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Stress

The effects of stress on your health can be far-reaching. Some of the conditions often associated with stress include insomnia , high blood pressure , tension headaches , anxiety , depression , decreased mental function , and drug or alcohol abuse . Stress is known to cause changes in the body's chemistry, altering the balance of hormones in our systems in ways that can lower our resistance to disease. As a result, we can become more susceptible to colds and flus , and other types of illness. Too much stress sometimes brings on outbreaks of cold sores or genital herpes for people who carry these viruses in their systems. Other chronic diseases such as irritable bowel syndrome , asthma , inflammatory bowel disease , and rheumatoid arthritis may also flare up during times of stress.
If it's possible to avoid situations that cause you to feel tense, unhappy, or worn down, that's obviously to your benefit. However, it isn't always possible to live a stress-free existence. Work deadlines, family demands, relationship problems, traffic jams, missed appointments, forgotten birthdays, personality conflicts, college exams—all of these things, and many more, can be sources of stress. Furthermore, though most of us associate stress with unpleasant events, even wonderful events in our lives, like weddings, vacations, and holidays, can be genuinely stressful.
Not everyone responds to these situations by getting "stressed out." There are those apparently unflappable folks whose pulse rate wouldn't even go up during an earthquake, and then there are those for whom being five minutes late constitutes reason for a state of total panic. How you manage the stress in your life can determine the impact it will have on you.
There are many different methods of dealing with stress. The basics for good health that we all know (but often forget) help in coping with stress: Eating a balanced diet and getting adequate rest help your body adapt and respond to the events in your life. Ironically, stress can interfere with your ability to take care of yourself in this way. When you're worrying so much you can't sleep, getting adequate rest becomes impossible. Stress can affect your eating habits too. So what else can you do? Exercise, meditation, and biofeedback are all widely accepted stress management tools that might help you break out of a stress-induced downward spiral.
For some people, stressful circumstances can trigger symptoms severe enough to warrant seeking medical attention. Conditions associated with stress, such as insomnia , anxiety , depression , and panic attacks , may become severe enough to require medications.

Principal Proposed Natural Treatments

One proposed natural approach to treating the physical consequences of stress involves the use of so-called adaptogens . The term "adaptogen" refers to a hypothetical treatment described as follows: An adaptogen helps the body adapt to stresses of various kinds, whether heat, cold, exertion, trauma, sleep deprivation, toxic exposure, radiation, infection, or psychological stress. Furthermore, an adaptogen should cause no side effects, be effective in treating a wide variety of illnesses, and help return an organism toward balance no matter what may have gone wrong.
However, physical exercise is the only indubitable example of an adaptogen. There is no solid evidence that any substance functions in this way. However there is a bit of suggestive evidence for the herb Panax ginseng , which is discussed in the next section.

Panax Ginseng

Most of the evidence cited to indicate that Panax ginseng has adaptogenic effects comes from animal studies involving ginseng extracts injected into the abdomen. Such studies are of questionable relevance to the oral use of ginseng by people; furthermore, the majority of these studies were performed in the former Soviet Union and failed to reach acceptable scientific standards. However, a few potentially meaningful studies in humans have found effects that are at least consistent with the possibility of benefits in stressful situations.
Animal Studies
According to a number of animal studies, most of which were poorly designed and reported, Panax ginseng injections into the blood stream or abdomen can increase stamina, improve mental function, protect against radiation, infections, toxins, exhaustion, and stress, and activate white blood cells. 1 However, when ginseng is injected into the abdomen or bloodstream, it enters the body directly without going through the digestive tract. This mode of administration is strikingly different from taking ginseng by mouth.
A smaller number of animal studies (again, most of them poorly designed) have looked at the potential benefits of ginseng administered orally, and often reported benefit. 2-8 In addition, studies in mice found that consuming ginseng before exposure to a virus significantly increased the survival rate and number of antibodies produced. 9,10
Human Studies
Human studies of Panax ginseng have only indirectly examined its potential benefits as an adaptogen. For example, a double-blind, placebo-controlled study found evidence that Panax ginseng may improve immune system response. 11 This trial enrolled 227 participants at three medical offices in Milan, Italy. Half were given ginseng at a dosage of 100 mg daily, and the other half received placebo . Four weeks into the study, all participants received influenza vaccine.
The results showed a significant decline in the frequency of colds and flus in the treated group compared to the placebo group (15 versus 42 cases). Also, antibody levels in response to the vaccination rose higher in the treated group than in the placebo group.
These findings have been taken by some researchers to support their belief that ginseng has an adaptogenic effect. However, the study might instead simply indicate a general form of immune support unrelated to stress.
Other studies have looked at Panax ginseng’s effects on overall mental function , 15-17general well-being , 18-21,54 and sports performance . 22-28,52 While it is true that positive results in such studies might tend to hint at an adaptogenic effect, the results were, in general, too mixed to provide conclusive evidence for benefit.
The bottom line: It is not clear that Panax ginseng offers general benefits for stress.
For more information, including dosage and safety issues, see the full Ginseng article.

