Wellness influencers constantly warn about high cortisol—what do your patients really need to know?

Cortisol, what is known as the stress hormone, is the talk of the internet.Wellness influencers warn about the various symptoms of chronically high cortisol: waking up at 3 a.m., swollen “cortisol face” and accumulating belly fat. And many offer diet and exercise routines that they claim will help.But do you really need supplements and advice from influencers to control your cortisol? Doctors say it's very unlikely.Don't be so quick to label this hormone as a villain, they say. And if you suspect something is off, talk to a professional.Here's what to know.Cortisol keeps you alive and disorders are relatively rareCortisol is a hormone and you need it to survive. It comes from the adrenal glands, located above the kidneys, and is one of many hormones at play in times of stress. It can influence inflammation, the immune system, metabolism, blood pressure and many other bodily functions.Cortisol is incredibly attuned to your body and environment. It fluctuates throughout the day, rising in the morning when you wake up and falling at night before you go to sleep. It also rises when you're sick or in other times of stress, doctors say.“Our cortisol level is regulated by the minute,” said Dr. Roberto Salvatori, a Johns Hopkins University endocrinologist. “It is very sensitive.”It’s rare that people have a disorder where cortisol on its own is the cause. If a person’s cortisol level is chronically low, doctors would diagnose them with 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 cortisol levels that are too high. Among its causes are tumours, 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 testThe symptoms of either high or low cortisol are wide-ranging and can overlap with signs of other health issues.Adrenal insufficiency can manifest as fatigue, unintentional weight loss, low blood pressure and loss of appetite. Cushing's syndrome comes with weight gain, high blood pressure, brittle bones, weight gain around the face and belly, abnormal hair growth in women, sleep issues and more.Diagnoses take time, multiple tests and an understanding of a patient's overall health, doctors said. Cortisol can be measured through the patient's saliva, blood or urine.“There’s a lot of nuance to interpreting cortisol and that’s what makes me a little bit nervous about patients getting cortisol testing for themselves without having some kind of physician oversight,” said Dr. Katie Guttenberg, an endocrinologist at UTHealth Houston.A one-off cortisol blood test won't provide useful information for most people, she said, and could lead to unnecessary stress and medical follow-ups. For example, women who are on birth control will have falsely high cortisol blood results, because of how the medicine works in the body.Be cautious of supplements that claim to lower cortisolEndocrinologists 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 “lowering cortisol.”Beyond Cushing's syndrome, chronically high cortisol is a concern, said Dr. James Findling, an endocrinologist with the Medical College of Wisconsin, but more research into treatments is needed.He worries about people taking unregulated supplements when it's not always clear what's in them.“They're not innocuous,” Dr. Findling warned.Even in patients who have Cushing's syndrome, the medications have to be carefully dosed, Dr. Salvatori said, because an overcorrection could drive cortisol levels too low and cause other health issues.Managing stress is good for you, regardless of cortisolDr. Salvatori notes there is a condition called “pseudo Cushing's syndrome,” which is often milder but causes some of the same physical effects despite the patient not having a tumour. It can be caused by alcoholism and other chronic issues.It is generally treated by addressing the underlying cause, doctors said, like getting the patient to stop drinking.Endocrinologists are learning new potential benefits for treating high cortisol, said Dr. Findling, who studies the condition. For example, it could potentially help diabetics who are on multiple drugs better control their blood sugar.The doctors also acknowledged that stress is highly subjective and Cushing's syndrome patients can go unheard and undiagnosed.But their advice for the vast majority of people: Talk to a doctor if you are concerned.For healthy people, rather than focusing in on one elusive hormone, the doctors recommended going back to the basics of stress management: Eat well, get enough sleep, move your body or go to therapy.“Nothing new about any of that,” Dr. Findling said.

Wellness influencers constantly warn about high cortisol—what do your patients really need to know?

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