Managing Stress

Key Points

  • Our stress response is a physical phenomenon that can have far-reaching impacts on our bodies, including anxiety, insomnia, immune-system suppression, heart malfunctions, muscle tension and extra wear on organs.
  • A cancer diagnosis is often a stressor, as are repercussions from both cancer and treatments.
  • Managing our responses to stressful situations and stimuli is possible and can benefit health.
  • Several complementary approaches promote healthy responses to stress, including natural products, mind-body approaches, eating well, sleeping well and social support.
  • Pharmaceuticals may help manage a stress response if complementary approaches are not sufficient.
  • Some stress responses may need professional intervention.
  • Some foods and habits can exacerbate stress and can be avoided.

The Oxford English Dictionary defines stress as “a state of mental or emotional strain or tension resulting from adverse or demanding circumstances.”1 Those adverse or demanding circumstances, called “stressors”, can disrupt your internal balance and call on your body to activate a stress response. This response is automatic and calls on every bodily system to bring the body back into balance.

A certain amount of stress is normal—in fact, we couldn’t survive without the stress response. However, a sustained stress response  can be damaging. "Chronic stress results in glucocorticoid receptor resistance (GCR) that, in turn, results in failure to down-regulate inflammatory response."2 Sustained stress leads to inflammation, a known driver of cancer.

Remember that stress is not only the challenging situation—it’s also your response to the situation. Even if you cannot change the stressors in your life, you may still be able to manage your response. On this page, we explore many tools that can help you manage your stress. However, seek outside or professional help if needed. Responses such as post-traumatic stress disorder (PTSD) may be beyond self-help.

Your Body’s Stress Response

The physical stress response is driven by a complex cascade of nerve activation and hormones:3

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The Stress Response and Cancer

Common Stressors in People with Cancer

Stress is our response to challenging situations in our lives. What is stressful for one person may not be for another. However, some events and environments are stressful for many cancer patients, survivors and caregivers:

  • The cancer diagnosis, all by itself, can be a stressor
  • Financial burdens from treatments, travel and caregiving
  • Uncertainty regarding your job, medical insurance, housing, child care and other logistics
  • Changes in roles of family members
  • Disruptions to schedules for work and family
  • Disruptions to eating, sleeping, recreation and other daily routines
  • Pain, anxiety, fatigue, grief, nausea and vomiting, and other symptoms
  • Feelings of isolation
  • Changes in physical appearance
  • Worry regarding suffering, dying and loved ones

How Stress Interacts with Cancer

When stressors and threats are frequent or constant, cortisol remains at high levels most of the time. When the stress response continues for a prolonged period, the constant bodily imbalance that it causes can be physically damaging. Over time, this delays restorative repair and pushes the body into pre-disease states.4 Stress hormones have been found to fuel cancer growth and spread.5

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Can Stress Cause Cancer?

People sometimes ask, “Did stress cause my cancer?” No one has a simple answer to this question. We do not have good evidence that stress causes cancer. Those of us with years spent caring for people with cancer believe that stress can affect the cancer itself as well as a person’s experience of having cancer. We know that the chemicals released in the stress response can speed up tumor growth. These stress-response chemicals can also promote conditions such as insulin resistance, which changes the tumor microenvironment in favor of the cancer.

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PTSD and Cancer

In addition to the stress from dealing with cancer, for some people with cancer and/or their caregivers, the experience can be traumatic and/or bring up past unresolved traumas. For these people, long-term problems may develop or resurface, such as adjustment difficulties, anxiety or depression. In addition to normal stress reactions, traumatic stress-like reactions may be seen in some people with cancer or their caregivers such as these:

  • Intrusive upsetting thoughts
  • Reacting to reminders such as follow-up scans
  • Avoidance

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Natural Substances for Managing Stress

According to naturopathic oncologist Lise Alschuler, evidence shows several herbs and nutrients have antistress properties. These substances seem to work by either helping the body recover from stressful situations or supporting the body’s organs and tissues that are affected in the stress response:17

Integrative oncologist Keith Block, MD, also includes natural substances in his integrative plan for balancing stress hormones and creating healthier biorhythms. Block distinguishes among three patterns of stress adaptation:

  1. Hyperadapted or high-stress pattern with prolonged elevated cortisol
  2. Inverted stress pattern, in which the timing of cortisol and melatonin are reversed.
  3. Non-adapted pattern, in which cortisol levels are either consistently high or depleted, melatonin levels are low, and both hormones have no circadian rhythm

Block’s approach with natural supplements varies with the pattern.18 This plan includes natural substances such as these:19

Products for Calming or Reducing Stress

Expand list

Mind-Body Approaches

The Relaxing Breath

Shanti Norris, a yoga teacher who works with people with cancer, explains: “One cannot feel anxious as long as one is breathing slowly and deeply.” Her instructions for managing stress with “The Relaxing Breath”:20

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Many mind-body approaches, such as meditation, progressive muscle relaxation, tai chi and music therapy help with regulating breathing and heart rate, bringing on a calm state. These are discussed in more detail on these pages:

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Even if you cannot change the stressors in your life, you may still be able to manage your response.

Theta Brain State

Theta brain state “is a state where tasks become so automatic that you can mentally disengage from them. The formation of thoughts and ideas that can take place during the theta state is often free flow and occurs without censorship or guilt. It is typically a very positive mental state.”23

Healthy Dozen Food Families

From Life Over Cancer:24

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Eating Well to Reduce Stress

Foods can support or undermine a healthy stress response and biorhythms.

