9 Steps to Perfect Health - #6: Manage Your Stress | Chris Kresser

9 Steps to Perfect Health – #6: Manage Your Stress

by Chris Kresser

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This content is part of an article series.

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Of all the 9 steps, stress management is probably the most important. Why? Because no matter what diet you follow, how much you exercise and what supplements you take, if you’re not managing your stress you will still be at risk for modern degenerative conditions like heart disease, diabetes, hypothyroidism and autoimmunity.

I see this every day in my practice. I have a lot of patients that are following a “perfect” diet, and yet they are still sick. Stress is often the cause. (I’ll define stress more clearly in a moment.) Yet as pervasive as stress is, many people don’t do anything to mitigate its harmful effects. The truth is it’s a lot easier to make dietary changes and pop some pills (whether drugs or supplements) than it is to manage our stress. Stress management bumps us up against core patterns of belief and behavior that are difficult to change.

I suspect this is why all of the articles I’ve written about stress management are among the least shared on Facebook and Twitter and have elicited the fewest comments. I think many of you may feel defeated or overwhelmed by stress. I understand this. Stress management is hard. It asks a lot of us. It forces us to slow down, to step back, to disengage (if only for a brief time) from the electric current of modern life. It asks us to prioritize self-care in a culture that does not value it.

While I feel your pain, and still struggle with stress management myself, I’ve got to lay down some tough love here.

If you’re not doing some form of regular stress management, you will sabotage all of your best efforts with diet, exercise and supplements. Stress management is absolutely crucial to optimal health and longevity.

If most health conscious people spent even half the amount of time they spend focusing on nutrition and exercise on managing their stress, they’d be a lot better off.

I’m going to suggest several strategies for stress management at the end of the article, but first let’s define stress more explicitly and learn more about the harm it causes.

What is stress?

Hans Selye, the famous physiologist who coined the term “stress”, defined it this way:

…the nonspecific response of the body to any demand made upon it.

The prominent psychologist Richard Lazarus offers a similar definition:

…any event in which environmental demands, internal demands, or both tax or exceed the adaptive resources of an individual…

At the simplest level, then, stress is a disturbance of homeostasis. Homeostasis is the body’s ability to regulate its inner environment. When the body loses this ability, disease occurs.

The adrenals are two walnut-shaped glands that sit atop the kidneys. They secrete hormones – such as cortisol, epinephrine and norepinephrine – that regulate the stress response. Because of this, the adrenals are what determine our tolerance to stress and are also the system of our body most affected by stress.

Most people are aware of the obvious forms of stress that affect the adrenal glands: impossibly full schedules, driving in traffic, financial problems, arguments with a spouse, losing a job and the many other emotional and psychological challenges of modern life.

But other factors not commonly considered when people think of “stress” place just as much of a burden on the adrenal glands. These include blood sugar swings, gut dysfunction, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems, inflammation and overtraining. All of these conditions sound the alarm bells and cause the adrenals to pump out more stress hormones.

Adrenal stress is probably the most common problem we encounter in functional medicine, because nearly everyone is dealing with at least one of the factors listed above. Symptoms of adrenal stress are diverse and nonspecific, because the adrenals affect every system in the body.

But some of the more common symptoms are:

  • Fatigue
  • Headaches
  • Decreased immunity
  • Difficulty falling asleep, staying asleep and waking up
  • Mood swings
  • Sugar and caffeine cravings
  • Irritability or lightheadedness between meals
  • Eating to relieve fatigue
  • Dizziness when moving from sitting or lying to standing
  • Digestive distress

How does stress harm the body?

The short answer is “in every way imaginable.” It would take books to explain the full effects of stress. And those books have been written. Check out Why Zebras Don’t Get Ulcers by Robert Sapolsky and When the Body Says No: Exploring the Stress-Disease Connection by Gabor Mate for a more thorough investigation. I’m just going to summarize here.

When stress becomes chronic and prolonged, the hypothalamus is activated and triggers the adrenal glands to release a hormone called cortisol. Cortisol is normally released in a specific rhythm throughout the day. It should be high in the mornings when you wake up (this is what helps you get out of bed and start your day), and gradually taper off throughout the day (so you feel tired at bedtime and can fall asleep).

