Stress Management

Synopsis:
Background
Signs of Stress
Lifestyle & Nutritional Approaches to Stress Management
Suggested Supplementation
References

 

Although the human body is relatively adept at managing acute physical and/ or psychological stressors, chronic psychological stress can produce a variety of adverse effects.

Chronic stress can increase our risk of suffering from a barrage of anxiety- and pressure-related diseases ranging from high blood pressure and dementia to depression. Chronic stress also increases our risk for some types of cancer (Thaker 2007; Jacobs 2000; Saul 2005; McEwen 1998; Liu 2010; Eiland 2010). 

Regrettably, while chronic stress produces significant adverse health effects, conventional medicine often relies upon psychoactive drugs to mask stressed patients’ symptoms. At the same time, mainstream stress management strategies often fail to address biochemical abnormalities, such as imbalanced adrenal hormone levels, that contribute to the detrimental health effects of chronic stress (Strous 2003; Wolkowitz 1997, 1999).

At the core of chronic stress is deregulation of the hypothalamic-pituitary-adrenal (HPA) axis, an interconnected network of physiologic command terminals that governs the production of stress hormones like cortisol and catecholamines like epinephrine and norepinephrine. Chronic stress leads to desynchronization of the HPA axis and subsequent imbalances in stress hormone levels, a critical feature of stress-related illness.

The Deadly Consequences of Chronic Stress

The consequences of chronic stress can be devastating. A chilling example is stress cardiomyopathy, a spontaneous weakening of the heart that predisposes victims to arrhythmia and even sudden cardiac death. While the mechanism is not clearly understood, it is thought that chronic stress-induced elevations in epinephrine (adrenaline) over-stimulate the cardiac muscle, altering its function and causing atrial remodeling (Sakihara 2007; Korlakunta 2005).

Prolonged stress has been linked with elevated circulating markers of inflammation, and increased intima media thickness, a measure of atherosclerosis progression (Gouin 2011; Roepke 2011). Chronic stress considerably increases the risk of anxiety and depression by causing structural and functional changes in the brain as well (McEwen 2004; Liu 2010). Moreover, those who do not properly manage and adapt to chronic stress are more likely to be overweight and develop sexual dysfunction (Kyrou 2008).

How the Body Responds to Stress

When an individual experiences a stressor, physical or emotional, internal or environmental, the body initiates a complex system of adaptive reactions to help cope with the stress. This reactive response results in the release of glucocorticoids, also known as stress hormones, and catecholamines, which stimulate adaptive changes in a variety of bodily systems.

The “Fight or Flight” Response

Under short-term circumstances, stress-induced changes prioritize functions involved in escaping danger; for example – redirection of blood flow to the muscles from most other body parts, increased blood pressure and blood sugar levels, dilation of pupils, and inhibition of digestion for energy conservation. During this time, fatty acids and glucose (blood sugar) are liberated from storage sites into the bloodstream where they become readily available for utilization by the muscles. This is known as the fight-or-flight response. This reactive and adaptive protection system originates in the brain.  And the brain-endocrine coordination comprises the hypothalamic-pituitary-adrenal (HPA) axis.

We modern humans live in an environment filled with emotional stressors, such as financial worries, and deadline pressures at work or school. All of these modern worries chronically activate the HPA axis in an evolutionarily unnatural way, leading to elevated stress hormone levels, and accompanying physiologic changes, throughout the day.

A few components of the fight-or-flight response are especially damaging to health when the stress response is active over a prolonged timeframe – insulin resistance, and high blood pressure (Lehrke 2008).

Eventually, chronic stress can lead to insufficient HPA axis activation and mood disorders, such as depression and anxiety, and fatigue commonly observed in individuals who have been under great stress for a long time.

Impaired Stress Response: A Major Cause of Anxiety and Depression

Often, chronic stress is accompanied by mood disorders, particularly anxiety and depression. In fact, depression and anxiety can both be viewed as manifestations of an impaired stress response; the underlying physiology of both is similar.

