Health is the foundation of well-being virtue, prosperity, wealth, happiness, and salvation.
—CHARAKA SAMHITA
I first met Savita fifteen years ago when she came to my office with her father-in-law, who was suffering from a heart ailment. She was a young bride then, and her husband, Pradeep, a bright young man, was working in marketing. They seemed to be a happy couple.
I didn't see them again until two years ago, when Pradeep brought Savita to my office complaining of pains in her chest. The pains had been going on for several weeks, but for the last two or three days they had been occurring at the slightest exertion and were accompanied by shortness of breath and some sweating.
The ECG and other tests confirmed that Savita had angina. She was only thirty-four—rather young for coronary heart disease. We kept her in the hospital for a few days till her pains stabilized. When her condition improved, I talked to her and Pradeep in depth. It seems that Savita had been suffering from depression and insomnia for nearly a year. As we spoke, the reasons came out.
Savita told me that she was very proud of Pradeep. "He is a
4 YOUR LIFE IS IN YOUR HANDS
wonderful husband and doing so well/' she said. Indeed, Pradeep was an achiever. A very ambitious, hard-working person, he went up the ladder quickly in the company he was working for when I first met them, and now had his own chain of companies. He was doing extremely well financially. But there were problems.
"He has no time for breakfast," Savita told me. “He hastily gobbles toast or something before he rushes to his office. At work there are tensions, anxieties, and the rush to beat each deadline before the next one comes up. We have no regular meals. When he finally reaches home—late, of course—he has a sandwich in one hand and a pen in the other. And he has a phone and a fax machine in the car."
"I can't help it," Pradeep broke in, somewhat defensively. "I have to work in the car. What else can I do? It takes a long time commuting to and from the office. You know how bad the traffic is. I can't afford to waste all that valuable time."
Savita picked up where she had left off. "In the office there are endless cups of tea and coffee, and overflowing ashtrays. At home, we have a fax machine in the bedroom, and there are phone calls all the time. When it is supposed to be our sleeping time, it is office time in New York and Pradeep has to talk business over the phone.
"Often he comes home so late, because of an important meeting, that I'm already asleep. This leads to arguments between us.
"Occasionally he may be home a little earlier than usual, but then he might ask me to get ready in just a few minutes as he has invited some friends for cocktails. Over drinks, the discussions on business matters with his clients from abroad may go on for hours, and we reach home very late.
"I thought that if I did some work in his office, that would keep me busy and I would see more of him. But in the office, I would hear discussions about the intricacies of business, and that was an extra strain on me."
Clearly, Savita's problems with her heart stemmed to a great extent from the stressful lifestyle she and Pradeep were leading.
Indeed, the effects of stress on the heart have been known since time immemorial. Five thousand years ago, according to the story recorded in the ancient Indian epic the Ramayana, King Dasharatha, in order to honor a boon he had long ago promised to his young queen Kaikeyi, had to send his beloved son Rama, heir to the throne, to the forest for fourteen years. The extreme agitation he felt resulted in his dying of cardiac arrest.
As the English physician William Harvey wrote in the early seventeenth century, “Every affection of the mind is attended by either pain or pleasure, hope or fear, and is the cause of agitation whose influence extends to the heart."
We gave Savita a balloon angioplasty treatment for her angina, and she felt much better. I didn't wish to upset her, but I had to inform her that in more than 33 percent of patients who undergo this treatment, restenosis (obstruction) recurs at the same or another site within only about three months, and the procedure has to be repeated. She needed to do something about the stress in her life.
Women and Heart Disease: Victims of Our Modern Lifestyle?
If you are thinking that it is unusual to use a woman as an example of a cardiac patient, until quite recently you would have been completely right. I used to teach my students in the medical college that women never have angina or heart attacks before the onset of menopause. The reason? Female hormones are protective against atherosclerosis, the hardening of the arteries caused by fatty deposits on the inner lining of the blood vessels, and atherosclerosis of the coronary arteries is a cause of heart attacks.
The situation has changed dramatically in recent years. Now more than one third of heart attack and angina patients worldwide are young women between the ages of thirty and forty-five. Apparently the protective effect of female sex hormones has been neutralized by women's newly acquired lifestyle.
6 YOUR LIFE IS IN YOUR HANDS
The majority of heart disease patients still are men, but more than one third are now women. The rate is higher in urban areas
and is rising steeply everywhere.