Other Proposed Natural Treatments

Multivitamins Plus Minerals

Surprisingly, a treatment as simple as multivitamin-mineral tablets may be helpful for stress.
In a double-blind, placebo-controlled study, 300 men and women were given either a multivitamin-mineral tablet or placebo for 30 days. 38 The results showed that people taking the nutritional supplement experienced less anxiety overall and an enhanced ability to cope with stressful circumstances. The supplement used in this study supplied the following nutrients and dosages: vitamin B 1 (10 mg), vitamin B 2 (15 mg), vitamin B 6 (10 mg), vitamin B 12 (10 mcg), vitamin C (1,000 mg), calcium (100 mg), and magnesium (100 mg).
Benefits were seen in another double-blind, placebo-controlled trial that enrolled 80 healthy male volunteers. 39 The supplement used in this trial was similar but not identical.
It's not clear how these nutrients help stress. But, considering that many of us would benefit from general nutritional supplementation in any case, it might be worth trying.

Eleutherococcus senticosus

In the 1940s, Dr. Brekhman, the same scientist who first dubbed Panax ginseng an adaptogen, decided that a much less expensive herb, Eleutherococcus senticosus , is also an adaptogen. A thorny bush that grows much more rapidly than true ginseng, this plant later received the misleading name of "Siberian" or "Russian ginseng." Its chemical makeup, however, is completely unrelated to that of Panax ginseng .
As with Panax ginseng , many animal studies finding adaptogenic benefits with eleutherococcus have been reported, but most were relatively poorly designed and used injections rather than oral administration of the herb, making the results not particularly relevant to the normal human usage of the herb.
Numerous human trials of eleutherococcus have been reported as well, some involving enormous numbers of participants. However, most of these were not double-blind and many were not even controlled , making the results nearly meaningless. (For information on why double-blind, placebo-controlled studies are essential to establish the effectiveness of a treatment, see Why Does This Database Rely on Double-blind Studies? )
Again, as with Panax ginseng , a few reasonably well-designed studies in humans have been reported that may have indirect bearing on the herb’s potential adaptogenic properties. For example, in one double-blind trial, participants took either 10 ml of extract of eleutherococcus or placebo 3 times daily for a 4-week period. Blood samples were analyzed to determine changes in immune cells. A statistically significant increase in numbers of cells important to immune functions was observed in the treatment group as compared to the placebo group.
This study has been widely advertised as proving the eleutherococcus strengthens immunity. However, mere changes in immune cell profile do not at all automatically translate into enhanced immunity. (See the Immune Support article for more information on why this is so.) More meaningful data was obtained in a double-blind, placebo-controlled study involving 93 people who experience recurrent flare-ups of herpes . 41 Use of eleutherococcus significantly reduced the severity, frequency, and duration of herpes outbreaks relative to placebo during the 6-month trial. This study does suggest a possible immune strengthening effect.
Like Panax ginseng , eleutherococcus has also been studied for potential sports performance enhancement benefits, but published studies have not been encouraging. 42,55 One small double-blind, placebo-controlled trial of endurance athletes actually found that use of eleutherococcus may increase physiologic signs of stress during intensive training. 52
For more information, including dosage and safety issues, see the full Eleutherococcus article.

