By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
I never served in the military and can only imagine the kind of hell that soldiers go through in combat.
I did, however, treat many combat veterans – young and old – to the best of my ability when they came to me as patients with cardiovascular disease. I listened to those who were open to talking, because I know how much stress can beat up the body and affect the heart.
To be sure, veterans are vulnerable to the same risk factors for heart disease as civilians, but for those who serve in combat there is the added potential for problems resulting from extreme emotional, psychological, and physical stress.
About Post Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) can develop in individuals after some terrifying experience involving physical harm or the threat of physical harm. When in danger, it’s totally natural to feel afraid, and in such situations the body shifts into a preparation mode, the so-called “fight or flight response.” But with PTSD this reaction morphs, lingers, and can become debilitating. Stress hormones stay high, and contribute to inflammation, hypertension, and heart and blood vessel damage.
PTSD was first brought to public attention in relation to war veterans, and is one of the few psychological conditions where a specific stressor is explicitly tied to the cause of health problems. People with PTSD often feel stressed or frightened even when they’re no longer in danger, and may also have anxiety and depression. Experts say these mental health issues stem directly from combat, and the more firefights the soldiers experience, the higher the rate of PTSD and depression.
Today, PTSD is regarded as a major public health issue. Statistically speaking, the majority of individuals who serve in combat do not develop PTSD (estimates are around 11-20 percent of Iraq and Afghanistan veterans; in Vietnam the number was about 30 percent). Yet today there are more than half-a-million U.S. troops deployed since 2001 who suffer from stress-induced problems.
No matter the source, stress seriously drains health on multiple levels. And, like a bomb or a bullet, it can kill as well. As a cardiologist, I have witnessed first-hand the damage it can do on heart health.
Combat Veterans and Heart Disease
In my clinical practice days, I saw many older combat veterans with heart disease, but I also saw young ones, individuals in their thirties. These patients were from different wars − World War II, Korea, and Vietnam. But their stress was similarly destructive regardless of where they served.
Among them, I encountered two basic kinds of responses. One was the individual who didn’t mind talking about his experience but cried or emoted in some significant way when he did. He had survivors’ guilt. The other response was not talking about it…burying the experience.
Over time I came to the conclusion that the best adjusted individuals and those less afflicted with cardiac disease and other disorders had learned to talk about their experiences and even cry; those who shared their feelings. They were better able to overcome.
I found this same quality and benefit among my civilian patients. Those more able to express their emotions, and even cry, had less hypertension (high blood pressure). Hypertension, of course, is often caused by stress and is a primary cause of heart disease.
The connection between veterans with PTSD and new onset heart disease was confirmed in a 2014 study published in the American Heart Association journal Circulation. Researchers from the Naval Health Research Center in San Diego discovered that combat deployment increases the risk of heart disease and that experiences of intense stress, such as under battlefield conditions, may increase the risk even more over a relatively short period among young service personnel.
The purpose of the study was to investigate the relationship between combat experience, PTSD, and heart disease, a connection not well defined, especially among young soldiers with recent fighting exposure. To do so, the researchers combed medical records for newly diagnosed heart disease among 60,000 service members who had served in Iraq and/or Afghanistan during the period from 2001 to 2008. They found the prevalence to be about 1 percent, about twice the rate of veterans without combat exposure.
A diagnosis of PTSD didn’t by itself necessarily predict new coronary heart disease in the analysis, the authors wrote, but PTSD appeared to be part of a mechanism by which combat raises the risk. They concluded that “exposure to stressful events such as combat may play an important role in the development of coronary heart disease in a young, otherwise healthy population of U.S. service members.”
Such is the destructive potential of intense battlefield stress.
An accompanying editorial in the journal commented that the findings “suggest that combat experience should be considered a risk factor for coronary heart disease.”
It is interesting to note also that in a follow-up 2015 study, the researchers found a higher risk of weight gain among the veterans with PTSD, leading to a higher incidence of overweight and obesity. A weight problem is an independent risk factor for cardiovascular disease.
What the Veterans Administration Does and Doesn’t Do
Getting treatment – and getting the right treatment − is a challenge for veterans.
