Cortisol and Neurological Function
By Theresa Dale
Overview
Did you know that the emotional and physical responses you have to stress are set in motion by a series of chemical releases and reactions? When you are understress, an alert goes off inside your body warning all parasympathetic forces.
released chemical cortisol weapons of brain destruction. Mobilize all internal defenses. Launch immediate counter-calm hormones before hippocampus is pummeled repeatedly by cortisol.”
Immediately, hormones rush to your adrenal glands to suppress the streaming cortisol on its way to your brain. Other hormones rush to your brain to round up all the remnants of cortisol missles that made it to your hippocampus. These hormones escort the cortisol remnants back to Kidneys for a one-way ride to the
Bladder. You have now reached metabolic equilibrium, also known as homeostasis.
When a danger finally passes or the perceived threat is over, your brain initiates a reverse course of action that releases a different flock of biochemicals throughout your body. Attempting to bring you back into balance, your brain seeks the holy grail of "homeostasis"; an elusive state of metabolic equilibrium between the stimulating and the tranquilizing chemical forces in your body.
An ongoing internal imbalance occurs if either the stimulating or tranquilizing chemical forces dominates the other without relief. This condition is known as chronic stress, which can have serious consequences for your brain cells.
Parasympathetic and Sympathetic Nervous System
The sympathetic nervous system (SNS) turns on the fight or flight response. In contrast, the parasympathetic nervous system (PNS) promotes the relaxation response.
Like two tug-of-war teams skillfully supporting their rope with a minimum of tension, the SNS and PNS carefully maintain metabolic equilibrium by making adjustments whenever something disturbs this balance.
The strongmen on these teams are hormones, the chemical messengers produced by endocrine glands. Named after a Greek word meaning "to set in motion," hormones travel through the bloodstream to accelerate or suppress metabolic functions.
The trouble is that some stress hormones don't know when to quit pulling. They remain active in the brain for too long – injuring and even killing cells in the hippocampus, the area of your brain needed for memory and learning. Because of this hierarchical dominance of the SNS over the PNS, it often requires conscious
effort to initiate your relaxation response and reestablish metabolic equilibrium.
Extreme Importance
Assessing stress levels is of paramount importance for every patient. Testing all 5 cortisol levels using the circadian 5 Element Saliva test is paramount in correcting hormone imbalances and balancing neurotransmitters so that depression, insomnia, immune burden, allergies and other chronic and acute symptoms can be alleviated. As we read on, you will see that immune function is directly related to
stress (ones perceptions). Stress ie dysfunctional cortisol release (abnormal cortisol levels) can lead to environmental sensitivity, gluten intolerance, allergies, hormone imbalance, neurotransmitter and neurological issues ie sleep insomnia, etc.
Distress Signals from Your Brain
Your sympathetic nervous system does an excellent job of rapidly preparing you to deal with what is perceived as a threat to your safety. Its hormones initiate several metabolic processes that best allow you to cope with sudden danger.
Your adrenal glands release adrenaline (also known as epinephrine) and other hormones that increase breathing, heart rate, and blood pressure. This moves more oxygen-rich blood faster to the brain and to the muscles needed for fighting or fleeing. And, you have plenty of energy to do either, because adrenaline causes a rapid release of glucose and fatty acids into your bloodstream. Also, your senses become keener, your memory sharper, and you are less sensitive to pain. Other hormones shut down functions unnecessary during the emergency. Growth, reproduction, and the immune system all go on hold. Blood flow to the skin is
reduced. That's why chronic stress leads to sexual dysfunction, increases your chances of getting sick, and often manifests as skin ailments. With your mind and body in this temporary state of metabolic overdrive, you are now prepared to respond to a life-threatening situation.
Getting Back to Normal
After a perceived danger has passed, your body then tries to return to normal. But this may not be so easy, and becomes even more difficult with age. Although the hyperactivating sympathetic nervous system jumps into action immediately, it is very slow to shut down and allow the tranquilizing parasympathetic nervous
system to calm things down.
Once your stress response has been activated, the system wisely keeps you in a
state of readiness.
Stress Hormones and Insomnia-Study
That stress can affect proper sleep seems obvious, but researchers at Pennsylvania State University College of Medicine have found another reason why middle-aged men may be losing sleep. It's not just because of what they worry about. Rather, it's due to "increased vulnerability of sleep to stress hormones,"
according to Dr. Alexandros N. Vgontzas.
