MS and Stress, What’s the Connection?

Hello Summer! For many people summer is when the schedule lightens up a bit, vacations are planned, the kids are out of school the days are longer and we all get outside a bit more regularly. In theory, summer is a less stressful time of year or at least that is how it is often portrayed in the media. But often the real world stressors don’t stop just because the weather gets nicer and all of the commercials and movies suggest that we are in the lazy hazy days of summer! Stress doesn’t really have a season and it can really wreak havoc on the body.

Stress Management Should Be Considered Required Maintenance

I’d like to revisit the analogy of the automobile that I brought up in my post about MS fatigue. In that post, I wrote about the importance of high quality fuel to optimize energy with an engine made less efficient by MS. Like a finely tuned automobile the body needs the right fuel (nutrient dense foods!) and regular maintenance to achieve optimal health and to remain fit and active with a high quality of life. Regular maintenance includes these behaviors:

• Do not smoke
• Get good sleep
• Stay physically active
• Manage your stress

What is Stress?

Acute vs. Chronic Stress

Acute Stress is the reaction to an immediate threat or perceived threat. Acute stress is also known as the fight or flight response. The acute stress response is immediate and intense. The engine is revved up and ready to go!

Chronic Stress is long term exposure to stressful situations. This type of stress can cause wear and tear on the mind and body and may contribute to the breakdown of  the “engine”. Chronic stress interferes with the body’s acute stress response system causing other body systems like blood pressure and blood sugar stay in fight or flight mode, which can lead to numerous health problems. How long would your car’s engine run optimally if everywhere you drove you had the gas pedal floored?

Stress and MS: Eliminating chronic stress is important for everyone but particularly important for those living with MS. The relationship between stress and MS is a lot like the age-old chicken and egg question: which came first? Too much stress in life can contribute to an MS relapse or symptom aggravation. Likewise, many common symptoms can trigger stress.

Some Physical Symptoms of Stress:

• Irritability or Anger
• Anxiety
• Fatigue
• Depression
• Lack of Energy or Interest
• Headaches
• Upset Stomach or Indigestion
• Muscular Tension

The Effects of Stress on Eating, Exercise, and Sleep Patterns Perpetuate A Vicious Cycle

Fatigue and stress impact everyone at some point. When people are tired and stressed out they are vulnerable to making poor food decisions because they appear to provide a “quick fix” to daily obstacles. Due to the ever-present nature of fatigue and stress with MS individuals with MS are even more vulnerable. But often these quick fixes can actually make matters worse and perpetuate a vicious cycle.

Stress:

In Stressful Situations The Brain Releases Stress Hormones, Including:

Epinepherine (Adrenaline): Causes increased heart rate, tense muscles, increased breathing, focused attention and a surge of energy— to get away from danger. In order to fuel these actions, epinephrine can cause cravings for fatty and sweet energy dense foods.

Cortisol: Prepares us for the fight or flight response by flooding the body with glucose for fuel. It inhibits insulin to prevent glucose being stored and therefore unavailable for use. Together with epinepherine, cortisol increases blood pressure.

These hormones are necessary and serve us well in survival mode. But survival mode is not meant to be an everyday way of life. Too much of these stress hormones can be detrimental to our health.

Stress Can Lead to Less Than Optimal Choices:

• Skipping Meals: Skipping meals is never a good idea, especially breakfast; doing so will virtually ensure that you will start the day with less fuel in your tank and can lead to overeating later in the day. 
• Overeating: Regularly consuming more energy (calories) than are needed can lead to weight gain.
• Opting for Unhealthy Foods (aka the quick fix!): The vending machine lunch, the drive-thru dinner, the comfort foods to soothe what ails us. Often these foods are energy dense but offer limited nutrients.
• Mindless Eating: Who hasn’t engaged in mindless eating at one time or another? Mindless eating can be defined as eating food without paying adequate attention to what and how much is being eaten. Often distractions from stress, conversations, reading or television can cause us to lose track of our actual hunger, lose track of portion sizes and actually interfere with our enjoyment of food. 
• Caffeine Dependency: Caffeine can offer a quick boost of energy but too much caffeine can actually contribute to fatigue when the boost wears off. It can interfere with sleep which will leave you feeling exhausted tomorrow.
• Alcohol Dependency: Reliance on alcohol to de-stress can be detrimental. In the short-term alcohol can disrupt sleep leaving you less rested. In the long-term it can lead to dependency.
• Skipping Out on the Exercise Routine: For many people times of stress are when they pass on the exercise.
• All of the above can contribute to  blood sugar and insulin irregularities, weight gain, fatigue, and additional health issues.

