How to Identify the Symptoms of Pandemic Stress & Fatigue and how to overcome them
It's the perfect time to reboot your wellbeing. Spring is coming, the world is beginning to open up, and hopefully, we are transitioning into an endemic phase of Covid-19. This blog post is dedicated to helping you take control of your health and wellness after what has been a challenging few years for everyone.
The last few years have created enormous stress for all of us. It's been hard to make plans. It has been challenging to see family and friends. There has been no finish line to work towards. Without this clarity and direction for the future, we all have had our resilience tested. It's been tough.
We want to share a range of tools across sleep, nutrition, exercise and more, so you can get ‘back to normal’ after COVID-19. Our health and wellness are more important than ever, given how the pandemic has impacted our collective wellbeing.
The content you will find:
How has the COVID-19 pandemic impacted us?
Symptoms of stress and fatigue
What is stress?
The different types of stress
The negative effects of stress
How to overcome stress
How has the COVID-19 pandemic impacted us?
Perhaps your fitness levels dropped, or you put on weight since the beginning of the pandemic. Maybe you have felt lonely at times, experienced anxiety, or found yourself going for weeks at a time in a low mood that is hard to shake off. It is essential to know that you are not alone. Peer-reviewed research is growing by the day, and it is clear that the Covid-19 pandemic hit all of us hard in different ways.
As a result of these difficulties, you might have had moments where you have struggled, both physically and mentally. This struggle is normal and to be expected.
It's not just our physical health that suffered. Mental health got worse too. A massive meta-review published in September 2021 evaluated mental health during the pandemic in over one million people across 36 studies. The results were compelling.
Before Covid-19, the World Health Organisation estimated that global depression and anxiety were 4.4% and 3.6%, respectively (3). During the pandemic, these figures skyrocketed (4). 27% of people experienced depression during the pandemic, and 28% experienced significant anxiety.
Not only that, but other indicators of stress, like insomnia, jumped too. In the first five months of the pandemic, Google searches for insomnia increased by 58% compared to previous years (5). Research also showed that the more socially distanced people were, the more insomnia we experienced (6). This has made it clear that as generally social creatures, we as humans need each other to thrive.
Symptoms of stress and fatigue
As the pandemic went on, you might have also noticed signs and symptoms associated with chronic stress. Today is a good day to draw a line in the sand and check in on your wellbeing. Take a few minutes to answer the 360 Energy Questionnaire™ below:
- Do you feel more emotionally drained than before?
- Do you experience ongoing fatigue that's not relieved by sleep?
- Do you experience lethargy, where everything seems like a chore?
- Do you feel like your ability to handle stress is less than before?
- Does it take longer to recover from illness or injury?
- Do you find it more difficult to concentrate lately?
- Do you experience "brain fog" or a "cloudy mind"?
- Do you feel less motivated and purposeful than usual?
- Do you find yourself getting frustrated more easily?
- Do you have digestive problems, such as bloating or indigestion?
- Do you have decreased libido compared to normal?
- Do you feel less productive than before, taking longer to complete tasks?
- Do you feel burned out?
- Do you notice that you have less tolerance and empathy for others than before?
- Do you find it difficult to relax and be in the present moment?
This is a helpful tool for understanding the effect of chronic stress on your body, brain and mind. The higher the number of questions you answered yes to, the more important it is to be patient and kind with yourself as you reclaim your wellbeing. If you answered yes to more than 10 questions, it would be well worth working with a healthcare practitioner to help rebalance the body and put you back in a position to win.
The great news is that all of us can make positive changes. All of us can turn our health around. I have worked in healthcare for 20 years and have been humbled time and again by people's capacity to bounce back after tough times and really challenging health issues. The first step in creating success here is understanding the science of stress and how this might determine your approach to wellness moving forward.
What is stress?
To understand stress, let's start with a metaphor. If you have ever enjoyed winter sports like skiing or snowboarding, you'll know the importance of balance. As the environment changes around you, you have to make micro-adjustments. You hit bumps, feel changes, and adapt as you go. It's a constant process of essentially losing and regaining your balance. Naturally, the more elegant you can be in this process, the better.
Well, it's the same in the body. Your physiology is continuously making micro-adjustments based on the ever-changing demands of your internal and external environment (7). You are exposed to many different stressors in this respect.
The different types of stress
- Mental stressors (workload, cognitive needs, etc.)
- Emotional stressors (worry, anxiety, fear, etc.)
