Oct
03
2015

What Stress Does

I like to discuss what stress does. We all are stressed out at times. Some people are stressed all the time and this is called chronic stress.

Acute stress

Let’s say you were in a minor rear-ender accident. It is annoying, but at least you had no injury. But you have to deal with the insurance company, get the repair done and maybe get a car rental during the time of repair. Yes, you may have a few days where you feel that your hands are shaky and your heart pounds, or your sleep may not be restful. But when everything is done things are back to normal. This is an example of acute stress with a shorter running time. It has a limited severity, is an inconvenience, but it does not really affect your body on the long-term.

Chronic stress

Let’s assume the car accident was more severe and you received a personal injury with a broken leg. You end up in hospital and the orthopedic surgeon fixes the fracture with a surgical plate. The leg has to be in a cast for several weeks, and you have to use crutches. Every day you feel reminded of the car accident, because it is awkward to walk with crutches. After weeks you notice that you have gained weight. Your doctor is also worried about you because your blood pressure showed higher readings. You do not sleep as well, waking up frequently and having nightmares about another fictitious accident. On top of that you came down with the flu. What happened here? The stress reaction released cortisol, which weakened your immune system and may be responsible for catching the flu.

High blood pressure and increased alcohol consumption

On the long-term cortisol can also contribute to high blood pressure, but so can alcohol consumption. You may have increased your alcohol intake in the evening to relax more, but with the chronic stress and the cortisol increase this can cause high blood pressure. The weight gain that you noticed has to do with the fact that you cannot work out any more because of your healing leg fracture and you having to use crutches. Inadvertently you may also eat a bit more rich food; a lot of people do that as food can be used as comfort food.

Disbalance of melatonin and cortisol with stress

And why do you sleep less well? Chronic cortisol elevation leads to lower melatonin levels, as these two hormones are natural opponents. A high melatonin level leads to a low cortisol level and vice versa. With relaxation methods you can lower cortisol and the melatonin level increases normalizing your sleep. Chronically elevated cortisol can also lead to weight gain as sugar is converted into fatty acids that are stored as subcutaneous fat. Muscles can melt down when cortisol is high giving the appearance of spindly arms and legs.

Causes of chronic stress

Holmes and Rahe tested a stress scale in 1970, which has become the standard ever since. You get a certain amount of points for a stressful event, e.g. 100 for the death of a spouse; 45 point for retirement; 23 for trouble with the boss etc. Add up all of the points that are affect you right now; if the total score is less than 150 points there is only a minor risk of getting medical problems from the chronic stress; for 150 to 299 points the risk of illness is moderate and for 300 and more points you are at a significant risk for illness.

Physical illness and mental illness from stress

There is physical illness and mental illness that chronic stress can cause. Physical illness can be high blood pressure, hardening of the arteries. The long-term risks from this are possible heart attacks and strokes. But chronic adrenalin and noradrenalin elevation associated with chronic stress can burn part of your brain cells in the hippocampus and medial prefrontal cortex. This can lead to memory loss, spatial memory loss and aggression. Mental illness caused by chronic stress can be anxiety, depression, social isolation, panic attacks and panic disorder. Psychosomatic symptoms can include headaches, back pain, abdominal pain and difficulties concentrating.

Job stress and cancer

Perhaps one of the best examples of job stress and cancer is a study where the amount of breast cancer was correlated to the amount of stress. I discussed this in another blog. Briefly, women with a less responsibility had the lowest rate of breast cancer, but they too had some stress as there was a higher breast cancer risk after 15 years on the job versus only 5 years on the job. The same study showed that women with high responsibility had the highest breast cancer rates.

How stress leads to higher breast cancer rates

A hormone disbalance can explain this based on high cortisol levels associated with chronic stress. If cortisol is high, the cortisol binding globulin (CBG) increases; this in turn also binds more circulating progesterone, as progesterone attaches to CBG. CBG is a transport protein for both cortisol and progesterone. The end result is that estrogenic compounds get the upper hand, a condition called estrogen dominance. I have explained under the above link that this was the real reason for the increase in breast cancer in the stressed women. Similar mechanisms are causing other cancers to occur more frequently with chronic stress.

