Although the human body is relatively adept at managing acute physical and/ or psychological stressors, chronic psychological stress can produce a variety of adverse effects.
Chronic unremitting stress can increase our risk of suffering from a barrage of anxiety- and pressure-related diseases ranging from high blood pressure and dementia to depression. Chronic stress also increases our risk for some types of cancer (Thaker 2007; Jacobs 2000; Saul 2005; McEwen 1998; Liu 2010; Eiland 2010). According to reports by the American Academy of Family Practice and the Russian Department of Family Care, nearly two-thirds of doctor’s office visits are related to stress (Mechanic 1978; Servan-Schreiber 2000; Saleeby 2006).
Regrettably, while chronic stress produces significant adverse health effects, conventional medicine often relies upon psychoactive drugs to mask stressed patients’ symptoms. At the same time, mainstream stress management strategies often fail to address biochemical abnormalities, such as imbalanced adrenal hormone levels, that contribute to the detrimental health effects of chronic stress (Strous 2003; Wolkowitz 1997, 1999).
At the core of chronic stress is deregulation of the hypothalamic-pituitary-adrenal (HPA) axis, an interconnected network of physiologic command terminals that governs the production of stress hormones like cortisol and catecholamines like epinephrine and norepinephrine. Chronic stress leads to desynchronization of the HPA axis and subsequent imbalances in stress hormone levels, a critical feature of stress-related illness.
Upon reading this DR Vitamin protocol, you will appreciate the dangers of chronic stress, understand how it contributes to various diseases and know how you can optimize your stress response by combining healthy lifestyle habits with scientifically studied natural therapies.
The Deadly Consequences of Chronic Stress
The consequences of chronic stress can be devastating. A chilling example is stress cardiomyopathy, a spontaneous weakening of the heart that predisposes victims to arrhythmia and even sudden cardiac death. While the mechanism is not clearly understood, it is thought that chronic stress-induced elevations in epinephrine (adrenaline) over-stimulate the cardiac muscle, altering its function and causing atrial remodeling (Sakihara 2007; Korlakunta 2005).
Another striking example is a condition the Japanese refer to as Karoshi (death from overworking); this condition was recognized in post-World War II Japan. Overworked and severely emotionally and physically stressed Japanese high level executives suffered strokes and heart attacks at alarming rates at relatively young ages. Researchers discovered that the death of these otherwise healthy men was due to chronic, unremitting stress. Government estimates in 1990 put the number of men dying each year from Karoshi at over 10,000 (DeMente 2002; Saleeby 2006).
Prolonged stress has been linked with elevated circulating markers of inflammation, and increased intima media thickness, a measure of atherosclerosis progression (Gouin 2011; Roepke 2011). Chronic stress considerably increases the risk of anxiety and depression by causing structural and functional changes in the brain as well (McEwen 2004; Liu 2010). Moreover, those who do not properly manage and adapt to chronic stress are more likely to be overweight and develop sexual dysfunction (Kyrou 2008).
TABLE 1: Health Risks Associated with Chronic Stress
|Stressor||Health Outcome||Increased Risk|
|Sleep Disturbances (Nilsson 2001)||Early Death from All Causes||170%|
|Occupational Injuries||38% (Men)|
|Perceived Stress (Nielsen 2008)||Early Death from All Causes||32%|
|Death from Respiratory Disease||79%|
|Death from Heart Attacks||159%|
|Death from External Causes||207%|
|Adverse Childhood Experiences (Brown 2009)||Death by Age 65||140%|
|Stress at Work (Heraclides 2009; Laszlo 2010; Heraclides 2011)||Risk of Type 2 Diabetes in Women||100%|
|Death from Heart Attack||181%|
|Early Death from All Causes||65%|
|Not Enough Reward for Effort at Work (Salavecz 2010)||Poor Self-Rated Health|| |
Up to 280%
|Divorce (Matthews 2002)||Total and Cardiovascular Death||37% (Men)|
|Major Negative Life Events (Kruk 2011)||Breast Cancer||533%|
How the Body Responds to Stress
When an individual experiences a stressor, physical or emotional, internal or environmental, the body initiates a complex system of adaptive reactions to help cope with the stress. This reactive response results in the release of glucocorticoids, also known as stress hormones, and catecholamines, which stimulate adaptive changes in a variety of bodily systems.
