Psychosocial Stress and CVD

It seems like eons that I have been trying to write a blog post that discusses how social factors influence health without losing the depth and complexity of the issue. Recently, I made a simple short status update on Facebook about psychosocial stress and cardiovascular disease(CVD). Quickly, some of my friends from all corners of the US chimed in and enriched my understanding of the topic. I then sat down trying to write another post after being influenced by all of my friend's input. Soon, I realized that this discussion took a more organic approach; similar to that of a grad seminar session, and it was already captured in print. After getting the permission of all but one of my friends/contributors, I posted it. I am so thankful to have such curious friends who love to engage in these types of deep discussions.


Chris Aloia:
Doing a lot of reading on psychosocial stress and CVD. Wow, mind blowing!

Katherine Moss: What's CVD?

Barbara Martinez: Cardiovascular disease

Katherine Moss: Ahhh thanks.

Name withheld and writing rephrased: Can you elaborate on what you are studying? It seems obvious that stress causes disease is there anything else?

Chris Aloia: a direct causative pathway has not been established etiologically, at least in humans. Most of the research points to stress as a modifier. Meaning that high stress causes poor lifestyle choices, which lead to poor health outcomes. Only a few researchers consider stress a direct cause. So there is a big debate that has been going on for at least 10 years and it has my full attention.

Dana Janezic: The evidence is there for a direct cause in baboons though so it really won't surprise me when they find it for humans.

Chris Aloia: yeah, Sapolsky again! But you can't randomize humans to stress. I think one group in Germany did it once, it is called torture. But there have been some awesome studies by extremely clever researchers. I buy it as a direct causal agent. The implications are intense!

Katherine Moss: Kind of gives new meaning to the phrase "broken hearted"

Dana Janezic: I'm of the school that thinks that when it comes to testing humans, we will be creative enough to come up with tests that don't involve torture. I really don't understand people who just give up and relegate human sciences to soft sciences... when we live in a world where people were creative enough to figure out how to test for the existence of neutrinos.

You're absolutely right, the implications are paramount. Think about the 30 year fixed rate mortgage in these terms. 30 years is a long long time for bad things to happen to a person all the while they have the stress of the obligation on that monthly note. It's particularly interesting when you consider the fact that the 30yfrm is a political creation...

Aaron Irons: Stress can indeed be a direct cause of cvd, whether left brained methods of perception, research or experimentation come to a widely held consensus or not. I mean that respectfully, while recognizing inherent biases in perception and thus accepted routes of validation which can become so familiar and accepted that the mental structures used to do analytical analysis can become their own barriers to equally valid insights and experience as well. With this respected such methods certainly have their use and place. As long as we remember to also release over attachment to them and allow for equal validity of so called right brain feeling, experiential, creative and perceptual capacities.
Even the short term effects of perceived stress with its effects of blood pressure, heart rate, adrenaline, fight or flight response can noticeably effect cardiovascular system unhealthfully to point of triggering angina, heart attacks and possibly strokes. Body sometimes overcompensates in its responses to perceived stressors by releasing, inhibiting or creating insulating fats, hormones or other chemicals which can have their own damaging effects.

Chris Aloia: Aaron, you bring up a great point. There is consensus that acute stress can induce a heart attack. However, short term stress does affect the cardiovascular system but to extrapolate that to CVD mortality is where things get VERY hazy.

And you are also right that individual perceptions of stress play major role, which again confounds the stress as direct causal agent theory because what triggers one person's stress response may not another.

Everyone is searching for hormones that are more stable markers for early stage CVD. Even Sapolsky has baboon blood in storage for the sole purpose of a discovery of a new hormones. Incredible! Thanks to all for posting. it helps me put this whole field into perspective.

Katherine Moss: Here's an idea for a study that doesn't involve torture. Put out a call for volunteers to participate in a study who describe themselves as "under severe stress". They would fill out a form describing their stressors: such as death in the family, job loss, divorce, child with medical issues, etc. Maybe they could be interviewed as well. Interview questions could include what level of social support people have, how often they see family and friends, if they feel comfortable discussing problems, if they belong to a church or other clubs, etc...Then they donate blood and it is examined. They have full cardiovascular workup. It could be a longitudinal study where they follow same subjects over time and ask about their stress levels and then compare results of heart tests? I realise that self selection isn't the best way to gather participants, BUT you would be getting people who subjectively see themselves as "stressed" which, as you say, varies from person to person even though they may be going through the same situations one person's stress might be greater than another. Just some thoughts. I'm sure someone is already doing this type of thing?

