Managing Stress: The Importance of Attitude

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM


Learn how managing stress can improve your healthStress is unavoidable, and thankfully, humans have been built for handling stress, managing stress, and even thriving under stress. In fact, a certain amount of stress is necessary for your health and well-being.

So what about all these studies that cite stress as a main factor in the rise of chronic illness? It has more to do with how you manage stress than whether you’re exposed to stress in the first place or not.

You may have heard the term “eustress” before. It implies that your reaction to stress is a positive one. It could be a stressful situation where you feel capable of effecting a positive change, or a situation you actually desire to be in, or a situation you can make the most out of. This is not to say that you have to be positive all the time in the face of all forms of stress – it’s just a more general outlook that you tend to have.

The kind of stressor, the timing of the stressor, and your state of mental and physical health when faced with this stressor will also greatly determine whether it becomes a type of eustress or a type of distress (the negative form of stress).

For example, if you are given a large workload that you would usually find interesting and challenging, but you are fighting an illness at the same time, you will probably find the workload more of a distress rather than a eustress.

Still, with a little bit of practice, you can find ways of managing stress so you can turn it into eustress. You should also learn to get the support you need when you are in distress. It is wise to develop a sensitivity to when eustress is about to turn into distress, and where your limits lie, so that you do not begin to suffer from chronic stress.

Chronic stress is the biggest factor in Adrenal Fatigue Syndrome (AFS) and the dysregulation of the NeuroEndoMetabolic (NEM) Stress Response, a situation that is much more widespread than most think.

But we must also consider that, just by living in these modern times where stress is pretty much baked into daily life, most of us do end up with a fair share of chronic stress at some point. The only option you truly have for preventing or lessening its damaging effects is to learn a skill set for managing stress.

The Science of Managing Stress

Many recent studies confirm the idea that how you react to stress may play a more important role in your overall stress level than how frequently you face stressors. One study that measured people’s reactions to stress found that those who managed to maintain a more positive attitude when faced with stress had lower levels of inflammation than those who did not.

Keeping calm and managing stressInflammation caused by stress has several markers. With inflammation, we see a rise in inflammatory markers such as c-peptides, c-reactive protein (CRP), and homocysteine levels. C-peptides levels are also a marker for how much insulin is in the blood and can help determine whether you have insulin resistance, or type 1 or type 2 diabetes. CRP can help determine how much inflammation is present in your system as a result of an infection or an inflammatory disease (like lupus or cancer, for example). And homocysteine levels are also markers of cardiovascular risk as well as vitamin B6 and B12 deficiency. All part of the inflammation response, these markers also indicate issues with other areas of the body caused by stress.

Just like stress, not all inflammation is bad overall. It’s actually part of a healthy and vital immune response to help the body fight harm. The inflammation response is one of the NEM’s six circuits that work together to fight stress, the others being the metabolism, hormone, cardionomic, neuroaffect, and detoxification responses.

You cannot maintain health and well-being without a strong immune system, and inflammation is a key part in immunity. It is only when inflammation is consistently high that you will start to run into trouble. Chronic inflammation is the root cause of many chronic diseases, including autoimmune conditions, heart disease, obesity, and even cancer.

But thankfully, recent findings have highlighted the importance of what is called “positive affect” in stress – the role of positive emotions and reactions in managing stress. This positive affect appears to help prevent and reduce stress-induced inflammation.

According to researchers at Penn State, people who have a hard time regulating their emotional responses may be at a higher risk for cardiovascular disease, cognitive decline, and frailty in old age.

In one study, they interviewed 872 people for eight days in a row. These people were asked to rate their emotions, whether positive or negative, and whether they encountered stressors that day. They also had their blood samples taken. The researchers were then able to calculate the “reactivity scores” for each of the participants and used these scores to try to predict two inflammation markers.

What’s also very interesting and new about this study is that they used different stressors than what was traditionally used in lab studies; they considered daily stressors instead of chronic or lab-based acute stress. These daily stressors ranged from arguments to discrimination. That helped show a more realistic picture of what average people naturally encounter.

