It’s not really surprising:  A Gallup poll conducted between March 21 and April 5 2020, as the COVID-19 crisis escalated, revealed that “the percentages of U.S. adults experiencing significant stress and worry on a daily basis have increased in an unprecedented manner compared with July-August 2019—with stress rising 14 percentage points to 60% and worry rising 21 points to 59%. The percentage experiencing significant daily enjoyment, in turn, has plunged 20 points during that time to 61%.”

With stress-filled days come sleepless nights. “Stress and sleep are inexpiably linked, and unfortunately, the impact of each can be cyclical in nature with the other,” says Trisha Sugarek MacDonald, BS, MS, Sr. Director of R&D at Bluebonnet Nutrition Corporation. “For instance, significant stress in an individual’s personal or work life causes the brain to send signals to the autonomic nervous system to release hormones like cortisol and adrenaline in large quantities. These hormones will engage the flight or fight response in the body, putting the brain and body on full alert, contributing to sleep deprivation. On the other hand, without quality sleep, the brain is unable to recollect itself, causing mental tasks, worries, and other cognitive stressors to carry over to the next day. To put this in perspective, the CDC approximates that 35.2% of adults in the U.S. are getting fewer than seven hours of sleep each night, which is far below the standard of seven to nine hours daily. This can lead to a sleep deficit that results in lasting physical and mental health problems and can contribute to stress, which roughly affects one out of every six adults in the form of depression and/or anxiety.”

A medical take: “A meta-analysis conducted by Pilcher et al. arrived at the conclusion that sleep deprivation adversely impacts mood health,” says Paul A. Sandford, Ph.D., Director of Compliance at Doctor’s Best Vitamins, Inc. “Dinges et al. demonstrated that healthy participants who slept only five hours per night for one week experienced a progressive worsening in mood. Moreover, a study by Yoo et al. reported a 60% increase in amygdala activity in response to an emotional stimulus when it was viewed under conditions of sleep deprivation compared to when rested… Hence, adequate sleep may be protective against the development of depressive disorders.” He adds that this is especially true in adolescence.

The effects of stress, Dr. Sandford says, are highly physical. “When stress happens, our body has powerful mechanisms to cope with it. One of them is known as ‘The Stress Response System.’ The key components of the Stress Response System are the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). When the hypothalamus is triggered by a stressor, it triggers a cascade of events that leads to the production of adrenocorticotropin hormone (ACTH) and the activation of the noradrenergic neurons of the locus coeruleus/norepinephrine (LC/ NE) system in the brain. The LC/NE system is primarily responsible for the immediate ‘fight or flight’ response, while ACTH drives the production of cortisol from the adrenal glands, located atop the kidneys. It is important to point out that this kind of hormonal response doesn’t distinguish between good stress (a challenge at work, for example) and bad stress (unemployment, for example). With any stress, cortisol raises your blood sugar and blood pressure while lowering immune system response. The resulting ‘fight or flight’ energy burst can last about 10 to 20 minutes. When it's gone, it leaves you feeling wired but also tired.”

Demand for stress and sleep support products is growing. Samantha Ford, Director of Business Development, tells WholeFoods: “AIDP’s sales of ingredients addressing these categories are growing well into the double digits. In addition to the stay-at-home measures driving growth, we see a diversification in the age demographics for these products. Younger individuals are taking control of their overall health with supplements and turning to a variety of stress and sleep support options.”

Acute vs. Chronic Stress

“Acute stress primarily affects the Sympatho-Adrenal System (SAS), causing an increase in the stress hormones epinephrine—adrenaline—and cortisol,” explains David Winston, RH(AHG), President of Herbalist & Alchemist, Inc. “Occasional short-term or acute stress in a healthy person is usually not a major issue: The body’s response to this stress is to increase immune response, cognitive function, and up-regulate molecular chaperones which allow the body to more effectively and appropriately respond to the stressor.” Those who choose to take steps to decrease acute stress may want to consider herbs known as nervines, which, Winston says, “do not depress the CNS. Rather, they are calming herbs that help to restore the emotional foundation and decrease our response to both acute and chronic stress.”

