Amina AlTai had always prided herself on her drive and resilience. When she began experiencing brain fog and fatigue, AlTai, 39, simply thought it was from working long hours at her marketing job. So she started writing reminders to stay on track. But then her hair started falling out, she gained and lost a lot of weight, and she started having gastrointestinal problems.
Ms. AlTai was sure something was wrong, but the first six doctors who saw her didn’t take her seriously, she said. Some told her she had so much hair that losing a little shouldn’t be a problem. Several said she looked healthy and dismissed his symptoms It was simply stress. It was only when another doctor ordered blood tests that Ms AlTai was diagnosed with Hashimoto’s disease and celiac disease, two autoimmune diseases that can damage the thyroid and small intestine.
“They called me and told me: ‘Don’t go to work. Go to the hospital instead, because multiple organ failure is days away,’” Ms. AlTai recalled. The two chronic illnesses had altered her ability to regulate hormones and absorb critical vitamins and nutrients.
Scientists now know that stress is closely linked to many chronic diseases: It can cause immune changes and inflammation in the body that can worsen symptoms of conditions such as asthma, heart disease, arthritis, lupus, and inflammatory bowel disease. Meanwhile, many problems caused by stress (headaches, heartburn, blood pressure problems, mood swings) can also be symptoms of chronic diseases.
For doctors and patients, this overlap can be confusing: Is stress the sole cause of someone’s symptoms, or is there something more serious at play?
“It’s really hard to unravel,” said Scott Russo, director of the Brain-Body Research Center at the Icahn School of Medicine at Mount Sinai.
How stress can trigger chronic diseases
Stress naturally triggers what is called the fight or flight response. When we are faced with a threat, our blood pressure and our heart rate increases, our muscles tense and our body concentrates blood sugar to make it easier to react quickly, said Dr. Charles Hattemer, a cardiovascular health specialist at the University of Cincinnati.
If people are stressed for weeks or months, their bodies may be unable to keep up with other functions, leading to problems such as forgetfulness, fatigue, and difficulty sleeping. Stress hormones, such as adrenaline and cortisol, can chronically raise blood pressure or increase plaque depositswhich can damage the heart over time, Dr. Hattemer said.
There is also evidence that stress can contribute to overactivation of the immune system and cause inflammation. In a study of 186 patients, researchers in Italy found that 67 percent of adults with Celiac Diseasehad experienced a stressful life event prior to their diagnosis.
More recently, Dr. Russo and his colleagues showed in two studies that distressed mice had higher levels of neutrophils, which cause inflammation, and fewer T and B cells in the bloodstream that could produce antibodies or kill virus-infected cells. .
He and his colleagues also found patients with major depressive disorder Researchers believe the body changes the composition of immune cells circulating in the blood as a way to reduce damage caused by infection or acute stress, Dr. Russo said.
However, when faced with chronic stress, sometimes the body “just can’t turn off the immune system,” Dr. Russo said.
For people who may already be at risk for chronic diseases, whether due to genetic predisposition, chemical exposure, air pollution, or viral infections, a prolonged period of stress can push them to the brink of becoming ill.
Lynne Degitz, 56, spent several years battling what seemed like serious infections from time to time. Once, she thought she had mononucleosis. Another time, she was sure it was bronchitis. Neither she nor her doctors thought it could be a chronic illness.
He then started a new, more stressful job and began experiencing fever, joint swelling, and fatigue almost every day. “I had an interesting and demanding job, so I kept going,” Degitz said. “I would just use short-term disability to recover or use vacation time to recover when I needed it.”
After more than two years of going back and forth to doctor’s appointments and trying treatments that ultimately didn’t help, Ms. Degitz was diagnosed with a type of arthritis known as Still’s disease. Doctors don’t know exactly what causes it, but investigation is beginning to suggest that it is likely a combination of factors, including abnormal reactions to infections and stress.
“We all have physical ailments and weaknesses,” Dr. Russo said. “Stress simply exploits them and makes them worse.”
When symptoms become a source of stress
For patients with chronic illnesses, the same stressors that may have triggered their symptoms can make it difficult to manage their condition.
And some said they don’t always feel like doctors understand how difficult it can be to manage stress, especially when they feel sick. When Teresa Rhodes was first diagnosed with rheumatoid arthritis several decades ago, a doctor suggested she exercise more to reduce stress and strengthen joints, which were being damaged by the disease.
But “the symptoms of the disease themselves were stressors,” said Rhodes, now 66. “It’s very hard to exercise when you’re so fatigued.” It was only after other stressors in her life faded — her children were grown and she left a difficult marriage — that she was able to get enough rest and eventually began exercising again.
Many doctors aren’t trained to ask about sources of stress or advise patients about the impact of stress, said Alyse Bedell, a clinical researcher who specializes in how stress affects digestive health at UChicago Medicine. A 2015 survey of more than 30,000 patient visits to doctors’ offices found that primary care physicians only advised patients about stress management during 3 percent of visits.
When Stephanie Torres’ 12-year-old son, Nico, was diagnosed with Crohn’s disease, he was surprised to hear that the gastroenterologist thought it was the family’s responsibility to manage the stress that was clearly triggering his symptoms. “His response was basically, ‘This is your problem. Go figure it out.’”
Patients said that instead of simply suggesting that they eliminate sources of stress, doctors could work with them on small ways to manage stress every day. Once AlTai was diagnosed with the disease and began taking medication for both conditions, she felt well enough to make the changes to her diet necessary to address the nutrient deficiencies caused by her illnesses. She began walking regularly and meditating in the morning.
AlTai eventually left her marketing job and became an executive coach, which allowed her to set her own schedule, she said. Being hospitalized and diagnosed with two chronic illnesses made her realize that these changes were necessary.
“I call it my stopping moment, because it literally stopped me dead in my tracks,” she said. “I had to really reevaluate my relationship with work, success and stress.”
