Long haulers: The fascinating link between stress, cortisol & COVID-19

Content reviewed by Donna Gates
Written by Body Ecology on November 10th, 2020

If we’ve learned anything about COVID-19 in recent weeks and months, it’s that everyone’s experience with the disease is different. For some, the infection causes no noticeable symptoms — at least, at first. For others, the disease has been fatal.

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You are what you eat, particularly when it comes to your gut health and immune function. Inside our Body Ecology Living Cookbook, you’ll find delicious and nutritious recipes that simplify eating for immunity: Cucumber Wakame Salad, Broccoli and Fresh Fennel Soup, Body Ecology’s Classic Kimchi, and Milk Kefir are just a few tasty antiviral options.

And for an increasing number of “long haulers,” COVID-19 can have protracted and perplexing effects that can both be a cause of stress and anxiety and that may well be exacerbated by stress and worries for the future.

The latest studies show that not only can COVID-19 mutate, causing different strains to be transmitted, but these genetic mutations might possibly create new and more serious symptoms.1

The research on cortisol strongly suggests that we’re not only more likely to get sick if we’re stressed, we’re also more likely to have a bad outcome if stress and elevated cortisol persist.

As we saw in the first article in this series, COVID-19 was initially thought to be almost exclusively a respiratory system infection. It is now known that the virus also attacks the nervous system, liver, kidneys, and even the eyes and other parts of the body.

It’s still unknown whether the virus can bypass the blood-brain barrier, but brain fog and other cognitive effects have been reported by many long haulers. Also, with long-term and lingering inflammation, both the brain and the gut are inflamed.

In this article, we’ll look at the connections between stress and symptoms of COVID-19 as recounted by long haulers. We’ll discuss the stress hormone, cortisol, and see how getting a handle on stress may be key to managing a healthy recovery from the infection. We’ll also suggest some natural solutions — like eating immunity-boosting and gut-friendly foods that we recommend in the Body Ecology Way of Life.

As a reminder, there isn’t just one Body Ecology “diet.” Your best diet is one based on the conditions you might be struggling with at this moment. With the new science of “Nutritional Genomics,” we can drill down even more into what you should and shouldn’t be eating. The ideal diet is the You Diet. Hopefully, researchers are looking at the genes of the long haulers.

How’s your level of stress these days?

Calming down stress signals certainly isn’t easy when symptoms and interactions with the medical establishment are stressful in themselves, which is why we’re dedicating this next article in our series to stress so you can help yourself if you’re a long hauler. You probably won’t be getting much help from the medical establishment right now.

Good health, made easy. Start rebuilding your immunity now.

Cortisol & COVID-19: Today’s stress levels have never been higher

Our adrenal glands primarily produce cortisol – the stress hormone. It readies the body to fight off a foe or to take flight, i.e., to run away from danger. Cortisol does this by temporarily increasing blood sugar, so the body has more immediate fuel to power up our muscles to run quickly.

At the same time, our immune system is suppressed, and so is our digestive system and our reproductive and hormonal system. Bone formation and other processes also shut down in order to redirect energy to fighting or fleeing.

Cortisol is a powerful chemical messenger that sounds the alarm throughout the body:

  • It affects mood and motivation, learning and memory, fear, and sleep; excess cortisol damages our DNA, which makes us age quicker and may even cause cancer.2
  • While cortisol gets a bad rap, we absolutely need it to help us survive for a number of functions. Google will tell you that, “Cortisol can help control blood sugar levels, regulate metabolism, help reduce inflammation, and assist with memory formulation. It has a controlling effect on salt and water balance and helps control blood pressure. In women, cortisol also supports the developing fetus during pregnancy.”3
  • The problems arise when this helpful protective mechanism becomes excessive and develops into a more permanent state of chronic stress with persistently elevated cortisol.

