Clarifying Cortisol: Why Stress Isn’t the Enemy

We unpack the science of cortisol — the hormone often blamed for everything from weight gain to burnout—and explain why it’s essential for survival. Cortisol isn't just your stress hormone — it’s your wake-up call, your emergency response system, and the reason you’re ready for a nap at 3 p.m. From saber-toothed tigers to modern-day deadlines, our stress response hasn’t changed much, even if our stressors have. We explore the difference between healthy stress and chronic stress, how cortisol affects mood, sleep, immunity, and metabolism, and why “adrenal fatigue” isn’t something to worry about. We share practical, evidence-based ways to manage stress — from prioritizing sleep and social connection to spending time in nature (and yes, petting a cat). Dr. Gillian Goddard also explains the rare condition Addison’s disease and what happens when the body can't produce enough cortisol. The Savvy Short: you don't need to “fix” your cortisol—you need tools to help your body and mind navigate life’s inevitable stressors.

In this episode, Dr. Gillian Goddard mentions The Human Connectome Project. Learn more at humanconnectome.org.

Note that Addison's disease is also known as primary adrenal insufficiency.

We take a moment to remind you that while this is a medical discussion, it is not providing a diagnosis or treatment or any medical advice. The only way to get a diagnosis, treatment or medical advice for your particular condition is through a discussion with your doctor.

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Get your copy of The Hormone Loop by Dr. Gillian Goddard wherever books are sold.

This episode was produced and edited by Erin Stein. Music: “All We Live For (instrumental)” by Wolfclub licensed through Audiio.com. Intro and outro edited, and video created, by Ian Mayer. The Savvy Patient logo by Amanda Spielman.

TRANSCRIPT

00:00 Understanding Cortisol and its Daily Cycle

07:27 Cortisol's Role in Survival Instinct

11:17 Not All Stress is Bad

14:03 Defining Stress vs. Anxiety

16:54 Chronic Stress and Its Impact

22:01 Managing Stress

29:36 Do Adrenal Glands Need Our Help?

33:12 Addison's Disease and Cortisol's Role in Fighting Illness

36:29 Not Too Much, Not Too Little

39:15 The Importance of Social Connections in Stress Relief

Gillian Goddard: Hi everyone, welcome to The Savvy Patient.

Erin Stein: Today we're going to talk about cortisol.

Gillian Goddard: And stress.

Erin Stein: I don't know much about cortisol, but I know a lot about stress. Yay.

Gillian Goddard: I think most of us have personal experience with stress on some level. It's just a matter of how much.

Erin Stein: I think many of our listeners would feel they have a lot of experience with it, especially in their midlife years.

Gillian Goddard: Yes. The sandwich years.

Erin Stein: The sandwich years, the years that our bodies decide to go haywire.

Gillian Goddard: Yeah. Yeah.

Erin Stein: Yeah. So as always, Gillian will tell us… what is cortisol? All I know is, it's a hormone.

Gillian Goddard: It is a hormone. It's made in your adrenal glands. Your adrenal glands are just these little, they look like three-cornered hats and they sit on top of your kidneys, which is where they get their name. They're ad-renal “above the kidneys”. And they make a few different hormones, but one of the big hormones that they make and the hormone we're going to be talking about today is cortisol. So basically, when our bodies sense stress, the brain takes in that information. It sends that information to the hypothalamus, which is a part of the brain, sort of at the crossroads of the brain. And the hypothalamus tells the pituitary gland to tell the adrenal glands to make cortisol, which is actually super important. It turns out we don't only have cortisol at times of stress. We actually need and have some cortisol all the time. And our cortisol levels under normal circumstances, normal boring Mondays, our normal cortisol levels ebb and flow over the course of the day. And the reason they're so important is because cortisol is one of the keys to maintaining our normal sleep-wake cycle. Cortisol rises first thing in the morning, wakes us up, helps us to wake from sleep and to be alert. It peaks in sort of mid-morning, eight, nine o'clock, and then it starts to gradually fall, and it falls, falls, falls, falls, falls all through the late morning and early afternoon, and it nadirs out in the midafternoon between one and three or so, and then it gradually rises again. It's high again, not super high, not as high as it was in the morning, but it's high again in the early evening around dinner and then it's actually at its lowest while we're sleeping at night from 11, 12 at night to four or five in the morning.

