Cortisol is one of the few hormones that generally increases with age, and that is not a good thing. The pituitary gland (in the brain) produces adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce cortisol. The actions of cortisol include raising blood sugar (to increase and store available energy [often as fat]), suppressing the immune system, stimulating alertness, and increasing sensitivity to adrenaline (epinephrine) and norepinephrine—essentially priming the body for the “fight or flight” response.

Chronically disordered cortisol not only has a significant effect on the production of thyroid hormone but also directly affects wound healing. 

Cortisol has a normal diurnal circadian rhythm—it rises early in the morning to wake you up. It usually peaks around 9:00 or 10:00 a.m. Production is shut down by morning sunlight, and it drops throughout the rest of the day until it is at its lowest right before bedtime. If your cortisol axis is functioning correctly, you should feel awake and energetic in the mornings and wind down and be able to get to sleep at night.

The best way to measure your cortisol is by getting levels at four or five different times during the day; this allows evaluation of your circadian rhythms. These tests are usually done on either saliva or dried urine and can be done in the privacy of your own home. It is important that you find a doctor who is knowledgeable about ordering and interpreting these tests.

Anybody who is under chronic stress (and what is more stressful than having a chronic wound?) may be suffering from hypothalamic pituitary adrenal (HPA) axis dysfunction, previously known as “adrenal fatigue.” When the brain is overwhelmed by having too much cortisol around for too long a time, it essentially shuts down cortisol production. When that occurs, the results include a lack of energy, foggy thinking, depression, chronic fatigue, poor wound healing, and a variety of other symptoms.

The treatments for both high and low cortisol include a special class of herbal medications known as adaptogens, which normalize the cortisol level whether it is high or low. These include rhodiola, ashwaganda, eleuthero, ginseng, licorice, astralgus, tulsi, and others. Those with high cortisol will also benefit from mindfulness techniques (meditation, yoga, prayer, Tai-Chi, Qigong, etc.). If your cortisol is low, you may also benefit from adrenal extracts and additional water-soluble B-vitamins and adequate trace minerals. In some cases, pharmaceutical grade hydrocortisone may be necessary.

Whether your cortisol is high or low (or normal) you need to pay strict attention to the circadian biology we have already discussed and make sure you are getting plenty of sleep and adequate amounts of sunlight, particularly in the mornings. Cortisol issues take at least six months and may take as long as two years to fix, but there is hope for getting them fixed and moving farther down the pathway to healing yourself and your wounds.

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