- Environmental stressors (air pollutants, microbes, viruses, etc.)
- Physical stressors (too little exercise, too much exercise, etc.)
- Nutritional stressors (dietary imbalances, micronutrient gaps, etc.)
- Circadian stressors (sleep debt, jetlag, etc.)
Our bodies are beautifully adapted to manage these stressors and keep physiological parameters within a healthy equilibrium. This inner balance is known as homeostasis and is a preferred state within the body (8).
We are also excellent at handling acute short-term stress. Over many millennia, our brain and body have learned how to rapidly respond to immediate threats in our environment (9).
To further understand this, we will use another metaphor. Imagine walking through the savannah and being faced by a lion. At this point, our autonomic nervous system would mobilise the sympathetic branch to increase heart rate, constrict blood, shut off digestion and divert blood to working muscles. All these changes happen within moments and enable us to run or fight.
In this scenario, if we make it out alive, the autonomic nervous system then switches gear. It reduces sympathetic activity and stimulates the parasympathetic branch, which is vital for regeneration, healing and rebalancing in the body.
Why is this science of stress relevant to our future health and wellness? Simply put, because of what we have just been through, with the COVID-19 pandemic. Understanding how stress impacts our physiology is central to getting the most from our wellbeing after the last few years.
The negative effects of stress
We are exquisitely designed for short-term acute stress but not long-term chronic stress (10). If we constantly activate the stress response, we perpetually blunt parasympathetic activity, and this has tangible effects:
- Digestion is impaired (11).
- Sex drive drops (12).
- Renewal is compromised (13).
In short, long-term building projects are put on hold. This is summed up perfectly in the book Why Zebras Don't Get Ulcers when Robert Sapolsky writes, "If there is a tornado bearing down on the house, this isn't the day to repaint the kitchen."
Chronic stress and uncertainty have adverse effects on the brain too. Our brain is plastic and is continually being remodelled based on our experiences and health. This neuroplasticity can be in our favour or it can have detrimental effects on our mental health (14).
For two years over the pandemic, everything around us was a source of "stranger and danger". We were told that everyone was a potential vector of disease. This stress has consequences. Metaphorically speaking, we walked around with a lion next to us everywhere we went.
The body does a fantastic job of trying to adapt to ongoing stress, but it comes at a cost. The cumulative "wear and tear" caused by excess stress is called allostatic load (15). This, in turn, impacts our energy, resilience and wellbeing.
A helpful way to think about allostatic load is with a rubber band analogy. Stress stretches physiology beyond the norms. If we are healthy and resilient, that rubber band can return to normal. However, there is a tipping point where chronic stress can stretch systems too far. The rubber band becomes frayed and no longer bounces back to the original position with the same elasticity. This is allostatic load. It is why we started this blog post with the 360 Energy Questionnaire™, to help you recognise the signs and symptoms, and to see if you had been impacted by chronic stress.
How to overcome stress
If you have felt a little beaten up by the last few years, that's ok! You can do so much to rebuild resilience, boost your energy, reclaim your wellbeing, and get the most out of your wellness.
An amazing feature of human design is the synergistic effect of health. Imagine that nutrition, exercise, sleep and stress management represent one point each. In health, 1+1+1+1 is not 4. It might be 5 or more, depending on your circumstances. This is called systems biology (16). As you make small but cumulative changes across your wellbeing, you will build physiological momentum in a positive direction, and results can take care of themselves.
You might like to improve many aspects of health and wellness. For the sake of simplicity and structure, in this post, we will give tips based on the following areas:
Do not worry about making sweeping changes across the board. You do not have to overhaul your life in all these different facets of health and wellness to get results. Start where you are, make small changes, and you will develop momentum.
In this respect, the book Atomic Habits by James Clear offers real clarity for people on the power of tiny changes:
"Habits are the compound interest of self-improvement. The same way that money multiplies through compound interest, the effects of your habits multiply as you repeat them. They seem to make little difference on any given day and yet the impact they deliver over the months and years can be enormous."
With that said, let's look at some simple changes you can make to reboot your wellbeing in 2022. These tips are based on the assumption that you have been exposed to cumulative stress of the pandemic and are starting fresh in many respects.
Without further ado, let's jump in 🚀
Setting yourself up for success before launching into a new wellness programme is important. This starts with mindset and motivation.
First, set direction. Don't worry about setting SMART (specific, measurable, achievable, realistic and time-bound) goals just yet. Zoom out and think of the bigger picture first: what success looks, feels and sounds like to you. In your mind, go to the point where you have created the results you want and retained that wellbeing for weeks, months or even years.
