Oxidative stress biomarkers and the role of lipid oxidation in cardiovascular disease

A general problem in studing oxidative stress in biological systems and in the evaluation of the effects of AO in vivo, i.e. in patients, concerns the strategies for reliable measurements of oxidative parameters. Several markers and methods have been used for the assessment of the generation of oxidation products (markers of oxidation) of various biomolecules in vitro, in ex vivo systems and in vivo. The in vitro measurements, although quite effective in the assessment of the antioxidant potential of a given compound in a controlled system, are not greatly predictive of the possible activities in vivo. It should also be added that since different antioxidants act through different mechanisms and different oxidative substrates may yield different types of products, assays should be aimed at measuring various oxidative products using different substrates (Halliwell, 1995).

Ex vivo measurements are often also used in connection with the evaluation of oxidative processes in pathological states, but again in some cases some artefactual modification may occur during the collection of the samples (e.g. cells, plasma preparation). The in vivo assays are made directly on samples collected without any manipulation, e.g. urines, but although they reflect processes occurring in the organism, they do not imitate the site(s) of these events. Measurement of isoprostanes, non-enzymatically produced oxidative metabolites of arachidonic acid, is considered, with the above-mentioned limitations, a valid indicator (biomarker) of lipid peroxidation. Increments of this marker have been observed in conditions in which enhanced lipid peroxidation may be predicted (in people who smoke, or have diabetes or hyper-cholesterolemia) (Pratico et al., 2001).

Concerning specifically the measurements of lipid peroxidation markers, ideal assays should have the following features (Halliwell, 1999):

In vitro (susceptibility of substrates to oxidation under controlled conditions) Substrates/markers:

Substrates = lipids: fats, oils, lipids in membranes and lipoproteins Markers: TBARS, conjugated dienes, lipid peroxides, oxygen uptake, fall of PUFA and vitamin E, isoprostanesSubstrates = Proteins: ±SH groups, amino-acid residues, etc.

Markers: electrophoretic mobility. adduct formation, carbonyl content, etc.

A. Substrates = Nucleic acids: DNA bases, deooxyguanosine

Markers: mass spectrometry (MS) of high performance liquid chromatography

(HPLC) of modified bases, electrophoresis of damaged 5'-GG-3' doublets, `comet

assay’ for DNA bases.

A. Substrates = sugars: ribose and deoxyribose in DNA

Markers: oxidation products

Ex vivo (evaluations on samples, e.g. blood, or cells, obtained from animals/humans without further treatments, except those made in vivo)

Antioxidant/oxidant status, antioxidant capacity, antioxidant levels and activities of AO enzymes, levels of negatively charged LDL (a fraction with different chromatographic behaviour in HPLC systems), antibodies against modified LDL, ex vivo assays of DNA oxidation, ex vivo assays of protein oxidation

In vivo (determinations in biological samples collected non-invasively)

Lipids/lipoprotein oxidation): urinary levels of isoprostanes, hydrocarbons in expired air

DNA damage: urinary levels of modified DNA bases

Quantitation of major products of the peroxidation process.Low coefficients of variation of analyses.No interference by other biomolecules.Methods: Chemically reliable (e.g. mass spectroscopy, MS or high performance liquid chromatography, HPLC) or validated.Possibly not confounded by oxidized lipids ingested with the diet.Assess steady-state levels of peroxidation products and total rates of ongoing lipid peroxidation.Parameters measured should be stable on storage and not produced artefactually.

Measurement of valid biomarkers of oxidative processes should be promoted before conducting studies on the effects of antioxidants in human studies (Mayne, 2003).

A vast literature over the past two decades has been produced, devoted to the possible involvement of oxidative stress and of ROS-derived products in various

pathological states. To some extent the published information is speculative, owing to major conceptual and analytical difficulties in the assessment of oxidative processes in vivo and in the evaluation of their real contribution to pathologies. Uncontrolled free radical production has indeed been advocated as a factor in a number of diseases: atherosclerosis, arthritis, diabetes, pulmonary diseases, cancers, Alzheimer’s disease, lateral amyothrophic sclerosis, neuritis, hepatitis and senile cataracts, but most of the attention has been devoted to the possible involvement of lipid/lipoprotein oxidation in atherogenesis and in cardiovascular disease, CVD (Steinberg, 1997, Berliner and Heinecke, 1996).

As to the issue of oxidative stress and atherosclerotic CVD, certainly rather convincing evidence has been produced in in vitro studies, showing that LDL that have been exposed to oxidative stress (oxLDL) through various mechanisms (exposure to chemicals, to physical factors or to cellular processes) are highly atherogenic. Atherogenesis induced by oxLDL has been shown to activate a sequence of events, involving several types of circulating cells (monocytes, platelets) and cellular components (e.g. smooth muscle cells, SMC) and present within the vessel walls (macrophages).

There are, however, still several issues to be defined. First, LDL are rather etherogenous molecular complexes, with significant individual differences in macro- and micro-components, including a number of lipophilic compounds that are associated to them, and it is difficult to identify and quantify all the products generated after exposure to oxidative stress, which may contribute to atherogenesis. Second, in vitro LDL oxidation is generally carried out in conditions that maximize the oxidative process, e.g. removal or depletion of hydrophilic and amphiphilic antioxidant compounds that are normally present in plasma, exposure to strong pro-oxidant factors that are difficult to compare quantitatively with in vivo free radical generating systems. Therefore the final products, i.e. oxidized LDL, cannot be easily compared with oxLDL possibly

generated in vivo. In vitro studies have also convincingly shown that several types of antioxidants are able to prevent LDL oxidation induced by various agents, but the use of AO, mainly in the form of supplements, in clinical studies has not shown significant protection against CVD. Although some of these issues are considered in detail in other posts, it is worth underlining some the strong and the weak points in the overall relationships between oxidative stress and CVD.

There is evidence that lipoproteins (LP) with some of the general features of oxLP produced in vitro, evaluated with the use of the typical markers of oxidation (see further), are present in atherosclerotic plaques. On the other side, it is not completely clear whether oxLDL are generated within the vessel wall exposed to high oxygen fluxes, from previously accumulated particles, or whether they are deposited in the vessel walls after being produced in the circulation, i.e. whether the presence of oxLDL is a secondary or an associated process, rather than a causative event.

For monocytes, again, the accumulated reactive material could be produced in a secondary process. In addition, the recognition by antibodies has several limitations: poor characterization of the oxLDL used as antigens for the preparation of the antibody, and eventual (epitope) differences between the artificially produced oxLDL and those generated in vivo. In addition there may be some lack of specificity and poor quantitative responses in the reaction.

Some of the previously mentioned limitations may apply to the presence of autoantibodies against oxLDL in sera of atherosclerotic patients. There is also some evidence that antioxidant consumption may slow the progression of the disease. This, however, is a rather controversial aspect. In essence, the difficulties in the evaluation of the outcome of the studies concern the form and doses of administration of the AO and in the selection of the people to be treated.

In addition to the role of oxidized LDL in the atherogenetic process, a number of studies have been devoted to assess the involvement of oxidative stress in several CV conditions and functions, as discussed in the following reviews: endothelial functions (Cai and Harrison, 2000; Lum and Roebuck, 2001; Matsuoka, 2001; Terada, 2002), neutrophil activation (Kaminski et al., 2002), macrophage involvement (Jessup et al., 2002), smooth muscle cell function (Bomzon and Ljubuncic, 2001), vascular ageing (Yu and Chung, 2001), congestive heart failure (Mak and Newton, 2001), arterial hypertension (Zalba et al., 2001) and diabetes (Bayraktutan, 2002). However, as already discussed, most of the evidence is derived from in vitro models, animal studies or ex vivo situations, i.e. in somewhat artefactual conditions where some of the processes may be amplified. It is therefore rather problematic to assess and quantify the actual role and relevance of oxidative stress in CVD.

Based on all the direct and indirect evidence in support of the hypothesis that free radical-mediated processes and specific products arising from them may play a role in CVD, great interest has been devoted to the possible protective effects of AO in the diet, or as pure compounds, on biomarkers and on clinical endpoints in population studies.

A vast number of studies have been carried out since 1990 on various aspects of the issue of AO protection: they range from epidemiological investigations to controlled trials and have involved a great number of participants. In reality, early observations on the relationships between dietary antioxidant vitamins and disease date back to the 1930s (Seventh-Day Adventists) and the 1950s (Mormons) (reported by Enstrom et al., 1992), and the whole area has been recently reviewed systematically (Asplund, 2002). This review is based on the following inclusion criteria: human studies only, published after 1989, reporting only original data, obtained in case-control, cohort or randomized controlled trials; related to AO vitamins only; mainly reporting on morbidity and mortality of clinically meaningful manifestations of ischaemic heart disease or stroke. The following contexts have been considered: primary prevention of various endpoints (ischaemic heart disease, stroke or combined cardiovascular events), the effects on intermediary endpoints (e.g. blood lipids and blood pressure), studies on secondary prevention in patients with manifest CV disease.

The main conclusions are: in observational studies (case-control or cohort design) people with high intake of AO vitamins by regular diet or as food supplements generally have a lower risk of myocardial infarction and stroke than low consumers. In randomized controlled trials, however, AO vitamins as food supplements have no beneficial effects in the primary prevention of myocardial infarction and stroke, with some report also of adverse events. In addition, in contrast with the initial favourable reports on AO in the secondary prevention of CVD, recent reports apparently failed to show beneficial effects. Some of the negative findings on the effects of AO vitamins, however, may be attributed to pitfalls in the design of the experiments: inadequate characterization of subjects under investigation in terms of ongoing oxidative stress, inappropriate formulations and dosages, especially in comparison with the situation in natural sources: single compounds rather than mixtures, concentrations too high (possibly pro-oxidant) or too low (ineffective), administered as a bolus (capsules or tablets) rather than in the context of foods (better absorption, protection vs. oxidation of dietary components, balance between various ingredients with maintenance of natural structural and functional relationships).

