The human body is quite amazing and is relatively skilled at managing acute physical and/ or psychological stressors. It becomes a problem however when this acute stress becomes more chronic in nature and can then lead to a variety of adverse effects.
Constant stress can increase our risk of suffering from a barrage of anxiety, and other pressure-related diseases (ranging from high blood pressure and dementia to various levels of depression). Chronic stress has the additional risk of increasing ones risk for some types of cancer. It is shocking to note that nearly 65% of doctor’s office visits are in some way related to stress.
It is unfortunate, that while chronic stress produces significant adverse health effects, conventional medicine often relies upon psychoactive drugs to mask stressed patients’ symptoms. The result is treating the symptoms instead of the cause. At the same time, stress management strategies that are usually used often fail to address biochemical abnormalities and imbalances, such as unbalanced adrenal hormone levels, that contribute to the detrimental health effects caused by chronic stress.
At the core of chronic stress is deregulation of the hypothalamic-pituitary-adrenal (HPA) axis. This HPA axis is an interconnected network of physiologic command terminals that governs the production of stress hormones like cortisol and catecholamines, such as adrenaline and noradrenalin. Chronic stress eventually leads to desynchronization of the HPA axis and subsequent imbalances in stress hormone levels, a critical feature of stress-related illness.
It is important to take note of the dangers of chronic stress, understand how it contributes to various diseases, and know how you can optimize your stress response. It is easily done by combining healthy lifestyle habits, with scientifically studied natural therapies.
When an individual experiences a stressor, which can be either physical or emotional, internal or environmental, the body initiates a complex system of adaptive reactions to help cope with the stress. This reactive response results in the release of glucocorticoids, also known as stress hormones, and catecholamines, which stimulate adaptive changes in a variety of bodily systems. This includes the well-knows term “Fight or Flight” response.
The “Fight or Flight” Response
Under short-term circumstances, the brain is the originator of the reactive and adaptive protection system. Stress-induced changes will prioritize various functions in the body to assist in escaping danger. This can include some, or all, of the following:
When the body perceives there to be a stressor, specialized neurons in the paraventricular nucleus of the hypothalamus (a major endocrine-regulating brain region) responds by releasing corticotrophin releasing hormone (CRH) and vasopressin (VP). These hormones will then stimulate the release of adrenocorticotropic hormone (ACTH) from the pituitary gland.
After entering circulation and reaching the adrenal glands, ACTH stimulates the production of glucocorticoids and catecholamines, which act throughout the body to induce the adaptive changes (i.e. increased blood flow, dilated pupils etc.). Together, this brain-endocrine coordination covers the hypothalamic-pituitary-adrenal (HPA) axis.
The fight-or-flight response is undoubtedly very necessary to initiate an autonomous response to impending danger in an acute situation, but when it is active, even at a low-level, for a long period of time it can have devastating health consequences.
Modern humans live in an environment that is filled with emotional stressors, including financial worries, and deadline pressures at work or school. All of these worries continuously activate the HPA axis in an evolutionarily unnatural way. This unhealthy state leads to elevated stress hormone levels, and accompanying physiologic changes throughout the day.
There are a few components of the fight-or-flight response which are especially damaging to health when the stress response is active over a prolonged time-frame. This can lead to insulin resistance, and high blood pressure in individuals that don’t manage their stress levels.
These negative effects, along with several other stress-related physiologic irregularities, can lead to a compromised health state. Once one’s health is compromised you are predisposed to an onslaught of age-related diseases.
Over time, chronic elevations in glucocorticoid levels damage and destroy neurons in the region of the hypothalamus responsible for regulating CRH release. This gives rise to erratic or insufficient HPA axis activation and may lead to mood disorders, such as depression and anxiety . Fatigue is also commonly observed in individuals who have been under great stress for a long time.
Cortisol is, in many ways, a paradoxical hormone. A certain amount of cortisol is necessary for optimal health, but too much or too little can be unhealthy, thus maintaining the right levels are crucial. As mentioned earlier, when the body experiences acute episodes of stress, more cortisol is released to help the body cope with physical or psychological stressors. Its primary functions in the body are:
In a healthy individual, cortisol levels peak in the early morning hours (usually around 8AM) and dip to their lowest between midnight and 4AM. The process of cortisol biosynthesis and release is very complex and highly sensitive to disruption by both internal and external factors. In the face of chronic psychological stress, for example, the adrenal glands excrete an abnormal amount of cortisol in an abnormal rhythm.
Cortisol, being a catabolic hormone (meaning it breaks down tissues), when out of balance and unregulated, can have detrimental effects on the body’s composition. Moreover, too much cortisol can suppress the immune system, while too little can lead to autoimmunity and rheumatologic disorders.
Cortisol receptors are situated throughout the body, including in the brain. Therefore, derangement of the biosynthesis, metabolism and release of cortisol can disrupt many physiologic systems.
Addison’s disease, sometimes referred to as “adrenal insufficiency” is a medical condition that can be life threatening. Addison’s disease is typically the result of an autoimmune disorder, but can arise due to specific genetic abnormalities too. Consequences of Addison’s disease are much more severe and acute than those induced by stress and the condition should be closely monitored by a qualified healthcare professional.
Adrenal fatigue is an alternative medicine term that often finds its way into discussions when talking about stress. Although “adrenal fatigue” is not a recognized diagnosis in conventional medicine at Health Renewal we believe that symptoms often attributed to “adrenal fatigue” arise from multifactorial pathological processes involving, among other systems, the HPA axis, and that these conditions must be treated as such.
