OK, WE NEED TO TALK ABOUT STRESS...
by Jelena Vulevic on Oct 28, 2021
April is stress awareness month, an annual awareness event aiming to increase awareness of both the causes and treatments for modern day stress. During these unsettling times, this year’s awareness event is expected to hold more interest than usual.
The last 13 months have undoubtedly been the most difficult we have all experienced thus far, heath wise. Dealing with a global pandemic whilst trying to balance work and life has taken a toll on every individual’s health in one way or another. Stress had already been one of the biggest issues affecting modern society today, and this pandemic has only very sadly exuberated the environmental and lifestyle stressor our body is experiencing.
What is stress?
Stress is a normal human reaction that happens to everyone. It’s the result of physical and mental responses that our body produces when experiencing any intrinsic or extrinsic stressors, such as a change or a challenge, and helps the body adjust to new situations.
Based on the type, timing and severity of the applied stressors, stress can exert various actions on the body ranging from alterations in the physiological balance to life-threatening effects and even death.
Stress is an important part of life, and it’s not always a bad thing. Sometimes it keeps you alert, ready to avoid danger or it gives you the motivation you need for hitting a deadline or performing your best. Stress is not an illness and doesn’t necessarily cause certain conditions, but it can make you ill or worsen the symptoms of many conditions, if stressors continue without relief or periods of recovery. Its manifestation is not limited to mental health conditions only, but also physical symptoms such as pain, gastrointestinal problems, immune function and skin appearance or hair loss. When physical symptoms worsen, they in turn increase a person’s level of stress, and that results in a vicious circle.
What contributes to stress can vary hugely from person to person. What one individual may think is positive pressure, another may perceive as excessive pressure or the final straw. The level of stress we can tolerate differs according to our social and economic circumstances, the environment we live in, our lifestyle, and our genetic makeup. Nevertheless, our stress response system is not built to be constantly activated. Its overuse, that occurs during chronic stress e.g. when we are repeatedly exposed to situations leading to release of stress hormones, contributes to the breakdown of our bodily systems over time.
Chronic stress is a widespread issue and well-documented as an environmental risk factor for mental and physical illness, particularly in individuals who are already susceptible due to other genetic and psychological risk factors. Not only is chronic stress associated with mental health issues like anxiety, panic attacks and depression, but it can also manifest in physical issues. Alongside other risk factors, chronic stress is linked to the onset of conditions such as diabetes, heart disease and obesity.
The biology of stress
The stress response system is part of the hypothalamic-pituitary-adrenal axis (HPA axis). When a stressor is perceived and interpreted, the stress response system starts up a cascade of biological events. The adrenal medulla releases the hormone adrenaline, which prepares the body for a fight or flight response. This increases heart beating, sweating, blood pressure, and breathing rates. The hypothalamus responds by activating the pituitary gland that in turn secrets adrenocorticotropic hormone (ACTH) through the bloodstream to the adrenal glands that sit on top of the kidneys. Their activation releases cortisol that after binding to its receptors can interact with other cells throughout the body.
Cortisol is a steroid hormone that plays a very important role in helping the body respond to stress, but also it regulates a wide range of vital processes throughout the body, including metabolism and the immune response. Depending on which sort of cells it is binding to/acting upon, cortisol is involved in controlling the body’s blood sugar levels and therefore regulating metabolism, acting as anti-inflammatory, influencing memory formation and blood pressure. In response to stress, extra cortisol is released to help the body respond appropriately. As the cortisol levels rise, they start to block the release of corticotrophin-releasing hormone from the hypothalamus and ACTH from the pituitary. As a result, ACTH levels start to drop, which then leads to a drop in cortisol levels, in a negative feedback loop.
What is the impact of chronic stress?
Too much cortisol (stress hormone) over a prolonged period of time, as a result of chronic stress, causes wear and tear of the body characterised by physical, emotional and behavioural symptoms that include:
Muscles and joints
Stress can cause pain, tightness or soreness in your muscles, as well as spasms of pain. It can lead to flareups of symptoms of arthritis, fibromyalgia and other conditions, mainly because stress lowers your threshold for pain. When you experience stress, your muscles tense up altogether; when stress goes away, your muscles release the tension.
Heart and lungs
Stress can affect your heart making your heart rate increase, as when you’re trying to meet a deadline at work, for example. Moreover, high cortisol levels may worsen the symptoms of heart and lung conditions, such as heart rhythm abnormalities, high blood pressure, stroke, shortness of breath, rapid breaching and asthma.
