You’re taking laxatives because you’re constipated, dieting because you’re gaining weight, or relying on coffee because you’re exhausted. You’re putting the tiredness down to work stress, broken nights or worrying about your children. Ongoing stress can affect the communication between your brain and adrenal glands, which helps control your response to stress. Changes in this system can affect your energy, digestion, sleep and appetite, as well as your menstrual cycle, thyroid function and immune system. You might be the cortisol metabolic type.
Your adrenal glands and cortisol
Your adrenal glands are two small glands, one above each kidney. They produce hormones, the chemical messengers that carry instructions around your body. These include cortisol and adrenaline, which help you respond to stress.
Cortisol works throughout the day, whether you feel stressed or not. It helps maintain blood pressure, keep fuel available between meals and regulate inflammation and the immune response. Levels normally rise around waking and fall towards bedtime. They also increase when your body needs to respond to a challenge, including illness or physical stress.
Your adrenals also produce DHEA. Your body can use this hormone to make androgens and oestrogens, so adrenal function belongs in a discussion about female hormone health.
How your brain controls the stress response
I describe the hypothalamus, a small area in your brain, as an air traffic controller. It receives information about what’s happening in your body and sends instructions through the pituitary gland, another small gland beneath the brain.
The pituitary sends messages to several hormone-producing glands:
- Your adrenal glands: to regulate cortisol production.
- Your ovaries: to help control ovulation, oestrogen and progesterone.
- Your thyroid: the gland in your neck that helps control how your body uses energy.
The communication route between your brain and adrenals is called the hypothalamic-pituitary-adrenal axis, or HPA axis. Cortisol sends information back to the brain too, helping regulate how much is released.
These systems influence each other. Ongoing stress can alter the signals between the brain and glands, hormone release and how the body responds. This helps explain why stress can affect several areas of your health at once.
You may have heard this called “adrenal fatigue”. Symptoms alone don’t establish that the adrenal glands themselves are exhausted. Changes in this communication system need assessing alongside other possible causes of your symptoms.
Stress doesn’t always mean high cortisol
You can feel anxious and overwhelmed without having persistently high cortisol. Research has found that some people reporting prolonged stress have a smaller cortisol rise during a stressful task. Responses vary, and chronic stress doesn’t follow one predictable progression from high cortisol to low cortisol.
We see clients whose cortisol results sit within the laboratory range despite how stressed they feel. We interpret those results alongside their symptoms, sleep, medication and sample times. A moderate daily result alone cannot tell us whether they released enough cortisol during an individual stressful event.
With the DUTCH test, we assess cortisol at timed points across the day, its daily total and its metabolites, the substances formed as your body processes it. We also assess DHEA-related markers. This gives us information about adrenal hormones alongside your female hormone results.
Signs of cortisol dysregulation
Are you struggling with any of these symptoms? They can occur with changes in the stress response, although thyroid problems, nutrient deficiencies, sleep disorders and changing female hormones can produce similar symptoms.
- Exhausted when you wake, even after a full night’s sleep.
- Relying on coffee to get through the morning.
- Crashing in the afternoon.
- Feeling tired but unable to switch off.
- Waking at 2 or 3am with your mind racing
- Feeling anxious, irritable or overwhelmed.
- Craving sugar or salty foods.
- Gaining weight around your middle.
- Bloating, constipation or diarrhoea.
- Brain fog and difficulty concentrating.
- Feeling drained after exercise or taking longer to recover.
- Feeling light-headed when you stand up.
- Changes in your periods during stressful times.
Salt cravings have several possible causes. Strong, persistent cravings alongside dizziness, low blood pressure, worsening weakness or unexplained weight loss need a GP assessment, because they can occur with adrenal insufficiency, a medical condition requiring treatment.
From exams to perimenopause
For some women, symptoms begin around GCSEs, university or a first job. Periods may change, gut symptoms develop or sleep deteriorates when the pressure increases. Later, trying to conceive, having a baby and broken nights bring different demands.
