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Stress Reduction in the Stress Reduction in the Non-Pharmacologic Non-Pharmacologic
Treatment Treatment of Metabolic Syndromeof Metabolic Syndrome
PAS 646 Master’s ProjectPAS 646 Master’s Project
Sherry KiernanSherry Kiernan
February 22, 2007February 22, 2007
Metabolic SyndromeMetabolic Syndrome
3 out of 5 of the following risk factors3 out of 5 of the following risk factors Abdominal ObesityAbdominal Obesity Increased Trig., LDL, Fasting Plasma Increased Trig., LDL, Fasting Plasma
GlucoseGlucose Decreased HDLDecreased HDL
The cardiovascular risk associated with The cardiovascular risk associated with the syndrome increases exponentially the syndrome increases exponentially with each additional factorwith each additional factor1 1
25% of adults fulfill the requirements for 25% of adults fulfill the requirements for MetSMetS22
Current Non-Pharmacologic Current Non-Pharmacologic Treatment OptionsTreatment Options
There is no “accepted” pharmacological There is no “accepted” pharmacological treatment plantreatment plan11
The recommended non-pharmacologic The recommended non-pharmacologic treatments are limited to treatments are limited to Diet and ExerciseDiet and Exercise
The challenge in recommending diet and The challenge in recommending diet and exercise is that not all programs are equally exercise is that not all programs are equally effective for everyone (high rate of failure)effective for everyone (high rate of failure)
Usual recommendation is a diet low in fat, Usual recommendation is a diet low in fat, high in fiber and fruits/veggies and at least high in fiber and fruits/veggies and at least 30 minutes of exercise daily30 minutes of exercise daily77
First Goal of TreatmentFirst Goal of Treatment
Clinically significant decreases in Clinically significant decreases in serum triglycerides, total serum triglycerides, total cholesterol, and increases in HDL cholesterol, and increases in HDL have been observed with even have been observed with even modest weight loss (10%)modest weight loss (10%)99
Improvement in blood pressure and Improvement in blood pressure and insulin resistance occurs as wellinsulin resistance occurs as well99
Weight Loss Should Be the Initial Weight Loss Should Be the Initial Goal of Treatment in MetS!Goal of Treatment in MetS!
Abdominal ObesityAbdominal Obesity To find an effective treatment, it is important To find an effective treatment, it is important
to understand the role of abdominal obesity in to understand the role of abdominal obesity in MetSMetS
The “pear shape” of Gynoid obesity is The “pear shape” of Gynoid obesity is notnot associated with developing MetSassociated with developing MetS
The “apple shape” of Android or Abdominal The “apple shape” of Android or Abdominal obesity is one of the defining characteristics obesity is one of the defining characteristics of MetS and may be the cause of developing of MetS and may be the cause of developing all of the other risk factorsall of the other risk factors
The main difference is the metabolism of The main difference is the metabolism of adipocytes depending on where they are adipocytes depending on where they are distributeddistributed
Role of Stress and Cortisol Role of Stress and Cortisol in in
Abdominal ObesityAbdominal Obesity Chronic Stress leads to HPA axis Chronic Stress leads to HPA axis
dysregulation of cortisol and plasma levels dysregulation of cortisol and plasma levels stay elevatedstay elevated
The The more metabolically activemore metabolically active abdominal abdominal adipocytes are more responsive to adipocytes are more responsive to chronically elevated levels of cortisolchronically elevated levels of cortisol
As a glucocorticoid, cortisol has many effects As a glucocorticoid, cortisol has many effects on glucose metabolism:on glucose metabolism: Opposition of insulinOpposition of insulin Inhibition of protein synthesis in peripheral tissuesInhibition of protein synthesis in peripheral tissues Activates lipoprotein lipase which causes an Activates lipoprotein lipase which causes an
accumulation of lipids in accumulation of lipids in abdominal adipocytesabdominal adipocytes
The Stress LinkThe Stress Link
Chronic stress contributes to MetS when the Chronic stress contributes to MetS when the stress is frequent and the ability to cope is stress is frequent and the ability to cope is impairedimpaired4,64,6
The HPA Axis becomes unresponsive to the The HPA Axis becomes unresponsive to the physiologic diurnal variation physiologic diurnal variation
Blood levels of cortisol never return to basal Blood levels of cortisol never return to basal levels after a period of stresslevels after a period of stress66
Animal studies have proven that a daily Animal studies have proven that a daily trough lasting several hours is necessary to trough lasting several hours is necessary to prevent negative effects of excess cortisol on prevent negative effects of excess cortisol on peripheral tissuesperipheral tissues88
Relationship Between Relationship Between Stress, Cortisol, and MetSStress, Cortisol, and MetS
MetS is not just about weight loss - it is a complex MetS is not just about weight loss - it is a complex syndrome with many causal factorssyndrome with many causal factors
There is a strong relationship between chronically There is a strong relationship between chronically increased levels of cortisol due to stress and increased levels of cortisol due to stress and accumulation of fat in the abdominal regionaccumulation of fat in the abdominal region
Stress is an integral part of every day life for most Stress is an integral part of every day life for most peoplepeople
Diet and Exercise may not be sufficient to correct Diet and Exercise may not be sufficient to correct the HPA axis dysfunctionthe HPA axis dysfunction
Incorporating a Incorporating a stress-reducing therapystress-reducing therapy into the into the treatment of MetS may help to break the cycle of treatment of MetS may help to break the cycle of dysregulation and assist patients in losing the dysregulation and assist patients in losing the abdominal fat that is contributing to the syndromeabdominal fat that is contributing to the syndrome
What Are the Stress-What Are the Stress-Reducing Options?Reducing Options?
