All blog posts from Dr. Allott are provided for educational and informational purposes only. As Dr. Allott is also a licensed medical practitioner, we must make it clear that nothing on the blog is intended to constitute medical advice, consultation, recommendation, diagnosis, or treatment. If you are concerned about your health, please seek appropriate care in your area.


Tenets for Practice that Put the Client at the Center

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I just finished a two-day training in Minnesota. Participants kept coming up to me and saying how much they appreciated my approach. What is that approach? How might it be different than other methods? What does it mean to be client-centered? What is the humanistic approach? Would mindfulness practitioners call this approach mindfulness? I tried to get clearer on what people are experiencing because all I experience is me.

I do have some tenets that I hold on to:

  • Don’t try to be smarter than God or Evolution. I embrace the fact that I understand very little of what’s happening for individual. However, I can set up experiments to test for what might be true.

  • Trust people to tell you close enough to the truth. Again, I don’t have to know everything. I just have to know what they are willing to try and what they won’t.

  • Encourage being inconsistently consistent. Perfection is always a prison. How I have seen people change is to try, stop, make new intension, try again, don’t make it, succeed for a little while, stop, try again, miss, change it up, learn, try, fail, pout, feel anxious, try again, and so it continues. What I have learned most from martial arts is to get up after every fall.

  • Willpower resides in our responsive brain. If we are not fed, we are reactive and can’t be responsive. Our anxiety, irritation, and agitation will escalate until we fuel our bodies.

  • Human physiology is common to all humans. The details of our choices arise from our past experiences, our current circumstances, and what our holds us back. But the physiology happens for everybody’s body.

  • Be curious about how the underlying physiology drives behavior. If someone is living in the complex world of homelessness, they might need to drink soda all day long to feed their pre-frontal cortex so that they can be responsive instead of reactive. Change comes from being responsive to one’s situation. Drinking soda all day is not a sustainable long-term behavior, but it may be what’s needed to get a toe hold on a new path.

  • Most of us cannot DO a food program. We make moment to moment decisions about how and what to feed ourselves based on what’s available. Having have some basic knowledge about what will be useful in-the-moment can be empowering and help us gain some understanding of what our possibilities are.

  • My job is to witness and to constructively add to people’s lives. Telling people to stop a behavior or to change is akin to suggesting a massive mountain climb. Teaching the skills needed for change and doing experiments along the way so people can begin to feel better in a single moment provides a more sustainable pathway for change.

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Most of these tenants are not unique to learning and healing. I think the connection to how physiology impacts and drives our behavior is important and sometimes lost to the drama of life.

The workbook that Natasha and I are writing describes how the physiology of glucose control can impact how we experience all forms of anxiety. I have witnessed that attending to the physiology helps not only anxiety, but other conditions as well: PTDS, OCD, night terrors, 3 am waking, fatigue, depression, ADHD, and others. It also supports effective decision making, creativity, and sustaining energy levels throughout each day.

If you have been using food to help yourself or the people you connect to feel better, we would love to hear how addressing glucose control has positively impacted different behavioral symptoms. How has understanding the ways in which protein and carbohydrates influence behaviors been helpful? Please take this 1-minute survey.

Minimal Metrics for Exercise

In 2018, my blog focused primarily on anxiety. This year I am thinking more about movement and mental health. A good starting place is identifying the minimal metrics for movement and how achieving these metrics can support mental health.

So, I spent some time reviewing the most recent studies for exercise.

What is definitive?

Exercise reduces dementia and reduces all causes of death. For mental health in general, cognitive functioning exercises in studies don’t always show that it is helpful. They have not shown that they decline cognitive functioning. Ok. Exercise dose not always helps to be smarter. But for depression, the research is clear: exercise is an excellent therapy on its own and in conjunction with other therapies. Exercise increases neuroplasticity, improves how the autonomic and endocrine systems respond to stress, improves sleep, improves self-esteem, …the list goes on. So, we can definitely say now that exercise is good for both the brain and body.

How much movement do the studies say is needed?

When people exercise three times a week for 12 to 24 weeks, there is a dramatic reduction of depression, and if the exercise continues, there is a reduction in recurrence. That sounds great! And… those people were selected and paid to be in the studies.