Recent research shows that chronic stress can not only increase absolute cortisol levels, but more importantly it disrupts the natural cortisol rhythm. And it’s this broken cortisol rhythm that wreaks so much havoc on your body. Among other effects, it:

  • raises your blood sugar
  • weakens your immune system
  • makes your gut leaky
  • makes you hungry and crave sugar
  • reduces your ability to burn fat
  • suppresses your HPA-axis, which causes hormonal imbalances
  • reduces your DHEA, testosterone, growth hormone and TSH levels
  • increases your belly fat and makes your liver fatty
  • causes depression, anxiety and mood imbalances
  • contributes to cardiovascular disease

These are all well-documented in the scientific literature, and the list of health problems caused by stress goes on. And on. In fact it’s not a stretch to suggest that stress contributes to all modern, chronic disease.

But most people don’t need much convincing of this. You’ve witnessed the negative effects of stress firsthand, every day of your life. So the question is, what do you do about it?

How to reduce the impact of stress

There are two different approaches to reducing the impact of stress, and both are important:

  1. Reduce the amount of stress you experience.
  2. Mitigate the harmful effects of stress you can’t avoid.

Reducing the amount of stress you experience

Reducing stress means just what it sounds like: reducing your total exposure to all forms of stress, whether psychological or physiological. Of course it’s never possible to completely remove stress from our lives. But even in the most stressful of circumstances, it’s still possible to reduce stress.

The first step is to avoid unnecessary stress. This often seems obvious, but it isn’t. It’s easy to overlook habitual patterns of thought and behavior that cause unnecessary stress above and beyond the stress we can’t avoid. Here are a few guidelines for how to avoid this kind of stress:

  • Learn to say “no”. Know your limits, and don’t take on projects or commitments you can’t handle.
  • Avoid people who stress you out. You know the kind of person I’m talking about. Drama kings and queens. People who are constantly taking and never giving. Limit your time with these people or avoid them entirely.
  • Turn off the news (or at least limit your exposure to it). If watching the world go up in flames stresses you out, limit your exposure to the news. You’ll still find out what’s going on, and still be able to act as a concerned citizen. But you’ll have more time for yourself. I stopped getting the paper years ago, and don’t even have TV. And believe it or not I’m still well-informed. The difference is I get to choose what I’m exposed to.
  • Give up pointless arguments. This is especially true for useless internet debating. There is obviously a place for discussion and debate, and working towards change. But have you noticed that most arguments don’t lead to change? In fact, they tend to have the opposite effect – each side becomes more defended and entrenched in their worldview. Find other ways to get your point across, learn to listen with empathy, and don’t waste precious time and energy trying to convert fundamentalists to your religion.
  • Escape the tyranny of your to-do list. Each day spend some time in the morning really considering what needs to be done that day. Drop unimportant tasks to the bottom of the list. Better yet, cross them off entirely. The world will go on.

The second step in reducing the amount of stress you experience is to address any physiological problems that are taxing your adrenals. These causes include anemia, blood sugar swings, gut inflammation, food intolerances (especially gluten), essential fatty acid deficiencies and environmental toxins. If you have one or more of these conditions, it’s probably best to get help from a skilled practitioner.

Mitigating the harmful effects of stress you can’t avoid

Obviously there are times when we just can’t avoid stress. Maybe we have a high-stress job, or we’re caring for an ailing parent, or we’re having difficulty with our partner or spouse. In these situations it’s not about reducing stress itself, but about reducing its harmful effects.

How do you do that? There are several different strategies:

  • Reframe the situation. We experience stress because of the meaning we assign to certain events or situations. Sometimes changing our perspective is enough to relieve the stress. For example, being stuck in traffic can be a “disaster” or it could be an opportunity for contemplation and solitude.
  • Lower your standards. This is especially important for you perfectionists out there. Don’t let the perfect be the enemy of the good. Let good enough be good enough.
  • Practice acceptance. One of my meditation teachers used to say “All suffering is caused by wishing the moment to be other than it is.” Many things in life are beyond our control. Learn to accept the things you can’t change.
  • Be grateful. Simply shifting your focus from what is not okay or not enough, to what you’re grateful for or appreciative of can completely change your perspective – and relieve stress.
  • Cultivate empathy. When you’re in a conflict with another person, make an effort to connect with their feelings and needs. If you understand where they’re coming from, you’ll be less likely to react and take it personally.
  • Manage your time. Poor time management is a major cause of stress. When you’re overwhelmed with commitments and stretched too thin, it’s difficult to stay present and relaxed. Careful planning and establishing boundaries with your time can help.

In addition to everything I’ve listed above, one of the most important things you can do to manage stress is to bring more pleasure, joy and fun into your life. This is the subject of Step 9, so I’ll just mention it briefly here.

Stress management practices and techniques

All of the stress management tips above are important, and can make a huge difference in your health and well-being. However, there’s a certain amount of stress in modern life that is simply unavoidable for most of us. That’s why it’s so crucial to have a regular stress management practice.

There are a lot of options here, of course. Things like exercise, yoga, tai qi, qi gong, a walk on the beach, etc. can all relieve stress. I’ll just share the practices I’ve found to be most helpful for myself and my patients over the years.

Meditation

In spite of the fact that I’m listing it here, I don’t consider meditation as a “stress management” technique – although it can certainly have that effect.

Meditation is an awareness practice. Through meditation we learn to witness our thoughts, feelings and sensations and dis-identify with the story we tell ourselves about them. We learn to stay present to our lives even in the face of great difficulty or pain.

Contrary to popular belief, you don’t have to be able to “relax” to meditate. Sometimes we are relaxed during meditation, sometimes we are quite agitated. We don’t meditate to manipulate our feelings, but to learn to observe them without reacting to or “becoming” them.

One of the books I often recommend to people who’d like to learn more about meditation practice is Opening the Hand of Thought, by Kosho Uchiyama. You may also want to check out Don Matesz’s recent article, 10 Reasons Why I Practice Mindfulness Meditation, for more on the benefits of meditation practice.

Mindfulness-based Stress Reduction

Mindfulness-Based Stress Reduction (MBSR) combines mindfulness meditation and yoga to cultivate greater awareness of the unity of mind and body, as well as of the ways the unconscious thoughts, feelings, and behaviors can undermine emotional, physical, and spiritual health. It was developed by Jon Kabat-Zinn at the Stress Reduction Clinic at the University of Massachusetts Medical Center in 1979.

Through clinical research at the University of Massachusetts and elsewhere, MBSR has been shown to positively effect a range of autonomic physiological processes, such as lowering blood pressure and reducing overall arousal and emotional reactivity. MBSR is offered as an 8-week intensive training in hospitals and medical centers around the world. It is also offered as an online course, and can be done via home study with books and audio recordings. MBSR is particularly effective for anyone struggling with chronic illness or pain.

UPDATE: You can also download a free recording of the Body Scan and other mindfulness techniques here.

Rest Assured

Rest Assured is a program for healing insomnia naturally. However, the way this is accomplished is by maintaining a greater state of relaxation and ease throughout the day. We can’t run around all day in a state of constant hyper-arousal and expect to fall into a deep and peaceful sleep at night. The body doesn’t turn on and off like a light switch. This is why sleep medications have become ubiquitous. They’re the equivalent of hitting yourself over the head with a sledgehammer so you can fall asleep.

The Rest Assured program contains simple exercises that coordinate breath and movement. Many of the exercises can be performed in as little as 3-4 minutes throughout the day, while some take 20-30 minutes and can be done when you have a little more time – or while you’re laying in bed before sleep. I’ve found these to be incredibly helpful myself, and my patients have as well.

So here’s my request. If you found this article to be helpful, please share it on Facebook and Twitter (you can use the FB & Twitter icons at the top of the post), or email it to someone you care about. Stress management is one of the most important things we can to do protect our health, yet it’s often the first thing that slips through the cracks in a busy life.

  1. It’s funny you mention to share this article on Facebook, when I have come to the conclusion that Facebook is an addictive technological trap for wasting an inordinate amount of time. I now check Facebook once every couple of weeks and have forced myself to refrain from comment battles. I also have forced myself to stay off other comment sections on other websites as well. I also spent a couple hours changing all my email contacts from yahoo to gmail because I found Yahoo’s news feeds diverting my attention virtually every time I went to check email (plus Yahoo ruined their email interface anyway and it is now a glitch prone mess). We don’t need so much ‘news’ and updates on all the people we know and all the hyper-media of today that truly bombards our minds. And last but not least put the smartphone away (not just airplane mode, turn it off!…when it is off you suddenly lose the temptation to busy yourself with apps…seriously try it) Step back from it all let your mind calm down. Go outside. Meet up with and have fun with friends and family. Make wholesome quality meals and take pleasure in doing so. Read a good book. That is the stuff of life and none of it causes stress (quite the opposite).

    • Hear, hear! I heartily concur, Evan. Well-said.
      Now I just have to make myself do it. I don’t spend that much time on devices, don’t have many, but I spend TOO MUCH on them–for sure.

    • So true Evan – having less is actually the key to having more (less worries, more time, more peace)!. Oh and Kris I just love your blogs which centre my attention on important health matters.

  2. This resonates w/ experience. I have always been sensitive to stress and have been working so hard to become the head of my department. I have succeeded in my professional goal, but my metabolism has crashed. I’m continuing to decrease carbs and trying to increase my strength training to try to restart my metabolism, but maybe I need stress management more. When I was a child I could enter deep meditative states without effort, but can’t seem to meditate now if my life depended on it. Not sure how to proceed.

    • Regarding your metabolism crashing, I’d rec suggest seeing a naturopath or functional medicine doc to check your adrenals. You sound a bit like me 3 years ago…entering adrenal fatigue. 😉 As for being able to meditate more as a child, the heavy use of technological devices rewires brain to multi-task…not meditate.

  3. In the mid-90’s, a huge research study was done with Kaiser Permanente and the CDC in which they asked 10 questions about patients’ childhood experiences. It was called the ACE Study (for Adverse Childhood Experiences) and they found a very strong link between childhood trauma and illnesses later in life. In my practice as a psychotherapist, I have seen numerous instances of this in my clients. I wondered about it for years before finally hearing about the ACE Study. If you are traumatized as a child and don’t get help for it, your chances of getting one or more serious illnesses is quite high. Another reason why the best diet, exercise and supplements may not be the cures people are looking for.

    • I couldn’t agree more with you Kathryn. I’m a holistic nutritionist and very quickly when I started practising I realized that sending a client out the door with a protocol to change their diet and $300 worth of supplements was all for naught if they were under a great deal of stress or had unresolved emotional issues that impacted their ability to do what was good for them. I now use EFT to help my clients deal with those unresolved emotional issues (I refer to a psychologist when it’s out of my scope) that drive self-sabotage and emotional or stress eating. It’s one thing to know what we SHOULD do to take care of ourselves, it’s another completely to DO it and I think those unresolved issues from childhood are key.

  4. Relatives and friends constantly told me to meditate, but I am not sure if meditation will help. I tried some of them briefly, but not enough time to tell if it would help. However, if you are someone who’s life partner is a type I diabetes who would go into hypoglycemia from time to time. Sometime, that means calling the ambulance in the middle of the night. Other times, I pray for safety when we are both in the car and he’s driving. I don’t know if you can really relax.

  5. What about stress from constant change of sleeping patterns? I believe it disrupts cortisol level big time.

  6. For anyone interested in meditation, I highly recommend any binaural-beat audio meditation technology. These audio programs put you in a deep meditative state without any effort on your part – without any practice! It’s as close to magic as anything I’ve experienced. After just a few months of daily practice, I noticed that I no longer experienced stress in many everyday life situations that previously were always stressful, without any conscious effort on my part to manage the stress. Nine years later, I still use it daily; it’s so easy. A program like this costs about $40 and you can use it forever!

