What are Anxiety Disorders?

Anxiety is a normal part of life. But anxiety disorders are different from
everyday worries. These disorders include:

 Generalized anxiety disorder (GAD)

 Obsessive compulsive disorder (OCD)
 Panic disorder
 Post-traumatic stress disorder (PTSD)
 Social anxiety disorder (SAD), also called social phobia
Causes
Scientists believe that many factors may combine to cause anxiety
disorders. Here are a few of the most likely:

 Brain chemistry. Symptoms are often relieved by medicines that

alter levels of chemicals in the brain.
 Life experiences. Exposure to abuse, violence, or poverty may
increase the likelihood of getting these illnesses.
 Family history (genetics). Studies show that anxiety disorders run
in families. Anxiety disorders can begin in childhood. If you are a
parent, watch your children for symptoms so they can be treated
early.
 Learned behaviors and thinking patterns. People with low self-
esteem and poor coping skills may be prone to anxiety disorders.

Symptoms
Generalized Anxiety Disorder (GAD)

 Restlessness or feeling “on edge”

  Fatigue and trouble concentrating
 Headaches and muscle tension
 Trembling, sweating, and hot flashes
 Feeling dizzy or out of breath
 Trouble falling asleep or sleeping through the night
Obsessive-Compulsive Disorder (OCD)

 Persistent, unwelcome thoughts (obsessions)

 Urgent need to repeat certain ritual behaviors (compulsions)
Panic Disorder

 Pounding heart, chest pain, shortness of breath, sweating,

trembling, dizziness
 Feeling unreal or disconnected
 Fear of having a heart attack or “going crazy” (a panic attack)
Post-Traumatic Stress Disorder (PTSD)

 Repeated and frightening thoughts and memories of the trauma

 Depression
 Feeling emotionally numb, especially toward people they were
once close to.
 Being irritable and perhaps more aggressive than normal.
 Having trouble working or socializing (in severe cases)
Social Anxiety Disorder (SAD, Also Called Social Phobia)

 Overwhelming anxiety in everyday social situations

 Intense fear of being judged by others or being embarrassed by
their own actions
 Difficulty making and keeping friends
The brain is a powerful organ. So much that the anxiety, the depression,
and the fear can turn mental fears into actual physical pains.
“Most people actually experience anxiety as a physical problem,” said
Jason Conover, social worker for Intermountain Healthcare’s Utah
Valley Hospital. “It often doesn’t get recognized because the physical
symptoms are so apparent and quite troubling that they might think they
are experiencing something else – for instance, a heart attack.”
Anxiety builds tension throughout the body. Conover said in the brain
can react to thoughts of fear and turn to the muscles to brace for a
moment that is not happening. Much like if you were about to get in an
accident or protecting your body to get punched. The action never
happens but chemically you just experienced it just from a random fear
thought that crept in.
Treating anxiety is important for better mental health and physical health
as well. Inflammation builds up from the stress, and inflammation is a
culprit in numerous chronic conditions – such as heart and
gastrointestinal conditions.
Here are several ways that anxiety manifests in physical problems.
Breathing – Due to the tension, your breathing can change, Conover
said. Breathing can become shorter, shallower, or even holding your
breath too long. The lungs do not fully exhale due to the tension.
Relaxation and breathing techniques can help.
“So if we practice letting go of all that air until our lungs are empty –
then we can slow our breathing,” Conover said.
Tight Muscles – Anxiety will run tension through the body and impact
different muscles. People feel the tightness in other areas. Some will feel
it in their neck, jaw, chest, or the stomach. There is no specific area –
wherever the brain sends the nerve signals.
If muscle tightness continues in an area for a long time, then it turns the
muscle tightness into actual pain.
When you have anxiety, your muscles are essentially experiencing non-stop energy,
and eventually, that energy can translate into muscle problems.

Stiffness is the direct result of the way that your muscles feel when they've been put
on edge as a result of your nervous system's constant barrage of adrenaline. They start
to tense up, and that leads to this feeling of stiffness that can be painful, irritating, and
possibly even affect range of movement.

Rapid Heart Beat – Heart rate’s changes can occur from different
sources. The shortness of breath will cause the heart to pump more
oxygen into the blood to compensate.
Another way the heart rate is affected is anxiety will drive adrenaline.
Typically released in moments of intense actions like sky diving or
mountain climbing. But these moments can happen from impending
thoughts in anxiety that are mediocre. Such as a fear of meeting
someone or standing up in front of a group.  The adrenaline cue leaves
people feeling shaky or a general off-feeling.
RELATED: Stress and Heart Disease
Sweating, Cold Extremities, and Light-Headed – Blood flow
contributes to these symptoms. In moments of panic, the body goes into
emergency mode.
“The body in emergencies will pull blood to main organs – the heart and
the large muscles,” Conover said.
Sweating will be common for anxiety where extra perspiration happens
during those moments. Cold hands, feet, fingers and toes happen
because blood is being pulled away to protect those major organs.  Also,
people with anxiety will feel periods of dizziness, light-headed.
Stomach Issues – “One of the all-time classic symptoms is the
stomach,” Conover said. As there are numerous gastrointestinal
problems that can come with anxiety. Diarrhea, constipation and acid
reflex are a few examples.
Tension in the muscles causes complications as well as the blood flow
wreaking havoc. Digestion suffers as the stomach does not fully empty.

Muscle Pain is a Complicated Issue

So many different issues can cause muscle pain. But there's no denying that anxiety
can have a very significant effect on your muscles. Just a small sample of
explanations for the links between anxiety and muscle pain include:

 Muscle Tension The most common cause of muscle discomfort from anxiety is

tension. Muscle tension is a common anxiety symptom, occurring especially
when you're experiencing stress. Tension puts strain on your muscles and
hardens them, which over time can cause your muscles to experience both dull
and sharp pains.
  Stress Adjustments In ways you may not realize, anxiety may also cause you to
change the way you sit, the way you stand, how often you stretch, and more. It's
not uncommon for those with anxiety to be constantly moving or acting
differently than they used to in minor ways they don't even realize - from
slouching to shifting to ticks or pacing. These adjustments may lead to their own
muscle stress, which in turn can cause muscle pain.

 Notice All Pain Muscle pain is a common problem that can potentially affect
everyone - even people who don’t have anxiety. Most people can ignore the
pains, but those with anxiety are more prone to noticing all types of pain and
experiencing it more strongly because their minds tend to automatically interpret
things in a negative way. They are also highly vigilant about what’s going on in
their body and may pick up on sensations that others might not have noticed.
This is known as "hypersensitivity/hypervigilance" and it is very common in those
with anxiety disorders.

 Nutrition, Exercise, and Hydration When you have anxiety, you may also find
yourself exercising less, eating poorly, and not drinking enough water. All of
those can lead to further anxiety, which can cause or exacerbate muscle pains.
Eating healthily, exercising frequently, and drinking more water is likely to
improve the way that you feel, although this will not necessarily eliminate your
anxiety. 

Those are just a few of the potential reasons that anxiety and muscle pain are related.
Some people also find that their hyperventilation (a symptom of panic attacks) causes
muscle pain. Others toss and turn at night or sleep in uncomfortable positions because
of their anxiety. There are a lot of different causes that are either linked directly to
anxiety or occur because of anxiety symptoms.

Do you Live with Anxiety?

Here Are 11 ways to cope
Breathe: There are ways to calm your anxiety
Know that feeling of your heart beating faster in response to a stressful
situation? Or perhaps, instead, your palms get sweaty when you’re confronted
with an overwhelming task or event.

That’s anxiety — our body’s natural response to stress.

If you haven’t recognized your triggers yet, here are a few common: your first
day at a new job, meeting your partner’s family, or giving a presentation in
front of a lot of people. Everyone has different triggers, and identifying them is
one of the most important steps to coping and managing anxiety attacks.

Identifying your triggers can take some time and self-reflection. In the
meantime, there are things you can do to try to help calm or quiet your anxiety
from taking over.

How to Stop Muscle Stiffness From

Anxiety
It doesn't matter if muscle stiffness is due to anxiety, exercise, injury, etc. The
stiffness is still there, and the pain and discomfort you experience needs to be dealt
with the same way it would be treated even if it wasn't caused by anxiety.

