Like inflammation, stress is an example of something that isn’t inherently bad for the human body but becomes problematic because of modern life. We talk about stress and being stressed probably more regularly than we discuss any other aspect of our health and wellness. However, it has become so big and so vague that we lose sight of the fact that stress isn’t external events. And we have far more control over our stress response than we do over our toxin exposure.
Stress is how our body responds to life events with the appropriate output of resources. Stress is heavily influenced by our life events (stressors), the chronic nature of them, and even our perceptions of them. And understanding all of this isn’t as complicated as most research papers would have you believe and is a very important part of anyone’s personal wellness plan.
What Is Stress?
Stress affects us all differently. Some people thrive on it and use that energy to get shit done. Others feel overwhelmed and check out. Maybe you get energized and motivated. Maybe your shoulders get tight. Maybe your whole body gets tight. Maybe you yell at people or drive recklessly. Maybe you space out. We all respond differently based on our previous experiences.
Physiologist Walter Cannon first proposed the idea of the “acute stress response” in 1915. He also termed it the “fight or flight response”—which is going to sound familiar; remember, the fight or flight response (which is, yes, also called the SNS vagal response) is what becomes trauma if it gets stuck. His use of the term “stress” comes from the engineering field. Stress, in the context of engineering, refers to the pressure or tension imposed upon material objects. Because (no shit) we are also material objects and experience pressure or tension on our state of being.
In the 1930s, a physiologist named Hans Selye’s inability to do basic lab draws led to our first understanding of the effects of stress on the body. He was trying to study the effects of ovarian extracts on rats but sucked horribly at the injections. He kept dropping the rats and ended up chasing them around the laboratory for hours on end. Fortunately, he was far better physiologist than rat handler, and he noticed that his ineptness was causing enlarged adrenal glands, fucked up immune systems, and ulcers in all of the rats that were fried by his continuous bullshit.
Our bodies are quite able to manage occasional stressors and have a nice orderly way of doing so. But as Selye discovered through his dumbass behavior, our bodies are not designed to respond to stress all the fucking time. When that happens our bodies get overloaded and we get sick. Selye referred to this overload as general adaptation syndrome, which today is called “adrenal fatigue.”
But in a clinical sense, stress is a more neutral term that refers to any event that requires an output of resources.
Stress can be good (output of resources to create art, run a race, or finish school) or it can be bad (coping with a car accident, an illness, or being terminated from a job). Kelly McGonigal, in her book The Upside of Stress defines stress in terms of meaning. Things are stressful to us because they fucking matter to us.
Whether the situation is good or bad, we can hit a point where we run out of the resources that we need to cope with the situation. And that is what distress is. The point of resource depletion. The point where we need support. It isn’t something you can do on your own. It isn’t a term that identifies someone as tragically fucked up. It’s a clinical term that we understand to mean this person needs some help.
If you have tipped into distress, maybe it’s because life has been throwing you too many curveballs and then you also just spilled your coffee and it was the last fucking straw. Or maybe it’s a lot of great stuff happening, like you’re on a fun trip and you hit exhaustion/sensory overload and the ziplining event reduces you to tears even though you were the one who planned it. They are both distress, not because they’re equivalently upsetting but because they’re overloading your system.
And it’s distress that researchers are talking about when they say that our “stress” numbers are through the roof, worldwide, according to the data collected within Gallup’s 2018 Negative Experience Index. The index tracks the human experience of stress, anger, pain, sadness, and worry throughout the world. In 2017, the global index score hit a new high score of 30. All of the markers of negative experiences went up in 2017 except anger (yeah, I dunno why not either). And stress and worry numbers went up the most, with almost 4 out of every ten people reporting stress and worry.
How Does Stress Work?
Stress—or distress—is regulated by something called our “HPA axis”, short for Hypothalymic-Pituitary-Adrenal Axis, which is basically our central nervous system as it is intertwined with our endocrine system—which produces our hormones.
