August 13, 2018
Here, at Tustin Longevity Center, we educate our patients about the importance of lifestyle choices as forming the foundation upon which optimal health is achieved. Diet and exercise are usually the first that come to mind. The third, but often overlooked, foundational lifestyle choice is stress management.
The stress response is designed to help us get out of dangerous situations. An acute stressor (being chased by a lion, for example) causes the adrenal glands to release cortisol, through release of corticosteroid releasing hormone (CRH) by the hypothalamus and thenadrenocorticotropin hormone (ACTH) from the pituitary gland. This is known as the HPA (hypothalamus-pituitary-adrenal) axis. Cortisol is a catabolic (or breaking down) hormone which mobilizes stored resources (glucose, fats and amino acids) to enable our body to quickly get away from the stressor. Epinephrine and norepinephrine are also released from the adrenal gland and are responsible for the fight or flight response. An excitatory neurotransmitter called glutamate is also secreted in the brain to make us more alert. This overrides GABA, the major inhibitory neurotransmitter in the brain that provides a calming effect. When the immediate threat starts to die down (we manage to find a hiding place or the lion encounters another animal that serves as its prey, for example), DHEA, human growth hormone and other anabolic (or building up) hormones are released to help repair the effects of catabolism. Cortisol itself, through a negative feedback system, dampens down the further production of CRH.
Unfortunately, modern stressors do not die down in a matter of minutes and our response typically does not include an all-out run to make use of the glucose, fats and amino acids that have been mobilized. As a result, disruptions to the negative feedback mechanism occur and the balance of catabolic and anabolic hormones gets thrown off and you end up with increased blood pressure, sodium and water retention by the kidneys, insulin resistance, decreased immune response. This also has direct and indirect effects on other hormones, like thyroid, estrogen, progesterone and testosterone. This is classically illustrated in women whose periods become erratic during times of stress or in the couple who become stressed because they have not been able to conceive in the typical time, only to become pregnant after they have given up any hope of doing so.
There are 3 stages of HPA axis dysfunction. Stage 1 is the alarm stage, characterized by elevated cortisol, anxiety/panic attacks, insomnia and restlessness. Stage 2 is the resistance stage, characterized by irregular cortisol rhythms, mood/sleep cycle issues, difficulty concentrating, energy crashes and other hormonal irregularities. Stage 3 is the exhaustion stage, characterized by low cortisol, fatigue, depression, pain, severe inflammation, hormonal imbalances and immune depletion.
While various supplements are available to help address each stage, prevention is always preferred. Being able to identify the 4 general categories of chronic HPA axis stress can guide behaviors that can help in such prevention.
The first category, mental/emotional stress, is typically what comes to mind when one hears the word, “stress”. This type of stress comes about in situations where there is novelty (like changing jobs or moving to a new city), unpredictability (like layoffs in the workplace), threat (like an abusive relationship) or sense of loss of control (like an illness or death of a loved one). In this category, it is important to directly address the stressors, where possible. Speaking with a therapist or meditation/introspection can help shed light on the source of the stress. Finding enjoyment even in the midst of challenges, spending time in nature, laughing often, simplifying, avoiding procrastination, exercising regularly (see my blog, “Got Exercise?”), expressing gratitude, and connecting with others while still setting aside time for yourself can aid in one’s ability to handle this type of stress.
The second category is sleep cycle/circadian disruption. This is exemplified by insomnia, getting less than 7 hours of sleep, sleep apnea and shift work. The first step in addressing this category is to acknowledge the importance of sleep and commit to getting a minimum of 7 hours every night. Then, create an environment that is conducive to sleep. Shut off electronics and limit liquid intake 1-2 hours before going to bed, use the bed only for sex and sleep, and ensure mattress and pillows provide enough neck and back support. As women approach menopause, progesterone levels drop, making them susceptible to insomnia and anxiety. They
may also experience night sweats as estrogen levels fluctuate and then decline. As such, hormone replacement therapy or supplements may be indicated. In both sexes, melatonin also declines with age and supplementation often helps improve the quantity and quality of sleep.
The third and fourth categories are less obvious causes of chronic HPA axis stress. The third category is chronic inflammation, associated with various medical conditions like inflammatory bowel disease, food allergies, back/joint pain, eczema and autoimmune disorders. Addressing gut health by following a simple rotation diet, eliminating food sensitivities and taking supplements (like probiotics and glutamine) is of the utmost importance here (see Dr. Faraj’s blog, “Inflammation: The Root Cause of Chronic Illness”). Other supplements like Vascuzyme (see Dr. Ellithorpe’s blog, “We Love Enzymes at TLC) and parent essential oils can also help in decreasing inflammation.
The fourth category is glycemic dysregulation. There is a vicious cycle between metabolic function, hormone signaling and stress. Obese, insulin resistant individuals are at increased risk for HPA axis disorders, while stressful events lead to HPA axis-related metabolic dysfunctions like insulin resistance and obesity. To address this category, we recommend intermittent, or longer, fasting and a diet low in carbohydrates, high in plant>animal-based fats and moderate protein (see my blog, “Fasting” and Dr. Meric’s blog, “All About Blood Sugar
Interestingly, one may notice a lot of overlap and redundancy in the issues we share with you this underlines how powerful these lifestyle choices are. The body is truly amazing and fully capable of healing itself or achieving optimal health without medications. *** All that is needed is knowledge, acceptance commitment and discipline.
*** I do draw a distinction between medications and hormones. Medications are foreign to our bodies. Hormones are produced in our bodies and as such, we have receptors for them. As we age or make poor lifestyle choices, these hormones deplete and replacing them may be necessary in some individuals.