Erin Stein: So, is that the circadian rhythm or is that different from the circadian rhythm?

Gillian Goddard: Our cortisol levels in the diurnal or two peaks, that rhythm helps maintain our circadian rhythms. There are other things that affect it, things like light and dark, things like melatonin production.

Erin Stein: I'm just thinking, like, my cortisol levels might be operating on a slightly different timeline than the one you described. Right.

Gillian Goddard: So sure, right? And we know that when teenagers shift their circadian rhythms, cortisol rises and falls at different times for them too. So that's if you're someone who's like waking up at seven in the morning and going to bed at like 11 at night, which is sort of like quote unquote “the norm.” I mean, obviously there's a great deal of variation from person to person.

Erin Stein: Right, so not the only thing at play, but one of the main things.

Gillian Goddard: An important one. One of the things that always makes me laugh is when people come in and they're like, I crash every afternoon. I'm sitting at my desk at like three o'clock and I just want to take a nap. And I'm like, mm-hmm, that's normal.

Erin Stein: Yeah, we all should get naps. It should be part of our workday.

Gillian Goddard: Think about this, across the world, across the entire world, across many different cultures, people have come up with ways of dealing with this midafternoon slump. In some of the Latin world, they do indeed take a nap. It's called siesta, which is great. 

Erin Stein: I know, I love it. Very jealous.

Gillian Goddard: Yeah. I know you live in a culture that takes the other approach.

Erin Stein: Do more. Have more meetings.

Gillian Goddard: I was thinking more about coffee. So, with caffeine or sugar. So, English tea time.

Erin Stein: Yeah, yes, stimulate yourself.

Gillian Goddard: Fika in Sweden, le goûter in France, are all where you're supposed to sit down and have sugar and caffeine in the mid- to late-afternoon.

Erin Stein: I never thought about afternoon tea that way, but that makes perfect sense. But also, you know, when you're working in an office, everyone starts wandering around looking for snacks at that time. And it, in your mind, it's like the workday is almost over, but it's not over yet. And you feel like you need something to get you through the day, but you literally do need something to get you through the day because it's nap time. Again.

Gillian Goddard: Right, it's nap time. 

Erin Stein: Another Seinfeld reference, that episode where George takes a nap under his desk. I always thought that was brilliant and wanted to try and do it.

Gillian Goddard: Yeah! Where he had the shelf put in and he had the alarm clock and the pillow. Yeah, no, it's very attractive.

Erin Stein: Yep. Yeah.

Gillian Goddard: And it's happening for a reason. Your cortisol levels are low. But like, think about the last time you had to get up like super early in the morning to go catch a flight. Or you were like pulling an all-nighter and you did okay. I mean, I remember this from being a resident. Everybody would do okay until like three, four in the morning. And so, you're awake at this time—three, four, five in the morning—when your cortisol levels are still super low. And I always feel nauseated and like I just can't keep my eyes open. Nausea is a symptom of not having enough cortisol. So, it's like your cortisol is super, super low and your body is like, we can't do this right now. We're not supposed to be doing this right now.

Erin Stein: Yeah.

Gillian Goddard: So we have to have some cortisol and our cortisol rises and falls throughout the course of the day. And that's normal and important to keeping our bodies running along smoothly.

Erin Stein: What is the point of rising and, I mean, obviously going to sleep and getting up is a rise and fall that makes sense because we need to go to sleep and recharge and all those other things, we'll have a whole episode about sleep probably at some point—but why the afternoon slump?

Gillian Goddard: I know, isn't that a good question? I don't actually know the answer to that.

Erin Stein: Yeah, I mean, it is a good question.

Gillian Goddard: Yeah, why doesn't it just stay sort of middling high all day long and then, I don't know.

Erin Stein: Yeah, yeah. I mean, maybe that's just not possible because it is a cycle, but I don't know.

Gillian Goddard: The adrenal system and the cortisol feedback loop obviously developed as we were evolving and is so totally critical to our survival that it's one of the most well-preserved systems in our bodies. There are rarely things that go wrong with it that are not environmentally imposed. Obviously, there was some benefit to having that afternoon lull. It may have been so that we could be alert in the evening at a time when being alert might be important for survival when we're stressed, we make more cortisol. You know, living in the hunter gatherer days and all of sudden we're out doing something away from our camp and we run into a, you know, good old saber tooth tiger…

Erin Stein: My favorite predator.

