HPA Axis: Regulating the Stress Response for Optimal Health. D r. T h a l i a C h a r n e y, N D ( i n a c t i v e )

Transcription

1 HPA Axis: Regulating the Stress Response for Optimal Health D r. T h a l i a C h a r n e y, N D ( i n a c t i v e )

2 Products covered in this talk NOW NOW NOW NOW NOW NOW NOW NOW Astragalus 500 mg Veg Capsules Relora 300 mg Super Cortisol Support Holy Basil Ashwagandha Siberian Ginseng (Eleuthero) American Ginseng Rhodiola 2

3 Perception of Stress Conclusion: High amounts of stress and the perception that stress impacts health are each associated with poor health and mental health. Individuals who perceived that stress affects their health and reported a large amount of stress had an increased risk of premature death. 3

4 Reframing Stress Chasing meaning Fighting stress 4

5 What is stress? state of threatened homeostasis or disharmony that triggers an adaptive stress response Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet Jun 21;383(9935):

6 What happens? Stress (allostatic load) stretches the physiological resilience and depletes the metabolic reserve of virtually every tissue. The Role of Stress and the HPA Axis in Chronic Disease Management, Point Institute 6

7 Maladaptation to stress Frequent stress Inadequate stress response Failure to respond Perception of stress 7

8 8 Chronic stress and metabolic reserve

9 Chicken and the Egg HPA Axis Dysfunction Chronic Stress 9

10 Hypothalamus Pituitary Adrenal Axis (HPA) Stress Response sodium & water blood pressure blood sugar insulin sensitivity growth hormone T3 (thyroid) immune response inflammatory response AA, fat & protein 10

11 HPA Axis Activity Increased Activity Chronic stress Depression Anorexia OCD Panic disorder Alcoholism Diabetes Central obesity PTSD Hyperthyroid Reduced Activity (adaption) Adrenal insufficiency Depression Chronic fatigue syndrome Fibromyalgia PMS Menopausal depression Following chronic stress Post steroids Hypothyroidism Asthma Eczema

12 General Adaption Syndrome Hans Selye ( ) Father of Stress Research *Hypertrophy of adrenal cortex *Atrophy of thymus & lymph nodes *Erosions and ulcers (duodenum) 12

13 What is stress? Mental/Emotional Anxiety/Depression Sleep Issues Light/Dark Disruption Jet Lag/Shift Work Perceived Stress Circadian Disruption Glycemic Dysregulation Inflammatory Signals 13 Low Fibre High GI Meals Insulin Resistance Obesity Allergies Infectious Disease Atopic Diseases Cardiovascular GI inflammation

14 Stress Response Internal/External Real or Perceived STRESS (Brain) Fight or Flight (Adrenal Medulla) Catecholamines HPA Axis 14

15 Adrenal Gland SEX (DHEA, NE, Adrenalin) SUGAR (CORTISOL) SALT (aldosterone) 15 Salt, sugar, sex; the deeper you go, the sweeter it gets.

16 Adrenal Fatigue NOT! Overused, oversimplified, and misunderstood HPA Axis dysfunction is more accurate Low cortisol and DHEA excess HPA status NOT adrenal function Peer-reviewed literature avoid this term

17 Better terms HPA Axis Dysfunction Hypocortisolism = low cortisol (regardless of cause) Primary adrenal insufficiency (Addison s Disease) disease of the adrenal cortex 17

18 Impact of adaptogens Temper stress-induced damage Physical, emotional, environmental & mental Enhance performance Increase working capacity, mental stamina, physical endurance In a background of fatigue and stress Are innocuous (normalizing influence) Versus conventional CNS stimulants that deplete resources and have S/E Normalizing influence 18

