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Is Cortisol Good or Bad?

We associate cortisol with stress, but that doesn’t mean it’s a bad hormone. In fact, we need it.

With Yasmin Akhunji MD

Cortisol keeps us alert in case we are threatened or there is a harmful change in our environment.

You may have noticed that cortisol is a bit of a buzzword, especially as more and more people are trying to understand its role in stress and the potential health problems that come along with it. It’s often seen as a “bad” hormone, one that you want none of — but that’s not entirely fair. Cortisol can both serve and hurt us. Here’s why:

Dr. Yasmin Akhunji, MD, an endocrinologist with Paloma Health, explains, “Cortisol is classically thought of as a stress hormone. When you feel fear or danger (or are sick), a section of your brain called the hypothalamus activates your fight or flight response. This calls on your pituitary gland to release a hormone called ACTH and subsequently the adrenal glands to release it.”

Cortisol serves many purposes

The all-mighty hormone serves a core purpose — one that Dr. Akhunji alludes to. Evolutionarily, it keeps us wide-eyed and alert in case we are threatened or if there is a harmful change in our environment. External stressors (or internal worries) trigger both adrenaline and cortisol release, which is part of what we call “fight or flight mode.”

Without this mode, we’d be slow to respond to threats. When cortisol is being used, all other systems functions — like digestion — sort of take a snooze, enabling our bodies to focus on the problem at hand.

More than its role in our fight or flight mode, cortisol is a power player, and that’s because many of our cells have a receptor for it. Cortisol:

  • helps our brains make memories
  • helps us wake up and feel alert
  • helps manage our inflammation levels
  • supports our metabolism
  • helps manage our salt and water retention levels
  • helps modulate our blood sugar levels
  • in pregnant women, it is crucial to fetal development.

Too much cortisol is the problem

Cortisol, as we can see, is more than a ‘stress’ hormone. The trouble occurs when we’re not in active fight-or-flight mode and cortisol production is still rampant. This constant cortisol release can happen when we’re always working too hard, dealing with toxic or challenging life situations, or feeling generally overwhelmed with the many facets of modern life. It’s especially rampant if we have no way of managing our stress.

“We know that chronic stress and elevated cortisol levels can increase one’s risk for depression, can make it increasingly difficult to lose weight, and can also perhaps lower life expectancy,” Dr. Akhunji says.

As cortisol is controlled by the hypothalamus, the adrenals, and the pituitary gland, doctors and wellness practitioners often refer to something called the “HPA axis.” When we continually respond to a threat (such as a taxing job or an ongoing family crisis), our brain presses on the cortisol gas pedal — and doesn’t stop.

Chronic high cortisol can lead to:

  • weight gain in the belly, back, and face
  • acne and skin issues
  • headaches
  • brain fog or concentration issues
  • high blood pressure
  • extreme fatigue that sleep can’t lessen
  • bruising easily
  • weak muscles
  • mood changes

When our bodies make too much cortisol, we are at risk for Cushing’s syndrome. It mostly affects adults, and more women than men. It can be caused by type 2 diabetes, the use of a group of medications called glucocorticoids (our endogenous, or internally made cortisol is already a glucocorticoid), a disorder of the adrenal glands, or certain kinds of tumors. Cushing’s syndrome is usually characterized by quick weight gain in the belly, face, or chest, a round face, high blood pressure, muscle weakness, mood issues, or the development of bruises.

There is a flipside to the story: When our bodies make too little cortisol, we may be at risk of Addison’s disease. This occurs when the pituitary or adrenal glands malfunction. Symptoms include weight loss, darkened skin, dizziness, and fatigue.

Living during COVID-19 triggers cortisol release

“The Coronavirus epidemic is causing increased stress and anxiety, especially now that it feels like we have constant chaos around us,” Dr. Akhunji says. “Reactions to the crisis can range from difficulty sleeping to impaired concentration, fear of contact with others, going into public spaces, and traveling on public transport, just to name a few.”

In fact, Dr. Akhunji says, people have been reporting symptoms like tachycardia (rapid heart pace) and gastrointestinal distress — all of which can stem from heightened cortisol levels.

The way each of us respond to stress is unique

In a normal situation, the body’s parasympathetic nervous system would hit the brakes. Unfortunately, each person’s HPA axis activity is different, and how your HPA axis responds to stress depends on several variables, such as early life environments, current stressors, and genetic predispositions, according to a study in Dialogues in Clinical Neuroscience.

Make managing your stress levels a personal goal

If you have symptoms of cortisol overload and have a tumor or are taking certain medications (such as prednisone or cortisone), it’s wise to speak to your doctor right away. But if you’re one of the millions of Americans experiencing chronic stress, adopting a stress-reduction routine is also key.

There’s a reason why doctors and wellness practitioners talk so much about stress relief. There are many signs of stress, all of which can affect the quality of your life, your job, your relationships, and your health, including:

  • nightmares
  • recurrent thoughts
  • feeling overwhelmed and oversaturated
  • having crying fits
  • feeling irritable and argumentative
  • experiencing panic attacks
  • dealing with skin problems and mysterious rashes

Get your cortisol under control by engaging in a regular sleep cycle, journaling, or speaking to a therapist about other ways to get a handle on stress. There’s no shame in asking for help.

Dr. Akhunji recommends three simple lifestyle choices for reducing cortisol:

Regular physical activity

 “A little bit of cardio goes a long way,” Dr. Akhunji says. “Just 20 to 30 minutes of activity most days of the week pays huge bonuses by lowering cortisol every day, and in the long run, adding to our peace of mind.”

Mindfulness and meditation

Any type of meditation will reduce anxiety and lower cortisol levels. Simply taking a few deep breaths sends a signal within your nervous system to slow heart rate, lower blood pressure, and decrease cortisol,” Dr. Akhunji says. Trying setting aside 10 to 15 minutes to practice mindfulness or meditation each day. You can do this anytime and anywhere — it doesn’t need to be in a fancy setting or in your bathtub. If noises distract you, it’s okay. Just breathe and continue focusing on your breath. Each slow breath signals “calm” to your body.


“I find it helpful to visualize my goals every day to manage stress and keep a positive state of mind,” offers Dr. Akhunji. “Define your daily and long-term goals. Write them down and sign it like a contract that you’re making with yourself. Following through with set goals is a great way to feel in control in an otherwise chaotic world.”

In the end, choose to commit to your own stress reduction. Take more breaks, engage in deep breathing throughout the day, and remove yourself from stressful situations whenever possible.

Turn to exercise and movement for a break from the daily stressors you face, and know that with each exercise or meditation session, you’re chipping away at those high cortisol levels — and carving a path toward better health.

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Stress, COVID-19, and Your Endocrine Health