In fact, the chronic elevation in glucocorticoids caused by chronic stressors in modern society can lead to physical changes in brain structure.

For example, dendrites, the branches of neurons that receive signals from other neurons, are shifted into less functional patterns upon chronic exposure to glucocorticoids. This has been documented in key brain regions associated with mood, short-term memory, and behavioral flexibility (Krugers 2010). Furthermore, glucocorticoids cause receptors for the mood-regulating neurotransmitter serotonin to become less sensitive to activation (van Riel 2003; Karten 1999). Other detrimental effects of chronic stress include both increased susceptibility to neuronal damage and impaired neurogenesis, the process by which new neurons are “born” (Krugers 2010).

Chronic Stress and Nutrition

Deficiencies, toxicities and life style habits impact the adrenal gland. Deficiencies in vitamin C and vitamin B5, which are essential co-factors in cortisol production and adrenal health, are two examples (Brandt 2012*; Daugherty 2002). Copper is a mineral that is essential in some bodily enzymatic reactions, but may disrupt adrenal function if levels are too high (Veltman 1986).

The fatty acid content of the diet also contributes considerably to stress response physiology. Relative imbalances of omega-6 fatty acids to omega-3 fatty acids create conditions that favor heightened inflammation and impaired stress response (Kiecolt-Glaser 2010).

 

 

Recognizing When Stress is getting to You

Everyone has an inborn ability to handle stress. However, tolerance is variable as some people can handle only low levels and short durations of stress, while others adapt and can accommodate higher levels stress for more prolonged periods.

According to Dr. Hans Selye, there are three states the body faces when dealing with stress. The first being the alarm state early on in the process, followed by the resistance state where the body attempts to adapt to the added stress (release of cortisol), and finally, after stress overwhelms and weakens the system, the exhaustion state (Kalaitzakis 2011; Tak 2011). These 3 states can be analogously detailed as physiologic mechanisms:

Recognizing that you are experiencing some or all of the following symptoms is an important initial step towards achieving better overall health and mitigating your risk for various diseases.

Signs that you are suffering the effects of chronic stress may include:

1. Excessive fatigue after minimal exertion; feeling “overwhelmed” by relatively trivial problems
2. Trouble awakening in the morning, even after adequate sleep
3. Relying on coffee (caffeine) and other “energy” drinks for a pick me up
4. Perceived energy burst after 6:00 PM
5. Chronic low blood pressure
6. Hypersensitivity to cold temperatures
7. Increased premenstrual symptoms (PMS) symptoms
8. Depression and/or mood swings
9. Mental “fog” and poor memory
10. Decreased sex drive
11. Anxiety
12. Craving sugar and salty foods
13. Decreased appetite
14. Imbalanced immune system
15. Chronic allergies
16. Generalized weakness and dizziness upon standing

Some of these symptoms may mimic, or overlap, with dysfunction of the thyroid gland, gonadal (sex) hormones, malnutrition, depression, chronic fatigue states, chronic illness, infections, alcohol and drug abuse, and heavy metal toxicity (Ng 1990; Gagnon 2006). Therefore, it is very important to rule out other possible causes before attributing symptoms to chronic stress alone.

 

 

Lifestyle Strategies for Overcoming Chronic Stress

Dr. Thierry Hertoghe, an internationally noted endocrinologist, advises a few lifestyle modifications that one should adhere to before consideration of natural or pharmacological therapies.

1. Avoid stressful situations and occurrences – If commuter stress, for example, is affecting your body, moving to a home closer to your workplace or finding a job closer to home is an obvious solution. If working third-shift causes disruption in your cortisol levels or circadian rhythm resulting in disease, then change your work schedule to eliminate this stressor (Wirth 2011). Smoking, and extremely vigorous or exhaustive exercise impact the adrenals in a negative way as well (Peters 2001; Wu 2008; Siddiqui 2001).

