Adrenal Dysfunction

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Adrenal Dysfunction

Advanced Clinical Focus: Hormones and Endocrinology Adrenal Hormones

• Adrenal hormones are the major response of the body to stress or trauma from outside or within. Advanced Clinical Focus: Hormones and Endocrinology Cortisol Steal

• Stress = ↓ed steroids

X X

Advanced Clinical Focus: Hormones and Endocrinology Stress

• A state of threatened homeostasis (physical or perceived)

• Anything that elevates ACTH or cortisol

Advanced Clinical Focus: Hormones and Endocrinology Homeostasis

• Described by Walter Cannon

• Coordinated physiological processes which maintain most of the steady states in the organism

Endocrine System Advanced Clinical Focus: Hormones and Endocrinology Stressors

Mental Emotional Spiritual Chemical Physical

Advanced Clinical Focus: Hormones and Endocrinology Response to Danger

• Freeze: ↑ed sensory acuity

• Flight: escape, ↑ed blood to muscle

• Fight: can’t escape

• Fright: tonic incapacitation

• Faint: no more resources

Bracha, SH. Freeze, Flight Fight, Fright, Faint: Adaptionist Perspectives on the Acute Stress response Spectrum CNS Spectr. 2004;9(9):679‐685

Advanced Clinical Focus: Hormones and Endocrinology Responses

Fear Love

• Stimulates SNS • Stimulates the PNS

• Activates adrenals • Adrenal-lowering hormones • Arousal of immune • Sleep • Shuts down reproduction • Reproductive hormones

Lipton, B. The Biology of Belief, 2011 Advanced Clinical Focus: Hormones and Endocrinology Functions of Cortisol

• Stims liver amino acids → glucose

• Stims ↑ed glycogen in liver

• Mobilizes fatty acids in blood

• ↑s coagulation

• Suppresses parts of inﬂammation

• Prevents Na loss

• Affects mood

Advanced Clinical Focus: Hormones and Endocrinology Functions of Cortisol: Prolonged

• Stims fat deposits

• ↑ed BP

• ↑ed protein breakdown

• Demineralization of bone

• Suppress immune

• Memory loss

• Depression

• ↑ed blood sugar

Advanced Clinical Focus: Hormones and Endocrinology Selye’s General Adaption Syndrome

• Stage 1: Alarm/Arousal

• Stage 2: Resistance/Adaptation

• Stage 3: Exhaustion Advanced Clinical Focus: Hormones and Endocrinology Selye’s General Adaption Syndrome

• Stage 1: Alarm/Arousal

• Cortisol and DHEA increase with episodic stress

• Recovery to baseline

• Asymptomatic

Advanced Clinical Focus: Hormones and Endocrinology Selye’s General Adaption Syndrome

• Stage 2: Resistance/Adaptation

• Cortisol chronically elevated

• DHEA declines

• “Stressed”, anxiety attacks, mood swings, depression

Advanced Clinical Focus: Hormones and Endocrinology Selye’s General Adaption Syndrome

• Stage 3: Exhaustion

• Adrenal insufﬁciency

• Low cortisol and DHEA

• Depression and fatigue

• “Burnt out” Advanced Clinical Focus: Hormones and Endocrinology Adrenal Fatigue Progression

Normal stressors/ Repeated stress-high adrenaline Constant Adrenal healthy stress stress-high overload- cortisol collapse

Advanced Clinical Focus: Hormones and Endocrinology Adrenal Fatigue Progression

Advanced Clinical Focus: Hormones and Endocrinology Adrenal Fatigue Progression Advanced Clinical Focus: Hormones and Endocrinology Stages of Adrenal Fatigue

• Follows Hans Selye’s “General Adaption Syndrome”

Stage 1 Stage 2 Stage 3

Advanced Clinical Focus: Hormones and Endocrinology Stage 1-Acute Arousal

• Rapid increase in adrenaline

• Concurrent but slower increase in cortisol

• Normalize after event

Advanced Clinical Focus: Hormones and Endocrinology Stage 1-Acute Arousal: Triggers

• Lack of sleep

• Low blood sugar

• Heat and cold

• Pain

• Life threats

• Emotional events or thoughts

• Drugs Advanced Clinical Focus: Hormones and Endocrinology Adrenal Cascade: “HPA Axis”

Stimulus

Rest/Digest Fight/Flight/Fright Stop/Think (PNS) (SNS)

Stress Hormones

Advanced Clinical Focus: Hormones and Endocrinology NUTS

• Novel

• Unexpected

• Threat to the ego

• Sense of loss of control

Advanced Clinical Focus: Hormones and Endocrinology

The only way to make sense of change is to plunge into it, move with it, and join the dance.

