Rachel,  one of my yoga students, came to me for some wellness counseling in 2015. She was experiencing extreme fatigue upon waking up, muscle pain and insomnia, all which were severely impacting her quality of life. At 28, diagnosed with fibromyalgia (FM), she felt frustrated that day-to-day activities were so draining on her energy.

I felt for her. I wanted her to feel vibrant and available to participate fully in her life.

My years of exploring wellness interventions and protocols supported the hypothesis that FM is a multi-system condition that requires a holistic interpretation of treatment. I knew that paying attention and incorporating methods to help reduce stress, decrease inflammation, and  balance hormones were essential components in shifting her experience.

I recently read a research article illuminating the role of cortisol, a stress response hormone,  in individuals with FM. Many fibromyalgia patients have experienced a traumatic or high-stress related event either prior to or around the onset of symptoms, and changes in neuroendocrine activity have been reported in some cases. When cortisol levels go too high or too low, problems with pain, sleep, cognitive function, mood and fatigue are prevalent.

In my previous column, I addressed nutrition interventions that help with FM symptoms, but nutrition isn’t enough with this disease. Addressing and managing stress is key.

So many of FM’s symptoms stem from hijacked circadian rhythms born out of a nervous system that is almost always in a “fight or flight” loop. As I continue to work in this field, I am more and more convinced that physical and psychological pain are connected, and are not mutually exclusive of one another. We must treat the whole system to heal.

Below are some of my favorite techniques for relieving stress and creating conditions for optimal health:

1. Mindfulness-based Stress Reduction — In this method,  individuals bring an awareness to direct experiences in the present moment. The experiences are labeled pleasant, unpleasant or neutral, and a nonjudgmental attitude is encouraged. The intention is to accept whatever arises with an open and kind presence. As the person pauses and brings attention to the ‘now,’ a choice about how to respond opens up. This shift in behavior leads to greater success in adapting and integrating stressful situations.   
2. Acupuncture — This ancient healing system from China that balances the energy that flows through body while naturally increasing the threshold for pain.  To start, weekly 30-minute acupuncture sessions can improve blood circulation, physiological process, immunity and nervous system operation. Results may only last a few hours in beginning sessions, but as time goes on the acupuncture’s effects can last months. As energy levels increase, maintenance treatments are all that are ultimately needed and usually once a month or seasonally is more than enough.
3. Meditation — Intentionally taking time to sit and be still is not only relaxing but helps to ward off depression and stress, contributors to the fatigue from FM. Meditating for at least 10 minutes a day, then working up to 20 or 30 minutes once or twice a day can have incredible results.
   To begin, find a quiet place to sit or lay down. Pay attention to your breath or a physical sensation such as your hands on your knees. Observe the changing nature of these sensations. As thoughts and images float through your mind and activate your body, allow them to move through you while utilizing mindfulness to discern their nature as pleasant, unpleasant, or neutral. Recommit to the anchor of the breath or the physical sensation as you notice yourself being pulled into the stories these images and thoughts create. Notice how the experience changes. This is the gift of meditation, everything is impermanent.
4. Yoga — Slow gentle stretches can be great for stretching the body and loosening up tight muscles and joints. The best postures will be low impact while providing increased circulation,  nervous system regulation, stability and flexibility. Some of my favorites include child’s pose, warrior one, forward fold (standing or seated), legs up the wall, and butterfly. Before beginning any yoga program, consult with your doctor to help determine the appropriate program for you.

To your level of comfort and ability, give at least one of these stress-relieving programs a try — sticking with it and practicing regularly — to see if it helps. My hopes are for us all to achieve “optimal health,” regardless of what challenges nature puts in our path.

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Alana Kessler, MS, RD, CDN, E-RYT, is a registered dietitian, nutritionist, weight management expert, and an accredited member of the CDR (Commission on Dietetic Registration) and the American Dietetic Association. She is also a yoga and meditation teacher, Ayurveda specialist, and the founder of the New York City-based fully integrated mind, body, and spirit urban sanctuary, BE WELL. Alana’s BE WELL ARC System and Method Mapping technique is a holistic multidisciplinary approach to health and wellness that blends Eastern and clinical Western diet and lifestyle support to effect long-lasting behavior change.

A graduate of NYU with a BA and MS in clinical nutrition, Alana is dedicated to helping others learn how to nourish themselves, create balance, and understand their true nature through nutrition, yoga, and inner wellness. She leads Yin Yoga workshops and trainings as well as wellness retreats at international locations. Her health, fitness, and lifestyle expertise has been featured in Aaptiv.com, Droz.com, EatThis.com, RD.com, Redbook, WomensHealthmag.com, and Vogue. For more information, visit her website at bewellbyak.com.