 

2. Reduce things that increase cortisol at inappropriate time – The consumption of alcohol and caffeinated beverages such as tea and coffee before bedtime is not recommended as caffeine can increase serum cortisol levels, which is counterproductive during the evening hours (Ping 2012). Additionally, caffeine and alcohol can cause a relative reduction in melatonin secretion during the night (Lovallo 2006).

 

3. Use other therapies that may help: Acupuncture, Traditional Chinese Medicine (TCM), Ayurvedic medicine, massage therapy, relaxation, yoga and music therapy (Hanley 2003; Dixit 1993; Field 2005).

 

4. Owning a pet – Several published studies suggest that owning a pet is associated with improved physical and psychological health (Barker 2008; Friedmann 2009). For chronically stressed individuals, adopting a dog or cat may help ameliorate some of the symptoms and effects of chronic stress (Allen 2001).

 

Nutrients to Counteract the Effects of Stress

B-Complex vitamins

Several members of the B-vitamin family impact varying aspects of stress response physiology. For example, pantothenic acid (B5) is necessary for the synthesis of coenzyme A (CoA), which is integral in the production of cholesterol, and in steroid hormone biosynthesis (Tahiliani 1991; Yasuda 2004). Pantothenic deficiency is rather rare, but it can result in adrenal insufficiency (Tarasov 1985; Webster 1998; Anon 1980; Plesofsky-Vig 1994).

Another correlation between B-vitamins was revealed in a clinical trial that found that injecting either ACTH (adrenocorticotropic hormone) or cortisol into healthy subjects for just four days significantly decreased levels of folic acid and B12 (Berg 2006). These findings suggest that not only are B-vitamins important to promote healthy stress response, but stress itself may lower B-vitamin blood levels. Therefore, B-vitamin supplementation may ameliorate the effects of stress from multiple angles.

 

Vitamin C (Ascorbic Acid)

Another crucial vitamin in adrenal function and maintenance of healthy levels of cortisol is vitamin C (Bornstein 2004; Morfin 2002). Deficiencies of this vitamin can have profound effects on adrenal function (Brody 2002; Carroll 2000). The benefits of vitamin C are multiple, acting as an anti-inflammatory and co-factor in soft tissue synthesis and repair (Eipper 1992; Hemila 1996; Evans 2008).

 

Minerals

Calcium, magnesium, sodium and potassium are all macro elements. A macro element means that they are found in our bodies in greater quantities than other elements or minerals. These four macro elements are important in supporting and maintaining balanced adrenal function (Kobayashi 1996; Carroll 2000). They are important in the formation and release of adrenal hormones.

Manganese, zinc, chromium, and selenium are some of the trace elements that have an impact on the function of the adrenal glands. Research shows that deficiencies in these trace elements can have a negative effect on adrenal function (Golf 1998; Wilborn 2004; Schulz 1998).

 

L-Theanine

L-theanine is an amino acid found exclusively in green tea that has traditionally been used to enhance relaxation and improve concentration and learning ability (Vuong 2011; Wakabayashi 2011; Nathan 2006).

L-theanine is chemically related to the neurotransmitter glutamate, and binds to glutamate receptors in the brain (Cho 2008). Unlike glutamate, however, which can cause a state called excitotoxicity that can destroy nerve cells, L-theanine protects brain cells against excitotoxicity, calming the nerve networks in the brain (Kakuda 2002; Nagasawa 2004; Di 2010).

L-theanine reduces evidence of anxiety and depression in several different animal models of stress (Yin 2011; Heese 2009). In one animal model, L-theanine led to decreases in nearly all frequencies of brainwave activity, indicating a state of calmness and relaxation (Dimpfel 2007). Moreover, L-theanine has been shown to act synergistically with the GABAergic drug midazolam, a relative of Valium® (Heese 2009).

