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Stress and supplement

To finish my report on stress, I talk to you in this blog about supplements commonly used for stress management and which are the subject of scientific studies. That said, as I tell my patients: supplementation is a temporary help. It should be taken on an occasional basis, allowing you time to make lasting changes to manage your stress in the long term. Supplements should be seen as one of your tools (and not the only one) to build a calmer version of yourself 😎. Other crucial tools to consider include:


• A more balanced dietary regimen (Mediterranean/anti-inflammatory type) with occasional indulgences.


• Sufficiently long nights of sleep (7 to 8 hours per night).


• Regular physical activity.


• A healthy microbiome (fiber, kefir, fermented foods, short-chain fatty acids, bile acid balance, polyphenols).


Also, consider activities that rebalance the sympathetic and parasympathetic autonomic nervous system. Stress is often associated with an overstimulation of the sympathetic nervous system (the body is in warrior mode) to the detriment of the parasympathetic nervous system (which soothes). It is important to engage in gentle exercises (yoga, pilates, stretching...), meditation, outdoor walks, hypnosis, as well as laughter, dancing, hugging, and lovemaking.


One last piece of advice before presenting my (non-exhaustive) list of supplements: never supplement without the guidance of a professional! Whether they are vitamins, minerals, or herbs, these are bioactive compounds that have effects on your health (after all, why else would we use them 😜). Improper supplementation, incorrect dosages, and/or poor quality (due to flawed extraction methods, questionable traceability, suboptimal absorption, drug interactions...) can have a detrimental impact on your health (and your wallet as well).



Magnesium

I'll start with magnesium, which is widely recognized in the management of stress. But it's also one of the supplements where I note the most inconsistency! What a shame when we know that most of the population is deficient in magnesium, especially people under stress. Indeed, since magnesium is a key cofactor in many metabolic reactions (energy production, neurotransmitter synthesis...), it's easy to understand why the needs increase in cases of acute or chronic stress (see September blog "a stress-free back-to-school"). Furthermore, in cases of chronic stress (for metabolic reasons that I'll spare you), an increase in urinary magnesium excretion is observed, leading to increased magnesium requirements. I would like to draw your attention to the fact that different magnesium salts are absorbed to varying degrees, so you should choose the right ones, such as bisglycinate, glycerophosphate, or magnesium citrate. Also, magnesium absorption is dose-dependent (it depends on the magnesium concentration in the intestine). The higher the dosage, the less it will be absorbed... so taking 3 magnesium capsules, hoping to triple the effectiveness, is not a good idea 😊. Other factors can influence magnesium absorption, such as:


• Alcohol

• Saturated fats

• Excessive dietary fiber

• Phytic acid

• Calcium

• Phosphorus

• Alkalinity


So, even though it's best to take magnesium during meals, make sure your meal is not too alcoholic and/or rich in saturated fats. Also, be cautious with dietary supplements that combine magnesium and calcium. Finally, if you take PPIs for gastric acidity (whose role is to alkalinize), you may absorb magnesium less effectively.



Taurine


Taurine is a sulfur-containing amino acid derived from cysteine, synthesized in the body. It is involved in the regulation of the central nervous system. It is considered an inhibitory neurotransmitter with effects similar to GABA, another neurotransmitter that I will discuss later. Taurine is also involved in the formation of bile salts because it is one of the compounds used in the conjugation step of detoxification processes. Taurine also plays a role as an antioxidant, anti-inflammatory agent, and an insulin sensitizer (improves glucose metabolism through its action on insulin).


 

There is a synergy of action between taurine and magnesium, making their combination very effective.

 

Group-B Vitamins

These vitamins are essential as they act as cofactors in many metabolic reactions, especially in energy production and neurotransmitter formation. B-group vitamins are naturally abundant in brewer's yeast. You can find it in organic stores in the form of small flakes that you can add to your salads or yogurt (but be careful not to overdo it, as excess is the enemy of good).



Omega-3

Omega-3 fatty acids have shown anxiolytic effects, but the mechanisms of action are still being elucidated. It has been clearly established that patients with depression and anxiety have lower levels of omega-3. Several hypotheses are discussed:


• The effect of DHA (one of the omega-3s, with EPA being the other) on specific receptors that allow the modulation of the expression of certain genes.

• Protection against neuronal inflammation (neuroinflammation) associated with stress.

• Regulation of the endocannabinoid system.

• Regulation of the hypothalamo-pituitary-adrenal axis or HPA axis (see September 2023 blog).


Regarding omega-3 intake, it's always better to obtain them through diet by consuming fatty fish twice a week, using oils rich in omega-3 (canola, walnut, or flaxseed), or munching on seeds (chia, pumpkin, or flax). If you have trouble meeting your omega-3 intake, opt for krill capsules or omega-3 supplements with added antioxidants (vitamin E, astaxanthin) to prevent oxidation.


