Are You Rundown with Burnout? How Relentless Stress Damages Our Health and What to Do About It

Burnout is real and it’s particularly present in this COVID-19 era. Naturopathic doctor Amy Rothenberg, ND reviews the impact of ongoing stress and what you can do to support the body to avoid burnout or avoid it.

There was an apropos article in the New York Times earlier this year about how the pandemic did something unexpected to a lot of people – it put them in a state of languishing. [1] Sadly, instead of flourishing or being at the peak of well-being or thriving, people feel joyless, unmotivated, stagnating and empty. It’s better known as burnout.

There has never been another time in my 35-year career when I have felt more people under so much stress for longer periods of time. Even before COVID-19 hit our communities, these last years of constant access to work, social media, the news cycle, issues of climate and environmental change created a backdrop of vulnerabilities that allowed COVID to reveal or exacerbate imbalances and illnesses across the physical, emotional and cognitive landscape for so many people.

This has me thinking about the role of stress, and especially chronic stress, on the health of my patients. For many people, those who had COVID-19 and those who have not, negative health outcomes from the far-reaching stress of the pandemic continue. Now when one adds grief over loss of loved ones, the inability to be with family and friends because of varying degrees of COVID-19 restrictions, loss of work and income, changes in school and other routines, the level of anxiety continues to rise.

Stress, Body Burnout and Bounce Back

With unrelenting stress, our capacity for adaptation is compromised. We’re not bouncing back like we used to because we have not had the chance to heal. Chronic stress leads the hypothalamus gland to stimulate the adrenal glands, which in turn generate and release adrenaline and cortisol. These hormones raise heart rate, blood pressure, respiratory rate, and glucose levels and, sadly, also lower immune function, all of which create risk factors for numerous symptoms and diagnoses.  Some people use the term adrenal burnout, which is not an accepted concept in the conventional medical world, but it sure does seem to sum up how many people are feeling.

It’s important to underscore that the way stress impacts any individual relates to their susceptibility, which is influenced by many factors including genetics, coping skills, personality, racism and access to support systems. Some stress can be good, for instance stimulating immune function, or sharpening focus, but too much has the opposite effect. Studies show that chronic stress may also lead to the release of histamine, which can cause allergy symptoms and asthma and rashes. [2]  

Psychological stress also alters insulin metabolism and sensitivity, one risk factor for developing diabetes. Stress also affects stomach acids, which can lead to all manner of digestive complaints. It’s also known that ongoing stress contributes to arterial plaque buildup worsened by a high-saturated fat diet and being sedentary This is also known as the Standard American Diet (SAD), which research show is associated with long-term stress that suppresses natural killer (NK) cells, and are important for many reasons, key among them, to prevent cancer metastasis.

Beyond physical ailments, we know that unmitigated and ongoing stressful times are contributing or aggravating factors for depression, anxiety, irritability, and insomnia. All elements of our health are intertwined, that’s why whole person, natural medicine approaches are key to healing, especially now. They offer a fresh perspective on the treatment of stress and how it relates and impacts the human condition. 

Though seemingly more common and stronger of late, emotions and the presence of stress are normal parts of life and need to be given time and attention. We are ever more aware that adverse events of childhood, income challenges and being an immigrant and/or a person of color, create additional kinds of stress. Stress is not meted out evenly across zip codes or populations. Indeed, racism, long a public health crisis, has been further highlighted by the pandemic.[3]

Yes, You Can Overcome the Relentlessness of Stress and Burnout

In the book, Burnout- The Secret to Unlocking the Stress Cycle,[4] Emily and Amelia Nagoski do a wonderful job describing the neurobiology of the stress cycle. They write about how every emotion has a beginning, a middle, and an end. You have to feel your emotion and get through it in order to move on. The authors suggest (and I concur entirely) that there are many ways to process emotions including: talking about them, having a good cry, doing regular deep breathing exercises, sharing a caring hug, having a deep belly laugh, getting physical exercise, doing something creative like writing, drawing or singing etc., and feeling like you are connected and have the support of family and friends.

