Heath Notes

Stress

“Stressed out” is a common phrase these days. While some stress is healthy, unwanted stress can be harmful. According to research or other evidence, the following self-care steps may help reduce destructive stress:

Get some extra C
Help normalize stress-hormone levels by taking 1 to 3 grams of vitamin C every day

Relax with rhodiola
Taking 170 mg a day of a standardized herbal extract during stressful phases may improve your feelings of well-being and support mental function

Work in a workout
Improve your resistance to stress by enjoying routine aerobic exercise

Participate in a program
Find a stress-reduction program that includes group counseling, instruction in coping skills, relaxation training, and other helpful techniques

Say no to smoking
Kick the habit to keep stress in check and to avoid other health hazards

Check out tyrosine
Occasionally taking this amino acid before a stressful activity can help maintain your mental capacity; calculate 150 mg for every 2.2 lbs of body weight and split into two doses (take the second dose 40 to 90 minutes after the first)

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full stress article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About stress

The popular idea of stress in relation to human health is often described as an unpleasant mental or emotional experience, as when people say they are “stressed out.” This expression relates primarily to the idea of prolonged or sudden and intense stress, which can have unpleasant effects on the body, impairing the ability to function, and even harming health.¹ ² ³ However, the biological concept of stress is much more broadly defined as any challenge (physical or psychological) that requires an organism to adapt in a healthy manner. In other words, responses to stress can sometimes be of benefit when the organism is strengthened by the experience. The discussion below focuses on reducing the effects of excessive, unwanted stress.

Product ratings for stress

Science Ratings	Nutritional Supplements	Herbs
	Tyrosine Vitamin C	Rhodiola
	DHA (docosahexaenoic acid) Flaxseed Multivitamin-mineral supplement	Asian ginseng Eleuthero
	Probiotics	Ashwagandha Maca
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Symptoms may include anxiety, fatigue, insomnia, stomach problems, sweating, racing heart, rapid breathing, shortness of breath, and irritability. Many health problems have been associated with various kinds of sudden or long-term stress, including alcohol abuse,⁴ asthma,⁵ chronic fatigue,⁶ ⁷ erectile dysfunction and male infertility,⁸ fibromyalgia,⁹ headaches,¹⁰ heart disease,¹¹ ¹² ¹³ high blood pressure,¹⁴ ¹⁵ immune system dysfunction,¹⁶ ¹⁷ ¹⁸ indigestion, irritable bowel syndrome,¹⁹ mood disorders such as anxiety and depression,²⁰ ²¹ peptic ulcers,²² pregnancy complications,²³ ²⁴ ²⁵ rheumatoid arthritis,²⁶ skin diseases,²⁷ impaired wound healing,²⁸ and others.²⁹ ³⁰ ³¹ ³² ³³ ³⁴ Problems with recovery from surgery and impaired workplace performance are also associated with excessive stress.³⁵ ³⁶ ³⁷ ³⁸

Dietary changes that may be helpful

Flaxseed is a good source of fiber and alpha-linolenic acid (an omega-3 fatty acid) and is a major source of lignans that may influence hormone function. A controlled study found that adding 30 grams per day of freshly ground flaxseed to the diets of postmenopausal women reduced the blood pressure–elevating effect of mental stress and reduced stress-related changes in fibrinogen, a blood component associated with increased risk of heart disease.³⁹ However, flaxseed had no significant effect on blood levels of an adrenal stress hormone.

Lifestyle changes that may be helpful

While cigarette smokers often describe their habit as relaxing, smoking is associated with increased stress levels,⁴⁰ and stopping the habit eventually results in reduced feelings of stress.⁴¹

Drinking alcohol can reduce feelings of stress,⁴² but using alcohol regularly in response to chronic or repetitive stress can lead to an unhealthy dependency.

