Fueling Resilience

The link between stress, cortisol, and nutrition for caregiver well-being

Seven years into caregiving I took a class for caregivers called Mind, Body and Health. I had reached a point where I needed ideas, stress management tools, you name it to be able to continue caring for my husband and our three children at the pace I’d been going. The eight-week class focused on stress, emotions, their effects on health, and self care. It was led by a licensed social worker and was offered through our local healthcare system. Signing up for the class made me anxious because I was deep into caregiving where planning rarely held.

During our first meeting we were asked to introduce ourselves and share our story. We were a group of ten women. I was the youngest by two decades. As each woman shared her story, more hopelessness crept in. It wasn’t their stories that saddened me, but the despair in their voices as they described being the target of their ill spouse’s frustrations, doctors who ignored their observations, and feeling alone.

The deep lines on their faces validated their experiences as they described the emotional toll of the the endless cycle of tasks, decisions, and responsibilities that left each of them feeling invisible and unseen. It was clear they had entered into the black hole of caregiving where they were convinced their needs no longer mattered.

By the seventh introduction, I vowed never to let myself reach their depth of despair. I promised myself that no matter how intense caregiving could get, I would hold onto the hope that I could still find moments of balance amidst the demands. But something happens during long-term, intense caregiving - a shift that anyone can be vulnerable to when the needs of the person you’re caring for constantly feel more urgent than your own. That “something” is a gradual erasure of self. For me, I started ignoring my own pain and exhaustion, lost touch with personal goals, and gradually became isolated from my friends and social circle. Psychologists call this “caregiver burnout.” It’s when caregivers become so consumed with caring for someone else that they disregard their own needs.

I’ve always felt discomfort with the term “caregiver burnout.” I think it minimizes the complexity of the caregiver experience. After years of caring for my family, I found it hard to admit to caregiver burnout. The term felt loaded with stigma, suggesting I wasn’t strong enough, which only deepened the guilt I already carried from being exhausted and drained.

The Cost of Ignoring Caregiver Burnout

Since that meeting a decade ago we’ve learned more about the impact of stress on our health. Relentless, long-term stress can significantly increase health risks, especially for the cardiovascular and immune systems. It starts with the hormone cortisol, which is best known for its role in our “fight-or-flight" response.

Under stressful conditions, such as needing to finish a project, a complex hormone cascade occurs with the adrenal glands secreting cortisol. This hormone then prepares the body for the fight-or-flight response by flooding it with glucose to supply it with an immediate energy source for our large muscles. Simultaneously, cortisol will slow or even stop insulin from being released making glucose even more available for immediate use for energy to fight or run away (flight). Cortisol will also temporarily narrow our arteries while the body’s recently released epinephrine increases our heart rate. Together cortisol and epinephrine then force our heart to pump blood harder and faster getting glucose quickly to those large muscles helping to improve our physical performance so we can fight or run.

Once we address the stressor (i.e., complete the project) and the situation resolves, the normal response is for the hormone levels of cortisol, insulin, and epinephrine to return to normal, our blood sugar level stabilizes, and the arteries relax decreasing the demand on our heart. But for many caregivers, the typical cortisol response can become a persistent cycle, rather than a temporary reaction.

Managing Stress and Cortisol Levels

While a caregiver may momentarily resolve a stressful situation, such as managing a medical emergency, the stress doesn't always end there. New challenges often develop before the body fully recovers from the previous stressor, preventing the natural return to baseline hormone levels. And therein lies the complexity of caregiving's impact on the caregiver's health. The body never truly resets leading to continually high cortisol levels, which can suppress immune function, increase blood glucose levels and inflammation, disrupt sleep, and contribute to caregiver burnout.

Lifestyle strategies that may help prevent chronically high cortisol levels are centered on prioritizing self-care, practicing relaxation techniques, setting boundaries, getting regular physical activity, and eating a balanced diet. However, this can be a significant challenge for many caregivers.

Prioritizing Self-Care

Much has been written about the importance of self-care for caregivers. I'll be honest, when I was deeply immersed in caring for my husband while raising our children, it used to really bother me when articles simply suggested that self-care was the answer to managing caregiver stress. It felt like one more thing to add to my list.

