Stress Management as Medicine

Psychological stress is an important factor in the development of most diseases and in our response to all illnesses and injuries.  The mind cannot be separated from the body, our thoughts and emotions influence our physical functions and our physical functions influence our thoughts and emotions.  Learning to manage stress effectively will not only prevent disease but also speed our recovery to optimal health.

 The concept of stress was introduced in1936 by Han Selye, an endocrinologist who noticed that lab animals developed a similar set of physical responses when exposed to unpleasant experiences regardless of the actual experience. He initially defined stress as a “non-specific response of the body to any demand for change.” This is still the best definition in my opinion because it allows for both negative and positive aspects of stress and hints at the management.

The stress response is activated when the brain perceives a demand for change in our internal or external environment.  The brain increases awareness and activates the adrenal glands which produce several hormones including Epinephrine (adrenalin) and Cortisol.  Epinephrine’s effects last for about 2 minutes and include increasing heart rate, breathing rate, blood pressure, blood glucose, and blood triglycerides for quick energy. It shunts blood away from the reproductive and digestive systems to the muscles for “fight or flight,” it makes blood clot faster in case of injury and it produces fear. Cortisol has a wide range of effects on almost all organ systems and is essential for normal metabolic function.  It is normally secreted in a diurnal pattern, with the highest levels around 6:00 – 8:00 AM for energy to start the day and the lowest levels around midnight- 4:00 AM during sleep.  During the stress response Cortisol’s actions include:
¨Enhancement of Epinephrine’s actions
¨Insulin resistance to increase blood glucose, triglycerides and amino acids for energy
¨Muscle breakdown to provide amino acids to the liver for increased glucose production     ¨Increased thyroid function to increase cellular metabolism for more energy
¨Decreased bone formation by inhibition of bone forming cells and calcium absorption
¨Decreased sex drive and reproductive function to avoid distraction
¨Inhibition and decreased sensitivity to progesterone, estrogen and testosterone
¨Shut down of the digestive system to conserve energy
¨Redistribution of fat to more metabolically active storage areas such as the abdomen and face
¨Disruption of memory formation and retrieval
¨Increased dopamine secretion in the brain for motivation and problem-solving
¨Suppression of the immune system to conserve energy

The stress response has 3 stages, the alarm reaction, adaptation and exhaustion.  Ideally, it is a temporary situation that ends after the alarm reaction where we fight, run away or adapt and if we survive our hormone levels return to normal. Unfortunately we cannot physically fight, run away or quickly adapt to many modern “demands for change” such as poverty, loneliness, marital conflict, fear of losing a job or getting a new job.  Sustained high levels or repeated surges in Cortisol disrupt the normal rhythm and lead to multiple hormonal imbalances and medical problems such as high blood pressure, bone loss, loss of muscle mass, and decreased sex drive. Prolonged insulin resistance and increased abdominal fat contributes to type 2 diabetes; increased blood clotting can lead to heart attacks and strokes, suppression of the immune system can lead to increased susceptibility to infections, slow wound healing and cancer growth.  Repeated dopamine surges in the brain leads to decreased dopamine receptors in the frontal cortex and addictive behaviors.  Repeated adrenal stimulation eventually leads to adrenal exhaustion, low Cortisol levels and a decreased ability to respond to further stress.  Low Cortisol levels are associated medical problems such as chronic fatigue, decreased thyroid function, susceptibility to chronic inflammatory autoimmune diseases such as lupus, and dependence on stimulants such as caffeine and amphetamines.  Effective stress management can prevent all of these conditions and make current medical treatments more effective.

Stress management can be challenging because human beings interpret their reality in different ways.  If you look at roller coaster riders you will see some with their eyes shut, jaws clenched and knuckles white from gripping the retaining bar, while others with their arms in the air enjoy every steep drop. The reality is the same, but the perceptions, expectations and stress levels are very different.   Effective stress management strategies include meditation, prayer, yoga and exercise but these strategies could be stressful if an individual feels forced to participate.

Natural ways to maintain normal Cortisol levels include:
1. Meditation, learn to meditate, and practice twice a day for 15-20 minutes.  Research consistently shows that meditation lowers cortisol levels and decreases high blood pressure.

2. Laughter, whenever possible see the humor in life events, laughter decreases Cortisol levels.

3. Massages, find a good masseuse and set a standing monthly appointment, massages decrease cortisol and increase serotonin and dopamine, hormones that increase feelings of wellbeing.

4. Maintaining good hydration decreases Cortisol levels.  Divide your weight by half and then divide that number by 8.  That is the number of 8 oz glasses of water you need every day.

5. Eating more fruits and vegetables as part of a whole food, low fat, plant based diet
¨      Factory farmed animals live under constant stress and even free range “happy” animals have a stress response when they sense that they are about to be killed.  When we eat these dead animals we are not just getting their artery-clogging cholesterol we’re also getting their Cortisol which is actually made from cholesterol.
¨      Meals high animal protein increases Cortisol secretion, high plant protein meals do not.
¨      Vitamin C in fruits and vegetables inhibits Cortisol release

6. Avoid stimulants such as caffeine that whip your adrenals to increase Cortisol secretion. If you like coffee or tea, drink it only in the morning when Cortisol levels are normally higher; later in the day high it may disturb sleep. Stop drinking sugary high caffeine sodas and energy drinks. Caffeine is a stimulant drug; withdrawal can last up to a week and be very unpleasant. If you cannot function without caffeine or other stimulant drugs you may have adrenal exhaustion, you should have your Cortisol levels tested.

7. List the activities that make you happy and increase the time you spend on each activity every day or week.  Feelings of happiness and contentment maintain normal Cortisol levels.

8. Choose your partners and friends carefully especially if you are a woman.  When married men go home after work, their cortisol levels drop regardless of how happily married they are. When married women go home after work their cortisol levels only drop if they are happily married, if not their cortisol level rises.  Having close friends and social support decreases cortisol levels, conflict and isolation increases it.

9.   Get enough sleep; lack of sleep causes a negative stress spiral.  High cortisol levels inhibit sleep and lack of sleep increase cortisol levels.  You have to break the cycle by making relaxation and sleep a priority.

10.  Giving up control and taking command of your life.  Control is an illusion that causes stress and increased Cortisol levels when things don’t go our way.  Learning to take command means acknowledging that you have no control over life events such as getting a disease or loss of someone’s love but you can be prepared and make intelligent decisions about what to do in response to whatever happens.