Stress, Anxiety, Insomnia…. Sympathetic Dominance…and more

Stress, Anxiety, Insomnia…. Sympathetic Dominance…and more


I. Introduction


Stress. Everyone has it. Some, more than others. A little is healthy. A lot, is not….especially if the stress is underlying, long-term and unremitting.

Without question, the onset of atrial fibrillation brings with it a new dimension of stress and might be argued in the ‘chicken/egg’ arena as to which came first. Regardless, the consequences of ongoing, chronic stress are widely recognized and people with various forms of stress manifestations are often treated with a one-size-fits-all approach and are given anti-anxiety or antidepressant drugs while the true cause of the stress manifestation goes unaddressed. Not an uncommon scenario.

A typical complaint from Afibbers is the prevalence of increased stress and anxiety related to the Afib, itself, or from the anticipation of the next occurrence and all that ensues downstream which often includes insomnia, gut disturbances and other symptoms. There is a connection between stress, increased cortisol production and inflammation. For afibbers, this inflammation can promote more events, the risk of thick, sticky blood and more.

…. “At the cellular levels all stress creates an inflammatory state caused by an overproduction of pro-inflammatory eicosanoids. Cortisol is sent out to lower the levels of these eicosanoids which is fine over the short run when stress is temporary. But having a high level of constant silent inflammation means you are going to have high levels of cortisol on a permanent basis, causing a number of nasty consequences such as increasing insulin resistance (which makes you fatter), killing nerve cells (which makes you dumber), and depressing your entire immune system (which makes you sicker). This is the collateral damage that comes from increased silent inflammation.”

….”Silent inflammation is the first sign that your body is out of balance and you are no longer well. You can’t feel it, but it is affecting your heart, your brain, and your immune system.” [References: Barry Sears, PhD The Anti-Inflammatory Zone]

This overview report briefly examines current thinking about the underlying stress response/feedback loop mechanism and why specific support is needed to help us either recover from stress and burnout or prevent progression of the inevitable if stress is not recognized or managed appropriately. This is a well-studied area of research and a large number of reports and papers are available that delve deeply into the topic. My notes and quotes are from various teleconferences and publications with functional medicine practitioners experienced in treating this type of patient. [References]

The intention is another Awareness Alert on the impact of stress on the body and to emphasize that in order to get relief, the sources of stress need to be recognized and managed and that appropriate testing is vital to make any sort of progress rather than just throwing pills at it as temporary guesses or fixes.

One of the very first assessments a nutritionally-oriented practitioner should do is assess the Hypothalamic-Pituitary-Adrenal Axis (HPA Axis) function. If that’s not done, find another practitioner to avoid spinning your wheels and spending a lot of time, energy and money.

It’s important to recognize the overall impact of stress on our health and functionality regardless if it’s stress initiated by Afib or other influences such as a demanding job, family issues, toxic burden, genetics, diet, overall health status, unemployment, social network, the economy or an early life trauma that remains imbedded in our subconscious. It all manifests initially by affecting the sympathetic side of the autonomic nervous system and then, all that follows as a result of that activation. We now have many more PTSD patients returning from military duties who are deeply stressed as well.

Practitioners report that job stress is highly prevalent…whether it’s mentally or physically demanding, it’s still stress. Working long hours and juggling family responsibilities add more stress and work days seem to be getting longer.

The patient’s toxic burdens not only add more stress but also interfere with the body’s natural detoxification pathways so just throws more fuel on the fire.

There are numerous effective (yet temporary) aids that help relax us and blunt the magnitude of the anxiety and physical feelings often rooted in understandable fear that accompanies an Afib event simply because of the unknowns as we begin the afib journey. It is, after all, your heart doing flip-flops and it’s not at all pleasant. Afib can be scary and often downright uncomfortable or even debilitating.

Most important, though, is determining by specific testing the underlying root cause of various organic dysfunctions and then treating with appropriate support because when adrenal issues (HPA A) are not addressed, then problems compound.

II. Signs and Symptoms
Practitioners typically find a brief questionnaire or first visit patient interview is useful as a start to determine the type and degree of stress.

It’s commonly asked… on a scale of 1 – 10, where is your stress level ? – 1 being low stress. Practitioners typically report that the response number is high and rarely 1 or 2.

Answers to questions such as the following can be large clues as to where to begin the focus. Patients are often asked what their health goals are so that they ‘own’ the problem and become their own health manager. It doesn’t work if they don’t buy into the program.

- How’s your energy level? Are you crashing mid-afternoon?
- Libido?
- Are you craving salty foods?
- Are you craving sugars and carbs?
- Do your wounds heal slowly?
- Do you have trouble falling asleep and /or staying asleep?
- Is your body tender to touch? Or more sensitive to weather changes?
- Do we see more thyroid symptoms despite ‘normal’ labs?

One telling question relates to self-medicating with stimulants and then needing something to relax or unwind in the evening or bedtime. Patients often report needing 6 or more cups of coffee to get them going and sustained throughout the day; yet winding down for sleep is impossible with the “tired, but wired” feeling so alcohol or other drugs are needed.

Symptoms or manifestations of stress can affect glandular function such as thyroid, hormonal, liver, pancreas, thymus (immune system) and as detailed later… the Hypothalamic Pituitary Adrenal Axis so it’s easy to see how one’s system can become unbalanced or aggravated when under chronic, ongoing stress.

A few of many common symptoms:

HPA – over-responsiveness - (catecholamines) excessive sympathetic nervous system issues
- hyper-aroused,
- hyper-vigilant
- anxious, worried
- elevated cortisol
- belly fat or weight loss
- decreased appetite
- decreased libido
- insomnia
- hypertension
- tachycardia
- arrhythmias
- pain and inflammation

Under-responsive – (excess parasympathetic nervous system)
- lethargy, fatigue, apathy
- low motivation
- low cortisol
- weight gain
- increased appetite
- hypersomnia, excessive sleep
- depressed immune activity
- auto-immune disorders and chronic pain

There are different stages of adrenal fatigue and burnout and cortisol can be either high or low…eventually high becomes low.

This is the end of the first segment.

Following segments review current thinking on the Stress Response Adaptation, Testing, and Nutritional Management of Stress-Induced Dysfunction. As you might surmise, research references are abundant. An abbreviated source list will be provided with hyperlinks.

Jackie

Great post Jackie,

Thanks, am starting day two at the International Symposium on the Left Atrial Appendage this Saturday morning (yes the LAA, once almost an afterthought in heart anatomy, has now risen in importance as both the significant stroke risk but also major source of arrhythmogenisis as to warrant its very own annual conference and is very well attended.