In summary, some relationship exists between intakes/plasma levels of some risk factor for vitamin C (reduction of cholesterol and blood pressure with high intakes/levels), for vitamin E (reduced platelet adhesiveness with high intakes) and for multivitamin supplementation (reduced platelet aggregation), but correlations are generally weak and the area has not been investigated in detail. For case-control studies there is some support for low plasma concentrations of beta-carotene, and possibly of vitamin E, being linked to increased risk of myocardial infarction. The same does not apply to vitamin C. Altogether, owing to rapid changes in plasma AO vitamins during CV events, the data must be interpreted with caution. Concerning cohort studies, people with high intakes of AO vitamins (regular food or food supplements) have a modest reduction of risk for CV events. Plasma levels of carotene and vitamin C are stronger predictors of future CV events than dietary intakes.

Primary prevention in healthy subjects: 1 out of 8 studies has shown protective effects with beta-carotene vs. retinol on a limited number (1203) of subjects. 1 study with beta-carotene show enhanced risk of lung cancer in smokersSecondary prevention of CVD in patients with manifestations of the diseaseOut of 14 studiesIn 5, reduction of CV eventsIn 9, no effectIn 1 increase of CV events (beta-carotene).

The effects of dietary supplements of AO in the primary and secondary preventions of CVD in randomized controlled trials are summarized above. The general conclusions from these studies are as follows:

People affected by ischaemic heart disease and stroke, and populations with high occurrence of CVD often have low intakes/plasma levels of AO vitamins (causal or unfavourable lifestyle factors?).In case-control or cohort studies, people with high intakes of AO vitamins (food or supplements) have a low risk of myocardial infarction and stroke.In randomized controlled trials, AO vitamins as supplements have no beneficial effect on risk for MI or stroke (not recommendable for prevention).Some support from observational studies that low intakes of fresh fruits/ vegetables may confer a high risk for CVD.

Diets, however, especially those rich in fruits and vegetables, contain several factors or mechanisms other than AO or AO other than vitamins, exerting protective effects on various systems (Halliwell, 1999). The issue of the effects of bioactive compounds in foods and their role in the prevention of CV disease is therefore quite complex, since a large number of potentially health beneficial substances have been described (Kris-Etherton et al., 2002).

Flavonoids in particular have been investigated in relation to possible health benefits (Ross and Kasum, 2002), owing to their potential antioxidant and free-radical scavenging activities observed in vitro. Human feeding studies have shown that their absorption and bioavailability are higher than originally believed, but their overall function in vivo has yet to be clarified, whether antioxidant, anti-inflammatory, enzyme inhibitor, enzyme inducer, inhibitor of cell division, or some other function (Rice-Evans, 2001). Epidemiological studies exploring the role of flavonoids in human health have been inconclusive: some studies support a protective effect of their consumption on CVD and cancer, other studies demonstrate no effect and a few studies suggest potential harm (Ross and Kasum, 2002). Additional selected classes of bioactive compounds with antioxidant and other types of potentially healthful activities are the large groups of phenolics that are present in edible fluids — obtained from fruits of plants exposed to stressful conditions, such as grapes and olives ­ which, since the beginning of recorded history, have been part of the diet of populations living in certain areas, such as the Mediterranean basin, i.e. wine and olive oil. A vast literature is available on the properties of these compounds (German and Walzem, 2000; Visioli et al., 2002), although the impact of their consumption on health through the diet has not yet been fully assessed.

Compounds           Examples                        Sources

Flavonoids

Flavones             Apigenin, luteolin             Parsley, thyme, celery

Flavonols            Quercetin, myricetin         Onions, broccoli, apples, cherries,

berries, tea

Flavanones         Naringenin, hesperedin     Cirtus foods, prunes

Catechins            Epicatechin, gallocatechin Tea, apples, cocoa

Anthocyanidins    Pelargonin, malvadin        Cherries, grapes

Isoflavones         Genistein, daidzein           Soya beans, legumes

Phytoestrogens

Lignans,                    Enterolatone, coumestrolk         Flaxseed oil, clover
coumestran

Resveratrol                                               Grapes, red wine, peanuts

Lycopene                                                 Tomatoes, tomato products

Organosulphur              Allicin, diallyl sulphide                 Garlic, onion, leek
compounds

Isothiocyanates            Phenethyl benzyl,                       Cruciferous vegetables
sulphoranes

Monoterpenes        d-Limonene, perillic acid   Essential oils of citrus fruit, rice

bran oil, cherries, mint

Plant sterols          Sitostanol, stigmasterol    Tall oil, soybean oil, rice bran oil

Olive oil                Hydroxytyrosol, oleuropein Olives, virgin olive oil

How to Stop Stress and Burn Your Fat

We encounter stress every day—during traffic jams on the freeway, in the workplace, at home with the spouse and kids, on the evening news. We feel stress when we worry about money or retirement or whether we will get a promotion. Those of us who are middle-aged might face the stress of prop­erly caring for aging or sick parents and our kids leaving the nest. Since September 11, we must also contend with the stress of knowing that our country and loved ones are not immune from possible terrorist attacks. Stressors surround us at every turn.

If stress is so bad for us, then why have our bodies developed the stress response in the first place? From an evolutionary standpoint, stress is not only useful but necessary for survival. For the first two hundred thousand years of humanity’s existence, stress was a useful mechanism that got our ancestors physically prepared to kill wild animals for food, run for their lives, fight an opponent, or survive a natural disaster such as a flash flood. Greater physical strength from the adrenaline rush, sharper hearing and vision, heightened brain function, and more energy to fight or flee were certainly useful.

But the catch is that stress was never meant to be a long-term condition of daily life. Our ancestors experienced the heightened physical and hor­monal response of a stress reaction during times of genuine physical dan­ger. They then discharged their energy while dealing with the problem, cleared the stress hormones out of their system, and returned to a physio­logically normal state.

In the modern world, unless we are being robbed at gunpoint in a dark alley, most of our stress is psychological in nature. Therefore, it is difficult to make it go away by an immediate physical response or action that dis­charges it. When you discover that your new secretary has gotten your mailing lists mixed up, yelling at him or her and pounding on the desk in frustration will not solve anything.

Stress has become a condition in which we accept a short-term level of heightened performance at the expense of long-term health. Whether physical or emotional, stress has many negative effects on the body. One of them is the accumulation of a hormone called cortisol. When faced with a stressful situation, the body produces an adrenaline rush that releases fat and glucose as an energy source to help deal with the stressor. Once the crisis subsides, cortisol becomes active and stimulates the appetite so that we can replenish our fat stores. Since most of us don’t reach for an apple or a chicken breast when we feel hungry, the release of cortisol usually leads to grabbing a quick carbohydrate snack such as a slice of pizza, a donut, a candy bar, or some type of high-carbohydrate fast food. Unfortunately, liv­ing with a high level of daily stress causes the body to produce a consis­tently high level of cortisol, leading to a vicious cycle of stress, frequent overeating, and fat gain.

One of the more serious effects of stress is that it redirects metabolic energy away from the immune system. A tremendous amount of energy is necessary to operate the complex cells, hormones, and organs that make up this system. Fifteen minutes of danger and a return to normal isn’t going to compromise your immune system, but living with constant stress will surely slow you down metabolically, making you more susceptible to illness. Stress can lead to stroke, hypertension, and type 2 diabetes. In fact, the six leading causes of death in the United States—heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide—are directly related to stress.

One recent study of how chronic stress weakens the immune system found that the protein interleukin-6 (IL-6) was present in unusually high amounts in people who suffered from chronic stress. IL-6 normally trig­gers inflammation to help fight infections. It also stimulates the production of C-reactive protein, which is a very accurate predictor of heart attack risk. High levels of IL-6 are also associated with type 2 diabetes, some cancers, osteoporosis, arthritis, and depression. Prolonged high levels of IL-6 can lead to a syndrome called permanently aged immune response.

This study also showed that very simple lifestyle changes, such as get­ting enough sleep, eating properly, stopping smoking, and exercising regu­larly, can dramatically reduce levels of IL-6.

Since all of us are stressed at one time or another, it is important to differ­entiate between being able to handle stress and feeling overstressed. I have written extensively about stress self-evaluation and stress management in Maximum Energy for Life, and I refer you to that book if you feel that not being able to handle stress is a major problem in your life. An important point to remember is that you will never be able to get rid of all of the stress in your life. The real goals should be learning to get rid of unneces­sary stress by making wiser lifestyle, work, and relationship decisions and learning how to manage the stress you can’t avoid.

This post has two simple questionnaires on stress and depression designed by the National Mental Health Association (NMHA). Some of their tips for controlling stress are also included.

Everyone handles stress differently—some better than others. If you think you have too much stress in your life, it may be helpful to talk with a doc­tor, clergy member, or other caring professional. Because reactions to stress can be a factor in depression, anxiety, and other mental and emo­tional disorders, you may consider working with a psychiatrist, psycholo­gist, social worker, or other qualified counselor.

Checklist of Negative Reactions to Stress and TensionDo minor problems and disappointments upset you excessively?Are you unable to stop worrying?Do you feel inadequate or suffer from self-doubt?Do you experience flashes of anger over minor problems?Have you noticed a change in sleeping or eating patterns?Do you suffer from chronic pain, headaches, or backaches?

If you answered yes to most of these questions, consider the following suggestions for reducing or controlling stress:

Be realistic. If you feel overwhelmed by some activities, learn to say no!Shed the superman/superwoman urge. No one is perfect, so don’t expect perfection from yourself or others.Meditate for ten to twenty minutes a day.Visualize how you can manage a stressful situation more success­fully.Take one thing at a time. Prioritize your tasks and tackle each one separately.Find a hobby that will give you a break from your worries.Live a healthy lifestyle with good nutrition, adequate rest, regular exercise, limited caffeine and alcohol, and balanced work and play.Share your feelings with family and friends. Don’t try to cope alone.Give in occasionally. Be flexible.Go easy with criticism. You may be expecting too much.

