Improve Your Brain Health Parkinson's Disease Edition

Your Path to Wellness

My name is:

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The greatest medicine of all is to teach people how not to need it.

Meet Dr. Ken Sharlin

Ken Sharlin, M.D., M.P.H., IFMCP, is a board-certified neurologist, consultant, functional medicine practitioner, Assistant Clinical Professor, researcher, author, and speaker.

His medical degrees are from Emory University, The University of Virginia, and Vanderbilt University. His functional medicine certification is through The Institute for Functional Medicine.

He is the author of the #1 best-seller The Healthy Brain Toolbox: Neurologist-Proven Strategies to Improve Memory Loss and Protect Your Aging Brain and co-author of Neurishment: The Brain Tune Up Food Guide.

Dr. Sharlin is also a significant contributor to Reversal of Cognitive Decline: 100 Patients, found in the peer-reviewed Journal of Alzheimer’s & Parkinsonism. He has been the primary investigator in several pharma-sponsored clinical trials that have helped bring new therapeutics to market.

DR. SHARLIN PRACTICES GENERAL NEUROLOGY AND DIRECTS HIS FUNCTIONAL MEDICINE PROGRAM, BRAIN TUNE UP! AT SHARLIN HEALTH AND NEUROLOGY, IN OZARK, MISSOURI.

Tell Us About You

(We want to know!)

Name:

Address:

Date:

Phone Number: Email:

D.O.B.:

Age:

Height: Weight:

Occupation:

Hours of work per week:

Place of Birth:

Desired weight:

Children: Pets:

Mother: Alive / Deceased

The health of your mother:

Father: Alive / Deceased

The health of your father:

Your current primary health goal:

Diagnosis/Symptoms:

When were you diagnosed?

What have you tried (medication and lifestyle) to improve your health and well-being?

Do you currently take any medications? Please list.

Any helpers, healers, or therapies with whom you are involved? Please list.

If we were having this conversation three years from today, what would have had to happen in that time for you to be successful in our program? What would your goals be for doing our program?

What do you think would prevent you from achieving those goals?

What or who is your support system?

What are some of your strengths?

In a given week, how many times do you eat out? Drink caffeine? Drink alcohol?

Do you smoke?

Crave sugar?

Do you ever feel weak, tired, or sluggish?

Are you on hormones currently (please be specific)?

(Please skip this page, if not applicable)

Are your periods regular? (Length and frequency)

Are your periods painful/symptomatic? (Please explain)

Reached or approaching menopause? (Please explain)

Birth control history:

Do you experience yeast or urinary tract infections? Please explain.

What is your typical diet?

What percentage of food is home cooked?

Where do you get the rest of your food?

What is your exercise routine like currently?

How Can We Help?

Do you, or does someone you love, suffer from any of the following issues? Would knowing more about the best options available to resolve them be of value to you? Do you have a go-to source you know you can trust for proven solutions for your problems?

AREAS OF CONCERN

(*We call these, “Not problems waiting to be solved, but successes ready to happen!”)

Please check all that apply:

O Fatigue

O Weight Gain

O Poor Sleep

O Brain Fog

O Poor Nutrition

O “Bad Genetics”

O Constipation/Crohn’s/IBS

O Inability to Stay Focused

O Difficulty Managing Stress

O Chronic Pain

O Anxiety/Depression

O Health Optimization

O Alzheimer’s Disease

O Memory Loss

O Parkinson’s Disease

Other/Comments on the checked boxes above:

O Multiple Sclerosis

O Fibromyalgia

O Migraine

O Amyotrophic Lateral Sclerosis

O Numbness

O Weakness

O Imbalance/Incoordination

Unique Five Pillar Approach

YOUR HEALTH, YOUR CHOICES, OUR SOLUTIONS

Ozark, Missouri, neurologist, Dr. Ken Sharlin’s Unique 5 Pillar approach:

IDENTIFY

We begin by correctly naming the problem. The last thing anyone wants is the wrong diagnosis or lack of solutions when you know something is wrong.

INVESTIGATE

We will take a deep dive with you to get to the root cause of your symptoms or chronic illness.

INTEGRATE

My team and I help you put the puzzle pieces together. We work with you to create an action plan that is specific, measurable, achievable, realistic, and time-based, so you know exactly what you need to do.

RESTORE

Whether it’s hormones or other areas of your life, we help you restore balance.

REGENERATE

We want you to feel like your BEST self. We facilitate the restoration of your brain and nervous system vitality by incorporating cutting-edge regenerative treatment strategies.

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Making and maintaining connections with your friends, family, and loved ones will help you maintain a sense of purpose and protect your brain health throughout your life.

Creating a Wellness Vision

Before setting any goals, it’s a good idea to look at the big picture of your health and well-being while establishing a clear vision of what you want to achieve. Once you have identified your desired image, you can set goals appropriately to guide you there.

STEPS TO ESTABLISHING A WELLNESS VISION

What do I value most about my life? What brings meaning?

Complete this sentence:

Because I have reached a turning point with , I am ready for action now. I am willing to modify the following with my sleep, nutrition, fitness, relationships, or spiritual resilience so that I can reach my vision of . (Provide a few details.)

Is there anything that stands in the way of reaching my vision?

On a scale of 1 to 10 (10 means I have achieved my wellness vision), where do I fall today? Circle your answer below:

Inflammation & Chronic Disease

WHY ARE THESE SO IMPORTANT?

Chronic diseases are defined broadly as conditions that last one year or more and require ongoing medical attention or limit activities of daily living. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the U.S.

Age, family history or genetics, and gender might seem to be barriers for older adults to avoid becoming a chronic disease statistic. Eighty percent of adults 65 and older have at least one condition, while 68 percent have two or more. With Americans getting older and the costs of health care rising rapidly, we have an evolving crisis. According to Fidelity Investments, a 65-year-old couple retiring in 2020 can expect to spend $295,000 in health care and medical expenses throughout retirement, not including nursing home costs.

