Fatigue, Stress, and Cortisol: How Chronic Stress Impacts Your Health
Fatigue is one of the most common complaints in modern healthcare. Nearly one in five family medicine patients presents with fatigue, and one in three adolescents reports feeling fatigued at least four days per week. Left unaddressed, fatigue can negatively affect work performance, family life, mood, and overall quality of life.
At STAT Wellness, you’ll often hear our providers reference our treatment pyramid. At the base of that pyramid is the foundation of health: lifestyle—including nutrition, movement, sleep, and stress management.
stress management is often the last thing people focus on—until symptoms show up and answers are hard to find. One key hormone frequently at the center of this conversation? Cortisol.
What Is Cortisol?
Cortisol is a steroid hormone produced by the adrenal glands and released into the bloodstream. It plays a critical role in many body systems, including:
Endocrine (hormones)
Metabolic (blood sugar and energy)
Immune and inflammatory response
Reproductive function
Cortisol is essential for survival. It helps us respond to acute stress, such as slamming on the brakes to avoid a car accident. In these moments, cortisol increases focus, stamina, and blood sugar availability—fueling the brain and muscles for a fight-or-flight response.
The problem isn’t cortisol itself.
The problem is chronic stress.
Signs and Symptoms of Chronically Elevated Cortisol
When the body remains in a prolonged state of stress, cortisol levels can stay higher than normal. Over time, this dysregulation may contribute to symptoms such as:
Persistent fatigue or exhaustion
Insomnia or disrupted sleep
Weight gain or unexplained weight loss
Digestive issues
High blood pressure
Decreased libido
Mood changes (anxiety, irritability, depression)
Menstrual irregularities
Brain fog
Frequent illness or slow healing
If several of these sound familiar, cortisol imbalance may be part of the picture.
How Cortisol Affects Key Body Systems
Thyroid Function
Elevated cortisol can inhibit the conversion of T4 to active T3, while increasing reverse T3. The result? Hypothyroid-like symptoms—even when standard labs appear “normal.”
Blood Sugar Regulation
Chronically high cortisol increases blood glucose and insulin levels, contributing to blood sugar instability, energy crashes, and difficulty with weight management.
Gut Health
Cortisol increases inflammation and immune activation, which can damage the gut lining. During stress, the body also diverts energy away from digestion, slowing motility and impairing nutrient absorption.
Reproductive Hormones
High stress is interpreted by the body as an unsafe time for reproduction. Cortisol can suppress GnRH and LH pulse signaling, affecting ovulation, menstrual regularity, and implantation.
Sleep and Energy Patterns
Cortisol should follow a predictable daily rhythm:
Highest in the morning to support wakefulness and energy
Gradually declining throughout the day
Lowest at night to allow for restful sleep
When this rhythm is disrupted, you may experience difficulty waking, midday crashes, trouble falling asleep, or nighttime awakenings.
How to Regulate Cortisol Naturally
Identify Sources of Stress
Stressors may include:
Work or family demands
Trauma or emotional stress
Food sensitivities
Over-exercising
Chronic illness or inflammation
Medications or environmental toxins
Often, multiple stressors stack together.
Prioritize Quality Sleep
Sleep deprivation increases cortisol and impairs immune function. Aim for 7–8 hours of uninterrupted sleep by:
Keeping consistent sleep and wake times
Getting natural daylight exposure during the day
Limiting light exposure in the evening
Avoiding screens 1–2 hours before bed
Avoiding caffeine later in the day
Support Adrenal Health With Nutrition
Anti-inflammatory, nutrient-dense foods help buffer the effects of stress and support hormone balance.
Consider Targeted Supplementation
In some cases, natural supplements can help rebalance the brain-adrenal connection when used appropriately and strategically.
Practice Active Stress Reduction
Effective tools include:
Yoga or gentle movement
Meditation or mindfulness
Deep breathing exercises
Gratitude practices
(No, “just relax” doesn’t count—but these do.)
Functional Medicine Testing for Cortisol and Adrenal Health
Comprehensive Wellness Blood Panel
This panel evaluates:
Blood sugar and cholesterol
Liver and kidney function
Vitamins and nutrients
Hormones such as cortisol and DHEA
This test is ideally drawn within one hour of waking while fasting. While helpful, it provides only a single snapshot in time.
Adrenal saliva test
Collected at home at four points throughout the day, this test assesses daily cortisol and DHEA patterns. It offers better insight into adrenal rhythm but does not show how cortisol is metabolized and cleared.
DUTCH test (Dried Urine Test for Comprehensive Hormones)
The DUTCH test provides a much more complete picture by measuring:
Total cortisol production
Cortisol metabolism and clearance
DHEA
Estrogen, progesterone, testosterone
Epinephrine and norepinephrine
Samples are collected over two days, offering a detailed view of hormonal function and stress response.
Personalized Care at STAT Wellness Charleston
With these results, your provider can make individualized recommendations for nutrition, lifestyle, supplementation, and treatment—so you’re not guessing and hoping for the best.
Many of these tests can be mailed directly to your home, and results can be reviewed virtually through our telehealth platform.
If you’re ready to understand how stress is truly affecting your health, you can schedule a wellness appointment with Athena Newell, FNP, and take the first step toward feeling better—because wellness should actually feel good.