The HPA axis is designed to keep our body balanced (or as scientists put it, in homeostasis). This means, weirdly enough, helping us react appropriately to stress. In order to stay on an even keel, we are meant to deal with problems quickly and efficiently so we can go back to point chill. Two of the main hormones that the HPA axis deploys to deal with stress, however, cause problems when they are activated regularly and run rampant. They are cortisol and adrenaline.
When our body determines an event to be stressful, a cascade of events is set off. The amygdala—the emotional center of the brain—starts the process, sending a signal to the hypothalamus in the brain stem region, which has the task of releasing hormones to help us level up to respond to the stressor. The hypothalamus flips the switch for the sympathetic nervous system to get ready to engage and tells the vagus nerve to shoot a message down to the adrenal glands that they need to pop the tab on an energy drink.
The adrenal glands say “bet” and release adrenaline into the bloodstream. Adrenaline (also called epinephrine) ups our heart rate and our blood pressure, expands our ability to take more air in our lungs, makes our pupils expand so we can take in more visually, and redistributes blood to our muscles. It gets us ready for action. Adrenaline is our first line of defense. It’s such an immediate response that it happens pre-awareness. Whatever we are looking at, hearing, or smelling, we haven’t even processed the information in the prefrontal cortex—the thinking brain—but the body is already chugging Red Bull. Because it happens so quickly, it also wears off really quickly. It’s that flush of energy you get when you have a really bad scare. Then when you feel kinda nauseous 20 minutes or so later, that’s the adrenaline wearing off.
After the adrenaline kicks in, if the amygdala says “nah, not done yet, need more juice” we end up with cortisol production.7 Cortisol is also a flip-switch for the sympathetic nervous system, causing rapid heart rate and and breathing and all the same energy drink feelings, but even more sustained.
Cortisol is slower-acting in the system than adrenaline, since it’s the second line of defense and is designed to keep our nervous system on the gas to deal with a longer-lasting situation. It takes more time to build up in the body, and takes longer to dissipate back out. When we are trying to test someone’s chronic stress levels, we look at cortisol. Cortisol levels going up are also correlated with vagal tone going down (as measured by heart rate variability), meaning we are far less likely to remain in our window of tolerance.
You’ve probably heard about how cortisol causes belly fat and heart attacks? That’s because it changes the body’s metabolism by altering our blood glucose when it is in our system all the damn time. Cortisol also increases amygdala activation and brakes hippocampal activity (which keeps the hippocampus from going in and telling the amygdala to calm its tits), which leads to more cortisol production (Thanks, brain!).
Continuous cortisol build up makes our thinking brain (the prefrontal cortex) far less effective. Just like trauma, chronic stress changes the blood flow in the brain because the blood flow is going to the muscles of the body to prepare us for an attack. Decreased blood flow means decreased brain activity which creates “holes” in our prefrontal cortex.8 It fucks with our ability to think clearly and remember things that aren’t related to stressful situations. Which is why you feel like you can’t think straight when you are really stressed out, because you can’t think straight when you are really stressed out.
Cortisol is a total asshole, BTW, if it’s something we have in our system on the regular. This whole response of the body makes evolutionary sense. It protected us from predators, right? But that’s not modern life and we are not suited to having this chronic chemical cascade going all the time in the face of everyday stressors.
It’s like driving a car and you get stuck in 5th gear. You may still technically be the one driving, but the actual amount of control you have over the car is pretty low. You’re kinda just looking for a pile of hay to crash into to avoid as much damage as possible, right? (Hi, yes, I grew up on The Dukes of Hazzard, why do you ask?)
The Consequences of Chronic Stress
The question, then, is how exactly does a normal, protective stress response lead to chronic, unhealthy distress? There is no one, singular answer because we are talking about really complex fucking systems. But Western medicine has been catching up in the past decade to what Eastern medical professionals have been saying for about three thousand years and functional medicine practitioners have been saying for over a hundred years—that there is quite likely a huge role being played by inflammation.
So we know inflammation is how the body responds to perceived threats through the production of cytokines activated by the stress response. And we know that the cytokines can stay upregulated when stress is chronic creating the perfect human body soup in which to cook up some physical and mental health issues.