Millions of consumers are seeking better care than what the current system offers. People want an approach that eliminates symptoms by resolving root causes, rather than just managing symptoms and never addressing why we get sick in the first place. But those solutions are hard to find. Consequently, consumers desperate for answers self-diagnose and experiment with advice from the internet because most doctors do not have the tools to help them.

You probably have a parent, friend, or co-worker who manages a condition right now. Or, perhaps you are managing one yourself. With these kinds of odds, you might wonder, is anything I can do to prevent the onset of symptoms or make managing an existing condition easier?

YES, YOU CAN!

It’s called functional medicine, an approach that addresses the root causes of disease. It looks at the dysfunction underlying chronic conditions and offers a care model to prevent or help reverse illness. It is based on how our genes are stimulated by and respond to our environment and the behaviors we practice. If we can change our environment and our behavior, we can change the way our genes perform. This is the science of epigenetics.

It’s important to understand that inflammation is the single most influential cause of all chronic neurological diseases. Inflammation influences gene expression and other responses inside our cells in a way that can be protective or harmful.

Inflammation is the body’s normal response to injury or threat from the environment. If inflammation is the orchestra, the musicians are the major players that make up the inflammatory process. Under normal circumstances, short-term inflammation is good. It protects us.

But when signals from the environment cause inflammation to be long-term, the consequences can be devastating—causing chronic inflammation. From a practical standpoint, seven things cause chronic inflammation.

DR. SHARLIN’S SEVEN SOLUTIONS FOR CHRONIC INFLAMMATION

On a scale from 1 to 10 (10 being the highest score), mark how you feel about each area in your personal life as of now.

Once you’re done, review your selections and note where you drew the lowest scores to see where you feel you need the most significant improvements to happen.

SLEEP: QUALITY AND QUANTITY (THE GOAL IS 7-8 HOURS AND FEELING RESTED UPON AWAKENING)

Sleep is one of the most important tools we have in our healthy brain toolbox. Sleep deprivation can impact your life in a variety of ways, from depression to appetite. Getting good quality sleep can help you preserve and protect your brain in the future.

EAT: YOU ARE WHAT YOU EAT

Your diet is one of the most influential factors in your health, happiness, and longevity. An anti-inflammatory diet can help you avoid long-term or chronic disease.

MOVE: EXERCISE WITH VARIETY

Getting your heart rate up for brief periods can help you preserve and protect your brain from long-term or chronic illnesses. Walking, moving, and dancing can all be great ways to start investing in your brain health. I exercise with variety and incorporate movements that challenge my brain.

BE AND PRACTICE STRESS RESILIENCE: MINDFULNESS IN ALL THINGS

Dedicate time to focus on the present moment. The more we can keep our focus on the present rather than on past or future events that may never come true, the less our thoughts of worry or anxiety will negatively impact mood, health, and overall wellness.

Staying in the moment can dramatically affect your mood, health, and overall wellness. I believe that taking 5 to 10 minutes each day to meditate and relax improves resilience and protects your brain throughout your life.

Making and maintaining connections with your friends, family, and loved ones will help you maintain a sense of purpose, a key lifestyle factor when it comes to improving your brain health, and protecting your brain throughout your life.

FILL IN THE GAPS: GET THE RIGHT NUTRIENTS

Getting enough of the right nutrients is essential to maintaining your vitality and giving your brain the tools it needs to protect itself. Understand which nutrients may be missing from your regular diet—adjust and supplement where necessary.

STIMULATE: ENGAGE YOUR BRAIN

Learn an instrument, a hobby, or a new skill. Engaging in these activities help preserve and grow your brain, creating new connections in your brain and protecting you from developing the long-term chronic illness as you age.

Judging from your scores above, what spheres of your life do you feel you need to improve the most?

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Functional medicine addresses the root causes of disease.

Nutrition

Six hundred seventy-eight thousand people die each year from an unhealthy diet, and the numbers could even be higher, as most chronic diseases can be traced back to diet. Remember when your grandma said, “eat everything on your plate,” or as we say, “you are what you eat.”

GUESS WHAT? YOU ARE WHAT YOU EAT.

So, what should you be eating? We recommend a modified Mediterranean diet or an anti-inflammatory diet. An anti-inflammatory diet consists of eating plenty of vegetables, nuts and seeds, low sugar fruits, and organic or wild-caught meats and fish. This diet should limit grains, especially gluten-containing grains while avoiding sugar, dairy, and processed foods.

Think about your supermarket and how the supermarket’s edges are where you will find all those delicious fruits and vegetables. Most of your plate should be vegetables that you roast, steam, or sauté in healthy oils, like avocado oil. Also, think about nuts, seeds, and small amounts of fruit like strawberries, blackberries, or blueberries, which do not raise your blood sugar too much. High blood sugar triggers inflammation, which affects the brain, causing diseases like Alzheimer’s, Parkinson’s, A.L.S., and Multiple Sclerosis.

What daily meals and snacks could you exchange for vegetables, lean meat, nuts, seeds, or fruit to make your diet healthier and make your body feel better?

Unhealthy/inflammatory food I eat: I’ll change it to this healthier option:

Your notes:

Neuro Fitness

The start of a Neuro Fitness plan is an evaluation of how you are moving now.

Do you have an exercise routine?

O No, but I want to.

O Yes, I do.

If you do, please describe in a few sentences that include duration, frequency, variety, and intensity.

For example, I exercise 3 days per week at the gym, where I do bodyweight exercises or lift weights for 30 minutes. Then I do interval training for another 7 to 10 minutes. The rest of the time is spent warming up and cooling down for a total of an hour.

