E66: The Physical Domain of Stress

Kirtly: Katie, welcome back.

Katie: Yes. I have been traveling for a while, and so I've left you alone for the 7 Domains of Stuff, but I am excited to be back and talk about the 7 Domains of Stress. Are we working our way down the alphabet?

Kirtly: Not quite, but that was going to be . . . It's great though.

Katie: So, anyway, I'm excited to be back and talking about stress, which is something we all deal with.

Again, by way of introduction, I'm a professor in the College of Nursing, and a practicing nurse practitioner with a clinical practice in women's health at the University of Utah. And I am co-hosting the 7 Domains of Women's Health podcast again with Dr. Kirtly Jones. Kirtly Jones is a reproductive endocrinologist with the University of Utah.

And as always, the format for these podcasts on the "7 Domains of Women's Health" is to take one topic, in this case it's going to be stress, and look at it from the physical domain, the social domain, emotional, intellectual, environmental, financial, and spiritual domains. Breaking it up in this way gives us a frame of reference that allows us to really do some deep exploration.

Today, we're going to start with the physical domain of stress. In other words, what is stress doing to our bodies?

Stress is certainly something that I think all of us talk about and we sort of . . . it's just this one thing, "stress." But I'm going to ask us today to really start to break down thinking about the things that stress us, the stressors, and our stress response.

So, in anthropology, we often look at what we call a mismatch between our current circumstances as modern humans living in a fast-paced urban world, and the environment our ancestors evolved in, and the systems that helped keep us alive in a very different environment.

For example, in the past, it was probably really good to be excellent at storing fat in case the food was scarce and famines were common, but in this day and age, being really good at fat storage isn't quite as helpful because food is plentiful and it doesn't take much effort to acquire it.

So when we talk about stress, it's kind of a similar thing where we have a stress response that likely saved every single one of our ancestors at some point in time.

As I mentioned, I've been gone for a while, and I was spending a lot of time outdoors touring old archeological sites and thinking about this a lot, that if you were living in these harsh circumstances and you were actually being chased by wild animals, lions and saber-toothed tigers and things, you needed a really strong stress response that allowed you to respond quickly if, say, a saber-toothed tiger jumped out of the bush.

And so we have the system that acts really quickly that releases adrenaline immediately, and that raises your heart rate and your blood pressure, and you release cortisol that raises your blood sugar, and the goal of all these things is to push blood to your muscles so that you can run away.

So I think we've all had this experience where, say, you miss getting into a car accident, and you have that feeling that your life passes before your eyes, time slows down, and you're focused on just that one narrow thing. In the past, running away from a saber-toothed tiger. For us, missing a car accident. And so your reflexes kind of happen in that instant. That is the stress response. It's designed for saving you from short-term things like saber-toothed tigers and car accidents.

For our ancestors, if it all worked right, they were able to run away, and either you got caught and died, or the threat passed and you ran back to the arms of your family and celebrated that you survived and got that relief. You had that chance to really breathe a sigh of relief and learn from that experience. You get the memory of where you saw that and what the warning signs were so that you can learn from it and save your life again when you see those same warning signs.

In the short-term things, that adrenaline goes away, the cortisol goes back down, and your body goes back to prioritizing the other things that it needs to do: digestion, fighting infection, growing, reproducing, all the other things that turn off in that instant when you're having that stress response.

But in the real world, in the world we live in, we have saber-toothed tigers everywhere, and all of us are dealing with kind of a constant low-grade stress response all the time.

Kirtly, do you have any stories about times when you've had a stress response like that?

Kirtly: Yeah. Well, certainly I've had the almost got run over by a truck kind of thing, or been hiking or skiing in the mountains and then being caught in a blizzard and then coming down and then feeling like everything tasted better. The world was brighter. For a while, I thought I was going to die on the mountain, but I didn't.

It's that whole amazing short-term process, and then the incredible release you get when you're back to normal again. You have some of the extra stress hormone with you that makes you feel very alive, and just everything is brighter, and everything is more wonderful when you come back to normal again.

Anyway, that's the goal for the stress response, and it's not just humans. Remember that if you have a dog or . . . Any animal that has an acute stress, they have the exact same response. They can quickly crank up their adrenaline, crank up their blood pressure, they're ready to fight or flight.

