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….


When Your Gluten Free Diet Goes Pear Shaped

 
 

You’re being really good. Doing all the right things. Yet your symptoms- the gas, bloating, general discomfort, joint pains, brain fog, headaches or feeling low; are still present. They did improve for a little while. But now they are creeping back.

You’ve been diligently looking at the labels of everything that you eat. You even started to buy organic wines now (which actually helps with the hangovers!). You can feel the desperation creeping back in. You’re terrified of being in that place again! Especially now that you’ve regained some control back and a sense of normality….

So what’s going on? Here are some potential reasons when this happens:

  • You are consuming gluten without knowing it. Its hard. Really hard. Even ketchup has gluten in it. Most commercial sauces have it and they mostly don’t have to list it as an ingredient.

  • There’s cross contamination. One reason I tell my patients to avoid gluten free oats. There’s almost always some degree of cross contamination. Even in restaurants where they are able to serve gluten free foods, cross contamination can and does happen.

  • An interesting possibility and the reason I wanted to write this blog…. Over-consumption of newly introduced foods or grains. The things that in the past, you may either never have eaten, or only ate sporadically.

Look back on your diet and have a think about what it used to look like and what it looks like now. I’ve been on this track and back. Feeling rather smug with the beautiful array of new grains and colours in my food. But secretely actually not too thrilled about the taste of some of them. At least the plate looked right and I felt great for following through on eating better 

The problem is when most people go gluten free, they frequently immediately look for substitutions in search of the same-looking plate of food. They still want to eat a cookie. But its now a gluten free cookie (with lots of other additives). Or bread (with gums to add elasticity that can be allergenic). Some common examples are these:

  • Buckwheat

  • Sorghum

  • Amaranth

  • Sesame

  • Quinoa

  • Hemp

  • Tapioca

  • Teff

  • Potato

  • Rice

  • Millet

  • Corn

Then there’s the somewhat poor understanding of what gluten actually is, with quite a few people avoiding bread but happily consuming rye, barley, spelt and oats.

Cyrex labs does a test that tests for these components. I normally ask for my patients to include this particular array (Array 4) when they are doing intolerance testing. I’ve found this test to be incredibly useful and is frequently an eye opener for my patients too. 

So the next question…. What can we do about it? Doesn’t it leave us with NOTHING to eat?  

It does if you think of food in terms of grain+veg+meat. However, if you think of how a paleo-like meal looks like, it comprises of veg+meat. Plus lots of good fats. Grains take a long time to harvest/soak/cook. Our ancestors were not capable of doing this. They were hunter gatherers. They didn’t have that kind of luxury. Our gut is not designed (yet) to consume the amount of grain that we do today. Is it any wonder that as a grain consuming nation, we are becoming sicker and sicker?

 What I personally do is this:

  1. I’m a rice eater. I don’t really want to go completely paleo. But I have reduced the quantity of rice drastically over the years. And I don’t need it for every meal. So my plate today looks different from years ago where it was rice heavy. These days, you struggle to find the rice which is hidden underneath the veg or meat and a good amount of fat.

  2. I practice a not-so-strict intermittent fasting. This is now a lifestyle and I don’t ever want to go back to eating so often. I feel very good, don’t get energy crashes and only crave sugar when I’m particularly stressed. I usually eat in an eight hour window (12pm to 8pm). It works for me as I simply push my breakfast later and later. I do have a cup of tea with a little milk. As milk is considered food, this is not strictly fasting. But I can stick to this and it works for me.

  3. I don’t snack normally. I simply don’t want to in the same way I used to. I like giving my gut a break from having to work so hard.

  4. I disagree with small frequent meals mostly (there are times this is necessary esp in adrenal fatigue). I also disagree with breakfast being the most important meal of the day (again, this rule is lifted in adrenal fatigue). I can’t really imagine our hunter-gatherer ancestors getting up to a nice breakfast every morning. It probably started about with the agricultural revolution where the farmer had to eat for energy before going out to the fields. These days, we generally go to a sedentary job.

