Stress Support (Whole Person Care Protocol)

Introduction

Whole person care is a person-centered approach to medicine. It goes beyond treating symptoms or isolated conditions, focusing on the interconnectedness of bodily systems and addressing a wide range of factors. These include biological makeup, behavioral habits, environmental factors, and a patient’s personal beliefs, values, and goals. By tailoring care to align with these unique aspects, healthcare providers can create highly personalized treatment plans that address not only physical health but also emotional and mental well-being.

This template aims to provide healthcare providers with practical suggestions for labs, supplements, and lifestyle strategies, helping them design personalized, whole person care plans for patients looking to support optimal stress management and build resilience to stressors.

Advanced lab testing evaluates the physiological impact of stress and its downstream effects on body systems. Hormone panels assess hypothalamic-pituitary-adrenal (HPA) axis activity and cortisol dynamics, offering providers insights into acute and chronic stress patterns. 

Stress is also known to impair gut integrity and nutrient absorption; therefore, a comprehensive stool analysis can evaluate gut microbiota balance, inflammation, and markers of intestinal permeability, which can become imbalanced and further perpetuate stress states via the brain-gut connection. (Beurel 2024) 

In addition, micronutrient testing helps identify stress-exacerbated nutritional deficiencies, such as minerals like magnesium, calcium, zinc, and iron, that may contribute to fatigue, mood dysregulation, and immune imbalance. (Lopresti 2019)

Evidence-based supplements target stress physiology through multiple mechanisms to restore homeostasis and reduce the burden of stress on the body. Adaptogenic botanicals modulate the HPA axis. Other nutrients and neuroactive compounds support neurotransmitter balance, reduce sympathetic overactivation, and support sleep quality.

Lifestyle modifications round out a holistic protocol by addressing key behaviors that influence stress resilience. Recommendations include shifting toward a nutrient-dense diet, engaging in regular physical activity, adopting mindfulness practices, and optimizing sleep hygiene.

Labs

DUTCH Plus

Doctor’s Data GI360

Micronutrient Testing

Magnesium, RBC

Calcium

Zinc, RBC

Iron, TIBC, and Ferritin Panel

Ingredients

Ashwagandha (Withania somnifera)

Dosing: 125–500 mg daily for at least eight weeks (Pandit 2024) 

Supporting evidence:

• Ashwagandha is an adaptogenic herb traditionally used in Ayurvedic medicine for stress reduction, cognitive enhancement, and general well-being. (Mukherjee 2021)(Khalid 2025) 
• Ashwagandha modulates the HPA axis, leading to reduced cortisol secretion and improved stress adaptation. (Wiciński 2023) Its antioxidant/anti-inflammatory properties and ability to enhance GABA and serotonin transmission may also contribute to its anxiolytic and calming effects. (Speers 2021)(Khalid 2025)
• RCTs and meta-analyses demonstrate that ashwagandha significantly reduces perceived stress and anxiety scores with a moderate to large effect size. (Gopukumar 2021)(Akhgarjand 2022) Specifically, positive outcomes correlated with supplementation include reductions in morning salivary cortisol and Hamilton Anxiety Rating Scale (HAM-A) scores, and improvements in quality of life, sleep quality, and cognitive function in stressed adults. (Lopresti 2019)(Gopukumar 2021)(Majeed 2023)

Holy Basil (Ocimum tenuiflorum)

Dosing: 125 mg twice daily for eight weeks (Lopresti 2022) 

Supporting evidence:

• Holy basil, also known as tulsi, is another medicinal adaptogenic herb widely used in Ayurveda for its purported anti-stress properties. (Jamshidi 2017) 
• It attenuates the stress response by modulating the HPA axis. This effect is partially mediated by antagonism of the corticotropin-releasing factor 1 (CRF1) receptor and inhibition of cortisol release. (C M 2023) 
• Animal studies have shown that holy basil extracts reduce stress-induced immobility and elevations in corticosterone during forced swim tests. (C M 2023)
• An RCT from 2011 demonstrated that stressed adults taking holy basil extract experienced reductions in general stress symptoms, including forgetfulness, exhaustion, sleep disturbances, and sexual dysfunction. (Saxena 2011) A more recent trial corroborated these anti-stress properties, reporting reductions in perceived stress, insomnia, hair cortisol levels, salivary amylase, and blood pressure. (Lopresti 2022)

Gamma-Aminobutyric Acid (GABA)

Dosing: 20–300 mg as a single dose (as needed) or daily for eight weeks (Hepsomali 2020) 

