Is cortisol to blame for illness?
Maybe you can’t sleep. Or you sleep too much. Maybe you keep breaking out, or getting sick. Perhaps your stomach bloats, your skin sags, you feel shaky. Maybe you can’t focus, eat or get rid of the tension in your spine.
If you’ve scrolled through TikTok lately, you might be inclined to blame one or all of these things on your cortisol levels. Over the past year or so, users have flooded the app with stories about how their supposed cortisol imbalances have led to a range of health concerns.
Cortisol, sometimes known as the stress hormone, is a chemical that helps regulate the way human bodies react to stress. “It’s a hormone that connects the mind and the body together,” said Martin Picard, an associate professor of behavioral medicine at Columbia University.
Nearly every organ has a receptor that responds to cortisol. It is crucial in helping us function throughout the day, whether by regulating blood pressure or combating inflammation.
That doesn’t necessarily mean that cortisol imbalances are responsible for the various ailments that people are sharing on TikTok, said Nia Fogelman, an associate research scientist at the Yale Stress Center. “I think it’s completely natural and understandable why people want to A, figure out what’s going on with their bodies, and B, to want some one thing that we can fix,” she said. But it’s not that simple.
When people experience stress, the pea-size pituitary gland in the brain — sometimes called the master gland — signals to the adrenal glands perched atop the kidneys, prompting them to secrete and deliver cortisol into the bloodstream.
REAL OR IMAGINED
Our bodies release the chemical when we are faced with a challenge, whether psychological or physical, real or imagined, said Jeanette M. Bennett, a health psychologist who studies the effects of stress on health at the University of North Carolina, Charlotte. We release cortisol when we encounter a tangible threat, such as coming across a bear on a hike, but also when we receive an ominous work email. The more threatening we perceive an event to be, the more cortisol we typically produce.
“The mind and the body will respond as if we were in danger of dying, when actually what’s happening is that our sense of self is being threatened,” Picard said.
This is a gift from evolution: Cortisol helps mobilize the energy we need to confront, or flee from, danger, partly by raising the amount of glucose in the blood. It also regulates metabolism. Levels fluctuate throughout the day, rising when we first wake up and falling as we drift off to sleep, said Dr. Gregory Fricchione, associate chief of psychiatry at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School.
“Cortisol is your friend,” Fricchione said, “until there’s too much of it.”
We function best when we have the right balance of cortisol. “Our bodies are this harmonic unit,” Fogelman said. But chronic stress can elevate baseline cortisol levels over time, leading to a cascade of consequences.
CORTISOL AND SLEEP
Persistently high cortisol levels can weaken the immune system, Fricchione said, as well as raise blood sugar levels and blood pressure. There’s also an integral link between cortisol and sleep: people need the hormone level to decrease so they can fully rest. People with high cortisol often struggle to fall and stay asleep, Fricchione said.
Some mental health conditions, including depression and post-traumatic stress disorder, are associated with cortisol imbalances, said Dr. Raza Sagarwala, a resident physician in the department of psychiatry at Vanderbilt University Medical Center who has studied the effects of non-pharmacological treatments on cortisol levels.
Without testing cortisol levels and consulting a physician, it’s almost impossible to determine whether something like acne or poor sleep is definitively linked to hormone imbalances — and cortisol could just be a convenient culprit that people can point to when they don’t have any other clear explanations for their health concerns.
“When people say they have elevated cortisol — I would tell you, you cannot feel that,” Bennett said.
But if people are truly worried about their cortisol levels, experts said, they can talk to their primary care doctors about getting tested.
SELF-TESTS CAN MISLEAD
You can use blood or saliva to test your cortisol levels at a particular moment, but a onetime snapshot isn’t likely to be useful, Picard said, because cortisol levels change throughout the day. Urine or hair samples can reveal cortisol levels over a longer period of time, although hair samples are primarily used in research settings.
Some companies offer athome cortisol tests, which typically involve finger pricks or saliva swabs. But experts instead recommend talking to a primary care doctor, who can refer you to an endocrinologist.
One reason for the caution is that physicians try to obtain a comprehensive picture of how cortisol levels ebb and flow before determining whether there may be any problems, said Dr. Mihail Zilbermint, an associate professor of clinical medicine specializing in endocrinology at Johns Hopkins Medicine. “It’s not hard to test cortisol levels, but it’s not easy to interpret,” he added.
STRESS REDUCTION
Some small studies have suggested that yoga and mindfulness interventions such as meditation could help lower cortisol levels, Sagarwala said.
Exercise can also be helpful for regulating cortisol, Bennett said, especially moderate physical activity such as jogging or cycling. Those movements prompt the body to mirror your stress response, raising heart rate and then lowering it once you stop working out. That cycle effectively trains the body to activate and shut down its stress response appropriately.
People should identify stress reduction methods that work best for them, Fogelman said. A few minutes of box breathing, for example, might soothe one person but not another. Once you find a strategy for alleviating stress, your cortisol levels can become more stable, she added; this is true even for people who have been exposed to longterm stress.
“Stress is not a bad word,” Fricchione said. “Just being a living organism means that there’s going to be stress.”