Men/Women

Forty-year-olds with excess abdominal fat are much more likely to develop Alzheimer’s disease compared to controls without big bellies.  Researchers followed 6,583 men and women aged 40 to 45 who had their belly fat measured during routine physical checkups between 1964 and 1973.  A caliper was used to determine the distance between their backs and the surface of their upper abdomens, with measurements of 10″ or more being classified as high.  Medical records were evaluated three to four decades later when the participants were aged 73 to 87 to determine how many had developed Alzheimer type dementia.  Of the 1,049 such cases identified, those who were obese due to large bellies in their forties were 3.6 times more likely to develop dementia.  Participants with pot bellies had an increased risk for dementia even if their weight was normal and they had no diabetes, hypertension or other health problems.  Women were more likely than men to have abdominal obesity and non-whites, smokers, people with high blood pressure, high cholesterol, diabetes, or who had less than a high school level of education were also at somewhat greater risk.

As noted in prior Newsletters, it has been well established that stress causes the deposition of deep abdominal fat due to increased secretion of cortisol.  Cortisol can also contribute to the memory loss and other cognitive problems seen in dementia.  In addition, autopsy studies have shown that changes in the brain associated with Alzheimer’s disease may start in young to middle adulthood, and that higher abdominal fat in elderly adults was associated with greater brain atrophy.  Having abdominal obesity in mid-life is known to increase the risk of diabetes, stroke and heart attacks.  In contrast peripheral obesity due to excess fat in the buttocks and extremities has an anti-atherogenic effect, possibly because abdominal fat secretes chemicals that promote insulin resistance.  However, this is the first time researchers have demonstrated that increased abdominal fat also increases risk of dementia.  Whether this is merely an associated or causal factor and possible mechanisms of action will be discussed in a future Newsletter. While there is no precise way to translate belly fat measurements into waist circumference, it is generally recommended that the upper girth limit should be 40 inches for men and 35 inches for women.

References:

1.    Whitmer RA, Gustafson DR et al. Central obesity and increased risk of dementia more than three decades later. Neurology, Published online before print March 26, 2008.
2.    Rosch PJ.  STRESS, SENIOR MOMENTS AND ALZHEIMER’S DISEASE. HEALTH AND STRESS, Newsletter #11, November, 2006.

“Sandwiched generation” women are much less likely to be happy than other Americans according to a poll commissioned by the New York Academy of Medicine and the National Association of Social Workers. The survey of over 1000 35 to 55 year-old women who had at least one living parent found that only 20% said they were very happy compared to 34% for the U.S. population overall obtained in another study earlier this year. Problems related to money, lack of time and health were the leading sources of stress and more than half were concerned about an elderly relative’s health. The term “sandwich generation” women refers to those who care for children at home as well as a parent in addition to their usual household obligations. Getting married later in life, later child-bearing and longer life spans are contributory factors since studies show that women do 70% of the care giving for elderly relatives with chronic problems.

About two thirds of those surveyed had jobs and the more than half who were concerned about a parent’s health were also much more likely to be depressed and worried about having enough time for other family members as well as more trouble managing stress. This was no surprise to one social worker who said, “I’ve had women burst into tears in my office. They say ‘Not only is my father in the hospital, and they’re calling me at work saying, “Figure out where he’s going next because he’s not going home,” but the school’s calling to say my learning-disabled child has developed another problem. ” Another researcher said, “The “sandwich years don’t even go away by the 60s anymore. We’ve got these 60-year-olds who take care of 92-year-old parents and 16-year-old kids.” Such overwork problems may be more common than generally appreciated based on another study by the Families and Work Institute reporting that 35% of U.S. employees said they had elder care responsibilities during the last year. As Ellen Galinsky, the Institute’s President noted, “It can be episodic, unpredictable and very stressful.”

Reference: USA TODAY 11/12/2006

In this study, ten unemployed men (high chronic stress) were exposed to two erotic videotapes and their arousal responses were compared to a matched group of normal controls re porting no unusual stress.  Acute stress was induced by telling the men that they would have to give a public talk on their own sexual behavior and fantasies and the stressful nature of this task was confirmed by their cardiovascular responses. Sexual arousal was evaluated by measuring penile tumescence. Half the men were told about the talk before seeing their tape and the other half were told in between the two erotic tapes, The results showed that the unemployed (high chronic stress men) had significantly less sexual arousal when acutely stressed prior to viewing the videotapes. There was no difference between the two groups when the acute stress of having to give a talk on personal sexual fantasy was presented between the two tapes. The authors thus concluded that impairment of erection occurred as a result of a combination of both chronic and acute stress.

