Fight Fat after Forty: The Revolutionary Three-Pronged Approach That Will Break Your Stress-Fat Cycle and Make You Healthy, Fit, and Trim For Life

1. The Stages of Stress

The Early History of Stress

I spend quite a bit of time in airports between flights, and I've found through the years that I've spent much of my waiting time watching for at least one traveler to implode. It almost always happens. Did you ever notice that?

Whether people are jostling for position at the baggage claim or fighting for a taxi, their nerves are frazzled and frayed. Airports are the perfect stress science laboratory.

One of my most memorable episodes happened when a flight I was about to take was inexplicably canceled. Along with a throng of other passengers, I was herded from one concourse to another and not given any information on the next available flight. Finally, we were told to go to a certain gate, where we would be issued a new boarding pass. I got my aerobic activity walking from one end of the airport to the other-and, of course, my resistance training carting what felt like fifty pounds of luggage.

When I finally huffed up to the gate, I joined the long line of unhappy passengers. The ticket agent behind the desk was desperately trying to do what he could. One man, about third in line, was tapping his foot anxiously. He had the Armani suit. He had the cell phone. He had the designer leather briefcase. And he was not happy. I could see, even from the back, that he was the one, the Imploder.

I waited. I watched. Sure enough, eventually he just couldn't handle it anymore. You could tell he was getting more and more stressed out. He abruptly stepped out of line, pointed at the young ticket agent, and yelled, "Do you know who I am?"

You could have heard a pin drop in the boarding area. I thought, "Oh, no, we're going to have a fight!"

Without missing a beat, the ticket agent calmly looked up at the man standing in front of the Imploder and said, "Sir, could you please help me? I would like you to assist the man behind you. He doesn't seem to know who he is!"

Needless to say, the Imploder was more than a little upset. He made a fuss about seeing the "supervisor," but then, red-faced, he took his boarding pass and sat down.

When I finally got up to the counter, I couldn't help but ask the young agent how he had managed that confrontation so gracefully. "Have you spent seven years in Tibet?" I asked with a laugh.

"No," he answered. "Come on, think of what I do for a living. Most of my customers are anxious and in a hurry." He used calm humor to neutralize a highly charged situation. He had a plan that worked for him.

I realized this is what life is all about: developing a plan that works. After learning what stress does to the human body, you'll be able to develop a plan that works for you.

Hans Selye, M.D., the father of stress physiology, said, "Life is stress and stress is life." But for many years, most advice on how to handle stress was within the purview of the science of psychology. Magazine articles, which ofttimes recommended that you "chill out...calm down...take a deep breath," rarely mentioned the scientific basis for those suggestions. We now have better science to help clarify the issue. I'm going to show you the irrefutable and elegant science behind stress and how to manage it.

Ironically, our understanding of the effects of stress began with a promising young scientist-Selye-in 1936. Originally, he wasn't interested in studying stress. Instead, he did research in the field of reproductive medicine, specifically the function of the ovaries. Assisting another colleague, he worked with rats in a lab, tagging them and observing their behavior. When they had lived out their natural lives, Selye would perform an autopsy on each of them to examine their ovaries.

In the laboratory, Selye tried frantically to tag the rats without dropping them. I don't know if you've ever tried to pick up rats, but they don't like it very much. Selye spent much of his time chasing the rats after inadvertently dropping them. Later, when performing autopsies on the rats, he made a startling discovery. To his amazement, the rats he had repeatedly dropped all had ulcers whereas the others did not.

At first he was unsure of what this discovery meant. He thought there might be a relationship between the stress of the dropping-a mental function-and its effects on body systems-the ulcers. In other words, what occurred in the mind affected the body. To prove his point, Selye decided to do a second study. This time, he studied two groups of rats. One group was treated normally, lived well, ate well, and was basically left alone. The other group he routinely dropped on schedule, every day. It may seem like a strange experiment, but scientific investigations are often that way. Many times, great discoveries occur through serendipity.

When the second group of rats finally died, Selye found ulcers in almost all of them. He had proven to himself that there was a direct relationship between mental stress and bodily disease.

Over the past twenty years, many scientists have devoted their careers to studying the effects of psychological stress on the body. For instance, Tiffany Fields, Ph.D., at the University of Miami School of Medicine, published studies that showed that therapeutic massage could accelerate the rate of growth of premature infants. Such babies endure tremendous physical and psychological stress. Hands-on nurturing was able to neutralize growth inhibition normally caused by their high level of chronic stress.

