight. A high calorie diet may raise cortisol levels.

Blood test and saliva test
A cortisol test is done to measure the level of the hormone cortisol in the blood, which may indicate problems with the adrenal glands or pituitary gland. A saliva cortisol test is also available to test whether there is an elevated cortisol or normal cortisol or low cortisol. There is some concern that different labs may not be consistent in measuring cortisol levels and there may be differences between various testing labs.

Fibromyalgia
Among women with fibromyalgia, pain symptoms early in the day are associated with variations in function of the hypothalamic-pituitary-adrenal axis. However, there is no significant differences in cortisol levels or diurnal cortisol variation between fibromyalgia patients and healthy controls.

Cortisol stimulation test - testing
ACTH (Cortrosyn) stimulation test measures the ability of the adrenal cortex to respond to ACTH by producing cortisol appropriately. ACTH is a hormone produced in the pituitary gland that stimulates the adrenal glands. In obese women, the only detected difference from lean subjects is a quicker suppression and recovery in serum cortisol levels after glucose administration.

Replacement
Cortisol is also known as cortisone and hydrocortisone.

Hair loss
A high level of serum cortisol in the body for prolonged periods could accelerate hair loss.

Effects on the body
Cortisol's job is to help the body respond to stress. Among its other functions, cortisol helps maintain blood pressure and cardiovascular function, slow the immune system's inflammatory response, balance the effect of insulin in breaking down sugar for energy and regulate the metabolism of proteins, carbohydrates and fats. The amount of cortisol produced is precisely balanced, and the adrenal glands along with the hypothalamus are responsible for maintaining balancing cortisol levels. Like many other hormones, cortisol is regulated by the brain's hypothalamus and the pituitary gland, a bean-sized organ at the base of the brain. One of the pituitary's main functions is to secrete ACTH (adrenocorticotropin), a hormone that stimulates the adrenal glands.

DHEA hormone
Effects of DHEA administration on episodic memory, cortisol and mood in healthy young men: a double-blind, placebo-controlled study.
Psychopharmacology. Psychobiology Research Group, School of Neurology, Neurobiology and Psychiatry, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
Dehydroepiandrosterone (DHEA) has been reported to enhance cognition in rodents, although there are inconsistent findings in humans. Twenty-four healthy young men were treated with a 7-day course of oral DHEA (150 mg b.d.) or placebo in a double blind, random, crossover and balanced order design. Subjective mood and memory were measured using visual analogue scales (VASs). Cortisol concentrations were measured in saliva samples. ERPs were recorded during retrieval in an episodic memory test. Low-resolution brain electromagnetic tomography (LORETA) was used to identify brain regions involved in the cognitive task. DHEA administration led to a reduction in evening cortisol concentrations and improved VAS mood and memory. DHEA treatment improved memory recollection and mood and decreased trough cortisol levels. The effect of DHEA appears to be via neuronal recruitment of the steroid sensitive ACC that may be involved in pre-hippocampal memory processing. These findings are distinctive, being the first to show such beneficial effects of DHEA on memory in healthy young men.

Obesity
Cortisol levels during an oral glucose tolerance test in lean and obese women.
Endocr Res. 2005. Division of Endocrinology and Metabolism, Akdeniz University, School of Medicine, Antalya, Turkey.
Because of the similarities between Cushing's syndrome and insulin resistance syndrome, cortisol metabolism in obesity has been investigated in numerous studies. Our study investigates serum glucose, insulin, and cortisol response to oral glucose stimulation in a group of obese and lean normotensive, normolipidemic, and glucose-tolerant premenopausal women. Previous studies reported altered hypotalamic-pituitary-adrenal axis activity, altered levels of urinary cortisol excretion, and increased metabolic clearance of cortisol in obesity. In our study in obese women, the only detected difference from lean subjects was a quicker suppression and recovery in serum cortisol levels after glucose administration.

Cortisol and 5-HTP
L-5-hydroxytryptophan induced increase in salivary cortisol in panic disorder patients and healthy volunteers.
Psychopharmacology 2002.
The results show that L-5-hydroxytryptophan stimulated salivary cortisol is a useful probe of serotonin function in healthy volunteers as well as panic disorder patients, and provide some evidence against a serotonin receptor hypersensitivity in panic disorder.

Cortisol weight loss pill
What do you think of Cortislim?
   I am not aware of any studies published with Cortislim nor with other similar "me too" products promoted as  "cortisol product for weight loss " and "natural cortisol blockers."

Q. Can DHEA or pregnenolone interfere with cortisol treatment?
     A. They certainly can. Pregnenolone could convert into cortisol. Both pregnenolone and dhea could cause heart rhythm abnormalities and hence make an arrythmia or heart palpitations worse, especially if the cortisol dosage is high.

Q. I have a general question regarding the use of 5-HTP in patients with high cortisol. If someone has elevated cortisol should 5- htp be used ? This client also has carb cravings, mild depression, and mild-moderate anxiety and does not want to do a psychotropic. The research is somewhat confusing as it indicates 5-htp can increase cortisol. However I have not found any contraindications. 5-htp also seems to support weight loss… so this is quite confusing…
     A. One should not base their decision on using a nutrient solely based on one hormone level but the overall evaluation of the patient.