Exercise has long been thought to have potential benefits to mental health and stress reduction;⁴³ ⁴⁴ however, exercise can also be stressful when it is intense or competitive.⁴⁵ ⁴⁶ Many preliminary studies have found that regular exercisers score higher on measures of psychological well-being and perceived stress,⁴⁷ ⁴⁸ ⁴⁹ ⁵⁰ ⁵¹ and that people who improve their exercise habits develop changes in their mental attitudes that are associated with better resistance to stress.⁵² A controlled trial found that a single session of aerobic exercise reduced the anxiety associated with a subsequent experience designed to be psychologically stressful.⁵³ However, studies of overall aerobic fitness have found that people with higher fitness levels are not different from those with lower fitness in their resistance to stress. One preliminary study gave aerobically fit and unfit women a mentally stressful test, and found no differences between them in physical or psychological measures of their stress reaction.⁵⁴ Another preliminary study found that while physical activity was associated with reduced stress symptoms, having high aerobic fitness had no influence.⁵⁵ This may mean that effects other than improved aerobic fitness, such as an improved self-image or the social support from belonging to an exercise group, are responsible for the benefits of exercise on controlling stress. A preliminary study in Thailand found that postmenopausal women who completed an aerobic exercise program consisting of 40- to 50-minute sessions twice weekly for 12 weeks had improved scores on a questionnaire designed to measure psychological stress.⁵⁶ In a controlled trial, cancer patients hospitalized for chemotherapy who exercised for 30 minutes daily until discharge had significant improvement in several measures of psychological distress, while a similar group who did not exercise showed no change in these measures.⁵⁷ In a controlled trial, 10 weeks of aerobic exercise resulted in healthier responses to acute mental stress in college students compared with students who did no exercise.⁵⁸

Other therapies

Medical management of stress includes teaching people how to avoid or cope with stressful situations and encouraging a healthful diet, good exercise habits, and adequate sleep. Those unable to find relief on their own might benefit from professional counseling.

Vitamins that may be helpful

Tyrosine is an amino acid used by the body to produce certain adrenal stress hormones and chemical messengers in the nervous system (neurotransmitters). Animal research shows that brain levels of these substances decline with stress, and that giving animals tyrosine supplements reverses this decline and improves various tests of performance in stressed animals.⁵⁹ In a controlled study, a protein drink containing 10 grams per day of tyrosine was more effective than a carbohydrate drink for improving mental performance scores in a group of cadets taking a stressful six-day combat training course.⁶⁰ A double-blind trial in humans found that one-time administration of 150 mg of tyrosine per 2.2 pounds of body weight helped prevent a decline in mental performance for about three hours during a night of sleep deprivation.⁶¹ Single administrations of tyrosine (100 to 150 mg per 2.2 pounds of body weight) have also helped preserve mental performance during physically stressful conditions such as noise or extreme cold in several controlled studies.⁶² ⁶³ ⁶⁴ ⁶⁵

Animal studies suggest that supplementing with vitamin C can reduce blood levels of stress-related hormones and other measures of stress.⁶⁶ ⁶⁷ ⁶⁸ ⁶⁹ Controlled studies of athletes have shown that vitamin C supplementation (1,000 to 1,500 mg per day) can reduce stress hormone levels after intense exercise.⁷⁰ ⁷¹ Surgery patients given 2,000 mg per day of vitamin C during the week before and after surgery had a more rapid return to normal of several stress-related hormones compared with patients not given vitamin C.⁷² In a double-blind trial, young adults took 3,000 mg per day of vitamin C for two weeks, then were given a psychological stress test involving public speaking and mental arithmetic.⁷³ Compared with a placebo group, those taking vitamin C rated themselves less stressed, scored better on an anxiety questionnaire, had smaller elevations of blood pressure, and returned sooner to lower levels of an adrenal stress hormone following the stress test.