Judging from the discoveries by Selye, Fields, and others, it seems we need frequent caressing or nurturing to reverse the effects of chronic stress. Every person perceives stress and handles it in a way that is comfortable to her. Some people are born with the ability to handle stress with greater ease than others. These individuals are actually born with body tissues that are more resistant to stress hormones and, therefore, hardier. Many factors must be considered when trying to understand what it takes to achieve the goal of Stress Resilience in the handling of daily life.

I have always been fascinated with what is required to achieve Stress Resilience. I am particularly interested in the role nutrition plays in improving or worsening daily stress. In pursuit of that goal, I became a Pew Foundation postdoctoral scholar in nutrition and metabolism while at the University of California at Davis. During my studies, it had become clear to me that so much of the disease and death I was observing as a physician was a direct result of how patients dealt with life stresses. It appeared that harboring chronic stress is toxic to most body systems. In addition, uncontrolled, chronic stress seemed to lead to destructive eating, poor nutrition, and a variety of diseases, including heart disease and diabetes. I wanted to understand why chronic stress exerts such a powerful force on the body.

After observing my patients over the years, I realized that everyone needs to be in a balanced state of mind and body. The achievement of this balanced state requires regular physical movement and appropriate eating. My goal was to develop a way of understanding how eating, exercise, and a Stress-Resilient attitude can extend the length and quality of life.

While at the University of California, I became acquainted with one of the leading scientists in the field of stress physiology, George Chrousos, M.D., Chief of the Pediatric Endocrinology Section of the National Institutes of Health (NIH) Developmental Endocrinology Branch. Dr. Chrousos and his team at the NIH had laid down the foundation for the study of the relationship between chronic stress and body systems such as immune function, reproduction, and growth. In 1990, I was invited to join his laboratory to study the relationship between chronic stress and nutrition.

At the same time as I began my work in Chrousos's laboratory, Bernadine Healy, M.D., became the first female director of the NIH. Under her tenure, the NIH Office of Research on Women's Health was founded to promote the study of women's health. Previous to that time, women had rarely been invited to participate in major medical studies. Specifically, women over the age of forty were only infrequently studied and usually only for rare medical conditions. Data on how women over forty aged and what affected that aging process, including chronic stress, were typically not gathered. This new interest in women's health care inspired me to investigate gender-specific responses to stress, which eventually led me to examine how women in the perimenopause handle chronic stress.

As I began my research, Chrousos taught me to appreciate the rich history of stress science, which extends back to the ancient Greeks. The Greeks were well aware of the effects of stress on the human body and referred to calm or balance as "harmony." We now call this harmony "homeostasis," which is derived from the Greek word meaning "steady state." Ancient physicians and philosophers realized that stress is a challenge to this balance. Disturbances to homeostasis are now called "stressors." The ways in which we respond to these stressors are our "adaptive responses." For the purpose of survival, the main function of the adaptive responses is maintaining balance and homeostasis.

As far back as 350 B.C., Hippocrates wrote about "health" as meaning the harmonious balance of mind and body and "disease" as being disharmony. Later, the French scientist Claude Bernard (1813-1878) talked about the stability of the internal landscape and first described the "milieu intérieur formed by the circulating organic liquid which surrounds and bathes all the tissue elements." While Bernard did not identify this liquid, we now know that it contains stress hormones that, if triggered on a constant basis, can have harmful effects on the body.

Of course, there are different types of stress and stressors of varying intensity and duration. Getting a speeding ticket is certainly stressful, but not as serious as the death of a loved one, a divorce, or getting a surprise audit by the IRS. But when everyday stress becomes very difficult to manage, a person is left feeling chronically out of control and overwhelmed. This can be an insidious process that results in a constant, dull, ever-present psychological background noise of which one may not even be aware.

The process may begin with a childhood hurt and/or abuse that is then carried into adulthood. It can even begin in utero if a pregnancy is stressful.

Research has shown that cortisol can be transferred from a mother to her fetus in utero. In essence, jumpy mothers have jumpy babies. Stressed-out mothers expose the fetus's cells to higher than normal levels of stress hormones. More serene mothers tend to have calmer babies. Premature infants are a special case; they are under incredible stress and thus have higher than average levels of stress hormones. This may cause their brain to become more sensitive to stressors. Later in life, they may be at risk to develop emotional problems, such as depression. Their response to stress may most likely fall in the abnormal range.

