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Is it Adrenal Fatigue?

An internet search of the term ‘adrenal fatigue’ will return a range of conflicting results from sites telling you what to do if you have this condition, to sites dispelling the condition as a myth.  The term itself is not found in medical literature.  It is not recognized by the conventional medical community as a condition.  Additionally, most physicians believe that long term stress has no effect on the body’s adrenal hormone output.  

While the functional medical community does believe that long term stress can damage the body and lead to disease, they do not believe that the adrenals are exhausted and drained by stress.  ‘Adrenal fatigue’ is not used to describe the set of symptoms that result from chronic stress over activating the pathways responsible for responding to stress.  The term is seen as an oversimplification of what is actually happening.  More accurate terminology to replace ‘adrenal fatigue’ is HPA Axis Maladaptation or HPA Axis Dysfunction (used interchangeably).  I know…that’s more of a mouth full than adrenal fatigue.    

What is the HPA Axis?


Symptoms of HPA Axis Maladaptation are listed in this article.  However, there needs to be an understanding of where the symptoms stem from.  Here’s some of the technical information simplified…Long term stress (chronic stress) impacts signaling (communication) in the pathways responsible for responding to stress.  The HPA Axis is one of the pathways responsible for responding to stress.  It refers to the (H) hypothalamus, (P) pituitary, (A) adrenal axis which work in concert to respond to stress.  HPA Axis function is about communication between the brain (hypothalamus & pituitary) and the adrenals (an endocrine gland).  Based on that communication, the body can adjust hormone production and/or availability to respond to stress.  When the body senses that it is under stress (real or perceived), the hypothalamus secretes CRH (corticotropin releasing hormone).  This stimulates the pituitary to produce ACTH (adrenocorticotropin hormone) which stimulates the adrenal glands to produce glucocorticoid hormones such as cortisol (our main stress hormone).  This process is a complex positive and negative feedback loop designed to maintain homeostasis.  In English…the HPA Axis is a complex system designed to respond to stress that regulates itself much like a thermostat does in order to maintain balance in the body.  


Are you still with me?  Read on for how chronic stress can cause HPA Axis Maladaptation. 

Cortisol – The Stress Hormone


Cortisol is the primary stress hormone released by the adrenal glands to help us manage stress.  Cortisol gets a bad rap as the culprit responsible for weight gain and fat storage around the mid-section.  However, it has many functions that serve us well including…

·        Acts as a potent anti-inflammatory. 

·        Helps us to regulate blood sugar and blood pressure.

·        Aids in digestion.

·        Assists in metabolism.

·        Necessary in emergency situations to give us energy for ‘fight or flight’.


Cortisol is necessary and is not a ‘bad’ hormone.  However, issues arise when the body does not return to homeostasis after a crisis.  That last sentence is key…the body needs to return to a balanced state, and it cannot do that if it is constantly under stress.  Chronic stress and the chronic release of cortisol puts us at risk for HPA Axis Maladaptation.  This is a breakdown in the signaling between the brain and the adrenals which impacts the levels of hormones being produced or that are available when we are stressed.  The body was designed to handle acute physical stressors, it was not designed for continuous exposure to stress which constantly activates the HPA Axis.  Unfortunately, modern life is full of stressors that continually activate this pathway.

Can you relate to any of the following stressors that are HPA Axis Dysfunction risk factors?  

·        Trauma…Physical, e.g, injury, or emotional, e.g., divorce

·        Poor diet

·        Chronic illness

·        Excessive exercise

·        Insomnia

·        Shift work

·        Toxic exposure


The Classic symptoms of HPA Axis Maladaptation are:

·        Unrefreshed after 8 hours sleep

·        Need for coffee or stimulants to function

·        Low energy in the afternoon

·        Second wind late at night – “tired but wired”

·        Waking in the middle of the night with a pounding heart

·        Poor immunity – catching anything that’s going around

·        Inability to handle stress

·        Anxiety

·        Depression

·        Brain Fog

·        Memory Issues

·        Dizziness with standing from laying or sitting

·        Shakiness or irritability when skipping meals or overly hungry

·        Inability to recover from exercise

Restoring HPA Axis Maladaptation:

The good news is there are things that can be done to ease chronic stress and resolve HPA Axis Maladaptation.  Recommendations are simple but this is not to say that they are easy to put into practice.  It is difficult, if not impossible to restore HPA Axis function if a person is unwilling to address the stress that led to the dysfunction.  Wellness hinges on addressing any physical or emotional traumas that are triggering the stress response.  Good news…therapy is more accessible than ever (the key is finding a good fit).  Additionally, two great resources for implementing positive change are the Adrenal Reset Diet by Alan Christianson, NMD., and Atomic Habits by James Clear.  

Work on the following general recommendations to manage stressors…

·        Implement an anti-inflammatory diet, don’t go too low in healthy carbs (avoid refined) or too low in fat which are stressors to the body.

·        Remove alcohol completely and limit caffeine and stimulants (especially after noon).

·        No fasting or intermittent fasting (stressor).  Eat breakfast – shoot for at least 30g of protein, and keep blood sugar stable with regular balanced meals.  

·        Remove food sensitivities (stressors).

·        Work on getting the right amount of quality sleep – check out Why We Sleep, by Matthew Walker, PhD.

·        Work on behaviors (for example…people pleasing, setting boundaries, or emotional eating).  Resources: Brene BrownZivliHeal Your Hunger.

*    Remove obstacles that are preventing wellness (for example…addressing draining relationships, an unhealthy work environment, etc.)

Article Sources:

Christianson, A. (2014). The Adrenal Reset Diet. New York: Harmony.

Nutrition, F. D. (2023). FDN Advanced: Stress and Hormones. Functional Diagnostic Nutrition.