"What exactly is burnout? What happens in the body when you are experiencing burnout?"
The term burnout was first defined in the 1970s by US Psychologist Herbert Freudenberger who described the key symptoms as loss of motivation, emotional depletion and cynicism caused by work-related stress. Whilst this all-encompassing exhaustion is often caused by overwork, it can be the result of a myriad of prolonged and consistent stressful situations, also including emotional strain and physical stress.
During stress (whether actual or perceived), the body releases stress hormones, namely cortisol and adrenaline, which increase blood pressure, elevate heart rate and boost available energy by flooding the bloodstream with sugar (glucose) to mobilise the body for battle. Historically this would have enabled us to run from a lion, and indeed, acute, short-lived stress can be beneficial in sharpening our concentration, energising us for the task at hand, and allowing us to build resistance and adapt. However, the body has not evolved to handle the pressure of modern-day prolonged stress: consistent exposure to stressors such as long work hours, caring for family members, experiencing emotional turmoil, family deaths and economic stress can all have the opposite effect.
When we experience chronic stress, without sufficient recovery, the strain put on the body is maladaptive at best, and increases your risk of burnout: when you feel physically, mentally and emotionally depleted. Here, your adrenals, which produce your stress hormones, can quite literally become “exhausted” and production of key hormones involved in the stress response, energy, blood pressure, metabolism and a variety of other systems become dysregulated. For this reason, it is often referred to as “adrenal fatigue”.
"What’s the difference between stress and burnout?"
Stress, which despite often being unpleasant, tends to energise people, even if accompanied by anxiety-like symptoms, and is usually perceived as manageable. After some rest and recovery, symptoms dissipate. Burnout describes a severe stress-related condition that encompasses physical, mental and emotional exhaustion which does not dissipate with recovery and results in hormonal disturbances. Those experiencing burnout may struggle to get out of bed, dread the day ahead, and have no capacity to engage in daily tasks. For this reason, it often masks as depression, or vice versa. They may also experience a myriad of stress-related health conditions, not in the least onset of auto-immune conditions and atopic conditions such as allergies and asthma.
Stress
● You put in a lot of effort and energy
● Emotions are heightened
● You may feel anxious and hyperactive
● You feel depleted but power through
● You generally feel refreshed on sleeping
Burnout
● You can no longer put in the same effort
● You feel apathetic and emotionally blunted
● You feel physically and emotionally overwhelmed
● You don’t have the energy to perform daily tasks
● You struggle to sleep, despite being exhausted, and don’t feel refreshed on waking
Burnout doesn’t dissipate by itself and, if left untreated, can lead to serious physical and psychological illnesses, not in the least depression, heart disease and diabetes.
"Are there some types of people who are more likely to experience burnout? E.g. new parents, specific life events?"
There are various types of people who are more likely to experience burnout than others. It goes without saying that those in particular professions (namely “helping professions”) such as doctors, nurses - and business executives- are prone to career-induced burnout. As are, I’m sure you’ve already guessed, parents – research shows that mothers and fathers are equally prone to burnout as are career executives.
Interestingly, personality can also render you more at risk of the condition. Type A personalities, comprising incredibly driven, perfectionist individuals who value control are also likely to burn the candle at every end. Not only is this because they’re more likely to always be “on the go”, but because they tend to have higher levels or circulating stress hormone, cortisol, which might energise them in small bursts, but ultimately puts them at higher risk of burnout over the long-term.
Other at risk individuals include pregnant and post-partum women, obese individuals, those with existing inflammatory conditions, diabetics and athletes.
Pregnancy and being post-partum may also create a unique risk factor.
Research suggests that oestradiol, a form of oestrogen, may contribute to the normal functioning of the Hypothalamic-Pituitary-Adrenal (HPA) response, otherwise known as our stress response. High levels of oestradiol among pregnant and post-partum women may actually increase levels of our stress hormones, namely cortisol and ACTH, priming the stress response. This seems to continue post-partum, as oestradiol and progestins decline – and doesn’t consider the exertion associated with a new born!
Obesity and stress are intricately related: increased HPA (stress) activity increases visceral adiposity (fat storage around the middle), whilst adiposity acts as a stressor and further activates the stress response. That being said, whilst obesity may, for various emotional and physical factors, be a stressful experience, being overweight in itself is perceived as an outside stressor by the body, dysregulating the HPA response and priming the body for burnout. Moreover, obesity-related insulin resistance and high levels of insulin (hyper insulinemic) drives hormonal dysregulation – including, you’ve guessed it, additional secretion of stress hormones - in a vicious cycle of weight gain, hyper-reactivity to stressors – and eventual burnout.
