Stress is an unavoidable part of life, and while it often carries a negative connotation, it is actually a fundamental survival mechanism. When faced with a perceived threat, whether physical or emotional, the body instinctively reacts to protect itself. This automatic response is commonly known as the "fight, flight, or freeze" response. While it serves an essential function in dangerous situations, chronic activation of this response due to daily stressors can have significant consequences for mental and physical health.

The body’s response to stress is rooted in human evolution. When our ancestors encountered a predator, their nervous systems immediately prepared them to either confront the threat (fight), escape to safety (flight), or become still and unnoticed (freeze). While modern-day stressors may not include wild animals, our nervous system reacts similarly to job pressures, financial worries, or social conflicts.

According to the Cleveland Clinic, stress is the body's response to change, activating a physiological reaction that helps us adapt and protect ourselves. While short-term stress can be beneficial, prolonged exposure can lead to an overactive stress response, negatively impacting overall well-being.

The Three Stress Responses: Fight, Flight, and Freeze

1. Fight

The fight response prepares the body for direct action. When triggered, the nervous system releases adrenaline, increasing heart rate, blood pressure, and muscle tension. While this reaction once helped early humans fend off predators, today it manifests as irritability, frustration, or aggression.

For instance, the employee who has experienced too much workload may work extremely long hours just to succeed. In short term, the action may produce good results but mostly ends in burnout, anxiety, and physical illness, for example, tension headache or digestion problems.

2. Fight

The flight response triggers an intense need to remove oneself from a stressful situation. Just as our ancestors would flee from danger, modern individuals may avoid conflict, quit jobs impulsively, or detach from relationships when overwhelmed.

Flight mode is linked with restlessness and anxiety. Individuals may have a sense of needing to get up and go-pacing, changing environments constantly, or avoiding tasks that seem too overwhelming. Someone with a flight response might have the desire to change jobs constantly, relocate constantly, or become reclusive in order to avoid perceived dangers.

3. Freeze

The freeze response occurs when the nervous system perceives a threat as too overwhelming to fight or flee. Rather than taking action, individuals shut down, feeling numb, disconnected, or paralyzed by fear.

Unlike fight or flight, which involve heightened activation, freeze mode slows down physiological functions. A person experiencing freeze mode may feel physically unable to move, struggle to make decisions, or find themselves dissociating from their emotions. This can manifest in situations such as public speaking anxiety, where someone might "blank out" or feel stuck in the moment.

What Happens in the Body During A Stressful Event?

When faced with a stressor, the autonomic nervous system (ANS) activates, triggering physiological changes, including:

• Increased heart rate and breathing: The body pumps more oxygen to muscles and the brain in case action is needed.
• Muscle tension: The body prepares for movement, sometimes causing trembling or stiffness.
• Dilated pupils: Vision sharpens to detect potential threats.
• Dry mouth: Saliva production decreases as the body redirects energy to essential functions.
• Changes in skin tone: Blood flow is directed to vital organs, sometimes making the skin appear pale or flushed.

For those experiencing the freeze response, the body undergoes a different reaction, often reducing heart rate and causing physical immobility rather than heightened activation.

Strategies for Coping and Managing the Stress Response

While the stress response is necessary for survival, frequent activation due to daily stressors can take a toll on health. Recognizing your default response—whether fight, flight, or freeze—can help in developing effective coping mechanisms.

1. Moving to a Safe Space

If possible, changing your environment can help signal to your brain that the threat has passed. Stepping outside for fresh air, finding a quiet place, or distancing yourself from overwhelming stimuli can help regulate emotions.

2. Practicing Controlled Breathing

Deep, slow breathing can be used to counteract the stress response by engaging the parasympathetic nervous system, which promotes relaxation. Techniques such as diaphragmatic breathing or the 4-7-8 method (inhale for four seconds, hold for seven, exhale for eight) can be particularly effective in calming the body.

3. Engaging in Physical Activity

This helps release pent-up energy and aids in the endorphin cascade, natural boosters for our mood.

4. Seeking Social Support

Relieving oneself from stress can come in many ways, but sharing it with trusted friends, a family member, or a good therapist will sure give that psychological boost of hope. Social support is an especially effective way of cushioning people against the stressors that they are subjected to in chronic forms.

When to Seek Professional Help

While occasional stress is normal, chronic activation of the fight, flight, or freeze response can indicate underlying mental health concerns, such as anxiety disorders or post-traumatic stress disorder (PTSD). If stress is affecting daily life—leading to sleep disturbances, difficulty concentrating, or persistent feelings of fear—it may be time to consult a mental health professional.

A cigarette after stress. Chewing tobacco during the day. Smoking to “calm the nerves”

But modern science is forcing us to confront the difficult truth; Tobacco does not treat mental health symptoms, in fact it quietly deepens it.

As Oncologists and physicians, we often see patients who say, “smoking makes them feel normal.” However, in reality, what they are experiencing is nothing more than the temporary relief from nicotine withdrawal not genuine emotional regulation.

Nicotine Creates A Cycle of Temporary Relief And Dependence

When we smoke or chew tobacco, nicotine stimulates dopamine release in the brain, creating a short-lived sense of relaxation or control. But overtime it leads to brain depending on nicotine to achieve the same baseline feeling again and again. The result is a vicious cycle of dependence, irritability, anxiety, and worsening emotional resilience.

Several large studies now show that long-term tobacco use is associated with higher rates of anxiety, depression, sleep issues and substance dependence. A 2023 review published in BMJ found that smoking cessation will result in improvements in both anxiety and depression and an improved mood with benefits comparable to antidepressant treatment in some individuals.

Also read: Lung Health After 40: Natural Changes, Warning Signs And Ways To Protect Your Lungs

Tobacco May Worsen Anxiety, Depression And Sleep Problems

This has serious implications for the urban Indian population in regard to the increasing prevalence of mental exhaustion, lack of social support, digital overload, work-related stress and lack of sleep. Tobacco often enters quietly during vulnerable moments of college pressure, workplace stress, loneliness, grief and gradually shifts from “social habit” to psychological crutch.

Although they think they believe in tobacco, many of them use it, thinking that they are using it to cope with their emotional symptoms, when in fact they are making the symptoms worse.

Also, recognize the biology of tobacco use. For example, the use of nicotine will result in long-term changes in how well your body handles emotional stress because of the role of long-term nicotine exposure in altering the system of cortisol regulation and the stress response pathways in neurons. So, with time, it will become harder and harder for a person to control his/her emotional response to stress because his/her body will not be able to do it. Thus, tobacco has a negative influence on the recovery process from emotional responses to stress, rather than a beneficial one.

Also read: Air Pollution May Increase The Risk Of Painful Rheumatoid Arthritis Flares, Study Finds

How Nicotine Alters The Body’s Stress Response?

Tobacco is a significant preventable risk factor for oral, head and neck, lung, oesophageal, pancreatic and bladder cancers. When many patients arrive at cancer centres, the addiction to tobacco is already set, and it is even more difficult to quit while receiving cancer treatment.

This is why it is important to help move the conversation on tobacco beyond cancer. Now, it's more than just a public health issue; it also includes issues of mental health. Individuals experiencing emotional difficulties should not think that they are being judged. They have to learn to find alternative coping strategies, get psychological support early on in their lives, sleep well, exercise, be part of the community, and access timely medical support. The goal of this care is not just to support someone in quitting tobacco, but to provide support for them to stop needing tobacco in order to feel good.

By Dr Amit Chakraborty, Consultant Oncologist, Saifee Hospital, Mumbai

India is facing a growing burden of non-communicable diseases (NCDs), with hypertension and diabetes among the major health concerns.

Experts warned that the risk of both conditions rises after 40, often without noticeable symptoms. Increasing age, weight gain, reduced physical activity, stress, dietary habits, and metabolic changes can all contribute to the risk.

Having hypertension and diabetes together is particularly concerning, as their coexistence can increase the risk of heart disease, stroke, kidney damage, retinopathy, and other complications.

Why Risk Rises After 40?

Dr. Santosh Gupta, Associate Director - CTVS, Paras Health Udaipur, told HealthandMe that several factors contribute to the rising risk after 40.

“After the age of 40, the risk of hypertension and diabetes increases due to factors such as changes in metabolism, reduced physical activity, weight gain, stress and dietary habits. What makes both conditions particularly concerning is that they can develop silently, without noticeable symptoms, while gradually affecting vital organs,” he said.

He added that uncontrolled hypertension can damage the heart, brain, kidneys, and blood vessels, while diabetes can affect the kidneys, eyes, nerves, and cardiovascular system.

"When both conditions occur together, the risk of heart disease, stroke and kidney complications becomes even higher,” Dr. Gupta added.

Because both conditions can remain silent for years, people may have high blood pressure or blood sugar without knowing it.

Also read: Breastfeeding Can Help Reduce Mothers' Risk of Type 2 Diabetes, Breast Cancer and More

Hypertension And Diabetes Often Coexist

A recent hospital-based analysis found that hypertension and diabetes frequently occur together, with their coexistence rising sharply from around age 40 among Indians.

The study, conducted by the Department of Clinical Research and Preventive Health Program at Max Healthcare, analyzed health records of more than 56,000 adults who underwent preventive health check-ups between January 2021 and December 2024.

Nearly 5% of adults had both conditions. Their coexistence increased rapidly from around 40, continued rising until approximately 58 and gradually reached nearly 17% by around age 70.

People with diabetes were nearly four times more likely to have hypertension, while those with hypertension were about 2.5 times more likely to have diabetes.

Dr. Abhaya Indrayan, Biostatistics Consultant, Max Healthcare, said the findings support screening for both conditions rather than assessing them separately.

Why Screening After 40 Matters

Read More: Confused By Your Cholesterol Report? Here's What LDL And ApoB Really Mean

Experts said that preventive healthcare should go beyond checking for individual diseases. Adults over 40 should routinely assess key cardiometabolic risk factors, including blood pressure and blood sugar.

Screening can help detect hypertension, diabetes or prediabetes early, when lifestyle changes and treatment can help prevent or delay complications.

“This is why regular screening after 40 is important, even for individuals who feel completely healthy. A routine blood pressure check, fasting blood glucose or HbA1c test can help identify hypertension, diabetes or prediabetes at an early stage, when timely lifestyle changes and medical intervention can prevent or delay complications,” Dr. Gupta said.

“Screening should not be viewed only as a diagnostic exercise; it is an opportunity to understand one’s health risks and take corrective measures before the disease begins to cause irreversible organ damage,” he added.

How To Lower The Risk

Preventive care also involves addressing modifiable risk factors. Regular physical activity, maintaining a healthy weight, limiting salt, sugar and highly processed foods, getting adequate sleep and avoiding tobacco can help lower the long-term risk.

For those already diagnosed with hypertension or diabetes, regular monitoring and adherence to prescribed treatment are important to reduce the risk of complications.

With the risk of both conditions rising after 40, experts recommend making routine health checks part of regular healthcare—even when there are no obvious symptoms.

Amid the ongoing monsoon season, Delhi-NCR is seeing a rise in H1N1 influenza cases, with Delhi reporting 1,344 cases so far this season.

The figure is nearly six times higher than the 229 H1N1 cases recorded during the same period last year, The Times of India reported.

According to health officials, Delhi recorded around 4,000 influenza cases last year, most of them caused by H3N2. This year, H1N1 is the dominant strain. Both H1N1 and H3N2 are subtypes of Influenza A and spread mainly through respiratory droplets.

What Is H1N1 and Why Is Testing Important?

H1N1 is a subtype of Influenza A and can cause sudden fever, cough, sore throat, headache, body aches and fatigue. These symptoms can overlap with those of other seasonal influenza strains, COVID-19 and respiratory syncytial virus (RSV), making it difficult to identify the infection based on symptoms alone.

Dr Aijaz Ilmi, Senior Consultant – Metabolic Diseases, Pacific OneHealth Hospital, told HealthandMe that testing is particularly important when fever or respiratory symptoms persist or worsen, especially among older adults, young children, pregnant women and people with diabetes, obesity, heart or lung disease, or compromised immunity.

“With the current rise in H1N1 cases in Delhi, we are also seeing other seasonal respiratory infections, including Influenza A and B, COVID-19, RSV and other respiratory viruses. At the same time, the monsoon season brings an increased risk of mosquito-borne illnesses such as dengue.

“The key message is, don’t panic, but don’t dismiss a persistent fever as ‘just a viral’. Early recognition is particularly important in vulnerable individuals.”

H1N1 vs Other Respiratory Infections: How Are They Different?

H1N1 can be difficult to distinguish from other respiratory infections because many of them cause similar symptoms.

• H1N1 and other seasonal influenza strains: Both can cause sudden fever, cough, sore throat, headache, body aches and fatigue. Symptoms alone generally cannot determine whether the infection is H1N1 or another influenza strain.

• COVID-19: COVID-19 can cause fever, cough, sore throat, congestion and fatigue. Some people may also experience changes in or loss of taste or smell, while gastrointestinal symptoms can occur.
• RSV: RSV commonly causes a runny nose, cough and wheezing. It can be more severe in infants, older adults and people with certain underlying conditions. In young children, it can cause bronchiolitis and breathing difficulties.
• Dengue: During the monsoon, dengue can also cause fever, headache, body aches and fatigue, which may initially resemble a viral respiratory infection. However, dengue is spread by mosquitoes rather than respiratory droplets and does not typically cause cough or sore throat.

How Can H1N1 and Other Infections Be Prevented?

Dr Sharwari Sudhir Dabhade, Consultant - Internal Medicine, Diabetology & Endocrinology, Madhukar Rainbow Children's Hospital, told HealthandMe that prevention should focus on reducing exposure and maintaining good hygiene. Other measures to reduce transmission include:

• Washing hands frequently.
• Covering mouth and nose while coughing or sneezing.
• Maintaining good indoor ventilation.
• Avoiding crowded or poorly ventilated places when respiratory infections are circulating.
• If you have respiratory symptoms, limit close contact with others and wear a mask.
• Getting vaccinated against influenza, particularly if you are an older adult, young child or have an underlying health condition.
• Prevent mosquito breeding and take precautions to avoid mosquito bites to reduce risk of dengue.

When Should You Seek Medical Help?

Most viral respiratory infections recover with supportive care. However, should seek prompt immediate medical assessment in cases of

• breathlessness
• persistent high fever,
• chest pain,
• confusion,
• dehydration,
• falling oxygen saturation
• significant worsening of weakness.