Beyond the studies and in my office

When people can feel that movement improves how they feel, then it becomes a useful tool for treating energy and mental clarity in the moment. I believe that part of treating depression, mental health, pain, and other diseased states, is to provide people with tools that move them towards resilience moment to moment. If a person has a tool that can help them feel better now, today, or later today, we can build experiences that move us away from depression, fatigue, low self-esteem, anxiety, pain, or whatever their points of suffering are. Why does this work? When people can experience change that they are in control of, and learn the value of the process, they have a model of change that can then apply to other things in their life.

But how do you actually get someone who is depressed moving?

At my last PESI training in Richmond, VA, I posed this question to the group of around 90. I like to start with the smallest possible metric, in large part because it is doable. And since I am all about being able to feel what’s going on in the body, I first asked everyone to do an experiment. You, the reader, can do the same experiment now.

The Minimal Movement Experiment

1. Check-in and rate your energy level at this moment, using the scale below.

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Now stand up. Choose one of the three possible movements that you will do four times. Here is a video of me squatting, marching and flapping my hands, in case you want to see what I am talking about.

  • Chair squats – have a chair behind you and sit down as though you are going to take a seat. Just as the chair touches you, stand back up;

  • March in place – with your knees coming up as high as it is comfortable; or

  • Overhead hand clap – raise both arms in the air and bring your hands together comfortably over your head. Clap your hands together if that sounds like fun.

Remember one of these, just four times.

3.  Sit back down and re-rate your energy level.

The majority of people in my training reported feeling at least 10% better. So, if you were initially at 6 (out of 10), you might now be at 7… in less than 30 seconds! What could you do with 10% more energy? Do you get up to snack or drink coffee at work when you might just need to move your body a little bit to get some energy and mental clarity?

Where can the experiment be done?

Certainly, YOU can do this experiment anywhere: at the office, in the bathroom, when you get off the couch from watching TV. Additionally, you can try this experiment with clients who present with fatigue or who are kinesics learners. I offer it as a mindfulness exercise for people with childhood history of trauma, as a way got them to learn to listen to their bodies. It is a small enough dose that it is unlikely to make fatigue worse. Maybe nothing is noticed, but they tried something new. I also like to give it to my clients as homework (“Since the exercise was helpful in my office, I would like you to try it when you have been sitting for more than three hours.”)

Throughout the year, I will write more about how to use movement as a way to improve energy and mental clarity.

References:

Medina JL, Jacquart J, Smits JAJ. Optimizing the Exercise Prescription for Depression: The Search for Biomarkers of Response. Curr Opin Psychol. 2015;4:43-47. doi:10.1016/j.copsyc.2015.02.003. Link to study.

Belvederi Murri M, Ekkekakis P, Magagnoli M, et al. Physical Exercise in Major Depression: Reducing the Mortality Gap While Improving Clinical Outcomes. Front psychiatry. 2018;9:762. doi:10.3389/fpsyt.2018.00762. Link to Study.

10 Tips For A More Enjoyable Holiday Season

It is never too early to create a plan to build willpower and practice waypower for your holiday eating, especially if your desire is to weather the season feeling your best and without unreasonable weight gain.

These 10 tips may serve as a thoughtful steps through the challenges that come during the most food-seductive time of year.

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1. For the months of November, December and January, mark the days on your calendar for “free eating” - a time to enjoy eating whatever you want.

2. When sugar cravings are especially high during the holidays, turn to protein: eat protein every 3 hours.

3. This is the time of year when exercise routines are often disrupted, so plan shorter workouts such as 10 minutes of walking, complete 20 squats, do a 20-count of plank, or 10 sit ups. I like calisthenics because I can break up the exercise routine throughout the day and still receive the benefits.

4. In early December make an appointment for after January 15th to meet with a friend for a walk, see a nutritionist or exercise person of choice and start a new routine. By mid-January you’ll know what your goals are for the New Year and will be open to assistance and ready for action.

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5. Include on your gift list a fitness band (a step-tracker, or other similar device) along with time from a tech savvy family member or friend to assist you in setting up the gadget. Fitbit and Jawbone are two programs that I have observed as really excellent, but there are others as well. Don’t forget: walking 10,000 steps a day changes health. This level of movement prevents diabetes, improves the quality of most sleeping and supports positive mental health. Increasing your daily movement will be far easier than you might imagine, when using one of these convenient programs.

6. Commit to eating a protein-rich breakfast daily.

7. Consider purchasing a full spectrum light for where you eat breakfast. It is a less expensive alternative is buying a full spectrum lightbulb for a lamp you already have.

