Allostatic Load: The Hidden Cost of Adaptation

The idea in one sentence

Allostatic load concerns the physiological costs that may accompany repeated or prolonged adaptation. In 1993, McEwen and Stellar introduced the concept into the discussion of stress and disease.^[1]

It reminds us to consider both the body's response now and how it has been coping over time.

Short-term adaptation helps meet challenges. Repeated adaptation over time may carry cumulative costs.

Why can adaptation have a cost?

Allostasis emphasises “stability through change”. The body adjusts activity across its systems to meet demands. A response that is useful in a short-term situation is not necessarily beneficial when maintained.^[1]

The curve below illustrates how a response changes over time. It has no physiological units and does not calculate a person's allostatic load.

Four pathways to cumulative cost

The classic framework describes several patterns that may carry cumulative costs: repeated challenges; a failure to habituate to recurring challenges; a response that continues after the demand ends; and inadequate responses in some systems that increase compensatory activity in others.^[3]

The aim is not to minimise every response. It is to understand whether the response fits the situation.

How do researchers measure it?

Researchers often combine indicators from multiple physiological systems into an index. The indicators, thresholds and calculations vary across studies, and comparability remains an ongoing question.^[4]

A single cortisol test, HRV value or fatigue questionnaire cannot, on its own, represent this multisystem research concept. When reading a study, first examine what it actually measured.

What we know, and what we do not

This is a useful framework for thinking about long-term challenges and regulation across multiple systems. But the concept itself, the predictive value of particular indicators and the effectiveness of specific interventions are separate questions.

This concept guide draws on the selected sources listed below. Consider each study’s population, measures and methods when interpreting the scope of its findings.

Understanding science includes knowing where the evidence ends.

Recorded claims

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References

1. Bruce S. McEwen, Eliot Stellar (1993). Stress and the individual. Mechanisms leading to disease. Archives of Internal Medicine. https://doi.org/10.1001/archinte.1993.00410180039004
2. Bruce S. McEwen (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine. https://doi.org/10.1056/NEJM199801153380307
3. Bruce S. McEwen, Peter J. Gianaros (2011). Stress- and Allostasis-Induced Brain Plasticity. Annual Review of Medicine. https://doi.org/10.1146/annurev-med-052209-100430
4. Shawna Beese, Julie Postma, Janessa M. Graves (2022). Allostatic Load Measurement: A Systematic Review of Reviews, Database Inventory, and Considerations for Neighborhood Research. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph192417006

Publication record

TAP-FTR-0001 · v0.4 · English

Scientific review has not been completed for this edition.

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