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What Doctors Don't Tell You

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July 2020 (Vol. 5 Issue 5)

Stress: The pain of going it alone

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Stress: The pain of going it alone image

But this report has uncovered some extraordinary findings

But this report has uncovered some extraordinary findings. Stress, we find, primarily results from a sense of isolation-from our families, our community and even from our God.

Stress is one of the great challenges of modern times. Unless we learn how to control and manage it, we may age prematurely and increase our chances of suffering from a range of minor ailments, including fatigue, indigestion, headaches, constipation, psoriasis and allergies, as well as life-threatening problems such as cancer and heart disease.

In and of itself, stress is not a 'bad' thing. It is part of our body's natural chemical response to a 'fight-or-flight' stimulus geared to meet an immediate challenge. This autonomic (automatic) physical response includes the release of hormones such as the catechol-amines, which include dopamine, epinephrine (adrenaline) and nor-epinephrine (noradrenaline), as well as glucocorticoids such as cortisol-the primary 'stress hormone', which is also known as 'hydrocortisone' in its synthetic form-and androgens such as DHEA (dehydroepiandro-sterone).

Nevertheless, these chemicals-however natural-become a slow poison when stress is chronic, when the body is continually and inappro-priately in 'fight-or-flight' mode. Levels of cortisol rise in periods of chronic stress, and this results in a fall in DHEA levels.

Such a chemical imbalance can eventually lead to heart disease, hypothyroidism (an underactive thyroid), prostate and breast cancers, menstrual irregularities, osteoporosis, and autoimmune diseases such as systemic lupus erythematosus (SLE) and rheuma-toid arthritis (Clin Exp Immunol, 1995; 99: 251-5; Clin Exp Rheumatol, 1992; 10: 25-30).

A recent study found a direct connection between stress and coronary heart disease when British researchers profiled 10,308 London-based male and female civil servants (Eur Heart J, 2008; 29: 640-8; online: doi:10. 1093/eurheartj/ehm584).

What is stress?

No one is absolutely certain as to what we mean by chronic stress. Medicine still hasn't come up with an agreed-upon definition, although the American Institute of Stress ( has arrived at two of the most commonly accepted descriptions of it: 'physical, mental or emotional strain or tension'; and 'a condition or feeling experienced when a person perceives that demands exceed the personal and social resources that the individual is able to mobilize'.

Even the term itself has problematic roots. The pioneer of stress research, Slovakian endocrin-ologist Hans Selye (1907-1982), was the first to come up with the term 'stress'-and ever after wished that he hadn't. At the time he coined the term, he wasn't aware that the term had been in scientific usage since the 17th century. Instead, he wished he had called it 'strain'.

One person's symptoms of stress will differ from those of another, including in their intensity and duration. In addition, we all have our own particular stress triggers, or 'stressors', as Selye called them.

Pioneering research by Rollin McCraty and others at the Institute of HeartMath, in Boulder Creek, CA, supports the idea that stress isn't 'all in the head'. In one study of 26 participants, he found that the heart is a receptive organ that can receive and respond to emotionally arousing stimuli, sometimes even before it occurs (J Altern Complement Med, 2004; 10: 133-43).

Medicine's response

This uncertainty as to what exactly the condition is makes it difficult for doctors to decide on the best way to deal with people who suffer from chronic stress. In very severe cases, they may prescribe an anti-anxiety drug such as the benzo-diazepine diazepam (Valium) or a selective serotonin reuptake inhib-itor (SSRI) type of antidepressant such as fluoxetine (Prozac). But often, they may simply recommend that the patient either changes the situation that is causing the chronic stress response, or change the response to it.

In fact, sometimes changing the situation may be enough-for instance, moving house if you live right next door to a noisy neighbour or directly under a flight path-but often, stress is caused by a multitude of minor daily events that are each irritating little stressors (Psychosom Med, 1994; 56: 216-24). This suggests that stress, which is cumulative, can also become your body's habitual chemical response-and this habit is what needs to be changed.

The technical term for stress control is allostasis, which is the body's ability to achieve harmony through change. It was coined by Sterling and Eyre in 1988 to describe "an additional process of re-establishing homeostasis" (N Engl J Med, 1998; 338: 171-8).

Fortunately, there are many proven methods that can help us achieve allostasis by altering our response to life's events and challenges.

Mind techniques

There is plenty of evidence that various meditation and mind techniques can be highly effective in changing our response to events that would usually make us feel stressed out.

