janice kiecoltjanice kiecolt--glaser, phdglaser, … stress...janice kiecoltjanice kiecolt--glaser,...

Janice KiecoltJanice Kiecolt--Glaser, PhDGlaser, PhDThe Ohio State University The Ohio State University

College of MedicineCollege of Medicine

“Oh, that’s Edward and his “Oh, that’s Edward and his fight or flight mechanism.”fight or flight mechanism.”

Glaser & KiecoltGlaser & Kiecolt--Glaser: Glaser: Nature Reviews Immunology, Nature Reviews Immunology, 20052005

g gg g

Critical periods of special health relevance Critical periods of special health relevance p pp pfor psychoneuroimmunology: Maximal for psychoneuroimmunology: Maximal

health impact from stressorshealth impact from stressorspp(Coe & (Coe & LubachLubach, , Brain, Behavior, & ImmunityBrain, Behavior, & Immunity, 2003), 2003)

Infants and children: Infants and children: immature immune and immature immune and endocrine responses endocrine responses ppOlder adults: normal ageOlder adults: normal age--related immunerelated immunerelated immune related immune senescence, which senescence, which increases riskincreases riskincreases riskincreases risk

““Nothing to worry about, it’s Nothing to worry about, it’s all part of the aging process.”all part of the aging process.”

Dementia family Dementia family caregiving as acaregiving as acaregiving as a caregiving as a chronic chronic stressor stressor --especially for especially for women women

“The 88-year old former airline pilot had been ill for five years, during which time his cognitive abilities had steadily deteriorated. At times he did not recognize his wife and accused her of being a stranger. He could only follow the most simple of commands. His moods were extremely labile, with frequent crying spells and occasional outbursts of anger. He often followed his wife around the house, interrupting her activity with questions and demands. Urinary incontinence and night time agitation were bothersome problems. He often paced at night, occasionally leaving the house and becoming lost... His wife of forty years now devoted her time to looking after her husband. She rarely left home except to do necessary shopping or bill paying, and rarely invited neighbors or friends to her home because of embarrassment about her husband’s behavior.”

Barnes et al., Journal of the American Geriatrics Society, 1981

STRESS ALTERS VACCINE RESPONSES:STRESS ALTERS VACCINE RESPONSES:CAREGIVERS’ ANTIBODY RESPONSES TO INFLUENZA VACCINE CAREGIVERS’ ANTIBODY RESPONSES TO INFLUENZA VACCINE WERE SUBSTANTIALLY POORER THAN WELLWERE SUBSTANTIALLY POORER THAN WELL MATCHED NONMATCHED NONWERE SUBSTANTIALLY POORER THAN WELLWERE SUBSTANTIALLY POORER THAN WELL--MATCHED NONMATCHED NON--

CAREGIVERS CAREGIVERS

Kiecolt-Glaser, Glaser, Gravenstein, Malarkey, Sheridan: Proceedings of , , , y, g fthe National Academy of Sciences, USA, 1996

Replication with caregivers published by Vedhara et al. in Lancet, 1999

6.00

PNEUMOCOCCAL ANTIBODY TITERS

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3.50

Baseline 2 weeks 1 month 3 months 6 months

Glaser, Sheridan, Malarkey, MacCallum, & Kiecolt-Glaser : Chronic stress modulates the immune response to a pneumococcal pneumonia vaccine. Psychosomatic Medicine, 2000

Vaccine responses provide a proxyVaccine responses provide a proxyVaccine responses provide a proxy Vaccine responses provide a proxy for responses to infectious diseasefor responses to infectious disease

M lti l l b h h tM lti l l b h h t l t dl t d Multiple labs have shown stressMultiple labs have shown stress--related related alterations in both antibody and Talterations in both antibody and T--cell cell responses to viral and bacterial vaccines responses to viral and bacterial vaccines i l dii l diincluding including Hepatitis BHepatitis B Influenza virusInfluenza virusInfluenza virusInfluenza virus Pneumococcal pneumoniaPneumococcal pneumonia RubellaRubella Meningitis C conjugateMeningitis C conjugate TetanusTetanus

STRESS SLOWS STRESS SLOWS

Caregivers took an average ofCaregivers took an average of

WOUND HEALINGWOUND HEALINGCaregivers took an average of Caregivers took an average of 24% longer than well24% longer than well--matched matched controls to heal the same small, controls to heal the same small, t d di d dt d di d dstandardized wound.standardized wound.

