The Stress Solution Read online

  It’s becoming increasingly common to see professional athletes, as well as weekend warriors, using HRV apps such as HRV4Training or Elite HRV to help them determine what sort of training they should be doing. A high HRV indicates that they’re relaxed and have low levels of stress and can benefit from going hard. A low HRV suggests that the body has taken the hit from multiple MSDs and is in need of rest, recovery and relaxation, so they might try yoga or stretching, or even give the workout a miss.

  I found using an HRV app absolutely fascinating. So many factors negatively impacted my readings, among them eating out, caffeine, a poor night’s sleep, alcohol and travel. A friend of mine, Alessandro Ferretti, studies HRV and religiously tracks his rate with medical-grade equipment. When he watched Masterchef Australia, with its genial and encouraging hosts, he found it relaxing and enjoyable and his HRV reflected this. But when he watched Masterchef USA, with Gordon Ramsay effing and blinding, he found it so irritating his HRV went down!

  These apps have also helped in the surgery. I recently saw a forty-eight-year-old patient, Andrew, who was a tech enthusiast and came armed with his own HRV readings. I decided to have a detailed look at his data. What I found was eye-opening. Every Wednesday afternoon Andrew had to run a team meeting at his firm of corporate headhunters. Because of the stress he’d endured that day, he’d often drink half a bottle of wine on Wednesday evenings. This would inevitably cause him to have disrupted sleep, which would lead him to wake up groggy and tired on Thursday. To compensate for his ill mood, he’d gorge on sweet treats and caffeine throughout the day and become progressively more tired and moody. He’d literally be counting the minutes until the end of the working week; Thursday and Friday were almost unbearable. He’d get through at least a bottle of wine on Friday nights and spend the rest of the weekend recovering.

  Andrew’s data showed that, after he consumed alcohol on Wednesday evening, his HRV readings plummeted, which meant that on Thursday mornings he’d be right up against his stress threshold. This helped explain why those days were so tricky for him. Armed with this information, we planned a strategy. On Wednesdays, he would no longer go back home, slump on the sofa and crack open a bottle of red wine. Instead, he found a local yoga class and would pop in on the way home from work. By making this single change to his routine, his working week was transformed. He would wake up on Thursday mornings feeling refreshed. He’d eat fewer sugary snacks and felt less of a need to drink caffeine. He also felt calmer and more productive at work. Over the next few weeks he fed back to me that Thursdays and Fridays were now his most enjoyable work days. He also told me that on Friday nights he would no longer drink a whole bottle of wine. He would either drink a single glass, or occasionally abstain, as he felt less stressed at the end of his week.

  By empowering himself with this knowledge and seeing the impact on his biology, Andrew was motivated to change his behaviour. When I saw him two months later he was beaming. His workload had not changed – he was still being hit by multiple MSDs throughout the day – but what had changed was his capacity to absorb those MSDs. Over the course of just a few weeks his energy levels had increased, he felt less stressed and his mood had improved.

  I’m sure you’ll have had mornings when you’ve woken up feeling great and rested. You march on into the day and deal with all those MSDs like a swordsman of old, batting them away as they come flying at you. You’ll very likely have a high HRV reading on days like this. Contrast that feeling to the times you’ve woken up a bit late, felt groggy, needed a gallon of caffeine and everything seemed to involve a lot of effort and stress. I’d bet, on a day like that, your HRV reading would be low. You would be very close to your personal stress threshold and it wouldn’t take much to push you over it. I’m not advocating that you meticulously track your readings every hour. I use a simple app once a day in the morning to give me an idea of what my status is for the day and to guide me in my exercise choices.

  ELEVEN WAYS TO INCREASE HRV

  These are just suggestions. You don’t need to do them all. Pick a few that you think you can implement in your life.

  1. Get enough sleep – ‘enough’ sleep should leave you feeling refreshed and rested. Seven to nine hours seems to be the sweet spot for most.

