On Your Mark Nutrition

Cortisol Awakening Response

Cortisol awakening response

Identify and Lower Your Stress

Do you have trouble losing weight? Are you always feeling sluggish and tired? Do you suffer from insomnia? Do you continually feel stressed at work?

Adrenal fatigue is a condition in which there is an imbalance of hormones secreted from the adrenal glands (i.e., "stress" glands), which are located above the kidneys. The adrenal glands release hormones that help our body respond to changes in our environment and our ability to combat stress. They play a pivotal role in regulating glucose, insulin, inflammation, muscle building, mood, stamina, libido and sleep. Continuous stress from emotional stressors (e.g., work or school) or physical stressors (e.g., sleep loss, too much training/exercise, pain) can lead to an imbalance of adrenal hormones.

The main hormone released is cortisol, the "stress" hormone that prepares our body for the "fight or flight" response

Cortisol is typically the highest within 30 minutes after waking up in the morning. It then declines throughout the day and reaches its lowest point in the evening. However, this goes out of whack in adrenal fatigue.

  • Symptoms of high cortisol levels include anxiety, increased abdominal weight gain, increased appetite and sugar cravings, lowered immunity, sleep disturbance, bone loss, decreased libido

    • High levels of cortisol can suppress the production of other hormones, especially those related to reproduction and immunity. When this happens for a long period of time, it can increase the risk for infection, low libido, bone loss and hypothyroidism.

  • Symptoms of low cortisol levels include chronic fatigue, low energy, poor exercise tolerance or recovery, food and sugar cravings, weaker immune system


Cortisol awakening response (car)

When we open our eyes upon waking, cortisol levels naturally begin to rise by an average of 50%. 30 minutes after waking, cortisol levels will still show this sharp increase. By 60 minutes after waking, cortisol levels have peaked and begin to decline. Measuring this rise and fall of cortisol levels at waking can be used as a “mini stress-test”. Research shows that the size of this increase correlates with HPA-axis function, even if the individual sample measurements are all within range. A quick saturation of saliva swabs upon waking, and at 30 and 60 minutes after waking, provide what is required to assess a patient’s cortisol awakening response. Additional samples at dinner and bedtime provide the daily picture of free cortisol.

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  • Low or Blunted CAR:

    • This can be a result of an under-active HPA axis, excessive psychological burnout, seasonal affective disorder (SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue and/or chronic pain.

    • A decreased CAR has also been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases.

  • Elevated CAR:

    • This can be a result of an over-reactive HPA axis, ongoing job-related stress (anticipatory stress for the day), glycemic dysregulation, pain (i.e. waking with painful joints or a migraine), and general depression (not SAD). A recent study showed that neither the waking nor post-waking cortisol results correlated to Major Depressive Disorder, but the CAR calculation (the change between the first two samples) did.

    • This measurement of the response to waking has independent clinical value showing dysfunction that may be hidden by current testing options.


ideal for those experiencing:

  • Weight Gain

  • Repetitive Illness (especially with a difficulty in getting back to healthy)

  • Negative Thoughts

  • Difficulty Concentrating

  • Poor Recovery From Training

  • Habitual Fatigue (especially in the morning and mid-to-late afternoon)

  • Higher Energy Levels in the Evening

  • Poor Sleep

  • Work Stress or An Overwhelming "Stressed Out” Feeling Overall


Test Details

  • Collection: 5 saliva samples over the course of one day

  • Test Results: 7-10 business days

  • Follow Up Testing: as necessary