We all experience stress from time to time. The release of stress hormones, including adrenaline and cortisol, helps you cope with immediate challenges. But when your level of stress becomes chronic or goes beyond what your body can handle, it can compromise your physical, emotional, and mental health—which can make it even harder for you to cope with future stress and stressors.
Did you know you can control how your body reacts to friendly and not-so-friendly stressors? Finding quick and effective “tension tamers” that turn off the alarm response and turn on the relaxation response helps your body return to normal functioning following a stressful event.
Try several of these techniques and find out what works best for you in times of stress. You’ll feel calmer within minutes!

1. Breathe from your belly.
   Sit in a comfortable position and take a few deep breaths by expanding your belly (rather than lifting your shoulders). Releasing physical tension and increasing oxygen intake calms you quickly—even if stressful events continue.
2. Take a short walk.
   Change your scenery and change your perspective—indoors or outdoors. Walking gets your blood circulating and helps you blow off stream so you can return with a new frame of mind.
3. Spring into action.
   Even a short burst of exercise (like running up several flights of stairs or several sets of push-ups or abdominal crunches) can reduce stress. Exercise helps deliver more oxygen to your brain and distracts you from stress to give you a fresh perspective. Even simple stretching can help bring a little relief.
4. Listen to music.
   Soft music can help relax tense muscles or get you in the zone when practicing other stress reduction activities: yoga, guided imagery, or soaking in the tub. And upbeat music can help lift your mood or keep you energized.
5. Dance or sing.
   Start moving to your favorite tunes or just sing along. Bursting into song or a silly dance move can transport you to a stress-free zone.
6. Take a mental break.
   Steal a few minutes of peace to gaze out your window or visualize yourself in your favorite space, doing your favorite things, or being with your favorite people. It renews the spirit and breaks the stress response quickly.
7. Laugh.
   Maintaining a sense of humor reminds us that our stressors may not be as menacing as they seem. Purchase or download a laugh track, cartoons, jokes, or your favorite comedy TV show or movies to enjoy when you’re feeling overwhelmed.
8. Write in a journal.
   If you like to write, journaling clarifies your thoughts and feelings for increased self-knowledge. Putting the experience on paper gets it off your mind and helps you refocus—and teaches you to cope the next time it happens.
9. Take a power nap.
   Midday sleep gives you more patience, better reaction time, increased learning, more efficiency, and better health. If you only have five minutes to spare, just close your eyes. Even brief rest reduces stress and helps you relax.

Don’t change your life; change your response to stress
You don’t have to make big changes in your life to reduce your stress level. Just lessen the impact that stressful occurrences can have on you. These quick and simple tips make it easy for you to change your response to stressors and live a more positive, fulfilling life.
For more help with living a lower-stress lifestyle, talk to your healthcare practitioner.

When you’re stressed, so is your thyroidEverything seems to be going wrong this morning—you’re out of coffee, traffic is bad, and you can feel tension from the tips of your toes to the top of your head. Maybe you’re under constant pressure at work or can’t catch a break on your bills. Stress is a part of your life, and when it’s ongoing, it can affect everything—including your thyroid. Learn why this is significant and what you can do to help reduce the effects of stress on this important gland.
Your thyroid: The regulator of body functionsSitting squarely at the front of your neck is the thyroid gland, a butterfly-shaped powerhouse of your body’s metabolism. As part of your endocrine system (a collection of glands in the body that produce hormones), the thyroid regulates many body functions including, but not limited to:

• Heart rate
• Body weight
• Body temperature
• Breathing
• Muscle strength
• Menstrual cycle
• Cholesterol levels
• Central and peripheral nervous systems

Yes, the thyroid is more than just a little important in the overall picture of you. It produces, secretes, and stores specific hormones. Two of the main hormones made by the thyroid are triiodothyronine (T3) and thyroxine (T4). Both hormones affect just about every cell in your body; having  too little or too much of either can throw several body systems out of whack and contribute to health issues such as:

• Hair loss
• Weight loss/gain
• Anxiety
• Mood swings
• Missed menstrual periods
• Temperature sensitivity

How stress affects the thyroidThe effect of stress on thyroid health is like a game of dominos: When one tile falls, the rest typically follow. Stress impacts the thyroid by influencing how other hormones balance with it. For example, cortisol (the “fight or flight” hormone) can surge due to chronic stress. This surge can cause problems with thyroid hormone production,1 pressing this important gland to work harder to produce and release more thyroid hormones, leading to an imbalance. Consequently, if the imbalance becomes chronic, it can contribute to the risk of developing a thyroid disorder.2
Another example of hormonal imbalance is insulin resistance, wherein the body resists insulin production, resulting in increased blood sugar levels. This leads to other associated health problems. Several of these conditions often occur with  hypothyroidism (when the thyroid doesn’t make enough of its hormones). The result? Increased products of dysregulated sugar metabolism, which lead to lower levels of thyroid-stimulating hormone (TSH) in the blood.3 Insulin resistance can also contribute to thyroid enlargement and nodules.4,5
Chronic stress has also been shown to increase the risk of developing an autoimmune thyroid condition.2 By affecting the immune system through the nervous and endocrine systems, chronic stress can “flip a switch” and increase the risk of autoimmune thyroid disorders for people who have a genetic predisposition.2
Don’t stress about your thyroidIf you’re concerned about chronic stress and how it may affect your thyroid, ask your healthcare practitioner for more information. He or she is the best person to consult about stress and thyroid health.
This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues.
References:

