A First Responders Guide to Cortisol

The stress of being a first responder can elevate your cortisol levels. But, there are ways to control and minimize the negative effects.

Summarized and written by Rhonda Cohen MFF, EMT, RD, LDN, CSN


It’s 0700 hours, your shift has begun. Perhaps you are pouring a cup of coffee, or sitting around the kitchen table setting the shift’s intentions for the day. Before long, the first call is dispatched.  The sound of the tones elicits a common response.  Your heart rate and breathing increase, your muscles tense, and perhaps your stomach feels tight.  These symptoms are related to the fight or flight stress hormone, cortisol.

Cortisol is a steroid hormone that is made naturally in your body.  It is secreted by the adrenal glands located on top of the kidneys.  When we perceive a threat or stressor, our bodies react within seconds to allow us to handle the situation or escape to safety.  Although cortisol is best known as a stress hormone, it participates in blood pressure regulation, glucose metabolism, immune function, nutrient metabolism, mental alertness, and provides increased energy.

When cortisol is released during the Fight or Flight response, the body responds by increasing glucose availability to the brain, heart, and large muscles (critical organs in the stress response).

Cortisol secretion varies among individuals. One person may secrete higher levels of cortisol than another, although responding to the same call.

Cortisol is naturally released in higher amounts in the morning and declines throughout the day.  For people who work night shifts, this pattern can reverse. First responders who experience abnormal sleep patterns in the course of a shift can secrete cortisol throughout the day and at night.

While small increases of cortisol have beneficial effects, too much cortisol in the bloodstream can cause a variety of health problems: high blood sugar, anxiety, depression, fatigue, gastrointestinal upset such as constipation, bloating, or diarrhea, increased abdominal fat, diabetes, headache, heart disease, high blood pressure, lowered immunity, decreased inflammatory response, irritability, memory and concentration problems, sleep difficulties, weight gain, and slow recovery from exercise.  Due to the fact that First Responders are subject to increased cortisol release, it is important to be aware of these negative symptoms.

Fortunately, there are effective lifestyle habits to help lower and manage cortisol levels.

  • Get quality sleep: While you don’t have control over your sleep schedule during your shift, it is imperative to practice good sleep habits when off duty. Keep a consistent sleep schedule by going to bed, and waking up at the same time each day.  This consistent practice will help your mind and body know when it is time to be active, and when it is time to rest.  Avoid caffeine at least 6-8 hours before going to bed.  Avoid eating at least 3 hours before going to bed to limit indigestion.  Sleep in a quiet, dark room. Turn off the lights, television, laptop, and phone before going to sleep. If you feel energized after exercise, establish a pattern to include exercise earlier in the day.


  • Exercise: Regular, moderate exercise promotes overall mental and physical health, producing endorphins (feel-good chemicals) which may suppress cortisol. However, high-intensity, endurance exercise can lead to increased circulating cortisol levels.  To achieve balance with your exercise, make sure you have a plan.  Recovery workouts like yoga and stretching should be combined with cardiovascular and functional strength training.  FRF has a great option for you to try for FREE.  Click here to discover how to create a functional and balanced workout for first responders (FREE). 


  • Recognize stressors: Identifying stressful thoughts and actions helps you to manage them, versus becoming a victim of them.  Stress management techniques include meditation, yoga, journaling, open communication, guided imagery, and deep-controlled breathing exercises. Experiment with box breathing (inhale deeply for four seconds, hold that breath for four seconds, exhale for four seconds).  Repeat this technique as many times as you feel necessary.  You can practice this breathing exercise anywhere, and at any time, it really helps!

  • Laugh: Laughing releases endorphins, suppresses cortisol, improves mood, boosts immunity, reduces stress, and lowers blood pressure.

  • Live your best life: Form and maintain lasting, and meaningful relationships. Find hobbies and shared interests you can do with others.  Adopt a pet.  Perform acts of kindness. Always have something to look forward to whether it be a vacation, an outing, a meal, etc.

  • Eat a nutritious diet: Consume foods to support a healthy gut.  In general, choose foods containing high biological protein (lean meat, fish, poultry, eggs).  Choose foods high in dietary fiber (oatmeal, fruits, vegetables, brown or wild rice, whole wheat/grain bread and pasta, barley, beans, legumes, quinoa, popcorn, buckwheat). Choose low-fat dairy products (skim or 1% milk, cheese, yogurt).  Choose healthy fats (salmon, nuts and nut butters, seeds, olive oil, avocados, dark chocolate).  Limit/avoid trans and saturated fats (commercial-processed baked goods, butter, margarine, fried foods, fatty meats such as ribs, sausage, bacon, whole milk, some cheese and ice cream, etc.).  Limit/avoid simple carbohydrates (cake, cookies, pie, brownies, candy, soda, white bread/rice/potatoes/pasta, some juices).

Get the FRF Five Steps to Better Nutrition Guide for FREE (CLICK HERE)


As First Responders we focus our attention on the citizens of the communities we serve, often neglecting our own health and wellbeing.  By effectively managing the physical and psychological effects of cortisol, we can continue to do the work we love while leading our own healthy, productive lives.

About Rhonda:
Rhonda Cohen has served 30 plus years as a Firefighter and EMT with the Wheaton Volunteer Rescue Squad in Montgomery County, MD. She encourages and inspires First Responders to perform optimally by providing individualized nutrition, fitness, and wellness education and training.  She is a graduate of the University of Maryland, where she earned a BS in Nutrition and Dietetics. She went on to become a Registered Dietitian, Licensed Dietitian Nutritionist, and Certified Sports Nutritionist.

We are excited to have Rhonda join the FRF Nation.  You can reach out to her with any questions (Click here).


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