Stress Flashcards
1
Q
Stress
A
Stress is defined as a non-specific response of the body to any disturbance / demand — triggering the ‘stress response’.
- The demand or ‘stressor’ can be positive (e.g., a new job, new relationship) or negative (e.g., fear, injury)
2
Q
Causes of stress
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- Poor nutrition: Nutritional deficiencies (e.g., highly-processed diets, high intake of alcohol).
- Personal stress: Not feeling happy with oneself; financial problems; problems with family members, friends, at work.
- Poor body functions: Injury or illness e.g., allergy, skin conditions, thyroid disorders, chronic inflammatory disorders. Detoxification — slow or fast detoxification of certain NTs or hormones may result in imbalances in stress hormones (e.g., COMT / MAO).
- Environmental stressors: Radiation e.g., mobile phones, x-rays, microwaves; pesticides, industrial and household chemicals.
3
Q
The general adaptation syndrome
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The general adaptation syndrome — a term coined by the endocrinologist, Hans Selye, that describes the 3 stages of a stress response which are controlled and regulated by the adrenal glands:
- Alarm phase (initial response often referred to as ‘fight or flight’).
- Resistance phase
- Exhaustion phase
3
Q
- Alarm phase (initial response often referred to as ‘fight or flight’).
A
- Alarm phase (initial response often referred to as ‘fight or flight’).
- Counteracts danger by mobilising resources for physical activity.
- Stressor hypothalamus sympathetic nervous system adrenal medulla releases adrenaline and noradrenaline.
- Adrenaline activates inflammatory cytokines — ↑ oxidative stress.
- ACTH release (anterior pituitary) cortisol release (adrenal cortex). Cortisol provides additional glucose, ↑ pain threshold and inhibiting immune responses.
4
Q
- Resistance phase
A
- Resistance phase:
- Once the stressor has gone the alarm phase abates and the individual returns to a state of equilibrium.
- The first two phases occur repeatedly in life and are part of evolving as human beings.
5
Q
- Exhaustion phase
A
- Exhaustion phase:
- If stress is prolonged or severe then equilibrium is not restored and exhaustion results.
- Prolonged release of stress hormones has negative health effects.
- Over time, cortisol levels especially decrease, leading to illness.
If the stressor is perceived as too intense or the duration is too long, maladaptive responses occur, which can lead to disease.
- Glucocorticoid receptors are expressed in most organs and tissues including several brain regions, sympathetic nerves and immune cells.
- Thus, continued stimulus causing hyperactivation of the HPAA can have widespread effects.
- Repeated surges of cortisol can lead to cortisol dysfunction, resulting in unmodulated inflammation, and various sequelae including pain, depression, GI issues and increased risk of cardiovascular disease and cancer
6
Q
Proposed mechanisms underlying cortisol dysfunction
A
Proposed mechanisms underlying cortisol dysfunction:
- 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 = corticotropinreleasing hormone - 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 a pro-inflammatory effect.
7
Q
Stress and inflammation
A
Inflammation is a key driver in the physiological effects of stress. Stress in turn increases inflammation. It’s a vicious cycle.
- Stress-induced inflammation is implicated in:
CVD, fibromyalgia, chronic fatigue syndrome, osteoporosis, rheumatoid arthritis, IBD, chronic back pain, TMJ dysfunction and more.
- Inflammation increases oxidative stress and free radical damage, cellular death, ageing and systemic tissue damage.
- The sympathetic response to stress is pro-inflammatory, serving a purpose in the short term (destroys pathogens and foreign bodies).
- In chronic stress situations it contributes to the inflammatory state
8
Q
Effects of prolonged cortisol secretion
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Effects of prolonged cortisol secretion:
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:
9
Q
Increased risk of insulin resistance and Type 2 diabetes
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Increased risk of insulin resistance and Type 2 diabetes:
- Cortisol increases gluconeogenesis and decreases glycogen synthesis. Prolonged elevations lead to hyperglycaemia.
- Cortisol also inhibits beta cell insulin secretion and impairs insulin-mediated glucose uptake.
10
Q
Weight gain with central adiposity
A
Weight gain with central adiposity:
- Cortisol stimulates appetite and intake of highly palatable foods.
- Causes redistribution / accumulation of fat in visceral fat cells.
- Impaired insulin response and consistently high blood glucose sends hunger signals to the brain leading to overeating.