From that point of success, you can work backwards to today. Take time to journal why you want to make this a reality. How does it enable you to get more from life? How does it support other areas of your life that matter to you, whether that's family, work or something else? How does success in your health and wellness help you evolve and develop as a person? It's not just the results that matter, who you become due to that success can often matter more.
Once you have a vision that feels exciting and meets your values, the next step is to brainstorm barriers that get in the way.
Identifying roadblocks can be simple. Begin by getting a piece of paper with two columns on it: barriers and solutions. On the left-hand column, write out factors that might stop you from achieving, such as energy, time, belief, equipment, expertise, etc.
On the right-hand column, write out 3 possible solutions for each barrier. These solutions do not have to be perfect. What you are doing here is building a sense of clarity, control and confidence about the next steps. This self-efficacy cannot be underestimated (17).
The third step toward building healthy motivation and mindset is habit-building. Building wellness requires developing new behaviours and skills that generate momentum over time. There are many ways to build better habits, but three tried-and-tested methods for success are:
- Step one, cue your environment. Make habits easy to do. For example, make it readily available if you want to start taking a top supplement like Kinetica Vitamin D. Put the spray bottle next to your toothbrush, so you can remember to get your daily dose of Vitamin D when you brush your teeth in the morning.
- Step two, stack helpful habits. For example, let's say you struggle to drink enough water. In that case, you might decide to work out in the morning when you naturally hydrate yourself. In doing this, you kickstart your day by doing two things that benefit you. Getting into the rhythm of drinking water in the morning means you are more likely to keep it going during the day. Kinetica Electro-C electrolyte tablets, added to water, provides you with a zesty, refreshing, lemon flavoured drink that will quench your thirst, replace electrolytes lost through sweating and increase fluid retention – which keeps you hydrated!
- Step three, attach positive emotion and meaning to your habits. As you practice a new habit, such as preparing healthy food, deliberately think about how this habit will generate success over time. For example, you might imagine the anti-oxidants from vegetables and spices circulating in the body, helping cells become healthier. This process of linking positive emotions to new habits makes them stickier.
Now that you have the foundations for success in your mind let's look at wellness habits directly. In our experience of helping people reclaim their energy and wellbeing after chronic stress, sleep is a game-changer.
Sleep debt has been associated with worse health outcomes across the board: from physical health to mental health and everything in between. Sleep is profoundly anti-inflammatory, it boosts our immune system, safeguards the heart, supports our metabolism, makes us more creative, increases emotional intelligence, and enhances decision-making (18, 19, 20, 21, 22, 23). It's the foundation for everything else.
Here are five strategies to improve your sleep quality:
- First, develop a consistent sleep routine. Look to get to bed and wake up at the same time every day - even on weekends. This consistency is vital for training healthy circadian rhythms in the brain (24).
- Second, enjoy foods high in magnesium in the evening. Dark leafy vegetables, whole grains, nuts and seeds are high in magnesium, which can help improve sleep quality. A magnesium supplement of over 300mg per day can improve sleep (25). Kinetica Zinc Mag+ has 420mg per dose and is perfect for helping you to relax and switch off.
- Third, if you are stressed in the evening, try Ashwagandha. Research shows that this incredible herb can play a very positive role in sleep by reducing stress and anxiety (26). A recent study found daily supplementation of 300mg improved memory and focus, psychological wellbeing, sleep quality, decreased stress levels, and was safe and well-tolerated (27).
- Fourth, find your sweet spot in terms of bedroom temperature. Elevated core body temperature has been associated with poorer sleep. The optimal temperature for most people to sleep is around 18–22 degrees Celsius (64–69F), which is cooler than many of us think.
- Fifth, train your circadian rhythms to function correctly by turning the lights out. Light received through the eye signals daytime to the brain. This suppresses melatonin - a central hormone for regenerative sleep (28). You can reduce this issue by dimming the lights in the house once the sun goes down, wearing blue-blocker glasses and avoiding digital devices in your bedroom. Blackout blinds and eye masks are also beneficial.
Learn more about the importance of sleep in our blog Sleep -The Instinctive Workout.
By making positive changes in your mindset and sleep, you will notice that results are easier to come by. But let's add to this. What can you do from a nutritional perspective to bounce back after a period of chronic stress? The key here is managing and reducing inflammation.
