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Stress Management: Phytotherapeutic Strategies for Adrenal Health Angela Hywood ND (Australia) B App Sc (Naturopathy); Dip Bot Med; Dip Hom; Dip NFM Member NHAA, ANTA, AHG. Hans Selye. Adrenal research pioneer
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Stress Management: Phytotherapeutic Strategies for Adrenal Health Angela Hywood ND (Australia) B App Sc (Naturopathy); Dip Bot Med; Dip Hom; Dip NFM Member NHAA, ANTA, AHG
Hans Selye • Adrenal research pioneer • Spent his lifetime in continuing research on General Adaptation Syndrome (GAS) and wrote some 30 books and more than 1,500 articles on stress and related problems, including: • Stress without Distress (1974) • The Stress of Life (1956) • Running out of GAS
General Adaptation Syndrome • Selye formulated the General Adaptation Syndrome (GAS) as a non-specific response to stress • This GAS enables you to increase your power of resistance to stressors and to adapt to environmental change www.jbpub.com/samples/0763740411
Stress & Adrenal Depletion • According to Hans Selye & W. Cannon (1935-6), stress is a state of threatened homeostasis • the term was borrowed from physics • A stressor is any agent or condition which threatens homeostasis www.jbpub.com/samples/0763740411
normalresistancestate anabolic phase catabolic phase exhaustion phase Phase 3 alarm phase Phase 1 resistance phase Phase 2 SELYE’S STRESS MODELGeneral Adaptation Syndrome www.brainconnection.com/topics/?main=fa/selye
Adaptation Energy • According to Selye there is a finite amount of “adaptation energy” which declines with increasing or continuous exposure to stressors • One of the sequelae to this decrease is faulty adaptation and disease Selye H. Br Med J 1950; 1(4667): 1383–1392
Sources of Stress • Environmental Stress • Weather (amount of sunlight, temperature) • Noise • Pollution • Radiation (gamma, ionizing, non-ionizing) • cell phones, computers, electrical equipment, power lines, air travel etc
Sources of Stress • Psychological and Social Stressors • Performance stress (school, job, home) • Financial • Emotional worry • Relationship issues
Sources of Stress • Physiological Stressors • Nutritional deficiency • Biological aging • Illness (surgery) • Trauma • Toxicity • Biological • Viruses • Bacteria • Parasites
Adaptogen vs Adrenal Tonics • Adaptogens conserve adaptation energy • Eleuthero • Withania • Rhodiola • Codonopsis • Polygonum • Korean Ginseng • Tribulus
Adaptogen vs Adrenal Tonics • General Tonics increase or release adaptation energy • Korean Ginseng • Astragalus • Adrenal tonics support the adrenal cortex • Licorice • Rehmannia • Tribulus
Allostasis and Allostatic Load • Allostasis refers to the process by which our bodies attempt to maintain homeostasis in response to environmental change and/or stressors1 • It links the brain which perceives a new or threatening situation, the endocrine system (HPA axis), and the immune system1,2 • Allostatic load refers to the cost of adaptation or the damage that an improperly functioning allostatic response causes or accumulates1,2 1 McEwen BS. Metabolism 2003; 52(10)(suppl. 2): 10-16 2 Ray O. Am Psychol 2004; 59(1): 29-40
Allostasis and Allostatic Load • The primary mediators of allostasis are adrenal steroids (cortisol), catecholamines (epinephrine, norepinephrine) and dehydroepiandrosterone (DHEA) • Each has short term protective adaptive actions (allostasis) and long term damaging effects (allostatic load) McEwen BS, Seeman T, Ann NY. Acad Sci 1999; 896: 30-47
SELYE’S STRESS MODELGeneral Adaptation Syndrome normalresistancestate anabolic phase catabolic phase exhaustion phase Phase 3 alarm phase Phase 1 resistance phase Phase 2 • Phase 1: Normal Adaptation and Resistance in Alarm phase • both Cortisol and DHEA increase with stress • usually asymptomatic
