This is a summary of the book "Why Zebras Don't Get Ulcers (the acclaimed guide to stress, stress-related diseases, and coping)", 3rd edition, for the second year course Stress, Health and Disease at Leiden University, 2018/2019. I summarized the chapters and the parts of the chapters we had to rea...
Summary Stress, Health and Disease (Sapolsky + 4 chapters from reader) (ISBN: 978080507369) 2021-2022
Why Zebras Dont get ulcers - Sapolsky - latest edition - Summary
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1
SUMMARY STRESS,
HEALTH AND DISEASE
IBP year 2 | semester 1 | block 1
, 2
Contents
Chapter 1: why don't zebras get ulcers? .......................................................................................................... 6
Chapter 2: glands, gooseflesh and hormones .................................................................................................. 7
Stress and the autonomic nervous system ................................................................................................... 7
Your brain: the real master gland ................................................................................................................ 7
Hormones of the stress response ................................................................................................................. 8
A few complications.................................................................................................................................... 8
Chapter 3: stroke, heart attacks and voodoo death .......................................................................................... 8
The cardiovascular stress response.............................................................................................................. 8
Chronic stress and cardiovascular disease................................................................................................... 9
Sudden cardiac death ................................................................................................................................... 9
Fatal pleasures ............................................................................................................................................. 9
Woman and heart disease ............................................................................................................................ 9
Voodoo death ............................................................................................................................................ 10
Personality and cardiac arrest: a brief introduction ................................................................................... 10
Reader chapter 1 ............................................................................................................................................ 10
The ins and outs of the mind’s effects on the body ................................................................................... 10
Chapter 13: why is psychological stress stressful? ........................................................................................ 13
The building blocks of psychological stressors ......................................................................................... 14
Not so fast ................................................................................................................................................. 14
Some subtleties of predictability ............................................................................................................... 14
Subtleties of control .................................................................................................................................. 14
Chapter 15: personality, temperament, and their stress-related consequences .............................................. 15
Stress and the successful primate .............................................................................................................. 15
The human realm: a cautionary note ......................................................................................................... 15
Psychiatric disorders and abnormal stress responses ................................................................................ 15
Type A and the role of upholstery in cardiovascular physiology .............................................................. 16
Interior decorating as scientific method .................................................................................................... 16
When life consists of nothing but squeezing tightly ................................................................................. 16
Chapter 17: the view from the bottom........................................................................................................... 16
Pecking orders among beasts with tails ..................................................................................................... 16
Do humans have ranks?............................................................................................................................. 17
Socioeconomic status, stress and disease .................................................................................................. 17
The puzzle of health care access ............................................................................................................... 17
Risk factors and protective factors ............................................................................................................ 17
, 3
Stress and the SES gradient ....................................................................................................................... 17
Being poor versus feeling poor ................................................................................................................. 18
Poverty versus poverty amid plenty .......................................................................................................... 18
How does income inequality and feeling poor translate into bad health? ................................................. 18
Chapter 8: immunity, stress and disease........................................................................................................ 18
Immune system basics ............................................................................................................................... 18
How does stress inhibit immune functioning? .......................................................................................... 19
Why is immunity suppressed during stress? ............................................................................................. 19
Surprise ..................................................................................................................................................... 19
Chronic stress and disease risk .................................................................................................................. 20
Testing the stress-disease link ................................................................................................................... 20
Aids ........................................................................................................................................................... 21
Stress and the big C ................................................................................................................................... 21
Cancer and miracles .................................................................................................................................. 22
Postscript: a grotesque piece of medical history ....................................................................................... 22
Chapter 4: stress, metabolism and liquidating your assets ............................................................................ 22
Putting energy in the bank ......................................................................................................................... 22
Emptying the bank account: energy mobilization during stressor............................................................. 22
So why do we get sick? ............................................................................................................................. 23
Juvenile diabetes ....................................................................................................................................... 23
Adult-onset diabetes .................................................................................................................................. 23
Metabolic syndrome/syndrome X ............................................................................................................. 23
Chapter 5: ulcers, the runs and hot fudge sundaes ........................................................................................ 23
Stress and food consumption..................................................................................................................... 23
Apples and pears ....................................................................................................................................... 24
Bowel movement and bowel movements .................................................................................................. 24
Bowels in an uproar................................................................................................................................... 24
Stress and functional gastrointestinal disorders ........................................................................................ 24
Ulcers ........................................................................................................................................................ 24
Chapter 6: dwarfism and the importance of mothers .................................................................................... 25
How we grow ............................................................................................................................................ 25
Neurotic patients: beware!......................................................................................................................... 25
Prenatal stress ............................................................................................................................................ 25
Postnatal stress .......................................................................................................................................... 26
