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The Functional Matrix of Stress Management Cheryl Burdette, ND Xymogen Director of Research Outreach & BOA Dunwoody Labs Progressive Medical Disclaimer • The information that follows represents XYMOGEN’s choices for presentation of studies, comments, and/or opinions. The statements have not been evaluated by the FDA. The products are not intended to diagnose, treat, cure, or prevent any disease. • It is assumed that the practitioner will investigate the topic further and not use this presentation as a sole source of information from which to derive an individualized patient protocol. Disclosure • I am not a XYMOGEN employee. • I am a XYMOGEN customer. • I will receive compensation from XYMOGEN for this presentation. • I am a XYMOGEN shareholder. • I am a physician, wife, mother (two human, two dogs) and a fellow human being on this planet. Stress and occurrence • Clinically relevant distress is present in 40% to 50% of cancer outpatients. (i, ii) • Chronic stress predicts the occurrence of coronary heart disease (CHD).(iii) • Employees who experience work-related stress and individuals who are socially isolated or lonely have an increased risk of a first CHD event. • A history of stressful life events is correlated greater incidence of metabolic syndrome (in men), especially in those men with elevated cortisol (independent of BMI and age). (iv) (i) Hoffman et al. Screening for distress in cancer patients: the NCCN rapid-screening measure. Psychooncology, 2004;13:792. (ii) Jacobsen et al. Screening for psychological distress in ambulatory cancer patients. Cancer, 2005;103:1494. (iii) Steptoe A, Kivimäki M. Stress and cardiovascular disease. Nat Rev Cardiol. 2012 Apr 3;9(6):360-70. (iv) Fabre B, et al. Relationship between cortisol, life events and metabolic syndrome in men.Stress. 2012 Apr 18. Stress can disrupt circadian rhythms and favor tumor initiation and progression • Night-time shift work, a condition that is known to disrupt circadian rhythms, is a risk factor for breast and colorectal cancer. • In mouse studies, tumor progression and mortality are dramatically accelerated after elimination of circadian rhythms by manipulation of light–dark cycles. • Two clinical studies have also shown that the status of circadian cycles, such as cortisol or the 24-hourrest– activity cycle, can predict long-term cancer survival. (i) Antoni MH, et al. The influence of bio-behavioural factors on tumour biology: pathways and mechanisms. Nat Rev Cancer. 2006;6 (3):240-8. Severe Adrenal Stress • Women with metastatic breast cancer had significantly flatter diurnal cortisol rhythms as compared with healthy controls. (i) (i) Abercrombie HC, et al. Flattened cortisol rhythms in metastatic breast cancer patients. Psychoneuroendocrinology. 2004;29:1082–1092. When To Suspect Adrenal Stress • • • • • • • Fatigue Hypoglycemic Symptoms Menopausal Symptoms Brain fog Worse under stress Insomnia Weight Gain This affects mortality Patients with metastatic breast cancer whose diurnal cortisol rhythms were flattened or abnormal had earlier mortality. (P =.0036) (i) ◦ N = 104 women with metastatic breast cancer followed for 7 years ◦ Flattened cortisol rhythm was associated with suppression of NK cell count and NK function may be a mediator or a marker of more rapid disease progression. Sephton SE, et al. Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst. 2000;92:994–1000. Pessimism is a factor • Clinical and epidemiological studies over the last 30 years have identified psychosocial factors especially stress, chronic depression and feelings of isolation as risk factors for cancer progression. • Chronicity of negative affect, as manifested by depressed mood or hopelessness/pessimism, appears to have stronger relationships with outcomes than do stressful events. (i) • This suggests that sustained activation of negative moods may provide the strongest links to cancer progression. (i) Moreno-Smith M, et al. Impact of stress on cancer metastasis. Future Oncol. 2010 Dec;6 (12):1863-81. In summary, pessimism was associated with higher levels of markers for systemic inflammation in a large, healthy, diverse population. These associations were independent of depression and cynical distrust. Common Markers That Reveal Stress Patterns • Glucose-- < 70 if fasting, adrenal fatigue • Glucose—climbing, gluconeogenesis due to stress • Sodium and Potassium: both less than midrange with no dietary reason • Low Reproductive Hormones • High Reverse T3 Stress and Pathology • Stress increases growth and metastatic spread of tumors in animal models (i) • Stress reduces host resistance to breast cancer recurrence (ii) • Stress increases inflammation and alters glucose metabolism (i) Ben-Eliyahu S, et al. Stress increases metastatic spread of a mammary tumor in rats: evidence for mediation by the immune system. Brain Behav Immun. 1991;5(2):193-205. (ii) Palesh O, et al. Stress history and breast cancer Contributing stress hormones • CRF • Cortisol • Epinephrine • Norepinephrine Vitamin C G-Coupling Increased mitosis with stress • The signals are transduced to the nucleus, where transcription factors regulate gene expression, and to the cytoskeleton to enable the spatial organization of signaling complexes. • Scaffolds provide a mobile 'toolbox' of protein kinases, phosphatases and adaptor molecules that add to the dynamic character of the responses. • Associations with microtubules, actin-filament networks and mitotic spindles are examples of the spatial organization of G-protein signaling within the cell. Stress hormones turn on the molecular switch • • • These receptors are coupled to G-proteins, and act as molecular switches to control downstream pathways. There are 9 sub-types, five αADRs and four ßADRs. (i) Certain ADRs activate stimulatory G-protein pathways which mediate activation of the cAMP dependent protein kinase pathways that result in growth and migration of cells. ßADRs are present on breast and ovarian cancer cells. α ADRs have been found to exert proliferative effects on prostate and pituitary cancer cells. (ii) • Cortisol and its metabolite cortisone has also been shown to stimulate the growth of prostate cancer cells in the absence of androgens and to increase the secretion of prostate specific antigen. (i) Moreno-Smith M, et al. Impact of stress on cancer metastasis. Future Oncol. 2010;6(12):1863-81. (ii) Zhao XY, et al. Glucocorticoids can promote androgen-independent growth of prostate cancer cells throug Stress and VEGF • • • • Resveratin NE has been shown to upregulate VEGF in adipose tissue through the ßADR–cAMP–PKA pathway. This pathway has been demonstrated in ovarian cancer cells and multiple myeloma cells. Clinical studies have shown links between higher levels of social support and lower levels of VEGF levels in serum (i) and in tumor tissues (ii) in ovarian cancer patients. In addition, depression and quality of life have been related to VEGF in colorectal cancer. (iii) (i) Lutgendorf SK, et al. Vascular endothelial growth factor and social support in patients with ovarian carcinoma.Cancer. 