Adrenal Fatigue: Symptoms, Causes & Treatments

Do you regularly experience brain fog, low energy, or difficulty waking up? Maybe you're unable to participate in activities that bring joy, or you have a dependency on coffee and stimulants to make it through the day. If any of these sound familiar, you're far from alone. One of the most common reasons patients come to see me is to get help with fatigue, which is so common in our society — and for good reason.

Many of us are constantly pushing ourselves to work harder, perform better, and get a ton accomplished each and every day. The problem is that “hustle culture,” relentless busyness, and the never-ending drive to perform and produce often lead to burnout and perpetuate feelings of exhaustion. In addition, many people have poor sleep habits, whether due to hectic work schedules, active social lives, or simply the environments they live in.

All of these habits place stress on the adrenal glands and cause what's referred to as “adrenal fatigue.” But is adrenal fatigue real? This article will delve into these exhaustion-related symptoms — and explain why they're actually due to HPA axis dysregulation — and discuss effective ways to help manage and treat this type of fatigue.

Here's what you can expect to learn below:

• How to improve your energy, eliminate adrenal fatigue symptoms, and feel better each day
• Why symptoms of “adrenal burnout” are more accurately associated with HPA (Hypothalamic-Pituitary-Adrenal axis) dysregulation
• How the HPA axis works and why women are more prone to HPA dysregulation
• How stress, poor nutrition, and lack of sleep can contribute to fatigue and HPA dysregulation
• Ways to take care of your adrenals, including  how to reduce stress and sleep better, such as lifestyle changes, supplements, and therapies

What Is Adrenal Fatigue?

Adrenal fatigue is a term that has gained popularity in recent years, often used to describe a collection of symptoms like tiredness, stress, and sleep disturbances.

But here's the thing: while adrenal fatigue symptoms are a very real phenomenon, the term adrenal fatigue is misleading and not a medically recognized condition.

“Adrenal fatigue” is not accepted as a medical diagnosis by many doctors; instead, it's seen as a collective range of symptoms that occur when there is a disruption in the adrenal hormone system.

What people refer to as adrenal fatigue can actually be due to:

• HPA Axis Dysregulation (HPA-D): where the brain and adrenal communication becomes dysregulated
• Cortisol receptor resistance: where the cell receptors become unresponsive to the signals of cortisol
• Increased enzyme activity: where cortisol is converted to its inactive form, cortisone

Your body has these mechanisms in place to keep you alive and protect you from the damage of excess cortisol. 

And your adrenal glands should never give out, with the exception being Addison's disease, which is an autoimmune disease that results in an adrenal crisis. In this condition, the immune system attacks the healthy adrenal gland so that it is unable to produce hormones and adrenal function is compromised.

Because of this, HPA dysregulation is a better way to describe this type of exhaustion. In many cases, it's associated with high levels of ongoing stress, a history of stressful events such as PTSD, sleep deprivation, or other illnesses, such as the flu.

Understanding HPA Axis Dysregulation

The HPA axis is a complex network involving the hypothalamus, the pituitary gland, and the adrenal glands. This system plays a critical role in regulating stress responses, mood, digestion, immune system, energy levels, and more.

How the HPA Axis Works

There are three components of the HPA (Hypothalamic-Pituitary-Adrenal) axis:

• Hypothalamus: This is a region in the brain that serves as the control center for the HPA axis. It detects stress and triggers the release of corticotropin-releasing hormone (CRH).
• Pituitary Gland (Anterior Pituitary): This gland is located at the base of the brain and receives CRH signals from the hypothalamus. In response to CRH, it releases adrenocorticotropic hormone (ACTH).
• Adrenal Glands (Adrenal Cortex): These are a pair of glands located on top of each kidney. They respond to ACTH by releasing cortisol, a stress hormone. Cortisol has a wide range of effects on the body, including regulating metabolism, immune response, and blood pressure.

The HPA axis operates on a feedback loop. High cortisol levels inhibit the further release of CRH and ACTH. When cortisol levels drop, the hypothalamus is stimulated to produce more CRH, restarting the cycle.

The HPA axis is primarily activated during times of stress. It helps the body adapt to stressors by increasing alertness, energy, and metabolic functions.

Role in Chronic Stress:

Prolonged or chronic stress can lead to dysregulation of the HPA axis. This can result in elevated cortisol levels, which may contribute to health issues like anxiety, depression, and sleep disturbances.

The HPA axis is also interconnected with other systems, including the endocrine and nervous systems. It helps regulate various hormones and physiological processes in the body.

