March 15th 2019
11 health resolutions your GP wants you to keep
January 6th 2019 / 0 comment
Tackling stress is one of the most important things we can do for our health and yet most of us are too blasé about the damage it's doing, says Dr Rangan Chatterjee. Use his simple interventions to reduce your daily stress dose and feel happier, leaner and more productive
Up to 80 per cent of all GP consultations are thought to be related to stress – think insomnia, low mood, anxiety, IBS, headaches – and although many of us might believe we’re managing because we’re still standing at the end of the day, probably propped up by a glass of Picpoul, this doctor begs to differ. Dr Rangan Chatterjee, whose latest book The Stress Solution: The 4 Steps to Reset Your Body, Mind, Relationships and Purpose is required reading for just about anyone who lives in the modern world, thinks we're too blasé about our stress load. It's an attitude he sees in his surgery all the time. "We think we can get away with burning the candle at both ends, but the reality is very different. Every day I see patients who are literally stressing themselves to an early grave."
We’re ignoring some pretty dire potential long-term consequences of high-pressure modern living: obesity, type 2 diabetes, strokes high blood pressure, cardiovascular disease, strokes and Alzheimer’s, to name but a few. And if you've glazed over, thinking that these are old person's diseases that don't apply to you right now, Dr Chatterjee has news for you.
It all starts with what he calls 'Micro Stress Doses' (MSDs). We're exposed to dozens of these every day and they all add up. For example, your alarms blares (MSD1), you check your Insta feed and see a colleague sunning themselves on a Greek island (MSD 2), you check the news and see some distressing images (MSD 3), you feel a bit groggy after last night’s late pizza and half a bottle of wine and reach for the paracetamol (MSD 4) and before you know it, you’ve had 20 micro-stress doses before breakfast. All these MSDs take us closer to our personal stress threshold, where body and mind suffer.
The Stress Solution, which follows on from Dr Chatterjee's top-selling guide to living well, The 4 Pillar Plan, leaves you under no illusion as to how our natural stress response is misfiring in the modern world. In a nutshell, it's this: short-term-stress is useful to get us out of danger – a pounding heart and rapid breath will speed blood to the muscles to help us run away. Our immune system fires up with inflammation to ensure any infected wounds are quickly healed, we have a surge in the stress hormone cortisol to keep our wits about us. However, long-term, the effects can be devastating. Chronic inflammation, for example, increases our risk of many killer diseases including depression, he explains. If we’re constantly making cortisol, it starts to kill nerve cells in the hippocampus - the brain’s memory centre – and increasingly younger people are presenting to him with memory problems. Excess cortisol can cause hormonal imbalance which can exacerbate menopausal symptoms and lower libido. And those are only a few examples.
Here, Dr Chatterjee takes a deep dive into modern stressors and gives some eminently doable and science-backed interventions, to reduce or MSDs. Simply changing how you greet your partner, for example, can lower your stress levels every day (see point 3 below).
“I have seen these tools change the lives of thousands of my patients,” says Dr Chattterjee. “I know they will do the same for you.” Here's where to start.
11 ways to reduce your daily stress dose, by Dr Rangan Chatterjee
1. Get dates in the diary to see your friends
Because of social media, we can see what our friends are up to, their holiday photos, their children, what they had for dinner, so we feel like we don’t actually need to see them in person. Loneliness is on the rise and affects young people as much as old and it causes physical changes in our body. On an evolutionary level, if we didn’t have a strong community to protect us we could be vulnerable to attack so our immune system would go on high alert, we’d become inflamed. Being isolated is a stressor in the same way.
One of the simplest things you can do to destress is to set a date to see one or two of your friends in person. Get a date in the diary – even if it’s in two months’ time.
I had a 37-year-old patient who was always working and checking her emails at the weekend, who came to see me because she was feeling low, with poor motivation and had difficulty concentrating at work. Her blood tests were all normal and so I recommended she made time to see one friend a week for six weeks and that they put their phones away. She came back and said, “I can’t believe how much it had changed me”. Just that simple act meant she felt better about herself, her mood improved and her self-esteem was better, she was more productive at work. Friendship is not a luxury but a necessity for our health.
2. Dose your exercise to reflect your stress levels
There are multiple stressors in modern life and, although it’s good, exercise can also be a stressor in the wrong dose. It’s a bit like coffee, the right amount can put you in the optimal zone, but too much can become counter-productive, you become jittery and anxious. When we’re deciding what workout to do, we’re often not thinking about it in the context of our stress levels as a whole. If you haven’t slept well the night before, you need something relaxing and rejuvenating like yoga rather than a spinning class that will deplete you even more
If you’re over-exercising in the context of a stressful lifestyle, you can find yourself unable to sleep at night after a vigorous workout, you might be sleeping more but still feel exhausted. You might wake up to find your heart still racing the day after. If you’re feeling irritable and moody after an intense workout, it’s probably too much right now.