19 What is a tonic? Something that helps relieve general debility and/or is an aid during convalescence 19

20 NOW Siberian Ginseng (Eleutherococcus senticosus) Ingredients: Siberian Ginseng (Eleutherococcus senticosus) (Root) 500 mg Non-Medicinal Ingredients: Veg Capsule (hypromellose, water), Magnesium Stearate (vegetable source). Directions: Adult Dosage: Take 2 capsules, 1 to 2 times daily. 20

21 NOW Siberian Ginseng (Eleutherococcus senticosus) Uses: Improve mental and/or physical performance after periods of mental and/or physical exertion Properties: Adaptogen and tonic Actives: Eleutheroside compounds 03-1% E, B, or total Historical use: HPA axis stress (hyperactive or hypoactive) with little chance of side effects 21

22 Eleutherococcus and Anaerobic Training 4 ml of an eleuthero tincture (300 mg root equivalent) for 8 days prior to a VO2 max test on a weighted erg improved performance and time to fatigue relative to both control and placebo. The magnitude of effect was a 5.4% greater time to exhaustion in placebo and 16.3% greater with eleuthero. 22

23 Eleutherococcus and fatigue resistance 800 mg of eleuthero (0.11% and 0.12% eleutherosides B and E) for 8 weeks in a small population of otherwise healthy persons is able to increase fatigue resistance, possible secondary to CNS-induced changes in fat oxidation 23

24 Eleutherococcus and cognitive function 300 mg eleuthero root daily for 8 weeks was associated with some minor improvements in cognitive function as assessed by survey and significantly improved social interactions 24

25 Other human studies Cardiovascular lowers blood glucose, decreases LDL Anti-aging decrease DNA damage and fat oxidation Immunity increase T cell and NK cell activation Not related to NOW product claims 25

26 NOW American Ginseng 500mg 100vcap Directions: Adult Dosage: Take 2 capsules 1 to 3 times daily. Ingredients: (each capsule contains): American Ginseng (Panax quinquefolius) (Root extract) mg Non-Medicinal Ingredients: Veg Capsule (hypromellose, water), Rice Flour, Magnesium Stearate (vegetable source). Claim: Helps maintain a healthy immune system. Used in herbal medicine as an adaptogen. 26

27 American Ginseng (Panax quinquefolius) Panax means all healing Quinquefolius means five leaves Native to eastern North America Quebec to Manitoba, northern Florida, Alabama & Oklahoma Used by traditional herbalists for centuries Bioactive compounds = terpenoid saponins called ginsenosides 27

28 American Ginseng (Panax quinquefolius) True Ginsengs are from the genus Panax Panax ginseng (Korean/Asian) is most popular P. Ginseng = more stimulating P. Quinquefolius = more adaptogenic Properties: Adaptogen, tonic, stimulant Investigated for nearly every potential disease-preventing mechanism in either cell culture, animal and/or human study Panax = all healing Numerous systemic reviews 28

29 Some studies Highest evidence Diabetes in doses 100 mg 3 gram daily (PMID: ) Upper Respiratory Infections, mg daily 3-6 months during flu season (PMID: ) Other Hypertension in diabetics 1 gram 3x daily for 12 weeks (PMID: ) Short-term memory, mg, taken 1-6 hours prior to cognitive testing (PMID: ) Systemic Review 2010 (PMID: ) Cancer-related fatigue, 2 gram twice daily for 8 weeks ( ) Systemic Review 2018 Fatigue (PMID: ) 29

30 NOW Astragalus Extract 500 mg Veg Capsules Medicinal ingredients: each capsule contains: Astragalus Root (4:1 Extract) Powder 500 mg ((Astragalus membranaceus) equivalent to 2000 mg of Astragalus) Non-medicinal ingredients: Veg Capsule (hypromellose, water), Cellulose, Silica, Magnesium Stearate (vegetable source). Health Claim: Traditionally used in Traditional Chinese Medicine to tonify the lungs and used for frequent colds 30 Directions: Adult Dosage: Take 1 capsule, 3 times daily with meals. For prolonged use consult a health care practitioner.

