Distress or De-Stress Robert A. Rakowski, DC, CCN, DACBN, DIBAK

Dirty

Dozen

1. Stress

2. Toxins

3. Heavy Metals

4. Digestion

5. Food Reaction

6. Inflammation

7. Dysglycemia

8. Mitochondria

9. Methylation

10. Immune

11. Infection

12. Hormones

Stress 'is top cause

of workplace

sickness' and is so

widespread it's

dubbed the 'Black

Death of the 21st

century‘ “Stress has even

eclipsed stroke, heart

attack, cancer and

back problems” http://www.dailymail.co.uk/health/

article-2045309/Stress-Top-cause-

workplace-sickness-dubbed-

Black-Death-21st-century.html

Ancient Human Teeth Show That Stress Early

in Development Can Shorten Life Span

"individuals with teeth marked

by early life stress lived 15.4

years less

than those without the defects." http://www.sciencedaily.com/releases/2010/02/100204204315.htm below

The Deadly Quartet

Toxins

Malnutrition

Laziness

“The stress response: in

the beginning it saved our

lives, making us run from

predators and enabling us

to take down prey. Today, human beings are turning

on the same life-saving physical reaction to cope with 30-year mortgages,

$4 a gallon gasoline, final

exams, difficult bosses and

even traffic jams — we can't

seem to turn it off. So, we're

constantly marinating in

corrosive hormones

triggered by the stress

response.” http://killerstress.stanford.edu/ below

“estimated

that 75 - 90

percent of all

visits to

primary care

physicians

are for stress

related

problems.”

http://www.stress.

org/americas.htm

?AIS=402db67648

73c177fe57ade43

799e929 below

http://www.biosbcc.net/barron/physiology/endo/adren.htm

vs. Amygdala

(Perception)

(Attitude)

“It is amazing that almost

any type of stress,

whether it be physical or

neurogenic, will cause an

immediate and marked

increase in ACTH

secretion by the anterior

pituitary gland, followed

within minutes by greatly

increased adrenocortical

secretion of cortisol.” Textbook of Medical Physiology

7th Edition; Guyton; © 1986 W.B.

Saunders Co., page 916 ISBN: 0-

7216-1260-1

"Adopting the

right attitude can

convert a

negative stress

into a positive

one."

Dr. Hans Selye http://www.wow4u.com/stress/

“half-life of

cortisol

disappeara

nce 155 (HYPOTHYROID)

vs. 73 min”

(Euthyroid) J Clin Endocrinol Metab.

1990 Jan;70(1):155-61.

PMID: 2294128 below

“The secret of health

and happiness lies in

successful adjustment

to the ever changing

conditions on this

globe;

the penalties for failure in this great

process of adaptation are disease and unhappiness.”

Selye, Hans The Stress of Life second

edition (preface xv)

ISBN 0-07-056212-1

Hans Selye

“With prolonged stress from multiple

sources, the stress response can become

as damaging as the stressors

themselves, depending on the genetic

sensitivities of the individual. The

individual becomes insulin-resistant. His

or her recovery after injury or illness

decreases. Libido and reproductive

function are adversely affected. Muscles

start to lose tone, and the body becomes

fatter as the individual develops an

“apple” body shape. Blood cholesterol,

triglycerides, and blood pressure

increase. Fatigue sets in and sleep is

restless. The person’s mood slips toward

depression due to altered

neurotransmitters. Inflammatory

conditions increase. Immune defense

against common infections like the cold

and flu decrease, and energy and

enthusiasm for life are lost.” 2002 Seminar Series, Nutritional

Endocrinology II: Breakthrough Approaches for

Managing Adrenal and Thyroid Function;

Jeffrey S. Bland, Ph.D. chapter 2.

http://btc.montana.edu/olympics/physiology/pb01.html below

Everyone!

Who Pays for STRESS?

Stress:

“Giving

something

more

significance

than it

really

deserves.”

Anthony

Robbins

“reduced telomere length is also

associated with chronic psychological

stress and mood disorders.” Brain Behav Immun. 2008 May; 22(4): 600–605. PMCID: PMC2386249 below

Figure 1 Telomerase activity is inhibited by cortisol

Te

lom

era

se

a

cti

vit

y

Stress

Accelerates

Aging

Paralyzed by

FEAR

(Saving Private Ryan)

“Exposure to

even mild

uncontrollable

stress impairs the

cognitive

functioning of the

prefrontal cortex, a brain region critical for

insight, judgment, and the

inhibition of inappropriate

behaviors.” Ann N Y Acad Sci. 2004 Jun;1021:143-7.

