What is adrenal fatigue?
What is commonly known as “adrenal fatigue” is the inability of the brain to regulate the activities of the adrenal glands. Strictly speaking, the adrenal glands themselves do not get tired. Rather, the hypothalamic pituitary adrenal axis (HPA axis) has difficulty downregulating the production of cortisol, leading to chronic health conditions. The HPA axis is a foundational system in your body, and if it isn’t functioning well, it can cause problems related to female hormones, immunity, gut health, and more. In this post, I’ll cover the causes HPA axis dysfunction as well as treatment with Functional Medicine.
What are the symptoms?
If you have HPA axis dysfunction you may be experiencing some of these symptoms:
- Fatigue
- Anxiety
- Depression
- Irritability
- PMS
- Infertility
- Menopausal Symptoms
- Food Cravings
- Insomnia
- Poor Immune Response
- Poor Wound Healing
- Weight Gain
- Muscle Loss
- Pain Syndromes

HPA Axis Feeback Loop
Normal Adrenal Function
Adrenal function is really about the function of the hormonal signalling system between the brain and the adrenals. The brain interprets a stress event, signalling the hypothallamus. By producing hormones, the hypothalamus then alerts the pituitary, which alerts the adrenals. The adrenals then produce cortisol to adapt to the stressful environment. Ideally, when the stress event passes, the higher levels of cortisol in the blood signal the hypothalamus to reduce cortisol production. However, if stress persists, then an elevated production of cortisol remains. This feedback loop is called the HPA axis (hypothalamic pituitary adrenal axis).
Cortisol Functions
Cortisol’s main purpose is to prepare the body for a stressful situation. As such, it does the following.
- Raises blood glucose levels by signaling the liver to release glucose from glycogen and go through gluconeogenesis.
- Releases amino acids from the liver to form glucose through gluconeogenesis.
- Stores glucose in fat tissue, particularly in the abdomen, to survive famine.
- Breaks down bone to release calcium for muscle function.
- Increases production of antibodies and neutrophils to fight infection.
- Diverts resources away from the nonessential immune system such as secretory IgA (mucosal membrane immunity).
- Decreases inflammation.
- Downregulates thyroid function by decreasing thyroid-stimulating hormone (TSH) and the conversion of T4 to T3.
Chronic Elevated Adrenal Stimulation

All of these functions are healthy for a short-term stress response. It’s when there is constant stress that cortisol begins to play a negative role in health. Long-term elevated cortisol levels will result in the following.
- Causes chronically elevated blood sugar levels leading to insulin resistance.
- Uses amino acids for fuel, causing a breakdown of muscle tissue.
- Leads to accumulated abdominal fat.
- Weakens bone structure.
- Depletes the immune system due to burnout from high antibody production.
- Leaves the gut prone to infection due to decreased secretory IgA.
- Causes hypothyroid symptoms such as weight gain and fatigue.
As you can tell, there are several systems that can become sick if the adrenals aren’t healthy. Most notably, adrenal dysfunction will affect the gastrointestinal, immune, female hormone, and thyroid hormone systems.
Metabolic Problems and Insulin Resistance
As a “glucocorticosteroid” one of the main functions of cortisol is to regulate blood sugar levels in an emergency. When cortisol increases the concentration of glucose in the blood, it signals a release of insulin to promote the uptake of glucose into the cells. When cortisol is consistently high, blood glucose is also consistently high. This in turn leads to chronic high levels of insulin. When the cells become accustomed to these high insulin levels they will not respond to it in the same way. This is called insulin resistance and is implicated as a factor in a number of health problems including the following.
- Diabetes
- Polycystic Ovarian Syndrome (PCOS)
- Cardiovascular Disease
- Cancer
What Causes a Chronic Stress Response?
The HPA axis works better for short-term stress situations such as running away from a predator. Ideally, after escaping from the predator, the high cortisol levels will signal the hypothalamus to reduce its production. However, in modern life, there are stresses that will continually signal the hypothalamus.
Anything that increases inflammation will activate the HPA axis. This includes chronic infections, inflammatory foods, toxins, and even long-term emotional stress. Any of the following may create a chronic stress response.
- Chronic gut infection
- Food Sensitivities
- Low blood sugar
- Heavy metal toxins
- Toxic pesticides
- Childbirth
- Death of a loved one
- Divorce
- High-stress jobs
What Are the Stages of Adrenal Dysfunction?
There are three main stages of adrenal dysfunction.
Stage 1: High Cortisol
During stage one, cortisol levels are elevated due to consistent stress. The higher cortisol levels can cause anxiety and insomnia.
Stage 2: Dropping Cortisol
As the body produces more cortisol, it eventually becomes depleted of the nutrients necessary to make the cortisol molecule. During this stage, cortisol levels are falling. Throughout the day the levels may bounce around between high and low. This can give a sensation of both feeling “wired” mentally, but tired at the same time.
Stage 3: Low Cortisol
In stage three the body has become so depleted of the nutrients necessary to make cortisol that the levels have completely bottomed out. During this stage deep fatigue sets in.

