Cortisol, widely known as the “stress hormone,” is currently a major topic of discussion online.
Wellness influencers frequently highlight several symptoms they attribute to chronically high cortisol, including waking up at 3 a.m., a bloated “cortisol face,” and increased abdominal fat. They often propose specific diets and exercise routines as remedies.
However, medical professionals largely dismiss the idea that supplements or advice from influencers are necessary to control cortisol, saying it is highly unlikely.
They warn against quickly labeling the hormone as a villain. However, if doubts arise, the advice is to consult a qualified professional.
This is what you should know.
Cortisol keeps you alive and disorders are relatively rare
Cortisol is a hormone and you need it to survive. It comes from the adrenal glands, located above the kidneys, and is one of the many hormones that intervene in times of stress. It can influence inflammation, the immune system, metabolism, blood pressure, and many other bodily functions.
Cortisol is incredibly in tune with your body and your environment. It fluctuates throughout the day, increasing in the morning when you wake up and decreasing at night before you go to sleep. It also increases when you're sick or during other times of stress, doctors say.
“Our cortisol level regulates minute by minute,” said Dr. Roberto Salvatori, an endocrinologist at Johns Hopkins University. “It's very sensitive.”
It is rare for people to have a disorder in which cortisol alone is the cause. If a person's cortisol level is chronically low, doctors would diagnose adrenal insufficiency. This includes an autoimmune condition called Addison's disease, in which the immune system attacks the adrenal gland.
People with Cushing's syndrome have too high cortisol levels. Among its causes are tumors, which are usually benign, in the adrenal or pituitary glands. It is treated with medication, surgery, or both.
Talk to your doctor before ordering a cortisol test
Symptoms of high or low cortisol vary widely and can overlap with signs of other health problems.
Adrenal insufficiency can manifest as fatigue, unintentional weight loss, low blood pressure, and loss of appetite. Cushing's syndrome is accompanied by weight gain, high blood pressure, brittle bones, weight gain around the face and abdomen, abnormal hair growth in women, sleeping problems, and more.
Diagnoses require time, multiple tests and an understanding of the patient's overall health, doctors said. Cortisol can be measured through the patient's saliva, blood, or urine.
“There are a lot of nuances in interpreting cortisol and that's what makes me a little nervous about patients doing cortisol tests on their own without having some kind of medical supervision,” said Dr. Katie Guttenberg, an endocrinologist at UTHealth Houston.
A one-time cortisol blood test won't provide useful information for most people, he said, and could lead to stress and unnecessary medical follow-ups. For example, women taking birth control will have falsely high blood cortisol results, due to how the medication acts in the body.
Be wary of supplements that claim to reduce cortisol
Endocrinologists say there are no proven over-the-counter treatments for high or low cortisol, despite claims that supplements like ashwagandha and magnesium are helpful in “reducing cortisol.”
Beyond Cushing syndrome, chronically high cortisol is a concern, said Dr. James Findling, an endocrinologist at the Medical College of Wisconsin, but more research is needed on treatments.
He worries that people take unregulated supplements when it's not always clear what they contain.
“They are not harmless,” Findling warned.
Even in patients who have Cushing's syndrome, medications must be carefully dosed, Salvatori said, because overcorrection could lower cortisol levels too much and cause other health problems.
Managing Stress Is Good for You, Regardless of Cortisol
Salvatori notes that there is a condition called “pseudo Cushing's syndrome,” which is usually milder but causes some of the same physical effects even though the patient does not have a tumor. It can be caused by alcoholism and other chronic problems.
It is usually treated by addressing the underlying cause, doctors said, such as getting the patient to stop drinking.
Endocrinologists are learning new potential benefits for treating high cortisol, said Findling, who studies the condition. For example, it could help diabetics who take multiple medications better control their blood sugar.
Doctors also recognized that stress is highly subjective and that patients with Cushing's syndrome can go undetected and undiagnosed.
But his advice to the vast majority of people is: talk to a doctor if you're worried.
For healthy people, instead of focusing on an elusive hormone, doctors recommended going back to the basics of stress management: eating well, getting enough sleep, moving your body or going to therapy.
“There's nothing new in all of this,” Findling said.
