Stress Management – Page 3 – Lifestyle Medicine

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This month, Stanford Lifestyle Medicine Assistant Director Douglas Noordsy, MD, recommends a breathwork practice called the 100-Breath Mindfulness Practice. Breathwork refers to the practice of controlling the pace of one’s breathing with the intention of steadying one’s mental, emotional, and physical condition. Mindfulness entails anchoring the mind in the present moment. Therefore, a mindful breathwork practice brings the mind into the present moment by focusing on the breath.

Dr. Noordsy recognizes that mindfulness meditation might be intimidating for some, so he offers this breathing practice as a quick-and-easy mindfulness exercise that one can do anytime, anywhere.

“The 100-breath practice is an excellent, portable technique for letting go of overthinking and reducing stress,” says Dr. Noordsy, head of Lifestyle Medicine Cognitive Enhancement and Professor of Psychiatry at the Stanford School of Medicine.

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100-Breath Mindfulness Practice

1. Get in a comfortable position and start taking long, slow, deep breaths.

You can do this sitting cross-legged on the floor or on a meditation cushion, sitting at your desk at the office, or even while taking a walk. If it helps you focus and it’s safe to do so, you can close your eyes during the practice.

2. Breathe in through your nose and out either your nose or mouth, whichever is more comfortable.

3. Focus all of your attention on your breath and count them from 1 to 100.

Inhale, “one.” Exhale, “two.” Inhale, “three.” Exhale, “four”…
The counting anchors your attention on your breath and in the present moment. It also curbs distraction and enhances your ability to focus. And since you are counting to 100, you can do the practice anywhere without watching the clock.

4. When you notice a thought enter your mind, bring your focus back to the practice, and count the next breath where you left off.

It’s important not to judge yourself when your mind is racing. Having a busy mind is completely natural. Be gentle with yourself when thoughts arise, simply let the thoughts come and go, and return your focus back to the breath.

5. Continue this process until you reach 100 breaths.

The average person takes 100 breaths in about 5 minutes.
If 100 breaths is too much to start with, try 25 or 50 breaths first and gradually work your way up. Remember, this is a practice, so it’s okay to start small.

6. Celebrate your body and mind for taking a moment to slow down and practice.

How Does Breathwork Affect the Body?

The 100-Breath Mindfulness Practice, like other breathwork exercises, works to calm both the body and mind by bringing the nervous system back into a state of peace. When the body is under stress, either physical or emotional, the sympathetic nervous system takes control, which increases heart rate, hastens respiration, and floods the body with adrenaline to either fight or flee from the source of stress. This is the body’s natural response to danger, which would be helpful if being attacked by a saber-toothed tiger but not so beneficial when feeling stressed about cooking a big holiday dinner or while parsing through work emails.

Instead, breathing exercises like the 100-Breath Mindfulness Practice, box breathing, or cyclic sighing can help shift our nervous system from the sympathetic (stressful) to the parasympathetic (peaceful) nervous system. Different organs, like the heart, lungs, and brain, constantly send each other “biofeedback” or signals that keep them operating in harmony. By slowing down breathing and directing one’s attention inwards, the diaphragm stimulates the vagus nerve, which then tells the rest of the body to relax. The breathing exercise helps to slow our heart rate down to match our relaxed breathing, leading to cardiac coherence and a tranquil state for the body and mind.

October 3, 2023/by dom-wp-admin

Can Lifestyle Reverse Your Biological Age?

Cognitive Enhancement, Healthful Nutrition, Movement & Exercise, Restorative Sleep, Social Engagement, Stress Management

