Decrease and Manage the Stress In Your Life

Oftentimes, our ancient brains don’t seem well equipped to deal with the speed and complexities of modernity. The landscape bombards us with perceived threats and problems, and we have trouble not ruminating on them. To navigate this environment, while maintaining our composure and sanity, we need to strengthen our resistance to stress.

My guest today has written a guidebook to how that’s done. Her name is Dr. Mithu Storoni, and she’s a medical doctor who also holds a PhD in Neuro-ophthalmology, as well as the author of Stress-Proof: The Scientific Solution to Protect Your Brain and Body — and Be More Resilient Every Day. Today on the show we discuss the difference between acute stress and chronic stress and why acute stress can actually be good for you, while chronic stress can change your brain so that you get more stressed out when you experience stress. We discuss how both cortisol and inflammation can actually be beneficial in the right amounts, and how to get them in the right doses — including the particular type of exercise that will best help you recover from stress, and the role diet and even Tetris can play in managing it. We end our conversation discussing how making time for hobbies can prevent you from falling into the stress trap.

Show Highlights

What is stress?
What’s the typical approach to stress management?
The difference between acute stress and chronic stress
How chronic stress lowers our ability to deal with more stress
How stress impacts the physical structure of your brain
The dangers of ruminating on things
Learning how to regulate your emotions
Why Tetris can help your stress (and why it’s sometimes good to distract yourself)
Inflammation — its bad rap, but also its occasional benefits
The importance of gut bacteria to your stress and overall health
Getting out of a stress-induced slump
The power of agency

Resources/People/Articles Mentioned in Podcast

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Read the Transcript

Brett McKay: Welcome to another edition of The Art of Manliness Podcast. Oftentimes, our ancient brains don’t seem well equipped to deal with the speed and complexities of modernity. The landscape bombards us with perceived threats and problems and we have trouble not ruminating on them. To navigate this environment while maintaining our composure and sanity, we need to strengthen our resistance to stress. My guest today has written a guidebook on how that’s done. Her name is Dr. Mithu Storoni and she’s a medical doctor who also holds a PhD in neuro-ophthalmology, as well as the author of the book Stress-Proof: The Scientific Solution to Protect Your Brain and Body and be More Resilient Every Day.

Today on the show, we discuss the difference between acute stress and chronic stress, and why acute stress can actually be good for you, while chronic stress can change your brain so you get more stressed out when you experience stress. We discuss how both cortisol and inflammation can actually be beneficial in the right amounts and how to get them in the right doses, including the particular type of exercise that will best help you recover from stress and the role of diet and even Tetris, yes, Tetris the game you played on Game Boy when you were a kid can help manage it.

We end our conversation discussing how making time for hobbies can prevent you falling into the stress trap. After the show’s over, check out our show notes aom.is/stressproof. Mithu joins me now via clearcast.io.

Dr. Mithu Storoni, welcome to the show.

Mithu Storoni: Thank you so much for having me. It’s a huge honor to be here.

Brett McKay: So you recently published a book called Stress-Proof. It’s all about managing stress or dealing with stress, which is something a lot of people say they got problems with these days. I’m curious, how did you get started down the path of researching and writing about stress?

Mithu Storoni: So, there was one big catalyst for my book, which was I moved from, well, I moved countries and continents from London to Hong Kong, and I was suddenly surrounded by lots of people. amongst to my husband was one who were in very high octane jobs, under a lot of pressure, and really suffering from the prequel to burnout. So suffering from stress. And given my background as a physician and a neuroscience, they asked me for advice. And despite all I knew, I realized I actually knew very little about stress, I knew very little about what the difference is between good stress and bad stress, why stress causes harm and what you can do about it.

So I decided to sit down and go through, I had a little bit of time, so I went through every single paper I could find cataloged in the National Library of Medicine of the United States. And I went through about 1000 and I condensed them to just under 600. And I kind of created a manual that I could just give to friends, to colleagues. And I got some good feedback from it and that turned into a book. So, that’s how the book appeared.

Brett McKay: So, let’s talk about how, so a lot of people are experiencing stress these days. What’s the typical approach that people take when it comes to stress?

Mithu Storoni: So the typical approach that people take is usually based on the first problem, which is that people don’t realize where their stress is coming from and people don’t realize stress is actually present. So, for instance, most of us recognize stress as the billboard image of stress is someone, the face of someone who’s under a lot of physical emotional pressure. But in fact, a chronic stress is much more insidious and much more long term and acts slowly, and it’s much more difficult to recognize and more importantly, to recognize its source.

So, people tend to resort to fixes that they assume will work for them because it’s worked for everyone else. So there are lots of a one size fits all approaches. And once they try these approaches, it becomes apparent that a one size fits all doesn’t work. And I think that’s the second problem. So the first is recognizing where the stress is actually coming from and the fact that it’s chronic stress. And secondly, it’s recognizing the fact that one person’s source of stress is going to be very different to another person. So what works a person B will not work for a person A.

