Understanding Stress and How Lifestyle Medicine Can Help

Overview

Hans Selye, a Hungarian-Canadian endocrinologist and known as the Father of Stress Theory, once said,

“Every stress leaves an indelible scar, and the organism pays for its survival after a stressful situation by becoming a little older."

Most of the time, you use the term “stress” to actually mean “stressors”. That is because, more often than not, you associate stress with undesirable situations.

One of the six areas of focus of Lifestyle Medicine is stress management. This article will discuss stress, how it affects you, and why Lifestyle Medicine focuses on stress management.

Good and Bad Stress

Any circumstance that causes you stress is called a stressor. It could be physical or physiological changes in the body, changes in the environment, life events, or behavioral changes. Even imaginary situations like worry and fear could become stressors.

However, stress is a normal physical and psychological reaction of your body to the demands of your daily life. A little amount of stress motivates you to perform better. Eustress or good stress does not only help you in restoring your energy but also improve your heart function and increase your stamina and strength. They sharpen your thinking and enhance your mental ability.

Distress on the other hand, has a negative impact on your body. It causes you anxiety or a feeling of displeasure. Distress affects your performance and can lead to your mental as well as physical problems.

With today’s modern living, stress becomes a double-edged sword that could kill you if left unmanaged over time. Hence, it is very important how you perceive an event or a situation because the way you handle stress is an indicator of your overall health and well-being.

The Physiology of Stress

General Adaptation Syndrome

In 1936, Hans Selye conducted a study on the hypothetical "non-specific response of the body to any demand". That was how Selye first describe "stress" in medical terms and the stress model General Adaptation Syndrome was conceived.

Selye theorized that the body adapts constantly to stressors in a predictable biological pattern so that the body's internal equilibrium or homeostasis would be restored and maintained. His study explains the stress response and how chronic exposure to stress can cause aging and diseases.

To understand how stress affects your body, Selye described the General Adaptation Syndrome into three stages:

Alarm Stage

The first step in a stress response is the perception of the threat or stressor --- real or imaginary. The hypothalamus in the brain perceives the stressor and performs the following:

1. Activates the Autonomic Nervous System (ANS)

The Autonomic Nervous System (ANS) regulates the activities of the internal organs like circulation, digestion, respiration, temperature regulation, excretion, etc. It consists of the sympathetic (arousal) and parasympathetic (relaxed) nervous system.

The sympathetic system is responsible for the fight-or-flight response. In response to a stressor, catecholamines --- epinephrine (adrenaline) and norepinephrine (noradrenaline) --- are released causing several changes like increase in your heart rate, increase in the force of heart contraction, vasodilation of arteries to the working muscles, vasoconstriction of arteries to non working muscles, dilation of pupil and bronchi, and reduction of digestive activities in the body. All these changes are required to prepare your body for fight-or-flight response which last for a few seconds.

2. Stimulates the Hypothalamic Pituitary Adrenal (HPA) axis by releasing Corticotropin Releasing Hormone (CRH)

Your pituitary gland controls the secretion of other hormones in the body. Upon stimulation of the CRH, your pituitary gland secretes Adrenocorticotropic Hormone (ACTH) which would stimulate the adrenal glands in the kidneys releasing glucocorticoids and mineralocorticoids.

Glucocorticoids release energy to cope with the ill-effects of stressors. The energy released converts glycogen into glucose and breaks down fats into fatty acids and glycerol. In addition, this corticoid also increases urea production, suppresses your appetite, suppresses your immune system, exacerbates your gastric irritation, contributes to your feeling depressed and loss of control. These are the symptoms generally seen in persons under stress.

Mineralocorticoids promotes sodium retention and elimination of potassium. This results in an increase of blood volume thus increasing blood pressure.

Also your adrenal gland secretes epinephrine (adrenaline) and norepinephrine (noradrenaline) as a backup system to ensure your physical survival as intermediate effects.

