Functional Medicine Q&A: Cortisol, the Stress Hormone

Episode 60

Podcast Drop Date: 

6/11/2025

In this Q&A episode, host Amber Warren, PA-C, answers listener questions and explores one of the most talked-about hormones in functional medicine: cortisol. She dives into topics like the truth behind "cortisol belly", how chronic stress affects blood sugar regulation, non-medication strategies for stress relief, and her go-to approach for feeling "tired but wired." Amber unpacks the impact of elevated cortisol, from disrupted sleep to stubborn weight gain, and shares actionable, research-based tips to help you rebalance your stress response naturally. Don’t miss this empowering conversation on understanding and managing cortisol more effectively.

Transcript:

Amber Warren, PA-C: Welcome to the Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper.

Amber Warren, PA-C: Hi everybody. Welcome back. So today we're going to do something just a little bit different. So we put out there on Instagram and our social media page. Throw us your questions on functional medicine, anti-aging, health optimization. And I'm going to do my best to answer some of those. We got some really intriguing and wonderful questions. So we had to kind of hone it in and decided to just keep it themed. Um, discussing stress reduction and cortisol is a stress hormone, so we'll just dig in and we'll do our best to answer some of your questions. If you like this format and you'd like to hear more of this type of approach within our podcast episode, then please let us know and submit your questions on Instagram. One of the first questions we had was what is cortisol belly? Is that really a thing? And I want to be the first to say, yes, it's absolutely a thing. But I don't think we can answer that question without fully explaining what cortisol is. So cortisol is our body's stress hormone. Right. And it's by design. We would die without cortisol. We need it. It regulates our blood pressure. It regulates glucose metabolism.

Amber Warren, PA-C: Our insulin response. Um, it acts as an alarm clock, so it wakes us up. We have this cortisol awakening response that makes us alert and active and alive and ready for the day. We also have cortisol that should come down at night as melatonin increases and gets us ready for bed. Um, your body is really smart, and, um, it's very primitive. Uh, and when we need to run from the tiger, um, or run from the bear, or run to pick up our child from the street, if a car is coming, our body knows how to respond. And so what we'll do is we will increase cortisol. And the response is cortisol will then pull blood sugar from our liver into our bloodstream so that we can react, we can move, we can run, we can perform. Right. Um, if we need to speak in front of an audience or do a podcast episode like today, I'm going to need a certain amount of cortisol to to do my thing. Um, But we want that response to be able to come down. We want to have homeostasis, and we want our glucose to then come down so that we don't become diabetic or pre-diabetic. We don't become insulin resistance. Um, we use a form of cortisone in medicine called hydrocortisone. It's a medication that we use for people having severe inflammation, asthma attacks, allergic reactions. Right. But what's the side effect of that medication? Patients gain weight.

Amber Warren, PA-C: Their blood sugar becomes really high. They have a hard time sleeping. They have a hard time calming down. They get really jittery. So we have side effects when there's too much cortisone, cortisol for too long. So it's really important to keep that relationship, um, in mind when you're thinking about these things. Um, it's hard to say. So. So my point is because of the relationship with cortisol and what it does to blood sugar regulation and insulin resistance. Yes, we tend to deposit adipose tissue or fat around our belly. So that is that cortisol belly response and reaction. Um it's hard to always make that direct comparison, because most people that are under significant amounts of stress will also reach for comfort foods. They might not be exercising as much as they are, right. So correlation doesn't always equal causation in this. In this case, there can be multiple factors at play. But regardless um it it cortisol belly is a thing. Um, our patients do tend to gain weight and it is avoidable if we can figure out the triggers and get cortisol responses to come down. Um, in functional medicine we test cortisol. Unfortunately, it's not always very accurate to look at cortisol levels in the blood. And so the most accurate way is actually to do a salivary cortisol test. So it's a spit test where we can look at cortisol um all throughout the day and all night.Because you might have really normal levels, say in the afternoon and evening, you might be spiking mid-morning. And that's maybe not the time to engage in high intensity exercise or do anything really stressful. You might also be spiking at night, and that's why you're having a hard time falling asleep and staying asleep. So that test can be very helpful.

Amber Warren, PA-C: Okay. Um, someone else asked. Once cortisol levels improve, how do you help your body let go of stored fat or tension? And this is a great question. So the first thing I would say is you definitely want to get your labs drawn. We take a whole, a whole thorough approach here in functional medicine. Um, we look at a lot of different things. No stone left unturned. So you really want to know what's still going on after you've fixed the stress hormone cortisol. Has it caused your blood sugar to become imbalanced? Has it caused you to leak nutrients from your system? We know when we're stressed out, we'll pee out more magnesium, for example. Um, so that would be my first piece of advice. My second one is to keep that cortisol regulated, to try and stay unstuck from that fight or flight. So that's where breathwork, sleep optimization, um, again, avoiding the triggers, getting yourself out of the very stressful environment, um, can all be very, very helpful.

