The Stress and Inflammation Link: Why It’s Never “Just Stress”
- Dr. Howard A. Friedman MD, founder of HHOM LLC
- Aug 3
- 5 min read
7-18-2025
By Dr. Howard Friedman MD | Veteran | U.S. Army Medical Corps | Internal Medicine | HHOM LLC
A moment of overwhelm, dismissed as stress—
But under calm lies real distress.
The labs say “fine,” the chart reads “clear,”
Yet pain and fog still persevere.Not weakness,
not a nervous guess—
The fire is real beneath the “yes.”
—Dr. Howard Friedman, MD
The Dismissal That Harms
They used to call it “nerves.” Now they call it “just stress.” Either way, the result is the same: symptoms dismissed, suffering minimized, and healing delayed.
In my work with veterans, I’ve heard the phrase too many times—usually after years of doctor visits, normal test results, and no answers. Headaches? Stress. Gut issues? Probably stress. Fatigue, brain fog, chronic pain? Just stress. For too long, symptoms like headaches, gut issues, fatigue, and chronic pain have been dismissed as 'just stress. But science tells a different story: the link between stress and inflammation is real, measurable, and harmful. Chronic stress isn’t harmless—it’s a biochemical chain reaction that can trigger long-term disease.
But here’s what gets lost in that phrase: stress is not benign. It is not imaginary. And it is not “just” anything.
Stress is a physiological event. It rewires the brain, alters immune function, raises blood pressure, disrupts hormones, and stokes inflammation. It leaves scars—not just on the psyche, but on the body itself. When medicine dismisses it, we don’t save time—we miss an opportunity for real care. "Research on the stress and inflammation link shows how the HPA axis drives hormone surges that disrupt immunity and fuel disease.
The truth is, “just stress” has become a euphemism for “we don’t know what to do with you.” And that’s unacceptable—especially for those who have already given so much in service.
Understanding the HPA Axis: The Body’s Stress Thermostat
We’re still wired like our hunter-gatherer ancestors—primed for danger. That survival system is regulated by the HPA axis (hypothalamus, pituitary gland, and adrenal glands), which governs our hormonal and inflammatory responses.
You’ve likely heard of “fight or flight.” That’s your HPA axis in action, powered by hormones like cortisol and epinephrine (adrenaline).
Cortisol helps regulate metabolism, controls blood sugar, and modulates inflammation. But when chronically elevated, it increases appetite, stores fat, suppresses immunity, and promotes insulin resistance.
Epinephrine triggers increased heart rate, blood pressure, and respiration—preparing the body for immediate action. Prolonged elevation, however, can damage blood vessels, raise cardiovascular risk, and keep the nervous system on high alert.
This system isn’t designed to stay activated indefinitely. But in our modern world—and especially in the military—it often does.
When the Body Bears the Burden
Many conditions are casually labeled “just stress” when in fact they’re driven by inflammation. Take:
IBS (Irritable Bowel Syndrome): A disorder involving gut-brain interaction and immune activation. The gut has its own nervous system, and in some people, chronic inflammation keeps it in overdrive.
Fibromyalgia and Chronic Fatigue Syndrome: Poorly understood, defined more by symptoms than clear etiology. But many of us in medicine now recognize their inflammatory roots.
Migraine: A vascular-inflammatory response triggered by environmental, emotional, or hormonal stimuli. The headache is only the end result of a cascade.
Autoimmune flares: Misguided immune responses that result in widespread inflammation, pain, and organ dysfunction. These are not “mental health” issues—they are immunologic battles.
We are similar biologically, but our immune responses differ. Some people are more reactive. For them, stress becomes inflammation—and inflammation becomes disease.
The Veteran Experience
For veterans, stress isn’t a theory—it’s a lived reality.
Military life starts with a high baseline of stress and discipline. Add exposure to burn pits, Agent Orange, solvents, physical trauma, sleep disruption, and moral injury—and you get a perfect storm of chronic inflammation.
Even worse, veterans are more likely to be dismissed, especially women and people of color, who often face an additional burden of disbelief. For many veterans, chronic stress in service set the stage for illness years later—proof that stress and inflammation are inseparable in real-world health outcomes. Every veteran has been exposed to inflammation. That’s not opinion—it’s reality.
The Inflammatory Truth
Stress is not invisible. It leaves a biochemical trail: cytokine surges, gut dysbiosis, hormone imbalance, poor sleep, and mood shifts.
Chronic stress is chronic inflammation. And chronic inflammation is the seedbed of chronic disease.
How that disease expresses itself—whether as joint pain, bowel issues, migraines, fatigue, or something else—depends on the individual. But make no mistake: it’s real. It’s medical. And it matters.
Why Nexus Letters Matter Here
Military service is paradoxical. You’re asked to endure extreme stress—but told to “suck it up.”
Fortunately, the VA disability system tries to make room for this reality. It asks three key questions:
Are you eligible?
Do you have the condition?
Can it be linked to your time in service?
That third question is where many claims fall apart. Not because the link isn’t real—but because it hasn’t been medically explained.
That’s where a Nexus Letter comes in. It offers expert medical insight into the relationship between military service and current illness—especially when the system says, “We don’t see it.”
Written by a qualified physician who understands both the medicine and the VA’s expectations, a Nexus Letter carries weight. That’s why we built Howard’s House of Medicine.
Toward Better Questions, Better Care
When someone says, “It’s just stress,” it’s usually an invitation to stop looking. But in my experience, that’s exactly where we should begin.
Instead of dismissing stress, we must understand it as inflammation in motion. We must ask why the system is overwhelmed—not simply if it is.
Medicine starts with listening. Really listening. Then making sense of the story, uncovering meaning, and finally advocating.
That is the HHOM LLC way. This is the work I believe in.
Thank you for reading.
—Dr. Howard Friedman,
MD Founder, HHOM LLC –
Howard’s House of Medicine
Frequently Asked Questions:
Q: Why is calling something “just stress” harmful?
A: Labeling symptoms as “just stress” often shuts down investigation instead of opening it. Stress isn’t imaginary—it has measurable effects on the brain, immune system, and hormones. When doctors dismiss it, they miss underlying inflammation that can lead to chronic conditions like migraines, gut disorders, and autoimmune flares. Real medicine listens, investigates, and treats—not dismisses.
Q: How does chronic stress cause inflammation in the body?
A: Stress activates the HPA axis, releasing hormones like cortisol and adrenaline. Over time, this constant activation disrupts normal immune function, raises blood pressure, alters gut health, and increases inflammatory signals throughout the body. These biochemical changes can manifest as pain, fatigue, digestive issues, or long-term disease—even when standard lab results appear “normal.
Q: How can a Nexus Letter help veterans whose conditions are blamed on stress?
A: For many veterans, chronic stress and toxic exposures during service set the stage for lifelong inflammation and illness. A Nexus Letter bridges the gap between lived experience and medical evidence, showing how military stressors likely contributed to current health problems. Written by a physician familiar with VA standards, it can turn a dismissed claim into a recognized, service-connected disability.
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