3. Secretes arginine vasopressin or Antidiuretic Hormone (ADH)

ADH is synthesized by your hypothalamus and released by your pituitary gland. It regulates fluid loss through your urinary tract by reabsorbing water in your body. Also, ADH has a role in regulating blood pressure during stress when your body's homeostasis is disturbed by the release of energy.

Another change occurring during stress is the distribution of energy to a particular organ that needs it most. This is achieved by increasing blood pressure. This occurs either through enhanced cardiac output or through constriction of the blood vessel.

Other hormones such as the growth and thyroid hormones also play a significant role in stress. Growth hormone raises the concentration of glucose and free fatty acids. It has been observed that in humans, psychological stimuli increase the concentration of thyroid hormones. Your thyroid gland releases thyroxine and triiodothyronine. These hormones also have some significant function in stress increasing your overall metabolic rate. Thyroxine also increases heart rate and sensitivity of some tissues to catecholamines.

Although serotonin and melatonin are not considered stress hormones, they are associated with mood which decrease during depression brought about by stress.

Adaptation or Resistance Stage

After the body has responded to the stressor, it is expected that the stress level has been reduced, if not eradicated. However, after your initial fight-or-flight response, your body’s defenses become weaker because your body allocates energy to repair the damaged tissues and to lower the production of the stress hormones.

Although your body has shifted to this phase of stress, it remains alert especially when the stressors persist and your body needs to fight them continuously. However, due to lower defenses, your body fights not as stronger as during the alarm stage.

If the stressful situation is not resolved, the body uses all its resources to adapt. This results in sleep problems, tiredness, muscle pains, indigestion, allergies, infections, common colds, lack of concentration, impatience, irritability, smoking and drinking.

Recovery or Exhaustion Stage

If your body’s compensatory mechanisms have succeeded in overcoming the stressor’s effects, recovery follows. But if your body has used up its resources and is unable to maintain normal function it leads to exhaustion.

During exhaustion, your body starts to lose its ability to combat the stressors because the adaptive energy is all drained out. The exhaustion stage can be the gateway towards burnout or stress overload, which can cause long term effects putting you at risk of suffering from more serious health conditions.

Impact of Stress to Your Body

Acute stress occurs for a short period of time. It comes on quickly and also goes quickly. Acute stress is generally recognized with symptoms such as anger, anxiety, irritability and acute periods of depression. Sometimes it may bring you thrill, pleasure and excitement.

When acute stress is felt too frequently it is called episodic stress. It occurs due to a series of stressful challenges occurring one after another in your life. Bills which do come frequently is an example of episodic stress.

When a stress persists for longer duration it is called chronic stress. It is brought about by your prolonged exposure to stressors. Chronic stressors may not be as intense as acute stressors but they are more harmful than acute stressors because the effect of chronic stress has accumulated for a long time.

Stress affects your body in many ways both physical as well as mental. The impact of stress on the body may not be the same in all people. It may vary depending on factors like the genotype, sex, age, physiological conditions and past experiences of the person. But some of these effects are common to every individual. Most of the effects are due to increased concentrations of corticoids and adrenaline.

Digestive System

Disturbed eating habits, acid reflux, diarrhea or constipation are the common symptoms seen in stressed persons. Stress can also be related to obesity which is linked to a host of other health problems. Hormonal changes occurring during the acute and chronic stress can affect glucose homeostasis in both healthy people and in those with diabetes.

Extreme stress can also be associated with diabetes because excessive cortisol can affect the insulin activity. The body can also become resistant to insulin which can lead to diabetes.

Circulatory System

Several studies show a strong relationship between stress and cardiovascular diseases. Stress plays a role in susceptibility, progress and outcome of cardiovascular diseases. Psychological stresses are also associated with cardiovascular diseases because it has become psychosomatic.

Increased adrenaline and cortisol during stress affect your heart and blood pressure. Too much adrenaline causes your blood pressure to elevate making your heart pump harder and faster. This action can result to heart disease, stroke, or cardiac arrest. Stress has been reported to be an indicator of coronary heart disease and hypertension.