Everyone has an inborn ability to handle stress. But it is important to note that tolerance levels will vary from person to person. Some people can handle only low levels and short durations of stress, while others adapt and can accommodate higher levels stress for more prolonged periods. The term stress was defined by Dr. Hans Selye, in 1935, who stated this to be a factor that induced behavioral changes in mammals. He then furthered this notion to include higher level organisms (humans) as being effected by stress in a harmful way.
According to Dr. Selye, there are three states the body faces when dealing with stress. The first being the alarm state early on in the process, followed by the resistance state where the body attempts to adapt to the added stress (release of cortisol), and finally, after stress overwhelms and weakens the system, the exhaustion state.
These three “states” can be detailed as physiologic mechanisms:
1) Alarm state: This is when the body adapts to acute stress; and experiences the “fight-or-flight” response;
2) Resistance state: The body starts to experience consequences of prolonged stress response activation (such as insulin resistance), and
3) Exhaustion state: This is the final state when the body experiences a decline in responsiveness and sensitivity of primary relays of the HPA axis. (This includes hypothalamic deterioration, dysfunction leading to erratic or insufficient stress hormone, and catecholamine production and subsequent mood disorders and fatigue).
The same imbalances in the HPA axis and stress response mechanisms that contribute to these signs and symptoms also contribute to more serious stress-related illness. Therefore, it is imperative that one recognizes that you are experiencing some or all of the following symptoms and then take the initial steps towards achieving better overall health and mitigating your risk for various diseases.
Impaired Stress Response: A major cause of anxiety and depression
It is often found that individuals that suffer from chronic stress will experience mood disorders, particularly anxiety and depression. Depression and anxiety can both be viewed as manifestations of an impaired stress response since the underlying physiology of both is similar. In fact, the chronic elevation in glucocorticoids caused by chronic stressors in modern society can lead to physical changes in brain structure.
As an example, dendrites which are the branches of neurons that receive signals from other neurons, are shifted into less functional patterns when constantly exposed to glucocorticoids. This pattern shifting has been documented in key brain regions associated with mood, short-term memory, and behavioural flexibility. Furthermore, glucocorticoids cause receptors for the mood-regulating neurotransmitter serotonin to become less sensitive to activation. Other detrimental effects of chronic stress include the increased susceptibility to neuronal damage and impaired neurogenesis, which is the process by which new neurons are “born”.
Interestingly, emerging research suggests that certain psychoactive drugs, like those used to treat anxiety and depression, may stabilize mood. This is done not only by the drugs acting upon neurotransmitter levels, but by modulating the action of glucocorticoids receptors within the brain. These new findings suggest that in order to alleviate mood disorders, controlling stress response is an important aspect of treatment. There are several genetic and epidemiological studies which have linked excessive stress, and the inability to efficiently adapt to stress, to increased rates of anxiety and depression.
A great deal of insight into the function of the adrenal glands can be gained through testing blood levels of DHEA and cortisol.
DHEA Hormonal Therapy:
DHEA, which is also an adrenal hormone, has the ability to counter-act the action of cortisol in many tissues. The balance between cortisol and DHEA is generally maintained during youth, however as we age, DHEA levels decline rapidly. The persistent action of cortisol in the presence of declining DHEA levels can contribute to stress-related diseases.
Furthermore, DHEA replacement therapy can restore balance between cortisol and DHEA.
A great deal of insight into the function of the adrenal glands can be gained through testing blood levels of DHEA and cortisol.
Deviations from the natural rhythm of adrenal function can be detected by an AM / PM cortisol test, in which levels of the adrenal hormone are tested early in the morning and early in the evening of the same day. A DHEA sulphate (DHEA-s) blood test can determine if DHEA levels are sufficient, or if supplementation is needed.
Supplemental doses of DHEA typically range from 10 – 25 mg daily for women and 25 – 75 mg daily for men, but should always be determined based upon DHEA-s blood tests. Please do not self-medicate! Make an appointment with one of our Health Renewal doctors, who will assess your situation and recommend a tailor-made treatment plan.
1. Melatonin hormonal therapy:
The hormone melatonin is known for its involvement with the sleep cycle. This hormone is released from the small pineal gland which is situated at the base of the brain. Melatonin has an antagonistic effect on cortisol, and the daily rise in melatonin levels at night correlates with a drop in cortisol. Low levels of melatonin can mean inappropriate and undesirable glucocorticoid signalling during the night when it should be at the lowest.
Chronic, late-night stress, whether physical or psychological, can result in an inappropriately elevated night time cortisol level; shift-work and working at night is an example of such a stressor. This chronic disruption and inappropriate release of cortisol at night may impair the normal day-to-day corticosteroid output in the morning. Melatonin is also a hormone with great penetration into the nucleus of the cells and is one of the most important antioxidant hormones. Melatonin protects cellular (mitochondrial and nuclear) DNA from oxidative and free-radical damage. Melatonin has been found to affect the levels of cortisol and the balance between DHEA and cortisol in circulation. Doses differ in individuals but can start as low as 0.3 mg; where some may require up to 10 mg daily.
2. Maintaining Sex Hormone Balance:
Imbalances in the sex hormones (testosterone for men, and oestrogen and progesterone for women) may exacerbate the detrimental effects of chronic stress. Some experimental data indicates that having low levels of sex hormones impairs the response to cortisol in the brain. Over time, this may lead to an over-compensatory increase in stress hormone production by the adrenal glands, which could become damaging to the rest of the body.
Likewise, human trials have confirmed that steroid hormones exert considerable influence over the stress response. In a small trial of women who were overcoming cocaine addiction, higher progesterone levels were associated with a blunted stress response to a drug cue. In another clinical trial, menopausal women who were treated long-term with hormone replacement therapy (HRT) coped with stress better than non-HRT users in an experimental setting.
