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Stress Control: Genesis to Good Health

Stress & Relaxation Stress & Relaxation
Longevity By Nature

They may see you about other complaints but helping your patients/clients to relax and manage stress will maximize their wellness journey with you.

You may have encountered the word “hygge” in an interior design sense. But this Danish word, which translates to “comfort” and “coziness,” also can apply to wellness, especially when stress, anxiety are at an all-time high, triggering sensory overload and an overall distressed well-being.

Your clientele may not understand that the results of runaway stress can cause myriad symptoms, some of which have landed them there in front of you. But what they can understand is some more immediate relief, CBD aside.

Most if not all your clients/patients won’t say they are visiting you because of “stress,” but this may be the real case or cause of their visit. It is, of course, up to you to discern his or her stress level and stressors in addition to the more prominently presenting challenge and symptomology.

Nancy Morrow, MS, nutrition support manager, Standard Process, Wisconsin, pointed out that the effects of stress can be far reaching, “and any smoldering condition can enflame due to unresolved stress.”

Many of your clients/patients are living with an activated inflammatory pathway as the “fight or flight” reaction is frequently activated. As such, elevated cortisol is a result of chronic stress that can activate proinflammatory processes controlled by nuclear factor kappa B (NF-kB), which in turn presents in numerous ways, depending on the individual—because continual stimulation of NF-kB can result in a proinflammatory state that’s been associated with a wide range of inflammatory conditions.

“A stress response should be assessed for each and every patient regardless of primary concern or health goal,” underscored Corey Schuler, FNP, DC, CNS, director of medical science for North Carolina-based Gaia Herbs. Stress is commonly assessed when the patient primarily reports anxiety, panic or depression. However, he elucidated, direct implications to stress and stress response often present as dermatological effects (sometimes mimicking atopic dermatitis), immune reactions including environmental allergies or autoimmune conditions, and gastrointestinal, cardiovascular and impaired immune function. “This is not to say these conditions should only be treated with stress-mediating therapies, but rather supporting stress response through lifestyle encourages health status,” he clarified.

Dr. Schuler explained that there are two indications that are critical to identify to begin to improve physical and mental health—experiencing a high number of stressful events and self-reported high perceived stress over long periods of time.

One definition he likes (Cohen et al.), is “experiences in which the environmental demands of a situation outweigh the individual’s perceived psychological and physiological ability to cope with it effectively.”

In this construct, he explained, identifying stressors as compared to stress response is quite useful as two people may have diametrically opposed responses to the same stress. In practice, framing these two distinct concepts with patients can help uncover an experience of stress versus the physiological sequelae of such event(s) which may be cognitive, emotional, and/or biological reactions. Practices often rely on screening tools for anxiety and depression with the GAD-7 and PHQ-2/PHQ-9 respectively. However, additional indices such as the Stress and Adversity Inventory (STRAIN) may offer more advanced insight.

Salivary markers of cortisol or urinary specimens may be used for functional assessment of stress as well as compared to serum values which are often used for pathological states and may provide false negatives for functional states. These biochemical markers can be used to provide a snapshot of physiologic response to stressors and can be run in serial fashion to track degree of improvement. However, they fail to identify the cause of the stressor if it is not apparent to the patient or the practitioner.

In consultative assessment, Dr. Schuler advises to discuss the several types of stressors to identify the root-cause. Types of stressors to be assessed when performing a root-cause analysis include:

Acute stress: Short-term, event-based exposures to threatening or challenging stimuli that evoke a psychological and/or physiological stress response, such as giving a public speech.

Daily hassles/stressors: Interruptions or difficulties that happen frequently in daily life such as minor arguments, traffic or work overload, and that can build up overtime to create persistent frustration or overwhelm.

Life events: Time-limited and episodic events that involve significant adjustment to one’s current life pattern, such as getting fired, being in a car crash, or the death of a loved one. Some life events can be positive (e.g. getting married, moving to a new place), and some become chronic (e.g. disability caused by car crash). A common assessment of stress of life events is the Holmes and Rahe Stress Scale.