More later, first talk is underway.

Shannon

Fantastic piece Jackie.

A lot of the topic and symptoms feel very familiar.......

Looking forward to the rest

Thank you again, Jackie, for another valuable Forum contribution. Am holding my breath for the next segment!

Louise

Thanks for the post, Jackie.


Phil

Segment 2

Stress, Anxiety, Insomnia… Sympathetic Dominance and more…

Terminology (for clarification of terms used in the following segment … just short comments – Google for elaborations)..

Catecholamines… are hormones that function as neurotransmitters and include dopamine, norepinephrine and epinephrine and are made by the adrenal glands… mainly the adrenal medulla. (Epinephrine was formerly called adrenaline. I still like it because everyone knows what an ‘adrenaline rush’ or adrenaline surge is).

Catecholamines control
• muscle tone
• heart rate
• blood pressure
• glucose (sugar metabolism)

Catecholamines are primarily produced in adrenal glands. Levels fluctuate in response to
• physical and emotional stress
• outside temperature
• blood loss
• exercise
• low blood sugar
• postural changes.. going from sitting to standing and vice versa.

Catecholamines break down into inactive substances in the body and show up in urine which can be measured by metabolic ash testing. [see Testing segment]

Dopamine becomes homovanillic acid (HVA)
Norepinephrine shows up in vanilmandelic acid (VMA)
Epinephrine shows up in VMA as well.
Serotonin breaks down to 5-Hydroxyindolacetate (5-HIA).

Neurotransmitters are brain chemicals found inside brain cells (neurons) that carry, relay and modulate signals (messages) such as heart rate, breathing and digestion between neurons (nerve cells) and other cells in the body. Neurotransmitters affect mood, sleep, focus or concentration and weight stability and when out of balance, can cause multiple adverse symptoms. Estimates are that 86% of the US population has suboptimal neurotransmitter levels caused by detrimental influences such as stress, poor diet, neurotoxins, genetics, drugs (prescription and recreational), alcohol and caffeine. Adult humans have 100 billion neurons-- each capable of making thousands of connections.

Neurotransmitters function as inhibitory and excitatory… excitatory meaning they stimulate the brain. Those that calm the brain and create mood balance are inhibitory. Inhibitory neurotransmitters are easily depleted when excitatory neurotransmitters are overly active.

Inhibitory Neurotransmitters include:
Serotonin – stabilizes mood and balances excessive excitatory neurotransmitter firing in the brain and plays a large role in regulation of mood, appetite, memory and learning. Using caffeine or stimulant medications daily can cause depletions of serotonin over time. Serotonin functions to regulate carbohydrate cravings, sleep cycle, pain control and functional digestion. Low levels of serotonin are associated with decreased immune system function. A lack of serotonin may result in low self-esteem, depression and/or aggression.

GABA – is often called “nature’s Valium-like substance.” GABA can have high or low excretion values out of range when an excitatory neurotransmitter in the brain is firing too often so GABA is sent to help balance the stimulation or over-firing.

Dopamine – plays a dual role as it can be both excitatory and inhibitory. Dopamine helps with depression and focus…detailed more in the Excitatory section. Dopamine helps information to flow to higher levels in the brain and plays a key role in regulating pain and pleasure.

Excitatory Neurotransmitters:
Dopamine - is the main ‘focus’ neurotransmitter. When either elevated or low, there can be focus issues as remembering where we put our keys, forgetting what we’ve just read or finding it difficult to stay “on task.” Dopamine is responsible for motivation or desire to get things done. Stimulant medications for ADD/ADHD and caffeine cause dopamine to be pushed into the synapse for improved focus. Over time, this continual stimulating can cause depletion of dopamine.

Dopamine is the one neurohormones most involved in evaluating a set of circumstances –such as ‘is this threatening’? or non-threatening? Dopamine is the key fear hormone

Norepinephrine – responsible for the body’s stimulatory processes. Helps make epinephrine. Can cause anxiety at elevated excretion levels and also has mood dampening effects. Low levels are associated with low energy, decreased focus ability and sleep cycle problems.

Epinephrine – excitatory and directly reflective of stress. Gets the body going in situations that require instant action or involve fear or danger. Often elevated when ADHD symptoms are present. Can become depleted with long-term stress or insomnia. Regulates heart rate and blood pressure.

Melatonin - is a ubiquitous, natural neurotransmitter-like compound produced primarily by the pineal gland. (Damage to the pineal gland by fluoride was presented in the post on brain health.) The enzymes of melatonin synthesis are activated and depressed, respectively, by darkness and light. Release of melatonin follows a circadian (circa: about; dias: a day) rhythm generated by the suprachiasmatic nuclei in response to daylight alterations. Through melatonin release, the pineal gland maintains the internal clock governing the natural rhythms of body function.

Melatonin is involved in numerous aspects of the biological and physiologic regulation of body functions. The role of endogenous melatonin in circadian rhythm disturbances and sleep disorders is well established. Melatonin synthesis depends on intact beta-adrenergic receptor function. Norepinephrine activates the N-acetyltransferase and beta-receptor blockers depress melatonin secretion.

Acetylcholine (ACh) is also the principal neurotransmitter in all autonomic ganglia. In cardiac tissue acetylcholine neurotransmission has an inhibitory effect, which lowers heart rate. However, acetylcholine also behaves as an excitatory neurotransmitter at neuromuscular junctions in skeletal muscle. It stimulates all muscle contractions and hence all behavior.

ACh is the transmitter of the parasympathetic half of the autonomic nervous system.
ACh is a transmitter in many brain areas (cortex, basal ganglia, hypothalamus to name a few) and is necessary for normal memory and cognition and motor control.

Terminology definition resources… [References]


Keep in mind as you read Part III, that Cortisol (a neuropeptide) interferes with the function of neurotransmitters; ie, interrupts transmission of messages from neuron to neuron.

Taurine: Throughout the literature and interview commentaries, Taurine is mentioned as being very useful as a membrane stabilizer. Taurine functions as an inhibitory transmitter in the cerebellum and is useful to depress seizure activity. It has a role as in inhibitory neurotransmitter. Taurine, a conditionally essential amino acid, is found to be abundant (or should be) in electrically excitable tissues such as brain, retina, heart and skeletal muscles. Taurine has been found as a protective agent against several environmental toxins and drug-induced multiple organ injuries resulting from hepatotoxicity, nephrotoxicity, neurotoxicity, testicular toxicity and cardiotoxicity in animal models.


