Stress: Understanding and Treating Stress Related Health Problems

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Many patients come to me in my clinical practice over the years with health problems that are poorly understood and not clearly diagnosed, and most of the time their medical doctor tells them that the problem is just due to stress or aging. Where that leaves us is a sort of limbo where we are faced with problems that we don't understand and can do very little about because of this highly generalized explanation. In truth, this explanation is not very helpful unless we come to grips with a scientific explanation of stress and aging that allows us to tackle and correct specific health imbalances.

Once we understand the meaning of stress, inclusive of both mental and emotional strain, environmental stress, and physical stress, much of which has a lot to do with the physiological process of aging as well, then we can tackle specific aspects of the problem. The key to treating health problems related to stress is to first individualize and understand your problem, then to restore either the acute or chronic stress related systems. With chronic stress and aging, the key is the restoration of a healthy homeostasis, and careful attention to systemic health, hormonal balance, metabolic balance, and inflammatory mechanisms is necessary in the assessment.

In the 1920s, the health researcher Hans Selye coined the term stress to describe the effects on patients that hindered health and healing, borrowing the term from his study of physics, meaning the force that produces strain on a physical body until it snaps. Stress was a non-specific strain caused by irregularities in normal bodily function (homeostasis), and the term stress hormone was coined to create a measurement of the response. Later, Dr. John Mason noted that psychological and emotional stress alone could trigger this same measurable response, raising levels of adrenaline and cortisone. Other studies showed that anticipation of strain could produce this stress response as well, and that the body and mind were very adaptive to stress. Extensive studies in Russia proved that specific herbal chemicals were very effective to help the body adapt to stress, and the term adaptogenic was coined for these medicines. In recent decades, studies of chronic levels of stress, even chronic anticipation of a negative event, could create chronic stress responses that impacted the health. The term stress was also adopted during this century as a common term, referring to disturbance in the daily routine that was upsetting, as in "stressed out", and most patients that try to deal with stress fail to see the complexity of the term, as well as the original non-specific nature intended by Dr. Hans Selve. The point of this study of stress, and coining of the term, was not to use it as a catch-all cause of diseases and symptoms that could not be easily explained by another specific cause, but to show that a more holistic view of health was sorely needed, and that general health, diet, lifestyle and adaptability were important in treatment. Today, we see a lot of diverse study of the effects of stress, still non-specific.

In 2009, three prominent researchers and professors, Jack Szostak, a genetics professor at Harvard Medical School and the affiliated Massachusetts General Hospital, Elizabeth H. Blackburn of the University of California San Francisco (UCSF), and Carol W. Grieder of Johns Hopkins University School of Medicine, won a Nobel Prize in physiology and medicine for their work showing how stress affects aging and disease by decreasing the function of an enzyme called telomerase, which protects the genetic chromosomes from degrading. The telomere, a repeated DNA strand at the end of our chromosomes, is a protective cap that prevents degradation and mutation of our genetic code. The telomere, a simple repeated genetic code (TTAGGG x CCCTAA), forms a nucleoprotein complex that protects healthy cells from degradation and is also required for cell replication. This telomere complex is highly variable and controlled, and cancer cells almost always have longer telomeres on cancer cell genes to prevent cancer cell death and allow tumor growth. The subject of telomeres is thus complex and demands a normal homeostasis and modulation of controls to keep us healthy. An allopathic drug or treatment to lengthen telomeres is likely to contribute to cancer. Subsequent study demonstrated how healthy diet and lifestyle, and real stress reduction in the body, could actually improve the telomerase metabolism and lengthen degraded telomeres, preventing the effects of aging and reducing cancer risk and mortality. Of course, this is not the whole definition of stress, but just one of many aspects of this broad term. In recent years, a concerted effort to objectively define stress, and the tangible signs and effects, has revealed how we may integrate Complementary Medicine, in the form of diet, lifestyle, mind-body techniques, acupuncture, herbal and nutrient medicine, and physiotherapies, to better treat tangible physiological stress and its consequences.

To demonstrate how acupuncture could help alleviate the objective measurements of stress, researchers in 1998, at the Heart Disease Research Foundation of New York, New York, U.S.A., found that acupuncture stimulation at the most common point used in clinical treatment, ST36, actually increased telomere length in healthy individuals and decreased telomere length in cancer cells, where the length of the genetic code telomeres dramatically increase with cancer cell mutation, allowing the cancer cells to evade normal controls of programmed cell death, or apoptosis. This study proved that acupuncture stimulation is modulating of normal homeostatic mechanisms. These researchers found that acupuncture stimulation at this one point could almost double the length of telomeres in normal subjects depleted by stress, in just one treatment. The research also showed the so-called "acupressure", or actually strong Shiatsu technique, produced a significantly less effect on the telomere length. While many patients are reluctant to be stuck with needles, and feel that so-called "acupressure" may be less painful, in reality, strong Shiatsu technique at an acupuncture point is usually more painful than needle manipulation, and this study, like a number of others, showed that gentle manual massage at the points produces little measurable benefit. This study also revealed that telomere length on the human chromosome is essentially the same in a healthy individual today as it was 5000 years ago. Human homeostasis is truly amazing. This study examined the telomeres in a preserved human trapped in ice in 3300 BC in the Italian Alps, now called the Otzi Caveman, who was discovered to have an array of tattoo points created by acupuncture techniques that used alchemical mineral elixir on stone needle points. Incredible! This research also reviewed findings of mummified Egyptian sisters from about 900 BC, finding that telomere length was about the same as seen on healthy cells today. To see this study, just click here: http://www.ncbi.nlm.nih.gov/pubmed/10193703 .

