Understanding Psychoactive Substances (And the Lifestyle Medicine Approach)

Overview

So far I have discussed Lifestyle Medicine and its three of the areas of focus namely: nutrition, sleep, and stress management. This time, I’ll be featuring the fourth focus: the avoidance of psychoactive substances and how Lifestyle Medicine could help you avoid these substances.

What are Psychoactive Substances?

The World Health Organization (WHO) defines psychoactive substances as essences which when taken into your body affects your mental processes. The term “psychoactive substances” is a neutral and descriptive term for a whole class of substances whether legal or illegal. The adjective “psychoactive” does not necessarily imply dependence or abuse, although it is commonly associated with addiction because of its effects in the brain.

Classifications of Psychoactive Substances

Psychoactive substances can be classified in different ways.

Purpose

Depending on your intention of using, psychoactive substances can be classified as therapeutic or recreational. Medicines are therapeutic substances however, these could also cause some side effects affecting our mental processes (like sleepiness, sluggishness, etc.). Alcohol and tobacco, on the other hand, are considered recreational because you only use them during recreational activities.

Legality

Depending on each country, psychoactive substances can be legal or illegal. Some countries in the world consider marijuana (Cannabis sativa) legal but some countries do not.

Nature

Depending on its source, psychoactive substances can be natural or synthetic. Tobacco, wine, coffee are just a few examples of natural psychoactive substances. Most illegal drugs are synthetic or man-made.

Route of Administration

Psychoactive substances can also be classified into the way these substances enter your body. It could be by inhalation, orally or by injection.

Mechanism of Action

The most used classification that allows to define better psychoactive substances is its mechanism of action in the body once consumed. This classification divides psychoactive substances into three:

Stimulants:

These are substances that activate the central nervous system and increase its activity. Cocaine, amphetamines, nicotine, and caffeine are just a few examples of stimulants.

Psychedelics:

These are also known as hallucinogens since they alter mental perception. Examples are LSD, ketamine, and marijuana.

Depressants:

These substances decrease the activity of the central nervous system and enhance inhibition. Alcohol, barbiturates, and benzodiazepines are just a few examples.

This classification is still too broad despite its usefulness because there are substances belonging to the same class but may present differences.

That is why I’m going to discuss the top four psychoactive substances that I believe you might be struggling to avoid, if not eradicate completely from your system.

Alcohol

Any alcoholic drink contains ethanol. Ethanol is a type of alcohol produced by fermentation of grains, fruits, and other sugar sources.

About 33% of the world population drink alcohol, making it one of the most widely used psychoactive substances. A discovery of an ancient jug dating back from the late Stone Age suggests that alcoholic drinks existed as early as 10,000 B.C. It just shows that drinking has been a part of many cultures.

Alcoholic drinks are divided into three classes: beers, wines, and spirits.

Beer

Beer is a beverage made from fermented grain mash, typically from barley or a blend of grains and flavored with hops. It is also carbonated due to its natural fermentation process. However, if the fermented mash becomes distilled, it is called a spirit.

Wine

Wine is a beverage made from fermented grapes and other fruits. Wine takes longer to ferment than beer and takes months or years to age. That is why its alcohol content is about 9% to 16% alcohol per volume (ABV).

Spirit

As mentioned earlier, spirit (sometimes called liquor) is an alcoholic drink produced by distilling beer. It is usually unsweetened and has an alcohol content of 20% ABV. However, other distilled drinks such as whiskey and vodka may have an alcohol content of 40% ABV. To distinguish the distilled beverages from the undistilled ones, the term “hard liquor” is used.

Why do you consume alcohol?

As an apéritif

Any alcoholic beverage served before a meal is called apéritif. It is served to stimulate the appetite. Common apéritifs are wines, liqueurs, and dry champagne which are usually dry rather than sweet.

As a digestif

An alcoholic drink served after a meal is called digestif. They are served after meals to improve digestion. Brandy, wines,and herb-infused spirits are just a few examples of digestif.

As a culinary ingredient

Wine is used as a flavor agent, primarily in stocks and braising since its acidity lends balance to rich savory or sweet dishes. There is no fear for being intoxicated because the alcohol has evaporated during cooking.

Alcohol is a depressant. In low doses it can cause euphoria, reduces anxiety, and increases sociability. In higher doses, it can cause drunkenness, stupor, unconsciousness, or can lead to death. Long-term use can lead to an alcohol use disorder, cancer, and physical dependence.

Alcoholic drinks contain 6.93 kilocalories per gram of alcohol. It also contains 10 to 15 grams of carbohydrates. That is why excessive daily intake may contribute to an increased body weight and “beer belly”. Alcohol is known to make the insulin response to glucose more active. It “instructs” the body to convert consumed carbohydrates into fat and suppresses carbohydrate and fat oxidation. Ethanol is directly processed in the liver therefore, chronic excessive intake of alcohol can lead to fatty liver which eventually leads to liver disease.

Tobacco

The dried leaves of the tobacco plant are rolled (as in cigars), or crushed and put into smoking implements (as in pipes), or processed and put into a small cylindrical paper (as in cigarettes). The dried leaves are then burned and the resulting smoke is breathed in to be “tasted” (as in menthol cigarettes) and inhaled. The inhaled smoke delivers active substances into the lungs, absorbs into the bloodstream and reaches bodily tissues.

Smoking dates back as early as 5000 B.C. and has been recorded in different cultures around the world. It is carried out as part of religious ceremonies or rituals to help induce trance-like states altering their minds for purposes of divination or spiritual enlightenment.

However, nowadays, people smoke for different reasons. Some say they started smoking because they were curious at first. Some say it was due to peer pressure. Others say it’s a bonding thing, to beat boredom, to let time pass by. Others reasoned that smoking let them think deeply, when in fact, it wasn’t the cigarette that actually helped them solve the problem; it was stepping away from the problem and taking a break. And speaking of taking a break, stepping outside to have a smoke gives them an excuse to take a break. It all boils down to these: no one in his right mind would take up a habit that has been proven to cause lung cancer and all of these reasons are just excuses.

