Cortisol and the Stress Connection

Balanced cortisol levels are essential to optimal health.

By John R. Lee, M.D. and Virginia Hopkins

The adrenal hormones respond to any stressors that increase energy requirements. Fasting, infection, intense exercise, pain or emotional or mental stress stimulate the secretion of a releasing hormone from the hypothalamus in the brain, which tells the adrenals to secrete extra cortisol. There’s also a regular daily cycle of cortisol release into the bloodstream, with peaks in the morning and late afternoon and lows in mid-afternoon and during deep sleep.

Cortisol is extremely important to survival when stress of any sort is present. If our lives were stress-free, a lack of cortisol would not be life-threatening. But without the corticosteroids, we can’t survive even the slightest stress. People who have had their adrenal glands removed or whose adrenals don't make enough cortisol are in danger of death from even mild illness. These people must use cortisol replacement for the rest of their lives, increasing their dose at any sign of extra stress or infection. Many of you are in a less extreme version of this scenario, with tired adrenals that have trouble responding appropriately to stress.

Excessive cortisol, on the other hand, creates a broad range of undesirable side effects including weight gain around the waist, elevated blood glucose which leads to insulin resistance, high blood pressure, osteoporosis, easy bruising, a susceptibility to fungal infections and disorders of the immune system.

Chronic stress leads to chronic high levels of cortisol in the bloodstream, which creates a need for more hormones (e.g. thyroid, insulin, progesterone, testosterone) in order to do the same job. Chronic cortisol exposure is toxic to brain cells in high concentrations and can cause short term memory loss. A lifetime of high cortisol levels may be a primary contributor to Alzheimer's disease and senile dementia. High cortisol is also a primary cause of osteoporosis because it blocks the bone-building effects of progesterone.

Like the other hormones, cortisol is essential to good health and even to life, but in excess or deficiency can be harmful. Maintaining healthy cortisol levels isn’t just a matter of tweaking your biochemistry with this or that diet, hormone, vitamin or mineral (although that can be a big help!). Balanced cortisol is also a matter of respecting yourself and caring enough about your health to get plenty of sleep, some moderate exercise and fresh air, and to bring some relaxation, laughter and fun into your life.

Nutritional and Herbal Support for the Adrenals

Vitamin C with bioflavonoids

Vitamin E (mixed tocopherols)

Pantothenic acid (a form of vitamin B5)

Vitamin B6

Vitamin B12



Sodium (salt)

Trace minerals, including zinc

Licorice root

Ashwangandha root


Use your extra energy to relax!

Recently we received a letter from a woman named Anne that illustrates the many ways that stress can affect our hormone levels and our health:

“About ten years ago I was leaving my marriage, moving out on my own, and building a new career. I was in my early forties, had very little money, few friends and my family lived on the other side of the country. Shortly after moving out I started to experience a lot of fatigue and mental fogginess—not what I needed to start life over! The more tired and foggy I got, the harder I tried to be “good.” I tried to force myself to work harder, to exercise, restricted my diet to vegetables, whole grains and soy, and eventually became so ill that I could barely move. My blood pressure was very low and my muscles were so weak I could barely stand up straight. I went to doctors who patted me on the head and offered me antidepressants like Prozac and anti-anxiety drugs like Ativan, but I knew that wasn’t the answer. I found myself going out to a coffee shop around mid-morning and loading up on cinnamon buns and coffee to try to get through part of a day. Finally a friend insisted that I go listen to a speaker who talked about progesterone and afterwards I told him my story. He exclaimed, “You need to use progesterone and eat more meat and salt! And stop exercising so much!” I did, and my health improved dramatically, but I still had a sense of underlying fatigue and fogginess that I fought with coffee.

 A few years later I got a bad case of poison oak that wouldn’t go away, and an alternatively-minded doctor put me on 20 mg of hydrocortisone a day for a week. What a change! Suddenly my energy was up and my head was clear. I felt like my old self. My doctor explained that this was an indication that I had adrenal fatigue, and put me on a regimen of vitamins and herbs to build up my adrenals, along with 5 mg of hydrocortisone twice a day. This worked really well, but I used the extra energy to take on more work than I was capable of reasonably handling, and got involved in an intense relationship that had a lot of ups and downs. I stayed up late working and had trouble getting out of bed in the morning and eventually I started to go downhill again.

 Next my doctor put me on thyroid, which again helped, and again I took advantage of the newly found energy to overdo it. When that stopped being effective, I turned to testosterone, and it helped for awhile, but that wore off too. I’m also eating a diet of mostly vegetables, meat and fish, and that’s helped a lot, but it wasn’t the whole answer.

 Dr. Lee, I’ve finally realized that the common denominator over the years has been my insistence on overdoing it and stressing myself out. Whenever my energy increases, I use it to push myself harder. I rarely rest except when forced to by exhaustion. I rarely take vacations and every time I do I get sick afterwards. I push and push and push myself to do more, when what I need to do is chill (as my young friends would say)!

 In the past six months I’ve started getting into bed by 10 p.m. and taking weekends off. I also take numerous little breaks during the day to take a few deep breaths, step back from my day-to-day life and get a larger perspective. It’s made a huge difference—as much as any of the hormones and vitamins have. Not that I’m going to give up my progesterone, but I’ve realized that boosting my hormones and nutrients isn’t going to help unless I also discipline myself to relax. Sounds like a contradiction, but it’s true!”

My guess is that many of you can relate to Anne’s story. Baby boomers tend to be a generation driven to relentlessly strive to have it all, but that comes at a cost. Let’s look more closely at what happens when we constantly flog our adrenal glands in the process of pursuing perfection.

If you're experiencing symptoms of low or high cortisol, you may want to consider testing your cortisol and/or DHEA levels.


Note to Reader from Virginia Hopkins
Dr. John Lee was my great friend, mentor, co-author and business partner. This website is dedicated to continuing the work that Dr. Lee and I did together to educate and inform women and men about natural hormones, hormone balance and achieving optimal health. Dr. John Lee was a courageous pioneer who changed the face of medicine by introducing the concepts of natural progesterone, estrogen dominance and hormone balance to a large audience of women and men seeking answers to their hormone questions. Dr. Lee's books have sold millions of copies, and he has left behind a wonderful collection of writings from his newsletters that are, in large part, freely shared on this website. Enjoy!

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