We’ve all heard it. “Stress… it’ll kill ya.” and everyone seems to be singing the same “I’m SO stressed out!” tune lately. It’s the new normal and it seems it’s waved as a badge of honor among friends and coworkers. Everyone is trying to one up each other. The more hours you work, the more activities you enroll your kids in, and the more groups and boards you’re a member of the “better”, “more successful” you appear to all your friends. If you’re not burning the candle at both ends you aren’t trying hard enough. How else are you going to fund the big house, the shiny new car, and to send your kiddos to private school? But the thing is, this go go go lifestyle we’ve all become trapped in is backfiring… big time. I see patients in my office every single day who are suffering from the effects of adrenal fatigue. Adrenal Fatigue? Yep, adrenal fatigue. What the heck is that you ask? Allow me to explain what it is, why you’re probably suffering from it to some degree, and what you can do to treat and avoid it.
First, let’s define stress. Stress is anything that disrupts homeostasis. Stress can be good or bad and we all perceive and react to stress differently. A little stress is a good thing and can be associated with positive events like the birth of a child, wedding, a new and exciting job . We’d be bored and become lazy good-for-nothings without a little stress in our lives. However, most of us have WAY too much stress in our lives, both good and bad.
Examples of major stressors and causes of chronic stress:
- Death of a family member or friend
- Birth of a baby
- illness or injury
- loss of a job or a new job
- financial problems
- sleep deprivation
- too much exercise (hello you wod-aholics)
- chronic inflammation and pain
- food intolerances
- temperature extremes
- undereating or malnutrition
- and many many more…
Now, let’s talk about how our bodies respond to stress. When stress is experienced, be it a car accident or staying up all night to finish a school or work assignment, the hypothalamus produces Corticotropin Releasing Hormone (CRH) which causes the anterior pituitary glad to produce Adrenocorticotropic Hormone (ACTH). ACTH causes the adrenals to produce cortisol. Cortisol helps to deliver glucose to muscle cells and the brain in times of stress. Epinephrine and norepinephrine are also produced during the stress response. These two neurotransmitters basically gets your body primed and ready to deal with the stressor. The digestive system and reproductive system shuts down, thus allowing all energy to be shuttled to surviving the stressor. This is most commonly referred to as the “fight or flight” response.
In summary, when stress is experienced:
- Blood flow is diverted away from digestion and toward the heart, brain and and skeletal muscles
- Heart rate and blood pressure increase
- Serum oxygen and glucose levels rise to supply the brain and skeletal muscles with energy and oxygen
- The brain becomes alert, sleep is unlikely
- Perspiration increases
- Secretions decrease, fluid retention increases
- The immune system is primed to clot and enhance inflammation to deal with potential injuries
- Pupils dilate and vision is enhanced
- Bowels and bladder are emptied to make the body lighter and faster
- Digestion, reproduction, and growth are halted
- Stress hormones disrupt all other hormonal processes not essential to the stress response
Many years ago, our ancestors would experience an acute stressor and would either live to tell the tale or become dinner for some larger, faster beast. In our modern day world, attacks by saber tooth tigers are rare but chronic stress is very common and it’s causing a lot of trouble physically and psychologically.
When stress is chronic our bodies struggle to maintain homeostasis eventually resulting in “Adrenal Fatigue” and numerous health problems.
Stress and Heart Disease
- Increased and chronic stress has been linked to increased cardiovascular disease and high blood pressure.
- Stress also causes an increase in homocystiene, an amino acid, that is believed to cause damage to the coronary arteries resulting in arteriosclerosis
- Increased norepinephrine and epinephrine levels causes constriction of blood vessels, increased blood pressure, and increased heart rate which can also lead to damage to the corary arteries and plaque build up.
- Sudden constriction of blood vessels can also cause reduced blood flow to the heart itself causes pain. So, when someone says they feel like their heart is breaking after an intense emotional stressor, believe them! Their heart really is hurting.
