Stress: Is your boss, spouse, or job killing you?
Stress in everyday life is something that is hard to avoid. In a previous article I described a study that linked life stress with premature gray hair. In this article will we go a little further to make a connection between stress and general health and in particular, cardiovascular health.
What is stress?
Stress is a very complex biological response. In involves many areas of the brain and multiple body systems, with the cardiovascular, endocrine and immune systems being noteworthy examples. The physiological fight or flight response is the basis for stress. Under ideal conditions we function as well tuned biological machines and live and in a kind of homeostatic bless; at least from a physiological point of view.
In less than an ideal world, we have to deal with stress -- often a lot of stress. Stress in everyday life usually takes the form of mental stress. Our brain reacts to our environment and in many cases the reaction leads to a change in physiology. It’s not much different than smelling something good to eat and then having your stomach growl. Your mental response to the smell of something good, led to the physiological response of your stomach preparing itself to receive food. If you don't eat the response is futile and the extra churning and acid, leads to strange sounds coming from within. Stress is like that. However, in the case of stress, it is not the stomach that is activated; instead, it is your neuroendocrine axis, which leads to the release of cortisol, among other things.
The above mentioned neuroendocrine axis is the axis used to turn on your Fight or Flight response. This is an extremely potent physiological response that prepares your body to fight for its life or run for its life. It would take pages and pages to describe all the changes that take place under these special circumstances. The list of all the things that change in preparation to fight or flee is impressive; even more impressive is that it all happens in a matter of 1 or 2 seconds. Any longer than that and your dead because you were too slow to fight or flee.
Many of you have perhaps experienced this feeling. I certainly hope none of you have ever had to fight or flee for your life, although, that would be one way to experience the physiological shock. Far more likely is that you have had a car accident or a near accident. In either case, in that second just before the event you felt the full impact of your fight or flight response. In the moments that followed you felt the physiological drop as your body systems slowly returned to normal. For some of you, this was accompanied by a feeling of being physically ill, perhaps your hands were shaking uncontrollably or you felt like you were freezing. On the outside, it may appear that nothing had happened to you, but on the inside you had just ridden a physiological roller coaster like nothing ever built by man. For some people, this feeling in very small doses is exciting and pleasant. Hence the appeal of amusement park rides that lift you high into the air and then drop you like a rock. What limits the intensity of the reaction at the amusement park is the rider’s firm belief that they will survive the ride, just as those who gone before survived. If you were to take away that firm belief, the intensity would be much, much greater and many of those exiting the ride would promptly collapse to the ground or throw-up.
So now we can define stress. Stress is chronic, low level, activation of the neuroendocrine pathway that leads to the fight or flight response. It means that day-in and day-out your body is chronically prepared to fight or flee, but it does neither. The changes are there, everything is in place, but the event never takes place, and as a result the preparation never ends. Fighting or fleeing is not an option in our modern lives, at home or at work. The often used analogy is not a bad one. We become clocks that are wound too tight. The effect is usually invisible on the outside, but what’s happening inside is ugly and ultimately destructive to our health. Physiologically, we simply aren't designed to be continuously wound that tight.
One of the many chemicals release as part of our fight or flight system is cortisol. Cortisol is a complex organic molecule base on cholesterol. However, don’t think of it as the problem, it’s really not; it’s the stress that is the problem. Blaming cortisol is like shooting the messenger.
Cortisol is produced by your adrenal glands, of which you have two. Each one sits atop one of your kidneys like a little cap and from them issues a variety of very potent and very important hormones, cortisol being just one. At normal levels cortisol plays an important part in regulating blood sugar, carbohydrates, protein and lipid metabolism, and the function of your immune system. At high doses (pharmacological doses) cortisol is an important medication. Cortisol, or its derivatives, can be used to treat asthma as well as some very nasty immune dysfunction diseases and conditions; things like psoriasis, eczema, arthritis and lupus, just to name a few.
