Stress - Lecture 9

Question 1

Causes of stress x4 + examples

Answer 1

1. Poor nutrition - deficiencies (highly processed food, alcohol), Low nutrients diet, high inflammatory diet, GMO, colouring, sweeteners. Erratic eating, skipping meals, binging, yoyo/chronic diet, low calories. BS imbalance, stimulants, cigarettes
2. Personal stress
3. Poor body functions - injury, illness, allergy, skin conditions, thyroid disorders, chronic inflammatory disorders, poor detox
4. Environmental stressors - radiation, pesticides, chemicals, overexercising, lack of sleep

Question 2

What is the general adaptation syndrome?

Answer 2

3 stages of a stress response which are controlled and regulated by the adrenal glands

1. Alarm phase (initial fight or flight response)
2. Resistance phase
3. Exhaustion phase

Question 3

In the general adaptation syndrome, describe the alarm phase?

Answer 3

when exposed to stress, the amygdala sends a distress signal to the hypothalamus => activates the sympathetic NS =>
* sends a message ti the adrenals to release adrenaline and noradrenaline
* increase BP
* vasoconstriction
* sweat
* dilate pupils
* increase breathing
* increase strength
* increase sugar release from the liver
* activate inflammatory cytokines (can cause oxidative stress if constantly activated)
*increase energy to the brain

Amygdala also activates the HPA axis => hypothalamus => release CrH (corticotropin releasing hormone) => trigger release of ACTH (adrenal corticotropic hormone) in anterior pituitary gland => signal release of cortisol from the adrenal Cortex

Question 4

What does adrenaline release activates

Answer 4

Inflammatory cytokines (increase oxidative stress)

Question 5

What is the role of cortisol

Answer 5

Provides additional glucose released from the liver
increase pain threshold and inhibit immune response
surpassed non vital organs (digestive or reproductive)
=> mitigate the stress response (anti inflammatory properties)
Cortisol stays elevated hours after the initial response

Question 6

In the general adaptation syndrome, describe the resistance phase?

Answer 6

Once the stressor is gone, individual should return to a state of equilibrium

Alarm and resistance phase are normal responses BUT when stress continue for longer and we don’t recover the body will adapt and continue secreting stress hormone

When too long on the resistance phase we move on to the exhaustion phase

Question 7

In the general adaptation syndrome, describe the exhaustion phase?

Answer 7

If stress is prolonged or severe and body does not recover from stress

Prolonged release of stress hormone is detrimental to health

Cortisol levels decrease => illness, burnout, fatigue => No tolerance to stressors

Question 8

What are the physiological effects of LT stress (constant alarm and resistance phase)?

Answer 8

1. hyper activation of the HPA axis
2. cortisol dysfunction (when cortisol function normally it binds to glucocorticoid receptors and decrease inflammation ST) => unmodulated inflammation and resistance to the glucocorticoid receptors blocking the binding of cortisol => pain, depression, GI issues, CVD risks, cancer risks

Question 9

What are glucocorticoid receptors?

Answer 9

Receptors for cortisol expressed in most organs and tissues

Question 10

explain the mechanism of cortisol dysfunction?

Answer 10

Prolonged cortisol secretion => desensitisation of the glucocorticoid receptors = cortisol resistance

=> impaired negative feedback (where cortisol would normally inhibit continued CrH release from the hypothalamus) => CrH keep being released

=> continued CrH release => mast cell activation, release of noradrenaline (proof;ammatory) and up regulation of glutamate in amygdala (fear based response to stress + pain amplification (fibromyalgia) + anxiety)

=> High surges in cortisol increase its affinity to bind to mineralocorticoid receptors where it has pro inflammatory effects => tissue inflammation, fibrosis, CVD

Question 11

What are the consequences of continued CrH release?

Answer 11

=> continued CrH release => mast cell activation, release of noradrenaline (pro-inflammatory) and up regulation of glutamate in amygdala (fear based response to stress + pain amplification (fibromyalgia) + anxiety)

Question 12

Link between high cortisol surges and mineralocorticoid ?

Answer 12

=> High surges in cortisol increase its affinity to bind to mineralocorticoid receptors where it has pro inflammatory effects => tissue inflammation, fibrosis, CVD

Question 13

Explain the role of inflammation in stress ?