In one study, two techniques-mindfulness stress reduction (MSR) and cognitive behavioural therapy (CBT)-were taught to a group of 50 adults. The MSR programme was an eight-week course that included meditation, gentle yoga and body scanning, while CBT involved cognitive and behavioural exercises to change the way of thinking and to reduce distress. CBT improved six of eight markers for stress, whereas MSR achieved improvements in all eight (J Altern Complement Med, 2008; 27 March, Epub ahead of print).

Mindfulness meditation also helped to lift depression among a group of 91 women who were sufferers of fibromyalgia. These women were divided into two groups: one, comprising 51 partici-pants, was taught the meditation technique while the remaining 40 women were used as the control for later comparisons. The meditation group reported significant improve-ments in depressive symptoms by the end of the eight-week study (Arthritis Rheum, 2007; 57: 77-85).

CBT fared even better in a study of 11 patients, all of whom reported a dramatic reduction in anxiety, worry, depression and mood swings by the end of a course of treatment (J Anxiety Disord, 2007, 22 July, Epub ahead of print).

Transcendental Meditation (TM) is an effective method for reducing stress, and may even help us to live longer. According to the pooled data from 202 patients participating in two randomized, controlled studies, who were either in the prehyper-tensive stage or in the early, stage I phase of the disease, those who practised TM over an 18-year follow-up period had a 23-per-cent better survival rate, a 30-per-cent decrease in fatal heart problems and a 49-per-cent decrease in deaths due to cancer.

The researchers concluded that the stress-reducing approach of TM was a main reason for these patients' longevity and good health (Am J Cardiol, 2005; 95: 1060-4).

Yogic meditation had a similarly positive effect on 12 patients when it was compared with mindfulness meditation. After three months, the yoga meditation group-who were practising kundalini yoga-showed greater improvements in mood, stress levels and obsessive- compulsive disorder. What's more, these improvements were still evident at the end of the study, 15 months later (CNS Spectr, 1999; 4: 34-47).

In a meta-analysis of seven studies, mindfulness meditation apparently helped to improve the participants' ability to sleep, usually because it was able to reduce worry and anxiety (Explore [NY], 2007; 3: 585-91).

Guided imagery is another effective way to reduce stress. This technique was tested in 176 individuals who had all practised guided imagery before the trial started. The researchers found that it was most effective among those who were the most adept (BMC Complement Altern Med, 2005; 5: 21). Another study of guided imagery, this time involving 148 participants, came to a similar conclusion. Again, it was most effective among those who were more experienced with the technique and who were better at doing it (Altern Ther Health Med, 2006; 12: 60-6).

Touch and massage

Touch is a simple and effective way of reducing stress. Indeed, it appears that even those who were hugged a great deal in their childhood by their parents are better able to cope with stress as adults (Science, 1997; 277: 1859-61). It may have something to do with the release of oxytocin, a nonapeptide that can reduce stress levels, and lower levels of blood pressure and cortisol. Oxytocin release is stimulated by touch, and also by a positive outlook, and by having a sense of warmth and empathy towards others (Z Psychosom Med Psychother, 2005; 51: 57-80).

Massage therapy was a more effective stress reliever than guided relaxation when a group of 54 people, aged 60 or over, tested the two methods. The participants received either massage-including Swedish, neuromuscular and myo-fascial massage-or guided relaxa-tion, which incorporated visualiza-tion and muscle relaxation, for 50 minutes in twice-weekly sessions for four weeks. At the end of the trial, the massage group reported signif-icant improvements in their levels

of anxiety, depression, vitality and general health compared with the relaxation group (Complement Ther Med, 2007; 15: 157-63).

Gentle touch massage was also effective when it was tested on 147 participants with 'psychological problems'. After four treatments, most reported an improvement in their stress, anxiety and depression levels (Evidence-based Compl Alt Med, 2007; 4: 115-23).

Another technique is HeartTouch, which teaches participants how to become conscious of their thoughts and feelings, and then how to reduce the stress they create through touch. Its effectiveness was tested on 58 nurses, who had been practising HeartTouch for at least a month, and their results were compared with a group of 40 nurses who did not use the technique. By the end of the study period, the HeartTouch group reported signifi-cant improvements in stress, 'hardiness' and spiritual wellbeing(J Holist Nurs, 2006; 24: 164-75).

Even something as simple as a 15-minute back massage once a week can reduce stress. Sixty nurses were recruited into just such a programme and, after five weeks, they reported a lowering in their levels of stress (Aust J Adv Nurs, 2006; 23: 28-33).

Furthermore, doing it yourself can be as effective as having somebody else massage you. One study tested the effectiveness of self-massage of the foot, using reflexology, with 46 women. After they had massaged their own feet for six weeks, the researchers reported that there was a "statis-tically significant" reduction in depression, perceived stress and systolic blood pressure (Taehan Kanho Hakhoe Chi, 2006; 36: 179-88).

