Robert Sapolsky discusses physiological effects of stress

Why do humans and their primate cousins get more stress-related diseases than any other member of
the animal kingdom? The answer, says Stanford neuroscientist Robert Sapolsky, is that people, apes and
monkeys are highly intelligent, social creatures with far too much spare time on their hands.

"Primates are super smart and organized just enough to devote their free time to being miserable to
each other and stressing each other out," he said. "But if you get chronically, psychosocially stressed,
you're going to compromise your health. So, essentially, we've evolved to be smart enough to make
ourselves sick."

A professor of biological sciences and of neurology and neurological sciences, Sapolsky has spent more
than three decades studying the physiological effects of stress on health. His pioneering work includes
ongoing studies of laboratory rats and wild baboons in the African wilderness.

Sapolsky discussed the biological and sociological implications of stress at a Feb. 17 lecture at the annual
meeting of the American Association for the Advancement of Science in San Francisco and in a recent
interview with Stanford Report.

Stress response

All vertebrates respond to stressful situations by releasing hormones, such as adrenalin and
glucocorticoids, which instantaneously increase the animal's heart rate and energy level. "The stress
response is incredibly ancient evolutionarily," Sapolsky said. "Fish, birds and reptiles secrete the same
stress hormones we do, yet their metabolism doesn't get messed up the way it does in people and other
primates."

To understand why, he said, "just look at the dichotomy between what your body does during real stress
—for example, something is intent on eating you and you're running for your life—versus what your
body does when you're turning on the same stress response for months on end for purely psychosocial
reasons."
In the short term, he explained, stress hormones are "brilliantly adapted" to help you survive an
unexpected threat. "You mobilize energy in your thigh muscles, you increase your blood pressure and
you turn off everything that's not essential to surviving, such as digestion, growth and reproduction," he
said. "You think more clearly, and certain aspects of learning and memory are enhanced. All of that is
spectacularly adapted if you're dealing with an acute physical stressor—a real one."

But non-life-threatening stressors, such as constantly worrying about money or pleasing your boss, also
trigger the release of adrenalin and other stress hormones, which, over time, can have devastating
consequences to your health, he said: "If you turn on the stress response chronically for purely
psychological reasons, you increase your risk of adult onset diabetes and high blood pressure. If you're
chronically shutting down the digestive system, there's a bunch of gastrointestinal disorders you're more
at risk for as well."

In children, the continual release of glucocorticoids can suppress the secretion of normal growth
hormones. "There's actually a syndrome called stress dwarfism in kids who are so psychologically
stressed that growth is markedly impaired," Sapolsky said.

Studies show that long-term stress also suppresses the immune system, making you more susceptible to
infectious diseases, and can even shut down reproduction by causing erectile dysfunction and disrupting
menstrual cycles.

"Furthermore, if you're chronically stressed, all sorts of aspects of brain function are impaired, including,
at an extreme, making it harder for some neurons to survive neurological insults," Sapolsky added. "Also,
neurons in the parts of the brain relating to learning, memory and judgment don't function as well under
stress. That particular piece is what my lab has spent the last 20 years on."

The bottom line, according to Sapolsky: "If you plan to get stressed like a normal mammal, you had
better turn on the stress response or else you're dead. But if you get chronically, psychosocially stressed,
like a Westernized human, then you are more at risk for heart disease and some of the other leading
causes of death in Westernized life."

Baboon studies
In addition to numerous scientific papers about stress, Sapolsky has written four popular books on the
subject—Why Zebras Don't Get Ulcers, The Trouble with Testosterone, A Primate's Memoir and
Monkeyluv. Many of his insights are based on his 30-year field study of wild African baboons, highly
social primates that are close relatives of Homo sapiens. Each year, he and his assistants follow troops of
baboons in Kenya to gather behavioral and physiological data on individual members, including blood
samples, tissue biopsies and electrocardiograms.

"We've found that baboons have diseases that other social mammals generally don't have," Sapolsky
said. "If you're a gazelle, you don't have a very complex emotional life, despite being a social species. But
primates are just smart enough that they can think their bodies into working differently. It's not until you
get to primates that you get things that look like depression."

The same may be true for elephants, whales and other highly intelligent mammals that have complex
emotional lives, he added.

"The reason baboons are such good models is, like us, they don't have real stressors," he said. "If you live
in a baboon troop in the Serengeti, you only have to work three hours a day for your calories, and
predators don't mess with you much. What that means is you've got nine hours of free time every day to
devote to generating psychological stress toward other animals in your troop. So the baboon is a
wonderful model for living well enough and long enough to pay the price for all the social-stressor
nonsense that they create for each other. They're just like us: They're not getting done in by predators
and famines, they're getting done in by each other."

It turns out that unhealthy baboons, like unhealthy people, often have elevated resting levels of stress
hormones. "Their reproductive system doesn't work as well, their wounds heal more slowly, they have
elevated blood pressure and the anti-anxiety chemicals in their brain, which have a structural similarity
to Valium, work differently," Sapolsky said. "So they're not in great shape."

Among the most susceptible to stress are low-ranking baboons and type A individuals. "Type A baboons
are the ones who see stressors that other animals don't," Sapolsky said. "For example, having your worst
rival taking a nap 100 yards away gets you agitated."

But when it comes to stress-related diseases, social isolation may play an even more significant role than
social rank or personality. "Up until 15 years ago, the most striking thing we found was that, if you're a
baboon, you don't want to be low ranking, because your health is going to be lousy," he explained. "But
what has become far clearer, and probably took a decade's worth of data, is the recognition that
protection from stress-related disease is most powerfully grounded in social connectedness, and that's
far more important than rank."