In children, a chaotic environment associates with persistently elevated cortisol and delays in the development of the prefrontal cortex, the part of the brain that deals with executive function.4 In adults, chronic stress and elevated cortisol have the same effect, preventing efficient problem-solving.5

And even before the current pandemic, the average stress level of adults was higher than that of many previous generations.6 What this means is that we were, as a society, far less equipped, stress-wise, to handle the fallout of a prolonged battle with a highly infectious and potentially fatal disease that has also increased social isolation and other sources of stress.

To be clear, it makes sense for the body to respond to an acute and serious infection with a marked increase in cortisol. Getting sick is stressful! The problem, though, is that elevated cortisol levels can actually inhibit the body’s ability to fight off infection and may exacerbate symptoms of an infection.

While you can’t eliminate all forms of outside stress, you can make a few simple changes that help mitigate the amount of cortisol surging through your body. Meditating, turning off the exciting TV shows and news at night, and taking a hot shower or soaking in a hot bath with Epsom salts can promote a healthy circadian rhythm and restful sleep.

A diet based on Nature’s 7 universal laws — that we recommend in Body Ecology — is one of your most powerful allies to help support immune function. With healing proteins and vegetables, low-sugar fruits, and high-quality, unrefined fats and oils, you’re off to a great start. Then by adding certain fermented foods, like cultured vegetables and coconut water kefir, you can jump to a whole new level of immunity.

Gut-healing foods and supplements like CocoBiotic, InnergyBiotic, Vitality SuperGreen, EcoPhage, and Ancient Earth Liquid Minerals can also play a role in helping to lower levels of chronic inflammation, thus supporting stronger immunity.7

Cortisol & immune function: Expect higher death risk & bad outcomes

Recent research found that people with higher baseline cortisol levels when admitted to the hospital had nearly twice the risk of death as those with a lower level of the stress hormone.8

Now, you might say that a very high cortisol level simply reflected the severity of the person’s infection at the time of testing. Indeed, that was the conclusion of the study’s authors. The implication being that the worse the infection, the worse the likely outcome, and that cortisol was just sort of along for the ride as an indicator of how bad the infection was.

However, what if you already have high cortisol levels when you encounter a bacteria or a virus? Well, earlier research showed that higher cortisol levels were not related to the severity of the illness.9 This research involved healthy people who had their cortisol levels tested first and then were exposed to a common cold virus.

Some did and some did not develop a cold. You might have guessed this already, but those with higher cortisol levels had a higher risk of developing an infection. And continued or prolonged elevations in cortisol were also predictive of more days of viral shedding, i.e., more days where a person was infectious.

This casts a different light on the COVID-19 researchers’ findings, where, “a doubling of cortisol concentration was associated with a significant 42-percent increase in the hazard of mortality.” This was after accounting for age, comorbidities (other health issues), and laboratory tests.

What’s more, many clinicians have noted that stress-related elevation in cortisol can suppress both innate and adaptive immune function.10 Lymphocyte (white blood cells) and cytokine activity that help the body to mount an attack on the virus in the early stages of the viral infection are inhibited.

And the severity of an infection has long been linked to elevated cortisol in a dose-response manner.11

Meaning that the higher the cortisol, the worse the infection, including in Cushing’s disease (characterized by very high levels of cortisol or hypercortisolemia).12

In the 2020 COVID-19 study, the researchers settled on 744 nmol/L of cortisol in blood as a useful marker. Those patients with cortisol levels lower than 744 nmol/L had a median survival of 36 days; those whose cortisol was higher survived just 15 days on average. Some patients had cortisol levels higher than 3,000 nmol/L.

Turning back to long haulers, what the research on cortisol strongly suggests is that we’re not only more likely to get sick if we’re stressed, whether acutely or chronically, we’re more likely to have a bad outcome if stress and elevated cortisol persist. There’s also another element to consider in all this: viral damage to the autonomic nervous system and a condition called POTS. We’ll discuss this in our next article.