Brett McKay: We’ll delve deeper into that. So what is the difference between acute stress and chronic stress?

Mithu Storoni: So, we all know, so I’ve heard some of your brilliant podcast episodes before. Like you, I’m a huge admirer of stoic philosophy where a little bit of acute stress or a little bit of pressure actually does us good. So I was always familiar with that when I entered into my research into stress. And the real gray line that is now starting to become clearer is where the distinction actually lies between stress being good in short bouts and stress turning bad or causing damage in longer bouts.

So if you just imagine, first of all, it’s taking a step back, of what stress actually is, what actually causes stress. And in order to understand that, I suggest going right back to the research of Hans Seyle, who’s considered the kind of the godfather of stress. So back in the 1930s, he was the first one to show that stress actually causes physiological effects, measurable effects on the body. And he first defined stress as, in calling it the general adaptation syndrome.

If we fast forward the past almost 80 years or so, we’ve now come to a place where more information about how the brain works is converging on the idea that the brain is constantly trying, the brain is in essence a prediction machine, and it’s trying to create a model of the universe and it’s trying to use Bayesian confirmation. So, it’s trying to create the model, create a hypothesis, make a prediction and then confirm that its prediction is true. So it’s trying to constantly predict the universe, the environment around us and updated its model.

With every single moment of passing time, the brain encounters change. When it encounters change, it has to update its calibration or change, it will modify its calibration process. But in order to be able to do that efficiently, it needs to know what’s about to happen next. So, one of the triggers of stress is not knowing what’s about to happen next. And so uncertainty, as we all know, is one of the most potent triggers of stress. And uncertainty, according to some theories, lies pretty much behind the, it forms the foundation of the acute stress response. Because the stress response is, in essence, default kind of a recalibration response to cover all bases in the face of uncertainty.

Now, that’s what acute stress is, and we’ve been used to acute stress for years and years. Our ancestors had it, it does is good. And we know that for instance, in acute stress, there are certain processes that happen, which are actually very beneficial. For instance, we know that neuronal plasticity, synaptic plasticity is temporarily increased during acute stress. We know that during acute stress, the brain instigates a mechanism which allows the body to survive no matter what the organism, so us, whatever we face.

In chronic stress, these processes stay turned on because one of the ideas, one of the theories is because the brain assumes that the uncertainty it faces isn’t over. And that’s one good way of looking at it. So any uncertainty that the brain is facing remains. Any threat that the brain is perceiving remains. And as a result, the stress response stays switched on, or there is insufficient recovery from a previous stress response. When this happens, the processes that the brain kick starts during an acute stress response stay turned on and they start going awry. And that is the distinction between acute and chronic stress.

So for instance, as soon as you become acutely stressed, motivation rises. But in acute and chronic stress, we find in both human and animal studies, that chronic stress relates to a decline in motivation. So that pathway goes awry. Acute stress increases plasticity in certain parts of the brain. But we know that the effect of glucocorticoids or the stress hormones that our body produces becomes different. And the difference is dose dependent, so it becomes different depending on how long the glucocorticoids, the stress hormones are produced for and how long they hang around for and how much the stress hormones are produced.

So all of these things change the same processes that are started in acute stress when they become chronic. And when they become chronic, they start causing harm.

Brett McKay: That was very useful. I’d like to delve deeper more into how our brain changes. So, you have sections of the book where you thoroughly explain like what happens through the brain, for example, when you experience acute stress, but then how the brain changes once you experience chronic stress, and how those changes in the brain can actually increase the chances you’ll become more stressed out whenever you experience stress again. So, what parts of our brain changes whenever we expect chronic stress that makes us less resilient to stress?

Mithu Storoni: So one way of thinking about it is stress is not a disease process. Stress is a state of the brain. And that’s really important distinction because the brain is constantly adapting to whatever is asked of it. And when the brain faces acute stress, it goes into a certain functional configuration. So, for instance, your alertness, your arousal is increased. Your emotional volatility is increased. Your ability to focus on one single thing generally is reduced. You become more attentive to everything. So these are things that are the temporary changes associated with acute stress.

Now because the brain is so plastic and it’s so intelligent, that intelligence has allowed us to survive until today, the plasticity allows the brain to change itself for maximal efficiency. So if it is constantly in an environment where it needs to remain hypervigilant or it’s constantly in an environment where its need for attentional focus diminishes. The brain almost changes its structure to compensate for that need.

Now, for a long time, most of these studies really came from animal observations because we couldn’t look well enough into the human brain. But actually, for the first time in history, a study published from the Karolinska Institute in January 2017, so just two years ago, just over two years ago, showed that chronic work stress exposure, so occupational stress exposure, actually causes thinning in parts of the prefrontal cortex, which is the part at the front of the brain. It caused, in that particular study, caused an increase in volume in parts of the amygdala and it caused a decline in volume in a part called the caudate nucleus. So, in this study, the researchers took a bunch of people who were exposed to occupational stress, compared them to controls, and that’s what they found.

