The Encyclopedia of Natural Medicine, 3rd Ed.

Stress Management



Stress is defined as any disturbance—for example, heat or cold, chemical toxin, microorganism, physical trauma, strong emotional reaction—that can trigger the “stress response.” How an individual handles stress plays a major role in determining his or her level of health. Comprehensive stress management involves a truly holistic approach designed to counteract the everyday stresses of life. Most often the stress response is so mild it goes entirely unnoticed. However, if stress is extreme, unusual, or long-lasting, the stress response can be overwhelming and becomes quite harmful to virtually every body system.

Before we discuss methods for helping to deal effectively with stress, it is important to understand the stress response. Ultimately, the success of any stress management program depends on its ability to improve an individual’s immediate and long-term responses to stress.

The General Adaptation Syndrome

The stress response is actually part of a larger response known as the general adaptation syndrome, a term coined by the pioneering stress researcher Hans Selye. The syndrome is composed of three phases: alarm, resistance, and exhaustion.1 These phases are largely controlled and regulated by the adrenal glands.

The initial response to stress is the alarm reaction, which is often referred to as the fight-or-flight response. The fight-or-flight response is triggered by activation of the sympathetic nervous system and ultimately the hypothalamic-pituitary-adrenal axis, which causes the adrenals to secrete adrenaline and other stress-related hormones.

The fight-or-flight response is designed to counteract danger by mobilizing the body’s resources for immediate physical activity. As a result, the heart rate and force of contraction increase to provide blood to areas necessary for response to the stressful situation. Blood is shunted away from the skin and internal organs, except the heart and lung, while the amount of blood supplying required oxygen and glucose to the muscles and brain is increased. The rate of breathing rises to supply necessary oxygen to the heart, brain, and working muscle. Sweat production increases to eliminate toxic compounds produced by the body and to lower body temperature. Production of digestive secretions is severely reduced because digestive activity is not critical for counteracting stress. Blood sugar levels rise dramatically as the liver converts stored glycogen into glucose for release into the bloodstream.

Although the alarm phase is usually short-lived, the next phase—the resistance reaction—allows the body to continue fighting a stressor long after the effects of the fight-or-flight response have worn off. Other hormones, such as cortisol and other corticosteroids secreted by the adrenal cortex, are largely responsible for the resistance reaction. For example, these hormones stimulate the conversion of protein to energy, so that the body has a large supply of energy long after glucose stores are depleted; the hormones also promote the retention of sodium to keep blood pressure elevated.

As well as providing the necessary energy and circulatory changes required to deal effectively with stress, the resistance reaction provides the changes required to handle an emotional crisis, perform strenuous tasks, and fight infection. The effects of adrenal cortex hormones are quite necessary when the body is faced with danger, but prolongation of the resistance reaction or continued stress increases the risk of significant disease (including diabetes, high blood pressure, and cancer) and results in the final stage of the general adaptation syndrome, exhaustion.

Exhaustion may be manifested as a partial or total collapse of a body function or specific organ. Two of the major causes of exhaustion are loss of potassium ions and depletion of adrenal glucocorticoid hormones like cortisone. Loss of potassium results in cellular dysfunction and, if severe, cell death. Adrenal glucocorticoid depletion diminishes glucose control, leading to hypoglycemia.

Another cause of exhaustion is weakening of the organs. Prolonged stress places a tremendous load not just on the adrenals but also on many other organ systems, especially the heart, blood vessels, and immune system, and is associated with many common diseases.

Diseases Strongly Linked to Stress



Autoimmune disease


Cardiovascular disease

Common cold


Diabetes (type 2)



Immune suppression

Irritable bowel syndrome

Menstrual irregularities

Premenstrual tension syndrome

Rheumatoid arthritis

Ulcerative colitis


Stress: A Healthy View

The father of modern stress research was Hans Selye. Having spent many years studying this subject, Selye developed valuable insights into the role of stress in disease. According to Selye, stress in itself should not be viewed in a negative context. It is not the stressor that determines the response; instead it is the individual’s internal reaction, which then triggers the response. This internal reaction is highly individualized. What one person may experience as stress, the next person may view entirely differently. Selye perhaps summarized his view best in the following passage from his book The Stress of Life:2

No one can live without experiencing some degree of stress all the time. You may think that only serious disease or intensive physical or mental injury can cause stress. This is false. Crossing a busy intersection, exposure to a draft, or even sheer joy are enough to activate the body’s stress mechanisms to some extent. Stress is not even necessarily bad for you; it is also the spice of life, for any emotion, any activity causes stress. But, of course, your system must be prepared to take it. The same stress which makes one person sick can be an invigorating experience for another.