That means that you should first talk to your doctor, and then consider the following:

 Stretching Often Stretching is, of course, a valuable way to relieve muscle

stiffness. It keeps your muscles loose and works out some of the tension that is
present in your muscles. It also reduces the risk of further injury, which is
important for stopping muscle stiffness.

 Exercise Exercise, in general, is essential for relief from both anxiety and muscle
stiffness. Exercise is known to be almost as powerful a cure for anxiety as many
anxiety medications because it creates and releases many of the same hormones
that are known to improve your mood. It also keeps your muscles loose and
healthy. Yoga is a great choice to consider because it is a form of both exercise
 and stretching which may have a positive effect on your future muscle
discomfort, as well as your mood.

 Massage Massage is also considered a way to combat both muscle stiffness and

anxiety together. Massage may decrease your anxiety and is also an effective way
to work out muscle stiffness. This makes massage a valuable choice for those
whose muscles have been stressed because of your anxiety.

 General Health - Your muscles are also very sensitive to your general health.
Ensure that you are getting enough sleep, eating healthy, and drinking enough
water. These seemingly simple changes can have a big effect on your anxiety, as
well as improve your muscle health, which should improve the way your muscles
deal with stress and anxiety.

If you're someone that uses modern medicine, traditional over the counter painkillers
should also be effective. Most muscle stiffness and pain responds fairly well to basic
over the counter treatments. Always make sure you talk to your doctor first before
taking any type of medication.

All of these should decrease the effects of muscle stiffness from anxiety, but they do
not necessarily improve your ability to deal with the anxiety itself. It's still going to be
very important for you to deal with your anxiety in order to ensure that you're able to
successfully stop the muscle stiffness from occurring.

5 quick ways to cope with anxiety

If your anxiety is sporadic and getting in the way of your focus or tasks, there
are some quick, homeopathic remedies that could help you take control of the
situation.

If your anxiety is focused around a situation, such as being worried about an

upcoming event, you may notice the symptoms are short-lived and usually
subside after the anticipated event takes place.
Question your thought pattern

Negative thoughts can take root in your mind and distort the severity of the
situation. One way is to challenge your fears, ask if they’re true, and see
where you can take back control.

Practice focused, deep breathing

Try breathing in for 4 counts and breathing out for 4 counts for 5 minutes total.
By evening out your breath, you’ll slow your heart rate which should help calm
you down.

The 4-7-8 technique is also known to help anxiety.

Use aromatherapy

Whether they’re in oil form, incense, or a candle, scents like lavender,

chamomile, and sandalwood can be very soothing.

Aromatherapy is thought to help activate certain receptors in your brain,

potentially easing anxiety.

Prevention
Although the cause of anxiety disorders is uncertain, there are steps you
can take to reduce the impact of symptoms and prevent anxiety attacks.
These steps include:

 Asking your healthcare provider for help early

 Learning to carefully manage your time and energy to reduce
stress
 Getting enough sleep and exercising regularly
  Keeping a journal to understand what triggers your anxiety
 Avoiding substances like alcohol, drugs, caffeine, and nicotine

Go for a walk or do 15 minutes of yoga

Sometimes, the best way to stop anxious thoughts is to walk away from the
situation. Taking some time to focus on your body and not your mind may help
relieve your anxiety.

Write down your thoughts

Writing down what’s making you anxious gets it out of your head and can
make it less daunting.

These relaxation tricks are particularly helpful for those who experience
anxiety sporadically. They may also work well with someone who
has generalized anxiety disorder (GAD) when they’re in a bind too!

However, if you suspect you have GAD, quick coping methods shouldn’t be
the only kind of treatment you employ. You’ll want to find long-term strategies
to help lessen the severity of symptoms and even prevent them from
happening.

6 long-term strategies for coping

with anxiety
If anxiety is a regular part of your life, it’s important to find treatment strategies
to help you keep it in check. It might be a combination of things, like talk
therapy and meditation, or it might just be a matter of cutting out or resolving
your anxiety trigger.

If you’re not sure where to start, it’s always helpful to discuss options with a
mental health professional who might suggest something you hadn’t thought
of before.

Identify and learn to manage your triggers

You can identify triggers on your own or with a therapist. Sometimes they can
be obvious, like caffeine, drinking alcohol, or smoking. Other times they can
be less obvious.

Long-term problems, such as financial or work-related situations, may take

some time to figure out — is it a due date, a person, or the situation? This
may take some extra support, through therapy or with friends.

When you do figure out your trigger, you should try to limit your exposure if
you can. If you can’t limit it — like if it’s due to a stressful work environment
that you can’t currently change — using other coping techniques may help.

Some general triggers:

 a stressful job or work environment
 driving or traveling
 genetics — anxiety could run in your family
 withdrawal from drugs or certain medications
 side effects of certain medications
 trauma
  phobias, such as agoraphobia (fear of crowded or open spaces)
and claustrophobia (fear of small spaces)
 some chronic illnesses like heart disease, diabetes, or asthma
 chronic pain
 having another mental illness such as depression
 caffeine

Adopt cognitive behavioral therapy (CBT)

CBT helps people learn different ways of thinking about and reacting to

anxiety-causing situations. A therapist can help you develop ways to change
negative thought patterns and behaviors before they spiral.

Do a daily or routine meditation

While this takes some practice to do successfully, mindful meditation, when

done regularly, can eventually help you train your brain to dismiss anxious
thoughts when they arise.

If sitting still and concentrating is difficult, try starting with yoga.

Try supplements or change your diet

Changing your diet or taking supplements is definitely a long-term strategy.

Research shows certain supplements or nutrients can help anxiety reduction.

These include:

 lemon balm
 omega-3 fatty acids
  ashwagandha
 green tea
 valerian root
 kava kava
 dark chocolate (in moderation)

However, it can take up to three months before your body is actually running
on the nutrition these herbs and foods provide. If you’re taking other
medications, make sure to discuss herbal remedies with your doctor.

Keep your body and mind healthy

Exercising regularly, eating balanced meals, getting enough sleep, and

staying connected to people who care about you are great ways to stave off
anxiety symptoms.

Ask your doctor about medications

If your anxiety is severe enough that your mental health practitioner believes
you’d benefit from medication, there are a number of directions to go,
depending on your symptoms. Discuss your concerns with your doctor.

50 Common Signs and Symptoms of Stress

 

1. Frequent headaches, jaw clenching or pain

2. Gritting, grinding teeth
3. Stuttering or stammering
4. Tremors, trembling of lips, hands
5. Neck ache, back pain, muscle spasms
6. Light headedness, faintness, dizziness
7. Ringing, buzzing or “popping sounds
8. Frequent blushing, sweating
9. Cold or sweaty hands, feet
10. Dry mouth, problems swallowing
11. Frequent colds, infections, herpes sores
12. Rashes, itching, hives, “goose bumps”
13. Unexplained or frequent “allergy” attacks
14. Heartburn, stomach pain, nausea
15. Excess belching, flatulence
16. Constipation, diarrhea, loss of control
17. Difficulty breathing, frequent sighing
18. Sudden attacks of life threatening panic
19. Chest pain, palpitations, rapid pulse
20. Frequent urination
21. Diminished sexual desire or performance
22. Excess anxiety, worry, guilt, nervousness
23. Increased anger, frustration, hostility
24. Depression, frequent or wild mood swings
25. Increased or decreased appetite

1. Insomnia, nightmares, disturbing dreams

2. Difficulty concentrating, racing thoughts
3. Trouble learning new information
4. Forgetfulness, disorganization, confusion
 5. Difficulty in making decisions
6. Feeling overloaded or overwhelmed
7. Frequent crying spells or suicidal thoughts
8. Feelings of loneliness or worthlessness
9. Little interest in appearance, punctuality
10. Nervous habits, fidgeting, feet tapping
11. Increased frustration, irritability, edginess
12. Overreaction to petty annoyances
13. Increased number of minor accidents
14. Obsessive or compulsive behavior
15. Reduced work efficiency or productivity
16. Lies or excuses to cover up poor work
17. Rapid or mumbled speech
18. Excessive defensiveness or suspiciousness
19. Problems in communication, sharing
20. Social withdrawal and isolation
21. Constant tiredness, weakness, fatigue
22. Frequent use of over-the-counter drugs
23. Weight gain or loss without diet
24. Increased smoking, alcohol or drug use
25. Excessive gambling or impulse buying

How Stress Affects Your Body

Another infographic from  Healthline  shows the effects of stress on your body.
Stress is a natural physical and mental reaction to life experiences. Everyone
expresses stress from time to time. Anything from everyday responsibilities like work
and family to serious life events such as a new diagnosis, war, or the death of a loved
one can trigger stress. For immediate, short-term situations, stress can be beneficial to
your health. It can help you cope with potentially serious situations. Your body
responds to stress by releasing hormones that increase your heart and breathing rates
and ready your muscles to respond.