2002;95(4):808-15. (ii) Lutgendorf SK, et al. Biobehavioral influences on matrix metalloproteinase expression in ovarian carcinoma. Clin Cancer Res. 2008;14(21):6839-46. (iii) Sharma A. et al. Vascular endothelial growth factor and psychosocial factors in colorectal cancer. Psychooncology. 2008;17(1):66-73. NE increases IL-6 Ig26 • NE binds to ßADR and increases IL-6 gene transcription. • Other proliferative, angiogenic genes are also upregulated including VEGF and IL-8. • Under the influence of NE, solid tumor cells’ secretion of high levels of IL-6, which promotes metastasis by increasing proliferation, angiogenesis, attachment and invasion, may increase. (i) (i) Nilsson MB, et al. Interleukin-6, secreted by human ovarian carcinoma cells, is a potent proangiogenic cytokine. Cancer Res. 2005;65(23):10794-800. Matrix Metalloproteinase and stress CurcuPlex • NE and E can increase MMP production by tumor cells. (i) • NE and E also act as chemoattractants to induce cell migration. • Stress levels of NE increased the in vitro invasiveness of ovarian cancer cells by 8% to 198%. (ii) • E also induced significant increases in invasion of ovarian cancer cells ranging from 64 to 76%. • NE and E significantly increase production of MMP-2 and MMP-9 by ovarian cancer cells through activation of the ßADR pathway. This has also been demonstrated in colon and head and neck cancers. (i) Yang EV, et al. Stress-related modulation of matrix metalloproteinase expression. J Neuroimmunol. 2002;133(1-2):144-50. (ii) Sood AK, et al. Stress hormone-mediated invasion of ovarian cancer cells. Clin Cancer Res. 2006;12(2):369-75. (i) Rangarajan S et al. Cyclic AMP induces integrin-mediated cell adhesion through Epac and Rap1 upon stimulation of the beta 2-adrenergic receptor. J Cell Biol. 2003;160(4):487-93. Cell adhesion to the proteins of the extracellular matrix is mediated in part by a group of heterodimeric transmembrane proteins called integrins. (i) • NE increases cAMP and cAMP cell adhesion in many cell types. • Thus, stress hormones may promote cell matrix attachment of cancer cells. Glucocorticoids may effect chemo • While glucocorticoid hormones induce apoptosis in lymphocytes and lymphoblastic leukemia cells, their effects are different in solid tumor cells. • GCs activate survival genes and downregulate apoptotic pathways. These actions protect solid tumor cancer cells from the effects of chemotherapy. (i) • Clinically, GCs are frequently administered with cytotoxic agents to reduce the risk of emesis and other potential acute toxicities. However, concerns have been raised about this combination since some studies suggest that GCs may reduce the efficacy of chemotherapy. (ii) CortiSolv (i) Distelhorst CW. Recent insights into the mechanism of glucocorticosteroid-induced apoptosis. Cell Death Differ. 2002;9(1):6-19. (ii) Zhang C, et al. Corticosteroid co-treatment induces resistance to chemotherapy in surgical resections, xenografts Stress-induced cortisol (C) binding to the glucocorticoid receptor (GR) causes translocation of the GR to the cell nucleus and changes in the expression of apoptotic and DNA repair genes. Antonova L, et al. Stress and breast cancer: from epidemiology to molecular biology. Breast Cancer Res. 2011;13(2): 208. Prolonged presence of cortisol, such as in periods of stress, leads to an increase in both the proliferative and antiapoptotic effects of the receptor, creating transformation-promoting intracellular conditions. Oncoplex Dopamine as a therapeutic target • • AdrenaMax • • • Dopamine, the third member of the catecholamine family and precursor in the synthesis of NE and E, is one of the major neurotransmitters in the brain and also has important roles in the periphery. DA has the opposite effect compared with NE and E with regard to the effects on tumor angiogenesis, growth and development of ascites DA levels are increased in the brain during acute stress. By contrast, under chronic stress, there is decreased release of DA. (i) DA treatment can counteract the stimulatory effects of NE on tumor growth in two ovarian stress cancer mice models. (ii) These findings implicate DA as a potential therapeutic strategy for blocking the deleterious effects of chronic stress. (i) Imperato A, et al. Repeated stressful experiences differently affect limbic dopamine release during and following stress. Brain Res. 1992;577(2):194-9. (ii) Moreno-Smith M, et al. Dopamine blocks stress-mediated tumor growth in ovarian carcinoma; Presented at: 100th Annual Meeting of American Association for Cancer Resesarch; Denver, CL, USA. 18–22 April 2009. Mast cells and stress • Stress activates CRH which, in turn, activates the HPA axis and mast cells. • Mast cells can accumulate around tumors in response to tumor-derived peptides • Mast cells secrete numerous vasoactive, inflammatory • and growth promoting mediators including IL6, IL-8, and VEGF (and CRF selectively stimulates secretion of VEGF) and promote: – Angiogenesis – Immune suppression – Tumor proliferation – Metastasis Mast Cell Degranulation • • • • OmegaPure AllerDHQ HistDAO Treat The Stress… BBB and stress • • • • • Mast cells encircle endothelial cells and pericytes making up the BBB and have been proposed to act as “gate keepers” of the BBB (i) Acute stress can disrupt the BBB through mast cell activation by corticotropin releasing hormone (CRH). Functional CRH-receptors (CRH-R) are expressed on human mast cells (ii) and on brain vessels (iii) Human mast cells not only respond to, but also synthesize and secrete CRH. (iv) CRH-R are expressed by a number of human cancers (v) IgY26 (i) Theoharides, T.C. Mast cells: the immune gate to the brain. Life Sci. 1990;46:607–617. (ii) Chrousos, G.P. The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N. Engl. J. Med. 1995;332:1351–1362. (iii) Theoharides, T and Cochrane D. Critical role of mast cells in inflammatory diseases and the effect of acute stress. J.Neuroimmunol. 2004;146: 1–12. (iv) Esposito, P. et al. Corticotropinreleasing factor (CRF) can directly affect brain microvessel endothelial cells. Brain Res. 2003;968:192–198. (v) Reubi, J. et al. Expression of CRF1 and CRF2 receptors in human cancers. J. Clin. Endocrinol. Metab. 