adrenal burnout
TRANSCRIPT
Burnout BasicsMichael Corsilles, ND, PA-C
WAPA spring recert 2015
Chief complaints I hear every day
I’m tired all day, but when I lay down to sleep it doesn't come. #tiredbutwired
I get easily irritated at coworkers, friends, patients – anyone really. #jerk
I initially did well in school and work, but now I think I developed ADD because I am easily distracted at work and can’t focus. #squirrel
I’m also gaining weight. But I exercise all. the. time. I do admit to craving sweets and carbs. Too bad I don’t crave kale! #sugarisdrugofchoice
Note:
This is NOT a talk on
Chronic Fatigue Syndrome
Not a talk on Cushing’s or Addison’s either
Cushing’s: Excessive cortisol or a “Cushion” of cortisol
Addison’s: Aka Adrenal Insufficiency. No cortisol or adrenal response. Need to “Add” cortisol.
But we all (providers included) suffer some degree of
Chronic Fatigue Syndrome...
It’s called “Burnout”
In the beginning... The Adrenals
In the end...the adrenals are burned out
The 2 big adrenal hormones
Norepinephrine (ADRENALIN) is commonly thought of as the fight-or-flight hormone. Basically, it prepares you for battle.
CORTISOL increases your appetite and energy level while toning down your immune system’s allergic and inflammatory responses. This hormone stimulates the storage and release of energy in the body, helps the body resist the stressful effects of infections, trauma, and temperature extremes, and helps you maintain stable emotions.
The cause of Burnout? Too much fight or flight
Do We Really Need the Stress Hormones? Cortisol and ObesityStress leads to a red alert and sends body into “fight
or flight” mode. Adrenaline and cortisol help mobilize carbs and fat for quick energy.
Your body assumes you have just physically exerted yourself, for example running from a lion, and need to restock your reserves by eating a lot of carbohydrates or fatty food that can easily be stored as fat.
In reality, you are probably still sitting in your car or at your desk, still fuming and stressed out!
Too much cortisol? Think of Cushing’sCommon signs and symptoms involve progressive obesity
and skin changes, such as:
Weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face), and between the shoulders (buffalo hump)
Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and arms
Slow healing
Acne
Fatigue
Muscle weakness
Depression, anxiety and irritability
Loss of emotional control
Cognitive difficulties
New or worsened high blood pressure
Glucose intolerance that may lead to diabetes
Headache
Do you have Provider Burnout?
Do you have the following 3 traits?
1. Physical and Emotional Exhaustion:
You are emotionally drained, depleted and worn out by work and not able to recover in your non-working hours
2. De-personalization:
The development of a negative, callous and cynical attitude toward patients and their concerns
3. A Reduced Sense of Personal Accomplishment:
The tendency to see your work negatively, without value or meaningless (“what’s the use?”) and see ourselves as incompetent.
Source: thehappymd.com by D.Drummond, MD
What to do when a patient comes to you with Burnout?
I.e., what happens when all workups come back normal?
If you’re burned out yourself, how are you supposed to take care of your burned out patients??
How to Heal Burnout
Coffee creates a fake alarm state
If you only have the occasional cup of coffee, your adrenals will be able to react quickly and capably to this kind of stimulation.
But if you are drinking several cups of coffee each day, you start to notice a weakened reaction.
Bottom line: Sorry, you’re in the wrong city for burnout.
Regular exercise and cortisol
Exercise forces the body to deviate temporarily from homeostasis, so it is perceived as a stress and causes the release of cortisol.
But, regular exercise training will decrease this effect, causing the body to have a better response to stress and require less cortisol release.
Hill EE1, Zack E, Battaglini C, Viru M, Viru A,
Hackney AC. J Endocrinol Invest. Exercise and circulating cortisol levels: the intensity threshold effect. 2008 Jul;31(7):587-91. http://www.ncbi.nlm.nih.gov/pubmed/18787373
Meditation lowers cortisol & slows aging
Mindfulness meditation lowers the cortisol levels in the blood suggesting that it can lower stress and may decrease the risk of diseases that arise from stress such as psychiatric disorder, peptic ulcer and migraine.
The more stressed people were, the shorter their telomeres and the lower their levels of telomerase.
Turakitwanakan W1, Mekseepralard C, Busarakumtragul P. J Med Assoc Thai. Effects of mindfulness meditation on serum cortisol of medical students. 2013 Jan;96 Suppl 1:S90-5. http://www.ncbi.nlm.nih.gov/pubmed/23724462
This is your face on stress
Sleep Deprivationand
Cortisol
Sleep loss affects the resiliency of the stress response
Note: No sleep also makes us fat!
Leproult, Rachel; Copinschi, Georges; Buxton, Orfeu; Van Cauter, EveSleep: Journal of Sleep Research & Sleep Medicine. Sleep loss results in an elevation of cortisol levels the next evening. Vol 20(10), Oct 1997, 865-870. http://psycnet.apa.org/psycinfo/1997-38275-003
Laughter and Cortisol
A Loma Linda 2006 study found that the anticipation of laughter lowered the levels of stress hormones.
