Cortisol imbalance: causes, effects & what to do

Stress is a natural response of the body to physical and emotional pressure. While short-term stress helps us react to danger, prolonged or chronic stress can affect our health—especially through its impact on the hormone cortisol. This blog explains the role of cortisol, how it behaves during stress, and what happens when cortisol levels are too high or too low.

Table of Contents

• What is the function of cortisol?
• What does cortisol do during stress?
• Cortisol and Cushing’s syndrome
• What are the symptoms of high cortisol?
• What can you do if your cortisol level is too high?
• Can you have low cortisol?
• Causes of low cortisol
• Symptoms of low cortisol
• What can you do if your cortisol level is too low?

What is the function of cortisol? 

Cortisol is a hormone. Hormones are chemical messengers that regulate a variety of processes in our body. Cortisol is produced in the adrenal glands which are located on top of the kidneys. This hormone has many important roles in the body, such as regulating the body’s stress response, immune system, sleep-wake rhythm, metabolism, blood pressure, and blood sugar (Cleveland Clinic, 2021). 

Cortisol is broken down in the liver and excreted in the urine. The level of cortisol in the blood fluctuates naturally during the day, with levels usually being highest in the morning and lowest around midnight (UMRC, 2023). The body works to maintain consistent levels of cortisol in the body, also known as homeostasis. Cortisol levels are consistently too high or too low can have negative effects on health, and may be caused by a medical condition that needs treatment (Cleveland Clinic, 2021).

What does cortisol do during stress?

The goal of the stress response is to prepare our bodies to react quickly to danger. The two primary hormones released during the stress response are cortisol and adrenaline. These hormones can act rapidly on multiple body systems at once, causing a range of symptoms. Adrenaline makes the heart beat faster, increases blood flow to the brain and muscles, and raises blood pressure. Cortisol increases sugars in the bloodstream that can be easily used for energy, as well as boosts the availability of substances that repair body tissues (Mayo Clinic, 2021). During acute stress, cortisol also slows body functions that are non-essential in a fight-or-flight situation, such as the digestive system. High cortisol from the stress response is designed to be a temporary reaction. While high cortisol can help us during a life-threatening situation, long-term exposure to high levels can harm our health. 

Cortisol and Cushing’s syndrome

Hypercortisolism is a condition in which the body produces too much cortisol. This can be caused by medication use or by tumors on the adrenal gland, pituitary gland, or other parts of the body. Cushing’s syndrome is the collective name for the symptoms that occur due to hypercortisolism, regardless of the cause (Cleveland Clinic, 2022).

Causes of Cushing’s syndrome

Cushing’s syndrome most often occurs in people who take corticosteroid medications for long periods of time (NIH, 2018). As these medications are synthetic forms of cortisol, long-term exposure can cause symptoms of hypercortisolism. Corticosteroid medications are used treat a range of diseases, including rheumatoid arthritis, chronic asthma, COPD, or eczema (Mayo Clinic, 2022). They may be injected, taken as a pill, or used directly on the skin as a cream. 

Tumors within the body can also cause an overproduction of cortisol. A tumor on the adrenal gland can produce too much cortisol, while tumors on the pituitary gland or in other parts of the body (such as the chest) can produce ACTH, the hormone that tells the adrenal glands to make cortisol (Pluta et al., 2011). Most adrenal and ACTH-producing tumors are benign, or non cancerous. Cushing’s disease occurs when Cushing’s syndrome is caused by an ACTH-producing tumor. 

What are the symptoms of high cortisol?

The stress response is designed to occur only until the source of danger is gone. However, if real or perceived stressors are always present, the fight-or-flight response may remain constantly activated. The same is true if an individual takes medications that increase cortisol or has a medical condition in which too much cortisol is produced. As cortisol is a hormone that affects many body systems, too much cortisol can cause a variety of symptoms and negative health effects. Elevated cortisol from chronic stress, medication use, or other health problems can cause:

