Cortisol, the new toll to pay

While the chatter online may only be about the puffy face it causes, the stress hormone impacts lives deeply, but more importantly, silently

Click once in your feed on any social media feed out of curiosity, and soon your timeline is flooded by somatic workouts to punch down cortisol levels, target that stubborn cortisol belly and that cortisol puffy face.

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Stress today is an uninvited guest, who not only refuses to leave, but brings along a host of biological malfunctions. While we’ve known for a while what chaos dysregulated hormones can wreck, cortisol has been singled out lately, maybe because it hits where it hurts the most—the face and the belly. And will not budge, and may even accelerate, with vigorous exercise.

Doctors have known stress-induced hormonal changes to be prevalent since the early 2000s, but cortisol has been making headlines lately. On TikTok, #puffycortisolface has been trending for almost a fortnight. “Cortisol, a stress hormone, is produced by the adrenal glands that sit right above the kidneys. It plays a crucial role in regulating metabolism, blood pressure, and immune responses. Unlike adrenaline, which acts quickly and subsides just as fast, cortisol lingers in the body. When stress becomes chronic, this prolonged elevation can lead to serious health problems,” explains Dr OP Tiwari, a general physician with over 30 years of experience spanning hospitals in Delhi, Mumbai, and Lucknow.

Janvi Chitalia, Dr Umran Sayed, Dr OP Tiwari and Dr Dhrupti Dedhiya, gynaecologist

The fitness industry has also pivoted to punch down cortisol with targeted routines, usually under the bundle of somatic exercises. Fitness trainer and digital content creator Sahil Rasheed agrees that “conversation around cortisol has recently gained traction. In fact, many professionals in the fitness industry are still catching up with the latest insights. Often, it’s only after consulting a doctor or a nutritionist that they become fully aware of the impact cortisol can have on health.”

Health issues associated with elevated cortisol are varied. Common problems include weight gain, particularly around the abdomen, high blood pressure, and disrupted sleep patterns. “It can also lead to irritable bowel syndrome, increased anxiety, and mood swings,” says Dr Tiwari. “While cortisol cannot directly kill you, it can weaken your immune system, making you more susceptible to illness and negatively impacting mental health.”

Santacruz-based integrative gut microbiome health coach and functional medicine nutritionist Janvi Chitalia notes that high cortisol has become the new normal for many. “Normally, cortisol levels should be in the range of 8 and 19, but in cases of burnout, they can backflip to as low as 1 and 2. This drastic shift leaves individuals feeling drained, even after a full night’s sleep, and can contribute to muscle pain and chronic fatigue,” she says.

Ishmeet Kaur, a Ludhiana resident, believes that awareness about cortisol imbalance is growing partly because it affects one’s appearance; (right) Nikhil maintains a rigorous workout routine, but the long-term effects of high cortisol have significantly impacted his overall health. Though not always visible, managing cortisol levels remains a persistent challenge for him. Pic/Anurag Ahire

Chronic stress nudges adrenal fatigue—a condition in which the adrenal glands are overworked and unable to function optimally. The overproduction of cortisol by the adrenal glands can push up Cushing syndrome, says Chitalia. A fatty hump between the shoulders, rounded face, and pink or purple stretch marks are indicators.

For women, the implications of elevated cortisol are particularly significant. “Cortisol can disrupt the balance of reproductive hormones such as oestrogen and progesterone, leading to irregular menstrual cycles, fertility issues, and exacerbating conditions such as PCOS. Many women don’t realise that their stress levels could directly impact reproductive health,” adds Dr Dhrupti Dedhiya, a gynaecologist.

It’s the weight gain, despite a healthy lifestyle, that sounds the alarm. “Cortisol triggers the body to store fat as a survival mechanism,” Dr Dedhiya explains. It’s crucial for women approaching menopause to manage cortisol as hormonal shifts during this time can be intensified by high levels of it, leading to severe hot flashes, sleep disturbances, and mood swings. Chitalia expands on this saying, “In women, cortisol impacts hormonal balance causing complications such as thyroid dysfunction, insulin resistance, and constant cravings for sugar and carbs as the body tries to fuel itself under stress.”

The threat posed by cortisol has led to the development of specific methods to isolate and read its levels. “Various methods have entered India in recent years to assess cortisol levels,” says Chitalia. “These include the Organic Acid Test (which measures organic acids in the urine), salivary cortisol tests, and DUTCH (Dried Urine Test for Comprehensive Hormones) test, which provide detailed insights into how the body is coping with stress throughout the day.” When cortisol levels drop suddenly, it can cause severe fatigue and brain fog. This ping-ponging with stress levels is most harmful.

