References and Suggested Reading

McEwen. B. S., Gianaros. P.J. (2001) Stress- and Allostasis-Induced Brain Plasticity Annu Rev Med. 2011 ; 62: 431–445. doi:10.1146/annurev-med-052209-100430 (opens in new tab).

Dietrich-Muszalska, A; Malinowska, J; Olas, B; Głowacki, R; Bald, E; Wachowicz, B; Rabe-Jabłońska, J (May 2012). “The oxidative stress may be induced by the elevated homocysteine in schizophrenic patients” (opens in new tab). Neurochemical Research. 37 (5): 1057–62. doi:10.1007/s11064-012-0707-3 (opens in new tab). pmc:3321271 (opens in new tab). pmid:22270909 (opens in new tab).

Rothschild. B. (2000) The Body Remembers. The Psychophysiology of Trauma and Trauma Treatment. Published by W.W Norton & Co. New York and London.

Smach, MA; Jacob, N; Golmard, JL; Charfeddine, B; Lammouchi, T; Ben Othman, L; Dridi, H; Bennamou, S; Limem, K (2011). “Folate and homocysteine in the cerebrospinal fluid of patients with Alzheimer’s disease or dementia: a case control study”. European Neurology. 65 (5): 270–8. doi:10.1159/000326301 (opens in new tab). pmid:21474939 (opens in new tab).

van Meurs, JB; Dhonukshe-Rutten, RA; Pluijm, SM; van der Klift, M; de Jonge, R; Lindemans, J; de Groot, LC; Hofman, A; Witteman, JC; van Leeuwen, JP; Breteler, MM; Lips, P; Pols, HA; Uitterlinden, AG (May 13, 2004). “Homocysteine levels and the risk of osteoporotic fracture” (opens in new tab). The New England Journal of Medicine. 350 (20): 2033–41. doi:10.1056/NEJMoa032546 (opens in new tab). hdl:1765/8452 (opens in new tab). pmid:15141041 (opens in new tab).

A Final Note

We used to think that your DNA was ‘fixed’, and as such more or less determined your health and wellbeing.  What we now know is that as your DNA expresses itself, the expression can change in response to experiences, and importantly it is how you perceive and manage those experiences that is gaining significance. So for example many people who have been trapped in Post Traumatic Stress Disorder (PTSD), may, with the right support, be able to break the neurological pattern of PTSD, and move into Post Traumatic Growth (PTSG) (Rothschild, 2000).

Your DNA relies on healthy methylation in order to repair and function properly, so what influences a healthy methylation of the DNA within your body?

Major influencers are stressors (the impact of which modify the methylation of your genes and are implicated in various diseases), how your body responds to these and the lifestyle choices you make (nutritional intake for example).  The genes involved in the HPA axis, neurotransmission and neuroplasticity are very important in managing responses to stressful experiences. If the expression of these genes become altered through stress-induced changes to DNA methylation patterns, this may bring about alterations in the physiological mechanisms that influence behaviour and mental health. Put more simply, we know that chronic stress is damaging, and it can come from various sources, such as from prolonged exposure to negative life events. Ultimately, these experiences incur physiological, cognitive and behavioural changes that often play out as mood and anxiety disorders.

Final Self-Reflection Exercise

You may now want to return to any reflective notes you have been keeping and consider what lifestyle changes you might want to make to support your mind and body in the future.

Nutrition (continued)

Glutathione

While we are on the subject of methylation we need to think about glutathione, the production of which relies on cysteine. Glutathione is your body’s master antioxidant and stimulates your immune system.

Glutathione is produced in your liver and made up of three amino acids and these are glycine, L-cysteine (cysteine) and L-glutamate. Glutathione facilitates methylation by ensuring B vitamins are ‘available’ for the methylation process. Stressors influence the production of glutathione by raising the production of cortisol and epinephrine, which depletes glutathione, over time this impacts the methylation process, your ability to detoxify, and increases homocysteine in your body. Just about anything that “stresses” your body or your mind will place a demand on glutathione.

