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Reference Guide
Cortisol Morning - AM30
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Cortisol Morning - AM30
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Cortisol Morning - AM30

Cortisol, a glucocorticoid hormone produced in the adrenal cortex, plays a crucial role in the body's stress response system.  

The cortisol awakening response (CAR) is the significant rise in cortisol levels within 30 minutes of waking, often measured through saliva samples.  This response, peaking about 30 minutes after waking, reflects the health of the hypothalamic-pituitary-adrenal (HPA) axis and is essential for stress regulation. 

Abnormal CAR patterns can indicate issues like chronic stress, PTSD, and burnout. 

Accurate assessment of AM30 cortisol levels helps in understanding and managing various physiological and psychological conditions.

What is Cortisol?  [20.] 

Classified as a glucocorticoid hormone, cortisol is a crucial component of the body's stress response system.

It is synthesized from cholesterol through a series of enzymatic reactions in the zona fasciculata of the adrenal cortex.  Cortisol is produced in the steroidogenesis pathway, which encompasses the biosynthesis of steroid hormones from cholesterol. 

What is AM30 Cortisol?

AM30 Cortisol levels refer to cortisol levels 30 minutes after waking.  AM30 Cortisol is often tested in saliva.  

Accurate and reliable measurement of AM30 cortisol levels is an essential component in assessing the cortisol awakening response, or CAR.

Clinical Significance of the Cortisol Awakening Response

In healthy individuals, cortisol is expected to rise in the morning by as much as 50%, peak approximately 30 minutes after waking, and fall back to morning waking levels within 60 minutes of waking. [10.]   

This is called the Cortisol Awakening Response, or CAR, and it provides valuable insight into the functioning of the HPA axis.  [17.]

The AM30 cortisol measurement is an essential measurement in assessing the CAR.  

The CAR is clinically relevant because it reflects HPA axis function, which is associated with various physiological and psychological factors.  

Research suggests that a robust CAR is indicative of healthy stress regulation and adaptation, while blunted or exaggerated CARs are linked to conditions such as chronic stress, PTSD, depression, chronic fatigue, and burnout.  [8., 10., 17., 18., 22., 23.]

Assessing CAR through laboratory testing can aid in identifying dysregulations in the hypothalamic-pituitary-adrenal (HPA) axis, which plays a central role in the body's stress response system.  [1.]

Laboratory Assessment of AM30 Cortisol

Sample Types

Two primary methods are used for AM30 cortisol testing: serum/plasma cortisol assays and salivary cortisol assays. 

Serum or plasma cortisol assays measure the total amount of cortisol in the bloodstream, providing a snapshot of cortisol levels at the time of sample collection.  

Salivary cortisol assays, on the other hand, measure the bioavailable or free cortisol levels, which are believed to better reflect the physiologically active form of the hormone.

Laboratory Testing, Sample Collection and Timing

The CAR is often assessed via saliva samples of cortisol immediately upon waking, 30 minutes after waking,and 60 minutes after waking.  Alternatively, blood samples may be used, but this requires multiple blood draws within a short time. 

The timing of sample collection is critical for accurate AM30 cortisol measurement, as cortisol levels can fluctuate rapidly in response to various stimuli. 

Samples must be collected within 30 minutes of awakening, with the recommended window being as narrow as possible to minimize variability. 

Factors such as sleep quality, stress levels, and certain medications can influence cortisol levels and should be taken into account during sample collection.

Interpretation of AM30 Cortisol Results

Optimal Levels of AM30 Cortisol

The pattern of the CAR provides the most clinical information.  Optimally, levels of AM30 cortisol are expected to rise by about 50% from waking cortisol levels, then fall back to roughly the levels seen upon waking about 60 minutes after waking.  

This indicates a healthy HPA axis response.  Increased or decreased levels may have clinical relevance, as discussed below.  

Elevated Levels of AM30 Cortisol  [2., 3., 9., 24.] 

 An elevated cortisol awakening response (CAR) has been linked to various physiological and psychological factors.  

Chronic stress, worry, work overload, and acute stress exposure are known to contribute to a larger CAR.  [2., 3.]  

Additionally, research suggests that an elevated CAR may be a biological factor associated with impairments in cognitive functions such as error processing, conscious error perception, and subsequent behavioral adjustment in healthy populations.  [24.]

