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Stress, Lifestyle Factors and Inflammation DrLindaMayerandProfRashidBhikha November2013 TheholisticapproachinTibbnotonlyillustratesthecomplexityofthe humanbeing,italsoillustratesthecomprehensiveunderstandingoftherelationship betweenthehumanbeing(microcosm)andtheenvironment(macrocosm),andtheroleof Physisinmaintaininghomeostasis.Itrecognisesthephysical,emotional,mental,socialand spiritualaspectsofthehumanbeing. Healthisastateofoptimalphysical,mentalandsocialwellbeing,which,inTibb,is dependentontheidealbalanceandratiooftheQualitiesandHumours,inrelationtothe Temperamentofanindividual. Tibbbelievesthatdiseaseisanaturalprocessandthatitssymptomsareanexpressionof thereactionsofthebodytorestorequalitativeand/orhumoralimbalances.Lifestyleand otherfactorsplayacrucialroleinmaintainingordisruptingthebalanceofthestateofthe body,whichmayresultinillnessordisease. Aself-preservativepowerorPhysis,strivestorestorethebalanceoftheHumours,inan efforttoregainand/ormaintainthehealthyequilibriumofthebody. Tibbrecognisesthemental,emotional,spiritualandphysicalcausesofillnessorhealth,as wellastechniquesofmodernscienceandmedicine.1Itseesthebodyasbeinginfinitely complex,notjustasimplemachine.Itunderstandsthatthereareseveralfactorsinthe originofmostdiseases.Itbringsinaperson’sdiet,lifestyle,emotions,interactionwiththe environmentandevenspiritualfactorsintoconsideration. Thereisadirectcommunicationbetweentheendocrine,theimmune,andthenervous systemsofthebody.Thebrainandtheimmunesystemcontinuouslysignaleachother, oftenalongthesamepathways,whichmayexplainhowone’sstateofmindinfluences health.Chemicalsproducedbyimmunecellssignalthebrain,andthebraininturnsends chemicalsignalstorestraintheimmunesystem.Theimmunesystemcommunicatesby releasingimmunecellsintothebloodstreamwhichtraveltonewlocationstodelivertheir messagesortoperformotherfunctions.2 Theimmunesystemisconnectedtothebrainandthebody,thereforesystemic inflammatoryreactionsandresponsescaninfluencethefunctioningofthebrain.Theblood brainbarrierfiltersbloodbornecellsandproteins,andperipheralcytokineseither penetratetheblood-brainbarrierdirectlyviaactivetransportmechanisms,orindirectlyvia vagalnerve.Thereisabundantevidencethatinflammatorymechanismswithinthecentral nervoussystemcontributetocognitiveimpairmentviacytokine-mediatedinteractions betweenneuronsandglialcells.3 Currentresearchsuggeststhatdepressionisaninflammatorydisorderbecausetheplasma levelsofcertaincytokinesareincreased,whileotherlevelsofmarkersarenotalteredin depression,suggestingthatthereisnoTcellactivationinthatillness.Findingsalsoindicate thatcell-mediatedimmuneactivationisthekeycomponentofdepression.4 StressandLifestyleFactorswhichtriggerInflammation LifestyleFactorsisbasedonthesystemsofthebody,andplayanintegralpartinthe maintenanceofhealthandpreventionandtreatmentofillness.“Health,stabilityandthe body’sstateofequilibriumareregulatedthroughmoisture,whichoppressestheheat. Eachofthesetwoqualitiesupholdstheother,andthebodyisupheldbythemboth. Whenoneofthemexceedstheother,thebodybecomesindisposedaccordingly.”5 Environmentalairandbreathingislinkedwiththerespiratoryandcardiovascular systems. • Foodanddrinkislinkedwiththedigestive,hepaticandmetabolicsystems. • Movementandrestarelinkedwiththemusculoskeletalsystem. • Sleepandwakefulnessislinkedwiththenervoussystem. • Emotionsarelinkedwiththenervoussystem. • EliminationandRetentionislinkedwiththerenal,dermatologicalandgenital systems. 