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February 5 - February 10, 2018
If we were doing everything right, why didn’t we see any indication that we could make a dent in this community’s dramatically reduced life expectancy? My patients kept coming back with high rates of illnesses, and I had the sinking feeling that when they grew up, their kids would keep coming back too.
If one hundred people all drink from the same well and ninety-eight of them develop diarrhea, I can write prescription after prescription for antibiotics, or I can stop and ask, “What the hell is in this well?”
If the toads-to-be were exposed to corticosterone late in development, it did speed up metamorphosis, allowing for the adaptive, timely leap out of the pond. But if the toads were exposed to the steroid early in development, it actually inhibited their growth. And it had other unexpected
negative effects, such as decreasing immune function, diminishing lung function, causing osmoregulatory problems (high blood pressure), and impairing neurological development. If the tadpoles were exposed to corticosterone for a prolonged period, the same problems occurred. The tadpoles’ stress response to overcrowding was adaptive, but only if it happened at the right time during development.
An extreme example of the impact of timing when it comes to hormones is a condition called hypothyroidism. Many of us know someone or have heard of someone who has an underactive thyroid. It basically means that the thyroid gland is not producing enough thyroid hormone, so a person’s metabolism slows down and he or she develops dry skin, brittle hair, and the most well-known symptom: weight gain. While somewhere around ten million adults have this condition, it often takes a long time to diagnose it. But the good news is that symptoms in adults tend to be relatively minor, and the treatment is
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It was a 1998 article in the American Journal of Preventative Medicine: “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: the Adverse Childhood Experiences (ACE) Study,” by Dr. Vincent Felitti, Dr. Robert Anda, and colleagues.
Felitti suspected that he might have glimpsed a hidden relationship between histories of abuse and obesity.
First, they discovered that ACEs were astonishingly common—67 percent of the population had at least one category of ACE and 12.6 percent had four or more categories of ACEs.
Second, they found a dose-response relationship between ACEs and poor health outcomes, meaning that the higher a person’s ACE score, the greater the risk to his or her health. For instance, a person with four or more ACEs was twice as likely to develop heart disease and cancer and three and a half times as likely to develop chronic obstructive pulmonary disease (COPD) as a person with zero ACEs.
It was childhood adversity. And it was making people sick.
Most people intuitively understand that there’s a connection between trauma in childhood and risky behavior, like drinking too much, eating poorly, and smoking, in adulthood (more on that later). But what most people don’t recognize is that there is a connection between early life adversity and well-known killers like heart disease and cancer.
A person with an ACE score of seven or more has triple the lifetime odds of getting lung cancer and three and a half times the odds of having ischemic heart disease, the number
But the stress response can do its job a little too well sometimes. This happens when the response to stimuli goes from adaptive and lifesaving to maladaptive and health-damaging. For example, almost everyone knows that soldiers sometimes come back from the front lines with posttraumatic stress disorder. This condition is an extreme example of the body remembering too much. With PTSD, the stress response repeatedly confuses current stimuli with the past in such a dramatic way that it becomes hard for these vets to live in the present. Whether it’s a B-52 bomber in the sky or a commercial
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Imagine if you lived in a forest where there were lots of bears. After the first one or two encounters, your body would want to become more efficient at responding to the bear problem. Essentially, cortisol helps the body adapt to repeated or long-term stressors, like living in bear-infested woods or handling prolonged food shortages. Some of the effects of cortisol are similar to those of adrenaline—it raises blood pressure and blood sugar, inhibits cognition (clear thinking), and destabilizes mood. It also disrupts sleep, which makes a lot of sense if you are living in a forest full of
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What an incredibly evolved system! Especially if you live in a forest and there are bears. But what happens when you can’t experience safety in your cave because the bear is living in the cave with you?
For many of my patients, the stress response was activated dozens and sometimes hundreds of times a day.
The morning peak wasn’t quite as high and the daily decline was not as steep, leading to higher levels in the evening and higher total daily cortisol.
We all know that adversity, tragedy, and hardship are a part of life. As much as we’d like to shield our children from illness, divorce, and trauma, sometimes these things happen. What the research tells us is that those daily challenges can be overcome with the right support from a loving caregiver.
Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support. This kind of prolonged activation of the stress-response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.
Just like tadpoles, children are particularly sensitive to repeated stress activation. High doses of adversity affect not only the brain structure and function but also the developing immune system and hormonal systems, and even the way DNA is read and transcribed. Once the stress-response system gets wired into a dysregulated pattern, the biological effects ripple out, causing problems within individual organ systems.
what happens in your immune system is deeply connected to what happens in your cardiovascular system. Next we’ll see the downstream effects of a stress-response system that has gone off the rails.
IF YOU WANT TO understand how a child’s stress response is working, try walking into the examination room with a tray full of needles and telling him it’s time for shots. By now, it seemed like I could almost guess the ACE score of a patient by the amount of commotion that took place when my nurse went in to give the vaccinations. We’d seen it all: screaming, kicking, biting, kids literally trying to climb the walls to get away from the needles. One patient got so upset he vomited on my white coat. Another ran out of the exam room and made it all the way down the block before we caught her.
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The kids who had the worst responses were also the ones whose caregivers were the least likely to hug, kiss, sing to, or otherwise soothe their child. We heard a lot of “Hold him down!” and “I don’t have time for this, I have to be back at work in a half hour.”
When you put a kid who had experienced adversity in an MRI machine, you could see measurable changes to the brain structures.
race. In preliminary interviews, the researchers asked the kids or their caregivers about PTSD symptoms and hyperarousal symptoms like difficulty sleeping, irritability, and trouble concentrating, to name just a few. Then they did an MRI and checked each kid’s salivary cortisol four times a day. Once the brain scans were in, they looked at the size of each child’s hippocampus by measuring the volume in 3-D. They found that the more symptoms a kid had, the higher his cortisol levels were and the smaller the volume of his hippocampus.
Despite the fact that these kids were no longer experiencing trauma, the parts of their brains responsible for learning and memory were still shrinking, showing us that the effects of earlier stress were still acting on the neurological system.
Apart from these revelations, the profound discovery was that our patients with four or more ACEs were twice as likely to be overweight or obese and 32.6 times as likely to have been diagnosed with learning and behavioral problems.
history. We know from the research that the life expectancy of individuals with ACE scores of six or more is twenty years shorter than it is for people with no ACEs.
cases, I was convinced that the problem was chronic dysregulation of the stress-response system,
Once again, I saw how critical it was to take a whole-system approach to examining kids who were at high risk.
Telling a kid to sit still, concentrate, and ignore stimuli that are flooding his brain with the need to act is a lot to ask. This
For some, it results in an inability to concentrate and solve problems, but in others it manifests as impulsive behavior and aggression.
When the amygdala gets activated during a major stress event, it sends signals to the hippocampus that disrupt its ability to knit together neurons, essentially making it more difficult for the brain to create both short-term and long-term memories.
Knowing that, it’s pretty obvious why this part of the brain is so critical to learning, and it’s easy to see how kids with quick-trigger amygdalae are behind the eight ball when it comes to everything from memorizing multiplication tables to spatial memory.
So for anyone looking to prevent young folks from developing dependencies on bad-for-you dopamine stimulators like cigarettes and alcohol, understanding that exposure to early adversity affects the way dopamine functions in the brain is an absolute must.
Due to the impact it has on the hormonal systems, the stress response can affect everything from menstrual cycles to libidos to waistlines.
But cortisol isn’t the only bad guy here; the hormones leptin and ghrelin are also increased with activation of the stress response. Together they intensify appetite and work with cortisol to do their worst for your waistline.
When you realize what toxic stress does to the hormonal systems of kids who have experienced multiple ACEs, you understand that it’s not just because they subsist primarily on a diet of fast food that they are overweight. It’s not just that they are living in a food desert (a term that refers specifically to a neighborhood with a dearth of nutritious food) and are being brought up by parents who think Taco Bell is a healthy alternative to McDonald’s. Those things compound the problem, to be sure, but they are not the whole story. Our data suggested how powerful the underlying mechanism of
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Dysregulation of the stress response has a profound impact on immune and inflammatory responses because virtually all the components of the immune system are influenced by stress hormones. Chronic exposure to stress hormones can suppress the immune system in some ways and activate it in others, and unfortunately none of it’s good.
even twenty years after their subjects had been maltreated as children, four different markers of inflammation were higher than they were in those who hadn’t been maltreated.
The consequences of toxic stress are not just neurologic and hormonal; they are also immunologic,
We know that babies who are born premature are at greater risk of neglect simply because they have greater needs—more irregular sleep patterns, more frequent feedings—and that those needs can be enough to overstress an exhausted new parent. But if an infant doesn’t have a caregiver’s reciprocal eye contact, stimulating facial expressions, snuggles, and kisses, hormonal and neurologic damage can occur, and that can prevent a child from growing and developing normally. When a baby is not being cared for, she doesn’t grow well, even if she has enough nutrition.
The irony was that, despite Cora’s intentions, the beating was undoubtedly unleashing a neurochemical cascade that made Tiny more likely to end up like his mom and his grandparents.
This is basically the human equivalent of hugs and kisses. What was fascinating was that not all moms did it to the same extent. Some moms exhibited high levels of licking and grooming behavior toward their pups. Other moms displayed low licking and grooming behavior, which meant they didn’t give as many sloppy kisses and embarrassing hugs when their pups were having a rough day. Here’s the part that made me sit up straight in my chair: Researchers observed that the development of the pups’ response to stress was directly affected by whether the mom was a “high licker” or a “low licker.” They
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the more licking and grooming the rat pups got, the lower their levels of stress hormones. In addition, the pups of high-licker moms had a more sensitive and effective “stress thermostat.” By contrast, pups of low lickers not only had higher spikes of corticosterone in response to a stressor (in this case, being placed in restraints for twenty minutes), they also had a harder time shutting off their stress response than did the pups of high-licker moms. The licking and grooming behavior that occurred in the pups’ first ten days of life predicted changes to their stress response that lasted for
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What they found was that the rat moms were, in fact, handing down a message to their pups that changed the way the pups’ stress responses were wired, but the mechanism, the how of the changes, turned out to be not genetic, but epigenetic.
we now know that both environment and genetic code shape both biology and behavior.
When a four-year-old breaks a bone, that trauma is not encoded in his epigenome; it doesn’t affect him in the long term. But when a four-year-old experiences chronic stress and adversity, some genes that regulate how the brain, immune system, and hormonal systems respond to stress get turned on and others get turned off, and unless there is some intervention, they’ll stay that way, changing the way the child’s body works and, in some cases, leading to disease and early death. There are a
all that licking and grooming ultimately changed the epigenetic markers on the rat pups’ DNA, leading to lifelong changes in the stress response.