By: Ben Maines, MD candidate

We all know that eating right, sleeping well, and minimizing stress are good for our health, but what if they could turn back the clock on biological aging? A small but groundbreaking 2020 study found that an 8-week prescription of a healthful diet, stress reduction breathing practices, and exercise decreased participants’ epigenetic age by a little over three years relative to a control group. Sounds too good to be true, doesn’t it? And what do we mean by epigenetic age? We’ll answer those questions and more, but first, a primer in epigenetics. Epigenetics describes reversible molecular modifications made to DNA. At the cutting edge of our modern understanding of medicine and cellular biology, epigenetics facilitates variation between genetically identical cells like your neurons and muscle cells. In the case of twins, for example, you can think of the DNA as the blueprint shared by twins, while epigenetics is the footnotes — instructions that dictate how the blueprint is interpreted and applied. Think of it as the mechanism that bridges nurture and nature, fine-tuning your genetics in response to your environment and lifestyle. At the molecular level, that tuning involves the addition or removal of small molecules like methyl groups to DNA and its packaging. Some molecules make the genes to which they are attached more accessible to the machinery that will translate them, essentially turning those genes on, while others do just the opposite. Evolutionarily, these changes facilitate rapid adaptation to an ever-changing environment. An individual’s experience of famine, for example, can epigenetically tune their metabolism and growth for energy conservation. These epigenetic changes may also be seen in their descendants for several generations to come. The exciting news is that tuning isn’t permanent, which is where lifestyle medicine comes in. Many of the epigenetic phenomena that we understand are related to metabolism and stress responses. Though evolutionarily conserved, these epigenetic changes can be maladaptive in the modern context. A traumatic childhood experience, for example, can trigger epigenetic modifications that not only alter an individual’s stress response to cause chronic stress, but are also heritable to their offspring. This enhanced stress response may have protected an early human in the savannah from repeating risky behaviors, but in our more predictable modern world, chronic stress more often contributes to poor mental health and diseases like cardiovascular disease and high blood pressure. Thinking back to epigenetic age, it seems rational then that if we know the patterns of epigenetic modifications associated with failing health and the diseases of aging, we can use them as a surrogate measure of healthfulness. Though we don’t yet fully understand its nuances, molecularly determined epigenetic age is a better predictor of an individual’s health and longevity than chronological age, presenting an exciting frontier for understanding and modifying health and longevity through lifestyle medicine and targeted therapeutics. For example, a team led by scientists here at Stanford and at the Buck Institute for Research on Aging used deep learning to identify key molecules of systemic inflammation such as CXCL9 that correlate closely with morbidity, cardiovascular degradation, frailty, and other signs of biological aging. As we age, this increasing chronic, systemic inflammation is likely driven by epigenetic changes, raising the tantalizing possibility that it could also be reversed.

How can we use lifestyle medicine to modify our epigenetic fate?

So far, the main clinical epigenetic therapies that have seen success are small molecules that reduce DNA methylation to treat cancer. These molecules function by pushing the reset button on many of the accumulated epigenetic changes that allow the cancer cells’ runaway growth. What if we could do the same to the changes that predict ageing, chronic inflammation, and disease? For now, it seems that our therapeutic tools are too blunt, lacking the precision to target the maladaptive and disease-associated epigenetic changes. So, for now, our best tool for harnessing our epigenetic destiny is our lifestyle. Let’s take a deeper dive into what that looks like at the cutting edge of each of our Stanford Lifestyle Medicine Pillars.

Epigenetics & Physical Activity

Daily exercise has long been associated with health benefits from reduced incidence of cardiovascular disease and improved cancer prognosis to slower cognitive decline. The CDC recommends getting at least 150 minutes of moderate-intensity aerobic activity and 2 strengthening workouts a week for optimal health benefits. There is now evidence that exercise also broadly improves the capacity of your cells to alter their methylation patterns. Exercise leads to higher levels of the protein superoxide dismutase, which works through a series of receptors and pathways in the liver to alter the methylation of key metabolism genes and enhance metabolic function. These pathways affect health in a myriad of ways including improving glucose tolerance to reduce the risk of diabetes. Though some of those epigenetic changes are maintained from parents to children, many are re-programmed during critical developmental periods in-utero, allowing maternal exercise during pregnancy to have profound impacts on offspring health later in life. Lifestyle, it seems, is preventive care that begins even before we’re born. The systemic epigenetic changes induced by physical activity were seen in a recent study by Washington State University that analyzed differences between physical activity and epigenetics in identical twins. Researchers found that twins who exercised for 150 minutes a week or more had more epigenetic markers related to lower risk of metabolic syndrome than twins who exercised less.

