The ZRT Laboratory Blog

Summary: 10 Key Takeaways for Hormone Replacement Therapy Webinar

Wed, 10 May 2023 16:09:31 -0700

When women enter menopause about 45-50 years of age, their estrogen and progesterone drop precipitously, causing a long list of unpleasant symptoms such as hot flashes, mood swings, and sleep disturbances. The drop in estrogen also leads to greater risk for cardiovascular disease and accelerated bone loss that may lead to osteoporosis and increased fracture risk. Women are faced with making a decision to start taking hormone replacement therapy (HRT) to hopefully alleviate most of the symptoms and risks associated with menopause. First and foremost, the patient must find a healthcare practitioner who is qualified to administer appropriate HRT. For healthcare practitioners, first identifying the hormone problem (usually low estrogen) can be done through observation of symptoms and lab testing. Physicians rely on pharmacists well trained in hormone therapy to help them determine the optimal hormone formula and type, and what method of delivery and dosage to use.

Peter Koshland, PharmD, presented a webinar for ZRT Laboratory on the 10 key takeaways for HRT for women. Dr Koshland is President/CEO of Koshland Pharm, a compounding pharmacy in San Francisco that works closely with patients and their doctors to prescribe medications tailored to individual needs. He is also an Assistant Clinical Professor of Pharmacy at the University of California at San Francisco (UCSF), and a graduate of Georgetown University and the UCSF School of Pharmacy.

Pharmacists see a lot of patients - especially in terms of HRT - so it makes sense to utilize their expertise because of the knowledge they have in this area. They can play a large part in helping patients and their healthcare providers with product selection and symptom management.

Hormone deficiency:

There’s an odd misconception around the idea that it’s natural for women who are going through menopause to live in a hormone-deprived way for about a third of their life (menopause).
It’s an unnatural state and it’s not good physiologically as the abrupt loss of hormones at menopause can accelerate the aging process and lead to disease that otherwise could have been prevented with appropriate hormone therapy.
When hormones are not present or balanced, there are fundamental changes in the way the body works.

The key takeaway: There are great tools that can help reestablish reasonable hormone function in women safely and effectively. We want to protect our patients’ bones, their brains, and muscles. Without estrogen, these protective effects go away.

Hormones are safe:

The key takeaway: At the core of the decision, hormones are safe. Of course, there are exceptions and side effects but there has been such an overfocus on the exceptions, side effects, and perceived risks, some of which haven’t been validated in the literature. The research we have should give healthcare practitioners more confidence in prescribing HRT.

A person’s overall health impacts hormone therapy success:

If we give hormone replacement to an unhealthy person, we may not get the desired outcomes.

The key takeaway: We should encourage our patients to look deeper into their overall health status and address any underlying health issues.

Different routes of administration behave differently. There are lots of options for delivering hormones into the body including:

Transdermal patches
Topical gels and creams
Vaginal
Oral
Sublingual
Troches
Subdermal pellets
Subcutaneous injection

The key takeaway: There are ways to safely switch or move patients from one delivery and dosage form to another. Different patients need different therapeutic deliveries.

Each hormone test type has limitations and advantages:

Serum testing
Saliva testing
Cycle mapping
Blood spot testing
Urine testing

The key takeaway: Match the type of testing with the type of supplementation. It has a great impact on the clinical usefulness of hormone assessments.

General testing considerations:

Does the lab have clinical support to help interpret labs?
What is the most patient-friendly, economical, and clinically relevant test to evaluate hormonal imbalance?

The key takeaway: It’s a good idea to become familiar with the testing labs that have a proven reputation for excellence and provide the best product and service. Be sure to vet the lab.

Develop a relationship with a good compounding pharmacy committed to quality:

Where does the pharmacy source its active pharmaceutical ingredients?
What specific procedures does the pharmacy follow to ensure quality?
How is the pharmacy accountable to the prescriber and to the patient?

