Find a Practitioner
Rates of burnout are undeniably skyrocketing, with 62% of Australians 5 and 70% of New Zealanders6 reporting the condition, compared to the global average of 48%. 5 Featuring core symptoms of severe mental, physical, and emotional exhaustion, loss of empathy, impaired cognition, feelings of reduced accomplishment and mood disturbances, 7 burnout negatively affects every aspect of life. While everyone can experience burnout, it is particularly common in high-stress professions such as medical practitioners 8,9 and teachers, 10 as well as in primary caregivers. Moreover, people with personality traits such as perfectionism, diligence and a work-focused persona are much more likely to develop burnout. 11 Given the prevalence of burnout, it is important that Practitioners build clinical skills to identify this condition.
Burning out, burnout, or something else?
Practitioners can use the Sydney Burnout Measure (SBM), developed by Professor Gordon Parker and colleagues, 12 to assess a patient’s current burnout status. Although there is no formal cut-off score, the authors suggest that individuals experiencing burnout would score 50 and above. Further, high scores are not exclusive to burnout, thus it is essential to use clinical reasoning to differentiate from other conditions such as depression, thyroid disorder or anaemia. The Burnout Protocol available on Metagenics Institute explores clinical diagnosis in more detail.
Once burnout is suspected, it is integral to understand the underlying drivers to enable Practitioners to support patients towards recovery.
Multiple drivers of burnout
Although our biology is built for adaptation and resilience, chronic stress is a major driver of hypothalamic-pituitary-adrenal (HPA) axis activation in burnout. Ongoing stressors lead to prolonged cortisol output and HPA axis dysfunction. Consequently, HPA axis dysfunction results in maladaptive changes in the body’s ability to adapt to stress (Figure 1) – all of which contribute to the symptoms of burnout.
Figure 1: Potential biological mechanisms of burnout. 13
SNS: Sympathetic nervous system; PSNS: Parasympathetic nervous system; HPC: Hippocampus; PFC: Prefrontal cortex; DHEA-S: Dehydroepiandrosterone sulfate.
Foundational nutrition paves the way to recovery
The best approach to support patients in their recovery from burnout is holistic treatment aimed at optimising the stress response to promote resilience.
Stress resilience is limited in the face of deficiency of key nutrients, including vitamin D 14 and iron. 15 Furthermore, chronic stress depletes vitamin C and B complex; key HPA axis supportive nutrients. A meta-analysis assessed the effects of multivitamin formulas, all of which included the B complex, on mood in a healthy cohort of 1,292 adults. 16 Supplementation significantly improved feelings of perceived stress, mild psychiatric symptoms and anxiety. Importantly, the authors concluded that the formulas with the highest doses of B vitamins provided the most statistically significant results, highlighting their importance to the stress response. Moreover, in a recent randomised controlled trial, 1,000 mg/d of vitamin C was found to significantly increase attention and work absorption, 17 factors that are diminished in burnout. Vitamins B5, B6 & C for Stress & Adrenal Health are therefore fundamental to a HPA axis under stress, supporting resilience during uncertain times.
Similarly, magnesium status is impacted by chronic stress and this mineral has been found to alleviate symptoms of stress 18 and low mood. 19 Further, acetyl-L-carnitine (ALC) reduces depressive symptoms 20 and improves mental and physical fatigue, and both ALC 21,22 and tyrosine have been shown to promote cognitive function. 23,24 Combining these ingredients, Mental and Physical Energy Powder improves energy production to provide patients support for fatigue and exhaustion.