Q. Do saw palmetto or lipoic acid influence cortisol levels?
     A. I don't know but I don't think they have a major influence.

Q.  I visited a doctor to get a blood sample test done to measure cortisol levels at around 9am. The test result came back with the reading 592 nmol/l which is at the high range of normal. This blood sample was taken after being well rested aswell (8 hours sleep). The problem is that even in the normal range reasonably high cortisol levels can be destructive to bodybuilding but no doctor wants to do anything about it unless you are actually SICK as in having Cushing's Disease (having 700nmol/L and over). Cortisol is a signficant factor to any athlete and I don't that many that have Cushing's Disease. My serum cortisol is likely to be much higher again with less sleep. Taking vit C and melatonin doesn't seem to help much. Do you have any advice about what I should do especially since getting a bad nights rest can really eat away at my hard earned gains the following day.
     A. We often have people who send us emails and are totally focused on one blood study, not realizing the complexity of the human body and that there are countless hormones and substances in the body that have an influence on health and disease. The cortisol level has to be taken in context with the overall health of the person and other blood studies. By itself, it gives little clue of what's going on in the body.

Q. Does the consumption of phosphatidylserine have to be taken for a few weeks before any benefits in lowered cortisol levels occur?
     A. Thus far I am not impressed with the research regarding phosphatidylserine and cortisol.

Q. I have recently been diagnosed with stress induced elevated cortisol levels at midday ad late afternoon via saliva testing. The use of low dose aspirin has been suggested to reduce elevated cortisol. Can white willow bark be used as a substitute for aspirin for elevated cortisol level?
   A. I can't see how aspirin would reduce stress levels or have a significant impact on cortisol levels. Hence, I can't sew how white willow bark would be effective.

Q. My physician has recommended a surgery after he found high cortisol levels is causing high blood pressure. Is this a common procedure?
   A. There are many causes for high cortisol levels, including an adrenal tumor. Treatment for the high cortisol depends on the specific reason for excess cortisol and may include surgery, radiation, chemotherapy, or the use of cortisol-inhibiting drugs.

Q. You have an excellent website and thank you for providing great service to public. Since your an expert in nutrition, could you reccomend me supplements for bile reflux and for low cortisol. My saliva adrenal stress shows I have low cortisol but bit high DHEA. I do see a health professional so whatever advise you give me about supplement, I will then ask my health professional if I can take them or not.
   A. When treating a patient, one has to review the whole history, medical examination and all lab studies rather than treating a particular result of a blood study of one hormone level. All symptoms and signs have to be evaluated, not just the blood test result. You may wish to review the page on GERD diet for suggestions on gastrointestinal matters.

Q. For my entire life I have had low blood pressure, low blood sugar, chronic constipation, dry skin and hair, and intolerance to cold. At 46 I was getting tired and requested to take the adrenal function saliva test at a compounding pharmacy. Well, it came back that my cortisol levels are dismally low, 15 in the am, down to 2.8 by noon and 1.8 by 6:30! I started taking IsoCort - the pharmacist said to take 4 in the morning, 3 at noon and 2 in the afternoon. It was amazing! I felt like I did 10 years ago in terms of energy, and my lifelong constipation disappeared! But after one month, the occasional night sweats I was getting started to get much worse. Could the cortisol-like supplement be causing this? I reduced the amount of Isocort by 30%, 3 in the morning, 2 at lunch and 1 in the afternoon just to see if it would help. It did not help, but I started feeling not as good - a bit shaky...like I used to if went too long without eating, but wasn't hungry. Can these type supplements be addictive or dangerous? Does cortisol buildup in your system so that I need to monitor the levels and start adjusting down the amount I take?
   A. According to a website: IsoCort is a freeze dried adrenal cortex extract containing herbs and medium chain triglycerides. Isocort is designed to provide adrenal support for the those who have adrenal fatigue or reduced cortisol levels and which to increase energy levels. Isocort may not be cortisol hormone itself. I have not seen studies with this product so I don't know what kind of benefits and side effects it has and whether it does contain cortisol.

