Laboratory values

Name: Escherichia coli
Significance: Leading germ, marker for gut ecology.
Interpretation: 1.0 × 10⁷ CFU/g — upper limit of normal (Ref. 10⁶–10⁷). 4) Additional diagnostics: In case of symptoms: Dysbiosis profile over time, check diet/prebiotics.

Name: Klebsiella spp.
Meaning: Potential pathobiont/opportunist.
Interpretation: 1.0 × 10⁷ CFU/g — significantly elevated (ref. <10⁴). Indication of dysbiosis/overgrowth. 4) Additional diagnostics: Follow-up monitoring, antibiotic history, if clinically relevant, further pathogen diagnostics/antibiogram.

Name: Enterococcus spp.
Meaning: Commensal lactic acid bacteria.
Interpretation: <1.0×10⁴ CFU/g — significantly reduced (Ref. 10⁶–10⁷). 4) Additional diagnostics: Consider diet (fiber), pro-/synbiotic strategy; monitor course.

Names: Proteus, Pseudomonas, Enterobacter, Serratia, Hafnia spp.
Meaning: Opportunists.
Interpretation: all low/<detection limit — within the target range.

Additional diagnostics: monitoring of disease progression, antibiotic history, possibly extended germ diagnostics/antibiogram if clinically relevant.

Name: Bifidobacterium spp.

Importance: Key microbiota (fermenters, SCFA).
Interpretation: (Ref. 10⁹–10¹¹).

Additional diagnostics: Prebiotic dietary fiber (inulin/fructans depending on tolerance), monitoring of progress.

Name: Bacteroides spp.

Meaning: Dominant anaerobes, protein/fat breakdown.
Interpretation: Normal range (10⁹–10¹¹), rather in the lower third of the normal range.

Additional diagnostics: Check fiber quality; monitor progress.

Name: Lactobacillus spp.

Importance: Lactic acid producer, pH stabilization.
Interpretation: (Ref. 10⁵–10⁷).

Additional diagnostics: Testing fermented foods/targeted probiotics; monitoring progress.

Name: Clostridium spp. (total)

Meaning: Heterogeneous group.
Interpretation: <1.0×10⁵ CFU/g — within the target range (Ref. <10⁵). 4) Additional diagnostics: None, if asymptomatic.

• Candida spp. – collective term for various Candida species
• Candida albicans – the most common pathogenic Candida species
• mold – e.g. B. Aspergillus, Penicillium, Mucor
• Geotrichum – a type of yeast, sometimes pathogenic in immunocompromised individuals.

Meaning

• These are opportunistic pathogens, meaning they usually only cause infections when the immune system is weakened or the barrier function is impaired.
• Candida albicans: typically causes mucosal infections (mouth, genitals, intestines)
• Geotrichum: rare, but possible in cases of immunodeficiency
• Mold fungi: inhalant → lungs, systemic → dangerous in immunocompromised individuals

interpretation

• Negative/below threshold = unremarkable, no indication of current pathogenic mycoses
• Normal colonization is possible, especially with yeasts in the gut4) Additional diagnostics (in case of suspected relevant fungal load or immunodeficiency)
  If clinical relevance is suspected (e.g., recurrent infections, chronic complaints, unclear symptoms), the following should be considered.

Diagnostic steps that are useful:

A) Check immune status

• Differentiated blood count analysis
• Leukocytes, lymphocyte subgroups (CD4/CD8), neutrophils, monocytes
• Immunoglobulins (IgA, IgG, IgM, IgE)
• Cytokine status (e.g. IL-6, TNF-α)

Indication of inflammatory activity or dysregulation

• T-cell function tests (in cases of unclear immunodeficiency)
  B) Gut microbiome & mucosal barrier (in case of Candida finding in stool)
• Microbiome analysis (stool)
• Composition, diversity, yeast load, short-chain fatty acids
• Zonulin (stool/serum)
• Marker for intestinal permeability (“Leaky Gut”)
• sIgA (secretory IgA in stool)
• Immune defense in the mucous membrane
  C) Specific fungal diagnostics (in case of clinical suspicion)
• Fungal PCR or culture (depending on location – stool, vaginal swab, sputum, etc.)
• (1,3)-β-D-glucan in serum
• Markers for systemic fungal infections (especially in the case of mold)
• Aspergillus antigen (galactomannan)

When is additional diagnostic testing particularly useful in cases of suspected invasive aspergillosis?

