With a few ifs and buts, the stress response is our friend. Its purpose is to keep us safe.
“When we talk about stress, we’re talking about a shift in the brain’s state,” says Dr Mithu Storoni, neuroscience researcher and author of Stress Proof: The Scientific Solution to Protect Your Brain and Body. “It changes its parameters and activates specific pathways to increase its chances of surviving any challenge.”
Short bursts of stress are protective and useful – whether giving us the focus, motivation and energy to perform in an interview, compete in a race or jump out of the way of an oncoming car.
But if we keep pushing the stress button too hard and too frequently, that acute stress turns into chronic stress. It’s like an overdose of medicine – the cure becomes a poison.
“Stress works best in short bouts – if some is good, more is not better. Instead, more causes harm,” says Storoni. “If the stress response stays switched on, its different pathways go awry.”
The damage to our physical and psychological health can be severe, even fatal. So what happens in the body when we are chronically stressed?
Inflammation
It’s the current health buzzword and is often linked to chronic illness: inflammation.
“Inflammation is part of your immune response,” says immunologist Dr Jenna Macciochi, author of Your Blueprint for Strong Immunity: Personalise Your Diet and Lifestyle for Better Health. “When you first get an infection, a fever, symptoms of a cold or a flu – that’s inflammation in your body making your body inhospitable.”
When you’re in fight-or-flight mode, some inflammatory markers go up almost instantly, adds Storoni. “An acute stress response and inflammation are likely linked because of our evolutionary history. A skirmish with predators would leave us with open wounds and an inflammatory response may have defended us from microbes entering through these wounds, saving our lives.”
In other words, acute stress puts us in a pro-inflammatory state – which, momentarily, is helpful – at least if your stress happens to involve a tussle with a sharp-clawed predator. But, says Storoni, chronic stress can sometimes leave us with persistent low-grade inflammation.
You might not notice any obvious signs of it, such as redness or fever, but, says Macciochi, “it is causing micro-damage around the body”. And chronic inflammation is associated with a host of illnesses, such as cancer, heart disease and inflammatory bowel diseases.
The fix
It’s not always possible to remove yourself from the stressful situation, so find ways to manage your stress, such as trying breathing techniques. Diet is key to reducing inflammation. Avoid highly processed foods, which add to inflammation, and fill your plate with an array of anti-inflammatory colourful vegetables.
Low immunity
Chronic stress suppresses the immune system. This is because if you are stressed, your body has to “triage” your energy, using it where it is most urgently needed.
“Evolution’s thinking is, ‘While I’m running to safety, I’m not going to deal with a head cold – that can wait’. So over prolonged periods of time of feeling constantly stressed, your immune system gets shut off,” says Macciochi.
The fix
“One of the most important factors in immunity is good gut health, since a significant proportion of our immune system resides in our gut,” says Kate Llewellyn-Waters, nutritionist and author of The Immunity Cookbook. So feed your gut microbes on a wide variety of prebiotic- and probiotic-rich foods.
Prebiotic-rich foods – containing nutrients that are broken down by gut bacteria – include apples, asparagus, artichokes and bananas. Probiotics, which are important for live microbes, include fermented foods, like sauerkraut, tempeh, miso, kefir and live natural yoghurt.
Skin flare-ups
When we’re chronically stressed, our immune system can turn on us, attacking parts of our body, including our skin. This is the case with auto-immune diseases such as psoriasis, which causes painful dry and flaky skin.
A dysregulated immune system can also affect allergic conditions, while eczema (or atopic dermatitis) may also be influenced by stress.
The fix
First-line treatments include moisturisers and creams. For many, though, these are ineffective and stronger topical steroids are often prescribed to help manage psoriasis and eczema.
Immunosuppressant medications, which inhibit inflammatory cells in the body, can help. Light therapy, which slows down the production of skin cells, is an effective treatment for some types of psoriasis.
Some suggest bathing in Dead Sea salt, while some research suggests that certain nutrients, including omega-3 fatty acids, may help reduce inflammation.
Teeth grinding
We feel physically tense when we’re stressed because our system is preparing to either run or fight, says Dr Sabine Donnai, consulting GP and founder of the Viavi Health Strategy clinic.
“If there’s no physical exertion following that stress reaction, you tense up more and more. Some of us feel that tension in our jaw, and we grind our teeth, because the muscles are seizing up completely.”
Donnai often sees chronically stressed patients who grind their teeth during sleep. “Their body has forgotten how to switch off. They’re in fight-or-flight mode day and night,” he says. Ideally we’d move and stretch our muscles to release that tension, she says. “That is why exercise is the best strategy for stress.”
The fix
A mouthguard can help with teeth grinding, and some people – in extreme cases – get good results from Botox injected into the jaw muscles, which can reduce clenching. Cognitive behavioural therapy (CBT) and other relaxation techniques have also been shown to be effective.
Depression
Chronic stress can increase the risk of depressive symptoms through routes involving melatonin (a hormone that affects sleep) and the body’s clock.
In a healthy person, there’s a natural burst of cortisol first thing in the morning, 35-45 minutes after waking up. “This cyclic regulation seems to be important for mental well-being,” says Storoni. However, under chronic stress, this natural variation in cortisol can change.
“Chronic stress can flatten the burst of cortisol we typically produce first thing in the morning,” she adds. A blunted cortisol awakening response (CAR) may, in turn, impair the way the body reacts and recovers from acute stress, so that we don’t clear stress hormones as quickly, perpetuating the state of chronic stress throughout the day.
The fix
Several studies show that yoga helps reduce stress and symptoms of anxiety and depression. Also consider talking to a therapist or trying CBT.
Headaches
If you have any vulnerability such as being prone to getting headaches or migraines, this is going to flare up when you’re stressed.
