DESIGNED TO SAVE US, BUT NOW IT’S KILLING US?

Aug 26, 2016

IMAP Beyond the Gym: The Stress Response

By Vincent Cambrea and Bev Browning

Stress is a life-saver.  No question about it.  When life and limb are threatened, stress is your primal first alert that you’re about to die if you don’t get moving. The will to survive is hardwired into your DNA, so your brain and body shift instantly into warp-drive to save your life. For three solid minutes of screaming terror, you’ll have more laser focus and explosive power than a superhero—plenty to outrun a lion.

Instant access to this much energy is a miraculous and complex partnership between the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS). They join forces in a circuit to mount a survival campaign of choice: fight, flight, or freeze. It’s called the “Stress Response.” And although it varies in degree among people, depending on heredity, it’s universal.  We’ll give you the short list of the sequence. All this happens within nanoseconds, so prepare to be amazed.

  • Heart rate increases.
  • Arterial pressure increases.
  • Blood is shunted away from the viscera and into the brain (for judgment) and large muscles (for power and strength).
  • Metabolism increases.
  • Carbohydrates form from proteins and fats in the liver for fuel.
  • Glycogen converts to accessible energy.
  • Muscles get stronger and more agile.
  • Brain is lit up.
  • Reaction time speeds up.
  • Digestion shuts off.
  • Pupils dilate.
  • Mood, memory, and motivation are stimulated in the hippocampus.
  • Pain response is diminished, if not eliminated.
  • The amygdala of the brain signals actual fear.
  • All hormonal systems regulating growth, reproduction, metabolism, and immunity are switched off (all beside the point when one is in danger of being eaten).
  • Kidneys recalibrate urine formation and output so that if the body requires more plasma volume, it has it.
  • Blood prepares to coagulate (just in case all this fails and the lion outruns the human).

SO, IF THE STRESS RESPONSE WAS DESIGNED TO SAVE US, WHY IS IT KILLING US?

The problem is that stress and the perception of stress are the same as far as the nervous system is concerned. We’re taking that entire bolus of chemicals and hormones—intended to save us from lions—and pumping it into a body seated in an air-conditioned, leather-seated Lexus doing 35 mph on the interstate because some idiot has slowed the right lane down to sludge. The driver stuck in traffic is not in danger of dying, but frustration, rage, and the pressure of being late ramp up the stress response and the body is now flooded with cortisol (hydrocortisone or glucocorticoid), and catecholamines like epinephrine (adrenaline) and norepinephrine.  We now have a full-blown stress response, but no way to use all the benefits.  With this much chemical firepower unleashed in a body continuously and no way to use or dissipate it, dangerous and measurable things start to happen.

Dennis H. Novack, who studied the link between emotions and health at Drexel University College of Medicine in Philadelphia, notes, “There is no such thing as a separation of mind and body. The very molecules in our body are responsive to our psychological environment.”  Once we perceive stress, we’re under stress for real.

And it can get even more complicated than that. Stanford University neurobiologist and expert on stress, Robert Sapolsky, explains that humans are very sophisticated cognitively. This gets us into trouble because we are able to anticipate stress and get ready for it. For example, if a gang of thugs approaches us on the street, we kick on our own stress response mechanism well before we have to defend ourselves. We’re awash in stress hormones without any real physical demand for energy. If the gang passes us by (and they probably will), we’re left to stew in our own juices. Literally. This is the same mechanism that creates anxiety – the anticipation of imagined threat, not real threat itself.

To state the self-evident, life is full of stressors – real and imagined and anticipated -and very few lions. So, most people in industrialized societies walk around in a never-ending stew of stress hormones and chemicals. We don’t need lions to kill us. Stress itself becomes the killer within. And worse than all that, our culture teaches us actually to admire the stressed-out multi-taskers who live on caffeine and thrive on the edge. They get more done. Their lives are more interesting. Frankly, they need to get more done and be as interesting as they can, because they’re not going to be with us for long. Let’s look at the consequences of prolonged stress:

Digestive Disorders – Stress hormones slow the release of stomach acid and the emptying of stomach contents. At the same time, they stimulate the colon to speed up. (This is where we get the expression, “It scared the crap out of me.”) Long-term GI dysfunction is common.

