The Science Of Stress
FEATURE
Laurie Mueller
BA, DC, CFMP
The Twenty-First Century Epidemic
Stress has been dubbed the “health epidemic of the twenty-first century” by the World Health Organization. After a 2013 Gallup poll announced that 70% of the American workforce was disengaged, the WHO estimated that workplace stress is costing American businesses up to $300 billion a year. The numbers are staggering.
Those were just numbers from dissatisfaction in the workplace. As we all know, human beings have a variety of emotional, spiritual, physical, and environmental stressors that come into play with health and well-being too, and they can take their toll.
From an evolutionary standpoint, there is a mismatch between today’s demands and even what our grandparents encountered back in a simpler time. Expectations were different; farming practices and the foods they ate were different; they didn’t consume nearly as much sugar; and they had much less exposure to toxins, pesticides, and hormones than we do today. A work-life balance was much more prevalent as compared to our career-centric world today, which often requires having multiple jobs and both parents working to make ends meet. It is no wonder that our stress levels are mounting.
In the chiropractic profession, we’ve long recognized the significant toll that “thoughts, traumas, and toxins” can take on the body.
Causes of Stress
Stress can be physical, emotional, or psychological, but these often overlap in “a perfect storm” of a variety of inputs. We offer several examples below that should sound very familiar in your patient base.
Thoughts: In 2011 in the United States, nearly 75 million unique prescriptions were written for Xanax and Ativan alone, just two of many antianxiety medications. One in 10 Americans age 12 and older take antidepressant drugs. Among women in their 40s and 50s, that number is one in four. (2016) People tend to be “on” all the time. Being tired is a norm. Multitasking and heads spinning to get things done. Not enough time, space, or quiet. Not able to eat right or exercise. No time or effort to truly relax and “turn off’ the noise. This way of living has become the new normal. It stems from expectations, our jobs, the ego-addictive nature of our “smartphones,” society’s unrealistic expectations—again the list goes on. In the spectrum of patients, you may see it in a homemaker who is overworked and underappreciated, or in a war veteran who has experienced profound trauma. You may
^One in 10 Americans age 12 and older take antidepressant drugs.
see it in a working professional who feels overburdened and worried about losing his or her job, as well as guilty for not spending more time with the kids. It also could be present in someone who loves his or her job but is very shy and basically lonely and powerless in his or her personal life. Coupled with bad diet and environmental stressors, these events can lead people to “burn out” faster than our ancestors.
Trauma: This can stem from accidents and personal injury; surgery that stresses the body; the death of loved ones; chronic illness of self or loved ones; or being involved in a traumatic incident. Be particularly cognitive of post-traumatic stress (PTS) in your patient population that has served in the military. Significant stress symptoms can come from a single incident, but also from ongoing exposure to stressors.
Toxins: Thoughts and trauma paired with all of the environmental toxins, pollutants, and chemicals that we are exposed to on daily basis is a recipe for disaster. There are approximately 80,000 chemicals registered for use in the United States. The Centers for Disease Control and Prevention reports that hundreds of these chemicals are present in our bodies. A variety of research shows that certain chemicals may affect our immune, endocrine, and reproductive systems. Common external toxins include things such as air and water pollutants, cigarette smoke, personal care products, heavy metals, household cleaning products, pesticides, preservatives/additives, and the list goes on.
Our bodies create internal toxins too, typically as part of our detoxification system. We may have intermediates such as ammonia, carbon dioxide, or fl ee radicals that cause damage if our systems are not operating properly.
Lifestyle: Lifestyle plays a huge role in all of the previous three Ts. Do our patients get enough sleep, exercise, or downtime? What are they eating? In today’s world, we see profound increases of things such as sugar, gluten, trans fats, and additives/preservatives in the diet that all can contribute to systemic inflammation and total body burden for stress and toxins. This includes exposure to antibiotics and additional hormones in food products used on the animals that we consume.
