General Adaptation Syndrome is one of the hall markers of modern-day life for many people. 

Unfortunately, it is the exhaustion stage of this cycle rather than the Alarm and Resistance stages that brings people to seek holistic support. As we know, the driving factors of this syndrome include nutrient deficiencies and the inflammatory cascade that dysregulates biochemical pathways in the body while reducing the function of the endocrine and nervous systems. However, a reality exists that for most people, this picture is only half the concern and as practitioners we must have an open and collaborative relationship that offers an effective treatment strategy while simultaneously directing our clients to additional support for the mechanisms that are outside our scope to change.

Presenting Symptoms

In this case a 39 year old female presented with extreme early evening fatigue marked with fluctuating pictures of insomnia. The patient experienced either sleep onset insomnia (despite tiredness), or once asleep would reawaken within 30 minutes and remain awake for a further three hours. She described this as ‘missing her window’ each evening, feeling so tired she could sleep at 6pm, however three hours later she felt wide awake, preventing a smooth transition to sleep. During periods of wakefulness at night she reported feeling anxious. This cycle would repeat during the night resulting in morning fatigue, and feeling ‘wired’ the next evening. Her aim for treatment was to achieve a regular energy pattern throughout the day and consistent sleep at night.

Systems Review

The patient reported frequently feeling cold, with very cold hands and feet. She would tire easily from minimal exercise, experiencing dizziness which prevented her partaking in workouts that required inversion of any nature. She recorded a healthy bowel movement once per day, however was prone to constipation after consuming gluten and prior to her menstrual cycle. Menstruation was 10 days in duration, with the middle 3 days being heavy and painful with large clots present. This past winter she recorded two viral infections in quick succession, however previously had experienced only one infection per year usually requiring antibiotic treatment.

Despite her fatigue she worked at least 10 hours per day, sometimes 6 days per week to maintain the workload in her private enterprise. Her BMI registered at 26, one point and approximately 5 kg above the “Heavy” weight range. The client typically recorded a blood pressure anywhere between 100/70 mmHg to 118/80 mmHg. Most recently it was recorded as low-normal by her doctor when she received treatment for her viral infection.

Her existing diet did not appear to meet her daily requirements in essential fatty acids, B vitamins or essential minerals such as magnesium, zinc, or iron. Caffeine intake was high at 2-3 double shot lattes per day. She consumed approximately 2 litres of water per day and alcohol was very occasional. However, recently she began consuming one glass of red wine per night and watching TV in bed on her laptop in order to fall asleep.

Analysis and Recommendations

This client presented with multiple signs of neurotransmitter and HPA axis dysregulation. It would appear that her work schedule and subsequent stress may be responsible for a possible   cortisol inversion affecting the appropriate levels of neurotransmitters such as serotonin and melatonin required for sleep onset and maintenance. However, the client also presents with multiple signs of low iron, and potential hypothyroid function evidenced by the fatigue, low exercise tolerance, lowered blood pressure, dizziness, and heavy menstrual cycle. Her diet was low in all key nutrients for mitochondrial function.

A salivary cortisol and female hormone profile was recommended in order to understand a clear cortisol picture and to discover her current expression of sex hormones to formulate the most accurate treatment plan. A recommendation was made for the client to undergo a full blood count with her GP to ascertain the levels of key iron markers, along with vitamin D, and a full thyroid panel.

The client’s prescription after the initial consultation included:

• A herbal tablet formula of Rehmannia glutinosa 5 g, Panax quinquefolius 3 g, Avena sativa 2 g and Lavandula angustifolia 2 g, prescribed twice daily to support pituitary and adrenal function and to reduce sympathetic nervous system activity affecting adrenal function and healthy sleep.
• A high dose magnesium (200 mg), carnitine (1.2 g), tyrosine (1 g) formulation also containing calcium, vitamin C, selenium, and mixed B vitamins – taken twice daily. This was given to support cellular energy production and reduce fatigue, as well as to reduce over-activity of the sympathetic nervous system
• Dietary corrections were recommended to ensure an adequate intake of protein, phytonutrients and essential fatty acids to assist with the nutrients required to prevent macro- and micronutrient deficiency impacting iron stores, thyroid, immune and adrenal function. A reduction in screen time in bed was also discussed for its role in melatonin deficiency.

At the follow up appointment two weeks later the client had not completed the salivary testing due to the timing of her menstrual cycle, therefore no results on sex hormones or cortisol could be obtained. Her blood tests suggested low ferritin (29 μg/L) with no irregularity in thyroid hormones. Vitamin D was untested. A repeat of the original prescription was prescribed along with 30 mg of elemental iron in a diglycinate form.

At this appointment she reported a 30% increase in daily energy, whilst still feeling stressed at night due to her overwhelming workload. Therefore, sleep maintenance insomnia was still present multiple times per week in varying degrees. There was sufficient change present to maintain hope, and also create the realization that additional parameters needed to be addressed. The salivary testing will be followed up along with coaching/counselling in relation to the management of her business and subsequent stress loads.

Conclusion

There are many factors that can contribute to the exhaustion stage of general adaptation syndrome. This client has been affected by chronic physical, emotional and mental stress in relation to her work, along with multiple nutrient deficiencies leading not only to lack of cellular energy production, but neurotransmitter dysregulation and borderline anaemia. This creates behaviours, habits and beliefs that perpetuate the cycle of panic and stress in which exhaustion continues to grow. The solution lies in approaching each area of this client’s life to maximise the success of the herbal/nutritional/diet plan as in cases such as this, there are causative factors outside the scope of our practice impacting the success of treatment.