Caitlin Whyte (Host): Welcome to BayCare HealthChat. I'm your host, Caitlin Whyte. And today we are talking all about how to manage our cortisol levels.

Joining us today is Dr. Drihti Das. She is board certified in internal medicine and endocrinology. Thank you so much for being on the show today, Doctor. Can you give us a brief explanation of just what cortisol is?

Drihti Das, MD: Sure. So, cortisol is a steroid hormone, and it is normally produced by our adrenal glands, which are these two small pyramid shaped glands that sit on top of our kidneys. They're responsible for producing cortisol, but they're also responsible for producing a couple of other hormones. And cortisol is usually involved in our body's response to stress. But it has effects on almost all of the other organs and tissues in our bodies, like our muscles, our bones, our immune system, so all of these other parts of our bodies are affected by the hormone cortisol.

Host: Great. Thank you for that. I don't know about you, but all over my Instagram and TikTok, I feel like the latest thing to talk about is cortisol and like how you can control it and how it's out of balance. So I'm really excited to dive into this episode with you today. So what is considered a normal secretion or release of cortisol?

Drihti Das, MD: Yeah, so, I think that's a really great and a really important question and a really important thing to talk about, because I too have seen all of those TikTok videos and Instagram videos, and while some of them are, you know, somewhat accurate, sometimes I see them and  I just ask, “What is going on?”

You know, there's so much misinformation. So that being said, I think one of the really important things to understand about cortisol is that while its release or its secretion from our adrenal glands is mainly regulated by ACTH, or adrenocorticotropin hormone, which comes from our pituitary glands in our brains. A lot of cortisol secretion is also regulated by our circadian rhythm, so like our normal sleep wake cycle. So if ACTH, that's secreted from our pituitary gland, is increased, then that ACTH goes to our adrenal glands and kind of tells them, “Hey, you need to start making some cortisol.” But cortisol also follows our sleep wake cycle.

So normally towards the evening or like the later hours of the day, cortisol secretion is really low. And I sort of like to think of it as, you know, because you need cortisol for your stress response and towards the end of the day, you're usually kind of winding down and getting ready to go to sleep; that's when our cortisol levels are usually at their lowest. And it's usually in the first few hours that we're sleeping, that cortisol levels are so low that they're probably undetectable. But somewhere around the fifth hour or sixth hour of sleep is when the cortisol levels start to rise again. And they're the highest when we wake up in the morning.

So that's why it's so important to, you know, maintain a normal routine and  abide by our body's normal circadian rhythm because it will really dictate how much cortisol our adrenals are producing and kind of how the rest of our day goes, if that makes sense.

Host: It does, yes. Thank you again for that explanation. So what are some typical reasons that someone might have too much cortisol, would you say?

Drihti Das, MD: So because cortisol is produced in extra amounts when we're under stress, pretty much any time our body is responding to like a physical stress, our cortisol levels will be a little bit more elevated than usual. And that can honestly be anything from a small stress like you know, a hypoglycemic episode in someone who's on insulin for diabetes or a major stress like a major surgery or prolonged surgery.

So usually when we have these little stresses or big stresses that go on, our adrenal glands and our bodies know to respond to these stresses with increasing amounts of cortisol. However, if you have prolonged or repeated stressors like this, that normal circadian rhythm that we spoke about before that kind of dictates cortisol secretion can be disrupted and so your cortisol level can grow to be too much or it can start getting lesser and lesser.

Host: Gotcha. And then on that note, what are some signs you may have too much cortisol?

Drihti Das, MD: The signs of too much cortisol are kind of non discriminatory. Like, they're very vague, I would say, or non specific. And a lot of the signs of too much cortisol can be seen in the general population. But it's  vague things like feeling tired all the time or chronic fatigue, gaining weight, back pain, muscle pain, difficulty focusing, issues with your memory, especially short-term memory, difficulty sleeping, and changes in your mood, which again, it's kind of non-specific because anyone who, you know, doesn't get enough sleep probably is a little bit irritable or, not really feeling totally focused. Things that  are  more specific to increased cortisol levels,  especially in women would be abnormalities with menstrual periods, things that are unusual for women to have like jawline acne, female pattern baldness, or the opposite, excessive hair growth in places that women don't normally grow hair, and then, pretty common with excessive cortisol levels are an increase in your blood pressure, increase in your blood sugar, and increased risk for type 2 diabetes, osteoporosis or low bone mineral density, and things like that, that contribute long term to chronic diseases.

Host: Well, then, wrapping up today, Doctor, what are some ways we can lower and manage our cortisol levels?

Drihti Das, MD: I would say that  the best way to really manage and make sure our cortisol levels stay within a normal range is to really develop a daily routine and find ways to manage your stress well. So, I know this is probably advice that, you know, every doctor gives their patients, but, eat a healthy diet.

Usually the Mediterranean diet is the one that's most recommended, but, you know, you want to eat foods that are not processed. You want to exercise daily. Actually, exercise briefly increases your cortisol level immediately afterwards, but it helps you sleep. So it contributes to that circadian rhythm that helps maintain normal cortisol levels.

Managing your stress with mindfulness techniques. If you know you're someone who has a short fuse, find a better way to deal with getting irritable or getting angry. Take some deep breaths, usually that actually helps because it increases the hormones that have the opposite effect of cortisol, so little things that you can do throughout your day to kind of maintain a routine and manage your stress better will ensure that your cortisol levels stay normal.

Host: Some wonderful information, Doctor, thank you for your work and for joining us today.

That wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all of the other BayCare podcasts. For more health tips and updates, follow us on your social channels. And if you found this podcast informative, please share it on your social media. And be sure to check out all the other interesting podcasts in our podcast library. I'm Caitlin Whyte.

Thanks for listening.