The “Fight or Flight” Response
Under short-term circumstances, stress-induced changes prioritize functions involved in escaping danger; for example – redirection of blood flow to the muscles from most other body parts, increased blood pressure and blood sugar levels, dilation of pupils, and inhibition of digestion for energy conservation. During this time, fatty acids and glucose (blood sugar) are liberated from storage sites into the bloodstream where they become readily available for utilization by the muscles. This is known as the fight-or-flight response. This reactive and adaptive protection system originates in the brain.
Upon perception of stress, specialized neurons in the paraventricular nucleus of the hypothalamus (a major endocrine-regulating brain region) respond by releasing, among other compounds, corticotrophin releasing hormone (CRH) and vasopressin (VP). Subsequently, these hormones stimulate the release of adrenocorticotropic hormone (ACTH) from the pituitary gland.
After entering circulation and reaching the adrenal glands, ACTH stimulates the production of glucocorticoids and catecholamines, which then act throughout the body to induce the adaptive changes mentioned in the opening paragraph of this section. Cumulatively, this brain-endocrine coordination comprises the hypothalamic-pituitary-adrenal (HPA) axis.
While the fight-or-flight response is undoubtedly necessary to initiate an autonomous response to impending danger in an acute situation (the “rush” you feel when you hear an unexpected loud noise, for example, is the fight-or-flight response in action), it can become devastating when active, even at a low-level, for a protracted period of time (Innes 2007).
We modern humans live in an environment filled with emotional stressors, such as financial worries, and deadline pressures at work or school. All of these modern worries chronically activate the HPA axis in an evolutionary unnatural way, leading to elevated stress hormone levels, and accompanying physiologic changes, throughout the day.
A few components of the fight-or-flight response are especially damaging to health when the stress response is active over a prolonged time frame – insulin resistance, and high blood pressure (Lehrke 2008).
The elevation in blood pressure and deteriorating insulin sensitivity contribute, along with several other stress-related physiologic irregularities, to a compromised health state that predisposes chronically stressed individuals to an onslaught of age-related diseases.
Eventually, chronic elevations in glucocorticoid levels damage and destroy neurons in the region of the hypothalamus responsible for regulating CRH release (Siegel 2006). This gives rise to erratic or insufficient HPA axis activation and may lead to the mood disorders, such as depression and anxiety, and fatigue commonly observed in individuals who have been under great stress for a long time.
A Closer Look at Cortisol
Cortisol is, in many ways, a paradoxical hormone. A certain amount of cortisol is necessary for optimal health, but too much or too little can be unhealthy. As mentioned above, during acute episodes of stress, more cortisol is released to help the body cope with physical or psychological stressors (Tomlinson 2004). Its primary functions in the body are:
-regulation of blood glucose levels by a process called gluconeogenesis in the liver
-regulation of the immune system;
-regulation of carbohydrate, protein and lipid metabolism
Essentially, cortisol is regarded as an anti-inflammatory hormone, a blood glucose modulator, an immune-modifier, and an adaptation hormone (Chrousos 2000). Depending on diet, exercise, stress, and time of day, serum levels of cortisol can vary.
During healthy conditions, cortisol levels peak in the early morning hours (usually around 8AM) and dip to their lowest between midnight and 4AM. The complex process of cortisol biosynthesis and release is sensitive to disruption by both internal and external factors (Beishuizen 2001; Tomlinson 2004; Weerth 2003). In the face of chronic psychological stress, for example, the adrenal glands excrete an abnormal amount of cortisol in an abnormal rhythm.
Cortisol, being a catabolic hormone (a hormone that breaks down tissues), when out of balance and unregulated, can have detrimental effects on body composition. Moreover, too much cortisol can suppress the immune system, while too little can lead to autoimmunity and rheumatologic disorders (Chrousos 2000; Wu 2008; Muneer 2011; Sapolsky 2002; Tak 2011).
Cortisol receptors are expressed throughout the body, including in the brain; therefore, derangement of the biosynthesis, metabolism and release of cortisol can disrupt many physiologic systems (Beishuizen 2001; Tomlinson 2004; Weerth 2003).
