The secret to coping with stress: How to protect your brain and body, and feel calmer now

Growing up, many of us were taught to just stay calm and carry on - as if stress was all in the mind, with no real effect on the body. But chronic stress can change your brain, raise your risk of heart disease, and even shorten your life. 

In this episode, we ask: what happens when a stress response built to last minutes never switches off?

Today, Professor Carmine Pariante, one of the world's leading researchers on stress, helps us understand what’s happening in your body during a stressful moment and why chronic stress disrupts sleep, appetite, and energy levels. Carmine also explains how worried you should be about cortisol, and whether "cortisol face" and "cortisol belly" are backed by evidence.

Next time you reach for wine, your phone, or something sweet after a hard day, ask yourself: is this helping you cope, or helping you avoid how you feel?

Try our science-backed and tasty wholefood supplement Daily30

Let your gut microbes snack on the ZOE Gut Health Bar

Build healthy habits. Download the ZOE app today and start your trial for just £2.30 for your first week. Join ZOE

Follow ZOE on Instagram.

Jonathan: Carmine, is stress always a bad thing?

Carmine: No.

Jonathan: Can enough mental stress damage my physical health?

Carmine: Yes.

Jonathan: Is cortisol something we should always be trying to lower?

Carmine: No.

Jonathan: Are stress and anxiety the same thing?

Carmine: No.

Jonathan: Can stress increase the levels of inflammation throughout your body?

Carmine: Yes. And finally, what's one thing that most people get wrong about stress?

Carmine: Guilt. They feel guilt about it rather than understanding that it's coming from outside.

Jonathan: I love that we're talking about stress because I think that everyone listening to this podcast knows what feeling stressed feels like. And honestly, I feel like I've been stressed since the day, nine years ago, when I decided to start ZOE with my co-founder.

Carmine: I'm not surprised.

Jonathan: So I definitely feel like I live with this, and in the modern age, it feels like stress is coming at us from every corner. Now, I was brought up in England to believe that you should just stay calm and carry on, and that since stress was in the mind, it wasn't real. It couldn't cause any physical symptoms, and basically, if you could just ignore it, then that was the best thing to do. And you're already starting to smile. And I'm also smiling a little because over the last few years, I've been starting to reassess, you know, this upbringing that I had. However, there is a lot of conflicting advice about stress from online influencers, and most of them have something that they want to sell. Like, we know what it means to experience stress, but I realize as I'm saying this, I have no idea what it actually is.

Carmine: Stress is every situation where the challenge that we're facing is bigger, or at least is perceived as bigger than our ability to cope with it, to deal with it. Once you interpret it this way, then you know there's always a mismatch, and it's a personalized mismatch between how you are at the moment in your life on the day and what's happening around you. Stress is not the same for everybody, and of course, we know this. You know, there are aspects of stress that most of us will consider intolerable, and I'm thinking about, for example, being in a war zone or, you know, being a soldier or, even if you choose to actually participate in a situation that would be life-threatening or very stressful. And then, of course, there are situations that most people will find not stressful, you know, perhaps even relaxing. And then everything in the middle, like, you know, from talking to podcasts today, talking to the public, having to give a speech at a wedding, having a difficult job performance, all of that will always be about how you as a person perceive that task on the day, because it also changes from day to day and it changes from how prepared you are and it changes based on what is your kind of background, mental health, and wellbeing at that particular moment. It's a very kind of personal but also kind of moment by moment definition, if you like.

Jonathan: What you're saying is stress is when the problem that I feel that I'm dealing with right now is bigger than I'm convinced that I can deal with?

Carmine: Yes. And often it is bigger than you can deal with it. Sometimes it's bigger than you think you can deal with it. Other times it is really bigger than what you can do about it.

Jonathan: So let's take an example. I mean, you mentioned a war zone, but I maybe want to go back into, like, my mental model of this, which is, like, our ancestors being chased by a lion. Can you explain a little bit about what's happening in my brain, you know, as that lion is starting to come towards me?

Carmine: I mean, by the time the lion comes towards you, probably your brain almost kind of goes into automatic functioning and your body is taking over. Your sympathetic nervous system gets activated. So this is a kind of direct system that originates from the brain and makes your heart beat faster, brings more blood to your muscles, kind of prepares you for the immediate run or fight. It also activates the immune system. These are the cells that we use in our daily life to fight infections. And of course, you want to be able to fight infection, to have an immune system that is primed to fight because we are gonna be injured. You know, it's a lion in front of us. Even if we run away, we're gonna be injured by, you know, running in a field. And if we get caught, of course there will be the injuries of the fight. So the immune system gets activated. A few minutes after that, cortisol kicks in. Cortisol is a hormone, so it's not directly produced by, if you like, the brain or the central nervous system, but it's downstream to the activation of the brain, and it's produced by a small organ, which is called the adrenal gland, which actually sits on top of our kidney, left and right. Cortisol goes straight into the bloodstream, produces more glucose, so more sugar in the blood. That's the basis of energy, which we'll really need. It kind of also helps shut down blood flowing to organs that we really don't need. So you know, we don't need blood in the stomach because digestion is not a priority when we have to fight for our life. And in the brain, cortisol kind of helps focus on the task ahead. So typically it kind of narrows the focus of our attention so that you almost become unaware of things that are not really important, except of course the lion or what you need to do to fight or run. This is more or less what happens. Now, as much as I love the predator models, we need to remember that these are models of acute stress. All of us will encounter acute stress. I mean, the very unlucky will encounter severe acute stress, you know, being in a car crash or being assaulted, being exposed to violence. And a lot of us will have intermediate acute stress. But the problem with today's society is much more about chronic stress. So the question is how a body that was really created for stress that will only last 15, 20 minutes, half an hour, so the time that you either fight the lion or run away from the lion, how does that body, that stress reaction deal with the fact that today's stressors are mostly psychosocial and continuous rather than acute and disappearing after 20 minutes?

