The relationship between stress and inflammation has been studied rigorously in the past decade, with researchers finding evidence that the inflammatory pathway is pivotal in the pathogenesis of many chronic diseases. In fact, 75% to 90% of human disease is related to stress and inflammation, including cardiovascular and metabolic diseases, and neurodegenerative disorders. Studies suggest that chronic stress results in glucocorticoid receptor resistance that, in turn, results in failure to downregulate inflammatory responses.
Large bodies of research indicate that chronic stress, whether experienced in early life or as an adult, is linked to increased coronary heart disease risk. In particular, childhood adversity, including physical and sexual abuse in childhood, has been shown to relate to higher morbidity of cardiovascular events in women. Work-related stressors, poor sleep, and emotional disturbances have been correlated with adult-related cardiovascular disease.
A 2018 finding using data from the Jackson Heart Study suggested that in African American adults, global stress (overall stress level) and major life events were associated with increased risk of metabolic syndrome severity, while weekly stress (minor stressors over a week’s time) was not. Additionally, men and women’s stress responses varied in severity, with men’s metabolic syndrome severity increasing significantly at lower levels of major life event stress relative to women’s metabolic syndrome severity.
Chronic psychological stress and inflammation are also associated with a greater risk of depression, autoimmune diseases, upper respiratory infections, and poor wound healing. For years, researchers have speculated that disorders of the gastrointestinal tract, such as Crohn’s disease and ulcerative colitis, are related to stress and inflammation, but the underlying mechanism remained largely unresolved. A groundbreaking 2018 study in mice suggests a clue, showing that chronic stress disturbs gut microbiota, triggering an immune system response and facilitating dextran sulfate sodium-induced colitis.
With a wide range of chronic diseases on the rise, how can Functional Medicine clinicians target stress-related factors with interventions that improve the health of their patients? Accumulating evidence points to the beneficial effects of regular exercise in preventing or improving the metabolic and psychological comorbidities brought about by chronic stress. A recent meta-analysis indicates that physical exercise improves the inflammatory state in children with obesity; however, it is unclear whether this effect can reduce the risk of cardiovascular and metabolic diseases in adulthood.
In 2017, a first-of-its-kind study on yoga and meditation showed improvement in biomarkers of cellular aging, which are associated with oxidative stress and complex lifestyle diseases like depression, diabetes, and cardiovascular disease. The researchers suggested that the improvement in stress and inflammatory response was mediated by changes in cortisol, ?-endorphin, IL-6, and other factors, with regulation by changes in the brain through the hypothalamic-pituitary-adrenal (HPA) axis.
Many diseases stemming from chronic stress and inflammation have early warning signs, meaning some cases can be prevented or improved with lifestyle changes that help manage stress. The Functional Medicine model focuses in on identifying specific interventions like exercise, meditation, and yoga that work for the individual patient. Tools such as the Functional Medicine Timeline can also help clinicians identify areas of life where stress may be problematic and design treatments that focus on improving stress management.
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