The Issue of “Adrenal Fatigue”
An alternative medicine term that often finds its way into discussions about stress is “adrenal fatigue”. Although “adrenal fatigue” is not a recognized diagnosis in conventional medicine Life Extension believes that symptoms often attributed to “adrenal fatigue” arise from multi-factorial pathological processes involving, among other systems, the HPA axis, and that these conditions must be treated as such.
On the other hand, Addison’s disease, sometimes referred to as “adrenal insufficiency” is a medical condition that can be life threatening. Addison’s disease is typically the result of an autoimmune disorder, but can arise due to genetic abnormalities as well. Consequences of Addison’s disease are much more severe and acute than those induced by stress and the condition should be closely monitored by a qualified healthcare professional. For those who would like more information, Addison’s disease is discussed in our Adrenal Disease protocol.
Recognizing When Stress is Getting the Best of You
Everyone has an inborn ability to handle stress. However, tolerance is variable as some people can handle only low levels and short durations of stress, while others adapt and can accommodate higher levels stress for more prolonged periods. Dr. Hans Selye, in 1935, devised the term stress as a factor that induced behavioral changes in mammals. He then furthered this notion to include higher level organisms (humans) as being effected by stress in a harmful way (Viner 1999).
According to Dr. Selye, there are three states the body faces when dealing with stress. The first being the alarm state early on in the process, followed by the resistance state where the body attempts to adapt to the added stress (release of cortisol), and finally, after stress overwhelms and weakens the system, the exhaustion state (Kalaitzakis 2011; Tak 2011). These three “states” can be analogously detailed as physiologic mechanisms:
1) Alarm state: adaptation to acute stress; “fight-or-flight” response;
2) Resistance state: emergence of consequences of prolonged stress response activation (i.e. insulin resistance)
3) Exhaustion state: decline in responsiveness and sensitivity of primary relays of the HPA axis (i.e. hypothalamic deterioration / dysfunction leading to erratic / insufficient stress hormone and catecholamine production and subsequent mood disorders and fatigue).
The same imbalances in the HPA axis and stress response mechanisms that contribute to these signs and symptoms also contribute to the deadly sequelae of more serious stress-related illness. Therefore, recognizing that you are experiencing some or all of the following symptoms is an important initial step towards achieving better overall health and mitigating your risk for various diseases.
Signs that You are Suffering the Effects of Chronic Stress May Include:
-Excessive fatigue after minimal exertion; feeling “overwhelmed” by relatively trivial problems
-Trouble awakening in the morning, even after adequate sleep
-Relying on coffee (caffeine) and other “energy” drinks for a pick me up
-Perceived energy burst after 6:00 PM
-Chronic low blood pressure
-Hypersensitivity to cold temperatures
-Increased premenstrual symptoms (PMS) symptoms
-Depression and/or labile mood swings
-Mental “fog” and poor memory
-Decreased sex drive
-Craving sugar and salty foods
-Imbalanced immune system
-Generalized weakness and dizziness upon standing
Some of these symptoms may mimic, or overlap, with dysfunction of the thyroid gland, gonadal (sex) hormones, malnutrition, depression, chronic fatigue states, chronic illness, infections, alcohol and drug abuse, and heavy metal toxicity (Ng 1990; Gagnon 2006). Therefore, it is very important to rule out other possible causes before attributing symptoms to chronic stress alone.
Impaired Stress Response: A Major Cause of Anxiety and Depression
Often, chronic stress is accompanied by mood disorders, particularly anxiety and depression. In fact, depression and anxiety can both be viewed as manifestations of an impaired stress response; the underlying physiology of both is similar. Stress can be effectively managed by supplements containing Gaba.
In fact, the chronic elevation in glucocorticoids caused by chronic stressors in modern society can lead to physical changes in brain structure.
For example, dendrites, the branches of neurons that receive signals from other neurons, are shifted into less functional patterns upon chronic exposure to glucocorticoids. This has been documented in key brain regions associated with mood, short-term memory, and behavioral flexibility (Krugers 2010). Furthermore, glucocorticoids cause receptors for the mood-regulating neurotransmitter serotonin to become less sensitive to activation (van Riel 2003; Karten 1999). Other detrimental effects of chronic stress include both increased susceptibility to neuronal damage and impaired neurogenesis, the process by which new neurons are “born” (Krugers 2010).