Amber Warren, PA-C: I talk about the right kinds of exercises when we're trying to keep somebody's cortisol, um, regulated and then get the body to perform when it comes to, um, building muscle and burning fat. So, um, some people, for a certain period of time, need to stop doing intense exercise. And that is something that my clients really don't like to hear, because that kind of intense exercise, um, is so good for the brain and it is just such a good stress reliever, but it can be really damaging to different hormones like cortisol, but also your sex hormones and thyroid. Um, so sometimes we need to calm the system down, calm the nervous system down. And so for a few months it might be walking and yoga and eventually adding in some resistance training and seeing how you do as you work on getting your heart rate higher and higher. Um, I often going back to kind of the labs, um, we try and assess mitochondrial health. And what's interesting is your mitochondria are the little, um, the little organelles that, um, are the powerhouses of the cell. So they actually produce ATP, which is your body's source of energy. And what's really interesting is you actually make cortisol, um, within within the mitochondria. The mitochondria is actually what produce cortisol in your adrenal glands. And so if you have damaged mitochondria, um, then they will really struggle to regulate cortisol appropriately.

Amber Warren, PA-C: So we're always talking about so many different diseases as they relate to mitochondrial health. Um, different things that damage the mitochondria: nutrient deficiencies, sleep deprivation, toxins, heavy metals, mold, parasites, even damage the mitochondria. Um, too much oxidative stress, insomnia, not getting enough oxygen day and night. Chronic viruses can really be damaging to the mitochondria. Um, if our clients are able to engage in hit training, um, hit training a few days a week, not necessarily every day can actually really improve your mitochondria within the skeletal muscle. So that's something we would encourage our clients to do if they're at a time when they can do it. Alcohol are very damaging to your mitochondria. Um, so I think my, my advice there, my long winded advice is find your trigger, find your source. Find the reason that you could easily get back into fight or flight. And just really learn how your body responds best to keep the weight off or keep the tension away and to stay in a, um, cortisol calm, fat burning mode.

Amber Warren, PA-C: Next question was how do blood sugar levels respond to chronic stress and how can you balance both? Um, so I kind of explained already just mechanistically how we have our blood sugar responds to our stress hormone cortisol. I hope I made that pretty clear. Um, but how do you work on balancing this? So, um, I'm really big on mindset and boundaries in your life. And I think that without saying too much, um, the media, whether that's social media or the media in general, has done a really good job of instilling fear in our lives and fear in our families and under our roofs. And so, um, I think it's up to us to decide what we expose our minds and our hearts and our bodies too. And avoiding what might trigger us. How we start our day. Do you wake up and look at your phone? You know, I have a motto in my life where it's Word before world. And so I'm reading my Bible and focusing on truth in my life before I let the world intervene and before I let the world start my day. And I mean, I already mentioned, but figuring out your your triggers, um, focusing on the things in your life that really matter, um, hopefully that's your marriage and your family and God and your children, and just finding time when you can just compartmentalize, um, the stress and and get away. Um, we do use a lot of supplements for our patients that are living in chronic stress and can't get out because, let's be honest, that's real. Um, there's marriages that are really hard. There's working environments that are hard, and you might just have to stay in that working environment to continue to provide for your family.

Amber Warren, PA-C: So we use a lot of supplements, um, to help both regulate blood sugar and help control cortisol. So Berberine is one that I love for blood sugar control. We also use Chromium um for cortisol. We have one of my favorite supplements called Cortisol Manager. And it's a really nice blend of adaptogenic herbs, um, to help regulate and balance cortisol, cortisol levels. So supplements can really come in in handy when you're working on balancing chronic stress and having to live, um, amidst chronic stress, because that that's that's the reality for a lot of people.

Next question. Is there a way to reset your stress response without medication? Yes. And I love this question because it really hits home. Um, you know, we live in a world in our conventional medicine world where we have a lot of polypharmacy, right? Pill for an ill. We just dispense medications without looking at root cause. And I think in functional medicine, we can get stuck in a similar mindset where we're using poly supplementation and not truly looking at root cause. A lot of patients maybe can't tolerate supplements, can't afford supplements. Um, and so we have to work on lifestyle and that's always where I start. Um, because no pill can really can really fix the chronic or acute stress in your life.

