The Age of Anxiety

Higher Anxiety? Our ‘age of anxiety’ began four centuries ago

It can come on suddenly and intensely, causing shaking, confusion and difficulty breathing for no apparent reason…trigger an irrational avoidance of elevators or public transportation…or become a steady drumbeat of worry always in the background. All are known as anxiety disorders, one of the country’s most commonly experienced yet largely untreated mental health issues. Is our era of 24/7 disturbing news, packed schedules and often unrealistic expectations spurring a rise in these disorders, or does it just seem that way? Are we in the midst of the Age of Anxiety?

Modern life can be disquieting, but the truth is that anxiety disorders have always impacted large numbers of people around the world. Consider this description of Hippocrates’ patient in 1621’s The Anatomy of Melancholy: “He dare not come into company for fear he should be misused, disgraced, overshoot himself in gestures or speeches, or be sick; he thinks every man observeth him” – a classic case of what would now be diagnosed as social anxiety disorder. Recent research notes that anxiety disorders may be under-recognized and under-treated, but there is no evidence that its prevalence has increased. While the incidence rose from 9 to 15 percent in college students since 2009, according to the Journal of American College Health, the authors attribute the finding to a greater willingness to admit having a mental health issue and increased acceptance of it as a bona fide health problem.

Constant anxiety undeniably takes a toll on health, potentially increasing levels of the stress hormone cortisol and raising blood pressure and may drive inflammation and plaque formation that leads to heart attack and strokes. A reaction to stress that occurs in a region of the brain called the amygdala, anxiety prepares people to confront a crisis by putting the body on alert. The ‘fight or flight’ response serves us well when faced with actual danger but is counter-productive when dealing with worries around work, money, family life or health. However, it’s only when daily function is affected that a disorder is diagnosed, as shown below:

Everyday Anxiety: Worry about finances, health, family or other important life issues
Anxiety Disorder: Constant and unsubstantiated worry that causes significant distress and interferes with daily life

Everyday Anxiety: Embarrassment or self-consciousness in an uncomfortable or awkward social situation
Anxiety Disorder: Avoiding social situations for fear of being judged, embarrassed or humiliated

Everyday Anxiety: A case of nerves or sweating before a big test, business presentation, stage performance or other significant event
Anxiety Disorder: Seemingly out-of-the-blue panic attacks and preoccupation with the fear of having another one

Everyday Anxiety: Realistic fear of a dangerous object, place or situation
Anxiety Disorder: lrrational fear or avoidance of an object, place or situation that poses little or no threat of danger

Everyday Anxiety: Anxiety, sadness or difficulty sleeping immediately after a traumatic event
Anxiety Disorder: Recurring nightmares, flashbacks or emotional numbing related to a traumatic event that occurred several months or years before

The American Psychology Association defines these types of anxiety disorders (obsessive-compulsive disorder and post-traumatic stress disorder are now categorized separately):

• Generalized anxiety disorder (GAD): the most common, it’s characterized by excessive, long-lasting worries about nonspecific life events, objects and situations.
• Panic disorder: brief or sudden attacks of intense terror and apprehension, leading to shaking, confusion, dizziness, nausea and breathing difficulties; can occur with or without a particular trigger.
• Specific phobia: irrational fear of a particular object or situation.
• Agoraphobia: fear of places, events, or situations, especially open spaces, that may cause you to panic and feel trapped, helpless or embarrassed.
• Social anxiety disorder: fear of negative judgment from others in social situations or of public embarrassment.
• Separation anxiety disorder: not exclusive to youngsters, but also experienced by adults who feel disconnected from a person or place that provides feelings of safety or security.

Additionally, anxiety disorders may play a role in exacerbating other conditions such as irritable bowel syndrome (IBS), chronic respiratory disease and heart disease.

Reassuringly, the number of treatment options, both pharmaceutical and non, has grown. Most effective is a combination approach of psychotherapy (cognitive-behavioral therapy, focused talk therapy or exposure therapy), stress management (deep breathing, meditation and yoga) and antidepressant and/or anti-anxiety medications.

Finally, considerable benefits are seen from a healthy lifestyle – reduced intake of caffeine, tea, cola and chocolate, avoidance of recreational drugs and excessive alcohol, and emphasizing exercise, a nutritious diet, and most importantly, a good night’s sleep. According to a recent University of California at Berkley study, the amygdala was particularly stimulated when sleep deprived, mirroring that of anxiety disorders, suggesting that sleep therapy could reduce anxiety in people suffering from panic attacks, GAD and other conditions.

Did You Know?