Answer 13

the sympathetic response to stress is pro inflammatory ( in the short term useful because destroys pathogens - but in chronic stress contributes to inflammatory state)

Inflammation increase oxidative stress and FR damage, cellular death, ageing and systemic tissue damage

Question 14

stress induced inflammation is implicated in which pathologies?

Answer 14

CVD, fibromyalgia, CFS, osteoporosis, RA, IBD, Chronic back pain

Question 15

Prolonged cortisol secretion consequences ?

Answer 15

• Inflammation
• Insulin resistance
• Weight gain with central adiposity
• Suppression of reproductive functions
• Impaired immune functions
• Suppresses thyroid function
• Suppresses GIT functions
• Down-regulate eCB system

Question 16

Prolonged cortisol secretion and Insulin resistance ?

Answer 16

Cortisol increases gluconeogenesis and decrease glycogen synthesis in the liver.

Cortisol impair insulin mediated glucose uptake and downregulate insulin secretion by inhibiting beta cells

Sugar has no way to go because of decreased insulin secretion => drive insulin resistance and type II diabetes

Question 17

Prolonged cortisol secretion and weight gain with central adiposity mechanism

Answer 17

Cortisol stimulates appetite for highly palatable foods

First adrenalin blunt the appetite but prolonged cortisol secretion stimulates appetite

Cause redistribution / accumulation of fat in visceral fat cells (metabolically active (IR and inflammatory cytokines)

Wasting of muscles around arms because of catabolic effect of cortisol

==> sends hunger signal but block insulin secretion => cells are starving => even more hungry sends hunger signal to the brain => overeating + bad food choices + no willpower because of cortisol

Question 18

Prolonged cortisol secretion and suppression of reproductive function mechanisms

Answer 18

HPA axis in chronic stress inhibit reproductive function components

CrH suppresses the release of GnRH (involved in releasing FSH and LH from the anterior pituitary) => disrupt FSH and LH and in turn oestrogen, progesterone and androgens => no ovulation = no progesterone = oestrogen dominance = infertility, sperm problems, PCOS

Progesterone and cortisol share the same precursor Pregnenolone.

Question 19

Prolonged cortisol secretion and impaired immune functions mechanisms

Answer 19

Cortisol is immunosuppressant - weakens the immune system pro-inflammatory response BUT chronic cortisol secretion => reduced level of cortisol => lack of immune regulation and chronic inflammation

=> increase infection susceptibility (decreased WBC)
=> Decreases T-cell proliferation and down regulation of T helper cells receptor expression necessary for Th1 immune response
=> Inhibits neutrophils, macrophages, NK cells and lymphocytes activity

Th1 dominance can lead to autoimmune diseases and chronic inflammation, while Th2 dominance can lead to allergies and other types of hypersensitivity reactions

Question 20

Prolonged cortisol secretion and impaired thyroid functions mechanisms

Answer 20

increased cortisol => HPA axis activation => reduced TSH production => thyroid is down regulated to conserve energy

=> Cortisol inhibit 5-deiodinase activity (converts T4 to T3) => T 4 converted to RT3 => inactive and attache to T3 receptor

=> adrenal fatigue => low cortisol =? decreased T3 receptor responsiveness => low body temperature, low pulse, low metabolic state, constipation, sluggishness, slow healing injuries, hair loss, wight gain, osteoporosis

Question 21

Prolonged cortisol secretion and impaired GIT functions mechanisms

Answer 21

Ongoing stress lead to changes in the gut brain axis
=> Altered gut motility => sympathetic NS and low thyroid slows down peristalsis and digestion
=> increase visceral perception = feel sensation in the body (need to urinate at nighttime, racing heart, stomach pain)
=> Changes in GI secretions => down regulation of HcL production and saliva
=> negative effects on gut microbiome and GI mucosa => decrease gastric renewal, increased mucosal barrier atrophy, less blood flow to the stomach (ulcers) => dysbiosis, leaky guts

==> leaky gut can lead to leaky brain = affect BBB integrity brain fog, depression

=> GORD, IBD, SIBO

Question 22

Prolonged cortisol secretion and down regulation of eCB system mechanisms

Answer 22

eCB has homeostatic roles incl. modulation of neural plasticity, neuroprotection, immunity, inflammation, pain, emotional memory, hunger and metabolism

eCB => CB1 and CB2 receptors (cannabinoid receptors) => interact with cannabinoid compounds found in hemp, black pepper, cloves, ginseng, dark chocolate, black truffles) => eCB is the body own cannabinoids.

