They claim to show whether you’re wound up, but do stress tests work?

The new stress tests on trial: They claim to show whether you’re truly wound up, but do they really work?

Where do you sit on a scale of zero to tense? Four out of five adults feel stressed during a typical week, and one in ten feels stressed all the time, according to a recent survey.

Meanwhile, more than half a million people suffer from work-related stress, anxiety or depression, the Health and Safety Executive reported last year.

And stress is as bad for our physical health as our mental health — a 2017 review led by Iranian researchers concluded that ‘many disorders originate from stress’, pointing to further links with heart attacks, heart rhythm disorders and high blood pressure, as well as inflammatory bowel disease.

Are you feeling it? More than half a million people suffer from work-related stress, anxiety or depression, the Health and Safety Executive reported last year

Even relatively minor stresses, such as a flat tyre or a disagreement with a colleague, have been linked with a greater risk of chronic illness and impaired mobility in later life, according to a study by the University of California last year. Stress is also known to play a role in weight gain, prompting the body to lay down fat, particularly around the abdominal organs.

Whether we really are all so stressed is up for debate, but whatever the answer, a new crop of DIY ‘stress tests’ have popped up in response to this ‘epidemic’.

These range from blood and saliva tests that measure levels of cortisol — the ‘stress hormone’ which gives us an extra burst of energy and alertness in response to stressors, making the heart beat faster, increasing blood pressure and suppressing non-essential functions, such as digestion or reproduction — to DNA tests that tell you if you are ‘predisposed to stress and anxiety’.

Prices vary from around £39 for a fingerprick kit to test morning cortisol levels ( up to £165 for a full DNA analysis.

But do you really need a test to tell you if you’re stressed?

According to Professor Angela Clow, a psychophysiologist at the University of Westminster, perhaps you do.

‘Sometimes there can be a mismatch between how people perceive their stress levels and their biological response to it,’ she says. ‘Our physiological response to stress is unknowable to us in the same way that you can’t know your blood pressure without taking a reading.’

Did you know? Even relatively minor stresses, such as a flat tyre or a disagreement with a colleague, have been linked with a greater risk of chronic illness and impaired mobility in later life, according to a study by the University of California, last year

To find out how stressed I am, I take a saliva test measuring my cortisol levels (£79, and another that claims to tell me about my genetic response to stress (Health Fit, £165, I’m hoping I will ‘pass’ with flying colours. After a difficult period of trying — and failing — to have a baby, I’ve recently swapped my busy office job (and up to three hours of commuting a day) for a gentler pace of life working from home: I get more sleep, do regular yoga, and take lunchtime walks.

The Thriva test involves taking four saliva samples throughout the day — within an hour of waking up, then at 12pm, 4pm, and just before bed — by chewing on small pieces of sponge (and yes, it is as horrible as it sounds).

These are sent back to the lab, the results interpreted by a doctor and a report is emailed to you containing a graph plotting your cortisol levels throughout the day.

If any results fall outside the normal range you’re advised on how to improve them, such as by eating more regularly — which Thriva says can help keep blood sugar stable, which in turn stops cortisol spikes — or meditating.

I do the test on a fairly uneventful day working from home. I go for a walk at lunchtime and in the evening, my husband and I relax in front of the telly.

‘Fundamentally, cortisol is not bad for you,’ says Professor Clow. ‘It’s an essential hormone with multiple functions including the stress response, but its main one is to regulate its 24-hour biological clock. The level of cortisol signals to cells what time of day it is.’ So levels fluctuate throughout the day, even without any stress.

We get a huge burst of cortisol in the morning to get us going, peaking around 30 minutes after we wake up, and then slowly tapering off until levels reach their lowest point just before bed.

According to Thriva, cortisol in the morning should range between 6 and 21nmol/L, whereas last thing at night it should be between 0.1 and 2nmol/L. Anything above this would be considered too high — but, counterintuitively, low cortisol levels can also suggest chronic stress.

‘If you experience something stressful, the normal response is for cortisol to rise, to prepare for the challenge and then go back down. But if you’re stressed all the time your levels start to remain high. That’s the first stage — people at this point might have trouble sleeping and feel “tired but wired”,’ explains Dr Vishal Shah, a GP and medical director of Thriva. ‘But over time, if stress is relentless, you might actually start to produce less cortisol.’