A therapy combining massage with music and aromatherapy helped to reduce stress levels among emergency-room nurses, who reported very high levels of anxiety, especially during the winter months (J Clin Nurs, 2007; 16: 1695-703).

Exercise and yoga

Strenuous exercise can help a stressed person relax and also lower blood pressure in people who are hypertensive. A group of 30 participants who either had normal or high blood pressure reported blood-pressure reductions. Indeed, they also felt more relaxed, even after just one session of exercise using a gym bike (Clin J Sport Med, 2006; 16: 341-7).

Tai Chi, the gentle controlled-movement Eastern form of exercise, is very effective at reducing stress levels, according to objective measures such as blood pressure, heart rate and amounts of cortisol in saliva. Twenty-one beginners who had been performing Tai Chi exercises for only 18 weeks all showed improvements in the three objective measurements mentioned above, as well as in the more subjective areas of general health and psychological wellbeing (Med Sci Monit, 2007; 13: CR488-97).

The effectiveness of yoga as a stress reducer is supported by more trials than any other type of exercise regime. As with other practices such as guided imagery, the effect is greater among those who are more adept. One study plotted the brain activity of eight experienced yoga practitioners, and found that their brain levels of gamma-aminobutyric acid (GABA), a neurotransmitter that induces relaxation and sleep, were raised after a 60-minute session. As depression and anxiety are associated with low GABA concentrations, the researchers recommend yoga as an effective way of treating these conditions (J Altern Complement Med, 2007; 13: 419-26).

In fact, yoga can have a beneficial effect even after a relatively short time. One study of patients with anxiety disorders discovered that it helped them after just 10 days of daily yoga exercise (Indian J Physiol Pharmacol, 2006; 50: 41-7).

It can even help cancer patients who are going through the rigours of chemotherapy. Of 68 breast cancer patients who were anxious and depressed because of their chemo- and radiotherapy, half of them did yoga while the remainder served as controls. Not only did those in the yoga group report improvements in their anxiety and depression, but even their DNA was less damaged subsequent to radio-therapy, compared with the non-yoga-practising controls (Integr Cancer Ther, 2007; 6: 242-50).

Spirituality and religion

A sense of connectedness and purpose are also powerful ways of countering stress, as researchers have repeatedly discovered on investigating people who are members of religious and social groups.

People who have strong religious beliefs are better able to cope following a stroke. This was the conclusion of researchers who followed 132 post-stroke patients, chosen at random, all of whom were being treated in hospital to help them rehabilitate. Those who held to religious or spiritual beliefs had less anxiety and depression than those who were agnostic or atheist (Stroke, 2007; 38: 993-7).

A similar picture was seen among Croatian war veterans. Those with strong religious beliefs were far less likely to attempt suicide, and had less chronic post-traumatic stress, than those who had no religious faith (J Nerv Ment Dis, 2008; 196: 79-83).

Indeed, people who attend church regularly and engage in private prayer are almost never depressed or stressed, even when their income is low. These were the findings when researchers looked at the psychol-ogical profiles of 230 older US-born and immigrant Latinos living in the US (Health Soc Work, 2008; 33: 9-21).

Even people who did not belong to a church, but still held religious or spiritual beliefs, enjoyed better mental equilibrium. Researchers tested one of two strategies in 165 patients with mood disturbances. For eight weeks, patients undertook either spiritual exercises through a home-study course, a meditation-based stress-reduction programme, or did nothing (controls). By the end of the study, those in the spiritual group had significantly lower scores (-43.1 per cent) on an assessment of mood states than did the meditation group (-22.6 per cent) which, nevertheless, still reduced their scores by more than twice that of the controls (-10.3 per cent). Also, this positive effect continued for at least four weeks after stopping the study (Altern Ther Health Med, 2006; 12: 26-35).

Stress can also be reduced by heartfelt forgiveness and empathy. When 99 subjects with psychological problems underwent an 'emotional education programme' for one year, with 47 others as controls, at the end of the course, the education group showed large reductions in their depression and stress, while increasing positive outcomes such as mastery, empathy, emotional intelligence, forgiveness and spirit-ual experiences (Explore [NY], 2006; 2: 498-508).

Other techniques

- Music therapy. Listening to music can help you relax and reduce stress levels-but what you listen to apparently matters. Mozart's Eine Kleine Nachtmusik was more effective than so-called New Age music. When 63 stud-ents either listened to the Mozart or to New Age ambient music, or read recreational magazines, for 28 minutes on three consecutive days, the Mozart listeners report-ed higher levels of peace and lower levels of negative emotions than did the other two groups (J Music Ther, 2004; 41: 215-24).

