adrenal burnout

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Burnout Basics Michael Corsilles, ND, PA-C WAPA spring recert 2015

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Page 1: Adrenal Burnout

Burnout BasicsMichael Corsilles, ND, PA-C

WAPA spring recert 2015

Page 2: Adrenal Burnout

Chief complaints I hear every day

I’m tired all day, but when I lay down to sleep it doesn't come. #tiredbutwired

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I get easily irritated at coworkers, friends, patients – anyone really. #jerk

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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

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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

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Note:

This is NOT a talk on

Chronic Fatigue Syndrome

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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.

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But we all (providers included) suffer some degree of

Chronic Fatigue Syndrome...

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It’s called “Burnout”

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In the beginning... The Adrenals

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In the end...the adrenals are burned out

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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.

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The cause of Burnout? Too much fight or flight

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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!

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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

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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

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2. De-personalization:

The development of a negative, callous and cynical attitude toward patients and their concerns

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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

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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??

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How to Heal Burnout

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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.

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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

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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

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This is your face on stress

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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

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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 

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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

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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/

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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

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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

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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

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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

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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

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We still need stress!

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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/

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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.

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