Transcript The Role of Daily stress in Health

The Role of
Daily stress
in Health
Adapted by Wouter Lox
Product specialist & Regulatory Affairs
Introduction
• This presentation is not intended to promote a
product, but is a presentation to explain the
influence of daily stresses on your health.
• This presentation is part of this workshop to
explain solely the importance of control the
negative effects of busy lifestyles and this
information can only be used in the framework of
this presentation
What happens during
stressful moments
• Start of the body’s primary reaction
– “Fight-or-Flight” response
– This reaction also Regulates inflammation,
carbohydrate metabolism, blood pressure,
cardiovascular function, etc…
•BUT
too much of this reaction for too long
leads to problems
Analogy...
• Cholesterol: hormone synthesis and cell membrane structure
• Too much cholesterol: leads to arterial plaque and poor heart
health (bad)
• Solution: control cholesterol (reduce it, don’t obliterate it)
Stressful moments
ACUTE Stressful
moment
•
•
•
brief
normal circadian rhythm
adaptive
CHRONIC Stressful
moments
•
•
•
prolonged & repeated
disrupted circadian rhythm
maladaptive
Why Zebras Don’t Get
Ulcers…
Robert Sapolsky, PhD
Stanford University - Stress Physiology
Humans are not Zebras…
…and are not meant to harbor chronic
stressful situations
A
Stress occurs!
Yikes !!!
Yikes !!!
D
Stress response continues
and stress hormones lead to
tissue damage
E
Stress could lead to health
problems
C
Modern stressors
do not permit
Fight or Flight
Figure 1.2
The “Type C” personality (The HUMAN stress response)
B
SAME stress response
begins in the brain
(lots of chemistry)
Body Response to Stressful
situations
LowWHR
0.25
cortisol (ug/dl)
HighWHR
0.20
0.15
0.10
STRESS
0
50
100
Minutes (Session 1)
Epel et al. Psychosom Med 2000;62(5):623-32
150
200
ACTH
Cortisol
50
Norepinephrine
18
1400
1300
16
30
20
14
1000
12
NE (ng/l)
Cortisol (µg/100 ml)
ACTH (pg/ml)
40
1200
1100
10
8
500
6
400
4
10
2
stress
0
-10 10
30
50
70
Trier Social Stress Test
(public speaking & arithmetic)
900
800
700
600
300
200
stress
0
-10 10
100
30
50
70
Time (min)
stress
0
-10 10
30
50
70
M. Altemus, Cornell University.
“Normal” Diurnal Cortisol
Rhythm
Cortisol Levels Throughout the Day
18
16
14
12
10
8
6
4
2
0
4AM
6AM
8AM 10AM Noon
2PM
4PM
6PM
8PM 10PM
Mid
2AM
“Modern” Cortisol
Rhythm
Cortisol Levels Throughout
the Day
18
16
14
12
10
8
6
4
2
0
4AM
6AM
8AM 10AM Noon
2PM
4PM
6PM
8PM 10PM
Mid
2AM
Psycho-Neuro-Immunology
stress
anxiety
depression
conflict
personality
bereavement
nervous system
immune system
HEALTH
endocrine system
Prevalence of
Chronic Stressfull situations
• One in three European workers is affected
by elevated stressful moments
• European studies show that 50-60% of all
lost working days are related to stressful
days
Sources: Working
on Stress - European Agency for Safety
and Health at Work (http://agency.osha.eu.int), U.S. Center for
Disease Control; World Health Organization; www.whmc.af.mil; 2000 Gallup Poll
“Attitudes in the American Workplace”
• Work-related stressful life is estimated to
cost the EU more than 265 billion Euros
annually
• More than half of all deaths between the
ages of one and 65 result from stressful
lifestyles
• Generalized anxiety disorder affects an
estimated 183 million people worldwide
Cortisol in the Media
• More Than 1,000 News Articles Over
the Past Year!
• Time, Washington Post, Men’s Health,
Prevention, Glamour, Shape, Woman’s
World, Reader’s Digest, Reuters, ABC,
MSNBC…
• Symposium on Cortisol, Stress and Health
• Park City, Utah - May 2002 - Experts from
United States, Canada, and Europe presented
emerging cortisol research
• New Book: The Cortisol Connection
(Sept
2002)
...Why Stress Makes You Fat & Ruins Your
Health…
– ...And What You Can Do About It…
–
Today’s Health “indicators”
1980’s = Cholesterol
Early 1990’s = Free Radicals / Antioxidants
Later 1990’s = Insulin / Blood Sugar
2000’s = Cortisol
Just as high cholesterol, free radicals, and high blood
sugar are considered indicators of declining health,
there is increasing evidence that high cortisol is emerging
as a significant health “indicator.”
Scientific Evidence
The Relationship Between Elevated body
responses to everyday stresses and health
Busy lifestyles and weight
maintenance
• High cortisol secretion is associated with abdominal fat
• Abdominal fat is most highly associated with a less
optimal health status:
• High cortisol secretion may be a contributing factor to
the abnormal metabolism often seen in abdominal
obesity2
1. Peeke PM, Chrousos GP. Ann NY Acad Sci 1995;771:665-76.
2. Bjorntorp P, Rosmond R. Nutrition 2000;16(10):924-36.
Abdominal fat & Stress-Related Cortisol
Stress-related cortisol
Abdominal Obesity
P<0.05
24
22.5
±3.7
23
21.5
±4.1
cm 22
21
0.34
±0.5
0.4
nmol/L 0.3
20.6
±2.2
0.15
±0.6
0.2
20
0.1
19
0
<10
P<0.05
0.5
11-20
<10
>21
Years in work
Rosmond, et al. Obes Res 2000;8:445-450.
