Stress is a health concerns that affects both physical and mental well-being. The World Health Organization’s (WHO) 2019 data estimates that 12 billion working days were lost globally due to depression and anxiety, a cost of U.S. $1 trillion annually.
Both globally and in India, psychological stressors are significant contributors to the disease burden. High levels of stress and lack of treatment for mental health issues, such as anxiety and depression, are major public health concerns, with significant barriers including social stigma and a lack of resources. Chronic, prolonged stress is also a contributor to elevated Hypothalamic-Pituitary-Adrenal (HPA) axis activity — the body’s main stress response system and cortisol production, which links stress to non-communicable diseases (NCDs) such as cardiovascular disease (CVD), stroke, and diabetes.
And at the centre of this discourse is cortisol often dubbed the “stress hormone.” Experts however say that this label is misleading. Cortisol is not just about stress; it is essential for survival as it influences metabolism, immunity, gut health and even cardiovascular function.
Understanding cortisol
Calling cortisol a stress-causing hormone is a misnomer, says K. S. Thalavai Sundar Ram, surgical endocrinologist, VS Hospitals, Chennai. “It helps the body stay agile in fight-or-flight situations, regulates metabolism, blood pressure, and has anti-inflammatory effects — provided levels remain within a normal physiological range.”
Priyanka Vignesh, associate consultant, endocrinology, MGM Healthcare, Chennai says that cortisol’s strong anti-inflammatory action makes it a therapeutic mainstay in autoimmune and inflammatory diseases. “Corticosteroids regulate glucose and fat metabolism, suppress immunity, and modulate inflammatory responses”
Abhay Ahluwalia, senior consultant, endocrinology and diabetology, Narayana Hospital, Gurugram explains how long-term imbalance can be damaging. “Excess cortisol may cause Cushing’s syndrome leading to high blood pressure, weight gain, mood swings, and loss of skin elasticity,” he says. Conversely, a deficiency may trigger Addison’s disease, with symptoms including low blood pressure, skin darkening, and poor appetite.
Dr. Vignesh also highlights cardiovascular risks, “Chronic glucocorticoid (any of a group of corticosteroids like hydrocortisone which are involved in the metabolism of carbohydrates, proteins and fats and have anti-inflammatory activity) exposure can cause uncontrolled diabetes, hypertension, dyslipidemia, obesity and increases the risk of myocardial infarction and stroke.” She also points to mental health consequences, including depression, psychosis and sleep disturbances.
Lifestyle disruptions
Modern routines can have a significant impact on cortisol levels. Cortisol follows a circadian rhythm, peaking in the early morning and dipping at night. Disrupted sleep cycles, night shifts and constant digital engagement alter this rhythm. “Staying up late at night and chronic stress can cause excess cortisol secretion, leading to Cushing’s-like (symptoms that resemble those of Cushing’s syndrome ) features,” notes Dr. Sundar Ram, recommending fixed sleep schedules.
Dr. Vignesh says that constant digital exposure dysregulates the cortisol axis, fuelling obesity, diabetes and memory issues, “Night-shift workers, airline pilots and soldiers face chronic stress due to disturbed circadian rhythms, making them more prone to metabolic and cardiovascular diseases.”
Gut and immunity
The hormone’s influence extends to digestion and immunity as well. “Excess or deficient cortisol affects the immune system, triggering irritable bowel-like symptoms and worsening inflammation,” says Dr. Sundar Ram.
According to Dr. Vignesh, cortisol is deliberately used to suppress immunity in conditions such as rheumatoid arthritis, lupus, asthma, dermatitis, and transplant medicine. But long-term exposure may cause ulcers and, in rare cases, pancreatitis.
Dr. Ahluwalia points to an altered gut microbiome as another consequence, linking high cortisol levels to intestinal inflammation, flatulence and conditions such as Crohn’s disease and ulcerative colitis.
Stress management
Early detection of altered levels of cortisol is key. “Morning blood tests, late-night salivary cortisol and 24-hour urinary cortisol estimation are commonly used,” explains Dr. Sundar Ram.
Dr. Vignesh notes that fasting morning cortisol levels (6–8 a.m.) remain the primary test, with suppression and stimulation tests helping to identify abnormalities. Dr. Ahluwalia adds that advanced methods, including electronic sensors and AI-based analysis, now allow 24-hour ambulatory cortisol monitoring, particularly useful for high-stress professions.
Experts emphasise the need to shed misconceptions. “It is incorrect to think cortisol causes stress, it is vital for survival,” stresses Dr. Sundar Ram .
Experts also point out that misuse or chronic exposure can weaken bones, causing osteoporosis, fractures, cataracts, glaucoma and recurrent infections. Dr. Ahluwalia notes growing evidence linking even non-pathological high cortisol levels to metabolic, cardiovascular and psychiatric illnesses, making stress management essential in modern life.
Published – August 26, 2025 04:41 pm IST