While it's true that high cortisol levels can result in the aforementioned symptoms (among others), cortisol's moniker is misleading. The truth is, we need cortisol. "Cortisol, which is one of the sex hormones, is essential for life," Harvard-educated doctor and author of Women, Food, and Hormones ($23), Sara Gottfried, MD, says. Dr. Gottfried explains that, like pretty much everything else in life, balance is key when it comes to cortisol. Too-high levels aren't good for health, but neither are too-low levels.
Functional medicine dietitian Lacey Dunn, RD, cosigns this in her new book, The Women's Guide To Hormonal Harmony ($30). "It's the Goldilocks effect. We don't want cortisol to be too high or too low; we want it to be just right," she says. Perhaps because so many people are perpetually stressed, you may automatically assume that if your cortisol levels are out of whack, it's because they're too high. But both hormone experts say cortisol levels can certainly dip too low. Keep reading to learn more about cortisol's role in the body, what can cause levels to dip, and how to bring balance to your body.
Symptoms of low cortisol to keep in mind
As both Dr. Gottfried and Dunn pointed out, cortisol isn't "bad"—in fact, it plays an important role in our overall health. "Cortisol is a fight-or-flight hormone that's outputted in times of stress or inflammation," Dunn says. "If we get sick, injured, or stressed, our adrenal glands are stimulated, activating our sympathetic nervous system."
This, she explains, leads to a domino effect of several hormones being released, cortisol being one of them. In the short term, she says this domino effect is a good thing; it's a part of our immune response and can help the body reduce inflammation. The problem, Dunn says, is when someone stays in the fight-or-flight response mode for a prolonged amount of time. "This can lead to both chronically high cortisol levels or chronically low cortisol levels," she says.
Both experts explain that a major part of what makes it difficult to know if cortisol levels are too high or too low is that the same factors can contribute to an imbalance on either end of the spectrum, and these imbalances manifest in very similar ways. Many of the symptoms of low cortisol are the same symptoms of high cortisol. "This is why it's important to see a doctor who can check your cortisol levels through blood, saliva, or urine tests instead of just guessing on your own," Dr. Gottfried says. "Something else that often happens is that someone can experience a pattern of high cortisol and low cortisol both in the same day," she adds. "I'll have a patient who has cortisol levels that are too high when she first wakes up, then they dip too low in the afternoon. This happens because when the body is depleted of cortisol, it will try to make up for it by producing too much, and then you're stuck in this vicious cycle."
Dunn says that while there are some overlapping causes of high and low cortisol levels, she says there are some causes that are more strongly associated with low cortisol levels. This includes experiencing a traumatic brain injury, post-traumatic stress disorder, chronic fatigue syndrome, and fibromyalgia. If you are experiencing one of these health conditions, it is especially important to have your cortisol levels checked.
Both experts emphasize that the main way to truly know if your cortisol levels are too low (or too high) is through blood, saliva, or urine testing at your doctor's office. Since cortisol levels can fluctuate, Dunn recommends getting tested at four different times over the course of the same day. That said, there are some telltale signs they say can tip you off; your body's way of telling you it's time to make that appointment. This includes the below:
1. Low energy
Dr. Gottfried says that while a classic sign of high cortisol levels is feeling "wired yet tired," so feeling completely exhausted could be a sign of low cortisol levels. This can manifest either as having very low energy all the time, or once a certain time in the day hits (such as mid- or late afternoon).
2. Craving salty or sugary snacks
This is an important symptom not to zero in on because, hey, a craving is generally just a craving. But Dunn says that craving sugary or salty snacks can be a sign of low cortisol. This is because, she explains, when cortisol levels are low, blood sugar drops.
This can lead to sugar and salt cravings.
3. Dizziness when you stand up too quickly
Headaches and feeling dizzy can both be symptoms of low cortisol levels. This is because of the same reason a craving for peanut butter cups can kick in: blood sugar levels have dropped, which can lead to sudden dizziness. This is especially true if you stand up too quickly.
4. Low libido
Considering that low cortisol levels can cause you to feel completely wiped, it's not exactly shocking that it can cause libido levels to drop, too. Another reason low cortisol can lead to low libido is that blood flow is decreased, including to parts of the body that turn you on (when you, you know, meaning you actually have the energy for it).
5. Muscle weakness
Dunn says that another marker of low cortisol levels is muscle weakness and the inability to get through a workout you normally would have no problem doing. Can you guess why this might be? Yep, low energy and low blood flow yet again. Blood flow is important for your muscles to work properly.
How to restore balance to the body if your cortisol levels are too low
None of the symptoms on this list are fun ones to live with. But fortunately, both Dr. Gottfried and Dunn say there's a lot you can do to bring balance to your body through diet and lifestyle habits. Here's what they recommend to anyone experiencing low cortisol levels:
1. Prioritize getting enough sleep
Dr. Gottfried says not getting consistent, good-quality sleep (about eight hours a night) can really mess with your cortisol levels. She explains that when you are getting good sleep, cortisol levels peak within 30 minutes of waking up. "That peak sets off all your other hormones, including your thyroid and estrogen. We can measure this officially as the cortisol awakening response, a sign of a healthy stress response."
When someone doesn't get good sleep, she says that it muddles this awakening response. "That can disrupt the tango between estrogen and progesterone. It can cause your thyroid to slow down, which can then affect your metabolism by slowing it down," she says. This is why getting consistently good sleep is important for bringing balance back to cortisol levels.
2. Don't skip meals
Eating well-rounded, nutrient-rich meals is, of course, always important, but Dunn says it's particularly important for people with low cortisol levels. "Don't skip meals," she says, explaining this is detrimental to blood sugar levels, which are already low. "Make sure you're getting good amounts of protein, healthy fats, and fiber which all help balance blood sugar levels—something that's especially important when cortisol levels are low," she says.
3. Snack on licorice or sip licorice tea
"Licorice raises urinary cortisol," Dr. Gottfried says, citing a study published in the Journal of Clinical Endocrinology and Metabolism. "It's generally recommended that people with low cortisol try a small dose of root extract, 600 milligrams," she specifies. This is one instance where you want to go for the herb, not the candy. Otherwise, the added sugar in your licorice would cancel out the balance-restoring benefits.
"Meditation is one of the best ways to give the mind a warm bath and reset cortisol levels," Dr. Gottfried says, adding that a few of her favorite meditation apps include Breathing Zone, Calm, and 10 Percent Happier. She also says that practicing diaphragmatic breathing—fully engaging the stomach, abdominal muscles, and diaphragm—while meditating can help as well. Meditation, she says, has been linked to lowering stress—a pretty noteworthy link when we're talking about bringing balance to a hormone so critical in the body's stress response.
5. Prioritize self-care
"Many of us were forced to over-function over the past year. The effect of that stress is measurable," Dr. Gottfried says. "I believe that if [people] can track their stress levels, they are more likely to find solutions that help them manage their stress." Find ways to incorporate self-care into daily routine—even if it is in small ways.
As you can see by the solutions offered here, the mind-body connection is very real and it directly affects cortisol levels. If you feel your cortisol levels may be off—whether too high, too low, or both—what's most important is to see your doctor to find out for sure. Then, you can work together and start putting some solutions in place. After all, this is a medical condition that has implementable solutions. "Cortisol, like any hormone, isn't 'good' or 'bad,' it just is," Dr. Gottfried says. Like most things in life, it all comes down to balance.
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