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Stress and Your Body

The WomenCare First Annual Day of HealthSylvia H. Regalla MD, MSACN, ABIHM

October 26, 2012

Don’t worry, BE HAPPY!

Does this look familiar?

What is Stress?

Surveys and research reports conducted over the past 2 decades reveal that 43% of all adults suffer adverse effects due to stress.

In fact, 75% to 90% of all visits to primary care physicians are in some way related to the adverse impact of psychosocial stress.

Stress can be defined as any perceived physical or psychological change that disrupts an organism’s metabolic balance.

Types of Stress

Physical stressNutritional

insufficienciesInflammationChronic

psychological stressOverweight / obesityToxins (environ /

internal)Infections

Genetic propensityFood / diet (molecular

messages)Food allergyChronic sleep

deprivationTraumatic emotional

eventsShift work

Foods are Molecular Messages

The central nervous system (CNS) acts as an “antenna” that translates stressors into biochemical signals filtered through the HPA axis

Hypothalamus-Pituitary-Adrenal Axis

Far Reaching Effects of HPA Axis

Acute Stress – FIGHT OR FLIGHT

In the face of acute stress, the body mobilizes the “stress response” which is essential to survival.

Chronic mobilization of the stress response carries a wide array of pathophysiological risks.

Foot is constantly “on the accelerator”

Chronic Stress Response

Chronic Stress

Sapolsky, RM. Stress: Stress Related Disease and Emotion Regulation.

In J. Gross (Ed.), Hand Book of Emotionsl Regulation. (pp 606-615). New York, Guilford. 2007

“Overwhelmingly, it is psychological rather than physiological stress which has the capacity to elevate and maintain the stress response chronically causing disease consequences, and affects the immune system.”

Sympathetic/Parasympathetic Nervous SystemThe Accelerator/Braking System

Effects of Stress on the Body

Chronic Stress

Research increasingly supports the critical role that stress and stress molecules can play in obesity, diabetes, osteoporosis, hypertension, cardiovascular disease, infectious disease, gastric ulcer, cancer, and gastrointestinal, skin, and neurologic disorders, as well as a host of disorders linked to immune system disturbances.

Chronic Stress

The American Institute of Stress. America’s #1 health problem and job stress. http://www.stress.org/problem.htm. November 2001.

Chrousos GP. The role of stress and the hypothalamic-pituitary-adrenal

axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and

target tissue related causes.Int J Obes Relat Metab Disord 2000;24(Suppl 2):S50-S55.

University of Michigan. Neuroendocrinology of the stress response.

http://www.umich.edu/~psycours/531/stress/sld001.htm. November 2001.

Chronic stress has also been shown to affect behavior in both human and animal models, and has been linked to psychiatric illness such as depression and anxiety in humans.

Hypothalamus-Pituitary-Adrenal Axis

Cortisol – Main Stress Hormone

Chrousos GP. The role of stress and the hypothalamic-pituitary-adrenal axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and target tissue-related causes.

Int J Obes Relat Metab Disord 2000;24(Suppl 2):S50-S55.

Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy.

Circulation 1999;99(16):2192-217.

Stress-induced hypercortisolemia, as well as the excessive release of catecholamines, may curtail life

expectancy by several years via their downstream effects on physiology and

organ/system function

Far Reaching Effects of HPA Axis

Too pooped for sex?

CORTISOL

Too pooped for sex?

Other ways to manage stress

Overall Clinical ApproachCreating a Strategic Plan

Lifestyle modificationDietary modificationNutritional supplementsBotanicalsHormone replacementStress reduction

Overall Lifestyle Changes

Stress and the Digestive System

A stress dominated system shuts down the appropriate functions of digestion

Decreases the nutrition absorbed from our meals and also causes an erosion of tissue which then create disorders such as irritable bowel syndrome (IBS), peptic ulcers, GERD, and others.

Dinan TG, et al. Gastroenterology 2006. Feb;130(2):304-311.Heitkemper M, et al. Am J Gastroenerol. 1996 May; 91(5):906-913.

Overall Dietary Approach

Anti-inflammatory

Mediterranean diet

Low glycemic load foods… do NOT raise your blood sugar by eating high fiber fruits, vegetables, and grains

Rich in phytonutrients – healthy compounds that occur naturally in foods and give food color (found in fruits, vegetables, nuts, and beans)

Unrefined carbohydrates

= nothing whiteAVOID caffeine

Eat small portions frequently throughout the day – high fiber and vegetable oriented diet

Drink half your body weight in water/day

150 lbs = 75 oz = 2.2 liters water

Probiotics = Healthy Bacteria

70% of serotonin (“feel-good” neurotransmitter) produced in your GI tract

70% of your immune system is in your GI tract

Basic Supplemental Approach

A good quality multivitamin with attention to: B Complex (co-factors in hormone production)

• B5 - pantothenic acid (1000-1500 mg)• B6 – pyridoxine (50-100 mg) ideally P-5-P• Biotin (1000 mcg)• Folic acid (400-800 mcg) ideally MTHF

Vitamin C (1-2 gm)

Magnesium (400-600 mg)

Omega-3-fatty acid (1-3 gm) = Fish oil

Effects of High Dose B vitamins w/ C

Randomized, placebo-controlled, double blind, parallel groups trial of aged 30-55 yo who were in full-time employment

Profile of Mood States (POMS), Perceived Stress Scale (PSS), Generalized Health Questionnaire (GHQ-12)

Vitamin/mineral supplementation led to significant improvements in ratings on the PSS, GHQ-12 and POMS

Psychopharmacology: 55-68, 2010

Vitamin D (Anti-inflammatory Hormone)

A special class of hormones called glucocorticoids is known to decrease expression of vitamin D receptor. The most well known glucocorticoid is cortisol.