Chronic stress, on the other hand, is an entirely different monster, Winston says. “It’s dealt with by the HPA axis and causes a long-term increase in cortisol with increased inflammation, decreased immunity, and increased risk of depression, anxiety, sleep disorders, hypertension, cardio-vascular disease, impaired digestion, cancer, Alzheimer’s disease, and other chronic degenerative diseases.” Here, Winston says, nervines are not enough—useful, but not strong enough alone. “Here, you need adaptogens. Adaptogens are herbs that help to create a state of nonspecific resistance to a variety of stressors (including psychological, noise, temperature, or physiological stress), are non-toxic in normal doses, and gently enhance and promote normal endocrine, nervous system, reproductive system, cardiovascular, and immune function. Some are calming, some stimulating, some nourishing, while others are warming or cooling, or drying or moistening. As a clinical herbalist, the type of stress determines the herbs combined in formulas I develop.” The Serenity Compound, for instance, contains four nervines and a mild adaptogen to help acute stress; Calm Adapt, which contains three adaptogens and two nervines, “appropriate for high-strung type A people who cannot relax”; Daily Adapt, to promote energy and help relieve stress; and Energy Adapt, which “provides support for people who feel a lack of energy or mental clarity.”
There are plenty of lifestyle choices that can support a healthy stress response and sleep schedule. Sugarek MacDonald’s recommendations: “Get active, eat a healthy diet, meditate, laugh more, connect with others, keep a journal, be creative, seek counseling. Be assertive, but not aggressive. Try yoga.” And, for those who need a helping hand and have spoken to their healthcare providers, supplements abound. Some options they can consider:

Ashwagandha. This adaptogen is well-known—and for precisely that reason, it’s important to stock it from trustworthy sources. On reason the herb is so in demand: Cheryl Myers, Chief of Scientific Affairs and Education at Terry Naturally/EuroPharma Inc., which offers Ashwagandha EP35, says it’s been clinically shown to aid sleep: “One study showed a 73% increase in sleep quality for those in the ashwagandha group, versus only 29% for those in the placebo group. Participants in the ashwagandha group fell asleep faster, had better sleep efficiency, greater total sleep time, and less time waking after the onset of sleep.” Myers also noted that it’s useful for stress—and that it works in a variety of ways: “A clinical study on the botanical we feature in Ashwagandha EP35 found that the herb reduced stress in men and women through a number of channels: through the hypothalamic-adrenal-pituitary axis, regulating cortisol and DHEA response; through its antioxidant abilities that lower the demands of free-radical damage; through anti-inflammatory action that quenches the initial sparks that can cause agitated mental states and physical discomfort; and by influencing serotonin and the activity of GABA, a neurotransmitter that we rely on to stop anxiety and sleeplessness.”

Fortunately, there are many ways to get this herb. In pills, like Terry Naturally’s, or like the KSM-66 brand ashwagandha offered by companies including YouTheory, or in teas, like the USDA Organic Anxietea offered by MoR Esscentials.

Cannabidiol. The biggest takeaway from our discussion with the experts: This one’s down to the individual. “Everyone’s endocannabinoid system is unique,” explains Lex Pelger, Director of Education at CV Sciences. “There’s no way for us—or your doctor or your friends—to tell you which product would work best for you. It’s not only the different CBD concentrations that add nuance, it’s also the presence of CBD Acid (CBDA). In the plant, CBDA is the precursor to CBD. Because it doesn’t cross the blood-brain barrier, it’s often referred to as inactive—but that’s very untrue. CBDA causes a host of positive reactions in the body that are distinct from CBD. Different people have different needs for using the cannabinoids from hemp, and the only way to know what works is to try CBD for yourself.”

When it comes to sleep, too, Pelger says the effect is “curiously variable.” “It’s probably about a third of the people who use CBD find it to be activating, so they tend not to take it in the evening. For another third, it’s just the thing for them to take before bed to promote a restful night. And for the last third, CBD doesn’t seem to affect their sleep or energy levels at all. The only way to know what category you fall into is by experimenting for yourself.”

