I see a lot of dark under-eye circles on the faces of patients in my practice — and I’m not a cosmetic surgeon. I’m a functional-medicine practitioner.
My patients typically come in because they have a host of niggling symptoms that don’t make sense: They can’t lose weight, they feel chronically anxious, or they have eczema that won’t go away. About 25 percent have hypothyroidism; almost 50 percent report sleep issues.
But what is clear right away is that they all feel tired, overwhelmed, and unable to get to the bottom of their to-do lists.
These patients are in a state of chronic stress, and their bodies are showing the signs. This condition is technically called “allostatic load,” and it occurs after their stress response has been activated for too long.
Our bodies are beautifully designed to handle short-term threats — the stress response makes us alert, energized, and able to withstand physical injury — but we’re not designed to stay in this hypervigilant state all the time. It wears us out.
We can’t eliminate all the high-pressure aspects of our lives, nor would we want to. We all need some stimulation to be healthy. Still, we can learn to recognize the signs that our bodies are stuck in fight-or-flight mode.
We can also start to choose from the various stress responses that our bodies are designed to deploy — ones that shift our systems away from chaos and toward rest and recovery.
Signs of Adrenal Overdrive
Getting stuck in survival mode leads to two conditions I see routinely:
- Adrenal overdrive: When you can’t turn off the stress response, and you feel wired and tired.
- Adrenal overdrive with exhaustion: When you can’t turn on the stress response and you’re so exhausted you can’t get moving.
These types of adrenal malfunction show how the positive aspects of the survival system can become liabilities. For example, the energy from a big rush of blood sugar saves you when you need to battle or flee, but when blood sugar stays elevated for too long, it can lead to insulin resistance and type 2 diabetes.
Likewise, adrenaline does a terrific job of raising your heart rate and constricting your blood vessels. But when this process goes on too long, hypertension can develop.
The first step to escaping survival mode is knowing how to identify it: In adrenal overdrive, you feel anxious, hyperalert, and tense. You may notice that you’re wired and tired at night.
In adrenal overdrive with exhaustion, you might feel wiped out when you wake up in the morning, tired all day long, and then wide awake with worry when you finally turn out the light at night. Because you can’t shut the vigilance off, you never really rest.
We often have no idea that these symptoms mean anything. We may think we’re “just tired,” or that anxious thoughts reflect a genuinely threatening reality (and sometimes they do).
We might completely dismiss the idea of stress because we believe we have it better than other people — even though the difficulties of homeschooling a wily teenager or meeting the demands of our jobs are intense.
In an achievement-oriented culture, we often feel ashamed if we can’t handle exorbitant amounts of pressure, because it seems like everyone else can. We think there must be some problem with us, and we keep quiet about it.
To a degree, these kinds of stress are part of being alive. But most of us never get — or take — a break.
Even before we were forced to contend with a global pandemic, we were always on. Checking our smartphones is often the first and last act of the day. We’re triggered by emails, headlines, and text messages right up until we go to bed — some of us even sleep with the TV on.
Our schedules override the normal circadian rhythms that would have us going to sleep when it gets dark and waking up when it’s light.
Day in and day out, a range of stimuli we might never suspect are triggering our nervous systems, causing unrelenting stress that can do real damage to our health over time.
Yet when we learn to appreciate how our bodies are meant to respond to stress, and to identify when we’re stuck in the fight-or-flight response, easing into modes that rebuild and restore our health can become second nature. After all, our bodies are designed to support us. We just need to give them the chance.
Hidden Triggers of the Sympathetic Stress Response
Almost anything the body perceives as a threat can kick the sympathetic nervous system into gear and keep it there, which is why many of us can be perpetually triggered without realizing it. Here are a few surprising factors that contribute to adrenal overdrive.
In-Utero and Early-Childhood Experiences
Our stress “set point” can be determined even before we’re born. It’s affected by exposures in utero as well as experiences during early childhood. If those periods involved a lot of hardship, it may make us even more sensitive to the stresses of daily life now.
For example, if your mother was worried about having enough food or money during her pregnancy with you, you were exposed to the stress hormones coursing through her system. This can affect your stress set point, potentially making you more reactive than someone whose mother enjoyed a more secure pregnancy.