III. The Stress Adaptation Response - Chronology & Current Views

[Notes and quotes from Moss/Brady interview - References]

The stress response is a normal, functional reaction intended to help us survive times of danger and was named the “fight or flight” stress response by the “Father of the Stress Response” Endocrinologist, Hans Selye, who brought forth the General Adaptation Theory in the mid-1900’s. Selye helped us understand that while everyone experiences stress or feels anxious at various times in certain situations and is a normal, functional reaction intended to help us survive danger, it’s not medically appropriate to have ongoing, unremitting stress. When that happens, various systemic dysfunctions and adaptations occur that eventually affect multiple organ spill-over into other organ involvement and health disorders.

The system whereby the body copes with stress, the hypothalamic-pituitary-adrenal axis (HPA Axis) system, was also first described by Selye. He pointed to an "alarm state," a "resistance state," and an "exhaustion state" largely referring to glandular states. Later he developed the idea of two "reservoirs" of stress resistance or stress energy. The neuro-endocrine involvement of the HPAA also involves thyroid function and the back and forth interplays so when addressing stress-related manifestations, one can’t just focus on the adrenal glands.

In the ‘90’s, clinicians observed not only the alarm and adaptation phase where we encountered stress, increased cortisol and catecholamines (epinephrine and norepinephrine) but a progression to chronic stress where cortisol levels remained elevated. The thinking became that elevated cortisol was no longer viewed as aberrant but a physiological adjustment. The ‘90’s were the fast-paced world of the high-flying baby boomers, skipping meals, getting by with four hours of sleep, feeling great because they were “adapted” and their elevated cortisol was seen as the norm.

At the end of the 20th century and into the 21st century beginning around 9/11, clinicians began noticing an alarming switch where patients looked stressed out and had the same symptomatology but cortisol tested as low. The thinking became that the focus had been too centrist on just the adrenals. It was wrong to focus just on elevated cortisol since there were other stress hormones involved that should be tested including the catecholamines, epinephrine, norepinephrine, in the chronically-stressed patient.

The problem of being chronically stressed continually is the resultant catabolic state or destructive metabolism. Along with this, eventually DHEA declines, but the stress continues and as the saying goes: “we have beaten the horse until it falls down” and we have the classic adrenal exhaustion or burnout.

Since 9/11 and especially in Northeastern US, clinicians report seeing many more of a different type of stressed patient who is not necessarily totally wiped out and fatigued, but rather, the opposite. They have the anxiety, palpitations, insomnia and are clearly stressed out plus cortisol measurements can be either high or low depending on the stage of the adaptation paradigm they are in. Testing is essential in order to treat the patient whether they test high or low so the appropriate systems can be supported.

What we typically see now is patients typically don’t have the old concept of depleted catecholamines,.but rather they actually have elevated catecholamines that we can now measure with metabolic profile testing…both the basic and comprehensive by organic acid evaluation showing the vanilmandelate (VMA) which is the ash of epinephrine and nor- epinephrine and also the HVA or homovanillate which is the ash of dopamine.…which serve as a guide for treatment approaches along with cortisol and DHEA. The literature really documents this adaptative response …in that when cortisol gets low and the adrenal cortex is quote: “exhausted” there is compensatory up-regulation of catecholamines so you have the sympathetic system come in-- the medullary hormones come in and pick up the slack.

Exactly correct. Landmark papers by Per Bjorntorp out of Scandanavia one of the great stress researchers and probably the first researcher to suggest that metabolic syndrome or Syndrome X was not just insulin and that stress came into play; that cortisol was a factor also which wasn’t widely accepted at that point. It was very revolutionary at the time. In the 90’s when Syndrome. X came out – the work of Gerald Reaven, everyone was looking at Insulin and Bjorntorp was one of the first to say “No, insulin is part of it but (he said) there is more to it than that.”

He said the concept of exhaustion that Seyle put out – the adrenals just collapse is not quite that clear cut. We really have to realize the two parts to the adrenals and the idea that they function in sequence all the time (one does what the other does is kind of antiquated thinking). As the adrenal cortex starts crashing… in the adaptation phase, the cortex is carrying most of the weight and after a period of never ending chronic stress the cortex just collapses.. .but as a last ditch effort…as mentioned., the medulla starts kicking in with sympathetic compensation and you start seeing the classic symptomatology. Generally, it’s the baby boomer, has years of stress and what we tend to see for example--patient says for years I’ve been depressed, lethargic, I wake up in the middle of the night, can’t fall back to sleep. Now, I feel anxious and now I can’t fall asleep at all. I have insomnia and all of a sudden I have these heart palpitations – I’m anxious, I’m worried but not depressed.

That’s a signal that catecholamine response is beginning to kick in for sympathetic compensation. Now, eventually what happens according to Bjorntorp is that you do get true burnout where both the medulla and cortex collapse and now you are into that true chronic fatigue syndrome a phase where the literature suggest from an endocrine standpoint, as well, We know Chronic Fatigue Syndrome can be related to many different things. From an endocrine standpoint, it’s total adrenal, total HPAA collapse.

Where do we see this clinically? One of the main areas is PTSD …and it’s not what we think of as classical PTSD as concentration camp survivors, but now in today’s world with 9/11, Iraq war, .an interesting issue is fewer are dying in wars as the upside, but the downside is that many are coming back maimed not only physically but psychologically and families are involved in these tragedies with many people directly and indirectly touched. It’s well documented that we are seeing this clinically.

In the PTSD patient, the elevated catecholamines can actually cause neuroplastic changes in the limbic system which affects serotonin levels, substance P levels and ultimately their perception of pain….and it can cause everything from the fibro fog, fatigue and symptoms that we relate with true, classic fibromyalgia but now with see with PTSD as one of the first variants we saw coming in our office but maybe didn’t know it at the time.

One of the things when you read the sad histories on PTSD patients and certainly FM patients, is the tragic amount of misdiagnosis and mistreatment. Just think about it. Classic PTSD patient walks into the classic, somewhat educated nutrition office and who thinks… “stress patient and typically thinks..we have to lower the cortisol” and we know even today that in many recent past Stress seminars, the focus is solely on just cortisol as being the issue… whether high or low. or even just cortisol. The point being, if you are cortisol centric and try to optimize that but ignore the catecholamines, it’s going to be a very frustrating experience for these patients.

So the bottom line is…we must understand the stress response better and the PTSD response in particular so that in these classic Fibromyalgia patients we’ve known for a long period of time and in the history of patients who have PTSD develop over a long period of time may have had a very stressful event which could be childhood abuse, sexual, psychological, physical abuse or could be could be a very significant unresolved issue with a parent, sibling, spouse. We’ve seen it after car accidents and with people who witnessed horrible events, so it makes more sense now why people would develop a such syndrome after such a stressful event.