The biological actions of the sex hormone progesterone within the brain are calming, and as a result, ageing woman who has a decline in progesterone levels may be predisposed to anxiety. Specifically, some metabolites of progesterone have been shown to function as ligands at the GABA-α receptor subunit, which is inhibitory upon activation.
Stressed men and women should review Health Andropause/ Renewal’s Male Hormone Restoration, and Menopause/ Female Hormone Restoration protocols.
See Menopause webpage
See Andropause webpage
Nutritional Therapies include the following
B-Complex vitamins
Several members of the B-vitamin family impact varying aspects of stress response physiology. For example, pantothenic acid is necessary for the synthesis of coenzyme A (CoA), which is integral in the production of cholesterol, and in steroid hormone biosynthesis. Pantothenic deficiency is rather rare, but ir left untreated it can result in adrenal insufficiency.
Another correlation between B-vitamins was revealed in a clinical trial that found that injecting either ACTH (adrenocorticotropic hormone) or cortisol into healthy subjects for just four days significantly decreased levels of folic acid and B12. These findings suggest that not only are B-vitamins important to promote healthy stress response, but stress itself may lower B-vitamin blood levels. Therefore, B-vitamin supplementation may ameliorate the effects of stress from multiple angles.
Vitamin C (Ascorbic Acid)
Another crucial vitamin in adrenal function and maintenance of healthy levels of cortisol and DHEA is vitamin C. Deficiencies of this vitamin can have profound effects on adrenal function. The benefits of vitamin C are multiple, acting as an anti-inflammatory and co-factor in soft tissue synthesis and repair. In addition, ultra-marathon runners who were given 1,500 mg vitamin C after a race displayed less dramatic elevations in cortisol and epinephrine levels than is typical after such extreme physical stress. Moreover, this same study found that vitamin C was able to suppress inflammation in the runners too.
Minerals
Calcium, magnesium, sodium and potassium are all macro elements. Being a macro element means that they are found in our bodies in greater quantities than other elements, or minerals. These four macro elements are important in supporting and maintaining balanced adrenal function and furthermore are also important in the formation and release of adrenal hormones. Manganese, zinc, chromium, and selenium are some of the trace elements that have an impact on the function of the adrenal glands. Research shows that deficiencies in these trace elements can have a negative effect on adrenal function.
L-Theanine
L-theanine is an amino acid found exclusively in green tea that has traditionally been used to enhance relaxation and improve concentration and learning ability. L-theanine is chemically related to the neurotransmitter glutamate, and binds to glutamate receptors in the brain. Unlike glutamate, however, which can cause a state called excitotoxicity that can destroy nerve cells, L-theanine protects brain cells against excitotoxicity, calming the nerve networks in the brain.
Omega 3-Fatty Acids (Fish Oil)
Research indicates that intake of fish oil or omega 3-fatty acids (n-3 EFA or EFA) can act in an adaptogenic fashion to help ameliorate the effects of Omega-3 fatty acids balance the effects of omega-6 metabolism. Fatty acid balance is also critical for glucorcorticoid hormone receptor function. In recent years omega-3 fatty acids have been documented to be successful in treating those suffering from depression and anxiety disorders, which themselves can be a consequence or an inducer of stress.
Phosphatidylserine (PS)
The phospholipid phosphatidylserine (PS) is found in cell membranes and is a critical component for healthy cellular communication. Several studies have shown that a diet rich in PS is able to balance the HPA axis and limit the negative consequences of over-activation of the adrenal cortex. Phosphatidylserine also helps attenuate the increase in cortisol levels during periods of intense, acute stress.
Licorice (Glycyrrhiza glabra and G. uralensis)
A mainstay in Traditional Chinese Medicine (TCM), liquorice extracts may be of benefit for those who have reached the exhaustion stage and are no longer producing sufficient cortisol. Liquorice has the ability to decrease the breakdown or metabolism of hydrocortisone by the liver, thus increasing the amount of cortisol in circulation and reducing the strain on the adrenal glands to produce it. The combination of low doses of liquorice with supplemental DHEA may help balance the HPA axis.
Sedative Herbs
Sedative herbs such as hops, passionflower, poppy, and valerian can provide calming effects to reduce stress. The herbal lemon balm has been shown in a number of studies to reduce stress. This is yet another herbal that has shown benefit in reducing negative effects of stress on the body.
In a recent small clinical trial including 20 stressed volunteers, a standardised lemon balm extract (Cyracos®) was shown to significantly combat anxiety symptoms and insomnia. The extract “reduced anxiety manifestations by 18%, ameliorated anxiety-associated symptoms by 15% and lowered insomnia by 42%.”
Adaptogenic Herbs
A class of herbs known as adaptogens are helpful in regulation of the HPA axis. Dr Nikolai Lazarev, a noted Russian pharmacologist during the cold war era, coined the term “adaptogenic herb” to describe 25 of the hundreds of medicinal herbs having particular properties. These properties are unique to this class of herbs making them important for human health, and a very valuable supplement.
To be classified as an adaptogen, herbs must have the following three properties:
Rhodiola
The adaptogenic herb Rhodiola (Rhodiola Rosea) has demonstrated in a number of studies to improve both physical endurance and cognitive performance when the correct supplemented dosage it was taken. Its ability to reduce fatigue associated with stress is documented in well-designed research papers. The apparent mechanism of action of Rhodiola is related to its ability in assisting neurotransmitter transport in the brain and the blunting of catecholamine release.
