While it is well established that children with high ACE scores who experienced toxic stress in childhood suffer from mental disorders at a higher rate than other adults, the damage to the biological functioning of the brain due to HPA dysregulation (stress response system) is a lesser-known consequence. These structural changes in the cells of the brain would have a big impact on the mood and mental state of the individual. The methods of treating mental disorders that are rooted in toxic stress experienced throughout childhood do not consider the changes in the function of a brain. Trying to successfully treat these individuals without addressing this very real underlying biological change can be less than successful. If these biological changes to the stress response in the brain are treated through nutrition, individuals may be able to correct brain chemistry imbalances and be more successful with other forms of therapy.
Chronically elevated or low levels of cortisol, one of the main hormones associated with the stress response, can be linked to the changes seen in HPA regulation and brain development. [1][2] Prolonged exposure to abuse and/or dysfunctional households have an epigenetic impact on the development of the stress response in the child’s brain that persists into adulthood due to this chronically elevated level of cortisol in the body.1 [3] [4] During a stressful situation, the hypothalamus stimulates the pituitary gland to release adrenocorticotropin (ACTH) which in turn stimulates the release of cortisol from the adrenal glands. The rising amounts of cortisol in the blood signals the hypothalamus to stop releasing ACTH and the negative feedback loop allow cortisol to fall and the system returns to a baseline.[5] In the event of chronic toxic stress however, this system is activated all the time and is not allowed to return to baseline, causing the cells of the body to become resistant to the signal of cortisol.[6] These psychobiological changes to the HPA feedback system coupled with other changes in stress response mechanisms, cause adult abuse survivors to experience chronic low or high levels of the hormone cortisol. 3
These brain changes are real and, in some ways, out of our control. When something triggers an adult trauma survivor, the nervous system and the stress response system are going to act in the same way they did when the trauma was occurring. In other words, the situation can be totally innocent and benign, but the body, brain and biochemistry will ramp things up anticipating trauma. The fight, flight, freeze or fawn response will be activated on a biological level and can persist long after the event has concluded. This biological response can be calmed down with the help of nutrition therapy and should be addressed along with the psychological aspect for the most holistic healing possible. The methods of treating mental disorders that are rooted in toxic stress experienced throughout childhood do not consider the changes in the function of a brain. Trying to successfully treat these individuals without addressing this very real underlying biological change can be less than successful. If these biological changes to the stress response and lipid structure in the brain are treated through nutrition, individuals may be able to correct brain chemistry imbalances and be more successful with other forms of therapy.
Unfortunately, this dysregulation to the HPA system and the altered levels of cortisol can have an impact on the level many different nutrients that are found in the body including omega 3 fatty acids, magnesium, zinc, and vitamin C to name just a few. [7][8] This process is a cycle where stress upregulates pro-inflammatory cytokines (talked about in this article) and the cytokines in turn increase the stress response. Nutritionally, this chronic stress response and pro-inflammatory state uses many of the vitamins and mineral stores in the body, and they are often not replaced adequately through diet and/or supplementation. The body then does the best it can with what it has, but when the proper nutrients are lacking, the brain and body are not going to work at their best.
The toxic stress that is experienced during the adverse childhood events causes high levels of oxidative damage to all the cells in the body. The delicate omega 3 fatty acids, including DHA and EPA, found in the brain are particularly susceptible to oxidative damage from reactive oxygen species (ROS). [9] When HPA dysfunction is present due to toxic stress, it sets up a cycle where the stress depletes the omega 3 fatty acid pool, and the depleted pool of fatty acids in turn causes more stress and inflammation to the system. 7 This is partly due to the fact that ROS damage alters the lipid membranes of cell in the brain so that key neurotransmitters are not as effective as they should be. [10] The reduction in omega 3 fatty acids also leads to neuronal membranes that are less fluid and more ridged. This rigidity makes the membranes less able to bind with neurotransmitters and alters other functions such as ion channels needed to generate action potentials. [11]