Glycine

Glycine is synthesised in your body from protein rich foods (such as beans, eggs, fish) and makes up some of the collagen in your body, it also regulates nerve impulses, specifically in your spinal cord. Glycine will also bind with toxic substances and aid in their excretion from the body.

Glutamine

Glutamine is produced naturally in your body, especially within your muscles. While some glutamine combines with other amino acids to form muscle proteins, most is released into the bloodstream. It travels in the blood to other parts of your body and exerts numerous effects.

For example, glutamine can raise and lower your blood sugar. To raise it glutamine will increase the production of glucose and when this is released into your blood, your blood sugar level rises. Glutamine stimulates specialised cells in your pancreas to release a hormone called glucagon into the bloodstream. When glucagon reaches the liver, it stimulates the liver cells to produce more glucose. The primary way glutamine lowers your blood sugar is by increasing a protein called glucagonlike peptide-1 (GLP-1) into your blood from cells in your intestines. GLP-1 works by increasing the release of insulin from your pancreas. Insulin is the main hormone that helps body cells take up glucose, thus lowering blood sugar levels.

L-glutamate

We have had a look L-cysteine (see above), so what about L-glutamate?  L-glutamate helps gut function, the immune system, and other essential processes in the body, especially in times of stress. Approximately a third of your requirements are produced from the synthetic action of glutamine and ammonia, the remainder is mostly taken from your skeletal system and your muscles and distributed for use in your body via your blood stream.

L-glutamate is also important for providing “fuel” (nitrogen and carbon) to many different cells in the body and is utilised in the production of glucose. So for example if you have ever had surgery or a traumatic injury, nitrogen steps in to help repair your wounds and keep your vital organs functioning. 

Self-Assessment

How Stress Affects your Body

Below is a great little film made by TedEd which explains the effects of stress on the body rather well. 

Reflective Learning Exercise

After watching this you may want to stop and reflect on how you believe your physical body might be being affected by stress.

Psychobiology of Stress

The Somatic Nervous System (SoNS) in your body is a voluntary system and is for the most part under your control. The SoNS includes the sensory and motor nerves serving your musculoskeletal system and skin, they help you to move gracefully in your yoga class and jump up and down in puddles, they also enable you to react and remove yourself from danger, say from being burnt by something hot.

The Autonomic Nervous System is not under your control (but you can influence it). Its purpose is to connect and affect all of the systems and functions in your body. It is divided into the:

  • Parasympathetic Nervous System (PNS)
  • and the Sympathetic Nervous System (SNS).

The PNS (Parasympathetic Nervous System)

The PNS is known primarily for ensuring your body can rest and digest when you are relaxed, resting, or feeding, the neurotransmitter in your body that enables this is called Acetylcholine.

Acetylcholine can slow your heart rate, lower your blood pressure, and stimulate your stomach and bowels to contract in order to aid digestion. Acetylcholine is also present in many of your brain neurons, and is essential for learning, cognition and memory functioning. People with Alzheimer’s disease are known to have significant decreases in Acetylcholine concentration and function.

The SNS (Sympathetic Nervous System)

Your SNS brings about your “fight, flight or freeze” response to an external stimuli that is perceived as a threat. In essence, it prepares you physically and cognitively to cope with whatever stressor you are experiencing.  In this instance, acetylcholine targets receptors that trigger the production of the neurotransmitters epinephrine and norepinephrine. These neurotransmitters activate your Hypothalmic-Pituitary-Adrenal (HPA) axis, beginning in your amygdala, where you hold your emotional memories.

Because at this stage you feel threatened, the amygdala memories that are associated with fear help to prime your next action which is to signal your hypothalamus (which releases corticotrophin-releasing hormone (CRH)). CRH then tells your pituitary to release adrenocorticotropic hormone (ACTH), which finally signals your adrenal glands to produce cortisol.

Your amazing brain responds to threat by releasing the following hormones (epinephrine, norepinephrine, corticosterone and cortisol) which gives you a whole body reaction to the threat.

