Stress is a protective feature of our normal human condition. It is our body’s way of protecting us from things that could harm us. When the body is under stress, it diverts its attention away from all unnecessary functions and refocuses them on life-saving measures. Our adrenal glands are the control center of our stress response, providing essential hormones that prepare us for the fight as well as protect us from damage.

Oftentimes, we think of stress as psychological or emotional (like job stress or relational stress). However, our body defines stress much more broadly. From our body’s perspective, learning a new skill is stress. Calorie restriction is stress. Infections or diseases are stress. Heck, even exercising or throwing a party is stress! These stressors may seem benign but our body responds to them the exact same way as it responds to job stress or relational stress. Regardless of the cause of stress, our body always reacts as if we’re running from a tiger. But it doesn’t know that we’re not. It treats everything as an emergency.

This normally isn’t a problem as long as the stressful event(s) eventually stops and our body can calm down. Too often in our lives, however, multiple stressors compound on top of each other and/or our body and mind never seem to rest at the end of the day. This is when we have a problem and our stress response deviates from normal, causing damage to our bodies and adrenal glands.

This blog is the first of three parts in our series on adrenal fatigue. In part one we’ll discuss the healthy response to stress, types of stress, and the stages and symptoms of adrenal fatigue. We’ll also cover how stress can cause chronic disease. We believe it’s important to be aware of what adrenal fatigue is and how it progresses so you can recognize when you need help and take steps towards healing.

Parts two and three of this blog series discuss the dietary and lifestyle changes that are necessary for healing and reversing adrenal fatigue. Part two discusses an eating plan that supports adrenal recovery. It emphasizes the importance of glycemic balance as well as shares some supplements that may be helpful in various stages of adrenal fatigue. In part three, we wrap up our discussion by addressing ways to manage and prevent stress, as well as tips for how to improve the quality and quantity of our sleep. Managing stress and sleep are essential for reestablishing healthy adrenal function.

The Healthy Response to Stress

The stress response is also called the “fight or flight” response, which is controlled by our sympathetic nervous system. The first stage is when our adrenal glands secrete two hormones called epinephrine and norepinephrine. You might be more familiar with the other name for epinephrine, called adrenaline. These hormones are released immediately after a stress trigger and have an explosive and aggressive impact. Together, these hormones quicken your heart rate, providing more blood flow to your muscles, lungs, and heart. Consequently, blood flow is decreased in the digestive system, slowing our gut motility and other digestive processes. Epinephrine and norepinephrine also sharpen your sight, hearing, and overall alertness, along with increasing endurance and physical strength. These two hormones act as the immediate, short-term response to stress, enough to get us out of harm’s way within a matter of minutes (around 15 minutes to be exact). Examples include jogging stairs, swerving to avoid a car accident, or public speaking.

This short-term response may be all that your body needs to escape danger. If, however, your body continues to perceive stress for longer than 15 minutes (like planning a wedding, giving birth, or anticipating a first date), the second part of the stress response occurs. This is when the adrenal glands release the hormone, cortisol. Cortisol is the prolonged response toward stress and prepares the body to weather the storm while protecting it from excessive damage.

In many ways, cortisol counter-balances some of the aggressive actions of epinephrine and norepinephrine. Cortisol is a powerful anti-inflammatory hormone and decreases the inflammation that was brought about by epinephrine and norepinephrine. Cortisol also suppresses our immune system, which was put on high alert during the first stage of the stress response. It increases blood sugar levels by freeing up stored glucose from the liver, and increases metabolism and appetite so we eat more food for energy. Lastly, cortisol suppresses our reproductive system. Afterall, procreation is not a main focus during prolonged stress.

After the stress event is over, whether short-term or prolonged, our adrenal glands clear away these hormones and homeostasis (balance) returns. We are now in the “rest and digest” mode, which is controlled by our parasympathetic nervous system.

Cortisol At Its Best

It’s important to note that cortisol is released throughout the day, whether or not a person feels stressed. Cortisol serves several functions such as regulating sleep cycles, helping with energy production and immune activity, repairing body cells, and regulating glucose and inflammation. It also plays a role in building muscle and bone as well as maintaining mental focus and stamina.

Healthy cortisol levels follow a diurnal schedule, peaking in the morning so you are alert to start the day. Levels drop down around mid-day and then gradually taper off as the day continues. Cortisol is at its lowest point around midnight, allowing you to sleep. A healthy stress response will disrupt this natural “cortisol curve” to help you get through the stress event.

DHEA During Health And Stress

Cortisol isn’t the only stress hormone that’s also necessary in daily life. DHEA is another hormone released by the adrenal glands each day, as well as during a stress response. When the body is in “rest and digest” mode, DHEA doesn’t really fluctuate throughout the day, unlike cortisol. DHEA is responsible for improving energy levels, lipid levels, bone mineral density, and overall well being. It also helps lower cholesterol, decrease body fat, and block inflammation-causing proteins. The brain also produces DHEA and it’s thought to help with memory and cognition. Lastly, DHEA creates testosterone and estrogen. The production of DHEA does decline with age, and deficiency levels are associated with age-related diseases.

