Understanding and Combating the Impact of Stress Natural Approaches AOR.ca By: Dr. Paul Hrkal ND AOR Medical Advisor
For additional information contact: tech@aor.ca
Disclaimer This webinar has not been evaluated by the Natural Health Product Directorate of Canada (NHPD). Supplements mentioned are not intended to diagnose, treat, cure, mitigate or prevent any medical condition. The only exceptions are those health claims approved by the NHPD, which are listed on the labels of each product and on the NHPD website for products with Natural Product Numbers (NPN) (http://webprod3.hcsc.gc.ca/lnhpd-bdpsnh/indexeng.jsp). Understanding and Combating the Impact of Stress: Natural Approaches Dr Paul Hrkal ND AOR medical Advisor Goals 1. Understanding stress Defined: What is stress? Physiology: how it affects the body 2. Chronic stress and hormones 3. Nutritional, lifestyle and supplemental options 4. AOR formulations and Combinations 1
Dr Paul Hrkal ND Graduated from McMaster university and CCNM Medical ladvisor for AOR, private medical practice in Toronto area Passion for education and patient centered care About Me What is Stress? What is Stress? Hans Selye: endocrinologist in the 1930s consequence of the failure of an organism to respond appropriately to emotional or physical threats, whether actual or imagined Non specific response looked sick 2
Selye made one mistake: Stress is specific What is Stress? Varies between different people Perception Coping Determines effect of stress on the body Recipe for Stress N U T S OVELTY PREDICABILITY HREAT TO EGO ENSE OF CONTROL INDIVIDUAL DIFFERNECES Mason, 1968; Dickerson & Kemeny, 2002, Lupien IFM symposium 2007 Stress Perception Absolute universal threat Eg. Tornado Relative open to interpretation Eg. Public speaking Can be positive or negative Eustress improves physiological function Distress beyond coping ability and causes negative effects Lupien et al. 2006 3
Physiology of Stress Perception Absolute Stress CRH/AVP NE Stress Response Attention is enhanced Increased focus Increased cardiac output respiration accelerated catabolism is increased blood flow is redirected to brain, heart and muscles Relative ACTH Cortisol Stress Hormones Adrenal Glands 2 small endocrine glands, sit above kidneys The stress organs Responsible for output of Cortisol, epinephrine, aldosterone and androgens 4
Affects memory storage Increases blood pressure Anti-inflammatory Prevents autoimmune Reactions suppresses TH2 Shuts down the reproductive system Overall Catabolic and stimulating = READY FOR ACTION Cortisol Reduces bone formation Reduces calcium absorption Aids in breakdown of carbs and fats Increases Blood Sugar via liver So Where is The Problem? Cortisol essential for life and function Shift from ACUTE CHRONIC elevation Chronic Cortisol elevation/dysregulation to much of a good thing Big Picture: Key to function and survival is the ability to ADAPT Adapting To Stress: Allostasis Allostasis: Body s ability to adjust to a new steady state in response to environmental stress Sterling & Eyer (1988) Chronic exposure to stress causes a new normal for bodily function and demand bodily function and demand Body ADAPTS to increased demand or fails 5
Stages of Stress First stage: ALARM REACTION Examples: Car accident, Speech, sports Good thing: Prepare for action, increases function Once the stress is removed the body slowly l goes back to normal function What if stressor continues, become chronic? Second Stage: RESISTANCE Stress endures Eg: repeated events, poor coping, overwhelmed Body tries to adapt manages... for a while Cortisol is HIGH 6