Without a receptor, vitamin D is left with nothing to do and nowhere to go; it remains inactive in the body. 

Dose: 1,000 - 5,000 IU/day

Keeping the Body Moving

Exercise

Exercise may increase body temperature, blood circulation in the brain, and impact the hypothalamus-pituitary-adrenal axis and physiologic reactivity to stress

Guszkowska M. Psychiatr Pol. 2004 Jul-Aug; 38(4):611-620S

Yoga

Women were randomly assigned to attend yoga practice for 90 min twice weekly for 8 weeks

The yoga group had lower morning and 5pm salivary cortisol levels and improved emotional well-being and fatigue scores

Journal of American Academy of Nurse Practitioners: 135-142. 2010

Yoga

Lifestyle Recommendations

Reframe your experiences Studies have shown that hostile individuals had

higher incidence of cardiovascular disease and insulin resistance (pre-diabetes)

Use positive affirmations throughout the day

Lifestyle Recommendations

Breathe deeply – this induces a deeper parasympathetic state (foot on the brake), increases your sense of well-being, and increases oxygen

Lifestyle Recommendations

Take new or challenging activities one step at a time.

“Inch by inch life is a cinch, yard by yard life is hard”

Amer J of Cardiology. 2005. July 1; 96(1):64-66

J Behav Med. 2005. June;28(3):295-299

Neuopsychobiology. 2006. 53(1):221-226

“Joy First….then anything else you have time for”

-Abraham Hicks

Botanicals

A Systemic Review

Nutritional and Herbal Supplements

for Anxiety and Anxiety-Related Disorders:

A total of 24 studies that investigated 5 different CAM (Complimentary/Alternative Medicine) monotherapies and 8 different combination treatments and involved 2619 participants met the inclusion criteria and were analyzed

Nutritional and Herbal Supplements

Based on this systemic review:

strong evidence exists for the use of herbal supplements containing extracts of passion flower or kava, and combinations of L-lysine and L-arginine as treatments of anxiety symptoms and disorders.

Nutrition Journal. 2010

Adaptogenic Herbs

An adaptogen is a metabolic regulator which increases the ability of an organism to adapt to environmental factors, and to avoid damage from such factors.

Environmental factors can be either physiological (external): injury or aging psychological (internal): anxiety

Adaptogenic Herbs

It must be innocuous with a broad range of therapeutic effects without causing any major side effects.

The adaptogen concept does not fit easily into the Western model of medicine.

Rhodiola rosea

Rhodiola – 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

Olsson EM, et al. Planta Med. 2009 Feb; 75(2):105-112

Rhodiola rosea

Darbinyan V. Phytomedicine. 2000 Oct;

7(5):365-371

Spasovv AA et al. Phytomedicine. 2000 Apr;

7(2):85-89.

Research has shown that Rhodiola significantly improves depression, fatigue, and insomnia.

St. John’s Wort - Hypericum perforatum

St. John’s Wort - Hypericum perforatum

Many patients with depression are noted to have excessive activation of the HPA axis manifested by oversecretion of cortisol

Flavonoids from

Planta Med. 2004 Oct; 70(10):1008-1011.

St John’s wort reduced corticosteroids (cortisol) after 2 weeks

Ashwagandha – Withania somnifera

Ashwagandha – Withania somnifera

Ashwagandha moderates the stress response, when exposed to chronic environmental stressors, including lessening of symptoms such as depression, increased blood sugar, glucose intolerance, increased cortisol, cognitive deficits and stomach ulcers.

Bhattacharya NP, et al. Pharmacol Biocem Behav. 2003 June; 75(3):547-555.

Dark Chocolate

Effects of Dark Chocolate on Micobiota, & Stress-Related Metabolism

40 grams of dark chocolate for 14 days

Human subjects with higher anxiety trait showed a distinct metabolic profile indicative of a different energy homeostasis, hormonal metabolism (adrenaline), and gut microbial activity

Effects of Dark Chocolate on Micobiota, and Stress-Related Metabolism

Dark chocolate reduced the urinary excretion of the stress hormone cortisol and catecholamines, and partially normalized stress related differences in energy metabolism, and gut microbial activities.

J Proteome Res. 2009 Dec; 8(12):5568-79.

1. Stress reduction techniques1. deep breathing

2. reframing

2. Dietary changes1. low glycemic diet

2. frequent small meals

3. AVOID CAFFEINE

3. Exercise & good, quality sleep

4. Multivitamin 1. extra magnesium

2. B complex

3. Vitamin C

4. Omega-3 fatty acids (fish oil)

5. Incorporate herbs and roots (Theanine, Rhodiola, Valerian, St John’s Wort, etc)

Modulating Stress

DON’T WORRY ….. BE HAPPY!!!

Sylvia H. Regalla MD, MSACN, ABIHM

THANK YOU…