QUESTION: I've been hearing a lot about high cortisol lately. Is this a fad or a true diagnosis?
ANSWER: High cortisol isn't a health concern for most people, despite claims you may have seen online. Wellness influencers blame cortisol for a host of ailments, including bloating, fatigue, irritability and overly "puffy" faces and waists.
But these claims stem from a vast oversimplification -- and at times misrepresentation -- of how our bodies work. In fact, the moniker "stress hormone" for cortisol is a bit misleading.
Cortisol is a hormone released in response to stress. It helps manage the body's reaction, which is often anti-inflammatory. Cortisol doesn't cause the stress, and the effects of chronic stress are regulated by many other molecules and hormones beyond cortisol.
Cortisol also serves many vital roles throughout our regular day. For example, it releases glucose into your bloodstream when you need extra energy, and it helps wake you up in the morning.
So let's not shoot the messenger -- especially one that isn't even delivering the package you think it is.
The real impact of stress and cortisol
When we talk about cortisol, stress is usually the underlying concern.
Decades of research have established that chronic stress, our body's reaction to emotional and physical challenges, impacts our health: It can raise the risk of cardiovascular disease by up to 1.6 fold. Stressful events in childhood, in particular, seem to have an outsize impact on adult disease risk.
But it's important to know that most convincing scientific studies measured stress using surveys, such as about work stress, abuse or social isolation. They didn't measure random cortisol levels, such as in the blood or saliva, where the evidence is far more mixed. Though there are a few situations when they're helpful, cortisol levels aren't considered a gold standard measurement of chronic stress.
In studies looking at cortisol levels and well-being, researchers haven't found a direct link. Also, there's a vast range of levels that would be considered normal, depending on your circadian rhythm, medications you may be taking, the presence of other illnesses and even routine activities like exercise.
Can cortisol make your face puffy?
On social media, some users claim you can "detox" your body from elevated cortisol and reduce puffiness in your face. These claims are often accompanied by striking "before" and "after" photos of the person's face. They call it "cortisol face."
But "cortisol face" isn't a real thing -- at least as it's being commonly described on social media by otherwise healthy people.
Like many pseudo-wellness fads, though, this one began with a grain of truth. Very high levels of steroid hormones in the body can result in Cushing's syndrome. This can happen when the adrenal glands produce too much cortisol or when someone takes high doses of steroids for a medical reason, such as for an autoimmune disease or cancer. Signs of Cushing's syndrome include, among other things, a markedly rounder face.
Last year, comedian Amy Schumer said she had Cushing's syndrome after many people commented on a change in her facial appearance while on "The Tonight Show Starring Jimmy Fallon." (She reported having received steroid injections.)
If you're concerned about Cushing's syndrome, it's important to discuss with a physician. But in most cases where you're not taking high-dose steroid medications, that's unlikely to be the answer: Cushing's disease is rare, affecting roughly 40 to 70 people out of every million.
But then ... what's up with those convincing before-and-after "cortisol face" photos?
The most straightforward explanation is overall weight changes (not to mention that we live in an age of effortless image manipulation). Also keep in mind: Some of the supplements touting a cortisol-lowering benefit include sleep aids, which may also account for some reported improvements in swollen eyes, attention spans and daytime irritability.
What I want my patients to know
If you're drawn to the promise of supplements that can fix "high cortisol," ask yourself, what is it that you're really worried about? Do you feel stressed or exhausted all the time? Is there something about your physical appearance you think has changed? Looking past the smokescreen of cortisol can help you -- and your physician -- explore the science-backed causes of your symptoms and get you the help you need.