Supporting evidence:

• GABA is the principal inhibitory neurotransmitter in the human central nervous system. Its binding to GABA receptors reduces neuronal excitability, resulting in anxiolytic and calming effects. (Ngo 2019)(Zhang 2024) 
• Oral GABA administration can acutely increase alpha brain wave activity (associated with relaxation) and reduce beta wave activity (linked to anxiety), with effects observed within one hour of intake. (Abdou 2006)
• While animal and early clinical data support GABA’s calming and stress-reducing effects, a 2020 systematic review reported limited and mixed evidence for its ability to reduce acute psychological and physiological stress. Further research is warranted to establish GABA’s clinical utility in stress management. (He 2019)(Hepsomali 2020)

L-Theanine

Dosing: 200–400 mg daily for at least four weeks (Hidese 2019)(Williams 2020) 

Supporting evidence:

• L-theanine is a non-protein amino acid found primarily in green tea (Camellia sinensis) leaves. It is well absorbed orally and crosses the blood-brain barrier (BBB). (Lardner 2014)(Dashwood 2025) It is believed to exert neurophysiological effects by modulating neurotransmitter systems, including GABA, serotonin, and dopamine, in selected brain regions. (Shen 2019)(Dasdelen 2022)  
• It may also act as a glutamate receptor antagonist, reducing neuronal excitation, thereby attenuating sympathetic nervous system activity and stress responses. (Dasdelen 2022)
• L-theanine increases alpha brain wave activity, which is associated with a state of relaxed alertness and selective attention. (Lardner 2014)(White 2016)
• RCTs in healthy adults have demonstrated that short- and long-term administration of L-theanine can reduce subjective and physiological stress, anxiety, and improve sleep quality (as measured by validated scales and biomarkers, such as the State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, and salivary alpha-amylase). (Hidese 2019)(Williams 2020)(Lim 2024)

Magnesium

Dosing: 250–500 mg daily for at least four weeks (Rawji 2024)  

Supporting evidence:

• Magnesium exerts calming effects on the nervous system by acting as an N-methyl-D-aspartate (NMDA) receptor antagonist, enhancing GABAergic activity, and reducing oxidative stress in the brain. (Pickering 2020)
• Studies indicate that 68% of Americans eat less than the recommended levels of magnesium, and stress further increases the risk of magnesium inadequacy/deficiency by increasing urinary magnesium excretion. Deficiency exacerbates stress symptoms like fatigue, irritability, nervousness, gastrointestinal upset, and headache. (Boyle 2017)(Pickering 2020)
• In an eight-week RCT, individuals with low magnesium and stress were given magnesium with or without vitamin B6. Anxiety and depression scores, measured by the Depression Anxiety Stress Scales (DASS-42), were improved in both treatment groups as early as four weeks, with continued improvements through the end of the trial. The greatest improvement was observed in the participants who were given magnesium with B6. (Noah 2021)
• In a double-blind RCT, 46 elderly individuals were randomly assigned to take daily magnesium or a placebo for eight weeks. At the end of the trial, those taking magnesium had significant improvements in subjective and objective measures of sleep and stress-related physiology:
  • Increases in total sleep time, sleep efficiency, and melatonin concentrations
  • Decreases in Insomnia Severity Index [ISI] scores, sleep onset latency, and serum cortisol concentrations. (Abbasi 2012)

Rhodiola (Rhodiola rosea)

Dosing: 200–1,500 mg daily for at least 28 days (Tinsley 2023)

Supporting evidence:

• The root and rhizome of rhodiola contain approximately 140 active compounds that work together to modulate the HPA axis, inhibit neuroinflammatory pathways that reduce the expression of stress-related proteins, stimulate endorphin production, and modulate neurotransmitter levels. (Ivanova Stojcheva 2022)(Bernatoniene 2023)
• In patients with burnout and fatigue syndrome, taking standardized rhodiola extract significantly reduced symptoms of stress-related fatigue and improved mental performance (especially concentration) and the cortisol awakening response (CAR). (Olsson 2009)
• In a clinical trial of 80 mildly anxious people, those who supplemented with rhodiola reported improvements in anxiety, stress, anger, confusion, and depression. (Cropley 2015)

Lifestyle Recommendations

Nutrition

There is a bidirectional relationship between stress and dietary patterns: psychological stress increases the likelihood of consuming energy-dense, palatable foods (high in sugars and saturated fats), while habitual intake of such foods is associated with higher perceived stress and adverse stress biomarkers. (Bremner 2020)(Canuto 2021) Conversely, higher diet quality, characterized by greater intake of fruits, vegetables, and whole foods, is associated with a more favorable stress and mental health profile. (Firth 2020) 

