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ANTC68 WINTER 2013 Lecture # 12 – Chronic Diseases STRESS  Long term chronic stress can make almost every other health problem worse (a syndemic)  Our bodies are adapted to dealing with short term immediate stressful threats as our hunter-gatherers ancestors  Our bodies deal with scarcity and uneven availability of food by consuming and storing calories  Fight or Flight – Immediate short-term stress; body goes into emergency mode o Unnecessary activities like digestion slow down o Blood is diverted to lungs, away from internal organs like stomach and intestines o Heart pumps faster, dilation of blood vessels o Narrow focus – tunnel vision  Parasympathetic (Calm)  Sympathetic (Fight or Flight)  Constricts pupil  Dilates pupil  Stimulate salvation  Inhibits salvation  Inhibits heart  Accelerates heart  Constricts bronchi  Relaxes bronchi  Stimulates digestive activity  Inhibits digestive activity  Stimlates gallbladder  Stimulates gloculsose release by liver  Contracs bladder  Secretion of epinephrine and norepinephrine from kidney  Relaxes rectum  Contracts rectum  Our bodies weren’t made to deal with long-term stress  Long term stress activates the hypothalmis-pitutitary-adrenal (HPA) axis  Our normal, “good” stress response becomes maladaptive  There is chronic rlease of stress hormones (glucocorticoids, cortisol is the most important of these)  Accumulation of body fat, especially in the midsection  Desire for high-fat, high-sugar foods  Depression & other psychiatric disorders  Interferes with sleep cycles  Reduction of brain’s memory centres  Decrease in immune functioning ANTC68 WINTER 2013  Long term stress can be manifested in three ways o Foot on the Gas – constantly aroused, angry, emotional o Foot on the breake – withdrawn, depressed, little energy o Foot on both – freeze under pressure, you appear calm outwardy but inwardly you are anxious, aroused  Metabolic Syndrome o Long term release of stress hormones o WHO Defintion  At least 1 of diabetes mellitus, impaired glucose tolerance, impaired fasting glucose, insulin resistance  At least 2 of high blood pressure, high lipid count in blood, central obesity, albumin excretion in urine  Stress and Environment o Our genes load the gun, but the environment pulls the trigger  Social Hierarchy and Stress o Research in baboons has shown that monkeys at the bottom of the dominance hierarchy show signs of chronic  Fail to grow, nervous behavior, depressive symptoms o Sometimes the human hierarchy is well defined such as the caste system, sometimes it isn’t such as SES  Depravation in Childhood o For humans, being chronically at the bottom of the social hierarchy (such as low SES) activates the HPA axis o Stress in childhood leads to poor educational attainment o Behavioral problems (hyperactivity, conduct disorders) o Emotional problems o Risk of cardiovascular problems in later life o Chilrhood stress interacts with other risk factors, such as low birth weight  Whitehall Studies, Black Report o Large-scale studies of social determinants of health o White Hall Studies – Study of British Civil Servants  First 1967-1976; Second mix of males and females  Researchers examined status in Civil Service and pay grades plus other health factors  Found: people in the lower pay grade had mortality rates that were 3X higher than those in the highest pay classes  Being at the bottom of the social hierarchy is not good for health o Black Report – 1980 – UK Department of Health ANTC68 WINTER 2013  Set out to look at the health inequalities  Found that the main explanatory variable for health
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