• Recurrent infections (especially Candida)
• Chronic fatigue, "brain fog", skin problems, digestive issues
• History of antibiotic use → disrupted microbiome
• Autoimmune diseases
• Immunosuppressive therapies (cortisone, chemotherapy)
• Diabetes mellitus

Designation
pH value in stool → measures whether the intestinal contents are more acidic or alkaline.

Meaning

• The pH reflects the microbiological fermentation behavior:
• Acidic pH (5.5–6.5) → sign of healthy carbohydrate fermentation by lactic acid bacteria and bifidobacteria (e.g., formation of short-chain fatty acids such as butyrate, acetate).
• Alkaline pH (>7.0) → indicates increased protein degradation processes (proteolysis) and a shift towards putrefactive flora.

interpretation

• Your value: 7.3 → slightly alkaline, above the reference range (5.8–6.5).
• Possible causes:
• Low fiber intake → fewer plant fibers for the "good" gut bacteria.
• High protein content (e.g., meat, shakes) → promotes putrefactive bacteria (Clostridia, Bacteroides).
• Reduced carbohydrate fermentation → less lactic acid production → pH increases.
• Antibiotic therapy or dysbiotic flora following stress/illness.

Designation
Visual assessment of consistency (firm, soft, mushy, liquid) and color (brown, light brown, dark, grey, green, black, yellow).

Meaning
These characteristics provide clues about:

• Digestive performance (fat utilization, bile acid flow)
• Transport time in the intestine
• Diet
• Possible pathologies (malabsorption, cholestasis, bleeding, etc.)
  

interpretation

• Mushy, light brown → mostly nonspecific, often functional or nutritional in nature.
• Light brown: normal to slightly faster intestinal transit, less bile influence.
• Loose stool: may indicate a higher water content in the stool (e.g., due to a high-fiber or high-fat diet, mild maldigestion, or stress).
  

A single finding without symptoms → not pathological.

In case of chronic loose stools, check for causes such as food intolerances (lactose, fructose, FODMAPs), bile acid loss, pancreatic insufficiency or irritable bowel syndrome.

Quantitative fat in stool

Label: Quantitative fat in stool

Significance: Provides information about fat digestion and absorption in the intestine. → Especially important for detecting disorders of fat absorption (e.g., due to intestinal diseases) or pancreatic insufficiency (pancreatic insufficiency).

Interpretation:

(Reference: < 3.5 g/100 g) → This means: There is slightly more fat in the stool than normal, i.e., minimal fat maldigestion or malabsorption. → This is called subtle steatorrhea (mild fatty stools, often without visible fat deposits).

Possible causes:

• Slightly reduced pancreatic elastase (pancreas produces too few digestive enzymes)
• Too high a diet or certain types of fat (e.g., MCT- or Omega-3-rich foods) • rapid intestinal transit (e.g., in cases of irritable bowel syndrome, infections)
• Bile acid deficiency or loss (in cases of gallbladder problems)

Additional diagnostics: → Food diary (check fat quantity/type) → Monitoring during the course of treatment → If symptoms persist: pancreatic elastase in stool or 72-hour fat balance for more precise quantification.

Quantitative sugar in stool

Label: Quantitative sugar in stool

Meaning: Does not measure "table sugar", but rather unabsorbed carbohydrates (especially disaccharides or monosaccharides). → Indication of carbohydrate malabsorption (e.g., lactose, fructose, or sorbitol intolerance).