Interestingly, emerging research suggests that certain psychoactive drugs, like those used to treat anxiety and depression, may stabilize mood not only by acting upon neurotransmitter levels, but by modulating the action of glucocorticoids receptors within the brain (Anacker 2011). These new findings strongly support the idea that in order to alleviate mood disorders, controlling stress response is an important aspect of treatment. Indeed, several genetic and epidemiological studies have linked excessive stress, and the inability to efficiently adapt to stress, to increased rates of anxiety and depression (Strohle 2003; Binder 2010).
Chronic Stress and Nutrition
Deficiencies, toxicities and life style habits impact the adrenal gland. Deficiencies in vitamin C and vitamin B5, which are essential co-factors in cortisol production and adrenal health, are two examples (Brandt 2012*; Daugherty 2002). Copper is a mineral that is essential in some bodily enzymatic reactions, but may disrupt adrenal function if levels are too high (Veltman 1986).
Even relative imbalances between minerals can affect cortisol levels. It has been documented that abnormal ratios of copper to zinc cause adrenal cortex disruption (Ng 1990; Gagnon 2006). A well balanced multivitamin can complement a healthy diet to help ensure that vitamin and mineral intake is sufficient to support optimal adrenal function.
The fatty acid content of the diet also contributes considerably to stress response physiology. Relative imbalances of omega-6 fatty acids to omega-3 fatty acids create conditions that favor heightened inflammation and impaired stress response (Kiecolt-Glaser 2010).
For example, a clinical trial examined the effects of parenteral fish oil infusions on the stress response induced by injections of an endotoxin called lipopolysaccharide. The group who received fish oil exhibited a much less severe stress response, with plasma norepinephrine levels remaining sevenfold lower and ACTH levels fourfold lower than the control group (Pluess 2007). Upon examination, it was found that the platelet phospholipid omega-3 content had increased substantially in fish oil group, reflecting a lowered omega-6 to omega-3 ratio, a state less conducive of inflammation.
It is believed that a diet high in omega-3 fatty acids may attenuate the effects of chronic stress by limiting the influence of inflammation on stress physiology (Kiecolt-Glasser 2010).
Since cholesterol is a building block of the cortisol hormone, ingestion in the diet of some saturated fat is important. However, the liver will synthesize cholesterol, if poor dietary ingestion occurs, from acetate (Hellman 1954). Of course, too much cholesterol has its drawbacks as well, so a happy medium must be reached. Both extremes of dietary fat ingestion have ill effects on the human body. Life Extension suggests an optimal total cholesterol level of 160-180 mg/dL.
Lifestyle Strategies for Overcoming Chronic Stress
Dr. Thierry Hertoghe, an internationally noted endocrinologist, advises a few lifestyle modifications that one should adhere to before consideration of natural or pharmacological therapies. Lifestyle modifications alone for some with mild to moderate forms of impaired stress response may ease symptoms (Kalaitzakis 2011; Tak 2001; Head 2009). Dietary supplements and/or hormone therapy can complement lifestyle modification to resolve adrenal dysfunction (Hertoghe 1999).
The obvious recommendation of avoiding stressful situations and occurrences goes without saying. If commuter stress, for example, is affecting your body, moving to a home closer to your workplace or finding a job closer to home is an obvious solution. If working third-shift causes disruption in your cortisol levels or circadian rhythm resulting in disease, then change your work schedule to eliminate this stressor (Wirth 2011). Smoking, and extremely vigorous or protracted bouts of exhaustive exercise impact the adrenals in a negative way as well (Peters 2001; Wu 2008; Siddiqui 2001).
With regard to the diurnal biorhythms of cortisol release, a few things increase cortisol at the inappropriate time. The consumption of alcohol and caffeinated beverages such as tea and coffee before bedtime is not recommended as caffeine can increase serum cortisol levels, which is counterproductive during the evening hours when the normal trough is expected (Ping 2012). Additionally, caffeine and alcohol affect the release of melatonin (melatonin counters some of the negative effects of cortisol), causing a relative reduction in melatonin secretion during the night when a spike is usually seen (Lovallo 2006).