Alan Watts Advanced Clinical Focus: Hormones and Endocrinology Adrenal Cascade: “HPA Axis”

Fear

Advanced Clinical Focus: Hormones and Endocrinology Perception is Everything

Eustress Distress

Advanced Clinical Focus: Hormones and Endocrinology Molecules of Emotion

As our feelings change, this mixture of peptides travels throughout your body and your brain. And they’re literally changing the chemistry of every cell in your body. Advanced Clinical Focus: Hormones and Endocrinology Symptoms of ↑ Adrenaline

• Insomnia

• Awakening with hot ﬂashes/ night sweats

• Elevated HR, palpitations

• Anxiety

• Tremor

• Headache

• Hot ﬂashes

Advanced Clinical Focus: Hormones and Endocrinology Modulators/Dampeners of Adrenaline

• GABA

• Endorphins

• Oxytocin

Advanced Clinical Focus: Hormones and Endocrinology Neutraceuticals That Support GABA

• Valerian root

• Passion ﬂower

• L-theanine

• Taurine

• B6, Mg, Zn, Mn

Kharrazian, Datis. Why Isn’t My Brain Working? 2013. Elephant Press. Advanced Clinical Focus: Hormones and Endocrinology Increasing Endorphins

• Laughter

• Lavender

• Sex

• Dark chocolate

The FASEB Journal. 2006;20:A382 Moss, M., Cook, J., Wesnes, K., & Duckett, P. (2003). Aromas of rosemary and lavender essential oils differentially affect cognition and mood in healthy adults. International Journal of Neuroscience, 113, 15- 38.

Advanced Clinical Focus: Hormones and Endocrinology Increasing Oxytocin

• Cuddle • Pets

• Hug • Sappy movies

• Trusting • Interactions on facebook

Zak, Paul J. The Moral Molecule: How Trust Works. Penguin Group USA. 2013

Advanced Clinical Focus: Hormones and Endocrinology Stage 2-Adaptation: Triggers

• Chronic sleep deprivation (non-adrenal cause)

• Emotional and/or physical trauma

• Infection

• Acute physical stress

• Work stress (burnout) Advanced Clinical Focus: Hormones and Endocrinology Stage 2-Adaptation: Triggers

• Stress (physical/psych.)

• Hx of prenatal/early trauma

• Toxins

• Infections

• Allergens

• Poor diet

• Sleep deprivation

Advanced Clinical Focus: Hormones and Endocrinology

Symptoms of Elevated Adrenaline and Cortisol

• Irritability/anxiety • Sugar cravings

• Fatigue/low energy • Weight gain (middle)

• Night sweats • Depression

• Muscular tremors

• Suppressed immune

• Shakiness btwn. meals

Advanced Clinical Focus: Hormones and Endocrinology Symptoms of Elevated Cortisol

• Memory loss

• Depression

• Elevated blood sugar/ eventually insulin

• Awakening at 2am

• Low sex hormones Advanced Clinical Focus: Hormones and Endocrinology Brain Shrinkage and Stress

Healthy Sustained Stress

Robert M. Sapolsky. Why Zebras Don’t Get Ulcers: Third Edition. 2004

Advanced Clinical Focus: Hormones and Endocrinology “Dinosaur Syndrome”

Big body, little brain, become extinct.

Dr. Daniel Amen

Advanced Clinical Focus: Hormones and Endocrinology Cortisol and Immune

• High cortisol may keep an overactive immune system under control

• But it may cause depression, hypothyroidism, and memory loss…

↑Cortisol ↓Immune Advanced Clinical Focus: Hormones and Endocrinology Stage 3: Exhaustion

• Depressed cortisol

• Depressed DHEA

Advanced Clinical Focus: Hormones and Endocrinology Symptoms of Depressed Cortisol

• Fatigue • ↑ed inﬂamm. and allergies • Apathy • Depression • Absent-minded • Early menopause • Poor coordination • Muscle pain • ↑ed sleep but ↓ quality

Advanced Clinical Focus: Hormones and Endocrinology Reasons for Loss of Adrenal Function