Chronic stress also leads to increased blood cholesterol levels. The persistent high levels of cholesterol and other fatty substances in the blood may cause atherosclerosis which could lead to heart attack.

Cortisol also plays a role in accumulating abdominal fat that leads to obesity.

Immune System

The persistent activation of your HPA axis in chronic stress response impairs your immune response leading to several infections. People under chronic stress are more susceptible to viral illnesses like flu, common cold, and other infections.

The high levels of stress hormones suppress the release of cytokines chemicals secreted by the T helper cells (a type of T lymphocytes). Cytokines regulate both cell-mediated and humoral immune response in your body.

Two types of cytokines are released from the T helper cells. Th1 cytokines stimulate cytotoxic T cells and Natural Killer cells. These are cells that directly kill intracellular pathogens (cell-mediated immune response). Th2 cytokines stimulate B cells to produce antibodies (humoral immune response). Chronic stress may deregulate Th1 and Th2 cytokines which can lead to suppression of both immune responses.

Chronic stress also affects cytokines involved in the inflammation process. Proinflammatory cytokines feed back to the CNS and produce symptoms of fatigue, malaise, loss of appetite, and listlessness, which are the symptoms usually associated with depression.

Studies have also found that faster progression to AIDS was associated with higher cumulative stressful life events, use of denial as a coping mechanism, lower satisfaction with social support, and elevated serum cortisol.

Other Body Systems

Cortisol also alters bone mineral density thus affecting bone development in the body. Stress may retard growth in young children .

In some cases, stress could also cause cancer. The persistent activation of the HPA axis in the chronic stress response impairs the immune response and contributes to the development and progression of some types of cancer.

Stress also interferes with the reproductive system both in men and women. Since sex life depends on fitness of both body and mind, chronic stress may decrease libido and may even cause erectile dysfunction or impotence in man. Testosterone levels can drop to an extent that can interfere with sperm production in chronic stress. In women, stress can affect the menstrual cycle. It can lead to irregular, heavier or more painful periods.

In addition to its direct effect on your body, stress also produces some behavioral changes. People living in stressful environments are more prone to smoking and are more vulnerable to alcohol consumption which has its own consequences.

How to Manage Stress

Identify The Triggers

The first step in managing your stress is to identify the factors which trigger your stress. These factors vary from person to person. Some of you may take things very seriously while others don't. Family problems are major stressors. Also, many of you are very much afraid of facing sudden changes in life and find yourselves in trouble whenever you encounter one. Some of you may find it difficult to travel or even when you have to face a large audience or person in authority.

Once you identify your possible triggers, then you can plan on how to manage your stress. Start managing your stress level by making changes in your daily routine and spending some time on yourself.

Watch Your Diet and Nutrition

Stress can disturb your eating habits which can cause nutritional deficiencies that could eventually stress your body. This is because your body uses more of your nutrients to cope up with stress. A balanced low-glycemic index can keep your blood sugar stable and can help you deal with stress better. Foods rich in vitamins and antioxidants can help you to boost your immune system during stress. Thus, a good diet is needed to help you cope with the ill effects of stress.

Exercise

Keeping yourself active not only reduces the stress but also helps in easing stress. Exercise keeps yourself physically as well as mentally active and healthy. Physical exercise not only reduces stress hormones but also stimulates the body to release serotonin and endorphins which help in relieving stress and boosting mood. Physical exercise loosens tight muscles and relaxes the body. It improves your breathing and helps in relaxation.

Have an Adequate Sleep

For good health, a sound sleep is very much required. When you do physical exercise it tires you physically which leads to a sound sleep. A good sleep is the key to keeping your worries out and keeping you cool.

Adopt a Relaxation Technique

Meditation focuses your mind on a particular activity, thought or object that improves concentration and awareness. It is a very powerful tool for stress management. Regular meditation induces deep physical and mental relaxation thus reversing the effects of the body’s fight-or-flight responses to stress. It slows heart rate, relaxes the muscles, relieves tension and activates the release of the so called "happy hormones": serotonin and dopamine.

