Stress Reduction: Questions & Answers
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I don't get it. I just want to lose weight, what does stress reduction have to do with it?
--SS, Ithaca, NY
We have found that the best way to lose weight is to commit to a more healthful lifestyle in many different ways, including making a commitment to reduce the stress in your life. In particular, emotional stress has been related to weight in several ways:
(1) Stress hormones change the way we handle blood sugar, which can increase appetite.
(2) Some, although not all, overweight people are emotional eaters, responding to stress with a craving for "comfort foods". Which foods provide comfort varies with the individual, but are generally higher in fat and sugar. Obviously, this can sabotage weight-loss efforts.
(3) If you commit to a more healthful nutrition plan, a moderate physical activity program, and stress reduction, it is the stress reduction component that will provide rewards first. Most people enjoy a more active lifestyle once they've tried it for awhile, but it does take time. Most people learn to like lowfat dairy products and whole grain foods, but those are acquired tastes. The benefits of a soothing bubblebath or a good night's sleep, however, will be felt almost immediately. Realizing how much better you feel is likely to provide you with motivation to go the distance with your other commitments. Give it a try, and let us know how it works for you!
My main problem is stress. Can I use diet, exercise, and changes in my environment to reduce stress? Put it all together for me!!
-- TA, New York, NY
Absolutely! That's the great thing about taking a holistic approach to a healthy lifestyle -- every part supports every other part.
Good nutrition will help provide you with the physical health that will make stress easier to deal with. In addition, you can time your meals to help you. Eat more protein earlier in the day when you want to be alert, eat more carbohydrates in the evening or when you want to relax. Eat smaller meals (supplement with snacks), you will feel less lethargic. As you avoid physical stress, you will find it easier to confront mental stress.
Physical activity is perhaps the best method of dealing with stress. Aerobic exercise improves circulation, including feeding your brain, making you more alert and responsive to your environment. It also causes the release of endorphins, which helps relax you. Activity has been found to be an important part of treatment for depression and anxiety. Work regular physical activity into your day, you will find yourself able to handle stress much more easily. Add some extra physical activity after extremely stressful episodes, you will find you can let them go more easily.
Your environment will either add to or ease your stress. Even the colors you choose to have around you can cause relaxation or tension. If you have no control over the colors of your walls, try to add something in your favorite colors -- favorite pictures, for example. You can also use scents to make you more alert when tired, or more relaxed when too tense. Experiment with the different aspects of your environment to see what works best for you!
It seems that when medical doctors can't figure out what is wrong with you, they blame it on stress. When no real medical diagnosis is found they just say it's stress and give you tranquilizers or anti-depressants. It seems perhaps they might be cognizant of alternative ways to reduce stress, if that is really what it is. Stress has just become a catch-all term when they fail to find a medical cause. I have been sick a lot the past couple of years and I'm not in any extremely stressful situations. My life is pretty calm. When they say "It's just stress" it reminds me of when they used to say it must be a virus. I'd rather be told "I just can't find what is wrong with you" and that they will keep looking. I just don't see how stress can make you run a temperature and be extremely fatigued.
-- SO, Nashville,TN
I know it seems like "stress" is the newest fad, but actually there are legitimate reasons for doctors to often blame sickness on stress, which I will get to below. However, I would like to encourage you to talk with your doctor again. First of all, be aware that stress does not have to be of the traumatic variety to cause health problems; the little day-to-day stressors can wear you down over time simply because they occur so frequently (3,7,8,9,10)*. So it is possible that you don't entirely realize how stressed out you are. We live in a fast-paced, have it all, do more, sleep less world, and so a lot of any doctor's patients probably are very stressed, and it is probably quite responsible of your doctor to bring the subject up. If you agree with your doctor that you are very stressed and it might be affecting your health, your doctor will try to help you manage your stressors. However. If you look very honestly at your life and you become convinced that stress is not a component of your getting sick, then you should certainly feel free to tell your doctor so.
It was not all that long ago that people who complained of stress were thought to be just a bunch of whiners, that emotional stress could not be all that damaging. The research has now validated the popular viewpoint that stress IS harmful to health (1-12), and doctors have begun to realize just what a health risk stress is. So if this is your doctor's attitude, congratulations! He is paying attention. So I would say something like, "Thank you, doctor, for your concern over how stress might be making me miserable. However, I assure you that this is not the case with me. I do not have all that much stress, and what stress comes my way I handle well. Something else is going on here that is affecting my physical health. Please keep looking for other causes."
Does that sound like something you can tell him or her? If not, you might consider visiting other doctors until you find one that you feel more comfortable talking with.
Now, as to how stress affects health, a thorough review of the literature found much research done on this topic, most of it within the last 5-10 years. So this is a hot and growing topic within the medical research field.