Research shows that ongoing low-grade inflammation is a significant driver of illness and disease (29). It's a root cause problem that impacts the ability of signalling molecules in the immune system to keep us healthy and resilient.
Inflammation is a normal response to injury, infection and toxicity. There are essentially two phases to inflammation - initiation and resolution. During the first phase, our frontline immune defences kick into gear and go to the site of the problem. Once the threat has been neutralised, such as a microbe or virus, the immune system should go into the second phase and resolution, bringing the body back into balance.
However, problems with this system occur in chronic stress: phase one initiation is not turned off properly (30). As a result, the body continues to release pro-inflammatory cytokines, and we do not get to phase two and resolution. The net effect of this is that we go about our day experiencing low-grade inflammation all the time.
However, it's not all bad news! Diet is a potent modulator of inflammation. We can do much to rebalance the immune system and stimulate better health.
Whilst there is a lot we can add here, here are five strategies to help you help ease stress through nutrition:
- First, maximise your phytonutrient intake. Phytonutrients are natural compounds found in plants that promote human health (31). They help us thrive in multiple ways, such as balancing inflammation, reducing oxidative stress and inhibiting genes related to chronic disease. There are many different types of phytonutrients, such as polyphenols, isoflavonoids, flavonoids, carotenoids, resveratrol and glucosinolates. You don't need to remember them because there is a simple way to boost your intake of phytonutrients: eat a rainbow a day. Eating a "rainbow a day" from natural, unrefined whole foods is a simple but elegant way to get a host of different nutrients to support your heart, brain, skin, gut, liver and immune health without ever thinking about it (32).
- Second, boost gut health through fibre. There are over 100x more genes in these microbes than the number of genes present in the human genome (33). As you may know, the gut microbiome plays a central role in our health. When it comes to diet, positive gut microbes use non-digestible fibre to produce short-chain fatty acids (SCFAs) (34). These SCFAs, in turn, play a crucial role in balancing inflammation and supporting our health (35).
- Third, decrease inflammation and offset allostatic load through high-quality fats, especially omega-three essential fats (36). A recent meta-analysis of 40 studies involving over 135,000 participants found supplementation reduced the risk of cardiovascular events. In other words, omega-threes are cardioprotective. Omega-3 fats also have very positive effects on the brain and can be very helpful in supporting mental health (37, 38).
- Fourth, in addition to consuming enough high-quality protein from various sources, consume collagen peptides in your daily diet. The word 'protein' comes from the Greek word prōtos, meaning 'of ﬁrst importance.' Every cell in our body contains proteins: they are the building blocks of life (39). Collagen is a unique form of protein digested differently from typical dietary protein (40). It has unique properties that can help with healing, healthy ageing, pain reduction and recovery from exercise (41, 42, 43, 44). As you can imagine, when the goal is to bounce back after a couple of hard years of stress, protein and collagen can make a huge difference. It's a way to help the body shift into an anabolic state. Kinetica's Collagen with Turmeric is also fantastic because it comes with other ingredients that can reduce inflammation.
- Finally, power up with certain foods that can help offset previous stress and support cardiovascular health. The cardiovascular system is impacted strongly by day-to-day stress (45). Nutrition can play a significant role in reclaiming our health, energy and wellbeing.
Here are some heart-healthy foods to help support cardiovascular health:
- Ground flaxseed
- Extra virgin olive oil
- Nuts and seeds
- Quality soy (miso, tempeh)
- Fish from wild sources, like Pacific salmon
- Leafy greens
- Beets -
- Onions, asparagus and artichoke
- Dark Chocolate (80%+)
- Green tea
A simple way to do all of the above is by adopting an eating pattern similar to the Mediterranean Diet.
The final part of the jigsaw as we move into the rest of 2022 is physical activity and fitness. Movement is medicine for the body and mind. A 2018 systematic review found that exercise was not just great for us physically - it also had a protective effect on our mental health (46).
You might already be back into a habit of training which is excellent. To help you look after your wellbeing in the context of the last couple of years, here are some simple tips to help you.
- First, balance "hard" exercise with "easy" exercise. Pushing yourself through a strenuous workout is fantastic, but it is another form of load on the body. If you are coming into this moment with a fair amount of stress behind you, take time to rebuild your fitness step-by-step with sufficient recovery in between. In sport, this periodisation of training is called load management (47). In my experience of coaching athletes for the last 20 years, it is central to health and high performance.
