Distress or De-Stress Robert A. Rakowski, DC, CCN, DACBN, DIBAK
Dirty
Dozen
1. Stress
2. Toxins
3. Heavy Metals
4. Digestion
5. Food Reaction
6. Inflammation
7. Dysglycemia
8. Mitochondria
9. Methylation
10. Immune
11. Infection
12. Hormones
Stress 'is top cause
of workplace
sickness' and is so
widespread it's
dubbed the 'Black
Death of the 21st
century‘ “Stress has even
eclipsed stroke, heart
attack, cancer and
back problems” http://www.dailymail.co.uk/health/
article-2045309/Stress-Top-cause-
workplace-sickness-dubbed-
Black-Death-21st-century.html
Ancient Human Teeth Show That Stress Early
in Development Can Shorten Life Span
"individuals with teeth marked
by early life stress lived 15.4
years less
than those without the defects." http://www.sciencedaily.com/releases/2010/02/100204204315.htm below
The Deadly Quartet
Toxins
Malnutrition
Laziness
“The stress response: in
the beginning it saved our
lives, making us run from
predators and enabling us
to take down prey. Today, human beings are turning
on the same life-saving physical reaction to cope with 30-year mortgages,
$4 a gallon gasoline, final
exams, difficult bosses and
even traffic jams — we can't
seem to turn it off. So, we're
constantly marinating in
corrosive hormones
triggered by the stress
response.” http://killerstress.stanford.edu/ below
“estimated
that 75 - 90
percent of all
visits to
primary care
physicians
are for stress
related
problems.”
http://www.stress.
org/americas.htm
?AIS=402db67648
73c177fe57ade43
799e929 below
http://www.biosbcc.net/barron/physiology/endo/adren.htm
vs. Amygdala
(Perception)
(Attitude)
“It is amazing that almost
any type of stress,
whether it be physical or
neurogenic, will cause an
immediate and marked
increase in ACTH
secretion by the anterior
pituitary gland, followed
within minutes by greatly
increased adrenocortical
secretion of cortisol.” Textbook of Medical Physiology
7th Edition; Guyton; © 1986 W.B.
Saunders Co., page 916 ISBN: 0-
7216-1260-1
"Adopting the
right attitude can
convert a
negative stress
into a positive
one."
Dr. Hans Selye http://www.wow4u.com/stress/
“half-life of
cortisol
disappeara
nce 155 (HYPOTHYROID)
vs. 73 min”
(Euthyroid) J Clin Endocrinol Metab.
1990 Jan;70(1):155-61.
PMID: 2294128 below
“The secret of health
and happiness lies in
successful adjustment
to the ever changing
conditions on this
globe;
the penalties for failure in this great
process of adaptation are disease and unhappiness.”
Selye, Hans The Stress of Life second
edition (preface xv)
ISBN 0-07-056212-1
Hans Selye
“With prolonged stress from multiple
sources, the stress response can become
as damaging as the stressors
themselves, depending on the genetic
sensitivities of the individual. The
individual becomes insulin-resistant. His
or her recovery after injury or illness
decreases. Libido and reproductive
function are adversely affected. Muscles
start to lose tone, and the body becomes
fatter as the individual develops an
“apple” body shape. Blood cholesterol,
triglycerides, and blood pressure
increase. Fatigue sets in and sleep is
restless. The person’s mood slips toward
depression due to altered
neurotransmitters. Inflammatory
conditions increase. Immune defense
against common infections like the cold
and flu decrease, and energy and
enthusiasm for life are lost.” 2002 Seminar Series, Nutritional
Endocrinology II: Breakthrough Approaches for
Managing Adrenal and Thyroid Function;
Jeffrey S. Bland, Ph.D. chapter 2.
http://btc.montana.edu/olympics/physiology/pb01.html below
Everyone!
Who Pays for STRESS?
Stress:
“Giving
something
more
significance
than it
really
deserves.”
Anthony
Robbins
“reduced telomere length is also
associated with chronic psychological
stress and mood disorders.” Brain Behav Immun. 2008 May; 22(4): 600–605. PMCID: PMC2386249 below
Figure 1 Telomerase activity is inhibited by cortisol
Te
lom
era
se
a
cti
vit
y
Stress
Accelerates
Aging
Paralyzed by
FEAR
(Saving Private Ryan)
“Exposure to
even mild
uncontrollable
stress impairs the
cognitive
functioning of the
prefrontal cortex, a brain region critical for
insight, judgment, and the
inhibition of inappropriate
behaviors.” Ann N Y Acad Sci. 2004 Jun;1021:143-7.
