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LE Magazine December 2005

Cortisol, Stress, and Health

Keeping levels of the stress hormone cortisol in check
may help prevent illness and slow aging
By Edward R. Rosick, DO, MPH, MS

Supplements to Combat Cortisol

Exercise and meditation are two important modalities that may help many individuals manage stress-filled lives. In addition, studies suggest that effective natural supplements, such as vitamin C, fish oil, phosphatidylserine, and herbal adaptogens, may help keep the HPA axis in equilibrium, reduce elevated cortisol levels, and help optimize health.

Vitamin C

Besides its beneficial effects in maintaining proper immune system function, vitamin C has been shown to help modulate high levels of cortisol brought about by stress. A study in 2001 examined the effects of supplemental vitamin C on high cortisol levels brought about by physical stress in marathon runners.31 In a randomized, placebo-controlled study, ultramarathon runners were given 500 mg a day of vitamin C, 1500 mg a day of vitamin C, or a placebo seven days before a marathon, the day of the race, and two days after the race. Researchers found that athletes who took 1500 mg per day of vitamin C had significantly lower post-race cortisol levels then those taking either 500 mg a day or placebo.31

Another study published in the journal Psychopharmacology reviewed evidence showing that vitamin C can reduce high cortisol levels brought about by psychologically induced stress.32 In a randomized, double-blind, placebo-controlled trial, researchers gave 3000 mg per day of vitamin C or a placebo to 120 volunteers who were subjected to psychological stress through the Trier Social Stress Test (TSST), a commonly used assessment tool in psychological research that simulates public speaking and arithmetic tests to induce stress and raise cortisol levels. Subjects who took vitamin C had lower blood pressure, subjective stress, and cortisol measures compared to those who were given placebo.

Fish Oil

In a number of clinical tests, fish oil has been shown to reduce cardiovascular risk in women and men. Preliminary research has shown that fish oil may help individuals cope with psychological stress and lower their cortisol levels. In a study published in 2003, researchers gave seven study volunteers 7.2 grams per day of fish oil for three weeks and then subjected them to a battery of mental stress tests.33 Blood tests showed that these psychological stressors elicited changes in the subjects’ heart rate, blood pressure, and cortisol levels. After three weeks of fish oil supplementation, however, the rise in cortisol levels secondary to stress testing was significantly blunted, leading the authors to conclude that supplementation with omega-3 fatty acids from fish oil “inhibits the adrenal activation elicited by a mental stress, presumably through effects exerted at the level of the central nervous system.”33


Another supplement that has been shown to be useful in combating the deleterious effects of stress is phosphatidylserine. This phospholipid constitutes an essential part of biological cellular membranes. For more than 10 years, studies have shown that phosphatidylserine is able to cut elevated cortisol levels induced by mental and physical stress. In one early study, 800 mg per day given to healthy men significantly blunted the rise in cortisol caused by physical stress.34 Another paper reported that even small amounts of supplemental phosphatidylserine (50-75 mg administered intravenously) could blunt cortisol increases secondary to physical stressors.35 In this study, eight healthy men had their blood drawn before and after physical stress induced by riding a bicycle ergometer. While all subjects showed increased cortisol levels, pretreatment with the 50- or 75-mg dose of phosphatidylserine significantly blunted cortisol response to the physical stressor.35

Finally, a study published in 2004 examined phosphatidylserine’s effects on endocrine and psychological responses to mental stress.36 The stressor used was the Trier Social Stress Test (TSST), which consists of 15 minutes of psychological stress induced via a mock job interview, followed by a mental arithmetic challenge. This double-blind study followed 40 men and 40 women, aged 20-45, for three weeks. The subjects were given either phosphatidylserine (either 400 or 600 mg daily) or a placebo before taking the TSST. Phosphatidylserine was effective in blunting the cortisol response to stressors, with those taking 400 mg daily (but not, surprisingly, 600 mg) of phosphatidylserine showing a significantly decreased cortisol response. The authors concluded that phosphatidylserine helped dampen the effects of stress on the pituitary-adrenal axis, and may have a role in managing stress-related disorders.36

Herbal Adaptogens

Plant-derived adaptogens can be a very useful in combating the mental and physical rigors of our modern lifestyle. Adaptogens work by modulating the levels and activity of hormones and brain neurochemicals that affect everything from cardiac activity to pain perception. For any herb or substance to be properly classified as an adaptogen, it should:

  • produce a non-specific response and increase an individual’s resistance to a wide range of deleterious stimuli
  • produce a normalizing response in an individual when subjected to physiological, emotional, or mental stressors
  • be non-toxic and not induce changes in the physiological, emotional, or mental state of a non-stressed individual.