Every year more than 19 million Americans experience clinical depres­sion. It affects men, women, and children of all races and socioeconomic groups, causing them to lose motivation, energy, and the pleasure of every­day life. Clinical depression often goes untreated because people don’t recognize many of its symptoms. The good news is that almost everyone who gets treated can soon feel better.

Here is a checklist of ten symptoms of clinical depression:

A persistent sad, anxious, or “empty” moodSleeping too little or sleeping too muchReduced appetite and weight loss or increased appetite and weight gainLoss of interest or pleasure in activities once enjoyedRestlessness or irritabilityPersistent physical symptoms that don’t respond to treatment (such as headaches, chronic pain, or constipation and other digestive dis­orders)Difficulty concentrating, remembering, or making decisionsFatigue or loss of energyFeeling guilty, hopeless, or worthlessThoughts of death or suicide

If you experience five or more of these symptoms for longer than two weeks, or if the symptoms are severe enough to interfere with your daily routine, see your doctor or a qualified mental health professional.

For more information on depression, or to locate a free, confiden­tial, and professional depression screening site in your area, call the National Mental Health Association at 800-969-NMHA (6642) or visit www.nmha .org for a confidential online depression screening.

Another helpful resource for evaluating stress levels is the well-known Rahe Life Stress Scale developed by Dr. Thomas Holmes and Dr. Richard H. Rahe, researchers at the University of Washington School of Medicine in Seattle. Based on their years of researching the connection between stress and health, these doctors have assigned numerical values to stressful events. For example, the death of a spouse is 119 points, pregnancy is 67, divorce is 96, changing jobs is 51, and sexual difficulties are 44. Even events that you might think of as good or pleasurable have an impact on your overall stress level. Marriage is 50 points, a major increase in income is 38 points, a vacation is 24, and the birth of a grandchild is 43. According to Drs. Holmes and Rahe, if you score below 200, you have only a low risk of illness. Between 201 and 300, your chances of getting sick are moder­ate. A score between 301 and 450 increases your odds of getting sick con­siderably, and a score greater than 450 puts you at imminent risk. While this test is not an absolute indicator of your risk for disease, it can give you a clearer picture of how many of your daily life circumstances are poten­tially stressful. If you wish to take this test, you can access it on the Inter­net at Dr. Rahe’s Web site: www.hapi-health .com.

If a healthy person is fasting or starving, 90 percent of his or her calories will come from fat stores and only 10 percent from protein. When a person is undergoing chronic stress, even if he or she is not injured or sick, only 70 percent of calories will come from fat stores and 30 percent will come from lean protein.

There is a direct correlation between the breakdown of protein for fuel and the greater metabolic need for glucose during times of physical or emotional stress or trauma. To get the extra glucose, the body takes amino acids from lean muscle mass, converts them to alanine, and changes the alanine into glucose to be used by the tissues as an emergency energy sup­ply. Physiological stress can greatly increase metabolic requirements. For example, after surgery metabolic needs increase by 20 percent; following a serious infection or a traumatic injury, they increase by 50 percent.

Following a well-balanced and nutritional diet such as the Fat-Burning tips becomes even more crucial when you are suffering from the effects of illness or long-term stress.

People who live with high levels of stress will be amazed at how effec­tively exercise combats stress. Stress is a killer because it undermines almost every system in the body, from the cardiovascular system to the immune system. Since I work with so many professionals whose jobs come with an unavoidable stress component, I am always gratified to see how greatly my Fat-Burning tips improves their ability to handle stress.

Bo Walker, the radio host who agreed to participate in a makeover for Let’s Live magazine, worked very hard at my plan and kept exercising even when the twelve-week makeover period was completed and the mag­azine articles had gone to press. Bo’s moment of truth came when the radio station announced that they were not renewing his contract. Suddenly, he was faced with the stress of being the forty-year-old unemployed father of a two-year-old child with financial, career, and self-esteem issues.

Once his job had officially ended, Bo felt no motivation at all to go to the gym. But his wife, Lisa, told him, “You’ve got to continue doing this for your own sanity.” Not giving up on his exercise program turned out to be Bo’s greatest emotional stabilizer: “It kept my mind occupied. I knew I had someplace to go two, three days out of the week. The exercise was cathartic. It allowed me to keep my mind off losing my job. It did more than just make me feel physically better. It was an emotional boost as well. Once I was at the gym, I could do my routine. It put me back on the track again. It’s helped me through quite a bit.”

Fortunately, Bo was only out of work for a few months. Sticking with his exercise program gave him the ability to reduce his stress and have the energy and focus he needed to find another job and get on with his life.

The two forms of exercise offered in the Fat-Burning tips are specifically designed to deal with stress. If you must navigate a series of several stressful events daily, then the steady-state exercises on days 1, 3, and 5 will help to create greater emotional homeostasis so that you can cope better. If you are experiencing continu­ous stress, such as having to be the caregiver for someone in the family who is seriously ill, the core and interval exercises on days 2, 4, and 6 will enable you to achieve greater emotional and physical equilibrium.

In 1994, the National Institute of Health mandated that both genders be more equally represented in the studies done by government and other medical research groups. One of the more interesting outcomes of that decision has been the discovery that men and women are biologically pro­grammed to have different reactions to stress.

When a research team at UCLA led by Shelley E. Taylor analyzed hundreds of stress studies done since 1985, they discovered that men and women release different hormones during stressful situations that result in different styles of coping. Men usually respond with the classic fight-or­flight behavior, increased arousal, and greater risk taking, which for many years had been considered the accepted model for both genders. However, it is now becoming clear that women more often manage stress by seeking out bonding activities.

The mechanism behind this response is the release of the hormone oxytocin. While the large amounts of testosterone produced in men during stress tend to counteract this hormone, estrogen enhances its effect. Oxy­tocin buffers the fight-or-flight response in women and instead encourages them to care for children and bond with other women. “Women are more likely to seek emotional comfort and solace by calling up a friend or relative,” Taylor says. These tending or befriending behaviors cause the body to release more oxytocin, producing a further calming affect.

One of my clients who was diagnosed with breast cancer spent a lot of time talking with her friends and family during her months of treatment: “Cancer is a great shock to everyone involved, not just the patient. I dis­covered that my relatives and friends were just as stressed as I was, and my parents and siblings really felt helpless because they lived all the way on the other side of the country. But when we kept in touch by phone and e-mail, it helped us a lot. My friends also appreciated it when I told them how I was really feeling and what I needed. It helped them to cope with their fear and anxiety. Letting them comfort me or bring over some food made them feel calmer and more empowered because they were doing something for me.”

Another gender difference is that women tend to feel more day-to-day stress than men. The reasons for this can be seen in how women’s emo­tional lives are structured.

Women engage in more multitasking than men in their everyday lives. A man may be the father and breadwinner, but a woman is the mother, career woman, housekeeper, caretaker, and friend and sup­porter of many other women. All of these activities take their toll, creating greater stress.Women are more vulnerable to physical violence, mugging, and rape than men.For a woman to be happy, she has to be in a good relationship with all of the people who are important to her including her kids, her spouse, her family, her coworkers, and her friends.Women are programmed to nurture, caretake, and defer to others, most often at the expense of their own emotional needs.Because nature designed women for child rearing, they are naturally hardwired to be more sensitive to their environment than men.

1. Get enough sleep at night.

2. Don’t skip meals. Have three square meals a day and two snacks.

3. Exercise regularly and at appropriate intensity levels for your gender.

4. Practice meditation or deep-breathing exercises for at least ten minutes a day.

5. Make time for yourself. Take a relaxing aromatherapy bath; listen to music; take a walk in a beautiful setting; do some gardening; buy yourself roses.

6. Try to be conscious of your needs and don’t always put your­self last.

Oxidative Stress and Cardiovascular Disease

Interest in the role of uncontrolled oxidative processes in response to oxidative stress in the onset and progression of disease, and as contributing factors in organ and system dysfunctions related to ageing, is underlined by the volume of research work and reviews devoted to this area since 1990. These studies cover diverse fields, from the chemistry of oxidative reactions of susceptible substrates in a test-tube, to the occurrence and detection of oxidative processes in living systems, and the relevance of these events in pathophysiology. Although these processes are considered factors in altering or modulating biological functions, it is difficult to reach reliable quantitative estimates of their contribution to multifactorial events such as diseases. This review discusses the links between oxidative stress, with special relevance to lipid oxidation, and cardiovascular functions and disease.

Oxygen is a key factor in energy metabolism in the animal kingdom since it participates in the major energy-releasing reactions, such as substrate utilization and formation of high-energy compounds. Oxygen is also directly involved in oxidative reactions catalysed by several enzymes, such as the oxygenases, resulting in the formation of a large number of bioactive products from lipids (e.g. the eicosanoids), or the hydroxylating enzymes involved in the formation of neurotransmitters from amino acids (e.g. the catecholamines), or in the metabolism of xenobiotics (e.g. hydroxylations or other types of oxygen-dependent reactions).

Under aerobic conditions, in addition to the participation of oxygen to redox reactions, highly reactive unstable and short-lived chemical entities, the so-called reactive oxygen species (ROS) are produced. ROS can be considered as the outcome of oxidative stress, a condition that, in addition to resulting from endogenous processes, can also be induced by a wide range of environmental factors, including UV exposure, pathogen invasion (hypersensitive reactions) and tissue reperfusion after oxygen deprivation. The term ROS, generally referring to the superoxide anion radical (O2 ), H2O2, and the hydroxylradical (OH’—), includes also hypochlorous acid (HOCl), chloramines, singlet oxygen and peroxyradicals. ROS are highly reactive and interact with major biomolecules: they bind to proteins, break DNA strands, react with vital cellular components, and alter structural lipids in biomembranes by attacking double bonds of polyunsaturated fatty acids (PUFA) in membrane phospholipids.