Their work is the first to show the link between inflammatory biomarkers and positive affect, and the results are promising. The findings confirm the need for developing skills for managing stress.

Stress and Adrenal Hormones

On top of these new findings, researchers have known for a long time that there are direct hormonal links to how your body reacts to stress. Other than the inflammation biomarkers discussed above, there are immediate changes in the physiology of the body that can be observed and tested.

How cortisol is used in managing stressOne major change involves levels of the adrenal hormones, of which there are over 50. But it is especially so with cortisol, the body’s main anti-stress hormone. Cortisol has important roles such as regulating blood pressure and blood sugar levels, maintaining heart and blood vessel function, and suppressing the immune system and neutralizing inflammation.

For a healthy individual, cortisol rises and falls according to a natural rhythm. It is higher early in the morning to help you wake up and get your day started, and it is lower at bedtime. It also rises and falls according to when and what you eat, when and how much you sleep, and many other factors.

As with all hormones, maintaining a delicate balance is essential for the health of the entire system, and any imbalance in one hormonal axis can cause a domino effect in many other hormones.

Cortisol is part of the hypothalamic-pituitary-adrenal (HPA) axis, which acts as a hormone cascade, beginning with a signal from the brain that stimulates the adrenals to secrete more cortisol. Once the job is done, any excess cortisol then signals the control centers in the brain to stop their stimulatory action.

However, when faced with consistent levels of stress, or if your body is not managing stress well, you might begin to experience symptoms of AFS. Your adrenals become overworked, trying to produce more and more cortisol to deal with the stress, and at some point, they dysregulate and become exhausted, and their cortisol output drops.

Other adrenal hormones that help in managing stress include adrenaline and norepinephrine, the “fight or flight” hormones whose dysregulation can create a host of symptoms like heart palpitations, anxiety, fast resting heart rate, sweating, shallow breathing, and more.

Symptoms of adrenal fatigue include tiredness, weight issues, sleep disruptions, mood disturbances, fertility problems, food and drug sensitivities, lowered immunity, lower libido, hypoglycemia, and more.

Also, without proper cortisol levels, inflammation can increase, since cortisol helps neutralize inflammation.

This is especially the case for women, who are at a higher risk of inflammation. That is mainly because women’s health is highly dependent on hormonal balance. Sex hormones like progesterone and estrogen are linked to inflammation, and this is why we often see chronic inflammation accompanying important hormonal transitions in women’s lives, such as pregnancy and menopause.

So, if you are a woman and you are in, or about to enter into, a key hormonal transition, you might want to keep an eye on your diet, stress levels, and environmental toxins. You might also want to get checked for inflammatory biomarkers to check for inflammation. The same goes for anyone whose health is not so good.

Lowering Inflammation and Managing Stress

Much has been said about the role of diet and exercise in lowering inflammation. And they are definitely very important aspects of a holistic approach to health. The anti-inflammatory diet is one of the best things you can implement in your life to reduce your risk for inflammation and chronic illnesses.

Weight loss while managing stressKeeping your weight in a healthy range, quitting smoking, reducing alcohol consumption, and exercising are also vital. But none of these changes will be deep and sustainable enough if you do not also make managing stress levels a priority in your life.

This is actually good news because learning a few different methods for managing stress can greatly enhance not just your physical health, but also your quality life and psychological state.

The first step in managing stress is being aware of it. Many of us have become so accustomed to consistently high levels of stress that it has become the norm in our lives. We are unaware that it’s actually not meant to be this way, until perhaps we go on vacation and feel the difference.

If this sounds like you, consider all the minute stresses you are constantly encountering. If you live in a big city, your body may see some of its features as stressors while your mind tunes them out. These can include traffic, noise pollution, air pollution, overstimulation, being exposed to ads and news that makes you feel anxious, dealing with other stressed-out people, the fast pace of life, feeling unsafe in your neighborhood, etc.

