Life-Style Changes

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This is the area for news articles from time to time.

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There has been a lot of debate on the time and amount of water you should be having before, with and after meals. A lot of people have the habit of downing umpteen glasses of water along with their meals, perhaps with the intention of washing down the food and hoping that this aids the digestive process. However, nutritionists across the world dismiss the idea strongly. Various studies show that the practice severely hampers digestion by diluting the essential gastric juices and causes an upsurge in insulin levels. The issue here is three-fold: consuming water before meals, consuming water alongside meals, and consuming water after meals.

Renowned nutritionist Dr. Anju Sood says, “It roughly takes two hours to digest what you eat. The food goes through your esophagus to the stomach, then to your colon before being flushed out of your system. There is a certain fluid-solid proportion in our gastric system. If you consume water before the meals, you are not only disturbing the fluid component by diluting what you eat, you are also fastening the digestion process as the food now enters the large intestine much sooner than it should. Hence it is not advisable to have water just before your meal.”

She also strongly dismisses the idea of having water alongside meals, as it not only fastens digestion but also tampers the natural absorption of nutrients after digestion. “Some people who drink water alongside meals have also shown a tendency to have an expanded colon,” she said.

Coming to the issue of drinking water right after your meals, Dr. Sood notes the ill effects, “By drinking water right after your meals, you are again tampering the natural time it takes for your food to digest. This also makes you feel hungrier faster than anticipated and results in overeating and bloating.” She recommends a 30 minute window both before and after your meals. “In these 30 minutes, your system proceeds to the next stage of digestion.”

Studies suggest that it is essential to maintain some gap after your meals as this helps in absorption of essential nutrients too. Consuming water right after the meal tends to dilute gastric juice. Though, our stomach is adept at absorbing water, but an excess intake of water after meal dilutes enzymes that are essential for digestion. This is responded by lesser secretion of digestive enzymes that in turn can lead to heartburn and acidity.

The hindered digestive process also leaves behind a lot of undigested food behind in the system. The glucose from this undigested food converts into fat and is stored in your body. This process leads to the upsurge of insulin, which causes a rise in the blood sugar levels of the body, and can lead to diabetes and obesity.

Therefore, while it is important to keep yourself hydrated and consume a minimum of two litres of water every day, you must also ensure you follow the right time to gulp down the wonder liquid.

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Drink liquids 30 minutes before a meal/30-60 minutes after a meal/during a meal if necessary

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Here are 5 reasons to avoid drinking diet soda
1. It can harm your heart.
According to research from the Karolinska Institute in Sweden, men who drank two or more servings of Diet Coke had a 23% higher risk of developing heart failure. In the study, 42,400 men were tracked over 12 years and 3,604 cases of a positive association between sweetened beverage consumption and risk of heart failure were found. In addition, 509 people died of the condition.
The study did not differentiate between diet soda and regular soda — but instead showed an equal amount of risk between both. Drinks included Diet Coke, Pepsi Max and other beverages that use artificial sweeteners.
Read more: Doing this 4 times a week drastically reduces heart disease

2. It can cause kidney problems.
A study done back in 2009 of over 3,000 women found a link between diet soda and kidney problems.
‘While more study is needed, our research suggests that higher sodium and artificially sweetened soda intake are associated with greater rate of decline in kidney function,’ said Dr. Julie Lin MD, MPH, FASN of Brigham and Women’s Hospital, Boston and coauthor of the study.
Researchers found that women who drank two or more diet sodas a day had as much as a 30% decrease in kidney function.
‘Thirty percent is considered significant,” said Dr. Lin. At least five studies have been done attempting to make the connection between soda and kidney disease, but only two have been significant.
3. It can increase your risk of metabolic syndrome and diabetes.
Several studies have linked diet drinks to increased risk of metabolic syndrome and diabetes.
Metabolic syndrome is a group of risk factors that raises your risk for heart disease and other health problems like diabetes and stroke, in addition to increased belly fat and high cholesterol.
A 2008 study of about 10,000 adults at the University of Minnesota found that 1 soda drink a day led to a 34% increased risk of metabolic syndrome. Additionally, another study found a 36% greater risk of metabolic syndrome related to drinking diet soda and a 67% greater risk of type 2 diabetes compared with people who did not drink any diet soda.

4. It leads to ‘increased waist circumference.’
Two studies done by the School of Medicine at the University of Texas Health Science Center in San Antonio, (one in 2011 and another in 2015), found that two servings of diet soda, specifically Diet Coke, increased waistlines by over three inches.
Compared with non-users, diet soft drink consumers had a 70% increase in ‘waist circumference’ than did non-users. But, frequent consumers — defined as consuming two or more diet drinks a day — had a 500% waistline increase over non-users, according to researchers.
Why is this? According to Perdue University, diet sweeteners trick the body and disrupt its natural ability to regulate calorie intake.
‘Artificial sweeteners trigger insulin, which sends your body into fat storage mode and leads to weight gain,’ says Brooke Alpert, RD, author of the book The Sugar Detox.
Read more: Best way to control your weight? Hint: It’s not just diet or exercise!

5. It alters your mood.
Scary as it is, aspartame, or the sweetener in Diet Coke, is on an EPA list of potentially dangerous chemicals contributing to neurotoxicity, right beneath arsenic.
The American Academy of Neurology has discovered that artificially sweetened drinks are connected to a higher risk of depression – at least 30% as much.
‘Sweetened beverages, coffee and tea are commonly consumed worldwide and have important physical—and may have important mental—health consequences,’ said study author Honglei Chen, MD, PhD, with the National Institutes of Health in Research Triangle Park, North Carolina.
‘Our research suggests that cutting out or down on sweetened diet drinks or replacing them with unsweetened coffee may naturally help lower your depression risk,’ he said. ‘More research is needed to confirm these findings, and people with depression should continue to take depression medications prescribed by their doctors.’
But, the good news is, coffee was connected to a lower risk of depression in the study.
Read more: Coffee could help reduce the risk of liver disease

Here are some better alternatives
So what might be some better alternatives to diet soda? If you don’t like the non-flavor of water, you could try Vitamin Water Zero which has zero calories but it sweetened with Stevia instead of aspartame, or you could opt for coffee or tea instead.
Additionally, you might try sparkling mineral water, but sparkling water also has some risks. The best (and cheapest) alternative to soda really is just plain ‘ole 100% water.

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Coffee lovers take their brew in lots of different ways. Some prefer it simple and black, and others stir in sugar, cream, or milk. We know what's in all those ingredients, so no mystery there. But what in the world is in non-dairy creamer?
Before you tip that container of powdered or liquid non-dairy creamer, consider these 7 facts:
Calling it "non-dairy" isn't always true. You would think that a product called "non-dairy" would be safe for those who avoid dairy in their diet, right? But vegans and those with lactose intolerance or a milk allergy be warned: While many non-dairy creamers contain no lactose - the sugar found in milk that many have a hard time digesting - those same products may still contain casein. Casein is a milk protein that can trigger reactions in those with milk allergies. It gets added to non-dairy creamer to impart a milky flavour and texture. Labels must list casein as a milk product in the ingredient information box. So, while the label may say "non-dairy" or "lactose-free," it does not mean it contains no dairy-derived ingredients. Vegans can opt for soymilk-based "creamers," though soymilk may still be problematic for those with milk allergies.
Calling it "creamer" isn't always true. This should be fairly obvious: "Non-dairy creamer" is actually an oxymoron. How can you have cream if you have no dairy? Vegetable oils - usually coconut or palm kernel oil - give "creamers" that creamy look, feel, and flavour.
Extra ingredients get added in to mimic qualities of milk and cream. Sugar, sodium, and corn syrup show up in ingredient lists because they add the flavour you lose when you lose the milk or cream. Food colourings find their way into the mix, too, to mimic the way milk or cream will change the colour of your coffee. In some cases, non-dairy creamers are more truthfully and clearly labelled as "coffee whiteners." If you have food colouring allergies, check labels, because sometimes "plain" or "original" flavoured varieties will not contain colouring.
Non-dairy creamers can boost your calorie count. Plain black coffee contains almost no calories. But once you start scooping or pouring in add-ons like non-dairy creamer, the fat and calories pile up. Be careful how much you scoop into your cup or risk serious portion distortion. Take note of the serving size on the label, and if you want more than recommended, multiply your calorie-and-fat intake accordingly. Like most food products, non-dairy creamer brands usually offer low-fat and low-calorie options. And the "original" or "plain" flavoured varieties of both powdered and fluid non-dairy creamers will likely contain fewer calories and less fat and sugar than those with additional flavouring.
Some non-dairy creamers contain trans fat. Trans fat is a kind of fat that increases your bad (LDL) cholesterol while lowering the more beneficial (HDL) cholesterol. This can boost your risk of heart disease, stroke, and diabetes. You should not consume more than 2 grams of trans fat in a day, and some brands of non-dairy creamer can contain 1 gram per tablespoon.
Non-dairy creamer can go bad. One of the perks of non-dairy creamers is that they keep longer than milk or cream. That doesn't mean they do not have an expiry date. Check package for best-by or use-by advice. Both powdered and liquid non-dairy creamers can take on an off odour, flavour, or appearance and should be discarded. Store powdered creamer in a cool, dry spot, sealed tightly. Liquid creamer should always be refrigerated and sealed tightly.
Powdered non-dairy creamer contains highly flammable ingredients. The popular TV program Mythbusters tested out an urban myth similar to the Mentos-Diet Coke reaction: Could powdered non-dairy creamer ignite an explosion? As it turns out, sodium aluminosilicate, an ingredient added to keep powdered creamer from caking together, can become flammable when dispersed. The Mythbusters packed a large amount of powdered creamer into a cannon and, when lit, it set off a massive fireball. Coffee drinkers stirring small spoonfuls into their morning cup shouldn't worry.

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If a product is approved by the Food and Drug Administration (FDA) and composed of natural ingredients, would you assume it is safe to consume?
If the same product is an artificial sweetener, would you assume it helps control your weight?
Millions of people use aspartame, the artificial sweetener known as NutraSweet™, with these assumptions in mind.
Foods with Aspartame
Aspartame can be found in over 6,000 productsi (often “sugar-free” or diet products), such as:
Instant breakfasts Pharmaceuticals and supplements, including over-the-counter medicines
Breath mints Shake mixes
Cereals Soft drinks
Sugar-free chewing gum Tabletop sweeteners
Cocoa mixes Tea beverages
Coffee beverages Instant teas and coffees
Gelatin desserts Topping mixes
Juice beverages Wine coolers
Laxatives Yogurt
Multivitamins Milk drinks

However, aspartame's tainted history of approval and potentially toxic ingredients cast serious doubt on the safety of this sugar substitute. Furthermore, aspartame may actually increase your appetite and risk for weight gainii.
While the FDA approval may signal the green light for safe consumption, 85 percent of all complaints registered with the FDA are for adverse reactions to aspartame, including five reported deaths. A closer look at the unscientific studies, suspicious approval methods, and its harmful ingredients, reveal the hidden dangers of this artificial sweetener. In reality, aspartame poses a public health threat.
Aspartame Side Effects
The components of aspartame can lead to a wide variety of ailments. Some of these problems occur gradually while others are immediate, acute reactions.
Aspartame is made up of aspartic acid and phenylalanine. The latter has been synthetically altered to carry a methyl group, which is responsible for aspartame’s sweet taste. The phenylalanine methyl bond, called methyl ester, allows the methyl group on the phenylalanine to easily break off and form methanol.
In fruits and vegetables, methanol is bonded to a fiber called pectin that allows it to be safely passed through your digestive tract. However, in aspartame, methanol is not bonded into anything that can help eliminate it from your body.
Once inside your body, the methanol is converted by alcohol dehydrogenase (ADH) enzyme into formaldehyde, which can wreak havoc on your DNA and sensitive proteins. All animals, except humans, possess the ability to break down methanol into formic acid.
A few of the many disorders associated with aspartame include the following:
Birth Defects
A study funded by Monsanto to study possible birth defects caused by consuming aspartame was cut off after preliminary data showed damaging information about aspartame. Additionally, in the book While Waiting: A Prenatal Guidebook, it is stated that aspartame is suspected of causing brain damage in sensitive individuals. A fetus may be at risk for these effects. Some researchers have suggested that high doses of aspartame may be associated with problems ranging from dizziness and subtle brain changes to mental retardation.
Cancer (Brain Cancer)
In 1981, an FDA statistician stated that the brain tumor data on aspartame was so "worrisome" that he could not recommend approval of NutraSweet™.iii
In a two-year study conducted by the manufacturer of aspartame, twelve of 320 rats fed a normal diet and aspartame developed brain tumors while none of the control rats developed tumors, and five of the twelve tumors were in rats given a low dose of aspartame.iv
The approval of aspartame was a violation of the Delaney Amendment, which was supposed to prevent cancer-causing substances such as methanol (formaldehyde) and DKP from entering our food supply.
A late FDA toxicologist testified before the U.S. Congress that aspartame was capable of producing brain tumors. This made it illegal for the FDA to set an allowable daily intake at any level. He stated in his testimony that Searle's studies were "to a large extent unreliable" and that "at least one of those studies has established beyond any reasonable doubt that aspartame is capable of inducing brain tumors in experimental animals..."
He concluded his testimony by asking, "What is the reason for the apparent refusal by the FDA to invoke for this food additive the so-called Delaney Amendment to the Food, Drug and Cosmetic Act? ...And if the FDA itself elects to violate the law, who is left to protect the health of the public?"v
In the mid-1970s, it was discovered that the manufacturer of aspartame falsified studies in several ways. One of the techniques used was to cut tumors out of test animals and put them back in the study. Another technique used to falsify the studies was to list animals that had actually died as surviving the study. Thus, the data on brain tumors was likely worse than discussed above. In addition, a former employee of the manufacturer of aspartame told the FDA on July 13, 1977 that the particles of DKP were so large that the rats could discriminate between the DKP and their normal diet.vi
Diabetes
The American Diabetes Association (ADA) is actually recommending this chemical poison to persons with diabetes, but according to research conducted by a diabetes specialist, aspartame:vii
• Leads to the precipitation of clinical diabetes
• Causes poorer diabetic control in diabetics on insulin or oral drugs
• Leads to the aggravation of diabetic complications such as retinopathy, cataracts, neuropathy and gastroparesis
• Causes convulsions
In a statement concerning the use of products containing aspartame by persons with diabetes and hypoglycemia, the researchers says:viii
"Unfortunately, many patients in my practice, and others seen in consultation, developed serious metabolic, neurologic and other complications that could be specifically attributed to using aspartame products. This was evidenced by the loss of diabetic control, the intensification of hypoglycemia, the occurrence of presumed 'insulin reactions' (including convulsions) that proved to be aspartame reactions, and the precipitation, aggravation or simulation of diabetic complications (especially impaired vision and neuropathy) while using these products... Dramatic improvement of such features after avoiding aspartame, and the prompt predictable recurrence of these problems when the patient resumed aspartame products, knowingly or inadvertently."
Another researcher stated that excitotoxins such as those found in aspartame can precipitate diabetes in persons who are genetically susceptible to the disease.
Emotional Disorders
In a double blind study of the effects of aspartame on persons with mood disorders, findings showed a large increase in serious symptoms for persons taking aspartame. Since some of the symptoms were so serious, the Institutional Review Board had to stop the study. Three of the participants had said that they had been "poisoned" by aspartame.
Researchers concluded that "individuals with mood disorders are particularly sensitive to this artificial sweetener and its use in this population should be discouraged."ix One researcher stated about aspartame, "I know it causes seizures. I'm convinced also that it definitely causes behavioral changes. I'm very angry that this substance is on the market. I personally question the reliability and validity of any studies funded by the NutraSweet™ Company."x
Additionally, there are numerous reported cases of low brain serotonin levels, depression, and other emotional disorders that have been linked to aspartame and often are relieved by stopping the intake of aspartame.
Epilepsy/Seizures
With the large and growing number of seizures caused by aspartame, it is sad to see that the Epilepsy Foundation is promoting the "safety" of aspartame. At Massachusetts Institute of Technology, 80 people who had suffered seizures after ingesting aspartame were surveyed. Community Nutrition Institute concluded the following about the survey:
"These 80 cases meet the FDA's own definition of an imminent hazard to the public health, which requires the FDA to expeditiously remove a product from the market."
Both the Air Force's magazine, Flying Safety, and the Navy's magazine, Navy Physiology, published articles warning about the many dangers of aspartame including the cumulative delirious effects of methanol and the greater likelihood of birth defects. The articles note that the ingestion of aspartame can make pilots more susceptible to seizures and vertigo.
Twenty articles sounding warnings about ingesting aspartame while flying have also appeared in the National Business Aircraft Association Digest (NBAA Digest 1993), Aviation Medical Bulletin (1988), The Aviation Consumer (1988), Canadian General Aviation News (1990), Pacific Flyer (1988), General Aviation News (1989), Aviation Safety Digest (1989), and Plane & Pilot (1990) and a paper warning about aspartame was presented at the 57th Annual Meeting of the Aerospace Medical Association (Gaffney 1986).
A hotline was even set up for pilots suffering from acute reactions to aspartame ingestion. Over 600 pilots have reported symptoms including some who have reported suffering grand mal seizures in the cockpit due to aspartame.xi
Why Don't We Hear About These Aspartame Dangers?
The reason many people do not hear about serious reactions to aspartame is twofold:
1. Lack of awareness by the general population. Aspartame-caused diseases are not reported in the newspapers like plane crashes. This is because these incidents occur one at a time in thousands of different locations across the United States.
2. Most people do not associate their symptoms with the long-term use of aspartame. For the people who have killed a significant percentage of their brain cells and thereby caused a chronic illness, there is no way that they would normally associate such an illness with aspartame consumption.
How aspartame was approved is a lesson in how chemical and pharmaceutical companies can manipulate government agencies such as the FDA, "bribe" organizations such as the American Dietetic Association, and flood the scientific community with flawed and fraudulent industry-sponsored studies funded by the makers of aspartame.
Erik Millstone, a researcher at the Science Policy Research Unit of Sussex University, has compiled thousands of pages of evidence, some of which have been obtained using the freedom of information act 23, showing:xii
1. Laboratory tests were faked and dangers were concealed.
2. Tumors were removed from animals and animals that had died were "restored to life" in laboratory records.
3. False and misleading statements were made to the FDA.
4. The two US Attorneys given the task of bringing fraud charges against the aspartame manufacturer took positions with the manufacturer's law firm, letting the statute of limitations run out
5. The Commissioner of the FDA overruled the objections of the FDA's own scientific board of inquiry. Shortly after that decision, he took a position with Burson-Marsteller, the firm in charge of public relations for G.D. Searle.
A Public Board of Inquiry (PBOI) was conducted in 1980. There were three scientists who reviewed the objections of Olney and Turner to the approval of aspartame. They voted unanimously against aspartame's approval. The FDA Commissioner, Dr. Arthur Hull Hayes, Jr. then created a 5-person Scientific Commission to review the PBOI findings. After it became clear that the Commission would uphold the PBOI's decision by a vote of 3 to 2, another person was added to the Commission, creating a deadlocked vote. This allowed the FDA Commissioner to break the deadlock and approve aspartame for dry goods in 1981.
Dr. Jacqueline Verrett, the Senior Scientist in an FDA Bureau of Foods review team created in August 1977 to review the Bressler Report (a report that detailed G.D. Searle's abuses during the pre-approval testing) said: "It was pretty obvious that somewhere along the line, the bureau officials were working up to a whitewash."
In 1987, Verrett testified before the US Senate stating that the experiments conducted by Searle were a "disaster." She stated that her team was instructed not to comment on or be concerned with the overall validity of the studies. She stated that questions about birth defects have not been answered. She continued her testimony by discussing the fact that DKP has been shown to increase uterine polyps and change blood cholesterol and that increasing the temperature of the product leads to an increase in production of DKP.
Revolving Doors
The FDA and the manufacturers of aspartame have had a revolving door of employment for many years. In addition to the FDA Commissioner and two US Attorneys leaving to take positions with companies connected with G.D. Searle, four other FDA officials connected with the approval of aspartame took positions connected with the NutraSweet™ industry between 1979 and 1982 including the Deputy FDA Commissioner, the Special Assistant to the FDA Commissioner, the Associate Director of the Bureau of Foods and Toxicology and the Attorney involved with the Public Board of Inquiry.xiii
It is important to realize that this type of revolving-door activity has been going on for decades. The Townsend Letter (formerlyThe Townsend Letter for Doctors and Patients 11/92) reported on a study revealing that 37 of 49 top FDA officials who left the FDA took positions with companies they had regulated. They also reported that over 150 FDA officials owned stock in drug companies they were assigned to manage.
Many organizations and universities receive large sums of money from companies connected to the NutraSweet™ Association, a group of companies promoting the use of aspartame. In January 1993, the American Dietetic Association received a US$75,000 grant from the NutraSweet™ Company. The American Dietetic Association has stated that the NutraSweet™ Company writes their "Facts" sheets.xiv
What is the FDA doing to protect the consumer from the dangers of aspartame?
Less Than Nothing.
In 1992, the FDA approved aspartame for use in malt beverages, breakfast cereals, and refrigerated puddings and fillings. In 1993, the FDA approved aspartame for use in hard and soft candies, non-alcoholic favored beverages, tea beverages, fruit juices and concentrates, baked goods and baking mixes, and frostings, toppings, and fillings for baked goods.
In 1991, the FDA banned the importation of stevia. The powder of this leaf has been used for hundreds of years as an alternative sweetener. It is used widely in Japan with no adverse effects. Scientists involved in reviewing stevia have declared it to be safe for human consumption--something that has been well known in many parts of the world where it is not banned. Some people believe that stevia was banned to keep the product from taking hold in the United States and cutting into sales of aspartame.xv
What is the U.S. Congress doing to protect the consumer from the dangers of aspartame?
Nothing.
What is the U.S. Administration (President) doing to protect the consumer from the dangers of aspartame?
Nothing.
Aspartame consumption is not only a problem in the United States--it is being sold in over 70 countries throughout the world.