What makes it difficult for you to quit is the symptoms of nicotine withdrawal. Physically, your body reacts to the absence of nicotine. Mentally, you are experiencing changes in habit and behavior which you find challenging. Emotionally, you might feel that you’re deprived or have lost something valuable.

Drugs

Although psychoactive substances and drugs bear many similarities and are often used synonymously, psychoactive substances do not exactly refer to the same elements as drugs. Earlier we defined psychoactive substances as any type of substance that when taken into the body affects mental processes. Thus, the term is broad and includes drugs. On the other hand, the WHO defines a drug as a substance that has the potential to prevent or cure a disease. However, we use the term drug in its colloquial sense, as substances used for recreational purposes and are most often illegal.

Thus, psychoactive substances not only refers to medicines but also illegal drugs.

Throughout human history, people have been using different psychoactive drugs for thousands of years. They use it to celebrate, to perform rituals, to deal with grief, etc.

But the use of drugs involves risk. And with risk comes harm. And harms can be acute or immediate like in vehicular accidents, or death from overdose. Or harm can be chronic like in the development of heart disease or cancer. These harmful effects vary depending on the characteristics of the drug, route of administration, and dosage.

Coffee

Coffee is a brewed drink prepared from roasted coffee beans. These coffee beans are seeds of coffee berries. Ripe coffee berries are picked, processed, and dried. Dried coffee seeds, which we usually refer to as “coffee beans” are roasted to varying degrees depending on the desired flavor. Roasted beans are ground and then brewed to produce what we drink as coffee.

Coffee is dark, bitter, acidic, and has a stimulating effect due to its caffeine content. It is one of the most popular drinks in the world and can be prepared and presented in various ways --- hot, iced, espresso, latte, etc.

Coffee drinking dates back to the mid-15th century Yemen and it spread from Asia to other parts of the world.

Studies show that moderate consumption of coffee is safe within usual levels of intake, is more likely to improve health, and mildly beneficial as a stimulant in healthy adults. Some say that coffee does have antioxidant properties which could reduce risks of some diseases, although the credibility of some of these studies are questionable.

Abuse, Addiction, Dependence, and Tolerance

The consumption of psychoactive substances generates multiple effects in the person’s brain depending on the qualities of the substance and on the form of use and the amount consumed. Beyond that, there are psychological situations that frequent users encounter: addiction, abuse, dependence, tolerance, and withdrawal.

Many people think the terms abuse, addiction, dependence, and tolerance are pretty much the same thing. However, each term means something different about how psychoactive substances affect a person’s brain.

Abuse

Abuse is any inappropriate use of legally prescribed medications or illicit substances. Thus, you are using a substance in a different manner for which it is not intended or in amounts which are in excess of what is safe over a period of time. When you are abusing a substance, you can stop taking it if you decide to do so without experiencing any withdrawal symptoms because you understand that you should not be using the substance inappropriately. However, abuse of psychoactive substances can lead to addiction.

Addiction

Addiction is a long-term, relapsing brain disorder characterized by regular substance seeking behavior and use, regardless of harmful consequences. It involves uncontrollable cravings and maladaptive substance seeking behavior that takes up much of your time. It is a more severe form of substance use.

It is considered a disorder because it already alters the structure and functioning of your brain often and its effects are long-lasting. The alterations in the brain can result in changes in personal, social, occupational, and other harmful behaviors observed in those who become addicted to substances.

Dependence

Dependence is when the body starts to seek a substance as if you cannot live without it, or to prevent withdrawal symptoms from happening. What is concerning about withdrawal is it becomes the main reason why you maintain to be dependent. When dependence begins, you are aware that there is a problem. So you will try to stop taking the substance and go cold turkey. Then, you will experience different withdrawal symptoms associated with the substance, either physically, psychologically or both. And because you don’t want to experience the negative withdrawal symptoms again, you tend to seek the substance which feels much “better”.

Tolerance

Tolerance is the progressive need to administer increasing amounts of a psychoactive substance because your body is already accustomed to its effects. Since your body is already used to the usual dosage, you feel that the substance is no longer giving the effect you expect. Thus, you increase your dosage just to experience the desired effect.

The Lifestyle Medicine Approach to Avoiding Psychoactive Substances

In Lifestyle Medicine we always promote a healthy lifestyle which embraces the idea of holistic well-being. In Lifestyle Medicine, you increase your control over your activities of daily living, striking a balance between choice and responsibility, between people and the environment. It focuses more on enabling people to increase control over their health than curing diseases.

Most people who practice a healthy lifestyle are engaged in health-promoting actions such as following low-risk drinking guidelines, avoiding smoking, and adopting safer use techniques. Promoting health actions involve a variety of motivational strategies and social marketing campaigns.

The whole human experience is complex. Helping you understand that complexity, and showing you the skills on how to manage it, helps you become actors rather than victims of these psychoactive substances in your life. Since many of you use psychoactive substances often or in part, either to promote health and well-being (like medicine and supplements), or to celebrate events (like an occasional champagne) promoting Lifestyle Medicine along these lines involves helping you manage your substance use in a way that it maximizes benefit and minimizes harm.

As for the withdrawal syndrome, it is best carried out in a substance abuse treatment facility that provides medical detoxification. Medical detoxification ensures that medical professionals are available to ensure you remain physically and emotionally safe by monitoring your vital signs and your state of mental health. Your physical stability that involves the removal of the psychoactive substance from your body is the first goal of detoxification. After that, your psychological withdrawal symptoms would be addressed.

