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  • Dr. Mimi Guarneri: Hi. I'm Dr. Mimi Guarneri, and today we are going to talk about the mindbodyspirit

  • connection and how it relates to health. The objectives for today are to review the science

  • of the mindbody connection. What is the link between how we respond to stressful events

  • and illness, particularly cardiovascular disease? We'll also spend some time today talking about

  • how we can use techniques that can very easily impact the stress response on our bodies,

  • and how we can take those techniques into our private practice immediately.

  • The former surgeon general was very, very smart. He had this to say. He said, "Of the

  • 10 leading causes of death in the US, seven could greatly be reduced if we changed the

  • way we lived our lives." This was his quote. “We need to modify our alcohol intake, lack

  • of exercise, poor diet, smoking”, and, my personal favorite, “unhealthy, maladaptive

  • responses to stress and tension. If we can impact these, we can basically impact the

  • health of the entire country.” [Julius B. Richmond]

  • Now, Hans Selye is the individual we probably consider one of the fathers of stress. He

  • really raised the level of consciousness of, how does stress affect the physical body?

  • This is how he defined stress. He said, "Stress can be defined as the state one experiences

  • when there is a mismatch between perceived demands and our ability to cope." That's very

  • important, because we all have demands, and we all have a certain level of resiliency.

  • It's when our resiliency is tapped that we start to feel stressed. That resiliency may

  • be different for everyone. Someone can have two things on their plate, someone else can

  • have 15, before they start feeling like, "I can't cope." It's this mismatch between perceived

  • demands ‑‑ and "perceived" is also an important word, because sometimes we don't

  • have to accept all those demands ‑‑ and our ability to cope.

  • How does this translate into health? The American Institute of Stress tells us that 75 to 90

  • percent of all visits to healthcare providers result from stressrelated disorders. Now,

  • that is an incredible statistic. We know, for physicians, that stress is running

  • rampant. This is a survey from Physician Executive looking at 1,200 actively practicing physicians.

  • 6 out of 10 said they have considered leaving medicine. 77 percent said they're fatigued.

  • 67 percent they're burntout. 33 percent have depression and some form of family discord,

  • and, as everyone knows, a very high incidence of divorce.

  • The way I teach it to my patients is this way. We are surrounded by events in our life.

  • We can't control those events 10 out of 10 times, but what we can control is how we respond

  • to those events and what our perception is. For example, if the Dow goes down, we might

  • say, "Hey, this is a great time to buy stock." That's one response. Or we might say, "Oh,

  • my God. Doom and gloom. I've lost all this money," and we will start off a whole cascade

  • of stress hormones. This is important, because two people can see the same exact thing and

  • have totally different responses. This is personal.

  • When we get into a cycle of feeling stressed, feeling like we can't cope, the body changes.

  • We have over 1,400 chemical reactions. The ones that we see happening, manifesting, every

  • day in our clinical practice are related to hormones like adrenalin, noradrenaline, aldosterone,

  • and cortisol. These are just some of the key stress hormones that impact our health and

  • our wellbeing. Let's take a look at the stress cascade. This

  • is just for the physical body. As a cardiologist, I was very intrigued to see that, as adrenalin

  • and noradrenaline and cortisol and aldosterone go up, platelets become sticky. Renin and

  • Angiotensin goes up. Insulin resistance goes up. People put on weight in their midline.

  • People have palpitations and skipped heartbeats. We also, of course, have hypertension. Even

  • cholesterol goes up in the setting of stress. In the 1990s, I looked at this list and I

  • said, "Wow, all of the drugs I'm giving are really hitting the stress hormones. For example,

  • I'm giving aspirin and Plavix ‑‑ that's affecting blood coagulation ‑‑ Metformin

  • for insulin resistance and diabetes, ACE inhibitors for Renin and Angiotensin, Statins for cholesterol,

  • beta blockers for arrhythmia, and the list goes on and on." It got me to think, maybe,

  • just maybe, we want to meditate and medicate, that we have to do something for this stress

  • response. Now, we can have acute stress, and that can

  • make us sick. We know in cardiology today, there's something called brokenheart syndrome.

