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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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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.
00:13:49
Okay.
00:13:50
Welcome back.
00:13:51
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
00:17:22
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.
00:17:33
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
00:17:43
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
00:17:51
be okay.
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So, some of the red flags that get overlooked every single day is normal cortisol on a blood
00:18:00
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
00:18:51
picture.
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So, the takeaway here is if you've been told that everything looks normal, but you feel
00:18:57
anything but, your labs may be incomplete or misinterpreted.
00:19:01
And it's time to take a functional approach.
00:19:03
You need to look at rhythms, patterns, and the full hormone landscape, not just a snapshot of
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numbers.
00:19:10
Now, that brings us to the fun part.
00:19:12
In the next segment, I want to talk through how to actually fix it naturally without jumping
00:19:17
straight to medications or hormone replacement.
00:19:21
So, how do we restore and balance our stress system naturally?
00:19:27
Now that we've uncovered what cortisol is, how it becomes dysregulated, and how to properly
00:19:33
test it, let's get into the solution.
00:19:36
So, good news that I want you to take away from this is that your body wants to heal.
00:19:40
You just need to give it the right input.
00:19:43
This isn't about suppressing cortisol, it's about restoring rhythm, resetting stress
00:19:48
system, and ultimately your HPA axis.
00:19:52
So, step one, this is takeaways that I want you, if you need to write it down, things that
00:19:57
you can integrate and start doing today.
00:20:00
Step one, reset your nervous system.
00:20:04
Chronic stress is not just in your head, it's hardwired into your autonomic nervous system.
00:20:09
And we need to shift from fight or flight into rest and repair.
00:20:13
So, here's how you do it.
00:20:14
Daily breath work.
00:20:16
Commit five to ten minutes.
00:20:18
Start with an exercise like box breathing.
00:20:20
This is where you do a four inhale, four second hold, four second exhale, four second hold,
00:20:26
repeat.
00:20:28
Or focusing on more of an extended exhale where you do four seconds in and then six to eight
00:20:33
seconds out.
00:20:34
This has been proven to lower cortisol and activate the parasympathetic system.
00:20:39
You could also use things like cold exposure.
00:20:42
Try for two to three days a week.
00:20:44
It doesn't have to be a plunge or an ice bath.
00:20:46
Just start with a cold shower for thirty seconds to two minutes a day.
00:20:50
This will help build resilience to stress and retrain your cortisol reactivity.
00:20:57
Also, practice grounding or nature therapy.
00:21:00
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.
00:21:11
Now, step two is you need to stabilize your blood sugar.
00:21:15
Cortisol rises when blood sugar crashes.
00:21:17
So, to heal your adrenals, we need to stabilize your energy supply.
00:21:21
We talked about this as well in a previous episode, but protein with every meal.
00:21:26
20 to 30 grams minimum.
00:21:28
Healthy fats like avocados, olive oil or nuts, these are going to help stabilize that insulin
00:21:33
response and blood sugar spike.
00:21:35
And then using complex slow digesting carbs like sweet potatoes or berries or quinoa, This
00:21:41
is gonna provide you with not such an elevated quick spike in blood sugar.
00:21:46
And then, the constant snacking.
00:21:48
Try not to graze every two hours.
00:21:50
Let your body feel hungry, let your blood sugar get back to normal.
00:21:54
Another thing you can try is considering intermittent fasting.
00:21:58
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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and then share this with someone who you think would need to hear it.
00:27:13
That's the only way we're gonna get to grow this message.
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We don't spend and take money to do any marketing for this.
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We just wanna provide value and we just ask that you share in return.
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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
Thank you for tuning in to Health Decoded, where we break down the truth about all things
00:28:09
health and empower you to take charge of your well-being.
00:28:12
If you found value in today's episode, please subscribe, leave a review, and share it with
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00:28:20
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00:28:27
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00:28:33
That's ask@alessifxhealth.com.
00:28:38
Until next time, stay curious, stay empowered, and remember, your health is in your hands.

