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.


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. No question, just a comment.

    After only one week of following (not up to speed on all points just yet) the diet rules of no grains/legumes/veg. oils/sugar, I can tell you that the way I manage stress is ALREADY different! I’m calmer than before.

    Coinicidence? No!

  2. In terms of good sleeping habits, and its effect on stress, I’ve been reading up about the effects of modern lighting and how blue wavelengths suppresses melatonin production. Up until the invention of the tungsten filament, and its mass-production by General Electric, nobody ever saw blue wavelengths after sundown. Campfire, torches, gas lamps, oil lamps, twilight we all low-temp amber lighting.

    Richard L. Hansler — a former researcher and scientist for General Electric’s lighting division — recently published a book documenting the established research on how exposure to blue (tungsten) light after sundown is suppressing our melatonin and wreaking havoc on our bodies. The book is called, “Great Sleep! Reduced Cancer! (By Richard L. Hansler, Ph. D.)”. Part of the trick to maintaining a good circadian rhythm is to eliminate blue wavelengths at the same time each evening and wake up at the same time each morning.

    Hansler has started a company called http://lowbluelights.com where he sells products to help reduce exposure to blue wavelengths. If one does their own research, you can find high quality “blue blocker” sunglasses at a fraction of the cost on Amazon.com — though Hansler maintains that his blue-blocking glasses block all of the blue wavelengths.

    From my own experience, reducing my exposure to blue light — even with cheap blue blockers — in the evenings really has improved my sleep a lot. I’m feeling more relaxed and refreshed than ever.

  3. Maybe this topic isn’t shared much, because causes of and solutions to stress are as varied as people. For example, the stress of unemployment from a layoff is different than the stress from disagreeing with your spouse about whether to have a second child, which is different than the stress from being a caregiver to an aging parent, and so are the approaches to managing these stresses.

  4. The topic of stress is pretty much the backbone of what I’m learning at the Institute for the Psychology of Eating, how it creates a kind of chemistry and physiology that gets people the opposite of what they want, like weight loss, healing digestive concerns, fatigue issues, etc. I believe it is the cause of most chronic diseases as you said. More and more I’m convinced this is why my health went down because of extreme emotional stress ever since puberty. I’ve de-stressed a lot the past 1-2 years, and it’s helping for sure. I noticed you do create your own stress in the way you choose to react to people…you can’t control what they say…so you have to figure out how to accept what they say and move on.

  5. Chris, you write that one symptom of adrenal stress is dizziness when moving from sitting to standing. Do you happen to know the mechanism behind this? This is happening to me.

  6. This post resonated with me, especially your point about our culture not valuing self-care. The medical profession is unfortunately a horrible example. I am a resident physician, and I have been suffering from a sundry of physiological problems related to chronic stress and sleep deprivation that has built up over my years of training. We all need a change of mindset, starting with those of us who are supposed to be giving health advice and treatment! I hope to somehow incorporate stress management for healthcare professionals into my career when I’m finished with residency. Thanks for this very useful information!

  7. Hi Chris,

    I couldn’t agree more on the importance of eliminating stress, and would like to add a reframing technique (and a different interpretation of the nature of stress) that your patients and readers might appreciate knowing about. Take a look at http://www.mythofstress.com. As you’ll see, I’m also a fan of challenging mainstream myths, and think that the way we look at stress might be one of the biggest.

  8. This is a GREAT article! Thank you for writing so clearly about such an important topic!

    Two things that have deeply influenced my return to health that you didn’t mention are chiropractic and self-hypnosis. It’s amazing how chiropractic adjustments can increase the functioning of your nervous system and enable your body to handle stress more efficiently. Self-hypnosis has also been an amazing stress releasing tool for me. I’ve never felt so relaxed as I do when I’m in hypnosis – it’s amazing!

  9. The word “Stress” actually relates to wear and tear as when the rubber meets the road on a tire or the brake pads pressing up against the rotor in the wheel. The term as it applies to living organisms was first introduced by Hans Seyle in the 1930’s who defined it as the consequence of the failure of an organism (human or animal) to respond appropriately to emotional or physical threats, whether actual or imagined. Thus stress symptoms are the manifestation of a chronic state of responses to stress triggers that are actually benign. Even a thought can set off the same response mechanism that would be in play while standing in front of a hungry lion. Hence, Seyle’s definition still reaches to the heart of stress management; the idea of the response being inappropriate and engaging in a process of altering ones misperception of pending disaster or imminent danger.

