Practitioner perspectives on coping with stress

Photo Cred: Edward Jenner/Pexels

By Laura Rokosz, PhD

My internal radar was activated in January when I went back to school to earn my certification in dietetics. The much younger student sitting next to me quietly went into his backpack and subsequently donned a facemask. What subsequently unfolded over the next two months was unpredictable.

So here we are and the United States now have more confirmed cases of coronavirus (COVID-19) than any other location in the world. Now that I am sequestered at home, seeing patients virtually along with taking and teaching classes online, I have been thinking about the many consequences, good and bad, of this pandemic. The first outcome that comes to mind is the effect of long-term stress. Some stress can be beneficial, but prolonged bouts not so much.

Stress hormones are produced from the adrenal glands, which are tiny appendages that sit on top of the kidneys. When someone is in danger, the adrenals produce adrenaline, or epinephrine, and norepinephrine. These hormones are part of the immediate stress response that creates a surge of energy, increased heart rate, increased focus, and a shift of blood flow to muscles, where it is needed most.

Cortisol is a stress hormone that the effects of are not immediate. This is the hormone that gets us moving in the morning. Levels drop substantially by the early afternoon. Coffee stimulates cortisol production, so it is best to have that first cup of java a few hours after waking up when cortisol levels are declining. Low levels of cortisol are associated with brain fog, depression, low blood sugar, and cravings for comfort foods.

If we allow the unknow prospect of COVID-19 to burden us continuously, then cortisol will cease to function as it should. We basically become “cortisol resistant,” which can also increase risk of depression.

Chronically elevated cortisol levels correlate with increased risk of chronic diseases such as heart disease, diabetes, and obesity. Some of this is due to lack of appetite control. When cortisol levels are too low or too high, we crave sugar and salt. Comfort foods are not called “comfort food” simply because they taste good. These foods help to regulate cortisol levels, and subsequently our ability to adapt to stress. While weight gain is never good for heart health, it has been reported that feeling anxious and stressed is linked with a 27 percent higher risk of heart attack, the same effect smoking five cigarettes a day. Those among us with type A personalities and the need for control are also at an increased risk of stroke.

The most concerning issue regarding chronic stress is the impact it has on the immune system. Chronically elevated cortisol levels impair the body’s ability to neutralize inflammation. This weakens the immune system, putting the individual at increased risk of chronic infection.

We should also consider the effect chronic stress is having on children. The current generation is already at risk of not outliving their parents. Chronic stress increases the aging process, which could amplify this prediction and impact the health of future generations.

Chronic exposure to cortisol is known to alter gene expression creating genetic “marks” that can be inherited. These epigenetic changes take multiple generations to correct provided there is an improvement in diet and lifestyle.

Finally, stress and diet have a direct impact on the gut microbiome. The beneficial bacteria that reside in the digestive tract do not thrive on comfort food. They prefer prebiotic foods that are high in fiber and resistent starch, such as leafy greens, oats, and legumes. When these friendly bacteria are well fed, they help regulate production of stress hormones, serotonin (the feel-good hormone), and dopamine.  

To help us through these times of uncertainty, here is my practitioner’s guide for dealing with stress:

1. Get seven to eight hours of sleep each night.
2. Stay hydrated and drink half your body weight in fluid ounces of any non-alcoholic beverage each day.
3. Exercise daily. This does not need to be rigorous but should avoid long bouts of sitting.
4. Alleviate stress with deep breathing or meditation.
5. Avoid weight gain with small meals spaced four hours apart.
6. Focus on immune-boosting foods high in vitamin C and other antioxidants, like fruits and vegetables. Include prebiotic foods to support the microbiome.
7. Replace bad fats from red and cured meats with good fats from fish, nuts, and seeds.
8. If health is less than optimal, make an appointment with a healthcare practitioner. Most providers are using telemedicine services to administer virtual support to their patients.

References

Aziz, Q., Doré, J., Emmanuel, A., Guarner, F., and Quigley, E. M. M. (2013) Gut microbiota and gastrointestinal health: Current concepts and future directions. Gastroenterology and Motility. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/23279728

Cohen, S., Janicki-Deverts, D., Doyle, W.J., Miller, G.E., Frank, E., Rabin, B.S., and Turner, R.B. (2012) Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proceedings of the National Academy of Sciences. Retrieved from : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341031

Garcez, A., Leite, H.M., Weiderpass, E., Paniz, V.M.V., Watte, G., Canuto, R., and Olinto, M.T.A. (2018) Basal cortisol levels and metabolic syndrome: A systematic review and meta-analysis of observational studies. Psychoneuroendocrinology. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/29800780

Murray, R. (2012) Work-related stress increases risk of heart attacks and deaths from coronary heart disease: study. New York Daily News. Retrieved from: https://bit.ly/2JGB3H7

Palma-Gudiel. H., Fañanás, L., Horvath, S. and Zannas, A.S. (2020) Psychosocial stress and epigenetic aging. International Review of Neurobiology. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/32204828

About the Author 

Laura Rokosz, PhD

Laura Rokosz is a pharmacologist and food scientist with 28 years of experience in the pharmaceutical and biotechnology industries. She received her Bachelor’s, Master’s and PhD in Food Science from Rutgers University and is the current Chair of the Rutgers Food Science Advisory Board.

Rokosz was employed with Schering-Plough, Merck, and Pharmacopeia where she supported drug discovery efforts related to metabolic diseases, Infectious disease, autoimmune disorders, Alzheimer’s disease, and cancer. She is the author of over 40 peer-reviewed journal articles including five expert opinion articles on obesity and cancer. Several her blogs on fitness and nutrition have recently been published on the syndicated website, Mind Body Green. Rokosz is currently the owner of EGGLROCK Nutrition, LLC, an integrative healthcare practice providing dietary and lifestyle guidance for disease prevention and health maintenance. EGGLRock Nutrition recently received the Rising Growth Success Award from the Small Business Development Center at Kean University and was named Business of the Year for 2016 by the Union Chamber of Commerce.

Rokosz also teaches a variety of nutrition courses at Kean University, Rutgers University, and Stevens Institute of Technology and she teaches group fitness classes at the Gateway Family YMCA of Union, New Jersey. She also hosts a weekly podcast, “Eat Right with Laura” which can be found on her website at www.egglrock.com.