Increasing cortisol in the morning can help you sleep better and give you more energy throughout the day

I'd place getting good quality and sufficient levels of sleep as probably the second most important thing, in my opinion, for helping to manage type 2 diabetes and metabolic syndrome in general. The most important thing is managing carbohydrate intake, especially fructose from sugar. What I've learned this week is that cortisol levels in the blood follow a daily pattern of being high in the morning and reducing to low levels by evening in preparation for a good night's sleep. This pattern both follows, and forms part of our circadian rhythm.

Before you wake up in the morning, your body's circadian rhythm starts preparing you for the day by increasing cortisol levels in the blood. Cortisol's primary function is to increase available energy to the brain, organs and muscles by doing the following:

• Increases blood glucose by using stored glycogen from the liver (glycogenolysis) and promoting de novo gluconeogenesis from fat stores.
• Promotes breakdown of fat into fatty acids (lipolysis) which can be converted into ketones for additional fuel if glucose stores become low.
• Promotes breakdown of protein such as muscle tissue in the absence of sufficient glucose and fat

Cortisol also suppresses inflammation and modulates the immune system.

High levels of cortisol early in the day are beneficial

The levels of cortisol will gradually decrease throughout the day and keeping levels higher throughout late morning and early afternoon will help to give you more energy and avoid feeling lethargic. To do this it's important to be aware of the fact that our ability to increase and sustain high levels is largely dependent on our early morning activities.

• Staying hydrated. Drinking a glass of water is my first priority in the morning (after feeding Alan the cat).
• Getting exposure to sunlight as soon as possible after waking. I try to get at least 15 minutes outside either by going for a walk or having a herbal (non-caffeinated tea) in the garden.
• Exercise in the morning. Varying the type of exercise can also be beneficial. I alternate weights and cardio at the gym with longer morning walks on non-gym days.
• Having a rest day once a week helps to keep your body guessing and reduces the dampening effect of cortisol habituation where your body has effectively trained-in to expect certain levels of stress and exercise at regular intervals.
• Hot and cold exposure. I don't currently do any cold water plunging or cold showers as it's practically difficult for me at the moment as my mixer tap is broken. I try to get out for a walk in the rain or walk back from the gym after getting sweaty or if I've gone to the gym in the car, I'll sit outside in the garden before having a hot bath (heat exposure has other metabolic benefits).
• If you have a stressful task planned for the day, try to get it done in the morning. I've always hated 9am business meetings but maybe choose 10am if you're given an option.

Dietary approaches to increasing cortisol levels:

• Caffeine
  • This can help to keep levels high if taken later in the morning or early afternoon. Habitual caffeine drinkers will have a reduced effect but it might still be worth looking at timing.
• Grapefruit
• Liquorice
• Low-carb or ketogenic (high-protein) foods for breakfast
• Morning fasting
  • If skipping breakfast works for you it will help to boost cortisol in the morning.
• Save carbohydrates for late afternoon/evening meals

Keeping cortisol levels low in the evening will help you sleep and improve glucose control

Pumping up your cortisol levels at night is going to keep you wide awake, because its job is to give you plenty of energy. It's best to avoid doing things that will elevate cortisol levels in the evening.

• Avoid bright light, especially white light from bulbs and blue light from screens on electronic devices. This will also help to avoid blocking your natural rise in melatonin which is important for quality sleep.
  • If you do have to use a computer screen turn the brightness down or turn on night shift mode on your mobile phone.
  • Use orange or red light bulbs rather than white where possible.
  • Use low level lights such as table lamps or floor lighting rather than overhead lighting in the evening.
• Avoid playing computer games, watching intense television programmes or movies e.g. crime dramas or thrillers within two hours of bedtime.
• Try to schedule any vigorous exercise to earlier in the day - ideally well before your evening meal.
• Avoid stressful situations as much as possible.
• Meditation or focused breathing exercises.

Dietary approaches to reducing cortisol levels:

• Include starches in your evening meal
  • With type 2 diabetes, you need to monitor your carbohydrate intake but a small amount with your evening meal will help to reduce your body's need to drive glucose production. I tend to have a small portion of potatoes or linguine.
• Try to avoid eating within two hours of bedtime but avoid going to bed hungry
  • Dark chocolate or cheese can be a good option if you need to have a small snack.
  • Magnesium-rich nuts will also be beneficial for sleep, such as pumpkin seeds, almonds, and cashews.
• Avoid caffeine after 3pm
• Avoid alcohol if possible
  • If you do drink alcohol try to stop drinking as early as you can.
• Chamomile tea
• Fresh parsley is particularly high in apigenin so including this with your evening meal would be a good option

Implications of cortisol modulation for type 2 diabetes

Cortisol is often associated with stress and although stress does cause cortisol levels to rise, high levels are a good thing at the right time of day. It becomes a problem when levels are elevated all of the time in a chronic stress situation. For type 2 diabetes, thinking about rising cortisol in the morning is a good idea because you want to do everything you can to help your body burn as much glucose as possible. Think of a sink filling with water that's about to overflow... We're all trying to drain that glucose sink and the plug hole isn't big enough, so anything we can do to increase the draining rate or stop more glucose pouring in, is the key to managing and improving the condition. Reducing carbohydrate intake is like turning the tap off and boosting cortisol in the morning helps to increase the drainage rate.

Thanks to Dr. Andrew Huberman for his podcast episode which highlighted this for me this week.