As men age, it appears they become more sensitive to the stimulating effects of corticotropin-releasing hormone (CRH). When both young and middle-aged men were administered CRH, the older men remained awake longer and slept less deeply. (People who don't get enough of this "slow-wave" sleep may be more
prone to depression.)
"The increased prevalence of insomnia in middle-age may, in fact, be the result of deteriorating sleep mechanisms associated with increased sensitivity to arousalproducing stress hormones, such as CRH and cortisol," Vgontzas and colleagues suggest.
In another study, the researchers compared patients with insomnia to those without sleep disturbances. They found that "insomniacs with the highest degree of sleep disturbance secreted the highest amount of cortisol , particularly in the evening and nighttime hours," suggesting that chronic insomnia is a disorder of sustained hyperarousal of the body's stress response system.
Neuroscientists now believe sleep is not only crucial to brain development, but is also necessary to help consolidate the effects of waking experience – by converting memory into more permanent and/or enhanced forms. Sleeping problems are almost always involved in mental disorders, including depression, schizophrenia, Alzheimer's disease, stroke, as well as head injury. And symptoms are strongly influenced by the amount of sleep a person gets. Difficulties may arise from the drugs used to control symptoms of a disorder, or from changes in the brain regions and neurotransmitters that control sleep.
Adult Snorers at Risk for Stroke-Study
Researchers evaluated 1,348 adults for the association between the risk of getting
a stroke with snoring, sleep duration, and daytime drowsiness. Even after taking
classic risk factors into consideration – age, race, gender, cigarette smoking, high
cholesterol, high blood pressure, diabetes – the risk for stroke was independently
and significantly associated with sleep factors.
"We found that certain sleep characteristics such as sleeping for more than eight
hours, the tendency to fall asleep during the day, and the tendency to snore
influence the likelihood of having a stroke," says the study's lead author Adnan I.
Qureshi, M.D., assistant professor of neurosurgery at the State University of New
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York at Buffalo. "Individuals who snore severely or have trouble staying awake
during the day should see a doctor to find out why."
Snoring Children and Intellectual Potential-Research
"Snoring should always be considered a problem, since snoring indicates the
presence of increased upper airway resistance during sleep," says Dr. David
Gozal, a researcher at the University of Louisville.
Gozal and his colleague Dennis W. Pope Jr. interviewed more than 1,500 middleschool
students. About 13% of those ranking in the bottom quarter of their class
reported loud and frequent snoring in early childhood, compared to only 5% in the
top quarter. Half the loud snorers lived with adults who smoked.
The disordered breathing – and disrupted sleep – associated with snoring can lead
to attention-deficits and hyperactivity, asthma and allergies, as well as aggression,
the investigators found. Because these problems can adversely affect academic
performance, snoring can be considered a serious threat to a child's intellectual
potential.
"These findings suggest that children who experienced sleep-disordered breathing
during a period traditionally associated with major brain growth and substantial
acquisition of cognitive and intellectual capabilities may suffer from a partially
irreversible compromise of their. . . potential for academic achievement," reported
the researchers.
Gozal believes "that the presence of frequent and loud snoring in children who
also demonstrate behavioral problems, learning problems, bedwetting, or failure to
thrive, should prompt referral to a primary care physician and strong consideration
of an evaluation by a pediatric sleep specialist."
Brain Function in Depression
The brain is the "command center" of the human body. It controls the basic
functions of our bodies, our movements, and our thoughts and emotions.
Researchers studying clinical depression tend to look at several aspects of brain
function including the structures of the limbic system and the function of
neurotransmitters within neurons.
Limbic System
Those who research clinical depression have been interested in a particular part of
the brain called the limbic system. This is the area of the brain that regulates
activities such as emotions, physical and sexual drives, and the stress response.
There are various structures of the limbic system that are of particular importance.
The hypothalamus is a small structure located at the base of the brain. It is
responsible for many basic functions such as body temperature, sleep, appetite,
sexual drive, stress reaction, and the regulation of other activities. The
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hypothalamus also controls the function of the pituitary gland which in turn
regulates key hormones. Other structures within the limbic system that are
associated with emotional reaction are the amygdala and hippocampus. The
activities of the limbic are so important and complex that disturbances in any part
of it, including how neurotransmitters function, could affect your mood and
behavior.
