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Posted on Sun, Apr. 11, 2004

Researchers look inside the stressed-out

By Jane E.

LOS ANGELES TIMES

As a high-level executive for a large computer manufacturer, Dan

Bishop was a self-described workaholic who thought he was ably

juggling daily demands and corporate pressures.

Then he woke up one night with tightness in his chest, barely able to

breathe. At first he suspected a heart attack.

The tightness quickly passed, but he was frightened enough to see his

doctor.

The doctor diagnosed an anxiety attack, caused by stress, and told

him to " stop being so driven. "

" I didn't know what stress was; I didn't think I had stress, " said

Bishop, now 52, referring to the 1990 diagnosis.

As Bishop found, stress can be insidious.

The pressures of daily life -- jobs, relationships, money, raising

children and now, war and terrorism -- have become such constant

companions that many of us operate with ever-present feelings of

pressure, anxiety or burnout.

The stress can become so unflagging that many people have accepted it

as a standard part of life.

Although we may try to ignore its presence, stress doesn't go away.

It just goes to work inside the body.

Prolonged stress contributes to many physical and psychological ills:

• It overrides natural defenses against viruses that cause AIDS,

chickenpox and the common cold.

• It encourages the production of inflammatory hormones that drive

heart disease, obesity and diabetes.

• It sparks flare-ups of rheumatoid arthritis and digestive disorders.

• It creates depression and ages the brain.

" Numerous studies show that psychological stress can lead to illness,

or even death, " said Dr. Irwin, director of the Norman

Cousins Center for Psychoneuroimmunology at UCLA's Neuropsychiatric

Institute.

" How we cope with stress and whether or not we get depressed is

crucial for our health. "

Unchecked stress sends out complex signals that unleash a cascade of

activity throughout the body.

When someone is confronted with stress, whether physical or

psychological, the brain is the first part of the body to respond,

reacting in two distinct ways.

In one of the reactions, a regulatory part of the brain called the

hypothalamus sends signals through sympathetic nerves near the spinal

cord to the adrenal glands, commanding them to release the stress

hormones epinephrine and norepinephrine (also called adrenaline and

noradrenaline).

These hormones gird the body for action.

They boost heart rate, blood pressure, breathing and blood flow to

the muscles and brain, providing an extra surge of energy in times of

physical danger.

They can also keep athletes, entertainers and others on their toes,

keeping them alert and productive when performance counts.

But chronic stress opens the floodgates to epinephrine and

norepinephrine, regardless of whether there's a threat, allowing

bacteria, viruses or tumors to flourish and making blood more prone

to clotting.

The brain's other reaction comes through the pituitary gland, which

sends signals through the bloodstream instructing the adrenal glands

to release the stress hormone cortisol and other steroids.

In the right amounts, cortisol helps the body recharge, enhances

disease resistance, fights inflammation and improves memory.

In excess, however, cortisol promotes the accumulation of abdominal

fat, suppresses immunity, shrinks brain cells and impairs memory.

Over time, cells become less sensitive to the protective effects of

cortisol, and inflammation goes unchecked.

Scientists are only now beginning to understand what happens when

stress disrupts the delicate interplay between the brain, the

endocrine system -- the glands and organs that make and release

hormones -- and the immune system, stimulating the release of

compounds that cause inflammation.

They're beginning to identify ways to stop this inflammation and

other stress-related biological effects, too.

" New treatments that teach us ways to relax and cope with daily

stress offer great promise in decreasing the risk for many

preventable illnesses, " Irwin said.

Recent research has identified some of the following ways in which

stress influences the course of illnesses linked to viruses, aging or

the body's misguided attack on its own tissues.

Physical or mental stress can take an enormous and sometimes deadly

toll on the heart.

It increases blood pressure, narrows blood vessels and causes blood

to become stickier and more likely to clot, increasing the likelihood

of a heart attack or stroke.

In February, Irwin published a study in the American Journal of

Psychiatry showing that stress and depression in heart attack

patients increase amounts of chemicals that make certain immune cells

sticky and help them travel to artery linings, where they produce

inflammation and promote coronary artery disease.