  • Epinephrine (aka adrenaline): Release of this hormone increases your heart rate, which enables an increased blood flow to your muscles and brain. It also raises your blood sugar by helping convert glycogen to glucose in the liver. This gives you the energy surge you may need to act quickly.
  • Norepinephrine (aka noradrenaline): Works with epinephrine in responding to stress. However, it can cause vasoconstriction (the narrowing of blood vessels) which contributes towards high blood pressure.
  • Corticosterone: This hormone works with hydrocortisone to regulate immune response and suppress inflammatory reactions.
  • Cortisol: Cortisol is a steroid hormone produced in the cortex of the adrenal glands, which are located on top of each of your kidneys. Cortisol breaks down and utilises proteins in your body, which have the knock on effect of increasing glucose, fatty acids and amino acids, all of which provides energy for tissue repair and adaptation to stressful situations.

A bit more about cortisol (because you need to know!)

Cortisol regulates energy output by selecting appropriate amounts of carbs/fat/and protein and will utilise your body’s stores, sometimes by moving it from one part of the body to another. If your dietary intake is insufficient, cortisol will facilitate gluconeogenesis, which is the process of converting amino acids into useable carbohydrate (glucose) in the liver.

Your body produces cortisol in a somewhat chaotic way, with natural peaks in the morning (typically around 9. a.m.), with fluctuations in output in response to what you are experiencing. So it can increase when you exercise, when you fast, when you have a physical trauma, and in response to psychosocial stressors.

We are interested in psychosocial stressors and your response to them, we know that when the stressors are manageable, cortisol can sharpen your cognitive ability, it can give you an ‘edge’ in your performance so that you do well.

When your stressors are unmanageable, you are saturated in cortisol and your body experiences something called ‘allostatic load’ (McEwan and Gianaros, 2011) which means your memory is affected, you make decisions that have poor outcomes, you make mistakes, and your physical body becomes threatened by the potential for disease and poor wellbeing.

Cortisol directly effects fat storage and weight gain in stressed individuals. Studies have shown that people who are experiencing high levels of cortisol often look differently from those who are coping, besides looking tired or ‘wired’, many people who are not coping gain weight, particularly in the midriff (abdomen). The reasons for this is that cortisol stimulates appetite, and, directly influences food consumption by binding to receptors in the brain (specifically, the hypothalamus) that stimulate the eating of food high in fat and/or sugar.

Cortisol can move fat deposits deep within the abdomen, and fat tissue contains an enzyme that converts inactive cortisone to active cortisol. Human visceral fat cells have greater blood flow and more of these fat converting enzymes compared to subcutaneous fat cells. All of which may lead to obesity due to the greater amounts of cortisol being produced at the visceral tissue level.

Introduction to Wellbeing I Summary

Congratulations!

Congratulations on answering your questions correctly and completing Introduction to Wellbeing Unit I©.

Summary

You can download a summary of the Introduction to Wellbeing Unit I© below.

Certificate

You can access your CPD learning certificate by clicking on the “Mark Complete” button at the bottom of the page. This will take you back to the front page of the module, where you’ll be able to download your certificate.

Nutrition

Eating and drinking well are important components of remaining well, especially during times of stress, for the purposes of this short course we would like to remind you that you are what you eat.

We have already seen that the chronic release of cortisol combined with altered tissue production is linked to the development of abdominal obesity in both men and women. Cortisol is associated with overeating, craving high caloric fatty and sugary foods, and relocating fat from the circulation and storage depots to the deep internal abdominal area

Your body needs all sorts of ‘fuel’ to survive and flourish; in this next section we are going to have a look at the importance of proteins (amino acids) and the role they play in activities such as cell production, healing, and gene expression.

Proteins are made up of 21 amino acids, which you absorb in the food you eat, and are then combined into thousands of variations in order to fulfil your body’s requirements.

One of the amino acids that is essential to your wellbeing is methionine, this is because it is crucial to the formation of proteins, and it contains sulphur, which contributes to the protection of your tissues, modifying your DNA and maintaining proper functioning of your cells.