The Adrenal Glands
An understanding of our stress glands—the adrenals—is paramount to this discussion. These two walnutsized endocrine glands that sit atop our kidneys are required for human life. As a review, cortisol is a primary
hormone secreted by the adrenals, gaining its fame from “fight-or-flight” reactions. We are designed to handle bursts of need in this way, but our modern lifestyle is subjecting people to more chronic unrelenting stress. What chronic stress does to our adrenal glands, no matter the source, is profound. It changes our body’s chemistry. In periods of chronic stress, this no longer becomes a temporary burst, but rather it becomes a more “stan-
dard” state of being, and this where it causes trouble.
As a quick review, our communication systems in the body include our endocrine hormones, neurotransmitters, neuroendocrine hormones, cytokines, paracrines, and autocrines. Clinically, we often focus on the HPA, HPT, and HPG axis, which are all interrelated (hypothalamic-pituitary-adrenal-thyroid-gonadal).
During the stress response, cortisol can affect thyroid hormone production and sex hormone production, and has been linked with insulin resistance. The take-home message here is that chronic stress can alter levels of other vital hormones as the body preferentially creates cortisol in the process of steroidogenesis.
The image here shows a simplified chart of steroidogenesis, which is how our steroid hormones are synthesized in a balanced flow (skinny arrows). The thick black arrows show what happens in chronic stress situations. As the production of cortisol takes preference for the body’s immediate needs, pregnenolone is shunted down a different path and the formation of DHEA is inhibited, which in turn alters the production of other important hormones, such as
the sex hormones.
Note that the process of steroidogenesis requires an important precursor—cholesterol, and more specifically, cholesterol from good fats that we consume. This is one reason that cholesterol-lowering drugs are so controversial, such as statins. A quick clinical pearl for your patients is that they need to be consuming good fats (fish oil, avocado, nuts, etc.), and if they are on statins, be aware that you may need to supplement with CoQlO. The mechanism of statin drugs can deplete the body of CoQlO, which is a cofactor essential for the creation of ATP. A depleted CoQlO level can also lead to a number of neurologic and myopathic syndromes (recall that a common side effect of statins is muscular pain and weakness).
Some Stress Is Good
A small amount of stress is actually good and allows the body to be adaptive involving Nrf2, as we see in the lighter portion of the chart. A small amount of stress promotes resilience. As stress progresses, however, it can lead to dysregulation of NFkB, an inflammatory mediator. Such dysregulation has been linked to cancer development, inflammatory diseases, and autoimmune issues. In the darker portion of the chart, where we see higher stress concentrations, we are promoting systemic inflammation, oxidative stress, and issues with cellular functions, such as gene expression, cell differentiation, proliferation, and apoptosis/cell death.
Stress Symptoms
Chronic stress is a totally different mechanism in the body. Think of it as a long-term survival tactic that comes at a high cost to other body functions. The bottom line is that anyone could suffer from stress, and how a person copes with perceived stressors can create different reactions with different people and take its toll with very individual symptoms. Many of our patients will tell us outright, “I feel stressed,” so that is definitely a big clue that the adrenals are at play. We know that many people in our modern population are suffering from chronic stress. With the systemic effect of hormone alteration, we can see how symptoms of stress can range from anxiety/depression to libido or fertility issues and beyond.
So what other symptoms might we see? Fatigue is a big one among an array of other hormonal issues and mood issues. Women may have issues with their menstrual cycle, while men may become aggressive or withdrawn. Patients may crave sugar, carbs, and caffeine-laden beverages. They may complain of panic attacks and anxiety, and depression symptoms are very common when the adrenals are fatigued. Many have headaches, trouble sleeping, or startle awake in the middle of the night. Many crave a coffee or strong jolt of sugar/caffeine around 3:00 p.m. because they consistently tend to bottom out. They may have a short temper or feel emotional, etc., but fatigue tends to be an overarching symptom among most patients. Stress is not a “mental illness,” nor is it “all in the head.” Stress has very real physical and chemical effects. In the realm of managing this type of imbalance, you may see adrenal symptoms, symptoms of thyroid disorder, and/or symptoms of sex hormone dysregulation. Within functional medicine protocols, it is recommended that you work with endocrine imbalances in that order. The endocrine system is very complex and interconnected, and as you balance one area, practitioners often find that other areas will balance out.