1. Physicalstress • Thehumanbodyisaverycomplexsystem,completelyintegratedandindependent.Whilst apersonmaybesufferingfromaheadacheormouthsores,andthelinkbetweenthisanda toxin-filledcolonmaynotbeapparent,butinTibbthislinkasthecause,isclearlyidentified. Hippocratesbelievedthathealthistheeffectivedigestion,assimilationandeliminationof thelifestylefactors.Thecorrectamountofsleepisrequiredforeachperson’sideal temperament;andadequateretentionofnourishmentandeliminationoftoxinsisvitalto theoverallhealthofanindividual. Exerciseisbeneficialforthemaintenanceofhealthandwellness,withrespecttothe physical,emotional,mental,socialandspiritualfacetsoftheindividual.Ahealthybody createsahealthymindandahealthysoul.Whenallthesefacetsareworkinginunisonwith oneanother,thehumoursandfunctioningofthebodyandallitsmemberswillbein harmonywiththeoverallqualityofthetemperamentoftheindividual.Anychangesinthe qualityand/orratiosofheat,moistness,coldnessordryness,willaffecttheoverallhealthof theindividual.Theamountofexerciseneededforanindividualisdependentontheideal Temperament. Thefunctioningofeachpartofthebodyisinterdependentupononeanother.Forexample, ifthebrainisnotfunctioningatitsoptimalcapacity,thiswillinfluencethephysiologicaland psychologicalfunctioningofthebody. Physicalstressorsinclude: • • • • • • • • Traumafromabluntorpenetratingobject,suchasafalloraknifewound.Trauma mayalsobearesultofburnsorfrostbite.Foreignbodiesincludesplinters. Intensephysicalexercisesuchasweightliftingandotherhighintensity training/competitions. Lackofexercisecanalsoleadtoinflammationduetopoormuscleandligament strengthandtone,whichincreasetheriskofinjuries. Repetitivemotionsuchastypingorwalking,cyclingorjogging. Infectionsfrombacteria,viruses,parasites,fungioryeast.Anexampleisthe Helicobacterpylori(Hpylori)whichisabacteriuminthestomachthatcontributesto inflammationandthedevelopmentofulcers,becauseofweakeningofthe protectivemucousofthestomachandduodenum,fromtheeffectsofhydrochloric acidandpepsin.Otherinflammatorydiseasesincludegastriculcer,colitisorirritable bowelsyndrome. Co-existingchronicmedicalconditionssuchasarthritis,oranyotherinflammatory illnesses. Immunereactionsarealsoknownashypersensitivityreactions,suchasan anaphylacticshock.Allergiesfromfood,suchascaseinandglutenareproteins whicharefoundinwheatanddairyproducts,maycauseaninflammatoryresponse. Anexampleiscoeliacdiseasefromwheatintolerance. Aweakenedimmunesystemmayresultfrompoorlycontrolledco-existing premorbiddiseases,and/orpoorlymanagedlifestylefactors.Thisresultissevere pressureofPhysistorestoretheidealhumoralcompositionrequiredbyan individual’stemperament. 2. Environmentalstress Tibbrecognizestheintimaterelationshipthatexistsbetweentheindividualandthe environment.Theexistenceandwellbeingofanindividualdependsonthecontinuous interactionandadjustmentbetweentheirinternalandexternalenvironmentalfactors. Ifthebodyaccumulatestoxinsmanydiseaseswilloccur,suchasallergiesduringspringtime. Airistheprimarysourceofnutritionasoxygentransformsnutrients,presentinfood,into energyandintohumoursandbodyfluids.However,pollution,climaticandtemperature changes,humidityandairspeed,maypredisposepeopletoheartattacks,strokes, respiratoryproblemsandotherdisorders.Ifthequalityoftheairispoor,thentheonset anddevelopmentofspecificdiseasescanbeaccelerated.Manyoccupationaldiseaseshave theirorigininlungswhichhavebeenweakenedbyexposuretopoorqualityair. Whentheorganismsfailtoadjustoradapttotheenvironment,eitherduetoaweakened immunesystem(innatedeficiency),orduetooverwhelmingantagonisticenvironmental factors,whicharecontrarytotheidealhumoralcompositionforanindividual’s temperament,itresultsindiseaseordeath. Illnessconditions,linkedtohumours,exacerbateinseasonswherethereisapredominance ofthequalitiesassociatedwiththerespectiveseason.Forexample: DuringsummertheBilioushumourismoreactive,andaccumulatesduetotheincreased heat.Duringwinter,thephlegmatichumourismoreactive,andaccumulates,duetothe increasedmoisture.Duringspring,thephlegmatichumour,whichhasaccumulatedand