Stress – the silent killer
IF YOU LIKE DETECTIVE STORIES, YOU’RE GOING TO LOVE THIS.
Back around 2000, a story came out about how the population of gray tree frogs in many American lakes was being decimated. The general consensus was that this was due to the use of a common pesticide, carbaryl (known by the brand name Sevin), which was found in large quantities in all of the lakes where frogs were dying. Carbaryl was clearly the villain, and environmentalists demanded that the company making carbaryl be held accountable.
A familiar story, right?
But here’s the thing: The manufacturers insisted that carbaryl wasn’t harming the frogs. They had a ton of studies showing that if you took the little creatures out of their lake homes, put them in a lab, and exposed them to the pesticide, nothing happened to them.
But the tree frogs were still dying. And the environmentalists were positive it had something to do with their continued exposure to this pesticide.
So who was right?
As it turns out, they both were. The studies were accurate. Self-serving though it might have been, the big, bad industrial manufacturer had good science showing that frogs were not being knocked off by its chemical. And the environmentalists had equally good science showing that carbaryl was the likely suspect in this massive decimation of gray tree frogs, frogs that managed to survive just fine, thank you very much, as long as there wasn’t any carbaryl around.
Enter Columbo in the form of Rick Relyea, Ph.D., a biochemical researcher from the University of Pittsburgh. Long story short, here’s what he discovered: The pesticide, carbaryl, was indeed pretty innocuous to frogs (meaning it didn’t kill them, at least) in the unnaturally tranquil setting of a lab. But most tree frogs don’t live in a lab; they live in the wild, where there are constant dangers from predators. When the frogs pick up a predator signal, when they literally “smell danger,” they secrete powerful stress hormones, just like our ancestors did when running from a wildebeest, or like we do when we’re caught in traffic or miss a deadline. Expose a stressed frog to the pesticide, and you’ve got a dead frog. Neither stress hormones nor pesticides alone were enough to kill the average tree frog, but thecombination of the two—stress hormones and pesticides—was lethal.
Subsequent studies over the next decade looked at the interaction between these two stressors—chemicals and predators—and examined how they interacted in a number of different organisms, including salamanders. Several of the studies tested different pesticide chemicals with and without “predator cues” (signals that trigger the release of stress hormones), and every study confirmed that the combination of a pesticide and predator cues was far more lethal than any of the chemicals alone.
The take-home point, and the reason for this story, is that environmental elements interact with physiological elements in ways that can cause serious problems. (In the case of the gray tree frog, the interaction was a death sentence.) Although certain environmental and physiological elements might not be detrimental by themselves, when they’re combined they can sometimes spell big trouble.
And the element of our physiology that’s most likely to cause major problems for the health of the heart happens, not coincidentally, to be the subject of this post: stress.
THE STRESS RESPONSE IN ACTION
Imagine, if you will, that you are a zebra grazing on the plains in the African Serengeti. Everything is peaceful, the grass is delicious, the sun is out, and all is well with the world. Suddenly you hear a faint rustling in the woods. You look up and see behind a bush the outline of a lion, a lion that is looking straight at you. You can almost see the thought bubble over its head: “Lunch!”
Your body switches into full alert, the equivalent of flipping to “red” in the Department of Homeland Security’s threat advisory system. The moment you see the lion, your hypothalamus, a section of the brain that acts as a kind of “first responder” in emergency situations, sends a hormonal signal to your pituitary gland. Instantly, the pituitary relays the message to the adrenal glands, two little walnut-shaped glands that sit on top of the kidneys. Their job is to pump out hormones whose actions are your only hope of living long enough to eat lunch tomorrow rather than becoming lunch today. These hormones—cortisol and adrenaline, specifically—are known as the stress hormones, and whether you’re a zebra running from a lion or a caveman running from a woolly mammoth, you have them to thank for your survival.
But these wonderfully adaptive, life-saving hormones have a dark side. They can, and do, contribute mightily to heart disease.
Let us explain.
Your stress hormones, also known as the “fight or flight” hormones, serve as a kind of turbocharger when you’re in a threatening situation. Without them, you’d be unable to react quickly enough to protect yourself from a predator or any other kind of danger. Cortisol and adrenaline, working together, and working far more quickly than you can read these words, prepare the body for action. Adrenaline, for example, immediately raises your heart rate and blood pressure as your heart begins to furiously pump blood through the vascular system in a mad rush to get it to the organs and muscles that need it most. Cortisol, the main stress hormone, causes sugar to be released into the bloodstream so that it can be delivered to the muscle cells and burned for energy, which happens to be particularly useful if you’re running for your life.
In response to these hormonal signals, the body diverts blood from wherever it’s not needed and directs it to where it is needed. (After all, if you’re running from a wild boar, it doesn’t make much sense for your body to send a ton of blood to your fingers, ears, reproductive organs, or digestive system.) The whole system is exquisitely designed to deliver just the right amount of nutrients, oxygen, and blood to the places where it’s most likely to contribute to your survival (the running muscles and the heart, for example).
This is the stress response in action. It’s meant to be quick, instant, and effective, its purpose singular: keeping you alive in a life-and-death situation. In the case of the zebra, it lasts only as long as it takes to get away from the lion, after which the zebra’s metabolism returns to normal, its heart rate slows down, and it goes back to grazing, blissfully forgetful that there was ever a problem in the first place.
Acute Versus Chronic Stress
This natural ability of animals to live in the moment as opposed to sitting around wondering whether there’s going to be another lion behind the next bush is what the great neurobiologist Robert Sapolsky was referring to when he titled his masterpiece on stress physiology Why Zebras Don’t Get Ulcers.
Sapolsky’s zebras experienced acute stress, which is ultimately temporary (unless of course the zebra is a slow runner, in which case the point is moot). Acute stress passes quickly, allowing us to return to “normal” and go about our business. The far more dangerous kind of stress, the kind that directly affects heart disease, is chronic stress. And that’s a whole different animal.
So here’s the big difference between the acute stress experienced by the zebra and the chronic stress that damages your heart. Acute stress is immediate and attention-grabbing. Your brain registers the threat of the marauding lion, and your stress response is instantly activated. It’s energetic, it’s explosive, and it’s wonderful—it’s what saves your life in an emergency. But if you turn it on too often, too long, or for psychological reasons—essentially the definition of chronic stress—you set yourself up for getting sick.