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Refined Carbs and Sugar: The Diet Saboteurs
How Choosing Healthier Carbs Can Improve Your Health and Waistline

French fries
They’re the comfort foods we crave when we’re feeling down or stressed: pasta, fries, white bread, cookies, pastries, ice cream, cakes. But these simple or refined carbohydrates cause rapid spikes in blood sugar, fluctuations in mood and energy, and a build-up of fat, especially around your waistline. Cutting back on these diet saboteurs doesn’t mean feeling unsatisfied or never enjoying comfort food again. The key is to choose the right carbs. Complex carbs such as vegetables, whole grains, and naturally sweet fruit digest slower, resulting in stable blood sugar and less fat accumulation. You’ll not only feel healthier and more energetic, you could also shed that stubborn belly fat so many of us struggle with.

Why are refined carbs and sugar so bad for your health?
Refined or simple carbohydrates include sugars and refined grains that have been stripped of all bran, fiber, and nutrients. These include white bread, pizza dough, pasta, pastries, white flour, white rice, and many breakfast cereals. They digest quickly and their high glycemic index causes unhealthy spikes in blood sugar levels.

When you eat refined carbs, your bloodstream is flooded with sugar which triggers a surge of insulin to clear the sugar from your blood. All this insulin can leave you feeling hungry soon after a meal, often craving more sugary carbs. This can cause you to overeat, put on weight, and over time lead to insulin resistance and type-2 diabetes. Diets high in refined carbs and sugar have also been linked to high blood pressure, heart disease, obesity, hyperactivity, mood disorders, and even suicide in teenagers.

For many of us, cutting back on sugary treats and overcoming our carb cravings can seem like a daunting task. As well as being present in obvious foods such as sugary snacks, desserts, and candies, sugar is also hidden in much of the processed food we eat—from soda, coffee and fruit drinks to bread, pasta sauce, and frozen dinners. But by focusing on whole foods and complex, unrefined carbs, you can reduce your intake of sugar and refined carbs, keep your blood sugar stable, maintain a healthy weight, and still find ways to satisfy your sweet tooth.

The not-so-sweet link between sugar and belly fat

A lot of belly fat surrounds the abdominal organs and liver and is closely linked to insulin resistance and an increased risk of diabetes. Calories obtained from fructose (found in sugary beverages such as soda, energy and sports drinks, coffee drinks, and processed foods like doughnuts, muffins, cereal, candy, and granola bars) are more likely to add weight around your abdomen. Cutting back on sugary foods can mean a slimmer waistline as well as a lower risk of diabetes.

Good carbs vs. bad carbs
Carbohydrates are one of your body’s main sources of energy. Health organizations such as the U.S. Department of Health and Human Services recommend that 45 to 65 percent of your daily calories should come from carbohydrates. However, the majority of these should be from complex, unrefined carbs rather than refined carbs (including starches such as potatoes and corn).

Unlike simple carbs, complex carbohydrates are digested slowly, causing a gradual rise in blood sugar. They’re usually high in nutrients and fiber, which can help prevent serious disease, aid with weight-loss, and improve your energy levels. In general, “good” carbohydrates have a lower glycemic load and can even help guard against type 2 diabetes and cardiovascular problems in the future.

Good carbs include:

Unrefined whole grains - whole wheat or multigrain bread, brown rice, barley, quinoa, bran cereal, oatmeal

Non-starchy vegetables - spinach, green beans, Brussels sprouts, celery, tomatoes

Legumes - kidney beans, baked beans, peas, lentils

Nuts - peanuts, cashews, walnuts

Fruit - apples, berries, citrus fruit, bananas, pears

What is the glycemic index and glycemic load?

The glycemic index (GI) measures how rapidly a food spikes your blood sugar, while the glycemic load measures the amount of digestible carbohydrate (total carbohydrate minus fiber) the food contains. While both can be useful tools, having to refer to different tables can be unnecessarily complicated. Unless you’re on a specific diet, most people find it easiest to stick to the broad guidelines of what makes a carb “good” or “bad”.

Switching to good carbs

While there are many health benefits to switching from refined to complex carbs, you don’t have to consign yourself to never again eating French fries or a slice of white bread. After all, when you ban certain foods, it’s natural to crave those foods even more. Instead, make refined carbs and sugary foods an occasional indulgence rather than a regular part of your diet. As you reduce your intake of these unhealthy foods, you’ll likely find yourself craving them less and less.

Choosing healthier carbs
Instead of… Try…
White rice Brown or wild rice, riced cauliflower
White potatoes (including fries and mashed potatoes) Cauliflower mash, sweet potato
Regular pasta Whole-wheat pasta, spaghetti squash
White bread Whole-wheat or whole-grain bread
Sugary breakfast cereal High-fiber, low-sugar cereal
Instant oatmeal Steel-cut or rolled oats
Cornflakes Low-sugar bran flakes
Corn Leafy greens
Corn or potato chips Nuts, or raw veggies for dipping
Added sugar is just empty calories
Your body gets all the sugar it needs from that naturally occurring in food—fructose in fruit or lactose in milk, for example. All the sugar added to processed food offers no nutritional value—but just means a lot of empty calories that can sabotage any healthy diet, contribute to weight gain, and increase your risk for serious health problems.

Again, it’s unrealistic to try to eliminate all sugar and empty calories from your diet. The American Heart Association recommends limiting the amount of added sugars you consume to no more than 100 calories per day (about 6 teaspoons or 24 grams of sugar) for women and 150 calories per day (9 teaspoons or 36 grams) for men. If that still sounds like a lot, it’s worth remembering that a 12-ounce soda contains up to 10 teaspoons of added sugar—some shakes and sweetened coffee drinks even more. The average American currently consumes 19.5 teaspoons (82 grams) of added sugar each day, often without realizing it. By becoming more aware of the sugar in your diet, you can cut down to the recommended levels and make a huge difference to the way you look, think, and feel.

How to cut down on sugar

Slowly reduce the sugar in your diet a little at a time to give your taste buds time to adjust and wean yourself off the craving.

Cook more at home. By preparing more of your own food, you can ensure that you and your family eat fresh, wholesome meals without added sugar.

Give recipes a makeover. Many dessert recipes taste just as good with less sugar.

Avoid sugary drinks—even “diet” versions. Artificial sweetener can still trigger sugar cravings that contribute to weight gain. Instead of soda, try adding a splash of fruit juice to sparkling water. Or blend skim milk with a banana or berries for a delicious, healthy smoothie.

Avoid processed or packaged foods. About 75% of packaged food in the U.S. contains added sugar—including canned soups, frozen dinners, and low-fat meals—that can quickly add up to unhealthy amounts.

Be careful when eating out. Most gravy, dressings, and sauces are packed with sugar, so ask for it to be served on the side.

Eat healthier snacks. Cut down on sweet snacks such as candy, chocolate, and cakes. Instead, satisfy your sweet tooth with naturally sweet food such as fruit, peppers, or natural peanut butter.

Create your own frozen treats. Freeze pure fruit juice in an ice-cube tray with plastic spoons as popsicle handles. Or make frozen fruit kabobs using pineapple chunks, bananas, grapes, and berries.

Check labels of all the packaged food you buy. Choose low-sugar products—but be aware that manufacturers often try to hide sugar on labels.

How to spot hidden sugar in your food
Being smart about sweets is only part of the battle of reducing sugar in your diet. Sugar is also hidden in many packaged foods, fast food meals, and grocery store staples such as bread, cereals, canned goods, pasta sauce, margarine, instant mashed potatoes, frozen dinners, low-fat meals, and ketchup. The first step is to spot hidden sugar on food labels, which can take some sleuthing:

Do some detective work

Manufacturers are required to provide the total amount of sugar in a serving but do not have to spell out how much of this sugar has been added and how much is naturally in the food. The trick is deciphering which ingredients are added sugars. Aside from the obvious ones—sugar, honey, molasses—added sugar can appear as agave nectar, cane crystals, corn sweetener, crystalline fructose, dextrose, evaporated cane juice, fructose, high-fructose corn syrup, invert sugar, lactose, maltose, malt syrup, and more.

A wise approach is to avoid products that have any of these added sugars at or near the top of the list of ingredients—or ones that have several different types of sugar scattered throughout the list. If a product is chock-full of sugar, you would expect to see “sugar” listed first, or maybe second. But food makers can fudge the list by adding sweeteners that aren’t technically called sugar. The trick is that each sweetener is listed separately. The contribution of each added sugar may be small enough that it shows up fourth, fifth, or even further down the list. But add them up and you can get a surprising dose of added sugar.

Let’s take as an example a popular oat-based cereal with almonds whose package boasts that it is “great tasting,” “heart healthy” and “whole grain guaranteed.” Here’s the list of ingredients:

Whole-grain oats, whole-grain wheat, brown sugar, almond pieces, sugar, crisp oats,* corn syrup, barley malt extract, potassium citrate, toasted oats,* salt, malt syrup, wheat bits,* honey, and cinnamon. *contain sugar, high-fructose corn syrup, honey, and/or brown sugar molasses.

Combine brown sugar, sugar, corn syrup, barley malt extract, high-fructose corn syrup, honey, brown sugar molasses, and malt syrup, and they add up to a hefty dose of empty calories—more than one-quarter (27%) of this cereal is added sugar, which you might not guess from scanning the ingredient list.

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How to Lose Weight and Keep It Off
Dieting Tips that Work and Won’t Make You Miserable

Woman on medical scale
In our eat-and-run, massive-portion-sized culture, maintaining a healthy weight can be tough—and losing weight, even tougher. If you’ve tried and failed to lose weight before, you may believe that diets don’t work for you. You’re probably right: some diets don’t work at all and none of them work for everyone—our bodies often respond differently to different foods. But while there’s no easy fix to losing weight, there are plenty of steps you can take to develop a healthier relationship with food, curb emotional triggers to overeating, and achieve lasting weight-loss success.

What's the best diet for healthy weight loss?
Pick up any diet book and it will claim to hold all the answers to successfully losing all the weight you want—and keeping it off. Some claim the key is to eat less and exercise more, others that low fat is the only way to go, while others prescribe cutting out carbs. So what should you believe?

The truth is there is no “one size fits all” solution to permanent healthy weight loss. What works for one person may not work for you, since our bodies respond differently to different foods, depending on genetics and other health factors. To find the method of weight loss that’s right for you will likely take time and require patience, commitment, and some experimentation with different foods and diets.

While some people respond well to counting calories or similar restrictive methods, others respond better to having more freedom in planning their weight-loss programs. Being free to simply avoid fried foods or cut back on refined carbs can set them up for success. So, don’t get too discouraged if a diet that worked for somebody else doesn’t work for you. And don’t beat yourself up if a diet proves too restrictive for you to stick with. Ultimately, a diet is only right for you if it’s one you can stick with over time.

Popular weight loss strategies
Cut calories

Some experts believe that successfully managing your weight comes down to a simple equation: If you eat fewer calories than you burn, you lose weight. Sounds easy, right? Then why is losing weight so hard?

