Stress
By Dr. Alice R. Laule
About 30 years ago, when the field of mind body medicine was in its scientific
infancy, if you had asked most physicians whether stress had any effect on
human health, 80% of them would have told you “no”. Then a field called
psychoneuroimmunology (PNI) was developed. I recall the first work published by
the PNI scientists. The initial studies were met with a great deal of derision.
Nonetheless, they were laying the groundwork for us to understand stress
much better. The earliest person to use the word stress as it relates to human
beings and their health was Hans Selye. He developed a scale of degree of
stressful events in a person’s life. Death of a loved one is tops on the list,
but even things like a wonderful new marriage, or a job advancement actually
create a lot of stress in our lives. Up until Hans Selye came along, stress was
a word that physicists used to describe events happening with physical objects.
By applying the word stress to humans, Dr. Selye helped us develop a far deeper
understanding of human health and disease.
Thanks to the PNI researchers, we know better what happens when we are
stressed. For early humans, we presume that the body’s stress response was
limited to brief situations, the fight-or-flight response. A series of
physiologic changes happen in the body to help us stand and fight an enemy, or
help us run to get away (classically, from the rampaging saber tooth tiger that
wanted human for lunch).
The part of the autonomic (involuntary) nervous system called the sympathetic
nervous system moderates this response. It includes a dilation of the pupils,
increase in heart rate and blood pressure to provide oxygen to vital areas, a
shunting of the blood flow away from the digestive organs and kidneys into the
brain and muscles and heart. Actually the liver receives increases blood flow
also, because it has a job in the stress response. The liver stores glucose as
glycogen, and it’s job is to flood the system with glucose for quick energy to
muscles and brain. It also releases fatty acids into the bloodstream. Then, for
plenty of available oxygen, the bronchial tubes dilate so more air can get into
the lungs. Lastly, the adrenal glands pump out adrenaline, for that extra
burst of strength, the kind of thing that allows a mother to lift a car off her
injured son, finding strength she never would ordinarily have. This is a
very clever response, allowing us plenty of blood flow, oxygen, glucose and
fats to burn for energy so we can be strong and smart if we are standing and
fighting, or be able to run like heck and still think fast enough on our
feet to escape. We even get the adrenaline boost for super human strength.
Our bodies are indeed very wise.
Sometimes our minds may not be so wise — when we make choices that change
stress from a brief event to a prolonged one that goes on week after week,
month after month. In fact if anyone
knows how to avoid chronic stress living in America in the 21st century, please
share. We live in a busy world.
So what happens in chronic, ongoing stress? Many of the same things as the
fight or flight response, only the change in physiology continues for so long
that the body more or less forgets what “normal” is. Therefore, the blood
pressure stays high, the liver continues to dump glucose into the blood stream
causing the need for extra insulin and additional glucose handling pathways to
kick in, all of which have downstream ill effects on the health. The fat that
is released into the blood stream goes unused (no fighting, no fleeing), and
causes cholesterol and triglyceride elevation, and cardiovascular disease. The
elevated adrenal gland hormones, adrenaline and cortisol, begin to cause
problems including loss of calcium from the bones, poor handling of
carbohydrates and sugars, thinning of the skin, and high blood pressure. The
digestive tract continues to get reduced blood supply, so digestion and
absorption become less efficient, providing fewer building blocks for repair
and maintenance of the body’s physical structure. Every side effect of taking
the medication cortisone can begin to happen from having constant high cortisol
levels being pumped out by our own adrenal glands. The high adrenal hormones
produce free radicals, which accelerate the aging process. Eventually the
adrenal glands become exhausted, at which time enormous fatigue sets in, as
well as problems with increased inflammation and dysregulation of the immune
system. Thus we are set up for autoimmune diseases, chronic fatigue, asthma and
allergies.
Just imagining all that’s going on when you’re stressed is enough to cause
stress, isn’t it? So the next question is, “What do we do about all this!!??”
How we react to stressful situations matters more than the degree of stress, so
training yourself to keep a larger picture, not obsess over unimportant
details, ask yourself “how much will this matter in ten years?” can help.
Courses on stress management are available and hopefully will be offered soon
in our new education facility.
Exercise can help use up the excessive fats and glucose kicked into the system.
This is of extreme importance.
Meditation or the “relaxation response” that Dr. Herbert Benson has written so
much about are well studied and useful almost beyond belief for something so
simple. I personally do not know how I would have survived medical school
without meditation. Whenever I stopped meditating I began to go “a little
crazy” with the level of stress.
Simple techniques like journaling — just telling yourself privately in a
journal how you feel, and what is going on — are helpful. Biofeedback can train
a person in release of muscle tension and reduced physiologic responses to
stress.
Stay well nourished. Drink plenty of water. It seems to be easy to forget to
take time to drink water when we are overly busy. Take B vitamins and
magnesium, all of which are used up in the stress response. Avoid pigging out
on sugar, chocolate, caffeine, and things to temporarily give you a boost. In
the long run all of these merely increase the very physiologic response that is
damaging your health.
Laugh — there is a tremendous outpouring of beneficial endorphins with
laughter, which help modulate the stress response.
Get plenty of sleep. Obsessing over a deadline and working while you’re
dog-tired can make a job take 3 hours to finish, and be riddled with mistakes,
when it might take only 2 hours to do it properly after a good night’s sleep.
I’ve had to learn that one the hard way, back when I was doing all the
bookkeeping at the office, exhausted at the end of a full day.
Frequently give thanks for all the good things in your life, and especially be
grateful that the world is not full of grinning saber tooth tigers that just
love to gnosh on humans. Doesn’t that make it a great world?
Take care of yourselves.
Alice
R. Laule, M.D.