8. Be outside at least 10 minutes a day, even on rainy or cloudy days.

9. Thoroughly enjoy food that you are eating, regardless of what it is. Stop to notice the taste, color, texture, and what you really like about it. Don’t feel guilty; guilt comes with no benefits. Have a plan to get your eating back on track the next day.

10. If you are tired, try a 20- to 40-minute nap.

For more Waypower ideas, check out our Holiday book, Surviving the Holidays, available on Amazon.

What diet types contribute to depression and anxiety?

I am reluctant to write this post. I’m sure I’m going to make a few people mad. In last month’s Connectors Meeting there were questions about how different diet types contribute to mental health concerns. When a person's diet choice restricts food categories, they can find over time that their diet is contributing to increased anxiety and depression. This is because a diet that limits food groups can lead to nutrient deficiencies if health metrics are not carefully monitored through diagnostic labs.

In this post I’ll review some things to watch out for when eating significant amounts of highly processed foods, following vegetarian or vegan diets, and keto/paleo/Atikins types of diets.

Highly Processed Food Diets

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Diets high in processed foods have been shown to increase depression and anxiety. These are diets with lots of white foods (bread, rice, potatoes, pasta, muffins, bagels, chips, sweets, fast food). With this diet, when I look at an individual's labs what I typically see are deficiencies in nutrients that help to synthesize dopamine and serotonin. Common deficiencies are protein, B vitamins, magnesium, zinc, omega 3, Vitamin D3, and fiber. Additionally, there is increased inflammation as indicated by elevated C-reactive protein (CRP) levels. Inflammation contributes to depression, fatigue, bipolar, cardiovascular disease, dementia, and diabetes, to name a few concerns. Dr. Felice Jacka provides a whole body of research about the impact of diet on mental health. Here is her seminal paper: Association of Western and traditional diets with depression and anxiety in women.

Vegetarian/Vegan

When I see vegetarians and vegans in my office, they tend to be very anxious individuals and the anxiety often leads to depression. I’m not saying that all vegetarians and vegans struggle with anxiety and depression. Rather, that individuals who are anxious and depressed and vegetarian tend to have higher levels of anxiety and depression due to nutrient deficiencies. Their anxiety is often caused by fluctuations in blood sugar levels because of the low carbohydrate to protein ratio in many of the foods they typically consume.

For example, let’s consider a bean burger. Beans have some protein and some carbohydrates. The bread is all carbohydrates. So this bean burgers contain a lot of carbs and not a lot of protein

Clinically, I have seen anxiety decrease significantly when we assure that they are getting enough protein throughout the day (8 grams per 20 pounds of body weight or at least 65 grams divided throughout the day for anyone over 140 lbs.)

There is a large body of research that suggests vegetarians have better physical health then omnivores. Vegetarians tend to have lower body mass index and cardiovascular disease. However, an Australian study with 9113 participants indicated that vegetarians and vegans have more anxiety and depression then omnivores.

Here are two more studies that may be of interest:

For vegetarians, the labs that I carefully look at are total protein, Omega 3, ferritin (iron stores), B vitamins, and Vitamin D3. In my client base, vegetarians and vegans tend to carry less muscle mass and more fat mass.

For vegans, I will also look to see what their primary sources of fats are. The addition of coconut milk and oil can help with fatigue caused by a lack of cholesterol in their diet; consuming enough cholesterol is important because it helps synthesize hormones.

Keto/Paleo/Atkins

I am going to make a “no duh” statement… But it’s one we often forget: Weight does not determine health.

High-fat mass can impact health, but it’s not everything. I’m far more concerned about an individual's ability to be self-compassionate, eat primarily health-sustaining foods, engage in some level of regular movement or exercise, sleep well, and have healthy labs.

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I have seen a number of individuals who started on a keto diet (low carbohydrate with high protein and high fat) to lose weight. However, after the initiation phase of just meat and fat, they did not add fruits or veggies back into their diets for years. They explain that primary reason for staying with this phase is because adding back fruits and veggies caused them to gain back the weight they had lost. This is true, because when we do quick weight loss programs it’s hard to not do quick weight gain as well. However, there are some serious health consequences not eating fruits and vegetables.

One of the consequences is that they became very low in B vitamins and Vitamin K. For women following this type of dietary restrictions, they started having heavy menses because their blood was not clotting well. This then also led to iron deficiency, which contributed to their story of depression/fatigue.