During times of stress, DHEA prevents systemic inflammation from getting out of control. It also protects part of the brain, called the hippocampus, from damage. DHEA begins rising evenly with cortisol in the beginning stages of stress. However, if stress becomes chronic and unhealthy, DHEA levels drop significantly, independent of cortisol. It eventually flatlines at the end stage of adrenal fatigue. The greater the spread, or ratio, between cortisol and DHEA, the greater the damage from stress and the more health issues arise.

Positive Stress Vs. Negative Stress

We’ve talked about two types of stress so far. The first was stress that is short-term, such as public speaking or avoiding a car accident. Stress events that are short-lived allow the body to recover afterwards without any damaging effects. The second type of stress discussed was “positive stress”, also called eustress, such as planning a wedding, exercising, or prepping for a first date. Positive stress is when we face a challenge that we believe is within our ability to handle. This kind of stress evokes feelings of excitement and anticipation. It motivates us to keep focused and improves our performance. These types of stress (short-lived stress and positive stress) are what our stress response, or “fight or flight” response, is designed to handle. Our body follows a set manual of instructions and acts in predictable ways. We are then saved from “danger” and return to rest and balance.

Conversely, there is another type of stress that acts against our body’s instruction manual. It opposes “rest and digest” and resists homeostasis, or balance. This type of stress is “negative stress,” also known as distress. Unlike eustress, distress is a stress event that we believe is outside our ability to handle. It causes feelings of anxiety, decreases our performance, and can lead to mental and physical health problems. Negative stress can be short-lived or long-term. Examples include filing for divorce, losing a loved one, enduring abuse or toxic relationships, being unemployed, having trouble sleeping, or fighting an illness. With negative stress, the stress event either lasts for years, or the body remains on alert long after the stress event is over. Either way, our body doesn’t return to baseline afterwards; it is in perpetual “fight or flight” mode. This is when things start going haywire and begin progressing towards adrenal fatigue.

Stages and Symptoms of Adrenal Fatigue

Adrenal fatigue is a slow fade, often progressing over decades. People usually enter this progression without ever noticing because it takes so little effort. The path towards adrenal fatigue involves four stages: Alarm, Resistance, Adrenal Exhaustion, and Adrenal Fatigue. Starting on this path is normal (and healthy), but progressing on this path causes increasing damage to our adrenals as well as our entire body.

The good news is that there are several off-ramps along the way and the vast majority of people find support and healing and take the nearest exit. The progression towards adrenal fatigue can be stopped and is reversible.

Each person responds to stress differently, depending on the actual stress event and how much stress is endured. People have varying levels of stress tolerance as well as varying abilities to cope with each stress event.

Most people cycle in and out of some of these stages throughout their life. Because, let’s face it, we aren’t immune to pain, fear, or worry. And life can dish out severe circumstances that are tough to cope with. Raising awareness of adrenal fatigue is key to identifying it in your own life and sparking the change you may need to turn it around.

Stage 1: Alarm

Stage 1 describes our normal stress response. As discussed earlier, when our stress response is triggered, our adrenal glands produce more cortisol to counterbalance the “threat.” We learned that cortisol works tirelessly to bolster some of our body processes (like increasing glucose for energy), while keeping the negative effects at bay (like lowering inflammation and calming our immune system). In essence, cortisol protects our body while also supplying it with what it needs to combat stress. The adrenals also pump out more DHEA, roughly equal to the amount of cortisol. The adrenals at this stage are able to produce enough of these hormones to carry you through the stress event, and hormone levels are still within the normal range and able to return to rest.

This stage does not cause any physical or psychological dysfunction. Fatigue, caffeine, and sugar cravings may occur but they would be mild. Those in stage 1 are classified as being “stressed and tired.”

Stage 2: Resistance

If the stress response continues, cortisol levels get ever higher; much higher than what is healthy. Usually there is a reversal response (called a negative feedback loop) that is designed to shut down cortisol production once it hits a certain height so that the body can return to rest. However, the body interprets the very high cortisol levels as a sign of even more danger to come. This tells cortisol to dampen this reversal response. Without the negative feedback loop to protect us, cortisol levels continue to rise to excessive and dangerous levels. As cortisol climbs higher, DHEA levels now begin to drop. This stage of constant high cortisol and low DHEA may last years. Many medical practitioners often treat each symptom of stage 2 as separate entities rather than recognizing (or testing for) poor adrenal function.

This high disparity between cortisol and DHEA levels causes a host of health issues during stage 2. As you might imagine, some of the protective actions of cortisol can get out of hand when they don’t turn off. For example, cortisol increases blood sugar but chronically high blood sugar can result in reduced insulin sensitivity. Furthermore, cortisol suppresses the immune system, but if this never turns off then it raises the risk of severe infection and subsequent inflammation. Cortisol also raises metabolism so we eat more food for energy, however, as cortisol rises, it’s common to crave sweet and fatty foods resulting in weight gain. Other symptoms in this stage include imbalances in sex hormones, hypothyroid issues, irritability, anxiety, insomnia, and ever increasing fatigue. Stage 2 is also known as the “wired but tired” stage, where people get jittery and develop an unhealthy relationship with coffee and other stimulants.

