Academic journal article Journal of Theory Construction and Testing

Allostatic Load: The Relationship between Chronic Stress and Diabetes in Native Americans

Academic journal article Journal of Theory Construction and Testing

Allostatic Load: The Relationship between Chronic Stress and Diabetes in Native Americans

Article excerpt

Despite advances in treatment; the Native American population suffers disproportionately from diabetes (Berry et ah, 2004). Research suggests that this health disparity is rooted in racial discrimination, residential segregation, poverty, life-style choices and cultural issues (Tashiro, 2005). Native Americans have survived generations of oppression, racism, genocide and forced relocation. As tribes were displaced and were unable to access their traditional food sources, they received government subsidized food assistance that contained highly refined food items. Until these subsidies were initiated in the 1940s, diabetes was non-existent in Native Americans (Young, 1994). These events caused generations of chronic stress. Studies have found a relationship between poverty, chronic stress and increased incidence of diabetes among Native Americans (Krieger, 2001; Szanton, Gill, & Allen, 2005). The purpose of this paper is to present the state of the science on the relationship between chronic stress and diabetes in the Native American population. The physiology of stress and allostatic load, as they relate to specific chronic stressors that are relevant to Native Americans is presented. Research that supports the relationship between these stressors and increased susceptibility to diabetes is explored. Finally implications for Native American health are discussed.

Historical Perspectives of Stress

The works of Hans Selye, Richard Lazarus and Bruce McEwen are instrumental for understanding the physiological and psychological reactions to stress and the development of chronic diseases. Selye introduced the idea of stress in his early studies about the body's reaction to noxious stimuli called stressors. Selye described three stages of stress. The initial alarm reaction to a stressor is the "fight or flight" mechanism. In the second stage, the body either adapts to or resists the noxious agent. Lastly, if exposure to the stimulus persists, the body enters a stage of exhaustion. When stress is prolonged, adaptation becomes inadequate and exhaustion occurs because the system burns out from constant wear and tear (Selye, 1993).

Lazarus expanded the stress model to include the relationship between the person and the environment (Lazarus, 1993). Lazarus conceptualized the stress response as a series of cognitive processes that included appraisal and evaluation of the threat. The individual must first judge whether the encounter is irrelevant, benign, positive, or stressful. Then an assessment is made about whether the risk of harm can be reduced. Finally the individual considers coping methods that can reduce the impact and promote emotional well-being.

Cognitive appraisal also triggers physiological responses designed to help the individual meet perceived challenges and maintain homeostasis. Homeostasis is the process by which the body maintains a stable chemical environment (McCance & Huether, 2002). Homeostasis applies to those internal factors such as pH, osmolarity, body temperature and oxygen tension that are critical to survival and are, therefore, maintained within a narrow range (Sterling & Eyer, 1988). They do not vary and are not a means of adaptation. The physiological responses that are activated for adaptation are termed allostasis. Allostasis means, maintaining stability (or homeostasis) through change. Examples include changes in blood pressure, blood glucose, and visual acuity because of activating the sympathetic nervous system. Allostasis can be applied to physiological mediators such as the secretion of cortisol and catecholamines. For instance, catecholamines and cortisol levels rise in early morning to increase blood pressure and blood glucose for the awake state, which requires increased perfusion and fuel (Sterling & Eyer).

When this adaptive response is activated too long or too often, the body remains in an over-aroused state, resulting in allostatic load. The concept of "allostatic load" introduced by McEwen (2005) refers to the deterioration that the body experiences after repeated cycles of allostasis and ineffective turning on or shutting off the stress response. …

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