The medical definition for stress includes mental tension and physiological reactions. I think most people, however, only consider stress to be a type of mental anxiety due to stressors from the outside environment: traffic, job, marriage. The natural biological reactions to unhealthy lifestyles, which can lead to diseases of adaptation, are not included in the everyday concept of stress. But if there’s going to be any kind of preventive medicine revolution in this country, these physiological stresses need to be understood.
Physiological reactions, or stresses, are happening to our bodies all the time. Exercise is regulated physical stress, in reaction to energy demands, with healthy benefits. Knocking our knee on the leg of the table and getting a bruise causes short-term localized stress while the body addresses the injury. Some lifestyle choices cause long-term stress to our bodies and result in unhealthy consequences.
Let’s consider smoking for instance. Nicotine, the stressor, causes blood vessels to constrict. The body reacts by working harder to pump sufficient amounts of blood. This high blood pressure is the stress. Depending on how much people smoke, their bodies might be in a constant state of this reaction. Someone who is on vacation lounging on an empty beach somewhere might think that their body is perfectly relaxed, but if they are feeding their smoking addiction, they are under physical stress.In 1936, endocrinologist Hans Selye developed a generalized series of three stages, which take place when the body is subjected to long-term physical stressors. It is called the general adaptation syndrome (GAS) and is still accepted today. According to Selye, when the body is subjected to a stressor, the first of three phases begins, the alarm reaction phase. At this stage, the body activates the sympathetic nervous system in reaction to the stressor. This causes a variety of different things to happen; among them are increases in heart rate and/or blood pressure, or secretion of hormones in some cases. Using our smoking example, the body would increase its heart rate and blood pressure at this time in reaction to the nicotine. Because the stressor is new to the body, it is assumed that there is plenty of energy for the system to combat the stressor. Sometimes the stressor expires and the body can resume normal functions, as in the case of an occasional smoker. If this first stage is insufficient to deal with the stressor, however, if the body detects nicotine at regular intervals for instance, then stage two begins.
Stage two is called the resistance phase. Here the body attempts to adapt to the stressor. As the body realizes that its initial reaction is insufficient to ward off the stressor, the stress of high blood pressure and hormone secretion will subside a little to conserve energy. Still, it remains higher than normal to compensate. When this has gone on for an extended period, it can be classified as a disease, or what Selye called a “disease of adaptation,” clinical high blood pressure or arterial hypertension. The body remains in this phase until the stressor is gone or the energy reserves to combat it are gone, which is the exhaustion phase.
During the exhaustion phase, all energy reserves become depleted and the body becomes very susceptible to illnesses such as heart attack, stroke, or cancer. With smokers, the body might run out of energy to pump blood fast enough to meet the needs of the organs and tissue, congestive heart failure (and this isn’t even considering what smoking does to the lungs!). One-third of American adults have high blood pressure, it’s no wonder that heart disease is the number one killer.
This concept can be applied to all kinds of lifestyle choices. A high fat diet can cause central obesity, which secretes adipokines that impair glucose tolerance, eventually leading to type 2 diabetes. The diet, obesity, and hormone secretion are the stressors, diabetes is the disease of adaptation, and the symptoms of diabetes are the physiological stresses. It goes on and on: too much sodium leads to hypertension, excessive caffeine can lead to osteoporosis, alcohol leads to ulcers and liver damage… stressors lead to stress and diseases of adaptation.
The top four causes of death in the U.S. are, for the most part, due to lifestyle choices: (1) heart disease; (2) cancer; (3) stroke; and (4) chronic lower respiratory diseases (lung cancer). Patients and the general public need to decide how important their health is to them, if lifestyle changes are the costs to improve it. Judging by the present situation though, I’d have to say that the majority of westerners don’t give a damn about their health. I am in awe that people don’t make positive changes in their lifestyle, especially considering these statistics and that the cost of heart operation at around $40,000, a nice chunk of debt to will to the children.
It is the fundamental mistake of modern western medicine to address these diseases by suppressing the symptoms with medications or performing expensive surgeries that provide only temporary relief, rather than identifying the stressor and eliminating it. The simplistic view that patients are on their way to recovery when their symptoms are subdued—without lifestyle changes—must be retired. Physicians should understand that if they follow the series of stressors back far enough from the stresses, the main cause will reveal itself. Once the cause is determined and eliminated, the symptoms can be addressed. This method of treatment should be used even in the cases of suspected genetically predisposed diseases since it has been shown that even these need to be triggered to occur, usually by a lifestyle stressor.
Interestingly, the section on nutrition has been removed from the Hippocratic Oath. Hippocrates’ original version included this: “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.” I guess health care officials omitted it since they had no idea what it meant.