Volume 2 Number 6, 1989

2nd International Montreux Congress on StressNovember 19-21, Hotel Excelsior, Montreux, Switzerland

State of the art presentations on Stress and Cardiovascular Disease include the Pathogenesis of Mitral Valve Prolapse in AnxietyDisorders and Stress, The Stress Connection to Sudden Death, Stress-Related Cardiovascular Hyperreactivity in thePathogenesis of Atherosclerosis and Coronary Heart Disease, The Role of Stress and the Sympathetic Nervous System-in thePathogenesis of Hypertension, and Hypertension as a Disorder ol Communication. Other sessions are devoted to Stress,Emotions, Personality and Health, and include an update on Perconality Traits As Predictors ol Mortality from CardiovascularDisease and Cancer and ke Benefrcial Effects of Stress Reduction Strategies. Other segments are devoted to the StressReduction Effects of Spa Therapy, How to Design and Deliver an Effective Stress Reduction Program, lsychophysiolog!9 StressAssessment Techniqies, etc. The concluding presentations are devoted to the Biobehavioral Effects of Low EmissionElectromagnetic Energt and their use in the treatment of insomnia, depression, anxiety and addictive disorders,

The close relationship between stress, emotions andhealth has been recognized since antiquity. Twothousand years ago the celebrated Greek physician,Galen, noted that melancholy women were muchmore likely to develop cancer of the reproductiveorgans, He attributed this to an excess of "black bile"(Gr. melas chole), Succeeding generations of physi'cians, poets and literary figures have written aboutvarious illnesses and afflictions believed to be due tostress. Anecdotal tales and folklore in almost every

In retponce to a nurnber of requeats, we will be devoting certain iscuec of the Newsletter to specifictopica-. The format will include an lntroductory general overuiew followed by sunnary articleareporting on recent relevant recearch reports. This issue features Strecs and the Immane Syctem acwell ae other articlee.

Stress and Resistance culture provide abundant additional support. How-ever, it has only been in the past few decades thatscientific advances have enabled us to verifu andexplain how such effects may be mediated.We commonly think of the body's response to stressin terms of the "fight or flight'reaction to a severephysical threat. The resultant outpouring ofadrenalinlike hormones had immediate effects on thecardiovascular, endocrine and cenhal nervotrs sys-tems that were purposeful for primitive man. Rapidbreakdown of fat and carbohydrate stores increasedthe blood sugar and cholesterol to provide moreenergy. Accelerated blood clotting lessened the likeli-hood of severe bleeding from laceration or internalhemorrhage. Increased heart rate and blood pressureprovided more blood flow to the brain to improvedecision making. Similarly, the circulation was shuntedaway from the gut to the large muscles of the(Continued on page 2)

To Disease

For further information on the original source of abstracts and otherreprints available on similar subiects, please send a self-addressedstamped envelope to: Reprint Division, Ametican Institute of Stress,124 Park Avenue, Yonkers, IIY 10703'

The Newsletter of THE AMERICAN INSTITUTE OF STRESSNEWSLETTER is published monthly by The American Instituteof Stress. Subscription rates: $35.00 annually. Copyright@ 1987by The American Institute of Stress. All rights reserved.

ALSO INCLUDED IN THIS ISSUE

The Fatal Link Between Cancerand Depression r r r r r r r r r r r r r r r r r r r r r r r r : r Z

Stress, Breast and Ovarhn Cancer 4455

Stress and Herpes.......Stress, Cancer and BrainMicrostress and Arthritis...Reducing Stress Reduces

Arthritic ComplaintsSocial Support and Adjustment to

Rheumatoid ArtrritisImproving the Immune System

with Vitamin ECan Vitamins Reduce Risk of Cancer?

