India, Aug. 29 -- "Doctor, my cortisol is acting up." It is a sentence I hear often. A patient recently came to see me with fatigue, disturbed sleep, and some weight gain. Searching the internet, she was convinced that her "cortisol was too high" and had discovered a bewildering array of advice on how to "lower cortisol naturally". Cortisol has become one of the most talked-about hormones on social media. It is blamed for abdominal obesity, poor sleep, anxiety, ageing, and lack of energy. Numerous websites and holistic practitioners promote coconut water, apple cider vinegar and rhodiola as ways of reducing cortisol. However, there is no good evidence that these remedies reliably lower or manage cortisol. The irony is that cortisol is not a bad hormone. We cannot live without it. Produced by the adrenal glands, two small glands above the kidneys, cortisol is essential for maintaining energy, blood pressure and the ability to respond to physical and psychological challenges. One of its major functions is in glucose metabolism-the process by which the body produces, maintains and uses glucose, its principal source of energy. Cortisol helps ensure that sufficient glucose is available to the brain and other vital organs, particularly during stress. Cortisol also follows a precise daily rhythm. Levels are normally highest in the early morning, helping us wake up and become alert, and gradually decline during the day, reaching their lowest levels around midnight. Thus, it is not simply the amount of cortisol that matters; its timing and pattern are important too. What happens when we become stressed? The body activates two closely coordinatedsystems. The first is the autonomic nervous system. Within seconds, the sympathetic nervous system triggers the familiar "fight-or-flight" response. Heart rate and blood pressure rise, breathing becomes faster and energy is rapidly mobilised. This isthe immediate, adrenaline-mediated response. The second response is slower but more sustained. The brain activates the hypothalamic-pituitary-adrenal,or HPA, axis. The hypothalamusand pituitary communicate with the adrenal glands, which release cortisol. This helps maintain glucose and other energy supplies while the body continues to deal with the challenge. Cortisol is, therefore, part of an elegant survival mechanism. If confronted with danger, the body does not want to spend energy on long-term projects such as building bone or storing nutrients. It wants energy immediately available to the brain, heart and muscles. Short-term stress, therefore, is not necessarily harmful. Our bodies are designed to cope with it. The difficulty comes when the stress response is repeatedly activated or remains disturbed for prolonged periods. Modern life exposes many people to persistent pressures - work demands, financial worries, inadequate sleep, family responsibilities and constant digital stimulation. Chronic stress can influence immunity, metabolism, cardiovascular function and mood, and may be associated with fatigue, disturbed sleep, hypertension and depressive symptoms. But this does not mean that every person with fatigue or weight gain has excess cortisol. Genuine cortisol excess is a medical condition. In Cushing syndrome, persistently high cortisol can produce a characteristic pattern: weight gain, particularly around the abdomen and face; muscle weakness; thinning skin; easy bruising; purple stretch marks; high blood pressure; high blood glucose and osteoporosis. Menstrual disturbances and psychological symptoms may also occur. At the opposite extreme, too little cortisol can be equally dangerous. Adrenal insufficiency may cause profound fatigue, weakness, loss of appetite, weight loss, dizziness and low blood pressure. Nausea, abdominal symptoms and salt craving may occur, while primary adrenal insufficiency may cause increased skin pigmentation. During severe illness, surgery or another major physical stress, inadequate cortisol can precipitatean adrenal crisis, a potentially life-threatening emergency. These are genuine medical disorders requiring proper evaluation and treatment. What about measuring cortisol todiagnose "stress"? Cortisol testing is generally reserved forsituations in which doctors suspect a specificdisorder, particularly adrenal insufficiencyor Cushing syndrome. It is not a routine test for psychological stress. Chronic stress can influence the HPA axis and alter the normal pattern of cortisol secretion. But this does not necessarily mean that chronically stressed people have persistently high cortisol levels. The relationship is much more complicated. Two people experiencing similar levels of stress may have quite different cortisol responses. Cortisol also varies with the time of day, sleep, illness, medications and other factors. There is currently no clinically accepted test that diagnoses "stress-related cortisol excess". The popular concept of "adrenal fatigue" is another matter. People living under prolonged stress can certainly feel exhausted. But the idea that everyday stress simply "tires out" the adrenal glands, causing them to stop producing adequate cortisol, is not an established medical diagnosis. Fatigue deserves proper evaluation rather than being automatically attributed to cortisol. Cortisol should not be viewed as something that needs to be "detoxed" or suppressed. Cortisol is essential for maintaining blood pressure, energy metabolism and the body's ability to respond to serious illness. Trying to manipulate it unnecessarily may do more harm than good. The better approach is remarkably simple: adequate sleep, regular physical activity, a balanced diet and sensible ways of reducing chronic stress. These measures are beneficial not because they "detox" cortisol, but because they improve overall health and help the body's stress-response systems function normally. So, when a patient without any features of cortisol excess tells me, "Doctor, my cortisol is acting up," my response is: "Try to relax and look at the real causes of your symptoms rather than blaming cortisol." Cortisol is the mediator, not the cause. It is one of the hormones that helps us meet life's demands. The objective is not to keep cortisol as low as possible. It is to have the right amount, at the right time, for the right circumstance. Stress is the problem; cortisol is part of the body's response to it. We need better strategies to manage chronic stress and not an endless quest to suppress a hormone we cannot live without....