Classical music also came out on top in a separate study of 56 college students who had gone through a stressful test before listening to music of their choice or sitting in silence. Again, those who chose classical music report-ed higher levels of relaxation than those who listened to heavy metal or sat in silence (Appl Psychophysiol Biofeedback, 2007; 32: 163-8).

- Owning a pet. Having a pet can help to calm us. In a study of 25 children (aged five to 18) who were in pain following surgery, those who had a visit from a dog while in hospital said their pain levels were lower afterwards (J Holist Nurs, 2006; 24: 51-7).

- Acupuncture. Electro-acupunc-ture, administered at both 5 Hz and 100 Hz, can reduce mental stress when 25 volunteers were immediately assessed after they had performed difficult mental arithmetic calculations (Auton Neurosci, 2005; 118: 93-101).

- Biofeedback. Although muscle relaxation training using biofeed-back failed to lower perceived stress levels in 36 women who underwent such training for eight weeks, twice a week, it did reduce the physiological symptoms of stress such as pulse rate, blood pressure and muscle relaxation (Taehan Kanho Hakhoe Chi, 2004; 34: 213-24).

Supplements and herbs

Supplements and herbs can also help reduce stress, but their role seems to be secondary, acting more as enablers to other approaches.

The herbs Ginkgo biloba and Panax ginseng can reverse the biochemical responses to acute and chronic stress. In rats (so not neces-sarily in humans), Ginkgo was better in cases of acute stress, whereas ginseng was better for chronic stress (J Pharmacol Sci, 2003; 93: 458-64). A standardized leaf extract of Ginkgo can also alleviate stress (J Food Sci, 2008; 73: R14-9). In a mouse study, ginseng was effective in countering the standard markers of stress (Pharmacol Res, 2006; 54: 46-9).

Antioxidants, including vitamins A, C and E, and the polyphenolic compounds found in berry fruits, such as strawberries and blue-berries, can help to protect against the age-related physical and mental effects of stress-at least in a review of studies using rodent models (J Agric Food Chem, 2008; 56: 636-41).

A matter of lifestyle

Stress has rightly been described as a disease of modern life. While most of us believe it's because of our hectic lifestyles, in fact, it may have more to do with the sense of iso-lation that we now experience as the nuclear family becomes less involved with the wider community.

It appears that the root emotions of stress are a sense of helplessness and loneliness, so it's not surprising that touch or massage therapies, or belonging to a spiritual or social group can do much to help these negative feelings. Meditation helps to still the emotions that stir up the dangerous chemical soup that can lead to heart disease and cancer.

Stress is a lifestyle disease, but in this sense: it is challenging you to decide how you wish to live your life, and to find ways to cope and respond to everyday events that don't involve either running away or aggressively attacking them.

Bryan Hubbard

Are you stressed?

These are some of the main symptoms of chronic stress. Although it's possible to have some of these symptoms without being chronically depressed, you may be if you find that you have a majority of the following:

- periods of irritability or anger

- apathy or depression

- constant anxiety

- irrational behaviour

- loss of appetite

- comfort eating

- lack of concentration

- loss of sex drive

- increased smoking, drinking or taking recreational drugs

- excessive tiredness

- skin problems such as eczema

- aches and pains from tense muscles

- increased pain from arthritis and other conditions

- heart palpitations

- feeling sick

- stomach problems

- missed periods.

Keeping a journal

Keeping a Stress Journal is an effective way to cope with your stress and to make yourself more conscious of the entire process. To create your journal, you should divide a piece of paper into four columns, with the following headings:

1. The cause of your stress

2. How you felt, both physically and emotionally

3. How you acted in response

4. What you did to cope or feel better.

After a few days, you will start noticing patterns or themes in what makes you feel stressed (your stressors) and how you are dealing with them.

Another journal that can give you a different view of the way you respond to events is a Gratitude Journal. As the name suggests, it is a way of expressing gratitude for the people and events in your daily life. Unlike the Stress Journal, it does not need a fixed format. Instead, it could be a daily essay in which you outline the things in your life for which you are grateful. This could include anything from simply waking up in the morning, and having a job or a family (even if this may also be a cause of stress), or the fact that you have a nice home or neighbourhood to live in.

The key is to keep writing, at least several times a week, and to keep it going. After a while, you may become aware of less obvious things for which you are grateful, such as the taste of a hot cup of coffee.

Are supplements necessary?

Last month, the well-respected Mayo Clinic announced in its newsletter that dietary supplements are not necessary if you have a varied, healthy diet. Here's a reminder of why they are wrong.

