Adrenal fatigue is real, and it peaks in midlife

Midlife woman with adrenal fatigue lying on a beach in a black bathing suit with a hat over her face
By Dr. Thara Vayali, ND

Middle age is commonly the season in which our social roles and responsibilities peak, our caregiving responsibilities surge, our careers ramp up, and we hold important roles in social dynamics. 

It’s often called “working the triple shift”: life, work, and community. Add this to the 35–40 or so years of life challenges we’ve waded through to get here, and you can see that each of the words “chronic” and “stress” have distinct meanings for us. 

While there is controversy around the term “adrenal fatigue”, it’s crystal clear in all healthcare professions that chronic stress severely impacts a person’s functioning. The key question is, What should I acknowledge and treat? Mind or body? I think this is how women, physicians, and healers alike are seeking answers about exhaustion.

While there is controversy around the term “adrenal fatigue”, it’s crystal clear in all professions that chronic stress severely impacts an individual’s functioning. 

I take a firm stand against separating mind and body. Mental health is not all in your head. Whatever your practitioner calls it — adrenal fatigue or burnout syndrome — it’s important to understand that chronic stress exerts very real and specific hormonal effects on the body, as well negatively affecting mental health. 

Let’s get real: medical history has a long-standing reputation of dismissing, ignoring, or misdiagnosing women. The worst of which is gaslighting women into “owning” their condition. Hysteria, nervous breakdown, anxiety, depression, burnout — ultimately, “it’s all in your head”. There’s an established resistance to acknowledging the physical realities of the load we bear, if the load appears to be invisible. 

Nouveau Burnout Syndrome: The new battle between “burnout” and “adrenal fatigue” 

Burnout used to be a non-medical term, one that was associated with the outcome of chronic and extreme stress, and the very real loss of function. With the 2019 World Health Organization (WHO) acknowledgment that work can be stressful (eye roll), the medical establishment has conceded to using the term “burnout”, but ONLY in the context of work environments and ONLY related to one’s mental fortitude through stressful work environments. Occupational burnout is the inability to pull your boots up and keep going. And if you feel sad or anxious about that, there’s a prescription medication for that.

As a naturopathic physician, I consider the new definition of burnout — which is occupational burnout and primarily about mental strength and mental health — nouveau burnout syndrome.

What is adrenal fatigue?

Adrenal fatigue, or what some call adrenal dysfunction, is a physical and mental condition. The current knowledge of stress physiology is built on decades of research and a deep understanding of human bodies, and the term adrenal dysfunction has been developed by caring clinicians who see the true impact of chronic stress in their patients. 

There are specific hormonal processes associated with the response to prolonged stressors (work-related or not) and there is a clear trajectory that the body takes toward burnout — which is not just a state of feeling distressed, but a stage of chronic stress. Adrenal fatigue occurs  when the body is unable to operate properly for extended amounts of time due to chronic stress.

What are adrenals? 

Adrenals are two small organs that sit atop each of your kidneys and are the orchestra of your stress response. They are the only organs that produce cortisol and adrenaline, two key hormones that amp up when stress is high. There’s more going on in your adrenals than just managing stress — a multitude of processes from blood-sugar regulation to immune response, and it’s worth recognizing that this is exactly WHY adrenal dysfunction affects physical health. 

The combination of altered cortisol levels associated with chronic stress and symptoms are prominent in midlife women. You will see this show up in the form of:

  • profound fatigue
  • unexplained weight changes
  • mood alterations
  • heightened anxiety 
  • disrupted sleep patterns

    Adrenal dysfunction sounds a lot like perimenopause, thyroid disorders, iron deficiency, depression, trauma response, and many other conditions — which is why there’s a lot of skepticism around it. And rightfully, no one should give you a label of “adrenal fatigue” without knowing what’s really under all your symptoms. 

    However, often the stress response is elevated in other conditions and the adrenals can be part of the symptom picture if the condition is chronic. Identifying the impact of stress on your adrenals is like any other condition. It’s best to assess before you address. 

    While you may feel absolute clarity that you have (or don’t have) adrenal fatigue, your objective patterns of cortisol mapped over your experience can affirm this or inform you to check on other conditions. 

