Amina Altay always prided herself on her drive and strength. Ms. Altai, 39, just thought it was because of working long hours in her marketing job. So she started writing reminders to keep herself going. But then her hair started falling out, she gained and lost a lot of weight, and she had gastrointestinal problems.
Mrs. AlTai was sure something was wrong. But the first six doctors she saw didn’t take her seriously, she said. Some told her she had so much hair that a little loss shouldn’t be a problem. Many seemed healthy, and simply dismissed her symptoms as anxiety. When another doctor ordered blood tests, Ms. Altai was diagnosed with Hashimoto’s disease and celiac disease, two autoimmune conditions that can affect the thyroid and small intestine.
“They called me and told me not to go to work. Go to the hospital instead, because it’s days away from multiple organ failure,” Ms. Altai recalled. The two chronic illnesses had maxed out her ability to regulate hormones and absorb vital vitamins and nutrients.
Scientists now know that stress is closely linked to many chronic diseases: it can cause immune changes and inflammation in the body, which can worsen the symptoms of diseases such as asthma, heart disease, arthritis, lupus and inflammatory bowel disease. Meanwhile, many stress-related issues—headaches, heartburn, blood pressure problems, mood swings—can also be symptoms of chronic diseases.
For doctors and patients, this overlap can be confusing: Is stress the sole cause of a person’s symptoms, or is there something more serious at play?
“Separation is very difficult,” says Scott Russo, director of the Center for Brain-Body Research at the Icahn School of Medicine at Mount Sinai.
How stress triggers chronic disease
Stress triggers the natural fight or flight response. When we face a threat blood pressure And heart rate increases, muscles tense and concentrates blood sugar so it’s easier for the body to respond quickly, says Dr. Charles Hatemer, MD, a cardiologist at the University of Cincinnati.
If people are under stress for weeks or months, their bodies can’t keep up with other functions, causing symptoms like forgetfulness, fatigue, and trouble sleeping. Stress hormones such as adrenaline and cortisol can significantly increase blood pressure. Increasing the stock of plasticThis can damage the heart over time, Dr. Hatmer said.
There are also indications that stress can cause the immune system to overwork and lead to inflammation. In a study of 186 patients in Italy, researchers found that 67 percent were adults Celiac disease He had a stressful life event before his diagnosis.
Recently, Dr. Russo and his colleagues showed that in two studies of depressed rats High levels of neutrophilsIt causes inflammation and the few T cells and B cells in the blood can produce antibodies or kill virus-infected cells.
He and his colleagues were attended by patients Major depression There was a similar imbalance in immune cells compared to healthy controls. Researchers believe the body changes the makeup of immune cells circulating in the bloodstream to reduce damage caused by infection or severe stress, Dr. Russo said.
However, when faced with chronic stress, the body sometimes cannot “shut down the immune system,” says Dr. Russo.
Prolonged periods of stress can put people on the brink of illness because of genetic predisposition, exposure to chemicals, air pollution, or viral infections.
Lynn DeGitz, 56, has spent years battling on-and-off serious infections. She once thought she had mono. Another time she was sure it was bronchitis. Neither she nor her doctors thought it might be chronic.
Then she started a new, high-stress job and started experiencing fevers, swollen joints, and fatigue almost every day. “I had an interesting and demanding job, so I kept going,” Ms. Degitz said. “I only use short-term disability to recover, or I use my time off to recover when I need it.”
After more than two years of going to doctor’s appointments and trying treatments that ultimately didn’t help, Ms. DeGits was diagnosed with a form of arthritis known as Steele’s disease. Doctors do not know the exact cause, however Research It is beginning to be suggested that it may be a combination of factors, including abnormal responses to infections and stress.
“We all have physical ailments and weaknesses,” said Dr. Russo. “Stress only exploits these and makes them worse.”
When symptoms are a source of anxiety
For patients with chronic pain, the same stressors that trigger their symptoms make it difficult to manage their condition.
And some doctors don’t always appreciate how difficult it is to manage stress, especially when they’re in pain. When Teresa Rhodes was first diagnosed with rheumatoid arthritis decades ago, a doctor suggested she do more exercise to reduce stress and strengthen her joints.
“The symptoms themselves were distressing,” says Mrs. Rhodes, now 66. “It’s hard to exercise when you’re so tired. It was only after the other stresses in her life lifted – her children were grown and she left a difficult marriage – that she was able to get enough rest and finally start working again.
Many doctors are not trained to ask about the sources of stress or to advise patients about the effects of stress, says Alice Bedell, MD, who specializes in how stress affects digestive health at UChicago Medicine. In the year A 2015 study of more than 30,000 patient visits to doctors’ offices found that primary care physicians only counseled patients on stress management. 3 percent Visits.
When Stephanie Torres’ 12-year-old son, Nico, was diagnosed with Crohn’s disease, she was surprised to hear that the gastroenterologist thought it was the family’s responsibility to manage the stress that triggered his symptoms. “Her response to me was basically, ‘This is your problem. He said to him, “Untie yourself and go.”
Instead of just suggesting that patients reduce sources of stress, doctors can work with them on small ways to manage stress every day, he said. Once Ms. Altai was diagnosed and started taking medication for both of her illnesses, she felt comfortable making the dietary changes needed to address the nutrient deficiencies caused by her illnesses. She started taking regular walks and meditating in the morning.
Ms. Altai said she eventually quit her marketing job and became a head coach, allowing her to set her own schedule. Hospitalization and two chronic illnesses made her realize that these changes were necessary.
“I call it my stopwatch, because it literally stops me in my tracks,” she said. “I had to really reassess my relationship with work and success and stress.”