As defined by Medicine Net, stress is “a physical, mental, or emotional factor that causes bodily or mental tension. Stresses can be external (from the environment, or psychological, or social situations) or internal (illness, or from a medical procedure). Stress can initiate the ‘fight or flight’ response, a complex reaction of neurologic and endocrinologic systems.” 
Stress is complicated, nuanced and sometimes nonsensical. On an individual level, there isn’t always a clear line from trigger point to physical stress response. A traumatic event in someone’s life may flare into a physical manifestation years later.
For many, its difficult to make this connection. Yet, recent research into how stress ultimately affects our physical well being, has started to paint an obvious picture: stress has a direct impact on wellness.
A Brief History of Stress
The body’s physical stress response evolved over the course of our evolution, to provide us with the tools we needed to manage dangerous environments. Whether it’s a dangerous hunt or an environmental threat, our bodies evolved to adapt and survive.
When we perceive a threat, real or imagined, our brain triggers a fight-or-flight response and a subsequent release of hormones. Scientists have pinpointed three, in particular, which have an immediate effect: adrenaline, norepinephrine, and cortisol.
These hormones quickly spur the body into action by boosting heart rate, energy levels, and increasing respiration rate – all mechanisms meant to get us out of danger, and swiftly too. At the same time, these hormones determine which bodily functions are not essential to survival, and they initiate responses to slow or shut down certain functions until the threat has passed. In most cases, our digestion, immune, and reproductive systems go into shutdown mode during stressful times
Generally speaking, stress is not necessarily a bad thing. When we experience short-term stress, and when stressful events are few and far between, our bodies easily return to normal. Within an hour, stress hormones dissipate, and our bodily functions return to perfect homeostasis. 
But what happens when our stress response is sustained over prolonged periods? What if we are always in fight-or-flight mode? Prolonged exposure to stress hormones can have extremely detrimental effects on all vital biological systems, from our hearts to our stomachs, to our lungs and beyond. Chronic mental stress affects all aspect of our health and wellness.
Stress and The Digestive System
An integral part of the gastrointestinal tract is the enteric nervous system, a mesh-like constellation of neurons that manages all aspects of digestion. The enteric nervous system is connected to the brain via the gut-brain axis. Chronic perceived stress, and its associated release of stress hormones like cortisol, have a direct impact on the function of the gastrointestinal tract through this system.
During prolonged periods of stress, the gut-brain axis slows down. It takes more time for food to empty from the stomach, gut permeability increases, and so too does colon activity. If these changes perpetuate, it can throw the digestive system completely out of sync.
There are many ways through which stress can have a direct impact on proper gastrointestinal function. Some or all of these symptoms can wreak havoc on digestive health. The effects of stress on the gut include:
- Higher cholesterol levels
- Higher risk of heartburn
- Lower metabolism
- Changes to the digestive flora
- Changes in nutrient absorption
- Increased enzyme activity
A large body of research has linked stress to gastrointestinal disorders. For example, 64 percent of people with gastroesophageal reflux disease reported an increase in the severity of their symptoms during stressful periods. When they followed some suggested guidelines for reducing stress, they reported a reduction in their overall symptoms.
Another gastrointestinal disease commonly associated with stress is ulcer disease. The long-held stereotype is that men who hold high-stress jobs tend to develop ulcers. This stereotype is not without merit. Ulcers were first linked to stress in a study of men in supervisory roles.
This male-focused ulcer research has since been expanded upon, and now there is evidence from all walks of life, including instances of ulcers in children. Ulcer development stems from more occurrences of emotional disturbances and traumatic events.
Irritable bowel syndrome (IBS) also has a deep connection to chronic stress levels. There is an undeniable link between patients with a history of emotional, physical, or sexual abuse and the development of IBS. A patient with such a history experiences the disease much more severely than someone without. This translates to more days spent in bed, more visits to the doctor, more surgeries, and reporting a 65 percent greater pain score. 
Stress and the Cardiovascular System
It shouldn’t come as a surprise that stress can have a direct and detrimental effect on heart health. Stress, even in healthy doses, raises blood pressure and increases heart rate. Over extended periods of time, this can place unneeded stress on all levels of cardiovascular function.
Mental stress, according to Dr. Nieca Goldberg, a cardiologist at NYU Langone Medical Center, and national spokesperson for the American Heart Association, increases the risk of cardiovascular disease. In some of the most compelling studies on the subject, people with symptoms of Post Traumatic Stress Disorder (PSTD), had higher levels of cardiovascular disease than those without.
In a comparison of veterans in California and Nevada, 57 percent of participants with PTSD had metabolic syndrome, while only 37 percent without PTSD had it. The researchers also determined that 35 percent of the PTSD diagnosed participants had developed insulin resistance compared with 19 percent of those without PTSD.