Interpretation: (Ref.: < 2.5 g/100 g) → More sugar residues remain in the stool than usual. → These are fermented by bacteria in the large intestine, which can lead to gas, bloating, diarrhea, or abdominal pain.

Possible causes:

• Lactose intolerance (milk sugar is not completely broken down)
• Fructose malabsorption
• too high a proportion of fermentable carbohydrates (FODMAPs)
• Rapid intestinal transit or small intestinal bacterial overgrowth (SIBO)

Additional diagnostic tests: → H₂ breath tests (for lactose, fructose, sorbitol) → possibly FODMAP dietary analysis → possibly stool flora analysis for chronic conditions

Quantitative nitrogen and water

Name: Quantitative nitrogen, water

Meaning:

• Nitrogen: Measure of protein breakdown products in stool → shows whether protein is poorly digested or not absorbed (e.g. in cases of inflammation, maldigestion).
• Water: Provides information about the water content of the stool → relevant in cases of diarrhea or constipation.

Interpretation:

• Nitrogen: 0.50 g/100 g – normal (< 1.0)
• Water: 80 g/100 g – normal (75–85)→

This means: Protein digestion is normal, no signs of malabsorption or inflammation. → The stool water content is also physiological, i.e., neither diarrhea nor excessively dry stool.

Additional diagnostic testing: → None required, as the results were unremarkable.

Overall rating:
Slightly elevated fat and sugar residues indicate mild digestive weakness — possibly due to:

short-term dietary factors (e.g., high-fat, low-fiber, or high-FODMAP meals),

• functional disorders (irritable bowel syndrome with rapid passage),
• or incipient enzyme deficiencies (e.g., pancreas, lactase).
  If you have symptoms such as bloating, fatty stools, diarrhea or a feeling of fullness, targeted further diagnostic testing would be advisable.

Pancreatic elastase

Meaning:
Pancreatic elastase is an enzyme produced exclusively by the exocrine pancreas and excreted in the stool. It serves as a marker for exocrine pancreatic function, i.e., the pancreas's ability to provide digestive enzymes.

Interpretation:
(>200 µg/g)
→ The value is within the normal range and indicates normal exocrine pancreatic function.

• >200 µg/g: normal function
• 100–200 µg/g: mild to moderate insufficiency
• <100 µg/g: severe exocrine pancreatic insufficiency
  

Comment:
A normal value practically rules out relevant pancreatic insufficiency as a cause of maldigestion.

Additional diagnostics:
The examination should only be repeated or supplemented (e.g., by imaging procedures such as sonography or MRCP) if there is clinical suspicion or for monitoring purposes (e.g., newly occurring fatty stools, weight loss, chronic diarrhea).

Bile acids (stool)

Meaning:
The determination of bile acids in stool is used to assess bile acid malabsorption syndrome or impaired bile acid reabsorption in the terminal ileum.
Bile acids are important for fat digestion; impaired reabsorption can lead to chronic diarrhea and fatty stools.

Interpretation:
(<70 µmol/l)
→ The value is within the normal range and argues against bile acid loss or malabsorption.

Comment:
A normal stool bile acid level largely rules out bile acid malabsorption, especially if there is no clinically evident chronic diarrhea or fat malabsorption.

Additional diagnostics:
In cases of persistent chronic diarrhea and continued clinical suspicion, a functional study may be considered as an additional measure.

Diagnostic procedures are performed:

• SeHCAT test (nuclear medicine, measures bile acid reabsorption)
• Serum C4 determination (marker for bile acid synthesis in the liver) Overall assessment:
  Both parameters (pancreatic elastase and bile acids in stool) are within the normal range.
  → No evidence of maldigestion or malabsorption due to pancreatic insufficiency or bile acid loss.
  
