Operating in the RED (Rest-Exercise-Diet) Zone

A Stress Reduction and Management Protocol

By Carmen Gioia, DC
It was the best of times, it was the worst of times. -- A Tale of Two Cities, Charles Dickens

Chiropractic's centennial year is a joyous occasion in which every chiropractor on the planet takes great pride. The profession has survived and flourished in the face of tremendous adversity.

But there is a great enemy lurking in the background, just waiting to destroy the chiropractor and his practice. It's not the insurance industry with all its UROs and IMEs, nor health care reform; it's not HMOs, PPOs, or UFOs for that matter. Chiropractic has always found a way to survive in the past, and will continue to do so.

The greatest threat to the chiropractic physician is chronic stress left untreated. Physician stress is probably going to increase for most solo practitioners as they become buried in increasing amounts of paper work required by HMOs, PPOs, and other organizations they must join to survive.1

Stress is defined as the sum of all nonspecific biological phenomena elicited by adverse external influences, including damage and defense. It may be localized, as in local adaption syndrome (LAS), or systemic, as in general adaption syndrome (GAS).2

Negative stress or distress plays havoc on the body's systems. Just a few examples:

  1. releases cortisone from the adrenal glands; if chronically elevated, decreases the body's immune response.


  2. increases thyroid hormone into the blood stream; my cause nervousness and insomnia.


  3. releases endorphins from the hypothalamus; chronic stress depletes endorphin levels, which has been shown to exacerbate migraines, backaches, and create arthritis type pain syndromes.


  4. decreases sex hormones;


  5. decreases digestion;


  6. releases sugar into the blood stream with an increase in insulin levels; excessive demands on the pancreas for insulin increases the likelihood of diabetes.


  7. increases blood cholesterol, mainly from the liver.

Stress causes a long-term activation of the sympathetic nervous system's fight or flight response, which is not designed to be activated for extended periods of time.

Stress manifests itself in many ways. Some signs and symptoms:

inability to sit still
tightness in neck
irritable foot tapping
blotchy skin
pacing the floor
slumped posture
tight throat
muscle aches
rapid breathing
poor sleeping
change in grooming
loss of appetite
making mistakes
irritable bowel
excessive focus

Now that we have a better understanding of stress and its effects, how can we deal with the harmful effects of chronic stress. One of the major difficulties is that many physicians will not admit that they have a problem. They are reluctant to seek help because of some perceived associated stigma, or simply don't know where to turn.1

There are many types of treatments for acute episodes of stress. I have found rest, exercise, and diet to be the best treatment protocol for myself and many of my patients.


How much rest do we need? Researchers have difficulty agreeing to the amount and duration required to have us function at optimum levels. Most research involving rest is done in the field of sleep studies. Insomnia is frequently stress related. According to a recent study "sleep deprivation is America's largest, deadliest, and costliest health problem.3,4

When we sleep is very important. Most of our activity takes place according to a circadian cycle, slightly longer than 24 hours. Sleep normally occurs during the time of reduced physiological functioning. REM sleep peaks during the early morning hours when our body temperature is at its lowest.

If we work late hours and stay up half the night worrying, we are likely to sleep but miss some of the rest needed from REM sleep. Serotonin is a brain neurotransmitter that has been linked to sleep deprivation and stress. When serotonin levels are low we are likely to experience depression, fatigue, and frustration.

Resting does not necessarily mean you have to go to bed and sleep. Resting is also learning to relax. There are a multitude of relaxation techniques available to all of us: massage; meditation; deep breathing exercises; biofeedback; and autogenic training. The key to rest is making the time for it. Note that I did not say finding the time. I can guarantee you the world will continue to spin if you take a few minutes to "stop and smell the roses."


Regular exercise provides an excellent outlet to relieve stress. It also provides a quiet time for contemplation and reappraisal of priorities. Exercise does not have to be vigorous to play a beneficial role in stress reduction. According to the U.S. Center for Disease Control and Prevention and the American College of Sports Medicine, moderate activity "most days" of the week improves physical health as effectively as vigorous prolonged exercise.5

Exercise seems to play a role in mental health as well. Regular jogging seems to reduce the symptoms of anxiety and depression in many patients. Runners experience a feeling of euphoria caused by increased endorphin secretion. Concentrated aerobic exercise has been shown to lessen stress by reducing blood pressure. However, excessive exercise does not produce excessive relaxation or excessive stress reduction. The key to exercise for stress reduction is moderation.6


Proper nutrition is essential for maintaining emotional and physical health. A diet high in fat is believed to be associated with heart disease, high blood pressure, and possible certain types of cancer. Stress also has been linked to these conditions. Research suggests a high fat diet reduces the body's ability to cope with stress by interfering with metabolism of hormones released during stress (adrenaline, nonadrenaline, and cortisol).1

Failure to metabolize these hormones at a rapid pace causes increase concentrations of fats and sugars in the blood and depresses the auto-immune system. Much has been written about serum cholesterol levels and fat intake: good cholesterol (high density lipids) and bad cholesterol (low density lipids), and the role they play in coronary heart disease. Current research is searching for a link between HDL levls, type A personalities, and stress related heart attacks.

The role of proper nutrition in stress management is based on common sense. Pay close attention to your body's signals: eat slowly and relax while you eat. Stop eating when you begin to feel full. Avoid large meals in the evening and late night snacks. Limit your caloric intake. Few adults over 40 need more than 1,800 calories a day. Under stressful conditions, eat less and be more selective about the foods you choose. Increase water intake and supplement your vitamin intake with C, pantothenic and folic acid, and the B complexes.

Stress related illnesses are treatable. The key to beating stress in knowing that stress is something we create, and therefore it is something we control. Stress must be intellectualized not internalized. Only then can treatment regimens like rest, exercise and proper nutrition play key roles in maintaining positive emotional health.


  1. American Medical News, March 15, 1993, p 3.


  2. Dorlands Illustrated Medical Dictionary, 1974, Philadelphia, W.B. Saunders, p. 1482.


  3. Newsletter of the American Institute of Stress, 1993, No. 7, p. 1.


  4. Newsletter of the American Institute of Stress, 1993, No. 1, p. 2.


  5. Journal of Sports & Exercise Psych, 15(1), March 93.


  6. Hobson M, Rejeski J. Wake Forest University, 1992.

Carmen Gioia, DC
Clairton, Pennsylvania

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