Cortisol Demystified: Stress, Immune Health, and Natural Management Strategies
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Cortisol Demystified: Stress, Immune Health, and Natural Management Strategies

In this episode, Dr. Alfred Alessi and Matt Tack begin by introducing the Health Foundations and the Alessi Total Care Program. They delve into the critical hormone cortisol, exploring its functions, the effects of stress, and the impact of imbalances. The discussion highlights cortisol's role in immune function, supported by case study insights. Effective methods for cortisol testing and stress assessment are examined, followed by a comprehensive guide to natural cortisol management. The episode emphasizes lifestyle interventions and personalized health planning with Alessi Functional Health. It concludes with a final call to action and closing remarks, offering listeners practical approaches to managing cortisol and stress effectively. (0:00) Introduction to Health Foundations and the Alessi Total Care Program (2:04) Understanding Cortisol: Functions, Stress, and Imbalance (9:42) Cortisol's Role in Immune Function and Case Study Insights (12:14) Sponsor: Authentic Nutrition (13:46) Effective Cortisol Testing and Stress Assessment (19:27) Comprehensive Guide to Natural Cortisol Management (26:09) Lifestyle Interventions and Personalized Health Planning with Alessi Functional Health (27:20) Final Call to Action and Closing Remarks

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It's all about getting back to the basics.

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And so, you don't have to be at the mercy of stress, right?

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Your body's not broken, it's actually extremely adaptive.

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And when you can support the foundations, which are sleep, food, rhythm, and recovery, you're

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gonna give your body that permission to heal.

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Welcome to Health Decode, your number one source for real health information, with your

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hosts, doctor Alessi and Matt Tack.

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Hey, Health Decoded listeners.

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Doctor Alessi here.

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Let me ask you a serious question.

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Are you tired of waiting until something goes wrong to finally see a doctor?

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At Alessi Functional Health, we take a different approach, the right approach.

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We believe true health care isn't about chasing symptoms.

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It's about preventing them in the first place.

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This is a functional medicine based membership that gives you proactive, personalized care

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Head on over to alessifunctionalhealth.com, click on our services tab, and go to Total

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Care.

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Your health is your greatest asset.

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Let's protect it proactively.

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Welcome back to another episode of Health Decoded.

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I am your host, doctor Alessi, and I'm excited to have you guys back today.

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Really great topic that we have for you and really excited to get into this.

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This is something that I believe is very misunderstood in health in general and

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something that a lot of doctors really don't know how to test for or how to look for.

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And ultimately, patients end up getting and people end up getting kind of bad advice in

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this topic.

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So, what we're going to talk about today is cortisol, and realistically how elevated

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cortisol can hijack your health in the long term.

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And so, you know, what I want to make sure I clear up right away is that cortisol is not

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your enemy.

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People throw it around as if it's a negative thing.

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In fact, you wouldn't survive without it.

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Cortisol is a steroid hormone.

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It's produced by your adrenal glands, which sit like little hats on top of your kidneys, and

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it's part of a very finely tuned system called the HPA axis, the hypothalamic pituitary

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adrenal axis.

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This system is essentially your body's stress command center.

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It decides when to mobilize resources, when to rest and how to respond to everything from a

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physical threat to emotional tension.

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Now, here's what cortisol is supposed to do in a healthy system.

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It helps regulate blood sugar so that you can have stable energy, reduce inflammation when

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appropriate.

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It controls and manages your sleep wake cycle, your circadian rhythm.

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It supports metabolism and the conversion of food into energy.

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It manages blood pressure and it mobilizes your body's fight or flight response in times of

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danger.

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So, picture this, you're hiking in the woods and suddenly you come across a bear.

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Your brain immediately signals your adrenal glands to release cortisol and adrenaline.

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Cortisol is going to increase your blood sugar so that your muscles will have energy, narrow

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your blood vessels to raise blood pressure, it sharpens your focus and reaction time, and it

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tells your immune system, Hold on, we have more pressing matters at hand.

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So, it's going to also halt digestion and reproduction to conserve resources.

