This blog post is a loose transcription of the interview with Parent Talk Podcast in June, 2018. This article was written by Dr. Mahannah and originally published by the Parent Talk Podcast website. To listen to the podcast interview, click here (Episode 24: Treating Stress and Burnout with Natural Medicine).

Many of us already know about the detrimental effects of stress on the body. More and more research is pointing towards stress as an underlying factor in a range of conditions from depression, to heart disease, to infectious disease. Many patients in my naturopathic practice report that stress is having a moderate to significant impact on their health, and are looking for natural ways to enhance their resilience to stress.

There are 3 hormones or neurotransmitters that are primarily involved in the stress response: cortisol, epinephrine and norepinephrine (also known as adrenaline). These are produced by our adrenal glands, which are tiny little glands that sit on top of the kidneys. Cortisol is an important hormone that is involved in our circadian rhythm (our daily sleep/wake cycle). Cortisol levels are normally highest first thing in the morning between 6am-7am; this should help us pop out of bed to start our day. Cortisol then declines slowly throughout the day, and should be nice and low at nighttime, which allows us to feel tired, calm, and fall asleep easily, without too much tossing and turning at night.

Of course, cortisol and adrenaline can spike throughout the day in response to stressful events. When we are posed with a stressful situation, for example, if we take the garbage out and see a mountain lion on our driveway, our bodies immediately go into “fight or flight” mode. Breathing rate increases, heart rate increases, we sweat a little bit, glucose is released into our blood stream to provide energy for our muscles, pupils dilate, and blood is shunted to the muscles so we can run away. Something else also happens during these moments: the organs are that are not immediately vital to our survival, like our digestive system or reproductive system, are ‘put on hold.’ By that I mean, blood is shunted away from these organs towards those that are most important for our immediate survival: heart, lungs, and muscles.

This is the immediate and fast-acting stress response. However, in this day and age, we aren’t fighting or fleeing from mountain lions daily (hopefully!) We are, however, bombarded by small or large stressors very regularly – daily, if not hourly. Work stress, taking care of the kids, relationship stress, emotional or physical trauma, perhaps larger life events like a divorce, loss of a family member, or caretaking for ill parents are just a few examples of stressors that patients report. These kinds of events can also trigger that stress response I previously described. Sometimes we get stuck in the ‘stress mode’, which over the long term takes a toll on our health. We are seeing more and more studies linking stress to heart disease, autoimmune disease, and high blood pressure, among many other health concerns.

It’s normal to have a stress response, and in fact it is healthy – but problems arise when it becomes chronic and we start having symptoms of what in naturopathic medicine we call “adrenal fatigue” or more correctly, “adrenal dysregulation,” or to use another common term, “burnout”.

What exactly is ‘adrenal dysregulation” and what are the symptoms?

Symptoms can vary from person to person depending on how long their stressors have been going on for. Symptoms may include:

• Low energy. One clue is your energy levels. If you wake up feeling exhausted, you have to drag yourself out of bed, and it takes a venti-sized coffee to wake you up… that might be a sign that your cortisol is abnormally low in the morning. Another clue is how you feel at bedtime. Some people find that they are exhausted all day long, but suddenly at 10pm, they are wide awake and can’t fall asleep until 2am. Some people feel tired and want to go to bed, but their mind is buzzing and won’t shut off.
• Cravings for salt and sugar. When our adrenals are ‘fatigued’, so to speak, or we’ve been on high alert for a long time, we may crave salt or sugar (or both) to help support the stress response and provide energy for the body.
• Anxiety. Feeling anxious, heart palpitations, being sensitive to stressors, feeling like you overreact to things that normally wouldn’t bother you, or that you just can’t handle daily stressors like you used to.
• Other symptoms: difficulty losing weight, carrying excess weight around the midsection, high blood pressure (or in more progressed cases, low blood pressure), blood sugar problems or feeling “hangry”.

Is there a test you can do to check your cortisol levels?

Yes. It is important to distinguish the use of medical testing for cortisol-related diseases, versus functional testing for cortisol ‘dysfunction’. The most extreme case of adrenal insufficiency is a rare condition called Addison Disease. This would present as extreme weakness, low blood pressure, dizziness, weight loss, and darkening of the skin. This is identified on blood tests, sometimes after being hospitalized. In contrast, mild to moderate cortisol dysregulation is quite common and can be identified using functional testing on a 4-point salivary cortisol curve. This involves taking a saliva sample 4 different times throughout the day. The lab maps out how high or low your cortisol is, compared to a normal range. Depending on how your cortisol curve looks, it can help explain the symptoms you’re experiencing and guide a naturopathic treatment plan.

