The stress response

(February 2007) — Chances are, if you’re an American, you know the importance of eating a heart-healthy diet. You know not to smoke, to watch your cholesterol, and to stay active. Our health educators are doing a great job. But despite all these precautions, you’re still more likely to die of heart disease than any other cause, including cancer.

Faulty hearts kill approximately 700,000 Americans each year and, according to the American Heart Association, only about half of these people have one or more of the standard risk factors for heart disease.

It makes sense to do what we can to minimize the coronary risk factors that we have some control over. Yet these efforts offer no guarantee that we will be “heart healthy.” After all, noted health educator Dr. Pritikin died of a heart attack while jogging.

Is the heart genetically our Achilles’ heel? I don’t think so. One hundred years ago, death from heart disease was quite rare. Our genes don’t change that quickly. Clearly, something else is going on.

What I see in my practice and what is just beginning to emerge in clinical research is this: long-term stress poses a significant threat to our health. In a New York Times survey of physicians, doctors estimated that 70 to 90 percent of all office visits were for stress-related conditions.

The stress response
Stress triggers a physiological reflex called the Stress Response, a complex cascade of events finely tuned over millions of years of evolution to maximize the chances of surviving an imminent threat to our life. The Stress Response alters nearly every physiological process in our bodies.

In a nutshell, the Stress Response can be thought of as resource management. Your body asks: “How can I maximize the utilization of my currently available resources to minimize my chances of becoming lion lunch?”

The Stress Response is designed to deal with immediate survival in the face of life-threatening, short-term threats, such as someone swerving into your lane. It was not designed for the chronic daily stresses of commutes and jobs and children.

Many researchers now consider hating your job to be as big a risk factor for heart disease as smoking or high cholesterol. The processes by which stressors are linked to heart disease are now well understood and continued research is giving us more detailed insights every day.

We have learned that stress is cumulative. Our bodies add up all the stresses we face and treat them as one. It doesn’t matter whether stressors are situational (sick children, stop-and-go traffic or an impending deadline), chemical (pesticide-laden food, toxic fumes or a heavy metal exposure), physiological (illness, over-exertion or lack of sleep), or psychological (fear, grief or depression).

If we have too many stressors at one time, when we add them up, the total is the same to our bodies as if we were staring a lion in the eye.

The health effects of stress
So what happens to a body under chronic stress? Most commonly, we see digestive problems — from indigestion and heartburn to irritable bowel disease and food sensitivities.

Digestion is arguably the body’s most energy-intensive physiological process. Stress halts digestion. Stress disrupts hydrochloric acid production and the body’s protection from hydrochloric acid. It disturbs digestive enzyme production, peristalsis, and the active transport of nutrients across the intestinal lining.

The liver takes glycogen, which it has stored during times of rest, and pumps it into the blood as glucose. Stress hormones are a known cause of diabetes, which is now at epidemic levels.

Stress damages the body in other ways, too. When your brain perceives stress, it tells your adrenal glands to make cortisol. Cortisol is your body’s natural steroid.

Cortisol imbalances can suppress your immune system. They can block general cell repair, which leads to thinning bones and skin. They interfere with insulin, raising blood glucose, which leads to weight gain and diabetes. They can cause the heart to beat more strongly, elevating blood pressure. They can interfere with memory functions. They also can affect the reproductive organs, leading to infertility and a lowered sex drive.

What to do
When someone comes into my office suffering from what is obviously a stress-related condition, I propose a comprehensive approach. Together the patient and I work to optimize digestive function, address food and chemical sensitivities, and treat weary adrenal glands.

But our work doesn’t end there. We have to identify and treat the source of stress. We can treat disease, often quite well, but if we don’t remove the triggers that caused the disease, it’s like treating an active oil indicator light on your car’s dashboard by unplugging the light bulb. Things might seem to be better for a while, but in the end they only are going to get worse.