GABA and Serotonin

GABA is an inhibitory neurotransmitter that counteracts the overstimulation of neurons that can occur during stress. It is particularly recommended in cases of excessive rumination, especially at bedtime. It is synthesized by the body in the brain from glutamate, an amino acid found in protein-rich foods (meat, fish, eggs, dairy products, tofu) and requires vitamin B6 and magnesium as cofactors. It is also naturally present in GABAlong tea (also known as oolong tea or garabon tea), astragalus, and in small quantities in chestnuts, potatoes, and rice. Due to its inhibitory effect in the brain, it is also used in epilepsy treatment. Still under study but promising: a bacterium called Lactobacillus rhamnosus directly influences GABA activity in the brain. I'll delve into this in more detail in the "psychobiotics" section.


It's worth noting that excess chlorine (detected by urinary tests) can disrupt GABA's action (GABA acts on chloride receptors). GABA supplementation will only be effective if you have a deficiency. To determine this, clinicians typically rely on questionnaires assessing symptoms because there aren't really any blood or urine tests to detect GABA deficiency.



Serotonin, another neurotransmitter strongly involved in stress management (see September 2023 blog). It is synthesized from tryptophan, an amino acid found in chicken, sesame seeds, cod, split peas, parmesan, gruyere, rabbit, turkey, eggs, steak, nuts... and requires iron, magnesium, and B-group vitamins as cofactors. The problem with serotonin synthesis is that it depends on certain gut bacteria and the availability of tryptophan. Even if the intake of tryptophan is sufficient, it is engaged in 4 different metabolic pathways: protein formation, serotonin formation, the kynurenine pathway, and the indoles and derivatives pathway. In cases of inflammation or dysbiosis, tryptophan can easily be diverted to the kynurenine pathway, which is associated with inflammation. For these reasons, when it comes to supplementation, I typically recommend 5-HTP (a metabolite naturally present in a plant, griffonia) as a direct precursor to serotonin, rather than tryptophan supplementation. Additionally, it's a good idea to optimize tryptophan intake through your diet while following an anti-inflammatory regimen.


Psychobiotics

In my opinion, they have a very promising future in the management of all anxiety, depressive disorders, and stress. Psychobiotics are probiotics that have shown a beneficial effect on the mental health of the host (the host being yourself). Not all mechanisms of action are understood, but studies reveal potential actions on the HPA axis, the production of neurohormones and neurotransmitters, inflammation, and immunity. Some strains of Lactobacillus, Bifidobacterium, Faecalibacterium prausnitzii, and the Clostridium butyricum strain have very promising effects.



Herbal medecine

Several plants have demonstrated their effectiveness, such as Ashwagandha (my favorite), passionflower, rhodiola, and saffron.


Ashwagandha or "Indian ginseng" is widely used in Ayurvedic medicine. It is an adaptogenic plant, meaning it contains pharmacological substances capable of inducing metabolic adaptation reactions to stress in the body. Studies in both humans and animals suggest that Ashwagandha's anti-stress and anxiolytic effects are due to its modulatory action on the HPA axis and metabolic pathways of GABA and serotonin. Personally, I frequently prescribe it to my patients.


Saffron is also a widely studied plant in the management of stress through phytotherapy. I recommend it more for serotonin deficiency and depressive states. The main bioactive compounds in saffron are crocin, crocetin, and safranal. Crocin acts by inhibiting the absorption of dopamine and norepinephrine, while safranal acts through serotonin. It is also attributed with significant antioxidant and anti-inflammatory effects. Several studies in mice and more recently in humans have shown that the dried stigmas and petals of C. sativus (aqueous and alcoholic extracts) have significant antidepressant effects. Unlike antidepressants, saffron has few side effects. However, it's essential to be cautious about these promising results: if you are currently taking antidepressants, do not switch from one to the other without discussing it with your doctor and seeking support.


Passionflower and rhodiola are two other plants used in herbal medicine. Personally, I do not use them because there is too little certainty based on scientific studies. Note that these two plants have interactions with certain medications and should not be taken blindly. Passionflower is said to have anxiolytic effects, but the problem is that there are hundreds of different passionflower species, and not all have been studied. The most commonly used in pharmacopoeia is Passiflora incarnata. Rhodiola (SHR-5 extract), on the other hand, is said to have effects on anxiety, stress resistance, and depression, especially by reducing cortisol levels and acting similarly to antidepressants.



 

Conclusion


There are many supplementation avenues to help reduce stress and its impacts on health. However, it is essential to view supplementation as a temporary help and not a one-size-fits-all solution. Sustainable changes in lifestyle and overall well-being are crucial for long-term stress management. In addition to supplements, it is imperative to maintain a balanced diet, prioritize adequate sleep, engage in regular physical activity, and promote a healthy gut microbiota. Additionally, activities aimed at restoring balance between the sympathetic and parasympathetic nervous systems, such as yoga, meditation and outdoor activities, play a significant role.


The supplements presented here, when used judiciously and as part of a holistic approach to health, can contribute to a more relaxed and balanced life. But I nevertheless insist on never undertaking supplementation without the guidance of a healthcare professional, as these bioactive compounds can affect your health and well-being. The right dosage, choosing the right supplement, and possible interactions with other medications must all be considered. All support must be personalized taking into account each person’s specific needs and individual circumstances.





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