Thea Singer2013-05-26T22:56:52-04:00Thea Singerhttp://www.huffingtonpost.com/author/index.php?author=thea-singerCopyright 2008, HuffingtonPost.com, Inc.HuffingtonPost Blogger Feed for Thea SingerGood old fashioned elbow grease.Can A Blood Test Really Tell How Long You'll Live?tag:www.huffingtonpost.com,2011:/theblog//3.8669832011-05-26T08:36:49-04:002011-07-26T05:12:01-04:00Thea Singerhttp://www.huffingtonpost.com/thea-singer/screaming headlines suggesting that a soon-to-be available blood test will be able to tell us how long we'll live -- and whether we can ward off the irksome outward signs of aging.
Ignore them. They distort the truth, reducing complex science to sensationalist soundbites.
Here are the facts:
As early as this fall, we may be able to get a simple blood test that can help us monitor not only our general health status, but also how fast we're aging -- or at least how fast our cells are aging. The test will measure the length of our telomeres: the caps on the ends of our chromosomes that keep our DNA intact and our cells thriving.
And while telomere scientists are divided as to the value of the test for individuals, no serious researchers are saying the telomere test will be some kind of crystal ball.
In fact, the new test represents a difference in degree rather than kind from the individual tests we currently use to assess health, such as cholesterol, triglyceride and glucose levels. Telomere tests aim to provide a one-stop snapshot of our statistical risk for everything from heart disease and diabetes to cognitive decline and mortality. If people can monitor their telomere length, the thinking goes, they can make lifestyle changes to alter that risk by boosting their cells' longevity.
How it works
How can a simple test that analyzes white-blood cells provide this kind of information?
When cells divide to replicate themselves, their telomeres shorten. That's led many scientists to view telomere length as a marker of biological aging, a "molecular" clock ticking off the cell's lifespan, as well as an indicator of overall health. So, in general, older people have shorter telomeres than younger ones. In February, Ronald A. DePinho, a cancer biologist at Boston's Dana-Farber Cancer Institute, proposed a unified theory of aging, with malfunctioning telomeres as the the "core pathway" causing health decline in advanced age.
But telomere length is just part of the picture.
"Telomere length, like any other risk measurement, tells us probability of disease and early mortality -- it is not a diagnosis," stresses Elissa Epel, a health psychologist at the University of California, San Francisco, and a cofounder of Telome Health Inc. (THI), one of the companies offering the test. "Telomere length is only helpful information when interpreted correctly, which is probabilistically," she says.
Here's how that interpretation will work: Like other medical tests based on risk assessments, the companies will compare your telomere length to a norm determined through statistical analysis of large groups of people similar in age, gender and behaviors to see whether you match, or fall above or below that norm. Both Meno Park-based THI and Life Length S.L., in Madrid, Spain, are conducting those studies now.
As molecular biologist Calvin B. Harley, chief scientific officer and a cofounder of THI, puts it, "The bottom line is that for every risk factor, it's not a diagnosis or a prognosis; it's a statistical result based upon large group analyses."
Ready or not?
That said, two of the most distinguished researchers in the field who shared the 2009 Nobel Prize for their telomere work -- Elizabeth H. Blackburn, a cofounder of THI, and Carol Greider, a molecular biologist at the Johns Hopkins School of Medicine -- disagree about the value of a test at this point in time. You've likely heard Greider elsewhere, perhaps in one of those misleading reports. Here she is in context.
Greider doesn't believe there have been enough large-scale clinical studies yet for a telomere-length measurement to give individuals useful information about their risk status. "We've known a lot about cholesterol for a long time, so you can pick out a particular individual and say for this individual we know what the risks are," she says. "And that's from many different laboratories over many, many years. And so it's established within the scientific community. That is not the current state of the status in terms of telomere length."
Blackburn, who has been traveling and so absent from the controvery until now, disagrees. "Multiple cohorts and multiple studies have established clear statistical links with telomere shortness and risks for common as well as less common diseases that include cardiovascular disease and mortality, certain cancers and diabetes, as well as associations with severe life-trauma exposures that themselves have clearly established risks for diseases," she emails from Iceland, where she is delivering a talk. "These studies include some additional, not yet published, longitudinal studies that, for example, Carol may not be aware of."
Greider further compares the current state of telomere testing to direct-to-consumer genetic testing, which offers to sequence your genome and tell you your susceptibility to certain diseases. "The concern there has always been: What are they going to tell people about those particular genetic variations" that they find? she asks. "The science isn't there yet" regarding what different configurations of genetic variations mean about predisposition to disease.
Again, Blackburn demurs, pointing out in an email that telomeres, though comprising DNA, do not carry "genetic-information content" like the genome does. Hence, changes in telomere length don't represent variations in genes, but rather the aging of cells and how that aging correlates statistically with disease risk.
There's a growing body of research showing correlations between telomere length, particularly white-blood-cell telomere length, and lifestyle. For example, studies show that those who exercise regularly have longer telomeres than couch potatoes. Folks rating highest on a pessimism scale have shorter telomeres than those rating lowest. Those who perceive themselves as the most stressed have shorter telomeres than those who see themselves as the least frazzled.