31 Astragalus Astragalus membranaceous (Astragalus) is another great traditional remedy used to tonify the immune system and with demonstrated abilities to boost white blood cells. Gentle enough for children, it is often taking for a period of months during cold and flu season. 31

32 Traditional Chinese Medicine Caution According to Traditional Chinese Medicine, do not use in cases of exterior excess, Qi stagnation, damp obstruction, food stagnation, Yin deficiency with heat signs, or skin lesions in their early stages or where there is a heat toxin. Menopause Acute illness with heat or mucous 32

33 NOW Licorice Root 450 mg Veg Capsules Ingredients (each capsule contains): Licorice (Glycyrrhiza glabra L.) (dried roots) 450 mg Non-Medicinal Ingredients: Veg Capsule (hypromellose, water), Stearic Acid. Claim: Traditionally used in treating dry cough and other lung disorders, sore throat, and laryngitis. Directions: Adult Dosage: Take 3 capsules, 3 times daily with water for up to 6 weeks 33

34 Licorice and adrenal support Active ingredient is glycyrrhizin glycyrrhizic acid, glycyrrhizinic acid Structure is similar to corticosteroids Blocks conversion of cortisol to INACTIVE cortisone Increases available cortisol levels 34

35 Licorice Safety and Dosing Well known mineralocorticoid-like side-effects Occurs in range mg of glycyrrhizin DGL is safe for anyone Women more vulnerable Microflora profile matters (metabolized via bacterial glucoronidases before absorbed) Conservative limit: mg glycyrrhizin/kg/day 165 lbs person can safely consume 17 mg glycyrrhizin daily long term 35

36 Risk info on bottle Consult a health care practitioner before taking if you have diabetes, hypokalemia or if you are taking any kind of hormonal therapies, diuretics, potassium depleting agents, or MAO inhibitors. Consult a health care practitioner if symptoms persist. Do not use if you are pregnant or breastfeeding or if you have impaired kidney or liver function, high blood pressure, heart disease or if you are a man with decreased libido. 36

37 Who should use Licorice Root Avoid in those with elevated cortisol, or stay below 17 mg glycyrrhizin safety limit (140 mg of 12% standardized extract or 85 mg of a 20% standardized extract) Monitor blood pressure Low morning cortisol levels Low total cortisol levels 37

38 NOW Relora 300 mg Veg Capsules Ingredients: Relora 300 mg (A proprietary blend of plant extracts Magnolia officinalis and Phellodendron amurense bark standardized to 8.5% Honokiol and 2.5% Berberine) Non-Medicinal Ingredients: Relora Excipients (pregelatinized starch, corn starch, silica), Rice Flour, Veg Capsule, (hypromellose, water) and Magnesium Stearate (vegetable source). Dose: Adult Dosage: Take 2-3 capsules daily. Consult a health care practitioner for use beyond 6 weeks. 38

39 NOW Relora 300 mg Helps to alleviate symptoms associated with stress Relaxing, but not sedating Common everyday life stress has been found to be a major contributing factor in overeating. Relora is a clinically validated blend of plant extracts from Magnolia officinalis and Phellodendron amurense that has been shown to support the body s response to minor, temporary stress, which can result in nervous tension, irritability, fatigue, sadness, and nervous eating. The relaxing effect of Relora has been shown to help control appetite and stress-related eating, thereby helping you to manage your weight. 39

40 Magnolia: Magnolol and honokiol Central nervous system (CNS) modulating Anti-inflammatory Hypoglycemic Smooth muscle relaxant Antidepressant Anxiolytic effects Magnolol suppress the conversion of cortisol to cortisone by blocking hydroxysteroid dehydrogenase, thereby increasing the production of corticosterone

