In a society that sometimes seems obsessed with finding ways to biohack wellbeing [1], you've probably come across the cortisol conversation before. The hormone is often referenced on social media as something that needs to be "regulated" or balanced — and it's blamed for things like irregular sleep [2], bloating, and breakouts. But it's hard to parse out fact from fiction in today's health and wellness landscape.
In some cases, content creators — some qualified, many not — have recommended certain supplements, lifestyle changes, and nutritional choices in order to regulate cortisol and operate at optimal health. But balancing cortisol levels is a bit more complex than just a few changes to the way you eat and live. There are also certain conditions associated with high and low levels of cortisol that require specific treatment.
So before you try and regulate your cortisol levels, here's a break down of everything you need to know about the so-called "stress hormone" — including whether balancing your cortisol is necessary, or even possible.
Experts Featured in This Article:
Mary Gover [3], MD, AAHIVS, is an internist at Montefiore Einstein Advanced Care.
Akua Ampadu [4], MD, is a board-certified internal medicine physician, blogger at DrAkuaMD.com, and advocate for holistic wellness.
What Is Cortisol, Exactly?
"Cortisol is one of several hormones produced by our adrenal glands, small glands found on top of either kidney," explains Akua Ampadu, MD [5], board-certified internal medicine physician and advisory board member for PS's Condition Center [6]. "It is one of the hormones responsible for body functions like blood pressure and temperature regulation, inflammation and weight management."
The reason cortisol is often referred to as the stress hormone is because most people are familiar with it in the context of getting the body ready for fight or flight, says Mary Gover, MD, AAHIVS, internist at Montefiore Einstein Advanced Care. "It's job is to get the body ready for action," she says. "It increases our blood pressure and releases glucose into our blood stream for fuel."
How Does the Body Work to Regulate Cortisol?
"The body has a very elegant system to regulate hormones, including cortisol," Dr. Gover says. Cortisol is released both on a natural rhythm (it's highest in the morning and decreases throughout the day) and in response to stimuli perceived by the brain as stressful.
In terms of how the hormone is actually released, Dr. Gover breaks it down: "The brain releases a hormone called ACTH, which acts on the adrenal gland and tells it to release cortisol," she says. "When the brain senses that there is enough cortisol in the blood, it stops releasing ACTH. It's a feedback loop."
What Causes High Cortisol Levels?
Increased cortisol levels can be caused by an increase in stress. "If your brain perceives stress frequently or continuously and is unable to manage that stress, then your body will release cortisol more frequently," Dr. Gover explains.
That said, wellness influencers can often blame symptoms of stress on "high cortisol," and the relationship isn't so straightforward. After all, stress and anxiety can cause issues like poor sleep [7], muscle tightness, and irritability — but whether those symptoms are all directly caused by high levels of cortisol is hard to say.
However, there are certain medical conditions associated with abnormally high levels of cortisol, particularly Cushing's Syndrome [8]. The rare condition is often caused by a tumor in the pituitary gland, which helps regulate the production of cortisol by the adrenals, or long-term use of glucocorticoid medication. It's typically marked by a redistribution of weight in the face, abdomen and upper back, in addition to blood sugar elevation [9], blood pressure elevation, skin markings (that look like stretch marks), and bone weakness, Dr. Gover explains.
What Are Symptoms of High Cortisol?
Again, it's hard to nail down what stress-related cortisol elevations might look like (since any stress symptom could theoretically be related to high cortisol). But here are some of the most common symptoms of clinically high cortisol levels, which are typically associated with Cushing's syndrome, according to Dr. Ampadu:
- Easy skin bruising
- Increased fat especially on the face and midsection
- Pink or purple striae/stretchmarks
- High blood pressure
- Bone loss
- Menstrual irregularities
- Mood changes
What Causes Low Cortisol Levels?
Extremely low cortisol levels are typically associated with Addison's disease, a condition that occurs when the adrenals don't produce enough of the hormone. It's characterized by symptoms such as lethargy, low appetite and low blood pressure, Dr. Ampadu explains.
If you have an underactive pituitary gland or a pituitary tumor, it can also limit ACTH production, per the Cleveland Clinic [10]: "ACTH signals your adrenal glands to make cortisol, so limited ACTH results in limited cortisol production."
What Are Symptoms of Low Cortisol?
Low cortisol levels related to Addison's disease are typically associated with the following symptoms, per Dr. Ampadu:
- Muscle weakness
- Abdominal pain
- Chronic fatigue
- Dizziness or feeling faint
- Low blood pressure
- Low blood sugar
- Mood swings
- Changes in skin color (noticeable darkening or bronzing of the skin)
Is It Important to Balance Your Cortisol Levels?
Persistently elevated cortisol can lead to negative long-term health consequences on your blood pressure [11], immune system, cardiovascular health, and weight, per Dr. Gover. So "balancing your cortisol levels" — and more precisely, managing your stress levels — can be important.
"But balancing cortisol isn't done with medications or supplements or novel therapeutics," Dr. Gover says. It is done by regulating your sleep, nutrition, and emotional stress. Physical activity can help as well. Below are some of Dr. Gover's specific recommendations:
- Sleep: Restful and restorative sleep is critical in balancing cortisol. Dr. Gover suggests seven to eight hours of sleep per night. "If you're awakening in the night or getting disturbance in your sleep, you may be releasing cortisol at times when it should not be released," she says. There are many reasons why sleep can be disturbed and she breaks them down into three buckets: external factors like street noise or work schedule; physical ailments like restless leg [12] or sleep apnea [13]; and internal factors like stress, anxiety. Another common impediment to sleep is alcohol use. Assessing these buckets to see where you're falling short on Zzz's can be crucial in helping to balance your cortisol.
- Physical activity: It's a wonderful stress reliever, for both for your body and your mind, Dr. Gover say. "It is a great use of the energy cortisol gives your body. It can also act as a mini-break in your day and can create space to clear your mind."
- Emotional stress relief: For this, Dr. Gover recommends mindfulness-based activities, particularly meditation, being in nature, breathwork [14], and journaling. "The way that these activities can help with stress is that they train the mind/brain to recognize stress and to recognize the body's reaction to stress," she says.
- Nutrition: The picture with nutrition isn't as clear. "Cortisol can lead to conditions like IBS [15] due to the brain-gut connection and may affect the gut microbiome. Plant-based diets [16] have a very positive impact on the gut microbiome. So, this could counteract the effects of cortisol, theoretically," she says.
When to See a Doctor About Cortisol
Because there is not a pill or specific treatment "for cortisol," Dr. Gover doesn't recommend seeing your doctor about cortisol. She does however recommend seeing your PCP if you're experiencing high levels of stress that are impacting you emotionally (anxiety, worry) or physically (poor sleep, poor diet, lack of physical activity, unexpected weight changes). Your healthcare provider will be able to advise you on certain lifestyle changes or in the case of Addison's or Cushing's, specific treatment options.
Alexis Jones [17] is the senior health and fitness editor at PS. Her passions and areas of expertise include women's health and fitness, mental health, racial and ethnic disparities in healthcare, and chronic conditions. Prior to joining PS, she was the senior editor at Health magazine. Her other bylines can be found at Women's Health, Prevention, Marie Claire, and more.