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Stress and the endocrine system

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Lined up: residents practise social-distancing as they queue at The MarketPlace’s A1 at the junction of Collector’s Hill Road and South Shore Road, in Smith’s in March (Photograph by Jonathan Bell)

Hormones. We all know about oestrogen, testosterone and many of us know about the thyroid. Hormones can wreak havoc with our emotions, affect our metabolism and weight, can cause sweats and even more visible signs, but did you know that they are an integral part of how we respond to stress?I am an endocrinologist, which means I study the glands that make hormones. Endocrine glands are different from the glands that have a tube, or duct, through which a secretion is delivered, such as the salivary or sweat glands. Glands that directly release fluid, enzymes or mucus through a duct, are called exocrine glands. The endocrine glands don’t have ducts; blood flows through them and this takes their secretions around the body. This means that the hormones secreted by endocrine glands don’t just have a local effect, but they can affect every organ of the body, regulating processes such as breathing, blood pressure, how much urine we make and our weight.You can imagine, therefore, that hormones are extremely important to how we function. An imbalance in hormones can cause an infinite range of conditions from obesity to weight loss, diabetes, osteoporosis, infertility, sweats, headaches, depression and anxiety. In this article, I have collaborated with Adriene Berkeley, a Bermudian-registered chartered counselling psychologist and registered neuroscientist. Dr Berkeley and I hope you will find our suggestions to manage your stress helpful. In my last article, I wrote about steroids and the adrenal glands. The adrenals are the endocrine glands that release adrenalin and cortisol, the main hormones that mediate our stress responses. They are directed by the pituitary gland in the brain. You will remember the adrenal glands from high-school science lessons. They are the ones responsible for the “fight or flight” response. When there is an acute stress such as an argument, a heart attack or a severe illness, it can lead to physical changes in our bodies. We go red (flush), our heart races (palpitations, pounding in our chest), our blood pressure increases (headache) and we may sweat and shake. This response is why we hear about people suddenly having what sounds like superhuman strength in an emergency situation such as lifting a car off a child. Adrenaline fuels the response to acute stress. Chronic, or long-term, stress is different. This is mediated primarily by cortisol. We make cortisol every day, starting with a surge first thing in the morning, which helps us to get out of bed. It reduces through the day and should be very low by the time we need to go to sleep again. During the day, cortisol has functions to balance blood sugar, blood pressure, hydration, inflammation, metabolism and brain function. If we are really stressed, then our cortisol level will not go down by night-time. Therefore, elevated cortisol is why we find it difficult to sleep when we’re worried. If this continues for days and weeks, chronically high cortisol levels can cause anxiety, depression, brain fog, heart problems, increased appetite and weight gain, bowel issues and immune dysfunction.Some people who have a history of trauma or are genetically predisposed may have an overactive stress response, leading to more significant impact from chronically elevated cortisol. What does this mean in the context of Covid-19? Everyone is stressed! There is so much we cannot control right now. We can’t plan, we’re sheltering in place, which creates social isolation and reduces our ability to let off steam through interactions with friends and colleagues.Many of us have had to rapidly develop new working styles, working from home while also homeschooling our children. Some can’t work at all, leading to financial worry. We’re grieving for those who have already lost their fight with the virus here and overseas and concerned about those who are working on the front lines. Others may be experiencing increased alcohol use, domestic violence and sexual abuse while they are forced to stay at home. We are also constantly bombarded with media giving us dreadful statistics and constantly changing recommendations and restrictions.Your endocrine system is key to managing these stresses. If you have any endocrine dysfunction such as like Cushing’s syndrome, hypothyroidism or diabetes, your stress response may be impaired. Because the endocrine system is intimately related to your immune function, this may not work so well, either. Managing stress levels, therefore, is even more important in the present pandemic. This may seem like a Catch-22!Many of us have developed unhealthy coping mechanisms for dealing with stress in our lives such as smoking, overeating or alcohol. Having a lot of stress can lead to negative thoughts — there’s that effect