‘Burnout’ A manifestation of chronic unmitigated stress.

'A state of being characterised by feelings of exhaustion, cynicism, and reduced efficacy'.

When under stress, your body undergoes changes that include making higher than normal levels of stress hormones such as cortisol, adrenaline, epinephrine, and norepinephrine. These changes are helpful in the short term, generating the energy to manage difficult situations, but over time, they start harming your body and mind.

Poor sleep, the need for additional sleep with no change in fatigue levels, craving sugar, salt or alcohol, gastrointestinal changes, headaches, muscle aches, anxiety and depression can all be part of the symptom profile.

Burnout is now recognised as a legitimate medical disorder by much of mainstream medicine and in the USA has even been given its own ICD-10 code (Z73.0 – Burn-out state of vital exhaustion).

Whilst there are several propositions to explain the generation of burnout there are understood to be six key components of the workplace environment that contribute to burnout: workload, control, reward, community, fairness, and values. Burnout emerges when one or more of these six areas is chronically mismatched between an individual and their job. Over time, passion erodes not only because people have too much to do, but because of these other factors.

Health care professionals at risk

Looking through PubMed, using the search term ‘burnout’ thousands of papers emerge but with an overriding preponderance focussed on health givers, but almost every workplace and home life situation has its research supporting the risks of burnout.

The last 2 years of Sars Cov-2 and related changes to life, occupations and health have also placed an additional burden on people and their wellbeing. With health care providers experiencing a dramatic increase in ‘burnout’. The increasingly complex web of providers’ highly conflicted allegiances, to patients, to self, and to employers and its attendant moral injury may be driving the health care ecosystem to a tipping point and causing the collapse of resilience. Journalist Diane Silver describes moral injury as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”

Post-traumatic growth

Post-traumatic growth entails ‘positive psychological change experienced as a result of the struggle with highly challenging life circumstances[1] . Such struggles may enable individuals to identify meaning in interpersonal relationships, have a greater sense of personal strength, change their priorities, have increased appreciation for small life events, and have a richer existential or spiritual life. Personality dynamics and trauma characteristics can lead to post-traumatic growth and spirituality; moreover, social support and opportunities for emotional disclosure can buffer against mental illness and stress response[2] .

Loss of Natural World

The ecocide of our natural world, which adds to the complexity of curbing the SARS-Cov-2 pandemic is also affecting people’s ability to recover or prevent burnout. The medical concept of One Health brings hope that the root causes of such pandemics can be prevented. One Health is a multisectoral and transdisciplinary medical approach working at all policy levels, with the goal of achieving optimal health outcomes by fostering positive health linkages between people, plants, animals, and their shared environments[3] . Both non-communicable and infectious diseases need the integrated approach of multidisciplinary engagement to develop a strategic approach to health generation [4]

Nutrition strategies for burnout management

Diet is a mediating and modifiable factor regarding burnout risk [5] . Chronic stress, such as the stress experienced by individuals suffering from burnout, has been shown to influence the amounts and types of foods individuals eat, contributing both to excessive eating and undereating and the development of chronic diseases. Dietary strategies to mitigate burnout should be developed based on existing evidence related to nutrition and mental health, incorporate effective behaviour change theory, and include a systems-level change to promote healthy eating among health care professionals. Evidence supports the application of the Mediterranean diet , nutrients such as omega 3 , ornithine and tryptophan , cognitive behavioural theory, and mindful eating interventions [6] ,[7] ,[8] ,[9] . A nutrient dense food selection, adequate protein, reduced refined carbohydrates and regular fibrous food intake are all beneficial strategies to enhancing resilience to adverse stress.

Mindful eating is most consistently described as making conscious food choices, developing a keen awareness of hunger and fullness cues, eating in response to those cues, being present during eating occasions, paying close attention to the effect of food on the senses, and noting physical and emotional responses to eating. Individuals experiencing burnout, especially women, maybe at high risk of emotional eating, where mindful eating interventions may be particularly beneficial[10] .

Targeted nutrition for recovery and resilience.

Nutritional supplements used for burnout management can support the health and well-being of individuals in various stages and should be flexible and individualised. Magnesium, rhodiola, theanine and saffron all have beneficial effects. Saffron extract for example appears to improve subclinical depressive symptoms in healthy individuals and may contribute to increased resilience against the development of stress-related psychiatric disorders[11] .