Chronic stress and cardiovascular disease

High stress jobs were found to cause a 2.2 to 2.4-fold increase of strokes and heart attacks due to cardiovascular disease when compared to low stress jobs. This was based on a British Medical Journal study in October 2002. As I discussed above under a brief description of chronic stress cardiovascular disease is often what develops as part of chronic stress. People who are under chronic stress feel that they do not have enough time to prepare good, healthy food at home. They tend to eat out more often. Even well educated people just swallow a quick hamburger and other processed foods.

Bad fats lead to heart attacks and stroke

This increases the bad fats like trans fats and omega-6 fatty acids in their system causing inflammation of the blood vessels as explained in this blog. The LDL cholesterol and triglycerides get elevated, sugar from sugary snacks oxidizes the LDL cholesterol and your coronary arteries and brain arteries get clogged up. This sets anybody on the downward pathway, and it is now only a matter of time when the chronically stressed person will develop a heart attack or stroke.

Chronic stress extremes: PTSD and burnout in soldiers

Dr. Thierry Hertoghe gave a lecture during the 22nd Annual World Congress on Anti-Aging Medicine in Las Vegas (Dec.10 to 14, 2014). The title was: “Burnout: A multiple hormone deficiency syndrome”. Burnout is the extreme of chronic stress. He said that burnout is a common condition where several hormones are affected, with the cortisol axis being the main one, but other hormone glands being stressed as well. As a result endocrine glands age prematurely. Symptoms are fatigue, exhaustion, gastrointestinal problems, anxiety, depression and aggressiveness. The underlying hormone abnormalities are a lack of cortisol, thyroid deficiency, growth hormone deficiency, testosterone and estrogen deficiency and oxytocin deficiency. Burnout is common in teachers and there is a questionnaire that has been developed for teachers (teacher’s burnout scale) to monitor them whether they are heading this way.

Burnout or PTSD

Soldiers who return from combative situations often suffer from burnout or from PTSD. The teacher’s burnout scale already mentioned can monitor their burnout severity. In suspected cases laboratory tests that measure hormone levels give concrete answers about hormone deficiencies. Treatment protocols were discussed in detail. Multiple bioidentical hormone replacements are necessary, possibly for prolonged periods, if not life long. In addition supportive counseling sessions from a counselor or psychiatrist will help to tone down increased brain activity and help regain the internal balance. Why is this important? It is important, because hormones are necessary on a cellular level and regulate the energy metabolism of every cell in the body. Also, by recognizing what is going on and helping the affected individuals, a lot of pain and suffering can be prevented.

Accelerated aging from telomere shortening

Chronic stress has been shown to cause telomere shortening. So does a lack of sleep (insomnia), smoking and alcohol overconsumption, all conditions that can be associated with chronic stress. What can we do about this? Learn what shortens telomeres and ultimately your life. Cut out what you can and take supplements that lengthen your telomeres.

Positive thinking combats stress

Negative thoughts are draining you of energy. You want to stay optimistic within what’s reasonable. Be thankful for all the good things in your life. Minimize what’s negative, but think about positive solutions to get rid of energy draining parts in your days. Do this persistently until it becomes part of your life and you will have extra energy that you didn’t waste in negative thinking or needless, anxious anxiety. Worrying does not get us anywhere, but it depletes our energy.

Relaxation methods counter stress

Self-hypnosis is a simple way to allow your whole body to relax. However, the various forms of yoga will do the same thing for you. Meditation is another way of finding peace and tranquility. Prayer is know to help people in sickness and in health. All of these methods will re-energize you. They calm your brain, help you to cope with stress and rebalance your hormones at the same time.

Building social ties and mutually supportive relationships will also build you up. It makes you feel that you belong, you have your place in society, you help others, and they support you.

Constant overdrive has physical consequences

We need some stress to get us going, but we do not need “distress”. Dr. Hans Selye, the father of the general adaptation syndrome due to stress, gave a lecture about this topic in Hamilton, Ont. in 1977, which I attended. I vividly remember how he projected a picture of his skeleton showing bilateral hip replacements. He said that chronic stress could lead to arthritis. In his case, he said, he had developed end stage arthritis in his hips requiring total hip replacements on both sides. To illustrate further that stress leads to physical consequences, he explained that one person may develop a heart attack, another a stroke, a third could get arthritis. Constant overdrive has physical consequences.

