Healthy Adrenals and Measuring Cortisol Levels


Your adrenal glands, located at the top of each kidney, produce cortisol, which is a natural, steroidal hormone that is crucial to life.  Your body simply cannot live without it.

What does cortisol do?  Many things, but just to name a few:

  • Aids your body in responding to stress
  • Stimulates metabolism of fats, proteins and sugars
  • Aids in maintaining ready energy levels.
  • Affects the level of activity of your immune system
  • Strongly influences your body’s ability to absorb nutrients
  • And more

Cortisol levels change with the conditions that your body encounters.

Serum cortisol levels include up to 90% cortisol that is “protein-bound”.  This is cortisol, in your blood serum, which has been “bound to” or combined with proteins in your blood serum.  This protein-bound cortisol is not readily available to affect or regulate body functions in the way that free cortisol is.  Yet it still shows up in most serum cortisol testing.  So measuring total serum cortisol levels does not really provide an accurate or very useful guide for balancing this crucial hormone.

Some may counter by pointing out that there are now cortisol level tests that measure “free cortisol”, that is cortisol in the blood serum that is not protein-bound.  This is true, although most serum cortisol testing measures total cortisol and not free cortisol.

But even if your doctor is careful about this and knows to request a “free cortisol” test for you, there is another problem with using serum to measure cortisol:

Your cortisol levels are supposed to fluctuate throughout the day.  This is natural and important in helping your body to follow its natural daily rhythms and for good health in general.

Our cortisol levels should be highest in the morning, tapering off to less than half the morning high around noon, tapering again to approximately 20% lower in the late afternoon/early evening, and finally settling at approximately 1/6th their morning level by nighttime when we are ready for sleep.

Because of this, your cortisol levels need to be sampled 4 times throughout the day to provide an accurate and complete picture.  Obviously, in most cases this will not be practical if the samples are blood serum-based.  It would mean returning to the lab to have blood drawn at 4 different times throughout the day.

This is yet another reason why I recommend using saliva to test cortisol levels.  It is easy to collect the required 4 samples throughout the day.  Saliva sampling is easily done at home or just about anywhere that you happen to be.  It is a self-collection process that does not require any assistance, let alone a lab technician.  And saliva testing avoids the problem of trying to distinguish between free cortisol and protein-bound cortisol.

The entire cortisol system appears to have evolved in most mammals, particularly in primates, to have the ability to help in response to short-term stress.  We run like a bat out of hell to catch our breakfast, or to avoid becoming the breakfast of another predator.  But these were typically short-term events that had a definite and immediate outcome, one way or the other.

The cortisol system does not do so well when it is subjected to long-term high levels of stress.  Keep in mind that our evolution did not prepare us for such long-term challenges to our survival.  And yet, in today’s world so many of us are subject to exactly this kind of stress:  It lasts for a long time without letup or relief, and it is maintained at a relatively high level.

We see the results in the drastic increase in serious, chronic health conditions that seem unprecedented in human history:

  • Long term fatigue
  • High blood pressure
  • Weakened immune systems
  • Cancers
  • Strokes
  • Heart disease
  • Obesity
  • Blood sugar problems
  • Many mental health issues
  • Sleep disorders
  • And more

All of these are at least frequently related to adrenal “burn-out” and cortisol imbalances.

So it pays to find out what your cortisol levels really are.  And once we know, then since it is difficult to significantly adjust the environment we live in, it may pay to use supplements and other natural health measures to re-balance our cortisol levels.

But this is not an area of health where guesswork cuts it.  To safely and effectively re-balance your adrenal system, you first need to know with accuracy and precision what the existing levels are.

By far, the best place to start is with a 4 sample saliva test.  This provides the baseline information needed to formulate a plan to restore adrenal health and cortisol balance that is appropriate for you and your body.

In most cases it makes sense to test the major reproductive hormones along with the cortisol levels. They are closely related and strongly affect each other within the human body. So at least when establishing a baseline before beginning any course of balancing, it is advisable to test the following in the initial test:

  1. Estradiol, (the form that estrogen takes in human being)
  2. Progesterone, (the crucial hormone that must balance estradiol for good health)
  3. DHEA, (a pre-cursor to several critical hormones, among other important fundtions that it has, including adreanl health and support)
  4. Testosterone, (crucial sex hormone for both men and women)
  5. Morning cortisol
  6. Noon cortisol
  7. Late afternoon/early evening cortisol
  8. Night cortisol

Here is a link to more information and to a great resource for saliva testing:

Saliva Testing by Labrix Labs

If you are testing for the first time, we recommend the 8-test panel, known as Profile III. The health investment for this comprehensive test panel is $327.00, plus $10.00 for shipping anywhere within the continental United States of America. This includes the doctor’signature to authorize the test, and a complimentary evaluation of your results. This is a $550.00 value.

To your health!

Jeff Bell

Note: If you are outside the continental United States, please DO NOT use the Buy Button above. Instead please e-mail me to request a custom quote. Not only are the shipping costs increased for testing outside the United States, but there may be legal restrictions depending on your location.

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  1. Kumar
    Posted August 22, 2016 at 9:57 pm | Permalink

    Hello Dr J Bell,

    Very good information. However it is not clear, whether proportion of bound and free Cortisol(Configuration) is always remain constant or can also change? If can change, what factors can effect it?

    Whether 4 times seprate urine samples for testing of Cortisol will not really be better than Salvia Cortisol testing? Many people may get increase or decrease in disease symptoms as per Cortisol cycle, so to understand better, 24Hrs urine test may not be so accurate.

    Best Regards,

    • Jeff Bell
      Posted October 9, 2016 at 3:47 pm | Permalink

      Hi Kumar,

      First, sorry to take so long to reply. We had a technical problem which prevented me from getting the usual notices for pending questions and comments. I apologize for that.

      Thanks for a great question. I believe I can clarify a few things here: I would not use urine to test for cortisol levels. When we are testing cortisol levels we want 4 different levels, taken throughout the waking day to correspond with the natural cortisol level fluctuations. We really want to look at all 4 as discrete levels. In contrast most urine tests that even include a cortisol assay will collect urine over a 24 hour period so there is no way to determine those discrete levels.

      So I think the saliva test is the way to go.

      To your great health!


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