Check out these articles:

In conclusion

Diets that support physical health do not always support mental health. Diets that are low in nutrient dense foods can contribute to mental health concerns through presentation of depression/fatigue and hypoglycemia/anxiety. When someone is considering medications or has tried medicines without the expected positive impact, it’s worth suggesting that they ask their primary care providers for a laboratory workup for fatigue. Going to a naturopathic physician, nutritionist, or acupuncturist to have their diet evaluated for deficiencies that could be contributing to their mental health status is also a good option.

Here are some additional resources:

Fuel for Thoughts: Panic Attacks in High Functioning People

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Have you ever known someone who seemly had it all together? And then, she or he seemed to spiral downward with anxiety and depression, even though it seemed out of character. Brad Stulburg, a published author on productivity and performance, recently published an article on his experience with anxiety and panic attacks. I have been following his blog lately because he encourages mindfulness, sleep, and exercise for executives. His anxiety and panic attacks are completely new phenomena to him. He writes candidly about the impact this had on his life and his advice toward the path out.

I was intrigued when Brad shared about the day of his first panic attack: his hadn’t fed his body well during the day, and after exercise he had an alcoholic drink and snacked on potatoes chips. We’ve all done it. You meet some friends at a bar for a drink after a long day and there is no real food available. This combination set up the event of his hypoglycemia (low blood glucose for the brain) and - in my opinion - a shot of adrenaline that was at a survival dose rather than risk taking/excitement dose.

This combination made his amygdala (the reactive/lizard part of the brain) hyper-sensitized to adrenalin. Emotionally, there was no good story about why his adrenalin hit was so high – no attack, no accident. So his brain is trying to find an emotional meaning for the event, when perhaps it was his physiology that was the driver of the adrenaline.

Exercise + refined carbs + alcohol + normal aging process = big release in insulin + sharp drop in glucose + big release in adrenaline = Anxiety and Panic attacks. 

This day of poor self-care set in motion his reactive brain trying to be in charge of his mind, and he has been working hard ever since to regain and maintain his mental health. This can happen to anyone. His example illustrates the importance of nutrition for taking care of one's body to maintain a stable brain and mind. His courage to share his experience helps us all know that we can return to health.

Question: How can we create food safety nets for ourselves and others? Can we keep protein bars or nuts in our bags? Or throw a box of protein bars into the truck of our teenager? Can we ask to meet at bars that have food? 

Share your thoughts by commenting below.

Do you "sheet cake"?

I laughed pretty hard when I watched Tina Fey's sheet caking skit on SNL's Weekend Update. It perfectly captured the way many of us (at least from time to time) use sugar to calm our anxiety.

The physiology that explains why this works can be found here, but in short: the sugar in sheet cake gives us a readily available glucose source that tells our lizard brains that everything is going to be ok.

What's missing from the skit is the ensuing sugar crash, which can leave us feeling even worse than before.

For a longer-lasting fix to calm anxiety, eat your favorite source of protein first. Then go ahead and indulge in that sheet cake if you still want it. I'm guessing the speed at which you eat - and the quantity you eat - will be less than without the protein. By focusing on adding protein with carbs,  mostly complex carbs but sometimes sheet cakes, you can avoid the sugar hangover and not let the stress of the night before move with you into the next day. 

What's impacting your anxiety?

In July's Connectors Group we reviewed the Snapshot of Anxiety Assessment handout introduced in June's webinar, , hearing stories of how Connectors have used this tool and answering questions. 

We then discussed my new handout, What Impacts Anxiety (WIA),  a worksheet that captures information about anxiety in a format that helps us see the daily pattern of how the symptoms of anxiety show up in our lives.

The focus of this handout is on learning how meeting the needs of your body, which is the power supply for your brain, impacts energy, anxiety and mental clarity. Since food, sleep, exercise, and our environment impact your body’s ability to create a stable platform for your brain and mind to work, they can be significant drivers to improve fatigue and anxiety.

Further, WIA can be used with other interventions to track improvement of the symptoms of anxiety, such as the introduction of medications, mindfulness, exposure therapy, and observing anxiety levels in different environments or around different people.

The WIA Handout can help you with the people you connect with understand their anxiety better, may they be clients, family members, teenagers and most importantly out selves. 