"What we do know is that in terms of cohorts, of groups of people, telomere length has some predictive power," says Thomas Von Zglnicki, professor of cell gerontology in the Institute for Aging and Health in Newcastle. He adds: "If we look at an individual and try to use telomere length as a predictor of anything, it's as good as a throwing the dice."
Which is why, the companies say, they -- like cholesterol testers -- are not in the business of predictions. Rather, they are exploring the probability of risk.
Monitoring ourselves
How might these shortening telomeres manifest themselves in our sagging jowls, wrinkled skin and gray hair?
Once a cell has divided to the point where its telomeres have been worn to a nub, it enters an arrested state called senescense, or it dies. Senescent cells emit all kinds of pro-inflammatory substances into the tissue and bloodstream. Some scientists believe that it is those toxins that chew away at the collagen and elastin -- protein fibers that hold together our organs (including our skin), leading to the "unsightly ripening," as Shakespeare would have it, that we witness in the mirror as we age.
The good news is that research has also shown that telomeres, through lifestyle changes, can lengthen over time, possibly driven by an increase in the intake of omega-3 fatty acids, reduction of stress and belly fat, the level of exercise advised in the 2008 CDC guidelines, meditation and other lifestyle interventions. For example, a recent paper showed that people who went on an intensive meditation retreat had higher levels of the restorative enzyme telomerase -- which can add to existing telomeres -- than those who stayed home. Another study showed that over a period of five years, telomeres actually lengthened in those with the highest levels of omega-3 fatty acids in their blood.
"It's early in the research to make any definitive statements," says Epel. "But the greatest benefit will probably come from personal relative measurements, that is, how your telomere length changes over time, say, at baseline and then after six months when certain lifestyle behaviors have been changed. This is about health maintenance, not detecting disease. People need feedback on whether their efforts are working besides the scale and lipid levels. Monitoring telomere length may be a helpful way to promote the paradigm shift toward prevention of disease."
The original version of this story ran in the Health and Science section of the Washington Post.
]]>Understanding Oprah's Mac-and-Cheese Binge From an Evolutionary Perspectivetag:www.huffingtonpost.com,2011:/theblog//3.8103212011-01-20T16:11:00-05:002011-05-25T18:25:24-04:00Thea Singerhttp://www.huffingtonpost.com/thea-singer/
Excessive? Yes. But logical, even -- in an extreme way -- life-preserving? Absolutely.
That we reach for greasy gloppy goodies when we're stressed (in Winfrey's case, to the point of depression) is an evolutionary necessity, wired into our brains to ensure our survival as a species. But these days, with such "comfort food" so accessible, the circuit has gone haywire. Winfrey, after all, had simply to ask her chef to whip up a massive batch of the cheesy goo.
Since at least the mid-1970s, scientists have been showing that cortisol, our primary stress hormone, activates the same reward system in the brain as cocaine, heroin and other drugs of abuse. True, the degree of activation is different, but the process is the same. Both cortisol and addictive drugs stimulate neurons in a part of the brain called the ventral tegmental area, which sits atop the brainstem, to release the neurotransmitter dopamine. The dopamine then zips via nerve fibers over to the nucleus accumbens, the so-called pleasure center of the brain. The information, "Ahh, pleasure," is then relayed to the prefrontal cortex, where it makes its way into consciousness.
Mind you, the dopamine itself is not the reward. Rather, it sparks the motivation to do the work to get the reward. The good feelings are ones of delicious anticipation. Dopamine supercharges wanting.
What we want during stress, scientists say, depends on context. The reward just has to be palatable, a natural reinforcer. Studies have shown that if a rat is stressed and a hunk of pork fat and regular chow are both within reach, it'll make a beeline for the pork fat. If cocaine is available at the push of a lever, it'll go for that. If a running wheel is the only game in town, it'll exercise its little legs off.
The food-as-drug comparison goes even further. Sweet, high-fat foods increase the release of endogenous opioids, or endorphins -- naturally occurring brain chemicals that also activate the brain's reward system. The opioids, in turn, increase the dopamine dump. The two together spur the intake of even more sweet, high-fat foods, which then increases the release of opioids, which...
It's a cycle remarkably similar to that of drug addiction. No wonder Winfrey couldn't stop at a mere 15 or 20 pounds of her mac-and-cheese fix.
Eating because of stress makes evolutionary sense beyond its tranquilizing properties. Cortisol, after all, exists to save our skins -- at least, that was its reason for being back when we were hunter-gatherers attempting, say, to spear a moose for dinner. Cortisol sparks the release of glucose, the simplest sugar, into the bloodstream from the liver and muscles. The glucose release ensured that the hunter-gatherer had plenty of accessible energy (calories) to either slay the moose or flee to safety -- and also that he had plenty of glucose to replenish energy stores once the stressor had passed. Moose carved up and hunks of meat over shoulder? Time to eat again.
