Stress Management (Self-Care Practices Part 6)

Stress is not inherently pathological. It is a biological survival response designed to help us adapt, perform, and respond to threat. In integrative medicine, we don’t aim to eliminate stress, we aim to understand how it is interacting with physiology, behaviour, and meaning in your life.

When stress becomes chronic, misaligned, or unprocessed, it begins to shape health in measurable ways: sleep disruption, blood sugar instability, hormonal shifts, immune dysregulation, digestive symptoms, mood changes, and eventually burnout. The key is not simply “coping better,” but assessing and recalibrating your system as a whole.

Taking Stock: Subjective vs Objective Stress

It’s nearly impossible to quantify for ourselves the amount of stress we are under. Most people, when asked how stressed they are, will list the outward things that are typically considered stressful like a high pressure job, managing children, relationship conflict, aging parents, etc. Other times we will be able to say yes I am stressed, or I feel burnt out, but how do we actually know how you specifically are doing with the stressors on your plate? We take stock of the subjective feelings and we objectively test your cortisol levels.

Subjectively, we explore how stress is experienced:

• Do you feel wired but tired?
• Is your sleep shallow or fragmented?
• Are you more reactive or emotionally flat?
• Is motivation dropping despite high output?
• Do you find yourself caring less or not finding as much pleasure in normally enjoyed activities?

These symptoms provide valuable clinical data.

Objectively, when appropriate and accessible, we may evaluate stress physiology. Cortisol testing, via saliva, urine, or blood, can provide insight into patterns such as elevated baseline cortisol, flattened diurnal rhythm, or a blunted response often seen in chronic stress or burnout states. We may also see downstream effects in thyroid markers, blood glucose, iron, inflammatory markers, and sex hormones.

The goal of testing is not to pathologize normal stress. It is to determine whether the stress response has shifted from adaptive to dysregulated.

Often, patients normalize feeling chronically depleted. Data can validate what the body is signalling.

Does the stressor have an endpoint?

From a neuroendocrine perspective, the body tolerates acute stress remarkably well, particularly when there is a foreseeable resolution. Preparing for a presentation, navigating a short-term caregiving demand, or training intensely for a goal can all activate stress pathways in a productive way.

Chronic stress without resolution is physiologically different.

When there is no clear endpoint the stress response remains partially activated. Over time, this may manifest as disrupted circadian rhythm, impaired sleep architecture, blood sugar variability, increased visceral fat deposition, and/or heightened inflammatory states.

In these cases, management shifts from eliminating the stressor (which may not be possible) to increasing capacity.

This includes:

• Stabilizing circadian rhythm through morning light exposure and consistent sleep timing
• Supporting blood sugar regulation with adequate protein and structured meals
• Incorporating resistance training and moderate aerobic work to improve stress resilience
• Building parasympathetic tone through breathwork, restorative practices, or contemplative time
• Ensuring micronutrient sufficiency (magnesium, B vitamins, iron status when relevant)

The question becomes: if the stress cannot be removed, how do we strengthen the person carrying it?

Love It or Change It

One of my favourite and most clinically useful frameworks in stress work is deceptively simple: love it or change it.

Chronic stress often persists not because circumstances are unbearable, but because we remain in silent resistance. The nervous system senses incongruence: staying in a situation while internally rejecting it.

When someone consciously chooses a stressor because it aligns with their values, like raising children, building a business, pursuing training, the physiology often responds differently. Meaning buffers stress.

If the stressor is misaligned, change becomes the intervention. That may look like boundary-setting, workload renegotiation, redefining expectations, or, in some cases, larger life transitions.

Resentment and helplessness perpetuate sympathetic activation. Agency reduces it.

Stress as a Marker of Misalignment

In my practice, a surprising amount of chronic stress is not simply about volume, but rather misalignment.

You may be high-functioning and outwardly successful while internally disconnected from purpose, creativity, rest, or relational depth. Over time, that dissonance becomes physiologically costly.

This is where a thoughtful life review can be powerful. Not impulsive change, but reflective inquiry.

• Are your daily actions congruent with your values?
• Does your work deplete you more than it nourishes you?
• Are you carrying roles that no longer fit who you are becoming?

The body often signals misalignment before the mind fully articulates it. Insomnia, anxiety, digestive symptoms, or persistent fatigue can sometimes reflect an internal tension between obligation and authenticity.

Realignment does not always require dramatic change. Often it begins with small corrections: protected time for something meaningful, clearer boundaries, honest conversations, or redefining success in more sustainable terms.

Building Capacity Rather than Chasing Calm

The goal of stress management in integrative medicine is not a perpetually calm nervous system but rather flexibility.

We want a system that can activate appropriately and then recover efficiently, that can handle acute stress without remaining chronically inflamed, and that can pursue ambitious goals without burning out.

Stress becomes problematic when activation outpaces recovery, or when life is lived in ongoing misalignment.

When we assess physiology, strengthen resilience, and realign with our core values, stress shifts from something corrosive to something informative. In many cases, the most profound stress intervention is not another supplement or protocol, but a conscious choice about how and why we are living the lives we are carrying.

Reflection and Homework: 

1. Take stock of how you are feeling regarding the subjective stress markers listed above
2. Talk to your MD or ND about testing your cortisol and other stress markers
3. List the things that cause the most stress in your life (don’t forget little daily stressors as well as big ones)
4. Notice which of your stressors has a finish line or an end point – if there isn’t one, how do you plan to sustain it?
5. What do you need to love vs what might requires a change?
6. If you’re up for it, this can be a good time for a life review – where are you sacrificing? Is there an alternative path?
7. In the places you carry the most stress – are there ways to let go, ask for help, create a deadline for change, etc?

And if all this feels like too much to handle alone, I am always here to help