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Adrenal Fatigue and How to Avoid It

Posted by Dr. Ian Bier on Mar 19, 2020 1:54:39 PM

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The past 25 years have brought about a wholesale shift in the frequency of doctor visits for adrenal problems. Although stress has always existed and been discussed, the level of adrenal weakness and HPA axis dysfunction is a much newer phenomenon.

Perhaps the most crucial foundation of any conversation about adrenal fatigue is the basic understanding that stress is not, inherently, bad. Stress is the body’s normal, natural, and essential reaction to acute situations, and it is necessary for survival. Whether it be running from a predator or preparing to speak in public, the adrenal glands fulfill their role of interpreting stressors and acting accordingly to enhance performance and allow us to react appropriately.

The problem stems from when this acute stress response begins happening chronically and stress hormones remain elevated continuously.

What is adrenal fatigue?

The adrenal glands are two small glands that sit atop the kidneys. They are part of one of the most important communication loops in your body called the hypothalamic-pituitary-adrenal axis, or HPA axis. We can think of the adrenals as the body’s emergency fund, and we borrow from them in times of stress. The HPA axis is activated any time a negative or positive stress event occurs, and it responds with stress hormones, like cortisol.

This axis communicates in a top-down fashion: your brain talks to your hypothalamus, which sends a chemical signal to your pituitary, which releases adrenocorticotropic hormone (ACTH) to turn on cortisol (and adrenaline) output from your adrenals so that your adrenals release stress hormones. When cortisol reaches high enough levels, it suppresses ACTH and the pituitary to help regulate your fight-or-flight response.

Adrenal fatigue is not a valid medical diagnosis but instead a way of describing a broad spectrum of symptoms that might occur from overextending yourself over a period of time. It’s a series of stress-related symptoms that are often thought to occur in phases, specifically the alarm, adaptation, and exhaustion phases.

The alarm phase is at the beginning of a stress response. You could feel anxious in response to a negative stressor, or quite effective, productive, and over-achieving in response to what you perceive as a positive stressor, typically due to abnormally high cortisol outputs. The adaptation phase happens when the acute stress doesn’t resolve and a chronic stressor remains. The body gets used to the stress, and we go back to how we felt prior to the stress, even though the stress is still present. That’s when you think you’re handling the stress well. The exhaustion phase comes after you’ve been in adaptation mode for a longer period and the body has run out of extra resources to keep you there. The body begins to tire, cortisol levels start to drop, and symptoms such as fatigue might begin. As the exhaustion phase moves forward, it leads to a more dramatic drop in cortisol and an increase in symptoms.

Are you missing signs of high cortisol and low thyroid levels? Find out what to  look for.

Symptoms of adrenal fatigue

While symptoms of adrenal fatigue can vary from person to person, the first sign is often a person who is seemingly healthy, yet is by nature an over-achiever and a high-performance individual. This situation can set the stage for the overproduction of stress hormones, followed by the later phases of lower hormone production and increased symptoms.

Other signs of adrenal weakness might include headaches, feelings of anxiety, heart palpitations, fatigue, gastrointestinal problems, increased hunger and cravings for carbohydrates and sugar, and trouble sleeping.*    

How to avoid adrenal fatigue

Although there is no exact recipe for managing negative forms of stress and avoiding adrenal fatigue, the following two rules apply:

1. Get Proper Rest

Sleep is when the body heals and repairs, so good sleep hygiene is vital. In today’s modern world, using technology in the evening for work or pleasure is far more common than it used to be, and it is wreaking havoc on your ability to sleep well.

If possible, avoid electronic devices for two hours before going to bed. If this is unavoidable due to work, take measures to mitigate the effects of blue light such as blue light blocking glasses, reading printed pages rather than tablets, and avoiding backlit devices. Challenge yourself to remove television sets from your bedroom and utilize the bed only for sleep and sex.

Related Article: How Stress Affects the Adrenal Glands

2. Control Blood Sugar

Controlling blood sugar levels to avoid adrenal fatigue is critical. It’s a well-documented fact that insulin levels increase during times of stress, and this can ultimately contribute to metabolic dysfunction, blood sugar dysregulation, weight gain, and additional health problems.1 The ripple effect of elevated stress hormones and insulin is increased hunger and cravings for sugary foods and carbohydrates, which leads to a vicious blood sugar roller coaster.

To mitigate the impact of stress, eating for blood sugar regulation is recommended. Instead of the conventional wisdom that you must eat every two hours to maintain stable blood sugar – typically a carbohydrate-based meal or snack – consider instead eating balanced meals rich in protein, healthy fats, and plenty of fiber and nutrients from vegetables.

If you are feeling hunger shortly after a meal, this could be a sign that you aren’t meeting your nutritional needs. However, if you know that you are under chronic stress and the adrenal glands may be suffering, a regular protein-based snack every two hours can help.


Adrenal fatigue stems from several factors that can vary from person to person. Getting adequate rest, eating for blood sugar control, and implementing strategies to lower stress levels can help prevent the body from reaching a tipping point from which it’s hard to return.

By Dr. Bier

* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. 

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1 Zamani-Alavijeh, F., Araban, M., Koohestani, H.R., & Karimy, M. (2018). The effectiveness of stress management training on blood glucose control in patients with type 2 diabetes. Diabetology & Metabolic Syndrome, 10:39. doi: 10.1186/s13098-018-0342-5.



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