Stress Physiology in a Stressful World

While I was in graduate school, I fell very ill from what we ultimately determined to be issues with my adrenal glands, a pair of tiny hormone- (signal) producing glands on your kidneys. These glands are most famous for producing our healthy stress responses, but chronic stress can make these stress responses way less healthy for us. I talk a lot about stress physiology online, but I also wanted to share tips in one place along with links to other resources. Standard disclaimer: I am not a medical doctor, do not take advice from me without also checking with a medical professional.

This post is quite long but is split into the following sections if you want to scroll to them directly:

-What is stress physiology?

-What does evolution have to do with it?

-What should we know about stress systems?

-What does stress physiology look like?

-How do we turn off a stress response?

-Tools for your stress-management toolbox:

-Eliminate stressors

-Reframing stressors

-Finding distractions that calm you

-Burn off anxiety with exercise

-Care for something

-Be with people

-Eat the right foods

-Eat enough food

-Sleep enough

-Learn how to activate your parasympathetic nervous system

-Do less

-Keep track of all these tools

-Forgive yourself

-But what about the global chaos right now?

Image credit: Stress physiology diagram, accessed via Wikipedia and reproduced under Creative Commons Attribution 3.0 Unported license. Source: Campos-Rodríguez R, Godínez-Victoria M, Abarca-Rojano E, Pacheco-Yépez J, Reyna-Garfias H, Barbosa-Cabrera RE, Drago-Serrano ME (2013) Stress modulates intestinal secretory immunoglobulin A. Front. Integr. Neurosci. 7:86. doi: 10.3389/fnint.2013.00086 http://journal.frontiersin.org/article/10.3389/fnint.2013.00086/full 

What is stress physiology? Our bodies respond to stressful information from both inside and outside our bodies. This can look like distress signals (like pain) sent from one organ system to another, or some external threat (like a predator approaching on a landscape or a news alert about some existential threat). Physiology is a fancy term for how our body functions; bodies are flexible systems that respond to information (stimuli) and adjust their performance accordingly. Stress physiology, then, is how our body interprets stressful stimuli and responds.

Further learning opportunity: free Khan Academy lecture on stress physiology (link: https://www.khanacademy.org/test-prep/mcat/processing-the-environment/stress/v/what-is-stress).

What does evolution have to do with it? The current tools that our bodies have to work with are the product of millions of years of evolution. For most of that (very long) time, our ancestors were facing acute stressors—finding food and shelter, avoiding predators on a landscape. Our bodies are therefore really well designed to deal with acute stress, the kind that we can solve by searching the landscape for food or by confronting a predator (our “fight or flight” system). We are not as good at dealing with long-term stress that we cannot escape from. While worldwide 24/7 news and information access has brought us many positive developments, it also gives us an opportunity to experience chronic stress that our ancestors did not have to manage. Societies that prioritize productivity over community and push people to work very long hours do not help either, but that is another blog post!

What should we know about stress systems? Human physiology is very complicated, certainly too complicated to explain in a single blog post. However, it is useful to understand the major players in stress systems. Our sensory organs (like our eyes, ears, etc.) send signals to our brain, which relays signals to our adrenal glands. Some of our organs send signals to our adrenal glands directly, bypassing the brain entirely; this is one of many reasons that it is very hard to think or reason our way out of stress. Our adrenal glands (near our kidneys) then produce hormone signals that help coordinate a stress response across our entire body. One such signal are the catecholamines, molecules you likely better know by their individual names: dopamine, norepinephrine (noradrenaline), and epinephrine (adrenaline). These molecules are very fast-acting—they coordinate the sudden spike in heart rate and the other actions we think of when we are in “flight or fight” mode. Another signal molecule is the steroid hormone cortisol, which helps manage stress responses by altering your blood sugar (to give your body fuel to continue a stress response), keeping you awake (until threats have passed), even altering your immune response in case the threat you are facing is a pathogen like bacteria! Cortisol release takes longer, but it is critical to a healthy stress response, as it keeps your body functioning and ultimately leads your body to turn off and recover from the stress response. These systems work really well if you are facing a short-term (acute) stressor, but can begin to be problematic if the stressor becomes chronic (never ends). This system that helps us respond to stressors (from the giant ones to everyday stress) is often described under the blanket term “sympathetic nervous system” and its associate endocrine (hormone) systems.