Rapid Stress Response at Unconscious Level-Study
Monitoring single neurons in the right prefrontal cortex, University of Iowa
researchers found that these cells responded remarkably rapidly to unpleasant
images, which included pictures of mutilations and scenes of war. Happy or
neutral pictures did not cause the same rapid response from the neurons.
"The changes in firing pattern of neurons responding to the aversive visual stimuli
happened within about 0.12 seconds, which is very fast and probably prior to the
patient consciously 'seeing' the image," said principal investigator Ralph Adolphs,
Ph.D., assistant professor of neurology. The findings are consistent with the idea
that the brain evolved systems that can respond extremely rapidly to potentially
dangerous or threatening kinds of stimuli.
Cortisol
Cboraritnis ocel lallss uo sien tteor cfeormesm wuintihc athtee wfuinthc teioacnh o of tnheeurr. o transmitters, the chemicals that
Of those individuals who are clinically depressed, about one-half will have an
excess of a hormone in their blood called cortisol. Cortisol is secreted by the
adrenal glands. Located near the kidneys, the adrenal glands assist us in our
reactions to stressful events. Cortisol may continue to be secreted even though a
person already has high levels in his or her blood. This hormone is believed to be
related to clinical depression since the high levels usually reduce to a normal level
once the depression disappears.
The hypothalamus may be the culprit when it comes to excessive levels of cortisol
in the blood. It is responsible for starting the process that leads to the secretion of
cortisol by the adrenal glands. The hypothalamus first manufactures corticotrophicreleasing
hormone (CRH). The pituitary gland is then stimulated into releasing
adrenocorticotrophic hormone (ACTH). This hormone then makes the adrenal
glands secret cortisol in the blood.
When the endocrine system is functioning properly, the hypothalamus monitors
the level of cortisol that is in the blood. When the level rises, the hypothalamus
slows down its influence on the pituitary gland in production of CRH. When cortisol
levels become reduced, the hypothalamus causes the pituitary gland to produce
more CRH. In a person who is depressed, the hypothalamus may continuously
influence the pituitary to produce CRH without regard to the amount of cortisol that
is in the blood.
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Other research concerning cortisol has shown that the timing of the release of this
hormone may be problematic in those who are depressed. People who are not
depressed tend to have secretions of cortisol at certain times of the day. Cortisol
levels are highest at approximately 8:00 a.m. and 4:00 p.m., and then lowest
during the night. This normal cycling of cortisol levels does not occur in some
people who are depressed. For instance, they might have a consistent level of
cortisol all the time, or highest amounts in the middle of the night.
The development of clinical depression may be a symptom of a disorder present
within organs that produce hormones. Such conditions include thyroid disorders,
Cushing's syndrome, and Addison's disease.
The Emotional Brain- Limbic System
The primary area of the brain that deals with stress is its limbic system. Because
of its enormous influence on emotions and memory, the limbic system is often
referred to as the emotional brain. It is also called the mammalian brain, because it
emerged with the evolution with our warm-blooded relatives, and marked the
beginning of social cooperation in the animal kingdom.
Whenever you perceive a threat, imminent or imagined, your limbic system
immediately responds via your autonomic nervous system – the complex network
of endocrine glands that automatically regulates metabolism.
The term "stress" is short for distress, a word evolved from Latin that means "to
draw or pull apart." The Romans even used the term districtia to describe "a being
torn asunder." When stressed-out, most of us can probably relate to this
description.
Stress is Not All Bad
Bear in mind that an appropriate stress response is a healthy and necessary part
of life. One of the things it does is to release norepinephrine, one of the principal
excitatory neurotransmitters. Norepinephrine is needed to create new memories
and improves mood. Problems feel more like challenges, which encourages
creative thinking that stimulates your brain to grow new connections within itself.
Stress management is the key, not stress elimination. The challenge in this day
and age is to not let the sympathetic nervous system stay chronically aroused.
This may require knowledge of techniques that work to activate your relaxation
response.
Stress Activates Immune System-Study
Some kinds of acute stress are beneficial. For example, Ohio State University
researchers found that stress from engaging in a memory task activated the
immune system, whereas the stress from passively watching a violent video
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weakened immunity (as measured by salivary concentration of SIgA, a major
immune factor).
Their results suggest that deadlines and challenges at work, even if annoying for a
short time, could be a good thing that helps strengthen the body's defenses.