  10. Good article, but you forget that many people havechronic stress finish with a dysregulation of HPA axis, with low cortisol. Adrenal fatigue is a reality. Many physician give vit C, vit B, adaptogen like licorice to recover. Some people never recover from that but this people have no addison’s disease. The best treatment is low dose of hydrocortisone. Pr Jefferies write a good book that explain this situation.

  11. I should clarify, on the podcast you were talking about blood sugar dipping too low during the evenings when low-carb dieting, which prompted an insulin response that wakes you up at 3:00 am with an anxiety attack. I had this happen twice last week, and listening to your podcast was like a light bulb going on over my head. I’ve been trying to add more carbs into my diet now. My weight loss has been stalled for months, but frankly sleeping through the night is more important than being ready for the beach.

  12. This posting made me think of a comment you made on your podcast a few weeks back regarding low-carb dieting, blood sugar and adrenal response. I imagine that a combination of intermittent fasting and low-carb dieting could really smoke your adrenals. Do you have a recommended calorie intake and macro-nutrient profile you recommend? The paleo community seems to be loathe to give such parameters, but for those who are far along the path of adrenal fatigue, trusting your appetite is just not going to work.

  13. The intention of meditation practice is to increase – not decrease – awareness. If it’s used to disassociate and withdraw from feelings, it really isn’t meditation anymore. That is a pitfall, however, which is why I recommend finding a teacher if possible.

    I practice zazen (Zen meditation) myself, but did Vipassana for several years before that. I think finding a good teacher to work with is more important than the specific practice.

  14. I’ve been dealing with dysthymia for years, and a couple psychologists believe that the root of my low-grade depression is that I withdraw from my emotions (especially in emotionally charged situations) either by not feeling that way as I express it (as in not actually feeling the anger as I admonish someone) or shutting down (by daydreaming or being really involved in my thoughts when life may get heavy).

    My question is this: what type of meditation should I practice. I fear that some types of meditation would just serve as another technique to withdraw from feelings.

  15. Alan – I combine hypnotherapy, imagery and mindfulness techniques in my coaching practice, because you are correct about the subconscious mind’s dominant role in our actions and reactions. When appropriate, I incorporate some Meridian Tapping (aka EFT) when a client is in state as a process of self-inquiry and reframing, and have found it very effective. However, I am not on the “Law of Attraction/EFT bandwagon” as it being a some billion dollar technique. Again, people are looking for instant cures without having to do deeper inner work, and although this process can be successful at getting to the heart of one’s limiting beliefs and negative self-talk patterns, bringing these things up without the guidance of a professional can be disastrous for people who have serious mental and emotional concerns.

    • I don’t use it as often as I should, but my wife, my brother, and I have found EFT to be effective.

      In the past I have also found The Sedona Method to be effective in terms of ‘letting go’ of bothersome stressors.

      For me, the key is to remember to do those things instead of hanging onto the things that are stressing me.

    • I find tapping really helpful. Robert Smith has loads of free You Tube videos. Highly recommend!

  16. Hi Mark,

    I know first hand how chronic stress can effect your life. I am now going through my second episode of adreanl fatigue. The adrenal fatige seems to hit worse AFTER the stress is gone, however I can tell it is coming on because all my symptoms (and there is a list much longer than what you gave above) start to rear their ugly head again.

    I am chemotherapy survivor and I am convinced that the chemo pushed my adrenals over the edge and I am no longer able to adapt to stress like I once was. Now, it is a constant battle for me to keep my adrenals healthy and working at optimal levels.

  17. I apologize for the double post myself, but my last comment made me realize I have a question. What are your thoughts on chocolate Chris (any other knowledgeable individuals opinion would also be appreciated)? When I eat 85% percent or higher my body doesn’t even seem to desire to eat more chocolate. Mark Sissan is really the only ‘paleo guru’ that has commented on it much at all. I just learned of you from Robb Wolf’s podcast, really liked your perspective and resonate with it and would love to hear your opinion on this food I make such a fulcrum of my diet and happiness (with great success I might add).