A study published last week in the journal Circulation found that

mental stress also triggers irregular heartbeats, which can be deadly.

Stress can certainly give you butterflies or a stomachache, but

chronic stress can trigger flare-ups of irritable bowel syndrome, an

intestinal condition that includes cramping, gas, diarrhea and

constipation.

Women with the condition (who vastly outnumber men) not only have

elevated levels of cortisol, but they have exaggerated differences

between the higher morning and lower evening levels found in healthy

people, Italian researchers reported in 2001.

Although stress is no longer believed to cause ulcers (they're

sparked by an infection of the bacterium H. pylori), it can worsen

symptoms.

HIV-infected gay men who keep their sexual orientation secret get

sicker and have shorter life spans than gay men who are more open

about their sexuality, a 1996 study found.

Closeted gay men tend to be shyer and their nervous systems overreact

to stress; as a result, their bodies pump out more stress hormones,

which encourage the virus to multiply.

Steve Cole is an assistant professor of medicine at UCLA who

conducted the 1996 study as part of his research into how disease-

causing organisms respond to stress.

He further reported in the December 2003 issue of Biological

Psychiatry that these more stress-sensitive men had higher levels of

the AIDS virus in their blood and didn't respond as well to AIDS

drugs.

Cole and his colleagues found that an excess of stress hormones makes

it easier for HIV to get into cells and reproduce more quickly, while

suppressing production of chemicals that would protect cells from the

invasion.

People who suffer from this autoimmune disease of the joints already

have high levels of hormones called inflammatory cytokines, which

cause swelling, pain and inflammation.

Stress and depression, which can intensify pain and create more

physical limitations, further increase those levels, according to a

study in the March issue of the Journal of Rheumatology.

As their understanding of the biochemistry of stress increases,

scientists around the country are developing and testing ways to

protect the body from its ravages, using yoga and meditation,

psychotherapy and medications, and even experimental devices.

Among the simpler interventions that hold the most promise is tai

chi, a centuries-old Chinese exercise often described as " meditation

through movement. "

In a study of adults older than 60, UCLA researchers found last year

that one type of tai chi improves immunity to shingles, a painful

nerve disease caused by the reemergence of the chickenpox virus.

Medications may also prove effective at blocking the destructive

effects of stress hormones.

For example, Cole and his colleagues have just started a study in

which they're giving beta blockers, which are typically prescribed

for hypertension and heart disease, to HIV patients.

The drugs should block the ability of stress hormones to make HIV

multiply, the researchers say, thus lowering viral loads.

Other medications, such as antidepressants and anti-anxiety drugs,

alter the brain biochemistry that makes some people overreact to

stress.

Dr. Tracey, head of the Center for Patient-Oriented Research at

the North Shore-Long Island Jewish Research Institute in Manhasset,

N.Y., has been using vagus nerve stimulation to decrease inflammation

in disorders aggravated by stress, including rheumatoid arthritis.

The vagus nerve controls involuntary functions such as heart rate,

respiration, digestion and bladder function.

Stimulating the vagus nerve to slow the heart rate, in this case with

a pacemaker-like device, is also the basis of biofeedback and

meditation.

Researchers at several institutions are experimenting with rapid

transcranial magnetic stimulation, which delivers electromagnetic

waves through a device placed against the roof of the mouth, to treat

anxiety attacks and other manifestations of chronic stress.

But, cautioned Dr. Rosch, president of the American Institute of

Stress in Yonkers, N.Y.: " Just as stress is different for each of us,

there is no stress-reduction strategy that's a panacea. "

As for Bishop, he first tried psychotherapy and the anti-anxiety

medication BuSpar to reduce the stress that triggered his first panic

attack.

He even tried changing jobs, becoming a consultant.

But the stress followed him; as his workload grew, he started getting

shortness of breath again.

Finally, he took a friend's advice and tried biofeedback, a mind-body

approach that harnesses people's ability to improve their health

using signals from their own bodies.

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