The Great Cholesterol Myth (28 page)

So why weren’t they dropping like flies?

That’s exactly what the medical researchers wanted to know.

Here’s what they found: Nearly all the houses in Roseto contained three generations of family members. Rosetans didn’t put their elderly in assisted living homes; they incorporated them into community life. They treated them as wise village elders. Folks took
evening strolls. They belonged to tons of social clubs. They participated in church and had community festivals. And remember those dinner tables piled high with the lard-fried food we mentioned a few paragraphs back? Those dinner tables happened to also offer enormous nourishment for, and nurturance of, the human spirit. They were family affairs where people connected, shared their experiences, and participated in family life in myriad ways.

Oh, by the way, the crime rate in Roseto—as well as the number of applications for public assistance—was zero.

What accounts for the Roseto Effect? Researchers now believe that the explanation can be summed up in two words:
community
and
connection
. These two things were (and are) such powerful protectors of health that they were apparently able to offset both cigarette smoking and a horrific diet.

Writing about the Roseto Effect in their classic book,
The Power of Clan
, Stewart Wolf, M.D., and sociologist John Bruhn correctly observed that the characteristics of tight-knit communities such as Roseto are
far
better predictors of heart health than cholesterol levels or even smoking. The social structures of communities such as Roseto are characterized by predictability and stability, with each person in the community having a clearly defined role in the social scheme of things. Everyone worked in Roseto, and they worked hard, all for a shared communal goal: creating a better life for their children. Being connected to other people in a close community makes you far less likely to be overwhelmed by the problems of everyday life. Being less likely to be overwhelmed by the problems of everyday life means you’re
also
less likely to be a victim of chronic stress.

And chronic stress is one of the biggest contributors to heart disease.

The men of Roseto had a ton of physical stressors in their lives. Working in the slate mines is hardly a day at the beach, and smoking certainly qualifies as a major physical stressor. But because the men were generally protected from the constant, unending mental stress that many folks endure on a daily basis—protected, presumably, by their close-knit community and their secure, nurturing family ties—these physical stressors didn’t seem to produce the collateral damage such stressors might be expected to produce. The absence of chronic mental stress seemed to afford the men some level of protection against heart attacks.

To understand why, we have to understand something about the stress response in general. And the best place to start is with a man named Hans Selye.

Selye didn’t invent stress, but he sure put it on the map. Back in the 1930s, Selye was a young researcher and assistant professor at McGill University in Montreal, and he was just beginning his work in the field of endocrinology—the study of hormones and what they do. A biochemist working just down the hall from Selye had isolated a specific substance from the ovaries, and everyone was wondering what the heck that ovarian extract actually
did
. So Selye did what any ambitious, unknown researcher would do—he got a bucketful of this strange ovarian stuff and decided to test it out on his rats.

Every day Selye would inject the rats with this mysterious stuff. But the thing is, Selye was a klutz. He’d try to inject the rats, but he’d drop them, or miss them, or they’d run behind the refrigerator. Selye wound up spending half the day running around the lab with a broom trying to coax the rats out from their hiding places and herd the terrified animals back into their cages.

After a few months passed, Selye began examining the rats to find out what the heck this stuff he’d been injecting them with did. Lo and behold, all of them had ulcers. Not only that, but they also had greatly enlarged adrenal glands and shrunken immune tissues. Selye was delighted. Clearly he’d discovered something important and new about the ovarian extract his colleague had discovered: It gave you ulcers!

Selye was at heart a good scientist, even if he had absolutely no talent for handling animals. And a good scientist always runs a control group, which is exactly what Selye did. The control group, of course, was a group of rats identical to the first group in every way except that they were
not
injected with the mysterious ovarian extract.

When Selye examined the rats in the control group, he made an even stranger discovery than before: All of the control rats
also
had ulcers.

Hmm.

Here he had two groups of genetically identical rats. One group had been injected with a substance, and the other had not, yet both groups wound up with ulcers. Thus, Selye quickly reasoned that the ovarian hormone couldn’t have been causing the ulcers. What
else
did the two sets of rats have in common?

The answer wasn’t hard to figure out, especially for a research-trained scientist such as Selye. The one thing both groups of rats had in common was Selye.

Selye had properly concluded that the ovarian hormone couldn’t possibly be responsible for the ulcers and swollen adrenal glands, because both groups of rats had developed ulcers, and only one of them had been exposed to the hormone. But perhaps his own inept handling of the rats—the incompetent injections, the dropping, the chasing, the running around—had something to do with it. Selye reasoned that the ulcers—as well as the shrunken immune tissues and enlarged adrenals—were some kind of response to
general unpleasantness
, which he came to refer to as
stress
.

So Selye set out to test his new theory. He created a high-stress environment. He put some of the animals up on the roof during the winter months. He put others in the basement next to the boiler. Others underwent stressful surgeries, or were subjected to very loud music, or were deprived of sleep.

Every one of them got ulcers. Every one of them had swollen adrenals.

