The 3 Phases of Adrenal Dysfunction

On a biological level, adrenal dysfunction is characterized by changes to the rhythm of the body’s cortisol levels. Like many hormones, cortisol levels have a distinct circadian rhythm controlled by the hypothalamus (15).

Ideally, cortisol levels should peak in the early morning and decline throughout the day, reaching their lowest level around midnight (4). However, constant stress can cause HPA axis dysfunction and alterations in cortisol levels throughout the day, often leading to changes in the cortisol curve as discussed below (4).

Note: Cortisol rhythm, cortisol curve, and cortisol slope are used interchangeably to describe the rise and fall of cortisol throughout the day. This can best be tested with a four point cortisol test. 

Chronic stress doesn’t have to be caused by “big things.” The fact is that due to our modern lifestyle many of us are chronically stressed simply because we don’t spend enough time outside, lack nutrients in our diets, work in stressful environments, are exposed to artificial light constantly, or have demanding schedules and financial obligations.

In addition to these more obvious stressors, seemingly healthy behavior — like overexercising, HIIT, fasting, and calorie restriction — can be perceived by the body as stressors if it’s not given the time needed to rest and recover. Good things can also be stressful: Planning for a wedding, moving into a new home, and welcoming a baby into the family are all joyful experiences that also come with undeniable stress.

A recent poll shows that around 27% of American adults report feeling so stressed they can’t function on most days (5).

To learn more about adrenal fatigue, read: Adrenal Fatigue 101 — Plus My Favorite Adrenal Cocktail Recipe

Adrenal dysfunction is not recognized within the conventional medical system, and that has a lot to do with the original term for it, adrenal fatigue, which came to popularity in the early 2000s (16).

The term adrenal fatigue implies that the adrenal glands have become “worn out” over time and can no longer produce cortisol. This hypothesis came about because many of the symptoms of adrenal dysfunction look similar to very mild levels of Addison’s Disease, which is severe adrenal insufficiency (16). Plenty of research has shown this is simply not what is happening on a biological level, which has led many in the conventional medical field to claim that adrenal fatigue isn’t real (17).

Symptoms of adrenal dysfunction tend to happen in a predictable order, which in my practice I separate into three phases — early, middle, and late — based on what I’ve learned in my training and my experience with my patients. You may see other practitioners dividing adrenal phase into slightly different phases using other names because as of yet it isn’t standardized. However, the progression of symptoms remains the same no matter what you call it.

In each of the below phases, supplements to consider are mentioned based on the typical experiences of each phase. It’s worth noting that these categories are not hard and fast. For example, you may resonate most closely with the description of late stage adrenal dysfunction and also feel that the benefits of one of the early stage supplements may be helpful for you. This is fine as there is a lot of overlap between these categories. Listen to the needs of your body. Always consult with your healthcare provider before starting any new supplements. 

During the early phase, which can also be termed the “stressed” phase, people experience symptoms like increasing anxiety, difficulty sleeping, nervousness, irritability, anger, and insomnia. At this phase, you might also start to see water retention, puffiness in the face, stretch marks, and weight gain around the middle plus sugar and salt cravings. Energy levels may feel too high, frantic, and “buzzy.” It is common to see people start increasing their exercise and cutting calories during this phase to combat weight gain, but this worsens the issue as it adds to the stress that their bodies are already struggling to cope with.

During this phase, cortisol levels on the four point cortisol test are usually higher than normal and the normal cortisol curve becomes flattened.

In my experience, supplements that help the most during this phase focus on lowering or balancing cortisol. Nutrients like theanine, magnesium, and B vitamins, plus herbs like ashwagandha, lemon balm, rhodiola, reishi, maca, holy basil, eleuthero, black cumin seed, and chamomile are options to consider.

At this phase, supplements to consider include Take A Chill Pill, Keepin’ The Peace Kava, Mighty Magnesium, Black Cumin Seed Oil, and Mother’s Peace & Calm. Check out the supplementation section below for a deeper dive into these and other adrenal and stress support supplements. 