According to a recent government report, women are twice as likely to suffer from major depression and three times more likely to attempt suicide compared to men. Women also experience anxiety disorders two to three times more often than men. These gender disparities have been attributed to fluctuations in female hormones, which can occur on a monthly basis in women with premenstrual syndrome who experience increased irritability and mood swings. PMS can cause such violent behaviors that it has been successfully used as a defense for criminal acts ranging from shoplifting to murder. Menopausal depression due to a drop in estrogen is not uncommon and improves in most patients with hormone replacement therapy. Estrogen levels soar 50 times higher than normal during the last trimester of pregnancy and then plummet in the 48 hours after birth. Progesterone increases 10-fold and similarly falls 90-95 percent and there may be significant changes in prolactin, oxytocin, thyroid and other hormones following delivery. Almost 80 percent of new mothers may experience temporary “baby blues” with mild symptoms of sadness and mood swings that disappear spontaneously after a few days. One in five suffers from postpartum depression, which is characterized by crying, difficulty sleeping, and a decreased ability to function normally or provide adequate infant care. Postpartum psychosis is much less common (1 in one thousand births) but also much more serious. Strange symptoms usually start to surface within a few weeks after delivery, such as; feelings of being ordered by God or a some higher power to do something harmful to oneself or the baby; seeing or hearing things that others do not; periodic feelings of intense confusion or agitation or fluctuating between extreme highs and lows of energy.

What triggers postpartum mental illness is not clear but risk factors include a past history of depression, especially after a prior pregnancy, and stressful events during the past year such as job loss, illness, marital conflict, and a pregnancy that is unwanted, unplanned or associated with complications. The association between stress and depression is well established since depressed patients frequently have elevated levels of cortisol due to overactivity of the hypothalamic-pituitary-adrenal (HPA) axis. This starts with stimulation of corticotropin releasing hormone (CRH) in the hypothalamus, which triggers pituitary production of ACTH that stimulates the adrenal cortex to secrete cortisol.

It is not generally appreciated that during pregnancy, the placenta also produces CRH, which is identical to hypothalamic CRH. The only difference is that while increased cortisol hypothalamic CRH, it stimulates the production of CRH in the placenta. As a result, production of placental CRH steadily increases during pregnancy and eventually reaches levels usually seen only during conditions of severe stress in nonpregnant controls. Researchers believe that the sudden disappearance of the placenta following delivery results in a sharp drop in CRH that can lead to postpartum depression by disrupting normal HPA axis regulation. Since this sudden change would be greatest in those with very high levels of CRH, it seemed likely that placental CRH measurements might be useful in predicting the likelihood of developing postpartum depression. The results were impressive in a recent study of 100 pregnant women, 16 of which developed postpartum depression. Researchers could accurately predict this in three out of four by blood tests alone and did even better when these results were combined with measurements of depression during pregnancy. This could be an important breakthrough if confirmed in larger studies now underway, since it would allow physicians to implement prompt preventive and treatment interventions that have been shown to be much more effective when implemented as early as possible.

References:

Yim IS, Glynn LM et al. Risk of Postpartum Depressive Symptoms With Elevated Corticotropin-Releasing Hormone in Human Pregnancy Arch Gen Psychiatry. 2009;66(2):162-169.

Rosch PJ. Stress – Is It Worse For Women Or Men? Health and Stress: The Newsletter of The American Institute of Stress. No. 7, July 2009

It has been suggested that the unexplained increase in breast cancer in middle-aged women may be due to job stress. The incidence of deadly ovarian cancer is also fourteen times higher in career oriented single working women compared to a control group of homemakers. Further support for a link between stress and breast cancer comes from a recent Israeli study.  Researchers studied 255 women with breast cancer under the age of 45 and 367 healthy controls to determine whether there was any significant difference in antecedent stress levels due to severe life change events such as loss of a spouse, parent, or close relative,  divorce of parents before age 20, separation from a spouse, loss of a job, an economic crisis, or severe illness in a close relative. After correcting for other possible influences,  it was found that the risk of breast cancer was increased by 62 percent in women who had experienced more than one such adverse life event.  General feelings of happiness and optimism seemed to offer protection against breast cancer, and as the senior author noted, “The more you are happy and feel optimistic with your life, the less the probability of developing breast cancer.” A study published earlier this year confirmed previous reports showing that increased perceived stress was similarly associated with higher rates of cervical cancer.