Research has also shown that many children who had a difficult time in utero may go on to become adults who have a stress response to life that is almost always toxic. They become overweight. They may be fragile and unable to absorb and deal with even minor daily annoyances. There is a growing body of research evidence that severe stress early in life has long-term effects on the brain's ability to adapt to stress normally. Trauma or stress in infancy, childhood, or adolescence can cause prolonged hypersensitivity to stress as an adult. People who suffer childhood trauma may be more vulnerable to depression and posttraumatic stress disorder (PTSD) later in life. Animal studies using rats and monkeys have shown that exposure to severe stress early in life results in persistently altered stress responses.

The process may also begin later in life with a traumatic personal stress such as being raped. Whatever its origins, human beings simply were not built to carry around constant disturbances to their homeostasis. When chronic stress is present, we now know through research that it sets off a chain of events that can seriously threaten the body. It appears that a healthy body does indeed start with a healthy mind.

When a frightening situation occurs, the body initiates a primal response to save your life. A burst of adrenaline and the stress hormone cortisol are secreted within the body. Together, these biochemicals activate the body to help us escape danger and prolong our survival. After the initial stressful mental shock, the body returns to its normal state, and the hormones that have flooded the muscles and tissues with important survival messages (stay alert, stay focused, get ready to escape) gradually leave the bloodstream.

But what happens when the stress comes in waves, when it is repeated over and over and never resolved? What happens if the stress hormones continue to wash through the system in high levels, never leaving the blood and tissues? What happens, more precisely, when the physical stress response runs constantly and is never shut down?

My colleague Robert Sapolsky, Ph.D., at Stanford University has written extensively about the links between mind and body in his book Why Zebras Don't Get Ulcers. Mammals, he postulates, don't get ulcers because they do not normally harbor chronic stress. That is something we humans do all the time.

Imagine a zebra on the Serengeti Plain. He's grazing with other zebras under a noonday sun, enjoying the sweet grass. Through experience, this zebra knows that there must be a lion out there somewhere. He knows enough not to go near the lion's home territory. Instead, he lives in the moment, enjoying the grass, not stressing about where the lion is and dealing with the problem only if the lion actually appears.

We humans, on the other hand, often make a second career out of wondering where our lions are.


Toxic Stress

Our science now shows that a sustained high level of cortisol, which results from chronic, unrelenting stress, can have a dangerous, even life-threatening effect on the body. For this reason, I call uncontrollable, chronic stress "Toxic Stress" because it literally poisons your body, making you more vulnerable to colds and flu, fatigue and infections. Toxic Stress can also impair your memory and concentration. And new evidence shows that it can give you a raging appetite! It appears that one of cortisol's major roles is to help refuel the body after each stress episode. Uncontrolled or Toxic Stress keeps the refueling appetite on, thus inducing stress eating and weight gain.

But this is a unique kind of weight gain. The excess fat weight from Toxic Stress, what I have dubbed "Toxic Weight," settles primarily inside the abdomen and is different from fat anywhere else on the body. Too much fat on your thighs may result in mental pain, but it's not associated with deadly diseases. But Toxic Weight, as we shall soon see, is highly associated with heart disease, diabetes, and cancer.

Some stress is what I call Annoying But Liveable (ABL). This includes standing in line at the airport and negotiating traffic jams. ABL stress is integral to daily life.

Other stress is, in fact, life-threatening. Everyday events that should be seen as ABL may become transformed into Toxic Stress when you fall into the habit of harboring anxiety and worry about daily events and relationships. A given individual may perceive a specific life event as either ABL or life-threatening.

I tell my patients that it's not unlike constantly dragging a huge invisible plastic bag of garbage behind you throughout the day, and each new stress adds to the unpleasant mix. Toxic Stress, therefore, is a burden physically, mentally, and emotionally.

True life-threatening stresses are obvious and serious business. These are the events you perceive as endangering your life. Meeting a mugger in a dark alley who is pointing a gun at your head is a life-threatening stress. People who work in dangerous occupations-for instance, as journalists in a war zone-are often exposed to life-threatening stresses.

