Fullscript Academy

Stress is the body’s natural response to change and is an unavoidable part of life. This response may be triggered by emotions, day-to-day situations, or environmental factors, such as air pollution and climate. (Münzel 2018) While short-term (acute) stress is a helpful protectant against dangerous threats and trauma, long-term (chronic) stress can have detrimental effects on mental and physical health. (Chu 2024)

Continue reading to learn more about stress and the best lab tests and evidence-based natural interventions to help manage and reduce its harmful effects.

How stress affects the body

The body's stress response is governed by the hypothalamic-pituitary-adrenal (HPA) axis. When a person feels threatened, the hypothalamus stimulates the release of adrenaline and cortisol from the adrenal glands. (Noushad 2021)(Wong 2011) Adrenaline increases heart rate, blood pressure, and energy supplies, while cortisol boosts blood glucose levels, alters immune responses, controls blood pressure, and reduces inflammation. (Healthdirect Australia 2023)(MedlinePlus n.d.)

Over time, chronic stress can lead to serious health issues, including depression, heart disease, diabetes, and high blood pressure. (National Institute of Mental Health 2020) Chronic stress can weaken the immune system, making a person more susceptible to illness. (Morey 2015) Stress can also impair functions of the gastrointestinal system, leading to poor motility, increased gut permeability, or disrupted gut microbiota. (Konturek 2011)

Did you know? If left unchecked, chronic stress can contribute to a range of health problems, such as heart disease, obesity, diabetes, lung disease, high blood pressure, and even cancer. (Mariotti 2015)

Types of stress

According to the American Psychological Association, there are three types of stress, each with distinct characteristics, symptoms, duration, and treatment approaches. (American Psychological Association)

Acute stress

Acute stress is the most common form of stress. It occurs as the body’s immediate reaction to something new—triggering the fight-or-flight response. Examples of acute stress triggers include being stuck in traffic, public speaking, or engaging in an argument. (Harris 2017)

Episodic acute stress

When acute stress happens frequently, it’s called episodic acute stress. Individuals experiencing episodic acute stress are often described as being anxious or irritable. They may take on too many responsibilities at one time and may struggle with organization and time management. (Harris 2017)

Chronic stress

If acute stress isn't managed well and occurs for an extended period of time, it becomes chronic stress. Chronic stress can be caused by a number of situations, such as relationship issues, financial struggles, or a stressful job. Chronic stress may be difficult to identify, often because it becomes a normal part of life. (Chu 2019)(Harris 2017)

Signs of stress

Recognizing the signs of stress early is important in being able to effectively diagnose and manage patient symptoms.

Physical signs of stress

• Change or decrease in libido

• Chest pain

• Digestive problems and upset stomach

• Dry mouth

• Fatigue

• Headaches

• Jitters

• Muscle pain or tension, including neck or back pain

• Rapid heartbeat

• Skin irritations 

• Trouble sleeping (Gholami 2017)(U.S. Department of Health & Human Services 2019)(Yosipovitch 2007)

Stress can manifest itself in many ways, including headache, irritability, and lack of appetite.

Mental and emotional signs of stress

• Anger

• Anxiety

• Feeling overwhelmed

• Forgetfulness

• Irritability 

• Lack of focus

• Lack of motivation

• Restlessness

• Sadness or depression (U.S. Department of Health & Human Services 2019)

Behavioral signs of stress

• Drugs or alcohol abuse

• Excessive eating

• Lack of appetite

• Reduced engagement in physical activity

• Social withdrawal

• Tobacco use (U.S. Department of Health & Human Services 2019)

Lab tests for chronic stress diagnosis

Lab testing can provide critical insights into a patient's physiological stress response and overall health status by identifying hormonal imbalances, nutrient deficiencies, and other biomarkers that indicate chronic stress.

Adrenal function panel

Two markers that can be included as part of an adrenal function panel include cortisol and DHEA-S (dehydroepiandrosterone sulfate) tests to evaluate adrenal gland performance. DHEA-S is another hormone produced by the adrenal glands and serves as a counterbalance to cortisol. Low levels may indicate adrenal fatigue or chronic stress. (MedlinePlus)

Cortisol levels

Cortisol, the primary stress hormone, follows a diurnal pattern with levels peaking in the morning and declining throughout the day. Abnormal cortisol patterns can indicate chronic stress or adrenal dysfunction. Salivary cortisol testing, serum cortisol testing, and 24-hour urinary-free cortisol testing are three different test options that measure cortisol levels at different times throughout the day to accurately assess a patient’s levels. (Kobayashi 2017)(Langelaan 2018)(NICHD 2017)

Inflammatory markers

Chronic stress is associated with increased inflammation, which can be measured through:

• C-reactive protein (CRP): An elevated CRP level is a marker of systemic inflammation. (Sproston 2018)

• Homocysteine: High levels are linked to increased cardiovascular risk and chronic stress. (Ganguly 2015)

• Cytokines: Pro-inflammatory cytokines like IL-6 and TNF-alpha can be measured to assess the inflammatory response. (Popko 2010)

Nutrient levels

Stress can deplete essential nutrients, exacerbating its negative effects. Lab tests such as a complete blood count (CBC), lipid profile, electrolyte test, and liver parameters can measure levels of key nutrients, detect any deficiencies or anemias, and aid in identifying the source of deficiencies. (Reber 2019)

Thyroid function

Chronic stress can impact thyroid function, leading to hypo- or hyperthyroidism. Assessing thyroid health involves measuring:

• Thyroid-stimulating hormone (TSH): Elevated or decreased levels can indicate thyroid dysfunction.

• Free thyroxine (T4) and free triiodothyronine (T3): These provide a direct measure of thyroid hormone production.

