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There is no longer a question regarding whether the quality of health can be impaired when an individual experiences stress that exceeds their ability to cope with the stress.

Holding handsCoping is the ability to manage and to overcome the problems and difficulties associated with the stress. If the ability to cope is unsuccessful, biological changes occur which have a negative effect on health.

The perception of something in an individuals environment as stress is associated with activation of areas of the brain that cause an increase in hormones, called 'stress hormones' in the blood. These hormones interfere with the ability of the immune system to resist infection, increase the likelihood of cholesterol deposition in the walls of the blood vessels of
the heart, and possibly, over a long period of time, interfere with mental function.

However, there are behaviors called 'stress buffers' that increase the ability of an individual to cope with stress. Individuals who utilize the stress buffers will have a lowered risk of stress induced health impairment.

STRESS BUFFERS

Friends

Most studies of stress related infectious disease are of upper respiratory viral infection. Research studies that infected human subjects with viruses that cause upper respiratory tract infections indicate that high levels of stress in ones life increases the susceptibility to infection. However, individuals who have a lot of friends and social support, even though they have high levels of stress in their lives, are less susceptible to infection. Social interactions through marriage, close friends, and group associations promote a better quality of health than occurs in individuals without such social support.

Religion/Spiritualism

Is involvement in religious activities capable of contributing to a better state of health and increased longevity? All of the data suggests that the answer is Yes! The emotional feeling provided through religion of greater satisfaction with life, personal happiness, and fewer negative psychosocial consequences associated with traumatic life events, are all likely to be
important factors in the health promoting influence of religion. Indeed, older adults, particularly women, who attend religious services at least once a week appear to have a survival advantage over those attending services less frequently.

Religion is something that can be measured in the sense of being able to count how many times an individual attends a place of worship or prays. Spirituality is something that is very personal, that cannot be measured, but which helps a person relax and calm their fears and anxieties. One may feel spiritual when they look at a beautiful painting, or a tree, or a
waterfall, or read as book they enjoy, or pray. Individuals who are high in spirituality have a better quality of both mental and physical health than those who are not.

Optimism

Is the glass half-empty or is it half-full, the standard question asked when evaluating optimism. Although a simple question that may seem humorous, the answer to the question has significance in regard to health. Those who are optimistic will have a better quality of both mental and physical health. To an optimist, the experience of a stressor is only a temporary inconvenience while to a pessimist it is a persistent problem. Optimists get over it and
move on. Optimists have a better quality of physical health. You should try to see the glass as half-full.

Sense of Humor

A sense of humor appears to an important buffer of stressor induced immune alteration. Hearty laughter has been found to decrease blood levels of stress hormones and humor tends to reduce the stressor induced elevation of heart rate.

Exercise

A regimen of regular exercise modifies the response of the body to psychological stress with less elevation of stress hormones than occurs in individuals who are not physically fit. There are numerous studies that show that exercise is capable of minimizing the effect of stress on altering the function of the immune system and that exercise has a beneficial effect on
health by reducing cardiovascular disease, cerebrovascular accidents, and malignancy.

By physical fitness I do not mean that one has to be an elite athlete. Rather, one simply has to engage in mild amounts of movement that are more than they are currently doing. As a general rule we say that if you are doing something for exercise, such as walking or climbing a flight of stairs, and you can whistle while you are doing it, you should do it a little more vigorously. If you cannot hold a conversation while you are doing it, you are doing it too vigorously. If you can hold a conversation, that is the correct level of intensity.

Do you have to do whatever you are doing for a set period of time, say 30 minutes? If you can that is fine but not necessary. Several brisk walks of 10 minutes a day is sufficient to achieve the benefit. Even as you go about your daily activities, doing them with a little more vigor than usual is beneficial to health.

Summary

It is not stress alone that is a determinant of an individual's resistance to an infectious disease, autoimmune disease, or malignancy. Rather, it is the balance between the amount of stress in an individual life (both acute and chronic) and the ability of an individual to cope with the stress. Thus, a high stress level with excellent coping skills may result in minimal effects on immune system function and health. A low level of stress in an individual's life, with poor coping skills, may produce alterations of immune function with a resultant altered susceptibility to disease. The actual amount of stress is only part of the information that is needed in
evaluating the effect of stress on immune function. However, the association between increased levels of stress and the potential of disease development is now well established and is assuming an increasingly important role as a concern of preventive medicine. Your utilization of the coping skills described above will help you to achieve a healthier and happier life.

Bruce S. Rabin, M.D., Ph.D.
Professor of Pathology and Psychiatry
Medical Director, UPMC Healthy Lifestyle Program
200 Lothrop St.
Pittsburgh, PA 15213-2582
Phone: 412-647-6150
FAX: 412-647-7741
E-mail: rabinbs@upmc.edu



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