KiecoltKiecolt--Glaser, Marucha, Glaser, Marucha, M l k M d & GlM l k M d & GlMalarkey, Mercado, & Glaser:Malarkey, Mercado, & Glaser:LancetLancet, 1995, 1995

ORAL WOUND HEALING AND ACADEMIC STRESSORAL WOUND HEALING AND ACADEMIC STRESS

d l d (SUBJECTS: 11 dental students (9 men, 2 women, average age=24.36)

DESIGN: Two punch biopsy wounds were placed on the hard palate

-at the end of summer vacation-three days before the first major exam of the term (contralateral side)

Psychological and health behavior data were collected at each time point

Each student served as her or his own control

Pain/discomfort ratings were low, with 95% reporting mild or no discomfort

Marucha, Kiecolt-Glaser, & Favagehi: Psychosomatic Medicine, 1998

Days to heal for each of the 11 students; no student healed as rapidly d i i h h d ki 40% ( 3 d ) l

16

during exams, with the average student taking 40% ( 3 days) longer

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14

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VACATION EXAMSVACATION EXAMS

Marucha, Kiecolt-Glaser, & Favagehi: Psychosomatic Medicine, 1998

Stress increases susceptibility to wound infectionsCompared to control mice, restraint stress delayed wound Compared to control mice, restraint stress delayed wound

healing by 30% and caused a 2healing by 30% and caused a 2--5 log increase in opportunistic 5 log increase in opportunistic bacteria (e.g., bacteria (e.g., Staphylococcus Staphylococcus aureusaureus))( g ,( g , p yp y ))

By day 7, 85.4% of restraintBy day 7, 85.4% of restraint--stress mice had bacterial counts stress mice had bacterial counts predictive of infection, vs. 27.4 of controlspredictive of infection, vs. 27.4 of controls

Rojas, Padgett, Rojas, Padgett, Sheridan Marucha:Sheridan Marucha:Sheridan, Marucha: Sheridan, Marucha: Brain, Behavior, and Brain, Behavior, and ImmunityImmunity 20022002

6h 6h 11 3 5 3 5 77

Days after woundingDays after wounding

Greater fear or anxiety prior to surgery isGreater fear or anxiety prior to surgery isGreater fear or anxiety prior to surgery is Greater fear or anxiety prior to surgery is associated with a slower and more complicated associated with a slower and more complicated postpost--operative recovery:operative recovery:

higher higher postpost--surgical distresssurgical distress

tt tt ti iti i l il igreater greater postpost--operative pain, more operative pain, more analgesic analgesic medicationmedication

more more postpost--surgical complicationssurgical complications

longer longer hospital stayshospital staysgg p yp y

slower return to normal activitiesslower return to normal activities

“…Healing is a living process, greatly under…Healing is a living process, greatly under the influence of mental conditions. It has often been found that the same wound o te bee ou d t at t e sa e wou dreceived in battle will do well in the soldiers that have beaten, that would prove fatal in ve be e , wou d p ovethose that have just been defeated.”

--Oliver Wendell Holmes, 1854,

Infection and Trauma Trigger theInfection and Trauma Trigger theInfection and Trauma Trigger the Infection and Trauma Trigger the Inflammatory ResponseInflammatory Response

Inflammatory mechanisms are critical to Inflammatory mechanisms are critical to resolving infections and repairing tissueresolving infections and repairing tissueresolving infections and repairing tissue resolving infections and repairing tissue damagedamageP i fl t t ki tt t iP i fl t t ki tt t i Proinflammatory cytokines attract immune Proinflammatory cytokines attract immune cells to sites of infection or injury, and cells to sites of infection or injury, and acti ate the cells to respond to the ins ltacti ate the cells to respond to the ins ltactivate the cells to respond to the insultactivate the cells to respond to the insult

Chronic or Recurring Infections Can Provoke PathologicalPathological Changes

Low levels ofLow levels of persistent inflammation (higher levels of proinflammatory cytokines) may becytokines) may be provoked by chronic infectious processes

