connection and how it relates to health. The objectives for today are to review the science

of the mind‑body connection. What is the link between how we respond to stressful events

and illness, particularly cardiovascular disease? We'll also spend some time today talking about

how we can use techniques that can very easily impact the stress response on our bodies,

and how we can take those techniques into our private practice immediately.

The former surgeon general was very, very smart. He had this to say. He said, "Of the

10 leading causes of death in the US, seven could greatly be reduced if we changed the

way we lived our lives." This was his quote. “We need to modify our alcohol intake, lack

of exercise, poor diet, smoking”, and, my personal favorite, “unhealthy, maladaptive

responses to stress and tension. If we can impact these, we can basically impact the

health of the entire country.” [Julius B. Richmond]

Now, Hans Selye is the individual we probably consider one of the fathers of stress. He

really raised the level of consciousness of, how does stress affect the physical body?

This is how he defined stress. He said, "Stress can be defined as the state one experiences

when there is a mismatch between perceived demands and our ability to cope." That's very

important, because we all have demands, and we all have a certain level of resiliency.

It's when our resiliency is tapped that we start to feel stressed. That resiliency may

be different for everyone. Someone can have two things on their plate, someone else can

have 15, before they start feeling like, "I can't cope." It's this mismatch between perceived

demands ‑‑ and "perceived" is also an important word, because sometimes we don't

have to accept all those demands ‑‑ and our ability to cope.

How does this translate into health? The American Institute of Stress tells us that 75 to 90

percent of all visits to health‑care providers result from stress‑related disorders. Now,

that is an incredible statistic. We know, for physicians, that stress is running

rampant. This is a survey from Physician Executive looking at 1,200 actively practicing physicians.

6 out of 10 said they have considered leaving medicine. 77 percent said they're fatigued.

67 percent they're burnt‑out. 33 percent have depression and some form of family discord,

and, as everyone knows, a very high incidence of divorce.

The way I teach it to my patients is this way. We are surrounded by events in our life.

We can't control those events 10 out of 10 times, but what we can control is how we respond

to those events and what our perception is. For example, if the Dow goes down, we might

say, "Hey, this is a great time to buy stock." That's one response. Or we might say, "Oh,

my God. Doom and gloom. I've lost all this money," and we will start off a whole cascade

of stress hormones. This is important, because two people can see the same exact thing and

have totally different responses. This is personal.

When we get into a cycle of feeling stressed, feeling like we can't cope, the body changes.

We have over 1,400 chemical reactions. The ones that we see happening, manifesting, every

day in our clinical practice are related to hormones like adrenalin, noradrenaline, aldosterone,

and cortisol. These are just some of the key stress hormones that impact our health and

our well‑being. Let's take a look at the stress cascade. This

is just for the physical body. As a cardiologist, I was very intrigued to see that, as adrenalin

and noradrenaline and cortisol and aldosterone go up, platelets become sticky. Renin and

Angiotensin goes up. Insulin resistance goes up. People put on weight in their mid‑line.

People have palpitations and skipped heartbeats. We also, of course, have hypertension. Even

cholesterol goes up in the setting of stress. In the 1990s, I looked at this list and I

said, "Wow, all of the drugs I'm giving are really hitting the stress hormones. For example,

I'm giving aspirin and Plavix ‑‑ that's affecting blood coagulation ‑‑ Metformin

for insulin resistance and diabetes, ACE inhibitors for Renin and Angiotensin, Statins for cholesterol,

beta blockers for arrhythmia, and the list goes on and on." It got me to think, maybe,

just maybe, we want to meditate and medicate, that we have to do something for this stress

response. Now, we can have acute stress, and that can

make us sick. We know in cardiology today, there's something called broken‑heart syndrome.

Bad news. Acute, stressful event. People come in with cardiomyopathy, many looking like

they need a heart transplant. Fortunately, with supportive care and medications, this

usually resolves and people get better. That's an extreme example, broken‑heart syndrome,

of the impact that stress can have on the human heart.

