Nutritional Supplements for Anxiety, Burnout and PTSD
By Steven Zodkoy DC, CNS, DACBN
Anxiety, Burnout, or PTSD will affect 25–30% of Americans at some point in their life as either a single diagnosis or as comorbidities. The chief complaint that links anxiety, Burnout or PTSD together is the many facets of stress. All three diagnosis have stress as a symptom, but it is their combined inability to deal with stress that links them together. The present treatment protocols of cognitive behavioral therapy and pharmacological intervention have been proven to be woefully ineffective over time. The need for many Americans to rely on medications for prolonged periods of time is causing a new epidemic, those addicted to anti-anxiety and anti-depression medications. (1) Recent clinical research has revealed the key biochemical pathways involved in anxiety, burnout and PTSD. Additional research has shown that proper nutritional supplementation can positively influence these pathways offering patients a safer, more effective and healthier approach to heal their issues vs. masking them. (2,3)
The HPA axis, Hypothalamus-Pituitary-Adrenal axis, has been accepted by healthcare professionals as the main biochemical pathway involved with how we deal with stress or do not deal with stress. (4) A person’s HPA axis is highly influenced by their genetics, personality traits, race, age, lifestyle and their physical and emotional environment from childhood to adulthood. These variables make it difficult to test the HPA axis with standardized lab test and limit the effectiveness of monodirectional medication to correct any dysfunction. If the HPA axis is to be balanced to relieve the epidemic of emotional complaints a new more effective method must be utilized; nutritional supplementation and lifestyle changes are the key to reversing the emotional healthcare crisis.
The HPA axis is a complex neuro-endocrine system with direct feedback from the brain via the Hippocampus. It is directly associated with stimulating the sympathetic side of the autonomic nervous system which stimulates the body but also has down regulation effect on the parasympathetic system which relaxes the body. The extensive reach of the HPA axis regulates and is involved with all major bodily processes including; moods, emotions, digestion, energy, hormone production, glucose storage, and the neuromuscular system. The HPA axis is the link between the nervous system and the endocrine system, it is the link between the mind and body, and it is the link between the how we relate the past to the present. Physical and mental health can only be achieved when homeostasis is returned to the Hippocampus-HPA axis. Nutritional supplementation is key to restoring balance to the mind-body and overall health versus medications which are designed to simply hide symptoms.
What has not been accepted by healthcare professionals is that dysregulation of the HPA axis is the true underlying problem with anxiety, burnout and PTSD. (5,6,7) The key to understanding that the HPA axis and its hormones are key for mental and physical health comes from understanding the main hormone involved in its function. Cortisol is a key hormone of the HPA axis which is directly linked to the amount of physical and mental stress we are under. It is known to be 10x higher in the morning then in the evening. A traditional lab test that only measures cortisol over 24 hours or a spot test may show a normal reading, even if the overall normal downward slope is lost which indicates dysfunction of the HPA axis. It is the HPA axis’ ability to fluctuate and adapt that is associated with health and the feeling of well-being not a single reading lab test reading. (8,9) Healthcare professionals continue to fixate on whether the hormones of the HPA axis are too high or low, but this is not the issue. If the HPA axis cannot manage its hormone output to match the stress a person is under then are person will begin to have symptoms whether the hormones levels, go high or low. Medications which are designed to push a biochemical pathway in one direction are not well suited to healing a system that is designed to naturally fluctuate throughout the day and with outside stimuli like the HPA axis. It is the dynamic nature of the HPA axis which adds to the confusion in research studies, and why medications and traditional cognitive therapies have had limited benefits for anxiety, burnout, or PTSD. Nutritional supplementation that restore and support homeostasis to the HPA axis and allow for normal dynamic fluctuation with life’s stressors are a more effective approach. (10,11,12)
There are numerous nutritional supplements to address anxiety, Burnout, or PTSD through the HPA axis biochemical pathways. The wide range and variety of nutritional supplements provides excellent flexibility to adapt nutritional supplements to a patient’s individual needs. Supplement protocols can be adapted do to address a patient’s major complaints of anxiety, Burnout, or PTSD; plus, their genetics, allergies, lifestyle habits and medical history. The goal of the nutritional supplements is to support the HPA axis natural fluctuation and to restore homeostasis function. A strong and flexible HPA axis is key to recovering form and preventing anxiety, Burnout and PTSD.
Nutritional supplements refer to a broad category that includes; vitamins, minerals, glandulars, herbs and other naturally occurring chemical compunds. The common factors that all nutritional supplements have in common are they are found in nature, restore homeostasis to the body and are safe when used properly. There are numerous well documented nutritional supplements that can help with restoring and preventing HPA axis dysfunction.
Hemp Oil (CBD) Full Spectrum with <0.3% THC is the hottest nutritional supplement in the US, reaching nearly $1B in sales 2018. Hemp has been used for over 8000 years for medical purposes and was the third most popular “OTC” medication until 1937. The reason behind this incredible success is two-fold; researchers and patients have found benefits for both physical and emotional issue and it has minimal side effects, risk factors, addictive tendency or attenuation. A recent study showed that 91% of PTSD felt relief with the use of CBD. (13) Additional studies showed that CBD reduced cortisol in stressed subject in accordance with the normal circadian rhythm for that hormone and the subject felt correlating stress relief. (14) Another large study recently showed that 80% of participants had their anxiety was relieved by over 75% with the use of CBD, this study also showed that CBD was well tolerated. (15)
Full Spectrum Hemp/CBD oil mechanism of action is through the Endocannabinoid System which directly interacts with 65 biochemical pathways in the brain and body. There is an extremely high affinity for receptors in the Hippocampus and Hypothalamus which explains why it is effective for treating anxiety, Burnout, fear, stress and PTSD. Research has concluded it can attenuate past and present fears thus reducing anxiety and stress. (16) The results suggest that CBD can attenuate acute autonomic responses to stress and its delayed emotional consequences by facilitating 5-HT1A receptor-mediated neurotransmission. (17) There are numerous additional pathways in which CBD can mitigate stress.