• Chemicals and drugs

• Infections

• Autoimmune

• Cancer

• Lack of necessary nutrients

• Overuse Advanced Clinical Focus: Hormones and Endocrinology Areas of Variability

• Perception • Second messenger system • Genetics • Production of • Prenatal programming hormones

• History (i.e. trauma) • Interaction of hormones • Receptors • Metabolism of hormones

Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction

• Stage I: Stressed and wired

• Stage II: Stressed and tired

• Stage III: Stressed and depleted

Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction

• Follow 4-point cortisol measure

• Saliva

Low Normal Optimal Normal High 50

37.5

12.5

0 Morning Noon Evening Night Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction

• Trouble with sleep

• “Wired and Tired”

Low Normal Optimal Normal High 50

37.5

12.5

0 Morning Noon Evening Night

Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction

• Insomnia

• Early morning waking

Low Normal Optimal Normal High 50

37.5

12.5

0 Morning Noon Evening Night

Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction

• Anxious during the day • Poor blood sugar control • Stressful job

Low Normal Optimal Normal High 50

37.5

12.5

0 Morning Noon Evening Night Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction

• Tired/groggy in the morning

• Difﬁculty waking and starting the day

Low Normal Optimal Normal High 50

37.5

12.5

0 Morning Noon Evening Night

Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction

• Tired always

• Poor blood sugar control

Low Normal Optimal Normal High 50

37.5

12.5

0 Morning Noon Evening Night

Advanced Clinical Focus: Hormones and Endocrinology Testing Adrenals: Iris

• Iris contraction test:

• Shine light into eye

• Look for inability to maintain contraction

• Normal = pupil remains contracted

• Adrenal fatigue = pupil dilates Advanced Clinical Focus: Hormones and Endocrinology

Testing Adrenals: Postural Hypotension

• Postural blood pressure:

• Lie down for 3-5 minutes

• Take blood pressure

• Stand up

• Take BP again

• Normal = ↑ BP 10-20 mmHg

• Adrenal fatigue = BP drops

Advanced Clinical Focus: Hormones and Endocrinology Healing the Adrenals

• Lifestyle and diet interventions are critical for success

• Lifestyle and diet interventions similar for all stages

Advanced Clinical Focus: Hormones and Endocrinology Healing the Adrenals: Critical

• Blood sugar control

• Low glycemic index/load diet

VS VS Advanced Clinical Focus: Hormones and Endocrinology Healing the Adrenals

• Avoid distress, engage • Balance work with play in eustress • Learn to say “no” • Change perceptions • Rest! • Avoid triggers (bright light, and loud noise)

• Sleep hygiene

• Avoid stimulants

Am J Cardiol. 2005 Jul 1;96(1):64–66. Am J Cardiol. 2005 Jul 15;96(2):221–226. J Behav Med. 2005 Jun;28(3):295–299. Health Psychol. 2006 Jul;25(4):484– 492. Neuropsychobiology. 2006;53(1):26–32..

Advanced Clinical Focus: Hormones and Endocrinology Healing the Adrenals

• HRV • Nature

• Meditation • Socialize

• The “right” exercise

• Deep breathing

• Music

• Calm environment

Advanced Clinical Focus: Hormones and Endocrinology Melatonin Advanced Clinical Focus: Hormones and Endocrinology Melatonin

• Strong antioxidant

• Protects the brain

• Improves libido

• Inversely correlated with cortisol

• Protects from estrogen

Sousa SC, Castilho RF. Protective effect of melatonin on rotenone plus Ca(2+)-induced mitochondrial oxidative stress and PC12 cell death. Antioxid Redox Signal. 2005;7(9-10):110-116. Turner, Natasha. The Hormone Diet. Random House 2009

