director for the allegheny general hospital integrated medicine program today we will be discussing stress and heart health heart disease is the leading cause of death in the united states more people die from heart disease than any other condition welcome dr neal thank you so it's so good to have you here thanks or inviting me to thank you doctor dr neal how does stress affect heart health well we've known for years of there's a relationship between stress and heart health because stress has always i'm sorry heart disease has always been more common in people who have more stress in their lives i think in years past we thought of it more as like that you know older male executive and now we're learning that it's pretty much anyone it affects women affects men it can affect people even at a younger age you don't have to have a stressful job we all have stress in our daily lives whether we have stressful jobs  not although it's kind of hard nowadays to have a job that isn't stressful and it probably the relationship is probably complicated when people are stressed they're more likely to make poor lifestyle choices like smoking even the wrong foods because they're too busy or you know just picking things for the wrong reason they might not exercise if they have a stressful situation in their life or are on the job so some of it is lifestyle re the stress causes them to or as a result of stress they make poor lifestyle choices but more recent research would tell us too that there are things that happen in the body that can promote heart disease there there are forms of inflammation in the body that are harmful and stress is something that tends to promote the kind of harmful inflammation in the body that can lead to blockages in the arteries that feed the heart and other problems that affect the heart so we're learning a lot more about these inflammation pathways we call them are you know kind of these chemical processes in the body and we know that stress is one of the things that promotes the kind of harmful information that can lead to a host of problems among them heart disease city that that is really interesting about the information in that connection to heart disease so does that mean in the past like the theory about statens instead of drugs now they're thinking that maybe cholesterol isn't so horrible statens are maybe the end all be all to treating heart disease and maybe we're switching to treating more of the the information in i think is th there has been research about maybe the benefits of statens really have more to do with and i'm flam atory effects of of the drug i think that's correct when the stem drugs came out of course you know people were thrilled because they are drugs  cholesterol right and we've known that in some people high cholesterol is a problem for heart disease that the thing that's always been a problem for that for medical people though is that we've always known that there are people with very high cholesterol levels that don't get heart disease and there are always there have always been people with low cholesterol levels that do get heart disease so we know that it's not a direct you know correlation we know that it's more complicated than what we see when we get a lab test the other thing that's it justine is that while staten drugs definitely lower cholesterol in almost everyone who takes them their effect on whether people have cardiac incidents or not like a heart attack or whether or not they die of heart disease is not always clear so for some groups of people that take staten drugs it lowers their cholesterol and it makes it less likely that they have a heart attack or die but other people take statens yes they're cluster all comes down but it doesn't really influence you know the actual outcome they can still get heart disease they can still die of heart disease so again it's not as simple as we thought it was and probably for those people i think there is research that shows that for people that do get benefit from staten drugs it may have something to do with information in addition to just getting cluster levels down ok what are some strategies that people can do to help reduce their their dangerous stress levels well first of all there are kind of two categories i would say of stress reduction ok one is you avoid taking on additional stress that you don't need ok so so you know there are two kinds of stress there is the stress that is unavoidable ok you know there are there people are always going to have stress in their life it's always going to be there and there are certain things that cannot be avoided but there are stresses that people put on themselves by taking on too many tasks volunteer in for too many things thinking that their house has to be perfect and their kids have to be perfect and every thing they do at work has to be perfect and that they can never make a mistake a all their relationships have to be perfect and you know that's the kind of stress that people put on themselves and you can learn over time to say no which doesn't come easily to people you know we all want to be productive helpful people but we don't have to do everything that comes our way it's ok to tell people sometimes that we can't do that right now because we're overloaded so you know easing up on ourselves and finding ways to do that taking breaks not having something going every minute of the day and even you know not filling our lives with all kinds of electronics and technology to which you know obviously those things are very helpful and can add a lot to our lives but electronics can be extremely stressful and there are people that you know have anxiety and depression and directly related to over he's electronic so you know those are ways that people can you know make for less stress in their own life for this stuff that you can't get rid of the unavoidable stress you know deadlines at work and family issues that are going to