Monday, March 30, 2009

Managing Stress-Related Disorders, Part 2: "Stressed and Wired"

Americans as a lifestyle maintain a state of hyper arousal of the adrenal glands. In this condition the cortisol and other stress molecules are upregulated. This state of arousal is an important survival mechanism for emergency situations, but chronically high cortisol is catabolic and sets that stage of all manner of dysfunction and disease.

For starters, high cortisol causes a chronic state of agitation, irritability, anxiety, nervousness, and even panic attacks. This can affect sleep patterns, increase cardiovascular risk factors, decrease the libido, impair the memory and learning patterns, cause muscle wasting, and reduce reproductive function, to name just a few.

Nutritional Management of Elevated Cortisol: B-vitamins
The B-vitamin family is important in any adrenal support program, because the B-vitamins help to support the neurological system and the adrenal glands themselves and change the way a patient interprets the stress. Folate, for example, ranging from as little as 200 mcg to as much 15 mg, has shown anti-depressive effects. Folate and B12 deficiency has long been associated with depression. B-vitamins are involved in norepinephrine, dopamine, and serotonin synthesis, and are coenzymes in the synthesis of adenosylmethionine (SAM), and shown to have antidepressive properties.

One note of interest is that folate in the form of folic acid does not cross the blood/brain barrier. There is only one form of folate that does, and that is the end metabolite of folate metabolism, 5-methyltetrahydrofolate (5-MTHF). It is important that any B-vitamin complex you are using for depression and/or anxiety contains this form of folate.

Studies in animals have shown that a deficiency in another important B-vitamin, pantothenic acid (B5), mimicked metabolic changes seen in adrenal insufficiency. Administering B5 increases the production of corticosteroids. In humans, it normalized the response to ACTH and deficiency led to reduced resistance to stress.

Vitamin B6 is also essential, in that it is important to the metabolism of most amino acids. It also converts tyrosine to dopamine for epinepherine synthesis and protects from homocystiene overproduction. A derivative, homocystiene lactone, can inhibit ACTH release.

Likewise, the B-vitamin, myo-inositol, has been shown to be remarkably effective by itself in the treatment of panic attacks, obsessive compulsive disorder, and depression. In one study comparing the effects of myo-inositol against the drug, Fluvoxamine, for panic disorder, the myo-inositol “reduced the number of panic attacks per week by 4.0 compared with a reduction of 2.4 with Fluvoxamine. Nausea and tiredness were more common with Fluvoxamine.” J Clin Psychopharmacol 2001 June;21(3)335-9

The American Journal of Psychiatry reported that inositol in doses of 6g/day and 12g/day “is a potential treatment for depression in both open and double-blind placebo controlled trials.” Double-Blind, Placebo-Controlled, Crossover Trial of Inositol Treatment for Panic Disorder, J Benjamin, et al, Am J Psychiatr, 152: 1084-1086

Myo-inositol is especially beneficial in overall nervous system function because it is an important naturally occurring component of cell membranes. Myo-inositol plays a major role in cell signaling by functioning as a precursor of an intracellular second messenger system. This system is especially important in the brain. For example, serotonin and norepinehprine receptors are linked to the inositol second messenger system.

Another micronutrient deficiency that can have an adverse effect on the stress response is magnesium. According the Journal of the American College of Nutrition, magnesium deficiency intensifies adverse reactions to stress. Such reactions are mediated by excess release of catecholamines and corticosteroids, and low magnesium and calcium levels increase the release of stress hormones, which further lower tissue magnesium, creating a snowball effect. Likewise, magnesium plays a role in maintaining healthy levels of the myo-inositol pool in the body.

Herbal Support for Stressed and Wired
A revered “vitalizer” and rejuvenative tonic in Ayurveda (Charaka Samhita 1000 BC), the herb ashwagandha has been traditionally used for stress tolerance, vigor and stamina, convalescence, nervous exhaustion, fatigue, geriatric debility, physical and mental stress, and insomnia, while no side effects have been reported.

Another remarkable rejuvenating herb, holy basil, has anti-stress activity, including a normalizing affect on the CNS. It has been shown to reduce incidence of gastric injury induced by cold stress and restraint stress. It also inhibits the lipoxygenase and cyclooxygenase prostaglandin pathways, antagonizes histamine, and decreases acid and pepsin output, enhances gastric mucosal strength, and helps normalize the stress-response.

Ayurvedic literature attributes a “non-specific increased resistance”to the herb bacopa (also known as brahmi), and has been traditionally used to revitalize the nerves, brain cells, and the mind. It helps to strengthen the adrenals and purify the blood, and in animal testing it improves adaptations in sensory, motor, and motivational systems. In humans bacopa exhibits beneficial effects on anxiety and mental functions (mental fatigue). The effects on the CNS may be mediated through stimulation of gamma-aminobutyric (GABA)ergic and cholinergic systems.

