Rise and Shine with Optimal Hormone Health: A Health Practitioner’s Guide to the Cortisol Awakening Response

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A woman in a white lab coat is holding her head while sitting at a desk, noticeably overwhelmed by the Cortisol Awakening Response.

Cortisol is a critical hormone in the body that works on the Goldilocks principle – not too little, not too much – we need it “just right.”

Cortisol testing is important for people suffering from fatigue, loss of libido, and brain fog.  If you’re a Health and Wellness Practitioner, you are likely already familiar with the importance of cortisol in the body.

It's a hormone produced by the adrenal glands that is involved in regulating our response to stress. However, what you may not be as familiar with is a specific kind of testing for cortisol called the Cortisol Awakening Response.

What is the Cortisol Awakening Response (CAR) and Why Is It Important?

The cortisol awakening response (CAR) is a measurement of the change in cortisol levels that occur in the first hour after waking up in the morning. It's a salivary test that can be done in conjunction with other hormone tests that are saliva based, or as part of the DUTCH test, which combines both urine and saliva testing and adds a new dimension to test results since a urine test or a saliva test on its own may not show the whole picture.

Why is this test important? Well, research has shown that the cortisol awakening response can provide valuable information about an individual's stress response. In particular, it can indicate whether someone's stress response is functioning properly or not.

To understand why this is useful information, let's take a closer look at how the cortisol awakening response works. 

Cortisol levels naturally rise and fall throughout the day, with the highest levels typically occurring in the morning and the lowest levels in the evening. This natural rhythm is known as the diurnal pattern of cortisol secretion.

However, when we experience stress, our cortisol levels can become dysregulated. This can result in either too much cortisol being produced or too little. Neither scenario is ideal, as both can have negative consequences for our health and well-being, including fatigue, brain fog, loss of libido, menstrual irregularities, food cravings and so much more.

Cortisol - Test with blood sample. Top view isolated on office desk. Healthcare/Medical concept

Measuring the Cortisol Awakening Response (CAR)

The cortisol awakening response is a way to measure whether the diurnal pattern of cortisol secretion is intact. In healthy individuals, cortisol levels should increase by at least 50% within the first 30-45 minutes after waking up in the morning. If cortisol levels do not rise as expected, this can indicate a problem with the body's stress response system.

When cortisol levels are too low, patients may experience symptoms such as fatigue, weakness, weight loss, low blood pressure, low libido, or anemia. 

On the other hand, when cortisol levels are too high, patients may experience symptoms such as anxiety, irritability, insomnia, increased blood pressure, weight gain, or muscle weakness. These imbalances can be caused by a variety of factors, including chronic stress, poor diet, lack of exercise, and certain medical conditions.

How to Use the Cortisol Awakening Response (CAR)

    1. Use the cortisol awakening response as part of a comprehensive assessment of stress. As mentioned earlier, the Cortisol Awakening Response (CAR) is just one piece of the puzzle when it comes to understanding an individual's stress response. You'll want to look at other factors, such as symptoms of burnout, sleep disturbances, and emotional well-being to get a more complete picture.

    2. Consider the Cortisol Awakening Response (CAR) when developing  protocols for stress-related conditions. If you find that a client has a dysregulated cortisol awakening response, this can inform your  approach. For example, you might recommend specific lifestyle changes, such as improving sleep hygiene or reducing sources of chronic stress to help regulate cortisol levels.

    3. Educate your clients about the importance of managing their stress response. The cortisol awakening response is a useful tool for identifying potential problems with the body's stress response system, but it's even better to prevent those problems from occurring in the first place. Encouraging your clients to prioritize stress management through practices like exercise, mindfulness meditation, or counseling can have far-reaching benefits for their health and well-being.

Overall, the cortisol awakening response is a valuable test for health and wellness practitioners to be familiar with. By using this tool to assess an individual's stress response, you can develop more personalized and effective treatment plans for stress-related conditions. Additionally, educating your clients about the importance of stress management can help them prevent problems before they occur and promote optimal health and well-being over the long term.

How to Interpret the Cortisol Awakening Response

The first step in interpreting the CAR is to measure the cortisol immediately upon awakening and then again through a saliva test within 30 minutes of waking up. Once you have your results, you can begin to analyze the pattern of your cortisol levels:

The Normal Pattern: This pattern shows a rise in cortisol levels within the first 30 minutes of waking up, followed by a gradual decrease throughout the day. This is the ideal pattern as it shows a healthy stress response.

The Flattened Pattern: This pattern shows a lower and flatter cortisol response in the morning, indicating a potential dysfunction in the HPA axis or chronic stress.

The Reverse Pattern: This pattern shows a decrease in cortisol levels in the morning, followed by a significant increase later in the day. This pattern is often seen in individuals with insomnia and other sleep disorders.

How to Address Abnormalities in the Cortisol Awakening Response

Once you have identified the cortisol pattern, you can suggest implementing lifestyle changes to improve your cortisol response, such as reducing stressors, improving sleep quality, and incorporating mindfulness practices.

However, in some instances, abnormal cortisol awakening response can indicate an underlying health issue. This can include either too high or too low levels of cortisol in the morning, which can have negative effects on a person's health. There are several ways to manage abnormal cortisol awakening response findings for patients.

Lifestyle changes – These are essential aspects of managing abnormal cortisol awakening response findings. Adequate sleep, stress management through relaxation techniques and appropriate exercise, and a healthy diet can help regulate cortisol levels in the body. Limiting the intake of alcohol, caffeine, and removing alcohol and processed foods can also help support cortisol regulation.

Medication – In some cases, medication may be prescribed to regulate cortisol levels. Medications that reduce or block cortisol production may be prescribed for patients who have high cortisol levels in the morning. In contrast, those with low cortisol levels may be prescribed medications that increase cortisol production. This is not something that should be done unless natural approaches have been exhausted and the imbalances are having a serious impact. 

Hormone Replacement Therapy – This is another option that can be used for individuals with low cortisol levels.   I’ve addressed this with supplementation of hormones like pregnenolone, DHEA or progesterone.  Be careful with replacement therapy, and only do it under the care of a functional practitioner who has evaluated the complete hormone picture, as in the DUTCH test.

Behavioral therapy – Behavioral therapy can be helpful for patients with high cortisol levels due to underlying conditions, such as depression or anxiety. Behavioral therapies such as cognitive-behavioral therapy (CBT) aim to help individuals identify and address the underlying causes of stress that contribute to increased cortisol production.

Overall, understanding and interpreting the Cortisol Awakening Response can provide valuable insights into how the body responds to stress, and ultimately help us make lifestyle changes to support overall health and well-being.

Cortisol Awakening Response Testing – Key Take-Aways and Next Steps

In conclusion, the cortisol awakening response is a vital component of our body's stress response system. While it is a natural and necessary physiological process, chronic stress can disrupt this response and lead to detrimental health effects. That is why it is crucial for us to take measures to manage our stress levels and support our body's stress response system.

If you're interested in learning more about how to support your body's stress response system and diving even deeper into learning about the cortisol awakening response, go to www.INEMethod.com or visit  https://reinventhealthcare.com/category/adrenals/ to listen to my podcast episodes about the adrenals.

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