Skeletal growth and stress dwarfism ......................................................................................................... 26
, 4
The mechanisms underlying stress dwarfism ............................................................................................ 26
Stress and growth hormone secretion in humans ...................................................................................... 26
Enough already.......................................................................................................................................... 26
Growth and growth hormone in adults ...................................................................................................... 27
A final word about the L-word .................................................................................................................. 27
Chapter 7: sex and reproduction .................................................................................................................... 27
Males: testosterone and loss of erections .................................................................................................. 27
Our friend, the hyena ................................................................................................................................. 27
Females: lengthened cycles and amenorrhea ............................................................................................ 27
Females: disruption of libido ..................................................................................................................... 28
Stress and the success of high-tech fertilization ........................................................................................ 28
Miscarriage, psychogenic abortions and preterm labor ............................................................................. 28
How detrimental to female reproduction is stress? ................................................................................... 28
Chapter 12: aging and death .......................................................................................................................... 28
Aged organisms and stress ........................................................................................................................ 29
Why you seldom see really old salmon ..................................................................................................... 29
Chronic stress and the aging process in the mainstream ........................................................................... 29
Reader chapter 2 ............................................................................................................................................ 29
Negative emotions, physiology and disease risk ....................................................................................... 29
How can negative emotions influence disease? ........................................................................................ 29
Reader chapter 3 ............................................................................................................................................ 31
Perseverative emotional cognition: ‘keeping the trouble online’ .............................................................. 31
Reader chapter 4 ............................................................................................................................................ 34
Unconscious stress .................................................................................................................................... 34
Chapter 9: stress and pain.............................................................................................................................. 34
The basics of pain perception .................................................................................................................... 35
Sensory modulation of pain perception ..................................................................................................... 35
Pain that goes on longer than normal ........................................................................................................ 35
No brain, no pain ....................................................................................................................................... 35
Stress-induced analgesia ........................................................................................................................... 35
Why is muzak in the dentist’s office painful? ........................................................................................... 35
Pain and chronic stress .............................................................................................................................. 36
Article: subjective health complaints, sensitization, and sustained cognitive activation (stress) – Eriksen and
Ursin .............................................................................................................................................................. 36
Introduction ............................................................................................................................................... 36
, 5
Symptoms or complaints? ......................................................................................................................... 36
Sensitization and its psychobiological basis.............................................................................................. 36
Cognitive bias, comorbidity, and sensitization to complaints ................................................................... 36
Cognitive activation theory of stress ......................................................................................................... 36
Conclusion................................................................................................................................................. 37
Article: stress in organizations – Sonnentag and Frese ................................................................................. 37
Introduction ............................................................................................................................................... 37
The stress concept ..................................................................................................................................... 37
Theories on organizational stress .............................................................................................................. 38
Empirical evidence .................................................................................................................................... 39
Stress interventions ................................................................................................................................... 41
Chapter 18: managing stress.......................................................................................................................... 42
Tales from the trenches: some folks who are amazing at dealing with stress ........................................... 42
Applying principles of dealing with psychological stress: some success stories ...................................... 43
Self-medication and chronic pain syndromes............................................................................................ 43
Increasing control in nursing homes ......................................................................................................... 43
Stress management: reading the label carefully ........................................................................................ 43
Exercise ..................................................................................................................................................... 43
Meditation ................................................................................................................................................. 44
Get more control, more predictability in your life.. maybe ....................................................................... 44
Social support ............................................................................................................................................ 44
Religion and spirituality ............................................................................................................................ 44
Picking the right strategy at the right time: cognitive flexibility ............................................................... 44
What was he going on about with that? .................................................................................................... 44
Just do it: the 80/20 quality of stress management .................................................................................... 45
A summing up ........................................................................................................................................... 45
, 6
Chapter 1: why don't zebras get ulcers?
The diseases today are of slow accumulation of damage. Now understanding that extreme emotional
disturbances can affect us. Stress can make us sick. Stress physiology: how the body responds to stressful
events, how all sorts of intangibles in our lives can affect bodily events.
Some initial concepts
For animals, most upsetting is acute physical crisis. Demand immediate physiological adaptations. Also
chronic physical challenges. Body's stress responses are reasonably good at handling these. Also:
psychological and social disruptions. Mostly limited to humans, strong emotions linked to mere thoughts.
For animals, stress is about short-term crisis. We have same physiological responses, but potentially
dangerous when provoked chronically. Homeostasis: all sorts of physiological measures are being kept at
optimal level. Stressor: anything in outside world that disturbs homeostasis. Stress response: what body
does to reestablish homeostasis. Stressor can also be just the anticipation. A lot of what the stress response
is about is preparative. Surprising generality. Hans Selye: injected rats daily in stressful manner, effects on
body were same with control group. Nonspecific responses of the body to generic unpleasantness. Called it
stress, formalized the concept with two ideas: the body has a surprisingly similar set of responses (general
adaptation syndrome, now called stress response), and if stressors go on for too long, they can make you
sick.
