Stress is by far one of the biggest threats to our health. Intense events like death, relationship breakdown, moving house, starting a business, or getting married, are acutely stressful times in our life, but many of us bounce back easily once the intensity of the stress dissipates. The more insidious stress that many people fail to consider, is the chronic low grade stress we encounter EVERY SINGLE DAY!
Chronic stress in a menacing and corrosive condition. Each small stress hit, is one that our body must counter. If the catabolic rate of stress and break down is higher than the anabolic rate of repair and metabolic reserve, then we will start to experience a negative shift in our health, towards a path of disease.
Enduring stress can be hard to notice as our health slowly slides along the spectrum from wellness to disease. As we shift further away from wellness, it’s still widely accepted that not feeling as good as we used to, is merely a process of aging. But just as we cannot become obese overnight, nor can we suddenly age overnight or get cancer or diabetes. It’s a process, and in order for disease to manifest, there have already been many insults to health along the way, that disrupted bodily functions.
Each insult to our health is like a tiny scratch on our skin. Each individual scratch is no major threat, but repeated scratches, over time with destroy the integrity of the skin, and start to cut us more deeply. As the attacks keep coming, and the wounds don’t heal, the scales tip and we begin to lose the healing battle.
Acute Stress vs. Chronic Stress
In response to stress, the sympathetic nervous system signals the hypothalamus and the adrenal medulla. The adrenal medula releases adrenalin into the blood stream, which stimulates the hypothalamus to release corticothrophic hormone CRH. CRH stimulates the pituitary to release adrenocorticotrophic hormone, which stimulates the adrenal cortex to release cortisol which raises blood sugar and is anti inflammatory.
In moments of acute of stress we can feel increased breathing and heart rate, perspiration, adrenalin, butterflies etc. Acute stress is an obvious feeling and an intense hit of adrenalin. It can help us cope with the stressor like in the case of running from a threat, avoiding a car accident, or public speaking! The stress response is designed to help us have a surge of energy, accompanied by a reduction of pain, digestion, sexual function, etc. After the stress has passed, it takes some time for our body to calm down and can sometimes leave us feeling shaky, nauseous or exhausted.
As stress moves from acute stress to chronic, the sensitivity of the Hypothalamus Pituitary Adrenal axis (HPA-axis) becomes diminished. Our body has many intelligent feedback loops that help us control the delicate balance of hormones, enzymes, blood sugar etc. Just as we can become insulin resistant with continued high blood sugar levels, the HPA- axis feedback loop can become less sensitive to sustained high levels or stress hormone cortisol.
As the feedback loop becomes damaged, any part of the system can become faulty, and our body may not get the message that levels are high/low. In the case of disruption to the stress response, and a departure from health homeostasis, it's theorised that there are 3 main phases of HPA axis dysregulation: Acute, Compensatory and Exhaustive. Each phase is dictated by the total sum of cortisol output.
Acute Phase
In the initial part of the acute phase this is a healthy response to stress, and it helps us overcome the stressor. We may still feel fine in this phase because we have high amounts of cortisol to increase energy, reduce pain, keep their blood sugar elevated, and so we often feel we can handle or do it all.
As we stay in this phase longer, we still may feel ok, but are aware our health is shifting. Blood sugar issues, sleeping problems, weight gain, fluid retention or feeling wired and tired is common in this phase.
Compensatory Phase
The compensatory phase of HPA-axis dysregulation is noted as having a cortisol sum that is within the reference range. On a test result, the reference range can depict both as homeostastis and optimal health, or more likely the compensatory phase. Because reference range is regarded as 'normal' a clients results could be deemed as ok. However based on clinical correlation with the client, we know that they probably are not experiencing optimal health, and in fact may be further along the spectrum of dysfunction. The client may remember feeling better (earlier in the acute phase), or having a big stressful event, but further down the path they no longer feel so good. DHEA the anabolic counter hormone to cortisol becomes depleted in this phase, and the adrenals start getting ‘tired’ which is why we used to call it adrenal fatigue, rather than HPA-axis dysregulation.
Exhaustive Phase
The exhaustive phase is dictated by a daily cortisol output that is below the optimal reference range and correlates with a client feeling exhausted, and often suffering multiple symptoms. In this phase the client is really losing their ability to respond to stress, and is really struggling. Symptoms are the last thing to occur in the disease process, and once they appear, we are already headed towards a disease state.