Suboptimal sCBs function => depression, fibromyalgia, migraine and IBS

Circulating eCB used in the cross talk between the intestinal microbiome and the brain => influence mood

eCB is master regulator in immunity, inflammation, neuroplasticity, metabolism

Question 23

typical symptoms of stress in clinical practice?

Answer 23

• insomnia => cortisol dysregulation => circadian rhythm dysregulation => tired in the am because get cortisol surge at night
• depression
• irritability
• headache
• digestive disturbance
• loss of appetite (especially in the am because run off stress hormones)
• urination at night
• being hungry all the time

Question 24

conditions liked to chronic stress?

Answer 24

• anorexia
• asthma
• AI
• cancer
• CVD
• chronic fatigue syndrome
• recurrent infections
• mood disorders
• type II diabetes
• IBS
• ulcers
• headache
• hypertension
• Thyroid disorders
• PMS

Question 25

How stress affects the HPA axis

Answer 25

• Initially leads to overactive HPA axis => depression anxiety, metabolic syndrome (hyperglycaemia, hypertension, lipid abnormalities, central adiposity)
• LT stress => underachieve HPA axis => fatigue, irritability, pain, CFS, fibromyalgia, arthritis

Question 26

what is the role of the adrenal glands in the stress response?

Answer 26

Release cortisol, noradrenaline and adrenaline and DHEA in a stress response

DHEA can act as a buffer to stress negative effects

Question 27

what is the role of DHEA in the stress response?

Answer 27

DHEA can act as a buffer to stress negative effects

protect against the neurotoxic effect of chronically elevated cortisol on the hippocampus and reduce anxiety and depression

Question 28

What is adrenal exhaustion

Answer 28

On going stress with prolonged DHEA and cortisol release leads to depletion with an impaired stress response and a loss of resilience

Question 29

Key signs and symptoms of adrenal exhaustion

Answer 29

Fatigue with increased need for sleep
inability to cope with stress
anxiety
irritability
loss libido
yawning a lot
lower back pain
recurrent infections
sweet cravings

Question 30

Role of adaptogens + examples

Answer 30

Help body response to stress to be effective again
Act as mild stressor to cells priming them to effectively respond to stress
Protects against adrenal exhaustion and assist recovery
- Ashwagandha = calming grounding effect, help reduce anxiety, anti inflammatory and neuroprotective => for tired but wired clients, arthritic pain, brain fog, nervous, anxious, CFS, Fibromyalgia
- Siberian Ginseng = uplifting and stimulating, help improve CV functions, endurance in athletes, improve concentration, BS stabiliser, help enhance immune functions
- Rhodiola = reduce anxiety, poor appetite, support strong mental function, hormonal balance and immune functions (NOT for Bipolar)
- Liquorice = regulate cortisol and blood sugar, mood lifter, help with digestion

Question 31

Assessing adrenal stress index results

Answer 31

• Normal cortisol and DHEA = normal
• raised cortisol and normal DHEA = normal short term stress
• raised cortisol and raised DHEA = chronic stress
• raised cortisol and low DHEA = first sign of adrenal fatigue
• low cortisol and low DHEA = adrenal exhaustion
• low cortisol and normal DHEA = start of recovery process

Question 32

Natural approach to stress - Nutrition

Answer 32

• CNM naturopathic diet
• anti-inflammatory diet to mitigate the oxidative stress caused by inflammation and stress mitigators
• stabilise BS levels = chronic stress increase hyperglycaemia risk
• Protein with every meal for neurotransmitter production
• potassium rich food
• microbiome support
• support digestion - breathing + bitter foods + mindful eating
• support the eCB system

Question 33

Which neurotransmitters are key in diet for stress

Answer 33

• Tyrosine (adrenaline, noradrenaline, dopamine production) = nuts, seeds, whole grains, legume, fish
• Tryptophan (serotonin and melatonin precursor) = brown rice, quinoa, oats, fish, eggs, bananas
• Glutamine (GABA) + B6, Zinc and Taurine) = cabbage, asparagus, broccoli, turkey, bone broth

Question 34

why need for potassium rich food when under stress?

