HealthSmith Wellness Letter

Marshalling wellness resources to help you optimize your health.           Fall  2000     Volume 3   Issue 4  

 How do you make work a healthier place?

Tracy has had headaches for years. She’s seen her doctor and a neurologist, but all the tests are normal and yet the pain persists. Last week, her counsellor suggested her pain might be work related.  Tracy loves her job, but her manager, Derek, is uncaring and rude. Her organization routinely overburdens its best workers until they burnout or leave. High demand and low reward make this a toxic workplace.
Toxic Workplaces: Disability claims total eight per cent of Canadian payroll costs. When the indirect costs of absenteeism, lost productivity, reduced quality, over-time pay, re-recruitment and re-training are factored in, the real price tag of toxic workplaces is nearly $20 billion annually. Toxic workplaces have low morale and high staff turnover. The most toxic have double the rate of heart disease, triple the rate of family violence and five times as much cancer compared to the least toxic workplaces.   Form a Change Team: Tracy met with interested colleagues and formed a change team, who were charged with prioritizing the changes necessary for a healthier workplace. Expect Resistance Of course, there was some grumbling from those afraid to voice their concerns and unmotivated to participate. Someone even leaked their intentions to HR. Upper management reacted swiftly to squash their protest, denying there was a morale problem and minimizing the high staff turnover rate. Create a Strategic Change Plan: Tracy knew this would happen, but she had a plan. The committed group of change agents continued to meet weekly. They knew they were on the right track. They just needed to figure out how to express themselves to the new CEO, Helen, in a compelling way. Use Confidential Assessments: Tracy knew of a web-site, improvenow.com that allowed workers to rate their managers using a confidential questionnaire followed by an anonymous e-mail to Helen. Leverage Personal Connections:  A month later Tracy bumped into Helen at the company golf tournament. After a few drinks, Tracy admitted that she had engineered the confidential assessments.  Seek out Leaders who Listen / Care: Helen seemed genuinely interested. Tracy felt safe to express her concerns about Derek and the way upper management had shut them down. Speak to stakeholders in terms of the impact of change on Shareholder Value: Helen was shocked. She now understood their high disability costs and decided that Derek’s management style was too focused on “productivity” ignoring the morale of the workers, thus increasing turnover and decreasing shareholder value. Seek top down initiative driven by bottom up communication: Tracy asked Helen to review Derek’s performance. It turns out that his file was full of complaints from both subordinates and superiors for the last 5 years, but no one had told Helen. Address Mental Illness without Stigma: Helen listened carefully and learned how Derek was devastated by the loss of custody of his son after his divorce five years ago. He became depressed, started drinking, and felt overwhelmed and out of control at work. He had been reluctant to seek help because of the stigma of mental illness in his family, the company and among his peers. Helen suggested in a supportive way, and Derek agreed to meet with the company’s addiction-trained physician and seek some counseling. Practice Self Care: Tracy started a yoga class, she’s eating more fruits and vegetables and is learning to talk about her frustrations rather than stuffing them down with food. As a result, she’s lost a few inches her sleep is deeper, and the headaches are rare. Never doubt the power of a small group of committed people: Derek got the help he needed. Helen funded a workplace wellness initiative including ongoing confidential assessments. Since then, customers and employees are happier, turnover has slowed and shareholder value is up.

Anthony Ocana, Medical Director

Wellness Update

Words That Sting

Words may not break bones, but new research shows that they may cause physical harm.  In a study of more than 1000 women, emotionally abused women were more likely to report poor physical health than other women, and their reported ailments were strikingly similar to those affecting physically abused women.

Ann Coker, Ph.D., a University of South Carolina associate epidemiology professor, discovered that psychologically battered women’s most commonly reported health problems were also stress-related and have been strongly linked to physical abuse.

In light of the study’s results, the researchers believe health care providers should regularly screen women for psychological abuse as well as physical and sexual violence. “Not to talk about it in a health care setting is to ignore a huge issue in mental and physical health,” Coker says. Psychology Today October 

Antioxidants in war on dementia

WASHINGTON--Eating your veggies and taking your vitamins high in antioxidants may lower your risk of Alzheimer's disease and other forms of dementia by 20% through decreased oxidative stress.

Two independent studies assessed long-term intake of dietary and supplemental antioxidants and subsequent incidence of dementia. Oxidative stress is caused by free radicals, very reactive chemicals that cause cellular and tissue damage, including the formation of amyloid plaques in the brain, one of the hallmarks of Alzheimer’s dementia.

"The brain is perhaps more susceptible to oxidative damage than other body organs because of its high metabolic rate, its lipid-rich content and the fact that there are few natural anti-oxidant defence mechanisms," said Martha Clare Morris (PhD), assistant professor at Rush Presbyterian-ST Luke's Medical Center in Chicago

Of four antioxidants investigated, dietary vitamin E had the strongest association with reduced risk of dementia, and beta-carotene and vitamin C had smaller effects. Flavonoids had no significant association with dementia risk.

Dr. Marianne Englehart, a researcher at the Erasmus Medical Center in Rotterdam, said this was the first study to look at the relationship between dietary intake of antioxidant and risk of dementias. The Medical Post August 22, 2000

Hormone Levels in Postpartum Depression

Researchers have for a long time suspected that rapid changes in levels of estrogen and progestins play a role in  postpartum depression. In this study, researchers simulated pregnancy and child birth in 2 groups; 8 had prior postpartum depression, and 8 had no such history. Five out of eight of the women with prior postpartum depression, but none of the controls, experienced significant worsening of depressive symptoms during hormone withdrawal.