2003;88:3312– 3320. Stress increases brain mets • Stress appears to permit brain metastases, and it also activates brain mast cells that disrupt the BBB. • Mast cells are involved in stress-induced inflammation (i) and could be critical in increasing BBB permeability and allowing cancer cell entry into the brain. • Acute stress permits brain metastases of mammary adenocarcinoma in mice. • Evidence suggests that chronic inflammation with increased mast cells accumulation and activation around tumors could promote tumor growth and BBB permeability. Ig26 • (i) Theoharides, T.C., Cochrane, D.E., Critical role of mast cells in inflammatory diseases and the effect of acute stress. J. Neuroimmunol. 2004;146:1–12. Immune/Auto-Immune shift due to Stress • • • • Vitamin D IgY26 Acute/short-term fight or flight stress can enhance innate immunity. Short-term stress enhances cellular immunity and increases early resistance to squamous cell carcinoma (i) Chronic elevation of stress hormones (catecholamines and GCs): Enhance Th2 immunity by shifting immunity from predominantly Th1 to Th2 cells which enables tumor cells to evade immune surveillance. (ii) Increase regulatory or suppressor T-cell numbers within tumors and in the circulation trigger lymphocyte apoptosis via increased expression of death ligand, Fas, resulting in lymphocyte reduction that, in turn, might result in an increase in the incidence of oncogenic viral infections and DNA damage (iii) (i) Dhabhar FS, et al. Short-term stress enhances cellular immunity and increases early resistance to squamous cell carcinoma. Brain Behav. Immun. 2010;24(1):127– 137. (ii) Calcagni E, Elenkov I. Stress system activity, innate and T helper cytokines, and susceptibility to immune-related diseases. Ann. NY Acad. Sci. 2006;1069:62–76. (iii) Shi Y. et al. Stressed to death: implication of lymphocyte apoptosis for psychoneuroimmunology.Brain Behav Immun. 2003;17 Suppl 1:S18-26. Stress decreases NK cells • Distress measured by self-report was correlated with low NK-cell cyto-toxicity in tumorinfiltrating lymphocytes from human ovarian cancers. (i) • Low peripheral NK-cell counts are prognostic for early breast cancer mortality, and reduced NK-cell cytotoxicity is predictive of a poor clinical outcome in patients with breast carcinoma. (ii) • Positive psycho-social factors such as social support , spiritual activities, and humor have each been associated with increased levels of NK-cell cytotoxicity in patients with breast (iii) and ovarian cancer. CortiSolv (i) Lutgendorf SK, et al. Social support, psychological distress, and natural killer cell activity in ovarian cancer. J Clin Oncol. 2005;23:7106–7113. (ii) Sephton SE, et al. Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst. 2000;92:994–1000. (iii) Levy SM, et al. Perceived social support and tumor estrogen/progesterone receptor status as predictors of natural killer cell activity in breast cancer patients. Psychosom Med. 1990;52:73–85. Telomeres Telomeres are essential for Chromosomal stability (protect the ends of the chromosomes). ‣ The steady shrinking of telomeres with each mitosis imposes a finite life span on cells (about 70 divisions for mammalian cells). ‣ Normal cells have minimal telomerase Short telomeres are predictive for malignant cells • While telomere elongation is a common molecular feature of advanced malignancies, short telomeres and concurrent chromosomal instability contribute to malignant cell transformation. • Prospective population study of 787 patients without evidence of cancer were followed for 10 years. (i) • Baseline telomere length was substantially shorter in participants with incident cancer (mean telomere length, 1.12; 95% CI, 1.01-1.23) than in those who remained free of cancer (mean telomere length, 1.53 [95% CI, 1.47-1.59]; P<001). • Tumors with a high fatality rate tended to exhibit more prominent relationships with telomere length and tumors with a more favorable prognosis showed modest or no associations. (i) Willeit P, et al. Telomere length and risk of incident cancer and cancer mortality.JAMA. 2010;304(1):69-75. Stress and telomere length • ‣ High perceived stress (with increased urinary output of stress associated Epi. and Norepi.) (i) • ‣ Full-time work and longer history of full time • work (related to stress) (ii) • ‣ Sleep deprivation shortens telomeres • ‣ Oxidative stress shortens telomeres: (iii) • o Obesity • o Cigarette smoking (i) Parks CG, et al. Telomere length, current perceived stress, and urinary stress hormones in women. Cancer Epidemiol Biomarkers Prev. 2009 Feb;18(2):551-60. (ii) Parks CG, et al. Employment and work schedule are related to telomere length in women. Occup Environ Med.2011;68(8):582-9. (iii) Valdes AM, et al. Obesity, cigarette smoking, and telomere length in women. Lancet. 2005 Aug 20-26;366(9486):662-4. Child abuse and telomeres Childhood adverse life events that provoke anxiety and distress are directly correlated with telomere length as an adult. ◦ Telomeres protect and stabilize chromosomes, reducing the risk of aneuploidy, methylation disruptions and mutations. (i) Kananen L, et al. Childhood adversities are associated with shorter telomere length at adult age both in individuals with an anxiety disorder and controls. PLoS One. 2010 May 25;5 (5):e10826. Higher pessimism is associated with shorter TL in leukocytes. Pessimism is also associated with higher basal levels of IL-6, an indicator of systemic inflammation (and oxidative stress). (i) (i) O’Donovan A, et al. Pessimism correlates with leukocyte telomere shortness and elevated interleukin-6 in post-menopausal women. Brain Behav Immun. 2009; 23(4): 446– 449. Stress Patterns Five stress-busting ingredients* Cortisolv Supplement Facts Serving Size: 1 Capsule Amount Per Serving %Daily Value Relora†® (a proprietary blend of a patented†† extract from Magnolia officinalis bark and a proprietary extract from Phellodendron amurense bark) 250 mg ** Sensoril® Ashwagandha (Withania somnifera) Root and Leaf Extract (10% withanolides) 150 mg ** Suntheanine® L-Theanine 100 mg ** Banaba Leaf Extract (Lagerstroemia speciosa)(1% corosolic acid) 50 mg ** Maral Extract (Rhaponticum carthamoides)(root) 50 mg ** Adrenal Treatments • Tired But Wired: CortiSolv, RelaxMax • Tired and Wired ++ : CortiSolv, RelaxMax, CortiCare • Tired And Tired: Adrenal Manager and CortiCare • Tired and Sick: Adrenal Essence (Cordyceps), CortiSolv • Tired and Depressed: AdrenaMax (Tyrosine) RelaxMax CortiCare Adrenal Treatments • Tired But Wired: CortiSolv, RelaxMax • Tired and Wired ++ : CortiSolv, RelaxMax, CortiCare • Tired And Tired: Adrenal Manager and CortiCare • Tired and Sick: Adrenal Essence (Cordyceps), CortiSolv • Tired and Depressed: AdrenaMax (Tyrosine) Adrenal Manager Adrenal Treatments • Tired But Wired: CortiSolv, RelaxMax • Tired and Wired ++ : CortiSolv, RelaxMax, CortiCare • Tired And Tired: Adrenal Manager and CortiCare • Tired and Sick: Adrenal Essence (Cordyceps), CortiSolv • Tired and Depressed: AdrenaMax (Tyrosine) Cordyceps AdrenaMax Normal Adrenal Function Early Adrenal Fatigue Early Adrenal Fatigue Early Adrenal Fatigue • CortiCare-2, 2x a day for three months or until improvement • CortiSolv-1-2, 2x a d Moderate Adrenal Fatigue Moderate Adrenal Fatigue Moderate Adrenal Fatigue • CortiCare-2, 2 or 3x a day • AdrenaMax-2 in the a.m. Severe Adrenal fatigue Severe Adrenal Fatigue Severe/The Whole Kitchen Sink • CortiCare-2, 2x a day • AdrenaMax-2 in the am and 2 in the afternoon • CortiSolv-2 in the pm Insomnia Insomniac Adrenal Fatigue Insomnia Pattern • • • • Sedalin-2 before bed Melatonin CR-one before bed RelaxMax-1 scoop before bed I5 Sedalin Melatonin CR High A.M. Cortisol What is The Night Time Stress • Apnea-obstructive • Night Terrors-5-HTP CR, Melatonin CR, OptiMg 125 or OptiMag Neuro 5-HTP CR GABA/Theanine Cream and Magnesium Cream (MagnaSol) Immunoglobulins and Stress • Immunoglobulins may represent a valid stress marker since they react slowly and over a long time. They may, therefore, represent an integrated function of sustained activation over prolonged time. Low levels of immunoglobulins have been found to relate to personality and subjectively experienced stress levels in a population subjected to long lasting work load with feelings of incompetence and insufficiency. No such relationships were found in a population which was subjected only to brief exposures to intense fear. The psychological factors in our own study explained up to 30% of the variance in the immunoglobulins and complements, even if all levels were within the normal range. The relationship between these findings and pathology has not been proven, but is a tempting opening for psychosomatic research and for identification of valid stress markers. Breakdown in Human Adaptation to ‘Stress’ pp 681-690 Immunoglobulins as Stress Markers? H. Ursin Stress is a Major Contributor To Leaky Gut!!! GL: 10/16/1955 • CC: fatigue and stomach issues • Standard blood work: elevated monocytes Dunwoody Labs Food Sensitivity Report We have reviewed scientific evidence that appears to demonstrate that probiotics may be used to treat allergies. •It’s important to remember that dietary supplements CANNOT mitigate diseases or replace drugs. • However, XYMOGEN products CAN give your patients their best chance to stay healthier longer* * These statements have not been evaluated by the US Food and Drug Administration. These products are not intended to diagnose, treat, cure , or prevent any disease. Treatment • OptiFiber SCFA: supporting fiber • Mito Kit: A combination arginine, alpha lipoic acid and resveratrol for mitochondrial support • S-acetyl glutathione: An orally absorbed form of glutathione • OptiMag 125 • OptiMetaboliX: Functional food for blood sugar regulation • IgG 2000 plus: Immunoglobulins in combination with probiotics • CortiCare: A combination of nutrients for adrenal function (B5, B6, Vitamin C, carnitine) * These statements have not been evaluated by the US Food and Drug Administration. These products are not intended to diagnose, treat, cure , or prevent any disease. Dunwoody Labs Food Sensitivity Report Complaint Number Of Patients Reporting For Initial Test Number Of Patients Reporting For Second Test Memory/Concentration 22 3 Anxiety/Mood/Depression 20 3 Bloating/Stomach Pain 18 2 Fatigue 18 4 Joint Pain / Stiffness / Swelling 13 1 Muscle Aches 13 1 Craving Sugar 12 2 Sleeplessness/Insomnia 12 0 Lightheaded/Dizzy 11 2 Allergies/Sinus 9 2 Cold Intolerance Inability to lose weight 9 9 3 2 IgY26 and IgG 2000 CWP Follow-up • • • • • • • Energy 7/10 Feels much better Less hair loss BM: 2 a day Gas/Bloating-Resolved H. Pylori-negative Monocytes – in normal range (Other treatment included working on treatment of parasite, identified with stool culture and concomitant high sIgA.) OptiGHI ProbioMax HistDAO Introducing CortiSolv™ Natural Stress Buster* *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Symptoms of everyday stress may reduce quality of life • Headache • Digestive complaints—Major cause of leaky gut • Fatigue • Muscle/Joint aches and pains • Sleep difficulties • Skin issues • Dry mouth • Clenching jaw/grinding teeth • Irritability Managing Stress • Healthy eating pattern and food selections • Relaxation techniques such as meditation • Exercise • Supportive friendships/relationships • Spiritual Support • Laughter • Professional counseling • Other Some Herbs Traditionally Used to Manage Stress • • • • • Magnolia officinalis Phellodendron amurense Withania somnifera (Ashwagandha) Lagerstroemia speciosa (Banaba) Rhaponticum carthamoides (Maral) (Effects of rhaponticum carthamoides versus glycyrrhiza glabra and punica granatum extracts on metabolic syndrome signs in rats) …and • L- theanine • • • • • …”a combination of Magnolia bark extract and Phellodendron bark extract (Relora®) reduces cortisol exposure and perceived daily stress, while improving a variety of mood state parameters, including lower fatigue and higher vigor. These results suggest an effective natural approach to modulating the detrimental health effects of chronic stress in moderately stressed adults.” • • J Int Soc Sports Nutr. 2013 Aug 7;10(1):37. doi: 10.1186/15502783-10-37. Talbott SM1, Talbott JA, Pugh M. Magnolia (Magnolia officinalis) and Phellodendron (Phellodendron amurense) barks are medicinal plants commonly used as traditional remedies for reducing stress and anxiety. Modern dietary supplements are intended to induce relaxation and reduce stress as well as stress-related eating. Previous studies have shown the combination of Magnolia/Phellodendron (MP) to reduce both cortisol exposure and the perception of stress/anxiety, while improving weight loss in subjects with stressrelated eating. Competitive athletes are "stressed" by their intense exercise regimens in addition to their normal activities of daily living and thus may benefit from a natural therapy intended to modulate baseline perceptions of stress and stress hormone exposure. METHODS: We assessed salivary cortisol exposure and psychological mood state in 56 subjects (35 men and 21 women) screened for moderate stress and supplemented with a standardized/patented MP combination (Relora®, Next Pharmaceuticals) or Placebo for 4 weeks. RESULTS: After 4 weeks of supplementation, salivary cortisol exposure was significantly (p<0.05) lower (-18%) in the Relora group compared to Placebo. Compared to Placebo, the Relora group had significantly better (p<0.05) mood state parameters, including lower indices of Overall Stress (-11%), Tension (-13%), Depression (-20%), Anger (-42%), Fatigue (-31%), and Confusion (-27%), and higher indices of Global Mood State (+11%) and Vigor (+18%). Effect of Magnolia