The strongest predictor of death from heart disease in women is diabetes, which carries a 4.5-fold increased risk. There are over ten million diabetics in India, the majority of them women. There are over fifteen million diabetics in the USA and nearly 1.5 million in the UK.
Another major risk factor, for both men and women, is high cholesterol levels in the blood. The body makes more cholesterol when you are emotionally stressed, and women are under greater emotional pressure than ever before. Women's average levels of both total cholesterol and the "bad” LDL cholesterol (low density lipoprotein) are high, while levels of the "good” protective cholesterol (high density lipoprotein, or HDL) are low.
Triglycerides, another risk factor for heart disease, appear in the blood after you eat a meal containing a lot of fat. Triglyceride levels are high among Indian women.
Yet another risk factor, especially when it occurs along with other risks, is obesity, or being significantly overweight. This too is increasingly common among women.
The increased incidence of obesity, diabetes, high cholesterol, and coronary heart disease can be attributed in large part to two main factors:
— poor diet, containing too many sweets, fatty foods, and deep- fried foods which have a lot of hidden fat, and
— insufficient physical activity, a condition common among middle-class and affluent urban women.
In addition, more and more women throughout the world are consuming tobacco, clearly shown to be a major risk factor for heart disease. Tobacco companies have proven adept at using advertising to successfully promote smoking as a sign of women's increasing independence and equality. Tragically, it will also be a cause of women's increasing suffering and death from lung cancer and heart disease.
Savita s life could hardly have been a more perfect example of these risk factors. She never undertook any exercise, was fond of chocolates and sweets, was overweight, and smoked. As the story of her life with Pradeep revealed, she had a lot of mental stress as well. And stress is one of the most powerful causative factors in heart disease. Savita, like her husband, was becoming a time-stacker, juggling with two or more tasks at a time without doing justice to any of them, and living life in the fast lane. She had no time to look at a beautiful sunset and relax; she had no time for traditional yoga and meditation. This adoption of a modern Western lifestyle by Indian women would seem to have brought about some negative effects on their health and happiness. More and more women work outside the home these days. This puts a heavy load on them as they often take primary responsibility for the children and the household in addition to working at their jobs.
Some Stress Has Its Place
Before we go any further, it is important to say that stress is an unavoidable fact of life that has been with us since the beginning of time, and will always be part of human life. Responding creatively to it has been responsible for our continued survival on this planet.
Some stress makes life interesting and meaningful. It keeps you on your toes. If you are driving in chaotic city traffic, it will help keep you alert about your safety and the safety of others around you. But too much stress and tension are cause for concern, as they will almost inevitably interfere with your daily activities and have a negative impact on your health and happiness.
Everybody has ups and downs, and surely life would be dull without them. The stresses and tensions of daily living cannot and should not be completely avoided or eliminated, otherwise life would become a mere passive existence, rather than active.
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creative living. But if it is not properly managed, stress can become a source of unhappiness and disease.
The Dangers of Stress
Let us first understand what stress can actually do to us; then we will be motivated to find ways to avoid letting it get us down.
Whenever we are faced with a threat, challenge, or danger, our body reacts with what is called the "fight or flight" response. The hypothalamus, a small portion of the brain that controls all the automatic functions of the body, activates the nervous system and hormonal system. What follows is an instantaneous and almost miraculous mobilization of all the body's forces, helping us to tackle the situation and protect ourselves, either by fighting or running away.
Chemicals such as adrenaline and noradrenaline are released into the bloodstream, producing a surge of energy along with faster heart rate (120-200 beats per minute), increased blood pressure, and faster breathing, in order to take in more oxygen. Blood flow to the brain and muscles increases, making us stronger and more alert. The pupils of the eyes dilate to increase visual ability, and hearing power is likewise heightened. Arteries in the limbs constrict and the blood clots more easily, to prevent blood loss in case of injury in the anticipated fight.
When the threatening situation has either been met or diverted, the nervous system allows the muscles to relax, and the heart rate and breathing return to normal. The body is, however, left with a residue of fatigue that can be quite considerable.
This response pattern served well when the primitive ape- man had to face a wild animal, and there are occasional events in life when it is an extremely helpful protective mechanism. But the manifestations are exactly the same when we need to face the boss or rush to meet a deadline, and that is the cause of many health problems.