- Second, use aerobic exercise to look after your brain. There is something quite magical about cardio, especially if you have experienced signs and symptoms of chronic stress, like brain fog and difficulty concentrating. A simple 20-30 minute aerobic workout oxygenates the brain and increases proteins such as BDNF that protect our brain cells (48). Indeed, a 2011 randomised controlled trial observed that moderate-intensity cardiovascular exercise performed three times per week actually increased the size of the hippocampus (49). The hippocampus influences our memory, emotion, and the autonomic nervous system. This shows how powerful exercise can be in peak performance and brain health.
- Third, enjoy mind-body practices like yoga, pilates and mobility training. This type of exercise stimulates the parasympathetic nervous system: that branch of the ANS responsible for stimulating regeneration, renewal and rebalancing of the body. They are excellent forms of exercise for improving sleep, countering stress and building resilience (50, 51).
I hope this post gives you new insight into how the pandemic has affected all of us and what we can do about it. Lifestyle medicine (mindset, sleep, nutrition and fitness) is at the centre of us reclaiming our energy and wellness after the stress of the last few years. Take your time, enjoy the process, and incorporate tips at a speed that work for you. You can do it, and you will build momentum 💪
About the author
Justin Buckthorp is a Kinetica Ambassador, a Health and Performance specialist and founder of 360 Health and Performance, a company passionate about helping people thrive. Justin has over 20 years’ experience working in clinics, professional sport, and corporate wellness, as well as extensive training in preventative health, functional medicine, strength & conditioning, and human performance.
Justin holds an MSc in Personalised Nutrition from Middlessex University and has a vast range of experience in numerous fields. He was an educator in the fitness industry delivering courses for the National Academy of Sports Medicine in the UK, has supported Team Europe in Ryder Cup events since 2008, and has sat on the European Tour Medical Advisory Board since 2009.
Justin is motivated by helping others achieve their goals, and in 2012 he founded 360 Health & Performance which leverages technology and education to help people in sport, the workplace, and healthcare. Justin also continues to support PGA, European Tour, LPGA Tour and LET golfers, which includes helping Justin Rose win the US Open in 2013, Olympic Gold in 2016, the Fedex Cup in 2018, and go from a world ranking of 70 in 2009 to world number one in 2019.
1: Bakaloudi, D.R., Barazzoni, R., Bischoff, S.C., Breda, J., Wickramasinghe, K., Chourdakis, M. (2021) ‘Impact of the first COVID-19 lockdown on body weight: A combined systematic review and a meta-analysis'. Clinical Nutrition. https://doi.org/10.1016/j.clnu.2021.04.015
2: Khubchandani, J., Price, J.H., Sharma, S., Wiblishauser, M.J., Webb, F.J. (2022) ‘COVID-19 pandemic and weight gain in American adults: A nationwide population-based study’. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 16(1): 102392. https://doi.org/10.1016/j.dsx.2022.102392
3: World Health Organization. (2017). Depression and other common mental disorders: global health estimates. World Health Organization. https://apps.who.int/iris/handle/10665/254610 License: CC BY-NC-SA 3.0 IGO
4: Sousa, G.M.d.Jr., Tavares, V.D.d.O., de Meiroz Grilo, M.L.P., Coelho, M.L.G., Lima-Araújo, G.L.d., Schuch, F.B., Galvão-Coelho, N.L. (2021) ‘Mental Health in COVID-19 Pandemic: A Meta-Review of Prevalence Meta-Analyses'. Front. Psychol. 12:703838. https://doi.org/10.3389/fpsyg.2021.703838