Changes in circulating hormones and ILChanges in circulating hormones and IL--6 with aging6 with aging

Papanicolaou et al. Annals of Internal Medicine 1998

AGEAGE--ASSOCIATED ASSOCIATED DISEASES LINKED TO DISEASES LINKED TO PROINFLAMMATORY PROINFLAMMATORY CYTOKINESCYTOKINESCardiovascular diseaseCardiovascular disease

Osteoporosis

Arthritis

Type 2 diabetesCancerPeriodontal disease

Alzheimer’s disease

Frailty & functional decline

Inflammation Impacts Cancer: PathwaysInflammation Impacts Cancer: PathwaysInflammation Impacts Cancer: PathwaysInflammation Impacts Cancer: Pathways

Aggarwal et al. Inflammation and cancer: How hot is the link? Biochem Pharmacol. 2006Aggarwal et al. Inflammation and cancer: How hot is the link? Biochem Pharmacol. 2006

Chronic or Recurring Infections CanChronic or Recurring Infections CanChronic or Recurring Infections Can Chronic or Recurring Infections Can Provoke Pathological ChangesProvoke Pathological Changes

Low levels of persistent inflammation may be provoked by chronic infectious processes, e.g.,

P i d t l diPeriodontal diseaseUrinary tract infectionsHelicobacter pyloriHelicobacter pyloriChronic pulmonary diseaseChlamydophila pneumoniaey p p

Stress/depression Stress/depression

Immune dysregulationImmune dysregulation

Enhanced risk of infection/prolonged Enhanced risk of infection/prolonged infections/delayed wound healinginfections/delayed wound healing

Increased proinflammatory cytokine Increased proinflammatory cytokine productionproductionproductionproduction

STRESS/DEPRESSION ENHANCE STRESS/DEPRESSION ENHANCE PROINFLAMMATORY CYTOKINE PRODUCTIONPROINFLAMMATORY CYTOKINE PRODUCTIONPROINFLAMMATORY CYTOKINE PRODUCTIONPROINFLAMMATORY CYTOKINE PRODUCTION

Major depression increases secretion of proinflammatory Major depression increases secretion of proinflammatory cytokines; treatment with antidepressants may decrease cytokines; treatment with antidepressants may decrease y ; p yy ; p ysecretion secretion (Maes; Irwin; Miller)(Maes; Irwin; Miller)

Depressive symptoms were linked to increased ILDepressive symptoms were linked to increased IL--6 in 6 in community samples of older adultscommunity samples of older adults (Dentino et al 1999)(Dentino et al 1999)community samples of older adults community samples of older adults (Dentino et al., 1999)(Dentino et al., 1999)

Depressed mood was associated with higher levels of Depressed mood was associated with higher levels of serum ILserum IL--6, TNF6, TNF--αα, and CRP, and CRP among older adults ages 70among older adults ages 70--797979 79 (Penninx et al., 2003)(Penninx et al., 2003)

Chronic stressors like caregiving have been associated with Chronic stressors like caregiving have been associated with heightened ILheightened IL--6 compared to noncaregiving controls 6 compared to noncaregiving controls gg p g gp g g((Lutgendorf et al.; KiecoltLutgendorf et al.; Kiecolt--Glaser et al.; Glaser et al.)Glaser et al.; Glaser et al.)

Acute stressors enhance production of proinflammatory Acute stressors enhance production of proinflammatory cytokinescytokines (Goebel et al., 2000; Steptoe et al., 2001; Kiecolt(Goebel et al., 2000; Steptoe et al., 2001; Kiecolt--Glaser etGlaser etcytokines cytokines (Goebel et al., 2000; Steptoe et al., 2001; Kiecolt(Goebel et al., 2000; Steptoe et al., 2001; Kiecolt Glaser et Glaser et al. 2005)al. 2005)

Acute psychological stressors can directlyAcute psychological stressors can directlyAcute psychological stressors can directly Acute psychological stressors can directly provoke transient increases in proinflammatory provoke transient increases in proinflammatory cytokinescytokines

InterleukinInterleukin--6 in 4 Groups of Community Women6 in 4 Groups of Community WomenInterleukinInterleukin--6 in 4 Groups of Community Women6 in 4 Groups of Community Women

7p < .001p < .001

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4 Young women (Young women (40)40)Older controlsOlder controls (76)(76)Movers (80)Movers (80)Caregivers (71)Caregivers (71)ILIL

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Lutgendorf et al., Journals of Gerontology, 1999Lutgendorf et al., Journals of Gerontology, 1999

00

L it di l it t d i 6L it di l it t d i 6Longitudinal community study spanning 6 Longitudinal community study spanning 6 years:years:

119 caregivers119 caregivers 106 noncaregivers (mean age at study entry, 71)

Key Measures: Key Measures: IL 6 in fro en plasma samples 2 / earIL-6 in frozen plasma samples, 2x/yearHealth behaviors associated with IL-6Depressive symptomsDepressive symptoms

Kiecolt-Glaser, Preacher, MacCallum, Atkinson, Malarkey, & Glaser (2003) d f h l A d f S SA(2003). Proceedings of the National Academy of Sciences, USA

MODELED CHANGE IN ILMODELED CHANGE IN IL--6 IN CAREGIVERS VS. 6 IN CAREGIVERS VS. NONCAREGIVERSNONCAREGIVERSIL-6 is represented as a linear function of age; each individual's pattern of change is represented by a straight line defined by an intercept (predicted level of IL-6 at age 55) and slope (predicted change in IL-6 per year).

pg/m

l

0.7

0.8

0.9

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5.01

6.31

7.94

CaregiversControls

3.19 = upper 3.19 = upper quartile, quartile,

ed IL

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), p

0.4

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q ,q ,epidemiologic studiesepidemiologic studies

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0.1

0.2

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1.26

1.58

2.00

Caregivers' average rate of increase in IL-6 was about four four

Age

55 60 65 70 75 80 85 90 95

g g fftimes as largetimes as large as that of noncaregivers, and the two slopes were significantly different from one another, p = .01.

Compared to Compared to noncaregiversnoncaregivers, men and women who , men and women who provide care to a spouse with a stroke or a dementia provide care to a spouse with a stroke or a dementia p pp pare at greater risk forare at greater risk for

developing diabetesdeveloping diabetesbecoming hypertensionbecoming hypertensionbecoming hypertension becoming hypertension coronary heart disease (CHD)coronary heart disease (CHD)

Lee et al., 2003; Shaw et al., 1999; Lee et al., 2003; Shaw et al., 1999; Vit liVit li t l 1996 2002t l 1996 2002VitalianoVitaliano et al., 1996, 2002et al., 1996, 2002

A large populationA large population--based study of the elderly drawn based study of the elderly drawn from a random, stratified sample: relative risk for allfrom a random, stratified sample: relative risk for all--cause mortality among strained caregivers was 63% cause mortality among strained caregivers was 63% higher thanhigher than noncaregivingnoncaregiving controls These datacontrols These datahigher than higher than noncaregivingnoncaregiving controls. These data controls. These data represent the “best case” scenario, with represent the “best case” scenario, with caregivingcaregivingdefined very broadly (defined very broadly (Schulz & Beach, JAMA, 1999)Schulz & Beach, JAMA, 1999)

WHAT HAPPENS WHEN CAREGIVING WHAT HAPPENS WHEN CAREGIVING ENDS?ENDS?

Normal bereavement: higher incidence of Normal bereavement: higher incidence of ggdepression and anxiety in widows and depression and anxiety in widows and widowers within the first several months after widowers within the first several months after the spouse’s death compared to nonbereavedthe spouse’s death compared to nonbereavedthe spouse s death compared to nonbereaved the spouse s death compared to nonbereaved controls. controls.

These group differences are typically notThese group differences are typically notThese group differences are typically not These group differences are typically not significant in followsignificant in follow--up data collected one to up data collected one to two years later (Harlow et al., 1991; Lund et al., two years later (Harlow et al., 1991; Lund et al., 1989; Thompson et al 1991)1989; Thompson et al 1991)1989; Thompson et al., 1991).1989; Thompson et al., 1991).

