Why Stress and Burnout Often Show up Together

In our age of burnout, a controversial diagnosis might offer an avenue to recovery

Our bodies are designed to recover from occasional bouts of stress, but when we go too hard for too long, we eventually break down. Yuris Alhumaydy/Unsplash

Do you have more stress than energy? Are you dragging all day, yet can’t fall asleep at night? Do you depend on stimulants to make it through life? Then you may be suffering from adrenal fatigue.

Adrenal fatigue is a new name for a very old diagnosis. It’s the idea that too much stress and not enough rest wear us down, accelerating the aging process, and draining us of the energy we once relied upon to get things done.

Adrenal fatigue covers a wide range of symptoms, such as weakness, fat accumulation, exhaustion, insomnia, inflammation, you name it. Virtually every system in the body can be impacted by this condition, but at the root are the adrenal glands—two small organs that sit atop each kidney.

Adrenal glands function like the body’s battery, pumping out stress hormones that get you revved up and focused to meet daily challenges. When you face imminent danger or some other high-stress situation, this battery switches into high gear, resulting in a fight-or-flight response.

Over Activated

Our resilient bodies are designed to react and recover from occasional bouts of stress, but when we go too hard for too long, we eventually break down. The theory behind adrenal fatigue is that our battery starts to lose power, triggering malfunction and fatigue.

Chinese medicine, Ayurveda, and other ancient healing traditions describe patterns very similar to adrenal fatigue, but this theory is extremely controversial in modern medicine. Conventional physicians say the condition doesn’t actually exist. A 2016 systematic review published in the BMC Endocrine Disorders found no hard evidence for adrenal fatigue. The review cites a “poor quality assessment of fatigue,” and “the use of an unsubstantiated methodology” as proof that the condition is a myth.

The only official diagnoses regarding adrenal health are rare examples of extreme underproduction and overproduction of hormones. However, a growing number of functional, integrative, and naturopathic physicians support the adrenal fatigue theory. Historically, this wouldn’t be the first time conventional medicine dismissed a real problem. Back in the 1990s, fibromyalgia and chronic fatigue syndrome were both thought to be nothing more than psychosomatic symptoms of otherwise healthy patients. However, with enough patient complaints and doctors willing to consider the evidence, both ailments have gained much more credibility.

Underestimated

So how can some doctors see a problem that most don’t? According to Nisha Jackson, a specialist in gynecology and functional medicine in Medford, Oregon, the conventional medicine paradigm doesn’t acknowledge adrenal fatigue because it lacks the perspective, tools, and treatment model necessary to address such a complex condition.

“Medicine today likes to treat people as efficiently as possible because that’s what it’s forced to do, and it has to treat it with medication,” Jackson told The Epoch Times. “Adrenal fatigue is more about a lifestyle that you have to change, and I think that is just not something that is talked about in the medical office.”

Even if doctors don’t recognize adrenal fatigue, they certainly encounter its symptoms. These visits typically translate into prescriptions for anxiety, insomnia, depression, or some other problem that can be identified and paired with a drug in under 10 minutes.

However, Jackson believes taking a deeper, more holistic view of a patient, where such symptoms can be linked to the same underlying cause, will result in a more meaningful solution.

Cortisol is a hormone produced by the adrenal glands that is released when a person feels stressed. After sending out “fight or flight” hormones like adrenaline, the body sends out cortisol to keep the body alert. That alert state can put other bodily processes on hold, such as digestion, immunity, and growth.

“When you’re under-producing cortisol, and this is a very simplistic way of explaining it, but you don’t have what it takes to get through your day,” Jackson said. “You don’t have what it takes to manage stress. You start having anxiety attacks, you’re not stable emotionally, and the worst thing is you’re exhausted. When you’re exhausted, you start eating things you don’t normally eat because you’re depressed.”

Rarely Tested

One reason doctors don’t see evidence for chronically underperforming adrenals is that they rarely, if ever, test for it. For doctors that do, it’s a different story. Jackson’s medical practice sees thousands of patients a month, and most test positive for adrenal insufficiency.

Her perspective may be unconventional, but it comes from almost 30 years practicing medicine. When she was an OB-GYN nurse practitioner, she saw women with symptoms she would later understand as adrenal fatigue. These patients didn’t find any relief from conventional treatment options, so Jackson began looking for answers elsewhere: acupuncture, mind-body therapies, herbs, and other nonstandard forms of medicine.

Jackson also gained valuable insights through her own experience with stress. A self-described workaholic trying to both start her own practice and raise a family, she said her insatiable drive and not taking enough care of her own health eventually burned her out.

In her book, “Brilliant Burnout,” Jackson describes how she got her energy back and how she has helped many of her patients recover, too.

The book is primarily aimed at women, but according to Jackson overstressed men can be just as susceptible to this condition, resulting in symptoms such as hair loss, belly fat, and low sex drive.

“The men that we see in our medical practices are very sick. They feel terrible. They feel depressed. They’ve lost a lot of their enthusiasm for life. Their testosterone levels are in the tank,” she said. “All of a sudden we’re seeing 30-year-old men with 80-year-old testosterone levels. That’s directly related to the adrenals. There’s no other explanation for it.”

Adrenal Effects

It’s called adrenal fatigue, but the condition can cause hormonal havoc throughout the body. Thyroid and sex hormones are often affected, as well as neurochemistry, leading to even more symptoms that can stress the body even more.

The condition doesn’t hit everyone the same way. Some people seem to be able to run on overdrive for years without any visible consequences, while others may see a decline following a few episodes of emotional upheaval that push them over the edge.