There are different kinds of stress. Physical stress, such as occurs with illness or injury, or extreme heat or cold, or lacking sleep or experiencing true hunger, is one sort of acute stress, and is likely to affect health relatively quickly. Emotional stress, however, activates many of the same physiological pathways, whether it is acute or chronic in nature. The nervous system and the hypothalamic-pituitary-adrenocortical pathway connect emotions, brain neurotransmitters, stress hormones such as adrenaline and cortisol, cardiovascular health, and immune function (3,4,8,9,10,11). At least one of the mechanisms by which immune function is affected is by a decrease in production of interleukin-1-beta, one of the major signaling mechanisms immune cells use to communicate (3). It is NOT imaginary that emotional stress can contribute to heart attacks, cancer, and even the common cold! All are connected via a complex interacting set of hormones and other biochemical signals in the body. In addition, bone minerals seem more likely to be lost under stress (7). And some brain cells seem to atrophy under conditions of stress (7), perhaps partly explaining why stress leads to poorer cognitive functioning (10) and depression (12). So this is not the catch-all pseudodiagnosis that it may seem.
Stress is also clearly a contributor to obesity. Some obese patients have a syndrome called night eating syndrome, characterized by eating many of their calories in the evening while having problems with insomnia (1). These patients have been shown to have higher circulating levels of cortisol, one of the stress hormones. Other obese patients may not have a nighttime eating disorder, but they may have metabolic syndrome. This is a disorder characterized by diabetes, high blood pressure, high levels of "bad" cholesterol and low levels of "good" cholesterol, cardiovascular disease, and obesity, particularly high levels of fat in the abdomen (2,6). These patients, too, have high levels of cortisol activity, as well as adrenaline and noradrenaline activity, and insulin resistance in the presence of high levels of circulating insulin. Cortisol appears to increase the body's production and storage of glucose (5). Even in subjects without a full-blown metabolic disorder, stress still predisposes to obesity characterized by abdominal fat (7).
Part of the difficulty in researching this topic has been that, it turns out, it is NOT how much stress you have in your life, or its severity. It is how YOU perceive it! If you feel out of control, if you let stressful events "get to you", THEN there will be health effects (9)! So some people have a tremendous amount of stress, when viewed objectively, yet sail through without any ill effects, because they cope well. And other people have tremendous difficulties with health problems, even when their lives as viewed objectively seem to have very little stress, because they're easily stressed out. So it's important, for the sake of your physical health, to learn to handle stress as well as possible. That's how we hope to be able to help through these Web pages.
Yes, stress can make you feel worn out. And stress can even play a role in making you run a temperature. Emotional stress activates the immune system, turning it on to "stand by at the ready" for an attack on your body. And any time your immune system begins to respond, you are likely to run at least a low grade temperature.
So, we have enlightened doctors who at last recognize that disease may be caused by or at least contributed to by stress. But then what should they do about it?
They could write you a prescription for a tranquilizer. In fact, a lot of this is happening, and in my opinion such drugs are overprescribed. They all have potential side effects. And the contribution of mild stress to disease is not as well documented as that of extreme emotional distress. Therefore if you do not have an identified anxiety disorder or other psychological diagnosis, it is well within the realm of possibility that the treatment in this case could be worse than the "disease" of stress. Thus, tranquilizers should be prescribed with caution.
They could refer you to a mental health professional. Unfortunately, there are not at this time recognized allied health professionals who function as stress reduction consultants. There probably should be. Mental health professionals, instead, have spent their efforts trying to end the stigma attached to going to see them. These efforts, unfortunately, have been less than successful. Many patients will be reluctant to see a mental health professional, whether psychologist, psychiatrist, or social worker, over "ordinary, everyday" type stress. They may even be insulted at the suggestion -- since they're "not crazy". Which leaves a stress reduction consultant, which from a doctor's point of view would probably be ideal, much like referring patients to dietitians when they need dietary advice; but these do not exist in an organized fashion yet.
They could recommend a variety of self help books to you. However, many people do not change their behavior after reading self help books! They read through the exercises rather than actually doing them, and so nothing changes. This is why it's generally better and more effective to speak with a change professional. If you are up to the task of reading the books, doing the exercises, and facing your problems and challenges in privacy, however, this route may work very well for you.
Actually, probably the best solution to daily stressors is societal change, including empowering the powerless and the impoverished. This, however, is quite a stretch outside of a medical doctor's field of expertise, and requires political action. It is, however, one of the reasons we recommend that people give volunteer work a try; it's not only good for the soul. When you meet with a group of like-minded folks, you might be pleasantly surprised at all you can accomplish!
Keep checking this site for more information on stress reduction, and keep writing in with your questions. We'll try to provide some of the information here that is not available from health care professionals elsewhere! But keep challenging your doctor to answer all your questions, too. Your doctor has a responsibility to keep looking for reasons for your illnesses that provide opportunities for treatment.
*Numbers in parentheses refer to journal articles on our References page.
If you have questions about stress reduction, please e-mail us and ask!! Questions of general interest will be posted on the Q&A pages ONLY IF you give permission.
This page was last updated on 04/23/03.