Stress Expert Dr Lavinia Ionita Explains How to Measure and Treat Stress
Stress: It is on the political agenda, health and wellness experts regularly blog about iT BuT HOW DO WE MEASURE IT?
Dr Lavinia Ionita
According to the World Health Organisation (WHO), the new epidemic of the century is not Ebola but stress. But even with all the talking one thing remains unclear; What is stress, exactly? Dr Lavinia Ionita, doctor, entrepreneur and contributing writer at Dosage explains.
What is stress?
There is a lot of confusion concerning the concept of stress. One reason for this is that stress is usually experienced differently from person to person. Today stress is often linked to something negative: insomnia, anxiety, burnout, divorce and the list continues. Stress is supposed to make you ill. Yet stress is a natural and essential part of life, and it can be positive. Stress can make you fly.
Animals and humans alike experience stress, but the triggers are often different
Stress is a succession of physiological mechanisms designed to help you react to external stimuli — a change in your surroundings, a mad dog, a difficult situation at work. When a zebra develops stress because a lion is about to attack, that stress will be lifesaving for the animal, the instant change in hormones in its body that follow will make it run quicker and have a bigger chance of escaping the predator.
Survival or not will depend on this initial stress response. Either way, the stress will be over shortly. That’s why biologist and neuroendocrinologist Robert Sapolsky wrote the book Zebras Don’t Get Ulcers. In the animal kingdom, stress doesn’t last: it appears only when needed and fades once the situation is over.
We needed stress to survive evolution
In many ways, you could say that we would not be here as a species without stress. But the machinery intended to defend us against impending danger turns itself against us when it becomes a chronic condition. There are very few situations where stress is triggered to save our life. Instead, it is caused by being stuck in traffic, being late for a meeting, or because we foresee a trying dialogue with our boss. Today a lot of stress is related to anticipating uncomfortable events or outcomes in the future, as supposed to an actual threat.
It was not difficult to discover the relationship between tobacco and lung cancer or alcohol and liver damage. Regarding stress, it’s less straightforward to understand what’s going on. It’s an experience that is not very well described or understood by health professionals today.
The history of stress
The concept of stress emerged at the beginning of the last century. Walter Bradford Cannon is one of the first experts to be credited for developing the science of stress. He was the first to see that all patients share a common feature: they develop non-specific reactions to stimuli. He is responsible for describing the “Flight or Fight Response” as well as adjusting the concept of homeostasis, which is one of the core principles in biology. Homeostasis can be described as a state of stable internal physical and chemical conditions sustained by living organisms. The main homeostatic systems in our bodies are temperature, blood sugar level and many more. The regulation processes are complex and sophisticated with various feedback loops (a bit like a thermostat will maintain an even temperature in your house). This complex system includes multiple hormones, including the stress hormones adrenaline and cortisol.
The first stress experiments
Research advanced in the 1930s thanks to a Hungarian endocrinologist called Hans Selye who is now viewed as a stress research forerunner. He conducted a series of trials on rats that he injected with ovarian extracts, and he caused the rats to be tremendously stressed. He was sure he had made a great hormone-related discovery when he dissected them as the rats (that had been injected with hormones) had developed ulcers, had bloated suprarenal glands and a weakened immune system.
Subsequently, he carried out another experiment with a control group (injected with saline water). To his big surprise, both groups showed the same physiological modifications (ulcers, etc.).
He asked himself what did all these rats have in common? Hans Selye felt there was more to explore in this case, and he piloted another round of experiments, where one group of rats were exposed to very cold temperatures and another one to very hot temperatures. The experiment showed the same results: That’s when he comprehended that he had made an important finding. This was to become the groundwork of all future stress research. After his discovering the term stress started to be used commonly.
Understanding stress today
Today we understand stress better. We know the physiological pathways of stress after decades of research. We know there are actual physiological changes related to stress. But we still are not sure what to do about it, and we are only beginning to understand the severity and the amount of damage it can do to our body.
Objectifying stress – how can we categorize it?
