Metabolic syndrome, hair loss, insomnia, frequent colds and flu, missed menstrual periods, ulcers, and orthopedic pain are just some of the health problems blamed on excessive stress.
Yet, stress is an elusive term. Is it a mental sequela related to life events such as high demands at work, busy kids’ schedules, planning finances, and what to make for dinner? Or rather, is it only related to traumatic life events such as a divorce, loss of a job, loss of a home, or death of a loved one? Is it related to physical events such as prolonged illness or overtraining?
The reality is, stress is the complex interplay of the nervous, endocrine, and immune systems' reaction to any stimuli that disrupt homeostasis in the human body (Chu et al., 2022). It is well known that chronic stress can contribute to many adverse health conditions, but why?
Stress is chapter 12 of the Certified Wellness Coach course and an extremely important subject for incorporating wellness.
What is Cortisol
Cortisol is a steroid hormone produced by the adrenal glands through a feedback loop in the hypothalamic-pituitary-adrenal (HPA) axis. Cortisol is present in the body in small amounts even during times of low stress.
However, once the hypothalamus senses stress, it quickly generates higher levels of corticotropin-releasing hormone (CTH) which stimulates the pituitary gland to increase production of adrenocorticotropic hormone (ACTH) notifying the adrenal glands that it is time to quickly produce larger amounts of cortisol (Gjerstad et al., 2018). The stress response, and hence the effects of cortisol, affect several body systems.
Fight or Flight Response And Cortisol
Once the body senses stress, the sympathetic nervous system is activated and stimulates the release of catecholamines (i.e., epinephrine and norepinephrine) leading to an increased heart rate, respiration rate, blood pressure, muscle strength (temporarily), and increase in alertness.
Cortisol is continuously released to keep the body in this alert state to respond to stressful stimuli. However, this heightened response comes with a higher energy cost, so the metabolic systems will be affected to keep a steady supply of energy coming to the brain (Chu et al., 2022).
Cortisol and blood glucose
Cortisol acts as a catabolic hormone (breaks things down) to increase glucose availability to the brain. This occurs via several pathways. High cortisol levels induce gluconeogenesis (creation of glucose via proteins and lactate) in the liver which will then be delivered into the bloodstream. The body must use amino acids (proteins) to complete this process and the body’s most readily available supply of protein is skeletal muscle.
Therefore, muscle tissue is broken down, glycogen stores are emptied, and the muscles decrease glucose uptake. Additionally, cortisol instructs the pancreas to decrease insulin production to keep the circulating levels of glucose higher (Thau & Sandeep Sharma, 2019).
8 Ways to Reduce Cortisol
We all hear about how we need to prioritize self-care, but what does that mean? The best way to engage in self-care is to select activities that we commit to as part of our daily/weekly routines that will help lower stress levels both acutely and long-term.
Here are 8 self-care activities that can be incorporated into even the busiest of lives to reduce cortisol:
- Spend time outdoors
- Engage in creative projects
- Care for a pet
- Exercise, but not too much
- Sleep, sleep, sleep
- Set limits/boundaries on work
- Learn to unwind at the end of the day
- Consume a healthy, balanced diet
#1 Spend time outdoors
Spending even 20 minutes per day in green spaces (i.e., parks, woods, on hiking trails, etc.) can significantly lower cortisol levels. Roe et al. (2013) measured salivary cortisol levels in middle-aged adults (35 to 55 years old) and separated the participants into groups that lived in areas with varying amounts of green space.
The cortisol levels of the participants who live in areas with a higher amount of green space demonstrated significantly lower cortisol levels than the individuals who lived in areas with less green space. The researchers concluded that higher exposure to green spaces has powerful cortisol lowering effects (Roe et al., 2013).
#2 Engage in Creative projects
Engaging in creative pursuits such as playing a musical instrument, getting involved in a community performance, or creating visual art (i.e., ceramics or painting) can also be helpful in lowering cortisol levels.
Kaimal et al. (2016) found that engaging in a painting project for 45 minutes dropped cortisol levels drastically in a group of 39 adults participating in art therapy.
#3 Care for a pet
Taking a few extra minutes to pet or play with your household pet can greatly reduce the perception of stress, lower blood pressure, reduce anxiety, raise oxytocin levels, and decrease cortisol levels (Beetz et al., 2012).
#4 Exercise, but avoid overdoing it
There is a delicate balance between exercise and cortisol levels. Moderate or vigorous exercise regularly (30-60 minutes daily) and increasing daily movement (i.e., step counts above 7,500 daily) can help to improve emotional resilience which can, in turn, reduce cortisol levels (Childs & de Wit, 2014).