Advanced Clinical Focus: Hormones and Endocrinology Shift Work and BreastCancer

physiologic determinants of alertness and have been shown to be genetically un- Rotating Night Shifts and performance, drives a circadian pace- stable and thus more prone to tumors (30). maker in mammals, with an intrinsic pe- Breast cancer is the most common can- Risk of Breast Cancer in riod averaging 24 hours. Light is the pri- cer among women in the United States. Women Participating in the mary stimulus to disrupt and reset this To date, the relationship between night Nurses’ Health Study pacemaker, which is expressed in chang- work and breast cancer risk has not been ing melatonin rhythms. Light exposure at evaluated in prospective cohort studies. A causal link between the two would be of Eva S. Schernhammer, Francine night may, therefore, be related to a vari- ety of behavioral changes and associated public health importance, because small Laden, Frank E. Speizer, Walter C. health problems not yet well explored. changes in shift patterns may create a sub- Willett, David J. Hunter, Ichiro Studies (1) have suggested an increased stantial decrease of disease burden among Kawachi, Graham A. Colditz risk of coronary heart disease among ro- women. tating night shift workers, not fully ex- In this report, we evaluate the relation- plained by an increased prevalence of ship between night work, as a surrogate Background: Melatonin shows poten- coronary risk factors. Others have linked for light exposure at night, and breast tial oncostatic action, and light expo- night work to an increased breast cancer cancer risk in a large prospective cohort sure during night suppresses melatonin risk among women (2). of premenopausal and postmenopausal production. There is little information, Melatonin, the “hormone of the dark- women. Our analysis is based on 10 years however, about the direct effect of ness,” has only recently gained substantial of follow-up in 78 562 women participat- night work on the risk of cancer. We ing in the Nurses’ Health Study. attention from the scientific community Downloaded from investigated the effect of night work in with regard to its potential oncostatic ac- breast cancer. Methods: We examined SUBJECTS AND METHODS tions and its possible effect on breast can- the relationship between breast cancer cer risk (3–10). Melatonin serum levels in and working on rotating night shifts In 1976, a total of 121 701 female registered humans decrease when people are ex- nurses 30–55 years of age and living in 11 large U.S. during 10 years of follow-up in 78 562 states were enrolled in the Nurses’ Health Study. posed to light at night (11). Suppressed http://jnci.oxfordjournals.org/ women from the Nurses’ Health Study. serum melatonin levels might enhance tu- Since baseline, they have completed biennial-mailed Information was ascertained in 1988 Women who workmor development on(12). rotatingObservational questionnaires night that comprise items about theirshifts health about the total number of years during status, medical history, and known or suspected risk studies (2,13–15) are compatible with an which the nurses had worked rotating effect of melatonin on breast cancer risk, night shifts with at least three nights reporting meaningful increases in breast with perat month. least From June 1988 three through nights perAffiliations month, of authors: E. S. Schernhammer, in cancer risk among postmenopausal women Channing Laboratory, Department of Medicine, May 1998, we documented 2441 inci- exposed to shiftwork. Recently, a tumor- Brigham and Women’s Hospital and Harvard Medi- dent breast cancer cases. Logistic re- promoting effect of light exposure was cal School, Boston, MA; F. Laden, F. E. Speizer, gression models were used to calculate demonstrated on chemically induced tu- Channing Laboratory, Department of Medicine, by guest on November 27, 2015 addition to days and eveningsBrigham and Women’sin Hospital that and Harvard Medi- relative risks (RRs) and 95% confi- mors in rodents (16). To date, melatonin cal School, and Department for Environmental dence intervals (CIs), adjusted for con- has been shown to be oncostatic for a va- founding variables and breast cancer Health, Harvard School of Public Health, Boston; riety of tumor cells in experimental car- W. C. Willett, Channing Laboratory, Department month,risk factors. appear All statistical tests were tocinogenesis have(17–26). The evidencea moderately of a of Medicine, Brigham and Women’s Hospital and two-sided. Results: We observed a mod- relation between melatonin and oncogen- Harvard Medical School, and Departments of Epi- erate increase in breast cancer risk esis in humans is conflicting (27), but demiology and Nutrition, Harvard School of Public among the women who worked 1–14 the majority of reports indicate protective Health; D. J. Hunter, Channing Laboratory, Depart- ment of Medicine, Brigham and Women’s Hospital increasedyears or 15–29 years risk on rotating nightofaction breast(28). cancer after shifts (multivariate adjusted RR = 1.08 and Harvard Medical School, and Department of Several mechanisms have been hy- Epidemiology, Harvard School of Public Health, [95% CI = 0.99 to 1.18] and RR = 1.08 pothesized to explain an association be- and Harvard Center for Cancer Prevention, Boston; [95% CI = 0.90 to 1.30], respectively). tween melatonin and breast cancer. Cohen I. Kawachi, Channing Laboratory, Department of extendedThe risk was further periods increased among et al. (29)ofproposed working that loss of pineal Medicine, rotating Brigham and Women’s Hospital and Har-night women who worked 30 or more years function and the resulting decreased mel- vard Medical School, and Department of Health and on the night shift (RR = 1.36; 95% CI = atonin serum levels may increase repro- Social Behavior, Harvard School of Public Health; G. A. Colditz, Channing Laboratory, Department 1.04 to 1.78). The test for trend was sta- ductive hormone levels and, in particular, shifts. of Medicine, Brigham and Women’s Hospital and tistically significant (P = .02). Conclu- estradiol levels, thereby increasing the Harvard Medical School, and Departments of Epi- sions: Women who work on rotating growth and proliferation of hormone- demiology and Nutrition, Harvard School of Public night shifts with at least three nights sensitive cells in the breast. More recent Health, and Epidemiology Program, Dana-Faber/ per month, in addition to days and eve- research focuses on potential mechanisms Harvard Cancer Center, Boston. nings in that month, appear to have a through which melatonin is directly onco- Correspondence to: Eva S. Schernhammer, M.D., moderately increased risk of breast static. Melatonin is believed to have anti- M.P.H., Channing Laboratory, 181 Longwood Ave., cancer after extended periods of work- Boston, MA 02115 (e-mail: eva.schernhammer@ mitotic activity by affecting directly hor- channing.harvard.edu). ing rotating night shifts. [J Natl Cancer mone-dependent proliferation through Reprint requests to: Graham A. Colditz, M.D., Inst 2001;93:1563–8] interaction with nuclear receptors (4). An- D.P.H., Nurses’ Health Study, Channing Labora- other explanation is that melatonin in- tory, 181 Longwood Ave., Boston, MA 02115. The suprachiasmatic nucleus in the hy- creases the expression of the tumor sup- See “Notes” following “References.” pothalamus, one of the most important pressor gene p53 (3). Cells lacking p53 © Oxford University Press