Measuring your Heart Rate Variability (the change in rhythm and strength from one beat to the next) is a great way to work out your optimum exercise dose on any given day. I have the HRV4Training app and every morning I take a one-off reading and it gives me an idea of the total stress load on my body. I often think of it as a marker of resilience – your body’s ability to cope with stress. Yesterday I had a high reading which told me that my body was in a rejuvenated and restored state and that I was stress resilient. I did a run and felt great. When your HRV is low it means that your body’s stress load is quite high and on those days, I know I don’t need to hammer it as my body is resilient enough for a hard workout. I will do deep breathing for five minutes, or some yoga stretches or Pilates and it means I still exercise daily.
3. Do the '3D Greeting'
We may have lots of friends on Instagram, but the relationships that are meaningful to us we’re not nurturing and that puts a big stress load on our body. When you get home, you might be distracted by looking at the last Instagram post or still trying to reply to an email, which means you won't truly connect with your partner or children. I find myself doing this too.
A quick way to regain a meaningful connection is the 3D Greeting. When you see your partner, children or good friends give them a hug, make eye contact and say something meaningful or nice. It doesn’t take long but it has a huge benefit. Every morning I greet my wife in three dimensions with eyes, touch and voice. It feels a bit weird the first few times, but before you know it, it becomes normal and you feel really close and connected.
When we talk about destressing we might talk about having a chamomile tea or a lavender bath - and that’s amazing - but there’s so much more to the texture of the human experience that can help us destress.
4. Cut down on liquid stress
Two of the biggest stressors in the modern world are caffeine and booze. It’s a bit like exercise, in the right amounts they can be fine, but too much and they start to create stress on the body.
So many people who are stressed use caffeine as a crutch, which makes them more jittery and disrupts their sleep. Lack of sleep is a huge stress on the body – it causes inflammation, stops you solving problems effectively or making decisions and your attention span decreases.
I say enjoy caffeine but have it in the morning. After 12 o’clock there’s a very good chance that it will be in your bloodstream at night when you are trying to go to sleep. So many patients tell me it’s not a problem, but when they cut it back suddenly they feel better, they are less irritable in the afternoons.
The more stressed we are, the greater the tendency there is to use alcohol to destress too. I’m not saying people should stop drinking, but the reality is that if you are drinking in the evening, for most of us it will affect our sleep; we wake up more in the night, we don’t get the same deep levels of REM sleep.
If you are going to have alcohol in the evening, make sure to have it as early as you can, but be aware that it can affect your sleep quality. Remember alcohol is a sedative, and sedation is not the same as sleep. When you monitor heart rate variability after a couple of glasses of wine the night before, the quality of your sleep will have tanked and that will leave you more prone to being stressed the following day because you haven’t had a good night’s sleep and so the cycle continues. I had a patient who always had half a bottle of wine on a Wednesday night after a stressful team meeting, which disrupted his sleep. Swapping the wine for a destressing yoga class made all the difference to the rest of his week.
5. Take a breath break
Your breathing state reflects your stress levels. If you have a work deadline that’s imminent, your breathing will start to speed up. Any time our stress response goes up, it’s because on a primitive level we feel under attack. Even though a deadline is not a physical threat, your body perceives it as that, and tries to get more oxygen to the muscles by increasing breathing and heart rate, as if you are running away from a lion.
However, you can absolutely trick your body into feeling that that world is safe by slowing down your breathing. My personal favourite breathing technique is my ‘3,4,5 breath’: breathe in for three, hold for four, breathe out for five. Making your out-breath longer than your in-breath, helps to switch off your stress state and activate your thrive state. You can do a few rounds before a big meeting or before you go to bed, it’s a really great way of unwinding and becoming more aware of your breath generally. Do one minute a day of conscious breath, slow it down, make it deep and the destressing effect is instantaneous.
Photography by Susan Bell
6. Have an affirmation for breakfast
The brain is constantly responding and adapting to the information that we give it. If we are chronically stressed, our brains adapt so that it actually becomes easier for us to stress out because the body is expecting stress. An affirmation is a way of directly feeding our brain positive information which then programmes it for success. It’s a short, powerful and positive statement of intent which you repeat regularly, and the more often you repeat it the better the impact.
