Does Stress Cause Stroke?

We all know too much stress in our daily lives is unhealthy. It can cause headaches, upset stomach, anxiety, difficulty sleeping and a whole lot more. But, does stress cause stroke? Ryan Sundermann, MD, UnityPoint Health, recommends you understand what happens during both stress and a stroke to determine if your current stress levels might put you at an increased risk.

Do I Have Too Much Stress?

Dr. Sundermann says many people ignore stress and don’t deal with it the way they should. Determining how much stress you have is difficult to measure because everyone has different tolerances to stress.

“One person’s stress is not the same as another’s. Some folks have a lot of stress just from dealing with kids and finances. Others might carry the stress of running a small business or an entire corporation. Then, there are jobs where people are faced with real world dangers, like firefighters and police officers where real world dangers are no big deal and they are as happy as anyone else. Regardless of your job, if you feel you’re under stress, you probably are,” Dr. Sundermann says.

If you’re still unsure, ask yourself these questions:

• Does your significant other tell you, you seem stressed?
• Are you at odds with coworkers and family members more than normal?
• Do you find less joy in things that normally make you happy?
• Do you find it difficult to fall or stay asleep compared to normal?
• Do you have a hard time getting out of bed, especially on days when you know there is going to be stress?
• Do you resort to alcohol, drugs or tobacco to alleviate stress?

What Happens in the Body During Stress?

Dr. Sundermann says during stress, the brain triggers a release of chemicals that do several things to prepare us for a threat. These chemicals are produced regardless of the type of stress: physical harm, fear, grief, daily stress from work and relationships, etc. Two primary chemicals the brain release are cortisol and adrenaline.

• Cortisol. It’s a hormone that forces our body to retain water and sodium that help to keep blood pressure up. It also has several mechanisms to store sugar, but also makes that sugar available for use, so our bodies have fuel. Evolutionarily, this process is great for preparing us to run from a dangerous animal, fight off an attacker or, in today’s world, deal with a big problem at work when we are tired from a long day.
• Adrenaline. This hormone is also known as epinephrine and is a type of catecholamines. Adrenaline, and its similar chemicals, cause increased heart rate and increased blood pressure to pump blood to vital organs.

How to Know if You Have High Cortisol Levels

"The big one is rapid weight gain — especially in the midsection. If someone reports gaining 20 pounds in a month without any lifestyle changes, that's a significant indicator,” says Chitravathi Reddy, MD, Endocrinologist, UnityPoint Health.

Other signs of high cortisol include:

• Fatigue
• Mood changes
• Sleep disturbances

When cortisol levels are high, men and women may develop what’s known as a “buffalo hump,” a buildup of fatty tissue at the base of the neck, resulting from the rapid accumulation of fat deposits.

Signs of High Cortisol in Women

“In younger, menstruating women, irregular cycles and difficulty getting pregnant are also symptoms,” Dr. Reddy says. “There may be excess facial and body hair and acne, too.”

Skin might be thin and bruise easily. Some women may develop large, purple stretch marks on the stomach.

Testing for High Cortisol

To check if your cortisol levels are too high, your doctor will start with some basic blood and urine tests.

Dr. Reddy says, “The urine test is a 24-hour collection to measure the amount of cortisol released. There’s also a dexamethasone suppression blood test. For this method, you take a pill, and the next morning your blood is tested. If the pill doesn't lower your cortisol like it should, it can be a sign your body is producing too much cortisol.”

If tests confirm you have high cortisol, the next step is to find out where it's coming from – either the adrenal gland (near the kidneys) or the pituitary gland (in the brain). Knowing the source helps doctors decide the best way to treat it.

Supplements for High Cortisol

Dr. Reddy says, "For chronic stress, if a thorough workup doesn't show a specific medical condition, supplements like omega-3 fatty acids, ashwagandha or magnesium may help with symptoms. Generally, they aren't harmful. If they offer relief, that's good. In particular, a mix of magnesium glycinate, citrate and malate show early promise for stress, anxiety and sleep, but medical evidence is still developing."

While some supplements may help with stress-related cortisol, it's important to see a doctor. Dr. Reddy also recommends meditation and deep breathing for a natural approach to lower cortisol.

What Happens in the Body During a Stroke?

There are two main types of stroke, those that block arteries and those that cause arteries to bleed.

• Hemorrhagic Stroke. These strokes are caused by bleeding in the brain. They happen due to a weak spot in the wall of the vessel, which can cause an aneurysm (bulging of the vessel wall). The vessels can also be weakened by chronic, very high blood pressure and break from force. When the vessel breaks, the blood leaks into surrounding tissue, and the brain doesn’t get the oxygen and nutrients it needs.
• Ischemic Stroke. These strokes result from blocked arteries, which often occur from cholesterol buildup, called plaque.

“You can think of plaques like scabs on the inside of the vessel. As an example, if you have ever lifted up a scab on your arm, if you lift too far, you can cause it to bleed again because it’s not done healing underneath. Then, you’ve created a new injury. In the case of your arm, a new scab forms by forming a clot, which is great for helping the skin heal. Similarly, plaques on the inside of the vessel can be fragile when blood flows past, causing the plaque to lift.  But in your blood vessel, when a plaque lifts up and the body tries to heal it like it would a scab on your arm, it makes a clot where that plaque lifted up which blocks blood flow and can lead to an ischemic stroke,” Dr. Sundermann says.

Does Stress Cause a Stroke?

You may have heard the term “stroke out,” but does stress cause a stroke? Dr. Sundermann says the short answer is no, but the longer answer is possibly.

“If you are otherwise low risk, then intermittent episodes of high stress shouldn’t put you at any increased risk for stroke,” Dr. Sundermann says.
Low risk includes:

• Normal weight/low body fat
• Low levels of bad cholesterol
• Blood pressure under control, with or without medication
• Exercise regularly
• Eat a well-balanced diet
• Don’t have a family history of vascular disease

“If you’re at increased risk because of your family history or you have other risk factors, such as tobacco use, high blood pressure, etc., then a very stressful event is going to increase cortisol and adrenaline, which can raise blood pressure and stress vessels already at risk. The increased blood flow could also disrupt plaques that might be fragile,” Dr. Sundermann says.

Dr. Sundermann says if you live in a chronic or persistent state of stress, there is some evidence of increased stroke risk. He notes, however, the connection is complicated and not fully understood. But, he says when you look at the basics of stress and stroke, it makes sense.

“When under constant stress, you have persistent high levels in cortisol and other stress hormones. This causes retention of salt, which increases blood pressure. Overtime, that would cause stress on blood vessels. Stress also causes an increase in blood sugar, which means the vessels can’t dilate or contract to better control blood flow. Increased cortisol also disrupts sleep cycles, which can make us more stressed and release more cortisol. Poor sleep means fatigue, and fatigue can cause us to gain weight for several reasons. Simply, when we are tired we are less likely to exercise and more likely to eat poorly,” Dr. Sundermann says.

He adds that anyone can be at risk of stroke for many reasons, not just stress. Sometimes, it’s just how you are made. However, if you are worried about your level of stress, talk to your doctor about ways to get it to a manageable level.

“Preventing stroke can be as simple as eating well, sleeping well, exercising regularly and eating the right foods. It’s nothing groundbreaking you haven’t heard your entire life. But, doing it is the hard part,” Dr. Sundermann says.