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Thursday, February 16, 2012


Stress, was a word that became popular in the 1920s. It comes from the Middle English word “destresse”, which is derived from the Latin word ‘stringere’ and means to “draw tight." It was used in biological and psychological circles to refer to a mental strain, unwelcome happening, or, more medically, a harmful environmental agent that could cause illness.

Did you know that 75% of all chronic disease begins with stress, and the physical presentation of this may trigger problems in the hormonal system (hormonal imbalance), sleep distress, immune suppression, and emotional issues that can range from irritability, to anxiety, PTSD and depression?

Most people associate stress with emotional and or psychological states. Stress may equate to a loss of a family member, divorce, major life changes and it can also mean a state of mind. Everyone has at one point or another felt stress. What is clear is that stress takes a toll on the body. It is important to know that how we handle stress in many ways will have an impact on our body. In a book by Hans Selye, 'The Stress of Life', stress was associated with hypertrophy of the adrenal gland, atrophy of the lymphatic organs (immune system), and stomach ulcers. He later defined stress in the context of what he called General Adaptation Syndrome (GAS)

The General Adaptation Syndrome presents in three stages:

1. The alarm reaction: Increased sympathetic activity and increased adrenal secretion of adrenalin.

2. Stage of resistance: A balanced adrenalin effect on the body and its fluid balance and carbohydrate metabolism.

3. Stage of exhaustion: A depletion of the adrenal glands and a weakness in the ability to make adrenalin and steroids.

It is important to make a difference between physical stress and psychological stress; both are different and the same.


Common physical and psychological stressors include:

1. High sense of pain

2. Constant and very bright lights

3. High level of noise

4. Extreme temperatures

5. Feeling of lack of control over environmental circumstances

6. Sense of inability to get food, air and/or water quality, housing, health, freedom, or mobility

7. Social issues such as struggles with difficult individuals

8. Feelings of relationship conflict, deception, or break ups

9. Major events such as birth and deaths, marriage, and divorce

10. Life experiences such as poverty, and unemployment

11. Clinical depression, obsessive compulsive disorder, and other psychological problems

12. Insufficient sleep

13. Performance pressure

14. Stress from exams and project deadlines

15. Extremely competitive personalities

16. Adverse experiences during childhood

Research has shown that the magnitude of the response and ability to recover from stress is individual and it is based more on perception rather than the stress itself.

Key points to consider when responding to stress are:

1. How new the issue is and the ability for each individual to deal with new changes

2. How unpredictable the issue is

3. The degree of threat to the body and ego

4. The sense of loss of control


Stress impacts the whole body. It involves the central nervous system and works closely with the body’s endocrine (hormone) system to regulate self defense mechanisms. A branch of the CNS, the sympathetic nervous system, is in charge of stimulating the adrenal gland to make adrenalin and steroids (cortisol). Adrenalin and cortisol activate many of the body’s physiological functions to make the body more adaptive to its environment. But it is not as simple as that. Almost all the systems and organs in the body are somehow and in some way touched by stress.

The organs involved in stress are the following:

1. Brain

a. Hypothalamus
b. Amygdala
c. Hippocampus
d. Locus ceruleus
e. Pituitary gland
f. Raphe nucleus in the pons of the brain stem
g. Spinal cord

2. Adrenal glands

3. Pancreas

4. Gastrointestinal system

5. Adipose (FAT) Tissue

6. Muscular System

7. Immune System

The hormones most likely to be involved with stress:

1. Adrenalin
2. Epinephrine
3. Norepinephrine
4. Cortisol
5. Insulin
6. Serotonin
7. Neuropeptide Y


Stress involves the central nervous system and works closely with the body’s endocrine (hormone) system to regulate self defense mechanisms. A branch of the CNS, the sympathetic nervous system, is in charge of stimulating the adrenal gland to make adrenalin and steroids (cortisol). Adrenalin and cortisol activate many of the body’s physiological functions to make the body more adaptive to its environment.

I will try to explain the adrenal glands and what they do in times of stress.

The adrenal glands are ruled by the pituitary gland in the brain. The adrenal glands produce cortisol, and adrenal androgens such as DHEA among other important hormones.