The production of cortisol during chronic stress actually happens on a spectrum in relationship with other hormones. Thus, there are stages of adrenal “burn out” and salivary cortisol testing is an excellent tool for this.
Causes of Stress
In the Journal of Evolutionary Medicine, researchers identified six factors that they deemed contributory to the chronic disease and biological stress as a result of today’s modern lifestyle. Their abstract reads: “Although psychological stress is an adaptive phenotypic state necessary for survival, chronic psychological stress in developed, industrialized human populations can be characterized as an immune-altering factor associated with a wide range of allergic, autoimmune, and other inflammatory-related diseases. Modern lifestyles, chronic disease, and psychological stress. Here we present a synopsis of factors in industrialized populations, which might increase or decrease psychological stress compared with pre-industrialized populations. Several sources are identified, which might increase chronic stress in post-industrialized society, although the stress induced by half of those is counterbalanced to some degree by decreasing the likelihood that individuals will be consigned to undesirable social roles that developed following the agricultural revolution. The environment of evolutionary adaptedness and disease. It is hypothesized that chronic stress in industrialized society might exceed that found in our environment of evolutionary adaptedness, particularly for those individuals who, for whatever reason, have not found satisfying social roles among the wide range of options available.”
Their big six list consists of the following things to consider:
1. An inflammatory diet high in sugar, salt, fat, and refined grains.
2. A sedentary lifestyle.
3. Chronic vitamin D deficiency from not spending time outside in the sun.
4. The depletion of our microbiome (in the gut), which is the important population of the bacteria that live as a part of us and have been depleted through things such as sanitation and medication.
5. The presence of infinite choices around jobs and social roles beyond what our brains evolved to handle, as well as limitations of choice, such as those imposed by socioeconomic status.
6. The constant bombardment of media that exposes us to violence, idealized body types, and superficial social relationships.
Certainly, there is more to be considered, but here we see the significance of a multifactorial approach that includes major dietary considerations, the health of our microbiome/gut function, common vitamin deficiencies, and socioeconomic and superficial stressors. As we combat stress symptoms, those factors must be addressed and include lifestyle changes, reducing inflammation, detoxification, and care, such as massage, meditation, or co-care with a counselor or other professional as warranted. Chiropractic is certainly a beneficial part of this plan and some DCs may opt for training to address the stress components in addition to the spinal components.
Another important side note here is to understand that many patients are dealing with this issue, so having a caring and welcoming office will provide them with a welcome reprieve from the stressors of life. Be sure to remind your staff to smile and be mindful of how they treat every single patient.
We hope that this article provided a good overview of the science of stress. Note that we did not offer clinical treatments here. It is important to note that there is no “cookie-cutter” approach to the complex issue of adrenal stress. If you are going to treat patients, you should be trained on how to analyze and approach specific patient needs or consider co-caring with a functional medicine practitioner. The functional approach to care is being sought after by more and more patients. With this approach, care plans are individualized for each patient. Lab results, supplementation needs, detox, dietary approaches, and lifestyle changes will all vary as patients present with differing symptoms, differing causes, are at a different stage of stress, and require different needs to help them find resolution. “Watch for FxMedOnline.com coming soon for DC’s!”
Laurie Mueller, BA, DC, CFMP, served in private practice in San Diego, California. She was the postgraduate director at Palmer College from 2000 to 2010; served as the ACC postgraduate subcommittee chair for six years; and peer-reviewed for the Research Agenda Conference. Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions LLC. She is a clinician, an educator, and an expert in online educational pedagogy. She is welcoming new clients and invites organizations to contact her directly at drmuelleronlinedfyahoo. com.
