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Stress Reduction in the NonPharmacologic Treatment of Metabolic Syndrome


Trials using Massage Therapy, Music Therapy, Yoga, Qigong, and TM all had ... Cortisol decreases and serotonin and dopamine increase following massage therapy. ... – PowerPoint PPT presentation

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Title: Stress Reduction in the NonPharmacologic Treatment of Metabolic Syndrome

Stress Reduction in the Non-Pharmacologic
Treatment of Metabolic Syndrome
  • PAS 646 Masters Project
  • Sherry Kiernan
  • February 22, 2007

Metabolic Syndrome
  • 3 out of 5 of the following risk factors
  • Abdominal Obesity
  • Increased Trig., LDL, Fasting Plasma Glucose
  • Decreased HDL
  • The cardiovascular risk associated with the
    syndrome increases exponentially with each
    additional factor1
  • 25 of adults fulfill the requirements for MetS2

Current Non-Pharmacologic Treatment Options
  • There is no accepted pharmacological treatment
  • The recommended non-pharmacologic treatments are
    limited to Diet and Exercise
  • The challenge in recommending diet and exercise
    is that not all programs are equally effective
    for everyone (high rate of failure)
  • Usual recommendation is a diet low in fat, high
    in fiber and fruits/veggies and at least 30
    minutes of exercise daily7

First Goal of Treatment
  • Clinically significant decreases in serum
    triglycerides, total cholesterol, and increases
    in HDL have been observed with even modest weight
    loss (10)9
  • Improvement in blood pressure and insulin
    resistance occurs as well9
  • Weight Loss Should Be the Initial Goal of
    Treatment in MetS!

Abdominal Obesity
  • To find an effective treatment, it is important
    to understand the role of abdominal obesity in
  • The pear shape of Gynoid obesity is not
    associated with developing MetS
  • The apple shape of Android or Abdominal obesity
    is one of the defining characteristics of MetS
    and may be the cause of developing all of the
    other risk factors
  • The main difference is the metabolism of
    adipocytes depending on where they are distributed

Role of Stress and Cortisol in Abdominal Obesity
  • Chronic Stress leads to HPA axis dysregulation of
    cortisol and plasma levels stay elevated
  • The more metabolically active abdominal
    adipocytes are more responsive to chronically
    elevated levels of cortisol
  • As a glucocorticoid, cortisol has many effects on
    glucose metabolism
  • Opposition of insulin
  • Inhibition of protein synthesis in peripheral
  • Activates lipoprotein lipase which causes an
    accumulation of lipids in abdominal adipocytes

The Stress Link
  • Chronic stress contributes to MetS when the
    stress is frequent and the ability to cope is
  • The HPA Axis becomes unresponsive to the
    physiologic diurnal variation
  • Blood levels of cortisol never return to basal
    levels after a period of stress6
  • Animal studies have proven that a daily trough
    lasting several hours is necessary to prevent
    negative effects of excess cortisol on peripheral

Relationship Between Stress, Cortisol, and MetS
  • MetS is not just about weight loss - it is a
    complex syndrome with many causal factors
  • There is a strong relationship between
    chronically increased levels of cortisol due to
    stress and accumulation of fat in the abdominal
  • Stress is an integral part of every day life for
    most people
  • Diet and Exercise may not be sufficient to
    correct the HPA axis dysfunction
  • Incorporating a stress-reducing therapy into the
    treatment of MetS may help to break the cycle of
    dysregulation and assist patients in losing the
    abdominal fat that is contributing to the syndrome

What Are the Stress-Reducing Options?
  • Massage Therapy
  • Music Therapy
  • Yoga
  • Qigong
  • Transcendental Meditation
  • (Just to name a few)

How do we measure Stress?
  • The intimate relationship between plasma cortisol
    levels, stress, and MetS suggests that measuring
    changes in cortisol production would be a
    consistent way of evaluating the efficacy of each
  • Changes in plasma, salivary, or urinary cortisol
    levels can be measured