go away and maybe a health crisis that you have or something in your life then you have to learn methods to cope with that for the stuff that you can't  away and there are a number of different techniques to people can use to deal with stress the first thing that i would mention is always exercise because people that exercise regularly are much better at handling stress in their life regular exercise is a great anxiety reliever it's a great mood elevator and many people who exercise regularly will feel more capable of handling the stress that comes at them so exercise is probably number one but then learning some kind of relaxation techniques or relaxation strategies you know just for instance like in a work environment if people can't sit in that a tape at work great but what you could do is if you work in an office and you have enough of your own private space there that you're not bothering other people instead of turning on some f m radio station with like blaring music all day you could play relaxing music on the cd while you're at work i do this every day and that makes it easier to be at work even if what i'm doing is stressful if you have the opportunity at work to get away from what you're doing like when you have a break either a you know are short break or lunch break it's really good to take that break and not spend that break doing more work and you know driving yourself more crazy but also you can learn you know breathing techniques that are relaxing and you can learn meditation techniques that are relaxing and you can learn you know things like type she or yoga you can go to classes like that or you can do them at home you know people there are just any number of different techniques that people can learn and the important thing is that you know sometimes if you can go to a class that takes an hour that's great but if you don't have time for that you can learn techniques that you can do in five minutes and you can do them while you're stopped at a traffic light and you can do them when you take a five minute break from your work what are some of those techniques because that's a really good point because that most people complain that they are really crunch for time because they are overstressed and does just taking five minutes doesn't actually make a physiological impact on your on your health it does and they've studied this extensively so when you're in the stress response and your heart rate go up you know it's not just something that you feel in your head there's really a physical response to it so when your heart rate goes up your blood pressure goes your breathing rate goes up and you put out more stress hormones like epinephrine things that sort of get you jazz to  face a stress the fight or flight exactly the problem is you know that was made for short term use and now when we're stressed kind of all day long that can i see you being exposed to those physical changes over long periods of time can be harmful and the good news is that doing something for even five or ten minutes can counteract the negative effects of stress so as a for instance we teach people the easiest thing that you can do especially in an acute situation like i had a colleague once who was stuck in turn afaik on the freeway when her husband gave her a call on her cell phone and basically told her that he thought he was having a heart attack so here she is stuck in unable to do anything about that and she just you know kind of started freaking out in her car and she had learned from a class that she had gone to with us that if you just take three or four slow deep breaths and then return to normal breathing that will actually lower your heart rate and lower your blood pressure lower your breathing rate and decrease the output of your stress related hormone so it starts making you feel a little better now you might have to do it again in two minutes if you're really acutely stressed and you only want to do it for three or four breast because if you keep doing it you might get light headed  but if you practice just three or four deep slow brass and then returned to normal breathing that really makes a difference and it takes like probably less than a minute since i think that's amazing that your body has the ability to you  actually people say oh i have no control over it but really you do you do you do and it does it starts with without breath and it's amazing i'll talk to people in the office and out i'll ask them to take a deep breath  that people are so used to breathing so shallow really and up player and when you breathe shallow and up here that almost keeps you in that it does deep makes you when you breathe in a shallow way it makes you feel like you're under more stress and so it's just a cycle that keeps kind of going around a circle and the first thing that happens when people feel stress is that they tighten up and they stop breathing you know sometimes they stop breathing at all but usually they  know less often and in much shorter breast because that's part of the stress response so you can do things that physically counteract that and start unwinding some of that response do you do you have stress management programs that the integrated medicine weeks or so you know we're a small program and we don't have tons of people so we make the best with what we have but i'm for instance a person could come to our psychologist and learn any number of different relaxation techniques she can teach people biofeedback she can teach people breathing techniques she can teach people how to use little computer based programs that are stressed reduction things and so you know you can learn over the course of one or two or three visits how to do this for yourself the goal is always to teach people things they can do for themselves because if you're stressed you don't have time to be coming in for all kinds of visits right and you don't want to have to worry about how much it costs