Fullscript Academy

Stress is an inevitable part of life. However, while short-term stress can be beneficial, chronic stress can lead to numerous health issues. Maintaining proper nutrition and a balanced diet is essential in mitigating the adverse effects of stress by supporting the body’s stress response and enhancing overall well-being.

How stress affects the body

The body's stress response is governed by the hypothalamic-pituitary-adrenal (HPA) axis. When a person feels threatened or stressed, the brain sends a distress signal to the hypothalamus, activating the sympathetic nervous system and releasing adrenaline, or epinephrine, from the adrenal glands. (Wong 2011) The hypothalamus also releases corticotropin-releasing hormone (CRH), prompting the secretion of adrenocorticotropic hormone (ACTH), which in turn stimulates the adrenal glands to release cortisol, the primary stress hormone. (Noushad 2021)

Adrenaline increases heart rate, blood pressure, and energy supplies, while cortisol boosts blood glucose levels, alters immune responses, controls blood pressure, and reduces inflammation. (Healthdirect Australia 2023) (National Library of Medicine n.d.) Once the threat passes, cortisol levels decrease, allowing the body to return to its normal state and maintain homeostasis.

Chronic stress, however, can lead to prolonged elevation of cortisol and other stress hormones, which can negatively affect:

• Cardiovascular health

• Digestion and gastrointestinal health

• Immune function

• Memory (Yaribeygi 2017)

• Mental health (Marin 2011)

• Metabolic health (McEwen 2017)

• Sleep (Da Estrela 2020)

Stress can negatively impact mental health. 

Key nutrients involved in stress response

Several nutrients are essential for the body to effectively manage and respond to stress.

B vitamins

B vitamins, particularly B6, B9 (folate), and B12, are crucial for brain health and the synthesis of neurotransmitters like serotonin and dopamine, which regulate mood. Deficiencies in these vitamins can lead to increased stress levels and impaired cognitive function. (Kennedy 2016)

Magnesium

Magnesium plays a vital role in the regulation of the HPA axis and the production of neurotransmitters. It has a calming effect on the nervous system, reducing anxiety and promoting relaxation. Magnesium deficiency is often linked to increased stress and anxiety. (Pickering 2020)

Omega-3 fatty acids

Omega-3 fatty acids, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are essential for brain health and have anti-inflammatory properties. (Dighriri 2022) They help modulate the stress response and improve mood. (Wani 2015) Omega-3s are also known to enhance cognitive function and reduce the risk of depression. (Mehdi 2023)

Vitamin C

Vitamin C is a powerful antioxidant that helps protect the body from the damaging effects of stress. It supports the immune system, reduces inflammation, and aids in the production of stress hormones. (Marik 2020) (Chambial 2013)

Zinc

Zinc is involved in numerous biochemical processes, including neurotransmitter function and the immune response. (Kiouri 2023) It helps modulate the body's stress response and has been shown to improve mood and reduce anxiety. (Totten 2023)

Assessing nutrition status

It’s important to assess a patient’s current nutrient status before recommending any nutritional strategies for stress management.

Diet

Review patient dietary habits to identify potential deficiencies or imbalances. This includes gathering detailed information about their food intake, meal patterns, appetite, and any digestion issues. (Reber 2019)

Lab tests

Lab tests such as a complete blood count, lipid profile, electrolyte test, and liver parameters can measure levels of key nutrients, detect any deficiencies, and aid in finding the source of deficiencies. (Reber 2019)

B vitamins

Common tests to evaluate B-vitamin status include:

• Homocysteine levels: Elevated levels indicate deficiencies in B6, B9 (folate), or B12. (National Library of Medicine n.d.)

• Methylmalonic acid (MMA): Elevated levels suggest B12 deficiency. (National Library of Medicine n.d.)

• Serum and plasma B-vitamin levels: These are standard tests for measuring B vitamin status. (National Institutes of Health n.d.)

Magnesium

Two of the primary tests for magnesium include:

• RBC magnesium: Measures magnesium levels within red blood cells, providing a more accurate assessment of magnesium stores over the preceding 2–3 months (Razzaque 2018)

• Serum magnesium: The most commonly used test, though not always a reliable indicator of magnesium status since less than 1% of total body magnesium is found in serum (National Institutes of Health n.d.)