The key takeaway: Talk to the pharmacy and ask key questions about their service.

Everyone has their own protocol – find yours

It’s important for practitioners to find their own protocol. You don’t want to reinvent the wheel with every patient. You want to have:

An effective way to evaluate your patients
A good starting regimen
Know there are ways to change the delivery and dosage of hormone to optimize the benefits
Have a good solid foundation to your approach to treating patients with hormones

We hope you’ll tune into Dr. Koshland’s webinar on HRT. He covers so much more including a discussion on baseline testing, key hormones in a comprehensive hormone replacement plan, optimal dosing, and compounded options. If you’re interested in finding a compounding pharmacist in your area, please refer to ZRT’s Find a Provider locator.

Q&A with Dr. Jade Teta: Women, Hormones and Weight Loss

Mon, 13 Mar 2023 17:21:07 -0700

Women who are in perimenopause, menopause or post menopause sometimes feel like they’re living in a different body. Many have a hard time losing or controlling their weight—whether it’s due to shifting and declining hormones, and a slowing down of metabolism combined with stress.

We sat down with integrative physician, Jade Teta, to talk about the role of hormones and weight, why he thinks some women are having difficulty losing or controlling their weight, and what they can do about it. As a practitioner of naturopathic medicine, Dr. Teta is an expert in nutrition, exercise, and supplements, with a specialty in integrative endocrinology.

Q: Dr. Teta, can you tell us about hormones and their role in weight loss?
A: There’s no doubt in my mind that hormones dramatically impact weight loss because they either directly or indirectly influence what we eat, what we crave to eat, and how much we eat. They influence appetite, sleep, and have everything to do with stress management, so they play a profound role in all of this.

Q: Which hormones are we talking about?
A: When most people think of hormones that pertain to weight, they’re thinking of estrogen, progesterone, and testosterone. But I would say the most important hormones are thyroid and adrenal, and more importantly, the appetite hormones (for example, leptin, ghrehlin, cholecystokinin, glucagon-like peptide-1, gastric inhibitory polypeptide). Estrogen and progesterone do play a pretty pronounced role—that’s for sure.

Q: How does estrogen influence a woman’s weight?
A: When estrogen is higher than progesterone during the menstrual cycle (a different metabolic reality compared to clinical estrogen dominance), a woman can eat more without storing as much fat. She’s more likely to build muscle. She can eat less and is less likely to have hunger and craving issues and is more likely to burn fat versus muscle. Estrogen makes a woman’s metabolism more flexible, and she will respond better to diet and exercise. She’s more insulin-sensitive and less cortisol reactive. Metabolism usually works in a “Goldilocks” zone—not too much, not too little, but just right. Estrogen helps find that zone.

Q: What about progesterone?
A: Progesterone has some opposite effects. While estrogen makes the body more insulin sensitive, progesterone makes the body more insulin resistant. When estrogen is dominant or higher in the first three weeks of the menstrual cycle, during the follicular or early luteal phase, the female metabolism is more responsive, flexible, able to handle more stress and, more or less, calories.

Q: When do the weight issues for women begin?
A: Once progesterone falls at perimenopause and women stop ovulating as much, stress becomes a bigger issue for a woman. One of the first major changes in perimenopause is that a woman is going to be more stress reactive. What ends up happening in perimenopause is that a woman will say, “My body is shifting. I feel like the same diet and exercise program are not as effective,” and she makes one key mistake here. She is dieting harder and exercising more. At this point in time, the dieting and exercising she was doing when estrogen and progesterone were at sufficient levels was probably not an issue. The body was handling it fine. But once she loses the influence of progesterone, that is more stress on the body.

Q: What can women in perimenopause do about this?
A: When first moving into perimenopause, I recommend that women move away from more exercise and harder dieting to more rest and recovery, easier workouts, more massage time, slow walking, time in nature and with pets, “woosah” activities, sauna therapies, and a more moderated diet—not going to extreme in calorie reduction or exercise. The Goldilocks zone we talked about earlier becomes far more important when progesterone starts to drop. A lot of women have the exact opposite intuition at this time.