Connectors Group Discussion: What Impacts Anxiety July 2017

  • Introduction: 0-0:21 minutes
  • Review of the Snapshot of Anxiety Assessment and Q&A: 0:21-20:28 minutes
  • Introduction of the new tool, What Impacts Anxiety: 20:28-34:17 minutes

This webinar is also available as a Podcast.

If you find this blog helpful, please tap on "Like", post comments or consider sharing it. Thank you. 

Snapshot of Anxiety Assessment

In June, the Connectors Group discussed one of the assessments I developed for the book I am writing on Addressing the Physical Causes of Anxiety. The handout Snapshot of Anxiety Assessment reviews how to distinguish anxiety from functional hypoglycemia.

As I discuss different chapters from my book with Connectors, I am very interested in getting your feedback. As you watch the 22 minute excerpt from June's Connectors Group webinar, please let me know what you think, reply to the following questions in the comments section below, or email me.

  • How is the Snapshot of Anxiety Assessment helpful?
  • What new perspective will this Assessment offer your clients?
  • What type of client would this help? Are there clients you would not use this with?
  • What are the obstacles to integrating this into your practice?
  • How likely are you to use and share the Snapshot of Anxiety Assessment?

Dr. Kristen Allott, June 9, 2017 (22.30 minutes)

  1. Introduction: 0-1.11 minutes
  2. Part 1: GAD-7: 1.11-3.19 minutes
  3. Part 2: Mind – Brain – Body Symptoms: 3.19-6.30 minutes
  4. Part 3: Global Symptoms: 6.30-13.00 minutes
  5. Part 4: Functional Hypoglycemia Score or the “It’s not in your head – it’s in your body” Score: 13.00-17.37 minutes
  6. Identify what’s most important to you about reducing anxiety: 17.37-22.28 minutes

This webinar is also available as a Podcast.

If you find this blog helpful, please tap on "Like", share your comments or consider sharing it. Thank you. 

Estrogen: changing the brain and body from menarche to menopause

In May's Connectors Group webinar, guest speaker Dr. Miranda Marti* of Whole Life Medicine discussed estrogen. Estrogen heralds changes not just in the physical body but in mood and libido. It also has the power to shift focus for relationships and careers, and change the salience of what the brain finds rewarding and reassuring.  For some women, these natural fluctuations of estrogen throughout life are experienced with grace, while other women may find themselves driven wild or to despair. 

Dr. Marti discussed why this occurs and how we can support hormonal changes, whether they be monthly cycles or the perimenopausal transition, with ease. The recorded webinar with slides is provided below in three parts. The full audio is available as a podcast.

In Part 1, Dr. Marti explains:

  • How estrogen levels change over a lifespan,
  • The different ways in which estrogen and progesterone affect brain function, and
  • How estrogen and serotonin-melatonin interact.

Dr. Miranda Marti, May 12th, 2017 (17:04 minutes)

In Part 2, Dr. Marti talks about:

  • Estrogen-dominant conditions,
  • 5 steps to balance estrogen, and
  • Answers questions from participants

Dr. Miranda Marti, May 12th, 2017 (23:34 minutes)

In Part 3, Dr. Marti explains:

  • Anxiety and the Vagus Nerve, and the Connection with Urinary Incontinence
  • 3 Steps for urinary Incontinence
  • And important differences between Vaginal Estrogen vs. Hormone Replacement Therapy

Dr. Miranda Marti, May 12th, 2017 (12:10 minutes)


*Dr. Miranda Marti is a naturopathic physician and acupuncturist specializing in the connections between women’s health, digestive health (the 2nd brain) and mental health. In addition to her private practice at Whole Life Medicine in Kirkland, WA, she leads wellness groups at a Seattle-based drug and alcohol recovery program and is adjunct faculty for the Bastyr University Health Psychology Department.

Addressing the Physical Causes of Anxiety

In February-March of this year I held a live online 3-part training Addressing the Physical Causes of Anxiety. We work with our anxiety and other people’s anxiety all the time. Anxiety can create challenges at work or within our family. We know what questions to ask about what makes us emotionally anxious; but what if part of the cause of our anxiety or the anxiety of the people around us is physical?

The recorded webinars and handouts from the three sessions is now available:

  1. Naming and Taming Anxiety
  2. Eating to Reduce Anxiety
  3. What to Ask Your Doctor

Everyone who purchases this program will receive updated materials and will be able to interact with me about this content, by email, through 2017.