hardened,beginstosoftenandmelt.Similarly,duringautumnanincreaseincold,cools downthelightandthinbilioushumour;bothseasonsarepreparingthesehumoursfor expulsion.6 Assummermovesintoautumn,thedaysremainhot,butthenightsgrowcolder.These wideningtemperaturefluctuationsputastrainonthebodytoadapt.Theporesmayopen andsweatduringtheheatoftheday,andalloweveningchillstoenter.Excesscoldfoods anddrinksconsumedinsummermayhavegeneratedsuperfluousphlegmatichumourthat mayincreaseone'svulnerabilitytochillswhentheweatherstartschanginginautumn.The coolweatherofautumncanproducedry,chappedskin,coryzaandsorethroats,coughsand hoarseness. Inwinterasaresultoftheincreasedfoodintaketoincreaseenergylevelstomaintain warmth,thephlegmatichumouraccumulatesandhardens.Ascoldbecomessevereand drynessintensifiesinmid-Winter,theMelancholichumourtendstogetaggravated, resultinginsymptomsofstiffandpainfuljointsandmuscles. Inspringthehardenedphlegmatichumourbeginstomeltandthevolumebecomesgreatin thecirculatorychannels.Asaresultoftheincreasedcirculatingphlegmatichumour,the digestiveactivityweakens,causingdiseases. 3. Emotionalstress Emotionsplayalargeroleinthehealthandwellbeingoftheindividual.Apositivemental attitudecaninfluencetheoutcomeofthehealingprocessandrecovery,whilstanegative mentalattitudecanresultinadelayorhaltinthehealingprocessandrecovery,illnessand evendeath. Thoughts,themind’senergy,directlyinfluencehowthephysicalbraincontrolsthebody’s physiology.Thought‘energy’canactivateorinhibitthecell’sfunction-producingproteins viathemechanicsorconstructiveanddestructiveinterference.7 Peopleresponddifferentlyundersimilarcircumstances,whichisinherentintheirgenetic make-upandTemperamentalQualities.Somepeoplecanhandlestress,andotherscannot. Somepeoplebynaturearecalm,andothersareeasilyruffled. Lifestressorssuchasbereavement,maritalseparation,academicexaminations,orthe stressofAlzheimerspousalcaregiving,haveallbeenshowntohaveeffectsonimmune function: Individualsundergoingbereavement,showalterationsofcellularimmunityand changesinbloodlevels. • Psychologicalstressduringrelativelyminoraversiveevents,suchasacademic examinations,temporallyincreaseswhitebloodcellcounts. • Chronicstressorsthatlastoverperiodsofoneormoreyearsnotonlyincreasethe riskfordepressionbutalsoarelikelytoresultinalterationsofimmunefunction.8 • Stressincreasesplateletactivation,whichisacauseofheartattacks.Other correlationsarepointedoutbetweenstressandgastrointestinaldisorders,chronic painanddiabetes. Everyemotionisconnectedtoaparticularorganofthebody,whichstimulatesarespective humourinthebody,forexample: • • • Angerhashotanddryqualities,andisconnectedtotheLiver,thegallbladder,the heartandthebrain.ApersonwithaBiliousTemperamentwillbemoreinfluenced bythenegativeeffectsoftheintensityofanger,duetoitssimilarqualitiesofheat anddryness. Anxietyandworryhavehotandmoistqualities,andareconnectedtothepancreas andspleen,andanexcessofheatandmoistnessmayresultintheimbalanceof glucosemetabolism,suchasinsulinresistanceandtype2Diabetes. • • • • Depressionhasmoistandhotqualities,andisconnectedtotheBrainandNerves, whichstimulatesthePhlegmatichumour.Excessivedepressionisharmfultothe brain,andcanleadtomarkedweaknessesinthebody,aswellaslackofenergy, enthusiasmandvitality. Fearhasqualitiesofcoldnessandmoistness,andisconnectedtothekidneysand urinarybladder,andlong-lastingfearresultsinexcessivecoldnessinthebody.Fear causesthebloodcirculationtosuddenlymoveinwards,causingtheskintobecome paleandcold,withshallowbreathing.Long-lastingfearresultsinexcessivecoldness inthebody. HappinessandExcitementhavequalitiesofheatanddryness,andareconnectedto theHeart. Griefhasqualitiesofcoldnessanddryness,andisconnectedtotheLungs,Brain, HeartandLiver.Excessivegrief,anguishorsadnessmayresultindiseasesand