Stress Reduction

Chronic Stress has been shown to be the single biggest risk factor for many inflammatory diseases. It should be taken very seriously, once your health starts to fail it is difficult to restore.

Common causes of stress include sleep loss, overwork, lack of social support, lack of control over your environment (this includes money matters) inadequate exercise, poor diet, worrying and the most damaging-social stress the regular contact with bullying and aggressive individuals (ref). 

Stress is cumulative, stress at work, at home and on the way to work all contribute to the stress burden on our bodies. Our bodies can cope with short, infrequent episodes of stress but when stress becomes constant and affects our ability to perform our usual activities this is indicative of chronic stress, a sign you really need to slow down and review your life situation.

Identify stress, it might just save your life.

People respond to chronic stress in different ways, but common symptoms to watch for include: depression; anxiety; difficulty concentrating; irritability; sleeping disorder; loss of libido; fatigue; loss of interest in hobbies and catching more colds and infections that linger.

Stress often builds up without you noticing and you may be developing coping strategies subconsciously like drinking more coffee, alcohol or smoking. You may be acting more irritable or over reacting emotionally. Pay attention to friends and family who may mention these things. Try a few online stress questionnaires (find some here: 1,2,3 and 4) and if they confirm that you are suffering , contact your health care professional and follow the suggestions below.

Your doctor may suggest saliva tests which can flag up if you are suffering from chronic stress and if you are at risk from ‘burn-out’, a state of physiological imbalance so great that you can no longer perform your usual activities.

Burn out (adrenal fatigue) can be considered the final stage of chronic stress and is to be avoided at all costs, not just because it is such an unpleasant experience but also because it can take so long to recover from such episodes. If symptoms of chronic stress are caught early remedies can be so much more effective, avoiding burn-out altogether. This will probably involve some permanent intervention in your lifestyle. Symptoms of burn out include: fatigue; depression; anxiety; nervous exhaustion; memory loss and a host of inflammatory diseases (ref). 

How stress effects our bodies-

Stress causes our adrenal glands to secrete what are called ‘Fight or flight’ hormones –Adrenaline and Cortisol. As the name suggests these hormones prime our bodies for physical exertion, Adrenaline raises heart rate, blood pressure and energy metabolism, whilst Cortisol stimulates the release of sugar into the blood and inhibits processes that are not essential to fight or flight such as the immune response, digestion and reproduction.  Once the stress stimulus is removed the body starts to reverse these temporary adaptations.

If stress persists, we suffer from a persistent high level of cortisol which suppresses our immune system. This explains why we become more prone to infection. However, if the stress continues our cells eventually lose their sensitivity to cortisol (a process called receptor desensitisation) and our adrenals and hypothalamus start to shrink. The hypothalamus regulates the adrenal glands which produce cortisol, an episode of chronic stress can damage the adrenals to the extent that they only produce a small amount of cortisol. Receptor desensitisation and low circulating cortisol makes our bodies less effective at suppressing inflammation.

This situation is compounded by the fact that stress turns on pro-inflammatory genes in our white blood cells which release pro-inflammatory cytokines into the blood (ref 1, 2).

This aggravated immune response causes systemic damage to tissues, and will continue to do so until we identify and reduce the stress in our lives and make the necessary lifestyle changes to improve our health. The failure to do so can, and often does result in heart disease, stroke and cancer.

To recap:   The effect of chronic stress can be thought of having two phases. The first in as a result of persistent elevated cortisol, which suppresses the immune system and causes anxiety. The second phase is the result of persistent low cortisol, a result of damage to the hypothalamus and adrenals and commonly results in fatigue.

Prevent and cure stress:

1.Deal with the causes:

An unpaid bill, an unresolved issue with a neighbour an impending deadline all contribute to your level of cortisol. If a thought about a particular aspect of your life makes you feel tense then you can be sure your adrenals will be pumping out cortisol. So the longer you are reminded, but fail to resolve an issue the longer this issue will contribute to your stress/cortisol levels.

Listen to your intuition!!

Dealing with issues that arise in a timely and peaceful manner is the best thing you can do. Open that bill, make that phone call, make that visit and make that apology as soon as is practically possible. Prevention is always better than cure. Apologising even when you are not in the wrong can have the ‘secret’ benefit of resolving a stress stimulus in your life.

Map out on paper all the areas in your life that might be stressing you and flesh out the details (relationships, work, money matters, rent, achievement, health etc.). The issues that keep popping into your mind without invitation are probably a good place to start, include all the things you have been trying to turn a blind eye to.

Discuss with someone you trust how each of these difficulties can be addressed. A great deal of relief can be attained by making that phone call, message or mail. One major cause of stress is feeling powerless over your situation, so as soon as you make a move to affect it you are empowering yourself and will feel some relief. Isolation and inactivity cause you to repeat the same messages to yourself which magnifies their importance, often at the expense of the reality of the situation. Dealing with little issues first my give you the strength to deal with the bigger issue later.