So you can argue that, okay, that’s just an association, that’s just a parallel change or that might be coincidental. The researchers then took these same individuals with this visible thinning and enlargement in volume in these distinct places. And they put these individuals through three months of stress management therapy, which included cognitive behavioral therapy but did not involve any medications. And then they measured, they looked at their brains again and they found that this thinning in the prefrontal cortex, parts of the prefrontal cortex was reversed in these individuals.

So, that was the first time in history that researchers showed that any thinning or any structural changes, which were more present in people with stress, were reversed when the stress was removed, when these people were given relief from stress. So that was the first, you know, an enormous step forward in showing that stress isn’t just a formless, psychological state of mind. It actually has implications and these implications act on the brain. But I think what’s important is, we cannot say that stress, these patterns of change in the stressed brain were necessarily pathological or were necessarily harmful. You could argue that they were, as I just mentioned, adaptive changes.

So if you place the brain in a chronically stressed environment, the parts of the brain that are used more, in effect, become, show change, and the parts of the brain that are used less also show change. So that’s kind of what’s happening when we see plastic change in the brain in response to chronic stress.

Brett McKay: The problem with those changes, it is adaptive, but in a way, it’s maladaptive because that prefrontal cortex comes in handy for solving problems, right? So if that’s diminished, it makes it harder to solve the problem that might be causing you chronic stress.

Mithu Storoni: That’s absolutely right. So, the important thing is the context of these changes. So in a day to day, in a healthy environment that we live in today, these changes, so shrinkage of the prefrontal cortex can indeed suggest that there is diminished prefrontal activity and we need the prefrontal cortex for, as you say, these higher mental functions.

And to support what you just said, a second study, more recent study showed that even in people who are not stressed, who are not complaining of stress, around young to middle age, young men and women have been shown in one study to have thinning in the prefrontal cortex, which was associated with higher levels of circulating cortisol, the stress hormone. And this thinning was associated with poorer working memory, even at a young and middle age when these people did not complain of stress and did not complain of memory disorders.

Brett McKay: The other kind of nefarious thing about stress in the modern age is, okay, I think we all understand that when you exercise or lift weights or run, you experience stress. Or if you see something dangerous happening, you experience stress and you can see how having that stress response would be useful in a situation where say there’s an accident, a car accident and the stress hormones kick in and it helps you deal with the situation.

The problem with a lot of stress today is that uncertainty that’s in our brain, and it’s like we’re just sort of kind of coming up with it in our head. It’s like you’re at work. And there’s nothing really like physically stressful happening to you. There’s no barking, there’s no lions chasing you at the office, hopefully. But it’s this more cognitive type of stress. Like you’re just imagining bad things happening to you. So it’s like the brain is actually, because we’re so good at thinking about the future and coming with different situations, we actually, we’re too smart for our own good in a way.

Mithu Storoni: That’s right. And actually, one of the biggest advances in stress and what the most recent data shows is that perceived stress is the primary driver of chronic stress. And perceived stress depends on your own perception and your own perception is going to be different from the perception of someone else. So, the perception of the world around you, the perception of a stress as of a stress as being a stressor, the perception of whether or not you can cope with a certain stressor, all depends on how, on the mechanisms and on the patterns of thought and patterns of behavior and patterns of reaction that your own brain carries out.

So it is possible to modulate the perception of stress. And we’re finding that certain soft factors, which are almost surprising in a way, can actually modulate the perception of stress and reduce the chronic stress burden.

So one example which I absolutely love, which I quote in my book is, we base, you know, we just talked about how the brain creates a model of the world from the cues it’s receiving in the environment around it. And this model of the world forms the basis for whether or not the brain gauges the presence of uncertainty. Now, different people will form a different model of reality, of the same reality. And the reason why this difference exists is because different people attend to different cues. As William James famously said, my experience is what I choose to attend to. So, everyone’s experience is different, and hence, the stress triggers and the stress interpretations will be different in each case.

So this example that I quote in my book is the following. If you have a stress reaction to anything, a psychological stress reaction, say an argument with a colleague, with a loved one, an altercation with your boss, your perception of that stress reaction will not correspond to reality. And one of the most intriguing things that recent stress research has revealed is this extraordinary relationship between rumination and chronic stress.

So, going back to the scene where you’re having an altercation with your boss. So you enter the office, and just say, on a Monday morning at 10 o’clock, you enter your boss’s office and you get three minutes of criticism. You have no altercation, your boss shouts at you for three minutes. At the end of this three minutes, you open the door and you leave the room. Now your boss knows your stressful experience, this only lasts three minutes, and it’s over. You know you’ve left the room and your stressful experience is over. But does the brain know? Does your brain know that your stressful experience is over? Your brain is using cues to create an image of reality.

So if after the stressful experience, your brain replaced the scene repeatedly as you leave the room, as you close the door, as you returned to your desk, your brain perceives that the experience is still going on. So it’s all your memory of the event is almost acting like an internal cue to distort your perception of reality and make that perception of stress last longer.

