Stress & burnout
17th Nov, 2022

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Wendy McLean (00:05): Welcome to Common Ground, a podcast series discussing new research and interesting projects in the field of complementary medicine. Hello, my name is Wendy McLean, Senior Writer and Presenter at is a digital platform, a professional health resource and a distribution service all in one.

Firstly, I’d like to begin by acknowledging the Gadigal people of the Eora Nation as the traditional custodians on the land on which we gather here. I would also like to pay my respect to their elders, past, present and emerging.

We did encounter some audio and internet problems, which we tried to clear up and edit as much as possible. We apologise for this, and we hope you still enjoy this episode. The transcript is also available to read on your podcast and platforms. Thanks.

Today on Common Ground, I'll be speaking with Brooke Schiller on stress and burnout and what we can do to manage and prevent these. Brooke is a degree qualified naturopath and nutritionist based in Adelaide with a passion for digestive health. Brooke follows an evidence-based approach and has a deep love of learning. Her own health journey led her to herbal medicine path, and now her greatest pleasure and number one driver is guiding people to better health. Welcome to Common Ground, Brooke.

Brooke Schiller (01:32): Thanks for having me on Wendy, what a topical time to be discussing stress and burnout.

Wendy McLean (01:37): Oh, absolutely. I mean, it's the end of the year, but it's the end of a hard few years, beginning with the bush fires, the pandemic, the floods, and now the long-term consequences of that we're seeing from the COVID-19 pandemic. So yeah, it's the perfect time. So I guess what exactly is stress and how does it impact the body?

Brooke Schiller (02:02): Yes. So stress might seem like a bad thing, but it's not always the case. The stress response is a natural, well-orchestrated process that occurs in the body. It's been named fight or flight because it's evolved as a survival mechanism enabling us to react quickly to life threatening situations. The hypothalamic pituitary adrenal axis, also known as the HPA axis, is the main stress response system, and it's the link between our perceived stress and our physical reaction to stress. So a hormone cascade begins every time we perceive stress, and the hypothalamus sends instruction to the adrenal glands, which pump epinephrine, also known as adrenaline, into the bloodstream. So we'll notice that when we feel threatened, the heart beats faster, pushing blood to the muscles, heart and other vital organs, our pulse rate and blood pressure increase. Breath becomes more rapid. Small airways in the lungs expand, allowing as much oxygen as possible with each breath. Additional oxygen is sent to the brain, which increases alertness, sight, hearing, and other senses become sharper. Glucose and fat are released from storage in the bloodstream, supplying the body with energy. So we can see how this adrenaline gives us the ability to fight and overcome danger.

Wendy McLean (03:30): Absolutely.

Brooke Schiller (03:32): Yeah. So it's really quite a fascinating way the body works but this stress, the stress that helps you stay more alert is known as acute stress, and this stress comes and goes. We all have it from time to time, and it doesn't last long, so it shouldn't last long. But unfortunately, after the initial surge of adrenaline eases, the hypothalamus activates the second part of the stress response system. And if the brain continues to perceive danger, it wants the sympathetic nervous system, which is responsible for our fight and flight, to stay charged. And it releases hormones which release a trigger of cortisol, which enables the body to stay revved up and alert for high periods of time. Unfortunately, our bodies can't tell the difference between being chased by a tiger and reading a bad email. So it physically responds in the same way, and the end result is equipping the body to run away from danger. So when these stressful situations repeat themselves day in, day out, rather than having acute stress responses and then a parasympathetic nervous system relaxing us back to baseline, our bodies end up in this chronic state of stress.

Wendy McLean (04:49): And certainly, I mean, acute stress, you're right, it can be helpful, particularly if you are, you're performing, or you need to do a challenging task. But yeah, when it's day in day out, it certainly can have quite severe consequences, can't it? And it can really impact health and wellbeing. And so what are some of the ways that it impacts our health long term?

Brooke Schiller (05:12): Yeah, there's a couple of key areas impacted by chronic stress, and firstly, it's our adrenal gland. So they produce hormones for the stress response. Digestion, reproduction and immunity are all impacted because they're not essential functions when it comes down to acute survival. And I think this is quite an interesting one. So people might notice, women may notice their period cease when they're really stressed, and that's because the body deems, it's not a safe time to have the child. Sleep takes a hit because elevated cortisol levels impact our ability to get to and stay asleep. People might notice problems with their brain function, so experience brain fogs or memory and cognition issues. Our blood glucose levels become dysregulated because we're having that effect where the body's flooded with glucose, but we're not using that energy store. So then we have to restore that energy, so it becomes an issue. And then people can notice other impacts like heart palpitations, headaches, acne, muscle tension. Really the list goes on.

