Managing Stress During Uncertain Times

// Danielle Huntsman, MS, CNS, LDN

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

Patient encounters during turbulent times 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 pressures 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 the world less weird for our patients or use that wand to unwind family dysfunction that may be inevitable. Notwithstanding, a dash of assessment and a dollop of adaptogens may be the best new recipe to attempt.

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 Procuring food for your family and managing changes to your routine may lead to feelings of dread. My wish for you, during this period of uncertainty is to not be that practitioner who disregards 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 muscle tension. Stress hormones such as adrenaline and cortisol levels can also be elevated. However, that which is acute may rear its 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.

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 encounter even if that encounter is occurring via video conference. But did you document that? Did your question about their current stress level 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 patient encounter, within a few minutes. A healthy and open communication line should not be undervalued or dismissed when developing a thorough evaluation and treatment plan; 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 are dealing with various stressors. 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 increases alpha brain wave activity, creating a sense of relaxation without daytime 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.*

Sleep quality may be decreased due to stressors including but not limited to job change or loss, financial obligations, illness, and drastic changes to routines. 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 and is non-habit forming.*10,11 Many practitioners recommend magnesium consistent with clinical need which makes standard dosing for sleep challenging. However, one placebo-controlled study provided a 320 mg dose 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.*

Supporting stress levels can be a valuable gift during especially turbulent times. In fact, it can be used as a time to recharge and reflect. I also recognize that I have to take care of myself during difficult times. If my patients’ 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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