A large, phase III placebo-controlled clinical trial was conducted in Sweden in 2009, studying participants aged 20-55 years with a diagnosis of stress-related fatigue. Subjects taking the Rhodiola extract had significantly lower cortisol responses to chronic stress than did the placebo recipients—and as a result, they had lower scores on scales of burnout and improved performance on cognitive testing.
Ashwagandha
Ashwagandha, also known as Withania somnifera, is an important Ayurvedic medicinal herb. It has many uses in traditional Indian medicine such as treatments for stress, fatigue, pain, diabetes, gastrointestinal and rheumatologic disorders. Ashwagandha has shown promising effects in neuroprotection as scientists have discovered that this adaptogenic herb prevents damage to neurons and improves neurological function in the face of stress. Additionally, data suggests that Ashwagandha may reduce the harmful effects of stress on male reproductive capacity.
Ginseng
This herb is probably the most recognised of the adaptogen herbs in the West ( also known as Panax ginseng). There are eleven species of this medicinal herb, Pamax ginseng being among the most widely studied American Ginseng. Panax quinquefolius is another species within the Panax genus that shares medicinal properties. While Siberian ginseng (Eleutherococcus senticosus), is technically not a true ginseng botanical, it still has similar beneficial properties and is closely related to the Panax family of plants.
A wealth of studies exists that show stress reducing properties of true ginseng and the other ginseng related herbals. For example, the isolated polysaccharides from P. ginseng have demonstrated anti-fatigue properties in one recent study. American ginseng extract shows a reduction in oxidative endothelial damage due to diabetes. Anti-depressive effects and the positive modulation that benefits the HPA axis is outlined in a research paper on protective ginsenosides in Panax and other ginseng plants showing usefulness in the management of chronic stress.
Holy basil (Occiumum tenuiflorum)
If a person has adrenal gland disorder it is common for them to show signs of increased cortisol and blood glucose levels. Increased blood glucose is also seen in people receiving chronic glucocorticoid treatment. Ocimum sanctum, or holy basil, is a herb widely grown in India that is known for its ability to control blood sugar. Clinical trials in humans have also shown the benefits of holy basil extract for improving immune function, as well as decreasing stress and depression associated with anxiety. Studies in healthy human subjects showed that treatment with 300 mg of holy basil extract for 4 weeks increased antibody levels and cells in the immune system.
Bacopa
The herb Bacopa monnieri is used in the classical Indian medicinal system of Ayurveda as a tonic for the nervous system and is known to promote mental health. It has also been shown to possess anti-anxiety properties.
Pycnogenol
At the time of this writing, a clinical trial is currently underway in Australia to test the effects of Bacopa and another herb, pycnogenol, in reducing cognitive decline with ageing. The trial will evaluate the effects of Bacopa supplementation for up to a year on mood, cognition, blood pressure, inflammation, and oxidative stress, among other tests.
Cordyceps
Oxidative stress damages cells and is associated with various health disorders. Cordyceps Sinensis is a type of mushroom used in Chinese medicine that has been found to boost the immune system and possesses anti-tumor and antioxidant properties.
Hormonal Therapies
1. DHEA (depending on blood test results),
2. Melatonin, and
3. Bio-Identical Hormone Replacement Therapy (BIHRT): Refer to andropause / Male Hormone Restoration protocol, or Menopause / Female Hormone Restoration protocol
For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. It cannot be over emphasized that one must not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified and practising integrative medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure, high sugar level, high stress levels (that can lead to adrenal burnout ) and high blood clotting factors that could lead to heart attacks and stroke. In addition, there is no single supplement prescribed to clients as there is no magic bullet that can support all the essential nutrients that one's body needs. Today's food is not functional and we need to supplement in order to maintain optimal bodily functions and nutrition.
Make an appointment to consult with your Health Renewal Doctor who is an integrative doctor and he/ she will assist you in determining your risk factors and how best to prevent any problems or conditions that you may be susceptible to.
The initial medical consultation at Health Renewal will be approximately 45 minutes. As this is a prolonged medical consultation, the initial consultation fee will be R 975 which can be claimed back from your medical aid.
On arrival, you will have to complete an in-depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation, your Health Renewal doctor will obtain a FULL medical history from you to determine your personal risk. A physical examination will be done after which he/she will decide which blood tests need to be requested from your local pathology laboratory. If you have a medical aid, these should be able to be claimed as well.
These results will then be analysed by your Doctor and this will be discussed with you at your follow-up appointment usually 2 weeks later. This will determine what abnormalities/ deficiencies exist and you will be advised on your treatment options. These options may range from prescription medications, nutraceuticals, bio-identical hormonal creams/tablets or alternatively to having bio-identical implants/pellets inserted. In office treatments such as carboxytherapy may also be recommended for certain conditions such as hair loss, erectile dysfunction, menopause or PMS. If you need to lose weight our Renewal Institute Diet may be recommended.
All these recommendations will be summarised on a sheet/print out which you can take home with you. The nutraceuticals offered at Health Renewal are of superior quality (Solgar) and are not rancid nor contain Hg or PCB'S (This is very important for Omega 3EFA) and are free of gluten, preservatives, Wheat, Dairy, Soy, Yeast, Sugar, Artificial Flavor, Sweetener and Color. We have a great professional team made up of doctors, trained and registered nurses and therapists to support you at any time. An added bonus is that any nutraceuticals purchased will go towards loyalty points at any Skin, Body and Health Renewal branches.
The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments, nutritional supplements and a healthy diet and lifestyle.