Q: How does stress fit into the weight loss/control picture then?
A: Let’s think about when women go on vacation, and they stop dieting and exercising. They lie out in the sun, sleep in, and generally just want to have a great time. When they return, they say, “How could this be possible? I lost weight.” What you’re seeing are the stress-reducing effects showing up. The metabolism is really a stress management system, not a calorie management system. Ultimately, at perimenopause, you want to give your metabolism a vacation and not make it work harder. When progesterone falls at perimenopause, it’s about stress reduction.

Q: What about when women enter menopause and post menopause?
A: Moving into menopause, estrogen falls off, and not only do women need to manage stress even more, but they have to take the rest and relaxation to the extreme. Start resting more and taking it easy. But now women are more insulin resistant, which means in mature women the percentage of calorie reduction coming from carbohydrates may make more sense because carbs are more of an insulin-producing macronutrient. When estrogen falls at menopause, it’s about carb reduction. It’s the time to start moderating sugar and starch intake and begin to elevate vegetable, fiber-based foods, protein-based foods, and maybe even more fat in lieu of carbs to deal with the insulin resistance. Testosterone also becomes a little more dominant during post menopause, so women should do more resistance training versus cardio.

Q: Can a hormone imbalance trigger women to put on weight?
A: When someone uses the term “hormone imbalance,” I say that it’s a stress management issue and stress management issues create hormone imbalances, primarily. By stress, I mean nutrient depletion, too many or too few calories, too much or too little exercise, and inflammatory mechanisms. All of these are stress. Normally when there’s a hormonal imbalance as a result of any stress mechanism, the first thing we’re going to see is a discrepancy between estrogen and progesterone. Progesterone is going to fall and/or estrogen is going to rise. Either way, whether it’s progesterone deficiency or estrogen excess (here I am referring to clinical estrogen dominance) this happens for many reasons. It happens in perimenopause naturally and whenever there’s prolonged or unremitting stress.

Q: What’s the solution?
A: When we think of hormone imbalance, it normally means that estrogen is going to be high, and progesterone is going to be lower. The way to deal with that is by using adaptogens. If a woman is tired but wired, one of the ones I love that’s over the counter and women-specific to combat this would be something like vitex. It tends to help the hypothalamus function a bit better, deal with some of the stress it’s under, help ovulation occur, and help the luteal phase not be defective in any way, meaning you get estrogen and progesterone to kick back up. Certainly, things like ashwagandha and rhodiola would work well too, although I see that more for women who are just tired.

Q: What are other options for women besides the adaptogens?
A: Let’s get the micronutrients on board that have been depleted with stress. That really can make a big difference in the number one place where women get hit—thyroid function. Women have far more thyroid disorders compared to men, and we know that zinc, selenium, and magnesium are helpful for thyroid and adrenal function. The other micronutrient I would add is vitamin D.

Q: If all else fails, what’s next?
A: I recommend then moving to hormone replacement therapy. The best one during perimenopause is oral progesterone therapy if what mentioned above doesn’t work. It can be a godsend for women under stress and is typically for women who are leaner and healthier who don’t have lot of body fat as they start going from perimenopause into post menopause. Slightly overweight women tend to fare better in terms of symptoms. Oral progesterone therapy would come before moving on to using topical estrogens and oral progesterone.

From ZRT: Each woman has a unique body chemistry, so what works for one woman does not necessarily apply to her friend, sister, or next-door neighbor. An effective approach to a woman’s weight gain certainly includes lifestyle and dietary improvements, stress-lowering techniques, key vitamins, minerals, herbs and/or bioidentical hormones as needed, to replenish and restore balance.

If women want to test active bioavailable hormone levels that correlate more closely to any symptoms they may be experiencing during perimenopause, menopause or post menopause, saliva testing is one of the best options because it captures the “free” fraction of hormone that has left the blood stream to become active in the target tissues of the body.