Cherry. “Cherries are not just another berry,” says Sugarek MacDonald. “Cherries, whether sweet, sour, or black, are rich in nutrients, such as beta-carotene and vitamins C and E, and provide varying quantities of phenolic compounds, such as gallic acid, p-coumaric acid, kaempferol, and quercetin, all of which act as potent antioxidants to support cellular health. Cherries are also natural sources of melatonin—tart cherries specifically contain high concentrations—and have been shown in research to improve sleep time and quality. Bluebonnet’s Targeted Choice Sleep Support Vegetable Capsules are wholesomely crafted with a complementary blend of herbs, botanicals, and superfruits, including tart cherry fruit extract, as well as valerian root extract, free-form L-theanine, 5-HTP from griffonia seed extract, passionflower whole herb extract and chamomile.”

Eleuthero. Eleuthero is an adaptogen, which can help support the body during times of stress, according to Sun Chlorella USA's website, which notes that the herb can also support sleep quality. And while people can take this herb in a tablet, Sun Chlorella has also made it available as a tea, for easy incorporation into a daily routine.

Ginseng. This is a good adaptogen for boosting energy levels depleted by stress, according to Myers. Terry Naturally’s HRG80 Red Ginseng Energy, she says, “helps preserve mental and physical energy, much like ashwagandha, through healthy HPA axis activity, and keeping serotonin, cortisol, and GABA levels in balance. Not only does it boost energy, stamina, the ability to resist the depletion of stress, and even immune system activity, it also improves mood.” She adds that HRG80 is grown using a unique process that “helps HRG80 Red Ginseng deliver seven times the rare, noble ginsenosides than conventionally grown and processed ginseng supplements.”

Lemon Balm. “A clinical study found that lemon balm can have amazing properties: It reduced feelings of agitation and tension by 18%; reduced stress-related symptoms like muscle tightness and headache by 15%; and reduced initial insomnia by 42%,” says Myers. “Additionally, 95% of the individuals in the study responded to the treatment—70% noted a full remission from stress, 85% from insomnia, and 70% from both. And this was with no side effects. The compounds in lemon balm include rosmarinic, usolic, and oleanolic acids, which inhibit the enzyme GABA-transaminase that reduces the amount of GABA. Lemon balm extract helps us retain appropriate levels of GABA and puts the natural relaxing and sleeping process in balance again.”

The Holistic Approach

“In clinical practice, we find as functional medicine providers that ensuring adequate magnesium is important for sleep. Yet, part of the key tenets of holistic medicine is to keep the natural intake of nutrients balanced. Therefore, other minerals such as calcium, iron, and zinc are strong considerations for individual patients,” explains Chris Meletis, N.D., Director of Science and Research for Trace Minerals. Calcium affects melatonin creation, and therefore sleep, he says. “Also, if vitamin D levels are low, this can alter calcium status. We must also remember that vitamin B6 is needed for over 60 different enzyme pathways in the body, including the creation of serotonin and melatonin from the amino acid tryptophan. And for severely stressed individuals, B6 and magnesium was reported in a 2018 article to be superior to magnesium as a standalone.”
Magnesium. “Magnesium is both a muscle relaxer and a brain relaxer, inhibiting neurotransmitter signaling by limiting it to the normal health range and supporting healthy neuron plasticity to promote functional memory and brain toxins,” explains Neil E. Levin, CCN, DANLA, Senior Nutrition Education Manager at NOW, which offers several types of magnesium in liquid, powder, and pill form.

One type of magnesium available to formulators: Magtein, a patented magnesium L-threonate distributed by AIDP. “It has published clinical support for improved memory, cognitive function, and speed of recall,” says Lauren Clardy, VP Branded Ingredients at AIDP. “It is magnesium for the brain. Magtein is the most effective form of magnesium able to cross the blood-brain barrier. In vivo work has demonstrated Magtein’s ability to enhance synaptic density and neuroplasticity, particularly in regions of the brain involved with fear and anxiety. In human clinical trials, Magtein has significantly improved cognition. Magtein was shown to reduce the effects of an aging brain by an equivalent of nine years.”

Melatonin. “Also known as the ‘sleep hormone,’ melatonin is a naturally occurring hormone produced by the pineal gland in the brain,” explains Harel Shapira, Director of Marketing at Natrol. “It regulates your sleep-wake cycle, telling your body when it’s time for sleep. When the sun sets, signals through our optic nerve instruct our brain to start producing melatonin, which signals the body to prepare for sleep by lowering the body’s temperature and heart rate. Bright light works on melatonin the same way it does on vampires, halting it in its tracks.” Melatonin is what puts us to sleep and keeps us asleep, and it may help those who have trouble with that. Natrol offers Sleep ‘n Restore, which combines melatonin with valerian extract, grape seed extract, L-glutamine, and calcium.