Amber Warren, PA-C: So, um, you know, my encouragement in that kind of situation would be and really, in all, in all scenarios is, is sleep. Um, you can't ever underestimate the importance of sleep when it comes to regulating cortisol and helping your body respond to stress better. So I educate a lot on circadian rhythms. Um, waking up with the sun, going to bed down with with the sun, um, putting your eyes, um, on the sun as, as the sun rises, that tells your brain to start shutting off melatonin and start making cortisol, that cortisol awakening response I mentioned and doing the same thing at night, shutting down your the artificial light, blue light devices and actually looking at the sunset so your body knows, um, to reverse that mechanism in the morning and start shutting down cortisol and then start making melatonin to prepare your body for rest and sleep and your deep restorative sleep. Um, so, um, whatever that looks like for you, that bedtime routine that tells your body it's time to prepare for sleep. I cannot again underestimate the importance of of sleep. Um, for helping to manage stress and cortisol. Um, going outside. I read a statistic that, um, we spend 93% of our, the average American spend spends 93% of their life inside. Um, and that's damaging for multiple reasons. Um, it really screws up our mitochondria.

Amber Warren, PA-C: It messes up our circadian rhythms. As I just mentioned, we weren't we weren't designed to live under artificial light and not touch the ground. Um, so again, if it's five minutes in the morning looking at the sun standing, standing on the earth, um, if it's taking a call, um, you know, instead of sitting at your desk on a call, you know, walking laps around your front yard. I mean, it's just doing what you can to breathe more fresh air, um, and get outside under natural sunlight. Um, breathwork is so huge. Um, to answer this question, we really underestimate how many deep breaths we take throughout the day. Um, and just to do, do those deep, deep belly breaths can right away within literally seconds bring bring your stress hormones back into balance. And so that's something that I really encourage my patients to do either first thing in the morning or before they go to bed and just creating boundaries. Right. This is, this is, um, one that we can all work on, um, saying no being where your feet are, being more present, um, saying no to things that that don't serve you or you don't feel called to do. I think that can really do wonders. You know, I have a friend who's a very successful local business owner, and, um, she's making a very intense effort to be around for her kids as they are becoming teenagers. And so she has asked her team not to call her between the hours of 3:30 and, you know, after 3:30, basically is the rule that she made because that is her family time. And I just really respect that she's setting up boundaries to help, to help with her work life balance and help her be an amazing wife, an amazing mom.

Amber Warren, PA-C: Um, how can breathwork sleep or movement reduce stress hormones quickly? Well, I think I just answered this, and, um, it really is that it will reduce cortisol right away. There's there's so much science that supports this. Um, and that's again where I will really encourage my patients to go outside, go for a walk. Um, talk to God, take your spouse, talk to them. Put that phone down. Um, these phones, these these devices, they are truly rewiring our brain and ruining our lives. Um, and so I'm always trying to encourage my patients to to be okay. Um, and to find joy in stillness and in quiet and engaging with, with people that you love and being in community. Um, so the breathwork, um, improving your sleep, movement, they all are known to, um, bring cortisol down very quickly, much more quickly than any supplement medication or herb can um, so please, please keep that in mind. But these are all really good questions.

Amber Warren, PA-C: So what's your go to protocol for someone who's tired and wired or wired and tired? Um, so the first way I want to answer this question is, is it's always it's always personal. Um, so that is it's a really difficult question to say, oh, I'm tired and wired. How would you approach me? Well, I want to know your story. I want to know when, um, when your adrenals had to start fighting. Your adrenals are the little, um, organs that sit on top of your kidneys, that pump out cortisol and also pump out some sex hormones. But I want to know when your adrenals started to struggle. What was your trigger? Um, you know, and maybe it was. It was from when you were a baby and you weren't fed nutrient dense foods, and, um, you were raised by parents who yelled a lot or raised by a sibling that bullied you, or, heaven forbid, there was abuse or sexual abuse in the family. So we asked those questions, um, because we want to know how long you've been under under the stress. And, um, it's also important to know that that we have different phases of adrenal dysfunction and your cortisol will get into your adrenals, I should say will start to adapt. And eventually, if you're ten, 15, 16 years into the fight, you eventually can just become where your cortisol is completely blunted.

