Sometimes, it takes a heart attack for us to slow down in our life and listen to our bodies.

This was the case with Andy Johns.

In 2018, he was promoted to becoming President at Wealthfront, an auto-investment service that managed $20 billion in assets back then.

But, within a few months of being promoted, he found himself in the emergency room with heart issues. He wrote in an article later,

“It seems commonplace within our work culture to push ourselves to a breaking point, whether it’s physical or psychological. Often it’s both, as our body and mind are intertwined. Nonetheless, as someone who was conditioned to always aim for the top, like many high achievers in the world of tech, I was having a hard time reconciling the limitations of my health with my professional ambitions.

[…] But it was clear that I needed to make a trade-off to avoid a fate that others had faced. It also required that I step back and make a holistic assessment of what matters to me. Not just with work but with the broader tapestry that makes up a complete life, including human connection and nurturing experiences.”

Stress has become so commonplace that the World Health Organization (WHO) declared it to be a health epidemic of the 21st century.

But how does stress really affect our bodies? How can we regulate (or better, leverage) it?

And, what goes on inside our bodies when we feel stressed?

It’s time we learn what our schools didn’t teach.


The Physiology of Stress


The word “stress” was coined by the pioneering Hungarian-Canadian endocrinologist Hans Selye, less than 90 years ago.


He incorporated the term “stress” into the medical lexicon to describe the “nonspecific response of the body to any demand.“

It consists of the internal alterations—visible or not—that occur when the organism perceives a threat to its existence or well-being.

In the early 1900s, almost every doctor linked diseases to a specific set of signs and symptoms, none of which took into account the emotional state of the individual. But Selye came along with a bold hypothesis:


There is something called stress. It is not just psychological. It’s also physiological.


Stress is not just a state of mind, but something that induces hormonal autonomic responses, and, over time, these hormonal changes can lead to ulcers, high blood pressure, arteriosclerosis, arthritis, kidney disease, and allergic reactions.

Let’s take a tour of our bodies to find out how this happens.


Side note: Interestingly, one of Selye’s regrets (as written by a close friend) is that he used the word “stress” to refer to his idea, whereas in fact, he should have used the word “strain.” As expressed in Hooke’s Law of 1658, the magnitude of an external force, or “stress”, produces a proportional amount of deformation, or “strain”, in a malleable metal. So Selye really was talking about “strain” (the response) and not “stress” (the stimulus) when he introduced the idea.


The HPA Axis


There are three major components involved in the physiology of stress: the hypothalamus (H), the pituitary (P), and the adrenal gland (A).


Together, they form the HPA axis, which is the hub of the body’s stress mechanism.



Think of them as three cities in a country.

The hypothalamus and pituitary are a short distance away from each other (think Seattle to Bellevue), nestled in the interior of your brain, whereas the adrenal gland — a small organ hidden in the fatty tissue coating your kidneys — is far away south (think Austin, Texas).

There’s an interesting distinction here: the pituitary and adrenal are both endocrine glands, which means they can secrete hormones directly into the bloodstream.

In the cities metaphor, it’s like saying Bellevue and Austin have the special privilege of having railroads built to all the other cities in the United States through which they can transport goods.

When you perceive a threat, your hypothalamus releases a hormone that reaches the pituitary, which in turn releases another hormone that enters the bloodstream. It flows all the way down to the adrenal gland, stimulating it to secrete the famous “cortisol”, widely (but incorrectly) known as your stress hormone.


Cortisol: Not Just Your Stress Hormone


Cortisol is special. It has access to pretty much every organ system in your body.


Why? This is because almost all tissues in your body have glucocorticoid receptors that can welcome cortisol. So when you feel stressed, the cortisol that is released into your bloodstream causes a domino effect.

  • You feel high energy as cortisol triggers the release of glucose (sugar) from your liver.
  • Your blood pressure increases as cortisol restrict your arteries.
  • Your immunity is boosted as cortisol limits inflammation.

Except, all these short-term remedies hurt you badly if prolonged into the long-term.

Imagine that your response to feeling stressed is eating a scoop of ice cream. Let’s say you feel exponentially better the moment you have it. This is great if you feel stressed once every 6 months. A little scoop every 6 months won’t harm you. But what if you feel stressed every single day? How often can you keep eating ice cream? How many scoops before you fall prey to a new host of problems, including heart disease, obesity, and diabetes?

What was a solution is now the cause of problems that are more severe than the one it was trying to solve. Cortisol is a little like that.

Cortisol does a great job of responding to acute stress. But when you have chronic stress — such as when you’re in an unhappy job or an unhappy relationship — cortisol is continually released into the bloodstream, leading to high blood pressure, weight gain, muscle weakness, weak bones, and excessive hair growth (especially for women).