List your present routine in the space below:

Maybe you are new to exercise and don’t know where to start. Do you walk the dog, climb stairs regularly, make an effort to walk outside, dance, or count your steps?

If you say yes to any of these questions, then give yourself credit because movement is medicine, and you’ve already started, whether you knew it or not!

Write down how much you move daily (without your exercise routine):

Next, think about what type of movement you enjoy or what action would you agree to try. You do not have to get it perfect.

You can make real gains just by increasing your routine daily activity. If your dog or dogs are anything like mine, they never object to more than one walk a day. Perhaps walk an extra 10 minutes, or one more time around the block than usual.

Can you park further away from a retail store and walk across the parking lot rather than the closest spot to the door? Any change in your everyday non-exercising habits is growth.

Now, think about what enjoyable exercise you could add to your daily routine or what action you are excited to try:

Your body works hard to keep a stable and balanced internal environment called homeostasis. Stressing the nervous system through exercise encourages brain, nerve, and muscle adaptation to build strength, endurance, and a bigger brain.

For example, weight training will stimulate muscle breakdown so that protein synthesis can rebuild that muscle to a more vital state. In other words, this temporary breakdown of muscle encourages your body to create stronger muscles to handle future stress more efficiently. Your body is smart. It learns how to do something as efficiently as possible in a relatively short time.

However, when you repeat the same movements every day, your body and brain go through motions with minimal stress on the system. Changing your routine requires your brain and body to learn a new pattern.

A new movement or practice might recruit different muscles and change the connections in your brain. Try something new and fun like yoga, dance, Tai Chi, Rumba, or maybe personal training at the gym. For neuro fitness gains, add a movement activity that requires thinking and moving at the same time.

This week I am going to try something new. As a commitment to moving for my brain and body, I intend to make the following change (keep it specific, measurable, and achievable – and fun):

REMEMBER, NO MATTER HOW YOU LOVE TO MOVE, CHANGE IT UP A BIT. THIS ACTION WILL UPGRADE BOTH THE HARDWARE AND THE SOFTWARE, LEADING TO A BETTER BODY AND A HEALTHIER, MORE RESILIENT BRAIN.

Cues to Eating & Physical Activity

Eating and drinking are often triggered by something other than hunger and thirst. These triggers are called cues, and they can impact how much activity we do and how much food we eat.

Some cues are positive and drive healthy behaviors, while other cues can lead to more eating and less activity. When we repeatedly respond to a signal in the same way, it changes the brain, and we form a habit. We are often unaware of our body signals, and identifying them is useful in making long-term behavioral change.

HERE IS A LIST OF SOME FAMILIAR CUES:

• Hunger

• Emotions

• Walking by the break room at work and seeing candy/sweets

• Attending parties or social events

Think about your negative dietary cues and how you will change them:

What are my negative dietary cues? What are my new responses?

Some of the negative physical activity cues that can deter your efforts include eating a heavy meal, not getting enough rest; feeling stressed; drinking alcohol; pain; being around others that do not value activity.

POSITIVE PHYSICAL ACTIVITY CUES INCLUDE:

• Setting dates with a friend to exercise

• Going to the gym

• Keeping your gym mat, shoes, or bike visible

• Creating reminders on your phone

• Setting the alarm to be more active

• Walking for 10 minutes after every meal

What positive activity cues could I add to my routine?

What challenges do I face trying to implement a positive cue?

Supplements & Pharmacology

VITAMINS AND NUTRIENTS

To say that nutrition is critical is not an overstatement.

But getting this essential needle-mover perfect every day is virtually impossible, even for the most dialed-in, conscientious eater. A list of common nutrient deficiencies in the United States includes vitamin D, iodine, vitamin B12, vitamin A, and magnesium. This list provides compelling information but does not include some of the most critical nutrients for brain health. These additional brain nutrients are omega 3 fatty acids and folate’s availability, often impeded by a common genetic variant of the enzyme MTHFR* .

Furthermore, given the critical connection between gut and brain, it turns out that the risk of developing conditions like Alzheimer’s and Parkinson’s disease is directly related to both the abundance and diversity of the gut microbiome. This observation should tell us that many individuals suffer from an imbalance in their gut. If you are concerned about your brain health from a nutrient perspective or know someone who is, then the best strategy is to work on your diet with a functional medicine-trained dietitian. At the same time, get your labs done. Lab studies will tell you where your imbalances exist and allow you to correct those imbalances with targeted supplementation.

If this approach is not feasible, then consider the following:

A

Invest in yourself by only using high-quality supplements certified by N.S.F. (nsf.org) and G.M.P. (Good Manufacturing Practices).

An advantage of using Dr. Sharlin’s supplements is that all of them meet this pharmaceutical quality standard, and these are the same supplements used in the Brain Tune Up! Program. On Dr. Sharlin’s website you will also find a detailed description of each supplement and how it helps support brain health.

Don’t delay getting these on board and working for you!

Your notes:

* methylenetetrahydrofolatereductase

Sleep

The first tool in reversing chronic illness is sleep. One out of three American adults is not getting enough sleep, which significantly impacts the brain. Older adults who aren’t getting enough sleep are at an increased risk for diseases like Alzheimer’s.

Changes in the brain that become Alzheimer’s disease can begin up to 20 years before the onset of illness. This means that Alzheimer’s disease may actually start in middle age.

Lack of sleep impacts the brain in so many ways. If you are looking to increase productivity in your life, begin with getting enough sleep. If you have a lot of daytime fatigue, look at your quality and quantity of sleep.

How satisfied are you with your sleep quality at the moment? Do you feel like you are getting good quality sleep? Are you sleeping 7-8 hours per night?