There have also been a number of studies done on large scale traumatic events and natural disasters, such as Hurricane Katrina, the Greek financial turmoil, and the like. After a widespread crisis, communities in recovery tend to have a higher risk of developing cardiovascular issues.
Researcher physicians from Tulane Medical Center have determined that there were three times more heart attacks post-Hurricane Katrina, than in the two years before the devastation. The study moreover made a point of mentioning that the patients suffering from a heart attack after the storm, also tended to be suffering from other stressors like unemployment, mental health issues (depression and anxiety), and higher cholesterol.
In Greece, after the financial crisis, instances of cardiovascular disease seem to have risen. According to data published by the General Hospital of Kalamata, heart attacks rose from 841 per year to 1,084. This was despite the fact that the overall demographics of the region did not change from one year to the next.
Interestingly, mental stress also contributes to cardiovascular disease in less linear ways. Anyone who has gone through periods of stress can attest to the fact that their eating habits change or their alcohol consumption changes, typically for the worse. Stress can cause people to smoke more, drink more, eat much more or much less, and to stop exercising altogether. These unhealthy habits all would have a direct impact on overall heart health, even if the stress itself did not have a measurable effect. 
The Difference of Gender: How Men and Women Experience Stress
There is more than one stereotype about how women experience and respond to stress, and according to a 2008 study published in the Alcoholism: Clinical and Experimental Research journal on gender differences in response to emotional stress, “men and women respond to stress differently, with women experiencing greater sadness and anxiety, while men show a greater integration of reward motivation (craving) and emotional stress systems.” 
According to the data presented in this study, women are at much greater risk of developing depression or anxiety in response to chronic stress. They were also more likely to internalize these negative emotions, causing more significant health issues down the line.
Men, on the other hand, externalize emotions, at least according to the data. They are more apt to take the stress and turn it into anger and aggressiveness, perhaps more in line with the fight-or-flight response.
Besides differences in the way that men and women mentally manage stress, they also experience a physical difference. According to data from the American Psychological Association (APA), women are more likely to suffer from fatigue, headaches, and indigestion. Men are much more likely to report no physical symptoms of stress at all.
According to the APA, stress in women is on the rise. The APA’s data show that 49 percent of women report that their stress has risen over the past five years, while only 10 percent of men felt the same. They also stated that, in general, women are more likely to report feeling significant stress – 28 percent of women compared to only 20 percent of men.
Tips and Tricks to Managing Stress
Clearly, the ability to manage mental stress has a direct impact on overall health. Extended exposure to cortisol actually inhibits new neuron formation and increases the amount of attention placed on threats. Cortisol puts your brain on constant alert for new threats, even when they don’t physically exist.
Practicing stress management techniques on a daily basis rebuild the neurological pathways in our brains to be better prepared if and when stress strikes. At the same time, suppressing stress simply serves to strengthen the negative pathways in our brains, reinforcing chronic stress instead of rerouting it.
Practice makes perfect, even when in distress. Trying meditation or breathing techniques once or twice won’t make much of a difference, but can, over time, have dramatic and positive effects. The top five distressing methods suggested by the APA aren’t by any means radical, but they are proven to work – if you put the time into practicing them.
- Social Support: Chronic stress is by its very nature socially isolating. To be social requires effort, and as most people will tell you, stress is extremely draining. Sometimes people just have nothing left to give, especially in social situations. But reaching out to someone you know and trust during a time of stress can make you feel less alone. They can help validate your concerns, listen to your experiences, and perhaps even get you to crack a smile.
- Take a Break: Getting away from the stressor in your life might seem impossible either because of physical restraints or mental barriers. For example, it may be difficult to step away from a family situation or work project, even if it’s the primary cause of your mental stress. However, it’s essential to identify the primary stressors in your life, and then take steps to break away from it, even if for short periods of time. Permit yourself to step away, and breathe.
- Exercise: Research continues to show that exercise improves stress in both short and long terms. According to the APA, exercise can provide some of the most immediate stress relief, even a short walk or stretch can have long-lasting effects.
- Meditation: Proven time and time again to reduce stress and improve overall stress response, meditation and mindfulness take practice. Nobody said meditation was easy, but it does rewire the brain in very important ways. One five minute session can reset your emotional response, and with continued daily practice, you can completely change it.
- Smile: Seek out laughter and positive experiences. Even if at first it may feel forced, keep trying; fake it until you make it, as they say. The more you surround yourself with love and put yourself in positive environments, it will eventually lead to natural laughter and genuine smiles. 
The first step to getting your stress under control is to identify it. Being mindful when and how you experience stress can be the very first steps to recovery. Even if you have already experienced some of the serious physical effects of stress, it isn’t too late to alleviate, even reverse them.
Explore what stress management techniques work for you. According to the APA, men find exercise a good stress relief, while women may turn to reading. These are by no means meant to be a restriction on stress relief by gender, but rather a demonstration that stress management works differently for everyone. Allow yourself the time to explore what works best for you.