How To Relieve Burnout and Stress According to a Naturopathic Doctor
This blog has not been approved by your local health department and is not intended to provide diagnosis, treatment, or medical advice.
In this article:
- What Is Adrenal Fatigue?
- Diagnosing Adrenal Fatigue
- Adrenal Fatigue Treatment
- Nutrients That Influence the Stress Response
- Supplements for Adrenal Fatigue, Stress and Burnout
- Lifestyle Factors
In simple terms, adrenal fatigue is synonymous with burnout. Symptoms can include low energy, brain fog, and low mood.
Adrenal fatigue is thought to occur when the adrenal glands are under-functioning from excessive, chronic stress. The adrenal glands are walnut-sized glands that sit atop the kidneys. These glands are crucial for initiating the stress response, releasing hormones like cortisol, epinephrine, and norepinephrine.
It is well accepted that the adrenal glands can fail, often in response to severe emotional or physical stress. Adrenal failure or “Addison’s disease” is an accepted standard medical diagnosis. Adrenal fatigue, however, suggests that the adrenal glands can wear down and function suboptimally even without outright failure.
Arguments have been made both for and against adrenal fatigue due to the complexity of the stress response. Research showing changes in stress hormone levels in situations of chronic stress suggests that adrenal fatigue can occur. However, the complexity and variability of these changes can make assessment difficult, contributing to the controversy.
Healthcare professionals that believe in adrenal fatigue will use salivary cortisol testing—typically four samples collected during a single day—to assess adrenal function. However, standardization of these tests between labs is nonexistent, and day-to-day stressors can impact test results.
In cases of suspected adrenal fatigue, other conditions that can cause or contribute to similar symptoms, including hypothyroidism, nutrient deficiencies, auto-immune conditions, depression, insomnia, sleep apnea, and fibromyalgia should get ruled out.
Salivary testing is not necessarily definitive but can still yield interesting information. In general, someone struggling with adrenal fatigue has been under chronic high-stress levels, and other causes of their symptoms have been eliminated.
While adrenal fatigue is a controversial diagnosis, burnout is a well-recognized mental-emotional state, usually related to an individual’s occupation. Due to the limited acceptance of adrenal fatigue as a diagnosis, there is limited research on treatment.
However, research on the effects of nutrients and herbs that have beneficial effects on the stress response and stress-related functioning is more robust. When working with patients struggling with adrenal fatigue, lifestyle changes and nutrient support can improve stress resiliency, energy levels, and mood.
Several nutrients help balance cortisol levels and influence the stress response, including pantothenic acid, vitamin C, magnesium, and L-tyrosine.
Pantothenic acid, or vitamin B5, is a necessary cofactor for steroid hormone production. Deficiency leads to low cortisol, fatigue, increased pain, depression, and excess inflammation. Studies in humans have shown that pantothenic acid can support and increase steroid hormone production.
An old study in mice supplemented pantothenic acid found that lifespan increased by 19%. Due to its ability to support steroid hormones, including cortisol, pantothenic acid is often considered a critical nutrient for treating adrenal fatigue.
Generally, when supplementing any B vitamin the other B vitamins are included to help balance out support. The B vitamins work best combined in their active forms since they do not require additional biochemical changes to provide benefits.
Of all the organs in the human body, the adrenal glands contain some of the highest levels of vitamin C. To produce cortisol, epinephrine, and norepinephrine, the adrenal glands require the vitamin. Of note, in response to stress, the adrenal glands secrete vitamin C into the bloodstream. In addition, vitamin C helps moderate cortisol levels in response to stress. Typically, adding some additional vitamin C can help to support adrenal function.
Magnesium is an anti-stress mineral. When we are stressed, our need for magnesium increases. Unfortunately, when stressed, we retain less of the mineral. In cases of chronic stress, loss of magnesium can worsen the stress response. As such, maintaining adequate magnesium is crucial for stress resiliency.
Research has shown that in response to different stressors, magnesium helps reduce elevated cortisol. Since magnesium is so commonly deficient, it is often a crucial supplement to help with stress-induced illness.
L-tyrosine is an amino acid and constituent of protein that acts as a precursor for both neurotransmitters and thyroid hormones. It appears to increase or improve energy levels and mental performance under stressful situations. An older trial exposed individuals to cold stress and low oxygen and found improved mood and performance.
Several additional trials exposing individuals to cold temperatures found similar results. A separate trial in young adults also found improved cognitive performance and decreased blood pressure while taking tyrosine.
A study by the United States Navy found improved performance under conditions of work stress and sleep deprivation. A study on military cadets under a demanding combat training course also discovered improvements in performance with tyrosine supplementation.
While tyrosine can be helpful for acute stress, some research suggests that if taken continuously, the benefits of tyrosine start to fade after a few weeks. Tyrosine likely works best on an as-needed, short-term basis.