and all that kind of stuff and by the way you know even if you didn't come into a program you can learn about this stuff in books in the library and on line there are a lot of things out there even apps for smartphones and tablets you know not that we want people hooked to their technology too much but you know  if years i've been stuck in an airport and there's a little labyrinth app on my i pad that i can use to calm my down and across a little finger labyrinth there's all kinds of stuff out there most of it's free but a person could come and see our psychologist we also have a person that we send out into the hospital units she mostly teaches employees of our hospital how to do stress management is one of those yet working in health care is pretty stressful nowadays and if you're trying to take care of someone it's kind of like the airline thing you know you have to put your own mask on first before you can help someone else yes so we try to teach people how to do their own stress management and we teach them how to use it with patience to how to calm a patient down in a stressful  can also work with patients when they're in the hospital but we have if you happen to have to come into the hospital as an inpatient we have people who do reiki for for patients we have a pet therapy program where people can visit with our therapy dogs which lowers blood pressure and six or eight go into the relaxation response so we we think that this is really important for any number of conditions that people suffer from and so we try to bring relaxation techniques to people and as many places in the hospital as we can doctor and you know this this is fascinating we need to cut to a commercial break stay with us we'll be right back i don't know but the what if it calls you to go halfway around the world do some things in life you can control and this booklet can help from keeping your family healthy to saving for retirement or your free copy now from the american diabetes association because we want everyone to be healthy and discussing stress and heart disease dr i kneel you were also a guest speaker at our our nature path a conference last year and he spoke about broken heart syndrome and that is having depression affect our health we think that it does and there's a lot of research that would show there's a connection between a number of different emotions or sort of mental health issues and heart disease you know as a person who works in complementary medicine i always think that someone who has a heart problem probably does have a broken heart in some way they may not even recognize what that is but because there's such a strong mind body connection the heart is very much affected by what happens and this is a sin germ that occurs primarily in women and it's really interesting that it looks exactly like a heart attack so the heart muscle stops working the way that it should and it looks and feels exactly like a heart attack but when these women go to the hospital and get checked by their doctors they don't have blocked arteries and they don't have elevated and sometimes and they they don't have the same kinds of problems that we normally see with a heart attack and this almost always occurs in the setting  acute serious stress so some really stressful life situation and what we know is happening now is that because of all of these things that happen in the stress response and this overload of chemicals that are not really supposed to be you know flooding us at that time the heart just stops working the way that it should and it's not because of blocked arteries or you know the kind of typical heart disease that we see it's because of an overwhelming stress response dr neil can that because when you're in that that centrum can that cause atrial fibrillation i think we know that stress can lead to atrial fibrillation which is a situation where instead of the normal regular beating of the heart the top part of the heart which is responsible for initiating the heart the heart beat in the lower part which is that the muscle pump part of the heart that top part of the heart where the rhythm starts is kind of not working correctly and instead of a nice regular heartbeat you get this really rapid and kind of weak heart beat that isn't as effective in pumping blood we know that atrial fibrillation is related to stress in some ways there are lots of reasons why people can get it but if they already have it stress definitely makes it worse and it's possible that stress even leads to the development of it in some people i'm not aware of a direct relationship between the  two separate things but we definitely know that stress and atrial fibrillation are are connected in some way you know we had some people from the dean ornish program on the show and it was interesting that the majority of the participants in the program had some type of traumatic events in their life preceding the heart disease and what would you think about the effectiveness of the of the dean ornish program i think the dean ornish program is a really great program because it gets at the three things that i think anyone needs for health whether you already have a disease or not you need regular exercise you need good nutrition or healthy diet and you need to do something to manage stress so the d program for years has looked at those three things you know most of medicine waits until people get sick and then comes at them with all kinds of medicines and procedures and dean ornish is something that people usually get into after they've had a heart attack right although you can use it to prevent one of the first place but when people are in the dean ornish program if they exercise regularly if they make changes in their diet and if they do stress management things that they learn they can actually reverse heart disease meaning that blockages that they have in their heart arteries can actually start to decrease and i mean even