Cortisol: More Than Just a Stress Hormone

How this one hormone can hijack your cycle, digestion, metabolism, and mood — and how to bring it back into balance

Cortisol got a big glow up this year! I don’t know about you, but I felt like there was no escaping the cortisol conversation in the wellness space this past year. And I get it, because so much of what I do on a day to day with patients is rooted in cortisol support too.

You may have heard it called the “stress hormone” but that oversimplifies its role. Cortisol is incredibly important to our sense of vitality and the conversation shouldn’t always be about wanting to lower it, but instead bringing it back to it’s natural balance.

Cortisol is your body’s built in alert system. It helps you wake up in the morning, manage blood sugar, regulate inflammation, balance energy, and respond to both emotional and physical stress. But just like anything in the body, too much or too little of a good thing can throw everything off.

So how do you know if your cortisol is balanced? What symptoms should you look out for? And what can you do to support your levels naturally? Let’s dig in.

The HPA Axis: Your Brain-Body Communication Highway

Cortisol is produced by your adrenal glands, which sit on top of your kidneys, but the command center for that production starts in your brain. This communication system is called the HPA axis (the hypothalamic-pituitary-adrenal axis). It's essentially the conversation happening between your brain and your adrenals to help you respond to whatever life is throwing your way.

Here’s how it works: when your brain perceives a stressor (anything from an emergency to feeling overwhelmed at work), it kicks into gear. The brain sends a signal down to your adrenal glands to release cortisol in response to the stress and once cortisol is out in the bloodstream, it helps your body respond: raising blood sugar for quick energy, keeping inflammation in check, and helping you stay alert and focused. Ideally once the stressor passes, your brain senses that the job is done and tells the adrenals to scale it back. That’s the feedback loop in action.

In a well-functioning system, this whole process happens seamlessly and it doesn’t just activate during emergencies. The HPA axis is also what helps you wake up in the morning with energy, manage dips in blood sugar throughout the day, and wind down when it's time to sleep. But the problem is, this system doesn’t have a filter. Whether the stressor is a near car accident or just your phone buzzing all day, the HPA axis reacts the same way. And when those signals never stop coming, it can throw the whole rhythm off — leading to cortisol patterns that feel anything but balanced.

Cortisol’s Ideal Daily Rhythm

As I’ve mentioned a few times already, cortisol isn’t just about stress! In a healthy body, cortisol follows a predictable 24-hour cycle called the diurnal rhythm. It should spike within about 30 minutes of waking (this is called the cortisol awakening response), giving you the energy to start your day. Mid-morning hours are typically the highest level of cortisol, giving your body the energy it needs to perform essential tasks. And from there, levels gradually taper off throughout the day, hitting their lowest point around bedtime to allow melatonin to rise and sleep to take over.

This rhythm is essential not just for feeling energized in the morning and sleepy at night, but also for synchronizing dozens of other hormones and biological processes — from immune activity to appetite regulation to thyroid hormone conversion.

But here’s the important part: cortisol doesn’t run on autopilot. It responds to a variety of signals in your environment and body, including:

• Light exposure: Bright light (especially natural sunlight in the morning) helps reinforce a strong morning cortisol spike. Artificial light at night can delay the drop in cortisol and disrupt sleep.

• Meal timing and blood sugar: Skipping meals or eating a diet high in refined carbs can cause blood sugar crashes, which the body responds to by releasing cortisol to help stabilize glucose.

• Stress and emotion: Cortisol surges in response to both physical threats (like injury or illness) and psychological ones (like emails, social conflict, or even overthinking).

• Inflammation and immune activity: Cortisol is naturally anti-inflammatory, so the body ramps up production in response to infection, injury, or chronic immune activation.

• Sleep quality and circadian alignment: Sleep deprivation or staying up late regularly can flatten your cortisol curve — leaving you groggy in the morning and wired at night.

• Movement: Gentle exercise like walking helps regulate cortisol, but intense training (especially when you're already depleted) can overstimulate production.

Cortisol is listening at all times. The goal is to create a daily rhythm of cues that say: you’re safe, you’re fed, you’re supported. That’s when the body starts to recalibrate and restore a healthy cortisol pattern.

Cortisol Imbalances: High, Low, and Everything In Between

Cortisol dysfunction doesn’t always show up the same way. Some people have too much cortisol all the time (think wired but tired), while others are running on fumes with barely enough to function. Then there are people with mixed patterns — high in the morning, low in the afternoon, or erratic spikes and drops throughout the day. Here’s how each of these might feel:

• High cortisol often shows up as anxiety, irritability, weight gain (especially around the belly), high blood pressure, insomnia, sugar cravings, and feeling “tired but wired.”