Wendy McLean (06:26): So it's quite systemic, widespread effects. And I imagine once sleep starts to suffer, it just really perpetuates that cycle as well. So I guess we are living through stressful times, but we are seeing these unprecedented levels of mental health issues in the community and burnout we're seeing particularly our wonderful teachers and medical professionals during the pandemic, so many of them are burning out after what they've been through. So can you talk a little bit more about this? What is burnout and how is that different from stress?

Brooke Schiller (07:08): Yeah, absolutely. So with chronic stress, everything is firing. Cortisol is high, theoretically we're at the top of the mountain. And then burnout is really when we fall. So its suggested that there's a hyperactivity of the HPA axis that occurs during stress, and this can eventually turn into hypoactivity after long term exposure to stressful circumstances without sufficient recovery. So from a mechanism perspective, it appears that the low levels of cortisol and DHEAS may be due to a HPA axis adaptation. So it down regulates to protect the tissues from the damaging effects of excessive cortisol rather than it being due to an inability of the adrenal gland to continue to produce adequate levels of these hormones long term. And I think that's a really fascinating area because it changes the way we look at it from adrenal fatigue, which was the old model to really a HPA access dysregulation.

Wendy McLean (08:15): Yeah, that's a really important point and a point of distinguishing that.

Brooke Schiller (08:21): Absolutely. And so that's really where burnout comes into play, is someone that's been stressed for long periods of, and the body is now going into the exhaustion phase as a protective mechanism. And as you touched on health, it's what happens during this exhaustion phase. Everything slows down due to these low levels of adrenal hormones. So energy is low, motivation is low, mood is low. Burnout is this state of complete physical, mental and emotional exhaustion. And wonderfully it's now recognised by the WHO. So this is a great step forward for classification and treatment purposes. They suggest burnout results from chronic workplace stress that has not been sufficiently managed, and it's characterised by those three key areas, feelings of energy depletion, increased mental distance from one's job, and a reduced professional efficacy.

Wendy McLean (09:23): Yeah, look, that is, it is an absolutely huge step forward by the World Health Organization and also the fact that they've renamed it as well from stress syndrome to burnout. I think that's so important because it helps to remove some of that stigma. I think a lot of people feel ashamed for having these feelings and being burnt out, feel like they can't live up to the work expectations. So I really do believe that's a huge step forward.

Brooke Schiller (09:56): Absolutely, absolutely. That's a very good point.

Wendy McLean (10:00): And I guess the other thing is, like you said, having it recognised now can help with that treatment and management, because I know previously a lot of people just treat it like a normal cold, Oh, I have a day off. I'll be right, I'll go back to work. But it's much larger than that and takes a longer time to recover.

Brooke Schiller (10:20): Absolutely. And I think people really need to know that and hear that and have that explained to them that it's not just them being lazy. There is something deeper at play here, which is causing them to have low energy.

Wendy McLean (10:37): Absolutely. And so I guess that flows on nicely to what can we actually do about stress and burnout. It's not just a case of managing it, is it? you really do need to address the root cause.

Brooke Schiller (10:51): Yes, a hundred percent. As holistic practitioners, we always need to look to the root cause. And I believe there are three root cause issues for stress that I want to discuss before we get into all of our beautiful adaptogen herbs. And they're boundary settings, mindset and resilience.

Wendy McLean (11:11): Okay, that's really interesting. So these three root causes, can you tell us a little bit more about what is boundary setting?

Brooke Schiller (11:19): Yes. So boundary setting falls in together with communication skills. And so often in consultations, clients will say to me, the stress in my job won't go anytime soon. I really understand that. And we can't all quit when something gets hard and nor should we. So the most important element of boundary setting is people feeling back in control of their lives. If you're a yes person, burnout at some point is inevitable, but if you learn what your boundaries are and how to effectively communicate them, your capacity to get through life without stress overwhelming you will greatly increase. So four tangible ways that someone can look to implement boundaries is learning when and how to say no, safeguarding their space and time. So this might look like not replying to emails in the evening or scheduling in some me time each week as they need. Number three, verbalising your needs. And lastly, I would highly recommend people seek help if they have difficulty implementing any of the above around boundaries. Psychologists are experts in that field.

