What is Cortisol and How is it Produced?
Better Health Channel (2017) describes cortisol as being a hormone produced by the two adrenal glands, into the bloodstream (Healthdirect 2016). There is one adrenal gland found on the top of each of the two kidneys (Better Health Channel 2017; Healthdirect 2016). The pituitary gland in the brain regulates how much cortisol is produced by the adrenal glands (Better Health Channel 2017). It does this by sending a signal to the adrenal glands to secrete the correct amount of cortisol (Healthdirect 2016).
How is Cortisol Used by the Body?
Cortisol is referred to as ‘essential for life’ due to its ability to:
- Maintain consistent blood pressure
- Maintain immune function
- Decrease inflammation
- Manage stress
- Collaborate with the hormone insulin to maintain blood sugar levels
- ‘convert protein into glucose to boost flagging blood sugar levels’
- Improve glucose metabolism
- React to dangers via the ‘fight or flight’ response
(Better Health Channel 2017; Healthdirect 2016)
What is Cortisol’s Role in the Stress Response?
Mayo Clinic Staff (2016) describe that the natural stress response is as follows:
- Perceived threat when a trigger/risk of danger presents (e.g. dog barking)
- The very small area of the brain, called the hypothalamus, alarms the body
- Nerve and hormone signals lead to the adrenal glands’ production of hormones inclusive of adrenaline and cortisol
- Adrenaline increases pulse rate, blood pressure and energy supply
- Cortisol is the chief stress hormone, and it increases: glucose in the bloodstream; the brain’s use of glucose; and, tissue repair constituent accessibility
- Cortisol lowers non-essential bodily functions that could prevent the effectiveness of the fight or flight response (e.g. digestion, growth, and reproduction)
- The stress response affects brain areas responsible for mood, fear and motivation also.
Whilst this stress response normally stops once the perceived threat has disappeared, some people experience long-term fight-or-flight response. This means that some people will experience ongoing or repeat exposure to excessive cortisol and related stress hormones (Mayo Clinic Staff 2016). Evidently, this means that other bodily functions are repeatedly or chronically affected (Mayo Clinic Staff 2016). This leads to the following issues:
- Digestive problems
- Heart disease
- Sleep problems
- Weight gain
- Memory and concentration impairment
- That’s why it’s so important to learn healthy ways to cope with the stressors in your life.’
(Mayo Clinic Staff 2016)
Burns (2017) explains that cortisol has also been associated with post-traumatic stress disorder (PTSD). Additionally, clients that experience ongoing/chronic stress and affected cortisol levels, are at risk of hypertension, heart disease, and ulcers (Burns 2017). Burns (2017) states that cortisol is a biomarker for stress and it can evidently foresee the development of certain mental and physical health conditions. Burns (2017) claims that hair cortisol collection may be more valid and beneficial than other forms of collection such as via urine, serum or saliva.
Excessive cortisol can result in Cushing’s Syndrome (hypercortisolism) (Better Health Channel 2017). This condition can be caused by (Better Health Channel 2017):
- Taking high doses of oral corticosteroid medications (e.g. to manage inflammatory diseases such as lupus)
Signs of Too Much Cortisol
Some of the signs that a person may be experiencing excessive cortisol, are (Healthdirect 2016):
- Weight gain namely at the face and abdomen
- Thin, fragile skin
- Slow-healing skin
- Facial hair in women
- Irregular menstrual periods for women
How can you help a client to deal with excessive or repeated cortisol in the body?
It is important to help clients deal with chronic or repeated excessive cortisol in their body by helping them to understand that each person experiences stress uniquely and responds to stress individually (Mayo Clinic Staff 2016). For example, genetic differences between individuals may mean that some people experience underactive or overactive stress responses (Mayo Clinic Staff 2016). Unique life events can mean for example that a person that has experienced trauma may have increased stress responses in comparison to a person that has not experienced trauma (Mayo Clinic Staff 2016). Mayo Clinic Staff (2016) express that childhood abuse places the client at particular risk for stress.
Clearly, it is essential that health professionals help clients to deal with cortisol and stress responses in a healthy manner (Mayo Clinic Staff 2016). This can include the encouragement of the client participation in the following activities (Mayo Clinic Staff 2016):
- Nutritious diet
- Regular exercise
- Adequate sleep
- Relaxation (e.g. yoga)
- Deep breathing
- Hobbies (e.g. music)
- Positive social/family relationships
- Community engagement (e.g. volunteer work)
- Professional counselling
One such form of treatment for clients experiencing stress and raised cortisol levels, can be CBT (cognitive behavioural therapy) (Holdevici & Craciun 2015). Holdevici and Craciun (2015) researched a CBT intervention that included mindfulness, and found that it successfully reduced the participants’ levels of stress (as per the Perceived Stress Scale) and cortisol (as per blood samples) pre- and post- intervention.
Rosnick et al. (2016) similarly highlight the need to support clients to manage stress and raised cortisol levels utilising CBT. Rosnick et al. (2016) convey that stress and raised cortisol levels are particularly concerning in later life, as it places older adults at risk of cognitive and physiological deterioration. Rosnick et al. (2016) conclude in their study that ‘CBT augmentation for late-life anxiety disorders’ could improve wellbeing.
Evidently, there are a range of ways in which health practitioners can support clients that experience stress and/or elevated cortisol levels. Health education and health coaching is undeniably crucial to improving the quality of life or wellbeing of said clients. Appropriate referrals to relevant health professionals (e.g. counsellors, qualified CBT therapists) is another important way to support clients, as is keeping up-to-date with current best practice and research findings for this condition.
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- Better Health Channel 2017, Hormones – cortisol and corticosteroids, Victoria State Government, viewed 30 November 2017, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Hormones-cortisol-and-corticosteroids
- Burns, AJ 2017, ‘Hair Cortisol-A Biomarker for Chronic Stress and Predictor of Disease’, Honors College Theses, 23, viewed 30 November 2017, http://digitalcommons.wayne.edu/honorstheses/23/
- Healthdirect 2016, The role of cortisol in the body, Healthdirect Australia, Australian Government Department of Health, viewed 30 November 2017, https://www.healthdirect.gov.au/the-role-of-cortisol-in-the-body
- Holdevici, I & Craciun, B 2015, ‘Cognitive – Behavioral Therapy Interventions and Mindfulness in Diminishing the Stress Level and Cortisol Blood Level’, Procedia – Social and Behaviourl Sciences, vol. 187, pp. 379-83, viewed 30 November 2017, http://www.sciencedirect.com/science/article/pii/S1877042815018649
- Mayo Clinic Staff 2016, ‘Chronic stress puts your health at risk’, Stress management, Mayo Clinic, viewed 30 November 2017, http://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037
- Rosnick, CB, Wetherell, JL, White, KS, Andreescu, C, Dixon, D & Lenze, EJ 2016, ‘Cognitive-behavioral therapy augmentation of SSRI reduces cortisol levels in older adults with generalized anxiety disorder: A randomized clinical trial’, Journal of Consulting and Clinical Psychology, vol. 84, no. 4, pp. 345-52.
Madeline Gilkes focused her research project for her Master's of Healthcare Leadership on Health Coaching for Long-Term Weight Loss in Obese Adults. She also has a Graduate Certificate in Adult & Vocational Education, Graduate Certificate in Aged Care, Bachelor of Nursing, Certificate IV Weight Management and Certificate IV Frontline Management. Madeline is an academic and registered nurse. Her vision is to prevent lifestyle diseases, obesogenic environments, dementia and metabolic syndrome. She has spent the past years in the role of Clinical Facilitator and Clinical Nurse Specialist (Gerontology and Education).