Cortisol is the body’s main steroid. It follows a daily rhythm, called the circadian rhythm. This means that cortisol is at its peak shortly after awakening, and it progressively falls throughout the day, and reaches its lowest a few hours after falling asleep. Cortisol is mostly known for its ability to allow the body to produce glucose (sugar) from a breakdown of glycogen in the liver. Cortisol also affects fat metabolism, reduces inflammation, and water balance. It is felt by almost every organ in the body including the heart, blood vessels, eyes, gastrointestinal tract, reproductive organs, muscles, and fat. Mood and behavior are highly influenced by cortisol and steroids in general. In general, cortisol correlates to break down of proteins and catabolism.

In summary these are the most common effects of cortisol:

a. Production of glucose from glycogen stores in the liver

b. Uses aminoacids from breakdown of muscle to produce glucose

c. Promotes breakdown and deposition of fat in particular areas (more in the middle of the body)

d. Promotes breakdown of bone and the release of calcium and magnesium to the blood stream and the elimination of these minerals

e. Inhibits vitamin D activity in the GI tract and reduces calcium absorption and other nutrients

f. Increases neural excitement

g. Initially increases antibody production yet it then leads to immune system failure

h. Increases circulation of defense cells called neutrophils and natural killer cells

i. Inhibits thyroid function:
a. Inhibits release of Thyroid Stimulating Hormone (TSH) from the pituitary gland
b. Inhibits the peripheral conversion of thyroid hormones- from T4 to T3 (the more active form of thyroid function)
c. Promotes peripheral conversion of thyroid hormone T3 to ‘reverse’ T3, a competitive antagonist to T3 the more active form of thyroid hormone


The hormone dehydroepiandrostenedione, also known as DHEA is also produced by the adrenals. DHEA is a cortisol ‘antagonist’. Chronic stress reduces DHEA and vice versa DHEA is needed to balance cortisol. It has been shown that people with chronic physical stress and illness have low levels of DHEA. These conditions known for low DHEA include chronic bowel inflammation, inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) as well as chronic depression and fibromyalgia. It is also known that the aging process is associated with a progressive decline in DHEA.


Stress can present itself in many forms, such as chronic anxiety, depression and chronic fatigue. Thyroid disease, particularly hypothyroidism, or an underactive thyroid can be a complicating factor and can be easily confused. What I mean by this, is that people who suffer chronic stress can also have thyroid disease, and thyroid disease treatment needs to be evaluated in the context of chronic stress.
Conditions commonly associated with a high cortisol and low DHEA are associated with chronic breakdown of tissues, and decreased ability for repair. This catabolic effect affects almost every cell in the body.

The following are physical and psychological symptoms and conditions associated with chronic stress:

1. Physical symptoms

a. Central obesity- abdominal obesity

b. Hypoglycemia

c. Hyperglycemia- Metabolic Syndrome, Insulin Resistance and Diabetes

d. Increased gastrointestinal issues –

i. Chronic constipation and chronic diarrhea
ii. Heartburn and reflux
iii. Chronic bloating and gas
iv. Inflammatory bowel disease
v. Crohn’s Disease
vi. Gluten intolerance and allergy

e. Insomnia and loss of daily circadian rhythm

f. Allergies

g. Asthma

h. Hypothyroidism

i. Reproductive system imbalance
i. Premenstrual syndrome (PMS)
ii. Premenstrual dysphoric disorder (PMDD)
iii. Infertility
iv. Polycystic Ovarian Syndrome – women
v. Low testosterone – men
vi. Severe menopause symptoms

j. Chronic fatigue and decreased cell energy

k. Osteoporosis / osteopenia – increased bone turnover

l. Kidney stones- calcium oxalate

m. Muscle wasting – increased metabolism of aminoacids

n. Weakened ligaments and cartilage

o. Short term memory loss

p. Chronic inflammation and decreased immunity

q. Poor wound healing

r. Easy bruising

s. Heavy metal toxicity – decreased ability of the liver to detoxify

t. Poor antioxidant control with decreased methylation by vitamin B

u. Increased pain

i. Fibromyalgia
ii. Headaches and migraines
iii. Arthritis

2. Psychological symptoms

a. Grief

b. Excitement

c. Fear

d. Anxiety

e. Guilt

f. Embarrassment

g. Depression

h. Insomnia

i. Mood swings

j. Irritability

k. Mental fog


Stress is difficult to measure in populations since each person is different and their personalities influence their ability to manage stress. Some people are able to process many stressors simultaneously, while others can barely address a few.

