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Cortisol testing.

What’s So Important About the Stress Hormone Cortisol?

The killer effect of stress isn’t just an old wives tale. Chronic stress is hurting the long-term health of Australians, in part by elevating their cortisol levels. The fast pace of modern life has a price. How much we pay partly depends on our ability to manage stress.

Experts from many fields agree that stress, and by association cortisol levels, will continue to rise in Australia. It already affects a far larger proportion of the population per capita than previously so we thought we’d take a closer look.

What is Cortisol?

Cortisol is a glucocorticoid (hormone) that is produced in the adrenal gland. It’s needed for everyday tasks requiring energy, immune function, and staying alert to your environment. Cortisol  is part of the ‘fight or flight’ response to a perceived danger that at one time could be an huge asset, and possibly still could save your life.

Each day our body produces cortisol in a pattern designed to assist us. When functioning correctly, our day should begin with a boost of cortisol in tune with the suns rising. One of the ways it does this is by binding to receptors on fat cells, which in turn elevates glucose levels for the muscles to use. This gives us the energy we need to go-out-an-get-em. By the time the sun sets that cortisol should be long gone, allowing for sleepiness to settle in and melatonin production to begin.

During rest periods, our cortisol reverts to its inactive form, cortisone, until the next time it is required. Usually this would be when you wake in the morning. This is referred to as the Cortisol Awakening Response (CAR).

Our stress response can get us in trouble.

How Are Stress and Cortisol Connected?

The answer is by design. When the brain stimulates its release in response to physical or emotional stress, the adrenal glands secrete cortisol into the general circulation. So stress triggers cortisol (not the other way around), and cortisol provides a boost designed to assist in a confrontation or any kind of emergency.

The problem is that our environment is changing, at least in the big cities.  Financial pressure, pressure to succeed and the increasing complexity of our jobs are just some of the many new-growth stresses we face. Remaining ‘on alert’ means we could be creating to much cortisol, too often.

Can Cortisol cause damage?

Unfortunately yes. If we stay stressed, our body isn’t reverting cortisol back to its inactive form cortisone when it should be. The resulting build up of cortisol can stuff up thyroid function, lower the production of sex hormones (estrogen and testosterone), disrupt metabolism (making it hard to lose weight and to control blood glucose levels), and lead to high blood pressure and weakened immunity.

It can also wreak havoc on our sleeping patterns by preventing the production of melatonin, leading to further stress.

Cortisol and the unborn baby

A lot of research has been done into the effects of hormones including cortisol on the unborn baby.

One study has identified a link between raised cortisol levels in the amniotic fluid (womb) and decreased brain function in children.  Further research carried out by British academics* and published in 2013 has shown that exposure to excessive levels of cortisol in the womb can lead to mood disorders later in life.

According to Professor Megan Holmes (University of Edinburgh, UK), “The stress hormone cortisol may be a key factor in programming the fetus, baby or child to be at risk of disease in later life. Cortisol causes reduced growth and modifies the timing of tissue development as well as having long lasting effects on gene expression,” This is a very stressful time, so to be told to avoid stress completely is not practical advice.

Is it worth Checking Cortisol Output?

We think so. By ruling imbalance either in or out, we are better informed about our own health. In cases where the results show a healthy cortisol output, the focus can move to other possibilities which could explain symptoms we may be experiencing. On the other hand, if the hormone is shown to not be functioning correctly, steps can be taken to address the issue which would include consulting with a GP. In less serious cases, a change in lifestyle, such as leaving a stressful working environment, residence or relationship can be all that is required.

How is Cortisol Collected / Tested?

Not only is saliva perfectly suited to measuring steroid hormones like cortisol. using saliva means we don’t need to take multiple blood samples in one day. Returning to the doctors surgery at all hours is impractical, and possibly painful too. No needles no blood, just simple to do saliva sample collection which can be done at home.  Samples should only be analysed by laboratories with NATA accreditation and takes between 5 and 11 working days.

Here are three widely used cortisol tests:  (NOTE: Not suitable for people using prednisone/prednisolone therapy)

  • The Cortisol Awakening Response  (sometimes referred to as ‘the mini stress test’), which includes three samples taken at thirty minute intervals upon awakening. This measures the expected rise and fall in the hormone which our bodies rely on to prepare us for the day ahead.
  • Another is the 24 hour cortisol (comprehensive) which provides a complete picture of the cortisol daily output. This is a four point test taken over a full day.
  • Finally the adrenal function extended profile which measures cortisol at four points over twenty four hours as well as the DHEAs. Low DHEAs indicates cortisol irregularity and is a handy clue when assessing adrenal function. Ideally, both of these hormones should be present in the right proportions, and with typical cortisol behaviour patterns observed.

The results for these include charts and graphs for easy interpretation. Sharing your results with a doctor is also a great idea especially if irregularity is discovered.

Remember – Always see your GP immediately if you are experiencing pain or discomfort.

*Professor Megan Holmes is a neuroendocrinologist from the University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science in Scotland (UK)

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