You will probably find certain individuals more sympathetic than expected, landlords, council tax offices and companies deal with similar problems all the time.

It may take courage to get out of some stressful situations, but you owe it to yourself, your health, your wellbeing. Look for support from people you trust, look for support from your work (human resources) or support agencies. Reducing your responsibilities for the sake of your health is no bad thing. Taking on too much does not benefit you or those involved….certainly not in the long term. Your wellbeing=wellbeing of your family and friends.

Protect yourself from stress. Defend your right to de-stress your life…you will be protecting your health.

The news can make you feel powerless, stop watching and reading it, empower yourself by engaging with a group that is trying to tackle the issues that most concern you. This will have the added benefit of meeting like-minded friendly people.

2.Seek positive social contact:

Women are less likely to develop stress related inflammatory diseases, and one reason is that women are more likely to seek support from their friends and family. Socialising and physical contact have been shown to release oxytocin, a hormone that has been shown to remedy stress (ref).

Positive skin touch, this includes petting animals, hugging friends, massage, and more intimate relations all release a lot of oxytocin. The more you trust a person the more oxytocin will be released when you spend time with them. In times of stress spend time with touchy-feely, non-judgemental friends and relations. Oxytocin stimulates the pleasure centres of the brain by up-regulating the brain’s opioids, and has been shown to alleviate inflammation, improve wound healing, promote learning, increase pain threshold, decrease cortisol and reduce anxiety (ref). Oxytocin is available as a nasal spray and has proven useful to some people (ref).

There is a flipside, socialising when you’re not in the mood, or in the wrong place or atmosphere can contribute to your anxiety and cortisol levels. Particularly if there may be aggressive individuals present. Peer pressure may make you more likely to use intoxicants which will not help your recovery.

If you are suffering from stress, or adrenal fatigue, don’t be afraid to refuse an invitation to an event that may make you feel awkward but don’t isolate yourself for long periods, choose your socialising wisely, a quiet night in a safe environment with a trusted friend is probably the best option for someone suffering chronic stress or adrenal fatigue.

3. Avoid bullies

Social stress is the most damaging form of stress and is most likely to cause inflammatory diseases. This stands to reason, one of cortisol’s functions is to get you out of harm’s way, and if you are regularly threatened (this includes passive aggression, and non-violent threatening behaviour) your cortisol levels are bound to be high. Aggressive and bullying individuals should be avoided, or steps made to minimise contact with them.

Confrontational behaviour without resolution is a floored strategy, it will prolong elevated cortisol levels in both individuals for as long as they have chance of meeting, unless the issue is resolved.  Sometimes to resolve stress requires a confrontation of sorts and it’s best to approach the other with the intention of making them aware of your difficulties rather than accusing them of transgression, remember you don’t want to elevate their cortisol levels and make them more prone to ‘fight or flight’! It will be better to meditate or spend time with a light hearted friend before trying to resolve something with a difficult individual just don’t lose sight of what outcome you want to achieve.

4. Meditate:

Meditation can help repair the damage to the brain caused by stress.
Meditation can help repair the damage to the brain caused by stress.

Find a meditation class near you, at your local Buddhist centre, yoga centre or community centre.

It has been proven that regular meditation can protect the brain from ageing and helps repair the damage done to the hypothalamus during chronic stress. Mindfulness based therapy can benefit a variety of psychological problems, and is especially effective for reducing anxiety, depression, bipolar disorder, substance misuse  and stress.

If you feel powerless to change the circumstances in your life, one thing you can certainly do is learn to meditate which will start to improve how you react those circumstances. Stressful situations will appear less stressful.

One way this works is that words no longer have such power over your emotions, this is because you practise impartiality during meditation. You learn to sit without judging the content of your mind and eventually the mind becomes quiet, and for periods of time non-verbal. One thing meditation requires is regular practise, many practioners will recommend 30 minutes to an hour per sitting, but 10 minutes a day has proven beneficial (ref).

Sitting crosslegged, or in the half or full lotus posture are recommended but you can sit on a seat or lie on your back. It is important to guard against drowsiness hence recommending upright postures. One of the first goals of sitting meditation is to achieve periods of quiet awareness without attaching to thoughts or sensations. Thoughts and sensations will arise, especially in the first 10-20 minutes of meditation depending on how experienced you are. Your attitude towards these thoughts and sensations should be impartial, non-judgemental- let them arise, let them pass. Forcing the mind into quiet will result in a tense experience.

You will become aware that you are day dreaming from time to time, do not chastise yourself, enjoy the stillness when these thoughts have dissolved. Substantial periods of quiet awareness will arise more often, the more you practise. Rest in non-verbal quiet awareness for as long as you have time. It is worth setting a pleasant sounding alarm so you know how long you can sit for.

Meditation can be practised anywhere at anytime, but beginners find it best to practise at quiet times in quiet places.

The benefits of meditation will be carried through into your everyday life, thoughts and speech will be less likely to cause tension in your mind and body, and you will feel more present in the moment as you go about your business.