Ability to Adapt Repeated Hits Chronic Stress Adequate Response McEwen (1998) Lack of Adaption Third stage: EXHAUSTION Adrenal gland function has decreased adrenal fatigue or subclinical hypoadrenalism chronic fatigue syndrome HPA hypofunction (Van Houdenhove B et al 2004) Leads to dysfunction in many other body systems Hormone, immune, digestive etc. Sign or Symptom Resistance vs Exhaustion Resistance phase (high cortisol) Exhaustion phase (low cortisol) Blood pressure High low Body weight Truncal fat Difficulty putting on muscle Hair Increased body/facial Decreased body/facial hair hair Musculoskeletal Osteoporosis Arthritis Blood sugar High (insulin resistance Low or diabetes) Skin acne Dry Sweat and secretions Excessive scanty cholesterol High triglycerides Low total chol. Friedman, Michael. The Fundamentals of Naturopathic Endocrinology. 2008. CCNM press. Toronto. 7
To Much of a Good Thing glucocorticoids and catecholamines, have both protective and damaging effects on the body (McEwen BS 2006) In the short run, they are essential for adaptation, maintenance of homeostasis, and survival (allostasis). Chronically elevated cortisol and low cortisol linked to many diseases Increases blood pressure = Cardiovascular Disease Causes peripheral insulin resistance = Diabetes, Obesity Affects memory storage = Alzheimer s dz Anti-inflammatory Prevents autoimmune Reactions = Infections Aids in breakdown of Cortisol carbs and fats = Obesity Reduces bone formation Reduces calcium absorption = Osteoporosis Increases Blood Sugar = Diabetes Health Problems Linked to Chronic Stress Increased Pain Heart disease diabetes Digestive problems Sleep pproblems Depression Memory loss Obesity Skin conditions Autoimmune diseases Suppressed immunity Korte et al., 2005; Lupien et al., 2006; McEwen, 1998b 8
Impact of Stress: Practical Examples Stress and Obesity Cortisol increases fuel blood sugars Modern lifestyle - Lack of physical exercise VS Chronic stress = blood sugar fluctuations Cravings = higher calorie intake Stored as fat Usually around waist Stress and Female Hormones Cortisol Progesterone is the primary raw material for producing cortisol Takes away from other hormonal production Compromised adrenal function profoundly affects hormonal balance Contribute 35 % of premenopausal hormones and 50 % of postmenopausal hormones 9
Stress and Thyroid Function Thyroid connection Elevated cortisol Impairs the conversion from thyroid hormones (T4 T3) Epinephrine, Norepinephrine Use tyrosine as their precursor (thyroid hormones also) TACKLING STRESS NATURALLY 10
Lifestyle Stress = negative input Counteract with positive input (active and passive) Yoga/mediation Reduces cortisol In breast cancer survivors (Banasik J, et al 2011) 30min daily reduced immune impairment (Gopal A, et al 2011) Laughing reduces catacholamines (Berk et al. 2008) Anger increases; plus risk of CHD Others Dancing, music, sex Help the Body Adapt Adaptogens Class of herbs Support hormonal production, metabolism long history of traditional and Naturopathic use Key Characteristics 1. it increases the resistance of the recipient to a variety of physical, chemical, or biological stressors; 2. it acts as a general stabilizer/normalizer Example: Ginseng Davydov and Krikorian. 2000 Withania Somnifera Indian Ginseng (Ashwagandha) Animals studies: counteracted many of the biological changes accompanying extreme stress, including changes in blood sugar, adrenal weight, and cortisol levels (Archana R 1999) Reduces the alarm phase of the nervous system, anxiolytic and anti depressive effects Reduces Cortisol 11
Withania Somnifera Calming adaptogen Wired and tired 600mg per cap, Very safe Other benefits Prevents over activation and suppression of the immune system (Bhattacharya and Muruganandam 2003) Increases thyroid hormone secretion (Panda and Kar 1999) Improves memory Increases nitric oxide Rhodiola rosea Enhances the body s physical and mental work capacity Balancing effects: anxiety, depression and blood sugar (Bystritsky et al 2008) improved concentration, decreased stress related fatigue and decreased salivary cortisol compared to the placebo group (Olsson et al 2009) Rhodiola rosea Rhodiola Rosea 100mg Panax Ginseng 100mg Rhodiola Rosea 340 mg Mental and Physical Stress Immune function Fatigue Higher dose: Mood Mental function 12