Journal of the National Cancer Institute, Vol. 93, No. 20, October 17, 2001 REPORTS 1563

Journal of the National Cancer Institute, Vol. 93, No. 20, October 17, 2001

Advanced Clinical Focus: Hormones and Endocrinology Sleep Hygiene

• Dark room or eye-mask

• No bright devices

• No electrical devices

• Bed by 10:00 pm

• No stimulating activities

• Lavender in diffuser or on pillow Advanced Clinical Focus: Hormones and Endocrinology Chew Gum

• 40 participants (mean age 21.98)

• Performed multi-tasking framework at 2 intensities both while chewing and not

• When chewing: better alertness, reduced anxiety, stress, and cortisol

• Overall performance better Physiology and Behaviour: 304-312, 2009

JoshGitalis.com

Advanced Clinical Focus: Hormones and Endocrinology Stress and Exercise

• Low-moderate exercise most effective when done for 15-30 minutes, 3x/wk+, for 10 weeks+

• Jog, swim, cycle, walk

• Increase body temp., brain perfusion, and impacts HPA axis

Guszkowska M. Psychiatr Pol. 2004 Jul-Aug;38(4):611-20.

Advanced Clinical Focus: Hormones and Endocrinology Stress and Yoga

• Women randomly assigned to attend yoga practice 90 min. 2x weekly, 8 wks

• Yoga group:

• Lower morning cortisol

• Improved emotional well- being

• Improved fatigue

Journal of American Academy of Nurse Practitioners: 135‐142. 2010 Advanced Clinical Focus: Hormones and Endocrinology Where Does Coffee Fit In?

It doesn’t.

Advanced Clinical Focus: Hormones and Endocrinology Stress and Digestion

• A stress-dominated system shuts down the appropriate functions of digestion

• Stress ↓’s nutrients absorbed and causes erosion of tissues that cause IBS, ulcers, GERD, and others.

Dinan TG, et al., Gastroenterology. 2006 Feb;130(2):304–311. Heitkemper M, et al., Am J Gastroenterol. 1996 May;91(5): 906–913. Lazebnik LB, et al., Eksp Klin Gastroenterol. 2002;(5):30–33, 126–127.