Stress is hell on our guts. That chronic production of cortisol is telling the body to get ready to fight, right? And the opposite of the fight/flight response is the rest/digest response. We can see how the body not having time to do the resting/digesting part affects the gut’s ability to protect us from other illnesses. The gut does this through an immunoglobulin called secretory IgA. Once that system starts going down, pathogens in the gut start running amuck.
Additionally, all that cortisol starts eating the glutamine, which is an essential amino acid, in our gut lining, which strips away another layer of protection. Then we get gut permeability (meaning pathogens get through the gut lining into the rest of the body). This breaks down our gut lining (and other tissue in our body, such as our muscles) and we are now more likely to have food sensitivities, less able to handle toxin exposures, and have more trouble absorbing nutrients in general.
All of this (waves arms around wildly) is modulated by the vagus nerve—both the emotional component and the inflammation component.
Pretty much everything that can go wrong with us, in terms of physical or mental health, has a stress connection. Naming them all and detailing the connection would be a multiple volume book series. WebMD (everyone’s favorite internet diagnostic tool) will tell you that chronic stress causes (to name just a couple) heart disease and asthma. And on the “mental” health side, depression and anxiety are strongly correlated with chronic stress.
Physical Symptoms of Chronic Stress
• Cardiovascular issues like abnormal heart rhythms, high blood pressure, heart disease, heart attacks, and strokes
• Disordered eating patterns and and weird weight fluctuations due to jacked up hunger signals from cortisol
• Menstrual problems
• Loss of sexual desire, sexual dysfunction, impotence, and premature ejaculation
• Problems with hair and skin (hair falling out, skin problems like rashes, eczema, acne, etc.)
• Gut upset (IBS, gastritis, ulcers, nausea, GERD, etc.)
• Low energy
• Headaches, other aches and pains (chronic or acute), and tenseness throughout the body
• Upset stomach, including diarrhea, constipation, and nausea
• Racing heart and rapid breathing
• Other nervous behaviors (fidgeting, picking at cuticles, etc)
• Changes in sleep
• Changes in appetite
• Getting sick more easily than usual (colds, flus, infections)
• Mental health problems, such as depression, anxiety, PTSD, and thought disorders
• Feelings of agitation and frustration
• Uncontrolled mood swings, racing thoughts
• Thinking you are losing control, being out of control
• Low level depression, hopelessness, helplessness, worthlessness
• Unable to relax or enjoy things you usually enjoy
• Avoiding people and situations you generally enjoyed in the past
• Inability to focus, feeling disorganized and forgetful
• Incessant worry
• Making bad choices and judgements
• Always framing things through a negative lens
• Struggling to stay organized and/or focus your attention
• Procrastinating and avoiding responsibilities
• Increased use of substances to manage mood (drugs, alcohol, nicotine, caffeine)
So for those of us with all kinds of continued stress-response upregulation of the HPA axis and its hormonal compadres, we start seeing the effects in our lives. It can also be complicated, because many of the symptoms of stress can be symptoms of other things. Is it stress or is it immediate death butt-cancer?
Saying it again for the people in the back who are worried about going all woo-woo and ignoring other serious medical issues: We always need to rule out other medical stuff that might be going on. And even if it isn’t immediate death butt-cancer, it’s still serious. Your body is trying to get your attention. Because early stress symptoms turn into chronic problems within the body which can lead to serious illness (and yes, more on that later).
Additionally, you may already have already had some of these issues and then they get exacerbated by stress. Everyone with a chronic physical or mental illness is totally nodding their head right now. When you look back at all of the chemicals associated with the stress response and look at how they operate within the body, this list starts to make tons of sense.
Stress affects everyone differently, and clearly, the more chronic the stress, the more likely it is to cause a cascade of issues. Which brings us to…
When Chronic Stress Becomes Worse
When chronic stress starts to cause more severe issues, we have what’s long been referred to as adrenal fatigue. Except you won’t find that diagnosis on your medical records anywhere. The problem is although it sounds clinical as fuck, adrenal fatigue still isn’t an accepted medical diagnosis. Adrenal insufficiency is something that can be measured on lab work, while adrenal fatigue cannot.