Yet if your stress response doesn’t stop firing, and these stress levels stay elevated far
longer than is necessary for survival, it can take a toll on your health. Chronic stress
can cause a variety of symptoms and affect your overall well-being. Symptoms of
chronic stress include:

 irritability
 anxiety
 depression
 headaches
 insomnia

Central nervous and endocrine systems

Your central nervous system (CNS) is in charge of your “fight or flight” response. In
your brain, the hypothalamus gets the ball rolling, telling your adrenal glands to
release the stress hormones adrenaline and cortisol. These hormones rev up your
heartbeat and send blood rushing to the areas that need it most in an emergency,
such as your muscles, heart, and other important organs.

When the perceived fear is gone, the hypothalamus should tell all systems to go
back to normal. If the CNS fails to return to normal, or if the stressor doesn’t go
away, the response will continue.

Chronic stress is also a factor in behaviors such as overeating or not eating enough,
alcohol or drug abuse, and social withdrawal.
Respiratory and cardiovascular systems
Stress hormones affect your respiratory and cardiovascular systems. During the
stress response, you breathe faster in an effort to quickly distribute oxygen-rich
blood to your body. If you already have a breathing problem like asthma or
emphysema, stress can make it even harder to breathe.

Under stress, your heart also pumps faster. Stress hormones cause your blood
vessels to constrict and divert more oxygen to your muscles so you’ll have more
strength to take action. But this also raises your blood pressure.

As a result, frequent or chronic stress will make your heart work too hard for too
long. When your blood pressure rises, so do your risks for having a stroke or heart
attack.

Digestive system
Under stress, your liver produces extra blood sugar (glucose) to give you a boost of
energy. If you’re under chronic stress, your body may not be able to keep up with
this extra glucose surge. Chronic stress may increase your risk of developing type 2
diabetes.

The rush of hormones, rapid breathing, and increased heart rate can also upset
your digestive system. You’re more likely to have heartburn or acid reflux thanks to
an increase in stomach acid. Stress doesn’t cause ulcers (a bacterium called H.
pylori often does), but it can increase your risk for them and cause existing ulcers to
act up.

Stress can also affect the way food moves through your body, leading to diarrhea
or constipation. You might also experience nausea, vomiting, or a stomachache.

Muscular system
Your muscles tense up to protect themselves from injury when you’re stressed.
They tend to release again once you relax, but if you’re constantly under stress,
your muscles may not get the chance to relax. Tight muscles cause headaches, back
and shoulder pain, and body aches. Over time, this can set off an unhealthy cycle as
you stop exercising and turn to pain medication for relief.
Sexuality and reproductive system
Stress is exhausting for both the body and mind. It’s not unusual to lose your desire
when you’re under constant stress. While short-term stress may cause men to
produce more of the male hormone testosterone, this effect doesn’t last.

If stress continues for a long time, a man’s testosterone levels can begin to drop.
This can interfere with sperm production and cause erectile dysfunction or
impotence. Chronic stress may also increase risk of infection for male reproductive
organs like the prostate and testes.

For women, stress can affect the menstrual cycle. It can lead to irregular, heavier, or
more painful periods. Chronic stress can also magnify the physical symptoms of
menopause.

Immune system
Stress stimulates the immune system, which can be a plus for immediate situations.
This stimulation can help you avoid infections and heal wounds. But over time,
stress hormones will weaken your immune system and reduce your body’s
response to foreign invaders. People under chronic stress are more susceptible to
viral illnesses like the flu and the common cold, as well as other infections. Stress
can also increase the time it takes you to recover from an illness or injury.

Stress Research
“The difficulty in science is often not so much how to make the discovery but rather
to know that one has made it.” – J.D. Bernal

2017 Stress Statistics

Statistic Verification

Source: American Psychological
Association

Research Date: 2017

Most Common Sources of Stress

 Percentage Source

1 63% Future of our nation

2 62% Money

3 61% Work

4 57% Political climate

5 51% Violence/crime
2014 Stress Statistics

Statistic Verification

Source: American Psychological Association,

American Institute of Stress

Research Date: 7.8.2014

Top Causes of Stress in the U.S.

Cause Factors

1 Job Pressure Co-Worker Tension, Bosses, Work Overload

2 Money Loss of Job, Reduced Retirement, Medical Expenses

3 Health Health Crisis, Terminal or Chronic Illness

Divorce, Death of Spouse, Arguments with Friends,

4 Relationships
Loneliness

Inadequate Nutrition, Caffeine, Processed Foods,

5 Poor Nutrition
Refined Sugars

6 Media Overload Television, Radio, Internet, E-Mail, Social Networking

Inability to release adrenaline and other stress

7 Sleep Deprivation
hormones

U.S Stress Statistics Data

Percent of people who regularly experience physical symptoms
77 %
caused by stress

Regularly experience psychological symptoms caused by stress 73 %

Feel they are living with extreme stress 33 %

Feel their stress has increased over the past five years 48 %

Cited money and work as the leading cause of their stress 76 %

Reported lying awake at night due to stress 48 %

Stress Impact Statistics

Percent who say stress has a negative impact on their personal and
48 %
professional life

Employed adults who say they have difficulty managing work and
31 %
family responsibilities.

Percent who cited jobs interfering with their family or personal time
35 %
as a significant source of stress.

Perccent who said stress has caused them to fight with people close
54 %
to them

Reported being alienated from a friend or family member because of

26 %
stress

Annual costs to employers in stress related health care and missed

$300 Billion
work.

Percent who say they are “always” or “often” under stress at work 30 %

People who cited physical symptoms experienced the following

Fatigue 51 %

Headache 44 %

Upset stomach 34 %

Muscle tension 30 %

Change in appetite 23 %

Teeth grinding 17 %
Change in sex drive 15 %

Feeling dizzy 13 %

People who cited psychological symptoms experienced the

following

Irritability or anger 50 %

Feeling nervous 45 %

Lack of energy 45 %

Feeling as though you could cry 35 %

Cardiac Coherence and Post-traumatic Stress Disorder in Combat Veterans

Jay P. Ginsberg, Ph.D.; Melanie E. Berry, M.S.; Donald A Powell, Ph.D.

Alternative Therapies in Health and Medicine, A Peer-Reviewed Journal, 2010;16

(4):52-60.
PDF version of the complete paper: Cardiac Coherence and PTSD in Combat
Veterans

Abstract-PTSD

Background: The need for treatment of posttraumatic stress disorder (PTSD) among
combat veterans returning from Afghanistan and Iraq is a growing concern. PTSD has
been associated with reduced cardiac coherence (an indicator of heart rate variability
[HRV]) and deficits in early-stage information processing (attention and immediate
memory) in different studies. However, the co-occurrence of reduced coherence and
cognition in combat veterans with PTSD has not been studied before.

Primary Study Objective: A pilot study was undertaken to assess the covariance of
coherence and information processing in combat veterans. An additional study goal
was an assessment of the effects of HRV biofeedback (HRVB) on coherence and
information processing in these veterans.

Methods/Design: A two-group (combat veterans with and without PTSD), a pre-post

study of coherence and information processing was employed with baseline
psychometric covariates.