The key statement Selye made may be “your system must be prepared to take it.” A significant body of knowledge has now accumulated on strategies to develop healthful, rather than disease-facilitating, responses to both short-term and long-term stress.

The Stress Scale

Evaluating the impact of stress on a person’s health status requires a complete clinical assessment (review of systems, medical history, physical exam, sleep history, etc.). Many people who are stressed out may not be able to identify exactly what is causing them to feel stressed. Typical presenting symptoms are insomnia, depression, fatigue, headache, upset stomach, digestive disturbances, and irritability.

One useful tool to assess the role that stress may play is the social readjustment rating scale developed by Holmes and Rahe (see below).3 The scale was originally designed to predict the risk of a serious disease due to stress. Various life-changing events are rated according to their potential to cause disease. Notice that even events commonly viewed as positive, such as an outstanding personal achievement, carry stress.

If a person is under a great deal of immediate stress or has endured a fair amount of stress for a few months or longer, it is appropriate to assess adrenal dysfunction more accurately with laboratory methods.

The standard interpretation of the social readjustment rating scale is that a total of 200 or more units in one year is considered to be predictive of a high likelihood of experiencing a serious disease. However, rather than using the scale solely to predict the likelihood of serious disease, anyone can use it to determine his or her level of stressor exposure, because everyone reacts differently to stressful events.

The Social Readjustment Rating Scale





Death of spouse






Marital separation



Jail term



Death of a close family member



Personal injury or illness






Fired at work



Marital reconciliation






Change in health of family member






Sex difficulties



Gain of a new family member



Business adjustment



Change in financial state



Death of a close friend



Change to different line of work



Change in number of arguments with spouse



Large mortgage



Foreclosure of mortgage or loan



Change in responsibilities at work



Son or daughter leaving home



Trouble with in-laws



Outstanding personal achievement



Spouse begins or stops work



Beginning or end of school



Change in living conditions



Revision of personal habits



Trouble with boss



Change in work hours or conditions



Change in residence



Change in schools



Change in recreation



Change in church activities



Change in social activities



Small mortgage



Change in sleeping habits



Change in number of family get-togethers



Change in eating habits









Minor violations of the law


Salivary Cortisol Levels

A popular assessment of the impact of stress is based on salivary levels of the stress hormone cortisol. Salivary cortisol levels are reproducible, comparable to plasma levels, and easy to assess.4,5 Salivary cortisol levels generally show a sharp rise when a person wakes up and during the first hour afterward. Generally, an initially overactive acute stress response results in elevated cortisol levels, but chronic stress, insomnia, or depression may blunt this effect.6,7

Another popular test is measuring salivary cortisol levels at awakening and in the evening, usually along with DHEA. The classic pattern associated with chronic stress is elevated cortisol combined with reduced DHEA, indicating a shift toward stress hormone production and away from sex hormone steroid production. This pattern is often associated with anxiety and depression. Adrenal exhaustion is characterized by low cortisol and low DHEA. Adrenal exhaustion is a common side effect of continual high stress as well as of steroid drugs such as prednisone, used in the treatment of allergic or inflammatory diseases.

Therapeutic Considerations

Whether you are aware of it or not, you have developed a pattern for coping with stress. Unfortunately, most people have found patterns and methods that ultimately do not support good health. Negative coping patterns must be identified and replaced with positive ways of coping. Try to identify any negative or destructive coping patterns listed below and replace those patterns with more positive measures for dealing with stress.

Stress management can be substantially improved by focusing on the following six equally important areas:

• Techniques to calm the mind, promote parasympathetic tone, and promote a positive mental attitude

• Lifestyle factors

• Exercise

• A healthful diet designed to nourish the body and support physiological processes

• Dietary and botanical supplements designed to support the body as a whole, but especially the adrenal glands

• Supervised stress management program

Negative Coping Patterns

Dependence on chemicals: legal and illicit drugs, alcohol, smoking


Too much television

Emotional outbursts

Feelings of helplessness


Excessive behavior

Calming the Mind and Body

Learning to calm the mind and body is extremely important in relieving stress. Among the easiest methods for the patient to learn are relaxation exercises. The goal of relaxation techniques is to produce a physiological response known as a relaxation response—a response that is exactly opposite to the stress response that reflects activation of the parasympathetic nervous system. Although an individual may relax by simply sleeping, watching television, or reading a book, relaxation techniques are designed specifically to produce the relaxation response.