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In that moment, cortisol could be a lifesaving ally.

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But the problem is that we're not always in that position, right?

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But your brain doesn't differentiate between a bear and your boss who just sent you a rude

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email at 9PM.

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Or maybe a toxic relationship or financial struggles or maybe doom scrolling on Instagram

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for two hours before bed.

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All of those micro stressors when experienced daily are going to trigger the same cortisol

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release as if you were in that situation.

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So, it's like your body thinks you're being chased by a bear 20 fourseven and it never gets

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the signal to stand down.

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When cortisol stays elevated for too long, that acute survival response becomes a chronic

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health disaster.

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So, here's a quick study spotlight from Psycho Neuroendocrinology in 2016.

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Chronic psychological stress is associated with sustained elevations in cortisol, contributing

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to metabolic dysfunction and immune suppression.

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That means that high cortisol, when elevated for a long time, can disrupt your immune system

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making you more vulnerable to infections.

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It can also increase belly fat because cortisol tells your body to store fat in the abdomen for

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fuel.

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It'll cause insulin resistance, unstable blood sugar, it can wreck your energy and your sleep

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and literally blunt your brain's ability to function.

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And over time, your adrenals are going to burn out leading to low cortisol, exhaustion and

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then ultimately complete burnout.

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So, this episode isn't just about feeling stressed and that biochemical process, we're

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talking about how do we maintain and manage cortisol long term to then ultimately avoid

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this kind of thing in the first place.

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And so, isn't bad, but chronically elevated cortisol is.

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So, in this episode, we're going to fix that.

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We're going to unpack how cortisol affects your weight, sleep, mood, metabolism, hormones, and

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more.

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And then, I'll show you how to take back control naturally.

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So, how does cortisol wreck your body?

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Alright, now that you understand what cortisol is, and why it matters, let's talk about what

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happens when it's out of balance, especially when it's chronically elevated or eventually

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bottoms out.

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Because when your cortisol rhythm is off, your entire system will suffer.

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So, let's break it down and let's go symptom by symptom of what happens.

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So, the first one on the list here is weight gain, right?

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Especially belly fat, abdominal adipose tissue.

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Cortisol raises blood sugar to fuel your muscles in a crisis, but when the crisis never

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ends, that sugar isn't burned, it's stored.

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Especially as visceral fat around the abdomen and organs.

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This belly fat isn't just cosmetic, it is metabolically active and inflammatory, which

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can feed the cortisol cycle even more.

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Even worse, chronically high cortisol will crank up your cravings for sugar and carbs,

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pushing you more towards an emotional binge type of eating.

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The next one on the list is insomnia.

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The thought of being tired but then wired at night.

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Cortisol is supposed to follow a diurnal rhythm.

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It should spike in the morning when you wake up and it should taper down to let melatonin rise

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towards the end of the day so you can sleep.

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When cortisol is too high at night, you're going to feel wired but you're exhausted.

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Lying in bed, maybe scrolling on your phone, your mind is racing and you can't fall asleep.

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Eventually, you're not going to wake up refreshed anymore, you're going to start the

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day already behind because your diurnal rhythm has now been flipped.

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The next thing that we can experience is brain fog.

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I've experienced this before.

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Chronic cortisol can impair your hippocampus, which is the part of your brain responsible for

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memory, focus and learning.

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So, you might feel like you can't remember basic things, you can't stay on task or you

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feel just mentally sluggish all day.

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It's not a motivation issue, it's a neurochemical imbalance.

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Chronically elevated cortisol can also impair hormone balance and cause low libido.

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Cortisol and your sex hormones share the same raw materials, primarily pregnenolone.

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When your body is under stress, it prioritizes survival over reproduction, a phenomenon called

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the pregnenolone steal.

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This can lead to low testosterone or estrogen, PMS, irregular periods or fertility issues, or

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total loss of libido or sexual energy.

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Another one is blood sugar spikes and insulin resistance.

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Chronically elevated cortisol raises blood sugar to help you survive, but if that sugar is

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not used, it creates insulin resistance over time.