What Stress Does

What Stress Does

Conclusion

Stress can be deadly, particularly if it lingers on and becomes chronic. But we can reorganize our lives to minimize stress. Some people may decide to seek a less stressful occupation. Others may elect to stay at that job, but develop hobbies, learn how to relax and take relaxation classes to combat job stress. The key is to start thinking about what stress you may be under and then develop a plan to counter it so you can allow yourself to rebalance your life.

Feb
20
2015

Hormone Changes With Burnout

At the 22nd Annual A4M Las Vegas Conference in mid December 2014 Dr. Thierry Hertoghe, an endocrinologist from Belgium gave a lecture on “Burnout: A multiple hormone deficiency syndrome”, in short: hormone changes with burnout. I have heard him speak on several congresses before. He is always very thorough and extremely knowledgeable. I decided to use this topic as a separate blog.

He said that burnout is common in teachers, soldiers, emergency room physicians (who have to deal with life and death situations) and firefighters. In essence they burn out their hormones. In burnout several hormones are affected, with the cortisol axis being the main one (low cortisol readings and flattening of the diurnal hormone curve), but at the same time other hormone glands are affected as well. As a result endocrine glands age prematurely and symptoms of fatigue, exhaustion, gastrointestinal problems, anxiety, depression and aggressiveness develop.

When hormone levels are measured, there is a lack of cortisol, thyroid deficiency, growth hormone deficiency, testosterone/estrogen and progesterone deficiency and oxytocin deficiency. Holocaust survivors were found to have lower 24 hour cortisol levels. With burnout already the morning output of the adrenal glands is reduced. The health care provider must check prolactin levels, because if prolactin is not high, cortisol will work; however, if prolactin levels are high, cortisol will be ineffective and high prolactin levels have to be addressed first. There is a questionnaire that has been originally developed for teachers (teacher’s burnout scale) to monitor whether burnout is imminent. Soldiers who return from combative situations will also benefit from being assessed with the teacher’s burnout scale; they often suffer from burnout or from PTSD. In suspected cases hormone laboratory tests give concrete answers about hormone deficiencies.

In men growth hormone, melatonin, thyroid, testosterone, cortisol, DHEA and aldosterone have to be replaced to bring the hormone balance back to normal. Instead of aldosterone (a adrenal gland hormone) fludrocortisone is used. In women missing hormones are replaced by bioidentical progesterone and estradiol, but small doses of testosterone are also required.

Dr. Hertoghe discussed cortisol deficiency and its replacement at some length, as this is the main stress hormone that is deficient with burnout. Different treatment protocols for cortisol replacement are used as dosing varies for different degrees of burnout. Other hormones must also be replaced as necessary, possibly for a prolonged period of time, if not life long. Supportive counseling sessions have been shown to elevate cortisol levels and several studies were discussed. A counsellor or psychiatrist will help to tone down increased brain activity and help regain the internal balance. Balanced hormones are necessary on a cellular level to regulate the metabolism of every cell in the body.

Hormone balance and symptoms of various deficiencies

Cortisol is placed on one side of the scales and is balanced by androgens (DHEA), estrogens in women and testosterone in men, growth hormone and melatonin on the other side of the scales. When fainting is part of the burnout, it is because of extremely low aldosterone from the adrenal glands. The best treatment for this is fludrocortisone, which will bring the blood pressure up and remove the hazardous symptom of fainting. Symptoms of “slow thinking, slow moving” and tiredness are often from hypothyroidism. The best treatment for this is T3/T4 (Armour thyroid) treatment. Many physicians still use either T3 or T4, which is not physiological. Symptoms of “poor resistance to noise” are due to DHEA deficiency. In addition there often can be moderately poor resistance to stress and joint aches (arthralgias).

When permanent fatigue is present it is time to measure sex hormone levels. If deficiencies are found in a woman, bioidentical estrogen (Bi-Est) is given transdermally from day 5 to 25 of the cycle, and progesterone transdermally from day 15 to 25 of her cycle. Depending on how severe the hormone deficiency is hormone replacement doses in women range from 2.5 to 5.0 mg for bioidentical estrogen and from 100 mg to 150-200mg for bioidentical progesterone per day.

