The physical toll of coronavirus-related stress and how to combat it – WBAL Baltimore

The constant stress of living in the age of coronavirus is affecting more than your mental health and emotional coping abilities. It's likely taking a toll on your body as well."We're living in a sea of stress hormones every day," said stress management expert Dr. Cynthia Ackrill, an editor for "Contentment" magazine, produced by the American Institute of Stress."We're not designed for a constant application of these chemicals," Ackrill said. "The stress hormone cortisol just ravages our bodies when it's dumped into our system repeatedly."Designed to keep you functioning throughout the day, cortisol levels are meant to rise in the morning and decrease as the day lengthens. The hormone's purpose is to maintain blood sugar levels to keep your brain and muscles functioning and suppress non-vital systems like digestion that might drag your energy down.But when triggered by a stressful occurrence, cortisol levels suddenly spike, and can take hours to dissipate. If that stress is constant, those levels don't drop, leading to cortisol malfunction and a disease-causing boost in inflammation."Inflammation is behind diabetes. Inflammation is behind heart disease. It's behind all of the autoimmune diseases. It's behind asthma and allergies, and the list goes on," Ackrill said.If you're genetically at risk or you already have an inflammatory condition, today's constant stress may well trigger or worsen your symptoms."The predispositions that people have, whether it is asthma or a history of migraine or underlying cardiovascular risk factors, stress on all of those are so much more acute now," said neuroscientist Peter Kaufmann, former deputy chief of the Clinical Applications and Prevention Branch of the National Heart, Lung, and Blood Institute."People have daily stress and often times they don't have any control over it. That's when stress has its greatest impact," said Kaufmann, who is now the associate dean for research and Innovation at Villanova University in Pennsylvania.Not dealing with that stress, he said, can even be deadly."In our work, we found that people who show physiological responses to mental stress have about a two- to three-fold higher mortality over the following five years," Kaufmann said.Here's how stress may be impacting five of your body's key systems.Your heartTension can directly increase heart rate and blood flow, and causes the release of cholesterol and triglycerides into the blood stream. Blood pressure can skyrocket from acute stress and may stay high as that stress continues.Yet hypertension and other heart disease symptoms are silent, with no real signs that you might be entering a danger zone.Some of our not-so-wonderful coping mechanisms, such as eating comfort food, drinking alcohol and smoking cigarettes or marijuana, can also raise our risk.Then there's the very real fear that we may lose someone we love to the coronavirus, or perhaps we already have. All of that can create a perfect storm of physical malfunction that may even shorten our lives.Kaufmann points to a recent study which showed how mental stress can cause a fall in cardiac ejection fraction a measure of how well your heart's main chamber pumps blood."The amount of blood that is pumped out by the heart with each stroke is reduced, and that fall is associated with a higher incidence of cardiovascular events, such as heart attacks, death, and unstable angina that requires hospitalization," Kaufman said.There's even such a thing as a stress-related heart attack, often called "broken heart syndrome." It occurs when the heart is stunned by sudden stress, and its left ventricle weakens."That has been shown to be triggered by severe acute events, such as the sudden loss of a loved one or an earthquake," Kaufmann said. "I think some of the post 9/11 cardiac events would fall in that category."In most cases, when the acute emotional stress dissipates, the heart recovers and goes back to its normal shape."But I've had patients who have developed acute congestive heart failure, life-threatening arrhythmias, even death from this condition," said New York cardiologist and author Dr. Sandeep Jauhar in a prior CNN interview."I think it's the clearest example of how our emotional lives directly affect our hearts."Your skinOne of the largest organs of the body, your skin is exquisitely sensitive to stress."The relationship between mind and skin is essential and undeniable," said dermatologist Dr. Alan Friedman, who is the interim chair of dermatology at the George Washington School of Medicine and Health Sciences."Stress absolutely exacerbates primary skin diseases from acne to psoriasis," Friedman said, "It can 'wake up' chronic viral infections like herpes simplex and herpes zoster ."Dermatologists across the country that CNN spoke to report increasing telehealth calls since March on such stress-related skin conditions as ache, eczema, psoriasis and shingles, a painful, blistery rash that can develop after having chicken pox.There's also an increase in calls from people experiencing the impact of increased hand washing and the wearing of personal protective equipment such as masks and gloves."Allergic contact dermatitis is huge right now where members of the public are now wearing gloves and masks they are not normally used to wearing," said Plano, Texas dermatologist Dr. Seemal Desai, who is on the board of directors for the American Academy of Dermatology."It's really quite alarming and disturbing how many skin conditions I'm seeing that are probably aggravated by stress and distress from the coronavirus," Desai said. "It's out of control."Your lungsHaving chronic obstructive pulmonary disease, or COPD, is a key underlying health condition that puts one at higher risk for a more severe case of COVID-19, the disease caused by the novel coronavirus.A group of diseases that cause airflow blockage and breathing issues, COPD includes emphysema and chronic bronchitis. Nearly 16 million Americans have COPD, according to the Centers for Disease Control and Prevention.Stress