Sleep problems can be the result of various conditions or medical problems. Many medications that are used to treat insomnia are only effective in the short term. Ongoing use of sleeping pills may lead to dependence and interfere with developing good sleep habits that can prolong sleep difficulties. It is essential to discuss your sleep problems with your doctor and find out what is right for you.

The most common cause of insomnia is a change in your daily routine, like traveling or changing work hours. But sleep problems can also result from hormone imbalances, structural changes to your airway, pain or other discomforts, and stress. This can lead to habits that interfere with your sleep. Paying attention to good sleep hygiene is the most important thing you can do to maintain good sleep. ‘Sleep hygiene’ is used to describe good sleep habits, and strategies for long- term solutions to sleep difficulties have been developed through considerable research on sleep.

SLEEP HYGIENE SUGGESTIONS

KEEP REGULAR SLEEP HOURS

Go to bed at the same time each day and get up at the same time, even on weekends and days off. This regular rhythm will make you feel better. Establish a relaxing bedtime routine. Such rituals may include a warm bath or shower, aromatherapy, reading, or listening to soothing music. Or, try using relaxing imagery to encourage your body to rest.

Use the table below to schedule your relaxation routine and the sleeping hours you will follow to improve the quantity and quality of your sleep:

Relaxation time: (for example, 9 p.m.)

Relaxation routine: (for example, aromatherapy or soothing music)

Sleep time: (that’s when you should be sound asleep in your bed)

Wake up time: (for example, 7 a.m.)

THE BEDROOM IS FOR SLEEPING

Use your bed for sleep and intimate activities, not with other activities like paying bills or watching T.V. Keep the temperature in your bedroom cool. Keep the bedroom quiet and dark enough to facilitate sleep.

Take a look at your bedroom. What improvements can you make for better sleep and relaxation? Do you keep the bills right on your nightstand, watch T.V., or have blinds/curtains that do not make the room dark?

What I would like to improve:

(for instance, you cannot resist watching the T.V. for long hours before you sleep)

HOW I will improve it:

(for example, move the T.V. set to your kitchen, study, or workroom)

REGULAR EXERCISE FOR BETTER SLEEP

Get regular exercise each day. Stretching and aerobic (cardiovascular) exercise may be best in the morning, while strength or resistance work may be better in the afternoon or early evening. This is because aerobic exercise tends to raise cortisol, which can disrupt sleep.

At the same time, strength work results in microtears in your muscles repaired during sleep when testosterone and growth hormone are secreted. Are you including movements that challenge your brain?

Think about how much you would like to exercise, then fill in the table below. Workdays/Weekdays Days of Rest/Weekends

Morning:

(Try to include stretching and aerobic exercise)

Afternoon/Early Evening:

(Are you including movements that build strength or challenge your brain?)

AVOID CAFFEINE, NICOTINE & ALCOHOL

These substances act as stimulants and interfere with falling asleep. Avoid caffeinated tea, coffee, and even chocolate (which can have as much as 12 mg of caffeine per ounce), some medications, and cigarettes for at least four to six hours before bedtime. (We don’t want you smoking anyway.)

Many people believe that alcohol is relaxing and helps them to get sleep. However, it can interrupt the quality of sleep by causing a disruption in sleep cycles and worsening sleep apnea.

If you take any of the stimulant substances, take a look at the table below and mark how many hours before sleep, you will aim to avoid them.

EAT RIGHT FOR BETTER SLEEP

A healthy, balanced diet will help you sleep well. However, avoid a heavy meal before bedtime. Ideally, we recommend no food for 3 hours leading up to sleep.

Do you often have heavy meals before bedtime? If so, think about light snacks you could substitute or if you can train yourself to stop eating 3 hours before bedtime.

AVOID NAPS DURING THE DAY

If you can’t make it through the day without a nap, make sure it is for less than an hour and before 3 p.m.

If you nap, think about the time you nap and how you can try to adjust it:

My present napping time: My ideal napping time (before 3 p.m.):

KEEP YOUR EYES OFF THE CLOCK

If you haven’t been able to get to sleep after about 20 minutes or more, get up and do something calming until you feel sleepy. Then return to bed and try again. Sit quietly on the sofa with the lights off, and take slow breaths, or listen to nature sounds or other ambient sound recordings. Avoid doing anything too stimulating or exciting.

Take a moment and think about what you find the most relaxing. What books or other activities do you think would make you the most sleepy when you cannot sleep?

USE A SLEEP DIARY

Keeping track of your sleep habits can be a useful way of making sure you are informed about your sleep. Also, consider writing down any worries or thoughts that are bugging you, allowing your brain to let go of them.

Use a weekly sleep diary we have prepared for you on the next page.

Sleep Diary

Each morning place a checkmark in the box beside the strategies you used the day before and then rate your overall sleep quality for that night.

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Practicing compassionate self-care allows the body to be in a state of balance and calm.

Stress

HOW DOES YOUR BODY RESPOND TO STRESS?

The autonomic nervous system is a control system that is part of the nervous system that supplies the internal organs, including the blood vessels. It works automatically without a person’s conscious effort.

There are two main divisions: The sympathetic and parasympathetic nervous system. .

SYMPATHETIC NERVOUS SYSTEM

The sympathetic division is the primary mechanism in controlling the flight-or-flight response and prepares the body to react to stress or emergencies.

The body sends cortisol, norepinephrine, and various other hormones and neurotransmitters in response to a perceived threat. The heart rate and force of contraction increases, and the airway widens to make breathing easier. The pupils dilate, palms sweat, and your hair may stand on end. Other body processes not critical to the perceived emergency, such as digestion and urination, slow down.

PARASYMPATHETIC NERVOUS SYSTEM

The parasympathetic division controls the body processes during ordinary situations and primarily conserves, restores, and repairs. It is powered by the vagus nerve, which is the longest cranial nerve and communicates with every organ.