Q. I have gained an enormous amount of knowledge from reading your website over the years, and want to thank you for that. Today I noticed that there appears to perhaps be an inaccuracy in your cortisol entry about a product. I don't have any relation or prior knowledge about this product -- I am researching it this afternoon myself, to see if it might be a solution for my health needs. I looked up what you had to say about it, and from what I read on other sites about its ingredients (including sites that sell it and list its ingredients), I think that you may have misunderstood it and mischaracterized its ingredients on your site. The product is called IsoCort, and you said on your site that the product doesn't have any cortisol in it. However, I've seen more than 3 sites today that say it has actual cortisol in it at a dosage of 2.5 mg. If you believe these sources (and I'm sure the manufacturer of it, Bezwecken, could be contacted as the final authority), please update your website entry for Cortisol. Assuming that this product does have cortisol in it, I would be very interested in your thoughts about it as a supplement that people can experiment with to see if it helps their low-adrenal-function symptoms, especially because it's available over the counter. If that would be reasonable to try, what dose, length of time, etc. would you recommend? Would there be any dangers to keep in mind?
    A. I am suspicious that this substance would contain cortisol in the amounts that are claimed since, unless I am mistaken, cortisol is a hormone available by prescription only. Assuming this product does contain 2.5 mg of cortisol, it would make it a dangerous over the counter supplement since the long term use of cortisol is associated with a number of serious health issues including immune system suppression. I came across a website that mentioned something interesting, *We are suspicious that each Isocort tablet does NOT contain 2 1/2 mg cortisol. When someone on 8 tablets of Isocort (which should be 20 mgs cortisol) switched to 15 mgs hydrocortisone, the 15 mg HC was FAR more potent!"
   Unless I see an independent lab analysis of this product that confirms it has 2.5 mg of cortisol, I am skeptical. And if it does have it, then I am concerned many people may be damaging their health if they use it this product, especially more than one tablet, for prolonged periods such as weeks or months.

Q. I don't see anything on your website about the treatment of adrenal fatigue with hydrocortisone. There is a famous older book that is referred to by people who are especially interested in this by William Mck Jefferies called The Safe Uses of Cortisol. There is also an entire network of thyroid patients using cortisol to boost their adrenals to "an optimal Level" so that they cantolerate thyroid meds. My personal experience with taking cortisol in low doses has been rather disastrous and caused many unpleasant side effects. But as I read about these sites, I discover that most occur only in less that 10%, and some in even less than 1% of the population. Too bad when that percentage is you! My worst symptoms ended up being severe anxiety, insomnia and finally arrhythmia at 2 am. No thank you, that was the end of the line for me. My symptoms began to subside when I stopped the hydrocortisone, though they did take about 5 days to diminish in severity. It left me wondering how safe really is this protocol, even at the allegedly "safe" low doses.
    A. I have not heard of William Mck Jefferies and his book, The Safe Uses of Cortisol. This hormone has terrible side effects and should only be used when a person is either deficient in the hormone or when prescribed by a medical doctor to treat a particular medical condition. Using cortisol as a natural remedy to "balance" hormone levels when a person is not deficient does not make sense to me. There is no safe use of cortisol if a person is not deficient.

Q. I don't sleep well. In fact, I haven't in over 20 years. I finally got someone to check my cortisol when I began gaining tons of weight at my waistline. It's now been checked 3 times within the last year and every time it is elevated. Two of the tests were blood tests and one was a 24 hr urinary test. Neither of the doctors who tested me even suggested I see an endocrinologist, which seems strange since I have Hashimoto's thyroiditis and my understanding is that if you have one autoimmune disease your chances of developing another one are increased. Both doctors just said to eat healthy, reduce stress, and SLEEP more! Well, I have a very small apetite regardless of my weight issue, (I've always been thin even though I am 50 lbs overweight right now), my stress levels are not good due to the fact that I can't work, I'm on SSD, have huge doctor bills, and have a chronic pain syndrome due to a brain/spinal condition. I also have cfs / fms. Hard not to be stressed with all this. So then they suggest getting more sleep! But that is why I asked for the cortisol test to begin with! Because I am wired at night, I don't sleep! Sometimes I just lay there 'vibrating'. What I would like to know is if there is any new research on natural supplements that SIGNIFICANTLY lower cortisol. I've tried everything from ashwaganda to phosphatidylcholine and nothing seems to really help. The one supplement made by CVS pharmacy called Soothing Sleep had a number of cortisol lowering supplements in it, but they stopped making it!! It helped only a little anyway and left me feeling hung over. I've been on every medication for sleep, literally, even Xyrem. And I'd go back on the Xyrem but for the narcotic pain-relievers I must take to function. I also have pain at night and we are trying to control it but the last medication, Opana ER that I was put on and was helping with the nighttime pain, made me retain water so bad, I had to stop it. So, again, I ask if you know of ANY GOOD cortisol-lowering supplements. BTW I am on ketoconazole and have been for a while due to the number of fungal infections and bacterial ones that I must take antibiotics for. I tend to develop yeast infections if I don't take an antifungal while on an antibiotic But I guess even though ketoconazole is supposed to lower cortisol, I am not on a high enough dose. Any help or suggestions you have would be appreciated. I don't mean to ask medical advice, just want to know of any good cortisol-lowering supplements out there.
    I am not aware of any specific vitamins or supplements that focus predominantly on lowering cortisol levels, although there was a study with vitamin C, but complex symptoms are often due to more than just one hormone alteration and require a drastic change in lifestyle habits including a significant increase in activity level and other changes rather than relying on a supplement pill.

Thank you very much for the information provided and I am sure that many have benefitted from it. I am rather interested in the point made in one of the response provided that prolonged level of cortisol in the body could lead to hair loss. I was perscribed kenalog for my hair loss and I was able to overcome my prob however when i stopped taking the injection for a few months, I experienced hair loss again. I had my blood test done and it indicated a low cortisol level when I was still under the medication. This is pretty confusing and I do not know what to do or who to see.