and anxiety can cause shortness of breath, leading "COPD symptoms to become worse and lead to further anxiety, faster breathing and fear," says the National Emphysema Foundation on its website."We tend to not breathe as well when we're stressed in general, so our oxygen exchange is worse. There's also a panic on top of it, which makes it worse," Ackrill said.Smoking is the leading cause of COPD and many other breathing-related illnesses. It comes as no surprise that smoking cigarettes or marijuana and the use of e-cigarettes may increase risk of severe consequences from COVID-19.Asthma is another underlying health condition that puts one at higher risk for a more severe case of COVID-19. Here again, stress is a common trigger for an asthma attack, and it can make existing symptoms worse.In fact, the stress a parent feels has even been linked to an increased risk for asthma in their children. One study looked at how parental stress affected the asthma rates of young children and found those with stressed out parents had a substantially higher risk of developing asthma."During an asthma attack it's almost like breathing through a straw because that inflammation is restricting the airway," said allergist Dr. Lakiea Wright in a prior CNN interview."You can imagine if a virus that causes extra inflammation gets in there, then that's going to be worse," said Wright, who specializes in allergies and immunology at Brigham and Women's Hospital in Boston."Those are the patients who might end up on ventilators to help with breathing because COVID-19 is doing a lot of damage in the lungs."Your brainStress is considered one of the most common triggers for headaches not just tension headaches, but migraines as well.Migraines are debilitating attacks that can level a person for hours to days with intense, throbbing pain, nausea and vomiting. According to the Migraine Research Foundation, the condition is the third most prevalent illness in the world, affecting 39 million men, women and children in the United States and one billion worldwide.Stress can cause migraines, the pounding pain creates more stress, and the circular pattern can make it tough for headache and migraine sufferers to cope.Chronic inflammation from stress can also affect the brain itself, shrinking or negatively affecting parts of the brain linked to memory, motivation and mental agility. That can lead to depression, anxiety and other mental disorders, which in another circular fashion are then made worse by stress.Chronic levels of cortisol can affect other chemicals in the brain which modulate cognition and mood, including serotonin, which is important for mood regulation and well-being. Elevated cortisol levels can also interfere with sleep, a key necessity for a happier, healthier attitude.Your gutOne thing stress doesn't do it doesn't cause peptic ulcers. That turned out to be a myth when science found this common type of ulcer is actually caused by a bacteria in the gut called H. pylori. Science estimates almost half of the world's population has H. pylori but not everyone gets an ulcer.However, stress can make ulcers worse. In fact, it can boost pain, bloating, nausea and other stomach discomfort from nearly every gastrointestinal complaint.First, we often overeat when tense, choose fatty comfort foods, overuse alcohol or smoke. All of those can increase chronic heartburn or gastroesophageal reflux disease, called GERD. Stress can affect how quickly food moves through the body, thus possibly causing gas, diarrhea and constipation.And for people with irritable bowel syndrome, inflammatory bowel disease or Crohn's disease, stress can increase their painful symptoms, such as cramping and diarrhea.Fight back against stressOne of the single best things to do to overcome stress is exercise. Exercise can create an anti-inflammatory response, improves mood, cognition and your physical health.Staying socially connected to friends and family a challenge while we are socially distancing is another great way to battle stress.Mindfulness and meditation are other key ways to ease tension, along with calming physical activities such as Tai Chi, yoga and gentle stretching.Those methods often teach deep breathing, another key way to reduce stress that can be used in the moment.To do it properly, breathe through your nose, hold it and then exhale very slowly out through your mouth like you're breathing through a straw."And when you breathe slowly out, you improve your whole picture of life and you reduce your nervousness," said trauma counselor Jane Webber, a professor of counselor education at Kean University in New Jersey, in a prior CNN interview.Webber also recommends cracking a smile. Watch funny movies, listen to comedy routines, ask everyone you talk to on the phone to tell you a joke."Remember, you can't be anxious and smile at the same time. That's a physiological thing," Webber said.Finally, do not hesitate to reach out for help, experts say. Cognitive behavioral therapy, a form of talk therapy that focuses on specific thoughts and actions, has been shown to help reduce stress when practiced with a therapist, Kaufmann said."It really takes people through mental exercises to understand whether or not certain kinds of reactions are appropriate under the circumstances and whether they have alternatives," he said."Without that cognitive aspect where people actually think about what's going on in their lives, you can't deal with the bigger issues simply by telling yourself to relax because those issues are going to continue," he added.If this worldwide epidemic can help us begin to talk about our stress and take action, that would be good news, Ackrill said."For decades we've swept stress under the carpet," she said. "And without a model in our mind of what it was and without specific skills or resources to deal with it, most of us felt shame that we weren't dealing with stress well."Shame compounds it," Ackrill added. "But I think now it may finally become a safe topic. I think it may finally safer to be vulnerable. And boy, do we need that. We need people to talk about it."