Ashwagandha is a classic Ayurvedic herb used for thousands of years to help tonify and support health. And more recently, the latest research has continued to support its historical use. A recent review concluded that “[ashwagandha] extracts exhibited noteworthy anti-stress and anti-anxiety activity in animal and human studies.” They also noted potential benefits for anxiety and depression.
Other research has found benefits in general for physical performance in both men and women. Ashwagandha also appears to have a consistent effect on lowering cortisol levels.
Another herb that has been well studied for supporting individuals under stress is rhodiola. The herb has a long history of use in Russia and Scandinavian countries to support energy and mood. Clinical trials of rhodiola have shown improved energy and mental performance in multitasking situations, along with reduced stress, anxiety, depression, and anger. Studies also support its use for improving mental performance for individuals with fatigue.
Schisandra is a tonifying Chinese herb that came under review for its clinical applications in Russia in the middle of the last century. Due to its benefits, the herb is included in the Russian National Pharmacopoeia and State Register of Drugs. Animal research found increased physical work performance while providing resistance to numerous physiological stressors. In humans, improved physical and mental performance were noted with moderating effects on stress hormone levels.
Ginseng is a classic Chinese herb for providing energy. Along with its long history of use, some of the latest research suggests benefits for stress, depression, and anxiety. A recent trial found improved stress responses for individuals under intense work stress with ginseng. Other research has found improved energy levels in patients with unexplained fatigue.
Any patient suffering from symptoms of adrenal fatigue also needs to reduce stressors in their daily life. Working nights or jobs with excessive travel to different time zones, in my experience, can strongly contribute to problems. High stress personal and work situations should also be reduced whenever possible. In addition, relaxation strategies and exercise are crucial for helping improve adrenal fatigue.
As with most health conditions, dietary factors are also important. In general, individuals should move towards reducing or eliminating processed foods and refined carbohydrates. Consuming quality protein and fat with complex carbohydrates is helpful. It is also important to get plenty of antioxidants from fruits and vegetables. Berries, in particular, have standout benefits.
Normalizing the sleep schedule is also key. Melatonin is a simple strategy to improve sleep quality or to help shift sleep schedules back to a more normal timeframe when needed.
While adrenal fatigue is a controversial diagnosis, there is no shortage of patients struggling with unexplained fatigue, burnout, depression, and anxiety. Researched strategies aimed at improving the stress response can be helpful for these individuals. Considering the safety of the included supplements, when used properly, the benefits for treating adrenal fatigue likely outweigh any concerns over the controversy for the diagnosis.
- Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review [published correction appears in BMC Endocr Disord. 2016 Nov 16;16(1):63]. BMC Endocr Disord. 2016;16(1):48. Published 2016 Aug 24. doi:10.1186/s12902-016-0128-4
- Wilson JL. Clinical perspectives on stress, cortisol and adrenal fatigue. Adv Integr Med. 2014;1(2):93-96. doi:10.1016/j.aimed.2014.05.002
- World Health Organization. Burn-out an "occupational phenomenon": International Classification of Diseases. who.int. Published May 28, 2019. Accessed August 12, 2021. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases.
- Gheita AA, Gheita TA, Kenawy SA. The potential role of B5: A stitch in time and switch in cytokine. Phytother Res. 2020;34(2):306-314. doi:10.1002/ptr.6537
- Fidanaza A, Floridi S, Lenti L. Panthenol and glucocorticoids. Boll Soc Ital Biol Sper. 1981;57(18):1869-1872.
- Pelton RB, Williams RJ. Effect of pantothenic acid on the longevity of mice. Proc Soc Exp Biol Med. 1958;99(3):632-633. doi:10.3181/00379727-99-24442
- Patak P, Willenberg HS, Bornstein SR. Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocr Res. 2004;30(4):871-875. doi:10.1081/erc-200044126
- Padayatty SJ, Doppman JL, Chang R, et al. Human adrenal glands secrete vitamin C in response to adrenocorticotrophic hormone. Am J Clin Nutr. 2007;86(1):145-149. doi:10.1093/ajcn/86.1.145
- Carrillo AE, Murphy RJ, Cheung SS. Vitamin C supplementation and salivary immune function following exercise-heat stress. Int J Sports Physiol Perform. 2008;3(4):516-530. doi:10.1123/ijspp.3.4.516
- Nakhostin-Roohi B, Babaei P, Rahmani-Nia F, Bohlooli S. Effect of vitamin C supplementation on lipid peroxidation, muscle damage and inflammation after 30-min exercise at 75% VO2max. J Sports Med Phys Fitness. 2008;48(2):217-224.