A relevant point about testing these patients…On cortisol findings --.specifically salivary cortisol findings on your burned out, low cortisol, PTSD patients, Bjorntorp talks about the “classic reverse curve."

In the salivary cortisol evaluation, the classic curve is parabolic-- starts high in the morning and it gradually decreases to the lowest point at night.-- even in the case with the classic elevated adrenal scenario you’ll still see some variance of high in the morning and low at night. But what you see in these patients-- ie the Bjorntorp reverse curve is they are low in the morning from a relative standpoint and higher at night – you’ll see almost a flat-line starting to go up in the evening and of course what tends to go along with that symptomatically, this patient who gets up in the morning and is exhausted – can’t get going, but at night when the cortisol is a little higher, can’t go to sleep; insomnia. And of course going along with that to accentuate the problem is the catecholamines. That’s one of the key findings that you’ll see from a cortisol standpoint in addition to what we discussed on the catecholamines.

So in addition to having those salivary tests looking at cortisol and DHEA throughout the day, having VMA, HVA and even 5 HIAA – the serotonin marker—tested is vital so the clinician looks at the whole picture including high or low cortisol and catecholamines. . And of course, there are multiple variations so patient treatment depends on the patterns as well as the history.

Note: If you haven’t read Conference Room session 2 – LAF and the Hormone Response by Hans Larsen, this is a reminder to do so or refresh your memory by reading again. Everything works in synergy…or should. [www.afibbers.org]

The final segments include Testing, Treatments and Key References.


Jackie

Final Segment

III. TESTING

Testing must be done to learn which systems are out of range so that supportive treatment can be effective.

Cortisol sampling is a timed collection of urine or saliva. Some practitioners use both. DHEA-S should be included in cortisol evaluations.

For neurotransmitters, fortunately, more sophisticated organic acid testing is available and can measure both a basic and comprehensive metabolic profiles. One urine collection segment measures neural function related to the metabolic ash of neurotransmitters, (epinephrine and norepinephrine). These measurements are significant if either high or low since abnormalities can relate to symptoms of mental, emotional and behavioral problems.

o Vanilmandelate (VMA) is ash of epinephrine and norepinephrine
o Dopamine becomes homovanillic acid (HVA)

Low levels indicate your body is not making enough of these neurotransmitters. Associated symptoms include depression, sleep disturbances, inability to deal with stress and fatigue. Treatment includes improving digestion and specific supplements to keep up with demand for the neurotransmitters.

Elevated markers indicate over-activation of nervous system function and is commonly associated with stress – both internal (mental/emotional) and external (environmental toxins) and anxiety.

(3) 5-Hydroxyindolacetate (5-HIA) is the breakdown product of the neurotransmitter, serotonin. Low levels indicate inadequate production of serotonin. Symptoms include constipation, depression, fatigue, insomnia and attention deficit and behavioral disorders. High 5-HIA occurs with increased utilization and breakdown of serotonin. If the person is taking an antidepressant, this can cause a significant increase in the amount of serotonin made and broken down which contributes to loss of the essential amino acid, L-tryptophan, from which serotonin is made. Digestion and gut health is involved as well. Therapy typically focuses on protein digestion via adequate stomach acid and pancreatic enzymes along with high consumption of tryptophan. Plus probiotics.

[Aside: Often people with either naturally low cholesterol levels or those with statin-induced low levels suffer from a decrease in the number of serotonin receptors in the brain as cholesterol levels become lower. Serotonin is one of the critical neurotransmitters involved in mood. …”The reciprocal connections of the serotonin and circadian systems likely have importance for neurobehavioral disorders, as suggested by their convergent contribution to a similar range of mood disorders including seasonal affective disorder (SAD), bipolar disorder, and major depression, and as suggested by their overlapping relationship with the developmental disorder, autism spectrum disorder.” [Neuroscience. 2011]

(4) Quinolinate elevations are caused by inflammatory processes induced by the immune system during infection and in the brain, can cause insomnia, irritability and nervousness - remedied by removing the source of inflammation and with magnesium supplementation.

Urine and Saliva testing for Cortisol and DHEA levels are readily available from various labs including Metametrix, Genova Diagnostics and Meridian Valley has a 24-Hour Urine Steroid Hormone Test.

Intestinal health can also play into insomnia issues as 95% of serotonin is produced in the gut by the enteric nervous system meaning sleep issues can start there so remedies also need to start there.

More complicated brain function issues also involve the biochemistry of methylation dysfunctions and the experienced clinician will know when that testing is also appropriate.

Reliable labs offer Comprehensive Metabolic Testing for Organic Acid evaluations and Adrenal Stress Profile, Comprehensive Digestive Stool Analysis testing:

Genova Diagnostics [www.gdx.net] [www.gdx.net] [www.gdx.net]

Meridian Valley [meridianvalleylab.com] [meridianvalleylab.com]

Metametrix [www.metametrix.com] [www.metametrix.com]

Be aware that chronically elevated levels of stress hormones have been linked with a variety of pathological processes including peripheral vasoconstriction, platelet hyperaggregtion and clotting, neuronal degeneration, insulin resistance, reduced cell-mediated and humoral immune responses and visceral fat deposition. So along with cortisol and neurotransmitter testing, one should also be evaluated for markers of these adverse health conditions. [Prothera]

A previous post on Stress,anxiety, insomnia based on an interview with clinical psychologist and author of The Mood Cure, Julia Ross, indicates this is a self-help book using questionnaires as self-evaluations for assessing mood, stress and emotions. In the symptoms list, one part allows the reader to assess where they are on the Adrenal Burnout continuum. (pp 79-80). © 2004. This book is definitely worth owning, especially for those in the pre-adrenal fatigue. [See Summary details]

IV – TREATMENTS

Functional Medicine (FM) practitioners agree that treatment does not begin with pills or potions of anything, but rather starts with basic assessments of lifestyle, dietary habits, and environmental toxins and then full commitment to the program. Patients must be an active participant in their recovery plan.

FM practitioners also agree problems arise when, all too often, patients present with typical adrenal stress symptoms and they are immediately prescribed oral hydrocortisone (Cortef) rather than doing the basic assessments. While in some cases, hydrocortisone may ultimately be necessary, they typically don’t think it should be the starting point. Problems arise when patients are not followed closely and especially when doses aren’t gradually lowered until the patient can wean off totally and then just support by natural means.

