Monday, March 30, 2009

Managing Stress-Related Disorders, Part 2: "Stressed and Wired"

Americans as a lifestyle maintain a state of hyper arousal of the adrenal glands. In this condition the cortisol and other stress molecules are upregulated. This state of arousal is an important survival mechanism for emergency situations, but chronically high cortisol is catabolic and sets that stage of all manner of dysfunction and disease.

For starters, high cortisol causes a chronic state of agitation, irritability, anxiety, nervousness, and even panic attacks. This can affect sleep patterns, increase cardiovascular risk factors, decrease the libido, impair the memory and learning patterns, cause muscle wasting, and reduce reproductive function, to name just a few.

Nutritional Management of Elevated Cortisol: B-vitamins
The B-vitamin family is important in any adrenal support program, because the B-vitamins help to support the neurological system and the adrenal glands themselves and change the way a patient interprets the stress. Folate, for example, ranging from as little as 200 mcg to as much 15 mg, has shown anti-depressive effects. Folate and B12 deficiency has long been associated with depression. B-vitamins are involved in norepinephrine, dopamine, and serotonin synthesis, and are coenzymes in the synthesis of adenosylmethionine (SAM), and shown to have antidepressive properties.

One note of interest is that folate in the form of folic acid does not cross the blood/brain barrier. There is only one form of folate that does, and that is the end metabolite of folate metabolism, 5-methyltetrahydrofolate (5-MTHF). It is important that any B-vitamin complex you are using for depression and/or anxiety contains this form of folate.

Studies in animals have shown that a deficiency in another important B-vitamin, pantothenic acid (B5), mimicked metabolic changes seen in adrenal insufficiency. Administering B5 increases the production of corticosteroids. In humans, it normalized the response to ACTH and deficiency led to reduced resistance to stress.

Vitamin B6 is also essential, in that it is important to the metabolism of most amino acids. It also converts tyrosine to dopamine for epinepherine synthesis and protects from homocystiene overproduction. A derivative, homocystiene lactone, can inhibit ACTH release.

Likewise, the B-vitamin, myo-inositol, has been shown to be remarkably effective by itself in the treatment of panic attacks, obsessive compulsive disorder, and depression. In one study comparing the effects of myo-inositol against the drug, Fluvoxamine, for panic disorder, the myo-inositol “reduced the number of panic attacks per week by 4.0 compared with a reduction of 2.4 with Fluvoxamine. Nausea and tiredness were more common with Fluvoxamine.” J Clin Psychopharmacol 2001 June;21(3)335-9

The American Journal of Psychiatry reported that inositol in doses of 6g/day and 12g/day “is a potential treatment for depression in both open and double-blind placebo controlled trials.” Double-Blind, Placebo-Controlled, Crossover Trial of Inositol Treatment for Panic Disorder, J Benjamin, et al, Am J Psychiatr, 152: 1084-1086

Myo-inositol is especially beneficial in overall nervous system function because it is an important naturally occurring component of cell membranes. Myo-inositol plays a major role in cell signaling by functioning as a precursor of an intracellular second messenger system. This system is especially important in the brain. For example, serotonin and norepinehprine receptors are linked to the inositol second messenger system.

Another micronutrient deficiency that can have an adverse effect on the stress response is magnesium. According the Journal of the American College of Nutrition, magnesium deficiency intensifies adverse reactions to stress. Such reactions are mediated by excess release of catecholamines and corticosteroids, and low magnesium and calcium levels increase the release of stress hormones, which further lower tissue magnesium, creating a snowball effect. Likewise, magnesium plays a role in maintaining healthy levels of the myo-inositol pool in the body.

Herbal Support for Stressed and Wired
A revered “vitalizer” and rejuvenative tonic in Ayurveda (Charaka Samhita 1000 BC), the herb ashwagandha has been traditionally used for stress tolerance, vigor and stamina, convalescence, nervous exhaustion, fatigue, geriatric debility, physical and mental stress, and insomnia, while no side effects have been reported.

Another remarkable rejuvenating herb, holy basil, has anti-stress activity, including a normalizing affect on the CNS. It has been shown to reduce incidence of gastric injury induced by cold stress and restraint stress. It also inhibits the lipoxygenase and cyclooxygenase prostaglandin pathways, antagonizes histamine, and decreases acid and pepsin output, enhances gastric mucosal strength, and helps normalize the stress-response.

Ayurvedic literature attributes a “non-specific increased resistance”to the herb bacopa (also known as brahmi), and has been traditionally used to revitalize the nerves, brain cells, and the mind. It helps to strengthen the adrenals and purify the blood, and in animal testing it improves adaptations in sensory, motor, and motivational systems. In humans bacopa exhibits beneficial effects on anxiety and mental functions (mental fatigue). The effects on the CNS may be mediated through stimulation of gamma-aminobutyric (GABA)ergic and cholinergic systems.

What to Use When
A B-vitamin complex featuring the active form of folate, and/or a high-potency B5/B6 formula is foundational for stress protection and the early signs of adrenal stress, typically presenting in the form of anxiety and high cortisol levels. Additionally, an herbal complex featuring bacopa, ashwagandha, and holy basil can be added for complementary support in helping to rejuvenate the body and support the CNS. If the anxiety becomes severe, one should consider the use of a myo-inositol and magnesium complex to control anxiousness and regulate the mood.

There are a number of other herbal-based remedies as well for the other stages of stress, and we will discuss those in the next post.
Stress formulas to consider: