Video: Tom Sult, MD, on Chronic Stress

According to the American Psychological Association (APA)’s 2018 Stress in America™ survey, 91% of those in Generation Z have experienced at least one physical or emotional symptom due to stress in the past month; 74% of adults overall report at least one symptom.1 That’s a staggering amount of stress. Worldwide, the 2019 Gallup poll found that over one-third of the population suffers from stress-related symptoms, with 55% of US adults reporting being stressed “a lot of the day” the day before, compared to 35% worldwide.2 High levels of stress are implicated in the development and progression of many chronic conditions.

Tom Sult, MD, IFMCP, shares how helping patients with stress management can alter brain and body.


The brain is the most powerful organ in the body.

If your brain is elaborating alarm signals and alarm chemicals, your entire body is going to be in alarm. We talk about HPA [hypothalamic-pituitary-adrenal], the HPA axis, and part of that is really the autonomic nervous system.

You think about what would normally, in an evolutionary point of view, what would cause somebody to be in fight or flight, in sympathetic overdrive? That would be a saber-toothed tiger jumping out in front of them. One of three things is going to happen; they’re either going to run, they’re going to fight, or they’re going to die, it’s going to be over.

In modern society, we’re chased by saber-toothed tigers all day. It’s the guy who drifts into your lane on the highway, it’s the letter from the IRS, it’s the disagreement you had with your spouse. It’s all of these things that are happening all day, every day.

So instead of having brief episodes of fight or flight, we’re having prolonged episodes of fight or flight. When you’re in fight or flight, you’re shunting blood away from your organs toward your large muscles. Now, what does that mean? That means that you’re not digesting and absorbing well. It means that because of altered transit times, the fermentable products in your gut are altered so your microbiome changes. That affects your immune system—70% of your immune system lines your gut. You’re shunting blood away from 70% of your immune system. That’s the bad news.

The good news is interventions can be very, very powerful. If you can get somebody to do some kind of mindfulness technique, or meditation, or heart rate variability biofeedback, that can have a profound effect on digestion and absorption, on the microbiome, and on the immune system.

These relatively easy and inexpensive interventions can have profound impacts on your most complex patients.


  1. American Psychological Association. Stress in America™: Generation Z. Published October 2018. Accessed September 3, 2019.
  2. 2019 global emotions report. Published 2019. Accessed September 3, 2019.

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