Studies have demonstrated that Chinese herbal medicines also exert this modulatory effect on telomeres. In 2015, for example, researchers at the Dongeui University College of Korean Medicine, and other university medical schools in South Korea, found that an active chemical in the herb Cordyceps (Dong Chong Xia Cao), called cordyceptin, actually could shorten the abnormal telomeres on cancer cells by downregulating gene expression of human telomerase reverse transcriptase (hTERT) and other transcription factors, as well as activating the anti-inflammatory pathways of PI3K/Akt cell signaling. Such study showed how cordyceptin could be effective in the treatment of leukemia, helping to stop the spread of cancer by helping the body to induce cancer cell apoptosis. To see this study, click here: http://www.ncbi.nlm.nih.gov/pubmed/10193703 . While these studies don't tell the whole story of how acupuncture and herbal medicine alleviate the harmful effects of stress, these findings are truly remarkable, and should reassure everyone of the value of treatment with Traditional Chinese Medicine.

Defining stress

In general, most of us think of stress in terms of a chronic emotional problem, and use such terms as 'stressed out' to describe it. In truth, like many words, the term stress has many meanings, and when your physician uses the term stress, he or she is probably using one of the other meanings than the one that comes into your mind, which is a mentally or emotionally disruptive influence, or distress. Mental and emotional stress, though, is associated with an array of physiological factors, and understanding these physiological factors helps us to achieve a more objective perspective of our mental and emotional stress when it applies to specific health problems. Mind-body medicine is a term that describes the interrelation of mental and physical health. Often, the first step in resolving health issues related to mental and emotional stress is to objectify it. When these health problems remain too subjective, there is often an aura of uncertainty that keeps us from taking concrete steps to resolve them. There needs to be better communication and patient education in this realm, because this area of health concerns, perhaps more than any other, depends on an interactive approach by both the patient and physician. Emotional and mental problem resolutions do not resolve completely by just taking a pill. On the other hand, there are stress factors in the body that have little to do with mental and emotional stress, and when the term stress is used without a specific context, the patient may jump to the conclusion that their physician is referring to mental and emotional problems, or that a vague psychological or emotional syndrome must be causing their physical or metabolic stress syndrome, or symptoms. These types of assumptions are often unhelpful in therapy, and once again, the importance of achieving a more concrete and objective defining of the health problems related to stress is very important to a successful outcome.

Physiologically, stress may refer to a mechanical or a metabolic strain. Stress on a joint may be mechanical, where an imbalance of muscular forces, and possibly poor body mechanics, places strain on the joint that causes mechanical deterioration. In most instances, though, the term stress, as applied to chronic health problems, is referring to metabolic stress, which overstrains the system in a variety of ways, especially with immune, hormonal, and nervous system dysfunctions. Metabolism is a term for the sum of chemical and physical changes occurring in our tissues, consisting of both anabolism and catabolism, the conversion of small molecules into larger ones, and the breakdown of larger molecules into smaller, as well as oxygen utilization, oxidation, energy utilization, synthesis and use of fats, and uptake of food nutrients. Metabolic stress may have many negative health consequences. The key to dealing with these types of stresses is understanding specifically what type of strain or imbalance is occurring, and what type of disorder is created that specifically relates to the health problem in question. Once again, a generalized use of the word 'stress' is not helpful. Many times, new patients come to the Licensed Acupuncturist because they were told, or they read, that acupuncture can reduce stress. In fact, many medical doctors over the years have put down the practice of Complementary Medicine and the scope of acupuncture, or Traditional Chinese Medicine, by implying that all it does is reduce stress and perhaps temporarily relieve pain. This is very misleading, and while acupuncture may help relieve the effects of distress, or emotional and mental stress, the real need of the patient, in most instances, is relieving specific metabolic and mechanical stresses and the specific problems that they create. By taking a thorough and holistic approach to one's health, the many factors that create stress in the body can be dealt with effectively.

Metabolic stress is also defined in a number of ways in medical dictionaries. Steadman's medical dictionary defines stress as: "reactions of the body to forces of a deteriorating nature, infections, and various abnormal states that tend to disturb its normal physiological equilibrium (homeostasis)." The same dictionary defines mental and emotional stress as: "a physical or psychological stimulus such as very high heat, public criticism, or another noxious agent or experience which, when impinging upon an individual, produces psychological strain or disequilibrium." While a standard medical practice may not be able to do anything about the noxious agents or experiences that are causing the imbalances that cause stress, a physician that spends the time and treats the problem holistically can both take care of the homeostatic disequilibrium, or health imbalance, and help make the patient more aware of the variety of factors that are causing physiological stress. This takes a cooperative and proactive approach to stress-related health problems on the part of the patient, as well as a physician that can take the time and work with the patient to correct specific health imbalances, strengthen the system, and engage the patient in this targeted proactive approach. The medical doctor in today's system does not have the time to spend, and in fact, is too expensive to engage properly in this type of therapy. The Complementary Medicine physician is ideally suited, and especially the Licensed Acupuncturist and herbalist, who brings a variety of effective tools and is relatively inexpensive, and often brings a wealth of scientific understanding to solve the individual puzzles of stress and holistic health imbalance.

In 2015, a large cohort study of childhood stress and risk of diabetes type 1, at Linkoping University in Sweden, headed by Dr. Johnny Ludvigsson, professor pediatric medicine at the university, showed that childhood stress and trauma of a varying nature contributes heavily to the onset of diabetes type 1, long considered primarily a genetic autoimmune disorder. This study used the large ASIS study data from the 1990s, which followed over 10,000 families with children born between 1997 and 1999 for over 14 years, and a follow-up study of the first 4400 children in this study clearly showed that psychosocial stress in childhood dramatically influenced both the metabolic and immune systems. An array of stressors, including poverty, parenting stress, poor diet, divorce, trauma, and racial discrimination were shown to be highly associated with diabetic risk in the future, especially when a number of predisposing factors were evident. Such study clearly demonstrates the need for a more holistic approach in medicine to treat and prevent disease.

