Chronic Fatigue Syndrome Not Caused by a Virus… or Is It?

Corot at Stresshacker.com Big news for people suffering from chronic fatigue syndrome (CFS), which affects an estimated one million Americans. Besides profound exhaustion, CFS symptoms include sleep disorders, cognitive problems, muscle and joint pain, sore throat and headaches. Patients show signs of abnormalities that affect immune and endocrine systems and neurological functioning. These symptoms are frequently diagnosed as a mind-body illness, perhaps related to stress, trauma, or other “non-medical” causes. There is often a veiled dismissal that can accompany these tentative diagnoses. Their suffering has just not been taken seriously enough, CFS patients complain, because nothing specific could be found through accepted diagnostic procedures… until now—maybe.

Two studies have just been published that report on evidence that CFS may be triggered by an acute viral illness. Both studies were conducted by impeccably reputable sources. Both targeted the connection between CFS and a viral cause. Neither is conclusive, because the studies’ results contradict each other.

The study that supports a viral cause for CFS was conducted by researchers from the National Institutes of Health, the Food and Drug Administration, and Harvard Medical School, and was published in May. The study discovered the presence of DNA from a xenotropic murine leukemia virus (XMRV) in the blood of 67% of CFS patients, as compared with 3.7% found in testing a control group of healthy individuals. Another test on  patients meeting accepted diagnostic criteria for CFS found traces of a similar virus (MRV) in 86%, compared with only 7% among healthy volunteer blood donors. The researchers concluded that there appears to be a strong association between CFS and these viruses, although they stopped short of saying whether these viruses play a causative role in the development of CFS, and whether they represent a threat to the blood supply.

But in July, researchers from another federal agency, the Centers for Disease Control and Prevention, published a study finding no XMRV or other MRV-related viruses in patients with CFS. This study tested 51 persons with CFS and 56 healthy persons for evidence of XMRV and the results were consistently negative. Thus, researchers from this study concluded that there is no trace of XMRV in the blood of CFS patients or healthy controls and  therefore there is no evidence to support an association of CFS with XMRV.

News of the conflicting findings has led some patients to express alarm that important scientific information about CFS might be suppressed. People with a diagnosis of chronic fatigue syndrome are used to hearing scientists, doctors, employers, friends and family members dismiss the condition as psychosomatic or related to stress or trauma, despite mounting anecdotal evidence that CFS often follows an acute viral illness.

The CFIDS Association of America, the advocacy group for CFS patients, expressed the hope that these studies will help “shape immediate and longer term priorities for research and will build consensus about these agents, the conditions with which they may be associated and the exact nature of those relationships, one to another,” and that “few will question whether CFS is real or not,” as this research may help “lay that controversy to rest, at long last.”

Stress at 40, Dementia at 60?

Vermeer at Stresshacker.com New research just published that falls into the “I sure hope this isn’t true” category: midlife psychological stress may have a relationship to the development of dementia later in life. As the number of people with dementia continues to increase dramatically with global aging of the human population, the exact causes of this frightening disease are poorly understood. Now comes this 35-year-long study, whose results have been published in the peer-reviewed journal Brain, that adds new fuel to the speculation that psychological (i.e. cognitive and emotional) stress may have something to do with the development of dementia…at least in women.

Swedish and American scientists at Gothenburg University and at the SUNY Downstate Medical Centre in Brooklyn analyzed the relationship between psychological stress in midlife and the development of dementia in late-life. A group of 1,462 women, whose age ranges between 38 and 60, were examined in 1968–69 and re-examined in 1974–75, 1980–81, 1992–93 and 2000–03. During the 35-year follow-up, 161 cases of dementia were diagnosed among the women in this study—105 of the Alzheimer’s type, 40 vascular dementia and 16 other dementias.

The results indicate that the incidence of dementia was higher among women who had reported frequent or constant psychological stress in 1968, in 1974 and in 1980. More specifically, women who reported frequent or constant stress in 1968 and 1974 had more cases of Alzheimer’s disease. Moreover, women who reported psychological stress at one, two or three examinations were found to have a sequentially higher risk of developing dementia in later years.

