“Don’t let your mind bully your body into believing it must carry the burden of its worries.”
–Astrid Alauda
Stress and the physical symptoms associated with it are on the rise. Most Americans are suffering from moderate to high levels of stress with 44%reporting that their stress levels have increased over the past five years and 77% stating they regularly experience physical symptoms caused by stress. It’s estimated that American employers spend $300 billion every year on health care and lost work days linked to stress.
Stress can be a very subjective term. Some characterize stress as a circumstance that causes distress or is unpleasant. The American Institute of Stress characterizes stress as being a combination of external and internal factors, both distressing and pleasant. Stress can be further categorized as acute or chronic. All of these variables can have an immediate or lasting effect on our overall wellbeing. Most of us would say that an appropriate amount of stress keeps us motivated and allows us to perform necessary daily tasks, eustress. Eustress is moderate or normal psychological stress interpreted as being beneficial for the experiencer. When we start to feel the effects of stress impacting our health and performance, this results in distress.
Literature reviews conclude that the exposure to stress increases risk of poor clinical outcomes across various health conditions including asthma, anxiety disorders, rheumatoid arthritis, depression, cardiovascular disease, chronic pain, stroke and cancer. One study suggests that being exposed to work stress increased risk of coronary heart disease by 50%. Another study showed women with the highest levels of perceived stress have increased in aging that is the equivalent of at least one decade of additional aging compared to low stress women.
Check out the graph below; there is good stress called “eustress”, but if it crosses a certain threshold it can quickly become “distress”. Bottom line is, too much stress impacts our wellbeing in a number of ways and deserves attention for chronic disease prevention and overall wellness. We recommend completing this quick Perceived Stress Scale (PSS) to determine how your stress levels are doing.
The most cited physical symptoms associated with stress are fatigue, headache, upset stomach, muscle tension, change in appetite, teeth grinding, change in libido, feeling dizzy,
Emotional symptoms include irritability, anger, feeling nervous, lack of energy and feeling as though you may cry.
THE SCIENCE:
Autonomic nervous system is comprised of our sympathetic and parasympathetic nervous system. Stress activates the hypothalamic-pituitary-adrenal axis which triggers a hormonal response (cortisol) and sympathetic nervous system.
The sympathetic nervous system (SNS) is in charge of our fight or flight response, a defense mechanism to protect our body from harm. The SNS is responsible for a hormone cascade that results in elevated cortisol, increased heart rate, increased blood pressure, sweating, increased respiratory rate and increased insulin and blood glucose. In a stress state, our body elevates our energy source, glucose, in the event we need to literally run for cover. If your body is in a constant state of stress, it can cause a number of unwanted symptoms including anxiety, depression, hypertension, heart disease, thyroid imbalances, sugar and carb cravings, and weight gain (especially around your abdomen from elevated blood sugar).
These days, most of us aren’t being chased by wild animals or having to defend ourselves from danger but on a cellular level we are. We work long hours, have stressful jobs, try and juggle social activities for ourselves and our family, we don’t sleep enough and many of us are doing long high intensity exercise in an attempt to get the weight off!
It’ll be very difficult to shed the pounds if your body is in survival mode.
Here’s where the parasympathetic nervous system (PNS) comes in, the one in charge of rest and digest. It is our bodies counterbalance to stress. It supports our bodies ability to calm down, sleep, recover, lower the heart rate and digest the food we’ve eaten.
In my experience, time has a way of teaching you.
While in my last year of grad school, we had our second child. He was dreamy and perfect, slept all night and made life with a newborn manageable while also being a fulltime graduate student. After graduating, I quickly transitioned to working and continued to figure out what it meant to have a work/life balance.
On paper everything was going well! My family was healthy, I was fortunate to have a job that accommodated being present with my family, and was learning and growing at work. But after a few months of working, I started to experience heart palpitations, chest tightness, heart racing and changes to my menstrual cycle which was VERY abnormal for me. My day was spent waking early, hustling to get our family ready for dropped off by 7:30am to make it to the clinic by 8:00am. I’d work a full day, seeing approximately 15-20 patients/day, refilling medications, making phone calls, and charting. As a new medical provider straight out of graduate school, it is already a steep learning curve, not to mention there was growing instability within the hierarchy of my work. I’d head home in the afternoon to continue the family hustle, dinner, baths, and off to bed. On my free time, I would go to the gym doing HIIT training further taxing my already stressed body. No wonder I was having physical symptoms! Fast forward 1 year and my symptoms have disappeared. With the assistance of a provider, we realized that while I was postpartum and certainly had hormonal imbalances, stress also played a huge role in my physical symptoms. Now that I’ve experienced what many of my patients feel, I have a firsthand understanding of ways to support them finding balance.
Here at STAT Wellness, we take a functional medicine approach to care, getting to the root of your health issues. Since stress can affect our health in a number of ways, we have many options for analysis to assess how you are coping with the stress factors in your life. Some tools we use include:
A wellness panel is the place we start with most of our patients. It gives us a large amount of information on where you stand on the wellness to illness spectrum. Within our wellness panel we analyze the quality of your blood, liver, kidney, blood sugar, cholesterol, nutrients, and hormones such as cortisol and DHEA which are produced by the adrenal glands in response to physical and emotional stress. This lab is drawn within one hour of waking and fasting which is when our cortisol should be the highest throughout the day. While this is a useful test, it only gives us a snapshot of one moment in time– when the blood is drawn. For some patients we need to dive deeper.
For someone who we suspect are having adrenal dysfunction, we may recommend an adrenal saliva test. This is collected at home at 4 points throughout the day to get a better sense of how your adrenals are responding throughout the day by looking at cortisol and DHEA hormones. Our goal is that your cortisol is high in the morning and gradually reduces as the day goes on. We want cortisol nice and low at night to help you get a good night rest.
Another tool we use to get a better idea of what’s happening within your body is the DUTCH test (Dried Urine Test for Comprehensive Hormones) is a useful tool to not only evaluate free and metabolized cortisol. This test is particularly useful because it gives total output of metabolized cortisol to assess not just production of stress hormones but also how you are metabolizing and clearing them. Other hormones measured in the DUTCH test include DHEA but also hormones like estrogen, progesterone, testosterone, epinephrine and norepinephrine. This test looks at 4 samples (5th one if you wake up in the night) over 24 hours. This gives a much larger and detailed picture of hormonal function.
With the results of these tests, your Provider can make recommendations for treatment, diet and lifestyle adjustments to help you thrive because wellness feels good.
If you’re looking for an in depth look at how stress is affecting your health, you can schedule a personalized medical visit with Kristin or Athena here!
In good heatlh,
Sources
https://www.apa.org/monitor/2011/01/stressed-america
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066570/
Kivimäki M, Virtanen M, Elovainio M, Kouvonen A, Väänänen A, Vahtera J. Work stress in the etiology of coronary heart disease—A meta-analysis. Scandinavian Journal of Work, Environment, and Health. 2006;32:431–442. Retrieved from http://dx.doi.org/10.5271/sjweh.1049.
Epel, Elissa S et al. “Accelerated telomere shortening in response to life stress.” Proceedings of the National Academy of Sciences of the United States of America vol. 101,49 (2004): 17312-5. doi:10.1073/pnas.0407162101
Cindy M. de Frias & Erum Whyne (2015) Stress on health-related quality of life in older adults: the protective nature of mindfulness, Aging & Mental Health, 19:3, 201-206, DOI: 10.1080/13607863.2014.924090
https://www.zrtlab.com/diurnal-cortisol-curves-saliva-vs-urine/