  5. I tend not to eat things where I need to read the label. So its mostly veg and meat. Close to no boxed foods.

  6. I break these rules often enough so I still am able to live a relatively socially normal life. But I always miss my own way and always, always go back to it. Simply because it makes me feel better

LDN Stories- Down and Depressed Amir

Amir, 43, came to see me after being referred by his nutritionist who was seeing him for adrenal fatigue. He is a professional who came upon some hard times which affected him badly.

He was on quite a few supplements for his fatigue and showed some signs of hormonal imbalance. I also thought that his diet was quite poor which would affect him quite significantly. He had brain fog, constant fatigue, struggled to recover from exercise, was moody and depressed and could not sleep well. Here's his story in his words.....

"Hi Dr Bains,

Thank you very much for your help and support. It has been a real life saver.

Prior to this adrenal fatigue, I was very fit and healthy, exercised 4 times a week, and was successful. An abusive marriage, mom dying and extreme stress caused me to become ill and life has been a struggle since 2003. Three years ago, after finishing an MBA,  I crashed completely and started work with a nutrionist making slow progress.  Prior to the LDN, my energy levels were very very low to non existent,  my mood was very low to depressed, I struggled to get 5-6 hours very poor quality sleep, and woke up feeling unrefreshed with high adrenaline levels. I felt like a zombie ,put on weight, was unable to think straight, had very bad brain fog, and was unable to do anything due to very low energy levels.

The turnaround with LDN has been nothing short of miraculous, and a real game changer.

We started the dose at 3mg, and things got worse before they got better. The LDN really ramped up an already primed immune system, increased my adrenaline, caused flu and cold like symptoms, i.e. phlegm from nose and chest, aches and pains, especially back ache, skin was horrendous and sleep was very poor due to the increased adrenaline.  However, 2 weeks after this, the immune system settled and my sleep went from 5 hours to 7 hours, and sleep quality improved from 5 to 6 out of 10. After letting the body rest and recover for 2 weeks, we increased the LDN again, causing the same cycle, but each time resulting in slightly improved sleep. Now at 5mg and after 4 months, the turnaround has been dramatic. I can sleep for 9 - 11 hours, of good quality sleep ( 8 out of 10 ), and things are improving at a faster rate. Energy levels are higher, brain fog has lifted, and most dramatic of all, my mood has improved 100%. I no longer feel depressed, despite being sub-optimal. I wake up happier, relaxed, and with a positive mindset, excited about the future. 

The key to LDN was definitely perseverance. Each stage caused initial upset, and then the reward phase followed. The big pay off being 4 months down the line. Definitely worth the wait.

Without your help, I would not have made this breakthrough.

I am now hoping to proceed to the next level of the program with my nutritionalist, and start the anti-microbial phase, and to be able to tolerate it well, due to the LDN and enhanced sleep. 

I have taken the advice you provided 4 months ago and incorporated healthy fats into my diet, started cooking with coconut oil,  watched YouTube videos and vastly improved my cooking skills. I'm struggling to add in fermented foods, and this is something my nutritionist is keen to do at a later stage.

I will now look into SIBO and get back to you."

10 Lesser Known Benefits of TRT

Most people think of Testosterone replacement therapy as a “Libido and Muscle” therapy. I have however, started noticing a trend of more and more people coming in asking for the lesser known benefits of TRT. These are usually people with normal jobs, family and life, just wanting a better quality of life. So here a little peep into what people are telling me:

 

  1. My hands and feet are warmer.

  2. I’m much calmer and not so anxious anymore.

  3. I’m able to handle stress better and hence, I feel that I perform better at work.

  4. I have the will and energy to play with my kids again.

  5. I’ve stopped yelling at my kids (as much) and the noise they make does not irritate me the way it used to.

  6. I’m more assertive and stand up for myself a lot more (to the detriment of some partners and co-workers!).

  7. I wake up more refreshed. My sleep has improved.

  8. I’ve put on weight but I’m trimmer (muscle weighs more than fat)

  9. I’ve better hair growth on my face (good for the current facial hair trend but not for all)

  10. Brain function is much better. Everything seems clearer and there is no brain fog anymore.

 

I decided to write this in the first person as its literally a snippet from different people’s stories. As a practitioner, its very gratifying to hear. It also means that after a while, they forget about harpal clinic- a wonderful thing- as life feels right again. These are on top of the well known benefits of libido enhancement and erectile issues; also the muscle building capacity which is dose dependent. Incidentally, this also applies to women on TRT.