The constant stress of living in the age of coronavirus is affecting more than your mental health and emotional coping abilities. It's likely taking a toll on your body as well.

"We're living in a sea of stress hormones every day," said stress management expert Dr. Cynthia Ackrill, an editor for "Contentment" magazine, produced by the American Institute of Stress.

"We're not designed for a constant application of these chemicals," Ackrill said. "The stress hormone cortisol just ravages our bodies when it's dumped into our system repeatedly."

Designed to keep you functioning throughout the day, cortisol levels are meant to rise in the morning and decrease as the day lengthens. The hormone's purpose is to maintain blood sugar levels to keep your brain and muscles functioning and suppress non-vital systems like digestion that might drag your energy down.

But when triggered by a stressful occurrence, cortisol levels suddenly spike, and can take hours to dissipate. If that stress is constant, those levels don't drop, leading to cortisol malfunction and a disease-causing boost in inflammation.

"Inflammation is behind diabetes. Inflammation is behind heart disease. It's behind all of the autoimmune diseases. It's behind asthma and allergies, and the list goes on," Ackrill said.

If you're genetically at risk or you already have an inflammatory condition, today's constant stress may well trigger or worsen your symptoms.

"The predispositions that people have, whether it is asthma or a history of migraine or underlying cardiovascular risk factors, stress on all of those are so much more acute now," said neuroscientist Peter Kaufmann, former deputy chief of the Clinical Applications and Prevention Branch of the National Heart, Lung, and Blood Institute.

"People have daily stress and often times they don't have any control over it. That's when stress has its greatest impact," said Kaufmann, who is now the associate dean for research and Innovation at Villanova University in Pennsylvania.

Not dealing with that stress, he said, can even be deadly.

"In our work, we found that people who show physiological responses to mental stress have about a two- to three-fold higher mortality over the following five years," Kaufmann said.

Here's how stress may be impacting five of your body's key systems.

Tension can directly increase heart rate and blood flow, and causes the release of cholesterol and triglycerides into the blood stream. Blood pressure can skyrocket from acute stress and may stay high as that stress continues.