Stress studies indicate that it causes stroke, atherosclerosis, accelerated aging,
memory loss and a gender response to stress (Men are more affected).
Stress Compromises the Blood-Brain Barrier
Stress can dramatically increase the ability of chemicals to pass through the
blood-brain barrier. During the Gulf War, Israeli soldiers took a drug to protect
themselves from chemical and biological weapons.
Normally, it should not have crossed the BBB, but scientists learned that the stress
of war had somehow increased the permeability of the BBB. Nearly one-quarter of
the soldiers complained of headaches, nausea, and dizziness – symptoms which
occur only if the drug reaches the brain.
The BBB (Blood Brain Barrier)
Permeating the human brain are 400 miles of blood vessels – providing nutrients,
fuel, and oxygen, while removing waste and excess heat. The capillaries in this
vascular system also comprise what is called the blood-brain barrier (BBB), a
protective network unique to the central nervous system.
Present in all vertebrate brains, the BBB is laid down within the first trimester of
human fetal life. Although far from perfect, it does shield neurons from some
poisons, viruses, and other toxins in the bloodstream – as well as from
unpredictable fluctuations in normal blood chemistry.
Primary and Secondary BBB
The primary BBB is formed by cerebral capillaries that are different from those
elsewhere in the body. Most capillary walls contain tiny openings called "slit pores"
that permit molecules to diffuse easily into the surrounding tissue – somewhat like
a soaker hose.
Cerebral capillaries do not have these clefts. They are lined with firmly connected
endothelial cells, whose intercellular junctions are as tight as any in biology.
Molecules must pass through cerebral capillary walls by active transport with
certain carrier molecules, instead of through slit pores.
The secondary BBB surrounds the cerebral capillaries. It is composed of "glial"
cells, the other family of brain cells that outnumber neurons by a factor of ten.
Certain types of glial cells form a buffer between the brain's capillaries and its
neurons. These support cells further obstruct toxins from the bloodstream, while
regulating the correct flow of necessary nutrients.
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What neurotransmitters do
Neurotransmitters are central to memory, learning, mood, behaviour, sleep, pain
perception and sexual urge. They operate at the junctions between neurons,
allowing communication between cells. When a nerve impulse arrives at the end of
an axon, neurotransmitters are released, diffusing across a tiny gap to the next
neuron. Here they bind to receptors – proteins on the surface of the cell – as a key
fits into a lock. On delivery of their 'messages' these chemical couriers are
destroyed or reabsorbed by the nerve endings in which they were produced.
Different neurotransmitters operate at different parts of the nervous system, and
have different effects. Some promote the transmission of impulses while others
inhibit it.
Involuntary nervous system neurotransmitters
Australian researchers played a major role in investigations into the
neurotransmitters of the involuntary (or autonomic) nervous system which controls
the gastrointestinal, cardiovascular, respiratory, excretory and endocrine system.
The existing theory held that only two neurotransmitters, acetylcholine and noradrenalin,
were involved in the control of internal organs. Max Bennett of Sydney
University detected nerves that did not release either of these substances. Since
there must be a chemical signal to relay the nerve impulse between adjacent
neurons, this discovery started a race to identify the other transmitters involved.
More Neurotransmitters are being found
Scientists have so far found hundreds of neurotransmitters, and the list is still
growing. Neurotransmitters have an important role in the normal functioning of an
individual. Research on neurotransmitters has brought greater understanding of
some psychological diseases and this has led to more successful treatments. For
example, we now know that manic depressive syndrome is a result of an
imbalance in neurotransmitters, and we can correct the imbalance with drugs.
Brain chemicals
One of the most recent finds is of a brain chemical aptly named anandamide after
'ananda', the Sanskrit word for bliss. Anandamide has a similar effect to
tetrahydrocannabinol (THC), the active chemical in cannabis. THC locks into
anandamide receptors in brain cells.
Scientists have recently discovered yet another natural brain chemical,
nociceptin, which reduces anxiety. Mice injected with nociceptin become fearless,
overcoming their terror of bright lights and open spaces.
