Stress, Cortisol and Burnout in the Era of COVID

Show of hands: how many of you have felt like there’s been a lot of “stress” in the last year? 

Over the last 8 months I’ve noticed a disturbing trend in my practice. Consistently more patients are coming in to their visits with concerns about stress, excessive fatigue, anxiety, disrupted sleep, hair loss, worsening chronic pain and female hormonal imbalance. 

To many people these concerns might seem unrelated. But to the trained eye they are clearly related to one thing: cortisol. 

To dive slightly deeper, those symptoms are related to the adrenal glands, which produce cortisol, and the HPA Axis, which governs how much cortisol the adrenal glands produce. 

Cortisol: The Goldilocks Hormones

Cortisol is a tricky hormone. Too abundant, and it’s deadly. Too little, and it’s also deadly. 

When it’s in balanced, cortisol has these critical functions in your body: 

• Acts as an anti-inflammatory to counter allergies, immune activation and pain

• Provides stress resistance 

• Promotes burning body fat 

• Maintains mood and emotional stability 

• Provides a boost of energy upon waking in the morning 

But when it’s out of balance cortisol can: 

• Increase blood sugar and insulin resistance 

• Break down muscle and promotes fat deposition 

• Slow digestion 

• Shut down the immune system 

• Increase sodium retention leading to high blood pressure 

• Alter thyroid function

• Disrupt the sleep cycle 

• Deplete your body of essential vitamins and minerals 

• Deplete testosterone, estrogen and progesterone 

• Disrupt the female menstrual cycle 

So what causes cortisol, or more accurately the HPA Axis, to become out of balance? 

In short: stress. 

How Stress Leads to Burnout

Your body interprets stress in many different forms. Of course there are the mental and emotional kinds of stress, but there’s also pain, inflammatory foods, infections, nutritional deficiencies, overtraining, blood sugar swings, poor sleep, etc. The uncertainty of the past year combined with major disruption of everyday life and lack of much-needed human connection was enough to push anyone’s stress levels to the maximum. 

Your body can adapt to stress for a while, but after a period of time, chronic stress leads to “burnout”.

Burnout really means that your HPA Axis can no longer adapt to the high stress load and has become dysfunctional. This is called HPA Axis Dysfunction. In my office, I stage the level of dysfunction from grades 1-3 based on the ability of your adrenal glands to produce cortisol and another hormone DHEA. 

I have a theory that we are only seeing the beginning of some very real physical impacts of the stress experienced during the COVID era. And that those impacts are going to first manifest themselves as HPA Axis dysfunction. 

Could I Be Experiencing Burnout? 

These are some of the warning signs that your HPA Axis might be in need of some TLC:

• Interrupted sleep or changes in your sleep habits 

• Weight gain that doesn't respond to diet and exercise, especially around the abdomen 

• Low energy, particularly when waking up in the morning 

• Getting a “second wind” after 8pm that keeps you up

• Worsening depression or anxiety 

• Getting dizzy when you stand up

• Cravings for salt and sugar 

• Difficulty focusing 

• Feeling “hangry” or other signs of low blood sugar 

Thankfully, it’s simple to test for and treat HPA Axis Dysfunction. Cortisol and DHEA, the two hormones that are produced by the adrenal glands, can be easily tested by saliva. I use this test to stage the level of HPA Axis Dysfunction and developed an individualized treatment protocol. Treatment usually lasts between 3-6 months, with 12 months being the absolute maximum. 

Think “Burnout” might be at the root of your health concerns? 

If you are ready to get to the root cause of your stress concerns, reach out to the EmpowerMed team of naturopathic doctors today. We take a collaborative approach to natural medicine, partnering with patients to help them achieve their unique health and wellness goals.

Contact us today at 760-456-7501 or use our booking link to schedule.

EmpowerMed Clinic is located just off the I-15 and Carroll Canyon within the Fitness Quest 10 Wellness Center of Scripps Ranch, San Diego County, CA. We serve the communities of North County San Diego, Poway, Rancho Bernardo, 4S Ranch, Mira Mesa, Ramona, Scripps Ranch, Santee, and more.