conditionsofthelungsandnervoussystems. Emotionalstressorsinclude: Inflammationismadeworsebystress,ashistamineisproducedasastress response.9 • Ifstressisexperiencedoveraprolongedperiodthelevelsofcortisolincrease,which alterstheeffectivenessofcortisoltoregulatetheinflammatoryresponse.Examples includeIrritableBowelSyndromeorInflammatoryBoweldisease. • Chronicstresscankillthegoodbacteriainthegut,suchaslactobacillus;alack thereofwillaffectdigestionandenzymesnecessaryforthegoodfunctioningofthe digestivetract.Examplesincludeindigestion,bloating,diarrhoeaorconstipation. • StresscausesthepHofthebodytobecomemoreacidic,whichenhancesthe environmentforthegrowthofbacteria.Thiscompromisestheimmunesystem, whichleadstodiseasesuchasulcerativecolitis. • Episodesofangerproduceharmfuleffectsintheheart,liver,anddamagethebrain. Excessiveoruncontrolledangerisassociatedwiththebilioustemperament,and increasesheatanddrynessinthebody. 4. ChemicalStress • Freeradicalsarechemicalswhichareproducedinthebodyfromoxidativestress,which largelyaffectsthejoints.Chemicalstressorsinclude: • • • • Theingestionofrancidfats. Anexcessofironorcoppersupplements,orotherfoodchemicals,cleaningfluid, cosmeticsandcarfumes. Irradiation. Toxins,suchasmercuryorpesticides. Anexcessintakeofalcohol,especiallysweetones,willpromoteinflammation. 5. Nutritionalstress • Thehumoursaretheprimaryfluidsthataremanufacturedfromthedigestionoffoodand drink,whichareprocessedandtransformedintheliver.Anydysfunctionintheliverwill affectthequantitativeandqualitativebalanceofthehumours. Excessiveintakeoffoodanddrinkwiththesamequalitiesasthedominantqualities associatedwithaperson’stemperamentwillincreasetherespectivehumourthefastestand themost.Forexample:ApersonwithadominantBilious(Hot&Dry)temperamentwillbe muchmoreaffectedbyfoodswhichhavequalitiesofheatanddryness,suchaschicken, onionandgreenandredpeppers.Hotanddryfoodswhicharepungent,spicy,seasonedor bitter,wouldalsoaffecttheBilioustemperamentthemost,because,ofthequalitiesofheat anddryness. TheuniqueTemperamentofanindividualenablesonetopredictwhoismorepredisposed tocertainillnessesconditions.Thisenablesonetobalancethequalitiesofheat,moistness, coldnessanddrynessbymakingtherightlifestylechoices,especiallyconcerningnutrition andtheintakeoftissuesalts.“Letfoodbethymedicineandmedicinebethyfood” (Hippocrates). Inflammationisonlypartofthedefencemechanismthebodyemploysinanattempttoheal itself.Whitebloodcellsareproducedinabundance,andrequirefuel,intheformof saturatedfatandcholesterol,bothforcellformationandrepair.9 Nutritionalstressorsinclude: • • • • Increasedbodyfatespeciallyinobesitywherebyfatcellsproduceinflammatory chemical; Adiethighinsaturatedfats(alsoknownas‘B’fats),mayhaveinflammatoryeffects onthebodyiftakeninexcess,orifonehasaco-existingmedicalconditionas explainedabove.Examplesincludedairyproducts,suchasbutter,cheese,cream andmilk. Adiethighintransfats(badcholesterol)andhydrogenatedfatsandoilsblocksthe productionofanti-inflammatoryagents.Examplesincludemargarineandpeanut butter.Transfatsalsocreatefreeradicalsthatdamagehealthycellsandtrigger inflammation. Adietwithanexcessintakeofomega-6polyunsaturatedvegetableoils,(alsoknown as‘A’fats)ishighinlinoleicacid,whichthebodyconvertsintoarachidonicacid, changingtheirnaturalant-inflammatoryqualitiestoinflammatoryones.Examples areassunflower,peanutsandsoy. • • • Adietconsistingofhighcarbohydratesandlowproteinisconsideredtobe inflammatory. Refinedsugarandotherrefinedandprocessedfoodshaveahighglycaemicindex, whichincreasesinsulinlevels,duetosurgesofbloodsugar.Thisput’stheimmune systemonhighalert.Hormonesinthebody,calledEicosanoids,whichactasantiinflammatoryagents,becomeimbalancedwheninsulinlevelsarehigh,which,in