Stress Kills via Inflammation (Possibly)

What a week.  And more busy weeks to come.  I've been neglecting the blog and have only now moderated several days worth of comments, so they have been published now if you were waiting.  I'm starting to feel a bit Kurt Harrisy about comments over time, but for now I am leaving them open.  For the most part things aren't too rambunctious, but I am more easily annoyed these days.  Maybe wiser?  (Not likely).

I am getting more and more requests if I know any other evo med/nutritionally interested psychiatrists around.  Folks are asking from Atlanta to Vienna.  At the moment I know of four, including myself.  Three of us are in New England and one, Ann Childers MD, in Oregon.  My only advice is to keep checking Primal Docs and the Paleo Physician's Network.  The three other psychiatrists I know of seem to be excellent, well-trained, and careful folks, for what it is worth.  If other psychiatrists want to drop me comment (I can see it and not publish it if you ask), I'm more than happy to keep a list and to ask ahead of time if you want your name released to an interested party.  We are also working on a forum for doctors to share case studies, experience, and documentation, so let me know if that would interest any physicians out there (again, can leave a public comment, or leave a comment with a note not to publish if you want to remain incognito).

Love this song (all the songs I like when I first hear them end up being advertisements for Apple.  They should hire me to spot music for them, for sure…) Come Home by Chappo (right click to open in new tab).

Now, science.  Overshadowed by events and personalities sometimes.  I'm a psychiatrist.  I'm used to that sort of thing, but it doesn't mean it is particularly fun for me.  Perhaps it is less fun, as it feels more like work.  But the journals march on, and it is finally spring here.  Lifetime exposure to chronic psychological stress is associated with elevated inflammation in the Heart and Soul Study.

(It is so uncool to post links to Elsevier nowadays, but they have my favorite journal hostage so what can we do?  Ethics only take us so far, and then we have to write a Graham Greene novel, but we are still left with what to do.  This issue is the eternal crux of clinical medicine.  My patient does not walk out of the files of a clinical trial, where all sorts of comorbitities are excluded, but my patient still has clinical depression and still wants some reasonable advice…)

I like the Heart and Soul Study.  They are on my wavelength.  The methods are solid.  All the subjects have a history of some sort of cardiovascular disease, which is important (and they are mostly male, derived mostly from the VA, so keep that in mind).  And here they have looked into people's history of psychologic stress, measured their inflammatory cytokines, and hypothesize a connection.  The connection is confirmed by many other studies linking a history of trauma (all sorts) to elevations in cytokines.

The DL is that stress is linked to bad cytokines (IL-6, TNF alpha, C reactive protein, etc.) and that stress is linked to PTSD and Major Depressive Disorder and anxiety disorders which are also linked to the bad cytokines… as is cardiovascular disease, even in psychologically healthy individuals.  In addition, there are harmful behaviors which increase the inflammatory cytokines (substance abuse, smoking), and ameliorating behaviors that decrease them (exercise, meditation, sleep) less likely to be adhered to by those who have undergone inordinate psychological stress.

Where the rubber meets the road is that higher lifetime trauma was associated with higher levels of inflammatory cytokines at baseline and 5 years later.  When the researchers controlled for psychological symptoms of the trauma (for example, PTSD or a clinical depression), the relationship held, meaning those who had undergone trauma had elevations of inflammation even if their behavior and coping seemed more normal by psychiatric diagnostic standards.  In these folks with pre-existing cardiovascular disease, higher inflammation is associated with greater risk of death and complication.

Maybe I should leave off and move to Hawaii after all...