...........,..... 7

The Newsletter of THE AMERICAN INSTITUTE OF STRESS

THT AMTRICAN INSTITUTE OF

Paul J. Rosch, M.D., F.A.C.P.Editor-in-Chief

Contributing Editors from The Board of Trurtees ofThe American Inctitute of StresaRobert Ader, Ph.D,, Rochester, NYHerbert Bencon, M.D,, Boston, MANorman Coueine, Los Angeles, CAMichael E. DeBakey, M.D., Houston, TXJoel Elhee, M.D., Louisville, KYJohn Laragh, M.D., New York, NYJamee J. Lynch, Ph.D., Baltimore, MDKenneth R. Pelletier, Ph.D., M.D., Berkeley, CABay H. Rorenman, M,D., Menlo Park, CACharlea F. Stroebel, Ph.D., M.D., Hartford, CTAlvin Toffler, New York, NYSue Thomar, RN, Ph.D., Baltimore, MD

Stress and ResistanceTO DiSgaSg (Continued from page one)extremities to increase strength in combat or speedof locomotion away from a scene of potentialperil.However, the nature of contemporary stress is nolonger apt to be the life threatening physical chal-lenges faced by our ancestors. Today, these formerlyuseful automatic and immediate reactions are notonly inappropriate, but have become harmful. Repeat-edly invoked several times daily, instead of once ortwice a month, it is not hard to understand how theycould contribute to diabetes, ulcers, muscle spasm,heart attacks, strokes, or sudden death, Modernday stress more often stems from a host of psycho-social stressors and daily hassles. These chronicand subtle pressures may invoke "fight or flight"responses, but more often produce their insidiousadverse health effects through quite different path-ways. Loneliness, social isolation, loss of importantpersonalrelationships, disruptive family ties have allbeen linked with a variety of diseases that seem toresult from depression of the immune system.The immune system is the body's defense mechan-ism to resist attack from viral, fungal, bacterialandother factors that cause disease. Although we arecontinually exposed to a variety of infectious andcancer causing agents, an efficient immune systemcan recognize and repel such threats. This abilityweakens as w€ grow older which may explain theincreased incidence of malignancy and infection inthe elderly. It has also been demonstrated thatcertain types of stress can similarlydepress immune

system activities, thus making us more susceptibleto various infections, and tumors, including herpes,AIDS, and breast and lung cancer.However, it's not all bad news, All of the greatintegrative systems of the body operate on a systemof self regulatory checks and balances. The involun-tary nervous system has counterbalancing sympa-thetic and parasympathetic components. Similarly,the endocrine system is largely governed by feedbackmechanisms that function much like a thermostat,so that pituitary stimulating hormones are pro-duced only when blood levels of target glandhormones fall, and signal the need for replen-ishment. Thus it seems likely that if negativeemotions or "bad" stress can weaken the immunesystem, there are quite likely positive emotions and"good" stress that can strengthen it. There are alsoa variety of stress reduction strategies, such as thatprovided by this videotape, which can effectivelydampen or block the injurious effects of stress onthe body. Additionalinformation on some of thesetopics is provided in the following abstracts basedon recent medical reports.

'A great many open minds should be closed for repairs."- Toledo Blake

The Fatal LinkBetween CancerAnd Depression

As noted previously, ancient Greek and Romanphysicians believed that depressed or melancholywomen were much more likely to develop cancer.This suspicion now also appears to have beenconfirmed for men, Over two thousand white maleemployees of a large corporation underwent a com-prehensive physical examination between 1957 and1958. This included a psychological evaluationusing the Minnesota Multiphasic Personality Inven-tory (MMPI), which consists of responses to 566 selfdescriptive statements. Various profiles or sub-scales can be constructed by analyzing responsesto groups of selected statements, thus revealing atendency towards depression, paranoia, schizo,phrenia, introversion, hostility, etc. The studygroup, was recently followed up whether theirpsychological profile 20 years previously couldpredict future health status, and specifically deathsdue to cancer or heart disease. The results revealedthat the death rate from cancer was significantlyhigher in those individuals showing high depression(Continued on page 3)

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The Fatal Link betweenCancer and Depression(continued from page 2)scores, even when possible confounding factorssuch as cigarette smoking, alcohol consumption,family history of cancer, etc., had been accountedfor. In another thirty-year retrospective study ofmedicalstudents, it was similarly found that thosewho were emotionally withdrawn or depressedwere more likely to develop cancer."In patients with malignant melanoma, depressionproved to be a powerfulpredictor of early mortality.Those with the most pessimistic attitudes also hadthe lowest levels of natural killer cells, which helpthe immune system ward off malignant invasion.Depression was also associated with an increase insuppressor T cells, which have the opposite eflectand suppress immune responses. This observationis of particular interest since lithium, which is oftenused to treat manic depressive illness, reducessuppressor cell activity.Widowed individuals die from cancer in the 12-18months after loss of a spouse at rates three totwelve times higher than their married counter-parts. Several research groups around the worldhave now confirmed that following the death of aloved one, there is apt to be aprompt and impressivedecline in immune system components responsiblefor resistance to cancer. While none of this provesthat stress or depression can cause cancer, theevidence is certainly strong, and tends to supportnumerous anecdotal observations.