Methionine

You ingest methionine from eating:

  • turkey
  • beef
  • fish
  • pork
  • tofu
  • milk
  • cheese
  • nuts
  • beans
  • and whole grains, like quinoa.

Of itself, methionine can help to reduce your cholesterol levels, and prevent kidney stones.

Because your body is so marvellous it is able to derive cysteine from methionine. Why is cysteine so important? Cysteine is an antioxidant and is involved in the way proteins within cells are folded and shaped. The folding and shaping of cells influences their functionality which helps them to connect to each other.

As another sulfide, cysteine contributes to the healthy metabolism of metals in your body such as zinc, iron and copper. The derivation of methionine to cysteine requires a methylation ‘dance’ with some B vitamins and a first stage transformation to homocysteine.  The process is as follows:

methionine + vitamins B6, B12 and folic acid = homocysteine, then…  

homocysteine + vitamin B6 converts homocysteine to cysteine.  

Ta da!

Because methylation is so crucial to your health and wellbeing we will look at it a little more closely now.

Methylation

Methylation is a vital metabolic chemical process that takes place in your body 24/7. It controls everything from your stress response to how you produce energy from the food you eat.  Methylation facilitates thinking processes, DNA repair and even detoxification. 

Methylation involves an amazing exchange of methyl, amino acids (protein via the food you eat), enzymes, and your DNA. In simple terms it requires the bonding of a methyl group to amino acids and enzymes (some of which are in you and some you absorb through your food) and your DNA. By bonding, the shape and function of your amino acids and enzymes are changed and your DNA is ‘expressed’ (your DNA purpose is realised). 

DNA and epigenesis

Gene expression happens through the thousands of genes in your cells, which are made up of DNA. Your genes encode proteins, which means not only can they self-regulate the myriad of functions they perform, but also determine what that cell can do. Critical to this are epigenetic markers, which determine cell fate as it is developing and how much or little of your genes are expressed.

The different experiences you have over your lifetime can rearrange those chemical markers. So that you demonstrate different behaviours, skills, wellbeing, coping and achievements from your peers. If you are enveloped in life affirming positive experiences, or negative experiences such as stress and trauma, these will leave a unique epigenetic “signature” on your genes. The permanence of some negative changes may be reversed or halted, the best thing you can do however is reduce stress exposure and develop healthy lifestyle and work choices.

In the methylation process that turns methionine into cysteine, the homocysteine that is produced, will normally become cysteine and any surplus cysteine is reverted back to methionine using vitamin B12 related enzymes. If however homocysteine cannot be converted into cysteine or returned to the methionine form, levels of homocysteine in the body increase.

Elevated homocysteine levels have been associated with cardio vascular disease, neuropsychiatric illness, fractures and Alzheimer’s disease (Smach, et al 2011; Dietrich-Muszalska et al, 2012; van Meurs et al, 2004). Unfortunately, if your body is not methylating efficiently, due to a genetic mutation, disease, chronic stress, or nutritional deficiency, you are likely lacking glutathione, which presents with further implications for your immune system.

Self-Assessment

Stress and Wellbeing

There is a potential to be overwhelmed by the amount of work (paid and unpaid) you do and the emotional energy that requires you to stay committed to your work and life responsibilities.

We know from the studies we have undertaken that most people who have challenging occupations and responsibilities want to sustain them because they love the work that they do and the people they are responsible for. This desire to continue is partially sustained through eudemonia that relates to your sense of kindness and compassion, and the ‘feel good’ reward you experience for what you do with your life.  

Eudemonia will only take you so far though and ultimately you may experience burn out (relating to your workload) and/or compassion fatigue (relating to the emotional energy being used to do what you are doing).

Workplace stress

If you stop and think about today’s workplace, you will know that it has the potential to be stressful. Work related stress incurs a huge personal and economic cost, to look at recent UK figures click here https://www.hse.gov.uk/statistics/causdis/stress.pdf (opens in new tab).  