When we are stressed, especially if we are stressed enough we are in “fight or flight,” our body is prepared for activity. We may feel like we have too much energy (nervous jitters) that can lead to problems falling asleep. Remember, this would have been very good if we were running from a predator! We slow digestion and tissue repair; your body can’t be resting, digesting, and healing if a predator is racing toward you. We are highly vigilant, perhaps even noticing sights and sounds we would not have detected otherwise; this can lead us to be easily distracted.

Our body can’t stay in this mode forever and still be healthy. At some point we need to rest, digest, sleep, and repair tissues. These functions are often dictated by the “parasympathetic nervous system” and its associated endocrine (hormone) systems, and frequently called “rest and digest” mode. When we are in this mode we are not very focused or active and will eventually fall asleep. This is completely necessary to get into this mode to repair after a stress response, but it is hard to get there if our stressors never end.

Further learning opportunities on stress physiology: free Khan Academy lecture about responding to stress (link: https://www.khanacademy.org/test-prep/mcat/processing-the-environment/stress/v/responding-to-stress).

What does stress physiology look like? You may be thinking “that was too much physiology mumbo-jumbo, what does this actually mean for me?” Well, it means that when we are experiencing stressors, we are going to see physical signs in the way our body functions. In the short term, we could see elevated heart rates, cold hands/feet (from blood circulation restrictions), higher blood sugar, racing thoughts, fear, hypervigilance, increased sensitivity to stimuli (loud noises, strong smells, etc.), issues focusing on the “right” things as we’re distracted by other stressors, irritability, problems falling asleep, and decreased digestion. These symptoms can be annoying in the short-term, but if we can eliminate the stressors we will switch to “rest and digest” mode and be fine.

It is more dangerous if our stress symptoms stay with us for a longer time (becoming chronic). Elevated heart rate can become long-term cardiovascular problems, like heart issues and high blood pressure. Circulation restrictions can lead to nerve damage, issues healing wounds, and noticeable changes on our skin (cellulite, scarring). Over time, high blood sugar can damage the systems that regulate digestion, blood sugar, and fat storage (such as our pancreas and liver), increasing risk of type 2 diabetes and liver damage. Long-term racing thoughts and fear can become chronic anxiety and mood disorders. Hypervigilance and increased sensitivity to stimuli can make it overwhelming to be in public spaces. Issues focusing can harm our work output and our relationships, as can irritability. Problems falling asleep can lead to insomnia and our sleep-wake cycles falling out-of-sync with the schedule we need to keep for our jobs and schooling. Decreasing digestion long-term can lead to reduced appetite, malnutrition despite eating a healthy diet, even disordered eating. How do I know this? All of these things happened to me.

Over time, our body may run out of the resources it needs to keep powering this runaway stress response. In my case, I burned out of the cortisol needed to regulate my stress responses, so my adrenal glands were making a lot of norepinephrine but not the cortisol needed to mount that stress response, turn it off, and recover from it. High norepinephrine: cortisol ratios are one of the physiological routes to PTSD, and I was experiencing every symptom of PTSD without the acute stressor (a single intense trauma) that would have led to it (in Europe this condition is recognized as complex PTSD, or cPTSD).  

Further learning opportunities:

-free Khan Academy lecture on the physical effects of stress: https://www.khanacademy.org/test-prep/mcat/processing-the-environment/stress/v/physical-effects-of-stress

-free Khan Academy lecture on the behavioral effects of stress: https://www.khanacademy.org/test-prep/mcat/processing-the-environment/stress/v/behavioral-effects-of-stress

How do we turn off a stress response: Unfortunately it is very hard (if not impossible) to think your way out of a stress response, in part because our brain does not directly control much of stress physiology. What you can do, however, is to reduce stressful stimuli as much as possible and give your body the tools it needs to get through a stress response and get to the healthy recovery on the other end. What does that look like? Well, the truth is, it varies for every person and for every type of stressful stimuli. But that just means you need to build a large “toolkit” of things to try each time you are stressed, to learn what works for you and have alternatives. The next sections give a bunch of resources that have worked for me, I encourage you to give them a try!