Animal and human studies suggest that deficiencies of omega-3 fatty acids may contribute to behaviors associated with unhealthy responses to stress.⁷⁴ ⁷⁵ A double-blind study of students with a low dietary intake of DHA (docosahexaenoic acid, an omega-3 fatty acid) reported that taking 1.5 to 1.8 grams of DHA per day for three months prevented an increase in aggressiveness in these students during a stressful final exam period.⁷⁶ This group of researchers reported in another double-blind study that 1.5 grams per day of DHA given to medical students during a stressful exam period resulted in changes in some, though not all, blood measurements indicating improved responses to stress.⁷⁷

When asked why they are taking nutritional supplements, combating stress is one of the most common reasons given by people.⁷⁸ ⁷⁹ ⁸⁰ Despite this popular attitude, human research on the effects of supplements on stress is sparse and conflicting.⁸¹ While there are animal studies and preliminary human reports suggesting that many vitamins are important for protecting the body from the consequences of physical stresses such as surgery,⁸² evidence supporting the use of vitamins to combat everyday stress is somewhat limited.

Several studies have evaluated a daily supplement of vitamin B1 (15 mg), vitamin B2 (15 mg), vitamin B3 (50 mg), vitamin B6 (10 mg), vitamin B12 (10 mcg), vitamin C (500 mg), pantothenic acid (23 mg), folic acid (400 mcg), biotin (150 mcg), calcium (100 mg), magnesium (100 mg), and zinc (10 mg) for combating stress effects. People participating in preliminary trials of this combination have reported some benefits that relate to the effects of chronic stress, including improved concentration, better mood, and less fatigue.⁸³ ⁸⁴ A small double-blind study of this combination reported no significant psychological benefits relating to stress.⁸⁵ However, in a larger double-blind trial with healthy young men, this supplement resulted in significantly less anxiety and perceived stress according to some measurements after one month, though other stress-related symptoms did not improve.⁸⁶ Another large, double-blind study of people experiencing high stress levels found this combination significantly helpful after one month according to several measures of anxiety, well-being, and psychological stress.⁸⁷

In a year-long double-blind trial, a one-a-day type multivitamin-mineral supplement was no better than a supplement containing only vitamin B2, calcium, and magnesium for improving mental or physical measures of quality of life in a group of healthy adults.⁸⁸

Stress is understood to have a detrimental effect on the balance of intestinal bacteria,⁸⁹ ⁹⁰ but whether probiotic supplements improve the ability to handle stress is unknown. In a six-month preliminary trial, a multivitamin-mineral (MVM) supplement that also contained a blend of Lactobacillus acidophilus, Bifidobacterium bifidum, and Bifidobacterium longum was effective for improving scores on a stress questionnaire.⁹¹ However, this improvement could have been a placebo effect or could have been due to the MVM component. Controlled research comparing MVM supplements with and without added probiotics is necessary to determine whether probiotics are helpful for treating stress.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

The herbs discussed here are considered members of a controversial category known as adaptogens, which are thought to increase the body's resistance to stress, and to generally enhance physical and mental functioning.⁹² ⁹³ Many animal studies have shown that various herbal adaptogens have protective effects against physically stressful experiences,⁹⁴ ⁹⁵ but whether these findings are relevant to human stress experiences is debatable.

Animal studies have demonstrated protective effects of rhodiola extracts against physical stresses.⁹⁶ ⁹⁷ ⁹⁸ A double-blind study of healthcare workers experiencing the stress of night duty found that taking 170 mg per day of a standardized rhodiola extract prevented some of the decline in a set of mental performance measures during the first two weeks. However, when this regimen was repeated after a two-week period of not taking the extract, rhodiola did not provide protection from mental performance decline.⁹⁹ In another double-blind study, 100 mg per day of the same extract was given to medical students during a stressful exam period. Those taking the extract reported a better sense of general well-being, and performed better on tests of mental and psychomotor performance.¹⁰⁰ A third double-blind study of military cadets performing a 24-hour duty showed that 370 to 555 mg of rhodiola extract per day significantly reduced mental fatigue, as measured by several performance tasks.¹⁰¹