Your Guide to Staying Hydrated

Mon, 21 Nov 2022 22:30:24 -0800

Your body is made up of 60% water [1] and drinking enough of it is essential to good health. There are numerous benefits of drinking water: improvements in your skin, organ and brain function; flushing out toxins; aiding in digestion and the gastrointestinal (GI) tract; ability to exercise at your best, and overall feeling more energetic and less sluggish.

Most people do not drink enough water. It’s usually a combination of not feeling thirsty until you are slightly dehydrated, not liking the taste of water or forgetting to drink during the day because you’re too busy.

Signs of dehydration

How fluid is controlled in the body is influenced by the brain, and receptors in the blood vessels including those in the heart, neck, and the kidneys.

One way to see if you’re not getting enough water is to pinch the skin on the back of your hand; if it doesn’t go right back down, you’re dehydrated. Known as the skin pinch dehydration test, it’s used to see if your skin’s elasticity has been reduced due to a loss of fluid. Other signs of dehydration include:

Feeling lightheaded or dizzy
Not urinating enough
Constipation
Dry mouth
Not sweating normally

“Severe dehydration can lead to organ shutdown and death, but fortunately this is rare. Most people are only mildly to moderately dehydrated,” says Lori Vance of Body Fitness Image in Portland, Oregon. Lori is a personal trainer who teaches functional strength and fitness to all age groups.

Causes of dehydration

Hot and humid weather, prolonged exercise, and particularly the two together will require more water intake to allow your body to cool itself through sweating. “Seniors often have a decreased sense of thirst and are at higher risk for dehydration and should be especially careful to drink enough,” Lori notes.

Severe diarrhea and vomiting, diuretics, excessive sweating, and of course not drinking enough water can cause dehydration.

In addition, if you have a headache or feel sluggish, try drinking a big glass of water.

Hydration and hormones

How fluid is controlled in the body is influenced by the brain, and receptors in the blood vessels including those in the heart, neck, and the kidneys. When there is decreased blood flow, the kidneys produce the hormone, renin, which triggers the release of angiotensin constricting blood vessels and triggers the adrenal glands to produce the hormone, aldosterone, and antidiuretic hormone, vasopressin. Aldosterone activates the mineral-corticoid receptors, leading to sodium retention in the kidneys thereby increasing water retention and increasing blood volume. Antidiuretic hormone is produced by the pituitary and causes restriction of blood vessels and causes the kidneys to increase reabsorption of water. As salt levels rise in the blood, the brain is triggered to increase the sense of thirst. Thirst is also triggered by dopamine, habits, taste, and psycho-emotional reasons. [2]

When hormones are well balanced, there is an improvement in water management with improved thirst signaling and water retention.

Estrogen and progesterone both influence the hydration status of the body. During the reproductive years for women, the fluctuations of estrogen and progesterone change water management throughout the month. Higher estrogen states as seen prior to ovulation increase water retention. Higher estrogen lowers the thirst triggers in the brain, requiring a lower amount of sodium in the blood to trigger thirst. Estrogen also increases antidiuretic hormone, which increases retention of fluid. Progesterone on the other hand, competes with the hormone, aldosterone, for mineral-corticoid receptors. This has the mitigating effect of decreasing the sodium retention and decreasing water retention.

Premenstrual syndrome - Many women notice significant water weight gain in the five days prior to their period that is relieved with the onset of the period. This is likely due to fluctuations of estrogens and drop in progesterone as well as other hormonal and chemical balances. Supporting progesterone, limiting salt intake, improving liver detoxification of estrogens, and focusing on proper hydration may all help. [3] Interestingly, a year-long study failed to correlate fluid retention to estrogen and progesterone, suggesting that cytokines and prostaglandins may also play a significant role .

