The Physical Manifestations of Emotional Stress

By Nieske Zabriskie, ND

Although we often think of stress as a mental condition, it can cause many physical ailments. Most of us are all too aware that after a difficult day of work, we have a hard time sleeping. However, the physical effects of stress go far beyond sleep deprivation. In fact, it is estimated that as much as 50-80 percent of physical disorders are stress related.1 Some diseases and symptoms associated with stress include irritable bowel syndrome, ulcers, indigestion, depression, insomnia, infertility, memory loss, decreased immune function, inflammatory conditions such as musculoskeletal pain, heart disease, and weight gain.

This article will discuss some of the physical consequences that can result from being in an agitated emotional state and the natural strategies that can be used to help our bodies cope with stress.

The Physiology of Stress

Stress causes activation of specific physiological pathways. The hypothalamus-pituitary-adrenal (HPA) axis is stimulated as well as the sympathetic and autonomic nervous system. Activation of the sympathetic nervous system increases the secretion of epinephrine and norepinephrine (NE) from the adrenal medulla. HPA axis activation includes release of corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) from the hypothalamus causing the release of adrenocorticotrophic hormone (ACTH) from the anterior pituitary gland. ACTH stimulates the adrenal cortex to secrete cortisol, the primary glucocorticoid responsible for much of the physical manifestations of stress (Figure 1).


HPA axis dysfunction causes various types of sleep disturbance. Hyperactivity of this pathway inhibits sleep and increases awakenings during the night. This may be due to increased nocturnal CRH and NE levels. Increased nocturnal cortisol levels are also found in insomniacs. In addition, fragmented sleep increases HPA axis activity, thus creating a vicious cycle.2

Melatonin is the hormone produced nocturnally by the pineal gland and acts as a circadian rhythm and sleep-anticipating signal in humans. In a study of insomniacs age 55 and older, those using melatonin supplementation found improvements in sleep quality, morning alertness, sleep onset latency and reported quality of life.3 Also, research has shown that in patients with insomnia currently taking benzodiazepines for treatment, concurrent supplementation with melatonin decreased or stopped the need for benzodiazepine treatment.4

Individuals whose insomnia is stress-related also may find 5-hydroxytryptophan (5-HTP) of interest. Created from the amino acid tryptophan, 5-HTP helps induce relaxation and has been shown to help encourage sleep in both adults and children. In a study of children suffering from sleep terrors, after 1 month of using 5-HTP, 29 of 31 (93.5 percent) patients no longer had sleep terror episodes. In the comparison group not using 5-HTP, after 1 month, the episodes disappeared only in four children (28.6 percent) while ten children (71.4 percent) showed the persistence of episodes with the same frequency as before, indicating that 5-HTP is able to modulate the arousal level and to induce a long-term improvement of sleep.5

Mood and Well-Being

Depression is also associated with the malfunction of the HPA axis that occurs during stress. This stress-depression link is confirmed by studies showing that late-in-life depression is associated with both below and above normal levels of cortisol, suggesting a sensitivity to any variation in the HPA axis.6 In addition to depression, stress, by virtue of dysregulation of the HPA axis, is linked to anxiety and panic disorders.7 Cognitive function is another surprising factor impacted by stress as studies indicate that higher levels of cortisol are associated with decreased cognitive performance including processing speed, eye-hand coordination, executive functioning, verbal memory and learning, and visual memory.8

B vitamins including pyridoxine (B6), thiamine (B1), and cobalamin (B12) have been shown to modulate the stress response and improve stress-related disease.9-10 In addition, thiamine deficiency is associated with memory and learning deficits.11

Mood-enhancing botanicals and amino acids can be used together with B vitamins in individuals whose well being has suffered at the expense of stressful events. Numerous studies have been published advocating the efficacy of St. John’s Wort in mild-to-moderate depression, as well as its potential to decrease related complaints such as fatigue and sleep disturbance.12-13

Phenylalanine, an essential amino acid metabolized into tyrosine, along with tyrosine itself can be used together with St. John’s Wort to help enhance well-being. Tyrosine is the precursor used for the synthesis of norepinephrine, epinephrine, and dopamine. Depletion of brain stores of norepinephrine is associated with stress-induced impairment of performance. Research shows tyrosine supplementation improves stress-associated declines in both neural norepinephrine levels and performance.14 In addition, individuals under psychosocial and physical stress who were supplemented with tyrosine performed better on memory and tracking tasks.15


As mentioned above, high levels of cortisol can also affect cognition and controlling cortisol is therefore important not only for stress reduction in general but specifically for maintaining memory. Three botanicals—Withania somnifera, Magnolia officinalis and Phellodendron amurense—are known especially for their ability to control cortisol levels. Sensoril™, a patented form of Withania somnifera (ashwagandha), is a medicinal plant used in Ayurvedic medicine. Historically, this adaptogenic herb has been used to modulate the stress response, and possesses anti-inflammatory activity.16 Research using animal models indicates that supplementation with ashwagandha moderates the stress response after exposure to chronic environmental stressors, including attenuation of symptoms such as depression, increased blood sugar, glucose intolerance, increased cortisol, cognitive deficits, and stomach ulcers.17

Relora®, a combination of Magnolia officinalis and Phellodendron amurense, is often used together with Withania somnifera. Research suggests that Phellodendron amurense has anti-inflammatory, anti-ulcer, and bactericidal properties.18 Constituents of the bark of Magnolia officinalis counteract the excitotoxicity induced by excitatory amino acids, suggesting it may provide neuroprotective effects.19