Then our children grow up, and the worry changes rather than disappears. Are they happy? Are they coping at university? Are they eating properly? You can be at home while your mind is somewhere else, worrying about them.
By perimenopause, you may have spent years managing work and family responsibilities with very little time to recover. Fluctuating oestrogen, declining progesterone and poorer sleep can affect your tolerance to stress further. The same demands can leave you feeling much more anxious or exhausted.
I discuss these connections in the adrenal dysfunction chapter of my book, Eat Right, Balance Hormones. Getting food, sleep and recovery in place before perimenopause is useful, and there is still plenty we can work on during perimenopause and after menopause.
Energy, anxiety and sleep
Cortisol helps make fuel available when your body needs it. Too much or too little can affect energy, although fatigue has many possible causes. Anxiety also involves adrenaline and other signals, so feeling anxious doesn’t tell us your cortisol level.
For women struggling with daytime fatigue and difficulty relaxing later, I often recommend my Energise in the morning and my Chill later in the day. Energise combines rhodiola, ginsengs and liquorice with CoQ10 for energy production inside cells. Chill contains Saffr’Inside saffron and L-theanine for stress, mood and relaxation.
If cortisol is elevated around bedtime, it can contribute to difficulty sleeping. Poor sleep can then affect the stress response the following day, leaving you exhausted and less able to manage ordinary demands.
If you wake during the night, we can arrange an additional sample with the appropriate DUTCH test. This assesses cortisol during that part of the night. We need to know when it was collected, because cortisol naturally begins rising towards morning. A raised result may contribute to disturbed sleep, although it doesn’t prove what woke you.
I also use my Magnesium Complex when muscle tension and poor sleep are common symptoms. Magnesium helps muscles contract and relax and is involved in the signals that travel between nerve cells.
Bloating, constipation and the stress response
During fight or flight, your body prepares for action. Your heart rate may increase, fuel becomes available and digestion can change. For some women, food and stool move more slowly, contributing to constipation and bloating. Others get diarrhoea or an urgent need to go before an exam, presentation or difficult conversation.
Stress can make the gut more sensitive too. A normal amount of gas may feel painful or leave you feeling much more bloated. This communication between the brain and gut is one reason digestive symptoms can worsen during stressful periods.
If you’re rushing meals, eating at your desk and working late into the evening, those habits need attention alongside any gut condition. Sit down to eat, put your phone away and chew each mouthful properly.
Cravings and weight gain
Cortisol helps make glucose available when you need fuel. Ongoing stress can affect appetite, food choices, sleep and blood sugar regulation, all of which can make managing your weight harder.
You miss lunch because you’re busy, crave sugar by late afternoon and arrive at dinner ravenous. The next morning, you skip breakfast to compensate. If that leaves you shaky, anxious and hungry again, regular meals are likely to suit you better.
In my book, Eat Right, Lose Weight, I use the cortisol metabolic type to describe a pattern of symptoms and habits that guides food and lifestyle advice. Weight gain around the middle can also involve menopause, insulin resistance and poor sleep, so we assess those factors too.
Progesterone, ovulation and menopause
Stress can disrupt the messages controlling ovulation. If you ovulate less consistently, you produce less of the progesterone normally released afterwards. In a study following women across their cycles, higher daily stress was associated with lower progesterone in the second half of the cycle and a greater chance of a cycle without ovulation.
This is sometimes described as progesterone being diverted to make cortisol. The better-supported explanation is disruption of reproductive signalling. Stress hasn’t been shown to routinely use up the progesterone prescribed as HRT.
After menopause, adrenal hormones such as DHEA provide material that other tissues convert into androgens and oestrogens. This becomes an important source of oestrogen, although it doesn’t replace the levels previously produced by the ovaries.
If you’re taking HRT and still feel exhausted or anxious, stress, sleep, thyroid function and nutrition need reviewing alongside your prescribed hormones.