Chronic Stress and Less Than Optimal Choices Lead to Health Problems:

Chronic stress and less than optimal food choices can lead to numerous health problems, many of which are comorbid conditions associated with MS. Each of these conditions can contribute new symptoms, new medications and new sources of stress. And so the cycle gets perpetuated. Some of the conditions associated with stress include:

• Heart Disease
• High Blood Pressure
• High Cholesterol
• Type 2 Diabetes
•  Depression
• Gastrointestinal Problems including indigestion, bloating, diarrhea, constipation, and IBS
• Impaired Immune Function

What Can I Do to Reduce or Manage My Stress?

There are a number of strategies to help you combat stress in your life. You may think that there is no time or energy this in your life. But if this is your initial thought I would like to refer back to the automobile analogy. What would be the consequences of an Indy 500 race car driver skipping the pit stops? Pit stops are intended for refueling as well as to fortify and sustain the car to finish the race successfully. At first, skipping the pit stop may seem to provide an advantage as other cars are stopping. But soon enough he will begin to run out of fuel, suffer breakdowns and stop functioning effectively.

The same is true of the human engine. We need to take the time to de-stress, fortify and sustain ourselves to live optimally each day. The process will likely look different for everyone due to personal preference but just like the professional race car pit stop it does not require a lot of time. If you have never actively engaged in stress management remember it is a learned skill and will get easier with practice. Some activities that may help to reduce stress include:

• Engage in a Hobby (needlework, photography, gardening, play an instrument, etc.): Getting engrossed on a regular basis in a hobby that you enjoy can be a very good way to de-stress. Learning a new skill like digital photography can be rewarding and help to improve cognitive function as well.
• Meditation:  There are a number of books and resources on the web to learn more about meditating. Try here and here to start.
• Keep a Gratitude Journal to highlight the positive aspects of your life: This can be a very simple practice of writing about three items at the end of each day.
• Laugh: Enjoy a silly movie or spend time with friends laughing. 
• Exercise: A thirty-minute walk can do wonders for stress. Add music to your walk by using an iPod or phone to provide your favorite music. Music can be a great addition to walking because it can set the tone. This is a tool that I  use quite often… when I am having a particularly bad day I use what I call the “mad music playlist.” After walking with my mad music I feel as if I have exorcised all of my frustrations and can leave them behind. On good days, there are other playlists as well as books on tape, podcasts or whatever interests you! But if you are walking in or near traffic don’t get so lost in your audio that you lose focus on your surroundings!

No matter how you relax, the physical and emotional impact of chronic stress can be reduced through regular practice of whichever form of relaxing and de-stressing works best for you.

What Role Does Diet Play In Stress and Stress Management?

The convenience of food often determines if one eats it or not. 

If you are fighting fatigue and other MS symptoms it may sound daunting to invest time during the week to plan and prepare meals. It may be helpful to think of this as a pay me now or pay me later argument. The time invested in meal planning and preparation will save time, energy, money and reward you with the availability of healthy and easy to prepare meals to eat during the week. With this availability, there is less vulnerability to quick fix food choices.

Meal planning can be as structured or as loose as works for you. You can plan out each and every meal for the week ahead and spend some time one day per week prepping meals in advance. Or if your family schedule is more fluid and not amenable to this much structure you can plan four to five dinner meals and have healthy options on hand for breakfasts, packed lunches, and snacks.

When planning your meals keep in mind the importance of using nutrient-dense foods throughout your day to give your body the best fuel possible. Refer to my past posts for more information about nutrient dense foods.

Some examples of foods that could be prepared in advance and used throughout the week:

Breakfast:

• Steel cut oats cooked in advance to be microwaved for breakfast in the morning
• Hard boiled eggs
• Whole grain pancakes
• Cut up fruit, greens, veggies and bag them in Ziploc bags for easy smoothies

Lunch/Dinner:

• Prep your favorite salad greens and toss-ins to create a quick healthy lunch (don’t add the dressing until it’s time to eat!)
• Leftover dinner makes a great warm lunch
• A pot of soup prepared on the weekend can be dinner one night and lunch later in the week. Or save any leftovers in the freezer for another day.
• Complex Carbohydrates! Bake a few sweet or white potatoes; they can be quickly reheated at mealtime. Cook a pot of brown rice, quinoa or other favorite whole grain to be served as side dishes with entrees, tossed into soups or salads, tossed into a frittata or used with beans and vegetables in a burrito.
• Plant Proteins! Make a lentil loaf or a cold bean salad that will make a nutritious and filling lunch. Beans, Seitan, Tofu or Tempeh all can be used to create a variety of entrees and sandwich fillings.
• Animal Proteins: If you are a meat eater, you could prepare a roast, bake chicken breasts, make salmon cakes, mix up some chicken or tuna salad in advance to use for meals throughout the week. 
• Nuts and Nut Butters: Great to keep around for sandwiches, smoothies, and snacks. If choosing nut butters opt for the variety with no hydrogenated oils, added salt or added sugars.

Snacks:

• Pre-cut veggies and fruit and place in Ziploc bags
• Purchase pre-portioned nuts or package your own
• Portion out some hummus and veggies

Comfort Foods! 