Coping with stress

What can baboons teach humans about coping with all the stress-inducing psychosocial nonsense we
encounter in our daily lives?

"Ideally, we have a lot more behavioral flexibility than the baboon," Sapolsky said, adding that, unlike
baboons, humans can overcome their low social status and isolation by belonging to multiple
hierarchies.

"We are capable of social supports that no other primate can even dream of," he said. "For example, I
might say, 'This job, where I'm a lowly mailroom clerk, really doesn't matter. What really matters is that
I'm the captain of my softball team or deacon of my church'—that sort of thing. It's not just somebody
sitting here, grooming you with their own hands. We can actually feel comfort from the discovery that
somebody on the other side of the planet is going through the same experience we are and feel, I'm not
alone. We can even take comfort reading about a fictional character, and there's no primate out there
that can feel better in life just by listening to Beethoven. So the range of supports that we're capable of is
extraordinary."

But many of the qualities that make us human also can induce stress, he noted. "We can be pained or
empathetic about somebody in Darfur," he said. "We can be pained by some movie character that
something terrible happens to that doesn't even exist. We could be made to feel inadequate by seeing
Bill Gates on the news at night, and we've never even been in the same village as him or seen our goats
next to his. So the realm of space and time that we can extend our emotions means that there are a
whole lot more abstract things that can make us feel stressed."

Pursuit of happiness

The Founding Fathers probably weren't thinking about health when they declared the pursuit of
happiness to be an inalienable right, but when it comes to understanding the importance of a stress-free
life, they may have been ahead of their time.

"When you get to Westernized humans, it's only in the last century or two that our health problems have
become ones of chronic lifestyle issues," Sapolsky said. "It's only 10,000 years or so that most humans
have been living in high-density settlements—a world of strangers jostling and psychologically stressing
each other. But being able to live long enough to get heart disease, that's a fairly new world."

According to Sapolsky, happiness and self-esteem are important factors in reducing stress. Yet the
definition of "happiness" has less to do with material comfort than Westerners might assume, he noted:
"An extraordinary finding that's been replicated over and over is that once you get past the 25 percent or
so poorest countries on Earth, where the only question is survival and subsistence, there is no
relationship between gross national product, per capita income, any of those things, and levels of
happiness."

Surveys show that in Greece, for example, one of Western Europe's poorest countries, people are much
happier than in the United States, the world's richest nation. And while Greece is ranked number 30 in
life expectancy, the United States—with the biggest per capita expenditure on medical care—is only
slighter higher, coming in at 29.

"The United States has the biggest discrepancy in health and longevity between our wealthiest and our
poorest of any country on Earth," Sapolsky noted. "We're also ranked way up in stress-related diseases."

Japan is number one in life expectancy, largely because of its extremely supportive social network,
according to Sapolsky. He cited similar findings in the United States. "Two of the healthiest states are
Vermont and Utah, while two of the unhealthiest are Nevada and New Hampshire," he noted. "Vermont
is a much more left-leaning state in terms of its social support systems, while its neighbor New
Hampshire prides itself on no income tax and go it alone. In Utah, the Mormon church provides
extended social support, explanations for why things are and structure. You can't ask for more than that.
And next door is Nevada, where people are keeling over dead from all of their excesses. It's very
interesting."

Typically, observant Mormons and other religious people are less likely to smoke and drink, he noted.
"But once you control for that, religiosity in and of itself is good for your health in some ways, although
less than some of its advocates would have you believe," Sapolsky said. "It infuriates me, because I'm an
atheist, so it makes me absolutely crazy, but it makes perfect sense. If you have come up with a system
that not only tells you why things are but is capped off with certain knowledge that some thing or things
respond preferentially to you, you're filling a whole lot of pieces there—gaining some predictability,
attribution, social support and control over the scariest realms of our lives."

New research

From a neuroscience perspective, Sapolsky pointed to several exciting new areas of research. "It's
becoming clear that in the hippocampus, the part of the brain most susceptible to stress hormones, you
see atrophy in people with post-traumatic stress disorder and major depression," he said. "There's a ton
of very exciting, very contentious work as to whether stress is causing that part of the brain to atrophy,
and if so, is it reversible. Or does having a small hippocampus make you more vulnerable to stress-
related traumas? There's evidence for both sides."

He also cited new studies suggesting that chronic stress causes DNA to age faster. "Over time, the ends
of your chromosomes fray, and as they fray your DNA stops working as well, and eventually that could
wind up doing in the cell," he said. "There are now studies showing that chromosomal DNA aging
accelerates in young, healthy humans who experience something incredibly psychologically stressful.
That's a huge finding."

According to Sapolsky, the most important new area of neuroscience research may be the effort to
understand differences in the way individuals respond to stress. "This gets you into the realm of why do
some people see stressors that other people don't, and why, in the face of something that is undeniably
a stressor to everybody, do some people do so much worse than others?" he said. "Genes, no doubt,
have something to do with it, but not all that much. However, there is evidence about development
beginning with fetal life—prenatal stress, stress hormones from the mom getting through fetal
circulation—having all sorts of long-term effects.

"We're now about 70 years into thinking that sustained stress can do bad things to your health. The
biggest challenge for the next 70 years is figuring out why some of us are so much more vulnerable than
others."

In the meantime, Sapolsky suggested that people do whatever they can to reduce stress in their daily
lives. "Try stress management, change your priorities or go into therapy," he said. "It takes work. Some
people clearly never can overcome it. But the same things that make us smart enough to generate the
kind of psychological stress that's unheard of in other primates can be the same things that can protect
us. We are malleable."