  However, if clinical symptoms such as bloating, diarrhea, or weight loss persist, further investigations should be carried out to rule out other causes, e.g.:
• Small intestinal bacterial overgrowth (SIBO breath test)
• Celiac disease (serology: transglutaminase Ab, IgA)
• Lactose / fructose intolerance
• Microscopic colitis

Tests for calprotectin and alpha-1-antitrypsin in stool are used to assess inflammation and barrier function of the intestinal mucosa.

• Calprotectin indicates whether there is inflammatory activity in the intestine (e.g., in Crohn's disease, ulcerative colitis, infections).
• Alpha-1 antitrypsin checks whether protein is lost through the intestinal mucosa or whether the intestinal barrier is damaged.

Calprotectin (stool)

Significance: Calprotectin is a protein found predominantly in neutrophils. It serves as a sensitive marker for inflammatory processes in the intestinal mucosa. Elevated levels indicate activation of the immune system in the gastrointestinal tract, as can occur in chronic inflammatory bowel diseases (e.g., Crohn's disease, ulcerative colitis) or infectious enteritis.

Result / Interpretation: normal (< 50 mg/l). The measured value is within the normal range. Therefore, there is no indication of relevant inflammatory activity of the intestinal mucosa at the time of the examination.

Additional diagnostics / recommendation: In the case of persistent gastrointestinal symptoms (e.g. diarrhea, abdominal pain, weight loss), follow-up monitoring may be useful in order to detect changes in the inflammatory process at an early stage.

In case of clinical suspicion of inflammatory bowel disease, further diagnostic testing may be necessary (e.g. colonoscopy, CRP determination).

Alpha-1 antitrypsin (stool)

Significance: Alpha-1-antitrypsin is a protein found in serum that is hardly excreted into stool when the intestinal mucosa is intact. It serves as a marker for impaired intestinal barrier function or for protein loss via the intestine (enteral protein-losing syndromes).

Result / Interpretation: (< 27.5 mg/dl). The value is within the normal range. There is no indication of increased intestinal permeability or relevant enteral protein loss.

Additional diagnostics / recommendation:

In case of persistent symptoms or suspected malabsorption syndrome, follow-up monitoring or additional diagnostic tests (e.g. stool elastase, pancreatic function tests, H2 breath tests) may be considered.

Name: sIgA (secretory immunoglobulin A)

Meaning:
Secretory IgA is the most important antibody of the mucosal immune defense. It is produced by plasma cells in the lamina propria and secreted into the intestinal lumen via epithelial cells.

sIgA binds to antigens, microorganisms, and toxins, thereby preventing their adhesion to the mucosa ("immune exclusion"). It thus serves as a key marker of mucosal immunocompetence.

Interpretation:
Value: (Reference: 510–2040 µg/ml).
→ Indication of an intact secretory immune defense of the intestinal mucosa.

Additional diagnostics:
Follow-up monitoring is only necessary in the presence of clinical symptoms (e.g., recurrent infections, chronic inflammatory bowel diseases, food intolerances). If values ​​remain persistently low or significantly elevated, further immunological or microbiological testing should be performed.

Zonulin (chair)

Meaning:
Zonulin is a physiological regulator of tight junctions in the intestinal epithelium. It controls the permeability of the epithelial barrier.

Elevated zonulin levels are interpreted as an indication of increased intestinal permeability (“leaky gut syndrome”) and can occur in various inflammatory, autoimmune or metabolic diseases.

Interpretation:
Value: (Reference: < 55 ng/ml).
→ There is no evidence of impaired barrier function of the intestinal mucosa.

Additional diagnostics:
In cases of persistent clinical symptoms (e.g., bloating, diarrhea, food intolerances, chronic inflammation), a supplementary assessment of other barrier or inflammatory markers (e.g., alpha-1-antitrypsin, calprotectin, serum lipopolysaccharide-binding protein) may be useful.

Histamine is a biogenic amine that acts as a messenger substance in the body – including in the immune system, the nervous system and the gastrointestinal tract.

It is produced both by the body itself (e.g. in mast cells) and by certain bacteria in the intestine.

