Corey Schuler, MS, DC, CNS, LN, FAAIM is a nationally recognized expert in the field of natural health and metabolism. He is a board-certified physician with the certification board of nutrition specialists, licensed nutritionist, and functional medicine practitioner with a profound curiosity about why one medicine heals one person with a condition but not another with the very same condition. He is a member of the American College of Nutrition and American Nutrition Association, holds a master’s degree in human nutrition, and teaches in post-graduate degree (MS, MSACN, MHS) programs of clinical nutrition.
Integrative Medicine: A Clinician’s Journal: The topic that we’re going to address today is the hypothalamic-pituitary-adrenal (HPA) axis and its relationship to stress. Let’s start off with an overview of what the HPA axis is all about.
Dr Schuler: I think that what most people think of when they hear about stress are the fast-acting mechanisms. We default to understanding the fight-or-flight terminology about stress response. While that is certainly a real thing—more of a fast-acting approach to it—the HPA axis is generally a slower responding system in the body. We are talking about a response to stress that maybe resolves over the course of 8 to 12 hours, rather than something that mobilizes all of your resources to either escape something or defend yourself.
I think that is one big difference from our mediocre or elementary understanding of what is going on with the stress response. It is realizing that there are 2 versions of it. There is the nervous-system response, which is very fast, and the endocrine response, which is much slower. We can think of it together as a neuroendocrine response.
IMCJ: Would the nervous system’s response would be more cortisol based, or more of an adrenaline-type response?
Dr Schuler: The release of epinephrine and norepinephrine are immediate, through stimulus of the locus coeruleus. That causes epinephrine and norepinephrine, to be released from the adrenal gland—the adrenal medulla, specifically.
IMCJ: Does that type of stress, on a long-term basis, cause harm to the body?
Dr Schuler: It is up for debate, because you cannot really separate them. If you have a fast-acting stress response, you also stimulate the slow response, too. There are definitely detrimental effects to that long-acting response, the cortisol response.
IMCJ: How does that combined response relate to a condition such as PTSD?
Dr Schuler: We do not know enough about that to treat it very effectively, or even understand some of the pathophysiology. It is really interesting, though. I just had a conversation with a researcher who is looking into the effect of DHEA on PTSD. I think some military medicine groups are going to be looking at this. For patients in the VA who are suffering and given DHEA, it is not necessarily that useful. Sometimes it helps a little bit. It can take the edge off but it is usually not that helpful, even if their DHEA levels are low.
The thought process is that it probably would be helpful if we gave it to them while they are experiencing the stressors. The question is, what if we were supplementing—fortifying—MREs or base meals with DHEA? Could that help reduce the incidence of something as difficult as PTSD? We do not have the answers, but it certainly is a neat proposal.
IMCJ: All that is great information, but we are talking about different type of stress than what the typical working mom deals with, right?
Dr Schuler: That is actually a good point. Traumatic combat-related stress is certainly on the outside, or on the far spectrum of stresses, where you know that you are battling for your life. However, the stresses that we experience have some of the same physiologic cascades on a day-to-day basis. A lot of people in my circles will say that what really stresses the modern human out is that we are stressed out about things that we know that we should not be stressed out about.
We are waiting in line, or we are late for a meeting, right? We have the same “I’m under fire” responses, yet we know that is not happening. We know that everything is going to be okay, but we are still bothered by it. Now we are bothered by the fact that we are bothered by it. That is just a human condition. Animals do not tend to respond that way.
IMCJ: Not to simplify things too much, but is chronic disease really about how all of us are being faced with chronic stress on a daily basis?
Dr Schuler: Right. What we have—and this is not scientific, it just seems to be empirical—is that different individuals have different stress tolerances. We know that by our interactions with other humans. Some people obviously react fine to stress. It is kind of like water off a duck’s back—not a big deal. They just handle things. My business partner is like that.
I am not like that. Stress affects me very deeply. I get sick easier. I tend to fall asleep quickly. There is a stress tolerance that we have to take into consideration when actually treating people. But, generally, people are not seeing us practitioners until they already have the disease state or they are already feeling sick and bothered. We are just managing the manifestations of that stress and we have to, at the same time, be able to reduce that root cause. It is a really interesting, but very difficult puzzle.