The oxidative modification of proteins and lipids is commonly defined as protein oxidation and lipid peroxidation, respectively. Free iron (Fe3+) and, in general, bivalent metal ions accelerate the decomposition of lipid hydroperoxydes (LOOH—) into compounds such as alkoxyl and peroxyl radicals, 4-hydroxynonenal (4-HNE) and malonylaldehyde (MDA). These compounds, in addition to being end products of peroxidative decomposition of polyenoic fatty acids in the lipid peroxidation process, are also reactive compounds that in turn can continue, amplify and extend the process beyond the initial oxidative event by oxidizing cellular thiol groups.

Lipid peroxidation can spread throughout the cell, and disrupt lipid membranes, even at sites not immediately associated with those where ROS have originated. Lipid peroxidation may be considered a major alteration in ROS-induced cellular derangements for various reasons. Interactions between ROS and cellular structures mainly take place at interfaces between water and cells. Cell membranes, the most obvious site for these interactions, are largely composed of structural lipids. The route oxygen takes from the atmosphere to animal cells and tissues involves a sequence of highly expanded cellular membranes and of membrane-bound particles: red blood cells (highly enriched in oxygen), other types of circulating cells, lipoproteins of different size and composition and endothelial cells.

The area of the surface of red blood cell membranes is in the order of about 0.5 m2/mL blood and that the global surface of the lipoprotein particles is over 1 m2/mL blood, an enormous value that suggests a high surface of exposure to lipid peroxidation. Of particular relevance in this respect is the role of erythrocytes, loaded with `quanta’ of oxygen, and endowed with highly expanded membranes (the peculiar shape of these cells results in a very high surface/volume ratio) enriched in PUFA in structural lipids. Erythrocytes in the arteries continually `bombard’ endothelial cells with `quanta’ of oxygen, and create a persisting highly oxygenated `background’ condition for the major components of vessel walls. In addition, the endothelium interacts with subpopulations of polymorpho-nuclear neutrophils (PMN) and leuckocytes that, upon activation, release ROS.

Addressing Your Stress Problem with Lifestyle Changes

Life moves quickly, and everyone experiences at least occasional periods of stress. If you feel that your stress level has reached the point where it’s negatively affecting your life, however, it’s time to address the problem and start working to make some changes to help you reduce your stress. You probably can tell when you’re overly stressed because you experience some symp­toms, such as headaches or digestive problems. The American Psychological Association provides this list of stress symptoms on its Web site:

> Headaches, muscle tension, neck or back pain

> Upset stomach

> Dry mouth

> Chest pains, rapid heartbeat

> Difficulty falling or staying asleep

> Fatigue

> Loss of appetite or overeating “comfort foods”

> Increased frequency of colds

> Lack of concentration or focus

> Memory problems or forgetfulness

> Jitters

> Irritability

> Short temper

> Anxiety

If you’re experiencing a number of these symptoms on a regular basis, you’ll need to address your stress level and consider what you might do to reduce your stress or at least be able to deal with it more effectively.

Small lifestyle changes, such as staying away from caffeine and making sure you get some exercise each day, can go a long way toward improving your mood and helping you to feel less stressed out and more able to enjoy life.

Remember that a major reason that teens are so susceptible to stress is that they lack control over many aspects of their lives. Most teenagers don’t get to choose where they live or go to school; those things have been determined for you by your parents and their life circumstances. Your parents probably set rules that you’re expected to follow, even if you don’t agree with them. You might feel boxed in by all your activities, or because you’re forced to give up your free time to help care for younger brothers and sisters. Maybe you don’t have as much money as some of your friends, or your parents can’t afford to buy you the brands of clothing that you’d like. All of these circum­stances are pretty much out of your control, and that can become a source of stress in itself, or intensify the effects of other sources of stress in your life.

Taking time to stand back, assess your lifestyle and make even small, positive changes will not only result in an improved sense of well-being, but also can help you to feel that you’re more in control of your life. That’s empowering, and it can go a long way toward reducing your stress level.

Lifestyle changes involve adding positive, healthy behaviors, and eliminating unhealthy behaviors. It’s making sure, for example, that you get some exercise every day and that you don’t dive into the Ben and Jerry’s whenever you feel your stress level rising.

There are three levels of stress response: the thoughts you have when you experience stress, the feelings or emotions that arise from those thoughts, and the behaviors or responses that result. The most obvious of those three levels are the behaviors, which can be either positive or negative. Of those three levels of stress response, only the behaviors are observable. If you respond to stress by kicking the trash can, people around you see that. They can’t see the stress that caused you to respond with thoughts that made you feel really angry and frustrated—they only see you kick the trash can. If you’re look­ing to reduce or better deal with your stress by making some lifestyle changes, your first step should be to make an assessment of the thoughts and emotions you experience when you experience stress, and the behaviors that you exhibit in response.

 

Take a little time to think about how you react when you encounter a stressful situation. What thoughts typically come to your mind? What emotions follow those thoughts? Do you feel angry, sad, or frustrated? And, what behaviors do you exhibit in response to those thoughts and emotions? Hopefully, you’re not reacting to stress in unhealthy or inappropriate ways, and, if you are, you’ll make the decision to ask someone for some help.

Raising your awareness of how you respond and react to stress can help you to assess your emotions and behaviors, which is an impor­tant tool if you’re going to attempt to change behaviors to help you better deal with stress.

A good idea is to write down the thoughts, emotions, and behav­iors you experience when confronted with a stressful situation. If you can get into the habit of doing this, you may begin to notice some pat­terns. For instance, you might notice that, on the days that you have to rush home from school because your mom goes to work and you have to baby-sit your little brothers and sister, you feel overwhelmed, anxious, and frustrated. And, that those emotions often lead you to stuff yourself with cookies and soda and whatever else you can find to eat. Being aware of your reactions to stress and the behaviors that result is the first step in getting ready to make positive changes in order to better deal with stressful situations.

Alicia is no stranger to stressful situations. Her brother Josh, who’s two years old than she is, has had tons of problems and has been in trouble for about four years now—starting when Alicia was in the sixth grade. Beset by problems with drugs and alcohol, her brother has been arrested, put into rehab, run away from home, and even sent off to one of those wilderness programs for kids who get into trouble.

Nothing seems to help, though, and, as you can imagine, Josh’s troubles are a constant source of worry and anxiety for Alicia and her parents. It seems that when her parents aren’t yelling at Josh, her mom is crying or they’re fighting about how to handle the latest crisis. Alicia pretty much stays in the background and tries to keep out of the way, but the truth is, she’s got plenty of problems of her own.

Often, when confronted yet again with a stressful situation, Alicia will get thoughts like “This is just way too much for me to handle” or “It’s so unfair that my life is like this all the time.” Along with those thoughts, she experiences feelings of being sad, overwhelmed, depressed, frustrated, and angry. When the situation gets really bad, and Alicia feels that she can’t stand one more minute of the turmoil around her, she has a secret weapon that she uses to make herself feel better—she cuts herself.

Cutting is the act of intentionally scratching or cutting the skin in order to hurt yourself, and it’s a type of self-injury that can be extremely harmful and dangerous. While it can bring some relief to someone who’s depressed, anxious, or under great stress, the relief doesn’t last and the act of harming yourself can get to be a habit. Ali­cia knows that cutting is not a healthy or acceptable way of dealing with her stress, but she doesn’t know what else to do when things get crazy in her house.

Alicia’s reaction to the stress that surrounds her begins with think­ing “This is way too much for me to handle” or “It’s unfair that my life is like this,” and progresses to feeling sad, depressed, angry, frus­trated, or overwhelmed. Those thoughts and emotions lead her to engage in the unhealthy behavior of cutting herself in an effort to find some relief from her situation. Other people might react negatively to stressful situations by overeating, using drugs or alcohol, or lashing out at others, all of which are unhealthy behaviors. Let’s have a closer look at some of those negative behaviors, and then we’ll address some healthy, positive ways to help you deal with stress.

Intentionally injuring oneself through cutting or another action is not an overly common behavior, but, as awareness of such acts has increased, we’ve learned that surprisingly large numbers of teens have tried it. Girls are more likely to cut themselves than boys, although guys are not immune. Both boys and girls also might engage in other methods of self-injury, such as burning themselves with a lighted match or cigarette, punching themselves, or pulling out hair.

While cutting or another form of self injury might make you feel a little better, at least at first, the relief won’t last. Most people who cut don’t really want to hurt themselves seriously, but there have been cases in which teens have been badly injured by accidentally slicing across an artery or cutting deeper than they’d intended to. Using an unclean tool to cut can result in infection.

Cutting or otherwise harming yourself is a serious situation that needs to be addressed. If you know someone who is engaging in this behavior, or if you are, the first step is to confide in a responsible adult who you trust, and ask for help. Self-injury is a treatable condi­tion, but it may require professional help.

Eating in response to an emotion—when you feel sad, angry, happy, or bored, rather than because your stomach is rumbling with hun­ger—is called emotional eating. It’s a recognized behavior, and one that most people engage in, at least occasionally.

When you’re eating to address an emotion, you typically crave a certain food, such as ice cream or candy, rather than being open to different options. Emotional eating often involves eating more than you know you should, or even more than you really want to eat, because you’re eating to fill a need or find relief. Hunger associated with emotional eating usually comes on suddenly, as opposed to physical hunger, which occurs gradually.

If you recognize that you eat when you’re angry, bored, happy, or sad, try taking another approach by getting some exercise, getting on Facebook and talking to a friend, listening to some good music, or watching a funny TV show or video. Changing your mood often will help you to get over the desire to eat.

