For many heart patients, stress is the elephant in the room when we discuss why they missed their goals for proper exercise, nutrition, abstinence from smoking, and proper sleep. Physicians aren't routinely taught how to advise others on stress-management techniques, and may do no better than the rest in terms of dealing with stress themselves.
I've just completed a series of lectures to the public on stress-management tips, and list them here in the hopes they may help others.
When I talk to patients about stress, I begin by describing adaptogens, or herbs that appear useful in stabilizing physiology and improving anxiety and stress. I do this because so many of them are already using pills — typically benzodiazepines like Xanax and Ativan — and my goal is to get them off those prescription medications ASAP.
Frankly, substituting one pill for another is something most patients accept faster than any other technique. I've had success in many patients using L-theanine 200 mg twice a day and ashwagandha 500 mg twice daily, usually together. Even elderly patients report they feel less stressed and more functional. Rhodiola is another adaptogen I like because it's been studied in heart patients and shows benefits for their symptoms. I recommend 100 mg a day.
There are many styles of breathwork, but I find I can teach my patients the 4-7-8 breathing practice in the office in just a few minutes, and they use it right away. I refer them to an online video created for children, and ask them to practice this at home and use it in their daily routine: