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

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This content is part of an article series.

Check out the series here


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. The is something I’ve never had a problem with growing up on the Islands and the coast, but chocolate has to be the other reason. I’m almost completely paleo aside from chocolate, but that’s because it plays as significant a role as the rest of the diet in that it makes me a perpetually happy person and being mostly saturated fat seems to be better than some cheats. I would highly encourage others to eat plenty of chocolate to reduce stress, it works wonders for me :D.

  2. Hi Dr. Smith,
    Thank you for commenting, I really respect your work and your opinion. I guess I just got stuck in the void of trying to lean out as quick as possible, taking it to the extreme. So should I just eat more calories of the same quality food? I only resorted to this method because I’ve done the unweighed/unmeasured gig before and I didn’t see much in the way of results but maybe I just didn’t give it enough time. I hear you that the feel-good effect of fasting and underrating is like a ticking time bomb. I guess many people just revert back to calorie counting because it’s something to track. Anyways, I’m going a seminar by Mat Lalonde tomorrow, I’m sure he’ll set me straight. Thank you again Dr. Smith and Chris. I really appreciate the help because even though I read a ton about this stuff, I still easily miss some important points.

  3. I support these techniques. However, for most people they are so overwhelmed that they need to address stress in a different way too.

    I suggest David Allen’s works: Getting Things Done,The Art of Stress-Free Productivity. The calm one can achieve by learning how to write down everything on your mind, define outcomes and next actions, categorize them in objective context lists, review them regularly, and keep everything out of your head–is phenomenal. Then, when you meditate you can be free of everything creeping into your head at the time, because you know you have a trusted system keeping everything in control for you.

    I shared this with my acupuncturist and he was delighted, I might add.

    • this sounds really valuable for me. i seem to get stressed out immediately when i get to work and have so many things to prioritize-all the thoughts are doing battle in my head vying for attention. i get really overwhelmed by my non-stop thoughts of things to do, both at work and at home. i often end up shutting down completely and can’t seem to do anything productive. i have adult ADD also so this makes it more challenging. one of my program leads at work gave me a “pep talk” yesterday and told me i need to slow down rather than rushing around trying to get stuff done. she basically said to stop trying to multi-task. i really don’t want to multi-task, but it’s so hard for me to concentrate on one thing w/o having all these other thoughts pop into my head. doesn’t help that my work involves a wide range of duties/tasks where i really do have to shift gears from one thing to another throughout the day.

  4. I am also emailing your article to a friend whose husband just had heart problems because of his stressful lifestyle. Thank you for this very good series.

  5. I suffered from stress for a year at a time every time we moved from one country to another and my body reacted very strongly to it by weakening my immune system, I suppose my whole metabolism . 2 month before my previous move I caught a virus and developed pneumonia and I felt that it was a pretty strong warning so 1 year before our last move I took up meditation, qi gong, and breathing therapy. I also allowed myself time for spontaneous pleasures . It worked great. Stress management is definitely an important regime to follow. Laughing yoga was also a great thing 🙂

  6. I agree with Garrett. I’m not a fan of calorie restricted diets because of their effects on cortisol. At that level of caloric intake, you’re going to lose lean mass and end up adding fat in your abdominal area (due to increased cortisol levels) over the long-term. Not a good strategy.

  7. Mark,
    At 1200-1500 Cals/day, you might be getting enough nutrition, but you aren’t getting enough energy.

    By doing this, you are forcing your body to pump out extra stress hormones, like cortisol and adrenaline, to keep your blood glucose levels from dropping. Lifting at the end of a 20-hour fast, when you’re only eating 1200-1500 Cal in a day means that your workout was fueled almost entirely by the result of stress hormones (and the energy they freed up).

    You’ll likely feel OK for a while, then your body will build a tolerance to your stress hormones, and you won’t feel so hot any longer.

    Just because you might use a high quality oil and the highest octane gas in your car doesn’t mean you’re going to get to drive twice as far on a tank of gas.

    Undereating, intermittent fasting, and intense exercise are all stressors. Your experiment has been done before, I deal with “survivors” of your experiment every day. See the RobbWolf.com forums, they’re all over there. It goes well for a while, sure. You think it will go on forever. I’m here to tell you that it won’t. Believe it or not.

