The HPA Axis Part 3: Cortisol Dysregulation
Thus far in this HPA axis series, we've discussed what the HPA axis is and the various hormones involved in that system. I know a lot of the information seemed pretty high level and involved lots of fancy words, but today is where we start to dive into what is more applicable to your life.
And that all begins with a little hormone called cortisol.
Cortisol is our stress hormone. It is necessary for human life and has numerous functions including breaking down proteins into amino acids, increasing energy, improving digestion, easing joint movement, enhancing the immune system, and providing emotional stability. It's a pretty impressive hormone!
Cortisol is a hormone that runs on a rhythm. It is meant to be high in the morning to wake us up and slowly fall throughout the day as melatonin rises to help us sleep at night.
However, problems start to arise when this rhythm becomes dysregulated. This could mean that our cortisol is chronically high, vastly depleted, off the regular rhythm it should follow, or some combination of these.
We'll talk in more detail about what can cause issues with cortisol and our other hormones on Thursday, but for now, it is enough to say that chronic, prolonged stress from any number of causes is at the root of cortisol dysregulation. This might include, but isn't limited to poor diet choices, gut infections, food sensitivities and allergies, lack of sleep, too much/too little exercise, mental and emotional stress, hormonal imbalances, blood sugar dysregulation, financial strain, relationship troubles, career issues or unhappiness, anxiety, depression, and so much more.
When the problem is that cortisol is chronically elevated, we start to see issues with our body's ability to regulate and manage our blood sugar, which can lead to insulin resistance. Insulin resistance is when our cells do not respond to insulin, whose job it is to take glucose (sugar) from the blood stream and shuttle it away for storage. Having insulin resistance, in turn, can also create cortisol resistance. This follows a similar path and means that our body has to continually pump out more and more cortisol to respond to even the smallest of stressors because the body has become numb to its effects. It's like an alcoholic who builds up a tolerance and needs more and more alcohol to get the effect they desire.
When we start to have cortisol resistance and high cortisol levels, we also see a decrease in DHEA levels and other steroid/sex hormones, thyroid issues, insomnia, anxiety, agitation, restlessness, digestive issues, depression of the immune system, and inflammation. This is not a good state to be in long term (I should know first hand, as my cortisol has been high for at least 3 years, if not longer) as it creates a catabolic (breaking down) state in the body. This is not ideal.
Eventually, our cortisol levels start to bottom out after being high for so long. This also results in a host of issues including inflammation, the down-regulation of other hormones, lack of neurotransmitters (which help with mental health), glucose/blood sugar instability, gut issues, trouble staying asleep, and feeling nervous or depressed.
As you can see, a lot of these symptoms overlap, which is why it is SO CRITICAL to test and see what your cortisol rhythm is. Then, you can start to piece together a plan to help either lower or raise or regulate your cortisol according to your results.
There are several ways to test your cortisol. The conventional doc will test one sample via blood. This is not accurate or desired as it measures the inactive form of cortisol AND only gives you one snapshot, not the full picture of your cortisol rhythm. There is no context provided.
On the other hand, saliva and urine tests provide better indicators of one's overall cortisol levels AND pattern and are much easier to take samples several times throughout the day in order to piece together the picture of your cortisol pattern.
Currently, I have access to order the latter two tests. They can be testing cortisol/DHEA alone or can also be combined with other sex hormones. If you suspect you might be dealing with any sort of cortisol dysregulation, this is definitely a course of action that would be worth pursuing. I can speak firsthand that it is NOT ideal to have these issues linger for years without managing them. Unfortunately, the problems don't just "go away" without any changes in lifestyle, diet, and sometimes supplements. If you are ready to make this change, let me know so we can get started on a test and individualized plan just for you!
In the last part of this series, we are going to dive into some of the causes of not only cortisol dysregulation, but also hormonal dysregulation in general. Stay tuned!