When stress persists, as it often does in people today, especially in those with certain personality and character traits, the abundance of cortisol from the adrenal cortex begins to promote hardening of the arteries. Hypervigilance, or being constantly on guard (that sense of waiting for the other shoe to drop), may also create an overabundance of cortisol, thus turning a psychological coronary risk factor into aphysical one. With this kind of chronic stress, we can overdose on our own adrenal hormones, making the heart vulnerable to unexpected cardiac events, such as heart attacks or arrhythmias. Remember that this damage doesn’t always occur immediately, but it will occur when the adrenal glands are pushed to the point of exhaustion. Overwork, prolonged stress, and exhaustion—all of which contribute to burnout—are harbingers of death by hormonal overdose. More on this in a moment.
The common notion that stress is just a psychological state—that it’s “all in your head”—is as outdated as the notion that cholesterol causes heart disease.
Stress, Stress, Who’s Got Stress?
If we asked you right now to sit down and list the top ten things in your life that you find stressful, we bet that none of you would have the slightest problem coming up with a list. (In fact, the challenge would be limiting it to only ten items!) We further bet that your list would be front-loaded with psychological stressors—deadlines, traffic jams, sick kids, money, relationships—all of which take a constant toll, physically and psychologically.
But the common notion that stress is just a psychological state—that it’s “all in your head”—is as outdated as the notion that cholesterol causes heart disease. Stress has physical and physiological correlates. When you’re under stress, your body releases specific hormones that have specific actions and measurable results.
The stress response can save your life. It can also kill you.
The Roseto Effect
Once upon a time, a country doctor was at a little tavern in Pennsylvania when in walked a doc from the “big city”; he was the head of medicine at the University of Oklahoma. The two physicians started talking shop over a couple of beers, and the local doc happened to casually mention a puzzling observation: Folks in his town were dying from heart disease at half the rate of the rest of the country.
Although this might sound like it’s the opening scene for some kind of reverse horror story—instead of being struck by some weird, alien disease, towns-people seem to be mysteriously protected from the very diseases that kill their neighbors!—it’s actually a true story. The meeting took place in the 1960s; the town was Roseto, Pennsylvania; and that chance meeting between two doctors at a local bar eventually led to an influx of medical researchers trying to understand the strange phenomenon, a phenomenon that ultimately became known as the “Roseto Effect.” (Google it. Go on. We’ll wait.)
WHAT YOU NEED TO KNOW
• Stress contributes to every disease known. And it can slow or prevent recovery.
• When you’re under stress, your adrenal glands produce stress hormones, known as “fight or flight” hormones. The main stress hormones are cortisol and adrenaline.
• An excess of stress hormones can create metabolic havoc and inflammation, and contribute to heart disease. When stress persists, the abundance of cortisol begins to promote hardening of the arteries.
• Stress causes the overproduction of platelets in the blood, which can then clump together and ultimately create a clot called a thrombus. When a thrombus blocks an artery to the heart, you have a heart attack.
In defiance of all logic, the residents of Roseto seemed to be eerily protected against heart disease. In Roseto the rate of death from heart disease was next to zero for men between the ages of fifty-five and sixty-four, not exactly an age group known to be immune to heart attacks. Men over the age of sixty-five did occasionally die from heart disease, but at a rate of about half the national average.
Okay, what could have been going on here? Tell the average American about the Roseto Effect, and he or she will probably say that the people of Roseto must have been living really healthy lives, going to the gym, eating low-fat diets, staying away from cholesterol, going easy on the salt, not eating red meat, and all that good stuff, right? That’s got to be the answer.
Well, not exactly.
Roseto, Pennsylvania, was, to put it gently, a hardscrabble town. Life was anything but easy. The men spent their days doing backbreaking, hazardous labor in underground slate mines. Their traditional Italian food was Americanized in the worst possible ways. They fried everything in lard. Most, if not all, of the men smoked. If there was a contest for “most likely to die of heart disease,” the men of Roseto could have won hands down.
So why weren’t they dropping like flies?
That’s exactly what the medical researchers wanted to know.
Here’s what they found: Nearly all the houses in Roseto contained three generations of family members. Rosetans didn’t put their elderly in assisted living homes; they incorporated them into community life. They treated them as wise village elders. Folks took evening strolls. They belonged to tons of social clubs. They participated in church and had community festivals. And remember those dinner tables piled high with the lard-fried food we mentioned a few paragraphs back? Those dinner tables happened to also offer enormous nourishment for, and nurturance of, the human spirit. They were family affairs where people connected, shared their experiences, and participated in family life in myriad ways.
Oh, by the way, the crime rate in Roseto—as well as the number of applications for public assistance—was zero.
What accounts for the Roseto Effect? Researchers now believe that the explanation can be summed up in two words: community and connection. These two things were (and are) such powerful protectors of health that they were apparently able to offset both cigarette smoking and a horrific diet.
Writing about the Roseto Effect in their classic book, The Power of Clan, Stewart Wolf, M.D., and sociologist John Bruhn correctly observed that the characteristics of tight-knit communities such as Roseto are far better predictors of heart health than cholesterol levels or even smoking. The social structures of communities such as Roseto are characterized by predictability and stability, with each person in the community having a clearly defined role in the social scheme of things. Everyone worked in Roseto, and they worked hard, all for a shared communal goal: creating a better life for their children. Being connected to other people in a close community makes you far less likely to be overwhelmed by the problems of everyday life. Being less likely to be overwhelmed by the problems of everyday life means you’re also less likely to be a victim of chronic stress.
And chronic stress is one of the biggest contributors to heart disease.
The men of Roseto had a ton of physical stressors in their lives. Working in the slate mines is hardly a day at the beach, and smoking certainly qualifies as a major physical stressor. But because the men were generally protected from the constant, unending mental stress that many folks endure on a daily basis—protected, presumably, by their close-knit community and their secure, nurturing family ties—these physical stressors didn’t seem to produce the collateral damage such stressors might be expected to produce. The absence of chronic mental stress seemed to afford the men some level of protection against heart attacks.
To understand why, we have to understand something about the stress response in general. And the best place to start is with a man named Hans Selye.
THE “INVENTION” OF STRESS
Selye didn’t invent stress, but he sure put it on the map. Back in the 1930s, Selye was a young researcher and assistant professor at McGill University in Montreal, and he was just beginning his work in the field of endocrinology—the study of hormones and what they do. A biochemist working just down the hall from Selye had isolated a specific substance from the ovaries, and everyone was wondering what the heck that ovarian extract actually did. So Selye did what any ambitious, unknown researcher would do—he got a bucketful of this strange ovarian stuff and decided to test it out on his rats.
Every day Selye would inject the rats with this mysterious stuff. But the thing is, Selye was a klutz. He’d try to inject the rats, but he’d drop them, or miss them, or they’d run behind the refrigerator. Selye wound up spending half the day running around the lab with a broom trying to coax the rats out from their hiding places and herd the terrified animals back into their cages.