normalresistancestate anabolic phase catabolic phase exhaustion phase Phase 3 alarm phase Phase 1 resistance phase Phase 2 SELYE’S STRESS MODELGeneral Adaptation Syndrome • Phase 2: Resistance Phase (early stage of exhaustion) • Cortisol increases but DHEA declines • “stressed”, anxiety attacks, mood swings, small constricted pupils • ANS in sympathetic dominance
normalresistancestate anabolic phase catabolic phase exhaustion phase Phase 3 alarm phase Phase 1 resistance phase Phase 2 SELYE’S STRESS MODELGeneral Adaptation Syndrome • Phase 3: Exhaustion Phase (late stage of exhaustion) • Both Cortisol and DHEA are low • depression and exhaustion; large pupils • ANS in parasympathetic dominance
Measurement of Cortisol Levels • The body's level of cortisol in the bloodstream displays what is known as a diurnal variation • normal concentrations of cortisol vary throughout a 24-hour period • Cortisol levels in normal individuals are highest in the early morning at around 6-8 am and are lowest around midnight Michaud K, Matheson K, Kelly O, Anisman H. Stress 2008; 11(3):177-97
Measurement of Cortisol Levels • In addition to early morning, cortisol levels may be somewhat higher after meals • While the most common test is measurement of the cortisol level in the blood, some doctors measure cortisol through a saliva sample, as salivary cortisol levels have been shown to be an index of blood cortisol levels Michaud K, Matheson K, Kelly O, Anisman H. Stress 2008; 11(3):177-97
Sample of Cortisol Circadian Cycle Figure 1. Circadian Cortisol Profile 30 25 20 15 10 5 0 Free Cortisol (nM) 8 am Noon 4 pm Midnight Reference Ranges Patient Results
Adrenal Hormones Involved in the Stress Response Cortisol influences the activity of: • Insulin • Thyroid • DHEA • Testosterone • Estrogen
Adrenal Hormones Involved in the Stress Response Cortisol is involved with: • Blood glucose regulation • Immune system response • Bone turnover rate • Mood and thought • REM sleep • Protein catabolism
Adrenal Hormones Involved in the Stress Response Elevated cortisol is associated with: • Anxiety • Insulin resistance • Obesity • Osteoporosis • Sex hormone imbalance • Onset insomnia • Accelerated aging • Immune suppression
Adrenal Hormones Involved in the Stress Response • Low cortisol is associated with: • CFS • Depression • Anorexia nervosa • PMS • Menopause • Fibromyalgia • Impotence in men • Infertility • Maintenance insomnia
DHEA (Dehydroepiandrosterone) • Functions as an androgen (a male hormone) with anabolic activity • Is a precursor to testosterone in men and is a precursor that is converted to testosterone in men and estrogen in women • Reverses immune suppression caused by excess cortisol levels Larsen P, et al. Williams Textbook of Endocrinology, 10th edition. Philadelphia: Saunders Publishers, December 2002.
DHEA (Dehydroepiandrosterone) • Stimulates bone deposition and remodeling to prevent osteoporosis • Improves cardiovascular status by lowering total cholesterol and LDL levels, thereby lessening incidences of heart attack • Increases muscle mass. Decreases percentage of body fat • Involved in the thyroid gland's conversion of the less active T4 to the more active T3 Larsen P, et al. Williams Textbook of Endocrinology, 10th edition. Philadelphia: Saunders Publishers, December 2002.
DHEA (Dehydroepiandrosterone) • DHEA negates many of the unfavorable effects of excess cortisol, creating subsequent improvement in energy/vitality, sleep, premenstrual symptoms, and mental clarity • Accelerates recovery from any kind of acute stress (eg insufficient sleep, excessive exercise, mental strain, etc) Larsen P, et al. Williams Textbook of Endocrinology, 10th edition. Philadelphia: Saunders Publishers, December 2002.