As symptoms manifest, multiple body systems become involved in the process because no one symptom, is the result of any one malfunction. The human body is an interdependant unit, function and wellness is a factor of how well the system as a whole can operate. If for example the gut starts to become compromised with pathogenic bacteria, then we may start to increase systemic inflammation through the body, or have toxic spillover that burdens the liver, or we may lose the ability to create neurotransmitters efficiently which will impact the brain - it's all connected.
It takes us a long time to deviate away from wellness and finally take notice of the bodies cries for help, and thus we must appreciate it may take awhile to get back towards optimal health.
It's Not That Simple
The above model is simple but effective to describe most case of stress, but the reality is it's far more complicated. The best method for accurately testing the stress response and cortisol is with Dried Urine which captures both free and metabolised cortisol. Saliva and blood only track free cortisol levels which is only half the picture, and leads to problematic treatment. For example see the below picture, you can see the dial for free cortisol is pointed to the right and is high, but the metabolised cortisol is low normal with the dial to the left. If this person was assessed with blood or saliva only, they would be prescribed a protocol to lower their 'high' free cortisol, which would make their situation worse because they actually are not producing a whole lot overall throughout their day.
This pattern can be an indication or low thyroid function, poor liver function, and reflects a slow clearance of cortisol, and the low daily output (low metabolised cortisol) could be a protective mechanism to down regulate the body given that the body is struggling to clear the high free cortisol levels. As you can see it's imperative to test, and now exactly what your free cortisol, metabolised cortisol AND cortisol daily rhythm are doing for best diagnosis, treatment and long term change. This is best done with the DUTCH test (dried urine test for complete hormones) from precision analytical. The most comprehensive test is to measure the DUTCH test plus Cortisol Awakening Response (CAR) which tests your initial response to stress on waking, where 50% of your daily cortisol is produced.
Too many people self diagnose and treat based on symptoms without knowing the complete picture which can cause many complications. Test, don't guess! The premsie of the functional medicine model is that everyone is unique, and we don't treat symptoms, or lab results, but rather seek to identify the complex patterns of dysfunction causing problems for the client.
Overlooked Stressors that Contribute to Chronic Stress
There are many low grade threats to our health that many may regard as insignificant. The reality is, that anything that isn't building us up, or adding to our quality of life, is breaking us down. On their own many of these stressors might not pose a significant threat to our system, but compounded with other factors, day in and day out, damage can accumulate.
The rate of repair must be greater than the rate of damage,
otherwise we are in the process of breaking down.
Environmental Disrupters
Poor diet, circadiam rhythm issues, blood sugar problems, low quality food, processed food, alcohol, toxic exposure from the environment, toxic body care or cleaning products, pollution, stressful relationships, bad lighting, over training, sedentary lifestyle, biotoxin exposure (mold etc), Electro magnetic fields, etc
Internal Disrupters:
Internal stressors may not be overtly obvious which is how they can cause significant declines in our health. insulin resistance and blood sugar problems, allergies, detoxification issues, leaky gut, dysbiosis, parasites, mental / emotional stress, injury, hormonal imbalance, heavy metals etc are all things to consider when the environmental factors have been address, but are not making a big enough difference.
What you can do
Run a DUTCH test with us which is around $359 AU and will provide a comprehensive look at cortisol, sex hormones, detoxification pathways, organic acids and overall stress response.
Reduce disrupters to your health (above) and increase things that promote your health
Eat well, hydrate well, move intelligently and often
Focus on great recovery habits like good quality sleep, breath work, heart rate variability training or myofascial release and mobility work
Supplement with basic vitamins and minerals to support your body. It’s important to know which phase you are in as needs in each phase require different treatments.
If you don’t feel 100%, find out which stage of HPA-Axis dysfunction you are in for more targeted treatment.
Investigate internal disrupters with an functional medicine practitioner.
Your health and vitality is not the result of luck, genes, or old age, and it's worth fighting for. If you are wiling to do the work, you can easily build a more healthful future for yourself! Look at ways you can reduce minor insults to your health, before they become major diseases.