What is Stress? Surveys and research reports conducted over the past 2 decades reveal that 43% of all adults suffer adverse effects due to stress. In fact, 75% to 90% of all visits to primary care physicians are in some way related to the adverse impact of psychosocial stress. Stress can be defined as any perceived physical or psychological change that disrupts an organism’s metabolic balance.
Acute Stress – FIGHT OR FLIGHT In the face of acute stress, the body mobilizes the “stress response” which is essential to survival.
Chronic mobilization of the stress response carries a wide array of pathophysiological risks. Foot is constantly “on the accelerator” Chronic Stress Response
Chronic Stress Sapolsky, RM. Stress: Stress Related Disease and Emotion Regulation. In J. Gross (Ed.), Hand Book of Emotionsl Regulation. (pp 606-615). New York, Guilford. 2007 “Overwhelmingly, it is psychological rather than physiological stress which has the capacity to elevate and maintain the stress response chronically causing disease consequences, and affects the immune system.”
Sympathetic/Parasympathetic Nervous System The Accelerator/Braking System
Chronic Stress Research increasingly supports the critical role that stress and stress molecules can play in obesity, diabetes, osteoporosis, hypertension, cardiovascular disease, infectious disease, gastric ulcer, cancer, and gastrointestinal, skin, and neurologic disorders, as well as a host of disorders linked to immune system disturbances.
Chronic Stress The American Institute of Stress. America’s #1 health problem and job stress. http://www.stress.org/problem.htm. November 2001. http://www.stress.org/problem.htm. November 2001 Chrousos GP. The role of stress and the hypothalamic-pituitary-adrenal axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and target tissue related causes. Int J Obes Relat Metab Disord 2000;24(Suppl 2):S50-S55. University of Michigan. Neuroendocrinology of the stress response. http://www.umich.edu/~psycours/531/stress/sld001.htm. November 2001.http://www.umich.edu/~psycours/531/stress/sld001.htm. November 2001 Chronic stress has also been shown to affect behavior in both human and animal models, and has been linked to psychiatric illness such as depression and anxiety in humans.
Cortisol – Main Stress Hormone Chrousos GP. The role of stress and the hypothalamic-pituitary-adrenal axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and target tissue-related causes. Int J Obes Relat Metab Disord 2000;24(Suppl 2):S50-S55. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999;99(16):2192-217. Stress-induced hypercortisolemia, as well as the excessive release of catecholamines, may curtail life expectancy by several years via their downstream effects on physiology and organ/system function
Stress and the Digestive System A stress dominated system shuts down the appropriate functions of digestion Decreases the nutrition absorbed from our meals and also causes an erosion of tissue which then create disorders such as irritable bowel syndrome (IBS), peptic ulcers, GERD, and others. Dinan TG, et al. Gastroenterology 2006. Feb;130(2):304-311. Heitkemper M, et al. Am J Gastroenerol. 1996 May; 91(5):906-913.
Overall Dietary Approach Anti-inflammatory Mediterranean diet Low glycemic load foods… do NOT raise your blood sugar by eating high fiber fruits, vegetables, and grains Rich in phytonutrients – healthy compounds that occur naturally in foods and give food color (found in fruits, vegetables, nuts, and beans)
Unrefined carbohydrates = nothing white AVOID caffeine
Eat small portions frequently throughout the day – high fiber and vegetable oriented diet Drink half your body weight in water/day 150 lbs = 75 oz = 2.2 liters water Probiotics = Healthy Bacteria 70% of serotonin (“feel-good” neurotransmitter) produced in your GI tract 70% of your immune system is in your GI tract
Basic Supplemental Approach A good quality multivitamin with attention to: B Complex (co-factors in hormone production) B5 - pantothenic acid (1000-1500 mg) B6 – pyridoxine (50-100 mg) ideally P-5-P Biotin (1000 mcg) Folic acid (400-800 mcg) ideally MTHF Vitamin C (1-2 gm) Magnesium (400-600 mg) Omega-3-fatty acid (1-3 gm) = Fish oil
Effects of High Dose B vitamins w/ C Randomized, placebo-controlled, double blind, parallel groups trial of aged 30-55 yo who were in full-time employment Profile of Mood States (POMS), Perceived Stress Scale (PSS), Generalized Health Questionnaire (GHQ-12) Vitamin/mineral supplementation led to significant improvements in ratings on the PSS, GHQ-12 and POMS Psychopharmacology: 55-68, 2010