Advanced Clinical Focus: Hormones and Endocrinology Basic Adrenal Nutrients

• Good quality multi- • Folate: 400-800 mg vitamin-mineral • Vitamin C: 1-2 grams • B-Complex • Magnesium: 400-600 • B5 (pantothenic acid): mg 1000-1500 mg • Zinc: 30-150 mg • B6 (pyridoxine): 50-100 mg • Balanced fatty acids

• Biotin: 1000 mcg

Eisenstein AB. Am J Clin Nutr. 1957 Jul-Aug;5(4):369-76. Advanced Clinical Focus: Hormones and Endocrinology Pantothenic Acid

• Stimulates adrenals to secrete corticosterone and progesterone

• Induces adrenal responsiveness to ACTH

Yoshida E at al., Biosci Biotechnol Biochem. 2010;74(8):1691‐3

Advanced Clinical Focus: Hormones and Endocrinology B-Vitamins

• B-vitamins are essential for adequate blood sugar and neurotransmitter regulation

↑ Glucose

Nakagawasai O, et al., Neuroscience. 2004;125(1):233–241.

Advanced Clinical Focus: Hormones and Endocrinology Vitamin C and Adrenal Function

• Immediately post race, marathoners serum cortisol and plasma adrenaline were signiﬁcantly lower in the runners supplemented with vitamin C

Int J Sports Med. 2001 Oct;22(7):537-43. Advanced Clinical Focus: Hormones and Endocrinology Vitamin C and Adrenal Function

• The group given vitamin C showed less increase in BP, decreased subjective stress response, and faster cortisol recovery

• Animals deﬁcient in vitamin C have signiﬁcant higher serum and saliva cortisol

1. Brody S, et al., Psychopharmacology (Berl). 2002 Jan;159(3):319–124. 2. Enwonwu CO, et al. Arch Oral Biol. 1995 Aug;40(8):737–742.

Advanced Clinical Focus: Hormones and Endocrinology B-Complex and Vitamin C

• RPCDB trial, 215 males, 30-55, full-time

• Measures:

• Proﬁle of Mood States (POMS)

• Perceived Stress Scale (PSS)

• General Health Questionnaire (GHQ-12)

• Supplementation = improvements on PSS and GHQ-12 and the “vigor” sub scale of the POMS

Psychopharmacology (Berl). 2010 Jul;211(1):55-68.

Advanced Clinical Focus: Hormones and Endocrinology Magnesium and Adrenal Function

• Mg deﬁciency = adverse reactions to stress

• Low Mg and high Ca increases release of stress hormones, which further lowers tissue Mg especially under conditions of stress

• Mg deﬁciency increases stress, paradoxically increases CVD and related

J Am Coll Nutr. 1994 Oct;13(5):429-46. Advanced Clinical Focus: Hormones and Endocrinology Omega-3 Fatty Acids and Adrenals

• Omega-3 supplements blunt the stress response elicited by mental stress

• Epinephrine, cortisol, and energy expenditure were all signiﬁcantly decreased with ﬁsh oil

• Omega-3 deﬁciency adversely affects learning and cognitive behaviour

• Omega-3 prevents CVD, Type2D, metabolic syndrome, hyperlipidemia, and depression

Delarue J, et al.,. Diabetes Metab. 2003 Jun;29(3):289–295. Moriguchi T, et al., J Neurochem. 2000 Dec;75(6):2563–2573. Hutchins H, Vega CP. Med-GenMed. 2005 Oct 19;7(4):18.

Advanced Clinical Focus: Hormones and Endocrinology Stage-Speciﬁc Botanicals

• Stage 1 and 2: Stressed and tired/wired

• Ginseng

• Cordyceps

• Rhodiola

• Phosphatidylserine

• L-theanine

Advanced Clinical Focus: Hormones and Endocrinology Panax Ginseng

• Helps adrenals recover

• Improves cortisol response

• Enhances energy metabolism during exertion

• Anti-anxiety affects

Avakian EV, et. al Planta Med 1984 Apr;50(2):151-154. Bhattacharya SK, Mitra SK. J Ethnopharmacol 34(1991):87-9.2. Advanced Clinical Focus: Hormones and Endocrinology Panax Ginseng

• Stimulates the immune system, increasing activity of natural killer cells

• Protects neurons from toxicity and hypoxia

• Improves cognitive performance

• Anti-atherosclerotic activity

• Improves wound healing

• Decreases allergic response

• Enhances insulin sensitivity

Radad K, et al. J Pharmacol Sci. 2006 Mar;100(3):175–186.

