Examining the Serious Health Effects of Stress

From a bulging belly to sleepless nights, your health might be more affected than you might think.
Illustration by Laura Liedo.

Stress is waiting for the results from a medical test, watching your kids go through the college admission process, ending a relationship or even beginning one. It’s the gnawing unresolved debt you’ve been meaning to pay off, but don’t know how. It’s the fact that people who are annoying will never know how annoying they are. It’s waiting in line at Starbucks watching baristas goof around behind the counter. It’s planning a vacation. It’s realizing your investment just hit the jackpot, but now what? It’s a million little things, good and bad, that when viewed over the span of time are part of life. It seems innocuous. It’s not.

“When the body is confronted with a stressful event, the hypothalamus, one of the brain’s control centers, signals the nervous system to release our ‘flight-or-flight’ stress hormones such as adrenaline and cortisol,” notes Allison Quistgard-Scherer, an integrative nutrition health coach based in Marin. “Breathing quickens, heart rate increases, muscles tighten and blood pressure spikes. The continual release of these hormones due to today’s lifestyle stressors take their toll on the body.”

Over time, cumulative stress has long-term consequences that encompass both physical and emotional symptoms. The long list includes anxiety and depression, agitation, more colds and infections, headaches, insomnia and even a loss of libido. Stress can also manifest as cognitive symptoms, including forgetfulness, disorganization and worry.

New research indicates the effects of stress go far beyond irritation or stomachaches, lodging deep in our physical and mental selves, and can even lead to life-threatening conditions like cardiovascular disease, high blood pressure, stroke and heart attack. To explore the manifestations of stress, we queried medical experts and therapists from the Bay Area and beyond, digging into the latest research in pursuit of solutions to some of the trickiest, most stressful scenarios modern humans endure.


Last July, researchers at the University of Arizona reported in the Journal of Epidemiology and Community Health that in a study of 11,000 postmenopausal women, those who cited high levels of social stress had lower bone density six years later. The subjects were asked to rate their social stress levels (from everyday interactions, conflicts and difficult life challenges) upon enrollment in the study; bone density measurements were taken both then and at the six-year mark. Women reporting high stress levels in the first interview showed a bigger decline in bone density compared with women who initially cited lower stress levels. This was true even after the researchers adjusted for other factors that may affect bone health, such as age, weight, smoking, alcohol use and education. The authors theorized that stress may harm bone health because it leads to higher blood levels of the hormone cortisol, a well-established reason for lower bone density.


From a boss who doesn’t respect the need for work-life balance to unexpected changes in job responsibilities, work can load stress onto any given day. According to the American Institute of Stress, workplace stress is having a major impact on our lives. While 83 percent of U.S. workers suffer from such stress, it causes around one million workers to miss work every day, results in 120,000 deaths and costs $190 billion annually in health care expense. And staying away from work can make the workload pile up even more, adding more stress to the equation.

American Institute of Stress research also found workplace stress has tripled in recent years and that women and men respond to it similarly, by consuming more caffeine, smoking more and exercising more often. Women, however, are also more likely to manage stress by talking with family and friends, which experts view as a healthy outlet, whereas men turned to increased sexual activity and illegal drug use. If you have ever found yourself eating a bowl (or container) of ice cream at the end of a particularly hard day, you already know that how much and when you eat isn’t always driven by hunger.


If you have ever found yourself eating a bowl (or container) of ice cream at the end of a particularly hard day, you already know that how much and when you eat isn’t always driven by hunger. Stress can drive you not only to eat more, but to disproportionately crave high-fat comfort foods, leading to weight gain. Stress also triggers the adrenal glands to produce more cortisol. While this hormone helps regulate metabolism and affects blood sugar management and memory, when blood levels of cortisol rise, it can promote inflammation and may spur the body to start stockpiling fat around the midsection.

The research of Elissa Epel, a Ph.D. in the UCSF Department of Psychology, takes a deeper dive into possible interconnections between stress, addiction, eating and metabolic health. High stress “shifts our behavior and our appetite, stimulates overeating, and is related to insulin resistance, the metabolic syndrome and general obesity,” she says in “A Fast-Paced, Fast Food Life,” episode six of The Skinny on Obesity, a University of California Television educational series. “Stress turns on the brain pathways that make us crave dense calories, and when you have a ‘stress brain,’ the food is even more rewarding.”

