Possible Effects Of Emotion

Categorical denials are dangerous in science. We prefer to answer the tension argument in this way: There is no objective evidence in man or animals that prolonged tension or emotional strain, or any number of periods of emotional excitement, can induce atherosclerosis or cause the blood to clot in the arteries. But emotions can certainly alter our way of life, reduce us to immobility or fire us to extreme exercise, shut off all desire for food, or, by a curious perversity, lead us to seek solace by overeating. Emotions may even persuade our appetites to favour some kinds of foods over others or alter our sense of values so that we are unresponsive to the sensible signals of a normal physiology telling us when we should eat or exercise or rest or stop doing these things. By such a devious pathway we can at least conceive of tension and emotion having an indirect effect on the development of coronary heart disease.

It may seem to be altogether beyond comprehension why there is such frequent acceptance of the theory that tension and emotional stress can cause coronary heart disease, but a leading British doctor, W. Melville Arnott, pointed out that this is really not so strange. The patient, stricken out of the blue, asks himself and his doctor, why? No obvious physical explanation being at hand, patient and doctor alike are driven to consider the intangible world of the spirit and the psyche. In most cases it is no use trying to suggest physical over-exertion; very likely the poor patient has really not had any heavy exercise for years. Nor, contrary to popular notion, is it often that the attack followed on an emotional crisis. But the theory of tension is providential; without explaining anything it seems to put the blame where it is most acceptable to all concerned. It suggests that the patient's trouble is the unjust reward of unremitting devotion to his responsibilities and the commendable pursuit of high ambitions - all of which is to say that he has been living in a state of stress, partly self-made (but laudable), partly occasioned by the high-pressure time we live in. The fact that this is only a plausible string of words does not make it the less acceptable. In dire illness we are particularly attracted to egocentric conceits, and this theory not only panders to the self-pity of the patient; it pleases the family and is likely to appeal to the physician. The doctor, in fact, is relieved to have recourse to such a well-received theory that also suggests the kind of advice he can give without risk - "take it easy, relax !"

By the same token it is understandable why there is often surprising resistance to the explanation that the diet, perhaps abetted by lack of exercise, probably played a major role in developing the disease that finally disclosed itself in the heart attack. To put it baldly, few patients like to think their sad state is the result of years of self-indulgence, of soft living on over-rich food, and a chronic state of physical indolence.

Stress And Cholesterol

Recently it has been reported that a period of "stress" of some days or weeks is frequently associated with a moderate rise in the level of cholesterol in the blood. Measurements have been made during a period of ordinary emotional life and again when life is disrupted by long hours and some anxiety - university students in final examination time, accountants in the income-tax season, and so on.

In none of these studies was there real control to assure constancy of the diet, exercise or the use of alcohol so it is not possible to conclude that the stress alone actually caused the blood cholesterol to rise. But these findings have been offered as the most "scientific" evidence that stress may tend to promote coronary heart disease.

Perhaps the most significant feature of these recent researches is the tacit acceptance of the idea that an elevation of the blood cholesterol is bad or dangerous and that stress may be detrimental on this account. But it should be noted that whether a person is under such emotional stress or not, reduction in the saturated fats in the diet and substitution of some poly-unsaturated fat will certainly cause the cholesterol to fall. The moral may be that people under stress should be particularly careful about their diet.

Exercise The idea that coronary heart disease may be blamed on too much physical exercise never had many adherents and has long since been abandoned. Sometimes, perhaps, an unusual bout of exertion is associated with the precipitation of a dramatic heart episode, but it is universally agreed that in such cases the basic disease was well established previously. Much more to the fore recently is the theory that lack of physical exercise promotes the disease. We ourselves are inclined to believe that sedentary life is something of a hazard and that exercise may have some prophylactic influence, but the evidence is far from clear and, moreover, it seems to get mixed up with the dietary problem.

The apparently better health record of farmers in regard to coronary heart disease has been offered as an example of the benefits of exercise. The advantage of hard work in the country is not always the rule, however, as we found in Finland where there is a very high incidence of coronary heart disease among the hardworking farmers and loggers. Most important may be the fact, recently found by the Food and Agriculture Organization of the United Nations, that in all parts of the world the rural populations tend to subsist on diets lower in fat concentration than those eaten by their more urban compatriots. Clearly, analysis of the effect of exercise is complicated by the fact that in most societies the men who do hard physical work also eat diets different from those eaten by the men in sedentary and light work.

The most impressive of recent studies purporting to show that lack of exercise promotes the development of coronary heart disease comes from London, where it appears that the bus drivers, who sit at their work all day, are more prone to have heart attacks than are the conductors who spend a good deal of time climbing up and down the stairs of the double-decker buses. The suggestion is that the difference between the two classes of employees is caused by the differences in the habitual level of physical activity. On closer examination, however, it is found that the two classes of busmen differ in at least one significant way before they start on their respective jobs. The men who take the job of driver are fatter than the conductors and this difference persists as time goes on. There is no information about the respective dietary habits of the two classes of men, but we should be surprised if they proved to be identical. We can say this with confidence because, if there is really a large difference between the activity and energy cost of the two types of jobs, the men must differ in the total amount of food eaten. And, if these men are like men studied elsewhere, those taking the greater calorie supply get the calorie difference largely in the form of non-fatty food such as bread, potatoes, and jam in England or as spaghetti in Italy.

The reported difference in the frequency of coronary heart disease between the two types of London busmen is significant, but it is really small compared with the differences observed between populations whose diets are markedly different in fat content. We suggest, then, that if exercise is a factor, its effect is much less than that of the diet or that the effect of exercise is at least partly a result of its influence on the diet; when you exercise you eat more low fat foods and the percentage of fat calories decreases in your diet.

All this does not prevent us from being in favour of more exercise for ourselves and for the public at large. But we are not impressed by a few minutes of calisthenics in the morning or a week-end spent on the golf course. Physiologically, there does not seem to be much prospect of achieving anything significant unless the exercise is hard enough or long enough, or both, to give the heart and circulation some real work to do and to add up to an appreciable number of calories burned, say at least 2,000 extra calories a week.

The coronary heart patient will, of course, be guided by his doctor in the matter of exercise. By and large the best modern thinking on that score is to encourage as much exercise as can be tolerated and to provide a programme of increasing exercise something like, on a lower level, the retraining of an athlete who has allowed himself to get out of condition. The heart muscle, even if it has a small scar in it, can be strengthened by exercise in the same way as any other muscle.