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Why Stress Tips the Scales

E-Newsletter No. 26

Why Stress Tips the Scales

Frayed nerves increase our desire for carbohydrates and fat. And, if the pressure is chronic, we try even harder to hold on to those pounds.

Lynn Butler has never been seriously overweight. In fact, if you ate lunch with her, you would think she was a model eater. But the 57-year-old's ovo-lacto-vegetarian diet degenerates into chaotic, solitary chocolate candy binges when she's upset.

With lots of exercise, Butler managed to stay a size 6 for most of her adult life. But two years ago a stress fracture curtailed her exercise, and her eating got so out of control that she gained 35 pounds. The depressing weight gain exacerbated the problem. "The more uncomfortable your clothes become, the more stress eating you do," she says.

Butler is far from alone. Sixty percent of Americans are overweight or obese, and many of them say that their eating habits worsen when they are stressed. Says Jean Curtis, a spokesperson for the American Dietetic Assn.: "Everybody deals with stress, and food happens to be one of the things they're manipulating. This is the reality in today's world." Out-of-control eating and weight gain may seem like an irrational, self-destructive response to stress. But food binges and weight gain make biological sense. Under stress, the brain shifts into self-preservation mode, unleashing an array of chemicals and hormones that protect the body from physical danger.

An essential survival mechanism when our ancestors expended lots of energy dodging mountain lions and wrestling with heavy farm equipment, this fight-or-flight response backfires in these sedentary times, when most of our stressors are of the nonphysical sort like IRS deadlines and crashing computers.

Those who have not inherited resilient bodies and minds that can shrug off traffic jams and long lines at the supermarket are more likely to continually enter this self-protective mode. Ultimately, not only do the stress hormones make them hungry, they also make them more likely to pack on the pounds.

Says Dr. Pamela Peeke, a professor of medicine at the University of Maryland who studied the link between weight and stress at the National Institutes of Health: "There is no question that chronic stress can make you fat."

Of course, chronic stress can trigger a number of other medical conditions, including memory loss, hypertension and heart disease. But bariatric physician Dr. Paul Rivas, author of "Turn Off the Hunger Switch," says that unlike those conditions, "emotional" overeating is seen as a character flaw when it leads to excess weight.

Rivas tells his guilt-ridden patients that their compulsion to overeat is a biological flaw, not a character flaw: "It is not because you lack willpower or self-control. You don't even know what you're doing. You're grabbing the food. It's compulsive. You're into a survival mechanism."


A Hormonal Cascade Causes Ravenous Hunger

When this stress response is activated, the brain releases a chemical called corticotropin-releasing hormone, or CRH, that suppresses appetite. The adrenal glands then secrete their powerful fight-or-flight stress hormones, adrenaline and cortisol, which propel sugar into the bloodstream for a short-term energy rush.

After that rush, cortisol sparks ravenous hunger for carbohydrates and fat. "When you're all stressed out, the last thing you reach for is a can of tuna," says Peeke. (She notes that "stressed" is "desserts" spelled backward.)

Worse, we do not give our bodies the downtime they expect after surviving a close call. Instead, we tax our fight-or-flight response by activating it throughout the day as we move from long commutes to demanding bosses to looming day-care pickup deadlines.

The result is prolonged, elevated cortisol levels that spur the release of insulin, the hormone that directs the body to hang on to the fat it has and store more. "If you have lots of stressors, you have lots of periods of rebound insulin secretion. The cumulative effect is a push toward obesity," says Robert Sapolsky, professor of biological and neurological sciences at Stanford University School of Medicine.

Stacking the biochemical deck further, the brain's complex appetite and satiety control system can go haywire under stress. Rivas says that even if his patients were lounging on a Tahiti beach, they would have to fight against their drive to overeat. Most people who overeat when stressed, he says, are genetically prone to an imbalance among at least three of the brain's neurotransmitters, serotonin, dopamine and norepinephrine, which help the body regulate both appetite and mood.

Add ornery children and late mortgages to the equation and, says Rivas, "everything gets worse." For example, when an already short supply of serotonin dwindles further under stress, overeaters launch into desperate forays for sweets because carbohydrates, unlike tuna fish, raise serotonin levels.

There are no reliable estimates of the number of stressed Americans who desperately scarf down too much food. Weight statistics, for example, don't give a complete picture because they miss some thin stress overeaters who compensate for their binges by starving themselves or exercising maniacally.

However, it is clear that many Americans who are overweight are stress overeaters. Cynthia Graff, chief executive of the 31-year-old Lindora Weight Loss Clinics, says her clients are increasingly asking for help not just with their eating, but with their frazzled lives: "They're not saying, 'I need to lose weight.' They're saying, 'My life is out of control.'"