From a medical view, there are a bunch of specific key biological indicators that can be used to evaluate the stress level and enables us to objectify stress and the impact it has on our physical wellbeing. Many times, there can be a dangerous gap between the way we see our stress and the real effect it has on our body. This gap in itself poses a significant threat to our health and wellbeing. You can mentally adapt to stress to the degree that you do not notice it, and yet it can still be highly physically harming. There are a variety of measurements that can be rapidly and easily taken to objectify stress
• The primary stress hormone is cortisol. You can easily measure cortisol by taking several saliva samples at different times of the day and thereby following the curve of daily secretion. A “normal” secretion curve has a peak of secretion in the beginning of the day, then a plateau and then a fall at the end of the day. Usually, the cortisol level follows your rhythm of work and rest. If you have a high cortisol secretion in the evening you will very likely experience sleeping problems. On the other hand, if the cortisol secretion is too high in the morning it can be advisable to incorporate a small meditation practice into your morning routine (rather than a running or boxing session, for example, that raises your cortisol levels). Paradoxically, if the secretion is low at all times, it is a good indicator of burnout. When the body can no longer secrete the hormone that makes you able to deal with long-lasting stress you have depleted your physical resources. The measure of cortisol secretion is a crucial source to objectify stress.
• Then there’s DHEA that prevents some of the negative effects of cortisol. The two hormones work hand in hand. DHEA is another important indicator.
• We also have biological markers like serotonin and dopamine and lastly adrenaline and noradrenaline; the catecholamine neurotransmitters whose presence in the blood increase when we are under stress. During sport and physical activity, catecholamines stimulate a sequence of physiological modifications (increased heart rate, blood pressure and blood sugar). Catecholamines enable you to react to imminent threats. Adrenaline will make us run quicker, which can be lifesaving if you encounter a predator. But this comes at a cost; the extra energy can only be mobilised because all the other functions of the body are bypassed. It does not serve the body to be dealing with digestion or immune function when challenged with the option of facing death? It makes sense that everything else has to be abandoned.
Physical, mental and emotional signs of stress
The highly important mechanism of stress is not meant always to be switched on. It’s not sustainable long term because it would use too much energy in the body. I think everybody would like to have wings all the time and be able always to perform your best, but it simply does not work like that. Being under chronic stress increases the risk of developing ulcers and hypertension, you might lose your libido or suffer memory losses and finally, depression. To simplify it; when under too much stress, your brain starts to shrink!
Some people believe that the more time and energy you devote to your work, the better the result. But that’s not always true.
Often less is more when it comes to working. You will have more energy and be more creative if you allow yourself to rest and have breaks and time to recharge your batteries. We need to start living in a less stressful way.
Work is one of the most significant reasons people are stressed today.
When you look at some statistics, it appears that 40% of people say they are feeling stressed at work. But this is self-reported and what people say when asked directly. Commonly, people do not believe themselves to be under stress, yet they deal with sleeping problems or stomach aches that are often associated with a stressful lifestyle.
Even though stress is not a stigmatised condition and theoretically there should be no difference between what people say and the reality, there is, in fact, some conscious or unconscious resistance to admitting you are feeling stressed. The people who run the corporate world will be hesitant to admit in public to being stressed. Silence and denial are common. Some people are sure they are not stressed because the stress symptoms they encounter are to them no signs of stress but part of their personality; This is the way I am! It’s rarely objectively measured. Blood sugar gets measured more often than cortisol, and yet many more people are dealing with stress than with diabetes.
General tips for companies to reduce stress at the work-place
I want to mention three essential factors.
1. The first is a good recruitment process. People who fit the company will not suffer from stress to the same degree. Overwork and unrealistic deadlines are often also a question of recruitment. And someone who feels they get too little responsibility at work can also be stressed as a result. I did not say it was easy, but moderation is the key.
2. The second thing is the management structure in a company. When employees are confident to take risks because fiasco is accepted, it will also lead to less stress and more innovation.
3. Lastly, I would like to mention the importance of the work environment. Many companies today encourage physical activity like yoga or running, or they have meditation rooms and healthy canteens to keep their employees healthy and happy. Perhaps in the future, companies will offer their employees more tools to combat stress by providing them with the possibility to measure and objectify their stress.
Looking at stress in a groundbreaking way
Akesio, the startup I have grown offers to measure the biological indicators of stress and based on those tests, we propose a personalised stress management program. This includes lifestyle recommendations, dietary supplements based on blood test and nutritional and other advice. This is the same as I do in my clinic as a doctor, but now you do not have to come and see me, and I can reach more people.
The symptoms I often encounter in my patients are indeed exhaustion, headaches, skin problems, digestion issues, overweight, sleep problems, depression and memory loss. These can all be related to stress, which has an impact on so many conditions. Sadly you can only help so many people face-to-face as a doctor, but with this startup, my goal is to help more people be empowered to make good choices regarding their health and their lifestyle. I believe that empowerment comes with the right tools and data to make the right choices.