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What is Cortisol? The meaning of high and low level

Cortisol, or stress hormone, is the main steroid hormone responsible for managing stress. In other words, it is secreted as a natural-protective response when our body detects a threat. It helps to check blood pressure-blood glucose levels, maintain immune function and prevent inflammatory reaction. It is a healthy stimulant when it is released in sufficient amount, but it can cause damage to health when the level increases. The level of cortisol is usually regulated by the body. However, high stress or cortisone drug therapies may increase the level of cortisol. It can lead to weight gain, hypertension, sleep disorder, psychological problems, low energy, and diabetes. Managing stress is the best way to lower the cortisol.

What is cortisol?

Cortisol is the primary hormone produced in the adrenal glands that is released in stressful situations. This vital hormone is continuously released in varying proportions throughout the day. Its release increases in stress moments, and it balances the reactions of the body.

What does cortisol do?

Its main task is to stimulate the body’s defense mechanisms against physical, mental and mental stress. When the hypothalamus in the brain becomes alarmed in the event of a threat, the pituitary gland triggers the adrenal glands by secreting a chemical hormone (adrenocorticotropic) to produce the required amount of cortisol.

This allows the body to quickly respond to the situation at hand, and adopt a survival posture such as fighting, escaping or freezing.

Roles of cortisol in the body

Since most of the cells have cortisol receptors, this hormone performs vital tasks in the body when released into the bloodstream. The most important task is to suppress body reactions such as rapid heartbeat, stomach disorder, diarrhea, dry mouth and panic. Other duties include:

  • Converting protein to glucose to increase blood sugar level (and therefore energy)
  • Keeping blood pressure under control
  • Preventing the development of sudden infection
  • Helping to regulate the immune system
  • Increasing the body’s defense mechanism by producing antibodies
  • Managing carbohydrate, fat and protein use
  • Organizing the sleep-wake up cycle
  • Preserving memory
  • Controlling the salt-water balance.

Effects of cortisol on health

Short-term secreted cortisol increases body resistance. Health effects depend on how often the hormone is circulating in the body.

Cortisol and stress

Cortisol, which is secreted under stress, keeps the blood sugar in the bloodstream, since the muscles use it for energy. It does this by suppressing insulin, which adjusts the blood sugar content. So that blood sugar can be used easily, instead of being stored. It also narrows the arteries to increase blood pressure. The person in danger will fight or escape.

Cortisol and diabetes

Cortisol is a major contributor to high blood sugar, insulin resistance and diabetes. When the body encounters stress, the hormone cortisol increases its blood sugar levels by preventing insulin from performing its function. Insulin resistance may develop if insulin is constantly suppressed with chronic stress, and then the risk of diabetes increases.

Cortisol and hypertension

Th;s hormone increases the blood pressure by narrowing the arteries in order to reduce the effects of stress on the body, and to achieve balance. If this condition persists, the constantly rising blood pressure can damage the blood vessels and causes hypertension or even a heart attack.

Cortisol and immune system

When inflammation occurs in the body, the release of cortisol increases. This is good against sudden dangers, but high level of chronic stress hormone weakens the immune system, and makes the person more vulnerable to diseases. It can also trigger auto-immune diseases where the immune system mistakenly attacks one’s own body.

Cortisol and depression

Irregular levels of cortisol may also cause depression and sometimes engender a sense of panic. Anxieties may develop. Especially high cholesterol plays an important role in depression. In addition, prolonged cortisol release may slow or reduce the production of nerve cells in hippocampus, memory center in the brain . This can lead to serious memory problems, even Alzheimer’s disease.

Cortisol and sexuality

Over-release of cortisol may adversely affect sexual performance. In particular, cortisol excess in the blood can inhibit sexual activity and reproductive system by suppressing dehydroepiandrosterone (DHEA), steroid hormones in the adrenal glands.

Besides, it can cause decreased production of testosterone in men, the reduction of testicles and impotence. It may increase the risk of ovarian shrinkage and infertility in women. The risk during pregnancy is premature birth and miscarriage.