Homeostasis plus: the more stress-appropriate concept of allostasis
Original conception of homeostasis had two ideas: single optimal level/number/amount for any given
measure in body --> but what is ideal under basal conditions is different than during stress (central to
allostatic thinking), and that the ideal set point was reached through some local regulatory mechanism -->
but allostasis says any given set point can be regulated in very many different ways, each with own
consequences. Allostasis is about the brain coordinating body-wide changes, often including behavior
change. Also feature of allostatic thinking: body doesn't pull of regulatory complexity only to correct some
set point that has gone awry, can also make allostatic changes in anticipation of set point that is likely to go
awry.
What your body does to adapt to an acute stressor
Stressor: throws body out of allostatic balance. Stress response: restore. Regardless of the stressor: same
response, generalized and stereotypical. Hallmark of stress response: rapid mobilization of energy (glucose)
from storage sites and inhibition of further storage, transport nutrients and oxygen, halt of long-term and
expensive 'projects'. Growth and tissue repair curtailed, sexual drive decreases, females less likely to
ovulate or carry pregnancies to term, males have erection problems and less testosterone. Immunity also
inhibited. Energy is more wisely expended. Perception of pain becomes blunted (stress-induced analgesia),
highly adaptive. Shifts in cognitive and sensory skills: aspects of memory improve, senses become sharper.
Walter Cannon: fight-or-flight. It can make us sick, why? Selye had wrong account with three stages.
Alarm stage: stressor is noted. Adaptation/resistance stage: successful mobilization of stress response
system and reattainment of allostasis. With prolonged stress, exhaustion: stress related diseases emerge,
because stores of hormones secreted during stress are depleted --> rather, with sufficient activation, stress
response can become more damaging than stressor itself. Constantly mobilize energy at cost of storage.
Chronic activation of cardiovascular system. In kids: stress dwarfism, in adults: repair and remodeling of
bones and other tissues disrupted, reproductive disorders. Also infectious diseases. Two elephants on a
, 7
seesaw model of stress related disease: if you constantly try to balance the seesaw with elephants instead of
kids, all sorts of problems emerge:
Damage because of how large, lumbering and unsubtle elephants are, hard to fix major problem
without knocking something else out of balance, long history of doing this produces wear and tear
throughout body called allostatic load
Tough for them to get off, sometimes stress related disease can arise from turning off stress
response too slowly or turning off different components at different speeds
You cannot appropriately turn on the stress response. Addison's disease or Shy-Drager syndrome show you
need stress response during physical challenges. If you repeatedly turn on the stress response, or if you
cannot turn off the stress response at the end of stressful events, it can become damaging. Repeated
stressors can potentially make you sick, stress increases risk of getting diseases that make you sick and
increases risk of body being overwhelmed --> more explanations for individual differences, easier to design
ways to intervene, explain why stress concept often seems so suspect of slippery.
Chapter 2: glands, gooseflesh and hormones
Stress and the autonomic nervous system
Brain sends messages through nerves that branch from it to spine and out to the periphery of the body.
Voluntary nervous system is conscious. Automatic nervous system is relatively involuntary and automatic.
Termed the autonomic nervous system. Has to do with response to stress. Two halves. Turned on is
sympathetic nervous system. Originating in the brain, sympathetic projections exit spine and branch out to
organs, blood vessels and glands. It is activated during emergencies, helps mediate vigilance, arousal,
activation and mobilization. Four F’s of behavior. Nerve endings of the system release adrenaline and
noradrenaline: epinephrine and norepinephrine. Epinephrine is secreted because of sympathetic nerve
endings in adrenal glands, norepinephrine by all other sympathetic nerve endings. Parasympathetic nervous
system: calm, vegetative activities. Promotes growth, energy storage etc.
Your brain: the real master gland
Mobilize waves of activity in response to stressor by secretion of hormones. Neurotransmitter: causes next
cell (mostly neuron) to do something different. Hormone: percolates in bloodstream and affects events far
and wide. “Brain has nothing to do with hormones” rejuvenation therapy and organotherapy. Injected in
rear with testicular extracts from animals and grafting. Didn’t work, no testosterone in extracts. Less
testosterone secretion not because of failing testes but lack of stimulatory signal from pituitary gland. A
peripheral gland releases hormone only if pituitary first releases hormone that activates the gland. Not the
master gland after all, following orders from the brain. Brain controls pituitary hormones by stimulating
release and controls others by inhibition. Geoffrey Harris: brain is also hormonal gland, releases hormones
that travel to pituitary and direct its actions. Roger Guillemin and Andrew Schally began looking for the
brain hormones. Brain communicates with pituitary by minuscule circulatory system. Each wanted to be
the first to isolate the putative hormones. Collected animal brains. Injected purified droplets into rats to see
if pituitary changed pattern of hormone release. One factor was scale, thousands of brains at a time. New
types of chemistry had to be invented. 14 years later, chemical structure of first releasing hormone was
published, later the next and then another. Hypothalamus contains huge array of releasing and inhibiting
hormones which instruct the pituitary, which regulates secretions of the peripheral glands. Brain can trigger
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