What can you do to manage symptoms of stress?

First, it is important to examine your stressors in the context of your life. Are some of the stressors modifiable? Can you delegate certain tasks? Can you ask for help? Of course a self-care routine, outlets for stress reduction are important components of treatment plants I discuss with patients.

Exercise is excellent for stress management, as is getting outside into nature. Studies show that walking in forests can reduce cortisol and blood pressure. I suggest low impact, low intensity exercise such as gentle walks, yin yoga, or meditation. Heavy exercise actually increases cortisol. For those who are doing intense workouts, aim to do them in the morning when cortisol is peaking, or should be peaking, rather than at night when your body wants to wind down and relax.

Sleep is another very important factor. Having a relaxing nighttime routine to help promote health melatonin secretion is important. I often advise patients to keep cell phones and TV’s out of the bedroom, and to read a book instead of watch TV before bed.

Are there foods you should focus on when you’re feeling stressed and burnt out?

There are certainly dietary recommendations that I provide patients with to help support their resilience to stress. Some of those tips include:

• Make sure you are actually eating – don’t forget to eat or skip meals.
• Start with a good quality breakfast, containing protein and healthy fat, every day.
• Pay attention to HOW are you eating. Sit, relax, chew thoroughly. If you are at work, take a proper lunch break to go eat somewhere away from your desk.
• Choose whole foods and avoid processed packaged foods as much as possible.
• Get your green leafy vegetables in! Try adding a daily green smoothie to the routine. I suggest a green smoothie with a protein powder – easy to make, quick, easy to digest.
• Avoid white refined flour, white baked goods, sugary treats – instead have a piece of good quality dark chocolate, paired with a little bit of protein (handful of almonds), or have a protein paired with a carbohydrate.
• Stay hydrated. Aim for 2L water per day. Our adrenal glands regulate electrolytes, so add a little bit of Himalayan sea salt, lemon juice or electrolyte powder to your water.
• Reduce caffeine. Don’t drink caffeine after 2-3pm; choose herbal teas instead.
• Get meal prep help. If time is a restriction for you, save time by utilizing Spud delivery or other grocery store delivery services, or use a food prep company like Hello Fresh. Alternatively, get in the habit of doing a big batch cook at the beginning of the week and popping meals in to the freezer.

What supplements or herbs could you use to help manage stress?

There are many options, and I recommend speaking with a Naturopathic Doctor to get the best recommendations given the symptoms you’re experiencing.

For sleep: If you sleep is affected, I sometimes suggest some nighttime nutrients or herbs to help calm the mind, relax the body, and improve your sleep. Magnesium, phosphotydylserine, L-theanine, melatonin, or calming herbs like lavender, passionflower, or even more sedating herbs like valerian or kava. Herbs can be taken in the form of a tea, or in a tablet.

Specific vitamins and minerals: Other important nutrients that help your adrenal glands and support your energy are the B vitamins, vitamin C, and magnesium, which can be taken during the day.

Herbal energy support: If a patient is struggling with low energy, I turn to a family of herbs called “adaptogens.” These are herbs that help us ‘adapt’ to stress, and enhance our resiliency to stress. They help improve mood, reduce anxiety, improve focus and concentration, and support sleep. Some of my favourite adaptogenic herbs are ashwaganda, rhodiola, or ginseng.

Ashwaganda (Withania somnifera). Good for people who feel tired but wired, feel anxious, struggling with poor memory or brain fog.

Eleuthero (Eleutherococcus senticosus) = slightly stimulating, for people struggling with brain fog or interrupted sleep.

Maca (Lepidium peruvianum) = nourishing herb, for moody, low libido and hormone imbalance.

Rhodiola (Rhosiola rosea) = for low energy, anxiety, brain fog, burn out.

Licorice (Glycyrrhiza glabra) = a good herb for people who have been stressed for a long time and who have low blood pressure, and feel faint or dizzy when they stand up. Because it can increase you blood pressure, those who have hypertension or high blood pressure should choose a different herb.

Overall, stress is something that we all experience, and depending on your health, coping skills, and life circumstances, utilizing natural medicine to help support your resilience to stress is a safe and effective way to feel better.