After a few months passed, Selye began examining the rats to find out what the heck this stuff he’d been injecting them with did. Lo and behold, all of them had ulcers. Not only that, but they also had greatly enlarged adrenal glands and shrunken immune tissues. Selye was delighted. Clearly he’d discovered something important and new about the ovarian extract his colleague had discovered: It gave you ulcers!
Selye was at heart a good scientist, even if he had absolutely no talent for handling animals. And a good scientist always runs a control group, which is exactly what Selye did. The control group, of course, was a group of rats identical to the first group in every way except that they were not injected with the mysterious ovarian extract.
When Selye examined the rats in the control group, he made an even stranger discovery than before: All of the control rats also had ulcers.
Here he had two groups of genetically identical rats. One group had been injected with a substance, and the other had not, yet both groups wound up with ulcers. Thus, Selye quickly reasoned that the ovarian hormone couldn’t have been causing the ulcers. What else did the two sets of rats have in common?
The answer wasn’t hard to figure out, especially for a research-trained scientist such as Selye. The one thing both groups of rats had in common was Selye.
Selye had properly concluded that the ovarian hormone couldn’t possibly be responsible for the ulcers and swollen adrenal glands, because both groups of rats had developed ulcers, and only one of them had been exposed to the hormone. But perhaps his own inept handling of the rats—the incompetent injections, the dropping, the chasing, the running around—had something to do with it. Selye reasoned that the ulcers—as well as the shrunken immune tissues and enlarged adrenals—were some kind of response to general unpleasantness, which he came to refer to as stress.
So Selye set out to test his new theory. He created a high-stress environment. He put some of the animals up on the roof during the winter months. He put others in the basement next to the boiler. Others underwent stressful surgeries, or were subjected to very loud music, or were deprived of sleep.
Every one of them got ulcers. Every one of them had swollen adrenals.
From this early work, Selye eventually developed what’s known as the General Adaptation Syndrome (GAS) theory of stress. The theory holds that the effect of stress on the body develops over three stages: alarm, resistance, and exhaustion. Here’s how it works.
The Three Stages of Stress
In the alarm stage, you recognize that there’s a danger. Your body secretes a bunch of adrenaline and cortisol to prepare you for action (i.e., fight or flight). Of course, if all this available energy is not used for physical action, big problems develop. For example, too much adrenaline will raise your blood pressure and ultimately damage the blood vessels of the heart and brain.
Selye eventually developed what’s known as the General Adaptation Syndrome (GAS) theory of stress. The theory holds that the effect of stress on the body develops over three stages: alarm, resistance, and exhaustion.
In the resistance stage, you deal with the stressor. If (hopefully) the situation resolves quickly, you return to something approaching a balanced state (what physiologists call homeostasis). Your stress hormones may come down, but you have also depleted some of your resources. More commonly, however, the situation persists, and now your body has to find a way to deal with it. Your body keeps trying to adapt and remains in a constant state of arousal. But you can’t keep this up forever, with the stress pedal pressed to the metal and a ton of hormones pumping out into the bloodstream. If this continues too long, or if you repeat this process too often with too little recovery, you eventually move into the third stage.
This stage, aptly named the exhaustion stage, is also known as burnout. It’s what we’re referring to on this website when we talk about “maladaptation.” Stress levels go up and stay up. These chronic stress levels deplete your immune system (one reason marathon runners are so much more susceptible to colds in the days following a race). Chronic stress levels also injure tissue cells, particularly in an area of the brain known as the hippocampus, which is involved with memory and cognition. (That’s one reason you can’t remember stuff you know when you’re taking a very stressful exam.) Animal studies have demonstrated that the hippocampus actually shrinks under the weight of cortisol overload. And all of this has profound implications for high blood pressure and heart disease.
How You Cope with Stress Matters More Than the Stress Itself
So what’s a stressor, anyway? It can be anything—and it’s different for different people. Technically, a stressor is something to which special weight and significance has been attached. A stressor can be something as simple as the feeling of being overwhelmed. It can be the inability to give in to a situation (resistance), a fear of losing control, or a feeling of struggle or uncertainty. Often a stressor can’t bechanged or even controlled—a hurricane or natural disaster, for example. What can be controlled, however, is your behavioral response to the external stressor. As Werner Erhard once said, “Riding a raft down white water rapids, a master has no more control over the water than you do. The difference is that a master is in control being out of control [Italics ours].”
Stressors come in all sizes, flavors, and packages. Hunger and deprivation are usually more significant stressors than a flat tire—except if you’re a young woman who has to deal with a flat tire on a deserted country road late at night with no jack! A failing grade sounds like it would be a lot more important to a college student than, say, a bad haircut, unless perhaps the haircut damages an already low self-esteem. In these cases, the flat tire and the bad haircut can be considered strong external stressors in the person’s life. How people respond to these (and other) stressors will determine their body’s physiological reaction and, ultimately, their health.
When the promotion doesn’t come, when the tire goes flat, when the haircut makes you look like Pee-wee Herman, you have only two choices—adapting or not adapting. You can adapt by “going with the flow,” accepting the situation, or working to effect some kind of change. Or you can maladapt by preparing your body for “combat,” either by withdrawing or pushing beyond normal expectations in an effort to make the stressor go away. When your coping styles are unhealthy and inappropriate—for example, abusing drugs or alcohol, overeating, or overworking—that’s maladaptability. And these activities take an enormous toll on the body.
The big difference between stress in the caveman era and stress in the modern era is that the caveman’s stress—and his adaptive responses—were largely physical. Ours are mental. We’re not fighting off saber-toothed tigers, or running up trees to escape from bears, or in danger of being attacked by a neighboring tribe. Instead, we have to “fight back” mentally and keep “cool” at the same time, leaving the nervous system and the cardiovascular system in a state of constant and continuous “overpreparedness.” It’s this continual state of visceral vascular readiness that makes the heart so darn vulnerable. The chronic alarm reaction that develops is a harmful response in which the body continuously overdoses on its own biochemicals.
The biochemical alterations that occur in response to stress are powerful. When these responses are inappropriate or ineffective (e.g., screaming and pounding the wheel when you’ve been stuck for two hours in unmoving traffic on California’s 405 freeway), you are maladapting rather than adapting, and pathological changes can (and do) occur in the body. The disruption in hormonalsecretions can be long term and even permanent.
Much of the answer in dealing with stress lies not in the stressors themselves, but in the way we deal with the stressors (which, like in-laws and taxes, have an annoying tendency to not go away). An important first step is to recognize the situations that create stress for you. These frequently include lack of communication, unfulfilled expectations, retirement, death of a loved one, job pressures, bad relationships, and, particularly important, dwelling upon past events or imagined future ones.
