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What is Adrenal Fatigue? Understanding The Three Stages Of Adrenal Fatigue

People in functional and naturopathic medicine often speak about Adrenal Fatigue or adrenal dysregulation. In conventional medicine, adrenal fatigue is generally only recognized at its most extreme stage – Addison’s disease. From a preventive health point of view, there are gradations in adrenal health and our response to chronic stress. Dr. Hans Selye, MD, PhD, was the first modern physician to describe the body’s and adrenal gland’s 3-phase adaptation to chronic stress, which he called the General Adaptation Syndrome (GAS).


Periodic activation of the sympathetic nervous system, causing cortisol and adrenaline release, breakdown of proteins and muscle tissue, blood sugar dysregulation, decreased production of thyroid and sex hormones, decreased white blood cell production.


  • High blood pressure
  • Anxiety & depression
  • Blood sugar dysregulation (high or low)
  • Poor memory under stress
  • Sleep problems
  • Sugar cravings
  • Frequent cold, flu, infection


Progression of the alarm phase in which signs and symptoms become chronic.


  • High or low blood pressure
  • Blood sugar dysregulation (high or low)
  • Tired but wired feeling
  • Increased need for caffeine or stimulants
  • Afternoon fatigue from 2-5 pm
  • Weight gain, increased abdominal fat
  • Sugar cravings
  • Anxiety & depression
  • Ulcers
  • Frequent cold, flu, infection
  • Fertility issues or irregular menstruation
  • Thyroid problems
  • Poor focus, memory, concentration
  • Sleep problems
  • Osteoporosis or osteopenia


Occurs with ongoing, unrelieved stress. Cortisol and adrenaline tend to be low. Chronic fatigue may be present. Can accompany post-traumatic stress disorder and occurs more frequently in people that have undergone major stressors in life, or sustained levels of high stress without recovery.


  • Extreme fatigue
  • Difficulty getting out of bed
  • Poor focus, memory, concentration
  • Low blood pressure
  • Blood sugar dysregulation
  • Dependence on caffeine or stimulants or caffeine and stimulants no longer have an effect on energy
  • Salt cravings
  • Nausea/vomiting/loose stools
  • Sleep issues—can sleep for 12-14 hours and still feel tired, or have insomnia

Selye cited genetics, preexisting disease, and diet as factors in determining the course of the General Adaptation Syndrome. We also know that sleep hygiene, establishing a mindfulness or spiritual practice, adequate social support, self-awareness, and a healthy gut microbiome also have a large influence.

Doctors assess adrenal dysfunction based on symptoms, physical exam and a 4-point salivary cortisol test. Depending on a patient’s phase of adaptation, they use personalized nutrition, specific nutrient supplementation, botanical medicine, and lifestyle counseling to support resilience, energy, immunity, healthy weight and stress hormone balance.

If you recognize yourself in one or more of the phases described above, you would benefit from further assessment and treatment. Stress resilience is one of the most important factors in health and chronic disease progression, and you can take great steps toward optimal health by addressing it now.