A recent Pew research poll conducted in February found that approximately one-third of the U.S. population experienced anxiety and occasional difficulty sleeping in the previous week. When asked about the future, only 22 percent of respondents reported feeling hopeful most of the time, leaving 78 percent with only occasional to slim feelings of hope for the future. Twenty-two percent felt depressed at least occasionally and about 20 percent reported feeling lonely.
Top Reasons for Stress
Before the pandemic, a number of polls and studies found that Americans felt stress for commonly expected reasons such as:
• Health and health care concerns
• Disapproval of government performance and worries over politics
• Natural disasters
• Current events like mass shootings
• Climate crisis
• Racial tensions
• Social media and technology
• Feelings of loneliness and depression.
Work, school, home, social and societal fronts all look different today than they did two years ago. During this pandemic time, every one of these categories above has been magnified and multiplicative for many people.
Typically, during the evolutionary process, we adapted to significant persistent change by DNA “upgrades,” one generation at a time. Significant change acts as a stressor which can be either good or bad but necessitates that we adapt. What we are experiencing now, this level of change in our private and public lives, for many people is over-taxing our capacity for adaptation as humans.
Before 2020, between 75 and 90 percent of all doctor’s office visits were related to conditions caused by stress, so, many of us did not enter this challenging time in a balanced and resilient state; therefore the impact of COVID-19 has been dramatic even for those who have not fallen ill with COVID-19.
What Is Chronic Stress?
Chronic stress is considered the type of stress that interferes with the ability to function normally over an extended period, such as more than six months. Most of us have reached that point. When faced with a physical or emotional stressor, the hypothalamus communicates with the adrenal glands triggering the release of adrenaline and cortisol. Cortisol is a steroid hormone in the glucocorticoid family, which puts the body into a state of heightened metabolism typified by increased heart rate, blood pressure, respiratory rate and glucose release, while suppressing immune function and stimulating other changes, which over time, become risk factors for symptoms and specific diagnoses, which can lead to poorer health.
Acute stress is normally dispersed in 90 minutes, however, with chronic stress people do not return to normal if the underlying issue is not resolved. And sometimes, even when the stressor is removed or the situation improved, the impact of chronic stress continues. Like poor diet, lack of sleep or sedentary lifestyle, chronic stress is leading to many physical effects, including:
• Altered digestive function resulting in IBS (irritable bowel syndrome) or changes in GI (gastrointestinal) function
• Headaches and migraines
• Increased risk of chronic diseases such as obesity, heart disease, diabetes, asthma and cognitive decline
Impacts on Mood and Cognition
Stress affects cognition in two main ways: rapidly via catecholamines and more slowly through glucocorticoids. Catecholamine actions change the short-term availability of glucose, whereas glucocorticoids alter synaptic plasticity over hours and also produce longer-term changes in dendritic structure, which last for weeks. Prolonged exposure to stress leads to loss of neurons, primarily in the hippocampus. Recent evidence suggests that these stress-related cognitive impairments involving declarative memory are likely related to these hippocampal changes.
Examples of cognitive effects are:
• Sleep problems and fatigue
• Overeating and weight gain, or sporadic eating patterns and skipping meals
• Choosing more sedentary activities and avoiding exercise
• Social isolation, loneliness and relationship challenges
• Short term memory problems
Naturopathic and Integrative Medicine Approaches Shine
None of us want less cognitive power. To help offset the effects of chronic stress there are numerous habits and approaches to take. Naturopathic doctors are uniquely trained in whole person lifestyle medicine essential for managing these complex yet increasingly common complaints. NDs recommendations include educating and empowering patients to
• Engage in regular exercise
• Take up or return to hobbies
• To experiment with breathing techniques
• Spend time in nature and outdoors
• Choose a nutrient-dense diet
• Practice at least a modicum of news avoidance
• Consider keeping a gratitude or other kind of journal
• Adopt further recommendations related to nutritional, botanical and other gentle medicine approaches delineated in the FAQ mentioned on page 15.
Many doctors also provide referrals to clinical psychologists to assist in stress management training like progressive muscle relaxation, meditation, biofeedback, cognitive behavioral therapy and more. It takes time to engage with a patient, to learn what kinds of approaches are appealing and can be sustained over time. NDs visits, typically 30 minutes or longer, provide ample time for that exploration and discussion.
As an aid for patients and the public, the Institute for Natural Medicine (INM) has two useful resources. One is an FAQ found on our website at www.naturemed.org on how NDs prevent cognitive decline and Alzheimer’s and another is our new e-book in our Food as Medicine series provides a curated collection of recipes designed to provide support for healthy cognition. You can find our Food and Mental Clarity e-book available for download on our website.
Michelle Simon, PhD, ND President & CEO, Institute for Natural Medicine
In 1992, the leadership core of naturopathic doctors established the Institute for Natural Medicine (INM) as a not for profit organization dedicated to advancing natural medicine. The purpose of the INM is to increase awareness of, broaden public access to, and encourage research about natural medicine and therapies. Among its milestones the INM counts the launch of the Association of Accredited Naturopathic Medical Colleges (AANMC) as an independent organization, leading California’s efforts to obtain licensure, developing an interactive childhood education program focused on healthy eating and lifestyles called Naturally Well in 2017, and expanding residency access by establishing and funding a residency program in 2018. INM has joined forces with the American Association of Naturopathic Physicians (AANP), serving as the charitable arm, to deepen access to naturopathic care, public education and research. Dr. Michelle Simon serves as president and CEO of INM, is a licensed naturopathic physician, clinician, educator, and leader in many organizations dedicated to improving the quality and delivery of health care. In addition to holding a naturopathic doctorate from Bastyr University, she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill. Dr. Simon has served on the boards for the Integrative Healthcare Policy Consortium (IHPC), the AANP and the Naturopathic Physicians Research Institute (NPRI). Dr. Simon also served nine years on the Washington State Health Technology Clinical Committee which is part of the Health Technology Assessment program that examines the scientific evidentiary basis for efficacy, safety and cost effectiveness of health care technologies. She was also an invited participant for health care economics at “Summit on Integrative Medicine and the Health of the Public” at the Institute for Medicine (IOM) in 2009. Dr. Simon was recognized as the 2018 Physician of the Year by the AANP.