Because all participants had been symptom free  for at least 1 year, the results suggest that their mood sensitivities to falling hormones levels result from biological vulnerabilities, including genetic factors.  These findings raise the possibility that mood swings induced by falling hormones may also explain the mood swings of PMS.

  Anger Increases Coronary Disease Risk

  Tendencies toward anger have been associated with high blood pressure and risk for coronary disease in some studies.  The importance of anger was explored in 12, 986 adults enrolled in a long term U.S. study.  All subjects completed the 10-item Anger Trait Scale.

     Compared with moderate or low scorers, high anger scorers were more likely to smoke, drink and have central obesity.  Among patients without hypertension, the risk for coronary events increased with increasing of anger. The demonstration of a dose-response relation between anger and coronary disease events strengthens the case for a causal relationship.  Whether an intervention to control anger can reduce the risk for coronary disease is unknown.               Circulation 2000 May                                                                             

What Patients Don't Say May Cause Problems

Dieting Damage

Weight conscious mothers beware: Counting your children’s calories may lead them to develop unhealthful eating habits. In a recent study published in the American Journal of Clinical Nutrition, 5 year old girls whose mothers restricted them from eating sweet, energy dense foods on a daily basis consumed about 50% more of these foods when presented with them- even on a full stomach- than girls who were allowed to include these foods in their everyday diet. “Heavier girls get more restrictions, but restrictions leads to greater intake,” explains Lean Birch, Ph.D., of Pennsylvania State.  She believes that instead of restricting children from eating certain foods, parents should regularly present their kids with healthy snacks, but still allow occasional treats. “Restriction focuses kids on food, so they learn to eat in its presence instead of paying attention to internal cues”.    Psychology Today October 2000

  Effects of Low Serotonin on Aggression in Men

A substantial amount of research suggests that reduced availability of serotonin is associated with increased aggression. This study, in 12 men with histories of aggression and in 12 men without, suggests that aggressive men are more prone to aggression than non-aggressive men after reduced of serotonin availability in the central nervous system by tryptophan depletion.  It is well known that anger attacks, commonly seen in depressed patients, respond to treatment with medications that raise brain serotonin levels.  This suggests that aggression in men can not only be treated, but also prevented with judicious medical intervention.          Neuropsychopharmacology 2000 Apr 22

Women exercise and risk of breast cancer?

Researchers at the Netherlands Cancer Institute in Amsterdam compared women aged 20 to 54 who had been diagnosed with invasive breast cancer with women who did not have cancer.  The women were interviewed about their lifetime recreational activity, type and duration. Activities included walking, gardening, running and competitive sports.

The study, published last January in the Journal of the National Cancer Institute, found that active women had a 30 percent lower risk of breast cancer than those who were inactive.  Regular activity offered the most benefit to women who managed to keep their weight proportionate to their height. A woman's age at the time of exercise was not as important as exercising regularly.

Breast cancer is hormone-related, and fatty tissue produces more estrogen and risk of breast cancer.  Vigorous activity early in life reduces estrogen by delaying the onset of menses. It can also help keep fat from accumulating around the abdominal area where it is known to increase breast cancer risk.             Women's Health Matters  May 2000

Combined Treatment Is Best for Chronic Depression

Chronic depression affects 3% of the U.S. population and accounts disproportionately for the societal burden of mental illness.  Both medication and psychotherapy are effective, although the advantage of combining treatments is unclear.  This large, multi-center study compared 12-week efficacy of antidepressant medication, cognitive-behavioral analysis, and combined treatment in 681 adults with chronic depression.

Although all groups showed significant improvement, combination treatment was far superior to single treatment.     Response rates for combination therapy, medication and psychotherapy were 73%, 48% and 48%.

 This  well designed study demonstrated that combined treatment is superior to medication or psychotherapy alone.  The more rapid onset of effect with medication and delayed effect with psychotherapy are consistent with studies of depression and other mood disorders.  Although the study lacked a placebo group, most studies of chronically depressed patients report placebo response rates of less than 20%.  Longer-term effects of treatment remain unclear; the presence of at least residual symptoms in 50% to 60% of patients indicates the need for additional treatments.     N Engl  J Med 2000 May 18

Women's Health Q and A

Q: Can an extended period of high stress bring on menopause or symptoms of menopause? 

A:  In medicine, almost anything can happen.  For example, menopause can follow a period of high stress, but that is different than suggesting that menopause can be caused by stress. Here's how menstrual periods are related to the brain.

The pituitary gland, at the base of the brain, releases two hormones called LH and FSH.  They travel through the bloodstream to the ovaries and signal the ovary to produce the hormones estrogen and progesterone and to begin the development of an egg.  As long as the ovary is able to respond, it takes just a little bit of LH and FSH to trigger the cycle.

Imagine that the brain uses FSH as its "Voice" and whispers to the ovary.  As women approach menopause, the ovary doesn't respond as well.  If we measure the FSH in women approaching menopause, we find that the level of FSH can be very high, but the ovary simply cannot respond as it used to.  The brain is shouting to the ovary, but the ovary doesn't hear.

This also happens if the ovaries have been damaged, for example, by radiation or certain chemotherapy drugs.  In these cases, the problem is with the ovary, and the FSH will rise.

During periods of stress, the pituitary gland stops sending out the hormones FSH and LH.  The stress may be emotional, a severe illness, a major weight loss or a combination of stresses.  When the stress symptoms subside, a woman's periods usually return.

Some women, particularly young women, are more susceptible to their periods not returning after extreme stress.  The problem here is not with the ovaries. It is in the brain where the periods are controlled.  Imagine in this case that the brain is not speaking to the ovary at all.