If the problem is one of metabolic stress, the first thing that must be done is to identify and define this stress, and make sure that the patient and the physician are on the same page when trying to clear this harmful metabolic stress. Since metabolic stress is defined medically as a deteriorating force, the medical problems resulting are usually chronic and degenerative. The specific stressor should be addressed and resolved, and the effects of the metabolic stress also treated intelligently. Sometimes, the stressor itself is no longer present in metabolic stress disorders, yet the disease of degenerative condition, and metabolic disequilibrium, is still present. A careful assessment of these stresses and consequences is absolutely necessary to restore a healthy homeostasis. For instance, a prolonged illness or recovery from injury or surgery may create a metabolic or mechanical stress syndrome, and the signs and symptoms noted well after the initiating cause or causes. Once the patient understands the health problems, and specifics of the metabolic or mechanical imbalance, they can be resolved with the help of a physician, and the Complementary Medicine physician, in the form of the Licensed Acupuncturist and herbalist, may provide the array of treatments to restore the metabolic and mechanical homeostasis, and health.

Besides metabolic stress and imbalance, mechanical stress can also be a big problem, not only causing mechanical degeneration and inflammatory problems with your tissues, but also creating impingment syndromes that result in neuropathies and dystrophies (lack of nutrient flow to tissues), as well as autonomic nervous dysfunctions that impact on the whole health. The extensive study of myofascial pain syndromes has confirmed that most patients with chronic myofascial pain syndromes also develop some autonomic symptoms. These commonly include nervousness, insomnia, apprehension, increased allergy symptoms, dry skin and constipation, and gastrointestinal disorders, involving an excess sympathetic nerve response and a deficient parasympathetic. The Licensed Acupuncturist that is skilled in various physiotherapies, termed Tui Na in Traditional Chinese Medicine, as well as acupuncture and herbal/nutrient therapy, is able to both resolve the mechanical stress and treat the consequences. Restoring balance in the autonomic nervous system reduces physiological stress greatly.

A new perspective of stress in modern medicine: Psychoneuroimmunology

For twenty years, the subject of psychoemotional stress has been heavily researched in modern medicine, especially in the realm of psychoneuroimmunology, a holistic perspective of health that explores the relationship between psychological factors, neurophysiological mechanisms, immune responses, and the hormonal, or endocrine functions. The subject of the placebo responses, cognitive effects on treatment, stress biomarkers, and the health consequences of beliefs, knowledge and expectancies on treatment outcomes has been a realm of medical research that has been exceedingly interesting to the University researchers, but generally put down by the clinical medical doctors and pharmaceutical researchers. This area of medicine has, in recent years, become a subject of interest to clinical nursing specialists, and is finally gaining some momentum in standard medicine. The term Mind-Body approach is now becoming common in standard practice, although a few years ago this would have been ridiculed by most M.D.s. Nevertheless, despite the bias against holistic medicine in standard practice, the sound research of decades makes this subject hard to reject. Of course, this same holistic connection between the Psyche, the Nervous System, and the whole physiology of the human organism, was a central facet of Traditional Chinese Medicine, and Daoist physicians, and was well documented in texts dated to at least 400 BC. The challenge for humanity today is to advance their modern understanding of stress and apply it holistically and objectively to medical treatment and improved health.

Many scientific studies in recent years are objectively measuring the benefits of mind-body therapeutics, such as meditation, yoga, Tai chi, and Qi Gong. For instance, at the University of California San Francisco, medical doctors have reacted to the findings that early treatment with hormone ablation and surgery for prostate cancer has produced more harm than good for the vast majority of prostate cancer patients, increasing stress and causing an array of negative health consequences, while not prolonging life for the vast majority of patients. These medical doctors have explored the integration of mind-body medicine to slow the progression of prostate cancer, usually a slow growing cancer in almost all cases, and found great success with this approach. Studies of the measurable effects of meditation practice and other stress reduction mind-body therapeutics have revealed that patients with initially high cortisol levels showed normalizations of diurnal cortisol patterns (Schedlowski et al 1994, Cruess et al 2000, van der Pompe et al 1997, in studies of breast cancer patients), while those with initially depressed cortisol levels showed an increase in cortisol, to normal levels diurnally (LE Caroson et al; Psychoneuroendocrinology 29; 2004; 448-474). A number of studies have confirmed that most patients with breast cancer displayed abnormal diurnal cortisol secretion patterns (Touitou et al 1996). Restoration of diurnal cortisol homeostasis may significantly aid the normalization of the hypothalamic-pituitary axis (HPA), or cycle of neurohormonal control between the various endocrine tissues, from the adrenals to the brainstem. These measurements show how such practices restore the homeostatic mechanisms programmed into our genetic code.

A 2007 controlled clinical study printed in the Harvard Men's Health Watch, a publication of Harvard Medical School, reported the findings from a multicenter study of patients with prostate cancer, headed by Dr. Dean Ornish and Dr. Peter Carroll of the University of California San Francisco, that a program of dietary changes, nutrient medicines, daily light exercise, and mind-body stress reduction (yoga, meditation etc.) resulted in a lowering of the PSA count and inhibition of prostate cancer cell growth by 70 percent. The control group showed a rise in PSA and inhibition of prostate cancer cell growth of only 9 percent. The results show that such therapy can play a dramatic role in normalizing homeostatic mechanisms and slowing of the growth of cancer, as well as improving the quality of life, perhaps better than any treatment available in standard medicine. If specific herbal medicines, acupuncture, and deep tissue physiotherapy are added to this protocol, the results may even be more dramatic. To read about the benefits to measured markers of neurohormonal stress from deep tissue physiotherapy, go to the article on this website entitled Deep tissue massage and its many benefits. Such holistic therapy not only resolves problems with mechanical stress, but deep tissue physiotherapies have been proven to normalize cortisol levels, immune cytokines, hormones such as oxytocin, and adrenal corticoids. The overall benefits to actual stress reduction are broad, and effect the nervous, endocrine and immune systems.