For example, it influences diurnal rhythms and cortisol secretion. Cortisol production normally follows a diurnal (daily) pattern, with higher levels in the morning and lower levels at night. This rhythm influences wakefulness and sleep patterns, but when the HPA axis becomes dysregulated, it can lead to symptoms like trouble falling and staying asleep, as well as daytime fatigue (or feeling “wired and tired”).

It is important to recognize that stress can come in many forms, including both physical stress and mental stress.

Adrenal Fatigue Symptoms (Or HPA Dysregulation Symptoms)

How do you know if you're experiencing symptoms of adrenal burnout, aka HPA dysregulation, or if they're due to another condition?

There are a range of symptoms to look out for to suggest your adrenals are working overtime. Common symptoms to watch for, which can indicate that you're body is under a lot of stress, can include:

• Extreme fatigue and tiredness, especially in the afternoon
• Difficulty in waking up, even after a long sleep
• Reliance on caffeine and stimulants to get through the day
• Salt cravings or feeling compelled to eat salty foods
• Decreased stress tolerance
• Weakened immune system and increased illnesses
• Difficulty in concentrating or brain fog
• Unexplained weight loss or weight gain
• Mood swings and irritability
• Acne and other skin problems
• Depression
• Low sex drive or libido
• Poor memory
• Irregular periods (here's how stress can impact your periods)
• Increased PMS and menopausal symptoms
• Dizziness, feeling light-headed, or having “head rushes” when rising from a lying or seated position
• Muscle weakness
• Blood glucose (sugar) imbalances

These adrenal stress symptoms can also be due to other conditions, which is why it is important to meet with a licensed health care provider if you're experiencing them. For example, these can also be a sign of thyroid gland disease. You can learn more about adrenal fatigue symptoms vs. low thyroid hormone here.

Adrenal Fatigue Treatment: How to Heal HPA Axis Dysregulation

Treating HPA axis dysregulation often involves a multifaceted approach, meaning a combination of several habits and lifestyle changes.

The goal is to cultivate a balanced approach to life — one that includes a combination of lifestyle dietary adjustments, stress management techniques, sleep habits, and sometimes professional guidance — that supports the body's natural ability to handle stress.

Here's a detailed look at each treatment strategy.

1. Lifestyle Modifications

For your body to cope with stress, you need to get enough sleep and balance your “allostatic load,” which means the accumulation of different stressors in your life.

• Adequate sleep: Prioritizing good sleep hygiene and ensuring 7-9 hours of quality sleep can help in the recovery of HPA axis function. Establish a regular sleep routine, avoid screens before bedtime, and create a comfortable, dark, and quiet sleeping environment.
• Regular, moderate exercise: Moderate exercise can reduce stress hormones and improve mood, but avoiding overexertion is important. While regular physical activity is important, overexercising can exacerbate HPA axis dysregulation. Incorporate a mix of activities, including cardiovascular exercises, strength training, and restorative practices like yoga or tai chi. Keep things moderate by taking walks, doing pilates, cycling, and so on, but avoid high-intensity exercise if it leaves you feeling drained.

2. Stress Management Techniques:

• Mindfulness and meditation: Practices like mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help significantly reduce stress levels and improve the body’s response to stress.
• Cognitive behavioral therapy (CBT): Working with a therapist, especially one trained in CBT (particularly for PTSD and anxiety), can help change negative thought patterns and ingrained beliefs and develop healthier coping mechanisms for stress that can support mental health.

3. Dietary Changes

A diet rich in whole foods, lean proteins, healthy fats, and complex carbohydrates can support the HPA axis.

• Balanced meals: Focus on a diet rich in whole foods, incorporating a balance of proteins, healthy fats, and complex carbohydrates. This balance is key to maintaining stable blood sugar levels, which in turn supports adrenal health. For help sticking to a healthy diet, check out my Hormone Starter Kit resource.
• Reduce stimulants: Limiting caffeine and sugar can help you sleep better, regulate cortisol levels, and improve overall adrenal function. Excessive caffeine, in particular, can further stress the adrenals.
• Electrolytes: Levels of potassium can become imbalanced when the adrenal gland system is not functioning optimally. This is because in addition to cortisol, the adrenal glands produce aldosterone, a hormone that helps regulate potassium levels. The electrolyte imbalances created are what can lead to muscle weakness, high blood pressure, dizziness, reduced exercise tolerance, and leg cramps. Including an electrolyte beverage (ideally one with a balance of sodium, potassium, and magnesium) into your daily routine is an easy step in supporting adrenal health and recovery.

4. Supplementation

Certain supplements like magnesium, B vitamins, and adaptogenic herbs may help support HPA axis health and the body's ability to handle stress.