So if you have five such episodes of stress triggered by not just an altercation with your boss but just say, you know, getting stuck in traffic or a miscommunication with a friend or an argument, misunderstanding with a stranger, if you have five such episodes during the day and you ruminate after each one, you will perceive, let’s just say, you ruminate for 45 minutes or an hour. In your head, that stressful experience has suddenly expanded in size. When you come home at the end of the day, rather than having had just 15 minutes of stress, you may well imagine, your brain may well perceive that it has had five hours of stress during the day. And this habit of dwelling on something is a very interesting one because it has such a simple solution.

So, the moment you you’re out of the stressful situation, if you do something as simple as distracting yourself so completely that your mind doesn’t wander, so ideally in an immersive activity, that alone will rapidly bring down your stress response, and treating rumination has been shown to reduce a high blood pressure in people suffering from chronic stress induced hypertension. So that’s how powerful this tiny little habit shift is. And it’s even more powerful because it shows you that at times of stress, you can’t tell your mind what to think but you can tell it what to do. So manipulating your thoughts through your behavior changes your perception of the environment, and hence can impact your chronic stress burden.

Brett McKay: There’s a lot to unpack there. But for now, let’s talk about some of the seven stress agents you highlight in your book. The first one you talked about is that our brain goes on emotional high alert when we get stressed. And that can cause us to overreact to things and make the problem worse. So what are some things that we can do, some research back tactics to mitigate that state of emotional sensitivity we experience whenever we get stressed?

Mithu Storoni: So, I talk about the seven agents of stress as you say, and the seven agents of stress are really seven things that the brain, the seven processes that the brain kicks off as soon as we become acutely stressed. And there are actually more than seven, but these seven have been most studied.

So my first one is generalized arousal, including emotional reactivity. And emotional reactivity is a very interesting, very interesting element of stress because as soon as we become acutely stressed, we become emotionally reactive. But at the same time, an inability to regulate emotions increases our vulnerability to stress. And the trick is here to, we know about it as emotional intelligence, but the trick is here to kind of play with attention, regulation, self-control, self-regulation, to regulate your emotions.

So what do I mean by that? So in a good healthy functional brain, and a good healthy person living a nice balanced life, and I’m being very generic here, you’re usually engaged in what we call goal-directed activity, which means your prefrontal cortex guides, kind of coordinates the rest of your brain like an orchestra, like a conductor coordinating an orchestra and guides your brain towards a goal that you have chosen. And when your prefrontal cortex is in that goal-directed mode, different parts of your brain, different departments of your brain are up-regulated and different departments of your brain are down-regulated.

And in order to achieve that goal and to carry your brain towards that goal, your prefrontal cortex does what is called self-regulation, or either you carry out self-regulation. Self-regulation basically means coordinating your brain to serve the goal. And it has elements of self-control because when you’re, you know, if you are writing an article or writing a piece for a deadline, any distraction is bad. So every time you have loud noise behind you or you’re tempted to go for a walk or to just go out and do something that’s better than writing whatever you’re writing, those temptations, those distractions are muted by a prefrontal cortex when it is carrying out good self-regulation. And if you have better self-control, you will also resist those temptations more.

Similarly, when you are working towards a goal, your emotions need to be regulated. You don’t want to pay heed to any emotions that are not relevant to you or don’t serve your purpose at that moment. And your prefrontal cortex along with other regions, so it’s not just a single kind of, this is a very reductionist kind of way in which I’m describing it, it’s actually much more coordinated process. But your prefrontal cortex sits at its center in this regard. So your prefrontal cortex regulates your emotional reactivity and regulates your emotional appraisal of things so that your emotions don’t react inappropriately while you’re serving that goal.

Now, because self-control forms part of that self-regulation, it’s logical that improving your self-control can improve your emotion regulation. And there are studies that confirm this. The area of research is still very early but it is progressing. So, there are few studies, for instance, that show that attentional control training that increases self-control will also help mute emotion, kind of distracting emotional thoughts.

There are also studies on using neurofeedback techniques, where you learn to mute your emotional reactivity by reducing your overall arousal by using breathing techniques, by using other kind of physical techniques to keep your brain in a state of good self-regulation so your emotions don’t surface. So self-control training, attentional control training, neurofeedback training, and within that I also mentioned yoga which can be used kind of as a tool of neurofeedback involving self-control, all of these things improve your state of self-regulation, and hence harness an inappropriate emotional reactivity.

Brett McKay: Is this where stoicism would come in as well or maybe cognitive behavioral therapy, where you learn or you tell your brain, okay, it’s just an emotion, just because I’m feeling this doesn’t mean it’s necessarily so?

Mithu Storoni: Yes. So cognitive behavioral therapy is definitely part of it. Cognitive reappraisal has been shown to be effective. You mentioned stoicism, and I think that the essence here is that you need to balance two things. The first thing is that when your brain is, when your mind or your brain is emotionally reactive, it’s very difficult to reason with emotions beyond a certain threshold. So, very early on in the process.