Skin and hair
The physical impact of stress on the skin is wide-ranging and includes redness, increased sensitivity, sagging, dryness and dullness. Excess cortisol increases also the activity of the sebaceous glands, causing Your skin to produce more oil, which leads to blocked pores and breakouts. Maintenance of excess cortisol, like when under chronic stress, can aggravate existing conditions as well. Over-production of oil is bad news for those with already acne-prone skin, but the pro-inflammatory nature of the stress response can also exuberate conditions such as psoriasis, rosacea and eczema. Additionally, the adrenal glands begin to produce fewer hormones that promote hair growth. This shifts hair follicles to shift from the growth phase into catagen resulting to the hair becoming weaker and beginning to shed.
Stress really shows in your gut — from the appearance of simpler symptoms such as pain, gas, diarrhea and constipation to aggravating more complex conditions such as irritable bowel syndrome (IBS), inflammatory bowel diseases (IBD) and acid reflux (GERD).
The ‘gut-brain axis’ describes a bidirectional communication between the central nervous system and the enteric nervous system, which uses signalling hormones and neurotransmitters to manage what we do and how we feel on a daily basis. Within your gut, the microbiome, the community of commensal microorganisms, is constantly processing dietary inputs into stimulus that impact this communication, affecting both the gut function and brain function. There is a huge amount of emerging research into the gut-brain-microbiome interaction, and findings suggest that both acute and chronic stress will disrupt the balance in your microbiome, which can result in feelings of anxiety and depression. Research has also shown that specific bacteria may increase the risk of depression and anxiety.
Several aspects of the immune system have been empirically associated with stress. During acute stress lasting a matter of minutes, the type and number of lymphocytes into the bloodstream is lowered, reducing the immune system’s ability to fight off infections, as well as increasing blood levels of pro-inflammatory molecules called cytokines. Chronic stress lasting from days to years, is also associated with higher levels of pro-inflammatory cytokines, but with potentially different health consequences as a result of chronic, systemic inflammation that is accelerating immunological and biological ageing increasing thus the risk for chronic diseases. Another consequence of chronic stress is activation of latent viruses, that reflects the loss of immunological control over the virus and can cause further wear-and-tear on the immune system. Interestingly, scientific research suggests that older adults are unable to terminate cortisol production in response to stress.
When you are stressed, you may experience many different feelings, including anxiety, fear, anger, sadness, or frustration. You may become withdrawn, indecisive or inflexible, irritable or tearful. These feelings can sometimes feed on each other and produce physical symptoms, making you feel even worse. Chronic stress increases the risk of mental health problems such as anxiety and depression, as well as substance use problems and sleep problems.
How to prevent chronic stress?
No one can avoid stress, but we can stop it from becoming overwhelming and chronic. Many daily activities can help keep stress at bay:
Stay connected with people who keep you calm, make you happy, provide emotional support and help you with practical things. A friend, family member or neighbour can become a good listener or share responsibilities so that stress doesn’t become overwhelming. Unhappy and unhealthy relationships are often main reason for raised cortisol levels.
Accept that you can’t control everything and find ways to let go of worry about situations you cannot change.
Relaxation activities such as meditation, yoga, breathing exercises and muscle relaxation. Even going for a walk and connecting with nature or immersing yourself in music can sometimes help to reduce cortisol.
Hobbies can be rewarding and satisfying way to lead to an increased sense of an overall wellbeing. For example, gardening has been shown to lead to decreased cortisol levels and improved quality of life.
Finding time to have fun and laugh is very important; its hard to feel stressed when we are having a good time and cortisol levels decrease in response to laughter.
Try and incorporate moderate physical activity into daily routine. Intense exercise, however, triggers an increase of cortisol because that’s how the body reacts to increased stress that the exercise places on it.
Having a good bedtime routine usually results in longer and better quality of sleep. A bad night’s sleep or more prolonged sleep deprivation leads to increased cortisol levels. Removing, or at least avoiding in the evening, the foods high in caffeine can improve sleep quality and also lower cortisol levels.
Eating a healthy, balanced diet and reducing sugar intake is a great way to lower cortisol. An example of foods to incorporate into diet for lowering cortisol include:
dark chocolate with its emotional impact and antioxidants
herbal teas that contain no caffeine
whole grains increase hormone called serotonin and help improve mood, concentration and focus
foods rich in omega-3 fatty acids (eg avocado, oily fish, nuts and seeds)
calcium rich foods (eg dairy, almonds, green leafy veggies, canned sardines)
foods rich in vitamin C (eg citrus fruits, berries, peppers, broccoli)
fibre rich foods (eg beans/legumes, nuts/seeds, any vegies or fruits fresh, dry or canned, though be warry of sugar content in canned and dried variaties)
Your gut health has a holistic impact on your body and your gut microbiome is emerging as a key player, not only for the level of extrinsic stressors your body has to respond to, but also for how your body will respond to those stressors. Most of the above mentioned foods are great to support your gut health and microbiome. Some supplements (eg probiotics, prebiotics, postbiotics) are also a good way to support your beneficial microbiome and reduce cortisol. Try and go for those that have been shown to reduce inflammation.