While emotional eating is harmless when it occurs only every now and then, continuously using food to find comfort or relief, or to relieve sadness or anger, is an issue that needs to be addressed. Overeating, particularly if you’re not getting lots of exercise, can lead to obesity, a condition related to serious health problems.

Emotional eating also can open the door to eating disorders, which are very serious conditions. About one out of every 100 teenage girls develop anorexia nervosa, an eating disorder characterized by a dis­torted body image, obsessive fear of gaining weight, and drastically limiting food intake. Anorexia nervosa can cause permanent damage to the heart and other organs; in extreme cases, it results in death.

Bulimia nervosa affects two to three of every 100 teen girls, and is characterized by overeating followed by forced vomiting or purging. If you or someone you know is affected by an eating disorder, the situation needs to be addressed.

When stress occurs over time or repeatedly, some people turn to drugs or alcohol to help them relax and feel better. This, of course, although common, is a very unhealthy means of dealing with stress, and can lead to both short- and long-term problems. Drug and alcohol use can lead to poor school performance, significant health problems, substance dependency, and other negative consequences. Using drugs and alcohol impairs judgment, which can put you at risk for crime, accidents, unsafe sex, and violence. Alcohol-related car accidents are the leading cause of death among teenagers, and every year, more than 100,000 Americans die of causes related to alcohol abuse.

More than half of all high school seniors admit to having used ille­gal drugs or alcohol, and, nationwide, more than 17 million people suffer from some sort of addiction.

Many teens who experiment with drugs and alcohol as a means of relieving stress think they’ll only do it once, or they’ll only drink one beer, or they won’t ever use any drug except for marijuana. People who are predisposed to addiction, however, can quickly become dependent on drugs and alcohol and find it very difficult, or even impossible, to stop using. When that occurs, lives can be extremely disrupted and relationships destroyed.

Using drugs or alcohol to deal with stress is a very bad idea. If you do not use drugs or alcohol, congratulate yourself and continue to be smart and use good judgment. If you do use drugs or alcohol, or both, get online and read everything you can find about the risks associated. If you’re worried that you have a problem with drugs or alcohol, you need to find someone to talk to about your concerns. You should be particularly aware of a potential problem if there’s a history of problems with drugs and/or alcohol in your family, for addiction tends to involve genetic components. If you can’t talk to a parent for whatever reason, consult with a school nurse, a teacher you trust, a minister or rabbi, or an adult friend who you believe will help you. Getting help with an addiction problem early on can greatly increase the chances of getting you back on track for a happy and productive life. Ignoring a problem with drugs or alcohol now can lead to even bigger problems in the future.

Just as some people eat to relieve stress or fill a void within them­selves, other people buy things. This is called compulsive spending, and is a real problem for many people. Researchers estimate that between 2 and 8 percent of Americans are compulsive spenders, some of whom seek treatment for their addictions. Gambling is a form of overspending, and, if it becomes a problem, can involve many of the same characteristics as being addicted to drugs or alcohol.

Compulsive spending is complicated, because, as a society, we’re encouraged to spend and buy things we don’t need. Companies spend millions of dollars in advertising, hoping to convince us to buy their products.

Overspending can lead to serious financial problems, and result in the same feelings of shame and depression as other addictive behav­iors, such as drug use. People who are compulsive spenders have a higher rate of suicide than those who are not. If you consistently buy things you know you don’t need, even though you know you should be saving the money you spend for other purposes; or steal money in order to buy things; or feel better about yourself after making some purchases, you might want to talk to a trusted adult about your con­cerns. You can learn more about compulsive spending at the Debtors Anonymous Web site at www.debtorsanonymous .org.

Some people react to stressful situations by withdrawing or isolating themselves from others. They find it easier to be alone than to have to explain how they’re feeling or deal with others. Some withdraw because they feel sad and don’t want to be around others who seem happy.

Some people retreat into video games or virtual worlds, playing for hours or even days on end. Others might read or sleep exces­sively. While nearly everyone occasionally feels that they need some time alone, shutting out the world isn’t a healthy reaction to stress because it doesn’t address the issues causing the stress—it merely temporarily removes you from the situation. A better means of cop­ing with stress is to invite a friend to go for a walk and talk about how you’re feeling.

While some people faced with stressful situations withdraw, others become aggressive and act out. They may express anger and frus­tration by punching, kicking, or yelling. Some drive aggressively or engage in violent behavior. Aggression can be physical or verbal, and often occurs in the form of bullying. Boys are more likely than girls to practice physical aggression such as shouting at someone or hitting, although the incidence of physical aggression among girls has been increasing. Both girls and boys practice indirect aggression, which includes behaviors such as forming cliques, gossiping, and spreading rumors or lies on the Internet.

Aggression also can be directed toward nonhuman targets. Some people take out their aggression on animals, while others may dam­age property. Aggressive behavior can cause you to become unpopu­lar and alienated from others, and could even put you at risk for legal and other problems. If you frequently engage in aggressive behavior, you may do well to talk to a counselor or mental-health professional.

You’ve probably heard somebody refer to somebody else as a “worka­holic.” Just as some people become dependent on alcohol, or shop­ping, or gambling, others become dependent on working, or, in the case of some teens, doing schoolwork.

People who develop extreme problems with compulsive working sometimes end up losing their families and other important parts of their lives. They find it difficult to think about anything other than work, and become resentful of other areas of life that take them away from work. While work needs to be taken seriously, there’s a saying to remember if you ever feel that work is consuming too much of your time and energy: “Your job will never love you back.”

Many people engage in unhealthy behaviors when they’re overly stressed, but, once you learn to recognize the situations that cause you to feel stressed, you can work to avoid those situations or train yourself to react to them in a more positive manner than by using those behaviors described above. In many cases, you can avoid getting into stressful situations in the first place by getting organized and preparing for what you need to do ahead of time instead of waiting until the last minute. Running around your house looking for your shoes or keys when you know the school bus is coming down the block is a stressful situation, but one that is fully avoidable.

In other instances, it may well be that you can’t avoid situations that upset you and cause you to feel stressed out. You might live in a neighborhood in which violence regularly occurs; or, like Alicia, you might have a sibling who causes a great deal of turmoil within your home; or maybe you’re preparing to audition for that prestigious music school you hope to attend after high school.

You can, however, learn how to respond to those situations with positive behaviors instead of negative ones, and to have some con­trol over the thoughts and emotions you experience when faced with stress. Let’s have a look at some healthy lifestyle options that can help you feel better prepared to deal with stressful situations, and some positive behaviors you can exhibit when faced with those situations.

Sleeping when you’re feeling stressed out can be difficult, and that can result in a catch-22 situation: The more stressed you feel, the harder it can be for you to get to sleep and stay asleep, and the more your sleep is interrupted, the harder it can be to deal with stress.

Getting a good night’s sleep is important, and it has been linked to overall positive health and the ability to better cope and deal with stress. Lack of sleep has been associated with some serious conditions, including lowered immune system functioning; memory impairment; increased risk for anxiety and depression; greater risk for some serious diseases, including heart disease and cancer; weight gain; and increased risk of accidents.

You might notice that it’s harder to pay attention in school when you haven’t gotten enough sleep the night before. You may tend to get irritable with your friends or family when you’re tired; you may feel like you don’t have enough energy to get through the day. You might rely on energy drinks or drinks that contain caffeine to help you get by. Many teens find themselves in a difficult situation when it comes to sleeping, through no fault of their own.

When you were younger, your body was ready for sleep at eight or nine o’clock. Those were natural times for you to go to sleep. As you entered your teen years, however, your circadian rhythm—an internal biological clock that regulates various physical processes—started to shift, and your natural time for falling asleep moved back. So, while you used to be ready to sleep at nine o’clock, you now might not be able to go to sleep until eleven or even midnight.

Schools in some places have shifted starting times so that older students begin later than younger ones, a move that makes sense in helping teens to get more sleep. Most schools, however, still require older students to start earlier than the younger ones; this means that if you have a long bus ride, you might have to get up at 5:30 or 6 A.M. to be ready on time. Such a situation is not conducive to getting the nine or nine and a half hours of sleep recommended for teenagers.

The National Sleep Foundation reported that the average 12th grader sleeps only 7.9 hours a night, more than an hour less that what’s recommended. In one survey, one in four teens report having fallen asleep in class due to lack of sleep the night before.

If you’re a teen who’s having trouble sleeping, or you feel like you don’t get enough sleep, you may have to make some lifestyle changes. Consider the following tips from the National Sleep Foundation:

> Try to sleep on the same schedule every night. This is a dif­ficult task for teens, who tend to try to “catch up” on sleep on mornings they don’t have to get up early for school or other tasks, but going to bed and getting up at roughly the same times every day can help you establish a regular sleeping schedule and improve the sleep you get.

> If you drink coffee or soda or other drinks or foods that contain caffeine, limit them to earlier in the day and avoid them for at least six to eight hours before bedtime. Remember that caffeine is present in hot and iced tea, chocolate, some prescription and nonprescription medicines, and many energy drinks. Check labels if you’re not sure.

> Relax before bedtime by taking a warm bath or shower, or by listening to calming music, reading, or just sitting quietly. A lot of teens are wired to be constantly doing something and find it difficult to just relax, but sleep comes easier when you’re in a relaxed state.

> Get plenty of exercise during the day, but don’t exercise at night because it can make you more alert and wide awake.

> Remove distractions from your sleep area. Again, many teens pretty much live in their rooms, which makes it hard to get away from your stuff. Still, you should shut down computers, turn off the TV, and turn off your cell phone before you go to bed.

> If you can’t fall asleep in the first 20 minutes or so, many experts recommend that you get up and read or engage in some other quiet activity until you feel more tired. Not being able to sleep can frustrate you and make it even more difficult to do so.

