I want to help you understand what your “cortisol slope” means. This is really important, but it still puzzles me just how much it is ignored in conventional medicine. And, additionally, how much it is misunderstood.
When it comes to things like adrenal insufficiency and adrenal fatigue, you can learn so much from your cortisol slope and how it affects the adrenal system in your body. So, let’s dive into understanding your cortisol slope today…
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The adrenal glands, which sit on top of the kidneys, make a variety of hormones. These hormones govern the body’s overall stress response – what we call the “autonomic nervous system.” That nervous system puts us into one of two modes:
The first refers to when we feel panicked and are doing things at any cost to survive the moment. The second, though, is where we fix everything back up.
Our bodies need to have appropriate balances of time spent being active and recovering. The difficulty is that we get too much of one, and not enough of the other.
This is a big part of almost all chronic diseases that you might be able to think about. The adrenals are part of what we call the hypothalamic pituitary axis (HPA axis).
When that doesn’t work right, we call it HPA dysfunction or dysregulation.
In natural medicine, we have this very popular term called “adrenal fatigue.” I have discussed this before, but “fatigue” here really isn’t the right word.
Dysfunction is a better one. Your adrenals are not weak or tired, they are simply choosing not to and deliberately making less.
The conventional world of medicine has rejected this outright. But, it ignores the reality of the thing we call adrenal dysfunctional.
And, when it comes to cortisol slope, this is what most accurately tracks what I am going to call adrenal dysfunction.
Think of your cortisol slope as a ski hill. When you trace a reading of your cortisol in the morning, versus the evening, there should be a distinct downhill slope.
You should make a nice amount in the morning, and less than half as much at night. When that slope doesn’t exist, we begin to see all of these complications emerge.
Key Insight: Your cortisol slope is massively important and explains your adrenal health or dysfunction. From morning to night, you should have a distinct downhill slope effect.
What This Means for You
There exists a very strong correlation between cortisol slope and anxiety, cancer, cardiovascular disease, depression and more which you can see in the chart below…Health Outcome Subtype 1
All of these things correlate with a negatively altered cortisol slope. Let’s talk a bit more about how to “read” a cortisol slope and what that looks like in practice.
When we read a cortisol slope, we are most often reading from a salivary cortisol panel. This is contrasting a morning cortisol with a midnight cortisol.
Some of these panels will check it four times, including readings at noon or five in the afternoon. Either can show that cortisol slope, but what we should see is a spike and a drop off as the day progresses.
When that is occurring normally, we call it “normal healthy function” or “thriving.” The other states that can occur are stages of dysregulation – and each correlates with all of these negative health outcomes I just mentioned.
The below chart does a good job of illustrating the four distinct states of adrenal dysregulation that can occur due to your cortisol slope…
Before we dive into the various stages, I want to take a moment to dive a bit deeper into the data. Specifically, starting with something called the “Whitehall II” study.
The Whitehall II study was performed on a group of British civil servants between 2002 and 2006. It involved a large range of adults.
What they looked at was mainly premature death rates. And, of those who died, what were the overarching health metrics that predicted that death.
They checked all of the things we would typically think about, including:
But, this study mainly found its way onto my radar because of one thing: cortisol slope. When it was all said and done, the cortisol slope was the biggest single predictor of cardiovascular death. It was the second predictor of death overall.
This is a big deal! If you do not feel well, it may be your cortisol slope. But, the good news is that you can definitely do something about it.
So, let’s get back to the main states of your cortisol function. These include:
Key Insight: These stages may not happen in step with one another. In fact, you may jump to level 2 or level 3 without ever needing to be in level 1. But, you can go back to a thriving state given the right amount of time. It is very much possible!
As mentioned, level 0, or “thriving” is not a state of dysfunction. In this one, you are feeling pretty good. Your energy levels are good throughout the day, and you can fall asleep and wake up well rested. You can also generally maintain good body weight and stable functioning.
In Thriving, there is a good morning spike of cortisol, followed by a gradual shutdown of cortisol as the day goes on. This gives the entire body a good circadian rhythm on a day-to-day basis.
Key Insight: Everything in the body is circadian! Your immune system, your detox pathways, energy regulation, reparative pathways, and cognitive function. It is all tied back to your circadian rhythms. If your cortisol slope isn’t right, nothing else moves right.
What is unique about this first stage is that, while you still see a distinct slope, the overall cortisol levels are too high across the entire day.
So, the total amount made throughout the day is more than the normal appropriate amount of cortisol that we would want to see.
And, there is a real lack in that nighttime drop off. At this point, there is often an experience of plenty of energy but a bit of edginess.
If this persists, we find ourselves quickly in stage two…
In stage two, the total amount of cortisol comes down, but the timing of it tends to become disrupted. At this point, the morning levels are often below range and the ones later in the day are often above range. Everything is flip-flopped!
In fact, your day’s total amount might be completely fine, but it is not being distributed at the ideal times. The slope isn’t happening where it needs to happen.
We suspect this when people feel wiped out early in the day, but they get a second wind. In fact, for many this feels completely wrong and you know it’s not how you should feel.
Now, if this keeps on progressing we hit the final stage…
At Crashed, the total day’s cortisol output is below what is ideal. We will often see a low morning cortisol and low levels throughout the day.
There are two problems here: Your total amount is low, and there is no fluctuation. The body needs a high point and a low point, but you only get low points in this stage.
A common misinterpretation is that the body is simply lacking in cortisol overall. But it’s not that the body can’t make it, but that the body is choosing not to make it.
You can sometimes give someone cortisol, and they might feel better, but it’s only a short-term fix for a very long-term problem.
Given these levels, we can see that your cortisol slope is incredibly important. It is a stronger predictor of longevity than even something like smoking, so we can really tie it back to so many health outcomes out there.
Thankfully, we can do things about it. But, the first step is understanding where you stand currently with your cortisol slope. When is your peak? What stage are you in? Are you thriving and can we get you back to thriving?
There’s a lot you can do in terms of lifestyle measures, diet, and adaptogens. In fact, when I wrote the Thyroid Reset Diet, this was my absolute main focus.
As a first step, I’d even recommend taking the Adrenal Quiz right now. This way, you can start to gain an idea of where you stand and how to get yourself back to thriving. I hope it helps you!
1 – Adam EK, Quinn ME, Tavernier R, McQuillan MT, Dahlke KA, Gilbert KE. Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology. 2017;83:25-41. doi:10.1016/j.psyneuen.2017.05.018
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Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet, The Metabolism Reset Diet and The Thyroid Reset Diet.
Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, diabetes, and regain energy. Learn more about the surprising story that started his quest.