Objective Signs of Metabolic Stress and their meaning

Laboratory analysis may now give the patient and physician some interesting biomarkers of stress. The two chief biomarkers relate to adrenal and metabolic strain from physiological and/or emotional/mental stress. These two biomarkers are diurnal cortisol and alpha-amylase, which are both measurable with inexpensive salivary samples. Understanding these two key biomarkers of stress helps us understand the complete picture of what we need to accomplish to better cope with stress and resolve pathologies related to chronic stress. Restoration of normal diurnal cortisol and alpha-amylase metabolism demands integration of Complementary Medicine.

Alpha-amylase is an enzyme that is created to yield increased glucose and maltose from the breakdown of large carbohydrates such as starch and glycogen (the chief form of carbohydrate energy storage in our bodies). Glycogen is the form of starch that is stored in animal tissues, commonly called 'animal starch' to distinguish it from plant starches in our food. We store most of our energy fuel as fats (triglycerides mainly), but our bodies do keep a significant amount of animal starch, or glycogen, in all of our cells, and this fuel is utilized mainly when a sudden increase in energy is needed in the organ cells or muscles. Such a sudden need of cellular energy is usually generated by stress, or strain above what our bodies can normally handle. The glycogen storage in our bodies that is accessible to our organs is primarily stored in the liver cells. Red blood cells and muscle cells store various amounts of glycogen to handle mechanical, or musculoskeletal, strain. Our brains store glycogen and starch that can be converted within the brain when needed, to glucose energy, by a localized process called glycogenesis. Our daily habits, and training, both physical training and mental, determine the amount of stored glycogen in our cells. When there is a daily strain from stress that we are not trained to handle, or are physically and mentally incapable of handling, there is too much alpha-amylase secreted that is not utilized, and will show up on the saliva tests.

Cortisol is a steroid hormone produced by the adrenal gland, or top of the kidneys, and is well known to be released in the body in acute response to stress, but is also useful in the body to increase blood sugar, stimulate gluconeogenesis in the brain, suppress immune inflammatory responses that are in excess, and aid in fat, protein and carbohydrate metabolism. Because of the wide array of immediate effects of cortisol, there are a number of pharmaceutical analogs used extensively in medicine. The levels of cortisol in the body are tightly regulated, with the hypothalamus-pituitary-adrenal axis controlling the levels, which normally follow a diurnal pattern, with less cortisol during sleep and more during the active portion of the day. When cortisol levels do not change quickly enough to provide a good response to stress, we generally say that the patient has a adrenal deficiency syndrome. Slow cortisol response that is chronic will create a feeling of daytime fatique and insomnia, and have quite a depressing affect on the thyroid function. To adequately assess cortisol levels, first a waking cortisol level is measured, usually with active metabolites in the saliva. If this is off, a diurnal cortisol panel is taken, with 4 samples space throughout the day and night. Other related adrenal hormones, steroid hormones, thyroid hormones, and cortisol binding globulin, are usually measured as well to produce a thorough analysis and diagnosis. The production of cortisol in the adrenal gland involves a series of precursors, cholesterol, pregnenelone, and progesterone, and deficiencies of these may decrease adrenal cortisol responses, as well as a problem with hydroxylase enzymes, or the aldosterone metabolism and feedback. Using a pharmaceutical cortisol analoque may also damage the natural cortisol response in the body, and hypothyroid conditions will, of course, affect the metabolic rate of cortisol production.

Many studied factors are well known to stimulate increased cortisol responses, including stimulants like caffeine, sleep deprivation, intense exercise, high mental stress, anxiety, anorexia, and long commuting. Oral contraceptives increase cortisol levels even in young women that exercise regularly. Patients with excess body fat may generate excess cortisol in these fatty tissues. Postmenopausal estrogen deficiency is highly linked to increased cortisol, or unhealthy changes in diurnal cortisol response. Many therapeutic measures have been studied and are shown to decrease excess cortisol levels, including acupuncture, massage therapy, stress reduction therapies, omega-3 fatty acids, magnesium, etc. The best long-term benefit, though, will come from a balancing of the endocrine system, with a holistic and comprehensive restoration of physiologically normal steroid hormone levels, thyroid and hypothalamic function, and adrenal function. A knowledgeable Licensed Acupuncturist and herbalist can prescribe inexpensive lab tests and analysis, and use a complete protocol to restore this homeostasis in a step-by-step process.

IgA (immunoglobulin A) and lysozyme have also been identified as biomarkers of stress. These metabolites are measurable in simple inexpensive salivary metabolite tests as well. While these biomarkers are not as clearly associated with stress disorders, they also provide additional information that the physicians of the future can assess and help guide therapy. Not all patients with high stress will test positive, and some patients may have other reasons in their health history for the high levels seen on tests. These facts do not rule out the usefulness of such biomarkers. Instead, a complete profile should be performed with individualized assessment. In standard medicine, there is much resistance to this strategy, as standard medical doctors have been convinced that they must use tests that are universally applicable in order to utilize drug therapies that are universally applicable. The difference in basic approach is becoming very clear to the patient population in recent years, and patients who respect the logic of the individualized comprehensive assessment and holistic integrated approaches in medicine are increasingly choosing to utilize Complementary and Integrative Medicine.