If you’re experiencing serious sleep problems you should consult with a doctor, as it could indicate an underlying problem, such as sleep apnea or depression. Don’t take sleep aids without first check­ing with a doctor.

As with getting enough sleep, eating the proper foods can help you better handle stress. Eating well also keeps you energized, helps to keep your brain functioning properly, minimizes the chance of devel­oping certain illnesses, and helps to regulate mood.

Unfortunately, many people slip up on healthy eating when they’re under stress and fall back on “comfort foods,” which tend to contain a lot of fat and carbohydrates. While eating a big bowl of ice cream or piece of pie might make you feel a little better in the short run, and is perfectly fine every now and then, making it a habit isn’t a good idea. Foods that are loaded with sugar and other refined carbohydrates cause your blood sugar to rise and fall, and that can zap your energy, making it even harder to cope with stress.

The fact is that most people eat a less-healthy diet than they think they do, and teens, who are exposed to fast food, soda, and junk food on a regular basis, are likely to have diets that don’t supply all the nutrients and vitamins that a body needs.

You should strive to eat foods that are low in fat and sugar, including plenty of whole grains, fruits and vegetables. Drink plenty of water and stay away from beverages containing lots of sugar or caffeine. To learn more about getting a proper balance of the foods you need, check out the U.S. Department of Agriculture’s Web site, which contains My Pyramid, an interactive tool that contains nutrition information, a food planner, tracker, and other features. You can find it at www.mypyramid.gov.

Eating at regular intervals is a problem for some teens, who often are rushed and on the go. And some teens, especially girls, intention­ally skip meals in an effort to consume fewer calories and control their weight. Skipping meals, however, is not a good idea for several reasons, including the fact that you tend to become overly hungry and eventually eat way more than you should in order to satisfy that hunger. It can also cause mood swings and fluctuating energy levels, making it harder to deal with stress.

Some studies have indicated that vitamin B can help to relieve stress. The B vitamins are found in whole grains, dairy products, leafy green vegetables, fish and seafood, meat and poultry, eggs, beans, and peas. You can also ask your parent or doctor about taking a B complex supplement.

You might think that reading or playing video games or texting friends are good methods of relaxing—but the truth is, they’re not. Those sorts of activities certainly can be enjoyable, but the true art of relax­ing doesn’t entail electronics or books or being in communication with someone else. It means sitting quietly in a quiet setting and just being with yourself.

Many people, especially teens, who are continuously plugged into music, information, or communications, have never learned how to relax. They simply don’t know how to do it. If that applies to you, you’re going to need to train yourself to relax, because relax­ation is extremely important in managing stress. The ability to relax your body automatically reduces the harmful effects of stress. Real relaxation causes your breathing to slow down, which causes your blood pressure to drop and your muscles to relax. You can learn to relax your body by paying attention to how you breathe and your muscles.

Breathing. Everyone breathes, but most people don’t breathe effec­tively or very well. Learning to control your breathing can greatly help you to learn to relax and better handle stress. When you’re under stress and get tense, your breathing becomes more shallow and only the tops of your lungs fill up with air. That causes your oxygen level to fall, and your body reacts by sending stress chemicals into your bloodstream. That in turn makes you feel even more stressed, and your breathing gets increasingly shallow, causing more stress chemi­cals to invade your system. Learning to breathe deeply—using the muscle at the bottom of your lungs called your diaphragm—can help you to reduce this vicious circle of shallow breathing and stress. To practice deep breathing, follow these instructions:

Get into a comfortable position, either seated or lying down.Close your eyes.Put your hands on your lap, shrug your shoulders a few times, and relax your arms.Slowly take deep breaths, feeling your lungs expand as you breathe.Breathe rhythmically from your diaphragm, concentrating on the deepness of your breaths. Work your way up to 20 times of slowly breathing in, holding the breath for a second or two, and slowly breathing out.

Learning to breathe properly takes some practice, but it’s a great tool for when you’re feeling stressed. Try to take a little time each day to practice, and pay attention to how you feel. Chances are, you’ll feel more focused and relaxed, and your energy level will improve. Once you’ve learned how to do it, you can practice deep breathing almost anywhere.

Relaxing your muscles. Progressive muscle relaxation is a tech­nique to help relieve stress in your body. As with learning how to breathe properly, it takes some practice, but it’s worth the effort. Again, you can sit or lie down, whichever is more comfortable. Just make sure you’re in a quiet place where you won’t be disturbed. The idea is to contract, or tighten up, a group of muscles, and then to con­sciously let the muscles relax. You can start at the top of your body or the bottom. If you start at the bottom, you’ll tighten up your foot mus­cles, and then let them relax as you say the word “relax.” Then you move to your ankle muscles, calf muscles, thigh muscles—all the way up your body to your face and head. Work slowly, and don’t proceed to the next muscle group until you’ve felt the previous muscles relax. When you’ve tightened and relaxed all the muscle groups, take about 10 minutes to simply lie still and enjoy the feeling of being relaxed.

You might find at first that being by yourself in a very quiet set­ting, without even a TV or music for company, is unsettling and a little uncomfortable. Once you get used to it and learn how to relax your body, however, you’ll find you’re much better able to cope with stress.

Learning to relax your body is a great start, but you’ve got to learn how to relax your mind, as well. Relaxing your mind means that you’ll banish all disturbing, stressful thoughts and replace them with peaceful, soothing images. It’s like transporting from a noisy, crowded hallway in school to a quiet, beautiful spot on a private beach, where you hear only the sound of the water.

A good way to accomplish that goal is to learn how to meditate, which simply means clearing your mind of clutter and move into a relaxed state of calm. Some people, such as certain monks or other religious people, spend their entire lives practicing the art of medita­tion. Almost anyone, however, can learn simple techniques of medita­tion that aid in relaxation by slowing heart rate and lowering blood pressure.

The more you practice meditating, the easier it will get and the less time you’ll have to spend doing it. At first though, try to have at least 20 minutes for meditating.

Meditation goes hand-in-hand with the deep breathing and muscle relaxation described above. The first thing you should do is concentrate on your breathing, and then tense and relax your muscles. Once you’ve completed those exercises, sit or lie quietly and, as you breathe out, silently repeat a word or two. This repeated word or phrase, called a mantra, can simply be a sound, such as om, or what­ever simple, calm word or words you’d like. Breathe in, and then out again, silently repeating your mantra as you do.

There are many different methods of meditating, but once you learn the trick of relaxing your mind along with your body, you’ll be able to do it anywhere—even before you have to give a big presenta­tion.

Most people know that exercising is good for their bodies. It’s also known to improve brain function, decrease stress and ten­sion, enhance mood, relieve anxiety and help with depression, and provide an overall sense of well-being. It’s not completely under­stood why exercising is good for your mood, but experts say that it stimulates certain hormones that help to improve mood, gets rid of stress hormones, and increases blood flow to your brain. In other words, exercise is a really good idea. If you’re already into the habit of exercising, give yourself a pat on the back and keep up the good work.

The U.S. Department of Health and Human Services recommends at least 60 minutes of moderate intensity physical activity on most and preferably all days, for people between the ages of six and 19. Moderate activity includes the following.

> Brisk walking (about three miles per hour)

> Riding a bike (at less than 10 miles an hour)

> Hiking

> Gardening or yard work

> Dancing

> Playing doubles tennis

> Jumping on a trampoline

> Rollerblading at a moderate pace or skateboarding

> Playing ping-pong

> Yoga

If you’re already getting lots of moderate intensity physical activity and you want to add some more demanding forms, vigorous activity includes those listed below:

> Playing competitive sports such as soccer, basketball, or field hockey

> Running or jogging (five miles per hour)

> Riding a bike (at more than 10 miles per hour)

> Swimming laps

> Very fast walking (more than four miles per hour)

> Aerobics

> Playing singles tennis

> Karate or judo

> Circuit weight training

> Vigorous rollerblading

Sixty minutes of exercise almost every day might seem like an impossible task, but remember that it doesn’t have to be done all at once. You can space out physical activity throughout the day by walking the dog at a brisk pace for 20 minutes in the morning and 20 minutes at night, jumping rope for 10 minutes when you get home from school, and pulling weeds for 10 minutes after dinner.

If those activities don’t work for you, identify ones that do. Many communities offer free swimming in a school or community center, or your school may have a weight room you can use after classes or at night. Even running up and down the steps in your house for 10 min­utes is a good form of exercise. If you can’t put in 60 minutes a day, try for 40, or even 30. Establishing a pattern of getting some exercise every day, however you get it, can lead to big improvements in your overall health and help you to better manage stress.

Did you ever have a problem that was really stressing you out until you poured out your heart to a friend, and all of a sudden the problem didn’t seem so big anymore? Talking over a situation that’s causing you stress is beneficial because it helps to clarify the situation and put it into perspective, and allows you the opportunity to receive feedback and advice.

Something that seems like a big deal in your head often doesn’t seem so big once it’s been verbalized. You might find out that your friend had a very similar situation and learn how she handled it. Just the fact that you have a friend with whom you can share a problem is comforting and reassuring in that you don’t have to worry alone.

While your friends can seem like the most important part of your life, remember that in some cases, it’s best to approach a trusted adult. If you have a problem that’s very serious, such as one that involves a legal issue, a medical condition, drug or alcohol abuse, or thoughts of harming yourself, you’ll need the advice and help of an adult.

Listening to others also can help with your stress levels. People who reach out and make connections with others typically enjoy bet­ter moods and greater levels of happiness than those who don’t.

Long-term Physical Effects of Stress

So you can see that, while short-term stress can be useful and necessary, long-term, prolonged, or unrelenting stress is not a good thing. What begins as a nervous stomach or feelings of nausea during a short-term stressful situation can develop into irritable bowel syn­drome, ulcers, and other serious physical ailments in cases in which stress is constant and severe.