• Low cortisol can feel like chronic fatigue, dizziness when standing, low blood pressure, brain fog, depression, salt cravings, and trouble getting going in the morning.

• Mixed patterns might include crashing mid-afternoon, feeling alert late at night, or fluctuating moods and energy throughout the day.

Medical Conditions to Know: Cushing’s and Addison’s

While many people live in the gray zone of cortisol dysregulation, there are two more extreme medical conditions worth mentioning.

• Cushing’s syndrome is when cortisol is abnormally high, often due to a tumor or long-term steroid use. People may gain weight (especially in the face, abdomen, and upper back), bruise easily, have thin skin, and experience muscle weakness or menstrual changes.

• Addison’s disease is a state of adrenal insufficiency — meaning cortisol is dangerously low. It’s often autoimmune and can cause fatigue, low blood pressure, darkening of the skin, digestive issues, and even life-threatening crises if not treated.

Most people won’t fall into these extremes, but understanding them helps clarify the spectrum of cortisol dysfunction and why it's important not to ignore your symptoms but also how to speak about your symptoms in a way that’s medically correct.

What Can Cause Cortisol to Go Off Track?

The HPA axis is sensitive to input — from your lifestyle, environment, thoughts, and even what you eat. Here are some of the biggest contributors to cortisol imbalance:

• Chronic psychological stress: overwork, emotional trauma, caregiving, constant overstimulation, lack of boundaries, and anything else within the terrain of causing mental and emotional stress

• Poor sleep: consistent poor sleep can cause dysregulation in cortisol, but even just one night of inadequate sleep can spike cortisol levels the next day

• Blood sugar swings: especially from high sugar diets or skipping meals, which activates cortisol to stabilize glucose

• Inflammation: whether from an infection, food sensitivity, gut imbalance, or toxin exposure

• Overexercising and/or under-recovering: especially from HIIT, cardio, or endurance training without adequate rest

• Caffeine overload: particularly if used to compensate for fatigue

• Restrictive dieting: long fast window during intermittent fasting or under-eating

• Environmental stressors: mold exposure, heavy metals, light pollution, and even noise can play a role

• Unresolved emotional trauma or burnout: can keep the nervous system in a constant state of alert

Essentially, cortisol imbalance isn’t just about stress in the traditional sense. It’s a reflection of how safe, nourished, and supported your body feels day to day.

How Cortisol Affects the Rest of Your Body

When cortisol is out of balance, it doesn’t just affect your energy and mood — it can throw off systems you might not even realize are connected. From your metabolism to your hormones, cortisol is quietly influencing the way your body feels and functions every day.

Cortisol plays a foundational role in regulating metabolism, so when levels are consistently elevated or chronically depleted, it can deeply affect how your body processes and stores energy. One of its primary jobs is to help raise blood sugar in times of need, which is helpful short term, but problematic when stress is unrelenting. Chronically high cortisol can contribute to insulin resistance, intense sugar cravings, and an increase in visceral fat — especially around the abdomen. On the other end of the spectrum, low cortisol can make it harder to maintain blood sugar between meals, leading to dizziness, irritability, and that classic “hangry” feeling. Either way, your metabolic stability takes a hit, and the result is often energy crashes, weight fluctuations, and a general sense of burnout.

Digestive function is also heavily influenced by cortisol. In a fight-or-flight state, digestion takes a backseat — cortisol slows the production of stomach acid, reduces bile flow, and can delay motility, which is why many people with cortisol dysregulation report bloating, constipation, reflux, or even a nervous stomach. Over time, this suppression of digestive function can lead to nutrient deficiencies, microbial imbalances, and increased gut inflammation. And because the gut is deeply tied to both immune and neurological function, those effects can ripple out even further — showing up as skin issues like acne or eczema, a lowered ability to fight off infections, or worsening food sensitivities.

Hormonally and neurologically, cortisol plays a huge role — it influences thyroid hormone conversion, ovulation, progesterone levels, and the production of DHEA and testosterone. When cortisol is consistently high, it can down-regulate thyroid activity and suppress reproductive hormone output, which may show up as irregular or painful periods, low libido, fatigue, increase in PMS, and/or difficulty with fertility.

