The alarming rise in rates of diabetes, obesity, depression, and other chronic health issues has put the spotlight on toxic stress.

Lawson Wulsin, professor of psychiatry and family medicine at the University of Cincinnati, explained good stress such as a demand or challenge you readily cope with is good for your health. Toxic stress, on the other hand, wears down your stress response system with lasting effects.

He pointed out science has shown the chances of developing serious mental and physical illnesses in midlife rise dramatically when people are exposed to trauma or adverse events, especially during childhood.

"Every person's threshold for toxic stress depends on the specific characteristics of their stress response system," Wulsin noted. "And the cumulative demands that they face over a lifetime."

The earliest effects of toxic stress are often persistent symptoms such as headache, fatigue or abdominal pain. After months of initial symptoms, a full-blown illness such as migraine headaches, asthma or diabetes may surface.

Research shows it is possible to retrain a dysregulated stress response system. The approach, called "lifestyle medicine," focuses on improving health through changing high-risk behaviors and adopting new daily habits. Wulsin emphasized positive lifestyle changes can help the stress response system self-regulate.

"These approaches combined, the daily practice of health behavior changes over six to nine months, with the help of weekly small groups of other people working on the same goals," Wulsin outlined. "It's not quick, not easy, but it works."

The National Diabetes Prevention Program, the Dr. Dean Ornish UnDo It! heart disease program and the U.S. Department of Veterans Affairs PTSD program have been shown to slow or reverse stress-related chronic conditions through weekly support groups and guided daily practice over six to nine months.

Wulsin added the programs help teach people how to practice personal regimens of stress management, diet and exercise to build and sustain new habits.

This story was produced with original reporting from Lawson Wulsin for The Conversation, in association with Media in the Public Interest and funded in part by The George Gund Foundation.


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A New York group has a new program to help veterans.

The Center for Independence of the Disabled New York's Veteran Direct Care program helps veterans choose a home care provider. Initially, the program began with a few veterans on Staten Island but has grown to include people from other New York City boroughs.

Sharon McLennon-Wier, executive director of the center, said the program has been a year in the making with some challenges along the way.

"There was a lot of paperwork to become a provider through the federal government, the Veterans Administration," McLennon-Wier explained. "It required a lot of background checks, it required developing a manual, a lot of training with getting connected to the VA portal system, their referral system, their payment structure."

Since the program's launch, she reported feedback has been positive since New York City did not have such a program before. McLennon-Wier noted it also provides benefits for veterans' caregivers, who can earn income from this program.

An AARP report showed caregivers for veterans spend an average of $11,500 of their own money, since they often require more advanced care.

Though the program is still relatively new, McLennon-Wier hopes to grow it into a new department at CIDNY to help veterans access necessary services but it comes as the state and nation face a shortage of mental health providers for veterans. She pointed out along with extra training, the roles involve an understanding of veteran culture.

"Post-traumatic stress disorder in a veteran is something that a clinician who hasn't worked with veterans needs to understand the nuances of it," McLennon-Wier emphasized. "It's a different military lifestyle. It's a different culture. It's a different mentality."

She added mental health providers would also need training to help veterans with traumatic brain injuries. A Department of Veterans Affairs Inspector General report found psychologists are the fourth top shortage position, while psychiatrists are the top shortage among specialty physicians.

November is National Diabetes Month and experts said with healthier habits, more Tennesseans can reverse prediabetes and prevent Type 2 diabetes and all its complications.

The prevalence of diabetes is quite high in Tennessee, at 14.6%, which is three points higher than the national average.

Dr. Griffin Rogers, director of the National Institute of Diabetes, Digestive and Kidney Diseases in Bethesda, Maryland, said it is possible to prevent the wide range of health problems caused by high blood sugar, from heart attack and stroke, to kidney disease and vision problems. Rodgers said a helpful acronym is "ABCs."

"The A stands for hemoglobin A1C. The A1C is a measure of what the average blood sugar is in the preceding three months. The 'B' stands for blood pressure, and the 'C' stands for cholesterol," Rogers outlined. "High blood pressure and high cholesterol, in addition to high blood sugars, can contribute to the nerve and blood vessel damage."

The "s" in ABCs stands for "stop smoking." He pointed out smoking can also damage your blood vessels and can cause or increase your risk of these complications.

Rodgers recommended a diet based on fresh fruits and vegetables, whole grains and lean proteins like fish. He also suggested replacing sugary drinks with water to improve overall health, plus regular exercise and getting seven to eight hours of sleep can help.

"On the physical activity side, 30 minutes a day, five days a week for most adults is what's generally recommended," Rodgers explained. "Just walking. And if you can't do the 30 minutes all at one time, breaking it into either two 15, or three 10-minute intervals is sufficient."

Rodgers stressed diabetes is preventable and manageable. He added it is important for people to have their blood pressure and blood glucose levels checked as part of their routine wellness visits.


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According to experts in the field, the system of developing new antibiotics is broken and doctors are running out of ways to treat deadly infections.

Lawmakers have proposed the PASTEUR Act to fix the pipeline. New antibiotics are critical but they must be used sparingly, which means private drug companies cannot recoup their investment.

David Hyun, director of the Antibiotic Resistance Project at the Pew Charitable Trusts, said the bill would establish a subscription model to fund research for certain drugs approved by the Food and Drug Administration.

"It delinks their revenue from the volume of sales and provides an up-front payment to the companies purely based on the value of the public-health value of the new antibiotic," Hyun explained.

The Centers for Disease Control and Prevention said patients in the U.S. contract 2.8 million antibiotic-resistant infections each year and more than 35,000 of them die. Experts estimate the U.S. spends $4.6 billion a year to treat infections caused by drug-resistant germs.

Dr. Sarah Doernberg, an infectious disease specialist and professor of medicine at the University of California-San Francisco, said the ability to treat infection dictates the safety of all kinds of medical procedures from giving birth to having surgery.

"We are able to operate ICUs and transplantation and give chemotherapy agent," Doernberg noted. "All of these things that we do that are very invasive and come with risks of infection, and we need to be able to treat the infections in order to be able to provide modern health care."

Despite bipartisan support, a similar bill failed to pass in 2021. Senate lawmakers reintroduced the PASTEUR Act in 2023 with reduced funding but it remains stalled in committee.

Support for this reporting was provided by The Pew Charitable Trusts.