Stress

Question 1

Causes of stress

Answer 1

• Poor nutrition
• Personal stress
• Poor body functions
• Environmental stressors

Question 2

3 Stages of Stress

Answer 2

1. Alarm phase
2. Resistance phase
   Once the stressor has gone the alarm phase abates and the individual returns to a state of equilibrium
3. Exhaustion phase
   If stress is prolonged or severe then equilibrium is not restored and exhaustion results

Question 3

Effects of prolonged cortisol secretion

Answer 3

• Increased risk of insulin resistance and Type 2 diabetes
• Weight gain with central adiposity
• Suppresses reproductive function
• Impaired immune function
• Suppresses thyroid function
• Suppresses gastrointestinal function
• Downregulates the endocannabinoid (eCB) system

Question 4

Proposed mechanisms underlying cortisol dysfunction

Answer 4

*Prolonged or excessive cortisol secretion leads to desensitisation of glucocorticoid receptors to cortisol (cortisol resistance).
*Impaired binding disrupts negative feedback where cortisol would normally inhibit continued CRH release.
*CRH ↑ mast cell activation, release of noradrenaline (pro-inflammatory) and upregulates glutamate in the amygdala to promote a fear-based response to stress.
*High surges of cortisol increase its affinity to bind to mineralocorticoid receptors, where it has apro-inflammatory effect.

Question 5

Typical symptoms

Answer 5

Insomnia, fatigue, depression, irritability, headache, and digestive disturbances.

Question 6

Conditions linked to chronic stress

Answer 6

Anorexia nervosa, asthma, autoimmunity, cancer, CVD, chronic fatigue syndrome, recurrent infections, mood disorders, Type 2 diabetes, IBS, ulcers, headaches, hypertension, menstrual irregularities, PMS and thyroid disorders

Question 7

DHEA

Answer 7

*Alongside the release of glucocorticoids, noradrenaline and adrenaline, the androgen DHEA is also produced in larger amounts in response to stress.
*DHEA has been suggested to play a significant role in protection against the negative consequences of stress.
*Also protects against neurotoxic effects of chronically elevated cortisol on the hippocampus and reduces anxiety and depression.
*Ongoing stress with prolonged DHEA and cortisol releaseleads to a depleted state (referred to as ‘adrenal exhaustion’) with an impaired stress response and loss of resiliency.

Question 8

Adrenal ‘exhaustion

Answer 8

*Fatigue and ↑ need for sleep, inability to cope with stress, anxiety, irritability, ↓ libido, lots of yawning, lower back pain, recurrent infections, sweet cravings, reactive dysglycaemia.
*Sensitivity to cold and heat, lower body temperature, poor digestion, postural hypotension, unstable pupillary reflex.

Question 9

Phase of adrenal fatigue

Answer 9

Question 10

Nutritional Approach

Answer 10

• Apply the CNM Naturopathic diet and adjust accordingly.
• Focus on an anti-inflammatory diet
• Stabilise blood glucose

Question 11

Nutritional Approach - Protein

Answer 11

*2–3 palm size portions of high quality protein *Especially tyrosine—adrenaline, noradrenaline, dopamine production *Tryptophan—serotonin, melatonin precursor

Question 12

Nutritional approach —potassium to sodium ratio

Answer 12

*Ensure good intake of potassium-rich foods and reduce sodium intake.
*Chronic stress and anxiety are associated with decreased levels of potassium.
*Stress hormones can cause reductions in serum potassium.
*Aim for a dietary potassium to sodium ratio greater than 5:1: most fruits and vegetables have a K:Na ratio of at least 50:1.
*Include 2 handfuls of dark green leafy veg daily (green smoothie).

Question 13

Nutritional approach —microbiome support

Answer 13

*Prebiotic foods —dandelion greens, chicory, Jerusalem artichoke, garlic, etc.

*Probiotic foods —kimchi, sauerkraut, kombucha, kefir, yoghurt (cultured) etc.

*Polyphenol-rich foods (to feed commensals and support the mucosal barrier) —green tea, blueberries, cranberry, currants etc.