Adrenal Hormones Involved in the Stress Response • Decline in immunity • Chronic fatigue • Arthridites • Insomnia • Decreased libido • Obesity • Depression • Osteoporosis Low DHEA-S is involved with:
Adrenal Depletion • In terms of herbal actions required for a treatment protocol for adrenal depletion: • Adrenal tonic or restorative herbs • Adaptogens • Tonics (general or whole body tonics) • Nervine tonics • Immune facilitators
Prolonged Stress • The systemic effects of stress include: • Increased levels of stress hormones such as cortisol • Decline in certain aspects of immune system function such as: • Natural killer cell cytotoxicity • Secretory-IgA levels • Disruption of gastrointestinal microflora balance
Echinacea: A Miracle Herb? • In an extraordinarily entitled paper: “Echinacea: a Miracle Herb against Aging and Cancer?”, Dr Sandra Miller has recently reviewed her research on Echinacea, specifically Echinacea purpurea root1 • Dr Miller’s interest in Echinacea was triggered by her team’s research on the drug indomethacin, which is a COX inhibitor that reduces the suppressors of natural killer (NK) cells, prostaglandins2,3 1 Miller SC. eCAM 2005; 2(3): 309-314 2 Christopher FL, Dussault I, Miller SC. Immunobiology 1991; 184: 37-52 3 Dussault I, Miller SC. Nat Immun 1993; 12: 66-78
Echinacea Boosts NK Cells • In healthy young adult mice, oral doses of Echinacea purpurea root (0.45 mg per 25 g body weight, similar to human dose rates) stimulated NK cell production by bone marrow in the first 7 days which resulted in significantly higher levels (around 25% more) of NK cells in the spleen by 2 weeks1 • In addition, the ‘helper’ or accessory cells for NK cells, the monocytes, were also increased by 25% 1 Sun LZ-Y, Currier NL, Miller SC. J Altern Complement Med 1999; 5: 437-446
Echinacea Boosts NK Cells • The Echinacea treatment influenced no other white blood cell counts • Polysaccharides, even by injection, were found to be not responsible for this effect • Dr Miller feels that alkylamides are largely responsible for the effect (personal communication) Currier NL, Lejtenyi D, Miller SC. Phytomedicine 2003; 10: 145-153
Echinacea ReversesImmune Aging • NK cells decline in number and function with age and this is thought to be one factor behind the increase of various cancers with age • Experiments conducted in healthy, elderly mice found that 2 weeks of oral doses of Echinacea returned NK cell numbers in bone marrow and spleen to the levels of young adults and also resurrected the functional capacity (target cell binding, lysis) of these cells1 1 Currier NL, Miller SC. Exp Gerontol 2000; 35: 627-639
Echinacea ReversesImmune Aging • On this result Dr Miller writes: “These observations appear to apply uniquely to this herb since we could never rejuvenate the NK cell-mediated component of the immune system in elderly mice by any of the other typical NK cell enhancers….” Miller SC. eCAM 2005; 2(3): 309-314
Echinacea is Beneficialif Taken Regularly • One of the persistent controversies about Echinacea is whether it is safe to be taken consistently for long periods of time. According to Miller’s findings, the answer is definitely in the affirmative • Mice were fed Echinacea purpurea root from 7 weeks of age to 13 months at the dose previously described.1 Long-term use of Echinacea was not only not detrimental, but distinctly beneficial 1 Brousseau M, Miller SC. Biogerontology 2005; 6: 157-163
Echinacea is Beneficialif Taken Regularly • By 13 months of age 46% of the control mice fed the standard chow were still alive compared to 74% of those consuming Echinacea • As might be expected from previous experiments, the NK cell levels in the Echinacea-fed mice were considerably elevated compared to controls Miller SC. eCAM 2005; 2(3): 309-314
Echinacea is Beneficialif Taken Regularly “Given that the key immune cells acting as the first line of defence against developing neoplasms in mice and humans are NK cells, it is not difficult to conclude that sustained enhancement of NK cells alone, throughout life, could readily account for the reduced frequency in deaths with advancing age. Miller SC. eCAM 2005; 2(3): 309-314
Echinacea is Beneficialif Taken Regularly Spontaneous neoplasms, clinically undetectable, are well known to increase with advancing age in humans and mice. Thus, the logical corollary from this study indicates that chronic daily intake of Echinacea, is clearly not detrimental to the immune system, but rather prophylactic.” Miller SC. eCAM 2005; 2(3): 309-314
Clinical Tests To Evaluate Physiological Stress • The most accurate objective method to assess adrenal status is via Adrenal Stress Index (ASI) Salivary Hormone Test • Metametrix Labs (www.metametrix.com) • Diagnostechs Labs (www.diagnostechs.com)
Primary Evaluation for Adrenal Fatigue Ragland’s Postural Hypotension Test • This test is performed by taking the blood pressure while the patient is lying down, and repeating immediately after the patient stands up • A systolic increase of 5 to 10 mm upon standing is a normal response to this sudden change in gravity • A systolic blood pressure that fails to rise (or falls) when standing, adrenal fatigue and a lack of adrenals ability to adapt to gravitational changes (physical stressor) Weatherby D, Ferguson S. In-Office Lab Testing - Functional Terrain Analysis. 2005.
