Stress As A Driver of Chronic Disease

What do the following have in common: toxin exposure, poor sleep, unknown or unaddressed food allergies, fasting, over-exercising, extreme dieting, maintaining a busy schedule, raising children and living in today’s modern world? These are all very common sources of modern day STRESS. As women (especially those keeping up with the latest trends in diet and exercise) it isn’t uncommon to be juggling at least a few (if not most) of these stressors daily!

In my last column I wrote about my own struggle with cancer. As you learned from my previous column, I was the poster-child for health and wellness and practicing what I preached since I was a teen. However, regardless of how hard I tried to put on that facade of “optimal wellness”, the truth is I also carry with me some deep-rooted emotional scars, a long history of toxin and chronic mold exposure, and a lifetime of high levels of stress. Today and in my upcoming column, I felt it would be appropriate to dive deeper into what I feel is the most common trigger and mediator for most chronic diseases- Stress.

Common Causes of Stress

In practicing Functional Medicine with my own patients and uncovering the underlying or “root causes” of chronic pain, autoimmune conditions, hormone imbalances, chronic fatigue, digestive issues, and even cancer, one of the main (and often overlooked) contributors I address with my patients is chronic stress. Stress may present in three different forms:

Physical/Emotional Stress- This form of stress is what we commonly think of when it comes to stress and does have the biggest impact on our adrenals, hormones and neurotransmitters. Physical and emotional stress often breaks down to how we perceive specific events and how we deal with them. Examples include: traumatic injury, excessive exercise, divorce, loss of a loved one, grad school, chronic pain, taking care of disabled or mentally ill family member, unhappy with job or marriage.

Dietary Stress- Inflammatory Foods, Nutritional Deficiencies, Food Sensitivities/Allergies, or Foods/Dietary Habits that lead to blood sugar imbalances are all stressors. Fasting or the act of avoiding food for periods of time can also create an increase in cortisol (and the body’s stress response) in some situations (more on this later).

Inflammatory Stress- These hidden stressors can fall under gastrointestinal dysfunction in which parasites, yeast, pathogenic bacteria, or dysbiosis trigger inflammation. Liver toxicity regarding mold toxicity, heavy metals, chemicals, and other environmental toxins triggering further inflammatory stress.

How Emotional Stress Impacts the Body (in a nutshell)

Although there are certain conditions in which chronically high levels of cortisol is produced (Cushing’s disease) as well as chronically low levels (Addisons disease), more commonly I find that various lifestyle stressors are typically responsible for an acute or chronic rise in cortisol levels through brain responses. More specifically, the hypothalamus, which releases corticotropin-releasing hormone (CRH), and stimulates the anterior pituitary gland to produce Adrenocorticotropic Hormone (ACTH) which in turn

causes the adrenal cortex to produce cortisol and the adrenal medulla to produce catecholamines (adrenalin). This is a natural and healthy response to acute stress but when the adrenals are continually stimulated through chronic stress (not uncommon in today’s world) this can lead to hypopituitary-pituitary-adrenal (HPA) axis dysfunction or “Adrenal Fatigue”. While the term “Adrenal Fatigue” suggests that this is a condition of the adrenals, it actually has a far more complex impact on several organs and body systems- not just the adrenals. Below are a few examples of what happens when our stressors become a burden our body can no longer handle.

Thyroid- Throughout this process, thyroid stimulating hormone (TSH) and the conversion of T4 to T3 (the active form of thyroid hormone) is inhibited and T4 now converts to reverse T3 (the inactive form of T3) leading to thyroid dysfunction.

Sex Hormones- Further complications of chronic stress lead to sex hormone dysregulation caused by a decrease in dehydroepiandosterone (DHEA) due to pregnenolone now being shunted towards cortisol production. This diversion away from sex hormone production makes sense as survival becomes more important than reproduction.