Weight loss isn’t a linear event over time. When you cut calories, you may drop weight for the first few weeks, for example, and then something changes. You eat the same number of calories but you lose less weight or no weight at all. That’s because when you lose weight you’re losing water and lean tissue as well as fat, your metabolism slows, and your body changes in other ways. So, in order to continue dropping weight each week, you need to continue cutting calories.
A calorie isn’t always a calorie. Eating 100 calories of high fructose corn syrup, for example, can have a different effect on your body than eating 100 calories of broccoli. The trick for sustained weight loss is to ditch the foods that are packed with calories but don’t make you feel full (like candy) and replace them with foods that fill you up without being loaded with calories (like vegetables).
Many of us don’t always eat simply to satisfy hunger. We also turn to food for comfort or to relieve stress—which can quickly derail any weight loss plan.
Cut carbs

A different way of viewing weight loss identifies the problem as not one of consuming too many calories, but rather the way the body accumulates fat after consuming carbohydrates—in particular the role of the hormone insulin. When you eat a meal, carbohydrates from the food enter your bloodstream as glucose. In order to keep your blood sugar levels in check, your body always burns off this glucose before it burns off fat from a meal.

If you eat a carbohydrate-rich meal (lots of pasta, rice, bread, or French fries, for example), your body releases insulin to help with the influx of all this glucose into your blood. As well as regulating blood sugar levels, insulin does two things: It prevents your fat cells from releasing fat for the body to burn as fuel (because its priority is to burn off the glucose) and it creates more fat cells for storing everything that your body can’t burn off. The result is that you gain weight and your body now requires more fuel to burn, so you eat more. Since insulin only burns carbohydrates, you crave carbs and so begins a vicious cycle of consuming carbs and gaining weight. To lose weight, the reasoning goes, you need to break this cycle by reducing carbs.

carb diet cycle
Most low-carb diets advocate replacing carbs with protein and fat, which could have some negative long-term effects on your health. If you do try a low-carb diet, you can reduce your risks and limit your intake of saturated and trans fats by choosing lean meats, fish and vegetarian sources of protein, low-fat dairy products, and eating plenty of leafy green and non-starchy vegetables.

Cut fat

It's a mainstay of many diets: if you don’t want to get fat, don’t eat fat. Walk down any grocery store aisle and you’ll be bombarded with reduced-fat snacks, dairy, and packaged meals. But while our low-fat options have exploded, so have obesity rates. So, why haven’t low-fat diets worked for more of us?

Not all fat is bad. Healthy or “good” fats can actually help to control your weight, as well as manage your moods and fight fatigue. Unsaturated fats found in avocados, nuts, seeds, soymilk, tofu, and fatty fish can help fill you up, while adding a little tasty olive oil to a plate of vegetables, for example, can make it easier to eat healthy food and improve the overall quality of your diet.
We often make the wrong trade-offs. Many of us make the mistake of swapping fat for the empty calories of sugar and refined carbohydrates. Instead of eating whole-fat yoghurt, for example, we eat low- or no-fat versions that are packed with sugar to make up for the loss of taste. Or we swap our fatty breakfast bacon for a muffin or donut that causes rapid spikes in blood sugar.
Follow the Mediterranean diet

The Mediterranean diet emphasizes eating good fats and good carbs along with large quantities of fresh fruits and vegetables, nuts, fish, and olive oil—and only modest amounts of meat and cheese. The Mediterranean diet is more than just about food, though. Regular physical activity and sharing meals with others are also major components.

Whatever weight loss strategy you try, it’s important to stay motivated and avoid common dieting pitfalls.

Control emotional eating

We don’t always eat simply to satisfy hunger. All too often, we turn to food when we’re stressed or anxious, which can wreck any diet and pack on the pounds. Do you eat when you’re worried, bored, or lonely? Do you snack in front of the TV at the end of a stressful day? Recognizing your emotional eating triggers can make all the difference in your weight-loss efforts. If you eat when you’re:

Stressed – find healthier ways to calm yourself. Try yoga, meditation, or soaking in a hot bath.

Low on energy – find other mid-afternoon pick-me-ups. Try walking around the block, listening to energizing music, or taking a short nap.

Lonely or bored – reach out to others instead of reaching for the refrigerator. Call a friend who makes you laugh, take your dog for a walk, or go to the library, mall, or park—anywhere there’s people.

Practice mindful eating instead

Avoid distractions while eating. Try not to eat while working, watching TV, or driving. It’s too easy to mindlessly overeat.

Pay attention. Eat slowly, savoring the smells and textures of your food. If your mind wanders, gently return your attention to your food and how it tastes.

Mix things up to focus on the experience of eating. Try using chopsticks rather than a fork, or use your utensils with your non-dominant hand.

Stop eating before you are full. It takes time for the signal to reach your brain that you’ve had enough. Don’t feel obligated to always clean your plate.

Stay motivated
Permanent weight loss requires making healthy changes to your lifestyle and food choices. To stay motivated:

Find a cheering section. Social support means a lot. Programs like Jenny Craig and Weight Watchers use group support to impact weight loss and lifelong healthy eating. Seek out support—whether in the form of family, friends, or a support group—to get the encouragement you need.

Slow and steady wins the race. Losing weight too fast can take a toll on your mind and body, making you feel sluggish, drained, and sick. Aim to lose one to two pounds a week so you’re losing fat rather than water and muscle.

Set goals to keep you motivated. Short-term goals, like wanting to fit into a bikini for the summer, usually don’t work as well as wanting to feel more confident or become healthier for your children’s sakes. When temptation strikes, focus on the benefits you’ll reap from being healthier.

Use tools to track your progress. Smartphone apps, fitness trackers, or simply keeping a journal can help you keep track of the food you eat, the calories you burn, and the weight you lose. Seeing the results in black and white can help you stay motivated.

Get plenty of sleep. Lack of sleep stimulates your appetite so you want more food than normal; at the same time, it stops you feeling satisfied, making you want to keep eating. Sleep deprivation can also affect your motivation, so aim for eight hours of quality sleep a night.

Cut down on sugar and refined carbs
Whether or not you’re specifically aiming to cut carbs, most of us consume unhealthy amounts of sugar and refined carbohydrates such as white bread, pizza dough, pasta, pastries, white flour, white rice, and sweetened breakfast cereals. Replacing refined carbs with their whole-grain counterparts and eliminating candy and desserts is only part of the solution, though. Sugar is hidden in foods as diverse as canned soups and vegetables, pasta sauce, margarine, and many reduced fat foods. Since your body gets all it needs from sugar naturally occurring in food, all this added sugar amounts to nothing but a lot of empty calories and unhealthy spikes in your blood glucose.

Less sugar can mean a slimmer waistline

Calories obtained from fructose (found in sugary beverages such as soda and processed foods like doughnuts, muffins, and candy) are more likely to add to fat around your belly. Cutting back on sugary foods can mean a slimmer waistline as well as a lower risk of diabetes.

Fill up with fruit, veggies, and fiber
Even if you’re cutting calories, that doesn’t necessarily mean you have to eat less food. High-fiber foods such as fruit, vegetables, beans, and whole grains are higher in volume and take longer to digest, making them filling—and great for weight-loss.

It’s generally okay to eat as much fresh fruit and non-starchy vegetables as you want—you’ll feel full before you’ve overdone it on the calories.

Eat vegetables raw or steamed, not fried or breaded, and dress them with herbs and spices or a little olive oil for flavor.

Add fruit to low sugar cereal—blueberries, strawberries, sliced bananas. You’ll still enjoy lots of sweetness, but with fewer calories, less sugar, and more fiber.

Bulk out sandwiches by adding healthy veggie choices like lettuce, tomatoes, sprouts, cucumbers, and avocado.

Snack on carrots or celery with hummus instead of a high-calorie chips and dip.

Add more veggies to your favorite main courses to make your dish more substantial. Even pasta and stir-fries can be diet-friendly if you use less noodles and more vegetables.

Start your meal with salad or vegetable soup to help fill you up so you eat less of your entrée.

Take charge of your food environment
Set yourself up for weight-loss success by taking charge of your food environment: when you eat, how much you eat, and what foods you make easily available.

Cook your own meals at home. This allows you to control both portion size and what goes in to the food. Restaurant and packaged foods generally contain a lot more sugar, unhealthy fat, and calories than food cooked at home—plus the portion sizes tend to be larger.

Serve yourself smaller portions. Use small plates, bowls, and cups to make your portions appear larger. Don’t eat out of large bowls or directly from food containers, which makes it difficult to assess how much you’ve eaten.

Eat early. Studies suggest that consuming more of your daily calories at breakfast and fewer at dinner can help you drop more pounds. Eating a larger, healthy breakfast can jump start your metabolism, stop you feeling hungry during the day, and give you more time to burn off the calories.

Fast for 14 hours a day. Try to eat dinner earlier in the day and then fast until breakfast the next morning. Eating only when you’re most active and giving your digestion a long break may aid weight loss.

Plan your meals and snacks ahead of time. You can create your own small portion snacks in plastic bags or containers. Eating on a schedule will help you avoid eating when you aren’t truly hungry.

Drink more water. Thirst can often be confused with hunger, so by drinking water you can avoid extra calories.

Limit the amount of tempting foods you have at home. If you share a kitchen with non-dieters, store indulgent foods out of sight.

Get moving
The degree to which exercise aids weight loss is open to debate, but the benefits go way beyond burning calories. Exercise can increase your metabolism and improve your outlook—and it’s something you can benefit from right now. Go for a walk, stretch, move around and you’ll have more energy and motivation to tackle the other steps in your weight-loss program.

Lack time for a long workout? Three 10-minute spurts of exercise per day can be just as good as one 30-minute workout.

Remember: anything is better than nothing. Start off slowly with small amounts of physical activity each day. Then, as you start to lose weight and have more energy, you’ll find it easier to become more physically active.

Find exercise you enjoy. Try walking with a friend, dancing, hiking, cycling, playing Frisbee with a dog, enjoying a pickup game of basketball, or playing activity-based video games with your kids.

Keeping the Weight Off

Few things are more discouraging to someone on a weight-loss plan than the oft-cited statistic that 95% of people who lose weight will regain it within a few years. The difficulty in sticking with a long-term weight-maintenance plan is one of the main reasons that weight-loss programs fail. To uncover clues to successful weight loss, researchers have been collecting information on people who have lost weight and successfully kept it off for many years. This project, known as the National Weight Control Registry (NWCR), records what these people did to achieve their goals.

Below are six strategies gleaned from NWCR participants who have kept off at least 30 pounds for at least one year:

Being physically active. They exercise about an hour a day, burning an average of 2,600 calories per week. Walking is the most popular exercise and about one in five engages in weight training.
Eating a diet low in calories and fat. Eating less fat and more fiber helps participants maintain a diet of about 1,360 calories per day and around 24% to 29% fat, which is lower than the typical American diet.
Eating breakfast. Seventy-eight percent said they ate breakfast (usually cereal and fruit) every day, and just 4% said they never ate breakfast.
Keeping tabs on how much you eat. Writing down what you eat every day in a food log or diary helps avoid weight regain.
Stepping on the scale regularly. Most participants weigh themselves at least once a week, and just over a third make weighing a daily practice. Researchers speculate that this habit allows people to detect a small weight gain and take action before the problem escalates.
Watching little television. The average American watches 28 hours of television per week, but about two-thirds of NWCR participants reported watching 10 or fewer hours per week, and only 12% watched 21 or more hours per week. Those who watched the most TV were more likely to regain weight than those who watched less, even after researchers controlled for diet and exercise differences.

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Emotional Eating
How to Recognize and Stop Emotional and Stress Eating

It’s the reason why so many diets fail: We don’t always eat just to satisfy hunger. Many of us also turn to food to relieve stress or cope with unpleasant emotions such as sadness, loneliness, or boredom. And after eating, we feel even worse. Not only does the original emotional issue remain, but we also feel guilty for overeating. No matter how powerless you feel over food cravings, though, there is an answer. By practicing mindful eating, you can change the emotional habits that have sabotaged your diet in the past, and regain control over both food and your feelings.
What is emotional eating?
Emotional eating (or stress eating) is using food to make yourself feel better—eating to satisfy emotional needs, rather than to satisfy physical hunger. You might reach for a pint of ice cream when you’re feeling down, order a pizza if you’re bored or lonely, or swing by the drive-through after a stressful day at work.
Occasionally using food as a pick me up, a reward, or to celebrate isn’t necessarily a bad thing. But when eating is your primary emotional coping mechanism—when your first impulse is to open the refrigerator whenever you’re stressed, upset, angry, lonely, exhausted, or bored—you get stuck in an unhealthy cycle where the real feeling or problem is never addressed.
Emotional hunger can’t be filled with food. Eating may feel good in the moment, but the feelings that triggered the eating are still there. And you often feel worse than you did before because of the unnecessary calories you’ve just consumed.
No matter how powerless you feel over food and your feelings, it is possible to make a positive change. You can find healthier ways to deal with your emotions, learn to eat mindfully instead of mindlessly, regain control of your weight, and finally put a stop to emotional eating.
Are you an emotional eater?
• Do you eat more when you’re feeling stressed?
• Do you eat when you’re not hungry or when you’re full?
• Do you eat to feel better (to calm and soothe yourself when you’re sad, mad, bored, anxious, etc.)?
• Do you reward yourself with food?
• Do you regularly eat until you’ve stuffed yourself?
• Does food make you feel safe? Do you feel like food is a friend?
• Do you feel powerless or out of control around food?
The difference between emotional hunger and physical hunger
Emotional hunger can be powerful, so it’s easy to mistake it for physical hunger. But there are clues you can look for to help you tell physical and emotional hunger apart.
Emotional hunger comes on suddenly. It hits you in an instant and feels overwhelming and urgent. Physical hunger, on the other hand, comes on more gradually. The urge to eat doesn’t feel as dire or demand instant satisfaction (unless you haven’t eaten for a very long time).
Emotional hunger craves specific comfort foods. When you’re physically hungry, almost anything sounds good—including healthy stuff like vegetables. But emotional hunger craves junk food or sugary snacks that provide an instant rush. You feel like you need cheesecake or pizza, and nothing else will do.
Emotional hunger often leads to mindless eating. Before you know it, you’ve eaten a whole bag of chips or an entire pint of ice cream without really paying attention or fully enjoying it. When you’re eating in response to physical hunger, you’re typically more aware of what you’re doing.
Emotional hunger isn’t satisfied once you’re full. You keep wanting more and more, often eating until you’re uncomfortably stuffed. Physical hunger, on the other hand, doesn't need to be stuffed. You feel satisfied when your stomach is full.
Emotional hunger isn’t located in the stomach. Rather than a growling belly or a pang in your stomach, you feel your hunger as a craving you can’t get out of your head. You’re focused on specific textures, tastes, and smells.
Emotional hunger often leads to regret, guilt, or shame. When you eat to satisfy physical hunger, you’re unlikely to feel guilty or ashamed because you’re simply giving your body what it needs. If you feel guilty after you eat, it's likely because you know deep down that you’re not eating for nutritional reasons.
Identify your emotional eating triggers
What situations, places, or feelings make you reach for the comfort of food? Most emotional eating is linked to unpleasant feelings, but it can also be triggered by positive emotions, such as rewarding yourself for achieving a goal or celebrating a holiday or happy event. Common causes of emotional eating include:
Stress – Ever notice how stress makes you hungry? It’s not just in your mind. When stress is chronic, your body produces as it so often is in our chaotic, fast-paced world, it leads to high levels of the stress hormone, cortisol. Cortisol triggers cravings for salty, sweet, and fried foods—foods that give you a burst of energy and pleasure. The moreuncontrolled stress in your life, the more likely you are to turn to food for emotional relief.
Stuffing emotions – Eating can be a way to temporarily silence or “stuff down” uncomfortable emotions, including anger, fear, sadness, anxiety, loneliness, resentment, and shame. While you’re numbing yourself with food, you can avoid the difficult emotions you’d rather not feel.
Boredom or feelings of emptiness – Do you ever eat simply to give yourself something to do, to relieve boredom, or as a way to fill a void in your life? You feel unfulfilled and empty, and food is a way to occupy your mouth and your time. In the moment, it fills you up and distracts you from underlying feelings of purposelessness and dissatisfaction with your life.
Childhood habits – Think back to your childhood memories of food. Did your parents reward good behavior with ice cream, take you out for pizza when you got a good report card, or serve you sweets when you were feeling sad? These habits can often carry over into adulthood. Or your eating may be driven by nostalgia—for cherished memories of grilling burgers in the backyard with your dad or baking and eating cookies with your mom.
Social influences – Getting together with other people for a meal is a great way to relieve stress, but it can also lead to overeating. It’s easy to overindulge simply because the food is there or because everyone else is eating. You may also overeat in social situations out of nervousness. Or perhaps your family or circle of friends encourages you to overeat, and it’s easier to go along with the group.
Find other ways to feed your feelings
If you don’t know how to manage your emotions in a way that doesn’t involve food, you won’t be able to control your eating habits for very long. Diets so often fail because they offer logical nutritional advice which only works if you have conscious control over your eating habits. It doesn’t work when emotions hijack the process, demanding an immediate payoff with food. In order to stop emotional eating, you have to find other ways to fulfill yourself emotionally.
In order to stop emotional eating, you have to find other ways to fulfill yourself emotionally. It’s not enough to understand the cycle of emotional eating or even to understand your triggers, although that’s a huge first step. You need alternatives to food that you can turn to for emotional fulfillment.
Alternatives to emotional eating
If you’re depressed or lonely, call someone who always makes you feel better, play with your dog or cat, or look at a favorite photo or cherished memento.
If you’re anxious, expend your nervous energy by dancing to your favorite song, squeezing a stress ball, or taking a brisk walk.
If you’re exhausted, treat yourself with a hot cup of tea, take a bath, light some scented candles, or wrap yourself in a warm blanket.
If you’re bored, read a good book, watch a comedy show, explore the outdoors, or turn to an activity you enjoy (woodworking, playing the guitar, shooting hoops, scrapbooking, etc.).
What is mindful eating?