Fat Gain – The continuous infusion of cortisol changes the way body fat is distributed and causes an increase of abdominal fat—the dangerous fat that also produces hormones. If you see an apple-shaped person, it’s possible you’re seeing a manifestation of stress. The National Institutes of Health report that continuous high levels of cortisol not only encourage the body to hold onto and store fat, but also stimulate appetite and lead people to overeat at night, contributing to fat gain.

Inflammation and Compromised Immune System – Cortisol suppresses the immune system, making a person more susceptible to bacterial and viral infections, fatigue, and fungus like yeast. When the body is under assault, it releases substances that cause inflammation, a primary risk factor in coronary heart disease. Additionally, the immune system of a stressed individual has a diminished ability to respond to vaccination, so even a physician might not be able to protect a person from disease.

Accelerated Aging – Stress literally wears a human being out according to researcher Thomas von Zglinicki, expert on aging and professor of cellular gerontology at Newcastle University in the United Kingdom. Stress alters human DNA, specifically the telomeres that protect and stabilize the ends of chromosomes. Telomeres are involved in regulating cell division. They shorten each time a cell divides over a lifetime until they are devitalized and then gone, causing the normal onset of age-related symptoms and disorders, including death. Stress accelerates their destruction, shortening life. It is thought that the stress-related acceleration can take as much as a full decade off an expected lifespan.

Increased Free Radicals – A human under the relentless assault of stress produces an increase in free radicals. Free radicals are molecules in the body, usually of oxygen, that have lost an electron. The free radical goes in search of electrons to steal. When they find one, they attack a molecule and snatch an electron. The raided molecule is crippled and can no longer function properly. It can even die. When a human is under stress and unleashing free radicals, the pituitary then stimulates the adrenal glands that pump cortisol, epinephrine, and norepinephrine. The resulting chemical reaction produces even more free radicals. It’s a double dose that damages cells, and is thought to contribute to risk factors for cancers and accelerated aging.

Lengthened Healing Time – Dr. Esther Sternberg, director of the Integrative Neural Immune Program at the National Institutes of Health, reports that people under stress don’t heal or recover as quickly as other people (even from a workout).

Impaired Cognitive Function – Dr. Bruce McKuen, Director of the Neuroendocrinology Laboratory at Rockefeller University, points out that the hippocampus of the brain is the center for learning and memory, and chronic stress changes these brain circuits and actually damages brain cells. He says that a stressed individual forgets things he knows perfectly well. The constant release of glucocorticoids “makes you stupid.”

Some Common Stress-Related Maladies

  • Rashes, hives, and acne
  • Tension headaches
  • Migraines
  • High blood pressure
  • Cardiovascular diseases
  • Elevated triglycerides
  • Elevated cholesterol
  • Elevated blood pressure
  • Elevated heart rate
  • Strokes
  • Sleep disorders, including insomnia
  • Social disorders
  • Bowel disorders
  • Irritability
  • Lack of energy
  • Lack of concentration
  • Eating disorders – eating too much or too little or not at all (anorexia)
  • Anger
  • Depression and anxiety
  • Asthma
  • Stomach cramping and bloating
  • Diabetes
  • Neck and back pain
  • Memory loss
  • Impaired cognitive ability
  • Diminished libido
  • Inability to ovulate or menstruate (women)
  • Diminished testosterone (men)
  • Cushing’s syndrome
  • Chronic fatigue syndrome
  • Autoimmune diseases like lupus or rheumatoid arthritis

While the list of physical ailments is impressive (in a horrifying way), the centerpiece of stress-related disorders is an uneasy, unhappy, unhealthy human.