    Is there a test for adrenal fatigue?

    To find out if you have adrenal fatigue, it’s as simple as saliva testing of your cortisol levels throughout the day. Naturopathic clinics offer the adrenal fatigue saliva test and my company, hey freya, offers this at-home cortisol test.

    Additionally, some companies offer testing of cortisol with estrogen and progesterone, but that type of testing must align with a very specific menstrual cycle date, which can be difficult for many women in midlife.

    Identifying the impact of stress on your adrenals is like any other condition. It’s best to assess before you address.

    Integrative approaches to addressing chronic stress 

    Addressing adrenal dysfunction involves a multipronged approach. Lifestyle modifications, targeted herbal remedies, and supportive community can all be part of the repair. Because the patterns of cortisol can vary widely, there is not one simple checklist to address adrenal fatigue, but these are the main pillars:

    7 tips to heal from adrenal fatigue

    1. Get tested for adrenal dysfunction

    At-home testing of salivary cortisol helps to determine where you lie on the burnout trajectory, and which of the rest of these pillars you should prioritize.

    2. Make sure you’re getting the right nutrients

    Vitamin D, Iron, Magnesium, Zinc, Folate, and Vitamin B12 are not just for healthy pregnancies. These nutrients are essential for supporting recovery from adrenal fatigue. A strong multi-vitamin and multi-mineral can address basic deficiencies that are common in women working the triple shift. I helped to create Thrive, which has all of these vitamins plus adaptogens that I mention next.

    3. Use adaptogenic herbs

    Ashwagandha, a traditionally Ayurvedic herb, is currently in fashion, but also one I’ve worked with extensively. It regulates cortisol and can significantly improve fatigue, sleep, and mood. Targeted herbal remedies blend ashwagandha with other hormonal herbs;  keep the dose somewhere around 150-200 mg of root extract.

    4. Use the rule of 3 to move your body

    Three times a week, do about 30 minutes of exertion that’s three times your current energy level. Depending on your current state, that might mean getting up out of bed and making a meal or doing HIIT workouts. The point is to increase movement relative to your current state, not your heart rate. 

    5. Rest intentionally

    Rest is not sleeping. While you also might yearn for sleep, rest is intentional and it is a claim of personal space and time. Push aside social media traps and incessant calling of to-dos. Rest needs you to invite her in; she doesn’t intrude. Rest looks different for everyone, but the one commonality is the pacing of the breath, which is slower and takes longer exhales. Box breathing is one way to begin exploring it, and to make it easier, I recommend doing it before you get into bed or before the busy day begins. 

    6. Enjoy your community

    A critical aspect of women’s health that’s often shoved aside is the importance of a supportive community. This can appear in asynchronous meaningful text threads or in-person meandering conversations. 
    Introvert or extrovert, you know which type of community fills you up. Research validates that when an individual feels they have a supportive confidante, it can improve their sleep quality and quantity. We don’t spend enough time valuing these engagements as medicine and instead see them as indulgences. It’s time to flip that script.

    7. One thing at a time

    Focus on only one of the above at a time.You don’t need to do it all. You never need to do it all. You have done so much already. Now, it’s time to focus on you, one pillar at a time.

    This article was originally published here on The Midst.

     Dr. Thara Vayali, ND

    Dr. Thara Vayali, ND is the Co-founder and Chief Medical Officer of hey freya, a doctor of naturopathic medicine, nutritionist, and educator with over ten years of clinical expertise in women’s health. She holds a BSc in Nutritional Sciences from the University of British Columbia, a Masters in Education & Communications from Royal Roads University, and doctorate from the Canadian College of Naturopathic Medicine. She is an advocate for broad-scale awareness about women’s physiology and body literacy. She speaks internationally and writes about health and wellness, stress, resilience, empathy, and mindfulness. She is a noted public speaker and marginalized women’s advocate. Thara has two children and devotes her time, outside of growing hey freya, to providing leadership in underrepresented wellness communities. As the daughter of two immigrant parents, she is devoted to increasing representation in the scientific community and health tech sectors.

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