Epigenetics & Nutrition

According to recent research, what you eat, and perhaps more unexpectedly, what your parents ate, seems to affect our health through epigenetics in two interesting ways. First, by the availability of small molecules that participate in and modulate the biochemical reactions that add and remove epigenetic tags. For example, plant-forward diets tend to be high in epigenetic substrates like folate, a precursor of the methyl groups added to DNA; cofactors that facilitate that reaction like vitamins A and C; and polyphenolic compounds like curcumin (found in turmeric) that modulate DNA Methyltransferase, the protein that initiates the reaction. Leading theories suggest that by maintaining abundant nutrients involved in epigenetic processes, the body’s response to stress and ever-changing metabolic supply and demand can be efficiently fine-tuned. Diseases like diabetes arise in part because of maladaptive or improper metabolic tuning. A second way that nutrition impacts epigenetics seems to be mediated by metabolic stressors and nutrient sensing. Our cells work along the spectrum between two main modes; when nutrients are limited, pathways turn on that favor maintenance, and clearing and recycling debris, to enhance cellular function and efficiency. Abundant nutrients, on the other hand, downregulate the efficiency pathways and promote storage and more reckless use of resources. With time, famine or feast can become encoded as heritable epigenetic changes, contributing to the increased risk of obesity, diabetes, and several other health conditions in the offspring of parents with poor diet and nutritional profile.

Epigenetics & Sleep

Sleep, namely the lack thereof, has been associated with everything from heart disease and stroke to metabolic disruption. Its greatest impact, though, is on the brain. Interestingly, susceptibility to sleep deprivation is a highly genetic phenomenon. Some people can barely function without 8 hours of sleep, while for others, 6 is more than enough. This suggests a significant role for epigenetics. Cognitive functions like learning and memory rely on neural plasticity, which requires fine-tuned epigenetic adjustments to the gene expression patterns of individual neurons. This process requires sleep, and even single sleep disruption events can impair them, especially in the hippocampus, one of our primary memory and learning centers. More chronic sleep deprivation can alter mood, exacerbate psychiatric disorders, and increase the risk of neurodegeneration as in Alzheimer’s. Most of the epigenetic changes seen with sleep deprivation modify genes involved in metabolism, circadian rhythm, and synaptic plasticity and signaling. For example, night shift workers have altered expression of the genes CLOCK and Dlg4, a master regulator of our body’s internal clock, and a protein implicated in autism that scaffolds synaptic signaling respectively.

Epigenetics & Stress

Technically, stress is any stimulus that disrupts our body’s homeostasis, whether running from a predator in our evolutionary past, experiencing a traumatic life event, or persistent psychological distress. The hypothalamus-pituitary-adrenal (HPA) axis, then, is the stress response control center, a system that connects our brain to our hormone-secreting glands that release systemic stress signals like cortisol, adrenaline, and pro-inflammatory molecules. These signals go on to modulate all our body’s systems, from metabolism and neuronal activity to immune function, and are themselves epigenetically tuned. Typically, our bodies overcome the stressor and return to homeostasis, but traumatic and chronic stress can lead to compounding epigenetic changes that dysregulate our immune, metabolic, neuronal, cardiovascular, and other systems. For example, traumatic childhood experiences trigger epigenetic changes in immune cells like macrophage, increasing pro-inflammatory reactivity and hormonal dysregulation, which may underlie the plethora of adverse health outcomes associated with childhood trauma. Much like the epigenetics of nutrition and exercise, parental stress can be passed on to children both through inherited epigenetic patterns, and through stress hormones circulated from the mother to the developing fetus. On the bright side, positive life experiences, social relationships, and mindfulness practices like meditation and breathing exercises all work to short-circuit these maladaptive stress responses and associated epigenetic changes. For example, one mindfulness-based intervention in breast cancer patients resulted in a reduction of greater than 50% in the epigenetically controlled levels of 91 pro-inflammatory hormones and molecules compared to control patients, an effect that persisted 12 months later.

