The Stress Test

What we seldom appreciate is that stress plays a beneficial role in our lives and in our health.

Stress. Everybody has it. We can’t live without it. But too much is, well, too much—and a real threat to our health and happiness.

Word origins so often set a rich context for a concept, and the origin of the word “stress” is no exception. From Latin, stringere means“to draw tight.” We’ve all had that feeling, when we’ve been under stress, that the string is being tightened to the point that it just might break. What we seldom appreciate is that stress plays a beneficial role in our lives and in our health. We all willingly engage in stressful situations that we know contribute to our health and well-being: sports, games, difficult puzzles, tense entertainment, raising children, the satisfaction of a difficult job well done. Much of the benefit we feel from these situations and activities derives from “just enough” of the stress response, drawing the string just tight enough to produce beautiful music.

So what happens with stress and how can we keep it in check so we get all of the benefits and none of the ill effects? Don’t fall off your chair yet, but there’s no perfect answer that works for everyone. First, let’s explore some of the body’s responses to stress.

Our bodies are finely tuned to try to maintain homeostasis,a condition of physical and chemical balance that’s set within fairly definite tolerances. Any challenge to that balance—whether it’s emotional, environmental or physical—sets off a very complex set of physical, hormonal, neurological and chemical changes, all of which are designed to let us respond to the challenge and move to a place of balance (or safety) again.

The example that’s easiest to illustrate is that of intense and imminent physical danger: a wild animal (your most important customer) chasing you (threatening to take their business elsewhere). Multiple systems spring in to action immediately, initiating what’s been aptly termed the “fight or flight response.” This was first characterized in 1926 by neurobiologist Hans Selye, and much has been done in the ensuing years to fully elucidate all the pathways involved. 

Faced with a threat, from a macroscopic view, our bodies immediately focus resources in ways that facilitate a response: Eyesight and hearing become more acute, muscle tone increases, heart rate and blood pressure increase and blood sugar rises, all helping with the physical response to the challenge. Some body processes are decreased to avoid unnecessary resource use: Hunger and thirst lessen, urinary and gut processes slow down, immune function and nonessential brain activity is suppressed.

From a microscopic, or neurobiologic, standpoint, there’s a very complex cascade of events that occur almost instantaneously to facilitate all those physical changes. While sketching out the entire sequence is well beyond our scope here, the most important end product is cortisol (often incorrectly referred to as adrenaline), produced by the adrenal glands, which sit on top of the kidneys. Cortisol facilitates many of the physical responses described here. Many other hormones and chemical mediators are involved: corticotropin releasing hormone, adrenocortocotropic hormone, serotonin, norepinephrine, neuropeptide Y and others.

While this response can be very beneficial and effective when there’s an immediate threat, if the threat (stress) persists over too long a time, is too indistinct to mount an effective discrete response, or if the threats are multiple, the physiologic responses tend to become dysfunctional and the resulting litany of ills corresponds directly to immediate responses such as elevated blood pressure, rapid heart rate, hypersensitivity, increased muscle tension, anxiety, insomnia, poor concentration, elevated blood sugar and other electrolyte disturbances, increased tendency toward infection,  depression, digestive upset and hyperacidity, bladder instability and many, many more. Many of the ailments, both acute and chronic, that I see every day as a family physician have their origins in this overdrawn stress response. So how can we avoid this?

The joke goes that when you’re out in the woods with a friend, you don’t have to outrun the bear, you just have to outrun the other guy. Put slightly differently, step back and try to put things in perspective. It’s a long race, a long life, a long career and we can do our best if we don’t let “perfect” get in the way of “good enough.” Not easy to do, but important.

Here’s a list of simple tips:

Take mini-breaks. Thirty seconds with your eyes closed, focused on something that really makes you happy, can stimulate production of very beneficial brain chemicals, slow your heart rate and decrease your blood pressure. Daily meditation is the extended version of this quick tip.

Exercise. Even short bursts of walking can help in the same ways.

Avoid excesses of alcohol, caffeine and simple carbohydrates, and don’t smoke. The short-term boost is usually paid for by a long-term lag.

Eat well. There is good evidence that a diet that’s low in animal proteins and fats and high in multicolored vegetables and fruits, nuts, seeds and fish all help to promote positive response to stress.

Make a list. If you fret during the night, write down what’s important and what you’ll do about it tomorrow before you go to bed and then put it aside. Warm milk also has chemicals in it that may help.

Make connections. Spend time every day with people who make you feel good, even if it’s just a few minutes.

Laugh every day. Maybe you need to have a book of good jokes on your desk.

Smile, even if you don’t feel like it. When someone smiles back, it’s like a mini-vacation for your brain.

Some stress can be your friend and, with some attention, you can minimize the ill effects of long-term excessive stress. The result? A happier, healthier you.