Stress & Fatigue
- Understanding how on-going stress can cause chronic (long-term) fatigue
- The physiology of stress, in short
- How stress makes us ill
- Stress affects the adrenal glands
- Stress affects our digestive system
- Stress affects the blood sugar levels
- Stress affects our thyroid gland
- Stress affects our mood
- Stress affects our mitochondria
- Shocking isn't it?
- Restoring your health
- Herbs which strengthen the immune system
- Sustainability is the key
- Restoring your health
We know that our contemporary lifestyle is not sustainable for the health of our planet, but it can also be unsustainable for our individual health. Low-grade recurrent stress can take a severe toll on our health, as many doctors and complementary therapists witness daily in their clinics. We were simply never designed to live with the unrelenting stress that our modern lives experience.
If we look back in time and observe how humans have slowly evolved to live, we notice that more natural lifestyles involved a great deal more leisure time. There was stress, but it was usually short and sharp, like the walking into a grizzly bear with her cub scenario. If the individual survived the stress, they could recover within their social group again. They lived at a much more humane pace of life than we do.
Our modern lifestyle is quite different. We experience short-term stresses, no doubt to a milder degree, at least several times a week, more realistically several times a day, for most of our lives. This may be a large factor why so many people feel tired all the time. It is worth bearing in mind that for the body to marshal resources of survival, a great deal of energy is required. The famous endocrinologist, Hans Selye said, “Every stress leaves an indelible scar, and the organism pays for its survival after a stressful situation by becoming a little older.”
When we register or anticipate a stressful situation, the brain immediately sends an urgent message of ALARM to the nervous system, which relays the message on to the adrenal glands. The adrenals instantly release the two hormones of stress, adrenaline and cortisol, into the blood stream to be delivered to every cell in our body. The body is in a state of alarm and ready to fight or flee. Within seconds the adrenaline reaches the brain, which continues to pass ALARM messages to the nervous system and the adrenal glands. Thus a cycle of ALARM is established, and this continues until the person's brain perceives a reason to calm down, after which the adrenal glands stop secreting adrenaline and cortisol.
This emergency response is perfectly healthy and life-saving, but only when used occasionally. Most of us live in a highly stressful world, and thus often experience very unhealthy levels of these emergency responses. The stress does not have to be stress or anxiety as we think of it. It can be a low-grade unrecognised type of stress, such as hard athletics training for extended periods of time, living in an unhappy home environment, working excessively long hours or under too much pressure, even falling in and out of love constantly. Our body cells recognise this as stress. Chronic (long-term) low-grade stress is very debilitating especially to the immune system, and quite often when there is the added burden of repeated viral infections, health collapses like a pack of cards.
For many years I have worked with people suffering with ongoing fatigue, and my experience is that they have lived very busily for most of their life. Consider one man who was in a volatile marriage, with five children and an unwell parent to care for, two businesses to run, and his relaxation method was working out hard at the gym. This person thought that he was coping with life pretty well until he caught a nasty cold, which was the final straw, and he was eventually diagnosed with Chronic Fatigue Syndrome. It was not the cold which made him ill – although he believed that was when his troubles began. The viral infection was the final tipping point when his body buckled under the strain. In my opinion, the real illness began years before with patterns of a lifetime.
Almost certainly, our understanding of the effects of stress on our physiology is still fairly primitive; however, by simply looking at the effects of two hormone of stress, we can come to the startling understanding of how devastating the effects of stress can be to our health and our lives.
As Hans Selye outlined in his theory of General Adaptation Syndrome (GAS), when stress hits us, we tend to be (metaphorically) knocked off course for a short period. At that time, the adrenal glands release lots of adrenaline and cortisol, which helps us to cope with the situation. The immune system is actually stimulated, and very soon we gather ourselves together and get on with our lives.
However, if the stress becomes prolonged, the adrenal glands are compelled to continue secreting cortisol and adrenaline. After some time, the glands become fatigued and they struggle to support the person, producing less and less cortisol. At this time the person may feel that they cannot cope with any more stress, and this is because their body actually physiologically can no longer cope with the stress.
If the stress persists, the person may develop adrenal fatigue, also known as adrenal exhaustion, adrenal insufficiency, hypoadrenia, or good old fashioned 'burn-out'. This condition is characterised by body pain, mental and physical exhaustion, brain fog, and a strong aversion to stimuli or stress of any kind. Sometimes the body is too exhausted even to digest food! These people feel that they just want to hide and can no longer cope with life.