Gillian Goddard: Of course. And we need to think fast, figure out what to do, and probably we need to run away and we need to run away very quickly. And so, cortisol, when we get this surge of cortisol, it makes our heart beat faster.

Erin Stein: I was just gonna say, “run away, run away!”

Gillian Goddard: It releases stored sugar from our liver and from our fat cells. It pumps more blood and sugar to our brain and to our muscles. And it allows us to intensely focus and to do more physical activity before our muscles become tired. The need to think about what we need to do to get away from the predator and do the physical work we need to do it.

Erin Stein: So, this is our survival instinct, right? This is what we call fight or flight, but is really fight, flight ,or freeze, which is now accepted. Like there are three things your body might do because not all large animals should be run away from. You should not run away from a grizzly bear. You should walk casually and talk to them. Yeah.

Gillian Goddard: Noted. I'll remember that next time I run into one.

Erin Stein: I learned that in Alaska where I was walking around a national park with a bunch of grizzly bears who did not care that we were there. But if you suddenly run away, they assume you're prey and go after you. So, you really got to check your predators. Some you should run away from and some you shouldn't.

Gillian Goddard: That is so wild. Noted. Presumably our ancestors had anecdotal knowledge about these things.

Erin Stein: I think through, unfortunately, experience they would have learned these things, but that is the extra blood flow to your brain is so you can recall these memories. This is the animal that I run away from, or this is the one I freeze in place until it goes away, or I need a spear to stab it in one of those things.

Gillian Goddard: Right, right, exactly. And humans are slow to evolve. so, we are still operating with the same system that our ancient ancestors with.

Erin Stein: Humans are slow to evolve, but also, we still do have real dangers. I mean, not so much of the wild animal variety, although occasionally that is true depending on what you're doing, but a car racing down the road or a big storm, another human being, there are still things to trigger that survival instinct. I think the problem is, we've created so many more things that trigger that instinct that are not life and death situations.

Gillian Goddard: Yes, this is true. but I think this is an important point where we need to talk about the idea that not all stress is bad. So, I think when we talk about stress and when the internet is talking to us about stress and how we have to fix our stress, the assumption is that all stress is bad and there's good data to show that that is not true. So, in fact, too little stress is not good for our brains and too much stress is not good for our brains. But low to moderate stress often in like bursts is actually quite good for our brains and is really important for maintaining our cognitive wiring and keeping our brains sharp and functioning. So, there's a study called the Human Connectome Project and they have done a lot of studies on stress and things like working memory and cognitive function. And what they have found is that both no stress and high stress lead to poor performance. So, our brains don't function well cognitively when we have zero stress. And they don't function well cognitively when we have high stress, but they function really well in that sort of low to moderate stress level. So, I'm thinking about like my kid going to take the SAT and getting his best score ever on the day of the actual test because of the increased stress and pressure of knowing that this was the actual test. Or someone who PRs [sets a personal record] in a race because, you know, this is the actual race and they've got those stress hormones pumping and that allows them to run faster. Giving a presentation at work or like a talk where you really are on your game and you're thinking quickly as people are asking you questions because there's just a little bit of stress in that situation.

Erin Stein: I was going to ask, what is a little bit? I mean does anyone lead a life with zero stress? I think that would be pretty rare.

Gillian Goddard: No, but I would say that there are probably situations in which people avoid the short but moderately stressful situation because it can be uncomfortable.

Erin Stein: Sure, I think we should also just pause and separate stress from anxiety if that's possible because, like thinking about right before a presentation, I personally will get super nervous about it right before the presentation. Like I'm fine, I'm fine, I'm fine. And then it's like an hour before and I'm getting ready and I start to, you know, freak out. Like, my gosh, I'm so nervous.

Gillian Goddard: Mm-hmm.

Erin Stein: I need to have all my prep stuff and I get what I would describe as anxious, but also could be described as stress. Is there a difference? What is the difference?