turn,activatesenzymesthatraiselevelsofarachidonicacidintheblood. Adietlowinantioxidants,suchasfreshvegetables,willpreventtheexpulsionoffree radicalsfromthebody. Anti-InflammatoryDiet • • • • • • Wholefoods:unprocessed,unrefined,realfoodandhighinpowerfulantiinflammatoryplantchemicalscalledphytonutrients.10 Monounsaturatedfats:suchasavocados,walnuts,almonds,pecansandBrazilnuts (alsoaplant-basedproteinsource),ricebranoil,grapeseedoilandwalnutoil.12 Fruitandvegetables:suchasgreenandbrightcolouredvegetablesandfruits,such asblueberries,strawberries,broccoli,spinach,squashandcarrots.Thesearerichin vitamins,minerals,fibre,antioxidantsandphytochemicals.11 Proteinsources:Nuts,leanpoultryandfattyfish(includesomega-3andprotein). Plant-basedproteinsourcesarefoundinlegumes,nutsandseeds,aswellassoyand soyfoods,suchastofu.11 Takeprobiotics:(“goodbacteria”)dailytohelpyourdigestiontoimprovethe healthybacteriainyourgutwhichreducesinflammation,suchasBulgarianyogurt.11 Otheranti-inflammatoryfoodsandantioxidantsinclude:Ginger,garlic,turmeric, oliveoil,berries,tartcherries,beets,tomatoes,peppers,soyandalmonds. Summary TheholisticapproachinTibbnotonlyillustratesthecomplexityofthehumanbeing,italso illustratesthecomprehensiveunderstandingoftherelationshipbetweentheindividualand theenvironment.Tibbemphasisestheneedforintegratingandrecognisingevery componentoftheindividual,fromthephysical,mental,emotionalandsocial,tothe spiritualaspects.Ittakesintoaccounttheidealtemperamentandhumoursofeach individual,respectingPhysis,inthemaintenanceofhealthandthecuringofdisease. ThesixlifestylefactorsareconsideredinTibbtobevitalcomponentsinthemaintenanceof healthandrestorationbacktohealthintheeventofdisease.Theseinclude:environment, airandbreathing;sleepandwakefulness;eliminationandretention;movementandrest; emotionsandfeelings,aswellasfoodanddrink. Wronglifestylechoicescantriggerinflammatoryreactionsinthebody,and,ifleft uncheckedorsuppressedbymedication,mayresultinchronicanddebilitatingconditions. References 1. Bhikha,R.A.H.&Haq,M.A.(2001).Tibb–TraditionalRootsofMedicineinModern RoutestoHealth.SouthAfrica:MountainofLight. 2. Sternberg,E.M.&Gold,P.W.(2013).TheMind-BodyInteractioninDisease.[Online]. Availablehttp://www.onbeing.org/program/stress-and-balancewithin/feature/mind-body-interaction-disease/1183 3. Craig,J.;Wilson,M.B.B.S.;Finch,C.E.;Cohen,H.J.(2002).CytokinesandCognition— TheCaseforAHead-to-ToeInflammatoryParadigm.JAGSDECEMBER2002–VOL.50, NO.12.[Online].Availablehttp://www.usc.edu/projects/nexus/faculty/deptldsg/finchcaleb/388%20Finch%20Cytokines%20and%20Cognition.pdf 4. Maes,M.(2011).Depressionisaninflammatorydisease,butcell-mediatedimmune activationisthekeycomponentofdepression.ProgNeuropsychopharmacolBiol Psychiatry.2011Apr29;35(3):664-75.[Online].Available http://www.ncbi.nlm.nih.gov/pubmed/20599581 5. Al-Jawziyya,Q.(2008).MedicineoftheProphet.Turkey:MegaPrinting. 6. TibbInstitute.(2013).TibbTrainingManual.LifestyleAdvisorTrainingCourse (revised).Johannesburg:IbnSinaInstituteofTibb. 7. Lipton,B.H.(2008).TheBiologyofBelief.UnleashingthePowerofConsciousness, Matter&Miracles.U.S.A.:HayHouse. 8. Irwin,M.(2000).[Online].PsychoneuroimmunologyofDepression.Available http://www.acnp.org/g4/GN401000098/CH096.html 9. Dean,J.(2011).Hyperbaricoxygenandinflammation.[Online].Available http://www.foodsmatter.com/natural_medicine_comp_therapies/oxygen_therapy/ articles/oxygen_inflammation.html 10. Bauer,B.(2013).BuzzedonInflammation.MayoClinicHealthLetter.[Online]. Available http://healthletter.mayoclinic.com/editorial/editorial.cfm/i/163/t/Buzzed%20on%20 inflammation/ 11. Jetvig,S.(2013).Anti-InflammatoryFoods.[Online].Available http://nutrition.about.com/od/dietsformedicaldisorders/a/antiinflamfood.htm