This past week, New York City's Health Commissioner, Dr. Thomas R. Frieden, announced a laundry list of medical conditions that aggravate the effects of swine flu and leave you more vulnerable. Many of these diseases are well known to all: diabetes, asthma, heart disease, lung problems, possibly obesity and a weakened immune system. Other factors not mentioned that are also potential risks include pregnancy, being very young (less than 2 years of age) and being over 65 years of age. About 50% of hospitalizations globally and 70 % of those in the US with swine flu seem to involve individuals suffering from underlying conditions. Conventional prevention - washing hands, containing exposure if you're ill and taking antiviral medications - makes good sense. As a primary care physician, I advise my patients to employ all these precautionary measures but I also screen them for something I feel is more predisposing than most of the conditions listed by the Health Commissioner: chronic stress.
American's are faced with stress from all quarters - financial stress is the most obvious, but our lifestyle is a mélange of stress producing events. Virtually every person with a job is facing greater expectations in terms of work hours needed to keep up with deadline and communication through computers, blackberries and cell phones has hurled us into a frenzied pace that leaves our nervous system's frayed.
According to the American Psychological Association's (APA) survey done in 2008, half of Americans surveyed reported that their stress level increased over the year with one third rating their stress as extreme. Furthermore, the stress experienced was severe enough to impact the ability of roughly 30% of those queried to make decisions and get things done. Respondents of both sexes reported that work and money were the most common reasons for their stress, but women were more significantly impacted and they reported more emotional and physical symptoms. Despite widespread awareness (80%) of the negative health impact of stress, less than half - only 47% -- did exercise to manage their stress . Time with family was greatly impacted by work demands - 56% reported that work interfered with their family and home responsibilities. And, close to sixty percent stated that they would be uncomfortable seeking professional advice to help manage their stress or stress related problems.
Mounting scientific evidence demonstrates that stress has an impact on health at even a cellular level. For the last several decades, research conducted by Dr. Elizabeth Blackburn, professor of biology and physiology in the Biochemistry and Biopphysics Department at the University of California, San Francisco (UCSF) and her colleagues has shown that at a cellular level stress accelerates the aging process. Furthermore, this year in the Journal, Brain, Behavior and Immunity, the lead author, Dr. Aoife O'Donnovan,, Visiting Scholar at UCSF and co-authors ( including Dr Blackburn) released a short communication indicating that pessimism similarly accelerates biological aging at the cellular level.
Dr. Kiecolt-Glasser, of The Ohio State University College of Medicine, demonstrated in1996 that chronic stress negatively impacts our body's immune responses to influenza (flu) infections and influenza vaccination responses. In other words, people who are chronically stressed are less able to effectively fight viral infections when they are exposed to them and less efficient in raising the body's capacity to protect itself if given a vaccine such as a flu shot. In subsequent studies even healthy adults (medical students under chronic stress) exhibited similar results.
From these studies its seems reasonable to conclude that chronic stress can be a significant obstacle to mounting our best body's healing response to Swine flu ( H1N1). But there is more - if stress negatively impacts our immunity, are there other factors that can positively reverse these unwanted responses? The answer is complicated, yet the message is still hopeful. In 2002, a study published by the Gerontological Society of America demonstrated that those adults aged 62 years or older who moderately exercised twenty minutes three times a week, ate a healthy diet and had a predominant mood of optimism mounted greater immune responses against the flu vaccine. Though this was a modest study of fifty-six adults, the conclusions showed that positive lifestyle factors can be linked with improved immune responses and, even more importantly, this was shown to be true in an elderly population--an age group that is typically more vulnerable to serious consequences.
As a pragmatic response to these research findings, I recommend that my patients take the following steps to boost their immunity and improve their general health:
1. Make time for modest exercise at least three times a week for thirty minutes. Track your distance by purchasing a pedometer, walk briskly and aim for an ultimate goal of 10,000 steps a day
2. Eat well. Fill your diet with fruits and vegetables lightly cooked and fresh as you can bear. Omit processed foods and highly fatty foods.
3. Socialize to boost your mood. See a friend at least once a week or, at a minimum, give them a call and have a nice, long chat.
4. Take a break during the day for at least 10- 15 minutes. Remove yourself from your workplace and walk outside the building. This will break the potential for a full day of work-related mental fatigue.
5. Enhance your relaxation response by finding something that gives you the sense of being on vacation for at least 10 minutes a day. Listen to music, do a breath exercise, take a relaxing bath, meditate, read a book or find something to smile about...
If you're not even sure you know how to relax, consider purchasing a biofeedback machine such as the Stresseraser® or Emwave®to help you "get into the zone" of relaxation. Use it for 10 - 20 minutes daily to so your body can experience the relaxation response. This will boost your natural restorative responses to stress.
6. Chronic stress has an insidious effect on our resilience to many things, including viral illnesses. Unfortunately, the first thing most of us tell ourselves is that we don't have the time to exercise, meditate, take a bath or call a friend. However, there has never been a better time to change this way of thinking, as your life might depend upon it.
It's not the work which kills people, it's the worry. It's not the revolution that destroys machinery it's the friction.
-- Henry Ward Beecher