Conclusion

For centuries, people have been using psychoactive substances to promote health and well-being. However, these same substances have caused harm to individuals and to society. Therefore, Lifestyle Medicine should revolve around helping people manage their substance use as safely as possible in order for the Lifestyle Medicine approach to be meaningful and successful. Our goal is healthy people in healthy communities.

If you are having problems dealing with psychoactive substances, feel free to schedule a consultation. I will help and work with you to make changes at whatever pace you are comfortable with. There is also a health program that might suit your needs. If you want to hear from me discuss more about Lifestyle Medicine, feel free to listen to my podcast. If you want to be updated with news and features from this website, subscribe to my newsletter or reach out using the contact forms below.

Sources:

Canadian Institute for Substance Use Research. 2010. “Understanding Substance Use: A Health Promotion Perspective | Here to Help.” HeretoHelp. BC Partners for Mental Health and Substance Use Information. 2010.

Dhamsaniya, Dr. Bhavin. 2018. “Psychoactive Substance Use Disorders.” Mann Homeopathy Clinic Rajkot. September 25, 2018.

Felman, Adam. 2019. “Caffeine: Effects, Risks, and Cautions.” Edited by Katherine Marengo LDN, R.D. Www.medicalnewstoday.com. Healthline Media UK Ltd. November 7, 2019.

Hawks, David, Katie Scott, and Nyanda McBride. 2002. “Prevention of Psychoactive Substance Use: A Selected Review of What Works in the Area of Prevention.”

It's Psychology. n.d. “Psychoactive Substances: Characteristics and Types.” It’s Psychology.

Melbourne Hypnotherapy Clinic. 2019. “10 Reasons Why People Smoke.” Melbourne Hypnotherapy Professional Services. February 10, 2019. .

Room, Robin. 2015. “The History of Psychoactive Substance Use and Problems and of Social Responses to Them.” In Addiction Medicine: Principles and Practice, edited by P. Haber, C. Day, and M. Farrell, pp. 3-8. Melbourne: IP Communications.

Stromberg, Joseph. 2013. “This Is How Your Brain Becomes Addicted to Caffeine.” Smithsonian. Smithsonian.com. August 9, 2013.

The American Cancer Society medical and editorial content team. 2020. “Why People Start Using Tobacco, and Why It’s Hard to Stop.” Www.cancer.org. American Cancer Society. November 12, 2020.

Tobacco Free Life Organization. n.d. “Side Effects of Nicotine on Your Health.” Tobacco-Free Life.

“WHO | Psychoactive Substances.” 2010. Who.int, December.

Understanding Stress and How Lifestyle Medicine Can Help

Overview

Hans Selye, a Hungarian-Canadian endocrinologist and known as the Father of Stress Theory, once said,

“Every stress leaves an indelible scar, and the organism pays for its survival after a stressful situation by becoming a little older."

Most of the time, you use the term “stress” to actually mean “stressors”. That is because, more often than not, you associate stress with undesirable situations.

One of the six areas of focus of Lifestyle Medicine is stress management. This article will discuss stress, how it affects you, and why Lifestyle Medicine focuses on stress management.

Good and Bad Stress

Any circumstance that causes you stress is called a stressor. It could be physical or physiological changes in the body, changes in the environment, life events, or behavioral changes. Even imaginary situations like worry and fear could become stressors.

However, stress is a normal physical and psychological reaction of your body to the demands of your daily life. A little amount of stress motivates you to perform better. Eustress or good stress does not only help you in restoring your energy but also improve your heart function and increase your stamina and strength. They sharpen your thinking and enhance your mental ability.

Distress on the other hand, has a negative impact on your body. It causes you anxiety or a feeling of displeasure. Distress affects your performance and can lead to your mental as well as physical problems.

With today’s modern living, stress becomes a double-edged sword that could kill you if left unmanaged over time. Hence, it is very important how you perceive an event or a situation because the way you handle stress is an indicator of your overall health and well-being.

The Physiology of Stress

General Adaptation Syndrome

In 1936, Hans Selye conducted a study on the hypothetical "non-specific response of the body to any demand". That was how Selye first describe "stress" in medical terms and the stress model General Adaptation Syndrome was conceived.

Selye theorized that the body adapts constantly to stressors in a predictable biological pattern so that the body's internal equilibrium or homeostasis would be restored and maintained. His study explains the stress response and how chronic exposure to stress can cause aging and diseases.

To understand how stress affects your body, Selye described the General Adaptation Syndrome into three stages:

Alarm Stage

The first step in a stress response is the perception of the threat or stressor --- real or imaginary. The hypothalamus in the brain perceives the stressor and performs the following:

1. Activates the Autonomic Nervous System (ANS)

The Autonomic Nervous System (ANS) regulates the activities of the internal organs like circulation, digestion, respiration, temperature regulation, excretion, etc. It consists of the sympathetic (arousal) and parasympathetic (relaxed) nervous system.

The sympathetic system is responsible for the fight-or-flight response. In response to a stressor, catecholamines --- epinephrine (adrenaline) and norepinephrine (noradrenaline) --- are released causing several changes like increase in your heart rate, increase in the force of heart contraction, vasodilation of arteries to the working muscles, vasoconstriction of arteries to non working muscles, dilation of pupil and bronchi, and reduction of digestive activities in the body. All these changes are required to prepare your body for fight-or-flight response which last for a few seconds.

2. Stimulates the Hypothalamic Pituitary Adrenal (HPA) axis by releasing Corticotropin Releasing Hormone (CRH)

Your pituitary gland controls the secretion of other hormones in the body. Upon stimulation of the CRH, your pituitary gland secretes Adrenocorticotropic Hormone (ACTH) which would stimulate the adrenal glands in the kidneys releasing glucocorticoids and mineralocorticoids.