Jonathan: I have this vision in my mind now of all these things being switched on in my body, you know, at the point that I see this lion in the distance coming towards me. I'm really interested to follow up now actually on what you're saying about how that might be the same or different in my modern life. I feel, though, that I get very anxious if I know I'm gonna be late for a meeting, for example, right? Which feels like that's completely different from a lion, but I definitely think, "Oh, I'm feeling stressed. I'm gonna be late." Is that a completely different set of things that are going on inside my body?

Carmine: No. It's just quantitatively different. You have an increase in proinflammatory signals, so your inflammation in the blood. So your immune system activation goes up even if you're doing an exam, for example. Your cortisol goes up if you're late and you're really worried about it, and your heart will be, you know, beating faster if you're anticipating a difficult meeting with your boss. So these mechanisms operate. The magnitude of the intensity, of course, is much higher when we are facing a real life-threatening situation versus a mildly challenging or just kind of worrying concern.

Jonathan: There's a range to this as well. It's not like it's either on or off. No. You can have all of those things you described, like, at different levels of intensity?

Carmine: Yes, absolutely. And this is why people have, for example, you know, stroke or other acute medical kind of complications under conditions of really intense stress, but they don't have it, luckily, you know, if they're late for a meeting. Because the level of activation, for example, of the sympathetic nervous system, which is the system that, you know, increases your heart beat so it gets faster, but also increases your blood pressure so you can get more blood to the brain because that's where you need the blood because you're, again, you have to decide what to do in front of the lion. While all of that may only increase a little if we're worried about being late, it increases really exponentially a lot if we are facing a life-threatening situation.

Jonathan: In a situation where I'm feeling a lot of stress, as all of these things have been switched on in my body, in fact, some of that is also to, like, my heart beats faster and more blood pressure. Is that related to this idea that you could have a heart attack if you're under- Yeah- too much stress?

Carmine: Absolutely. This is both in terms of chronic activation of the stress systems, which increases your risk of cardiovascular problems really across a variety of mechanisms because unfortunately, having a chronic activation of your stress system is not the same as having the acute activation that, you know, we're having in the jungle. Because in the jungle, our ancestors would face a predator for a few minutes, 20 minutes, half an hour, maybe not even every day. But for us it's different, right? So it's the stresses of daily life, the pressure of work, the social isolation, the difficulty we have with relationships that stays with us every day. So it's continuous.

Jonathan: So I think you're saying that there's a big difference between probably what our ancestors experienced, which is a very high level of stress, but for a short period of time, and I think you've mentioned conversely this idea of like chronic stress. Could you help us to understand what that means?

Carmine: A lot of the conditions that we're now facing today and we're perceiving as stressful are of situations that stay with us for weeks or months or years. It could be a work pressure, it could be relationship difficulties, it could be, you know, feeling lonely. A lot of the problems that we are facing as a society, they tend to be there for a long time. And so at that point, it's very difficult to switch the biological stress response off because the challenge is always there. While with the lion, once the lion is gone or if you're dead, we don't need the stress system anymore.

Jonathan: And so Carmine, what's happening in those sort of long-term situations? So like, I've got a horrible boss and my relationship is difficult and I'm worried if the company's gonna go bankrupt, et cetera, et cetera. Is that a completely different set of reactions that's going on in my body from the one you described with the lion?

Carmine: It's the same, but it stays on longer. So your sympathetic nervous system that is supposed to kind of make your heart beat faster and your blood pressure go up for 20 minutes or half an hour until you deal with the problem, actually increases your blood pressure for days and weeks and months in a row. And you know, the baseline stays on. Because the baseline stays on, then when there is an acute thing happening on top of it, you know, you're starting already from an activated baseline, so it goes up faster and higher. And it is the same with cortisol. So your cortisol gets constantly activated, and so the system is just more responsive. And so when you're facing a small stress in the context of the ongoing stress, then your cortisol goes up more and goes up higher. And cortisol, you know, in the short term helps because you want to have more sugar in your blood so that you can, again, have the energy to run. In the long term, that means your risk of diabetes or metabolic disorders, your risk of weight gain, your cardiovascular problems, all of that goes up. Because it's something that your body's doing not for half an hour, but it's doing it for weeks and months in a row.

Jonathan: So this raised level of cortisol, it's not just that it makes me feel maybe more focused and feel stressed, but actually it's gonna increase my risk of serious disease like diabetes, but also a risk of weight gain?

Carmine: Yes, weight gain. Together, especially with the inflammatory component, because inflammation does the same. So inflammation also increases our risk of metabolic dysfunction. It kind of potentiates the negative effects of cortisol. One of the things that cortisol does is it activates mechanisms of reward that increase eating as a way of coping with stress. So some of the negative consequences of the stress are the unhelpful ways that we cope with them.