Maintaining balance in today’s stressful world requires a multimodal approach that encompasses various factors:
The human body is quite amazing and is relatively skilled at managing acute physical and/ or psychological stressors. It becomes a problem however when this acute stress becomes more chronic in nature and can then lead to a variety of adverse effects.
Constant stress can increase our risk of suffering from a barrage of anxiety, and other pressure-related diseases (ranging from high blood pressure and dementia to various levels of depression). Chronic stress has the additional risk of increasing ones risk for some types of cancer. It is shocking to note that nearly 65% of doctor’s office visits are in some way related to stress.
It is unfortunate, that while chronic stress produces significant adverse health effects, conventional medicine often relies upon psychoactive drugs to mask stressed patients’ symptoms. The result is treating the symptoms instead of the cause. At the same time, stress management strategies that are usually used often fail to address biochemical abnormalities and imbalances, such as unbalanced adrenal hormone levels, that contribute to the detrimental health effects caused by chronic stress.
At the core of chronic stress is deregulation of the hypothalamic-pituitary-adrenal (HPA) axis. This HPA axis is an interconnected network of physiologic command terminals that governs the production of stress hormones like cortisol and catecholamines, such as adrenaline and noradrenalin. Chronic stress eventually leads to desynchronization of the HPA axis and subsequent imbalances in stress hormone levels, a critical feature of stress-related illness.
It is important to take note of the dangers of chronic stress, understand how it contributes to various diseases, and know how you can optimize your stress response. It is easily done by combining healthy lifestyle habits, with scientifically studied natural therapies.
When an individual experiences a stressor, which can be either physical or emotional, internal or environmental, the body initiates a complex system of adaptive reactions to help cope with the stress. This reactive response results in the release of glucocorticoids, also known as stress hormones, and catecholamines, which stimulate adaptive changes in a variety of bodily systems. This includes the well-knows term “Fight or Flight” response.
The “Fight or Flight” Response
Under short-term circumstances, the brain is the originator of the reactive and adaptive protection system. Stress-induced changes will prioritize various functions in the body to assist in escaping danger. This can include some, or all, of the following:
When the body perceives there to be a stressor, specialized neurons in the paraventricular nucleus of the hypothalamus (a major endocrine-regulating brain region) responds by releasing corticotrophin releasing hormone (CRH) and vasopressin (VP). These hormones will then stimulate the release of adrenocorticotropic hormone (ACTH) from the pituitary gland.
After entering circulation and reaching the adrenal glands, ACTH stimulates the production of glucocorticoids and catecholamines, which act throughout the body to induce the adaptive changes (i.e. increased blood flow, dilated pupils etc.). Together, this brain-endocrine coordination covers the hypothalamic-pituitary-adrenal (HPA) axis.
The fight-or-flight response is undoubtedly very necessary to initiate an autonomous response to impending danger in an acute situation, but when it is active, even at a low-level, for a long period of time it can have devastating health consequences.
Modern humans live in an environment that is filled with emotional stressors, including financial worries, and deadline pressures at work or school. All of these worries continuously activate the HPA axis in an evolutionarily unnatural way. This unhealthy state leads to elevated stress hormone levels, and accompanying physiologic changes throughout the day.
There are a few components of the fight-or-flight response which are especially damaging to health when the stress response is active over a prolonged time-frame. This can lead to insulin resistance, and high blood pressure in individuals that don’t manage their stress levels.
These negative effects, along with several other stress-related physiologic irregularities, can lead to a compromised health state. Once one’s health is compromised you are predisposed to an onslaught of age-related diseases.
Over time, chronic elevations in glucocorticoid levels damage and destroy neurons in the region of the hypothalamus responsible for regulating CRH release. This gives rise to erratic or insufficient HPA axis activation and may lead to mood disorders, such as depression and anxiety . Fatigue is also commonly observed in individuals who have been under great stress for a long time.
Cortisol is, in many ways, a paradoxical hormone. A certain amount of cortisol is necessary for optimal health, but too much or too little can be unhealthy, thus maintaining the right levels are crucial. As mentioned earlier, when the body experiences acute episodes of stress, more cortisol is released to help the body cope with physical or psychological stressors. Its primary functions in the body are:
In a healthy individual, cortisol levels peak in the early morning hours (usually around 8AM) and dip to their lowest between midnight and 4AM. The process of cortisol biosynthesis and release is very complex and highly sensitive to disruption by both internal and external factors. In the face of chronic psychological stress, for example, the adrenal glands excrete an abnormal amount of cortisol in an abnormal rhythm.
Cortisol, being a catabolic hormone (meaning it breaks down tissues), when out of balance and unregulated, can have detrimental effects on the body’s composition. Moreover, too much cortisol can suppress the immune system, while too little can lead to autoimmunity and rheumatologic disorders.
Cortisol receptors are situated throughout the body, including in the brain. Therefore, derangement of the biosynthesis, metabolism and release of cortisol can disrupt many physiologic systems.
Addison’s disease, sometimes referred to as “adrenal insufficiency” is a medical condition that can be life threatening. Addison’s disease is typically the result of an autoimmune disorder, but can arise due to specific genetic abnormalities too. Consequences of Addison’s disease are much more severe and acute than those induced by stress and the condition should be closely monitored by a qualified healthcare professional.
Adrenal fatigue is an alternative medicine term that often finds its way into discussions when talking about stress. Although “adrenal fatigue” is not a recognized diagnosis in conventional medicine at Health Renewal we believe that symptoms often attributed to “adrenal fatigue” arise from multifactorial pathological processes involving, among other systems, the HPA axis, and that these conditions must be treated as such.