1. Ranibar S et al. Indian J Endocrinol Metab. 2011;15(1):18–22.
2. Mizokami T et al. Thyroid. 2004;14(12):1047–1055.
3. Walter K et al. Thyroid Res. 2012;5:13.
4. Rezzonico J et al. Thyroid. 2008;18(4):461–464.
5. Yunzhao T et al. Int J Endocrinol. 2017;2017:1617458.

By Whitney Crouch, RDN & Kirti Salunkhe, MD
What is stress?Stress can be defined as a  constellation of events, starting with a stimulus or stressor that causes a reaction in the brain leading to the stress response commonly known as  the “fight-or-flight” reaction that can affect many body systems.1 Unfortunately, stress is a fact of life that we all experience at some time or another. Stressors that are acute, or short-lived, are often physical or physiological. Psychological or emotional stress is usually chronic in nature.  
The immune system and stressThe immune system is made up of cells, tissues, and organs working together as the body’s defense mechanism to protect us from illness. Scientists say short-term stress (lasting from minutes to a few hours) may be beneficial for our immune health, as it stimulates immune activity and prepares us for possible periods of longer stress—a “fire drill” of sorts. However, chronic stress is actually harmful.2
White blood cells (WBC) are critical for the body’s immune response to foreign invaders. These cells are produced, and stored, in many areas of the body including the spleen, bone marrow, and thymus (a small gland found behind the sternum and between the lungs).3 There are two types of WBCs associated with the immune system: Phagocytes, which actively attack foreign organisms, and lymphocytes, which remind the body to recognize previous invaders and help destroy them.4 The main phagocyte is the neutrophil. Neutrophils primarily fight bacteria and infections. The main lymphocytes are the B lymphocytes or B-cells and T lymphocytes or T-cells. B-cells start out and mature in the bone marrow. T-cells start out in the bone marrow but mature in the thymus. These two cell types are the “special ops” of the immune system and have specific functions. B-cells make antibodies to fight bacteria and viruses and T-cells directly attack invading organisms.4
Acute stress and the immune responseOne of the most familiar reactions to acute stress is the “fight-or-flight” response. This physiological reaction usually occurs during an emergency or a fearful mental or physical situation.3 When a threat is perceived, there is a release of hormones to prepare you to either stay and deal with the threat or to run away to safety. It represents choices our ancient ancestors made when faced with dangerous situations. Nowadays, it’s more likely those dangerous situations are ones leading to a wound or infection, but our body reacts the same way.3 During periods of short-term stress, our sympathetic nervous system releases “stress hormones:” epinephrine (adrenaline) and norepinephrine (noradrenaline), as well as corticotropin-releasing hormone (CRH), adrenocorticotropin (ACTH), and cortisol from the adrenal glands.3 These work together to prepare the body for “fight-or-flight” by increasing alertness, focusing the mind, elevating heart and breathing rates, as well as increasing blood flow to skeletal muscles and brain.4
Interestingly, research has shown acute stress activates the immune system. Immune activation is critical to respond to immediate demands of a stressful situation that may lead to a wound or an infection. Acute stress triggers immune cells and stimulates production of proteins known as cytokines. The two major types of cytokines are: pro-inflammatory cytokines and anti-inflammatory cytokines. The pro-inflammatory cytokines process the pain often found with inflammation; the anti-inflammatory cytokines work by controlling, or limiting, the spread of inflammation. Both are necessary for normal healing.3
While acute, or short-term, stress acts as an “immune stimulator,” readying the body’s immune system for an adverse situation, situations involving long-term or chronic stress actually suppress and dysregulate the body’s immune responsiveness, leading to illness and poor outcomes.3
Chronic stress and the immune responseJust as we all have differing genetic and biochemical composition, we also have varying perceptions of stress and individual responses to how we process and cope with it.5
Occasionally, there can be a  crossover between the mind and body, as in the “fight-or-flight” response. A mentally stressful situation may require a physical response or action, but what about those psychological or emotional stressors that may be difficult but don’t actually pose any pressing physical dangers? Stressors related to pressures of a work project requiring focused concentration over long days and nights, or the continual emotional drain from a difficult relationship or other similar circumstance?
Studies have shown prolonged mental stress can adversely affect regular lifestyle routines, including decisions we make about sleep, nutritional intake, and exercise and can even persuade us to use poor judgment regarding alcohol and drug intake.5,6 These studies have also shown the adverse effects (acute and chronic) that mental and emotional stress places on physical health and wellbeing and have been directly linked to suppression of the immune system.5 How acute mental stress affects physical health was seen in a recent study of college students during their final exams.7 To understand the link between mental stress and changes in blood biomarkers, researchers took blood samples and administered questionnaires about anxiety and depression to 24 college students during finals week. Baseline values had been established by prior blood draws and questionnaires completed midsemester. When compared to baseline levels, during finals week, there were elevations in pro-inflammatory cytokines along with increased reports of anxiety and stress.7 Other studies have noted increased stress can lead to prolonged wound healing time with reduced levels of anti-inflammatory cytokines and increases in pro-inflammatory cytokines.6
Multiple studies have evaluated the immune response in conditions of long-term and emotional stress. These conditions are similar to those found with caregiving of an ill or elderly relative, experienced after a difficult divorce and have even been reported as related to loneliness.7-9 Findings from these studies showed links between emotional stress and increased risk for viral illness, reemergence of latent viruses (Epstein-Barr, herpes simplex, and cytomegalovirus), and onset of autoimmune disease.5,10,11 Other studies have shown long-term psychological stress was linked to detrimental cardiovascular health12-14 as well as increased risk for immunologic conditions including inflammatory bowel disease, allergies, atopic dermatitis, and celiac disease.15-18
Even the most vulnerable members of the population, our children, can be affected by psychological stress that results in a reduced immune response. Investigators evaluated children who had a history of recurrent colds and flu and reported higher levels of psychological stress. The data demonstrated the children had reduced salivary immunoglobulin ratios (IgA/albumin). A reduction in this ratio supports a potential link between reduced immune function with a greater susceptibility to colds and flu.19
Lifestyle approaches to stress managementWhile the effects of stress can be useful on some occasions, adverse effects of stress can play a role in both acute and chronic illness. While there are a number of strategies that come into play with stress management, evidence supports the benefits of lifestyle modification and improved dietary or nutritional intake as a part of a comprehensive strategy.