40 million

People in the U.S. affected by anxiety disorders
Source: NIMH.gov

37%

Percentage of Americans with an anxiety disorder who receive treatment
Source: ADAA.org

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Autoimmune Disease on the Rise

The Enemy Within

Autoimmune Disease, a condition that is thought to have tripled in prevalence over the last 50 years, impacting over 23 million people, could justifiably be seen as an epidemic, or at least, a growing health concern. Autoimmune diseases are not often thought of in that way because they manifest as 80+ different illnesses that nevertheless share the same root cause: a malfunctioning immune system that mistakenly attacks its own tissues. Virtually every human organ system can be impacted: the brain and spinal cord in multiple sclerosis, the skin in psoriasis, the joints in rheumatoid arthritis, the intestines in Crohn’s disease and ulcerative colitis, the insulin-producing cells in the pancreas in Type 1 diabetes, the thyroid in Hashimoto’s disease, among others.

Ironically, 100 years ago, Nobel Prize-winning immunologist Paul Ehrlich, MD, was openly skeptical of a concept in which the body turns on itself, calling it “horror autotoxicus” (literally, the horror of self-toxicity). That set back acceptance of autoimmunity another half century, according to today’s leading neuro-immunologists. Now we are beginning to recognize the pervasiveness of autoimmune disease and develop therapies based on new research into its complex causes.

Notably, the gut, which houses 80 percent of the immune system, has come under increased scrutiny for the role it can play in causing disease. One theory posits that a ‘leaky gut’ may allow undigested food particles, microbes and toxins to enter the blood stream, and trigger inflammation that goes on to disrupt the proper functioning of the immune system.

There is also a growing consensus that these diseases result from complex interactions between genetic and environmental factors. Autoimmune disease is commonly clustered in families, but may affect different organs. For example, a mother may develop rheumatoid arthritis while her daughter copes with juvenile diabetes, her sister has Hashimoto’s thyroiditis, and her grandmother deals with Graves’ disease. Environment and lifestyle may contribute to the increased incidence of these diseases, including chronic stress.

For the many living with an autoimmune condition, there is hope in the form of new medications, advanced treatments and genuine breakthroughs in the precision medicine approach. Experts predict substantial advances in the next decade, fueled by more than 310 medicines and vaccines for autoimmune diseases already in clinical trials or awaiting review by the Food and Drug Administration (FDA). Options go well beyond simply relieving symptoms or replacing substances destroyed by the disease, including:

• Therapies to suppress the immune system and preserve organ function, such as methotrexate, used to treat cancer, now also successfully used for rheumatoid arthritis and several other autoimmune diseases.
• Real progress in biologics, which target specific enzymes and proteins. Monoclonal antibody medicines are being used to block inflammation in rheumatoid arthritis, preventing irreversible joint damage and enabling remission; to inhibit the activity of proteins implicated in Crohn’s and colitis and systemic lupus erythematosus; and are newly approved by the FDA to neutralize inflammatory processes linked to psoriasis.

Running on a parallel and complementary path are natural methods, which continue to gain traction. Areas under investigation include: reducing foods high in sugar and saturated fat, practicing de-stressing techniques, lowering the toxic burden caused by constant exposure to environmental factors and restoring intestinal health with a diet that includes prebiotic and probiotic foods.

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Bring It Down: Healthy Blood Pressure Numbers May Go Even Lower

If you’ve ever wondered why a blood pressure check is part of almost every visit to a doctor’s office, consider what is communicated through the familiar black cuff in just a few seconds. The force of blood pushing against the walls of the arteries as the heart pumps is a critical measure of how well your heart muscle works – systolic blood pressure (SBP, or the top number of a reading) measures the pressure in the arteries when the heart beats; diastolic blood pressure (DBP, or the bottom number) refers to the pressure in the arteries when the heart muscle is resting between beats and refilling with blood.

Readings that exceed the norm, hypertension or high blood pressure, indicate an increased risk of heart attack, stroke and kidney failure. However, exactly what constitutes ‘normal’ blood pressure for optimal health has been debated and tested for decades, and recommendations have fluctuated over time. While the gold standard is under 120 mm Hg/80 mm Hg, the targets for treating hypertension have varied over the years – less than 140/90 in the 1990s, down to 130/80 in 2003, raised to a controversial 150 or less in 2014, and retreating to less than 140 in 2015.

At the end of 2015, a landmark study of more than 9,300 patients, the Systolic Blood Pressure Intervention Trial (SPRINT), moved the needle down even further. Those who were treated most aggressively to drive down blood pressure to 120/80 experienced a significantly lower risk of cardiovascular events, chronic kidney disease, and death. In fact, the outcomes were so convincing that the trial was actually halted after just three years, much sooner than planned, leading the American Society of Hypertension to state: “The early termination of this trial represents an exciting moment in the history of hypertension treatment.” Still, notes of caution were sounded because multiple medications were required, sometimes causing adverse side effects, and experts
agreed more study was needed to justify changes in clinical practice.  Additional evidence followed this year, with an analysis of adults aged 75 years and older who participated in the SPRINT study. The benefits of lowering blood pressure to 120 were even more pronounced, resulting in a one third reduction in risk of cardiovascular events and death, even among the frailest older patients. This finding could benefit almost six million seniors over 75 with elevated blood pressure, according to the Journal of the American College of Cardiology.

