Stress – Taking back control (by Richard Sutton)
Richard Sutton is a member of the International Association of Healthcare Professionals and is a clinically trained neurovascular practitioner, with a background in bio-kinesiology. Thank you for allowing us this article:
Stress has become somewhat of a preoccupation. We are exposed to it constantly and it impacts our lives immeasurably.
By definition, it is a state of strain (physical and mental) that results from demanding circumstances. Life is demanding, and bar complete removal from society, stress is and will remain very much part of our daily reality. For us to become more resilient to stress and even harness the positive effects of stress (yes – stress can be very beneficial), we need to consider three things.
Firstly, we need to understand what stress is and how it affects the body. Secondly, we need to change our perception of stress. And lastly, we need to change our behaviour in response to stress.
Research into the effects of stress
For over 70 years, scientists have been studying stress and health outcomes. Time and time again the same conclusions have been drawn – chronic stress negatively impacts health, something we intuitively know.
In 2015, researchers from Harvard and Stanford Universities published a collaborative meta-analysis involving 228 studies on stress and health outcomes. What was interesting about this extensive study was that it was able to determine a direct causal nexus between certain types of stress and premature mortality, as well as declines in mental and physical health. Different stress experiences included family conflict, work conflict, job insecurity, high job demands, as well as lack of control in the workplace and poor social support.
Interestingly, on-going conflict (either in a work or family setting) had one of the more profound effects on health. The study showed that chronic conflict was associated with a 90% probability of developing physical health issues and an even greater likelihood of developing mental health issues.
In particular the meta-analysis showed that job insecurity, high job demands and long working hours dramatically increased the risk of developing major health issues and were associated with significant rises in premature mortality. Of course, longer working hours, extended working weeks and less annual leave are more prevalent in the modern workplace, all of which, according to this study, appear to be having detrimental effects on our health.
In 2015, the ‘Lancet’ Journal published a study on the relationship between long working hours and the impact that it has on our health. The researchers analysed volumes of data from studies involving over 600 000 individuals and found that, when compared with standard working hours (35-40 hours a week), those who worked over 55 hours increased their risk of having a stroke by 33%. There was also a significantly increased risk of developing heart disease in response to long working hours.
On-going stress is typically associated with numerous health ailments, some of which include infertility, depression, cardiovascular diseases, autoimmune diseases, pain syndromes and as we have all experienced at some stage in our lives – lowered immunity.
Scientists find link between stress and genetic damage
Although the abovementioned health conditions appear independent and non-related, Nobel Prize winner Dr Elizabeth Blackburn discovered that there is actually a strong underlying connection. The connection is that they are all associated with genetic (DNA) compromise and damage and that chronic stress is one of the major triggers in this process. Blackburn and her team discovered that chronic stress accelerates the erosion of a very specific unit of DNA, known as a “telomere”. When these segments shorten and erode it creates numerous cell issues that include poor function, abnormalities, possible mutations and even cell death. In fact, erosion of this DNA segment is believed to be one of the primary causes of aging and development of chronic diseases. Knowing this, it makes sense why people looked ‘aged’ in response to compounding life traumas.
Stress can be good – really good!
Yet despite the overwhelming research as to the negative impact that stress has on our health and of course society’s negative perception of ‘big bad stress’, there are many instances in which stress can enhance ones functionality and performance (physical and cognitive). The fundamental difference between the beneficial versus the destructive effects of stress lies with the critical factor – time.
Stress in short bursts (known as acute stress) protects, strengthens and enhances our abilities. It is important to understand that the actual stress response is one of the reasons we have been able to survive the most hostile of environments for thousands of years. The stress response is a strong biological reaction to danger or perceived threat, which is able to integrate the all the major systems of the body (immune, cardiovascular, hormonal and nervous) as a unified force to create powerful defenses – instantly!
In a moment this protective response liberates enormous amounts of energy, increases the availability of oxygen, enhances muscle power, promotes pain resistance, provides mental acuity as well as strong immune defenses. Essentially the whole purpose of such an organized biological force is to help us cope better with change and successfully react to emergencies. We are primed for success in this state.
Adrenaline – the first stress wave
The basic physiology of stress is as follows: stress begins in the brain with the perception of a threatening or more commonly, a disturbing situation. The brain acts by sending signals to the adrenal glands (located on the kidneys), which responsively produce the hormone adrenalin (otherwise known as epinephrine). This powerful hormone causes our heart rate, respiration and blood pressure to increase, improves circulation to the brain and limbs, liberates energy into the blood stream, results in the release of endorphins (molecules that reduce our perception of pain) and mobilizes our immune system into action.
At this point you may be thinking how can this be bad? There is certainly no down side to having more energy, being mentally sharper, physically stronger and feeling no pain? Well, it’s not that simple. The drawback is such that in order to prime the body for action and heightened responsiveness, simultaneously several systems need to be shut down – you can’t have it all.
One of the functions of adrenaline is to redirect blood away from the skin, digestive and reproductive systems. Reproduction and food consumption are unlikely activities in periods of acute stress and consequently these systems are ‘shut down’ in favor of better performance of the brain, cardiovascular and muscular systems.