The term relaxation response was coined by Harvard professor and cardiologist Herbert Benson in the early 1970s to describe a physiological response that he found in people who meditate.1 The relaxation response is just the opposite of the stress response. With the stress response, the sympathetic nervous system dominates. With the relaxation response, the parasympathetic nervous system dominates. The parasympathetic nervous system controls bodily functions such as digestion, breathing, and heart rate during periods of rest, relaxation, visualization, meditation, and sleep. Although the sympathetic nervous system is designed to protect against immediate danger, the parasympathetic system is designed for repair, maintenance, and restoration of the body.



The heart rate and force of contraction of the heart increase to provide blood to areas necessary for response to the stressful situation.

The heart rate is reduced and the heart beats more effectively. Blood pressure is reduced.

Blood is shunted away from the skin and internal organs, except the heart and lung, while the amount of blood supplying required oxygen and glucose to the muscles and brain is increased.

Blood is shunted toward internal organs, especially those organs involved in digestion.

The rate of breathing rises to supply necessary oxygen to the heart, brain, and exercising muscle.

The rate of breathing decreases as oxygen demand is reduced during periods of rest.

Sweat production increases to eliminate toxic compounds produced by the body and to lower body temperature.

Sweat production diminishes, because a person who is calm and relaxed does not experience nervous perspiration.

Production of digestive secretions is severely reduced because digestive activity is not critical to counteracting stress.

Production of digestive secretions is increased, greatly improving digestion.

Blood sugar levels rise dramatically as the liver dumps stored glucose into the bloodstream.

Blood sugar levels are maintained in the normal physiological range.

The relaxation response can be achieved through a variety of techniques. It doesn’t matter which technique you choose, because all have the same physiological effect—a state of deep relaxation. The most popular techniques are meditation, prayer, progressive relaxation, self-hypnosis, and biofeedback. To produce the desired long-term health benefits, use the relaxation technique for at least 5 to 10 minutes each day.


Producing deep relaxation with any technique requires learning how to breathe properly. One of the most powerful methods of producing less stress and more energy in the body is by breathing with the diaphragm. Diaphragmatic breathing activates the relaxation centers in the brain and the parasympathetic nervous system. Following is a technique for teaching diaphragmatic breathing.

Instructions for Diaphragmatic Breathing

1. Find a comfortable and quiet place to lie down or sit.

2. Place your feet slightly apart. Place one hand on your abdomen near your navel. Place the other hand on your chest.

3. You will be inhaling through your nose and exhaling through your mouth.

4. Concentrate on your breathing. Note which hand is rising and falling with each breath.

5. Gently exhale most of the air in your lungs.

6. Inhale while slowly counting to four. As you inhale, slightly extend your abdomen, causing it to rise about one inch. Make sure that you are not moving your chest or shoulders.

7. As you breathe in, imagine the warmed air flowing in. Imagine this warmth flowing to all parts of your body.

8. Pause for one second, then slowly exhale to a count of four. As you exhale, your abdomen should move inward.

9. As the air flows out, imagine all your tension and stress leaving your body.

10. Repeat the process until a sense of deep relaxation is achieved.

Progressive Relaxation

One of the most popular techniques for producing the relaxation response is progressive relaxation. The technique is based on a very simple procedure of comparing tension with relaxation. Many people are not aware of the sensation of relaxation. In progressive relaxation, an individual is taught what it feels like to relax by comparing relaxation with muscle tension.

The basic technique is to contract a muscle forcefully for a period of one to two seconds and then give way to a feeling of relaxation in that muscle. The procedure systematically goes through all the muscles of the body, progressively producing a deep state of relaxation. The procedure begins with contracting the muscles of the face and neck, then the upper arms and chest, followed by the lower arms and hands. The process is repeated progressively down the body, from the abdomen through the buttocks, the thighs, and the calves to the feet. This whole process is repeated two or three times. This technique is often used in the treatment of anxiety and insomnia.

Progressive relaxation, deep breathing, or some other stress reduction technique is an important component of a comprehensive stress management program.


A person’s lifestyle is a major determinant of his or her stress levels. In addition to those factors described in the chapter “A Health-Promoting Lifestyle,” two areas of concern are time management and relationship issues.