Eleutherococcus senticosus Eleutherococcus senticosus Siberian Ginseng, Russian trials Farnsworth et al 1985 Review: 2100 human subjects increases the ability to accommodate to adverse physical conditions improves mental performance enhances the quality of work under stressful conditions Reduces heart rate, blood pressure under stress Glycyrrhiza glabra (Licorice) Glycyrrhiza glabra (Licorice) Mild glucocorticoid activity binds to receptors (Armanini et al 1983) Acts like cortisol Excellent for EXHAUSTIVE phase Caution: high blood pressure mineralocorticoid activity Supply Building Blocks Nutrients play a critical role in the optimal functioning of the adrenal gland and manufacturing of hormones Larger amounts required and used in stress Vitamin C dumping Vitamin B6, vitamin B5 (pantothenic acid), and vitamin C often become depleted with prolonged hyperactivity of adrenal gland activity and increased production of cortisol (Patak et al 2004) 13
Head and Kelly 2009 Ortho Adapt Nutrients Adrenal Tissue 250mg Adrenal Cortex 200mg Vitamin C 500mg Pantethine 200mg Botanicals Licorice 800mg Siberian ginseng 200mg Rhodiola 150mg Ashwagandha 200mg Directly supports stress hormone function/production Comprehensive formula and dosing Diet High quality, nutrient dense foods NO REFINED SUGAR 6-8 serves of colourful veggies Balanced aa meals eas limit blood sugar spikes Complex carbs, protein and fat with each meal Steady nutrient supply Eat a complete breakfast Need blood sugar restoration and balance Adequate protein (10-15g) Wilson, James. Adrenal Fatigue: The 21st Century Stress Syndrome. 2001 14
Balancing Blood Sugar Almost all adaptogens have blood sugar balancing effects Rhodiola, Panax ginseng, ashwagandha etc. Holy Basil (Ocimum sanctum) Sacred Ayurvedic herb Actions Lowers blood sugar (Agrawal 1996) Anti-Anxiety Anti-stress Anti-inflammatory, microbial Sleep Viscous cycle stress insomnia Insomnia increases stress hormones HPA axis hyperactivity can lead to fragmentation of sleep, decreased slow-wave sleep, and shortened sleep time (Hudson and Bush 2010) Rest and sleep 10:30 in bed (7-9 hours) Sleep hygiene Don t over do it on the good days Chronic fatigue Calming the Brain GABA inhibitory Plays a role is calming brain and reducing signal to secrete cortisol Has peripheral effect Anti-stress effect: Promoted alpha brain wave patterns, reduced diameter of the pupil, and heart rate, as well as reduction of the stress markers salivary cortisol and chromogranin A Immune: Reduced IgA suppression during stress (Abdou et al 2006) 600mg 15
L-Theanine Applications: A cup of black tea contains approximately 20 mg theanine increases dopamine, serotonin, and the inhibitory neurotransmitter glycine (Yamada et al 2009) normalized brain waves focus, calm Acute anxiety and stress relief 200mg 40 min (Ito et al 2008) Nutrients Serving Size: 2 Capsules GABA - 100mg L-Theanine -200mg 5HTP- 100mg Melatonin - 3mg Ortho Sleep Botanicals Valerian Root - 150mg Passionflower - 32mg CYRACOS TM - 300mg Key features: Comprehensive formula Multiple neurotransmitters and receptors impacted = best sleep induction Rapid onset usually works first night Caution: Does not solve root cause Do not use with other sleep or anxiety medication Acute and Resistance Phases Key Symptoms: Insomnia, anxiety, difficulty losing weight, elevated heart rate, and high blood pressure Morning/daytime Before bed/evening 16
Exhaustive Phase Key Symptoms: fatigue, Insomnia, muscle pain, low blood sugar, salt cravings, sweet cravings, lightheadedness, PMS, low blood pressure. Build ability to deal with stress, improve energy; can be used preventatively Bringing It All Together 1) Identify Stressors - Define and practice coping - Reduce, reframe remove 2) Diet Low refined sugar and CHO High in nutrients and fibre Good quality fat and protein 3) Exercise and sleep 4) Maintain Optimal - 20 min a day physical activity Nutrient Levels: -Magnesium - combo: Yoga, martial - B vitamins arts - 8 hours of sleep - Vitamin D 5) Supplements to balance hormones -Herbs - Support brain neurotransmitters - Sleep and immunity Questions Thank You! drhrkal@aor.ca tech@aor.ca www.aor.ca 17
