Fatigue and Chronic Stress
Short of withdrawing from everyone and everything, there is probably no way any of us are going to avoid the stress of daily living. Of course, isolation can be one of the endpoints of chronic stress, so even withdrawing creates a continuous nidus of stress. Stress management is the subject of a whole field of cognitive behavioral therapy, which can be an important component to the management of fatigue and exhaustion. It is estimated that up to 90% of all physician office visits have stress as their origin. In this post, we will superficially review the physiologic effects of stress which should illuminate the reasons for 90% of those physician office visits.
The American Institute of Stress lists 50 common symptoms of stress, of which #46 is constant tiredness, weakness and fatigue ( http://www.stress.org/stress-effects). In my opinion, fatigue and exhaustion are the common denominator symptoms for most of these stress effects on the body. For this reason, a thorough evaluation of stress takes all of these effects into account, many of which may require treatment on their own to eliminate fatigue and exhaustion. As stated in a previous post, the initial history and evaluation may take a thorough physician upwards of two hours to properly complete.
Stress affects almost every aspect of human physiology. Chronic stress can create serious alterations in physical and psychological health due to the release of chemicals involved in the “fight or flight” response of the body. When stress is constant, your body is in a continuous state of “danger”, attempting to manage the needs of a person in crisis. In acute stress, the body reacts in the moment, but then has time to achieve a state of homeostasis as chemical levels return back to baseline. If crisis management is constant in response to chronic stress, there is no time for the body return to normal. The body and mind are in communication, producing interactions between them leading to physical and chemical changes in response to stress.
Stress and the Nervous System
The autonomic nervous system responds to stress through it’s sympathetic and parasympathetic branches. Simply put, the sympathetic nervous system responds to stress (action) while the parasympathetic nervous system provides a return to baseline calmness (relaxation). The sympathetic nervous system initiates the “fight or flight” response to stress. In patients exposed to chronic stress, the sympathetic nervous system is always turned on and the parasympathetic system never has a chance to take over and return all systems to normal.
The sympathetic nervous system sends out signals in reaction to stress, instructing the adrenal gland to release the hormones adrenaline (epinephrine) and cortisol which increases heart rate, blood pressure, respiratory rate and changes the digestive process. The liver responds to epinephrine by releasing more glucose for an immediate energy boost. In acute stress, once the danger has passed, the body returns to normal with the parasympathetic nervous system. With chronic stress, this mechanism is turned on most of the time, leading to the illnesses for which patients present to their doctor.
Stress and the Cardiovascular System
In reaction to stress, the epinephrine released in response to the sympathetic nervous system elevates heart rate, directing blood flow to the heart, brain and muscles needed to manage immediate danger. Blood vessels to these organs dilate, while other blood vessels constrict to direct increased blood flow to the required organs and large muscles.
Constant and chronic stress may lead to inflammation of these blood vessels. Inflammation of the heart (coronary) arteries is thought to lead to heart attacks. Chronic stress may also result in high blood pressure in response to a sympathetic nervous system that is always on guard from danger. Hypertension is also known as the silent killer as it frequently has no obvious symptoms. Prolonged elevation of blood pressure increases the risk of stroke, heart attacks, kidney failure and heart failure.
Stress and the Endocrine System
When under stress, the brain sends out information from the hypothalamus to direct the adrenal glands to produce more adrenaline and cortisol. These hormones are known as the stress hormones and are responsible for the “fight or flight” response of the body. The liver responds to this increase in stress hormones by releasing more glucose, the sugar that provides an immediate increase in energy levels for the fight or flight response to perceived danger.
Stress and the Gastrointestinal System
Chronic stress may lead a person to eat much less or much more than normal. This can affect energy levels as well as weight management. In addition, increased use of alcohol or tobacco in reaction to stress may lead to increased reflux and heartburn symptoms. Stress effects on the stomach can include nausea, vomiting, increased acid production and painful reflux. The bowels may react to stress with changes in digestion and the amount of nutrients absorbed. How rapidly food moves through the bowels may change, leading to constipation, increased gas or diarrhea.
Stress and the Musculoskeletal System
Stress leads to greater blood flow to large muscles in response to the sympathetic nervous system. Prolonged contraction of muscles can lead to tension headaches, muscle pain (myalgia), and migraine headaches. Protracted muscle contraction leads to the buildup of lactic acid resulting in soreness of muscles. In addition, chronic muscle contraction can affect the joints, leading to the predisposition of arthritis and degenerative joint problems.
Stress and the Reproductive System
In men, excess cortisol production in response to stress can affect normal reproductive function. Chronic elevation of cortisol levels can affect testosterone production, may decrease sperm production and can lead to impotence.
In women, excess cortisol can result in irregular menstrual periods, increased cramps during menses, decreased sex drive and may effect fertility.
Stress and Miscellany
The above reactions to stress involve what most perceive as serious consequences. The miscellaneous effects of stress may be more noticeable and actually more troublesome for most patients. If high blood pressure, ulcers, migraine headaches aren’t bad enough, how about adding insomnia, mood swings, loss of hair, excess anxiety, worry, tremors, cold hands and dry mouth? When communicating, do you feel inadequate getting your points across? Do you feel unable to concentrate or do you have loss of memory? Do you feel depressed and withdrawn? Does your weight increase despite no change in your eating habits? Review the 50 common symptoms of stress from the American Institute of Stress and see how many apply to you.
The end result for most people is a feeling of fatigue and exhaustion. Addressing these symptoms and all systems involved in the stress response should help pinpoint medical issues that are contributing to lack of overall well being. It is easy to see why a thorough evaluation cannot be accomplished in the typical 10-15 minute physician office visit. It takes time, effort and determination to treat the underlying causes of fatigue and exhaustion. Find a doctor who will take the time, put forth the effort and is determined to treat and reverse the issues that lead to the resultant fatigue in response to chronic stress.