• Adaptogens: Herbs like ashwagandha, rhodiola, and holy basil are known as adaptogens. They may help the body adapt to stress, help keep cortisol levels balanced, and can support better sleep and HPA axis function. 
• Magnesium: Often referred to as the relaxation mineral, magnesium can help improve sleep quality and help manage the effects of high stress levels. It's involved in hundreds of biochemical reactions in the body, many of which are related to stress response. Many adults lack magnesium in their diets; therefore, a magnesium supplement can often come in handy.
• Phosphatidylserine: To have more energy during the day, we need to support restorative sleep that allows the adrenal glands to heal. In the evening, cortisol should decline as melatonin rises. In cases of HPA-D, it is often that cortisol remains elevated in the evening, preventing the necessary recovery to wake refreshed. Phosphatidylserine is an amino acid that supports the body's natural lowering of cortisol in the evening. 
• Vitamin B5 and Vitamin C: The adrenal glands require both of these nutrients in order to function and maintain healthy hormone levels. Including bell peppers, guava, kiwi, and citrus can provide you with dietary vitamin C. Vitamin B5 can be found in mushrooms, salmon, and avocado. You'll find a list of recipes with these nutrients available for free download here.

For comprehensive supplementation support, consider trying my Adrenal Support formula, which features adaptogens, B vitamins, and other essential nutrients to help balance stress hormones, support a healthy menstrual cycle, and optimize energy.

Additionally, my Adrenal Calm formula features a synergistic blend of adaptogenic and nervine herbs, paired with nourishing B vitamins and calming amino acids, like L-Theanine and phosphatidylserine, to help you get restful sleep and balance cortisol production.

Adrenal support is the morning formula, while Adrenal Calm is the evening formula. Together they provide 24 hour support for fast tracking adrenal balance.

If you think you may be struggling with adrenal burnout, it can also be insightful to read my article 7 Adaptogenic Herbs for Adrenal Health

5. Regular Medical Check-ups

• Hormone testing: Regular check-ups and hormone testing (discussed below) can help monitor the levels of cortisol and other hormones affected by HPA axis dysregulation. This can guide treatment choices and track your progress as you make changes to your lifestyle.
• Addressing underlying health Issues: Sometimes, symptoms attributed to HPA axis dysregulation can be due to other underlying health issues, like thyroid disorders, iron-deficiency anemia, hidden infections, or depression, for example. It’s important to rule out or treat these conditions.

6. Holistic Therapies

While they're not a cure-all for everyone, many people find the therapies below to be relaxing and rejuvenating.

• Acupuncture: This traditional Chinese medicine technique may help balance the body’s energy flow (Qi) and has been found to be beneficial in managing stress and hormonal imbalances.
• Massage therapy: Regular massage may help reduce cortisol levels and increase levels of neurotransmitters that reduce anxiety, such as oxytocin and serotonin.

7. Social Support and Community

Having a strong social support system can provide emotional comfort and practical help during stressful times. Engaging in community activities or support groups (including ones online) can be beneficial for feeling less isolated and anxious.

What Are the Causes of Adrenal Fatigue (HPA Axis Dysfunction)?

Stress is the main culprit when it comes to adrenal fatigue or HPA axis dysfunction. When we experience stress, the adrenals respond by releasing hormones such as cortisol and adrenaline, which have effects including increasing your blood pressure and your heart rate.

With long-term stress, this constant production of cortisol leads both your adrenal glands and you to feel more exhausted than usual while causing other symptoms, too, such as changes in your mental performance, mood, sleep, and libido.

HPA axis dysfunction can be caused by various factors, including:

• Chronic stress: Prolonged exposure to stress, as well as an accumulation of stress from different factors, can lead to an overstimulation of the HPA axis, eventually causing its dysregulation.
• Poor diet: High consumption of processed foods, sugars, and caffeine can disrupt the balance of the HPA axis. Being deficient in vitamins and minerals, such as zinc, iron, selenium, magnesium, and iodine, may also make symptoms such as fatigue worse.
• Lack of sleep: Inadequate or poor-quality sleep can impair the functioning of the HPA axis.
• Chronic infections and illnesses: Long-term health conditions can strain the HPA axis, including by disrupting gut health linked to hormone production.
• Overuse of stimulants: Excessive use of stimulants like caffeine can exacerbate HPA axis dysfunction, while smoking and alcohol can worsen inflammation, interfere with sleep, and have other negative effects.
• Emotional trauma: Past traumas, PTSD, and emotional stress, including those in the earliest year of life, can have a lasting impact on HPA axis regulation even years after the traumas occur. Memories and beliefs are powerful and can affect someone's mindset, potentially leading to anxiety and lowering one's ability to cope with stress.

