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

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