Wendy McLean (12:36): That's such an important point because for many people it's not an easy thing and it does take time and practice and support. A good tip I learnt about we are constantly bombarded by emails and messages on different platforms. And so learning just to, maybe one example of boundary setting is to just have set times for checking emails, like first thing in the morning, last thing in the afternoon or at lunch, something like that. Certainly one way to look at setting boundaries.

Brooke Schiller (13:11): Definitely. I love that. I love that because as you said, people take years to learn their habits that they have today, so it can take years to unlearn. So it's not just a snap of the fingers, but something that they can work on and work toward.

Wendy McLean (13:27): And I read a great quote recently, it's learn to rest, not quit.

Brooke Schiller (13:33): Oh, I love that.

Wendy McLean (13:34): So I am trying to take that on board. Now your second one was mindset. So can you share what's mindset? What do we do there?

Brooke Schiller (13:46): Yes. So mindset is the way we perceive something. And there's a great Ted talk called How to Make Stress, Your Friend by Kelly McGonigal. It's really worth a watch. But in this talk she explains the way that we view stress can impact how it changes or how it affects our body, I suppose. So I'll briefly summarise. Kelly talked through a study done by Harvard University where participants are taught to rethink their stress response as helpful before undergoing a social stress test. So the rethink went as follows, your pounding heart is preparing you for action. If you're breathing faster, it's no problem. It's getting more oxygen to your brain. And participants who learn to view that stress response as helpful were less stressed out, less anxious, more confident, and their physical stress response changed in a beneficial way. So it really showed that how you think about stress matters.

So I'm not saying that we can just will stress away, we need to take the next step, which is action. And action can be reframed. So you can say these to yourself at the start of the day, or if you're in a stressful situation, rather than saying, I'm so stressed, there's not enough time in the day, try some of the following. So I feel energised from stress right now, which will help me through the day. I have good boundaries in place on my time, I'll do what needs to be done, the rest can wait. And it's shown that your head space and bodily reaction will be a whole lot different. So again, this one is not necessarily easy to implement, but a great goal to work towards ongoing.

Wendy McLean (15:36): Wow, you've definitely given some great pointers there. And especially I feel energised from stress trying to do that reframing into something positive. And also I do, I'll do what needs to be done. The rest can wait. Certainly something that I think a lot of people would need practice with.

Brooke Schiller (15:58): Absolutely. It's not an easy one, but an important one.

Wendy McLean (16:01): And so then your third one was resilience. So can you tell us a little bit about that?

Brooke Schiller (16:07): Yes. One my favorite areas. So resilience speaks to our ability to be in and recover from a stressful situation much quicker. So having good boundaries and good mindset helps with resilience. But there are some other tangible practices which can help. Meditation is my absolute favourite, and so many people say they can't do it, which I think is the whole point. It's really uncomfortable to sit with yourself every day. And meditation is about getting used to being uncomfortable, learning to stick at it despite the discomfort prepares you when you're confronted with an uncomfortable situation in your life, you've learned how to breathe through it and master your mind, and that helps your resilience when life gets tricky. And I'm sure everyone saw footage of the incredible Ned Brockman run from Cottesloe to Bondi and his tagline was, get comfortable being uncomfortable. And I absolutely love this from a resilient standpoint, it's just, it's bang on.

So there are some other wonderful techniques for building resilience and that can be hot and cold therapy. So finishing your showers on cold, which is another great one. Also breathing exercises and expressive journaling can be really beneficial at building up resilience. But I do want to put a little disclaimer here that if you are going through a hard time mentally seek professional help from a psychologist, I by no means want to trivialise people's circumstances. And if it feels beyond what they can manage themselves or beyond what these pointers will help with, then speak to someone who can help you with that one on one.

Wendy McLean (17:59): Absolutely Brooke. That's the most important point. And there's a lot of great resources and organisations out there as well that people can reach out to such as Beyond Blue and Lifeline. And I think another thing is to point out, people can think, oh, meditation, but there's different types of meditation, isn't there? Not just one form sitting there in silence, there's walking meditations, there's mindfulness meditation and then there's different types of breathing exercises as well. One of my favourites is the box breathing that actually the Navy Seals do, which is derived from pranayama. So I do like that.

Brooke Schiller (18:44): That one in a stressful response is so effective. Yes, I use that myself and I find it very helpful.

Wendy McLean (18:50): You don't even have to do too many cycles of it to really notice of an effect. So I guess that now leads us on nicely to what else can we do? So we've got our diet, food as medicine, lifestyle, herbs and nutrients. Tell us about some of those.

