Best Natural Supplements for Stress Management

The Best Natural Supplements for Stress Management

Research shows stress significantly increases the amount of nutrients used and excreted by the body. Therefore, if your patients present with chronic stress, it is highly probable they also have chronic nutrient insufficiencies or deficiencies and could benefit from a foundational stress management protocol.

Stress is a common cause of micronutrient depletion in modern society, which can exacerbate the symptoms of stress and cause further dysfunction and disease throughout the body since vitamins, minerals, and other nutrients are essential for optimal physical and mental function. The nutrient insufficiencies and deficiencies that occur secondary to stress can be an underlying cause of many health concerns beyond stress. This article dives into the latest research to explore the health concerns fueled by stress and determine the best supportive supplements for stressed-out patients.

What is Stress?

In the simplest terms, stress is the response to a stressor. A stressor can be physical or emotional, acute or chronic, real or perceived, and the impact of a stressor on individual patients can vary widely. The same stressor that causes negligible effects in one patient may result in life-threatening effects in other patients.

From a biological standpoint, the stress response comprises a series of reactions involving the hypothalamic–pituitary–adrenal (HPA) axis. When a stressor is experienced, several hormones are released to respond to the stressor, including adrenaline, noradrenaline, and cortisol.

While the stress response is essential for life, excessive acute or chronic activation of the stress response is associated with several health concerns. Acute stress is associated with asthma, eczema, urticaria, migraines, headaches, blood pressure concerns, pain conditions, gastrointestinal symptoms (abdominal pain, dyspepsia, diarrhea, constipation, etc.), and mental health disturbances, including panic attacks and psychotic episodes.¹

Chronic stress is also associated with numerous health concerns, including anxiety, depression, Alzheimer’s disease, cardiovascular diseases, metabolic disorders (obesity, metabolic syndrome, and type 2 diabetes), insomnia, restless leg syndrome, and several cancers.¹

Fortunately, research confirms natural supplements can support optimal physiologic function during stress and balance the stress response.

Magnesium for Stress Relief

Both stress and magnesium deficiency are highly prevalent health concerns in modern times. Numerous studies have investigated the effects of magnesium on the physiological stress response, and the research shows magnesium plays a key role in the regulation and neurotransmission of a healthy stress response.²

In general, sub-optimal magnesium status correlates with suffering from psychological stress and the associated symptoms.² Evidence also suggests that exposure to stressors is associated with lower blood magnesium concentrations and increased urinary excretion of magnesium.¹ Since magnesium is used and excreted during a healthy stress response, repeated or chronic exposure to stressors could potentially exacerbate the symptoms of stress if the magnesium is not replenished daily.²

An abundance of clinical studies confirm magnesium supplementation supports stress management. Since the severity of stress and other mental health concerns can be somewhat difficult to measure, the Depression Anxiety Stress Scale (DASS) was developed. It is a validated psychometric measure of stress.³

In one clinical study, individuals with fibromyalgia and mild to moderate stress were supplemented with 50 mg of magnesium twice daily for one month. Their scores on the DASS significantly decreased from 22.1 ± 2.8 to 12.3 ± 7.0, while there was no beneficial change in the placebo group (21.9 ± 11.9 to 22.9 ± 11.9).⁴

Pouteau et al. studied the beneficial effect of magnesium alone and magnesium plus vitamin B6 supplementation on subjects between 18 and 50 years of age with moderate to extremely severe stress per the DASS assessment. The dose of magnesium administered in the study was 300 mg per day.³

The study results demonstrated eight weeks of daily magnesium supplementation significantly alleviated stress. Magnesium plus vitamin B6 and magnesium supplementation alone reduced stress by approximately 40% in the study subjects. In those with severe or extremely severe stress, though, magnesium combined with vitamin B6 provided a 24% greater reduction in stress than magnesium alone.³

This study highlights the synergistic benefits that can be achieved with a supplementation protocol that includes a combination of supportive nutrients. In addition to magnesium, research shows supplementation with an adaptogen, such as Ashwagandha, plus a vitamin B-complex, are evidence-based, natural treatment options to support optimal stress management.

Vitamin B-Complex for Stress Relief

As mentioned above, combining vitamin B6 with magnesium may provide superior stress management support compared to magnesium alone for extreme stress. Research also shows B vitamin deficiencies, especially vitamins B1, B6, B7, B9, and B12, are associated with mood disorders and increased stress.^5,6

A study that compared dietary intake of B vitamins with mental health concerns found that a higher dietary intake of dietary B vitamins, including biotin and vitamin B6, was associated with a lower prevalence of stress symptoms.⁶ A randomized, placebo-controlled, double-blind, parallel groups trial assessed the effects of a B-complex vitamin and mineral supplement in 215 healthy 30 to 55-year-old males. Only 33 days of supplementation with the B-complex significantly reduced subjective stress ratings in the study subjects.⁷

A recent systematic review and meta-analysis of randomized controlled trials revealed evidence that suggests an overall positive effect of B vitamin supplementation for stress management. The latest research continues to demonstrate supplementation with a B-complex reduces stress levels in adults.⁸

How Do B Vitamins Reduce Stress?