Glucocorticoids release energy to cope with the ill-effects of stressors. The energy released converts glycogen into glucose and breaks down fats into fatty acids and glycerol. In addition, this corticoid also increases urea production, suppresses your appetite, suppresses your immune system, exacerbates your gastric irritation, contributes to your feeling depressed and loss of control. These are the symptoms generally seen in persons under stress.

Mineralocorticoids promotes sodium retention and elimination of potassium. This results in an increase of blood volume thus increasing blood pressure.

Also your adrenal gland secretes epinephrine (adrenaline) and norepinephrine (noradrenaline) as a backup system to ensure your physical survival as intermediate effects.

3. Secretes arginine vasopressin or Antidiuretic Hormone (ADH)

ADH is synthesized by your hypothalamus and released by your pituitary gland. It regulates fluid loss through your urinary tract by reabsorbing water in your body. Also, ADH has a role in regulating blood pressure during stress when your body's homeostasis is disturbed by the release of energy.

Another change occurring during stress is the distribution of energy to a particular organ that needs it most. This is achieved by increasing blood pressure. This occurs either through enhanced cardiac output or through constriction of the blood vessel.

Other hormones such as the growth and thyroid hormones also play a significant role in stress. Growth hormone raises the concentration of glucose and free fatty acids. It has been observed that in humans, psychological stimuli increase the concentration of thyroid hormones. Your thyroid gland releases thyroxine and triiodothyronine. These hormones also have some significant function in stress increasing your overall metabolic rate. Thyroxine also increases heart rate and sensitivity of some tissues to catecholamines.

Although serotonin and melatonin are not considered stress hormones, they are associated with mood which decrease during depression brought about by stress.

Adaptation or Resistance Stage

After the body has responded to the stressor, it is expected that the stress level has been reduced, if not eradicated. However, after your initial fight-or-flight response, your body’s defenses become weaker because your body allocates energy to repair the damaged tissues and to lower the production of the stress hormones.

Although your body has shifted to this phase of stress, it remains alert especially when the stressors persist and your body needs to fight them continuously. However, due to lower defenses, your body fights not as stronger as during the alarm stage.

If the stressful situation is not resolved, the body uses all its resources to adapt. This results in sleep problems, tiredness, muscle pains, indigestion, allergies, infections, common colds, lack of concentration, impatience, irritability, smoking and drinking.

Recovery or Exhaustion Stage

If your body’s compensatory mechanisms have succeeded in overcoming the stressor’s effects, recovery follows. But if your body has used up its resources and is unable to maintain normal function it leads to exhaustion.

During exhaustion, your body starts to lose its ability to combat the stressors because the adaptive energy is all drained out. The exhaustion stage can be the gateway towards burnout or stress overload, which can cause long term effects putting you at risk of suffering from more serious health conditions.

Impact of Stress to Your Body

Acute stress occurs for a short period of time. It comes on quickly and also goes quickly. Acute stress is generally recognized with symptoms such as anger, anxiety, irritability and acute periods of depression. Sometimes it may bring you thrill, pleasure and excitement.

When acute stress is felt too frequently it is called episodic stress. It occurs due to a series of stressful challenges occurring one after another in your life. Bills which do come frequently is an example of episodic stress.

When a stress persists for longer duration it is called chronic stress. It is brought about by your prolonged exposure to stressors. Chronic stressors may not be as intense as acute stressors but they are more harmful than acute stressors because the effect of chronic stress has accumulated for a long time.

Stress affects your body in many ways both physical as well as mental. The impact of stress on the body may not be the same in all people. It may vary depending on factors like the genotype, sex, age, physiological conditions and past experiences of the person. But some of these effects are common to every individual. Most of the effects are due to increased concentrations of corticoids and adrenaline.

Digestive System

Disturbed eating habits, acid reflux, diarrhea or constipation are the common symptoms seen in stressed persons. Stress can also be related to obesity which is linked to a host of other health problems. Hormonal changes occurring during the acute and chronic stress can affect glucose homeostasis in both healthy people and in those with diabetes.

Extreme stress can also be associated with diabetes because excessive cortisol can affect the insulin activity. The body can also become resistant to insulin which can lead to diabetes.

Circulatory System

Several studies show a strong relationship between stress and cardiovascular diseases. Stress plays a role in susceptibility, progress and outcome of cardiovascular diseases. Psychological stresses are also associated with cardiovascular diseases because it has become psychosomatic.

Increased adrenaline and cortisol during stress affect your heart and blood pressure. Too much adrenaline causes your blood pressure to elevate making your heart pump harder and faster. This action can result to heart disease, stroke, or cardiac arrest. Stress has been reported to be an indicator of coronary heart disease and hypertension.

Chronic stress also leads to increased blood cholesterol levels. The persistent high levels of cholesterol and other fatty substances in the blood may cause atherosclerosis which could lead to heart attack.

Cortisol also plays a role in accumulating abdominal fat that leads to obesity.

Immune System

The persistent activation of your HPA axis in chronic stress response impairs your immune response leading to several infections. People under chronic stress are more susceptible to viral illnesses like flu, common cold, and other infections.

The high levels of stress hormones suppress the release of cytokines chemicals secreted by the T helper cells (a type of T lymphocytes). Cytokines regulate both cell-mediated and humoral immune response in your body.

Two types of cytokines are released from the T helper cells. Th1 cytokines stimulate cytotoxic T cells and Natural Killer cells. These are cells that directly kill intracellular pathogens (cell-mediated immune response). Th2 cytokines stimulate B cells to produce antibodies (humoral immune response). Chronic stress may deregulate Th1 and Th2 cytokines which can lead to suppression of both immune responses.

Chronic stress also affects cytokines involved in the inflammation process. Proinflammatory cytokines feed back to the CNS and produce symptoms of fatigue, malaise, loss of appetite, and listlessness, which are the symptoms usually associated with depression.

