I see this every day in my practice. I have a lot of patients that are following a “perfect” diet, and yet they are still sick. Stress is often the cause. (I’ll define stress more clearly in a moment.) Yet as pervasive as stress is, many people don’t do anything to mitigate its harmful effects. The truth is it’s a lot easier to make dietary changes and pop some pills (whether drugs or supplements) than it is to manage our stress. Stress management bumps us up against core patterns of belief and behavior that are difficult to change.
I suspect this is why all of the articles I’ve written about stress management are among the least shared on Facebook and Twitter and have elicited the fewest comments. I think many of you may feel defeated or overwhelmed by stress. I understand this. Stress management is hard. It asks a lot of us. It forces us to slow down, to step back, to disengage (if only for a brief time) from the electric current of modern life. It asks us to prioritize self-care in a culture that does not value it.
While I feel your pain, and still struggle with stress management myself, I’ve got to lay down some tough love here. If you’re not doing some form of regular stress management, you will sabotage all of your best efforts with diet, exercise and supplements. Stress management is absolutely crucial to optimal health and longevity. If most health conscious people spent even half the amount of time they spend focusing on nutrition and exercise on managing their stress, they’d be a lot better off.
I’m going to suggest several strategies for stress management at the end of the article, but first let’s define stress more explicitly and learn more about the harm it causes.
What is stress?
Hans Selye, the famous physiologist who coined the term “stress”, defined it this way:
…the nonspecific response of the body to any demand made upon it.
The prominent psychologist Richard Lazarus offers a similar definition:
…any event in which environmental demands, internal demands, or both tax or exceed the adaptive resources of an individual…
At the simplest level, then, stress is a disturbance of homeostasis. Homeostasis is the body’s ability to regulate its inner environment. When the body loses this ability, disease occurs.
The adrenals are two walnut-shaped glands that sit atop the kidneys. They secrete hormones—such as cortisol, epinephrine, and norepinephrine—that regulate the stress response. Because of this, the adrenals are what determine our tolerance to stress and are also the system of our body most affected by stress.
Most people are aware of the obvious forms of stress that affect the adrenal glands: impossibly full schedules, driving in traffic, financial problems, arguments with a spouse, losing a job and the many other emotional and psychological challenges of modern life. But other factors not commonly considered when people think of “stress” place just as much of a burden on the adrenal glands. These include blood sugar swings, gut dysfunction, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems, inflammation, and overtraining. All of these conditions sound the alarm bells and cause the adrenals to pump out more stress hormones.
Adrenal stress is probably the most common problem we encounter in functional medicine, because nearly everyone is dealing with at least one of the factors listed above. Symptoms of adrenal stress are diverse and nonspecific, because the adrenals affect every system in the body. But some of the more common symptoms are:
- Decreased immunity.
- Difficulty falling asleep, staying asleep and waking up.
- Mood swings.
- Sugar and caffeine cravings.
- Irritability or lightheadedness between meals.
- Eating to relieve fatigue.
- Dizziness when moving from sitting or lying to standing.
- Digestive distress.
How does stress harm the body?
The short answer is “in every way imaginable.” It would take books to explain the full effects of stress. And those books have been written. Check out Why Zebras Don’t Get Ulcers by Robert Sapolsky and When the Body Says No: Exploring the Stress-Disease Connection by Gabor Mate for a more thorough investigation. I’m just going to summarize here.
When stress becomes chronic and prolonged, the hypothalamus is activated and triggers the adrenal glands to release a hormone called cortisol. Cortisol is normally released in a specific rhythm throughout the day. It should be high in the mornings when you wake up (this is what helps you get out of bed and start your day), and gradually taper off throughout the day (so you feel tired at bedtime and can fall asleep).
Recent research shows that chronic stress can not only increase absolute cortisol levels, but more importantly it disrupts the natural cortisol rhythm. And it’s this broken cortisol rhythm that wreaks so much havoc on your body. Among other effects, it:
- Raises your blood sugar.
- Weakens your immune system.
- Makes your gut leaky.
- Makes you hungry and crave sugar.
