Stress and Fatigue Flashcards
Which type of ketone is measured in the blood?
Beta-hydroxybutyric acid
Which infectious organism is implicated in the proposed aetiologies of chronic fatigue syndrome and ME?
Epstein-barr virus
Which nutrient Is a cofactor in the serotonin melatonin pathway supporting mood and sleep?
Magnesium
Mitochondria make over what percentage of the body’s energy as ATP?
90%
What vitamin has been shown to reduce stress-induced cortisol release?
Vitamin C
Continued stress can eventually result in ________ that is associated with various disorders including chronic fatigue syndrome, fibromyalgia and arthritis.
hypo-activation of the HPAA (due to adrenal fatigue)
Ongoing stress with prolonged ______ and cortisol release leads to a depleted state (referred to as ‘adrenal exhaustion’) with an impaired stress response and loss of resiliency.
DHEA
What is the typical macronutrient ratio to support nutritional ketosis in CFS/ME?
75% fat, 20% protein, 5% carbohydrate.
Elevated levels of which hormone have a direct inhibitory effect on the reproductive axis?
Corticotropin-releasing hormone
What ratio of potassium to sodium should a client suffering with stress be aiming for?
Greater than 5:1
List the 4 categories of the causes of stress (with an e.g. for each)
- Poor nutrition (alcohol, highly-processed foods)
- Personal Stress (financial problems)
- Poor body functions (allergy, thyroid disorders, slow detoxification)
- Environmental (radiation, household chemicals)
Give the definition of ‘stress’
a non-specific response of the body to any disturbance/demand - triggering the ‘stress response’
What controls and regulates the body’s stress response?
The adrenal glands
What are the stages of the stress response called and who coined the term?
The general adapation syndrome
Hans Selye
What are the three stages of stress in the General Adaptation Syndrome
- Alarm phase (fight or flight)
- Resistance phase (return to balance)
- Exhaustion phase (in cases of prolonged stress)
What is released in the alarm phase of a stress response (from where?)
Adrenaline and noradrenaline (adrenal medulla)
ACTH (anterior pituitary)
Cortisol (adrenal cortex)
What is activated by adrenaline that increases oxidative stress?
Inflammatory cytokines
Give 3 actions of cortisol
- provides additional glucose
- increases pain threshold
- Inhibits immune responses
Receptors for cortisol are called….
Where are they found in the body?
Glucocorticoid receptors
Expressed in most organs/tissues (brain, sympathetic nerves, immune cells)
Why is it important to test cortisol levels
To see if the client is in a hyper-activation of the HPAA or a hypo-activation of the HPAA stage
Issues associated with HPA hyper-activation
- Depression
- Anxiety disorders
- Metabolic syndrome (hyperglycaemia, hypertension, dyslipidaemia, central adiposity)
Issues associated with HPA hypo-activation
- Fatigue
- Irritability
- Pain and associated disorders:-
- Chronic fatigue syndrome
- Fibromyalgia
- Arthritis
7 conditions linked ti chronic stress
- Anorexia nervosa
- Asthma
- Autoimmunity
- Cancer
- CVD
- CFS
7.T2DM
6 symptoms of stress
- Insomnia
- Fatigue
- Depression
- Irritability
- Headache
- GIT issues
7 effects of prolonged cortisol secretion
- Increased risk of IR and T2DM
- Weight gain with central adiposity
- Suppresses reproductive function
- Impaired immune function
- Supresses thyroid function
- Suppressed GIT function
Downregulates the endocannabinoid system
Describe the process by which cortisol resistance can occur
Excessive or prolonged cortisol secretion leads to desensitisation of glucocorticoid receptors to cortisol (cortisol resistance)
- Explain the role of inflammation in stress states
- Why is the body’s stress response pro-inflammatory?
- Repeated surges of cortisol can lead to cortisol dysfunction which results in unmodulated inflammation
- The sympathetic response to stress is pro-inflammatory which is useful in the short-term (to destroy pathogens and foreign bodies
3 actions of cortico-releasing hormone (hormones involved)
- CRH increases mast cell activation
2.CRH causes the release of noradrenaline - CRH upregulates glutamate in the amygdala (promotes fear-based response to stress)
Explain why prolonged cortisol secretion increases the risk of insulin resistance (2 ways)
- Cortisol increases gluconeogenesis and decreases glycogen synthesis - causing hyperglycaemia
- Cortisol inhibits beta cell insulin secretion and impairs glucose uptake
2 ways cortisol causes weight gain and central adiposity
- Stimulates appetite and stress eating
- causes redistribution /accumulation of fat in visceral fat cells
- Impairs insulin response/keeps blood sugars high - sending hunger signals to the brain (over-eating)
Explain how prolonged cortisol secretion supressed reproductive function
CRH supresses the secretion of GnRH (thus disrupting the release of FSH and LH and subsequently oestrogen, progeterone and androgens)
2 ways cortisol impairs the immune system
- Decreases T-cells
- Downregulates T-helper cell receptor expression (required for Th1 immune response)
- Inhibits neutrophils, macrophages, NK cells, lymphocytes
How does cortisol inhibit thyroid function? 4 ways
- HPA axis activation and increased cortisol, reduces TSH production
- Glucocorticoids inhibit the enzyme that converts T4 to T3
- T4 is shunted into inactive rT3
- Adrenal fatigue means low cortisol which downregulates T3 receptors
4 ways cortisol supresses the GIT function
- Reduces gut motility - impairing digestion and elimination
- Reduces Hcl production
- Increases intestinal permeability (leading to mast cell degranulation and mucin depletion)
- Negatively effects the microbiota
What is the role of the endocannabinoid system?
