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Cortisol: Friend or Foe? The First in a Series of Stress Management Strategies

From our content partners Labrix Clinical Services


Cortisol has two primary functions:

  • “Proactive” – where it promotes the coordination of circadian events such as the sleep/wake cycle and food intake
  • “Reactive” – where it facilitates the ability to cope with, adapt to, and recover from stress.


In the proactive mode, cortisol is released by the adrenal glands in a diurnal pattern, with the highest level of cortisol, the cortisol awakening response (CAR), released 30 minutes after awakening. From there, in a healthy cortisol response pattern, the levels steadily decline throughout the day, until they reach a nadir at night, enabling sleep.

The reactive mode accounts for life’s unpredictability when additional cortisol is needed from time to time to cope with, adapt to, and recover from unexpected stressors encountered throughout the day. Cortisol is released whenever the Hypothalamic-Pituitary-Adrenal system is activated by what is perceived as stress – be it emotional, mental, spiritual or physical. Robert Sapolsky may have described this best in his book Why Zebras Don’t Get Ulcers. In the scenario of a cheetah chasing an antelope, there are only two possible outcomes: the antelope gets away, or he doesn’t. During the time of stress where the antelope is being chased by the cheetah, physiologic changes take place to maximize the antelope’s chances of getting away- heart rate, blood pressure and respiration escalate and physiologic activity that could detract from escape, such as digestion, decreases.

A human’s response to an initial acute stressor is similar to that of the antelope’s described above. The difference between the human and the antelope is this: after the antelope successfully escapes the cheetah’s advances, she can be found grazing calmly in a state of “rest and digest” 15 minutes after the affront. Comparably, it would be an unusual human who wouldn’t have to spend some time “processing” such a close escape. Even after the threat has passed, the same physiologic changes that enabled the antelope to escape the cheetah may continue in the human for hours, days, weeks, or months depending on the person – lending to what we know as adrenal dysfunction.

Testing salivary cortisol levels allows the provider to identify the phase of patients’ adrenal dysfunction. When addressing hyper or hypoadrenia in patients, it can come as a surprise and disappointment to providers and patient alike when, after 6 months of complying with a prescribed herbal and supplement regimen, adrenal dysfunction persists. In many of these cases, ongoing stress creates an obstacle to healing; lifestyle modifications to account for this and minimize daily stressors are key to optimizing adrenal health.

Teaching stress management and providing tools for lessening the physiologic effects of stress are as essential to adrenal gland recovery as adaptogenic herbs and vitamin C, yet many people in today’s bustling society either do not know how to relax or simply don’t make stress management and relaxation a priority in their daily lives. As providers, incorporating tangible stress management techniques into patients’ treatment plans is essential for successful adrenal support and health.

Need uncomplicated and straightforward stress management techniques to incorporate into your treatment plans? Read our next newsletter for tools that are both simple to relay and simple to implement.



  • Why Zebras Don’t Get Ulcers, Sapolsky, Robert. Holt Paperbacks; 3rd edition (August 26, 2004)
  • Murray M, ND; Stress, Anxiety and Insomnia: What the Drug Companies Won’t Tell You and Your Doctor Doesn’t Know. Mind Publishing; First edition March 1, 2012
  • Varvogli, Liza and Darvir, Christina. Stress Management Techniques: Evidence Based Procedures that Reduce Stress and Promote Health. Health Science Journal. Vol. 5, Issue 2 (2011).
  • Kiecolt-Glaser JK, et al. Depressive symptoms, omega-6:omega 3 fatty acids, and inflammation in older adults. Psychosom Med. 2007 Apr;69(3):217-24.
  • Pawlow L. A., Jones, G. E.The impact of abbreviated progressive muscle relaxation on salivary cortisol. Biological Psychology, 2002; 60 (1), 1-16.

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