PMID: 15251883 Below

© Rakowski 2006

“Lethal stress

will

immediately

reduce your

judgement and

performance at

least 50%.” Sensei Grant Kruhly

Lipton, Stress Physiology blood is shunted from

the organs to the muscles

“there is universal agreement that 50% to 75% of patients with major depression exhibit hyperactivity of the HPA axis”

J Clin Psychiatry. 1989 May;50 Suppl:13-20; discussion 21-2. PMID: 2654128 Below

*

“Appropriate

regulatory control of

the HPA axis is crucial

for health and

survival” Nature Reviews Neuroscience 5,

917- (December 2004)

“increased

activity of HPA

axis are

considered as

state marker of

depression.” Nippon Rinsho. 2007

Sep;65(9):1585-90. PMID:

17876979 below

In an given 1 year period, 9.5 % of the

population, or 19 million American adults suffer from

a depressive illness

Depression lifetime risk: approx. 20% (50 million U.S.)

Affects about 12.4 million women and over 6 million men

in the United States each year

National Institute of Mental Health, Information Resources and Inquires Branch Website: http://www.nimh.nih.gov

“When compared

to other chronic

diseases

depression may well be the

world’s

most

disabling

disease” http://www.netscape.com/ article +

link below

*

“high cortisol levels induce high tryptophan oxygenase Acta Med Okayama. 1997 Aug;51(4):233-6. PMID: 9284972 below

“Proinflammatory cytokines induce IDO (indoleamine 2,3-

dioxygenase) “Stress. 2008;11(3):198-209 PMID: 18465467 below

Insomnia and

Depression

Implications

Glutamate

“elevated

cortisol

induced by

stress

increases

serotonin

uptake” Cognitive, Affective, &

Behavioral Neuroscience,

Volume 1, Number 1, 1 March

2001 , pp. 96-104(9) abstract

below

Cortisol

“Sucks

up”

Serotonin

Serotonin

transport

activity

increased by

interferons

(Scan J of

Immunology

2006;106-

15.)

Nitric Oxide increases SERT

and lowers Serotonin SSRI’s

lower Nitric Oxide SERT is a

Serotonin

Vacuum Cleaner

Serotonin - over

70,000,000 U.S.

prescriptions in 2007

Source Jay Lombard, DO

Cortisol promotes (SERT).

DHEA buffers cortisol

“chronic interpersonal stress is associated with greater stimulated

cellular production of IL-6 along with impairments in the capacity of

glucocorticoids to inhibit this cellular inflammatory response. Moreover,

these findings add to a growing body of data that implicate heightened

proinflammatory cytokine activity in those at risk for fatigue symptoms.”

Brain Behav Immun. 2008 Jan;22(1):24-32. PMID: 17706915 below

Chronic Stress is Pro Inflammatory, promotes depression and fatigue

“Highly stress-

resistant animals

have higher endo-

genous serotonin”

Bethea CL, et al. Sensitivity to Stress-Induced Reproductive

Dysfunction Linked to Activity of the Serotonin System. Obstet Gynecol

Surv. 2005 Jul;60(7):448-450. PMID: 15995560 BELOW

“Hippo-

campal

neurons

show the

highest

density of

cortico-

steroid

receptors” Nature Reviews

Neuroscience 5, 917-

(December 2004) below

© Rakowski 2006

http://www.exploratorium.ed

u/memory/braindissection/1.

html

“high salivary cortisol concentrations predict a decline in memory function

over the next 3 years.” Neurobiol Aging. 2005 Nov 3; PMID: 16274857 Below

© Rakowski

2006 “The present study

revealed that elderly

human subjects

showing increasing

cortisol levels over

years with currently

high cortisol

levels are

impaired on

hippocampus-dependent

memory and

have a 14%

reduction in

hippocampal

volume, compared to

elderly subjects showing

decreasing cortisol levels

over years with currently

moderate cortisol levels.”

Nat Neurosci. 1998

May;1(1):69-

73.PMID: 10195112

Article Below

© Rakowski 2008

“Deficits in memory and hippocampal atrophy

seen in (Alzheimer's disease) AD have been

associated with hypercortisolism” Psychoneuroendocrinology. 2008 Oct;33(9):1293-6. PMID: 18774653 below

“chronic

stress leads

to

premature

aging of the

immune

system.” Neuroimmunomodulation.

