Cortisol is a crucial hormone produced by the adrenal glands, known for its role in the body’s stress response, metabolism, and immune system regulation. Addison’s disease is a common cause of low cortisone levels, affecting about 100-140 of every million people in developed countries.
It’s helpful to explore how to support cortisol levels, understand cortisol’s effects on the human body, and consider strategies for individuals with clinically low cortisol (often due to adrenal insufficiency). Doing so can help maintain cortisol production, support hormonal balance, and promote overall health and well-being.
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Recognizing the Signs of Low Cortisol
Cortisol is sometimes called the “stress hormone”. It’s produced by the adrenal glands located on top of the kidneys. Hormones are chemicals that transmit messages through the body and tell it what to do. Proper hormone balance is vital to proper body functioning and preventing worrisome complications.
Recognizing the signs of low cortisol levels can help manage an Addisonian crisis and the medical problems associated with this condition.
Symptoms of Cortisol Deficiency
The symptoms associated with low cortisol levels (adrenal insufficiency) include:
- Poor appetite
- Chronic fatigue
- Low blood pressure (hypotension)
- Unintentional weight loss
- Muscle weakness
- Irregular or no menstrual periods in women
Not addressing low cortisol levels can lead to an adrenal crisis (Addisonian crisis) and the following symptoms:
- Abdominal pain
- Pain in the side (flank)
- Loss of appetite
- Long-lasting fatigue
- Weakness
- Unexplained weight loss
- Diarrhea
- Dehydration
- Fever
- Confusion
- Joint pain
- Dizziness
- Fainting
- Lightheadedness
- Coma
- Shock
- Kidney failure
- Seizures
- Headache
- Low blood sugar (hypoglycemia)
- Low blood pressure
- Vomiting
- Nausea
- Increased heart rate
- Rapid breathing
Patients should see a medical professional at the first sign of these or other new, unusual, or concerning symptoms. An adrenal crisis is a medical emergency that requires immediate attention.
How to Diagnose Low Cortisol
The diagnostic process for low cortisol may consist of one or more of the following tests:
- Blood tests
- Cortisol saliva tests
- Cortisol urine tests
- ACTH stimulation tests
- Insulin-induced hypoglycemia test
- Imaging procedures
Risk factors for Addison’s disease, a common cause of low cortisol levels, include:
- History of diseases or surgery that affects the adrenal or pituitary glands
- Hypothyroidism, type 1 diabetes, or other autoimmune endocrine conditions
- Genetic changes that affect adrenal or pituitary glands
- Congenital adrenal hyperplasia
- Traumatic brain injury
Patients need to consult with an endocrinologist or healthcare provider for the most accurate assessment and diagnosis of specific hormone irregularities.
Their specialist discusses a patient's symptoms and medical history, completes a physical examination, and determines which diagnostic tests to order before developing a management plan.
The Top 4 Ways to Support Cortisol Levels
Tips for how to support cortisol in patients with low levels include:
#1. Use Medical Interventions When Appropriate to Support Cortisol
Corticosteroid Therapy
A primary approach for low cortisol is corticosteroid replacement therapy, as this treatment works to mimic the body’s natural cortisol rhythms.
Physicians may prescribe hydrocortisone (Cortef), methylprednisolone (Medrol), or prednisone (Rayos) to replace cortisol. They could recommend fludrocortisone to replace the hormone aldosterone. Providing the right dosage and establishing medication accuracy and timing is crucial.
Patients might need to take medications short-term or for the rest of their lives, depending on the underlying cause of hormone imbalance. Providers may have to adjust medication dosages if patients experience trauma, an infection, surgery, or another stressful situation to help manage an adrenal crisis.
Patients need to consume enough salt in their diet, particularly during periods of hot weather, heavy exercise, or if they have diarrhea.
Overtreatment with hydrocortisone could result in osteoporosis, obesity, or type 2 diabetes, while overtreatment with fludrocortisone could cause high blood pressure. That’s why providing the right dosage and routine medical monitoring are crucial.
Adrenal Crisis Care
Patients in an adrenal crisis (Addisonian crisis) need immediate medical attention. Treatments for this type of medical emergency include hydrocortisone injections and an intravenous saline solution. Some patients also need antibiotics to address a bacterial infection if this is the underlying cause of their symptoms.
Management for dehydration or an electrolyte imbalance related to adrenal crises includes water, coconut water, sports drinks, or intravenous (IV) fluids. Consuming carbohydrates can help manage low blood sugar in patients with hypoglycemia.