Jonathan: That's really interesting. So you're saying that our modern environment is having the same reaction to me as I'm designed to have against, like, this scary lion. It's not quite as high, but it's just on for months, and part of that system is, like, increasing my inflammation. It's increasing this cortisol, and you're saying that that actually is likely to lead me to put on weight. It's likely to make me eat more. That's slightly crazy.

Carmine: It is, but it's, you know. And the environment, of course, facilitates that. High-fat food and high-sugar food, they have a kind of rapid anti-stress effect. They kind of... You know, they can reduce cortisol because they kind of give you a feeling of reward. Food obviously is available to everybody. I guess alcohol and smoking, you know, come immediately after in terms of availability. And then of course, some people use drugs of addiction. I mean, these are the negative ones. You can add, I guess, social media, scrolling, and everything that takes the pressure away from you, even if for, like, a minute or an hour. It will be, in a highly stressful situation, a welcome relief.

Jonathan: It's not like I know my cortisol is high, right? No. So you're saying that, like, in my biology, it's sort of saying, "Ah, if you get that, it's gonna reduce. I'm gonna feel better." So I'm sort of learning- Yeah- these behaviors. We now know in our modern world that eating lots of sugar is not gonna be good for us. But similarly, alcohol, which I think for many of us, we do think, like, at the end of a really stressful day, "I'd love to have a drink." I definitely can often feel I would really like a glass of wine. There's a physical relationship to do with the level of pressure that I felt earlier and this raised stress and this raised cortisol?

Carmine: Yes. There's, and there's also the mental aspect. I mean, of course, all these strategies we use to cope with stress.

Jonathan: I'm really struck that you said that there's not a complete difference between sort of physical and sort of emotional or social threats. Is there really genuinely my body is gonna respond in the same way to a really high intensity- Like emotional situation as it would to a really high-intensity situation with, like, a physical threat?

Carmine: It does. It's only really a matter of quantity and for how long it stays on, all of these mechanisms. We have one way of coping with stressful situations, which is usually a way that allows us to, as I said, either run away or kill. And unfortunately, in modern society, we can... often we cannot run away from the stressors, and most of the time we cannot, you know, kill the stressor metaphorically or physically.

Jonathan: Why is it that you're saying it's today that we live with this chronic long-term stress? Why wouldn't our ancestors have just been chronically stressed all the time?

Carmine: There's really a lot to unpack in here. So first of all, our ancestors had different expectations on their life, on what is their wellbeing, if you like, to use a term they probably would not have used

Jonathan: or understood. Probably not a lot of wellness influencers- Not a lot of wellness

Carmine: influencers... back in the savanna. Absolutely. So they would have had different expectations. They would know exactly how often they would've been able to eat, and they would know that a lion was always behind the corner. They would have developed strategies to deal with it. Also, they would have developed, I guess, acceptance of what the world around them was. And, you know, this is not dissimilar to a lot of things that have changed over the last 100 years. There've been plenty of discussions how our attitude toward death, for example, has changed in society. How, you know, 100 years ago, for example, you know, with the infant mortality being much higher, and of course illness and, you know, medical care being much less developed than today, it was unfortunately a common experience to lose someone in your family, to lose maybe a child. And there was a different relationship with bereavement and the loss of someone. I'm just giving you one of, I guess, hundreds of examples of how society has changed even recently. So we are in a situation now that, if you like, is the worst possible combination, where we have high expectations that life should be perfect and everything should go well, but we have less, if you like, spiritual or kind of philosophical frames to make sense of what's happening to us. And we are a society that is more difficult to live with in terms of, you know, more fragmented. We don't have a village where we trust, you know, people we have been living with for all our life. So I think it's, you know, it's a weird combination of a much better quality of life and a much worse kind of way of dealing with the difficulties that are still here.

Jonathan: I'd love to talk about what happens to us today now that we are living in this long-term stress, and particularly how it affects our health. So imagine someone is experiencing this, like, low-level long-term stress. You know, what symptoms might they notice, and what might be going on inside them perhaps that they're not even gonna be aware of?

Carmine: We're all different in terms of some people tend to express stress in more, in a physical way, and some people tend to be more mindful of their emotional wellbeing and reactions. I think at the minimum, yeah, I would imagine someone who's going through a really difficult time, the major thing would be disrupted sleep, so inability to fall asleep, maybe ruminating before going to bed about what's happening, or waking up early in the morning, again, with the kind of waking up with these concerns. Appetite changes. A lot of people when they're under stress, they stop eating or they eat less, they lose weight. Other people eat more. And sometimes it's like a curve, a shift. So I know it, not as a scientist, but as a stressed person, that if I'm a little bit stressed, I eat more. But if I'm really stressed, then I stop eating. So each of us will have this kind of curve. It may, you know, some people only have one style or the other.

Jonathan: So those are both potentially responses- They're both potential- to the same underlying stress.

Carmine: Absolutely. You know, whatever, in a way, whatever works for you or for me at that particular time. But

Jonathan: this is a real physical reaction. This isn't just all in my mind, a bit the way I was brought up. Like, there are some real physical things that are happening inside me as a result of the stress responses that you're talking about.