Epigenetics & Social Engagement

Our capacity to form complex social bonds is evolutionarily foundational to survival, so it’s no wonder that relationships, too, are intimately tied to epigenetics. On one hand, the epigenetic changes associated with chronic and traumatic stress are implicated in impaired capacity for developing and maintaining social bonds. On the other hand, Strong social relationships are important for mitigating stress and its deleterious epigenetic effects, and are one of the strongest predictors of health, happiness, and longevity. Though this is one of the more complex and least understood areas of epigenetics, it’s hard to overstate its role. For instance, mutations in MeCP2, a gene that helps interpret epigenetic methylation patterns, results in the profound cognitive and social dysfunction known as Rhett syndrome.

Epigenetics & Cognitive Enhancement

As it turns out, synaptic plasticity, the phenomenon underlying higher cognitive functions like memory and learning, is largely governed by epigenetic mechanisms. In a highly simplified sense, the strength of patterns and combinations of synaptic firing are enhanced by repeated stimulation, and conversely tuned down in the absence of activity. This is accomplished by epigenetic changes that modulate the sensitivity of neurons to subsequent stimulation. Carrying that principle one step farther, research indicates that enhanced synaptic activity is also essential in synaptic and axonal regeneration after damage such as in the brain of a stroke patient. In animal models, for example, exposure to stimulatory physical and social environments after a brain injury or in disease states such as Parkinson’s leads to increased synaptic activity, which triggers epigenetic changes that promote regenerative healing. Given this observation, it is speculated that similar mechanisms underlie the positive effects of exposure to nature and socially stimulating environments on cognitive and neurological recovery after a brain injury or in diseases like Alzheimer’s. Further, it is plausible that the epigenetic benefits of physical fitness, a varied, plant-based diet, sleep, and relationships translate to beneficial effects on cognitive performance in both health and recovery. For example, the Mediterranean Diet is associated with slowed brain aging and improved cognitive functioning, whereas the Western Diet has been implicated in accelerating natural brain aging processes.

April 26, 2023/by dom-wp-admin

Sauna Use As a Lifestyle Practice

Cognitive Enhancement, Stress Management

By: Vanika Chawla, MD

Emerging evidence suggests that beyond its use for pleasure, sauna bathing may be linked to several health benefits including cardiovascular, neurological and metabolic benefits. A recent review by Patrick & Johnson outlines evidence of the benefits of sauna use, potential mechanisms of action, and adverse effects and contraindications. Sauna bathing is characterized by short-term exposure to high temperatures (ranging from 113F to 212F), and there are various forms including “dry” and “wet” saunas which differ in the amount of humidity.

A large study done by Laukkanen et al., examining data from over 2000 middle-aged men in Finland showed that men who used saunas two to three times a week had a 27% reduction in mortality associated with cardiovascular disease compared to those who used saunas once a week, and men who used saunas four to five times a week had a 50% reduction rate in mortality associated with cardiovascular disease. The risk of mortality from all causes was reduced by 40% in frequent sauna users compared to infrequent users! Duration of sauna use was inversely correlated with the risk of cardiovascular disease and coronary heart disease, meaning those who used saunas for longer than 19 minutes had better outcomes than those who used saunas for less than 11 minutes. Results were adjusted for factors such as socioeconomic status.

Many of the physiological effects of sauna use are similar to those elicited during moderate to vigorous-intensity aerobic exercise. Studies show that aerobic exercise in combination with frequent sauna use has a synergetic effect in reducing cardiovascular and all-cause mortality. Exposure to high temperatures stresses the body and this heat exposure induces protective responses that promote cardiovascular health, such as increased heart rate, decreases in blood pressure, and improved blood flow. Heat stress may lead to improved physical fitness by increasing cardiorespiratory fitness, endurance and preserving muscle mass. During exercise the core body temperature rises and heat acclimation from the sauna optimizes the body for tolerating core body temperature elevations during future exercise, as well as supporting other cardiovascular and thermoregulatory functions that are important in fitness and exercise. pThese mechanisms contribute to muscle mass maintenance and prevent muscle loss that can occur with aging.

