The Stress Effect on Health

Anne Weinberger, ANP-C
Bitterroot Physicians Clinic
A Service of Marcus Daly Memorial Hospital
1200 Westwood Drive
Hamilton, MT 59840
(406) 363-1100

The Stress Effect on Health
Many of us go about our lives without examining how our behavior affects our health. The media focuses on diet and exercise and the effect on heart health and risk of diabetes. We don't often think about how stress affects health.

In my clinic recently, I asked a patient how much stress they were experiencing in their life. They answered with another question, "How can you quantify stress in one's life?" I was taken back by this question. We measure pain on a scale of 0-10 with 0 being no pain and 10 being excruciating pain, but how do we measure our stress? How much importance do we place on stress in our lives if we don't even have a way to measure it. The intention of this article is to help understand how stress affects us and our health.

The American Psychological Association has developed a scale divided into three categories with high levels of stress having a rating of 8 or higher on a 10 point scale, moderate levels of stress with a rating between 4 and 7, and low stress with a rating of 3 or less. The American Psychological Association commissioned an annual survey for two years in a row with the following results: 25% of Americans are experiencing high levels of stress at 8 or more, while 50% reported moderate levels of stress of 4 to 7, and the remaining 25% low levels of stress, less than 3. Given continuing economic instability in this country and abroad; concerns about money, work, and the economy rank as the top sources of stress for Americans.

Stress is unpleasant, even when it is transient. Stressful situations, whether environmental, such as a looming work deadline, or psychological, such as persistent worry about losing a job, can trigger a cascade of stress hormones that produce well-orchestrated physiological changes. Stressful incidents can make the heart pound and breathing quickened. Muscles tense and beads of sweat appear.

This combination of reactions to stress is also known as the "fight or flight" response because it evolved as a survival mechanism, enabling people and other mammals to react quickly to life threatening situations. The carefully orchestrated yet near instantaneous sequence of hormonal changes and physiological responses help someone to fight the threat off or flee to safety. Unfortunately, the body can also overreact to stressors that are not life threatening, such as traffic jams, work pressure, and family difficulties.

Over the years researchers have learned the long-term effects stress has on physical and psychological health. Over time repeated activation of the stress response takes a toll on the body. We know prolonged stress contributes to reduction in the immune system, high blood pressure, promotes increased cholesterol, and causes brain changes contributing to anxiety, depression, and addiction. It is believed chronic stress may also contribute to obesity, both through direct mechanisms, such as causing people to eat more, or indirectly, with decreasing sleep and exercise.

The stress response is like sounding the alarm, beginning in the brain. When someone confronts an oncoming car or other danger, eyes or ears or sometimes both send the information to the amygdala, the area of the brain that contributes to emotional processing. The amygdala interprets the images and sounds, perceives danger and instantly sends a distress signal to the hypothalamus.

The hypothalamus is like a command center. This area of the brain communicates with the rest of the body through the autonomic nervous system, which controls such involuntary body functions as breathing, blood pressure, heartbeat, and the dilation or constriction of blood vessels and small airways in the lungs called bronchioles. The autonomic nervous system has two components, the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system functions like a gas pedal in a car. It triggers the fight or flight response, providing the body with a burst of energy so we can respond to perceived dangers. The parasympathetic nervous system is like a brake pedal. It promotes the "rest and digest" response that calms the body down after the danger has passed.

After the amygdala sends a distress signal, the hypothalamus sends a message to the pituitary gland which sends a message through the blood stream to the adrenal glands, which sit on top of the kidneys.

These glands respond by pumping the hormone epinephrine, also known as adrenaline, into the bloodstream. The epinephrine circulates through the body causing the heart to beat faster pushing blood to the muscles, heart, and other vital organs. Pulse rate and blood pressure increase. The person undergoing these changes also starts to breathe more rapidly. Extra oxygen is sent to the brain, increasing alertness. Sight, hearing, and other senses become sharper. Meanwhile epinephrine triggers the release of blood sugar, or glucose, and fats from temporary storage sites in the body. These nutrients flood into the bloodstream, supplying energy to all parts of the body.

All of these changes happened so quickly that people aren't aware of them. In fact, the wiring is so efficient the amygdala and hypothalamus start this cascade even before the brains visual centers have had a chance to fully process what is happening. This is how people are able to jump out of the path of an oncoming car even before they think about what they are doing.

As the initial surge of epinephrine subsides, the hypothalamus activates the second component of the stress response system known as the HPA axis. This network consists of the hypothalamus, the pituitary gland, and the adrenal glands. The HPA axis relies on a series of hormonal signals to keep the sympathetic nervous system, the gas pedal, activated. If the brain continues to perceive something as dangerous, the HPA axis stays turned on promoting the release of cortisol. The body stays revved up and on high alert. When the threat passes, cortisol levels fall. The parasympathetic nervous system, the brake, then dampens the stress response.

Many people aren't able to find a way to put the brakes on stress. Chronic low-level stress keeps the HPA axis activated, much like a motor that is idling too high for too long. After a while, this has an effect on the body that contributes to health problems associated with chronic stress.

Persistent epinephrine surges can damage blood vessels and arteries, increasing blood pressure and raising risk of heart attacks or strokes. Elevated cortisol levels create physiological changes that help to replenish the body's energy stores that are depleted during the stress response. They inadvertently contribute to the buildup of fat tissue and weight gain. For example cortisol increases appetite, so people want to eat more to obtain extra energy. It also increases storage of unused nutrients as fat.

Stress is unavoidable. Arming ourselves with the understanding of the stress response can help us to minimize stress and its impact on our minds and bodies. Consumption of large amounts of caffeine, sleep deprivation, and alcohol all increase cortisol levels stimulating the stress response. Techniques can be learned to counter the stress response by using a combination of approaches to elicit the relaxation response. These can include deep abdominal breathing, focus on soothing words, visualization of tranquil scenes, repetitive prayer, yoga, and tai chi. Exercise to stifle the buildup of stress such as taking a brisk walk shortly after feeling stress, can deepen breathing and help relieve muscle tension. Social and emotional support is helpful to individuals at times of stress and crisis. The good news is stress levels can rest largely on our behavior and decisions we make can optimize our body's response to stress based on how we live our daily lives.

Do you live with chronic pain? Pain can cause stress! Marcus Daly Memorial Hospital's last class in the Healthcare Education Series is about "Knee Pain." Join us on Thursday, April 14, 2016 from 5:30pm to 6:30pm in the Blodgett and Canyon View conference rooms as Michael Dolecki, MD from Bitterroot Orthopedics and Sports Medicine talks about the many treatments available, and explores ways to reduce or maybe alleviate knee pain altogether. For information about the "Knee Pain" class, other upcoming classes or to register to receive e-newsletters visit mdmh.org/hes or call (406) 363-2211.

Questions and or comments regarding this week's health column please contact, Anne Weinberger, ANP-C at Bitterroot Physicians Clinic, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier community!