Cortisol and Cushing Syndrome

An excess of cortisol in the blood may cause “Cushing Syndrome”. Cortisone drugs are active in the development of this syndrome. Since tumors in any part of the body (especially in the pituitary and adrenal glands) can increase the production of cortisol, they may cause Cushing’s syndrome. The most common symptoms are weight gain, hypertension, memory problems, loss of attention and concentration.

Cushing’s syndrome can lead to osteoporosis, muscle weakness, increased thirst, frequent urination, bruises and cracks in the skin, facial rash and sexual reluctance.

Cortisol test

It is used to investigate problems with the pituitary or adrenal gland and to diagnose Cushing’s syndrome or Addison’s disease. Since this hormone can be found all over our body, it can be measured from blood, urine and saliva.

  • Cortisol blood test: Blood tests are widely applied. The timing of the test is important because cortisol levels change throughout the day. Usually 2 measurements per day are done (in the mornings where cortisol is high, in the afternoons where cortisol falls).
  • Cortisol Urine Test: This test is also called a 24-hour urine specimen test. It can be used to achieve more precise results. Samples are collected at home following the instructions of the health practitioner. The first urine sample is collected in the morning. Additional urine samples will be taken throughout the day, noting down the hour. Samples collected in individual containers are kept in the refrigerator. The next day, they are delivered to the laboratory.
  • Cortisol saliva test: It is usually administered at home late at night (around 23.00 pm) when cortisol levels are low. Nothing is eaten and drunk, the teeth are not brushed 15 min. before the test. A rod is used for sampling and rounded and covered with saliva, then placed in a container. It is important that the fingers do not touch the end of the rod. The next day the sample is given to the laboratory.

What should be the cortisol level?

Normal cortisol values in adults are as follows:

  • Morning: 0,25-0,60 mg/dl
  • Noon: 0,08-0,20 mg/dl
  • Evening: 0,04-0,13 mgr/dl
  • Night: 0,02-0,07 mgr/dl

Reference values and results vary depending on the method used by the laboratory, age, gender, health history and sleep patterns of the person.

Causes of cortisol deficiency

Cortisol deficiency occurs when the adrenal glands do not produce enough cortisol. Main reasons:

  • Pituitary gland damaged by tumor or head trauma
  • Disfunction of the adrenal glands
  • Loss of function or surgical removal of adrenal glands

Other diseases such as excessive blood loss, tuberculosis, AIDS, congenital adrenal hyperplasia (an enzyme disorder) can also lead to cortisol deficiency.

What kind of health problems does cortisol deficiency cause?

Cortisol deficiency may cause Addison’s disease (primary adrenal insufficiency). It is a rare autoimmune disease that harms the adrenal glands. Symptoms usually start slow, but may be serious. Among main symptoms are excessive fatigue, excessive muscle-weight loss, skin changes and mood changes.

Symptoms of cortisol deficiency

  • Continuous fatigue, headache, weakness, orthostatic hypotension and dizziness.
  • Nausea, vomiting, diarrhea are common
  • It progresses to irritability and depression unless treated.
  • Pain in the abdomen, back and legs, collapse of blood vessels
  • Infection, or an autoimmune disorder often develops.
  • Fever, immune system weakness and disturbance of sleep patterns may also occur.

Treatment of cortisol deficiency

If cortisol deficiency is suspected, first a cortisol blood test is performed. If the deficiency is of a small amount, drug treatment is not usually used, but if cortisol is considerably high, hydrocortisone or prednisone medication is used. In addition, at least 8 hours of sleep, stress avoidance, balanced-healthy nutrition can be suggested. Vitamin C supplements can be added to the nutrition program to support the body’s immune system.

Cortisone drugs

Synthetic cortisol hormones similar to the ones produced in the body are called cortisone, which are included in the corticosteroid medication group.

The type of medication to be used in treatment depends on the person’s condition:

  • Creams: Applied to the affected areas of the skin.
  • Tablets: The dosage varies, but usually the lowest dose is used.
  • Injections: To prevent side effects of tablets, they are injected directly into the affected joints, especially in arthritis disorders.
  • Inhalers: They are used in the treatment of inflammation in the lungs or sinuses.