Omega-3 fatty acid profile

To assess omega-3 fatty acid levels, consider:

• Fatty acid profile: A more comprehensive test that includes omega-3, omega-6, and other fatty acids to evaluate the overall balance of fatty acids (Sun 2007)

• Omega-3 index: Measures the percentage of EPA and DHA in red blood cell membranes, reflecting long-term omega-3 intake and status (Harris 2010)

Vitamin C

Testing options for vitamin C include:

• Plasma vitamin C: Measures the current circulating levels of vitamin C in the blood and is the most commonly used method to assess vitamin C status (Mitmesser 2016) (National Institutes of Health n.d.)

Zinc

Key tests for evaluating zinc levels include:

• Plasma (serum) zinc: The most common test to assess zinc status, but may be influenced by factors such as diet, inflammation, and pregnancy

• Urinary zinc: Measures zinc excretion through urine, which decreases significantly with zinc deficiency (Wieringa 2015)

Symptom assessment

Evaluate symptoms that may indicate nutrient deficiencies. Common symptoms may include:

• Depression

• Dry, flaky scalp

• Dry or misshapen nails

• Dull or depigmented hair

• Fatigue

• Frequent illnesses

• Irritability

• Poor concentration

• Skin changes like edema, pigmentation, and pallor

• Vision impairment

• Weakness (Reber 2019)

Nutritional strategies to manage stress

There are several nutritional strategies that can be implemented to support a balanced diet and healthy stress response.

Hydration

Ensure patients are drinking enough water throughout the day. Dehydration can exacerbate stress and impair cognitive function. (Stefanaki 2018) (Masento 2014)

Encourage moderation in caffeine and alcohol consumption as well. Excessive caffeine and alcohol can increase stress levels and disrupt sleep. (Richards 2015) (Sayette 1999) Try recommending green tea as an alternative, as green tea contains L-theanine which has been found to reduce stress and anxiety. (Williams 2019)

Staying hydrated is an important way to stay health and manage stress levels.

Anti-inflammatory foods

Incorporate foods with anti-inflammatory properties, such as fruits, vegetables, whole grains, nuts, seeds, and fish. (Stromsnes 2021) These foods help reduce inflammation, which can be exacerbated by chronic stress. (Liu 2017)

Key nutrients

Include foods rich in B vitamins like meat, fish, eggs, dairy products, potatoes, starchy vegetables, dark green leafy vegetables, fruits, nuts, and beans. Consider B-complex supplements for those with significant deficiencies. (National Institutes of Health n.d.) (National Institutes of Health n.d.) (National Institutes of Health n.d.)

Encourage the consumption of magnesium-rich foods such as nuts, seeds, whole grains, legumes, and leafy greens. Magnesium supplements can be beneficial for individuals with low levels. (National Institutes of Health n.d.)

Incorporate foods rich in omega-3 fatty acids, including fatty fish like salmon, mackerel, tuna, herring, and sardines, as well as plant-based sources like flaxseeds, chia seeds, and walnuts. Omega-3 supplements can be considered, especially for those with limited fish intake. (National Institutes of Health n.d.)

Encourage vitamin C intake through citrus fruits, berries, kiwi, bell peppers, tomatoes, and broccoli. Vitamin C supplements may support individuals with increased stress levels. (National Institutes of Health n.d.)

Include zinc-rich foods such as meat, shellfish, eggs, legumes, seeds, and nuts. Zinc supplements can help those with dietary restrictions or absorption issues. (National Institutes of Health n.d.)

Mindful eating

Encourage mindful eating, including paying attention to hunger cues, eating slowly, and savoring food. This can enhance digestion and reduce stress-related eating behaviors. (Cherpak 2019)

Healthy snacking is another mindful eating technique. Recommend nutrient-dense snacks to maintain energy levels and prevent stress-induced overeating. (Allan 2022)

Reduce stress-inducing foods

Highly processed foods often contain additives, preservatives, and high levels of sugar and unhealthy fats, which can worsen stress and inflammation. (Cortes 2021) High sugar consumption can lead to blood sugar fluctuations, contributing to mood swings and increased stress. (Jacques 2019) Encourage natural sweeteners and whole foods.

Managing stress through nutrition

Chronic stress can lead to a variety of health problems. By targeting the nutrients that play a key role in the body’s stress response, patients can begin to manage stress levels through a healthy diet. Incorporate some of these nutritional strategies into patient treatment plans to support overall health outcomes.