PMID: 15251883 Below
© Rakowski 2006
“Lethal stress
will
immediately
reduce your
judgement and
performance at
least 50%.” Sensei Grant Kruhly
Lipton, Stress Physiology blood is shunted from
the organs to the muscles
“there is universal agreement that 50% to 75% of patients with major depression exhibit hyperactivity of the HPA axis”
J Clin Psychiatry. 1989 May;50 Suppl:13-20; discussion 21-2. PMID: 2654128 Below
*
“Appropriate
regulatory control of
the HPA axis is crucial
for health and
survival” Nature Reviews Neuroscience 5,
917- (December 2004)
“increased
activity of HPA
axis are
considered as
state marker of
depression.” Nippon Rinsho. 2007
Sep;65(9):1585-90. PMID:
17876979 below
In an given 1 year period, 9.5 % of the
population, or 19 million American adults suffer from
a depressive illness
Depression lifetime risk: approx. 20% (50 million U.S.)
Affects about 12.4 million women and over 6 million men
in the United States each year
National Institute of Mental Health, Information Resources and Inquires Branch Website: http://www.nimh.nih.gov
“When compared
to other chronic
diseases
depression may well be the
world’s
most
disabling
disease” http://www.netscape.com/ article +
link below
*
“high cortisol levels induce high tryptophan oxygenase Acta Med Okayama. 1997 Aug;51(4):233-6. PMID: 9284972 below
“Proinflammatory cytokines induce IDO (indoleamine 2,3-
dioxygenase) “Stress. 2008;11(3):198-209 PMID: 18465467 below
Insomnia and
Depression
Implications
Glutamate
“elevated
cortisol
induced by
stress
increases
serotonin
uptake” Cognitive, Affective, &
Behavioral Neuroscience,
Volume 1, Number 1, 1 March
2001 , pp. 96-104(9) abstract
below
Cortisol
“Sucks
up”
Serotonin
Serotonin
transport
activity
increased by
interferons
(Scan J of
Immunology
2006;106-
15.)
Nitric Oxide increases SERT
and lowers Serotonin SSRI’s
lower Nitric Oxide SERT is a
Serotonin
Vacuum Cleaner
Serotonin - over
70,000,000 U.S.
prescriptions in 2007
Source Jay Lombard, DO
Cortisol promotes (SERT).
DHEA buffers cortisol
“chronic interpersonal stress is associated with greater stimulated
cellular production of IL-6 along with impairments in the capacity of
glucocorticoids to inhibit this cellular inflammatory response. Moreover,
these findings add to a growing body of data that implicate heightened
proinflammatory cytokine activity in those at risk for fatigue symptoms.”
Brain Behav Immun. 2008 Jan;22(1):24-32. PMID: 17706915 below
Chronic Stress is Pro Inflammatory, promotes depression and fatigue
“Highly stress-
resistant animals
have higher endo-
genous serotonin”
Bethea CL, et al. Sensitivity to Stress-Induced Reproductive
Dysfunction Linked to Activity of the Serotonin System. Obstet Gynecol
Surv. 2005 Jul;60(7):448-450. PMID: 15995560 BELOW
“Hippo-
campal
neurons
show the
highest
density of
cortico-
steroid
receptors” Nature Reviews
Neuroscience 5, 917-
(December 2004) below
© Rakowski 2006
http://www.exploratorium.ed
u/memory/braindissection/1.
html
“high salivary cortisol concentrations predict a decline in memory function
over the next 3 years.” Neurobiol Aging. 2005 Nov 3; PMID: 16274857 Below
© Rakowski
2006 “The present study
revealed that elderly
human subjects
showing increasing
cortisol levels over
years with currently
high cortisol
levels are
impaired on
hippocampus-dependent
memory and
have a 14%
reduction in
hippocampal
volume, compared to
elderly subjects showing
decreasing cortisol levels
over years with currently
moderate cortisol levels.”
Nat Neurosci. 1998
May;1(1):69-
73.PMID: 10195112
Article Below
© Rakowski 2008
“Deficits in memory and hippocampal atrophy
seen in (Alzheimer's disease) AD have been
associated with hypercortisolism” Psychoneuroendocrinology. 2008 Oct;33(9):1293-6. PMID: 18774653 below
“chronic
stress leads
to
premature
aging of the
immune
system.” Neuroimmunomodulation.