Other biomarkers now utilized in the analysis of stress related pathologies include reserved B lymphcytes, the C3 subunit of the complement system, various cytokines of the complement system, and the imbalance of helper T-cell responses. Of course, each individual patient may present a different array of these various biomarkers, and the baseline values of each individual may be somewhat different. This lack of universality of stress biomarkers has led to an easy skepticism over the years, as standard biomedical research is looking for factors that can be applied universally to make a universally applied pharmaceutical realstic. The truth is that various biomarkers of disease must be analyzed on an individual basis, and the sum total of a variety of objective values in laboratory analysis must be applied to the signs and symptom patterns of the individual patient. With this approach, a clear set of treatment protocols may be individually tailored to each patient, vastly improving the potential treatment outcomes. A number of modern laboratories are now offering such an approach.

To objectively assess that imbalances associated with chronic metabolic stress, simple saliva and veinous bloodstick testing is now readily available and highly accurate. Years of research and testing have resulted in the laboratory experts refining these tests and proving accuracy. Laboratories such as ZRT (Zava Research Technology) in Portland, Oregon, now provide much information to both patients and physicians to insure trust in these laboratroy assessments, the science involved, and the professional assessments that are individualized to the patient. These tools now enable the Complementary Medicine physician to utilize modern objective laboratory values and biomarkers to enhance and individualize the treatment of stress related disease and disorder. These tests also help the patient and physician understand what can be done to prevent an unwanted acceleration of the aging process, and to prevent diseases related to aging.

Acupuncture and Stress Reduction: Scientific proof

Numerous studies in recent years are proving how acupuncture reduces stress, both physiological (metabolic) and psychological. It has been well known that acupuncture is a good treatment for stress reduction for many years, but proving this in studies proved complicated. A number of human studies cited below show how acupuncture, even in simple and uniform choice of needle sites without stimulation, provided changes in the key biomarkers of stress, cortisol and IgA. The effects of an array of integrated treatments in Traditional Chinese Medicine (TCM), or the Acupuncture scope, may address a variety of underlying causes of stress dysfunction, though, that greatly exceeds these effects seen from needle therapy. When the stress is analyzed from a holistic and individualized perspective, the puzzle of what is causing the metabolic, physical or psychoemotional stress can be solved, and treatment individually tailored to both resolving symptoms and treating the causes of the disorder. By combining an array of treatment protocols in a single course of treatment, such as acupuncture, Tui na soft tissue mobilization, herbal and nutrient medicines, the effects will be greatly enhanced. The individualized choices in this protocol cannot be achieved by just buying a product off the shelf, and utilization of a knowledgeable Licensed Acupuncturist and herbalist with these varied skills is essential to achieve a great outcome.

In 2015, experts at the Georgetown University Medical Center, in Washington D.C. U.S.A. conducted randomized controlled studies of the effects of electroacupuncture at just a single point, ST36, and concluded that the rise in adrenal corticosterone and ACTH induced by stress was prevented with a treatment of frequent electroacupuncture treatments at just one point, ST36, in a 10-day course, and that these effects were observed to continue for at least 4 days after the acupuncture stimulation was stopped. Some of the control groups received an adrenal glucocorticoid (adrenaline) block with the drug RU-486 to confirm that the acupuncture treatment worked with effects in the central nervous system, and this was confirmed. To see this study, just click here: http://www.ncbi.nlm.nih.gov/pubmed/26196540 . Of course, this is just a small preliminary study of a single acupuncture point stimulation for a very short course, but there are now a great number of such studies that confirm such measurable benefits, and virtually no studies that deny that these beneficial effects do not take place with acupuncture. Our present medical trial system is not set up to fund and conduct the types of tests that would measure the actual clinical holistic and individualized treatment in TCM care in a large number of human volunteers, as this is the realm of the trillion dollar drug industry, set up to primarily test safety, not efficacy. A new medical study system being proposed, the Big Data approach, will provide a quantum set of data, a virtual 'cloud' of scientific findings, that will combine such proof as this with all of the other data to arrive at scientific conclusions. We will see from this that CIM/TCM provides valuable adjunct care to treat and prevent all types of stress and keep us healthier. Integrating short courses of acupuncture, herbal and nutrient medicine, and even deep soft tissue mobilization, will provide benefits in management of stress that standard medicine cannot provide, and these are measurable and proven.

Standard medicine, with its allopathic approaches, does not provide this healthy outcome with adaptation to stress. While the approach in modern pharmaceutical medicine is to block production of these stress related chemical factors when there is a clear association with disease, this is often a very problematic approach. If the patient is found to have high morning cortisol, or high alpha-amylase in saliva, simply blocking the production of cortisol and alpha-amylase will not really restore health. Acupuncture may modulate these chemicals in the body by restoring homeostatic mechanisms to better health, something that the current pharmaceutical approaches have not really tried to accomplish. This doesn't mean that there is no place for pharmaceuticals in the treatment of stress related pathology, just that it not a question of either / or, but a question of how best to design a treatment protocol that integrates various approaches to achieve the ultimate patient outcome. Traditional Chinese Medicine (CIM/TCM) is the benchmark for holistic medical care, and has utilized this approach for centuries, with modern research now guiding its use as well. Many patients today are realizing the sound efficacy of Traditional Chinese Medicine and this holistic restorative approach, and coming to realize that the bias against this type of approach and therapy has not been one of patient concern, but of economic self-interest in the medical community.

