Cortisol is often called the body’s “stress hormone” for a good reason. It plays a central role in managing your response to stress, but its influence extends much further than that.
Cortisol helps regulate your energy, metabolism, immune function, and even your sleep-wake cycle. When it becomes imbalanced, it can disrupt many aspects of health, leading to fatigue, weight gain, anxiety, sleep disturbances, and even gut issues.
A simple way to gain insight into your cortisol levels is through a functional medicine salivary cortisol test. This non-invasive test helps assess adrenal function and identifies potential imbalances in how your body handles stress.
What Is Cortisol?
Cortisol, produced by the adrenal glands, is often associated with the body’s stress response. However, its functions extend well beyond managing stress. Below are some of the key roles cortisol plays in maintaining overall health.
- Helps regulate blood sugar levels by promoting the release of glucose from the liver, providing energy during times of stress.
- Increases nervous system excitability, which enhances focus and perceptual abilities in response to stress.
- Boosts the immune system’s readiness by increasing antibody production, preparing the body for potential infections.
- Diverts resources away from less urgent functions like digestion and immunity, prioritizing immediate survival needs.
- Influences fat storage, especially around the trunk, which can lead to weight gain when cortisol levels remain elevated.
As you can see, while these functions are beneficial in the short term, prolonged or heightened cortisol levels can lead to less desirable effects.
When you’re under stress, whether perceived or hidden sources of stress, your body releases more cortisol to help you cope. Think of it like your body’s internal alarm system—it kicks in when you need to fight, flee, or figure things out.
What happens when your cortisol levels stay high (or too low) over time? That’s when the negative effects kick in—fatigue, weight gain, anxiety, and poor sleep are often signs of cortisol imbalance.
How Does the Functional Medicine Saliva Test Work?
The salivary cortisol test is straightforward and non-invasive. It measures your cortisol levels at different times throughout the day, offering a clear picture of how your adrenal glands are functioning.
Here’s how it works:
1. You collect saliva samples at different times (usually morning, noon, afternoon, and bedtime).
2. Each sample gives us insight into your body’s cortisol rhythm.
3. We analyze the results to see how your cortisol levels rise and fall over the day.
The best part? You can do this test from the comfort of your own home.
Salivary cortisol is also a reliable way to measure some hormones and has been shown to accurately correlate to cortisol levels in the blood. This is helpful since taking multiple blood samples would be quite uncomfortable and the needle stick alone can cause cortisol levels to rise.
Why Your Cortisol Rhythm Matters
When we look at the spectrum of function, measuring cortisol isn’t just about one number; it’s about your personal hormonal rhythm. In a healthy individual, cortisol is highest in the morning (to help you wake up) and gradually drops throughout the day, hitting its lowest point at night when you’re ready to sleep.
When this rhythm is disrupted, it may indicate HPA-axis dysfunction (often called adrenal fatigue). This often shows up as exhaustion in the morning and feeling wired at night, or dragging through the day with no energy at all.
But remember, cortisol impacts much more than just emotional stress. Its balanced function is crucial for your immune system, metabolism, bone and muscle strength, gut health, and so much more!
Understanding the Cortisol Awakening Response (CAR)
A key part of cortisol function is the Cortisol Awakening Response (CAR), the surge in cortisol levels within the first 30-45 minutes of waking. CAR is part of your body’s natural rhythm and is critical for kickstarting your day.
- Prepares You for the Day: Upon waking, your body anticipates the need for energy and sharpness. Cortisol levels rise significantly to help you feel alert, energized, and ready to take on mental or physical tasks.
- Boosts Cognitive Function: The morning cortisol spike enhances focus, memory, and cognitive performance, helping you start your day strong.
- Regulates Your Stress Response: A healthy CAR ensures your body is ready to handle everyday stressors as you move through your morning routine and begin your day.
When the Cortisol Awakening Response is too low, you may struggle with fatigue, brain fog, and sluggishness upon waking. Conversely, if CAR is too high, it could lead to feelings of being “wired” or anxious, especially early in the day. Imbalances in CAR are often linked to HPA axis dysfunction as well.
Functional Medicine Cortisol Testing vs. Conventional Adrenal Diagnosis
Now, you might wonder—is something medically wrong with my adrenals? This testing is not looking for the same kind of conditions or diagnoses that your conventional practitioner or endocrinologist might be concerned with.
Conventional cortisol testing is used to evaluate for and diagnose extreme adrenal conditions that are rare but serious. They are used to detect medically-recognized adrenal diseases like Addison’s Disease (where your adrenal glands don’t produce enough cortisol) or Cushing’s Syndrome (where you produce too much cortisol).
