Dr. Swiner’s Medical Note of the Month-Jan. 2010-Stress induced disorders

This month makes a year that I’ve been writing articles for medical education. My first article centered on the issue of depression and being self-aware of the warning signs.

ical and physical complaints that we have or have to discuss can in some way or another be due to or can be worsened by stress. Let’s review some of those that have evidence behind them.

  1. Depression and anxiety/panic disorders. This is pretty easy to understand. The more stress a person has, the worse underlying mental health disorders can become. The stress of loss of a loved one, loss of a job or threat of losing your job, or a strained relationship can lead to overwhelming sadness or symptoms of panic. Insomnia and sleep disturbances can occur as racing thoughts and worry increase at night. Alcohol and tobacco abuse can also occur concurrently as ways to self-medicate in the absence of correct ways of treatment such as prayer, counseling, therapy or prescribed medication.
  2. Hypertension and heart disease. Otherwise known as high blood pressure, stress can cause an increase in constriction of blood vessels. Stress has not been proven as a direct cause of high blood pressure, but it can have an overall effect on the release of hormones from the nervous system and circulatory systems, which makes it harder for the heart to pump blood to our vital organs. If blood pressure is chronically high and blood vessels have enough damage or cholesterol buildup, heart disease can be the result. Some chest pain can even be linked to stress.
  3. GERD (acid reflux) and stomach ulcers. Emotional stress can lead to an increased production of acid from proton pumps and H2 receptors in our stomachs. If acidity is prominent, a burning sensation can be felt and pain can extend from the stomach (in the center and to the left of the middle of the stomach) all the way up to the esophagus and throat. Foods that we eat, including caffeinated beverages, spicy ingredients and citrus can make this worse. If left for too long, ulcers, or an eating away of the lining of the stomach, can develop and even worsen to the point of bleeding.
  4. Obesity. Stress can cause an increase of the hormone cortisol to be released from the adrenal glands. Cortisol is linked to increased glucose (blood sugar) and weight gain. Also, while some of us eat less with stress, many of us eat more “comfort foods,” which are generally more sweet and fatty, and have more calories.
  5. Headaches. Migraines are thought to be the most common type of headache, but tension is probably higher on the list of causes of headache. Both types can increase with stress. With tension headaches, a tense pressure or squeeze can be felt in any part of the head, usually with muscle tension and soreness of the neck and even shoulders. Migraines are thought to be associated with signals from the nervous system that relax blood vessels. When vessels relax, blood rushes to them and cause dilation. If too dilated, this can cause pain.
  6. Abnormal menstrual cycles. Skipping a period can be very distressing for a woman, especially if unexplained. Although we don’t know what the certain cause is, it is thought that emotional stress affects release of certain pituitary hormones that can cause irregular periods. If weight is lost or gained due to stress, estrogen or a lack thereof, it can also cause irregular periods.
  7. Viral infections. When we’re stressed or fatigued, our immune system doesn’t work as well to prevent us from infection. We all have antibodies from vaccines or from previous infections that have built up in memory cells and are programmed to increase when we are exposed to infections. Stress reduces this response. Colds can occur more frequently and, even worse, viruses such as herpes and HPV (human papilloma virus can show themselves during these “down” times.
  8. Cancers. This one is controversial, as some studies say one thing and some say another. The conflicting data questions whether stress can be a direct cause of some cancers. In 2002, a study was done on patients who had breast cancer that was treated. The question was asked if stress could be linked to the cancer coming back. The study could not prove it to be true. However, in animal studies, an increase of stress hormones was linked directly to growth of some tumors. Long story short, the evidence is inconsistent, but there may be truth to the claim that stress can lead to certain cancers.

All in all, be self-aware of the signs. If you’re feeling overwhelmed, as we all at some point do, be pro-active by exercising, drinking plenty of water, getting good restful sleep and doing those things that you enjoy doing with those you love. If it still feels like life is crashing down on you or your body is breaking down, please see your doctor.

  1. Nicole Price Swiner, MD, works for the Durham Family Practice in Durham. Contact her at 220-9800.

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