Yet hypertension and other heart disease symptoms are silent, with no real signs that you might be entering a danger zone.

Some of our not-so-wonderful coping mechanisms, such as eating comfort food, drinking alcohol and smoking cigarettes or marijuana, can also raise our risk.

Then there's the very real fear that we may lose someone we love to the coronavirus, or perhaps we already have. All of that can create a perfect storm of physical malfunction that may even shorten our lives.

Kaufmann points to a recent study which showed how mental stress can cause a fall in cardiac ejection fraction a measure of how well your heart's main chamber pumps blood.

"The amount of blood that is pumped out by the heart with each stroke is reduced, and that fall is associated with a higher incidence of cardiovascular events, such as heart attacks, death, and unstable angina that requires hospitalization," Kaufman said.

There's even such a thing as a stress-related heart attack, often called "broken heart syndrome." It occurs when the heart is stunned by sudden stress, and its left ventricle weakens.

"That has been shown to be triggered by severe acute events, such as the sudden loss of a loved one or an earthquake," Kaufmann said. "I think some of the post 9/11 cardiac events would fall in that category."

In most cases, when the acute emotional stress dissipates, the heart recovers and goes back to its normal shape.

"But I've had patients who have developed acute congestive heart failure, life-threatening arrhythmias, even death from this condition," said New York cardiologist and author Dr. Sandeep Jauhar in a prior CNN interview.

"I think it's the clearest example of how our emotional lives directly affect our hearts."

One of the largest organs of the body, your skin is exquisitely sensitive to stress.

"The relationship between mind and skin is essential and undeniable," said dermatologist Dr. Alan Friedman, who is the interim chair of dermatology at the George Washington School of Medicine and Health Sciences.

"Stress absolutely exacerbates primary skin diseases from acne to psoriasis," Friedman said, "It can 'wake up' chronic viral infections like herpes simplex [cold sores] and herpes zoster [shingles]."

Dermatologists across the country that CNN spoke to report increasing telehealth calls since March on such stress-related skin conditions as ache, eczema, psoriasis and shingles, a painful, blistery rash that can develop after having chicken pox.

There's also an increase in calls from people experiencing the impact of increased hand washing and the wearing of personal protective equipment such as masks and gloves.

"Allergic contact dermatitis is huge right now where members of the public are now wearing gloves and masks they are not normally used to wearing," said Plano, Texas dermatologist Dr. Seemal Desai, who is on the board of directors for the American Academy of Dermatology.

"It's really quite alarming and disturbing how many skin conditions I'm seeing that are probably aggravated by stress and distress from the coronavirus," Desai said. "It's out of control."

Having chronic obstructive pulmonary disease, or COPD, is a key underlying health condition that puts one at higher risk for a more severe case of COVID-19, the disease caused by the novel coronavirus.

A group of diseases that cause airflow blockage and breathing issues, COPD includes emphysema and chronic bronchitis. Nearly 16 million Americans have COPD, according to the Centers for Disease Control and Prevention.

Stress and anxiety can cause shortness of breath, leading "COPD symptoms to become worse and lead to further anxiety, faster breathing and fear," says the National Emphysema Foundation on its website.

"We tend to not breathe as well when we're stressed in general, so our oxygen exchange is worse. There's also a panic on top of it, which makes it worse," Ackrill said.

Smoking is the leading cause of COPD and many other breathing-related illnesses. It comes as no surprise that smoking cigarettes or marijuana and the use of e-cigarettes may increase risk of severe consequences from COVID-19.

Asthma is another underlying health condition that puts one at higher risk for a more severe case of COVID-19. Here again, stress is a common trigger for an asthma attack, and it can make existing symptoms worse.

In fact, the stress a parent feels has even been linked to an increased risk for asthma in their children. One study looked at how parental stress affected the asthma rates of young children and found those with stressed out parents had a substantially higher risk of developing asthma.

"During an asthma attack it's almost like breathing through a straw because that inflammation is restricting the airway," said allergist Dr. Lakiea Wright in a prior CNN interview.