Other Possible Adaptogens

Three small double-blind trials suggest that the herb rhodiola ( Rhodiola rosea ) may improve mental alertness in people undergoing sleep deprivation or other stressful circumstances. 44,45,56
Numerous other herbs are said to be adaptogens as well. These include ashwagandha , astragalus , maitake , reishi , shiitake, suma , and schisandra . However, there is little to no real evidence as yet that they have adaptogenic effects.
One study failed to find greater adaptogenic effects with fish oil as compared to placebo. 59

Alternative Therapies

Many people report that they experience stress relief through the use of alternative therapies, such as biofeedback , guided imagery , hypnotherapy , relaxation therapy , Tai chi , massage , and yoga . Regarding the use of massage therapy, one study failed to find regular massage more effective for controlling stress than use of a relaxation tape. 60 Whereas, a large 2012 review of 35 studies involving 1,794 people found evidence to support the use of yoga to decrease stress and anxiety, although the overall quality of these studies was poor. 75

Other Options

A study failed to find either cognitive behavioral therapy or increased physical activity helpful for stress-related illnesses. 68
Preliminary evidence, including small, double blind trials suggest that the amino acid tyrosine may improve memory and mental function under conditions of sleep deprivation or other forms of stress. 50,51,69
One double-blind study found that use of vitamin C at doses of 3,000 mg daily (slow release) reduced both physical and emotional responses to stress. 53
In small double-blind studies, theanine, a constituent of black tea , appeared to reduce the body's reaction to acute physical or psychological stress. 61,65 Benefits have also been seen with a combination of lysine (2.64 g per day) and arginine (2.64 g per day). 67
One double-blind study found evidence that a processed form of casein (a protein found in milk) may reduce a variety of stress-related symptoms. 66
According to another small, double-blind trial, a mixture of soy phosphatidylserine and lecithin may decrease the physiological response to mental stress. 62 Another study evaluated use of phosphatidylserine for reducing stress in golfers, but the benefits seen failed to reach statistical significance . 74
A proprietary Ayurvedic herbal formula containing Bacopa monniera and almost 30 other ingredients has shown some promise for treating symptoms of stress. In a 3-month, double-blind, placebo-controlled trial of 42 people in high-stress jobs who complained of fatigue, participants using the herbal formula reported fewer stress-related problems. 57 Also, in a 3-month, double-blind, placebo-controlled study of 50 adult students, this formula appeared to improve memory and attention and reduce other signs of stress. 58
In naturopathic medicine, adrenal extract are often recommended for treatment of stress, but there is no evidence that this treatment is effective.
Equivocal evidence hints that valerian , alone or in combination with lemon balm, might reduce anxiety symptoms during stressful situations. 46,63-64
Three studies failed to find Bach flower remedies helpful for situational anxiety (anxiety caused by stressful situations). 70-72
For other natural treatments relevant to stress, see the discussion in the articles on insomnia and anxiety .

References

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42 Dowling EA, Redondo DR, Branch JD, et al. Effect of Eleutherococcus senticosus on submaximal and maximal exercise performance. Med Sci Sports Exerc. 1996;28:482-489.

44 Darbinyan V, Kteyan A, Panossian A, et al. Rhodiola rosea in stress induced fatigue—a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty. Phytomedicine. 2000;7:365-371.

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47 Fahey TD, et al. Hormonal effects of phosphatidylserine during 2 weeks of intense training [abstract]. Med Sci Sports Exerc. 1998;30(5 suppl).

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51 Neri DF, Wiegmann D, Stanny RR, et al. The effects of tyrosine on cognitive performance during extended wakefulness. Avit Space Environ Med. 1995;66:313-319.

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66 Kim JH, Desor D, Kim YT, et al. Efficacy of alpha-s1-casein hydrolysate on stress-related symptoms in women. Eur J Clin Nutr. 2007;61:536­41.

67 Smriga M, Ando T, Akutsu M, et al. Oral treatment with L-lysine and L-arginine reduces anxiety and basal cortisol levels in healthy humans. Biomed Res. 2007;28:85-90.

68 Heiden M, Lyskov E, Nakata M, et al. Evaluation of cognitive behavioural training and physical activity for patients with stress-related illnesses: A randomized controlled study. J Rehabil Med. 2007;39:366-373.

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74 Jager R, Purpura M, Geiss KR, et al. The effect of phosphatidylserine on golf performance. J Int Soc Sports Nutr. 2007 Dec 4.

75 Li AW, Goldsmith CA. The effects of yoga on anxiety and stress. Altern Med Rev. 2012;17(1):21-35.

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