Carmine: Yes, because there's no mind and body and brain separation. You know, it's all one single entity, if you like, communicating. And so the high level of cortisol stimulates the brain and may, for example, increase hunger as a way of coping with stress. The food will have a reward effect, so the pleasant experience of the sugar or fat will give our brain a feeling of kind of pleasure, which will then relax us and therefore, you know, the body relaxes after that. So it's a continuous communication between mind, body, and brain.

Jonathan: And so you were saying that if I start living with this long-term stress, like, I start to get these physical effects, and that might be disrupted sleep, appetite changes. Is there anything else?

Carmine: Yeah. Well, you know, high blood pressure and stomach pain. You know, the famous stress gastritis, problems with indigestion or reflux or gastric acidity. And this, again, is driven, is largely driven by actually cortisol's effect on the internal layers of the stomach, that the cortisol increases the kind of acidity. And that's why in very acute situations, people may have, you know, when they're going through a severe stress, they may have an acute gastritis. They may need to kind of go and see a doctor just for that. So these are all kind of consequences of stress. The inflammation goes up, although we don't feel it as much. However, we do feel it a little bit because probably the high level of inflammation during stress is what drives the feeling of fatigue and lack of energy.

Jonathan: I can't feel my inflammation directly- No- but I might feel like this fatigue, this tiredness, this lack of energy, and that is actually sort of how my brain is aware that my inflammation is high.

Carmine: Yes, because you need to remember talking about ancestors again. So when we have an infection, any type of infection, one of the responses of our body to the high level of inflammation is to shut down. So to kind of reduce our physical activity. Think about how you felt last time you had the flu. You know, those unlucky who had COVID, how bad it was physically, how tired we felt. And this is because the brain is programmed to respond to the high level of inflammation by shutting down kind of what we call the reward system. So the activities that make you seek things that you like, because really you need to kind of sit down and wait and so that your body keeps all the energy to fight the infection. And possibly from an evolutionary point of view, there's also a principle of kind of social isolation, a natural social isolation. So we stop moving. We just want to kind of be in bed. We don't want to socially interact as a way of protecting our peers from the infection. So that's another issue, like ancestral mechanisms similar to the stress, that it works also in daily life. And so when we are stressed, the inflammation goes up and the brain perceives that almost like if there is an infection going on. And so it signals the body to feel really tired and stop doing stuff.

Jonathan: Really interesting. So my stress can trigger inflammation that is the same as if I actually had got- Yeah- you know, a cold or flu or something like this.

Carmine: Absolutely. Absolutely. I mean, if you measure it, you'll see the same levels. Not as high as having, you know, COVID or sepsis or like a real severe infection, but definitely as high as having a cold.

Jonathan: So I could measure that. What would you measure in- Yeah- someone's blood?

Carmine: We do that every day. We take the blood and you can measure what we call cytokines. So these are chemicals produced by the immune cells, the white cells that are circulating in our blood. They kind of send it in the blood to communicate with other immune cells that are in our lymph nodes, in our spleen, and they go up. There's one that we study a lot, it's called interleukin 6. And you know, it goes up with depression, it goes up with stress. It goes up acutely with an exam, but it goes up chronically in people who are, you know, for example, as I said, have major depression.

Jonathan: I think that's amazing. As I said, I was like, I was definitely brought up in this idea that, you know, your brain and your body are separate. Keep calm, carry on. And so the idea that you could feel stress and there would actually be a chemical you could measure in your blood that's changed, that is physically affecting you, you know, is a pretty big hole in this idea that these are completely separate.

Carmine: Yes. And in fact, I would argue that if you completely dissociate from the emotional content, if you like, of your life, the risk is that your body keeps feeling stressed and feels the effect of stress. However, you're not even aware of it because you're kind of dissociated from the emotional component. So it's like, okay, I'm not gonna be feeling sad. I'm not gonna be feeling worried about it because it's all in my brain. But your body will continue to feel sad.

Jonathan: So these are sort of like the short-term impacts. How serious can this be for our long-term health?

Carmine: Very serious. I mean, chronic stress that is so embedded in their life that eventually brings clinical anxiety or clinical depression. So, you know, with mental illnesses, for example. They die younger because of the ongoing physical effect of, you know, the biological changes that happen in the body and in the brain with high levels of stress. As I said, sometimes it's also some of the mechanisms that we use for stress. So, you know, the changes in our eating behavior, the use or abuse of alcohol or smoking or substances.

Jonathan: So it's really true. Like, if I'm highly stressed over the long term, I'm just gonna die earlier.

Carmine: You're gonna die early or you're gonna have a miserable life. And probably the people living with you will have a miserable life too.

Jonathan: Well, lots of people living with me might say they're having a miserable life, so that might be true.

Carmine: You know, stress has an emotional cost. Stress is a physical cost in the body, but it's an emotional cost as well, in the way we behave, in the way we communicate with other people around us, including the people that are closer to us.

Jonathan: And so you've mentioned already the fact that if I'm under this stress for a long time, like that will lead likely to weight gain. We know that obviously that's really bad for your health. You talked about high blood pressure. What about other diseases? And I definitely think that sort of heart attacks are the thing that I have... You know, I think all the way back to before I was born, right? Somehow like 1960s sort of Mad Men, everyone was like, "You're gonna drop dead of a heart attack 'cause of your stress." Like, is that not true? Yeah.