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Go back two episodes and listen to our episode on blood sugar, that will make more sense.

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This can then lead to blood sugar crashes, mood swings, sugar cravings, and eventually this

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becomes prediabetes or even full blown type two diabetes.

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Another thing cortisol can do is suppress the thyroid gland.

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So, high cortisol can inhibit your conversion of T4 to T3, basically your active thyroid

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hormone.

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It can also increase reverse T3, which then blocks your receptors from using thyroid

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hormone effectively.

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So, what does this mean?

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Even if your thyroid labs are looking normal, you could still have slow metabolism, the cold

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hand and feet symptoms, constipation, thinning hair and chronic fatigue.

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And then, next, last on the list here is immune dysfunction.

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We touched on this for a second.

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Cortisol has an immunosuppressive effect, which is great for short term inflammation control,

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but it's a disaster when this is sustained long term.

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So, you might find yourself getting sick more often, experiencing long recovery from colds,

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or developing or worsening autoimmune flares like Hashimoto's, rheumatoid arthritis or

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eczema.

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And now, here's the kicker, the longer you stay in this stress state, the more depleted your

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adrenal glands become.

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And eventually, your body cannot sustain the output anymore and your cortisol production

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crashes.

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This is where people move from the wired and tired to just plain exhausted and the body

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totally burns out.

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They wake up fatigued, no motivation, they feel emotionally numb, depressed, physically heavy.

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That's not just burnout, it's what we call HPA axis dysfunction, or adrenal exhaustion.

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And it is a serious thing.

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So, here's a real case study, and this is a patient we worked with.

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I'm not going to say any names, but we worked with a 42 year old entrepreneur type A, high

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performer, early riser, late night emails until really he started breaking down and noticing

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about over the span of six months to a year.

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He noticed he was gaining weight, even though he was working out like crazy and eating clean.

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He couldn't sleep.

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He lost all drive, libido, sex drive with his partner, and even his creativity.

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Event everything eventually felt kind of like a chore to him, even just getting out of bed.

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So, we ran his labs, we looked at a full hormone panel, thyroid panel, inflammation, and

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his cortisol was basically flat lined in the morning, when it should have been at its

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highest.

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And it was spiked at night when it should have been at its lowest.

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So, this is what we just alluded to, this was that adrenal dysfunction.

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Classic HPA axis dysfunction.

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His stress response system had burned out from chronic overuse.

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But the cool thing here was that we implemented a strategy with lifestyle, supplements, and

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nutritional interventions.

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And he put in the work and eventually we rebuilt his body's HPA axis to be functional

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again.

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Now, the takeaway here is chronic cortisol imbalance is really a silent saboteur of modern

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health.

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And again, this is something not a lot of doctors talk about, because not a lot of

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doctors know about.

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So, if you're struggling with weight, energy, mood, or sleep, or hormones, it's time to start

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asking yourself, what is my cortisol rhythm actually doing?

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And start getting some answers.

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And that's exactly what I want to get into now in this next segment.

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Labs, testing, what to look for, and ultimately what most doctors are gonna miss.

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But before we do that, here's a quick word from one of our sponsors.

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Now back to the episode.

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Okay.

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Welcome back.

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Now let's get into testing the stress response and what your labs can ultimately reveal and

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what most doctors are ultimately missing when it comes to testing this.

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So, say you're dealing with symptoms, you've got brain fog, fatigue, cravings, maybe even

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hormone issues.

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Here's the truth, if you don't test these things, you're just guessing.

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And if you test the wrong things, you're still guessing.

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So, let's talk about how do you properly assess cortisol and the overall stress response, and

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why average blood tests and your CBC are really not going to cut it.

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The problem with conventional testing is you walk into your doctor's office feeling off,

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fatigued, overwhelmed, not yourself.

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If they run anything, it's going to be a single blood cortisol level and maybe they take that

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at 8AM.

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And they say, Oh, you're in range.

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First off, what does in range actually mean?

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Right?

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Are you on the higher end of reference range?

