I am thrilled to have Dr Ranulf Crooke write for the Health Library. He's one of the Cotswold's most prominent physicians, and specialises in lifestyle and precision medicine. Ranulf is the Director of Cotswold Optimal Health; a modern-thinking clinic which aims to achieve and maintain your health by understanding your genetics, your biochemical make up and your health, and by applying tailored, personalised medicine.
None of us are immune to stress. It pervades the web of our daily life in one shape or another, making it difficult to escape. It has the potential to have a profound effect on not only our mental health but our physical health too. In the UK, 15.4 million days of work were lost in 2017/18 due to work stress.
Stress can be both positive (e.g. the pressure of a work promotion, public speaking) and negative (e.g. death of a close relative, relationship breakdown). They can have short and long-term effects on our health.
Acute stressors are time-limited. Positive acute stressors can have the advantageous effect of a phenomenon called hormesis. This is when the cells and our bodies are able to adapt and become more resilient to a mild or moderate stress. Exercise is a great example of a positive stress that results in significant health benefits through the subsequent physiological adaptations we make following this exposure.
Chronic stress can be a significant life event that causes personal upheaval (e.g. becoming a carer, divorce) or traumatic (e.g. combat stress, physical abuse) and have a prolonged influence over a lifetime. Both positive and negative stressors have the potential to impact our health.
Cortisol is the "stress hormone". The effect of an increase in this hormone causes an increase of our heart rate, our blood pressure, our inflammatory response and our blood sugar levels. However, the way our bodies respond to cortisol varies from individual to individual. That is to say, the biological effects on our health at a certain level of the hormone is different for each of us.
Cumulative exposure to regular, repeated negative stressors results in greater risk of age-related chronic diseases, such as heart disease, diabetes, lowered immunity and cognitive function (1,2).
Significant life events have even been demonstrated to alter the actual structure of our brains (3), especially the areas of our brain associated with memory, possibly again through the high cortisol levels (2). When we talk about age, we are often referring to chronological age, how long an individual has been alive. Biological age is another term we use which refers to the equivalent age at which the body seems to be functioning.
If someone is particularly healthy, their biological age will be lower than their chronological age. Conversely, when someone’s biological age is greater than their chronological age, it means their body is functioning at the level of someone who is older. Stress can, therefore, be a contributing factor for speeding up the ageing process and promoting an earlier onset of age-related disease (4).
This association between stress and people with multiple chronic diseases appears greatest in those with the lowest incomes (5). There are a number of reasons postulated for this, such as less money to pay for healthcare and more financial stress, as well as some of the behavioural consequences of stress and low socioeconomic status: smoking, poor diet, increased alcohol consumption and a sedentary lifestyle. Finding ways to better manage stress may thus also reduce rates of these risky health behaviours with the consequential impact on chronic health (6).
What are the best strategies for increasing our resilience to life’s stressors?
Nurture social connections
Increasing those in the close circle around us helps incorporate more resilience in our lives. Evidence shows that building strong social networks can even offset genetic influences on the way our bodies handle stress (7). Good support from those around us has also been shown to reduce levels of our stress hormone, cortisol (8).
Practicing mindfulness can increase our capacity to cope with everyday stress as well as improving more significant mental health problems such as depression and even physical health too (9). Mindfulness can take many forms but these all allow us to focus on our present, excluding external or past and future concerns. There are many apps, such as Calm and Headspace, there are also practitioners and courses that are designed to help teach the art of meditation that are available now.
There is a bidirectional effect between sleep and stress. High levels of stress have a negative impact on our sleep but trying to optimise the amount and quality of the sleep that we are able to get by prioritising good sleep habits is essential to maximise resilience to the influence of stress on our health.
Regular Physical Activity
Some people combine physical activity with mindfulness as a powerful stress-relieving activity. Even when done without a mindfulness focus, exercise can increase self-efficacy (10). Independent of its effects on stress management, regular physical activity also mitigates the stress-related chronic health issues such as cardiovascular disease, diabetes, cognitive impairment and obesity.
The Gut-Brain Axis
Comfort eating is a well-known coping response to a stressful day. High stress levels affect our food choices and decisions. It can work the other way around too. What we eat impacts our emotional health. Eating the right type of foods actively promotes better mental and physical health.
One mechanism through which theses effects are mediated has recently risen in prominence in the scientific and popular literature, the microbiome. Through complex pathways, the bacteria, fungi and viruses that make up our “friendly” gut microbiome produce chemicals that signal to the brain via a large nerve called the vagus nerve (11). This link has been named the “gut-brain axis”. Reducing alcohol, avoiding refined carbohydrates such as added sugars, increasing fibre and having a diverse intake of plenty of plants all help promote a beneficial balance of the bugs in our guts and their positive effects on our health.
What works for each of us is as unique as we are as individuals. Some find benefit in quantifying their levels of stress using wearable devices to identify not just what stressors are having the most impact on their internal physiology but also what methods of introducing resilience are the most effective and should be prioritised. For others, this level of detail can just add another stressor to the day.
The key is to do what feels good and to test and try many different approaches to find what works best for you.
1. Zsoldos E, Ebmeier KP. Aging and Psychological Stress. In: Stress: Concepts, Cognition, Emotion, and Behavior: Handbook of Stress. Elsevier; 2016. p. 311–23.
2. Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. Vol. 16, EXCLI Journal. Leibniz Research Centre for Working Environment and Human Factors; 2017. p. 1057–72.
3. Papagni SA, Benetti S, Arulanantham S, McCrory E, McGuire P, Mechelli A. Effects of stressful life events on human brain structure: A longitudinal voxel-based morphometry study. Stress. 2011 Mar;14(2):227–32.
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10. Goldstein E, Topitzes J, Brown RL, Barrett B. Mediational pathways of meditation and exercise on mental health and perceived stress: A randomized controlled trial. J Health Psychol [Internet]. 2018 May 1 [cited 2020 Jan 24];1359105318772608. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29733230
11. Moloney RD, Desbonnet L, Clarke G, Dinan TG, Cryan JF. The microbiome: Stress, health and disease. Vol. 25, Mammalian Genome. Springer New York LLC; 2014. p. 49–74.