• Weight gain: Cortisol builds fat reserves that the body can use in situations where it needs to provide extra energy. This can increase appetite, particularly for energy-dense (high calorie) foods. High levels of cortisol can also affect fat distribution on the body, with increased fat storage in the abdomen (chest, back, and belly) or face (Clutter, 2011).
• Increased blood sugar: cortisol can elevate blood sugar levels to ensure that the body is appropriately energised to react to danger. However, long term high cortisol can lead to persistent high blood sugar levels (Cleveland Clinic, 2021).
• Insulin resistance: since cortisol is designed to increase short-term energy availability, it reduces the secretion of insulin in the body and can make fat and muscle cells not respond as well to insulin, also known as insulin resistance (UCSF, 2023). In people with diabetes, this may mean you will need to take more insulin to control your blood sugar. 
• High blood pressure: cortisol increases blood pressure and heart rate as a part of the stress response. Chronically elevated cortisol is associated with increased blood pressure and risk of cardiovascular events, such as stroke or heart attack (Inoue et al., 2021).
• Loss of muscle strength and volume: persistently high cortisol can stop protein synthesis, meaning it is harder for your body to build muscle. It can also cause the body to use muscle as a source of energy, which is why high cortisol is associated with lowered muscle strength (Peeters at el., 2008).
• Increased susceptibility to infection: during short-term stress, cortisol suppresses inflammation and the immune system while the body responds to danger. However, long-term high cortisol can cause increased inflammation and a weaker immune response (Morey et al., 2015). 
• Anxiety and depression: increased cortisol has been linked with mental health conditions such as depression (Dziurkowska & Wesolowski, 2021) and anxiety (Mayo Clinic, 2021).
• Skin changes: high cortisol can cause the breakdown of proteins in skin and weakening of blood vessels, leading to thinning skin that may bruise, become discoloured, break easily, or develop red-purple streaks (striae) (Philips, 2007).
• Hair growth in women (hirsutism): women who have high cortisol due to overproduction of the hormone ACTH may experience dark and coarse hair growth where hair does not usually grow, such as the face and back (Hafsi & Badri, 2022). This is because ACTH also can stimulate the production of androgens, hormones responsible for certain male sex characteristics, such as facial hair.
• Heart disease: Stress and elevated cortisol levels are risk factors for further illnesses. A high level of the stress hormone cortisol is associated with an increased risk of cardiovascular diseases such as heart attack, stroke, and high blood pressure (American Heart Association, 2021). Stress also contributes to unhealthy behaviors like smoking, overeating, and physical inactivity, which are risk factors for heart disease (Mayo Clinic, 2023).
• Sleep problems: Approximately 10% of the general population suffers from insomnia – a pathological sleep disorder (Cleveland Clinic, 2023). Cortisol works together with melatonin and fluctuates throughout the day to regulate the sleep-wake cycle or the internal “clock,” which makes us feel sleepy in the evening and awake in the morning. If this rhythm is disrupted, sleep quality or the ability to fall asleep may be impaired (Hirotsu, 2015).

What can you do if your cortisol level is too high?

The treatment for high cortisol depends on the cause. If high cortisol is caused by medication use, stopping corticosteroids and/or taking drugs that reduce cortisol may be recommended. If high cortisol is caused by a tumor, radiation, chemotherapy, or surgery may be used (Cleveland Clinic, 2022). If you are diagnosed with Cushing’s syndrome, your healthcare provider will work with you to identify the cause and an appropriate treatment plan.

If your cortisol levels are elevated from chronic stress or lifestyle factors, stress management can have a positive effect. Try the following tips:

Adequate sleep

Adequate sleep is essential for good health, and a sleepless night can leave you feeling especially stressed or irritable. Lack of sleep or poor sleep quality, such as frequent awakenings, is linked to elevated cortisol levels (Cleveland Clinic, 2024). Getting enough sleep and maintaining a regular sleep schedule can help regulate cortisol levels and prevent disruptions in the sleep-wake cycle. For adults, 7 to 9 hours per night is ideal, although individual needs may vary. To improve sleep, it can help to stick to a regular sleep routine, exercise during the day, and reduce screen time in the evening. Avoiding large meals, caffeine, and alcohol before bed can also support better sleep quality (CDC, 2022).

Physical activity

Whether you bike to work daily, walk your dog, or are passionate about sports – physical activity significantly supports your health. Exercise has been shown to reduce stress hormone levels and increase endorphins – brain chemicals that can improve mood (Harvard Health, 2020). While a walk may seem less effective than a run or HIIT workout, less intense physical activity can actually be most beneficial for cortisol levels. Studies have shown that low to moderate intensity exercise lowers cortisol levels in the body, while high intensity can lead to an increase (Hill et al., 2008).

Mindfulness and meditation

Mindfulness and meditation are practices that use physical and mental techniques to clear and calm the mind. Although these practices have been used in various religions for centuries, mindfulness and meditation are now recognized as valuable tools for managing stress and promoting mental health. Several studies have shown that meditation practices can lower cortisol levels, and meditation can help people manage stress and stressful thoughts more effectively (Pascoe et al., 2017).

Social support

Studies show that social support plays a crucial role in reducing cortisol release caused by stress. Experiencing emotional support and a sense of belonging in social networks—whether from family, friends, or colleagues—can effectively lower stress levels. Access to social support during acute stress can help reduce stress hormones in the body and lessen the cardiovascular response to stress. Joy and laughter are also key to stress management, as they promote the release of endorphins (the body’s natural painkillers) and help reduce cortisol levels (Heinrichs et al., 2003; Pilcher& Bryant, 2016).

A healthy and balanced diet

Our diet has a major impact on our health and well-being. The following tips can help support your body during stress and lower your cortisol levels.