Also, inflammation is a key component of migraines, Donnai says: “Any inflammatory reaction in our system is normally well-controlled, until we get stressed.”
Plus, headaches can be caused by stress-induced muscular tension in our neck.
The fix
Try relaxation exercises, or unwind with yoga or Pilates. On the whole, simple painkillers that you can buy over the counter, such as ibuprofen, paracetamol and aspirin, will usually work to resolve a tension headache within 20 minutes.
For stronger treatment, consult your GP.
Cardiovascular risk and high blood pressure
When we experience acute stress – whether during physical exercise, because we’ve had a fright, or if we have experienced some significant acute mental stress, such as being the victim of a crime, our body reacts by releasing adrenalin, says Dr Rahul Potluri, consultant cardiologist at the Royal Devon University Healthcare NHS Foundation Trust.
“It increases the heart rate, increases blood pressure, and keeps other aspects of the body alert, such as the muscles, the eyes and other sensory organs.”
But chronic stress – in particular psychological chronic stress – can exact a severe toll on our heart and blood pressure. If you are the type of personality who is constantly stressed about little things, he says, “Over time, that leads to cardiovascular risk factors, such as increased blood pressure, because the arteries get so used to the fluctuations that they start to stiffen up or they can’t relax as much as they normally would do.”
That makes you more susceptible to hypertension, which, Potluri says, “is a risk factor for strokes and heart attacks”.
The fix
Relaxation techniques and exercise can make a difference, advises Potluri. Regular exercise can help reduce blood pressure as well as relieving stress. Start small and build up. Maintain a healthy weight and cut down on salt intake, as it makes your body hold onto water, raising your blood pressure further.
Poor digestion and IBS
Stomach pain, reflux, indigestion, gas and a change in bowel habits can all get a grip on our guts when we’re stressed. Irritable bowel syndrome (IBS), is common among those who are chronically stressed.
“Stress changes the gut’s bacterial profile, and gut bacteria play a critical role in digestion, motility [ability to move independently] and other key functions,” says Storoni. The autonomic nervous system (ANS), which controls unconscious processes like your breathing and heartbeat, also modulates the gut’s normal physiology.
When we are chronically stressed, our ANS is not regulating some of these things like it does in a healthy person. Inflammatory conditions affecting the gut, such as Crohn’s disease and ulcerative colitis, can also be exacerbated by chronic stress.
The fix
Eat slowly, sitting down, aiming to spend at least 20 minutes on a meal. Hypnotherapy, meditation and counselling can all help ease IBS. Gentle exercise can also help. See your doctor to rule out inflammatory gut issues and other more ominous problems.
Disrupted sleep
“Sleep is one of the key victims of stress,” says Russell Foster, professor of circadian neuroscience at the University of Oxford and author of Life Time: The New Science of the Body Clock, and How It can Revolutionize Your Sleep and Health.
“The natural pattern of human sleep is to wake up several times in the night. But the problem for people who are stressed and anxious is that when they wake up, their mind is immediately flooded with all the reasons why they’re stressed – and they then can’t get back to sleep,” he says.
Sleep disruption then exacerbates the problem. “If you get short sleep, you’re going to drive the stress response even higher to cope with the fact that you haven’t had the sleep you needed,” Foster adds, thus overriding the sleep drive.
The fix
Try cognitive behavioural therapy for insomnia (CBT-I) a structured programme that helps people identify thoughts and behaviours that make sleep problems worse, then replace them with “healthy” alternatives.
Try the Sleepio app, which offers an online sleep improvement programme that you can tailor to your needs. Consider “sleep restriction” – go to bed only when sleepy and get up as soon as you wake. Follow the “15-minute rule” – if you can’t sleep after 15 minutes, get up rather than tossing and turning.
Weight gain
Imagine, says Storoni, thousands of years ago, you’re fleeing a sabre-toothed tiger. “You’re getting tired as you run, but you want to make sure there’s enough sugar for the brain to stay sharp and stay alive,” she says.
“A stress response helps to keep the brain supplied with sugar by temporarily blocking insulin, releasing glucose from the liver and muscle cells to the blood so that it can supply the brain. This temporary state of ‘insulin resistance’ ends as soon as the stress response is over.”
However, she adds, “Some studies have shown that people under chronic stress can be at increased risk of developing Type 2 diabetes and metabolic syndrome – the symptoms of which include weight gain and high blood pressure.”
The fix
Aim to lose excess weight through diet and exercise to improve insulin sensitivity. Reduce your sugar intake and find healthy recipe swaps to replace high-fat or sugary foods.
Back pain
Your stress levels are through the roof, and that nagging back pain feels worse than ever. Why? Scientists believe that the prefrontal cortex plays a role in the perception of pain, says Storoni.
And when you’re under chronic stress, the dynamics of the brain change. “Your level of prefrontal regulation is impaired. We think this reduction in its regulation causes you to feel, for instance, back pain more,” she says. When our lifestyle is unremittingly frantic and psychologically fraught, our autonomic nervous system (ANS) can shift to “a sympathetically dominant state” says Storoni – you’re almost constantly in fight-or-flight mode.
The parasympathetic nervous system – “rest and digest” mode – the other arm of our ANS, which is more active when we’re calm and relaxed, doesn’t balance you as it should.
The fix
“Regularly practising an activity that improves autonomic regulation –whether breathing exercises, general exercise or yoga – can be extremely helpful in building stress resilience, by providing a counterweight,” says Storoni.
Speak to a qualified physiotherapist for specific back pain exercises.
Twenty minutes is the recommended time to spend on a meal – while seated 35 to 45 minutes after waking up is when a healthy person experiences a burst of stress-clearing cortisol.