- Brody S, Preut R, Schommer K, Schürmeyer TH. A randomized controlled trial of high dose ascorbic acid for reduction of blood pressure, cortisol, and subjective responses to psychological stress. Psychopharmacology (Berl). 2002;159(3):319-324. doi:10.1007/s00213-001-0929-6
- Kim HY, Lee SY, Lee HS, Jun BK, Choi JB, Kim JE. Beneficial Effects of Intravenous Magnesium Administration During Robotic Radical Prostatectomy: A Randomized Controlled Trial. Adv Ther. 2021;38(3):1701-1712. doi:10.1007/s12325-021-01643-8
- Golf SW, Bender S, Grüttner J. On the significance of magnesium in extreme physical stress. Cardiovasc Drugs Ther. 1998;12 Suppl 2:197-202. doi:10.1023/a:1007708918683
- Pickering G, Mazur A, Trousselard M, et al. Magnesium Status and Stress: The Vicious Circle Concept Revisited. Nutrients. 2020;12(12):3672. Published 2020 Nov 28. doi:10.3390/nu12123672
- Banderet LE, Lieberman HR. Treatment with tyrosine, a neurotransmitter precursor, reduces environmental stress in humans. Brain Res Bull. 1989;22(4):759-762. doi:10.1016/0361-9230(89)90096-8
- Deijen JB, Orlebeke JF. Effect of tyrosine on cognitive function and blood pressure under stress. Brain Res Bull. 1994;33(3):319-323. doi:10.1016/0361-9230(94)90200-3
- Neri DF, Wiegmann D, Stanny RR, Shappell SA, McCardie A, McKay DL. The effects of tyrosine on cognitive performance during extended wakefulness. Aviat Space Environ Med. 1995;66(4):313-319.
- Deijen JB, Wientjes CJ, Vullinghs HF, Cloin PA, Langefeld JJ. Tyrosine improves cognitive performance and reduces blood pressure in cadets after one week of a combat training course. Brain Res Bull. 1999;48(2):203-209. doi:10.1016/s0361-9230(98)00163-4
- Mahoney CR, Castellani J, Kramer FM, Young A, Lieberman HR. Tyrosine supplementation mitigates working memory decrements during cold exposure. Physiol Behav. 2007;92(4):575-582. doi:10.1016/j.physbeh.2007.05.003
- Kishore K, Ray K, Anand JP, Thakur L, Kumar S, Panjwani U. Tyrosine ameliorates heat induced delay in event related potential P300 and contingent negative variation. Brain Cogn. 2013;83(3):324-329. doi:10.1016/j.bandc.2013.09.005
- Reimherr FW, Wender PH, Wood DR, Ward M. An open trial of L-tyrosine in the treatment of attention deficit disorder, residual type. Am J Psychiatry. 1987;144(8):1071-1073. doi:10.1176/ajp.144.8.1071
- Speers AB, Cabey KA, Soumyanath A, Wright KM. Effects of Withania somnifera (Ashwagandha) on Stress and the Stress-Related Neuropsychiatric Disorders Anxiety, Depression, and Insomnia [published online ahead of print, 2021 Jul 12]. Curr Neuropharmacol. 2021;10.2174/1570159X19666210712151556. doi:10.2174/1570159X19666210712151556
- Bonilla DA, Moreno Y, Gho C, Petro JL, Odriozola-Martínez A, Kreider RB. Effects of Ashwagandha (Withania somnifera) on Physical Performance: Systematic Review and Bayesian Meta-Analysis. J Funct Morphol Kinesiol. 2021;6(1):20. Published 2021 Feb 11. doi:10.3390/jfmk6010020
- Lopresti AL, Smith SJ, Drummond PD. Modulation of the hypothalamic-pituitary-adrenal (HPA) axis by plants and phytonutrients: a systematic review of human trials [published online ahead of print, 2021 Mar 2]. Nutr Neurosci. 2021;1-27. doi:10.1080/1028415X.2021.1892253
- Anghelescu IG, Edwards D, Seifritz E, Kasper S. Stress management and the role of Rhodiola rosea: a review. Int J Psychiatry Clin Pract. 2018;22(4):242-252. doi:10.1080/13651501.2017.1417442
- Panossian A, Wikman G. Pharmacology of Schisandra chinensis Bail.: an overview of Russian research and uses in medicine. J Ethnopharmacol. 2008;118(2):183-212. doi:10.1016/j.jep.2008.04.020
- Panossian A, Wikman G. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Curr Clin Pharmacol. 2009;4(3):198-219. doi:10.2174/157488409789375311
- Jeong HG, Ko YH, Oh SY, Han C, Kim T, Joe SH. Effect of Korean Red Ginseng as an adjuvant treatment for women with residual symptoms of major depression. Asia Pac Psychiatry. 2015;7(3):330-336. doi:10.1111/appy.12169
- Flanagan SD, DuPont WH, Caldwell LK, et al. The Effects of a Korean Ginseng, GINST15, on Hypo-Pituitary-Adrenal and Oxidative Activity Induced by Intense Work Stress. J Med Food. 2018;21(1):104-112. doi:10.1089/jmf.2017.0071
- Kim HG, Cho JH, Yoo SR, et al. Antifatigue effects of Panax ginseng C.A. Meyer: a randomised, double-blind, placebo-controlled trial. PLoS One. 2013;8(4):e61271. Published 2013 Apr 17. doi:10.1371/journal.pone.0061271