  2. Eat your last meal of the day at least three hours before going to bed (see here for more details).

  3. Prioritize exercise. Do a form of strength training at least twice a week and move as much as possible each day.

  4. Practise deep breathing, the 3–4–5 breath and alternate-nostril breathing for five to ten minutes every morning (see pp. here).

  5. Eat a diet rich in whole, unprocessed foods (see Eating the Alphabet here).

  6. Do some form of regular yoga practice. I like patients to do ten minutes a day. Weekly classes can be helpful as well, but I find doing less but more often is a much better way of reducing stress and raising HRV levels.

  7. Practise meditation.

  8. Listen to relaxing music.

  9. Go for a walk in nature.

  10. Take up t’ai chi.

  11. Do a daily practice of gratitude (see here).

  RELEASING STRESS FROM THE BODY

  Because our bodies store stress, we can also use our bodies to release it. In this, we’re no different from animals such as polar bears, who are seen vigorously shaking or trembling after traumatic incidents in order to discharge feelings of stress.

  • DO ONE MINUTE OF INTENSE ACTIVITY. This will help your body ‘process’ the stress that has built up in your system. It could be twenty press-ups, some star jumps or even a brisk walk.

  • DO SOME FORM OF BODY WORK SUCH AS DEEP-TISSUE MASSAGE OR MYOFASCIAL RELEASE. Fascia is the cling-film-type substance that surrounds our tissues and organs which helps reduce friction and pain as we move. Myofascial release aims to stretch this cling film out. It’s thought many of us ‘store’ our stresses in our bodies, which is why many people have dramatic emotional responses to deep-tissue work or therapies such as myofascial release. A regular form of body work may help you discharge your stress.

  • DO TWO MINUTES OF DEEP BREATHING. This helps to change your physiology immediately and give your brain the signals to put you into a thrive state. (For more on breathing, see here.)

  • HAVE A GOOD CRY. Everyone tends to feel better after crying and, if you are highly stressed, it can often be easier to take full deep breaths after a good cry.

  • LAUGH UNCONTROLLABLY FOR A FEW MINUTES. Watch your favourite comedian on YouTube or have a giggle with your friends. This helps to release endorphins that can reduce stress.

  • PRACTISE YOGA. Stretching out the muscles, focusing on the breath and quietening the mind can be hugely beneficial.

  • TRY PRIMAL SCREAMING. Although we don’t have robust scientific evidence on this, I have seen many patients who report that this technique can be a great stress reliever. The idea is to scream at a comfortably loud volume in order to release your anger and stress. Ideally, you would do this with the lower register of your voice and the sound should come from your belly and not the throat. It is best to do this in a safe environment like your house and some like to do it into a pillow to muffle some of the volume. Some patients report additional benefits from doing it in a guided group session. It may sound rather unusual but if you struggle with stress it is certainly worth a try.

  • TRY REFLEXOLOGY. Studies have shown that this gentle and relaxing therapy can help reduce levels of the stress hormone cortisol. Many patients have reported back to me that reflexology helps lower their stress levels and improve their sleep quality.

  Chapter 9

  RESET YOUR RHYTHM

  Our biological systems are a bit like an orchestra that’s being led by an astonishingly precise conductor. Whereas a musical orchestra has its strings, brass, percussion and horns, we have digestion, muscular strength, liver function and our sleep cycles. The internal rhythms that our bodies live by have been finely tuned over millions of years. Bu
t in the last couple of hundred years, since the advent of artificial light, our bodily rhythms have been knocked out of time. It’s as if there are now two conductors, one that’s trying to get the orchestra to play Mozart, the other to play Eminem. These rhythms we live by are information. Make that information chaotic and the body will respond by switching into stress state.

  THE MYTH OF THE NIGHT OWL

  Perhaps the most well-known internal rhythm is the circadian – the one that wakes us up and sends us to sleep. There’s a widespread belief that people possess one of two different kinds of circadian rhythms, with some being ‘morning larks’, bouncing happily out of bed bright and early, while others are ‘night owls’. While there is some truth to this, I’ve come to believe that this difference has been wildly exaggerated.