However, engaging in repeated bouts of high-intensity activity with little to no recovery time in between can have the opposite effect and raise cortisol levels. While exercise is a powerful tool in stress management, it is important to prioritize recovery as well (Kreher & Schwartz, 2012).
#5 Sleep, sleep, sleep
Sleep is necessary for our bodies to recover from daily strain. Sleep deprivation is strongly associated with the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis leading to increases in cortisol.
Having good sleep hygiene such as going to bed and waking up at regular hours (even on weekends), avoiding television and smartphone use right before bed, limiting alcohol, and aiming for 7 to 9 hours of sleep each night can go a long way in the reduction of cortisol levels (Hirotsu et al., 2015).
#6 Set limits on work/obligations
This is perhaps the hardest part for many of my own personal clients who are struggling to balance careers, kids, and demanding homelives. As much as we want to do it all, we have real physiologic limits. Humans tend to perceive failure when they are unable to meet expectations.
Eventually, this feeling of failure leads to a sense of lack of control and activation of the stress response (Hannibal & Bishop, 2014). Setting personal limits and being somewhat selfish with your time can also help to reduce stress. Make a list of your obligations. Set realistic goals for what you can accomplish. Which of these things are important and which are not worth your time?
#7 unwind At The End of The Day
Engaging in daily relaxation techniques can interrupt the stress response and allow your body to return to homeostasis. Techniques such as progressive relaxation, visualization, guided meditation, breathing exercises, and autogenic training can be used daily to reduce both acute and long-term stress (National Institutes of Health, 2021).
#8 Consume a healthy, balanced diet
Cortisol-friendly foods have long been a topic of research. Consumption of high fat/high carbohydrate foods, which exist rarely in nature, is linked to HPA axis dysregulation and an overall increase in cortisol levels (Duong et al., 2011). Conversely, diets low in carbohydrate intake are also linked to higher cortisol levels, especially in females (Soltani et al., 2019).
Similarly, long-term low-calorie dieting can also increase cortisol levels and disrupt sleep (Tomiyama et al., 2010). Overall, a healthy balanced diet with adequate high-quality carbohydrates and adequate vitamins and minerals is your best bet to achieving ideal cortisol secretion patterns. If weight loss is desired, consider shorter (8 to 12 week) periods of calorie deficits intermixed with periods of maintenance calories to minimize the stress response from dieting.
Related resource to check out: Preventing Stress-Related Weight Gain
How Does Cortisol Affect Health?
The body’s adaptations of high levels of cortisol to increase blood glucose levels and catecholamines may be a highly effective short-term strategy for dealing with stress, but what happens when this hormone is chronically elevated? Although high cortisol temporarily decreases inflammation, exposure to the hormone long-term will have the opposite effect.
In a sense, just as people can become insulin resistant from long-term exposure to high insulin levels, the same occurs with cortisol. Since cortisol fails to function as an anti-inflammatory in the presence of a stress stimulus, the result is a chronic state of inflammation in the body in the setting of the metabolic responses (i.e., increase in glucose, muscle breakdown, etc).
The health consequences of this state have been linked to many conditions such as fibromyalgia, chronic pain, anxiety, depression, irritable bowel syndrome, sleep disorders, and autoimmune conditions such as rheumatoid arthritis. In fact, there is some research that has led some to theorize that many idiopathic (no cause is found) autoimmune conditions may be caused by chronic cortisol elevation (Hannibal & Bishop, 2014).
Most commonly, metabolic syndrome is a constellation of conditions (i.e., insulin resistance/diabetes, dyslipidemia, binge eating, substance use disorders, obesity, and visceral (central) fat accumulation) that is highly associated with cortisol elevation (Paredes & Ribeiro, 2014).
Read more: How Stress Affects The Body
Chronic stress leading to continuous cortisol elevation is bad for overall health. Yet, cortisol elevation is a common phenomenon these days. Although many humans in Westernized societies are no longer running from wild animals or facing real dangers in everyday life, our bodies do not always realize this. Stress from work, family obligations, relationships, and overscheduling can still tell the brain that a flight or fight response is needed (Hannibal & Bishop, 2014).
However, we have the power to control our responses to stress, thereby restoring the normal function of cortisol.
Is Cortisol Something You Can Target with Wellness Coaching?