The mechanisms of action involved in some of these relationships between stress and female cancers vary.  With respect to jobs stress, it has been well established that the younger a woman is when she has her first child or even becomes pregnant, the less likely she is to develop breast cancer.  Pregnancy lowers prolactin, which stimulates breast tissue growth and promotes breast cancer in experimental animals.  As more and more women enter the work force, they tend to remain single, marry later in life, and decide not to have children, or do so only when they are much older.  The  number of women having their first child after the age of 35 has quintupled over the past four decades.  Animal studies show that some breast cancers may be due to viral infection and stress reduces immune system resistance to viral and bacterial invaders.  Increased cervical cancer is also thought to be due to HPV and other viruses that cause premalignant lesions.  In a study of 300 low-income women receiving family planning advice in health department clinics, psychosocial stress due to divorce, infidelity, excess arguments and physical violence from partner was associated with a significant increase in precancerous cervical lesions.

References:

Peled R et al. Breast cancer, psychological distress and life events among young women.

BMC Cancer. 8:245-7. August 22, 2008

Lillberg K et  al. Stressful Life Events and Risk of Breast Cancer in 10,808 Women: A Cohort Study. Am. J. Epidemiol. 157: 415-423 2003

Fang CY. Perceived Stress is Associated with Impaired T-Cell Response to HPV16 in Women with Cervical Dysplasia. Annals of Behavioral Medicine 35:87-96, Feb. 2008

Coker AL et al. Psychosocial Stress and Cervical Neoplasia Risk. Psychosom Med. 2003; 65: 622-651.

Rosch PJ  Health and Stress Newsletter, Stress, Skin, Cervical and Breast Cancers, February, 2005.

Rosch PJ. Stress And Cancer: Disorders Of Communication, Control And Civilization

Cooper, CL ed. Handbook of Stress, Medicine and Health, CRC Press, Inc., 1996.

A government report indicated that while overall cancer rates are declining, there has been a disturbing upward swing in breast cancer in middle-aged women.  The reasons for this are not clear, although it has been established that women who have had children are less likely to develop breast cancer that those who have not.  Also, the younger you are when you have your first child, the better your chances for escaping this problem.  Pregnancy appears to lower concentrations of prolactin, a hormone which is known to cause breast tissue growth and contribute to malignant breast tumors in experimental animals. It has been noted that in the past few decades, more females have become career women and consequently, do not marry and become mothers, or do so when they are comparatively older.  In addition, such individuals may be subjected to various forms of job stress due to frustration in advancement or obtaining parity with male workers having equivalent skills, training and experience.  Emotional stress has been demonstrated to cause a depression in immune system defense against cancer and a variety of viral-linked disorders.  One study of women who had married between the ages of 17 and 44 revealed that those who never had children were much more susceptible to sudden death due to heart disease.  Possible explanations offered include an abnormal endocrine state which possible constributed both to infertifily and cardiac disease because of estrogen deficiancy as well as the psychsocial stres associated with being barren.  In any event, it appears that motherhood bestows certain health benefits, as well as more obvious rewards.

Most attempts to rate or quantify stress place death of a spouse or a loved one at the top of the list with loss of other important emotional relationships such as divorce, marital separation, and retirement next in line.  Death of a spouse has been shown to result in a prompt prolonged depression of immune system function possibly explaining why recently widowed individuals had 3 to 12 times higher death rates than married controls.  Recent studies now confirm that marital separation is also associated with a significant impairment in immune system function.  Women who had been separated one year or less had much greater depression of immune responses than matched married counterparts.  Among the separated-divorced group, those with greater attachment to their ex-husband exhibited the highest levels of emotional depression and poor immune system.