Brain wave studies have shed some light on the mechanism by which L-theanine may appease anxiety. In one study, healthy subjects took a soft drink containing green tea enriched with L-theanine while their brainwave power was measured (Dimpfel 2007). Power was initially reduced in all frequencies and areas during the first hour, indicating relaxation. Later changes indicated both an increase in mental performance and a higher degree of relaxation. In this case, L-theanine seemed to produce desirable increases in attention, accompanied by durable relaxation—that means subjects could concentrate better without being distracted by anxiety.

 

Omega 3-Fatty Acids (Fish Oil)

Research indicates that intake of fish oil or omega 3-fatty acids (n-3 EFA or EFA) can act in an adaptogenic fashion to help ameliorate the effects of stress (Bradbury 2004; Delarue 2003). Omega-3 fatty acids balance the effects of omega-6 metabolism (Warren 1999; Puri 2007; Maes 2005). Fatty acid balance is also critical for glucorcorticoid hormone receptor function (Hirata 1980; Hidalgo 1978; Willis 1981). In recent years omega-3 fatty acids have been documented to be successful in treating those suffering from depression and anxiety disorders, which themselves can be a consequence or an inducer of stress (Logan 2004; Araujo 2010; Silvers 2005).

 

Phosphatidylserine (PS)

The phospholipid phosphatidylserine (PS) is found in cell membranes and is a critical component for healthy cellular communication. Several studies have shown that a diet rich in PS is able to balance the HPA axis and limit the negative consequences of over-activation of the adrenal cortex (Monteleone 1990; Kelly 1999; Benton 2001; Kimura 2006; Hellhammer 2004). Phosphatidylserine also helps attenuate the increase in cortisol levels during periods of intense, acute stress (Fahey 1998).

 

Melatonin

The hormone melatonin, which is released from the small gland at the base of the brain called the pineal gland, is known for its relationship with the sleep cycle. Melatonin has an antagonistic effect on cortisol, and the circadian rise in melatonin levels at night correlates with a drop in cortisol (Presman 2012). Low levels of melatonin can mean inappropriate and undesirable glucocorticoid signaling during the night when it should be at the lowest.

Chronic, late-night stress, whether physical or psychological, can result in an inappropriately elevated night time cortisol level; shift-work is an example of such a stressor (James 2007). This chronic disruption and inappropriate release of cortisol at night may impair the normal circadian corticosteroid output in the morning (Soszynski 1989; Bruls 2000, Pawlikowski 002; Hertoghe 1999).

Melatonin is also a hormone with great penetration into the nucleus of the cells and is one of the most important antioxidant hormones as it protects cellular (mitochondrial and nuclear) DNA from damage (Reiter 2002). Melatonin has been found to affect the levels of cortisol and the balance between DHEA and cortisol in circulation (Soszynski 1989; Bruls 2000; Pawlikowski 2002). Doses differ in individuals but can start as low as 0.3 mg; some may require up to 10 mg daily.

 

Herbal Therapies

Licorice (Glycyrrhiza glabra and G. uralensis)

A mainstay in Traditional Chinese Medicine (TCM), licorice extracts may be of benefit for those who have reached the exhaustion stage and are no longer producing sufficient cortisol.

Licorice has the ability to decrease the breakdown or metabolism of hydrocortisone by the liver, thus increasing the amount of cortisol in circulation and reducing the strain on the adrenal glands to produce it (Methlie 2011). The combination of low doses of licorice with supplemental DHEA may help balance the HPA axis (Tarasov 1985).

It is important to understand that licorice may not be ideal for everyone dealing with day-to-day stress. In high doses over prolonged periods licorice may cause electrolyte imbalance (hypokalemia) and elevations in blood pressure, a syndrome called hypermineralocorticoidism (Schambelan 1994). Due to its ability to increase cortisol levels, licorice is best reserved for those individuals who are experiencing fatigue due to chronic stress and also have low cortisol levels.

 

Sedative Herbs

Sedative herbs such as hops, passionflower, poppy, and valerian can provide calming effects to reduce stress. The herb lemon balm (Melissa officinalis) has been shown in a number of studies to reduce stress. This is yet another herbal that has shown benefit in reducing negative effects of stress on the body (Kennedy 2004 and 2006; Dimpfel 2004).