But like humans, the stress response, if it happens all the time, they can get sick too. So if you adopt a dog that's been particularly abused for a long period of time, those are hyperreactive dogs. They alert to everything. They are afraid of everything. They just can't calm down. So the things that happen to humans is not just human. It's built into the mammal system.

Katie: Right. And I think the thing you were talking about before of when it's over that you feel this sense of relief and things feel brighter and better, I think that's an important part of knowing if the stress you're experiencing is temporary and you get . . . An author I like describes it as completing the stress cycle. So there's that end of it. I sometimes seek out things where I experience an acute . . .

Kirtly: "Sometimes," Katie? You always seek out things. I think you're sort of a stress junkie or . . .

Katie: No, actually, it's . . .

Kirtly: You do amazing things, but you always come down to baseline.

Katie: But I will do things, and my friends joke because I talk about completing the stress cycle. So I will sometimes choose to go bungee jumping, for example.

Kirtly: Don't do that. I don't do that.

Katie: But I get the whole cycle of that. I do something frightening, I get the frightening feeling, but I get the, "Oh, wow. That was great."

So building in I think small, little completed stress cycles is probably good for us. It's probably the reason rollercoasters are fun, and that you go out and do those things so that you get that full circle experience.

Kirtly: Or we watch scary movies. Why do we watch scary movies? That just is crazy to me, but we watch scary movies, we get totally stressed out in the middle of the movie, and when it's over and our screen turns dark, we can say, "Wow, that was really cool. What's for dinner? What's for dessert? Where's my ice cream?"

Katie: Yeah, let's talk about ice cream. Well, we'll come back to ice cream in a minute, because I think there are lots of things that we do to manage our stress.

I think the unfortunate thing is the world we live in, we have a lot of stress that just doesn't go away. I almost, on a podcast about stress, hate to start listing them, but when you think about it, there's the climate, the air quality, and the wars going on, and inequality, politics, mass shootings, car accidents, mean angry people, unrealistic expectations, and mounting bills.

And I think the thing for me is not enough time. There are not enough hours in the day for all the things I feel like I need to do and want to do. I mean, the list just goes on and on. We can add in all kinds of other things.

But I think that's the problem for all of us, is that like the animal you talked about, we're living with this kind of chronic low-grade stress that doesn't get dealt with and it just is still there day after day after day.

And that's where I think understanding the difference between the things that are stressors and your body's stress response . . . That whole reaction that we just talked about with adrenaline and cortisol, that's what our bodies call the fight or flight system, or fight, flight, or freeze sometimes is the other thing that we'll do about that. If you're constantly in that state, then, like the dog you were talking about or lots of people, that starts to lead to real physical illness in humans.

Kirtly: It does.

Katie: So that long-term having your blood pressure raised and your heart rate up and your mind sort of hyper-focused on the things that are stressing you out, that's going to start to cause anxiety and depression and feeling truly burned out and disassociated from what you do.

And because of the way those hormones work in our body, their goal is to get you to run away from the danger, but that means you're not sending enough blood flow to your stomach for digestion, and so people end up with digestive problems and stomachaches, and headaches from the blood pressure, and muscle tension, and then high blood pressure and heart disease and insomnia. You're reprioritizing your sugar, so that can affect your weight, and you're not fighting infections. And so that low-grade stress really does make you sick.

Kirtly: It does. It does in the sense that chronically slightly elevated cortisol, which is part of this stress response, makes you store fat. And anybody who's taken prednisone, which is a steroid, it's like cortisol, for a long period of time know that they get fat. They gain weight.

I'm going to back up just a little bit because I think the brain has its own net with which it sorts out the world and decides what's stressful or what's not. When it decides something is stressful, it could be an acute stress, and we talked about a car accident, or a chronic stress, like a diet that's really low in calories, a starvation diet.

It sends a message to the hypothalamus, that part of the brain that's a hormonal gatekeeper, to send a message to the pituitary, and the pituitary sends out a long message to the body that includes endorphins.

So it was meant to help you deal with acute pain, but then it hangs around too long. And the message also goes to the adrenal gland to make cortisol, but then hangs around too long.

For people who are stressed chronically . . . and I use the food-restrictive diet just because it's such a great example in women with anorexia or any woman who goes on a crash diet and loses weight. That long-term message is sent and it turns off your ovaries. So it's not difficult to see women who have a very low body weight or who are acutely stressed all the time calorically, they stop ovulating.