Carmine: No, no, it's true because... And again, all these are all the same mechanisms kind of focusing on one single, you know, potential kind of negative episode because the increase, you know, in food intake or the high level of cortisol, the stimulation of more glucose will also increase your lipids in the blood. That will increase accumulation of cholesterol. And so your blood vessels start to kind of become smaller and smaller and smaller, especially the ones in the heart. The inflammation activates the response of cells that are circulating in the blood. They make it stickier, so they stick to the blood walls and coagulation happens, basically like an accumulation of cells that block the flow of blood in the heart, and you have a heart attack. So all of these mechanisms operate in giving all of these different, if you like, negative effects. Of course, we all come with different predispositions, maybe genetically or, you know, based on how we, the kind of life we had as a child or, you know, the type of nutrition or physical activity or other lifestyle that we have. So some people may suffer more in the stomach. Some people may have a heart attack. Some people may, you know, develop diabetes. But they're all downstream negative effects of stress.

Jonathan: And I know that you conduct a lot of research into inflammation and sort of mental health conditions, and you've already touched on sort of fatigue and lack of energy. But what is happening in the brain, if anything, as a result? And does that affect, like, my mood or anything like that?

Carmine: Yeah. So we now kind of know that high level of inflammation is present during depression, is also present during anxiety and other mental disorders. But it's certainly important in the creation or at least some of the symptoms of depression. Inflammation typically affects the reward system. I keep going back to the reward system because they come with this area of the brain that allows us to feel pleasure. And if we don't feel pleasure anymore because this part of the brain gets shut down and it gets shut down by the high level of inflammation, then of course our life will become dull and we'll feel sad and unable to ever feel kind of normal again.

Jonathan: I think one of the things I often personally struggle with is being able to experience a lot of happiness and I definitely have quite a lot of pressure in my life, but I never thought about it as being related to that. It sounds like you're saying that stress might lead to an impact on my brain that affects my ability to be happy and experience- Correct- joy? Because that's not so obvious. Yes. I think we understand, I can understand the anxiety, but I'm surprised to hear that it would also affect maybe then being able to even feel these positive emotions.

Carmine: These are all kind of downstream, if you like, negative effects of something that in the short term is helpful. So again, if we're going back to the idea that you have an infection, you really want your brain to concentrate on fighting the infection. So you just don't want to be seeking pleasure or pleasurable activities. You don't want to go out. This again, lasts hours, days, or you know, you die because of the infection as a lot of our ancestors would've done, you know, maybe even until 100 years ago when the antibiotics were discovered. Now we have these mechanisms, they're operating weeks, months, because they're chronic and one of the downstream effects of this is certainly the fact that inflammation reduces the ability of our brain to respond to reward, so to respond to pleasure. And we know it because the studies that we and others have been conducting in using anti-inflammatory strategies, so literally medication that has been developed for inflammation, so for pain or for autoimmune disorders or inflammatory disorders like arthritis, use this medication in people with depression, and we can see that one thing that lifts is this ability to experience pleasure and the brain areas that respond to pleasure get to work again, if you like.

Jonathan: You can actually sort of scan someone's brain, and if you reduce the inflammation that comes from the stress, like parts of their brain are suddenly sort of switching on- Yeah- that before were sort of dark and switched off?

Carmine: Yeah.

Jonathan: That's crazy.

Carmine: Yeah. Well, you know, it's kind of trying to understand how we can help people with depression.

Jonathan: I think it's incredibly interesting, this link between stress and inflammation, and then inflammation and mood, and this idea that there's a continuum. So it's not like you're either clinically depressed or not. You could have some of that. I'm also partly struck because we meet so many other scientists talking about other things in our modern life that contribute to inflammation. You know, on this show we talk a lot about food, for example. And so presumably if I'm eating a modern Western diet and I have some level of inflammation, if I'm then stressed on top, does that mean my inflammation is therefore gonna go even higher?

Carmine: Well, we know that, for example, part of the inflammation in people with major depression or other mental disorders is driven by an increase in weight because the fat tissue is actively producing inflammation and it's putting it in the blood. Your inflammation makes the body more metabolically responsive. The stress maybe increases your food intake, which then in the context of increased inflammation will kind of create more problems from a metabolic point of view, you know. But it'll be, your body will be more sensitive to developing a high level of cholesterol, a high level of fats in the blood, a high level of sugar, and at the same time, the deposition of fat increases inflammation. So it's all, unfortunately, they're all kind of negative cycles kind of potentiating each other.

Jonathan: Let's talk about cortisol a little bit longer, 'cause you've mentioned it a lot through this discussion, and I've been struck by that because cortisol has become a bit of an online buzzword recently. Yes. But I've now got one of the world experts, so I'd like to ask you. So there's a lot of people talking about cortisol face and cortisol belly. Like, is there any truth to that? Can cortisol be causing you to lay down fat in these places?

Carmine: As you were saying, cortisol does increase food intake as a coping mechanism with stress. People that have very high levels of cortisol, but not because of stress, because of endocrine dysfunction, also tend to put on weight. And unfortunately, we see, for example, with people who take steroids, which is really just cortisol, exogenous cortisol, they're kind of medication that mimic cortisol. However, having said all of that, I think what I don't like, if you like, of the buzz about cortisol is that somehow it's something that we can measure or interpret or modify or... I mean, yes, cortisol is important in stress responses. However, you know, is that something that we can manipulate beyond just kind of trying to have a less stressful life? And certainly it doesn't help to measure it, and there's nothing pharmacologically you can do to reduce it unless you take medication that is quite toxic. So I just think stress is not about measuring your cortisol. Coping with stress is not about measuring your cortisol. Coping with stress is about improving the aspects of your life that you can control to make you more able to deal with stress.

