The Cortisol Series – Part 2: How Cortisol Is Produced and What Triggers It

Clinical Insight from PharmXHealthOne Integrated Medical Clinic

In Part 1, we established that cortisol is essential for survival—but harmful when chronically elevated or poorly regulated. In Part 2, we explain how cortisol is produced, why it is so easily over-activated in modern life, and how clinical lab markers help identify cortisol-driven metabolic dysfunction.

How Cortisol Is Produced: The HPA Axis Explained

Cortisol production is controlled by a sophisticated stress-response network called the

Hypothalamic–Pituitary–Adrenal (HPA) Axis.

The Cortisol Cascade

1. Hypothalamus (Brain) detects stress

2. Releases CRH (Corticotropin-Releasing Hormone)

3. Pituitary gland releases ACTH (Adrenocorticotropic Hormone)

4. Adrenal glands release cortisol into the bloodstream

This system is designed for short-term emergencies, such as escaping danger or fighting infection.

The Problem

Modern stress is chronic, not acute. The HPA axis was never meant to be activated:

• All day

• Every day

• For years at a time

When the “off switch” fails, cortisol remains elevated—even at night—disrupting sleep, blood sugar, hormones, and weight regulation.

The Normal Cortisol Rhythm (What Healthy Looks Like)

In a healthy individual, cortisol follows a predictable daily pattern:

• Morning (AM): High cortisol → wakefulness, focus, energy

• Midday: Gradual decline

• Evening (PM): Low cortisol → relaxation and sleep initiation

This rhythm is critical. When cortisol is high at the wrong time, symptoms appear—even if total cortisol output seems “normal.”

Common Triggers That Elevate Cortisol

At PharmXHealthOne, we find that cortisol dysregulation is rarely caused by a single factor. Instead, it is driven by stacked stressors.

1. Psychological & Emotional Stress

• Work pressure

• Financial stress

• Trauma

• Anxiety

• Chronic worry

The brain does not distinguish between physical danger and emotional stress—both activate cortisol.

2. Blood Sugar Instability

Low blood sugar is perceived as an emergency.

Triggers include:

• Skipping meals

• Extreme calorie restriction

• Very low-carbohydrate diets (for some individuals)

• Excessive caffeine without food

Result: Cortisol is released to raise blood sugar—often worsening insulin resistance.

3. Sleep Deprivation

Poor sleep directly disrupts cortisol rhythm:

• Raises nighttime cortisol

• Suppresses morning cortisol

• Increases insulin resistance the following day

This creates a vicious cycle of fatigue, cravings, and stress.

4. Over-Exercising or Excessive Cardio

Exercise is a stressor.

When excessive or poorly timed:

• Cortisol rises

• Muscle breaks down

• Fat loss stalls

• Recovery is impaired

This is especially common in individuals trying to “outrun” weight gain.

5. Inflammation & Illness

• Chronic infections

• Autoimmune conditions

• Gut inflammation

• Food sensitivities

Inflammation forces the body to continuously release cortisol to suppress immune overactivation.

Clinical Lab Correlations: How We Identify Cortisol Dysregulation

Cortisol imbalance rarely exists in isolation. At PharmXHealthOne, we evaluate cortisol in context with metabolic markers.

1. AM Cortisol (Morning Cortisol)

What it shows:Ability to initiate energy and alertness

Common patterns:

• Low AM cortisol: Fatigue, brain fog, difficulty waking

• High AM cortisol: Anxiety, jitteriness, rapid heart rate

Low morning cortisol often reflects burnout or adrenal suppression after prolonged stress.

2. PM Cortisol (Evening or Night Cortisol)

What it shows:Ability to shut down and recover

Common patterns:

• High PM cortisol: Insomnia, racing thoughts, early waking

• Normal labs but symptoms: Rhythm disruption, not quantity issue

Elevated nighttime cortisol is one of the most overlooked causes of chronic sleep problems.

3. Insulin Levels

Cortisol raises blood sugar to support survival.

High cortisol → high insulin demand → insulin resistance

Clinical implications:

• Fat storage, especially abdominal

• Sugar cravings

• Energy crashes

This is why cortisol management is essential in weight-loss and diabetes programs.

4. Hemoglobin A1C

A1C reflects average blood sugar over 3 months.

Chronic cortisol elevation can:

• Raise fasting glucose

• Increase post-meal spikes

• Elevate A1C even with “clean eating”

Patients are often told they are “prediabetic” without addressing the cortisol driver.

Why Standard Labs Often Miss the Problem

Many patients are told:

“Your cortisol is normal.”

However:

• One-time blood tests do not assess daily rhythm

• Normal ranges do not reflect optimal function

• Symptoms often appear before labs fall outside reference ranges

This is why functional assessment and clinical context matter.

PharmXHealthOne Clinical Perspective

Cortisol dysregulation is one of the most common root causes behind:

• Weight-loss resistance

• Fatigue

• Poor sleep

• Blood sugar instability

• Hormonal imbalance

Addressing cortisol early prevents the need for more aggressive interventions later.

Next in the Series

Part 3 – Signs, Symptoms, and Health Conditions Linked to High Cortisol

We will detail:

• Physical symptoms patients overlook

• How cortisol drives belly fat and insulin resistance

• Links to diabetes, thyroid dysfunction, and hormonal imbalance

• When symptoms appear even with “normal” labs