Are your adrenals really “exhausted,” or is there something bigger at play? Does inflammation, hormone, and gut health play a role in adrenal function? Despite over 80% of adult Americans suffering from adrenal fatigue at some point in their life, the concept is popular but largely misunderstood. This article discusses the misconceptions behind adrenal fatigue and the actual root causes of the health epidemic. 

What is adrenal fatigue?

When you experience debilitating fatigue, mood swings, anxiety, insomnia, salt and sugar cravings, brain fog, and chronic stress—you’ve probably got adrenal fatigue. In both the functional and conventional medical communities, doctors will often test cortisol levels (the stress hormone produced by the adrenal glands) when someone comes with symptoms like these. 

Usually, cortisol comes up low in the morning, when levels should be a bit higher to help you get out of bed and moving. When cortisol is this low, you probably experience the above symptoms. 

The problem is that lab testing doesn’t recognize adrenal fatigue. It only recognizes Addison’s disease, which is primary adrenal insufficiency or a complete deficiency of the hormones made in the adrenals. Someone who has Addison’s disease lacks hormone production as a result of physical destruction to the gland, often a result of autoimmunity. 

In secondary adrenal insufficiency, the glands are usually fine, but there is typically a suppression of hormone production from the pituitary gland, which signals adrenal hormone production. Anything that impacts the pituitary gland will affect the adrenals because of something called the HPA axis, which we will get into in a bit. 

Now adrenal fatigue is kind of like the mystery diagnosis that leaves you frustrated. It means you’re not sick enough to be diagnosed with primary or secondary adrenal insufficiency but still have all the symptoms. This is why addressing adrenal fatigue as soon as possible is critical so that you don’t make it to secondary or primary. Usually, when you are told you have adrenal fatigue, there is no explanation. Cortisol is low, but you have quote on quote normal labs. This is why we are getting to the root cause in this article. 

What is the HPA Axis?

Think of your body’s HPA axis as your stress response system. In this communication network, your hypothalamus, pituitary gland, and adrenal glands talk to each other to control their hormonal output. 

According to Chris Kresser, HPA axis dysregulation is a root cause of adrenal fatigue. He says that it’s not that your adrenals can’t produce cortisol (unless you have Addison’s), but it’s that once you’re under chronic stress for a long time, your body wants to protect you from the dangers of prolonged exposure to high cortisol levels. 

As part of this protection, your hypothalamus and pituitary gland downregulates the entire HPA axis and stops telling your adrenals to produce cortisol, resulting in levels that are too low and cause fatigue. 

Root Causes of HPA Axis Dysregulation and Adrenal Fatigue 


What is stressful for one person may not be stressful for another person and vice versa. Stress looks different for everyone. For one person, negative self-talk may be a pattern causing chronic stress. For another person, a large to-do list is the root of their constant stress. Research also shows early-life trauma may result in an over-reactive HPA axis, contributing to anxiety and metabolic effects. Working with a therapist to get to the root of these patterns may be an important part of your adrenal healing protocol. The goal here is to look at your perceived stress and use stress management techniques that feel good to you. 

If you want to dive into childhood trauma and heal from those experiences, look into EMDR, hypnotherapy, and other alternative somatic therapy techniques. Having a therapist, support group, counselor, or even a loyal friend can be so helpful during your healing journey. 

Commit to other daily stress management techniques. Consistency is key. Develop a morning and evening routine that helps you ground, be present, and connect with your most authentic self and desires. Try meditation. That looks different for everyone. Sitting silently, dancing to repetitive music, knitting, gardening, baking. Do things that get you out of your mind and into your body. Walking is another practice we can’t get enough of. More on that in a future post. 

Remember: Healing from adrenal fatigue requires patience and compassion. This is a slow process, but it can help you fall in love with yourself and life. 

Poor Gut Health & Inflammation

Inflammation that impacts the adrenals can also be caused by hidden gut infections like candida, parasites, and SIBO. Unfortunately, this is extremely common these days, in part because of conventional farming practices and our diets as a result of this. 

When your gut is inflamed, it throws your hormones out of whack making it impossible to get good quality sleep. Keyword here is quality not quantity. 

Poor quality sleep is a huge culprit of adrenal fatigue. 

Do you have trouble falling asleep? Staying asleep? Do you frequently wake up in the middle of the night? Are you tossing and turning all night? Do you feel completely wiped out in the morning despite having slept for 8+ hours?

Poor sleep is linked to gut inflammation. And beyond gut infections, a poor diet or one that is not diverse can cause adrenal fatigue. There are a couple of possible solutions here. You can try an elimination diet which requires eliminating common gut irritants for six weeks. Common gut irritants include nightshades, grains, beans, seeds, dairy, gluten, soy, corn, and more. See how your sleep changes over these weeks. After you are done those weeks, start reintroducing food groups in one at a time to see if you have any reaction. Not only is this diet an excellent choice for gut inflammation, but also for skin and hair. If you have psoriasis, acne, hair loss, and bloat, this may be a good solution for you. 

Another solution, in this case, is to get tested for hiding GI infections and address them. To heal the HPA axis, you need to clear up pathogens like candida, parasites, and bacteria. Including more diverse veggies and healthy fats in your diet can be helpful during this time. 

Blood Sugar imbalances

Blood sugar dysregulation (both high and low) will trigger inflammation. It will also cause issues with leptin and insulin signaling, which impacts the HPA axis– which we know we need to regulate when we have adrenal fatigue. 

Eating balanced meals is essential for balancing blood sugar. Too many processed carbs and sugary foods with not enough healthy protein and fat will through blood sugar levels off. The solution here is to eat balanced meals with healthy fats to keep your blood sugar balanced. This is going to look different for everyone. For some, low carb works best; for others, maybe not so much. If you have super low blood sugar, try eating smaller, more frequent meals to support your adrenals and keep your blood sugar in check. 

Poor Quality Sleep 

We already talked about how poor gut health and inflammation in the gut can impact sleep. Now let’s dive a little deeper into how poor quality sleep can impact adrenal function. 

Sleep is when our bodies get the chance to heal themselves. Hormonal imbalance happens when we don’t get that time to replenish and reset. We just learned that addressing gut inflammation can help improve sleep. But there are also a lot of other ways to address poor sleep. Before we dive into that, let’s talk about how poor sleep impacts the adrenals. 

Circadian Rhythm Disruption 

A common theme here is sleep issues. When your circadian rhythm is disrupted, cortisol and the HPA axis are not regulated. Your circadian rhythm should peak in the morning, meaning you should be ready to start your day. At night, it should be lulling so that your sleepy hormone, melatonin, can take over. 

The problem with sleep these days is that most of us have an inverted circadian rhythm. Meaning, our energy is lacking in the morning and peaking at night when we are supposed to be getting ready for bed. 

Circadian disruption can happen for a number of reasons: not getting enough natural sunlight in the morning, getting too much blue light at night–enter Netflix and late-night social media scrolls. This right here is the cause of our modern HPA axis dysregulation epidemic. 

Here are some solutions:

  • Get sunlight immediately in the morning 
  • No tv or phone a couple hours before bedtime 
  • Purchase blue light blocking glasses, and use before bedtime 
  • Find a nighttime wind-down routine that works for you 

Adrenal fatigue is a modern-day epidemic, and we’re on a mission to help you heal. I hope these root causes have resonated with you and that you found some accessible solutions. Stay tuned for more education on adrenal fatigue healing.