Whether we call it adrenal fatigue, general adaptation syndrome, or hypoadrenia, there is no real diagnostic criteria to determine it exists. It’s a catchall term for a set of symptoms like body aches, fatigue, nervousness, sleep disturbances and digestive problems. It’s hard to define what we can’t measure. And the medical establishment understandably worries that there is another medical illness causing those symptoms that are being left untreated, like major depression, Addison’s Disease, or even ME.
And that’s entirely fucking fair. Other serious medical issues should always be ruled out first. But if we do rule out other stuff and are still feeling low-level shitty all the time, we are doing ourselves a disservice by not considering that we might be experiencing a physiological maladaptation to stress causing a chronic dysregulation of the HPA axis.
Our bodies are not designed for being in a constant state of stress. Modern living and anticipatory distress have made it far more likely that we remain in this state of disequilibrium on an ongoing basis. And with more and more research linking patterns of adrenal hormone output to other chronic illnesses, I think that we are doing ourselves a disservice to dismiss that the cascade of events caused by the stress response, if activated constantly, causes dysregulation of the HPA axis. One term I’ve seen more recently in response to this idea is HPA-D (HPA-Dysregulation) as a replacement term for adrenal fatigue.
So rather than looking just at adrenal output as a measure of disease, we are looking at the entire system becoming hypo-activated. That is, slowing down from overuse.9 It’s the body’s ways of adapting, physiologically, to the constant influx of stress hormones—by decreasing production of those same stress hormones. Just like the whole HPA axis activation is a complicated process, so is the adaptation of the process to chronic stress which appears as HPA dysregulation. And when we slow down on producing stress hormones, our body is less able to effectively respond to stress (which remains a legitimate need), which causes more stress, and begins the cycle again. This can lead to more complex physical and mental health issues, like…
While we can’t measure issues within the adrenal glands until they are shutting down (which then gives us a possible diagnosis of a disease like Addisons, Cushings, etc), we can measure for patterns of elevated cortisol with a fairly simple saliva test. We can also measure an individual’s Cortisol Awakening Response and their Cortisol-to-DHEA ratio.
Even easier than that? Another common symptom of HPA dysregulation is orthostatic postural hypotension. Meaning, a drop in blood pressure when you stand up. If I suspect HPA-D, I will have someone lie down on the floor and take their blood pressure after resting there a few minutes (the floor in my office is clean, though, it’s cool). Then I will have them stand up and take it again. Normally, someone’s blood pressure should go up when standing up, but if it drops (especially by 10 or more points) that’s a sign of HPA-D. The bigger the drop, likely the bigger the problem. I know this sounds a little ridiculous, but a recent study of patients in Poland found orthostatic hypertension in all of the study participants who had both adrenal insufficiency and adrenal crisis.
How We Think HPA-D Continues to Self-Reinforce
Long story short, there are usable testing techniques that we can employ to recognize a body overloaded by stress before we develop an even more complex and chronic mental health issue. I see it akin to treating chronic allergies before it becomes a bronchial infection or pneumonia. We can also look at good old clusters of symptoms in our lives.
The symptoms associated with HPA-D may feel super vague to you, but they are still a good starting point. And when we see certain patterns in symptoms we can get a better idea of what’s going on. Symptoms of HPA-D due to chronic stress can look somewhat different from stress symptomatology. Here’s what we look for:
• Difficulty getting up in the morning
• High levels of fatigue each day
• Inability to handle stress (small things get really big, really fast)
• Cravings for salty foods
• Higher energy levels in the evenings (and not just because you are finally away from your stupid job or school day)
• Overuse of stimulants like caffeine (I feel attacked)
• A weak immune system (every bug that makes the rounds, you get)
If this sounds super familiar to you, it’s another case where it’s good to find a doctor who takes this stuff seriously. Not one who says “Hahaha, just relax, it’s not that bad!” Plus, everything we talk about later in this book about supporting a healthy body, was written with stress hormones in mind, not just vagal response (cuz it’s a system that self-references constantly, right?). Making lifestyle changes is hard work, but you’re already doing the hard work of living with an exhausted body, so this will be a cakewalk in comparison!