I would add to this, the importance of spending time outdoors, in greenspaces at parks or in the woods. The more we study the need for time outdoors, the more we see its positive impact on overall health.[5]  Television, computers, the internet, and video games have become a fallback activity for many children and adults and we’re missing out on the essential role of sunshine, greenspace and time away from screens. Feeling all the way through, especially the more challenging emotions, is one clear way to keep moving forward. See below for more on the Institute for Natural Medicine’s eBook on Nature Bathing in Nature as Healer, Get Outside for Better Health.

What are the best ways to support yourself of a person who is burned out or languishing? Will these feelings ever go away? Is there such a thing as adrenal exhaustion? Or adrenal burnout?

The conventional medical literature says no, but we certainly have patients who feel exhausted, have complaints across the physical, emotional and cognitive spheres and seem to experience their problems at least in part, as fallout from chronic stress.[6] There are a number of tools to consider when seeking help for the physical and physiological damage caused by stress.

Nine Natural Necessities to Address Burnout and Adrenal Fatigue:

1.   A healing, anti-inflammatory, appropriate-for-you diet is often key, while addressing any nutritional deficiencies or potential food sensitivities. Work toward balancing blood sugar levels as you are able, by reducing frequent snacking and cutting down on or eliminating refined sugars, refined carbohydrates and alcohol.

2.   Adequate hydration helps and remains easier for some people than others. For my under-hydrated patients, I ask them to set out four small juice glasses of water as a starting goal and we work up from there. We’re aiming for half a person’s weight in ounces. It’s amazing how being adequately hydrated can help many people feel better. I recommend herbal teas or diluted fruit juice, lemon or lime in water as ways to make water a bit more inviting for those who are not big fans.

3.   Sufficient, regular and restful sleep, which is just a handful of words to write but an enormous mountain of a challenge for some. Naturopathic doctors have a broad range of recommendations to help you sleep better.

4.   Exercise as tolerable and I would say for most people more is better, with the caveat that over-exercising, or being exercise-bulimic itself is another contributing factor to feeling overwhelmed and unwell, so check in with yourself about that and seek help if you feel you over exercise as a rule.

By and large I encourage and work to get most of my patients moving more, not less, and remind people that exercise comes in three parts: aerobic, weight lifting and stretching. Exercise is one of the best ways to blow off steam, clear the mind, sweat out natural toxins related to typical metabolism, improve sex drive and help with sleep. Research also shows that it improves quality of life and delays the onset of more than 40 chronic ailments! [7]

5.   Individualized nutritional supplementation or botanical medicines may be called for to address specific or synergistic biochemical issues. The main ones here include:

a.    Vitamin C for its many roles related to improving energy and reducing overall inflammation[8],

b.   Vitamin B Complex for its roles related to stress and cognition.

c.    Adaptogenic herbs like Ashwagandha and Rhodiola. Each address both mental and physical fatigue.[9, 10, 11]

d.   Licorice root (Glycyrrhiza glabra) is another wonderful plant-based medicine that among many of its biological activities, supports adrenal function.[12]  Use deglycyrrhizinated protects which do not raise blood pressure, often abbreviated to DGL.

e.    Curcumin (Curcuma longa), one of the bioactive compounds in turmeric (INM Ingredient of the Month), has so many positive attributes as a culinary and medicinal herb from being anti-inflammatory to carrying anti-oxidant impact. Studies show it also improves overall quality of life.[13]

f.     There are many others, potentially prescribed for particular symptoms or underlying conditions. Consider working with a licensed naturopathic doctor to help tailor a whole-person plan for you. NDs take time to understand how you feel contextualized within the rest of your life.

6.   Body-mind approaches to help normalize an activated stress response are often in order, to be practiced regularly, so that when especially needed, they are there for you to use! Think here about breathing techniques, mindfulness meditation, Qigong, yoga and hobbies such as art, music and even building model airplanes, anything really that helps you relax.[1] [2] [3] 

7.    Simplifying your home and work space a la Marie Kondo. From her website: “The KonMari Method™ encourages keeping only those things that speak to the heart. Discard items that have outlived their purpose; thank them for their service – then let them go. People around the world have been drawn to this philosophy not only due to its effectiveness, but also because it places great importance on being mindful, introspective and forward-looking.”