    • Actually you probably felt GREAT becuz when you’re destroying your body, it feels good. That runner’s high is a sign that All Is Not Well. It’s to keep us going when we truly need to keep going, like in a time-limited crisis. That rush is not good to have chronically, day after day.
      Really.
      Physiologically you are harming yourself. Just the same as a smoker is ruining his lungs well before he first starts hacking up in the mornings.
      The piper will be paid.

  8. Hey Beth,
    I feel really good actually. I at first thought that it would be drastic but I’m kind of running an experiment and so far it’s going good. Last night I deadlifted the same weight and reps that I did last week when I was eating more calories, so that was a good sign. And that was on the end of about a 20-hour fast. This is why I’m researching this stuff because if I can make 1,200 calories super nutritious and thereby not harm my body, then I don’t see the need for the extra calories. You know what I mean?

  9. Thanks Jack. I will likely order the BO and CLO blend. I’m only considering the grams of fat because I’m under-eating right now to lose body fat. Once I get to a desired level of leanness, I definitely plan on increasing my pastured butter intake to the point where I don’t put fat back on. I’ve had fun researching this as I want to lean out in the healthiest way possible.

  10. To add to Jack’s reply to Mark, heating/pasteurizing does kill off the Wulzen factor … so if you’ve got any stiffness/arthritis, it’s probably worth adding the HVBO over the butter or ghee.

    That said, anyone else concerned about a 6′ 190lb guy only eating 1500 calories on a daily basis? Hmmm.

  11. Mark,

    The butter is a highly concentrated extraction of the fat soluable vitamins/nutrients in butter from cows that ate fast growing green grass. To get that amount, I’ve read that it’s about 5 times as much grass fed ghee and more than that for butter, but keep in mind that the HVBO is raw and they claim that the ‘fast growing green grass’ makes a difference, a la Weston A Price himself. I’m not sure if a “grass fed” label necessarily indicates fast growing, but I think that’s getting pretty technical.

    Eating pasture butter and ghee does indeed provide K2 though, and it could be argued that consuming pasture butter could be adequate for K2, so long as you eat enough of it daily. Don’t be concerned about the fat content of the butter oil. It’s not about the g of fat. It’s about what’s in those 2.5 g of fat. Personally, I take the GP royal blend, and eat pasture butter/ghee like a maniac.

    Chris,

    Excellent article on stress management. Weird thing to mention, but I know this gal at work that eats terribly, I mean super terribly. She will not touch any form of meat, and she’ll eat a pack of M&M’s and a regular coke for breakfast. A bagel with butter substitute and a Red Bull for lunch. Today I saw her eating a little Debbie chocolate cake snack for breakfast. She does this daily, and yet she is fairly in shape and even has made comments to me about others about being out of shape. I jokingly scoff at her diet to her all the time (she’s ok with it) and she pokes fun at my butter and eggs and sardines and what not. My point… she is pretty laid back… doesn’t seem to stress much, and is generally self confident. It will likely catch up to her soon enough, but it still makes me wonder how much that plays a role in her physiological ability to eat that way and still be pretty fit for being in her late 50s.

    Anyway I already have a couple people in mind that I want to forward this too. Thanks so much for your diligence.

    Jack K

    • She is a genetic anomaly. The kind of woman that other women hate lol. I doubt it will catch up with her if it hasn’t by her mid50s. SIGH
      Genetics is JUST not fair.
      I don’t want to smoke till 95 and drink every nite till I’m 90. I just want to look normal lol

  12. Hi Chris

    just have two questions I’d like to run by you:

    1. In terms stress monitoring, do you recommend the Adrenal Stress Index ? Reckon its a consistant measure ?

    2. Any experience using supplements such as Phosphatidyl Serine, Licorice Root and Holy Basil ?

    Thanks Chris

    Barry

  13. Excellent post Chris – posting the link on my Facebook page.
    Stress in one form or another is at the core of every one of my client’s presenting issues. I deeply appreciate your promotion of the efficacy of mindfulness practices in the mitigation of stress (including the link to eMindful), as well as the excellent tips to proactively help reduce it in the first place. With the instant gratification mindset that is pervasive in our culture, it can be a challenge to inspire people to do what it takes to be fully present and responsible for the impact their thoughts, choices, actions and behaviors have upon their mind and body (as well as everyone else their life comes into contact with). The evidence-based education you provide along with a dose of “tough love” (one of my favorite tools) is a gift to those who are ready to take the necessary steps to feel good and live well. Many thanks to you.