Gillian Goddard: Yeah, this is really difficult to tease apart. And I think that some of that is because of the way we use the words anxious and anxiety. So, cortisol can cause anxiety, which is the real mood disorder anxiety. But I think sometimes now we talk about anxiety colloquially in a way that is slightly different from that mood disorder. And I think that that would probably be more in the category of like moderate stress. Anxiety, by definition is either out of proportion to the situation or feeling anxious when there is no situation, when there is no threat. It's a maladaptation of the brain, right? The brain perceiving threat when there isn't one or perceiving a threat to be bigger than it is. And turning on all these systems.

Erin Stein: Yes, I think that's right. And as a person who does have some anxiety, I would say when it's anxiety versus just some stress, the anxiety might prevent me from doing something. Right?

Gillian Goddard: That's correct. Versus stress probably wouldn't.

Erin Stein: It makes it unpleasant, to get to that point of it, whatever it is, but I would still do it. And anxiety is when I don't want to do it and don't do it because I'm so anxious about it. I would say anxiety then extends the period that you're feeling it.

Gillian Goddard: Moderate stress. Yeah.

Erin Stein: Like you said, it's out of proportion, part of that is you're anxious about something for so long and you're, as we call it, spiraling and thinking about it too much and making it too big a deal and you're paralyzing yourself. So that actually makes sense. And I think it is important because we do always talk about being anxious or anxiety. And sometimes it's just, it really is just stress. And then sometimes we talk about stress when it's really something bigger than that, you know.

Gillian Goddard: Yeah, and I think it is important too to recognize that high stress or chronic significant stress isn't good for us. I think it's always helpful to think about some examples. I'm talking about like the toxic work environment, someone who's being physically or emotionally abused. Someone who is participating in the care of a very sick family member, has really chronically sick kid. Those types of stress keep our cortisol levels pumping all the time. And then cortisol can start to have bad effects on our body. It can cause depression and anxiety because it's affecting how dopamine is functioning in our brain and how serotonin is functioning in our brain. It actually leads to poor cognitive performance. It disrupts sleep. It can decrease our immune response and make us more susceptible to illness. And it can cause weight gain, high blood sugars, high blood pressure. And so, we have to be really careful because we're talking about things along a spectrum where when you get to either end of the spectrum, cortisol may be doing bad things for you, but in the middle, this is true of so many things… One of my mentors used to say that all of endocrinology is a Goldilocks problem. You don't want too much and you don't want too little. And that's true of stress too. You don't want too much, but you don't want too little.

Erin Stein: Well, an example I think of is when I was getting married and planning my wedding, which was pretty similar to the time you were planning your wedding, because it was only a few months apart. 

Gillian Goddard: Very similar. 

Erin Stein: I broke out in hives and I went to the dermatologist you know, thinking I had something else going on because I have allergies and whatever. He said, are you getting married? And I'm like, yes. He's like, I see it all the time in brides. It's stress. It's a stress response. And I was like, that's weird, but also makes sense. And I didn't even feel that stressed, although I guess I was pretty stressed out. So now, it's happened a few other times during stressful times that I would break out in hives, but now I know what it is, but that's a temporary period of stress and we all have times in our lives where we're dealing with really tough, chronic stress. Like you said, dealing on a daily basis with an ill family member, or if you're living with emotional abuse or abuse at work. And I kind of want to just point out that a lot of it is emotional experiences. We're not talking about working on the railroad back in the day, although that probably was stressful because there was the threat of death constantly. But so much of this is emotional stress. Something is triggering your physical responses, but it's usually an emotional thing that is not letting up. It never gives you a break.

Gillian Goddard: Right. Yeah.

Erin Stein: And that's when it becomes this chronic condition, causes all of these health problems. And so, you have to do what you can for some of these things. There's not any way out, but through.

Gillian Goddard: Yeah, this is where professional support in the form of therapy can be very helpful.

Erin Stein: Yes. Therapy, medication, perhaps. This is why we talk about self-care all the time. Like it may not be big, dramatic things you can do for yourself, but if you need to turn off your phone and go take a nap or snuggle a cat or do something, even if it's for 10 minutes, that will lower your cortisol level. 

Gillian Goddard: Indeed, indeed.

Erin Stein: Look at me!

