To help visualize the effects of chronic stress on the body, jelly doughnuts can help.
“If you squish a jelly doughnut, or put pressure on it, the jelly has to squirt out somewhere,” says Kharah M. Ross, Ph.D., a researcher and assistant professor of psychology at Athabasca University in Canada. The tasty analogy helps demonstrate the phenomenon of “allostatic load,” which refers to heavy, chronic stress causing wear and tear on the body over time. The jelly is cumulative stress; the doughy, delicious walls of the doughnut represent your body, its “health” torn and damaged from the pressure.
It’s a simple way to look at it, sure. But decades of research supports a link between stress and health problems, including obesity, diabetes, high blood pressure and heart disease. However, allostatic load, although it has much to do with stress, is different. It’s a profound toll we should consider differently than the way we look at day-to-day stresses, such as, for example, homeschooling a 7-year-old who has regressed during the shutdown and is having daily tantrums like a 4-year-old.
The concept of allostatic load was developed as a framework in the fields of physiology and psychology to really understand what it means to carry cumulative stress, says Anita Chandra, Dr.P.H., senior policy researcher at the RAND Corporation and vice president and director of RAND Social and Economic Well-Being. It helps explain why we’ve seen health disparities in the US for a long time, she says.
“It’s the idea that, for example, African American men are bearing not only visible but invisible — or only visible to some — stress from structural racism and historical inequities,” Chandra says. “That compounds, so it can be stored in the body as part of this accumulation of stress, and can result in things like high blood pressure and other chronic illnesses that can grow and worsen over time.”
Allostatic load probably has something to do with why we’re seeing COVID-19 infection disproportionately affect African Americans and Latinos, she adds. It’s an issue of degree and an accumulation of stress, or wear and tear over repeated cycles. It can look different for different people, she continues: Some experience stress more physiologically, and others bear it as a combination of emotional and physical effects that batter their health and wellbeing.
“What does that assault mean to the body and mind over time?,” Chandra poses. “And not just some of the obvious things that happen in the moment, but with that accumulation of stress that can degrade our ability to weather adversity?”
The Biology of Allostatic Load: How Our Bodies Adapt to Stress
As we experience increasing levels of stress, our bodies adapt and re-adapt to these levels trying to prevent the stress from causing us physical harm, says Janelle Louis, a naturopathic doctor who specializes in treating people with high Adverse Childhood Experiences (ACE) scores and possibly related health problems.
Put another way, a body in a stressed state releases different hormones to cope with the stress, or keep the level of arousal up to deal with the perceived threat, says Emin Gharibian, Psy.D., a psychologist in La Canada, California, who wrote his dissertation on allostatic load. One of those hormones is cortisol, which research suggests can lead to heart disease, strokes, and high cholesterol if levels are chronically high, he says.
“Imagine constantly having high blood pressure and a rapid heart rate,” Gharibian says. “Your body can only take so much. On top of that, people who are stressed aren’t eating or sleeping well. Those things together have a snowball effect on your health.”
Researchers gauge the effects of stress with physiological tests such as checking cortisol levels but also by noting basal temperature and blood pressure — classic biomarkers —over time, Chandra says. In addition, researchers do psychological assessments via surveys such as the Everyday Discrimination Scale.
Geneticists also study allostatic load: “The field of epigenetics essentially links your genetic map to environmental stressors and looks at how these things turn off and on,” Chandra says.
How Allostatic Load Affects Communities
A RAND study examined the effects of allostatic load on whole communities, examining their ability to bounce back and return to a semblance of normality in the aftermath of a crisis, such as a hurricane, mass shooting, or pandemic.
“When whole communities have an accumulation of stress because of historical and systemic reasons, their communities feel it collectively as well as individually,” Chandra says.
Allostatic load is an important piece to consider when we look at how people will recover — economically, emotionally, and physically — after the pandemic. It’s not just adding up all the individual stresses; whole communities can feel it, she says.
“They feel it in the time of the response and also in how long it takes communities to recover from things like this,” Chandra says. “We saw this after Hurricane Katrina — because of those preexisting stresses, this accumulation of stress can make it harder for people to respond and recover, and can really degrade people’s ability to be as healthy and well as they need to be.”
