Our society values long hours devoted to work. Many individuals work 60, 80, or more hours per week to fulfill their professional demands and/or family needs, but at what cost? The cost of these long work weeks without adequate rest creates enormous amounts of wear and tear. Over time, it robs the body. We see it as professional burn-out, clinical depression, or an increase in substance abuse or other damaging activities. As the toll increases from overwork and stress, fatigue occurs. Often a short vacation can relieve and rejuvenate simple case concerns. Fatigue, though, that is not relieved by rest can get locked in and create “vital exhaustion”.

What is Vital Exhaustion?

Vital exhaustion presents as fatigue that is unrelenting fatigue not dispelled by a good night’s rest or time off. It is a lack of energy that gnaws away at your vitality. Recovery from fatigue does not occur well or at all. Irritability and feelings of demoralization accompanies this fatigue. These three criteria – fatigue, irritability, and demoralization are known as vital exhaustion. Vital exhaustion is defined as occurring in healthy individuals, and no other underlying cause of fatigue. It is considered a different entity than burn-out, depression, and fatigue from other causes. Vital exhaustion occurs in otherwise healthy adults with no health problems.

Scientists are engaged in a bit of a terminology turf war in attempts to classify fatigue and its different states. In the case of vital exhaustion, researchers sought to clarify the fatigue as “calm tiredness” or “tense tiredness”. In calm tiredness, the individual can bounce back after rest and selfcare, whereas, “tense tiredness” or that of vital exhaustion refers to negative fatigue and increased clinical risk of health concerns.

Tense tiredness, or vital exhaustion, includes presence of depressed mood, an inability to relax or recover after work, and symptoms of burnout. This is different than fatigue from cancer, Chronic Fatigue Syndrome or other autoimmune disorders, diabetes, anemia, sleep disorders, over-training syndrome, or shift-work, etc. Simply put, one may feel worn-out, grumpy, and without the vitality of youth with vital exhaustion.

Increased Health Risks as Exhaustion Continues

A systematic review and meta-analysis study analyzing studies from the 1980-2015 found conclusive evidence that vital exhaustion is associated with increased risk and reoccurrence of coronary heart disease or heart attacks. Vital exhaustion and heart disease is considered independent of other known clinical or lifestyle related risk factors.

Vital exhaustion increases the risk for type 2 diabetes. Increased risk of stroke also occurs with vital exhaustion. The risk was considered independent of inflammation.

It’s not just middle-age and older adults who experience vital exhaustion. Pregnant mothers may also experience vital exhaustion and cardiovascular complications. Health consequences from insufficient sleep and stress of pregnancy may lead to metabolic changes, increased inflammation and complaints about vital exhaustion. Exhaustion in pregnancy contributes to a higher likelihood of placental abruption and premature birth.

HPA Dysfunction and The Straw that Breaks the Camel’s Back

Two physiological reasons identified for vital exhaustion are dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and an increased allostatic load. Studies have identified subtle changes in the HPA axis with lower cortisol levels in patients with vital exhaustion. Those who had greater HPA dysregulation and lower cortisol had greater fatigue and poor sleep quality and ultimately greater concerns with vital exhaustion and risk for loss of health.

Allostatic load refers to adaptation, homeostatic balance and survival within the body. If the allostatic load becomes too great from bad or toxic stress, the allostatic load becomes like “the straw that broke the camel’s back” with a breakdown in healthy physiology. Changes in energy production and mood may occur. Managing allostatic load in the body is a balance between oxidative stress, inflammation, free radicals, energy production, steroid hormones (cortisol and catecholamines), mitochondria balance within the neuroimmunoendocrine system.

Measurement of allostatic load and the body’s response to chronic work stress exhaustion uses some common lab tests to see maladaptive changes. These include cortisol, epinephrine, norepinephrine, DHEA, waist/hip ratio, hemoglobin A1C, HLD, cholesterol/HDL ratio, blood pressure, TNF-a, hsC-reactive protein, fibrinogen, D-dimer, triglycerides, fasting blood sugar, and percent body fat.