11
Q
Suppresses reproductive function
A
Suppresses reproductive function:
- Normal function is inhibited by various components of the HPAA in chronic stress.
- CRH suppresses the secretion of GnRH, disrupting pulsatile release of FSH and LH and in turn, oestrogen, progesterone and androgens.
12
Q
Impaired immune function
A
Impaired immune function:
- Increases infection susceptibility.
- Decreases T-cell proliferation and downregulates T-helper cell receptor expression — necessary to induce Th1 immune response
- Inhibits neutrophil, macrophage, NK cell and lymphocyte activity.
13
Q
Suppresses thyroid function
A
Suppresses thyroid function:
- HPAA activation with increases in cortisol is associated with reduced TSH production.
- Glucocorticoids inhibit 5-deiodinase activity, which converts thyroxine to triiodothyronine.
- Thyroxine is shunted into the ‘inactive’ rT3.
- In adrenal fatigue, low cortisol ↓ T3 receptor responsiveness.
14
Q
Suppresses gastrointestinal function
A
Suppresses gastrointestinal function:
Ongoing stress leads to changes in the ‘gut-brain’ axis (this includes responses from the ANS and HPAA) causing:
- Altered GI motility (impairing digestion and elimination).
- Increased visceral perception.
- Changes in GI secretions — e.g., downregulates HCl production.
- Increased intestinal permeability to large antigenic molecules.
It can lead to mast cell degranulation and colonic mucin depletion.
- Negative effects on microbiota and GI mucosal regenerative.
- Clinical consequences include GORD, peptic ulcers, IBD, SIBO etc.
15
Q
Downregulates the endocannabinoid (eCB) system
A
Downregulates the endocannabinoid (eCB) system:
- The eCB system has various homeostatic roles including modulation of neural plasticity, neuroprotection, immunity, inflammation, pain, emotional memory, hunger and metabolism.
- Suboptimal function of the eCB is linked with conditions such as depression, fibromyalgia, migraine and IBS.
- Circulating eCBs are used in the crosstalk between the intestinal microbiome and brain — specifically influencing mood.
16
Q
Typical symptoms of stress
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Insomnia, fatigue, depression, irritability, headache, and digestive disturbances.
17
Q
Conditions linked to chronic stress include
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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
- Persistent stress initially leads to hyperactivation of the HPAA and is commonly associated with issues such as depression, anxiety disorders and metabolic syndrome (hyperglycaemia, hypertension, lipid abnormalities and central adiposity).
- Continued stress results in hypo-activation of the HPAA and is linked with fatigue, irritability, pain and associated disorders including chronic fatigue syndrome, fibromyalgia and arthritis.
18
Q
DHEA = dehydroepiandrosterone (a precursor to sex hormones)
A
The adrenal glands play an integral role in the stress response:
* 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 release leads to a depleted state (referred to as ‘adrenal exhaustion’) with an impaired stress response and loss of resiliency.
19
Q
Adrenal ‘exhaustion’ - key signs and symptoms
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Adrenal ‘exhaustion’ — key signs and symptoms include: * 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.
20
Q
The role of adaptogens
A
The role of adaptogens:
- Act as mild stressors to cells, priming them to be able to effectively respond to stress (analogous to repeated physical exercise).
- Protect against adrenal exhaustion and assist recovery e.g., ashwagandha, Siberian and Korean ginseng, rhodiola.
21
Q
General interpretation of adrenal stress index results
A
General interpretation of adrenal stress index results:
- Normal levels of cortisol and DHEA = normal (no stress).
- Raised cortisol, normal DHEA = normal short-term stress.
- Raised cortisol and raised DHEA = chronic stress.
- High cortisol, low DHEA = first sign of adrenal ‘fatigue’.
- Low cortisol, low DHEA = adrenal ‘exhaustion’. As seen in sample report.
- Low cortisol, normal DHEA = start of recovery process.
21
Q
Nutritional approach to stress
A
Nutritional approach:
- Apply the CNM Naturopathic diet and adjust accordingly.
- Focus on an anti-inflammatory diet — inflammation drives stress and stress drives inflammation. Include:
‒ 8–10 portions of energetically balanced fresh fruit and vegetables, rich in vitamins, minerals and phytonutrients such as polyphenols, flavonoids and organosulphur compounds.