officinalis and Phellodendron Amurense (Relora®) on cortisol and psychological mood state in moderately stressed subjects. Salivary Cortisol (ug/ml). Salivary cortisol was 18% lower (p<0.05) in the Relora group compared to Placebo at Week 4 (0.525+0.190 to 0.642+0.353). Profile of Mood States (POMS). Numerical scores for each of the 6 subscales of the POMS (McNair et al., [9]). The Relora group showed significantly improved mood state parameters compared to Placebo at Week 4 (* = p<0,05). Talbott et al. Journal of the International Society of Sports Nutrition 2013, 10:37 http://www.jissn.com/content/10/1/37 Effect of a proprietary Magnolia and Phellodendron extract on weight management: a pilot, double-blind, placebo-controlled clinical trial. • N=28 , healthy, overweight (BMI 25 to 34.9), premenopausal female adults, 20 and 50 years, who typically eat more in response to stressful situations and scored above the national mean for women on self-reported anxiety • 250 mg cap w herbal extracts or placebo cap TID x 6 wks. • Measured salivary cortisol levels, weight change, psychological measures of stress and anxiety. • Continued on next slide….. • Altern Ther Health Med. 2006 Jan-Feb;12(1):50-4. [PMID: 16454147 ] Effect of Magnolia officinalis and Phellodendron Amurense (Relora®) on cortisol and psychological mood state in moderately stressed subjects. • Extracts of M officinalis and P amurense were well tolerated. • Results: The treatment group tended to have lower levels of cortisol in the evening; whereas the control group tended to have higher levels of cortisol in the evening. Bedtime cortisol levels decreased in the treatment group and increased in the placebo group. – Placebo group had significant weight gain (P < ,01); Magnolia and Phellodendron group had no significant weight gain (P < .89). – Participants in both the treatment and placebo groups had improved scores on a number of psychological measures during the study. There was a correlation between perceived stress and weight change. • “The results of this pilot clinical study indicate that obese subjects who eat in response to stress may benefit from taking a dietary supplement ingredient containing proprietary extracts of M officinalis and P amurense. The mechanism of action appears to be through reduction of cortisol levels and possibly perceived stress, thereby helping participants maintain body weight. The sample size was small, however, and there was higher attrition in the control group than in the treatment group.” Altern Ther Health Med. 2006 Jan-Feb;12(1):50-4. [PMID: 16454147 ] A standardized Withania somnifera extract (WSE) significantly reduces stress-related parameters in chronically stressed humans; a double-blind, randomized, placebo-controlled study Results: > Subjects taking lowest dose - significant reductions on the Hamilton Anxiety Scale (HAM-A), reduced levels of cortisol and C reactive protein, drop in pulse rates and BP compared to placebo. > Subjects taking lowest dose - significant increases in DHEA and hemoglobin. > Response on all measures - dose-dependent > Compared to control, subjects taking WSE less fatigue, headache and muscle pain, sleeplessness, forgetfulness, feelings of doom, and irritability. WSE group - better appetite and concentration. > No reports of adverse side effects. Conclusion: “Our findings that WSE reduces experiential feelings of stress and anxiety at all dosage levels tested supports the traditional claims of WSE's anti-stress adaptogenic effect.” • • • • • • • • Study Design: Randomized, DBPC. Subjects took WSE or a placebo. Stress levels measured baseline, 30 & 60d Subjects: 130 chronically stressed subjects (98 completed) Dosage: 125 mg QD, 125 mg BID, or 250 mg of WSE BID, or a placebo x 60 days Subjects taking the lowest dose saw significant reductions on the Hamilton Anxiety Scale (HAM-A), and in their levels of cortisol and Creactive protein as well as their pulse rates and blood pressure, compared to placebo. Subjects taking lowest dose also had significant increases in DHEA and hemoglobin. Dose-dependent responses on all these measures. Subjects taking the withania somnifera experienced less fatigue, headache and muscle pain, sleeplessness, forgetfulness, feelings of doom, and irritability than the control group. In addition, they had better appetite and concentration. There were no reports of adverse side effects. JANA. 2008;11(1):50-56. Evaluation of a Highly Standardized Withania Somnifera Extract on Endothelial Dysfunction and Biomarkers of Oxidative Stress in Patients with Type 2 Diabetes Mellitus: A Randomized, Double Blind, Placebo Controlled Study. • • • • 66 subjects on metformin - placebo or 250 mg WSE bid or 500 mg WSE bid X 12 wks Withania somnifera (Ashwagandha) – used aqueous roots extract highly standardized by HPLC - not < 10% withanolide glycosides, not > 0.5% of Withaferin-A and not < 32% of oligosaccharides Primary efficacy measure - change in endothelial dysfunction, assessed by > 6% change in reflection index at 12 weeks in all Tx groups Secondary efficacy parameters -change in oxidative stress markers (malondialdehyde, nitric oxide and glutathione), serum levels of nitric oxide, hsCRP and lipid profile at 12 weeks in all TX groups. Safety and tolerability also assessed. • “Conclusion: Withania somnifera showed significant improvement in endothelial function, reduction in biomarkers of oxidative stress and systemic inflammation and can be used as a therapeutic adjunctive in patients with type 2 Diabetes mellitus.” Int. J. Ayur. Pharma Research. 2014;2(3):22-32 Anti-stress effect of theanine on students during pharmacy practice: positive correlation among salivary α-amylase activity, trait anxiety and subjective stress • • • SBPC, n= 20, 5thyr pharmacy students 200 mg Theanine bid after breakfast and lunch, one wk prior to pharmacy practice and 10 days into practice period. State-trait anxiety inventory test & Salivary α-amylase activity sAA (marker of sympathetic NS activity) • RESULTS: • • • Morning sAA (pre-practice sAA) was higher in placebo than in theanine-group during the pharmacy practice (p=0.032). Subjective stress was significantly lower in the theanine-group than in the placebo-group (p=0.020). Students with higher pre-practice sAA showed significantly higher trait anxiety in both groups (p=0.015). Similarly, higher pre-practice sAA was correlated to shorter sleeping time in both groups (p=0.41×10(-3)). • CONCLUSION: • Stressful condition increased the level of sAA that was essentially affected by individual trait anxiety. The low levels of pre-practice sAA and subjective stress in the theanine-group suggest that theanine intake suppressed initial stress response of students assigned for a long-term commitment of pharmacy practice Pharmacol Biochem Behav. 