Quite often, hypoglycemia is a largely-overlooked source of stress. Either the patient may not make the connection or the doctor doesn’t delve deeply enough in the initial verbal assessments to make the association. Frequent findings indicate a large amount of biologic/systemic stress can be reduced with the proper eating choices and patterns. Food sensitivities and true allergies produce stress. When people eat the same foods daily and are also sensitive to the food, stress complications start to build.

Sleep…people aren’t sleeping properly or predictably. Sleep patterns differ wildly on weekends and it’s critical to keep to the same schedule with sleep starting around 10 pm and getting up at 6:30 or 7 am…consistently. The bedroom should be a dark, cool, comfortable place for sleeping and intimacy. Beds not shared with dogs or kids and no TV or WiFi connected in the bedroom…at all. Period. Do not sleep with cell phones turned on. Upon awakening and if there is sunshine, take a short walk in the sunshine to start the day. Or in winter, at least pull up the shades and let in the sunlight.

Breakfast – very important to get adequate quality protein intake and not the typical American breakfast of high carbs and caffeine as that’s a death sentence for the adrenals.

When you self-medicate with caffeine to wake up or alcohol to calm down or snack on sugar for energy, that’s counterproductive to adrenal healing and can set yourself up for a stress cycle throughout the day

Adequate caloric intake. Sufficient, high quality calories every day. When one is subsisting on 1,000 calories or less a day, that’s starvation and a huge stressor, itself. No treatment will work and you just become worse.

Stress Reduction Techniques for relaxation such as meditation, yoga, prayer, reading, Pilates, guided imagery, deep breathing, whatever you enjoy and do it for 10 minutes or so several times a day. Do something every day for fun and enjoyment. That’s mandatory. Don’t forget EFT – tapping for quick stress reduction.

Learn about toxins in your home, environment, food and water and take steps to eliminate or reduce significantly. They all are stressors.

SUPPLEMENTATION – SUPPORTIVE NUTRIENTS

Test results and symptoms dictate treatment approaches and specific supportive nutrients.

Classic adrenal or stress nutrients that enhance resistance to a wide variety of stressors include herbals and specific vitamins… such as vitamin C, phosphorylated forms of B vitamins (B2, B5, B6 and folate)… all very important for adrenal cortex and medulla and for the production of the adrenal hormones such as catecholamines. The most bioavailable form of L- tyrosine (N-Acetyl-L-Tyrosine) is useful as the building block of catecholamines often depleted under chronic stress conditions. .Also, vitamin D if testing indicates low levels.

Pantothenic acid or vitamin B5 is essential for proper adrenal function and supplementing with this vitamin has been shown to increase adrenal responsiveness to pituitary stimulation. Deficiency results in adrenal hemorrhage, hypertrophic alterations of the adrenal glands and impaired adreno-cortical function.

ADAPTOGENIC HERBALS

Nutrients restore and support the adrenal glands and herbals, called adaptogens, help adapt when challenged by physical or emotional stress. These adaptogenic herbs have a property called amphoteric meaning they are “auto-correcting.” If cortisol is low, they tend to bring it back to a normal physiological range. Conversely, if cortisol is high, they tend to lower to the normal physiological range. The pharmacognic property of some of these herbs allow them to do that whereas drugs usually only send something on one direction.

Botanicals have the advantage of not really stimulating production or inhibiting productions of adrenal hormones--in this case and work mainly on the hypothalamic receptors that recognize cortisol.

Many studies have shown in cases of ADD, and ADHD – where they often have very stressful young lives or even in infancy with lack of parental handling, stressful situations at home, and their cortisol goes high during the developing years of the nervous system, this can actually physically damage or ‘fry ‘ their cortisol receptors in the hypothalamus. So the adaptogenic herbs like the ginseng herbs are known to regenerate and restore the hypothalamic cortisol receptor so that the body can use it to hone homeostatic mechanisms to bring cortisol back where it is supposed to be by allowing the body to recognize cortisol better.

[The interview discussed adrenal support professional grade products by Designs for Health. The following describes the actions of the herbals in their products. Other formulations may be similar and you can compare ingredients, herbal standardizations and dosage amounts in other brands to theirs as a guide by using Google searches. See also the Shames report which lists adaptogenic herbals and thyroid nutritional support such as vitamins A, D, E, zinc and selenium as key nutrients for Stress-Induced Dysfunction – [References]

The good news is that iHerb now offers the Designs for Health, Metagenics, Thorne and Planetary Herbals. It’s always important to buy herbals from extremely reliable sources to assure purity and standardization.

[[b]Caveat[/b]: This report is not a recommendation to dose yourself with these herbals. If you are treating with a clinician who recommends herbals and you are also taking prescribed drugs, it’s always important to check for drug compatibility and any herbal product that may be recommended just to be safe. Verify for yourself to be sure.]

Eleuthrococus or Siberian Ginseng protects nerve cells and assists the adrenals when under stress. Eleuthro has a lot of research from its old Soviet Union days with their athletes, plant workers, showing they were able to do long-term concentration, tasking, repetitive tasks, in particular, with fewer errors and for longer periods of time and they recovered faster from mental stressors. There is a standardized 8% eleuthrosides material in the 200 mg which is a therapeutic dose.

Eleuthro was one of the first herbs considered to have adaptogenic properties so it has had a good deal of performance exposure and a large number of trials. Benefits include lower blood pressure in those with hypertension, improved renal function, improved sleep and sense of well being in those complaining of extreme exhaustion, insomnia, irritability diminished work capacity, improvements in lab tests including immune reactivity and reduced aberrant electrocardiographic activity. [Caution for those with atherosclerotic heart disease… two studies report an associated effect of arrhythmia in a minority of patients.]

[Aside: Interesting dichotomy… Google searches on the arrhythmia connection… if it’s a holistic or natural healing website, the uses will be positive; if it’s traditional medicine, there are warnings about arrhythmias.]

Panax Quinquifolius or American Ginseng and a favorite. Mention Ginsing and most people automatically think about Panax Ginseng or Korean or Chinese Ginseng. The American Ginseng or Panax Quinquifolius is actually stronger per milligram as an adaptogen. Very prized in Asia. In fact, it was exported so aggressively to Asia because it was so valuable and they wanted it so much over there as they appreciated how efficacious it was, they almost wiped out the North American crops so the Government put on strict controls and now the plant has come back… growing in the northern Mid-west – Wisconsin, Minnesota areas.

The wonderful thing about American Ginseng is that not only is it stronger as an adaptogen than Asian ginseng but is unlike Chinese and Korean ginseng which actually is a little bit stimulating. We’ve all heard of ‘ginseng abuse syndrome’ where it stimulates the catecholamines a bit, but American Ginseng is slightly sedating – if anything. Mostly neutral but lends toward relaxation or sedation.