Recommended lifestyle modifications:

• Practicing mindfulness through meditation20
• Regular aerobic exercise21
• Acupuncture22
• Improving nutritional intake23

Discussing individual situations and specific stressors with your healthcare provider can discover the underlying cause(s) of your stress, and working together, you can find personalized solutions to manage stress and support your immune health.
This information is for educational purposes only. This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues.
References:

1. Dhabhar FS et al. Acute stress enhances while chronic stress suppresses immune function in vivo: a potential role for leukocyte trafficking. Brain Behav Immun. 1997;11:286–306.
2. Dhabhar FS. Effects of stress on immune function: the good, the bad, and the beautiful. Immunol Res. 2014;58(2-3):193-210.
3. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentID=35&ContentTypeID=160  Accessed January 16, 2019
4. Vitlic A et al. Stress, ageing and their influence on functional, cellular and molecular aspects of the immune system. Age (Dordr). 2014;36(3):9631.
5. Gunnar M et al. The neurobiology of stress and development. Annu Rev Psychol. 2007;58:145–173.
6. Marucha PT et al. Mucosal wound healing is impaired by examination stress. Psychosom Med. 1998;60(3):362–365.
7. Kiecolt-Glaser JK et al. Marital quality, marital disruption, and immune function. Psychosom Med. 1987;49(1):13–34.
8. Kiecolt-Glaser JK et al. Marital discord and immunity in males. Psychosom Med. 1988;50(3):213–229.
9. Kiecolt-Glaser JK et al. Marital conflict in older adults: endocrinological and immunological correlates. Psychosom Med. 1997;59(4):339–349.
10. Nowak M. The evolution of viruses—competition between horizontal and vertical transmission of mobile genes. J Theor Biol. 1991;150(3):339–347.
11. Pariante CM et al. Chronic caregiving stress alters peripheral blood immune parameters: the role of age and severity of stress. Psychother Psychosom. 1997;66(4):199–207. 
12. McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338(3):171–179.
13. Phillips AC et al. Cardiovascular and cortisol reactions to acute psychological stress and adiposity: cross-sectional and prospective associations in the Dutch famine birth cohort study. Psychosom Med. 2012;74(7):699–710.
14. Sedova L et al. Diet-induced obesity delays cardiovascular recovery from stress in spontaneously hypertensive rats. Obes Res. 2004;12(12):1951–1958.
15. Segerstrom SC et al. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004;130:601–630.
16. Mawdsley JE et al. Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut. 2005;54:1481–1491.
17. Montoro J et al. Stress and allergy. J Investig Allergol Clin Immunol. 2009;19(Suppl.1):40–47.
18. Arndt J et al. Stress and atopic dermatitis. Curr Allergy Asthma Rep. 2008;8:312–317.
19. Drummond PD et al. Increased psychosocial stress and decreased mucosal immunity in children with recurrent upper respiratory tract infections. J Psychosom Res. 1997;43(3):271–278.
20. Black DS et al. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann N Y Acad Sci. 2016;1373(1):13-24.
21. Harvard Health Publishing. Exercising to relax. https://www.health.harvard.edu/staying-healthy/exercising-to-relax; Accessed January 21, 2019
22. Liang F et al. Acupuncture and Immunity. Evid Based Complement Alternat Med. 2015;2015:260620.
23. https://www.health.harvard.edu/staying-healthy/how-to-boost-your-immune-system. Accessed January 21, 2019.