Meaning:
An elevated histamine level in the stool may indicate histamine exposure or microbial dysbiosis (imbalance of the intestinal flora).

• Some intestinal bacteria (e.g. Morganella, Proteus, Klebsiella, Enterobacter) produce histamine.
• Stress, intestinal inflammation, increased permeability of the intestinal wall (leaky gut) or an unbalanced diet can increase local histamine production.
• Furthermore, a deficiency of histamine-degrading enzymes (e.g., diamine oxidase – DAO) can worsen the situation.

Interpretation:
Normal value: < 200 ng/ml → low/normal

• A value below this limit does not indicate a relevant histamine load.
• Values ​​above 200 ng/ml may indicate increased activity of histamine-producing intestinal bacteria or a reduced degradation capacity.
  In some laboratories, an increase up to about 950 ng/ml is described as mild to moderate exposure, while values ​​above this are considered significantly elevated.
  

However, the exact assessment depends on the laboratory results and the clinical symptoms.

Additional diagnostics:
An isolated measurement in the stool is usually not sufficient for diagnosis.
Useful additional examinations (only in the case of corresponding symptoms such as headache, skin redness, digestive problems, fatigue, etc.) include:

• DAO activity in the blood (serum): → Reduced values ​​indicate a limited ability to break down histamine from food.
• Histamine in plasma or urine: → Provides indications of systemic (whole-body) histamine levels.
• Gut flora analysis (microbiome): → Can show whether histamine-producing bacteria are overrepresented.
• Dietary history: → Histamine-rich foods (e.g., red wine, cheese, sausage, canned fish, tomatoes, spinach) and food reactions (IGG test) often lead to symptoms.
• Stress diagnostics : → Chronic stress can activate mast cells and increase histamine release.

Faecalibacterium prausnitzii

Name: Faecalibacterium prausnitzii

Meaning:

• One of the most important butyrate producers in the human intestine.
• Butyrate (butyric acid) is a short-chain fatty acid that serves as the main energy source for intestinal epithelial cells (colonocytes).
• It has an anti-inflammatory effect by inhibiting NF-κB signaling pathways and promoting regulatory T cells.
• A high proportion is associated with an intact intestinal mucosa, lower susceptibility to inflammation and better metabolic balance.
  

Interpretation:

• Reference range: > 5.0 × 10¹⁰ CFU/g
• Rating: Very good – above the reference value. → Indication of stable butyrate production and a favorable microbial environment.
  

Additional diagnostics / recommendations:

• Maintain dietary fiber diversity: Different plant fibers promote microbial diversity.
• Particularly beneficial: resistant starch (e.g., cooled potatoes/rice), inulin, pectins, oat β-glucans.
• Continue to monitor chronic inflammation (e.g., IBD, irritable bowel syndrome with a tendency to inflammation) over time.
• A decline is possible with antibiotic therapy – consider preventive nutrition or probiotic support if necessary.

Akkermansia muciniphila

Name: Akkermansia muciniphila
Meaning:

• A key representative of mucin layer-associated bacteria.
• It breaks down mucin (a component of the intestinal mucosa) in a controlled manner and simultaneously stimulates mucus production – important for mucosal integrity and barrier function.
• It has beneficial effects on metabolism, body weight, blood sugar regulation and inflammation balance.
• Reduced concentrations are associated with obesity, type 2 diabetes, fatty liver disease and chronic inflammatory bowel diseases.
  

Interpretation:

• Reference range: > 1.5 × 10¹⁰ CFU/g
• Assessment: Slightly reduced – indication of possible impairment of the mucosal barrier or reduced mucin layer activity.
  

Additional diagnostics / recommendations:

Polyphenol-rich foods: e.g., berries, green tea, pomegranate, grapes, red cabbage.

Prebiotics: Inulin, fructooligosaccharides (FOS), resistant starch promote Akkermansia.

Periods of fasting or moderate calorie reduction can promote population growth.