Further learning opportunity: free Khan Academy lecture on stress management (link: https://www.khanacademy.org/test-prep/mcat/processing-the-environment/stress/v/stress-management).

Tools for your stress-management toolbox:

-Eliminate stressors: Obviously it is very useful to remove stressors if you can. That can include restricting your access to stressful media (limit your news app time!), logging off from social media at a set time before bed, choosing to work in less-stressful environments when possible, even dramatic changes like changing your career path (or getting out of graduate school!). While we may not be able or ready to make really dramatic changes, critically assessing what little changes we can make to eliminate some of the stressors in our lives can help. The norepinephrine released from your adrenal glands is not labelled like “stress from the news” or “stress from the traffic on my commute”: eliminating the little stressors (like finding alternative routes to work) can help lower our norepinephrine levels in general.

-Reframing stressors: The truth is, we do not have direct control over our stressors. But, to a degree, we do have some control over how much they can stress us. I would argue we do not have as great an ability to mentally reframe things as we might assume, especially when we are stressed (since norepinephrine in our brain reduces activity in our higher-thinking frontal lobes). But where we can, it can be very useful to reframe some stressors, to “look on the bright side” as much as we can. Last weekend I was stuck in standstill traffic for almost 30 minutes, I chose to focus on being grateful that my friends were kind about my delaying our plans and to focus on the many ways that drivers were being thoughtful (letting each other zipper merge, choosing not to honk). Sometimes these mental gymnastics can be super silly; when someone cuts me off in traffic I always pretend they must be rushing to the hospital even if there is no evidence of that. Reframing is not something you can necessarily just jump in and start doing—it takes active work and practice. Speaking with a licensed therapist can help you reframe your daily stressors, but of course it is not for everyone (or for all of our circumstances). At the end of the day, we can’t reframe everything without turning into a demented Pangloss (Candide reference), but it can help a little bit with minor stressors!

Tips for positive reframing: https://online.sbu.edu/news/strategies-reframing-negative-thoughts

-Finding distractions that calm you: Checking out, choosing distractions, and willfully dissociating can be helpful in the short term (although unhealthy in the long term). When I am stressed enough I am starting to panic, I rely on a bunch of short-term distractions. These can look like simple games (I’m partial to Bubble Shooter and Sudoku), relaxing podcasts (I like the Lonely Island and Seth Meyers one, politics-free and a bunch of friends who love each other), or favorite media. I personally like watching children’s cartoons—the stakes are not insurmountably high, good guys win with the power of love and friendship, etc. I recommend Avatar The Last Airbender, the She-Ra reboot, Kipo and the Age of Wonderbeasts, Steven Universe, and others like those shows. I also like taking walks with my dog, focusing on flowers (and posting them to iNaturalist so I learn their names). Just beware of distractions that do not actually calm you—for me that includes social media, shows that are too high stakes to lower my norepinephrine (Andor is great but is stressing me out), reading news articles, and games that require too much focus/effort.

Here is a list of possible calming hobbies, but be aware of how you feel when you try them, as each one may not be calming for every person (for example, crossword puzzles frustrate the hell out of me): https://wanderhealthy.com/relaxing-hobbies/

-Burn off anxiety with exercise: If possible, I try to exercise more when I am stressed, although I know that my body likely is not well enough for high-intensity workouts. For me, that means walking to get my heart rate up but not up so high I am giving too much extra work for my organs!

