Editor's Note: This article is a reprint. It was originally published June 18, 2017.
Burnout is becoming a more common problem in the United States and around the world. How can you avoid it or recover from it if you've already hit the proverbial wall? Dr. Joseph Maroon, a professor of neurosurgery at the University of Pittsburgh Medical Center, has written a book that addresses these very questions.
"Square One: A Simple Guide to a Balanced Life" grew out of his own struggles with burnout, setbacks and depression after he'd become a world-class neurosurgeon before the age of 40.
"I've had rather impressive success [and] cataclysmic failure personally," Maroon says. "I was intent on becoming the very best that I could in terms of my profession, neurosurgery. I worked extremely diligently. It became an all-encompassing pursuit for me in my life … with success, societal approval, writing papers, going to national meetings …
Soon after becoming chief of neurosurgery at a major university hospital, I [cracked]. My father died, my wife and children left me, I had to quit my profession as a neurosurgeon due to the overwhelming stress … all within one week … The next week, I [was] helping my mother run a rather dilapidated truck stop left to her by my father in Wheeling, West Virginia, living on a farm.
One day I was doing brain surgery and [the next] literally filling up 18-wheelers and flipping hamburgers in a rundown truck stop. It was a great fall. It was kind of like an Icarian metaphor of flying too near the sun. I got scorched and I plummeted into the sea — a sea of depression."
Recognizing Burnout
Maroon went through all of the symptoms of burnout, which are now reported in 50% of physicians: emotional and physical exhaustion, loss of perspective, depression and a lack of connection to his work. In "Square One," Maroon describes how after he'd reached rock bottom, he rediscovered a book he'd received years before as a high school prize. Written by William H. Danforth, the thin book, "I Dare You," became a real turning point:
"What Danforth emphasized was that balance is the most important thing to attain, to live life as a whole person," Maroon says. "To attain balance, you have to really take into consideration, what are your priorities, what you do, speak and interact with on daily basis.
Balance requires you prioritize the social side or family, the spiritual side and the physical side, including diet in equal terms as your work side. Danforth depicts this concept as a square with four equal sides."
Square One — Regaining Balance
Danforth emphasizes that you have not one but four lives to live, and these four entities make up the sides of a square:
- Physical life
- Spiritual life
- Work life
- Relationship life
When Maroon analyzed how much time he spent on each of these, he realized the problem: There was no family, spirituality or physical sides to his existence because he had become consumed by his work. It was only when he began to exercise that he got healthy enough to begin to rebalance his life.
"Pretty soon, my neurotransmitters, if you would, were in balance. I began to lose weight. It was the physical and then subsequently the spiritual aspect to a semblance of balance," he says. "A year later, he was back working as a neurosurgeon and eventually competing as an Ironman Triathlete.
I literally was a dropout, burned-out from all work all the time. It was through exercise and its incredibly powerful effect on my brain, that increased my dopamine, the brain-derived neurotropic factor (BDNF) that makes new brain cells, new synaptic connections and neuroplasticity, that really started me back into my profession and life, and back into a balanced place."
Indeed, research clearly shows exercise is one of the most effective ways to reverse symptoms of depression. The great news is you don't even need an enormous amount of exercise to get and stay healthy, and I strongly recommend targeted high-intensity training to get the most out of every minute.
Nutritional Ketosis for Brain Health
Maroon has collaborated with Thomas Seyfried, Ph.D., an expert on the metabolic basis of cancer, and together they've written a couple of important articles on malignant brain tumors.
"I read Tom's papers and subsequently contacted him and Miriam Kalamian [about the] ketogenic diet as a way to possibly aid in the treatment of brain tumors … I went on a ketogenic diet myself," he says. "It's a very difficult diet without help. I'm an incredible proponent of what Tom's teaching, lecturing and recommending to get the diet right.
After reading your [Dr. Mercola] book, 'Fat for Fuel,' you've done a tremendous service to help [those] who want to go on the mitochondrial metabolic diet, essentially a ketogenic diet. You have guidelines in there and explanations that are beautifully outlined and absolutely needed, not only for brain tumors but for any patient with a malignant tumor that depends on glucose for its metabolic substrate."
In "Fat for Fuel," I strongly emphasize the importance of cycling in and out of ketosis once you've made the transition to burning fat as your primary fuel. Staying in nutritional ketosis indefinitely can result in loss of muscle mass, which is hardly beneficial for your health.
Once your body regains the ability to burn fat as its primary fuel, it is best to cycle in and out of ketosis, intermittently eating 200% to 300% more healthy net carbs and fruits, but do it in a sensible fashion where you still maintain the metabolic flexibility to burn fat. Maroon experienced adverse effects just as I did when he experienced excessive nutritional ketosis.
"I became weaker. I didn't have the stamina, the strength. I continued to train for triathlons. I found myself not having enough fuel to do that … When I read your outline of how to approach this … it [worked] so well for patients. [It's] understandable, doable and it's basically what I evolved to on my own. You've been able to beautifully elucidate it …
I think the various diseases that it's good for … [includes] everything from fibromyalgia to arthritis, cancer [and] neurodegenerative diseases of the brain. I clearly have recommended [nutritional ketosis] as a thing that people can do to, hopefully, prevent amyloid and neurofibrillary tangles to slow down the neurodegenerative process," Maroon says.
Resilience Is Developed Through Adversity
Many biological and physical stressors — including exercise, fasting and thermogenesis — activate genes that produce very positive metabolic factors. Maroon's book, "Square One," discusses the concept of epigenetics and the metabolic factors that are activated by each side of the square.
Keeping the four sides of the square in balance is key — the physical, work, spiritual and social sides of life. The most important aspects of this is mindful awareness of all four sides and the ability to handle adversity and stress.