Chris Aloia: Yeah this has been done many times. The key is there is NO stable measure of stress. Self-reported stress can be confounded by lifestyle choices because people who report higher levels of stress are usually of low-income. low-education, they smoke more, etc etc. So no one knows which causes what. Does stress cause poor lifestyle choices? Do poor lifestyle choices create higher levels of stress? Is it education? Is it childhood SES? Crazy interwoven complexity and I love it.

Katherine Moss: What if the researchers eliminated those of low income or education or those who smoke from the pool?

Katherine Moss: I'm sure there are plenty of rich, well educated smokers who are stressed. In fact, they could use college professors as a start! LOL

Chris Aloia: Besides all these very interesting ideas above, there is also a political side. There is a mountain of evidence that shows a good chunk of the explanation for poor health outcomes are from social structures. The implication here is that what many call "human agency" is not as strong as some Republicans might argue. The pulling one up from the boot straps happens a lot a lot a lot less in low-income areas and even middle-income as well. This means the elites not only get the cash, the babes, the vacations, but they also live longer. Got to love that! Human civilization is more animal than human in my mind. I have no trouble with Darwin.

Katerine Moss: sad but true.

Personal Paradigm Shift

Spending 11 weeks this summer in India, where the heat is 109 degrees and walking 4 days per week, administering surveys door-to-door, negatively affects my daily routine of Tai Chi. It is simply too hot to move. I have been doing some Chi Gung at night before bed. But I still feel like I am missing my daily one-hour routine of Tai Chi. I have felt jealous of my friends back in the US who aren’t missing a beat in their own practice. Then I had an epiphany that led to my own personal paradigm shift.

My choice of going into health research as opposed to acupuncture or some other health care delivery was just the beginning of incorporating my research into my life. Scientific research is a systematic method of adding knowledge about the world around us by collecting data, lots of data. My research here in India is trying to ascertain how people’s dietary habits impact their physiology. What I am finding thus far is that small, simple choices in an individual’s and a culture’s diet can negatively impact their life span. In short, people’s cultures are killing them slowly.

My research in India takes me door-to-door asking people in their homes about their lifestyle choices. Everyday I meet people who are overweight, with high blood pressure, not exercising, making poor dietary choices and of the age where their first MI (myocardial infarction, or heart attack) is not far off. So many of them think that they are healthy and that they are eating just fine. They truly are in a state of denial. The stats tell another story: About 17.5 million people die from cardiovascular related deaths every year. That is 30% of all deaths in the world, which means that CVD kills more people than any other disease.

Although I haven’t been doing as much Tai Chi as I like, I am seeing first hand through a scientific lens that, overwhelmingly, lifespan is determined by the choices people make day in, day out, many of them based on cultural norms. The average life span in India is 64 years of age. The people I meet here are creating a pattern of behavior that will affect their child’s life span as well. Science has given me the tools to see this. By collecting data from hundreds of people I can infer whether a certain behavior is rampant or not. If you just follow a tradition or culture that is orally interpreted or passed down in books you might not notice what is actually happening on the ground. A state of denial is created because tradition is kind of like a rule book or a map following it confirms you are doing well. Unfortunately, many of the directions are flat out wrong or not appropriate to the present time frame. I am finding that the people of India follow their traditions and are very devout, much like people of other places, but unfortunately without that scientific lens they can’t see where the health outcome of their tradition leads. The Hindu religion states the eating of meat is forbidden, with beef strictly taboo. Although the attitude toward chicken is more casual, many people proudly don’t consume it for religious reasons. However, chicken is a more efficient protein, with less fat, than the daily consumption of whole milk (in tea and drunk plain), paneer (a type of cheese), and whole milk yogurt that makes up a big part of the Indian diet.

Even in my beloved Tai Chi there is very little information on dietary behaviors. There is some wisdom on the balancing of the 5 elements and their dietary correlates: sweet, sour, salty, pungent, and bitter. Unfortunately, it doesn’t give any measurements or of course the wise sages could not fore see the transition from a rural old world diet rich in whole grains to a modern diet full of processed refined grains heavy in salt and sugar. Consequently, Tai Chi instructors without training in western science do not pass on that kind of wisdom. The Tai Chi literature also says to avoid any type of cardio activity. Although there is some wisdom within those words when applied to elderly people but it is poor advice for middle-aged adults who are in need a cardiovascular exercise for their heart.

Absorb what is useful, discard the rest

It is difficult not to be influenced by cultural traditions. Tradition gives many of us meaning in life and even makes us aware of many positive activities as well. The Tai Chi literature is full of all kinds of awesome behaviors to follow, that is why I love it and read so much of it but there is a fundamental lack of precision. Following the scientific method gives me the insight of what is actually happening on the ground from the data collected. The choices I make of which many come from the Tai Chi literature are tempered and corrected by the large body of literature amassed by the western science paradigm. So I can as Bruce Lee has advised, “absorb what is useful, and discard the rest.”