Dr. Jonny: Is It the Stress or Is It the Response?
I grew up in a large, seven-room co-op in Jackson Heights, Queens (New York City). Many years ago, when my parents were in their late sixties, they went on a weeklong vacation to Bermuda. When they got back, the apartment was essentially empty.
Burglars had cased the joint and done a darn good job of it. No one saw or heard a thing, including their very friendly neighbors who would have called the police in a heartbeat had they suspected anything fishy was going on. The burglars clearly knew when people would be around and were exquisitely well prepared. They stripped the house as quickly and efficiently as a school of piranha might strip the meat from the carcass of a dead cow.
That house contained just about every material thing of any value that my parents had jointly collected over thirty-five years of marriage.
So that’s what happened. A pretty big stressor, wouldn’t you say?
My mother’s response was one of her finer moments and one I will always remember.
“You know,” she said, “the important things—our health, our family, our love—they didn’t take. Sure, I’m sad to see all this stuff go. But you know what? It’s kind of exciting in a way. Now we have the opportunity to create something completely new. We can design new rooms, get some new furniture, which I’ve been wanting to get anyway, and basically start again.”
By shifting the way she reacted to this event, she turned it from a potential tragedy and enormous stressor into something that oddly enough sounded like an adventure.
What happened couldn’t be changed. But how she reacted was in her control. Her reaction is what determined the toll this stressor would take on her. It was her reaction—not the stressor itself—that determined the result.
And the result—thanks to her attitude and serenity—was that minimal damage was done to her health.
You can’t control the “event” (i.e., what actually happens), but you can control the “story” (i.e., what you make it mean). By making this event mean opportunity rather than tragedy, my mother probably saved herself quite a lot of physical damage, and in the long run that probably extended her life.
STRESS AND YOUR HEART
When you’re under constant (chronic) stress, you secrete more hormones, such as epinephrine and the glucocorticoids, which prepare the body to fight or flee. At the same time, you make less of other hormones, such as growth hormone. Why? Because at this point, at least from the body’s point of view, these hormones are a big waste of time.
When your life is at stake, or your body thinks it is, your body does an instant evaluation (like a triage nurse) and decides what’s essential and what’s not. When you’re running for your life, it doesn’t make much sense to invest energy in reproductive or digestive functions, and it doesn’t make sense to increase circulation to the stomach or the ears. What does make sense is keeping you alive, so the body diverts blood from the gut and sends it to the legs (so you can run faster). It doesn’t bother with little extras, such as growth hormone or sex hormones, because if you’re not going to be around past dinnertime, what’s the point? Instead, it mobilizes all of its resources to combat the immediate life-threatening problem at hand.
This “triage” phenomenon was first noted around 1833 by a bunch of physician scientists treating a man with a gunshot wound.3 When the docs were about to patch him up, they noticed, not surprisingly, that he had a significant amount of red and rosy blood flow beneath where his guts were exposed. Then, for some reason—who knows, maybe he didn’t like the doctors’ aftershave—the guy got pissed off and angry. His body treated his anger and pissed-off-ness as an emergency, and his stress response kicked in immediately. Suddenly that red and rosy blood they were seeing in his guts turned pink and pale. It was almost as if all that deep red blood had disappeared!
So what happened?
What the docs were witnessing was a vivid visual example of the triage phenomenon described earlier. Stress hormones divert blood flow from the areas that aren’t immediately necessary to your survival and send it to where it can do the most good in an emergency—the heart, lungs, and running muscles. That’s why the blood in the guts of the guy with the gunshot wound changed color.
So your body perceives a life-threatening emergency (and remember, your body makes no distinction between an “old-school” emergency, such as an attacking lion, and the modern version of the same thing, such as being stuck for hours on the freeway). But releasing stress hormones that divert blood from nonessential to essential areas is only the beginning. You also need to get more blood into your system, or at least make sure you don’t lose any of the blood you already have! (Remember, from an evolutionary and historical point of view, most life-threatening “emergencies” carried with them the distinct possibility of blood loss!)
Now what does your body do? It makes more of a certain type of red blood cell called a platelet. Platelets stick together and form clots, which, when you think about it, is a pretty spiffy protection against the possibility of bleeding out.
So stress hormones trigger the production of platelets, a good thing in the short run when your body is anticipating the possibility of a major bloodletting wound, but not such a good thing in the long run. When stress hormones are constantly in the “on” position, you’re overproducing platelets. Inevitably, the platelets begin to stick together, and your blood thickens. They combine with other red and white blood cells, as well as with a compound called fibrin, to form a kind of “super clot” called a thrombus. When a thrombus blocks an artery that leads to the heart muscle, you have a heart attack.
Okay, so what else does your body have to do in a life-threatening emergency to ensure that you stay alive? Divert blood from nonessential areas to essential, check. Make sure you don’t lose any more blood than you absolutely have to by making more platelets so that you can clot more easily, check. But wait! What about replacing any blood that you might lose in battle? You’re going to need replacement blood, and where the heck is that going to come from?
Glad you asked.
Heart Attacks Waiting to Happen
Because there are no blood transfusions available in the African Serengeti, you’re going to have to make your own blood. The first thing you’ll need is water, which is found in the kidneys! The kidneys are sitting around, peacefully filtering water and getting ready to send it out into the universe in the form of urine, but now, with the new demand for water, your stress hormone–fueled body runs down to the kidneys and says, “Wait! Hold the presses! Don’t send that water out into the universe, because we’re gonna need it right here to make more blood!” And because the kidneys really don’t speak English, this message is sent to them via a hormone aptly named the anti-diuretic hormone, or ADH, which tells the body to reabsorb water from the kidneys and put it into circulation to increase blood volume.
Brilliant. And it all makes total sense from the point of view of survival.
But what happens when you do this chronically?
Let’s take a look.
See, if you increase the volume of your blood pressure for thirty seconds while you run from a lion, you are one smart dude, from an evolutionary point of view at least. But elevate it for weeks, and you have chronic hypertension. And this is exactly the state that many of us are in today—heart attacks waiting to happen. According to the World Health Organization (WHO), hypertension is one of the most important causes of premature death worldwide, and it’s certainly one of the most important risk factors for heart disease.4 Let’s take a look at why.
Stress and Blood Pressure: The Missing Link to Heart Disease
When blood pressure increases, the heart starts pumping blood with more force, pushing the blood vessels outward in response to the sheer power of it. (Imagine a garden hose hooked up to a fully opened fire hydrant. The garden hose would look like it’s about to burst!)
