Stress and Fatigue

Chronic Stress & Fatigue – Causes, Symptoms & Natural Treatment

Stress can come from events that cause feelings of frustration, anger, irritability, nervousness, tension, etc. Stress is a normal part of the adrenal fight-flight response, and in small doses is important in order to cope with challenges.

Stress causes a response in the sympathetic nervous system and adrenal glands. When the adrenal glands are functioning well, the body can cope with stress easily. Healthy stress responses are beneficial to mental and physical health.

However, in situations of severe or prolonged stress without adequate recovery, the stress response can predispose to neurological and physiological changes due to constant high cortisol levels, leading to chronic pathology such as neurological imbalances, insulin resistance, endocrine disturbances and immune suppression.

The general adaptation syndrome (GAS) was the first theory of stress developed by Hans Selye in 1935. He hypothesised three stages of the body‘s response to stress: alarm, resistance and exhaustion.

• Alarm stage: typical fight-flight response to the stressor, characterised by increased sympathetic nervous system activity which stimulates the adrenals to release cortisol and noradrenaline, and the thyroid to release thyroxine. This leads to heightened alertness, increased blood pressure, breathing and heart rate, while digestion, sleep and reproductive functions are suppressed.
• Resistance stage: in this stage, the body has adapted to the stressor and the symptoms of fight-flight are no longer readily apparent. However, cortisol and noradrenaline remain upregulated.
• Exhaustion stage: characterised by fatigue and inability to cope. Cortisol and noradrenaline have dropped to below normal levels. In Selye‘s experiments on rats, this stage was also characterised by enlarged adrenals, smaller lymph organs and gastric ulcers.

Physiology of Stress

Under normal circumstances, cortisol is highest in the morning and lowest in the evening. When cortisol levels are elevated, proteins and fats are mobilised to provide glucose for the fight-flight response. This leads to a hyperglycaemic state which can eventually lead to insulin resistance. High cortisol also decreases white blood cell counts, effectively dampening the immune response. It also negatively influences digestion, reproduction, growth and thyroid functions by inhibiting GnRH, LH, GH and TSH respectively.

Another hormone released by the adrenal cortex is aldosterone which retains sodium and water in the body, leading to fluid retention, increased blood volume and, hence, high blood pressure.

If stress becomes chronic or intense, or exceeds the individual‘s resources, it can eventually lead to generalised fatigue or adrenal exhaustion (Stage 3 of the GAS). This may be due to cortisol resistance, for instance the adrenals can still produce cortisol, but the cells are no longer capable of responding to it.

High circulating cortisol has been linked to many diseases, including anxiety, addictions, neurological disorders, recurrent infections, osteoporosis, insulin resistance, metabolic syndrome, loss of cognitive functioning, thyroid dysfunction and hormonal disturbances.

Prolonged exposure to stress can lead to lowered cortisol levels and hypoglycaemia, leading to sugar and carbohydrate cravings. This state of lowered adrenal function can also lead to fatigue, depression and an inability to cope with stressors.

Causes / Risk factors of Stress and Fatigue

Any of the following factors can activate the stress response in the body

• Psychological stress: life stress, trauma, worry, grief, traumatic experiences, etc
• Inflammation and immune activation (allergies, infection, autoimmunity)
• Toxicity: gut dysbiosis, heavy metal and environmental toxicity
• Methylation imbalances
• Food intolerances and allergy
• Nutritional deficiency
• Obesity
• Sedentary lifestyle or over-exercise
• Hormonal imbalances
• Deficient sleep or poor sleep quality
• Substance abuse

Signs and symptoms of Stress and Fatigue

• Mood changes: anxiety, worry, irritability, anger
• Fatigue
• Insomnia
• Muscle tension
• Headaches
• Palpitations
• Excessive sweating
• Digestive dysfunction e.g. IBS
• Poor immunity
• Insulin resistance

TREATMENT STRATEGY FOR STRESS & FATIGUE

• Address underlying causes
• Support nervous system
• Support adrenals
• Modify lifestyle factors

Diet Plan Guidelines that supports Stress and Fatigue

• Fresh, whole food, unrefined diet high in fresh fruit and vegetables, quality protein and healthy fats
• Regular, low GI meals that include healthy protein and fats in order to balance blood sugar levels
• Include complex carbohydrates to boost serotonin
• Include foods high in magnesium: green leafy vegetables, whole grains, nuts and seeds
• Include foods high in B-vitamins: nuts and seeds, chicken, seafood, eggs, green leafy vegetables, brewer‘s yeast
• Black tea can help with stress recovery– studies show that tea drinkers had lower levels of cortisol following stressful situations
• Avoid stimulants such as sugar, caffeine and alcohol

Supplements that support Stress & Fatigue

• Magnesium –  to calm sympathetic nervous system response and support energy production
• Active B-complex – to support healthy neurotransmitter production
• L-tryptophan – especially if associated with depression and/or insomnia
• Vitamin C – to support adrenal function; reduces adrenaline and cortisol production
• Tyrosine – especially if underactive thyroid or low dopamine, careful with this supplement as it can be too stimulating and cause an excess stress response if not indicated
• CoQ10 – needed for energy production
• Glutamine –  needed for GABA production
• Zinc – a cofactor for GABA production

Herbal Medicine Treatments that support stress and fatigue

• Nerve tonics – St John‘s wort, skullcap, bacopa, oats, gotu kola, vervain, chamomile, lemon balm
• Anti anxiety –  passionflower, valerian, kava, California poppy, lavender, zizyphus
• Adaptogens – withania, Siberian ginseng, rhodiola, astragalus, schisandra, shatavari
• Adrenal tonic (best suited to low circulating cortisol) – licorice, rehmannia.

Lifestyle / Physical measures

• Regular exercise – extremely important to cope with ongoing stress
• Meditation, relaxation, deep breathing
• Yoga, tai chi
• Assess work/life balance: take regular breaks, holidays, etc
• Express creativity
• Counselling to deal with external stressors

FUNCTIONAL MEDICINE TREATMENT OF STRESS AND FATIGUE

Stress and fatigue affect many people on a daily basis.  Life in general causes stress and fatigue, however certain individuals are more prone to the effects and cannot seem to cope with as much stress as other people.  Often stress and fatigue will become such an issue that they affect the ongoing quality of life of the individual.

Understanding the patients stress response and mechanisms at play that allow humans to deal with stress is vital in overcoming stress.  Often it is not practical to remove the stressor and as such, we need to be able to handle the stress, and our bodies need the tools to deal with the stress more efficiently. 

Adrenal fatigue, HPA axis dysregulation, methylation, neurotransmitter imbalances, gut dysbiosis, mineral and vitamin deficiencies are all common causes of a heightened stress response.

At our Perth clinic of Advanced Functional Medicine we are experienced with a dysregulated stress response and adrenal fatigue.  Balancing the chemistry of the body allows the a person to be able to deal with stress much more effectively.  

If you or a family member are struggling to cope with daily life and stress we would love to hear from you.  There may be underlying causes that are contributing to how you cope with the stress. 

Have you investigated how well your gut is functioning?  Are your neurotransmitters imbalanced?  Do you know if you have the MTHFR genetic variation?  What are your best stress coping strategies?  Please leave a comment below.

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