Mindful eating is a practice that develops your awareness of eating habits and allows you to pause between your triggers and your actions. Most emotional eaters feel powerless over their food cravings. When the urge to eat hits, you feel an almost unbearable tension that demands to be fed, right now. Because you’ve tried to resist in the past and failed, you believe that your willpower just isn’t up to snuff. But the truth is that you have more power over your cravings than you think.
Take 5 before you give in to a craving
Emotional eating tends to be automatic and virtually mindless. Before you even realize what you’re doing, you’ve reached for a tub of ice cream and polished off half of it. But if you can take a moment to pause and reflect when you’re hit with a craving, you give yourself the opportunity to make a different decision.
Can you put off eating for five minutes? Or just start with one minute. Don’t tell yourself you can’t give in to the craving; remember, the forbidden is extremely tempting. Just tell yourself to wait.
While you’re waiting, check in with yourself. How are you feeling? What’s going on emotionally? Even if you end up eating, you’ll have a better understanding of why you did it. This can help you set yourself up for a different response next time.
Learn to accept your feelings—even the bad ones
While it may seem that the core problem is that you’re powerless over food, emotional eating actually stems from feeling powerless over your emotions. You don’t feel capable of dealing with your feelings head on, so you avoid them with food.
Allowing yourself to feel uncomfortable emotions can be scary. You may fear that, like Pandora’s box, once you open the door you won’t be able to shut it. But the truth is that when we don’t obsess over or suppress our emotions, even the most painful and difficult feelings subside relatively quickly and lose their power to control our attention. To do this you need to become mindful and learn how to stay connected to your moment-to-moment emotional experience. This can enable you to rein in stress and repair emotional problems that often trigger emotional eating.
8 steps to mindful eating
This ancient practice can transform the way you think about food and set the stage for a lifetime of healthy eating.
Like most of us, you’ve probably eaten something in the past few hours. And, like many of us, you may not be able to recall everything you ate, let alone the sensation of eating it. Because we’re working, driving, reading, watching television, or fiddling with an electronic device, we’re not fully aware of what we’re eating.
By truly paying attention to the food you eat, you may indulge in foods like a cheeseburger and fries less often. In essence, mindful eating means being fully attentive to your food—as you buy, prepare, serve, and consume it. In the bookSavor: Mindful Eating, Mindful Life, Dr. Lillian Cheung and her co-author, Buddhist spiritual leader Thich Nhat Hanh, suggest several practices that can help you get there, including those listed below.
1. Begin with your shopping list. Consider the health value of every item you add to your list and stick to it to avoid impulse buying when you’re shopping. Fill most of your cart in the produce section and avoid the center aisles—which are heavy with processed foods—and the chips and candy at the check-out counter.
2. Come to the table with an appetite—but not when ravenously hungry. If you skip meals, you may be so eager to get anything in your stomach that your first priority is filling the void instead of enjoying your food.
3. Start with a small portion. It may be helpful to limit the size of your plate to nine inches or less.
4. Appreciate your food. Pause for a minute or two before you begin eating to contemplate everything and everyone it took to bring the meal to your table. Silently express your gratitude for the opportunity to enjoy delicious food and the companions you’re enjoying it with.
5. Bring all your senses to the meal. When you’re cooking, serving, and eating your food, be attentive to color, texture, aroma, and even the sounds different foods make as you prepare them. As you chew your food, try identifying all the ingredients, especially seasonings.
6. Take small bites. It’s easier to taste food completely when your mouth isn’t full. Put down your utensil between bites.
7. Chew thoroughly. Chew well until you can taste the essence of the food. (You may have to chew each mouthful 20 to 40 times, depending on the food.) You may be surprised at all the flavors that are released.
8. Eat slowly. If you follow the advice above, you won’t bolt your food down. Devote at least five minutes to mindful eating before you chat with your tablemates.

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Emotional Eating
Imagine you've had a fight with your best friend. It's a stupid fight, something you'll both get over. But right now you're upset. When you walk in the door, your mom asks what's wrong. How are you most likely to respond?
• Tell your mom what happened and have a long, comforting talk about it.
or
• Tell your mom, "Everything's fine" and head to the freezer for the ice cream.
But can that pint of Rocky Road really help you feel better — or just make you feel sickeningly full?
What Is Emotional Eating?
Emotional eating is when people use food as a way to deal with feelings instead of to satisfy hunger. We've all been there, finishing a whole bag of chips out of boredom or downing cookie after cookie while cramming for a big test. But when done a lot — especially without realizing it — emotional eating can affect weight, health, and overall well-being.

Not many of us make the connection between eating and our feelings. But understanding what drives emotional eating can help people take steps to change it.
One of the biggest myths about emotional eating is that it's prompted by negative feelings. Yes, people often turn to food when they're stressed out, lonely, sad, anxious, or bored. But emotional eating can be linked to positive feelings too, like the romance of sharing dessert on Valentine's Day or the celebration of a holiday feast.
Sometimes emotional eating is tied to major life events, like a death or a divorce. More often, though, it's the countless little daily stresses that cause someone to seek comfort or distraction in food.
Emotional eating patterns can be learned: A child who is given candy after a big achievement may grow up using candy as a reward for a job well done. A kid who is given cookies as a way to stop crying may learn to link cookies with comfort.
It's not easy to "unlearn" patterns of emotional eating. But it is possible. And it starts with an awareness of what's going on.
"Comfort" Foods
We all have our own comfort foods. Interestingly, they may vary according to moods and gender. One study found that happy people seem to want to eat things like pizza, while sad people prefer ice cream and cookies. Bored people crave salty, crunchy things, like chips. Researchers also found that guys seem to prefer hot, homemade comfort meals, like steaks and casseroles. Girls go for chocolate and ice cream.
This brings up a curious question: Does no one take comfort in carrots and celery sticks? Researchers are looking into that, too. What they're finding is that high-fat foods, like ice cream, may activate certain chemicals in the body that create a sense of contentment and fulfillment. This almost addictive quality may actually make you reach for these foods again when feeling upset.
Physical Hunger vs. Emotional Hunger
We're all emotional eaters to some extent (who hasn't suddenly found room for dessert after a filling dinner?). But for some people, emotional eating can be a real problem, causing serious weight gain or cycles of binging and purging.
The trouble with emotional eating (aside from the health issues) is that once the pleasure of eating is gone, the feelings that cause it remain. And you often may feel worse about eating the amount or type of food you did. That's why it helps to know the differences between physical hunger and emotional hunger.
Next time you reach for a snack, check in and see which type of hunger is driving it.

Questions to Ask Yourself
You can also ask yourself these questions about your eating:
• Have I been eating larger portions than usual?
• Do I eat at unusual times?
• Do I feel a loss of control around food?
• Am I anxious over something, like school, a social situation, or an event where my abilities might be tested?
• Has there been a big event in my life that I'm having trouble dealing with?
• Am I overweight, or has there recently been a big jump in my weight?
• Do other people in my family use food to soothe their feelings too?
If you answered yes to many of these questions, then it's possible that eating has become a coping mechanism instead of a way to fuel your body.
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Breaking the Cycle
Managing emotional eating means finding other ways to deal with the situations and feelings that make someone turn to food.
For example, do you come home from school each day and automatically head to the kitchen? Stop and ask yourself, "Am I really hungry?" Is your stomach growling? Are you having difficulty concentrating or feeling irritable? If these signs point to hunger, choose something light and healthy to take the edge off until dinner.
Not really hungry? If the post-school food foraging has just become part of your routine, think about why.
Tips to Try
These three techniques can help:
1. Explore why you're eating and find a replacement activity.
For example:
• If you're bored or lonely, call or text a friend or family member.
• If you're stressed out, try a yoga routine. Or listen to some feel-good tunes and let off some steam by jogging in place, doing jumping jacks, or dancing around your room until the urge to eat passes.
• If you're tired, rethink your bedtime routine. Tiredness can feel a lot like hunger, and food won't help if sleepless nights are causing daytime fatigue.
• If you're eating to procrastinate, open those books and get that homework over with. You'll feel better afterwards (honestly!).
2. Write down the emotions that trigger your eating. One of the best ways to keep track is with a mood and food journal. Write down what you ate, how much, and how you felt as you ate (e.g., bored, happy, worried, sad, mad) and whether you were really hungry or just eating for comfort.
http://kidshealth.org/en/teens/food-journal.html
Through journaling, you'll start to see patterns emerging between what you feel and what you eat. You'll be able to use this information to make better choices (like choosing to clear your head with a walk around the block instead of a bag of Doritos).
3. Pause and "take 5" before you reach for food. Too often, we rush through the day without really checking in with ourselves. We're so stressed, overscheduled, and plugged-in that we lose out on time to reflect.
Instead of eating when you get in the door, take a few minutes to transition from one part of your day to another. Go over the things that happened that day. Acknowledge how they made you feel: Happy? Grateful? Excited? Angry? Worried? Jealous? Left out?
Getting Help
Even when we understand what's going on, many of us still need help breaking the cycle of emotional eating. It's not easy — especially when emotional eating has already led to weight and self-esteem issues. So don't go it alone when you don't have to.
Take advantage of expert help. Counselors and therapists can help you deal with your feelings. Nutritionists can help you identify your eating patterns and get you on track with a better diet. Fitness experts can get your body's feel-good chemicals firing through exercise instead of food.
If you're worried about your eating, talk to your doctor. He or she can make sure you reach your weight-loss goals safely and put you in touch with professionals who can put you on a path to a new, healthier relationship with food.

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Sometimes the strongest food cravings hit when you're at your weakest point emotionally. You may turn to food for comfort — consciously or unconsciously — when facing a difficult problem, feeling stressed or even feeling bored.
Emotional eating can sabotage your weight-loss efforts. It often leads to eating too much, especially too much of high-calorie, sweet and fatty foods. The good news is that if you're prone to emotional eating, you can take steps to regain control of your eating habits and get back on track with your weight-loss goals.
Emotional eating is eating as a way to suppress or soothe negative emotions, such as stress, anger, fear, boredom, sadness and loneliness. Major life events or, more commonly, the hassles of daily life can trigger negative emotions that lead to emotional eating and disrupt your weight-loss efforts. These triggers might include:
• Relationship conflicts
• Work stress
• Fatigue
• Financial pressures
• Health problems
Although some people eat less in the face of strong emotions, if you're in emotional distress you might turn to impulsive or binge eating, quickly consuming whatever's convenient without enjoyment.
In fact, your emotions can become so tied to your eating habits that you automatically reach for a treat whenever you're angry or stressed without thinking about what you're doing.
Food also serves as a distraction. If you're worried about an upcoming event or stewing over a conflict, for instance, you may focus on eating comfort food instead of dealing with the painful situation.
Whatever emotions drive you to overeat, the end result is often the same. The emotions return, and you likely then bear the additional burden of guilt about setting back your weight-loss goal. This can also lead to an unhealthy cycle — your emotions trigger you to overeat, you beat yourself up for getting off your weight-loss track, you feel bad and you overeat again.
When negative emotions threaten to trigger emotional eating, you can take steps to control cravings. To help stop emotional eating, try these tips:
• Keep a food diary. Write down what you eat, how much you eat, when you eat, how you're feeling when you eat and how hungry you are. Over time, you might see patterns that reveal the connection between mood and food.
• Tame your stress. If stress contributes to your emotional eating, try a stress management technique, such as yoga, meditation or deep breathing.
• Have a hunger reality check. Is your hunger physical or emotional? If you ate just a few hours ago and don't have a rumbling stomach, you're probably not hungry. Give the craving a time to pass.
• Get support. You're more likely to give in to emotional eating if you lack a good support network. Lean on family and friends or consider joining a support group.
• Fight boredom. Instead of snacking when you're not hungry, distract yourself and substitute a healthier behavior. Take a walk, watch a movie, play with your cat, listen to music, read, surf the Internet or call a friend.
• Take away temptation. Don't keep hard-to-resist comfort foods in your home. And if you feel angry or blue, postpone your trip to the grocery store until you have your emotions in check.
• Don't deprive yourself. When trying to lose weight, you might limit calories too much, eat the same foods repeatedly and banish treats. This may just serve to increase your food cravings, especially in response to emotions. Eat satisfying amounts of healthier foods, enjoy an occasional treat, and get plenty of variety to help curb cravings.
• Snack healthy. If you feel the urge to eat between meals, choose a low-fat, low-calorie snack, such as fresh fruit, vegetables with low-fat dip or unbuttered popcorn. Or try low-fat, lower calorie versions of your favorite foods to see if they satisfy your craving.
• Learn from setbacks. If you have an episode of emotional eating, forgive yourself and start fresh the next day. Try to learn from the experience and make a plan for how you can prevent it in the future. Focus on the positive changes you're making in your eating habits and give yourself credit for making changes that'll lead to better health.
If you've tried self-help options but you still can't control emotional eating, consider therapy with a mental health professional. Therapy can help you understand why you eat emotionally and learn coping skills. Therapy can also help you discover whether you have an eating disorder, which can be connected to emotional eating.