Amber Warren, PA-C: And that is where patients, their frontal cortex and their brain can actually start to shrink. Um, they have a difficult time getting out of bed. Severe depression hits in, um, and you can actually start to just your, your adrenals just give out. Um, so that's where, as I mentioned earlier, the testing of your cortisol levels can become really imperative. But the wired and tired definitely makes me think high cortisol. Um, you're in that that phase where your adrenals are doing their best to keep up and they're just pumping out, pumping out, pumping out cortisol. Um, so that's where we, again, dig to try and find the root causes and what the imbalances are in your body that's driving this stress is not just, um, just physical. Um, it can also be, um, well, it's not just psychological. I could say there can also be, um, some, some other things that are driving this. Right. It's very stressful for your body to not get good quality sleep. Minimum seven hours of sleep. Right? It is very stressful for your body to have severe vitamin and nutrient deficiencies. It is very stressful for your body to have an autoimmune disease. So there are so many other sources of stress and we almost have to redefine stress. Um, because those things are all very stressful for the body. So that's where root cause medicine becomes really imperative. Um, this would be another person that would really benefit from some herbs.

Amber Warren, PA-C: I mentioned that supplement Cortisol Manager. Within that supplement is an herb called phosphatidylserine. And that is something that is beautiful at lowering cortisol. So my patients that are tired and wired at night, um, they could really benefit from, from phosphatidylserine to bring their cortisol levels down and prepare them for sleep. This is also someone that I would really encourage to prioritize sleep, putting up boundaries at night, having a bedtime routine. Um, my rule of thumb for sleep, going back to optimizing sleep is 10, 3, 2, 1. So ten hours before bed, no caffeine. Caffeine has a pretty long half life in most individuals. So that means that if you drink a, um, afternoon latte at 2 p.m., half of that caffeine is still going through your body at two at 2 a.m.. So, um, no caffeine. Ten hours before bed, three hours before bed. Um, try to finish your last meal so your body is not working on digesting food, and it can be working on preparing for rest. Two hours before bed, nothing stressful. Stop working. Um, try to not engage in any stressful conversations with a spouse or your mother in law or another loved one. And then one hour before bed, um, dim the lights. You know, I have, I've mentioned this before, but I have, um, a lot of amber colored lights in my home, and I don't turn on the bright white, um, beautiful lights, um, before bedtime in my kiddos bedrooms are really, really orange colored lights in their closet and their bedroom so when we're reading and getting ready for bed, we don't have that white artificial light that really disrupts your melatonin production. Um, so those are all, all, all ways that we really try and optimize sleep. Um, but again, this is a person that we want to make sure their thyroid looks good. We want to make sure nutrient levels, um, look good to, to regulate their nervous system. Um, we're working on their mitochondria. We're really optimizing protein intake and, and eating real good quality foods that come from the ground, ideally organic. Um, and again, these are clients that I'm, I'm probably asking them to stop doing their high intensity interval training. They probably shouldn't be training for a half marathon. Um, I'm going to ask them to do that more restorative walking, hiking, yoga, um, maybe just some some lifting heavy weights and trying to keep their heart rate down.

Amber Warren, PA-C: The last question is, is is a really good one? Can burnout from motherhood or high performance lifestyles cause long term metabolic shifts? Um, long term, yes, but not permanent shifts. Um, so if we don't get clients, um, out of their cycle, that's driving their prediabetes, driving their insulin resistance, um, then, yes, these long term metabolic shifts can happen where you can't kick the baby weight.

Amber Warren, PA-C: You're really struggling in perimenopause, perimenopause and menopause to lose that belly fat or get your brain fog, um, to, to, um, dial back. Um, but this is where we, we really work on, um, working with our dietician again, cutting the carbs, alcohol, sugar. Um, we, we do a lot of continuous glucose monitoring here in our clinic, um, again, so we can really work on that metabolic health piece. Um, saunas are wonderful for metabolic health and also really good for relaxation. Um, so we encourage a lot of that. Um, so yes, we see a lot of metabolic changes with a lot of these clients. And from you mamas that are out there just, um, nonstop, always thinking, always worrying, not getting deep, restful sleep. Um, there is so much hope. Um, but it really does take a personalized approach. And looking at, um, your serum labs and seeing what your profile looks like, um, and similar to the, you know, the question also asked about high performance lifestyles. These are the people that are burning the candle at both ends. Um, you know, I have a lot of friends that, um, that are career women and, and running hard and they, they travel. And so those shifts, you know, the different, um, time shifts that their bodies deal with can be, can be really difficult. But, you know, you do your best.

Amber Warren, PA-C: And when you're home, you optimize rest and sleep and again, restorative exercise and nutrition. Um, and there is so much hope because so many things can be reversed when we start to catch these things early. Um, that's even better. So I hope you guys found this helpful. Um, we'd love to do more of these sessions if our listeners want this. So please, um, please report back and give us your comments. And please don't ever hesitate to submit your questions on Instagram because we we love hearing them and responding to them. Thanks so much for tuning in.

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Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today. Specialties available at the FMI Center for Optimal Health and the highest quality of supplements and more, go to funmedfoundations.com.