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The lower end, but you're still within range?

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Those are two different things.

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That one number doesn't give us enough of a picture of how cortisol is flowing throughout

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the day or how it's affecting your hormones, thyroid, immune system, or brain.

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So, think of it like this, you wouldn't judge an entire movie by one still frame, right?

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So, why would you judge your entire stress system by one number?

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So, the functional medicine approach, what we test and why is that, you know, we want to see

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a full picture of what this is doing and what your body is doing throughout a daily basis.

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So, the number one thing we're going to look at is what's called a cortisol awakening response

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or a CAR.

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This is a saliva test taken multiple times in the first thirty to sixty minutes after waking,

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as well as throughout the day.

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This is going to measure how quickly your cortisol spikes start, as well as what that

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rhythm looks like midday, end of the day and at night.

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And so, a spiked CAR may mean chronic anxiety or inflammation.

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Another test we often use is a Dutch test.

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This is a dried urine test for comprehensive hormones.

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This is going to give us cortisol and cortisone patterns, both the free and the metabolized.

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This is going to give us estrogen, progesterone, testosterone, and how your body

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is processing them.

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Melatonin levels, as well as the organic acid markers for how your body is metabolizing

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vitamins, glutathione and more.

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And so, you get an hour by hour map of your hormones and your stress response.

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This is not something that a basic blood test will show.

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The other things we need to see is fasting insulin and glucose and your hemoglobin A1C,

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because these are tightly linked to cortisol.

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So, cortisol is often going to lead to insulin resistance even if your glucose looks normal.

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We discussed this back in the blood sugar episode as well.

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Go back and listen to that.

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So, these tests are going to show us how well you're handling sugar and stress.

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Next, what we look at is a full thyroid panel.

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We want to see not just TSH, we want to see free T3, free T4, reverse T3, as well as

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antibodies.

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Remember, discussed there's a link between immune suppression and worsening of autoimmune

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conditions.

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So, we want to see those thyroid antibodies.

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Because chronic cortisol will slow thyroid conversion, increase reverse T3 and even mask

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hypothyroid symptoms.

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Another thing that we want to see that this is not 100% necessary but is beneficial is looking

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at key nutrients.

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So, key nutrients for adrenal and stress support are going to be B12, zinc, magnesium,

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vitamin D, ferritin and selenium.

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These are the raw materials that your adrenal glands and nervous system use to function.

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And so, people are walking around with borderline or even deficient levels, especially

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magnesium and B12 and they don't even know it.

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And the worst part is most doctors are going to miss this because they consider within range to

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be okay.

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So, some of the red flags that get overlooked every single day is normal cortisol on a blood

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test but a reverse daily rhythm, flat in the morning, high at night.

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Low free T3, so even if TSH is normal, this can signify early thyroid dysfunction.

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Estrogen dominance in both men and women.

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Low DHEA, which is a key adrenal hormone that often crashes with chronic stress.

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And then B12 in range, but functionally low, especially if you have fatigue or brain fog.

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So, here's a quick study spotlight from the Journal of Psycho Neuroendocrinology in 2018.

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Salivary cortisol patterns often offer a more precise insight into HPA axis dysfunction and

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psychological stress than single serum values.

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Now, that's exactly what we just talked about, that snapshot versus looking at the whole

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picture.

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So, the takeaway here is if you've been told that everything looks normal, but you feel

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anything but, your labs may be incomplete or misinterpreted.

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And it's time to take a functional approach.

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You need to look at rhythms, patterns, and the full hormone landscape, not just a snapshot of

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numbers.

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Now, that brings us to the fun part.

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In the next segment, I want to talk through how to actually fix it naturally without jumping

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straight to medications or hormone replacement.

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So, how do we restore and balance our stress system naturally?

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Now that we've uncovered what cortisol is, how it becomes dysregulated, and how to properly

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test it, let's get into the solution.

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So, good news that I want you to take away from this is that your body wants to heal.

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You just need to give it the right input.

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This isn't about suppressing cortisol, it's about restoring rhythm, resetting stress

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system, and ultimately your HPA axis.