In the journal of "Circulation" in 1995, there was a study that looked at over 1,600 people

coming to the emergency room with heart attack. They were asked, "What were you doing two

hours before your heart attack?" They concluded that an anger outburst increased the risk

of a heart attack 230 percent. That is huge. Now, in California, we had the Northridge

earthquake. Of course, that's a sudden shock to the entire Northridge community. What the

research showed was there was a five‑times increase in cardiovascular‑related sudden

death on the day of the Northridge earthquake. We saw something similar after 9/11, where

patients who had AICDs in, a much higher incidence, in the month following 9/11, of malignant

cardiac arrhythmias. What about a sports game? This was from the

"British Medical Journal." There was a 25‑percent increase in heart‑attack admissions in London

when England lost to Argentina in the World Cup Soccer Tournament in 1988.

It's an acute response that can quickly affect the physical body, but it's not only the physical

body. It's the mental‑emotional body as well. For example, we know that people under

stress do not think clearly. They don't make their best decisions. I've had many patients

come in and say to me, "I can't recall anything. My memory is not like it used to be." We do

an MRI because we're concerned they may have a brain tumor.

When you look at the stress spectrum, this is what you find. Loss of focus and mental

clarity. Inability to relax and sleep. Low self‑esteem, because we feel like we can't

get anything done right. We feel tired, because we can't sleep. Very frequently, if we have

a lot of things that we can't cope with, our response is one of anger, and we just heard

how bad anger is for the heart. What about chronic stress? We talked about

acute events ‑‑ the Northridge earthquake, 9/11. What about people who are chronically

stressed? Well, Louis Pasteur said this ‑‑ "The microbe is nothing. The soil is everything."

To me, this translates into, how is your resiliency? What do you have to stabilize your life, so

that when life throws you a curve ball, you don't respond with the 1,400 chemical reactions

and the stress hormones that we just talked about.

A lot of research has been done on chronic stress. Dr. Janice Kiecolt-Glaser has done

enormous studies. For example, she took caregivers and compared them to well‑matched controls.

She did a simple punch biopsy on their skin, and what she found was that caregivers took

24 percent longer to heal a simple punch biopsy. She also found that if she took medical students,

during vacation time and during exams, that it took them 40 percent longer to heal the

same simple punch biopsy during exam week. What does this translate to? This translates

to chronic stress, which is leading to increased cortisol, and immune suppression can affect

wound healing. Same thing with the influenza vaccine. She

look at caregivers below 71 years of age and above 71 years of age and compared them to

well‑matched controls. What she found was caregivers, across the board, were less likely

to produce the antibodies when they were given the flu vaccine ‑‑ again, demonstrating

that chronic stress has an impact on the immune system. The ability to mount an antibody response,

which also translates into the ability to fight an infection and fight a cancer, all

of these are affected by stress. The body of research is enormous. As cortisol

goes up, DHEA goes down. What do we see in this situation? We see accelerated aging,

brain‑cell death. Our ability to learn and our memory are greatly impaired. We see reduced

bone density, osteoporosis, loss of muscle, reduced skin growth and repair. Our immune

system, as we just said, is affected. Our blood sugar, as we discussed previously, goes

up, and we put weight on in our mid‑line. Let's think about this for a second. If I

have accelerated aging, and my memory is failing and I have osteoporosis and I have less muscle

mass, and my skin is not as taut or tense as it could be and it's not regenerating appropriately,

these are all the biological markers for aging. High cortisol leads to increased aging. Stress

leads to increased aging. This has been confirmed in research, for example, by Dr. Elizabeth

Blackburn, who has demonstrated that people under chronic stress have a reduction in their

telomere length and their telomerase activity. This is phenomenal research because, for the

first time, what it's telling us is chronic stress affects the age of our cells, which

could be totally different than our biological age.

The obvious question is, what do we do about it? How do we turn stress into strength? How

do we transform the way we respond? How do we change our perception? Because, remember,

it's your response and your perception. For my patients, I give them a lot of choices.

I say peace. Peace. Finding inner peace is like the center of a wagon wheel. Your path

could be very different for different people. For some people, it's exercising in nature.

That may be one spoke of the wheel. For someone else, it may be repetitive prayer, like mantra

repetition or saying the rosary. For some people, it may be meditation. For some people,

it may be practicing appreciation, practicing gratefulness, changing one's perception. For

others, it's learning how to breathe, simple breathing techniques. Meditation, yoga, Tai

Chi, spirituality, spiritual practices. It's whatever it takes for an individual to find

inner peace, and it's different for each and every one of us.

Remember that stress is almost always an emotional reaction to a situation. It's our perception.

It's our response. It impacts our thinking. How many smart people do you know who've said

some really silly things under stress? We've all done it. We're under stress and we say

something we regret five seconds later. It affects our ability to perform at our best.

It affects our physical health, our mental‑emotional well‑being, and it even affects those around

us. Because, quite frankly, no one wants to be around someone who's stressed and responding

with anger. Mark Twain said this. Mark Twain said, "I

have suffered a great many misfortunes, most of which never happened." I really like that

quote. Adyashanti said, "Suffering happens between the ears. Everything else is just

a situation." This concept of perception and our imagination

and our ability to worry, these are things that we can change immediately in our life,

and there are simple tools to do that. Remember what we said about response and perception.

I can't control the initiating event. We can't control everything our teenagers do or say,

can't control most of the events around us, can't control our spouses and significant

others half the time. The only person we can change is us. We can change how we see the

world, how we respond to the world, and what we're seeing is what's affecting our physical

well‑being, and how we're seeing it. Let's take a look at a beautiful study that

illustrates this. Medical students were asked to watch a movie about Mother Teresa, and

they were also asked to watch a neutral film. 92 percent of these students had an improvement

in their immune system watching Mother Teresa. When those students were questioned about

the movie, they said, "Oh, I love Mother Teresa. She's terrific." They felt good watching the

movie. They felt like they were doing service. They felt really good.

Eight percent of the students said they hated the movie. They didn't like it at all. Those

same students had a reduction in their immune system, their salivary IgA, while they were

watching the movie. Again, two people seeing the same exact thing, totally different response.

I loved the movie, my immune system improves. I hated the movie, my immune system was suppressed.

When they looked at the health records of these students over the previous year, they

found that those students who disliked the movie, who also responded negatively to photographs

that were shown to them ‑‑ and when they generated a story, the story was not a nice

one ‑‑ were the ones that were sickest the previous year. This concept of what do

you see in the world, how do you see the world? We use the expression, "rose‑colored glasses,"

right? Well, is your glass half‑full or half‑empty? For those students with the

half‑empty glasses, they had more illness the previous year.

Now, when the economy changed a couple of years back, I was looking for ways to really

help my patients. This was a quote I found that was quite helpful, by Eric Butterworth,

in his book called "Spiritual Economics." He said, "You see things not as they are but

as you are." Again, your perception. Your perception, how you see the world, is

shaped by your previous experiences, your faith, and according to where you are in consciousness.

Do you believe that everything works out for the best? Do you believe there's a reason

for everything? Your faith and where you are in consciousness. More important than changing

the things out there ‑‑ which is quite hard to do ‑‑ is changing the way you

see them. Getting our patients to change the way they

see things or to look at their lives through a new set of lenses is going to have a profound

effect on their health. We say change your environment, get rid of the teenagers, the

spouse, the boss, and so on. Unlikely, but change the way we react and the way we perceive

our environment. I just love this photo, because two people

can look at this photo and one will say, "I see angels," and someone else will look at

it and say, "I see devils." Every time I show this slide in one of my talks, I never have

someone say, "I see both simultaneously." Again, the concept of perception.

Darwin said, "It's not the strongest of the species that survives, nor the most intelligent,

but the one most responsive to change." If you're one of those people who don't like

change, then you need to read the book, "Who Moved My Cheese?" because change is inevitable.