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I recently read an article in the New York Times by Melinda Wenner Moyer entitled, Your Body Knows You’re Burned Out. Having studied and written about the effect of chronic stress on the body, and particularly the digestive system, I normally wouldn’t have taken the time to read about this topic in the lay press.

But this time it was different. Several weeks ago, I started experiencing strange and unaccustomed symptoms, which were very unfamiliar to me. I found myself waking up between 2 and 4 AM every morning in a state of sympathetic arousal, including a pounding heartbeat, feeling hot and not being able to return to sleep for hours. My mind was racing in circles obsessed with loops of thoughts that I couldn’t stop thinking about. The thoughts were around unfinished projects and self-imposed challenges and deadlines. Sometimes, I found myself going to the kitchen and snacking on something in the fridge. In the morning I woke up, feeling fatigued and non-refreshed, a feeling that recurred several times during the day, sometimes so severe that it forced me to walk away from my desk to take a nap, which often lasted up to an hour.

My physical energy level was greatly reduced, preventing me from pursuing my daily 4-mile hike or going to the gym. Furthermore, my mood state fluctuated between low grade depression alternating with moments of feeling normal and energized. I became easily irritated, short-tempered and angry from minor irritations. In many ways it was the opposite body and mind experience that I have been enjoying all my life and that I have been promoting in my writings and talks.

The term burnout is a topic that I had dealt with, written, lectured about, and researched for many years, and that I remember from conversations with collaborators in Sweden many years ago. In the Swedish literature, a very similar constellation of symptoms is called exhaustion disorder which at the time was a major cause of absenteeism in Sweden. In addition to the symptoms I described above, one study of people in Sweden suffering from this syndrome found that 67% reported experiencing nausea, gas or indigestion, and that 65% had headaches. While the syndrome had already reached epidemic proportions in Sweden in the 90s, it was not perceived as a significant health problem in the US at the time. But things have changed. Especially after millions of people dealing with the constant stress caused by the pandemic and the associated worries, there have been dramatic changes in lifestyles and work habits.

According to the NYT article, the phenomenon has practically become ubiquitous in our culture as reflected by some worrisome statistics. “In a 2021 survey of 1,500 U.S. workers, more than half said they were feeling burned out as a result of their job demands, and a whopping 4.3 million Americans quit their jobs in December in what has come to be known as the “great resignation.” Similar prevalence numbers could probably identified amongst frontline healthcare workers during the pandemic, and even amongst medical students and young physicians. The World Health Organization describes burnout as a workplace phenomenon characterized by feelings of exhaustion, cynicism and reduced efficacy. But while the close bidirectional connections to the workplace experience are important, the causes for the symptoms are certainly not limited to the workplace but can arise from all aspects of life, as I’ve experienced myself.

Allostatic Load

Burnout has a lot to do with the way our brains and bodies react to different types of stress, or perturbations of normal functioning. While the acute stress response, orchestrated by an elaborate system of signaling molecules in the brain, including the molecule corticotropin releasing factor (CRF) released from the hypothalamus, synchronizes all mental and body functions to optimally respond to the stress event (like to a threatening event), evolution hasn’t really prepared us for a world of chronic, relentless, or recurrent stress exposure. The hormonal and neural responses to an acute stressor, such as transient increase in the stress hormones cortisol or epinephrine, or the transient activation of the sympathetic nervous system, quickly return to their normal levels by powerful regulatory mechanisms in the brain. However, if faced with chronic or recurring severe stress, or if the brain system determining the amount of perceived stress becomes more sensitive, stress can have wear and tear effects on the body, especially when it doesn’t ease up after a while.

The reason for this wear and tear is the fact that the brain tries to respond by putting the same ancient, and highly effective acute stress response systems into overdrive, resulting in negative consequences for the body and brain, a situation called allostatic load. One of the biological hallmarks of allostatic load is the presence of low-grade activation of the immune system throughout the body with negative health consequences for all organs, including the brain. The clinical consequences are impaired sleep, fatigue, anxiety, depression, weight changes and all the symptoms I had experienced myself.

According to the NYT article, when researchers in Italy surveyed frontline health care workers with burnout during the first peak of the pandemic, they found that 55% reported having difficulty falling asleep, while nearly 40% had nightmares. A complicating factor of insomnia can be the common habit of midnight snacking in an attempt to calm down the mind before going back to bed. In the study of Italian health care workers, 56% reported changes in food habits with both increases and decreases in food intake. Extensive research suggests that hormones released during chronic stress can affect appetite in both directions; overeating in an attempt to attenuate the stress, or feeling less hungry than usual when they’re under a lot of stress.

What Can You Do to Overcome Burnout?

When trying to get out of the hole I found myself in, one thing that became clear to me quickly was that advice from others to do mindfulness exercises, and to put less projects on my plate wasn’t enough. Here are some effective steps that I have learned in this process, which are based on a view of an interconnected system of mind and body, and which are aimed at reducing systemic immune activation:

1. Make sure you had a recent normal medical checkup and that there are no new alarm signs and symptoms. Unintentional weight loss, loss of appetite and loss of energy can also be symptoms of other physical conditions.
2. Identify all the projects that you are currently engaged in and occupied with –including but not limited to work-related deadlines, unresolved financial issues, taking care of aging parents, the realization of getting older, finding enough time for regular exercise, planned travel, socializing etc. Put all these projects into a spreadsheet or on a whiteboard, and assign numbers of priority to each, including deadlines.
3. Once you have generated such a priority list, focus on the most important one or two at a time, and try to accomplish this particular task, before embarking on another one. This will free up the memory banks in your brain and you won’t have to go through all of them every night when you can’t sleep.
4. Put your mind and body for at least 15 min once or twice a day into a meditative state by practicing abdominal breathing, progressive muscle relaxation, autogenic training, or mindful based stress reduction. Simple versions of such programs are available online and you should be able to fit them into even the busiest schedule.
5. When you awaken in the middle of the night with thoughts racing through your mind preventing you from falling asleep again, get up, read an entertaining book totally unrelated to your work and go back to sleep after an hour or so. This strategy can stop the recurring worrying thoughts and will help you to fall asleep again.
6. Sustain a reduced but daily physical exercise program, including both aerobic and weightbearing exercises. Change your daily runs to walks and your resistance training to stretching exercises. This is not the time to push yourself to your limits, but to keep your body and muscles in a healthy state of activity.
7. Now more than ever, eat a diet that is healthy for your gut, your gut microbes, and your brain. As explained many times in this blog and in my books, such a diet is largely plant-based, with a high variety of fruits and vegetables, with added fermented products. It will increase the microbial production of anti-inflammatory short chain fatty acids and will take advantage of the countless health promoting molecules contained in such foods. And don’t forget to avoid caffeinated drinks and minimize your alcohol intake. This will give your brain time for a reset without external stimulants and calming influences.

Did this program work for me? To be honest, things didn’t get better overnight. But by conscientiously sticking to this self-help program, I was able to regain my usual vitality, refreshing uninterrupted sleep and my usual excitement about life.