Digestive System

Elevated stress is associated with several digestive complaints such as irritable bowel syndrome (IBS), stomach ulcers, and changes in appetite. Studies indicate that individuals with IBS have elevated cortisol as well as increased pro-inflammatory markers. These patients show an exaggerated cortisol and ACTH response to CRH.20 This exaggerated ACTH response means that in individuals with IBS, the adrenal cortex is secreting excessive amounts of cortisol. Individuals with IBS also exhibit increased urinary norepinephrine and epinephrine levels.21

Lactobacillus, a probiotic found in the intestines that is important for metabolizing food, absorption of nutrients, and preventing colonization by pathogenic bacteria, can help safeguard the digestive tract from the negative effects of stress. One study showed that supplementation with lactobacillus in children with IBS decreased pain after 4 weeks.22 In an additional study, individuals with IBS were given a probiotic supplement and evaluated over 6 months. In the treatment group, symptoms including pain, flatulence, distension, and rumbling decreased by 42 percent.23 Furthermore, supplementation with digestive enzymes, which are important in the proper breakdown and absorption of nutrients in food, have been shown to decrease digestive complaints such as abdominal pain and pressure, nausea, and flatulence.24

Physical and psychological stress can also induce stomach and duodenal ulcers.25 Research has demonstrated that individuals with duodenal ulcers have sympathetic-adrenal systems that exhibit elevated sensitivity to environmental stressors.26 Mastic gum, by virtue of its ability to inhibit Helicobacter pylori, a common gastric bacterium, is known to support the health of individuals with ulcers that are caused by this bacterium. In one double-blind clinical trial, researchers found that oral doses of one gram per day of mastic over a period of two weeks produced symptomatic relief in 80 percent of patients with duodenal ulcers.27

Weight Management

One of the most under-recognized reasons for weight gain is high levels of cortisol, which is associated with increased abdominal obesity. Stress also is the most commonly reported trigger of binge eating. One group of researchers found that the binge-eaters had higher morning basal cortisol than the non-binge-eating group. The binge eaters’ waist circumference was related to cortisol levels. Furthermore, the subjects whose cortisol levels were highest had a hard time losing weight even after dieting.28-29

The study authors concluded, “In BED [binge-eating disorder], there is a hyperactive Hypothalamic Pituitary Adrenal axis related to abdominal obesity that persists even after treatment, suggesting that cortisol might be a primary factor in the disorder.”

Studies show that cortisol increases appetite as well as levels of leptin, a polypeptide hormone that modulates appetite.30 Leptin also appears to influence factors that control cortisol production. Furthermore, the hormone ghrelin, which stimulates increased food intake and fat mass, is increased by stress-induced rise in cortisol.31

Therefore, controlling cortisol levels is important for any weight management program. As discussed above, Withania somnifera combined with Magnolia officinalis and Phellodendron amurense can support healthy cortisol levels and play an important part in a weight management program. Researchers performed a study examining the combination of extracts of Magnolia officinalis and Phellodendron amurense in stress and weight management. Supplementation with these botanicals lowered levels of cortisol in the evening whereas the control group tended to have higher evening cortisol. Furthermore, the control group subjects gained weight while the Relora group maintained their current weight.32 Additionally, the combination of these two botanicals has been shown in animal models to positively affect anxiety.33 Reducing anxiety levels is of key interest for anyone who reaches for a pint of ice cream during moments of stress.

Musculoskeletal System

Musculoskeletal pain—aches that occur in the bones, joints and muscles—and inflammation may also be stress-induced. Studies have shown increased work-related stressors are related to musculoskeletal pain.34 Additional studies have shown a correlation between increased depressive symptoms and reported stress with neck/shoulder pain and low back pain in adolescents.35 Other researchers have demonstrated that perceived stress is correlated closely with the complaint of musculoskeletal symptoms such as shoulder and low back pain.36

Glucosamine sulfate and chondroitin sulfate are commonly used to moderate the symptoms associated with osteoarthritis such as joint pain. Numerous studies have reported symptomatic relief in osteoarthritic symptoms when subjects were supplemented with glucosamine sulfate and chondroitin sulfate.37 Additionally, Methylsulfonylmethane (MSM) has been shown to modulate pain and physical impairment in individuals, particularly those with osteoarthritis.38

When bone, joint and muscle pain is the result of stress, anti-inflammatory nutrients can offer an additional means of support. Stephania tetrandra has shown significant effect in reducing the neutrophil-induced inflammation in rheumatoid arthritis.39 Boswellia serrata inhibits 5-lipoxygenase, an enzyme that promotes inflammation in the body.40 The flavonoid Luteolin possesses strong anti-inflammatory and anti-allergic activity in vivo.41 Holy basil (Ocimum sanctum), an East Indian herb highly esteemed in Ayurvedic medicine, inhibits both cyclooxygenase-2 (COX-2) and 5-lipoxygenase.42


The effects of stress are often considered to be primarily emotional. However, stress is as damaging to the body physically as it is emotionally. In addition to insomnia, stress can play a major role in depression, cognitive dysfunction, digestive disorders, weight gain and muscle and joint pain. Melatonin and 5-HTP to promote healthy sleep, Phenylalanine, Tyrosine and St. John’s Wort to promote a sense of well-being, Withania somnifera, Magnolia officinalis and Phellodendron amurense to decrease cortisol levels associated with weight gain and poor memory, Digestive Enzymes, Lactobacillus GG, and mastic gum to support the health of the digestive tract and glucosamine, MSM and anti-inflammatory herbs to reduce stress-triggered muscle and joint pain can each be used to address the various physical manifestations of stress.


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