Reduce caffeine consumption

Caffeinated drinks like coffee and energy drinks are very popular and consumed daily by many people. However, caffeine affects the release of cortisol and causes a temporary increase in cortisol levels (Lovallo et al., 2006). This rise is greater in people who do not usually drink coffee than in daily coffee drinkers (Lovallo et al., 2005). Limiting caffeine to 1-2 drinks per day and avoiding it in the evening can help reduce its impact on sleep and overall cortisol levels.

Limit inflammatory foods

Chronically elevated cortisol is linked to chronic inflammation, a condition involved in diseases such as type 2 diabetes, arthritis, heart disease, inflammatory bowel disease, and Alzheimer’s (Cleveland Clinic, 2025; Snead, 2023). Diet is a key method for fighting inflammation. Pro-inflammatory foods include those high in sugar (e.g., pastries, sweets, sugary sodas), refined carbohydrates (white bread and pasta), fried foods, red meat, and processed meat (e.g., sausages and breakfast meats). A balanced diet rich in fruits, vegetables, and whole grains can help reduce inflammation and cortisol levels in the body.

Harness the protective effects of food

Many foods contain valuable nutrients that can support the body during stress or have preventative effects. The following nutrients may positively influence cortisol levels:

• Dark chocolate (contains antioxidants)

• Bananas and pears (rich in potassium)

• Leafy green vegetables (vitamin C and magnesium)

• Fatty fish (omega-3 fatty acids)

• Probiotics like yogurt and kefir (for a healthy gut flora)

These nutrients can have the following effects:

• Antioxidants: Oxidative stress is a condition where there are too many free radicals in the body’s cells and not enough antioxidants to eliminate them, leading to cell and tissue damage (NCI). Oxidative stress is associated with high cortisol levels. A diet rich in antioxidant foods like fruits, vegetables, and nuts can help reduce oxidative stress and promote overall health (Cleveland Clinic, 2023).
• Anti-inflammatory foods: Since inflammation is linked to high cortisol, an anti-inflammatory diet can be a helpful step in lowering cortisol levels. A diet rich in unprocessed, anti-inflammatory foods like leafy greens, berries, nuts, and fatty fish can help reduce inflammation in the body and support overall health (Cleveland Clinic, 2024).
• Omega-3 fatty acids: These “healthy fats” have a positive effect on cortisol levels, may support heart health, and have anti-inflammatory properties (McCabe et al. 2017). Foods rich in omega-3 fatty acids include salmon, avocados, flaxseeds, and chia seeds.
• Magnesium and B vitamins: Foods rich in magnesium and B vitamins can support the metabolism of cortisol and reduce inflammation (Cleveland Clinic, 2024). Foods high in B vitamins include beef and chicken, while magnesium-rich foods include avocados, bananas, broccoli, and dark chocolate.

Chronic stress and elevated cortisol levels can negatively affect our health and well-being. A healthy lifestyle that includes adequate sleep, regular physical activity, and a balanced diet can help manage stress and reduce cortisol and inflammation in the body. If you experience symptoms that may indicate high cortisol levels, consult your doctor and get tested.

Source: Harvard Health, 2021

Can you have low cortisol?

Cortisol is essential for good health, and both too much and too little can cause health problems. Low cortisol (or hypocortisolism) occurs when the adrenal glands do not produce enough cortisol. This is also known as adrenal insufficiency. There are three types of adrenal insufficiency:

• Primary adrenal insufficiency is also caused Addison’s disease and occurs when the adrenal gland does not produce enough cortisol.
• Secondary adrenal insufficiency occurs when the pituitary gland does not produce enough ACTH, the hormone that tells the adrenal glands to make cortisol.  
• Tertiary adrenal insufficiency occurs when the hypothalamus in the brain does not produce enough CRH- the hormone that tells the pituitary gland to produce ACTH. 

Source: NIH, 2018

Causes of low cortisol

Low cortisol from adrenal insufficiency can be caused by:

• Autoimmune diseases 
• Infection of the adrenal glands
• Genetic disorders that affect the development or function of the adrenal or pituitary gland
• Surgical removal of the adrenal gland for other reasons
• Suddenly stopping corticosteroids
• Pituitary tumors or infection

Source: NIH, 2018

Symptoms of low cortisol

Symptoms of adrenal insufficiency include fatigue, general weakness, and weight loss. The severity and types of symptoms experience depend on the cause of the adrenal insufficiency and the severity of the lack of cortisol. Other symptoms can include:

• Abdominal pain
• Loss of appetite
• Nausea and vomiting
• Diarrhoea
• Low blood pressure
• Craving salty foods
• Low blood pressure that drops when standing, causing dizziness or fainting
• Decreased sexual desire

Source: NIH, 2018

What can you do if your cortisol level is too low?

Adrenal insufficiency is treated with hormone replacement therapy. Treatment is often required for life, usually with daily oral medication. Correct use of replacement medications is needed to minimise symptoms and avoid adrenal crisis, a life-threatening condition caused by a severe lack of cortisol. With correct medical care, people with adrenal insufficiency can live active and healthy lives.