1. The Role of Daily stress in Health Adapted by Wouter Lox Product specialist & Regulatory Affairs

2. Introduction This presentation is not intended to promote a product, but is a presentation to explain the influence of daily stresses on your health. This presentation is part of this workshop to explain solely the importance of control the negative effects of busy lifestyles and this information can only be used in the framework of this presentation

3. What happens during stressful moments Start of the body’s primary reaction – “Fight-or-Flight” response – This reaction also Regulates inflammation, carbohydrate metabolism, blood pressure, cardiovascular function, etc… BUT too much of this reaction for too long leads to problems Analogy... Cholesterol: hormone synthesis and cell membrane structure Too much cholesterol: leads to arterial plaque and poor heart health (bad) Solution: control cholesterol (reduce it, don’t obliterate it)

4. Stressful moments ACUTE Stressful moment brief normal circadian rhythm adaptive CHRONIC Stressful moments prolonged & repeated disrupted circadian rhythm maladaptive

5. Why Zebras Don’t Get Ulcers… Robert Sapolsky, PhD Stanford University - Stress Physiology

6. Figure 1.2 The “Type C” personality (The HUMAN stress response) A Stress occurs! B SAME stress response begins in the brain (lots of chemistry) D Stress response continues and stress hormones lead to tissue damage C Modern stressors do not permit Fight or Flight Yikes !!! Humans are not Zebras… …and are not meant to harbor chronic stressful situations E Stress could lead to health problems

7. Body Response to Stressful situations STRESS Epel et al. Psychosom Med 2000;62(5):623-32

8. M. Altemus, Cornell University. Trier Social Stress Test (public speaking & arithmetic)

9. “Normal” Diurnal Cortisol Rhythm

10. “Modern” Cortisol Rhythm

11. Psycho-Neuro-Immunology HEALTH endocrine systemnervous system immune system stress depression anxiety conflict personalitybereavement

12. Prevalence of Chronic Stressfull situations One in three European workers is affected by elevated stressful moments European studies show that 50-60% of all lost working days are related to stressful days Sources: Working on Stress - European Agency for Safety and Health at Work (http://agency.osha.eu.int), U.S. Center for Disease Control; World Health Organization; www.whmc.af.mil; 2000 Gallup Poll “Attitudes in the American Workplace”

13. Work-related stressful life is estimated to cost the EU more than 265 billion Euros annually More than half of all deaths between the ages of one and 65 result from stressful lifestyles Generalized anxiety disorder affects an estimated 183 million people worldwide

14. Cortisol in the Media More Than 1,000 News Articles Over the Past Year! Time, Washington Post, Men’s Health, Prevention, Glamour, Shape, Woman’s World, Reader’s Digest, Reuters, ABC, MSNBC…

15. Symposium on Cortisol, Stress and Health Park City, Utah - May 2002 - Experts from United States, Canada, and Europe presented emerging cortisol research New Book: The Cortisol Connection (Sept 2002) –...Why Stress Makes You Fat & Ruins Your Health… –...And What You Can Do About It…

16. Today’s Health “indicators” 1980’s = Cholesterol Early 1990’s = Free Radicals / Antioxidants Later 1990’s = Insulin / Blood Sugar 2000’s = Cortisol Just as high cholesterol, free radicals, and high blood sugar are considered indicators of declining health, there is increasing evidence that high cortisol is emerging as a significant health “indicator.”

17. Scientific Evidence The Relationship Between Elevated body responses to everyday stresses and health

18. Busy lifestyles and weight maintenance High cortisol secretion is associated with abdominal fat Abdominal fat is most highly associated with a less optimal health status: High cortisol secretion may be a contributing factor to the abnormal metabolism often seen in abdominal obesity 2 1. Peeke PM, Chrousos GP. Ann NY Acad Sci 1995;771:665-76. 2. Bjorntorp P, Rosmond R. Nutrition 2000;16(10):924-36.

19. Abdominal fat & Stress-Related Cortisol Years in work Abdominal Obesity Stress-related cortisol <10 11-20 >21 11-20 >21 19 20 22 24 23 21 0 0.1 0.3 0.5 0.4 0.2 20.6 ±2.2 21.5 ±4.1 22.5 ±3.7 P<0.05 0.04 ±0.3 0.15 ±0.6 0.34 ±0.5 P<0.05 Rosmond, et al. Obes Res 2000;8:445-450. nmol/Lcm

20. Abdominal Fat Accumulation Busy lifestyles / High Cortisol Normal life / Normal Cortisol

21. Epel et al. found that purely psychological intervention that reduces anxiety and cortisol also reduces abdominal fat Anxiety Epel et al., Psychoneuroendocrine Workshops, 2000 Cortisol rhythmicityAbdominal fat r =.76 r = -.63 r = -.86 Behavior?