Gillian Goddard: Indeed. Yeah, I mean, I think that the truth is none of us are going to stress-free lives. And most of us will have some time in our lives when we are experiencing high stress. There may be different degrees of high stress, but it's hard to get through life without having someone you care about be ill or have a job situation that is far from ideal. But, you know, most of us do need to work for a living. And so, I think most people at some point deal with this type of high stress, chronic stress, and it's important to have tools in your toolkit to help you manage that.

Erin Stein: Let's just talk about what might be some things you can do even if you're going through one of these periods and you can't stop the stress at the moment. 

Gillian Goddard: Right, maybe you don't want to. Sometimes people are under stress for good reasons, even if it's highly stressful.

Erin Stein: You might be a doctor working in an emergency room.

Gillian Goddard: You might be a doctor working in emergency room. You might be a doctor working a full-time job and publishing a book at the same time that your oldest child is graduating from high school. Perhaps, maybe, I know someone like that. And so all those things are good, but that doesn't mean that the stress doesn't have to be managed.

Erin Stein: Mm-hmm. You might have volunteered for that. How are you managing this stress you're currently feeling by choice?

Gillian Goddard: Good question. So, for me, there are some things that I find really helpful during, highly stressful periods. One is really prioritizing sleep and in a way that is really regimented, giving myself a bedtime, making sure I'm in bed, having a very clear bedtime routine, and having those things be things that I really enjoy. Right now, I snuggle up with my two middle kids and we watch a show and then they go off to their rooms and I, settle down after, but we watch something fun and relaxing, nothing too intense. I use exercise to manage stress a lot. For me, running is a huge way in which I manage my stress. And so, I really do try to prioritize exercise as much as possible. And the other thing that's important for me is planning, but a little bit like longer range, sort of thinking about, yes, the next six, eight weeks are going to be very busy. And then there's going to be this period of time where I can see the light at the end of the tunnel. I think one of the times when chronic stress is most challenging is when there is no clear end in some of these situations like we've talked about, or if that clear end is unpredictable. So, say in the case of like a terminal illness. In this case, I know that when I drop my youngest child off for camp at the end of June, the rest of the summer should be pretty relaxed.

Erin Stein: That's nice. I think at this point in our lives, we've all developed some coping mechanisms and some are better than others. I wish mine was as healthy as yours, running. That does not de-stress me at all. but I've been going through an extremely stressful period because there's family stuff going on many fronts, and it's ongoing and doesn't have a clear end in sight and is really a lot to deal with. And then I have my own, I had breast cancer, there's other people going through health stuff, and so I don't have children, but I have cats. Snuggling and petting a cat or a dog or a hamster, whatever you have really does help you relax and calm down. 

Gillian Goddard: There's data on that actually, it’s why they like bring animals into hospital, like trained animals into hospitals to interact with patients.

Erin Stein: Yeah, It's a real thing. Yes. Having a cat sleep on you helps me sleep, honestly. So, the cats are getting a lot of extra forced cuddling. And then we moved into a house five years ago and we have a backyard, we have woods and just going outside, even for five minutes.

Gillian Goddard: Mm-hmm. Nature.

Erin Stein: Being outside in nature with trees and animals. We have a lot of birds, we have chipmunks, just being in the sun when you can when it's summer and we have it, because we don't have it much in the winter here. But even just going out and resetting for five minutes, I find helpful. And also breathing, right?

Gillian Goddard: So underappreciated.

Erin Stein: People give different counts, count to 10, count to seven, count to five, whatever, but in out, just thinking about your breathing even for 30 seconds helps calm yourself down a little bit. I've started doing that more when I'm trying to fall asleep at night. And there's a little retail therapy occasionally within reason. My husband and I both, when we're stressed, you know, we watched a little bit of TV every night and when we are just both mentally exhausted, we're watching like repeats of the British baking show or we're not watching The Pit about emergency physicians. Although I do really want to watch it, but he's like, it's too stressful. So, you know, we're watching something calming and pleasant and nice and something that's not stressful.

Gillian Goddard: No. My kids and I just finished watching Parks and Rec. Start to finish. Yeah, really nice way to end the day with an episode or two of that.

Erin Stein: Oh my god, I love Parks and Rec so much. 

Gillian Goddard: Yeah. Well, now we sing “bye bye little Sebastian” all the time.

