The US Preventive Services Task Force, an independent, volunteer group of national experts, recently recommended annual screening for anxiety by a primary caregiver. Stress and anxiety are a common part of life and are our natural defenses against dangers. Acute stress or stress for short time such as having a deadline to meet or illness is perfectly normal. In contrast, chronic stress, or the stress happening repeatedly over a long time and resulting in anxiety can adversely affect health. Chronic stress and anxiety are known to cause sleeping disorders and health issues such as immune dysregulation, digestive problems, cardiovascular (heart) problems, and reproductive issues. Indeed, some of the common symptoms of chronic stress are excessive worry, loss of sleep, body ache, lack of energy, cloudy thinking, or lack of focus. If left unaddressed, chronic stress may lead to serious health issues such as high blood pressure, anxiety disorder, obesity, and metabolic syndrome, Type II diabetes, heart disease among other. To be clear these complex health issues do not suddenly appear one day after an acute stress episode but are the outcome of chronic stress over a long period of time. Prolonged stress also increases the risk of mental health problems including anxiety disorder and depression.
Given the constant encounters with unrelenting stressors in modern life, one needs to actively manage both acute and chronic stress. Simple lifestyle changes are often effective in managing stress. These changes include incorporating daily exercise (as simple as walking for 30 min), eating healthy, getting more sleep, and learning and practicing mindfulness among others. Of note, these lifestyle changes can be tailored and one should tailor them according to their need and time – it is not a “one size fits all” situation.
In the past decade, several herbs used in Ayurveda and other traditional medicine have also been shown to help reduce stress. The adaptogenic herbs such as Ashwagandha, Korean ginseng, and Brahmi have been extensively studied for their stress-reducing properties using animal models as well as clinical trials. While the debate is still on – these herbs appear to be safe and effective in reducing stress. For example, Ashwagandha supplementation in patients suffering from chronic stress was shown to significantly reduce chronic stress symptoms and cortisol levels (1). Similar effects of Ashwagandha supplementation were found in another more recent study (2). Ashwagandha supplementation significantly reduced the anxiety scores and cortisol levels suggesting potent anti-stress effects. Both of these studies also monitored for any adverse events in the patient but none was found indicating Ashwagandha supplementation was safe. Interestingly study (2)suggests that stress-relieving effects of Ashwagandha likely occur via the hypothalamus-pituitary-adrenal (HPA) axis. Dysregulation of the HPA axis, particularly stress hormones glucocorticoid and cortisol is known to play an important role in chronic stress and associated health problems. Ashwagandha’s positive effect on the HPA axis and resulting stress reduction may also help with anxiety as the HPA axis is also directly linked to anxiety disorders (3).
References.
1. Chandrasekhar K, Kapoor J, Anishetty S. 2012. A Prospective, Randomized Double-Blind, Placebo-Controlled Study of Safety and Efficacy of a High-Concentration Full-Spectrum Extract of Ashwagandha Root in Reducing Stress and Anxiety in Adults. Indian Journal of Psychological Medicine 34:255-262.
2. Lopresti AL, Smith SJ, Malvi H, Kodgule R. 2019. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine 98:e17186.
3. Faravelli C, Sauro CL, Godini L, Lelli L, Benni L, Pietrini F, Lazzeretti L, Talamba GA, Fioravanti G, Ricca V. 2012. Childhood stressful events, HPA axis and anxiety disorders. World journal of psychiatry 2:13.