5: Zitting, K-M., Lammers-van der Holst, H.M., Yuan, R.K., Wang, W., Quan, S.F., Duffy, J.F. (2021) ‘Google Trends reveals increases in internet searches for insomnia during the 2019 coronavirus disease (COVID-19) global pandemic’. Journal of Clinical Sleep Medicine. 17(2). https://doi.org/10.5664/jcsm.8810
6: Halsøy, Ø., Johnson, S.U., Hoffart, A., Ebrahimi, O.V. (2021) ‘Insomnia Symptoms in the General Population During the COVID-19 Pandemic’. Front. Psychiatry. 12:762799. https://doi.org/10.3389/fpsyt.2021.762799
7: O'Connor, D.B., Thayer, J.F., Vedhara, K. (2021) ‘Stress and Health: A Review of Psychobiological Processes’. Annual Review of Psychology. 72. https://doi.org/10.1146/annurev-psych-062520-122331
8: Wu, N.N., Zhang, Y., Ren, J. (2019) ‘Mitophagy, Mitochondrial Dynamics, and Homeostasis in Cardiovascular Aging’. Oxidative Medicine and Cellular Longevity. https://doi.org/10.1155/2019/9825061
9: McEwan, B.S., Bowles, N.P., Gray, J.D., Hill, M.N., Hunter, R.G., Karatsoreos, I.N., Nasca, C. (2015) ‘Mechanisms of stress in the brain’. Nature Neuroscience. https://dx.doi.org/10.1038%2Fnn.4086
10: Mariotti, A. (2015) ‘The effects of chronic stress on health: new insights into the molecular mechanisms of brain–body communication’. Future Science OA.1(3). https://dx.doi.org/10.4155%2Ffso.15.21
11: Qin, H-Y., Cheng, C-W., Tang, X-D., Bian, Z-X. (2014) ‘Impact of psychological stress on irritable bowel syndrome’. World Journal of Gastroenterology. 20(39). https://dx.doi.org/10.3748%2Fwjg.v20.i39.14126
12: Phelan, N., Behan, L.A., Owens, L. (2021) ‘The Impact of the COVID-19 Pandemic on Women's Reproductive Health’. Frontiers in Endocrinology. 12:642755. https://doi.org/10.3389/fendo.2021.642755
13: Mathur, M.B, Epel, E., Kind, S., Desai, M., Parks, C.G., Sandler, D.P., Khazeni, N. (2016) ‘Perceived stress and telomere length: A systematic review, meta-analysis, and methodologic considerations for advancing the field’. Brain, Behavior, and Immunity. https://doi.org/10.1016/j.bbi.2016.02.002
14: Price, R.B., Duman, R. (2020) ‘Neuroplasticity in cognitive and psychological mechanisms of depression: an integrative model’. Molecular Psychiatry. 25(3). https://doi.org/10.1038/s41380-019-0615-x
15: McEwan, B.S. (2017) ‘Neurobiological and Systemic Effects of Chronic Stress’. Chronic Stress. https://doi.org/10.1177%2F2470547017692328
16: Kirkwood. T.B.L. (2011) ‘Systems biology of ageing and longevity’. Philosophical Transactions of the Royal Society B. 366. https://doi.org/10.1098/rstb.2010.0275
17: Neumann, R.J., Ahrens, K.F., Kollmann, B., Goldbach, N., Chmitorz, A., Weichert, D., Fiebach, C.J., Wessa, M., Kalisch, R., Lieb, K., Tüscher, O., Plichta, M.M., Reif, A., Matura, S. (2021) ‘The impact of physical fitness on resilience to modern life stress and the mediating role of general self-efficacy'. European Archives of Psychiatry and Clinical Neuroscience. https://doi.org/10.1007/s00406-021-01338-9
18: Irwin, M.R., Opp, M.R. (2017) ‘Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity’. Neuropsychopharmacology. 42(1). https://doi.org/10.1038/npp.2016.148
19: Nagai, M., Hoshide, S., Kario, K. (2010) ‘Sleep Duration as a Risk Factor for Cardiovascular Disease- a Review of the Recent Literature’. Current Cardiology Reviews. 6(1). https://dx.doi.org/10.2174%2F157340310790231635
20: Jouret, J. (2013) ‘Interlinks between sleep and metabolism’. The Lancet Diabetes and Endocrinology. 1(1). https://doi.org/10.1016/S2213-8587(13)70018-4
21: Lewis, P.A., Knoblich, G., Poe, G. (2018) ‘How Memory Replay in Sleep Boosts Creative Problem-Solving'. Trends in Cognitive Sciences. 22(6). https://doi.org/10.1016/j.tics.2018.03.009
22: Stenson, A.R., Kurinec, C.A., Hinson, J.M., Whitney, P. Van Dongen, H.P.A. (2021) ‘Total sleep deprivation reduces top-down regulation of emotion without altering bottom-up affective processing’. PLoS ONE. 16(9). https://doi.org/10.1371/journal.pone.0256983