From this early work, Selye eventually developed what’s known as the General Adaptation Syndrome (GAS) theory of stress. The theory holds that the effect of stress on the body develops over three stages: alarm, resistance, and exhaustion. Here’s how it works.

In the
alarm
stage, you recognize that there’s a danger. Your body secretes a bunch of adrenaline
and cortisol to prepare you for action (i.e., fight or flight). Of course, if all this available energy is
not
used for physical action, big problems develop. For example, too much adrenaline will raise your blood pressure and ultimately damage the blood vessels of the heart and brain.

Selye eventually developed what’s known as the General Adaptation Syndrome (GAS) theory of stress. The theory holds that the effect of stress on the body develops over three stages: alarm, resistance, and exhaustion.

In the
resistance
stage, you deal with the stressor. If (hopefully) the situation resolves quickly, you return to something approaching a balanced state (what physiologists call
homeostasis
). Your stress hormones may come down, but you have also depleted some of your resources. More commonly, however, the situation persists, and now your body has to find a way to deal with it. Your body keeps trying to adapt and remains in a constant state of arousal. But you can’t keep this up forever, with the stress pedal pressed to the metal and a ton of hormones pumping out into the bloodstream. If this continues too long, or if you repeat this process too often with too little recovery, you eventually move into the third stage.

This stage, aptly named the
exhaustion
stage, is also known as
burnout
. It’s what we’re referring to in this book when we talk about “maladaptation.” Stress levels go up and stay up. These chronic stress levels deplete your immune system (one reason marathon runners are so much more susceptible to colds in the days following a race). Chronic stress levels also injure tissue cells, particularly in an area of the brain known as the
hippocampus
, which is involved with memory and cognition. (That’s one reason you can’t remember stuff you know when you’re taking a very stressful exam.) Animal studies have demonstrated that the hippocampus actually shrinks under the weight of cortisol overload. And all of this has profound implications for high blood pressure and heart disease.

So what’s a stressor, anyway? It can be anything—and it’s different for different people. Technically, a stressor is something to which special weight and significance has been attached. A stressor can be something as simple as the feeling of being overwhelmed. It can be the inability to give in to a situation (resistance), a fear of losing control, or a feeling of struggle or uncertainty. Often a stressor can’t be
changed or even controlled—a hurricane or natural disaster, for example. What
can
be controlled, however, is your behavioral response to the external stressor. As Werner Erhard once said, “Riding a raft down white water rapids, a master has no more control over the water than you do. The difference is that a master is
in control
being
out of control
[Italics ours].”

Stressors come in all sizes, flavors, and packages. Hunger and deprivation are usually more significant stressors than a flat tire—except if you’re a young woman who has to deal with a flat tire on a deserted country road late at night with no jack! A failing grade sounds like it would be a lot more important to a college student than, say, a bad haircut, unless perhaps the haircut damages an already low self-esteem. In these cases, the flat tire and the bad haircut can be considered strong external stressors in the person’s life. How people respond to these (and other) stressors will determine their body’s physiological reaction and, ultimately, their health.

When the promotion doesn’t come, when the tire goes flat, when the haircut makes you look like Pee-wee Herman, you have only two choices—adapting or
not
adapting. You can adapt by “going with the flow,” accepting the situation, or working to effect some kind of change. Or you can
maladapt
by preparing your body for “combat,” either by withdrawing or pushing beyond normal expectations in an effort to make the stressor go away. When your coping styles are unhealthy and inappropriate—for example, abusing drugs or alcohol, overeating, or overworking—that’s maladaptability. And these activities take an enormous toll on the body.

The big difference between stress in the caveman era and stress in the modern era is that the caveman’s stress—and his adaptive responses—were largely physical. Ours are mental. We’re not fighting off saber-toothed tigers, or running up trees to escape from bears, or in danger of being attacked by a neighboring tribe. Instead, we have to “fight back” mentally and keep “cool” at the same time, leaving the nervous system and the cardiovascular system in a state of constant and continuous “overpreparedness.” It’s this continual state of visceral vascular readiness that makes the heart so darn vulnerable. The chronic alarm reaction that develops is a harmful response in which the body continuously overdoses on its own biochemicals.

The biochemical alterations that occur in response to stress are powerful. When these responses are inappropriate or ineffective (e.g., screaming and pounding the wheel when you’ve been stuck for two hours in unmoving traffic on California’s 405 freeway), you are
mal
adapting rather than adapting, and pathological changes can (and do) occur in the body. The disruption in hormonalsecretions can be long term and even permanent.

Much of the answer in dealing with stress lies not in the stressors themselves, but in the way we
deal
with the stressors (which, like in-laws and taxes, have an annoying tendency to not go away). An important first step is to recognize the situations that create stress for you. These frequently include lack of communication, unfulfilled expectations, retirement, death of a loved one, job pressures, bad relationships, and, particularly important, dwelling upon past events or imagined future ones.