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The Stress Response
Although “stress” appears to be a mental condition, stress causes numerous physiological changes in the body, which may result in sub-optimal functioning or disease. It is estimated that 50-80 percent of physical disorders are stress related.1 The stress response entails complex physiological processes triggered by some type of perceived stressor. Chronic activation of this response results in adverse physiological effects and the development or aggravation of disease.
Several systems are involved in the stress response. The hypothalamus-pituitary-adrenal (HPA) axis is a cascade of hormone activation resulting in cortisol secretion from the adrenal cortex. Cortisol is the primary stress hormone and causes numerous effects throughout the body such as increasing blood sugar and blood pressure, suppressing the immune response, decreasing bone formation and cognition changes.
In addition, the sympathetic nervous system becomes activated increasing the secretion of epinephrine and norepinephrine from the adrenal medulla. This causes an increase in heart rate and respiratory rate and shunting blood away from organs to muscles. These physiological actions are part of the fight-or-flight response, and are logical in an evolutionary perspective, dating back to when ancient man was prey running from a predator.
Thus, the stress response is a normal physiological process. However, it functions best in addressing acute or short-term stressors. Chronic activation of these physiological pathways results in undesirable changes. Initially, the adrenal gland is able to respond to the chronic stimulation with increased hormone output. However, over time the adrenal gland cannot maintain the high hormone output and hormone levels drop below normal physiologic levels.
Physiologic Effects of Stress
Numerous studies have shown that increased psychosocial stress is linked to increased levels of inflammatory markers, suggesting one mechanism in which all body systems are affected.2 The most well-established effects impact the cardiovascular system. A recent study indicates that the individuals in the general population with the highest cortisol levels measured over a 6-year period had five times the risk of dying due to cardiovascular disease compared to those individuals with the lowest levels.3 Elevated blood pressure and blood lipids, atherosclerosis and stroke have all been associated with chronic psychosocial stress,4-6 likely through inflammatory pathways. Another study showed that in adults without obvious signs of coronary heart disease, the subjects with a greater cortisol response to a mental stressor had significantly increased detectable coronary artery calcification compared to “non-responders.”7
Psychosocial stress has also been shown to play a role in weight gain and the development of type 2 diabetes. In one study, researchers evaluated changes in body mass index (BMI) and the association with psychosocial stress related to work, personal relationships, life constraints and finances. The study found that in the subjects with high baseline BMI, increased weight gain was associated with psychosocial stress related to job-related demands, perceived constraints in life and difficulty paying bills.8 Research suggests that the mechanism in which stress impacts obesity is through inflammatory pathways, and estimate that inflammatory markers independently accounted for approximately 25 percent of the association between stress and obesity.9Furthermore, type 2 diabetes, which is associated with obesity, is also affected by psychosocial stress. One study showed that over a 15-year follow-up period, women with increased work-related stress had nearly double the risk of developing type 2 diabetes.10 Similarly, another study showed that subjects with increased stress and negative coping styles had increased insulin levels after eating a meal, indicative of insulin resistance, which is often the precursor to developing type 2 diabetes.11
The digestive tract is also highly susceptible to stress, which may result in the development of irritable bowel syndrome (IBS), stomach and duodenal ulcers, or gastroesophageal reflux disease (GERD). A large population-based study found that psychosocial stress, particularly job strain and time pressures, was associated with double the risk of developing GERD (heartburn).12
IBS is a functional disorder of the colon that presents with cramping, abdominal pain, diarrhea and/or constipation. Research indicates that compared to healthy subjects, individuals with IBS exhibit an exaggerated cortisol response, with elevated levels in the morning and low levels in the evening.13 Additionally, these individuals have elevated urinary cortisol, norepinephrine and epinephrine levels, suggesting that both the sympathetic nervous system and HPA axis are involved.14 Data suggests that stomach and duodenal ulcers are also associated with increased physical and psychosocial stressors.15 One interesting study found that young patients with duodenal ulcers demonstrate enhanced sensitivity of the sympathetic-adrenal system in stressful situations, resulting in increased stomach acid secretion.16