In a recent small clinical trial including 20 stressed volunteers, a standardized lemon balm extract (Cyracos®) was shown to significantly combat anxiety symptoms and insomnia (Cases 2011). The extract “reduced anxiety manifestations by 18%, ameliorated anxiety-associated symptoms by 15% and lowered insomnia by 42%.”

 

Adaptogenic Herbs

A class of herbs known as adaptogens are helpful in regulation of the HPA axis. Dr. Nikolai Lazarev, a noted Russian pharmacologist during the cold war era, coined the term “adaptogenic herb” to describe about 25 of the hundreds of medicinal herbs having particular properties (Kelly 2001). These properties are unique to this class of herbs making them important for human health.

To be classified as an adaptogen, herbs must have the following three properties: They must have no toxicity; they must have a normalizing ability (i.e. the same dose can raise or lower physiologic properties), and the mechanisms by which the herbs carry out their effects must be due to more than one physiologic or pharmacologic mechanism (Lipnick 1992; Brekhman: 1969; Saleeby 2006). Unlike any other compound, adaptogens condition your body to respond favorably to stress.

Adaptogenic herbs can become an important supplement to support a healthy HPA axis stress response. The list of adaptogenic herbs include about twenty-five known, and of these several have been studied for their effects on the HPA system. Ginseng (Panax ginseng), Eleuthero (Eleutherococcus senticosus), Rhodiola (Rhodiola rosea), Cordyceps (Cordyceps sinensis) and Ashwagandha (Withania somnifera) to name a few. (Gaffney 2001; Saleeby 2006; Panossian 2005; Kelly 2001; Spasov 2000).

Rhodiola

The adaptogenic herb Rhodiola (Rhodiola rosea) has demonstrated in a number of studies improvements in both physical endurance and cognitive performance (De Bock 2004; Spasov 2000; Shevtsov 2003). Its ability to reduce fatigue associated with stress is documented in well-designed research papers (Olsson 2009; Spasov 2000; Panossian 2009). The apparent mechanism of action of Rhodiola is related to its ability in assisting neurotransmitter transport in the brain and the blunting of catecholamine release (Stancheva 1987; van Diermen 2009).

A large, phase III placebo-controlled clinical trial was conducted in Sweden in 2009, studying participants aged 20-55 years with a diagnosis of stress-related fatigue (Olsson 2009). Subjects taking the Rhodiola extract had significantly lower cortisol responses to chronic stress than did the placebo recipients—and as a result they had lower scores on scales of burnout and improved performance on cognitive testing.

Ashwagandha

Ashwagandha, also known as Withania somnifera, is an important Ayurvedic medicinal herb. It has many uses in traditional Indian medicine such as treatments for stress, fatigue, pain, diabetes, GI and rheumatologic disorders (Mishra 2000). Ashwagandha has shown promise in neuroprotection as scientists have discovered that this adaptogenic herb prevents damage to neurons and improves neurological function in the face of stress (Cooley 2009; Tohda 2005; Choudhary 2004). Additionally, data suggests that Ashwagandha may reduce the harmful effects of stress on male reproductive capacity (Ahmad 2010).

A double blind, randomized, placebo-controlled clinical trial assessed the effects of ashwagandha in 130 chronically stressed subjects (Auddy 2008). Over a 60-day period, doses ranging from 125 mg to 500 mg daily of a patented ashwagandha extract (Sensoril®) significantly improved scores on a standardized measurement of stress intensity, and also favorably modulated several biomarkers associated with cardiovascular health, including C-reactive protein and blood pressure. Moreover, at the end of the study period subjects that received 500 mg of ashwagandha daily had cortisol levels nearly 30% lower than subjects who took a placebo, and their DHEA-s levels were significantly higher as well.