Also offering a formula with melatonin: Sanutra Wellness Relax & Sleep from American’s Finest, Inc. The blend includes melatonin, which may shorten the amount of time it takes to fall asleep, with chamomile, a powder derived from a flower that may help to induce sleep, reduce anxiety and quiet an upset stomach, the company says.

Reishi. “Reishi offers its healing gifts to those concerned with either or both sleep and stress,” says Mark Kaylor, Consultant with Mushroom Wisdom and Founder of the non-profit Radiant Health Project. “In fact, in my opinion Reishi’s benefits can best be summed up with the word ‘balance.’ Reishi has been found to lower stress hormone levels and help the body back to homeostasis, along with helping with falling asleep and improving overall sleep quality.” Kaylor notes that poor sleep and high stress can affect cardiovascular health, inflammation, and immune health—and that Reishi can help with all of those. “One tip for using Mushroom Wisdom’s Super Reishi or any other Reishi product: Take it at the end of your day to help the body de-stress, balance, detox, and support immune function.”

Tulsi. “Tulsi, Ocimum tenuiflorum, is considered as an adaptogen, balancing different processes in the body,” says Clardy. AIDP sells a Tulsi ingredient, OciBest, backed by clinical studies. One of those studies examined OciBest’s use in stress, and in forgetfulness. “Forgetfulness can be caused by too little sleep and too much stress. A randomized, double-blind, placebo-controlled study found that after six weeks of intervention, symptoms such as forgetfulness, sexual problems of recent origin, frequent feeling of exhaustion, and frequent sleep problems of recent origin decreased significantly in the OciBest group as compared with the placebo group—overall, scores of general stress symptoms improved 1.6 times more than in the placebo group. No adverse events were reported during the study.”

Vitamin C. Most people know vitamin C as an immune support vitamin, but Dr. Sandford explains that it’s important when it comes to stress, too. “Vitamin C is also believed to be a stress ‘buster’ and reduces the stress by supporting the adrenal glands and allows a person to bounce back more quickly,” Dr. Sandford says. “The body’s stress response system exhausts the body’s physical resources in vital nutrients such as vitamin C. Early studies in animals and humans have demonstrated that when stress depletes vitamin C levels in the body, it reduces the body’s resistance to infection and disease and increases the likelihood of further stress. When vitamin C intake is increased, the harmful effects of the stress hormones are reduced and the body's ability to cope with the stress response improves. Vitamin C helps to recover more quickly from emotional and physical stress, which may otherwise weaken adrenal glands and increase fatigue.” Dr. Sandford also notes that repeated and unpredictable stress situations increase reactive oxygen species (ROS) production in the rodent brain; vitamin C can reduce ROS in the brain, and reverse behavioral and biochemical alterations induced by chronic unpredictable stress in the brain.

Stress and Immunity

“We must de-stress before we become dis-stressed, for distress is a state of not being at ease, which leads to dis-ease—disease.” This is a favorite saying of Trace Minerals’ Dr. Chris Meletis, who explains: “High cortisol levels are associated with poor immune competence, since stress hormones lower the immune system and raise blood sugars that can fuel illness and are reflective of a dysregulated state of being.” His suggestion: an attitude of gratitude. “This is a focus for my patients, which includes the daily proclamation: ‘All I can do is my best, and my best is all that I can do.’”

One option for those who need a supplemental assist: Maitake. Mark Kaylor recommends Mushroom Wisdom’s Maitake D-Fraction, “a standardized concentrated extract of the constituents found in the maitake mushroom that have demonstrated the strongest immune system supporting benefits and actions. It is a unique beta-glucan that has the optimal size and structure to be orally bioavailable. Comparison studies have confirmed D-Fraction as one of the strongest immune health supporting allies. Whole maitake will contain some of the D-Fraction, of course, but not at nearly as high a level as the D-Fraction, but it will contain other compounds that support a range of other activities,” including cognitive health and antioxidant protection.