In response to this distending, the blood vessels build up more muscle around them (more layers of rubber on the garden hose), which now makes the vessels more rigid. This in turn requires even morepressure to get the blood through them, which means—not surprisingly—your blood pressure goes even higher.
If blood pressure is increased, the heart muscles pay the price. Because blood is being pumped out with more force, it slams back with more force as well. And the area that takes the brunt of this returning blood under high force is the left ventricle. The muscle there begins to enlarge—a condition known as left ventricular hypertrophy—and that sets the heart up for irregularities.
Now we’ll discuss how this can cause inflammation and trigger the whole chain of events that leads to heart disease, a chain of events in which cholesterol is the most minor of players.
Coming out of your heart is one huge blood vessel called the ascending aorta. After a certain distance, this vessel splits into two, a process called bifurcation. Each of these two vessels eventually splits into two more vessels, which keep bifurcating until you’re down to the little capillaries. Now when your blood pressure goes up, the bifurcation—the point where the vessel divides into two—is exactly the spot that gets the brunt of this bashing by the increased force, or blood pressure. Eventually you start to get what’s known in physics as fluid turbulence. (Think of a tube with fluid moving through it with more and more force; the fluid starts to resemble a miniature version of the water sloshing around a tunnel at a water park.) As the fluid—blood, in this case—slams into the weak spots with increasing force, you get little bits of scarring and tearing, which soon become inflamed. These spots of vessel damage attract more inflammatory cells (such as oxidized LDL cholesterol), which gets into the inflamed areas, sticking to them. Before you know it, you’ve got plaque.
You’ve also got damaged blood vessels. Healthy coronary blood vessels vasodilate (open) when you need more blood (e.g., when you’re running from a saber-toothed tiger). That makes sense—water flows more freely through a fire hose than through a garden hose, and blood flows more easily through a dilated (open) vessel than a constricted (closed) one. But when the coronary blood vessels are damaged, they no longer vasodilate. Just when you need them to open up the most, they actually close up, or constrict. Now the heart doesn’t get enough blood or oxygen, and you have something calledcardiac ischemia (lack of oxygen to the heart). The heart muscle isn’t getting enough energy, and it hurts. The all-too-familiar name for this pain is angina.
And at the core of all this is inflammation.
“Twenty years ago, if you wanted to measure one thing to see how the cardiovascular system was doing, you’d measure your cholesterol,” Sapolsky said. “In recent years people have realized that cholesterol is important, but that other things are more important. If you have undamaged vessels there’s no place for cholesterol to stick to,” he explained. “If you don’t have inflammation, there’s no problem.”
A man wakes in the morning feeling unwell and complains of pain and distress in his chest and abdominal area. He is sweating profusely and gasping for air. His alarmed wife calls 911, but the man dies before the paramedics arrive.
Frequently, the first symptom of heart disease, at least the first symptom that gets noticed, is sudden death. (Sudden death tends to get people’s attention.) Unfortunately, there is no chastisement, no warning to mend our ways, no trade-off or time to bargain with fate. The heart, omnipotent organ that it is, demonstrates its power over us with one unforgiving defensive maneuver—it attacks us.
Clinical studies have found that from 40 to 50 percent of the time, the first recognized symptom of heart disease is a fatal heart attack, also known as sudden cardiac death (the number one killer of people between the ages of thirty-five and sixty). The big problem with cardiac disease is that it happens with little or no warning. It’s literally ominous in its silence. Ninety percent of individuals with heart disease are asymptomatic.
Many of us have heard stories about “voodoo death” (sudden death related to psychogenic stress), a concept researched in detail by the American physiologist Walter B. Cannon, who first introduced the word homeostasis and coined the term fight or flight. Cannon traveled around the world studying voodoo death in places such as Africa, the Pacific Islands, and Australia. According to Cannon, voodoo death defies the imagination of modern Western man. He cited a case in which a Maori woman died within a day after discovering that she had eaten a piece of fruit that came from a “tabooed” place.
Well, unless you believe that the fruit was cursed or had magical powers, there’s clearly another explanation, and it’s this: the person’s belief that the curse was inescapable. A common feature of such a belief, shared by many who believe in the supernatural, is a heightened emotional response. The stress hormones go crazy. The heart pumps blood like sailors bailing out a sinking ship—quickly and furiously. Blood pressure goes through the roof, causing vascular injury. The possessed woman, and other members of her family, believed that she was doomed to die. She had to deal with the sheer, unmitigated terror of the curse itself, compounded by the fact that she was physically and emotionallyisolated. She was all alone in a terrible struggle that eventually ended in death.
But how and why did she die?
Did the social isolation or despair cause a loss of hope and a willingness to die? Or was it the curse itself? Many voodoo deaths are commonly preceded by alienation, isolation, and lack of social support for the person enduring the experience. In the cases that he observed, Cannon concluded that the victims of voodoo death were overcome by terror at the exact moment that they found themselves without the safety net of a supportive environment. The combo was lethal. The victims accepted their deaths as a way to escape an intolerable, miserable situation.
But with all that, there’s still no perfect explanation for the physical mechanism of death. What went wrong? Did these people’s cholesterol levels suddenly jump?
Here’s what Cannon concluded: The overwhelming stimulation of the sympathetic nervous system provokes lethal electrical instability in the heart. In modern terms, doctors would describe this whole “sudden death syndrome” as the result of malignant arrhythmia culminating in ventricular fibrillation, or acute coronary spasms and myocardial infarction—in other words, a heart attack.
What’s important here is not the exact way that the heart fails, but the fact that its breakdown—whatever the specifics—are precipitated by a profound loss of hope. Interestingly, Cannon observed that this profound loss of hope was so deep that all attempts to revive these individuals were fruitless.
Once again, we see that psychological belief can determine physical destiny, or at least have a profound influence on it.
Experimental research has demonstrated the impact of acute psychological stress on sudden cardiac death. In one study, 91 percent of patients who experienced sudden cardiac death but were then successfully resuscitated reported that they were experiencing acute psychological stress at the time of their “sudden death” experience. A typical scenario: A middle manager is winding down after a busy week. The economy is in recession. The guy has to cut costs. His overhead is ridiculously high. There’s a real potential of losing his job, and with the loss of his job would come a loss of self-esteem. He is not involved in a loving relationship and is isolated and depressed. He’s exercising at his local gym when he hears unexpected and disturbing news. He drops dead suddenly from a massive coronary.
It’s not the stressor, per se, that killed him. Under other circumstances—or in another person—disturbing news would be, well, disturbing. Not fatal. Much like people who catch colds easily because their immune systems are weak, he is far more susceptible to being hit like a sledgehammer by news that would merely shake a less vulnerable person. In his weakened, vulnerable state, the disturbing news acts like the pesticide carbaryl on a stressed-out frog—it kills him.