What Were the Findings?
  • Trials using Massage Therapy, Music Therapy,
    Yoga, Qigong, and TM all had positive findings
    for lowering cortisol levels
  • Most of the studies had other positive findings
    such as lowered blood pressure or better insulin
    utilization further supporting the benefits for
    Met S patients

Transcendental Meditation May Decrease
Healthcare Costs
  • Numerous studies have shown the benefits of TM
    for lowering stress and improving the risk
    factors associated with MetS15
  • What makes TM unique is that the cost-benefit of
    using TM for health improvement has actually been
  • 5 years of insurance claims by 2000 practitioners
    of TM were analyzed
  • They had 87 fewer inpatient admissions and
    outpatient visits for cardiovascular disease
  • The non-cardiovascular disease related visits did
    not change so there was no aversion to
    traditional medicine

Advantages and Disadvantages to each type of
Relaxation Therapy
  • Alleviating chronic stress helps to normalize
    cortisol levels
  • Restoring balance decreases deleterious effects
    of cortisol excess on peripheral tissues
  • May help to lose the abdominal obesity - improves
    all aspects of the syndrome
  • Adding a relaxation method to diet and exercise
    may be the key to treatment success in Metabolic
    Syndrome Only more research will tell

  • 1. Hadley, RD. Treatment options for metabolic
    syndrome. The Clinical Advisor. 2005 Nov45-55.
  • 2. Levy D. Epidemiology of obesity and its
    cardiovascular consequences. Audio-Digest Special
    Topics. 2006 May10(2).
  • 3. Nesto R. Metabolic syndrome and obesity.
    Audio-Digest Special Topics. 2006 Jun10(3).
  • 4. Gans, RO. The metabolic syndrome, depression,
    and cardiovascular disease interrelated
    conditions that share pathophysiologic
    mechanisms. Med Clin N Am. 200690573-91.
  • 5. Hjemdahl, P. Stress and the metabolic
    syndrome an interesting but enigmatic
    association. Circulation. 20021062634.
  • 6. Bjorntorp P. Do stress reactions cause
    abdominal obesity and comorbidities? Obes Rev.

  • 7. Kushner R. Modest weight loss and
    cardiometabolic risk. Audio-Digest Special
    Topics. 2006 May10(2).
  • 8. Jacobson L. Hypothalamic-pituitary-adrenocortic
    al axis regulation. Endocrinol Metab Clin N Am.
  • 9. Borgman M, McErlean E. What is the metabolic
    syndrome? Prediabetes and cardiovascular risk. J
    Cardiovasc Nurs. 200621(4)285-90.
  • 10. Field T, Hernandez-Reif M, Diego M, Schanberg
    S, Kuhn C. Cortisol decreases and serotonin and
    dopamine increase following massage therapy. Int
    J Neurosci. 20051151397-1413.

  • 11. Miluk-Kolasa B, Obminski Z, Stupnicki R,
    Golec L. Effects of music treatment on salivary
    cortisol in patients exposed to pre-surgical
    stress. Exp Clin Endocrinol. 1994102(2)118-20.
  • 12. Innes KE, Bourguignon C, Taylor AG. Risk
    indices associated with the insulin resistance
    syndrome, cardiovascular disease, and possible
    protection with yoga a systematic review. J Am
    Board Fam Pract. 200518491-519.
  • 13. Lee MS, Lee MS, Kim HJ. Qigong reduced blood
    pressure and catecholamine levels of patients
    with essential hypertension. Int J Neurosci.

  • 14. Lee MS, Rim YH, Kang CW. Effects of external
    Qi-therapy on emotions, electroencephalograms,
    and plasma cortisol. Int J Neurosci.
  • 15. Paul-Labrador M, Polk D, Dwyer JH, Velasquez
    I, Nidich S, Rainforth M, et al. Effects of
    randomized controlled trial of transcendental
    meditation on components of the metabolic
    syndrome in subjects with coronary heart disease.
    Arch Intern Med. 20061661218-1224.
  • 16. Waltonb KG, Schneider RH, Nidich S. Review of
    controlled research on the transcendental
    meditation program and cardiovascular disease.
    Cardiol in Review. 200412262-6.

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