Are You Stressed?

This week I was challenged by one patient, as to why I had not written an article on stress. This being so, here it is.

Stress is ubiquitous and universally pervasive, presenting a serious health and economic issue in modern societies. Exposure to stress often leads to impairments of physical and mental health or aggrevating pre-exisiting disorders. Moreover, individuals exposured to chronic stress are more likely to develop coronary heart disease and cognitive dysfunction.

One central stress regulating system is the hypothalamic pituitary adrenal axis (HPAA), which allows for adaptation to stressful challenges by releasing the glucocorticoid, cortisol, via corticotrophin-releasing hormone and adrenocorticotrophic hormone (ACTH). Cortisol, is known to have multiple actions on the central nervous system, immune system and metabolism.

There is evidence to suggest that exposure to long term stress may result in dysfunction of HPAA, leading to maladapative responses such as nervousness, excessive worrying, sleeplessness, changes in eating habits, lowered immune response, fatigue, tension, head and body aches, a racing mind, forgetfulness and lack of concentration.

HPAA function can be assessed by determining HPAA activity, reactivity and/or sensitivity. A potent measure of HPAA activity is cortisol awakening response (CAR), a circadian response, to awakening in the morning, most likely to serve in facilitating glucose mobilisation in anticipation for the upcoming day. Cortisol has a diurnal pattern with a distinct peak approximately 30 minutes after waking, during which cortisol concentration rise by an average of 70 percent in healthy adults. CAR, previously mentioned, is rather robust and distinct from diurnal HPAA activity, which varies considerably in response to physical and psychological manifestations, whether that be, visceral obesity, sleep disorders, depression, post traumatic stress syndrome, chronic fatigue, burnout, exhaustion and chronic stress. Some dysfunctions in HPAA activity may only be apparent when the system is challenged, that is, when individuals are exposed to stress. This being so, it holds as a reliable marker in association with the aforementioned conditions.

Recent research has examined the relationship between milk based phospholipids and chronic stress. Phospholipids are most concentrated in the brain and serve to regulate the activity of receptors, enzymes and signalling molecules. Previous research has shown that phospholipids act to buffer the effects of stress. A 2012 study examined HPAA activity  and reactivity by measuring cortisol levels in chroncially stressed men receiving high-content milk-derived phospholipid for a period of 2 months. The research team undertaking this study hypothesised that the intake of phospholipids normalises the cortisol response of the HPAA and improves memory. The data from this study found that phospholipids improve the ability of an individual to adapt to chronic stress. Researchers utilised a dose of 1 percent phospholipid, which they suggest may be protective in individuals who are persistently exposed to chronic stress with respect to both physical and mental health. The supplement used in the forgoing study included: sphingomyelin, phosphatidylcholine, phosphotidylethanolamine, phosphotidylserine and phosphatidylinositol.

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