Focusing on your breathing is the simplest form of meditation which helps take your mind off your worries. When your mind is turned off from your problems, you feel relaxed. Meditation can recharge your body and enables you to build up a greater control over your thoughts, worries and anxieties.

Yoga is another stress relieving practice. Regular yoga relieves muscle tension, lowers blood pressure and decreases cholesterol levels.

Have a Good Social Network

Sitting alone with your problems will never help solve your problems. It will always increase stress in your life. On the other hand when you talk to other people it not only takes your mind off your problems but also helps you to find solutions. Having a good social network of family and friends is always good. Good friends may not always have solutions to all your problems but they can definitely keep you away from your problems. Good communication especially between life partners and family members is very essential for a healthy relationship because poor communication or communication gap is a major reason for conflicts in families.

Avoid Smoking, Alcohol, and Other Substances

Stressed people smoke, drink alcohol, or take drugs as a way to "numb" the effect of the stressor thinking that it would go away. But it does not.

Smoking contains nicotine and prolonged, consistent smoking is linked to mouth, throat, and lung cancers.

Alcohol is considered a depressant so drinking them during stress would add to the stress even more.

Taking pills to relieve symptoms for a prolonged period of time could result to addition, drug resistance, or drug abuse.

However, if your smoking, alcoholism, and/or drug use start to form the foundation of your mental issues, it is better to address this directly with a mental health professional.

Be Positive

Your attitude determines your stress level. Stress is not an event. The way you interpret your stressor makes you stressful. Therefore, have a positive attitude and start changing your unhealthy mind set. Always think that there is something good in every bad situation. If you think this way, you will never feel stressed.

They say that laughter is the best medicine. True, because laughter has been show to boost serotonin, the so-called happy hormone, release pain relieving endorphins, and lowers cortisol and adrenaline, the stress hormones. Laughter also relaxes your muscles, lowers blood pressure, and boosts your immune system.

Set SMART Goals

SMART means specific, measurable, attainable, realistic, and time-bound. When you set goals for yourself, you will have a positive sense of commitment, you feel you are in control, and become optimistic. This will remove your worries over things which you do not have control (like the weather and other people) and makes you focus on those things you can actually control (yourself and your tasks). Start setting SMART goals for your career, relationships, creativity, play, and health now.

Conclusion

Everyday, you are exposed to many physical, environmental, physiological and psychological stressors that cause stress responses in your body. If stress exists for prolonged time, it causes many health problems. Although it is not possible for you to completely avoid stress, it can be managed by making little changes in your attitude and lifestyle. Have you not noticed that some of the tips on managing stress are actually the focus of Lifestyle Medicine?

Proper stress management is one way to combat the negative effects of stress. It can improve your mood, boost your immune function, and promote long life. It is important to know how you perceive an event or a situation because the way you handle stress is an indicator of your overall health and well-being. So do not wait until stress damages your health.

If you are having problems dealing with stress, feel free to schedule a consultation. I will help and work with you to make changes at whatever pace you are comfortable with. There is a health program that might suit your needs. If you want to hear from me discuss more about Lifestyle Medicine, feel free to listen to my podcast. If you want to be updated with news and features from this website, subscribe to my newsletter or reach out using the contact forms below.

Sources:

Harvard Health Publishing. 2015. “Best Ways to Manage Stress.” Harvard Health. Harvard Health Publishing. January 8, 2015.

Sarah Mae Sincero. 2019. “General Adaptation Syndrome by Hans Selye.” Explorable.com. 2019.

Sharma, Dushyant Kumar. 2018. “Physiology of Stress and Its Management.” Journal of Medicine: Study & Research 1 (1): 1–5.

Tan, Siang Yong, and A Yip. 2018. “Hans Selye (1907–1982): Founder of the Stress Theory.” Singapore Medical Journal 59 (4): 170–71.