The Complete Doctor's Stress Solution: Understanding, Treating and Preventing Stress-Related Illnesses

Penny Kendall-Reed, BSc, ND is a naturopathic doctor specializing in weight loss reduction and health concerns. She appears regularly on ABC, NBC, CTV and Fox Network television and radio health shows.

Dr. Stephen C. Reed, BM, BCh, MA, MSc, FRCSC, is an orthopedic surgeon and a graduate of Oxford University Medical School.

Introduction

CASE STUDY: Not Good News

David rolls over and squints at the alarm clock through tired, blurry eyes. 2:15 am. Feeling too warm, he pushes the duvet to one side and rearranges the pillows to try and get comfortable. Attempting to relax and drift off to sleep once more, he tries to clear his mind of the rapidly invading thoughts: "What will I say at the breakfast meeting? Will I have time to get back for the conference call? Shall I get up early to go over the production figures? What about getting the kids off to day care? Then there's my doctor's appointment in the afternoon for my annual checkup:'

2:45 a.m. Now wide-awake, David is staring at the ceiling, the room lit by the glow of the city below the new condominium. He knows this oh-so frequent pattern will leave him exhausted for the day ahead, cloud his mind and judgment, with only endless cups of coffee keeping him from slumping over his desk mid-morning.

He turns to his wife Sue, "Are you awake?" "Yes," she replies. "I can't sleep with all your tossing and turning!' David gets another hour or two of sleep, but wakes up feeling tired, frustrated, and already looking forward to collapsing into bed the following night

Now up for the day, David stands in front of the full-length bathroom mirror. Inhaling deeply, he sucks in the flesh creeping over the top of his underwear. He breathes out and lets gravity take control of his '1-pack' once more. Only 35 years old, the flat stomach and athletic legs toned during years of football are already a distant memory. David still manages to grab a quick 30 minutes at the gym during lunch, but no amount of crunches, squats, or bench presses seem to slow the loss of muscle tone. Since the birth of his two children, he's had to put an end to the leisurely 5:00 to 7:00 p.m. workout and sauna. Weekends at the new cottage mean a long drive though ever-worsening traffic for the two days of 'rejuvenation', invariably fixing a broken pipe or planting a new tree.

Later that day... Dr. Jones looks up over gold bifocals and shuffles through David's lab results. "Not good news, I'm afraid. Blood pressure is up, cholesterol is high, and you are borderline diabetic!' David's eyes widen. A wife, two children, two mortgages. He is scared. His stress response kicks into gear again. His condition only gets worse

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WHO DOESN'T HAVE STRESS? We all have it, right? Yes! Stress is necessary for our survival. It's perfectly natural, a part of being human. "Complete freedom from stress is death," Dr. Hans Selye commented in his pioneering research into the effects of stress on our health. But too much stress -- or stress that isn't properly managed -- contributes to disease conditions that can lead to our death.

Our response to stress is necessary for our survival. Our bodies are designed to react quickly to stressful situations, either to fend off or flee from danger. This is called the fight-or-flight response. This specific reaction takes place every single time our body senses stress of any kind. It doesn't matter whether the stressful situation is real or perceived, physical or psychological, once our brain interprets a situation as stressful, the reaction is the same. The glands responsible for producing stress hormones can't differentiate between the stress of a wedding or a funeral. They will react in a similar manner to a physical threat, increased workload at the office, financial difficulty, or a relationship problem. Whatever the stressor, the reaction is the same -- the fight-or-flight response.

Caveman vs. Downtown Man

You're probably familiar with the scenario typically used to teach the principles of stress. A prehistoric 'caveman' meanders along, minding his own business, wondering whether to wear the bison or the bearskin loincloth for dinner, when a sabre-toothed tiger leaps out of the bushes. The fight-or-flight mechanism is activated. Adrenaline kicks in, causing the caveman's pupils to dilate, heart and breathing rate to jump, skin to go cold, and hair to stand up. Muscles twitch in anticipation of the next move. Senses are heightened.

The caveman throws a rock (fight), then jumps quickly into a gully (flight), running as fast as he can, powered by the surge of energy from increased levels of blood sugar. By now, cortisol, the major stress hormone, is beginning to rise, supporting the initial adrenaline rush to permit a prolonged reaction to the inherent danger. Cortisol is more potent and longer-lasting than adrenaline, with profound effects at the cellular level.