41 Relora Supports Healthy Adrenal Response and Weight Management Garrison R, Chambliss WG. Effect of a proprietary Magnolia and Phellodendron extract on weight management: a pilot, doubleblind, placebo-controlled clinical trial. Altern Ther Health Med. 2006;12(1):50-4. Kalman DS, Feldman S, Feldman R, et al. Effect of a proprietary Magnolia and Phellodendron extract on stress levels in healthy women: a pilot, double-blind, placebo-controlled clinical trial. Nutr J. 2008;7:11. 41

42 Relora Study

43 43

44 Astringent Berberine Properties Anti-inflammatory Anti-microbial Antioxidant Hypoglycemic Antidepressant Increased levels of norepinephrine, serotonin, and dopamine with antidepressant effect (rodents) Cognitive effects (performance) 44

45 NOW Holy Basil Extract 500 mg Veg Capsules Directions: Adult Dosage: Take 2 capsules daily. Ingredients: (each capsule contains) Holy Basil (Tulsi) Extract (Leaves) 500 mg (Ocimum tenuiflorum) (Standardized to contain 2% Ursolic Acid) Non-Medicinal Ingredients: Veg Capsule (hypromellose, water), Silica, Rice Flour, Magnesium Stearate (vegetable source). Claim: Used in Herbal Medicine as an adaptogen to help increase energy and resistance to stress 45

46 Holy Basil Extract 500 mg Veg Capsules Risk Info: If you are pregnant or if you are attempting to conceive, do not use this product. Consult a health care practitioner prior to use if you are breastfeeding, have diabetes, or if you are taking any heart or blood pressure medication. If symptoms persist or worsen, consult a health care practitioner. Dose: Adult Dosage: Take 2 capsules daily 46

47 Holy Basil (Tulsi) Sacred plant in Ayurveda traditional anti-fertility agent (ursolic acid) and libido enhancer Powerful adaptogen (recent discovery) May support healthy carbohydrate metabolism and normal glucose management 47

48 48 Holy Basil in Rat Study Suggest Adaptogen

49 Holy Basil and Anxiety and Depression Tulsi leaves, 1g daily (in two doses of 500 mg, taken with meals) was able to reduce anxiety and its related depression/stress over 60 days of supplementation in a population of persons with Generalized Anxiety Disorder but not Depression or on medications. Vicariously through the reduction in anxiety and depression, attention was increased. Statistical significance was in relation to baseline values, study did not have a control group. 49

50 Holy Basil and Immunity Findings: 300 mg of an ethanolic extract of Tulsi leaves was able to increase the levels of IFN-y, IL-4 and T-helper cells (cells and cytokines of the immune system) after 4 weeks. NK cell activity also increased. Conclusions: These observations clearly ascertain the immunomodulatory role of Tulsi leaves extract on healthy volunteers. 50 PMID:

51 NOW Ashwagandha 400 mg 90 Veg Capsules Directions: Adult Dosage: Take 1 capsule daily Ingredients: (each capsule contains) Ashwagandha Extract (15:1) (Withania somnifera) (Root) 400 mg Non-Medicinal Ingredients: Rice Flour, Veg Capsule (hypromellose, water), Magnesium Stearate (vegetable source). Claim: Traditionally used in Ayurveda as Rasayana (rejuvenative tonic) 51

52 About Ashwagandha Also called Withania or Indian Ginseng (although not related) Root of small woody shrub Primary herb in Ayurveda Actives: steroidal lactones (withanolides) 52

53 Ashwagandha Preliminary evidence suggests potent anxiolytic effects in the context of chronic stress, with lesser potency in standard forms of anxiety not related to stress. There may be more benefit to social anxiety as well with Ashwagandha relative to other anxiolytics 53

54 54 Systemic Review of 5 Trials

55 55 Type: Double Blind Randomized Placebo Controlled Subjects: 130 adults (18-60) with uncomplicated stress Method: WSE 125 mg QD, 125 mg BID, 250 mg BID & placebo Results: Dose dependent significant trends in most variables of stress (reduced cortisol, CRP, B/P, pulse, loss of appetite, irritably and flushing; increased DHEAS)