Important Neurotransmitters
Different types of cells secrete different neurotransmitters. Each brain chemical
works in widely spread but fairly specific brain locations and may have a different
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effect according to where it is activated. All of the major neurotransmitters are
made from amino acids except acetycholine. Some 60 neurotransmitters have
been identified, but the most important, listed top to bottom, seem to be:
Dopamine
Controls arousal levels in many parts of the brain and is vital for giving physical
motivation. When levels are severely depleted, as in Parkinson's disease, people
may find it impossible to move forward voluntarily. Low dopamine may also be
implicated in mental stasis. LSD and other hallucinogenic drugs are thought to
work on the dopamine system.
Serotonin
This is the neurotransmitter enhanced by Prozac, and has thus become known as
the 'feel-good' chemical. It has a profound effect on mood and anxiety -- high
levels of it, or sensitivity to it, are associated with serenity and optimism.
Acetylcholine (ACh)
Controls activity in brain areas connected with attention, learning and memory.
People with Alzheimer's disease typically have low levels of ACh in the cerebral
cortex, and drugs that boost its action may improve memory in such patients.
Noradrenaline
Mainly an excitatory chemical that induces physical and mental arousal and
elevated mood. Production is centered in an area of the brain called the locus
coreuleus, which is one of several putative candidates for the brain's 'pleasure'
centre.
Glutamate
The brain's major excitatory neurotransmitter, vital for forging the links between
neurons that are the basis of learning and long-term memory. Enkephalins and
Endorphins These are opioids that, like the drugs heroine and morphine, modulate
pain, reduce stress and promote a sensation of floaty, oceanic calm. They also
depress physical functions like breathing and may produce physical dependence.
Excerpts from "Mapping the Mind", Rita Carter -Weidenfeld & Nicolson, 1998
How Opiates Affect The Brain
There are three large pro-compounds: proenkephalin, prodynorphin, and proopiomelanocortin.
Endorphins can further decompose to small fragments,
oligomers, which are still active.
Oligomers pass the blood-brain barrier more readily. Enzymatic degradation of
small-chain endorphins is accomplished by dipeptidyl carboxypeptidase,
enkephalinases, angiotensinases, and other enzymes. This limits their lifetime in
the unbound state.
Opiate receptors presynaptically inhibit transmission of excitatory pathways.
These pathways include acetylcholine, the catecholamines, serotonin, and
substance P.
Substance P is a neuropeptide active in neurons which mediate our sense of pain;
its antagonists are currently under investigation as clinically useful moodbrighteners.
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Endorphins are also involved in glucose regulation. Opiate receptors are
functionally designated as mu, delta, kappa, etc. These categories can be further
sub-classified by function or structure.
Opioidergic neurons are particularly concentrated in the ventral tegmental area.
The VTA is an important nerve tract in the limbic system.
It passes messages to clusters of nerve cells in the nucleus accumbens and the
frontal cortex.
This forms the brain's primary reward pathway, the mesolimbic dopamine system.
Its neurons are called dopaminergic because dopamine is manufactured,
transported down the length of the neuron, and packaged for release into the
synapses.
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PROTOCOL
Cortisol, Neurological & Neurotransmitter Balance
Correcting the Pathways that become Dysfunctional due to Stressors.
Assessing stress levels is of paramount importance for every patient. Testing all 5
cortisol levels using the circadian 5 Element Saliva test is paramount in correcting
hormone imbalances and balancing neurotransmitters so that depression,
insomnia, immune burden, allergies and other chronic and acute symptoms can be
alleviated. Stress (abnormal cortisol levels) can lead to environmental sensitivity,
gluten intolerance, allergies, hormone imbalance, neurotransmitter and
neurological issues ie sleep insomnia, etc.
• Five Element Saliva Test –FI PP (food intolerances and parasites plus
hormones) ~Estrone, Estradiol, Estriol, P1, 17OH Progesterone, DHEA
pools, Free Testosterone, Fasting Insulin, SigA (immune burden), FSH, LH,
Parasites, Wheat, Egg, Soy, Gluten (Gliaden), and Candida. Total of 29
tests in my one panel. From this blueprint of the patients health and their
case history we create a custom program for you, at no charge.
• Blood Testing (if deemed necessary) Always using Dr. Dale’s Optimal
Reference Ranges.
• Follow program from Saliva Test results. You may need to adjust dosages
in 3 to 6 weeks according to hands-on NeuroPhysical Testing (2 day
training). Dr. Dale’s products has suggested use and dose on labels of both
nutritional and homeopathic products but they are a minimum dosage.
• Determine if virus, bacteria, parasites and Candida are present: Use
homeopathic BioTox for Pathology.