When the parasympathetic response is activated, acetylcholine, DHEA, and many other soothing hormones and neurotransmitters are produced to slow the system down.

The heart rate slows, the blood pressure decreases to normal, and the digestion is stimulated to process nutrition and eliminate any waste, so the energy is available to restore and build tissue.

THE RELAXATION RESPONSE

The relaxation response occurs when the body is no longer in perceived danger. The autonomic nervous system function returns to normal balance, countering your body’s stress response. The relaxation response is the opposite of your body’s stress response.

Typically the body can turn off fight-or-flight when the perceived threat is gone. However, for many reasons in our current world, our fight-or-flight response is often triggered many times during the day.

We react to a wide range of stressors, most of which are more situational than an actual need for survival. With this persistent stress reaction, the body is trained to always be on alert, which overtaxes the nervous system and eventually wears on our health and well-being. Digestion is affected, so we do not receive nutrients, and therefore, the body cannot rest or repair itself.

When the body feels safe, the vagus nerve alerts the brain to release neurotransmitters, hormones, and other chemical signals to reduce and control inflammation, and to repair and restore balance.

PURPOSEFULLY CHOOSING RENEWING THOUGHTS AND EMOTIONS IS ONE WAY TO CREATE AN ATMOSPHERE OF SAFETY SO THAT THE BODY RESPONDS AND THE VAGAL NERVE CAN DO ITS WORK.

Try to formulate a couple of calming thoughts that you will try to use next time you face the situations you have just listed above:

There are other ways to send the message of calm and safety to the body. These include gargling, which directly stimulates the vagus nerve, breathwork using deep belly breathing and laughter to release soothing neurotransmitters, fasting to give the digestion process a break, yoga using gentle movement, and massage to stimulate the lymphatics, and also improve vagal tone.

Practicing compassionate self-care allows the body to be in a state of balance and calm.

THE GOAL IS TO BE MORE RESILIENT TO STRESS AND REACT APPROPRIATELY WHEN AN ACTUAL EMERGENCY PRESENTS ITSELF.

STRESS TRIGGERS & HEALTHY RESPONSES

Stress and anxiety can take a toll on your well-being and contribute to setbacks.

You cannot always control events, but you can learn new ways to cope with them. Be aware of past situations that have caused you stress.

Stress can come from:

• Physical environment (weather, traffic)

• Social environment (friends, family, colleagues)

• Physiological state (illness, fatigue)

• Your thoughts (anxiety, depression)

What are your sources of stress? What can trigger this stress? What is your emotional or behavioral response to this stress? Is this response working? What could be a new response to the stress trigger or source of stress? (Journal, practice yoga, or speak to a counselor).

If your typical reaction is not helping you deal with stressful situations, it’s time to develop new strategies to manage your stress. Be specific about these new reactions.

Sources of Stress Triggers Your Response New Reaction

After trying this for a few weeks, think about what worked well and what didn’t.

If the new solution didn’t help you cope with the stress, consider a new reaction. It might be a process of trial and error before you find the answer.

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Purposefully choosing renewing thoughts and emotions is one way to create an atmosphere of safety so that the body responds, and the vagal nerve can do its work.

Practicing Mindfulness

Mindfulness is paying full attention to the present moment. It’s noticing your thoughts, feelings, and sensations without judging them.

When we begin paying attention to our mind’s activity, it’s common to see that we often judge our experiences. We categorize what we like and do not like. What makes us feel good or bad?

Take a moment and try to focus on your thoughts and feelings at this very moment: what makes you feel happy or stressed? What emotions do you feel right NOW?

Do you notice neutral experiences? When you do find your mind judging, do not stop it, but instead, just observe. Mindfulness is a focus on “being” rather than “doing.” It can reduce stress and anxiety, manage pain, sleep, and boost the immune system.

When we are not mindful, we can develop automatic reactions to stress that can be harmful. We may perceive everything as a threat. Stress hormones are released, blood pressure and heart rate increase, and we are less likely to access the reasoning mind. We may get furious at others and get into a mindset of catastrophic thinking.

Formal practices of mindfulness include:

• Deep breathing

• Yoga

• Tai chi

• Meditation

Mindfulness is NOT:

• Multitasking

• Thinking about the past

• Creating and rehearsing future scenarios

• Worrying about what might happen

• Eating in front of the T.V.

What activities that are the opposite of mindfulness get too much focus from you?

TIPS ON PRACTICING MINDFULNESS

• Allow thoughts to come in and accept them as they are.

• Thoughts and feelings come and go like clouds in the sky, and they will pass.

• Tell yourself that your thoughts are just thoughts.

• When an uncomfortable feeling comes up, pause and simply notice before acting on it.

Think about situations where you can apply the tips on mindfulness that would help you cope with stress.

Building Motivation

Behavioral change takes more than willpower. It requires learning how to navigate your environment, problem-solving, practicing mindfulness, and setting SMART goals:

S Specific M

Measurable A

Attainable R Relevant T Time-bound

It is a simple tool to help you translate ambiguous goals into an actionable plan. Prepare to become your own lifestyle coach!

If you are struggling to find the long-term motivation to change, consider using the exercise below.

MOTIVATION EXERCISE

Recording the benefits helps establish a stronger foundation for change. When you experience a short lapse in behavior, consider returning to your list for inspiration.

Pros of changing:

Cons of not changing:

On a scale of zero to 10 (10 being most important), how important is it to make changes now? Circle your answer below:

What are my current obstacles to making changes now?

What will it take to overcome these obstacles?