Studies have also found that faster progression to AIDS was associated with higher cumulative stressful life events, use of denial as a coping mechanism, lower satisfaction with social support, and elevated serum cortisol.

Other Body Systems

Cortisol also alters bone mineral density thus affecting bone development in the body. Stress may retard growth in young children .

In some cases, stress could also cause cancer. The persistent activation of the HPA axis in the chronic stress response impairs the immune response and contributes to the development and progression of some types of cancer.

Stress also interferes with the reproductive system both in men and women. Since sex life depends on fitness of both body and mind, chronic stress may decrease libido and may even cause erectile dysfunction or impotence in man. Testosterone levels can drop to an extent that can interfere with sperm production in chronic stress. In women, stress can affect the menstrual cycle. It can lead to irregular, heavier or more painful periods.

In addition to its direct effect on your body, stress also produces some behavioral changes. People living in stressful environments are more prone to smoking and are more vulnerable to alcohol consumption which has its own consequences.

How to Manage Stress

Identify The Triggers

The first step in managing your stress is to identify the factors which trigger your stress. These factors vary from person to person. Some of you may take things very seriously while others don't. Family problems are major stressors. Also, many of you are very much afraid of facing sudden changes in life and find yourselves in trouble whenever you encounter one. Some of you may find it difficult to travel or even when you have to face a large audience or person in authority.

Once you identify your possible triggers, then you can plan on how to manage your stress. Start managing your stress level by making changes in your daily routine and spending some time on yourself.

Watch Your Diet and Nutrition

Stress can disturb your eating habits which can cause nutritional deficiencies that could eventually stress your body. This is because your body uses more of your nutrients to cope up with stress. A balanced low-glycemic index can keep your blood sugar stable and can help you deal with stress better. Foods rich in vitamins and antioxidants can help you to boost your immune system during stress. Thus, a good diet is needed to help you cope with the ill effects of stress.

Exercise

Keeping yourself active not only reduces the stress but also helps in easing stress. Exercise keeps yourself physically as well as mentally active and healthy. Physical exercise not only reduces stress hormones but also stimulates the body to release serotonin and endorphins which help in relieving stress and boosting mood. Physical exercise loosens tight muscles and relaxes the body. It improves your breathing and helps in relaxation.

Have an Adequate Sleep

For good health, a sound sleep is very much required. When you do physical exercise it tires you physically which leads to a sound sleep. A good sleep is the key to keeping your worries out and keeping you cool.

Adopt a Relaxation Technique

Meditation focuses your mind on a particular activity, thought or object that improves concentration and awareness. It is a very powerful tool for stress management. Regular meditation induces deep physical and mental relaxation thus reversing the effects of the body’s fight-or-flight responses to stress. It slows heart rate, relaxes the muscles, relieves tension and activates the release of the so called "happy hormones": serotonin and dopamine.

Focusing on your breathing is the simplest form of meditation which helps take your mind off your worries. When your mind is turned off from your problems, you feel relaxed. Meditation can recharge your body and enables you to build up a greater control over your thoughts, worries and anxieties.

Yoga is another stress relieving practice. Regular yoga relieves muscle tension, lowers blood pressure and decreases cholesterol levels.

Have a Good Social Network

Sitting alone with your problems will never help solve your problems. It will always increase stress in your life. On the other hand when you talk to other people it not only takes your mind off your problems but also helps you to find solutions. Having a good social network of family and friends is always good. Good friends may not always have solutions to all your problems but they can definitely keep you away from your problems. Good communication especially between life partners and family members is very essential for a healthy relationship because poor communication or communication gap is a major reason for conflicts in families.

Avoid Smoking, Alcohol, and Other Substances

Stressed people smoke, drink alcohol, or take drugs as a way to "numb" the effect of the stressor thinking that it would go away. But it does not.

Smoking contains nicotine and prolonged, consistent smoking is linked to mouth, throat, and lung cancers.

Alcohol is considered a depressant so drinking them during stress would add to the stress even more.

Taking pills to relieve symptoms for a prolonged period of time could result to addition, drug resistance, or drug abuse.

However, if your smoking, alcoholism, and/or drug use start to form the foundation of your mental issues, it is better to address this directly with a mental health professional.

Be Positive

Your attitude determines your stress level. Stress is not an event. The way you interpret your stressor makes you stressful. Therefore, have a positive attitude and start changing your unhealthy mind set. Always think that there is something good in every bad situation. If you think this way, you will never feel stressed.

They say that laughter is the best medicine. True, because laughter has been show to boost serotonin, the so-called happy hormone, release pain relieving endorphins, and lowers cortisol and adrenaline, the stress hormones. Laughter also relaxes your muscles, lowers blood pressure, and boosts your immune system.

Set SMART Goals

SMART means specific, measurable, attainable, realistic, and time-bound. When you set goals for yourself, you will have a positive sense of commitment, you feel you are in control, and become optimistic. This will remove your worries over things which you do not have control (like the weather and other people) and makes you focus on those things you can actually control (yourself and your tasks). Start setting SMART goals for your career, relationships, creativity, play, and health now.

Conclusion

Everyday, you are exposed to many physical, environmental, physiological and psychological stressors that cause stress responses in your body. If stress exists for prolonged time, it causes many health problems. Although it is not possible for you to completely avoid stress, it can be managed by making little changes in your attitude and lifestyle. Have you not noticed that some of the tips on managing stress are actually the focus of Lifestyle Medicine?

Proper stress management is one way to combat the negative effects of stress. It can improve your mood, boost your immune function, and promote long life. It is important to know how you perceive an event or a situation because the way you handle stress is an indicator of your overall health and well-being. So do not wait until stress damages your health.