Cortisol drugs are generally used for skin diseases such as psoriasis, asthma, ulcerative colitis, lupus, some types of arthritis, especially immune-related cancers such as leukemia and lymphoma, and Addison’s disease. This group of drugs is used to prevent the body from rejecting the organ in the organ transplantation, since it prevents the immune response of the body. In high doses or long-term use, a number of complications may occur, such as osteoporosis and diabetes.

With the use of high-dose corticosteroids for a long time, cortisol production is significantly reduced and the pituitary and adrenal glands may be impaired. If the medication ceases suddenly, cortisol deficiency may develop with sudden symptoms such as shock. If this is the case, you should see your doctor.

What causes high cortisol?

Excessive stress, birth control pills, drugs containing high doses of cortisone are the main causes of cortisol elevation. In addition, adrenal gland related diseases, tumors, excessive secretion of thyroid hormone can lead to high cortisol.

What kind of health problems does high cortisol cause?

  • Chronic complications: High blood pressure causes such disorders as type 2 diabetes. Osteoporosis can develop by suppressing collagen formation in muscles, tendons and joints, as well as in the whole body, which is vital for structural support. Muscles and bones can begin to weaken.
  • Weight gain: It increases appetite, changes the metabolism to store fat into the body, and creates the risk of obesity.
  • Excessive fatigue: It interferes with the daily cycle of other hormones, disrupts sleep patterns and causes fatigue.
  • Weakened brain function: It contributes to memory loss, learning disability and mental blur.
  • Infections: It inhibits the immune system and weakens the person against infections.
  • Cushing syndrome: Very high levels of cortisol can cause this syndrome, which is a rare but serious condition.
  • In addition; the cells and immune system work quickly and get sensitive to damages. Period irregularities in women and impotence in men can also occur.

Symptoms of high cortisol

  • Weight gain, especially around the abdomen and face
  • Thin and fragile skin that does not heal quickly
  • Acne
  • Facial hair growth in women

Treatment of cortisol elevation

Usually, the underlying cause is investigated and, depending on the situation, drug therapy is applied, which reduces cortisol release (such as Nizoral and Metopirone). If the cause of the elevation is a tumor that develops in the adrenal glands, treatments such as radiotherapy and chemotherapy begin. If the tumor is in advanced stage, adrenal glands may be removed.

What to do to reduce cortisol levels?

Factors that can reduce hormone production and negative effects of high levels of cortisol are balanced nutrition, timely rest and physical exercise.

Eat healthy

A nutritionally rich diet with fibers, antioxidants and healthy fats such as omega-3 is effective in stabilizing the level of cortisol. Be careful not to consume excessive coffee, packaged foods, to avoid alcohol and sugary drinks, not to consume large amounts of protein and fatty foods. Sugar should be used with caution. Vitamin C, magnesium, fish oil supplements should be taken.

Cortisol reducing foods

  • Dark chocolate
  • Bananas, pears and all citrus fruits
  • Probiotics such as yogurt, pickles
  • Seafood rich in omega-3 such as salmon, oysters
  • Olive oil
  • Garlic
  • Oats
  • Black tea and chamomile tea
  • Plenty of water

Side effects of cortisol

  • Cortisol leads to weight gain,
  • Affects the brain,
  • Weakens the immune system,
  • Contributes to developing cardiovascular diseases,
  • Causes bone resorption,
  • Inhibits sexual function,
  • Makes muscle formation difficult,
  • Delays recovery,
  • Increases anxiety and depression,
  • May cause mental illness.

Recommendations for people with cortisol problems

  • Learn how to cope with stress: Meditation or yoga can help reduce stress.
  • Adjust your sleep: Pay attention to the amount and quality of your sleep. Do not consume caffeinated drinks in the evening. Limit fluid intake near bedtime. Prepare yourself to sleep before bedtime.
  • Relax: Have some relaxing hobbies or engage in activities, such as listening to music or jigsaw puzzles.
  • Exercise: Do light exercises like walking at least 30 min. every day (Intensive exercise may increase cortisol levels.)
  • Socialize: Try to have fun with positive people around you.
  • Have pets: Close contact with animals such as dogs can reduce cortisol levels.

References: 1- Cortisol Test, 2- Cortisol and corticosteroids, 3- The role of cortisol in the body

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