Health for Life M.D.: Coping With Stress

Edmonton, Ky.: Do we build up resistance to stress? My job is stressful, but as the years go by I seem to handle stress better. I have had seven bypasses and have a pacemaker.
Dr. Michael Craig Miller: I don't know if we actually build up a resistance, but with experience and practice, many of us do handle stress better. I understand this process to be a basic feature of the brain. Consider a sport like tennis or golf. If you practiced every day, your brain would strengthen the circuits that enable you to move your body in ever more precise ways. Roger Federer and Tiger Woods may have plenty of innate talent, but they would not be at the top of their games unless they spent many, many hours practicing their craft. They also, by the way, have high-pressure jobs. And they, like you, have also spent many hours learning how to manage the pressure. You have an impressive record of surviving heart disease. Maybe your illness and the value of your time have put the stress of work in the right perspective, too.

Cincinnati: How is stress compounded by death and the loss of loved ones? What's a reasonable amount of time to expect to regain the balance and energy needed to move forward?
Grief is stressful, but it is unavoidable and—in that sense—normal. It can be intense and disturbing, partly because some of the thoughts and feelings surprise the person going through it. The bereaved may feel not only sadness but also anger and resentment. He or she may suspect the motives of people who are trying to help. They may turn the events leading up to death over and over in their thoughts. They may feel lonely and helpless. Some consider suicide. As many as half of people who have lost a spouse develop symptoms typical of major depression in the first few months after losing a loved one.

Sometimes a loss of such magnitude puts other daily stresses in perspective. I lost my sister suddenly almost two years ago. On top of the loss, the reality of death so close changes one's perception of the importance of time and reshapes priorities.

Since close relationships fortify people against stress, the loss of an important source of support can make a person more vulnerable. Rebuilding after such a loss itself takes a lot of work. You will sometimes hear the view that it takes about a year to adjust. Maybe this view stems from the idea that the first time through the calendar without someone brings a unique reminder of what has been lost.

Although the term of a year may be considered "reasonable," the reality is that a year may also be unreasonably short or long. A year is too short because certain losses—for example, the loss of a child—you never get over. Usually, the pain gradually becomes more manageable, but there is no absolute time period. And there is no reason to wait to get help to live your life. If the bereaved person or family members think help is necessary, don't wait a year to get that help.

Oakland: How significant is a proper diet in controlling stress?
Diet can indeed influence stress levels. Good nutrition is as important for the brain as it is for every other part of your body. Being overweight can deprive you of energy and self-esteem. Nothing is more difficult than changing eating (and exercise) patterns that are years in the making. And if you already feel stressed, you may turn to food as one of the few available rewards. To make matters worse, you may then experience the stress of guilt or shame. But it is good to remember that keeping healthful habits is not a moral issue—it is merely a difficult task.

It turns out that the diet your doctor might recommend for your heart will probably reduce stress as well if you can follow it. The "Healthy Eating Pyramid" developed by Dr. Walter Willett of the Harvard School of Public Health is a sensible, no-nonsense approach to eating that will provide many benefits to health, including improved self-esteem and reduced stress. (Article continued below...)

Jackson, Miss.: Being a doctor, you have a job that is demanding, time-intensive and stressful. Would you please share some of the things you do to reduce stress in your life?
You can never have just the right amount of stuff to do. You can only be too busy or not busy enough. Being too busy, especially in this economy, is definitely the preferred problem. So I am too busy. I try to manage it by employing some basic time-management principles. I try to be realistic about how much I can achieve. I try to say no sometimes, so I can focus on my top priorities. Sometimes it is hardest to keep the commitments we make to ourselves; I certainly find that it is difficult. For example, I try to follow my own advice to do one thing at a time, though I rarely can keep the demons of the to-do list completely at bay. I try to accept "good enough" from myself and, since mistakes are unavoidable, live with the possibility that I will be criticized when I make one.

But I am lucky because my work is meaningful to me. I also have many—probably too many!—interests and activities that are meaningful to me, including spending time with my wonderful family and playing and listening to music. And, oh yeah, I try to eat right and exercise every day.

WALLA WALLA, WASH: For years, I had anxiety attacks so severe I literally thought I was having heart attacks, based on the pain I felt in my chest. My EKGs were always normal. Is there any evidence that chronic anxiety attacks can eventually damage the heart?
Any grave danger can trigger an acute stress response. The heart pounds, breathing quickens, blood is pumped to the brain and muscles, which makes us more alert and gives us a blast of energy. This survival mechanism readies us to confront danger or run from it. During a panic attack, the body goes through the same changes, but in the absence of a real, physical danger, it does us no good and just makes a person feel awful.

Experts do discuss the possibility that a key blood vessel supplying blood to the heart muscle could go into spasm at such a time, but it is probably pretty rare. Living with anxiety attacks and the stress of anticipating such attacks is the bigger problem because it can keep your stress-response system revving a bit too high, and that aggravates cardiovascular disease. My other concern is that a chronic anxiety problem could cause you to retreat from life or become less active.

Remember that your overall risk for heart damage goes down when you stay active and engaged. If anxiety is stopping you, it should be encouraging to know that anxiety of this type usually responds well to psychotherapy, medication or a combination of the two.

FLORENCE, MASS.: What is the single most important daily practice you would recommend to decrease stress?
Boy, that's a tough question. But I'll take a stab at it with a piece of advice that I have a hard time following myself. Stop multi-tasking! It simply doesn't work. If you have a long to-do list, or competing demands from several important people in your life, take a step back, and pick one thing to do. Don't spend too much time worrying about which thing is absolutely most important. Pick one to do and do that. Then pick the next thing.

CARIBOU, CALIF.:Is there any relationship between prolonged stress and cancer? I definitely have noticed that my immune system is down when I am under stress. Is an active immune system as important to fighting a cold as it is to fighting cancer?
Fortunately, there is no direct evidence that stress causes cancer. But you are smart to ask the question about the immune system, because some scientists think it could be our first defense against cancer. The body may protect itself by recognizing and destroying cells before they can multiply out of control.

Short-term stress may boost immune-system function, while chronic stress may weaken it. Theoretically, a weakened immune system could let cancer cells proliferate. The body's fight against cancer is much more complex than its fight against a cold. And the links from stress to the immune system to cancer are not proven. There are plenty of reasons to try to reduce chronic stress, but cancer is not at the top of the list.

MADRAS, ORE.: Can psychological stress trigger a stroke or heart attack?
The steady drip of psychological stress over time does appear to increase the risk of cardiovascular disease, including heart attack and stroke. Stress may adversely affect lipid levels. Blood pressure can go up. Inflammation inside blood vessels may increase. And platelets, which are instrumental for forming blood clots, may get stickier. Sticky platelets inside inflamed arteries are a problem, because clots can form that block the blood supply to the heart or brain.

Some of us are old enough to remember that doctors used to advise patients after a heart attack to rest completely. They warned family members to tiptoe around the convalescent to avoid upsetting him or her. "Don't make your father angry," mothers might have said to their children in the 1950s. But that was counterproductive, because the long-term effects of stress are more dangerous than a sudden fright or a temper flair. And the best way to fight chronic stress is to stay engaged in your life. Stress probably makes it harder to maintain the healthy habits that reduce cardiovascular risk. But what's good for your heart is also good for your brain.