Herbal and Nutrient Medicine in Stress Reduction: Scientific proof

A significant part of the practice of the Acupuncture profession, or Traditional Chinese Medicine, involves integrating acupuncture needle stimulation with herbal formulas and nutrient medicine. Much research has come to light in the last few years concerning the amazing efficacy of utilizing specific herbal and nutrient chemicals in treating specific stress related disorders. This type of research is now proceeding with a greatly accelerated advance in the number, size and complexity of studies. Dr. Dean Ornish, of the University of San Francisco, is now becoming well known for his years of research showing how healthy diet and lifestyle choices, as well as specific nutrient medicines, may dramatically decrease physiological stress and promote a healthy homeostasis. The results of such research clearly show how these benefits may treat chronic disease and cancer, as well as contribute to health aging, or longevity. While the whole array of this research is too big to present here, some samples will help you to realize the incredible benefits of herbal and nutrient medicine when applied with knowledge and skill. Many other scientific studies have shown how specific acupuncture stimulation and herbal extracts are proven to reduce a variety of effects of stress, and also work by normalizing stress hormones in the adrenal-hypothalamus axis. An intelligent holistic protocol that is individualized to counter stress, combining acupuncture, herbal medicine and nutrient medicine, is able to provide the most effective outcomes.

Most of the population still does not understand the science of nutritional medicine. The general notion is still stuck in the past, with an idea that nutritional deficiencies occur with poor diet and a general supplementation with a multivitamin will probably fix all of these problems. While this is part of the story, it is a small part, and may be relegated to research from about 70 years ago. Most studies in recent years have clearly demonstrated how simple supplementation with multivitamins and mineral complexes do little to resolve health problems. Modern research reveals that specific nutrient chemicals may play an important role in specific physiological mechanisms, and are becoming an important part of integrated approaches even in standard medicine today. Professional prescription of herbal and nutrient medicine, based on sound research, is the key to success. This is where Complementary and Integrative Medicine (CIM/TCM), and utilization of the Licensed acupuncturist and herbalist, or the Naturopathic physician, comes into play. Of course, the adoption of a legal mandate for coverage of Complementary Medicine by governmental health organizations and private insurance companies in Europe greatly accelerated the adoption of these protocols in European standard practice, and such mandates are needed in the United States as well, for the public good.

One good example of nutrient medicine in stress related pathology is a 2006 randomized and double-blinded clinical trial of glutamine, an amino acid, in the treatment of post-surgical patients at intensive care units (quite a stress) at 16 hospitals in France, conducted by Rouen University Hospital. The study found that supplementation with glutamine in IV nutritional fluid (parenteral) greatly improved clinical outcomes. The randomized groups (but with similar types and severity of injuries) had drastically different outcomes of complications of infection, pneumonia, survival time, hyperglycemia, and insulin-requiring patient status. Most of these measured outcomes showed improvement of 20-80% with the inclusion of glutamine (see link to the study below). Such a study shows how this amino acid could be applied in standard clinical practice as well, with a more comprehensive treatment and preventive protocol.

Oxidative stress is the key word that comes up in most studies of metabolic stress and disease mechanisms. Oxidative stress can be defined as the imbalance of oxidative tissue clearing need versus the ability of the body to clear the oxidative free radicals that accumulate in this process. When the body is faced with tissue degeneration, inflammatory injury, cancerous growths, etc. there is a need to clear the old tissues and cells and replace them with new healthy growth. Breaking down these unhealthy tissues and cells, and cellular components, is accomplished mainly via the oxidative metabolism, where oxygen compounds react with these tissues, cells and cellular components in a way that breaks them down to smaller components and allows the body to circulate them away. Hydrogen peroxide is an example of a common oxidative molecule that we are all familiar with. Unfortunately, if the body's capacity for clearing the debris and utilizing these oxygen radicals is less than optimal, this process can lead to damaging oxidative stress. Antioxidants are a broad class of herbal and nutrient chemicals that help our bodies achieve this clearing of oxidative free radical accumulation, and reduce this type of metabolic physiological stress. An enormous amount of research has shown the amazing array of antioxidant effects in herbal medicine as well as nutrient medicine.

The most intriguing arena of anti-stress research concerns the class of herbs called adaptogenic. This term implies that an array of synergistic chemicals in the plant helps the organism to adapt to a broad array of stressors. Much research in Russia confirmed that an array of Chinese herbs did achieve remarkable adaptogenic effects in the the 1980s, including Siberian ginseng (Eleutherococcus or Acanthopanax senticosus), Rhodiola rosea, Ginseng and Withania senticosus. A large number of studies across the world confirmed these effects, yet human clinical trial study design is difficult to confirm specific effects, basically because these effects are not specific, and are variable because they help adapt individual systems to stress by improving individual homeostatic mechanisms. Nevertheless, specific chemicals in these herbs are proven to effect various stress-related pathways, modulation of stress hormones, provide significant antioxidant effects, and work synergistically to relieve stress-induced fatigue, both physical and mental. Further research is showing that combinations of these herbs in formula, and combination of these herbs with probiotics, pharmaceuticals and nutrient chemicals, achieve even greater effects. Some of this research is provided below in Information Resources and Links to Scientific Studies.