Furthermore, an abnormally high CAR could potentially indicate underlying neurological conditions: individuals with bilateral or unilateral hippocampus damage and hippocampal atrophy tend to lack a normal CAR, suggesting that an elevated CAR may be indicative of hippocampal dysfunction or atrophy, which can have implications for cognitive impairment.  [24.]

Certain environmental and lifestyle factors have also been shown to influence CAR levels. Morning light exposure, high-intensity exercise, greater physical activity levels, and short-term sleep deprivation have all been associated with an increase in CAR.  [3.]

It is important to note that the clinical significance of an elevated CAR should be interpreted in the context of an individual's overall health status, as well as other relevant biomarkers and diagnostic criteria.  

The CAR alone is not a definitive diagnostic tool but rather a potential indicator of underlying physiological or psychological conditions that warrant further investigation and evaluation.

Decreased Levels of AM30 Cortisol

A decreased or blunted cortisol awakening response (CAR) has been associated with various clinical conditions and psychological states including fatigue or pain.  [7.]

It has also been associated with conditions such as poorer general health, AIDS, cancer, post-traumatic stress disorder, chronic stress and burnout.  [7.]

It is important to note that the clinical significance of CAR abnormalities should be interpreted in the context of the individual's overall clinical presentation, as well as other relevant biomarkers and diagnostic criteria.  

Strategies to Support a Healthy CAR 

  • Practice mindfulness-based stress reduction techniques, including meditation, deep breathing exercises, and yoga.  [21.]
  • Engage in regular physical activity and ensure adequate sleep each night to support cortisol regulation.  [4.]
  • Maintain a balanced diet rich in whole foods, while limiting caffeine, alcohol, and sugar intake to stabilize cortisol levels.
  • Foster a supportive social network and seek professional counseling or therapy to address underlying stressors effectively.
  • Consume a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats to provide essential nutrients for adrenal health and cortisol regulation.
  • Incorporate foods high in magnesium, such as leafy greens, nuts, seeds, and legumes, which may help reduce cortisol levels and promote relaxation.
  • Avoid excessive caffeine, refined sugars, and processed foods, as they can spike cortisol levels and contribute to chronic stress.  [5., 6., 12.] 

Supplements To Support A Healthy CAR:

  • Herbal adaptogens: incorporate adaptogenic herbs like ashwagandha and holy basil into your routine to regulate cortisol levels and enhance stress resilience.  [11., 15.] 
  • Explore supplements such as phosphatidylserine to support adrenal health, reduce inflammation and maintain cortisol balance.  [19.]
  • Vitamin C: Supports adrenal gland function and cortisol production.  [14.]
  • B Vitamins (B5, B6, B12): Essential for adrenal hormone synthesis and energy metabolism.
  • Magnesium: Helps regulate cortisol levels and supports adrenal gland function.  [16.]
  • Zinc: Supports immune function and aids in adrenal hormone production.
  • Omega-3 fatty acids: Have anti-inflammatory properties and support adrenal health.  [13.]

Prior to initiating any new supplements it's crucial to consult with a healthcare provider, particularly if you have preexisting health conditions or are currently on medications, to guarantee safety and effectiveness.

Order Cortisol Awakening Response Testing

Click here to compare testing options and order testing for CAR assessment. 