One such herbal adaptogen is Rhodiola rosea, or rhodiola. In traditional Asian and European medicine, this herb has been used for centuries to increase physical endurance and longevity, as well as to manage fatigue, depression, and impotence. Rhodiola’s positive effects are thought to be mediated through the actions of rosavins and salidrosides, chemical compounds found in the plant’s roots. Multiple studies from the former Soviet Union have demonstrated rhodiola’s effectiveness in combating both physically and psychologically stressful conditions.37

Another herb that serves as an adaptogen is ginseng, which has been used throughout Asia since antiquity. It is important to note that ginseng is the name given to three different plants used as adaptogens. The most widely used ginseng is Panax ginseng, also known as Korean, Chinese, or Asian ginseng. Panax quinquefolium—or American ginseng—is also considered a “true” ginseng. However, Siberian ginseng (Eleutherococcus senticosus), while commonly referred to as ginseng, is not a true ginseng but a closely related plant. Yet no matter what the genus or species, all three of these plants have experimental evidence backing their adaptogenic claims. Animal studies have shown that ginsenosides, bioactive compounds in ginsengs, improve the sensitivity of the HPA axis to cortisol.38,39 In addition, studies suggest that all three plants provide protection against both physical and psychological stresses.38,39

Finally, another plant that deserves mention as an adaptogen is ginkgo biloba. For the last 5,000 years, leaves of the ginkgo tree have been used to treat various medical conditions. While ginkgo is currently used to help combat the debilitating effects of memory decline and dementia,40-42 emerging evidence suggests that it may be useful in treating the impact of stress and elevated cortisol levels. A recent double-blind, placebo-controlled study published in the Journal of Physiology and Pharmacology examined ginkgo’s effects in modulating cortisol and blood pressure levels in 70 healthy male and female subjects.43 When subjected to physical and mental stressors, subjects who were given 120 mg per day of a standardized ginkgo extract saw smaller increases in their cortisol levels and blood pressure then did their counterparts who were given a placebo.

Rholiola rosea seed heads.

Raising DHEA Levels

While cortisol levels stay the same or even increase as we age, levels of another vitally important hormone, DHEA, decrease with each passing year. This relationship between cortisol and DHEA has led some to suggest that these adrenal hormones may play a significant role in the aging process and its associated negative health effects. A recent paper in the European Journal of Endocrinology examined the pathophysiological correlates of age-related changes in the HPA axis.44 The authors showed that the cortisol/DHEA ratio increases significantly as one ages, and is even higher in elderly patients who suffer from dementia. Supplemental DHEA, however, enhances the brain’s resistance to stress-mediated changes, maintains functional abilities, and protects against age-related diseases. The authors concluded, “the changes of the hormonal balance [between cortisol and DHEA] occurring in aging may contribute to the onset and progression of the aging-associated neurogenerative diseases.”44


Exercise, stress management techniques such as relaxation and meditation, and nutritional supplements can help you manage stress and lower cortisol to promote optimal health and longevity. The following are scientifically supported techniques that can help support a healthy response to stress.

1. Behavioral techniques to lower stress and manage high cortisol levels

  • Exercise: 30-45 minutes of both anaerobic (resistance training) and aerobic (jogging, cycling) every other day.
  • Meditation/relaxation: 15-30 minutes daily.

2. Supplements to reduce high cortisol levels secondary to stress

  • Vitamin C: 1000-3000 mg/day.
  • Fish oil (omega-3 fatty acids):1-4 gm/day.
  • Phosphatidylserine: 300-800 mg/day.
  • Rhodiola rosea: 100-200 mg/day, standardized extract.
  • Ginseng: 100-300 mg/day, standardized extract.
  • Ginkgo biloba: 100-200 mg/day, standardized extract.
  • DHEA: 25-50 mg/day (any hormone supplementation should be monitored by your physician).

Emerging studies suggest a link between central obesity—marked by abdominal fat and a high waist-to-hip ratio—and elevated cortisol levels.

One such study examined 59 healthy premenopausal women, 30 of whom demonstrated central fat distribution as determined by a high waist-to-hip ratio, and 29 of whom did not.45 All 59 women participated in three sessions of psychosocial challenges on four consecutive days to gauge and measure their reaction to stress. Women with higher waist-to-hip ratios experienced the laboratory challenges as more threatening, performed more poorly on them, and reported more chronic stress. These women also secreted more cortisol than women with lower waist-to-hip ratios. The investigators noted that central fat distribution is related to greater psychological vulnerability to stress and cortisol reactivity. Furthermore, stress-induced cortisol secretion may contribute to central fat.

In a study published in 2004, researchers examined the relationship between stress levels, cortisol, and abdominal obesity in 22 obese women, 11 of whom had a binge-eating disorder.46 The researchers found a positive correlation between high stress and cortisol levels and central obesity, noting, “hyperactive HPA axis due to stress raises cortisol, which may contribute to binge eating and abdominal obesity.”

Clearly, there is an intimate relationship between stress, cortisol levels, and overall health. Modulating cortisol levels may thus offer support for healthy weight management and prevent negative health outcomes associated with central obesity, such as type II diabetes.


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