Setting: The study was conducted at a VA Medical Center outpatient mental health
clinic.
Participants: Five combat veterans from Iraq or Afghanistan with PTSD and five
active-duty soldiers with comparable combat exposure who were without PTSD.

Intervention: Participants met with an HRVB professional once weekly for 4 weeks
and received visual feedback in HRV patterns while receiving training in resonance
frequency breathing and positive emotion induction.

Primary Outcome Measures: Cardiac coherence, word list learning, commissions

(false alarms) in go—no go reaction time, digits backward.

Results: Cardiac coherence was achieved in all participants, and the increase in
coherence ratio was significant post-HRVB training. Significant improvements in the
information processing indicators were achieved. Degree of increase in coherence was
the likely mediator of cognitive improvement.

Conclusion: Cardiac coherence is an index of the strength of control of

parasympathetic cardiac deceleration in an individual that has cardinal importance for
the individual’s attention and affect regulation.

The Effect of a Biofeedback-based Stress Management Tool on Physician Stress: A Randomized

Controlled Clinical Trial

Jane B. Lemaire, Jean E. Wallace, Adriane M. Lewin, Jill de Grood, Jeffrey P.

Schaefer

Open Medicine 2011; 5(4)E154.

PDF version of the complete paper: physician-stress-randomized-controlled-clinical-
trial

Abstract- Biofeedback-based Stress Management

Background: Physicians often experience work-related stress that may lead to

personal harm and impaired professional performance. Biofeedback has been used to
manage stress in various populations.

Objective: To determine whether a biofeedback-based stress management tool,

consisting of rhythmic breathing, actively self-generated positive emotions and a
portable biofeedback device, reduces physician stress.
Design: Randomized controlled trial measuring the efficacy of a stress-reduction
intervention over 28 days, with a 28-day open-label trial extension to assess
effectiveness.

Setting: Urban tertiary care hospital.

Participants: Forty staff physicians (23 men and 17 women) from various medical
practices (1 from primary care, 30 from a medical specialty and 9 from a surgical
specialty) were recruited by means of electronic mail, regular mail and posters placed
in the physicians’ lounge and throughout the hospital.

Intervention: Physicians in the intervention group were instructed to use a

biofeedback-based stress management tool three times daily. Participants in both the
control and intervention groups received twice-weekly support visits from the
research team over 28 days, with the intervention group also receiving re-inforcement
in the use of the stress management tool during these support visits. During the 28-day
extension period, both the control and the intervention groups received the
intervention, but without intensive support from the research team.

Main outcome measure: Stress was measured with a scale developed to capture short-
term changes in global perceptions of stress for physicians (maximum score 200).

Results: During the randomized controlled trial (days 0 to 28), the mean stress score
declined significantly for the intervention group (change -14.7, standard deviation
[SD] 23.8; p = 0.013) but not for the control group (change -2.2, SD 8.4; p = 0.30).
The difference in mean score change between the groups was 12.5 (p = 0.048). The
lower mean stress scores in the intervention group were maintained during the trial
extension to day 56. The mean stress score for the control group changed significantly
during the 28-day extension period (change -8.5, SD 7.6; p < 0.001).

Conclusion: A biofeedback-based stress management tool may be a simple and

effective stress-reduction strategy for physicians.

Coherence Training In Children With Attention-Deficit Hyperactivity Disorder: Cognitive

Functions and Behavioral Changes

Anthony Lloyd, Ph.D.; Davide Brett, B.Sc.; Ketith Wesnes, Ph.D.

Alternative Therapies in Health and Medicine, A Peer-Reviewed Journal, 2010; 16

(4):34-42
PDF version of the complete paper: coherence-training-in-children-with-adhd

Abstract-ADHD

Attention-deficit hyperactivity disorder (ADHD) is the most prevalent behavioral

diagnosis in children, with an estimated 500 000 children affected in the United
Kingdom alone. The need for an appropriate and effective intervention for children
with ADHD is a growing concern for educators and childcare agencies. This
randomized controlled clinical trial evaluated the impact of the HeartMath self-
regulation skills and coherence training program (Institute of HeartMath, Boulder
Creek, California) on a population of 38 children with ADHD in academic year
groups 6, 7, and 8. Learning of the skills was supported with heart rhythm coherence
monitoring and feedback technology designed to facilitate self-induced shifts in
cardiac coherence. The cognitive drug research system was used to assess cognitive
functioning as the primary outcome measure. Secondary outcome measures assessed
teacher and student reposted changes in behavior. Participants demonstrated
significant improvements in various aspects of cognitive functioning such as delayed
word recall, immediate word recall, word recognition, and episodic secondary
memory. Significant improvements in behavior were also found. The results suggest
that the intervention offers a physiologically based program to improve cognitive
functioning in children with ADHD and improve behaviors that is appropriate to
implement in a school environment.

Efficacy and Implementation of HeartMath Instruction in College Readiness Program: Improving

Students’ Mathematics Performance and Learning

Michael Vislocky, Ph.D. and Ronald P. Leslie, Ph.D.

University of Cincinnati Clermont College, 2005.

PDF version of the Executive Summary: efficacy-and-implementation-of-heartmath-
instruction

Abstract-Math Instruction

In 2002, the University of Cincinnati Clermont College (UCCC) and the Greater
Cincinnati Tech Prep Consortium (GCTPC) formed a partnership to address the
pedagogical needs of high school students in the area of mathematics in order to
prepare them for entry into higher education. Over the past four years (2002-2005),
HeartMath emotional management training has been offered to Tech Prep students. It
is well established that both math courses and math tests can lead to anxiety, and
anxiety, in turn, interferes with students’ performance in mathematics. On the first day
of instruction, students completed the COMPASS Math Placement Test and the post-
test was completed on the last day. The math portion was in the form of guided
program learning directed at their skill level as determined by their score on the
COMPASS pre-test. Instructors were available to answer student questions. In the
years 2002-2004, instruction on HeartMath tools and math skills were presented in
separate classrooms. In 2005, the two forms of instruction were combined in the 3-
hour class. Looking at the average improvement in test points from the COMPASS
pre-test and post-test, the following results were obtained: 2002 – 19% average
percent increase; 2003 – 15% average percent increase; 2004 – 24% average percent
increase; 2005 – 73% average percent increase.

Coherence and Health Care Cost – RCA Actuarial Study: A Cost-Effectiveness Cohort Study

Woody Bedell; Mariette Kaszkin-Bettag, Ph.D.

Alternative Therapies in Health and Medicine, A Peer-Reviewed Journal, 2010;16

(4):26-31.
PDF version of the complete paper: rca-actuarial-study-coherence-and-health-care

Abstract-Health and Medicine

Chronic stress is among the most costly health problems in terms of direct health
costs, absenteeism, disability, and performance standards. The Reformed Church in
America (RCA) identified stress among its clergy as a major cause of higher-than-
average health claims and implemented HeartMath (HM) to help its participants
manage stress and increase physiological resilience. The 6-week HM program
Revitalize You! was selected for the intervention including the emWave Personal
Stress Reliever technology.

From 2006 to 2007, completion of a health risk assessment (HRA) provided eligible
clergy with the opportunity to participate in the HM program or a lifestyle
management program (LSM). Outcomes for that year were assessed with the Stress
and Well-being Survey. Of 313 participants who completed the survey, 149
completed the Revitalize You! The program and 164 completed the LSM. Well-being,
stress management, resilience, and emotional vitality were significantly improved in
the HM group as compared to the LSM group.

In an analysis of the claims costs data for 2007 and 2008, 144 pastors who had
participated in the HM program were compared to 343 non-participants (control
 group). Adjusted medical costs were reduced by 3.8% for HM participants in
comparison with an increase of 9.0% for the control group. For the adjusted pharmacy
costs, an increase of 7.9% was found compared with an increase of 13.3% for the
control group. Total 2008 savings as a result of the HM program are estimated at $585
per participant, yielding a return on investment of 1.95:1. These findings show that
HM stress-reduction and coherence-building techniques can reduce health care costs.

Metabolic Syndrome
Topic Overview
What is metabolic syndrome?
Metabolic syndrome is a group of health problems that include too much fat around the waist, elevated blood
pressure, high triglycerides, elevated blood sugar, and low HDL cholesterol.
Together, this group of health problems increases your risk of heart attack, stroke, and diabetes.

