By Dr. Shawna Darou, ND
Overtraining syndrome is not a condition limited only to competitive athletes, and I actually find more cases in recreational athletes who have a frequent intense workout schedule. It is absolutely critical to build in rest days, fuel your body for your workouts, and cross-train to avoid overworking the same muscle groups. Proper training requires a balance between overload and recovery, and when there is too much overload and not enough recovery, it can results in physical and psychological symptoms. Because the signs and symptoms often include anxiety, sleep disturbance and mood swings, this condition is almost always misdiagnosed.
What is overtraining syndrome?
Overtraining syndrome happens when you are training beyond your body’s ability to recover. It is a neuroendocrine disorder meaning it impacts your nervous system and also your hormones.
Signs and symptoms of overtraining syndrome:
Some of these signs are very obvious, but others you may not be linking to your training – for example anxiety, sleeplessness and panic attacks, neurological signs like numbness and tingling, and an emotional reaction when you take days off.
Here is a list of common signs:
- increased heart-rate, and in some cases very low heart-rate
- more colds, sore throats, infections
- more injuries
- body aches and pains
- moodiness and irritability
- anxiety and panic attacks
- neurological symptoms such as numbness, tingling
- change in you period – missed, coming early or coming late
What puts you at higher risk of overtraining syndrome?
Quite simply, you are at higher risk if your baseline stress level is also high. An intense workout temporarily increases stress on your body. Remember that your body has a threshold with stress, and high-intensity or high-duration workouts contribute to this threshold.
You’re also at higher risk of overtraining at time of hormone transition: perimenopause, menopause, post-partum. During these times, because of the underlying stress of hormone changes, you may also be at higher risk of overtraining syndrome.
And finally, if your life is out of balance with poor sleep, not enough hours of sleep, irregular eating and especially under-eating you will not have the resilience to bounce back from harder workouts.
How overtraining affects your hormones:
(1) Cortisol & adrenal hormones
The Hypothalmic-pituitary-adrenal (HPA) axis regulates our body’s hormonal system. It helps the body adapt to stress through the release of hormones such as cortisol and adrenalin. Cortisol is a hormone that is fairly easy to measure, and with overtraining it may be either high or low depending on the duration and other layers of stress. Both high and low cortisol can create feelings of anxiety and fatigue.
(2) Thyroid hormones
A marker I find very accurate for assessing overtraining syndrome is free T3 (free Triiodothyronine). It is important to note that low free T3 levels can occur when the thyroid itself is perfectly healthy. The level becomes low when the body deliberately tries to slow down your metabolism in response to metabolic stress (among other things). In my patients I have found the low T3 to be responsible for many of the strange sensations they experience – extreme fatigue with body anxiety, numbness and other sensations in the body, and may also cause dry skin, hair thinning, constipation and feeling chilled.
(3) Ovulation and progesterone levels
Since all of your hormonal systems are connected, when the body is over-taxed, you will likely see changes in your menstrual cycle ranging from complete absence of menstruation to a change in cycle length (either closer together or farther apart), or more extreme PMS due to a drop in progesterone. If you’re also in perimenopause or menopause at this time, your symptoms of the hormone shift will be exaggerated.
Since many of you may identify with a real person and how overtraining syndrome is often misdiagnosed, I’m going to share a case with you. Please note I have changed the patient’s name for privacy, and have consent to post the details below.
Julia is 46 years old, a mom of 2 children and has a job that requires a significant amount of travel. She identifies her job as being very demanding, and is constantly on the go. In the past 4 years she has been working out intensely, and has come to really love high-intensity interval training and weight lifting. When she was not traveling, she was training up to 6 days per week and rarely took days off.
Last spring Julia’s work hit another level of stress with a promotion and extremely long hours. To help with her stress levels, she continued to workout intensely however her sleep became less consistent and she often skipped meals. She remembers this time as a period where she was just running on adrenaline and caffeine.