On a scale of zero to 10 (10 being most confident), how sure am I that changes are possible now? Circle your answer below:

DAY-TO-DAY VISUALIZATIONS

There’s ongoing communication between the mind and body. Your imagination is powerful, and if professionally mentored, your thoughts can manifest into actions.

Mental workouts activate and stimulate many of the same neural networks that connect the body with brain impulses. We can apply visualization to our day-to-day experiences to improve motivation, stay more positive, and build resilience.

The essential elements of effective visualization involve all your senses. Visualization techniques should be done with full emotional energy. Try to involve as many senses as possible: smell, touch, taste, and hearing, along with imagery to “feel it”.

Be an active participant in the scene – not a spectator. Visualize yourself running. Your heart, leg muscles, and breathing pattern should feel like you had a good run.

The process should be positive. If you want to stay away from sweetened drinks, visualize yourself being satisfied by water rather than imagining that you dislike sugary beverages.

Think of 3 visualizations you will practice daily to improve your health and well-being: 1.

REFLECTION

What went well last time— what can be improved?

Have you attempted to make behavioral changes in the past?

Take stock of what you accomplished and be proud of your successes. It is also an excellent time to ponder the low points. What worked for me in the past?

What did I learn from my previous experience?

What do I need to do differently to be more successful?

What personal strengths can I draw from the past to help me be healthier?

What am I good at doing?

Accountability Strategies

Accountability is critical to behavior changes’ success. Even with the right information and honorable intentions, you won’t succeed if you let yourself off the hook when it’s time to do the work.

WAYS TO INCREASE YOUR ACCOUNTABILITY

There are two amazingly effective ways to increase your accountability.

CHALLENGE YOUR EXCUSES HEAD ON:

The first approach challenges your excuses head-on. No matter how difficult your circumstances may be, the only way to succeed is to take personal responsibility for making things work out the way you want. Own your excuses, and do not use them to let yourself off the hook.

HAVE A WRITTEN CONTRACT WITH YOURSELF:

The second approach requires a written contract with yourself. A contract is a visible reminder of the commitment you have made to yourself, as well as a useful tool to combat pesky excuses. If taken seriously, you will find it more challenging to break the contract than to overlook an ambiguous resolution to try harder.

CHALLENGE YOUR EXCUSES

Challenging your common excuses requires observing your inner self and what goes on in your mind. This is especially important when you do not want to do something that you know you should do. What do you say to yourself at that moment?

Some excuses are much easier to identify than others. For example, throwing in the towel just because you made one poor food choice is unnecessary.

Other reasons are less obvious. For example, many people feel they do not have enough hours in their day to fit in some form of exercise or prepare a healthy meal. In most cases, it is a matter of improving time management.

Try to think of the 3-5 most common excuses you use now for not improving your health and well-being, and write them down below:

IDENTIFY APPROPRIATE COUNTERMEASURES

One solution is to begin thinking about yourself in a different light—one that puts you in charge. For each excuse or rationalization, think of an effective countermeasure.

For example, if you find that your schedule is often so busy that you skip your workouts, countermeasure by spending a few minutes each morning planning what has to be done, what can be postponed, what might save time, and who might be able to help you get things done.

What is the most common excuse I use that gets in the way of my health goals? What is a countermeasure I will practice?

Excuse

Countermeasure

SELF-TALK

Everyone has trouble with negative self-talk occasionally. We are often our worst critics. The little voice inside may be telling you that you are not working hard enough or that you are not worth it, and you should give up on your goals. It’s not always a rational voice.

Merely being aware of your inner dialogue weakens negative self-talk. Try to replace the negative belief with a countermeasure.

For example: instead of saying, “I’m never going to lose weight, I just don’t have enough willpower,” say, “I can lose weight if I stay focused, keep a food journal, and manage my stress more effectively.”

It is also important to respect yourself and others. You are more likely to feel better about yourself. Be kind and honest to others, as well as yourself. Building self-confidence can take time, so be persistent.

Think of the negative phrases you keep telling yourself and rephrase them using positive reinforcement and encouraging words:

Negative phrases I use: I’ll change them to:

Building a Support Network

A strong social support network can be as critical to your success as the goal itself. Your family, friends, and co-workers are an essential part of your life, and it’s never too soon to cultivate these critical relationships. Taking the time to build a social support network is a wise investment. Numerous studies have shown that a network of supportive relationships contributes to physical and psychological well- being.

A SENSE OF BELONGING:

Spending time with people helps ward off loneliness. Whether it’s parents, pet lovers, fishing buddies, or siblings, just knowing you are not alone can help you cope with stress.

A SENSE OF SELF-WORTH:

Having people who call you a friend reinforces the idea that you are a good person to be around.

A FEELING OF SECURITY:

Your social support network gives you access to information, advice, guidance, and other types of assistance. It’s comforting to know that you have people you can turn to in a time of need.

YOUR SUPPORT NETWORK

Going public with your goals allows friends and family to know what you are trying to accomplish and how you plan to get there.

A good support person or group:

• Holds you accountable to your goals, no matter what.

• Listens to you and is non-judgmental.

• Can help you solve problems and brainstorm strategies.

• Models healthy behaviors.

• Provides positive feedback and celebrates your success.

Choose a few people in your social support network and ask if they would periodically follow-up with you on your goals.

Explain why this change is so significant to you and share a copy of your goals with them. It’s a lot harder to let your friends down or slack off when others know and care about your goals!

What do I look for in a support person or group?

What type of support is helpful?

Make a list of friends or family members that you will ask to be a part of your support network and help you be accountable for your success:

TIPS FOR CULTIVATING YOUR SOCIAL NETWORK

• Pick a cause that is important to you and get involved. You are sure to meet others who share similar interests and values.

• Join a gym or the local community center or start a fitness group at work. You’ll make friends and get some exercise in the process.