What causes metabolic syndrome?

Metabolic syndrome is caused by an unhealthy lifestyle that includes eating too many calories, being inactive,
and gaining weight, particularly around your waist. This lifestyle can lead to insulin resistance, a condition in
which the body is unable to respond normally to insulin. If you have insulin resistance, your body cannot use
insulin properly, and your blood sugar will begin to rise. Over time, this can lead to type 2 diabetes.

What are the symptoms?

If you have metabolic syndrome, you have several disorders of the metabolism at the same time, including
obesity (usually around your waist), high blood pressure, low HDL cholesterol, and resistance to insulin.

Why is metabolic syndrome important?

This syndrome raises your risk for coronary artery disease (CAD), even beyond that caused by high LDL
cholesterol alone.footnote1 It also increases your risk for diabetes.

What increases your chance of developing metabolic syndrome?

The things that make you more likely to develop metabolic syndrome include:footnote2, footnote1
 Insulin resistance. This means that your body cannot use insulin properly.
 Abdominal obesity. This means having too much fat around your waist.
 Age. Your chances of developing metabolic syndrome increase as you get older.
 Lack of exercise. If you do not exercise, you are more likely to be obese and develop
metabolic syndrome.
 Hormone imbalance. A hormone disorder such as polycystic ovary syndrome (PCOS), a
condition in which the female body produces too much of certain hormones, is linked with metabolic
syndrome.
 Family history of type 2 diabetes. Having parents or close relatives with diabetes is
associated with metabolic syndrome.
 A history of diabetes during pregnancy (gestational diabetes).
 Race and ethnicity. People with African, Hispanic, First Nations, Asian, and Pacific Islander
backgrounds are at higher risk than whites for type 2 diabetes.

How is it treated?
The main goal of treatment is to reduce your risk of coronary artery disease (CAD) and diabetes. The first
approaches in treating metabolic syndrome are:

 Weight control. Being overweight is a major risk factor for CAD. Weight loss lowers LDL
cholesterol and reduces all of the risk factors for metabolic syndrome.
 Physical activity. Lack of exercise is a major risk factor for CAD. Regular exercise can help
improve cholesterol levels. It can also lower blood pressure, reduce insulin resistance, lower blood
sugar levels, and improve heart function.
 Assessing risk category for CAD and diabetes. Then you and your doctor may discuss other
treatments to lower LDL, high blood pressure, or high blood sugar.

6 Herbs and Supplements for Depression

Alternative remedies for

depression
The U.S. Food and Drug Administration (FDA) has approved a number
medications for the treatment of depression. If you live with depression but opt
not to take one of these medications, you still have other options. Some
people look to herbs and natural remedies to find relief from their symptoms.

Many of these remedies have been used medicinally for centuries as folk and
alternative treatments. Today, many herbs are marketed as mood boosters for
people who experience chronic feelings of sadness or hopelessness.
Studies have attempted to track the benefits of herbs for treating depression.
Here are several herbs that may help lift your mood when you experience mild
to moderate depression.

1. St. John’s wort

St. John’s wort is a plant that’s native to Europe, western Asia, and northern
Africa. Europeans commonly take St. John’s wort as a way to treat
depression, but the FDA hasn’t approved the herb to treat this condition.

Taking St. John’s wort has been linked with increasing the amount of
serotonin in the body. Serotonin is a feel-good chemical in the brain that
people with depression are often low in. Several antidepressants work by
increasing the amount of serotonin in the brain.

According to the National Institutes of Health (NIH)Trusted Source, St. John’s

wort may help milder forms of depression, although its effects haven’t been
conclusively proven either way. A 2008 review of 29 studies on St. John’s wort
found that the plant was just as effective for treating mild to moderate
depression as antidepressants, yet resulted in fewer side effects. On the other
hand, the NIH’s National Center for Complementary and Integrative
HealthTrusted Source sponsored two separate studies that found it wasn’t
better than a placebo for treating depression.

It’s important to note that St. John’s wort is known for interacting with lots of
medications. This is especially true for blood thinners, birth control pills, and
chemotherapy medications. Always check with your doctor before taking this
herb.

Shop online for St. John’s wort supplements.

2. Omega-3 fatty acids
Omega-3 fatty acids are a healthy type of fat found in fish such as salmon,
trout, and sardines. They’re available in supplement form and are sometimes
called fish oil capsules. According to the Mayo Clinic, researchers have found
that people who have low levels of two brain chemicals found in fish oil
supplements may be at an increased risk of depression. It’s ideal to get a
higher ratio of DHA to EPA, which are both types of omega-3 fatty acids.

In addition to taking fish oil supplements to get omega-3 fatty acids, you can
also increase the amount of fish you eat. Eating fish three times a week can
increase your omega-3 fatty acids without the aid of supplements.

Keep in mind that some fish can have high levels of mercury. These include
swordfish, tilefish, king mackerel, and shark. Avoid these in favor of fish with
lower levels of mercury, such as light canned tuna, salmon, freshwater trout,
and sardines.

Shop online for omega-3 supplements.

3. Saffron
Saffron is a spice derived from a dried portion of a crocus, a flower in the iris
family. According to a study in Alternative Medicine ReviewTrusted Source,
taking saffron stigma (the end of the carpel, or rod-like stem, in the flower) has
been shown to be effective in treating mild to moderate depression.

Shop online for saffron.

4. SAM-e
SAM-e is short for S-adenosylmethionine. This supplement is designed to act
like a synthetic form of the body’s natural mood-boosting chemicals.
According to the Mayo Clinic, SAM-e is regarded as a supplement in the
United States — the FDA doesn’t consider it a medication.

You shouldn’t take SAM-e along with antidepressants. You should also be
aware that SAM-e can cause health effects such as upset stomach and
constipation if you take too much.

Shop online for SAM-e supplements.

5. Folate
There may be a linkTrusted Source between low levels of folic acid (the
synthetic form of folate) and depression. Taking 500 micrograms of folic acid
has been linked with improving the effectiveness of other antidepressant
medications.

One way to increase your folate levels is to consume folate-rich foods daily.
These include beans, lentils, fortified cereals, dark leafy greens, sunflower
seeds, and avocados.

Shop online for folate supplements.

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6. Zinc
Zinc is a nutrient linked with mental functions such as learning and
behavior. Low levels of blood zinc are associated with depression, according
to an analysis in Biological Psychiatry.

According to Nutrition NeuroscienceTrusted Source, taking a 25-milligram zinc

supplement daily for 12 weeks can help reduce depression symptoms. Taking
zinc supplements can also increase the amount of available omega-3 fatty
acids in the body.

Shop online for zinc supplements.

Herbs not yet proven to ease

depression
Health food stores may market herbs and supplements as being able to treat
depression. However, according to a review published in BJPsych Advances,
several of these treatments haven’t been shown to be effective in treating
depression. These include the following herbs:

 Crataegus oxyacantha (hawthorn)
  Eschscholzia californica (California poppy)
 Ginkgo biloba
 Lavandula angustifolia (lavender)
 Matricaria recutita (chamomile)
 Melissa officinalis (lemon balm)
 Passiflora incarnate (maypop, or purple passionflower)
 Piper methysticum (kava)
 Valeriana officinalis (valerian)

If you do choose to use these or other herbs, always check with your doctor
first to make sure they won’t interact with any medication you might be taking.

Also note that herbs and supplements are not monitored by the FDA, so there
may be concerns about purity or quality. Always buy from a reputable source.