Ginseng

Probably the most recognized of the adaptogen herbs in the West is Ginseng (Panax ginseng). There are eleven species of this medicinal herb, P. ginseng being among the most widely studied (Chen 2004; Huang 1999). American Ginseng (Panax quinquefolius) is another species within the Panax genus that shares medicinal properties (Chan 2000). Siberian ginseng (Eleutherococcus senticosus), while not technically a true ginseng botanical, has similar beneficial properties and is closely related to the Panax family of plants (Davydov 2000).

A wealth of studies exist showing stress reducing properties of true ginseng and the other ginseng related herbals (Barton 2010; Ma 2008). For example the isolated polysaccharides from P. ginseng have demonstrated anti-fatigue properties in one recent study (Wang 2010).

American ginseng extract shows a reduction in oxidative endothelial damage due to diabetes (Sen 2011; Amin 2011). Anti-depressive effects and the positive modulation that benefits the HPA axis is outlined in a research paper on protective ginsenosides in Panax and other ginseng plants showing usefulness in the management of chronic stress (Liu 2011; Cao 2011).

Holy basil (Occiumum tenuiflorum)

Increased cortisol and blood glucose levels are common in people with disorders of the adrenal gland (Pozza 2012). Increased blood glucose is also seen in people receiving chronic glucocorticoid treatment (Mcmahon 1988). Ocimum sanctum, or holy basil, is an herb widely grown in India that is known for its ability to control blood sugar (Grover 2002). A study in mice showed that extracts of Ocimum sanctum decreased serum concentrations of both cortisol and glucose. This study suggested that Ocimum sanctum extract could potentially regulate diabetes mellitus that has developed secondary to corticosteroid treatment (Gholap 2004). Compounds isolated from an extract of holy basil leaves were shown to normalize hyperglycemia, plasma cortisol levels, and adrenal hypertrophy in rats (Gupta 2007).

Furthermore, clinical trials in humans have also shown the benefits of holy basil extract for improving immune function, as well as decreasing stress and depression associated with anxiety. Studies in healthy human subjects showed that treatment with 300 mg of holy basil extract for 4 weeks increased antibody levels and cells in the immune system (Mondal 2011). In a clinical trial, 35 subjects with generalized anxiety disorder were treated with 500 mg of holy basil extract twice daily for 60 days. At the end of the study, these subjects showed decreased stress and depression, improved attention, and an increased ability to adapt to changes (Bhattacharyya 2008).

Bacopa

The herb Bacopa monnieri is used in the classical Indian medicinal system of Ayurveda as a tonic for the nervous system and is known to promote mental health (Bhattacharya 1998). It has also been shown to possess anti-anxiety properties. Experiments have shown that rats fed with extracts of Bacopa showed decreased anxiety, which was comparable to that in rats fed lorazepam, a common anti-anxiety drug. The Bacopa-fed rats did not show any adverse effects on physical activity (Bhattacharya 1998). Bacopa possesses adaptogenic properties and evidence shows that it can normalize levels of corticosterone and noradrenaline in rodents exposed to stressful conditions (Sheikh 2007). In a clinical trial on the mental and emotional effects of Bacopa in the elderly, 54 subjects aged 65 years or older were given 300 mg Bacopa or placebo for 12 weeks. Subjects receiving Bacopa showed significantly reduced anxiety and improved cognitive performance (Head 2009). At the time of this writing, a clinical trial is currently underway in Australia to test the effects of Bacopa and another herb, pycnogenol, in reducing cognitive decline with aging. The trial will evaluate the effects of Bacopa supplementation for up to a year on mood, cognition, blood pressure, inflammation, and oxidative stress, among other tests (Stough 2012).