So when your brain is becoming more and more aroused or alert and it’s just about to descend into stress, if you tackle your brain when it’s at that point when your arousal levels, your alertness levels are really, really high but you haven’t quite kicked off your hormonal response to stress, if you tackle it at that point, you can kind of reason with your brain and draw back. You can have greater control over your stress reactivity and draw back.

But once it goes over the hill and it descends into a stress response, it’s difficult to use logic with your brain. And at that point, you have to use things which target the nerve network that’s responsible for your stress reaction, so your autonomic nervous system, because targeting the nerve network doesn’t involve you having to reason with your mind. So in the middle of a stress reaction, you can’t reason so you have to use different techniques.

Brett McKay: And what would those techniques be?

Mithu Storoni: So, one of the really interesting areas here is we know that in order to stem a stress reaction, so we know that chronic stress relates to perceived stress. And perceived stress relates to things like rumination, things like how quickly you recover after each stress response. Now, we know that increasing the gradient, so making your stress response shorter, recovering your normal functioning state of your autonomic nervous system, all of these things reduce the burden of that particular stress episode. So they reduce the perception of stress during that time. So things that target autonomic flexibility or things that improve autonomic flexibility have a role to play in mitigating your stress response.

So one study I can think of straightaway that I think I’ve quoted also in my book is, you know, even a single bout of something that trains your autonomic reactivity. So for instance, we know that certain types of yoga done in very certain ways can train your autonomic reactivity. But it doesn’t just have to be yoga by extension, it can in theory be anything else that trains your autonomic reactivity. One session of yoga reduces the impact of a psychosocial stress response immediately after the yoga session.

So, in the study I’m talking about, this is actually a recent study, some researchers just gave a bunch of people a lesson on yoga through a video. And immediately after that, the volunteers were subjected to psychological stress. They measured cortisol and they measured markers of the autonomic nervous system, the nerve network involved in stress throughout the stress response and afterwards. And they found that compared to controls, compared to the control condition, yoga reduced stress reactivity and it increased recovery after stress.

So, in very general terms, what this means is that anything that improves your autonomic reactivity improves flexibility of your autonomic nervous system, will enable you to recover faster from stress in the situation where you can’t reason with yourself to recover. So you need your autonomic nervous system to stay flexible at all times. So improving flexibility is key to stress recovery.

And I’m going to bring something else in here which is very interesting. The stress response really has two parts. It has the nerve part, which is the autonomic nervous system, and it has the hormonal part, which we abbreviate to the HPA axis. Now, we all use cortisol as a marker of stress, we call it the stress hormone, and we think that lots of cortisol equates to lots of stress. But actually, there is a dissociation because you can have too much cortisol or too little cortisol.

What many of the stress studies have ignored for a long time is that your autonomic nerve network is key, not just in your stress reactivity but also in your well being. And in people who suffer from chronic stress, the flexibility of your autonomic nervous system becomes limited, it becomes smaller. So people with chronic stress don’t show the autonomic nerve response to acute stress as much as they should. And again, it’s not necessarily the absolute state of your hormones and of your nerve network that’s contributing to chronic stress, it’s the flexibility of it. So things that improve the flexibility will help that.

Brett McKay: So besides yoga, you talk about in your book that breathing techniques can help improve that flexibility too. So I want to go back to that idea you mentioned earlier about rumination because that’s a part of, so we might experience a stressful situation with our boss, it only lasted three minutes. But the thing that can amplify the effect of the stress is us thinking about it over and over again. Our mind can’t differentiate between like something actually happening to you and like just you thinking about it in your head. You mentioned you can distract yourself from that using different tactics. How can you distract yourself from ruminating so you don’t experience that stress over and over again?

Mithu Storoni: So, you need to have an activity that is so interesting and so engaging that your mind does not have the chance to wander. That’s the key. So that activity can be anything. It can be playing a game on your phone. There are studies that show Tetris has this effect. So I mentioned Tetris, for instance, in the book, but it doesn’t have to be Tetris, it can be any any activity or game that engages you to the extent that your mind can’t wander. Because if your mind can’t wander, it can’t replay the scene. If it can’t replay the scene, you can’t imagine the scene is happening.

Brett McKay: Good. So I mean, I think that maybe, so it’s a distraction, I think that’s why some people when they get stressed out, they do unhealthy things like they shop or they eat or do things like that because it’s a distraction. But playing Tetris, that’s not going to hurt your waistline or your pocketbook.

Mithu Storoni: That’s right. I mean, one of the problems with stress, with what we do immediately following stress, which kind of leads into some of its negative maladaptive consequences is we deal with stress in inappropriate ways. And having strategies out there that you can resort to or having backup strategies on your phone is a very helpful way of preventing you from resorting to distraction techniques through inappropriate way.

So another example, for instance, is alcohol. Many people use alcohol to unwind after stress. And there is, this is again, a very maladaptive practice because not only does excessive alcohol use harm the very same parts of the brain that you need to stay well to maintain a healthy stress reactivity but chronic stress kind of acts in synergy with alcohol to cause cognitive damage. So, alcohol is one way people try to relax from stress, but again, playing Tetris is far safer.

