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….


“Anti – ageing” – Is there a cheap, quick treat to anti-ageing?

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It isn’t a secret that in the world we live in seems we are more concerned by our body appearance more than our immune function. We are troubled by either shifting or decreasing than maintaining our body mass, we are worried by the risk of age related diseases such as cardiovascular, osteoporosis, cancer and neurodegenerative disorders and general frailty in our later years.

Social media encourages us to seek for the #gymbody, the #lookgoodfeelgood factor, which is not entirely possible. Of course, there are measures we can take such as cosmetic surgery, anti-ageing measures in the form of bioidentical hormone replacement, cocktails of vitamins, antioxidants, anti-inflammatory compounds and aesthetics, however, the point is, not everyone can afford or is favourable to these treatments.

The question raised here at the top in bold here warrants a brief explanation, and before reading on, the answer is yes – there is a quick treat anti-ageing treatment, which helps us feel and look good without anticipating needles prodding and pricking.

Most importantly, we should remember that the ageing process is simply characterised by the declining functional capacity, increasing vulnerability to disease, debility, and unfortunately, death. I would like to think, we all aim to live longer, try to reverse our ageing process and fight against all of these traits. We know that as we get old, some of us have a higher risk to disease than others and frailty is a consequence of natural ageing.

Clinically, beyond the obvious signs and symptoms, we want to analyse the  biomarkers of cellular ageing, inflammation and age associated immune deficiencies at tissue and cellular level, to identify these deficits.

Keeping these markers optimum, at least within normality there are things we can try to do without contemplating blood draws or swallowing a pill. Surprisingly, it is what we have all heard before.

  • Exercise (both resistance and aerobic) in combination with adequate protein and energy intake.

As we age it is natural that we lose muscle mass. Moreover, during chronic illness our body wastes plus muscle mass is wasted and weakened. Lean muscle mass has been reported to decrease at approximately 1% per year after 30 years of age and observed at the end of the fifth decade. In layman’s terms, we have to replace what we are losing and gain muscle to slow down this process.

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Yes, it is the cheapest, safest and most reliable route to anti-ageing. I'll highlight the word protein purposefully as it deserves clarification. Studies in anti-ageing have shown that adequate protein intake, particularly, leucine-enriched balanced amino acids and possibly creatine enhancing muscle strength. Some studies have even recommended the amount protein ingested should be spread equally throughout the day, i.e, equivalent amounts at breakfast, lunch, and dinner. Also, if additional protein supplementation is given it should be administered between meals. Levels of protein intake as high as 1.6 g of protein/kg/day have been demonstrated to increase exercise-induced muscle hypertrophy in older persons. Without getting deeper into the protein debate which will be up for discussion in future blogs, the equation is so far simple. A  dose of aerobic exercise + increased protein intake + resistance/strength exercises to increase muscle mass =  (- ageing + feel good/look good).

Secret Behind Off Label or Unlicensed Medications

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As a private practice, we are frequently approached by patients who require certain medications “off label” or “unlicensed”. This can sound quite scary for the average person who is deciding to undergo this route or for carers of the patient who may be nervous about what this may entail.

Here's a little background on these off label medications....

Every drug is developed and tested for treating certain conditions. Clinical trials are conducted and the drug is deemed “safe” to use for its intended purpose. Occasionally, the initial purpose a drug is being developed becomes null and void when one of their “side effects” then becomes the more interesting feature of the drug. A good example is Viagra. Viagra was originally developed to treat high blood pressure and angina (chest pain). Its side effect- causing erections- became an unexpected and highly lucrative venture for the manufacturers. Another good example is Botox- initially developed to treat facial tics and spasms. When they had a side effect of decreasing wrinkles, this became its main and highly lucrative use.

Pharmaceutical companies are then allowed to patent the drug for a certain number of years. This is to allow them to claw back their investment in research and development that has gone into making those drugs. It is also to enable them to make a profit- they are a business after all. This system works well. If you consider the number of drugs that don’t make the cut for human use- which translates into millions of dollars of lost revenue for the drug manufacturer, its only fair that the risk they take gets rewarded when one of their experimental drugs do work.

So let’s say that viagra was indeed licensed for high blood pressure. Now according to the medical guidelines, we as doctors, should only prescribe them for that purpose. But we are highly trained and frequently have to use our judgement in every individual case to decide the best course of action for that particular person. Guidelines exist for a reason but at the end of the day, the reason our job is not done by a computer is because of the human quality, experience and instinct that we are able to hone over the years- that beats the computer. This means that I can now decide that for my patient with an erection issue, I can give him viagra in a suitable dose to help with his erection, but not any blood pressure issues (which he may not have). That would be a classic off label use of a drug.

Some examples of off label use medications are low dose naltrexone, clemastine, various hormones, aspirin, cholestyramine and metformin amongst others.

Now lets say that a drug that has been long approved and deemed safe for a purpose has now been found to have another use. A good example is LDN (low dose naltrexone). Initially developed for addictions, it is now used in a very low dose for immuno-modulation amongst other things. This benefit has been stumbled upon. Our challenges as practitioners are listed below:

  • Someone needs to inform other practitioners about this

  • Other practitioners may well be quite sceptical as there are no large trials to “prove” this fact

  • Big pharma are not very interested in conducting large trials. These things cost money and since the initial drug has already lost its patent, there’s no money to be made.

  • So its up to individual practitioners, happy patients and word of mouth to get the word out

  • There are risks and we know it. And there’s a lot we don’t know regarding potential side effects, other uses, risks and benefits. But we’re willing to take the chance and happy to monitor closely

  • In an ideal world, we will all do research and audits on all our patients. Sample sizes will be small but something is better than nothing. However, this does mean tons of paperwork and potentially increase in staff size which unfortunately translates into increased costs for the practitioner. One reason why there are so few trials for off label medications. Its simply a few good doctors and too much work.

  • We as practitioners, also take the risk of being thought to be unsafe by fellow doctors who may not understand our reasons for going off label. This is a big issue and concerns us gravely as it can lead to suspension of our practising privileges.

I hope that this article puts things into perspective a little so that it can be more clearly understood where we- as practitioners- stand when we take the decision to use an unlicensed medication and so that you- as a patient or carer of a patient- will be able to make an informed decision as to how to decide if its the right option for you. It will probably mean more paperwork as we try to safeguard ourselves, we may ask you to participate in trials and we may even ask you to volunteer your time to help us analyse data and eventually make things more available in the future.

Do let us know if you would like to contribute anything at all ie ideas, time, money to help towards pushing these ideas forward. We have recently registered our charity Fighting Chance Foundation. But I envisage that its going to take quite a long time to get anything going mainly due to lack of time and staff at present. We would however, love to hear from you and know that we have some support. Contact mimi@harpalclinic.co.uk if you’re keen to help in any way.