'Cortisol face': I'm a doctor - here's why this TikTok and Instagram trend is a myth

There is a trend on TikTok and Instagram which is suggesting that excess cortisol caused by stress alone can cause characteristic changes in the facial appearance called cortisol face - but is this true? I have been examining the facts and research evidence to see if this is indeed correct and if so what we can do about it.

Excess stress is certainly not healthy, especially in the longer term. It is linked to poor sleep, reduced concentration, anxiety leading to low mood, and in the long term depression, increased blood pressure, which can lead to a higher risk of heart disease and stroke.

Stress does increase the body's level of cortisol, especially at night when naturally it should drop as part of a regular circadian rhythm. It is well known that too much cortisol in the body can cause changes in physical appearance including weight gain, especially around the midsection - and facial puffiness, with a rounded jaw line, redness and spots has become known as cortisol (or moon) face.

The main cause of excess cortisol, however, is steroid medication prescribed by many doctors, including myself for a variety of medical conditions ranging from asthma, allergies or to alleviate the side effects of chemotherapy. Patients are warned about these side effects which not only cause weight gain but face changes that have more sinister risks such as diabetes, osteoporosis and lowered immunity. Sometimes benign tumours of the adrenal gland can produce too much cortisol, a condition called Cushing's which causes severe steroidal effects including weak muscles, a fatty lump between shoulders, pink or purple stretch marks, and easy bruising as well as the moon face.

There is no direct link between stress and cortisol face. Increased cortisol levels can cause a number of negative health consequences. However, there have not been any published scientific papers which have reported that the level of cortisol, caused by stress alone, is enough to cause the characteristic moon face. That said, stress can contribute to a poor gut health which can lead to weight gain which could make the face look bigger. Poor gut health combined with stress can cause insomnia. Most of us have experienced that our faces in the mirror after a restless night often appear more puffy.

Over time, stress and poor gut health is linked to premature aging of the skin which can also affect our appearance.

Lifestyle tips to reduce stress

Even if stress does not directly cause cortisol face it is not good for our appearance and long-term health, so calming, anti-stress strategies should be a routine aspect of our daily routine. Here are 10 evidence-based practical tips to help you manage and reduce stress:

1. Practise mindfulness, meditation and controlled breathing

Stay present in the moment by focusing on your breathing or surroundings which help reduce the mental noise caused by stress - key components of mindfulness. Regular meditation helps calm the mind, reduce cortisol levels, and improves emotional regulation. Even 10 minutes a day can make a difference. Practise deep breathing techniques, such as box breathing (inhale for four counts, hold for four, exhale for four, and hold for four), to quickly reduce stress and calm the nervous system.

2. Exercise regularly

Physical activity boosts the production of endorphins, dopamine, and serotonin, which are known to improve mood, happiness and reduce feelings of stress, anxiety and depression. Whether it's a brisk walk, yoga, or a full workout, moving your body helps relieve stress and improve mood. Avoid long periods of sedentary behaviour and try to take part in a regular group exercise such as the Saturday morning parkrun.

3. Maintain a healthy diet

Eating a balanced diet can help stabilise your mood and improve energy levels. Include foods rich in Omega-3s and essential minerals such as magnesium, iodine and molybdenum which support brain function. To achieve this, try to eat more seaweed, clams and oysters but if you don't like these foods or it is not feasible to include them, a multimineral supplement may be a sensible boost to the diet. Try to limit stimulants such as caffeine and alcohol which can elevate stress levels and lead to energy crashes or anxiety.

4. Increase phytochemical rich plant-based foods

Phytochemicals are found in tasty, colourful plants and are known for their ability to enhance alertness, mood, motivation and memory and reduce stress. Many of these plants have multiple different phytochemicals which work together to help the whole body but some such as turmeric, cranberry and pomegranate, specifically, have more evidence for their brain protection properties.

5. Improve gut health

Most people are aware of a significant ‘Gut-Brain Axis’. Stress can affect the gut but conversely poor gut health causes stress, insomnia, fatigue and low mood. Strategies to improve gut health include eating more prebiotic-rich foods such as mushrooms and beans as well as foods which contain healthy bacteria such as kimchi and for some who don’t eat these a good quality probiotic capsule could help.

6. Get enough sleep

Aim for seven to nine hours of quality sleep per night. Lack of sleep can increase stress levels and affect your ability to cope with daily challenges. Here are some links for healthy sleep hygiene strategies including evidence based dietary interventions.

7. Time management and organisation

Organise your tasks and prioritise what’s important. Breaking large projects into smaller steps can make them more manageable and reduce overwhelm.

8. Avoid processed sugar

Robust clinical studies have firmly established that overindulgence of refined sugar is one of the most harmful dietary habits we do for our mental health. Studies have shown that sugary foods in the evening can disrupt regular sleep patterns by adversely affecting the sleep hormones melatonin and cortisol.

9. Connect with nature

Spending time outdoors, in a park, garden, or near water, can lower stress levels and improve mental clarity. A simple walk in nature can reduce tension. Consider walking barefoot in the garden, a process called earthing or grounding which has some scientific basis.

10. Stay connected with loved ones and engage in social activities

Talking to friends, family, or loved ones can provide emotional support and reduce feelings of isolation. It not available, consider joining a walking or arts group or try some volunteering. Social interaction can also lift your mood and relieve stress. Hobbies like painting, reading, gardening, or playing an instrument can help distract your mind from stress and provide a sense of accomplishment and relaxation.

In conclusion, incorporating these habits into your routine can help you manage stress more effectively over time. Finding what works best for you is key to long-term stress reduction.