  • Bad news. Acute, stressful event. People come in with cardiomyopathy, many looking like

  • they need a heart transplant. Fortunately, with supportive care and medications, this

  • usually resolves and people get better. That's an extreme example, brokenheart syndrome,

  • of the impact that stress can have on the human heart.

  • In the journal of "Circulation" in 1995, there was a study that looked at over 1,600 people

  • coming to the emergency room with heart attack. They were asked, "What were you doing two

  • hours before your heart attack?" They concluded that an anger outburst increased the risk

  • of a heart attack 230 percent. That is huge. Now, in California, we had the Northridge

  • earthquake. Of course, that's a sudden shock to the entire Northridge community. What the

  • research showed was there was a fivetimes increase in cardiovascularrelated sudden

  • death on the day of the Northridge earthquake. We saw something similar after 9/11, where

  • patients who had AICDs in, a much higher incidence, in the month following 9/11, of malignant

  • cardiac arrhythmias. What about a sports game? This was from the

  • "British Medical Journal." There was a 25‑percent increase in heartattack admissions in London

  • when England lost to Argentina in the World Cup Soccer Tournament in 1988.

  • It's an acute response that can quickly affect the physical body, but it's not only the physical

  • body. It's the mentalemotional body as well. For example, we know that people under

  • stress do not think clearly. They don't make their best decisions. I've had many patients

  • come in and say to me, "I can't recall anything. My memory is not like it used to be." We do

  • an MRI because we're concerned they may have a brain tumor.

  • When you look at the stress spectrum, this is what you find. Loss of focus and mental

  • clarity. Inability to relax and sleep. Low selfesteem, because we feel like we can't

  • get anything done right. We feel tired, because we can't sleep. Very frequently, if we have

  • a lot of things that we can't cope with, our response is one of anger, and we just heard

  • how bad anger is for the heart. What about chronic stress? We talked about

  • acute events ‑‑ the Northridge earthquake, 9/11. What about people who are chronically

  • stressed? Well, Louis Pasteur said this ‑‑ "The microbe is nothing. The soil is everything."

  • To me, this translates into, how is your resiliency? What do you have to stabilize your life, so

  • that when life throws you a curve ball, you don't respond with the 1,400 chemical reactions

  • and the stress hormones that we just talked about.

  • A lot of research has been done on chronic stress. Dr. Janice Kiecolt-Glaser has done

  • enormous studies. For example, she took caregivers and compared them to wellmatched controls.

  • She did a simple punch biopsy on their skin, and what she found was that caregivers took

  • 24 percent longer to heal a simple punch biopsy. She also found that if she took medical students,

  • during vacation time and during exams, that it took them 40 percent longer to heal the

  • same simple punch biopsy during exam week. What does this translate to? This translates

  • to chronic stress, which is leading to increased cortisol, and immune suppression can affect

  • wound healing. Same thing with the influenza vaccine. She

  • look at caregivers below 71 years of age and above 71 years of age and compared them to

  • wellmatched controls. What she found was caregivers, across the board, were less likely

  • to produce the antibodies when they were given the flu vaccine ‑‑ again, demonstrating

  • that chronic stress has an impact on the immune system. The ability to mount an antibody response,

  • which also translates into the ability to fight an infection and fight a cancer, all

  • of these are affected by stress. The body of research is enormous. As cortisol

  • goes up, DHEA goes down. What do we see in this situation? We see accelerated aging,

  • braincell death. Our ability to learn and our memory are greatly impaired. We see reduced

  • bone density, osteoporosis, loss of muscle, reduced skin growth and repair. Our immune

  • system, as we just said, is affected. Our blood sugar, as we discussed previously, goes

  • up, and we put weight on in our midline. Let's think about this for a second. If I

  • have accelerated aging, and my memory is failing and I have osteoporosis and I have less muscle

  • mass, and my skin is not as taut or tense as it could be and it's not regenerating appropriately,

  • these are all the biological markers for aging. High cortisol leads to increased aging. Stress

  • leads to increased aging. This has been confirmed in research, for example, by Dr. Elizabeth

  • Blackburn, who has demonstrated that people under chronic stress have a reduction in their

  • telomere length and their telomerase activity. This is phenomenal research because, for the

  • first time, what it's telling us is chronic stress affects the age of our cells, which

  • could be totally different than our biological age.

