Stress and Cortisol

Learn about stress and cortisol and reduce your risk of chronic health problems

What is stress?

The American Psychological Association (APA) defines stress as a pattern of emotional, cognitive, behavioural and/or physiological response to a real or imagined situation that a person perceives as threatening a goal or their well-being. These threats are called ‘stressors’.

How can stress affect you?

Stress can affect people in different ways and what one person perceives as stressful another person may not.

Here are some of the ways stress can affect you.

  • Emotional (impacts how we feel)
  • Cognitive (impacts on what we think)
  • Behavioural (impacts on how we behave)
  • Physiological (impacts our body)

How a person copes with stress can depend on lots of factors including their genetics, early life events, personality traits and social and economic circumstances.

Different types of stress

There are different types of stress. Here you will find information on the differences between short and long-term stress. It’s important to remember that stress is a normal part of life. But stress that lasts for a long time can have serious consequences for your health.

Short-term (acute) stress

Feeling stressed from time to time is a normal part of everyday life. For example, conducting a public speaking task or sitting in traffic on the way to work. This type of short-term stress is called ‘acute stress’ and in some situations it can be useful for getting you ready for a stressful situation.

In fact, research has shown that short-term stress may actually be good for us e.g., heightening our cognitive awareness and mobilising energy to prepare us for ‘fight or flight’.

Long-term (chronic) stress

Stress that lasts weeks, months or even years is called ‘chronic stress’ and this kind of stress can result in wear and tear on the body referred to as ‘allostatic load’. Chronic Stress can have serious consequences for our physical and mental health. The stressor does not need to be physically present to have its effects. Even recollecting a stressful situation can cause a person to feel chronic stress.

How does stress affect the body?

Stress is able to impact health by affecting several systems that are important for maintaining health.

Autonomic nervous system

There are two systems that are central to how the body responds to stress. These systems are known as the autonomic nervous system and the hypothalamic pituitary adrenal (HPA) axis.

The sympathetic and parasympathetic nervous systems are distinct parts of the autonomic nervous system. Both branches play key roles in our immediate response to acute stress. The sympathetic system is responsible for preparing our body for action (i.e., fight or flight) when we perceive a stressor.

In a stressful situation several immediate responses occur within the body that are driven by the sympathetic system including dilation of pupils, increases in heart rate, slowing of digestion and other functions that are not immediately needed. The overall purpose of these events is to provide enough energy to deal with the stressful situation. Once the stressor subsides, the parasympathetic branch of the autonomic nervous system restores the body to normal functions.

The HPA axis

The Hypothalamus Pituitary Adrenal (HPA) axis is the system that produces cortisol and controls how your body responds to stress.

It includes a part of the brain called the hypothalamus, the pituitary, and the adrenals that sit on top of the kidneys. The HPA axis is closely connected with the functioning of the immune system and other systems throughout the body.

Common signs and symptoms of stress

How you might feel

Mental symptoms associated with stress

  • Irritable, angry or impatient
  • Feeling depressed
  • Feeling anxious, nervous or afraid
  • Difficulty concentrating
  • Struggling to make decisions
  • Feeling worried
  • Repetitive negative thoughts
  • Being forgetful
  • Feeling overwhelmed and unable to cope
  • Existing mental health problems getting worse

Physical symptoms of stres

Here are some signs associated with chronic stress

  • Feeling generally unwell
  • Regular infections
  • Severe Fatigue
  • Low mood
  • Diarrhea, nausea and vomiting
  • Headaches
  • Cognitive difficulties
  • Depression
  • Anxiety
  • Bone loss and weakness
  • Chest pains and high blood pressure
  • Decreased Libido
  • Bone loss and weakness
  • Chest pains and high blood pressure
  • Decreased Libido
  • Difficulty getting pregnant
  • Irregular periods
  • Erectile dysfunction
  • Low blood sugar
  • Weight gain or weight loss
  • Existing physical health problems worsening

How stress can make you behave

  • Being irritable and snappy
  • Sleeping too much or too little
  • Eating too much or too little
  • Snapping at people
  • Biting your nails
  • Crying or feeling tearful regularly

Did you know?

Research has shown that stress can affect a range of health outcomes from your likelihood of chronic illness to cellular ageing.

Managing your cortisol levels with a Cortisol Over Time (COT) test will help you manage and prevent the effects of stress on your physical and mental health.

Stress can affect:

  • Your likelihood of chronic conditions
  • How well your body responds to vaccines
  • How well you recovery from surgery
  • Can increase your risk of heart disease
  • Can reduce male and female fertility
  • Your mental health

How to manage your stress levels?

Here are some of the ways you can manage stress.

Remember that what works for one person may not work for another so try to find what works for you.

