Stress and Inflammation

"It's just stress."  

How often have we said those words and moved on? 

But what if stress is far more than a feeling, or something we need to manage? Nearly 70% of doctor visits are thought to be connected to stress, yet there's no magic pill to make it disappear. 

After twenty years in practice, I've learned that stress looks different for everyone. For one person, it may show up as restless sleep. For another, digestive issues, fatigue, headaches, brain fog, or simply feeling like they're running on empty. 

Stress isn't just something you feel. It's something your body experiences. Let’s dive deeper. 

Short-Term Versus Chronic Stress 

Short-term stress, from a physiological standpoint, can be beneficial for the body. It’s an adaptive response that can temporarily improve performance and help the body respond to a challenge.  

When the brain registers stress, the sympathetic nervous system responds within seconds, producing a surge in noradrenaline and adrenaline, followed shortly after by cortisol release. In the first minutes to hours, these physiologic changes can be beneficial, leading to increased alertness and focus. The increased heart rate and blood pressure help deliver more oxygen and nutrients to peripheral tissues. Immune defenses may temporarily ramp up, helping combat injury or infection and allowing healing. 

Repeated, manageable challenges followed by proper recovery can make the body more resilient and better able to handle future challenges. Exercise is a prime example of a short-term physiological stressor. During and immediately after exercise, stress hormones can increase, and exercise may appear "inflammatory." However, this type of stress is a signal for adaptation. During recovery, the body increases mitochondrial capacity, improves insulin sensitivity, and repairs muscle. The body is now stronger, more resilient, and better prepared for the next challenge, or stressor. This type of adaptive response is fundamentally designed for survival and growth. 

Potential problems arise when stress becomes chronic. This is where the body can shift from an adaptive physiologic response toward chronic inflammation and metabolic dysfunction. The issue is not stress itself but rather the inability to shut it off. Think of every ongoing worry, looming deadline, or conflict that stays "in your head." Modern life and the digital age rarely allow time for the "off" switch. This may result in poor sleep, weight gain, loneliness, chronic pain, irritable bowel syndrome, brain fog, insomnia, headaches, and anxiety. The stress response stays activated, leading to increased circulation of pro-inflammatory molecules. 

Understanding Cortisol 

A healthy cortisol cycle follows the circadian rhythm. Cortisol begins to rise before you wake up and usually increases further during the first 30–45 minutes of your day. This cortisol awakening response helps prepare us for the day ahead by increasing alertness and energy.  

Cortisol then gradually declines during the day, although exercise, stressors, and meals may cause brief rises. By evening, cortisol should generally be low, helping the body relax into sleep. It usually reaches its nadir around midnight to 2 or 3 a.m., then starts rising again in the early morning hours to prepare for waking. 

With chronic stress, cortisol can become dysregulated in a number of ways, including different ways in the same person over time. Dysregulated cortisol can present as an exaggerated or diminished awakening response, a blunted cortisol response to new physiologic stressors, a flattened daytime slope, or higher-than-expected evening cortisol.  

The timing and amplitude of the curve matter, not just the number. Normally, cortisol helps limit inflammatory signaling and turns inflammation "off" through glucocorticoid receptors. However, prolonged exposure to stress can make immune cells less responsive to cortisol. This can result in the body staying in a prolonged state of inflammation and metabolic dysregulation, thus leading to a multitude of symptoms and chronic disease. 

Ways to Prevent Stress 

If only I had all the answers to this. But a good place to begin is by learning your body: what occupies your mind? How does that affect your body? Once you identify and understand your stressors, or triggers, you can begin considering ways to manage them. 

Adequate sleep is a priority, as things almost certainly feel more daunting when sleep is chronic and nonrestorative. Physical movement, even brief bursts of 1–2 minutes of activity throughout the day, can help reduce stress. A healthy, anti-inflammatory diet can reduce the body's inflammatory and metabolic burden.  

Simple practices like breathwork, humming, and singing may help stimulate the parasympathetic nervous system and promote relaxation. Time in nature, positive social connections, and laughter often promote a calmer state of mind.  

Although we may not be able to eliminate stress from our lives, we can understand its impact and strengthen our ability to recover from it.