The End of Stress As We Know It by Bruce McEwen               Joseph Henry Press 2002 It’s not easy to write an engaging book about the science of stress but Bruce McEwen is up to the task. He is a world-renowned expert on the biology of stress so his information is detailed, leading edge and authoritative. But he has also written a book (with co-author Elizabeth Norton Lasley) that is well organized and easy to read. It contains a wealth of information in its 200 pages. And it covers the subject thoroughly – from the history of stress research to brain science, from sleep and junk food to the immune system and insulin. The author describes a paradox: “stress protects under acute conditions, but when activated chronically it can cause damage and accelerate disease.” This is not a new concept but he describes in scientific detail how this marvelous protective mechanism goes off the rails – and what can be done about it. He also introduces new terminology to distinguish good stress from bad: the former he calls “allostasis”, the latter “allostatic load”. The book has chapters on basic stress physiology, the emotional connection, the cardiovascular system (explaining all the ways in which chronic stress harms the heart), the immune system (acute stress actually enhances the immune response, but chronic stress suppresses it and leaves us vulnerable to infection), the brain (chronic stress impairs memory and, over time, can lead to atrophy of the memory centers) and the body’s metabolic functions (chronic stress can lead to insulin resistance, obesity and even diabetes.) The key hormone in all of this is cortisol – which resembles the steroid, cortisone, and is made from cholesterol. Adrenaline, the well-known hormone in acute stress, seems to get most of the “press” in lay discussions of stress, but cortisone is the one that does most of the chronic “wear and tear” damage. McEwen notes that “among living beings, only humans can become stressed-out from things that exist in idea only.” He calls this “anticipatory angst or anxiety”. Another key difference between us and the animal kingdom is that, in animals, the stress reaction is turned on at times of true physical threat but is turned off when the threat subsides. In humans, the stress reaction can be kept going almost indefinitely and this is what causes so much wear and tear on our bodies. The book has a fascinating section about salmon migrating upriver to spawn. This journey can take up to 9 months and is initiated by rising cortisone. Most of these migrating salmon actually die from severe stress – they end up exhausting themselves and most dying salmon show massive infection. Be careful where you go fishing! Professor McEwen makes important note of the fact that, in addition to the effects of chronic stress, our coping strategies can actually add to our stress. For example, overeating or eating a diet rich in fat actually increases cortisol (think “comfort foods” such as potato chips, donuts and ice cream!) Staying up late has a price too. Sleep deprivation turns on the stress reaction through cortisol. As he notes, “scientific research shows that we can guard against the ravages of stress by following advice our grandmothers could have given us” sleep, a good diet, regular exercise and support of family, friends, religion and community.” This book is important, really interesting and very readable. I highly recommend it.