Oral contraceptive pills - High levels of ethinyl estradiol and progestins commonly lead to water retention. If this is an issue for you, the progestin, drosperinone, is related to the medication spironolactone, which opposes aldosterone and leads to increased water excretion.

Menopause - The drop of both estrogen and progesterone leads to changes in water management.

Perimenopause - The drop of progesterone leads women to be relatively estrogen dominant and retain more fluid.

Menopause - The drop in estrogen increases water loss and also decreases the sensitivity of the brain to fluid changes. Essentially, this means that thirst is blunted as women age. All of this combines to have dehydration more common in menopausal women. [4]

Hormone replacement - Imbalances in estrogen and progesterone replacement may cause water retention, which can be seen as weight gain and breast enlargement. But, when hormones are well balanced, there is an improvement in water management with improved thirst signaling and water retention. [4]

How much water should you drink?

Lori recommends a starting point of half your body weight (pounds) in ounces of water daily. “A great idea is to always have a water bottle with you so that you can drink all throughout the day,” she advises, “with more emphasis earlier in the day.” Interestingly, minimal research has been done in how much water is necessary to intake for optimal health, but the Dutch scientists found that 2000-3000 mL (8-10 cups) per day does appear to be adequate (Meinders, 2010). This amount compensates for the amount of water lost through sweat, evaporation, urination, and defecation. This amount is also adequate to decrease aldosterone and increase the circulatory volume signaling adequate intake.

Tips for drinking more water

Experiment to find what you like. Chilled water, sparkling water, and water with fruit or berries are great options. Water-rich fruits such as watermelon, grapes, cherries, and berries are also good choices. “Tea without caffeine and with minimal sweetener is also good,” Lori says. Fruit juices can be used if diluted.

Lori recommends drinking from a metal water bottle, which may give a better taste to the water, and therefore, make water more appealing. Here are a few more suggestions:

Drink a big glass of water when you get up to get your day started on the right track.
Drink room temperature water versus very cold so that you don’t decrease thirst signals before you're hydrated.
Limit caffeine and alcoholic drinks unless you are drinking additional water to offset them.
Sip water throughout the day including during your workout.
Replace juices and sodas with water. Sugar-sweetened beverages are not good as the health effects and calories counterbalance any benefits.
Always have a full water bottle with you.
Avoid drinking large amounts of water close to bedtime as that might disturb your sleep.

Glowing skin is a sign of good health, good nutrition, and good hydration—so, drink up!

References

Not Getting a Good Night’s Sleep? Here are the Best Tips!

Wed, 05 Oct 2022 19:33:07 -0700

Adequate sleep has long been known to be vital to good health but not getting enough sleep can be detrimental on many levels. Sleeplessness at night results in lack of alertness during the day, impairing your judgment and increasing the risk for accidents. Chronic sleeplessness can affect the appearance of your skin, reduce libido and overall vitality, decrease cognitive function, contribute to weight gain, and increase the risk of diabetes and cardiovascular diseases.

Your quality of sleep can be affected by many things including perimenopause (hot flashes, night sweats, sharp drop in melatonin over age 40); obesity (over half of obese people also have sleep apnea); shift work (interrupts sleep/wake cycle) and the use of tablets and phones at bedtime (blue light keeps us awake).

Ideally, the sleep hormone melatonin (produced by the pineal gland) should be in balance with the stress hormone cortisol (produced by the adrenal glands in response to stress), creating a healthy sleep/wake cycle. Disturbances in this balance can affect the quality of your sleep too.

There are some common hormone-related causes of sleep loss that often involve:

High Cortisol

Results in insomnia, anxiety, sugar cravings, feeling tired but wired and increased belly fat.

Low Melatonin

Low melatonin contributes to poor sleep onset or prolonged sleep onset. Poor sleep causes fatigue and depression.

Neurotransmitter Imbalance

Changes in sex steroid hormone levels during menopause can impact neurotransmitter levels, leading to recurring sleep issues.