#2. Use Nutritional Support to Help Maintain Cortisol Levels
A patient’s diet can affect their cortisol levels. Providers should encourage patients to support adrenal health and balance cortisol levels by consuming a balanced diet rich in vitamins and minerals.
Patients should maintain a healthy body weight by eating various fruits, vegetables, whole grains, protein-rich foods, and heart-healthy fats (olive oil, avocados, etc.). It’s also important to drink plenty of water to promote overall health and avoid dehydration.
It’s vital to consume adequate levels of salt (suggest adding salt to foods or trying salt tablets if necessary) for some patients with adrenal insufficiency. They should meticulously follow their provider’s advice regarding nutrition, sodium intake, and hydration to avoid complications.
Encourage patients to avoid excessive alcohol, high amounts of caffeine, and using tobacco products since these lifestyle habits can affect cortisol levels.
#3. Use Adaptogenic Herbs to Support Healthy Cortisol Levels
Incorporating adaptogenic herbs into your daily routine can be a natural way to support healthy cortisol levels and enhance overall well-being. The following have been shown in research to be effective for naturally supporting cortisol levels:
Licorice (Glycyrrhiza glabra)
- Benefits: Helps to maintain healthy cortisol levels by inhibiting the enzyme that breaks down cortisol, thereby prolonging its action.
- Recommended Dose: Standardized extract (containing 20% glycyrrhizic acid) 250-300 mg three times daily
- Contraindications/Drug Interactions:
- May raise blood pressure and cause potassium depletion.
- Contraindicated in individuals with hypertension, kidney disease, or heart disease.
- Can interact with corticosteroids, diuretics, and medications that lower potassium levels.
Rhodiola (Rhodiola rosea)
- Benefits: Known for its adaptogenic properties, rhodiola helps to balance cortisol levels, reduce stress, and improve mental performance.
- Recommended Dose: For adults, oral doses of 100-600 mg daily for up to 12 weeks
- Contraindications/Drug Interactions:
- May cause dizziness or dry mouth in some individuals.
- Use with caution in individuals with bipolar disorder or those taking SSRIs, as it can potentially interact with these medications.
- Avoid during pregnancy and breastfeeding due to a lack of safety data.
Ashwagandha (Withania somnifera)
- Benefits: Acts as an adaptogen to reduce stress and support cortisol levels, promoting overall hormonal balance.
- Recommended Dose: A standard dose ranges from 250 to 500 mg and should be taken 1-2x daily.
- Contraindications/Drug Interactions:
- May cause gastrointestinal upset in some individuals.
- Avoid in individuals with hyperthyroidism, as it can increase thyroid hormone levels.
- Can interact with sedatives, thyroid medications, and immunosuppressants.
- Not recommended during pregnancy as it may cause early labor.
General Guidelines for Using Adaptogenic Herbs
- Consistency is Key: For best results, these adaptogens should be taken consistently for at least several weeks.
- Quality Matters: Choose high-quality, standardized extracts to ensure potency and efficacy.
- Consult with a Healthcare Provider: Always discuss with a healthcare professional before starting any new supplement, especially if you have underlying health conditions or are taking other medications.
#4. Use Stress Management Techniques to Support Cortisol Levels
Stress management, including relaxation techniques, can support adrenal gland health by reducing the risk of too-high cortisol levels. Examples of stress management techniques to try include:
- Mindfulness
- Meditation
- Gentle yoga
- Getting adequate sleep
- Exercise
- Being outdoors
- Lightening up a busy schedule
- Taking mental days off from work
- Making time for family, friends, and vacations
The connection between stress and cortisol production is well-researched. Studies show that average cortisol levels increase by about 9% during stressful times compared with periods of relaxation.
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Key Takeaways
It’s helpful to recognize how to support cortisol levels when needed to help manage complications and improve quality of life, particularly in patients diagnosed with Addison’s disease.
Patients should take an active role in their health by following professional medical advice, properly adhering to their management plans, taking any medicines exactly as directed, and making informed lifestyle choices that support optimal hormone balance.
It’s important to adopt healthy habits that include nutritious meal plans, regular exercise, high-quality sleep, a strong social support network, and relaxation techniques patients can complete on a routine basis.
Additionally, individuals should seek immediate medical attention at the first sign of low cortisone levels, particularly if they show signs of an Addisonian crisis.
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