What to Use When
A B-vitamin complex featuring the active form of folate, and/or a high-potency B5/B6 formula is foundational for stress protection and the early signs of adrenal stress, typically presenting in the form of anxiety and high cortisol levels. Additionally, an herbal complex featuring bacopa, ashwagandha, and holy basil can be added for complementary support in helping to rejuvenate the body and support the CNS. If the anxiety becomes severe, one should consider the use of a myo-inositol and magnesium complex to control anxiousness and regulate the mood.

There are a number of other herbal-based remedies as well for the other stages of stress, and we will discuss those in the next post.
Stress formulas to consider:

Monday, March 16, 2009

Mastering Stress Related Disorders

Stress-related disorders has been called America’s number one health problem because it sets the stage for so many other health problems. Stress has been linked to heart disease, cancer, neurological problems, depression, sleeplessness, changes in blood sugar and body composition, and a host of other maladies.

It is interesting to note that those who have a positive outlook on life and generally feel that things just always seem to work out also generally enjoy better health phyically and emotionally. However, those who feel that life is hard and that fortunate breaks are few and far between suffer more health problems. Those who focus on bad news and tend to revolve their lives around the predictions of economists and so on are those who also tend to have the most negative outlooks and tend to suffer more health challenges.

The current statistics on stress taken from are as follows:
  • 43% of all adults suffer from stress (probably a very conservative number)
  • As much as 90% of all visits to primary care physicians are for stress-related complaints and/or disorders
  • Stress has been linked to ALL leading causes of death
  • National turbulence causes stress to escalate. Doctor visits related to stress went up 40% after 9/11, and current economic concerns have increased the stress load significantly.

Selye’s 3 Stages of Stress
There are 3 stages of the stress response, as identified by Dr. Hans Selye, who pioneered much of the work that has led to our current understanding of the body’s stress response and the disorders that can ensue under chronic stress. The three stages are:
  1. Arousal, which is characterized by a rapid release of catecholamines and a slower release of corticosteroids.
  2. Adaptation, which is characterized by a sustained increased levels of corticosteroids and alarm molecules. This stage often leads to altered glucose tolerance, blood pressure, thyroid hormone and sex hormone metabolism.
  3. Exhaustion, often characterized by degenerative diseases due to the adverse influence of chronic high levels of corticosteroids and alarm molecules.

According to Selye's theory, anything that causes stress endangers life unless it is countered by an adequate adaptive response. If the stress is severe and/or prolonged enough, the body often cannot counter sufficiently, and all manner of maladies can result.

The list of maladies caused by chronic stress is too long to list completely, but here is a partial list:

  • Fatigue
  • Loss of libido
  • Inflammatory disorders like autoimmune disease and allergies
  • Apathy
  • Chronic pain
  • Restless sleep
  • Heart attack and increased risk for CVD disease
  • Inability to cope with mild and routine stressors in everyday life
  • Agitation/irritability
  • Depression
  • Impaired memory/learning
  • Digestive disorders
  • Poor immunity
What Stress Does Metabolically

Stress pretty much disrupts everything. It increases insulin, cortisol, ephineprhine and norepinephrine, while diminishing all the sex hormones. It also increases oxidative stress and inflammatory mediators, which can set the stage for profound degenerative changes throughout the body.

The thesis for Robert Sapolsky’s excellent book, Why Zebras Don’t Get Ulcers, is that stress in its acute state is necessary and not harmful to the body. When a herd of zebras is confronted with a danger like a predator, for example, the sympathetic dominant state kicks in and stress hormones skyrocket in order to engage all the body systems in preserving life and escaping danger. But when the predator is outrun, they immediately go back to their baseline autonomic state and all is well. The basis for the human stress-related disease, however, is the high percentage of time spent in the sympathetic dominant state, and that chronic state of alarm sends molecules constantly racing throughout the body that can have extremely detrimental consequences when exposed to them long term.

For example, one study in the American Journal of Epidemiology 2003 showed that there was a clear correlation between the risk of breast cancer in women and stressful life events such as divorce/separation and the loss of a husband. Similarly, the British Medical Journal in 2002 showed that “people who reported persistent stress due to high work demands, low job security, or few career opportunities had the same level of risk for fatal heart attacks as people who smoke and do not exercise.”

Dealing with Stress
There are a number of ways to help the body to cope with stress more capably. Moderate exercise, relaxation techniques such as those correlated with prayer/meditation, biofeedback and deep breathing, and diet all play an important role. Also, practicing thankfulness and focusing on what is right in one's life has also been associated with relieving depression and generating a more positive outlook, as has getting involved in humanitarian efforts and community service. Of course, getting out from under chronically stressful situations is the best method of dealing with stress, but that is not always possible in today’s world of fast-paced job demands and dysfunctional families.

Many people simply do not have the reserves to deal with even small amounts of stress, and for them a multi-faceted approach of the above list along with therapeutic supplementation is in order. Certain micronutrients can help the body to interpret the stress differently, and certain combinations of novel botanical agents along with specific micronutrients can help support the hypothalamus/pituitary/adrenal (HPA) axis and invigorate a lack-luster stress response.

The nutritional approach to stress-related disorders will be the focus of the next couple of posts. Stay tuned.