No matter how much stress we can tolerate, Jackson believes everybody has a breaking point—a level of stress at which the adrenal glands are forced to reduce hormone production in an act of self-preservation.

“At some point, their adrenal glands are going to say, ‘We can’t do this anymore. We can’t keep up with you. So in order for us to go into preservation mode, we are now going to underproduce cortisol,”’ she said.

Reenergized

Doctors who specialize in treating adrenal insufficiency say it’s rarely an easy fix, and the more severe the case, the longer it can take to heal it. Adrenal fatigue isn’t the kind of condition where one pill makes everything better. Many issues often have to be addressed over a period of time in order to turn the situation around.

When people read about adrenal fatigue online, they’re often tempted to tackle the problem by supplementing with the hormones they believe they lack. However, this strategy runs a real risk of harm, and may even lead to worse problems.

Jackson does prescribe bio-identical hormones made from yams with dosages based on regular blood serum tests. The most important and profound recovery comes from patients learning how to manage the stress that got them sick in the first place, she said, and by learning how to care for their bodies so they can better handle the stress they’re facing.

“Sometimes your hormone levels just rebalance themselves once you start changing your lifestyle habits,” she said.

Ideally, people with adrenal fatigue can cut back on their hectic schedules, but that’s not always realistic when they have to pay bills and must fulfill other obligations. However, if you can focus on the basics of good health—sleep, diet, and reducing emotional distress—your body will be able to handle your must-do list much easier, Jackson said.

Sleep

At the top of the adrenal recovery program list is sleep. No matter how busy our lives become, we can’t replenish our energy without a good rest.

It’s important to make time for bed, but what if we still can’t sleep once we get there? Sleeplessness is likely due to a backward cortisol rhythm, Jackson said.

Ideally, adrenals produce the most cortisol during the day to give us energy, stamina, and focus so we can deal with the stress that comes our way. Cortisol is supposed to drop at night so we can fall asleep and sleep deeply. However, Jackson said that for many, this rhythm is flipped.

“You will be exhausted during the day, but wired and tired at night,” she said. “It’s a huge problem.”

Such a flipped rhythm results from years of routinely pushing yourself when your body is begging for rest. Yet instead of slowing down, many of us reach for stimulants to get us through the day, using more energy than our adrenals naturally want to give.

When we finally give our exhausted adrenals a break at the end of the day, they get a chance to recover, switching on again right before bed—at exactly the wrong time for sleep.

One supplement Jackson uses to help with a flipped cortisol rhythm is phosphorylated serine. When taken before bed, this safe amino acid helps lower cortisol levels so your brain can power down and allow you to sleep.

One thing to avoid is drinking alcohol before bed. It may help knock you out, but alcohol actually creates more sleep problems because it interferes with the body’s ability to regenerate.

Diet

Food is the second major factor affecting our energy level. If we’re dragging through our days, we often look to sugar for energy. However, a high-sugar diet actually costs us energy in the long term.

The key to adrenal recovery is to keep blood sugar levels steady, Jackson said. To do this, it’s best to eat regularly, with emphasis on vegetables, protein, and healthy fats such as nuts and seeds. What you shouldn’t be eating is sugar or simple carbs.

“Protein is the nutrient that helps stabilize your blood sugar longer, and that’s probably the most important thing in adrenal fatigue,” Jackson said. “Big peaks and troughs in your glucose levels is a disaster because it calls for more cortisol to be made to help you deal with the blood sugar imbalance.”

Another important nutrient is vitamin C—a substance vital for making cortisol.

Mental Downtime

Our body needs mental rest just as much as physical rest. Jackson recommends adopting a meditation practice, but if that seems daunting, just find a quiet space (even if you have to go into the restroom) and concentrate on your breath and releasing anxiety and worry. Instead of scrolling through your phone during breaks, develop a habit of giving your overfilled brain a moment of clarity.

Exercise

Rather than depending on stimulants for energy, try exercise. It may sound counterintuitive, but not working out can cause fatigue. Exercise is one of the best ways to help your body better adapt to stress. It increases oxygen flow to your brain and muscles to help sustain your energy throughout the day.

Adaptogen Herbs

In ancient times, doctors treated symptoms such as weakness, premature aging, and fatigue with herbs. These same herbs today are used to treat adrenal fatigue and are known as adaptogens because they help the body better adapt to stress. They help elevate or lower your hormones according to your own individual needs. Some of the best adaptogens for adrenal fatigue include Korean ginseng and ashwagandha.

Boundaries

Learning to say “no” is another important aspect of adrenal fatigue recovery. Avoid people who drain your energy, and don’t agree to things you don’t have the energy to do.

“I’m constantly weeding people out who drag on my energy,” Jackson said. “While that sounds kind of harsh, it’s a very important thing to do, because there is only so much energy that you can emit in one day.”

Of course, better management of relationships can potentially resolve some of these problems without having to end the relationship entirely.

Avoid Relapse

The recovery plan for adrenal fatigue boils down to the same factors that have always been at the heart of a healthy life: adequate rest, a good diet, and a calm mind.

However, once you feel better, it’s tempting to return to your old ways. When we get our energy back, the to-do list starts to grow again, and we forget about maintaining the basics of good health and self-care. Soon, we may end up right back where we started.

Relapse is very common, Jackson said, so she encourages her patients to take note when they feel their best, and remember what it took to get there.

“I’ve learned that I have to do the basic things every day or I’m not going to be able to do what I really want to do in life,” she said. “I love being plugged in. I love helping people. And I know that if I’m not doing those basic things I’m going to hit the wall at some point.”