The middle phase of adrenal dysfunction is when people start experiencing profound energy changes. The typical experience is waking up feeling exhausted even with a full night’s sleep, needing coffee to wake up, experiencing a mid-day energy crash sometime between 2-4 pm, and an after dinner second wind that makes it difficult to wind down and get to sleep on time, followed by possibly waking once or twice in the middle of the night. It is common for people to overwork during their windows of energy to compensate for their periods of fatigue, and this worsens the problem.

In this phase the cortisol curve is inverted. It is low in the morning when it should be high and high in the evening when it should be low.

During this phase, people often experience mood swings, difficulty focusing, emotional outbursts, and impatience. Weight gain, cravings, and puffiness continue, and immune issues start. People also tend to get more infections and take longer to recover from them. New allergies might pop up and existing allergy symptoms may worsen. Blood sugar regulation starts to become less effective and people may start experiencing “hanger,” dizziness, and headaches if not eating regularly.

Supplements to consider at the phase are those that balance cortisol. Herbs like ashwagandha, rhodiola, ginseng, maca, holy basil, reishi, black cumin seed, eleuthero, plus nutrients like magnesium, fish oil, B vitamins, and vitamin C are often helpful.

During this phase, helpful supplements may include: Adrenal Me This, Super Food Green Tea, Wholly Zen Master, Help Me Sleep!, and Mother’s Energy. These are described in more detail in the supplementation section below. 

Late phase adrenal dysfunction is characterized by near-constant fatigue and exhaustion. People in this phase may over or under sleep with some people sleeping excessively and others experiencing profound insomnia. People in this phase may experience difficulty with the tasks of daily life including cooking, cleaning, personal hygiene, and meeting work/life expectations. It is common for people in this phase to lean on stimulants to get them through the day, which worsens the problem and eventually the stimulants stop working altogether.

In this phase, the cortisol curve is flattened and low at all points.

The good news about adrenal dysfunction is that most people recover relatively quickly (no matter which phase they are in) once lifestyle changes are made. This underscores the idea that adrenal dysfunction is simply a dysfunction and not an outright disease.

When reading about the lifestyle changes below, remember the key is consistency. Our bodies like a consistent routine because it signals safety, which in turn lets us turn off our internal stress signals and reset to normal. In my clinical experience, most people start experiencing improvements within 1-2 weeks of lifestyle change and can feel “back to normal” within 30-90 days. However, the consistency usually needs to be maintained for 6-12 months (in some cases more) before the body fully recovers. 

Adequate sleep is fundamental to adrenal health (7). Aim for 7-9 hours of quality sleep each night. Establish a consistent sleep schedule, going to bed and waking up at the same time each day, even on weekends. Create a restful environment by minimizing light and noise, and avoid stimulating activities or electronics at least an hour before bedtime.

If insomnia is an issue, natural sleep aids like melatonin or magnesium supplements may help. Blood sugar crashes are an often overlooked cause of night wakings. Consider having a small blood sugar balancing snack before bed, like chia pudding or a handful of nuts & seeds.

Would you like to read more about healthy sleep? Read these articles: Understanding Insomnia: Sleep Onset vs. Sleep Maintenance, 9 Reasons Your Kids Aren’t Sleeping (And How To Help), and Sleep Essentials For Kids. 

Nutrition plays a crucial role in supporting adrenal function (8). Focus on a diet rich in whole foods, including plenty of vegetables, fruits, lean proteins, and healthy fats. Avoid processed foods, excessive sugar, and refined carbohydrates.

Ensure regular meals and snacks to maintain stable blood sugar levels, and try to ensure each meal contains plenty of protein and a small amount of healthy carbs.

Foods high in vitamin C (such as oranges and bell peppers), foods high in B vitamins (like animal products and legumes), and magnesium (found in leafy greens and nuts) may be particularly helpful.

In my practice, I recommend individuals with adrenal dysfunction refrain from fasting or ketogenic diets. If desired, these practices can be reinstated once adrenal dysfunction symptoms have been gone for two to three months.