2013 Oct;111:128-35. doi: 10.1016/j.pbb.2013.09.004. Epub 2013 Sep 16.[PMID: 24051231] What are the objectives? • Help the Body Cope with the Physiological Effects of Stress • Support Healthy Cortisol Levels • Support Relaxation and Restful Sleep • Promote Mental Clarity • Help Alleviate Fatigue The effects of L-theanine (Suntheanine®) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. • Protocol: Subjects: n=98, ages 8-12 years, w ADHD. Equal distribution of stimulant/non-stimulant treated subjects in active and placebo groups. – two chewable tablets bid (at breakfast and after school), with each tablet containing 100 mg of L-theanine (total 400 mg daily Suntheanine®) or identical tasting chewable placebo for six weeks. – Eval x five consecutive nights using wrist actigraphy baseline/end. – Parents completed Pediatric Sleep Questionnaire (PSQ) baseline/end. • Results: – Boys who consumed L-theanine obtained significantly higher sleep percentage and sleep efficiency scores – L-theanine at relatively high doses was well tolerated with no significant adverse events. • This study demonstrates that 400 mg daily of L-theanine is safe and effective in improving some aspects of sleep quality in boys diagnosed with ADHD.” Lyon MR, Kapoor MP, Juneja LR. Altern Med Rev. 2011 Dec;16(4):348-54. [PMID: 22214254]. Full study: http://www.altmedrev.com/publications/16/4/348.pdf L-theanine partially counteracts caffeineinduced sleep disturbances in rats. • • • • • • Jang HS1, Jung JY, Jang IS, Jang KH, Kim SH, Ha JH, Suk K, Lee MG. Abstract L-theanine has been reported to inhibit the excitatory effects of caffeine. The present study examined the effects of L-theanine on caffeine-induced sleep disturbances in rats. Rats received the following drug pairings: saline and saline (Control), 7.5 mg/kg caffeine and saline, or 7.5 mg/kg of caffeine followed by various doses of L-theanine (22.5, 37.5, 75, or 150 mg/kg). Vigilance states were divided into: wakefulness (W), transition to slow-wave sleep (tSWS), slow-wave sleep (SWS), and rapid-eye-movement sleep (REMS). Caffeine significantly increased the duration of W and decreased the duration of SWS and REMS compared to the Control. Although Ltheanine failed to reverse the caffeine-induced W increase, at 22.5 and 37.5 mg/kg (but not at 75 and 150 mg/kg), it significantly reversed caffeineinduced decreases in SWS. In conclusion, low doses of L-theanine can partially reverse caffeine-induced reductions in SWS; however, effects of Ltheanine on caffeine-induced insomnia do not appear to increase dosedependently. Copyright © 2012 Elsevier Inc. All rights reserved. PMID: 22285321 Pharmacol Biochem Behav. 2012 Apr;101(2):217-21. doi: 10.1016/j.pbb.2012.01.011. Epub 2012 Jan 21. [PMID: 22285321] What are the objectives? • Help the Body Cope with the Physiological Effects of Stress • Support Healthy Cortisol Levels • Support Relaxation and Restful Sleep • Promote Mental Clarity • Help Alleviate Fatigue Effect of standardized aqueous extract of Withania somnifera on tests of cognitive and psychomotor performance in healthy human participants. N=20 healthy males 250 mg two capsules twice daily WSE or matching placebo for a period of 14 days. RT = reaction time DSST = digital symbol substitution test DVT = digit vigilance test CST = card sorting test FTT = finger tapping test SRT =simple reaction test CDT =Choice descrimination test Compared to placebo, statistical difference between WSE and placebo in RT for CDT, DSST, DVT Pingali U, Pilli R, Fatima N. Pharmacognosy Res. 2014 Jan;6(1):12-8. doi: 10.4103/0974-8490.122912. PubMed PMID: 24497737; PubMed Central PMCID:PMC3897003. Full study: http://www.phcogres.com/article.asp?issn=09748490;year=2014;volume=6;issue=1;spage=12;epage=18;aulast=Pingali Randomized placebo-controlled adjunctive study of an extract of withania somnifera for cognitive dysfunction in bipolar disorder • N= 60 euthymic subjects w DSM-IV bipolar disorder • Placebo or WSE 500 mg/d as a procognitive agent added to bipolar disorder meds. • significantly > improvement - mean digit span backward, neutral mean response time and the mean social cognition response rating clinicaltrials.gov (identifier: NCT00761761). Chengappa KN, Bowie CR, Schlicht PJ, Fleet D, Brar JS, Jindal R. J Clin Psychiatry. 2013 Nov;74(11):1076-83. doi: 10.4088/JCP.13m08413. PubMed PMID: 24330893. Full study: http://www.psychiatrist.com/jcp/article/Pages/2013/v74n11/v74n1107.aspx What are the objectives? • Help the Body Cope with the Physiological Effects of Stress • Support Healthy Cortisol Levels • Support Relaxation and Restful Sleep • Promote Mental Clarity • Help Alleviate Fatigue Adaptogens: tonic herbs for fatigue and stress. • Panossian A. Alt Comp Ther 2003;Dec:327-31. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0 CCEQFjAA&url=http%3A%2F%2Fwww.researchgate.net%2Fprofile%2FAlexande r_Panossian2%2Fpublication%2F244889830_Adaptogens_Tonic_Herbs_for_Fati gue_and_Stress%2Flinks%2F0c960521c4f911f827000000.pdf&ei=EOjwVODyO4 79oQT02YDoCg&usg=AFQjCNGmbpu4VMkvMZsuhfBFGss_YwbQSQ&bvm=bv.8 7269000,d.cGU Great full article that covers many aspects of adaptogens in general and includes SWE, magnolia, phelledron, and Rhaponticum carthamoides (maral) ---Improved Quality of Life Effects of Magnolia officinalis and Phellodendron amurense (Relora) on Cortisol and Psychological Mood State in Moderately Stressed Subjects • Double-blind, placebo-controlled Subjects: 35 men and 21 women screened for moderate stress Age range: 19-59 with an average age of 28 Duration: 4 weeks Relora Group: 500mg/day No adverse effects reported Fatigue decreased over 30% J Int Soc Sports Nutr. 2013 Aug 7;10(1):37. doi: 10.1186/1550-2783-10-37. We have examined studies demonstrating ingredients that meet stress management objectives. Medical conditions were mentioned. Now we will discuss a dietary supplement. •It is important to remember that dietary supplements CANNOT mitigate diseases or replace drugs. •However, XYMOGEN products CAN give your patients their best chance to stay healthier longer* * These statements have not been evaluated by the US Food and Drug Administration. These products are not intended to diagnose, treat, cure , or prevent any disease. Introducing CortiSolv™ Natural Stress Buster* *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Five stress-busting ingredients* Cortisolv™ Supplement Facts Serving Size: 1 Capsule Amount Per Serving Relora†® (a proprietary blend of a 250 mg patented†† extract from Magnolia officinalis bark and a proprietary extract from Phellodendron amurense bark) Sensoril® Ashwagandha (Withania somnifera) Root and Leaf Extract (10% withanolides) %Daily Value ** 150 mg Suntheanine® L-Theanine 100 mg Banaba