The Trouble with Burning Out...

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One of the commonest things we see at the clinic is burn out. Also known as adrenal fatigue (not recognised in conventional medicine). When presented to your regular doctor, most people are given a sick note to take time off work; antidepressants is a common crutch plus the advice to take it easy.

“Take a holiday!”

Easier said than done. After all, in today’s world, one big cause of burnout is overworking and money constraints. So taking time out is quite a tough option. Especially if you are the responsible type and understand that by you taking time out, others get the brunt of your workload. Not an ideal situation. This is worse when the buck stops with you.

So, does traditional management work? Yes, certainly to an extent. Rest is highly important and time away gives one the right perspective and a better ability to prioritise. It also clears the mind and hence performance is enhanced. So you end up working smarter, not harder. Most people notice that their performance and work enjoyment increases after a break.

What about antidepressants? This does make a difference. I’m not a huge fan of it but nevertheless, there is a place for it. Especially when burnout causes other symptoms like raised anxiety, difficulty falling and maintaining sleep; anger, depression and a feeling of helplessness or lack of control over one’s life. To boil things down to the very basics- antidepressants numbs a person. This means that nothing feels as bad as it potentially would. This is a very useful crutch and should not be underestimated. It buys time until your body has healed enough to take over. The danger is a reliance on antidepressants for too long.

So what is it that we do, as functional and hormonal practitioners, that make our approach different from conventional medicine? The clue is in the underlined sentence above. We go to the root of the problem and help the body heal itself; therefore speeding up recovery. I also use this approach to prevent getting to a burnt out state; or in some extreme high stress situations, to delay getting there (not ideal but life is life).

We deal with the ‘burning out’ of the adrenals, which are small glands above the kidneys that release the hormones adrenaline and cortisol amongst others. A normal reaction of stress hormone (cortisol) release is excessive production when you are stressed, to cope with the increased demands on the body. When this happens consistently over a prolonged period of time, something happens. The body now goes into a state where it cannot produce enough cortisol to meet demand. At this point, you now start producing too little cortisol, contrary to popular believe. During a burn out, you produce too little to be useful. This is when you feel the need to crawl under the duvet, turn the lights off, sleep or to try to sleep and shut the world off. This is the body’s way of trying to heal the glands, so that it is able to once again produce cortisol in the right quantity to deal with your body’s needs.

This phenomenon happens to other glands too- the most commonly known of which is the pancreas which produces insulin. Early stages of diabetes signifies a problem with too much insulin release. These people need tablets to manage their sugar intake and keep their insulin low. Late stage diabetics need insulin injections. Because they now have the opposite problem where the excessive demand on the gland has caused it to burn out and the body can no longer produce enough insulin to meet demand.

We manage adrenal fatigue or impending fatigue with the right adrenal support and hormones where necessary. This will be covered in another blog. We also educate our patients so that they can see the signs and know when to self manage because that it the end goal- for you to understand your body to such an extent that you can read what your body is trying to tell you.

One problem with this- and the reason for writing this blog- is that when we most need help is when we are at our highest point in stress and time constraints and when we are most liable to forget these principles. We forget to utilise the support. I see this again and again. This blog is a reminder that when things get tough and you need a little guidance and for someone else to steer the boat- reach out for practitioners such as ourselves. We are in a position to help your body help itself. Don’t get to burn out. Its really not worth it. It takes a really long time to heal once you’re burnt out. Don’t do that long run or that very tiring HIIT session. Just rest, be lazy, day dream, order take out if need be (short term only) and allow yourself to just be. Which reminds me, I need to take my adrenal support now….


Tired All The Time- What Could Be Wrong? (Part 1)

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I would say that of all the complaints I hear at my clinic, this is by far the commonest. The scary thing is that it seems to transcend age and sex. This means that ‘tired all the time’ (tatt in dr’s world) can attack anyone at any age. So how can you avoid it?


Before we can answer that question, we need to understand what is normal and why tatt happens.


