Remember those predictions about working a four-day workweek in the new millenium? Well, it hasn’t worked out that way, has it! Computers and BlackBerrys, while making us more efficient, have also made us more accessible to work on evenings and weekends. Cutbacks often result in one person doing work that was previously assigned to several people. In my world, a lack of pharmacists often means long hours and less vacation time.
The result is increased stress—a contributing factor in many disease states that is rarely addressed in the course of a routine medical visit. Stress is listed as one of the modifiable causes of heart disease, and several of the effects of the stress hormone, cortisol, match up alarmingly with the symptoms of metabolic syndrome: increased blood pressure, weight gain around the waist, increased cholesterol and insulin resistance. Could it be that excess production of cortisol due to stress is that elusive connection to metabolic syndrome that increases risk of heart disease?
Researchers have observed that the appearance of cancer in many patients is preceded by a stressful event about two years earlier. Anyone who suffers from cold sores will tell you that they are most likely to show up when they are under stress. Emergency wards and student health centres note an increased demand for services during stressful times. Excessive production of cortisol is known to have a negative effect on the immune system, and the metabolic pathways by which this occurs have actually been identified. And stress hormones, being structurally similar to our reproductive hormones, can worsen the symptoms of menopause.
It’s enough to make you wonder why we don’t routinely test for and treat elevated cortisol blood levels…Perhaps it’s because physicians themselves have not been spared from the increased pace of life, and few are able to take time during an appointment to discuss the issues surrounding stress in a patient’s life.
Non-drug options for stress
Anti-depressants and tranquilizers are standard medications offered to highly stressed patients, but, as well as having high side effect profiles, they do not directly address the production of cortisol. However, in the herbal world, there are a number of medicines known as cortisol modifiers and adaptogens that lower cortisol production and lessen the impact of stress. As well, simple changes in lifestyle, attitudes and nutrition can result in a healthier response to the everyday stresses of life.
Those who really need help should see a stress specialist. However, for those who are less severely stressed, I can pass along some self-help suggestions and recommend nonprescription supplements.
A good place to start is with a lifestyle assessment. Make a list of factors that are “good for me” versus “bad for me,” then devise a plan to relieve the worst factors, using a strategy to “change, adapt to, or leave” the most stressful situations. As stress hormones set up the body for “fight or flight,” exercise can be recommended to help reverse some of the effects of these hormones. Dietary recommendations to lower cortisol include eating balanced meals regularly throughout the day, ingesting a small amount of salt (sodium is required for adrenal function), avoiding simple sugars, increasing protein and essential fatty acids, and avoiding coffee, including decaffeinated (both contain theobromine, which tends to raise cortisol).
Substituting green tea for coffee, and vegetable juice for fruit juice is often advised. Vitamin C up to 3000 mg per day (either in divided doses or as a slow-release tablet) is recommended, as are B vitamins, particularly B5 or pantothenic acid, to support healthy adrenal function. Magnesium is a co-factor for many reactions that involve energy metabolism and nervous system function. Therefore the need for magnesium may be increased during periods of stress.
Magnesium is also necessary for muscle relaxation, and a deficiency increases the risk of muscle spasms that will often develop as a response to stress.
Herbal medications available for treating stress are divided into two major categories: the cortisol-modulating supplements (such as theanine, epimedium, and phytosterols) and the adaptogens or general anti-stress supplements (such as ginseng, schisandra, and astragalus). I will review some of the properties of a few of these supplements to help distinguish which might be best for a particular client.
Cortisol modulating herbs
Theanine Theanine is an amino acid. It acts as a non-sedating relaxant, helping to increase the brain’s production of alpha waves, one of the four basic brainwave patterns. Alpha wave production is associated with relaxed alertness, increased focus and concentration, promotion of creativity and improved overall mental performance. Theanine occurs naturally in tea leaves, and is converted by the plant gradually over time into catechins, the substance in tea known for its antioxidant benefits. Green tea, which is less aged than black tea, therefore contains more theanine than the other more aged varieties. As well, users should be aware that the decaffeination process removes theanine from tea along with the caffeine. Theanine has been shown in clinical studies to be effective in dosages from 50 to 200 mg per day. Three to four cups of green tea contain 100 to 200 mg of theanine. It is also available in supplement form.
Epimedium Epimedium, also known as horny goat weed, has been shown to restore low levels of both testosterone and thyroid to normal levels, in addition to reducing cortisol levels when elevated. Hence, it has a reputation for improving libido in stressed individuals. Water-extracted epimedium, the traditional method of preparing this herb, is considered a safer form than the alcohol extract as rodent studies suggest that high doses of icariin, an alcohol-soluble constituent, may be associated with kidney and liver toxicity. A suggested dose for cortisol control is 250 to 1000 mg per day.
