One fifth of family medicine patients present with fatigue, and one third of adolescents report having fatigue at least four days per week. Fatigue can negatively affect work performance, family and social relationships.  At STAT you’ll often hear one of our providers referencing our treatment pyramid. The base being the foundation: lifestyle modifications which includes diet, exercise, sleep and stress management.  Stress management can be the last thing on our minds until we start having symptoms and go searching for answers. Cortisol is a hormone that can be responsible and commonly goes unaddressed.

What is cortisol?

Cortisol is a steroid hormone made in the adrenal glands and released into the blood, which is transported around the body having an effect on many systems including the endocrine, metabolic, reproduction systems and immune response. Cortisol is necessary to adapt to stressful moments such as avoiding a car accident. This protective mechanism is needed to provide the hormonal support to encourage focus, stamina, and blood sugar support to supply our brain and muscles with the fuel needed to fight-or-flee.

When living in a state of chronic or long term stress and higher than normal levels of cortisol you may experience these symptoms:

  • Fatigue/exhaustion
  • Insomnia
  • Weight change: gain or lose
  • Digestive disturbances
  • Hypertension
  • Decreased libido
  • Mood disturbance
  • Menstrual irregularity
  • Brian fog
  • Frequent illness and slow healing

Cortisol levels Influence the following functions:

  • Thyroid: Cortisol inhibits the conversion of T4 to active T3, and increases the conversion of T4 to reverse T3 leading to hypothyroid type symptoms
  • Blood sugar: elevated insulin and blood glucose
  • Gut health: cortisol increases immune response and inflammation which can damage the gut lining. Cortisol also shunts energy way the gut during times of stress slowing digestion and motility.
  • Reproduction: changes to the reproductive system is a protective mechanism to decrease ability to conceive during times of high stress. Cortisol can cause a  slowing of LH pulse frequency reflecting a decreased GnRH activity which affects ability to ovulate causing menstrual abnormalities and an impairs implantation.
  • Sleep and energy: Cortisol is a hormone that fluctuates in response to stress, perceived positive or negative. The ideal pattern of cortisol release starts at its highest point in the morning giving you the energy and motivation to get out of bed and start your day. The cortisol slowly decreases throughout the day being at its lowest point at night time, allowing you to rest. Dysregulation of this pattern can result in difficulty waking, midday fatigue having an inability to fall asleep or waking in the night and being unable to fall back asleep.

What can you do to regulate cortisol?

  • Identify triggers causing stress on the body: Possible drivers could include toxins, work or family stress, trauma, food sensitivity, over-exercising, medications– there are many causes that can compound cortisol dysregulation.
  • Get enough quality sleep: Lack of sleep impairs our immune system, placing stress on the body resulting in increased cortisol.  The goal is to get 7-8 hours of uninterrupted sleep. A few ways to support:
    • Support quality sleep by sticking to a regular sleep/wake schedule,
    • LIGHT: getting natural light during daytime hours and limiting light exposure in the evening.
    • Avoid computers, phones, and tv for 1-2 hours before
    • Avoid stimulants later in the day such as caffeine.
  • Support your adrenals with good nutrition. Anti-inflammatory foods can help mediate the effects of high stress on our body systems.
  • Adding natural supplementation to rebalance brain-adrenal connection.
  • Practice active stress reduction with yoga, meditation and mindfulness, deep breathing, gratitude,

Consider a functional medicine visit to get to the root of your symptoms. At STAT Wellness, we take a deeper dive into what you are experiencing and help find out WHY. During a medical visit with one of our providers, we will help identify the root cause of symptoms and evaluate diagnostics testing in developing a treatment plan.

Diagnostic testing:

  • Comprehensive wellness panel: Within our wellness panel we analyze the quality of your blood, liver, kidney, blood sugar, cholesterol, vitamins and nutrients, and hormones such as cortisol and DHEA which are produced by the adrenal glands in response to physical and emotional stress. This lab is ideally drawn within one hour of waking, fasting when our cortisol should be at its highest point for the day. While this is a useful test, it only gives us a snapshot of one moment in time– when the blood is drawn. For some patients we need to dive deeper to see how our adrenal glands are functioning throughout the day.
  • Adrenal saliva test: This is collected at home at 4 points throughout the day to get a better sense of how your adrenals are responding throughout the day by looking at cortisol and DHEA hormones. While this test is useful, it doesn’t give insight into how we’re metabolizing and clearing the cortisol we make.
  • DUTCH test (Dried Urine Test for Comprehensive Hormones) which looks at a number of hormones levels. This test is particularly useful because it gives total output of metabolized cortisol to assess not just production of stress hormones but also how we’re metabolizing and clearing them.  Other hormones measured in the DUTCH test include DHEA, estrogen, progesterone, testosterone, epinephrine and norepinephrine to name a few. This test collects 4 samples over the course of two days and gives a much larger and detailed picture of hormonal function.

With the results of these tests, your provider can make recommendations for treatment, diet and lifestyle adjustments to help you thrive because wellness feels good.

The adrenal saliva test and DUTCH test can be mailed to you and we can review the results virtual through out telehealth platform during this tough time. What better time to invest in your health!

If you’re looking for an in depth look at how stress is affecting your health, you can schedule a wellness appointment with Athena Newell, FNP, Kristin Oja, DNP , or Kyle Compaan, FNP here!

Meet the Author:

Athena Newell, FNP

Athena is a Nurse Practitioner and mom of two. She has bachelors degrees in both Nursing and Exercise Science as well as a Masters in Nursing Practice. When Athena’s not seeing patients at STAT Wellness, you can find her hanging out with her kiddos, getting in some exercise, or cooking a deliciously healthy meal.