0.04
±0.3
11-20
>21
Abdominal Fat Accumulation
Busy lifestyles / High Cortisol
Normal life / Normal Cortisol
Epel et al. found that purely
psychological intervention that
reduces anxiety and cortisol also
reduces abdominal fat
Anxiety
Behavior?
r = -.86
r = .76
Abdominal fat
r = -.63
Cortisol rhythmicity
Epel et al., Psychoneuroendocrine Workshops, 2000
% Change in Abdominal Fat
Treatment
Control
Abdominal Fat (%)
1.0
0.5
0.0
-0.5
-1.0
-1.5
*
-2.0
-2.5
TREATMENT
baseline
post-tx (3 mo.)
Time
F=9.7, p< .008
Epel et al. Psychosom Med 2000;62(5):623-32.
follow-up (6 mo.)
Busy lifestyles and Appetite
• Women with high cortisol response (compared to
women with low cortisol response):
• consumed more calories
• ate significantly more sweet foods
• had more negative moods
• High dietary restraint is associated with high urinary
cortisol excretion
• Dietary Restraint = Consciously trying to limit food intake
to achieve or maintain a desired body weight
1. Epel ES, et al. Psychoneuroendocrinology 2001;26:37-49.
2. McLean JA, Barr SI, Prior JC. Am J Clin Nutr 2001;73:7-12.
Changes in Anxiety and Cortisol Rhythm
30
20
10
0
r = -.86, p < .01
-10
-30
-20
-10
0
10
Change in Trait Anxiety
Epel et al., Psychoneuroendocrine Workshops, 2000
Additional Research
Elevated Cortisol and Osteoporosis
• High cortisol excretion associated with high dietary restraint
may cause long-term implications for bone health through
the effect on ovulatory function.1
Elevated Cortisol and Depression
Fifty percent of women suffering from mood implications have high cortisol in
conjunction with HPA axis dysregulation.2
Additional research has also focused on cardiovascularhealth status,
diabetes, mental function, and fatigue
1. McLean JA, Barr SI, Prior JC. Am J Clin Nutr 2001;73:7-12.
2. Sheline YI, et al. J Neuroscience 1999;19(12):5034-5043.
Stress and your skin
Stress linked to skin problems in 50%
of French women
Poli et al. J Eur Acad Dermatol Nov 2001 (3,305 women
aged 25-40 yrs)
Dermatology Service, Mondor Hospital, Creteil, France
Stress hormones => Stimulate oil
formation = skin problems
Zouboulis et al. Proc Natl Acad Sci, May 2002
Dept of Dermatology, Free University of Berlin, Germany
“Adult female acne [is] a modern phenomenon…a lot more
common than 100 years ago”
Richard Glogau, MD, Professor of Dermatology, Univ California San
Francisco (Allure, Aug 2002)
“Adult acne [is] an epidemic [with] an exponential increase in
sufferers in the past ten years”
Steven Grekin, MD, Clinical Professor of Dermatology, Univ of Health
Sciences, Des Moines (Allure, Aug 2002)
“During stressful times - or any time the economy is bad - we
definitely see more acne”
Debra Jaliman, MD, American Academy of Dermatology (Allure, Aug
2002)
increase in skin thickness (% baseline)
Acute stressful situations enhances a skin response
control
stress
70
60
50
40
30
20
10
0
0
1
2
3
4
5
6
T im e (days after challenge)
Dhabhar & McEwen, 1996, J. Immunology, 156, 2608-2615.
increase in skin thickness (% baseline)
Effect of Cortisol on Skin Response
acute corticosterone
control
chronic corticosterone
70
60
50
40
Too much
stress/cortisol makes
you “thin-skinned”!
30
20
10
0
0
1
2
3
4
5
Time (days after induction)
Dhabhar & McEwen, 1999, PNAS, 96: 1059.
Cortisol Levels Are Elevated In...
– Chronic stressful situations
– Sleep deprivation
– Dieting / Restrained eating
Adults who need to control cortisol levels are…
• Frequently confronted with stressful situations
• Getting less than 8 hours of sleep every night
• Limiting caloric intake to lose weight
There is a strong scientific association
between chronically elevated cortisol levels
and stress-related body responses…
Therefore, it is important for long-term health to
control your body responses to busy lifestyles
Example of Health Benefits when
controlling cortisol levels
• Enhances feelings of
wellbeing and control in
response to stressful situations
• Improves performance and
increased vigor throughout the
day
• Better mental concentration
and focus
• Supports weight maintenance
efforts
You can control cortisol levels via:
Stress Management Techniques
• Meditation, Coping strategies, etc…
Exercise
– Daily, moderate aerobic and strength training
Nutrition
– Balance carbohydrates with protein
– Maintain adequate hydration
– Avoid caffeine
Supplements
– Avoid ephedra and related stimulants
– Cortisol-controlling supplements
– (Phosphatidylserine, Beta-sitosterol...)
– Relaxation supplements (Ashwagandha, Theanine…)
...Evaluation (every month to see how you are doing)
Why Supplements?
Stress Management
• It works...
Exercise
BUT...
• It works...
Nutrition
•It works
Supplements
•Supplements offer an “easy” first step in the right direction...
•Which may allow the other strategies to follow in time…
•Choose those with evidence for Efficacy AND Safety...
Common “Anti-Stress”
Solutions
Valerian
Kava Kava
Melatonin
Tyrosine
None of these supplements directly address cortisol control
Scientific Substantiation of ingredients
that could influence the Cortisol levels
Garlic
• reduces cortisol levels during high stress
L-Theanine
•promotes relaxed alertness and concentration; nonsedating
Phosphatidylserine
• reduces cortisol levels following strenuous
exercise; improves mental function
Beta-sitosterol
• balances cortisol:DHEA ratio
*References available upon request
Good Health!