Animal studies support the idea that Asian ginseng is an adaptogen.¹⁰² Some studies have suggested that Asian ginseng can enhance feelings of well-being in elderly people with age-associated memory impairment,¹⁰³ nurses working night shifts,¹⁰⁴ or people with diabetes.¹⁰⁵ In a double-blind trial, people taking a daily combination of a multivitamin-mineral supplement (MVM) with 40 mg of ginseng extract (standardized for 4% ginsenosides) for 12 weeks reported greater improvements in quality of life measured with a questionnaire compared with a group taking only MVM.¹⁰⁶ The same MVM-ginseng combination was tested in a double-blind study of night-shift healthcare workers.¹⁰⁷ Compared with a placebo group, the group receiving the MVM-ginseng combination improved on one out of four measures of mental performance, one out of three measures of mood (increased calmness, but no change in alertness or contentment), and a measure of reported fatigue. However, in another double-blind study, healthy adults given 200 or 400 mg per day of a standardized extract of Asian ginseng (equivalent to 1,000 or 2,000 mg of ginseng root) showed no significant improvement in any of several measures of psychological well-being after two months.¹⁰⁸

Animal research has reported antistress effects of Eleutherococcus senticosus (also known as Siberian ginseng),¹⁰⁹ and Russian research not available in the English language reportedly describes human studies showing similar effects in humans.¹¹⁰ ¹¹¹ A double-blind study of healthy elderly people reported that those who took 60 drops per day of a eleuthero liquid extract (concentration not specified) scored higher in some quality-of-life measures after four weeks, but not after eight weeks, compared with a group taking a placebo.¹¹² Athletes experiencing the stress of training who took an eleuthero extract equivalent to 4 grams per day had no changes in their blood levels of an adrenal stress hormone after six weeks.¹¹³ More research is needed to clarify the value of eleuthero for treating stress.

Animal studies have suggested that ashwagandha may be helpful for reducing the effects of stress,¹¹⁴ ¹¹⁵ ¹¹⁶ including chronic psychological stress.¹¹⁷ However, no controlled research has been done to explore these effects in humans.

An herbal formula from the Ayurvedic medicine tradition, containing extracts of ashwagandha, asparagus, pueraria, argyreia, dioscorea, mucuna, and piper, has been studied as an aid to coping with the stress of military combat. A double-blind study found that soldiers performed similarly in a set of mental and psychological tests after an eight-day combat mission whether they were given two capsules daily (exact content not revealed) of this formula or a placebo.¹¹⁸ This suggests there was no real benefit of the herbal formula under these conditions.

Animal studies have shown that maca can reduce the negative effects of stress; however, whether maca is effective in humans is unknown.¹¹⁹

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful

Mind-body medicine is a branch of healing that focuses on the role of thoughts and emotions on physical health. Many techniques used in this healing system, including biofeedback, relaxation training, tai chi, yoga, and meditation, affect the nervous system in ways that could theoretically help people cope with stress.¹²⁰ In a controlled trial, tai chi practice, meditation, walking exercise, and quiet reading all resulted in similar biochemical and psychological improvements in the response to a stressful experience.¹²¹ Meditation, practiced for spiritual reasons, for relaxation, or as part of the treatment of a disease, has been reported helpful for stress reduction in preliminary studies.¹²² ¹²³ ¹²⁴ A controlled study found 15 minutes of meditation twice a day reduced measures of stress in adolescents during two experiences designed to produce stress.¹²⁵ Other controlled studies have found reductions in reported stress and related psychological measures after a program of meditation.¹²⁶ ¹²⁷

Stress reduction programs involving combinations of group counseling, instruction in coping skills and problem-solving, relaxation training, meditation, or other methods are effective for reducing stress and helping to prevent or manage health problems relating to stress, according to preliminary and controlled research.¹²⁸ ¹²⁹ ¹³⁰ ¹³¹ ¹³² ¹³³

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

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