Leaf Extract 50 mg (Lagerstroemia speciosa)(1% corosolic acid) Maral Extract (Rhaponticum 50 mg carthamoides)(root) ** Daily Value not established Other Ingredients: HPMC (capsule), L-leucine, ascorbyl palmitate, medium-chain triglyceride oil, silica, and microcrystalline cellulose. ** ** ** ** Relora® • All-natural, Non-irradiated, Non-ETO* treated, Non-GMO, vegetarian • Proprietary blend of patented extract Magnolia officinalis bark and Phellodendron amurense bark • Well-studied by third parties * ethylene oxide A Brief Summary of Relora Clinical Trials Reference Type of Study # Participants Dosage Outcome Kalman DS, Feldman S, Feldman R, et al. Nut J. 2008;7:11 Randomized, parallel, placebo controlled study 26 healthy, overweight (BMI 25 – 34.9), premenopausal females 250mg 3 times daily for 6 wks In comparison to placebo, significantly reduced temporary, transitory anxiety as measured by Spielberger STATE anxiety questionnaire * Garrison R, Chambliss WG. Altern Ther Health Med. 2006;12(1):50-4. Randomized, doubleblind, placebocontrolled pilot clinical study 26 healthy, overweight, premenopausal female adults, 20-50 yrs of age 250mg 3 times daily for 6 weeks Weight gain less in those taking Relora than in placebo due to lowered cortisol levels * *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. A Brief Summary of Relora Clinical Trials (Cont’d) Reference Type of Study # Participants Dosage Outcome LaValle J. Unpublished Data Open label, single center, pilot clinical trial 12 subjects with mild to moderate stress (27 – 52 yrs) 250mg 3 times daily for 14 days Salivary cortisol and DHEA levels were checked; marked reduction in morning cortisol occurred and an improvement in DHEA levels * Talbot SM. Unpublished Data Randomized placebocontrolled, double- blind clinical trial 56 subjects (35 men, 21 women) 250mg 2 times a day for 4 weeks Improvement in salivary cortisol levels, mood, and other indices of overall health* *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Sensoril® • Optimized ashwagandha (Withania somnifera) root and leaf extract • Proprietary/patented extraction process produces very high, powerful levels of stress-fighting, cognition-enhancing ashwagandha bioactive constituents.* • Standardized to a minimum of 10% glycowithanolides. • Subject of five RDBC human clinical trials • excellent safety record* *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Sensoril® Mechanism of Action: • Active constituents, glycowithanolides, a type of steroidal lactone imitate certain corticosteroids which shut off the stress response, protecting the body against the harmful effects of prolonged stress or overreaction to stressors.* – As a result of their mimicking action, glycowithanolides decrease serum cortisol* *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Suntheanine® • Pure form of L-theanine produced via a patented fermentation process • 100% pure L-isomer-theanine • Shown to be safe based on numerous favorable toxicology and efficacy studies* • Does not cause drowsiness* • GRAS Affirmation (Generally Recognized as Safe) of Suntheanine received confirmation from the US FDA in 2007 (GRN 000209). *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Banaba (Lagerstroemia speciosa) • Leaf extract • Long history of use in folk medicine, particularly in SE Asia as a glucose modulator* • Animal & human research on banaba leaf and its actives, including corosolic acid, suggest multiple mechanisms that influence glucose and lipid metabolism.*[1,2] • Standardized to 1% corosilic acid – corosolic acid inhibits the enzyme that facilitates the conversion of cortisone to cortisol.*[3] 1.) Evid Based Complement Alternat Med. 2012;2012:871495. [PMID: 23082086] 2.) Biol Pharm Bull. 2004 Jul;27(7):1103-05. [PMID: 15256748 ] 3.) Bioorg Med Chem. 2010 Feb 15;18(4):1507-15. [PMID: 20100662] *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Maral Extract Rhaponticum cathamoides • Root • Widely used in traditional Siberian medicine, mainly to treat overstrain and common weakness resulting from illness. It has also been used historically as a stimulant. • Main bioactive constituents -ecdysteroids, flavonoids, and phenolic acids.[1] • “adaptogenic herbal remedy.”*[1] • Preliminary animal research suggests – – lowers corticosterone levels – positively influences glucose and fat metabolism.*[2] 1.) Phytochemistry. 2009 May;70(7):842-55. [PMID: 19457517] 2.) BMC Complement Altern Med. 2014 Jan 29; 14:33. [PMID: 24444255] General Information - CortiSolv • DIRECTIONS: Take one capsule twice daily, or as directed by your healthcare practitioner. • Consult your healthcare practitioner prior to use. Individuals taking medication should discuss potential interactions with their healthcare practitioner. Do not use if tamper seal is damaged. • STORAGE: Keep tightly closed in a cool, dry place out of reach of children. • DOES NOT CONTAIN: Wheat, gluten, yeast, soy, dairy products, fish, shellfish, peanuts, tree nuts, ingredients derived from genetically modified organisms (GMOs), artificial colors, artificial sweeteners, or artificial preservatives. High Cortisol: • Adrenal Stress Test: Treatment Recommendations • : 1 scoop before bed, or when cortisol peaks to calm the effects of RelaxMax: symptoms • Sedalin: 1-2 before bed • Cortisolv before bed to oppose action of cortisol. This botanical is very useful for those that feel “tired but wired,” a since of anxiety, of insomnia. Ashwaganda can help to give people more energy without increasing anxiety, it can also help to turn off racing thoughts to improve sleep. • Melatonin can be used to oppose high cortisol and protect the brain from free radicals while sleeping. Controlled release melatonin releases first to put you to sleep, but again 4 hours later, so you stay asleep. Stress and Melatonin • • • • • • • • Biomed Khim. 2015 May;61(3):394-399. doi: 10.18097/PBMC20156103394. [Effect of melatonin on antioxidant enzyme activities in blood erythrocytes of rats during acute emotional stress]. [Article in Russian] Pertsov SS1, Kalinichenko LS1, Koplik EV1, Nagler LG2, Alinkina ES2, Kozachenko AI2. Author information Abstract in English, Russian The effect of the epiphyseal hormone melatonin on the activity of antioxidant enzymes, glutathione peroxidase (GPx), glutathione reductase (GR), and Cu/Zn-superoxide dismutase (Cu/Zn-SOD) was studied in peripheral blood erythrocytes of behaviorally passive and active Wistar rats. Acute emotional stress was modeled by immobilization of animals for1 h with simultaneous electrocutaneous stimulation. Basal activity of antioxidantglutathione enzymes in erythrocytes of behaviorally passive rats was higher than that in active animals. Administration of melatonin (2 mg/kg, intraperitoneally) was