As noted in prior Newsletters, the Harvard Study of Adult Development is the longest and most comprehensive investigation of the aging process ever
conducted.  Since the 1930′s, researchers have closely followed more than 800 men and women from adolescence to old age to seek clues about behaviors and activities that are associated with healthy longevity.  Some of the findings surprised George Vaillant, the current director of this project and author of Aging Well.   He had anticipated that “the longevity of your parents, the quality of your childhood and cholesterol levels would be very influential”. They were not.  Keeping mentally active and having lots of friends were much more important.  A happy marriage or good long term relationship at age 50 was a leading indicator of being healthy at age 80 but a low cholesterol level had very little significance.

How can such findings be explained?  With respect to cholesterol, Newsletter subscribers are already aware of mounting evidence that elevated cholesterol, like premature baldness and a deep earlobe crease, may be associated with a higher incidence of heart attacks, but does not causethem.  Similarly, the cardioprotective benefits of statins are not due to
cholesterol lowering since they are also seen in patients with low LDL and cholesterol.  It is much more likely, that, like low dose aspirin, reduction of inflammation and other activities are responsible.  In addition, numerous studies show that cholesterol lowering is of little value in reducing mortality in senior citizens and that a low cholesterol is actually associated with increased death rates and numerous health problems.

But why would a happy marriage or having lots of friends promote healthy aging?  The most likely explanation is that stress can accelerate the aging process and that having strong social support from friends or family reduces the harmful effects of
stress.  Stress can contribute to illness and premature mortality in many ways, including suppression of the immune system’s ability to ward off infections and certain cancers. British researchers recently reported that in a study of more than 180 senior citizens who received influenza vaccine, those who said they were happily married developed higher antibodies and more protection than others who reported less marital satisfaction.  Participants also completed questionnaires designed to rate exposure to stressful life events and those who had experienced a significant bereavement in past 12 months had poorer antibody responses than controls.  A happy marriage or long term relationship also provides strong emotional support, which is a powerful stress buster.

References: References: Vaillant GE. AGING WELL: Surprising
Guideposts to a Happier Life from the Landmark Harvard Study of Adult
Development. Little, Brown and Co. New York, 2002. Health And Stress Newsletter,
#5, #7 2005, #10 2002, #7 2000, #9 1999.

A happy marriage can help you live a longer and healthier life. One of the benefits of a happy marriage seems to be improved immune system function and studies show that stress can impair immune system. Medical students who were severely stressed because of concerns about an impending important exam had lower than normal antibody responses to Hepatitis-B vaccine. A similar poor response to influenza vaccine compared to well-matched controls was seen in those caring for a spouse with Alzheimer’s.  Another study showed that such caregivers took an average of 9 days longer than controls to completely heal a small biopsy wound because of impaired immune responses.  Caregivers had higher levels of Interleukin-6, which disrupts immune system function and increases risk for heart disease, arthritis, osteoporosis, Type-2 diabetes and possibly certain malignancies. These changes can persist up to three years after care giving activities cease.

There is little doubt that having to provide constant care to a spouse suffering from Alzheimer’s can cause severe stress
that impairs wound healing and increases susceptibility to disease.  However, a recent study showed that even if spouses usually get along well, the stress caused by a brief argument can slow healing of a surgical wound by as much as a
day.  Researchers admitted 42 couples who had been married on average for 12.5 years for two 24-hour visits, separated by two months.  At each visit, all participants were subjected to a suction blister device that produced eight
identical tiny wounds. During the first visit, all couples completed questionnaires designed to measure their stress levels and were then asked to engage in two 10-minute discussions during which they were asking for and providing social support so that their behavior could be evaluated.  Theprocedure was the same during the second visit except that the 10-minute
discussions were about areas of disagreement designed to produce emotional and sometimes hostile responses.   Couples who were classified as  “high hostile” took a day longer to heal than others not only after the conflict visit (7 days versus 6) but also after the social support encounter (6 versus 5)  Differences were found in immune system cytokine measurements in the delayed healing group that could explain these results.

If a short spat in a laboratory can have such effects, one can only wonder what the response would be to a full-fledged fight at home that lasted hours or days.Frequent fights could significantly delay wound healing and reduce resistance to infection.  The Honeymooner’s Ralph Kramden was probably lucky that he never needed emergency surgery.

References:
Kiecolt-Glaser JK et al.
Hostile Marital Interactions, Proinflammatory Cytokine Production, and Wound
Healing. Arch Gen Psychiatry.
2005;62:1377-1384. BBC News Online 11/08/2005.
Health And Stress Newsletter
#7, 1999