One of the biggest stressors for most people is time. They simply do not feel they have enough of it. Here are some tips on time management.

Tips for Improved Time Management

• Set priorities. Realize that you can accomplish only so much in a day. Decide what is important, and limit your efforts to that goal.

• Organize your day. There are always interruptions and unplanned demands on your time, but create a definite plan for the day on the basis of your priorities. Avoid the pitfall of always letting the immediate demands control your life.

• Delegate authority. Delegate as much authority and work as you can. You can’t do everything yourself. Learn to train and depend on others.

• Tackle tough jobs first. Handle the most important tasks first, while your energy levels are high. Leave the busywork or running around for later in the day.

• Minimize meeting time. Schedule meetings to bump up against the lunch hour or quitting time; that way they can’t last forever.

• Avoid putting things off. Work done under pressure of an unreasonable deadline often has to be redone. That creates more stress than if it had been done right the first time. Plan ahead.

• Don’t be a perfectionist. You can never really achieve perfection anyway. Do your best in a reasonable amount of time, then move on to other important tasks. If you find time, you can always come back later and polish the task some more. The old adage “The perfect is the enemy of the good” contains much wisdom.

Another major cause of stress for many people is interpersonal relationships. Interpersonal relationships can be divided into three major categories: marital, family, and job-related. The quality of any relationship ultimately comes down to the quality of the communication. Learning to communicate effectively goes a very long way toward reducing the stress and conflicts of interpersonal relationships. Here are seven tips for effective communication, regardless of the type of interpersonal relationship.

Keys to Improving Communication

• Learn to be a good listener. Allow the person you are communicating with to really share his or her feelings and thoughts uninterrupted. Empathize; put yourself in the other person’s shoes. If you first seek to understand, you will find yourself being better understood.

• Be an active listener. This means that you must be truly interested in what the other person is communicating. Listen to what he or she is saying instead of thinking about your response. Ask questions to gain more information or clarify what the other person is telling you. Good questions open lines of communication.

• Be a reflective listener. Restate or reflect back to the other person your interpretation of what he or she is telling you. This simple technique shows the other person that you are both listening to and understanding what he or she is saying. Restating what you think is being said may cause some short-term conflict in some situations, but it is certainly worth the risk.

• Wait to speak until the person you want to communicate with is listening. If the person is not ready to listen, your message will not be heard no matter how well you communicate it.

• Don’t try to talk over somebody. If you find yourself being interrupted, relax; don’t try to outtalk the other person. If you are courteous and allow the other person to speak, chances are he or she will eventually respond likewise. If that doesn’t happen, point out that the other person is interrupting the communication process. You can do this only if you have been a good listener. Double standards in relationships seldom work.

• Help the other person become an active listener. This can be done by asking whether the other person has understood what you were communicating. Ask him or her to tell you what he or she heard. If the other person doesn’t seem to understand what you are saying, keep trying.

• Don’t be afraid of long silences. Human communication involves much more than human words. A great deal can be communicated during silences; unfortunately, in many situations silence can make us feel uncomfortable. Relax. Some people need silence to collect their thoughts and feel safe in communicating. The important thing to remember during silences is that you must remain an active listener.


The immediate effect of exercise is stress on the body. However, with a regular exercise program the body adapts, and exercise becomes an effective stress reduction technique. With regular exercise, the body becomes stronger, functions more efficiently, and has greater endurance. Exercise is a vital component of a comprehensive stress management program and overall good health.

People who exercise regularly are much less likely to suffer from fatigue and depression. Tension, depression, feelings of inadequacy, and worries diminish greatly with regular exercise.

Exercise alone has been demonstrated to have a tremendous effect in terms of improving mood and the ability to handle stressful life situations. This effect is seen in adolescents as well as adults. In one study, 2,223 boys and 2,838 girls (mean age 16.3 years) from 10 teams and 25 different individual sports were studied for the relationship between emotional well-being and psychological well-being. Engagement in sports and in vigorous recreational activity was positively associated with emotional well-being independent of other variables.8


An individual suffering from stress or anxiety must support the biochemistry of the body by following some important dietary guidelines:

• Eliminate or restrict the intake of caffeine.

• Eliminate or restrict the intake of alcohol.

• Eliminate refined carbohydrates from the diet.

• Eat a diverse range of colorful, whole foods.

• Increase the potassium-to-sodium ratio.

• Eat regular planned meals in a relaxed environment.

• Control food allergies.