There probably are other contributing factors as well as I tend to manage stress where relevant, at the same time. This is hugely important as both stress hormone and testosterone share similar building blocks. Therefore a ‘steal’ happens whenever more stress hormones need to be built, as they are the more important in hormonal hierarchy. In any case, these snippets are from my 3 month reviews post commencing therapy and its likely to stay the same or improve. Pretty exciting I’d say!

 

 


IV Cocktail Drip or Myers- What's the Big Deal?

Myers Cocktail is named after the Baltimore doctor that invented it, Dr John Myers. It comprises of a cocktail of vitamins and mineral given intravenously. Historically, it was given to help treat various ailments. Today, it has an interesting reputation as the latest celebrity ‘trend’ with everyone from Simon Cowell, Rita Ora and Rihanna to Madonna, Cindy Crawford and even Cara Delevingne. The focus on it being a celebrity trend has done a few things:

 

  • highlight the existence of this very interesting treatment

  • downplayed its real advantages by…

  • highlighting the ‘other benefits’ like post-binge drinking treatment, tiredness, and even dehydration as sadly, its more newsworthy

  • taken away from its relevance in managing a whole host of problems that are increasing with our modern day lifestyle and stresses, including exposure to pesticides and environmental toxins

 

The classic Myers is just the right mix of vitamins and minerals for overall wellness and maintenance. It comprises of a cocktail consisting of a variety of B and C vitamins, minerals like magnesium and occasionally trace minerals too.

So the million dollar question is- do we really need it?

 

My take is this. Assuming that the plate of food we eat today has the same nutrient content of a same plate of food, say 50-80 years ago, I’d say we probably don’t need it. In today’s term, someone who lives in the countryside (less pollutants, hence less oxidative damage to the body) and grows their own food or mostly eats organically (no chemicals or pesticides we hope), probably is fine and is able to extract nutrients from food efficiently. The nutrient that they are able to get is probably plentiful as well as balanced.

 

Fast forward to the rest of us living in the city, commuting for a living (stress+pollutants), eating quickly and cost-effectively (stress+low nutrient foods), having little downtime but a lot of work time (stress+++), little play and family time (stress++), travelling a lot (stress+pollutants), living the high life (nutrient depletion+stress) amongst any other variables you can think of.

 

There is a reason celebrities do it. They need to not fall sick and to be able to keep up with the demands of their gruelling schedule. They also happen to have access to people who are able to find short-cuts for them and they have the money to access these short cuts. We don’t think twice or judge them for using fashion stylists as a short cut to getting great style. IV drips are a short cut of sorts for someone who is generally well. So does that make it wrong? For some yes, for others (myself included), not at all- life’s too short to be ill!

 

For the well person, what does it do?

You might have noticed that I talk about stress a lot. We all suffer so much from it that its become part of our lives. But have you wondered biochemically what stress actually does in our bodies?

 

We are fight or flight kind of creatures. We thrive on it. But in this day and age, stress is constant and unrelenting. We have a continuous flow of stress hormones being released in our bodies. These hormones have to be made. The main building block for making hormones is cholesterol. With the whole low fat fad, the body is attacked yet again. We now have not as much building material. Cholesterol is then used to start the building work. Different types of workmen are required to do different things eg roofer, plumber, electrician. They can’t do each other’s jobs. They are the enablers- enabling different things to happen. Vitamins and minerals are the enablers in your body. Without them, a lot of chemical reactions cannot take place. We become depleted. Tired. Needing more and more sleep. Putting on more weight in the classical ‘stress’ fashion of fat face and belly with skinny limbs- then going to the gym for a high intensity workout that’s a stressor to the body- to try to lose that weight. And the cycle continues.

This is a very simplistic picture of what happens in our bodies but perhaps you get the idea. In a future blog on this subject, I will go into some research papers and medical uses of Myers.

In the meantime, have a think about the stressors in your life and how its affecting you. There's so much that can be done and knowledge is king.