Herbal heroes in the burnout breakthrough
Beyond foundational nutrition, herbal medicine allows individualised, targeted, symptom relief.
|
|
Rehmannia Complex for Nervous Exhaustion is a suitable option. Rehmannia glutinosa (rehmannia) and Panax quinquefolius (American ginseng) have been used extensively in traditional Chinese medicine for conditions associated with debility and fatigue due to ongoing stress and anxiety. 25 American ginseng enhances working memory, 26 while Avena sativa (wild oats) increases the speed of performing cognitive tasks and executive function. 27 Together these herbs help calm the nervous system and restore HPA axis function, improving physical and mental energy in stressed patients. |
Herbal and Nutritional Support for Adrenal Health is a suitable option. Withania somnifera (ashwagandha) has been demonstrated to significantly reduce anxiety 28 and perceived stress, 29 boost cognition 30 and enhance sleep quality. 31,32 Further, Rhodiola rosea (golden root) improves mood scores and decreases emotional instability, 33 fatigue and cognitive impairment, 34 while Panax ginseng (Korean ginseng) aids cognitive performance 35 and ameliorates mental fatigue. 36,37 These synergistic herbs uplift fatigued patients, while improving cognition and HPA axis regulation. |
Given the impact of personality traits and life stressors in the aetiology of burnout, therapy is an important part of recovery. Therapeutic approaches like cognitive behavioural therapy (CBT) 38,39 and acceptance and commitment therapy (ACT) 40 have been found to reduce symptoms of burnout and should be considered for patient care.
Helping patients to reignite their flame
Although the prospect of reigniting the flame following burnout may seem bleak, Practitioners can support patients to rekindle their inner light. Foundational nutrition including Vitamins B5, B6 & C for Stress & Adrenal Health and Mental and Physical Energy Powder support stress resilience, while Rehmannia Complex for Nervous Exhaustion or Herbal and Nutritional Support for Adrenal Health provide individualised symptom relief. Together with therapy from a suitable, registered therapist, these combinations can have patients well on the road to recovery.
For more information on burnout visit metagenicsinstitute.com.au or metagenicsinstitute.co.nz, or contact our Clinical Support team on 1800 777 648 (Australia) or 0508 227 744 (New Zealand).
References
- 1. Curtin AC, Johnston CS. Vitamin B6 supplementation reduces symptoms of depression in college women taking oral contraceptives: a randomized, double-blind crossover trial. J Diet Suppl.2023;20(4):550-562. doi:10.1080/19390211.2022.2030843
2. Ramachandran HJ, Mahmud MSB, Rajendran P, Jiang Y, Cheng L, Wang W. Effectiveness of mindfulness‐based interventions on psychological well‐being, burnout and post‐traumatic stress disorder among nurses: a systematic review and meta‐analysis. J Clin Nurs. 2023;32(11-12):2323-2338. doi:10.1111/jocn.16265
3. Wang H, Jin M, Xie M, et al. Protective role of antioxidant supplementation for depression and anxiety: a meta-analysis of randomized clinical trials. J Affect Disord. 2023;323:264-279. doi:10.1016/j.jad.2022.11.072
4. Rojas B, Catalan E, Diez G, Roca P. A compassion-based program to reduce psychological distress in medical students: A pilot randomized clinical trial. PLOS ONE. 2023;18(6):e0287388. doi:10.1371/journal.pone.0287388
5. Tamaray P. Australian employees suffer mass burnout. Published October 4, 2022. Accessed July 20, 2023. https://www.hcamag.com/au/specialisation/mental-health/australian-employees-suffer-mass-burnout/422659#:~:text=The%20latest%20Microsoft%20Work%20Trend,average%20of%2048%25%20of%20employees
6. Bergh R van den. NZ workers are more likely to suffer burnout than in any other country - report finds | Stuff.co.nz. Published May 24, 2023. Accessed July 20, 2023. https://www.stuff.co.nz/business/132127430/nz-workers-are-more-likely-to-suffer-burnout-than-in-any-other-country--report-finds#:~:text=New%20Zealand%20workers%20are%20more,59%25%2C%20the%20report%20said.