The problem is, these days most of our stressors are not of the short-lived physical kind; they bubble up and take hold in our heads: when we're in traffic, or obsessing about money, or plowing through mountains of work, or caring for aging parents -- or, in Oprah Winfrey's case, when "Chucky" trounced "Beloved." We don't need that extra glucose spurt, nor do we need to replenish glucose stores once the stressor has passed, but our brain and body don't know that. And so we eat, and the added fat goes right to our belly, the worst place for it to be.
We can break the cycle. Here are two ways to start:
Learn to eat mindfully. Indiana State University's Jean. L. Kristeller, Ph.D., co-founded an entire center to educate people about mindful eating. The site includes everything from "Principles for Mindful Eating" to downloadable MP3s of presentations on topics such as "Unintentional Eating" and "Different Types of Hunger." With Kristeller's method, people first rate their level of hunger and fullness when they're ready to eat, then learn how to savor the food for part of the meal. "The process slows down eating in a manageable way and increases enjoyment," says UCSF health psychologist Elissa Epel, Ph.D., who studies the relationship between stress and obesity. "Even a few moments of being fully aware can change the quality -- and the size! -- of a meal."
Sever the stressed-digest connection. Partly what drives us to reach for, say, a boatload of mac-and-cheese when we're stressed is the memory that the stuff made us feel better last time. So rather than reaching automatically for your particular brand of comfort food, develop a new association -- to something that makes you feel better and is good for you -- before the next stressor strikes. Remember: Many activities can kick off the reward circuit. Me? I high-tail it to my swanky club, where I can watch movies on a giant flat-screen TV while I power away on the elliptical -- a wonderful treat, given that I own just a tiny box of a TV sans the cable to even get movies.
This article was adapted from Stress Less: The New Science That Shows Women How to Rejuvenate the Body and the Mind, by Thea Singer (Hudson Street Press, 2010).
Sources:
Adam TC, Epel ES. Stress, eating and the reward system. Physiol Behav. 2007 Jul 24;91(4):449-58. Epub 2007 Apr 14. Review.
Brydon L, Wright CE, O'Donnell K, Zachary I, Wardle J, Steptoe A. Stress-induced cytokine responses and central adiposity in young women. Int J Obes (Lond). 2008 Mar;32(3):443-50. Epub 2007 Dec 4.
Dallman MF, Pecoraro NC, la Fleur SE. Chronic stress and comfort foods: self-medication and abdominal obesity. Brain Behav Immun. 2005 Jul;19(4):275-80. Review.
Dallman MF, Pecoraro N, Akana SF, La Fleur SE, Gomez F, Houshyar H, Bell ME, Bhatnagar S, Laugero KD, Manalo S. Chronic stress and obesity: a new view of "comfort food." Proc Natl Acad Sci U S A. 2003 Sep 30;100(20):11696-701. Epub 2003 Sep 15.
Dallman MF, Warne JP, Foster MT, Pecoraro NC. Glucocorticoids and insulin both modulate caloric intake through actions on the brain. J Physiol. 2007 Sep 1;583(Pt 2):431-6. Epub 2007 Jun 7. Review
Dallman MF, Pecoraro NC, La Fleur SE, Warne JP, Ginsberg AB, Akana SF, Laugero KC, Houshyar H, Strack AM, Bhatnagar S, Bell ME. Glucocorticoids, chronic stress, and obesity. Prog Brain Res. 2006;153:75-105. Review.
Dallman MF, Akana SF, Pecoraro NC, Warne JP, la Fleur SE, Foster MT. Glucocorticoids, the etiology of obesity and the metabolic syndrome. Curr Alzheimer Res. 2007 Apr;4(2):199-204. Review.
Daubenmier J, Yglecias L, Kuwata M, Maninger N, Jhaveri K, Purnell D, Kristeller J, Hecht F, Kemeny M, Epel E. Effects of mindfulness meditation training on eating behavior, cortisol and body fat distribution. Abstract presented at American Psychosomatic Society, Baltimore, MD; Mar 12-15, 2008.
Epel E, Jimenez S, Brownell K, Stroud L, Stoney C, Niaura R. Are stress eaters at risk for the metabolic syndrome? Ann N Y Acad Sci. 2004 Dec;1032:208-10.
Epel E, Adler N, Ickovics J, McEwen B. Social status, anabolic activity, and fat distribution. Ann N Y Acad Sci. 1999;896:424-6.
Epel E, Lapidus R, McEwen B, Brownell K. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology. 2001 Jan;26(1):37-49.
Epel ES, McEwen B, Seeman T, Matthews K, Castellazzo G, Brownell KD, Bell J, Ickovics JR. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med. 2000 Sep-Oct;62(5):623-32.
Foster MT, Warne JP, Ginsberg AB, Horneman HF, Pecoraro NC, Akana SF, Dallman MF. Palatable foods, stress, and energy stores sculpt corticotropin-releasing factor, adrenocorticotropin, and corticosterone concentrations after restraint. Endocrinology. 2009 May;150(5):2325-33. Epub 2008 Dec 23.
Gesta S, Tseng YH, Kahn CR. Developmental origin of fat: tracking obesity to its source. Cell. 2007 Oct 19;131(2):242-56. Review. Erratum in: Cell. 2008 Oct 17;135(2):366.