  • The obvious question is, what do we do about it? How do we turn stress into strength? How

  • do we transform the way we respond? How do we change our perception? Because, remember,

  • it's your response and your perception. For my patients, I give them a lot of choices.

  • I say peace. Peace. Finding inner peace is like the center of a wagon wheel. Your path

  • could be very different for different people. For some people, it's exercising in nature.

  • That may be one spoke of the wheel. For someone else, it may be repetitive prayer, like mantra

  • repetition or saying the rosary. For some people, it may be meditation. For some people,

  • it may be practicing appreciation, practicing gratefulness, changing one's perception. For

  • others, it's learning how to breathe, simple breathing techniques. Meditation, yoga, Tai

  • Chi, spirituality, spiritual practices. It's whatever it takes for an individual to find

  • inner peace, and it's different for each and every one of us.

  • Remember that stress is almost always an emotional reaction to a situation. It's our perception.

  • It's our response. It impacts our thinking. How many smart people do you know who've said

  • some really silly things under stress? We've all done it. We're under stress and we say

  • something we regret five seconds later. It affects our ability to perform at our best.

  • It affects our physical health, our mentalemotional wellbeing, and it even affects those around

  • us. Because, quite frankly, no one wants to be around someone who's stressed and responding

  • with anger. Mark Twain said this. Mark Twain said, "I

  • have suffered a great many misfortunes, most of which never happened." I really like that

  • quote. Adyashanti said, "Suffering happens between the ears. Everything else is just

  • a situation." This concept of perception and our imagination

  • and our ability to worry, these are things that we can change immediately in our life,

  • and there are simple tools to do that. Remember what we said about response and perception.

  • I can't control the initiating event. We can't control everything our teenagers do or say,

  • can't control most of the events around us, can't control our spouses and significant

  • others half the time. The only person we can change is us. We can change how we see the

  • world, how we respond to the world, and what we're seeing is what's affecting our physical

  • wellbeing, and how we're seeing it. Let's take a look at a beautiful study that

  • illustrates this. Medical students were asked to watch a movie about Mother Teresa, and

  • they were also asked to watch a neutral film. 92 percent of these students had an improvement

  • in their immune system watching Mother Teresa. When those students were questioned about

  • the movie, they said, "Oh, I love Mother Teresa. She's terrific." They felt good watching the

  • movie. They felt like they were doing service. They felt really good.

  • Eight percent of the students said they hated the movie. They didn't like it at all. Those

  • same students had a reduction in their immune system, their salivary IgA, while they were

  • watching the movie. Again, two people seeing the same exact thing, totally different response.

  • I loved the movie, my immune system improves. I hated the movie, my immune system was suppressed.

  • When they looked at the health records of these students over the previous year, they

  • found that those students who disliked the movie, who also responded negatively to photographs

  • that were shown to them ‑‑ and when they generated a story, the story was not a nice

  • one ‑‑ were the ones that were sickest the previous year. This concept of what do

  • you see in the world, how do you see the world? We use the expression, "rosecolored glasses,"

  • right? Well, is your glass halffull or halfempty? For those students with the

  • halfempty glasses, they had more illness the previous year.

  • Now, when the economy changed a couple of years back, I was looking for ways to really

  • help my patients. This was a quote I found that was quite helpful, by Eric Butterworth,

  • in his book called "Spiritual Economics." He said, "You see things not as they are