Cortisol and Alcohol: Understanding the Connection

Cortisol is a hormone in our body that helps us manage stress. It is released by the adrenal glands, and its production is regulated by the pituitary gland and hypothalamus. Factors such as lifestyle, chronic stress, cancer, and infection can lead to excess cortisol (Cushing syndrome) or too little cortisol (Addison disease). 

Alcohol consumption is a lifestyle factor that can change the amount of cortisol in the body, potentially affecting the body’s ability to manage stress. This article aims to explore the relationship between alcohol and the body’s stress hormones. 

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What is Cortisol?

Cortisol is a glucocorticoid (steroid hormone) made from cholesterol. Steroid hormones deliver important information to target cells and organs and allow our cells to grow, change, or respond to different stimuli. 

Glucocorticoids, in general, have an important role to play in many body functions. In the immune system, these messengers may help manage inflammation by encouraging the programmed cell death of T cells (apoptosis). They may also reduce the activity of B cells and the neutrophil response when inflammation occurs. 

When the body is under stress, the amygdala (the fear center of the brain) sends a message to the hypothalamus, which allows the adrenal glands (located above the kidneys) to release cortisol, in a process that governs the body's “flight or fight” response. 

High cortisol levels also encourage the body to use its fat cells (lipids) and glycogen (the storage form of glucose) for energy. 

How Alcohol Affects Cortisol Levels

Alcohol impacts cortisol production in two ways: 

First, increased alcohol intake activates the HPA axis, potentially changing the amount of cortisol released. 

Second, consuming alcohol in excess can affect the function of the liver, which may reduce its ability to process cortisol. 

Short-term vs. Long-term Effects

Individuals who binge drink may experience increased cortisol levels in the short term. Also, increased alcohol use over a longer period may expose the body to chronic stress, which could change the responsiveness of the cortisol control center, potentially leading to “pseudo-Cushing’s syndrome." 

Symptoms of this condition may include a round face, buffalo hump, stretch marks, and decreased immune function. These symptoms of elevated cortisol may improve when alcohol intake is stopped or decreased. 

Long-term excess alcohol intake may reduce the body’s ability to manage cortisol levels naturally, resulting in more circulating levels of the hormone. 

Consequences of Altered Cortisol Levels Due to Alcohol

The changes in the hypothalamic-pituitary-adrenal (HPA) axis that result from alcohol consumption and affect cortisol levels can have various health impacts.

Physical Health Impacts

• Increased blood pressure: this can increase stroke risk and place additional stress on the heart and blood vessels. 
• Insulin resistance: increased insulin levels and high blood sugar (hyperglycemia) can lead to type 2 diabetes. 
• Dyslipidemia: High cholesterol and high triglycerides can also occur 
• Truncal obesity: where adipose tissue is localized in the abdomen, and it can increase stress on the organs. 

These four conditions may place the patient at risk for diabetes, heart disease, metabolic syndrome, and stroke. 

Cortisol is involved in immune function and bone metabolism. Excess cortisol may decrease both the body’s ability to fight infection and impact the ability to maintain bone density (increasing the risk of fractures).

Mental Health and Mood Impacts

Chronic stress from elevated cortisol levels can affect the brain and mental health, as the brain may maintain an active stress response. This impacts the brain’s neuroplasticity. The alterations in cortisol from alcohol consumption can also increase the risk of mental health conditions. 

Cortisol concentrations are often altered in conditions like depression, post-traumatic stress disorder, anxiety, and psychosis. 

The Cycle of Alcohol Use and Stress

The cycle of alcohol use and dependence may be difficult to break, especially when stress and high cortisol levels are involved. 

Alcohol is often used as temporary stress relief, but drinking alcohol can place the body under more stress over the long term. Thus, a cycle of attempting stress relief while increasing cortisol can occur. This can lead to a habitual response and alcohol dependence. 

How to Recognize the Signs of Alcohol-Induced Stress

Identifying the signs and symptoms of stress related to alcohol consumption is very important for diagnosis and treatment. Possible signs of alcohol-induced cortisol imbalance include:

• A rounded “moon face”
• Central obesity
• Buffalo hump (fat on the upper back)
• Stretch marks on the skin
• Elevated heart rate
• High blood pressure
• A feeling of constant stress
• Depression
• Anxiety
• Increased infections

Possible signs of alcohol dependence include:

• Inability to cut down on drinking
• Much of the day is spent drinking, buying alcohol, or being “hung over” from drinking
• A strong urge to drink
• Continuing to drink even though it causes problems at home and work
• Inability to fulfill responsibilities at home and work
• Reducing time spent with others or doing enjoyable activities in order to drink
• Increased tolerance to alcohol, requiring more alcohol to achieve the same desired effect
• Experiencing symptoms of withdrawal such as sweating, nausea, and shaking 

If you or a loved one is experiencing signs of alcohol dependence, help is available by dialing 988 or 1-800-662-HELP (a US-based helpline available in English and Spanish). 

How to Manage Cortisol Levels and Alcohol Consumption

Balancing cortisol levels can help break the cycle of chronic stress and support a balanced stress response. Reduced alcohol consumption may help reduce the stress response associated with drinking. Additional cortisol management techniques include:

• Adequate sleep (7-9 hours for adults)
• Stress reduction techniques (meditation, breathing exercises, yoga)
• Adaptogenic Herbs (such as Rhodiola, Ashwagandha, Asian Ginseng, and Holy Basil)
• Social support
• A balanced diet of whole foods
• Reducing caffeine intake

Tips for Reducing Alcohol Consumption

• Reducing alcohol consumption can be very difficult; keeping healthy boundaries with alcohol and seeking professional help when necessary remain key.  
• Stress management techniques can reduce the urge to drink to deal with life challenges. 
• Discovering other hobbies and leaning on your sources of social support can also help. 
• The availability of non-alcoholic options at restaurants and stores is increasing, providing options for patrons seeking to eliminate or reduce their alcohol intake. 

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Key Takeaways 

A balanced relationship with alcohol, which can impact cortisol regulation, is key to avoiding placing excess stress on the body and mind and remains a vital part of promoting overall well-being and health. 

Learn More About Cortisol:

• Cortisol Test: Understanding Your Stress Hormone Levels
• Cortisol Levels by Age (Changes & Impacts)
• How to Balance Cortisol Levels Naturally