Digging Deeper: Mitochondria, Adrenals, and Allostatic Load

Frontiers in Neuroendocrinology April 2018 review publication delved into the fascinating interplay of mitochondria and adrenal steroid hormones. A delicate, enormously complex relationship occurs with the balance of cortisol, catecholamines (adrenaline, norepinephrine, dopamine) and mitochondria. Production of steroid hormones or steroidogenesis takes place in mitochondria. Mitochondria are found throughout the entire body, but the adrenal cortex, the outer portion of the adrenal glands is rich in mitochondria. The adrenal mitochondria produce the steroid hormones from cholesterol.

The natural daily rhythm and at times of stress, stimulus from the brain causes release of cortisol and other steroid hormones from mitochondria within the adrenal cortex and other part. It effects the day-night, sleep-wake cycle, motor function, learning, appetite and more. With good mitochondria and adrenal gland function, great energy, motivation, endurance, and stress tolerance occurs. However, when the balance is disrupted from too much cortisol-stress hormones, it leads to increased production of free-radicals that damage the mitochondria and shut down the mitochondrial electron transport chain. As the body becomes further depleted, it may manifest as HPA dysregulation and impaired adrenal function. Mitochondrial function becomes impaired.

Management of energy and allostatic load depends on this interplay of mitochondria, adrenal glands, and the HPA axis. The key point to remember is that mitochondria activity is dependant upon glucocorticoid production in the adrenal glands and the adrenal glands are dependent upon healthy mitochondrial function and integrity. It is a reciprocal relationship.

Fatigue, loss of energy, and poor stress tolerance reflect dysregulation of this system. Scientists believe that mitochondrial dysregulation plays a significant role in the management of allostatic load and the effect on the central nervous system and HPA axis. This dysregulation eventually leads to a loss of energy production, vitality, and manifests as metabolic dysregulation (diabetes), depression, and dementia.

In addition, mitochondria are cellular producers of heat and energy or thermogenesis. This is part of what makes mammals warm blooded. If you get cold and exhausted from stress, this might be a warning sign that the balance between your body’s adrenal hormones, nervous system, and mitochondria are stressed. Other effects seen with mitochondrial-adrenal hormone dysregulation include appetite changes or increased stress-eating, not hungry in the morning, trouble with coordination, changes in memory, emotions, and impulse control, weight gain, elevated cholesterol, insulin resistance and increased inflammatory toll on the body, like the heart.

Restoration of Vitality

An April 2018 randomized, double-blind, placebo-controlled study compared individuals experiencing high stress loads with supplementation or not. Those who received the nutritional support achieved “significantly greater improvements” in their stress scores or improvement in vital exhaustion. It is vital to remember that stress increases nutrient needs. The more stress the body has to deal with, the greater the nutritional need. The Western Diet is calorie rich and nutrient poor. This is just the opposite of what one needs to manage exhaustion, stress, and depletion.

Here are several additional articles that provide insight into stress recovery and restoration of health and vitality.

Stress and Adrenals: Restoring the HPA Axis

Taming the Mind at Night: Help for Insomnia 

Adaptgenic Herbs Improve Stress Tolerance, Adrenals, and Energy 

High Stress Leads to Heart Disease and Diabetes 

Staying Healthy in the Midst of Life’s Storms 

Atrial Fibrillation, Cardiac Disorders Linked with Mitochondrial Dysfunction 

Nutrients Help Depression, Anxiety, Mental Health 

Stress Induced Burnout: The Path Back to Happiness 

Feeling Fatigued? Jump-Start Your Energy 

Mitochondria – Drugs that Injure and What Mitochondria Injury Looks Like 

Broken Heart Syndrome 

Antidepressant Risks During Pregnancy and Breastfeeding 

Mitochondria Take Center Stage 

We live in a time when stress is at an all-time high and there is no end in sight. It is up to you to ensure that you fortify yourself with appropriate nutritional support, stress management, and a healthy lifestyle. If you don’t recover after a good night’s sleep and life’s stressors have breached your body’s coping point, stop, rest, and replenish. The end result of vital exhaustion will either be further breakdown in health or a restoration of vitality. What path are you are on?