Insulin Resistance- When under stress, blood sugar rises in order to supply energy for fight or flight. Stress increases the body’s demand for energy, whether it is an acute life and death situation, or coping with chronic physical or emotional issues. Over time, cells can become resistant to insulin due to the constant rise in glucose (energy) that floods our blood stream in response to the stress hormones adrenalin and cortisol. As insulin resistance builds, the pancreas can become over-taxed as it tries to produce adequate amounts of insulin and ultimately leads to hyperglycemia, weight gain, and Type 2 diabetes.

Gastrointestinal- The digestive system is compromised due to cortisol downregulating Secretory IgA within the gut which lowers the immune response allowing for pathogens to manifest. Intestinal permeability becomes an issue when cortisol pulls the amino acid glutamine within the gut lining to be used as fuel. This catabolic physiology breaks down the protein building blocks within our gut lining as well as the other healthy metabolic tissues within our body such as muscle. We also become more susceptible to food sensitivities, more toxin exposure, and poor nutrient absorption.

Toxic Burden and Inflammation- Our detoxification pathways become compromised from the already abundant amounts of toxins in our environment which is now compounded due to our leaky gut. The liver takes on a burden it can no longer keep up with and the body begins to hold on to toxins which drives up the level of oxidative stress and leads to more inflammation.

So now you have the big picture as to how STRESS impacts our overall health and well-being and can even be the primary trigger of disease. While often overlooked and underappreciated, stress is often the gateway to the main drivers behind most of our modern day degenerative chronic diseases.

When addressing every person as a unique individual using a more Functional Medicine approach, I find that with a thorough history and specific lab testing, these drivers often overlap and can all be interconnected. Thus, problems with one area often cause problems with another which ends up creating a downward spiral of dysfunction and disease. Pinpointing and managing chronic stressors must be the first step when working to reduce these drivers of chronic illness and compromised health.

Diet and Lifestyle First

Diet: Women currently under or with a history of chronic stress (and likely HPA dysfunction) who are trying to practice regular fasting or intermittent fasting may find that this practice just doesn’t work for them. If fasting results in decreased sleep quality, anxiety, feelings of low blood sugar, feeling “hangry” or light headed, I highly recommend discontinuing this practice and reverting back consuming 3-4, higher protein Paleo meals per day, starting with the first within an hour of waking and the rest spaced every 3-4 hours throughout the day. Food allergies should also be assessed and addressed to ensure these aren’t adding additional stressful burden.

Exercise: Exercise should be a form of stress relief. For our cross fitters or exercise enthusiasts trying to maintain a rigorous workout schedule of 4-6 high intensity workouts each week or our endurance athletes pounding endless miles of moderately paced cardio, these workout schedule, combined with other stressors scattered throughout the day may be too much. Depending on one’s current level of stress, I recommend no more than 1-2 days of intense exercise, 1-3 days of heavy lifting, and 2-3 days of light (leisurely) activity such as walking, hiking, swimming etc. For those under stress and those attempting to heal overtaxed adrenals walking really is the best form of exercise.

Sleep: I can’t stress just how important sleep is for managing stress. Sleep allows the body to rest, repair, detox, and reset for the upcoming day. While some simply neglect getting enough sleep, there are those who would love to log a good 7-9 hours of solid sleep each night but find that they cannot fall or stay asleep. Feeling emotional unease, dietary habits (fasting, ketogenic diet), chronic exercise, and hormone dysregulation can all affect quality of sleep. This is a viscous cycle to get into as we find that when quality sleep is hindered, the body creeps further into a state of chronic stress and dysfunction.

Toxins: Hopefully those reading this publication are already well on their way to reducing exposure to common toxins. Simple steps here include buying organic when possible, avoiding plastic food storage containers, checking labels of body care products, avoiding processed foods and being mindful of things like household cleaners and chemicals.

For those currently dealing with thyroid dysfunction, insulin resistance, chronic inflammation, GI issues, hormone imbalances, poor sleep, weight loss struggles, chronic fatigue, chronic illness, or just feeling like the body is “off”, I would suggest taking a look at the possible stressors in your life. In my next column I will be discussing the lab testing available, levels of severity, as well as nutritional and supplement recommendations for recovering from the various stages of HPA dysfunction (aka Adrenal Fatigue).





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