Wellness coaching can be a highly effective tool in combating stress. Clark et al. (2014) determined that six months of wellness coaching in 100 adults produced improvement in quality of life, perceived stress, and mood. Recall that the stress response is what sets the cascade of cortisol dysregulation. It is easy to suggest stress reduction strategies, but it is more difficult to implement them in daily life.
A skilled wellness coach can help a client push past perceive life barriers to stress reduction and help their client discover and implement effective stress reduction strategies. Likewise, a skilled wellness coach can help a client improve sleep hygiene and optimize dietary intakes. These measures can help to reduce cortisol levels both acutely and long-term thereby reducing the potential for negative health consequences.
Beetz, A., Uvnäs-Moberg, K., Julius, H., & Kotrschal, K. (2012). Psychosocial and Psychophysiological Effects of Human-Animal Interactions: The Possible Role of Oxytocin. Frontiers in Psychology, 3(234). https://doi.org/10.3389/fpsyg.2012.0023
Childs, E., & de Wit, H. (2014). Regular exercise is associated with emotional resilience to acute stress in healthy adults. Frontiers in Physiology, 5(161). https://doi.org/10.3389/fphys.2014.00161
Chu, B., Marwaha, K., Sanvictores, T., & Ayers, D. (2022). Physiology, Stress Reaction.
PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541120/#:~:text=A%20stress%20response%20 is%20mediated
Clark, M. M., Bradley, K. L., Jenkins, S. M., Mettler, E. A., Larson, B. G., Preston, H. R.,
Liesinger, J. T., Werneburg, B. L., Hagen, P. T., Harris, A. M., Riley, B. A., Olsen, K. D., & Vickers Douglas, K. S. (2014). The Effectiveness of Wellness Coaching for Improving Quality of Life. Mayo Clinic Proceedings, 89(11), 1537–1544. https://doi.org/10.1016/j.mayocp.2014.04.028
Duong, M., Cohen, J. I., & Convit, A. (2011). High cortisol levels are associated with low quality food choice in type 2 diabetes. Endocrine, 41(1), 76–81. https://doi.org/10.1007/s12020-011-9527-5
Gjerstad, J. K., Lightman, S. L., & Spiga, F. (2018). Role of glucocorticoid negative feedback in the regulation of HPA axis pulsatility. Stress, 21(5), 403–416. https://doi.org/10.1080/10253890.2018.1470238
Hannibal, K. E., & Bishop, M. D. (2014). Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. Physical Therapy, 94(12), 1816–1825. https://doi.org/10.2522/ptj.20130597
Hirotsu, C., Tufik, S., & Andersen, M. L. (2015). Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Science, 8(3), 143– 152. https://doi.org/10.1016/j.slsci.2015.09.002
Kaimal, G., Ray, K., & Muniz, J. (2016). Reduction of Cortisol Levels and Participants’ Responses Following Art Making. Art Therapy, 33(2), 74–80. https://doi.org/10.1080/07421656.2016.1166832
Kreher, J. B., & Schwartz, J. B. (2012). Overtraining Syndrome. Sports Health: A Multidisciplinary Approach, 4(2), 128–138. https://doi.org/10.1177/1941738111434406
National Institutes of Health. (2021, June). Relaxation Techniques for Health. NCCIH. https://www.nccih.nih.gov/health/relaxation-techniques-what-you-need-to-know
Paredes, S., & Ribeiro, L. (2014). Cortisol: the villain in Metabolic Syndrome? Revista Da Associação Médica Brasileira, 60(1), 84–92. https://doi.org/10.1590/1806- 9282.60.01.017
Roe, J., Thompson, C., Aspinall, P., Brewer, M., Duff, E., Miller, D., Mitchell, R., & Clow, A. (2013). Green Space and Stress: Evidence from Cortisol Measures in Deprived Urban Communities. International Journal of Environmental Research and Public Health, 10(9), 4086–4103. https://doi.org/10.3390/ijerph10094086
Soltani, H., Keim, N. L., & Laugero, K. D. (2019). Increasing Dietary Carbohydrate as Part of a Healthy Whole Food Diet Intervention Dampens Eight Week Changes in Salivary Cortisol and Cortisol Responsiveness. Nutrients, 11(11), 2563. https://doi.org/10.3390/nu11112563
Thau, L., & Sandeep Sharma. (2019, February 15). Physiology, Cortisol. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538239/
Tomiyama, A. J., Mann, T., Vinas, D., Hunger, J. M., Dejager, J., & Taylor, S. E. (2010). Low calorie dieting increases cortisol. Psychosomatic Medicine, 72(4), 357–364. https://doi.org/10.1097/PSY.0b013e3181d9523c