22. % Change in Abdominal Fat baselinepost-tx (3 mo.)follow-up (6 mo.) -2.5 -2.0 -1.5 -0.5 0.0 0.5 1.0 Treatment Control Abdominal Fat (%) Time TREATMENT * F=9.7, p<.008 Epel et al. Psychosom Med 2000;62(5):623-32.

23. Busy lifestyles and Appetite Women with high cortisol response (compared to women with low cortisol response): consumed more calories ate significantly more sweet foods had more negative moods High dietary restraint is associated with high urinary cortisol excretion Dietary Restraint = Consciously trying to limit food intake to achieve or maintain a desired body weight 1. Epel ES, et al. Psychoneuroendocrinology 2001;26:37-49. 2. McLean JA, Barr SI, Prior JC. Am J Clin Nutr 2001;73:7-12.

24. Changes in Anxiety and Cortisol Rhythm r = -.86, p <.01 Epel et al., Psychoneuroendocrine Workshops, 2000

25. Additional Research Elevated Cortisol and Osteoporosis High cortisol excretion associated with high dietary restraint may cause long-term implications for bone health through the effect on ovulatory function. 1 1. McLean JA, Barr SI, Prior JC. Am J Clin Nutr 2001;73:7-12. 2. Sheline YI, et al. J Neuroscience 1999;19(12):5034-5043. Elevated Cortisol and Depression Fifty percent of women suffering from mood implications have high cortisol in conjunction with HPA axis dysregulation. 2 Additional research has also focused on cardiovascularhealth status, diabetes, mental function, and fatigue

26. Stress and your skin Stress linked to skin problems in 50% of French women Poli et al. J Eur Acad Dermatol Nov 2001 (3,305 women aged 25-40 yrs) Dermatology Service, Mondor Hospital, Creteil, France Stress hormones => Stimulate oil formation = skin problems Zouboulis et al. Proc Natl Acad Sci, May 2002 Dept of Dermatology, Free University of Berlin, Germany

27. “Adult female acne [is] a modern phenomenon…a lot more common than 100 years ago” Richard Glogau, MD, Professor of Dermatology, Univ California San Francisco (Allure, Aug 2002) “Adult acne [is] an epidemic [with] an exponential increase in sufferers in the past ten years” Steven Grekin, MD, Clinical Professor of Dermatology, Univ of Health Sciences, Des Moines (Allure, Aug 2002) “During stressful times - or any time the economy is bad - we definitely see more acne” Debra Jaliman, MD, American Academy of Dermatology (Allure, Aug 2002)

28. . 6543210 Time (days after challenge) 0 10 20 30 40 50 60 70 control increase in skin thickness (% baseline) Dhabhar & McEwen, 1996, J. Immunology, 156, 2608-2615. Acute stressful situations enhances a skin response

29. Effect of Cortisol on Skin Response. 543210 0 10 20 30 40 50 60 70 control acute corticosterone Time (days after induction) increase in skin thickness (% baseline) Dhabhar & McEwen, 1999, PNAS, 96: 1059. chronic corticosterone Too much stress/cortisol makes you “thin-skinned”!

30. – Chronic stressful situations – Sleep deprivation –Dieting / Restrained eating Cortisol Levels Are Elevated In... Adults who need to control cortisol levels are… Frequently confronted with stressful situations Getting less than 8 hours of sleep every night Limiting caloric intake to lose weight

31. There is a strong scientific association between chronically elevated cortisol levels and stress-related body responses… Therefore, it is important for long-term health to control your body responses to busy lifestyles

32. Example of Health Benefits when controlling cortisol levels Enhances feelings of wellbeing and control in response to stressful situations Improves performance and increased vigor throughout the day Better mental concentration and focus Supports weight maintenance efforts

33. You can control cortisol levels via: Stress Management Techniques Meditation, Coping strategies, etc… Exercise – Daily, moderate aerobic and strength training Nutrition –Balance carbohydrates with protein –Maintain adequate hydration –Avoid caffeine Supplements –Avoid ephedra and related stimulants –Cortisol-controlling supplements –(Phosphatidylserine, Beta-sitosterol...) –Relaxation supplements (Ashwagandha, Theanine…)...Evaluation (every month to see how you are doing)

34. Why Supplements? S tress Management It works... E xercise It works... N utrition It works BUT... S upplements Supplements offer an “easy” first step in the right direction... Which may allow the other strategies to follow in time… Choose those with evidence for Efficacy AND Safety...

35. Common “Anti-Stress” Solutions Valerian Kava Melatonin Tyrosine None of these supplements directly address cortisol control

36. Garlic reduces cortisol levels during high stress L-Theanine promotes relaxed alertness and concentration; non- sedating Phosphatidylserine reduces cortisol levels following strenuous exercise; improves mental function Beta-sitosterol balances cortisol:DHEA ratio Scientific Substantiation of ingredients that could influence the Cortisol levels *References available upon request

37. Good Health!