Tuesday, October 19, 2021

From Chaos to Calm Part 1


Carrie Demers, MD

August 19, 2019

Remember the tale “The Lady or the Tiger?” As it ends, the hero is standing before two identical doors: one conceals a beautiful maiden; the other, a ferocious tiger. He must open one of the doors—the choice is his—but he has no way of knowing which will bring forth the lady and which will unleash the tiger.

I am sometimes reminded of this story when a patient is describing one of the symptoms of chronic stress: headaches, indigestion, ulcers, tight muscles, high blood pressure, or some combination of these. When I point out that the symptom is stress-related, the patient seems resigned—stress is such a constant in most people’s lives that all the doors seem to have tigers lurking behind them. Most people who find their way to my office know the fight-or-flight response is hardwired into our nervous system, and many have come to accept a constant feeling of tension as normal, even inevitable.

Like the hero in the story, we have a choice.

It isn’t. Like the hero in the story, we have a choice. There is another response to the challenges of everyday living—another door—also hardwired into our nervous system. And unlike the hero, whose destiny rests with chance, we can discover which door is which. A general understanding of how the nervous system responds to stress, coupled with training in three simple techniques, makes it possible for us to distinguish one door from the other. Practicing these techniques gives us the power to open the lady’s door while keeping the tiger’s door firmly closed.

Unleashing the Tiger

The autonomic nervous system controls the body’s involuntary processes: respiratory rate, heart rate, blood pressure, gastric juice secretion, peristalsis, body temperature, and so on. It has two main branches: sympathetic and parasympathetic. When we feel stressed, our brain activates the sympathetic nervous system—the fight-or-flight response we’ve all heard so much about. This response causes the adrenal medulla to secrete adrenaline, a hormone that circulates in the bloodstream affecting almost every organ.

Adrenaline revs up the body to survive a threat to life and limb: The heart pumps faster and harder, causing blood pressure to spike and respiration to increase and move primarily into the chest. Airways dilate to bring more oxygen into the body; blood sugar rises to provide a ready supply of fuel; some blood vessels constrict to shunt blood away from the skin and the core of the body, while others dilate to bring more blood to the brain and limbs.

The result? A body pumped up to fight or run and a hyper-alert mind. When we find ourselves face-to-face with a tiger, this stress response dramatically increases our chances of surviving. Once the threat has passed, our sympathetic nervous system calms down and homeostasis is re-established.

We need mild sympathetic nervous system stimulation to get us out of bed in the morning, to focus, to plan. We need a bit more to speak or perform in front of a group, for example, but we need it at full throttle only to meet a life-threatening situation. The problem is that many of us have lost our capacity to regulate our fight-or-flight reaction, and full-throttle activation is almost constant. The source of our stress is psychological rather than physical—a perception that something crucial to us is threatened. We worry about the future, our jobs, our relationships, our finances, or getting stuck in traffic, but even though the perceived threat is psychological, it triggers the archaic survival response.

We find ourselves in a constant state of tension.

The upshot? We find ourselves in a constant state of tension, poised to fight or flee, with stress hormones washing through our bodies almost continuously. You can see the consequence if you consider what happens when adrenaline floods the body: elevated blood pressure, rapid shallow breathing, high blood sugar, and indigestion. Adrenaline makes our platelets stickier, so our blood will clot quickly if we are wounded, which increases our chances of surviving a physical injury. However, chronically sticky platelets are apt to clot and create blockages in our arteries, thus setting the stage for a heart attack or stroke.

The damage doesn’t end there. When we are constantly in fight-or-flight mode, the adrenal cortex secretes cortisol, a steroid whose job is to help us adapt to a prolonged emergency by ensuring that we have enough fuel. Cortisol acts on the liver and muscle tissues, causing them to synthesize sugars (glucose) and fats and release them into the bloodstream. Excess sugar in the bloodstream leads to diabetes, and excess fat to high cholesterol/high triglycerides. Both conditions boost our chances of developing heart disease. Cortisol has been the focus of a lot of research on stress in the last decade and is now linked to multiple disease states including insulin resistance and diabetes, osteoporosis, thyroid dysfunction, and even memory loss.

Sounds grim, doesn’t it? It is. A chronically activated sympathetic nervous system keeps the body under constant pressure. If we ignore the early warning symptoms—tight shoulders, digestive upset, recurring headaches, a tendency to lose our temper or become easily upset—sooner or later the tiger will tear us up.

Rather than living under the tyranny of a ramped-up sympathetic nervous system, we can learn to trigger the parasympathetic system instead—the rest-and-digest response. Just as the fight-or-flight response automatically kicks in when danger threatens, the rest-and-digest response automatically responds to our sense of equilibrium. When it is activated, our heart rate drops, our blood pressure falls, and our respiration slows and deepens. Blood flow to the core of the body is re established—this promotes good digestion, supports the immune system, and infuses us with a sense of well-being.

We enter this state unconsciously when we’re enjoying a vacation, in the throes of a hearty laugh, or in deep sleep. It feels good, and it offers a much-needed respite from the hectic pace we set for ourselves. But, unfortunately, we have come to accept stress as the norm and to expect the feeling of relaxed well-being to come about only sporadically—and so it does. We release the tiger a dozen times a day, even though the other door is also there in every moment. Once we learn to open it at will, we can override the harmful habit of triggering our stress response, by activating the rest-and-digest component of our nervous system instead.

Meeting the Lady

I use a variety of natural therapies in my medical practice to minimize chronic stress. The three that are simplest and most accessible are exercise, diaphragmatic breathing, and relaxation. Exercise generally loosens physical tension and dissipates the pent-up energy that the stress response fosters. Deep breathing and systematic relaxation nourish and strengthen the parasympathetic nervous system, so that the rest-and-digest response is activated and in time becomes our normal mode. With that in mind, let’s look at some ways we can open Door Number Two.

... to be continued