There are reproductive systems, all those kinds of things that can affect your immune system adversely when stress is chronic. We don't come back to baseline, and it's pretty difficult. It's not good for you.

Katie: No.

Kirtly: So, in pregnancy, a woman who's chronically stressed during pregnancy sends levels of cortisol to her fetus, who is born with a reset for being chronically stressed. So these babies are born with higher levels of cortisol in their umbilical cord, and these babies have a cranked-up stress response. They're more irritable, they're less likely to calm down, they're more likely to have ADHD in childhood, they're more likely to have high blood pressure and cardiovascular disease when they grow up.

And I think the first studies on this were in Holocaust survivors, women who survived the Holocaust, but were forever traumatized by this and were always on edge. When they became pregnant, even though they weren't under stress at the time, that chronic memory . . . This is why PTSD is so harmful. Their babies were born more stressed.

And more recently during 9/11, women who witnessed, were in New York and who were pregnant were followed after their pregnancy. Their babies were born with higher levels of cortisol, and had an acute stress response. They just were harder to calm.

So it is a big deal for us to learn where our stressors are coming from, and how we can come back to baseline. Anyway, that's how I look at it.

Katie: It's such an important thing, and especially because there is a certain amount of stress in the world. Hopefully the Holocaust and 9/11 and things like that don't happen to many people, and maybe don't ever happen again, but just our day-to-day living, some of the lists we just talked about, those things are there and we do need to learn to manage what we can.

And I'm hoping that as we do this deep dive into these different domains, that within each domain we can look at some ways to think about what are those stressors and what . . . I'm going to go back to the serenity prayer a little bit here, but what are the things you can do around accepting the things that you can't change? And where can you make some changes to manage the stressors?

But I also want to talk a little bit about how you manage your stress response, because I think there are some tools that all of us can use that helps us manage that.

Kirtly: Well, I want to jump in here because I have a favorite book called "Man's Search for Meaning" by a psychiatrist named Viktor Frankl who survived the Holocaust. He wrote a book about how people survived this enormous, stressful, horrific episode in their lives, and he said, and I'm quoting here, "Between stimulus and response, there is a space. And in that space is our power to choose our response. In our response lies our growth and our freedom."

So when I think about raising kids, and as we're going to be talking about this as we go through the other domains, we need to help our children as 2-year-olds manage their response to stress of not getting their chocolate or not getting their strawberries when they want them.

I watched that meltdown in my own granddaughter. I was like, "No, you can't have your strawberries right now." But how do we get little ones to learn how to take a deep breath?

When I was watching the Olympics, I'd watch these women. I like women's gymnastics. Before they would do this very difficult routine, they would stand there and they would take a deep breath, and their cheeks would puff out. They were doing this breathing because they need to be ready, but they can be overstimulated and then they'll fall or they'll misjudge something. So they take this big deep breath before they start.

And that's what I want to tell everybody. That's what we all have been hearing now. "Take a deep breath."

Katie: That space between the stimulus and the response, and slowing that down for a minute and saying, "Okay. I'm recognizing the stimulus before I respond in my usual way, creating a little bit of space," and that creates a different outcome.

Kirtly: So you were talking about . . . I mean, we're going to talk about this in the social domain and the emotional domain, and we'll talk a little bit more about it, but as I think about our mutual friend, an anthropologist who spent a lot of time in Africa and in Indonesia, these are very difficult places to live in. There has been starvation all the time, but people hang out and they chit-chat with each other. It's a way of sitting around with people and talking about what's going on.

As we go into the other domains, we're going to be talking about how our social lives can help us or harm us in terms of our stress response.

Katie: Yeah. And then, Kirtly, we talked for a minute about fetal effects, but I think the other thing is each of us has different genetics, and that may affect how we respond to stress, our ability to deal with that. And then each of us has different life experiences and our maternal life experiences.

But I think we also want to think a little bit here about the construction of . . . we sometimes call them the social determinants of health. That's another thing too. If your mother was stressed and her mother was stressed and the impact that that multi-generational . . . Where you were born and what are the things in your environment and generations of stress, what does that do generation after generation after generation?