- Stabilise blood glucose — drops in blood glucose trigger cortisol release; chronic stress increases hyperglycaemia risk:
– Complex carbohydrates — release glucose at a steady rate, high in fibre, rich in B vitamins e.g., whole grains and legumes.
22
Q
Nutritional approach — protein
A
Nutritional approach — protein:
- 2–3 palm size portions of high quality protein e.g., legumes, nuts and seeds, whole grains, fish and eggs, to ensure amino acids required for neurotransmitter production.
- Especially tyrosine — adrenaline, noradrenaline, dopamine production e.g., nuts, seeds, whole grains, legumes, fish.
- Tryptophan — serotonin, melatonin precursor e.g., brown rice, quinoa, oats, fish, eggs, bananas.
Glutamine — GABA (ensure B6, zinc, taurine) e.g., cabbage juice, asparagus, broccoli, turkey, bone broth. ↓ intestinal permeability. ½ cup cabbage juice or 1 cup bone broth daily
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Nutritional approach — potassium to sodium ratio
Nutritional approach — potassium to sodium ratio:
* 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.
* Readily achieved with a diet rich in fruits and vegetables because 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)
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Nutritional approach — microbiome support
Nutritional approach — microbiome support:
Stress induces changes in the gut microbiota. Support this with: * 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.
* Avoid: Refined carbohydrates, high fructose, artificial sweeteners, high fat consumption especially damaged fats, alcohol, high intake of animal and soy protein
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Nutritional approach — Avoid
Nutritional approach — Avoid:
* Refined carbohydrates — alongside disruption to the microbiome, disturbs blood glucose regulation.
* Alcohol — a chemical stressor that impairs communication and processing pathways in the brain and contributes to mood and sleep disorders; depletes glutathione and Vitamin B1 — it is potentially neurotoxic.
* Caffeine — stimulates adrenaline and cortisol release, driving the stress response; blocks adenosine receptor activity inhibiting sleep. Replace with herbal teas that relax the nervous system.
Includes chamomile, lemon balm, passionflower, lime flower, hops.
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Supporting digestion
* Encouraging abdominal breathing techniques prior to meals (↑ vagal stimulation as it passes through the diaphragm).
* Eating a fist-sized amount of bitter foods and herbs 15 minutes before meals e.g., rocket, dandelion greens, or use tinctures such as gentian. Bitters increase release of gastric acid (vagal reflex) and prime pancreatic enzymes and bile. Apple cider vinegar — 1 tsp. in 100 ml water before main meals will have a similar action.
* Mindful eating focusing on aroma, texture and taste, and chewing food well shifts thoughts away from stress and improves digestion
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Nutritional approach — supporting the eCB system
Nutritional approach — supporting the eCB system:
eCB = endocannabinoid
* Increase dietary intake of omega-3 fatty acids.
* Polyunsaturated fatty acids play a fundamental role in the eCB system.
* Arachidonic acid is needed in the biosynthesis of eCBs.
* However, surplus of omega-6 fatty acids and inadequate omega3 (common in Western diets), causes excess synthesis of eCBs. This leads to desensitised and downregulated eCB receptors.
* Omega-3 fatty acids are required for normal eCB (McPartland et al. 2014) signalling and act as regulators of the eCB system
* Prebiotics and probiotics support the eCB system.
* The eCB system interacts with the central and enteric nervous systems influencing gut motility, reducing GI inflammation and balancing the reaction to stress.
* Inclusion of pre and probiotic foods and probiotic supplementation supports the eCB system.
* Black pepper, cinnamon, oregano, basil, lavender and rosemary contain the phytocannabinoid beta-caryophyllene.
* Cold water exposure has been shown to increase eCB levels.
* EVOO has been shown to upregulate CB1 receptors
27
Vitamin C (ascorbic acid)
Dosage: 500 mg — 2 g daily.
* Key water-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 ↑ psychosocial 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. ↓ hyperactivation of the HPA-axis.
* Enhances immune function — upregulates natural killer cells, interferons and T-cells.
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Vitamin B5 (pantothenic acid)
Dosage: 100300 mg / day.
* 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
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Vitamin B6 (pyridoxine)
Dosage: 50100 mg / day.
* 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
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B complex vitamins
High dose combination
* 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
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Vitamin E
Dosage: 400–800 iu / day
* 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.