  1. Recognise when stress is a problem
  2. Think about where you can make changes
  3. Build supportive relationships
  4. Eat healthily
  5. Be aware of unhealthy behaviour such as smoking and drinking too much
  6. Get some exercise
  7. Take time out
  8. Try mindfulness
  9. Get some restful sleep
  10. Regularly check you cortisol levels

The role of cortisol

By testing your cortisol levels you can find out if stress may be impact your overall health. Here you will find information on what Cortisol and what it does.

What is cortisol?

Cortisol is a glucocorticoid steroid hormone that is often known as the ‘stress hormone’ because it plays an important role in how the body responds to stressful situations. Cortisol helps prepare the body for ‘fight or flight’ and helps to generate the energy the body needs to deal stressful situations called ‘stressors’.

Cortisol also plays other vital roles within the body such as regulating the immune system, reproductive function and maintaining brain health.

It’s important to know that many lifestyle factors such as the quality of your diet, how much exercise you get and your sleep patterns also affect cortisol levels.

How is cortisol controlled?

Cortisol is controlled by the Hypothalamus Pituitary Adrenal (HPA) Axis which is the system that produces and manages cortisol levels throughout the body. It includes the hypothalamus and pituitary, which are located in your brain and your adrenal glands that sit on top of your kidneys. The HPA axis works by sending signals through constant feedback between the hypothalamus, the pituitary and adrenals and interacting with other systems throughout the body to regulate and control a range of vital functions and maintain cortisol function.

When cortisol levels in the blood are low, the hypothalamus releases corticotrophin-releasing hormone, which causes the pituitary gland to secrete another hormone, adrenocorticotropic hormone, into the bloodstream. High levels of adrenocorticotropic hormone are detected in the adrenal glands and stimulate the secretion of cortisol, causing cortisol levels to rise.

As the cortisol levels rise, they start to block the release of corticotrophin-releasing hormone from the hypothalamus and adrenocorticotropic hormone from the pituitary. As a result, the adrenocorticotropic hormone levels start to drop, which then leads to a drop in cortisol levels. This is called a ‘negative feedback’ loop.

Cortisol and overall health

Almost every cell and system throughout the body contains receptors for cortisol and so cortisol can affect overall general health and have different actions depending on the systems and cells in the body it is acting upon.

A range of lifestyle factors over time can dysregulate the Hypothalamus Pituitary Adrenal (HPA) axis leading to low or high cortisol levels.

Levels that are too low or too high can increase risk of a range of health problems and can lead to specific endocrinological conditions such Addison’s disease and Cushing’s syndrome.

Different types of cortisol tests

There are several ways you can test cortisol levels and it’s important to know which test is best for you.

Blood, saliva and urine

Blood, saliva and urine cortisol tests are called ‘acute’ tests because they only provide an indication of your cortisol levels over a short period of time.

Blood and saliva tests usually give you information on cortisol levels around 20-40 minutes before testing. A urine test can provide information on your cortisol levels over several hours. Doctors may use a blood test in an acute medical emergency such as an ‘adrenal crisis’.

Blood, saliva and urine tests are not suitable for testing the impact of chronic cortisol levels on your long-term health.

This is because cortisol levels change quickly and vary throughout the day. These factors can affect the reliability of your test results.

To understand how your cortisol levels may be affecting your long-term health a Cortisol Over Time (COT) hair test is recommended to assess your average cortisol levels over several months.

Cortisol Over Time (COT) Test

Our Cortisol Over Time (COT) test uses a sample of your hair to assess your cortisol levels over several months. This avoids having to take daily blood or saliva tests over several months to test your cortisol levels.

A hair test is more accurate than saliva and blood tests for testing your cortisol levels over time.

References

The American Psychological Association (APA) https://dictionary.apa.org/stress

Greff, M et al. 2019. Hair cortisol analysis: An update on methodological considerations and clinical applications. Clinical Biochemistry, 63, 1-9.

McEwen BS. 1998. Protective and damaging effects of stress mediators. NEJM, 338: 171-179.

Lovallo WR. (2016). Stress and Health: Biological and Psychological Interactions, 3rd edn. Sage Publications, Los Angeles, CA.

Raul J-S, Cirimele V, Ludes B, Kintz P. 2004. Detection of physiological concentrations of cortisol and cortisone in human hair. Clin. Biochem. 37:1105–11

Segerstrom, S., & Miller, G. (2004). Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol. Bull. 130:601–30

Tomlinson, J, W. (2017). How do I determine cortisol deficiency in the critically ill patient. Society for Endocrinology. Issue 123.

O’Connor, D., Thayer, J., and Vedhara, K. (2020). Stress and Health: A review of psychobiological processes. Annual Review of Psychobiological Processes. Annual review of Psychology, 72, 4.1-4.26.

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