PASSING STRESS TO THE NEXT GENERATION AND BEYOND

Paul J. Kenny, PhD, neuropsychopharmacologist and Associate Professor in the Department of Molecular Therapeutics at the Scripps Research Institute, gives us another compelling reason to get stress and stress related dysfunctions under control now. His research reveals that damage to DNA due to long-term stress is passed along to one’s offspring. While a stressed parent’s children will certainly be reared in a family culture of stress that will affect them for life, the biological consequences are more far-reaching. They appear to skip one generation. So the genetic propensity toward stress-related diseases, abdominal obesity, and “addictive behaviors” that are not so healthy might show up in grandchildren. If ever there was a reason to get lifestyle under control, it’s responsibility to not pass misery beyond one’s own generation. 

STRESS AND CONTROL

When you understand the insidious toll stress takes on us, it seems a logical strategy to identify the sources and eliminate them or learn to cope. But life is rarely so simple. And frankly, stress is proving to be more elusive and deceptive a stalker than any of us thought. The work of Dr. Robert Sapolsky might have revolutionized the way we look at stress individually and as a society. Sapolsky is a professor of Biological Sciences, and professor of Neurology and Neurological Sciences and, by courtesy, Neurosurgery, at Stanford University in California. For four months every year, he spent over thirty years in Kenya, observing and examining baboons, whose behavior and culture mirror humans’ in many ways.

As Sapolsky observed, the baboon troop he followed was a brutal community, where females, juveniles, young males of low rank, and any weak member got bullied or beaten mercilessly by anyone bigger and stronger or higher ranking – apparently just for the fun of it.  And when someone took a drubbing, he turned around and looked for some other, even more vulnerable baboon to torture. Brutality and cruelty constantly trickled down from the top through the troop to those members who were least able to defend themselves.

As Sapolsky anesthetized and examined individual baboons in this threatening, violent, power-driven tumult, he discovered that they exhibited all the classic hormonal and physiological symptoms of stress. Over years of time, the symptoms increased and intensified. Additionally, he documented that the more stressed the baboons were, the more fat they carried in their abdomens. It appeared that the physiological changes triggered by chronic stress even affected the way a baboon stored fat: more and in the middle (known in humans as the “apple shape”). Remember, abdominal fat is dangerous; it functions like an organ in the endocrine system and produces hormones on its own.

He also discovered something fascinating and significant to any human paying attention: The lower the rank within the troop, the higher the physiological evidence of stress.  Conversely, the higher the rank, the lower the stress. To sum it up: Those who are forced to submit = high stress. Those who dominate = low stress. Arguably, “It’s good to be the king.”

The findings regarding hierarchy, power, and stress among the baboons are substantiated in many other studies—among them, the Whitehall studies in the United Kingdom. The first longitudinal Whitehall study was set up in 1967 by Professor, Sir Michael Marmot. It followed 18,000 male civil servants, the rank-and-file backbone of British government workers. This was the perfect population to study because they all had safe, stable jobs with income and equal access to quality medical care, so two significant variables in the health equation were eliminated.

The study demonstrated that men in the lowest employment grades didn’t live as long as their superiors, but this disparity couldn’t be explained with usual risk factors like smoking. In 1985, the Whitehall II study was launched. It included 10,038 workers (this time nearly 1/3 women) and examined, among other things, the significance of psychosocial factors such as work stress, the perception of unfairness, and work-family conflict to socio-economic inequalities in heart disease and diabetes. The first Whitehall study and the Whitehall II study corroborate Sapolsky’s findings: low rank means high stress, more disease, more serious disease, and shorter life span. Chronic stress, the killer of both Sapolsky’s baboons and the workers in the Whitehall studies, has a common theme: lack of control.

To quote from the Whitehall conclusions:

A way of thinking about stress at work that more closely accords with people’s experience is that it results from an imbalance between the psychological demands of work on the one hand and the degree of control over work on the other. Many jobs involve high demands. It is not demands themselves that are the major cause of illness although high demands are independently associated with ill health. It is the combination of high demand and low control.

(Excerpted from “Work, Health, and Stress – the Whitehall II Study” published 2004 by Public and Commercial Services Union on behalf of Council of Civil Service Unions/Cabinet Office. Available in its entirety: http://www.ucl.ac.uk/whitehallII/history)

MITIGATING THE NEGATIVE EFFECTS OF STRESS WITH EXERCISE

Short of moving to Utopia, most people have no choice but to cope with stress. No question, some of us are better at it than others. There are a lot of strategies, but IMAP Training concentrates on making wise choices in lifestyle: eating well, drinking plenty of water, getting sufficient rest, positive thoughts, and exercising. Let’s talk specifically about exercise.