How To Get Rid of Depression: 5

Herbal Remedies That Could Help
Some ayurvedic herbs and spices can help reduce the symptoms of
depression. An Ayurvedic expert suggests some herbal remedies for
depression.
We are not oblivious to the fact how depression is fast becoming a common lifestyle problem
with many of us suffering from symptoms like anxiety, stress and insomnia. These may seem
like mere day to day problems, but they can turn into a matter of concern in the long run.
According to the World Health Organization (WHO), depression is the leading cause of ill health
and disability worldwide. More than 300 million people are living with depression with an
increase of more than 18 percent between 2005 and 2015. The depression rate in India in 2016-
17 was 36 percent. The fear of stigma and lack of support for people with mental disorders have
known to be the biggest reasons for not being able to get the right treatment. There may not be
a sure shot cure for depression, but there is a possibility to slow it down and calm your
perturbed self. If you haven't known, we tell you how to get rid of depression. Ayurvedic
herbs can help in healing your body in more ways than one. According to Dr. Ashutosh Gautam,
Clinical Operations and Coordination Manager, Baidyanath, "During depression, your feel good
hormones are not competent anymore to handle many situations, hence, putting you in different
moods. Some ayurvedic herbs and spices have proved to help reduce the symptoms of
depression."

Follow These Herbal Remedies For Depression

1. Ashwangandha
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inRead invented by Teads

Ashwangnadha is believed to relieve stress and anxiety due to the presence of active
compounds like steroidal lactones, saponins, alkaloids and withanolides that
provide antidepressant, anti-inflammatory and anti-anxiety properties. These properties
help in reducing stress caused by emotional and physical fatigue. It also balances out
the constant mood swings and increases mental alertness, focus and concentration. It
helps restore the normal physiological functioning. Ashwangandha can be consumed in
its powdered form or as a liquid extract.

(Also Read: 6 Foods That May Cause Depression And Related Symptoms!)

Ashwangandha helps restore normal physiological functioning

2. Brahmi
Brahmi is a small perennial creeping herb that has an age old reputation of curing
stress. Brahmi acts as an adaptogen, which simply means that it helps the body adapt
to new or stressful situations. When consumed, it is believed to increase the serotonin
levels in the brain that help the mind keep calm and give relief from anxiety and
nervousness.

Brahmi helps in adapting new or stress situations

3. Jatamansi (Spikenard)

Jatamansi is a perennial herb that helps curing insomnia and other sleeping disorders. It
is also known for its anti-depressant, anti-stress and anti-fatigue properties. The roots of
jatamansi are used for the medicinal purposes in Ayurveda which are known to give a
therapeutic effect to mood swings and stress disorders. Jatamansi can erase negative
thoughts by channelizing the energies of the mind in the right direction.

(Also Read: Depression Raises Risk Of Early Death in Women: 5 Foods That May Help
Curb Depression)
4. Pudina (Peppermint)
Pudina or peppermint has been used for centuries to cure nervous system disorders
due to the presence of menthol as it helps calm the frazzled nerves and has a cooling
effect. It is loaded with vitamin A and C, minerals including magnesium, manganese,
calcium, iron, folate, copper and potassium. Menthol helps cure insomnia by keeping
your mind calm and lets you sleep in peace. 
 

Pudina has menthol that keeps your mind calm

5. Maca (Peruvian Ginseng)

Maca also known as Peruvian ginseng is a herb that is power packed with nutrients. It is
a rich source of vitamins, amino acids, various minerals and phytonutrients that
increase stamina and decrease excessive anxiety. A Peruvian plant that belongs to the
radish family, maca has proved to be a natural healer that helps with hormone and
neurotransmitter production due to the presence of adaptogen. Additionally, maca is a
natural energizer and helps people overcome lethargy.
 
Maca is a natural energizer and helps overcome lethargy

COMMENTSIt is imperative to refer to a doctor before you switch to herbal remedies as the
result majorly depends on the dosage and the form in which they are consumed. 

Natural remedies for depression: Are they

effective?
I've heard natural remedies for depression, such as St.
John's wort, can work as well as antidepressants. Is that
true?
Answer From Daniel K. Hall-Flavin, M.D.

So-called natural remedies for depression aren't a replacement for medical diagnosis
and treatment. And natural doesn't always mean safe. However, for some people
certain herbal and dietary supplements do seem to work well, but more studies are
needed to determine which are most likely to help and what side effects they might
cause.
Here are some supplements that are promoted by marketers as helping with
depression:

 St. John's wort. This herbal supplement is not approved by the Food and Drug
Administration (FDA) to treat depression in the U.S., but it's available. Although it may be
helpful for mild or moderate depression, use it with caution. St. John's wort can interfere with
many medications, including blood-thinning drugs, birth control pills, chemotherapy,
 HIV/AIDS medications and drugs to prevent organ rejection after a transplant. Also, avoid
taking St. John's wort while taking antidepressants — the combination can cause serious
side effects.
 SAMe. This dietary supplement is a synthetic form of a chemical that occurs naturally in
the body. SAMe (pronounced sam-E) is short for S-adenosylmethionine (es-uh-den-o-sul-
muh-THIE-o-neen). SAMe is not approved by the FDA to treat depression in the U.S.,
though it's available. More research is needed to determine if SAMe is helpful for
depression. In higher doses, SAMe can cause nausea and constipation. Do not use SAMe if
you're taking a prescription antidepressant — the combination may lead to serious side
effects. SAMe may trigger mania in people with bipolar disorder.
 Omega-3 fatty acids. These fats are found in cold-water fish, flaxseed, flax oil, walnuts
and some other foods. Omega-3 supplements are being studied as a possible treatment for
depression and for depressive symptoms in people with bipolar disorder. While considered
generally safe, the supplement can have a fishy taste, and in high doses, it may interact with
other medications. Although eating foods with omega-3 fatty acids appears to have heart-
healthy benefits, more research is needed to determine if it has an effect on preventing or
improving depression.
 Saffron. Saffron extract may improve symptoms of depression, but more study is
needed. High doses can cause significant side effects.
 5-HTP. The supplement called 5-hydroxytryptophan (hi-drok-see-TRIP-to-fan), also
known as 5-HTP, may play a role in improving serotonin levels, a chemical that affects
mood. But evidence is only preliminary and more research is needed. There is a safety
concern that using 5-HTP may cause a severe neurological condition, but the link is not
clear. Another safety concern is that 5-HTP could increase the risk of serotonin syndrome —
a serious side effect — if taken with certain prescription antidepressants.
 DHEA. Dehydroepiandrosterone (dee-hi-droe-ep-e-an-DROS-tur-own), also called
DHEA, is a hormone that your body makes. Changes in levels of DHEA have been linked to
depression. Several preliminary studies show improvement in depression symptoms when
taking DHEA as a dietary supplement, but more research is needed. Although it's usually
well-tolerated, DHEA has potentially serious side effects, especially if used in high doses or
long term. DHEA made from soy or wild yam is not effective.
Nutritional and dietary supplements are not monitored by the FDA the same way that
medications are. You can't always be certain of what you're getting and whether it's
safe. It's best to do some research before starting any dietary supplement. Make sure
you're buying your supplements from a reputable company, and find out exactly what
they contain.
Also, because some herbal and dietary supplements can interfere with prescription
medications or cause dangerous interactions, talk to your health care provider before
taking any supplements.

Cortisol — Its Role in Stress, Inflammation, and Indications for Diet Therapy
By Dina Aronson, MS, RD
Today’s Dietitian

Cortisol, a glucocorticoid (steroid hormone), is produced from cholesterol in the two

adrenal glands located on top of each kidney. It is normally released in response to
events and circumstances such as waking up in the morning, exercising, and acute
stress. Cortisol’s far-reaching, systemic effects play many roles in the body’s effort to
carry out its processes and maintain homeostasis.

Of interest to the dietetics community, cortisol also plays an important role in human
nutrition. It regulates energy by selecting the right type and amount of substrate
(carbohydrate, fat, or protein) the body needs to meet the physiological demands placed
on it. When chronically elevated, cortisol can have deleterious effects on weight,
immune function, and chronic disease risk.

Cortisol (along with its partner epinephrine) is best known for its involvement in the
“fight-or-flight” response and temporary increase in energy production, at the expense of
processes that are not required for immediate survival. The resulting biochemical and
hormonal imbalances (ideally) resolve due to a hormonally driven negative feedback
loop. The following is a typical example of how the stress response operates as its
intended survival mechanism:

1. An individual is faced with a stressor.

2. A complex hormonal cascade ensues, and the adrenals secrete cortisol.

3. Cortisol prepares the body for a fight-or-flight response by flooding it with glucose,
supplying an immediate energy source to large muscles.