Phytosterols Phytosterols include hundreds of plant-derived sterol compounds that are structurally similar to cholesterol but do not clog our arteries. By controlling production of inflammatory cytokines, phytosterols help modulate immune function, inflammation and pain levels. They have been shown to prevent immune system suppression and cortisol elevation usually seen in athletes after endurance events. Preliminary evidence from animal studies suggests that dietary phytosterols retard the growth and spread of breast cancer cells. Beta-sitosterol, one of the major phytosterols, has been shown in humans to normalize activity of T-helper lymphocytes and natural killer cells following stressful events that normally suppress immune system function. A typical dosage is 100 to 300 mg per day of mixed phytosterols, including 60 to 120 mg per day of beta-sitosterol. A handful of roasted peanuts or 2 tablespoons of peanut butter contain 10 to 30 mg of beta-sitosterol. Rice bran, corn, wheat germ and flaxseed are examples of rich food sources of phytosterols. See www.dietaryfiberfood.com for more information on the phytosterol content of foods.
Phosphatidylserine Phosphatidylserine has been shown to modulate many aspects of cortisol overproduction, especially after intense exercise. There is scientific evidence that it can help improve mental function and depression, even in Alzheimer’s disease. Because cortisol causes catabolism of muscle tissue, athletes will frequently use this supplement to promote recovery from exercise and help slow muscle loss. Practitioners sometimes suggest phosphatidylserine supplements be taken late in the day to reduce nocturnal awakening due to surges in cortisol production during the night. Doses of 100 to 500 mg per day for one month are recommended for mental support, followed by a maintenance dose of 50 to 100 mg per day.
Tyrosine Tyrosine is an amino acid that was studied by the U.S. military for its potential to help soldiers cope with the stress of battle. Their studies showed that 2000 mg of tyrosine helped memory and cognitive ability during stress. Studies, with volunteers exposed to stressful situations such as shift work, sleep deprivation and fatigue, found that 100 to 200 mg per day helped to prevent declines in mental performance and increased their ability to concentrate. Other amino acid groups, referred to as the branched chain amino acids (BCAAs) have been shown to counteract the rise in cortisol and drop in testosterone and immune function that is often seen in endurance athletes. Although tyrosine and BCAAs are available in supplement form, they can easily be obtained from protein foods. Hence, the recommendation above to increase protein content of the diet.
Adaptogenic herbs
Ginseng Ginseng is the best known of the adaptogens. Many animal and human studies have shown that ginseng can increase energy and endurance, improve mental function and improve resistance to various stressors including infection, extreme exercise and sleep deprivation. Human studies have shown improved immune function and reduced incidence of colds and flu with Panax ginseng 100 mg per day. Siberian ginseng (Eleuthrococcus), while not a true ginseng, contains compounds that give similar effects. While generally considered safe, ginseng has been reported to increase blood pressure in some individuals, and caution should be used in those prone to hypoglycemia, due to its reported effect of reducing blood sugar levels.
Schisandra Schisandra is a traditional Chinese medicine used to promote energy, protect the liver, alleviate exhaustion and correct immune system disturbances caused by stress. It is generally considered safe when used in recommended doses of 100-500 mg per day, although mild indigestion and skin rash has been reported. Because it may induce uterine muscle contractions, it should not be used by pregnant women.
Astragalus Astragalus is an adaptogen herb commonly recommended for stimulation of the immune system and for energy-promoting properties. It has been used for centuries both in Traditional Chinese and Native American medicines, and animal experiments suggest that it enhances function of T-cells, lymphocytes and neutrophils. It is often combined with other adaptogenic herbs to keep the immune system functioning during periods of high stress. As a single ingredient it would be used in doses of 250 to 500 mg per day, or in combination as 100 to 200 mg per day.
Treating the cause
Many of these herbal medicines are available in combination “stress formula” products, and this is often the easiest way to supplement with them. People with high levels of stress on an ongoing basis would be well advised firstly to maintain a healthy diet and supplement with vitamin C, vitamin B complex and magnesium. If they are having difficulty coping with chronic stress or if stress is causing detrimental physical effects, they should next consider taking cortisol-modulating supplements as well. Adaptogenic herbs, available as combination products from several herbal manufacturers (for example: AdrenPlus from Enzymatic Therapy, Corti Lite from Vita Plus), would generally be used periodically during episodes of increased stress to counteract the detrimental effects of elevated cortisol.
Animal studies have shown that stress-induced rises in cortisol levels lead to increased visceral (in the abdominal cavity) fat deposits that are associated with disease states such as diabetes and heart disease. It would appear that we are focusing on treating all the diseases caused by excessive stress, while ignoring the “elephant” in the room. Perhaps the tools described above, along with improvements in diet and lifestyle, can help us to become healthier and improve our chances of avoiding chronic disease.
Originally published in Drugstore Canada
