Transcript
Let’s talk about stress.
It is just such a common, common problem that we see in practice today.
I think everybody is stressed and it comes as no surprise because we are really living in unprecedented times in terms of just pace and information overload.
But we can’t learn how to manage our stress or how to build resilience if we don’t understand what’s actually happening in our bodies.
So let’s go through it.
Stress can be a real threat, something really obvious, like the threat to our health or our lives or injury, for example.
But it can also just be a potential or a perceived threat and that’s really, really important to understand because sometimes I ask patients, well, you know, do you feel stressed?
And they turn around and they say, absolutely not.
I’ve got nothing to be stressed about.
But even if we’re not aware of stress or it’s not overt, it can still be there.
For example, if you have a little gum infection that you’re not even aware of, that is enough to create inflammation in your body and the signal of inflammation in your body is the stress signal that can set off your whole stress response system.
Also, if we think about the emotional landscape, there are sometimes feelings that we’re not fully, fully conscious of, feelings such as rage or anger or grief that may unconsciously be triggering our physical stress response system all the time.
So we need to be clear and careful about how we think about stress and how we define stress.
When we are stressed, what happens is we activate the physical stress response system of the body, which is primarily comprised of three things, your brain, your adrenal glands where you make cortisol and some adrenaline and noradrenaline, those are the hormones of stress, and your autonomic nervous system.
The autonomic nervous system has two branches.
It has a sympathetic branch, which is part of your fight-and-flight response, and then it has a parasympathetic branch, which is all about relax, digest, rest, and recover.
We’re hearing a lot at the moment about nurturing the parasympathetic nervous system and improving vagal tone, but we’re going to talk about these strategies in some of the other vlogs to come.
So we have a stress response system that’s made up primarily of these three organs in the body.
And really, when we’re stressed in the short term, when we’re facing something like a deadline or a breakup, or perhaps even if you’re an athlete and you’re gearing up for a race, the body has to meet challenge.
So stress is the force of challenge that is being placed upon the body and mind, and the body is designed to respond to that, to galvanize itself through the stress response system to meet that challenge.
And if we just look at the picture here, at the topmost picture, you can see an example and graph form of what a normal, healthy stress response would look like.
So in this graph, we see that when there’s stress or pressure or challenge, the stress response system responds to that.
The graph goes up, which shows us that there is a galvanization, an activation of the stress response system, and we should be able to meet the demand or the pressure or the deadline.
When that demand or pressure or challenge is then over, the whole system should then calm down and return to normal, which we can also see represented in this picture.
So after the stressful situation is dealt with, there is recovery, and the whole stress response system and all our stress chemicals settle down, and that is what we would call a healthy and adaptive stress response.
So it’s all about being able to rise up to challenge, meet challenge, and adapt to challenge and change.
It’s when we lose the ability to adapt to change and pressure that things start to go wrong.
So we can start to see real health problems develop when people go on to develop chronic or long-term stress responses.
So in the short term, short-term stress can be a very healthy thing, a very adaptive thing.
You can see in the picture on the slide, second from the top, the graph doing this a little bit, and that just really shows us that we can go in and out of an acute or short-term stress state many times in a day, and that can be normal.
You know, you have a meeting at 10 o’clock, then a kids’ concert at 11 o’clock, and then a call with your lawyer at 12 o’clock, and then perhaps a meeting with your doctor at 4, and you’re in and out of stress throughout the day, absolutely fine.
It also shows in the picture just next to that that we do, in fact, have the inherent ability to adapt to stress and pressure, meaning that if we know what to do, what tools to deploy or use, when we are met with challenge or change or stress, we can actually train the body to respond in a less pronounced way over time.
So there’s the potential for adaptation, which is curious because it gives us a tool to use to counter stress.
When we go into long-term stress, this means that we’re not recovering properly between stressful episodes.
So it’s very different having short-term stress, like cutting your finger, and then your body recognizes that it’s injured and deploys the stress response system to fix and correct the injury, to then going into a long-term stress response, which doesn’t shut off.
So the key to a healthy short-term stress response is that there’s a break, there’s an endpoint, there’s recovery.
If the body gets into a dysregulated state where it cannot recover, we go into the territory of long-term chronic stress, and in medicine we say this is a maladaptive response, it’s not healthy anymore, there are consequences for your health.
We recognize that there are two distinct types of patterns to chronic stress.
The first, represented by the bottom left-hand side picture, is a hyperactivated stress response system.
This means a system that is overactive, and it also means that patients in this space often have higher levels of circulating cortisol.
We can’t always test this on a blood test because blood cortisol testing is often not accurate, but in theory and in research studies, these are people who are producing high levels of cortisol consistently over time, and this is really, really not great for health because if you’re producing high cortisol all the time, you’re going to feel wired, edgy, irritable, you’re going to feel like you’re living off fumes, you’re going to feel tired because it’s really hard for the body to sustain the state of high cortisol production.
Cortisol is not great for the brain, so our concentration, our ability to concentrate goes down as well.
We may develop that cortisol belly weight around the middle, sugar problems, and even blood pressure problems.
The body can’t stay in such a high cortisol state permanently, so after a period of time, if we don’t find a way to adapt to the pressure and the stress, we can go into a different kind of unhealthy stress response where we actually become underactive or hypoactivated.
The whole stress response system almost shuts down or shifts itself down, and we can go into a state of lower cortisol production.
So this is the body’s way of actually trying to protect itself from the very high levels of cortisol that are not good for it.
But unfortunately, that attempt of the body to adapt and protect itself by shutting down the stress response system almost backfires in a sense because if we have low circulating levels of cortisol, unfortunately, we also don’t feel well and we also have symptoms.
So some of the symptoms of low circulating cortisol might be things like absolute exhaustion, not just fatigue, but really pronounced fatigue, poor concentration, brain fog, depressive symptoms, melancholia, feeling flat, feeling apathetic.
Studies have shown that patients who have low circulating levels of cortisol often have a higher association with pain.
So we see this link typically in patients who have illnesses like fibromyalgia or chronic widespread pain.
And then there’s also a really, really interesting relationship between cortisol and the immune system, and they are intricately linked.
So when patients are in a low cortisol space, we often see that the immune system shifts more towards an inflammatory state.
So it can be a time where things like autoimmune diseases develop or allergies, things like eczema on the skin or even asthma.
So knowing about long-term unhealthy stress is super important and knowing about the different kinds of patterns, because it’s not just going to affect how you feel today, some of the symptoms you might be having, but the effects on the entire system of your body and the future of your health are profound.