*The optimist expects his dreamspessimist expects his nightmares to."

to come true, a

- Anonymous

Stress and AIDSAs its name implies, the basic problem in AIDS is adeficiency in the immune system. Since stress canalso depress immune function, it seems likely that itmight contribute to the clinicalappearance of AIDSor aggravate existing signs and symptoms. Manypatients who harbor the AIDS virus never developthe disease, or do so only after an incubation periodof up to twelve years. Many authorities believe thatstress plays a crucial role in precipitating theappearance of AIDS in apparently healthy carriers,as well as the subsequent course of the disease.Conversely, it has been observed that AIDS patientswho have developed a stress resistant attitude ofbeing in controlare able to fight their illness muchmorc effectively, Several reports reveal that im-mune system function is improved in patients whoare able to openly express their emotions, and havea strong feeling of control over their condition, Aswith many cancer patients, maintainingan aggressive

spirit anddenial of illness, also appears to be associatedwith longer survival. In one report, researchersstudied 39 homosexual men who had been recentlydiagnosed as having the AIDS virus. Immune systemfunction was poorest in those who reported the mostdepression, anxiety, and loneliness. Individuals ratedas having an attitude of vigorous denial, and animproved ability to express anger and other emotions,had the best immune system responses. In anotherstudy, sixty-four recently diagnosed AIDS malesattended 8 two-hourweekly sessions in additionto anall day retreat. They learned stress-reduction tech-niques such as yoga and meditation, and receivedinstruction and training in nutrition and exercise.However, the major emphasis was on how to recognizeand manage stress. The program resulted in asurprisingly sharp reduction in the frequency andnumber of sexual contacts, which had not beenanticipated. However, it also improved immune systemfunction to a degree similar to that achieved with theuse of the leading AIDS drug, AZT,The average life span after an AIDS diagnosis iseighteen months, In a New York City study, 20V"ofmore than 57,000 AIDS patients had diedwithinth'reeyears, andthere was only a 5Tochance of living longerthan five years. However, eflective stress reductiontraining appears to reverse this trend. A recentnewspaper article reported on a 40-yearold patientdiagnosed as having AIDS four years previously.When faced with the facts, he gave up his stressful jobof crisis intervention with the emotionally handi-capped in New York City, and moved back to Kansaswhich he describedas a"low stress-low riskarea."Hebegan a program of regular meditation, daily exercise,and embarked on a healthier diet in an attempt to takecontrolof his physicaland mental health. Despite thefact that he took no medication, his skin lesions ofKaposi's Sarcoma, which is usually fatal for AIDSpatients, miraculously disappeared.At present a five-year European study of 500 AIDSpatients with the AIDS virus is under way to determinewhether or not certain stress-related psychologicalvariables can be correlated with both the developmentof clinicalillness as well as its severity and duration.The researchers postulate that AIDS positive patientsmay live longer when:1) they see a purpose in life2) they see their illness as a challenge and do not

simply succumb orbecome resignedto their fate3) they have a strong social support system4) they have a greater feeling of control over their

illness5) they are more optimistic and less depressed

about their situation6) they have developed good coping strategies to

combat stressA variety of self'help AIDS giroups also report improvedhealth benefits and life expectancy which they attributeto an improved ability to reduce and cope with stress.

