The Deadly Consequences of Chronic Stress
The consequences of chronic stress can be devastating. A chilling example is stress cardiomyopathy, a spontaneous weakening of the heart that predisposes victims to arrhythmia and even sudden cardiac death. While the mechanism is not clearly understood, it is thought that chronic stress-induced elevations in epinephrine (adrenaline) over-stimulate the cardiac muscle, altering its function and causing atrial remodeling (Sakihara 2007; Korlakunta 2005).
Another striking example is a condition the Japanese refer to as Karoshi (death from overworking); this condition was recognized in post-World War II Japan. Overworked and severely emotionally and physically stressed Japanese high-level executives suffered strokes and heart attacks at alarming rates at relatively young ages. Researchers discovered that the death of these otherwise healthy men was due to chronic, unremitting stress. Government estimates in 1990 put the number of men dying each year from Karoshi at over 10,000 (Kondo 2010; Saleeby 2006).
Prolonged stress has been linked with elevated circulating markers of inflammation, and increased intima media thickness, a measure of atherosclerosis progression (Gouin 2011; Roepke 2011). Chronic stress considerably increases the risk of anxiety and depression by causing structural and functional changes in the brain as well (McEwen 2004; Liu 2010). Moreover, those who do not properly manage and adapt to chronic stress are more likely to be overweight and develop sexual dysfunction (Kyrou 2008).
How the Body Responds to Stress
When an individual experiences a stressor, physical or emotional, internal or environmental, the body initiates a complex system of adaptive reactions to help cope with the stress. This reactive response results in the release of glucocorticoids, also known as stress hormones, and catecholamines, which stimulate adaptive changes in a variety of bodily systems.
The “Fight or Flight” Response
Under short-term circumstances, stress-induced changes prioritize functions involved in escaping danger; for example – redirection of blood flow to the muscles from most other body parts, increased blood pressure and blood sugar levels, dilation of pupils, and inhibition of digestion for energy conservation. During this time, fatty acids and glucose (blood sugar) are liberated from storage sites into the bloodstream where they become readily available for utilization by the muscles. This is known as the fight-or-flight response. This reactive and adaptive protection system originates in the brain.
Upon perception of stress, specialized neurons in the paraventricular nucleus of the hypothalamus (a major endocrine-regulating brain region) respond by releasing, among other compounds, corticotrophin releasing hormone (CRH) and vasopressin (VP). Subsequently, these hormones stimulate the release of adrenocorticotropic hormone (ACTH) from the pituitary gland.
After entering circulation and reaching the adrenal glands, ACTH stimulates the production of glucocorticoids and catecholamines, which then act throughout the body to induce the adaptive changes mentioned in the opening paragraph of this section. Cumulatively, this brain-endocrine coordination comprises the hypothalamic-pituitary-adrenal (HPA) axis.
While the fight-or-flight response is undoubtedly necessary to initiate an autonomous response to impending danger in an acute situation (the “rush” you feel when you hear an unexpected loud noise, for example, is the fight-or-flight response in action), it can become devastating when active, even at a low-level, for a protracted period of time (Innes 2007).
We modern humans live in an environment filled with emotional stressors, such as financial worries, and deadline pressures at work or school. All of these modern worries chronically activate the HPA axis in an evolutionarily unnatural way, leading to elevated stress hormone levels, and accompanying physiologic changes, throughout the day.
A few components of the fight-or-flight response are especially damaging to health when the stress response is active over a prolonged timeframe – insulin resistance, and high blood pressure (Lehrke 2008).
The elevation in blood pressure and deteriorating insulin sensitivity contribute, along with several other stress-related physiologic irregularities, to a compromised health state that predisposes chronically stressed individuals to an onslaught of age-related diseases.
Eventually, chronic elevations in glucocorticoid levels damage and destroy neurons in the region of the hypothalamus responsible for regulating CRH release (Siegel 2006). This gives rise to erratic or insufficient HPA axis activation and may lead to the mood disorders, such as depression and anxiety, and fatigue commonly observed in individuals who have been under great stress for a long time.
Is stress getting the best of you and your health? I have many patients on a weekly basis that are overwhelmed with work, family, life circumstances, and you name it. Do the following symptoms match up with how you feel?
Signs that You are Suffering the Effects of Chronic Stress May Include:
- Excessive fatigue after minimal exertion; feeling “overwhelmed” by relatively trivial problems
- Trouble awakening in the morning, even after adequate sleep
- Relying on coffee (caffeine) and other “energy” drinks for a pick me up
- Perceived energy burst after 6:00 PM
- Chronic low blood pressure
- Hypersensitivity to cold temperatures
- Increased premenstrual symptoms (PMS) symptoms
- Depression and/or labile mood swings
- Mental “fog” and poor memory
- Decreased sex drive
- Craving sugar and salty foods
- Decreased appetite
- Imbalanced immune system
- Chronic allergies
- Generalized weakness and dizziness upon standing
Chronic stress will cause cortisol level fluctuations and may complicate other health issues in the body. High cortisol will directly create glucose and insulin problems for patients having a hard time regulating their blood sugar levels. I like using my Genova testing to evaluate cortisol levels on my patients to truly address adrenal function. See an example of it below. You can see in this example that this patient has elevated levels at the 11am-1pm window.