  One of my oldest friends, Andy, spent most of his life convinced he was a night owl. At university, he’d be up late partying at the weekends and lie in recovering every morning. He told everyone he did his best work late at night, when the world was quiet and most people were sleeping. He believed it was his most creative time and, indeed, he did do some really good work after midnight. But the next day he’d struggle to perform well, especially in the afternoons, and would rely heavily on caffeine to get him through. That post-lunch lull convinced him even more that he was just the kind of person who was naturally primed for the hours of dark.

  About two years ago Andy became a father. His nights would often be disrupted by his young family, who’d typically wake him up at around 5.30 a.m. He was growing more and more tired and, out of desperation, phoned me for help. He insisted he couldn’t go to bed much earlier than he was already because he was a night owl so he’d end up lying there for hours, staring at the ceiling. I told him that if he kept going to bed at one in the morning and waking with his kids at 5.30 a.m. he was going to burn himself out, and fast. I recommended that he start going to bed before ten o’clock, limit his caffeine to the morning, cut out booze in the evenings and stay off his screens for at least an hour before he went to bed. Before I put the phone down I’d managed to persuade him to give this new routine a go for two weeks, then we’d reassess.

  Before the first week was out Andy noticed that those afternoon lulls which he’d assumed were just part of his biological make-up didn’t happen any more. He also became way more productive during daylight hours and started doing much of his best work in the mornings. He’s now decided that he’s a lark!

  I told Andy’s story to Dr Satchidananda Panda, one of the world’s premier scientists investigating circadian rhythms, when I was lucky enough to lecture alongside him recently in Iceland. ‘I’m a little confused by the whole night-owl and morning-lark thing,’ I told him one night, over dinner.

  ‘It’s interesting,’ he replied. ‘We took some of our volunteers on a camping trip where there was little or no artificial light. We found, after a few days of living with natural light rhythms, that the owls and the larks did show a difference. They would go to sleep at different times, but not by very much.’

  ‘How much?’ I asked.

  ‘Between about thirty minutes and an hour.’

  I’ve since come to believe that this idea of natural-born owls and larks is, for many of us, a myth. That’s not to say there aren’t any genetic differences that influence our circadian rhythms. The Nobel Prize-winning researcher Mike Young has shown that some people carry a particular mutation that predisposes them to stay up somewhat later. However, of those that do, we don’t know how many are actually impacted by it.

  The bottom line is this. Most of us are adopting behaviours that are throwing our circadian rhythms out. Partly, this is a simple consequence of modern urban living. One study found that we’re exposed to 10,000 times more light at night today than we were in the 1700s, which can shift the body clock back by up to three hours. In the twenty-first century we stay up later, we eat later, we exercise later and we keep our brains in an active, alert state for longer. We think we’re fixing the problem by having lie-ins at the weekend, but waking up at 6 a.m. every weekday then at 9 a.m. at the weekends is like travelling across three time zones. You’re giving yourself jet lag. In some people, lie-ins can even trigger migraines. On top of all this, many of us are now working shifts. Rather than realizing we have a problem, lots of us are simply calling ourselves night owls and thinking we’ve been born this way. In fact, right now, throughout the West, we’re living through a sleep-deprivation epidemic.

  SLEEP’S STRESS-BUSTING SIGNATURE

  If you’re not prioritizing your sleep, it’s highly likely that you’re not getting enough. When we’re as time poor as we are these days, sleep tends to be the first thing to be pushed to the side. This is because we just don’t realize how much we need it and how much stress a lack of it can cause.