We hope we’ve convinced you that stress isn’t just “in your head,” and that the mind and the body operate very much as an integrated unit. A trauma to the body can cause enormous amounts of psychic pain and ultimately even lead to depression or fibromyalgia. And a trauma to the psyche has significant repercussions for the body. They can’t be separated, nor should they be. Both are part of the whole person. This is why medicine that looks at the entire person, and how everything is connected, is aptly called holistic medicine. (Dr. Sinatra and Dr. Jonny share this orientation; Dr. Sinatra has been practicing “integrative” [holistic] medicine for decades, and Dr. Jonny’s Ph.D. is in holistic nutrition.)
In this next section, we’re going to talk specifically about stress and the impact it can have on your heart and your health. And we’ll make recommendations for how you can reduce stress with an easy exercise that anyone can do.
HOW THOUGHTS AND FEELINGS AFFECT YOUR HEART
An essential part of our prescription for heart health involves monitoring and reducing stress, and that means exploring (and expressing) your thoughts and your feelings.
If you want proof that what you think about affects your heart, try this exercise: Sit quietly and peacefully until you feel your breathing calm and your heart rate steady. Concentrate on peaceful words and images. Imagine yourself in a safe, warm, engulfing place—perhaps a favorite beach or even an imaginary tropical island. Stop reading and breathe deeply for a few minutes before continuing to the next paragraph.
Now that you’re in this “state,” think about something that really disturbs you, maybe a situation at work, or at home, or with your kids or mate. Maybe some incident that caused a great deal of distress in your life, such as a mugging, or the theft of your car, or the death of a loved one. It can even be something that didn’t affect you directly—a real-life disaster such as Hurricane Katrina or the BP oil spill. Stop reading for another minute and really feel whatever comes up for you when you think of that disturbing event or situation.
Okay, what happened? Your heart rate probably went up, as did your blood pressure. You might have been able to hear your own heartbeat as it pounded in your ears. You might have felt anxiety and distress mounting in your body. Yet absolutely nothing happened physically. All that changed was your mental state, but this had a noticeable effect on a variety of physical measures.
Years ago, the great neuroscientist Antonio Damasio did a clever experiment that demonstrated how dramatically thoughts affect your body’s physiological reactions. He asked Herbert von Karajan, the legendary conductor of the Berlin Symphony, to sit quietly in a chair while hooked up to a variety of devices that monitored heart rate, blood pressure, and brain waves. After getting baseline measurements, he gave von Karajan the score to a Beethoven symphony and asked the conductor to go through it, imagining that he was conducting the orchestra through each passage, but without any significant physical movement. Damasio measured the exact same changes in brain waves, blood pressure, and heart rate that he had observed when von Karajan actually conducted that same symphony. By merely thinking about and imagining the score, von Karajan’s body had responded exactly as it did when he was actually conducting the score.
Overdosing on Adrenaline
Your nervous system can be conveniently described as having two parts, voluntary and involuntary, which pretty much cover the two major classes of functions that the nervous system performs.
The voluntary nervous system refers to those bodily functions that are under conscious control (doing the tango, knitting, walking, filing your nails, filing your taxes, playing golf, or talking, for example). The involuntary nervous system—technically called the autonomic nervous system—is not under conscious control and includes the lion’s share of our nervous system and functions (heartbeat, digestion, hair growth, hormone secretion, biochemical release—all the things your body does automatically without your thinking about them). Many of our functions—breathing, for example—run automatically (such as when we sleep), except when we consciously take charge of them (for example, when we “breathe deeply” or “hold our breath”). If this weren’t the case, we’d be like the proverbial centipede trying to tell each leg where to go.
Our involuntary functions—those that are for the most part automatic—are very sensitive to our emotions. When we’re startled or frightened, the diaphragm, our main breathing muscle, automatically flattens (inhales) and then stays flattened until the emergency is over, and we exhale with a “sigh of relief.” Unfortunately, this is also the case with chronic anxiety. People suffering from anxiety—along with women in labor, or even people with chronic respiratory disease—are taught how to take voluntary control of their diaphragms, inhaling, sighing, or humming to promote exhalation.
The heart is even more vulnerable to our emotions.
Our emotions affect the heart through the autonomic nervous system, which is divided into two opposite and opposing branches. These branches are the sympathetic nervous system and theparasympathetic nervous system. Ideally, they work together to create a nice state of balance called homeostasis.
The sympathetic system is what prepares us for fight or flight. It’s basically responsible for everything that happens once the “warning light” is turned on signaling an emergency. It’s the sympathetic nervous system that’s responsible for you swerving to avoid an oncoming car or quickly scaling the nearest tree when a wild boar starts charging your campsite. The sympathetic system is in charge of increasing your heart rate and blood pressure while at the same time suppressing “nonemergency” functions such as digestion. The parasympathetic system, on the other hand, is responsible for slowing down. It lowers pulse rate, lowers blood pressure, and stimulates gastrointestinal movements.
Like our ancient ancestors did, we rely on the sympathetic nervous system for extra energy in situations of physical and emotional stress, including combat and athletic events. But such high arousal without an outlet for expression can be damaging. Emotional and psychological arousal (such as fear, dread, worry, and anger) can generate cardiac arrhythmias and coronary artery spasms. They can (and do!) increase blood pressure. And they can even provoke heart attacks and sudden cardiac death.
How does this happen? What life-and-death communications travel between the nervous system and the heart? How can they produce such physiological and pathological responses to both real—and imagined—events?
Well, just as two ordinarily happy partners can have some knock-down, drag-out arguments, in a very real sense the brain and heart can also have some “lethal conversations.” Obviously we don’t mean that the two organs sit down and have a nice chat over a latte at Starbucks—the communication takes place through the nervous system by way of chemical messengers (hormones!) that literally serve as harbingers of death. Yes, we can even overdose on our own adrenaline in situations that involve fear, horror, excessive arousal, or deep despair and depression. The body can commit suicide by overstimulating the heart. And the heart running wildly in panic mode terminates with ventricular fibrillation.
So the brain and the heart are in constant communication. There’s definitely a heart–brain “hotline.” Identifying people at risk for sudden death depends on identifying not only the traditional risk factors for heart disease but also psychological and emotional elements.
Thoughts, unconscious and conscious, appear to be critical factors that link our “personalities” with the centers of the brain that control the functions of the heart. These are the hidden emotional risk factors for heart disease. And they’re far more important than cholesterol is!