Even before COVID-19, she points out, the US was seeing a drop in life expectancy across a lot of populations.
“So the ability to handle that stress is really important,” she says. “because the idea that you’re just going to bounce back every time is a falsehood.”
How Allostatic Load Might be Affecting You During Coronavirus
The effects of allostatic load have to do with more than racial and socioeconomic factors. How you handle stress also has to do with your personality, upbringing, and whether you experienced trauma, to name a few major factors.
The list of childhood adversities that seem to have an impact on people’s health in the long-term is lengthy, Louis says: household dysfunction, including parental divorce or separation; domestic violence; parental mental illness; parental incarceration; substance abuse in the household; abuse (physical, sexual, or emotional) and neglect (physical or emotional). Other scenarios also might lead to chronic stress in childhood, such as sickness or death of a family member, being in foster care or having a chronic illness yourself. All these things and more can, basically, add jelly to your doughnut.
“It does add up over time,” Gharibian says. “Imagine if a parent has a history of abuse and they never coped with it and carried it their whole lives. If it’s debilitating and they haven’t gotten a hold of it, it kind of manifests itself into their environment.”
People who haven’t learned to cope with past trauma might develop depression, anxiety or substance misuse, he says, all of which have an effect on your well-being and affects your partner and your children. But a history of trauma and chronic stress doesn’t necessarily doom your health and the health of your children.
“It’s not necessarily the specific trauma causing these types of problems, it’s the impact the trauma has on your well-being,” he says. “In other words, it’s not that it happened to you but how you cope with it. The people I see who are struggling the most have a history of trauma that they never dealt with.”
Especially in this time when stress is cropping up from additional and unusual directions, take stock in how it’s impacting your day-to-day life, Gharibian recommends. Stress commonly affects sleep and eating patterns, with people doing either too much or too little. Alcohol use also tends to tick up in times of unusual stress, he says.
“When we’re in a hyper-alert state, alcohol is an easy solution and instant gratification,” he says. “It’s not a problem in and of itself, but it could be if it’s your only way of coping with stress.”
Partners can help each other weather stress in these strange times, Ross says.
“Communication and being responsive to your partner is important,” she says. “When we’re caught up in stress it’s easy to forget to do that.”
Simple things, such as asking your partner how they’re feeling or pausing to hug can have a big impact, she says.
Stress and Your Family
The difference between allostatic load and everyday stress getting out of hand is that with the latter, people are experiencing it in obvious ways. They might say, “Oh, I had such a stressful week,” or “I’m going through a divorce, and it’s really stressful.” But although those experiences can be traumatic and might even cause physical manifestations of stress such as problems eating or sleeping or an uptick in blood pressure, the effects of allostatic load are different.
“The kind of stress with which you see allostatic load is happening constantly through institutions and systems,” Chandra says. “It’s getting stored even if you’re not explicitly reflecting on or representing it, and that’s why it’s different.”
That’s not to say we should minimize the effects of ordinary levels of stress, she says.
“We all experience stress, and it’s important to take notice of it because it can degrade your psychological and physiological well-being,” Chandra says. “It’s not something to just kind of push through.”
Understanding allostatic load puts stress in context, however.
“It’s not that your stress isn’t important, but it’s important to understand there are levels of stress and communities and populations that have a disproportionate share,” she says.
As a parent, you’re in a unique position to mitigate some of these effects — on yourself and on your children, both of which impacts your community.
“As parents, we need to be aware of the inequities that apply to our children, but we can’t place all the focus on the inequities,” Louis says. “We have to teach them how to function in a world that’s filled with them, but focus on the opportunities instead.”
Parents can help kids recognize their gifts and talents so that they have more and greater opportunities, which can help them overcome at least some of the inequities she says. In addition, resilience and grit, or perseverance, can be taught.
“As parents overcome the physical, mental, societal effects of our own adversity, they open the way for their children to do the same,” she says. “More than anything we say, our children learn by what we do. If they see us persevering and being resilient they’ll adopt those same traits.”