Consumer Concerns

NOW’s Neil Levin says that some customers ask about the effects of poor sleep. His answer: “Missing sleep makes people groggy, tired, disoriented, unbalanced, irritable, unfocused, and less able to deal with immune challenges. If that happens for a night or two, people can generally recover pretty well, but continuing over days, weeks, or months it becomes a growing concern. Sleep is essential to proper repair of the body. This includes shutting down chronic stress mechanisms by sleeping enough (in a dark place!) to generate melatonin, which reduces cortisol and lets the adrenal gland recover.”

This brings us to the next question Levin says NOW gets—what are the effects of stress? “Chronic stress impacts these health factors without let-up, magnifying their effects. Blood pressure, blood sugar, immunity, mood, appetite, and metabolism are all affected by stress levels. Stress uses up nutrients, as well. The adrenal glands concentrate vitamins C and B, for example, and utilize cholesterol and amino acids to make hormones. Stress potentially uses all of these substances, and chronic stress would use even more, increasing the risk of insufficient nutrient stores to do the jobs that we need them to do.”

Cheryl Myers, with Terry Naturally, says she receives different questions. “A common denominator in the questions we get about both sleep and stress is that people want something that reduces stress or helps them sleep, but also doesn’t leave them feeling tired or sluggish during the day, or the next morning after waking up. Stress is a difficult condition because while it can make a person feel agitated and ‘revved up,’ it is also exhausting. I think that people want two things when it comes to anxiety relief—an immediate sense of calm and confidence, and a sense that they can deal with stressful events in the future.” Myers recommends Terry Naturally’s AnxioCalm: “It features a clinically studied, specialized extract of Echinacea angustifolia, developed at the Hungarian Academy of Science in Budapest, Hungary. They found that the unique alkamides profile in AnxioCalm best attached to cannabinoid 1 (CB1) receptors in the brain’s endocannabinoid system—even matching the prescription drug chlordiazepoxide (Librium) for results, but without any of the side effects. AnxioCalm does not cause daytime sleepiness, grogginess, changes in judgment, or other adverse effects associated with typical anxiety interventions.”

Myers notes, however, that sleep can be disrupted by more than just stress. “Physical pain can be a barrier to restorative sleep as well. For sleep issues that are due to physical pain, I recommend our Curamin PM. It features pain-relieving ingredients found in our award-winning Curamin supplements, including BCM-95 and Bos-10 Boswellia, but it also delivers melatonin and vitamin B6 in a bioactive form to support muscle repair and balanced serotonin levels.”

Other worries: travel. “Terrific Zzzz is perfect for people who are looking for a non-habit-forming way to get the restful sleep they need without feeling groggy in the morning,” Myers says. “And while it can be used every night, I like to think of it as a corrective combination that helps people get back into the cycle of healthy sleep. Some may only need to take it for a few days, and after that, they’re set and back into a rhythm of rest. For anyone traveling, it can be an ideal supplement.” Terrific Zzzz features lemon balm, lavender, mandarin, and ravintsara.

Myers’ final tip: “Talking to customers can make a difference. Find out if they are dealing with ongoing stress or sleeplessness, or just occasions that may require nutrients that help them feel calm and promote restful sleep.”
Final Takeaway

“We can only deliver the benefits consumers expect from herbal products if they are of good quality, skillfully formulated, and taken in the amounts known to be effective,” asserts Herbalist Alchemist's Winston. And while the above list is not 100% herbs—maybe only 90%—Winston’s point holds for the two holdouts. “Quality and therefore efficacy varies widely. The reputation of the manufacturer is therefore key. When a retailer is selecting products for a store, they should ask questions about how the products are developed, how they are made, what their process for confirming identity is, all of which relate to the overall quality and therefore efficacy.”

Kaylor agreed. “A fairly recent independent study found that ~75% of reishi products tested did not contain any reishi mushroom.” And when products do contain reishi, Kaylor emphasizes that how it is produced makes a big difference: “It should be extracted in both hot water and alcohol; should use the appropriate part, namely the fruiting body; and be grown on its natural food source, ideally log grown.” Stress and sleep have huge effects on quality of life. If a customer buys a product from you that makes a difference, they’ll come back—but for that, the product has to be high quality and efficacious. WF

1. Dan Witters and Jim Harter, "In U.S., Life Ratings Plummet to 12-Year Low," Posted 4/14/2020. Accessed 7/1/2020.