Brooke Schiller (19:09): Absolutely. I like to refer to these as our eight defenders. So we have routine, nutrition, sleep, rest, exercise, social connection, herbs and nutrients. And please don't think about them as an add to your to-do list, but really view these about structuring your life and your day. So the elements that serve you are a core part of it. And number one, I think routine comes first. So having a good routine helps to organise the chaos and makes implementing your chosen defenders much easier.

Wendy McLean (19:50): Absolutely. And I'm, there's tools I guess that can help you with a routine, isn't there? I mean there's lots of apps now as well, but I'm a fan of the old to-do list. Yeah, written hard copy diary.

Brooke Schiller (20:05): Agreed. I think I read somewhere once. Just putting three most important tasks on your to-do list as the core things that you want to try and achieve, make that also much easier to do.

Wendy McLean (20:18): Absolutely. Cause yeah, to-do list, I guess on the flip side can be overwhelming in themselves.

Brooke Schiller (20:24): Yes, a hundred percent. Number two is nutrition. And I put this second because I think it's such a great baseline for good health and supporting that stress response. In the past, I do believe that I was too busy to eat, was really seen as a badge of honour. But I think it's changing and I'm so pleased. Fasting increases cortisol, so if you're stressed and not eating, your cortisol levels are going even higher. So I highly recommend people do their best to eat regular meals even when they have a full day. My favourite sort of style of eating, if we want to talk about specifics, is looking towards the Mediterranean diet. It's lots of fresh fruit and veggies, adequate protein, oily fish, nuts and seeds, legumes, whole grains. Nice and simple.

Wendy McLean (21:17): Absolutely.

Brooke Schiller (21:19): And then this one is always very controversial when I broach it at clinic but avoid stimulants. I have had clients blown away when they've seen how much better they feel off coffee and caffeine. So I always broach it as a, not forever, but not when stressed.

Wendy McLean (21:38): Yes, I am definitely guilty of that but there's other options is in there, which you will talk about I guess when you get onto your herbs and your adaptogens, they can really help with your energy.

Brooke Schiller (21:52): Definitely, definitely. And there's so many wonderful drink replacement options these days that seems like matcha or medicinal mushroom mixes.

Wendy McLean (22:01): I do like Lion’s Mane.

Brooke Schiller (22:03): An energy boost without the damaging stimulant factor.

Wendy McLean (22:07): Yes.

Brooke Schiller (22:10): Number three is sleep. So prioritising seven to nine hours depending on how much your body needs. Again, insufficient sleep increases cortisol, so we really want to try and get those hours. And people whose stress has gone so far that they're struggling with sleep, they're having trouble with it, there are some really great herbs and nutrients that can help. We'll be going through herbs and nutrients down the track. So we'll discuss it at that point.

Wendy McLean (22:39): Great.

Brooke Schiller (22:41): Number four is rest or play. So rest is whatever you want it to be. A nap, lying on the couch, listening to a podcast in the sun, breaking out of the mindset that we need to be doing something productive all the time. And for people who struggle with rest, I think thinking of it as play can be equally restoring. So doing a puzzle or having a dip in the ocean or kicking the ball around with your child, it's all about being in the moment and switching off, which is really restorative for our nervous system.

Wendy McLean (23:16): Definitely.

Brooke Schiller (23:20): Exercise is next. So moving in a way that makes your body feel good. If people are in the exhaustion phase, I really recommend restorative exercise. So walking, yin yoga, keeping it really simple. Nothing too high energy.

Wendy McLean (23:38): Yeah, absolutely. That's important. And I think doing some of those gentle forms of exercise in nature can be even more restorative as well. So a lot of studies looking at the effects of nature and forest bathing on really calming the nervous system, benefits for immune system, reducing hypertension, those kinds of things.

Brooke Schiller (24:01): Yeah, absolutely. It is quite fascinating, isn't it? that just changing that environment can increase the beneficial impact.

Wendy McLean (24:09): Absolutely. And studies you have looked at the effects of water as well and being in the ocean.

Brooke Schiller (24:17): And you feel it like, I don't know about you, but training in a gym compared to outside, there's just a dramatic difference.

Wendy McLean (24:25): Absolutely.

Brooke Schiller (24:28): Okay, so number six is social connection. I think a good laugh fixes most things,  plus it has been shown to reduce cortisol and other stress hormones. So have a laugh with a friend, connect with people, share your challenges. Talking about things can be a real emotion diffuser and it allows you to process the event and move on. Whereas if you keep it in your head and you keep ruminating on it, it can prolong that stress response in your body.