A network of receptors and enzymes involved in pain sensation, appetite, memory and mood.
The communication link betweek the gut (microbiome) and the brain.
What is the role of DHEA in stress response?
Released in higher amounts in response to stress
- protection against negative consequences of stress
- protects against neurotoxic effects of cortisol
- reduces anxiety and depression
5 signs and symptoms of adrenal exhaustion
- Fatigue
- Reduced resilience to stress
- Anxiety
- Reduced libido
- recurrent infections
What would indicate normal stress levels on an adrenal stress index test?
Normal levels of cortisol and DHEA
What would indicate normal short-term stress on an adrenal stress index test?
Raised cortisol, normal DHEA
What would indicate chronic stress on an adrenal stress index test?
Raised cortisol and raised DHEA
What would indicate adrenal fatigue on an adrenal stress index test?
High cortisol and low DHEA
What woud indicate adrenal exhaustion on an adrenal stress index test?
Low cortisol and low DHEA
What would indicate the start of adrenal recovery on an adrenal stress index test?
Low cortisol, normal DHEA
Give 6 elements to a nutritional approach to stress
- Naturopathic diet
- Anti-inflammatory foods
- Stabilise blood glucose
- Ensure good protein intake
- Rebalance potassium:sodium ratio
- Support microbiome
3 amino acids that are particularly important to include in the diet when addressing stress
- Tyrosine (adrenaline, noradrenaline, dopamine production)
- Tryptophan (serotonin, melatonin precursor)
- Glutamine (GABA)
4 foods that contain tyrosine
4 foods that contain tryptophan
4 foods that contain Glutamine
- Tyrosine: nuts, seeds, wholgrains, legumes
- Tryptophan: brown rice, quinoa, eggs, bananas
- Glutamine: cabbage juice, asparagus, bone broth
3 things to avoid in the diet when addressing stress
Refined carbohydrates
Alcoho
Caffeine
3 ways to support digestion by in times of stress
- Abdominal breathing/vagal stimulation
- Bitter foods
- Mindful eating
Expain why the correct ratio of omega-3 to omega-6 is key for the eCB system
Arachidonic acid is important for biosynthesis of eCBs but a surplus of 0-6 and not enough 0-3 causes excess synthesis leading to desensitised/downregulated eCB receptors.
Omega-3 is needed for proper functioning of eCB signalling
2 ways cold water exposure is helpful in stress
- Activation of the vagus nerve
- Increases eCB levels
Foods that contain the phytocannabinoid beta-caryophyllene
Black pepper
Cinnamon
Basil
Rosemary
Why is EVOO good for the eCB system?
it upregulate CB1 receptors
8 nutrients that are beneficial for stress (dosage)
- Vit C - 500-2000mg
- B5 - 100-300mg
- B6 - 50-100mg
- Vit E - 400-800IU
- Magnesium - 100-400mg
- Phosphatydylserine - 200-400 mg
- L-theanine - 200-400mg
- Reishi - 3-9g
Functions of vitamin c on stress
- Antioxidant - reduces free radicals
- Adrenal support (cofactor for glucocorticoid synthesis)
- Reduces stress-induced cortisol release (reduced hyperactivation of HPAA)
- Enhances immune system
Stress: functions of B5
- Precursor to co-enzyme A (essential role in adrenal cortex function)
- Increases glucocorticoid production (and other adrenal hormones)
- Reduces secretion of cortisol in times of stress
Stress: function of B6
- GABA and Serotonin modulator
- Downregulates glucocorticoid receptors
When a client exhibits adrenal fatigue, why might a b complex be beneficial?
- Co-factors for Krebs cycle (ATP production)
- B1 - for nervois system support
- B6, B9, B12 - for methylation
- A complex of Bs is shown to improve mood
Stress: Vitamin E - functions
- lipid soluble anti-oxidant - protects neural membranes and myelin from oxidative damage
- Supports immunity
Stress: Magnesium functions
- Regulates HPA activity/reduces ACTH and cortisol
- GABA synthesis co-factor
- Serotonin-melatonon pathway co-factor
- Breaks actin-myosis bonds - muscle relaxation
Which forms of magnesium are most beneficial for stress and why?