The Newsletter of THE AMERICAN INSTITUTE OF STRESS

Stress, Breast andOvarian Cancer

Stress and Herpes

The lastest gov€rnment figures report a puzzlingincrease in the incidence of breast cancer in middle-aged females, despite a decline in the rate of othermalignancies. Although experts have no explanationfor this, there has been increased interest in the roleof stress in breast cancer with a recent book beingdevoted entirely to this subject. One possible factormay be related to the increased number of womenentering a male-dominated work force. It has beenwell established that the earlier a woman becomespregnant or has her first child, the less likely she isto develop breast cancer. This protective effect ofpregnancy is thought to be related to a reduction inprolactin, a pituitary hormone that stimulates breasttissue growth and promotes breast cancer in experi-mentalanimals. As more and more career orientedwomen enter the work force, they tend to remainsingle, marry and decide not to have children, or doso only when they are much older. The percent ofwomen having their first child after the age of 35 hasalmost quintupled since 1970.We have also seen that stress can depress theimmune system defenses against cancer. Manyworking women are now increasingly subjected tointense stress because they have to juggle workresponsibilities with being a wife, supermom, singleparent, or providing custodial care for an agingrelative. In addition, many find that despite equalorsuperior training, experience, and ability, they arepaid less than thejr male counterparts and usuallyreach a dead end when they attempt to climb theupper rungs of the corporate ladder. Often they aresubjected to subtle as wellas overt sexualharass-ment. An aggressive attitude is justifiable if notencouraged in males who are striving to get ahead.However, it is not considered ladylike or feminineand is apt to be viewed as undesirable if notunacceptable for aspiring female executives. Thus,working women are often frustrated because theyhave to "act like a lady, think like a man, and worklike a dog" just to survive. Further examination ofthe available data couldcorroborate the linkbetweenjob stress and the "puzzling" increase in breastcancer in middle-aged women.Similarly, a recent medical report revealed that"career-oriented women, especially those with nochildren, may fit the highest-risk profile for deadlyovarian cancer." The stress of life in the fast lanewas also thought to be a factor. Single careerwomen have fourteen times the average risk ofovarian cancer than a matched group of homemakers,

"Destiny is not the amount of chance; it is a matterof choice. It is not a thing to be waited for; it is a thing

As noted above, it is believed that stress con.tributes to cancer and various viral infectionsbecause it depresses our immune system's ability toresist such threats to our health. Despite theplausibility of such a hypothesis, it is difficult toprove and critics point out that numerous otherfactors may be involved, What we arbitrarily labelas "The Immune System" really consists of manydisparate components whose functions and statusare measured by very specific techniques. Thus wecould measure the numbers and ratios of B and Tcells, helper cells, suppressor cells, natural killercells, various immunoglobulins, interferons, inter.leukins, etc. Depending upon what is being measured,it is quite conceivable tht "stress" could improvecertain aspects of immune system function whilelowering others. Stress can depress immune systemcomponents which provide defenses against cancerand other virallinked illnesses, but that stilldoes notprove that stress is necessarily the cause of suchproblems. Evidence is not the same as proof.It has long been observed that patients suffering fromherpes tend to have recurrences of their problemwhen under stress. Allof us know about "cold sores"and "feverblisters." Herpes patients provide a uniquelyvaluable population to study the relationship betweenstress and viraiillness, The herpes virus resides in aninactive or dormant phase in the cells of affectednerves. Under certain stresses, such as fever, menstru-ation, or emotionalupset, the virus becomes activated,and rapidly reproduces itself, and travels down conduct-ing fibers to the skin, where it results in the formationof typical "cold sores" or blisters. In a recent study,men with recurrent herpes were evaluated bothpsychologically as well as immunologically. The find-ings in married men were compared to matchedcontrols who were separated or divorced. The assump-tion was that that the latter group would score higheron scales of loneliness and depression and wouldexhibit a correspondingly higher incidence of herpesepisodes. The psychological tests did confirm thatsingle or divorced males were more "anxious,

depressed, and lonely than their married counter-parts" and they also had higher levels of herpes virusantibodies. These antibodies rise during periods ofreactivation of the virus which produce clinicalsignsand symptoms and thus reflect the inability of adepressed immune system to keep the infectionunder control. Even in the married group, those whoreported poorer personal relationships also exhibitedhigher viralantibody levels and other immune systemalterations consistent with decreased resistance toinfection. The immune system is also suppressedduring the acute "fight or flight" response, providingfurther support for the stress - decreased immuneresponse - disease hypothesis,

to be achieved." - William Jennings Bryan

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Stress, Cancer, andBrain Messengers