In addition to fatty acid damage and depletion, there are studies that show in animals and in humans, that magnesium and zinc are greatly reduced during stress responses.8 For trauma survivors this response is chronic, so this depletion is also chronic in nature if not replaced in the diet. Magnesium is involved in over 300 enzymatic reactions in throughout the body and is needed for everything from ATP production to protein synthesis. Magnesium plays a role in quieting down the stress response system and is inadequate in the modern American diet in general, and potentially severely lacking in the diet of someone with a dysregulated stress response system. [12] It is another vicious feedback cycle like others we’ve explored in the stress system gone haywire; chronic stress uses magnesium stores which causes magnesium to be low, and the low levels of magnesium in turn cause more stress to the system. Zinc is another nutrient that is involved in hundreds of different enzymatic reactions including proper gene expression and brain function and is reduced in certain tissues (the brain included) as a response to stress and inflammation. Depletion of this important mineral can contribute to depression, anxiety, emotional dysregulation, and other mental issues adult trauma survivors often face. [13]
Last but not least, in our tour of nutrients depleted during the stress response, is vitamin C. Vitamin C is used by the adrenal glands to produce various hormones so during the stress response, when the adrenal glands are activated, they are using up the body’s stores of vitamin C rapidly. Vitamin C is also a potent antioxidant in the brain, seeking out those ROS that are so damaging to the fatty acid membranes of neuronal cells. Depletion of vitamin C at a subclinical level can be linked to mental issues such as depression and anxiety which many C/PTSD patients suffer from. Additionally, proper levels of vitamin C can help to turn down the stress response by modulating the effect of ACTH from the pituitary. There is also evidence that vitamin C itself can have an antidepressant effect on neurons in the brain by stimulating specific neurotransmitters and pathways. [14]
The nutrients that I’ve outlined above are just a few that are involved and depleted in chronic stress situations and can contribute to the mental issues many adult trauma survivors suffer from. This depletion is caused by chronic stress activating the HPA axis which will use up any stores of vitamins and minerals in the body. The longer this imbalance occurs, the more the entire system will be thrown off which manifests as various diseases in the person. Treating these nutrient deficiencies will help the brain and body on a biochemical level which will help the person think and function better. This translates into further healing with other modalities and methods in their lives, helping give these people so much needed peace.
References
[1] Jack P. Shonkoff, M.A. The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics. 2019; 29(1): e232-e246.
[2] Joos CM, McDonald A, Wadsworth ME. Extending the toxic stress model into adolescence: Profiles of cortisol reactivity. Psychoneuroendocrinology. 2019; 107:46-58.
[3] Trickett PK, Noll JG, Putnam FW. The impact of sexual abuse on female development: lessons from a multigenerational, longitudinal research study. Dev Psychopathol. 2011;23(2):453-476.
[4] Jiang S, Postovit L, Cattaneo A, Binder EB, Aitchison KJ. Epigenetic Modifications in Stress Response Genes Associated With Childhood Trauma. Front Psychiatry. 2019;10:808.
[5] Gjerstad JK, Lightman SL, Spiga F. Role of glucocorticoid negative feedback in the regulation of HPA axis pulsatility. Stress. 2018;21(5):403-416.
[6] Merkulov VM, Merkulova TI, Bondar NP. Mechanisms of Brain Glucocorticoid Resistance in Stress Induced Psychopathologies. Biochemistry (Mosc). 2017;82(3):351-365.
[7] Thesing CS, Bot M, Milaneschi Y, Giltay EJ, Penninx BWJH. Omega-3 polyunsaturated fatty acid levels and dysregulations in biological stress systems. Psychoneuroendocrinology. 2018; 97:206-215.
[8] Lopresti AL. The Effects of Psychological and Environmental Stress on Micronutrient Concentrations in the Body: A Review of the Evidence. Adv Nutr. 2020;11(1):103-112.
[9] Schiavone S, Jaquet V, Trabace L, Krause KH. Severe life stress and oxidative stress in the brain: from animal models to human pathology. Antioxid Redox Signal. 2013;18(12):1475-1490.
[10] Du J, Zhu M, Bao H, et al. The Role of Nutrients in Protecting Mitochondrial Function and Neurotransmitter Signaling: Implications for the Treatment of Depression, PTSD, and Suicidal Behaviors. Crit Rev Food Sci Nutr. 2016;56(15):2560-2578.
[11] Husted KS, Bouzinova EV. The importance of n-6/n-3 fatty acids ratio in the major depressive disorder. Medicina (Kaunas). 2016;52(3):139-147.
[12] Pickering G, Mazur A, Trousselard M, et al. Magnesium Status and Stress: The Vicious Circle Concept Revisited. Nutrients. 2020;12(12):3672.
[13] McClain CJ, McClain ML, Boosalis MG, Hennig B. Zinc and the stress response. Scand J Work Environ Health. 1993;19 Suppl 1:132-133
[14] Moritz B, Schmitz AE, Rodrigues ALS, Dafre AL, Cunha MP. The role of vitamin C in stress-related disorders. J Nutr Biochem. 2020; 85:108459.
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