If you are having problems dealing with stress, feel free to schedule a consultation. I will help and work with you to make changes at whatever pace you are comfortable with. There is a health program that might suit your needs. If you want to hear from me discuss more about Lifestyle Medicine, feel free to listen to my podcast. If you want to be updated with news and features from this website, subscribe to my newsletter or reach out using the contact forms below.

Sources:

Harvard Health Publishing. 2015. “Best Ways to Manage Stress.” Harvard Health. Harvard Health Publishing. January 8, 2015.

Sarah Mae Sincero. 2019. “General Adaptation Syndrome by Hans Selye.” Explorable.com. 2019.

Sharma, Dushyant Kumar. 2018. “Physiology of Stress and Its Management.” Journal of Medicine: Study & Research 1 (1): 1–5.

Tan, Siang Yong, and A Yip. 2018. “Hans Selye (1907–1982): Founder of the Stress Theory.” Singapore Medical Journal 59 (4): 170–71.

Understanding Sleep in Lifestyle Medicine

Overview

Ever since I re-launched this website, I started discussing Lifestyle Medicine as a medical discipline and started the six areas of focus with nutrition. Each area of focus is important in itself and these should go along with the others. So enumerating them does not mean that is the order or a pattern to be followed. The next area of focus of Lifestyle Medicine I am going to share today is about sleep.

Isn’t it funny that although everyone sleeps, it is difficult for us to define precisely what sleep is? Try asking people randomly what sleep means to them and you will get different answers. Yet, and this is a reality, sleep is a human activity that almost everyone takes for granted.

Sleep Health and World Sleep Day

Last month, World Sleep Day® was celebrated. Yes, there is such a thing. It is held every Friday before Spring Vernal Equinox each year. For this year, it was held last March 19th. This annual event is intended to be a celebration of sleep and at the same time, create a call to action on important issues related to sleep which includes medicine, education, productivity, driving, and other social aspects of human life.

It goes to show that Sleep Health is being recognized as a component of Lifestyle Medicine. Sleep Health or sleep medicine is relatively new in the field of Lifestyle Medicine that scientific studies and related literature on sleep health are limited. Be that as it may, this article is going to provide you an overview of the key issues associated with sleeping habits and how to incorporate this knowledge into your own lifestyle for better health.

Definition of Sleep

Sleep is a body and mind activity which is natural, recurring, and reversible. It is characterized by altered consciousness, decreased responsiveness to external stimuli, inhibited senses, reduced muscular activity, reduced interactions with surroundings, rapid eye movement, and dreams. It is associated with a typical posture of lying down with eyes closed. Scientists say that during sleep there are brain wave activity changes, as well as changes in the rate of breathing, heart rate, body temperature and other physiological functions. Also, sleep is relatively easy to reverse which distinguishes it apart from coma and other disorders of consciousness.

The Anatomy and Physiology of Sleep

For many centuries, physicians used to believe that sleep was a period of physical and mental inactivity only to realize over the last 60 years that the brain remains active during sleep. In fact, several brain structures are involved in sleep.

The brain’s hypothalamus contains nerve cells that control sleep and waking up. Within the hypothalamus is the suprachiasmatic nucleus (SCN) that receives information about light exposure directly from the eyes and controls your behavioral rhythm. The brain stem (includes the pons, medulla, and midbrain) communicates with the hypothalamus to control the transitions between wake and sleep. A brain chemical called GABA is produced in the hypothalamus and the brain stem. It reduces the activity of arousal centers. The pons and medulla send signals to the limbs and other body muscles to relax so that you don’t involuntarily act out your dreams while sleeping. The thalamus which relays information from the senses to the cerebral cortex becomes quiet, letting you tune out the external world. During REM sleep, the thalamus sends the cerebral cortex images, sounds, and other sensations which make your dreams come alive. The amygdala becomes active during REM sleep because it processes the emotions. The pineal gland receives signals from the suprachiasmatic nucleus (SCN) which increases the production of melatonin, a hormone that puts you to sleep once it gets dark. The basal forebrain promotes sleep and wakefulness, while a part of the midbrain acts as an arousal system. Release of adenosine, a chemical by-product of cellular energy consumption supports your sleep drive.

There are two basic types of sleep: the non-REM sleep and the rapid eye movement (REM) sleep.

The first stage of sleep is a non-REM sleep that changes over from your wakefulness then it slows down to your sleep. This lasts for only several minutes, thus it is short. It is characterized by a relatively light sleep. Your heartbeat, breathing, and eye movements are slow. Your skeletal muscles start to relax with occasional twitches. Your brain waves begin to slow down, too.

The second stage of sleep is also a non-REM sleep which is a period of light sleep before entering the deeper sleep. Your heartbeat and breathing are slow, your body cools down, your skeletal muscles relax even further, and your eye movements stop. Your brain wave activity slows down but with brief bursts of electrical activity. Most of your sleep cycles happen at this stage more than in any other stages.

The third stage of sleep is a non-REM sleep characterized by a period of deep sleep that you need to feel refreshed in the morning. It occurs during the first half of the night and has a longer period. Your heartbeat and breathing are slow at their lowest levels during sleep. Your skeletal muscles are relaxed. This is the stage where it would be difficult to wake you up. Your brain waves become even slower.

REM sleep occurs within the first 90 minutes after you fall asleep. Your eyes move rapidly from side to side behind closed eyelids. Your brain wave activities seem closer to that of your wakefulness. Your breathing becomes faster and irregular, and your heartbeat and blood pressure increase to near waking levels because most of your dreaming occurs at this stage. The arm and leg muscles become temporarily paralyzed preventing you from acting out your dreams.

Process C and Process S

There are two body mechanisms that work together to regulate your sleep: the Circadian regulation (Process C) and homeostatic control (Process S). Although there are other factors affecting your sleep, understanding these two processes will help you strive towards a consistent sleep schedule.