Do you remember looking at kids and their boundless energy levels? When they eat sugar, they get hyperactive and start running around. A totally normal response to excessive sugar in the blood that the body needs to get rid of as sugar is inflammatory and the body knows it. So parents, please let your kids run around- its a good thing. What about in adults? What happens when we consume too much alcohol or sugary drinks (liquid carbs)? How about snacks; including ‘healthy’ snacks? We hardly ever need to run around to burn it after. This is not the ideal response to that sugar excess. So what happens here?


Your body releases insulin. Insulin’s job is to make sure that the excess sugar is picked up and either used or stored. A lot of this happens in the liver. So the liver is now under stress to deal with all this. Cortisol the stress hormone is released. Cortisol and insulin work hand in hand (not quite so simple but good enough for the layperson). You’ll find that if you consume too much rubbish or are overly stressed, you put on weight in the middle- a classic tell tale sign of the start of insulin or cortisol issues. Unfortunately with age, this worsens as the body’s ability to adapt decreases. Now, a lot of nutrients are used up in this process. When we talk about nutrients, we talk about vitamins, minerals, amino acids, antioxidants etc. So someone with a poor diet or highly stressed life actually need more nutrient support as they probably do not get enough from their diet to make up for how quickly things get used up. These hormones also communicate with other hormones- thyroid being an important one. Thyroid controls your metabolism. Or how effectively your body consumes fuel (or sugar/fat). With age, this function goes down as well. Or perhaps you’ve accumulated ‘problems’ over the years that affect your body’s functionality.


What kind of problems are those? A whole host of potential issues. Let’s list some down:

  • Environmental issues such as toxic mold (in a old, damp house), or fumes from a brand new carpet or paintwork

  • Living and working in the city - exposure to exhaust fumes containing lead, arsenic and other heavy metals

  • Accumulation of toxins from food - e.g. mercury from seafood, sprayed chemicals (pesticides) in fruits and veg, chemical fertilisers

  • Accumulation of toxins or change in ionic charge in your body when you have e.g. metal fillings or 2 or more different types of metals in your body. This is really interesting. If you develop tatt after an orthopedic procedure or after getting dental work; including a simple brace- think about this. Its not well known enough so do your due diligence

  • Day to day stresses like SAD (seasonal affective disorder), lowered immunity due to antibiotic overuse or excessive exposure to bugs; overwork

  • Age related hormonal decline

  • Too much screen time

  • Excessive exposure to EMR (electromagnetic radiation)

  • Start or autoimmunity where the body starts attacking itself


This is merely a snapshot. The list goes on. On its own, there probably isn’t enough to knock the average person down but when a few factors are present, the cumulative effect can have a large effect.


This is mostly the reason why the average person will try various things to improve their tatt status and find that they may improve things for awhile but that they cannot shift it. It is also why in long standing cases, most people need help to get over it. It simply is not as easy as it seems to get to the bottom of.


So what can we do? We will investigate this in the second part of this blog series, so stay tuned….


Gluten and Thyroid- What’s the connection?

 

Many people who are fairly well read about thyroid problems will know that the general advice is to go gluten free. This is for both hyper and hypothyroid, especially if one has autoimmune thyroid disease like Graves’ and Hashimoto’s thyroiditis. We will be talking mostly about Hashimoto’s when referring to autoimmune thyroid disorder.

Hashimoto’s is usually diagnosed by doing a thyroid antibody profile. The profile consists of Thyroid Peroxidase Antibody (TPO Ab) and Thyroglobulin Antibodies (TgAb). TPOAbs are present in nearly all (>90 %) patients, while TgAbs can be seen in approximately 80%. So a negative test does not necessarily mean that you don’t have Hashimoto's.

This test is not done that often in the NHS as it does not alter management in most instances. With functional medicine practitioners however, we treat most autoimmune diseases by attempting to decrease the body’s attempt to attack itself.

The problem with gluten is that the molecular structure of the protein component of it- gliadin- actually resembles the structure of the thyroid gland. When gluten/gliadin is eaten, it passes into the blood stream and the body tags it for destruction by the immune system antibodies. These same antibodies will then also attack the thyroid gland because of the resemblance to gliadin.