  1. 1. Matthew T Maurano, Sitharam Ramaswami, Paul Zappile, Dacia Dimartino, Ludovic Boytard, André M. Ribeiro-dos-Santos, Nicholas A. Vulpescu, Gael Westby, Guomiao Shen, Xiaojun Feng, Megan S. Hogan, Manon Ragonnet-Cronin, Lily Geidelberg, Christian Marier, Peter Meyn, Yutong Zhang, John A. Cadley, Raquel Ordoñez, Raven Luther, Emily Huang, Emily Guzman, Carolina Arguelles-Grande, Kimon V. Argyropoulos, Margaret Black, Antonio Serrano, Melissa E. Call, Min Jae Kim, Brendan Belovarac, Tatyana Gindin, Andrew Lytle, Jared Pinnell, Theodore Vougiouklakis, John Chen, Lawrence H. Lin, Amy Rapkiewicz, Vanessa Raabe, Marie I. Samanovic, George Jour, Iman Osman, Maria Aguero-Rosenfeld, Mark J. Mulligan, Erik M. Volz, Paolo Cotzia, Matija Snuderl, Adriana Heguy. Sequencing identifies multiple early introductions of SARS-CoV-2 to the New York City Region. Genome Research, 2020; gr.266676.120 DOI: 10.1101/gr.266676.120.
  2. 2. M.Al-natsheh. 13P – The impact of cortisol on immune cells and its effect on cancer-immune cells co-culture in a 3D spheroid of ovarian cancer. Annals of Oncology
    Volume 30, Supplement 5, October 2019, Page v4.
  3. 3. Hormone Health Network. “Cortisol | Hormone Health Network.” Hormone.org, Endocrine Society, 10 November 2020.
  4. 4. Carrion VG, Weems CF, Richert K, Hoffman BC, Reiss AL. Decreased prefrontal cortical volume associated with increased bedtime cortisol in traumatized youth. Biol Psychiatry. 2010;68(5):491-493. doi:10.1016/j.biopsych.2010.05.010.
  5. 5. Arnsten, A. Stress signalling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci 10, 410–422 (2009). https://doi.org/10.1038/nrn2648.
  6. 6. Almeida, D. M., Charles, S. T., Mogle, J., Drewelies, J., Aldwin, C. M., Spiro, A. III, & Gerstorf, D. (2020). Charting adult development through (historically changing) daily stress processes. American Psychologist, 75(4), 511–524. https://doi.org/10.1037/amp0000597.
  7. 7. Morshedi, M., Hashemi, R., Moazzen, S. et al. Immunomodulatory and anti-inflammatory effects of probiotics in multiple sclerosis: a systematic review. J Neuroinflammation 16, 231 (2019).
  8. 8. Tan T, Khoo B, Mills EG, et al. Association between high serum total cortisol concentrations and mortality from COVID-19. Lancet Diabetes Endocrinol. 2020;8(8):659-660. doi:10.1016/S2213-8587(20)30216-3.
  9. 9. Janicki-Deverts D, Cohen S, Turner RB, Doyle WJ. Basal salivary cortisol secretion and susceptibility to upper respiratory infection. Brain Behav Immun. 2016;53:255-261. doi:10.1016/j.bbi.2016.01.013.
  10. 10. Aucott JN. Glucocorticoids and infection. Endocrinol Metab Clin North Am. 1994 Sep;23(3):655-70. PMID: 7805661.
  11. 11. Janicki-Deverts D, Cohen S, Turner RB, Doyle WJ. Basal salivary cortisol secretion and susceptibility to upper respiratory infection. Brain Behav Immun. 2016;53:255-261. doi:10.1016/j.bbi.2016.01.013.
  12. 12. Graham BS, Tucker WS Jr. Opportunistic infections in endogenous Cushing’s syndrome. Ann Intern Med. 1984 Sep;101(3):334-8. doi: 10.7326/0003-4819-101-3-334. PMID: 6331781.


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