ThusThus——caregivers should look no different than caregivers should look no different than noncaregivers ~2 years after the spouse’s deathnoncaregivers ~2 years after the spouse’s deathnoncaregivers ~2 years after the spouse s deathnoncaregivers ~2 years after the spouse s death

On entry into this portion of the longitudinal study, 28 of the caregivers' On entry into this portion of the longitudinal study, 28 of the caregivers' spouses had already died; an additional 50 of the 119 spouses died during spouses had already died; an additional 50 of the 119 spouses died during the 6 years of this studythe 6 years of this studythe 6 years of this study. the 6 years of this study.

Selected for this analysis: continuous caregivers vs. those bereaved 3 or more years

Former caregivers’ average rate of annual change in ILFormer caregivers’ average rate of annual change in IL--6 did not differ 6 did not differ from that of current caregivers, even several from that of current caregivers, even several yearsyears after the death of the after the death of the i i di i d

3 or more years

ml 0.8

1.0

Current CaregiversFormer Caregivers

impaired spouseimpaired spouse

d IL

-6 (l

og10

), pg

/m0.4

0.6

gControls

KiecoltKiecolt--Glaser, Preacher, Glaser, Preacher, MacCallum Atkinson Malarkey &MacCallum Atkinson Malarkey &

55 60 65 70 75 80 85 90 95

Pred

icte

d

0.0

0.2MacCallum, Atkinson, Malarkey, & MacCallum, Atkinson, Malarkey, & Glaser (2003). Glaser (2003). Proceedings of the Proceedings of the National Academy of Sciences, USANational Academy of Sciences, USA

Age

55 60 65 70 75 80 85 90 95

TELOMERESTELOMERESInflammation triggers TInflammation triggers T--cell proliferation and cell proliferation and enhances the leukocyte turnover rate resultingenhances the leukocyte turnover rate resultingenhances the leukocyte turnover rate, resulting enhances the leukocyte turnover rate, resulting in telomere shortening.in telomere shortening.TelomeresTelomeres----bits of DNA on the ends ofbits of DNA on the ends ofTelomeresTelomeres bits of DNA on the ends of bits of DNA on the ends of chromosomes that promote chromosomal chromosomes that promote chromosomal stability and regulate cells’ lifespan. Each time a stability and regulate cells’ lifespan. Each time a cell divides, it loses a little of its DNA at the ends. cell divides, it loses a little of its DNA at the ends. The more often that cells divide, the more DNA is The more often that cells divide, the more DNA is l tl t lti t ll i lllti t ll i lllostlost——resulting eventually in cell senescence.resulting eventually in cell senescence.Shortened telomeres have been linked to health Shortened telomeres have been linked to health behaviors like obesity and smoking as well asbehaviors like obesity and smoking as well asbehaviors like obesity and smoking, as well as behaviors like obesity and smoking, as well as aging, ageaging, age--related diseases, and mortality.related diseases, and mortality.

CAREGIVERS HAVE SHORTER CAREGIVERS HAVE SHORTER TELOMERES THAN CONTROLSTELOMERES THAN CONTROLS

First Report:First Report: EpelEpel, Blackburn et al., Blackburn et al. ProcProcFirst Report: First Report: EpelEpel, Blackburn et al. , Blackburn et al. Proc Proc NatlNatl AcadAcad SciSci 20042004

DamjanovicDamjanovic, Yang, Glaser, Kiecolt, Yang, Glaser, Kiecolt--Glaser, Nguyen, Glaser, Nguyen, Laskowski, Laskowski, ZouZou, Beversdorf, Weng, , Beversdorf, Weng, Journal of Journal of ,, , , g,, , g,Immunology, Immunology, 20072007

Early Life Stress, LongerEarly Life Stress, Longer--Term RisksTerm RisksEarly Life Stress, LongerEarly Life Stress, Longer Term RisksTerm Risks