2008;15(4-6):251-9. Epub 2008
Nov 26. PMID: 19047802 below
“NK cells are
the most
"sensitive"
cells to the
suppressive
effect of
stress” CHROUSOS, GEORGE P., The Stress
Response and Immune Function: Clinical
Implications: The 1999 Novera H. Spector
Lecture Annals of the New York Academy
of Sciences 917:38-67 (2000)
“Recent studies indicate that “Ganoderma lucidum
(G. lucidum) activates NK cells … Our results
indicate that G. lucidum induces NK cell cytotoxicity
against various cancer cell lines” Innate Immun. 2013 Jun 26. PMID: 23803412 below
“Scientists have discovered that everyday emotional
stress is a trigger for the growth of tumours” http://www.telegraph.co.uk/health/healthnews/6981222/Stress-could-cause-
cancer-claim-scientists.html below
“These analyses
suggest that
stress-related
psychosocial
factors have an
adverse effect
on cancer
incidence and
survival” Nat Clin Pract Oncol. 2008
Aug;5(8):466-75. PMID:
18493231 below
“By far, the best-known
metabolic effect of cortisol
and other glucocorticoids on
metabolism is their ability to
stimulate gluconeogenesis by
the liver, often increasing the
rate of gluconeogenesis as
much as six-to tenfold.” “. .
all of the enzymes required to
convert amino acids into
glucose are increased in the
liver cells.” “. . cortisol
causes mobilization of amino
acids from the extrahepatic
tissues, mainly from muscle.”
Textbook of Medical
Physiology 7th Edition;
Guyton; © 1986 W.B.
Saunders Co., page 914 ISBN:
0-7216-1260-1
HOOC-C-N-H
H H
R
Keto Acid
Glucose
Amino
Group
Ammonia
Urea
Amino Acids Amino Acids?
“Glucocorticoids
stimulate protein
degradation in
muscle, skin
and lymphoid
tissue, the released amino acids being
used for glucose and glycogen
synthesis (Darmaun et al. 1988;
Beaufrere et al. 1989).”
Exp Physiol 2003;88;129-
140 Below
Promote Synthesis: GH, IGF1, Test, AA (BCAA) Insulin
Prevent Degradation: Insulin, IGF1,
Promote Degradation: Cortisol, Inflammation
Cortisol is Catabolic and Anti Anabolic
Stress & Body
Composition
Cortisol
Methyl
Depletion
Pleasure
Perception
CHO
Hunger
Insulin
Opposition
Insulin
SHBG
5’Deiodinase
T4 to T3
Reverse T3
Thyroid
Action
Central
Obesity
Aromatase
Estrogen
THBG
DHEA
Sarcopenia
Obesity
PPAR
Fat Burning
Fat Burning
Mito-
chondria
IL-6
N.O.
Depression
Catecholamines
Stress & Body
Composition
Cortisol
Methyl
Depletion
Depression
Pleasure
Perception
CHO
Hunger
Insulin
Opposition
Insulin
SHBG
5’Deiodinase
T4 to T3
Reverse T3
Thyroid
Action
Central
Obesity
Aromatase
Estrogen
THBG
DHEA
Sarcopenia
Obesity
PPAR
Fat Burning
Fat Burning
Mito-
chondria
Lose Muscle,
Gain Fat
"The increase in cortisol secretion seen in
patients with abdominal obesity may
contribute to the metabolic syndrome” Endocrinol Metab Clin North Am. 2002 Mar;31(1):173-89. PMID: 12055988 below
“Local
production of
active cortisol from inactive
cortisone
driven by 11-β-HSD-1
activity is very
high in VAT” Nutr Metab (Lond). 2004 Nov 5;1(1):12.
PMID: 15530168 article below
“Alternatively, obesity could also be a source of stress
promoting the visceral fat accumulation since
visceral fat is able to release cytokines which
stimulate the HPA axis” Panminerva Med. 2003 Sep;45(3):189-95. PMID: 14618117 Below
Figure 13. Reciprocal relations between
obesity and stress. http://www.endotext.org/obesity/obesity13/obesity13.htm below
“Glucocorticoid
(GC) (Cortisol)
excess is
characterized by
increased
adiposity,
skeletal
myopathy and
insulin
resistance” Diabetes. 2009 Aug 12.
PMID: 19675138 below
“In postmenopausal
women, all estrogens
and nearly all
androgens are made
locally in peripheral
target tissues from
the inactive adrenal
steroid precursor
dehydroepiandroster
one (DHEA). In adult
men, approximated
50% of androgens
are made locally.”
This new section of endocrinology, which describes the local formation of sex
steroids, has been named intracrinology.” Semin Reprod Med. 2004
Nov;22(4):299-309. ABSTRACT BELOW
These hormones are made locally
and act locally. This seriously
limits interpretation of serum
levels!!! Wendy Warner, MD, 10-5-13
“All the enzymes required to
transform DHEA into androgens and/or estrogens are expressed in a cell-specific manner in a large series of peripheral target tissues…
intracrinology.” “its (DHEA) potential
use as a physiological HRT could well provide a physiological balance of androgens and estrogens”
J Endocrinol. 2005 Nov;187(2):169-96. PMID: 16293766 PMID: 16293766 Below
Adrenal Steroid Synthesis and Progesterone Steal
http://www.hormonepr
ofile.com/pregnenolon
e.htm
Glucocorticoid
Mineralcorticoid
Cortical Sex Hormones
Progesterone
Steal
“You are
either
making
stress
hormones or
sex
hormones.”