- Stress can also cause disrupt the signals the brain stem send to the heart to beat regularly therefore increasing irregular heart rhythms and increasing the chance of heart attack.
Stress, Insulin, and Weight
- Chronic stress causes cortisol production which causes the release of glycogen to be used for fuel to “fight or flight”. But, if the glucose isn’t used it’s stored in the abdomen as fat.
- Chronic stress triggers cravings for sugar. Cortisol depletes serotonin levels which is a neurotransmitter that causes feeling of happiness and calm resulting in depression and increases epinephrine production which causes increased anxiety. Eating sugary comfort foods causes an increase in serotonin production. However, when the sugar level comes crashing down so does the serotonin level and the cravings are back again causing a roller coaster or eating crappy carbs, feeling ok for a bit, then crashing. Also, grains (found in many “comfort foods” are known to cause inflammation in the gut where over 95% of serotonin is produced further reducing serotonin production and causing even deeper depression and mood disorder.
- Chronic stress and production of cortisol also causes the kidney to excrete sodium, potassium, and magnesium causing cravings for salty foods.
- Increased stress is linked to insulin resistance to make sure there is adequate glucose circulating in the blood for use by skeletal muscles if needed. However, when there is chronic stress prolonged elevation in circulating blood sugar causes the pancreas to try to compensate by producing more insulin, eventually causing the pancreatic beta cells to fail leading to diabetes.
Stress, Sexual Function and Baby Making
- Ovulation is inhibited by endorphins and CRH released during times of increased stress
- Increased levels of cortisol inhibit the pituitary hromones, Follicle Stimulating Hormone (FSH) and Leutinizing Hormone (LH). These two hormones are needed for ovulation and sperm production.
- Cortisol also depresses the production of estrogen, progesterone, and testosterone.
- The sympathetic nervous system also diverts blood away from the reproductive organs during stressful situations which may cause problems with egg implantation should an egg become fertilized and decrease sexual desire and function.
- Increased cortisol can cause increased body fat and aromatase (an enzyme that causes increased conversion of testosterone to estrogen) which can cause hormone disruption in men and women.
- When cortisol is high and ovulation does not occur progesterone levels are incredibly low causing anxiety, reduction in libido, and anxiety/depression.
- Oxytocin production is decreased during stress which can cause loss of libido, an inability to achieve orgasm, and a lack of desire to connect with other people.
- Prolactin is increased during stress which can cause erectile dysfunction, loss of physical arousal in women.
- When the sympathetic nervous system dominates (like during stressful times) erection is difficult to maintain and premature ejaculation may become a problem
Stress, Anxiety, and Depression
- Stress increases noepinephrine and epinephrine production. When stress is chronic the brain is overstimulated by epinephrine which can cause anxiety and panic attacks. It also causes many imbalances in other neurotransmitters like GABA, acetylcholine, dopamine, etc. which can cause multiple mental health problems and symptoms like anxiety, insomnia, etc..
- Chronic stress also increases cortisol which depletes the tryptophan (an amino acid) which is needed to produce serotonin (a “feel good” neurotransmitter) which can lead to depression.
- Also, in those with depression the normal secretion of cortisol becomes deranged. Normal cortisol excretion is highest in the morning and slowly decreases over the course of the day allowing one to feel aroused and awake during the day time and sleepy at night. When one is depressed or chronically stressed cortisol secretion may be reversed and higher at night making sleep difficult or low during the day time causing ”chronic fatigue”.
Stress and the GI tract
- Stress decreases the secretion of saliva and digestive enzymes making digestion difficult.
- Undigested food may damage the intestinal lining allowing particles to permate the intestinal wall and cause problems (food sensitivities, autoimmune disease, wide spread inflammation). Those who are familiar with the paleo diet may also remember that grains can also cause damage to the intestinal wall in much the same way causing the same kind of problems.