  7. This article is probably the most important one that has come into my inbox this year. Like so many others who have commented, I am currently experiencing this first hand. I am that person, perfect diet, exercise…was in perfect health and still should be. Stress has caused me blood sugar issues and hypothyroidism. Now my world has fallen apart around me, forcing me to assess stress and self care. It’s so amazing how things happen. The affect that stress has on ones health has been something I have been exploring and thinking about a lot and wanting to write about for my site. This is definitely the missing link in so many health and wellness practices and plans. Thank you for this amazing article and reminder.

  8. Hi Chris,
    thanks for this article… it reminds me that I am doing the right thing taking time out to try to reduce my stresses in life…
    I suffer with chronic anxiety and chronic fatigue syndrome with multiple health and digestive issues… I feel I am making progress but at times get overwhelmed with wanting full health yesterday lol …. I can relate with “doing all the right things diet wise” but seem to have hit a brick wall … i am still having digestive issues and finding weight loss difficult (although i have lost 10kg in the last year but that seems to have halted for now)… Joanne

  9. Thanks Chris for this very insightful piece.

    Should people called ‘patients-in-hospitals’ automatically be assumed to have high cortisol levels, and relaxation techniques be employed as fundamental to healing … including message, good-food, good-music, and hydrotherapy … perhaps, a chuckle or two?

  10. I have used Emotional Freeing Technique, Tapas Acupressure Technique, Eye Motion Desensitization and Reprocessing and Reiki to reduce my response to stress. I started with EFT about 10 years ago, added TAT about three years ago, was attuned to Reiki (level two) six years ago and finally learned EMDR two years ago. EFT I learned off the net for free and made good progress with on my own for quite a while. After my mother died from breast cancer and I lost her, most of my family (mental illness all around) and my home I needed more help than I could achieve on my own. Two gifted therapists got me through the two years of intense depression- which coincided with being diagnosed, finally, with hypo-thyroid, adrenal exhaustion, hormonal imbalances and finally chronic fatigue. If it weren’t for EFT, TAT, EMDR and Reiki an extremely understanding and supportive husband, literally months of intense rest and these two therapists I doubt I would be alive today. I highly recommend any and all of them for anyone wanting to manage emotional problems of any sort, especially with the help of qualified professionals. The best diet in the world would not have saved me but these techniques did!

    • Amen Felicia. I’m an EFT practitioner trained with Tina Craig, Gary Craig’s daughter. Gary’s free tutorial can be found at http://www.emofree.com for anyone that ‘s interested in learning more about it.
      EFT has been life-changing for me as well. It helped me through losing my father 11 years ago as well as MANY other stressful events in my life.
      I’m initiated in Reiki as well. Sound like we’re on similar paths. 🙂

  11. Great post. I tell my clients at ExecuCare that the first step to managing stress is making a plan to recognize and address it. Ask yourself: what are my physical and psychological signs of stress that I should watch for? What are certain situations that increase my stress levels? What activities and daily routines can I add to my life that will help me relax and combat stress?

  12. For 10 years now, following my own leukemia diagnosis, I have practiced massage therapy exclusively for cancer patients. Research has shown approximately half of all reported anxiety, depression, pain and nausea from cancer and it’s treatment is due to the amplification effect of stress. Stress is kerosene on the fire.

    The daily results are nothing short of amazing. It is best summed up by an early client, “It’s like a vacation from cancer.”

  13. Hiya!

    I’ve read the steps in perfect Health up until now and I really liked this article. You’ve pointed out one thing I’ve never heard anyone else mention in connection to stress management. And that was to see and acknowledge your feelings and to grow as a person.

    I have, I think the most perfect teacher in the world. His name is Skansen and he’s a horse. For little more than a year I’ve practied “horsemanship” with him and it’s worked very well.

    I’m now good enough to realize when he’s in a mood to play or not and when I’m doing something wrong. A couple weeks ago nothing worked and I was very frustrated becuase I couldn’t see what I was doing wrong. After thinking about it I finally realized, I wans’t at all in that emotional, open minded zone I usually am with him. And he reacted to that in a negative way. Next time we practiced I made sure to find that “zone” again and was rewarded accordingly 🙂

    Thank you for making this articte, it made me realise that what I experienced wasn’t just imaginary or a fluke.

    /Jenny

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