If we live our life with so much anxiety and tension that everyday events feel like tigers about to pounce, we will be con-
tinually gearing ourselves up for battle, and the body's powerful fight or flight response will recur day after day. This will be exhausting, and the resulting build-up of stress on body and mind may end up making us miserable, worried, sleepless, depressed, and ill. And if, like Savita, we allow it to build up week after
week, month after month for fifteen years or more, it can also lead to serious heart problems.
Stress can also induce or aggravate other diseases, such as bronchial asthma, colitis, and neurodermatitis. But the brunt of it (especially in the elderly) generally falls on the heart. If there is already high blood pressure, stressors such as extremes of weather as well as anxiety, anger, and frustration may precipitate exa gg erate d levels of harmful chemicals in the body, which can then aggravate heart disease or trigger a heart attack.
Experiments have been conducted in which a person is asked to do mental arithmetic, solving difficult problems in a short time while a stern examiner repeatedly reproaches him for incorrect answers. The result of this stressful experience is a marked rise in both systolic and diastolic blood pressure both in people who have high blood pressure and (to a lesser extent) in those with normal pressure. The heart's rhythms may also become quite irregular.
Stress in the modern world comes from every direction. Many of us are busy killing ourselves slowly by indulging in smoking, alcohol abuse, greed, jealousy, and the race to acquire wealth at all costs, by means fair or foul. Other psychological pressures, such as anxiety, a fit of anger, or having sex with someone other than one's marital partner, have been known to bring on heart attacks.
Repeated exposure to stress induces changes in the nervous system that can provoke the heart to miss beats. Cumulative stress can cause potentially dangerous irregularities of the heartbeat and decreased flow through the coronary arteries.
So far, I have been focusing on Savita because she was the patient who came to me with the actual heart problem. But if you
10 YOUR LIFE IS IN YOUR HANDS
look at Pradeep's life, you can see that he has been under even more stress than his wife for many years, and it is clear that he is headed for trouble.
Pradeep told me that sometimes he feels completely exhausted but does not know what he can do about it. He feels that he has to continue doing what he is doing. "Why should I slow down?" he asked me, without expecting a convincing answer. "Each little bit of effort means another step up the ladder"—in his case to heights of glory in the business world. And why should he stop smoking and consuming alcohol? Both help him to relax. After all, he said, he has no symptoms of disease.
The fact is that Pradeep doesn't realize what he is heading for. Probably his sense of achievement is protective to some extent, and perhaps he has been genetically blessed with a strong constitution, but how long can he keep going? Even now he can't sleep without a tranquilizer. Scotch whisky helps him to relax, but its effect is over in a few hours. He admits he has been more irritable lately, and gets angry with his staff over minor matters.
Although he has no specific disease symptoms, Pradeep certainly cannot be considered a healthy man. Many diseases, including heart disease, may remain in the formative stages for years. During this time the person has no obvious symptoms except perhaps a general feeling of not being quite up to the mark.
Besides, a positive state of health and happiness is much more than the absence of disease.
Symptoms of Stress
Typical symptoms of excess stress include nervousness, heart palpitations, loss of appetite, and difficulty sleeping. These are all symptoms of anxiety. Some anxiety is a natural part of life, but prolonged anxiety can lead to serious conditions such as stomach ulcers, high blood pressure, angina, heart disease, and cancer.
Stress can also bring on depression. Again, a certain amount of depression may be considered normal in human beings and
may occur, for example, when we fall short of what we expect or hope for. But prolonged depression can result in deep fatigue, inability to concentrate and to cope with one's responsibilities, sleeplessness, loss of appetite, feelings of worthlessness and hopelessness, and a lack of interest in family, sex, and life in general.
Prolonged or repeated episodes of stress can exacerbate the disease process and accelerate aging. This is illustrated by a rather heartless biology experiment performed a number of years ago, in which young rats were thrown time and again into a tank of water. Rats are not adept swimmers, so the animal will flail about trying in vain to climb out of the tank, only to repeatedly slip back down from the glass wall into the water.
After a few minutes the rat is totally exhausted and on the verge of drowning. The experimenter pulls it out and allows it to rest. The procedure is repeated over the following days. Within a short period, usually less than three weeks, the rat undergoes dramatic changes. The pressure of so much daily stress ages its tissues enormously. If the experiment is continued, the rat will die of “old age” in a matter of a month. On dissection, its heart, liver, lungs, and other organs will be as dark, tough, and fibrous as those of a rat that lived a normal lifespan of two or three years.