Amino acid chelates: taurate and glycinate
Taurine: GABA agonist
Glycine: inhibitory neurotransmitter
Stress: functions of phosphatidylserine
- Normalises stress response
- Buffers HPAA response
- Normalisation of cortisol binding globulin
Stress: functions of L-theanine
Increases serotonin
Increases dopamine
Increases GABA levels
Beneficial actions of Reishi for stress
- Adaptogen
- Sedative effect (triterpenes)
- Polypeptides acts as precursors to neurotransmitters
- immune support
4 herbs for stress (main action)
- chamomile (mild sedative/anxiolytic/GIT refief from pain and spasm)
- Passionflower (anxiolytic, promotes sleep, increases resilience to stress)
- Lavender (mood elevator, limbic system interaction
- Lemon Balm (mild sedative and antispasmodic - relaxes smooth muscle, raises GABA)
2 adaptogens for stress (functions)
- Ashwagandha (GABA agonist, enhances cognition, adaptogenic and tonic)
- Siberian ginseng (mental and physical performance improvement, enhances immunity)
Define ‘fatigue’
A symptom experienced when energy demad exceeds energy delivery
3 things mitochonria are highly susceptable to
- Nutrient deficiencies
- Toxins - environmental
- Oxidative damage
Why do mitochondria get damaged by oxidative damage
When ROS production in the mitochondria outpaces antioxidant activity
2 factors that increase mitochondrial dysfunction
- Hyperglycaemia
- Inflammatory mediators (TNF-a) - increases ROS generation
Reasons for raised inflammatory markers
- Intestinal mucosal degredation (LPS)
- Pro-inflammatory diet
- Glucose dysregulation
- Smoking
3 key antioxidant enzymes (and co-factors) to protect mitochondria
- Superoxide Dismutase (manganese)
- Glutathione peroxidase (selenium)
- Glutathione reductase (B3
4 factors associated with mitochondrial damage
- ROS leakage when ATP is produced
- Ageing
- Genetics
- Toxic metals
Key nutrients required for glycolysis
Magnesium
B3
Key nutrients required for Acetyl CoA formation
B1
ALA
B5
Key nutrients required for Krebs cycle
Magnesium
Manganese
Iron
B1
B2
B3
Key nutrients required for Electron Transport Chain
Iron
B2
Sulphur
CoQ10
Copper
What is the function of L-carnatine?
What dose is recommended?
b-oxidation of fats (transports fatty acids)
500-2000mg (acetyl L-carnatine)
5 strategies to improve mitochondrial health
- Optimise nutrients
- Bood sugar regulation
- Reduce inflammatory mediators
- Decrease toxin exposure
- Strength training
Coenzyme Q10 dosage
100-300mg
CoQ10 function
- transports electrons into the electron transport chain
- Intra-mitochonrial antioxidant (neutralises ROS)
ALA dosage
300-600mg
Magnesium dosage
200-400mg
What is the difference between CFS and ME?
CFS: long-term physical and congnitive fatigue, not alleviated by rest
ME: CFS plus inflammation
7 aetiologies of CFS and ME
- Infectious organisms
- Immunological (increased cytokines, NK cell abnormalities, decreased CD8 cells)
- Abnormal HPAA functioning
- Mitochondrial dysfunction / high oxidative stress
- Serotonin implicated (reduced extracellular serotonin
- Gut-brain communication issue
- Microbiome role: high clostridium and ruminococcus and decreased faecalibacterium
What is the action of glucocorticoids on enzyme 5-deiodinase?
Inhibition, which reduces the amount of active thyroid hormone
Which nutrient dampens the effects of prolonged cortisol secretion on brain function allowing for better quality sleep and decreased anxiety?
Phosphatidylserine
Which herb is most useful for depression (where it influences the limbic system), accompanied by restlessness, insomnia or anxiety?
Lavender
What would you expect to see on an Adrenal Stress Index as the first sign of adrenal ‘fatigue’?
High cortisol and Low DHEA
CoQ10 is required for ATP production as part of which process?
Electron transport chain
Which nutrient increases mitochondrial oxidative phosphorylation, thereby increasing ATP production and reducing mtROS?
Acetyl L-carnitine
3 features of the ‘Alarm Phase’ of the fight or flight response
- Inhibition of immune response
- Increased oxidative stress.
- Increased pain threshold
Which amino acid is especially required for the production of adrenaline, noradrenaline, and dopamine?
Tyrosine
The average core temperature reflects __________ function. The fluctuations reflect _________ function. Fill in the blanks.
- Thyroid
- Adrenal