Gibson EL. Emotional influences on food choice: sensory, physiological and psychological pathways. Physiol Behav. 2006 Aug 30;89(1):53-61. Epub 2006 Mar 20. Review.
Grigson PS. Like drugs for chocolate: separate rewards modulated by common mechanisms? Physiol Behav. 2002 Jul;76(3):389-95. Review.
Kelley AE, Bakshi VP, Haber SN, Steininger TL, Will MJ, Zhang M. Opioid modulation of taste hedonics within the ventral striatum. Physiol Behav. 2002 Jul;76(3):365-77. Review.
Kuo LE, Czarnecka M, Kitlinska JB, Tilan JU, Kvetnanský R, Zukowska Z. Chronic stress, combined with a high-fat/high-sugar diet, shifts sympathetic signaling toward neuropeptide Y and leads to obesity and the metabolic syndrome.Ann N Y Acad Sci. 2008 Dec;1148:232-7.
Kuo LE, Kitlinska JB, Tilan JU, Li L, Baker SB, Johnson MD, Lee EW, Burnett MS, Fricke ST, Kvetnansky R, Herzog H, Zukowska Z. Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome. Nat Med. 2007 Jul;13(7):803-11. Epub 2007 Jul 1. Erratum in: Nat Med. 2007 Sep;13(9):1120.
Lutter M, Sakata I, Osborne-Lawrence S, Rovinsky SA, Anderson JG, Jung S, Birnbaum S, Yanagisawa M, Elmquist JK, Nestler EJ, Zigman JM. The orexigenic hormone ghrelin defends against depressive symptoms of chronic stress. Nat Neurosci. 2008 Jul;11(7):752-3. Epub 2008 Jun 15.
Naleid AM, Grimm JW, Kessler DA, Sipols AJ, Aliakbari S, Bennett JL, Wells J, Figlewicz DP. Deconstructing the vanilla milkshake: the dominant effect of sucrose on self-administration of nutrient-flavor mixtures. Appetite. 2008 Jan;50(1):128-38. Epub 2007 Jul 18.
O'Hare E, Shaw DL, Tierney KJ, E-M K, Levine AS, Shephard RA. Behavioral and neurochemical mechanisms of the action of mild stress in the enhancement of feeding. Behav Neurosci. 2004 Feb;118(1):173-7.
Pani L, Porcella A, Gessa GL. The role of stress in the pathophysiology of the dopaminergic system. Mol Psychiatry. 2000 Jan;5(1):14-21. Review.
Pecoraro N, Reyes F, Gomez F, Bhargava A, Dallman MF. Chronic stress promotes palatable feeding, which reduces signs of stress: feedforward and feedback effects of chronic stress. Endocrinology. 2004 Aug;145(8):3754-62. Epub 2004 May 13.
Rosmond R. Role of stress in the pathogenesis of the metabolic syndrome. Psychoneuroendocrinology. 2005 Jan;30(1):1-10. Review.
Russell SJ, Kahn CR. Endocrine regulation of ageing. Nat Rev Mol Cell Biol. 2007 Sep;8(9):681-91. Review.
Shively CA, Register TC, Clarkson TB. Social stress, visceral obesity, and coronary artery atherosclerosis: product of a primate adaptation.Am J Primatol. 2009 Sep;71(9):742-51. Review.
Sinha R. Chronic stress, drug use, and vulnerability to addiction. Ann N Y Acad Sci. 2008 Oct;1141:105-30. Review.
Teegarden SL, Scott AN, Bale TL. Early life exposure to a high fat diet promotes long-term changes in dietary preferences and central reward signaling. Neuroscience. 2009 Sep 15;162(4):924-32. Epub 2009 May 22.
Teegarden SL, Bale TL. Effects of stress on dietary preference and intake are dependent on access and stress sensitivity. Physiol Behav. 2008 Mar 18;93(4-5):713-23. Epub 2007 Nov 28.
Wand GS, Oswald LM, McCaul ME, Wong DF, Johnson E, Zhou Y, Kuwabara H, Kumar A. Association of amphetamine-induced striatal dopamine release and cortisol responses to psychological stress. Neuropsychopharmacology. 2007 Nov;32(11):2310-20. Epub 2007 Mar 7.
Zellner DA, Loaiza S, Gonzalez Z, Pita J, Morales J, Pecora D, Wolf A. Food selection changes under stress. Physiol Behav. 2006 Apr 15;87(4):789-93. Epub 2006 Mar 6.
]]>This Holiday Season, Boost Your Brain by Giving of Yourselftag:www.huffingtonpost.com,2010:/theblog//3.7959062010-12-17T10:15:00-05:002011-11-17T09:02:45-05:00Thea Singerhttp://www.huffingtonpost.com/thea-singer/
At night she'd wake with a start, terrified: Her mother's care cost some $6,000 a month, and the trust her father had left them was dwindling. "I can bluff my way through a lot, but the reality was, how was I going to pay for next month?" she says. Her blood pressure soared -- and for the first time in her life she had to take blood-pressure medication.
She began seeing a psychotherapist and turned to her three dogs for comfort. But she also coped by giving support.