Sports fatigue

In this age of exaggerated sports activities a new entity of burnout, the sports fatigue has emerged. A low free testosterone/cortisol ratio is a reliable marker for overtraining. When this ratio shows a decrease of 30% or more, it shows that there is a temporarily incomplete recovery from intensive training. In the lab often an increase in the sex hormone-binding globulin (SHBG) can be measured, which leads to a lack of free testosterone. In a study of Chinese over-trained soldiers there was a complete recovery from this sports fatigue with multi-vitamins and a liposomal testosterone gel.

Sleep abnormalities

Restless, non-restorative sleep can be a symptom of melatonin deficiency and happens more often in people above the age of 50 as there is a natural hormone decline with age in the older generation. Treatment consists of replacement, which is easily achieved either with sublingual tablets (mild: 0.05mg, moderate: 0.15 to 0.5 mg, severe: 0.5 to 1mg). Oral melatonin doses are more problematical as there are average absorbers and poor absorbers. For mild, moderate to severe symptoms of insomnia the dosages are for average absorbers 0.2mg, 1 mg, 2mg and for poor absorbers 0.3mg, 1.5mg and 10mg. One should use the lowest effective dose of melatonin as it opposes cortisol and when melatonin is overused, adrenal gland weakness can be the result.

Exhaustion

An overpowering feeling of exhaustion can be due to growth hormone (GH) deficiency. This is diagnosed by taking insulin-like growth factor-1 (IGF-1) levels. When these are low, daily subcutaneous injection of low-dose human growth hormone is given. Depending on how severe growth hormone deficiency is, different GH doses are administered. The patient self-injects with an insulin injector. Mild GH deficiency requires 0.05 mg (1 click) per day, moderate deficiency 0.1 mg (2 clicks) per day and severe deficiency 0.15 mg (3 clicks) per day.

Adrenaline deficiency

Dr. Hertoghe pointed out with the help of a publication where runners had developed overtraining syndrome that adrenaline deficiency can be part of burnout. Laboratory tests on these runners showed that overnight catecholamine (metabolized adrenaline) excretion was only 50% of healthy runners. Often this is associated with thyroid deficiencies (in males and females) or with estrogen deficiency in women. Treatment consists in rectifying the thyroid and sex hormone deficiencies (estradiol and progesterone treatment in women).

Hormone Changes With Burnout

Hormone Changes With Burnout

Treatment of burnout

Dr. Hertoghe suggested a 5-step treatment protocol.

  1. Improve the diet

This involves the removal of sugar and starch as both lower the levels of essential hormones. He specified that sweets, chocolate drinks, soft drinks, milk, bread, pasta, commercial mueslis and high temperature cooked meats need to disappear from the diet plan.

The consumption of animal protein is desirable, but the food should be cooked at low temperatures. Fresh vegetable and fruit consumption should be increased. I like to add that these foods are best consumed as organic foods. These foods will increase your natural hormones and produce energy in your cells (ATP, NADPH).

  1. Improve your sleep

This requires a dark bedroom at night and day light exposure in the morning. Avoid TV’s, electrical alarm clocks, i-phones, computers at the bedside (EMF can disturb your sleep). If your environment is noisy, you may require ear plugs to shut out the noise. In case of hormone deficiency, it may be necessary to replace missing melatonin, growth hormone, see hormones above (especially progesterone in women), and oxytocin.

  1. Treat adrenal deficiency, if present
    The missing hormones here to be replaced are cortisol, DHEA and often aldosterone, which is replaced with fludrocortisone.
  2. Treat other associated hormone deficiencies

The other hormones, which are often overlooked, are growth hormone, thyroid hormones, estradiol/progesterone in women and testosterone in men.

  1. Treat nutritional deficiencies

The most common missing minerals and vitamins are iron, magnesium, folic acid, vitamin B12, vitamin E and others. Replacement of these along with the missing hormones is essential for normal cell function.

Conclusion

In an attempt to add to our physical fitness we may overlook our limits and run into a burnout situation without noticing it. Your medical care provider should think about multiple hormone and nutritional deficiencies that can be treated, although treatment can be multifaceted. If in doubt ask for a referral to an anti-aging physician.

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