Healthy solutions to end sleepless nights

The American Academy of Sleep Medicine recommends that adults get at least seven hours of sleep every night. It’s also important to stick to a sleep schedule. “We all have a built-in biological clock called our circadian rhythm and tend to function best if we are ‘in sync’ with our rhythm,” says Fariha Abbasi-Feinberg, MD, FAASM, Medical Director of Sleep Medicine at Millennium Physician Group in Fort Myers, Florida.

“Keeping a regular sleep/wake schedule helps to entrain our circadian rhythm and keeps our bodies healthy and functioning well,” Dr. Abbasi-Feinberg adds. She usually recommends keeping wake-up times within one hour of your normal wake-up time. “If you vary it too much on the weekends, for instance, you can have trouble falling asleep on Sunday night and start the week with sleep deprivation. It can take a few days to retrain your rhythm, so it is healthiest to stick to a schedule.” Dr. Abbasi-Feinberg is board certified in sleep medicine and has been practicing for over 20 years.

Trouble falling asleep quickly and/or lying awake for hours?

Do you ever notice that the harder you try to fall asleep, the more difficult it becomes? If you are struggling to fall asleep, here are a few solutions:

Get out of bed and do something else for a while.
Read or listen to a relaxing podcast.
Consider listening to a favorite show or audiobook over and over each night.
- Choose one that preferably has words and dialogue. This can help you pay attention to the external dialogue versus your own internal dialogue.
- When you listen to a show multiple times, your brain knows what is coming next. This allows the brain to relax, and it becomes easier to fall asleep faster.
- It might sound crazy but sometimes a movie like, “Star Wars,” might be easier to focus on and tune out rather than a meditative show.
Write down your thoughts in a journal, which can often help you work out troubling issues.
Remember to stay away from electronic devices near bedtime as that may delay sleep onset even more.
Skip the nighttime news.

Eating and drinking before bedtime

“It’s always surprising to me, how many people are not aware of the effects of caffeine on sleep,” Dr. Abbasi-Feinberg says. “It can stay in your system for many hours and can interfere with sleep onset and sleep quality.” If you’re having trouble with sleep, she says to stay away from caffeine after 1 - 2 pm, which includes coffee, tea, sodas, energy drinks, chocolate, and some ice creams. Having a very heavy meal and too much sugar can also disrupt sleep, and no alcohol one to two hours before bed.

Studies have shown that the ideal eating time for the best sleep is a few hours before bedtime. There are people who feel very hungry right at bedtime and can’t sleep but do okay with a small light snack. Keep in mind, however, that the human body is designed to have a digestive rest at night so you will probably sleep better if you don’t eat after dinner.

Worry, stress, and naps

Without a doubt, worrying and stress can interfere with sleep. Dr. Abbasi-Feinberg recommends setting up a “worry time” a few hours before bed to write down all your thoughts with possible solutions. She’s also a huge fan of making lists before bed. “So often you are thinking about everything you need to do tomorrow, and you don’t want to forget,” she says. “If you write it down, you know you will not forget, and it relaxes the mind.”

In addition, if you have a ritualistic evening routine, it can slow you down at bedtime and allow sleep to occur. Some people also find meditation and prayer very helpful and there are certain apps and podcasts that can help with relaxation as well.

In terms of napping, there is much individual variability. “For some people, short naps earlier in the day, give them more energy and the ability to enjoy life in the evening hours,” Dr. Abbasi-Feinberg says. But if you have trouble sleeping at night, she usually recommends you avoid naps. “You need to allow the natural drive for sleep to build up during the day and a nap can delay nighttime sleep. If you absolutely have to nap, keep it short (20 to 30 minutes).”

Other tips

What else can be done to set the stage for a good night’s sleep?