She volunteered as an assistant dog trainer at a club near her home in tiny Rushville, Ohio and joined a program that taught prison inmates to care for abandoned dogs and prepare them for adoption. Later, she became a medical guardian for the Honor Flight Network, which flies World War II veterans to Washington, D.C., to visit their memorials.
Soon she was able to cut her blood-pressure medication in half. "I'm like my mother," she says. "If I help people, that's a good thing for Emily."
As the holidays approach and we stress over not just what gifts to buy but how, in these tough economic times, we'll pay for them, consider this: Giving of ourselves provides huge benefits to us as well as our recipients, making us healthier in both mind and body. Indeed, it can actually change our brains, rejuvenating broken connections and building new ones.
Just how does such doing get under not just the skin but the skull? Michelle C. Carlson, Ph.D. tunneled into the brains of adults ages 55 and over to find out.
For her study, Carlson, an associate professor at the Johns Hopkins Bloomberg School of Public Health, turned to a program called Experience Corps (EC), co-founded in 1995 by Linda P. Fried, Ph.D., then also at Johns Hopkins. EC places older volunteers into underserved public elementary schools across the U.S. to work as tutors and mentors to youngsters through third grade. Volunteers work 15 hours a week for at least one school year. The giving and getting goes both ways: The kids get one-on-one help with reading, library activities, and conflict resolution, and the adults increase their social engagement, thereby exercising both their bodies (supervising recess, shelving library books) and brains (working memory, problem-solving skills and brain flexibility).
"The goal of the program is to provide the older adults with social, cognitive, psychological, and physical engagement to hopefully enhance their aging," says Teresa Seeman, who collaborated with Carlson on a pilot study investigating how integrated programs such as EC affect cognition.
"To what degree did they have increased social interaction with people, both in school and outside? Does being involved in something like this enhance their sense of mastery and efficacy because they feel they're doing something important? At the same time, the aim is to benefit the children by improving their academic achievement."
Carlson recruited eight female EC volunteers from the Baltimore community and matched them with a control group, women who would become EC volunteers the following year. All participants were African American and had low income and a low education level. Mental state was only so-so, indicating risk for cognitive impairment. In particular, Carlson wanted to learn if over the six-month trial the EC volunteers would show increased activity in the prefrontal cortex, which oversees executive functions, including working memory, planning, scheduling, recognition of consequences and dealing with ambiguity. It's a region known to show substantial age-related degeneration.
"We wanted to see if those at greatest risk for dementia as exhibited through memory impairments could, through this intervention, have enduring changes in brain plasticity," says Carlson. Earlier studies had shown that, as a group, those who scored lower on executive-function measures showed the most benefit short-term because they had so much room for improvement.
At the start of the study, Carlson did brain scans -- specifically, functional magnetic resonance imaging (fMRI) -- of all the participants. An fMRI looks at the brain in slices, front to back, like a loaf of bread, and tracks blood flow to its various parts. She noted similar brain patterns for both the volunteers and the controls. She then scanned them all again, after the EC volunteers had been working with students in the Baltimore schools for six months.
She was "pretty shocked" at the results. The EC volunteers -- but not the controls -- showed increases in brain activity precisely in the areas targeted by the intervention: the left prefrontal cortex (executive-function territory) and the anterior cingulate cortex, an area implicated in efficient filtering or inhibiting of conflicting information (say, focusing on a single voice amid a cacophony of exuberant young conversations, and remembering what page you're on in "Chicken Little.")
The scientists acknowledge that the sample size was small and specific to women. But it provided "proof of concept" and lay the groundwork for a larger, even more rigorous trial.
The bottom line: Volunteering in Experience Corps reversed cognitive decline by waking up neurons that had been napping. One EC volunteer put it more simply: "It removed the cobwebs from my brain."
Here are some ways to give to receive, integrating EC elements (tie these up with a bow!). You can offer to:
Round up a group to go caroling, plotting the route and selecting songs
Run a playgroup in your home for your friends' children for a set period of time
Be the housecleaning service for a relative, along with a helper or two
Watch your sister's children so she and her husband can have a month's worth of nights out on the town
Walk the neighbors' dogs (yes, dogs are social beings too!)
Take charge of errands for folks who are stretched to the limit
]]>Recovery Month: Stress and Addictiontag:www.huffingtonpost.com,2010:/theblog//3.7159752010-09-17T07:00:00-04:002011-11-17T09:02:45-05:00Thea Singerhttp://www.huffingtonpost.com/thea-singer/
"It's the closest thing I had to a bathing suit," she told me skittishly, before wandering off to smoke a Camel.
Then, she disappeared for two hours. She reappeared only when everyone had left, running to us across a field, so skinny her bones seemed to rattle.
Looking back, her choice of swimwear should have been another of the warning bells going off that year. There were the false teeth she'd gotten to replace her own because of a rare gum disease. The frequent, sudden naps -- in a chair, on my rug. The strange gifts -- used teleconferencing software for me, worn beige tap shoes for my daughter. The way she'd fought me -- bitterly, unrelentingly -- when I'd refused to let her take my bike out late one night for a spin.