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Stress Management
Using Self-Help Techniques for Dealing with Stress

It may seem like there’s nothing you can do about stress. The bills won’t stop coming, there will never be more hours in the day, and your work and family responsibilities will always be demanding. But you have a lot more control than you might think. In fact, the simple realization that you’re in control of your life is the foundation of managing stress. Stress management is all about taking charge: of your lifestyle, thoughts, emotions, and the way you deal with problems. No matter how stressful your life seems, there are steps you can take to relieve the pressure and regain control.
Why is it so important to manage stress?
If you’re living with high levels of stress, you’re putting your entire well-being at risk. Stress wreaks havoc on your emotional equilibrium, as well as your physical health. It narrows your ability to think clearly, function effectively, and enjoy life.
Effective stress management, on the other hand, helps you break the hold stress has on your life, so you can be happier, healthier, and more productive. The ultimate goal is a balanced life, with time for work, relationships, relaxation, and fun—and the resilience to hold up under pressure and meet challenges head on. But stress management is not one-size-fits-all. That’s why it’s important to experiment and find out what works best for you. The following stress management tips can help you do that.
Tip 1: Identify the sources of stress in your life
Stress management starts with identifying the sources of stress in your life. This isn’t as straightforward as it sounds. While it’s easy to identify major stressors such as changing jobs, moving, or a going through a divorce, pinpointing the sources of chronic stress can be more complicated. It’s all too easy to overlook how your own thoughts, feelings, and behaviors contribute to your everyday stress levels. Sure, you may know that you’re constantly worried about work deadlines, but maybe it’s your procrastination, rather than the actual job demands, that is causing the stress.
To identify your true sources of stress, look closely at your habits, attitude, and excuses:
• Do you explain away stress as temporary (“I just have a million things going on right now”) even though you can’t remember the last time you took a breather?
• Do you define stress as an integral part of your work or home life (“Things are always crazy around here”) or as a part of your personality (“I have a lot of nervous energy, that’s all”)?
• Do you blame your stress on other people or outside events, or view it as entirely normal and unexceptional?
Until you accept responsibility for the role you play in creating or maintaining it, your stress level will remain outside your control.
Start a stress journal
A stress journal can help you identify the regular stressors in your life and the way you deal with them. Each time you feel stressed, keep track of it in your journal. As you keep a daily log, you will begin to see patterns and common themes. Write down:
• What caused your stress (make a guess if you’re unsure)
• How you felt, both physically and emotionally
• How you acted in response
• What you did to make yourself feel better
Tip 2: Replace unhealthy coping strategies with healthy ones
Think about the ways you currently manage and cope with stress in your life. Your stress journal can help you identify them. Are your coping strategies healthy or unhealthy, helpful or unproductive? Unfortunately, many people cope with stress in ways that compound the problem.
Unhealthy ways of coping with stress
• Smoking
• Using pills or drugs to relax
• Drinking too much
• Withdrawing from friends, family, and activities
• Bingeing on junk or comfort food
• Procrastinating
• Zoning out for hours looking at your phone
• Filling up every minute of the day to avoid facing problems
• Sleeping too much
• Taking out your stress on others
If your methods of coping with stress aren’t contributing to your greater emotional and physical health, it’s time to find healthier ones. No single method works for everyone or in every situation, so experiment with different techniques and strategies. Focus on what makes you feel calm and in control.
Tip 3: Practice the 4 A's of stress management
While stress is an automatic response from your nervous system, some stressors arise at predictable times—your commute to work, a meeting with your boss, or family gatherings, for example. When handling such predictable stressors, you can either change the situation or change your reaction. When deciding which option to choose in any given scenario, it’s helpful to think of the four A's: avoid, alter, adapt, or accept.
The four A's - Avoid, Alter, Adapt & Accept
Avoid unnecessary stress
It’s not healthy to avoid a stressful situation that needs to be addressed, but you may be surprised by the number of stressors in your life that you can eliminate.
Learn how to say "no." Know your limits and stick to them. Whether in your personal or professional life, taking on more than you can handle is a surefire recipe for stress. Distinguish between the "shoulds" and the "musts" and, when possible, say "no" to taking on too much.
Avoid people who stress you out. If someone consistently causes stress in your life, limit the amount of time you spend with that person, or end the relationship.
Take control of your environment. If the evening news makes you anxious, turn off the TV. If traffic makes you tense, take a longer but less-traveled route. If going to the market is an unpleasant chore do your grocery shopping online.
Pare down your to-do list. Analyze your schedule, responsibilities, and daily tasks. If you’ve got too much on your plate, drop tasks that aren’t truly necessary to the bottom of the list or eliminate them entirely.
Alter the situation
If you can't avoid a stressful situation, try to alter it. Often, this involves changing the way you communicate and operate in your daily life.
Express your feelings instead of bottling them up. If something or someone is bothering you, be more assertive and communicate your concerns in an open and respectful way. If you've got an exam to study for and your chatty roommate just got home, say up front that you only have five minutes to talk. If you don't voice your feelings, resentment will build and the stress will increase.
Be willing to compromise. When you ask someone to change their behavior, be willing to do the same. If you both are willing to bend at least a little, you'll have a good chance of finding a happy middle ground.
Create a balanced schedule. All work and no play is a recipe for burnout. Try to find a balance between work and family life, social activities and solitary pursuits, daily responsibilities and downtime.
Adapt to the stressor
If you can't change the stressor, change yourself. You can adapt to stressful situations and regain you sense of control by changing your expectations and attitude.
Reframe problems. Try to view stressful situations from a more positive perspective. Rather than fuming about a traffic jam, look at it as an opportunity to pause and regroup, listen to your favorite radio station, or enjoy some alone time.
Look at the big picture. Take perspective of the stressful situation. Ask yourself how important it will be in the long run. Will it matter in a month? A year? Is it really worth getting upset over? If the answer is no, focus your time and energy elsewhere.
Adjust your standards. Perfectionism is a major source of avoidable stress. Stop setting yourself up for failure by demanding perfection. Set reasonable standards for yourself and others, and learn to be okay with “good enough.”
Practice gratitude. When stress is getting you down, take a moment to reflect on all the things you appreciate in your life, including your own positive qualities and gifts. This simple strategy can help you keep things in perspective.
Accept the things you can't change
Some sources of stress are unavoidable. You can’t prevent or change stressors such as the death of a loved one, a serious illness, or a national recession. In such cases, the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation you can’t change.
Don't try to control the uncontrollable. Many things in life are beyond our control—particularly the behavior of other people. Rather than stressing out over them, focus on the things you can control such as the way you choose to react to problems.
Look for the upside. When facing major challenges, try to look at them as opportunities for personal growth. If your own poor choices contributed to a stressful situation, reflect on them and learn from your mistakes.
Learn to forgive. Accept the fact that we live in an imperfect world and that people make mistakes. Let go of anger and resentments. Free yourself from negative energy by forgiving and moving on.
Share your feelings. Expressing what you’re going through can be very cathartic, even if there’s nothing you can do to alter the stressful situation. Talk to a trusted friend or make an appointment with a therapist.
Tip 4: Get moving
When you’re stressed, the last thing you probably feel like doing is getting up and exercising. But physical activity is a huge stress reliever—and you don’t have to be an athlete or spend hours in a gym to experience the benefits. Exercise releases endorphins that make you feel good, and it can also serve as a valuable distraction from your daily worries.
While you’ll get the most benefit from regularly exercising for 30 minutes or more, it’s okay to build up your fitness level gradually. Even very small activities can add up over the course of a day. The first step is to get yourself up and moving. Here are some easy ways to incorporate exercise into your daily schedule:
• Put on some music and dance around
• Take your dog for a walk
• Walk or cycle to the grocery store
• Use the stairs at home or work rather than an elevator
• Park your car in the farthest spot in the lot and walk the rest of the way
• Pair up with an exercise partner and encourage each other as you work out
• Play ping-pong or an activity-based video game with your kids
The stress-busting magic of mindful rhythmic exercise
While just about any form of physical activity can help burn away tension and stress, rhythmic activities are especially effective. Good choices include walking, running, swimming, dancing, cycling, tai chi, and aerobics. But whatever you choose, make sure it’s something you enjoy so you’re more likely to stick with it.
While you’re exercising, make a conscious effort to pay attention to your body and the physical (and sometimes emotional) sensations you experience as you’re moving. Focus on coordinating your breathing with your movements, for example, or notice how the air or sunlight feels on your skin. Adding this mindfulness element will help you break out of the cycle of negative thoughts that often accompanies overwhelming stress.
Tip 5: Connect to others
There is nothing more calming than spending quality time with another human being who makes you feel safe and understood. In fact, face-to-face interaction triggers a cascade of hormones that counteracts the body’s defensive “fight-or-flight” response. It’s nature’s natural stress reliever (as an added bonus, it also helps stave off depression and anxiety). So make it a point to connect regularly—and in person—with family and friends.
Keep in mind that the people you talk to don’t have to be able to fix your stress. They simply need to be good listeners. And try not to let worries about looking weak or being a burden keep you from opening up. The people who care about you will be flattered by your trust. It will only strengthen your bond.
Of course, it’s not always realistic to have a pal close by to lean on when you feel overwhelmed by stress, but by building and maintaining a network of close friends you can improve your resiliency to life’s stressors.
Tips for building relationships
1. Reach out to a colleague at work
2. Help someone else by volunteering
3. Have lunch or coffee with a friend
4. Ask a loved one to check in with you regularly
5. Accompany someone to the movies or a concert
6. Call or email an old friend
7. Go for a walk with a workout buddy
8. Schedule a weekly dinner date
9. Meet new people by taking a class or joining a club
10. Confide in a clergy member, teacher, or sports coach
Tip 6: Make time for fun and relaxation

Beyond a take-charge approach and a positive attitude, you can reduce stress in your life by carving out “me” time. Don’t get so caught up in the hustle and bustle of life that you forget to take care of your own needs. Nurturing yourself is a necessity, not a luxury. If you regularly make time for fun and relaxation, you’ll be in a better place to handle life’s stressors.
Set aside leisure time. Include rest and relaxation in your daily schedule. Don’t allow other obligations to encroach. This is your time to take a break from all responsibilities and recharge your batteries.
Do something you enjoy every day. Make time for leisure activities that bring you joy, whether it be stargazing, playing the piano, or working on your bike.
Keep your sense of humor. This includes the ability to laugh at yourself. The act of laughing helps your body fight stress in a number of ways.
Consider taking up a relaxation practice
Relaxation techniques such as yoga, meditation, and deep breathing activate the body’s relaxation response, a state of restfulness that is the opposite of the fight or flight or mobilization stress response. As you learn and practice these techniques, your stress levels will decrease and your mind and body will become calm and centered.
Develop a "stress relief toolbox"
Come up with a list of healthy ways to relax and recharge. Try to implement one or more of these ideas each day, even if you're feeling good.
• Go for a walk
• Spend time in nature
• Call a good friend
• Sweat out tension with a workout
• Write in your journal
• Take a long bath
• Light scented candles • Savor a warm cup of coffee or tea
• Play with a pet
• Work in your garden
• Get a massage
• Curl up with a good book
• Listen to music
• Watch a comedy
Tip 7: Manage your time better
Poor time management can cause a lot of stress. When you’re stretched too thin and running behind, it’s hard to stay calm and focused. Plus, you’ll be tempted to avoid or cut back on all the healthy things you should be doing to keep stress in check, like socializing and getting enough sleep. The good news: there are things you can do to achieve a healthier work-life balance.
Don't over-commit yourself. Avoid scheduling things back-to-back or trying to fit too much into one day. All too often, we underestimate how long things will take.
Prioritize tasks. Make a list of tasks you have to do, and tackle them in order of importance. Do the high-priority items first. If you have something particularly unpleasant or stressful to do, get it over with early. The rest of your day will be more pleasant as a result.
Break projects into small steps. If a large project seems overwhelming, make a step-by-step plan. Focus on one manageable step at a time, rather than taking on everything at once.
Delegate responsibility. You don’t have to do it all yourself, whether at home, school, or on the job. If other people can take care of the task, why not let them? Let go of the desire to control or oversee every little step. You’ll be letting go of unnecessary stress in the process.
Tip 8: Maintain balance with a healthy lifestyle
In addition to regular exercise, there are other healthy lifestyle choices that can increase your resistance to stress.
Eat a healthy diet. Well-nourished bodies are better prepared to cope with stress, so be mindful of what you eat. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day.
Reduce caffeine and sugar. The temporary "highs" caffeine and sugar provide often end in with a crash in mood and energy. By reducing the amount of coffee, soft drinks, chocolate, and sugar snacks in your diet, you’ll feel more relaxed and you’ll sleep better.
Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or drugs may provide an easy escape from stress, but the relief is only temporary. Don’t avoid or mask the issue at hand; deal with problems head on and with a clear mind.
Get enough sleep. Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.

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Stress Symptoms, Signs, and Causes
Improving Your Ability to Handle Stress

Stress isn’t always bad. In small doses, it can help you perform under pressure and motivate you to do your best. But when you’re constantly running in emergency mode, your mind and body pay the price. If you frequently find yourself feeling frazzled and overwhelmed, it’s time to take action to bring your nervous system back into balance. You can protect yourself — and improve how you think and feel — by learning how to recognize the signs and symptoms of chronic stress and taking steps to reduce its harmful effects.
What is stress?
Stress is your body’s way of responding to any kind of demand or threat. When you sense danger—whether it’s real or imagined—the body's defenses kick into high gear in a rapid, automatic process known as the “fight-or-flight” reaction or the "stress response".
The stress response is the body’s way of protecting you. When working properly, it helps you stay focused, energetic, and alert. In emergency situations, stress can save your life—giving you extra strength to defend yourself, for example, or spurring you to slam on the brakes to avoid an accident.
Stress can also help you rise to meet challenges. It’s what keeps you on your toes during a presentation at work, sharpens your concentration when you’re attempting the game-winning free throw, or drives you to study for an exam when you'd rather be watching TV. But beyond a certain point, stress stops being helpful and starts causing major damage to your health, your mood, your productivity, your relationships, and your quality of life.
Fight-or-flight response: what happens in the body

When you feel threatened, your nervous system responds by releasing a flood of stress hormones, including adrenaline and cortisol, which rouse the body for emergency action. Your heart pounds faster, muscles tighten, blood pressure rises, breath quickens, and your senses become sharper. These physical changes increase your strength and stamina, speed your reaction time, and enhance your focus—preparing you to either fight or flee from the danger at hand.
The effects of chronic stress
Your nervous system isn’t very good at distinguishing between emotional and physical threats. If you’re super stressed over an argument with a friend, a work deadline, or a mountain of bills, your body can react just as strongly as if you’re facing a true life-or-death situation. And the more your emergency stress system is activated, the easier it becomes to trigger and the harder it becomes to shut off.
If you tend to get stressed out frequently—as many of us do in today’s demanding world—your body many be in a heightened state of stress most of the time. And that can lead to serious health problems. Chronic stress disrupts nearly every system in your body. It can suppress your immune system, upset your digestive and reproductive systems, increase the risk of heart attack and stroke, and speed up the aging process. It can even rewire the brain, leaving you more vulnerable to anxiety, depression, and other mental health problems.
Health problems caused or exacerbated by stress include:
1. Depression and anxiety
2. Pain of any kind
3. Sleep problems
4. Autoimmune diseases
5. Digestive problems
6. Skin conditions, such as eczema
7. Heart disease
8. Weight problems
9. Reproductive issues
10. Thinking and memory problems
Signs and symptoms of stress overload
The most dangerous thing about stress is how easily it can creep up on you. You get used to it. It starts to feel familiar — even normal. You don’t notice how much it’s affecting you, even as it takes a heavy toll. That’s why it’s important to be aware of the common warning signs and symptoms of stress overload.
Cognitive symptoms
• Memory problems
• Inability to concentrate
• Poor judgment
• Seeing only the negative
• Anxious or racing thoughts
• Constant worrying
Emotional symptoms
• Depression or general unhappiness
• Anxiety and agitation
• Moodiness, irritability, or anger
• Feeling overwhelmed
• Loneliness and isolation
• Other mental or emotional health problems
Physical symptoms
• Aches and pains
• Diarrhea or constipation
• Nausea, dizziness
• Chest pain, rapid heart rate
• Loss of sex drive
• Frequent colds or flu
Behavioral symptoms
• Eating more or less
• Sleeping too much or too little
• Withdrawing from others
• Procrastinating or neglecting responsibilities
• Using alcohol, cigarettes, or drugs to relax
• Nervous habits (e.g. nail biting, pacing)
Causes of stress
The situations and pressures that cause stress are known as stressors. We usually think of stressors as being negative, such as an exhausting work schedule or a rocky relationship. However, anything that puts high demands on you can be stressful. This includes positive events such as getting married, buying a house, going to college, or receiving a promotion.
Of course, not all stress is caused by external factors. Stress can also be internal or self-generated, when you worry excessively about something that may or may not happen, or have irrational, pessimistic thoughts about life.
Finally, what causes stress depends, at least in part, on your perception of it. Something that's stressful to you may not faze someone else; they may even enjoy it. For example, your morning commute may make you anxious and tense because you worry that traffic will make you late. Others, however, may find the trip relaxing because they allow more than enough time and enjoy listening to music while they drive.
Common external causes of stress
• Major life changes
• Work or school
• Relationship difficulties
• Financial problems
• Being too busy
• Children and family
Common internal causes of stress
• Pessimism
• Inability to accept uncertainty
• Rigid thinking, lack of flexibility
• Negative self-talk
• Unrealistic expectations / perfectionism
• All-or-nothing attitude
Top 10 stressful life events
According to the widely validated Holmes and Rahe Stress Scale, these are the top ten stressful life events for adults that can contribute to illness:
1. Death of a spouse
2. Divorce
3. Marriage separation
4. Imprisonment
5. Death of a close family member
6. Injury or illness
7. Marriage
8. Job loss
9. Marriage reconciliation
10. Retirement
How much stress is too much?
Because of the widespread damage stress can cause, it’s important to know your own limit. But just how much stress is “too much” differs from person to person. Some people seem to be able to roll with life’s punches, while others tend to crumble in the face of small obstacles or frustrations. Some people even thrive on the excitement of a high-stress lifestyle.
Things that influence your stress tolerance level
Your support network - A strong network of supportive friends and family members is an enormous buffer against stress. When you have people you can count on, life’s pressures don’t seem as overwhelming. On the flip side, the lonelier and more isolated you are, the greater your risk of succumbing to stress.
Your sense of control - If you have confidence in yourself and your ability to influence events and persevere through challenges, it’s easier to take stress in stride. On the other hand, if you believe that you have little control over your life—that you’re at the mercy of your environment and circumstances, with limited ability to make changes—stress is more likely to knock you off course.
Your attitude and outlook - The way you look at life and its inevitable challenges makes a huge difference in your ability to handle stress. If you’re generally hopeful and optimistic, you’ll be less vulnerable. Stress-hardy people tend to embrace challenges, have a stronger sense of humor, believe in a higher purpose, and accept change as an inevitable part of life.
Your ability to deal with your emotions - If you don’t know how to calm and soothe yourself when you’re feeling sad, angry, or troubled, you’re more likely to become stressed and agitated. Having the ability to identify and deal appropriately with your emotions can increase your tolerance to stress and help you bounce back from adversity.
Your knowledge and preparation - The more you know about a stressful situation—including how long it will last and what to expect—the easier it is to cope. For example, if you go into surgery with a realistic picture of what to expect post-op, a painful recovery will be less stressful than if you were expecting to bounce back immediately.
What's stressful for you?
Karen is terrified of getting up in front of people to perform or speak, while her best friend, Nina, lives for the spotlight.
Phil thrives under pressure and performs best when he has a tight deadline, while his coworker, Matt, shuts down when work demands escalate.
Anita enjoys helping her elderly parents. Her sister, Constance, helps out as well but find the demands of caretaking very stressful.
Improving your ability to handle stress
Get moving