Many people work in two ‘workplaces’: one is the employed workplace and the other is the caring workplace, the caring workplace may require you to take on complex demanding roles for family, friends and/or neighbours. Our studies have resulted in the coining of the phrase ‘the third workforce’ that is now used to reflect the caring role people provide to fill any gap in services between health and social care. Your experiences in these ‘workplaces’ may well be extremely rewarding, they may also cause overwhelm, what you need to do is to become self-aware so that you remain proactive about taking good care of yourself.

Life events and stress

You live in a complex and ever-changing world, from the day you are borne life will provide all sorts of experiences that will challenge you. Many of them, you will hopefully ultimately be grateful for, some however can prove to be very painful and hard to accept. The difficult ones may relate to your health or of the health of someone else, with an outcome that could require hospital treatment and result in disability or a shortened life expectancy.

The world of work is often fraught with uncertainties so you may experience redundancy and unemployment; some events have a knock on effect and can lead to partnership breakdown and result in you having money worries.

Some events that you plan and desire also bring stressors, so for example moving house, sitting an exam in order to gain a qualification, or getting married, can bring concerns and sleepless nights.

When you step back and look at some of the events that you may have been experiencing and managing overtime, you can begin to understand why stressors can have an impact on your wellbeing.

Social determinants

Social determinants are significant contributing factors in how you respond to stress. From your early beginnings, you are socialised into the world, and through this process your thoughts about who you are, are shaped, and as your thoughts shape your reality the process becomes an affirmation of who you are.

When you are loved, supported, respected and cared for, the thoughts you hold about yourself affect you so deeply that your biology changes, and your behaviour changes. You can see then that if you are unloved, unsupported, disrespected and uncared for then your biology and behaviours also change to reflect these experiences.

You and I need people, we are social animals, we need to feel as though we belong, that others like us, that others are glad that we are around, that the world we care about also cares about us. We all need the balm of kindness, whoever we are and whatever our circumstances.

Reflective Learning Exercise

While we work through this section you may want stop and note significant events that have occurred in your life, how you have managed them, and how you might plan to deal with things in the future.

Self-Assessment

Introduction to Wellbeing I

Dr Dee Gray

Hello and welcome to your Introduction to Wellbeing programme. During your programme you will be learning about wellbeing in a way that is both evidence based and very practical. When you have successfully completed your programme, you will have acquired a notional 3 CPD hours and a certificate of completion for your portfolio.

Thank you for joining us!

Dr Dee Gray

Programme aims

The aim of your Introduction to Wellbeing Programme© is to help you to develop knowledge and skills pertaining to wellbeing from a salutogenic and ‘best self’ perspective. You will be able to apply your learning within your professional and personal lives.

Structure

Your introductory programme is divided into two units. Unit I (this unit) is about stress and wellbeing. In this unit we introduce some of the technical terminology that explains how your perception of stressors lead to biological changes in your body. If the terminology is new, take your time, take some notes and allow your new knowledge to sink in.

Unit II (opens in new tab) is all about the wellbeing theories that underpin good practice, during unit two we introduce you to salutogenesis and the ‘best self’ model; both of which help you to identity where you are in terms of your wellbeing and manage events in a holistic way.

Units I and II in the Introduction to Wellbeing Programme© leads to our Wellbeing in Practice© programme, which shows how to apply all you have learned and practically apply that knowledge to manage stressors and sustain wellbeing during stressful episodes.

We highly recommend you take part in all of the learning activities in all of our programmes and engage in reflective learning episodes.

Assessment

Your learning is assessed at intervals using short question and answer sections. When you have answered each question correctly you can progress through the programme. On successful completion of Unit I you will be able to:

  1. Understand the connections between external stressors and your physical being
  2. Consider ways in which make positive changes to your nutrition and external environment
  3. Develop your understanding about external stressors and reflect on how you might reduce these

After you have successfully completed The Introduction to Wellbeing Programme© Unit I, you will be able to download your CPD certificate and a unit summary.