Two months after the party, I learned the reason for the get-up and behavior: My sister, then 42, had become addicted to methamphetamine. The shirt and long pants on that hot summer day were to cover the tracks from shooting up. And the lateness? Victim to the compulsive behavior that is one of meth's hallmarks, she'd been sidetracked diving into dumpsters to collect "treasures" on her way to see us.
What had driven this successful juvenile-defense attorney to turn to drugs? As she tells it, a big part was precisely that: the stress of winning cases--of keeping moms from having their parental rights terminated (one client's child died while in foster care). My sister, upended by the child's death, had "burned out."
September is National Alcohol and Drug Addiction Recovery Month, proclaimed as such by President Barack Obama. It's a time for the Substance Abuse and Mental Health Services Administration (SAMHSA), of the U.S. Department of Health and Human Services, to celebrate folks like my sister (she's eight years clean this month!), as well as those who provide recovery services. This year the Recovery Month theme, "Join the Voices for Recovery: Now More Than Ever!," highlights how psychological stress contributes to alcohol and/or drug use, and the disorders or relapse that may follow.
My sister could have been the poster child.
"Stress is not a vague term; it is generally concerned with profound events in a person's life," says H. Westley Clark, M.D., director of SAMHSA's Center for Substance Abuse Treatment, which oversees Recovery Month. He ticks off several common stressors: job loss, death of a loved one, illness, financial worries. Why choose the theme "stress" now? "Given the current state of the economy, this is a particularly stressful time," he says.
How can we know if we might be at risk for alcohol or drug abuse? We can note not only if we're drinking more, but also our reactions to stressors. "Listen to other people," says Clark. "Are they saying you seem angry or irritable, or that your personality has changed--that perhaps you're more explosive or more withdrawn?" Those may be red flags.
Yet the relationship between stress and addiction is deeper than circumstantial; indeed, it runs right down to the cells in our brain.
Since at least the mid-1970s, scientists have been showing, through animal and human studies, that stress hormones--particularly "glucocorticoids" ("cortisol" in humans)--activate the same reward system in the brain as cocaine, heroin, and other drugs of abuse.
True, the degree of activation is different, but the process is the same. Both glucocorticoids and addictive drugs stimulate cells in a part of the brain called the ventral tegmental area (which sits atop the brainstem), to release the neurotransmitter dopamine. The dopamine then zips via nerve fibers over to the nucleus accumbens, a.k.a. the "pleasure center" of the brain. The information, "Ahh, pleasure," is then relayed to the prefrontal cortex, where it makes its way into consciousness.
Mind you, the dopamine itself is not the reward. Rather, it sparks the motivation to do the work to get the reward. The good feelings are ones of delicious anticipation and mastery: "Yes we can!" chanted Obama volunteers, their dopamine flowing, knowing in their hearts that the presidency was within reach. This dopamine-inspired drive exists to keep us alive. When we're hungry or thirsty, it drives us to seek food and water. When it's time to reproduce, it drives us to seek sex. Good job! the reward circuit tells us when we've located the watering hole or a mate, thereby reinforcing the behavior. We beam. Glucocorticoids pump up that drive, making the water appear even more sparkling and the mate even hunkier. They supercharge the wanting.
What we want during stress, scientists say, depends on context. The reward just has to be palatable, a natural reinforcer. Studies have shown that if a rat is stressed and a hunk of pork fat and regular chow are both within reach, it'll make a beeline for the pork fat. If cocaine is available at the push of a lever, it'll go for that. If a running wheel is the only game in town, it'll exercise its little legs off.
"The more glucocorticoids, the more dopamine," says Mary F. Dallman, Ph.D., professor emeritus at UCSF and an expert on stress physiology. "The more the dopamine, the more this pleasure center stuff turns on--the wanting, the salience."
Turning down the volume
Are there skills we can learn to turn down the volume of the wanting?
UCSF psychologist Judith T. Moskowitz, Ph.D., M.P.H., studies ways to "plant seeds of resilience" in people under extreme stress because they've recently been diagnosed with a chronic illness, in particular HIV. She knows, through years of research, that positive and negative emotions "co-occur" under conditions of stress but that people need help countering the negative and allowing the positive to rise through the muck. After scouring the scientific literature, she identified specific cognitive skills that are especially effective at helping people achieve this.
"Find at least one of these that works for you, and do it every day," she advises.
• Notice something good that happened to you today, and tell someone about it or write it down. The "event" can be as small as drinking an excellent cup of coffee or climbing out of bed when you planned to.
• Keep a "gratitude" record. Every day, to counter shortfalls, write down one thing you're grateful for. Again, it doesn't have to be earth shattering, or even big.
• Concentrate on being mindful for at least 10 minutes a day. Forget the past, forget the future: Take in, without judgment, your thoughts, feelings and physical sensations right now. For example, go for a 10-minute walk and zero in on the crunch of gravel beneath your feet and the wind on your face.
• Reinterpret a negative experience. The reinterpretation must be "do-able," says Moskowitz. You miss the bus to work and know your boss will be furious that you're late. But then another bus arrives, and you sit next to someone who tells a joke that sends you into hysterics. In a meta-analysis of studies about coping with HIV, Moskowitz found that reappraisal was one of the skills most effective at reducing negativity.
