Cortisol: What it is and When to Worry

What Is Cortisol?

Popularly known as the "stress hormone," cortisol is a steroid hormone manufactured in the adrenal glands.

"Our bodies need these hormones," said Nabeeha Siddiqui, MD, a family medicine doctor at Cedars-Sinai. "Cortisol is responsible for maintaining constant blood pressure and blood glucose levels, regulating immune function and anti-inflammatory mechanisms, and dictating our fight-or-flight response."

Cortisol levels naturally fluctuate throughout the day. Stress does cause a rise in cortisol production, but the increase is typically temporary and doesn't necessarily indicate a larger health problem, Malkani said.

"Just because a person's cortisol level spikes at a given moment in time, which is a normal response to life stress, does not mean they will have high cortisol forever," she said. "In fact, having too much-or too little-cortisol is actually quite rare."

Read: Dealing with Stress: Know the Hidden Symptoms

Natasha P. Malkani, MD

More Serious Signs

How can a patient tell if they have abnormally high or low cortisol levels? A doctor can check cortisol levels with a blood test, but this is usually only necessary when a person has very specific symptoms.

For instance, adrenal insufficiency-a rare disorder-can cause low cortisol, but it is generally accompanied by other symptoms, such as sudden and unexplained weight loss, fatigue, nausea, vomiting, low blood sugar, and lightheadedness.

Similarly, Cushing's syndrome, which is even more uncommon, is characterized by high cortisol but also presents with bruising on the stomach, high blood pressure that is difficult to control, increased fat distribution on the collarbone and the back of the neck, and weak arm muscles.

"These symptoms tend to be pretty dramatic, and if patients are experiencing them, they should have their doctor test their cortisol levels to assist with diagnosis," Malkani said. "Otherwise, I would urge them not to be overly concerned about cortisol. Feeling stressed about the stress hormone will only lead to more stress-and higher cortisol!"

Read: After Decades of Research, New Clinical Trial for Cushing's Disease

Tips for Tranquility

Most often, high cortisol is simply correlated to the stressors people encounter during the course of an ordinary day. Lowering cortisol levels is usually just a matter of developing constructive stress-management techniques.

"When I see a patient who is concerned about cortisol and stress, I want to know what their lifestyle is like. We discuss implementing regular exercise, a balanced diet and good sleep hygiene, along with seeking help, if needed, to manage their mental health, which is also very important in stress control," Siddiqui said. "Getting yourself into a good rhythm with those things can dramatically lower stress and is an essential component of effective preventive care."

Many websites and holistic practitioners tout the benefits of natural remedies for cortisol reduction (such as coconut water, apple cider vinegar and rhodiola), but Siddiqui pointed out these remedies are not backed by evidence.

"People should stick with the science," she said. "What the data suggests is that when stress goes up, cortisol does, too. So, the most direct and impactful way to get those levels down is to make sure we're taking care of ourselves."

Nabeeha H. Siddiqui, MD

A Proactive Approach

The bottom line when thinking about cortisol: Prioritize healthy lifestyle choices and don't skip routine checkups with your primary care doctor.

"Having good coping skills is critical to keeping stress low," Malkani said. "Rather than worrying about cortisol, people should focus on building stress-reduction strategies. Also, they should check in with their doctors regularly to ensure they are staying on top of emerging health concerns. Working together, we can manage stress and cortisol to help patients stay healthy over the long term."