5. Exercise regularly:

Exercise can prevent stress building up, it can also help repair damage done during chronic stress.

Cortisol, the ‘fight or flight’ hormone primes us for exercise. Providing more energy to muscles primed by Adrenalin. Exercise will allow the stress response to resolve naturally by clearing these hormones from our blood, helping to prevent stress building up.

Exercise can repair a stress damaged brain

Moderate aerobic exercise increases the production of Brain-derived neurotrophic growth factor (BDNF), which strengthens neuronal connections and stimulates the growth and differentiation of brain cells in the hippocampus, cerebral cortex, thalamus, hypothalamus and cerebellum. The benefits will be increased if moderate aerobic exercise is combined with controlled calorie restriction/fasting and regular meditation (ref 1,2)

If you are suffering from chronic stress then twenty minutes or more a day of moderate aerobic exercise like brisk walking, cycling and swimming in a pleasant environment is the best remedy (source).  Avoid competitive sports, contact sports and the gym if they make you feel tense, at least until you feel better. Excessive exercise and intensive anaerobic gym workouts have both been shown to raise cortisol, so don’t push yourself too hard (source 1,2). If you need advice on how to start exercising if you are suffering from a heart condition or related illness we have some advice on our exercise page.

6. Alleviate stress at work when it happens!

If you are getting stiff, loosing concentration and fidgeting it is time to get up and move about….stretch as many parts of your body as possible. Taking frequent break from work at your desk to stretch and stroll, or using the stairs will greatly reduce your stress in work.  Can you alter the way you work to minimise stressful time at the desk? Face to face communication and telephone calls are more healthy than online communications as long as those you are communicating to are friendly. If you have just had a stressful meeting consider running up a flight of stairs or stroll round the block. The more physically varied your routine the better. Can you create some distance between yourself and those that make you stressed but still get your job done effectively, talk this through with a friendly colleague.

7. Regular quality sleep

Getting good sleep should be a priority to improve your health. Deep sleep is when most healing occurs and requires a regular sleeping pattern.

Good sleep is worth preparing for. Create a great place to sleep. As dark and quiet as possible with a good air supply. The prime time for healthy sleep is a couple of hours after sun set. Dim the lighting and avoid work on electronic devices for a couple of hours before bed.

Some people are particularly sensitive to caffeine, and if you suffer from insomnia you may want to cut it out altogether.

Your attitude towards sleep is important. Getting frustrated when you can’t sleep will only aggravate your stress levels, it’s better to get up and do something relaxing and go back to bed when you feel properly tired. This principle also applies more generally to regaining your health, there is no point being hard on yourself because you feel ill or fatigued, this only creates more stress which hampers the healing process. Try and accept the feeling, even if it is recurring, and happily take the rest that it is demanding. This is part of a greater practise of self-compassion.

Shift work is bad for your health and irregular shift work that has cycles of shorter than 3 weeks is the worst. This is because our bodies do not have time to adjust their circadian rhythms to each new shift, and as a consequence hormones and digestive enzymes are released at the wrong times of day, which is why bowel upsets are so common with shift work and insomnia. If shift work is unavoidable then make your sleeping ritual mimic that of night time, get black out curtains and ear plugs if necessary, this will give your hormones the best chance to adjust.

8. Dietary considerations:

Your diet will certainly affect how you feel, and a healthy diet will offer the best chance of recovery from chronic stress and burnout. As we have argued on this site, a nutritious low carbohydrate diet is healthiest, but is subject to controversy regarding how it affects cortisol levels. Those against argue that low carbohydrate diets cause our blood sugar to drop below a healthy level which stimulates the production of cortisol. However if done properly a ketogenic diet evens out blood sugar levels, spikes and dips are avoided, and repair mechanisms are switched on in the body and brain with an increase in production of BDNF. It has been proven that Ketogenic diets and fasting turn on repair mechanisms in the brain, and may rejuvenate a hypothalamus damaged by stress. However, a word of caution if you dip in and out of a ketogenic diet, i.e. by eating carbohydrate in significant amounts sporadically this will cause blood sugar spikes and dips as described in the article (here) which can stimulate the secretion of cortisol which we are trying to avoid. Inform yourself on how to do a ketogenic diet properly, you ideally want to enter a state known as nutritional ketosis, which does not stress the body but stimulates mechanisms of repair in the body. Read more (here).

Initially there was concern a Ketogenic diet would elevate cortisol levels, and one study indicates that certain measures of cortisol are elevated in very low carbohydrate diets (10% calories  as complex carbs), levels of production in the liver was decreased but increased in body fat.

For those suffering chronic stress, perhaps the best option is a low, rather than a very low carbohydrate diet.. consuming complex carbohydrates in the evening to promote sleep.

It may be worth purchasing a blood glucose and ketone meter, to ascertain what your healthy baseline blood glucose is and avoid dipping below this which may elevate cortisol. Perform in tandem with cortisol testing.

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Site authors: Professor Rodney Bilton, Dr Larry Booth, and Joseph Bilton M.Sc B.Sc