Kirtly: So we talk a little bit about genetics, but then there's epigenetics in the sense that when you've had chronic stress, you change the way your DNA works, and you change the way your fetus's DNA works. And in fact, even sperm can do this. So if you stress out a male rat, and there are cruel, meaning awful, ways to stress out a male rat, it turns out that his sperm are changed, and his offspring have some changes in their behavior. So I don't want to put all the burden on women, because it's men too.

Katie:Fair.

Kirtly:And I think it's meant to be if you're living in times of famine that go on 100 years or wars that go on forever, you need to be ready for the next bad thing. So it's good to change not your genes, those are harder to change, but the way your genes work that can be passed on.

But between the stress and the response, even if our genes have an exaggerated response for us, we have some ways, I think, that are useful to help us calm down, come down to baseline, whatever your baseline is. Come on down to someplace where you can live.

Katie: Well, my favorite way to close my stress cycle is to exercise. And so that is one tool that everybody has in their toolkit, is to get some kind of exercise. So all of that stress response is sort of designed to help you run away. Maybe running, but also walking or lifting weights or any other . . . biking, anything else that where you're taking advantage of that blood flow to your muscles and your heart rate, and you're using that, and then stopping. So you exercise and then you stop. And that is one way that we can sort of manage some of that reaction to stress.

Kirtly: Well, our listeners are listening to a committed, strong, powerful hiker-biker. That's Katie. And of course, you're listening to me who is a semi-committed couch potato who gets exercise because it's good for me. I wouldn't use it to get rid of my stress because it's so stressful for me to do that.

I might call my sister. I really use deep breathing a lot. And now as I'm living in times which are stressful for me and unpredictable, I practice my breathing a lot.

So exercise is a great idea. Besides, it'll undo the calories that you consumed if you did some stress eating. But anybody can take some deep breathing anywhere.

Katie: Yes, and I know that the breathing is your . . . And you've talked about this previously on the other 7 Domains. I do that too. Breathing for me I use in the nighttime when I'm having trouble sleeping. So that's one of my techniques for trying to get back to sleep, is to really do that kind of circular breathing where I'm counting my breathing in and I'm counting a hold and I'm counting the expiration. If I do that just a few times, really, I slow my heart rate down and I get bored with the counting and fall asleep.

But yes, I agree with you about the spending time with friends and talking and journaling. Therapy can be helpful. Laughing, anything that makes you laugh. These are all things that start to bring around that feeling that you described of the sky being brighter and feeling better. All of those things start to tap into that way of closing the stress cycle.

There are a lot of things that tap into some of those feel-good hormones though that probably aren't so healthy. So I think one of the other outcomes of living with chronic stress is often we turn to things that probably aren't so good.

Kirtly:Exactly.

Katie:So that'd be eating, drinking. And I think in this day and age, just zoning out on social media or playing Candy Crush, or . . . There are so many ways that we kind of escape into something else. Our body needs a little of that. You need to find escapes, but you need to sort of tune into what's a healthy way of escaping, and when is that escaping becoming a problem?

And for me, I know the amount of time I spend staring at a screen takes up time of my day. We've always only gotten 24 hours out of a day, and somehow now I have 5 of them to give to screens. Those are coming out of something. They're coming out of my sleep or my time with friends or my . . . You sort of think you have friends because you're seeing people on your screen, but it's not the same as spending time with the people you love.

Kirtly: Well, as we go on to the next domains, we're going to be talking about when the emotional context of our own inner voice or the voices around us become stressful, and what you can do about that.

What are the social determinants of health around your social life that actually you weren't . . . Maybe you were born into them or maybe there's not much you can do about them, but how can you manage for yourself, for your children, and for people in your community?

Of course, we'll talk about the environmental domain. And nobody's had financial stress, right?

Katie: No.

Kirtly: We'll be working on these as we go through the 7 Domains of Stress.

Katie: But in the meantime, we'll leave you today with breath work and exercise.

Kirtly: Yes, absolutely.

Katie: So if you are feeling stressed out, those are two go-to treatments that are going to help relieve your stress. And listening to podcasts while you're exercising or breathing, that would be great too.

We are happy to be back together for the 7 Domains of Stress, and looking forward to the next six in the series.

Kirtly: And check in with our other podcasts on the "7 Domains of Women's Health," wherever you get your podcasts. We will be spooling out these next 7 Domains of Stress, so share it with a friend. Use it as a way to start a conversation with people you love, or people you don't love so much who are stressing you out. We'll talk later. Bye.