The Connection Between Stress & Disease

“This is the reason why the cure of so many diseases is unknown to the physicians of Hellas; they are ignorant of the whole. For this is the great error of our day in the treatment of the human body, that physicians separate the mind from the body.” — Socrates

Socrates lamented that 2500 years ago.


Yet, we’re still coming to terms with the realization that the mind and body are deeply interconnected.


In 1985, a study was conducted with 63 women, a day before they went in for a breast cancer biopsy after a suspicious node was detected in all of them. They were asked a series of questions to assess their psychological states and asked to answer a questionnaire-type personality test.


Based on the psychological analysis, the interviewers were able to predict the presence of cancer correctly in 83% of women (who eventually ended up testing positive).


Some of the characteristics that stood out in women who had cancer were self-sufficiency and altruistic nature.

The study says,

“When asked whether they expected help and support from family members or others after the operation, the substantial majority of cancer patients answered that they were very self-sufficient and always dealt with their problems on their own.”

And furthermore,

“The balance between “give” and “take” was shifted in almost all the cancer patients. Far more than the control women, they tended to play down their own interests and not to spare themselves either emotionally or physically where others — and particularly the family — are concerned.”


I hope you see what’s wrong with the above observations.


While self-sufficiency and altruism can be good virtues in moderation, they become harbingers of illness when taken to the extreme.


These women were suppressing their own interests at the expense of their families and suffering in silence (possibly for years), not reaching out for help and support.

In another study on lung cancer, Dr. David Kissen, a British chest surgeon, observed that male patients with lung cancer have a diminished outlet for emotional discharge, compared to those who did not have lung cancer. In fact, Dr. Kissen found that the risk of lung cancer was five times higher in men who lacked the ability to express emotion effectively.

These studies, and many more, point to the (immediate) need for us to build emotional competence.


Building Emotional Competence

Dr. Ross Buck, a professor of communication and psychology, defines emotional competence as “the ability to deal in an appropriate and satisfactory way with one’s own feelings and desires.”

Emotional competence requires:

  • the capacity to feel our emotions, so that we are aware when we are experiencing stress;
  • the ability to express our emotions effectively and thereby assert our needs and maintain the integrity of our emotional boundaries;
  • the facility to distinguish between psychological reactions that are pertinent to the present situation and those that represent residue from the past. What we want and demand from the world needs to conform to our present needs, not to unconscious, unsatisfied needs from childhood. If distinctions between past and present blur, we will perceive loss or the threat of loss where none exists; and
  • the awareness of those genuine needs that do require satisfaction, rather than their repression for the sake of gaining the acceptance or approval of others. Stress occurs in the absence of these criteria, and it leads to the disruption of homeostasis.


Imagine a scenario where a child is unhappy because she doesn’t like her food. She expresses her dissatisfaction by crying and raising her voice.

Sitting next to her is an exhausted mom who immediately feels irritated. She shows her irritation by first shushing her kid. When that doesn’t work, she resorts to screaming at her and slapping her on the back. The child quiets down, but now she associates expressing her emotions with a negative feedback loop. The more this keeps happening, the more she learns to repress her emotions and keep them to herself.


Emotional competence, although a critical tool we all need in our toolbox, is usually taken away in childhood by parents (unintentionally).


But it’s never too late to re-build it for yourself.

Since I read about emotional competence, it’s been lingering in the back of my mind.

Quite recently, my mom and I were having a conversation about something stressful that happened in my life. When I shared that with her, she responded, “Oh, don’t worry about it. You’ll get over it.”

This was her usual response when I shared something that upset me. In the past, I would overlook it even though it irked me. But this time, I responded back and said,

“Mom, I understand you tend to take things more lightly than me and I respect that. But, that is not the response I need when I share something stressful with you. I’m looking for you to validate my feelings and acknowledge them first. Your response is not helpful for me and I’d like you to take this feedback seriously.”

She paused for a moment, but then said, “Okay, I hear you.”

That meant a lot to me.


Closing Thoughts

Dr. Gabor Maté, a Hungarian-Canadian psychologist and advocate for the mind-body connection, writes in When The Body Says No,

“The flight-or-fight alarm reaction exists today for the same purpose evolution originally assigned to it: to enable us to survive. What has happened is that we have lost touch with the gut feelings designed to be our warning system. The body mounts a stress response, but the mind is unaware of the threat. We keep ourselves in physiologically stressful situations, with only a dim awareness of distress or no awareness at all. […] The physiology of stress eats away at our bodies not because it has outlived its usefulness but because we may no longer have the competence to recognize its signals.


We have reached a stage where we’re desensitized to our own stress.


It took Andy Johns going to the emergency room to hear that his body was begging him to slow down. It took the women in the study getting breast cancer to take care of themselves and ask for help.

But do we need these life-changing experiences to wake up and be more attuned to our bodies?

I truly hope not.