In my practice I see people with adrenal fatigue every day, yet it does not seem to be recognised by mainstream medicine. It is my opinion that adrenal fatigue may, in many cases, be a major forerunner to full scale Chronic Fatigue Syndrome (CFS/M.E.). Some studies consider CFS/M.E. to be a mild form of Addison's disease, which is complete adrenal failure.  One scientific study measured the size of the adrenal glands in a group of people with CFS with a CT scanner. In each case, the glands had atrophied (shrivelled) by over 50%. 
When we eat in a hurry or under stress, we do not secrete adequate digestive acids and enzymes, and consequently the food is not completely broken down. The food remains like a lump in our gut, eventually starting to ferment, produce gas and a feeling of bloating. The fermenting foods leak toxins, which in time can overburden the liver and inflame the gut lining, leading to a leaky gut. Without sufficient stomach acid, the unfriendly bacteria which are swallowed with the meal are not killed and they can multiply in our intestines. These unfriendly bacteria also secrete toxins, further inflaming the intestinal lining and promoting gut permeability. Undigested food particles can slip through the enlarged holes in the gut lining into the blood stream, allowing food intolerances to develop, which causes symptoms such as body pain, brain fog and lethargy.
Often, the muscles of “anxious gut” seize up, so the food cannot progress along the digestive tract. When faecal matter in the bowel is not adequately evacuated due to a spastic colon, the bowels become clogged. Toxins from old faecal matter leach back into the blood stream through the colon wall, poisoning your body. At the very least, there will be bad breath and probably headaches, but possibly the intestinal lining will become inflamed so that absorption of nutrients becomes impaired, and the person becomes poorly nourished, with a toxic congestion and even less able to cope with life. I have so often heard people say, “I feel poisoned.”
One of the roles of cortisol is to maintain even blood sugar levels by converting amino acids into glucose when our blood sugars drop too low. If, however, the adrenal glands are debilitated, they simply cannot manufacture enough cortisol to do this conversion, and one of the most obvious signs of fatigued adrenal glands is when the person experiences sudden sugar cravings, because their adrenal glands are no longer able to maintain their own blood sugar levels effectively.
It is common for modern people to live in a rush, and consequently have elevated adrenaline, which elevates the blood sugar levels, and this leads to elevated insulin levels. Over time, too much insulin leads to insulin resistance, where the cells cannot absorb the blood sugars, and diabetes, cardiovascular disease, obesity, abnormal cholesterol levels or Polycystic Ovary Syndrome can be the result.
Scientists have also linked insulin resistance affecting the brain to loss of memory, poor learning, a feeling of brain fogginess, inability to think clearly, forgetting what you are about to do and verbal memory loss. 
I have noticed a trend amongst my patients that when they are very stressed and tired, they will use sugary snacks and caffeine to keep going. The high levels of sugar feed the yeast cells, such as Candida albicans, living in the gut. The Candida can develop mycelia (root-like structures), which penetrate the intestinal wall, allowing the yeast to enter the blood stream and overwhelm the immune system. Systemic Candida can produce many symptoms, such as brain fog, muscle pain and chronic fatigue. For more information on Candida, see my previous M.E. Support article titled Candida & M.E.
If your thyroid function is under-active, you can feel cold, fatigued, depressed and mentally sluggish, amongst other symptoms. Note how similar some of the symptoms associated with a hypoactive thyroid are to those of adrenal fatigue. Although these are two separate conditions, it is common that those who suffer from a low thyroid function not caused by an auto-immune disease, may also suffer from poor adrenal function.
In a healthy person, the pituitary gland in the brain secretes Thyroid Stimulating Hormone (TSH), which stimulates the thyroid gland to produce the inactive thyroid hormone T4. This is converted into the activated thyroid hormone T3 in the liver and kidneys and then enters the cells of the body, influencing metabolism. Excess T4 needs to be cleared from the body, so any left-over T4 is converted into another inactive hormone known as Reverse T3 (rT3).
When there is excessive cortisol in the bloodstream, it can down-regulate the secretion of TSH.  Cortisol can also inhibit the conversion of the inactive T4 into the active T3. Further down-regulation of thyroid activity can occur when T4 is not converted into active T3, but rather into the rT3.