Finally, cortisol is often described as anti-inflammatory, and it is! One of its primary roles is to help the body resolve inflammation after a stressor, infection, or injury. It works by dampening the immune response and calming overactive cytokine activity. But when cortisol becomes dysregulated, this system stops working the way it should. In cases of chronic stress and persistently elevated cortisol, the body can develop a kind of cortisol resistance, where tissues stop responding to its signals effectively and inflammation remains elevated. It’s similar to how insulin resistance works: the message keeps getting sent, but the cells stop listening. On the flip side, if cortisol production becomes depleted, the body can’t mount a proper anti-inflammatory response when it needs to — so inflammation lingers and becomes chronic. Either way, what starts as a protective mechanism ends up fueling low-grade inflammation throughout the body, contributing to symptoms like joint pain, brain fog, skin issues, gut problems, and even autoimmune flare-ups. So while cortisol is technically anti-inflammatory, its dysregulation is often a key driver of the very inflammation it's meant to control.

How to Test Cortisol

There are a few ways to evaluate cortisol levels:

• Blood cortisol is most useful for diagnosing serious conditions like Addison’s or Cushing’s but doesn’t show patterns across the day.

• Saliva testing offers a 4-point reading across the day, revealing your diurnal rhythm (wake-up spike, afternoon dip, bedtime drop).

• Urine testing (like DUTCH) offers a 4-point reading across the day and can show cortisol metabolites to give insight into how you’re producing and clearing cortisol over 24 hours.

The best test often depends on the person and what we’re trying to uncover. Saliva and urine are typically the most useful for functional medicine assessments. I personally utilize the DUTCH urine testing the most frequently in my practice.

How to Support Cortisol with Lifestyle

Cortisol thrives on rhythm, safety, and consistency. While supplements and herbs can offer support, it’s your daily habits that do the heavy lifting when it comes to recalibrating cortisol. Here’s how to create an environment that helps your HPA axis feel regulated and supported:

• Prioritize consistent, high-quality sleep: Cortisol and melatonin exist in a dance. When one rises, the other falls. Getting to bed before 11 p.m. helps preserve that rhythm and encourages the natural nighttime dip in cortisol. Aim for 7–9 hours of uninterrupted sleep, keep your room cool and dark, and avoid bright screens in the hour before bed. Morning sunlight exposure also helps anchor your cortisol awakening response so try to get outside within 30–60 minutes of waking, even for just 10 minutes.

• Eat in regular intervals to support blood sugar stability: Cortisol is one of the body’s backup systems when blood sugar drops too low. Skipping meals, under-eating, or relying on sugar-heavy snacks can push cortisol to overcompensate. Eating every 3–5 hours with a combination of protein, healthy fat, and fiber helps keep blood sugar balanced, so cortisol doesn’t have to step in as often. This is especially important for those with low cortisol or those recovering from burnout.

• Balance your movement: Movement is one of the best ways to regulate the nervous system and support cortisol, but only when matched to your current capacity. For those with high cortisol, favor lower-intensity movement like walking, Pilates, mobility work, or gentle strength training. For those with low cortisol and exhaustion, start slow — walking in nature, stretching, or even light yoga can be powerful. High-intensity exercise like HIIT or long-distance running may be beneficial once your energy and sleep have improved, but can be too taxing during recovery phases.

• Limit caffeine, especially in the morning on an empty stomach: While coffee can feel like a lifeline during fatigue, it spikes cortisol and can interfere with your natural cortisol rhythm, especially if consumed before eating or later in the day. If you’re dealing with cortisol dysregulation, try delaying caffeine until after breakfast, switch to gentler options like matcha, or reduce your overall intake. A few weeks without stimulants can give your HPA axis the space to reset.

• Build in daily stress-relief rituals: You don’t need a perfect morning routine to heal your cortisol, but small consistent practices make a big difference. Breath work, leg up the wall, journaling, creative hobbies, time in nature, or even a few deep exhales between tasks all help signal to your nervous system that you’re safe. The key is consistency — choose a few simple tools that feel good and do them often.

• Address emotional stress and practice nervous system regulation: Chronic stress isn’t just about what’s happening outside of you — it’s also what’s going on inside. Learning to regulate your nervous system through somatic tools, therapy, inner child work, or trauma healing can shift your baseline state from fight-or-flight to rest-and-repair. The more often your system feels safe, the less cortisol it will need to produce to stay alert.

• Create structure and rhythm in your day: The HPA axis responds well to predictability. Waking, eating, moving, and resting around the same time each day supports hormonal balance. Having an actual wind-down routine in the evening tells your body that it’s safe to turn off and recover — dim lighting, magnesium, herbal tea, screens off, maybe even a warm shower or gentle stretching.