Self-tests, like the one I included in this blog, are the most frequent and easy way for people to identify how stressed they really are as they are individualized and can be used repeatedly to identify improvement of previously reported problems. For example, if a person routinely answers a self- test, he or she can determine if there has been an improvement in their overall “stress” score. Some psychologists use standardized tests such as the Trier Social Stress Test in an attempt to isolate the effects of personalities on the ability to handle stress in a laboratory environment.

Physicians and health care providers are using salivary measurements of cortisol and other hormones to identify loss in the daily rhythm of hormone secretion and the total amount secreted, yet there continues to be some controversy about this. Salivary tests are not commonly used in main stream healthcare, yet I believe that they are important and should be considered as a tool to identify the degree of impact stress is having on health and wellbeing. I use salivary testing in my office to help me decide the best treatment approach, and to establish a baseline to compare to after treatment.


The first response to a stressful event is the realization of the impact this has on our feelings and body. Coping is defined as the ability of a person to feel in control of the situation. Once the event is identified as stressful, a person needs to determine whether the situation is potentially benign or threatening, meaning it constitutes a potential harm, a loss or a challenge. Both personal and environmental factors influence this primary determination. Problem-focused coping is directed at managing the problem, whereas emotion-focused coping processes are directed at managing the negative emotions. Once a person is able to identify what needs to be done, what resources are needed to deal with the problem, and how one is feeling about the situation, stress can be controlled.


1. Manage and organize your time effectively. Learn ways to manage your time such as creating a schedule and a list of things to do. Think about which things are most important and do those first.

2. Focus on the present.

3. Listen to relaxing music.

4. Try to look for the humor in life. Laughter really can be the best medicine.

5. Work on letting go of things you cannot change.

6. Reprogram the way you think. When you find yourself starting to worry, try to stop the thoughts and write them down. At a later moment, try to identify if there are other ways to tackle this issue

7. Find better ways to cope. Look at how you have been dealing with stress. Be honest about what works and what does not. Think about other things that might work better. Ask for help…

8. Take good care of yourself.
a. Make time for sleep
b. Try to have a healthy diet low in processed carbohydrates, low in sodium, and rich in vegetables, non-animal protein and high fiber.
c. Don't smoke.
d. Limit how much alcohol you drink.
e. Practice self-love

9. Learn to say "no" : Boundaries are important when you are chronically stressed

10. Speak up. Not being able to talk about your needs and concerns creates stress and can make negative feelings worse. Assertive communication can help you express how you feel in a thoughtful, tactful way.

11. Ask for help. People who have a strong network of family and friends manage stress better, you may even feel that you should speak with your doctor or care provider

12. Exercise. Regular exercise is one of the best ways to manage stress and walking is a great way to get started.

13. Learn ways to relax your body. This can include breathing exercises, muscle relaxation exercises, guided meditation, massage, aromatherapy, or relaxing exercises like tai chi and qi gong. Try meditation, imagery exercises, or self-hypnosis.

14. Practice Yoga

15. Swim

16. Write. It can help to write about the things that are bothering you.

17. Let your feelings out. Talk, laugh, cry, and express anger when you need to with someone you trust.

18. Do something you enjoy. A hobby can help you relax.

19. Volunteer work: When you feel meaningful to another person, you feel meaningful to yourself and may be a great source of happiness.
In our next blog we will discuss the foods that are known to increase the ‘feel good hormones’ such as serotonin and we will also discuss the principles behind some naturopathic remedies that are known to be very successful in helping manage stress.

I hope this blog has been informative and can be of use to you so you can be proactive about your health and wellbeing.

Margarita Ochoa-Maya, MD

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