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Health Protocols

Stress Management

How Does Stress Cause Health Problems?

Prolonged stress is associated with many chronic disorders and diseases affecting all of the body’s organ systems, and as life’s stressors take their toll on the psyche and body, chronic illness itself becomes a source of stress. The two-way relationship between stress and disease creates a downward spiral in mental and physical health that can become difficult to overcome.2

Stress and the Circadian Rhythm

The HPA axis is closely regulated by circadian signaling in the brain. This circadian signaling is affected by day and night (light and dark) cycles, patterns of eating times, and most likely other factors yet to be discovered. Normally, cortisol levels peak shortly after waking in the morning and are lowest around bedtime. By acting on receptors throughout the body, cortisol imposes diurnal (two-phase; day-night) rhythms to other physiological functions.17,25

Numerous studies have shown that disruption of the circadian clock, such as due to shift work, sleep apnea, and other sleep disorders, is associated with health problems including cardiovascular disease, type 2 diabetes, obesity, and an array of age-related diseases.26,27 Circadian disturbances may even correlate with reduced lifespan.28 Chronic stress appears to impair circadian control of the HPA axis, which can result in either excess evening levels or blunted morning levels of cortisol.29 These dysfunctional patterns of cortisol release may be an underlying factor in the negative physical and mental health consequences of chronic stress and circadian rhythm disruption.30

Stress and Inflammation

One important way that chronic stress affects long-term health is through dysregulated inflammatory signaling. Although cortisol is best known for its immunosuppressive action, its effects on immunity are complex, stimulating some aspects of immunity and inhibiting others.1,25 A phenomenon known as glucocorticoid resistance, in which tissues and cells become less responsive to cortisol, occurs following long-term elevation of cortisol levels due to chronic stress.31,32

Chronic stress-induced immune dysfunction results in reduced immune protection against infections and cancer, as well as inflammatory conditions, such as allergic and autoimmune disorders, and conditions related to low-level systemic inflammation like heart disease and diabetes.1,33 Once inflammation is initiated, it perpetuates the stress response through the actions of cytokines (small signaling proteins of the immune system) on the hypothalamus, pituitary, and adrenal cortex.25,34

Stress and the Microbiome

Chronic stress may impact health through interactions with the gut microbiome—the trillions of microorganisms that reside in the intestines. Through its relationship with nervous system signaling, often referred to as the “gut-microbiota-brain axis,” and its ability to regulate the immune system, a healthy microbiome appears to be essential for modulating stress responsiveness and preventing overstimulation of the HPA axis. Conditions associated with chronic stress have been shown to alter the composition of the gut microbial community. Microbial imbalances, in turn, can cause intestinal and systemic inflammation and abnormal neurological signaling that can trigger HPA activation.35-38

The Epigenetics of Stress

Exposure to stress early in life can alter stress responsiveness and resilience throughout life. Part of this is likely due to effects of stress on brain and adrenal gland development; another important element is epigenetics. Epigenetics refers to environmentally induced modifications to gene expression patterns (as opposed to changes in gene sequence) or factors that control how genes are used to direct protein synthesis in cells. These modifications are lasting, but can be reversed by future circumstances.39

The epigenetic changes induced by prenatal and early life stress result in hyperresponsiveness of the HPA axis and increased risk of neuropsychiatric problems in adulthood, such as depression, anxiety, and post-traumatic stress disorder.39-41 Emerging research has shown that stress-induced epigenetic changes can also occur in adulthood, affecting HPA axis responsiveness and increasing vulnerability to stress-related health problems.42 In addition, because the epigenome is passed on to offspring by both parents, exposure to intense or unremitting stress has implications for resilience and health that may span multiple generations.41,43,44

Hormesis—The Benefits of Intermittent Mild Stress

While chronic stress has toxic effects that can ultimately shorten lifespan, short-term exposure to stress can promote development of adaptive strategies, supporting health and longevity. The process of developing coping mechanisms in response to minor stressors as a means of building resilience against greater stress has been called hormesis. Another way of expressing the concept of hormesis is the common phrase, “What doesn’t kill you makes you stronger.”45,46

Exercise is an example of a hormetic stressor: it causes stress by increasing body temperature, mechanical demands, nutrient and oxygen demands, and free radical production.46 The cellular responses to the stress induced by regular moderate exercise can lead to resiliency reflected in a broad spectrum of health benefits and longer life. On the other hand, extreme exercise, such as bouts lasting 18–24 hours without interruption, exhausts the body’s ability to adapt, can harm health, and may shorten lifespan.45,46 Moderate calorie restriction also confers hormetic benefits: adapting to lower energy availability involves changes in metabolic, immune, and neuroendocrine function that are associated with healthy aging and may extend life.47,48

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