Denial Ain’t a River in Egypt
Some people truly don’t feel the pain of their symptoms because, frankly, they’re living in denial, which, for our purposes, we’ll define as a state of being cut off from the awareness of what is happening to your body. Living in denial—out of touch with your body and its feelings—often leads to disaster. You fail to admit that a problem exists. Or you believe your symptoms are “nothing,” or something very “minor.” (Steve has seen this situation time and time again in many coronary-prone patients who told him they were experiencing indigestion when in fact they were having a heart attack.)
Take, for example, the case of Jim.
Jim was a banker, opening up a checking account for a new client, as he had done many times in the past. The client had a bunch of questions, all of which Jim answered patiently. But the client persisted with more questions and concerns. Jim had another client waiting and began to feel trapped.
He probably should have told his client that he had someone else waiting and that they’d have to continue another time. But instead—as is typical in many type-A men—he withheld his emotions and frustrations. He was feeling so much stress that he had to wipe the sweat off his brow.
Jim totally denied this bodily sensation, as well as all the other obvious messages his body was sending him. His hands began to sweat. He had difficulty breathing. He became dizzy, and he experienced chest pains.
Thinking the pain was just indigestion, Jim didn’t let anyone around him know how he was feeling. Fifteen minutes later, Jim was brought to the emergency room after suffering a heart attack.
Thus, a seemingly everyday occurrence ended in tragedy. But why? Why does a man put so much strain on his body that he ends up in total collapse?
The answer is simple. Jim was living in denial.
Living with awareness about your body is really the key to preventing ill health. Jim denied all the signals his body was sending him. (Although we can’t know for sure, it’s a safe bet to say that Jim’s lifelong habit of repressing his feelings was a strong contributing factor to his heart attack.) Instead, he pushed beyond his normal expectations and almost died in the process. Jim was really out of touch with his body. He really didn’t listen to any of the “conversations” that went on between his brain and his heart. The mind saying one thing while the body is saying another is at the root of what cardiologists callsilent myocardial ischemia (a lack of blood flow to the heart, which often results in damage to the heart muscle). The EKG tells us the heart is in trouble, even though the patient has no sensation. But the body is telling the truth, as the heart reveals its distress.
No one questions that there are strong behavioral and psychological factors that frequently precipitate cardiac arrest. It’s no coincidence that sudden psychological or emotional stress frequently occurs just prior to a heart attack. It’s well documented that Monday morning, the day most people go back to work after a weekend away, is the most common time for sudden cardiac death. Approximately 36 percent of all sudden deaths occur on Monday! And interestingly, the second most common time is Saturday. Why? Could it be the result of psychologically and emotionally gearing up (Monday) or gearing down (Saturday)? Is the office a safe place? Or is it a place of combat and stress (especially for the heart)? Look, some people may loathe going to work, but others may loathe going home. Whatever the stress is, the heart will reveal it. And the heart will tell the truth about it.
I remember the unfortunate case of a fifty-two-year-old diabetic woman who had spontaneously bled into her eye and required emergency surgery. Two years before, she had sustained a heart attack but had since enjoyed a good quality of life. She was not experiencing any symptoms of chest pain or shortness of breath, and there were no other obvious signs of heart problems. She was admitted to the hospital and underwent immediate surgery that was, unfortunately, unsuccessful.
Upon learning of the loss of her eyesight, she became deeply saddened and depressed. (Who wouldn’t be?) I remember seeing her in the hospital ward and feeling her depth of sorrow. Sitting in a wheelchair, she was despondent that she couldn’t see. She talked in a monotone voice and kept her head down. She said that she had lost all hope and had nothing to look forward to.
She died a day later.
STRESS AND CHOLESTEROL
Your doc may tell you to fast before certain blood tests, but we’ll bet that no doc ever told you to meditate before taking a cholesterol test. Now granted, we don’t think cholesterol test results are important (unless you get the particle size test we recommended earlier). But your doctor undoubtedly does. And he or she would probably be surprised to learn that stress can actually influence those cholesterol test results. After all, how could stress—which clearly originates in the brain—influence something like cholesterol in the bloodstream?
Glad you asked. Here’s what Dr. Sinatra has to say:
Some years ago, I was asked to submit to a fasting serum cholesterol test for an insurance evaluation. Because I was performing three cardiac catheterizations that day, I asked that blood be drawn prior to 7:30 in the morning.
At that time, my blood cholesterol was 180 mg/dL, a number my doctors and I were utterly delighted with. After performing two of the three cardiac catheterizations, both of which went smoothly, I tackled the third case, which was anything but routine. This was an individual with complex congenital heart disease. The cardiac catheterization itself was further complicated by the fact that during the procedure, the patient suffered cardiac arrest. The patient actually stopped breathing, though, luckily, he was successfully resuscitated. The procedure took a grueling five hours, and it required multiple catheters and multiple pharmacological interventions.
Man, I really sweated during that case, even though, thankfully, it all ended well.
When the procedure was over, it was approximately three in the afternoon, and I hadn’t eaten all day. As I was walking to the cafeteria, I passed the blood lab where I had blood drawn earlier that morning. Because I had a strong belief in the effect of psychological stress on the body, I was curious to see whether the day’s activities had produced any changes in my own blood. So I asked my colleagues to perform a second blood test.
My blood cholesterol had risen to 240 mg/dL, a number that would cause virtually any conventional practitioner to put me on a statin drug immediately.
I had been fasting for nearly 20 hours at this point, and there was absolutely no dietary variable that could have caused this jump of 33 percent in my cholesterol. Obviously, my body reacted to the stressful events of the day by producing an excessive amount of cholesterol.
The connection between stress and elevated cholesterol is well documented. In 2005, researchers conducted a study of about 200 middle-aged government workers in London.6 First the workers gave blood samples and “rated” their levels of stress. Then they were given two paper and pencil tests, both designed to be somewhat stressful. In the first test, they were shown mismatched words and colors. For example, the word “red” would be written in blue letters. The participants had to name the color in which the words appeared (in this case “blue”). It’s a confusing and annoying test and makes people uneasy. In the second test, the participants were told to trace the outline of a star in a mirror, under a deadline. (Try it sometime—it’ll make you crazy.) Afterward, the participants gave blood again, had their cholesterol checked, and rated their stress levels.
Three years later everyone had their cholesterol levels measured again.
The first finding was interesting on its own: Cholesterol rose for everyone after doing the stress-inducing paper and pencil tests. But it rose for some people a lot more than it did for others. Let’s call them the “high reactors.”
Now check this out: Three years later, the high reactors had the highest cholesterol levels.
The researchers created three “thresholds” for cholesterol: low, medium, and high. After the three years, those who hit the “high cholesterol” threshold included 16 percent of those who had initially shown little cholesterol reaction to the stress tests and 22 percent of those who had initially shown a “moderate” cholesterol reaction to the stress tests.