The American Academy of Pediatrics has already warned that more and more teens are exhibiting physical symptoms linked to stress, including headaches, chest pain, sleep disorders, and belly pain. That’s worrisome news, since those sorts of problems have the potential to become more serious and result in conditions such as digestive disorders, sleeping disorders, migraines, heart disease, and perhaps even contribute to some types of cancer. Doctors are urging their patients to be aware of the warning signs of stress-related physi­cal problems and to take measures to address them.

In this post we’ll have a look at situations that can result in long-term stress, how long-term stress can affect you physically, what physical symptoms you might experience, and how you can recognize potential problems. Long-term stress also can have significant psycho­logical effects, and you’ll learn more about those in the next post. To begin, let’s look at some common and not-so-common situations that can result in continual or frequent stress.

As you know from previous post, How Stress Affects You Emotionally, some people are more susceptible to stress than others, and some are better able to deal with it when it occurs. Some situations, however, are pretty much universally stressful, as noted on the Holmes and Rahe stress scale. Among those universal stressors are the deaths of a spouse or child, divorce or separation, serving time in jail, death of a family member, illness, marriage, preg­nancy, a child leaving home, changing schools, and having a mortgage. (It’s interesting that even occasions or events that we consider to be happy ones—such as getting married or preparing to welcome a new baby into the family—come to us with a good measure of stress).

Fortunately, most of these big stressors occur only on an occasional basis and are not ongoing. Some situations, though, are ongoing and can result in ongoing or constant stress.

Certainly, ongoing physical, sexual, or emotional abuse is reason for extreme levels of stress. So is living in a violent environment, such as a war zone or even a very dangerous urban neighborhood. These sorts of situations, even if they stop, have long-lasting results, includ­ing both physical and psychological problems.

While it’s impossible to ignore terribly traumatic experiences like physical, sexual, or emotional abuse or other forms of violence, there are other stressors that might be so constant in your life that you don’t even recognize them. It’s a worrisome fact that you can get accustomed to living with stressful situations to the point where you barely think about them—they’re just the way it is. These situations might include constant worrying about succeeding in school, getting accepted into college, finding the money to go to college or rent an apartment, getting invited to the prom this year, your girlfriend or boyfriend breaking up with you—these sorts of low-level stressors that often remain under the radar. They might not be at the forefront of your mind’s agenda, but they’re always a little below the surface, nagging at you like a mosquito bite that won’t stop itching.

If you’re exposed to ongoing or long-term stress, you might notice over time that your neck and shoulders feel cramped and tight, mak­ing it difficult some days to even turn your head without neck pain. You might notice that your stomach is frequently churning, and you wonder if it’s safe to eat or whether you should skip lunch and just have a soda. You don’t understand why you have headaches so often until your dentist says she can tell that you’ve been grinding your teeth as you sleep, a habit that often results in headaches. To top

it off, your asthma, which you thought you’d outgrown by sixth or seventh grade, has returned, making it difficult for you to play on the baseball team.

You feel like your body is falling apart and you’re only 18 years old! What will it be like when you’re 40 or 50 or 60? If you feel that you’re stressed out and already experiencing some physical prob­lems as a result, the best thing you can do is to address the situation now. If you don’t learn how to handle stressful situations now can mean that you’ll lack the skills you need to cope with them as you get older, and it’s likely that physical problems would only become more severe. Let’s take a look at some of the serious physical con­ditions that are associated with stress, and the problems they can cause.

Also known as hypertension, high blood pressure causes the heart to work harder to pump blood to the body and contributes to car­diovascular disease, stroke, eye problems, and kidney disease. While experts are still trying to determine whether long-term stress actually causes high blood pressure, evidence strongly points to a connection between the two. The School of Public Health at Johns Hopkins Uni­versity in Baltimore reported on a study which revealed that ongoing stress among teens can lead to elevated blood pressure, more than doubling the risk that those teens would experience chronic high blood pressure as adults.

Increasing numbers of teens also are experiencing elevated blood pressure levels due to factors such as obesity, inactivity, and poor eating habits. Other factors that contribute to high blood pressure include genetics and aging. High blood pressure has been called “the silent killer,” because there usually are no symptoms. This makes the condition particularly dangerous.

A doctor or nurse can measure your blood pressure with a device called a sphygmomanometer, which consists of a stethoscope, arm cuff, dial, pump, and valve. You can also get your blood pressure taken at health fairs, at special machines in some drug or grocery stores, or with home blood pressure monitors. High blood pressure can be treated with lifestyle changes and medications, if necessary. People who are susceptible to hypertension should be careful to monitor their blood pressure so it can be kept at an acceptable level. If you’ve never had your blood pressure taken, or haven’t had it taken for a long time, it’s a good idea to do so in order to establish a base­line reading. If you have your blood pressure taken several times with similar results, you’ll be able to keep an eye on it to see if remains about the same.

Keep in mind, though, that blood pressure is susceptible to your reactions to what’s going on around you and can vary significantly within a short period of time. If you’re on your way to a health fair to have your blood pressure checked and you’re nearly run over by a bus on your way, for instance, chances are your blood pressure will be quite high when you arrive! A good thing to do would be to wait for an hour or two and have it taken again to see if it’s come down.

Blood pressure for some people tends to elevate just at the thought of having it checked, resulting in a sort of false reading. Some people with high blood pressure do well to purchase a machine they can use at home to keep track of daily readings. If there’s a history of high blood pressure in your family—that is, if your mom, dad, or any of your grandparents have or had the condition—you should get yours checked occasionally and keep track of the results.

 

As with high blood pressure, it’s not yet clear whether stress is an independent factor or a primary cause of heart disease, but evidence strongly points to a link. It’s sort of like a chain, where one link leads to another. People who are under a lot of stress for a prolonged period might end up feeling isolated or angry, traits which have been linked to increased risk of heart disease. Or, stress causes some people to react with unhealthy behaviors, such as smoking, excessive drinking, physical inactivity, or overeating, all of which also can contribute to heart disease. Experts suspect that high stress levels can further elevate blood pressure and levels of cholesterol, which is a soft, waxy substance found in your body’s bloodstream and cells. Everyone needs cholesterol, but when too much of it builds up it can block the flow of blood to the heart and result in health problems, including heart attack. Some studies suggest that stress changes the way the blood clots, and that could be a factor for heart disease. If stress actu­ally is a primary factor in heart disease, it could be due to frequent and excessive exposure to stress-related hormones such as cortisol and adrenaline.

Regardless of whether stress is a cause or a contributor to heart disease, the evidence certainly points to a link between the two.

The term heart disease actually refers to a number of condi­tions that affect the heart, including coronary heart disease and heart attack, congestive heart failure, and congenital heart disease. Together, those conditions cause more than 652,000 deaths in the United States every year, according to the Centers for Disease Control and Prevention—more than any other disease. The most common type of heart disease is coronary heart disease, which is when the arteries that allow blood to flow to and from the heart get narrowed and hardened due to buildup of plaque.

Some people don’t have any symptoms of coronary heart disease until they have a heart attack, also known as a myocardial infarction. This happens when the heart can’t get enough blood and the cells of the heart muscle don’t receive enough oxygen and begin to die. The more time that passes between the beginning of a heart attack and the start of treatment to restore blood flow, the more damage will occur to the heart muscle. If the heart sustains a great deal of dam­age, cardiac arrest could result; this is when the heartbeat stops, and it can lead to death.

Other people get a warning that coronary heart disease is present in the form of angina, which is a pain or feeling of pressure in the chest, and sometimes in the shoulders, arms, and back. This occurs when the heart muscle isn’t receiving enough oxygen.

Tests to determine whether or not a patient suffers from coronary heart disease include:

> Electrocardiogram (EKG), which measures the electrical rhythms, rate, and regularity of the heartbeat

> Echocardiogram, which provides an image of the heart

> Exercise stress test, which measures how effectively the heart pumps when it’s working harder than usual, requiring more oxygen for the heart muscle

> Chest X-ray, which provides an image of the inside of the chest, including the heart

> Cardiac catheterization, in which a thin tube is inserted into an artery in the groin or arm and threaded up to reach the coronary arteries. This allows a doctor to check the insides of coronary arteries to determine blockage and other factors affecting the arteries and your heart.

> Coronary angiography, which is when a dye is injected through the catheter used in a cardiac catheterization, allowing a doc­tor a better look at the flow of blood and whether blockages are present

Treatment for coronary heart disease usually involves making lifestyle changes, and it often includes medicines and medical treat­ments. Sometimes, but not always, surgery is required to open arter­ies and improve blood flow.

Congestive heart failure, sometimes called chronic heart failure, occurs when the heart can’t pump enough blood and oxygen to keep other body organs healthy and functioning properly. This can result in a number of serious problems, including kidney failure and other conditions. There is no cure for congestive heart failure, but in many cases it can be managed through lifestyle and with medicines and other treatments.

Congenital heart disease is the most common type of major birth defect; it can be caused by genetic factors, or, sometimes, because a developing fetus is exposed to something that damages the heart. Congenital heart defects include abnormal valves and holes in the walls that divide the chambers of the heart.

Simply being exposed to high levels of stress does not cause any of these conditions. In people who have other risk factors or exist­ing problems, however, stress is suspected as a contributing factor to heart disease.

Strokes are sometimes called “brain attacks” because, as during a heart attack, blood flow is restricted. With a stroke, however, the blood flow to the brain is cut off, meaning that the brain doesn’t get the oxygen and glucose that it needs to survive, and brain cells begin to die. If a stroke is not treated early, it can cause permanent brain damage.

There are two kinds of stroke: ischemic and hemorrhagic. Ischemic stroke, which accounts for about 80 percent of all strokes, occurs because either a blood clot or too much plaque clogs blood vessels and blocks the flow of blood to the brain. A hemorrhagic stroke occurs when a blood vessel in the brain breaks or ruptures and blood seeps into brain tissue, damaging brain cells.