More reading on anxiety and exercise: https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety

-Care for something: Humans are social animals, we have evolved systems that “reward” us for taking care of each other (releasing oxytocin, prolactin, and other hormone signals that lead to rest and repair). When I am very stressed, I try my best to exploit this system, to care for others as a way to care for myself. This can look like caring for your family members but also strangers, and the “care” doesn’t have to be large—it can look like helping someone with doors, carrying groceries, letting someone merge in traffic, etc. as long as you let yourself realize that you have cared for someone. I try to do something kind for a random stranger every day—the other day I noticed someone looking on the sidewalk and offered to help them find what they were looking for (dropped earring). Caring for animals also works because our brain releases those same care-associated chemicals when we pet dogs/cats, care for wildlife, etc.

Here’s a list of little ways you can build your capacity to care for others: https://healthy.kaiserpermanente.org/health-wellness/healtharticle.7-ways-to-show-someone-you-care

-Be with people: It is very natural to become isolated when you are stressed, but resisting that is an important way to ease the effects of stress in your life. It can be challenging to connect with people when you are preoccupied by stress, but I have found that being honest about that can be very helpful; both to warn people that you may not be on your A-game but also to give others an opportunity to share their own stressors. Doing anything on this list with other people (rather than alone) can increase their effectiveness! I try to find community activities (choirs, exercise classes, bird walks) on a set schedule to keep me motivated to continue participating even when it is challenging to do so, with the caveat that when I really can’t manage it I can always take a week off. Human interaction online is good (especially in video-chat formats where you can see faces) but in-person is the most effective if you can safely manage it!

Scientific evidence of the benefits of group activities: https://www.kiltrohealth.com/blog/the-power-of-group-activities-science-backed-benefits-for-mental-health

-Eat the right foods: The nutrients our bodies need are not static over space and time. There is no one “healthy choice” that will give you what you need in every scenario. While it is always good to make generally healthy choices (diverse foods, avoiding processed foods that have lost much of their nutrients during processing), the foods that are “healthy” during a stress response will vary with your particular body’s response to stress. In my case, I needed to make sure my body did not have many of the chemical requirements to make norepinephrine because it already had too much, so I avoided foods with excess phenylalanine needed to make norepinephrine (since aspartame is broken down into phenylalanine, that meant avoiding Diet Coke!).

I wanted to make sure I had enough of the tools needed to break down excess norepinephrine—since one enzyme that does that requires magnesium, I tried to increase my intake of high-magnesium foods (list: https://www.urmc.rochester.edu/childrens-hospital/nutrition/magnesium-foods) and also take high-absorption supplements when needed (it is water-soluble, so we readily pee out the excess). Since magnesium is water-soluble it washes out of prepared foods, so I try to make sure I’m not over-cooking foods or eating only heavily processed foods that may be lower in magnesium than they would be otherwise.

Because I knew that I was low on cortisol, that all steroid hormones (like cortisol) are made from cholesterol, and that cholesterol is made from saturated fats, I increased my intake of saturated fats by eating a lot of ice cream. My doctors were skeptical that would help (especially since my blood sugar was pre-diabetic) but it did, and then I found this article in The Atlantic about the possible health benefits of ice cream for people experiencing stress: https://www.theatlantic.com/magazine/archive/2023/05/ice-cream-bad-for-you-health-study/673487/. Many of our ancestral/cultural “comfort foods” are high in fat and calories, the nutrients we need to survive stress and repair from it. Every time I am very stressed I plan meals like I am planning a Polish-American funeral potluck (if you know you know). Here’s an article on such “sad foods”: https://maisonneuve.org/article/2013/05/27/sad-food/.

Because stress impacts digestion, it also impacts the healthy bacteria and fungi that live in your guts. Making sure you eat not only foods that are good for human cells but also foods that are good for bacterial and fungal cells (high fiber foods) is especially important when you are stressed. I also try to be very aware of the fact that some artificial sweeteners have antibiotic properties (that is why dentists recommend xylitol sugar-free gum!) and avoid those to avoid hurting my gut bacteria that aid my digestion, mood, and general health.