Inflammatory conditions foster burnout. Similarly to obesity, chronic stress increases circulating cytokines, inflammatory messengers which perpetuate inflammation through the blood and brain - and result in conditions such as arthritis, diabetes, heart disease and Alzheimer’s Disease. As you’ve probably guessed, these, too, exacerbate the body’s stress response. Not only is inflammation a stressful experience for the body in itself, but these inflammatory messengers also increase the secretion of stress hormone, cortisol.
Type 2 diabetics are more likely to suffer from burnout. Cortisol and blood glucose levels have an intimate relationship. When stressed, cortisol, the body’s main stress hormone, triggers the release of glucose into the blood stream to mobilise the body for the stressful situation. When blood glucose subsequently dips during the characteristic rollercoaster associated with blood sugar dysregulation, hypoglycaemia (low blood sugar) also triggers the release of stress hormone cortisol – which ultimately results in higher blood sugar levels. Cortisol also de-sensitises insulin, the main hormone responsible for glucose uptake into cells. What does this sound like? Diabetes Type 2. What came first – the chicken or the egg?
Athletes and gym goers are also at increased risk of burnout. During exercise, the body releases the stress hormone, cortisol. In short bursts, this helps to dull inflammation, and blood cortisol levels return to normal relatively quickly. However, in endurance athletes and those exercising for multiple hours consecutively, blood cortisol levels can remain high for several days, which can result in catabolism, or break down of muscle – and impeded performance and recovery. If sufficient rest, recovery and low intensity sessions are not factored in, this is a recipe for burnout. The result is not only declining performance, but frequent onset of infections and injuries, mood changes and lack of motivation to train, and complete exhaustion. Given the association between burnout and inflammatory conditions like arthritis, this can be even more debilitating for a budding athlete.
"How common is burnout? Are women more likely to be affected than men?"
Recent research suggests that, whilst gender-typing presumes men will be at most risk of burnout, female workers are actually the most likely, with contributing factors including working longer hours, difficulties in separating work and personal life (increasingly difficult when working from home) – and family life. Studies suggest that mothers in employment are 28% more likely to experience burnout than their male counterparts. When we factor in the hormonal changes experienced during pregnancy and post-partum, without considering the pressures of motherhood and working life, it’s easy to see how this can prompt burnout.
However, concrete figures regarding burnout are opaque, especially since it has only recently been officially recognised as a syndrome (in 2019), namely in relation to badly managed workplace stress, which does not consider burnout suffered by other types of individuals. According to the World Health Organisation, 1 in 4 people in the workplace alone will now be impacted by burnout, which does not factor in burnout as a result of parenthood, athletic endeavours, pregnancy and that experienced by post-partum women, type A personalities and those with pre-disposing factors such as inflammatory conditions.
"What are the most common symptoms of burnout? What are the signs you are on the edge of burnout?"
Burnout has some distinct characteristics:
1. Complete exhaustion –even after a good night’s sleep
2. Inability to perform usual daily tasks
3. Lack of motivation, apathy and general blunted emotions
4. A feeling of overwhelm and hopelessness
5. Feeling detached from family, work and / or society
Given its impact on an array of hormones and variety of systems, including immune, nervous, reproductive and digestive systems, amongst others, it can also be accompanied by various health conditions. Low immunity to infections and viruses, gastrointestinal problems including food reactivities and bloating, headaches, muscular and joint pain, hyper-reactivity to small stressors, reduced recovery from exercise, irregular periods and fertility problems, low libido, problems regulating blood glucose and insulin resistance and dysregulated (low or high) blood pressure are only a few potential co-morbidities, which can also signify that you’re on the edge of burnout.
"What are your top 3-5 lifestyle tips to overcome burnout?"
The overarching key to tackling burnout is to recognise it early on, and not to ignore the symptoms that could foster further escalation and promote physical, mental and emotional harm.
Find Purpose. Outside of work, your role as a parent or your training. Research shows that having a firm purpose in life is associated with less anxiety and lower incidence of stress-associated symptoms. Ever heard of centenarians, living past 100? This is their secret power. For some, this might be finding spirituality or religion, whilst for others this might mean volunteering at an animal shelter or finding a new hobby. It doesn’t matter what this is, as long as it makes you happy. Research is clear in that those scoring lowest on “purpose in life” show excessive sympathetic nervous system (stress) activity, and hyper reactivity to stressors.
Engage In Box Breathing. Box breathing (in 4-sec, hold 4-sec, out 4-secs, hold 4-secs, repeat) has been shown to turn down the sympathetic nervous system (fight and flight stress response) and turn up the parasympathetic nervous system (relax and digest). Mindfulness and meditation practice can have similar effects.