Approaching burn-out? Four out of five adults feel stressed during a typical week, and one in ten feels stressed all the time, according to a recent survey

That’s not a good thing. It shows that the system that controls the release of cortisol, the hypothalamic pituitary adrenal axis, is not functioning as it should.

‘With chronic stress, you start to get lower levels of cortisol in the morning and higher levels at night, so you end up with a flat cycle,’ explains Professor Clow. ‘This means vital biological processes in our bodies are not getting proper information about day and night, and start failing to function properly.

‘Over time, whatever system of yours happens to be your vulnerable spot, whether your cardiovascular health or immune system, will be exposed.’

And what about the gene test? This looks at, among other things, which versions you have of genes that affect factors involved in our stress response. You swab a sample from inside your cheek, and then post it off for analysis. DNAfit then produces a report for you.

My report suggests I have a ‘low tolerance’ for stress, based on the versions I have of 12 different genes. These include the COMT gene, which controls an enzyme of the same name that helps balance chemical messengers in the brain, such as dopamine and adrenaline, breaking them down if levels go above a certain point. I produce slightly less of this enzyme.

And this suggests I am a ‘strategist’ rather than a ‘warrior’ — a worrier, in other words, according to Craig Pickering, head of sport science at DNAfit. ‘Warrior gene types tend to work best under pressure,’ he explains. ‘Whereas someone with your genetic make-up may do better working at a steadier pace, with longer to prepare.’

This is unfortunate news for a journalist. Tight deadlines come with the territory. But should I be, errr, worried about my worrier tendencies? Dr Giles Yeo, a geneticist from the Medical Research Council’s Metabolic Diseases Unit at the University of Cambridge, is unconvinced. While there are known gene variations that mean a person will have a certain characteristic — such as blue eyes or lactose intolerance — the relationship between other gene variants and certain traits is less clear.

‘Many traits — including our response to stress — are “polygenic”, which means it’s not down to any one gene, but a mix,’ adds Dr Yeo. ‘In short, it’s impossible for a test like this to say for certain.’

What is post-traumatic stress disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events.

People with PTSD often suffer nightmares and flashbacks to the traumatic event and can experience insomnia and an inability to concentrate.    

Symptoms are often severe enough to have a serious impact on the person’s day-to-day life, and can emerge straight after the traumatic event or years later. 

PTSD is thought to affect about one in every three people who have a traumatic experience, and was first documented in the First World War in soldiers with shell shock.

People who are worried they have PTSD should visit their GP, who could recommend a course of psychotherapy or anti-depressants, the NHS say. 

Combat Stress operate a 24-hour helpline for veterans, which can be reached on 0800 138 1619.  

As for the cortisol test, my results came back as mostly normal — albeit with a spike at 4pm to 9.79 nmol/L. Thriva suggests it should be below 5.5.

‘This is not dangerous, but could reflect that you are experiencing stress,’ says the doctor’s report.

Professor Clow isn’t too concerned though. ‘It could have been anything — you could have had a meeting or missed the bus, in which case a little burst of cortisol would be entirely normal.

‘In an ideal world, I’d suggest you need to look at it over a couple of days — research has shown that six days is best. But that might be asking too much of most people.’

At £79 a go, it wouldn’t be a cheap experiment.

As for whether the tests are a good approach: ‘I’m in two minds,’ says Professor Clow. ‘Part of me thinks that people should be able to monitor their cortisol levels and use that information to take ownership of their health.

‘But I worry about the feedback people will get and whether it will frighten them unnecessarily.’

Cortisol monitoring could be helpful in managing type 2 diabetes, she says. ‘Type 2 diabetes is an insensitivity to insulin, which means you can’t take up glucose — the sugar in your blood — properly. But because cortisol facilitates the release of glucose into the bloodstream it can make it worse. It’s a double whammy.’

Thriva’s Dr Shah believes home testing makes people more likely to take action over their health.

‘In my experience, you can talk to patients about the importance of managing stress, but, for them to take that message fully on board, it helps to provide physical evidence,’ he says.

I can see his point. Looking at the results in black and white did make me reflect: lately I’ve been sleeping a little worse, and the hours spent at my desk were slowly creeping up again.

And while I can’t see any editor going for the ‘I need a longer deadline, it’s in my genes’ excuse, I’m reconsidering an as-yet-untouched ‘mindfulness and relaxation’ colouring book I was given for Christmas. Perhaps my family were trying to tell me something long before the tests did . . .


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