Any trending health and wellness topic will find a home on TikTok, where millions of users—most without a medical degree—tell viewers how to cure any ailments. Case in point: Millions of videos address cortisol imbalances, and many are geared toward women.

The rise of #howtoreducecortisol on tiktok. ELLE.

 

 

The #cortisol content mill spans the spectrum. For starters, there are the “signs and symptoms” of cortisol imbalance videos. One such video, uploaded by The Workout Witch, says that being misdiagnosed with an autoimmune disorder or needing to urinate frequently could be a sign of high cortisol. When users reply with their own symptoms or questions, they’re then directed by the creator to a $57 “release stress and trauma” course. 

Other videos aim to help people lower their cortisol through diet and, as a result, “lose more belly fat,” “have less brain fog,” and “feel 1,000 times better.” Because of these videos, millions of TikTok users may be inaccurately diagnosing their own health issues. One study found that one in four users have self-diagnosed based on social media content.

Is self-diagnosis on social media helping or hurting people’s health?

 

 

A brief look at cortisol

 

Cortisol is referred to as the ‘stress hormone,’ which results in a reductive understanding of how it works in the body. Research published in Emotion shows that the hormone is more dynamic than it seems. An “emerging body of research highlights a complex, adaptive role of elevated cortisol,” the authors write. “Our findings suggest that cortisol may play a role in promoting positive affect.”

Cortisol also plays a role in nearly every function of the body, including immunity, stress response, and inflammatory responses. The hormone is regulated by the hypothalamus-pituitary-adrenal (HPA) axis.

Thau L, Gandhi J, Sharma S. Physiology, cortisol. In: StatPearls. StatPearls Publishing; 2023.

 

According to Kecia Gaither, MD, OB/GYN and Maternal Fetal Medicine Director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx, NY, cortisol impacts blood pressure, insulin, and sleep cycle regulation; inflammation reduction; energy production; and the body’s fight or flight reactions. 

When someone responds to either internal or external stressors, the parasympathetic nervous system (PNS) is called upon. Eventually, the hypothalamus is looped in to deal with the ‘threat’ and stimulates the HPA axis so that the adrenal cortex releases cortisol.

Thau L, Gandhi J, Sharma S. Physiology, cortisol. In: StatPearls. StatPearls Publishing; 2023.

 

 

“In periods of stress, cortisol is produced, allowing for the mobilization of energy from carbohydrates and fat to provide for instant energy,” Dr. Gaither says. 

These stressors can be acute and part of everyday life, but it’s when someone is exposed to “excessive and long-term stress” that dysregulation may occur.

Degering M, Linz R, Puhlmann LMC, Singer T, Engert V. Revisiting the stress recovery hypothesis: Differential associations of cortisol stress reactivity and recovery after acute psychosocial stress with markers of long-term stress and health. Brain Behav Immun Health. 2023;28:100598.

 

 

“Other causes of this clinical presentation include Addison’s disease, Cushing's syndrome, and autoimmune phenomena,” Dr. Gaither says. Cushing’s syndrome can occur when the body makes too much cortisol, while Addison’s disease occurs when the body doesn’t make enough of certain hormones, such as cortisol.

Cushing’s syndrome - niddk. National Institute of Diabetes and Digestive and Kidney Diseases.

Addison’s disease - Symptoms and causes. Mayo Clinic.

 

 

 

Why is cortisol such a popular topic today?

 

According to Omaira Ferreira, FDN-P, HHP, a functional diagnostic nutrition practitioner, it’s not a surprise that so many women are turning to social media to find ways to deal with stress: “With worldly stressors like COVID-19 and current events…people [have had] to really navigate so many changes in comfort zones on different levels and factors, and that in itself created conversation around cortisol,” Ferreira says. Ironically, she says, excessive screen time and constant stimulation—from social media platforms, for example—can lead to heightened stress. 

Given society’s constant stress levels—among women in particular, and specifically due to COVID-19—TikTok’s obsession with cortisol may seem appropriate. Some experts, however, aren’t so sure that all roads (such as weight gain or sleeping issues) lead back to cortisol. 

According to Nandita Palshetkar, MBBS, MD, an OB/GYN, “It's important to distinguish between normal variations in cortisol due to everyday stress and hormonal imbalances that require medical intervention. Not all stress responses lead to clinical cortisol imbalances. The narrative often lacks the nuance of differentiating between normal stress responses and actual endocrine disorders,” she says. 

Langer also takes issue with the many videos that suggest diet can lower cortisol levels. “There is no diet or supplement that lowers cortisol,” she says. “Many people and companies selling these ‘fixes’ ignore the fact that cortisol level is a metric that’s hard to pin down, which means this makes it tough to see if you’re ‘better’ after their treatment.” 

Patients should be warned that finding health advice on social media can be dangerous, Langer notes. Research shows that false or misleading health information spreads even more easily than actual scientific fact on social media. For example, researchers at The Ohio State University found that 73% of content shared on TikTok about women’s health—specifically related to gynecologic cancers—was “inaccurate and of poor educational quality.”

Suarez-Lledo V, Alvarez-Galvez J. Prevalence of health misinformation on social media: systematic review. J Med Internet Res. 2021;23(1):e17187.

Study: Gynecologic cancer misinformation widespread on TikTok. The James, Ohio State University.

 

“[Social media misinformation] can prevent [patients] from getting professional help for serious problems, and it also lacks the individualized care that people need. Some random [user] on TikTok doesn’t know your health history. One-size-fits-all recommendations aren't appropriate,” Langer adds. 

Rather than turning to TikTok, Dr. Gaither says, patients should see a doctor about suspected hormonal imbalances.