In addition to its adverse effects on the irnmunesystem, stress and emotionaldepression nray con-tribute to cancer via other pathways. Depression isalso associated with decreased levels of the brainneurotransmitter, dopamine, although it is stillnotclear whether this is cause or effect. Other brainmessengers such as the endorphins, also havepowerful effects on mood and behavior and areintimately involved in the response to stress. Adepression-dopamine-cancer pathway is supportedby a recent report from India, demonstrating thatdopamine injections markedly reduced experi-mental tumor growth in mice. Tumors were onlyhalf as large in the treated group, and their lifeexpectancy was 40olo greater than untreated con-trols. Other studies show that dopamine levels areincreased in "novelty-seeking" individuals and peoplewho are usually curious. A high degree of curiosityhas also recently been found to be associated withimproved immune system function. Psychothera-pists have previously emphasized the significantbenefits that can be achieved by encouraging thedevelopment of curiosity and novelty-seeking traitsin depressed cancer patients. Another brain messen-ger known as corticotropin-releasing factor (CRF)may also play a role. When CRF is injected into thebrain, there is a prompt reduction in naturalkillercellactivity. These specialized agents seek out anddestroy cancer cells. Clinically depressed individ-uals have been shown to have lower levels of naturalkiller cells, and it has been suggested that this maybe due to increased CRF activity. Responses toCRF and adrenal steroid administration are fre-quently used to diagnose and differentiate differenttypes of depression. It is quite likely that other brainneurotransmitters and hormones are also involvedin the complex relationships between stress, immunesystem function, and other mechanisms that deter-mine our resistance to cancer and infections.

"Men call vices the pleasures which escape them,and virtues the infirmities which they have |eft."

- Alfonse Karr

Microstress and ArthritisWe have seen that severe stress or trauma canprecipitate rheumatoid arthritis, probably mediatedby effects on the immune system. Other reportssuggest that "microstress" or everyday "hassles"

can have a similar effect. An Arizona study investi-gated immune system function in 33 women withrheumatoid arthritis. The participants were alsoasked to list their exposure to a number of minor

stresses or hassles during the preceding month.These included getting a parking or speeding ticket,family fights, arguments with co-workers, custom-ers, friends, etc. Women with higher "hassle"

scores also showed a decrease in certain white cellsof the immune system which seem to protectagainst arthritis flare-ups. Some of the more than200 minor life stresses identified fell into the fol-lowing categories of problems:1) recreationaVsocial life - having to call off a

vacation, losing a close friend, arguments withfriends, death of a pet.

2) money and finance - unexpected expenseover $50 but under $500, unfavorable errors inchecking balance, increase in rent or mort-gage payment.

3) transportation - car breaking down,long waitin traffic, parking or traffic ticket.

4) children (under 18) - can't find a babysitter,discovering that child has a problem with theteacher or the school, disobedience or failure toadhere to family rules,

5) love and marriage - criticism from spouse ormate, minor sexual problems, suspicion ofinfidelity.

6) health and illness - not being able to stopsmoking, increased alsohol use, not being ableto stay on a weight reduction diet, allergyflare-ups.

7) household events - problems with plumbing orelectricity, objectionable neighbors, repairmanfails to show up on time or does faulty work.

8) job problems - rumors of impending layoff,having more responsibility but less authority,being responsible for poor work done by sub-ordinates, etc.

Among the stress reduction techniques which weretaught were:

meditation - sitting with the eyes closed in acomfortble, quiet location and concentrating onbreathing regularly or on a single word that isrepeated at regular intervals with expiration.guided imagery - taking a mentalstrollthrougha beautiful garden or a walk on a peaceful,secluded beach, often with the help of anappropriate guide or tape recording.deep muscle relaxation - which involves slowlytensing and relaxing progressive muscles untilawave of relaxation passes through the body.self hypnosis - by concentrating on simplepositive suggetions such as, "my arms are filledwith helium;l can lift them without pain."

"To learn all kinds of things, one must relate to all kinds

a)

b)

c)

d)

of people." - Anonymous

The Newsletter of THE AMERICAN INSTITUTE OF STRESS

Reducing Stress ReducesArthritic Complaints

The main complaints associated with arthritis arepain and loss of mobility or function. Teachingpatients how to reduce stress by developinga senseof control can provide impressive benefits. In onestudy, arthritis sufferers received detailed back-ground information about their disease and werealso instructed in exercises to improve mobility.One year later, when compared to a controlgroupwho had not been involved in the program, it wasfound that there had been a significant improve-ment in pain and range of motion in the affectedjoints that could be verified objectively. Theresearchers were curious as to whether it was theinformation or the exercises, which were primarilyresponsible for these benefits, To their surprise,neither of these two components, appeared toaccount for the marked improvement.Puzzled, they looked into the matter in greaterdetail by extensive interviews with the improvedpatients. What they found was that the programhad produced a significant change in the attitude ofthe participants. The best way to characterize thismight be that it had given them a sense of control-a belief that they could do something about theirdisease. That seems to make a lot of sense. If "bad