This same abnormal acceleration of aging can happen to us, if we allow ourselves to live under prolonged stress. However, unlike the rats, we can use our intellect and sense of discrimination to manage stress to our advantage, and thus avoid premature aging and falling victim to disease. Use your physical and mental abilities to the full, but don't be on the run all the time, or you will be separated from your loved ones much earlier than you should be. Wise men hasten slowly in life.
Causes of Stress
Medical science has identified many causes of stress:
— the death of a spouse, family member, or friend
— a sudden difficult or painful event, such as a major illness, an accident, or loss of a job
_divorce or separation from a spouse
— financial problems, such as reduced income or mounting debts
— a new job
— moving to a new location
_increased family responsibilities, such as a new child
_retirement, with its enforced leisure and reduced income.
Even without these unusual events, the ordinary events of daily life are often stressful enough to bring on serious medical problems. Serum cholesterol, one of the risk factors for heart disease, can be greatly elevated by chronic work stress. One study, for example, found that cholesterol levels went up in certified public accountants in the USA during their tax preparation season.
Increased sickness and higher death rates due to heart attacks are more common in people who lack close family and community ties, and particularly among bereaved men. Heart disease is also more common in people who have financial problems or interpersonal conflicts, and among those who are overachievers or have very aggressive personalities.
Strong emotions, or situations that are emotionally trying, frequently have an adverse affect upon the heart. One of my patients, who was in the hospital for angina, underwent ventricular tachycardia (irregular heartbeat) and showed other changes on his ECG whenever his business partner visited him. Another patient suffered from spasms of the arteries supplying the heart when his estranged wife came for a visit.
Cumulative stress can affect the already functionally compromised hearts of elderly people much more adversely than those of younger people, and then an emotional upheaval can lead to a heart catastrophe. In a study published in the American Journal of Cardiology in 1993, patients with a history of angina were asked to recall a recent event that had made them angry. As they thought about the upsetting situation, significant narrowing of the coronary arteries was observed, along with symptoms of angina.
This astonishing fact—that even the thought or memory of
anger can unfavorably affect the heart-gives us an important clue regarding how we can manage stress to create better health. It suggests that our ability to handle stress depends to a large extent on our minds, and on the quality of our thoughts. We will look in depth at this crucial insight in Chapter 2.
Savita's balloon angioplasty treatment completely eliminated her angina symptoms. She was feeling much relieved a few days later, when I had a long talk with her and tried to impress on her that this was not the end of the story.
"You know, you have the same heart as before the treatment, I told her. "The arteries of your heart are not normal, and m one or two places the narrowing is critical. We have dealt with this for the moment, and you are fine. But to remain fine, without those horrible chest pains, and to avoid bypass surgeiy or the possibility of a heart attack, you need to change your lifestyle. Surgeiy is not the way to keep healthy. If you continue with the same life you had before the treatment, you are inviting recurrences."
It took me several sittings with Pradeep and Savita to convince them they needed to change their way of living in order to lead a truly happy, healthy life. Once they became convinced, they acted immediately on their new understanding. We had sessions together on diet and on exercise. I sent them to classes to learn yoga asanas, pranayama (breathing exercises), and meditation. It is two years now since both of them began to meditate regularly and took up a low-fat vegetarian diet. Selfdestructive habits, including smoking and excess alcohol use, have dropped off spontaneously.
They are far more relaxed, happy, contented, and healthy, and are really enjoying life after many years of suffering. They find more time to play with their children. They are working together now; harmony and peace prevail at home and in the office.
Once Pradeep realized how much stress he was carrying, and how very much better he could feel without drinking, smoking, and pushing himself beyond a reasonable limit, I think he would have accepted some decrease in his business success as a fair
price to pay for increased happiness and better health. But the fact is that his business is flourishing even better than before.
You cannot avoid stress in your life, but you can learn to manage it. I have used this chapter to paint a rather dark portrait of the problems of stress and ill health facing us as individuals and as a society. But in the story of Pradeep and Savita I have also given a glimpse of where the solutions lie. In the rest of the book I will introduce you to many effective ways to combat stress and improve your health and well-being using simple, entirely natural means.
Although I have come to recognize and appreciate these strategies over fifty years of medical practice, they are not my private discoveries. Rather, they are the fruit of modern scientific research and time-tested ancient wisdom. In an age of ever- increasing stress, they are vital secrets to good health. And according to the great Indian physician Charaka, “Health is the foundation of well-being, virtue, prosperity, happiness, and
salvation."