Stress is a prime suspect in the things that kill us: heart disease, cancer, accidents, suicide, murder. Sometimes it's acute stress -- anger which leads to murder -- but most often the killer is chronic. Long-term stress leads to the subtle and potentially fatal changes in our bodies that may eventually produce heart disease and even cancer.
Stress reduction is a vital part of good health but an exhaustive treatment of it is outside the scope of this book. What you will find here is food for thought and some tips to get you started.
Acute stress can kill, mostly by causing spasms in coronary arteries which can precipitate a heart attack. Acute stress can also kill by dramatically increasing blood pressure. This may cause a rupture of weakened blood vessels in the brain (a hemorrhagic stroke) or an aneurysm in other parts of the body.
It's not uncommon to read of people who died of heart attacks precipitated by bank robberies, earthquakes or other sources of acute stress. But these numbers are miniscule compared to the hundreds of thousands affected by the insidiousness of chronic stress.
Chronic stress increases "bad" LDL cholesterol, depresses "good" HDL cholesterol, makes blood more likely to clot, causes arteries to constrict, increases blood pressure and makes arteries more susceptible to developing atherosclerotic lesions. Chronic stress has been known to depress the immune system, opening the door to many diseases including cancer.
California Pacific Medical Center cardiologist, Dr. Dean Ornish, M.D., has taken the stress connection further than anyone else in the medical field. In his book, Reversing Heart Disease, Dr. Ornish says stress may be the most important ultimate cause of heart disease and that other physical manifestations, including high cholesterol and hypertension, may result from stress.
Dr. Ornish's program for reversing heart disease involves stress reduction, a diet drastically low in fat and moderate exercise. He feels that social isolation and the lack of an interpersonal support network are the most damaging factors.
"Anything that promotes a sense of isolation leads to chronic stress and, often, to illnesses like heart disease," Dr. Ornish writes. "Conversely, anything that leads to intimacy and feelings of connection can be healing." His emphasis on meditation and the "touchy-feely" aspects of relationships and human relations have made many traditionalists uncomfortable, but a great deal of scientific research is available to support his contention.
Dr. Ornish points to numerous studies showing that married people live longer than single ones and that people active in a church, club or synagogue have fewer illnesses and lower blood pressure than non-participants. A roommate or even a pet can dramatically influence overall death rates, particularly those from cardiovascular disease.
Research finds the greatest risk of illnesses caused by stress when people feel they have little or no control over their work or personal lives.
Numerous excellent books exist on meditation, stress reduction and developing better interpersonal relationships. Dr. Ornish's book is a good place to start because it integrates these concepts into the framework of better cardiovascular health.
The family and societal ties in Mediterranean cultures like Italy, Greece and southern France can teach Americans much about reducing stress through personal connections. Extended families are more common and, as a whole, people are more involved with church and community groups.
The pace is far more relaxed for these cultures. People take more care preparing meals and linger over the eating. There is a Mediterranean philosophical acceptance that life is fleeting; whatever human wealth and works can be accomplished by driving oneself to the limits of endurance will eventually be irrelevant. There is a very good reason that the concept of la dolce vita -- the sweet life -- is Italian.
This dilemma was recognized in a letter written to the San Francisco Chronicle in 1992.
"Editor --I am of Irish heritage, and am interested in becoming Italian since Italians seem to have so much more fun (not to mention more sex). If you're brunette and want to be blond, you just go to the drugstore -- easy. But how does one go about changing one's heritage? I know this sounds funny, but I'm serious and would welcome any suggestions your readers might have. I'm sure I'm not the only one with this problem." Larry McCarthy, San Francisco.
"But I live in America," you say, "and even if my name is Sangiacomo or Orsini, I'm an American and have to live the American pace."
If you accept this premise, then you accept that you have no control over your life -- and that's a fast track to the cardiac unit at your local hospital -- if you live long enough.
Changing your heritage wouldn't help much anyway. Numerous studies show that "cultural" genetics play little or no role in preventing heart disease. Immigrants begin to adopt American ways of life and eating and quickly lose their cultural advantage. Of course, individual genetics play a huge role in your health, but the health advantages experienced by ethnic people in other countries is more a function of lifestyle than DNA.
-- Develop family rituals. They can be as simple as hot chocolate and cookies every evening before bed and a set dinner time several nights a week when everyone sits down together without the television.
-- Invite friends and relatives to dinner. Don't make the meal preparation a high-stress event; concentrate on the friendship instead.
-- Stretch out the length of your meal times. One good way to do this is to eat in courses -- don't put everything on one plate. Split your dinner wine into courses too, a little white with salad, a little red (or another white) with the main course.
-- Take a meditation course which teaches you to disconnect from the stress.
-- Watch your body. Research has shown that just as emotions are mirrored in facial expressions and muscle tension, your emotions will respond to facial clues and muscle tension. Smiling even when you're tense or angry will help chase away the bad emotions.
-- Monitor your breathing. When you're tense, you tend to breath rapidly and shallowly. Concentrate on slow, deep breathing and you can break up a bad mood.
-- Relax. Just as stress can tense up muscles, consciously relaxing muscles can reduce emotional stress.
-- Get a massage. Have someone else relax your muscles.
-- Take a nap. Many prominent and successful people take a 15 to 20 minute afternoon nap which reinvigorates them and divides one day into two. If your work schedule is not flexible, take a late lunch and make the first quarter hour a nap.
-- Exercise moderately. Most Mediterranean people avoid health clubs like they do bad fish. But they walk and cycle as part of their everyday lives -- to work, to market, for recreation. Try it.
-- When things are going very, very badly take a quiet moment, relax, control your breathing, smile and visualize an image of some wonderful time in your life. Focus on walking along that beach, catching that fish, gazing on that unforgettable sunset. Transport yourself into the image and out of the stressful situation.
-- Get a good night's sleep.
-- Allow yourself enough time for tasks. Running late causes far more stress than getting up 15 minutes early or leaving for a meeting with time to spare.
-- Ask for help. When you're overloaded, rely on friends, family and at work, your co-workers. If you can't depend on these people you need to remove yourself from that situation. Consider professional counseling to help with the motivation and guidance to make this decision and for the support to carry it out.
-- Let it all out. But not on your friends. Punch a bag, take a brisk walk where every step is a kick at your nemesis.
-- Don't take it out on those who love you.
-- If it's been a bad day, take a walk around the block or the yard before you greet your spouse, roommate, children, significant other, mother, father, brother, sister, dog, parakeet. They can't support you if you take your anger out on them.
-- Be irresponsible on occasion. You probably have some deadlines, maybe most of them, that won't matter a lot if they aren't met. Don't let your friends or loved ones down, but being a day late on some things won't matter.
-- Take a paid vacation day if you're feeling angry, depressed or stressed out. Do something nice for yourself -- go to the beach or the ballpark, get a massage, have a picnic, take a drive. This is a no-obligation, no-guilt, stress-free day for what you want to do, not what you feel you should do.
-- If you're single, build your own support relationships by joining a church, synagogue, club, civic group, taking classes, volunteering for charities.
-- Get a pet if you're alone.
-- Maintain a sense of humor. Read a book of jokes or cartoons; check out a comedy videotape or watch the stand-up comics on television; go to a live comedy club. When you laugh, you're in control and that can keep you out of the hospital.
-- Have a glass of wine. Not too many, not too few.