I altered my diet with supervision from doctors, but not everyone has access to that. So what can we do? I would argue (again, not a medical doctor here) that we should listen to our bodies when we are stressed. What are we craving? Whenever I have a weird food craving, I let myself eat as much of it as I want, then I research what micro- and macronutrients are available in the food. Was there something in that food that I was craving in particular? That is important, because our bodies may only be needing one tiny portion of that particular food item—when I run low on potassium I crave potato chips. I need their potassium, but I probably do not need some of their other components (like all that salt!). With that in mind, I then search for foods that are high in potassium and choose alternative options so I am not only eating potato chips. We may not always crave food for their nutrients—our preferences may be psychological (which is not a bad thing, but you just will not find the answers on the nutrition labels!). Our bodies do not inherently know what foods are high in some nutrients (there is no gene that says “potato chips have high potassium”)—we likely learn these things by eating and digesting foods, so eating a varied diet it important to give your body multiple ways to try required micro- and macronutrients.  

-Eat enough food: Mounting a stress response, repairing the damage, and recovering from it is a lot of work! I’ve estimated that I burn as much as 50% more calories a day when I am dealing with high stress (racing heart, restlessness) but stress makes it hard to replace those calories. But times of stress are a terrible time to restrict your calorie intake, so when I need it I rely on high-nutrient drinks to replace the meals I am struggling to prepare and eat. I prefer these ones (Boost brand Very High Calorie Nutritional Drink) recommended by disordered eating patient advocates—I cannot say I liked the taste or texture at first, but over time my body must have learned that they contain what I need to survive a stress response (saturated fat, protein, micronutrients) so I now crave them when I am not doing well: https://www.boost.com/products/boost-very-high-calorie?gad_source=1&gbraid=0AAAAADpqQiShDd5w-QCArOAN_R0LouiYm&gclid=Cj0KCQjwzrzABhD8ARIsANlSWNOnoL2P6gqjMRswgeanooGv-8lCSfR48DItgHqbGRhmWxOpnYaD5xkaAvNaEALw_wcB&gclsrc=aw.ds

-Sleep enough: While we sleep, our bodies repair the damage our tissues took during the day (including damage from our stress responses). We need to sleep, likely even more than usual, when we are dealing with stress, but of course stress makes it hard to sleep. Supplementing magnesium to lower my norepinephrine helps me sleep, as does light exercise. Other tips I have learned (as a chronic insomnia-sufferer) include eliminating stimuli in the hours before bed; this includes external stimuli like bright screens and loud TV/music, but also internal stimuli, like exciting books or work. I like to pick a topic to read about on Wikipedia each evening—it cannot be related to current stressful events or my research, but something interesting enough to distract me from my anxiety but not interesting enough to keep me from relaxing enough to fall asleep. I like articles about historical adventurers and natural events (Carrington Event, volcanoes, etc.). Weighted blankets can help release calming oxytocin. Sleep masks allow me to block light stimuli without keeping my room so dark it is hazardous if I need to get up suddenly. Cuddling with my sleepy pets helps soothe me. I am also terrible at keeping a healthy sleep schedule when I am stressed, so I like gentle sleep apps that use positive enforcement to keep me on a healthy schedule (this is my favorite because I’m a millennial and I like that it has scientific references: https://www.pokemonsleep.net/en/).

-Learn how to activate your parasympathetic nervous system: Our parasympathetic nervous system switches us into “rest and digest” from “fight or flight.” Learning ways to switch your body between modes can be life-saving, especially if you are prone to panic (as I am). Some of the ways to active the system may be obvious (and covered in previous sections) but others were less obvious to me. I work through lists (like this one: https://healyournervoussystem.com/45-techniques-to-activate-your-parasympathetic-nervous-system-and-lower-stress/) and try out the options, knowing not all of them will work for my particular body or mindset. As you can imagine, I am more soothed by techniques that have peer reviewed research supporting them, but the placebo effect is really powerful and you can use it to your advantage: if you can convince yourself something is calming, it could be actually calming for you! Therefore, calming techniques can be very dependent on your own personal and cultural background—as an ex-Catholic praying the rosary is very calming for me, but likely is not as calming for other people. You can also just make up calming techniques if you want to, it is not silly if it works! I was anxious to take off on long solo road trips, so I convinced myself that giving cash to needy community members would keep me safe on the road trips, using the human predilection for superstition to my advantage will also trying to care for my neighbors. Others on the previously-linked list that I personally find extraordinarily helpful include nature therapy (birding), breathwork, massages, hot showers, cuddling pets, stretching, and singing in a group. Obviously, as an ornithologist, I spend a lot of time finding peace and joy in birds; if you want to give it a try I recommend checking out my #TenMinMerlin blog post!