While the outcomes are promising, and point in an even more downward direction, experts have not yet reached a consensus on optimal blood pressure targets. For now, hypertension patients should consult with their doctor to determine whether this lower goal is best for their individual care.

Who’s at risk? Virtually everyone

Even those who don’t have high blood pressure by age 55 face a 90 percent chance of developing it during their lifetime, so learning how to identify, prevent and control hypertension can benefit us all.  Consider these best practices:

Identify.

• Regular checkups are key, as people can live with high blood pressure for years without experiencing any symptoms while internal damage to other parts of the body may be silently occurring.

Prevent.

• Keep a healthy weight: in an overweight person, every 2 pounds of weight lost can reduce SBP by 1 mm Hg.
• Eat well: a diet rich in fruits, vegetables, and lowfat dairy products can reduce SBP by 8 to 14 mm Hg.
• Limit sodium: (see Nutrition Corner, below)
• Keep active: 30 minutes of aerobic activity most days of the week can reduce SBP by 4 to 9 mm Hg.
• Moderate alcohol consumption: for women, a single drink a day may lower SBP by 2 to 4 mm Hg.
• Quit smoking: not only does smoking raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls.

Control.

• If lifestyle measures alone are insufficient, your physician will determine the appropriate medication, which may include diuretics, beta-blockers or ACE inhibitors.

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Joint Assets

The aching, swollen, stiff joints associated with osteoarthritis (OA) have long been considered an inexorable result of aging. According to conventional wisdom, cartilage, the smooth connective tissue on the end of bones that cushion the joints, simply breaks down over a lifetime of walking, exercising and moving, allowing the bones to rub together. When medications and physical therapy no longer provide relief, a costly and time-intensive mechanical joint replacement may be the only solution. However, advances in research and a focus on prevention are providing
a new outlook on an ageold problem…we bring you the latest insights, below.

Prevention

The connection between overweight and OA is even stronger than previously thought. Recent studies show that up to 65 percent of cases of OA of the knee could be avoided if weight was reduced. Consider that your knees bear a force equivalent to three to six times your body weight with each step, so a lighter weight relieves the burden considerably. For women, extra weight is even more of a risk factor than men. In addition, fat tissue produces proteins called cytokines that cause inflammation, and in the joints, this can alter the function of cartilage cells.  Gaining weight results in your body releasing more of  these harmful proteins. However, losing even a few pounds can reduce joint stress and inflammation and decrease by half the risk of OA.

Avoid practicing a sport in an intensive and prolonged way. An injured joint is nearly seven times more likely to develop arthritis than one that was never injured. The condition is now seen more frequently among 30 to 50-year-olds than previously because young athletes or middle-aged ‘weekend warriors’ who tear their anterior cruciate ligament (ACL) or menisci of the knee have a much higher risk of osteoarthritis 10 to 20 years after their injury. Take steps to manage or prevent diabetes, which may be a significant risk factor for OA. Some studies suggest high glucose levels trigger the formation of molecules that make cartilage stiffer and less resistant to stress, and cause inflammation that leads to cartilage loss.

Management

Low impact exercise is key to living well with osteoarthritis. While resting aching joints can bring temporary relief, lack of movement will ultimately lead to more discomfort.
Exercise strengthens the muscles around the joint, acting like a shock absorber, helping to reduce pain. In addition, exercise helps with weight control and is a natural mood elevator. Experts recommend low-impact activities like swimming, walking, biking, and moderate weight lifting. The Arthritis Foundation developed a form of tai chi specifically for people with arthritis,
featuring agile steps and a high stance, that helps increase flexibility and improve muscle strength inthe lower body.

Some new approaches to pain management show promise, but beware of unsubstantiated claims. Platelet-rich plasma (PRP) injections, which involve withdrawing blood, spinning
it to separate the platelets and then injecting the concentrated platelets into a joint, are being studied for long-term effectiveness.  Experts advise against costly supplements such as glucosamine, chondroitin and shark cartilage, all of which have proven of little benefit for people with OA. Some elements of Chinese medicine, including herbs and acupuncture, may help control OA symptoms in some people, but these therapies have not yet been confirmed in large, well-designed clinical studies. Also unproven are low-power laser light, copper bracelets or magnets, chiropractic manipulation and acupressure. The most effective over the counter medication are NSAIDs (non-steroidal anti-inflammatory drugs such as Advil). While Tylenol helps reduce pain and is the safest medicine for older people or those with kidney disease, it does not lower inflammation.

Finally, if you do need an orthopedic implant in the future, take comfort in the fact that development of the next generation of devices is well underway. They will likely be biologic, composed of protein and cells instead of metal and plastic,…functioning as well as a normal joint and created to last a lifetime.

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