Put Down the Blue Light. You’ve probably heard the dangers of blue light (smart phones, kindles and other hand-held devices, alongside televisions), but this expands outside of interrupted sleep. Non-natural light, especially blue light, triggers release of cortisol, our stress hormone – this not only keeps us awake at night, but sensitises our stress response even further.
Seek Support From Loved Ones. When you feel like burnout is overwhelming you, it’s important that loved ones understand your situation, including your current limitations, and what extra support they can provide to support your recovery. A trained professional can also help you take a step back, re-assess and figure out what hasn’t been working for you.
Take Regular Epsom Salt Baths. Including 1-2 cups pure Epsom salts, for at least 20-minutes, each night. A plethora of literature associates magnesium deficiency with anxiety, stress-related symptoms and hyperarousal of the HPA-axis (stress response). Conversely, magnesium supplementation can dampen anxiety and circular thinking. An Epsom salt bath not only allows for the intra-dermal absorption of magnesium, but for some time out to relax and unwind.
"What are your top 3-5 nutrition tips to overcome burnout?"
Make Smart Meal Choices. Skipping meals or eating foods rich in simple carbohydrates (bread, pasta, pizza, white rice, and baked goods like cakes and pastries) ultimately result in a hypoglycaemic state which increases cortisol and your stress response. Whilst you might not feel like eating, or crave sugared, salted and highly refined foods during times of stress and fatigue, these will worsen burnout. Fill up on vegetables, lean protein sources (especially oily fish), healthful Omega-3-rich fats (avocado, nuts and seeds, cold-pressed extra virgin olive oil) and fibre-rich carbohydrates (quinoa, brown rice, oats, buckwheat).
Avoid Caffeine. Caffeine dependency often precipitates burnout. Whilst you may feel more energised and alert in the short-term, caffeinated beverages mimic the impact of actual stress, stimulating the release of adrenaline and cortisol – your stress hormones. Consider swapping coffee for green tea, which contains nervous system supporting L-Theanine to enhance focus whilst also promoting relaxation.
Include An Adaptogenic Blend in Your Daily Ritual. ‘Adaptogenic’ herbs refer to botanicals which can help improve our resistance to physical, emotional and environmental stressors, helping us “adapt” to stress. They were even used historically in times of war to give soldiers extra resilience on the field. Whilst various adaptogens exist, I like those of the mushroom variety, which can easily be incorporated as powders into smoothies, juices, soups, stews – or as a coffee alternative. My favourites include Reishi, Chaga and He Shou Wou, which have special nervous system-calming effects and can help reduce anxiety and the impact of stress. Mushroom specialist Hifas da Terra offers a range of capsule and powder form mushrooms, alongside blends.
Increase Consumption of Oily Fish. Aim for 3 fillets, weekly, of a good quality fish, especially SMASH fish (sardines, mackerel, anchovies, sardines and herring), rich in Omega-3. If you’re vegetarian or vegan, ensure you’re eating at least one serving of unsalted nuts, seeds and avocado daily, and you may want to consider supplementation with a good quality Omega-3 supplement like that offered by Norsan. Omega-3 fatty acids not only promote cognition, overall brain health and mental state, but are also used in the production of hormones, so can be key in supporting burnout.
Take A Good Quality Multi-Vitamin, like that offered by Evity Multivitamins, Not only is nutrient deficiency associated with lowered resilience to stress, but stress depletes key nutrients with provide resilience, such as B vitamins and Vitamin C, which escalate burnout. Ensuring you’re meeting your daily needs for B Vitamins (which promote resilience to stress, cognition, mood and energy), Vitamin C (immune support, production of sex hormones), Vitamin E (protection for stress-associated free-radical damage) and Magnesium (nervous system calming), alongside other micro-minerals (zinc, copper, manganese, selenium, molybdenum, chromium and iodine, important for adrenal cortex function) is key.
"At what point should you consider getting support from a professional? What kind of expert can help with burnout?"
Acute stress often energises you, but the turning point is when you instead start feeling depleted, lethargic and apathetic. Whilst many of us can attest to feeling like this, for those on the road to burnout, the downwards spiral keeps on going, so it’s important to address this as soon as possible. Whilst this might signify something easily remedied, like a nutritional deficiency, it’s best to address it early on.