If you add adverse childhood experiences to this — like an abusive caregiver, or a death in the immediate family — it can lower your resilience even further.
Constantly striving for perfection triggers the primal fear that if we don’t do everything, and do it just right, we’ll get kicked out of the social community.
This fear stems from the time in our species’ history when we needed the group for protection, because a predator could easily eat us if we were alone. So perfectionism isn’t just anxiety about mistakes themselves; it’s anxiety that we’ve jeopardized our sense of belonging — which sparks the survival response.
Learning to embrace your mistakes and vulnerabilities (and those of others) may be a far better survival strategy.
Low Blood Sugar
When your blood sugar stays low for a long time, your body switches to an energy-conservation mode. It doesn’t know that you just skipped breakfast because you were busy; instead, it behaves as though you were entering an indefinite period of food shortage.
Starvation is one of the original mortal threats, so when you’re hungry for too long, the body raises cortisol and sets the stress response in motion. Eating adequate amounts of high-quality protein and fat, and avoiding excess sugar (which yanks insulin around), helps keep the nervous system in balance.
Food sensitivities involve immune reactions. For instance, if you’re gluten intolerant and eat gluten, your immune system releases an inflammatory cascade to vanquish the invader. The body treats inflammation as a crisis and fires up the stress response. This means if you regularly eat a food that your body doesn’t tolerate, it will continually provoke the stress response.
Body-care products, air pollution, and chemicals in our homes and work spaces all can contain toxins that can trigger the immune response and, by extension, the stress response.
Two particular genes — MTHFR and COMT — influence the body’s ability to eliminate toxins. If you’re exposed to toxins and you carry alterations on either of these genes, your body won’t eliminate them as well as someone with no alterations.
Additionally, people with an alteration on COMT don’t break down stress hormones as effectively. So when they get a hit of adrenaline, it stays in their systems. They generally can’t tolerate coffee and often avoid roller coasters and scary movies, because they know that when they’re exposed to these kinds of stimulation, it will take a long time for them to calm down.
Simmering viral infections stimulate the stress response in the same way that food sensitivities do, resulting in chronic inflammation that triggers a state of alarm in the body.|
The Stress Alarm
The stress response can be activated by stressors that are concrete (such as not having enough money to pay your bills) or abstract (persistent perfectionism). But the physiological reaction to both types of trigger is the same. The process looks like this:
- You notice a danger, which might be an immediate threat (a car speeding toward you) or a perceived one (your boss gives you a funny look).
- This perception triggers your amygdala, the area of your brain associated with self-preservation memories. These memories helped our ancestors avoid threats, such as plants that had once made them sick. Today, it helps us prepare for daily situations that we know to be stressful.
- Your amygdala sends an alarm message to your hypothalamus, which passes it along to your pituitary gland, which alerts your adrenal glands that they need to pump out the hormone cortisol.
- Cortisol acts to protect your body: It elevates your blood pressure so that if you bleed copiously you won’t go into shock. It mobilizes your immune system to fight infection, and dumps glucose into your bloodstream for an immediate surge of energy, along with insulin from your pancreas to mop up that glucose once the crisis is over.
- The threat message signals your medulla (which controls involuntary functions) to send an adrenaline burst. This jump-starts your heart rate, dilates your pupils, and makes you hyperalert. You are now primed to escape, subdue, and survive a mortal threat.
Signs That You’re Stuck in Overdrive
These are signals that your body may be having trouble downshifting:
You have intense food cravings. We often crave sweet or salty foods when we’re in adrenal overdrive because they provide energy and replenish our systems. When our stress lessens, cravings usually do, too.
You feel judgmental and picky. When we’re in survival mode, we naturally scan our surroundings for danger, and a “negativity bias” prevents us from missing any potential threats. Yet when we see only what’s wrong with everyone and everything, it can make us unpleasant and miserable — and even more stressed.
You’re waking up tired. If you go to bed at a decent hour but wake up feeling like you haven’t slept at all, this is a sign that your cortisol is not rising in the morning as it should. This can happen when your adrenals have stopped producing enough of the hormone.