We know that stress raises cortisol levels, which, like the medicine cortisone, has a supressing effect on our immune system. Part of the immune system known as the T-helper cells are divided like a seesaw with Th1 at one end and Th2 at the other. In a healthy person, the seesaw swings more or less equally between these two, with Th1 raised (dominating) at night and Th2 dominating during the day. The Th1 immune response is geared towards killing viruses, bacteria and cancer cells. The Th2 response activates allergic and inflammatory responses.
Now, during a bout of short-term stress, the immune system swings into Th1 domination, which can fight off and kill any viruses. However, if the stress is ongoing, the immune scales will then tip from Th1 to Th2 domination, and the person has much less resistance to viruses (low Th1) and is more susceptible to developing environmental and food sensitivities (high Th2). Some studies have shown that people suffering from CFS have a bias towards higher Th2 and lower Th1 , which means that they have higher prevalence towards food intolerances and lowered resistance to viruses. 
In my experience, it is at this stage that many sufferers of CFS/M.E. believe they got ill, but you can see that, actually, they have been gearing up for this illness for years. Long-term unrelenting stress gave rise to elevated cortisol levels, which skewed the immune system towards a T2 bias, making the person vulnerable to viral attack, and when the virus struck, the immune system could not fight it off. Ironically, the infection takes a further toll on the adrenal glands. For the body to destroy viruses, it needs the Th1 response to raise the temperature. Many invading organisms survive only in a very narrow temperature band, and raising the body's temperature helps to kill them. However, for the body to raise its temperature even 1 degree Celsius takes approximately 10% of our available energy, and fatigued people simply do not have the resources to achieve that temperature rise. This is why sufferers of CFS/M.E. often do not get colds or have a temperature.
It is not just the virus which needs to be treated, but the whole cascade of events leading up to this breakdown which needs to be healed, and when my CFS/M.E. patients tell me that they have had a cold for the first time in years, we celebrate. The immune system has swung back into balance and recovery slowly begins.
Serotonin is often called our “happy hormone” and low levels of this natural chemical are linked to depression. A study in Israel found that increased levels of cortisol stimulate the white blood cells to take up more serotonin than is normal. The result was less serotonin available for the nervous system, and depression is the consequence. 
High levels of cortisol also directly affect memory and emotion by shrinking the Hippocampus in the brain.  This part of the brain is rich in receptors for cortisol, but if too many cortisol molecules dock into these receptors, they start to destroy the nerves, resulting in memory loss. 
A person with depleted cortisol levels tends to become hyper-vigilant and even quite aggressive, in order to protect themselves from the stress which they know that they cannot cope with any longer. When even mild stress occurs, someone with burn-out may find that they over-react with anger, frustration, or may startle very easily. They frequently feel anxious but without a reason, and experience difficulty recovering from general stresses of life. Any stress at all 'knocks them for six' and they can take days to recover. Don't forget how cortisol affects the thyroid, and how low thyroid function is associated with fatigue and depression.
Professor of Biochemistry and Basic Medical Sciences, Dr Martin Pall  explains how prolonged stress can elevate the production of chemicals called nitric oxide and peroxynitrite in our cells. These chemicals stimulate oxidative damage to the mitochondria (our energy centres in our cells), and consequently the energy production is severely diminished. 
This is only the tip of the iceberg. The effect of stress on our body is profoundly disruptive to our health and well-being. Long-term stress significantly affects every part of our bodies, and clearly, treating with anti-depressants is utterly inadequate. The underlying cause of illness must be addressed to achieve sustainable long term health. Learning how to slow down and stay calm amid the chaos of life, to maintain even blood sugar levels, eat highly nutritious food, and using herbs to support the adrenal glands and rebalance the immune system is an excellent start to regaining positive health.
In my experience, people who develop adrenal exhaustion or burn out are often the type who think they can bust their way out of the illness. “I am not going to let this get the better of me.” But this non-stop approach to life is why they got ill in the first place. So the first thing people need to learn is how to be kind to their minds and bodies. This is how you do it:
- Get off the hamster wheel. Reconsider your life style – a hectic lifestyle isn't sustainable. Take time for yourself. Do the things which make your heart sing.
- Make sure you are in bed by 10 pm, even if you don't sleep – just read, write in your diary, talk to your partner or friends (etc.). Writing a diary is very good because it brings you back in touch with yourself. Don't forget to count your blessings too.
- Cut out the sugar and caffeine. Keep the blood sugar levels even with six small, densely nutritious meals a day.
