Stressed out and exhausted? You might have a cortisol imbalance

Everyone experiences stress from time to time. Some people experience it more intensely and more frequently than others, but no matter how "normal" you think stress is for you, there's a point that indicates things are out of hand. 

That point is an imbalance in cortisol levels. 

Excessively high or low levels of cortisol can leave you feeling like you're a hamster in a running wheel. If you think you might be battling wacked-out adrenal glands, keep reading -- three hormone health experts share what it's like to experience a cortisol imbalance and how to fix it. 

What is cortisol? 

Cortisol is the body's primary stress hormone, says Melissa Groves Azzaro, a registered dietitian and author of A Balanced Approach to PCOS. The hormone is produced in the adrenal glands in response to internal or external stressors. 

Most people know cortisol for its role in the "fight-or-flight" response, which is important, but cortisol actually plays many other roles in the body. 

In addition to curbing any body functions that are nonessential in a fight-or-flight scenario, cortisol also: 

• Helps control blood sugar levels and blood pressure
• Acts as an anti-inflammatory
• Assists with memory formation
• Regulates metabolism 

The majority of your body's cells contain cortisol receptors, so it's a really important hormone, but like any hormone, too much or too little of it can be detrimental to your body and health. 

Signs of cortisol imbalance 

Everyone's exact experience with cortisol imbalance will differ, particularly when it comes to differentiating between high and low cortisol. 

Symptoms of high cortisol include:

• Weight gain, especially in the abdominal area
• Anxiety and irritability
• Trouble falling asleep and staying asleep
• Nervousness 
• Shakiness
• High heart rate
• Blood sugar and blood pressure instability

Symptoms of low cortisol include:

• All-day low energy
• Feeling "wired but tired" 
• Severe fatigue and lack of focus
• Sugar and salt cravings
• Apathy
• Low libido 
• Memory problems 

What causes cortisol imbalances? 

"Generally a cortisol imbalance can come about due to extremely high stress or prolonged stress," Azzarro says. "While there are clinical diagnoses of high (Cushing syndrome) and low (Addison's disease), which require medical treatment, there is a large spectrum of 'out of range' cortisol levels or inappropriate cortisol patterns that can affect our day-to-day lives," she explains.

Importantly, cortisol imbalances aren't always a simple matter of high or low. Having a cortisol imbalance can also mean your cortisol is too high at certain times of day or too low at other times, rather than a constant surplus or shortage.

Regardless, there are some common culprits behind cortisol imbalances of every type. 

Stress

Excessive and prolonged stress is the primary cause of cortisol imbalance, whether high or low. 

"High cortisol happens when the body perceives a stressor," says Dr. Tara Scott, a functional medicine doctor. "Your brain doesn't know if you are running from a bear or have a deadline at work." 

Excess cortisol increases your heart rate, makes you more alert by increasing norepinephrine (a neurotransmitter that can also make you feel anxious) and increases your blood sugar, Scott explains. 

"Low cortisol occurs after prolonged stress, when your body sends a negative feedback signal to the brain saying, 'We have plenty of cortisol down here, don't stimulate more production!'" Scott says. 

So your brain decreases adrenocorticotropic hormone (ACTH, the hormone that stimulates production of cortisol), and periods of low cortisol occur. Levels may fluctuate during the day or can be low all day long, Scott says.

Exercise

Exercise is considered eustress, or good stress, Azzaro says -- up to a point. "While there is an immediate rise in cortisol with exercise, the overall impact is to improve mood and lower stress. But if we overexercise, the stress becomes detrimental," she says. 

Azzaro recommends considering your overall life stress when planning an exercise regimen. If you aren't getting enough sleep and you're battling high stress at work, it may not be the best time for you to incorporate high-intensity exercise, Azzaro explains. 

"If you are finding yourself getting sick more often or feeling depleted after a workout, rather than energized, you are probably working out too hard for your current cortisol levels," she says.

Nutrition

The foods we eat can help reduce cortisol or spike it, says Lauren Minchen, registered dietitian and nutrition consultant for Freshbit. "Processed foods that are rich in carbs and sugar may immediately help lower cortisol at first, but the blood sugar spike caused by these foods can actually over time increase stress, inflammation and cortisol levels in the body," Minchen says. 

"Sugar is known for being one of the biggest cortisol triggers, and white refined flour foods produce a similar blood sugar spike and cortisol effect, so eating foods high in these ingredients regularly can lead to elevated cortisol over time."

Alcohol and caffeine also impact your cortisol levels, and consuming too much of either or both over time impacts your cortisol levels. Alcohol increases inflammation, which places stress on the body, triggering cortisol production. Withdrawal from intoxication also stimulates more cortisol in the bloodstream, Minchen says.

"Depending on how much coffee one regularly drinks and how high their cortisol levels are day to day, increasing caffeine intake may have little to no effect on raising cortisol even more," Minchen says. "This effect may lead to actually feeling more tired with more caffeine, due to adrenal gland burnout. The adrenals can only work so hard before they are no longer able to keep increasing cortisol production."

On the flip side, eating healthy whole-food carbs, such whole grains, fresh fruit, legumes and potatoes, can provide help with cortisol management. Also, consuming a balanced amount of protein, carbs and fats helps your body receive the energy it needs to keep blood sugar available and stable, which ultimately helps keep cortisol under control, Minchen says.

How to fix high or low cortisol 

"It's not super sexy," Azzaro says, "but your body is telling you to rest. The dirty work of correcting a cortisol imbalance is to identify what the root cause of the imbalance is and then correct that to bring cortisol back into balance."

We discussed general causes of cortisol imbalance above, but dig deeper. Go past "diet" or "exercise" and ask yourself if your hormone levels are wacky because of: 

• Your job 
• Relationship stress (significant other or family)
• Hustle culture/doing too much
• Lack of sleep 
• Too much of one type of exercise (probably HIIT) 
• Alcohol or caffeine consumption
• Lack of mindfulness or stress-management practices

Also, it's important to identify your specific imbalance, says Inna Lukyanovsky, a pharmacist and functional medical doctor. Ask your primary care provider if they run hormone tests or if they can get you a referral to an endocrine specialist. Or order an online cortisol test to take at home and send to a lab. 

This step is crucial because what works to correct a high cortisol level may not work to correct a low cortisol level. To really get to the root cause, "Testing ideally should be for both cortisol, DHEA, sex hormones and even melatonin just to see a better picture of one's adrenal health," Lukyanovsky says. Your symptoms might be the product of multiple hormone imbalances.

Fixing a cortisol imbalance will take a lot of work and patience. First and foremost, get some rest. When you do feel rested, try making a list of all possible stressors in your life -- and be honest.

Then write down how you could go about reducing each stressor. Maybe you reduce your weekly workout routine from five sessions to four; maybe you have a serious talk with your partner about stress levels and home responsibilities; maybe you ask your boss to lighten your load at work for a while (or even better, take some time off completely). 

High or low cortisol levels can make life much harder than it should be. Battling constant stress, anxiety and fatigue is not easy, and as always, if you need mental health support, use the resources available to you.