Recently Epel conducted clinical trials to explore whether dramatically reducing psychological stress might change the body’s hormonal balance, lower cortisol levels and reduce abdominal fat.

In a program called mindfulness-based stress reduction, her team trained research subjects to “pay attention to the moment and notice those thoughts when [people] start worrying, to recognize where they keep tension in their body and notice when they are hungry so they are really in tune with their physical state.” Findings showed that reducing anxiety and cortisol could indeed change a participant’s relationship to food: “The more they decreased their anxiety and chronic stress, the more abdominal fat they lost,” Epel says.


Other research is exploring how a link between stress and ghrelin, known as the hunger-triggering hormone, might affect reproduction and fertility. A preclinical study at Royal Melbourne Institute of Technology (RMIT) in Australia suggested that high levels of ghrelin, which is released during stress and stimulates appetite, could be harmful to some aspects of reproductive function. The team found that by blocking the ghrelin receptor in female mice, they were able to reduce the negative effect of chronic stress on the body’s ovarian primordial follicle reserve, a source of early-stage eggs.

The study, published in the Journal of Endocrinology, pointed to a need for further research on the long-term impact of chronic stress on fertility and a possible role for ghrelin in regulating such effects. (High or low levels of the hormone can reduce the total number of follicles and prevent them from maturing, limiting the quantity that can release an egg cell for fertilization.)

“The current findings could have implications for those with underlying fertility issues,” the study’s senior co-author Luba Sominsky, Ph.D. noted in a ScienceDaily online article last May. “Stress is an inseparable part of our lives, and most of us deal with it quite efficiently, without major health problems,” she added. But while “young and otherwise healthy women may experience only temporary and probably reversible effects of stress on their reproductive function, for women already suffering from fertility problems, even a minor impact on their ovarian function may influence the chance and timing of conception.”

Although the RMIT study subjects were mice, humans and mice have certain aspects of stress response and reproductive function and development in common. “Getting a better understanding of the role of ghrelin in all of this brings us an important step closer to developing interventions that can keep these critical parts of the reproductive system healthy,” Sominsky wrote.


Get a handle on stress and find your calmer moments with these tips.


“Once you appreciate that going through stress makes you better at it, it can be easier to face each new challenge,” says Kelly McGonigal, a Stanford University psychology lecturer and program developer for the Stanford Center for Compassion and Altruism Research and Education, in a 2015 article for Stanford News. By viewing some stress as helpful rather than harmful, she suggests, you can boost your overall health as well as your emotional well-being and productivity at work.


Spending just 20 minutes connecting with nature can help lower stress hormone levels, according to a study described in Frontiers in Psychology. Three days a week, head to any outdoor place — your yard, a public park, a green area near your office. Then walk or sit with the grass and trees and feel your cortisol levels drop.


“Emotional energies” become “trapped within our bodies, wreaking havoc in our lives,” says Sarah Strizzi, a certified body code and emotion code practitioner who offers stress management assistance through her Nurture Light program. “The average person has between 200 and 300 trapped emotions that exert a dramatic effect on how they think and feel on a daily basis,” she says, resulting in anxiety, panic, depression and other symptoms of imbalance. In her practice, Strizzi helps clients identify and release emotional energies in an effort to relieve symptoms and improve ability to handle stress.


These definitions from the American Institute of Stress can help you better understand mental and emotional pressures.


Situations that trigger the fight-or-flight response, in which the body physiologically prepares to defend itself. It takes about 90 minutes for metabolism to return to normal.


The toll of daily living: bills, kids, jobs. This is the stress we tend to ignore or push down. Left uncontrolled, it affects your health, body and immune system.


Exciting stress from situations or occasions with positive effects: a wedding, promotion, having a baby, winning money, new friends, graduation.


Stress from situations that cause negative feelings: divorce, punishment, injury, financial crises, work conflicts.

This article originally appeared in Marin Magazine’s February 2020 issue with the headline: “The Silent Enemy”.

Categories: Feature Story, Health