accompanied by a decrease in the activity of GPx and GR in erythrocytes from non-stressed passive animals. After experimental stress, passive rats demonstrated a significant increase in the activity of Cu/Zn-SOD and GPx in peripheral blood erythrocytes. The absence of stressinduced changes in functional activity of antioxidant defense enzymes in the blood of behaviorally active animals suggests a relatively constant oxidative status of tissues in these animals under stress conditions. Melatonin administration had little effect on stress-induced changes in functional activity of the erythrocyte antioxidant system in passive rats. Active specimens pretreated with melatonin before stressexposure were characterized by activation of study antioxidant enzymes. Quantitative parameters of the erythrocyte antioxidant defense enzymes did not differ in behaviorally active and passive rats subjected to experimental stress after melatonin injection. Thus, exogenous melatonin abolishes differences in the activity of study antioxidant enzymes in erythrocytes of animals with different behavioral parameters under basal conditions and after experimental stress. In passive rats melatonin mainly reduced the initial tension of oxidative processes. By contrast, administration of this hormone to active specimens is followed by an increase in functional activity of the antioxidant enzyme system under conditions of acute stress. Melatonin as gut treatment? J Physiol Pharmacol. 2008 Aug;59 Suppl 2:33-51. Thirty four years since the discovery of gastrointestinal melatonin. Bubenik GA. Department of Integrative Biology, University of Guelph, Guelph, Ontario, Canada. [email protected] After the discovery of melatonin in the pineal gland by Lerner and co-workers in 1958, melatonin was also detected in the retina and the human appendix. Later, melatonin was confirmed immunohistologically in all segments of the gastrointestinal tract (GIT), in the guts of bovine embryos and in the GIT of low vertebrates. Melatonin was also confirmed in the pancreas and the hepatobiliary system. Melatonin is produced in the enteroendocrine cells of the GIT mucosa. The concentrations of melatonin in the GIT are 10-100x higher than in the plasma and the total amount of melatonin in the GIT is around 400x higher than the amount of melatonin in the pineal gland. Similar to pineal melatonin, GIT melatonin is a multifunctional compound which exhibits some general as well as some specific effects, depending on the organ and the location of GIT tissue. In the GIT, melatonin exhibits endocrine, paracrine, autocrine and luminal actions. Generally, the episodic secretion of melatonin from the GIT is related to the intake and digestion of food and to the prevention of tissue damage caused by hydrochloric acid and digestive enzymes. Some actions, such as the scavenging of hydroxyl free radicals, immunoenhancement and antioxidant effects are of general nature, whereas others, such as an increase of mucosal blood flow, the reduction of peristalsis and the regulation of fecal water content, are specific to the tubular GIT. Generally, melatonin actions oppose those of serotonin. Laboratory and clinical studies indicate that the utilization of melatonin can prevent or treat pathological conditions such as esophageal and gastric ulcers, pancreatitis, colitis, irritable bowel disease, and colon cancer. Low Cortisol: • • • • • AdrenaMax or Tyrosine: 1-2, in the am and afternoon as needed to provide the amino acid tyrosine to increase production of cortisol. Licorice will potentiate cortisol and other ginsengs will improve adrenal function. These herbs are known to be adaptocrines which means improving adrenal function when high or low. Will improve energy and mood, as well as immune function. CortiCare: 1-2, one to two times a day to rebuild adrenal health. This provides critical nutrients such as B5, B6 and Vitamin C to build adrenal function so they begin to make their own cortisol. These nutrients repair the ware and tear of stress on adrenal function. AppeCurb: Amino acid precursors for epinephrine and norepinephrine tyrosine and phenylalanine. Both of which improve energy, focus and concentration. This will improve concentration, and also increase other neurotransmitters which help with a sense of well-being. AdrenaEssence-glandular (ProAdrenal) High DHEA: • TREAT THE STRESS • I5-to balance hormones and lower overproduction of DHEA. High DHEA could be associated with conditions such as polycyctic ovarian syndrome. Some people may have difficulty converting DHEA to testosterone. Optimal Cleanse helps to aid this conversion. • RelaxMax-1 scoop once a day to two times a day to offset irritability from high androgens and to augment progesteronic activity through inositol helping ovarin function and GABA acting synergistically with progesterone in the body. Low DHEA • DHEA: 5-20mg for a female, 25-75mg for a male. Low DHEA may contribute to fatigue and hormonal imbalances. Increasing levels improves energy, mood, and fertility. • DHEA helps to maintain strength and stamina and supports testosterone production. High sIgA • Identify and treat possible infection— Berbermycin, Candicidal can be used to treat the infection present. A typical dose of 1-3, 1-3x a day can be deployed based on severity. These are combinations of botanicals designed to decrease bacterial, yeast or parasitic overgrowth. • Immunoglobulins (IgG CWP) Low sIgA sIgA makes up 85% of our immune function. It lines our gut and is our first line of defense from the outside world. It plays a role in immune tolerance and inflammation. Immunoglobulins Treat The Stress I5 ProbioMax GI Protect GlutAloeMine Pancreatic Enzyme GastrAcid GastAcid Sacchromycin DF Vitamin A Vitamin A Adrenals And Stress • Adrenals help to manage stress • Stress can damage adrenals (its bidirectional) • As adrenal function is built we become more resistant to stress • Treating the adrenals gives us a way to treat stress when we can’t treat the “cause” When To Order Adrenal Stress Testing • • • • • • • Fatigue Hypoglycemic Symptoms Menopausal Brain fog Worse under stress Insomnia Any one who we want to be optimized in the face of stress Adrenal Treatments • Tired But Wired: CortiSolv, RelaxMax • Tired and Wired ++ : CortiSolv, RelaxMax, CortiCare • Tired And Tired: Adrenal Manager and CortiCare • Tired and Sick: Adrenal Essence (Cordyceps), CortiSolv • Tired and Depressed: AdrenaMax (Tyrosine) Stress • Stress has direct effects right down to the tissue • Stress changes enzyme activity • Stress makes a cancer more aggressive, and more likely to pass the blood brain barrier • Stress plays a roll in auto-immune conditions • Stress, like temperature, cooks our environment to determine our biochemical function