Recommendations: 

• • Encourage a whole-foods diet: Diets high in sugars, saturated fats, snacks, fast foods, and alcohol are consistently associated with higher perceived stress, elevated basal cortisol, and altered diurnal cortisol patterns. (Canuto 2021)(Khaled 2021)
  • Recommend a plant-based diet: Low intake of fruits and vegetables is independently associated with increased perceived stress. (Ju 2025) Incorporating specific subgroups of fruits (apples, pears, citrus, bananas) and vegetables (cruciferous, yellow/orange/red vegetables, legumes) is linked to a lower odds of high perceived stress. (Radavelli-Bagatini 2022) 
  • Recommend limiting sodium intake: Lower sodium intake (<2,300 mg daily) is linked to reduced psychological and physiological stress load. (Soltani 2018)(FDA 2020) 
  • Encourage intake of magnesium-rich foods: Magnesium-rich foods include such as green leafy vegetables, legumes, nuts, seeds, and whole grains, may help subjective and objective measures of sleep and stress-related symptoms. (Abbasi 2012)(NIH 2022)

Movement

Regular physical activity enhances stress resilience and emotional well-being by modulating neurobiological, psychological, and physiological pathways, reducing stress reactivity and improving mood and cognitive function. (Bernstein 2018)(Nowacka-Chmielewska 2022) 

Recommendations: 

• Encourage regular moderate exercise: Recommend at least 150 minutes of moderate-intensity aerobic activity weekly, such as walking, cycling, and swimming, tailored to the individual’s needs and physical abilities. Even short bouts and single sessions of exercise provide immediate mood and stress benefits. (Piercy 2018) 

• Incorporate strength training: Include muscle-strengthening activities at least twice per week. (Piercy 2018)

• Practice yoga: Meditative and dynamic forms of yoga are correlated with reductions in feelings of stress, anxiety, and burnout, in addition to improvements in quality of life, self-regulation, and compassion. (Marshall 2020)(Zok 2024) 

• Avoid high-intensity exercise at nighttime: High-intensity exercise within one hour of bedtime may impair sleep efficiency and delay sleep onset. (Stutz 2019) Most evidence indicates that high-intensity exercise ending at least 2–4 hours before sleep does not negatively impact sleep. (Leota 2025)

Stress Reduction

Stress reduction techniques modulate the physiological stress response, improving clinical biomarkers like the CAR, salivary cortisol, perceived stress, and anxiety scores. (Li 2023)(Rogerson 2024)

Recommendations: 

• Mindfulness practices: Practicing mindfulness-based stress reduction for 10-20 minutes daily can help regulate the stress response and build resiliency to stressors. (Pascoe 2017)(Palmer 2023)

• Emotional services: Counseling, such as cognitive behavioral therapy or group-based support, provides coping strategies and encourages emotional processing. (Manigault 2019) 

• Fostering relationships and community: Maintaining social connections through group activities, peer support, or community engagement attenuates cortisol responses to psychosocial stressors and uplifts mental health through fostering a sense of purpose and belonging. (Engert 2017)(Haim-Litevsky 2023) 

Sleep

Insufficient and poor-quality sleep dysregulates the HPA axis by increasing baseline cortisol levels and heightening stress reactivity. Consistent, restorative sleep stabilizes neuroendocrine function and mitigates the physiological impacts of stress. (van Dalfsen 2018)

Recommendations: 

• Ensure adequate sleep duration: Adults should aim for 7–9 hours of sleep per night. (NIH 2022)

• Educate on sleep-disrupting triggers: Discourage consumption of caffeine, nicotine, alcohol, and heavy meals and exposure to bright light later in the day, which are associated with fragmented sleep. (Baranwal 2023)

• Encourage sleep-promoting habits: Sleep hygiene practices positively correlate to better quality sleep and mental health. (Alanazi 2023) These include maintaining a regular bedtime/wakeup schedule, a nightly wind-down routine, creating a bedroom environment conducive to deep sleep, and only using the bedroom for sleep and sex. (Baranwal 2023)

• Support healthy circadian rhythms: Exposure to natural sunlight in the morning and limiting blue light exposure in the evening supports healthy hormonal balance involved in the sleep-wake cycle. (Blume 2019)(Wahl 2019)

Patient resource:

• Supporting Stress Resilience: A Whole Person Care Approach