When doctors talk about a specific condition they describe it in terms of the signs and symptoms it causes. Signs are things that can be measured such as blood pressure and symptoms are those things that must be reported by the patient such as pain. Cortisol imbalance is associated with both signs and symptoms. Some of the signs include:
These features are all the result of high cortisol interfering with the function of insulin, or a phenomenon termed insulin resistance.
Imbalanced cortisol levels also cause several symptoms which can be more subtle. The typical symptoms include:
Usually the first symptom to show up with cortisol imbalance is sleep difficulty. As cortisol is an “alert” hormone, higher levels at night activate conscious activity in the brain interfering with sleep. To prevent this, humans have a normal circadian rhythm with cortisol where the levels are highest in the morning and gradually fall reaching a very low level around the normal time of initiating sleep. This allows another hormone, melatonin to increase in the brain. Melatonin is the opposite of cortisol causing diminished brain activity allowing sleep.
With normal adrenal gland function, cortisol will not rise to a level sufficient enough to cause arousal until about 30 minutes before our normal wake time. In fact, it is cortisol that causes us to wake up about the same time each day. Unfortunately, with adrenal gland imbalance, too much cortisol is often produced in the evening (causing difficulty getting to sleep) or after 3-4 hours of sleep causing us to wake up and be unable to get back to sleep. Below is a normal cortisol test showing the levels at different times of day. Notice the highest level in the morning and the lowest at midnight.
The test below is of someone with adrenal imbalance producing too much cortisol with a rise between 4 PM and Midnight causing trouble getting to sleep.
When the adrenal glands are stressed too long, they will become “dysregulated” often producing too much cortisol at night and not enough in the morning. This results in the terrible combination of waking up and not being able to get back to sleep and being very tired in the morning. The cortisol test below demonstrates adrenal dysregulation.
Eventually, the adrenal glands will become very fatigued with low cortisol at all times resulting in pronounced fatigue, lack of energy, low blood pressure which causes lightheadedness particularly when getting up fast. Ironically, in this phase sleep actually worsens further the result of compensation at night by another hormone, epinephrine or “adrenaline”. Below is a test showing adrenal fatigue.
Fortunately, adrenal gland/cortisol imbalance can be corrected by removing the stress factors discussed in last week’s blog (too many refined carbohydrates, food sensitivities, too much psychosocial stress) and a nutritional support program to revive adrenal function. The first step is to know where the function is; high, dysregulated or low. The signs and symptoms help determine that as does a 16-hour saliva cortisol profile.
Next week, I will discuss how adrenal cortisol imbalance aggravates the symptoms of menopause.