What is it about certain foods that make them comforting? Is it the call of the stress hormone for energy dense foods or is it the familiarity of Mom’s macaroni and cheese?  Are there foods that can be comforting and provide nutrients? Yes! 

Craving Carbohydrates?  Opt for complex carbohydrates to stimulate serotonin and help stabilize blood sugar. Consider whole grains, sweet potatoes or a bowl of oatmeal.

Craving Fats? Opt for healthy fats to satisfy the craving and provide some essential fatty acids. Consider adding sliced avocado onto a sandwich or in a salad, have a handful of walnuts or almonds and if you include fish in your diet try a serving of salmon or tuna.

Craving Something Creamy? Consider low sodium cottage cheese and some fresh fruit or some plain Greek yogurt with a spoonful of all-fruit preserves and a bit of granola or some toasted walnuts.

Craving a soothing beverage? Consider replacing stimulant beverages with a warm mug of milk. It will provide you with a good shot of calcium and many people find it soothing. If warm milk is not your cup of tea, why not try a cup of tea? Some people find the ritual of tea to be soothing in itself.  Decaf or green tea can provide comfort plus a boost of antioxidants.

Craving Chocolate? Eat some chocolate! Chocolate lovers have always known that chocolate was good for the soul but recent evidence seems to confirm that including chocolate in your diet can be beneficial for your heart.

Really, Really Craving Mom’s Macaroni and Cheese? Then by all means enjoy Mom’s Macaroni and Cheese! There is no reason to completely avoid foods that you enjoy. Just be mindful of portion size, pay attention to your hunger and fullness cues. Read more about Mindful Eating and Intuitive Eating by following links in the resource section.

Mindful Eating: 

Mindful eating is the opposite of Mindless Eating. It is awareness while eating. It is a process of paying attention (on purpose), to your actual eating experience, without judgment. By focusing on taste, texture and other sensations you are able to better enjoy your food. Choose foods that are bot pleasing to you and nourishing to your body.

Intuitive Eating:

Intuitive eating is an approach that includes the principles of Mindful Eating but also goes beyond to encourage becoming more attuned to your body’s natural hunger and fullness signals. It is learning how to distinguish between physical feelings and emotional feelings. It encourages us to eat when we are hungry, stop when we are full.

Slow Down:

Eating while stressed can result in indigestion and upset stomach. Sit down, slow down, eat slowly, chew thoroughly and enjoy your meals.

Takeaway Message:

Fueling our bodies with healthy foods is a very important part of being healthy with Multiple Sclerosis. But it is only one part. Stress management should be considered routine maintenance for keeping our engines in good working order. Often specific food choices, meal planning, and organization or being more mindful and in tune with our hunger and fullness cues can help us to optimize our food choices but food alone cannot reduce or eliminate chronic stress on the body. Make time for a pit stop that will help to fortify and sustain you through your day.

Make time for stress management, you are worth it.

Resources

• nimh.nih.gov — National Institute of Mental Health
• nmha.org — Mental Health America (formerly the National Mental Health Association)
• apa.org — The American Psychological Association
• stress.org — The American Institute of Stress
• helpguide.org — Stress at Work
• intuitiveeatingcommunity.org–What is Intuitive Eating?
• Eatingmindfully.com –Mindful Eating Blog of Susan Albers, Psy.D.
• NationalMSSociety.org — Get a Handle on Stress

References

• American Psychological Association. Stressed in America. January 2012.
• Block JP, He Y, Zaslavsky AM, Ding L, Avanian JZ. Psychosocial stress and change in weight among US adults. Am J Epidemiol. 2009;170(2):181-192.
• Chiesa A. Serretti A. Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. Database of Abstracts of Reviews of Effects (DARE). 2010.
• Dhabhar FS. Enhancing versus suppressive effects of stress on immune function: implications for immunoprotection and immunopathology. Neuroimmunomodulation. 2009;16(5):300-17. Epub 2009 Jun 29.
• Hall AM, Kamper SJ, Maher CG, et al. Symptoms of depression and stress mediate the effect of pain on disability. Pain. 2011;152(5):1044-51.
• Larzelere MM, Jones GN. Stress and Health. Primary Care: Clinics in Office Practice. 2008;35(4):839-856.
• Pusceddu M, Kelly P, Ariffin N, Cryan J, Clarke G, Dinan T  n-3 PUFAs have beneficial effects on anxiety and cognition in female rats: Effects of early life stress.  Psychoneuroendocrinology. 2015 Aug;58:79-90.
• Roberts NP, Kitchiner NJ, Kenardy J, Bisson JI. Early psychological interventions to treat acute traumatic stress symptoms. Cochrane Database Syst Rev. 2010;(9): CD007944.
• Vriezekolk JE, van Lankveld WG, Geenen R, van den Ende CH. Longitudinal association between coping and psychological distress in rheumatoid arthritis: a systematic review. Ann Rheum Dis. 2011;70(7):1243-50.