It forms part of my routine each morning, but you can do it before a big meeting or on the bus (you can whisper it in your head if there are people around). I do it with my two kids. The one I’m using at the moment is “I'm happy and calm and stress-free”. You repeat that for about a minute and while you're saying it, you are actually feeling it. It sounds a bit whacky, but it really makes a difference: you feel happier, you feel calmer. One study showed affirmations to improve problem-solving performance in undergraduates. It's another really powerful trick to convince the body that all is OK and take us out of stress state and into thrive state.
7. Eat all your food within a 12-hour window
Our bodies have a natural daily rhythm. Eating out of rhythm is a stress on the body and a simple way you can recalibrate is to eat all of your food within a 12-hour window. Pick any 12 hours e.g. 7am to 7pm or 8am to 8pm and don't eat anything outside that window. It’s very achievable and sustainable. We know that it helps lower stress levels, helps improve our immune system function, blood sugar control and even helps us with our weight. Time Restricted Eating (TRE) I believe is one of the most important things anyone can do for their health.
8. Eat the alphabet every month
Stress signals don’t just go from the brain to the gut (think of exam nerves and how they make you want to go to the toilet). There are also communication pathways from the gut up to the brain – the gut-brain axis. The food you consume can either send your body stress signals or calm signals. If you are eating highly processed foods and you are not eating a diverse range of different nutrients, you're not giving your gut bugs the information they need to thrive and therefore stress signals go up from the gut to the brain. We've all got our favourite veg – our broccoli or our peas – but what we really want is diversity in order to nourish a variety of different gut bugs. A diverse microbiome is a resilient one, which sends calm signals up to the brain.
A simple thing that we can do is eat the rainbow each day (as many different coloured plant foods as possible) or to eat the alphabet every month – 26 different plant foods. Download my free Eat The Alphabet chart here.
9. Turn off all notifications on your phone
Each time we look at our phone we get a Micro-Stress Dose. We're living in an era of information overload and it’s just too much for our brains to deal with. The result is often memory loss, and I’m seeing increasingly in my practice people in their 30s and 40s even sometimes in their 20s, concerned about their memory. The neuroscientist Manfred Spitzer was on to something when he coined the term ‘digital dementia’.
If we've got too much going on – too many deadlines, trying to keep up with all our social media channels – we get to the point where we just can't think anymore; we reach what I call our ‘personal stress threshold’. And when we get to that stage our memory goes, we overreact, we get angry, emotional and stressed. Switching off our notifications is a powerful way of reducing our daily MSDs and taking back control from your smartphone. We don't really need to know every single time someone likes one of our Instagram comments or retweets us or that we've got an email. It's a simple thing that has such a large knock-on benefit. When I pick up my phone to make a phonecall, I don't know if I've got 10 emails or zero emails as I have to manually refresh my inbox.
10. Play board games to train your brain to resist temptation
We're all becoming very impatient – we live in the era of Netflix, we get our Amazon Prime order on our doorstep the next day and have voice assistants to obey our command. But the ability to delay gratification and defer reward has been linked to all kinds of positive life outcomes.
A simple thing you can do is to focus on activities that require skill and patience such as a board game or playing cards. Playing chess, for example, encourages fierce concentration, mindfulness and focus. Even computer games can be useful. A colleague bought her daughter a computer game that teaches dance routines – you are watching, learning and staying focused.
Anything that promotes increased focus and concentration helps you to exercise a part of your brain called the dorsolateral prefrontal cortex. This is involved with our ability to exercise self-control and make rational decisions. If you're chronically stressed, you have a smaller dorsolateral prefrontal cortex, which means a reduced ability to self-regulate.
I see the effects of this with people who are over-use digital media, who are constantly on the go and always looking at their phones. They become impatient, their memory is affected and they lose the ability to delay gratification. Exercising the dorsolateral prefrontal cortex will help you to be less impulsive when you're confronted by temptation. And that goes for food too. It becomes easier to say "I’m not going to have that sugary treat right now".
11. Do something each day that you love
We are so busy these days that most of our time is spent doing what we need to do rather than what we love doing. But we should prioritise pleasure in the same way that we prioritise drinking enough water or eating enough colourful fruit and veg.
We know that having little daily doses of pleasure makes you more resilient to stress, but that conversely, people who are chronically stressed actually find it harder to get pleasure from simple things. By doing something each day that you love, whether that’s reading your book, listening to your favourite music or inspiring podcast, or watching your favourite comedian on YouTube for ten minutes every evening, you are doing a huge favour for your wellbeing, your emotional health, your brain health and reducing your stress levels.