B vitamins reduce stress via several mechanisms. B vitamins are required daily for the synthesis of nucleic acids, coenzymes, steroid hormones, fatty acids, amino acids, neurotransmitters, glutathione, and more. Together, the efficient production of these substances supports optimal health and stress management every day.⁹

B vitamin intake also affects the health of the gut microbiome, which can then impact the HPA axis and mental health. Research shows supplementation with riboflavin increases the abundance of Faecalibacterium prausnitzii, Roseburia spp., and Prevotella spp. – microbiota that produce short-chain fatty acids (SCFAs).¹⁰

A higher intake of pantothenic acid, riboflavin, vitamin B-6, and vitamin B-12 is linked to an increased abundance of SCFA-producing Prevotella spp. In study participants with low-grade inflammation, B12 supplementation increased the concentration of Bifidobacteria, which produce exopolysaccharides (EPS). Research suggests EPS may offer anti-inflammatory, immunostimulatory, anti-tumor, and antioxidant properties to promote optimal physical and mental health.¹⁰

In adults, a higher intake of vitamin B-12 is associated with increased alpha diversity of the gut microbiome. However, in infants and children, there is no significant association between vitamin B-12 intake/status and alpha diversity. Alpha diversity refers to the variety of species present in a single sample of the gut microbiome.¹⁰ The results of clinical and animal studies consistently show supplementation with a vitamin B complex reduces levels of cortisol, tumor necrosis factor-α, cyclooxygenase-2, lipid peroxidation, and interleukin-1 beta to support optimal mental and physical health.¹⁰

Stress During Pregnancy, B Vitamins, and Neural Tube Defect (NTD)

A recent systematic review and meta-analysis highlights a clinically concerning association between stress levels during pregnancy and the development of neural tube defects (NTDs) potentially secondary to sub-optimal vitamin B status.¹¹

Analysis reveals that mothers who experience stressful life events during the periconceptional period are at a significantly greater risk of having a baby with an NTD than those who do not. Moreover, the researchers suggest the effect of maternal stressful life events on NTD risk might be mediated by folic acid supplementation. They also note common stress-related lifestyle changes, such as cigarette smoking and reduced nutrient intake, could contribute to the increased risk.¹¹ A clinically effective stress management protocol could be beneficial for all women of child-bearing age to improve generational health.

The Adaptogen Ashwagandha (Withania somnifera) for Stress Relief

Ashwagandha (Withania somnifera) is an adaptogenic medicinal herb with an abundance of bioactive phytonutrients that have many beneficial effects throughout the body. The various phytonutrients in Ashwagandha are still being discovered, but the list includes withananine, somniferine, scopoletin, somniferiene, somnine, tropine, tropanol, somniferinine, pseudo-withanine, pseudotropine, choline, cuscohygrine, isopelletierine, withasomidienone, withaferin A, withanolides A-Y, withanone, withadomniferin A, withasomniferols A-C, and bioflavonoids, including quercetin and its glycosidic derivative, 3-O-rutinoside-7-O-glucoside.^12-14

Botanical adaptogens improve the ability to adapt to change and cope with stress – physically, emotionally, and mentally. The latest definition for adaptogens is “a class of metabolic regulators that enhances the body’s ability to adapt to environmental factors and avoid the damage they could imply.” Thus, by definition, adaptogens safely reduce the negative impacts of stress.¹²

Ashwagandha for Stress Management – Clinical Evidence

Clinical research studies provide ample evidence Ashwagandha root extract supports stress relief. One single-center, prospective, double-blind, randomized, placebo-controlled trial included 64 participants with chronic stress. After only 60 days of supplementation with Ashwagandha, the study group that took the Ashwagandha root extract experienced a significant reduction in all stress assessments.¹⁵

The Perceived Stress Scale (PSS) is a validated psychological scale for assessing stress levels. A PSS score can range from 0 to 40, with a score of zero equating to the absence of stress. After only 60 days of treatment, there was a 44.0% reduction in perceived stress in the Ashwagandha group, compared to only a 5.5% reduction in baseline PSS scores in the placebo group.¹⁵

The GHQ-28 questionnaire is another validated assessment of overall stress. The total score for the questionnaire represents a measure of overall stress. The subjects in the study group who received Ashwagandha reduced their total GHQ-28 scores by approximately 72%, compared to the placebo group’s reduction of only 2%.¹⁵

Results were similar for the DASS questionnaire. The study group that took Ashwagandha for 60 days reduced their score on the “Stress” item subset by 64.2%, while the score for the placebo group decreased by only 10.4%.  These results are consistent with several other clinical studies on Ashwagandha.¹⁵ A randomized, double-blind, placebo-controlled study published in October 2023 also determined that 60 days of supplementation with an Ashwagandha root extract significantly reduced the PSS score compared with a placebo.¹⁶