- Consider enlisting the help of a medical herbalist, nutritionist or naturopathic doctor. There are specific herbs and nutrients which can significantly help your recovery, but I emphasise that you will benefit far more from these supplements if they are prescribed by a medical herbalist or nutritionist who is able to access top quality products, and will prescribe the correct products for your specific recovery programme. There is no one-size-fits-all prescription in natural medicine.
Their job will be to:
a) Clearly direct you towards a healthy diet and life-style.
b) Find out if you have Candida, and if so, kill it with herbs/supplements.
c) Repopulate your gut with the correct probiotics.
d) Use herbs and nutrition to heal gut permeability.
e) Reduce your viral load, and support the immune system recovery.
f) Restore your adrenal glands with herbs and supplements.
g) Use herbs and supplements to rebuild your stamina and resilience.
h) Make sure that you feel calm and balanced, and that you sleep deeply.
Restoring optimal adrenal health
Restoring the adrenal glands is one of the hubs around which we focus to bring you back to optimal health and vitality after too much stress. This is not something that happens quickly, and it is realistic to expect recovery to take from 6 to 9 months – sometimes much longer.
Liquorice (Glycyrrhiza glabra) has long been used to help with the recovery of adrenal fatigue; in fact, it was the 'drug' of choice in former times for the treatment of Addison's disease, which is a disease of complete adrenal failure. This root supports the glands by reducing their need to manufacture cortisol, because it provides a natural constituent called beta-glyrrhetinic acid, which behaves like cortisol, thus sparing the glands the necessity of producing their own cortisol. And so the adrenal glands can rest and recover.
Liquorice also demonstrates anti-inflammatory and anti-allergic actions,  which is very helpful for those with the Th2 dominance, and depressed Th1 immune imbalance. Marvellously, liquorice also has anti-viral properties. [13, 14] For these reasons, liquorice is an excellent choice for those who are burnt out with a poor immune response to viruses. Do be aware that large doses of liquorice can increase the blood pressure and reduce potassium levels.
Ashwagandha (Withania somnifera) is particularly useful for people who have been debilitated for long periods of time. The person may feel weak, easily succumbing to shock or fright with further weakness and fragility. Usually, someone in that state has a low libido. Discussing libido may seem as if I am deviating from the point, but a person's libido is a good indication of their vitality. If you are too tired or wired, sex isn't going to happen.
Hence, this herb restores energy levels in those who are debilitated, and is also used as a sexual and fertility tonic.  Withania helps to rebalance the immune system when Th1 is too low. 
Look at the name – Withania somnifera; somnifera means “to promote sleep”. I find this herb marvellously restorative when given at bedtime to people with adrenal fatigue. If given with a little liquorice and passionflower it promotes a wonderfully restful sleep, nourishing the adrenal glands while the person is resting.
Adrenal imbalance can often leave you craving salt. Most of us are aware that salt can increase blood pressure, but low blood pressure (hypotension) is a very common sign of adrenal imbalance. Making a cup of liquorice tea with a pinch of sea salt is a great tonic for the adrenal glands. It is very helpful if you can drink this “tea” and then lie down for 10 – 30 minutes. It really gives a lift.
When under stress, the adrenal glands and the body as a whole require a great deal of B vitamins as well as magnesium (commonly found in oats, cashews, brazils, hazels, walnuts and pecans, organ meats, egg yolks, wholegrain bread, berries, brown rice, and soya beans). The adrenals also require great quantities of vitamin C, and a supplement is crucial, but try to include lots of the following foods which are rich in vitamin C – green leafy vegetables, plus broccoli, tomatoes, most brightly coloured fruits, especially berries and kiwis, sweet red peppers.
Helping the digestive system and blood sugar levels
One of the most immediate and effective things you can do for your health is to keep your blood sugar levels even. Low blood sugar levels are very stressful for the body, and the adrenal glands have to pump out cortisol to raise blood sugars. By regularly eating small quantities of highly nourishing foods which are rich in healthy fats and protein, such as half an avocado, some smoked mackerel, a blob of humus and sliced raw tomato, or a bit of raw coconut, you will instantly feel more balanced and strong. Eating slowly and enjoying your food will encourage your stomach to secrete digestive enzymes, so that food is broken down and absorbed into the blood stream, delivering the healing nutrients to every cell in your body. Caffeine, sugar and alcohol will give you nothing but short-term stimulation, which crashes you further over the edge of health collapse.