Wendy McLean (24:57): Absolutely. And I think if there's anything we've learned from the pandemic is that importance of social connection.

Brooke Schiller (25:06): Definitely. I love Lost Connections, the book by Johann Hari. I think that's a really great read for anyone who's interested.

Wendy McLean (25:13): Definitely.

Brooke Schiller (25:17): Number seven are our beautiful herbs. So we've got quite a few categories of herbs that can help. Adaptogens, I think most people have heard of, they increase the body's resistance and adaptability to physical, emotional, or biological stresses. They include herbs such as Korean ginseng, Rhodiola, Schisandra, Shatavari, Siberian ginseng. And of course, Withania, Ashwagandha.

Wendy McLean (25:45): My favourite.

Brooke Schiller (25:45): Yeah, it's got such a wonderful reputation. Adrenal tonics are next. So they improve the tone and function of the adrenal glands. So especially beneficial when someone is in that burnout sort of phase. And they include herbs like Licorice and Rehmannia. Then nerve tonics are another great category. So they help to improve the tone and function of the nervous system, which helps to relax and energise. My absolute favorite is Skullcap but we also have the Bacopa, Oats, Schisandra and St John’s Wort.

Wendy McLean (26:28): All great herbs and I guess dosing with adaptogens throughout the day can calm the nervous system and help with sleep at night. But are there any specific herbs that you would use for sleep at night?

Brooke Schiller (26:44): Definitely, definitely. So they are called, there's a category called sedatives in herbal medicine and they can be really useful when sleep is poor. And within that category it's Passionflower, which is one of my favourites.

Wendy McLean (26:58): Me too.

Brooke Schiller (26:59): Kava, so beneficial as well. I find people respond very well to, but we also have herbs like Zizyphus and Valerian, which are excellent there too. Depends on whether someone's having trouble getting to sleep or staying asleep, which ones you go for.

Wendy McLean (27:17): That's right.

Brooke Schiller (27:20): And then lucky last, our beautiful nutrients. So magnesium is my number one responder in stressful circumstances. Our bodies use higher levels of magnesium when stressed and low levels of magnesium intensify stress. So this creates vicious cycle. Magnesium glycinate in the evening is another great one to assist with sleep.

Wendy McLean (27:45): Yes, absolutely. And I think magnesium, we burn through it when we're stressed, but I think we're also actually consuming a lot less magnesium through diet, as well, for various factors, such as processed food, declining levels in soil, those kinds of things. So yeah, you're right, it is a really important nutrient.

Brooke Schiller (28:07): Agreed, Agreed. B vitamins are another one I find really beneficial. So specifically B1, B2, B3, B5, B6, and B12. Although I generally recommend someone take a complex if they're looking to supplement with B vitamins. Yes, they help to maintain that healthy nervous system and really support the body through times of stress.

Wendy McLean (28:31): Yes

Brooke Schiller (28:33): Vitamin D is another great one and quite topical cause everyone's so sick at the moment, but it's also an antioxidant which can directly reduce levels of stress hormones in the blood and it's necessary for optimum function of our adrenal gland. And lastly, amino acids. So there are a number of amino acids that can really help to settle the nervous system and can also be quite beneficial for sleep. Looking to GABA, L-theanine and glycine.

Wendy McLean (29:05): Yes, absolutely. A great combo and combined with those nutrients and some lovely herbs as well. So important.

Brooke Schiller (29:17): Absolutely so important. And I just want people to know that they really can help. And I think when you're in that stress phase, you just keep getting on with it and you don't stop to think about how you can make the situation better. But just implementing a couple of these can really help you get through.

Wendy McLean (29:34): Absolutely. And I think some of those herbs to help with sleep. If you can even have a couple of good night’s sleep, it really can help you set you on the right path to recovery.

Brooke Schiller (29:47): Yes, agreed. Agreed. It's key, isn't it? getting a good night's sleep. So they are our three root causes and our eight defenders and I just think people keep them in mind and find out which ones work for them and then try to implement those slowly through their lives.

Wendy McLean (30:07): Yeah, absolutely. Well, Brooke, thank you so much. You've given us so many great tips today, holistic tips as well, and also really highlighting that people are not alone and there's a lot of resources out there and healthcare practitioners that can help. And there's a team of people out there that can help.

Brooke Schiller (30:31): 100%. Thank you for having me on, Wendy. I've loved it.

Wendy McLean (30:34): It's always a pleasure. Brooke, thank you so much and thank you so much for tuning into this episode today. We really do appreciate their support and feel free to give us a review. We'd love to hear from you. Thank you.