But a whopping 56 percent of those who initially had the biggest change in their cholesterol after the stress tests were now in the “high cholesterol” group! And this was even after making adjustments for weight, smoking, hormone therapy, and alcohol use.
The short stress tests were excellent predictors of how people—and their cholesterol levels—responded to stress. “The cholesterol responses we measured in the lab probably reflect the way people react to challenges in everyday life,” said lead researcher Andrew Steptoe, D.Sc. “The larger cholesterol responders to stress tasks will be large responders to emotional situations in their lives,” he added. “It is these responses in everyday life that accumulate to lead to an increase in fasting cholesterol . . . three years later. It appears that a person’s reaction to stress is one mechanism through which higher [cholesterol] levels may develop.”
Stress and Depression
Stress is certainly a trigger for depression, and the relationship between depression and heart disease is well established. Individuals who suffer from mood disorders are twice as likely to have a heart attack when compared to people who are not depressed.
One researcher who has spent much of his career investigating the relationship between depression and heart disease is Alexander Glassman, M.D., a professor of psychiatry at Columbia University and chief of clinical psychopharmacology at New York State Psychiatric Institute. In a number of published studies, he has shown that medically healthy but clinically depressed patients are at increased risk of both cardiovascular disease and cardiac death. Depression following a heart attack especially increases the risk of death. “It is now apparent that depression aggravates the course of multiple cardiovascular conditions,” he wrote.
The Stress of Sorrow
If we look at those suffering a bereavement, sudden death is two to ten times higher than in the general population. It’s even worse if a man loses his wife than if a woman loses her husband. In general, women adapt better than men do. Women express feelings more often. They find joy in sharing those feelings, especially with other women. They form networks and nurture each other. Men, on the other hand, build walls. They hold feelings in. They keep secrets and sometimes have a really hard time communicating.
As trite as it sounds, love heals.
In my “Healing the Heart” workshops, we see profound cholesterol lowering when a patient experiences contact and connectedness in a supportive environment. In these four-to seven-day workshops, cholesterol levels have been lower in every one of our participants, with some losing as much as 100 mg/dL of cholesterol in just a few days!
The dramatic reduction in cholesterol supports the notion that emotional contact can positively affect our health.
Once, during a workshop, a physician from Greece was asked about the relative lack of heart disease in Crete and Greece. He immediately responded by speaking of the healing powers of nurturing relationships, particularly among the males. He described how men in Crete spend quality time with one another, talking over lunch about real feelings. The typical topics discussed when American men get together—sports, politics, and money—just aren’t central in their conversations. They talk about feelings. They talk about their families. They talk about their dreams and even their spiritual beliefs. And they rarely wear “social masks.” Instead, they argue, cry, support, and even hold each other. The Greek doctor felt that such camaraderie—occurring often over games of chess or during two-hour lunches—is a major factor in the reduction of coronary heart disease.
Maybe part of the “secret” of the Mediterranean diet isn’t the diet at all. Maybe it has something to do with how the people in the Mediterranean live.
When you support and nurture yourself, your positive self-esteem reflects itself in the healing of your body.
Although digging into your emotions and allowing yourself to be vulnerable can be difficult if you are unaccustomed to such soul-searching, we invite each of you to consider looking more deeply into your emotional self. Such introspection can initially be painful, but it is well worth the effort in the long run. When you support and nurture yourself, your positive self-esteem reflects itself in the healing of your body. Such nurturing and protective influences have been validated in studies time and time again.
Animals and the Stress of Heartbreak
If you’re an animal lover like we are, you might not want to read the next few paragraphs. We’re going to tell you about a horrible and sad study that nonetheless dramatically illustrates the role of psychological stress in heart disease and death. (Don’t say we didn’t warn you.)
Baboons are some of the most lovable creatures on earth. They sleep and travel in groups of about fifty individuals. They’re highly social and very connected. Adults sit in small groups grooming one another while the youngsters romp and play. They forage for about three hours in the morning, rest during the afternoon, and then forage again later on before returning to their sleeping places. Before bed, they spend more time grooming each other, which not only keeps them clean and free of external parasites, but also serves to strengthen their bonds. And they’re ambassadors for “family values”—they mate for life.
Early in the twentieth century, Soviet experimenters performed the following experiment. They reared eighteen baboon couples together, and then, after the bonds were strongly established, they removed the male from the cage and replaced him with a new male. The ex-mate was placed only a few feet away in another cage, fully able to observe his former partner and her new “mate.”
Within six months, every one of the eighteen “ex-husbands” died.
Technically, they died of strokes, hypertension, and heart attacks. Less technically, we could say they died of heartbreak. Either way, the acute psychological stress of being trapped, heartbroken, and, most important, helpless to do anything about it, overwhelmingly resulted in death.
Warren Buffett is a particular hero of mine, but not because he’s the richest dude in America. Rather, I admire him because, by all accounts, he is remarkably down-to-earth, unpretentious, compassionate, and unafraid of expressing his feelings—not exactly a constellation of traits most of us associate with incredible wealth and power.
Much of this probably has to do with Susie.
Susie met Buffett in 1950, and they were married two years later. “She put me together,” he said. Susie was big on civil rights and fairness. She was involved in helping the cause of integration in Omaha back in the 1960s and influenced Buffet so much that he became active in overturning anti-Semitic membership rules at the fancy Omaha Club.
She humanized him.
Prior to meeting Susie there was little time in Buffet’s life for anything but moneymaking. Although they eventually separated, they shared a great love, and it was probably the most transformative relationship of Buffett’s life. Susie even introduced him to her friend Astrid, who, with Susie’s blessing, eventually became his mistress and, after Susie’s death, his second wife.
Seven years after Susie’s death, Buffett was the subject of a Time cover story by Rana Foroohar. When discussing Susie, he burst into tears. Foroohar reported that it took several moments for him to recover. She put her hand on his arm. “Eventually,” she said, “we moved on to an easier subject—his investments.”
Few men of Buffett’s station in life would allow themselves to feel vulnerable enough to break down and cry in front of a reporter when talking about the love of their life. In fact, few men of any station in life would feel free enough—and be in touch with their feelings enough—to do so.
Buffett eats a horrific diet of fast food, is reported to drink about 60 ounces (1.7 liters) of Coca-Cola a day, and has never been seen at a gym. Yet at eighty-one, he’s sharp, active, involved, and engaged.
He’s also healthy.
Could his dyed-in-the-wool optimism coupled with his ability to express his feelings easily and relate to people deeply be profoundly protective of his heart?