• Redirect your attention to your strengths.
• Make a list of attainable goals for the week, and work toward achieving one every day. Think how good you'll feel when you can cross that item off that list!
• Do something nice for someone else. The University of British Columbia's Elizabeth W. Dunn, Ph.D., has done several studies showing that giving can make people happier. In one, she had 46 UBC students rate their happiness, and then gave them envelopes containing $5 or $20 and told them either to spend the money on themselves or toward a bill, or to give it to charity or as a gift. Those who gave the money away rated themselves as happier at the end of the day than those who kept it for themselves.
Thea Singer is a science/health journalist. Her new book, "Stress Less," which comes out September 23, covers the latest findings on stress and how to reduce it to slow--or even reverse--aging. Her sister is a policy analyst for the National Council for Alcoholism and Drug Dependence--New Jersey and tells her story nationally to help others find recovery. Learn more at www.theasinger.com.
References
Adam TC, Epel ES. Stress, eating and the reward system. Physiol Behav. 2007 Jul 24;91(4):449-58. Epub 2007 Apr 14. Review.
Dallman MF, Pecoraro NC, la Fleur SE. Chronic stress and comfort foods: self-medication and abdominal obesity. Brain Behav Immun. 2005 Jul;19(4):275-80. Review.
Dallman MF, Pecoraro N, Akana SF, La Fleur SE, Gomez F, Houshyar H, Bell ME, Bhatnagar S, Laugero KD, Manalo S. Chronic stress and obesity: a new view of "comfort food." Proc Natl Acad Sci U S A. 2003 Sep 30;100(20):11696-701. Epub 2003 Sep 15.
Dallman MF, Warne JP, Foster MT, Pecoraro NC. Glucocorticoids and insulin both modulate caloric intake through actions on the brain. J Physiol. 2007 Sep 1;583(Pt 2):431-6. Epub 2007 Jun 7. Review
Dallman MF, Pecoraro NC, La Fleur SE, Warne JP, Ginsberg AB, Akana SF, Laugero KC, Houshyar H, Strack AM, Bhatnagar S, Bell ME. Glucocorticoids, chronic stress, and obesity. Prog Brain Res. 2006;153:75-105. Review.
Dallman MF, Akana SF, Pecoraro NC, Warne JP, la Fleur SE, Foster MT. Glucocorticoids, the etiology of obesity and the metabolic syndrome. Curr Alzheimer Res. 2007 Apr;4(2):199-204. Review.
Epel E, Lapidus R, McEwen B, Brownell K. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology. 2001 Jan;26(1):37-49.
Gibson EL. Emotional influences on food choice: sensory, physiological and psychological pathways. Physiol Behav. 2006 Aug 30;89(1):53-61. Epub 2006 Mar 20. Review.
Grigson PS. Like drugs for chocolate: separate rewards modulated by common mechanisms? Physiol Behav. 2002 Jul;76(3):389-95. Review.
Kelley AE, Bakshi VP, Haber SN, Steininger TL, Will MJ, Zhang M. Opioid modulation of taste hedonics within the ventral striatum. Physiol Behav. 2002 Jul;76(3):365-77. Review.
Naleid AM, Grimm JW, Kessler DA, Sipols AJ, Aliakbari S, Bennett JL, Wells J, Figlewicz DP. Deconstructing the vanilla milkshake: the dominant effect of sucrose on self-administration of nutrient-flavor mixtures. Appetite. 2008 Jan;50(1):128-38. Epub 2007 Jul 18.
O'Hare E, Shaw DL, Tierney KJ, E-M K, Levine AS, Shephard RA. Behavioral and neurochemical mechanisms of the action of mild stress in the enhancement of feeding. Behav Neurosci. 2004 Feb;118(1):173-7.
Pani L, Porcella A, Gessa GL. The role of stress in the pathophysiology of the dopaminergic system. Mol Psychiatry. 2000 Jan;5(1):14-21. Review.
Pecoraro N, Reyes F, Gomez F, Bhargava A, Dallman MF. Chronic stress promotes palatable feeding, which reduces signs of stress: feedforward and feedback effects of chronic stress. Endocrinology. 2004 Aug;145(8):3754-62. Epub 2004 May 13.
Teegarden SL, Scott AN, Bale TL. Early life exposure to a high fat diet promotes long-term changes in dietary preferences and central reward signaling. Neuroscience. 2009 Sep 15;162(4):924-32. Epub 2009 May 22.
Teegarden SL, Bale TL. Effects of stress on dietary preference and intake are dependent on access and stress sensitivity. Physiol Behav. 2008 Mar 18;93(4-5):713-23. Epub 2007 Nov 28.
Wand GS, Oswald LM, McCaul ME, Wong DF, Johnson E, Zhou Y, Kuwabara H, Kumar A. Association of amphetamine-induced striatal dopamine release and cortisol responses to psychological stress. Neuropsychopharmacology. 2007 Nov;32(11):2310-20. Epub 2007 Mar 7.