Cortisol Morning - AM30
Cortisol Morning - AM30 is a test that measures the level of cortisol, a vital hormone produced by your adrenal glands, in your body. This hormone plays a key role in various functions of your body, including managing stress, maintaining blood sugar levels, reducing inflammation, and assisting with memory formulation. It also plays a crucial part in your body's "fight or flight" response. The test is typically conducted in the morning, around 30 minutes after waking up, as this is when cortisol levels are naturally at their highest. This test helps to ensure that your body is producing the right amount of cortisol to keep you healthy and your body's functions running smoothly.
If Your Levels Are High
High levels of cortisol in your AM30 test could indicate a variety of conditions or factors. One possibility is Cushing's syndrome, a condition where your body produces too much cortisol over a long period. It could also be a sign of a tumor in your adrenal or pituitary gland, as these tumors can cause an overproduction of cortisol. High cortisol levels can also be a result of certain medications, such as oral corticosteroids or drugs used to treat arthritis, asthma, or lupus. Chronic stress or lack of sleep can also lead to elevated cortisol levels. It's important to note that while these could be potential causes, high cortisol levels are not definitive proof of any specific condition and further testing would be needed for a precise diagnosis.
Symptoms of High Levels
Symptoms of high levels of cortisol may include weight gain, particularly around the abdomen and face, thinning skin that bruises easily, pink or purple stretch marks on the skin, muscle weakness, fatigue, high blood pressure, mood swings, increased thirst and urination, and difficulty concentrating.
If Your Levels are Low
Low levels of cortisol in your AM30 test could indicate that your adrenal glands may not be working properly. This could be due to conditions like Addison's disease, which is a disorder where your adrenal glands don't produce enough hormones, or hypopituitarism, a condition where your pituitary gland doesn't signal your adrenal glands to produce enough cortisol. Certain medications, like steroid drugs or some types of antidepressants, can also lower your cortisol levels. Stress, poor nutrition, and lack of sleep can also contribute to low cortisol levels. It's important to remember that this test is just one piece of the puzzle and other tests may be needed to confirm a diagnosis.
Symptoms of Low Levels
Symptoms of low levels of cortisol may include fatigue, muscle weakness, loss of appetite, weight loss, low blood pressure, and abdominal pain.
See References

[1.] Adam EK, Quinn ME, Tavernier R, McQuillan MT, Dahlke KA, Gilbert KE. Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology. 2017 Sep;83:25-41. doi: 10.1016/j.psyneuen.2017.05.018. Epub 2017 May 24. PMID: 28578301; PMCID: PMC5568897.

[2.] Berger, M., Leicht, A., Slatcher, A. et al. Cortisol Awakening Response and Acute Stress Reactivity in First Nations People. Sci Rep 7, 41760 (2017).

[3.] Cortisol Awakening Response - an overview | ScienceDirect Topics.

[4.] De Nys L, Anderson K, Ofosu EF, Ryde GC, Connelly J, Whittaker AC. The effects of physical activity on cortisol and sleep: A systematic review and meta-analysis. Psychoneuroendocrinology. 2022 Sep;143:105843. doi: 10.1016/j.psyneuen.2022.105843. Epub 2022 Jun 24. PMID: 35777076.

[5.] Di Polito N, Stylianakis AA, Richardson R, Baker KD. Real-World Intake of Dietary Sugars Is Associated with Reduced Cortisol Reactivity Following an Acute Physiological Stressor. Nutrients. 2023 Jan 1;15(1):209. doi: 10.3390/nu15010209. PMID: 36615866; PMCID: PMC9823716.

[6.] Duong M, Cohen JI, Convit A. High cortisol levels are associated with low quality food choice in type 2 diabetes. Endocrine. 2012 Feb;41(1):76-81. doi: 10.1007/s12020-011-9527-5. Epub 2011 Oct 9. PMID: 21983796; PMCID: PMC3253931.

[7.] Fabian LA, McGuire L, Page GG, Goodin BR, Edwards RR, Haythornthwaite J. The association of the cortisol awakening response with experimental pain ratings. Psychoneuroendocrinology. 2009 Sep;34(8):1247-51. doi: 10.1016/j.psyneuen.2009.03.008. Epub 2009 Apr 17. PMID: 19375866; PMCID: PMC2740898.

[8.] Fries E, Dettenborn L, Kirschbaum C. The cortisol awakening response (CAR): facts and future directions. Int J Psychophysiol. 2009 Apr;72(1):67-73. doi: 10.1016/j.ijpsycho.2008.03.014. Epub 2008 Sep 30. PMID: 18854200.

[9.] Kudielka BM, Kirschbaum C. Awakening cortisol responses are influenced by health status and awakening time but not by menstrual cycle phase. Psychoneuroendocrinology. 2003 Jan;28(1):35-47. doi: 10.1016/s0306-4530(02)00008-2. PMID: 12445835.

[10.] Lim WT, Torpy DJ. Chronic Fatigue Syndrome. [Updated 2023 Aug 30]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA):, Inc.; 2000-. Available from:

[11.] Lopresti AL, Smith SJ, Metse AP, Drummond PD. A randomized, double-blind, placebo-controlled trial investigating the effects of an Ocimum tenuiflorum (Holy Basil) extract (HolixerTM) on stress, mood, and sleep in adults experiencing stress. Front Nutr. 2022 Sep 2;9:965130. doi: 10.3389/fnut.2022.965130. PMID: 36185698; PMCID: PMC9524226.