In just moments, the threat is over. The tiger has stopped pursuing the man, distracted by a passing rabbit, which proves to be a more accessible prey. With a sigh of relief, the danger now past and his cave in sight, the caveman's alarm system turns off. The stress hormones stabilize his body before switching off and returning to normal levels. The fight-or-flight mechanism has worked, enabling survival in the face of danger and restoring his life to normal with no ill effects -- apart from a battered prehistoric ego!

Now, several thousands of years later, 'downtown man', tired from a sleepless night, has already battled with what he perceives as the first stressful situation of the day -- whether to wear the Armani or Prada power suit to the corporate merger presentation -- and is now sitting in traffic, 15 minutes late for work. His mobile phone rings. It's his boss, informing him that if he's late, he might as well not show up at all. No one to fight, nowhere to flee. Reaching to put the phone down, he knocks his coffee over the presentation sheets on the passenger seat. The traffic hasn't moved an inch. Despite the fact that none of this is anywhere near as dangerous as confronting a sabre-toothed tiger, he perceives it as a threat to his employment and his ego. His brain is programmed to interpret such situations as stress.

The primitive areas of the brain and associated hormone reactions involved in the response to stress have not changed much since caveman's loincloth days. The fight-or-flight mechanism kicks into action. The cascade of adrenaline begins in response, followed by longer-lasting cortisol, raising heart rate, blood pressure, and breathing levels. Downtown man sweats, honks the horn, feels rage. He no longer thinks clearly, awash in a recurring cycle of stress hormones.

Unlike the caveman's stress, downtown man's situation does not resolve quickly, and when it does, it is rapidly replaced by another. The stress reaction continually battles to restore the normal biological balance of his body to a 'safe' condition but does not succeed. Eventually, his general health may begin to suffer.

Acute Stress Response Cascade

• Brain perceives danger or threat.
• Sympathetic nervous system initiates fight-or-flight response.
• Heart rate, blood pressure, blood sugar and breathing levels increase.
• Adrenaline supports sympathetic system short term.
• Cortisol sustains fight-or-flight response.
• Once the danger or threat is resolved, the body stabilizes.

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Acute Stress Response

The stress response involves a series of events designed to promote survival in a threatening or harmful situation. In its simplest terms, it works like this. The brain interprets incoming information (sight, sound, smell, touch, etc.) and decides that the body is in danger. Almost instantly, the activity of one of the body's automatic nervous systems (the sympathetic nervous system) increases. These nerves transmit impulses to most organs and tissues in the body so that within seconds, the fight-or-flight response is initiated. This sympathetic system is powered by adrenaline released from the nerve endings and is backed up by rapid release of large additional amounts of adrenaline into the bloodstream by the adrenal glands. The sympathetic system provides a rapid but short-lived response in the stress cascade.

The adrenal glands boost this initial output and then provide a stronger and more sustained reaction. Cortisol, also released from the adrenal glands, is the hormone that drives the majority of the fight-or-flight response, acting on tissues and organs throughout the body, altering metabolism and cellular processes in a way that will benefit the body in the short term to overcome the dangerous situation. Once resolved, the system shuts down, levels return to normal, and the body stabilizes.

Chronic Stress Response

In the chronic stress response, rather than benefiting the body, the fight-or-flight response becomes so overstimulated that two things occur. First, rather than a controlled daily cycle of cortisol release with intermittent peaks, there is persistent secretion. While short bursts of this hormone are essential to normal function (for example, the surge in levels just before getting up in the morning), chronically elevated levels have a severely detrimental effect on most tissues and cells in the body.

Second, the body becomes unable to handle a real emergency. Akin to a hormonal 'cry wolf' situation, truly dangerous circumstances fail to produce sufficient cortisol release from the adrenal glands. The result of these two factors is a body that is overweight, sleep-deprived, poorly muscled, fragile, prone to infection, and often depressed, unable to perform under pressure or handle a difficult or threatening situation or illness.

Continual stimulation of the fight-or-flight response and adrenal cortisol secretion seems to reset the body's 'set' point where biological balance or equilibrium rests. There is now a persistent secretion of cortisol, disruption of the normal daily cycle, development of 'cortisol resistance', and impairment of the feedback mechanism that would normally exert control over the whole system.