Over the summer, Julia suddenly started to experience anxiety at a level she had never had before, and was waking in the night with nightmares. She was feeling tingling in her skin, and got anxious about strange sensations running through her arms and legs. She felt like she was on the edge of a panic attack all the time. Because exercise had always been her go-to stress-reliever, Julia continued to workout, and found short-term relief with each intense workout. In fact, on days she didn’t workout she was exhausted, depressed and irritated.
The strange body sensations, anxiety and sleeplessness were what brought Julia to see me because she was worried that she was developing a neurological disorder, or was starting to go into menopause, and yet her doctors couldn’t find anything abnormal on basic testing. Her family doctor recommended an antidepressant, suggesting that Julia had experienced anxiety through most of her life.
After speaking with Julia, and recognizing the neuro-endocrine pattern I suspected overtraining syndrome, with underlying HPA-axis dysfunction. We started with some bloodwork, specifically for cortisol, luteal phase estrogen and progesterone, iron, vitamin B12 and a full thyroid panel.
- Normal vitamin B12 and iron
- Low-normal cortisol
- Low-normal progesterone and estrogen
- Very low free T3, with otherwise normal thyroid levels (TSH and free T4)
I explained to Julia that many of her symptoms were coming from the very low T3, which is the body’s protective mechanism to slow down the metabolism during times of prolonged high stress, over-exercising and under-eating. I have seen this pattern several times: when the nervous system is still on overdrive, but the body is trying to slow down, you can experience tingling, vibration, or what feels like a current of energy moving through the body.
Our treatment plan first and foremost was to temporally stop all high-intensity and high-duration workouts. Activity was limited to walking, dancing and yoga for several months of recovery. We prioritized sleep quality and quantity, ensured Julia was eating enough calories and regular meals, and used supplements to calm the nervous system (adaptogen herbs), and others to bring up the T4 to T3 conversion of thyroid hormones.
I’m happy to report that after two months of recovery exercise, and excellent self-care, Julia was able to resume some of the higher intensity workouts she loved, but in a more sustainable and balanced way.
Where to start to reverse overtraining syndrome
- If you suspect that overtraining may be causing your hormonal and neurological symptoms, the first place to start is with an honest check-in about your workouts and training. Are you building in rest-days, or rest weeks for recovery? Are all of your workouts intense?
- For immediate relief, it will likely be necessary to take a break from the intensity to allow your hormonal system to reset.
- Prioritize balanced nutrition & optimize your sleep. Ensure that you are eating three full meals per day, getting enough protein and carbohydrates in your diet, and sleeping at least 7 hours per night.
- Lab testing is highly recommended, especially your hormonal markers: am serum cortisol, full thyroid panel including free T3, luteal phase progesterone and estrogen, ferritin (iron stores), and vitamin B12 levels.
- Although taking a break from training is the most important step, there are many nutritional supplements that can help with your recovery, and to get you back into your sports and activities more quickly. This may include supplements that balance cortisol, supplements to support estrogen and progesterone levels, and others to improve T4 to T3 conversion.
An ounce of prevention:
If you love to train hard, and are just starting to see some of the signs, there are some steps you can take immediately to prevent overtraining syndrome.
- Build in breaks: Train smarter, not harder. Just like managing overall stress, it’s not how hard you work but more importantly how well you rest and recover afterwards. Your body needs off-days during the week, and regularly scheduled recovery weeks to keep you in peak performance.
- Cross train: Variety in your workouts will allow you to continue with regular exercise without burning out. For example, if you’re a runner, add in some cycling and yoga.
- Fuel for fitness: Ensure that you are eating optimally for your training, and keeping up with the extra calories required for performance. If you have questions about this, please ask!
- Sufficient sleep: Good quality sleep is just as important as rest days. Remember that your body needs recovery time from your daily stresses, and also your training schedule.
- See a naturopathic doctor for the right lab tests. You’re likely in a situation where your basic lab markers are all looking normal, but you may not be feeling your best. Tracking your hormone markers can give you early alert to overtraining.
I hope this article has given you insight into overtraining syndrome. This is a very commonly misdiagnosed condition, and yet balancing out the hormonal systems can make a profound difference in how you feel, and also your athletic performance.
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