  14. Oh ok, I only asked because a serving of butter oil has 2.5g of fat while a tbsp of Kerry Gold has 11g. I’m not sure if there is research on this but do you think that I could get the same benefits by eating the Kerry Gold butter instead of taking the butter oil? And if so, do you have any idea how much butter I would need to eat to get same nutrition provided in 5 ml (which is the amount that I think you recommend) of butter oil? Thank you for your help. Basically I’m wondering if I’m overeating the fats as I’d be happy to just eat the essential amount to absorb the vitamins and then just eat protein and carbs as needed.

  15. Matt: as I mentioned in the article, I believe the answer to your questions comes down to beliefs, habits and patterns of behavior. We all operate within a structure created by years of conditioning. It’s usually possible to change our diet, take supplements and exercise more without threatening this structure. But stress management actually requires us to question the beliefs and change the habits and behavioral patterns that this structure is comprised of. That’s what make stress management so much more difficult. It actually requires us to grow and evolve.

    Mark: FCLO and BO are fats, so you don’t need extra fat to absorb the vitamins they contain.

    • Hi chris, this an article all need to look at in detail.its very enlightening indeed.but lifestyle management is a real problem.i have a friend who works long hours on the computer as a means of livelihood. Missing meals and poor sleep are life parteners to such a way of life. I have given my friend lots of advice on diet and how to improve sleep. …at least now initating sleep is not a problem but missing meals is kind of like a habit due to, well, being engrosed with work. Chris what do suggest for this sort of situation?

  16. Hey Chris,
    Love your stuff. After reading and listening to your material, along with reading the good material over at The Perfect Health, I have come to some conclusions that I’d like to run by you.

    Basically, I’m working at leaning out from my current level of about 15%. So to do this in a smart way, I want to eat the most nutritious that I can with the limited amount of calories that I eat per day (1,500 at the most – I’m 6’0″, 193 lbs and 27 yo if that matters). With this in mind, I know that I need to get vitamin D, K, and A at a minimum. So I was thinking about getting the Green Pastures Butter Oil and CLO but wasn’t sure if I need a certain amount of added fat to absorb those vitamins or will they absorb fine without added fat? I have been eating 1-2 tbsp of Kerry Gold butter per day and supplementing with CLO pills and vitamin-D in an effort to get the same benefits but if I could cut the calories by using the Green Pastures product and not eating extra butter, then I would likely go that route. Sorry if this comment is kind of all over the place. Thank you for your help.

  17. I’ve often come to wonder if, instead of being overwhelmed by stress, people simply do not understand stress and no not think they have it. I think this is what I tend to see in my massage practice.. “I’m not here to relax, I’m here because my back hurts!”
    You have a wonderfully simplified explanation of stress and what it does to the body. I think using this article as a reference will help me by leaps and bounds to help people understand their stress. Thank you!

  18. Such an important article and topic. I believe it was stress – from emotional, dietary and lifestyle sources that plunged me into chronic fatigue and a multitute of chronic symptoms.

    I am exactly the person you describe. Seemingly knowing/implementing everything when it comes to diet and supplements but then being extremely unmotivated and apathetic towards stress relief and relaxation. I can’t quite understand why I’m so committed to the things you would think are more challenging, such as sourcing and preparing top quality food, cooking frequently to balance my blood sugars, working out all the macronutrient ratios, researching this or that supplement etc but then find it so difficult to implement some sort of relaxation or meditation routine, even if it’s only for a few minutes initially. It’s like I can’t escape my desire to get well, which is keeping me unwell! When I could be reading a book or drifting off to sleep, the lure of the laptop and checking all the paleo/WAP blogs is too strong!

    I WILL be forwarding this to people I know, but it looks like I need to work out how to look after number one, somehow…..

    Thanks Chris

  19. I started doing neurofeedback this past fall after reading about it in Nora Gedgaudas’ book. My doc would object to this, but I call it computer-facilitated meditation. Not for everyone (it’s not covered by insurance), but I’m finding it invaluable to break some of my decades-old, stress-related habits.

    One thing my neurofeedback doc recommended adding to my stress management practice is an emWave PSR from HeartMath. I use the emWave in the AM and PM while listening to classical music and watching a slideshow of nature pics on Flickr. Lovely way to unwind!

    With both the actual neurofeedback and the emWave, I find that there’s something about having actual feedback that makes “sitting” far more tolerable, and thus something I can actually continue doing on a regular basis.