Stress plays an important role in our patients’ lives. In fact, the American Psychological Association’s Stress in America survey reports that 63% of Americans consider the future of our nation to be a significant source of stress, 62% consider finances to be a major stressor, 61% are stressed about work, and 51% consider violence and crime to be major stressors. [1] As practitioners, our patients’ stress levels should be of concern to us, specifically because of the prevalence of chronic stress across all patient populations and because of stress’ effects on our patients’ immune systems and overall productivity. The fact is that we can initiate huge shifts in our patients’ wellbeing by helping them to modulate their stress levels. We can help our patients live their healthiest lives now by making simple, minimally invasive recommendations, such as incorporating exercise and intravenous vitamin and/or mineral therapy into their current treatment plans. By educating ourselves regarding these simple yet extremely beneficial recommendations, we can ensure that our patients not only survive, but also thrive.
How Does Stress Affect the Immune System?
The hypothalamic-pituitary-adrenal axis is the key player in the activation of the chronic arm of the stress response. When we are exposed to a chronic stressor, the hypothalamus releases corticotropin-releasing hormone (CRH), which then leads to the secretion of adrenocorticotropic releasing hormone (ACTH) from the anterior pituitary gland. Next, ACTH travels to the adrenal cortices where it stimulates the release of cortisol and other glucocorticoids.
As the most prominent glucocorticoid in the stress response activation process, cortisol also has an activating effect on the immune system; the stress response and the immune response tend to be activated together. Through negative feedback mechanisms, cortisol is instrumental in the deactivation of both the stress and immune responses, because it decreases the secretion of CRH, ACTH, and, as a result, cortisol, and it also “turns off” the immune response that it helps to initiate.
Because of this intimate connection that exists between the stress and immune responses, when our bodies are exposed to high levels of cortisol for extended periods of time (such as when we are experiencing chronic stress), the result is a suppressive effect on the immune system and increased susceptibility to infections. [2] As an example, one study demonstrated that individuals who reported chronic stress that lasted one month or longer were at significantly increased risk of coming down with the common cold when exposed to rhinovirus. [3] Thus, exposure to chronic stress suppresses our patients’ immune systems making them more susceptible to illness and this, of course, significantly reduces productivity.
Is Exercise a Relevant Lifestyle Recommendation for Stress Reduction?
As a means of modulating stress levels, exercise is a superb option. This is because exercise leads to the production and release of endorphins. Endorphins elevate the mood and promote feelings of relaxation. When recommending exercise to our patients for the purpose of stress reduction, however, there are a few things we must keep in mind.
What Type of Exercise Is Best for Stress Reduction?
When recommending exercise to our patients for stress reduction, we must keep in mind that sustained, high-intensity exercise can serve as a physical stressor and that physical stressors activate the stress response and lead to increased cortisol levels in a similar manner to psychosocial stressors. [4] Therefore, in the cases of highly stressed individuals, low-intensity exercise is preferred for stress reduction. In a relevant study, low-intensity exercise, defined as exercise involving a maximal oxygen uptake of 40%, led to a reduction in cortisol levels, whereas moderate- and high-intensity exercise (60% and 80%, respectively) led to increases in circulating cortisol levels. [5]
For our stressed patients who need to engage in moderate- to high-intensity exercise for other reasons, such as weight loss or athleticism, we should keep the following points in mind:
Engaging in these types of exercises later in the day when the natural diurnal rhythm of cortisol is at a lower point is preferable to doing so in the morning when cortisol is at its highest
When engaging in high-intensity exercise, keeping sessions short and prolonging rest periods (e.g. high-intensity interval training) is preferable to sustained, high-intensity training
What Effect Does Nutrient (Vitamin and/or Mineral) Therapy Have on Stress Levels?
Many vitamins and minerals have been demonstrated to help reduce stress and stress-related fatigue in our patients. This includes B vitamins, magnesium, and vitamin C, to name a few. For example, in a randomized, double-blind, placebo-controlled study, administration of a multivitamin consisting of high-dose B complex, vitamin C, magnesium, and other minerals resulted in significant improvements in participants’ mood, stress levels, and general health compared to the control group. [6]
A second study demonstrated that one month of magnesium supplementation led to a significant decrease in basal cortisol concentrations in participants. [7] We now know that this is partly because magnesium decreases the release of ACTH and modulates the adrenal cortices’ sensitivity to this hormone, thus reducing cortisol levels. [8] In a third study, intravenous vitamin C reduced participants’ stress-related fatigue two-hours post administration and the effect continued throughout the day. [9]
While some studies resort to oral nutrient administration, intravenous administration of these nutrients is preferable in many cases because it bypasses the digestion and absorption limitations that we see with oral administration. If you would like to learn how you can safely and effectively incorporate intravenous nutrient therapy into your practice, check out the IV Therapy Academy.
Winerman L. (2017) By the numbers: Our stressed-out nation. Monitor on Psychology, 48(11), 80.
Glaser R1, Kiecolt-Glaser JK. (2005) Stress-induced immune dysfunction: implications for health. Nature Reviews Immunology. 5(3), 243-251. doi: 10.1038/nri1571.
Stone AA, Bovbjerg DH, Neale JM, Napoli A, Valdimarsdottir H, Cox D, Hayden FG, Gwaltney JM Jr. (1992) Development of common cold symptoms following experimental rhinovirus infection is related to prior stressful life events. Journal of Behavioral Medicine. 18(3), 115-120.
Skoluda N, Dettenborn L, Stalder T, Kirschbaum C. (2012) Elevated hair cortisol concentrations in endurance athletes. Psychoneuroendocrinology. 37(5), 611-617. doi: 10.1016/j.psyneuen.2011.09.001.
Hill EE, Zack E, Battaglini C, Viru M, Viru A, Hackney AC. (2008). Exercise and circulating cortisol levels: the intensity threshold effect, Journal of Endocrinological Investigation, 31(7), 587-591.
Kennedy DO, Veasey R, Watson A, Dodd F, Jones E, Maggini S, Haskell CF. (2010). Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males. Psychopharmacology, 211(1), 55–68. doi:10.1007/s00213-010-1870-3
Zogović, D, Pešić V, Dmitrašinović G, Dajak M, Plećaš B, Batinić B, Popović D, Ignjatović S. (2014). Pituitary-Gonadal, Pituitary-Adrenocortic1al Hormones and IL-6 Levels Following Long-Term Magnesium Supplementation in Male Students, Journal of Medical Biochemistry, 33(3), 291-298. doi: 10.2478/jomb-2014-0016
Cuciureanu MD, Vink R. Magnesium and stress. In: Vink R, Nechifor M, editors. Magnesium in the Central Nervous System [Internet]. Adelaide (AU): University of Adelaide Press; 2011.Available from: https://www.ncbi.nlm.nih.gov/books/NBK507250/
Suh, S. Y., Bae, W. K., Ahn, H. Y., Choi, S. E., Jung, G. C., & Yeom, C. H. (2012). Intravenous vitamin C administration reduces fatigue in office workers: a double-blind randomized controlled trial. Nutrition journal, 11, 7. doi:10.1186/1475-2891-11-7