Exercise improves glucose tolerance and insulin sensitivity, dyslipidemia (abnormally high levels of fat in blood), and hypertension, and diminishes abdominal fat. It lowers triglycerides and cholesterol. The process is not complicated and is fairly consistent and predictable in results. When muscle mass increases, the body has an increased capacity for oxidizing fuels, increasing basal metabolism, dropping fat and mobilizing energy. An exercising, fit human reconnects with his natural design and the physical and neural patterns laid down by his ancestors to ensure survival and recover from stress. In other words, an exercising body begins to function as nature intended it.

The benefits of exercise go far beyond the physical and physiological. Researchers conclude that exercise actually enhances the ability to think clearly, and reduces stress-related disorders like anxiety and depression by raising levels of serotonin and dopamine (the brain’s signal that something really good is available) and releasing endorphins, the feel-good hormones.

How? There are a number of simple theories posited by Chantal Gosselin and Adrian Taylor in their research for Stress News. Our guess is that they are all valid:

  • Cognitive Behavioral Theory – Mastering the exercises creates self-esteem.
  • Social Interaction Theory – Being with other people is stimulating and fun.
  • Distraction Theory – It’s healthy to be away from the source of stress and do something different.
  • Cardiovascular Fitness Theory – Being fit enhances health and wellbeing, and a person feels better. (The reasons are many.)

TURNING (PREVIOUSLY) BAD HABITS INTO GOOD ONES: WORKING OUT

Paul J. Kenny from the Scripps Research Institute is adamant that exercise is the antidote to stress and the “unbelievable answer to replacing bad habits.” Getting to the gym should be a no-brainer. But as we all know, it’s not. Dr. Kenny understands why. He wisely notes that exercise is not immediate gratification. So a client considering an exercise program will have to use willpower to overcome deeply engrained habits that to date have prevented him from getting to the gym. Let’s make two distinctions so you’ll understand the mechanism necessary for re-patterning deeply held practices:

  • A habit is an unconscious, engrained response that helps us feel good or helps us to not feel bad. It’s primitive.
  • Willpower is conscious. It is preceded by thought and followed by action to carry out one’s decisions, plans and wishes. Willpower originates in an advanced part of the brain.

A stressed human might not be particularly mindful. In fact, probably not.  Dr. Kenny says, “When you are stressed, your brain favors solutions to immediate problems, not longer-term goals. Things that alleviate stress and feel good are quickly transformed into habits. Stress increases the value of immediate rewards.” It’s a whole lot easier to dive into a bag of potato chips for comfort than to drive across town in your shorts and work out for an hour. Let’s face it: exercise is not necessarily instant gratification. The benefits come over time. So your challenge as an IMAP coach will be to honor a client’s conscious decision to come to you at all, and make it “feel good” until his willpower gives way to a good habit. Reinforcing the promises of fitness and well-being will cause his brain to release dopamine, the Geiger counter that detects good things are coming, and he’ll feel better. Soon exercise will be a habit.

But not at first.

We suggest building experiences that are successful and assure your client of achievement, even in small ways. Without being disingenuous, be a little generous with praise and encouragement. Help the client to recognize all the good things in every experience so that his brain will re-pattern until his body catches up. Soon everything will be obvious, and you’ll have a happy, healthy client.

MORE STRESS? REALLY?

Now that we’ve convinced you that chronic over-stress is a bad thing that can be overcome to a large extent with exercise, we’re going to tell you that you’re about to inflict more stress on your clients. Take heart. You’ll be using your powers for good, not evil.