This chronic stress condition is surprisingly common. An increasing body of evidence is showing how chronic stress is contributing to disease in the general population.

Metabolic Syndrome

Metabolic syndrome or syndrome-X is well recognized as the association of a number of health conditions in one individual. They include obesity (abdominal), high blood pressure, high insulin levels with insulin resistance, diabetes, high cholesterol, and increased risk of heart attack and stroke. The syndrome affects a large proportion of the adult population of industrialized countries and likely represents the largest single threat to health in the upcoming decade. Initial theories about the development of this syndrome center around diet, and while this is clearly an important factor, evidence is pointing to chronic stress as being the primary cause.

Stress Solutions

Fortunately, chronic stress can be treated and prevented. While the first section of this book further explains the basis of the chronic stress condition based on an extensive review of current scientific research, the second section presents a comprehensive solution to this chronic stress problem, involving a combination of therapies, including diet, supplementation, exercise, physical therapies, and relaxation programs. The third section of the book practically applies this program to specific stress-related disorders and diseases, ranging from diabetes and heart attack to anxiety and depression. The programs presented are relatively easy to implement, safe, and effective. They have been proven in our medical practice and are supported by many of our colleagues in the medical and naturopathic doctor professions.

Most of us cannot immediately or completely change our lifestyles. Stressful situations will continue to bombard us every day. We can, however, change our bodies to handle the stress more efficiently, without detrimental effect to our health. After all, we never know when that sabre-toothed tiger is going to come round the corner. So, we should be ready.

Chronic Stress Response Cascade

• Brain perceives danger.
• Sympathetic nervous system initiates fight-or-flight response.
• Heart rate, blood pressure, blood sugar, and breathing levels increase.
• Adrenal supports sympathetic system short term.
• Cortisol sustains fight-or-flight response.
• Stress is not resolved; the body does not stabilize.
• Persistent, low-level secretion of cortisol.
• Cry wolf response: the body is unable to handle a real emergency.
• Body becomes overweight, sleep-deprived, poorly muscled, fragile, prone to infection, and often depressed, unable to perform under pressure or handle a difficult or threatening situation or illness.
• Metabolic syndrome may result.

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Are You Stressed?

Some people seem to cope with stress better than others, for reasons that aren't always clear. They seem to have a special gift for completely 'turning off' their mental thought processes when they get into bed, despite a very important business meeting they have at 9:00 am. the next day. Other people are not as fortunate -- or relaxed. How many times have you lay awake in bed at night trying desperately to fall asleep? The more you try, the harder it becomes. Then you start worrying about that meeting, exam, or interview the next morning and how you must get some sleep to prepare for it.

The fact that you aren't sleeping becomes yet another stressor and ultimately makes the entire situation worse. If you are lucky enough to fall asleep, you may again find yourself wide awake between 2:00 and 4:00 am. and begin the entire process all over again. You feel and hear your heart beat as you lie there in bed trying to count sheep jumping over the fence. If any of these events sound familiar read on.

Attitudes Toward Stress
Here is a sample of different attitudes toward stress, some more healthy than others.

"I know I'm stressed most of the time."
You have already made it over the first hurdle. You are listening to your body and know you are stressed. You may already know about some of the ill effects that stress causes. This book will both expand your knowledge of stress-related disease and allow you to reduce your own personal stress.

"I'm occasionally stressed, but that's normal."
Being stressed once in a while is definitely part of life, but that doesn't necessarily mean it's healthy. Even brief regular stressful episodes can have a detrimental effect on your well-being, and the likelihood is that many of these stressors remain unresolved, resulting in a low level of chronic, unrecognized stress.

"I don't think I'm stressed"
Of course, we realize there are individuals who remain cool, calm, and collected through all adversity, and they may indeed have their stress response under control. Others may have lifestyles free from the rigors of modern-day life, a perfect family or personal relationships, and a happy work environment

We suspect, however, that these individuals are the exception rather than the rule. Most people who believe they are not stressed have not taken a close look at their life and their health, and are not listening to their body. They attribute their fatigue, recurrent colds, anxiety attacks, and skin rashes to other factors, ignoring the hectic pace at which they live. Recognizing the 'red flags' of chronic stress and learning how illness and stress are related is vital for this category of individual. Having realized that "perhaps I am a little stressed," you can make simple lifestyle changes to enhance awareness of your body's response to stress along with a plan to control it.