Ashwaganda – sometimes called Indian Ginseng even though it’s not really part of the Ginseng family. The botanical name for ashwaganda is Withania somnifera . When you hear the word, somnolence – you think sleep and somnifera induces relaxation. It’s a very nice herb that is an adaptogen but it’s not stimulating. Should be standardized to the highest standardization available commercially which is 1.5% withanolides.

Ashwaganda is a safe, natural way of strengthening the body’s stress-response system. Ashwaganda has potent anti-inflammatory and neuroprotective effects. One study found ashwaganda inhibits calcium-induced neuronal excitation and may help to counteract anxiety. In mice studies, ashwaganda reversed memory deficiency induced by injection of beta-amyloid fibrils and suggests it could be useful in preventing and treating dementia-related memory impairment.

A trial in India found that Ashwaganda significantly decreased symptoms of nervousness, palpitations, poor concentration, headache, stomach upset, insomnia, irritability and fatigue in a group of 30 individuals diagnosed with “anxiety neurosis.”

A Canadian trial using ashwaganda to treat 82 postal workers for moderate to severe anxiety were found to have significantly lower anxiety symptoms after 12 weeks.

Rhodiola rosea - Also an adaptogenic herb, Rhodiola grows at high elevations in the Arctic areas of Scandinavia and Asia and has been used for centuries in to reduce fatigue, improve work performance, enhance resistance to physical and mental stress and increase longevity. Rhodiola increases dopamine and is known to enhance physical and mental performance.

Researchers suggest that the adaptogenic effects observed in studies may serve to favorably modulate the HPAA and sympathoadrenal axes. Russian trials have generally found rhodiola to relieve symptoms of fatigue, weakness, poor appetite, irritability and insomnia. Especially promising and useful, medical systems outside the U.S. have used Rhodiola extract to treat “asthenia” or neurasthenia where symptoms include a state of persistent exhaustion accompanied by muscle aches, irritability, headaches and sleep disturbances and was found to effectively alleviate fatigue and other vegetative symptoms. U.S. double-blind, placebo controlled clinical trials found beneficial effects for those working the night shift and problems related to associated thinking, short-term memory, calculation, ability to concentrate and speed of audio-visual perception…as well as improvement of stress during exams.

Glycyrrhiza -The DFH product includes some licorice which is often questioned about being stimulating or beating the dead horse. Might cause hypertension? But the amount of licorice or glycyrrhiza is only 20 mg and is only in there as a balancing, complementary herb. And at 20 mg, it is really there to spare cortisol in the serum.

Glycyrrhiza’s main effect on stress physiology is that it spares cortisol – cortisol lasts longer in serum before it decays. In reality, the wise use of licorice rests the adrenal glands. If you over-use licorice at a higher dose, then you can get into overt cortical stimulation and you can start putting out more cortisol and actually be fatiguing the adrenal glands and potentially causing hypertension. Although, if you look at all the case studies in the medical literature of hypertension, it is generally high-dose licorice – over 150 mg a day for long lengths of time in those who already have hypertension and it exacerbates it. There are precious few cases of licorice even at high doses causing hypertension in a normotensive patient.

Adrenotone™ combines some classic adaptogens. We tried to keep the stimulating ones out and give nutritional support for the adrenals including the best form of tyrosine so this once again is for the person who would have normal cortisol levels and a low VMA or no anxiety component.

CatecholeCalm™ (another DFH product) was designed a little later for a different purpose for the new anxiety-based – high catecholamine, palpitation, panic attack variant. The name tells you what it does….calms the catecholamine pathways down…and is very similar to Adrenotone from a nutritional standpoint. Has the vitamin C, all of the phosphorlated B vitamins B5, B6 etc for adrenal health and magnesium for the calming effect - but it does not have tyrosine as we don’t want to feed the catecholamine pathway but we did include some calming neurotransmitter precursors – such as taurine, L theanine which many have also used separately to calm people down.

But the botanical profile is different. The one commonality between Adrenotone and CatecholaCalm when it comes to herbs is that the featured herb of CateccholaCalm.. is Ashwaganda, also found in Adrenotone, but it’s the featured herb in Catecholacalm because it calms the sympathetic pathway and is also a wonderful adaptogen to try to also control cortisol.

The other herbs are called nervines or sedatives or even hypnotic…Valarian root, passion flower or passiflora , Melissa or lemon balm – herbs that have a long standing use as muscle relaxers, sleep promoters, and relaxation.

There is also 50 mg of phosphatidyl serine - which is enough. A lot of studies on phos serine and blunting the stress response to acute stressors – some indicate high dose –couple hundred milligrams and one at 800 mg showing it blunts the acute stress response in athletes but there is work that duplicated the same response at very, very low doses – down as low as 20 mg….so the 50 mg dose in CatecholaCalm with all the others acting in synergy is an adequate dose.

Use Catecholamine particularly when the VMA and the HVA are high….either one or particularly when both are high. So when cortisol is abnormal and catecholamines are high, we use CatecholaCalm… When cortisol is abnormal and VMA and HVA are low, we use Adrenotone. Or if you prefer a glandular approach, particularly for the kinesiologists, we have the Adrenal Complex which has both adrenal cortex and adrenal medullary tissue which comes from Argentina, a prion-free country…all organic, freeze-dried materials so is as safe as glandular can possibly be.

Others aids include, stand alone Phos serine and Stress Arrest - a GABAergic type of product. BTW – all the herbs in CatecholaCalm--- are GABAergic; they hit GABAergic receptors so they act almost like a mild benzodiazpene medication but without the side effects of sleep hangover or putting someone into overt sedation.

[Aside: Refer to Conference Room Sessions 4, 5 and 6 on GABA… [References]

Stress Arrest is not an herbal product. It’s a nutrition and amino acid product containing niacin, B6 panthothenic acid combined with GABA and glycine and is a stress-relieving product.

Taurine – as mentioned in the foregoing segment and throughout the literature and interview commentaries, Taurine is knows as being a very useful membrane stabilizer. Taurine functions as an inhibitory transmitter in the cerebellum and is useful to depress seizure activity. It has a role as an inhibitory neurotransmitter. Taurine, a conditionally-essential amino acid, is found to be abundant (or should be) in electrically excitable tissues such as brain, retina, heart and skeletal muscles. Taurine has been found to be a protective agent against several environmental toxins and drug-induced multiple organ injuries resulting from hepatotoxicity, nephrotoxicity, neurotoxicity, testicular toxicity and cardiotoxicity in animal models.

