Feeling Stressed? A Doctor's One-Day Plan To Balance Cortisol Levels

Integrative Medicine Doctor By Aviva Romm, M.D.
Integrative Medicine Doctor
Aviva Romm, M.D. is both a midwife and an Internal Medicine and Board Certified Family Physician with specialties in Integrative Gynecology, Obstetric and Pediatrics, with a focus on women’s endocrinology.
Feeling Stressed? A Doctor's One-Day Plan To Balance Cortisol Levels

If there's one thing we've lost in our 24/7, go-go-go way of life, it's rhythm. And I don't mean whether you can bust a move (I'm sure you can). I'm talking about cortisol rhythm. Without a firm rhythm in place, we can feel the imbalance!

Cortisol, a hormone, and one of the main stress response chemicals produced by the adrenal glands—the other is adrenaline—is responsible for maintaining the health of and proper communication between every cell in your body. When it is in a healthy rhythm, cortisol is highest in the morning to give us energy to get our day started, keep inflammation low, and immune response at its peak. It is naturally lowest before bed allowing us to wind down into a rest-and-repair phase. When this natural "diurnal" cycle is disrupted, we can end up with:

  • Sleep problems (insomnia, waking in the night, waking up tired in the morning)
  • Hormonal imbalances
  • Anxiety and depression
  • Blood sugar and metabolic problems (including sugar cravings, metabolic syndrome, PCOS, and diabetes)
  • Weight challenges
  • Decreased memory, focus, and willpower
  • Immune system imbalances leading to more frequent infections, reactivation of old viruses, allergies, inflammation, and even autoimmune disease

In fact, most long-term chronic health problems can be traced to disturbances in the natural cortisol pattern. For example, obesity, digestive problems, and diabetes, have been linked to disturbances in cortisol rhythm. So resetting your cortisol rhythm, which is what we're really getting at when we talk about "resetting our adrenals," is one of the most important steps we can take to feel in balance in our lives now and ensure our health for the long term.*


Everything you need to reset your cortisol rhythm

Resetting your cortisol rhythm doesn't require any fancy foods, crazy diet plans, or dance steps. It's actually shockingly simple. It does, however, require a commitment to reclaiming rhythm in your life. But who doesn't want that?

Here are six simple steps to resetting your cortisol rhythm and with it your adrenal stress response.

1. Reset your sleep schedule.

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Sleep is the ultimate pause we need at the end of every day; it's impossible to reset your internal clocks without good quality—and enough quantity—sleep. Cortisol regulates the production of melatonin, which is important not only for sleep but for detoxification and immunity. Elevated cortisol actually suppresses melatonin, increasing your risk of not only sleep problems but also inflammatory conditions ranging from diabetes to dementia and cancer.

Further, when your sleep is disrupted, it tends to exacerbate other symptoms: Your sugar and carb cravings go up, your energy and focus go down, and so does your immunity.


How much sleep do you need?

Here's the magic number: I've found during my practice that most people need at least seven hours of good sleep every night to reset cortisol rhythm—and importantly, do a brain dump. When you sleep your brain literally processes the knowledge, memories, information, and cellular waste that accumulates in it during the day, as does your body.

Is bedtime and wake time important?

Especially important is a regular sleep cycle that has you waking and going to bed at roughly the same times each day, preferably waking by about 7:00 a.m. and getting to bed between 10:00 p.m. and 11:00 p.m.


How can I get to sleep more easily?

What's the No. 1 disrupter of sleep for most women right now? From what I hear at my practice, it's using electronic devices in the hour before bed! So the most important recommendation for resetting your sleep and cortisol? A digital detox each night in the hour before sleep—no smartphone, Kindle, or iPads. Do "old-fashioned" things like read a real book (with pages!), take a hot bath, journal, have sex, and meditate, even if only for a few minutes. When done consistently, this step alone can transform your life.

What if I work nights?

This is a tough situation because working nights is inherently harder on your adrenals. But there are things you can do to protect yourself:

  • Get extra sleep before your shift. I know that sounds wonky, but a phenomenon called sleep banking—sleeping ahead to store up on rest—really is scientifically proven to help prevent exhaustion and physiologic consequences from missed sleep.
  • Eat well on the job. It's so tempting to nosh out at night, but keeping only to nutrient-dense foods overnight can keep your cortisol sane and the unhealthy calories off.
  • Use adaptogenic herbs, which have been shown to help manage stress.*
  • Make time to decompress when you get home (see above).

2. Follow the light.

Your cortisol rhythm is anything but colorblind! In fact, light spectrum is part of what helps keep it in balance. Bright natural sunlight in your eyes in the morning can reset your morning cortisol cycle, and with it your energy, mood, mental clarity, all day long.

Can't get natural light in the morning because of your work schedule or where you live? Try light box therapy instead. It can help reset your internal clock and has been shown to bust through depression, too. Throughout the day, try to get natural light exposure by sitting near a window when you work. And then follow the digital detox in the evening. Added bonus? Set your phone to "night shift" to make sure that blue light is not emitted, or download blue-light-blocking apps like f.lux to help offset the negative effects of looking at your computer late at night.

3. Eat the right foods, at the right time.

While a low carb diet may sound like a weight-loss winner, interestingly, and particularly in women, a very low carb diet actually increases your cortisol and likelihood of putting on, not taking off, belly fat. In fact, many of my clients benefit from eating a small healthy carbohydrate choice three to five hours before going to sleep to create a healthier cortisol pattern while improving sleep—a win-win.

Healthy choices include a serving of a whole grain, for example brown rice or quinoa, and/or a serving of sweet potato, winter squash, or potatoes (baked or roasted) and cooled almost to room temperature before eating. In general, eating within three hours of bedtime can impair both sleep and cortisol, and skipping meals also has a negative impact on cortisol.


4. Reset after work and before dinner.

Studies have shown relaxing and rebooting mentally and emotionally after a hard or long workday leads to healthier cortisol levels and better sleep. Make it a weekday end-of-work habit to decompress for even just 15 minutes with a favorite activity when you get home from work.

My personal favorite is a solo dance party (no judgments here)! But a shower, brisk walk, yoga session, and playing with your kids all work too!

5. Avoid caffeine and alcohol later in the day.

While a great cup of coffee can be one of life's pleasures, caffeine, including from green tea, chai, and chocolate, can keep you up at night. If you're super sensitive, do a caffeine detox for three weeks while you reset your adrenals; if caffeine doesn't make you jittery and wired, enjoy a small amount but not after noon to prevent it from jacking up your afternoon and keeping you from getting sleep.

Similarly, while you might love an evening glass of wine, almost all of my patients report that their sleep improved dramatically, particularly their ability to stay asleep and feel refreshed in the morning, when they stopped drinking alcohol.

6. Eat clean.

Chronic inflammation is huge trigger of cortisol imbalances. In addition to the blood sugar balance I mentioned above, processed foods, poor-quality fats, and a high-sugar diet can cause inflammation that leads to chronically overactivated cortisol production. Cleaning up your diet so you're only getting real, healthy, low-inflammatory foods can do wonders for your adrenal reset.

While adrenal fatigue, thyroid issues, Hashimoto's, trouble sleeping, anxiety, and weight issues are tough to bear, the good news is that there is so much we can do from a nutrition, exercise, and lifestyle standpoint. If you think your adrenals and thyroid might be at the root of your problems, I urge you to connect with your doctor, get the tests, and in the meantime, eat, sleep, and live in a way that supports your body's endocrine systems. You deserve it!

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