Other therapies such as acupuncture, Traditional Chinese Medicine (TCM), Ayurvedic medicine, massage therapy, relaxation, yoga and even music therapy have shown success in stress management (Hanley 2003; Dixit 1993; Field 2005).
Several published studies suggest that owning a pet is associated with improved physical and psychological health (Barker 2008; Friedmann 2009). For chronically stressed individuals, adopting a dog or cat may help ameliorate some of the symptoms and effects of chronic stress (Allen 2001).
Alternative Stress Management Strategies
DHEA, also an adrenal hormone, counters the action of cortisol in many tissues (Buoso 2011). The balance between cortisol and DHEA is generally maintained in youth. However, as we age, DHEA levels decline sharply (Zaluska 2009). The unabated action of cortisol in the presence of declining DHEA levels can contribute to stress-related diseases.
Furthermore, DHEA replacement therapy can restore balance between cortisol and DHEA (Ferrari 2001). DHEA has been shown to reduce the negative impact of elevated levels of cortisol on the brain of dementia and Alzheimer’s disease study subjects (Rasmuson 2002). The heart benefits as well, with a decline in the incidence of coronary artery disease with DHEA supplementation (Barrett-Connor 1986; Feldman 1998; Shufelt 2010). In the context of metabolic syndrome, which is characterized by abdominal obesity, lipid disorders, insulin resistance, and hypertension, DHEA reduces lipid levels, lowers adipose tissue formation and reduces cardiovascular risk (Villareal 2004; Lasco 2001).
DHEA also has a positive effect on cognitive function and mood (Ferrari 2004; van Broekhoven 2003; Schmidt 2005). DHEA appears to be beneficial in those with glucose intolerance and diabetes, lowering average serum glucose levels and averting the destructive effects of diabetes (Kameda 2005; Dhatariya 2005). There have been reports of cancer risk reduction with DHEA supplementation as well (Ciolino 2003). With regards to age related bone mineral loss, DHEA supplementation has been shown to combat osteoporosis (Villareal 2000).
A great deal of insight into the function of the adrenal glands can be gained through testing blood levels of DHEA and cortisol. Deviations from the natural rhythm of adrenal function can be detected by an AM / PM cortisol test, in which levels of the adrenal hormone are tested early in the morning and early in the evening of the same day. A DHEA sulfate (DHEA-s) blood test can determine if DHEA levels are sufficient.
Supplemental doses of DHEA typically range from 10 – 25 mg daily for women and 25 – 75 mg daily for men, but should always be determined based upon DHEA-s blood tests. Life Extension suggests that in order to counter the negative effects of aberrant cortisol production, DHEA-s blood levels should remain between 350 – 490 µg/dL for men, and 275 – 400 µg/dL for women.
The hormone melatonin, which is released from the small gland at the base of the brain called the pineal gland, is known for its relationship with the sleep cycle. Melatonin has an antagonistic effect on cortisol, and the circadian rise in melatonin levels at night correlates with a drop in cortisol (Presman 2012). Low levels of melatonin can mean inappropriate and undesirable glucocorticoid signaling during the night when it should be at the lowest.
Chronic, late-night stress, whether physical or psychological, can result in an inappropriately elevated night time cortisol level; shift-work is an example of such a stressor (James 2007). This chronic disruption and inappropriate release of cortisol at night may impair the normal circadian corticosteroid output in the morning (Soszynski 1989; Bruls 2000, Pawlikowski 002; Hertoghe 1999).
Melatonin is also a hormone with great penetration into the nucleus of the cells and is one of the most important antioxidant hormones as it protects cellular (mitochondrial and nuclear) DNA from damage (Reiter 2002). Melatonin has been found to affect the levels of cortisol and the balance between DHEA and cortisol in circulation (Soszynski 1989; Bruls 2000; Pawlikowski 2002). Doses differ in individuals but can start as low as 0.3 mg; some may require up to 10 mg daily.
Maintaining Sex Hormone Balance
Imbalances in the sex hormones (testosterone for men, and estrogen and progesterone for women) may exacerbate the detrimental effects of chronic stress. Some experimental data indicates that having low levels of sex hormones impairs the response to cortisol in the brain (Mitsushima 2008). Overtime, this may lead to an over-compensatory increase in stress hormone production by the adrenal glands, which could become damaging.