Further analysis of the data from Finland also showed that men who used saunas four to seven times a week had a 66% lower risk of developing dementia compared to those who used saunas once per week. Proposed mechanisms for improved brain health in response to sauna include heat exposure and the subsequent cardiovascular response increasing the expression of brain-derived neurotrophic factor (BDNF), which is an important factor that supports the development of new neurons in the brain, and increased blood flow to the brain. Heat shock proteins also protect against brain disease.

Findings from the study also show that regular sauna users had a lower risk of developing pneumonia and sauna use may bolster the response of the immune system and promote respiratory health.

Caution should be exercised for sauna use in special populations such as pregnant women and children. There are some reports of reduction in male sperm count following sauna use in a 10-person study, but measures returned to normal within 6 months of sauna use cessation. Some contraindications for sauna use include alcohol use, hypotension, recent heart attack, severe aortic stenosis, and altered or reduced sweat function (such as in certain autoimmune or neurological disorders). Proper hydration is recommended prior to and during sauna use.

You may want to consider using a sauna as you cultivate a positive, healthy lifestyle. It can be pleasant and soothing on a cold winter’s day, and may reduce your risk for some upper respiratory infections. There is no clear evidence indicating whether the benefits of sauna are limited to specific climates or seasons, or whether sauna bathing during hot weather confers health benefits.

References:

Patrick RP, Johnson TL. Sauna use as a lifestyle practice to extend healthspan. Exp Gerontol. 2021;154:111509. doi:10.1016/j.exger.2021.111509

Laukkanen T, Khan H, Zaccardi F, Laukkanen JA. Association between sauna bathing and fatal cardiovascular and all-cause mortality events. JAMA Intern Med. 2015;175(4):542-548. doi:10.1001/jamainternmed.2014.8187

March 27, 2023/by dom-wp-admin

A Mindfulness Program May Be Just as Effective as Medication at Reducing Anxiety

Stress Management

A recent study called Treatments for Anxiety: Meditation and Escitalopram (TAME) compared an 8-week standardized evidence-based mindfulness-based intervention (mindfulness-based stress reduction, MBSR) with medication for the treatment of anxiety disorders. The study included over 200 adults with a diagnosed anxiety disorder that were assigned to either 8 weeks of the weekly MBSR course or taking a medication for anxiety called escitalopram. The MBSR course involved weekly 2.5 hour classes, 45-minuter daily home exercises, and a day-long weekend retreat during the fourth or sixth week. The classes and home exercises involved mindfulness meditation, body scans (directing attention to one part of the body at a time to increase inward awareness), and mindful movements such as stretching. At the end of the 8 weeks, the results showed that the mindfulness program was just as effective at reducing anxiety as medication.

By: Vanika Chawla, MD

Journal Reference:

Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. 2023;80(1):13–21. doi:10.1001/jamapsychiatry.2022.3679

January 13, 2023/by dom-wp-admin

Exercise During Difficult Times May Have Prolonged Positive Effects on Mood and Stress

Movement & Exercise, Stress Management

During periods of stress, many of us forgo exercising and indulge in unhealthy eating. This study provides insight into how physical acitivty can lead to stress reduction and enhance positive feelings if we are able to include exercise into our daily schedule during difficult times. The effect of physical activity lasts for hours after the session and has prolonged positive effect.

By: Sarita Khemani, MD, Head, Lifestyle Medicine Stress Pillar

Journal Reference:

Schultchen D, Reichenberger J, Mittl T, Weh TRM, Smyth JM, Blechert J, Pollatos O. Bidirectional relationship of stress and affect with physical activity and healthy eating. Br J Health Psychol. 2019 May;24(2):315-333. doi: 10.1111/bjhp.12355. Epub 2019 Jan 22. PMID: 30672069; PMCID: PMC6767465.