Also helped mood and immunity: 2 hormones – beta-endorphins (the family of chemicals that alleviates depression) and human growth hormone (HGH) – which helps with immunity when volunteers anticipated watching a humorous video.
http://www.the-aps.org/mm/hp/Audiences/Public-Press/Archive/08/10.html
Panax Ginseng enhanced Cognition
The 10 minute "cognitive demand" battery comprised a Serial Threes subtraction task (2 min); a Serial Sevens subtraction task (2 min); a Rapid Visual Information Processing task (5 min); and a "mental fatigue" visual analogue scale. The Panax Ginseng group rocked.
Reay JL, Kennedy DO, Scholey AB. J Psychopharmacol. Effects of Panax ginseng, consumed with and without glucose, on blood glucose levels and cognitive performance during sustained 'mentally demanding' tasks. 2006 Nov;20(6):771-81. Epub 2006 Jan 9. http://www.ncbi.nlm.nih.gov/pubmed/16401645
Holy Basil
After 6 weeks on Holy Basil, frequent forgetfulness, sexual problems, exhaustion, and sleep problems decreased significantly.
Saxena R, 1 Singh R, 2 Kumar P, et.al, Evid Based Complement Alternat Med. Efficacy of an Extract of Ocimum tenuiflorum (OciBest) in the Management of General Stress: A Double-Blind, Placebo-Controlled Study. 2012; 2012: 894509. Published online 2011 Oct 3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185238/
Fish oil and stress
Fish oils reduced indicators of hostility and aggression, by modulating levels of proinflammatory cytokines or the neurotransmitter norepinephrine (adrenalin).
Bradbury J, Myers SP, Oliver C. Nutr J. An adaptogenic role for omega-3 fatty acids in stress; a randomised placebo controlled double blind intervention study (pilot)2004 Nov 28;3:20. http://www.ncbi.nlm.nih.gov/pubmed/15566625
Ashwagandha and Cortisol
The treatment group that was given Ashwagandha root extract showed a significant reduction in scores on all the stress-assessment scales on Day 60, relative to the placebo group.
Chandrasekhar K, Kapoor J, Anishetty S. Indian J Psychol Med. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. 2012 Jul;34(3):255-62. http://www.ncbi.nlm.nih.gov/pubmed/23439798
Rhodiola
Rhodiola extract exerts an anti-fatigue effect that increases mental performance, particularly the ability to concentrate, and decreases cortisol response to awakening stress in burnout patients with fatigue syndrome.
Olsson EM, von Schéele B, Panossian AG. Planta Med. A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. 2009 Feb;75(2):105-12. doi: 10.1055/s-0028-1088346. Epub 2008 Nov 18. http://www.ncbi.nlm.nih.gov/pubmed/19016404
Combo of herbs worked too
Rhodiola, Schisandra, and Eleutherococcus (Siberian Ginseng)
Significant difference in attention, speed, and accuracy between the two treatment groups.
The subjects in the herbal combo group quickly (two hours) gained improved attention and increased speed and accuracy during stressful cognitive tasks, in comparison to placebo.
Aslanyan G, Amroyan E, Gabrielyan E, Nylander M, Wikman G, Panossian A. Phytomedicine. Double-blind, placebo-controlled, randomised study of single dose effects of ADAPT-232 on cognitive functions. 2010 Jun;17(7):494-9. doi: 10.1016/j.phymed.2010.02.005. Epub 2010 Apr 5. http://www.ncbi.nlm.nih.gov/pubmed/20374974
Change your Perspective re: Stress
In order to get companies and employees to take stress seriously, most trainers/coaches/providers emphasize that:
stress is the number 1 health threat in the US; that 70-90% of provider visits are due to stress-related issue; and that stress is linked to the 6 leading causes of death (American Psychological Association).
This is the wrong approach to treat burnout!
Harvard Business Review https://hbr.org/2011/02/make-stress-work-for-you
We still need stress!
It’s All About Your Perspective:
Positive Stress?
Acute stress – short-lived (not chronic) – primes the brain for improved performance!
Positive effects of stress: Research indicates that stress creates greater mental toughness, deeper relationships, heightened awareness, new perspectives, a sense of mastery, a greater appreciation for life, a heightened sense of meaning, and strengthened priorities.
http://newscenter.berkeley.edu/2013/04/16/researchers-find-out-why-some-stress-is-good-for-you/
Bottom Line
Here’s how to heal burn out for you
and your patients:
1. Exercise more2. Eat better3. Get more sleep4. Take more vacations5. Don’t work yourself into the ground.
Remember this...No one benefits if you are tired.Not your patients.Not your coworkers.Not your children.Not your spouse.Not your sanity!
Stop the insanity, and rest for crying out loud.No one benefits when you are tired, particularly you and the results you want to create.