Everyone has an inborn ability to handle stress. But it is important to note that tolerance levels will vary from person to person. Some people can handle only low levels and short durations of stress, while others adapt and can accommodate higher levels stress for more prolonged periods. The term stress was defined by Dr. Hans Selye, in 1935, who stated this to be a factor that induced behavioral changes in mammals. He then furthered this notion to include higher level organisms (humans) as being effected by stress in a harmful way.
According to Dr. Selye, there are three states the body faces when dealing with stress. The first being the alarm state early on in the process, followed by the resistance state where the body attempts to adapt to the added stress (release of cortisol), and finally, after stress overwhelms and weakens the system, the exhaustion state.
These three “states” can be detailed as physiologic mechanisms:
1) Alarm state: This is when the body adapts to acute stress; and experiences the “fight-or-flight” response;
2) Resistance state: The body starts to experience consequences of prolonged stress response activation (such as insulin resistance), and
3) Exhaustion state: This is the final state when the body experiences a decline in responsiveness and sensitivity of primary relays of the HPA axis. (This includes hypothalamic deterioration, dysfunction leading to erratic or insufficient stress hormone, and catecholamine production and subsequent mood disorders and fatigue).
The same imbalances in the HPA axis and stress response mechanisms that contribute to these signs and symptoms also contribute to more serious stress-related illness. Therefore, it is imperative that one recognizes that you are experiencing some or all of the following symptoms and then take the initial steps towards achieving better overall health and mitigating your risk for various diseases.
Impaired Stress Response: A major cause of anxiety and depression
It is often found that individuals that suffer from chronic stress will experience mood disorders, particularly anxiety and depression. Depression and anxiety can both be viewed as manifestations of an impaired stress response since the underlying physiology of both is similar. In fact, the chronic elevation in glucocorticoids caused by chronic stressors in modern society can lead to physical changes in brain structure.
As an example, dendrites which are the branches of neurons that receive signals from other neurons, are shifted into less functional patterns when constantly exposed to glucocorticoids. This pattern shifting has been documented in key brain regions associated with mood, short-term memory, and behavioural flexibility. Furthermore, glucocorticoids cause receptors for the mood-regulating neurotransmitter serotonin to become less sensitive to activation. Other detrimental effects of chronic stress include the increased susceptibility to neuronal damage and impaired neurogenesis, which is the process by which new neurons are “born”.
Interestingly, emerging research suggests that certain psychoactive drugs, like those used to treat anxiety and depression, may stabilize mood. This is done not only by the drugs acting upon neurotransmitter levels, but by modulating the action of glucocorticoids receptors within the brain. These new findings suggest that in order to alleviate mood disorders, controlling stress response is an important aspect of treatment. There are several genetic and epidemiological studies which have linked excessive stress, and the inability to efficiently adapt to stress, to increased rates of anxiety and depression.
A great deal of insight into the function of the adrenal glands can be gained through testing blood levels of DHEA and cortisol.
DHEA Hormonal Therapy:
DHEA, which is also an adrenal hormone, has the ability to counter-act the action of cortisol in many tissues. The balance between cortisol and DHEA is generally maintained during youth, however as we age, DHEA levels decline rapidly. The persistent action of cortisol in the presence of declining DHEA levels can contribute to stress-related diseases.
Furthermore, DHEA replacement therapy can restore balance between cortisol and DHEA.
A great deal of insight into the function of the adrenal glands can be gained through testing blood levels of DHEA and cortisol.
Deviations from the natural rhythm of adrenal function can be detected by an AM / PM cortisol test, in which levels of the adrenal hormone are tested early in the morning and early in the evening of the same day. A DHEA sulphate (DHEA-s) blood test can determine if DHEA levels are sufficient, or if supplementation is needed.
Supplemental doses of DHEA typically range from 10 – 25 mg daily for women and 25 – 75 mg daily for men, but should always be determined based upon DHEA-s blood tests. Please do not self-medicate! Make an appointment with one of our Health Renewal doctors, who will assess your situation and recommend a tailor-made treatment plan.
1. Melatonin hormonal therapy:
The hormone melatonin is known for its involvement with the sleep cycle. This hormone is released from the small pineal gland which is situated at the base of the brain. Melatonin has an antagonistic effect on cortisol, and the daily rise in melatonin levels at night correlates with a drop in cortisol. Low levels of melatonin can mean inappropriate and undesirable glucocorticoid signalling during the night when it should be at the lowest.
Chronic, late-night stress, whether physical or psychological, can result in an inappropriately elevated night time cortisol level; shift-work and working at night is an example of such a stressor. This chronic disruption and inappropriate release of cortisol at night may impair the normal day-to-day corticosteroid output in the morning. Melatonin is also a hormone with great penetration into the nucleus of the cells and is one of the most important antioxidant hormones. Melatonin protects cellular (mitochondrial and nuclear) DNA from oxidative and free-radical damage. Melatonin has been found to affect the levels of cortisol and the balance between DHEA and cortisol in circulation. Doses differ in individuals but can start as low as 0.3 mg; where some may require up to 10 mg daily.
2. Maintaining Sex Hormone Balance:
Imbalances in the sex hormones (testosterone for men, and oestrogen and progesterone for women) may exacerbate the detrimental effects of chronic stress. Some experimental data indicates that having low levels of sex hormones impairs the response to cortisol in the brain. Over time, this may lead to an over-compensatory increase in stress hormone production by the adrenal glands, which could become damaging to the rest of the body.
Likewise, human trials have confirmed that steroid hormones exert considerable influence over the stress response. In a small trial of women who were overcoming cocaine addiction, higher progesterone levels were associated with a blunted stress response to a drug cue. In another clinical trial, menopausal women who were treated long-term with hormone replacement therapy (HRT) coped with stress better than non-HRT users in an experimental setting.