References McEwen BS, Wingfield JC. The concept of allostasis in biology and biomedicine.horm Behav. 2003 Jan;43(1):2-15. B. S. McEwen (1998), Protective and damaging effects of stress mediators, The New England Journal of Medicine, 338, 171-179 Juster, R.-P., et al., Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci. Biobehav. Rev. (2009) McEwen BS. Protective and damaging effects of stress mediators: central role of the brain. Dialogues Clin Neurosci. 2006;8(4):367-81. Irwin M, Daniels M, Risch SC, et al. Plasma cortisol and natural killer cell activity during bereavement. Biol Psychiatry 1988;24:173-178. Irwin M, Patterson T, Smith TL, et al. Reduction of immune function in life stress and depression. Biol Psychiatry 1990;27:22-30. Opstad K. Circadian rhythm of hormones is extinguished during prolonged physical stress, sleep and energy deficiency in young men. Eur J Endocrinol1994;131:56-66. References Head KA, Kelly GS. Nutrients and botanicals for treatment of stress: adrenal fatigue, neurotransmitter imbalance, anxiety, and restless sleep.altern Med Rev. 2009 Jun;14(2):114-40. Berk et al. 2008 "Cortisol and Catecholamine stress hormone decrease is associated with the behavior of perceptual anticipation of mirthful laughter". The FASEB Journal 22 (1): 946.11. Davydov M, Kik Krikoriani AD. Eleutherococcus senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look. J Ethnopharmacol 2000;72:345-393. Archana R, Namasivayam A. Antistressor effect of Withania somnifera. J Ethnopharmacol 1999;64:91-93. Bhattacharya SK, Muruganandam AV. Adaptogenic activity of Withania somnifera: an experimental study using a rat model of chronic stress. Pharmacol Biochem Behav 2003;75:547-555. References Ziauddin M, Phansalkar N, Patki P, et al. Studies on the immunomodulatory effects of ashwagandha. J Ethnopharmacol 1996;50:69-76. Bystritsky A, Kerwin L, Feusner JD. A pilot study of Rhodiola rosea (Rhodax) for generalized anxiety disorder (GAD). J Altern Complement Med2008;14:175-180. Olsson EM, von Scheele B, Panossian AG. A randomised, double-blind, placebo-controlled, parallel group study of the standardized extract SHR-5 of the roots of Rhodiola rosea in the treatment of subjects with stressrelated fatigue. Planta Med 2009; 75:105-112. Stancheva SL, Mosharrof A. Effect of the extract of Rhodiola rosea L. on the content of the brain biogenic monamines. Med Physiol 1987;40:85-87 Patak P, Willenberg H, Bornstein S. Vitamin C is an important co-factor for both adrenal cortex and adrenal medulla. Endoc Res. 2004;30:871-875. 18
References Ito K, Nagato Y, Aoi N, et al. Effects of L-theanine on the release of alphabrain waves in human volunteers. Nippon Nogeikagaku Kaishi 1998;72:153-157. Yamada T, Terashima T, Kawano S, et al. Theanine, gammaglutamylethylamide, a unique amino acid in tea leaves, modulates neurotransmitter concentrations in the brain striatum interstitium in conscious rats. Amino Acids 2009;36:21-27. Abdou AM, Higashiguchi S, Horie K, et al. Relaxation and immunity enhancement effects of gamma aminobutyric acid (GABA) administration in humans. Biofactors 2006;26:201-208. Panda S, Kar A. Withania somnifera and Bauhinia purpurea in the regulation of circulating thyroid hormone concentrations in female mice. J Ethnopharmacol. 1999 Nov 1;67(2):233-9. Agrawal P, Rai V, Singh RB. Randomized placebo-controlled single-blind trial of holy basil leaves in patients with non-insulin-dependent diabetes mellitus. Int J Clin Pharmacol Ther. 1996; 34: 406-409. 19
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