4. Cortisol inhibits insulin production in an attempt to prevent glucose from being stored,
favoring its immediate use.

5. Cortisol narrows the arteries while the epinephrine increases heart rate, both of which
force blood to pump harder and faster.

6. The individual addresses and resolves the situation.

7. Hormone levels return to normal.

So what’s the problem? In short, the theory is that with our ever-stressed, fast-paced
lifestyle, our bodies are pumping out cortisol almost constantly, which can wreak havoc
on our health. This whole-body process, mediated by hormones and the immune
system, identifies cortisol as one of the many players. But isolating its role helps put into
context the many complex mechanisms that lead to specific physiological damage.

Whole-Body Effects of Elevated Cortisol

Blood Sugar Imbalance and Diabetes

Under stressful conditions, cortisol provides the body with glucose by tapping into
protein stores via gluconeogenesis in the liver. This energy can help an individual fight
or flee a stressor. However, elevated cortisol over the long term consistently produces
glucose, leading to increased blood sugar levels.
Theoretically, this mechanism can increase the risk for type 2 diabetes, although a
causative factor is unknown.1 Since a principal function of cortisol is to thwart the effect
of insulin—essentially rendering the cells insulin resistant—the body remains in a
general insulin-resistant state when cortisol levels are chronically elevated. Over time,
the pancreas struggles to keep up with the high demand for insulin, glucose levels in the
blood remain high, the cells cannot get the sugar they need, and the cycle continues.

Weight Gain and Obesity

Repeated elevation of cortisol can lead to weight gain.2 One way is via visceral fat
storage. Cortisol can mobilize triglycerides from storage and relocate them to visceral
fat cells (those under the muscle, deep in the abdomen). Cortisol also aids adipocytes’
development into mature fat cells. The biochemical process at the cellular level has to
do with enzyme control (11-hydroxysteroid dehydrogenase), which converts cortisone to
cortisol in adipose tissue. More of these enzymes in the visceral fat cells may mean
greater amounts of cortisol produced at the tissue level, adding insult to injury (since the
adrenals are already pumping out cortisol). Also, visceral fat cells have more cortisol
receptors than subcutaneous fat.

A second way in which cortisol may be involved in weight gain goes back to the blood
sugar-insulin problem. Consistently high blood glucose levels along with insulin
suppression lead to cells that are starved of glucose. But those cells are crying out for
energy, and one way to regulate is to send hunger signals to the brain. This can lead to
overeating. And, of course, unused glucose is eventually stored as body fat.

Another connection is cortisol’s effect on appetite and cravings for high-calorie foods.
Studies have demonstrated a direct association between cortisol levels and calorie
intake in populations of women.3 Cortisol may directly influence appetite and cravings
by binding to hypothalamus receptors in the brain. Cortisol also indirectly influences
appetite by modulating other hormones and stress responsive factors known to
stimulate appetite.

Immune System Suppression

Cortisol functions to reduce inflammation in the body, which is good, but over time,
these efforts to reduce inflammation also suppress the immune system. Chronic
inflammation, caused by lifestyle factors such as poor diet and stress, helps to keep
cortisol levels soaring, wreaking havoc on the immune system. An unchecked immune
system responding to unabated inflammation can lead to myriad problems: an
increased susceptibility to colds and other illnesses, an increased risk of cancer, the
tendency to develop food allergies, an increased risk of an assortment of
gastrointestinal issues (because a healthy intestine is dependent on a healthy immune
system), and possibly an increased risk of autoimmune disease.4,5

Gastrointestinal Problems
Cortisol activates the sympathetic nervous system, causing all of the physiologic
responses previously described. As a rule, the parasympathetic nervous system must
then be suppressed, since the two systems cannot operate simultaneously. The
parasympathetic nervous system is stimulated during quiet activities such as eating,
which is important because for the body to best use food energy, enzymes and
hormones controlling digestion and absorption must be working at their peak
performance.

Imagine what goes on in a cortisol-flooded, stressed-out body when food is consumed:

Digestion and absorption are compromised, indigestion develops, and the mucosal
lining becomes irritated and inflamed. This may sound familiar. Ulcers are more
common during stressful times, and many people with irritable bowel syndrome and
colitis report improvement in their symptoms when they master stress management.5
And, of course, the resulting mucosal inflammation leads to the increased production of
cortisol, and the cycle continues as the body becomes increasingly taxed.4

Cardiovascular Disease
As we’ve seen, cortisol constricts blood vessels and increases blood pressure to
enhance the delivery of oxygenated blood. This is advantageous for fight-or-flight
situations but not perpetually. Over time, such arterial constriction and high blood
pressure can lead to vessel damage and plaque buildup—the perfect scenario for a
heart attack. This may explain why stressed-out type A (and the newly recognized type
D) personalities are at significantly greater risk for heart disease than the more relaxed
type B personalities.6

Fertility Problems
Elevated cortisol relating to prolonged stress can lend itself to erectile dysfunction or the
disruption of normal ovulation and menstrual cycles. Furthermore, the androgenic sex
hormones are produced in the same glands as cortisol and epinephrine, so excess
cortisol production may hamper optimal production of these sex hormones.5

Other Issues
Long-term stress and elevated cortisol may also be linked to insomnia, chronic fatigue
syndrome, thyroid disorders, dementia, depression, and other conditions.4,5

Assessing Cortisol Levels

The adrenal stress index (ASI), a salivary test, is the preferred test for adrenal function
and a well-accepted, noninvasive, reliable indication of cortisol levels.7-10 However, a
trained professional should interpret the results because factors such as age, gender,
timing with the menstrual cycle, pregnancy, lactation, smoking, medications, medical
conditions, caffeine and alcohol consumption, caloric intake, and other test results
(particularly related hormone tests such as sex hormone levels) will contextualize the
significance and meaning of the measurement.9,10

The ASI is available as a home kit. Four saliva samples are taken at specific times and
then shipped to a laboratory for analysis. Conveniently, in addition to measuring the
adrenal hormones cortisol and dehydroepiandrosterone, the same test also measures
antibodies to gliadin, often used as a marker for intestinal inflammation, Candida
infections, and sensitivity to gluten-containing grains. (Note that this test cannot
diagnose gluten sensitivity definitively.)7

A blood cortisol test is available, but it is considered inferior to the salivary test for three
reasons: It tests cortisol levels only at one given point in time, which provides less
information than levels at four times (which reveals important imbalances); the blood
test itself (or simply going to the doctor) can stress a person enough to cause a cortisol
surge; and it is considered less sensitive because it measures the total hormone level
as opposed to specific components.5

The Good News

So far, it may seem as though stressed-out folks are destined for failed health despite
their best intentions. Fortunately, there is much we can do for our clients (and
ourselves) to reverse the path of destruction. The best approach to keeping cortisol
levels at bay is mastering stress management and optimizing diet.

Stress Management
First, regardless of our scope of practice, we can always recommend strategies for
effective stress management. Books such as Woodson Merrell’s The Source have
some powerful yet commonsense, evidence-based advice for de-stressing and
regaining optimal health. Some strategies include getting more and better quality sleep,
breath work, acupuncture, cardio/resistance/relaxation exercises, and addressing
psychological/emotional issues. Minimizing stress may require a team approach; we
can acknowledge its importance and leave the details to the experts.

The Anti-Inflammatory Diet

Systemic inflammation, as noted previously, causes elevated cortisol levels. If we can
naturally decrease inflammation in the body and minimize stress, decreased cortisol
levels should follow, resulting in decreased chronic disease risk and improved wellness.
The biochemical processes leading to and abating inflammation are complex and multi-
faceted, but as experts in diet and lifestyle, we can make a significant difference.

Like any diet designed to manage a condition, there is no one perfect anti-inflammatory
diet. However, based on known properties of foods and clinical research, we can devise
a generally low-inflammatory diet and tweak it over time. Obviously, maximizing the
anti-inflammatory foods and minimizing the proinflammatory ones is a big step toward
controlling inflammation. Incidentally, dietary strategies for controlling inflammation may
also help with adrenal support in general, since diet can directly affect adrenal burden
(eg, cortisol is released in response to metabolic demands).

