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Stress makes us sick -- and we do it to ourselves
San Francisco Chronicle

December 11, 2007
Tuesday AM

SAN FRANCISCO -- A sensible person might argue that at 74, Connie Berto should be enjoying the quiet luxuries of retirement, like afternoon naps and baking pies. But like most Americans, Berto has picked the rush of an active, nonstop lifestyle over peace and quiet.

"I'm always on the go, go, go," said Berto, of Marin County, Calif. "My husband and I have a lot of interests and volunteer work and grandchildren -- 2-year-old twins that I babysit all the time. I have two horses in the backyard, and I do all the cleaning and the cooking myself."

And don't get her started on the holidays. "With five kids and their spouses and trying to get Christmas presents for everybody, well, we're always on a tight schedule," she said.

There's no doubt, Berto said, that Americans are more stressed out than ever before. Doctors agree. In fact, they say, Americans are so riddled with stress these days that it's making them sick.

An office worker develops a strange rash from the daily pressures of dealing with a demanding boss. A child complains of a stomachache from too much homework or grueling daily soccer practices. A teenager lives on coffee and energy drinks in order to squeeze in more time for social activities.

Chronic stress has been linked to depression, heart disease, autoimmune disorders, premature cell aging, and obesity and diabetes. It can cause hives and numbness, gastrointestinal problems and acne. It can make people more susceptible to the flu.

The really frustrating part for doctors is that much of the stress patients experience is manufactured -- the result of an increasingly connected society that has everyone expecting instant gratification, and instant results. Very few people are making the time to unplug and relax, even for just a few minutes every day.

"Our being connected to everyone all the time is a good thing and a bad thing," said Dr. David Spiegel, a professor in the department of psychiatry and behavioral sciences at Stanford University School of Medicine. "I can be in touch with colleagues around the world, but all that seems to do is enhance expectations for productivity. We work harder, and we're never disconnected.

"A long time ago, when it got dark, you ate dinner and went to sleep. Now we've turned night into day. We're getting a lot less sleep. It all adds up to a lot of stress, and our minds and bodies are not prepared to deal with it."

There has been much research into the effects of chronic stress on the body. Most of it comes down to a hormone called cortisol, which is released by the adrenal gland when people are under stress. Cortisol stimulates systems that put the body in a "fight or flight" mode, said Dr. Don Mordecai, chief of psychiatry at Kaiser Permanente's Santa Teresa Medical Center in San Jose, Calif. It diverts blood to critical areas like the heart, lungs and muscles that make people better able to deal with an emergency.

"You breathe more, you get more oxygen to your muscles so if you have to flee your legs are ready. Your pupils contract so that you're seeing things more sharply. Your brain is ready to process things more quickly," Mordecai said.

That's great if you're about to get eaten by a grizzly bear -- or rear-end someone on the freeway -- but it can be damaging when people experience that kind of stress day in and day out for long periods of time.

Cortisol can weaken the immune system, or, alternatively, send it into overdrive. People can become more vulnerable to sickness, or autoimmune disorders flare up, leading to stress-related symptoms like skin problems.

Relatively new evidence suggests that cortisol also makes people crave fatty, sugary comfort foods, which can lead to obesity and insulin resistance.

"We think stress plays a large but hidden role in the obesity epidemic," said Elissa Epel, an assistant professor of psychiatry at the University of California at San Francisco and an expert on the physiological effects of stress. "We are surrounded by an abundance of this high-caloric food and our brains are hard-wired to eat it. It's very hard for people to not become overweight, especially if they're stressed."

The point, researchers say, is that there's no doubt that chronic stress is unhealthy.

The hard part for many people is figuring out how much stress is too much. Everyone experiences daily frustrations and anxieties -- rush-hour traffic, looming deadlines at work, petty office politics.

"We're so used to it that we don't even think about stress anymore. It's just life," Spiegel said. "We think if we're really tough we'll work through these limitations. We're not very respectful of our bodies and that creates the real problem.

"Listen to your body. It's smarter than you are, and it's telling you you're taking on too much."

But with increasing pressure to perform and meet higher and higher expectations -- make more money, send the kids to better schools, lose weight, make sure everyone in the family has their best Christmas ever -- it's becoming harder and harder for people to let go.

For many people, just giving themselves a break, literally and figuratively, can make a huge difference in how they handle stress. That could mean deciding that this year's Christmas party is a potluck instead of a dinner for mom to slave over.

Doctors also suggest taking a few minutes several times a day to meditate, or finding a quiet spot to sit down and relax. Exercise helps a lot, doctors say, and taking a brisk walk before or after work can clear the mind.

Of course, people with chronic stress may need professional help to control it. Psychiatrists say that if people are having a physical reaction to stress, they should at least check in with their primary care doctor. They might also want to see a psychiatrist or get therapy if relationships are suffering or they're no longer able to do their job because of stress.

Medication can help for anxiety disorders or depression, which can occur when stress leads people to feel hopeless and out of control. Behavioral therapy is also available to help people learn coping mechanisms. Mordecai said he sees many patients who "catastrophize" events in their life -- they stress over worst-case scenarios to the point where they can't function. It can take a lot of work, but learning to think through a stressful situation can alleviate symptoms of stress.

"I see people who say, for instance, that they have a party to go to and they know they're going to say the wrong thing and embarrass themselves and lose their job," Mordecai said. "They are bringing stress upon themselves from a hypothetical situation. But we can take a look at their thought patterns and replace them."


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