Information Resources and Links to Scientific Studies

  1. The Centres for Study of Human Stress provides a good definition of stress, the history of the term, and many intelligent resources: http://www.humanstress.ca/stress/what-is-stress/history-of-stress.html
  2. Many researchers have hypothesized in the past that stress related disorders were the subject of socioeconomic problems instead of physiological problems endemic to the population. This study, in 2005, at Princeton University and the University of Michigan, found that key biomarkers of chronic stress, especially basal cortisol levels, had no significant correlation with socioeconomic status: http:/www.ncbi.nlm.nih.gov/pmc/articles/PMC2566242/
  3. A 1999 study of stress biomarkers found that IgA and Lysozyme enzymes were higher in a significant percentage of subjects testing high on stress scales: http://journals.lww.com/joem/Abstract/1999/10000/Are_Salivary_Immunoglobulin_A_and_Lysozyme.13.aspx/
  4. Genetic assessment has also been introduced into the arena of biomarkers of stress, with telomere shortening being an accurate biomarker of stress as well as aging in the body: http://ouroboros.wordpress.com/2006/08/23/telomere-length-as-a-biomarker-of-stress-and-aging/
  5. Elizabeth Blackburn PhD, a research scientist and cell biologist at the University of California San Francisco, won the Nobel Prize with two other prominent researchers from Harvard and Johns Hopkins in 2009. She is continuing to prove the a healthy diet and lifestyle may do more than pharmaceuticals and surgery to prevent the degradation of the chromosome ends, or telomeres, preventing and treating early stage cancers, and preventing a host of diseases, as well as adverse effects of aging: http://ucsfchancellor.ucsf.edu/priorities/new-science-stress-can-we-turn-back-biological-clock
  6. A 2004 paper presented to the National Academy of Sciences of the United States of America (PNA) by Elizabeth H. Blackburn, Elissa S. Epel, Jui Lin, et al, demonstrated that there was significant proof at that time that women with the highest levels of biological stress have DNA chromosome telomeres significantly shorter than average, leading to the shortening of life by an entire decade. A holistic approach, integrating Complementary Medicine, is needed to decrease biological stress and reverse telomere shortening, reduce excess oxidative stress, and improve the health of peripheral blood mononuclear cells: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC534658/?rendertype=abstract
  7. A 2015 large cohort study at the University of Linkoping, in Sweden, clearly showed that psychosocial stress in childhood was one of the key factors that raise risk of developing Diabetes type 1, a metabolic and autoimmune disorder: http://www.researchgate.net/publication/8053889_Psychological_stress_may_induce_diabetes-related_autoimmunity_in_infancy
  8. The response to stress is often complex and beneficial, showing that a healthy ability to adapt is the key to prevention of stress-related disease. Here, experts at the University of Washington, in Seattle, Washington, U.S.A. and the Howard Hughes Medical Institute, in Cincinnati, Ohio, U.S.A. showed in 2015 that the response to cardiac stress involved more growth to the heart muscle to protect it, and the pathways involved an enzyme called TAK1 (transforming growth factor kinase), via the calcineurin-NFAT and the IKK-NFkbeta crosstalk, which activate the T cells and nuclear factors in cells to stimulate a cascade of responses. The ability to adapt and respond to stress may be more important than the elimination of stress: http://www.ncbi.nlm.nih.gov/pubmed/26564789
  9. A 2015 study at the Federal University of Rio de Janeiro, and the University of Sao Paolo, in Brazil, showed that acupuncture stimulation could help with adaptation to stress by modulating the stress responses. Here, the acupuncture shifted the response to startle in horses from the sympathetic to the parasympathetic responses, and balanced that vagal-autonomic response to this stress: http://www.ncbi.nlm.nih.gov/pubmed/26413116
  10. A 2014 study at Stanford University, in Palo Alto, California, U.S.A. showed that acupuncture stimulation could reduce physiological stress or improve adaption to stress over time as measured by heart rate variability: http://www.ncbi.nlm.nih.gov/pubmed/25352944
  11. Scientific study explains how a type of Siberian ginseng (Eleutherococcus senticosus, or Ci wu jia) aids decreases in fatigue as well as caffeine with enhancement of normal healthy biological processes. Use of a Siberian ginseng tincture could provide a much healthier alternative to energy drinks and coffee: http://www.sciencedirect.com
  12. Scientific study at the University of Tsukuba, Japan, in 2010, found that acupuncture attenuated decrease in salivary IgA, a biomarker of stress, that was induced by heavy exercise: http://www.ncbi.nlm.nih.gov/pubmed/20351374
  13. Scientific study published in the 2013 Journal of Endocrinology by researchers at Georgetown University, Washington DC, found that electroacupuncture at a single point, ST36, could block stress-induced rises in hormonal elevations in the adrenal-hypothalamic endocrine axis, as well as stress-induced rises in sympathetic nervous system peptides, without affecting normal neurohormonal levels: http://www.ncbi.nlm.nih.gov/pubmed/23386059
  14. Another study of the effects of electroacupuncture on the ST36 point, at Georgetown University, by the School of Nursing, showed that a course of this stimulation on laboratory animals, in a randomized controlled trial, achieved normalization of cortisol levels (stress hormone) in animals with induced stress, bringing these levels to that of normal control animals. This effect was blocked when a chemical was used to inhibit the cortisone and ACTH receptors, RU-486, showing that the acupuncture effects modulated that hypothalamus adrenal axis. These adaptogenic effects were seen 4 days after the course of acupuncture stopped, even though the animals continued to be subjected to stress: http://www.ncbi.nlm.nih.gov/pubmed/26196540
  15. A 2014 randomized controlled study of the use of electroacupuncture stimulation during surgery, at the Tianjin Medical University, in Tianjin, China, found that electroacupuncture at the points ST36 and SP6, combined with standard anesthesia, mitigated the adrenal cortical inhibition induced by anesthesia and improved levels of cortisol and ACTH during the surgery: http://www.ncbi.nlm.nih.gov/pubmed/24621826
  16. Scientific study in 2013 at the University of Manitoba, Canada, found in a controlled randomized human clinical trial, that acupuncture exerted local, as well as systemic, effects on the sympathetic nervous system, showing localized increase from baseline in healthy patients that were physically stressed of blood circulation and tissue perfusion, as well as skin conductance, and decrease in skin temperature. The modulatory changes ranged from 98 to 146 percent, proving the local circulatory effects of acupuncture stimulation: http://www.ncbi.nlm.nih.gov/pubmed/23376998