Brett McKay: So you mentioned hormones, and we think cortisol is bad but it’s useful, there’s a purpose there. But too much of it can be a bad thing. And so it’s not so much the stress hormone itself, that’s a problem, it’s an imbalance of the stress hormones. So, are there things we can do if we are experiencing chronic stress or even acute stress so that those hormones, they help us more than they hurt is I guess what I’m trying to ask.

Mithu Storoni: Cortisol is actually very, very interesting because, you know, as you say, we associate cortisol as being bad. So we say, oh, this raises our cortisol so it’s a bad thing or stress, we measure stress using cortisol. And hence, cortisol is a bad thing. But actually, cortisol has got a very interesting effect because cortisol, as anyone with asthma or with eczema will know, cortisol actually has an antiinflammatory effect.

Cortisol is, we don’t know why we have evolved to have the stress response that we have but one theory is that cortisol is produced at the end or towards the second half of the stress response. And the first half of the stress response increases inflammation, whereas the second half, the latter part, we don’t know where the distinction is between the first and second, by the way, but essentially, the latter part of the stress response kind of acts to restore us back to our healthy form, back to our normal form. And so cortisol actually has an antiinflammatory effect in short bursts.

But what’s so interesting with cortisol, and actually, with pretty much all the hormones involved in the stress reaction, as you say, is that all of these, in all of these cases, the dose makes the poison. So, while short sweet bursts of cortisol can have an antiinflammatory effect, excessive amounts of cortisol increases inflammation. And another thing I’d love to kind of bring in here is the relationship between growing new brain cells and synaptic plasticity. Acute bouts of stress actually increase plasticity in mouse studies, not in human studies, they’ve been shown to increase the birth of brain cells. Essentially, they increase synaptic plasticity in the hippocampus and possibly in parts of the prefrontal cortex.

Now, what’s really interesting is BDNF is a kind of a growth and nerve growth factor nerve growth, a synaptic plasticity elixir is one way of looking at it. And BDNF production, BDNF is produced during acute stress, and BDNF production actually correlates with cortisol. So if you have a really big bout of cortisol released during acute stress, you have, it corresponds to a good amount of BDNF production as well. But the cortisol has to decline very fast for the BDNF effect to be at its peak.

As regards to what we can do to reduce cortisol, the idea isn’t necessarily to reduce cortisol but it’s to cut short its production after stress. In fact, we want to produce good amounts of cortisol during a stress reaction and chronic stresses is associated in some cases with less cortisol production during the acute stress reaction. So, what we want to do is cut it short, we want to produce a good amount, we want to cut it short. And things we can do to cut it short are as follows. So one example I’ve given in the book is exercise. But again, like with all the other things, the dose makes the poison. So there is evidence, one study that I’ve coached quoted shows that the dose of exercise can make a difference to what it does to cortisol levels.

Now, you know, as per nature’s philosophy, a little bit of stress is good for us and we think that’s kind of how exercise works. Exercise is a stressor. And little bits of exercise or regular little bits of exercise do us a great deal of good.

Now, in the context of cortisol, we know that in the study I’ve quoted, they measured the intensity of exercise as per VO2 measurements and low intensity exercise. So in that study, people who exercised at intensities at or less than 40% VO2 max, for those people, 30 minutes of exercise actually reduced cortisol circulating cortisol levels in their blood. Whereas exercise at 60% or 80% VO2 max level increased levels of cortisol. So following immediately, following a stress reaction, when you want to bring down your cortisol levels as quickly as possible, low intensity, longer duration exercise is one very good idea. So that’s one example.

Brett McKay: Let’s talk about inflammation because that’s another stress agent. And inflammation is one of those other things that have gotten a bad rap. We think that all inflammation is bad. But inflammation can be useful, for example, after you lift weights, I know your muscles experience inflammation, and you actually need that inflammation for your muscles to get stronger or to adapt. So I guess there’s a point where too much inflammation can actually be a bad thing, right? So the sort of same thing with cortisol.

Mithu Storoni: Right. So, inflammation is essential for our survival. The role of inflammation within an acute stress response is in case there are any bugs entering us, entering our bodies through our wounds, we want there to be, or we have any cuts, we want to have inflammation to protect ourselves. So it’s a defense mechanism.

Now, when it comes to stress and inflammation, there are some very, very interesting threads. So, one interesting thread I’ll bring in here is recent evidence that this is deviating from stress a little bit but recent evidence that in certain conditions, in certain settings of depression, which can be a long term sequelae of chronic stress, in certain cases of depression, anti-inflammatories seem to be more effective than standard antidepressant medications. Now, that’s not saying all depression is caused by inflammation at all. It’s not even saying that all depression cases need to be treated by anti-inflammatories. But it shows you how inflammation and disease of the brain that relate to the stress pathways have a relationship.