Stage 3: Adrenal Exhaustion

However, our adrenal glands can’t maintain high cortisol production forever. They were not designed to meet these constant high demands and before long they become overworked. The adrenal glands are unable to keep up with demand and they begin slowing their production of cortisol down to low-normal levels. DHEA levels are now well below normal. At this stage, both cortisol and DHEA fall below the minimum required levels for normal functioning. In response, our body tightly controls what’s left, conserving it only for the most essential body processes. This stage of near-failure is very serious and is the beginning of a catabolic phase where muscles are broken down for energy and nonessential functions are shut down. People should seek medical attention if they haven’t already, but recovery at this stage will be slower and many may never fully regain their original energy levels or body homeostasis.

Stage 3 is where any prior symptoms from earlier stages begin getting worse and even become chronic. Infections will be more constant, anxiety and depression will be more severe, and getting out of bed becomes a daunting task. Digestion and metabolism slows down causing constipation and risk of digestive disorders. A person may have only small bursts of energy but overall will be mentally, emotionally, and physically exhausted. Caffeine and other stimulants no longer help and quality of life lowers. Other symptoms in this stage include lack of enthusiasm, low libido, inability to handle stress, low exercise tolerance, and brain fog. This stage describes the adrenal crash and can last for several months to years.

Stage 4: Adrenal Fatigue

This stage is also called adrenal insufficiency and marks the point where cortisol levels are flatlined throughout the day and DHEA levels are in the tank. The body furthers its catabolic processes and is breaking down. Regaining homeostasis in the body is essentially impossible.

Even the smallest stressor at this stage can trigger cardiovascular collapse and can even be fatal if left untreated. Luckily, stage 4 is very rare and most people never reach this phase, having found successful treatment in earlier stages. Recovery from stage 4 is possible but takes the right kind of support and lots of time.

Symptoms of stage 4, adrenal fatigue include little to no interest in surroundings, severe weight loss and muscle weakness, diarrhea and vomiting, low blood pressure, low blood sugar, dizziness, depression, and intense pain in the legs and abdomen.

Chronic Stress Can Cause Chronic Disease

There is a large body of evidence linking chronic stress and psychological trauma to chronic diseases such as CVD, gastrointestinal diseases, fibromyalgia, diabetes, chronic fatigue syndrome, and musculoskeletal disorders like rheumatoid arthritis (RA). Some of these are autoimmune disorders, like fibromyalgia, RA, and some gastrointestinal diseases like Crohn’s and ulcerative colitis.

How do chronic diseases occur under high amounts of stress? Stress itself does not directly cause disease. Rather, it’s the subsequent effects of high stress that are the drivers behind chronic disease. These drivers are the immune system, digestive system, and systemic  inflammation.

Immune System Diseases

Immune system dysfunction is unique in that it can cause disease from being too alert and from being too suppressed. Depending on where a person is in the stress response stages, their immune system may be either overactive or under-active. With an overactive immune response, the immune system can mistakenly launch an attack on our body’s own tissues. This is the underlying progression of autoimmune disease. If the immune system is under-active, it opens us up to higher risk of infection and longer recovery periods. A common bacterial infection is H. pylori which can cause digestive issues.

Digestive System Diseases

Ongoing high stress also impacts our digestive system, which slows down so that other body systems can have more energy. A slowed digestive system slows down gut motility and can cause constipation, bloating, and gas. If gut motility does not improve, a person can develop gastrointestinal disorders like inflammatory bowel disease (autoimmune disease), irritable bowel syndrome, SIBO, or GERD. The sugar and carb cravings associated with high cortisol levels would further exacerbate these conditions, as well as cause an imbalance of bad gut bacteria. When there is too much bad gut bacteria and not enough good bacteria, a whole host of issues can occur ranging from mental health issues, impaired glucose metabolism, and a dysregulated immune system.

Inflammatory Diseases (which are all diseases)

Inflammation is a normal process that easily gets out of hand when there are no controls over it. Cortisol is one way that inflammation is kept in check. Once the adrenal glands become exhausted and cortisol levels drop, inflammation can now spread freely throughout the body. Systemic inflammation is the one common thread that links all chronic diseases together. Left untreated, it can precede and perpetuate all disease development. If a person already has a chronic disease (like those described above), uncontrolled inflammation will worsen their condition.


A healthy stress response keeps us alive. Not only does it allow us to run from the proverbial tiger, but it also gives us energy and focus to tackle the tough stuff of life. We can thank our stress response and adrenal glands for acing a test, nailing a speech, running a race, or planning an event. This is the positive stress we were designed to handle. Of course, most of us are worried by negative stress events. Life puts us in the fast lane and we feel like we have to keep up. When negative stress never seems to end, our adrenal glands start a slow decline and begin to malfunction. We feel the results of this and begin to malfunction too. The four stages of adrenal fatigue (or adrenal insufficiency) carry us further down the road towards progressively worse symptoms and a higher risk of chronic disease.

Stress doesn’t have to progress this far! It can be stopped and reversed at any stage with the right support, lifestyle changes, and diet. This is what we discuss in parts two and three of our adrenal fatigue series. Check them out!