Adults who experienced abuse or neglect asAdults who experienced abuse or neglect as Adults who experienced abuse or neglect as Adults who experienced abuse or neglect as children, compared to those without a similar children, compared to those without a similar history:history: show an enhanced emotional sensitivity to stressshow an enhanced emotional sensitivity to stress are more likely to develop psychiatric disorders when are more likely to develop psychiatric disorders when

f ti b t t ti l lf ti b t t ti l lconfronting subsequent stressors, particularly confronting subsequent stressors, particularly depressiondepression

more likely to showmore likely to show neuroendocrineneuroendocrine stress responsestress responsemore likely to show more likely to show neuroendocrineneuroendocrine stress response stress response sensitization including enhanced sensitization including enhanced glucocorticoidglucocorticoidresistanceresistance

6.6

6.8

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(Kb)

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Childhood Adversity

Mean (Mean (±±SEM)SEM) telemoretelemore length as a f nction of childhoodlength as a f nction of childhoodMean (Mean (±±SEM) SEM) telemoretelemore length as a function of childhood length as a function of childhood adversity in models adjusted for age, sex, BMI, marital adversity in models adjusted for age, sex, BMI, marital status, and status, and caregivingcaregiving status. status.

The telomere difference between individuals reporting no The telomere difference between individuals reporting no adversities and those reporting multiple adversities couldadversities and those reporting multiple adversities couldadversities and those reporting multiple adversities could adversities and those reporting multiple adversities could thus translate into a 7thus translate into a 7--15 year difference in lifespan15 year difference in lifespan

STRESS PROMOTES POOR HEALTH BEHAVIORS THAT ENHANCE

STRESS PROMOTES POOR HEALTH BEHAVIORS THAT ENHANCE O S C

PROINFLAMMATORY CYTOKINE PRODUCTION O S C

PROINFLAMMATORY CYTOKINE PRODUCTION

High saturatedHigh saturated High saturated High saturated fat dietfat diet

Less exerciseLess exercise Less exerciseLess exercise Poorer sleepPoorer sleep Smoking Smoking Alcohol abuseAlcohol abuse

Stress, anxiety, and depression Stress, anxiety, and depression interfere with sleep:interfere with sleep:

Trouble falling asleepTrouble falling asleep

A k i d i th i ht dA k i d i th i ht dAwakening during the night and Awakening during the night and finding it difficult to get back to sleepfinding it difficult to get back to sleep

Sleeping fitfully with shallowSleeping fitfully with shallowSleeping fitfully with shallow Sleeping fitfully with shallow sleep and frequent awakeningssleep and frequent awakenings

Early morning awakeningEarly morning awakeningEarly morning awakeningEarly morning awakening

And aging compounds the And aging compounds the problemsproblems——medications, chronic medications, chronic pp ,,health conditions, less restful sleephealth conditions, less restful sleep

Modest sleep deprivation enhances ILModest sleep deprivation enhances IL--6 production6 production2424--hour hour ILIL--6 circadian 6 circadian secretorysecretory pattern pattern before (bottom) and after (top) sleep before (bottom) and after (top) sleep restriction (2 hours/night for 1 week) in restriction (2 hours/night for 1 week) in 2525 h lthh lth dd 191925 25 healthy healthy men and womenmen and women, , ages 19ages 19--34.34.

The thick black bar on the abscissaThe thick black bar on the abscissaThe thick black bar on the abscissa The thick black bar on the abscissa represents the sleep recording period represents the sleep recording period during baseline. The open bar on the during baseline. The open bar on the abscissa represents the sleepabscissa represents the sleepabscissa represents the sleep abscissa represents the sleep recording period during partial sleep recording period during partial sleep restriction. restriction. VgontzasVgontzas et al., 2004, et al., 2004, J J ClinClin Endo Endo MetabMetab

“Adipose tissue is the largest organ in “Adipose tissue is the largest organ in the body…”the body…”Matsuzawa, 2005, Best Practice Res Clin Endo Metab

Up to 30% of ILUp to 30% of IL--6 may be 6 may be produced by adipose tissueproduced by adipose tissue

MohamedMohamed--Ali 1997, Ali 1997, J J ClinClin Endo Endo MetabMetab

Abdominal adipose tissue

Electron microscopic features ofElectron microscopic features of

may secrete up to three times as much IL-6 as

th b t f tElectron microscopic features of Electron microscopic features of adipose tissue adipose tissue (Matsuzawa, 2005)(Matsuzawa, 2005) other subcutaneous fat

tissues Browning; Proc Nutri Soc 2003Browning; Proc Nutri Soc 2003

WEIGHTY MATTERSWEIGHTY MATTERSIndividuals with a higher body mass index have higher levels ofmass index have higher levels of IL-6, TNF-α and CRP