Eating Well: Strategies

Dietary strategies for supporting a healthy stress response and biorhythms:

  • Reduce use of caffeine and other stimulants.
  • Avoid excessive alcohol consumption: alcohol as a nightcap or to relax can instead disrupt melatonin production as well as cause repeated awakening from sleep.26
  • If you eat a late-night snack, keep it light and let it consist of protein and/or whole grains. Avoid eating during the hour before bedtime.27
  • Include complex carbohydrates in your diet: whole grains, beans, and whole fruits and vegetables.
  • Work with your doctor or dietitian/nutritionist to improve your ratio of omega-6 to omega-3 fatty acids.
  • If diet, fitness and mind-body approaches do not completely manage stress chemistry and biorhythms, consider using a combined stress hormone support supplement in addition to a program of taking a cancer-specific multivitamin and fish oil supplements and also eating what Block calls the “healthy dozen food families” listed in a side box above.

Pharmaceuticals for Managing Stress

A good integrative cancer care plan will include mind-body therapies, eating well, moving more, and possibly natural products to manage stress. Sometimes, however, these therapies may not be enough. If natural treatments alone are inadequate, then even more symptoms of stress can arise, causing needless emotional suffering.

As Dr. Keith Block points out, patients commonly resist medical treatments for stress or depression, fearing treatments indicate they are psychologically unstable. However, because managing stress is key to many aspects of wellness, consider working with your physician to see if medications—such as antidepressants, tranquilizers and even stimulants—can help you.

Evidence suggests that propranolol, a prescription drug for heart disease, may have anticancer effects, possibly in part due to its effects on stress hormones which can fuel cancer growth and spread.28

For more information about the effects of propranolol and other beta-blockers on the stress response, see Propranolol page.

Sleep and Managing Stress

Getting good sleep and rest is a key practice in creating a body that doesn’t encourage cancer. Poor sleep and stress can become a self-reinforcing cycle: unmanaged stress can disrupt biorhythms, including sleep. When sleep quality is poor, the stress response hormone cortisol rises at night when it should instead be lower. Because a chronic rise in blood cortisol can speed tumor growth and cause any number of increased health problems for people with cancer, consistently good sleep and rest are tools to combat stress. Effectively managing stress will improve the quality of sleep. For more information on sleep and rest, see our Sleeping Well page.

Social Support

The loss of love causes intense feelings of helplessness in many people, perhaps by tapping into psychological wounds received in childhood through experiences of rejection and criticism.”

David Servan-Schreiber29

Stress Inventory: Creating a Stress Score

The Holmes-Rahe Stress Inventory assigns a score to the top stressors in people’s lives to allow people to assess their risk of developing a stress-induced breakdown. Of the 25 biggest stressors, 14 relate to changes in relationships and social support.30 The Holmes-Rahe Inventory makes a profound statement about the importance of relationships in influencing one’s health.

Mediating the stress response with social support is an important part of an integrative cancer care plan. “The effect of social support on life expectancy appears to be as strong as the effects of obesity, cigarette smoking, hypertension, or level of physical activity.”31

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Stress Offenders

Medical acupuncturist Janet Spitzer, MD, and Keith Block, MD, inform us about foods and natural substances that can promote a stress response.34

Foods and Natural Products

Anything that is a stimulant increases heart rate, anxiety and the stress response:

  • Caffeine in coffee, tea or chocolate
  • Ephedra
  • Other stimulants, including ginseng and bitter orange
  • Alcohol
  • Spicy foods

 In addition, some eating patterns can promote stress:35

  • Low-carb, high-fat diet
  • Low-carb, high-protein diet
  • High ratio of omega-6s to omega 3s

Eating Habits That Are Stress Offenders

Dr. Keith Block lists eating habits that can promote a stress response:36

  • Timing of snacks and drinks (eating within one hour of bedtime; eating a heavy evening meal or snack)
  • Overeating

 Reducing stress offenders is an important step in managing stress.

Be sure to determine if any stress management therapies involve potentially harmful interactions with your cancer treatment.

Cautions

Several of the therapies mentioned on this page come with cautions about interactions with other therapies or with medical conditions. For example, ashwagandha may increase testosterone, so use is not recommended by people with prostate cancer. Use is also contraindicated in patients with hemochromatosis.37 Please review cautions listed on therapy summaries or outside linked pages and consult your integrative physician before use.

Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.

Commentary

Janet Spitzer, MD, April 16, 2018: “According to the Chinese 5 Element Theory, it would be helpful to ‘cool’ or at least not overheat the Fire element (heart, pericardium). Salty flavor would help cool the heat, while sour and excessive bitter flavors would tend to aggravate the heart. Alcohol also powerfully ‘heats’ the Heart-fire element.

I generally aim more at supporting/nourishing the adrenals when someone has chronic stress (ashwaganda, holy basil, Siberian ginseng, etc.) and decreasing oxidative stress with antioxidants (vitamin C, vitamin E) and decreasing inflammation (fish oil, turmeric/curcumin) and nutrients that help soothe the nervous system and support biochemical pathways (like magnesium, CoQ-10, Ribose, etc.).”

Written by Laura Pole, RN, MSN, OCNS, and Nancy Hepp, MS; most recent update on December 11, 2018.

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