The researchers conclude that this study demonstrates a clear association between psychological stress in middle-aged women and the development of dementia, especially Alzheimer’s disease. While they caution that additional studies are needed to confirm these findings and to study potential neurobiological mechanisms of these associations, nonetheless the length of the study and the rigorous collection of data from multiple sources lend credibility to the results.

Marriage Reduces Level of Stress Hormones

Venice at Stresshacker.com It is a well-established fact that being married can improve health outcomes. Now, new research findings get more specific and suggest that a long–term bond between two people can also reduce the production of hormones associated with stress. This is according to Dr. Dario Maestripieri, Professor in Comparative Human Development at the University of Chicago and lead researcher, who published the results of the study in the August 2010 issue of the peer-reviewed journal Stress.

To measure the effects of a committed relationship on stress levels, Dr. Maestripieri and his team monitored changes in salivary concentrations of testosterone and cortisol in response to a mild psychosocial stressor (a set of computerized decision-making tests) on a sample of over 500 participants. The aim of the study was to investigate any gender differences in hormonal responses to psychosocial stress; the relationship between pre-test hormone levels and stress-induced hormonal changes; and any possible sources of same-gender variation in pre-test hormone levels as compared to hormonal responses in a larger human subject population. 

The results show that males had higher concentrations of the stress hormone cortisol than females both before and after the test. After the stress-test was administered, cortisol level increased in both sexes but the increase was larger in females than in males. Single males without a stable romantic partner had higher testosterone level than males with stable partners, and both males and females without a partner showed a greater cortisol response to the test than married individuals with or without children.

It would appear from the test results of this study that married individuals, when faced with a new stressor, respond with a lower production of stress hormones. This can have two major benefits: it can permit a more deliberate response to the stressor (as the system is not overloaded with a debilitating and hormone-filled stress reaction), and it can, over time, reduce the accumulation of allostatic load on the organism—two good things that help married people confront challenges in more supportive, less stressful, and more effective ways.

Seems Obvious, Now Proven: Yoga Reduces Anxiety

LouetLighthouse_EN-US97578274From research at Boston University School of Medicine and McLean Hospital comes the hardly startling news that yoga reduces anxiety. Even a beginner can confirm that yoga does have a relaxing effect on stress and anxiety. However, the researchers at Boston U.  did not mean to restate the obvious, but rather to provide a scientific explanation of yoga’s relaxing effects.

It turns out that the practice of yoga elevates brain levels of gamma-aminobutyric (GABA), the nervous system’s principal inhibitory neurotransmitter. GABA is secreted by nerve terminals in the spinal cord, cerebellum, basal ganglia, and many areas of the cortex.

Adequate or elevated levels of GABA help reduce brain and nervous system activity, with a corresponding relaxing effect on the muscles and major organs of the body. Reduced levels of GABA are associated with a wide variety of neurological and psychiatric disorders, including epilepsy, anxiety states, alcoholism, chronic pain, Huntington’s chorea, and other movement disorders.

The research findings, published in the May 2010 issue of the Journal of Alternative and Complementary Medicine, provide significant evidence that yoga is a possible treatment for depression and anxiety, both associated with low GABA levels. Pharmaceutical companies have already caught on to the benefits of increasing GABA levels, and both disorders have been successfully treated with pharmaceuticals (gabapentin, pregabalin) that boost GABA production.

According to Chris Streeter, MD, an assistant professor of psychiatry and neurology at BUSM and a research associate at McLean Hospital, yoga is a promising alternative to medication in improving depression, anxiety and epilepsy symptoms.

The confirmation that GABA levels can be boosted and the symptoms of high stress and anxiety can be reduced with a natural approach such as yoga (or tai chi for fibromyalgia) is indeed welcome news. Even though we already knew that the practice of yoga has a relaxing effect, knowing why should convince the skeptical to give this time-proven remedy at least a try.

