You had an argument with your partner, you’re attempting to focus on your third Zoom call in a row, and your back pain is acting up. Sound familiar? If you experience stress, you’re not alone. According to the American Psychological Association, more than 75 percent of Americans report physical or emotional symptoms of stress, including headache, feeling tired, or altered sleeping habits.
While the term stress might sound benign, it’s anything but—especially when everyday stress becomes chronic. Chronic stress is something Parsley Health doctors see every day and is a factor driving many forms of disease in the US. But it doesn’t have to be.
What is chronic stress?
“Essentially, chronic stress is a prolonged response to a threat,” says Jamie L. Guyden, MD, a doctor at Parsley Health. She explains the threat might be real, as in being held at gunpoint, or perceived, as when you’re speaking before a large group. In both cases you may experience the same psychological and physiological reactions.
When you perceive a situation as stressful, your hypothalamus, a gland at the base of your brain, activates your sympathetic nervous system (SNS), or the fight-or-flight response. When it turns on, your brain releases epinephrine (also known as adrenaline) and norepinephrine, which are hormones. You might notice a temporary increase in your heart rate and blood pressure along with increased alertness, and decreased digestion and urine. This is your body’s way of diverting your energy toward managing the stressor, says Dr. Guyden.
Simultaneously, your adrenal glands release cortisol, the primary anti-inflammatory stress hormone, to release glucose (sugars) into your bloodstream so you can take quick action. “Cortisol will also activate the inflammatory cascade in an effort to aid in tissue repair and recovery,” explains Dr. Guyden. Once the stressor recedes, your body should return to homeostasis. This reaction “is designed to be short-lived,” she explains.
When the stress response remains activated for a prolonged period and engages too frequently, you’re at risk for chronic stress. According to Dr. Guyden, chronic stress results from multiple sources of stress you’ve been experiencing for three months or more. This leads to sustained activation of the body’s stress system, the Hypothalamic-Pituitary-Adrenal Axis (HPA axis), which releases stress hormones. Meanwhile, psychological stress provokes the immune response, sending chemicals known as pro-inflammatory cytokines, to attack the threat. Over time, Dr. Guyden says, your body can become cortisol resistant, which means your inflammation response never “shuts off.” Chronic inflammation can lead to a number of serious health conditions.
It’s important to note that the same circumstances may elicit the fight-or-flight response in some individuals but not others. “Some people find excitement in small amounts of stress, and thus, their bodies don’t respond to them as ‘stressful,’ and potentially, have no physiological response,” says Dr. Guyden. “Others, depending on multiple factors including, but not limited to, lifestyle, socioeconomics, childhood trauma, and genetic factors, respond to very small stressors as if they are life-threatening.”
A large study published in the American Journal of Preventive Medicine found a significant graded relationship between exposure to childhood abuse or household dysfunction and the presence of adult diseases. Dr. Guyden also notes, “people of color, those who have been marginalized and people of lower socioeconomic class are arguably more susceptible to chronic stress.” Research shows that ethnic minorities experience worse overall health than do white Americans.
Symptoms of chronic stress
According to Dr. Guyden, “Our brilliant bodies are designed to respond to stress.” However when prolonged or multiple stressors suppress the parasympathetic nervous system, you may experience a variety of chronic stress symptoms.
The long-term activation of the HPA axis and elevated cortisol levels can cause:
- increases in blood pressure, cholesterol, and heart disease
- increase in blood sugar levels (as in diabetes)
- weight gain
- lowered immune function
- digestive problems
- memory issues
- mood disturbances such as depression, anxiety, or irritability
- fatigue but difficulty sleeping (a.k.a. wired but tired)
- chronic pain
- muscle tension
- urinary problems
“Interestingly, with long-term chronic stress, cortisol may eventually decrease, causing chronically low cortisol, leading to a slightly different picture,” says Dr. Guyden. Symptoms can include:
- low blood pressure
- craving salt and spicy foods
- morning fatigue
- diminished motivation
- poor concentration
- hormonal issues such as early menopause in females and low libido.
This might appear to be a long list of unrelated symptoms but Dr. Guyden has an explanation: “Chronic stress can affect any organ or gland in the body, as our hormonal system works through a sophisticated symphony throughout the body, heart, and mind.”