Avoid excessive sugar, saturated fats and alcohol, as these can inhibit Akkermansia.

Follow-up examinations are recommended after approximately 3–6 months, especially in case of clinical symptoms (e.g. mucosal irritation, bloating, signs of dysbiosis).

Summary of the microbiological situation:

• Butyrate production: very well developed → anti-inflammatory, protective environment.
• Mucin layer stability: slightly impaired → starting point for nutritional and lifestyle-related optimization.

Meaning / Description
Cortisol is the body's most important glucocorticoid (stress hormone) and is produced in the adrenal cortex (zona fasciculata).
It is regulated via the hypothalamic-pituitary-adrenal (HPA) axis:

• The hypothalamus releases CRH (corticotropin-releasing hormone).
• This stimulates the pituitary gland to release ACTH (adrenocorticotropic hormone).
• ACTH then stimulates the adrenal cortex to produce cortisol.

Cortisol exhibits a distinct daily rhythm (“circadian rhythm”):

• The level is highest in the morning (shortly after waking up) to activate the body.
• It slowly drops around midday.
• The value is lowest in the evening/at night, so that the body can rest.

Saliva measurement is particularly informative because it only measures the free, biologically active cortisol – that is, the amount that actually acts in the tissue (as opposed to total cortisol in serum, which is also bound to transport proteins).

An elevated cortisol level means that the body is under stress or strain – either acute (short-term) or chronic (long-term).
Cortisol is released in stressful situations to provide energy and make the body “ready to fight”.

Possible causes:

• Psychological or physical stress
• Lack of sleep or irregular sleep
• Overload, chronic stress, anxiety
• Inflammation, infections, pain
• Overactive adrenal glands (e.g., Cushing's syndrome)
• Certain medications (e.g., cortisone preparations)
  

Effects of a persistently high cortisol level:

• Elevated blood sugar and cravings (especially for sweets)
• Weight gain (especially around the abdomen)
• Elevated blood pressure
• Sleep disturbances and restlessness
• Concentration problems, irritability, mood swings
• Weakened immune system (susceptibility to infection)
• Muscle loss, thinner skin, slowed wound healing
• Menstrual irregularities in women, loss of libido
  In the short term, an elevated cortisol level is normal and even vital, e.g. in the morning when waking up or during acute exertion.
  

However, persistently high levels are unhealthy and lead to exhaustion and regulatory disorders.

When cortisol is too low:
A low cortisol level means that the body is producing too little of the stress hormone or that the adrenal glands are exhausted or underactive.
This can occur after prolonged periods of stress, when the adrenal glands are "burned out" and can no longer provide enough cortisol.

Possible causes:

• Chronic stress over a long period → “Adrenal fatigue”
• Adrenal insufficiency (Addison's disease) • Pituitary gland disorder (too little ACTH)
• Prolonged cortisone therapy (suppression of endogenous production)
• Hypoglycemia or very restrictive diets
• Lack of sleep or persistent exhaustion
  Effects of low cortisol levels:
• Severe fatigue and lack of motivation
• Low blood pressure, dizziness upon standing
• Low blood sugar, trembling, weakness
• Difficulty concentrating
• Depressive mood, irritability
• Low stress tolerance ("small things quickly cause stress")
• Increased tendency towards inflammation, weak immune system
  

A cortisol level that is too low means that the body can no longer react adequately to stress – stress resistance is reduced, and those affected often feel exhausted or “empty”.

Additional diagnostic testing (to clarify the causes)

• DHEA in saliva or serum → ratio to cortisol shows balance between “stress and regeneration hormones”.
• Serum ACTH → indicates whether the control by the pituitary gland is functioning correctly.
• Cortisol awakening response (CAR test) → measures the increase within the first 30–45 minutes after waking, very sensitive for stress regulation.
• Stress hormone profile (adrenaline, noradrenaline, dopamine in 24-hour urine) → shows sympathetic activation.
• Thyroid parameters (TSH, fT3, fT4) → important, as cortisol and thyroid hormones influence each other.