New Therapy for Fibromyalgia Is Not New at All

Sunset at Sea, 1882Fibromyalgia, the stress and trauma-related disorder that affects millions of people, is characterized by widespread pain in the muscles, ligaments and tendons, fatigue, multiple tender points, difficulties with sleep, impaired functioning, and depression. There are a few treatments that show at least some efficacy in relieving fibromyalgia’s often severe symptoms. These include pain medication, psychotherapy, and physical therapy. Now, the ancient Chinese practice of tai chi has been added as an effective treatment option.

Compared to wellness education and stretching, 60 minutes of classic Yang-style tai chi twice a week for 12 weeks can significantly improve even the most severe fibromyalgia symptoms. These are the results of a study conducted by a team of researchers at Tufts University’s Division of Rheumatology on 66 randomly chosen patients. Half of the participants were assigned to a control group that was treated with education about stretching exercises and how to best deal with the disease, while the other half was treated with a regimen of tai chi. Compared to baseline results and to the control group, tai chi-treated patients showed a significantly greater improvement in their symptoms and quality of life. A follow-up test after 24 weeks showed that these gains were maintained. No adverse side effects were observed.

The results of this important new study were published in the New England Journal of Medicine on August 19, 2010.

Smoking Relieves Stress: True or False?

Whistler_1862_White-girlFalse, according to a newly published study on the effect of stopping smoking on perceived stress. Even though many smokers believe that smoking helps them cope with stress, and that stopping smoking would deprive them of an effective stress management tool, this turns out not to be the case, except in the very short term.

This long-term study conducted jointly by the University of London, the Wolfson Institute of Preventive Medicine, and The London School of Medicine and Dentistry project has provided more robust data on post-cessation changes in perceived stress levels. The individuals studied were a group of 469 smokers admitted to the hospital after a heart attack or for coronary bypass surgery. They were seen upon admission and completed a 1-year follow-up. Of the patients, 41% maintained abstinence from smoking for 1 year, while the others did not. Abstainers recorded a significantly larger decrease in perceived stress than those who continued to smoke.

The conclusions reached by the research team were that in highly addicted smokers who report that smoking helps them cope with stress, giving up smoking significantly reduced their stress levels. Among those who did not quit, regardless of any immediate effects smoking may have on their perceived stress, it was shown to generate or aggravate their negative emotional states.

The results are being used to reassure smokers who may be worried that quitting may deprive them of a valuable stress-reduction resource. Quitting is better than continuing to smoke, from all health-related points of view, including stress.

Top 3 Ways Exercise Can Reduce Stress

Frauenberg at Stresshacker.comExercise is the omnipresent treatment adjunct for physical health. It is a prescription that is hard to escape, as even a routine visit to your physician will attest. But while the virtues of exercise may appear to be self-evident for the body, is there a rational scientific explanation of the mechanisms by which exercise is effective in mental health and well-being, and in particular for stress reduction?

The Research Evidence

Among the most significant evidence linking exercise to an increase in the ability to cope with emotional stress is the Nicholson, Fuhrer, & Marmot (2005) study of 5,449 cardiovascular disease patients, whose results confirmed an earlier study by Pelham, Campagna, Ritvo, & Birnie (1993). Both studies provided evidence that, among patients suffering from physical or psychiatric disorders, exercising increased motivation to be well while decreasing negative mood states.

In a study (Perna, Antoni, et al., 1998) among men and women rowers to verify the effects of a cognitive-behavioral stress management program, exercise was shown to reduce negative mood states and the level of cortisol. The rowers experienced significant reductions in depressed mood, fatigue, and cortisol level when compared to other individuals in the control group.

What Type of Exercise Is Most Beneficial?

When the available evidence is analyzed, no one type of exercise appears to be the “best” for stress reduction. Rather, personal preference and the enjoyment of the physical activity of exercise appear to be the two most important factors for mental health benefits. High-intensity aerobic activity does not appear to be necessary to achieve the mental health benefits of exercise (Doyne, Schambless, & Beutler, 1983; Martinsen, 1993; Blumenthal et al., 2002), unlike exercise prescribed for physical fitness, where aerobic activity and high-exertion for at least twenty minutes appear to be required for optimal results.