Have you ever noticed that when you are having a stressful time, you develop issues with your digestive system? A 2011 study by German researchers published in the Journal Physiology and Pharmacology, showed that stress not only reduces blood supply to the gut by 400%, but also affects movement of the intestines, the secretion of enzymes within the digestive system, lowers regional defenses and alters the composition of bacterial colonies that reside in the gut. Although other hormones influence this ‘shut down’, adrenaline is the primary protagonist.
Elevated adrenaline also impairs the body’s regenerative, reparative and growth potential. As an adult with low physical demands, one can get away with this (at least for short periods of time), however the big concern is our children. Chronic stress is becoming increasingly more prevalent in adolescents. Higher demands, greater expectations, technology, information overload and lower activity levels all contribute to impaired growth, weaker physical profile and greater predisposition to pain syndromes and health ailments.
In adults, a big concern with repeated adrenaline surges (a consequence of chronic stress) is the impact on the cardiovascular system (heart, lungs and blood vessels). According to renowned neuroscientist and world authority on stress Dr. Bruce McEwen, these surges result in dramatic increases in blood pressure, which can damage blood vessels within the brain and heart.
Cortisol – The second wave
Following the initial adrenaline surge, centers the in brain (hypothalamus and pituitary gland) produce hormones that signal the adrenal glands to produce yet another hormone known as cortisol.
In the short term, cortisol has a very positive effect on our immune system in that it improves responsiveness and helps to regulate function. This is especially important considering that adrenaline mobilizes the immune system into action and without cortisol to balance this effect, the immune system could become over active and potentially destructive.
As with everything in life, balance is important. Whilst cortisol in the short term regulates immune behaviour, in the long term we see a very different picture. Long-term elevations of cortisol lead to immune system suppression predisposing us to latent viruses and infections, which is why we often get sick after long periods of stress.
There is even more complexity within this biological process. Recent discoveries by Sheldon Cohen and his team from Rockefeller University showed that chronic elevations in cortisol create a resistance of cells and tissues to the actions of cortisol, which has major implications for autoimmune diseases (diseases where our immune system attacks our body).
Essentially prolonged cortisol can either supress our immune system or completely fail to regulate it, both of these scenarios are extremely antagonistic to health.
The general effects of the hormone cortisol are varied. They include increased activity levels (urge to keep ‘busy’), disrupted sleep patterns (especially when cortisol is elevated late in the day), demineralization of our bones, muscle break down, increased gastric acid secretion (reflux), as well as altered brain chemistry.
From an energetic perspective high cortisol increases fat storage. In fact, cortisol can lead to significant weight gain, despite good dietary intensions. It does this through different channels, which include increased appetite, reduced sensitivity of the body’s cells to the insulin (a hormone that lowers sugar levels in the bloodstream) and reduced levels of a youth and vitality promoting hormone called, growth hormone.
Cortisol shrinks the brain
One of the greatest concerns with chronic exposure to stress is cortisol’s effect on the brain. In 2012 researchers from the departments of Psychiatry and Neurology at Yale University published a study which showed that chronic elevations of cortisol are associated with lower brain mass in regions of the brain affecting executive function, complex intellectual behaviour, self-awareness, coordination and even motivation (prefrontal cortex, insular cortex and anterior cingulate).
Interestingly, this was not the first study to show the negative effects of cortisol on brain tissue. Extensive research on animals and humans show that the memory and emotional centres (hippocampus and amygdala) are particularly prone to compromise with regard to structure and functioning.
Although historically the literature shows that elevated cortisol causes brain cell shrinkage and death, neuroscientists at the University of California have discovered another way in which chronically raised cortisol influences the brain. Daniela Kaufer and her team discovered that cortisol could also trigger stem cell malfunction, changing the overall composition of the brain.
The collective effect of brain cell shrinkage, brain cell death and reorganization of brain tissue is dramatic within the behavioural and cognitive space. We have all experienced these neurological changes in some way or another after long periods of stress in that they result in poor focus, impaired memory, low attention span, anxiety, fear as well as general emotional instability.
So what are the biggest drivers of stress in today’s society?
Over the last few decades, the medical community’s attention has been increasingly drawn towards the social determinates of health. Two acclaimed studies performed by Sir Michael Marmot, a Professor of Epidemiology and Public Health at University College London, have provided extraordinary insights.
Marmot’s ‘Whitehall studies’ monitored 28 000 people over a 40-year period. The studies confirmed that stress in the workplace directly affects employee health and longevity, but more importantly it discovered that the grade of employment i.e. “ranking” within the organization and/or society, also had a profound impact on health (due to higher perceived levels of stress).
Logically one would assume that more senior, high-ranking employees would be more prone to health issues, partly due to increased responsibilities and partly due to seniority in age. However, the studies showed the exact opposite. It was the lower ranking employees within the organization that had the worst health and highest risk of premature death. In fact, those in the lowest ranking positions had a 300% higher risk of mortality when compared to the most senior employees over a 10-year period.