Central adiposity may be Central adiposity may be associated with larger stressassociated with larger stress--gginduced cytokine responsesinduced cytokine responses

BrydonBrydon et al., et al., Int J Int J ObesObes 20072007

High saturated High saturated fat fat meals (fast food) can fuel meals (fast food) can fuel postprandial inflammatorypostprandial inflammatory responses withresponses withpostprandial inflammatory postprandial inflammatory responses, with responses, with larger and more persistent changes in larger and more persistent changes in overweight/obese peopleoverweight/obese peopleoverweight/obese peopleoverweight/obese people

Postprandial changes in circulating Postprandial changes in circulating ILIL--6 6 after a highafter a high--fat breakfast fat breakfast containing a high (71:29, black containing a high (71:29, black g g ( ,g g ( ,circles) or low (55:45, white circles) circles) or low (55:45, white circles) saturated:unsaturatedsaturated:unsaturated fatty acid fatty acid profile. profile. D, dinner; L, lunch; S, snack. D, dinner; L, lunch; S, snack. PoppittPoppitt et al. et al. Nutrition, Nutrition, 20082008

Moderate Physical Activity Reduces Moderate Physical Activity Reduces Ch i I fl tiCh i I fl tiChronic InflammationChronic Inflammation

When assessed rigorously and When assessed rigorously and objectively by maximal exerciseobjectively by maximal exerciseobjectively by maximal exercise objectively by maximal exercise testing, fitness is inversely testing, fitness is inversely associated with inflammation associated with inflammation

((KasapisKasapis J AmJ Am CollColl CardiolCardiol 2005)2005)((KasapisKasapis, , J Am J Am CollColl CardiolCardiol 2005)2005)

35% reduction in CRP after 6 35% reduction in CRP after 6 months of supervised moderate months of supervised moderate exercise in men and women at riskexercise in men and women at riskexercise in men and women at risk exercise in men and women at risk for future heart attack for future heart attack

(Smith et al.(Smith et al. JAMA 1999)JAMA 1999) Elite athletes: basal ILElite athletes: basal IL--6 was 30% 6 was 30%

higher in the offhigher in the off--season compared to inseason compared to in--season inseason in members of the Norwegian members of the Norwegian national cross country ski team national cross country ski team

((RR t lt l S di i J M dS di i J M d S iS i ii ((RonsonRonson et al., et al., Scandinavian J Med Scandinavian J Med SciSci in in Sports, Sports, 2001) 2001)

Interventions that diminish stress orInterventions that diminish stress or Interventions that diminish stress or Interventions that diminish stress or depression and/or inflammation may depression and/or inflammation may

h h lth i t th h th ih h lth i t th h th ienhance health in part through their enhance health in part through their positive impact on immune and positive impact on immune and endocrine regulationendocrine regulation

Yoga’s Impact on Inflammation, Mood, and Fatigue in Breast Cancer Survivors: A Randomizedin Breast Cancer Survivors: A Randomized

Controlled Trial

Kiecolt-Glaser, Bennett, Andridge, Peng, Shapiro, Malarkey, g g p yEmery, Layman, Mrozek, & Glaser; under review

Age Enhances RiskAge Enhances RiskAge Enhances RiskAge Enhances Risk

Chief collaborators:Ronald Glaser, Ph.DWilliam Malarkey, MDWilliam Malarkey, MD

“WE COLLABORATE. I’M AN “WE COLLABORATE. I’M AN EXPERT, BUT NOT AN AUTHORITY, EXPERT, BUT NOT AN AUTHORITY, AND DR GELBIS IS AN AUTHORITYAND DR GELBIS IS AN AUTHORITY

Papers from our lab:Papers from our lab:htt // i d /htt // i d /AND DR. GELBIS IS AN AUTHORITY, AND DR. GELBIS IS AN AUTHORITY,

BUT NOT AN EXPERT.”BUT NOT AN EXPERT.”http://pni.osumc.edu/http://pni.osumc.edu/

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