What Makes Exercise Effective in Stress Management?

As you might guess, since there is no hard-fast indicator of efficacy as too many individual factors cannot be precisely measured, theories abound as to what exactly makes exercise work in improving mood and reducing stress. Here are the three that are most widely accepted among researchers.

According to the Anesthetic Pain Relief Theory, the vigorous exercise of running, jumping, or weight lifting generates multiple minor traumas to skin, muscles and bones. These micro-traumas trigger the release of the body’s own painkillers, opioid substances such as endorphins and endocannabinoids. In addition to reducing the pain provoked by micro-traumas, these morphine-like substances also generate an unmistakable and very pleasurable sense of well-being (also known as the exercise high).

According to the Stress and Relaxation Hormone Theory, deficiencies in the hormones norepinephrine and serotonin signal the onset of depression. Exercise appears to increase the levels of both hormones, thus restoring their adequate levels and lifting the individual’s mood to correspondingly higher levels.

According to the Rebound Restorative High-Quality Sleep Theory, stress affects the quality and quantity of sleep and is in turn exacerbated by sleep deprivation. With respect to work stress, higher levels of stress at work appear to be closely correlated with sleeplessness at night and sleepiness during daytime (Dahlgren, Kecklund, & Akerstedt, 2005). Exercise has been shown to be very effective in improving the quality of sleep. Thus, exercising appears to indirectly reduce stress by increasing the quality of sleep.

PUFAs-Inflammation-Stress: The Axis of Evil

Nighttime at Stresshacker.comIn a prior post on the benefits of fish oil in preventing stress-related illness, the subject of inflammation—the principal cause of stress-related illnesses—was touched upon briefly. It is of such importance, however, that we return to it today and discuss further the connection between inflammation, stress and low polyunsaturated fatty acids (PUFAs) intake.

The Problem: Too much ALA, Not Enough LA

In most industrialized countries, including the United States, we now consume five to 20 times as much proinflammatory omega-6 fatty acids than anti-inflammatory omega-3s. What’s the difference between the two, where do these fatty acids come from, and why is this happening?

Omega-6 and omega-3 are the two major types of PUFAs, contributing between 95 and 98% of dietary PUFA intake. Omega-3’s principal component is linoleic acid (LA) and omega-6’s is a-linoleic acid (ALA). LA is abundant in corn, sunflower, soybean oils, and their margarines. ALA is found in green vegetables, soybean and rapeseed oils, nuts, flaxseed and flaxseed oil. The availability of LA in Western countries increased greatly in the second half of the 20th century, following the introduction and marketing of long-shelf-life cooking oils and margarines. This changed pattern of consumption has resulted in a significant increase of bad-PUFA omega-6 intake vs. good-PUFA omega-3.

Why Do We Need PUFAs?

PUFAs are important in the membrane protein function of human cells, in maintaining
membrane fluidity, in regulating cell signaling and gene expression, and in overall cellular
function. It is through the interactions of fatty acids that anti-inflammatory agents in the bloodstream can pass through blood vessel walls and reach the site where their intervention is needed.

Inflammation can be caused by a physical pathogen (an insect bite, a burn, or a traumatic injury), or by a stressful event that triggers the body’s defensive mechanisms and causes the release of inflammatory agents such as norepinephrine and cortisol in the blood stream. PUFAs are active in facilitating the removal of inflammation induced by either a physical pathogen or by stress.

Which PUFAs Reduce Stress?

Omega-6 and omega-3 PUFAs play different roles in facilitating anti-inflammatory responses. Research indicates that it is the ratio between these fatty acids that is most important in preventing or reducing the severity of stress-induced diseases such as rheumatoid arthritis, asthma, and inflammatory bowel syndrome. A favorable ratio of LA (eating foods rich in omega-3) vs. ALA (eating less food that contains omega-6) appears to produce the best anti-inflammatory effects.

Foods Rich in Omega-3 Fatty Acids

  • Nuts: walnuts.
  • Vegetables: kidney beans, navy beans, tofu, winter and summer squash, broccoli, cauliflower, green beans, romaine lettuce, and collard greens.
  • Fruits: raspberries and strawberries.
  • Meats: free-range beef and poultry.
  • Fish: herring, mackerel, sturgeon, salmon, and anchovies.

