Stress is a natural reaction that occurs in response to a real or perceived physical or emotional challenge.  At a neurobiological level, awareness of an environmental threat stimulates the brain to signal the release of epinephrine (adrenaline) and cortisol - the body’s “stress hormones” - from the adrenal glands.  These chemicals help to acutely raise the body’s alertness, energy level, blood pressure, heart rate, and glucose availability, establishing what we commonly refer to as the “fight or flight” response.   While we often think of stress as having a purely negative connotation, it is this activation of the sympathetic nervous system that optimizes one’s ability to run from a predator, perform in an athletic competition, or fight off a serious infection.

All humans, and in fact all animals to varying degrees, experience stress.  It is a primitive, instinctual response deemed necessary for survival.  One could say that a lack of sufficient stress response would result in a greater risk of being eaten alive (whether in the realm of a corporate office setting... or a literal jungle).  Stress is ideally a transient phenomenon.  It is only when the wired response becomes perpetual and pervasive that it begins to induce significant health problems.

Chronic stress often manifests physically, impacting just about every organ system.  Stress hormone elevation can trigger intestinal spasms and reduce the diversity of the gut microbiome, thus contributing to symptoms of abdominal cramping, bloating, and IBS.  Changes in nutritional habits, either due to appetite suppression or overeating as a coping mechanism, can further exacerbate gastrointestinal issues.  Stress-induced muscle tension can commonly result in neck or back discomfort, tension headaches, TMJ, and other forms of chronic pain.  Consistent epinephrine and cortisol elevation can constrict blood vessels and raise blood pressure, placing an individual at risk for hypertension, cardiovascular disease, and stroke.  Chronically high cortisol (akin to what can be observed in cases of long-term exogenous steroid therapy) tends to metabolically trigger glucose elevation and weight gain, particularly in the abdominal area.  It also tends to weaken or otherwise adversely impact the body’s immune response, posing greater risk for infection and (possibly) cancer.

There are multiple lifestyle and supplemental strategies for stress management:

• Maintenance of sufficient duration and quality of sleep is amongst the most important stress-mitigating lifestyle parameters.  Not only does sleep, in and of itself, help rid the body of toxins, promote mental alertness, and possibly enable a form of emotional processing.  But lack of sleep is perceived by the body as yet another form of distress, further triggering cortisol elevation and the systemic stress response.  Adequate sleep is well-established as being associated with lower levels of anxiety.

• Nutritional habits are incredibly important.  We can stabilize or de-stabilize our cortisol levels, sleep patterns, and emotional responses, depending on what we choose to consume on a regular basis.  Inflammation, and therefore stress, is universally enhanced by substances such as sugar, refined carbohydrates, processed foods, and gluten.  It is conversely reduced by intake of leafy greens, olive oil, and foods rich in omega-3 fatty acids (such as salmon). Keeping alcohol in moderation (or avoiding it altogether) and limiting caffeine to sensible amounts in the morning hours only are strongly advised.  As we learn more and more about the ever-important “gut-brain” axis, it’s also becoming increasingly clear that the gastrointestinal microbiome plays a role in our capacity to handle stress and ward off both physical and psychological instability.  Thus, a high-fiber diet rich in vegetables and naturally fermented foods (like kimchi and sauerkraut) is ideal.  

• Simple breathing exercises are easy to perform and can be incredibly helpful in calming down an overactive nervous system.  While guided meditation and yoga practices offer more formalized strategies incorporating breath work, intentional breathing doesn’t have to be complicated or cumbersome.  A deep inhalation through the nose, followed by a 4-5 second breath-hold, then a long, slow exhalation through the mouth can be performed anywhere, anytime.  Repeating this, even for just a minute or two, is known to have real-time benefits with respect to reducing heart rate, blood pressure, and anxiety.

My preferred supplements in the realm of stress management include:

• Magnesium – typically 300->400 mg at bedtime (higher doses can trigger diarrhea for some).  Magnesium helps to naturally relax both the mind and body.  Magnesium glycinate (or bisglycinate) is a reliable, well-absorbed, all-around formulation, while Mag citrate may be better for those also suffering from constipation.  There are a multitude of options over-the-counter.
• L-theanine – on its own, or alternatively in combination with other stress-reducing compounds such as ashwagandha and magnolia (as found in the supplement “Cortisol Manager” by Integrative Therapeutics).  
• Priobiotics - I’m in favor of dietary optimization first.  But for those who may not be consuming sufficient amounts of naturally fermented foods, then a dedicated probiotic (rich in Lactobacillus and Bifidobacterium strains) can be helpful.
• Omega-3 fatty acid supplements, alone or in combination with Coenzyme Q10, have also shown promise in reducing stress and anxiety levels.