Cortisol is a vital hormone with a very broad effect throughout the entire organism.

It is often referred to as the "stress hormone" because it is released in increased amounts during stressful situations to enable the body to adapt and react quickly. However, its effects extend far beyond stress.

In metabolism, cortisol ensures that the body has sufficient energy available. It increases the production of new glucose in the liver (gluconeogenesis), inhibits the effect of insulin, and thus promotes higher blood sugar levels. This is beneficial in stressful situations because the brain and muscles then receive more energy. However, if cortisol levels remain elevated over a prolonged period, this can lead to:

• Weight gain, especially in the abdominal area,
• and lead to insulin resistance.
• Cortisol has a suppressive effect on the immune system.
• It suppresses inflammation and excessive immune responses. Therefore, it is often used medically as an anti-inflammatory or immunosuppressant drug (e.g., cortisone).
• However, persistently high cortisol levels can weaken the immune system, which increases susceptibility to infection or slows wound healing.
• In the cardiovascular system, cortisol supports blood pressure regulation.
• It ensures that the blood vessels can respond appropriately to other hormones such as adrenaline.
• However, excessively high cortisol levels over a prolonged period can lead to high blood pressure .
• In the brain, cortisol increases alertness, attention, and concentration.
• In the short term, it helps to think clearly and react quickly.
• However, if the level is chronically elevated, this can lead to nervousness, irritability , sleep disorders or depressive moods.
• In muscles and bones, cortisol has a catabolic effect: it promotes the breakdown of muscle protein to produce sugar and inhibits bone formation.
• Therefore, in the long term, excessively high cortisol levels can promote muscle loss or osteoporosis .
  Cortisol also has a significant influence on mental health.
• In acute stress phases, it promotes motivation, focus and performance.
• However, prolonged stress and exhaustion can cause cortisol production to decrease – then you feel tired, lethargic and emotionally exhausted.

Cortisol levels can fluctuate significantly depending on life circumstances, stress levels, and health status. What's important is not so much a single measurement, but rather the pattern throughout the day and over a longer period.

If cortisol levels are consistently too high or too low, this can indicate various disorders of stress regulation.

Persistently elevated cortisol levels often indicate a sustained activation of the stress system. This means the body is constantly "on high alert" —even when there is no actual immediate danger. Causes can include chronic psychological or physical stress, overwork, lack of sleep, emotional strain, or inflammatory processes in the body. In such cases, the HPA axis remains overactive, and cortisol is continuously released.

In the long term, this can lead to symptoms such as inner restlessness, sleep disorders, concentration problems, weight gain (especially in the abdominal area), increased blood pressure, irritability and a weakened immune system.

Depressive moods or a so-called "burnout" state can also be associated with chronically elevated cortisol levels. In rare cases, pathologically elevated levels can also be caused by hormonal disorders, such as Cushing's syndrome (overactive adrenal cortex or an ACTH-producing tumor).

Persistently low cortisol levels, on the other hand, can indicate adrenal fatigue or a weakening of the pituitary gland's control mechanism. This often occurs after prolonged periods of stress, when the body is "burned out" and can no longer properly adjust cortisol production.

People with low cortisol levels often feel very tired, lethargic, and exhausted. They frequently suffer from low blood pressure, dizziness, difficulty concentrating, and increased sensitivity to stress. Hypoglycemia, muscle weakness, and depressive moods can also occur. Severe adrenal insufficiency is called Addison's disease – however, this is rare and requires medical treatment.

Generally speaking, a balanced cortisol rhythm – high in the morning, low in the evening – is crucial for energy, performance, good sleep, and emotional stability. Deviations from this rhythm indicate that the stress response system is out of balance. Depending on the direction (too high or too low), this can be a sign of overexertion or exhaustion and should be investigated further by a doctor, especially if symptoms persist.