- Reduces your ability to burn fat.
- Suppresses your HPA-axis, which causes hormonal imbalances.
- Reduces your DHEA, testosterone, growth hormone and TSH levels.
- Increases your belly fat and makes your liver fatty.
- Causes depression, anxiety and mood imbalances.
- Contributes to cardiovascular disease.
These are all well-documented in the scientific literature, and the list of health problems caused by stress goes on. And on. In fact it’s not a stretch to suggest that stress contributes to all modern, chronic disease.
But most people don’t need much convincing of this. You’ve witnessed the negative effects of stress firsthand, every day of your life. So the question is, what do you do about it?
How to reduce the impact of stress
There are two different approaches to reducing the impact of stress, and both are important:
- Reduce the amount of stress you experience.
- Mitigate the harmful effects of stress you can’t avoid.
Reducing the amount of stress you experience
Reducing stress means just what it sounds like: reducing your total exposure to all forms of stress, whether psychological or physiological. Of course it’s never possible to completely remove stress from our lives. But even in the most stressful of circumstances, it’s still possible to reduce stress.
The first step is to avoid unnecessary stress. This often seems obvious, but it isn’t. It’s easy to overlook habitual patterns of thought and behavior that cause unnecessary stress above and beyond the stress we can’t avoid. Here are a few guidelines for how to avoid this kind of stress:
Learn to say “no”. Know your limits, and don’t take on projects or commitments you can’t handle.
Avoid people who stress you out. You know the kind of person I’m talking about. Drama kings and queens. People who are constantly taking and never giving. Limit your time with these people or avoid them entirely.
Turn off the news (or at least limit your exposure to it). If watching the world go up in flames stresses you out, limit your exposure to the news. You’ll still find out what’s going on and still be able to act as a concerned citizen. But you’ll have more time for yourself. I stopped getting the paper years ago (except for Sunday), and don’t even have a TV. Believe it or not, I’m still well-informed. The difference is I get to choose what I’m exposed to.
Give up pointless arguments. This is especially true for useless internet debating. There is obviously a place for discussion and debate, and working towards change. But have you noticed that most arguments don’t lead to change? In fact, they tend to have the opposite effect—each side becomes more defended and entrenched in their worldview. Find other ways to get your point across, learn to listen with empathy, and don’t waste precious time and energy trying to convert fundamentalists to your religion.
Escape the tyranny of your to-do list. Each day spend some time in the morning really considering what needs to be done that day. Drop unimportant tasks to the bottom of the list. Better yet, cross them off entirely. The world will go on.
The second step in reducing the amount of stress you experience is to address any physiological problems that are taxing your adrenals. These causes include anemia, blood sugar swings, gut inflammation, food intolerances (especially gluten), essential fatty acid deficiencies and environmental toxins. If you have one or more of these conditions, it’s probably best to get help from a skilled practitioner.
Mitigating the harmful effects of stress you can’t avoid
Obviously there are times when we just can’t avoid stress. Maybe we have a high-stress job, or we’re caring for an ailing parent, or we’re having difficulty with our partner or spouse. In these situations it’s not about reducing stress itself, but about reducing its harmful effects.
How do you do that? There are several different strategies:
- Reframe the situation. We experience stress because of the meaning we assign to certain events or situations. Sometimes changing our perspective is enough to relieve the stress. For example, being stuck in traffic can be a “disaster” or it could be an opportunity for contemplation and solitude.
- Lower your standards. This is especially important for you perfectionists out there. Don’t let the perfect be the enemy of the good. Let good enough be good enough.
- Practice acceptance. One of my meditation teachers used to say “All suffering is caused by wishing the moment to be other than it is.” Many things in life are beyond our control. Learn to accept the things you can’t change.
- Be grateful. Simply shifting your focus from what is not okay or not enough, to what you’re grateful for or appreciative of can completely change your perspective—and relieve stress.
- Cultivate empathy. When you’re in a conflict with another person, make an effort to connect with their feelings and needs. If you understand where they’re coming from, you’ll be less likely to react and take it personally.