Thyroid, immunity and histamine
Cortisol and thyroid hormones influence each other. Higher cortisol exposure can suppress the brain’s thyroid signal and reduce circulating T3, the active thyroid hormone. Under-eating can affect thyroid hormones too. Fatigue, constipation, feeling cold and hair loss therefore need a thyroid assessment alongside the stress history.
Cortisol helps regulate inflammation. During prolonged stress, immune cells can become less responsive to its signals, making inflammation harder to control. Stress-related disorders have also been associated with a higher risk of later autoimmune disease, although this doesn’t establish stress as the cause of an individual woman’s condition.
Stress can influence mast cells, the immune cells that release histamine. This helps explain why hives, eczema and nasal allergies can worsen during stressful periods. These reactions involve several stress signals and don’t tell us whether cortisol is high or low.
If these symptoms are continuing, a Discovery Consultation gives us time to review your history and decide whether DUTCH testing, blood tests or another assessment would give us the information we need.
What to eat for the cortisol metabolic type
Regular meals and enough food provide the fuel and nutrients your body needs. Protein, vitamins and minerals are involved in hormone production, energy release and communication between cells.
- Have around 30g of protein at breakfast. Include protein at lunch and dinner too, using foods such as fish, chicken, tofu, eggs or yoghurt if you tolerate them.
- Eat regularly. If delaying breakfast leaves you shaky or drained, eat within an hour of waking. Make time for lunch.
- Include magnesium-rich foods. Pumpkin seeds, nuts, beans and leafy greens provide magnesium and other nutrients.
- Eat vitamin C-rich foods daily. Include peppers, broccoli, kiwi, berries and citrus fruit.
- Include B vitamin sources. Fish, meat, eggs, lentils, chickpeas and mushrooms contribute different B vitamins involved in energy production.
- Keep enough carbohydrate in your meals. Oats, rice, lentils and root vegetables can be included according to your needs.
- Have coffee with or after food. Reduce it gradually if it makes you anxious or you’re using several cups to get through the day.
My Magnesium Complex can contribute when food intake is falling short. I also use my B Complex where additional B vitamins are needed. The choice needs to fit your diet, symptoms and medication.
Lifestyle tips for the cortisol metabolic type
- Eat sitting down, away from work. Put your phone aside and give yourself time to eat.
- Chew each mouthful 30 times, or until it’s mush. This is one of the 5 Foundations of my Pippa Campbell Method, which all our practitioners use in clinic.
- Match exercise to your recovery. If a workout leaves you exhausted for the day or disrupts your sleep, reduce the intensity.
- Get outside after waking. Morning daylight helps set your body clock. This effect comes through your eyes, so you don’t need to expose your skin.
- Keep waking and bedtime reasonably consistent. Reduce bright light and work messages in the evening.
- Reduce one recurring demand. Delegate a task, ask for help or say no to something you don’t have time for.
- Make time for people and activities you enjoy. Put recovery into your week alongside work and family responsibilities.
For women who need daytime energy support and help relaxing later, Energise and Chill are a pairing I use regularly. Their ingredients have been studied for stress-related fatigue, mood and sleep. Energise contains liquorice and is unsuitable if you have high blood pressure.
Feeling overwhelmed? Choose one thing to start with
Pick whichever feels easiest, then add another when you’re ready.
- Have 30g of protein at breakfast. Protein helps keep you full and reduces hunger between meals. Examples include three eggs with 50g smoked salmon, or a smoothie with enough protein powder to provide 30g protein. Chicken sausages are another option; check the label for the protein per serving.
- Before eating, breathe in for four counts, hold for one, then breathe out for six. Repeat gently for one minute. Slower breathing can reduce the physical stress response and help you settle before your meal.
- Chew each mouthful 30 times, or until it’s mush. Chewing breaks food down, making it easier to digest. It also slows you down when stress has you rushing through meals.
My Cortisol Metabolic Type Bundle provides supplement support alongside these food and lifestyle changes. If you’re the cortisol metabolic type, use it with the recommendations above to support your energy, relaxation and daily nutrition.
