Monday night marked the first debate of Secretary Hillary Clinton and businessman Donald Trump. Though no fits of any kind - coughing or otherwise - were thrown, the two gave jabs as expected. Mrs. Clinton stated, “You live in your own reality, Donald.” Later, Mr. Trump asserted that while he has been campaigning she has been noticeably absent on the trail- “You have been at home.”
She thwarted any attempted health discussion or resurrection of her recent pneumonia as a topic by responding “I think Donald Trump just criticized me for preparing for this debate… and I will prepare as President.” His subsequent discourse included, “I have better judgement and much better temperament… I have a winning temperament…She doesn’t…She doesn’t have the stamina.”
And, though I would have put both of them in a time out and reconsidered the lollipop in my prior pediatric office, “stamina” got me thinking. No matter your politics, it is an essential trait for the task. It is the ability to sustain over long periods of time physical and mental effort. To make it this far in so vitriolic a campaign, they clearly both possess it. So, what are the challenges to this endurance and strength? Well, they abound.
Frequent flying, travel Frequent travel is replete with many hazards:
First, the effects of sleep deprivation and jet lag are very real, in particular, when traversing times zones and longer flights. Both candidates are flying constantly. It appears Secretary Clinton and Mr. Trump have cross-country domestic agendas in the coming weeks.
Second, the risk of forming blood clots increases the greater the flight duration. This is offset when a person routinely walks around inflight. Secretary Clinton’s deep vein thrombosis (DVT) history is public knowledge. As a result, she takes a closely monitored blood thinning medicine, (aka Coumadin) and follows with a hematologist (aka blood specialist). The risk of recurrence is higher in a person who has had one.
Third, flying is dehydrating, so drinking lots of fluids is crucial for frequent fliers. Due to cabin pressure changes and taking in less oxygen, you can have stomach upset, bloating and be impacted especially if you have a breathing condition. (1)
Fourth, it exposes you to radiation. Because it is unknown what level is safe, very long flights with higher latitudes, going over certain locations and doing it a lot carry greater risk of exposure. The National Council on Radiation Protection and Measurements reported that aircrew have the largest average annual effective dose of all US radiation-exposed workers. (2)
The cumulative result will vary per person. A candidate’s personal history of occupational exposures to date, lifetime number and type of CT Scans and radiation subjection matter. Assuming presidential candidates bypass the airport scanners, it would appear that added risk is not as relevant to this discussion.
Sleep Deprivation and Jet Lag Sleep disturbances from air travel can have mental, emotional and physical adverse effects. Acute loss of it may prompt inattention, reduced vigilance, mood fluctuation and neurocognitive issues that impede memory, logical reasoning and executive function.
Sleep loss is often a culprit in traffic and other accidents. Fortunately, since the candidates have drivers and attendants to assume these responsibilities this is unlikely a major factor.
The deficit can lower an epileptics’ seizure threshold, for instance. From a cardiac perspective, it can raise blood pressure precipitating cardiovascular disease and stroke. Metabolic changes including the breakdown of glucose (aka sugar) are influenced as well.
Chronic Stress Some stress is good. Our bodies were designed to be able to mount a ‘fight or flight’ response when hazards entered our life. Stress hormones surge when in danger so blood and oxygen divert to the vital organs of the heart, brain and lungs allowing you to survive. It is pathological when it is chronic and enduring. While running for president, stress hormones remain elevated for a prolonged period instead of a short burst which can affect any part of the body.
Possible mental consequences: Indecision, emotional lability, irritability, anxiety, or sadness. Nervous energy can consume the mind leading to excessive worry and disorganized thinking lacking sound judgement. Some self-medicate with alcohol, cigarettes or drugs when unable to control or minimize it. Over and under eating are not surprising survival tactics.
Common somatic complaints: headaches, stomach pains, diarrhea, nausea and general aches. Chest pain and rapid heart rate. Sexual health declines, heart disease and stroke risks escalate. Hair loss and skin changes. Additionally, it worsens existing conditions while it may suppress immunity to fighting off infections.
Endocrine and Hormone Disruption In response to chronic stress, your cortisol and adrenaline levels precipitously rise. These generate increased output of the heart, blood flow to muscles, heightened alertness and expand the lung’s ability to carry oxygen. Fat deposition is enhanced which contributes to weight gain.
Too little sleep upsets the body’s natural equilibrium, in particular, hormonally: blood sugar rises, reduced sex drive and function (e.g. lowered libido, impotence in males), reproduction is impaired. Thyroid and insulin hormones can be antagonized, exacerbating disease. Diabetes’ risk can rise.
Life Expectancy A resource from the Division of Sleep Medicine at Harvard Medical School affirms “data from three large cross-sectional epidemiological studies reveal that sleeping five hours or less per night increased mortality risk from all causes by 15%.” (3)
Since the intense pace of Trump and Clinton’s political paths is a marathon and not a sprint, it is likely that both have created some tricks to impose an element of normalcy in their predictably unpredictable current lifestyles. Running for president is a full-time job and then some. The Center for Disease Control’s (CDC) recommendations to manage stress in the most challenging of times may not be so realistic: avoid drugs and alcohol, find support and connect socially, eat a well-balanced diet, maintain a normal routine, get plenty of sleep and stay active with exercise, hobbies and relaxation techniques. A sense of humor is a bonus to stress reduction.
Unfortunately, the social connection most likely to relate to your angst is your challenger. I don’t see Hillary and Donald grabbing lunch any time soon. How one handles stress -which is present in all of our lives - is a distinguishing factor in its medical impact. Symptoms are highly variable since what stresses each of us isn’t always the same.
Sleep of < 6 to 7h per sleep period is considered sleep deprivation despite the fact optimal length is not known - some are “naturally short sleepers” needing only 3-6 hrs per night. Untoward effects, however, can occur with less than 7 hrs a night. (4)
(1)(4) Weingarten J, Collop N. Air Travel: Effects of Sleep Deprivation and Jet Lag. CHEST. 2013; 1394-1401
(2) CDC’s National Institute for Occupational Safety and Health (NIOSH):
(3) Harvard Medical School's Division of Sleep Medicine