Low Dog T. Building resiliency: A strategy to cope with stress. Altern Complement Ther. August 2012;18(4):177-180.

In her column, Low Dog discusses issues of stress and coping. Stress is neither good nor bad; like many biological processes, it is necessary and neutral. However, when poorly managed or out of control, it is a factor in many mental and physical conditions. Stress is associated with obesity, sleep disorders, depression, anxiety, and heart disease. These effects can cascade; in an international study of over 29,000 participants, depression, social isolation, and hopelessness (anxiety) increased women's heart attack risk more than diabetes, high blood pressure, smoking, or obesity.

Human beings are programmed to adapt to changing environmental stressors and have innate resiliency. However, factors that have traditionally and historically supported individual resiliency – families, friendships, faith traditions, and time off from work – have become more difficult to sustain in modern society. New technological communications, for example, increase our ability to be in touch with friends and family, but also increase demands to be constantly available, work overtime, and spend too much time interacting with electronic devices. Human beings, social animals, need "face time" with each other, as well as time rejuvenating in nature, to maintain resiliency against stress. Low Dog urges practitioners to inquire about patients' social lives as well as cholesterol levels. Loneliness and isolation, in a review of 149 studies, increased mortality risk by 50% compared to those with strong social relationships.

To build resiliency in other ways, she first addresses nutrition. She scathingly describes the typical American diet, brimming with "highly processed, high-glycemic-load foods, leading to inflammation and insulin resistance, and increasing the risk for heart disease, diabetes, and cancer . . . if one wants to give one's brain and body everything that it needs to function in an optimal way, one has to give it premium fuel. One does not put the cheapest gas available in a high-performance car." Beyond physical needs, food nourishes our senses, and sharing food with others is a deeply social act. Specific dietary supplements Low Dog finds most important to resiliency are omega-3 fatty acids, a daily multivitamin, and magnesium.

Besides tying many people 24 hours a day to electronic devices, modern technology has removed much of the need for physical exertion. Most people in the US, for example, can buy groceries or prepared foods relatively easily, rather than having to forage, hunt, harvest, or prepare every bite. Modern transportation, household appliances, and even the television remote control enable a sedentary lifestyle. However, physical exercise and physical fitness are essential to good health. Exercise relieves tension and stress and boosts mood. Fitness is related to maintaining memory and cognitive function with increasing age. Physical activity increases blood flow to the hippocampus, decreasing risks of memory loss and dementia. Low Dog particularly recommends "green exercise," or outdoor physical activity. Just 5-10 minutes of outdoor activity can produce benefits.

Sleep is another key to resilience. Sleep deprivation produces errors, accidents, irritability, depression, cravings for sugar and fatty foods, and higher stress hormone and C-reactive protein levels. Here again, clinicians are urged to ask patients how they are sleeping, and if they are not sleeping well, to ask about specifics such as environmental factors, work schedules, and nicotine, alcohol, caffeine, and medication use. Sleep apnea or restless leg syndrome may be involved. The blue light from computer screens suppresses melatonin production and should be avoided 2-3 hours before bedtime.

Low Dog relies on three adaptogens to help overstressed patients. Rhodiola (Rhodiola rosea) is for those who are "burned out." They may have more physical and somatic issues, chronic fatigue or fibromyalgia, and low cortisol levels. Asian ginseng (Panax ginseng) benefits patients who have strong constitutions but are getting more colds or flus, feeling less alert, etc. She recommends ashwagandha (Withania somnifera) to patients who cannot sleep, despite being tired, due to thinking about their waking concerns. All three herbs help regularize the hypothalamic-pituitary-adrenal axis.

Finally, Low Dog urges clinicians to plan "resiliency visits" with patients to discuss lifestyle issues rather than clinical ones. In addition to helping provide patients with tools to better manage stress and build resiliency, such visits build better patient-practitioner relationships, not solely based on illness or disease, but on wellness. If a practitioner cannot schedule such visits, a team member may be designated, either within a practice or in the larger community, for such health coaching.