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So, step one, this is takeaways that I want you, if you need to write it down, things that

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you can integrate and start doing today.

00:20:00
Step one, reset your nervous system.

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Chronic stress is not just in your head, it's hardwired into your autonomic nervous system.

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And we need to shift from fight or flight into rest and repair.

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So, here's how you do it.

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Daily breath work.

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Commit five to ten minutes.

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Start with an exercise like box breathing.

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This is where you do a four inhale, four second hold, four second exhale, four second hold,

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repeat.

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Or focusing on more of an extended exhale where you do four seconds in and then six to eight

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seconds out.

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This has been proven to lower cortisol and activate the parasympathetic system.

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You could also use things like cold exposure.

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Try for two to three days a week.

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It doesn't have to be a plunge or an ice bath.

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Just start with a cold shower for thirty seconds to two minutes a day.

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This will help build resilience to stress and retrain your cortisol reactivity.

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Also, practice grounding or nature therapy.

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Being barefoot on the grass and walking outside with the sun on your face can work numbers for

00:21:06
lowering inflammation and modulating your cortisol naturally.

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Now, step two is you need to stabilize your blood sugar.

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Cortisol rises when blood sugar crashes.

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So, to heal your adrenals, we need to stabilize your energy supply.

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We talked about this as well in a previous episode, but protein with every meal.

00:21:26
20 to 30 grams minimum.

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Healthy fats like avocados, olive oil or nuts, these are going to help stabilize that insulin

00:21:33
response and blood sugar spike.

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And then using complex slow digesting carbs like sweet potatoes or berries or quinoa, This

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is gonna provide you with not such an elevated quick spike in blood sugar.

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And then, the constant snacking.

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Try not to graze every two hours.

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Let your body feel hungry, let your blood sugar get back to normal.

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Another thing you can try is considering intermittent fasting.

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But only if cortisol is stable.

00:22:00
You don't want to fast if you're already tanked.

00:22:02
Now, you're adding more stress to an already stressed state.

00:22:05
We discussed fasting and how to implement it a few episodes back as well.

00:22:10
Go back and listen to that one if you've never tried fasting and you're interested.

00:22:14
Step number three, heal your gut.

00:22:17
Your gut and brain are in constant conversation with each other and inflammation in the gut

00:22:22
drives stress signals to the brain and vice versa.

00:22:25
So, start by removing the inflammatory triggers: gluten, dairy, processed sugars,

00:22:31
alcohol.

00:22:33
Then, rebuild the gut with L glutamine, zinc carnosine, probiotics, bone broth and collagen.

00:22:40
For a deep dive on this, go revisit episode 16 on gut health where we gave you a whole game

00:22:45
plan for that.

00:22:48
And now step four, you have to, have to, have to rebalance your circadian rhythm.

00:22:54
Cortisol is supposed to rise in the morning and fall at night.

00:22:57
But a lot of people have this backwards.

00:22:59
So, here's how you reset it.

00:23:01
Your morning routine should look like bright light within thirty minutes of waking.

00:23:05
Ideally, natural sunlight or a high lux lamp, 10 amps.

00:23:11
Movement, so walking, stretching, mobility work, and a protein rich breakfast.

00:23:16
Get rid of the sugary cereals and the sugary coffee in the mornings, which is only going to

00:23:21
spike your cortisol anyway.

00:23:23
And then the night routine, which is basically setting you up for this, no screens one hour

00:23:28
before bed, I prefer two.

00:23:30
And then using some kind of blue light blocker if you are going to be on your screen.

00:23:35
You need those glasses that can help filter the blue light because the blue light stimulates

00:23:39
the optic nerve which stimulates cortisol.

00:23:43
Dim the lights after sunset, let your body kind of understand that now it's starting to get

00:23:47
time for bed.

00:23:49
Use things like magnesium glycinate or L Theanine if needed at night.

00:23:53
And then the biggest thing I think you can do that makes the biggest impact is going to bed

00:23:59
and waking up at the same time every day, even on the weekends.