Cordyceps

Oxidative stress damages cells and is associated with various health disorders. Cordyceps sinensis is a type of mushroom used in Chinese medicine that has been found to boost the immune system and possesses anti-tumor and antioxidant properties (Li 2003). An experimental study showed that Cordyceps extract stimulated corticosterone production in mice (Leu 2005). Another study found that orally administered Cordyceps extract increased swimming capacity and reduced fatigue in mice (Koh 2003). Also, the weight changes in adrenal glands, which are considered a stress index, were suppressed in rats following a 48-hour stress period (Koh 2003). Furthermore, a polysaccharide isolated from Cordyceps was found to reduce plasma glucose levels in diabetic and hyperglycemic mice (Kiho 1999).

In a clinical trial, Cordyceps powder was provided for 2 weeks to sedentary male subjects who then underwent exhaustive exercise. Exercise tolerance and catecholamine and cortisol levels were compared before and after Cordyceps treatment. Subjects receiving Cordyceps showed improved exercise tolerance, increased levels of epinephrine and norepinephrine, and a slight decrease in cortisol levels. Overall, Cordyceps supplementation appeared to improve energy generation and reduce fatigue (Nagata 2005).

Schisandra

Exposure to chronic stress leads to sustained increases in cortisol levels and deleterious effects on various body systems (Anderson 2008). Schisandra chinensis is traditionally used in East Asia for its anti-stress properties. It was found that Schisandra reduced the levels of corticosterone and glucose and preserved the structure of the adrenal cortex in rats exposed to stress (Sun 2009). Athletes exposed to acute exercise show increased levels of cortisol and nitric oxide (which helps in conducting signals between cells) in the blood and saliva. However, extremely well-trained athletes who are exposed to chronic exercise-related stress do not show such increases. When such subjects are given Schisandra, they start showing increased cortisol and nitric oxide levels, meaning that they further adapted to heavy physical loading. Thus, adaptogens such as Schisandra may increase the ability of the body to respond to stress stimuli (Panossian 2003).

 

 

Maintaining balance in today’s stressful world requires a multimodal approach that encompasses healthy eating habits, getting plenty of exercise, and using natural ingredients to support the body’s natural adaptive abilities. 

Nutritional Therapies

• B-Complex vitamin:
  • Thiamine (B1): 75 – 125 mg daily
  • Riboflavin (B2): 50 mg daily
  • Niacin (B3): 50 – 190 mg daily
  • Folate (preferably as L-methylfolate): 400 – 1000 mcg daily
  • Vitamin B12: 300 – 600 mcg daily
  • Biotin: 300 – 3000 mcg daily
  • Pantothenic acid: 100 – 600 mg daily
• Vitamin C: 1000 – 2000 mg daily
• Fish oil (with olive polyphenols): 2,000 – 4000 mg daily
• Phosphatidylserine: 100 – 600 mg daily
• L-Theanine: 200 – 400 mg daily
• Calcium: 200 – 1200 mg daily
• Magnesium: 140 – 500 elemental milligrams of highly-absorbable magnesium
• Zinc: 30 mg daily
• Chromium (Crominex™): 500 mcg daily
• Selenium: 200 mcg daily
• Manganese: 1 mg daily
• Comprehensive multivitamin formula: Per label instructions (note: some of the nutrients mentioned in the protocol [i.e. zinc, selenium, manganese, and vitamin C] can be obtained by taking a high quality multivitamin/ mineral supplement).
• Melatonin: 0.3 – 5 mg before bed (sometimes up to 10 mg)

Herbal Therapies

• Lemon Balm extract: 300 – 600 mg daily
• Valerian root: 400 – 1000 mg daily
• Licorice Root: 450 – 900 mg daily (for those with low cortisol levels)

Adaptogens

• Rhodiola rosea; standardized extract: 250 – 500 mg daily
• Ashwagandha; standardized extract (Sensoril®): 125 – 250 mg daily
• Ginseng (Panax); standardized extract: varying doses
• Holy basil (standardized to 2.5% triterpene acids): 600 mg daily
• Standardized blend of bacopa, ashwagandha, and cordyceps extracts: 516 mg daily
• Schisandra chinensis extract (standardized to 9% Total Schisandrins): 250 mg daily

 

 

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