[12.] Lovallo WR, Whitsett TL, al'Absi M, Sung BH, Vincent AS, Wilson MF. Caffeine stimulation of cortisol secretion across the waking hours in relation to caffeine intake levels. Psychosom Med. 2005 Sep-Oct;67(5):734-9. doi: 10.1097/01.psy.0000181270.20036.06. PMID: 16204431; PMCID: PMC2257922.

[13.] Madison AA, Belury MA, Andridge R, Renna ME, Rosie Shrout M, Malarkey WB, Lin J, Epel ES, Kiecolt-Glaser JK. Omega-3 supplementation and stress reactivity of cellular aging biomarkers: an ancillary substudy of a randomized, controlled trial in midlife adults. Mol Psychiatry. 2021 Jul;26(7):3034-3042. doi: 10.1038/s41380-021-01077-2. Epub 2021 Apr 20. PMID: 33875799; PMCID: PMC8510994.

[14.] Peters EM, Anderson R, Nieman DC, Fickl H, Jogessar V. Vitamin C supplementation attenuates the increases in circulating cortisol, adrenaline and anti-inflammatory polypeptides following ultramarathon running. Int J Sports Med. 2001 Oct;22(7):537-43. doi: 10.1055/s-2001-17610. PMID: 11590482.

[15.] Remenapp A, Coyle K, Orange T, et al. Efficacy of Withania somnifera supplementation on adult’s cognition and mood. Journal of Ayurveda and Integrative Medicine. 2022;13(2):100510. doi:

[16.] Schutten JC, Joris PJ, Minović I, Post A, van Beek AP, de Borst MH, Mensink RP, Bakker SJL. Long-term magnesium supplementation improves glucocorticoid metabolism: A post-hoc analysis of an intervention trial. Clin Endocrinol (Oxf). 2021 Feb;94(2):150-157. doi: 10.1111/cen.14350. Epub 2020 Oct 26. PMID: 33030273; PMCID: PMC7821302.

[17.] Stalder T, Kirschbaum C, Kudielka BM, Adam EK, Pruessner JC, Wüst S, Dockray S, Smyth N, Evans P, Hellhammer DH, Miller R, Wetherell MA, Lupien SJ, Clow A. Assessment of the cortisol awakening response: Expert consensus guidelines. Psychoneuroendocrinology. 2016 Jan;63:414-32. doi: 10.1016/j.psyneuen.2015.10.010. Epub 2015 Oct 20. PMID: 26563991.

[18.] Stanczykiewicz Bartłomiej Stańczykiewicz, Bogudzinska Bogna Bogudzińska, Kowalski KE, Misiak B. The association between depression and the cortisol awakening response is moderated by loneliness in men from a non-clinical sample. Psychoneuroendocrinology. 2024;160:106924-106924. doi:

[19.] Starks MA, Starks SL, Kingsley M, Purpura M, Jäger R. The effects of phosphatidylserine on endocrine response to moderate intensity exercise. J Int Soc Sports Nutr. 2008 Jul 28;5:11. doi: 10.1186/1550-2783-5-11. PMID: 18662395; PMCID: PMC2503954.

[20.] Thau L, Gandhi J, Sharma S. Physiology, Cortisol. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: 

[21.] Turakitwanakan W, Mekseepralard C, Busarakumtragul P. Effects of mindfulness meditation on serum cortisol of medical students. J Med Assoc Thai. 2013 Jan;96 Suppl 1:S90-5. PMID: 23724462.

[22.] Wessa M, Rohleder, Kirschbaum C, Flor H.  Altered cortisol awakening response in posttraumatic stress disorder. Psychoneuroendocrinology. 2006;31(2):209-215. doi:

[23.] Wüst S, Wolf J, Hellhammer DH, Federenko I, Schommer N, Kirschbaum C. The cortisol awakening response - normal values and confounds. Noise Health. 2000;2(7):79-88. PMID: 12689474.

[24.] Zhang, L., Duan, H., Qin, S., Yuan, Y., Buchanan, T. W., Zhang, K., & Wu, J. (2015). High cortisol awakening response is associated with impaired error monitoring and decreased post-error adjustment. Stress, 18(5), 561–568.

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