Question 14

Nutritional approach —Avoid

Answer 14

*Refined carbohydrates *Alcohol
*Caffeine

Question 15

Stress: Specific Nutrients

Answer 15

Vitamin C
Vitamin B5
Vitamin B6
B complex
Vitamin E
Magnesium
Phosphatidyl serine
L-theanine
Resihi Mushroom

Question 16

Vitamin C
(ascorbic acid)

Answer 16

• Keywater-soluble antioxidant in blood and tissues inclusive of CNS.Stress increases free radical damage.
• The CNS is especially sensitive to oxidative stress, which is in turn linked with ↑psycho-social stress, anxiety and depression.
• Shown to improve recovery from mental stress.
• Adrenal support —is a co-factor in glucocorticoid synthesis.
• Vitamin C supplementation has shown to reduce stress-induced cortisol release. ↓ hyperactivationof the HPA-axis.
• Enhances immune function —upregulates natural killer cells, interferons and T-cells.

500mg - 2g

Question 17

Vitamin B5
(pantothenic acid)

Answer 17

• As a precursor to coenzyme A plays an essential role in adrenal cortex function.
• Increases production of glucocorticoids and other adrenal hormones.
• Thought to reduce secretion of cortisol in times of stress

Dosage: 100-300 mg / day

Question 18

Vitamin B6
(pyridoxine)

Answer 18

*Exerts modulatory effects on GABA and serotonin, neurotransmitters that regulate anxiety, depression and pain perception.
* Downregulates activity of glucocorticoid receptors, ↓the physiological impact of corticosteroid release.

50-100mg/day

Question 19

B complex vitamins

Answer 19

• Co-factors in the Krebs cycle —needed for ATP production.
• Required to maintain nervous system health—B1 in particular enables the brain to utilise glucose.
• Vitamins B6, B9 and B12 have specific roles in methylation and decarboxylation processes that support synthesis of monoamine and catecholamine neurotransmitters.
• B group vitamins taken as a complex have been shown to improve mood and quality of life in individuals experiencing depression and anxiety.

Question 20

Vitamin E

Answer 20

• Acute and chronic stress increase free radical formation, especially in the CNS and adrenal cortex.
• As a lipid soluble antioxidant, vitamin E protects neuronal cell membranes and myelin sheaths from oxidative stress.
• Has been shown to protect the adrenal cortex from free radical damage and decrease stress-induced release of cortisol.
• Supports immunity —increases phagocyte activity and promotes differentiation of immature T-cells in the thymus.

400-800 ie/day

Question 21

Magnesium

Answer 21

• Deficiency upregulates HPA activity, while supplementation attenuates activity with reductions in ACTH and cortisol.
• Is a co-factor for GABA synthesis, heightens GABAergic availability by reducing presynaptic glutamate release —net effect anxiolytic.
• Is a co-factor in the serotonin-melatonin pathway.
• Stress-related muscle tension —breaks actin-myosin bond.
• Amino acid chelates —taurate / glycinate: Taurine is a GABA agonist and glycine acts as an inhibitory neurotransmitter, so potentially even more useful.

100-400mg/day

Question 22

Phosphatidylserine

Answer 22

*Normalises stress response.
*Buffers HPAA response, restoring normal ACTH and cortisol activity, allowing for better quality sleep, decreased anxiety and improved mood
*The effect is believed to be mediated through normalisation of cortisol binding globulin (CBG).

200-400 mg/day

Question 23

L-theanine

Answer 23

L-theanine (N-ethyl-L-glutamine) is a major amino acid uniquely found in green tea. L-theanine increases brain serotonin, dopamine, GABA levels, supporting cognitive function and aiding relaxation

20-400mg/day

Question 24

Reishi mushroom

Answer 24

• Regardedas an adaptogen.
• Triterpene constituents have a sedative action, calming the nervous system to support relaxation and sleep.
• Contains polypeptides that act as precursors to neurotransmitters and endorphins supporting the stress response
• Assists the immune system at times of stress including increased number and activity of NK cells, macrophages and T-lymphocytes

Dosage: 3–9 g / day. Use as a powderin tea, food, capsules.
Considered non-edible; has a bitter, woody taste.

Question 25

Herbal support for stress

Answer 25

Camomile - mild sedative
Passionflower - anxiolytic
Lavender - elevates mood
Lemon balm - mild sedative
Ashwaganda - adaptogen
Siberian Ginseng - counteracts stress