Cortisol Awakening Response Protocol

Support for the Cortisol-Awakening Response (CAR)

The CAR is a normal response when light enters the eyes upon waking. Cortisol is released very quickly over the course of about 30 to 45 minutes, until it reaches a peak. Normally, cortisol then begins its decline until it reaches its lowest point at night.

Testing salivary cortisol can reveal how well the adrenal glands are functioning. Initially, under acute stress, it’s common for people to feel anxious or hypervigilant, and have difficulty sleeping, due to high cortisol levels. These people may show elevated cortisol all day and into the evening. But if high stress continues over time, there is a negative feedback loop that can shift high cortisol gradually lower and lower, and eventually people become tired and “burned out”. It’s at this point that some people may have a blunted CAR.

A healthy CAR is considered a sign of resiliency. The CAR is influenced by brain health and quality of sleep. Waking in the morning is like a mini stress test for the body, so an abnormally low CAR is an indication that the person is not mounting an appropriate physiologic response to stress. They probably feel sluggish upon waking, have difficulty getting out of bed, and take a long time to wake up, maybe resorting to a lot of coffee just to function.

Restoring a healthy CAR requires a holistic approach, which includes ensuring adequate sleep, waking up at the same time each day, getting bright light upon waking, and movement each day, and may be further aided by taking supportive supplements.

In the morning, activities that may help encourage a healthy CAR include:

Exposure to bright, natural light immediately on waking. Open the curtains, go outside, or use a full-spectrum lightbox or light bulb.
Perform exercise and movement within 30 to 45 minutes of waking.
Take dietary supplements within the first 30 to 45 minutes of waking to help support cortisol production. Repeating supplementation at lunch or in the early afternoon is optional. (Be aware that not all supplements can be taken with thyroid medication that’s also taken upon waking.)

Nutritional support for a healthy CAR includes vitamin C and B vitamins, but also includes energy supporting herbs for the HPA-axis and the brain. Licorice is most well known for supporting morning cortisol response, rhodiola is an energizing adaptogen for the HPA axis, and bacopa is a stimulating herb for the brain. Working together, these herbs may help patients restore a normal CAR.

Because of the role of mitochondria in cortisol production, we want to also consider ingredients like pyrroloquinoline quinone (PQQ), coenzyme Q10 (CoQ10), alpha-lipoic acid (ALA), or resveratrol for mitochondrial support as part of the foundational supplement regimen.

An important part of restoring a normal CAR is bringing the whole circadian rhythm back to normal. Getting to bed earlier and getting more sleep are just as important as a consistent waking routine. Supplements that support calming cortisol in the evening and help support sleep include phosphatidylserine, l-theanine, magnolia or honokial and magnesium at night. Many practitioners find theanine before or right after the evening meal begins to calm the whole nervous system and set the stage for restful sleep.

Carrie Jones ND, FABNE, MPH is an expert on HPA-axis function. We recently shared her protocol for foundational HPA Axis & Mitochondrial Support which can be found in the Wellevate Protocol Library. This week, Dr. Jones shares her top product recommendations for supporting a healthy CAR in her Cortisol Awakening Response Protocol.

At Emerson Ecologics and Wellevate, it’s our goal to keep you updated with the latest and greatest wellness protocols from renowned integrative experts.Your Wellevate account gives you access to the Wellevate Protocol Library’s full catalogue of expert protocols from dozens of today’s integrative thought leaders, including Dr. Carrie Jones.

Carrie Jones, ND, FABNE, MPH, is an internationally recognized speaker, consultant, and educator. Dr. Jones graduated from the National University of Natural Medicine (NUNM), where she also completed a two-year residency in women’s health, hormones, and endocrinology. She later graduated from Grand Canyon University’s Master of Public Health program. She was an adjunct faculty member at NUNM for many years, teaching gynecology and advanced endocrinology. While in practice, Dr. Jones served as the medical director for two large integrative clinics in Portland, Oregon. Dr. Jones is board certified through the American Board of Naturopathic Endocrinology and is currently the medical director for Precision Analytical, an Oregon-based clinical laboratory that specializes in hormonal testing and reporting.