Upping your activity level is something you can do right now to help relieve stress and start to feel better. Regular exercise can lift your mood and serve as a distraction from worries, allowing you to break out of the cycle of negative thoughts that feed stress. Rhythmic exercises such as walking, running, swimming, and dancing are particularly effective, especially if you exercise mindfully (focusing your attention on the physical sensations you experience as you move
Connect to others

The simple act of talking face-to-face with another human can trigger hormones that relieve stress when you're feeling agitated or insecure. Even just a brief exchange of kind words or a friendly look from another human being can help calm and soothe your nervous system. So spend time with people who make you feel good and don’t let your responsibilities keep you from having a social life. If you don’t have any close relationships, or your relationships are the source of your stress, make it a priority to build stronger and more satisfying connections
Engage your senses

Another fast way to relieve stress is by engaging one or more of your senses—sight, sound, taste, smell, touch, or movement. The key is to find the sensory input that works for you. Does listening to an uplifting song make you feel calm? Or smelling ground coffee? Or maybe petting an animal works quickly to make you feel centered? Everyone responds to sensory input a little differently, so experiment to find what works best for you. Read:
Learn how to relax

You can’t completely eliminate stress from your life, but you can control how much it affects you. Relaxation techniques such as yoga, meditation, and deep breathing activate the body’s relaxation response, a state of restfulness that is the polar opposite of the stress response. When practiced regularly, these activities can reduce your everyday stress levels and boost feelings of joy and serenity. They also increase your ability to stay calm and collected under pressure.

Eat a healthy diet

The food you eat can improve or worsen your mood and affect your ability to cope with life’s stressors. Eating a diet full of processed and convenience food, refined carbohydrates, and sugary snacks can worsen symptoms of stress while eating a diet rich in fresh fruit and vegetables, high-quality protein, and omega-3 fatty acids, can help you better cope with life’s ups and downs.
Get your rest

Feeling tired can increase stress by causing you to think irrationally. At the same time, chronic stress can disrupt your sleep. Whether you’re having trouble falling asleep or staying asleep at night, there are plenty of ways to improve your sleep so you feel less stressed and more productive and emotionally balanced.

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• Nearly everyone experiences stress at some time. Stress produces changes in many body systems; examples include increased heart rate and blood pressure and altered immune function.
• Some amount of stress is healthy, but excessive stress, left untreated, can lead to anxiety and illness.
• In the American Psychological Association's Stress in America Survey, major causes of stress listed included work, money, and the economy. Stress-related unhealthy habits were also reported, with many Americans noting they were overeating or eating unhealthy foods due to stress.
• Several strategies have been shown to help reduce stress, such as exercise, practicing mindfulness-based stress reduction (meditation and yoga), and engaging in a cognitive behavioral therapy program.
• Cognitive-behavioral therapy (CBT) has been shown to help reduce the stress associated with many chronic medical conditions, including back pain, arthritis, and tinnitus (buzzing in the ears).
• Research suggests that the risk of long-term disability from low back pain can be reduced through early intervention for depression and stress.
• Given today's technological advances, several pilot projects are underway to assess the effects of "virtual healing" using devices such as video game simulators that might augment traditional stress management therapies.
Introduction
Stress affects most people in some way. Acute (sudden or short-term) stress leads to rapid changes throughout the body. Almost all body systems (the heart and blood vessels, immune system, lungs, digestive system, sensory organs, and brain) gear up to meet perceived danger.
These stress responses could prove beneficial in a critical, life-or-death situation. Over time, however, repeated stressful situations put a strain on the body that may contribute to physical and psychological problems. Chronic (long-term) stress can have real health consequences and should be addressed like any other health concern.
Fortunately, research is showing that lifestyle changes and stress-reduction techniques can help people manage stress.
External and Internal Stressors
People can experience stress from external or internal factors.
• External stressors include adverse physical stimulus (such as pain or hot or cold temperatures) or stressful psychological environments (such as poor working conditions or abusive relationships).
• Internal stressors can also be physical (infections and other illnesses, inflammation) or psychological (such as intense worry about an event that may or may not occur). As far as anyone can tell, internal psychological stressors are rare or absent in most animals except humans.
Acute or Chronic Stress
Stressors can also be defined as short-term (acute) or long-term (chronic).
Acute Stress. Acute stress is the reaction to an immediate threat, commonly known as thefight or flight response. The threat can be any situation that is perceived, even subconsciously or falsely, as a danger.
Common acute stressors include:
• Noise (which can trigger a stress response even during sleep)
• Crowding
• Isolation
• Hunger
• Danger
• Infection
• High technology effects (such as playing video games or frequently ringing mobile phones)
• Imagining a threat or remembering a dangerous event
Under most circumstances, once the acute threat has passed, levels of stress hormones return to normal. This is called the relaxation response.
Chronic Stress. Frequently, modern life exposes people to long-term stressful situations. Stress, then, becomes chronic. The urge to act (to fight or flee) must therefore be controlled.
Common chronic stressors include:
• Ongoing work pressure
• Long-term relationship problems
• Loneliness
• Persistent financial worries
Stress in America Survey
The American Psychological Association conducted its most recent Stress in America Survey in 2011. Representative samples of 1,226 adults in the general population, 1,221 adults living with chronic illnesses, and 300 adult caregivers. The survey found that Americans are experiencing somewhat less stress than 5 years earlier, but many individuals perceive their stress levels as having increased over the same time period. People are also engaging in unhealthy habits due to stress. Although many people understand the benefits of stress reduction, they are not taking advantage of strategies, such as exercise.
Specific results include:
• Most Americans report feeling moderate-to-high stress levels.
• 44% of adults report that their stress level has increased in the past 5 years.
• Money, work (concerns about job loss), and the economy are major sources of stress.
• 39% of adults report overeating or eating unhealthy foods due to stress.
• More than half of Americans acknowledge that exercise is important, but only a third were satisfied with their level of exercise.

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The Body's Response
The best way to envision the effect of acute stress is to imagine yourself in a primitive situation, such as being chased by a bear.
The Brain's Response to Acute Stress
In response to seeing the bear, a part of the brain called the hypothalamic-pituitary-adrenal(HPA) system is activated.
Release of Steroid Hormones and the Stress Hormone Cortisol. The HPA systems trigger the production and release of steroid hormones (glucocorticoids), including the primary stress hormone cortisol. Cortisol is very important in organizing systems throughout the body (including the heart, lungs, circulation, metabolism, immune systems, and skin) to deal quickly with the bear.
Release of Catecholamines. The HPA system also releases certain neurotransmitters (chemical messengers) called catecholamines, particularly those known as dopamine,norepinephrine, and epinephrine (also called adrenaline).
Catecholamines activate an area inside the brain called the amygdala, which appears to trigger an emotional response to a stressful event. In the case of the bear, this emotion is most likely fear.
Release of Neuropeptide S. The brain releases neuropeptide S, a small protein that modulates stress by decreasing sleep and increasing alertness and a sense of anxiety. This gives the person a sense of urgency to run away from the bear.
Effects on Long- and Short-Term Memory. During the stressful event, catecholamines also suppress activity in areas at the front of the brain concerned with short-term memory, concentration, inhibition, and rational thought. This sequence of mental events allows a person to react quickly, either to fight the bear or to flee from it. It also interferes with the ability to handle difficult social or intellectual tasks and behaviors during that time.
At the same time, neurotransmitters signal the hippocampus (a nearby area in the brain) to store the emotionally loaded experience in long-term memory. In primitive times, this brain action would have been essential for survival, because long-lasting memories of dangerous stimuli (such as the large bear) would be critical for avoiding such threats in the future.
Research also finds that during times of stress, nerve cells in the brain interpret chemical signals incorrectly. Instead of switching "off," these nerve cells perceive the signals as telling them to switch "on." It's as though the brain's "brakes" fail in response to stress.
Response by the Heart, Lungs, and Circulation to Acute Stress
The stress response also affects the heart, lungs, and circulation:
• As the bear comes closer, the heart rate and blood pressure increase instantaneously.
• Breathing becomes rapid, and the lungs take in more oxygen.
• The spleen discharges red and white blood cells, allowing the blood to transport more oxygen throughout the body. Blood flow may actually increase 300 to 400%, priming the muscles, lungs, and brain for added demands.
The Immune System's Response to Acute Stress
The effect of the confrontation with the bear on the immune system is similar to mobilizing a defensive line of soldiers to potentially critical areas. The steroid hormones reduce activity in parts of the immune system, so that specific infection fighters (including important white blood cells) or other immune molecules can be repositioned. These immune-boosting troops are sent to the body's front lines where injury or infection is most likely to occur, such as the skin and the lymph nodes.
The Acute Response in the Mouth and Throat
As the bear gets closer, fluids are diverted from nonessential locations, including the mouth. This causes dryness and difficulty talking. In addition, stress can cause spasms of the throat muscles, making it difficult to swallow.
The Skin's Response to Acute Stress
The stress effect moves blood flow away from the skin to support the heart and muscle tissues. This also reduces blood loss in the event that the bear causes a wound. The physical effect is cool, clammy, sweaty skin. The scalp also tightens so that the hair seems to stand up.
Metabolic Response to Acute Stress
Stress reduces digestive activity, a body function that is not essential during short-term periods of hard physical work or crisis.
The Relaxation Response: the Resolution of Acute Stress
Once the threat has passed and the effect has not been harmful (for example, the bear has not wounded the human), the stress hormones return to normal. This is known as therelaxation response. In turn, the body's systems also return to normal.
Risk Factors for Stress
At some point in their lives, virtually everyone will experience stressful events or situations that overwhelm their natural coping mechanisms. In one poll, 89% of respondents indicated that they had experienced serious stress in their lives. Some people are simply biologically prone to stress. Many outside factors influence susceptibility as well.
Conditions Most Likely To Produce Stress-Related Health Problems. Conditions that are most likely to be associated with stress and negative physical effects include the following:
• An accumulation of persistent stressful situations, particularly those that a person cannot easily control (for example, a high-pressure job plus an unhappy relationship)
• Persistent stress after a severe acute response to a traumatic event (such as an automobile accident)
• Acute stress accompanying a serious illness, such as heart disease
Factors That Influence the Response to Stress. People respond to stress differently, depending on different factors:
• Early nurturing: People who were abused in childhood may have long-term abnormalities in the hypothalamus-pituitary system, which regulates stress.
• Personality traits: Certain people have personality traits that cause them to over-respond to stressful events. For example, those who are neurotic may get stressed more easily and turn to dangerous behaviors such as smoking and heavy drinking as a result. Being more outgoing and aware of the world may improve a person's response to stress by lowering levels of stress-related inflammatory hormones.
• Genetic factors: Some people have genetic factors that affect stress, such as having a more or less efficient relaxation response.
• Immune regulated diseases: Certain diseases that are associated with immune abnormalities (such as rheumatoid arthritis or eczema) may weaken the response to stress.
• The length and quality of stressors: The longer the duration and the more intense the stressors, the more harmful the effects.
Individuals at Higher Risk for Stress. Studies indicate that the following people are more vulnerable than others to the effects of stress:
• Older adults: As people age, achieving a relaxation response after a stressful event becomes more difficult. Aging may simply wear out the systems in the brain that respond to stress, so that they become inefficient. The elderly, too, are very often exposed to major stressors such as medical problems, the loss of a spouse and friends, a change in a living situation, and financial worries. No one is immune to stress, however.
• Women in general and working mothers specifically: Working mothers, regardless of whether they are married or single, face higher stress levels and possibly adverse health effects, most likely because they bear a greater and more diffuse work load than men or other women. This effect has been observed in women in the U.S. and in Europe. Such stress may also have a harmful effect on their children. It is not clear, however, whether stress has the same adverse effects on women's hearts as it does on men's.
• Less educated individuals.
• Divorced or widowed individuals: Numerous studies indicate that unmarried people generally do not live as long as their married contemporaries.
• Anyone experiencing financial strain, particularly the long-term unemployed and those without health insurance.
• People who are isolated or lonely.
• People who are targets of racial or sexual discrimination.
• People who live in cities.

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Childhood Factors
Children are frequent victims of stress because they are often unable to communicate their feelings accurately. They also have trouble communicating their responses to events over which they have no control. Certain physical symptoms, notably repeated abdominal pain without a known cause, may be indicators of stress in children.
Various conditions can affect a child's susceptibility to stress.
Parental Stress. Parental stress, especially in mothers, is a particularly powerful source of stress in children. Young children of mothers who are highly stressed (particularly if they are also depressed) tend to be at high risk for developing stress-related problems. This may be especially true if the mothers were stressed during both the child's infancy and early years. Stressed parents may even make their children more likely to develop asthma. Some evidence supports the old idea that stress during pregnancy can have adverse effects on the infant's mood and behavior. Older children with stressed mothers may become aggressive and anti-social. Stress-reduction techniques in parents may improve their children's behavior.
Gender Differences in Adolescent Stress. Adolescent boys and girls experience equal amounts of stress, but the source and effects may differ. Girls tend to become stressed from interpersonal situations, and stress is more likely to lead to depression in girls than in boys. For boys, however, specific events, such as changing schools or getting poor grades, appear to be the major sources of stress.
Work and Stress
Health care costs are much higher in workers who are stressed or depressed than in others who are not stressed. Nearly half of American workers describe their jobs as very stressful, making job-related stress an important and preventable health hazard. In a struggling economy, worry about job loss produces a tremendous amount of stress.
Several studies are now suggesting that job-related stress is as great a threat to health as smoking or not exercising. Stress impairs concentration, causes sleeplessness, and increases the risk for illness, back problems, accidents, and lost time from work. Work stress can lead to harassment or even violence on the job. At its most extreme, chronic stress places a burden on the heart and circulation that in some cases may be fatal.
Not all work stress is harmful. However, studies suggest the following job-related stressors may increase health risks, particularly in men:
• Having no control over decisions that affect one's responsibilities
• Unrelenting and unreasonable performance demands
• Lack of effective communication and conflict-resolution methods among workers and employers
• Lack of job security
• Night-shift work, long hours, or both
• Spending too much time away from home and family
• Wages not matching levels of responsibility
Reducing Stress on the Job. Many companies put intense pressure on their employees to behave in ways that increase tension. Yet, there are numerous effective tools and techniques available to reduce stress. Furthermore, treatment for work-related stress has proven benefits for both the employee and employer. Studies show that stress management programs save in workers compensation costs, and may lower employees' blood pressure.
In general, however, few workplaces offer stress management programs, and it is usually up to the employees to find their own ways to reduce stress. Here are some suggestions:
• Seek out someone in the Human Resources department or a sympathetic manager and communicate concerns about job stress. Work with them in a non-confrontational way to improve working conditions, letting them know that productivity can be improved by reducing the pressure on employees.
• Establish or strengthen a network of friends at work and at home.
• Restructure priorities and eliminate unnecessary tasks.
• Learn to focus on positive outcomes.
• If the job is unendurable, plan and execute a career change. Send out resumes or work on getting a transfer within the company.
• If this isn't possible, be sure to schedule pleasant activities and physical exercise every day during free time.