Measuring cortisol in the blood provides only a snapshot of cortisol levels. The levels will naturally fluctuate with your stress levels, sleep, and natural circadian rhythms. However, cortisol also is deposited in your hair and since hair grows slowly, about 1 mm a month, hair can use it to look back in time and determine average cortisol levels over an extended period.
That’s exactly what Dr. Laura Manenchijn did in a study published in the April 17, 2013 issue of the Journal of Clinical Endocrinology & Metabolism. The study found that participants with the highest levels of cortisol in their hair had 2.7 times the risk of cardiovascular disease compared to those with the lowest levels of cortisol. This increased risk is in the same ballpark as the increased risk due to (1) high blood pressure, (2) abdominal obesity, (3) high triglycerides and high cholesterol, and (4) diabetes mellitus (type 2). These four risk factors are all very well known, and what this study suggests is that chronic stress, which causes chronic elevation of cortisol in the blood, might be just as significant. If you add chronic stress on top of one or more of the other risk factors then the risk of cardiovascular disease become even more pronounced. The same study also asked participants to evaluate their level of stress. As you might have guessed, there was a correlation between perceived stress and the amount of cortisol in hair.
Another study (Pereg et al., Stress, 2011) found that men coming to the emergency room for a myocardial infarction had significantly higher hair cortisol levels than men coming to the emergency room for all other reasons.
A retrospective study, also by Dr. Manenchijn, looked at the hair cortisol of senior citizens and then compared it with their medical records. The comparison revealed that those seniors with the highest cortisol levels in their hair were more likely to have a medical history of cardiovascular disease than those with the lowest amounts of cortisol in their hair.
How can stress be reduced?
Like many people, I have stress and sometimes it shows. Good intentioned people will come up to me and say “You should reduce the stress in your life.” In general my response is to want to slap ‘em and shake ‘em, however, since I do neither, it only contributes to my overall stress. It’s like the old joke where the patient says, “doctor it hurts when I do this,” and doctor says, “then don’t do that.”
So what can you do? For starters, alcohol doesn't help much. I know there is a lot of talk about how 1 or 2 glasses of red wine for dinner is good for you, but you can achieve about the same results by adjusting your diet and consuming grape juice or alcohol free red wine. There are studies that report moderate alcohol intake can improve certain anti-inflammatory markers, however, these effects MUST viewed in light of potential liver, pancreas, stomach and esophagus damage. Most likely it is not the alcohol that helps, but instead it is the antioxidants in the red wine. Stress causes a great deal of oxidative damage at the cellular and molecular level and antioxidant rich foods and beverages can undo or prevent some of the damage. Unfortunately it doesn't undo the core problem -- the stress itself. Here are a few things that can help.
- Exercise: Fighting or fleeing both use muscles and a lot of what cortisol does is to get your muscles ready for action. So give them some action. Let them use the cortisol for its intended purpose and let the stress out through activity. Multiple studies have found a significant positive benefit from even small amounts of daily exercise. Just a little extra walking can help reduce mental stress and use up some that cortisol you have floating around in your blood stream.
- Reduce smoking and alcohol consumption: While these do not directly reduce stress, it reduces things that amplify the damage caused by stress.
- Change the foods you eat: As above, this is mostly to offset the damage done by stress. Google ‘foods high in antioxidants’ and you will see hundreds of things that you can easily include in your diet to undo some of the damage caused by stress and prevent future damage.
- Evaluate your environment: We can handle a little stress without any problem; it is the fight or flee stress that does the damage. Look around, identify the elements of your personal environment that create the fight or flight response. Since you can neither fight nor flee, you need to figure out how to manage these trigger events. It’s easier to say than to do, but the alternative is to let a crummy boss, a miserable relationship or a lousy co-worker, ruin your health and potentially shorten your life. Don't let the current circumstances of your life steal your health or your longevity, it’s your life so ultimately it will boil down to the choices you make.
Sometimes the person we need to shake and slap is the one looking at us in the mirror.