Zellner DA, Loaiza S, Gonzalez Z, Pita J, Morales J, Pecora D, Wolf A. Food selection changes under stress. Physiol Behav. 2006 Apr 15;87(4):789-93. Epub 2006 Mar 6.]]>Stress Relief and More Brain Cells? The Secret Could Be in the Bedroomtag:www.huffingtonpost.com,2010:/theblog//3.6851462010-08-18T07:00:00-04:002011-11-17T09:02:45-05:00Thea Singerhttp://www.huffingtonpost.com/thea-singer/
All stress is not equal. Indeed, as Bruce S. McEwen, Ph.D., director of the neurendocrinology lab at Rockefeller University, puts it, if we got rid of stress, "we'd be dead." Stress comes in flavors: "good" and "bad." Good, or "challenge," stress comprises moderate, transient stressors that we have the resources to cope with--in other words, stimulation. Exercise is a form of challenge stress, as is learning new things. Bad, or "threat," stress, on the other hand, refers to situations that are overwhelming, in which we feel helpless in the face of the onslaught. That's the stuff that doesn't let up, such as caring for a chronically ill child.
Stanford University neurobiologist Robert Sapolsky, Ph.D., author of the acclaimed "Why Zebras Don't Get Ulcers," conjures up a roller coaster to frame good stress this way: "Circumstances where you voluntarily relinquish a degree of control and predictability in a setting that overall is benevolent."
That sounds a lot like a roll in the hay to me, too. And a new study by Princeton neuroscientist Elizabeth Gould, Ph.D., and colleagues provides the science to give the theory legs (among other body parts).
Gould is a pioneer in the study of "neurogenesis"--that is, the birth of new brain cells, or neurons, in the adult brain. Neuroscientists shunned the idea of neurogenesis until the end of the 20th century. But then, in the late nineties, Gould showed in adult rats and primates that new neurons are born in a part of the brain called the hippocampus, the seat of memory consolidation and retrieval.
At the same time, Fred H. Gage, Ph.D., at the Salk Institute, revealed neurogenesis in humans, using brain cells of people who had died of cancer. The specific area of the hippocampus showing the growth is the "dentate gyrus," a worm of a structure sitting atop the seahorse-shaped hippocampus, and "good" stress activities, like exercise, spark it. Later research showed that the brain's olfactory bulb, which processes smell, generates new neurons, too. Ever wonder why pregnant women start heaving when they smell, say, broccoli or brussels sprouts? It's an evolutionary hangover: Pregnancy spurs neurogenesis in the olfactory bulb to ensure survival of the species--albeit generally for the nonhuman among us, for whom sniffing equals routing out danger.
Gould's new study, just out in the journal PloS ONE in July, shows that sex, too, increases neurogenesis, particularly in the brain area that regulates anxiety--and the more sex (not overdoing it, of course), the better.
Here's what she and Princeton colleagues Benedetta Leuner, Ph.D., and Erica R. Glasper, Ph.D., did:
The scientists exposed adult male rats to "sexually receptive" females either one time or--for the real Don Juans--for 14 consecutive days. Rigorously designed, the study also included "control" groups: male rats exposed to "non-receptive" females (the "I've got a headache" type), and male rats who got no action at all. Later, the researchers tested the male rats' eating behaviors in an unfamiliar environment to assess how anxious they were. Finally, they measured the level of stress hormones in their blood--specifically, the hormones known as "glucocorticoids"--and then "decapitated" (to use scientific parlance) the critters to see if new cells had sprouted in the dentate gyrus of their brains.
What did they find? In the one-timers, even though glucocorticoid levels had increased, new brain cells proliferated. As for the marathoners, they experienced a triple bonus (on top of the sex itself, that is): Their levels of glucocorticoids did not increase, new brain cells continued to sprout, and they chowed down anxiety-free in the food drill.
That the glucocorticoid levels rose but still new brain cells grew had the scientists scratching their own heads. Numerous earlier animal studies had shown that increases in glucocorticoid levels from stressors--predator odor, cold water, restraint--not only inhibited neurogenesis but impaired learning and memory functions.
The scientists wondered: Might the nature of the stressor, its so-called "emotional valence," make the difference?
It appeared so. The bad effects of excess glucocorticoids in the brain--no new neurons, problems with memory and learning--were apparently "overridden" in the rats getting it on by the "hedonic value," that is, the pleasure quotient, of the stressor (here, sex), they wrote. The scientists speculated that the benefits of brain chemicals let loose by sexual experience, such as endogenous opioids, the neurotransmitter dopamine and the neuropeptide oxytocin, might be outweighing the negative effects of the boosted stress hormones. In other words, the "hedonic value" of a stressor may be what determines whether it's Jeckyll or Hyde.
"It's uniquely important work showing that glucocorticoids are context dependent," says McEwen about Gould's promiscuous rats. "They don't have a unitary effect--they depend on other factors."
Thea Singer is a science/health journalist whose new book, "Stress Less: The New Science that Shows Women How to Rejuvenate the Body and the Mind," comes out on September 23 from Hudson Street Press. Learn more at www.theasinger.com.