November 4, 2022/by dom-wp-admin

Healthy Lifestyle Habits Have Positive Effects on Mental Health

Movement & Exercise, Restorative Sleep, Stress Management

This review article clearly highlights the importance of healthy lifestyle choices on mental health. Whole plant based diet and daily exercise have remarkable effects on our mood. In many studies, the effect has been described as equivalent to taking antidepressant medications. In addition, good sleep, daily gratitude, positive thoughts about the future, and being of service to others has also been shown to have lasting positive effects on our mental health.

By: Sarita Khemani, MD, Head, Lifestyle Medicine Stress Pillar

Journal Reference:

Morton DP. Combining Lifestyle Medicine and Positive Psychology to Improve Mental Health and Emotional Well-being. Am J Lifestyle Med. 2018 Apr 18;12(5):370-374. doi: 10.1177/1559827618766482. PMID: 30283261; PMCID: PMC6146362.

November 4, 2022/by dom-wp-admin

Now Might Be the Time to Add Mindfulness Activities in Your Daily Routine

Stress Management

The beneficial effects of yoga, meditation and mind-body health were demonstrated in this study. 38 participants took part in a 3-month yoga and meditation retreat. Various measurements were obtained pre and post retreat. Significant increase in the plasma BDNF (brain derived neurotrophic factor) level was found post retreat. BDNF promotes development, survival, and plasticity of neurons in brain areas that play important roles in learning, memory and higher cognition. In addition, increase in the CAR (cortisol awakening response) was observed in participants post retreat suggesting role in improving stress resilience. Lastly, improvement in pro and anti-inflammatory biomarkers was also seen. Now might be the time to add meditation, yoga or other mindfulness activities in our daily routine.

By: Sarita Khemani, MD, Head, Lifestyle Medicine Stress Pillar

Journal Reference:

Cahn BR, Goodman MS, Peterson CT, Maturi R, Mills PJ. Yoga, Meditation and Mind-Body Health: Increased BDNF, Cortisol Awakening Response, and Altered Inflammatory Marker Expression after a 3-Month Yoga and Meditation Retreat. Front Hum Neurosci. 2017 Jun 26;11:315. doi: 10.3389/fnhum.2017.00315. Erratum in: Front Hum Neurosci. 2022 Apr 08;16:868021. PMID: 28694775; PMCID: PMC5483482.

November 4, 2022/by dom-wp-admin

Practice of the Month: 100-Breath Mindfulness Practice to Reduce Stress

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100-Breath Mindfulness Practice

How Does Breathwork Affect the Body?

5 Simple Changes to Your Bedroom for Better Sleep

How to Beat Jet Lag and Get Better Sleep While Traveling

Sleep Apnea: Causes, Symptoms, and Treatments

Finding Purpose in Midlife and Beyond

How Mindfulness Can Soothe Tension at Family Gatherings

Practice of the Month: Cultivating a Habit of Optimism

What Does it Mean to be Spiritual but Not Religious?

Jumping into the Ice Bath Trend! Mental Health Benefits of Cold Water Immersion

Supplements for Elite Athletic Recovery

Protein Needs for Adults 50+

Lifestyle Medicine Physician Works with Veterans to Improve Nutrition

Meal Prep Ideas for Busy People

3 Ways to Get (and Stay) Motivated to Exercise

The Impact of Exercise on Brain Health and Preservation

How Joy is Linked to Gratitude and Well-being

Optimism as a Means to a Longer Life

Health for the Holidays: Transforming Traditional Recipes with Expert Guidance

Epigenetics & Nutrition

Epigenetics & Sleep

Epigenetics & Stress

Epigenetics & Social Engagement

Epigenetics & Cognitive Enhancement

Sauna Use As a Lifestyle Practice

A Mindfulness Program May Be Just as Effective as Medication at Reducing Anxiety

Finding Purpose in Midlife and Beyond

How Mindfulness Can Soothe Tension at Family Gatherings

Practice of the Month: Cultivating a Habit of Optimism

What Does it Mean to be Spiritual but Not Religious?

Exercise During Difficult Times May Have Prolonged Positive Effects on Mood and Stress

Healthy Lifestyle Habits Have Positive Effects on Mental Health

Now Might Be the Time to Add Mindfulness Activities in Your Daily Routine

Resources

Pillars