Based on the key educational points that I review with my individual clients, this content represents a value over $700. Your cost for the full online training package: $150

How practice affects brain function

Here's an interesting TED-ED video on the value of practice, what makes good practice, and how practice actually improves brain function. Lots of things can be practiced, from music to knitting to developing a healthier diet or new habit.

Key elements of practice are (nearly) daily repetition, constant curiosity about how to do something better, and working at the edge of a know skill set without jumping in too deep.

Importantly, by going through the process of trying something, messing up or finding room for improvement, and trying again, practicing gives us skills to deal with anxiety in other areas of our lives as well.

Mastering any physical skill takes practice. Practice is the repetition of an action with the goal of improvement, and it helps us perform with more ease, speed, and confidence. But what does practice actually do to make us better at things? View full lesson.

 

Preventing CEO Burnout

John, the CEO of a mid-size family company, has been putting in 90-hour workweeks for 11 months.  Between the tight economy, an aggressive new competitor, and several family dramas, his taking a vacation now has been out of the question.  It is hard for John to get to sleep; it is even harder for him to stay asleep, and his brain turns off only after several cocktails before going to bed.  John knows that he can’t continue this pattern, but he doesn’t know how to stop, or frankly, what else to do.

One night recently, he woke up gasping for air.  John and his wife thought that he might be having a heart attack and frantically called 911.  As they waited for the ambulance’s arrival, several heavy thoughts registered in a back corner of John’s mind.  He was simultaneously afraid and relieved:  Afraid . . . This is it!  I’m going to die.  And yes, relieved:  Why, if I were to survive the heart attack, I might actually get a break!

At the ER, the medical team conducted blood tests and monitored his heart.  After several hours, the team informed John that he had experienced a panic attack.  He was given two prescriptions and encouraged to check in with his primary care physician as soon as possible. The first prescription was for four days worth of Clonazepam, a benzodiazepine that immediately quiets the brain, but is very addictive.  Also, the ER doctor prescribed Celexa, an antidepressant that aids in reducing anxiety.

The experience stunned John.  “I’m not the sort of guy who has panic attacks!”  Then, dozens of other questions came:  What does this mean? . . .  Am I not cut out for this level of leadership? . . .  Am I failing and don’t know it? . . . How can I take care of the company and my family, if I am not a strong leader? . . .

After taking a couple of days off, “due to a family emergency,” John returned to work and to the stress that comes with being a man who has many people depending on him and great responsibilities.  Soon, getting access to another Clonazepam tablet became a daily matter for him - a disturbing and frightening concern because he has seen other family members struggle with addictions to prescription drugs.  He called his family physician whose only suggestion was to take time off.

On Tuesday, May 7, 2013. The Wall Street Journal published Leslie Kwoh’s article “When the CEO Burns Out.”  She listed fatigue, resentment, and loneliness as causes for burnout.  She gave examples of well-known companies that have lost valuable leadership, when men and women took vacations and/or left to recover physically and mentally.   As remedies. she suggests time off and medications, as needed.

Wait a minute.  We can do better than that!  CEO and C-suite executives do not burn out.  Their brains and bodies do! These same brains and bodies begin to break down when they are exposed to chronic stress.  A common symptom of CEO breakdown caused by chronic stress is loss of a person’s ability to focus. 

In prudent organizations today, leaders understand that executive brains and their physical well-being are the most important assets of any venture.  Therefore, owners and boards of directors anticipate their organization’s needs; after all, they are used to essential scheduled maintenance on machines.  It’s required for all human assets too!

The idea is a sound one.  Therefore, it doesn’t take long for someone to ask: What should be included in an organization’s prevention plan for executive burnout?  At a minimum plans should include:

 1.    Instilling in your corporate culture the behaviors that increase the body’s ability to cope with stress.  These tenants are eight hours of sleep, 30 minutes of exercise daily, and at least three meals with protein and vegetables per day. 

 2.   Insisting on time away:  Our brains function better when we take time away from complexity and sameness.  Rest, relaxation, and discontinuous time and activities produce fresh perspectives - essential in thinking strategically.

 3.  Scheduling annual physical examinations with primary care physicians for C-suite executives.  Metrics of high blood pressure, high cholesterol, and weight gain are symptoms of a body not handling stress well.

Rather than being surprised and in crisis when an executive must step out or step down, which is extremely costly, why not create a preventive maintenance plan for key executives in your organization?