7. Parker G, Tavella G. Is burnout simply a stress reaction? Australian New Zealand J Psychiatry. 2022;56(9):1065-1067. doi:10.1177/00048674211070221
8. Matthews RP, Hyde RL, Llewelyn F, Shafiei T, Newton MS, Forster DA. Who is at risk of burnout? A cross-sectional survey of midwives in a tertiary maternity hospital in Melbourne, Australia. Women Birth. 2022;35(6):e615-e623. doi:10.1016/j.wombi.2022.02.010
9. Hoffman R, Mullan J, Bonney A. “A cross-sectional study of burnout among Australian general practice registrars.” BMC Méd Educ. 2023;23(1):47. doi:10.1186/s12909-023-04043-4
10. Carroll A, Forrest K, Sanders-O’Connor E, et al. Teacher stress and burnout in Australia: examining the role of intrapersonal and environmental factors. Soc Psychol Educ. 2022;25(2-3):441-469. doi:10.1007/s11218-022-09686-7
11. Martin SR, Fortier MA, Heyming TW, et al. Perfectionism as a predictor of physician burnout. BMC Heal Serv Res. 2022;22(1):1425. doi:10.1186/s12913-022-08785-7
12. Parker G, Tavella G, Eyers K. Burnout: A Guide to Identifying Burnout and Pathways to Recovery. Allen & Unwin; 2021.
13. Bayes A, Tavella G, Parker G. The biology of burnout: causes and consequences. World J Biological Psychiatry. 2021;22(9):686-698. doi:10.1080/15622975.2021.1907713
14. Roy S, Sherman A, Monari-Sparks MJ, Schweiker O, Hunter K. Correction of low vitamin D improves fatigue: effect of correction of low vitamin D in fatigue study (EViDiF Study). North Am J Medical Sci. 2014;6(8):396-402. doi:10.4103/1947-2714.139291
15. Kapoor MP, Sugita M, Kawaguchi M, et al. Influence of iron supplementation on fatigue, mood states and sweating profiles of healthy non-anemic athletes during a training exercise: a double-blind, randomized, placebo-controlled, parallel-group study. Contemp Clin Trials Commun. 2023;32:101084. doi:10.1016/j.conctc.2023.101084
16. Long SJ, Benton D. Effects of vitamin and mineral supplementation on stress, mild psychiatric symptoms, and mood in nonclinical samples. Psychosom Med. 2013;75(2):144-153. doi:10.1097/psy.0b013e31827d5fbd
17. Sim M, Hong S, Jung S, et al. Vitamin C supplementation promotes mental vitality in healthy young adults: results from a cross-sectional analysis and a randomised, double-blind, placebo-controlled trial. Eur J Nutr. doi:10.1007/s00394-021-02656-3
18. Pouteau E, Kabir-Ahmadi M, Noah L, et al. Superiority of magnesium and vitamin B6 over magnesium alone on severe stress in healthy adults with low magnesemia: a randomized, single-blind clinical trial. Plos One. 2018;13(12):e0208454. doi:10.1371/journal.pone.0208454
19. Tarleton EK, Littenberg B, MacLean CD, Kennedy AG, Daley C. Role of magnesium supplementation in the treatment of depression: a randomized clinical trial. Plos One. 2017;12(6):e0180067. doi:10.1371/journal.pone.0180067
20. Veronese N, Stubbs B, Solmi M, Ajnakina O, Carvalho AF, Maggi S. Acetyl-L-carnitine supplementation and the treatment of depressive symptoms. Psychosom Med. 2018;80(2):154-159. doi:10.1097/psy.0000000000000537
21. Vermeulen RCW, Scholte HR. Exploratory open label, randomized study of acetyl- and propionylcarnitine in chronic fatigue syndrome. Psychosom Med. 2004;66(2):276-282. doi:10.1097/01.psy.0000116249.60477.e9
22. Malaguarnera M, Gargante MP, Cristaldi E, et al. Acetyl l-carnitine (ALC) treatment in elderly patients with fatigue. Arch Gerontol Geriat. 2008;46(2):181-190. doi:10.1016/j.archger.2007.03.012
23. Steenbergen L, Sellaro R, Hommel B, Colzato LS. Tyrosine promotes cognitive flexibility: evidence from proactive vs. reactive control during task switching performance. Neuropsychologia. 2015;69:50-55. doi:10.1016/j.neuropsychologia.2015.01.022
24. Bloemendaal M, Froböse MI, Wegman J, et al. Neuro-cognitive effects of acute tyrosine administration on reactive and proactive response inhibition in healthy older adults. eNeuro. 2018;5(2):ENEURO.0035-17.2018. doi:10.1523/eneuro.0035-17.2018
25. Chen R, Moriya J, Yamakawa J ichi, Takahashi T, Kanda T. Traditional Chinese medicine for chronic fatigue syndrome. Evidence-based Complementary Altern Medicine Ecam. 2010;7(1):3-10. doi:10.1093/ecam/nen017
26. Scholey A, Ossoukhova A, Owen L, et al. Effects of American ginseng (Panax quinquefolius) on neurocognitive function: an acute, randomised, double-blind, placebo-controlled, crossover study. Psychopharmacology. 2010;212(3):345-356. doi:10.1007/s00213-010-1964-y
27. Kennedy DO, Jackson PA, Forster J, et al. Acute effects of a wild green-oat (Avena sativa) extract on cognitive function in middle-aged adults: a double-blind, placebo-controlled, within-subjects trial. Nutr Neurosci. 2017;20(2):135-151. doi:10.1080/1028415x.2015.1101304
28. 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. 2019;98(37):e17186. doi:10.1097/md.0000000000017186
29. Choudhary D, Bhattacharyya S, Joshi K. Body weight management in adults under chronic stress through treatment with ashwagandha root extract. J Evidence-based Complementary Altern Medicine. 2016;22(1):96-106. doi:10.1177/2156587216641830
30. Choudhary D, Bhattacharyya S, Bose S. Efficacy and safety of ashwagandha (Withania somnifera (L.) dunal) root extract in improving memory and cognitive functions. J Diet Suppl. 2017;14(6):1-14. doi:10.1080/19390211.2017.1284970
31. Cheah KL, Norhayati MN, Yaacob LH, Rahman RA. Effect of Ashwagandha (Withania somnifera) extract on sleep: a systematic review and meta-analysis. PLoS ONE. 2021;16(9):e0257843. doi:10.1371/journal.pone.0257843
32. Langade D, Thakare V, Kanchi S, Kelgane S. Clinical evaluation of the pharmacological impact of ashwagandha root extract on sleep in healthy volunteers and insomnia patients: a double-blind, randomized, parallel-group, placebo-controlled study. J Ethnopharmacol. 2021;264:113276. doi:10.1016/j.jep.2020.113276
33. Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malmström C, Panossian A. Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression. Nord J Psychiat. 2009;61(5):343-348. doi:10.1080/08039480701643290
34. Lekomtseva Y, Zhukova I, Wacker A. Rhodiola rosea in subjects with prolonged or chronic fatigue symptoms: results of an open-label clinical trial. Complementary Medicine Res. 2017;24(1):46-52. doi:10.1159/000457918
35. Reay JL, Scholey AB, Kennedy DO. Panax ginseng (G115) improves aspects of working memory performance and subjective ratings of calmness in healthy young adults. Hum Psychopharmacol: Clin Exp. 2010;25(6):462-471. doi:10.1002/hup.1138
36. Reay JL, Kennedy DO, Scholey AB. Effects of Panax ginseng, consumed with and without glucose, on blood glucose levels and cognitive performance during sustained ‘mentally demanding’ tasks. J Psychopharmacol. 2006;20(6):771-781. doi:10.1177/0269881106061516
37. Reay JL, Kennedy DO, Scholey AB. Single doses of Panax ginseng (G115) reduce blood glucose levels and improve cognitive performance during sustained mental activity. J Psychopharmacol. 2005;19(4):357-365. doi:10.1177/0269881105053286
38. Ghasemi F, Herman KC, Reinke WM. A cognitive-behavioral approach to teacher burnout: a randomized controlled trial of a group therapy program. Anxiety, Stress, Coping. 2023;36(4):533-541. doi:10.1080/10615806.2022.2103118
39. Ghasemi F. A randomized controlled trial of an adapted group cognitive-behavioral therapy for burned-out teachers. Psychother Res. 2023;33(4):494-507. doi:10.1080/10503307.2022.2131476
40. Lappalainen P, Pakkala I, Strömmer J, Sairanen E, Kaipainen K, Lappalainen R. Supporting parents of children with chronic conditions: a randomized controlled trial of web-based and self-help ACT interventions. Internet Interv. 2021;24:100382. doi:10.1016/j.invent.2021.100382
