The connection between stress, inflammation and chronic disease has become quite clear to me in my practice. Let’s talk about a patient of mine (name and details changed) to illustrate the point and then discuss some of the supportive science.
Case Study
Dev (name changed) is a 45-year-old hard driving Silicon Valley executive who was referred to me for a consult after experiencing a heart attack. I reviewed his chart before seeing him in the exam room and expected to see the typical overweight, insulin resistant, inactive patient but was surprised to see that Dev looked remarkably fit. He actually had a company physical with labs a year before that showed normal lipids, normal blood pressure, and normal blood glucose. He was an exercise fanatic who ran 5 days a week and attended spin classes on weekends. He had no family history of heart disease and ate a healthy diet. The only thing that stood out on his lab report was an elevated hsCRP, a marker for inflammation. What was going on? Dev’s case was not unique. Although the majority of patients I see have identifiable, mostly reversible risk factors for heart disease like diabetes, obesity, and abnormal cholesterol, I’m seeing a growing number of occult heart disease in remarkably fit and healthy appearing patients. They may have most of the usual items checked off their healthy lifestyle list, like nutrition and exercise, but they continue to push one key factor aside….STRESS! Even after Dev’s heart attack, his hsCRP levels remained elevated and he had a hard time accepting the fact that his intense workout regimen layered upon a high stress lifestyle may have been the culprit. There is growing evidence that endurance athletes like marathon runners may have a higher risk of developing heart disease as discussed here. Most of my patients are not training at this level, but many are leading highly stressful lives followed by intense workouts with very little rest periods in between.
NF-kB: A Genetic Switch for Inflammation
Molecular evidence for this points to a key protein found in cells called NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) which upon activation turns on multiple genes involved in triggering inflammation, the underlying process behind heart disease and virtually every chronic health condition from cancer to Alzheimer’s disease. It’s literally a genetic switch that stokes the flames of inflammation. Exercise sessions can trigger a transient bout of NF-kB induced inflammation which is a classic example of a phenomenon known as hormesis. Hormesis means exposure to a low dose of toxin or stress, in this case exercise, can trigger beneficial after effects such as the creation of anti-oxidant substances and pathways that slow aging. However some individuals who exercise hard every day or dive directly into a busy work day after a hard workout may not be allowing enough time to allow hormesis to manifest. In talking to Dev, this appeared to be the case. He slept 5 hours a night and had barely any rest periods built into his daily schedule. Chronic emotional and physical stress were feeding a 24-7 cycle of inflammation that ultimately manifested in a near fatal heart attack. Emotional stress and mental disorders like depression appear to activate NF-kB as shown here.
Meditation Can Tame NF-kB Overactivation
Fortunately NF-kB induced inflammation can be brought under control with stress-reducing practices like meditation. This study shows how a specific 12-minute meditative practice, known as Kirtan Kriya Meditation or KKM reversed NF-kB activation. Studies also suggest improved memory in practitioners of KKM which is actually recommended on the Alzheimer’s Disease Research and Prevention Foundation website here. Any form of meditation or a practice that involves slow movement and breathing (Yoga, Tai chi, etc.) should produce similar results. Here’s an article I wrote on Prescription Meditation.
Dev’s Transformation
I was finally able to convince Dev to dial down his intense workouts to twice a week, I prescribed an activity monitor and asked him to walk at least 8,000 steps daily, and he added a program of daily meditation for 10-20 minutes. It took several months, but finally his hsCRP dropped down to normal. By the way, even if your hsCRP level is normal, you may still be experiencing chronic inflammation since no single blood test can detect this predictably and accurately. Emotional stress is not the only reason for elevated hsCRP and inflammation, but I’ve seen enough cases where hsCRP dropped after stress management to convince me that the two are strongly correlated. There is lots of individuality and nuance to this. I’m not telling you to stop exercising hard, but to instead follow your mind-body signals to make sure you are not wearing yourself down. Exercise produces a surge in pleasure-generating endorphins that can be downright addictive, preventing you from seeking sufficient rest periods between exercise intervals. If you’re suffering from chronic stress, understand that exercising longer and harder may not be the answer and may actually be doing more harm than good.