With regard to stress, the acute inflammation we get in stress does us no harm. And in fact, the rise in inflammatory markers, so we know that there is a rise, for instance, in one cytokines, which is inflammatory marker rather than an actual instigated inflammation called Interleukin 6. The temporary rise in these things is fine because they decline. In chronic stress, these inflammatory markers, the cytokines and other inflammatory markers, they persist. And as stress becomes more chronic, there is evidence that people with chronic stress have very low levels of chronic inflammation.

And as you see, again, with regard to inflammation like with regard to cortisol, the dose makes the poison. Where there is an element of chronic inflammation, that chronic inflammation can have repercussions on communication within the brain and on disease processes affecting the body. And that’s where chronic stress we think relates or translates into some of its manifestations. So for instance, one very interesting study is the discovery of markers of inflammation within the reward pathways of the brain, which in animal studies correlate with the kind of the decline in the ability to feel pleasure that accompanies chronic stress.

When I talked about the psychiatric conditions, mental illness conditions such as depression, that can be treated with anti-inflammatories, we know that certain cases of these conditions and certain cases of depression show evidence of low level inflammation, peripheral inflammation. So if you test their blood, you find evidence of inflammatory markers. And it’s these patients who benefit the most from antiinflammatory therapy. So inflammation has a very nuanced relationship, short bouts are good, but when they become chronic, their effects change.

Brett McKay: I’ve noticed, I don’t know if this is related, maybe could be just coincidental. But I when I’ve gotten like a sinus infection and I’ve gone in to get an antiinflammatory shot, I feel great right away, but then I also I’m just like super motivated. I just like want to get a lot of work done. And it happens very quickly. I wonder if there’s something, there’s a connection there somehow.

Mithu Storoni: So, with regard to cortisol, there are several possible explanations for that. But one of them relates to what I just mentioned about the animal studies where inflammatory markers in the brain, in certain parts of the brain, the reward pathways in the brain correlated with the inability to feel pleasure and be motivated. So removing these, so achieving a state where there are no inflammatory markers in that part of the brain was associated with feeling more motivated towards pleasure.

So, this could relate to your own experience of this. The evolutionary kind of mechanism or theory behind this is that if you have inflammation in yourself, you want to sit there and you want to heal the wound before exposing yourself to uncertainty through exploration, which is what motivation invites us to do. Motivation increases our need, our desire, our want of exploration. So, it’s a kind of trade off that when you’re in danger, you repair and heal yourself. And then when you’re better and you’re well equipped to deal with any dangers that’s lurking behind uncertainty, you have your motivation back.

Brett McKay: So, what are things people can do to keep inflammation in check? Is it a matter of exercising, diet, things like that?

Mithu Storoni: Yes. So, coming back to acute stress and inflammation, actually, one of the really kind of intriguing things that tends to happen with acute stress is acute stress is a state where because you are running a default program, your brain is putting in a default mechanism that puts you in a state to deal with absolutely anything and to optimize your chances of survival. Your brain becomes king.

So all the nutritional aspects, energy aspects, all other aspects are there to serve your brain. So, during acute stress, there is evidence that our intestines become, the intestinal wall lining becomes a little bit broken or a little bit kind of compromised. And when the intestinal lining loses its kind of intact surface, not only do things that are good for us leak into our bodies from the gut, but also pathogenic bacteria also leak in to the blood from the gut, and also other fragments of these microorganisms that trigger inflammation.

So one of the routes through which stress or acute stress increases inflammation maybe through increasing gut permeability. So for instance, the stress of speaking in public has been shown to increase intestinal permeability.

Now in chronic stress, we know for instance that microbial flora act as gatekeepers, essentially keeping the lining of the gut intact. They have a really important function because if you think about it, your intestinal lining, your gut lining is where your environment becomes you. It’s where you meet your environment.

And so, you have lots of things, lots of elements passing through there which could be harmful, but they are dangerously close to your body. So you have a very large immune presence that’s along your intestinal, along your digestive tract. And there is a lot of crosstalk between the bacteria in your intestinal tract and these immune agents. And some of these immune agents are responsible for telling your body that this is safe and this is not safe and hence triggering an immune reaction. So, some of the ways in which you can keep your inflammation low, one strategy, which is very simple is to adopt a diet which reduces the inflammatory burden on your body.

Brett McKay: Yes. Some of the foods you listed as, or nutrients that you list is antiinflammatory or dietary fiber, which a lot of people don’t get enough of beta carotene, you get that in sweet potatoes and carrots. Turmeric is another one. But you got a whole list there in your book that people can check out.

Mithu Storoni: So yes, so choosing your food carefully is one way of reducing inflammation. Other environmental effects, of course, treating the other pathways is important as well. And also with regard to choosing your food carefully. And with regard to these microorganisms manning your intestinal lining, gut bacteria may well play a role in inflammation. So again, many of these studies are association studies. We’re only just getting the kind of early prospective randomized trials on this.

