Amina Altai has always prided herself on her drive and tenacity. When she started feeling foggy and fatigued, the 39-year-old figured it was simply because of long hours at her marketing job. So she started writing down reminders to stay on track. But then she started losing her hair, gaining and losing weight rapidly, and having gastrointestinal problems.
Altai was convinced something was wrong, but she says the six doctors she first saw didn’t take her seriously. Some told her she had lots of hair and that a little loss was normal. Others said she looked healthy and dismissed the symptoms as just stress. It wasn’t until another doctor ordered blood tests that Altai was diagnosed with Hashimoto’s and celiac disease, two autoimmune disorders that can damage the thyroid and small intestine.
“They called me and said, ‘Don’t go to work, go to the hospital, you’re just a few days away from multiple organ failure,'” Altai recalled. The two chronic illnesses had impaired her ability to regulate hormones and absorb important vitamins and nutrients.
Scientists now know that stress is closely linked to many chronic diseases. Stress can trigger immune changes and inflammation in the body, exacerbating the symptoms of asthma, heart disease, arthritis, lupus, inflammatory bowel disease, and more. Meanwhile, many problems caused by stress (headaches, heartburn, blood pressure problems, mood changes) can also be symptoms of chronic diseases.
For doctors and patients, this overlap can be confusing: Is stress the only cause of symptoms, or is something more serious at play?
“It’s really hard to tease out,” says Scott Russo, director of the Brain-Body Research Center at the Icahn School of Medicine at Mount Sinai.
How stress causes chronic disease
Stress naturally triggers what’s known as the fight-or-flight response: When we encounter a threat, our blood pressure and heart rate increase, our muscles tense up, and our body focuses our blood sugar so we can react quickly, said Charles Hattemer, PhD, a cardiovascular health expert at the University of Cincinnati.
Stress over a period of weeks or months can make the body less able to cope with other functions, which can lead to problems like forgetfulness, fatigue and sleep disorders. Stress hormones like adrenaline and cortisol can chronically increase blood pressure and increase plaque deposits, which can damage the heart over time, Dr. Hattemer said.
There are also indications that stress may contribute to overactivation of the immune system, leading to inflammation: A study of 186 patients by Italian researchers found that 67% of adults with celiac disease had experienced a stressful event before their diagnosis.
More recently, in two studies, Dr. Russo and his colleagues showed that stressed mice had higher levels of inflammation-causing neutrophils and fewer T and B cells in their bloodstream that can produce antibodies and kill virus-infected cells.
Russo and his colleagues also found that people with severe depression had similar imbalances in immune cells compared with healthy controls. The researchers believe that the body changes the composition of immune cells circulating in the blood as a way to reduce damage from infection or acute stress, Russo said.
But when faced with chronic stress, the body may not be able to “shut down the immune system,” Dr. Russo said.
For people who are already at risk for chronic disease due to genetic predisposition, exposure to chemicals, air pollution or viral infections, prolonged stress can put them at greater risk of falling ill.
Lynn DeGitz, 56, had been battling bad infections on and off for several years. At one point, she thought she had mononucleosis. At another, she was sure she had bronchitis. Neither she nor her doctors suspected it might be a chronic condition.
She then took a new, stressful job that left her with fevers, swollen joints and fatigue almost every day. “It was interesting and challenging, so I just stuck with it,” DeGitz says. “I used short-term disability benefits to recover and took time off when I needed.”
After more than two years of repeated doctor visits and ultimately ineffective treatments, DeGitz was diagnosed with a form of arthritis called Still’s disease. Doctors don’t know exactly what causes it, but research is beginning to suggest it’s likely caused by a combination of factors, including infections and an abnormal response to stress.
“We all have physical ailments and weaknesses,” Dr. Russo says, “and stress only makes them worse.”
Symptoms that cause stress
For those with chronic illnesses, the same stressors that may have triggered symptoms can also make it harder to control their condition.
They also said doctors don’t always understand how hard it can be to manage stress, especially when you’re feeling unwell. When Theresa Rose was first diagnosed with rheumatoid arthritis decades ago, her doctor encouraged her to reduce stress and exercise more to strengthen the joints that had been damaged by the disease.
But “the symptoms themselves were stressful,” says Rose, now 66. “When you’re really tired, it’s really hard to exercise.” After other stressors in her life subsided — her children were grown and she got out of a difficult marriage — Rose was finally able to get enough rest and finally start exercising again.
Many doctors aren’t trained to ask about sources of stress or to counsel patients about its effects, says Alice Bedell, a clinical researcher at the University of Chicago Medicine who specializes in the effects of stress on digestive health. A 2015 study of more than 30,000 patient office visits found that primary care physicians advised patients about stress management in just 3% of visits.
When Stephanie Torres’ 12-year-old son, Nico, was diagnosed with Crohn’s disease, she was surprised to hear his gastroenterologist think it was the family’s responsibility to manage the apparent cause of the symptoms: stress. “Her response was basically, ‘This is your problem. You solve it.'”
Patients say that rather than simply recommending they cut out sources of stress, their doctors work with them to find small ways to manage stress every day. After Altai was diagnosed and began taking medication for both illnesses, she felt well enough to make the dietary changes necessary to address the nutritional deficiencies caused by her illnesses. She went for regular walks and began meditating in the mornings.
Altai eventually quit her job in marketing to become an executive coach and take control of her own schedule, a change she says she realized was necessary after being hospitalized and diagnosed with two chronic illnesses.
“I call this my ‘pause moment’ because it literally stopped me in my tracks,” she told Business Insider. “I had to really reevaluate my relationship with work, success, and stress.”