For many people, however, certain daily situations, which some would perceive as ABL, may be perceived as life-threatening. If you are deathly afraid of public speaking, being asked to give the graduation address at your alma mater may be perceived by your brain as the equivalent of a life-threatening situation even though someone else might relish the challenge and breeze through it. Giving a presentation at work in front of two hundred executives who will be responsible for your performance evaluation may be perceived as life-threatening, even though it's a normal occurrence in the business world. For a terrified speaker, such an experience feels just as life-threatening as a confrontation with a mugger and may actually induce many of the same biochemical responses as occur when a person faces a gun-toting stranger in a dark alley.

ABL stress can be short- or long-term. For example, you may be in the express line at the grocery store and the man in front of you has twenty-five items and you're in a hurry. Or you may receive the good news that your son has won a place on the state soccer team. The bad news is that you will have to chauffeur him all over the state for the next three years, interrupting your normal weekend self-care and family schedule. These are the kinds of daily stresses we all encounter. Many people can handle these life events without imploding and turning them into Toxic Stress.

Stress becomes toxic only when it begins to poison the system and threaten the natural state of homeostasis on a chronic level. A caregiver with a mother diagnosed with Alzheimer's may start to feel guilty about the time she spends away from home. She may stop taking her daily walks. She may decrease her outside activities and turn down social engagements. Feelings of sadness, worry, and anxiety may start to suffocate any thoughts of self-care. Finally, she may lose her sense of balance and sink into a world of limitless giving, damaging her important relationships and disrupting her family life. If she does not maintain the balance of self-care in her life, her caregiving will become toxic.

Toxic Stress is the greatest threat to balance because it never allows the body to shut down the stress response. According to Selye, "Stress is essentially reflected by the rate of all the wear and tear caused by life." When Toxic Stress becomes a way of life, it may be reflected in something as obvious as one's face. All we need to do is to look at the faces at a funeral: the deeply furrowed brows; the frown lines; the look of worry, fatigue, and dejection. Now imagine what that same stress, that same trauma, on a daily basis would do to the delicate tissues inside the body.

When Toxic Stress is allowed to permeate your daily existence, it can result in self-destructive behaviors. These behaviors include anything perceived as an antidote to emotional pain, such as inappropriate eating, excessive alcohol consumption, and use of tobacco or drugs. They can set into motion a downward spiral that only results in more stress. For example, a woman who suffers from Toxic Stress exposes her body tissues to prolonged elevations of cortisol, which, as we have mentioned earlier, induce a stress-response refueling appetite. This may lead to excessive eating and weight gain. The stress eater may then resort to an extreme fad diet to lose her weight, which creates even more Toxic Stress resulting from the food deprivation plus the anxieties and compromised self-worth so characteristic of the diet mind-set. The Toxic Stress of dieting then leads to more weight gain and the accumulation, over time, of Toxic Weight inside the abdomen.

One of my patients, Jennifer, who was at least 50 pounds overweight and in her forties, was shopping for clothes in the maternity department. She first came to see me in 1996. As we discussed her dieting history as a lifelong binge eater, she began confiding in me about her mother, who has always been rail thin and paranoid about her daughter's figure. Jennifer had been put on diet pills at the age of eight. Her mother had also severely restricted her diet, forbidding her even an infrequent snack. In grade school, Jennifer had suffered the humiliation of having to stand in the "fat girl" line at her cafeteria.

Her mother, who had suffered from depression and sought therapy, had been a control freak. Her father had been ineffective and weak. He and Jennifer had been forced to sneak out of the house to eat even a hot dog.

Jennifer wept as she told the story. The memory of that cafeteria line still haunted her. She had been singled out, humiliated, and hurt.

I could have predicted what had happened next: she developed into a binge eater, sneaking forbidden cakes into her closet at night. As soon as she was given an allowance, she secretly spent all her money on junk food and treats. What I could not have predicted was how this childhood stress, once it was revealed to me in my office, would alter the course of Jennifer's life. This was the origin of her problems with food.

The first weeks and months were not easy, as we literally had to reprogram her thinking. But Jennifer bravely took the first steps to reclaim the second half of her life. No longer forced to stand in the "fat girl" line at the school cafeteria, she is now a size 10. How did she do it? By finally processing and learning to neutralize the Toxic Stress of her childhood.

Reprinted from Fight Fat After Forty by Dr. Pamela Peeke by permission of Viking Books, a member of Penguin Putnam Inc. Copyright (c) 2000 by Pamela Peeke. All rights reserved. This excerpt, or any parts thereof, may not be reproduced in any form without permission.