According to Selye, whether or not stress is harmful is based on the strength of the system.2 From a purely physiological perspective, it can be strongly argued that delivery of high-quality nutrition to the cells of the body is the critical factor in determining the strength of the system.

When the eating habits of Americans are examined as a whole, it is little wonder that so many people are suffering from stress, anxiety, and fatigue. Most Americans are not providing their bodies with the high-quality nutrition they need. Instead of eating foods rich in vital nutrients, most Americans focus on refined foods high in calories, sugar, fat, and cholesterol.


The average American consumes 150 to 225 mg caffeine per day, or roughly the amount of caffeine in two cups of coffee. Although some people can handle this amount, others are more sensitive to the effects of caffeine. Even small amounts of caffeine can affect sensitive people, whereas those with normal sensitivity respond to large amounts. Excessive caffeine consumption can produce “caffeinism,” which is characterized by symptoms of depression, nervousness, irritability, recurrent headache, heart palpitations, and insomnia. People prone to feeling stress and anxiety tend to be especially sensitive to caffeine.9One way to determine if you are suffering caffeinism is to stop drinking coffee and all other sources of caffeine (chocolate, tea, medications with caffeine, etc.). Developing headaches is a sure sign you are consuming too much.


Alcohol produces chemical stress on the body and increases oxidative stress, resulting in the depletion of the critical intracellular antioxidant glutathione. It also increases adrenal hormone output and interferes with both normal brain chemistry and normal sleep cycles. Although many people believe that alcohol has a calming effect, a study of 90 healthy male volunteers given either a placebo or alcohol demonstrated significant increases in anxiety scores after consumption of alcohol.10

Refined Carbohydrates and Glycemic Volatility

One of the consequences of the stress response is abdominal fat cell growth and loss of muscle mass, a scenario that obviously leads to insulin resistance and obesity. A complex set of events orchestrated by cortisol, released as a result of the stress response, is ultimately responsible for the fact that stress promotes weight gain. Cortisol is also a factor contributing to rapidly fluctuating blood sugar levels, which are generally related to some degree of insulin resistance and made worse by overconsumption of foods with a high glycemic impact. Refined carbohydrates (e.g., sugar and white flour) are known to contribute to problems with blood sugar control, especially hypoglycemia as well as glycemic volatility. The association between hypoglycemia and impaired mental function is well known. Numerous studies have shown that hypoglycemia frequently develops in depressed patients.11,12 As depression is one of the most common causes of anxiety, this finding provides a link between hypoglycemia and feelings of stress. Simply eliminating refined carbohydrate from the diet may be all that is needed for patients who have depression or anxiety due to hypoglycemia.

Potassium-to-Sodium Ratio

One of the key dietary recommendations to support the adrenal glands is to ensure adequate potassium levels within the body. This can best be done by consuming foods rich in potassium and avoiding foods high in sodium. Most Americans have a dietary potassium-to-sodium (K:Na) ratio of less than 1:2. In contrast, most researchers recommend a dietary K:Na ratio higher than 5:1. However, even this recommendation may not be optimal. A natural diet rich in fruits and vegetables can produce a K:Na ratio higher than 50:1, as most fruits and vegetables have a K:Na ratio of more than 100:1.

Meal Planning

Mealtimes should be spent in a relaxed environment. As noted previously, digestion is a process largely controlled by the parasympathetic nervous system. Eating in a rushed manner or in a noisy or hurried environment is not conducive to good digestion or good health.

Food Allergies

People with symptoms of anxiety or chronic fatigue must be concerned about food allergies. As far back as 1930, pioneering allergist Albert Rowe began noticing that anxiety and fatigue were key features of food allergies.13Originally Rowe described a syndrome known as “allergic toxemia,” which included symptoms such as anxiety, fatigue, muscle and joint aches, drowsiness, difficulty of concentration, and depression. Around the 1950s, this syndrome began to be referred to as the “allergic tension-fatigue syndrome.” With the current focus on chronic fatigue syndrome, many physicians and other people are forgetting that food allergies can lead to anxiety as well as chronic fatigue.

Nutritional Supplements and Botanical Medicines

Nutritional and botanical support for the individual experiencing signs and symptoms of stress largely involves supporting the adrenal glands. Long-term stress and corticosteroids cause the adrenal glands to shrink and become dysfunctional, aggravating anxiety, depression, and chronic fatigue.