Likewise, human trials have confirmed that steroid hormones exert considerable influence over the stress response. In a small trial of women who were overcoming cocaine addiction, higher progesterone levels were associated with a blunted stress response to a drug cue (Sinha 2007).
In another clinical trial, menopausal women treated long-term with hormone replacement therapy (HRT) coped with stress better than non-HRT users in an experimental setting (Patacchioli 2006).
The biological actions of the sex hormone progesterone within the brain are calming, and so age-related declines in progesterone levels may predispose women to anxiety. Specifically, some metabolites of progesterone have been shown to function as ligands at the GABAA receptor subunit, which is inhibitory upon activation (Majewska 1986).
Stressed men and women should review Life Extension’s Male Hormone Restoration, and Female Hormone Restoration protocols.
Nutrients to Counteract the Effects of Stress
Several members of the B-vitamin family impact varying aspects of stress response physiology. For example, pantothenic acid is necessary for the synthesis of coenzyme A (CoA), which is integral in the production of cholesterol, and in steroid hormone biosynthesis (Tahiliani 1991; Trumbo 2006). Pantothenic deficiency is rather rare, but it can result in adrenal insufficiency (Murray 1997; Webster 1998; Anon 1980; Plesofsky-Vig 1994).
Another correlation between B-vitamins was revealed in a clinical trial that found that injecting either ACTH (adrenocorticotropic hormone) or cortisol into healthy subjects for just four days significantly decreased levels of folic acid and B12 (Berg 2006). These findings suggest that not only are B-vitamins important to promote healthy stress response, but stress itself may lower B-vitamin blood levels. Therefore, B-vitamin supplementation may ameliorate the effects of stress from multiple angles.
Another crucial vitamin in adrenal function and maintenance of healthy levels of cortisol and DHEA is vitamin C (Bornstein 2004; Morfin 2002). Deficiencies of this vitamin can have profound effects on adrenal function (Brody 2002; Carroll 2000). The benefits of vitamin C are multiple, acting as an anti-inflammatory and co-factor in soft tissue synthesis and repair (Eipper 1992; Hemila 1996; Evans 2008).
In addition, ultra-marathon runners who were given 1,500 mg vitamin C after a race displayed less dramatic elevations in cortisol and epinephrine levels than is typical after such extreme stress (Peters 2001). Moreover, this same study found that vitamin C was able to suppress inflammation in the runners as well.
Calcium, magnesium, sodium and potassium are all macro elements. A macro element means that they are found in our bodies in greater quantities than other elements or minerals. These four macro elements are important in supporting and maintaining balanced adrenal function (Kobayashi 1996; Carroll 2000). They are important in the formation and release of adrenal hormones.
Manganese, zinc, chromium, and selenium are some of the trace elements that have an impact on the function of the adrenal glands. Research shows that deficiencies in these trace elements can have a negative effect on adrenal function (Golf 1998; Wilborn 2004; Schulz 1998).
L-theanine is an amino acid found exclusively in green tea that has traditionally been used to enhance relaxation and improve concentration and learning ability (Vuong 2011; Wakabayashi 2011; Nathan 2006).
L-theanine is chemically related to the neurotransmitter glutamate, and binds to glutamate receptors in the brain (Cho 2008). Unlike glutamate, however, which can cause a state called excitotoxicity that can destroy nerve cells, L-theanine protects brain cells against excitotoxicity, calming the nerve networks in the brain (Kakuda 2002; Nagasawa 2004; Di 2010).
Animal studies verify the behavioral benefits of these biochemical effects. In in vitro studies, L-theanine reduces electrical activity associated with anxiety (Dimpfel 2007). L-theanine reduces evidence of anxiety and depression in several different animal models of stress (Yin 2011; Heese 2009). In one animal model, L-theanine led to decreases in nearly all frequencies of brainwave activity, indicating a state of calmness and relaxation (Dimpfel 2007). Moreover, L-theanine has been shown to act synergistically with the GABAergic drug midazolam, a relative of Valium® (Heese 2009).