The dosage for full spectrum Hemp/CBD oil is very broad. It is recommended that a person start with 10 mg a day of in a liquid oral form, double that amount if taken in capsule form. The dosage can be doubled every 7 days, the half-life is 1–4 days so do not rush the process, until relief is achieved. While there is no risk in taking too much, there also is no benefit. While many patients feel relief with 10 mg/day dosages, studies have used 300+ mg/day safely and effectively.
Phosphatidylserine (PS) is compound known as a phospholipid that is found in all cells membranes. it is an important part of how cells communicate with each other. It is found throughout the body but is much more densely found in the brain and nerve tissue. Research has found that anxiety linked is linked to a shrinking hippocampus which triggers flashbacks and fear. This issue is exacerbated by sufferers self-medicating with alcohol. The hippocampus is the starting point for the HPA axis and so any issues in this area of the brain will lead to anxiety, Burnout, and stress.
Supplementation with PS can help restore normal Hippocampus HPA axis function and mediate the symptoms while restoring memory function. (19) The mechanism of action is thought to be normalization of hormone status, cortisol. (20) A typical dosage of PS is 300mg/day, preferably 100 mg — 3x day. PS is safe and most commonly derived from the Lecithin which is found in many food products.
Omega 3s play an important part in repairing the damage that long term stress has on the brain. This is no surprise considering the brain in 60% fat. Researchers have determined that there are 4 main mechanisms of action for Omega3s helping with anxiety; reduced inflammatory Response, Brain-Derived Neurotrophic Factor (BDNF), Cortisol, and Cardiovascular Activity. (21)
It is also known that alpha linoleic acid, a vegetarian based Omega 3 is directly linked to reducing fear. EPA and DHA, Omega 3s from animal products, have a synergistic effect with Hemp oil improving its effectiveness by 10%. The body can convert EPA and DHA into EPEA and DHEA which can directly stimulate the ECS through increased CB1 receptors which will promote a feeling of wellbeing and balance in the mind-body.
The recommend dosage for Omega-3 is 2000+mg/day, lower dosages were not found to be effective (22)
ADAPTOGENS are a loose family of nutritional supplements that are thought to help the body “adapt to stress”. Their mechanisms of action all differ but their goal is the same, to restore the mind-body to homeostasis. Many adaptogens work by stabilizing the HPA axis and the associated hormone response to stress. (23, 24)
Magnolia Bark has two main components, honokiol and magnolol, which have been a part of traditional Chinese medicine for centuries. Research has shown that Magnolia Bark can pass through the brain-blood barrier and is neuroprotective which means it helps to protect the brain. Its mechanism of action is through the down regulating of Glutamate receptors; Glutamate is neurotransmitter which excites the brain and nervous system when we are stressed. (25) Magnolia Bark also works through the Endocannabinoid system in a similar manner to CBD. Animal studies have shown that Magnolia Bark has a direct regulating effect on the HPA axis which reduces the negative effects of stress and helps will the associated depression. (26) A typical dosage would be 250 mg/day an hour before bed. An additional 250 mg can be used for anxiety episodes.
Rosenroot (Rhodiola rosea) has been shown in research to reduce cortisol and down regulate the HPA axis which helps with stress and anxiety. (24,27) It has the benefit of working within 30 minutes and lasting for up to 6 hours making it one of the most effective adaptogens. Rhodiola dosage at 600 mg / day has been shown to reduce burnout and stressed induced fatigue. (28)
Ashwagandha is unique as an adaptogen because its mechanism of action is involves modulating the GABA receptors in the brain and nervous system to promote a sense of calm and reduce triggering of the HPA axis. (29) GABA is a neurotransmitter that opposes the stimulus of the Glutamate neurotransmitter. GABA receptors are where medications like Xanax and Valium attach to control anxiety and stress, having a safe and natural alternative is key for many who suffer with anxiety. Research has shown that a dosage of 300 mg twice a day is helpful for stress reduction weight loss and lowering BMI. (30,31)
The examples above are only a sample of the adaptogens available. Adaptogens have been linked to numerous health benefits; improved cognitive function, sleep, energy, moods, physical endurance, sexual desire and function to name just a few. The underlying reason for their wide-ranging health benefits comes from their ability to regulate the HPA axis and the Endocannabinoid system to restore balance to the mind-body.
Conclusion:
Nutritional supplementation is a part of the answer to anxiety, burnout and PTSD. Research has shown that the mechanism of action for nutritional supplements for these issues is though the return of homeostasis to the Hippocampus-HPA axis and Endocannabinoid system. Synergy is achieved when nutritional supplementation is used in conjunction with other natural therapies including; mindfulness, meditation, cranial electric stimulation, dietary changes, exercise, and emotional desensitization techniques (NET, Tapping, EFT, Emotion code).
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