Process C refers to your internal clock, regulated by the suprachiasmatic nucleus (SCN) of the hypothalamus. This clock regulates and controls your 24-hour sleep-wake cycle via the influence of light and melatonin. In the absence of light, as during the evening, melatonin is produced by your body promoting sleep but in the presence of light, your production of melatonin ceases, signaling your brain that it is daytime and you need to wake up. However, your behavior can override these natural signals. For example, bright lights at night shut down your production of melatonin, delaying your sleep until late hours of the night.

Process S promotes your sleep based on the previous amount of time that you spent awake. During wakefulness your brain accumulates substances that promote sleep, when you sleep these substances are cleared up and you feel alert again. This process is particularly important when you take naps in the afternoon, because you deplete the sleep promoting substances and you are not able to fall asleep at a reasonable time in the evening. The best sleep is when you synchronize your sleep/wake times to your internal clock and find a perfect equilibrium between your Process C and Process S.

Why Do We Sleep?

There are numerous theories on why you sleep and no theory will ever be proven correct. However, sleep may be explained by two or more of these theories. By understanding why you sleep, you will learn to respect sleep as a body function and enjoy its benefits rather than taking it for granted.

Inactivity Theory

Also known as the Adaptive or Evolutionary Theory, this suggests that inactivity at night is an adaptation and means to survive especially when you would be vulnerable.

Energy Conservation Theory

According to this theory, sleep reduces your demand for energy and your energy expenditure during the day especially at times when you are not in search of food. This is because your body temperature and caloric demand decreases while sleeping. Studies show that energy metabolism goes down by 10 percent during sleep. This supports the opinion that sleep helps organisms conserve their energies.

Restorative Theory

This theory is based on the belief that sleep restores what your body has lost while you are awake. It provides a time for your body to repair and rejuvenate. There are findings that show muscle growth, tissue repair, protein synthesis, and growth hormone release happen during sleep.

Brain Plasticity Theory

This theory is based on findings that sleep is correlated to changes in the structure and organization of the brain known as brain plasticity. Its connection to sleep has critical roles especially in the brain development among infants and young children and with adults as well. This is seen in the effect sleep deprivation on learning and performance of various activities.

While these theories do not directly answer the question why you sleep, it does set the stage for putting sleep in a new context and generating new knowledge about this essential body activity.

How much sleep do we need?

Some people prefer going to bed early while others have a preference for staying up late. But as mentioned earlier, children need to get more sleep which is essential for proper growth and development. As you age, sleep influences your immune system, memory, attention, hunger, mood, response time, and many other body functions.

The CDC has recommended the number of hours of sleep for every age group. Refer to the image below:

Although individual sleep needs and patterns may vary, most adults usually need seven to nine hours of sleep. If you feel refreshed and energized upon waking up, you are getting enough sleep. But if you’re not, you probably feel sleepy, tired, sluggish, clumsy, forgetful, and even cranky.

The Sleep-Work-Life Balance Challenge

You have twenty-four hours in a day and one-third of that is allotted for sleep and the other two-thirds are for your activities during wakefulness. That two-thirds of a day is still divided into your working hours (mainly, your job) and your time for other activities of daily living (family, personal time, exercise, meals, commute, etc.).

But have you reflected on how you spend your twenty-four hours? Some of you may say no probably because you are too focused on your priorities like your job, or your family’s needs. A few of you would say yes because it has been your habit to track down what you’re doing.

Here is a challenge for you: For one week, try to take note of how many hours of sleep, work, and other activities of daily living you spend in a day. At the end of the week, count the number of hours you spent on sleep. If you get less than fifty hours of sleep in a week, reflect if you felt tired or sluggish most of your waking hours. Most likely you will answer yes and unaware that you already show signs of sleep deprivation.

Here is an example from a journal that shows the sleep-work-life balance:

Impact of Lifestyle and Technology Developments on Sleep

You are living in modern times, and that means you are too busy to sleep. It is increasingly difficult for you to sleep with so many things vying for your attention.

Screens

You might be spending many hours in front of your television set everyday. Americans spend more than four hours on average watching TV. That is more than three hundred hours a year spent staring at a bright television screen.

Social Media

Your social media keeps you from getting sleep because you are glued to your smartphones texting, chatting, or engaging on your different social media accounts even on bed.

Work

You value their work that there are times you bring home some of it. Now, you are probably working from home. Both setups affect your sleeping routines. Not only that, the concept of 24/7 company work shifts, or even working on a different time zone affects your sleep and can cause a sleep disorder called shift work sleep disorder.

Travel

Jet lag is characterized by difficulty of falling asleep during or after a flight, disrupted sleep, and loss of appetite. Although your friends may tag you as a jet-setter, the negative effects on your health is not “cool”.

Smoking

You already know that smoking is bad for your health. But smoking also affects sleep. A study shows that smokers sleep less and the quality of their sleep is lower as compared to non-smokers.

Substance Abuse

Some of you might take alcohol or medications just to get some sleep. Others take drugs so as not to fall asleep. These substances affect your sleeping routines severely and also lower the quality of the sleep over time.

Chronic Diseases and Sleep Deprivation

Sleep deprivation is a cumulative effect of not obtaining adequate sleep. It adversely affects the body, brain, mood and cognitive functions and impacts all aspects of health. Excessive daytime sleepiness, fatigue, clumsiness, and weight gain or loss are just several signs of sleep deprivation

Sleep deprivation can also increase your risk of vehicular accidents because lack of sleep can slow down your reaction time and decreased alertness. Also, when you don’t get enough sleep, your ability to fight infection may decrease.

We’ve been saying that chronic diseases are becoming top causes of death and illnesses. And I’ve been advocating that Lifestyle Medicine can reverse these chronic diseases. One of the areas of focus in Lifestyle Medicine is sleep. Therefore, there should be an interest in the role of sleep health in the management of chronic diseases. As per the National Heart, Lung and Blood Institute, insufficient sleep has been linked to the development and management of type 2 diabetes, cardiovascular disease, obesity, and depression.