Exercise is stress. And while IMAP Training is the right kind of stress, it does pose threats to your clients. Because you know the benefits, it’s easy to overlook the problems, but being sensitive to them might help you ease the client into the program more comfortably.  Among the stressors are:

  • IMAP Training is new and unfamiliar … every day. The client doesn’t know what you’re going to do each time. And while this is certainly part of the appeal, your client is always off kilter – uncertain about meeting the demands of your program. With expectations high, she’s wondering about her abilities and performance levels. The prospect of the workout might be intimidating.
  • Client might feel humiliated. It might be embarrassing for a client to put on shorts and show up for training when he’s out of shape, overweight, and uncertain. The fear of judgment from the coach, other clients, and staff might be overwhelming. Worse, if the client is an athlete and assumes he’s fit, but the workout is beyond his capability, then his self-confidence will be shaken deeply in front of other people. While humility is good for the soul, it requires a level of maturity and experience. Until that’s achieved, there’s only crushing defeat and stress.
  • Time might be challenging to harness. Lack of time is the most often cited excuse for not working out. Difficulty in time management doesn’t go away automatically when the client decides to join an IMAP Training program. Something’s got to give. Putting one more activity into an already full life will demand that some other activity is sacrificed. Those choices aren’t easy and the stress of sacrifice might be tough to engineer.
  • Support from family, friends, and employers might not come easily. When a person decides to better himself, that choice is counter to the natural order of his universe. People who share his life might feel threatened and betrayed. There might be attempts at sabotage. The sacrifices a client makes might include time and effort previously reserved for people who’ll resent his sudden departure from “normal.” He might have a fight on his hands.
  • Change might be brutal. You’ll soon be nudging a client toward a sweeping, comprehensive adjustment in lifestyle that includes a lot more than showing up for one hour at the gym three times a week. Stepping out of an already jammed life, she’ll be dealing with such things as juggling schedules and finding time for exercise, financing her program, meeting and working out with new people, dealing with workout clothing and requisite laundry, designing menus with unfamiliar foods, shopping for and preparing food more frequently, and adjusting the deeply engrained flow of home life to accommodate new meal plans and a new sleeping schedule. There also will be things to give up. She’ll be bidding farewell to food and drink that are part of her culture and bring her joy. These omissions from the dining table will put her on the outside of her social and family circles. The changes, all good, might be hard.

So what happens when an already chronically stressed-out human adds the stress of a new exercise program to his overload? Only good things. Let us take you back to the Whitehall studies and Sapolsky’s baboon research and one key point. Chronic stress is linked to lack of control.

To drive the point home, let us finish the story of Sapolsky’s baboon troop in Kenya. They raided a garbage dump where human food and waste had been discarded. Because the alpha males were in charge, as usual, they claimed all rights to the bounty. Females, juveniles, young males of low rank, and weak members weren’t allowed near it. Unfortunately, the dump was infested with tuberculosis. Nearly all the alpha males died from the disease. And suddenly the bullies were gone. A miraculous thing happened. Instead of everyone merely stepping up one rung on the bully ladder, they just stopped torturing altogether. Over the next six months, their culture changed from one of random violence to one of social affiliation and peace. There were now twice as many females as males. The males left were the nice guys. Babies were born who had never experienced violence. When other baboons came in with old traditions of torture, they were ousted. Within a very short time, Sapolsky discovered that the physiological markers of stress were diminishing from the population and life was good.

What happened? The threat of violence was gone. Baboons who previously had been out of control of their own safety and had no standing in the hierarchy were in control. The change in their culture had been prompted by a random tragedy, but it became conscious choice.

The lesson is clear. Fitness puts a person in control of his own body, and as a consequence, his life. And here’s something that makes IMAP perfect for allowing reclamation of control. The program isn’t just about physical fitness; it addresses discipline and control from many angles: managing sleep, food, water, and mindset. Best of all, clients are in an environment that allows social interaction and support from both the group and the coach. A culture of excellence is born. Of course, we can’t make life perfect for a client or remove all the stressors inherent in being human, but when the pieces come together, people are proud and they get happy again.

Vincent Cambrea is the Director of the Florida School of Massage. He is the creator of the Integrated Massage and Personal (IMAP) Training for massage therapists. This article is part of the curriculum of the Integrated Massage and Personal Training program (offered only to Florida School of Massage students at this time.)