But there is evidence of bacteria playing a role for instance, I mean, a study came out I think just a few days ago, which has shown that certain combinations of bacteria in the intestinal lining through their crosstalk with the immune regulators that line the intestinal lining regulate our immune response. So, all of these kind of weigh into the food you’re eating, your gut bacteria, anything that promotes or prevents them. In my book, I mentioned elements of foods such as emulsifies, which have been shown to have a negative effect on your bacterial flora in the gut. So this is one very, very potent way of reducing inflammation.

Another way of reducing inflammation is, of course, recovering as quickly as possible after each stress response, so that the inflammatory state in which the stress response puts you is very, very temporary and short.

Brett McKay: All right. So eat your yogurt, get that good bacteria, get your fiber. Just eat a healthy diet, and you’ll probably be, got your bases covered for the most part.

Mithu Storoni: Right, right.

Brett McKay: So let’s talk about one more, so one more agent of stress that you’ve mentioned throughout this conversation, this idea that stress acutely can, actually increases motivation. But when experienced chronically, we can become depressed and unmotivated. So, how do you get out of a stress induced slump? Because it’s hard, there’s all these things we’ve been talking about, these tactics you can use to alleviate chronic stress. Well, you’re not feeling motivated to do them because like all this chronic stress has left you unmotivated to do anything. So how do you bootstrap your way out of that unmotivation so you can do these things that can solve your problem that you have?

Mithu Storoni: So, it’s very easy to, stress acts as a vicious circle because when you start feeling encumbered by stress, you start doing less and less, and you start doing different things with the time you have free. And one of the dangers of that is you start shaving things off your day or off your life, which actually have some very potent benefits. So, one of the things I recommend is reintroducing or making sure you never leave behind things in your day or in your week that give you pleasure.

And there are two other angles to this. The first angle is, one of the sources of stress or rather two of the sources of stress or uncertainty and a sense of a lack of control. So a lack of, a locus of control, of being kind of an agent of your environment. Being in command of your environment, being able to make things happen around you. And people with low levels of this sense of control and low levels of a sense of certainty, so people think the world around them is uncertain and feel they have no control over it have been shown to have more potent stress reactions.

So, when you’re in this downward slump of depression or not necessarily of depression, of chronic stress, then one of the really kind of beneficial ways of lifting yourself up again is convincing yourself off your sense of control, convincing yourself of certainty in your environment and controllability. And also, essentially kind of feeling in command of your environment. And a great way to do that is by taking part in a challenge.

So, you will have heard many people are aware that there’s something called active coping in which when you’re feeling stressed by something, doing something makes you feel better. And that something that you do doesn’t necessarily have to be directly related to the stressor. So, many people for instance take up training, they train more when they go through stress. I’ve had patients where when the patient is ill with some kind of very bad illness, their carer or their loved one spends the time alone at home building, putting new shelves up in a room or redoing the garage or doing something like that.

So active coping is really important to bring your controllability back, your sense of controlability. Taking part in a challenge and overcoming that challenge, again, reinstates your sense of agency reinstates the fact, the sense that you can make things happen, you are in control of your life. And being better today than you were yesterday is another element of growth, which again, has been shown to improve stress resilience. And again, challenge, taking part in the challenge or taking part in kind of an incremental growth related challenge, incremental improvement release a challenge is another great way to kind of bring yourself back out of that slump.

Brett McKay: So it sounds like get a hobby is like an easy way. And you might think, well, I don’t have time for hobby, I got too much going on. Sounds like you’re saying here’s like you actually don’t have time not to do a hobby or do something that’s going to give you pleasure because that’s actually going to help you, it’s going to carry over to other aspects of your life. Well, Mithu, there’s a lot more we could talk about, but where can people go to learn more about the book and your work?

Mithu Storoni: So, I have a website, my name mithustoroni.com, www.mithustoroni.com. So that has links to the book and links to me and it has a contact form as well if anyone wants to get in touch with me. And I’m also on Twitter on @Storonimithu and I also have a Facebook and Instagram presence with Dr. Mithu Storoni.

Brett McKay: Well, Dr. Mithu Storoni, thanks for your time, it’s been a pleasure.

Mithu Storoni: Thank you so much for having me.

Brett McKay: My guest today was Dr. Mithu Storoni. She’s the author of the book Stress-Proof. It’s available on amazon.com and bookstores everywhere. You can find out more information about her work at her website, Mithustoroni.com. Also check out our show notes at aom.is/stressproof, where you can find links to resources, we’re going to delve deeper into this topic

Well, that wraps up another edition of the AOM Podcast. Check out our website at artofmanliness.com where you can find our podcast archives, there’s over 500 episodes there, as well as thousands of articles we’ve written over the years, including articles about how to manage stress and how to not be so stressed out. Also, if you’d like to enjoy new episodes of The Art of Manliness ad free, you can do so only on stitcherpremium.com. Go to stitcherpremium.com. Sign up, use code ‘Manliness’ to get one month free to Stitcher Premium. And then once you’re done signing up, download the Stitcher app for iOS or Android and you can start enjoying ad free episodes of The Art of Manliness.

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