• Reverse T3 (rT3): This is a less active form of T3 produced from T4 during times of stress resulting in lower metabolic response.

• Thyroid antibodies: Including anti-thyroglobulin and anti-thyroid peroxidase antibodies, these tests help diagnose autoimmune thyroid conditions like Hashimoto's thyroiditis or Graves' disease. (NIDDK 2023)

5 natural ways to reduce stress and anxiety

The following natural strategies are effective in reducing all types of stress levels. (American Psychological Association)

Exercising

Participating in physical activity can improve stress resilience. (Childs 2014) During exercise, the body releases endorphins, which can improve mood and reduce anxiety. (Anderson 2013) Adults should participate in at least 150 minutes (2.5 hours) of moderate-intensity exercise each week to reap the many health benefits exercise offers. (The Department of Health & Human Services 2019)

Meditating and using other relaxation techniques

Meditation, mindfulness, and breathing exercises can help minimize feelings of stress and anxiety. Meditation has also been shown to lower high blood pressure, reduce resting heart rate, and decrease the body’s stress hormone, cortisol. (Sharma 2015) Encourage patients to set aside a few minutes each day to focus on their breathing without external distractions or listen to a guided meditation exercise online.

Planning ahead and prioritizing tasks

Encourage patients to set time each week to plan out daily tasks and upcoming events. Keeping tasks organized can limit unnecessary stress. Many strategies can help with planning and organizing, from using a mobile app to keeping a paper planner.

Reducing screen time and increasing time outdoors

Technology is entwined with our daily lives, but too much screen time can lead to increased stress and feelings of anxiety. (Khouja 2019) Encourage patients to step away from their computer or phone at regular intervals throughout the day. Spending time outdoors offers numerous health benefits, including improved mood and reduced stress levels. Research suggests that even simply looking at photos of nature can help improve mood. (Franco 2017)

Talking to friends and family

Staying connected with family and loved ones can improve resilience to stress and contribute to effective coping strategies. (Ozbay 2007) Population groups across the world with the highest concentrations of centenarians, known as “Blue Zones,” prioritize family and social circles, which suggests that social connection plays a role in longevity and overall health. (Buettner 2016)

The 7 best supplements to help manage and reduce stress

Recommending dietary supplements to patients experiencing symptoms of stress may be a helpful treatment strategy.

Ashwagandha

Ashwagandha is extracted from the roots of an evergreen shrub native to India and Southeast Asia. (National Institute of Diabetes and Digestive and Kidney Diseases 2012) This increasingly well-known herb demonstrates a range of health benefits, including being a safe and well-tolerated natural stress remedy. Ashwagandha mitigates stress by lowering elevated levels of cortisol in the body. (Chandrasekhar 2012) Additionally, ashwagandha may improve several sleep parameters, including total sleep time and sleep quality, for those suffering from insomnia often triggered by stress and anxiety. (Khouja 2019)

Chamomile

Chamomile has long been used as a mild sedative to promote calmness and ease feelings of anxiety. (Amsterdam 2009)(Gupta 2010) Chamomile may improve moderate-to-severe symptoms associated with generalized anxiety disorder (GAD), one of the most common chronic psychological disorders. (Mao 2016) Furthermore, vaporized essential oils extracted from chamomile flowers may help relieve anxiety. (Gupta 2010)

Lemon balm

Lemon balm has been shown to reduce feelings of anxiety and promote well-being. (Scholey 2014) One study found that supplementing with lemon balm for eight weeks resulted in a significant reduction in symptoms of depression, anxiety, and stress. (Haybar 2018)

Drinking a beverage infused with lemon balm can help lower stress and anxiety. (Scholey 2014)

L-theanine

L-theanine, an amino acid found in green tea, has been shown to have calming effects. A meta-analysis of nine peer-reviewed articles concluded that L-theanine supplementation reduces stress and anxiety in individuals experiencing stressful situations. (Williams 2019) One study showed that perceived stress was significantly reduced one hour after supplementation and cortisol levels decreased after three hours. (White 2016)

Did you know? Low-caffeine green tea can improve sleep quality in middle-aged and elderly individuals by suppressing stress. (Unno 2017a)(Unno 2017b)

Magnesium

Magnesium has been shown to reduce feelings of anxiety and stress. Approximately 68% of North Americans don’t intake enough daily magnesium, which is associated with increased feelings of stress and anxiety. Under acute stress, the body excretes increased levels of magnesium through the urine. Supplementing with magnesium can help maintain adequate magnesium levels and support the stress response. (Boyle 2017)

Valerian root

Valerian root, most commonly used for its sedative effects to improve sleep, has also been found to reduce both physical and psychological symptoms of stress. (Bent 2006) One of the compounds in valerian root extract, valerenic acid, has a tranquilizing effect and contributes to a calm state of mind by preventing the breakdown of gamma-Aminobutyric acid (GABA) in the brain. (Houghton 1999) GABA is an inhibitory neurotransmitter responsible for blocking impulses between nerve cells in the brain. Low levels of GABA are associated with increased anxiety. (Allen 2020)

B vitamins

B vitamins, most significantly B6, B9, and B12, may be helpful in alleviating symptoms of high stress. (Stough 2014)(Young 2019) Vitamin B complexes have a variety of scientifically proven benefits when taken daily, including combating depression, anxiety, and the effects of work-related stress. (Stough 2014)

Taking supplements and vitamins can make for an easy, cost-effective method for managing stress. 

Addressing stress naturally

Chronic stress can have detrimental health effects, making it vital to recognize the symptoms and conduct relevant lab assessments in a timely manner. Implementing natural stress relief strategies is a great way to support patient health outcomes.