For sleep… the muscle relaxing product – MyoSedate™ with magnesium, calcium and the botanical relaxing sedating herbs – good to use to help induce sleep. Some also like the CatecholaCalm in the evening along with 5 HTP and melatonin.
Vitamin D – Julia Ross (The Mood Cure) comments that vitamin D is an important regulating hormone so it’s necessary to test the 25 OH D levels and replete if low. She tests also for Pregnenolone levels since cortisol, DHEA and all the other adrenal hormones are made from that.

SUMMARY: Occasional stress is a natural part of life. Stress on a continual basis is detrimental to health. Mild cases of occasional anxiety and feelings of being ‘unsettled’ can often be managed by using L-theanine, PharmaGaba, Bach Flower Rescue Remedy which is homeopathic herbal liquid or pastilles, Ashwaganda, plenty of magnesium.

However, when insomnia and overt nervousness is constant, you must suspect dysregulation of the HPAA, HPTA and have the appropriate screening testing in order to treat appropriately and make treatment progress.

Refer to the post on Stress, anxiety, depression, insomnia, cravings dated Sept 13, 2006 which is a review of the very useful book (The Mood Cure) by Julia Ross, MA.- Clinical Psychology… [www.afibbers.org] (Unfortunately, the document is cluttered with artifacts that resulted from a system change that apparently didn’t recognize some forms of punctuation the annoying squares are difficult to ignore.) Read the post and buy the book to take the self-test as a start for assessment of your own stress levels and organ involvement. Julia has received positive feedback from over a hundred thousand readers. It’s a great start. If stress is severe, then go straight to a practitioner who can order the appropriate testing before starting any other regimens….otherwise, as stated initially, you spin your wheels, waste money and become even more frustrated.


Endnotes: My personal HPAA/HPTA history began after testing when I first became a patient of my FM MD at age 64 and I can’t be grateful enough for that evaluation and findings that indicated adrenal burnout with thyroid complications. I was 59 when my arrhythmia began and my history is one of always being on stress overload. I often say, ”I was born stressed.” Prior to her initial assessment, unfortunately, none of the other Endocrinologists (3), Internists (2). Cardiologists (3) or eventually the EP’s I’ve seen over the years were remotely interested in knowing or assessing whether I had stress-related HPAA/HPTA dysfunction that might be driving the hypoglycemia, arrhythmia, thyroid complications.

My treatment began with detoxification and then adrenal support nutrients from the Metagenics product line. Eventually, I settled on those by Designs for Health. My FM MD requires that everyone read and use as ‘homework’ the book by endocrinologist, Diana Schwarzbein, MD. Schwarzbein Principle II. Because of my glucose handling issues, I modified the Schwarzbein eating plan to have fewer grain carbs, became gluten free and eventually reversed both the adrenal and glucose handling problems. It took well over a year. I was re-tested periodically. I also tested very low for Vitamin D levels and had some methylation areas that needed work which are now resolved.

I continue to use adrenal support herbals and other overall nutritional support. With iodine supplementation, I have substantially reduced the dose of Armour Thyroid hormone to 15 mcg three times a week. I take small doses of Pregnenolone. My last Adrenal Stress Profile graph was “perfect” and except for the period of hypoglycemia and the stress during the early onset Afib, thankfully, I have not suffered from any of typical sleep disturbance issues.

Sleep is so important to overall health. The body heals and restores during an uninterrupted sleep cycle.

As a preventive tactic, if I think I will be encountering a stressful situation, then ahead of time, I take 100 mg. L-theanine. If I become stressed without prior warning, to relax, I use 100 mg L-theanine, Bach Flower Rescue Remedy and if needed, extra Ashwaganda (Planetary Herbals). I also have on hand Pharma GABA (Natural Factors) which is nicely calming as well. Over time, I’ve found I need these aids less and less, but it’s a comfort to know that if I do, they work quickly without feeling sedated or impaired.

Note that the usefulness or efficacy of these aids is highly individualized. What works for one person, may not work at all for others. Obviously, severe cases of stress involvement and adrenal dysfunction are going to take more than these gentle aids to reverse the imbalances and until that’s accomplished by the treatment measures mentioned, stress will continue to wreak havoc on various organ systems …including the heart and for this discussion, promote Afib.

Peace,
Jackie


The End


REFERENCES
Sympathetic Dominance Teleconference with Jeffrey Moss, D.D.S., C.N.S., C.C.N and David M Brady, ND, DC, CCN,CNPA. Chief Medical Officer for Designs for Health and vice provost of the Division of Health Sciences, director of the Human Nutrition Institute, and associate professor of clinical sciences at the University of Bridgeport in Connecticut, Courtesy of Designs for Health.

Adrenal Dysfunction Teleconference with Compounding Pharmacist Baylor Rice, R.Ph., FIACP. Baylor Rice has an impressive track record as a compounding pharmacist and health professional. He has been a licensed pharmacist since 1994. After earning his degree at the Medical College of Virginia, Baylor worked in community pharmacies. In 1998, Baylor and his wife opened South River Compounding Pharmacy in Midlothian, VA. His vision of treating each patient based on their individual needs and using a “team approach” by working together with the patient’s physician has proved to be quite successful with positive outcomes for the patients. South River Compounding Pharmacy also incorporates wellness screenings for disease state prevention and maintenance. Baylor was one of the first pharmacists in the United States to incorporate a cognitive memory test into a community pharmacy. He also offers individual consultations for patients

Shames, Richard L, MD Nutritional Management of Stress-Induced Dysfunction Applied Nutritional Science Reports. Published in Advanced Nutrition Publications © 2002.

ABSTRACT: In today’s fast-paced society the vast majority of
individuals are under a constant barrage of stressors. These
stressors are translated by the neuroendocrine system into
signals that alter the body’s biochemistry to support a “fight or
flight” response. While some of these changes may be beneficial
to survival in the short term (acute stress), they present an
increased risk of various physical and psychological health
challenges in the long term (chronic stress). There is no doubt
that stress is an inevitable consequence of modern life; fortunately,
the downstream damage caused by it is not. The use of
natural substances can support normalization of stress-induced
biochemical and organ function changes and increase nonspecific
resistance to stress. These natural alternatives offer
healthcare professionals a safe and effective way to support the
health and well-being of their patients through stressful periods,
promote healthy aging, and help prevent the vast array of health
issues that are associated with chronic activation of the body’s stress response. [www.lucieblouin.com]

Interactions of the serotonin and circadian systems: nature and nurture in rhythms and blues. Ciarleglio CM1, Resuehr HE, McMahon DG. Neuroscience. 2011 Dec 1;197:8-16 [www.ncbi.nlm.nih.gov]