"We all know that you can't avoid stress in this world — bad relationships, divorce, stressful jobs and health concerns are just a few. Forty percent of people now report difficulty with job-related stress. A Mayo Clinic study [said] 50% of doctors have reported burnout symptoms, such as physical or emotional exhaustion from being overworked, overwhelmed and overcommitted.
What happens with uncontrolled stress [is] you get elevated cortisol levels in your blood. What does [excess] cortisol do to the brain? It kills brain cells, especially those that code for memory. That's what was happening to me … excess chronic unremitting stress overwhelmed me. Fortunately I was able to rebalance.
My stress also led to incredible depression. Most doctors think depression is [treatable] with antidepressants. For me I have no doubt that physical activity was the most effective antidepressant … [Exercise] stimulates the production of neurotransmitters, like dopamine, serotonin and acetylcholine that are all reduced during depression.
The point is we can't escape adversity. We can't escape stress. But what happened to me is I didn't recognize how bad off I was in a unidimensional [all work] life. I didn't recognize it until I was working at a truck stop as a pump jockey … I think the most important thing I missed was mindfulness. I didn't have insight into where I was; insight on how I got there, when everything was lost."
How to Regain Balance and Recover From Burnout
So, how do you prevent or recover from burnout? There is sound evidence that the best ways are through exercise, a healthy diet that optimizes mitochondrial function and limits inflammation, mindfulness and stress reduction.
"You need exercise. You need a degree of meditation and spirituality. You need to avoid the environmental toxins … If you look at people who live to be centenarians, more than any place else, where are they? Okinawa, Sardinia, Seventh-day Adventists in Loma Linda, California.
They all have in common a healthy diet and physical work. They work hard, which is their physical activity. They live in areas generally with fewer environmental toxins. They control stress with, usually, a very strong family unit, spirituality, religion or meditation.
All those things are mindfulness. All reduce stress, the excess cortisol, and try to keep our bodies in balance … I personally returned to the principles of Christianity — helping and reaching out to others. I think that's a key portion. We give but little when we give up our possessions. It's when we give up ourselves that we truly give. It's getting out of yourself. It's not me, me, me all the time. It's [about] reaching out to others," advised Maroon.
Avoiding Toxins
In addition to these approaches to address burnout, I must also address the need to avoid toxins such as alcohol, contaminated water, air pollution and food pesticides.
While not covered in Maroon's book, one of the most dangerous toxins out there most people are not aware of is microwave radiation from cellphones, cellphone towers and Wi-Fi routers. While it would be virtually impossible to eliminate these things at this point, it's important to use them wisely and to guard against excessive exposure.
The primary concern with cellphone use is not related specifically to brain tumors. In fact, that idea can even be counterproductive as most people don't know cellphone users who have brain cancer.
The real danger lies in damage from the reactive nitrogen species peroxynitrite that these microwaves generate in your body. Increased peroxynitrite from cellphone exposure will damage your mitochondria, thereby increasing your risk of all cancers — not just brain cancer — as well as heart disease, diabetes and Alzheimer's.
You can have the best diet, the best exercise, the best meditation and spiritual practice, and the best sleeping habits. Yet, if you're consistently exposing your body to excessive levels of this radiation that you cannot see, hear or feel (unless you're electrosensitive), you're going to incur mitochondrial damage and will invariably die prematurely as a result of this exposure.
This becomes quite clear when you study the literature, and there's no way around it. You simply have to take precautions to limit unnecessary exposure.
On Traumatic Brain Injuries
On a side note, Maroon has worked with the Pittsburgh Steelers for over 25 years, investigating and treating various sports-related problems such as neck problems, low-back pain, ruptured discs and concussions.
The long-term effects of concussion are actually now under intense study, and one thing that appears to be central to many neurodegenerative diseases is excessive immune response and inflammation. Maroon discusses some simple yet powerfully effective dietary and physical interventions that may help.
"You don't eat a Western diet. You don't stop exercising. You don't overload with toxins like alcohol, opioids, smoke and drugs, and you control stress. It's the four epigenetic factors that need to be emphasized to these individuals who have had multiple hits to the head," Maroon says.
"Again, what you outline in 'Fat for Fuel' are [the] kinds of things I think athletes in contact sports could benefit from … My agenda this year is to [launch] a program for individuals who are potentially at risk from long-term, sports-related head trauma that would include specialized diets to reduce inflammation."
Besides metabolic mitochondrial therapy, which includes a cyclical ketogenic diet and high-intensity exercise, compelling evidence suggests near-infrared light in the 830 to 850 nanometer (nm) range can significantly reduce symptoms of Alzheimer's, even in its more advanced stages. For more information about this, I recommend listening to my interview with Michael Hamblin, Ph.D., who is a leading expert from Harvard on the use of photobiomodulation.
In this near-infrared range, light helps recharge your mitochondria and stops mitochondrial dysfunction secondary to inflammation and trauma, and it's not toxic in any way. Other important strategies include the use of high-dose bioavailable curcumin, animal-based omega-3 fats, resveratrol, L-carnitine and α-lipoic acid. All of these agents help enhance mitochondrial function.
More Information
"Square One: A Simple Guide to a Balanced Life" is an excellent primer on burnout — what it is, how to address it and how to prevent it in the future. As Maroon notes, "If you are burned out, overwhelmed, overworked or overcommitted, you need to get your life back in order."
It all boils down to accepting that we are responsible for four areas of our lives — our health, our work, our relationships and our sense of purpose — and the easy-to-read "Square One" sets forth these simple principles. But make no mistake: There's great wisdom in this simplicity, and the key is to understand and implement it.