Furthermore, research confirms Ashwagandha root extract offers a glowing safety profile. A recent randomized, placebo-controlled clinical study with healthy individuals concluded Ashwagandha root extract is safe, well-tolerated, and does not cause serious adverse events. All physical, hematological, and biochemical parameters measured in the healthy male and female participants remained within the normal range throughout the study.¹⁷

A Synergistic Protocol to Manage and Reduce Stress

Research suggests combining nutrients, herbal extracts, and other nutraceuticals could offer powerful synergistic benefits beyond supplementation with only one. A clinical study by Harris et al. confirmed supplementation with a multivitamin, mineral, and herbal formulation significantly reduced overall stress.¹⁸

Supplementation with a combination of an adaptogen, magnesium, green tea, and B vitamins has been shown to objectively improve the stress response via brain imaging studies. After only 28 days of supplementation with the synergistic blend, the brain response to stressful (thermal) stimuli in chronically stressed individuals was effectively modulated.¹⁹

Manage Stress Naturally with the Top Evidence-Based Holistic Supplements

Research shows supplementation with the three natural supplements mentioned above – magnesium, B vitamins, and adaptogenic herbs – significantly reduces stress levels and may reduce the risk of developing stress-associated diseases. Stress promotes multiple health concerns, including neurological conditions, hypertension, diabetes, obesity, etc., so stress can be a serious health issue for you and your patients. Remaining mindful of the latest medical research when prescribing a treatment protocol for stress management could result in superior outcomes for your patients.

If stress is a concern for you or your patients, order an Adrenal Stress Index Panel for insight into the health of the Hypothalamic-Pituitary-Adrenal (HPA) axis. To place a test order, click here. As a reminder, DiagnosTechs will drop ship test kits directly to your patients. You may select this option at the top of the order form. 

Please visit our Provider Tools page for more information about Choosing the Right Test and Adrenal Restoration. 

References:

1. 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. doi:10.1093/advances/nmz082
2. Pickering G, Mazur A, Trousselard M, et al. Magnesium Status and Stress: The Vicious Circle Concept Revisited. Nutrients. 2020;12(12):3672. doi:10.3390/nu12123672
3. Pouteau E, Kabir-Ahmadi M, Noah L, et al. Superiority of magnesium and vitamin B6 over magnesium alone on severe stress in healthy adults with low magnesemia: A randomized, single-blind clinical trial. PLoS One. 2018;13(12):e0208454. doi:10.1371/journal.pone.0208454
4. Macian N, Dualé C, Voute M, et al. Short-Term Magnesium Therapy Alleviates Moderate Stress in Patients with Fibromyalgia: A Randomized Double-Blind Clinical Trial. Nutrients. 2022;14(10):2088. doi:10.3390/nu14102088
5. Sofyan M, Fitriani DY, Friska D, et al. B Vitamins, work-related stress and emotional mental disorders: a cross-sectional study among nurses in Indonesia. Nurs Open. 2022;9(4):2037-2043. doi:10.1002/nop2.1213
6. Mahdavifar B, Hosseinzadeh M, Salehi-Abargouei A, et al. Dietary intake of B vitamins and their association with depression, anxiety, and stress symptoms: A cross-sectional, population-based survey. J Affect Disord. 2021;288:92-98. doi:10.1016/j.jad.2021.03.055
7. Kennedy DO, Veasey R, Watson A, et al. Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males. Psychopharmacology (Berl). 2010;211(1):55-68. doi:10.1007/s00213-010-1870-3
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9. Calderón-Ospina CA, Nava-Mesa MO. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther. 2020;26(1):5-13. doi:10.1111/cns.13207
10. Śliwiński W, Gawlik-Kotelnicka O. Circulating B vitamins metabolites in depressive disorders – connections with the microbiota-gut-brain axis. Behav Brain Res. 2024;472:115145. doi:10.1016/j.bbr.2024.115145
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13. John J. THERAPEUTIC POTENTIAL OF WITHANIA SOMNIFERA: A REPORT ON PHYTOPHARMACOLOGICAL PROPERTIES. Int J Pharm Sci Res. 2014;5(6): 2131-2148.
14. Wiciński M, Fajkiel-Madajczyk A, Kurant Z, et al. Can Ashwagandha Benefit the Endocrine System?-A Review. Int J Mol Sci. 2023;24(22):16513. doi:10.3390/ijms242216513
15. Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012;34(3):255-262. doi:10.4103/0253-7176.106022
16. Majeed M, Nagabhushanam K, Mundkur L. A standardized Ashwagandha root extract alleviates stress, anxiety, and improves quality of life in healthy adults by modulating stress hormones: Results from a randomized, double-blind, placebo-controlled study. Medicine (Baltimore). 2023;102(41):e35521. doi:10.1097/MD.0000000000035521
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