The Three Stages of Adrenal Dysfunction
So that’s what cortisol is doing during each stage, but how do we determine that someone isn’t just having a healthy stress response with elevated levels in stage one? To answer that question we look at another molecule called dehydroepiandrosterone (DHEA). This hormone is a precursor to testosterone and estrogen hormones. When the body demands a high production of cortisol it will prioritize it above the production of DHEA, because the body prioritizes survival over sex. Over time, DHEA levels will drop in order to supply cortisol production. Thus, the DHEA marker is necessary to determine if HPA axis dysfunction is occurring. If it’s low it indicates that chronic stress has occurred.
Adrenal Stress Test
There are two main ways to do a functional test for HPA axis dysfunction. They use either salivary or urinary samples that are taken several times throughout the day. These are take-home tests that allow you to take the samples yourself.
How to Heal HPA Axis Dysfunction Naturally
Whether or not you use a supplement or herbal protocol to correct adrenal dysfunction, your lifestyle decisions must support the change. Without proper lifestyle adjustments, the gains made from a program will either take a long time to work, or you will slip back into the same adrenal dysfunction problem when it is finished. The main areas to focus on are diet, exercise, sleep, and stress management. Don’t try to change all of these at once. Make it simple for yourself and prioritize just one at a time. In my opinion, a healthy diet will have the biggest impact on your health.
Diet
The number one rule for correcting adrenal dysfunction is to eat frequently throughout the day. Without consistent food intake, your body goes into a stress response, because it is preparing for starvation. It will produce more cortisol in these situations. Fasting has many health benefits but will cause more damage for someone who has dysfunctional adrenals. Decrease inflammation by eating anti-inflammatory foods including olive oil, fish (or omega-3 fatty acids), avocados, berries, peppers, and turmeric. Avoid alcohol and foods that are fried or have added sugar as they are known to cause inflammation. One powerful way to restore health is through a comprehensive elimination diet.
Exercise
Since cortisol promotes the use of amino acids as fuel, it can cause a breakdown of muscle tissue. Therefore, it’s important to do muscle toning exercises to counteract this process. Cardiovascular exercise will use higher amounts of amino acids as fuel for someone who is experiencing adrenal dysfunction. Prioritize muscle toning until your adrenal system is repaired.
Sleep
There’s nothing quite as healing as an early bedtime. Be in bed by 10 p.m. to get the highest quality sleep. Not all sleep is equal in quality, and the hours between 10 p.m. and 12 a.m. have a very powerful healing effect.
Stress Management
As I mentioned earlier, emotional stress is one way that the adrenals are stimulated to produce cortisol. Find some way to manage your stress. Some popular activities that help manage stress are meditation, exercise, yoga, qigong, and spending time in nature.
Treatment of HPA Axis Dysfunction with a Protocol
If you’ve had adrenal dysfunction for a long time you may need some help in order to repair the HPA axis from extreme deficiencies. With a functional medicine approach, we can retrain your HPA axis to work well again. The process involves a low dosage of bioidentical hormones derived from plants. Taking these hormones in low dosages for several months is a safe strategy with proven efficacy in restoring a healthy stress response so that you don’t have to experience adrenal dysfunction symptoms.
Non-Testing Protocols
I do recommend getting your adrenals tested with a bioidentical hormone protocol as it is the fastest and most powerful way to restore your health if you have adrenal dysfunction. However, if you prefer to explore other ways to heal your adrenals there are a few herbs and supplements that will be useful. This adrenal protocol can be found at my Fullscript dispensary along with dosage instructions. Here’s a summary of the items in this protocol.
Adaptogenic Herbs: The formulation in this protocol contains vitamins and herbs that are designed to repair the HPA axis.
Lipoic Acid: This is a supplement that supports your blood sugar regulation. If you have adrenal dysfunction then your body will have difficulty controlling blood sugar levels, and it is safe to assume that you have some level of insulin resistance. Lipoic acid will actually repair insulin receptors, increasing insulin sensitivity.
Vitamins and Minerals: You’ll need plenty of “raw materials” to repair your adrenal function. This protocol gives your body an abundance of the necessary materials to heal.
How Long Does it Take to Recover from HPA Axis Dysfunction?
Using the bioidentical hormone strategy, the adrenal function can be restored within 6 – 12 months. It takes longer for more severe conditions or for stressful lifestyles.
If you suspect you have HPA axis dysfunction I can help. If you’d like to start addressing these health problems then you can schedule a free 15-minute consult to learn more. Click below to check my availability.
Disclaimer: This website does not provide medical advice. The information contained on this website is for informational purposes only. No material on this site is intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of a healthcare professional with any questions you may have regarding a medical condition and treatment before undertaking a new healthcare regimen.