Ask The Expert: Is cortisol really to blame for my weight gain and fatigue?

Dr Eberta Tan is a senior consultant specialising in endocrinology at Raffles Diabetes & Endocrine Centre

Those terms you see on social media, like “cortisol face” or “cortisol belly” are not medical terms. More often than not, a person can have a rounded face and a belly due to other reasons, rather than pathologically high cortisol levels. We do not diagnose high cortisol levels solely based on how a person looks. I will test for it if the clinical suspicion is present from a patient’s symptoms, characteristic physical signs and risk factors.

What is cortisol?

The biggest misconception is that cortisol is a “bad” hormone, and that it explains why one is feeling tired, stressed, bloated or is gaining weight. Cortisol is a hormone essential for life. It is made and released by the adrenal glands, which sit on top of our kidneys, and helps our body respond to stress, regulates our blood pressure, controls how our body uses glucose for energy, handles inflammation, and controls our sleep-wake cycle.

A healthy cortisol pattern is highest around the time we wake up, falling first quickly, then gradually through the day, and is at its lowest levels around midnight. Stress causes short-term rises in cortisol that settle once the stressful situation resolves.

Cushing’s syndrome is a disorder that results from having abnormally high cortisol in the blood for a long period of time. The most common cause is long-term steroid medication use. Less often, it is caused by a tumour in the pituitary gland or adrenal gland, or an underlying cancer. Cushing’s syndrome caused by the body itself is rare, affecting roughly 10 to 15 people per million every year. It is more common in women, and occurs more often in people between the ages of 30 and 50.

When cortisol stays very high for a long time, it disrupts the brain signals that drive ovulation and the normal production of oestrogen and progesterone. As a result, periods can become irregular or stop, and fertility can be affected.

When to seek help

See a doctor if you are experiencing a cluster of new changes to your body, including weight gain around the face, upper back and tummy while arms and legs stay thin, wide purple stretch marks, thin skin, bruising without obvious trauma, muscle weakness, periods that become irregular or stop, difficult-to-control high blood pressure or blood sugar levels, or the development of high blood pressure or diabetes at a young age.

If levels of cortisol are too low, there can be serious life-threatening consequences if it is not detected and treated. Some signs include persistent and extreme fatigue, dizziness on standing, unintended weight loss, poor appetite, nausea, salt cravings and darkening skin. Severe vomiting, confusion or fainting can signal an adrenal crisis, which is a medical emergency that requires urgent care.

Habits over hacks

To support normal cortisol levels and a healthy stress response, keep consistent sleep and wake times, get morning daylight, and if having caffeine, get it earlier in the day so that it does not affect the quality of your sleep. Ensure regular, balanced and minimally processed meals, and avoid crash diets. Exercise regularly and balance intense sessions with lighter exercise, especially later in the day.

Caring for your mental well-being is also important. If I could tell every woman one thing about cortisol, it would be this: Cortisol is not your enemy. It is one of the hormones keeping you alive and well. If you feel stressed and exhausted, start by looking at your daily habits like sleep, food, movement and support. However, if you notice a pattern of new symptoms, see a doctor for medical advice, so that you can get properly tested.