Advanced Clinical Focus: Hormones and Endocrinology Panax Ginseng

• 200 mg BID standardized extract 4% ginsenosides

• American ginseng = less stimulating

• Asian ginseng = more stimulating

Panossian A and Wagner, H. Stimulating effect of adaptogens: an overview with particular reference to their efﬁcacy following single dose administration. Phytother Res. 2005 Oct;19(10):819‐38.

Advanced Clinical Focus: Hormones and Endocrinology Cordyceps sinensis

• ↑s cortisone production

• ↓s blood glucose

• ↓s blood lipids

• Protects kidneys

• Stims immune (T-helper, NKC) Advanced Clinical Focus: Hormones and Endocrinology Cordyceps sinensis

• 400-800 mg BID

Panossian A and Wagner, H. Stimulating effect of adaptogens: an overview with particular reference to their efﬁcacy following single dose administration. Phytother Res. 2005 Oct;19(10):819‐38.

Advanced Clinical Focus: Hormones and Endocrinology Rhodiola Rosea

• Anti-fatigue effects that ↑s mental performance/ concentration

Olsson EM, et al. Planta Med. 2009 Feb;75(2):105-12.

Advanced Clinical Focus: Hormones and Endocrinology Rhodiola Rosea

• Some stress chemicals may act as excitotoxins

• Rhodiola prevents excessive calcium channel activity induced by KCl and glutamate

J Asian Nat Prod Res. 2006 Jan-Mar;8(1-2):159-65. Advanced Clinical Focus: Hormones and Endocrinology Rhodiola Rosea

• Signiﬁcantly improves depression, insomnia, and emotional instability

• Reduces general fatigue under stressful conditions

Darbinyan V, Phytomedicine 2000 Oct;7(5):365-71. Spasov AA et al. Phytomedicine 2000 Apr;7(2):85-9.

Advanced Clinical Focus: Hormones and Endocrinology Rhodiola Rosea

• 100-1000 mg/day (increase over 1 week)

• Possible stimulating effect in sensitive individuals

• Take 30 minutes before meals

Phytomedicine. 2003;10(2‐3):95‐105 single dose research Panossian A and Wagner, H. Stimulating effect of adaptogens: an overview with particular reference to their efﬁcacy following single dose administration. Phytother Res. 2005 Oct;19(10):819‐38.

Advanced Clinical Focus: Hormones and Endocrinology Phosphatidylserine Advanced Clinical Focus: Hormones and Endocrinology Phosphatidylserine

• Blunts cortisol and ACTH

• Improves cognitive function on tasks such as learning and memory skills in elderly

Benton D, et al., Nutr Neurosci. 2001;4(3):169–178. Maggioni M, et al. Acta Psychiatr Scand. 1990 Mar; 81(3):265–270.

Advanced Clinical Focus: Hormones and Endocrinology Phosphatidylserine

• PS at 300-800 mg/day has been shown to attenuate the serum cortisol response to acute stress, increase performance, improve mood, and lower feelings of stress

• For sleep take 300-800 mg 1-2 hours before bed

Kingsley M. Sports Med. 2006;36(8):657-69. Starks MA, et al. J Int Soc Sports Nutr. 2008 Jul 28;5:11

Advanced Clinical Focus: Hormones and Endocrinology L-Theanine (from green tea)

• Attenuates response to acute stressor

• ↓ed HR and salivary IgA demonstrated

• ↑s dopamine and serotonin

Kimura K, et al. Biol Psychol. 2006 Aug 21 Yokogoshi H, et al., Neurochem Res. 1998 May;23(5): 667–673 Advanced Clinical Focus: Hormones and Endocrinology Brain Waves

L-theanine

Advanced Clinical Focus: Hormones and Endocrinology L-Theanine (from green tea)

• 200-1200 mg per day in divided doses

Advanced Clinical Focus: Hormones and Endocrinology Chocolate

• 40 grams of chocolate for 14 days

• ↓ed urinary excretion of cortisol and catecholamines and partially normalized stress-related differenced in energy metabolism

Proteome Res. 2009 Dec;8(12):5568- Advanced Clinical Focus: Hormones and Endocrinology Stage-Speciﬁc Botanicals

• Stage III: Stressed and Depleted

• Licorice

• Ashwagandha

• St. John’s Wort

• Valerian

Advanced Clinical Focus: Hormones and Endocrinology Withania somnifera - Ashwagandha