  I had a conversation with Professor Matthew Walkerfn1, sleep scientist and author of the bestselling Why We Sleep, in which he told me, ‘Sleep loss in the brain has a signature that’s similar to stress.’ When we expose ourselves to a lack of sleep, it expresses itself in the body as a stressor. If you look in the brain, you see a collapse in memory, attention, cognitive function, decision-making capacity and ability to learn new things. In the body, levels of adrenaline, noradrenaline and cortisol increase, inflammatory markers go up, and we become resistant to insulin, which makes it more likely that we will develop type 2 diabetes. Lack of sleep also causes hunger and satiety hormones to reverse (see here), meaning that our appetite goes up and we feel less full, making weight gain more likely. If you are lacking in sleep, you’re going to be significantly less likely to eat the alphabet because you’ll be craving sugary junk food.

  And there’s an impact at the cellular level. One fascinating study carried out by researchers at the Surrey Sleep Research Centre compared people who had six hours’ sleep a night to those who had eight and a half hours’ sleep. After just one week, those who had their sleep restricted to six hours a night developed distortions in 711 genes. About half of these – among them genes associated with chronic inflammation, stress, cardiovascular disease and cancer – went up in activity. The other half – associated with having a balanced immune system and a stable metabolism – went down in activity. Sleep deprivation was changing the way the genes expressed themselves. In addition, sleep loss lowers heart-rate variability (a marker for increased stress; see here), is associated with damaged telomeres, which is a key sign of cellular ageing, increases activity in the HPA axis (our stress broadcast service; see here) and negatively impacts the microbiome (see here).

  These are just some of the mechanisms through which lack of sleep can put the body into stress state. But it also gives the brain information that things are wrong. This is partly due to its effects on our emotional brain. Researchers have shown that the amygdala, our emotional brain’s alarm system, is significantly more reactive when we are sleep deprived. This is why we have such an increased tendency to overreact to negative stimuli. One study found a 60 per cent increase in reactivity when sleep-deprived individuals were exposed to stressful stimuli.

  But just as a lack of sleep can radically lower our stress and wellbeing thresholds, getting enough can be amazingly healing. It’s been shown to reduce the impact of the most serious stressful and traumatic experiences. If you experience a Macro Stress Dose and your sleep is disturbed afterwards, you’re more likely to develop PTSD and depression. Similarly, if you’ve had a stressful day, one of the most important things you can do is prioritize your sleep that evening.

  RAISING MELATONIN

  In the evening, as it gets dark, a hormone called melatonin is released by the pineal gland, which is located deep inside our brain. We thought for many years that melatonin was simply there to help us fall asleep, but it’s now known to have multiple effects on the body. It switches off oxidation – a type of rusting process in the body that can become harmful if it is not kept in check – and helps to dampen down inflammation. But many of us are messing up the timing
of our melatonin secretion by exposing ourselves to unnatural light, not least from smartphones and other electronic devices, which are typically held close to the face. Several studies have found that device use before bed can reduce the amount of melatonin you release by more than 50 per cent. If there was a drug that had such a huge and potentially damaging side effect, there’d be warnings printed all over the packet.

  At this point, you may well be thinking, ‘Well, that’s sad for those unlucky people. I can fall asleep just fine after reading on my device.’ If you are, I have some disturbing news. Even if you can physically get to sleep after looking at your device, the quality of that sleep is likely to be significantly impaired. You’ll lose significant amounts of a critical phase of deep sleep called REM (see here). This will leave you feeling much more tired the following day. Even more worryingly, your melatonin levels may be affected for several days afterwards, even if you stop using your device completely. This is why I always recommend that patients remove temptation by leaving their devices outside the bedroom.

  GETTING THE RIGHT LIGHT

  A huge part of getting our circadian rhythms moving to the right beat is about getting the right light at the right time. This means exposing ourselves to as much light as possible in the mornings and as little as possible in the evenings. Morning light is blue light and energizes and refreshes. Japanese authorities have recently begun harvesting the power of blue light in extraordinary ways. Japan has one of the highest rates of suicide in the world and many people choose to take their own lives by jumping into the path of oncoming trains. To combat this, blue-light-emitting LEDs have been installed at the end of some station platforms. In some locations where lights have been put in, suicide rates have fallen by a truly remarkable 84 per cent.