"I'm stressed but I thrive on it."
Sound familiar. At the gym by 5:00 a.m. and in the office by 7:00. Lunch on the fly. Leave work at 8:00 p.m., head out for drinks and dinner. Party until 2:00 a.m., then head home for a couple of hours sleep before starting again. With catch phrases like, "I work better under stress" and "I only need 4 hours sleep a night," these individuals are invincible -- or at least they think they are!

No doubt about it, when you're young, your body will put up with more or less anything you throw at it. However, while you seem to be able to cope with stress much better the damage to your health is already being done. Take a look at your boss! Overweight, high blood pressure, diabetes, stomach ulcers? That could be you in 10 years. While, we do not expect you to settle into a middle-aged lifestyle at 22, we hope to institute some simple changes that will keep you healthy so you can enjoy that time when it comes!

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Natural Biological Therapies

Our approach to treating chronic stress can best be called natural biological therapy. The goal is to restore biological balance in the body by altering hormone levels, enzymes, blood sugar, and neurotransmitters in order to re-establish a homeostatic balance. This corrects the physiologic malfunction at the root of stress and thus resolves disturbing physical, emotional, and neurological symptoms.

To achieve this goal, we recommend natural therapies, which include good nutrition, natural supplementation (for example, botanical extracts, vitamins, and minerals), exercise, physical therapies (for example, massage, shiatsu, and yoga), and relaxation techniques to create physiological changes in the body. These treatments all affect the physical body in several ways to solve the problem of chronic stress. Natural biological therapies are some of the easiest to execute from a patient's point of view and are easily incorporated into one's lifestyle.

Natural therapies can be used successfully in conjunction with psychological counseling. Together, these therapies prepare the physical body to address emotional issues, such that harmony is restored both physiologically and psychologically.

While in traditional medical and psychological practice, biological therapy per se includes the use of pharmaceutical drugs, shock therapy, and surgery, we only cover drug therapy in this book.

Stress-Related Diseases and Disorders

The following illnesses have direct links to chronic stress and raised cortisol levels.

• Obesity
• Diabetes
• Heart Disease
• High Blood Pressure
• High Cholesterol
• Infertility
• Insomnia
• Weak Immunity
• Cancer
• Allergies and Asthma
• Osteoporosis
• Arthritis
• Overtraining Syndrome
• Irritable Bowel Syndrome
• Inflammatory Bowel Disease
• Peptic Ulceration
• Migraine Headache
• Fibromyalgia
• Chronic Fatigue Syndrome
• Anxiety and Depression
• Post-Traumatic Stress Disorder

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Stress Checklist

Many people suffer from chronic stress, but do not realize it. They assume their ill health is normal, part of a hectic 21st-century lifestyle. They fail to realize that the longer they live at this pace, ignoring the warning signs of chronic stress, the higher the chances they could have potentially life-threatening consequences.

If any of the following symptoms are familiar, this book is for you. We show you many ways you can help yourself both on your own and with the skill and guidance of different practitioners to restore emotional and physical balance to your body.

• Weight gain principally in the mid-section of your body.
• Waking up tired in the morning despite seemingly adequate sleep hours.
• Difficulty falling asleep, waking between 2:00 and 4:00 a.m., often restless with racing thoughts.
• Frequent irritability with episodes of anger.
• Anxiety attacks.
• Constant worry or fear about life.
• Jaw clenching or teeth grinding.
• Frequent colds and flu.
• Heart palpitations, high blood pressure and heart disease.
• Slow recovery from illness or injury.
• Bowel irritability or irregularity.
• Frequent headaches or migraines.
• Poor concentration and memory.
• Feeling overwhelmed at work or at home.
• Depression or episodes of despair or weepiness.
• Irregular menstrual cycles.
• Reduced libido.
• Difficulty getting pregnant despite normal test results.

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CASE STUDY: ...continued

Good News

David wakes up from a good night's sleep, refreshed and ready to face the day ahead. His decision to take control of his stress was the right one. The moment he left his doctor's office, he had vowed to find out why his health was at risk and do something positive about it. Having recognized chronic stress as a major factor in his physical and mental deterioration, David endeavored to find out as much as possible about this condition and what steps he could take to reverse it.

During our first meeting with David, we explained how chronic stress, even if it is unrecognized, can have an impact on many systems of the body, causing dysfunction and ill health. We also introduced him to the various effective biological therapies he could use to return his body to a stable and healthy state.

