As a medical professional over the last twenty years, I can surely say that chronic stress is the leading cause for several of the health concerns that we are seeing these days. The last two years have escalated the numbers even higher however, it would be fair to say that even back in 2019 chronic stress was a cause of concern. I feel the biggest issue is the lack of insight of how chronic stress has an impact on overall health – both physical as well as mental. It often surprises me when I ask my patients if they are stressed, to get an answer stating ‘well isn’t that just normal part of life?’. Recently someone left feeling very moved after her consultation and said ‘I never knew you could talk to a doctor about stress’.
Acute stress is sometimes helpful to deal with immediate situations. In today’s world stress is persistent throughout the day and its chronic presence, is what makes our health suffer. There is plenty of evidence that chronic stress is linked with increased severity of chronic health conditions like heart disease, diabetes as well as mental health problems like anxiety and depression. It is a major cause of inflammation at cellular levelwhich results in changes in the gut microbiome, our immunity, brain function, cardiovascular system as well as the proper interactive functioning of our hormones. Studies are showing that autoimmune health conditions like rheumatoid arthritis, coeliac disease, Crohn’s disease and ulcerative colitis are linked to stress and chronic inflammation too. In their book ‘The Telomere Effect’ Elizabeth Blackburn and Elissa Epel highlight how stress shortens the telomeres, which are the protein ends of every chromosome in out body. Shorter telomeres have been linked with chronic inflammation as well as ageing.
Stress has three phases. The initial alarm phase where the body reacts by pouring out adrenaline to prepare the ‘flight or fight’ mode. The second stage is when the body goes into a state of resistance. So for example your peer gets a bonus and you don’t. You are able to resist reacting to this in the forefront, however the body is slowly responding and being drained by the inner thought process. The third phase is the stage of exhaustion, when the body has used all the ways of coping and is left depleted. This is where health starts suffering. Most of us seem to be on this rollercoaster where one day leads into another, not even realising when this stage of exhaustion has kicked in.
What can you do to manage stress?
Awareness: I have kept this as the first thing as what is not known, cannot be resolved or managed. Knowing your triggers is important. These could be lack of sleep, busy work week coming up, too many appointments in the diary. Or is it that even the weekends are too busy and there is no time to ‘just be’. For me one of the first signals is a pain in between my shoulder blades. As soon as I notice this, I know that I need to look into what is happening. The other one is if I don’t feel motivated to face work on a Monday morning, it is a clear ‘ping’ moment that I am not managing my stress well. Then I will make sure I have a closer look at what needs to change.
Creating space to reflect: Once you are aware of what your triggers are, it’s important to give yourself that space where you can reflect. What are you wanting to achieve? What is taking up your time? What are the priorities? What are your values and are you making your day to day decisions according to what is important to you? I have personally find that having the time to reflect, can be a powerful tool to be able to tease out what needs to happen next. My space for this kind of reflection is normally when I’m journaling. Putting pen to paper and being honest with my raw emotions, just seems to unravel what is going on. It helps me make choices which are focused on some of the questions mentioned above and what matters to me. It makes me come to terms with issues which are not in my control.
This is an exercise which several of my patients have found helpful. I talk about the ‘Circle of influence’ by Stephen Covey. Imagine there are two circles. One inside the other. The bigger outer circle represents things you are worried about but have no control over. The smaller inner circle is about things you can influence by the choices you make. This inner circle is what you can focus on, in any given situation. Focusing on the inner circle when you feel overwhelmed, will help you decide how you are going to deal with the issue in front of you.
Planning: Life is not always predictable and there will always be things which take us by surprise. But planning ahead for the day, month or even the next quarter can help in keeping things organised. I sit down every Sunday to see what my diary looks like and then it gives me a mental frame of where I may notice things could be tight. It makes me structure other things for that week accordingly and yes, the days which are over packed; I make peace that this is also my choice. On busy weeks, I even plan what I could listen to or read, to keep me going through the perceived tough patches. Planning gives an opportunity to weave your schedule comfortably around what may give rise to the triggers you have already become aware of.
Some of my ‘tools’ that I find useful when dealing with stress.
Physical movement: This is one thing that works every time. Just a long walk or even a bit of gardening can get me out of the ‘negative chatter’ after a stressful day. Any form of physical exercise has been shown to wind the stress levels down. I have patients who find running helpful and others who de-stress while swimming.