00:24:03
Even if your schedule changes, try to do it at the same time.

00:24:07
Because sleep is your most powerful hormone therapy.

00:24:12
And then, step five, you can supplement with things like adaptogens.

00:24:17
These are not magic pills, they're not going to replace anything we just talked about, but they

00:24:21
can support the rebuilding process when you use them strategically.

00:24:25
A fantastic one is Ashwagandha.

00:24:27
This helps to lower those elevated cortisol levels, get you back towards a normal balance.

00:24:31
Rhodiola, phosphatidylserine, magnesium and then a vitamin C and B complex.

00:24:38
These are essential co factors for adrenal hormone production.

00:24:42
If you don't know where to start, work with a practitioner or functional medicine doctor to

00:24:46
make sure you're dosing these properly based on your labs.

00:24:50
And then step six, as always, move.

00:24:53
Move your body.

00:24:54
But don't burn it out.

00:24:56
Exercise is a stressor and so when you're already fried, intense exercises can push you

00:25:02
further off the cliff.

00:25:03
So, start with walking.

00:25:05
10 steps a day is a great goal.

00:25:07
Get into some zone two cardio.

00:25:09
Lower heart rate but longer duration.

00:25:12
And then practice strength training, two to three days a week, but keeping the intensity

00:25:16
more moderate at first until you can handle it.

00:25:19
If you feel worse after working out, you're overdoing it.

00:25:23
This is a great, great warning sign.

00:25:26
So, you know, in cadence here, lifestyle wins before pills, right?

00:25:32
So, me be clear, there's a time and a place for hormone replacement therapy or medications.

00:25:37
I'm not knocking them completely.

00:25:39
I just think they're overused when there's other things we can do fundamentally first.

00:25:44
So, if you skip over the lifestyle foundations we just covered, you're basically building on

00:25:48
sand.

00:25:49
Supplements aren't going to work, prescriptions aren't going to hold, and you're putting the

00:25:53
cart before the horse essentially.

00:25:55
And so, here's a real great quote from the American Journal of Lifestyle Medicine in 2021.

00:26:01
It said, Lifestyle interventions should be the first step in addressing HPA axis dysfunction

00:26:07
and cortisol related disorders.

00:26:09
This is one of the most popular journals for lifestyle medicine that exists.

00:26:13
And so, that should just tell you that there's it's all about getting back to the basics.

00:26:18
And so, don't have to be for a final takeaway here, you don't have to be at the mercy of

00:26:22
stress, right?

00:26:23
Your body's not broken, it's actually extremely adaptive.

00:26:27
And when you can support the foundations, which are sleep, food, rhythm, and recovery, you're

00:26:33
going to give your body that permission to heal.

00:26:36
Now, if you want to take this a step further, and you want to learn more about how we help

00:26:40
people to diagnose, reverse, and heal adrenal fatigue and hormone imbalances within our

00:26:46
functional medicine programs, go to AlessiFunctionalHealth.com, schedule a

00:26:51
consultation where you can meet with me or one of my teammates, and let's create a

00:26:55
personalized plan for lifelong health.

00:26:58
If you're a listener of the podcast, you're always going to get exclusive discounts and

00:27:01
price reductions on all of our lab protocols and testing.

00:27:05
As always, if you found any value in today's show, I just ask you please like, subscribe,

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00:27:20
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00:27:24
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00:27:28
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00:27:34
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00:27:39
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00:27:40
You're gonna learn more about our approach to nutrition and cutting edge therapies.

00:27:44
I wanna thank you again for being a part of this and for joining us on today's episode.

00:27:49
Thanks for tuning in, where we break down the science, we bust the myths, and we help you

00:27:54
take control of your health naturally.

00:27:56
So until next time, I'm doctor Alessi.

00:27:59
Stay curious, stay empowered, and remember that your health is in your hands.

00:28:03
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00:28:09
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00:28:12
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00:28:27
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00:28:33
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00:28:38
Until next time, stay curious, stay empowered, and remember, your health is in your hands.