Primary Evaluation for Adrenal Fatigue • Pupil Dilation Test • Equipment required: flashlight and a mirror • Shine the flashlight into the pupil of one eye • It should contract if adrenals are healthy and adapting to light stressor • If after 30 seconds, it stays the same or, even worse, dilates, this is an indicator of adrenal fatigue • Pain when pressing on adrenal glands (located over kidneys) • Palpation or symptom of chronic lower back pain in the absences of structural issues
Natural Medicine for Adrenal Health • These include: • Adaptogenic herbs such as Eleuthero and Withania • Adrenal Tonic herbs such as Licorice and Rehmannia • Vitamin C • Vitamin B1 • Vitamin B6 • Vitamin B5 (pantethine) • Vitamin B12 (methylcobalamin) • Tyrosine • Lipoic acid (naturally found in liver) • Phosphatidylserine • Plant sterols, such as those found in Tribulus and Korean Ginseng Rogero MM, Mendes RR, Tirapegui J. Arq Bras Endocrinol Metabol 2005 Jun; 49(3):359-68 Epub 2006 Mar 16
Core Phytotherapy for Adrenal Health Adaptogens • Withania • Korean Ginseng • Tribulus Adrenal Tonics • Licorice
Adrenal Tonics • Nourish the adrenal glands • Allow for improved regulation of cortisol and DHEA output • Release stored adaptation energy • Reduce side effects of corticosteroid drug use • Cortisol sparing action in cases of Phase 3 exhaustion of adrenals
Mode of Action of Adaptogens General Effects • Fine-tune the stress response mechanism so that Phase 1 of GAS is more efficient • Response is stronger and faster and feedback control is more effective so the response is shut off faster • Have a sparing effect in Phase 2, so that Phase 3 is delayed • So they are biphasic, can increase or decrease stress response Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, 2000. Gaffney B, et al. Medical Hypotheses 2001; 56(5): 567-572
Mode of Action of Adaptogens Specific Effects • Positive effects on biosynthesis of RNA and proteins • Positive effects on carbohydrate metabolism, eg increased formation of glucose-6-phosphate • Reduction of catecholamine depletion by inhibition of catecholamine-O-methyl transferase (COMT) – especially in CNS (mainly Eleuthero) • Inhibition of breakdown of corticosteroids via inhibition of 11-beta hydroxysteroiddehydrogenase in CNS Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, 2000 Gaffney B, et al. Medical Hypotheses 2001; 56(5): 567-572
Mode of Action of Adaptogens Adaptogens and Immunity • Increased secretion of glucocorticoids in response to injury or infection is to prevent defence mechanisms from overreacting • Acute and chronic stress can result in immune suppression (well-known in athletes), probably by this mechanism • By their positive effects in Phase 2, adaptogens will counter chronic immune depletion in stressed individuals Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, 2000.
Actions of Adaptogens • Improved adaptation to stress • Promote regeneration • Increased concentration • Fewer mental errors • May sensitize corticosteroid feedback on the HPA axis making the stress response more efficient • Increase glucocorticoid action
Stress Management Protocol Treatment Strategy • Support the adrenal gland function with adrenal restorative (adrenal tonics) herbs such as: • Licorice High Grade 1:1 • 2-4 mL per day • Phase 2 or 3 adrenal stress or exhaustion • Contraindicated in hypertension • If hypertensive patient, use Tribulus Forte (2 tablets twice daily) as alternative