disappear what i think is most interesting about the dinner is program the diet is really hard to follow because it's really restrictive and a of people fall off the diet a lot of people don't do the exercise as often as they should but what studies have shown is that the people that continue with the stress management stuff even if they don't stick to the diet and they don't exercise as much as they should they also get reversal of heart disease that's fascinating and so we know that that you know it's not just some little thing that you tack on the to the end very really is critically important to do the stress management that that is from lime lime flowers lime leaves make a cup of tea of it it tastes good but it's really good for heart palpitations related to stress and that's something that that doesn't interfere with with any medications and just just very very calming when some of those herbs they really do help with focus concentration and then help people just with their stamina get getting through it through their day and through work so what is the name of the this psychologist at the allegheny general process that's going on in your own body to help worrying about how to turn down your own stress so the one that we knew is in involves a little sensor that goes on the fingertip and it actually is reading your pulse ok so some biofeedback things go on skin temperature you put a sensor by the side of your eye and it goes on the muscle tension around your eye but the one that we use is a little sensor that's going to read the pulse from your finger and we know that the pulse is how many times a minute your heart beats and we know that heart rate or that number of heart beats per minute is very closely tied to how much stress people feel when you're stressed your heart rate goes up and when you're feeling and relaxed your heart rate goes down so in the program that we use you have this little sensor on your finger it's reading your heartbeat and then you're watching something that's giving you that feedback so you're watching a screen or something that tells you how often your heart is beating and the program that we have uses a computer screen that has kind of a kamin scene on it and as you look at the common scene you're asked to kind of think about something that really makes you  feel kind of warm and sort of heart felt like maybe if you have children you might want to think about your child or you might want to think about some person in your life that's important nor some event that was you know really a good thing in your life and as you think of that you know noticing that your heart rate is going down and as your body is your brain can see that your heart rate is going down you can actually learn how to get it to keep going down further and further like the supreme example of this is like monks in tibet that can actually hear their own biofeedback and they don't have any technology they just pay attention to their body they can lower their body temperature to what most people probably would have difficulty even surviving but they can lower their heart rate their blood pressure their body temperature to a level that you know like is unheard of and just by paying attention to their own body so you know and their thoughts and their thoughts and i 'm a big believer in that it's also about your perception and it's if you can just change the way that you perceive things it affects every everything else you and i i do recommend things like  saying negative things inside their head about their life in themselves and as i said you know that's a big part of the stress that we put on ourselves in addition to the stuff that comes at us from the rest of the world right do you believe in supplementing the diet with nutritional s i do but you know within reason i always tell people that supplements are never a substitute for a healthy diet so you can't smoke cigarettes and then supplement your way out of that right so  start with a healthy diet and i think that people should get most of their nutrition from their food but i think that certain supplements can be helpful in certain situations i think it's a mistake to take a big handful of stuff every day that supplements are not regulated and if you're not careful about where they come from they could have fillers in additives that are not helpful so you know i think you need to minimize the number of supplements you need to make sure they come from good quality sources and i would prefer instead of people just taking you know all kinds of stuff or whatever if they focus on one or two issues that they think they have a concern about that they try to supplement for that problem or that issue and not just you know sort of take all kinds of stuff thinking that they're going to you know have better health what about fish oil well fish oil is probably one of the supplements that i would recommend for almost everybody unless you are sick to fish because they contain omega three fatty that really have been sort of industrialised out of our diet you know the way that food is produced now our food has many fewer omega three fatty acids than it used to and so unless you eat oily fish as you know five times a week i think fish oil might be a good thing for you to use because it's helpful for so many things it's helpful for heart disease it's helpful for people that have high blood pressure it's good for mood and you know depression anxiety it seems to be a little fishy i think that doing studies on supplements is always problematic because it whatever they use in the study is not going to be what people use you know when they go to the grocery store or whatever and i think that again if you buy a decent quality supplement fish oil is not going to hurt you in any way it's basically food and i think that it may have some real benefits i take it that i do to you betsy it was a pleasure seeing you again this this was so informative