Lack of perceived control is the single biggest determinant of stress and ill health
The Whitehall II study identified that the key differences between the lower and higher-ranking employees included less social support, less variety at work but most importantly an overwhelming sense of ‘lack of control’ within the lower ranking group. What the study clearly showed was that environments where a sense of control was lacking have the highest levels of stress and greatest health compromise.
Supporting this, a 2015 meta-analysis published in Behavioral Science & Policy, Harvard professor Jim Goh and Stanford professor Jeffrey Pfeffer describe a lack of job control to be the leading cause of premature mortality (>40% greater risk) within the framework of stress.
Albert Einstein once said, ‘Reality is merely an illusion, albeit a very persistent one’ and when it comes to stress resilience, perception is everything.
A recent study published the ‘Journal of Health Psychology’followed 28 753 adults over 8 years with the objective to determine whether or not the belief that ‘stress is bad’ impacted health outcomes.
The study involved a questionnaire pertaining to the previous 12 months, asking participants how much stress they had experienced over the previous year, and how much has they believed that stress affected their health.
Within the context of premature death and general health outcomes, neither the amount of stress, nor the perception that ‘stress is bad’ independently predicted poor health outcomes. However the study showed that when a stressful event was combined with the perception that stress is bad for ones health, it increased the risk of premature mortality by 43%.Studies by researchers from the department of psychology at Harvard University strongly support the notion that the way we perceive stress has an impact on our health and wellbeing.
This is a powerful message in that we can’t always control the stressors that we are confronted with on a daily basis, but we can control the way in which we perceive them, giving us considerable control over our health.
Our behaviour can create stress resilience
As mentioned earlier, the stress response is associated with the increased production/release of adrenaline and cortisol. Recent evidence now shows that stress also triggers the release of oxytocin. Oxytocin is a hormone and neuropeptide (a molecule that influences brain function), which has powerful effects on both our psychological and physical wellbeing. Until recently, very little was known about this hormone other than its association with childbirth, human bonding and maternal behaviour.
In 2005, Swedish researchers published a paper on the affects of oxytocin on the body within the context of healing and protection. The paper that appeared in the Journal ‘Psychosomatic medicine and Psychotherapy’ highlighted the powerful influence that oxytocin has on behaviour and perception-of-self. The hormone promotes self-worth, confidence, fearlessness, optimism, a sense of calm, generosity, connectedness, empathy towards others as well as generosity – an ideal profile for success in any endeavour.
From a physical standpoint oxytocin’s effects are profound. Oxytocin is linked to lowered cortisol, lowered heart rate and lowered blood pressure, thereby counteracting the common effects of the stress response. Additionally, oxytocin has anti-inflammatory actions, antioxidant effects and increases the production of serotonin and nerve growth factor (key elements in proper brain functioning).
However, oxytocin loses half its initial effectiveness within 3-5 minutes. For us to derive benefit we require more frequent releases, and this is achieved almost exclusively through our behaviour during times of stress.
Many medical researchers speculate that the sole purpose of the initial burst of oxytocin (in response to stress) directs our behaviour to seek support from others, connect to others and feel empathy for others in times of crisis.
Here’s the amazing thing. When we connect with others, we release more oxytocin, thereby creating considerable physical and psychological resilience to stress.
The physical triggers in oxytocin release include contact with others such as hugging, light touch, massage as well as eye contact. Another mechanism by which we increase oxytocin levels is through prosocial behaviour. Caring for others, giving to others and feeling empathy towards others, all trigger oxytocin release and this release promotes considerable stress resilience!
In 2013, Michael Poulin from the Department of Psychology, at the University of Buffalo and a team of researchers from other institutions published a study entitled; ‘Giving to Others and the Association Between Stress and Mortality’. The study monitored 846 individuals over a 5-year period. Participants completed baseline interviews that assessed past-year stressful events and whether the participant had provided tangible assistance to friends and/or family members during this time. Mortality rates were assessed through access to public records.
The study revealed that for every major life event, there was a 30% increase in the likelihood of premature death. However, the study also showed that those who provided care for others had no negative health outcomes following a stressful event. In simple terms, caring for others, giving to others and attending to the needs of others promoted incredible stress resilience – principally through oxytocin pathways. Many other studies have been published since, all supporting these findings.
The power of prayer
According to neuro-economist Dr. Paul Zak, a global authority on the effects of oxytocin within the context of economics and consumer behaviour, one of the most powerful triggers in oxytocin release is prayer! The mere practice of prayer is able to promote optimism, trust, generosity, empathy and self-esteem while at the same time lowering blood pressure, cortisol and heart rate – all through oxytocin pathways.
Medical science has reliably shown that chronic stress has the capacity to dramatically affect our health and the quality of our lives. At the same time it continually highlights that positive perception and prosocial behaviour offer stress protection and immeasurable resilience. Creating control within ones life, daily structure, proper health practices, having a strong sense of community, supporting and connecting to others, caring, giving and empathy all independently protect us from the onslaught of those challenges that we face everyday. By incorporating these elements into our lives, not only are we able to promote stress resilience, but also derive benefit from the powerful stress response.
SOURCE : http://www.suttonhealth.co.za/articles/17