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2017 Health & Wellness Fest

Medical Compass: Long-term health impacts of chronic stress

by David Dunaief - November 1, 2020

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chronic stress — Chronic stress can cause wear and tear on your mind and body. METRO photo

Cortisol resistance can increase susceptibility to viruses and infection

By David Dunaief, M.D.

This has been a tough year, where many of us have been under continual stress. While some stress is valuable to help motivate us and keep our minds sharp, high levels of constant stress can have detrimental effects on the body.

Nowhere is the mind-body connection clearer: although stress may start in the mind, it can lead to acute or chronic disease promotion. It can also play a role with your emotions, causing irritability and outbursts of anger and possibly leading to depression and anxiety.

Stress symptoms can include stiff neck, headaches, stomach upset and difficulty sleeping. Stress may also be associated with cardiovascular disease, with an increased susceptibility to infection from viruses causing the common cold, and with cognitive decline and Alzheimer’s (1).

A stress steroid hormone, cortisol, is released from the adrenal glands and can have beneficial effects in small bursts. We need cortisol in order to survive. Some of its functions include raising glucose (sugar) levels when they are low and helping reduce inflammation and stress levels (2). However, when cortisol gets out of hand, higher chronic levels may cause inflammation, leading to disorders such as cardiovascular disease, as research suggests.

Let’s look at the evidence.

Inflammation

Inflammation may be a significant contributor to more than 80 percent of chronic diseases. In a meta-analysis (a group of two observational studies), high levels of C-reactive protein (CRP), a biomarker for inflammation, were associated with increased psychological stress (3).

A study of over 73,000 adults found that with CRP higher than 3.0 there was a greater than twofold increase in depression risk. The researchers suggest that CRP may heighten stress and depression risk by increasing levels of inflammatory communicators among cells (4).

In one study, results suggested that stress may influence and increase the number of hematopoietic stem cells (those that develop all forms of blood cells), resulting specifically in an increase in inflammatory white blood cells (5). The researchers suggest that this may lead to these white blood cells accumulating in atherosclerotic plaques in the arteries, which ultimately could potentially increase the risk of heart attacks and strokes. Chronic stress overactivates the sympathetic nervous system — our “fight or flight” response — which may alter the bone marrow where the stem cells are found. This research is preliminary and needs well-controlled trials to confirm these results.

Infection

Stress may increase the risk of colds and infection. Over the short term, cortisol is important to help suppress the symptoms of colds, such as sneezing, cough and fever. These are visible signs of the immune system’s infection-fighting response. However, the body may become resistant to the effects of cortisol, similar to how a type 2 diabetes patient becomes resistant to insulin.

In one study of 296 healthy individuals, participants who had stressful events and were then exposed to viruses had a higher probability of catching a cold. It turns out that these individuals also had resistance to the effects of cortisol. This is important because those who were resistant to cortisol had more cold symptoms and more proinflammatory cytokines (6).

Lifestyle changes can reduce effects of stress

Lifestyle plays an important role in stress at the cellular level, specifically at the level of the telomere, which determines cell survival. The telomeres are to cells as the plastic tips are to shoelaces; they prevent them from falling apart. The longer the telomere, the slower the cell ages and the longer it survives.

In a one-year study of women aged 50 to 65, those who followed a healthy lifestyle — one standard deviation over the average lifestyle — were able to withstand life stressors better since they had longer telomeres (7). This healthy lifestyle included regular exercise, a healthy diet and a sufficient amount of sleep. On the other hand, the researchers indicated that those who had poor lifestyle habits lost substantially more telomere length than the healthy lifestyle group.

In another study, chronic stress and poor diet (high sugar and high fat) together increased metabolic risks, such as insulin resistance, oxidative stress and central obesity, more than a low-stress group eating a similar diet (8). The high-stress group members were caregivers, specifically those caring for a spouse or parent with dementia. This is a good reminder that it’s especially important to eat a healthy diet when under stress.

