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Holiday Stress: What You Need to Know For Your Patients’ Health

// Danielle Huntsman, MS, CNS, LDN

Holiday Stress: What You Need to Know for Your Patients' Health

Office visits during the holiday season are akin to full moons in the hospital. Nothing is ordinary. One of my mentors touted this refrain. “Address the stress. It’s a mess. Listen to your patients, give them a quiz or give them a test.” Thanks to the persistent busyness and stress, a patient’s complaints range from occasional anxiousness, stress, fatigue to trouble sleeping through the night. But stress or the consequences of it may take a backseat to the reason for their visit. Nevertheless, address the stress. In practice, we may wish to use our magic wand to make work parties less weird for our patients or use that wand to unwind family dysfunction that may be inevitable when they gather. Notwithstanding, a dash of assessment and a dollop of adaptogens may spice up the season in just the right way.

Evaluating Stress

Due to the close relationship between the endocrine system, the central nervous system, and the immune system, even short-term, acute stress can significantly affect one’s overall health.1 Full shopping carts can bring joy or dread. The subsequent credit card bill likely provides a bit more of the latter. My wish for you, this holiday season is to not be that practitioner who disregards holiday stress as something simply to be endured. The body can respond to stress in various ways, typically expressed as elevated heart rate, occasional anxiety, and increased in muscle tension. Stress hormones such as adrenaline and cortisol levels can also be elevated. However, that which is acute may rear it's ugly head as the beginning of something chronic unless the practitioner-patient team has eyes fully fixed on resolving stressors and returning the body to homeostasis.

Address the stress, it's a mess”

Salivary or urinary cortisol, if available, is helpful for clinical evaluation. While lab results are a valuable piece of information, through dialogue and physical cues, you can often assess a patient’s stress level during an office visit. But did you document that? Did your question about holiday stress or the season come off as the lame rhetorical “how are you?” that their coworker asked in an email? Assessments such as the Hamilton Anxiety Rating Scale (HAM-A) or Beck Depression Inventory (BDI) serve as useful screening tools, which can be completed before or during an office visit, within a few minutes. A healthy and open communication line should not be undervalued or dismissed when developing a thorough evaluation and treatment plan, but assess and address the stress.

Adaptogenic Herb Benefits for Stress*

Adaptogenic herbs such as ashwagandha, rhodiola, and Holy basil, are unique as they aid in the homeostasis of the body’s stress response.* Considered to be a sacred herb in India, holy basil supports improved attention and feelings of occasional anxiousness.*2 Along with its benefits on mental performance, clinical studies have also shown ashwagandha to aid in stress resilience.*3 Rhodiola, specifically WS 1375®, at a dose of 200 mg, twice daily, has been shown to support healthy energy levels as well as improved mood.*4

The Importance of Sleep

Your patients have a to-do list a mile long during the holidays and they are constantly checking it. Sometimes they even do so while resting on their pillow. Mental check-listing before bed may be an indication that a healthy cortisol rhythm should be supported. Phosphatidylserine is a favorite among colleagues; it has been shown to blunt the response of both adrenocorticotropin hormone and cortisol.*5 L-theanine, an amino acid derived from green tea increases alpha brain wave activity, creating a sense of relaxation without added side effects such as drowsiness.*6 Benefits of L-theanine have been shown at a dose of 50 mg to start with to clinical trials using as much as 600 mg per day.6,7 Doses of 400-500 mg may be necessary in individuals with challenges of staying asleep.*8 Ashwagandha has been shown to return cortisol levels to a healthy range, while also increasing mental performance and concentration.*9 Supporting healthy cortisol levels can influence not only the body's stress response but also the sleep-wake cycle.*

Speaking of lists, where do you suspect sleep is on the average person’s healthy behavior list during the holidays? Probably page two! Due to its vital role in daily cortisol rhythm and energy production, proper sleep hygiene should not be forgotten. You may already be using melatonin; it can be a fantastic choice when it comes to sleep quality and duration without morning drowsiness or added side-effects.*10,11 L-theanine, is also great for restorative sleep and unwinding and has a role in balancing neurotransmitters.12 Many practitioners recommend magnesium consistent with clinical need which makes standard dosing for sleep challenging. However, one placebo-controlled study provided a 320 mg dos of magnesium in order to support sleep. 13 Investigators in that study tracked the Pittsburgh Sleep Quality Index (PSQI).

Dietary Effects on Stress

Lastly, while perhaps an obvious question, asking about dietary choices can confirm if they are receiving enough antioxidants and micronutrients to compensate for the added stress. Water soluble vitamins such as vitamin C and B vitamins are rapidly depleted during times of stress and are essential for adrenal health.* B vitamins such as folate, B3, and B6 serve as coenzymes in the synthesis of neurotransmitters such as dopamine, serotonin, and GABA.

The holiday season is a time to share and celebrate with family and friends; supporting stress levels can be a valuable gift. In fact, I too use this time to recharge and reflect. Part of my self-care is ensuring my patients do not flood my schedule with post-holiday affective disorder (not a real thing, I made that up) along with their New Year’s resolutions and bigger problems. If my patients’ holiday stress is not managed or addressed, it can turn into my mess. A preventative solution is proactively addressing the stress.

Danielle Huntsman, MS, CNS, LDN

Danielle Huntsman, MS, CNS, LDN is a certified nutrition specialist and licensed nutritionist. She holds an MS in Nutrition and Integrative Health from Maryland University of Integrative Health and is a graduate of the College of Charleston. Danielle has a special interest in gastrointestinal and endocrine health, supporting clients through an integrative approach with proper diet and nutrition. She actively sees clients remotely and within the Philadelphia area.

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