• Revered “vitalizer” in Ayurveda American Pharmacopeia™ (Charaka Samhita 1000 BC) aAnmde !richaernapHeuetribca"l oPmhpaenrmdiaucmopoeia Ashwagandha Root • Used for weakness caused by age, Withania somnifera Analytical, Quality Control, illness, overwork, sleep deprivation, and Therapeutic Monograph

or nervous exhaustion April 2000 Editor: Roy Upton Herbalist Associate Editor Cathirose Petrone

Research Associate Diana Swisher BA • Traditional use: stress tolerance, Board of Directors Roy Upton President American Herbal Pharmacopoeia™ Santa Cruz, CA

vigor, stamina, convalescence, Michael McGuffin President American Herbal Products Association Silver Spring, MD nervous exhaustion, fatigue, geriatric Joseph Pizzorno ND Founding President Bastyr University debility, physical and mental stress, Kenmore, WA

insomnia A H P

• Studies conﬁrm HPA balancing action

Singh N, et al. Withania somnifera (Ashwagandha), a rejuvenating herbal drug which enhances survival during stress (an adaptogen). Int J Crude Drug Res 1982;20(1):29-35. Gupta SK et al. 39-47.Cardioprotection from ischemia and reperfusion injury by Withania somnifera: a hemodynamic, biochemical and histopathologicalassessment. Mol Cell Biochem. 2004 May;260(1-2):

Advanced Clinical Focus: Hormones and Endocrinology Withania somnifera - Ashwaganda

• Moderates the stress response

• Lessens depression

• ↓s blood sugar

• Improves glucose tolerance

• ↓s cortisol

• Improves cognition

• ↓s stomach ulcers

• Supports thyroid

Bhattacharya SK, et al., Pharmacol Biochem Behav. 2003 Jun;75(3):547–555. Visavadiya NP, et al. Phytomedicine. 2007 Feb;14(2-3):136-42. Advanced Clinical Focus: Hormones and Endocrinology Withania somnifera - Ashwagandha

• 500-1000 mg 2x/day

• Standardized to contain at least 1.5% withanolides

• Minimum of 1-6 months

Advanced Clinical Focus: Hormones and Endocrinology Glycyrrhiza glabra - Licorice

• Lowers cortisol, cortisone, aldosterone and prostaglandins

• Cortisol sparing effect

Cortisol - Cortisone Glycyrrhizic acid

↑ Na Aldosterone-like effects ↓ K ↑ BP

Baker ME, Fanestil DD. Licorice, computer‐based analyses of dehydrogenase sequences, and the regulation of steroid and prostaglandin action. Mol Cell Endocrinol. 1991 Jun;78(1‐2):C99‐102. Armanini, D., et al., Steroids 2004; 69(11-12):763-66.

Advanced Clinical Focus: Hormones and Endocrinology Glycyrrhiza glabra - Licorice

• 1-2 grams per day

• Solid (dry powdered) extract (4:1): 250 to 500 mg Advanced Clinical Focus: Hormones and Endocrinology

Hypericum perforatum-St. John’s Wort

• People with major depression often have excessive HPA activation manifested by hypersecretion of ACTH and cortisol

• SJW effect genes involved in HPA regulation

• Flavonoids from SJW shown to ↓ ACTH and corticosterone after 2 weeks

Planta Med. 2004 Oct;70(10):1008-11.

Advanced Clinical Focus: Hormones and Endocrinology

Hypericum perforatum-St. John’s Wort

• 900-1800 mg per day

• Standardized extract: 0.3% hypericin and 3% to 5% hyperforin

Advanced Clinical Focus: Hormones and Endocrinology Valerian

• Valerian promotes cell proliferation in the hippocampus of the depressive rats, and may play a role in saving injured neurons on the hippocampus

Zhong Xi Yi Jie He Xue Bao. 2008 Mar;6(3):283-8. Advanced Clinical Focus: Hormones and Endocrinology Valerian

• 1.5-3 grams per day

Advanced Clinical Focus: Hormones and Endocrinology Nutraceutical Application

• Multi-vitamin • PS 600 mg at noon and evening • Adaptogens morning and afternoon • L-theanine 200 mg 3x/day

Low Normal Optimal Normal High 50

37.5

12.5

0 Morning Noon Evening Night

Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction

• Multi-vitamin • Licorice root

• Adaptogens throughout day Low Normal Optimal Normal High 50

37.5

12.5

0 Morning Noon Evening Night Advanced Clinical Focus: Hormones and Endocrinology