2008;15(4-6):251-9. Epub 2008

Nov 26. PMID: 19047802 below

“NK cells are

the most

"sensitive"

cells to the

suppressive

effect of

stress” CHROUSOS, GEORGE P., The Stress

Response and Immune Function: Clinical

Implications: The 1999 Novera H. Spector

Lecture Annals of the New York Academy

of Sciences 917:38-67 (2000)

“Recent studies indicate that “Ganoderma lucidum

(G. lucidum) activates NK cells … Our results

indicate that G. lucidum induces NK cell cytotoxicity

against various cancer cell lines” Innate Immun. 2013 Jun 26. PMID: 23803412 below

“Scientists have discovered that everyday emotional

stress is a trigger for the growth of tumours” http://www.telegraph.co.uk/health/healthnews/6981222/Stress-could-cause-

cancer-claim-scientists.html below

“These analyses

suggest that

stress-related

psychosocial

factors have an

adverse effect

on cancer

incidence and

survival” Nat Clin Pract Oncol. 2008

Aug;5(8):466-75. PMID:

18493231 below

“By far, the best-known

metabolic effect of cortisol

and other glucocorticoids on

metabolism is their ability to

stimulate gluconeogenesis by

the liver, often increasing the

rate of gluconeogenesis as

much as six-to tenfold.” “. .

all of the enzymes required to

convert amino acids into

glucose are increased in the

liver cells.” “. . cortisol

causes mobilization of amino

acids from the extrahepatic

tissues, mainly from muscle.”

Textbook of Medical

Physiology 7th Edition;

Guyton; © 1986 W.B.

Saunders Co., page 914 ISBN:

0-7216-1260-1

HOOC-C-N-H

H H

R

Keto Acid

Glucose

Amino

Group

Ammonia

Urea

Amino Acids Amino Acids?

“Glucocorticoids

stimulate protein

degradation in

muscle, skin

and lymphoid

tissue, the released amino acids being

used for glucose and glycogen

synthesis (Darmaun et al. 1988;

Beaufrere et al. 1989).”

Exp Physiol 2003;88;129-

140 Below

Promote Synthesis: GH, IGF1, Test, AA (BCAA) Insulin

Prevent Degradation: Insulin, IGF1,

Promote Degradation: Cortisol, Inflammation

Cortisol is Catabolic and Anti Anabolic

Stress & Body

Composition

Cortisol

Methyl

Depletion

Pleasure

Perception

CHO

Hunger

Insulin

Opposition

Insulin

SHBG

5’Deiodinase

T4 to T3

Reverse T3

Thyroid

Action

Central

Obesity

Aromatase

Estrogen

THBG

DHEA

Sarcopenia

Obesity

PPAR

Fat Burning

Fat Burning

Mito-

chondria

IL-6

N.O.

Depression

Catecholamines

Stress & Body

Composition

Cortisol

Methyl

Depletion

Depression

Pleasure

Perception

CHO

Hunger

Insulin

Opposition

Insulin

SHBG

5’Deiodinase

T4 to T3

Reverse T3

Thyroid

Action

Central

Obesity

Aromatase

Estrogen

THBG

DHEA

Sarcopenia

Obesity

PPAR

Fat Burning

Fat Burning

Mito-

chondria

Lose Muscle,

Gain Fat

"The increase in cortisol secretion seen in

patients with abdominal obesity may

contribute to the metabolic syndrome” Endocrinol Metab Clin North Am. 2002 Mar;31(1):173-89. PMID: 12055988 below

“Local

production of

active cortisol from inactive

cortisone

driven by 11-β-HSD-1

activity is very

high in VAT” Nutr Metab (Lond). 2004 Nov 5;1(1):12.

PMID: 15530168 article below

“Alternatively, obesity could also be a source of stress

promoting the visceral fat accumulation since

visceral fat is able to release cytokines which

stimulate the HPA axis” Panminerva Med. 2003 Sep;45(3):189-95. PMID: 14618117 Below

Figure 13. Reciprocal relations between

obesity and stress. http://www.endotext.org/obesity/obesity13/obesity13.htm below

“Glucocorticoid

(GC) (Cortisol)

excess is

characterized by

increased

adiposity,

skeletal

myopathy and

insulin

resistance” Diabetes. 2009 Aug 12.

PMID: 19675138 below

“In postmenopausal

women, all estrogens

and nearly all

androgens are made

locally in peripheral

target tissues from

the inactive adrenal

steroid precursor

dehydroepiandroster

one (DHEA). In adult

men, approximated

50% of androgens

are made locally.”

This new section of endocrinology, which describes the local formation of sex

steroids, has been named intracrinology.” Semin Reprod Med. 2004

Nov;22(4):299-309. ABSTRACT BELOW

These hormones are made locally

and act locally. This seriously

limits interpretation of serum

levels!!! Wendy Warner, MD, 10-5-13

“All the enzymes required to

transform DHEA into androgens and/or estrogens are expressed in a cell-specific manner in a large series of peripheral target tissues…

intracrinology.” “its (DHEA) potential

use as a physiological HRT could well provide a physiological balance of androgens and estrogens”

J Endocrinol. 2005 Nov;187(2):169-96. PMID: 16293766 PMID: 16293766 Below

Adrenal Steroid Synthesis and Progesterone Steal

http://www.hormonepr

ofile.com/pregnenolon

e.htm

Glucocorticoid

Mineralcorticoid

Cortical Sex Hormones

Progesterone

Steal

“You are

either

making

stress

hormones or

sex

hormones.”

