What is cortisol?

Al mentioned cortisone. Cortisol and cortisone are two very similar hormones. They're both steroid hormones. Cortisol is also known as hydrocortisone, to make it even more confusing. We tend to measure cortisol more frequently here and talk about it more often here in the US. From what I gather, in other countries like the UK and Australia, I hear cortisone discussed more regularly. I'm not sure if that's just the context that I'm hearing it in or if that's actually the case.

Cortisol, as I said, is a steroid hormone. It's released by the adrenals, which sit on top of the kidneys. I'm sure most people listening have heard of cortisol, so I'm not going to go into too much detail. Basically, it's a stress hormone that gets released in order to manifest our fight-or-flight response in stressful conditions. Another thing that cortisol can do is raise blood sugar if it's dropped below a safe level, through gluconeogenesis. Then finally, cortisol has the ability to suppress the immune system and act as an anti-inflammatory compound. Now, cortisone is another steroid hormone. It's also released by the adrenal glands and it has very similar properties to cortisol. It acts as an anti-inflammatory compound. It can act as an antidiuretic hormone. Like cortisol, it has the ability to elevate blood pressure in stressful conditions. So cortisol, cortisone, they're both steroid hormones. The difference is cortisol is the more active form when it comes to glucocorticoid activity. Cortisone is a precursor that can be converted to cortisol, in a process that I'm not going to go into. It gets complex.

But the real gist here and the thing to be aware of is these are stress hormones that are produced in a stress response. That stress response can be anything from what most people typically think of as stress, which would be driving in a traffic jam, getting in an argument with your spouse, financial stress or working too much; all of that sort of thing. But physiological conditions can also cause a stress response. I've often said to some of my patients who say, "Oh, I don't have any stress in my life," you know, if you're independently wealthy, laying on the beach in Thailand somewhere, and you have a gut disorder, parasite, leaky gut, autoimmune disease or something like that, you are under stress. That's a disturbance of homeostasis in the body, and you're experiencing a physiological stressor. So all of these things can cause an elevation in cortisol, produce cortisol. The problem, of course, is that these days, in our hectic modern lifestyle, even though we might not experience life-threatening events very often, we are under a constant background of low-level or even sometimes high-level stress, which causes the chronic overproduction of cortisol.