You’ve gained belly fat. The weight we gain around our midsections is often a signal that we’re experiencing a cortisol overload.|
More Sustainable Stress Responses
Fortunately, our bodies have other ways of responding to stress — processes designed to move us out of the state of alarm and into a state that’s calm, secure, and restorative. With a little practice, we can learn to consciously shift into these modes whenever we notice we’re stuck in the heart-racing state of adrenal overdrive.
1. Rest and Digest
We aren’t meant to spend most of our time in overdrive. Part of life necessarily involves replenishing ourselves by triggering a parasympathetic response — what you experience when you nap, get a massage, or lie in savasana at the end of a yoga practice. This restorative state helps us recover from the wear and tear of daily life and times of stress.
The problem is that most of us don’t take time to hit the pause button, because we think we can’t — or shouldn’t. But intentionally taking time to recuperate after a stressful event will lessen its effects. Better yet, we should regularly build this time into our schedules.
I recommend creating a nightly routine that helps you downshift; this guarantees that your body has a chance to escape fight-or-flight mode daily. Try to eat dinner at least three hours before bed, so your body can finish the period of active digestion and use those nutrients for rest and repair while you sleep. Turn off devices at least an hour before bedtime to avoid upsetting messages and the light from the screen that signals the pineal gland that it’s time to wake up.
Other ideas to shift into “rest and digest” that you can try anytime include the following:
- Breathe slowly and deeply for five minutes.
- Spend 30 minutes a day in nature.
- Take a relaxing hot bath.
- Attend a yoga class.
- Meditate, even for just 10 minutes.
2. Tend and Befriend
There’s a physiological reason it feels so good to call a friend when you’re feeling anxious or down. UCLA researcher Shelley Taylor, PhD, has identified this as the “tend and befriend” stress response.
Along with adrenaline and cortisol, the body produces a small amount of oxytocin in response to a threat. Sometimes called “the cuddle hormone,” oxytocin triggers us to bond with others, which helps us feel safe and settle down.
When Taylor’s research group investigated why reaching out for support is typically easier for women, they concluded that it makes sense from an evolutionary perspective. It’s not easy to fight off a beast or to run if you’re pregnant or caring for small children, so females relied more on the group for protection.
Men also benefit greatly from social support — and for them, a little bonding goes a long way because they seem to have fewer oxytocin receptors than women do.
Either way, it’s worth silencing the achievement-oriented voices of shame in your head that tell you to avoid sharing your worries. The idea that you should be able to handle stress without help is just not true; we never have. And why deny yourself one of nature’s great “chill pills”? Shifting into this mode isn’t hard:
- Do something social — anything that allows you to bond with others. You don’t need to discuss problems to get the benefit of social bonding.
- Connect with a good friend on the phone or take a walk and talk it out. Studies show that verbalizing our concerns automatically turns off the sympathetic nervous system.
3. Excite and Delight
You don’t have to shut down when you feel pressure. It’s possible to open up and use the energy of stress to become more interested in what’s going on. This is called the “excite and delight” response.
Because it also involves cortisol and adrenaline, you feel the same level of alertness and awareness as you do in fight-or-flight. But rather than narrowing your focus, you choose to open up, to be curious.
Marilee Adams, PhD, calls this a “learner mindset.” When we’re faced with a situation we don’t know how to handle, we start asking questions.
Its opposite is a “judger mindset”: We see something unfamiliar or threatening and make quick judgments — no questions asked. This is the default of the fight-or-flight response, in which hormones limit our perception of the bigger picture.
If you deliberately adopt a learner mindset, a challenging situation can become a chance to learn or experience something new. If you’re ill, for example, you can view your symptoms as a chance to listen to your body instead of seeing them as signs of your demise.
Or if someone is being aggressive toward you, you could ask yourself what’s going on with that person, rather than reacting defensively. This might lead to compassion instead of more anger. Curiosity expands your problem-solving options — and often resolves issues more quickly and easily.
Once you’ve developed a habit of being interested, you can use all the best parts of the stress response — alertness, energy, focus — to enjoy new kinds of experiences, ones in which you use your excited energy to expand your abilities and ideas instead of shutting down.
Asking yourself these questions can help you shift into excite-and-delight mode:
- What’s really happening here?
- What else might be going on that I’m not seeing?
- What’s interesting about this situation?
This article has been updated. It was originally published on September 26, 2016.