“Stress significantly reduced the

probability of conception each day during the fertile window”

Buck Louis et al. Stress reduces conception probabilities across the fertile

window: evidence in support of relaxation. Fertility and Sterility, 2010

© Rakowski

2008

Figure 6.

Schematic

representati

on of the

detrimental

effects of

chronic

stress on

adipose

tissue, bone

and muscle

metabolism.

GH: growth

hormone.

Stimulation

is

represented

by solid

green lines

and

inhibition by

dashed red

lines.

http://www.endotext.or

g/adrenal/adrenal8/adr

enal8.htm

Increase FAT

(VAT) decrease

muscle and

bone

© Rakowski 2006

CORTISOL

“The most frequent

adverse effects include

atrophy, striae,

rosacea, perioral

dermatitis, acne,

and purpura. Those

that occur with lower

frequency include

hypertrichosis,

pigmentation alterations,

delayed wound healing,

and exacerbation of skin

infections.” J Am Acad Dermatol. 2006 Jan;54(1):1-15;

quiz 16-8. PMID: 16384751 Below http://cnserver0.nkf.med.ualberta.ca/cn/Schrier/Vol3/Fig.%204-18B.jpg

STRESS MANAGEMENT

101

The Serenity Prayer

God grant me the

serenity

to accept the things I

cannot change;

courage to change the

things I can;

and wisdom to know

the difference.

2. 3.

1.

43% increased risk

of

premature death”

PMID: 22201278

If it is to

be,

it is up to

me!

PMID:

22201278

“most likely, all New World primates …

have (CORTISOL) resistance”

2010 PMID: 20649902

melatonin

inhibits

ACTH-

stimulated

cortisol

production.” J Clin Endocrinol Metab. 2003 Jan;88(1):450-

8. PMID: 12519889

“the gut

contains at

least 400

times more

melatonin

than the

pineal gland” World J Gastroenterol 2011 September

14; 17(34): 3888-3898 PMC3198018

abstract below

Supplement

Melatonin

Every

Hour

The Magnificent Seven

Eat right

Drink right Think right Poop right Move right

Talk right Sleep right Eat right

Drink right Think right Poop right Move right

Talk right Sleep right

Stress

Solutions:

Don’t

Worry Be

Happy!

Rakowski

Life

Pyramid

Love

Purpose

Discipline

Life-Style

Unique Needs

Give Happy, Live Happy!

“And this, too, shall

pass away.”

“adaptogens

can be defined

as "smooth"

pro-stressors which reduce reactivity

of host defense

systems and

decrease

damaging effects

of various

stressors” Phytomedicine. 1999 Oct;6(4):287-300.

PMID: 10589450 Below

Everyone Responds to Stress

Differently. Signs of stress are often the most

common presenting complaints. But not everyone

responds to stress in the same way. That’s why we

developed Identi-T, to help you easily identify each

patient’s unique response to stress and recommend

an effective, customized approach. http://www.metagenics.com/practitioners/programs/identi-t-program-

personalized-stress-relief#0,48

Identi-T

Stress Typing with Identi-T

1. Identify Stress Type

2. Specific Adaptogens

3. Stress relief and Lifestyle

Strategies

0102030405060

HPACalming HPA

StimulatingHPABalancing

AdrenalSupport

Blood Sugar

Cardiovascular

MoodCognition

Immunity

Hypersomnia

Chronic Pain

Digestion

Libido

Respiratory

InsomniaMuscle

Type 5: Stressed & Mentally

Exhausted Holy Basil, Ashwaganda, Amla, Bacopa

Identi-T

“What’s the

one thing I can

do, such that

by doing it

everything

else is easier

or unnecessary?”

Gary Keller

Make it Fun!

Make it Fun!

Joy

Cost of a meal at an

inexpensive restaurant =

$10.00.

http://www.numbeo.com/cost-of-living/country_result.jsp?country=Unite

d+States

Restaurants Median Range

Meal, Inexpensive

Restaurant 10.00 $

8

15

Meal for 2, Mid-range

Restaurant, Three-course 45.00 $

32.98

60

Combo Meal at

McDonalds or Similar 6.00 $

5.87

7

Domestic Beer (0.5 liter

draught) 3.28 $

2.75

4

Imported Beer (0.33 liter

bottle) 4.75 $ 3.79

Cappuccino (regular) 3.59 $ 3

4

Coke/Pepsi (0.33 liter

bottle) 1.50 $

1.25

2

Water (0.33 liter bottle) 1.25 $ 1

1.5

Success is a numbers game

5 shakes per week

x

4 weeks per

month

x

500 patients

x

$4 profit per shake

= $40,000 per month