A new study from South America adds substance to the stress-heart disease hypothesis that Malcolm Kendrick espouses in his book I recently reviewed.
Researchers studying a group of subjects in Latin America experiencing their first heart attack found that psychosocial stress was the leading cause, followed by high blood pressure, diabetes, smoking, and abdominal obesity. Last on the list of risk factors evaluated was dyslipidemia, but, as we will see, being last in reality doesn’t mean being last in the cholesterol-fevered minds of the researchers.
Although these risk factors seem to be different, they all are likely to be a part of the stress syndrome. Chronic stress often causes high blood pressure. Increased cortisol can certainly lead to abdominal obesity, and if unchecked, to diabetes. Stress also drives it’s victims to smoke and to binge on all the wrong foods.
It would seem that a program of stress reduction would work wonders on the rate of heart disease in South America and elsewhere.  Based on the findings in this study that would certainly be my recommendation.
How about the authors of this paper?  What do they recommend?

…reducing behavioral risk factors [smoking, eating fat, etc.], lowering blood pressure, and modifying lipids…

Yep, gotta get those lipids down.
Sounds to me like the researchers in South America are no different than the ones here. Let’s treat the symptoms, not the cause. And make sure that somehow lipids are one of the symptoms.
(Graphic: Self-Portrait by Gottfried Helnwein, watercolor on cardboard, 1982.)


  1. I agree. I think stress is a cause of many health issues. In today’s fast paced life style the increased stress is a killer. But as you say, let’s not worry about the cause let’s get that cholesterol down.
    In the minds of so many cholesterol trumps everything else.

  2. Hi Dr. Mike. What do you think are the best ways to combat stress? Especially, if you can’t eliminate the cause. For example, if the stressor is money/extended unemployment, the problem won’t go away soon, even with a resolution. What do you think are the best ways to stay healthy in these types of situations? Thanks!
    Hi Rick–
    A tough problem.  One way is to meditate, which really helps.  Another is to get a good night’s sleep as often as possible.  This is difficult for me during stressful times.  I’m one who can suppress problems during the day, but toss and turn all night obsessing over them.  I’ve found that one mg of melatonin dissolved under the tongue after the lights are out works pretty well to get me to sleep and keep me there.  You can find sublingual melatonin at most health food stores or whole food grocers.  Don’t take more than the one mg. even if you have to break the pills.
    Yet another way to decrease stress in the situation you describe is to find something positive to focus on that helps you out of the stress-causing situation.  The feeling of helplessness, that you’re being buffeted around by forces out of your control, is incredible stressful.  Try not to worry about the things you can’t control and focus on those you can control.
    A great book on this subject is Take Effective Control of Your Life by my favorite psychiatrist William Glasser.  It’s out of print right now, but you can buy used copies of it for a penny at Amazon.com.
    Hope all this helps.

  3. I also agree. My husband and I are currently working to eliminate as much stress as possible from our lives. We are trying to go back to a less complicated lifestyle. Less obligations and more quite family time at home sounds like heaven!
    My husband has started having high blood pressure, which as never been an issue before, and I believe it’s due to stress.
    I hope some day there will be more focus on the causes and less on the symptoms.

  4. If stress is the primary indicator for heart health, is it safe to say that during WW II and the Korean and Vietnam wars that heart attacks spiked for the military and civilian populations? I’m not trying to be presumptuous, by all accords, what could be more stressful to ones heart health than war?
    Hi Byron–
    I don’t know about Korea but in England during WW II heart disease actually declined, but picked back up after the war was over.  Many people have speculated as to why this was the case since there was incredible stress during that time.  If chronic stress were a major factor in the development of heart disease, it would make more sense if heart disease rates went up.  But they didn’t.  My money is on the changes in diet and smoking caused by the rationing that took place at the time.  Sugar and tobacco were rationed at home to provide these ‘necessities’ to the troops on the front.

  5. Hi, Mike,
    I know you’re an avid reader so I wanted to suggest “The Worst Hard Time” by Timothy Egan about those who survived the Dust Bowl castastrophe. Strictly low carb reading!
    Barb, Pittsburgh
    Hi Barb–
    Coincidentally, a friend of mine recommended this book to me.  It’s on it’s way via Amazon.com.

  6. So perhaps all the excitement over the “heart healthy” Mediterranean diet owes more to the relaxed meals and lifestyles than tons of fresh fruits and grains?
    I wouldn’t be a bit surprised.

  7. Not just stress but too much right? Unrelenting stress with no breaks eventually leads to the strain that breaks things.
    We need appropriate stress like we need to exercise our muscles. And then some rest too.
    Professor Mario Kyriazis, medical adviser to the British Longevity Society, explains: “If you want to live a long and healthy life, quite the worst thing you can do is to avoid stress to either mind or body. Ageing is due to the loss of complexity in our system, and the way to boost complexity is to challenge the system. If you want to live long and healthily, don’t settle into routines.”
    Exactly on the money.  Stress is like a lot of things: a little of the right kind is good; a lot is very bad.