Erin Stein: Yes, a good comedy is also delightful, but my version of comedy is watching Real Housewives. I find watching them yell at each other very relaxing and my husband does not understand it, but it's the truth. So, I mean, we all have these things, right? 

Gillian Goddard: Haha! Fair enough.

Erin Stein: Or get yourself a little coffee treat at Starbucks, you can't do that every day, but once in a while, treat yourself. And I think the main thing is for everybody in any of these situations that you can't control, you can control turning off the phone, staying off social media, and just going in a room by yourself. Just be like, I need half an hour to myself. Someone else can be in charge for half an hour, right? You just got to do it. Everyone reaches their breaking point and I think as women particularly, we take on so much responsibility for everybody else and there's this default that we will take care of it, that we will do it, that we will do the planning, we will do the driving, we will make sure the doctor's appointments happen, that the food is made and that it's healthy food and remind people to do everything they're supposed to be doing. And we take on the care of our parents. Plus, if you have children, you're taking on the bulk of that. It's just a societal thing that we are expected to do it and we do it and are pretty good at it. So, then people expect us to just do it more. Like, well, you're so good at it. I can't tell you how many times I've heard this, but you're so good at it. Doesn't mean I want to do it all the time though. And we need to set boundaries for ourselves and push back and delegate to other capable adults who should be taking on some of this work.

Gillian Goddard: True. Yes. So, but I think this brings us around to a question that I get all the time from women who are like the women you just described, right? Like maybe there's no one specific big stressor, but just sort of the stresses of day-to-day life are starting to get wearing. And so, I hear a lot of questions about how this taxes our adrenal glands. And I think that this is a conversation on the internet. That this sort of chronic stress is taxing to our adrenal glands and we need to do something to support our adrenal glands. And I think it's really important to know that none of that is based in science. So, the things we just talked about, respite, sleep, self-care, those things are based in science. Taking adrenal support supplements, adaptogens…

Erin Stein: What's an adaptogen? I don't even know what that is.

Gillian Goddard: These are usually botanical substances that are thought to help our immune system and our cells adapt to stress. They're often antioxidants, but not always. 

Erin Stein: Okay.

Gillian Goddard: And there's just not a lot of evidence that they are helpful in this particular situation. Our adrenal glands can keep making cortisol as long as we need them to in the vast majority of situations. They don't get fatigued. They don't run out of cortisol. Cortisol is made of cholesterol. We can keep making more.

Erin Stein: Mm-hmm.

Gillian Goddard: And so, you don't need to be taking fancy, expensive supplements. The things that you can do to help manage these stressors are both much simpler and, in some ways, much harder, but there are also the things that are evidence-based and much more effective than any sort of supplement or other adrenal fatigue diet is ever going to be because adrenal fatigue is not something that's supported as existing in the literature.

Erin Stein: What I'm hearing is that there's nothing to do to quote unquote, “treat” your adrenal gland for stress, but that high stress, high cortisol production is creating other things happening in your body. And that's what you can do.

Gillian Goddard: Right. And an adrenal support vitamin isn't going to do that. Getting some respite, doing all the things that we were just talking about, petting a cat. Those are the things that are helpful. There is science behind those things.

Erin Stein: Petting a cat, calming your breathing, you know. We do have a fight or flight response. That is what some people call our lizard brain, but we also have our cognitive function and our frontal cortex that we have evolved to be quite large. And so, what happens is you have that first instinct, but then your cognition kicks in and says, this is not something to be that worried about, you know, and even when it is something you're chronically worried about and is ongoing, your brain can say, you know what, I need to take a deep breath. I need to center myself. I need to take care of myself. And that is the bonus of having such a large prefrontal cortex is overriding that instinct that lizard brain a little bit.

Gillian Goddard: Yeah, for sure.

Erin Stein: But is there a scenario where your adrenal gland does not work, or your cortisol production is not happening the way it should?

Gillian Goddard: Yes, less than 1% of people. It's a very rare thing. But occasionally, the immune system attacks the adrenal glands so they can no longer make cortisol. And this is a medical emergency. It's called Addison's disease. I think the most famous person with Addison's that I can ever think of is actually, President Kennedy had Addison's disease. Usually, it's diagnosed in childhood or in adolescence. I actually have a couple of different patients who were diagnosed like late in high school or early in college. That's a very common time to get diagnosed. And because we have to have cortisol, we have to give these people cortisol and they can end up in situations if they can't get enough cortisol with pills where it can be life threatening. So, it is a very serious thing, but luckily it's super, super rare and I screen many more people for it than I ever diagnose with it.

