**EP241: A Refresher On Stress**
**Dr. Oreck Bishop:** I believe we can prevent heart attacks. We can put in place strategies to reduce risk. We can literally plan to change your future. Welcome. My name is Dr. Oreck Bishop. I'm a cardiologist, an author, and a keynote speaker. Together with that, I'm the CEO of the Healthy Heart Network, and I'm all about trying to help people live as well as possible for as long as possible.
You probably know that heart disease is huge in Australia. Every 20 minutes, someone suffers a heart attack, and we know that over 20 people per day die from heart disease. This is on the backdrop of over 9 million people globally being impacted by this condition. Truthfully, most of these could probably have been avoided if only we knew what to do.
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**Dr. Warwick Bishop:** Hi, my name is Dr. Warwick Bishop, and welcome to my podcast and videocast station. Look, today I wanted to recap on stress, depression, anxiety, and the impact they can have on our heart health and on our total health.
There's no question that depression and anxiety are closely linked as associations to increased risk of major cardiovascular events. We've observed that for at least a decade or more, and we are aware that people who suffer from depression and anxiety travel a worse course when it comes to cardiovascular health. Well, what's behind it all?
Essentially, there are two main drivers of stress in our body. One driver is related to the nerves, the electrical system within our body. The other system is related to the hormones that our body releases. If we think about the nerves, they can directly send messages to the blood vessels to tighten up those blood vessels, which drives up the blood pressure. Those nerves can also directly impact the heart, increasing heart rate and stroke volume, i.e., how much blood the heart is pumping. That's really a fight or flight type response.
So, stress responses through the nerves, through what we call the sympathetic nervous system, which is an automated or automatic nervous system, will drive the heart and drive blood pressure up. That's not great, but it is important if you want to fight a saber-toothed tiger, or if you want to run away from a fire, or if you've been injured. All those things from an evolutionary past that we need that sympathetic nervous system for.
The hormones that our body releases include, again, adrenaline—a fight or flight hormone—and cortisol. Both of these, of course, in the longer term, lead to fluid retention and elevated blood pressure, let alone the effect of adrenaline directly on blood vessels and the heart. The consequence of that cascade, combined with cortisol, is driving insulin, insulin resistance, and inflammation.
Now, of course, we need some sort of fight or flight response. We need that sympathetic drive. But we were never designed to have it run for hours and hours or days or weeks at a time. Think of a gazelle on the African plain who is relaxed, enjoying their grazing when they're alerted by a predator. Their fight or flight kicks in. The whole event is over within minutes as one of the flock or herd is taken by the predator. And then, some 15 to 20 minutes later, everything returns back to normal.
We don't have the same responses in our modern world. Traffic will drive... well, before we even get into the traffic, our alarm clock is waking us up. We're rushing to get kids ready for school. Then we're jumping in traffic, which is frustrating. We hit work and are confronted with the deadlines that keep pushing us. Often, we're idling above our natural idle speed. We're driving that sympathetic nervous system, driving blood pressure, driving adrenaline, cortisol, and heart rate.
Well, one of the reasons that might be really important is because that environment obviously then changes the environment that cells are operating in, and our cells are constantly dividing and replenishing dead cells and changing over. Well, the impact of that stress drive on the body acts as an external influence on the way DNA may be converted into proteins. We call that an epigenetic phenomenon, where something outside of the body's DNA is impacting the way the body's DNA is expressed. These are epigenetics, and there's becoming more and more data that this may well be linked to some of the reasons that we see abnormal cellular division that results in the consequence of cancer formation. Pretty important stuff.
So, what do we do to try and keep that depression away, that anxiety away, and try and bring our sympathetic nervous system back into line? Well, there's a whole lot of things. First, a bit of awareness and mindfulness, and knowing that you might be suffering a problem there is a pretty good starting point. There's no question that exercise is incredibly valuable. Four, five, six times a week has been shown to be as effective as an antidepressant. So, exercise is a fantastic way to rebalance mood and rebalance that energy system within your body.
Some people might try meditation. I know in the last six to nine months I've embraced meditation for the first time ever and have found it extremely valuable. But be aware, stress is not your friend. There is really little good stress available. Most stress will have its consequences in the longer term, and that consequence can be very hard to predict, particularly in a world where the epigenetics or the way that DNA is represented can be impacted.
Well, that's enough for me on stress for today. It is a huge topic and one that I really hope that you are aware of and have, if you like, your own system for gauging where you are. Check with those around you who love you, and check with work and figure out where you are because there's no good upside to carrying excess stress for prolonged periods of time. Work on that downtime, work on that relaxation, and look after yourself.
I hope you've enjoyed today's podcast. If you have any queries or questions, drop us a note as always. Online, I'm going to wish you the very best. I hope you live as well as possible for as long as possible. Take care and bye for now.
Did you know that coronary artery disease kills one in four people? So, most of us are likely to carry some risk or know someone who does. If you're interested in finding out more about how to evaluate that risk, check out www.virtualheartcheck.com. It will give you information about risk and what else can be done to be even more precise.