Traumatic life events: Traumatic life events are a subclass of life events in which one’s physical and/or psychological safety is threatened.

Chronic stress: Prolonged threatening or challenging circumstances that disrupt daily life and continue for an extended period of time (minimum of one month).

Dr. Schuler commented, “Practitioners are often biased toward one or two of these types of stressors and may inadvertently neglect the others. Given the ubiquitous nature of stressors and the variance of stress response amongst individuals, holistic evaluation of stress in the ambulatory care setting is of utmost importance.”

One common exhibition of stress that many misread is the allergy response. Excess cortisol, a great example of “too much of a good thing,” can masquerade itself in this manner.

Brian Keenan, ND, LAc, lead medical writer, Ayush Herbs Inc. of Washington, said there are two sides to the hormonal activation from stress. One is to limit the body’s ability to maintain a healthy immune defense against daily insults, such as allergens we’d encounter day to day, thus lowing our immune function.

Two, he explained, is the flipside, an overaction of the immune system, as cortisol also functions to dampen severity of the immune systems response to stressors, and when dysregulated, we can then also see overaction of the immune system, as in allergies, because the cortisol is failing to inhibit the inappropriate immune response.

Additionally, in times of stress, the body produces more histamine, giving rise to inflamed itching and sneezing, which can often be isolated as an allergic response but may need tools to reduce stress response.

Citing data from the American Psychological Association’s (APA) Stress in America 2019 report, Kim Plaza, registered nutritional therapist and technical advisor, ADM Protexin (Florida), asserted, “Although many Americans believe that a healthy level of stress may sit at around 3.8 out of 10 (where 1 is “little or no stress” and 10 is “a great deal of stress”), in 2019 the average stress level reported within a past month was 4.9/10.”

What a difference a year makes: the impact of COVID-19 has seen significant increases in psychological distress, with 78 percent of adults reporting that the pandemic is a significant source of stress (APA Stress in America 2020).

“Awareness of stress levels within an individual is an important consideration, with these statistics, it implies that the majority of clients making visits to see a practitioner, will be experiencing levels of significant stress,” Plaza said. “It could mean that any protocol that is put in place may be hampered, meaning fewer positive outcomes.”

She advised, “When clients present with signs and symptoms that would initially seem distant to signs of stress, consider some of the possible pathways that may result from an imbalanced stress response.”

For example, stress is a known marauder, rapaciously using up precious resources in the body. For example, magnesium and B vitamins are often quickly depleted during elevated stress response, and as such, this may then result in symptoms of tiredness, fatigue and ironically, further stress. “Chronic stress may also dysregulate adrenal hormones via an imbalance in the hypothalamic-pituitary-adrenal (HPA) axis, the consequences of this are far reaching, as stress hormone dysregulation may impact neurotransmitter regulation, resulting in altered mood states and potentially a factor in the development of mood disorders, such as depression,” she explained.

Where stress dysregulation occurs, Plaza elaborated, it may result in reduced levels of energy and motivation, due to an increased excretion of B vitamins and poor blood sugar balance. However, it may also impact energy levels via the interrupted production of serotonin. Stress has been shown to reduce circulating levels of serotonin, and as serotonin is the precursor to melatonin, your clients could be both somewhat depressed and listless, as well as experiencing choppy sleep. This, as in typical vicious circle patterns, leads to more stress and fatigue.

According to Plaza, “Evidence suggests that blood-brain barrier integrity or ‘tightness’ is modulated by the sleep/wake cycle, with sleep facilitating the clearance of toxins. It therefore may be logical to suggest that stress could affect concentration and cognitive abilities. However, explaining this pathway to clients may encourage greater motivation to manage stress levels.”

The HPA affects the human microbiota, and the stress response has impact here, Plaza explained. Stress may also significantly disrupt the gut microbiota and reduce the representation of lactobacillus and bifibacterium species. According to Plaza, this reduction alters the microbiome, such as changing the pH, short-chain fatty acid levels and bacteriocin production. Consequently, some opportunistic microbes may have a greater chance of establishing niches, this could therefore lead to digestive symptoms including, bloating, gas, diarrhea and constipation; additionally, permeability of the gut barrier lining could become compromised.

