The stress response is a normal physiological function that was designed to assist you during short-lived but potentially life-threatening events, such as being chased by a lion or other “fight or flight” emergency situations. Nowadays your ‘lions’ have transformed into everyday pressures at work and home that may not be life-threatening, but nevertheless can lead to an excessively prolonged stress response. This ongoing up-regulation of the sympathetic nervous system (SNS) can lead to disruptions in the HPA axis, which puts you at increased risk of a variety of health disorders. In today’s modern world, with technology appearing to make life easier, it seems that many if not all patients presenting in our clinic have some level of stress. However, many patients may not even be aware of the physiological impact of prolonged stress, particularly as over time they will typically adjust to this way of feeling. During my consultations how often do I hear my patients say “I am not stressed”, when clearly there is a lot happening in their lives. Both short and long-term stress can be a common underlying driver of numerous presentations ranging from lowered energy, poor immunity, insomnia, skin and digestive disorders, or other seemingly unrelated health conditions.
As holistic Practitioners it is important to treat the whole person sitting before us, and an abnormal stress response may be the missing piece of the puzzle requiring attention in order for my patient’s condition to resolve. The Stress Less Program offers a strategy with which to treat a patient’s stress symptoms, incorporating nutritional and herbal support to address neurotransmitter function imbalances along with resources to help educate patients over the long-term.
Be Calm – Herbal Help is on the Way
When a patient with excessive HPA activation presents, they may be teary during your consult and will commonly be experiencing some degree of anxiety and insomnia. These are the patients that tell you, “I cannot switch my mind off – it keeps racing when I try to sleep”. Passiflora incarnata (passionflower) is an effective anxiolytic and mild sedative with hypnotic properties,1 making it an excellent calming herb and one that has been used traditionally in Western herbal medicine for nervous conditions and insomnia. The anxiolytic effects of passionflower have been confirmed in a study on generalised anxiety disorder (GAD), using a benzodiazepine as a control. Although the benzodiazepine had a more rapid onset of action, after seven days the differences between the two groups were no longer significant (Figure One).
Figure One: Hamilton Anxiety Score (mean ± SEM) for Passionflower vs. Benzodiazepine in Generalised Anxiety Disorder (ns = non-significant).
Another anxiolytic and sedative herb is Ziziphus jujuba (zizyphus), which has a long history of incorporation into traditional Chinese medicine (TCM) herbal formulas used to treat heightened SNS activity that can lead to anxiety and insomnia. A combination of ziziphus and Magnolia officinalis (magnolia) has been found to improve sleep difficulties associated with stress, anxiety and restlessness. During the two week, open-label study over 80% of the 295 participants reported feeling more relaxed and obtained a more restful sleep. Herbal Support for Hyper HPA and Stress combines the herbs zizyphus and magnolia along with passionflower, and can be used to reduce anxiety and nervous tension as well as improve patients sleep during times of stress.
There is a solution for those Wired and Tired
Modern life can play havoc with our stress response, which is designed to ‘switch off’ again once the stressor has ceased. However, the continual stimulation of the HPA axis by everyday events such as driving in traffic, work pressure, relationship issues, etc., can lead, over time, to symptoms of nervous exhaustion, fatigue and disturbed sleep patterns. When these patients present to you in clinic their story is often the same: “I am so tired during the day, yet I cannot sleep at night”, or they may feel frustrated as they struggle to get up in the morning yet their energy levels improve in the afternoon and into the night. These patients are the ‘wired (anxious) and tired’ types who commonly have abnormal elevations of cortisol later in the day due to constant adrenal stimulation, which has led to HPA dysfunction. Rehmannia glutinosa (Rehmannia) is a TCM herb that can be used to support the adrenal cortex, the region which produces cortisol. Rehmannia is considered a nourishing and supportive adaptogen, without being overstimulating, making it appropriate for the wired and tired patient. A Herbal tonic containing Rehmannia along with Panax quinquefolium (American ginseng), as well as the traditional nervines lavender and wild oats might be a solution. This combination can be used to nourish the nervous system and restore healthy adrenal function during times of prolonged stress.
Who would benefit from Adaptogens?
Continual stimulation of the HPA axis due to physical or emotional stressors leads to a gradual reduction in normal adrenal function, manifesting clinically as a marked decrease in cortisol levels, and in extreme cases adrenal hypertrophy. Patients with adrenal insufficiency may present with stress-induced physical and mental fatigue, low motivation and an inability to cope with even the smallest everyday challenges, as their stress response system becomes more and more dysfunctional. Herbal adaptogens are used in these cases to help increase the body’s physical and mental resistance when faced with stress.
One of the most highly valued medicinal herbs is Panax ginseng (Korean ginseng), used in TCM to tonify qi, and in Western herbal medicine as a tonifying adaptogen. Korean ginseng enhances the body’s ability to withstand stress and is indicated in cases of fatigue and debility to increase vitality. Various mechanisms have been proposed for the efficacy of adaptogenic herbs. For example, the ginsenosides (a major constituent in Korean ginseng), have been shown to have corticosteroid-like effects, binding to the glucocorticoid receptor. These steroidal saponins may partly explain the efficacy of Korean ginseng in both acute and chronic stress research. The Ayurvedic herb Withania somnifera (withania) may also be used as an adaptogen, however it also offers nourishing nervine and mild sedative qualities,8 that are helpful in cases where ongoing stress has led to exhaustion. Herbal and Nutritional Support for Adrenal Health combines Korean ginseng and withania, along with the adaptogens Eleuthrococcus senticosus (Siberian ginseng) and Rhodiola rosea (rhodiola). This potent combination is suitable for use with patients who present flat and exhausted due to adrenal insufficiency; to support and nourish the adrenal glands and help normalise HPA function.
We Support our Patients
In today’s society, being exposed to everyday pressures and challenges is an inevitable part of life; with each person coping with their stress in different ways. However, it is not uncommon for patients to be unaware that stress is an underlying driver of their health condition and us, as their Practitioner, are perfectly placed to offer support and education about the role that stress may be playing in their life. Our Stress Less Program offers a range of tools to help our patients, including Specialised test and other in-house test and Mood and Stress Questionnaire, online neurotransmitters assessment: a useful screening tool that can guide me to customise a patient’s prescription according to their individual needs as well as monitor their progress over time. In addition, patient booklets offer dietary and lifestyle ‘stress busting tips’ to assist your patients to manage the stress in their life over the longer term. No matter what level of stress your patient may be experiencing – with The Stress Less Program, help is just around the corner.
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Akhondzadeh S, et al. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001;26(5):363-7.
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Koetter U, et al. Interactions of magnolia and ziziphus extracts with selected central nervous system receptors. J Ethnopharmacol. 2009;124(3):421-5.
Mills S, Bone K. Principles and practice of phytotherapy. Churchill Livingstone, Edinburgh. 2000;519-522.
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Lee YJ, et al. Ginsenoside-Rg1, one of the major active molecules from Panax ginseng, is a functional ligand of glucocorticoid receptor. Mol Cell Endocrinol. 1997;133(2):135-40.
Pole S. Ayurvedic medicine: the principles of traditional practice. Elsevier/Churchill Livingstone, Philadelphia. 2006;133-4.