Massage TherapyMassage Therapy Music TherapyMusic Therapy YogaYoga QigongQigong Transcendental Transcendental
MeditationMeditation
(Just to name a (Just to name a few…)few…)
How do we measure How do we measure Stress?Stress?
The intimate relationship between The intimate relationship between plasma cortisol levels, stress, and plasma cortisol levels, stress, and MetS suggests that measuring MetS suggests that measuring changes in cortisol production would changes in cortisol production would be a consistent way of evaluating the be a consistent way of evaluating the efficacy of each therapyefficacy of each therapy
Changes in plasma, salivary, or Changes in plasma, salivary, or urinary cortisol levels can be urinary cortisol levels can be measuredmeasured
What Were the Findings?What Were the Findings?
Trials using Massage Trials using Massage Therapy, Music Therapy, Therapy, Music Therapy, Yoga, Qigong, and TM all Yoga, Qigong, and TM all had positive findings for had positive findings for lowering cortisol levels lowering cortisol levels
Most of the studies had Most of the studies had other positive findings other positive findings such as lowered blood such as lowered blood pressure or better insulin pressure or better insulin utilization further utilization further supporting the benefits supporting the benefits for Met S patientsfor Met S patients
Transcendental Meditation Transcendental Meditation
May Decrease Healthcare May Decrease Healthcare CostsCosts Numerous studies have shown the benefits of Numerous studies have shown the benefits of
TM for lowering stress and improving the risk TM for lowering stress and improving the risk factors associated with MetSfactors associated with MetS1515
What makes TM unique is that the cost-What makes TM unique is that the cost-benefit of using TM for health improvement benefit of using TM for health improvement has actually been studiedhas actually been studied1616
5 years of insurance claims by 2000 practitioners 5 years of insurance claims by 2000 practitioners of TM were analyzedof TM were analyzed
They had 87% fewer inpatient admissions and outpatient They had 87% fewer inpatient admissions and outpatient visits for cardiovascular diseasevisits for cardiovascular disease
The non-cardiovascular disease related visits did The non-cardiovascular disease related visits did not change so there was no aversion to traditional not change so there was no aversion to traditional medicinemedicine
Advantages and Advantages and Disadvantages to each type Disadvantages to each type
of Relaxation Therapyof Relaxation TherapyRelaxation Relaxation Tech.Tech.
AdvantageAdvantage DisadvantageDisadvantage
Massage Massage TherapyTherapy
Widely Widely availableavailable
ExpensiveExpensive
Music Music TherapyTherapy
Cost EffectCost Effect ??????
YogaYoga Widely Widely availableavailable
Very physical Very physical and few and few studies in USstudies in US
QigongQigong Limited avail. Limited avail. of trained of trained prof.prof.
Culturally Culturally acceptable???acceptable???
TranscendentTranscendental Meditational Meditation
Non-physical Non-physical and very and very versatileversatile
Life-style Life-style changechange
ConclusionConclusion
Alleviating chronic stress helps to Alleviating chronic stress helps to normalize cortisol levelsnormalize cortisol levels Restoring balance decreases deleterious Restoring balance decreases deleterious
effects of cortisol excess on peripheral tissueseffects of cortisol excess on peripheral tissues May help to lose the abdominal obesity - May help to lose the abdominal obesity -
improves all aspects of the syndromeimproves all aspects of the syndrome Adding a relaxation method to diet and Adding a relaxation method to diet and
exercise exercise may be the keymay be the key to treatment to treatment success in Metabolic Syndrome – Only success in Metabolic Syndrome – Only more researchmore research will tell will tell
SourcesSources 1. Hadley, RD. Treatment options for metabolic 1. Hadley, RD. Treatment options for metabolic
syndrome. The Clinical Advisor. 2005 Nov;45-55.syndrome. The Clinical Advisor. 2005 Nov;45-55. 2. Levy D. Epidemiology of obesity and its 2. Levy D. Epidemiology of obesity and its
cardiovascular consequences. Audio-Digest Special cardiovascular consequences. Audio-Digest Special Topics. 2006 May;10(2).Topics. 2006 May;10(2).