Stress, Anxiety and Insomnia – What the Drug Companies Won’t Tell You and Your Doctor Doesn’t Know by Michael T. Murray, N.D. © 2012

The Mood Cure by Julia Ross, MA © 2002

The Schwarzbein Principle II by Diana Schwarzbein, MD © 2002

The Hypothalamic-Pituitary-Adrenal Axis: The Actions of the Central Nervous System and Potential Biomarkers, Kelly L. Olson, Ph.D.;David T. Marc, M.S.; Lindsay A. Grude, B.S.; Corena J. McManus, M.S.; Gottfried H. Kellermann, PhD

Conclusion The HPA axis is influenced by a variety of brain nuclei in response to stress. Stress is typically associated with emotional or social demands; however, a broader definition can be applied to stress to include inflammatory processes due to infection or injury. Whether stress occurs due to a traumatic event, divorce, or a severe burn, brain pathways are initiated to activate the HPA axis. The coordinated actions of the brain and HPA axis in response to stress results in the release of cortisol, epinephrine, and norepinephrine into the periphery.

The production of these hormones from the adrenal gland is essential to overall health and wellbeing. They provide a mechanism in which humans and other organisms exposed to many different forms of stress can regain homeostasis. However, continuation of stressors can leave an individual at risk for developing mood disorders or infections caused by pathophysiological functioning of the adrenal gland. Urinary epinephrine and norepinephrine and salivary cortisol can be used as HPA biomarkers to help identify contributing factors to various clinical conditions and provide insight into potential intervention points. Continue: [www.neurorelief.com]

Bjorntorp
Professor Per Bjorntorp, deceased, Gothenburg University, Sweden. Extensive HPAA research regarding the Stress Response. [www.nature.com]

Alterations in the Ageing Corticotrophic Stress-Response Axis
Derek J. Chadwick, Jamie A. Goode, Per Björntorp

Summary ‘Stress’ embraces the reaction to a multitude of poorly defined factors that disturb homeostasis or allostasis. In this overview, the activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system have been utilized as objective measurements of stress reactions. Although long-term activation of the sympathetic nervous system is followed by primary hypertension, consequences of similar activation of the HPA axis have not been clearly defined. The focus of this overview is to examine whether or not repeated activation of these two stress centres may be involved in the pathogenesis of abdominal obesity and its comorbidities. In population studies adrenal hormones show strong statistical associations to centralization of body fat as well as to obesity. There is considerable evidence from clinical to cellular and molecular studies that elevated cortisol, particularly when combined with secondary inhibition of sex steroids and growth hormone secretions, is causing accumulation of fat in visceral adipose tissues as well as metabolic abnormalities (The Metabolic Syndrome). Hypertension is probably due to a parallel activation of the central sympathetic nervous system. Depression and ‘the small baby syndrome’ as well as stress exposure in men and non-human primates are followed with time by similar central and peripheral abnormalities. Glucocorticoid exposure is also followed by increased food intake and ‘leptin resistant’ obesity, perhaps disrupting the balance between leptin and neuropeptide Y to the advantage of the latter. The consequence might be ‘stress-eating’, which, however, is a poorly defined entity. Factors activating the stress centres in humans include psychosocial and socioeconomic handicaps, depressive and anxiety traits, alcohol and smoking, with some differences in profile between personalities and genders. Polymorphisms have been defined in several genes associated with the cascade of events along the stress axes. Based on this evidence it is suggested that environmental, perinatal and genetic factors induce neuroendocrine perturbations followed by abdominal obesity with its associated comorbidities.

Summary: The problem with determining whether ageing is followed by perturbations of the regulation of the hypothalamic-pituitary-adrenal (HPA) axis is that ageing per se is very difficult to separate from the effects of environmental insults. Data in ageing rodents indicate that with age the winding-down of cortisol after challenges is prolonged. This is probably due to an insufficient feedback regulation by glucocorticoid receptors in specific fields in the hippocampus. The functional and topographic characteristics of these changes are identical to those seen after prolonged stress, suggesting that such factors might be of significance. Data in humans also suggest that with age basal cortisol secretion, diurnal rhythm, and the early response to challenges are not affected but similar to animal data the return to baseline values after stimulation seems to be delayed, probably due to a diminished feedback control. Several studies suggest that common diseases of age, for example cardiovascular disease and type 2 diabetes mellitus, are associated with similar HPA axis perturbations as those seen in old subjects. Recent population studies indicate that adrenal hyperactivity, associated with a stressful environment, is generating risk factors for these diseases. This is likely to be dependent on genetic susceptibility, and associated polymorphisms have been found in several candidate genes of importance for neuroendocrine and autonomic regulations.

Published Online: 7 OCT 2008 ttp://onlinelibrary.wiley.com/doi/10.1002/0470846542.ch4/summary
[onlinelibrary.wiley.com]

Systemic inflammation, as noted previously, causes elevated cortisol levels. Important to manage silent inflammation.

The Anti-Inflammation Zone - Reversing The Silent Epidemic That's Destroying Our Health. © 2005 by Barry Sears, PhD
Barry Sears is a leader in the field of dietary control of hormonal response. A former research scientist at the Boston University School of Medicine and the Massachusetts Institute of Technology, Dr. Sears has dedicated his efforts over the past 25 years to the study of lipids and their inflammatory role in the development of chronic disease. He holds 13 U.S. patents in the areas of intravenous drug delivery systems and hormonal regulation for the treatment of cardiovascular disease.

ProThera – Broad Nutrient and Herbal Support for Adrenal Function – Monograph [www.protherainc.com]

Terminology definition resource…
Neurotransmitters [www.neurogistics.com] [www.uni.edu]
Melatonin [www.medscape.com]

Mechanism of the protective action of taurine in toxin and drug induced organ pathophysiology and diabetic complications: a review. Food Funct. 2012 Dec;3(12):1251-64. doi: 10.1039/c2fo30117b. [www.ncbi.nlm.nih.gov] PMID:22930035

Testing

Genova - [www.gdx.net], [www.gdx.net], [www.gdx.net]

Meridian Valley [meridianvalleylab.com]

Metametrix [www.metametrix.com]
[www.metametrix.com]

Conference Room Proceedings on GABA (4, 5 6) [afibbers.org]

Additional References… I have 260 related study references that I can share if interested. Send me a PM.

Many thanks Jackie for this excellent detailed overview of Stress and the HPA axis issues which are so fundamental for so many of us.

Lets make both of these into an AFIB Resource link as well for the long term, if you agree?

Cheers!
Shannon

Jackie,
A very informative post. Thank you!

Jean