Jonathan: I would love to go to that, but first, I have a specific question the research team said I have to ask. So apparently, also online, there's a lot of noise about a cortisol cocktail that can allegedly reduce your cortisol levels. So they've told you you're gonna get cortisol face and cortisol belly, and I'd just love to tell you what's in it so you can tell us all whether it's gonna work. Apparently it's orange juice, coconut water, salt, and potassium or magnesium powders. Is this going to fix my cortisol?

Carmine: To me that doesn't ring any bells. 'Cause I cannot link any of these compounds or things in the cocktail to anything that particularly would affect cortisol levels.

Jonathan: So for those of you who've been taking your cortisol cocktail, we recommend you stop. I'd love to talk about, you know, what we can do. But can I even start maybe with, like, my aim? Should I be aiming to have no stress in my life?

Carmine: It's impossible. It may be actually that that's the reason why we feel so stressed, is because our expectation that we should have a stress-free life. And so it's a continuous disappointment when we are stressed and when we feel stressed, hence the guilt, you know, because maybe we're doing something wrong because we should not be feeling stressed. So this is completely the wrong way around of looking at it. The correct way is to deal with it. Stress will be behind the corner every moment, and I need to learn how to cope with it. Avoiding it will only make it worse.

Jonathan: So don't try and avoid it. Life is difficult. Let's learn how to cope with it. So could you talk to us now about whether there are any evidence-based things we can do to handle this stress that inevitably comes our way?

Carmine: Plenty of strategies. The first thing to remember is that stress is particularly bad, or is perceived as particularly bad when is what we call uncontrollable stress or something on which we feel we don't have any control. If I come to this podcast because I want to do it and I really enjoyed the idea, this would be a rewarding experience for me. If someone obliged me to come to a podcast that I hate, because I hate to be talking in front of a microphone, this would be highly stressful, and if I cannot say no to that request, it would feel even more stressful. So the first question we need to ask ourselves is, how much control do I have on the situation that makes me feel really stressed? And sometimes control is about choices. That's the most important strategy about having control on what you feel is stress or what you feel is stressful. But you need to start by doing an analysis of the situation. What can you control? And maybe you cannot change your job, but you can maybe work less or you can use better the hours that you're not working so that you're kind of compensating your quality of life. It's a balance, so if you cannot objectively reduce stress levels, maybe you can increase the positive aspects in your life, and so focus more on the positive aspects, give more time and more attention to the positive things in your life. Things like spending quality time with family, friends, your hobbies, your passion. We tend to think of the pleasurable side of life as the weak one, as in, 'I don't need that,' you know? 'I want to become a very famous professor. I don't need to spend time reading books or...' You know, or walking in the woods. But these are essential activities for our wellbeing. Whatever it is that is important for you, traveling, you know, walking, they generally do reduce levels of stress. I mean, we recently did some work using singing groups for mothers that were suffering from postnatal depression. And we measured literally from before the singing session, one-hour singing session to the end of the singing session, a reduction in cortisol and inflammation. And that, you know, this is just one thing that we have been doing. There are hundreds of other studies like this. The same is for walking in the green areas, dedicate time to culture, art, creativity, but also, you know, spending time with friends and having a social network, social support. And you know, just next to it is the spiritual element, which again, it doesn't mean that you have to have a religion or have to have a religious group or an official spiritual, if you like, attitude. However, things that will feed your soul, if you like, or feed your mind will really help you with the stress.

Jonathan: I'm really interested that the first thing that you've gone to is not some sort of meditation, but you've gone straight to both having some control over work and some time with friends and family. That's because you feel these are the biggest things you can do to really-

Carmine: Yeah. And of course the more personal lifestyle choices that will help you. I mean, you know, physical exercise, whatever helps you maintain a physical activity and a healthy... You know, your body will benefit from movement, from physical fatigue.

Jonathan: Could you tell us a bit more about that? Because thinking from my own experience, I started doing the gym about a decade ago, and it was driven by, like, a physical issue. I was having some pain, and then I think supported by the things I was learning sort of through ZOE about how good it was for my long-term health to be doing exercise and resistance training, things like that. But interestingly, I now think about it as being an essential part of sort of managing my mental health, and, you know, my job is quite stressful, like I think lots of people listening to this, and I've started to think about, like, doing that exercise regularly through the week as something that helps me cope mentally. But I have no idea if there's anything real in that or it's just sort of- No.

Carmine: There is. There is. And, you know, again, in this complex mind, body, brain, exercise does so many things because you can measure inflammation in the blood, and actually we know that physical exercise is anti-inflammatory. Recent research shows that the muscles actually doing exercise produce chemicals that are against inflammation. But also exercise gives a feeling of reward and satisfaction with yourself because of course if there's one thing that you can get better at is exercise, whatever it's gonna be, because you learn the skills, the technique, your body gets more used to it, whatever it is. There are so many elements that are positive about having a regular rewarding physical activity, both from a body point of view and from a mental point of view. And I'm, you know, I do a lot of physical exercise, and certainly it helps me with coping with stress a lot.