An abnormal adrenal response, either deficient or excessive hormone release, significantly alters an individual’s response to stress. Often the adrenals become “exhausted” as a result of constant demands put on them. An individual with adrenal exhaustion usually suffers from chronic fatigue and may complain of feeling “stressed out” or chronically anxious. He or she typically has a reduced resistance to allergies and infection.

Nutritional Supplements

The nutrients especially important for supporting adrenal function are vitamin C, vitamin B6 (pyridoxine), zinc, magnesium, and pantothenic acid (vitamin B5). All of these nutrients play a critical role in the health of the adrenal gland as well as the manufacture of adrenal hormones. During stress, the levels of these nutrients in the adrenals decrease substantially.

For example, during chemical, emotional, psychological, or physiological stress, the urinary excretion of vitamin C is increased. Examples of chemical stressors are cigarette smoke, pollutants, and allergens. Extra vitamin C in the form of supplementation and a higher intake of vitamin C–rich foods is often recommended to keep the immune system working properly during times of stress.

Equally important during high periods of stress or in individuals needing adrenal support is pantothenic acid. Pantothenic acid deficiency results in adrenal atrophy, characterized by fatigue, headache, sleep disturbances, nausea, and abdominal discomfort. Pantothenic acid is found in whole grains, legumes, cauliflower, broccoli, salmon, liver, sweet potatoes, and tomatoes. In patients who suffer from chronic stress or have a history of corticosteroid (prednisone) use, the typical level of supplementation is 100 to 500 mg per day.

Gamma-Aminobutyric Acid (GABA)

Gamma-aminobutyric acid (GABA) is a major neurotransmitter that is abundantly and widely distributed throughout the central nervous system. A low level of GABA or decreased GABA function in the brain is associated with several psychiatric and neurological disorders, but primarily anxiety, depression, insomnia, and epilepsy. Currently, many popular antianxiety drugs—the sedative-hypnotics—interact primarily with GABA receptors. These drugs include the benzodiazepine drugs such as alprazolam (Xanax) and diazepam (Valium), as well as drugs such as flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), triazolam (Halcion), zolpidem (Ambien), and baclofen (Kemstro and Lioresal).

Clinical studies with a product called PharmaGABA, naturally manufactured by a fermentation process that utilizes Lactobacillus hilgardii, have shown it to produce significant antistress effects.14Specifically, PharmaGABA has been shown to produce relaxation, as evidenced by changes in brain wave patterns, diameter of the pupil, and heart rate, as well as reduce markers of stress, including salivary cortisol levels. These effects are thought to be the result of activation of the parasympathetic nervous system rather than the PharmaGABA crossing the blood-brain barrier. The typical dosage is 100 to 200 mg up to three times per day. The general guideline is to take no more than 1,000 mg within a 4-hour period and no more than 3,000 mg within a 24-hour period.

Botanical Medicines

Several botanical medicines support adrenal function. Most notable are Chinese ginseng (Panax ginseng) and Siberian ginseng (Eleutherococcus senticosus), rhodiola (Rhodiola rosea), and ashwagandha (Withania somnifera). All of these plants exert beneficial effects on adrenal function and enhance resistance to stress and are often referred to as “adaptogens.” These plants have historically been used to:

• Restore vitality in debilitated and feeble individuals

• Increase feelings of energy

• Improve mental and physical performance

• Prevent the negative effects of stress and enhance the body’s response to stress

Both Siberian and Chinese ginseng have been shown to enhance the ability to cope with various stressors, both physical and mental.15,16 Presumably this antistress action is mediated by mechanisms that control the adrenal glands. Ginseng delays the onset of the alarm phase of the general adaptation syndrome and reduces its severity.

People taking either of the ginsengs typically report an increased sense of well-being. Clinical studies have confirmed that both Siberian and Chinese ginsengs significantly reduce feelings of stress and anxiety. For example, in one double-blind clinical study, nurses who had switched from day to night duty rated themselves for competence, mood, and general well-being and were given a test for mental and physical performance along with blood cell counts and blood chemistry evaluation.17 The group who were given Chinese ginseng demonstrated higher scores in competence, mood, and mental and physical performance compared with those receiving placebos. The nurses taking the ginseng felt more alert, yet more tranquil, and were able to perform better than the nurses who were not taking the ginseng.

