Functional Medicine and Burn Out
You have probably experienced the thrill of a good burst of Adrenaline.
That is Adrenaline’s job – to burst you out of a dangerous situation or boost you towards your next adventure.
The downside of too many hours, days, and months of running on Adrenaline is that it uses up many of your essential bank accounts.
The word Adrenaline, in day-to-day conversations, refers to your overall adaptive response to intense change – be it short term or long-term. This includes other stress hormones like cortisol, and over time, all of your other hormones. This creates imbalances in your neurotransmitters and weakens and/or irritates your immune system.
This conversation usually turns into a lecture on Adrenal Fatigue, but instead, I want to bring your attention to the very common-sense relationship of adaptability and becoming tissue catabolic – or in biochemical over-draft.
Adaptability is your most important ally and your most precious bank account in terms of how you experience health and how you feel about yourself in the world. The image below shows a graph of how your body adapts to chronic stress.
The Four Stages of Adaptive Overload
When you first get into a stressful situation, your body goes into a state of Adaptive Arousal (Stage I). If the situation doesn’t improve over time, perhaps a few months, you will shift into the state of Adaptive Overstrain (Stage II). Clinically, the term overstrain implies using a muscle, a hormone, or another part of your body until it is strained or hurt. If you use that part of your body again, before it has time to completely restore itself to health, you will have an overstrain. The graph above shows how your ability to produce cortisol will continue to increase until you run out of the ability to make more. All of the stress and neurological chaos are still happening, your body is just unable to keep making enough.
This chronic state of futile over signalling with inner alarm bells is what causes or, at least accelerates most chronic illness and decelerates wound healing.
If the stressful situation continues for a year or two, you will shift into the state called Adaptive Resistance (Stage III). This is where your deepest survival instincts start rearranging how your body works in some subtle ways to keep you going. Imagine bank robbers running around your body, stealing from one place to solve the next emergency. This can go on for fifteen years!
Just to make sure I am communicating this clearly, imagine living in a city with line-ups for food, alarm bells going off randomly 24/7, the banks keep going bankrupt, calling an ambulance or a fire truck doesn’t always work out well, and the bridges are falling apart – for 15 years.
Imagery helps sometimes. It brings empathy.
If you are still swinging for the fences after fifteen years you will eventually enter a state called Adaptive Exhaustion (Stage IV). This is usually when people are diagnosed with Chronic Fatigue Syndrome, Fibromyalgia, degenerative neurological conditions like Parkinson’s and MS. These conditions can arise for other reasons as well, but most of my patients with these conditions can describe each of these four stages of Adaptive Overload over the last decade or so.
In the later part of Stage Two and throughout Stage Three your lab tests would begin to show a very specific imbalance between Cortisol and DHEA. I think of Cortisol as the gas and DHEA as the oil. DHEA is a hormone that helps your body grow and repair itself – it handles the friction.
When Cortisol is higher than normal (or tries to be) for a long time, it starts to draw on the bank account that supplies all of your other sex hormones, stress hormones and DHEA. Over time, your lab tests would show consistently high Cortisol and gradually diminishing DHEA. At a certain point, your body becomes so catabolic that you may start losing muscle mass. If this ratio gets bad enough, I send people to the hospital.
Quick Aside: 200 years ago, the worst chronic illness you could get was called Consumption.
After years and years of going in and out of being Catabolic, your Cortisol will ‘gas out’, or become unsustainable. This is the classic Adrenal Fatigue experience. As your body passes its Adaptive Capacity and you become unable to keep going, your body shifts into a self-induced Winter – or time of hibernation.
This is where things get precarious for a while. I want to see their Cortisol and DHEA come back up slowly and together. Sometimes, especially with people who have experienced trauma, their Cortisol comes back a lot faster than their DHEA. This means that they are going to become Catabolic again, lose more muscle mass and do more damage to every Adaptive Resource that they have left.
If you want to learn more about how all of this works, I put a couple of videos on my old youtube channel that covers the essential Physiology.