of excess cortisol on the brain! — and making healthy choices can be more difficult. There are ways that we can help to reduce our cortisol levels both in the short and long term. Don’t beat yourself up if you’re not developing a new career during the lockdown. Take control of what you can and try not to dwell on the things you can’t. Focus on the positives as much as you can. Meditation, yoga, deep breathing, exercise and journaling can all work to reduce stress. None of us are going to manage all of these practices while juggling everything else, but if you can integrate some of them into your routine, you will reap the benefits. Deep, diaphragmatic — or abdominal — breathing is another way of reducing cortisol. It’s the way babies breathe. Yoga and deep-breathing work by stimulating the vagus nerve near the diaphragm. Remember the “fight or flight” response mentioned earlier? We have another response to temper that. Stimulating the vagus nerve lowers the heart rate and blood pressure, and floods the brain with “feel-good” neurotransmitters — brain hormones — producing a calming effect. Sit or lie comfortably and breathe in through your nose, into your belly. You will see your stomach rise. Breathe out slowly through your mouth. Imagine you’re breathing in calm and serenely, stress leaving your body as you breathe out. Mindfulness and meditation. These buzzwords have been very popular in recent years, but actually they influence our endocrine system by calming our stress response, reducing cortisol levels and balancing other hormones. There are apps that can help, if you have never done it before.I use the Calm app, which I put on to help me to get to sleep and to get back to sleep if I wake in the night and my mind is overactive. During the day, just going for a solitary walk — remaining six feet from others — taking deep breaths of fresh air can help. If you are tired, let yourself rest. Ideally, we should sleep seven hours per night. Try to have a regular routine so that your body knows what time to switch off and wake up. Things that can make it more difficult to sleep include working in your bedroom, scrolling social media or watching television in bed and drinking alcohol to excess in the evening. Exercising during the day and eating relatively early in the evening, so that you are not bloated when you get into bed, can really help with sleep. If you are like me, you may lie there worrying about not sleeping, which stops you sleeping. That’s when I use my Calm app. Many of the practices in this tool involve the deep-breathing techniques mentioned earlier. You can also try listening to soft music or writing your worries down before you try to sleep. Self-care — this is another term that is used a lot these days. Many of us have been brought up to think that spending time and energy on yourself is selfish. However, we’re also learning that you cannot pour from an empty cup! When you don’t take time for things that make you feel mentally and physically well, you deplete your confidence and self-esteem, which increases emotional distress and cortisol levels. Before social-distancing and Covid-19, we might have taken a “mental health day” or gone to the spa. Our options are obviously more limited at present, but whether it’s going for a walk, dancing to your favourite song, taking a bubble bath or chatting with friends on Zoom, self-care reduces the stress response in our brains and body. Everyone has good days and bad days, but if you think you’re getting overwhelmed or seriously depressed, reach out for help. There are many mental health professionals in Bermuda who are available to support you. Common symptoms of significant depression include:• Lack of interest or pleasure in activities you used to enjoy• Changes in appetite or motivation to eat• Withdrawing/isolating from others/social interactions• Inability to sleep or excessive sleeping and reduced self-care• Thoughts of self-harm•.”Brain fog”, with changes in concentration, focus, memory, problem solving • Annabel Fountain, MD, is a Bermudian physician who is board-certified in endocrinology, diabetes and internal medicine. She is the owner and medical director of Fountain Medical Group. Dr Fountain is available for telemedicine appointments during the Covid-19 isolation recommendations. Please call your primary-care physician for a referral or 232-2027 to make an appointment. Dr Fountain is available for telemedicine appointments during the Covid-19 isolation recommendations. Please call your primary-care physician for a referral or 232-2027 to make an appointment. • Adriene Berkeley, MD, is a Bermudian-registered chartered counselling psychologist and registered neuroscientist in Bermuda and Britain. To make an appointment with Dr Berkeley, please call 292-3456 or e-mail info@solstice.bm. The Bermuda Government’s mental health hotline can be reached by dialling 543-1111

Annabel Fountain, MD, is a Bermudian physician who is board-certified in endocrinology, diabetes and internal medicine. She is the owner and medical director of Fountain Medical Group