Psychosocial stress is related to numerous other conditions such as insomnia, cognitive difficulties and mood disorders. Insomnia has been shown to both induce and result from HPA dysfunction. Insomnia is associated with increased cortisol and the pro-inflammatory mediator interleukin-6 during sleep.17 Studies show that primary insomnia appears to be mediated through HPA axis overactivity and excess secretion of corticotrophin releasing hormone, adrenocorticotropic hormone and cortisol suggesting the role of HPA dysregulation.18 Other research indicates that both depression and anxiety are associated with abnormally high or low cortisol levels.19HPA axis dysregulation is also associated with low cognitive performance, particularly in the elderly, and has been shown to affect visual memory, verbal fluency, processing speed, eye-hand coordination and verbal memory.20-21
Immune function is also impacted by the stress response. Research shows that elevated cortisol and reduced DHEA secretion results in suppression and alterations in immune functioning cells.22
Natural Support for Stress
Due to the normal stress experienced at this time of year combined with the additional stress of the poor economy, supporting the body is essential. Adaptogenic botanicals are important to help both those individuals with elevated cortisol levels as well as those with adrenal fatigue and low cortisol secretion. Adaptogenic herbs such as Eleutherococcus senticosus, Ashwagandha (Withania somnifera), and Schisandra chinensis (all found in AdaptaPhase® I) are believed to improve the nonspecific response to and promote recovery from stress.23Adaptogenic botanicals including Schisandra and Eleutherococcus have been shown to increase endurance and mental performance and attention in patients with fatigue in several studies, likely by modulating the HPA axis.24
The nutrients above are effective in cases of low and high cortisol, but more and more practitioners are seeing patients suffering from adrenal insufficiency. Their cortisol levels are depleted completely and they need to increase their cortisol levels simply to get through the day. The natural substances N-acetyl tyrosine, Adrenal glandular, Citrus Bioflavonoids, L-carnitine, Eleutherococcus senticosus, Licorice root extract, Bacopa monnieriand Rhodiola rosea root (found in CortiTrophin®) help address various aspects of adrenal insufficiency. For example, Licorice root extract works with adaptogens such as Eleutherococcus senticosus. Its components glycyrrhizin and glycyrrhetinic acid impact enzymes that result in a net increase of cortisol availability, which is restorative for the adrenal glands.25-26 Bacopa monnieri also plays an adaptogenic role. It has many impressive cognitive and anti-fatigue benefits. Studies also show significant mood-enhancing effects.27-30 The amino acid tyrosine enhances dopamine and catecholamine synthesis and improves stress-associated declines in noradrenaline and performance.31
B vitamins and vitamin C (both found in CortiTrophin) have also been shown to play a role in the stress response. Therefore, it is helpful to add extra B vitamins (as in Extension B-Plex) to an adrenal-supporting regimen. Pyridoxine phosphate, an active coenzyme of vitamin B6, is required for the production of gamma-aminobutyric acid (GABA), serotonin, dopamine, and norepinephrine. Animal models have shown pyridoxine deficiency caused sympathetic nervous system overstimulation, and supplementation with vitamin B6 in pyridoxine-deficient animals results in normalization of the sympathetic response of epinephrine and norepinephrine.32 Studies looking at pre-surgical and post-surgical stress have shown that thiamine (vitamin B1) provides adrenal gland protection from functional exhaustion by normalizing corticosteroid fluctuations.33Research has also shown that under psychological stress, subjects supplemented with vitamin C showed less increase in blood pressure, decreased subjective stress response, and a faster cortisol recovery compared to the subjects receiving placebo.34 A recently published clinical trial investigated the effect of supplementation with a B complex plus vitamin C for 33 days on reported stress, fatigue, and mood. The results showed that the subjects receiving the vitamin supplementation had significant improvements in reported stress and fatigue and on tests of cognitive performance.35
Other nutrients that support stress reduction are the amino acid L-theanine, GABA, Passion Flower and Valerian Root (all found in Allay™). L-theanine has been shown to significantly increase activity in the alpha brain waves indicating that it relaxes the mind without inducing drowsiness.36 In human studies, GABA has induced relaxation and reduced anxiety while improving immunity under stressful conditions.37 Passion flower also has an important role in reducing tenseness, restlessness and irritability with difficulty in falling asleep38 while valerian exerts a regulatory effect on the autonomic nervous system and has been demonstrated to provide a tranquilizing effect.39-41
With the added pressures of an unpredictable economic environment and increased fears or job or home loss, this holiday season for many individuals will result in increased stress and resulting physiological impairments. Numerous nutritional supplements have shown efficacy in modulating the stress response and may provide the resilience needed to endure this holiday season.
|This article was published on Thursday December 08, 2011.|
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