-Do less: The unfortunate truth (in our productivity-based society) is that the things that put food on the table and promote our careers are rarely calming. We are made to feel like we are failing if we spend time resting, relaxing, or being less productive than normal. But we cannot mount a healthy stress response and recover from it without resting, relaxing, and unplugging. Think of it as investment in your future productivity if you have to: you cannot do good work if you can’t focus, sleep, eat, or control your racing thoughts. It is better to make constant investments in your well-being even if it means slightly less productivity in the short-term if it prevents burnout and disabling organ failure in the long term (ask me how I know). For me that looks like constantly forgiving myself for not accomplishing as much (in my work, hobbies, personal relationships, and housework) as I had wanted, and vocally extending that same forgiveness to others.

-Keep track of it all: If this sounds like a bunch of work, I’m sorry to confirm that it absolutely is, but it is work worth doing to avoid burnout and the long-term (and deadly) effects of chronic stress. I manage all these tasks using gentle self-care apps—I prefer Finch because when I complete self-care tasks I get to raise a baby bird. I made sure that I did not put any productivity tasks in the app (progress on work!) until I knew that having them in the app wouldn’t stress me out more than it helped, and instead filled the app with basic self-care tasks (taking my medications, eating meals, going to bed on time, spending a few minutes watching birds, petting my dog, even “surviving the day”). The app also has easy breathing, stretching, and journaling exercises if that would help you and it is free: https://finchcare.com/. If you don’t want to fill it with care tasks but want access to the other features without feeling the pressure of tasks, know that sending well-wishes to friends counts as tasks and you can find friends on the Discord (or add me, my friend code is: JNZGTNV75Q).

-Forgive yourself: Our stress physiology varies—some of us can manage stress more readily than others, and may not need to invest much time in caring for ourselves. I am not in this category unfortunately. Our amount of stress varies too—our identities, our social groups, our jobs, our socioeconomic realities, our upbringing and more can give us more stress than others (something I understand very clearly as a transgender scientist right now). Forgive yourself for not handling stress the way you want to. Forgive yourself for not doing a great job doing all these self-care tasks. Forgive yourself for failing to forgive yourself. Start every day anew, keep trying, and give yourself space to fail. Then extend that to others!

But what about the global chaos right now? I get it, it seems impossible to be stress-free right now if you are paying attention at all. We are all going to need to invest more time in self-care than we have in the past. It can feel like a betrayal of your suffering community when you take time to rest, relax, and find joy. But remember that we are in it for the long haul right now—we need to stay well, and staying well means finding rest, relaxation, and joy as much as we can. Staying well and filled with joy can be an active form of resistance, especially when we use it as fuel to power our helping our communities. In times like these I draw upon history for examples of badass freedom fighters and social justice workers taking care of themselves and each other, especially the history of queer joy (details: https://outrightvt.org/blog/embracing-queer-joy-as-a-form-of-empowerment) and examples of self-care in the civil rights and women’s rights movements (details: https://www.communitysolutions.com/resources/origins-of-self-care-and-why-activists-and-advocates-need-to-practice-it).

Joy and care are vital right now, for our bodies and for any causes we promote. The best way to maintain our wellness is by learning more about our stress physiology and learning to take care of our bodies as we navigate these unprecedented stressors. Good luck out there, we will all need it!