Long-term health effects of chronic stress
According to Dr. Guyden, long-term activation of the HPA axis and the release of cortisol that come with chronic stress, can cause serious long-term damage, including diseases of inflammation. “Over time, with consistent activation of these systems, the body continually tries to adapt to the stressors by upregulating and eventually downregulating these systems, leading to high/low cortisol and imbalanced SNS/PNS activity.” If left unchecked chronic stress can lead to conditions including:
1. Blood sugar dysregulation
During the stress response, the release of cortisol triggers the release of glucose, giving your muscles a burst of energy to run from a burning building. But if you’re anxiously stuck in traffic, that excess sugar circulates through your bloodstream, leaving you with high blood sugar. Cortisol also inhibits the release of insulin, which is the hormone responsible for regulating your blood sugar. Chronic stress then leads to chronic high blood sugar, which creates problems even if you don’t end up with type 2 diabetes. Such problems include frequent urination, increased thirst, fatigue, nausea/vomiting, fruity breath odor, dry mouth, dizziness/lightheadedness, and weight gain.
If you do develop type 2 diabetes, chronic stress can bring on complications. A Diabetes Care study found that diabetes 2 patients with elevated HPA axis activity were more likely to experience neuropathy, retinopathy, kidney disease, and macroangiopathy.
2. Cardiovascular disease
Dr. Guyden explains that the release of cortisol due to stress causes narrowing of the arteries and the release of epinephrine to increase heart rate and pump blood harder. Like all hormones, cortisol is made from cholesterol. Therefore, “chronic cortisol elevation will require more precursor and thus cholesterol production.”
According to a 2019 Current Cardiology Reports study, increased cortisol levels can result in elevated cholesterol, high blood pressure, and elevated triglycerides. Elevated cortisol can also cause changes that encourage the buildup of plaque in the arteries and abdominal adiposity, or belly fat. All of these factors increase the risk of cardiovascular disease, including heart attack, stroke, heart failure, and arrhythmia.
3. Depression and anxiety
Chronic stress can also lead to depression. According to a Psychoneuroendocrinology study, as many as 20 to 50 percent of people develop depression following a major life stressor. Dysregulation of the HPA axis can lead to a drop in dopamine and serotonin, adversely affecting mental health.
A 2020 study in Brain, Behavior, and Immunity, found that chronic stress induces a pro-inflammatory cellular response in the brain, which triggers anxiety. A 2018 Biological Psychiatry study had similar findings; mice who were exposed to a painful stimulus (chronic stress) demonstrated an inflammatory immune response that was linked with behaviors characteristic of anxiety and depression.
Although cortisol is anti-inflammatory and typically suppresses pro-inflammatory cytokines, chronic cortisol elevation can result in a “resistant” immune system, according to a 2015 Current Opinion in Psychology study. This comes along with an accumulation of stress hormones that creates an inflammatory response that further depresses the immune response. Altered immune function due to HPA axis dysregulation has been shown to exacerbate irritable bowel syndrome and multiple sclerosis. It also plays a role in HIV, cancer, and schizophrenia.
5. Fatigue and impaired cognition
According to Dr. Guyden, many people with chronic stress report feeling “wired but tired.” In other words, you might feel exhausted but when your head hits the pillow, you struggle to fall asleep.
Chronic stress can also interfere with cognition, causing “brain fog” or difficulty with memory and concentration. Research has established a connection between healthy levels of cortisol and brain function. A 2019 Frontiers in Immunology study found higher rates of fatigue in patients with conditions associated with the immune system activation, such as allergies, Type 1 diabetes, and infections, suggesting inflammation contributes to fatigue.
Chronic stress can wreak havoc on the finely tuned hormonal balance supporting reproduction. A Minerva Endocrinologica review found that for women, elevated cortisol can suppress the hormone that triggers ovulation. According to a 2015 Nature study, in men, psychological stress can cause reduced testosterone levels, leading to low sperm count. Additionally, experiencing chronic stress while pregnant can lead to permanent changes in the baby’s endocrine function and stress-related behaviors.
Seeking treatment for chronic stress
“We shouldn’t be waiting until we are in emergent states of health to address the chronic stressors that many of us face,” says Dr. Guyden. This is particularly true if you have high blood pressure, high cholesterol, or diabetes. “As we’ve learned, these are diseases of stress and should be addressed holistically,” she explains.
A functional medicine doctor and health coach, such as those as Parsley Health, will address the root cause of your health problems, not just the symptoms. “By connecting an individual with where and how chronic stress has crept in, understanding one’s response to stress, how an individual restores and rejuvenates and what long-term traumas, emotional distressors an individual has perceived,” says Dr. Guyden, “we are able to create a pathway to reversal.”