stress" can make arthritis worse, isn't it likely thatopposing factors, or "good stress" could counter-act such influences and bolster immune defenses.Stress is not a very usefulword for scientists, simplybecause it is a highly personalized phenomenonthat cannot be objectively defined. What is distress.ful for one individual, may actually be pleasurablefor another, or alternatively have no significance.However, allof our clinical and laboratory researchsuggest that the sense or feeling of being out ofcontrol is uniformly and extremely distressful. Thus,it would follow that developing a sense of controlcould significantly reduce the harmful effects ofstress. It was apparently the development of thisfeeling, or what has been called "self-efficacy," thatwas responsible for the improvement in pain reliefand joint mobility.There is other evidence to support this. Scientistshave been studying what happens in the centralnervous and endocrine systems when one developsa sense of controlor capability. One of the prom-inent changes appears to be the release of adrenalinand noradrenalin in the brain. These catechola-mines are produced in large amounts by the adrenalglands as part of the "fight or flight" response toacute stress. In one study, women who had a severephobia about spiders, were taught certain strat-egies to overcome their fear. It was found that themore successful the women were in learning thetechniques to conquer their problem, the less theysecreted these hormones. Other neuroendocrinetransmitters, such as the endorphins, which have

powerfuleffects on mood and pain perception mayalso be involved.Interviews with the arthritis patients who hadparticipated in the program also revealed a strongconnection between feelings of depression andpain. Depression is often characterized by feelingsof helplessness, hopelessness, or lack of control.When the participants were rated as to their extentof improvement, it became quite clear that theirability to achieve a sense of control by reachingattainable goals, was consistently predictive for asimilar degree of pain relief. Those who had partic-ipated in the program which promoted self-efficacyexperienced a 357o reduction in pain, 20Vo decreasein swollen joints, and a similar improvement indepression. In addition, the quality of their lives hadimproved as a result of the socialsupport benefitsprovided by the group sessions.

"True success can only be measured through theinner satisfaction of getting thete."

- Anonymous

Social Support andAdjustment To

Rheumatoid ArthritisIf "bad stress" can make you sick, then it's probablyquite likely that there is such a thing as "good

stress" that promotes health or counteracts theeffects of distress. Having a positive attitude, devel-oping a feeling of control seem to reduce stress, asdog.s- having a strong socfl support system andsense of belonging. All of our'automatic reactions tostress have developed as adaptive changes wererequired to insure survival, during the hundreds ofthousands of years of man's evolution. Althoughsome of these are no longer appropriate or mayeven be harmful, many still provide importantbenefits.Group activities, particularly those which are di.rected towards a common goal, would obviouslyhave been purposeful or even life saving for primi-tive man. Banding together to fight a pack offerocious wolves, or to withstand the ravages of anatural disaster such as a flood, would have hadsurvival value for our ancestors. Therefore, it couldbe argued that individuals, not so motivated, wouldhave died more frequently and at younger ages,leaving survivors with more altruistic and socialsupport tendencies. A sense ofstrong social supportalso appears to improve immune system defensesagainst viral infection and cancer-causing agents,In one study, over one hundred patients withrheumatoid arthritis were interviewed extensively.A particular focus of inquiry was their satisfaction(Continued on page 7)

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Social Support andAdjustment toRheumatoid Arthritis(Continued from page 6)with various components of their social support.Physicians and other health care providers werealso asked to rate their opinion of the patient'soverall support systems based on personalobser-vation and specific questions. There was goodagreement between self ratings and those made byothers with respect to adequacy and efficacy ofsocial support. The relationship between supportsatisfaction and psycho-social adjustment seemedto increase with the patient's level of disability,suggesting that social support provided a powerfulstress buffer, It also appeared quite evident thatdisturbance or disruption in established socialrela-tionships was a significant source of stress, that wasoften manifested by a flare-up of symptoms.