- Stomach acid decreases and gastric emptying slows which can allow bactera overgrowth in the gut (normally controlled by gastric acid).
- SIgA, an antibody secreted in the intestines, is decreased during stress which also allow bacteria overgrowth
- Because intestinal motility increases with stress, nutrient absortpiton decreases.
- Because of these effects stress can have on the gut many people develop IBS, GERD, Peptic Ulcer Disease, and Leaky Gut Syndrome.
- Also, it’s not a myth that one can have a “nervous stomach”. The gut produces over 90% of the serotonin in the body and also produces neurotransmitters like dopamine, acetylcholine, norepinephrin, and endorphin. The gut also have a “brain” of it’s own called the enteric nervous system (ENS) which is located in the musosal lining of the intestines. The ENS provied two communication between the brain and the gut. It resonable to think that when our bodies are under stress or when we create stress in the intestines by eating poorly serotonin and nuerotransmitter production becomes deranged, GI function is disrupted, and many physcial and mental problems can occur.
Stress, Infections, Cancer, and Viruses
- Acute stress temporarily improves immune function. However, chronic stress decreases immune function by inhibiting t-helper cells, macrophages, etc. which produce interleukin, lymphokines and other immune subtances which fight off infection.
- Viruses may be reactivated during times of stress either by: a) hormones and nervous system changes that acitivate the latent virus or b) reduced cellular immunity that allows a latent curis to become reactivated
- There are severa types of viruses that are known to cause cancer (HPV, Hepatitis B and C, Epstein-Barr, etc.). Because stress reduces cytotoxic T-cells and natural killer cells (these cells scour the body detecting and detroying cells with mutated DNA, herpes infected cells, and tumor cells) there is an increased risk for cancer.
- Studies have shown that people under chronic stress have shorter than normal telomeres (aka accelerate aging). Telemores are the caps at the ends of chromosomes that limit the number of divisions of a cell and shorten with age. They also had fewer white blood cells and more depression.
Stress and Thyroid Function
- Just to make this all a little more clear, let’s review thyroid function for a minute. The hypothalamus produces thyrotropin-releasing hormone (TRH) which signals the pituitary to produce thyroid stimulating hormone (TSH). TSH then signals the thyroid glad to produce the thyroid hormones T3 and T3. T4 has little effect on the metabolism of the body and for the most part is inactive until the body converts T$ to the more active T3. The body achieves this by removing a key iodine molecule from T4 to make T3. T3 is the thyroid hormone that really serves as “the worker bee”. It’s responsible for energy production and metabolism.
- When the body is under stress it preserves all energy for the stress response (remember that fight or flight thing?) so it slows the metabolism down by down regulating the conversion of the thyroid hormone T4 to T3. Cortisol, in excess, inhibits the removal of the correct iodine molecule from T4 and makes an ineffective T3 called reverse T3. This makes diagnosis of hypothyroid difficult for many because under these conditions the TSH level, T4 and perhaps the T3 levels can looks fine but reverse T3 will be high but it’s very rarely checked by most health care providers.
- Corticotropin releasing hormone (CRH) also down regulates the production of TSH when under stress which also decreases the thyroids production of T4 and T3. However, most providers will only use the diagnosis hypothyroid when the TSH is elevated.
- Stress, inflammation, and poor eating habits may cause inflammation and leaky gut which in the end cause the body to produce antibodies that can attack the thyroid glad causing the autoimmune diseases Hashimoto’s thyroiditis (a disease of under active thyroid function) or Grave’s disease (a disease of over active thyroid).
Ok, so… WOW! Right?! I’m sure you’re thinking you need to quit your job or at least reduce your hours, take up yoga and meditation, and do everything within your power to reduce stress like NOW! Well, don’t do anything too rash. We all have to work and make money to pay the bills. Being broke will only increase your stress. Stay tuned for the next article which will review nutritional, supplemental, and behavioral strategies to reduce stress and keep your endocrine system functioning properly.
And about a million other places and people!