Women’s Heavy Burden of Stress-Gets Heavier

Lake Wanaka at Stresshacker.comThe most recent survey of stress in America indicates that women continue to bear the heavier burden of stress, particularly due to financial concerns and worries over their family’s health and family responsibilities. Women consistently report more physical and emotional stress than men, and are more likely to lack the willpower to make changes recommended by health care providers, the survey results also show. What is causing this unhealthy gender bias? Allostasis, or more precisely allostatic load, is the key to understanding gender differences in stress. Let’s first understand allostasis, its benefits, and potential dangers.

Allostasis: Too Much of a Good Thing

Allostasis defines the processes that attempt to maintain the body’s internal stability in the face of physical or psychological challenges. Physiological and behavioral changes are initiated automatically during the stress reaction to external environmental and developmental threats, such as danger, conflict, financial worries, interpersonal difficulties, family and job demands, and other life stressors. Allostasis as a process is a very good thing and aids in survival and coping. It can work well at restoring the body’s equilibrium and ensure an adequate response to the threat. However, allostatic processes can cause physical and psychological damage when they extend beyond their intended short-term activation. This prolonged state of activation creates a burden on the system, known as the allostatic load.

Four factors can contribute to the formation of a heavy allostatic load:

  1. Repeated physical or psychological challenges (e.g., prolonged financial stress, a stressful job, multiple and conflicting demands of time and resources, a serious illness, childhood trauma, adult abuse or violence)
  2. Inability to adapt to these repeated challenges (the feeling of being at the end of one’s rope)
  3. Inability to produce an adequate response to the stressor (such as the phenomenon of learned helplessness, depression or anxiety)
  4. Inability to end the stress reaction even after the stressor has been removed (chronic stress)

Allostatic load accumulates over time. The continuation of multiple small changes in physiological and psychological functioning (which are meant to be only short-term), due to a persisting state of alert against perceived threats (the classic stress syndrome), creates the potential for illness.

What Happens to the Body During Allostasis

During the normal stress response and the body’s process of allostasis, the stress hormones serum dehydroepiandrosterone (DHEA), cortisol, norepinephrine and epinephrine are secreted into the blood stream. The immune system and neurological responses are activated, along with muscular, cardiovascular and pulmonary system. Alongside these physical reactions, psychological changes take place in response to anxious, fearful, hostile or aggressive states produced by the stressor. Behavioral changes also occur in trying to cope with the stressor, sometimes consisting of alcohol abuse and other substances,  working too many hours, or exercising compulsively. Sleep disturbances, depression and other psychological symptoms are usually the first evidence of an increasing allostatic load.

At the physiological level, allostatic load can cause atrophy of the hippocampus and structural changes in the amygdala and the prefrontal cortex, resulting in a more or less severe impairment in spatial learning and memory. Certain tell-tale physical responses are also indicative of a heavier allostatic load: higher blood pressure, changes in waist-hip ratio, higher serum high-density lipoproteins (HDL) and cholesterol, and glycosylated hemoglobin levels.

These psychophysical changes, though helpful in the short run, can cause damage. This damage is the cost of maintaining an allostatic state longer than is optimal for health. Numerous studies of allostasis show the risk of stress-induced illnesses such as cardiovascular disease, atherosclerosis, metabolic syndrome, Type 2 diabetes, depression, anxiety, and immune/auto-immune disorders.

What about the effects of allostatic load on women?  Details after the jump.

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Is Fish Oil a Cure for Chronic Stress?

Paphos_EN-US3975269776Fish oil may be just what the doctor orders in combating the effects of chronic stress. Its ingredients are powerful anti-inflammatory agents. But what does inflammation, which is a response of the body to injury or irritation, have to do with stress and how is fish oil able to neutralize it? Let’s take a closer look.