Jonathan: So the exercise really does have an effect on stress.

Carmine: It does. You need to enjoy it, or, at the beginning when you don't enjoy it, push it until you start enjoying it. It doesn't come with the first time you go to the gym. I'm sure you had exactly the same-

Jonathan: Honestly, it took me years- Yeah- to start to enjoy it, and as I said, for years, "Oh, I don't get any pleasure out of it." This is actually not true anymore. Like, I do actually get pleasure from it now. I did not grow up doing lots of exercise at all so it's normal that it might take quite a while.

Carmine: Yes. It's different if you were, you know, in some kind of team playing something when we were kids, so we're always used to it. I think for people like, I guess, you and me as well, that we're not very sporty children, it does require time. But I'm now at my fittest level. I've never been as fit as now, and I'm, you know, I'm 60, so.

Jonathan: Well, you don't look 60. So it's definitely working well. When we talk about exercise, what do you need to do? Like, do you need to be, like, lifting weights or going for a run to be doing, like, this exercise is gonna help with your stress?

Carmine: I think the most important thing is to doing something that you really like that increases your heart rate a little bit so that you feel... You need to feel tired after it. You need to feel fatigue while you're doing it. You know, you need to push yourself a little bit.

Jonathan: Could a long walk, for example-

Carmine: Yes, a long walk also works. It's always beneficial because you tend to focus on the repetitiveness of the stepping, and there's a little bit of, kind of creates a little bit of meditation even if you don't want to do it, basically.

Jonathan: What about diet and how it can affect stress? And if I'd said that to you 10 years ago, I'd been like, "That's mad to think that diet could have any impact on stress." But I've definitely been reassessing that myself. What does the science say?

Carmine: The best evidence is on things like fish-rich diets, and after that, with a little bit less evidence but promising, if you like evidence, fruit and vegetables. And these are coming from largely studies at the population level or cultural groups that have a diet that is particularly rich in fish or vegetables or fruit or both or a combination. They tend to have overall as a population lower levels of depression or lower levels of mental disorders. It is possible that you need a lot, if you like, to actually have a therapeutic effect or preventative effect. So we're talking about kind of eating fish twice a week or having lots of fruit and vegetables every day. I think, again, even just having some kind of control in avoiding the bad food, not in a way that deprives us of, you know, the pleasure of chocolate. But at least having a feeling of control that we can actually decrease the sugar intake, we can decrease the fat intake. You know, a feeling of control is always good for our mental health, partly because it has a really positive effect.

Jonathan: One thing you haven't really mentioned that I would definitely like to ask about is alcohol. 'Cause I'm sure there are a lot of people listening to this podcast who say, "You know what? I know what I do. I've had a really tough day. I get home. Maybe I finally got the kids to bed and have that wonderful noise when you take the cork out of a bottle of wine and you're gonna pour a glass of wine and you're gonna drink it. And I feel like my stress just falls straight after-" Of course it does. Yeah- this alcoholic drink. Does alcohol reduce my stress, I guess is the first question, in the short term or- No.

Carmine: I mean, it reduces literally for like 10 minutes, half an hour that you are drinking and you're under the effect. I would argue that actually if you feel that it's actually reducing your stress a lot while you're drinking, you're probably drinking too much. It's numbing it and then usually gets worse after. I mean, partly alcohol increases cortisol. People with alcohol problems, they have sky-high levels of cortisol. They increase inflammation terribly. So people with alcohol dependence and alcohol abuse, they have high levels of cortisol and high levels of inflammation. So physiologically it does everything that you don't want to do because it activates the stress response. I still think it's nice to have a glass of wine or share a bottle of wine with friends at the end of a difficult day. But I think that if you start using it to numb yourself, then A, it's only gonna be very temporarily, and B, it's gonna get worse the day after. These are all dysfunctional coping mechanisms. They become dysfunctional at some point. We all enjoy... And, you know, social media or spending time scrolling or spending time on the internet, it could be pleasurable, interesting, and then it becomes numbing because we are so entrenched into, you know, the moment or-

Jonathan: Well, I love that you've talked about phones 'cause I did want to ask- Yeah- because it feels like there's this growing evidence that they might actually be harmful for us. A lot of people take out the phone almost as a sort of way to de-stress, but is it in fact making us more stressed?

Carmine: It depends why we're doing it. I suspect most of us, that includes me, we're doing it because at the moment we don't want to think of what is worrying us or we don't want to feel the emotion that we are feeling. Am I saying that people should not have 10 minutes of kind of relief by looking at a mobile phone? Of course not. The same way that people could have, you know, the glass of wine. If it's becoming, you know, being drunk every night or not interacting with your family or with your friends because you're constantly on your phone, then you need to ask yourself, "What am I avoiding in my mind by putting all my attention on the glass or on the phone or whatever it is?" The principles of wanting to use all of the strategies, whatever works for us to numb our emotions, are the same across all of this. So we need to try to understand how we're using it, are we using it in a healthy way that is acceptable? Are we using it in an unhealthy way? Whatever it is that we're using.

Jonathan: So these aren't fundamentally going to help with my stress, whereas then you're talking about these other things like time with my friends and family, actually trying to understand my stress and see if I can have more control over it. You know, exercise, these things can actually reduce my stress genuinely and therefore lead to a sort of long-term improvement in how I feel in my health.