Functional medicine testing detects imbalances in how your body manages stress over time. It helps catch subtle dysfunctions before they develop into more serious health issues.
In other words, most people don’t have adrenal disease, but they can experience HPA-axis dysfunction—this is when the brain, adrenal glands, and hormones aren’t communicating as smoothly as they should.
Read this to explore more about how functional medicine differs from conventional approaches.
The key takeaway here is that a functional medicine salivary cortisol test is about optimizing your stress response and supporting resilience, not diagnosing adrenal disease. It’s important to work with a conventional medicine practitioner if you or your functional medicine practitioner suspects such adrenal diseases.
What Can the Cortisol Saliva Test Reveal?
This test isn’t just about whether your cortisol is “high” or “low.” It gives a detailed look at how your cortisol levels fluctuate throughout the day. By understanding these patterns, you can take action to correct imbalances and get back on track. Here are some examples of what testing can reveal:
High Cortisol Levels May Indicate:
- Chronic stress and anxiety
- Sleep disturbances (trouble falling/staying asleep)
- Blood sugar imbalances and weight gain (especially around the abdomen)
- Weakened immune function (increased risk of infections)
- Hormonal imbalances (disrupting thyroid and sex hormones)
If you’re curious about how high cortisol affects your health, check out 10 Ways High Cortisol Can Negatively Impact Your Health.
Low Cortisol Levels May Indicate:
- Adrenal fatigue or burnout (chronic low energy)
- Chronic fatigue syndrome (exhaustion and poor stress tolerance)
- Depression or low mood
- Low blood pressure and dizziness
- Weakened immune response (susceptibility to infections)
Erratic Cortisol Levels May Indicate:
- HPA axis dysfunction (poor stress response regulation)
- Sleep-wake disruptions (low morning, high evening cortisol)
- Blood sugar fluctuations and energy crashes
- Mood swings and irritability
- Inflammation (poor immune/inflammatory control)
Cortisol imbalance over time can also lead to bigger issues like hormone imbalances, thyroid problems, and even cardiovascular risks. This is why it’s so important to catch it early and take action. The concept of allostatic load—the cumulative burden of stress on your body—plays a key role here.
Tips for Cortisol Balance & Importance of a Functional Medicine Practitioner
Once you receive your cortisol test results, the next step is to address any imbalances. While lifestyle changes are a great starting point, working with a functional medicine practitioner is essential to develop a personalized, targeted approach.
Lifestyle Tips for High or Low Cortisol:
For High Cortisol:
- Incorporate stress-reduction techniques like yoga, meditation, or deep breathing.
- Follow an anti-inflammatory diet and consider adaptogens like ashwagandha.
- Focus on improving sleep quality (7-9 hours a night).
For Low Cortisol:
- Support adrenal health with morning sunlight exposure, gentle movement, and nutrient-rich foods.
- Consider adaptogens like licorice root and focus on light exercise to avoid overexertion.
- Focus on improving sleep quality (7-9 hours a night), sleep is critical!
While these strategies can help manage your cortisol levels, working with a trained practitioner ensures a comprehensive approach. A well-trained practitioner can interpret your results within the context of your overall health, identify patterns within your cortisol rhythm, and see how it may be affecting areas like hormone balance, gut health, or immunity.
Cortisol imbalance is just one piece of the puzzle. A functional medicine practitioner will craft a personalized plan that includes stress management, nutrition, and supplements to fit your unique needs.
Conclusion:
Balancing cortisol is key to optimizing your body’s stress response, resilience, and to support overall health. Whether you’re dealing with high, low, or erratic cortisol levels, functional medicine testing can help uncover these patterns and even the root causes of imbalances.
The insights gained from a cortisol saliva test can guide targeted lifestyle changes and, when combined with the support of a well-trained functional medicine practitioner, help you regain control of your energy, mood, and overall wellness.
If you’re ready to take the next step in understanding your health, consider getting started with functional medicine testing today. Stay connected with me for more tips by joining my email list or following me on Instagram. Let’s begin your personalized journey toward optimizing health.
About the Author
Kenny Mittelstadt is an acupuncturist and functional health practitioner based in San Antonio, Texas. He is trained through the Institute for Functional Medicine and received both of his doctorate degrees with highest honors from Southern California University of Health Sciences. He focuses on empowering patients through creating opportunities for integrated understanding and personalized root-cause healing - starting with gut health and growing beyond!