"You can imagine if a virus that causes extra inflammation gets in there, then that's going to be worse," said Wright, who specializes in allergies and immunology at Brigham and Women's Hospital in Boston.

"Those are the patients who might end up on ventilators to help with breathing because COVID-19 is doing a lot of damage in the lungs."

Stress is considered one of the most common triggers for headaches not just tension headaches, but migraines as well.

Migraines are debilitating attacks that can level a person for hours to days with intense, throbbing pain, nausea and vomiting. According to the Migraine Research Foundation, the condition is the third most prevalent illness in the world, affecting 39 million men, women and children in the United States and one billion worldwide.

Stress can cause migraines, the pounding pain creates more stress, and the circular pattern can make it tough for headache and migraine sufferers to cope.

Chronic inflammation from stress can also affect the brain itself, shrinking or negatively affecting parts of the brain linked to memory, motivation and mental agility. That can lead to depression, anxiety and other mental disorders, which in another circular fashion are then made worse by stress.

Chronic levels of cortisol can affect other chemicals in the brain which modulate cognition and mood, including serotonin, which is important for mood regulation and well-being. Elevated cortisol levels can also interfere with sleep, a key necessity for a happier, healthier attitude.

One thing stress doesn't do it doesn't cause peptic ulcers. That turned out to be a myth when science found this common type of ulcer is actually caused by a bacteria in the gut called H. pylori. Science estimates almost half of the world's population has H. pylori but not everyone gets an ulcer.

However, stress can make ulcers worse. In fact, it can boost pain, bloating, nausea and other stomach discomfort from nearly every gastrointestinal complaint.

First, we often overeat when tense, choose fatty comfort foods, overuse alcohol or smoke. All of those can increase chronic heartburn or gastroesophageal reflux disease, called GERD. Stress can affect how quickly food moves through the body, thus possibly causing gas, diarrhea and constipation.

And for people with irritable bowel syndrome, inflammatory bowel disease or Crohn's disease, stress can increase their painful symptoms, such as cramping and diarrhea.

One of the single best things to do to overcome stress is exercise. Exercise can create an anti-inflammatory response, improves mood, cognition and your physical health.

Staying socially connected to friends and family a challenge while we are socially distancing is another great way to battle stress.

Mindfulness and meditation are other key ways to ease tension, along with calming physical activities such as Tai Chi, yoga and gentle stretching.

Those methods often teach deep breathing, another key way to reduce stress that can be used in the moment.

To do it properly, breathe through your nose, hold it and then exhale very slowly out through your mouth like you're breathing through a straw.

"And when you breathe slowly out, you improve your whole picture of life and you reduce your nervousness," said trauma counselor Jane Webber, a professor of counselor education at Kean University in New Jersey, in a prior CNN interview.

Webber also recommends cracking a smile. Watch funny movies, listen to comedy routines, ask everyone you talk to on the phone to tell you a joke.

"Remember, you can't be anxious and smile at the same time. That's a physiological thing," Webber said.

Finally, do not hesitate to reach out for help, experts say. Cognitive behavioral therapy, a form of talk therapy that focuses on specific thoughts and actions, has been shown to help reduce stress when practiced with a therapist, Kaufmann said.

"It really takes people through mental exercises to understand whether or not certain kinds of reactions are appropriate under the circumstances and whether they have alternatives," he said.

"Without that cognitive aspect where people actually think about what's going on in their lives, you can't deal with the bigger issues simply by telling yourself to relax because those issues are going to continue," he added.

If this worldwide epidemic can help us begin to talk about our stress and take action, that would be good news, Ackrill said.

"For decades we've swept stress under the carpet," she said. "And without a model in our mind of what it was and without specific skills or resources to deal with it, most of us felt shame that we weren't dealing with stress well.

"Shame compounds it," Ackrill added. "But I think now it may finally become a safe topic. I think it may finally safer to be vulnerable. And boy, do we need that. We need people to talk about it."

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The physical toll of coronavirus-related stress and how to combat it - WBAL Baltimore