Slowing down the pace: With the demands of modern life, we are all expected to be time watching and dancing to deadlines. This fast pace life creates stress and there is nothing more powerful than knowing how you can slow it down for yourself. Doing some slow breathing, journaling, mindfulness, sitting in silence, yoga and Tai Chi are some on my favourite.
A date with yourself: This will sound very odd but something I learned few years back, while reading the ‘Artist’s way’ by Julia Cameron. It is a planned time with yourself where you do something you enjoy, alone. Ideally done weekly but try to explore how you want to fit it in your routine. I love planning these dates which include going to a farmer’s market, visiting a book store or sometimes just sitting near a river with a coffee.
Find what keeps you in ‘flow’: Flow, as described by positive psychologist Mihály Csíkszentmihályi, is a state of mind where one is totally immersed in an activity. For me this state of flow is when I am cooking something, or writing a blog which resonates with me, gardening when trying to arrange a patch and colour co-ordinate the plants, or even creating my little tiles of information for Instagram! Finding something which wakes up the creative side of you can be a good start.
Pet therapy: I was recently reading an article from the Lifestyle Medicine journal and this study really stuck with me. A group of adults in high-stress professions, who also had high blood pressure, were randomized to either just start Lisinopril (blood pressure medication) or start Lisinopril and acquire a pet. At the end of the study it was seen that the adults only using medication had a good response to the resting blood pressure, whereas the pet ownership reduced the blood pressure response to stress as well. I know that everyone may not be able to get a pet but if you already have one, it is good to know that they are extremely valuable in de-stressing us.
Sleep: This is the time when the body repairs and restores all the damage done during the day. It is vital to make sure that one gets 7-8 hours of restful sleep. Stress can affect quality and duration of sleep but it is also important to remember that lack of sleep can have a negative impact on our ability to handle stress too. I try and prioritise my sleep schedule as much as I can, otherwise my poor boys get to brunt of a frazzled mum!
Support/ connecting: ‘Social connections’ is an important pillar of lifestyle medicine however I do feel it is even more important in its role with stress management. Having a close group of people where you can just be yourself and let off steam or get unbiased advice is like a treasure for me. I have what I call ‘my parliament of wise owls’. A group of friends and family who I contact when I need pearls of wisdom or support to deal with whatever is bothering me. Sometimes these are niggly day to day issues and at other’s it can be life changing decisions.
Nutrition: This blog would not be complete without nutrition as when we are stressed the need for fast food or caffeine is higher than ever. Not forgetting the increased urge to smoke and drink more alcohol. We reach out for the high salted snacks and crave for the sugary treats, which not only inflict more stress, but stimulate us further when the resources in our body and mind are already depleted. Making sure that we are including good sources of protein in every meal helps the cells repair the damage caused This can be in the form of lentils, whole grains, beans and pulse as well as healthy soya products. B vitamins help the body cope with stress better and support the nervous system. Nuts and seeds, whole grains, fermented food like tempeh, mushrooms, corn on the cob, potatoes as well as nutritional yeast are good sources of Vitamin B. Magnesiumis good for muscle relaxation, heartbeat regulation, cellular repair as well as fatty acid formation. This can be easily incorporated by adding leafy green vegetables, avocadoes, dark chocolate, fruits like bananas and pumpkin seeds. Omega three fatty acids help in regulating the chronic the inflammation caused by stress. Plant sources of omega three are linseeds, chia seeds and walnuts. Last but not least, vitamin C which protects the immune system and helps lower cortisol levels. Good sources of vitamin C would include red bell peppers, citrus fruits, cruciferous vegetables, tomatoes, amla berry and strawberries.
Information diet– Positive emotions enhance life satisfaction by building resiliency. Research shows that the ideal ratio of positive to negative emotions is 3:1, as the negative emotions can be overpowering. This is why I feel the information we feed our minds throughout the day makes a big difference in our stress levels. Including some positive re-enforcement through what we listen, read or discuss can be a game changer for the day. My positive quotes in the morning, podcasts during my drives and my gratitude list at the end of the day keep a positive hum in the background. So be mindful of the information you are constantly feeding your mind.
Remember we cannot get rid of stress in life, but if we implement some of these tools and experiment with them, it is possible to approach stressful events in a constructive way.
I am now going to put my essential oil diffuser on and relax before the week starts.
Enjoy your week ahead.
Anni