"Man gradually comes to associate his doings withthe consequences,"

- John Dewey

Imnrovinq the ImmuneSy3tem ufith Vitamin E

It is wellknown that as we grow older the incidenceof certain infections and malignancies appears toincrease. This is thought to be due to an age-relateddecline in immune system function. Certain oxi-dative changes occur in the cells of various tissuesas part of the aging process, These make themmore vulnerble to attack by viruses and othercancer-causing agents, Vitamin E is an antioxidantand in large doses can counteract such damagingoxidative injuries. In one study, 32 healthy in-dividuals over 60 were given either vitamin E orplacebo for one month, and immune system functionwas evaluated before and after the experiment.Most of the vitamin E group showed a significantimprovement in immune system function, with a 10to 507o boost over pretreatment values.However, the dosage of vitamin E used was 800international units, about 26 times the recom-mended daily allowance. Patients in the placebogroup showed no change, Another experiment inchickens infected with lethal bacteria, demon-strated that mortality could be reduced by as muchas 80o/o simply by providing a diet with six times theusual content of vitamin E. Adding megadoses ofvitamin E to an antiviralsheep vaccine more thandoubled its protective effects again suggesting thatit can improve immune responses. In anotherstudy, large doses of vitamin E reduced the oxi-

dative damage often seen in smokers, and whichare thought to play a role in the development of lungcancer.

"The greatest discovery in our generation is that humanbeings by changing the inner attitudes of their minds canchange the outer aspects of their lives."

* William James

Can Vitamins ReduceRisk of Cancer?

Animal studies suggest that vitamin A relatedcompounds known as retinoids can reduce thedevelopment of breast and other cancers. Compar-isons of vitamin A intake in breast cancer patientsand normalcontrols revealed that the cancer riskfor those withthe lowest vitamin A intake was aboutdouble that of the highest group. A large study isnow under way in Italy in 5,000 women who havehad cancer of the breast to determine whether theadministration of vitaminA rich retinoids willreducethe appearance of cancer in the unaffected breast.Retin-A creams protect against skin cancer and inthe laboratory, retinoids have been shown to halt orinterfere with the growth and development ofleukemic and precancerous cells. Another largestudy in smokers suggests that retinoids mayreduce the incidence of lung cancer.As noted elsewhere, there is also evidence thatlarge doses of vitamin E may improve immunesystem defenses against cancer. None of theseresearch findings prove any causative effect, butmerely demonstate an association. Many otherfactors not accounted for may have an importantinfluence. Thus, a long-term follow-up study ofcollege graduates revealed that sedentary femaleshad almost twice the rate of breast cancer as thosewho were athletic and active on college sportsteams. Stress may also play an important role sinceit may increase the production of prolactin whichcontributes to breast cancer. Stress can also lowerthe body's immune activities which provide defen-ses against malignancy.

"There is much pleasure to be gained from uselessknowledge." - Bertrand Russell

Mark Your Calendar:2nd International Montreux

Congrece on StressNovember 19 - 21,1989

Book Reviews o Meetings and Items of InterestBook Review

Stress Managernent for Chronic Diaeace, Ruesell,M.L. (ed). Pergarnon Precs, New York, 1988, 316 pp.,$45.00.This volume addresses a serious problem that is increasing bothwith respect to diversity ahd intensity. As our elderly populationrapidly increases, so does the incidence and complicationsrelated to chronic disease. Stress-related problems are partic'ularly prominent because of growing social isolation in the aged,difficulties related to the continuing care of disabled relatives withAlzheimer's or Parkinson's disease, and a host of other afflic-tions and infirmities which interfere with the quality of life, but notnecessarip its duration. Lack of control over one's activitiesbecause of poor health is the most common source of stress insenior citizens. And their problerns can cause severe stress infrustrated caregivers, as is demonstrated so frequently in therelatives of Alzheimer's disease victims who remain at home.This volume, which is part of the Pergamon General PsychologySeries, grew out of a local conference held several years ago inHouston, so that most of the authors are from the surroundingarea and the 16 chapters reflect their areas of particularexpertise. Thus chapters are devoted to stress management andhypnosis, TMJ syndrome, headaches, obstetrics and ryne-cology, eating disorders, etc., which are not really top priorityproblems for the elderly or even chronic disease. Most of thechapters are well written and referenced, but the level ofpresentation is uneven and the scanty Index is only one-and'a'half pages long. The title of this book promises more than itdelivers. That is probably a reflection of the fact that it isessentially limited to the expertise of local authorities. While thepresentations are commendable and some are superb, theywould probably be more appropriate and effective if directed toan audience different from the one likeb to be attracted to thistitle. The stress-related effects of chronic disease have vastmedical, psychosocial and liscal implications and deserve a moreeclectic and appropriate treatment than this volume provides'