Erin Stein: JFK, popping pills. 

Gillian Goddard: JFK. Well, some of those were cortisol, but some of them were not.

Erin Stein: Some were not.  What is life threatening about it if we don't have cortisol, or stress? Is it that we just literally can't function at all without it?

Gillian Goddard: So, without cortisol, particularly in stressful situations, you can end up in a situation called adrenal crisis. Basically, you'll lose weight. You can't maintain your blood pressure. So, blood pressure will be really, really, really, really low. Electrolytes like sodium and potassium can get all off. It is a really dangerous thing. Our cortisol levels rise when we get sick to help our body fight off infection. And so oftentimes these kids get diagnosed because they get sick with a run of the mill virus and then that tips things off.

Erin Stein: Talk about that. What is cortisol doing when we get sick?

Gillian Goddard: So, cortisol doesn't know. It's a molecule, right? So, it doesn't know, and our adrenal glands don't know whether the stress we're experiencing is the saber-toothed tiger or whether it's a virus. 

Erin Stein: So, you're saying we don't have sentient hormones in our body? [laughs]

Gillian Goddard: We don't have sentient hormones or sentient glands. We are sentient as a whole, but our individual parts are not. And so, it does the same things. It increases our heart rate. It increases circulation. It helps the brain and the blood and the blood vessels function better. And the reason that that's important is because when we get sick, our body needs more support. Our different organs need that support to fight off the infection.

Erin Stein: So, cortisol, it’s important.

Gillian Goddard: Very important, one of the most important hormones we have.

Erin Stein: Pretty important. Pretty good.

Gillian Goddard: Pretty good, but a Goldilocks thing, you don't want too little and you don't want too much.

Erin Stein: Thinking about this, I'm like, well, if it increases your heart rate in a way it sounds like exercise, right? Like it's good for you to have extra blood flow and higher heart rate, except that you're not supposed to exercise 24/7 either, right?

Gillian Goddard: Right, correct. And your heart can't beat at a high rate 24/7. Yeah.

Erin Stein: So, it's the same as all things. You don't want to have too much happening. You don't want to have your cortisol at a high all the time. But the takeaway is that you're not treating the cortisol per se. 

Gillian Goddard: You're treating the thing that is causing it.

Erin Stein: You're treating the thing that's causing it. And when you can't, there are situations where we can't control. Then you're treating the results you're basically calming your system down in whatever way you can. Right.

Gillian Goddard: Yeah. Yeah, I think that's a great way of explaining it.

Erin Stein: Because whether it's before or after, you need to calm all these things working in tandem as a system in whatever way works for you. And that may require professional support, highly recommend it. One of the things I forgot to say, one of the things I've started doing is just talking to friends a little more often.

Gillian Goddard: So that they can keep functioning. Yeah. highly recommend it. There's a lot of data around the importance of social contact, around things like laughing, around physical touch. But yeah, community support is, you know, having a good time.

Erin Stein: Yeah. Yeah. I'm getting most of my physical touch from the cats… just kidding. But it's really hard at this time of life to spend time with your friends because they don't all live down the hall, like on Friends, which I've always been like, who wants to live next door to me? Come on, people. I want easy access to someone to hang out with. But the reality, yeah.

Gillian Goddard: In retirement when I'm a widow, I'll live next door.

Erin Stein: We will live in our community house that we've already talked about. But just reminding myself, I do have friends and they do support me and, reaching out via text is one thing and everybody sends memes on social media. That's another thing, but it's been nice to just talk. Like I have one friend, we just started talking on the phone once a week. We live in different states, so we don't get to hang out that much, but just talking and catching up once a week is amazing. And I don't like talking on the phone. I don't like making phone calls, but chatting with a friend is really nice. And for me, venting about stuff has always been a stress reliever. I'm a huge gossip. There are studies about the benefits of gossip.

Gillian Goddard: Yeah. But see that's why this is so fun. I get to hang out and chat with a friend.

Erin Stein: It is! That's why we're doing it together. Exactly. So, you know, go chat with a friend.