Why symptoms of chronic illness are often dismissed as stress

Amina AlTai was always proud of her strength and endurance. When she started experiencing brain fog and fatigue, Ms. AlTai, 39, simply thought it was from working long hours at her marketing job. So she started writing reminders to keep herself on track. But then her hair started falling out, she gained and lost a lot of weight, and she started having gastrointestinal problems.

Mrs. AlTai was sure something was wrong. But the first six doctors she saw didn’t take her seriously, she said. Some told her she had so much hair that a little loss shouldn’t be a problem. Some said she seemed healthy and dismissed her symptoms as just stress. Only when another doctor ordered blood tests, Ms. AlTai was diagnosed with Hashimoto’s disease and celiac disease, two autoimmune conditions that can damage the thyroid and small intestine.

“They called me and said: ‘Don’t go to work. Go to the hospital instead because you’re days away from multiple organ failure,’” Ms. AlTai recalled. The two chronic illnesses had improved her ability to regulate hormones and absorb critical vitamins and nutrients.

Scientists now know that stress is closely linked to many chronic diseases: it can trigger immune changes and inflammation in the body that can worsen the symptoms of conditions such as asthma, heart disease, arthritis, lupus and inflammatory bowel disease. Meanwhile, many issues caused by stress – headaches, heartburn, blood pressure problems, mood swings – can also be symptoms of chronic diseases.

For doctors and patients, this overlap can be confusing: Is stress the sole cause of someone’s symptoms, or is something more serious at play?

“It’s really hard to separate,” said Scott Russo, director of the Brain-Body Research Center at the Icahn School of Medicine at Mount Sinai.

How stress can cause chronic disease

Stress naturally triggers what is called the fight-or-flight response. When we encounter a threat, our blood pressure and heart rate increase, muscles tense up and our bodies concentrate blood sugar to make it easier to react quickly, said Dr. Charles Hattemer, a cardiovascular health specialist at the University of Cincinnati.

If people are stressed for weeks or months, their bodies may not be able to keep up with other functions, leading to problems such as forgetfulness, fatigue and sleep problems. Stress hormones like adrenaline and cortisol can chronically raise blood pressure or increase plaque deposits, which can damage the heart over time, said Dr. Hattemer.

There are also suggestions that stress can contribute to over-activation of the immune system and lead to inflammation. In a study of 186 patients, researchers in Italy found that 67 percent of adults with celiac disease had experienced a stressful life event before their diagnosis.

Recently, Dr. Russo and his colleagues showed in two studies that anxious mice had higher levels of neutrophils, which cause inflammation, and fewer T cells and B cells in the bloodstream that can produce antibodies or kill cells infected with the virus. viruses.

He and his colleagues also found that patients with major depressive disorder had similar imbalances in immune cells compared to healthy controls. Researchers believe the body changes the composition of immune cells circulating in the blood as a way to reduce damage from an infection or acute stress, said Dr. Russo.

However, when faced with chronic stress, the body sometimes “simply can’t shut down the immune system,” said Dr. Russo.

For people who may already be at risk of chronic disease, whether due to their genetic predisposition, exposure to chemicals, air pollution or viral infections, a prolonged period of stress can make them sick.

Lynne Degitz, 56, spent several years battling what seemed like extreme infections. Once, she thought she had mono. Another time she was sure it was bronchitis. Neither she nor her doctors thought it could be a chronic illness.

Then she started a new, higher-stress job and began experiencing fevers, swollen joints, and fatigue almost every day. “I had interesting, demanding work, so I kept going,” said Ms. Degitz. “I’ll just use the short-term disability to recuperate or use the vacation time to recuperate when I needed to.”

After more than two years of going back and forth to medical appointments and trying treatments that ultimately didn’t help, Ms. Degitz was diagnosed with a type of arthritis known as Still’s disease. Doctors don’t know exactly what causes it, but research is beginning to suggest it’s likely a combination of factors, including abnormal responses to infections and stress.

“We all have illnesses and physical infirmities,” said Dr. Russo. “Stress just wears them out and makes them worse.”

For patients with chronic illnesses, the same stressors that may have caused their symptoms can make their condition difficult to treat.

And some said they don’t always think doctors appreciate how difficult it can be to manage stress, especially when they’re feeling sick. When Teresa Rhodes was first diagnosed with rheumatoid arthritis decades ago, a doctor suggested she exercise more to reduce stress and strengthen her joints, which were being damaged by the disease.

But “the symptoms of the disease themselves were stressful,” said Ms. Rhodes, who is now 66. “It’s very hard to exercise when you’re so tired.” Only after the other stressors in life were removed—her children were grown and she left a difficult marriage—was she able to get enough rest and eventually start working out again.

Many doctors aren’t trained to ask about the sources of stress, or to counsel patients about the impact of stress, said Alyse Bedell, a clinician-researcher specializing in how stress affects digestive health at UChicago Medicine. A 2015 study of more than 30,000 patient visits to doctors’ offices found that primary care physicians only counseled patients about stress management during 3 percent of visits.

When Stephanie Torres’ 12-year-old son, Nico, was diagnosed with Crohn’s disease, she was surprised to hear that the gastroenterologist felt that managing the stress that clearly caused his symptoms was the family’s responsibility. “Her response to me was basically, ‘That’s your problem. You go and choose'”

Patients said that instead of simply suggesting they stop sources of stress, doctors could work with them on small ways they can manage stress every day. Once Ms. AlTai was diagnosed and started taking medication for both of her conditions, she felt well enough to make the dietary changes needed to address the nutrient deficiencies caused by her illnesses. She started taking regular walks and meditating in the morning.

Ms. AlTai eventually quit her marketing job and became an executive coach, allowing her to set her own schedule, she said. Being hospitalized and diagnosed with two chronic illnesses made her realize that those changes were necessary.

“I call it my stopping moment because it literally stopped me in my tracks,” she said. “I had to really reevaluate my relationship with work, success, and stress.”