The Veteran Administration’s National Center for PTSD website provides basic information on PTSD, crisis line numbers, and advice on how to find therapists and local mental health services. It also conducts research on trauma and PTSD, but does not, however, offer diagnosis or treatment. I find that disgraceful and a disservice to veterans.
You can find more resources here in a national directory put together by the VA and Department of Defense.
Those who do get treatment are often dissatisfied. According to a 2014 American Legion survey of 3,100 veterans with PTSD or traumatic brain injury, nearly 60% reported either feeling no improvement or worse after undergoing treatment, and 30% said they had terminated their treatment plan before completion.
Left untreated, PTSD cripples functioning and puts military personnel and veterans at greater risk of self-destructive and violent behavior: severe depression, alcoholism, drug abuse, anxiety or emotional numbness, employment and family problems and suicide. More than 6,500 veterans commit suicide every year.
Complementary Treatments for PTSD
Defusing stress is a critical step in the healing process. There are, of course, pharmaceutical remedies, such as anti-depressants and tranquilizers. But drugs have side effects, are often over- prescribed, can be abused, and don’t deal with the underlying cause.
One of the findings of the American Legion survey is that nearly half of the veterans contacted discussed some type of complementary- and alternative-based treatment with their providers.
My preference has always been finding more natural and effective techniques as well as inspiring individuals to seek the help of support groups, which could be in military or religious settings, or even among friends and family.
One technique that I often recommended to highly-stressed patients, and one I have practiced for years, is Transcendental Meditation (TM). Multiple studies over many years show that meditation superbly calms the stress of wired-up, burnt-out, anxious, and depressed civilians. Research also indicates that this simple close-your-eyes practice serves as well as a remedy to defuse the high stress burden of veterans.
In 2011, the journal Military Medicine published a study showing effectiveness in reducing PTSD in veterans of Iraq and Afghanistan. Participants had a 50 percent reduction of symptoms after just eight weeks of meditation.
And back in 1985, a report in the Journal of Counseling and Development demonstrated a significant reduction of symptoms among Vietnam War veterans practicing TM for at least three months. A comparison group utilizing psychotherapy was found to have had no significant improvements during the same time period.
Besides TM, there are other meditation techniques that can be tried. Tai-Chi and yoga are also beneficial in calming the nervous system. Mind/body approaches like these can also be used along with conventional treatments.
Another out-of-the-box approach is Earthing, also known as Grounding. It involves going barefoot outdoors for a half-hour or so and maintaining bare skin contact with the natural, subtle electric charge on the surface of the planet. Going barefoot outside may not be practical or possible for many people, and there’s always the weather, so you can make use of conducting grounding products inside such as bed sheets, floor mats, and body bands. These products are connected to the Earth via a cord that plugs into the ground port (third hole) of an electrical outlet. Although no research has been done yet with PTSD, studies have shown that Earthing promotes sleep, reduces inflammation and pain, and calms the nervous system. I believe this simple approach can be very beneficial for distressed veterans. Moreover, it’s utterly simple. There’s nothing to really do. I’ve participated in some of the research and the findings are remarkable.
If you or a loved one are a veteran suffering with PTSD, I hope you’ll learn as much as you can, and take a look and see if any of my suggestions fit your situation.
One last one is getting a service dog specifically trained to help people with PTSD – more on that here.
References & Additional Resources:
- Crum-Cianflone N, et al. Impact of Combat Deployment and Posttraumatic Stress Disorder on Newly Reported Coronary Heart Disease Among US Active Duty and Reserve Forces. Circulation. 2014;129:1813-20.
- LeardMann CA, et al. Post-traumatic stress disorder predicts future weight change in the Millennium Cohort Study. Obesity (Silver Springs). 2015;23(4):886-92.
- U.S. Department of Veterans Affairs. Treatment of PTSD.
- Brooks SB. Legion survey: PTSD/TBI care not working. June 2014.
- Rosenthal JZ, et al. Effects of transcendental meditation in veterans of Operation Enduring Freedom and Operation Iraqi Freedom with posttraumatic stress disorder: a pilot study. Military Medicine. 2011;176(6):626-30.
- Brooks JS, Scarano T. Transcendental Meditation in the Treatment of Post-Vietnam Adjustment. Journal of Counseling & Development. 1985;64(3):212-215.