“Stress significantly reduced the
probability of conception each day during the fertile window”
Buck Louis et al. Stress reduces conception probabilities across the fertile
window: evidence in support of relaxation. Fertility and Sterility, 2010
© Rakowski
2008
Figure 6.
Schematic
representati
on of the
detrimental
effects of
chronic
stress on
adipose
tissue, bone
and muscle
metabolism.
GH: growth
hormone.
Stimulation
is
represented
by solid
green lines
and
inhibition by
dashed red
lines.
http://www.endotext.or
g/adrenal/adrenal8/adr
enal8.htm
Increase FAT
(VAT) decrease
muscle and
bone
© Rakowski 2006
CORTISOL
“The most frequent
adverse effects include
atrophy, striae,
rosacea, perioral
dermatitis, acne,
and purpura. Those
that occur with lower
frequency include
hypertrichosis,
pigmentation alterations,
delayed wound healing,
and exacerbation of skin
infections.” J Am Acad Dermatol. 2006 Jan;54(1):1-15;
quiz 16-8. PMID: 16384751 Below http://cnserver0.nkf.med.ualberta.ca/cn/Schrier/Vol3/Fig.%204-18B.jpg
STRESS MANAGEMENT
101
The Serenity Prayer
God grant me the
serenity
to accept the things I
cannot change;
courage to change the
things I can;
and wisdom to know
the difference.
2. 3.
1.
43% increased risk
of
premature death”
PMID: 22201278
If it is to
be,
it is up to
me!
PMID:
22201278
“most likely, all New World primates …
have (CORTISOL) resistance”
2010 PMID: 20649902
melatonin
inhibits
ACTH-
stimulated
cortisol
production.” J Clin Endocrinol Metab. 2003 Jan;88(1):450-
8. PMID: 12519889
“the gut
contains at
least 400
times more
melatonin
than the
pineal gland” World J Gastroenterol 2011 September
14; 17(34): 3888-3898 PMC3198018
abstract below
Supplement
Melatonin
Every
Hour
The Magnificent Seven
Eat right
Drink right Think right Poop right Move right
Talk right Sleep right Eat right
Drink right Think right Poop right Move right
Talk right Sleep right
Stress
Solutions:
Don’t
Worry Be
Happy!
Rakowski
Life
Pyramid
Love
Purpose
Discipline
Life-Style
Unique Needs
Give Happy, Live Happy!
“And this, too, shall
pass away.”
“adaptogens
can be defined
as "smooth"
pro-stressors which reduce reactivity
of host defense
systems and
decrease
damaging effects
of various
stressors” Phytomedicine. 1999 Oct;6(4):287-300.
PMID: 10589450 Below
Everyone Responds to Stress
Differently. Signs of stress are often the most
common presenting complaints. But not everyone
responds to stress in the same way. That’s why we
developed Identi-T, to help you easily identify each
patient’s unique response to stress and recommend
an effective, customized approach. http://www.metagenics.com/practitioners/programs/identi-t-program-
personalized-stress-relief#0,48
Identi-T
Stress Typing with Identi-T
1. Identify Stress Type
2. Specific Adaptogens
3. Stress relief and Lifestyle
Strategies
0102030405060
HPACalming HPA
StimulatingHPABalancing
AdrenalSupport
Blood Sugar
Cardiovascular
MoodCognition
Immunity
Hypersomnia
Chronic Pain
Digestion
Libido
Respiratory
InsomniaMuscle
Type 5: Stressed & Mentally
Exhausted Holy Basil, Ashwaganda, Amla, Bacopa
Identi-T
“What’s the
one thing I can
do, such that
by doing it
everything
else is easier
or unnecessary?”
Gary Keller
Make it Fun!
Make it Fun!
Joy
Cost of a meal at an
inexpensive restaurant =
$10.00.
http://www.numbeo.com/cost-of-living/country_result.jsp?country=Unite
d+States
Restaurants Median Range
Meal, Inexpensive
Restaurant 10.00 $
8
15
Meal for 2, Mid-range
Restaurant, Three-course 45.00 $
32.98
60
Combo Meal at
McDonalds or Similar 6.00 $
5.87
7
Domestic Beer (0.5 liter
draught) 3.28 $
2.75
4
Imported Beer (0.33 liter
bottle) 4.75 $ 3.79
Cappuccino (regular) 3.59 $ 3
4
Coke/Pepsi (0.33 liter
bottle) 1.50 $
1.25
2
Water (0.33 liter bottle) 1.25 $ 1
1.5
Success is a numbers game
5 shakes per week
x
4 weeks per
month
x
500 patients
x
$4 profit per shake
= $40,000 per month