  17. Scientific study in 2010 at the Institute of Biomedical Research at the Pontifical Catholic University of Rio Grande do Sul, in Brazil, concluded that acupuncture was efficient in attenuating psychological stress in elderly patients, as well as improving immune function: http://www.ncbi.nlm.nih.gov/pubmed/20709154
  18. Scientific study has also measured the effects of acupuncture stimulation on the brain and increased athletic endurance, as this study in 2002 from the Research Institute of Sports Science in Seoul, South Korea demonstrates: http://www.sciencedirect.com/8
  19. A 2014 randomized controlled study at the Federal University of Ceara, in Brazil, showed that electroacupuncture stimulation with a varied 2/100 Hz stimulation reduced oxidative stress and attenuated the inflammatory responses in laboratory animals with induced stress: http://www.ncbi.nlm.nih.gov/pubmed/25054876
  20. By 1999, study of adaptogenic herbs and herbal chemicals produced much evidence of effectiveness, but difficulty in designing studies that took into grant the whole array of factors that would need to be studied to define effects that countered stress, a nonspecific array of health factors that pushed the homeostatic potential to protect the organism to its limits. This 1999 study at the Seth GS Medical College, in Mumbai, India, acknowledges that much study over the entire world has confirmed that adaptogenic potential of Eleutherococcus senticosus (Siberian ginseng), Rhodioloa rosea (Hong jin tian), Withania somnifera (Ashwaghanda), Panax ginseng (Ren shen), Ocimum sanctum (Holy basil), and Raponticum carthamoides (Lour lu). Here, more Ayurvedic herbs are studied with a design to consider the more holistic responses. Tinospora cordifolia (Kuan jin teng) was found to reverse the stress on the gastrointestinal system induced by the chemotherapy drug cysplatin, and the toxin carbon tetrachloride (refrigerant and cleaning solvent), with modulation of immune effects and gastric function. The chemicals in this herb acted synergistically with the human immune responses. Further studies have found that the herb also has an effect to help genotypic adaptation, or the ability of the individual gene type, or epigenetic expression, to adapt to health problems, a more long term benefit: http://www.ncbi.nlm.nih.gov/pubmed/10404532
  21. A 2010 randomized controlled human clinical trial of an adaptogenic herbal formula that consisted of Eleutherococcus senticosus (Ci wu jia), Rhodioloa rosea (Hong jin tian), and Schisandra chinensis (Gou qi zi) found that a single dose did in fact improve cognitive function in attention, cognitive speed, and accuracy in testing during stressful exams: http://www.ncbi.nlm.nih.gov/pubmed/20374974
  22. A 2009 study of these adaptogenic herbs on physical stress and fatigue, at the Swedish Herbal Institute and Development center, in Askioster, Sweden, found that Rhodiola rosea extract achieved these adaptogenic effects via specific biochemical mechanisms that included modulation of c-Jun protein kinase on cortisol and nitric oxide: http://www.ncbi.nlm.nih.gov/pubmed/19500070
  23. A 2014 study at the Indian Institute of Technology, in Varanasi, India, found that the Chinese herb Andrographis paniculata (Chuan xin lian), and the active chemical andrographolide, modulated an array of stress markers in laboratory animals, especially immune and endocrine markers of stress-induced pathologies: http://www.ncbi.nlm.nih.gov/pubmed/25035059
  24. A 2013 study at the Central South University School of Medicine, in Changsha, China, showed how the Chinese herb Tribulus terrestris (Ci ji li) could reverse pathological markers of stress induced in laboratory animals that are associated with mild chronic depression and anxiety: http://www.ncbi.nlm.nih.gov/pubmed/23789222
  25. A 2011 study of the adatpogenic herb Eleutherococcus senticosus (Ci wu jia), or Acanthopanax senticosus, called Siberian ginseng, by the Second Military Medical University, of Shanghai, China, found that this herb contained a large number of benefiicial chemicals, with studied activities confirming anti-stress, anti-radiation, anticancer, anti-inflammatory and liver protective effects: http://www.ncbi.nlm.nih.gov/pubmed/21434569
  26. A 2015 study by the Slovak Academy of Sciences, in Kosice, Slovakia, found that a combination of a new probiotic strain AL-41 (Enterococcus faecium) and an extract of Eleutherococcus senticosus (Siberian ginseng) effectively reduced pathogenic overgrowth of bacteria types in the gut and promoted weight gain in laboratory animals. Such study shows the potential for more holistic treatment protocols: http://www.ncbi.nlm.nih.gov/pubmed/26354790
  27. A 2006 randomized double-blinded study in France, at 16 hospital intensive care surgical units, conducted by Rouen University Hospital, found that the amino acide glutamine reduced post-surgical complications dramatically in these stressful conditions: http://www.ncbi.nlm.nih.gov/pubmed/16505644
  28. A 2014 study at the Institute of Pediatric Endocrinology in Montpelier, France, found that a comprehensive treatment protocol with TCM actually modulated estrogen metabolism and balanced the effects of estrogen receptor types to resolve stress-induced stunted growth in a child. Such study cannot be realistically be applied to large randomized controlled human clinical trials, as the treatment parameters are individualized and complex, but such study demonstrates clearly the benefits of Traditional Chinese Medicine clinically, with acupuncture, pediatric Tui na, and gentle herbal and nutrient medicines acting synergistically to achieve amazing results: http://www.ncbi.nlm.nih.gov/pubmed/25300391
  29. A 2015 study at the National Academy of Sciences of Belarus demonstrated that plant chemicals called Brassinosteroids, derived from campesterol, do exert significant hormonal activity and modulation in humans, including adaptogenic reactions to treat or prevent adverse effects of stress of various types. Campesterol is found in the Chinese herbs Shu di huang, Mu dan pi, Huang Bai, as well as herbs such as Lychnis viscaria, Aegle marmelos Correa, Annona cherimola, and Evening primrose (Oenothera biennis), as well as foods such as buckwheat in small amounts. Such study demonstrates that aid in a more holistic protocol from common Chinese herbal formulas, as well as the potential for using higher dosage of the single herbs, or isolated active chemicals in a higher concentration to provide aid in adapting to various types of stress:http://www.ars-grin.gov/cgi-bin/duke/highchem.pl