Although stress does not directly cause strokes to occur, people with high blood pressure are four to six times as likely to have a stroke as those who don’t have high blood pressure, and stress also has been connected to other risk factors for stroke, including irregular heart rhythm, smoking, excessive use of alcohol, being overweight, and coronary artery disease.

The immune system is an amazing collection of cells, proteins, tis­sues, and organs that continually work together to fight off substances that threaten to harm the human body. The immune system employs a series of steps, known collectively as the immune response, to seek out and destroy organisms and substances that, if left alone, could cause disease or infection. When the immune system is functioning properly, it is incredibly effective in protecting you. It can kill bacte­ria, viruses, and infected cells; assure immunity from diseases; and generally help keep you healthy.

When the immune system is compromised, or not working prop­erly, however, it is not always able to protect the body as it should. Basically, there are four things that go wrong with the immune sys­tem: immunodeficiency disorder, autoimmune disorder, allergic disor­der, and cancers of the immune system.

Immunodeficiency disorder occurs when parts of the immune system are not working the way they should—or don’t even exist. Some people are born with deficient immune systems, while the immune systems of others are damaged by infections or drugs. There are different levels of immunodeficiency disorder, ranging from mild to severe. People with mild immunodeficiency disorders might suffer from allergies and tend to get more colds and other respiratory infec­tions than others, while someone with very severe immunodeficiency disorder may be almost completely helpless in fighting infection. You may have heard of “the bubble boy disease,” a condition called severe combined immunodeficiency. Its more informal name comes from the case of a boy from Texas who lived in a plastic bubble that had to be kept entirely free of germs because his damaged immune system did not allow him to fight off any sort of infection. That, of course, is an extreme form of immunodeficiency disorder.

Sometimes immunodeficiency disorder occurs when the immune sys­tem is damaged by a disease or certain types of drugs. AIDS (acquired immunodeficiency syndrome) is a disease that, over time, destroys the immune system by making it unable to fight off what would normally be harmless organisms. Some medicines, including chemotherapy and immunosuppressant medicines given to people who have had organ transplants, also can cause immunodeficiency disorder.

Autoimmune disorders occur when something in the immune sys­tem goes haywire, causing it to attack a part of the body as if it were an invader looking to cause harm. Autoimmune disorders include lupus, which causes pain in the joints and muscles and can involve the kidneys and other organs; juvenile rheumatoid arthritis, in which the immune system attacks joints of the hands, feet, or knees; and scleroderma, which leads to inflammation of the skin, internal organs and joints. These disorders can be life altering and debilitating.

Sometimes the immune system overreacts to certain substances within the body, causing an allergic disorder. This can cause symptoms ranging from sneezing and watery eyes to a dangerous condition called anaphylaxis. Examples of allergic disorders include asthma; eczema; drug allergies; seasonal allergies; food allergies; animal allergies; aller­gies to toxins, such as bee stings; and environmental allergies, such as allergies to dust mites or mold.

Cancers can occur in the immune system, as in other parts of the body, when cells grow in an uncontrolled manner. This damages the immune system and makes it unable to do its work. The two most common types of cancers affecting kids and teenagers are leukemia and lymphoma. Thankfully, most cases of these cancers are curable.

Researchers and doctors have discovered a link between stress and disorders of the immune system. Studies have shown that long-term stress, particularly when those experiencing it can not see any ending to it or have no hope of escaping it, weakens almost all aspects of the immune system, making those affected more susceptible to a variety of problems. Some researchers believe this is due to the presence of cortisol, a stress-related hormone that may affect the cells within the immune system and limit their ability to fight off diseases.

Continued research is occurring as scientists and doctors learn more about the ways in which stress affects the immune system. It has been observed, however, that people exposed to long-term stress are more susceptible to a variety of problems, ranging from colds to cancer. Addressing overall health is extremely important when con­sidering the immune system and how to keep it at peak functioning levels. Proper nutrition, sufficient exercise, and keeping stress under control are all factors that affect how efficiently your immune system works.

There is no proof that stress, by itself, causes cancer. Studies con­ducted over the past three decades, however, have suggested a rela­tionship between psychological factors, including stress, and cancer risk, according to the National Cancer Institutes, a branch of the National Institutes of Health.

While some studies have indicated that stress might actually increase the risk of developing cancer, others have suggested that high stress levels may lead to faster progression of the disease once it occurs. Still other studies have linked stress to certain types of virus-related tumors that occur when the immune system is compromised.

This is a complicated topic, because, as with high blood pressure and heart disease, it’s not known whether stress is a factor in the development of cancer, or if it contributes to the effects of other cancer factors, such as obesity, smoking, and alcohol abuse. Someone with a strong family history of cancer may experience a great deal of stress worrying that she too will get cancer, raising the question of whether the stress may contribute to the likelihood of the cancer occurring. And, researchers wonder, once cancer has been diagnosed, could the stress that accompanies such a diagnoses contribute to the progression of the disease?

Most scientists believe that cancer is caused by a combination of factors, including genetics and environmental and behavioral factors. As more research is conducted, we should get a better understanding of a possible link between stress and cancer. We do know, however, that stress can negatively affect the immune system, and the immune system is an important tool in fending off cancer.

A common stress response for many people is to eat. And, gener­ally, when you’re feeling stressed out and looking for relief, a celery stalk is not the first food you reach for. Most people who seek stress relief through food gravitate toward foods high in fat, sugar, and salt—pizza, fried chicken, and donuts, rather than fruits, vegetables, and whole grains.

Many people eat when they are bored, happy, sad, angry, or frus­trated—not just because they are hungry. Researcher Brian Wansink claims that the average person makes about 200 decisions pertain­ing to food every day, most of which are made with little thought or awareness, and most of which have hardly anything to do with hunger. Eating habits, Wansink asserts, depend largely on who we’re with, where we are, and how we’re feeling at the time we decide to eat. So, if you and friend always take a different route home from school on Fridays because you stop at the café for a water ice or gelato, you’re likely to indulge, even if you’re not particularly hungry. If you’re feeling stressed or upset, you might indulge even more than you normally would.

There’s a lot of truth to jokey mottoes such as “When all else goes wrong, reach for chocolate,” because that’s exactly what many people do. Some people use food for escape, just as others might use alcohol or drugs.

A recently released study of more than 1,000 low-income adoles­cents in Boston, San Antonio, and Chicago revealed that kids who reported high levels of stress based on five factors experienced an obesity rate almost 10 percent higher than their peers who did not feel overly stressed. The five factors considered were: academic problems, drug or alcohol use, depression or poor mental health, aggressive behavior, and lack of future orientation.

The increased obesity in the highly stressed kids could be caused by behaviors adopted in response to stress, such as overeating and not exercising, researchers said. Or, obesity itself may be a stressor, leading to a vicious cycle.

In addition to stress-affected eating habits, scientists recently dis­covered another connection between stress and weight gain. A study led by Georgetown University Medical Center revealed that a mol­ecule called neuropeptide Y (NPY), which helps in new tissue growth, is released from certain nerve cells during times of stress. The NPY molecule has been linked to appetite and obesity, leading researchers to suspect a link between stress and fat growth. The body of a per­son who experiences stressful situations on a regular basis could be releasing this molecule often, promoting the production of fat.

Diabetes is another disease which, although not caused by stress, may be affected by it. And, stress may be a contributing factor in the presence of the disease. When someone has diabetes, his or her body doesn’t produce insulin (type 1 diabetes), or doesn’t use insulin properly (type 2 diabetes). Insulin is a hormone necessary to convert sugar, starches, and other foods into energy. Nearly 8 percent of the American population has diabetes, and the incidence of the disease is rising. Both genetics and environmental factors, including obesity, play a role in the development of this disease.

Ninety to 95 percent of people suffering from diabetes have type 2, in which their bodies don’t use insulin properly. Traditionally, type 2 was known as “adult diabetes,” because it usually didn’t occur until well into adulthood. Today, however, children as young as seven have been found to exhibit early signs of type 2 diabetes, and, alarmingly, the number of children being diagnosed with this type of the disease is increasingly rapidly. Overall, the incidence of diabetes in the United States increased by 13.5 percent between 2005 and 2007, according to the American Diabetes Association.

Experiencing frequent stress poses particular problems for some­one with diabetes. When the fight-or-flight response kicks in, so do stress hormones. The hormones allow stored up energy in the body to be released into the cells to get the body into shape for fleeing or fighting. A person who has diabetes may not have insulin to help that stored-up energy get into the cells—the glucose and fat that makes up the energy gets stacked up in the blood. For such a person, stress occurring on a regular or constant basis, can result in long periods of high levels of glucose in the blood.

Also, people who have diabetes and find themselves under stress may not take care of themselves as well as they should, which can have a negative effect on their health.

As you have read, long-term stress plays a role in a number of very serious diseases, as well as causing less serious problems such as headaches, digestive problems, neck and shoulder pain, sleeping problems, and skin rashes. If you are already experiencing any of the physical problems associated with stress, you should make an appointment to see your doctor. If you haven’t had a physical exami­nation for two years or more, it’s advisable to try to schedule one. If you don’t have a family doctor or can’t afford to see a doctor, there may be alternatives available to you. You’ll read more about that in this post, Paying for Care – Health care coverage for Stress.

> While short-term stress can be useful, long-term stress can cause a variety of problems, including serious physical conditions.

> Many people become accustomed to living with ongoing stress and no longer recognize that the stressful situation exists.

> If you’re already experiencing physical symptoms of stress, you should address the situation now so it doesn’t continue to worsen as you get older.

> Stress is believed to play a role in high blood pressure, heart disease, stroke, problems of the immune system, cancer, obe­sity, and diabetes.

> While stress doesn’t cause these serious diseases and condi­tions, it might contribute to their presence or make them worse once they are diagnosed.

> If you believe you may be experiencing stress-related physical problems, you should consult with a doctor or other health professional.