• Join a support group or attend a church, synagogue, or other spiritual gatherings.

• Take time to thank your friends and family and express how important they are to you. Be the first to raise your hand when they need support.

• Avoid spending too much time with people who are negative or critical of you or the world around them or are involved in unhealthy behaviors such as alcohol or substance abuse.

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To attain your desired outcome, it is critical to create a routine that allows you to review your goals every week.

SMART Goals and Progress Tracking

GOAL SETTING

ESTABLISHING THREE-MONTH GOALS

Now that you have established your vision and a blueprint of where you would like to go, it’s time to set some goals. It’s essential to have goals that are just long enough to make it a meaningful process and short enough to create a sense of urgency and focus.

GOALS SHOULD BE QUANTIFIABLE AND MEASURABLE.

It is not enough to say, “I will exercise more” or “I will cut back on sugar.” Well-written goals include, “I will walk 30 minutes per day, five days a week in the morning before work,” or “I will limit beverages to water and unsweetened coffee or tea and limit dessert to once per week.”

Combine both outcome and behavioral goals. For example, an outcome goal is to lose three inches off your waist or lower your blood pressure to 120/80. Examples of behavioral goals are to exercise 45 minutes a day, five days a week, or eat at least 8 to 10 servings of fruits and vegetables per day.

YOUR HEALTH AND WELLNESS GOALS

STEP 1: MAKE YOUR GOAL DETAILED AND SPECIFIC.

Try to answer who, what, where, how, and when. How will I reach this goal?

List at least three action steps and be specific:

STEP 2: MAKE YOUR GOALS MEASURABLE.

Tracking a meaningful goal helps you monitor and acknowledge your progress.

I will measure/track my goal by using the following methods (for example, minutes of exercise logged or amount of weight loss):

STEP 3: MAKE YOUR GOAL ATTAINABLE.

Find the sweet spot, a goal that is both challenging and realistic—something within reach that will take you out of your comfort zone:

What resources do I need to achieve this goal?

How will I make time for this goal?

What do I need to learn before I move forward?

Who can I talk to for support?

STEP 4: MAKE YOUR GOAL RELEVANT.

A goal typically addresses something that is required immediately, necessary, and (hopefully) a priority in your life. Set goals that are appropriate to you and your specific situation.

Create a list of reasons why you want to reach your goal:

STEP 5: MAKE YOUR GOAL TIME-BOUND.

Establish how much time you need to achieve your goal and set periodic benchmarks. Be realistic with your date to maintain performance and create a sense of urgency by making a short deadline.

I will reach my goal by (date):

REVIEWING PROGRESS

To attain your desired outcome, it’s critical to create a routine that allows you to review your goals every week.

By regularly evaluating your progress, you can more easily address roadblocks and make small adjustments as necessary. Write down when you will review your goals regularly.

Day of week:

Time of day:

Establish a time each week to create an action plan and review your progress.

This helps you organize and assess your goals, ensuring they remain relevant and meaningful. It’s also critical that you acknowledge progress, no matter how small or challenging.

Some weeks will be more challenging than others. Set aside self-blame. Suppose there is a week when you don’t meet your goals. Ask yourself what you learned from the situation.

What will help you be more successful next time? Write your ideas below:

PLAN TO CREATE YOUR ACTION PLAN

This week, my goal(s) is:

Some challenges I face:

My strategies:

My confidence level is (10 being the most confident):

My successes this week:

I learned where I could improve:

REWARDING YOUR PROGRESS

Changing habits is difficult, and taking small steps in the right direction should be celebrated. Rewards can help us stay focused on our goals and increase motivation.

REWARDS DO NOT HAVE TO COST MONEY, BUT THEY SHOULD ALWAYS BE HEALTHY.

Using food or alcohol as a reward can add unnecessary calories to your diet, and the benefits are temporary. You may feel less motivated afterward.

Examples of non-food related rewards:

• Massage

• Reading a new book

• Taking a walk or hike

• Taking a hot bath

• Playing a game

• Keep a journal

Think about how you will reward yourself after you reach your next milestone, and take a note of that below:

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Acknowledge progress, no matter how small or challenging.

Bonus: Tips for Reducing Stress

BREATHING

Our breathing changes when we feel anxious. We tend to take short, quick, shallow breaths or hyperventilate, which is called “over-breathing”. This can make you feel even more anxious due to a racing heart, dizziness, or headache. Calm breathing is a tool you can use whenever you are feeling anxious. It involves taking smooth, slow, and regular breaths.

Sitting upright is usually better than lying down or slouching because it can increase your lungs’ capacity to fill with air. It is best to “take the weight off” your shoulders by supporting your arms on the side-arms of a chair or your lap.

• Position yourself on your sit bones and rotate your clavicle out, allowing your shoulders to relax and drop.

• Place your tongue on the roof of your mouth.

• Take a slow deep breath in through your nose and allow your rib cage to expand, and it will enable the air to expand your belly like a balloon.

• Hold your breath for one or two seconds.

• Release your tongue and slowly exhale from your mouth.

• Repeat the deep breath and place your attention on the center of your chest. You may even imagine there is a golden light surrounding your heart.

• Each time you take a breath, expand the feeling from your heart, or the golden light, into your shoulders, arms, palms, and fingers. Then push the next breath into your hips, legs, feet, and toes.

• About 4 to 6 breathing cycles per minute is often helpful to decrease anxiety. But find your comfortable breathing rhythm. This means 4-5 seconds in and 5-7 seconds out.

• Ensure you are not over-breathing; it is essential to pause for a few seconds after each breath.

• Try lying down on the floor with one hand on your heart, placing your other hand on your abdomen. Watch the hand on your belly rise as you fill your lungs with air, expanding your chest. (The hand over your heart should barely move, if at all.)