Answer 34

chronic stress and anxiety are associated with declined levels of potassium because aldosterone causes sodium to be retained in the body and excrete potassium
Aim for dietary potassium 5:1
Diet rich in fruits and vegetables especially dark leafy greens 2 handful a day

Question 35

Which food to include to support the microbiome?

Answer 35

Prebiotic foods = dandelion greens, chicory, Jerusalem artichoke, garlic
Probiotic foods = kimchi, sauerkraut, kombucha, kefir, greek yogurt
Polyphenol rich foods = green tea, matcha, cranberry, currents, bright colours fruits and veg.

Question 36

Which food to avoid under stress and why?

Answer 36

Refined carbs = dispirit the microbiome, disrupts BS, Blood sugar roller coaster
Alcohol= chemical stressor, impair communication pathways in the brain, mood and sleep disorders, deplete glutathione, vitamin B1 - potential neurotoxic.
Put stress on the liver and can lead to hormonal issues such as oestrogen dominance symptoms which can in turn cause insomnia and increase stress response to area of the brain linked to depression
Caffeine = stimulates adrenaline and cortisol release, drive stress response, blocks adenosine receptors activity, inhibit sleep and causes coffee crashes. Affect blood sugar on an empty stomach, causes BS drops. Adenosine is what are brain produce when we are tired and coffee blocks adenosine receptors but doesn’t stop producing the adenosine => adenosine floods the brain and creates a coffee crash.

Question 37

What herbal tea to replace coffee with for a stress patient?

Answer 37

• Chamomile = calming effect on the NS + Aspingenin (binds to receptors in the brain to decrease anxiety), help initiate sleep
• Lemon Balm = memory, alertness, calmness, good for mental stress
• Passionflower = help increase GABA in the brain
• Linden = contain farnesol essential oil = sedative for the NS - good for insomnia and nervous palpitations - good anti-inflammatory and mucilaginous functions
• Hops = anxiety and sleep disorder

Question 38

How to support the eCB system?

Answer 38

• omega 3 FA
• PUFA
• AA - omega 6

be careful, excess omega 6 causes excess synthesis of eCB => desensitisation and dyregulation of eCB receptors

SMASH fish

eCB interacts with the central and enteric NS in the brain => add pro a and probiotics

Black pepper, cinnamon, oregano, basil, lavender and rosemary contain the phytocannabinoid beta-caryophyllene that acts on the eCB

Cold water exposure increase eCB levels and activate the vagus nerve that connect to the brain and the guts => digestion restored - helps with depression

EVOO - up regulate eCB1 receptors

Question 39

supplements to help support stress
- Vitamin C
- Vitamin B5
- Vitamin B6
- B complex
- Vitamin E
- Magnesium
- Phosphatidyl-serine
- L-theanine
- reshi
- Chamomile
- Passion flower
- Lavender
- Lemon Balm
- Ashwagandha
- Siberian Ginseng

Question 40

Vitamin C to support stress - dosage and uses

Answer 40

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. Help fight with FR 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.
• Need for vit C increase in times of stress
• Dose => give a split dose during the day depending on client sensitive (may cause loose stool if too much), increase to bowel tolerance
• Magnesium ascorbate which leans more to relaxation, rosehip and cherries (also get flavonoids component for extra antioxidant activity)

Question 41

Vitamin B5 for stress dosage and uses

Answer 41

Vitamin B5 (pantothenic acid)
Dosage: 100- 300 mg / day  help reduce the secretion of cortisol

• Production of energy as well
• As a precursor to coenzyme A plays an essential role in adrenal cortex function  cortex secretes adrenal hormones and glucocorticoids so needed for the stress response
• Increases production of glucocorticoids and other adrenal hormones.
• Thought to reduce secretion of cortisol in times of stress.

Question 42

Vitamin B6 for stress dosage and use

Answer 42

Vitamin B6 (pyridoxine)
Dosage: 50- 100 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.