In addition to these human studies, several animal studies have shown the ginsengs to exert significant antianxiety effects. In several of these studies, the stress-relieving effects were comparable to those of Valium; however, while Valium causes behavior changes, sedative effects, and impaired motor activity, ginseng has none of these negative effects.15,16

On the basis of the clinical and animal studies, ginseng appears to offer significant benefit to people suffering from stress and anxiety. Chinese ginseng (P. ginseng) is generally regarded as being more potent than Siberian ginseng. P. ginseng is probably better for the person who has experienced a great deal of stress, who is recovering from a long illness, or who has taken corticosteroids such as prednisone for a long time. For the person who is under mild to moderate stress and is experiencing less obvious impairment of adrenal function, Siberian ginseng may be the better choice. Dosages are as follows:

Panax ginseng (Chinese or Korean ginseng)

  images High-quality crude ginseng root: 1.5 to 2 g one to three times per day

  images Fluid extract (containing a minimum of 10.5 mg/ml ginsenosides with Rg1:Rb1 greater than or equal to 0.5 by HPLC): 2 to 4 ml (1/2 to 1 tsp) one to three times per day

  images Dried powdered extract standardized to contain 5% ginsenosides with an Rb1/Rg1 ratio of 2:1: 250 to 500 mg one to three times per day

Siberian ginseng (Eleutherococcus senticosus):

  images Dried root: 2 to 4 g one to three times per day

  images Fluid extract (1:1): 2 to 4 ml (1/2 to 1 tsp) 2 to 4 g one to three times per day

  images Solid (dry powdered) extract (20:1 or standardized to contain more than 1% eleutheroside E): 100 to 200 mg 2 to 4 g one to three times per day

Another useful botanical medicine to support stress management is Rhodiola rosea (Arctic root), a popular plant in traditional medical systems in Eastern Europe and Asia, where it has traditionally been recommended to help combat fatigue and restore energy. Modern research has confirmed these effects and its qualities as an adaptogen. However, the adaptogenic actions of rhodiola are different from those of Chinese and Siberian ginsengs, which act primarily on the hypothalamus-pituitary-adrenal axis. Rhodiola seems to exert its adaptogenic effects by working on neurotransmitters and endorphins. Rhodiola appears to offer an advantage over other adaptogens in circumstances of acute stress because it produces a greater feeling of relaxation and antianxiety effects. A single dose of rhodiola extract prior to acute stressful events has been shown to prevent stress-induced disruptions in function and performance, but like the ginsengs, R. rosea has also shown positive results with long-term use.1821 In one randomized, placebo-controlled trial of 60 patients with stress-related fatigue, rhodiola was found to have an antifatigue effect that increased mental performance, particularly the ability to concentrate; it also decreased the cortisol response to the stress of awakening from sleep.21

On the basis of results of clinical trials with a standardized R. rosea extract, the therapeutic dose varies according to the rosavin content. For a dosage target of 3.6 to 7.2 mg rosavin, the daily dose would be 360 to 600 mg for an extract standardized for 1% rosavin, 180 to 300 mg for 2% rosavin, and 100 to 200 mg for 3.6% rosavin. When rhodiola is used as an adaptogen, long-term administration is normally begun several weeks before a period of expected increased physiological, chemical, or biological strain and continued throughout the duration of the challenging event or activity. When rhodiola is used as a single dose for acute stress (e.g., for an examination or athletic competition), the suggested dose is three times the dose used for long-term supplementation. No side effects have been reported in the clinical trials, but at higher dosages some individuals might experience greater irritability and insomnia.

Clinical studies with Sensoril, a patented proprietary extract of roots and leaves from ashwagandha (Withania somnifera), have shown considerable antistress and adaptogenic effects. In one double-blind study, chronically stressed subjects taking Sensoril had significant reductions in anxiety, serum cortisol, C-reactive protein, pulse rate, and blood pressure compared with the placebo group, as well as significant increases of serum DHEA and hemoglobin. In addition, there were dose-dependent responses in lowering fasting blood glucose and improving blood cholesterol levels. Dosage is 125 to 250 mg per day.22

Additional Therapies

DHEA (Dehydroepiandrosterone)

With prolonged stress, levels of DHEA tend to be reduced. One of the key indicators of too much stress or a poor stress response is a reduction in salivary DHEA and an increase in salivary cortisol. DHEA supplementation is being recognized for its important health-supporting effects, including an ability to lower cortisol levels.23 For men age 40 to 50, we recommend DHEA if they are complaining of reduced libido or fatigue, if they have diabetes, or if they have been subject to high levels of stress for a long period of time. We recommend basing the dosage on blood levels of DHEA and testosterone; typically the dosage ranges from 15 to 25 mg per day. For men over 50, typically, the dosage we recommend is between 25 and 50 mg. For women who have not yet passed through menopause, we do not recommend DHEA unless there is confirmation that DHEA levels are in fact low. The reason is that as many women approach menopause there is actually an increase in DHEA levels. Taking extra DHEA may lead to acne and increased facial hair. After menopause, DHEA may be used with caution and in low dosages ranging from 5 to 15 mg unless the woman has an autoimmune disease or diabetes.