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Caregiving
Caregivers of Family Members. Studies show that caregivers of physically or mentally disabled family members are at risk for chronic stress. Spouses who care for a disabled partner are particularly vulnerable to a range of stress-related health threats, including influenza, depression, and heart disease. Caring for a spouse who has even minor disabilities can lead to severe stress.
Specific risk factors that put caregivers at higher risk for severe stress, or stress-related illnesses, include:
• Wives: Some studies suggest that wives experience significantly greater stress from caregiving than husbands.
• Having a low income.
• Being African-American: African-Americans tend to be in poorer physical health, and have lower incomes, than Caucasians. They therefore face greater stress as caregivers to their spouses than their white counterparts.
• Living alone with a patient.
• Helping a highly dependent patient.
• Having a difficult relationship with a patient.
Intervention programs that are aimed at helping the caregiver can reduce stress, and help the caregiver maintain a positive attitude. Moderate-intensity exercise can also be very helpful in reducing stress and improving sleep in caregivers.
Health Professional Caregivers. Caregiving among health professionals is also a high risk factor for stress. One study, for example, found that registered nurses with low job control, high job demands, and low work-related social support experienced very dramatic health declines, both physically and emotionally.
Anxiety Disorders
People who are less emotionally stable or who have high anxiety levels tend to experience specific events more stressfully than others. Some doctors describe an exaggerated negative response to stress as "catastrophizing" the event (thinking of a problem as a catastrophe). However, research has found that patients with anxiety disorder do not have any differences in their actual physical response to stress (such as heart rate, blood pressure, or release of stress hormones) compared to people without anxiety.
Lacking a Social Network
The lack of an established network of family and friends predisposes a person to stress disorders and stress-related health problems, including heart disease and infections. Older people who maintain active relationships with their adult children are buffered against the adverse health effects of chronic stress-inducing situations, such as low income or lower social class. This may be because people who live alone are unable to discuss negative feelings to relieve their stress.
People who remain happy and healthy despite many life stresses typically have very good social support networks. Having a pet may help reduce medical problems that are aggravated by stress, including heart disease and high blood pressure.
Complications
In prehistoric times, the physical changes in response to stress were an essential adaptation for meeting natural threats. Even in the modern world, the stress response can be an asset for raising levels of performance during critical events, such as a sports activity, an important meeting, or in situations where there is actual danger or a crisis.
If stress becomes persistent and low-level, however, all parts of the body's stress apparatus (the brain, heart, lungs, blood vessels, and muscles) become chronically over-activated or under-activated. Such chronic stress may produce physical or psychological damage over time. Acute stress can also be harmful in certain situations, particularly in individuals with pre-existing heart conditions.
Psychological Effects of Stress
Studies suggest that the inability to adapt to stress is associated with the onset of depression or anxiety.
Some evidence suggests that the repeated release of stress hormones produces hyperactivity in the hypothalamic-pituitary-adrenal (HPA) system, and disrupts normal levels of serotonin, the brain chemical that is critical for feelings of well-being. Some people appear to be more at risk for an overactive HPA system under stress, including those with personality traits that cause perfectionism. On a more obvious level, stress reduces quality of life by affecting feelings of pleasure and accomplishment. In addition, relationships are often threatened in times of stress.
Heart Disease
The full impact of mental stress on heart disease is just coming to light, but the underlying mechanisms are not always clear. Stress can influence the activity of the heart when it activates the automatic nervous system, which affects many organs, including the heart. Such actions and others could negatively affect the heart in several ways:
• Sudden stress increases the pumping action and rate of the heart, while at the same time causing the arteries to constrict (narrow). As a result blood pressure rises.
• The emotional effects of stress alter the heart rhythms, which could pose a risk for serious arrhythmias (rhythm abnormalities) in people with existing heart rhythm disturbances.
• Stress causes certaini blood cells to become stickier (possibly in preparation for potential injury).
• Stress appears to impair the clearance of fat molecules in the body.
• Stress that leads to depression appears to be associated with increased intima-medial thickness, a measure of the arteries that signifies worsening blood vessel disease.
• Stress causes the body to release inflammatory markers into the bloodstream. These markers may worsen heart disease or increase the risk of a heart attack or stroke.
• Studies have reported an association between stress and high blood pressure, which may be more pronounced in men than in women. According to some evidence, people who regularly experience sudden spikes in blood pressure (caused by mental stress) may, over time, develop injuries to the inner lining of their blood vessels.
Evidence is still needed to confirm any clear-cut relationship between stress and heart disease. However, research has linked stress to heart disease in men, particularly in work situations where they lack control. The association between stress and heart problems in women is weaker, and there is some evidence that the ways in which women cope with stress may be more heart-protective.
A condition called stress cardiomyopathy (or Takotsubo cardiomyopathy) is widely recognized. In this disease, intense emotional or physical stress causes severe but reversible heart dysfunction. The patient experiences chest pain, and EKGs and echocardiograms indicate a heart attack, but further tests show no underlying obstructive coronary artery disease.
Psychological stress is also recognized as a possible cause of acute coronary syndrome (ACS), a collection of symptoms that indicate a heart attack or approaching heart attack. High levels of psychological stress are associated with harmful changes to the blood. Research suggests that stress has the potential to trigger ACS, particularly in patients with heart disease. Studies also suggest that the risk is greatest immediately after the stressful incident, rather than during it.
Stress Reduction and Heart Disease. Studies suggest that treatments that reduce psychological distress improve the long-term outlook in people with heart disease, including after a heart attack. Evidence indicates that stress management programs may significantly reduce the risk of heart attacks in people with heart disease. Specific stress management techniques may help some heart problems but not others. For example, acupuncture in one study helped people with heart failure but had no effect on blood pressure. Relaxation methods, on the other hand, may help people with high blood pressure.

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Stroke
In some people, prolonged or frequent mental stress causes an increase in blood pressure, a risk factor for stroke and heart disease.
Effect on the Immune System
Chronic stress affects the immune system in complicated ways, and may have various results.
Susceptibility to Infections. Chronic stress may have an effect on the immune system's response to infections. Several studies claim that people who are under chronic stress have low white blood cell counts and are more vulnerable to colds. Once a person catches a cold or flu, stress can make symptoms worse. People who carry the herpes virus may be more susceptible to viral activation after they are exposed to stress.
Inflammatory Response. Some evidence suggests that chronic stress triggers an over-production of certain immune factors called cytokines. Such findings may partly explain the association between chronic stress and numerous diseases, including heart disease and asthma.
Cancer
A relationship between excess stress and cancer has not been proven. However, there may be a connection between stress and cancer survival. One study suggested that cancer patients who were separated from their spouses had lower survival rates than married cancer patients. Although stress reduction techniques have no effect on survival rates, studies show that they are very helpful in improving a cancer patient's quality of life.
Gastrointestinal Problems
The brain and intestines are closely related. They are controlled by many of the same hormones and parts of the nervous system. Some research suggests that the gut itself has features of a primitive brain. It is not surprising then that prolonged stress can disrupt the digestive system, irritating the large intestine and causing diarrhea, constipation, cramping, and bloating. Excessive production of digestive acids in the stomach may cause a painful burning.
Irritable Bowel Syndrome. Irritable bowel syndrome (or spastic colon) is strongly related to stress. With this condition, the large intestine becomes irritated, and its muscular contractions are spastic rather than smooth and wave-like. The abdomen is bloated, and the patient experiences cramping and alternating periods of constipation and diarrhea. Sleep disturbances due to stress can make irritable bowel syndrome even worse.
Peptic Ulcers. It is now well established that most peptic ulcers are caused by H. pyloribacteria or the use of nonsteroidal anti-inflammatory (NSAID) medications (such as aspirin and ibuprofen). Nevertheless, studies still suggest that stress may predispose a person withH. pylori to ulcers.
Inflammatory Bowel Disease. Although stress is not a cause of inflammatory bowel disease (Crohn's disease or ulcerative colitis), there are reports of an association between stress and symptom flare-ups.
Eating and Stress
Stress can have varying effects on eating problems and weight.
Weight Gain. Often stress is related to weight gain and obesity. Many people develop cravings for salt, fat, and sugar to counteract tension. As a result, they gain weight. Weight gain can occur even with a healthy diet, however, in some people who are exposed to stress. In addition, the weight gained is often abdominal fat, which increases the risk of diabetes and heart problems.
The release of cortisol, a major stress hormone, appears to boost abdominal fat and may be the primary connection between stress and weight gain. Cortisol is a glucocorticoid. These hormones, along with insulin, appear to be responsible for stress-related food cravings. Evidence suggests that hormonally induced cravings for "comfort foods" may have a biological benefit for managing stress. Eating comfort foods appears to reduce the negative hormonal and behavioral changes associated with stress, which might lessen the impact of stress on an individual. Carbohydrates in particular may increase levels of tryptophan and large neutral amino acids. This leads to more production of the chemical messenger serotonin, which might improve mood and performance under stress.
There may be a "reward-based stress eating" model. In this theory, stress and tasty, high-calorie foods cause the brain to make chemicals called endogenous opioids. These neurotransmitters help protect against the harmful effects of stress, slowing activity of a brain process called the hypothalamic-pituitary-adrenal (HPA) axis, thus weakening the stress response. Repeated stimulation of the reward pathways through stress-induced HPA stimulation, eating tasty food, or both, may lead to changes in the brain that cause compulsive overeating.
Research finds that overeating may be triggered by different stressors in men and women. Women tend to put on extra pounds when dealing with financial and work problems, as well as strained family relationships. Men gain more weight from lack of decision authority at work and difficulty in learning new skills on the job.
Eating Disorders. Chronically elevated levels of stress chemicals have been observed in patients with anorexia and bulimia. Some studies, however, have not found any strong link between stress and eating disorders. More research is needed to determine whether changes in stress hormones are a cause or a result of eating disorders.
Diabetes
Stress can exacerbate existing diabetes by impairing the patient's ability to manage the disease effectively.
Pain
Researchers are attempting to find the relationship between pain and emotion, but the area is complicated by many factors, including the effects of different personality types, fear of pain, and stress itself. Evidence suggests that chronic pain may impair the action of neutrophils, thereby weakening the immune response.
Muscular and Joint Pain. Stress may intensify chronic pain caused by arthritis and other conditions. Psychological distress also plays a significant role in the severity of back pain. Some studies have clearly associated job dissatisfaction and depression to back problems, although it is still unclear whether stress is a direct cause of the back pain. Research suggests that the risk of long-term disability from low back pain can be reduced through early treatment for depression and stress.
Headaches. Tension-type headaches are highly associated with stress and stressful events. Sometimes the headache does not start until long after the stressful event has ended. Additionally, stress can contribute to the development of headaches or cause headaches to occur more frequently.
Some research suggests that people who experience tension-type headaches may have some biological predisposition for translating stress into muscle contractions. Among the wide range of possible migraine triggers is emotional stress (although the headaches often erupt after the stress has eased).
Sleep Disturbances
The tensions of unresolved stress frequently cause insomnia, which prevents stressed people from sleeping or causes them to awaken in the middle of the night or early morning. This appears to be due to the fact that stress causes physiological arousal during non-rapid eye movement sleep.
Sexual and Reproductive Dysfunction
Sexual Function. Stress can reduce sexual desire and cause women to be unable to achieve orgasm. The stress response can lead to sexual problems, including erectile dysfunction, in men.
Premenstrual Syndrome. Some studies indicate that the stress response in women with premenstrual syndrome may be more intense than in those without the syndrome.
Fertility. Chronic stress may affect fertility. Stress hormones have an impact on the hypothalamus, which produces reproductive hormones. This effect may lead to changes in a woman's menstrual cycle, as well as a reduction in a man's sperm count. Stress can also reduce sex drive.
Effects on Pregnancy. Old wives' tales about a pregnant woman's emotions affecting her baby may have some credence. Stress may cause physiological alterations, such as increased adrenal hormone levels or resistance in the arteries, which may interfere with normal blood flow to the placenta. Maternal stress during pregnancy has been linked to a higher risk for miscarriage, lower birth weight, and an increased incidence of premature births. Some evidence also suggests that an expectant mother's stress can even influence the way in which her baby's brain and nervous system will react to stressful events. One study found a higher rate of crying and low attention in infants of mothers who had been stressed during pregnancy.
Menopause. A drop in estrogen levels during perimenopause and menopause may be responsible for changes in mood precipitated by stress.
Memory, Concentration, and Learning
Stress affects the brain, particularly memory, but the effects vary widely depending on whether the stress is acute or chronic.
Effect of Acute Stress on Memory and Concentration. Studies indicate that the immediate effect of acute stress impairs short-term memory, particularly verbal memory. On the plus side, high levels of stress hormones during short-term stress have been associated with enhanced memory storage, improved working memory, and greater concentration on immediate events. The difference in effect may be due to how cortisol impacts glucocorticoid receptors in the hippocampus and prefrontal cortex.
Effect of Chronic Stress on Memory. If stress becomes chronic, sufferers often lose concentration at work and home, and they may become inefficient and accident-prone. In children, the physiologic responses to chronic stress can interfere with learning. Studies have connected long-term exposure to excess amounts of the stress hormone cortisol to a shrinking of the hippocampus, the brain's memory center. It is not yet known whether this shrinking is reversible.
Other Disorders
Skin Disorders. Stress may worsen numerous skin conditions, including hives, psoriasis, acne, and rosacea, and it is one of the most common causes of eczema. Unexplained itching may also be caused by stress. Evidence suggests that experiencing the stress of a traumatic event (parental divorce or separation, or a severe disease in a family member) before age 2 increases the risk of developing eczema.
Unexplained Hair Loss (Alopecia Areata). Alopecia areata is hair loss that occurs in localized (individual) patches. The cause is unknown, but stress is suspected as a player in this condition. For example, hair loss often occurs during periods of intense stress, such as when people are in mourning.
Teeth and Gums. Stress has now been implicated in increasing the risk for periodontal disease, which can cause tooth loss and has been linked to heart disease.