Though they may seem like oddities in this increasingly overweight country, there are those who turn away from food when they feel their lives are out of control. Peeke says biology is destiny for these "stress undereaters" as well: "Their biological instinct is to reject food." Stress undereaters exhibit "very high" levels of the appetite-depressing CRH, which trumps cortisol's appetite-enhancing properties. Peeke notes that anorexics have some of the highest levels of CRH ever measured in humans.

Even stress overeaters may shift to undereating in the wake of catastrophic stress, like the death of a parent or a divorce. When 42-year-old Bay Area marketing consultant Elisa Williams got divorced five years ago, she lost 20 pounds in a few weeks, down from a size 10 to a size 6. She splurged on a mini-sized wardrobe.

After four months she gained the weight back; her mini clothes are still hanging in her closet. "Divorce weight doesn't last long," says Williams. Now she warns other women going through divorce to refrain from spending big bucks on a divorce wardrobe.

That's great advice, because tight-fitting clothes can be a powerful stressor, especially for women. Women are more likely to stuff themselves when they're anxious and more likely to feel guilty about it, according to Alice Domar, a professor at Harvard Medical School and director of the Mind/Body Center for Women's Health at Beth Israel Deaconess Medical Center in Boston: "When a man gains 10 pounds he buys a new pair of pants. When a woman gains 10 pounds she hates herself."


Very Restrictive Diets Are Often Counterproductive

To shed those stress-related pounds and stop stress overeating, experts offer a range of solutions, including restrictive diets. But Domar warns against strict diets because they often backfire. When rigid dieters fall off the wagon by eating a food on their forbidden list, "They experience the 'What the hell' effect, then go and eat for the rest of the day like crazy," she says.

Domar teaches an "80/20" plan that focuses on eating healthy foods 80% of the time; 20% of the time her clients eat whatever they want. "You remove the guilt so they get less stressed," says Domar.

Rivas, many of whose patients have lost weight with "boot camp" food regimens only to find that they regain that weight and more, doesn't believe in restrictive diets either. He prescribes drugs that balance some of the brain's neurotransmitters and believes that genetically unlucky stress overeaters will likely need to take the drugs in low dosages for the rest of their lives.

Rivas concedes that the drugs do not work for all stress overeaters, but says that's because scientists have yet to completely unravel the complicated mechanisms that link food and stress: "They have brain chemistries that we don't yet understand."

Tom Riley, 49, says the drugs have been a godsend for him: "For the first time in the last 15 years I know what it is to be hungry. I had forgotten what it was like."

Riley, who works in intelligence at the Department of Defense, says that since Sept. 11 the pace at work has been frenetic. Work-related and other stresses used to intensify his cravings for the peanuts, doughnuts and chocolate chip cookies that pushed his weight to an all-time high of 305. No more. Riley is now eating like his naturally thin wife, who never turns to food when she is under pressure, even though stress is "just as hard on her" as it is on him.

But some clinicians worry about the long-term safety of such drugs, especially since 1997 when the popular weight-loss drug fenfluramine was taken off the market because it was linked to heart valve damage. In addition, those who counsel stress overeaters argue that in most cases the drugs are not necessary.

"I believe individuals can learn methods to identify how they respond to stress and how not to let food be the only solution," says dietitian Jean Curtis. Popular behavioral therapies include journals in which overeaters connect their emotions to their eating, the substitution of a nurturing, nonfood treat--like a bubble bath--for self-destructive overeating, and stress management techniques like biofeedback.

Dr. Paul Rosch, president of the American Institute of Stress, warns that there is no magic destressing technique that works for everyone: "You have to find something you enjoy and will adhere to rather than complying with some regimen you will most likely quit after a short time."

Similarly, therapists urge their patients to find an exercise regimen they like. The morphine-like endorphins released during exercise help dissipate stress hormones, providing the release that humans used to get when they led more physical lives.

Now that her stress fracture is healed, Butler is back to the exercise she loves, long-distance running. When she was a "severe sugar addict" she used running not just for the joy of it, but also to "combat the calories of cake and candy." With her doctor’s help, she has lost 14 pounds and considers herself a reformed sugar addict.

Butler says she changed her eating habits by changing her thinking habits. She has let go of the notions that she has to eat perfectly every day and that she can control everything in her life.

It's an attitude that comes naturally three miles into her runs, when she experiences an endorphin-induced "runner's high." Butler's lengthy to-do list disappears, she becomes philosophical about the stress in her life and she looks for peace within herself, not in a bag of peppermint patties.

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