Holiday Stress – What’s in Your FxMed Toolbox?

Patients and Holiday Stress

We’ve made it successfully through the Thanksgiving rush. But do you or your patients need a set-and-refresh to make it through the rest of the holidays?

The holidays are supposed to be full of cheer, family, friends, good food and good feelings, but that’s often not the case.  Beyond the specter of seasonal colds and flu, patients may seek our help for another reason in December: stress.

Stress can affect a multitude of biological systems, from cardiovascular to the respiratory system—but for the acute seasonal stressors like travel, family, and dietary changes, we most often see its effects on the central nervous system and the digestive system. Tension headaches, occasional trouble sleeping, indigestion and irregularity are common culprits that we can easily address with small lifestyle changes and supplementation.

The hypothalamic-pituitary-adrenal (HPA) axis is responsible for maintaining hormonal homeostasis during times of stress, including physical, mental and emotional stress. It balances mood, energy and cognition. When back-to-back office parties produce understandably higher-than-normal levels of the hormone cortisol, our HPA axis may struggle to bring the body back into balance.

 

Approaches to Managing Stress

Easy-to-implement lifestyle habits to manage stress and help balance cortisol levels include mindfulness practices like meditation and boundary setting, taking steps to improve and optimize sleep habits, and dietary supplements.

 

Mindfulness Practices

Begin to tackle holiday stress with a practical approach like incorporating mindfulness techniques into daily routines. For example, meditation apps can provide quick sessions for immediate stress relief. They are convenient and can be used anytime, anywhere, to help ground patients in the present moment.

Guided meditation, physical activity and breathwork all positively impact a patient’s response to stress. A recent Stanford study found that 5 minutes of exhale-focused cyclic sighing breathwork improved mood and anxiety, and reduced physiological markers of arousal, like heart and respiratory rates.

Aerobic exercise reduces adrenaline and cortisol production, so a brisk walk around the neighborhood once a day could help support a patient’s mental well-being from now until the New Year. It’s also appropriate to suggest yoga or gentle stretches.

 

Optimizing Sleep

Quality of sleep affects a patient’s mental health. During the holidays, if a patient isn’t getting high-quality sleep, they can be starting from behind when faced with mental stressors. An easy way to help optimize sleep is to make use of the “warm bath effect.” After a stressful day of travel or meal planning, taking a warm bath or shower for as little as 10 minutes can help the transition from wakefulness to full sleep if taken 1-2 hours before rolling over and turning off the light. Of course, guided meditation, removing digital devices from the bedroom, and supplementation can assist sleep hygiene. And if staying with family is overwhelming, booking a hotel room or Airbnb can provide a necessary refuge and ensure quality sleep.

 

Supplementation

Consider the benefits of herbs, adaptogens, and key amino acids. These can be taken in various forms and are known for their stress-modulating properties. Even a nightly ritual involving herbal teas like chamomile can be an effective way to signal to the body that it’s time to wind down and prepare for rest. Here are some additional supplemental support options:

L-Theanine for a relaxed mental state.

Human studies have found that supplemental L-theanine promotes the generation of alpha brain waves, suggesting a state of relaxation.* And controlled clinical trials have shown that L-theanine can support a healthy stress response.*

Lavender oil to reduce stress*

Lavender has long been associated with relaxation – and there is clinically-studied oral lavender oil that is well-tolerated in patients.  Ongoing use of oral lavender oil has been shown to foster sleep quality in those experiencing occasional anxiety, calm nervousness, and support general mental health.*

Adaptogens

Adaptogens have become a standard approach to stress management in health care, with clinical trials and research supporting their use. In 60 occasionally anxious but otherwise healthy adults, one study administered ashwagandha extract over 60 days. Compared to the placebo group, the group administered ashwagandha extract demonstrated statistically significant reduction in stress scores and reduced levels of cortisol first thing in the morning.*

Phosphatidylserine for balancing cortisol*

Phosphatidylserine has been shown to support a healthy endocrine response to mental stress (loaded political conversations over turkey, anyone?).* One such study of supplementation with phosphatidylserine combined with phosphatidic acid measured the effects on the endocrine stress response (ACTH, saliva and serum cortisol) to a psychosocial stressor in 75 males over 42 days. Supplementation was shown to normalize the ACTH response, salivary and serum cortisol responses in those subjects who had higher baseline stress to begin with.*

 

Approaches for Supporting the Gastrointestinal Tract During the Holidays

During this time of the year, patients are often exposed to new foods or traditional favorites and menus higher in fat and sugar. They feel obliged to indulge in ways differing from their normal eating habits during celebrations. Even the most disciplined of patients may have unusual digestive reactions to otherwise-normal potatoes and green beans when anticipating charged conversations with distant relatives.

The HPA-axis has been shown in animal studies to support not only neurological systems, but also gastrointestinal systems suggesting that an imbalance of the HPA-axis could potentially explain stress’ effect on a patient’s gut. Acute threat to homeostasis (stress) can impact the brain-gut axis: gut physiology can be impacted with changes in motility, changes to gastrointestinal secretions, increases in intestinal permeability, and a negative impact on intestinal microbiota. Even neurological impacts of stress, like migraines, have been associated with the brain-gut axis, by way of inflammatory modulators, gut microbiota, neuropeptides, serotonin pathways, stress hormones and nutritional substances.

 

Supporting the GI Tract During Times of Stress*

Mucosal support*

Psychological and physical stress has been shown to disrupt the mucosal barrier which protects the delicate tissues of the stomach.

Deglycyrrhizinated licorice was shown in 1980’s animal studies to support stomach mucosal lining. It has since then become a regular ingredient to soothe and relieve occasional stomach discomfort.*

Probiotics

When your patient’s flight gets canceled, their brain perceives psychological stress. This can modulate the composition of the intestinal microbiota, as well as various functions of the gut through the HPA-axis and the sympathetic and parasympathetic nervous system.

Probiotics are an easy way to encourage patients to support the balance of good bacteria in the gut before stressful situations occur.

 

Supporting Digestion*

Mindful eating is the practice of making deliberate food choices that support easy digestion. Opting for straightforward, warm meals like soups, stews, and roasted vegetables are gentle on the stomach.

On the other hand, a high-fiber diet with whole grains, beans, and vegetables is essential; they’re proven to help promote regularity and help manage both occasional diarrhea and constipation. For those larger meals, taking pancreatic enzymes can assist in the digestion of food, helping digestive systems work more efficiently.

Enzymes

The production of hydrochloric acid and gastric enzymes can be vulnerable to the effects of stress and occasional sleeplessness. Supplementing with pancreatic enzymes like amylase, lipase and protease, can support digestion in the stomach and upper intestine.*  A combination of betaine hydrochloride and pepsin can work with the body to support healthy stomach acidity, gastric function, and protein digestion.*

Lifestyle improvements with Fiber and GI Motility

Occasional constipation can be a somatic response to stress, or the result of other stress responses like not drinking enough water, not getting enough physical activity, and not eating enough dietary fiber. Many patients don’t meet daily fiber recommendations in the best of circumstances! Acute stress hormones can divert blood flow away to more “important” organs, leaving the large intestine without the resources it needs to eliminate waste. Supplements can also play a supporting role: a combination of ginger and artichoke extracts have been shown to significantly improve gastric emptying. These two approaches ensure gastric comfort for patients who find themselves constipated over the holidays.

While holidays can often herald stressful times, as a practitioner, you can proactively ensure that patients are well-equipped to balance their stress and digestive health from now through January. Enacting some of these diet, lifestyle and supplemental supports now can help your patients experience the gift of a joyful, healthy holiday season.

 

*This statement has not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.