Since lifestyle factors are generally the most significant modulators of inflammation,
nutrition professionals can make a huge difference in our clients’ and patients’ overall
health.4 The following is a general list of diet and lifestyle factors believed to be the
most significant contributors to inflammation:

• high glycemic load;

• saturated and trans fatty acids;

• caffeine;

• alcohol in excess;

• insufficient intake of micronutrients and antioxidants;

• a low-fiber diet;

• a sedentary lifestyle; and

• overweight.4

To minimize inflammation, the following are recommended:

• a low glycemic load diet;

• elimination of trans fats and minimal intake of saturated fats;

• elimination or reduction of caffeine;

• alcohol in moderation or not at all;

• boosting consumption of whole plant foods to maximize intake of fiber, antioxidants,

and phytonutrients: with vegetables, fruits, whole intact grains, nuts, seeds, and beans;
• meeting recommended intake of omega-3 fatty acids (may be best measured as a
ratio to omega-6 fatty acids);

• regular exercise; and

• probiotics, if warranted.

Clearly, these are merely guidelines. Therapeutic nutritional recommendations need to

be customized for each individual’s condition, preferences, and goals.

Note that while medications such as nonsteroidal anti-inflammatory drugs temporarily

alleviate inflammation, hundreds of studies have demonstrated that long-term use can
cause damage over time and even exacerbate systemic inflammation.

Summary
Cortisol is a fascinating hormone that is important to nutrition science on many levels.
Understanding the science behind it, including its behaviors and relationships to other
biochemical components, the immune system, and health outcomes, is crucial to our
success in treating people who seek dietary intervention for stress, illness, fatigue, and
other common complaints.
 Implementation of targeted dietary and lifestyle approaches is an extremely powerful
way to reduce stress, minimize inflammation, and reduce the risk for illness and chronic
disease. True, the many biochemical processes involving cortisol and other hormones,
stress, and inflammation and their impact on health and disease risk are complex and
elaborate. The therapeutic diet and lifestyle strategies, however, are not. The more we
learn about the way the body responds to the demands placed on it, as well as its
extraordinary healing power, the more we are valued as professionals who can
effectively change people’s lives by improving health, inspiring change, and increasing
longevity.

— Dina Aronson, MS, RD, owns Welltech Solutions, a nutrition and technology
consulting company.

High Cortisol Symptoms:

What Do They Mean?
 Symptoms

 Meaning

 See a doctor

 Takeaway

What is cortisol?
Cortisol is known as the stress hormone because of its role in the body’s
stress response. But cortisol is about more than just stress.

This steroid hormone is made in the adrenal glands. Most of the cells in our
bodies have cortisol receptors that use cortisol for a variety of functions,
including

 blood sugar regulation

  inflammation reduction
 metabolism regulation
 memory formulation

Cortisol is important for your health, but too much of it can wreak havoc on
your body and cause a number of unwanted symptoms.

What are the symptoms of high

cortisol?
High cortisol can cause a number of symptoms throughout your body.
Symptoms can vary depending on what’s causing the increase in your cortisol
levels.

General signs and symptoms of too much cortisol include:

 weight gain, mostly around the midsection and upper back

 weight gain and rounding of the face
 acne
 thinning skin
 easy bruising
 flushed face
 slowed healing
 muscle weakness
 severe fatigue
 irritability
 difficulty concentrating
  high blood pressure
 headache

What do high cortisol levels

mean?
A high cortisol level can mean several things.

High cortisol may be referred to as Cushing syndrome. This condition results

from your body making too much cortisol. (Similar symptoms can arise after
taking high doses of corticosteroids, so it’s recommendedTrusted Source that
this be ruled out before testing for Cushing syndrome).

Some common symptoms of Cushing syndrome include:

 fatty deposits in the midsection, face, or between the shoulders

 purple stretch marks
 weight gain
 slow-healing injuries
 thinning skin

Several things can contribute to the development of high cortisol.

Stress

Stress triggers a combination of signals from both hormones and nerves.

These signals cause your adrenal glands to release hormones, including
adrenaline and cortisol.
The result is an increase in heart rate and energy as part of the fight-or-flight
response. It’s your body’s way of preparing itself for potentially dangerous or
harmful situations.

Cortisol also helps to limit any functions that aren’t essential in a fight-or-flight
situation. Once the threat passes, your hormones return to their usual levels.
This whole process can be a lifesaver.

But when you’re under constant stress, this response doesn’t always turn off.

Long-term exposure to cortisol and other stress hormones can wreak

havoc on almost all of your body’s processes, increasing your risk of many
health issues, from heart disease and obesity to anxiety and depression

Pituitary gland issues

The pituitary gland is a tiny organ at the base of your brain that controls the
secretion of various hormones. Issues with the pituitary gland can cause it to
under- or over-produce hormones, including adrenocorticotropic hormone.
This is the hormone that triggers the adrenal glands to release cortisol.

Pituitary conditions that can cause high cortisol levels include:

 hyperpituitarism (overactive pituitary gland)

 benign pituitary tumors, including adenomas
 cancerous pituitary tumors

Adrenal gland tumors

Your adrenal glands are located above each kidney. Adrenal gland tumors
can be benign (noncancerous) or malignant (cancerous) and range in size.
Both types can secrete high levels of hormones, including cortisol. This can
lead to Cushing syndrome.

In addition, if the tumor is large enough to put pressure on nearby organs, you
might notice pain or a feeling of fullness in your abdomen.

Adrenal tumors are usually benign and found in approximately 1 in 10

people having an imaging test of the adrenal gland. Adrenal cancers are much
more rare.

Medication side effects

Certain medications can cause an increase in cortisol levels. For example,

oral contraceptives are linkedTrusted Source to increased cortisol in the
blood.

Corticosteroid medications used to treat asthma, arthritis, certain cancers, and

other conditions can also cause high cortisol levels when taken in high doses
or for a long period of time.

Commonly prescribed corticosteroids include:

 prednisone (Deltasone, Prednicot, Rayos)

 cortisone (Cortone Acetate)
 methylprednisolone (Medrol, MethylPREDNISolone Dose Pack)
 dexamethasone (Dexamethasone Intensol, DexPak, Baycadron)

Finding the right dose and taking corticosteroids as prescribed can help
reduce the risk of high cortisol levels.
Steroid medications should never be stopped without gradual tapering.
Abruptly stopping can cause low levels of cortisol. This can cause low blood
pressure and blood sugar, even coma and death.

Always speak to your doctor before making any changes to your dosing
schedule when taking corticosteroids.

Estrogen

Circulating estrogen can increase cortisol levels in your blood. This can be
caused by estrogen therapy and pregnancy. A high circulating concentration
of estrogen is the most common cause of high cortisol levels in women.

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Should I see a doctor?

If you think you might have high cortisol, it’s important to see a doctor for a
blood test. High cortisol causes common signs and symptoms that can be
caused by many other diseases, so it’s important to confirm what’s causing
your symptoms.

If you’re experiencing symptoms that may be caused by high cortisol levels,

your doctor may recommend the following tests:

 Cortisol urine and blood tests. These tests measure the levels of
cortisol in your blood and urine. The blood test uses a sample of blood
drawn from your vein. A test called the 24-hours urinary free cortisol
excretion test is used to check your urine. This entails collecting urine
over a 24-hour period. Blood and urine samples are then analyzed in a
laboratory for cortisol levels.
  Cortisol saliva test. This test is used to check for Cushing syndrome. A
sample of saliva collected at night is analyzed to see if your cortisol
levels are high. Cortisol levels rise and fall throughout the day and drop
significantly at night in people without Cushing syndrome. High cortisol
levels at night would indicate you may have Cushing syndrome.
 Imaging tests. CT scans or an MRI may be used to obtain images of
your pituitary gland and adrenal glands to check for tumors or other
abnormalities.

Unmanaged high cortisol levels can have serious consequences on your

health. Left untreated, high cortisol can increaseTrusted Source your risk of
serious health conditions, including:

 cardiovascular disease
 osteoporosis
 insulin resistance and diabetes
 psychiatric disorders