I used to look at self-care as indulgent. I felt guilty taking time for myself which is a common sentiment I’ve heard from many caregivers. I wish I had recognized early on that self-care isn’t a personal indulgence, but an essential practice for sustaining the energy and well-being required to care for others.

Self-care can take on many different forms. Take some time to identify what you need and what you can do for yourself. Maybe it’s asking for more help with daily chores so you can carve out time to walk a few days a week. Maybe it’s saying “No” to avoid taking on too many responsibilities and protect your energy - energy that could be used for your once favorite hobbies like reading, painting, or gardening. Or, as a gift to yourself, maybe it’s making small changes to your diet to help manage your body’s response to stress.

Foods that Increase Stress

Refined carbohydrates and refined sugar

Snacks and drinks high in refined carbohydrates and added sugars can have a significant impact on cortisol levels. When we consume foods high in refined sugars or simple carbohydrates (i.e., white bread, candies, or sugar sweetened beverages), they cause a rapid spike in blood sugar. The body then responds by releasing insulin to lower the blood sugar level, but this can eventually lead to low levels of blood sugar which can then trigger the body to release other hormones including cortisol to bring the blood sugar level back up. And off we go with more cortisol circulating.

Caffeine

While a morning cup of coffee or tea can give a temporary energy boost, too much caffeine can stimulate the adrenal glands to release more cortisol. Excessive caffeine consumption can lead to feelings of anxiety, jitteriness, and even disrupt sleep patterns, further exacerbating stress. It’s a good idea to avoid multiple cups of coffee, energy drinks, or sugar-containing caffeinated beverages especially later in the day. Try to limit caffeine to 300 mg a day.

Nutrients and Foods that Help Reduce the Body’s Stress Response

Nutrients to focus on to help balance cortisol include:

1. Magnesium can improve vascular tone, offsetting some of the long-term effects of cortisol on the vascular system. Foods containing magnesium include spinach, almonds, cashews, and bananas.

2. Vitamin C can help strengthen our immune system. When we are under chronic stress and cortisol levels are running high it can deplete vitamin C in our body. Foods rich in vitamin C include citrus fruits, bell peppers, and strawberries.

3. Omega-3 fats can also be depleted when cortisol levels are elevated from stress. Adding to the negative situation, a lower level of Omega-3 in the body can make us more susceptible to the effects of stress. Omega-3 fatty acids are found in fatty fish such as salmon and sardines as well as walnuts, chia seeds, and flax meal.

4. The many B vitamins can also help the body manage stress. Vitamin B1 (thiamin), for example, helps regulate blood sugar levels. Vitamin B2 (riboflavin) helps regulate carbohydrate metabolism. Vitamin B3 (niacin) supports serotonin levels. Vitamin B5 (pantothenic acid) helps regulate the adrenal gland. Foods sources rich in B vitamins include most plant foods such as whole grains, legumes, fruits and vegetables as well as animal products include dairy, eggs, chicken, fish, pork, and beef.

5. L-theanine is an amino acid that has been shown to ease anxiety, stress and insomnia. It can be found in green tea, black tea and some mushrooms.

Bottom line

Prolonged caregiving without adequate support can result in caregiver burnout and negatively impact both short-term and long-term health. Understanding the body’s response to stress and incorporating small dietary changes, such as limiting refined carbohydrates and caffeine, while adding nutrient-rich foods high in magnesium, vitamin C, omega-3 fatty acids, B vitamins, and L-theanine can help regulate cortisol levels and reduce stress.

Resources to Help Caregivers Experiencing Burnout

Following are resources (with links to the website) that may be helpful for caregivers who are exhausted and burning the candle at both ends.

Caregiver Action Network (CAN)
CAN provides a wide variety of tools, including forums where caregivers can connect with each other, share stories, and find emotional support.

ARCH National Respite Network and Resource Center
This organization helps caregivers find respite care providers and programs nationwide. Respite care can provide a much needed break and help reduce burnout.

The Mighty Caregivers Community
This online community offers a space for caregivers to share their stories and challenges with others facing similar situations. The Mighty also has specialized groups for caregiving in specific conditions like chronic illness or mental health.