"Moon face", weight gain and hair loss: how to lower your cortisol levels

There's been plenty of debate online about the recent findings of the 2024 World Happiness Report in March, which ranked Singapore the happiest country in Asia.

While the United Nations-backed report – which surveys about 1,000 individuals per country – placed the Lion City at the 30th spot among a total of 143 nations globally, Singapore fell five spots from ranking 25th in 2023.

In a similar vein, a 2022 mental health and wellness survey conducted by Rakuten Insight in Singapore reveals that 59% of respondents aged between 24 and 34, and 52% of the respondents aged between 35 and 44, indicated higher levels of stress or anxiety in the past 12 months.

Needless to say, we are one stressed out nation. Which begs the question: What are the harmful effects of being chronically wired and tired? And is it possible for us to undo all the damage caused to our physical and mental health?

What is cortisol and how does it affect us?

First, we need to get acquainted with cortisol, a steroid hormone produced by the adrenal glands that is often referred to as the body’s primary stress hormone.

Dr Andrew Fang, family physician at Doctor Anywhere, shares that cortisol plays an important role in orchestrating numerous bodily processes, such as managing our stress response, controlling blood sugar and blood pressure levels, and even regulating our circadian rhythm (sleep-wake cycle).

“​​Cortisol production is regulated by a complex system known as the hypothalamus-pituitary-adrenal (HPA) axis,” explains Dr Fang. “On a regular day, the HPA axis maintains cortisol levels to carry out normal bodily processes.”

For many of us, the stressors of daily life can be hard to predict. Is there anything can we do about it then?

Identify your triggers

“Anything that triggers the body's stress response ultimately leads to cortisol production,” shares Dr Naras Lapsys, Dietitian & Longevity Medicine Consultant at Chi Tree Health. Psychological stress, whether it’s from work, financial concerns or relationship issues, as well as physical stress, including illnesses, injuries and sleep deprivation, can all send our stress response into action.

This all sounds like anything but good news. But Dr Lapsys assures that stress response isn’t anything to sweat about. It is simply the body’s way of adapting to these difficult moments. For example, if we are meeting back to back deadlines, more cortisol is produced to raise blood sugar levels, heighten alertness, reduce pain, and even curb inflammation.

This fight-or-flight response ensures that our bodies are equipped with what it needs to pull through those taxing times. Typically, cortisol levels return to normal shortly after this period is over. But what happens when we’re constantly on edge?

The painful effects of chronic stress

According to both Dr Lapsys and Dr Fang, serious health problems like poor sleep quality, diabetes, high blood pressure, osteoporosis, muscle atrophy, depression, and even anxiety can manifest if we are frequently stressed. Women who are looking to start a family should also take note, as some studies have shown that abnormalities in cortisol levels may have an impact on fertility.

According to Dr Fang, elevated levels of stress-induced cortisol production will disrupt the production of female hormones like oestrogen and progesterone in the body. Not only can this result in irregular menstrual cycles or changes in the menstrual flow, it could also potentially affect a woman’s ability to conceive and maintain a healthy pregnancy.

Alongside these health risks, prolonged elevation in cortisol levels can also manifest physically. “In circumstances where cortisol levels remain abnormally elevated for a long period of time, a condition known as Cushing’s syndrome can develop,” adds Dr Fang. He reveals that common symptoms of this hormonal dysregulation include poor hair quality and hair loss, as well as excessive weight gain, which then results in “moon face” (a symptom characterised by excess fat deposition in the face, giving it a rounded moon-like shape).

Undoing the damage one step at a time

For those who are overwhelmed and overworked, stress management is key. Dr Fang recommends that we aim for a healthy and balanced diet, establish a regular sleep cycle, and practise techniques or activities that promote calmness in stressful situations. “Engaging in physical and emotional well-being practices can effectively mitigate the adverse impacts of cortisol,” he shares.

When it comes to managing our workload, Dr Lapsys recommends delegating responsibilities and establishing healthy boundaries, as this will help us from being overwhelmed. Additionally, he suggests practising relaxation techniques like deep breathing, meditation and yoga, as well as clocking in at least seven hours of quality sleep each night.

Regular physical exercises are also great for maintaining bone density and good muscle quality. Calorie management, matched with cardiovascular exercises like jogging, running, kickboxing and spinning, can help with weight loss. However, he warns against overtraining as it increases cortisol levels in the body.

Where nutrition is concerned, Dr Lapsys highly recommends opting for fresh produce, including whole grains, lean meat, as well as fruits and vegetables, as they provide the body with necessary nutrients for optimal health. This can have positive effects on hair quality and regrowth, as well as enhance one’s mood. For those who are planning to start a family, Dr Fang recommends a diet that is nutritious and balanced, rich in vitamin D, omega-3 fatty acids, as these nutrients may aid in reproductive health. The experts collectively warn that one should avoid processed food as they are high in sugar and preservatives, which can disrupt the body’s hormone regulation.

Supplements are also something to look into. Dr Lapsys shares that adaptogens, like ashwagandha, rhodiola rosea, and schisandra, may have stress-reducing properties. Leonica Kei, founder and principal trichologist at Leonica K Trichology recommends magnesium glycinate as it promotes relaxation and quality sleep.

As for cortisol-related hair health, Leonica says that elevated cortisol levels can precipitate the onset of pattern baldness and weaken hair follicles, resulting in thinner strands. She recommends those who are experiencing hair loss or thinning to consider undergoing scalp treatments. “These treatments are specifically designed to cleanse the scalp thoroughly, eliminating dead cells and excess sebum. By improving blood circulation, they create a more conducive environment for hair follicles to produce healthy hair,” she shares. She also suggests using a scalp tonic designed to stimulate blood circulation and block dihydrotestosterone (DHT). DHT is an androgen that can shrink your hair follicles and shorten the hair growth cycle, thus causing hair loss.

If all else fails, are hair transplants a solution to consider? “This procedure is not suitable for everyone, as it requires a sufficient quantity of good quality donor hair,” she warns. She further explains that even though the transplanted hair might grow successfully, there can be continued deterioration of hair at the frontal and crown areas. “This may result in unsightly patches of transplanted hair surrounded by areas of thinning.”

And before you decide to book an appointment with your doctor to sculpt your “moon face”, Dr Rachel Ho, medical director at La Clinic, notes that aesthetic treatments will not help much in this pursuit. “I would only recommend patients experiencing these changes in their physical appearances to seek aesthetic and dermatological treatments under selective conditions,” she says.

One of the most common aesthetic treatments to sculpt and contour the face is Botox. However, Dr Ho explains that Botox is not recommended when addressing a moon face, which is due to abnormal fat deposition in the face. “When used for face slimming or contouring, Botox is injected into the masseter muscles or the skin (eg Dermalift) to slim down enlarged jaw muscles or to lift saggy skin respectively. Botox is unable to remove the abnormal fat deposition in the face,” she explains. “Instead, treating the cause of Cushing’s syndrome should be the priority.”

The bottom line

While it is impossible to completely avoid stress, especially in a time when there’s a constant need for speed, it is important to know when to slow down. Feeling run down from time to time is normal, but look out for tell-tale signs and persistent symptoms such as a loss of appetite, changes in your menstrual cycle, poor sleep quality, and drastic changes in mood. Physical manifestations of stress, such as hair loss and the building up of fat around the belly, face, and between the shoulder blades, are also red flags to take note of, as they can potentially be symptoms of Cushing’s syndrome.

“Consider taking the holistic steps to reduce stress first. However, if you’re experiencing any concerning symptoms or suspect a cortisol imbalance, it’s always best to consult your GP or a healthcare professional,” advises Dr Fang.