• Remove and Detoxify the following stressors:
o Diet: Follow diet in patients program to remove all food stressors.
o BioFilm Detox: to detach and flush biofilm that is protecting pathogens
in the mouth and gut.
o Heavy Metal Detox: Mercury detoxification using Mercury Plus Detox
and Lymph Detox after mercury amalgam removal.
o Detoxification of all Filtering Organs: Slow Cleanse
o Balance Hormones: NuFem and/or EndoPure Homeopathic Hormone
Rejuvenation to fix the HPA Axis.
o Balance Neurotransmitters: NeuroBalance Pro
o Detoxify Brain of Chemical and Heavy Metals: Use Hepatic
Glutathione Pathway formula to open this pathway so that heavy
metals and chemicals can be release from the brain causing
neurological problems.
o Handle emotional stressors with (Fibonacci Sequence Based)
Mind~Body~Meridian Formulas.
o Discontinue use of any toxic supplements containing fillers, binders,
coloring, non-organic animal products, preservatives, coloring and
supplements that contain heavy metals. If minerals are in a
supplement they DO contain heavy metals. The only minerals that do
NOT contain heavy metals are Ionic Minerals. Review our Nano Ionic
Minerals.
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21. Archives of General Psychiatry, February 1, 2000
22. Acta Neuropathol (Berl) 1993;86(2):136-44
23. Neuroscience, March 2001
24. Journal of Athletic Training, October 2001
Exercise
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3. Society for Neuroscience, Annual Meeting, November 11, 2001
4. Keep Your Brain Alive, Lawrence C. Katz, PhD. http://www.neurobics.com/exercise.html
5. Bingo 'helps beat memory loss', Ananova News Portal, February 23, 2001
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6. Brain Research, March 30, 2001
7. National Association for Sport and Physical Education's Shape of the Nation 1997 survey
8. Economy Class Syndrome, Marshall Space Flight Center, Wellness Center Newsletter,
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9. Prevention, October 1996
10. Archives of Internal Medicine, July 23, 2001
11. Journal of Aging and Physical Activity, January 2001
12. Genes and Development, March 2001
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15. Nature, July 29, 1999
16. Journal of Neurology, Neurosurgery and Psychiatry 2001;71:29-32Rest
Stress on the Brain
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2. Arch. General Psychiatry, April 1998
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3. Neuroscience 2000 Conference, November 7, 2000
4. American Institute of Physics, Acoustical Society of America meeting, December 2000
5. Family Circle, November 1991
6. New York Times, March 6, 1990
7. The Journal of Pain, February 2001
8. ABC News, August 27, 2001
9. Annals of Behavioral of Medicine, August 2001
10. Journal of Applied Psychology, October 2000
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19. Nature Neuroscience, October 1999
20. Stroke: Journal of the American Heart Association, August 2001
21. Epidemiology, March 2001
22. Arteriosclerosis, Thrombosis, and Vascular Biology, January 2001
23. Experimental Biology conference in Orlando, March 2001
24. Discover, May 1997
25. Nature Neuroscience, January 2001
Sleep and Stress
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2. Journal of Clinical Endocrinology and Metabolism, April 2001
3. Journal of Clinical Endocrinology and Metabolism, August 2001
4. Associated Sleep Societies annual meeting, June 2001
5. Developmental and Behavioral Pediatrics, June 1999
6. Stein,M.,Mendelsohn, J., Obermeyer, W.H., Amromin, J., Benca,R., Sleep and Behavior Problems in
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8. Pediatrics, June 2001
9. American Thoracic Society annual meeting, May 2001
10. Pediatrics, November 5, 2001
11. American Journal of Respiratory and Critical Care Medicine, August 2001
12. Neuron, April 26, 2000
13. Learning & Memory, March-April, 2001
14. Science, November 2, 2001
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Relieve Your Stress
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2. Alternative Therapies, January 1998
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8. American Journal of Health Promotion, July 2001
9. Alternative Therapies, May 1997
10. Self Healing, October 1996
11. Prevention, June 1998
12. American Journal of Epidemiology, March 15, 2001
13. Preventive Medicine, May 2000
14. American Society of Hypertension annual meeting, May 2000
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15. Psychosomatic Medicine 1999;61
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20. British Medical Journal, August 11, 2001
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22. Self Healing, May 1997
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24. American Psychosomatic Society annual meeting , March 2001