Stress Management Programs

Supervised stress management programs are thought to offer greater compliance and better results than unsupervised, patient-directed programs. In one study, stress management experts evaluated six widely used occupational stress management interventions (relaxation, physical fitness, cognitive restructuring, meditation, assertiveness training, and stress inoculation) on the basis of 10 practicality criteria and 7 effectiveness objectives. They found that relaxation was the most practical intervention, and that meditation and stress inoculation were the least practical. Physical fitness was rated as the most effective intervention, and both meditation and assertiveness training were rated overall as the least effective. These results imply that although relaxation training may be the most practical intervention, physical exercise was the most effective intervention.24

Although in this evaluation meditation was shown to be the least practical and least effective method, when it is part of supervised program it can be very effective. In one trial of 103 adults, 59% and 61% of the meditation and control groups, respectively, completed the study.25 The intervention program consisted of an eight-week group stress reduction program in which subjects learned, practiced, and applied mindfulness meditation to daily life situations. Those in the control group received educational materials and were encouraged to use community resources for stress management. Compared with the control group, intervention subjects reported significant decreases in the effect of daily hassles (24%), psychological distress (44%), and medical symptoms (46%); these were maintained at the three-month follow-up.



• How an individual handles stress plays a major role in determining his or her level of health.

• Stress management can be substantially improved by focusing on the following six equally important areas:

  images Techniques to calm the mind, promote parasympathetic tone, and promote a positive mental attitude

  images Lifestyle factors

  images Exercise

  images A healthful diet designed to nourish the body and support physiological processes

  images Dietary and botanical supplements designed to support the body as a whole, but especially the adrenal glands

  images Supervised stress management program

• One of the most powerful methods of producing less stress and more energy in the body is breathing with the diaphragm.

• Learning to manage time and communicate effectively goes a very long way in reducing stress.

• Exercise is a vital component of a comprehensive stress management program and contributes to overall good health.

• Excessive caffeine consumption can produce “caffeinism,” characterized by symptoms of depression, nervousness, irritability, recurrent headache, heart palpitations, and insomnia.

• One of the consequences of the stress response is abdominal fat cell growth and loss of muscle mass, a scenario that leads to insulin resistance and obesity.

• One of the key dietary recommendations to support the adrenal glands is to ensure adequate potassium levels within the body.

• The nutrients especially important for supporting adrenal function are vitamin C, vitamin B6, zinc, magnesium, and pantothenic acid.

• Clinical studies with PharmaGABA have shown it to produce significant antistress effects.

• Chinese ginseng (Panax ginseng) and Siberian ginseng (Eleutherococcus senticosus), rhodiola (Rhodiola rosea), and ashwagandha (Withania somnifera) exert beneficial effects on adrenal function and enhance resistance to stress.

• DHEA supplementation can help lower cortisol levels.

• Formal stress management programs produce measurable benefits.



A comprehensive approach to a healthier, calmer life is an absolute must in modern life. Below are guidelines based upon an individual’s need for support.

Level 1 Support

In addition to the general lifestyle and dietary guidelines discussed above and the regular utilization of techniques to calm the mind and body, Level 1 support simply involves the four cornerstones of good health presented in Section II:

• A positive mental attitude

• A health-promoting lifestyle

• A health-promoting diet

• Supplementary measures

Level 2 Support

Level 2 support encompasses Level 1 support plus the use of PharmaGABA (100 to 200 mg up to six times per day) to deal with situational stress and nervousness.

Level 3 Support

In the more anxious individual, Level 3 support encompasses Level 2 support plus the use of an herbal adaptogen (dosages given above).

Level 4 Support

For people who are experiencing significant signs of adrenal fatigue, generalized exhaustion, and/or anxiety, Level 4 support encompasses Level 3 support plus the recommendations in the chapter “Anxiety,” and/or those in the chapter “Insomnia.” In particular, improving sleep quality is essential to restoring adrenal function, a positive mood, physical and mental energy, and healing.