Governments in both the US and UK continue to assert that food supplements are not necessary if your diet is healthy and balanced, a view backedby EU legislation that still threatens to reduce the legal upper limits in supple-ments to absurdly low levels. The evidence, however, suggests otherwise.

The recommended daily allowances (RDA) were formulated to prevent deficiency diseases such as rickets and scurvy, not to underpin lifelong health. In the UK, the reference/recommend-ed nutrient intakes (RNI) that have replaced RDAs have higher baseline levels of nutrients, making these only slightly less unacceptable.

The view that RDAs are sufficient-still espoused by health officials and practitioners-originates from the belief that food does what it says onthe seed packet: oranges have lots of vitamin C; wheat is rich in selenium; and watercress is a good source of iron. However, here are the facts, according to nutritional analysts.

- Food is not nearly as rich in micro-nutrients as it was 100 years ago.

A comparison between food values in 1963 and today shows that the amount of calcium and vitamin A in broccoli and apples has been halved, and the vitamin C in sweet peppers has plummeted by 30 per cent, while watercress has 88-per-cent less iron, and cauliflower has 50-per-cent less vitamin C.

A review of studies from 1983 to 1993 showed that the mean blood selenium in seven EU countries was 79 mcg/L, whereas values of 100 mcg/L are considered optimal. In 1994, a UK survey found intakes of only 34 mcg/day, low even compar-ed with the RNI of 75 mcg/day (BMJ, 1997; 314: 387-8).

Mass production compromises quality for volume. Most salad vegetables in supermarkets now, for example, are grown hydroponically -in water-and never even touch soil, although soils today are depleted of minerals. Food is stored for long periods, which loses nutrients, and modern cooking methods, such as microwaving, deplete nutrients even further.

- Most of us are deficient in micro-nutrients. The National Diet and Nutrition Survey (NDNS) found that 66 per cent of adults don't get enough vitamin B2, 50 per cent of girls have inadequate magnesium intakes and 9 per cent of elderly women are iron-deficient.

- What goes into the mouth may not be taken up into the body. British nutritional physician Dr Alan Stewart found that only 20-50 per cent of the nutrients we consume are actually absorbed into the blood-stream.

- According to the prestigious Harvard Medical School, we all need to sup-plement with vitamins (JAMA, 2002; 287: 3116-26; JAMA, 2002; 287: 3127-9).

- We need much more than the RDA to achieve optimal health. Tracking 13,000 people for 15 years enabled researchers to calculate the SONAs (suggested optimal nutrient allow-ances) for optimal health (see www. for a comparison of SONA and RDA values).

- The RDA for vitamin D is 5 mcg/day, yet just one day in the sun would give you 10,000 mcg. Dr Robert Verkerk, director of the UK Natural Health Alliance, says that we would benefit from supplementing vitamin D at levels 100-1000 times greater than the RDA.

- Individual needs vary considerably. According to Dr Damien Downing, editor of the Journal for Nutritional and Environmental Medicine, ani-mal studies show a 20-fold variation from one animal to another, while humans show a fourfold variation.

- Micronutrient needs depend on the genotype. Some genotypes have an inherently higher requirement for folic acid, and vitamins B6, B12 and B2. An analysis of breast cancer cases found an increased risk of the disease in those with below-median levels of folate or above-median levels of homocysteine; low levels of B12 were also associated with a greater risk of breast cancer among postmenopausal women (Carcinogen-esis, 2001; 22: 1661-5).

- Some conditions require even higher supplementation. Autism comes with a higher need for vitamin B6. Of 22 studies, 21 showed the bene-fits of high-dose B6-on average,

8 mg/lb of bodyweight/day-more than 1000 mg/day for a 135-lb person (Autism Res Rev Int, 2005; 19: 3).

- Your own genetic makeup may determine what's safe for you. Even though the current daily US recom-mendation for vitamin B6 is 1.3 mg/ day, this won't apply to those who have a particular enzyme variant, who will need considerably more than this.

- Having an illness will make your needs for micronutrients skyrocket. Taking 1800 mg/day of calcium with 800 IU (20 mcg)/day of vitamin D3 may prevent colon cancer. In addition, 800 IU/day of vitamin D may enhance survival rates among breast cancer cases (Ann NY Acad Sci, 1999; 889: 107-19).

However, as individual tolerances and benefits differ with treatment even more markedly than for prevention, even nutritionists who support megadosing against disease are reluctant to set even notional benchmarks. Although there are many anecdotal cases of people overcoming disease through self-medicating with micronutrients, this is one area in which it may be preferable to obtain the advice and supervision of a qualified nutritional practitioner.

Tessa Thomas and Lynne McTaggart

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