Last month, a 34-year-old patient came to Vivek Nangia, director of the department of pulmonary and infectious diseases at Delhi’s Fortis Flt Lt Rajan Dhall Hospital. His complaint: low-grade fever and a persistent cough. Tests confirmed he had tuberculosis. But Dr Nangia’s diagnosis didn’t end there. The patient, who works in a mid-management role in a multinational firm, wanted to get to the root of the problem. “Doc, why did this happen?” Dr Nangia recalls the patient asking. Further probing showed the patient had a demanding job, stayed out late and, more often than not, ate poorly. He had a suppressed immune response due to stress.
Dr Nangia’s approach and diagnosis is not rare—diseases brought on by the effects of stress are so common now that a whole interdisciplinary branch of medicine, psychoneuroimmunology, is devoted to it. Dr Nangia says he sees one or two cases daily where the root cause is stress, due either to work or other life situations. Most of the patients who come to him have ailments triggered or worsened by stress and are in the 20-35 age group, usually in corporate jobs.
Last year, Akinori Nakata of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention in the US, published an article titled “Psychosocial Job Stress And Immunity: A Systematic Review” in the Methods in Molecular Biology journal. In the article, Nakata said that while cause and effect relationships between job stress and immune response need to be established more clearly, what emerges from the review without a doubt is that “exposure to psychosocial job stress...had a measurable impact on immune parameters”. According to the study, psychosocial job stress could arise from a number of factors, such as “high job demands, low job control, high job strain, job dissatisfaction, high effort-reward imbalance, overcommitment, burnout, unemployment, organizational downsizing, economic recession”.
The possible effects of job stress include coronary heart disease, hypertension, immune-related disorders, musculoskeletal disorders and depression. It can also trigger adverse health behaviour such as alcohol dependence, substance misuse, physical inactivity, poor sleep and obesity, according to the study.
Most Indians have the tuberculosis bacteria, among other “natural resident flora”, in their bodies, explains Dr Nangia, but our immune system keeps these in check. The body’s white blood cells—natural killer cells—act as an inbuilt defence mechanism. But when one is subjected to stress, the body redirects its resources to fight the perceived threat. There is an endocrinal imbalance as the hypothalamus in the brain tells the adrenal glands to release cortisol, a steroid hormone, and catecholamines such as adrenalin and noradrenalin. These hormones then increase the pulse; one’s breathing becomes faster; the heart rate, blood pressure and blood sugar levels go up; and the immune function is suppressed as the body’s resources are redirected to handle the trigger for the stress.
“The release of cortisol helps mobilize muscles. It affects the liver, to produce sugar to combat the threat. And steroids—cortisone being one—suppress antibodies,” explains Monica Chib, psychiatrist at Delhi’s Indraprastha Apollo Hospital. Doctors, both internal medicine practitioners and specialists, often bring in a psychiatrist to deal with stress-related immune disorders.
"‘Stress affects our overall sense of well-being, cheerfulness, sleep pattern, thought processes and eating habits.’"
Anoop Misra, chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, adds: “Cortisol acts as an immunosuppressant—it increases the blood sugar level, and once that happens, the cells which attack bacteria can no longer function in the same manner.”
And that’s okay if the body gets time to rejuvenate after a stressful event. S.K. Gupta, a cardiologist at Indraprastha Apollo Hospital, New Delhi, explains that the body goes into “sympathetic overactivity” to deal with stress—that is, it produces hormones and enzymes to break down sugar and proteins, to give the body extra bursts of energy to cope. Once the source of the strain is taken away, it falls into “parasympathetic activity”, which is to rest and let the body recuperate. But if the stimulus continues over a period of time, a condition described as chronic stress, the system is unable to flush out the excess stress hormones at an adequate rate.
The resulting pressure on blood vessels and organs such as the brain, heart, liver and kidneys from high levels of cortisol in the body may lead to a range of ailments, from flu, loss of sleep and diarrhoea to hypertension, depression and cardiovascular, metabolic and respiratory diseases.
“Stress reduces the release of interferons (proteins that are made at the cellular level in the body to combat pathogens such as bacteria and viruses),” explains Raman Abhi, senior consultant, internal medicine, Fortis Memorial Research Institute, Gurgaon. “Just before an exam, you’ll find that children get cold and cough more easily,” says Dr Abhi by way of an example.
But cortisol is not the villain of the piece—it helps in proper glucose metabolism and affects the body’s anti-inflammatory response. It’s the excessive build-up due to chronic stress that’s the problem.
Signs to look out for
Although everyone reacts to stress in their own way, doctors say there are some symptoms that should make you sit up and take notice. Samir Parikh, director, mental health and behavioural sciences, Fortis Memorial Research Institute, Gurgaon, says anyone with a hectic schedule should keep an eye out for behavioural or personality changes—like greater hostility or aggression. “Stress affects our overall sense of well-being, cheerfulness, sleep pattern, thought processes and eating habits,” says Dr Parikh. Any sudden or unaccountable changes in these should automatically raise a red flag.
Dr Abhi points to other signs—spontaneous crying, a sudden stop in communication, or talking too much. He says one group that is particularly at risk is people who are lonely, especially those who are living alone. And if you don’t get along with your boss, don’t like your job or workplace, have inadequate time management skills, then that’s a negative too, says Dr Chib.
A lot of what doctors have to say about managing stress seems commonsensical, yet few people implement simple tweaks in their daily routine. Eat healthy, balanced food, recommends nutritionist Shipra Saklani Mishra, senior clinical nutritionist, Fortis La Femme, New Delhi. Go ahead and cheat a little if it makes you happy, she says. Eat that piece or two of chocolate for a serotonin (feel-good hormone) boost, but don’t overdo it.
Do some exercises while at your cubicle and prioritize so you don’t end up chatting with colleagues at the coffee machine till you’re dangerously close to deadline, says Dr Chib. Avoid partying till late if you have work the next day, says Dr Nangia. Multivitamin supplements, especially vitamin C, can help fight the cumulative effects of chronic stress, he adds.
Dr Abhi says the important thing is to keep talking, to express your thoughts by either sharing them with someone or just writing them down. “And don’t remain idle,” he advises.
Pankaj Mankad, director-physician, Xcode Life Sciences Pvt. Ltd, Chennai, says stress hormones circulating in the bloodstream may “turn on” the genes that make us susceptible to certain diseases. Another important factor to watch out for is an alteration in food habits because of chronic stress, he says. So, if one starts consuming more alcohol or takes to smoking because of stress, that can also have the same effect. His recommendation is to get a hobby—it doesn’t matter if it’s reading, swimming or playing computer games—and try and achieve a work-life balance as far as possible.
Dr Misra says resetting the body’s systems after years of cumulative effects of stress can be hard. A combination of good diet, exercise and meditation may help to some extent. He recommends a 60-minute daily routine, broken down into 30 minutes of scheduled aerobic activity, 15 minutes of resistive exercise with weights and at least 15 minutes of working out at the workstation.
Meditation, he adds, does seem to have a restorative effect though, “as a scientist, I would like to see more data to show it works”.