23: Chen, J., Liang, J., Lin, X., Zhang, Y., Zhang, Y., Lu, L., Shi, J. (2017) ‘Sleep Deprivation Promotes Habitual Control over Goal-Directed Control: Behavioral and Neuroimaging Evidence’. The Journal of Neuroscience. 37(49). https://doi.org/10.1523/jneurosci.1612-17.2017
24: Potter, G.D.M., Skene, D.J., Arendt, J., Cade, J.E., Grant, P.J., Hardie, L.J. (2016) ‘Circadian Rhythm and Sleep Disruption: Causes, Metabolic Consequences, and Countermeasures’. Endocrine Review. 37(6). https://doi.org/10.1210/er.2016-1083
25: Nielsen, F.H., Johnson, L.K., Zeng, H. (2011) ‘Magnesium supplementation improves indicators of low magnesium status and inflammatory stress in adults older than 51 years with poor quality sleep’. Magnesium Research. 23(4). https://doi.org/10.1684/mrh.2010.0220
26: Langade, D., Thakare, V., Kanchi, S., Kelgane, S. (2021) ‘Clinical evaluation of the pharmacological impact of ashwagandha root extract on sleep in healthy volunteers and insomnia patients: A double-blind, randomized, parallel-group, placebo-controlled study’. Journal of Ethnopharmacology. 264:113276. https://doi.org/10.1016/j.jep.2020.113276
27: Gopukumar, K., Thanawala, S., Somepalli, V., Rao, T.S.S., Thamatam, V.B., Chauhan, S. (2021) ‘Efficacy and Safety of Ashwagandha Root Extract on Cognitive Functions in Healthy, Stressed Adults: A Randomized, Double-Blind, Placebo-Controlled Study’. Evidence-Based Complementary and Alternative Medicine. https://doi.org/10.1155/2021/8254344
28: Tähkämö, L., Partonen, T., Pesonen, A-T. (2019) ‘Systematic review of light exposure impact on human circadian rhythm’. Chronobiology International. 2. https://doi.org/10.1080/07420528.2018.1527773
29: Furman, D., Campisi, J., Verdin, E., Carrera-Bastos, P., Targ, S., Franceschi, C., Ferrucci, L., Gilroy, D.W., Fasano, A., Miller, G.W., Miller, A.H., Mantovani, A., Weyand, C.M., Barzilai, N., Goronzy, J.J., Rando, T.A., Effros, R.B., Lucia, A., Kleinstreuer, N., Slavich, G.M. (2019) ‘Chronic inflammation in the etiology of disease across the life span’. Nature Medicine. 25. https://doi.org/10.1038/s41591-019-0675-0
30: Cohen, S., Janicki-Deverts, D., Doyle, W.J., Miller, G.E., Frank, E., Rabin, B.S., Turner, R.B. (2012) ‘Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk’. PNAS. 109(16). https://doi.org/10.1073/pnas.1118355109
31: Gupta, C., Prakash, D. (2014) ‘Phytonutrients as therapeutic agents’. Journal of Complementary and Integrative Medicine. https://doi.org/10.1515/jcim-2013-0021
32: Rebas, E., Rzajew, J., Radzik, T., Zylinska, L. (2020) ‘Neuroprotective Polyphenols: A Modulatory Action on Neurotransmitter Pathways’. Current Neuropharmacology. 18(5). https://doi.org/10.2174/1570159x18666200106155127
33: Hooper, L.V., Gordon, J.I. (2001) ‘Commensal Host-Bacterial Relationships in the Gut’. Science. 292(5519). https://doi.org/10.1126/science.1058709
34: den Besten, G., van Eunen, K., Groen, A.K., Venema, K., Reijngoud, D-R., Bakker, B.M. (2013) ‘The role of short-chain fatty acids in the interplay between diet, gut microbiota, and host energy metabolism’. Journal of Lipid Research. 54(9). https://dx.doi.org/10.1194%2Fjlr.R036012
35: Nogal, A., Valdes, A.M., Menni, C. (2021) ‘The role of short-chain fatty acids in the interplay between gut microbiota and diet in cardio-metabolic health’. Gut Microbes. 13(1). https://doi.org/10.1080/19490976.2021.1897212
36: Bäck, M., Hansson, G.K. (2019) ‘Omega-3 fatty acids, cardiovascular risk, and the resolution of inflammation’. The FASEB Journal. 33(2). https://doi.org/10.1096/fj.201802445r