The biological actions of the sex hormone progesterone within the brain are calming, and as a result, ageing woman who has a decline in progesterone levels may be predisposed to anxiety. Specifically, some metabolites of progesterone have been shown to function as ligands at the GABA-α receptor subunit, which is inhibitory upon activation.
Stressed men and women should review Health Andropause/ Renewal’s Male Hormone Restoration, and Menopause/ Female Hormone Restoration protocols.
See Menopause webpage
See Andropause webpage
Nutritional Therapies include the following
B-Complex vitamins
Several members of the B-vitamin family impact varying aspects of stress response physiology. For example, pantothenic acid is necessary for the synthesis of coenzyme A (CoA), which is integral in the production of cholesterol, and in steroid hormone biosynthesis. Pantothenic deficiency is rather rare, but ir left untreated it can result in adrenal insufficiency.
Another correlation between B-vitamins was revealed in a clinical trial that found that injecting either ACTH (adrenocorticotropic hormone) or cortisol into healthy subjects for just four days significantly decreased levels of folic acid and B12. These findings suggest that not only are B-vitamins important to promote healthy stress response, but stress itself may lower B-vitamin blood levels. Therefore, B-vitamin supplementation may ameliorate the effects of stress from multiple angles.
Vitamin C (Ascorbic Acid)
Another crucial vitamin in adrenal function and maintenance of healthy levels of cortisol and DHEA is vitamin C. Deficiencies of this vitamin can have profound effects on adrenal function. The benefits of vitamin C are multiple, acting as an anti-inflammatory and co-factor in soft tissue synthesis and repair. In addition, ultra-marathon runners who were given 1,500 mg vitamin C after a race displayed less dramatic elevations in cortisol and epinephrine levels than is typical after such extreme physical stress. Moreover, this same study found that vitamin C was able to suppress inflammation in the runners too.
Minerals
Calcium, magnesium, sodium and potassium are all macro elements. Being a macro element means that they are found in our bodies in greater quantities than other elements, or minerals. These four macro elements are important in supporting and maintaining balanced adrenal function and furthermore are also important in the formation and release of adrenal hormones. Manganese, zinc, chromium, and selenium are some of the trace elements that have an impact on the function of the adrenal glands. Research shows that deficiencies in these trace elements can have a negative effect on adrenal function.
L-Theanine
L-theanine is an amino acid found exclusively in green tea that has traditionally been used to enhance relaxation and improve concentration and learning ability. L-theanine is chemically related to the neurotransmitter glutamate, and binds to glutamate receptors in the brain. Unlike glutamate, however, which can cause a state called excitotoxicity that can destroy nerve cells, L-theanine protects brain cells against excitotoxicity, calming the nerve networks in the brain.
Omega 3-Fatty Acids (Fish Oil)
Research indicates that intake of fish oil or omega 3-fatty acids (n-3 EFA or EFA) can act in an adaptogenic fashion to help ameliorate the effects of Omega-3 fatty acids balance the effects of omega-6 metabolism. Fatty acid balance is also critical for glucorcorticoid hormone receptor function. In recent years omega-3 fatty acids have been documented to be successful in treating those suffering from depression and anxiety disorders, which themselves can be a consequence or an inducer of stress.
Phosphatidylserine (PS)
The phospholipid phosphatidylserine (PS) is found in cell membranes and is a critical component for healthy cellular communication. Several studies have shown that a diet rich in PS is able to balance the HPA axis and limit the negative consequences of over-activation of the adrenal cortex. Phosphatidylserine also helps attenuate the increase in cortisol levels during periods of intense, acute stress.
Licorice (Glycyrrhiza glabra and G. uralensis)
A mainstay in Traditional Chinese Medicine (TCM), liquorice extracts may be of benefit for those who have reached the exhaustion stage and are no longer producing sufficient cortisol. Liquorice has the ability to decrease the breakdown or metabolism of hydrocortisone by the liver, thus increasing the amount of cortisol in circulation and reducing the strain on the adrenal glands to produce it. The combination of low doses of liquorice with supplemental DHEA may help balance the HPA axis.
Sedative Herbs
Sedative herbs such as hops, passionflower, poppy, and valerian can provide calming effects to reduce stress. The herbal lemon balm has been shown in a number of studies to reduce stress. This is yet another herbal that has shown benefit in reducing negative effects of stress on the body.
In a recent small clinical trial including 20 stressed volunteers, a standardised lemon balm extract (Cyracos®) was shown to significantly combat anxiety symptoms and insomnia. The extract “reduced anxiety manifestations by 18%, ameliorated anxiety-associated symptoms by 15% and lowered insomnia by 42%.”
Adaptogenic Herbs
A class of herbs known as adaptogens are helpful in regulation of the HPA axis. Dr Nikolai Lazarev, a noted Russian pharmacologist during the cold war era, coined the term “adaptogenic herb” to describe 25 of the hundreds of medicinal herbs having particular properties. These properties are unique to this class of herbs making them important for human health, and a very valuable supplement.
To be classified as an adaptogen, herbs must have the following three properties:
Rhodiola
The adaptogenic herb Rhodiola (Rhodiola Rosea) has demonstrated in a number of studies to improve both physical endurance and cognitive performance when the correct supplemented dosage it was taken. Its ability to reduce fatigue associated with stress is documented in well-designed research papers. The apparent mechanism of action of Rhodiola is related to its ability in assisting neurotransmitter transport in the brain and the blunting of catecholamine release.