But having lived like this for years, or decades, you might not even notice how your body reacts to these stressors. Your “fight or flight” response may be triggered so often that it feels like a part of normal life.

Other stressors you might not be aware of include food sensitivities such as gluten and dairy (that cause inflammation and leaks in your gut), dehydration (most people don’t drink enough water), poor sleep quality or not getting enough sleep, and living a sedentary lifestyle.

Of course, the usual suspects are also at work but may also have become so habitual that you barely recognize them anymore. These can include working overtime, having impossible expectations of yourself, caring for an older parent or children, financial stress, relationship problems, dealing with a difficult boss, managing a longstanding illness, and enduring long commutes.

Once you have a good idea of the different stresses you are facing consistently, it’s time to categorize them. Think about ways you can reduce or avoid some stressors, or calm yourself down with soothing activities afterward.

Are there some stressors that you can avoid completely? For example, if you are gluten sensitive, going gluten free can be one of the best things you can do, not just for your body, but for your mental state too. Many studies have now shown that the health of the gastrointestinal tract can influence mood and cognitive function.

Learning to say NO while managing stressAnother thing you can do is learning to say “no” to requests or invitations that you really don’t want to accept. This is very hard for some people, and if you fear disappointing or hurting others, you will probably struggle with this a lot. But with a little bit of practice, not only will you get used to it, but the people in your life that care about your well being will get used to it as well.

With regards to stressors that you cannot avoid altogether, you can begin training your reaction to them. This is the holy grail of managing stress.

Eustress and Positive Affect

The way you react to stress is a learned behavior. It is something you picked up from those around you, like parents, siblings, relatives, babysitters, teachers, and friends when you were growing up. This means that you can unlearn any negative reaction and learn a new, healthier one.

One of the best ways to do this is to list those you know that do have this positive affect, this ability to turn stress into eustress. Once you have someone in mind and how they react when faced with a difficult situation, emulate them.

It also helps to create a gap between the stressor and your reaction. This gives you time to reflect on how you want to react, rather than rely on learned mechanisms. In general, when you are learning a new behavior, you can default into old patterns when you’re in a less-than-optimal state. So creating that gap is one way to ensure you persevere with the new habit rather than fall off the wagon.

Of course, if you are suffering from serious psychological pressure, you might want to consider more than just what was outlined above. Find a good therapist, talk with nonjudgmental friends and family, meditate, journal, or engage in spiritual or creative practices.

If you have AFS, you will want to improve the health of your adrenals, because weak adrenals make it much harder to cope with stress. If you are in more advanced stages of AFS, you might find even the smallest stressor too much for your system to handle. In this case, you will want to start with adrenal breathing exercises.

Practice deep breathing from the diaphragm, but don’t fill your lungs to over 80% capacity or hold your breath. Do this daily. Adding a few simple and easy stretches can also help, as exercise is known to be great for managing stress.

Pushing your body to the next level after managing stressOnce you’re feeling a little better, the next phase is to increase muscle tone and strength, and, finally, when you feel strong enough, you can do adrenal yoga exercises and work up to aerobic training.

As with any big health or lifestyle changes, you want to go slowly so you don’t add to your stress levels. This is especially the case if you are in a very weak or fragile state. For example, cutting out coffee is normally a good step towards adopting an anti-inflammatory diet, but going cold turkey while you have advanced AFS may actually lead to crashes.

Even if you’re in relatively good health, going overboard with exercise can lead to injury, nausea, and exhaustion. You want to have a long-term perspective, where you gradually build up to an optimal routine that includes diet, exercise, and managing stress.

© Copyright 2017 Michael Lam, M.D. All Rights Reserved.


Dr. Lam’s Key Question

No one can avoid stress, and without stress, you can’t grow and learn. But the great thing is that you can turn stress into an opportunity to train your mind to react in a positive way that will support your health and happiness. That is the secret in managing stress.


Managing stress