Diabetes

Studies show that people who habitually slept for only a few hours are not able to process glucose. It seems that sleep duration and sleep quality could be predictors of Hemoglobin A1c levels, an important marker of blood sugar control. This could mean that they are most likely to develop type 2 diabetes. Therefore, it is suggested to optimize your sleep duration and quality in order to improve your blood sugar.

Cardiovascular Disease

Persons with sleep apnea, a sleep disorder, have an increased risk for a number of cardiovascular diseases like hypertension, stroke, coronary heart disease and irregular heartbeats. Also, sleep apnea and atherosclerosis share some characteristics suggesting that sleep apnea may be an indicator of cardiovascular disease.

Obesity

Research shows that obesity is linked to metabolic changes during a short sleep. Studies conducted also revealed an association between short sleep duration and excess body weight particularly in children. Sleep in childhood and adolescence is important for brain development and insufficient sleep among children may adversely affect the function of the hypothalamus which regulates appetite and food energy expenditure.

Depression

There is a complex relationship between sleep and depression. While sleep deprivation has been held as a sign of depression, recent research indicates that symptoms may decrease once sufficient sleep is restored. The study further suggests that it is important to assess the sleep sufficiency of persons with depression and to monitor symptoms of depression among persons with a sleep disorder.

Lifestyle Medicine’s Focus on Sleep

Lifestyle Medicine encourages a systematic approach to lifestyle issues including nutrition, exercise, and stress management. It also emphasizes heightened sensitivity to environmental factors in general and sleep health.

However, conventional medicine’s approach to sleep disorders falls short because they encourage reliance on sedative-hypnotics. This has taught us much about the biomedical view of sleep but it has forgotten the sleeper.

Lifestyle Medicine reduces this reliance on sedatives by (1) restoring our regard for you, the sleeper; (2) significantly expanding the range of effective interventions; and (3) reframing sleep health as a lifestyle issue.

Personalization begins by complementing standard evaluation procedures with an invitation to tell your personal “sleep stories.” Lifestyle Medicine emphasizes the importance of the doctor-patient partnership in healing. It also acknowledges your natural inclination to heal. Lifestyle Medicine has the wide range of evidence-based interventions available for sleep health in terms of sleep aids, relaxation practices, and alternative medical systems. Utilizing these interventions can help address overreliance on prescription and over-the-counter sleep medications. In recent years, practices that have long been staples of Lifestyle Medicine, such as yoga, mindfulness meditation, and breathing exercises, are finding acceptance in more mainstream medicine.

Tips to a Better Sleep

If you are having problems sleeping, here are a few tips:

1. Establish a regular bedtime and waking time. If you need to set an alarm, that’s fine, just don’t snooze.

2. Do not exceed 45 minutes of nap or daytime sleep. If you do, you may not be able to follow your established bedtime.

3. Do not smoke and do not drink excessive alcohol four hours before bedtime.

4. No coffee, tea, soda, or chocolate six hours before bedtime.

5. You are allowed to take a light healthy snack before bedtime but avoid eating heavy, creamy, spicy, or sugary foods four hours before bedtime.

6. If you think exercise will put you to sleep, you’re wrong. You are encouraged to exercise regularly but not before bedtime.

7. It also helps to have a short tepid or warm shower before bedtime.

8. Use a comfortable bed and keep your room well-ventilated. Your bed is for sleeping and should not be used for work. If you’re working at home in the bedroom, make sure that your workstation is away from the bed.

9. Turn off the lights and block out the noise.

Conclusion

Sleep Health is relatively new just as Lifestyle Medicine. Sleep, which is a natural body activity, should never be taken for granted because insufficient sleep could lead to sleep disorders and impact chronic diseases.

If you are having problems with your sleep, feel free to schedule a consultation. I will help and work with you to make changes at whatever pace you are comfortable with. There is a health program that might suit your needs. If you want to hear from me discuss more about Lifestyle Medicine, feel free to listen to my podcast. If you want to be updated with news and features from this website, subscribe to my newsletter or reach out using the contact forms below.

Sources:

American Sleep Association. 2017. “Sleep Deprivation: Symptoms, Causes, Treatments.” American Sleep Association. May 12, 2017.

Centers for Disease Control and Prevention. 2019a. “How Much Sleep Do I Need?” Centers for Disease Control and Prevention. 2019.

———. 2019b. “Sleep and Chronic Disease.” Centers for Disease Control and Prevention. 2019.

DePietro, MaryAnn. n.d. “Why Is Sleep Important?” American Sleep Association. Accessed March 29, 2021.

Division of Sleep Medicine. 2019. “The Characteristics of Sleep.” Healthy Sleep. Harvard Medical School. 2019.

———. n.d. “Why Do We Sleep, Anyway?” Healthy Sleep. Division of Sleep Medicine at Harvard Medical School. Accessed April 8, 2021.

Levy Andersen, Monica, and Sergio Tufik. 2015. “Sleep and the Modern Society.” Journal of Sleep Disorders & Therapy Volume 4 (Issue 5): 131.

Naiman, Rubin. 2015. “Integrative Medicine Approaches to Insomnia.” Sleep Review. Medqor. August 17, 2015.

National Heart, Lung and Blood Institute. 2018. “Sleep Deprivation and Deficiency | National Heart, Lung, and Blood Institute (NHLBI).” Nih.gov. November 5, 2018.

Office of Communications and Public Liaison. 2019. “Brain Basics: Understanding Sleep.” National Institute of Neurological Disorders and Stroke. National Institutes of Health. 2019.

World Sleep Society. n.d. “World Sleep Day.” World Sleep Day. World Sleep Society. Accessed March 29, 2021. https://worldsleepday.org/.