Growing up in Long Island as the daughter of a high-powered New York state judge, Dr. Karen Koffler was accustomed to one lifestyle: the fast lane. She started her medical career in high gear as an intensive-care physician.
Then everything changed during her first week of a fellowship with the famed Dr. Andrew Weil and his integrative-medicine program at the University of Arizona in Tucson. But it didn’t change because Koffler was there to learn about meditation, visual imagery and other holistic health techniques that help control stress. It was because she got a speeding ticket.
“Nobody gets caught for speeding in Tucson,” said Koffler, director of the integrative-medicine program at Evanston Northwestern Health Care. “You have to pay a $200 fine and are required to attend a daylong driving school on a Saturday.
“I decided right then, in driving school, that I was going to change. Now I am one of the most relaxed drivers you’ll ever see. The aggravation and stress [of traffic or getting to your destination] just isn’t worth it.”
Most drivers would like to say the same about their behavior. Truth is, stress usually wins out on the roadways–and pretty much everywhere else in life. Stress is in constant gear in our society and even more revved up with the events of the last month.
Stress is driving personal health more often than not. A big reason is because we don’t stop long enough to realize the damage that stress causes our bodies.
A common problem
Research shows about 75 percent of Americans say they experience “great stress” on a weekly basis. That’s up from the 55 percent reported in the same independent study commissioned by Prevention Magazine in 1983. The federal Centers for Disease Control and Prevention estimates that 70 percent to 80 percent of our health-care dollars are spent on stress-related disorders.
The statistics are not surprising. Americans know they are stressed out. They spend billions on potential remedies ranging from decaffeinated coffee (a $1 billion annual business) to anti-anxiety pills ($2 billion) to books and workshops ($42 billion).
Yet the stress epidemic stays on record pace. It’s likely the term “adrenal burnout” is about to become a household term. In her new book “Tired of Being Tired” (G.P. Putnam’s Sons, $24.95), Dr. Jesse Lynn Hanley details the five stages of adrenal burnout as “driven, dragging, losing it, hitting the wall and burned out.” She argues that many Americans are exhausting their adrenal glands in their 40s and 50s.
Education leads to control
“Adrenal burnout is crisis mode,” she said. “You cannot get out of bed. You are snapping at the ones you love. Your creativity is long gone. . . . Everything you do is a major effort.”
Koffler explained that learning more about what stress does to your health is an important first step to controlling it.
“I spend a lot of time with patients explaining what mechanisms are at work when we live with chronic levels of stress,” said Koffler, whose integrative-medicine practice is in Glenview. “The adrenal glands are constantly responding and revving up our cardiovascular and immune systems.”
Such a boost is positive in the short term–for getting out of bed, preparing for a major presentation, meeting a blind date, hitting deadlines, to name a few–but a constant state of stress is decidedly negative.
“Lots of people are getting out of bed, immediately get their lists going, fighting traffic, trying to make all of their appointments, then fighting traffic to get home and maybe arguing with a spouse or kids when they get there,” Koffler said. “That’s their day.”
What happens under such chronic stress is the body makes an abnormal amount of the stress hormones, cortisol and adrenaline. They are both secreted from the adrenal glands, a tiny pair of triangular glands that rest above each kidney. The brain sends out neurological messages to these glands (each one is no bigger than two or three pinto beans) to produce cortisol and adrenaline, which in turn affect virtually every bodily function.
The brain signals the adrenal glands in proportion to the intensity of a situation, Hanley explained. The “fight-or-flight” reaction one learns about in Psychology 101 is associated with the response of early humans when encountering a life-threatening animal and trying to decide whether to stay for the fight or flee.
We inherited the same basic mechanism in our bodies today, even though few of us are facing any wild animals in our daily schedules. Instead, we have an adrenal response to any situation that requires intensity and creates tension. It could be from hearing criticism in a meeting or scrambling back to a curb if a car runs a red light.
Cortisol is highest in the morning as the body manufactures it in the last few hours of sleep. Best-case, cortisol drops steadily until bedtime, allowing you to unwind and sleep soundly. Problems start with worst-case days, in which cortisol (and adrenaline) stays too high. This elevated level of cortisol and adrenaline can suppress the immune system and mobilize fat and cholesterol in the bloodstream.
One result is an unhealthy constriction of the arteries, including and especially when the heart is at rest.
“Basically, the person is suffering from a relative state of oxygen deprivation,” Koffler said. “Chronic stress reduces the flow of blood, oxygen and nutrients to the muscles and organs, including the heart and lungs. It also inhibits the body’s ability to clear toxins from cells.”
Disturbing physical effects
Although we tend to think of stress as an emotional component of health, doctors and scientists are clearly finding significant and disturbing physical effects on the cardiovascular and immune systems.
“People under stress experience increased blood pressure, heart rate and respiratory rate,” said Dr. Benjamin Fusman, a cardiologist at the University of Chicago. “There is also a change in the blood platelets; they tend to be more sticky, and that’s when people can develop heart attacks.”
Fusman would know. He is an interventional cardiologist, which means his specialty is performing procedures on heart-attack victims.
“It’s amazing how many patients present at the hospital with a heart attack after a fight with their spouse,” Fusman said. “The sudden surge of stress can release hormones that can cause a heart attack in people with coronary plaque that is predisposed to rupture.”
Bad habits increase risks
Interpretation: If you lead a sedentary life, eat too much saturated fat, don’t get enough sleep and subject yourself to constant stress, these risk factors can align in a dangerous fashion. Same goes for someone with a family history of premature cardiovascular disease.
The last 15 years of stress research identifies some of the more serious consequences of holding in our anxiety. One of every five healthy people responds to stress in a manner destructive to the cardiovascular system (it’s one of two for anyone with high blood pressure). Stress causes cholesterol levels to increase as much as, and sometimes more than, dietary habits do.
