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

Figure 1.1 The “normal” stress response

A Stress occurs!

B Stress response

begins in the brain (lots of chemistry) D

Stress response ends and stress

hormones dissipate

C Fight or Flight

Yikes!!!!! Whew!

Why Zebras Don’t Get Ulcers…

Robert Sapolsky, PhDStanford University - Stress Physiology

Figure 1.2

The “Type C” personality (The HUMAN stress response)

A Stress occurs!

B SAME stress response

begins in the brain (lots of chemistry)

D Stress response continues

and stress hormones lead to tissue damage

C Modern stressors

do not permit Fight or Flight

Yikes !!! Yikes !!!

Humans are not Zebras…

…and are not meant to harbor chronic stressful situations

EStress could lead to health

problems

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Body Response to Stressful situations

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Epel et al. Psychosom Med 2000;62(5):623-32

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M. Altemus, Cornell University.Trier Social Stress Test(public speaking & arithmetic)

“Normal” Diurnal Cortisol Rhythm

Cortisol Levels Throughout the Day

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“Modern” Cortisol RhythmCortisol Levels Throughout the Day

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Psycho-Neuro-Immunology

HEALTH

endocrine systemnervous system

immune system

stress

depression

anxiety

conflict

personality bereavement

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 / AntioxidantsLater 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 EvidenceThe 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

Years in work

Abdominal Obesity Stress-related cortisol

<10 <1011-20 >21 11-20 >2119

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0.34±0.5

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Rosmond, et al. Obes Res 2000;8:445-450.

nmol/Lcm

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

Epel et al., Psychoneuroendocrine Workshops, 2000

Cortisol rhythmicityAbdominal fat

r = .76

r = -.63

r = -.86

Behavior?

% Change in Abdominal Fat

baseline post-tx (3 mo.) follow-up (6 mo.)

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F=9.7, p< .008Epel et al. Psychosom Med 2000;62(5):623-32.

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

Change in Trait Anxiety

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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

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.

Elevated Cortisol and DepressionFifty 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

Stress and your skin

Stress linked to skin problems in 50% of French womenPoli 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 problemsZouboulis 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)

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Acute stressful situations enhances a skin response

stress

Effect of Cortisol on Skin Response

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Too much stress/cortisol makes you “thin-skinned”!

– Chronic stressful situations– Sleep deprivation– Dieting / Restrained eating

Cortisol Levels Are Elevated In...

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• It works...

Nutrition •It works

BUT...

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

ValerianKava KavaMelatoninTyrosine

None of these supplements directly address cortisol control

Garlic• reduces cortisol levels during high stress

L-Theanine•promotes relaxed alertness and concentration; non-sedating

Phosphatidylserine• reduces cortisol levels following strenuous exercise; improves mental function

Beta-sitosterol• balances cortisol:DHEA ratio

Scientific Substantiation of ingredientsthat could influence the Cortisol levels

*References available upon request

Good Health!