8.    But you should think more broadly too, not just about material possessions, but about what you are trying to accomplish on any given day. Sometimes we put too much pressure on ourselves to get through the to-do lists, to produce, to be productive, as if we were human doings instead of human beings! A tremendous amount of stress can be alleviated by literally doing less. I know it’s counter-intuitive, but for some of you reading this, you will know exactly what I mean!

9.   There are older, whole person medicines to consider in homeopathy and acupuncture for addressing the oftentimes complex complaints associated with being burned out or feeling overly stressed. Constitutional homeopathy is by definition individualized to the patient. A remedy can address the impact of stress, whether stressors aggravate underlying PMS[14] or insomnia or bring on anxiety and can and also raise your  threshold for feeling stress so you are less susceptible to the same interaction, news, experience, person or place.[15,16] Acupuncture has a long history of helping patients with overall energy level, anxiety and stress, as well as numerous physical complaints that cause pain and discomfort.[17,18,19] For most patients, the experience of having a homeopathic case or acupuncture treatment are both interesting and relaxing. Look for an experienced provider for either of these approaches.

I welcome conversations with patients to help identify what the most stressful things are in their lives and to appreciate that there’s the stress and then there’s the stress response.  I invite you to work with both ends of this equation. Firstly, to think about ways you might actually reduce your stress, whether letting go of a difficult relative, shifting the work schedule, or adjusting expectations from family members. Then there are all the approaches listed above to help let go and process the stress response. Addressing both makes good sense.

We also need to address any underlying chronic disease states and do our best to mitigate or perhaps reverse those ailments. Depression, overwhelm and burnout are not uncommon side effects of chronic disease but it’s circular too, as stress and depression put us more at risk for certain ailments.

For many patients who are languishing or burned out or have what they consider adrenal fatigue, it will be a long unwinding back to health. But whole-person natural medicines that address root cause, stimulate the body’s inherent healing capacity, and work to reverse the role of chronic stress, can all help. Taking stock and welcoming change plays a role here too, to help people feel better and handle stress without all its undue impacts.

If you haven’t yet seen INM’s Nature Bathing eBook, it taps into the knowledge of naturopathic doctors and experts to help you get the most out of your time in nature. In this eBook you will learn the art and science of shinrin-yoku or “forest bathing.” The practice allows one to take in the forest atmosphere as an antidote to modern societal burnout and to inspire us to reconnect with nature and forests. Download here at our content partners website at Better Nutrition.


[1] https://www.nytimes.com/2021/04/19/well/mind/covid-mental-health-languishing.html

[2] Salleh MR. Life event, stress and illness. Malays J Med Sci. 2008 Oct;15(4):9-18. PMID: 22589633; PMCID: PMC3341916.

[3] https://amy-44829.medium.com/racism-is-a-serious-threat-to-the-publics-health-says-rachel-walensky-md-mph-director-of-the-7ba8722a5935

[4] Nagoski, Amelia, Nagoski, Emily ( 2021) Burnout-The Secret to Unlocking the Stress Cycle. Random House Publishing Group.

[5] Hartig T, Mitchell R, de Vries S, Frumkin H. Nature and health. Annu Rev Public Health. 2014;35:207-28.

[6] Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC: 10.1186/s12902-016-0128-4. Erratum in: BMC Endocr Disord. 2016 Nov 16;16(1):63. PMID: 27557747; PMCID: PMC4997656.

[7] Ruegsegger GN, Booth FW. Health Benefits of Exercise. Cold Spring Harb Perspect Med. 2018 Jul 2;8(7):a029694

[8] Tardy AL, Pouteau E, Marquez D, Yilmaz C, Scholey A. Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence. Nutrients. 2020 Jan 16;12(1):228..

[9] Ibid.

[10] Lopresti AL, Smith SJ, Malvi H, Kodgule R. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine (Baltimore). 2019 Sep;98(37):e17186.

[11] Edwards D, Heufelder A, Zimmermann A. Therapeutic effects and safety of Rhodiola rosea extract WS® 1375 in subjects with life-stress symptoms–results of an open-label study. Phytother Res. 2012 Aug;26(8):1220-5.

[12] Yang R, Wang LQ, Yuan BC, Liu Y. The Pharmacological Activities of Licorice. Planta Med. 2015 Dec;81(18):1654-69.

[13] Hewlings SJ, Kalman DS. Curcumin: A Review of Its Effects on Human Health. Foods. 2017 Oct 22;6(10):92.

[14]Danno K, Colas A, Terzan L, Bordet MF. Homeopathic treatment of premenstrual syndrome: a case series. Homeopathy. 2013 Jan;102(1):59-65.

[15] Naudé DF, Stephanie Couchman IM, Maharaj A. Chronic primary insomnia: efficacy of homeopathic simillimum. Homeopathy. 2010 Jan;99(1):63-8.

[16] Danno K, Colas A, Terzan L, Bordet MF. Homeopathic treatment of premenstrual syndrome: a case series. Homeopathy. 2013 Jan;102(1):59-65.

[17] Danno K, Colas A, Terzan L, Bordet MF. Homeopathic treatment of premenstrual syndrome: a case series. Homeopathy. 2013 Jan;102(1):59-65. doi: 10.1016/j.homp.2012.10.004. PMID: 23290881.

[18] Schroeder S, Burnis J, Denton A, Krasnow A, Raghu TS, Mathis K. Effectiveness of Acupuncture Therapy on Stress in a Large Urban College Population. J Acupunct Meridian Stud. 2017 Jun;10(3):165-170. doi: 10.1016/j.jams.2017.01.002. Epub 2017 Jan 16. PMID: 28712475.

[19] Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, Irnich D, Witt CM, Linde K; Acupuncture Trialists’ Collaboration. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018 May;19(5):455-474.


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Deb Hubers

Debra Hubers is a serial entrepreneur and has started seven businesses; ranging from an advanced genomics to an employer health care purchasing cooperative. Deb has over 35 years of experience in healthcare finance, education, technology, and pharmacogenomics.

Ms. Hubers has dedicated her career to measuring and improving healthcare outcomes. Her expertise is leveraging technology to deliver personalized, preventative medicine. Ms. Hubers co-founded La Vita Compounding Pharmacy in 2007. Collaborating with her business partner, physicians and strategic partners, Deb has grown La Vita to be one of the most respected and sought-after personalized medicine providers on the west coast. She is also Co-Founder of EpigeneticsRx, a leading provider of precise, personalized, prevention which positively impacts genetic expression.

Alex Keller, ND

Dr. Alex Keller, ND, AFMCP is a graduate of the University of Ottawa with an Honours Bachelor in Health Sciences and Psychology. Although originally intending to attend conventional medical school, following a three-month volunteer internship at a rural Kenyan hospital where he observed how doctors used local food to treat patients, he shifted his career goals and pursued a degree in naturopathic medicine at the Canadian College of Naturopathic Medicine in Toronto.

After one year of practicing with the esteemed Dr. Chris Pickrell, ND, RH in a community acupuncture setting, in 2015 he and his wife Dr. Jenn Keller, ND moved to rural Ottawa, Canada where they started an organic farm and retreat center. In the same year, Alex and his athletic therapist sister Jess Keller combined their practices to form Keller Active Health, an integrative physical therapy clinic.

Ever curious and passionate about the education of evidence-based natural medicine, in 2017, Dr. Keller joined a fledgling Ottawa-based health tech startup named Fullscript. He serves as its Medical Director and oversees the development of medical education content for practitioners across North America.

Prior to medicine, Alex worked in the renewable energy sector, where he developed a deep passion for sustainable agriculture and environmental stewardship. This connection between medicine and agriculture now drives Alex to focus much of his energy on bringing awareness to the quality and sourcing standards in the supplement and organic agriculture supply chains.

Today, he splits his professional time practicing as a clinician, working for Fullscript, and expanding the farming operation while chasing his kids with Jenn and occasionally running ultra-marathon trail races. He is also currently completing an Executive MBA through the Quantic School of Business & Technology with a focus on supply chain innovation.

Pamela Snider, ND

Pamela Snider, ND, is Executive and Senior Editor for the Foundations of Naturopathic Medicine Project, producing a first of its kind international textbook of Naturopathic medicine through a series of international retreats and symposia. A nationally recognized integrative health and policy leader, she is active in both national and regional integrative health initiatives. Dr. Snider serves on the Board of Directors, was founding Executive Director and co-founder of the Academic Consortium for Integrative Health (ACIH/ACCAHCa consortium of the councils of schools, accrediting agencies and certifying bodies of the licensed, traditional and emerging integrative health professions, and is currently Vice Chair and co-founder of the Integrative Health Policy Consortium (IHPC).  Dr. Snider served as a founding Board Member of the Academy of Integrative Health & Medicine from 2014-2016. Her public policy work includes completing a two year appointment to the DHHS Center For Medicaid and Medicare Services (CMS) Medicare Coverage Advisory Committee (MCAC); serving as a Steering Committee Member for  the HRSA funded American College of Preventive Medicine NCCIM Integrative Medicine in Preventive Medicine Residency program, co-directing in USPHS Region X the Building Bridges Between Provider Communities Group, an exploration of interdisciplinary collaboration and common ground between public health and CAM; serving for 22 years on Washington State’s Health Professional Loan Repayment and Scholarship Program Advisory Committee (HPLRSP); providing technical assistance to and developing key language for the enabling legislation for NIH Center for Complementary and Alternative Medicine (NCCIH/NCCAM); and staffing Joseph Pizzorno ND during his appointment as Commissioner on the White House Commission on CAM Policy.

From 1994-2003, Dr. Snider served as Associate Dean for Public and Professional Affairs and Naturopathic Medicine at Bastyr University, dividing her work between academic and public affairs activities, including chairing the Naturopathic Medicine Program Curriculum Review Committee.  Dr. Snider has been teaching, publishing and lecturing widely on Naturopathic philosophy, theory integrative health, public policy, and other topics for over 30 years. Currently, an Associate Professor at National University of Natural Medicine (NUNM) in Portland, OR, Dr. Snider also continues at Bastyr University in her 22nd year as a faculty member teaching naturopathic medicine history, clinical theory, and global context. Among her Naturopathic medicine professional roles she serves on the Institute for Natural Medicine’s Leadership Council.  In 1989, she co-led the naturopathic profession with Dr. Jared Zeff, in developing a unifying definition of naturopathic medicine and its principles of practice adopted unanimously by the American Association of Naturopathic Physicians (AANP) House of Delegates. She was a co-investigator in the 2004 NIH NCCAM research study, the North American Naturopathic Medical Research Agenda and CAM Advisor in NIHCCAM’s Financing Integrative Health Care (University of Washington).  Her areas of experience include healthcare education; naturopathic and interdisciplinary clinical theory, curriculum development; clinical practice; government and legislative affairs, public policy, interdisciplinary collaboration, and community organizing.  Dr. Snider has received the Ontario Naturopathic Physician of the Year Award, the Physician of the Year Award from the AANP, the President’s Outstanding Vision Award and Distinguished Alumnus Award at Bastyr University, AANP’s President’s Award, an honorary Doctorate of Naturopathic Philosophy from the Canadian College of Naturopathic Medicine (CCNM), the William A Mitchell Vis Award from the AANP and The Gathering – NMSA’s Beacon Award. She received her ND degree in 1982 from Bastyr University of Natural Health Sciences and is a licensed naturopathic physician in the State of Washington. She lives with her husband and children at their homestead in North Bend Washington, in the beautiful mountain to sea landscape and home of The Revival – Restore the Vis, an annual student-led community gathering.

Susan Haeger

Susan Haeger is Founder/Principal of Transformative Health Solutions Inc. She has applied her twenty plus years in executive leadership to help shape and drive adoption of progressive health policy for whole person healthcare. She was a section contributor to the 2021 INM/AANP published professional white paper, Naturopathic Physicians as Whole Health Specialists: The Future is Whole Person Health Care that provides supporting evidence for the profession’s significant and unique contributions to preventive, whole person care and models of integrative clinical practice.

Bruce Barlean

Bruce Barlean is an owner and founder of Barlean’s, a global dietary supplement manufacturer located in the Pacific Northwest in Ferndale, WA. Bruce has been actively involved in the Natural Products industry since 1989 and is passionate about making a difference in the world and positively impacting the lives of others.

Bruce believes that people can make a difference in the world through ordinary purchases. He is committed to improving the quality of life for every person on the planet by making the best products and by using the profits to support outreach programs. Bruce summarizes it simply, “We make good stuff to do good stuff”.

In the late 1980’s Bruce became passionate about how health could be dramatically improved with Flax Oil Supplementation. Bruce along with his entrepreneurial parents saw the potential to improve the lives of many people and in 1989 they began selling Flax Oil under the Barlean’s name. From 1989 – 2000 the business grew an average of 40% year over year. While most companies saw a decline in business in the 2001 recession, Barlean’s continued to grow and soon became America’s #1 selling flaxseed oil and continues to be to the present. The brand has since expanded to include additional oils, green food concentrates and other premium supplements. Bruce continues to drive innovation and over the years his products and company have won countless awards including: Eight consecutive Vity Awards for #1 EFA, Six consecutive Vity Awards for #1 Greens Food Supplement, Natural Choice Award for Best Specialty Supplement, Best Product of the Year, Best New Product, Gold Medal Taster’s Choice Award, Gold Medal American Masters of Taste Award, #1 Health Food Store Brand for Consumer Satisfaction by Consumer Lab, and Manufacturer of the Year.

In 2013 as the company was on the eve of celebrating the 25th year in business Bruce and his parents decided to take their desire to help people to a new level that they call Pathway to a Better Life – which is now seen in the Barlean’s logo. Bruce and his parents had always been generous in their giving and support of charities, but as part of the Pathway to a Better Life they decided to increased partnership with charitable organizations such as: Vitamin Angels, Compassion International, KidsTown International, Autism Hope Alliance, Engedi Refuge, Project 92, and others. And because so many people are unable to meet basic nutritional needs, Bruce created a comprehensive Omega-3 and multivitamin formula that he distributes free-of-charge to local food banks. In addition, Bruce decided the company would supply food banks with organic coconut oil to provide people with a health alternative to standard cooking oils.

Always generous with his time Bruce has served as a youth leader for his local church for several years and continues to mentor youth. He has been on several not for profit boards including; Whatcom County Pregnancy Center (2003-2006), Natural Products Association (dates?), and the Institute for Natural Medicine Leadership Council (presently).

The Barlean family have been avid supporters of Bastyr University since the 1990’s and in 2013 were given Bastyr’s most prestigious honor, the Mission Award, which recognizes their leadership over time in improving the health and well-being of the human community.

Bruce currently resides in Ferndale, WA with his wife Lisa and their two dogs: Heinz & Shadow. When he’s not helping others he can be found fishing (catch & release).

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Michelle Simon, PHD, ND

President & CEO

As president and CEO of INM, Dr. Simon brings her passion for working with organizations dedicated to improving the quality and delivery of healthcare. This desire stems from her years of practice as a licensed naturopathic physician. In addition to holding a Naturopathic Doctorate from Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill.

She has served on boards for the American Association of Naturopathic Physicians (AANP), the Naturopathic Physicians Research Institute (NPRI), and several advisory boards. Dr. Simon served nine years on the Washington State Health Technology Clinical Committee, as Ambassador to the Academy of Integrative Health and Medicine (AIHM) and was recognized as 2018 AANP Physician of the Year. Dr. Simon shares with her husband a passion for adventure travel, preferably by boat or motorcycle. She also enjoys teaching a women’s off-road motorcycling class.