37: Dyall. S.C. (2015) ‘Long-chain omega-3 fatty acids and the brain: a review of the independent and shared effects of EPA, DPA and DHA’. Frontiers in Aging Neuroscience. 7(52). https://dx.doi.org/10.3389%2Ffnagi.2015.00052
38: Luo, X-D., Feng, J.S., Yang, Z., Huang, Q-T., Lin, J-D., Yang, B., Su K-P., Pan, J.-Y. (2020) ‘High-dose omega-3 polyunsaturated fatty acid supplementation might be more superior than low-dose for major depressive disorder in early therapy period: a network meta-analysis'. BMC Psychiatry. 20(1). https://doi.org/10.1186/s12888-020-02656-3
39: Paddon-Jones, D., Campbell, W.W., Jacques, P.F., Kritchevsky, S.B., Moore, L.L., Rodriguez, N.R., van Loon, L.J. (2015) ‘Protein and healthy aging’. The American Journal of Clinical Nutrition. 101(6). https://doi.org/10.3945/ajcn.114.084061
40: León-López, A., Morales-Peñaloza, A., Martínez-Juárez, V.M., Vargas-Torres, A., Zeugolis, D.I., Aguirre-Álvarez, G. (2019) ‘Hydrolyzed Collagen—Sources and Applications’. Molecules. 24(22). https://doi.org/10.3390/molecules24224031
41: Sugihara, F., Inoue, N., Venkateswarathirukumara, S. (2018) ‘Ingestion of bioactive collagen hydrolysates enhanced pressure ulcer healing in a randomized double-blind placebo-controlled clinical study’. Scientific Reports. 8(1). https://doi.org/10.1038/s41598-018-29831-7
42: Choi, F.D., Sung, C.T., Juhasz, M.L.W., Mesinkovska N.A. (2019) ‘Oral Collagen Supplementation: A Systematic Review of Dermatological Applications’. Journal of Drugs in Dermatology. 18(1). PMID: 30681787.
43: Khatri, M., Naughton, R.J., Clifford, T., Harper, L.D., Corr, L. (2021) ‘The effects of collagen peptide supplementation on body composition, collagen synthesis, and recovery from joint injury and exercise: a systematic review’. Amino Acids. https://doi.org/10.1007/s00726-021-03072-x
44: Clifford, T., Ventress, M., Allerton, D.M., Standfield, S., Tang, J.C.Y., Fraser, W.D., Vanhoecke, B., Prawitt, J., Stevenson, E. (2019) ‘The effects of collagen peptides on muscle damage, inflammation and bone turnover following exercise: a randomized, controlled trial’. Amino Acids. 51(4). https://doi.org/10.1007/s00726-019-02706-5
45: Vaessen, T., Rintala, A., Otsabryck, N., Viechtbauer, W., Wampers, M., Claes, S., Myin-Germeys, I. (2021) ‘The association between self-reported stress and cardiovascular measures in daily life: A systematic review’. PLoS ONE. 16(11) https://doi.org/10.1371/journal.pone.0259557
46: Schuch, F.B., Vancampfort, D., Firth, J., Rosenbaum, S., Ward, P.B., Silva, E.S., Hallgren, M., Ponce De Leon, A., Dunn, A.L., Deslandes, A.C., Fleck, M.P., Carvalho, A.F., Stubbs, B. (2018) ‘Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies’. 175(7). https://doi.org/10.1176/appi.ajp.2018.17111194
47: Verhagen, E., Gabbett, T. (2019) ‘Load, capacity and health: critical pieces of the holistic performance puzzle’. British Journal of Sports Medicine. 53(1). http://dx.doi.org/10.1136/bjsports-2018-099819
48: Yang, J.L., Lin, Y.T., Chuang, P.C., Bohr, V.A., Mattson, M.P. (2014) ‘BDNF and exercise enhance neuronal DNA repair by stimulating CREB-mediated production of apurinic/apyrimidinic endonuclease 1’. Neuromolecular Medicine. 16(1). https://doi.org/10.1007/s12017-013-8270-x
49: Erickson, K.I., Voss, M.W., Prakash, R.S., Basak, C., Szabo, A., Chaddock, L., Kim, J.S., Heo, S., Alves, H., White, S.M., Wojcick, T.R., Mailey, E., Vieira, V.J., Martin, S.A., Pence, B.D., Woods, J.A., McAuley, E., Kramer, A.F. (2011) ‘Exercise training increases size of hippocampus and improves memory’. Proceedings of the National Academy of Sciences. 108(7). https://doi.org/10.1073/pnas.1015950108
50: Wang, W-L., Chen, K-H., Pan, Y-C., Yang, S-N., Chan, Y-Y. (2020) ‘The effect of yoga on sleep quality and insomnia in women with sleep problems: a systematic review and meta-analysis'.
BMC Psychiatry. 20(1). https://doi.org/10.1186/s12888-020-02566-4