In people eating gluten regularly  for example toast in the morning, sandwich for lunch and pasta for dinner, you can see how over time, this can cause a critical situation of your thyroid gland being constantly attacked a few times a day, every day for months or years on end. One frequent reason that despite ‘adequate’ T4 supplementation, those with Hashimoto’s simply don’t feel that well.

This is also the reason that desiccated thyroid like Armour, is not a good idea in autoimmune thyroid. The animal glandular tissue looks like thyroid tissue and is then attacked by the body which subsequently also attacks the thyroid gland at the same time. In these instances, I prefer using compounded thyroid T4 and T3 where relevant.


The take home message is that if you have thyroid problems and you’re not sure if you have autoimmune thyroiditis and your GP is not happy to test you for it, do try going completely gluten free for at least 3 weeks and see how you feel. Its well worth your time and effort.

 

LDN- the miracle cure?

I stumbled upon LDN (low dose naltrexone) not too long ago and was intrigued and felt a need to find out more and more. Being in the field that I’m in, that’s actually quite a big deal. We are exposed to so many new ‘miracle cures’ from prescription medications to herbs and supplements that it becomes a problem to know when to stop.

There’s also the bias of the person ‘pushing’ the agenda. I don’t mean this in a bad way as most people ‘push’ their ideas based on their own experience, expertise, passion and interests. Just a quick look at amazon books will tell you that. I’ve come to the point where I’ve given up on deciding who the ‘master’ is.

In the hormone world, the ‘master hormone’, depending on who wrote the book, is one of these below:

  • Melatonin

  • DHEA

  • Human Growth Hormone

  • Thyroid

  • Leptin

 

I’m quite sure I’m forgetting a few but those spring to mind.

 

The world of supplements and prescriptions is even more fun. Its a little hard to follow but I’m sure most of you know a little about Goji berries, macca, ginseng, garlic, ginger, turmeric,  Vit B12, Vit C, Vit D, Vit K, Magnesium and the list goes on.

 

So to bring things back to my original point- it actually takes quite a lot to get me excited these days. I’m a little jaded…

 

LDN first came to my attention when I was researching SIBO (small intestinal bacterial overgrowth). Because I didn’t know anything about it, I did the usual due diligence of giving it my hour’s worth. The hour turned to many hours and before I knew it, I was hooked. I didn’t have any experience in it but has many patients who I thought fitted the profile of how it could help. I even created a special LDN only consultation to see what would happen (this is quite different from my usual consults but I wanted it to be more accessible).

 

This is my opinion to date. I’m still in early days but already have a good number of patients on it at present. Most people have autoimmune issues. I personally prefer the sublingual route of administration as it bypasses the gut. From my experience, even those without obvious gut issues may have absorbability problems and its worth the slightly higher price point.

 

It is NOT a miracle cure and is not even a cure at all. What it does is to facilitate the body in mending itself by increasing our own production of feel good neurotransmitters. These don’t only make us feel good but also improve our immune system- one of the hardest things to achieve. Most people should anticipate that they will be on it for at least 3 months. Below is what you can expect (this differs based on diseases etc but is a good general guide):

  • Around 30% won’t find that it makes any difference at all

  • Of the remainder 70%, around 15% might have miraculous results

  • 30% will find a niceable difference

  • The rest will not find much of a difference until they stop it- upon which they will then realise that there actually was a positive difference

 

*Please bear in mind that this is a rough estimate of my personal experience and may not correspond to other practitioners or to what you may have read. This is not a scientific accurate analysis.

 

My opinion on it- and I promise I will update you whenever I get more information- is this:

  • Due to the relatively low cost of it, I believe that it is worth a trial of at least 3 months

  • For those in whom it works, some need to take it for life if theirs is a lifelong autoimmune problem

  • For others, they only need to take it until their symptoms clear up and in my opinion, probably upto 3 months after. These would be the gut dysbiosis patients amongst others.

  • For mild side effects, lower the dose but do persevere

 

If one has realistic expectations of what can be achieved, I believe that this could prove to be a very exciting opportunity and another avenue for those who have exhausted all other avenues.