Product Recommendations

There are many products you can recommend but some of them are more about long-term support than the instant “I’m back in control” relief (e.g., kava kava).

Ayush Herbs’ Ayu-Dep features several key herbs, “each with solid research into how they support the body,” said Dr. Keenan. Several human trials support saffron’s use for mood stabilization as well as improving sleep quality, which we know is necessary for overall stress management. Ayu-Dep also contains ashwagandha, whose withanolides have been directly studied for direct stress relief with positive results. Bacopa monnieri has also been researched in humans to support stress relief, but also improves focus and attention which often falters during times of stress.

Ashwagandha Forte from MediHerb is a product that can be recommended for getting to the root of many issues caused by increased cortisol, said Morrow of Standard Process. Ashwagandha Forte contains a 400 mg extract of ashwagandha root containing 10 mg withanolides per tablet. “One randomized, double-blind, placebo-controlled study of adults with a history of chronic stress found that supplementing with an ashwagandha extract containing 30 mg/day of the active component (withanolides) for 60 days resulted in a decrease in the stress hormone cortisol and improvement in other parameters associated with stress,” she reported.

Another randomized, double-blind, placebo-controlled study of healthy adults supplemented with either 12.5 mg or 30 mg withanolides from ashwagandha root found statistically significant reductions in cortisol in both groups, and significant improvements in anxiety and sleep quality in the group taking 30 mg withanolides.

Another companion supplement that may be recommended is MediHerb’s E-Z Mg, “because stress challenges can frequently interrupt sleep patterns, and adequate sleep is necessary for managing stress, a vicious cycle can occur. E-Z Mg can help address some underlying deficiencies that play a role in these issues,” Morrow said.

According to Dr. Schuler, “long-term and recurrent stress is best supported with HPA Axis: Homeostasis, designed to be used for up to two months at a time as a jumpstart to a stress rehabilitation program.” HPA Axis: Homeostasis is a blend of herbs using what Dr. Schuler calls a “synchronous extraction;” these herbs include eleuthero, schisandra, Southern prickly ash, Asian ginseng, licorice, rhodiola, cordyceps and Rhaponticum carthamoides (maral root).

“Patients whose main stressors are daily hassles are best supported with HPA Axis: Daytime Maintenance,” Dr. Schuler added. This product also contains a higher dose of rhodiola but in combination with holy basil as a supercritical CO2 extract. In addition to these ingredients, HPA Axis: Daytime Maintenance contains a synchronous extraction blend of oats milky seed extract, holy basil leaf, schisandra berry and ashwagandha root. Bio-Kult Migréa from Protexin contains 14 probiotic strains with additional magnesium and vitamin B6, according to Plaza. Vitamin B6 was included because it is well known for its ability to reduce fatigue, which can often be associated with stress and burn out. She noted, “The strains within Bio-Kult Migréa were tested for their ability to produce neurotransmitters and many of them were found to produce GABA (gamma-aminobutyric acid), an amino acid known for supporting relaxation, stress-regulation and mood enhancement, where low levels have been associated with chronic and acute stress, as well as anxiety and sleep disorders.”

To paraphrase a common cheeky saying, “Stress happens:” Making stress-care a paramount part of your client’s/patient’s initial experience will go a long way to helping improve overall well-being, vitality and life quality.

Healthy Take Aways

• Elevated cortisol is a result of chronic stress that can activate proinflammatory processes.
• In times of stress, the body produces more histamine, giving rise to inflamed itching and sneezing, which can often be isolated as an allergic response but may need tools to reduce stress response.
• Stress may significantly disrupt the gut microbiota and reduce the representation of lactobacillus and bifibacterium species.

For More Information:

ADM Protexin, www.bio-kult.com
Ayush Herbs, www.ayushherbs.com
Gaia Herbs, www.gaiaherbs.com
Standard Process, www.standardprocess.com