Some of these tests track the pattern of cortisol release, giving a detailed picture of how levels fluctuate over 24 hours. As in the case of Shraddha Dodmani, whose cortisol levels could be measured by just regular blood tests, these latest testing methods offer a thorough understanding of cortisol levels for more effective hormone management strategies. The retail professional who works at a jewellery firm in Andheri, was diagnosed with chronic anxiety in 2022. Shortly after, routine blood tests revealed that her cortisol level was high.

It was physical strain and not just mental stress that spiked Ludhiana-based Ishmeet Kaur’s cortisol levels. We exercise for the adrenalin rush, but it’s over-working of precisely this gland that produces excess cortisol. When Kaur’s weight didn’t budge despite a month of muscle training at the gym, her doctor confirmed that her nervous system was in a fight-or-flight mode due to high cortisol and adrenaline.

“Despite being active and maintaining a rigorous workout routine, I noticed that my body shape wasn’t changing; the stubborn belly fat just wouldn’t go away,” says Andheri resident and food writer Nikhil Merchant. After consulting multiple doctors and trying various medications, he found no answers until his nutritionist pointed out that his high-stress lifestyle of sitting at a desk for long hours, eating outside food, and then rigorous exercise was likely the cause. “Dealing with cortisol is tricky because it doesn’t just go away even after intense workouts; it keeps coming back, creating a cycle of chronic stress and inflammation.”

Canada-based Umran Sayed, a licensed clinical exercise physiologist explains this: “People often focus on unsustainable methods to lose belly fat, like intense workouts. While working out five days a week may seem effective initially, the frequency often drops over time. It’s more sustainable to find a physical activity you enjoy and can do daily to help keep belly fat in check.”

Levelling rising levels requires months of effort and a holistic approach. “Reversing the effects of high cortisol can take up to six months,” says Chitalia. “[It takes] Focusing on gut health, sleep, and overall nutrition. Cutting down on starches and sugar is crucial, but incorporating complex carbohydrates such as millets, brown and red rice, and good fats can help stabilise blood sugar levels and calm the gut. Magnesium-rich foods like bananas are key in regulating the nervous system, which in turn, gets the adrenaline gland humming harmoniously.”

Merchant has since shifted focus to managing stress better. “Breathing exercises, switching from intense workouts to cool-down phases, and a diet tailored by my nutritionist have made a significant difference. I adopted a no gluten, no dairy diet, along with a whole range of grains and millets like bajra, nachni, jowar in various forms along with cooked vegetables. Within a week, I felt lighter and more in control,” he says.

“Diet plays a significant role,” says Kaur. “The polluted air we breathe and the fertilisers used to grow our food contribute to cortisol spikes, putting the body under constant stress.” She took a more holistic approach: “I don’t take any specific medications, but practise Yin Yoga, Vipassana, and somatic exercises. Many people underestimate the power of simply breathing and relaxing—it really can make a huge difference to rising cortisol levels.” Dodmani follows a different, yet similar routine. “Exercise, practising meditation, and making sure I get enough sleep have been key strategies in keeping my cortisol levels in check,” she says.

It’s common for cortisol-related issues to be misdiagnosed, or symptoms to be misinterpreted. “My symptoms were visible but general enough to be mistaken for other problems,” says Kaur. If you’re constantly anxious, always hungry, struggling with sleep, or if your digestion is off, it could be a sign of elevated cortisol levels.” Merchant never had a puffy face. “Which is why I didn’t immediately suspect high cortisol levels,” he says. Dodmani faced similar challenges. “Symptoms can be subtle—feeling constantly tired, say—and often go unnoticed until they start to impact daily life. I gained around 5-8 kgs when my cortisol was at its peak,” she says.

Kaur believes that awareness about cortisol imbalance is growing partly because it affects one’s appearance. “We need to spread awareness and encourage people to slow their lives down not just for appearance, but to cultivate positive energy and vibes around us,” she says, “which is only possible when we’re truly relaxed. Looks are just one aspect of the issue. In the pre-smartphone era, life was slower. Now, with the constant pressure to be updated, things have only become worse, and most people with elevated cortisol levels don’t even realise it.”

“For city slickers like us, work is perhaps the main source of stress,” Dodmani observes. “Even when we’re not working, we worry about work—whether it’s landing a job or managing it. It’s easy to say ‘your life, your body,’ but our ambitions, and responsibilities toward our loved ones put us under stress, one way or another.”

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