3. Nesto R. Metabolic syndrome and obesity. Audio-3. Nesto R. Metabolic syndrome and obesity. Audio-Digest Special Topics. 2006 Jun;10(3).Digest Special Topics. 2006 Jun;10(3).
4. Gans, RO. The metabolic syndrome, depression, and 4. Gans, RO. The metabolic syndrome, depression, and cardiovascular disease: interrelated conditions that cardiovascular disease: interrelated conditions that share pathophysiologic mechanisms. Med Clin N Am. share pathophysiologic mechanisms. Med Clin N Am. 2006;90:573-91.2006;90:573-91.
5. Hjemdahl, P. Stress and the metabolic syndrome: an 5. Hjemdahl, P. Stress and the metabolic syndrome: an interesting but enigmatic association. Circulation. interesting but enigmatic association. Circulation. 2002;106:2634.2002;106:2634.
6. Bjorntorp P. Do stress reactions cause abdominal 6. Bjorntorp P. Do stress reactions cause abdominal obesity and comorbidities? Obes Rev. 2001;2:73-86.obesity and comorbidities? Obes Rev. 2001;2:73-86.
SourcesSources 7. Kushner R. Modest weight loss and cardiometabolic 7. Kushner R. Modest weight loss and cardiometabolic
risk. Audio-Digest Special Topics. 2006 May;10(2).risk. Audio-Digest Special Topics. 2006 May;10(2). 8. Jacobson L. Hypothalamic-pituitary-adrenocortical 8. Jacobson L. Hypothalamic-pituitary-adrenocortical
axis regulation. Endocrinol Metab Clin N Am. axis regulation. Endocrinol Metab Clin N Am.
2005;34:271-92.2005;34:271-92. 9. Borgman M, McErlean E. What is the metabolic 9. Borgman M, McErlean E. What is the metabolic
syndrome? Prediabetes and cardiovascular risk. J syndrome? Prediabetes and cardiovascular risk. J Cardiovasc Nurs. 2006;21(4):285-90.Cardiovasc Nurs. 2006;21(4):285-90.
10. Field T, Hernandez-Reif M, Diego M, Schanberg S, 10. Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cortisol decreases and serotonin and Kuhn C. Cortisol decreases and serotonin and dopamine increase following massage therapy. Int J dopamine increase following massage therapy. Int J Neurosci. 2005;115:1397-1413.Neurosci. 2005;115:1397-1413.
SourcesSources 11. Miluk-Kolasa B, Obminski Z, Stupnicki R, Golec 11. Miluk-Kolasa B, Obminski Z, Stupnicki R, Golec
L. Effects of music treatment on salivary cortisol in L. Effects of music treatment on salivary cortisol in patients exposed to pre-surgical stress. Exp Clin patients exposed to pre-surgical stress. Exp Clin Endocrinol. 1994;102(2):118-20.Endocrinol. 1994;102(2):118-20.
12. Innes KE, Bourguignon C, Taylor AG. Risk indices 12. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Pract. yoga: a systematic review. J Am Board Fam Pract. 2005;18:491-519.2005;18:491-519.
13. Lee MS, Lee MS, Kim HJ. Qigong reduced blood 13. Lee MS, Lee MS, Kim HJ. Qigong reduced blood pressure and catecholamine levels of patients with pressure and catecholamine levels of patients with essential hypertension. Int J Neurosci. essential hypertension. Int J Neurosci. 2003;113:1691-1701.2003;113:1691-1701.
SourcesSources 14. Lee MS, Rim YH, Kang CW. Effects of external Qi-14. Lee MS, Rim YH, Kang CW. Effects of external Qi-
therapy on emotions, electroencephalograms, and therapy on emotions, electroencephalograms, and plasma cortisol. Int J Neurosci. 2004;114:1493-1502.plasma cortisol. Int J Neurosci. 2004;114:1493-1502.
15. Paul-Labrador M, Polk D, Dwyer JH, Velasquez I, 15. Paul-Labrador M, Polk D, Dwyer JH, Velasquez I, Nidich S, Rainforth M, et al. Effects of randomized Nidich S, Rainforth M, et al. Effects of randomized controlled trial of transcendental meditation on controlled trial of transcendental meditation on components of the metabolic syndrome in subjects components of the metabolic syndrome in subjects with coronary heart disease. Arch Intern Med. with coronary heart disease. Arch Intern Med.
2006;166:1218-1224.2006;166:1218-1224. 16. Waltonb KG, Schneider RH, Nidich S. Review of 16. Waltonb KG, Schneider RH, Nidich S. Review of
controlled research on the transcendental meditation controlled research on the transcendental meditation program and cardiovascular disease. Cardiol in program and cardiovascular disease. Cardiol in Review. 2004:12:262-6.Review. 2004:12:262-6.
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