A special class of hormones called glucocorticoids is known to decrease expression of vitamin D receptor. The most well known glucocorticoid is cortisol. Without a receptor, vitamin D is left with nothing to do and nowhere to go; it remains inactive in the body. Dose: 1,000 - 5,000 IU/day
Exercise Exercise may increase body temperature, blood circulation in the brain, and impact the hypothalamus-pituitary-adrenal axis and physiologic reactivity to stress Guszkowska M. Psychiatr Pol. 2004 Jul-Aug; 38(4):611-620S
Women were randomly assigned to attend yoga practice for 90 min twice weekly for 8 weeks The yoga group had lower morning and 5pm salivary cortisol levels and improved emotional well-being and fatigue scores Journal of American Academy of Nurse Practitioners: 135-142. 2010 Yoga
Lifestyle Recommendations Reframe your experiences Studies have shown that hostile individuals had higher incidence of cardiovascular disease and insulin resistance (pre-diabetes) Use positive affirmations throughout the day
Lifestyle Recommendations Breathe deeply – this induces a deeper parasympathetic state (foot on the brake), increases your sense of well-being, and increases oxygen
Lifestyle Recommendations Take new or challenging activities one step at a time. “Inch by inch life is a cinch, yard by yard life is hard” Amer J of Cardiology. 2005. July 1; 96(1):64-66 J Behav Med. 2005. June;28(3):295-299 Neuopsychobiology. 2006. 53(1):221-226
“Joy First ….then anything else you have time for” -Abraham Hicks
A Systemic Review Nutritional and Herbal Supplements for Anxiety and Anxiety-Related Disorders: A total of 24 studies that investigated 5 different CAM (Complimentary/Alternative Medicine) monotherapies and 8 different combination treatments and involved 2619 participants met the inclusion criteria and were analyzed
Nutritional and Herbal Supplements Based on this systemic review: strong evidence exists for the use of herbal supplements containing extracts of passion flower or kava, and combinations of L-lysine and L- arginine as treatments of anxiety symptoms and disorders. Nutrition Journal. 2010
Adaptogenic Herbs An adaptogen is a metabolic regulator which increases the ability of an organism to adapt to environmental factors, and to avoid damage from such factors. Environmental factors can be either physiological (external): injury or aging physiological psychological (internal): anxiety psychological
Adaptogenic Herbs It must be innocuous with a broad range of therapeutic effects without causing any major side effects. The adaptogen concept does not fit easily into the Western model of medicine.
Rhodiola rosea Rhodiola – exerts an anti-fatigue effect that increases mental performance, particularly the ability to concentrate, and decreases cortisol response to awakening stress in burnout patients with fatigue syndrome Olsson EM, et al. Planta Med. 2009 Feb; 75(2):105-112
Rhodiola rosea Darbinyan V. Phytomedicine. 2000 Oct; 7(5):365-371 Spasovv AA et al. Phytomedicine. 2000 Apr; 7(2):85-89. Research has shown that Rhodiola significantly improves depression, fatigue, and insomnia.
Many patients with depression are noted to have excessive activation of the HPA axis manifested by oversecretion of cortisol Flavonoids from Planta Med. 2004 Oct; 70(10):1008-1011. St John’s wort reduced corticosteroids (cortisol) after 2 weeks
Ashwagandha moderates the stress response, when exposed to chronic environmental stressors, including lessening of symptoms such as depression, increased blood sugar, glucose intolerance, increased cortisol, cognitive deficits and stomach ulcers. Bhattacharya NP, et al. Pharmacol Biocem Behav. 2003 June; 75(3):547-555.
Effects of Dark Chocolate on Micobiota, & Stress-Related Metabolism 40 grams of dark chocolate for 14 days Human subjects with higher anxiety trait showed a distinct metabolic profile indicative of a different energy homeostasis, hormonal metabolism (adrenaline), and gut microbial activity
Effects of Dark Chocolate on Micobiota, and Stress-Related Metabolism Dark chocolate reduced the urinary excretion of the stress hormone cortisol and catecholamines, and partially normalized stress related differences in energy metabolism, and gut microbial activities. J Proteome Res. 2009 Dec; 8(12):5568-79.