Brain wave studies have shed some light on the mechanism by which L-theanine may appease anxiety. In one study, healthy subjects took a soft drink containing green tea enriched with L-theanine while their brainwave power was measured (Dimpfel 2007). Power was initially reduced in all frequencies and areas during the first hour, indicating relaxation. Later changes indicated both an increase in mental performance and a higher degree of relaxation. In this case, L-theanine seemed to produce desirable increases in attention, accompanied by durable relaxation—that means subjects could concentrate better without being distracted by anxiety.
Another brainwave study demonstrated that L-theanine significantly increased activity in the frequency band associated with relaxation without inducing drowsiness (Nobre 2008). A third trial concluded that L-theanine plays a general role in sustaining attention during a long-term difficult task (Gomez-Ramirez 2009).
Another way to assess stress and anxiety is by measuring vital signs such as heart rate and salivary content of certain proteins that are increased during stress. Japanese researchers did just that with 12 subjects during a mental arithmetic test given as an acute stressor (Kimura 2007). Results showed that the supplement reduced heart rate response to the acute stress task, compared with placebo. In addition, heart rate variability was improved, a sign that the L-theanine was modulating the sympathetic nervous system, or “fight-or-flight” response.
Research indicates that intake of fish oil or omega 3-fatty acids (n-3 EFA or EFA) can act in an adaptogenic fashion to help ameliorate the effects of stress (Bradbury 2004; Delarue 2003). Omega-3 fatty acids balance the effects of omega-6 metabolism (Warren 1999; Puri 2007; Maes 2005). Fatty acid balance is also critical for glucorcorticoid hormone receptor function (Hirata 1980; Hidalgo 1978; Willis 1981). In recent years omega-3 fatty acids have been documented to be successful in treating those suffering from depression and anxiety disorders, which themselves can be a consequence or an inducer of stress (Logan 2004; Rocha 2010; Silvers 2005).
The phospholipid phosphatidylserine (PS) is found in cell membranes and is a critical component for healthy cellular communication. Several studies have shown that a diet rich in PS is able to balance the HPA axis and limit the negative consequences of over-activation of the adrenal cortex (Monteleone 1990; Kelly 1999; Benton 2001; Kimura 2006; Hellhammer 2004). Phosphatidylserine also helps attenuate the increase in cortisol levels during periods of intense, acute stress (Fahey 1998).
Sedative herbs such as hops, passionflower, poppy, and valerian can provide calming effects to reduce stress. The herbal lemon balm (Melissa officinalis) has been shown in a number of studies to reduce stress. This is yet another herbal that has shown benefit in reducing negative effects of stress on the body (Kennedy 2004 and 2006; Dimpfel 2004).
In a recent small clinical trial including 20 stressed volunteers, a standardized lemon balm extract (Cyracos®) was shown to significantly combat anxiety symptoms and insomnia (Cases 2011). The extract “reduced anxiety manifestations by 18%, ameliorated anxiety-associated symptoms by 15% and lowered insomnia by 42%.”
A class of herbs known as adaptogens are helpful in regulation of the HPA axis. Dr. Nikolai Lazarev, a noted Russian pharmacologist during the cold war era, coined the term “adaptogenic herb” to describe about 25 of the hundreds of medicinal herbs having particular properties (Kelly 2001). These properties are unique to this class of herbs making them important for human health.
To be classified as an adaptogen, herbs must have the following three properties: There can be no toxicity associated with them; they must have a normalizing ability, (i.e. the same dose can raise or lower physiologic properties), and the mechanisms by which the herbs carry out their effects must be due to more than one physiologic or pharmacologic mechanism (Lipnick 1992; Brekhman: 1969; Saleeby 2006). Unlike any other compound, adaptogens condition your body to respond favorably to stress.
Adaptogenic herbs can become an important supplement to support a healthy HPA axis stress response. The list of adaptogenic herbs include about twenty-five known, and of these several have been studied for their affects on the HPA system. Ginseng (Panax ginseng), Eleuthero (Eleutherococcus senticosus), Rhodiola (Rhodiola rosea), Cordyceps (Cordyceps sinensis) and Ashwaghanda (Withania somnifera) to name a few. (Gaffney 2001; Saleeby 2006; Panossian 2005; Kelly 2001; Spasov 2000).
