By: Graeme Jones, clinical physiologist and CEO at Nordic Clinic Stockholm

Published: 03/04/2020

As the COVID-19 pandemic sweeps the world, doom and despair dominate the news around the clock. We fear for the health and livelihood of ourselves and our loved ones. In times like these it’s important that we maintain perspective.

Given the current situation I’d like to contemplate the pandemic from another point of view. Let me start by saying that chronic disease is THE leading cause of death and disability throughout the developed world. This is completely different to our grandparents and previous generations who primarily dealt with infectious disease and diseases of nutritional deficiency. Now as such, modern healthcare systems are well-equipped to address these acute conditions. 

With the arrival of better hygiene, antibiotics, and identification and manufacture of essential nutrients, we have these conditions mostly under control. Get a bacterial infection, take an antibiotic. Have a B12 deficiency, take a supplement. But now there’s a new threat to our health, and it’s growing. Surprisingly you might wonder, this threat is not COVID-19, but rather the possible implications that COVID-19 is having on our society. 

With the current COVID-19 situation and the huge economic and social impact being enforced on our populations, I dare ask myself this question:  although the political actions taken may save lives within the “at risk groups” and reduce burden on the healthcare systems, what could be the larger potential fallout from these stringent measures? I cannot help but recognize how all of this is causing so much stress, worry and anxiety.  I encounter mood and anxiety disorders in my everyday work of seeing clients, and I follow research on the topic closely, noting a jump in the prevalence of these conditions throughout populations world-wide. Mood and anxiety disorders are becoming increasingly common forms of chronic disease.  Furthermore, stress, mood and anxiety disorders predispose and associate with other forms of chronic disease. For example, there is a well-studied relationship between functional gastrointestinal disorders and mood disorders¹. Insomnia and depression are also linked², as are depression and chronic pain³.  

Chronic disease is nothing like acute infection or nutritional deficiency. While you can use the term “cure” to describe what happens when you treat acute infection effectively, chronic disease is more about management. This is not to say that chronic disease cannot be cured, just that it cannot be approached like acute infection/nutritional deficiency. In fact, some common chronic diseases, like type II diabetes can be cured and many can at least be effectively managed through lifestyle changes. 

Addressing chronic disease successfully requires a recipe that uses a “personalized overview” sort of approach, as we use in Functional Medicine. It needs a large dose of lifestyle intervention accompanied by a targeted medical and detective approach that addresses and understands underlying causes. But let’s make no mistake, the lifestyle portion is crucial, and stress plays a huge role in it all.

Stress and chronic disease: Predisposing factors, acute stressors, and perpetuating habits

A recently published paper put forth an interesting paradigm for Post-Traumatic Stress Disorder (PTSD)⁴. It’s such an elegant paradigm that it likely applies to how stress exacerbates and perpetuates most chronic disease. The infographic below details the model:

In this model, there are three categories of factors that promote susceptibility:

• Genetic predisposition ‒ genes that set the tone for your sensitivity to stress
• Cacostatic load ‒ the cumulative amount of stress your body is under
• Early environment ‒ early life experiences that set your stress “tone”. Things such as fetal stressors (smoking, premature birth), the environment you were raised in, socioeconomic status, and early life trauma

Traumatic stress refers to the triggering event that tips a person into chronic disease. In PTSD this may be combat, loss of a loved one, major financial loss, tragic accident, or major illness. But in a condition like irritable bowel syndrome (IBS), it may be an initial food poisoning leading to post-infectious IBS. The stress need not be psychological; anything that stresses the body will do.

The combination of susceptibility and a traumatic stressor can lead to a disruption of our circadian rhythm; our evolutionary preferred wake/sleep patterns. This is especially likely in those with genes that predispose to it. In PTSD this leads to alterations in glucocorticoid signaling (stress hormones, such as cortisol). In type 2 diabetes it may lead to improper glycemic (blood sugar) control.  In functional gut disorders, it could lead to alterations in bile output (which helps to break down fat), gut motility (which helps to protect against IBS), or pancreatic insufficiency (lack of enzymes to break down food).

This puts the patient at a pivotal point. If they correct the circadian disruption, symptoms are transient and the patient recovers. However, if the circadian disruption persists and becomes chronic, this traps the patient into a state of chronic disease. Since chronic disease tends to beget chronic disease, comorbidities accumulate.

Addressing excessive and cumulative stress

Most of the factors in this paradigm are constants. Stressful events are going to happen no matter how hard you try to control for them. At the top level, you have no control over your genes or your early life environment; those things are set in stone. You can, however, adjust your cacostatic load and work to prevent chronic circadian disruption after the triggering event.

Cacostatic load simply refers to the cumulative amount of stress your body is under, including disease states. Genetic susceptibility and early environmental stress regulate how your body responds to stress. They also play a role in the amount and types of stress you can deal with. Be that as it may, lifestyle is a big factor as well.

Many lifestyle factors regulate our sensitivity to stress as well as our capacity to deal with it, including:

• Sleep ‒ maintain a consistent schedule and good sleep hygiene
• Circadian rhythms ‒ pay attention to your light environment & feeding/fasting cycle
• Exercise ‒ get adequate moderate to vigorous physical activity every week (>150 minutes)
• Being active ‒ walk more, sit less
• Weight ‒ maintain a healthy weight
• Diet ‒ follow a nutrient dense, unprocessed diet with a high of variety of different foods
• Stress ‒ reduce stress exposure and/or manage stress using tools such as meditation and yoga

Building resilience by prioritising these behaviors lowers cacostatic load and increases the amount of stress you can experience before hitting the tipping point. It also ensures that the acute circadian disruption after a traumatic event is acute, and transient.

Take action – resilience is key

Many face – or have already faced – major personal or financial loss due to COVID-19. We return to the question at hand; may the soaring anxiety levels make more damage to our health than the pandemic itself? In my experience of working with stress-related illness, it may well be. Indeed, science provides robust support to the stress-disease hypothesis.

Stress is a major contributor to the chronic disease burden in the developed world. Whereas our ancestors were intermittently exposed to acute stressors, most of us are under chronic stress. Our cumulative exposure to stress can place a burden on us that is represented by cacostatic load. Other factors such as genetics and early life environment play a role in susceptibility, too.

Building a strong foundation of resilience is key to preventing stress from pushing yourself past the tipping point. It’s also critical to being able to bounce back when a strong enough triggering event knocks you down. Sleep well, keep a schedule, exercise, eat a healthy diet, manage your stress and remove the stressors you can. It could make the difference between being happy and healthy or sick and depressed. This is even more pertinent in the current times. 

References

1. https://www.ncbi.nlm.nih.gov/pubmed/28087404

2. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-1075-3

3.https://www.sciencedirect.com/science/article/abs/pii/S0165032717308364?via%3Dihub

4. https://www.frontiersin.org/articles/10.3389/fpsyt.2019.01003/full?fbclid=IwAR3tY-fER9ItPOJ38xPtdcywHOJ6DlFL2fbWkxRAPGOiwODaI0gVlK8chuw