Cortisol is a steroid hormone produced by the adrenal glands from cholesterol that orchestrates how the body mobilizes and manages energy. It directs energy toward the tissues that need it most, especially the brain, so that the body can effectively respond to challenges like stress and maintain stability by regulating metabolism, blood pressure, inflammation, and immune function.

It plays a central role in maintaining balance by operating within the hypothalamic-pituitary-adrenal (HPA) axis, which is the body’s central stress-response system. When the brain detects stress, in the form of danger, pressure, or anticipation, it signals the adrenal glands to release cortisol. This increases blood sugar for immediate energy, sharpens focus, and temporarily slows processes like digestion and growth, ensuring that the body’s resources are prioritized where they’re most needed.

Cortisol naturally follows a daily rhythm: it peaks in the early morning to help you wake and declines at night to support rest. This rhythm is essential for balanced energy, focus, and recovery.

Cortisol connects nearly every major physiological system. It works alongside insulin to regulate blood sugar, influences thyroid hormones that govern metabolism, and modulates immune activity to prevent excessive inflammation. Because of this broad reach, even subtle shifts in cortisol can have systemic effects impacting mood, energy, cognition, and long-term resilience.

High Cortisol

It’s normal for cortisol to rise and fall, but when cortisol remains high for extended periods or the body’s cortisol rhythm is off—due to chronic stress, sleep loss, illness, or inflammation—it signals that the body’s stress-regulation network is locked in overdrive. Since cortisol influences nearly every major body system, including the nervous, metabolic, immune, and cardiovascular systems, chronic elevation keeps the body in a sustained state of activation and imbalance. Over time, this can contribute to anxiety, insomnia, abdominal weight gain, insulin resistance, high blood pressure, weakened immunity, and impaired memory. In severe cases, sustained excess leads to Cushing’s syndrome, a disorder characterized by abnormally high cortisol production and metabolic disruption. If unaddressed, chronic elevation can accelerate aging, promote cardiovascular disease, and diminish neuroplasticity, which dictates the brain’s capacity to learn and adapt.

Low Cortisol

Low cortisol, on the other hand, means the body’s stress system isn’t responding as it should. This can happen when the adrenal glands don’t produce enough cortisol, when the brain isn’t sending the right signals through adrenocorticotropic hormone (ACTH), or after long periods of chronic stress and burnout that exhaust the system. When cortisol levels stay too low, individuals may experience fatigue that doesn’t improve with rest, dizziness, salt cravings, or low blood pressure.

Protocols

A root cause approach to addressing elevated cortisol or imbalanced cortisol rhythms involves identifying and managing factors contributing to chronic stress and hypothalamic-pituitary-adrenal (HPA) axis overactivation, such as sleep disruption, blood sugar imbalances, nutrient deficiencies, toxin exposures, and lifestyle influences. This approach focuses on implementing strategies that support balanced cortisol rhythms and overall stress resilience.

For most people, interventions emphasize regulating the HPA axis through evidence-based lifestyle strategies:

• Consistent sleep-wake cycles and light exposure: Aligning sleep with natural circadian rhythms and morning sun light within ~30-60 minutes of waking helps trigger an appropriate cortisol awakening response; evening dimming of lights and avoiding screens and other sources that emit short-wavelength light (blue, white LED) exposure starting about two hours after sundown may support the decline phase to keep rhythms more balanced.
• Balanced blood sugar and nutrition: Combining protein, fiber, and healthy fats at each meal helps stabilize glucose and reduce reactive cortisol spikes. Consuming starchy carbohydrates (rice, potatoes, yams) in the last meal of the day and avoiding eating anything for two hours before sleep can help balance blood sugar and cortisol. Foods rich in magnesium, B vitamins, omega-3s, and antioxidants may help regulate inflammation and support adrenal hormone production.
• Mind-body practices: Practices like breathwork (e.g., a physiological sigh: a big inhale through the nose, a short second inhale through the nose, followed by a long exhale through the mouth until the lungs are empty), meditation, or restorative yoga engage the parasympathetic nervous system and lower evening cortisol output.
• Consistent moderate physical activity: Walking, resistance training, and yoga support stress recovery, while overtraining, especially late in the day without proper recovery, may elevate cortisol and interfere with the next-day rhythm. Exercise within the same two-to-three-hour window each day in the morning, or at least three days a week, may provide a strong "entrainment cue" that reinforces the high morning timing.
• Stimulant timing: Avoiding caffeine after around mid-afternoon may help to prevent evening cortisol elevation.

Targeted supplements may be used under medical supervision in some cases in addition to lifestyle strategies such as:

• Ashwagandha (Withania somnifera): 300-600 mg taken in the late afternoon/evening may augment efforts to keep cortisol low. Reduces stress, supports hypothalamic-pituitary-adrenal (HPA) axis resilience, and lowers cortisol levels.
• Apagenine: 25-50 mg of apagenine, a flavonoid found in chamomile and other plants, can be taken about 30-60 minutes before sleep to augment efforts to decrease cortisol and aid sleep by working on GABA pathways.
• Magnesium threonate: 1,500-2,000 mg/day (depending on individual tolerance and needs) of the threonate form of magnesium supports the stress response, promotes nervous system relaxation, and may improve sleep quality.

Clinical considerations

• If cortisol levels are persistently elevated or symptoms such as persistent anxiety, poor sleep, fatigue, abdominal weight gain, high blood pressure, or menstrual or mood changes continue despite lifestyle adjustments, consulting a clinician is recommended to assess for underlying adrenal, thyroid, or metabolic imbalances and determine whether further testing or treatment is needed.
• Clinicians typically assess sleep quality, psychological stress, blood sugar stability, and stimulant or medication use.
• Testing may include blood, urine, or salivary cortisol, ACTH, DHEA-S, or 24-hour urinary free cortisol to clarify rhythm and adrenal activity.
• Retesting is typically guided by the degree of change and ongoing symptoms: mild changes may warrant retesting in 3-6 months after implementing lifestyle strategies; significant or persistent symptoms may benefit from clinical follow-up and retesting in 6-8 weeks; and for those managing ongoing stress or adrenal imbalance, annual monitoring can help track recovery and rhythm stability.

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