56 NOW Rhodiola 500 mg Ingredients: Rhodiola (Rhodiola rosea) (Root) 500 mg (Standardized to contain 3% Rosavins) Non-Medicinal Ingredients: Veg Capsule (hypromellose, water), Cellulose, Silica and Magnesium Stearate (vegetable source). Directions: Adult Dosage: Take 1 capsule once daily on an empty stomach. Not to be taken immediately before bedtime. For occasional use only. Claim: To temporarily support physical stamina 56

57 Rhodiola (Rhodiola rosea) AKA: Rosenroot, golden root or artic root Indigenous to the arctic and alpine (high altitude) regions of Europe, Asia and America Long history as tonic/adaptogen NOW Rhodiola is standardized to 3% total Rosavins and min. 1% Salidroside Phenylpropane/phenylethane derivatives 57

58 Rhodiola doses and uses Daily preventative against fatigue: reported to be effective in doses as low as 50 mg Acute usage for fatigue and anti-stress: mg range Bell-curve response: dosages higher than 680 mg may be ineffective Never think more of a good thing is always better! 58

59 Levels of evidence Notable Effects Fatigue 4/4 notable effect (8 human studies) Cognition 3/4 notable effect (4 human studies) Subjective wellbeing 3/4 (4 human studies) Depression 2/3 (1 human study) 59 Minor Effects Exercise tolerance 2/3 Perceived exertion Lactate production Muscle damage Stress Attention

60 Rhodiola and fatigue 11 Randomized controlled studies Several Systemic Reviews on RCT High level evidence Variable quality and design Decrease in fatigue is quite strong Somewhat reliable when a low dose is given over a prolonged period or a high dose is given acutely 60

61 Rhodiola raises salivary CAR (cortisol awakening response) Pre-VERSUS post-treatment cortisol responses to awakening stress were significantly different in the treatment group compared with the control group. It is concluded that repeated administration of R. ROSEA extract SHR-5 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. 61

62 8 Human Studies 7d0f747dbb9d3f7.pdf

63 One study of 8 on Rhodiola and fatigue 200mg of rhodiola extract ( mg root equivalent) twice daily for 4 weeks in persons with life and work-related stress was greatly able to reduce dysfunction and fatigue associated with stress in a time-dependent manner. Significant improvements were noted in social and work function secondary to reduced fatigue and improved mood.\ 63

64 Rhodiola and Cognition Notably rhodiola's effects on cognition relate to fatigue reduction in current studies 20 days of rhodiola supplementation during examination periods for students (100 mg SHR-5) was able to improve neuromotoric fitness (accuracy of maze drawing test), fatigue, and well being relative to placebo. Exam scores were 8.4% higher in the rhodiola group relative to placebo. 64

65 NOW Super Cortisol Support Relora 200 mg (A proprietary blend of plant extracts Magnolia officinalis & Phellodendron amurense standardized to 8.5% Honokiol & 2.5% Berberine) Green Tea Extract (Camellia sinensis) (Leaf) 90 mg (Standardized to 50% EGCG & 1% Caffeine) Lecithin (from Soya Oil) 50 mg Vitamin C (as Calcium Ascorbate) 33 mg Rhodiola Extract (Rhodiola rosea) (Root) 20 mg (Standardized to % Rosavins & 1% Salidrosides) Ashwagandha Extract (Withania somnifera) (Root) 20 mg (Standardized to 4.5% withanolides) Holy Basil Extract (Ocimum tenuiflorum) (Leaf) 20 mg (Standardized to 2% Ursolic Acid) Banaba Extract (Lagerstroemia speciosa) (Leaf) 4 mg (Standardized to 1% Corosolic Acid) Reishi (Ganoderma lucidum) Mushroom Powder 20 mg Vitamin B5 (as Calcium Pantothenate) 10 mg Calcium (from Calcium Carbonate & Ascorbate) 12 mg Magnesium (as Magnesium Oxide) 8 mg Chromium (as Chromium Amino Acid Chelate) (Chelavite ) 20 mcg 65

66 NOW Super Cortisol Support Covered: Relora, Rhodiola Extract, Ashwagandha Extract, Holy Basil Extract Green Tea Extract: theanine causes relaxation Banaba Leaf Extract: antidiabetic Reishi: general well being (tonic) General Adrenal support: Vitamin C, Vitamin B5, Magnesium Calcium Chromium blood sugar balance 66

67 Vitamin C and Adrenal Support The adrenal gland has the highest concentration of vitamin C in the body. It is used as a cofactor for the production of epinephrine and steroid hormones. During times of stress the demand for the production of these hormones increases so the body naturally has a higher demand for vitamin C One randomized, placebo-controlled trial looked at 120 healthy adults and if vitamin C supplementation had any effect on their ability to handle stress. The results showed that those people that took 3 grams of the vitamin daily had a lower blood pressure, their cortisol levels recovered quicker and they felt less stressed. 67

68 Magnesium and Adrenal Support Key role in producing energy. This makes it vitality important for all cellular functions and processes, especially the ability to maintain function in times of stress. Adequate levels of magnesium are required to offset stress related muscle tightness. A number of studies have shown that deficient levels of magnesium decrease resistance to stress related changes in blood pressure or heart rhythm. 68

69 Vitamin B5 (Pantothenic Acid) & Adrenals B5 plays a key part in producing Coenzyme A. The adrenal glands require CoA for the synthesis of the powerful hormones through which the body adapts to stress. Stress can therefore seriously deplete the body of vitamin B5, and in-turn supplemental B5 can help correct this stress-induced deficiency. B5 in several animal studies appear to enhance adrenal gland function. A human study using Pantethine showed a lower rise in urinary cortisol metabolites after simulating a stressful situation which suggests that pantethine can down-regulate excess cortisol production. 69

70 Summary Slide for Chronic Stress Chronic stress: Now Super Cortisol Support and most below (not licorice) Stress related poor memory: Rhodiola, Siberian Ginseng Stress with recurrent colds/flu: American Ginseng, Astragalus Stress with hypothyroid: Ashwagandha Stress related to physical performance: Siberian Ginseng Stress with fatigue: Rhodiola, Astragalus, Siberian Ginseng, Licorice (and low blood pressure) Stress with low blood pressure: Licorice (monitor) Stress and weight gain: Relora (stress eating), Ashwagandha (thyroid) Stress with anxiety: Ashwagandha, Holy Basil Stress with fatigue, poor cognition and depression: Rhodiola Stress and fatigue with cancer: Astragalus 70

71 NOW Continuing Education Programs NOW University / NOW Product-ology Free training & rewards (product) exclusive to NOW Retailers Incorporates training sessions on a variety of healthy topics and ingredients To register Fill in required information Your Code is PS100 You will be sent 2 s; 1 with password info & 1 welcome Ongoing access to courses, go to: Lead Contact thalia.charney@puresource.ca 71

72 Complimentary Product NOW84605 Astragalus 500mg 100vcaps NOW83342 Relora 300mg 60vcaps NOW83124 Holy Basil 500mg 90vcaps NOW94603 Ashwagandha Ext 500mg 90vcaps NOW84030 Siberian Ginseng 500mg 100vcaps NOW84754 Rhodiola Ext 500mg 60vcaps NOW84675 Fo-Ti (Ho Shou Wu)560mg 100vcaps 72

73 NOW Complimentary Product Request Please with the following information 1. Your store name & telephone phone number 2. Your name 3. The phone number that you called from when you called into the tele-training 4. The name of the tele-training session 5. The name and/or sku number of the product 6. The password given during the training 73