• Try calm breathing for at least five minutes twice a day. Once you are comfortable with this technique, you can start using it in situations that cause anxiety.

PROGRESSIVE MUSCLE RELAXATION

Practicing progressive muscle relaxation may help reduce anxiety and stress in your body. Regular practice allows you to become aware of tension in your body and gives you skills to experience immediate relaxation.

By tensing each muscle before the point of strain and then releasing it, you will allow the muscle to relax. If you have an injury or intense pain, you may want to avoid that area or be very gentle. Pay attention to the feeling of releasing the tension in each muscle.

Close your eyes and sit back in your chair or lie down in a comfortable position. Breathe from your nose, filling your chest cavity, and hold for a few seconds.

Passively release the air from your mouth for a count of five. Repeat. Breathe in through your nose for a count of five, then allow the air to leave for a count of five. Notice the tension leave your body as you release the air. Take in several more breaths, counting to five, holding, and releasing tension on the count of five.

Now, place your attention on the area of your feet. Begin by tensing your feet by curling your toes and the arch of your foot. Hold the curl and feel the tension in the muscles noticing the feeling for the count of five.

(Pause to breathe in through your nose to the count of five.)

As you passively breathe out, release the tension in your foot, and notice the foot relax as the air leaves your body.

*PAUSE TO BREATHE IN THROUGH YOUR NOSE TO THE COUNT OF FIVE AND PASSIVELY RELEASE THE AIR FROM YOUR MOUTH TO THE COUNT OF FIVE.

Next, place your attention on your lower leg area and tense the muscles in your calves. Hold tightly yet gently and pay attention to the feeling of tension in the muscles. (Pause to breathe in through your nose to the count of five) As you passively breathe out, release the tension from your lower legs, noticing the feeling of relaxation.

*PAUSE TO BREATHE IN THROUGH YOUR NOSE TO THE COUNT OF FIVE AND PASSIVELY RELEASE THE AIR FROM YOUR MOUTH TO THE COUNT OF FIVE.

Place your attention on the muscles of your upper legs and pelvis area and tense the muscles. You can squeeze your thighs together, feeling tension but not to the point of strain.

(Pause to breathe in through your nose to the count of five.)

As you passively breathe out, release the tension from your upper legs and pelvis area.

*PAUSE TO BREATHE IN THROUGH YOUR NOSE TO THE COUNT OF FIVE AND PASSIVELY RELEASE THE AIR FROM YOUR MOUTH TO THE COUNT OF FIVE.

Place your attention on your stomach and chest area by sucking in your stomach and holding the tension.

(Pause to breathe in through your nose to the count of five.)

As you passively breathe out, release the tension from your chest and stomach.

*PAUSE TO BREATHE IN THROUGH YOUR NOSE TO THE COUNT OF FIVE AND PASSIVELY RELEASE THE AIR FROM YOUR MOUTH TO THE COUNT OF FIVE.

Now place the attention on your back by tensing the muscles by bringing your shoulders together behind you. Hold firmly but not to the point of straining.

(Pause to breathe in through the nose to the count of five.)

As you passively breathe out, release the tension from your back, and feel the tension slowly leaving your body and a feeling of relaxation. Notice how your body feels when you allow it to come to ease.

*PAUSE TO BREATHE IN THROUGH YOUR NOSE TO THE COUNT OF FIVE AND PASSIVELY RELEASE THE AIR FROM YOUR MOUTH TO THE COUNT OF FIVE.

Place your attention on the area of your arms and tense your arms from your hands to your shoulders. Make a fist and squeeze up your arm.

(Pause to breathe in through your nose to the count of five.)

As you passively breathe out, release the tension from your arms and shoulders. Notice the feeling in your fingers, hands, arms, and shoulders. Your arms may feel limp and at ease.

*PAUSE TO BREATHE IN THROUGH YOUR NOSE TO THE COUNT OF FIVE AND PASSIVELY RELEASE THE AIR FROM YOUR MOUTH TO THE COUNT OF FIVE.

Move your attention to the area of your neck and your head as you tense your face and neck, contracting the muscles around your eyes and mouth.

(Pause to breathe in through your nose to the count of five.)

As you passively breathe out, release tension from your face and neck, totally giving into the relaxation.

*PAUSE TO BREATHE IN THROUGH YOUR NOSE TO THE COUNT OF FIVE AND PASSIVELY RELEASE THE AIR FROM YOUR MOUTH TO THE COUNT OF FIVE.

Finally, become aware of your entire body as you tense every muscle. Tense your feet, legs, stomach, chest, arms, head, and neck. Tense harder, without straining.

(Pause to breathe to the count of five as you hold the tension.)

As you passively release the breath, allow your whole body to go limp. Notice the feeling of relaxation and how different it feels from tension.

*PAUSE TO BREATHE IN THROUGH YOUR NOSE TO THE COUNT OF FIVE AND PASSIVELY RELEASE THE AIR FROM YOUR MOUTH TO THE COUNT OF FIVE.

Gently wiggle your fingers and your toes. Move your ankles and wrists. Bend your elbows and move your shoulders. Allow your body to move and adjust to comfort. Flutter your eyelashes to slowly allow in the light as you continue your day, or just maybe you are in dreamland.

FINAL NOTE: PRACTICE PROGRESSIVE MUSCLE RELAXATION OFTEN, WHETHER YOU ARE FEELING TENSION OR NOT. THIS WILL MAKE THE EXERCISE EVEN MORE EFFECTIVE WHEN YOU DO NEED TO RELEASE STRESS. WITH REGULAR PRACTICE, YOU WILL DEVELOP THE HABIT AND THE SKILL THAT WILL BECOME AN ESSENTIAL PART OF MANAGING YOUR ANXIETY.

Your Notes

Your Notes