There are innumerable ways to support yourself through stress or to give yourself a short reprieve through relaxation techniques. Yoga, meditation and guided imagery provide proven benefits after stress and they often help bodies handle stress better as it is happening. Eating plenty of whole grains, fruits, vegetables and high-quality proteins, as well as avoiding caffeine, processed foods and sugars will benefit us, too.

These approaches help handle existing stresses but do nothing to prevent the Stress Response from triggering in the first place. And that’s the goal — to keep from triggering the Stress Response before the damage is done.

Stressful situations can be divided into two types: those you can do something about and those you can’t. If there is anything you can do reasonably to change or leave a stressful situation, by all means, do it.

When facing an unavoidable stress, such as a sick loved one or Seattle traffic, you don’t have to be a victim. There are skills you can learn that protect your health when circumstances are out of your control.

For example, recent research on advanced meditators showed that when they were in a state of pure awareness and were presented with a loud sudden noise, their muscles didn’t twitch, their brain waves didn’t even flicker. Clearly, awareness is a powerful tool when learning how to manage stress.

Attaining the consciousness of a yogi is an admirable aspiration. Fortunately for most of us, though, effective protection from stress can be achieved with much less time spent meditating. Awareness is a tool that can be practiced throughout the day, one we can master to stay healthy in the presence of long-term psychological and emotional stresses.

Here is the key: There’s an old adage that one person’s stress is another person’s recreation. What makes the difference? Attitude. Perception. If we perceive something as stressful, it is likely that our body will respond in kind. If we see it as a manageable challenge, most likely our body will do just that: manage the challenge.

Our reactions to the world are greatly influenced by the lenses through which we perceive our experiences. We all have our own personal set of these lenses. They are the filters through which our mind views all of our experiences, both internal and external.

Simultaneously, all of our life experiences influence and shape the lenses. For simplicity’s sake, let’s call these lenses beliefs. If we want to change how we experience our life — for example, changing a stressful experience into an interesting challenge — we have to change our beliefs.

If you could chart all of your mental activity for a given 24-hour period, how much of it would you be consciously aware of? About 3 to 5 percent, on a good day.

So, guess what part of the mind, conscious or non-conscious, houses most of the beliefs comprising our lenses? Right, the non-conscious.

Therefore, to stay healthy and keep from stimulating the stress response unnecessarily, you need to have a way of uncovering your non-consciously held unsupportive beliefs, change them into supportive ones, and put the new beliefs back down into the non-conscious mind where they will become your new “lens.” Simple, right? Unfortunately not. This is where the true work lies.

You might recognize the process of changing beliefs, attitudes and perspectives as precisely the mechanism by which education changes us. As we think different thoughts, we have different feelings and these different feelings change our breathing patterns, circulation, digestion, immune function, muscle tensions and pattern of circulating hormones.

Perhaps if long-term stress is making us sick, we are being asked to become a different kind of student of life. Our non-consciously held beliefs show us what they are via our feelings and bodily symptoms. Our bodies hold a deep wisdom that most of us have been taught to ignore. We need to listen to our bodies in ways that most of us haven’t listened before.

Studies have shown that uncovering and permanently changing deeply held beliefs takes at least six months of focused practice. One cannot reasonably expect to do this quickly, just by reading a book or attending a weekend workshop.

The skills needed to uncover and permanently change unsupportive beliefs can be learned and practiced until they become second nature, but it takes time. Supportive beliefs transform our perceptions. Remarkably, events that previously would have been experienced as stressful become tolerable.

The commitment required to learn and practice these skills is well worth it. In the process, you will restructure your relationship with stress. By doing so, you will be treating the cause of 70 to 90 percent of your health concerns. If you take the time to unlock your unhealthy beliefs, you will most likely also unlock the missing key in the heart risk-factor equation.

Steven M. Hall, MD, practices integral medicine on the Eastside. In addition, he teaches courses on Restructuring Your Relationship to Stress (see www.stevenmhallmd.com). Patti Pitcher is a freelance writer, organic gardener and novice beekeeper.