Depression is more closely linked to stress than to genetics, and depression is up threefold among young people since World War II (adjusting for the population boom). What’s more, one preliminary study published this year indicates that higher stress levels at work cause increased back, shoulder and wrist pain. Another 2001 paper links stress to a delayed ability for skin to heal, while University of Michigan researchers report the increased blood pressure of chronic stress can lead to a higher risk of stroke.
Interestingly, although dramatic danger prompted early humans to pump adrenaline through their bodies, it appears drama of any sort spurs modern-day stress. The renowned Holmes-Rahe Life Changes Stress Test (see chart accompanying this story), first developed nearly 40 years ago, quantified stress levels of both negative and positive events. For instance, getting married and getting fired are considered comparable in creating higher levels of cortisol and adrenaline. Same goes for pregnancy or serious illness in the family.
Avoiding the `drama’
Koffler said the key to managing your stress–rather than the unrealistic and unwanted goal of eliminating it completely–is not to “get involved in the drama” whenever possible.
“Whatever you do for relaxation should allow you to regain perspective in a situation by becoming aware of your body,” Koffler said. “Watching TV doesn’t cut it, even if it is sports or entertainment. You are still engaged and not in touch with your breathing, for example.
“We work as a team at our integrative-medicine center, with Chinese medicine practitioners, body workers, an art therapist and imagery teacher, nutritionist and yoga therapist. Each one of us has a contribution to make for a patient’s healing. But we all come together on the one big health piece for all patients–how they manage stress or what I sometimes call the `insults of life.’ It’s critical.”
How to manage stress
Once we discover what stress does to the body, we need to develop a management plan. You can’t eliminate stress, nor do your want to, but you can contain it and make it work for you. Here are some techniques:
– Regular exercise: Everything from aerobics to weight lifting to yoga will contribute to less stress. Be careful about competitive sports; you can create stressors by aiming too high with opponents. Some individuals cause undue stress by competing with themselves to better times or distances.
No one can motivate you to be more physically active but yourself. University of Chicago cardiologist Dr. Benjamin Fusman says he sees too many heart-attack patients return for other emergency procedures. On the other hand, he is always gratified when a patient takes his advice on positive lifestyle changes. One 40-something man who had a heart attack on the same day his mother died (he recovered in time to make the funeral) decided enough was enough: Following Fusman’s plan for regular exercise and low-fat eating, the man lost 40 pounds and continues to be physically active.
– Breathe into it: Dr. Karen Koffler, director of integrative medicine at Evanston Northwestern Health Care, recommends a simple yet effective breathing-relaxation technique she learned from Dr. Andrew Weil, the best-selling author and pioneer of natural health. Called “4-square,” it suggests inhaling on a count of four, then holding for a count of four, next exhaling on a count of four and finishing with holding for a count of four. You can repeat three times in any stressful situation and experience noticeable physiological changes in less than a minute.
“I always ask people when was the last time they completely relaxed,” Koffler said. “This technique creates space for even a brief moment. You just don’t re-enter a stressful situation with the same level of aggression.”
– Condensed worrying: William T. Riley, a psychologist at the Medical College of Virginia in Richmond, suggests setting aside a half-hour each day for concentrated fretting. His concept is that the worry will be exhausted after 30 minutes of dwelling on it.
– Put it into words: Some researchers and psychotherapists say that simply talking about your stressful situation with a friend can help you control anxiety. Writing in a journal is another stress-busting option.
– Take a break: Rest is highly underrated. Sleep rejuvenates the immune system and protects it from stress damage. Getting up from your desk for 5 or 10 minutes is a simple but effective stress-fighter. Newer research from the University of Chicago points out that sleep deprivation can be highly taxing on the cardiovascular systems of young, healthy men in just two weeks.
– Planning: Setting goals and staying organized can reduce stress. Just don’t make your plans inflexible or unrealistic.
– Other ideas: Relaxation techniques run the gamut: meditation, breathing exercises, progressive muscle relaxation, tai chi, massage, listening to soothing music. Start by adding 5 to 10 minutes of any relaxation activity to each day, and work your way to a half-hour.
“What works is any activity that allows you step out of stressful situations and go inward,” Koffler said. “The goal is to reach a state of deep relaxation–I compare it to the physical feeling we have upon waking up but before we are completely awake. One you feel this deep relaxation, you will know what is truly a relaxation technique and what’s not.”
–Bob Condor
STRESS SCORE
Two famous researchers, R.H. Rahe and T.H. Holmes, developed this stress scale nearly 40 years ago. It is still widely used to make the point that stress can be caused by both positive and negative events in our lives.
2 POINTS
Minor violations of the law
3 POINTS
Change in sleeping habits
Going on vacation
Christmas
Change in eating habits
Change in social activities
Change in church activities
Change in recreation
5 POINTS
Moving back home
Changing schools
Making extensive home improvements
Job under threat
Change in work habits/conditions
Spouse begins or stops work
6 POINTS
Child leaving home
Starting or leaving school
Arguments at work/home
Rapid promotion
Jet lag (twice or more)
Minor illness/injury
Large mortgage
Debt problems
7 POINTS
New job
Foreclosure of mortgage or loan
Change to different type of work
8 POINTS
Sexual problems
Death of close friend
Marked change in financial situation
Demotion at work
9 POINTS
Pregnancy
Illness in the family
Retirement
Job layoff
11 POINTS
Major personal injury or illness
Marriage or reconciliation
Getting fired
15 POINTS
Divorce
Death of close family member
Being sent to jail
20 POINTS
Death of a spouse
TOTAL
If the total is greater than 40, you have a high risk of developing a stress-related illness or exhaustion.