A large, phase III placebo-controlled clinical trial was conducted in Sweden in 2009, studying participants aged 20-55 years with a diagnosis of stress-related fatigue. Subjects taking the Rhodiola extract had significantly lower cortisol responses to chronic stress than did the placebo recipients—and as a result, they had lower scores on scales of burnout and improved performance on cognitive testing.
Ashwagandha
Ashwagandha, also known as Withania somnifera, is an important Ayurvedic medicinal herb. It has many uses in traditional Indian medicine such as treatments for stress, fatigue, pain, diabetes, gastrointestinal and rheumatologic disorders. Ashwagandha has shown promising effects in neuroprotection as scientists have discovered that this adaptogenic herb prevents damage to neurons and improves neurological function in the face of stress. Additionally, data suggests that Ashwagandha may reduce the harmful effects of stress on male reproductive capacity.
Ginseng
This herb is probably the most recognised of the adaptogen herbs in the West ( also known as Panax ginseng). There are eleven species of this medicinal herb, Pamax ginseng being among the most widely studied American Ginseng. Panax quinquefolius is another species within the Panax genus that shares medicinal properties. While Siberian ginseng (Eleutherococcus senticosus), is technically not a true ginseng botanical, it still has similar beneficial properties and is closely related to the Panax family of plants.
A wealth of studies exists that show stress reducing properties of true ginseng and the other ginseng related herbals. For example, the isolated polysaccharides from P. ginseng have demonstrated anti-fatigue properties in one recent study. American ginseng extract shows a reduction in oxidative endothelial damage due to diabetes. Anti-depressive effects and the positive modulation that benefits the HPA axis is outlined in a research paper on protective ginsenosides in Panax and other ginseng plants showing usefulness in the management of chronic stress.
Holy basil (Occiumum tenuiflorum)
If a person has adrenal gland disorder it is common for them to show signs of increased cortisol and blood glucose levels. Increased blood glucose is also seen in people receiving chronic glucocorticoid treatment. Ocimum sanctum, or holy basil, is a herb widely grown in India that is known for its ability to control blood sugar. Clinical trials in humans have also shown the benefits of holy basil extract for improving immune function, as well as decreasing stress and depression associated with anxiety. Studies in healthy human subjects showed that treatment with 300 mg of holy basil extract for 4 weeks increased antibody levels and cells in the immune system.
Bacopa
The herb Bacopa monnieri is used in the classical Indian medicinal system of Ayurveda as a tonic for the nervous system and is known to promote mental health. It has also been shown to possess anti-anxiety properties.
Pycnogenol
At the time of this writing, a clinical trial is currently underway in Australia to test the effects of Bacopa and another herb, pycnogenol, in reducing cognitive decline with ageing. The trial will evaluate the effects of Bacopa supplementation for up to a year on mood, cognition, blood pressure, inflammation, and oxidative stress, among other tests.
Cordyceps
Oxidative stress damages cells and is associated with various health disorders. Cordyceps Sinensis is a type of mushroom used in Chinese medicine that has been found to boost the immune system and possesses anti-tumor and antioxidant properties.
Hormonal Therapies
1. DHEA (depending on blood test results),
2. Melatonin, and
3. Bio-Identical Hormone Replacement Therapy (BIHRT): Refer to andropause / Male Hormone Restoration protocol, or Menopause / Female Hormone Restoration protocol
For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. It cannot be over emphasized that one must not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified and practising integrative medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure, high sugar level, high stress levels (that can lead to adrenal burnout ) and high blood clotting factors that could lead to heart attacks and stroke. In addition, there is no single supplement prescribed to clients as there is no magic bullet that can support all the essential nutrients that one's body needs. Today's food is not functional and we need to supplement in order to maintain optimal bodily functions and nutrition.
Make an appointment to consult with your Health Renewal Doctor who is an integrative doctor and he/ she will assist you in determining your risk factors and how best to prevent any problems or conditions that you may be susceptible to.
The initial medical consultation at Health Renewal will be approximately 45 minutes. As this is a prolonged medical consultation, the initial consultation fee will be R 975 which can be claimed back from your medical aid.
On arrival, you will have to complete an in-depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation, your Health Renewal doctor will obtain a FULL medical history from you to determine your personal risk. A physical examination will be done after which he/she will decide which blood tests need to be requested from your local pathology laboratory. If you have a medical aid, these should be able to be claimed as well.
These results will then be analysed by your Doctor and this will be discussed with you at your follow-up appointment usually 2 weeks later. This will determine what abnormalities/ deficiencies exist and you will be advised on your treatment options. These options may range from prescription medications, nutraceuticals, bio-identical hormonal creams/tablets or alternatively to having bio-identical implants/pellets inserted. In office treatments such as carboxytherapy may also be recommended for certain conditions such as hair loss, erectile dysfunction, menopause or PMS. If you need to lose weight our Renewal Institute Diet may be recommended.
All these recommendations will be summarised on a sheet/print out which you can take home with you. The nutraceuticals offered at Health Renewal are of superior quality (Solgar) and are not rancid nor contain Hg or PCB'S (This is very important for Omega 3EFA) and are free of gluten, preservatives, Wheat, Dairy, Soy, Yeast, Sugar, Artificial Flavor, Sweetener and Color. We have a great professional team made up of doctors, trained and registered nurses and therapists to support you at any time. An added bonus is that any nutraceuticals purchased will go towards loyalty points at any Skin, Body and Health Renewal branches.
The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments, nutritional supplements and a healthy diet and lifestyle.
Maintaining balance in today’s stressful world requires a multimodal approach that encompasses various factors: