Your Body, DecodedVol. 19
Is It Stress, or Is It Something Else?
An Thanh Tùng
BooksVol. 19Coming soon
Is It Stress, or Is It Something Else?
How to Tell Everyday Stress From Thyroid, Anemia, Sleep, Hormone and Mood Problems That Look Like It
by An Thanh Tùng
About this book
“Stress” should be a conclusion you reach after asking: could it be something else?Chapter 1
A plain-language, evidence-labeled guide for adults who keep hearing "it's probably just stress". Racing heart, tiredness that won't lift, poor sleep, brain fog, anxiety, midlife changes: the same symptoms can come from stress, an overactive or underactive thyroid, iron deficiency, sleep apnea, perimenopause, low testosterone, depression or what is in your cup and medicine cabinet, and very often from stress and something else together. Three lanes help you decide what to do next: see a doctor soon, check it out with a plan, or try something and set a date to review, with warning signs, worksheets, the questions to ask and the tests you don't need.
What you'll learn
- Ch. 2A slope, not a coastlineStress symptoms rise and fall with your circumstances. When they only climb, ask more questions.
- Ch. 3A heartbeat like a switchA racing heart that starts and stops suddenly is the moment to look further. Stress may be the trigger, but not the gun.
- Ch. 4Not anaemic doesn't mean not lowDon't dismiss iron deficiency just because your blood count is still normal.
- Ch. 5Ask the person beside you“Do I ever stop breathing?” Their answer may be worth more than any sleep-tracking app.
- Ch. 9Low testosterone comes lastOnly after asking about sleep, weight, alcohol and mood, and after two morning tests.
- Ch. 11Look at your cup and your cabinetCoffee, alcohol and everyday medicines cause many “stress” symptoms. Ask before stopping anything prescribed.
How the book is organized
- Part IWhy “Probably Stress” Is a Risky Answer
- Part IIThe Look-Alikes
- Part IIIAfter You've Checked
Look inside
Pages from the book
From the review draft.
- How to read this book
- Chapter 1 opens
- Every claim carries a label
- Try it at home
- If you remember one thing
- A printable worksheet
- Notes and sources
Free with your email
Worksheets from this book
From the review draft. Final versions are posted on publication day.
- Safety card When to Call Emergency Services Get the PDF
- Safety card Where to Find Help Get the PDF
- Reference table If You Notice… Read… Get the PDF
- Safety card Safety Flags at a Glance Get the PDF
- Worksheet The Three-Lane Worksheet Get the PDF
- Worksheet The 14-Day Diary Get the PDF
- Worksheet Worksheet 5a. Ask the Person Beside You Get the PDF
- Worksheet Worksheet 5b. My Daytime Get the PDF
- Worksheet Resting Pulse and Episode Log Get the PDF
- Worksheet GAD-7 Score Sheet Get the PDF
- Worksheet Cup and Cabinet Inventory Get the PDF
- Worksheet Three-Month Cycle Calendar Get the PDF
- Worksheet Appointment Sheet Get the PDF
- Worksheet The Four-Week Plan Get the PDF
- Reference table Look-Alike Dictionary Get the PDF
58 references
Notes and sources
Ch. 1One Sentence, Four Endings3
- What happens to people who see a doctor about tiredness Nijrolder I, van der Windt D, de Vries H, van der Horst H. Diagnoses during follow-up of patients presenting with fatigue in primary care. CMAJ 2009;181(10):683–687. doi:10.1503/cmaj.090647. PMID 19858240.
- Iron and fatigue without anaemia Houston BL, Hurrie D, Graham J, et al. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials. BMJ Open 2018;8(4):e019240. doi:10.1136/bmjopen-2017-019240. PMID 29626044.
- Sleep apnoea in women Bouloukaki I, Tsiligianni I, Schiza S. Evaluation of obstructive sleep apnea in female patients in primary care: time for improvement? Med Princ Pract 2021;30(6):508–514. doi:10.1159/000518932. PMID 34438402.
Ch. 2What Stress Really Does (and Doesn't)2
- "Adrenal fatigue" Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord 2016;16(1):48. doi:10.1186/s12902-016-0128-4. PMID 27557747.
- Burn-out in ICD-11 World Health Organization. Burn-out an "occupational phenomenon": International Classification of Diseases. News release, May 28, 2019.
Ch. 3Racing Heart, Shaky Hands, Sweats3
- Overactive thyroid Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016;26(10):1343–1421. doi:10.1089/thy.2016.0229. PMID 27521067.
- Rhythm disorders mistaken for panic Lessmeier TJ, Gamperling D, Johnson-Liddon V, et al. Unrecognized paroxysmal supraventricular tachycardia: potential for misdiagnosis as panic disorder. Arch Intern Med 1997;157(5):537–543. PMID 9066458.
- Caffeine EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific opinion on the safety of caffeine. EFSA J 2015;13(5):4102.
Ch. 4Tired All the Time4
- Iron and fatigue without anaemia Houston et al. 2018. See Chapter 1.
- Underactive thyroid Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet 2017;390(10101):1550–1562. doi:10.1016/S0140-6736(17)30703-130703-1). PMID 28336049.
- Iron-deficiency anaemia Camaschella C. Iron-deficiency anemia. N Engl J Med 2015;372(19):1832–1843. doi:10.1056/NEJMra1401038. PMID 25946282.
- Ferritin cut-offs Ko CW, Siddique SM, Patel A, et al. AGA clinical practice guidelines on the gastrointestinal evaluation of iron deficiency anemia. Gastroenterology 2020;159(3):1085–1094. doi:10.1053/j.gastro.2020.06.046. PMID 32810434.
Ch. 5Poor Sleep: Stress or Breathing?5
- Treatment of sleep apnoea Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2019;15(2):301–334. doi:10.5664/jcsm.7638. PMID 30736888.
- Sleep apnoea: features and risk factors Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet 2014;383(9918):736–747. doi:10.1016/S0140-6736(13)60734-560734-5). PMID 23910433.
- Screening people without symptoms US Preventive Services Task Force. Screening for obstructive sleep apnea in adults: US Preventive Services Task Force recommendation statement. JAMA 2022;328(19):1945–1950. doi:10.1001/jama.2022.20304. PMID 36378202.
- Sleep apnoea in women Bouloukaki et al. 2021. See Chapter 1.
- Restless legs and iron Winkelman JW, Berkowski JA, DelRosso LM, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2025;21(1):137–152. doi:10.5664/jcsm.11390. PMID 39324694.
Ch. 6Anxious, Keyed Up, Panicky5
- Treating anxiety disorders Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci 2017;19(2):93–107. doi:10.31887/DCNS.2017.19.2/bbandelow. PMID 28867934.
- CBT compared with placebo Carpenter JK, Andrews LA, Witcraft SM, et al. Cognitive behavioral therapy for anxiety and related disorders: a meta-analysis of randomized placebo-controlled trials. Depress Anxiety 2018;35(6):502–514. doi:10.1002/da.22728. PMID 29451967.
- Screening for anxiety US Preventive Services Task Force. Screening for anxiety disorders in adults: US Preventive Services Task Force recommendation statement. JAMA 2023;329(24):2163–2170. doi:10.1001/jama.2023.9301. PMID 37338866.
- The GAD-7 Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166(10):1092–1097. doi:10.1001/archinte.166.10.1092. PMID 16717171.
- Rhythm disorders mistaken for panic Lessmeier et al. 1997. See Chapter 3.
Ch. 7Brain Fog and Forgetting3
- Vitamin B12 deficiency Stabler SP. Vitamin B12 deficiency. N Engl J Med 2013;368(2):149–160. doi:10.1056/NEJMcp1113996. PMID 23301732.
- Sleep apnoea and cognition US Preventive Services Task Force 2022. See Chapter 5.
- Medicines in older adults American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2023;71(7):2052–2081. doi:10.1111/jgs.18372. PMID 37139824.
Ch. 8Midlife: Stress, or Perimenopause?3
- Diagnosing perimenopause National Institute for Health and Care Excellence. Menopause. Quality standard QS143, quality statement 1; based on NICE guideline NG23, Menopause: identification and management.
- Stages of reproductive ageing Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause 2012;19(4):387–395. doi:10.1097/gme.0b013e31824d8f40. PMID 22343510.
- Heavy periods and iron Camaschella 2015. See Chapter 4.
Ch. 9Men at Midlife: Stress, Low Testosterone, or Something Else?4
- Diagnosing and treating testosterone deficiency Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2018;103(5):1715–1744. doi:10.1210/jc.2018-00229. PMID 29562364.
- Weight loss and testosterone Corona G, Rastrelli G, Monami M, et al. Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. Eur J Endocrinol 2013;168(6):829–843. doi:10.1530/EJE-12-0955. PMID 23482592.
- Testosterone and the heart: the TRAVERSE trial Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone-replacement therapy. N Engl J Med 2023;389(2):107–117. doi:10.1056/NEJMoa2215025. PMID 37326322.
- Depression in men Martin LA, Neighbors HW, Griffith DM. The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication. JAMA Psychiatry 2013;70(10):1100–1106. doi:10.1001/jamapsychiatry.2013.1985. PMID 23986338.
Ch. 10Warning Signs: Symptoms Never to Blame on Stress Before They're Checked5
- Chest pain National Institute for Health and Care Excellence. Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis. Clinical guideline CG95; 2010, updated 2016.
- Stroke National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline NG128; 2019, updated 2022.
- Fainting National Institute for Health and Care Excellence. Transient loss of consciousness ('blackouts') in over 16s. Clinical guideline CG109; 2010, updated 2023.
- Weight loss, bleeding, difficulty swallowing, persistent fatigue National Institute for Health and Care Excellence. Suspected cancer: recognition and referral. NICE guideline NG12; 2015, updated 2026.
- Weight loss as a warning sign Nicholson BD, Hamilton W, O'Sullivan J, et al. Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis. Br J Gen Pract 2018;68(670):e311–e322. doi:10.3399/bjgp18X695801. PMID 29632004.
Ch. 11The Look-Alikes in Your Cup and Cabinet4
- Caffeine EFSA 2015. See Chapter 3.
- Alcohol and sleep Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res 2013;37(4):539–549. doi:10.1111/acer.12006. PMID 23347102.
- Restless legs and what makes them worse Winkelman et al. 2025. See Chapter 5.
- Hormones in "adrenal support" supplements Akturk HK, Chindris AM, Hines JM, et al. Over-the-counter "adrenal support" supplements contain thyroid and steroid-based adrenal hormones. Mayo Clin Proc 2018;93(3):284–290. doi:10.1016/j.mayocp.2017.10.019. PMID 29502560.
Ch. 12A Letter to Someone With Normal Results4
- Tiredness without a diagnosis Nijrolder et al. 2009. See Chapter 1.
- ME/CFS National Institute for Health and Care Excellence. Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management. NICE guideline NG206; 2021.
- Physical activity and mood Singh B, Olds T, Curtis R, et al. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br J Sports Med 2023;57(18):1203–1209. doi:10.1136/bjsports-2022-106195. PMID 36796860.
- Psychological therapy for unexplained physical symptoms van Dessel N, den Boeft M, van der Wouden JC, et al. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev 2014;(11):CD011142. doi:10.1002/14651858.CD011142.pub2. PMID 25362239.
Ch. 13How to Be Heard, and Tests You Don't Need4
- Safety netting NICE guideline NG12, recommendation 1.15.2. See Chapter 10.
- Saliva cortisol and "adrenal fatigue" Cadegiani and Kater 2016. See Chapter 2.
- Hormone tests for perimenopause NICE quality standard QS143. See Chapter 8.
- Screening for sleep apnoea US Preventive Services Task Force 2022. See Chapter 5.
Ch. 14Your Three-Lane Plan1
- Safety netting NICE guideline NG12, recommendation 1.15.2. See Chapter 10.
BackWorksheets at the back of the book8
- When to call emergency services See Chapter 10 (NICE CG95, NG128, CG109, NG12).
- Where to find help 988 Suicide and Crisis Lifeline (US, Canada); Samaritans (UK, Ireland); Lifeline (Australia); 1737 (New Zealand); findahelpline.com.
- Three-lane worksheet, 14-day diary, appointment sheet, four-week plan This book's own tools, built from Chapters 1, 4, 13 and 14 (NICE NG12 on safety netting).
- Worksheets 5a and 5b Written for this book; they are not the Epworth Sleepiness Scale or the STOP-Bang questionnaire and give no score. See Chapter 5 (Jordan et al. 2014).
- Resting pulse and episode log See Chapter 3 (Lessmeier et al. 1997).
- GAD-7 score sheet Spitzer et al. 2006. See Chapter 6.
- Cup and cabinet inventory See Chapter 11.
- Three-month cycle calendar See Chapter 8.
Updates and corrections
Evidence last reviewed October 29, 2026
Each evidence label shows how solid the evidence was on the day it was last reviewed. Corrections are posted here with the date they were made, and included in the next printing.
No corrections have been posted for this edition. Spotted an error, or a study that should change a label? Email hello@yourbodydecoded.org
Most likely to change
- Guidelines on diagnosing and treating testosterone deficiency, and long-term trial results (Chapter 9)
- Ferritin cut-offs for diagnosing iron deficiency (Chapter 4)
- Screening recommendations for anxiety and sleep apnoea (Chapters 5, 6)
- Guidance on ME/CFS and long-lasting symptoms after viral infections (Chapter 12)
- Age thresholds and referral criteria in guidance on suspected cancer (Chapter 10)
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