A Lot of What You’ve Heard About Cortisol Is Wrong

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By Sumathi Reddy

The stress hormone isn’t all bad. Here’s what to know about your cortisol levels.

If you’ve noticed people talking about managing their cortisol lately, you’re not alone.

Chatter about the stress hormone has surged. Doctors say patients are bringing it up more often, and Google searches for how to lower cortisol reached a high in April. Wellness influencers warn about having too much cortisol or too little, and some promote supplements that claim to help.

So what’s the deal with cortisol? And why are people obsessed now?

Endocrinologists say many myths abound.

Most people don’t need to be concerned about their cortisol levels or so-called “adrenal fatigue,” they say. And cortisol, which doctors typically measure with saliva, urine, or blood tests, isn’t innately bad. Cortisol levels that stay elevated for too long can be a problem, but the hormone itself is essential.

Supplements that claim to help manage cortisol levels don’t help, doctors say, and might even contain unknown, potentially harmful substances.

“Cortisol is a normal essential hormone,” says Dr. Susan Spratt, an endocrinologist at Duke University. “You cannot live without cortisol.”

What is cortisol?

Cortisol helps our bodies respond to stress. It also helps control our use of fats, proteins, and carbohydrates; suppresses inflammation; and helps regulate blood pressure and blood sugar, says Dr. Divya Yogi-Morren, medical director of the Cleveland Clinic Pituitary Center who specializes in pituitary conditions.

On a normal day, cortisol levels peak in the morning when you wake up and then decline, doctors say. They are at their lowest at bedtime and while you’re asleep.

Cortisol production begins with signaling from the brain and the pituitary gland, says Yogi-Morren. The pituitary gland—a pea-sized gland at the base of the brain—sends signals to adrenal glands, located on top of the kidneys, to produce cortisol.

If you’re exposed to stress—real or imagined, physical or physiological—your body produces more cortisol, which kicks off an important cascade of events to help deal with that stress. For example, the body will release glucose so the brain and muscles have enough fuel to manage a stressful situation.

When cortisol becomes a problem

Once the stressful situation has gone away, your cortisol levels should decline. Chronic stress can lead to chronically elevated levels of cortisol, which can result in high blood sugar, weight gain, and hypertension.

“Cortisol is a good hormone that is supposed to help us deal with short-term stress and after that, it’s supposed to go down,” says Yogi-Morren. “Cortisol stops being your friend when it doesn’t go down.”

For most people, unless you have certain medical conditions, the best way to manage elevated cortisol levels is to treat the stress: Get enough sleepexercise regularly, eat a healthy diet, and try mindfulness exercises, like yoga or meditation. Pay attention to how stressed you’re feeling.

In rare cases, people have health conditions that cause cortisol levels to be either too high or too low.

To get a diagnosis, see a doctor who might order blood, saliva, or urine tests. Don’t attempt to diagnose yourself: Symptoms of these disorders, such as fatigue or weight fluctuations, have a lot of overlap with other conditions.

People who produce too much cortisol might be diagnosed with a rare but serious disease known as Cushing’s syndrome. Weight gain, changes in fat distribution such as a round face and lump between the shoulders, and red or purplish stretch marks, are symptoms.

Cushing syndrome happens when the body has too much of the hormone cortisol for a long time. This can result from the body making too much cortisol, or from taking medicines called glucocorticoids, which affect the body the same way as cortisol.

Too much cortisol can cause some of the main symptoms of Cushing syndrome — a fatty hump between the shoulders, a rounded face, and pink or purple stretch marks on the skin. Cushing syndrome also can cause high blood pressure or bone loss. Sometimes, it can cause type 2 diabetes.

Treatments for Cushing syndrome can lower the body’s cortisol levels and improve symptoms. The sooner treatment starts, the better the chances for recovery.

Also rare is a condition called adrenal insufficiency, when people produce too little cortisol.

Addison’s disease is a rare autoimmune disease that causes adrenal insufficiency. Other causes can include pituitary tumors or certain medications, such as opiates and steroids. Symptoms of adrenal insufficiency include weight loss, fatigue, abdominal pain, nausea, and dizziness from low blood pressure.

The lowdown on ‘adrenal fatigue’

One term that has made its way into wellness conversations is adrenal fatigue. That’s the idea that the adrenal gland goes into overdrive, producing so much cortisol when people are super stressed that it gets depleted and stops producing it.

Dr. Scott Isaacs, an Atlanta-based endocrinologist and president-elect of the American Association of Clinical Endocrinology, says “adrenal fatigue” isn’t a real diagnosis. Underscoring that point was the title of a 2016 review study: “Adrenal fatigue does not exist: a systematic review.”

“For the average healthy person who is not overweight and doesn’t have signs of [Cushing’s] it’s really pointless to check your cortisol level,” says Spratt. “Cortisol levels fluctuate, the last thing you want to do is accidentally get diagnosed for Cushing’s when you don’t have it.”

Managing your cortisol levels

Doctors advise against trying supplements that claim to manage cortisol levels because they can have ingredients that aren’t listed on the label.

A 2018 study in the journal Mayo Clinic Proceedings analyzed 12 supplements marketed for adrenal fatigue or support and found most contained at least one steroid hormone and all contained a small amount of thyroid hormone.

Dr. Sasan Mirfakhraee, an associate professor and endocrinologist at the University of Texas Southwestern Medical Center at Dallas, says at least once or twice a month someone will end up in the hospital because they are taking a cortisol supplement with a potent steroid—dexamethasone—which can cause the body to halt production of cortisol.