David started the '8-Week Stress Solution Program' described in this book. He began a naturopathic diet for stress management, supported by a number of 'anti-stress' supplements, including vitamin B complex, calcium-magnesium, hydrolyzed milk peptide, and essential fatty acids. He changed his exercise routine so that he only worked out three times per week, but these were at a higher intensity than his previous daily efforts. On the other days, he followed a stretching routine and performed deep-breathing exercises, following a simple program laid out in this book. He began regular weekly bodywork sessions, alternating aromatherapy and reflexology. He also followed the meditation guide described in this book. Simple lifestyle changes, such as listening to relaxing music and taking a lavender bath, enhanced his stress reduction program.

David never had to start medication for blood pressure, cholesterol, or diabetes. He is back at his university football weight and allows a smile to creep across his face as he checks out his rediscovered abdominal muscles in the mirror. He is calmer, more productive. He finds he has more time and energy for his children. His relationship with his wife is better than ever.

A simple daily program deals with regular day-to-day stresses, and while life is still hectic at times, with unexpected stresses appearing at the most inopportune moments, he now knows how to deal with them. And they pass. David is looking forward to a healthy future.

Introduction

1. The Stress Problem

Stress Systems

• Role of the Stress Response
• Nervous system
• Endocrine System
• Hypothalamus-Pituitary-Adrenal Interactions
• Summary

Stress Response

• HPA Axis
• Daily Cortisol Cycle
• Fight-or-Flight Response

Chronic Stress

• Cortisol Levels
• Adrenal Fatigue
• Central Stress Response
• Theories of Chronic Stress
• Summary

2. Stress Solutions

Anti-Stress Diet

• Nutrition Basics
• Diet and Stress
• Naturopathic Diet
• Caffeine and Stress
• Alcohol and Stress

Anti-Stress Natural Supplements

• Selecting and Combining Supplements
• Vitamins
• Minerals
• Herbs
• Amino Acids
• Other Anti-Stress Supplements

Anti-Stress Exercise Therapies

• Exercise Basics
• Stretching Exercises
• Strength-Training Exercises
• Cardiovascular Exercise

Anti-Stress Physical Therapies (Bodywork)

• Finding a Bodywork Practitioner
• Massage Therapy
• Aromatherapy
• Reflexology
• Acupuncture
• Rei-Ki
• Shiatsu
• Craniosacral Therapy
• Yoga
• Tai Chi

Anti-Stress Mental Therapies

• Relaxation Techniques
• Counseling

Anti-Stress Medication

• Antianxiety and Antidepressant Drugs
• CRH-Receptor Blockers

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8-Week Stress Solution Program

Four Stages

Program Components

• Naturopathic Diet
• Natural Supplements
• Cardiovascular Exercise
• Physical Therapy
• Relaxation Techniques

8-Week Program

• Stage 1 (Weeks 1 and 2)
• Stage 2 (Weeks 3 and 4)
• Stage 3 (Weeks 5 to 8)
• Stage 4 (Maintenance)

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3. Treating and Preventing Stress-Related Disorders and Diseases

Diabetes

• Treatment Program

Cardiovascular Disease

• Hypertension
• Treatment Program
• Heart Attack
• Treatment Program

Gastrointestinal Disorders

• Irritable Bowel Syndrome
• Treatment Program
• Inflammatory Bowel Disease
• Treatment Program
• Peptic Ulceration
• Treatment Program

Immune System Disorders and Allergies

• Immunity Disorders
• Treatment Program
• Allergic Response
• Treatment Program

Musculoskeletal Disorders

• Overtraining Syndrome
• Treatment Program
• Osteoporisis
• Treatment Program
• Arthritis
• Treatment Program
• Low Back Pain
• Treatment Program

Reproductive Disorders

• Infertility
• Treatment Program
• Irregular Menstruation
  
• Menopause
• Treatment Program

Sleep Disorders

• Treatment Program

Chronic Pain Disorders

• Migraine
• Treatment Program
• Fibromyalgia and Chronic Fatigue Syndrome
• Treatment Program

Anxiety and Depression

• Panic Attack
• Treatment Program
• General Anxiety Disorder
• Treatment Program
• Post-Traumatic Stress Disorder
• Treatment Program

Glossary
References
Index