How to Test for Adrenal Fatigue

In addition to paying attention to your symptoms and what your body is trying to tell you, lab testing can help reveal how well or unwell your adrenal system is functioning.

Blood Tests for HPA-D

• ACTH: measurement of pituitary signaling to the adrenal glands
• Morning cortisol: single measurement to evaluate the response of the adrenal glands to ACTH
• DHEA-S: a hormone produced by the adrenal glands that can provide insight into adrenal function

Learn more about DHEA-S here.

Adrenal Stress Index

This type of test utilizes several samples of saliva to test levels of stress hormones and insulin to paint a picture of your metabolic and hormonal health.

An ASI looks at 6 parameters in evaluating your adrenal health:

• Cortisol measurements: Helps evaluate your stress response and your rhythm of cortisol release during the day.
• Insulin: Evaluates blood sugar regulation, which is related to cortisol and inflammation.
• DHEA: Helps determine how you've adapted to stress.
• Secretory IgA: Evaluates impact on the immune system and gut permeability.
• 17-OH progesterone: Helps determine adrenal reserve.
• Gluten antibodies: Helps determine intolerance to gluten, as an intolerance can damage the gut, trigger inflammation, and contribute to hormonal imbalance.

DUTCH Test

In addition to DHEA, sex hormones (estrogen, progesterone, testosterone), and melatonin, the DUTCH test also provides insights about cortisol and cortisone ratios. This can be helpful in understanding if you're unable to make ample cortisol or if instead, you are inactivating it to cortisone. 

The DUTCH test provides many useful insights into adrenal health, along with helpful information about your waking cortisol response and sex hormone metabolites.

Why Isn't Adrenal Fatigue An Accurate Term?

HPA axis dysregulation (or dysfunction) occurs when there is an imbalance in this system, leading to various symptoms that are often called adrenal fatigue.

When we say HPA axis dysregulation, we're acknowledging that there are complex interactions and feedback mechanisms involved in someone's stress response that depend upon communication between the hypothalamus, pituitary gland, and adrenal glands, rather than suggesting that the adrenal glands are solely to blame.

Below is an explanation of why HPA dysregulation describes this condition more accurately than adrenal fatigue.

1. Holistic Understanding of the Body's Stress Response

Focusing solely on the adrenal glands oversimplifies the complex nature of the body’s response to stress.

HPA axis dysregulation encompasses the entire system responsible for managing stress, acknowledging that dysregulation can occur at multiple levels and involve various factors, including neurological, hormonal, and psychological components.

2. Distinguishes Symptoms From Adrenal Insufficiency

The term adrenal fatigue suggests that the adrenal glands are “tired” or “burned out” and unable to produce adequate amounts of hormones, particularly cortisol.

This is misleading because true adrenal insufficiency (Addison's disease) is a rare, medically recognized condition where the adrenal glands cannot produce enough hormones due to an underlying disease, which is not the case in so-called adrenal fatigue.

Unless someone has Addison's disease, they can still produce cortisol and may even be producing more of it than usual.

3. More Scientific Evidence

No scientific evidence supports the idea that prolonged stress leads to “exhausted” adrenal glands. Medical tests do not support the existence of this condition, and the symptoms attributed to it are nonspecific and could be due to many other health issues.

 In contrast, there is substantial evidence showing that chronic stress can lead to alterations in the normal functioning of the HPA axis. This can manifest in various ways, including changes in cortisol rhythms and sensitivity to stress hormones.

3. Better Understanding of Broad and Nonspecific Symptoms

Drawing on the point above, symptoms of adrenal fatigue are so broad and nonspecific (like tiredness, sleep disturbances, and mood swings) that they can apply to many different conditions, leading to potential misdiagnosis and inappropriate treatment.

Recognizing the role of the HPA axis in stress response allows for a more nuanced understanding of these symptoms. It opens up a broader range of diagnostic possibilities and more targeted treatment options.

The Bottom Line

The shift from “adrenal fatigue” to “HPA axis dysregulation” represents a more scientifically grounded understanding of how chronic stress affects the body. It acknowledges the complexity of the body's stress response and the need for comprehensive approaches to diagnosis and treatment.

Key Takeaways on Adrenal Fatigue Symptoms, Causes, and Treatments

While “adrenal fatigue” as a diagnosis is a misnomer, the symptoms it describes are very real and often point to HPA axis dysfunction. Understanding this distinction is crucial for effective treatment. By addressing the root causes and implementing lifestyle changes, it's possible to restore balance and improve overall well-being.

Remember, each individual's journey to recovery is unique, so it's important to approach treatments with patience and to work with a trustworthy healthcare provider who considers your individual needs.