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Adrenal Glands and Cortisol


What are the Adrenal Glands?

The adrenal glands are 2 small glands located on top of your kidneys that are partcularly important in mediating the body's response to stress. They produce a number of hormones including cortisol, aldosterone, testosterone, DHEA, epinephrine and norepinephrine. For the purpose of this article we will be focusing on the hormone cortisol. 

What is the function of cortisol?

Cortisol is the body's natural anti-inflammatory agent. It decreases the movement of inflammatory cells into sites of inflammation and also inhibits the secretion of pro-inflammatory substances. Stress, exercise, periods of 'starvation' or extended time between meals leads to the secretion of cortisol by the adrenal glands to maintain adequate blood glucose levels. 

The Cortisol Cycle

Secretion of cortisol follows a daily cycle. Approximately 50% of the daily cortisol production occurs during the 6th-8th hours of sleep and this is typically around 6-8am. At this time, cortisol secretion is maximal. This when we start our day with the most energy. From there cortisol levels gradually decrease throughout the day hence our decline in energy as the day goes on just in time for us to sleep at night. Cortisol levels then rise again around 6am and the cycle continues. This is an ideal cortisol cycle found in healthy individuals. 

The Mechanism of Stress on our Body

Stress forms an integral part of our lives and encompasses physical and mental-emotional components. We need stress to survive and a good example of beneficial stress is the stressors of daily life to keep us motivated or weight-bearing exercises to stress our bones so as to keep them strong.  

The release of cortisol and other stress hormones (eg: epinephrine and norepinephrine) by the body is a natural response to a stress on the body. This is mediated by the sympathetic nervous system. From an evolutionary standpoint, this would serve to protect us as we ready ourselves to run away from a wolf. This is also known as the 'fight or flight' response where cortisol stimulates the production of glucose to feed our muscles; epinephrine causes our pupils to dilate allowing us to see better; blood is shunted to vital organs and away from processes that are not currently critical (eg: digesting your lunch wouldn't be the main priority when you encounter imminent danger); and blood pressure increases so as to meet the increased oxygen demand by your muscles. 

Once the danger has passed, stress hormone levels drop and homeostasis (balance) is reestablished. However in our current society, our adrenal glands are not given a chance to recover from the constant onslaught of stress. Normally, balance is achieved with the help of our parasympathetic nervous system which controls our involuntary processes like digestion, healing, breathing etc. This can be 'over-ridden' by the constant activation of the sympathetic nervous system. Now, when bodily processes such as digestion, healing etc. are not allowed to take place normally this is where problems with our health start to creep in. 

The General Adaptation Syndrome (GAS)

Hans Selye, an endocrinologist in the 1930s proposed a mechanism by which the body copes with stress. 

There are 3 stages: 

1) Alarm reaction: The body enters the "fight or flight" state in this initial reaction to stress. Stress hormones are released and there is a decrease in one's ability to handle the stress.

2) Resistance: In the second stage, the body begins to adapt and build a resistance to the stress. Organism is handling the stress. Everything appears normal. At this stage, there is a continued high rate of production of cortisol. Morning cortisol levels are usually high and above normal limits.  

3) Exhaustion: If the stress continues for prolonged periods, the body is no longer able to resist the stress and exhaustion occurs. The 'reserve' to handle stress is 'spent'. The adrenal glands can no longer keep up with the demands and adrenal fatigue sets in. Morning cortisol levels are usually low to very low. 

"Every stress leaves an indelible scar, and the organism pays for its survival after a stressul situation by becoming a little older" - Hans Selye -

Adrenal Fatigue & The Cortisol Steal

The human body is an extremely resilient organism but it does have its limits. When the adrenal glands are pushed beyond its limits and when it can no longer meet the demands of stress, adrenal exhaustion or adrenal fatigue occurs. This can manifest in many different ways and 2 people will not necessarily present with the same symptoms. 

Symptoms of Adrenal Fatigue/Exhaustion

  • Chronic fatigue

  • Blood sugar instability
  • Weight gain
  • Chronic allergies
  • Salt & Sugar cravings
  • Low blood pressure
  • Waking unrested
  • Insomnia
  • Foggy thinking
  • Frequent infections
  • Environmental sensitivities
  • Sudden burst of energy at night


When adrenal exhaustion occurs, the adrenal glands can no longer produce sufficient cortisol and the body compensates by diverting certain pathways towards the production of more cortisol. Pregnenolone is the 'master' hormone in this pathway that gets converted into cortisol, DHEA, testosterone, estrogens, aldosterone. In order to produce more cortisol to meet with demands, conversion of pregnenolone -->  progesterone - ->  cortisol increases. This results in an overall decrease of progesterone levels and a decline in production of other hormones such as DHEA, testosterone and estrogens. This is known as the 'Cortisol Steal'.

"The Cortisol Steal"

After an extended period of time, the ovaries and the testes also known as the gonads, end up having to compensate for the depleted adrenal glands in order to produce sufficient sex hormones. This results in a 'burning out' of the adrenal glands and the gonads over time, leading to severe hormonal imbalances. 

Correcting Hormone Imbalances

Hormone imbalances and deficiencies can be corrected through the use of herbs and nutrients and also through the use of hormones themselves. In early stages of hormone imbalances, herbs and nutrients can be used but in more severe hormone deficiencies, they tend to work slower and might be insufficient to correct the deficiencies. This is where hormone replacement comes into play. 

It should be noted that there are 2 different kinds of hormone replacement therapies available. There is Hormone Replacement Therapy (HRT) and Bioidentical Hormone Replacement Therapy (BHRT). The main difference between the 2 is that with BHRT, the hormones possess the same molecular structure as the hormones that we produce in our bodies whereas the hormones used in HRT do not. This is perhaps the basis behind the side effects associated with HRT which include stroke, cardiovascular disease, breast and endometrial cancer etc. An added benefit to using BHRT is that the dosages of BHRT can be specifically tailored to suit each patient but hormone dosages in HRT are fixed. 

When the adrenal glands are exhausted, the use of bioidentical cortisol not only helps to correct the hormone imbalance but it also gives the adrenal glands "a rest" and a chance to recover. After a period of time, the dosage can be reduced and tapered off gradually allowing the adrenal glands to resume their normal function. Herbs and nutrients can be maintained to allow for gentle support until the adrenals have fully recovered.