• Reduce your exposure to “invisible” stressors: Not all stressors are obvious. Exposure to blue light at night, constant phone notifications, loud environments, processed foods, alcohol, and even scrolling social media all register as stress to the body. While you don’t need to eliminate everything, minimizing these modern inputs (especially in the evening) can lower the baseline load on your adrenals.

• Make time for real connection and joy: Positive social interaction is one of the most healing things for your nervous system. Laughter, hugs, deep conversation, play, and affection all release oxytocin and lower cortisol. Make space for joy —whether it’s music, dancing, gardening, cooking with a friend, or anything that makes you lose track of time in a good way.

Supplements to Support Cortisol Health

When it comes to supporting cortisol, supplements can be a powerful tool especially when paired with the right lifestyle changes. They can help smooth out the recovery process, calm the nervous system, and fill in nutritional gaps that may be keeping the adrenals from functioning optimally.

Foundational nutrients like magnesium, vitamin C, and B vitamins are essential here. Magnesium (especially in forms like glycinate or threonate) supports relaxation and deep sleep, both of which are critical for healthy cortisol regulation. Vitamin C helps fuel the adrenal glands directly and is often depleted during times of chronic stress. B vitamins, particularly B5 and B6, play a role in adrenal hormone synthesis and energy metabolism.

If cortisol is especially high at night, phosphatidylserine can be helpful — it’s been shown to blunt evening cortisol spikes and improve sleep quality. This is one of my favorite tools to use in patients who feel wired but tired at night and have a tough time getting deep rest.

Herbs for Cortisol: Adaptogens vs. Nervines

When we talk about herbal support for cortisol, it usually falls into two categories: adaptogens and nervines. These two groups of herbs work differently, but both are incredibly valuable when supporting HPA axis regulation.

Adaptogens are herbs that help the body adapt to stress. They’re not stimulants and they’re not sedatives — they’re modulators. Think of them like a thermostat that helps keep your stress response within a healthy range. If cortisol is too high, the right adaptogen can help bring it down. If it’s too low, the right one can help bring it back up. Not all adaptogens are interchangeable though — they each have a personality and knowing when to use which one makes a big difference.

• For high cortisol patterns, calming adaptogens are ideal. Ashwagandha is a pretty popular choice — it helps reduce cortisol and improve sleep while supporting overall resilience. Holy basil is another gentle adaptogen that soothes the nervous system and lifts mood. Reishi mushroom can also help regulate high cortisol and support deep rest.

• For low cortisol, more stimulating adaptogens can help rebuild stamina and energy over time. Rhodiola is a great choice for mental clarity and endurance, especially in the morning. Eleuthero supports energy, immune function, and helps buffer the effects of chronic stress. Schisandra is another lesser known adaptogen that supports liver detoxification and physical endurance, while also modulating cortisol output.

• For mixed patterns, a blended adaptogen formula may work best. Combining something calming (like ashwagandha or holy basil) with something more energizing (like rhodiola or schisandra) can help gently restore rhythm without overstimulating.

Nervines, on the other hand, are herbs that work more directly on the nervous system. While adaptogens support the HPA axis, nervines help calm the sensory overload and emotional intensity that often accompanies cortisol dysregulation. They’re especially helpful for people who feel frazzled, reactive, or emotionally drained — think of them like a cozy blanket for your nervous system.

• Chamomile, lemon balm, and passionflower are great choices for evening use, especially if stress is interfering with sleep. Skullcap is a beautiful option for those with racing thoughts or tension in the body. Milky oats is a deeply nourishing tonic for those recovering from long-term stress or burnout, especially when emotions feel blunted or depleted.

You don’t always have to choose between the two categories — they can be layered together. For example, someone with high cortisol and poor sleep might pair ashwagandha with passionflower. Someone with low cortisol and anxious fatigue could combine rhodiola with milky oats to support both energy and emotional calm.

Final Thoughts

Cortisol isn’t the enemy. It’s a survival hormone, a wake-up hormone, a resilience hormone. The goal isn’t to have “low” cortisol — it’s to have the right amount at the right time, in a rhythm that supports energy during the day and rest at night. Most of us are somewhere on the cortisol rollercoaster, especially in a world that glorifies hustle and rarely values rest.

But your body wants to be in balance. With the right inputs (sleep, nourishment, movement, boundaries, and yes, the occasional adaptogen) it’s absolutely possible to restore that rhythm and feel like yourself again.