Burnout is now considered a medical syndrome, so will be more readily recognised and addressable by your local GP. However, it’s important to not just address the symptoms, but understand the root cause for a preventative approach. Burnout is an area that has long been supported by a variety of registered practitioners, including those in nutritional and naturopathic fields, alongside acupuncturists, herbalists and a variety of other practitioners, not in the least psychotherapists who can help you understand contributing events.
"How long does it take to overcome burnout?"
Burnout is a very personal experience, and recovery very much depends on the individual, their situation and how long they’ve been suffering from burnout. Once stress has progressed into burnout, it can take a minimum of around 3-months for recovery. However, for many, it may take 1-2 years to fully recover, especially if burnout has triggered other health conditions. An engaged and active approach to altering diet, lifestyle and contributing factors can help shorten this time as much as possible.
"How can you keep your cortisol/stress levels in check in the long-term? Can you give us some great tips that will keep us on top of burnout?"
As you can see, cortisol is impacted by a variety of factors, not in the least stress. However, lack of sleep, high glycaemic load diets (including white, refined carbohydrates and simple sugars), nutrient deficiencies, caffeinated beverages, mind-set and lack of boundaries, amongst other factors, can contribute to high cortisol secretion and elevated stress.
Prioritise Sleep. Stress, including burnout, can disrupt your circadian rhythm, decreasing your quality of sleep. However, poor sleep increases in cortisol and hyper-sensitises the stress response, further disrupting sleep whilst also and priming the body for burnout. Turn off all blue-light emitting devices a few hours before bed (which trigger cortisol and suppress the sleep hormone, melatonin), engage in a habitual, nightly ritual to help the body engage in a predictable nightly wind-down routine (e.g. hot bath, chamomile tea) and don’t drink/ eat within a few hours of sleep. This will help regulate hormones, including stress hormones, alongside promoting overall health.
Reduce Your Glycaemic Load. High glycaemic foods, not only chocolate, sweets and desserts, but bread, pasta, white rice and other refined grains and white flour-filled goods (,pastries, cakes) dysregulate blood sugar and ultimately lead to hypoglycaemic states – which trigger cortisol. Swap refined carbohydrates for complex, fibre-rich carbs like brown rice, quinoa and buckwheat; include lean protein; and ensure your meal is rich in Omega-3 from olive oil, olives, nuts, seeds, avocados and oily fish. This will promote blood sugar and hormonal regulation, including that or cortisol, whilst also providing additional nutrients for resilience to stress.
Eat The Rainbow. Eating a variety of colour fruits (namely berries, pears, apples and other fibre-rich fruits) and vegetables (think red cabbage, tomatoes, beetroot, squash, carrots, peppers, kale, spinach, sprouts, etc.) will ensure you’re diversifying your nutrients to support overall health, and maximising consumption of blood sugar (and thus cortisol) regulating foods, alongside those which promote resilience. Aim for at least tri-coloured plates – and preferably the whole rainbow.
Limit Caffeinated Beverages. These mimic the stress response, and directly elevate cortisol. Swap them out for L-Theanine-rich Green Tea, which is nervous system calming, or coffee substitutes, such as Your Super’s Super Brew. Have no more than 400mg caffeine (around 3-4 cups) coffee daily. In times of stress, limit caffeine more.
Alter Your Mind-Set. Our body does not differentiate between actual, physical stress (running away from the lion) and perceived stress (deadlines, marital disharmony, negative political talk on news channels…). Regardless of whether you’re being physically threatened or sitting at your desk reading a particularly foreboding article, your body will still have the same stress response. Changing your mind-set goes far when it comes to controlling your reaction to stress, and practices which teach observation of (but detachment from) thoughts, such as mindfulness, meditation and breathwork can help us to become less sympathetically (stress response) reactive, and more parasympathetically (rest and digest) dominant.
Set Boundaries. The modern world does not facilitate boundary-setting, and we’ve been conditioned to push boundaries. Whilst this might sound sexy, the physical result for our body’s is not. It’s important to set clear boundaries – whether that be work hours to enforce and work-life balance, boundaries within your relationships or even limiting mal-adaptive practices like binge drinking. Journaling can be a good way of identifying maladaptive themes and discovering your boundaries.
For the gym-goers amongst us, it can be easy to go that bit faster, that bit longer, and down-play the importance of a rest-day. But physiologically, this can do a lot of damage, especially if you exercise across multiple hours, which elevates cortisol for up to a few days. Leave intense training sessions to the afternoon (when cortisol is naturally lower), limit the majority of your training to 1-hour or less, ensure you disperse enough low intensity steady state (LISS training) sessions in your regime – and take at least 1-2 full rest days weekly. Eating carbohydrate and protein rich meals immediately after exercise will also help blunt your cortisol response.