  8. Gottfried Helnwein..is who painted the piccy(self portrait supposedly but does look bizarrely similar to Rudy Schenker)..used by Teutonic rockers ‘Ze’ Scorpions on their 82 album Blackout.
    Hows that for useless drivel ?!
    Useless drivel, eh. There’s one for the Department of Redundancy Department.
    I’ve been a fan of Helnwein since I saw a show of his in Vienna 25 years ago.

  9. It would seem there’s quite a bit of overlap between the “stress hypothesis” and the “inflammatory hypothesis”. We generally think of stress in psychosocial terms, but after reading Kendrick’s book it would seem that anything that stimulates the HPA axis should be termed “stress.” Kendrick just touches on the relationships between blood sugar, insulin, and HPA axis stimulation (notably cortisol secretion), but it seems to me that a high-carb diet constitutes chronic stress under this broader definition.
    I also tried to ferret out what (if any) relationship exists between omega-3/omega-6 fatty acids and HPA axis stimulation. I came up with very little, though clearly the stress response invokes an inflammatory response (e.g. increase in clotting factors), so omega-6-based prostaglandins get in the game at some point. But does a surplus of omega-6 itself constitute “stress” in the sense of leading to a corresponding surplus of stress hormones?
    Hi Dave–
    I’m working up a post on this very subject right now. It should be up in a day or two.
    Yes, omega-6 cause stress in the sense of increasing stress hormones and cytokines. Here is a recent paper on the subject.

  10. Dr Eades, have you checked out the book “Why Zebra’s Don’t Get Ulcers” by Robert Sapolsky. He is one of my favorite authors, and this book has everything you could ever want to know about the stress response and its effects on us. I think you would truly enjoy it and it would be a useful book for getting more information about the relationship between stress and our overall well-being.
    Hi Pete–
    I read Sapolsky’s book (and listened to his tapes from the Learning Company) years ago.  It is an excellent book, and I highly recommend it.

  11. nice. My wife was working this job she hated. She went to the doc, who measured her with “stroke level BP.” Took her off her birth control when wife was pretty sure it was job stress.
    Wife’s BP stayed high for a month or so after dropping birth control. Then she quit the job. And week by week, she’s come down to normotensive. New doctor, new appointment next week, but I’m guessing she’s not gonna get the BC back, because that was clearly the problem. No the job, not the constant cortisol bombardment.
    Damn consensus opinions.
    Hi Max–
    Have her start taking (if she’s not already) 500 or so mg of chelated magnesium daily at bedtime.  Should help her pressure even more.
    I wouldn’t think the new doctor would balk at giving her a BC Rx if her pressure is okay without drugs when checked at his/her office.  Speaking of which, if it’s a he, you might want to try a her the next time if you don’t get the Rx.
    Good luck.

  12. Here’s one for you to pick apart
    Hi Simon–
    I read this article when it came out in the Times but haven’t read the BMJ article yet.
    Here’s the paragraph from the article, though, that says it all.

    The actual numbers of heart attacks and strokes are small — 76 heart attacks, 19 strokes and 23 heart deaths without previous warning — in both TOPH 1 and 2. So it remains possible that chance, or incomplete follow-up, have distorted the findings.

    I wonder how many farmers reading this article will remove the salt licks from their farms?
    My own opinion is that most of us probably don’t get enough of the right kind of salt.  I’ll post on it in the future. 

  13. Cholesterol is the root of all evil. Just get that cholesterol down and there would be less disease of all kinds, less stress, end world hunger…. LOL
    Apparently a lot of people think so. 

  14. My sister’s MS symptoms improved greatly when she finally quit a very stressful job. Now that hubby’s been diagnosed with portal hypertension, I’ve been much more mindful about keeping the stress level low in our house. I figure every little bit helps.
    Stress reduction is never a bad thing, no matter what the underlying condition. 

  15. Dr. Eades,
    The article you reference linking Omega 6/Omega 3 ratios with depression and inflammation was very interesting.
    I’m concerned about the high level of Omega 6 fatty acids in the beef I buy (which I’m quite sure has never seen a blade of grass in its life.) In addition to supplementing with krill and fish oil, do you recommend lowering beef intake in favor of fatty fish like salmon?
    Hi John–
    The omega-6 in lot-fed beef is a little higher than that in grass fed, but I don’t believe that beef is the source of most of the omega-6 fat we eat. Beef–grass-fed and/or lot-fad doesn’t contain a lot of long-chain polyunsaturated fat, so you don’t get enough to worry about.  Most omega-6 fat comes from vegetable oils that seem to be in everything.  I’m not a big fan of eating a lot of salmon, which I do love the taste of, because of the mercury and other contaminants.
    What seems to be important is the ratio of omega-6 to omega-3, so if you work to avoid vegetable oils and take fish oil and/or krill oil, you should keep your ratios where they ought to be. 

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