Carmine: Exactly, because these things are doing it without numbing us. So they are strategies that help us to cope with stress while being present to our stress. While, you know, the negative coping strategies, if you like, are the ones that are numbing the stress, but they're not helping us finding a solution or finding a way of dealing with it.

Jonathan: When I'm stressed, I find it really hard to sleep, but then being tired I think makes me feel more stressed and is a sort of vicious cycle. How much should I worry about this, and is there anything I can do?

Carmine: So I think most of the time, a kind of compassionate waiting, accepting this is a difficult time, accepting that there will be some difficult nights for sleeping, and try to minimize things that are disrupting us. You know, again, screen time. Try to go to bed always at the same time, not too late. Reading maybe or whatever we feel that is distracting, reading a book or, you know, whatever helps us kind of relaxing. That's probably the best strategy. Once it becomes a problem that you cannot work or, you know, you cannot kind of... It goes beyond just the discomfort of not sleeping, then that's when you need to ask kind of professional advice or help. And of course, there are more specific psychological interventions you can do. I'm not saying that people should take medication for sleeping problems, and certainly when they do, they usually recommend it only for like a week or so, just to go through the acute phase.

Jonathan: Final question. If someone listening to this podcast right now is feeling really stressed, what's the first thing that you would recommend that they do?

Carmine: Talk about it to a close person, a friend, a relative, partner. Don't keep it inside. Talk about it. Start with that.

Jonathan: Carmine, I really enjoyed that. I would like to do a little summary. I mean, the first thing that springs to my mind, actually, is this thing about alcohol, that it actually increases my cortisol, and so it doesn't actually reduce my stress, it just sort of numbs me to it.

Carmine: Yes.

Jonathan: I think the big thing I took away, though, is, you know, stress is natural. Don't feel guilty about it. Life is difficult, so you're going to have stress in your life, and therefore you're gonna cope better with it just by knowing that. But we also have to recognize that having long-term stress is bad for us, 'cause it increases this cortisol, encourages us to eat high-fat and high-sugar food more than we need. It encourages us to drink alcohol and smoke and all these sorts of things. It is this very deep system within us, and so you describe brilliantly, like, what happens if I saw a tiger in the distance, but it's the same thing maybe if I'm running late for my meeting. The sympathetic nervous system is being turned on, my heart beats fast and my blood pressure goes up. You know, my blood goes to muscles. All of this stuff about being ready to fight or flee, which obviously makes no sense for a meeting, but it's all being switched on. My immune system is being turned on, and this is turning on my inflammation to get ready, 'cause it thinks I'm gonna get injured, and it kicks in this cortisol, which you describe as being, like, this really key drug that's having a big impact on me. And also does some funny things like, you know, switches off the blood flow to my stomach, which helps explain also why so many people feel these gut problems related to their anxiety. This is all completely natural, and we shouldn't feel worried that we get this short, sharp stress from time to time. The problem is that in our modern life, we tend to live with chronic stress. It doesn't get switched off properly, and it just sort of stays turned on. That is a problem- Absolutely- over months and years. And what you describe is it disrupts our sleep. You know, it causes appetite changes and stomach pains. It increases our inflammation, which is a really big problem. That leads to fatigue and low energy. It increases our cortisol, and so that increases how much we eat, so we put on weight. Leads to a risk of diabetes, heart disease, but, you know, ultimately all of this together means we're gonna die younger, so that's a pretty serious physical risk. But interestingly, there's a real mental side to this as well. Not just the fatigue, but you said you can end up feeling more sadness and an inability to feel pleasure. So it's not just a long-term thing, it's really gonna affect how we feel. But the good news is it's not like there's nothing we can do about stress. You said spend time with your friends and family. Understand what the stress is that's causing this deep ongoing thing. And even just thinking about it, you may feel like I have more control, maybe not to remove all of that stress, but to think about what else you're doing in your life. You know, maybe you've got to keep the job, but you can just change a bit the rest of what you're doing- Yeah- to feel like you have more control over it. Exercise is genuinely anti-inflammatory, so try and add exercise into your life. It doesn't have to be like lifting weights or running. Actually, if you can do like a long walk that you feel tired about afterwards, that could really be reducing your cortisol and reducing this stress. Even better, like it's getting you out into nature- Yeah- which you're describing is really beneficial for this. Be aware of dysfunctional behaviors that are numbing this. Yeah. And so you talk quite a bit about the phone, for example. It's not really reducing your stress. It's sort of numbing you from the underlying issue. So it's not triggering these positive sort of biological systems that are sort of reducing the cortisol, you know, like the alcohol. And then maybe the final thing that I took away is try to accept that life can be difficult. Yeah. You know, that maybe the biggest difference between us living in 2026 and our ancestors is our ancestors just assumed that life would be difficult, and therefore, actually, they didn't have chronic stress because they're just like, "Well, this is normal." Whereas we feel everything should be easy and perfect, and therefore constantly stressed because life isn't matching that. But this isn't real, and if we can come to terms with the fact that life can be difficult, weirdly, we might feel more relaxed.

Carmine: Absolutely. It's the principle of acceptance, you know, accepting the difficulties that we will encounter. You know, it's just part of life.