The adaptogenic herb Rhodiola (Rhodiola rosea) has demonstrated in a number of studies improvements in both physical endurance and cognitive performance (De Bock 2004; Spasov 2000; Shevtsov 2003). Its ability to reduce fatigue associated with stress is documented in well-designed research papers (Olsson 2009; Spasov 2000; Panossian 2009). The apparent mechanism of action of Rhodiola is related to its ability in assisting neurotransmitter transport in the brain and the blunting of catecholamine release (Stanchev 1987; van Diermen 2009).
A large, phase III placebo-controlled clinical trial was conducted in Sweden in 2009, studying participants aged 20-55 years with a diagnosis of stress-related fatigue (Olsson 2009). Subjects taking the Rhodiola extract had significantly lower cortisol responses to chronic stress than did the placebo recipients—and as a result they had lower scores on scales of burnout and improved performance on cognitive testing.
Ashwagandha, also known as Withania somnifera, is an important Ayurvedic medicinal herb. It has many uses in traditional Indian medicine such as treatments for stress, fatigue, pain, diabetes, GI and rheumatologic disorders (Mishra 2000). Ashwagandha has shown promise in neuroprotection as scientists have discovered that this adaptogenic herb prevents damage to neurons and improves neurological function in the face of stress (Cooley 2009; Tohda 2005; Choudhary 2004). Additionally, data suggests that Ashwagandha may reduce the harmful effects of stress on male reproductive capacity (Ahmad 2010).
A double blind, randomized, placebo-controlled clinical trial assessed the effects of ashwagandha in 130 chronically stressed subjects (Auddy 2008). Over a 60-day period, doses ranging from 125 mg to 500 mg daily of a patented ashwagandha extract (Sensoril®) significantly improved scores on a standardized measurement of stress intensity, and also favorably modulated several biomarkers associated with cardiovascular health, including C-reactive protein and blood pressure. Moreover, at the end of the study period subjects that received 500 mg of ashwagandha daily had cortisol levels nearly 30% lower than subjects who took a placebo, and their DHEA-s levels were significantly higher as well.
Probably the most recognized of the adaptogen herbs in the West is Ginseng (Panax ginseng). There are eleven species of this medicinal herb, P. ginseng being among the most widely studied (Chen 2004; Huang 1999). American Ginseng (Panax quinquefolius) is another species within the Panax genus that shares medicinal properties (Chan 2000). Siberian ginseng (Eleutherococcus senticosus), while not technically a true ginseng botanical, has similar beneficial properties and is closely related to the Panax family of plants (Davydov 2000).
A wealth of studies exist showing stress reducing properties of true ginseng and the other ginseng related herbals (Barton 2010; Ma 2008). For example the isolated polysaccharides from P. ginseng have demonstrated anti-fatigue properties in one recent study (Wang 2010).
American ginseng extract shows a reduction in oxidative endothelial damage due to diabetes (Sen 2011; Amin 2011). Anti-depressive effects and the positive modulation that benefits the HPA axis is outlined in a research paper on protective ginsenosides in Panax and other ginseng plants showing usefulness in the management of chronic stress (Liu 2011; Cao 2011).
A mainstay in Traditional Chinese Medicine (TCM), licorice extracts may be of benefit for those who have reached the exhaustion stage and are no longer producing sufficient cortisol.
Licorice has the ability to decrease the breakdown or metabolism of hydrocortisone by the liver, thus increasing the amount of cortisol in circulation and reducing the strain on the adrenal glands to produce it (Methlie 2011). The combination of low doses of licorice with supplemental DHEA may help balance the HPA axis (Palermo 2004).
It is important to understand that licorice may not be ideal for everyone dealing with day-to-day stress. In high doses over prolonged periods licorice may cause electrolyte imbalance (hypokalemia) and elevations in blood pressure, a syndrome called hypermineralocorticoidism (Schambelan 1994). Due to its ability to increase cortisol levels, licorice is best reserved for those individuals who are experiencing fatigue due to chronic stress and also have low cortisol levels.
DR Vitamin Recommendations
Maintaining balance in today’s stressful world requires a multimodal approach that encompasses healthy eating habits, getting plenty of exercise, and using innovative natural ingredients to support the body’s natural adaptive abilities. Regular blood testing of DHEA-s, and morning and evening cortisol levels help ensure that stress hormones remain in balance.
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