Stress, Fatigue & Burnout - What You Need to Know About Cortisol Dysregulation
We live in a very busy, stressful, on-the-go society. We work long hours while juggling the demands of family life, we sacrifice sleep, we rely on coffee to keep us awake, and reach for sugary foods for an extra energy boost. Over time these habits affect us physically, mentally, and emotionally.
When we engage in stressful activities our bodies enter into a ‘fight or flight’ response. Cortisol is a hormone that is released from our adrenal glands to provide us with a burst of energy in order to ‘survive.’ It does so by breaking down our carbohydrate and protein stores, increasing blood sugar, and suppressing the immune system to conserve energy. Over time high cortisol can lead to insulin resistance, weaken our immune system, and lead to muscle wasting, if not properly addressed. It can also impact our thyroid and sex hormone balance. Eventually our adrenal glands may not be able to keep up with the stress in our lives, and cortisol levels will drop, leading to chronic mental and physical fatigue and burnout.
What is cortisol dysregulation?
Cortisol dysregulation occurs after a period of acute or chronic stress, and results in the dysregulation of our normal circadian cortisol production. Cortisol is produced by our adrenal glands, along with our sex hormones (androgens and estrogen), neurotransmitters (adrenaline and noradrenaline), and a blood pressure regulating hormone (aldosterone). With acute or chronic stress cortisol imbalances are first to be seen. Over time adrenal stress can lead to other hormone imbalances including imbalances in insulin, sex hormones, blood pressure hormones, and even thyroid hormone.
What are common causes of stress?
Lack of sleep
Poor diet (processed food, junk food, skipped meals)
Emotional stress (unhealthy relationships, loss of a loved one, perfectionistic personalities)
Rigorous work and/or home schedule
Over exercising (marathons, exercising without rest days)
Stimulants (caffeine, sugar)
Chronic physical illness
Lack of fun and excitement
What are the symptoms of cortisol dysregulation?
Symptoms of cortisol dysregulation will depend on whether you have high or low low cortisol levels. However, because cortisol fluctuates in a circadian rhythm, it is not uncommon to see a combination of both high and low cortisol symptoms.
Naturally we have the highest levels of cortisol in the morning, and throughout the day our levels will slowly decline, with cortisol being lowest at night. If we have low cortisol in the morning we’ll have problems waking and will generally feel sluggish. If we have high cortisol at night on the other hand, we may have problems falling or staying asleep.
How is cortisol dysregulation diagnosed?
In my practice, I listen to the symptoms and assess the lifestyle of my patients in order to determine whether or not they have a cortisol imbalance. In many cases I also order salivary or urine hormone testing to determine baseline levels of cortisol to fine-tune my treatment plan.
How is cortisol dysregulation treated?
The best way to treat cortisol imbalances is to address the underlying cause: STRESS. Examine your personal daily stressors, slow down, and take your health back into your own hands. If you suffer from cortisol dysregulation, the most important thing you can do is establish a routine. Below are some of my suggestions for establishing an adrenal friendly routine.
Go to bed at the same time every night, and get at least 8 hours of sleep.
Do something relaxing every day (deep breathing, warm bath, nature walk, yoga, meditation, massage, acupuncture, etc.)
Learn to say NO when you’ve reached your limit.
Eat protein with every meal.
Don’t over-exercise. If you feel fatigued, scale down the intensity, or take a day or two off to recover.
Avoid processed foods, simple carbohydrates (cookies, muffins, cakes, white bread, pasta) and sugar.
Decrease or eliminate caffeine.
Consider supplementation with adaptogenic and nervine herbal medicines.
Adaptogenic herbs help the body adapt and cope with stress. My favourite adaptogenic herbs are Licorice Root, Ginseng, Rhodiola, and Withania.
Nervine herbs help to bring your nervous system back into parasympathetic mode (ie. the ‘rest and digest’ response). Common nervine herbs are passionflower, skullcap, lavender, and oat straw.
References:
Edwards L et al. “ Hypocortisolism: An Evidence-Based Review.” Integrative Medicine, 10(4), 2011.
Oosterholt BG et al. “Burnout and cortisol: evidence for a lower cortisol awakening response in both clinical and non-clinical burnout.” J Psychosom Res, 78(5):445-51, 2015.
Head K et al. “Nutrients and Botanicals for Treatment of Stress: Adrenal Fatigue, Neurotransmitter Imbalance, Anxiety, and Restless Sleep.” Alternative Medicine Review, 14(2), 2009.