Sleep deeply and peacefully
Many people with long-term fatigue are utterly exhausted, yet ironically, they cannot sleep properly. All through the day they feel drained, with no energy, but then, a miracle occurs! The clock strikes 11pm and, PING – they wake up! Suddenly they have the energy that they have lacked all day; so they whizz around getting things done and often don't go to bed until the early hours. If you allow yourself to become a night owl, the pattern becomes very hard to break and this can become quite an isolating way of life.
Others find that they just cannot fall asleep because they are “tired but wired”, or some fall asleep but wake suddenly in the night. What can you do?
Get to bed early enough
Do try to be in bed by 10pm with a lovely warm drink, and a gentle book or music to soothe your mind. If you do choose to watch television, steer away from the rampant misery which seems to be so popular and more towards kindly programmes. Do not read thrillers because, exciting as they are, they are also difficult to put down. Do not surf the net, which is stimulating too. There is evidence that the light from screen interferes with melatonin production in the brain. Instead, read something gentle, then you will find that your mind slows down and by that watershed hour of 11pm, you have dropped your book and slipped into a restful slumber. In time, this pattern will help to re-set your internal clock.
Please do be aware that if you have struggled to sleep for months or years, when you do finally start to have regular full nights’ sleep, you will probably wake in the morning feeling even more tired than before. That is quite normal and it will change. The body has had such a long time managing without adequate rest that now it is finally able to let go. After a few weeks, the tiredness will lift and you will start to feel pockets of wonderfulness again.
It might be helpful to have a warm bath with a double handful of Epsom salts, which is rich in magnesium and will relax your muscles, and promote a good sleep. A few drops off essential oil makes bathtime a delightful spa-like experience.
Before you take your bath, you might like to have a dose of Passiflora incarnata. This wonderful herb quietens the mind, leaving one feeling deeply peaceful. Or you might prefer to take to bed a cup of warm milk, with a little honey and a lavender flower head floating in the milk – this comforting and delightful drink will help you to have a restorative night’s sleep.
Often people awake during the night because their blood sugar levels have dropped. Keep a snack, like half a cup of oats soaked in almond milk, next to your bed so that you can have a little nibble and drop back to sleep.
St John's Wort is so much more than just a herbal anti-depressant. Medical herbalists think of this plant as a nerve restorative, calming and nourishing a debilitated nervous system. It also has significant anti-viral properties. [17, 18, 19] By helping to restore the exhausted nervous system whilst at the same time reducing the viral load, this herb offers significant help to the over-stressed and burnt-out individual.
Astragalus membraneus also has significant anti-viral effects,  as well as acting as an immune and stamina tonic. [21, 22]
Dr Holick of the Boston University School of Medicine points out that low vitamin D levels are associated with muscle weakness and pain and may be misdiagnosed as fibromyalgia and chronic fatigue syndrome.  Vitamin D has significant immune tonifying actions, so if you find yourself vulnerable to recurrent viral infections, and suffer from an unexplained aching body, ask your health care practitioner to check your vitamin D status, and then get your skin into the sun.
Coriolus falls into the category of medical mushrooms, which have been used for centuries by the Chinese to sustain immunity and stamina. Coriolus modulates the immune system by up-regulating Th1, and down-regulating Th2, restoring that crucial Th1/Th2 balance. [24, 25] Furthermore, Coriolus shows impressive anti-viral properties against HIV and herpes viruses, as well demonstrating liver protective properties. 
I propose that stress might be one of the greatest unacknowledged causes of illness in our age. We are all talking about sustainability now, and chronic stress is unsustainable for us as organisms to live under. The unsustainable environmental pressure on our planet presents a good reflection of the way modern people are treating their bodies. You can train yourself to live more kindly, gently and respectfully towards your own well-being. Your loved ones will notice and hopefully the positive habits will rub off on them, and so a groundswell of a kindly sustainable lifestyles grow. Surely it must the very basics of health that we progress sustainably within our own lives, and in harmony with our natural environment.
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|Jo Dunbar-Lane (MSc, Dip Herbal Medicine, Hypnotherapy) runs a busy practice from her two herbal apothecaries. She helps patients through a broad range of health problems using herbal medicine, essential oils and nutritional supplements; and has a strong interest in helping people to recover from chronic fatigue. She has written a book focusing on how to recover from Candida: How to Cope Successfully with Candida, (Wellhouse Publishing), and more recently she wrote a book titled Recovering from Stress, Burnout and Fatigue.|