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.