- Manage your time. Poor time management is a major cause of stress. When you’re overwhelmed with commitments and stretched too thin, it’s difficult to stay present and relaxed. Careful planning and establishing boundaries with your time can help.
In addition to everything I’ve listed above, one of the most important things you can do to manage stress is to bring more pleasure, joy and fun into your life. This is the subject of Step 9, so I’ll just mention it briefly here.
Stress management practices and techniques
All of the stress management tips above are important and can make a huge difference in your health and well-being. However, there’s a certain amount of stress in modern life that is simply unavoidable for most of us. That’s why it’s so crucial to have a regular stress management practice.
There are a lot of options here, of course. Things like exercise, yoga, tai qi, qi gong, a walk on the beach, etc. can all relieve stress. I’ll just share the practices I’ve found to be most helpful for myself and my patients over the years.
In spite of the fact that I’m listing it here, I don’t consider meditation as a “stress management” technique—although it can certainly have that effect. Meditation is an awareness practice. Through meditation we learn to witness our thoughts, feelings and sensations and dis-identify with the story we tell ourselves about them. We learn to stay present to our lives even in the face of great difficulty or pain.
Contrary to popular belief, you don’t have to be able to “relax” to meditate. Sometimes we are relaxed during meditation; sometimes we are quite agitated. We don’t meditate to manipulate our feelings, but to learn to observe them without reacting to or “becoming” them.
One of the books I often recommend to people who’d like to learn more about meditation practice is Opening the Hand of Thought, by Kosho Uchiyama. Another excellent resource is Meditation for Beginners by Jack Kornfield.
Mindfulness-based stress reduction
Mindfulness-Based Stress Reduction (MBSR) combines mindfulness meditation and yoga to cultivate greater awareness of the unity of mind and body, as well as of the ways the unconscious thoughts, feelings, and behaviors can undermine emotional, physical, and spiritual health. It was developed by Jon Kabat-Zinn at the Stress Reduction Clinic at the University of Massachusetts Medical Center in 1979.
Through clinical research at the University of Massachusetts and elsewhere, MBSR has been shown to positively effect a range of autonomic physiological processes, such as lowering blood pressure and reducing overall arousal and emotional reactivity. MBSR is offered as an 8-week intensive training in hospitals and medical centers around the world. You can also learn via home study with books and audio recordings. MBSR is particularly effective for anyone struggling with chronic illness or pain.
The word yoga comes from the Sanskrit yuj, which means “to unite.” Today, yoga is used as a general term to refer to physical, mental, and spiritual disciplines that originated in ancient india. Yoga has been shown to reduce stress as well as improve cardiovascular and respiratory health, flexibility, cognitive performance, and overall well-being. It is particularly effective in relieving stress-induced or stress-related disorders such as insomnia, anxiety, depression, hypertension, and asthma.
Yoga is a great choice for stress management for several reasons. First, it’s a movementbased practice, which is often suitable for people who are new to stress management or who have very busy minds and find it difficult to sit still. Second, yoga is often practiced in a group or class setting, which has additional benefits. Third, because of its popularity, it’s now easy to find a class in most places.
Biofeedback is a process of becoming aware of the body’s physiological functions. Specialized sensors deliver information about blood pressure, heart rate, skin temperature, and muscle tension, which the participant uses to learn to modify his or her physiological response to stress.
Biofeedback has been shown to significantly reduce stress and anxiety in groups of people who are highly stressed, such as nursing students and physicians. It has also been shown to reduce chronic pain associated with stress, to improve sleep in soldiers in combat zones, and to lessen preoperative anxiety in children with cancer. In the past few years, low-cost, portable biofeedback devices have been developed that work with smartphones and tablets. (Emwave2, BioZen, and Quantum Life are examples.) This is perhaps the easiest and most accessible way to learn biofeedback.
- Make stress management a high priority.
- Reduce the amount of stress you experience.
- Mitigate the harmful effects of stress you can’t avoid.
- Practice regular stress management techniques like meditation, mindfulnessbased stress reduction, yoga or biofeedback.