Updated: Nov 14, 2022
Chronic stress can literally shrink your brain and reduce your ability to think. Fortunately, there are several things you can do, from lifestyle choices to high-quality supplements, that can protect, repair and boost cognitive function.
Stress. Some people thrive off it, getting amped up even thinking about the word. For others the thought of stress elicits, well, more stress. No matter where you fall on that spectrum, chances are that you are so used to living with it constantly that you don't recognize all the triggers or symptoms.
And unfortunately, there is plenty of stress to go around nowadays. Along with food and sleep, stress is one of biggest external contributors to our changing physiology. Clearly, we cannot make all of our stress go away. But how we react to it can make an immense difference in how our body deals with it.
In fact, how we react to stress has an immense and direct impact on immune function, weight control, sleep, mood, energy, hormone regulation and balance, and maybe most importantly - cognitive function.
As a neurologist, improving cognitive health is something close to my heart (and brain). As an integrative physician, I can unequivocally say that a functional and integrative approach is the best method to maximize, maintain and restore your cognitive health. Whether you are dealing with transient brain fog or frank dementia, stress is typically a major contributor to worsening symptoms - seeping in from all sorts of places. During consults with my patients, I make it a point to delve into a patient’s social history, identify stressors, discuss the importance of mitigating stress, and ultimately help guide patients on how to best manage stress.
When people get stressed, the body releases an elevated amount of a hormone called cortisol from the adrenal glands. In the short run, this can be beneficial. Cortisol liberates sugar in the blood stream, improves the brain’s use of glucose and promotes your adaptive "fight or flight" responses.
However chronic stress can lead to chronically elevated cortisol which can have significant negative impacts that touch nearly ever organ system and domain of health. Studies clearly show that elevated levels of cortisol have deleterious impacts on the brain. Specifically, chronically high levels of cortisol increase the activity in the fear centers of your brain (called the amygdala) and impair signaling in your learning and memory center (called the hippocampus). To top it all off, chronically elevated levels of cortisol and a stressed brain result in cortical atrophy, or a shrunken brain over time. (Find out more about it here and here).
So what can you do about it? Is damage caused by stress permanent? Thankfully the answer is no. Recent research is demonstrating that you can increase neuroplasticity and rebuild grey matter. Even better - many of the steps required don't cost you a thing. Knowing how stress can have such far reaching effects, especially regarding cognitive health, I routinely counsel my patients on proper lifestyle measures to ensure stress is being kept at bay.
Centering practices, such as meditation, breathing, prayer, or even engaging in hobbies are an important key to incorporate into your daily routine. A recent review of 13 studies on meditation for participants with and without cognitive impairment found that all 13 showed significant increases in grey matter volume. Studies on meditation and brain volume also highlight that the limbic system, which is involved in emotion and memory, are particularly preserved in those who meditate and pray regularly.
Exercise has been shown to protect the brain, specifically increasing brain derived neurotrophic factor (BDNF) and increasing neuroplasticity. BDNF is essentially a protein that acts a a growth trigger for neurons and plays an important role in neuronal survival and growth. It is involved in neuroplasticity, which is essential for memory and learning. Plasticity is a measure of the brain and nervous tissue's ability to restructure, functions and connections. The greater the plasticity, the more able the brain is to reorganize and develop new skills, retain information and operate more quickly.
With exercise, more isn't necessarily better. Exercising temporarily increases adrenalin and cortisol.
During the cool-down period, the body reduces cortisol levels (helping to train it to regulate the hormone more effectively). Studies have shown that these effects can be achieved without strenuous exercise.
Daily activities like walking or gardening can count as much as the most intense hill-sprints or gym sessions. In fact, depending on your state of adrenal fatigue, over exertion may slow recovery time and increase your risk of injury. It's always best to consult a profession before starting an exercise program, but as a basic rule of thumb, shoot for 30 minutes 5 days / week of varied programs (cardio, stretching, strength training) to see the benefits of reduced stress hormones.
Following an anti-inflammatory diet and addressing any gut imbalances are essential to managing cortisol levels. The gut and the adrenals are directly connected in a back and forth dance that can create a virtuous (or vicious) cycle.
Chronically elevated levels of cortisol increase gut permeability (or “leaky gut”), which leads to a host of unwanted gut as well as systemic effects. Gut imbalances and increased intestinal permeability can also trigger the adrenals to increase cortisol, which in turn exacerbate the gut permeability.
A proper functioning gut, on the other hand, helps to naturally regulate cortisol levels and adrenal function. Without excess cortisol, the gut is able to work more efficiently, helping it produce the host of other neurotransmitters, proteins and peptides required to support a properly functioning body.
Restoring adequate sleep is a must to keep you on track to dealing with stress and restoring cognitive function. They physiology of sleep is complex, and had been somewhat of a mystery for quite some time, however a clearer picture is emerging.
Sleep is a time for cellular restoration for the brain and body. During sleep, cells in the brain have the opportunity to clear out waste and conduct their own detox.
Additionally, the body releases hormones during sleep which impacts cell repair and use of energy. Quality and amount of sleep even has impacts on metabolism and one's risk for a pre-diabetic state. Sleep also gives your brain the opportunity to lock in new memories and enhances your ability to learn and memorize new skills. So, a healthy amount of sleep is critical for brain "plasticity".
For many people, the pressures of life in this current environment, work, kids, other responsibilities mean that lifestyle isn't enough to overcome all the adrenal exhaustion. In those cases, herbs, vitamins and supplements can help build a bridge back to a spot where your body can manage cortisol and stress more naturally, and even improve cognitive function.
Supplements include a broad category of products, with highly variable degrees of quality. As with anything, you get what you pay for - but in this case if extremely important to pick the best. Below are my recommendations for supplements and the brands that I use at Case Integrative Health. (If you don't already have a profile with Fullscript, you will be required to create one- but it's worth it for access to the best products on the market.)
I've listed recommendations individually below, or click here to see the whole bundle of my favorite products.
Good foundational supplements include:
Ascorbic Acid (Vitamin C). I prefer Pure Encapsulations.
B vitamins from Vital Nutrients.
Magnesium from Designs for Health
Cortisol lowering supplements include:
Phosphatidylserine from Designs for Health
L-Theanine from Pure Encapsulations
Lavender from Integrative Therapeutics
GABA from Designs for Health
These all support and are used in high quantities by the adrenal glands.
Finally, Ashwaghanda (again, I turn to Pure Encapsulations) among other adaptogenic herbs, can be quite helpful in balancing adrenal function, as well as being neuroprotective.
So, take some time out for yourself to survey what brings you stress in your life, and stay on a path towards better perseverance in the face of stress which will ultimately preserve your cognitive status.
Dr. Rana Mafee, MD
Note: None of the information listed above is intended to supercede or replace a plan you have created with a healthcare professional already. As with any changes to diet or supplementation, you should consult with your healthcare provider before implementation.