Low magnesium status has been reported in several studies assessing nutritional aspects in subjects suffering from psychological stress or associated symptoms. This overlap in the results suggests that stress could increase magnesium loss, causing a deficiency; and in turn, magnesium deficiency could enhance the body’s susceptibility to stress, resulting in a magnesium and stress vicious circle[12] .

Rhodiola. Rosea has received attention from the scientific community for its potential therapeutic capacity as an adaptogen. Adaptogens are “[most commonly] natural herbal products which are non-toxic in normal doses, produce a non-specific response, and have a normalising physiologic influence”[13] .

L-theanine is a naturally occurring psychoactive ingredient in organic Japanese green tea that’s known for boosting mood and cognitive performance and reducing mental and physical stress without drowsiness. In effect, it is shown to calm the mind and produce a state of "alert relaxation[14]

Used individually or in combination, these nutrients and adaptogens have an excellent safety record, with no addictive components and may be used as a targeted nutritional intervention along with lifestyle changes to prevent or recover from burnout.

References

[1] Chen, R., Sun, C., Chen, J.-J., Jen, H.-J., Kang, X.L., Kao, C.-C. and Chou, K.-R. (2021), A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic. Int. J. Mental Health Nurs., 30: 102-116.

[2] Shuwiekh, H., Kira, I. A. & Ashby, J. S. (2018). What are the personality and trauma dynamics that contribute to posttraumatic growth? International Journal of Stress Management, 25, 181.

[3] Osterhaus, A.D.M.E., Vanlangendonck, C., Barbeschi, M. et al. Make science evolve into a One Health approach to improve health and security: a white paper. One Health Outlook 2, 6 (2020).

[4] Destoumieux-Garzón D, Mavingui P, Boetsch G, Boissier J, Darriet F, Duboz P, Fritsch C, Giraudoux P, Le Roux F, Morand S, Paillard C, Pontier D, Sueur C and Voituron Y (2018) The One Health Concept: 10 Years Old and a Long Road Ahead. Front. Vet. Sci. 5:14

[5] Esquivel MK. Nutrition Strategies for Reducing Risk of Burnout Among Physicians and Health Care Professionals. Am J Lifestyle Med. 2020;15(2):126-129. Published 2020 Dec 2.

[6] Ventriglio A, Sancassiani F, Contu MP, Latorre M, Di Slavatore M, Fornaro M, Bhugra D. Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review. Clin Pract Epidemiol Ment Health. 2020 Jul 30;16(Suppl-1):156-164.

[7] Jacka FN, O'Neil A, Opie R, Itsiopoulos C, Cotton S, Mohebbi M, Castle D, Dash S, Mihalopoulos C, Chatterton ML, Brazionis L, Dean OM, Hodge AM, Berk M. A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial ). BMC Med. 2017 Jan 30;15(1):23

[8] Grosso G, Galvano F, Marventano S, Malaguarnera M, Bucolo C, Drago F, Caraci F. Omega-3 fatty acids and depression: scientific evidence and biological mechanisms. Oxid Med Cell Longev. 2014;2014:313570. Epub 2014 Mar 18.

[9] Wurtman J, Wurtman R. The trajectory from mood to obesity. Curr Obes Rep. 2018;7:1-5.

[10] Kristeller JL, Wolever RQ. Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation. Eat Disord. 2011;19:49-61

[11] Jackson PA, Forster J, Khan J, Pouchieu C, Dubreuil S, Gaudout D, Moras B, Pourtau L, Joffre F, Vaysse C, Bertrand K, Abrous H, Vauzour D, Brossaud J, Corcuff JB, Capuron L and Kennedy DO (2021) Effects of Saffron Extract Supplementation on Mood, Well-Being, and Response to a Psychosocial Stressor in Healthy Adults: A Randomized, Double-Blind, Parallel Group, Clinical Trial. Front. Nutr. 7:606124.

[12] Pickering G, Mazur A, Trousselard M, et al. Magnesium Status and Stress: The Vicious Circle Concept Revisited. Nutrients. 2020;12(12):3672. Published 2020 Nov 28.

[13] Ishaque S, Shamseer L, Bukutu C, Vohra S. Rhodiola rosea for physical and mental fatigue: a systematic review. BMC Complement Altern Med. 2012;12:70.

[14] Williams JL, Everett JM, D’Cunha NM, et al. The Effects of Green Tea Amino Acid L-Theanine Consumption on the Ability to Manage Stress and Anxiety Levels: a Systematic Review. Plant Foods Hum Nutr. 2020 Mar;75(1):12-23