Meetings and ltems of Interest

Sept. 24, Healthy Pleasures, Boston, MA (M.l.T.) lnstitute forthe Studyof Human Knowledge. Contact Margaret Caudill, M'D., ISHK/Boston. Box 1062, Camb,ridg, MA 02238.Oct. 2-4, Neuropeptides and Immunopeptides, New York, NY. NewYork Academy ofSciences,2 E. 63rd St., N€w York, NY 10021. (212)838.0230.Oct. ll-15, Amerkan Academy of Child and Adolescent Psphology,New York, tlY. (202) 966-7300.

Oct,23-25, The Ecology of Work: Improving Productivity andthe Qualityof WorkLife. Toronto, Ontario. Contact TomChase,R.R. #2, Box lKa, Northwood, NH 03261.Oct.26-29,Academy of Psychosomatic Medicine, Las Vegas,NE. Academy of Psychosomatic Medicine, 5824 N. Magnolia,Chicago, IL 60660. (3L2) 7U-2025.Oct. 27-30, Fifth Annual Meeting of the Society for TraumaticStress Studies "Learning from Victim/Survivors: Insights forPrevention, Intervention, and Care," San Francisco, CA. TheSociety for Traumatic Stress Studies, P.O. Box 1564, Lancaster,PA 17603.Nov. 2-4, Cardiac Wellness and Rehabilitation, St. Thomas, VI.Medical Education Resources, (800) 421-3756.Nov.2-4, NeuroimmunologyVl: The State of theArt, Chicago,IL. University of Chicago School of Medicine. (3L2) 702'1056.Nov. 2-5, 1989 23rd Annual Convention of the Association forAdvancement of Behavior Therapy, Washington, DC. (212)279.7970.Nov. 4-5, Teaching Humanistic Medicine: An Exploratio! ofGoals, Teihniques and Experiences, NewYork, NY, NYU PostGraduage School. (272) 340-5295.Nov. 5-19, Topics in Psychopharmacology and EPsychiatry Moscow, Samarkand, Tashkent, Leningrad,Professional Seminar Consultants. Inc. (800) 365'5357.

Nov. 5-19, Topics in Psychopharmacology and BiologicalPsychiatryMoscow,s_amarkand,Jashl-e-q!,^Le_ningr_ad,USSR.Professional Seminar Consultants, Inc. (800)Nov. 9-11, Addiction Medicine: State of the Art CalifomiaSociety for the Treatment of Alcoholism and Drug Addiction, SanDego, CA. (415) 42&9091.Nov. U-20, 26th furnual Psychiatric Institute oq Group Behaviorand Group Leadership, Peachtree City, GA, Emory UniversitySchool of Medicine. (404) 727'5695.Nov. 19-21, Second Annual International Montreux Congresson Stress, Montreux, Switzerland. American Institute of Stress(914)%3-1200.Dec. 3-7, Intemational Round Table on Silent MyocardialIschemia. For detailed information contact the Congress Secre-tariat, Tel Aviv; contact Kenes Ltd.' P.O. Box 50006, Tel Aviv61500.Dec. 7-9, Cardiac Wellness and Rehabilitation, Acapulco,Mexico. Medical Education Resources (see above for details-same as August 4.)Dec. lll-'3d, Wellness and lts Relationship to Health Romotion,Protection and Dsease kevention (Cruise: Rio De Janeiro toBuenos Aires, Argentina). Seminars and Slrnposia Inc. (212)5'-t-75n.Feb. 2S-Mar 2, 1990, American Journal of Health Promotion,Cancun, Medco. (313) 258-3754.Mar. 29-Apr. l, 1990, American Qqciety of ConternporaryMedicine and Surgery (Stress and Hypertension), Phoenix,Arizona.

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