Keep your bedroom cool, dark, and quiet (kind of like a cave).
No laptops or TV; white noise or earplugs can help.
Have a comfy bed and the nicest coverings (make it a delight to get into bed).
Participate in regular physical activity and/or exercise early in the day (about four to six hours before bed; too close to bedtime can interfere with sleep). Match your exercise activity to your stress levels.
An evening walk can be beneficial for sleep too.

If you have tried these ideas and are not getting answers, consider testing your neurotransmitter and hormone levels.

Additional Resources

How to Keep Your Stress Levels in Check

Wed, 10 Aug 2022 10:55:16 -0700

The COVID-19 pandemic has only magnified what we already know: Working in health care can be stressful. A survey conducted by Mental Health America between June-September 2020 of 1,119 health care workers found that 93% were experiencing stress in addition to anxiety, frustration, exhaustion, burnout, and feeling overwhelmed. (1)

Why Is Self-Care So Hard?

Without a doubt, a large part of taking care of yourself is managing your stress levels. People attracted to the world of health care are often empathetic and caregivers by nature. Providing care can be rewarding but at the same time it can be challenging and overwhelming, and can easily exhaust your physical and emotional energy, leading to chronic stress and burnout. Controlling the stress level that comes into your world and controlling your response and perception of stress is the key to burnout.

Everything you give to others has to come from somewhere so you must recharge and refill that place inside you and do things that bring you happiness and peace.

Certified Health Coach Brenda Shropshire, who’s the Wellness Coordinator at Community Behavioral Health in Philadelphia, says that those who choose a career that involves caring for others often over-give and their inner “well” becomes depleted. “There is no endless supply of you,” she says. “Everything you give to others has to come from somewhere so you must recharge and refill that place inside you and do things that bring you happiness and peace.”

Signs of Feeling Stressed

Everyone internalizes stress differently but there are some signs that indicate your body is feeling the strain. Nod your head if any of these symptoms sound familiar: aches and pains, sleep disturbances, chronic irritability, weight gain in the waist, depression, morning or evening fatigue, low libido, and sugar/food cravings, to name a few.

Not only is it important to recognize when your stress is out of control, it’s equally essential to realize when you need a dose of self-care to function at your best.

Tips for Self-Care and De-Stressing

Fortunately, there are ways to relieve your stress levels:

Say NO! Just because you know how to or can do something doesn’t mean you have to do it.
Eat regularly and make sure your meals are nutritious and healthy (control your blood-sugar stressors).
Counteract stress with stretching, deep breathing, yoga, Pilates, or walking. Exercise helps reduce cortisol.
Exercise aerobically to relieve stress—and outside whenever possible. Matching stress levels with intensity of exercise can improve sleep.
Consider daily meditation to help decrease stress on the mind and body. Work up to 20-minute daily sessions. Mindfulness slows down your perceptions of stress and helps ground you to the present. It’s easy to feel burned out if you feel like you are always catching up.
Increase fun activities that fuel your creativity such as gardening, painting, or cooking—whatever you enjoy. If you are struggling to make time, sign up for a class. Even an hour a week makes a difference.
Sleep 7-8 hours per night, and if you can’t, don’t overlook a 15-minute power nap.
Share how you’re feeling with someone, whether it’s a friend, family member, colleague, or therapist.
Get more help if you need it. Suicide levels in health care workers is real. The world would be less special without you. The number for the National Prevention Suicide Hotline is 988.

Brenda recommends that you also schedule in some downtime to “recharge your batteries” and advises thinking back to a time when you did something that brought you joy. Then, evaluate your schedule and look for opportunities to create a time designated just for you. She says not to think of taking care of yourself as something decadent or selfish. If you don’t get in your ME time, it will show up in your attitude and daily outlook.

Your new mantra for the rest of the year: When caring for others, care for yourself, too. In other words, you have to put on your own oxygen mask before you can help anyone else.

References

Vizheh M, Qorbani M, Arzaghi SM, et al. The mental health of healthcare workers in the COVID-19 pandemic: a systematic review. J Diabetes Metab Disord. 2020;(19):1967-1978.