Question 43

B complex for stress use and dosage

Answer 43

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.
• Legume, wholegrains and good quality animal products need to be stable of the diet
• Use as a supplemental as a complex because work synergistically

Question 44

Vitamin E for stress

Answer 44

Vitamin E
Dosage: 400–800 iu / day. Work with the client in front of you, start loa and then work your way up

• Acute and chronic stress increase free radical formation, especially in the CNS and adrenal cortex.  stress can create fatigue pain and brain fog and vit E can be very helpful with that
• 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.
• Supportsimmunity—increases phagocyte activity and promotes differentiation of immature T-cells in the thymus.
• Vitamin E for hormonal health when not enough progesterone to balance out oestrogen  oestrogen dominance  vitamin E can help antagonise excess oestrogen

Question 45

Magnesium for stress

Answer 45

Magnesium
(as citrate (if sluggish bowel), malate (for energy production for fatigue) taurate, glycinate (easy on the stomach and gentle and absorbable and great for sleep).
Dosage: 100–400 mg / day. Starts slow and go up if needed

• Most calming mineral and crucial for stress and energy support  Dual effect
• Deficiency upregulates HPA activity, while supplementation attenuates activity with reductions in ACTH and cortisol.
• Is a co-factor for GABA synthesis (anti anxiolytic neurotransmitter affect and if we don’t have enough GABA then we have too much glutamate which is stimulating and can cause anxiety on the system), heightens GABAergic availability by reducing presynaptic glutamate release — net effect anxiolytic.
• Co factor for serotonin and melatonin pathways
• Restless legs, twitching eyes, leg cramping at night, quivering tongue (sign of magnesium deficiency)
• 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

Question 46

Phosphatidyl- serine (PS) for stress

Answer 46

Phosphatidyl- serine (PS)
Dosage: 200– 400 mg / day. Expensive as a supplement

• Normalises stress response.
• adaptogen effect to the HPA response, can buffer it down if overactivated or normalise it if under activated
• 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).
• Dampen the effect of prolonged cortisol secretion on the brain  anxiety, sleep and mood

Question 47

L-theanine for stress

Answer 47

L-theanine
Dosage: 200 - 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.

Help brain serotonin dopamine and GABA levels.  green tea has a calming effect in the NS as opposed to coffee which has a stimulating jittery effect.

Question 48

Resishi mushroom for stress

Answer 48

Reishi mushroom
Ganoderma lucidum
Dosage: 3–9 g / day. Use as a powder in tea, food, capsules. Considered non- edible; has a bitter, woody taste.

Regarded as an adaptogen.
* Triterpene constituents have a sedative action, calming the nervous system to support relaxation and sleep (great for insomnia).
* 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.
* HBP, high cholesterol, CVD, help with BS levels  diabetic and hypertensive medication clients be mindful of drug nutrient interaction  bitter taste to use as a powder or capsule

Question 49

Chamomile for stress vs Passion flower and Lavender and Lemon Balm

Answer 49

• Chamomile - 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.
• Good to have throughout the day or at the end of the day to help with sleep
• Passionflower - 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.
  *Good for not being able to switch of the brain before bed.
  *Apoptogenic herb and can help increase resilience to stress – anti anxiety effect for racing brain
• Lavender - 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  helps the body response to intense emotions and we acess the limbic system with our sense of smell so lavender oil smell).
  *Be mindful of essential oils with young children  lavender essential oil on pillow, eye mask with dried lavender to fall asleep and inhale lavender
  *If you infuse it don’t infuse too long because has volatile oils

Lemon balm aerial parts =
*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.
*Also high in volatile oils

Question 50

Ashwagandha vs Siberian Ginseng foe stress

Answer 50

Ashwagandha - root =
*Is both adaptogen and tonic — conserves energy and boosts energy reserves. Restorative to help body more resilient to stress and helps restore energy which can be affected by stress.
*In the CNS is neuroprotective, sedative, anxiolytic (GABA agonist  good for people struggling with anxiety and fear), and cognition enhancing. Good for feeling of tired and wired where they are tired but cannot fall asleep.
*Good to sooth the muscles (mind, mood and muscle soother)
*Good libido tonic (especially under stress)
*Shown to increase physical capability as well as improving psychological parameters.
*Powder and tincture  very bitter herb

Siberian ginseng - root =
*Helps the body to counteract and adapt to stress.
*Uplifting and stimulating herb  but also help reduce anxiety
*Improves mental and physical performance and minimises negative effects of stress.  in athletes help with endurance
*Help increase concentration, stabilise BS levels
*Enhances immunity, esp. NK cells and T-helper cells.
*Great for depression and feeling of being overwhelmed