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Magnesium (as citrate, taurate, glycinate).
Dosage: 100–400 mg / day
* 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
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Phosphatidylserine (PS)
Dosage: 200400 mg / day.
* 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)
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L-theanine
Dosage: 20–400 mg / day
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.
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Reishi mushroom Ganoderma lucidum
Dosage: 3–9 g / day. Use as a powder in tea, food, capsules. Considered nonedible; has a bitter, woody taste.
* Regarded as 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.
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Herbal support for stress
Key herbal strategies are aimed at calming heightened nervous system activity and supporting resistance to stress.
* Herbs can be used as infusions — 2 teaspoons of dried herb infused for 10 minutes in just boiled water, 2–3 cups daily.
* For herbal products follow dosages as per label recommendations.
* Nervine relaxants and mild sedatives calm the nervous system and promote restful sleep.
* Adaptogens increase the body’s resistance to stress through modulation of hormone and neurotransmitter physiology.
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Chamomile Matricaria recutita flowers
* Has mild sedative and anxiolytic effects and has demonstrated benefits in alleviating symptoms associated with generalised anxiety disorder.
* Relieves GI pain and spasm and is particularly helpful for GI complaints associated with stress
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Passionflower Passiflora incarnata aerial parts
* Has anxiolytic properties and promotes restful sleep.
* Shown to increase resistance to stress (i.e., ↑ resilience), with improvements in inner restlessness, fear, sleep disturbance and exhaustion
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Lavender Lavandula officinalis flowers, essential oil
* Elevates mood; useful for depression especially where accompanied by restlessness, insomnia or anxiety.
* The essential oil interacts with the limbic system (deals with emotion and memory)
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Lemon balm Melissa officinalis aerial parts
300–600 mg
* Mild sedative and antispasmodic properties (relaxes smooth muscle) and is used traditionally for insomnia, anxiety, irritability, depression, colic, nervous dyspepsia.
* Effect thought to be by inhibition of GABA transaminase system, raising levels of GABA
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Ashwagandha Withania somnifera root
* Is both adaptogen and tonic — conserves energy and boosts energy reserves.
* In the CNS is neuroprotective, sedative, anxiolytic (GABA agonist), and cognition enhancing.
* Shown to increase physical capability as well as improving psychological parameters.
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Siberian ginseng Eleutherococcus senticosus root
* Helps the body to counteract and adapt to stress.
* Improves mental and physical performance and minimises negative effects of stress.
* Enhances immunity, esp. NK cells and T-helper cells
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Other natural strategies to deal with stress
* Exercise: Facilitates regulation of the HPAA,
and influences neurotransmitters associated with mood such as dopamine and serotonin.
‒ Include regular physical activity (several times a week), e.g., walking, jogging, Pilates.
* Natural therapies: Acupuncture, aromatherapy, massage, reflexology, cranial osteopathy, Bach flowers, homeopathy etc.
* Other ways of reducing stress: Optimise sleep hygiene, avoid reading / listening to bad news, talk to a friend, go for a walk in daylight, reduce blue light, fulfil responsibilities you have
establish a purpose / goal in life of your client: Purpose in life (Japanese ikigai) plays a major role in longevity. It acts as a buffer against stress and helps reduce overall inflammation.
* Facilitate / explore this concept with your clients.
* Work out life goals, how to achieve them and how to overcome hurdles.
* Achieving goals helps to overcome stress and, therefore, disease.
* Work on future goals rather than over-evaluation of the past.
Overcoming hurdles is part of life. It creates a sense of fulfillment
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A practical approach to solving stress / problems
1. Ask your client: Write down all problems you have: Personal, work, financial, feeling overwhelmed, relationship difficulties etc.
2. Ask then: Read them over asking yourself:
“How do I solve them”?
3. Get the client to solve the easy ones first — one step at a time.
4. Support the client in working out how to solve the bigger problems by breaking them down.
5. Encourage to seek additional support if needed, e.g., financial advice
Steer client away from indecisive language:
* e.g., “I try, I hope, I am not sure”.
* e.g., focusing on the obstacles. Instead you should:
* Encourage your client to take control.
* Get your client to focus only on solutions and positive things.
* Acknowledge every progress made, small or large.
* Encourage your client to keep pushing forward, further and further to make the changes they desire