The principal cause of stress-related illness is inflammation. Inflammation is the rapid and nonspecific response of human organisms to danger, usually caused by a physical pathogen (an insect bite, an open flame, an injury) that attacks the body’s integrity. Inflammation is also triggered, however, in response to a psychological threat. When a stressful event or situation triggers the release of norepinephrine and other hormones during the stress reaction, the immediate mobilization of the body’s defense excites and energizes metabolic, vascular and immune systems. Inflammation is capable of damaging tissues and organs if not controlled. To prevent such damage, anti-inflammatory molecules cortisol, interleukin-10, and growth factor-p are released and suppress the inflammation.

What happens when the stressor persists or is not resolved? When inappropriate, excessive, or long-lasting, the stress response (and the attending inflammation) morphs into chronic stress, which is the underlying cause of many diseases of the heart, lungs, digestive system and muscular structures. Thus, it can be said that the inflammation resulting from continuing stress or inadequate responses to a stressor is the major factor contributing to coronary heart disease, irritable bowel syndrome, asthma, muscular tension and pain, and many other stress-related illnesses.

The Best Defense Against Chronic Stress

Naturally, the best defense against stress is keeping it from becoming chronic. As long as stressors are resolved, avoided or eliminated as they come up, the body has a remarkable capacity to return to a natural state of relaxation. Addressing relationship issues, problems at work, or health challenges in a timely and effective way is the best remedy against stress. Putting things off or denying their existence is seldom a good choice and often leads to a persistent state of alarm that is the precursor to the more serious consequences of chronic stress.

What about fish oil? Read about new research findings on its anti-inflammatory benefits after the jump.

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Stress and Burnout Endanger Clergy Health

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Members of the clergy are more likely to suffer from stress-related illnesses such as obesity, arthritis, diabetes, high blood pressure, asthma and depression than most Americans. These are the first published results of the continuing survey of 1,726 ministers, which began in 2007 and is being conducted in North Carolina by the Clergy Health Initiative at Duke University. Researchers Proeschold-Bell and LeGrand report that the obesity rate among clergy aged 35–64 years is nearly 40%, or over 10% higher than among the local population.

A similar survey by the Evangelical Lutheran Church in America (and cited by the New York Times) reported 69% of its ministers as being overweight, 64% as having high blood pressure, and 13% as taking prescription antidepressants. Similarly, a 2005 survey of Presbyterian clergy had reported that occupational stress and burnout played a factor in 4 times as many ministers leaving the profession during the first five years of ministry, as compared with the 1970s.

What Is Occupational Burnout?

According to its most widely accepted definition, occupational burnout includes:

  1. Emotional exhaustion, which can result in diminished interest in work, fatigue, and detachment.
  2. Depersonalization, or the defensive distancing from the surrounding world, which can result in diminished contact with coworkers and the public, withdrawal of psychological investment, self-absorption, and negative attitude toward others.
  3. Dissatisfaction, or the perception of unsatisfactory personal accomplishment, which can result in feelings of failure, fatalism, diminished competence, and incapacity to respond to further environmental demands.

There are several theories that have been proposed to explain the genesis and development of occupational burnout. Read about them after the jump, with some suggested remedies and a summary of the most recent research.

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Oil Spill Causing Stress Symptoms in Gulf Coast

More than a third [of the Gulf residents surveyed] report children with new rashes or breathing problems, or who are nervous, fearful or “very sad” since the spill began. And even though the gusher of oil has been stanched, almost a quarter of residents still fear that they will have to move.

These are some of the findings of the first major survey of Gulf Coast residents conducted since the BP oil well was successfully capped. The survey, conducted from July 19 to 25 by the National Center for Disaster Preparedness at Mailman School of Public Health at Columbia University, suggests that the spill’s effects have not been contained along with the oil itself. The NYTimes article is at After Spill, Broad Anxiety Among Gulf Resident, Survey Finds – NYTimes.com.

All of the above, plus other reported symptoms such as a persistent and overwhelming level of anxiety, a substantial level of psychological stress, concerns about children’s mental health, more insecurity, and mysterious rashes that can become infected, point to a widespread stress reaction to the oil spill and to its economic and environmental consequences.