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Substance Abuse
People who are under chronic stress often turn to alcohol or tobacco for relief. Stress compounds the damage these self-destructive habits cause under ordinary circumstances. Many people also resort to unhealthy eating habits, smoking, or passive activities, such as watching television when they are stressed.
Alcohol affects receptors in the brain that reduce stress. Lack of nicotine increases stress in smokers, which creates a cycle of dependency on smoking.
The cycle is self-perpetuating: a sedentary routine, an unhealthy diet, alcohol abuse, and smoking all promote heart disease. They also interfere with sleep patterns, and lead to increased rather than reduced tension levels. Drinking four or five cups of coffee, for example, can cause changes in blood pressure and stress hormone levels similar to those produced by chronic stress. Animal fats, simple sugars, and salt are known contributors to health problems.
Conditions with Similar Symptoms
The physical symptoms of anxiety disorders mirror many symptoms of stress, including:
• A fast heart rate
• Rapid, shallow breathing
• Increased muscle tension
Anxiety is an emotional disorder, however, and is characterized by feelings of apprehension, uncertainty, fear, or panic. Unlike stress, the triggers for anxiety are not necessarily or even usually associated with specific stressful or threatening conditions. Some individuals with anxiety disorders have numerous physical complaints, such as headaches, gastrointestinal disturbances, dizziness, and chest pain. Severe cases of anxiety disorders are debilitating, interfering with a person's career, family, and social life.
Depression
Depression can be a disabling condition, and, like anxiety disorders, it may sometimes be linked to chronic stress. Individuals with a high level of work-related stress are more than twice as likely to experience a major depressive episode, compared with people who are under less stress. Evidence also suggests that certain people may be genetically susceptible to depression after they experience stressful life events.
Depression shares some of the symptoms of stress, including changes in appetite, sleep patterns, and concentration. Serious depression, however, is distinguished from stress by feelings of sadness, hopelessness, loss of interest in life, and, sometimes, thoughts of suicide. Acute depression is also accompanied by significant changes in the patient's functioning. The person may need professional therapy to determine whether depression is caused by stress, or if it is the primary problem.
Post-Traumatic Stress Disorder Symptoms
Post-traumatic stress disorder (PTSD) is a reaction to a very traumatic event, and it is typically classified as an anxiety disorder. The event that brings on PTSD is usually outside the norm of human experience, such as intense combat or sexual assault. The patient struggles to forget the traumatic event and frequently develops emotional numbness and event-related amnesia. Often, however, there is a mental flashback, and the patient re-experiences the painful circumstance in the form of dreams and disturbing thoughts and memories. These thoughts and dreams resemble or recall the trauma. Other symptoms may include a lack of pleasure in previously enjoyed activities, hopelessness, irritability, mood swings, sleep problems, inability to concentrate, and an excessive startle-response to noise.
While various interventions to treat or prevent PTSD have been tested, research has not shed much light on the best approach.
While various interventions to treat or prevent PTSD are being tested, no one program will help all victims. Many experts favor a multifactorial approach to therapy that includes talk therapy (such as cognitive behavioral therapy) and medications (such as drugs in the SSRI family).
On the horizon are "virtual therapies," computerized programs or simulations, to treat PTSD symptoms. This approach is being studied in military veterans suffering from PTSD.
Treatment
The process of learning to control stress is life-long. Overcoming stress will not only contribute to better health, but it will also increase an individual's ability to succeed.
When to Seek Professional Help for Stress
Stress can be a factor in a variety of physical and emotional illnesses, which should be professionally treated. Many stress symptoms are mild and can be managed with over-the-counter medications (for example, aspirin, acetaminophen, or ibuprofen for tension headaches; antacids, anti-diarrhea medications, or laxatives for mild stomach distress). A physician should be consulted, however, for physical symptoms that are out of the ordinary, particularly those that get worse or wake a person up at night. A mental health professional should be consulted for unmanageable acute stress or for severe anxiety or depression. Often short-term therapy can resolve stress-related emotional problems.
The Depression Anxiety Stress Scales (DASS) and other assessment tools are available to help identify aspects of stress such as difficulty relaxing, nervous arousal and being agitated/irritable, and determine whether depression and/or anxiety are present as well. The DASS is available to the public online.
Considerations for Choosing a Stress-Reduction Strategy
When choosing specific strategies for treating stress, several factors should be considered.
• No single method is always successful: A combination of approaches is generally most effective.
• What works for one person does not necessarily work for someone else.
• Stress can be positive as well as negative. Appropriate and controllable stress provides interest and excitement and motivates the individual to greater achievement. A lack of stress may lead to boredom and depression.
Stress may play a part in making people vulnerable to illness. A physician or psychologist should be consulted if there are any indications of accompanying medical or psychological conditions, such as heart symptoms, significant pain, anxiety, or depression.
Overcoming Obstacles to Treatment
People often succeed in relieving stress for the short term. However, they go back to their previous stressful thoughts and behaviors because of outside pressure, long-held beliefs, or old habits. The following are some obstacles to managing stress:
• The fight or flight urge: The very idea of relaxation can feel threatening, because it is perceived as letting down one's guard. For example, an over-demanding boss may put a subordinate into a psychological state of fighting-readiness, even though there is no safe opportunity for the subordinate to fight back or express anger. Stress builds up, but the worker has the illusion, even subconsciously, that the stress itself is providing safety or preparedness. For this reason, the employee does nothing to correct the condition.
• Many people are afraid of being perceived as selfish if they engage in stress-reducing activities that benefit only themselves. The truth is that self-sacrifice (in the form of not reducing one's stress) may be inappropriate and even damaging, if the person making the sacrifice is unhappy, angry, or physically unwell.
• Some people believe that certain emotional responses to stress, such as anger, are natural and unchangeable features of their personality. Research has shown, however, that with cognitive behavioral therapy, individuals can be taught to change their emotional reactions to stressful events.
Reducing stress and staying relaxed clears the mind so it can begin the appropriate actions to get rid of the stress-related conditions.
Stress Reduction and Its Effects on Health
Although treating stress cannot cure medical problems, stress management can be a very important part of medical treatment. Specific stress reduction approaches may benefit different medical problems. For example, acupuncture can help reduce harmful heart muscle actions in people with heart failure, but it has no effect on blood pressure. Relaxation methods, on the other hand, may help people with high blood pressure. Stress reduction may improve well-being and quality of life in many patients who are experiencing stress because of severe or chronic medical conditions.
Important Note: Never use stress reduction techniques as the only treatment, or in place of proven treatments, for any medical condition.
Lifestyle Changes
A healthy lifestyle is an essential companion to any stress-reduction program. People can enhance their general health and stress resistance by getting regular exercise, eating a diet rich in a variety of whole grains, vegetables, and fruits, and avoiding excessive alcohol, caffeine, and tobacco.
Exercise
Exercise in combination with stress management techniques is extremely important for many reasons:
• Exercise is an effective distraction from stressful events.
• Exercise may directly blunt the harmful effects of stress on blood pressure and the heart (exercise protects the heart).
Vary the exercise program, combining aerobic exercise with strength training. Start slowly. Strenuous exercise in people who are not used to it can be very dangerous. In addition, half of all people who begin a vigorous training program drop out within a year. Discuss any exercise program with a health care provider before starting. The key is to find activities that are exciting, challenging, and satisfying. The following are some suggestions:
• Aerobics classes at a gym
• Brisk walking (even short walks can relieve bouts of stress)
• Swimming (an ideal exercise for many stressed people, including pregnant women, people with musculoskeletal problems, and those who have exercise-induced asthma)
• Yoga or Tai chi (these techniques combine many of the relaxation benefits of breathing, muscle relaxation, and meditation while toning and stretching the muscles)
As in other areas of stress management, making a plan and executing it successfully provides feelings of mastery and control, which are very beneficial in and of themselves. Start slowly. Just 10 minutes of exercise three times a week can build a good base for novices. Gradually build up the length of these sessions to 30 minutes or more.
Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) is among the most effective ways of reducing stress, whether the source of stress is chronic pain or a chronic disease. CBT may be more helpful than support groups for improving well-being and quality-of-life.
A typical CBT approach includes identifying sources of stress, restructuring priorities, changing one's response to stress, and finding methods for managing and reducing stress.
Identifying Sources of Stress. One key component in most CBT approaches is keeping a diary to record daily events and activities. The first step is to note activities that put a strain on energy and time, trigger anger or anxiety, or precipitate a negative physical response (such as a sour stomach or headache). Also note positive experiences, such as those that are mentally or physically refreshing or that produce a sense of accomplishment.
After a week or two, try to identify two or three events or activities that have been significantly upsetting or overwhelming.Questioning the Sources of Stress. Individuals should then ask themselves the following questions:
• Do these stressful activities meet my goals or someone else's?
• Have I taken on tasks that I can reasonably accomplish?
• Which tasks are under my control and which ones aren't?
Restructuring Priorities: Adding Stress Reducing Activities. The next step is to attempt to shift the balance from stress-producing to stress-reducing activities. Eliminating stress entirely is rarely possible, but there are many ways to reduce its impact.
Consider as many relief options as possible. Examples include:
• Listen to music. Music is an effective stress reducer in both healthy individuals and people with health problems. Research finds that listening to soothing music can decrease blood pressure, heart rate, and anxiety levels in heart patients.
• Take long weekends or vacations.
• If the source of stress is in the home, plan times away, even if only for an hour or two a week.
• Replace unnecessary time-consuming chores with pleasurable or interesting activities.
• Make time for recreation. This is as essential as paying bills or shopping for groceries.
• Own a pet. Research finds that pet owners have a lower blood pressure increase in response to stress than people who do not own pets.

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Discuss Feelings. The concept of communication and letting your feelings out has been so excessively promoted and parodied that it has nearly lost its value as good psychological advice. Nevertheless, feelings of anger or frustration that are not expressed in an acceptable way may lead to hostility, a sense of helplessness, and depression.
Expressing feelings does not mean venting frustration. In fact, anger may cause a spike in blood pressure in some people. Some therapists strongly recommend just talking, rather than venting anger.
The primary goal is to explain and assert one's needs to a trusted individual in as positive a way as possible. Direct communication may not even be necessary. Writing in a journal, writing a poem, or composing a letter that is never mailed may be sufficient.
Expressing one's feelings solves only half of the communication puzzle. Learning to listen, empathize, and respond to others with understanding is just as important for maintaining the strong relationships necessary for emotional fulfillment and reduced stress.
Keep Perspective and Look for the Positive. Reversing negative ideas and learning to focus on positive outcomes helps reduce tension and achieve goals. The following steps, using an example of a person who is alarmed at the prospect of giving a speech, may be useful:
• First, identify the worst possible outcomes (forgetting the speech, stumbling over words, humiliation, audience contempt).
• Rate the likelihood of these bad outcomes happening (probably very low, or the speaker would not have been selected in the first place).
• Envision a favorable result (a well-rounded, articulate presentation with rewarding applause).
• Develop a specific plan to achieve the positive outcome (preparing in front of a mirror, using a video camera or tape recorder, doing relaxation exercises).
• Try to recall previous situations that initially seemed negative but ended well.
Use Humor. Research has shown that humor is a very effective mechanism for coping with acute stress. Keeping a sense of humor during difficult situations is a common recommendation of stress management experts. Laughter not only releases the tension of pent-up feelings and helps a person maintain perspective, but it also appears to have actual physical effects that reduce stress hormone levels. It is not uncommon for people to laugh intensely during tragic events, such as the death of a loved one, because this laughter helps them endure the emotional pain of the experience.
Relaxation and Other Alternative Techniques
Relaxation Methods. Because stress is here to stay, everyone needs to develop methods to promote the relaxation response, the natural unwinding of the stress response. Relaxation lowers blood pressure, respiration, and pulse rate, releases muscle tension, and eases emotional strain. This response is highly individualized, but there are certain approaches that seem to work for most people. Meditation during the run-up to a stressful event can reduce the stress response without impairing alertness, concentration or memory.
Combinations of these techniques probably work best. No one should expect these approaches to completely relieve their stress, but if they are done regularly, these programs can be very effective. In a recent review, it was shown that mindfulness bases stress reduction (MBSR) techniques are effective stress relievers and reduced stress in healthy people. Techniques include yoga and meditation. Significant reductions in stress levels were seen in participants compared to those not engaging in any treatment. Outcomes were assessed using the Mindfulness Attention Awareness Scale (MAAS).
Acupuncture. Some evidence suggests that acupuncture might improve some of the physical factors associated with both stress and health problems. For example, acupuncture may improve stress-related heart muscle activity in heart failure patients, which could provide an important benefit to these patients. However, acupuncture has no effect on stress-related blood pressure or heart rate.
Hypnosis. Hypnosis may benefit some people with severe stress. In one study of patients with irritable bowel syndrome, stress reduction from hypnosis led to improvements in many bowel symptoms.

Relaxation Methods Specific Procedure
Deep Breathing Exercises.During stress, breathing becomes shallow and rapid. Taking a deep breath is an automatic and effective technique for winding down. Deep breathing exercises consciously intensify this natural physiologic reaction and can be very useful during a stressful situation, or for maintaining a relaxed state during the day. • Inhale through the nose slowly and deeply to the count of 10.
• Make sure that the stomach and abdomen expand, but the chest does not rise.
• Exhale through the nose, slowly and completely, also to the count of 10.
• To help quiet the mind, concentrate fully on breathing and counting through each cycle.
• Repeat five to 10 times, and make a habit of doing the exercise several times each day, even when not feeling stressed.
Muscle Relaxation.Muscle relaxation techniques, often combined with deep breathing, are simple to learn and very useful for getting to sleep. In the beginning it is useful to have a friend or partner check for tension by lifting an arm and dropping it. The arm should fall freely. Practice makes the exercise much more effective and produces relaxation much more rapidly. Small studies have reported beneficial effects on blood pressure in patients with high blood pressure who use this technique. • After lying down in a comfortable position without crossing the limbs, concentrate on each part of the body.
• Maintain a slow, deep breathing pattern throughout this exercise.
• Tense each muscle as tightly as possible for a count of five to 10, and then release it completely.
• Experience the muscle as totally relaxed and lead-heavy.
• Begin with the top of the head and progress downward to focus on all the muscles in the body.
• Be sure to include the forehead, ears, eyes, mouth, neck, shoulders, arms and hands, fingers, chest, belly, thighs, calves, and feet.
• Once the review is complete, imagine tensing and releasing the internal muscles.
Meditation.Meditation, used for many years in Eastern cultures, is now widely accepted in this country as a relaxation technique. The goal of all meditative procedures, both religious and therapeutic, is to quiet the mind (essentially, to relax thought). Small studies have suggested that regular meditation can benefit the heart and help reduce blood pressure. Better research is needed, however, to confirm such claims.
Some experts recommend meditating for no longer than 20 minutes in the morning after waking up and then again in the early evening before dinner. Even meditating just once a day is helpful.
New practitioners should understand that it can be difficult to quiet the mind, and should not be discouraged by a lack of immediate results.
Several techniques are available. A few are discussed here.
The only potential risks from meditating are in people with psychosis, in whom meditating may trigger a psychotic event. Mindfulness Meditation.Mindfulness is a common practice that focuses on breathing. It employs the basic technique used in other forms of meditation.
• Sit upright with the spine straight, either cross-legged or sitting on a firm chair with both feet on the floor, uncrossed.
• With the eyes closed or gently looking a few feet ahead, observe the exhalation of the breath.
• As the mind wanders, simply note it as a fact and return to the "out" breath. It may be helpful to imagine the thoughts as clouds dissipating away.
Transcendental Meditation (TM). TM uses a mantra (a word that has a specific chanting sound but no meaning). The person meditating repeats the word silently, letting thoughts come and go.
Mini-Meditation. The method involves heightening awareness of the immediate surrounding environment. Choose a routine activity, for example:
• While washing dishes, concentrate on the feel of the water and dishes.
• Allow the mind to wander to any immediate sensory experience (sounds outside the window, smells from the stove, colors in the room).
• If the mind begins to think about the past or future, or fills with unformed thoughts or worries, redirect it gently back.
• This redirection of brain activity from your thoughts and worries to your senses disrupts the stress response and prompts relaxation. It also helps promote an emotional and sensual appreciation of simple pleasures.
Biofeedback.Biofeedback is a technique that measures bodily functions, such as breathing, heart rate, blood pressure, skin temperature, and muscle tension. By watching these measurements, individuals can learn how to alter these functions by relaxing or holding pleasant images in their mind. • During biofeedback, electric leads are taped to a subject's head.
• The person is encouraged to relax using methods such as those described above.
• Brain waves are measured and an audible signal is emitted when alpha waves are detected, a frequency that coincides with a state of deep relaxation.
• By repeating the process, patients associate the sound with the relaxed state and learn to achieve relaxation by themselves.
Massage Therapy. Massage therapy may decrease cortisol levels, and
some research suggests a possible role of physical touch in managing
stress. Many massage techniques are available, such as the following:
Swedish massage is the standard massage technique. It uses long smooth strokes, and kneading and tapping of the muscles.
Shiatsu applies intense pressure to the same points targeted in acupuncture. It can be painful, but people report deep relaxation afterward.
Reflexology manipulates acupuncture points in the hands and feet.
Herbal and Natural Remedies
Some people who experience chronic stress try herbal or natural remedies. Although many benefits are claimed, few (if any) have been proven. In addition, just as with standard drugs, so-called natural remedies can cause health problems, which can sometimes be serious. Similarly, homeopathic remedies have not shown to be effective treatments for anxiety or stress.
Aromatherapy. The smell of lavender has long been associated with a calming effect. In addition, several other aromatherapies are now used for relaxation. Use caution, however, as some of the exotic plant extracts in these formulas have been associated with a wide range of skin allergies.
Valerian. Valerian is an herb that has sedative qualities, and it may reduce stress and its associated physical effects. This herb is on the FDA's list of generally safe products. However, the herb's effects could be dangerously increased if it is used with standard sedatives. Side effects include vivid dreams. High doses of valerian can cause blurred vision, excitability, and changes in heart rhythm. Other interactions and long-term side effects are unknown.
Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like drugs, however, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been numerous reported cases of serious and even lethal side effects from herbal products. Always check with your doctor before using any herbal remedies or dietary supplements.
Special Warning on Kava. Kava has been commonly used to reduce anxiety and stress. It is now highly associated with liver injury and even liver failure in a few cases. Experts now strongly warn against its use.
People seeking relief from stress should be wary of any product that promises a quick cure, or that requires the purchase of expensive treatments. These treatments may be useless and sometimes even dangerous.
Resources
• www.nimh.nih.gov -- National Institute of Mental Health
• www.nami.org -- National Alliance for the Mentally Ill
• www.nmha.org -- Mental Health America (formerly the National Mental Health Association)
• www.amtamassage.org -- American Massage Therapy Association
• www.healthyminds.org -- The American Psychiatric Association
• www.apa.org -- The American Psychological Association
• www.naswdc.org -- The National Association of Social Workers
• www.aacap.org -- American Academy of Child and Adolescent Psychiatry
• www.stress.org -- The American Institute of Stress
• www2.psy.unsw.edu.au/groups/dass// -- Depression Anxiety Stress Scale (DASS)