Interestingly, in terms of sleep, the Evolution of Pathways to Insomnia Cohort (EPIC) study shows that those who deal directly with stressful events are more likely to have good sleep quality. Using medication, alcohol or, most surprisingly, distractors, such as television watching or other activities, to deal with stress all resulted in insomnia after being followed for one year (9). Cognitive intrusions or repeat thoughts about the stressor also resulted in insomnia.

The most important message from this study is that how a person reacts to and deals with stressors may determine whether they suffer from insomnia.

We need to recognize the effects of constant stress. If it’s not addressed, it can lead to suppressed immune response or increased levels of inflammation. To address chronic stress and lower CRP, it is important to adopt a healthy lifestyle that includes sleep, exercise and diet modifications. Good lifestyle habits may also be protective against the effects of stress on cell aging.

References:

(1) Curr Top Behav Neurosci. 2014 Aug. 29. (2) Am J Physiol. 1991;260(6 Part 1):E927-E932. (3) JAMA Psychiatry. 2013;70:176-184. (4) Chest. 2000;118:503-508. (5) Nat Med. 2014;20:754-758. (6) Proc Natl Acad Sci U S A. 2012;109:5995-5999. (7) Mol Psychiatry Online. 2014 July 29. (8) Psychoneuroendocrinol Online. 2014 April 12. (9) Sleep. 2014;37:1199-1208.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

Medical Compass: Should you be taking vitamin D?

by David Dunaief - November 20, 2018

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Vitamin-D — While vitamin D may not be a cure-all, it may play an integral role with many disorders. Stock photo

Recent trial results question supplementation benefits

By David Dunaief, M.D.

Vitamin D is one the most widely publicized and important supplements. We get vitamin D from the sun, food and supplements. With our days rapidly shortening here in the Northeast, let’s explore what we know about vitamin D supplementation.

There is no question that, if you have low levels of vitamin D, replacing it is important. Previous studies have shown that it may be effective in a wide swath of chronic diseases, both in prevention and as part of the treatment paradigm. However, many questions remain. As more data come in, their meaning for vitamin D becomes murkier. For instance, is the sun the best source of vitamin D?

At the 70th annual American Academy of Dermatology meeting, Dr. Richard Gallo, who was involved with the Institute of Medicine recommendations, spoke about how, in most geographic locations, sun exposure will not correct vitamin D deficiencies. Interestingly, he emphasized getting more vitamin D from nutrition. Dietary sources include cold-water fatty fish, such as salmon, sardines and tuna.

We know its importance for bone health, but as of yet, we only have encouraging — but not yet definitive — data for other diseases. These include cardiovascular and autoimmune diseases and cancer.

There is no consensus on the ideal blood level for vitamin D. For adults, the Institute of Medicine recommends more than 20 ng/dl, and The Endocrine Society recommends at least 30 ng/dl.

Cardiovascular mixed results

Several observational studies have shown benefits of vitamin D supplements with cardiovascular disease. For example, the Framingham Offspring Study showed that those patients with deficient levels were at increased risk of cardiovascular disease (1).

However, a small randomized controlled trial (RCT), the gold standard of studies, called the cardioprotective effects of vitamin D into question (2). This study of postmenopausal women, using biomarkers such as endothelial function, inflammation or vascular stiffness, showed no difference between vitamin D treatment and placebo. The authors concluded there is no reason to give vitamin D for prevention of cardiovascular disease.

The vitamin D dose given to the treatment group was 2,500 IUs. Thus, one couldn’t argue that this dose was too low. Some of the weaknesses of the study were a very short duration of four months, its size — 114 participants — and the fact that cardiovascular events or deaths were not used as study end points.

Long-awaited VITAL study results for cancer and cardiovascular events

Most trials relating to vitamin D are observational, which provides associations, but not links. However, results of the VITAL study, a large, five-year RCT looking at the effects of vitamin D and omega-3s on cardiovascular disease and cancer were just published this week (3). Study results were disappointing, finding that daily vitamin D3 supplementation at 2000 IUs did not reduce the incidence of cancers (prostate, breast or colorectal) or of major cardiovascular events.

Mortality decreased

In a meta-analysis of a group of eight studies, vitamin D with calcium reduced the mortality rate in the elderly, whereas vitamin D alone did not (5). The difference between the groups was statistically important, but clinically small: 9 percent reduction with vitamin D plus calcium and 7 percent with vitamin D alone.

One of the weaknesses of this analysis was that vitamin D in two of the studies was given in large amounts of 300,000 to 500,000 IUs once a year, rather than taken daily. This has different effects.

Weight benefit

There is good news, but not great news, on the weight front. It appears that vitamin D plays a role in reducing the amount of weight gain in women 65 years and older whose blood levels are more than 30 ng/dl, compared to those below this level, in the Study of Osteoporotic Fractures (4).

This association held true at baseline and after 4.5 years of observation. If the women dropped below 30 ng/dl in this time period, they were more likely to gain more weight, and they gained less if they kept levels above the target. There were 4,659 participants in the study. Unfortunately, vitamin D did not show statistical significance with weight loss.

USPSTF recommendations

The U.S. Preventive Services Task Force recommends against giving “healthy” postmenopausal women vitamin D, calcium or the combination of vitamin D 400 IUs plus calcium 1,000 mg to prevent fractures, and it found inadequate evidence of fracture prevention at higher levels (6). The supplement combination does not seem to reduce fractures, but does increase the risk of kidney stones. There is also not enough data to recommend for or against vitamin D with or without calcium for cancer prevention. But as I mentioned previously, the recent VITAL study did not show any benefit for cancer prevention.

When to supplement?

It is important to supplement to optimal levels, especially since most of us living in the Northeast have insufficient to deficient levels. While vitamin D may not be a cure-all, it may play an integral role with many disorders. But it is also important not to raise the levels too high. The range that I tell my patients is between 30 and 55 ng/dl, depending on their circumstances — those who are healthy and those who have chronic diseases and what type of chronic diseases.

References:

(1) Circulation. 2008 Jan 29;117(4):503-511. (2) PLoS One. 2012;7(5):e36617. (3) NEJM. 2018 published online Nov. 10, 2018. (4) J Women’s Health (Larchmt). 2012 Jun 25. (5) J Clin Endocrinol Metabol. online May 17, 2012. (6) JAMA. 2018;319(15):1592-1599.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Port Jefferson Chamber of Commerce hosts annual Health & Wellness Fest

by Alex Petroski - April 27, 2017

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“Eat well, live well” was the tagline for the Greater Port Jefferson Chamber of Commerce annual Health & Wellness Fest, which was held April 22 at Earl L. Vandermeulen High School in Port Jefferson. Attendees were instructed on how to do both by vendors set up at tables in the school’s gymnasium, featuring representatives from Stony Brook Medicine, John T. Mather Memorial Hospital, St. Charles Hospital and many others.

“It’s been growing every year, and in the last two years, we were so fortunate as to have St. Charles Hospital provide us with the healthy snacks, and that’s really helped us boost the attendance,” Chamber President Jim Karras said in an interview during the event.

Chamber director of operations Barbara Ransome was also pleased with the number of vendors who turned out to offer advice to interested community members.

“We had no extra tables this year,” she said. “We had over 80 tables this year…I think there were like 45 individual vendors…All of our local nonprofits, we don’t charge them, so we feel like this is giving back to our community.”

Karras said he is proud of what the chamber has built with the annual event.

“There’s a lot of health and wellness events in the area, but I think we’re the only one that has the three major hospitals sponsoring them,” he said. “That makes a big difference.”

Ransome thanked the district for their hospitality.

“We want to put a shout out to our school,” she said. “Fred Koelbel, who is the superintendent of buildings here for the Port Jefferson School District, and for them to allow us to use this great facility, we have elevated this event.”

Other vendors included Jefferson’s Ferry lifecare community, L.I. Botanical Wellness, Save-A-Pet, Paws of War, Port Jefferson Hearing and many more.

2017 Health & Wellness Fest

Medical Compass: Long-term health impacts of chronic stress

Cortisol resistance can increase susceptibility to viruses and infection

Medical Compass: Should you be taking vitamin D?

Recent trial results question supplementation benefits

Port Jefferson Chamber of Commerce hosts annual Health & Wellness Fest

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