Corey Schuler, MS, DC, LN, CNS of Integrative Therapeutics
Most integrative medicine practitioners know a fair amount about cortisol. Many patients have an understanding about cortisol. Conventional medicine practitioners test for cortisol when they suspect certain conditions. However, there may be things that even the most astute practitioners may not be aware of as it relates to factors affecting cortisol.
Cortisol has fallen victim to clinical factoids. We learn about cortisol through sound bites. Stress causes cortisol release. Cortisol is produced in the adrenal cortex. ACTH (adrenocorticotropic hormone) from the pituitary gland stimulates cortisol release. Cortisol is produced in highest concentrations in the morning in a healthy person. Cortisol stimulates fat deposition. Cortisol is related to blood sugar. Cortisol can be measured in blood, saliva, and urine. And the list goes on.
Factors affecting cortisol really have two categories: those things that change cortisol awakening response and those things that mediate how a person responds to submaximal stressors.
Major factors that affect how much cortisol is produced within the first 30-45 minutes of wakening include

  • Being a “morning person” versus being a “night owl” ,
  • Restricted sleep (alarm clock)
  • Bright light 800+ Lux
  • Abrupt shifts in awakening time
  • Situational (psychological and social) factors ,

Whenever we see lower than expected cortisol production within the first 30-45 minutes of the day , an assumption, which is often correct, is made that the individual tested is in late-stage hypothalamic-pituitary-adrenal (HPA) axis function. Interventions are typically aimed at increasing measured cortisol levels while eliminating or mediating contributing environmental stressors. This requires reviving not only the adrenal cortex, but also retraining these neuroendocrine tissues to be more responsive to stimuli.
The example of a morning person versus a night owl is particularly illustrative. Someone who reports being a “morning person” yet also has normal or low normal morning cortisol production may in fact be a false negative for late stage HPA axis function since they have a naturally high cortisol production in the morning. Make sense?
High morning cortisol is associated positively with amount of perceived chronic stress and perceived loneliness. Again, this is ripe for false negatives.
Morning cortisol is altered in chronically stressed care-givers, victims of bullying/ mobbing (bullying at work), and those suffering from burnout/ vital exhaustion. Because cortisol production is not necessarily in excess or insufficient, these patients are often categorized with mid-stage HPA axis function. Interventions for these individuals include supporting adaptation of the HPA axis.
Factors affecting cortisol production throughout the rest of the day include

  • Smoking
  • Caffeine
  • Alcohol
  • Excess glycemic load/ excess energy , ,
  • And of course, submaximal psychological or social stress

High levels of cortisol production throughout the day often place a person in early-stage HPA function. Typically interventions include those things that manage cortisol production as well as determining the causes of increased production.

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