To learn more about my approach to healthy eating, read: The Basics Of Anti-Inflammatory Eating For The Whole Family

While exercise is important, it’s generally advised to avoid overexertion during recovery. During early and middle stages of adrenal dysfunction, engage in moderate physical activity such as walking, biking, hatha yoga, pilates, dance, weight lifting, or swimming, ideally outside. During late stage adrenal dysfunction, gentle, low intensity activity is recommended. Walking, tai chi, stretching, forest bathing, and restorative yoga are all options.

Listen to your body and avoid high-intensity workouts that can further tax the adrenal glands. Gradually increase the intensity and duration of exercise as your energy levels improve. I want to emphasize not to avoid exercise completely as being sedentary is also stressful to the body. Focus on consistent daily movement that feels good and rest when needed.

To learn more about exercise, read: Micro Workouts With Babies

Certain supplements can support adrenal health and stress recovery. Adaptogenic herbs like rhodiola, and holy basil help balance stress hormones (9,10) and improve resilience. Vitamins and minerals such as vitamins B5, B6, C, and magnesium are required for optimal adrenal function (11,12,13). Many of the calming herbs and focus-enhancing herbs provide noticeable improvements right away, but their full potential is seen when taken for at least 90 days.

It can’t be overstated that supplementation alone won’t fix adrenal dysfunction. Lifestyle change is necessary. 

Our favorite Dr. Green Life supplements for adrenal dysfunction include:

• Take A Chill Pill - for when stress, irritability and lack of focus are troublesome symptoms. Key balancing herbs like ashwagandha, rhodiola, and holy basil are complemented with calming passionflower and lemon balm. ✝︎

• Adrenal Me This - adrenal balancing herbs combine with energizing ginseng for sustainable energy, uplifted mood, immune fortification, and stamina. ✝︎

• Mother’s Energy - energizing herbs grounded with adrenal nourishing herbs for sustainable energy without the crash. Formulated with pregnant and breastfeeding mothers in mind, but suitable for any adult who needs a little extra pep in their step. ✝︎

• Adrenal & Focus - this uplifting and nourishing blend of herbs really shines when low energy and lack of focus are the primary concerns. This blend also works well at times of day when energy is low (e.g. on waking and at the 2-3 pm “dip”). ✝︎

• Mighty Magnesium - our magnesium glycinate powder is unflavored and dissolves easily in your favorite beverages. Magnesium is a good idea during all phases of adrenal dysfunction. We love it before bed in a Sleepy Time Mocktail. ✝︎

• Mother’s Peace & Calm - stress hormone balancing reishi combines with calming lemon balm, theanine, oatstraw, linden and hawthorne for a nourishing, calming blend that provides a peaceful, grounded experience without sedation. Formulated with pregnant and lactating mothers in mind, but suitable for all adults. ✝︎

• Black Cumin Seed Oil - is a wonder herb for stressed people. Research shows that it can lower cortisol, improve sleep, enhance immunity, help with blood sugar levels, and more. Benefits build when taken long term (20, 21). ✝︎

• Wholly Zen Master - holy basil is the star of this multi-tasking formulation. Research has shown that it has benefits for stress management, cortisol levels, metabolism, BMI, and mood (22,23). ✝︎

• Keepin’ The Peace Kava - this single herb tincture is helpful for frazzled nerves, difficulty relaxing, anxious thoughts, winding down before bed, and short tempers. ✝︎

• Nerve Tonic Tea - calming, nourishing herbs come together in a delicious tea that helps provide a moment of soothing self-care and relaxation. Formulated with pregnant and breastfeeding mothers in mind, but suitable for anyone. ✝︎

• Super Food Green Tea - an adrenal-friendly alternative to coffee for those who still want a morning caffeine boost. This delicious green tea blend also features cleansing and nourishing herbs. (Note: any amount of caffeine may be too stimulating for some people during adrenal dysfunction). ✝︎

• Elite Omega - omega-3 fatty acids are the cornerstone of any supplementation protocol that aims to balance inflammation or nourish the nervous system. ✝︎

• Beef Liver Capsules - a nutrient-packed powerhouse, beef liver is energizing and nourishing without being overstimulating. ✝︎

• Help Me Sleep! - a combination of melatonin plus relaxing & sedating herbs for addressing occasional difficulty sleeping. ✝︎

• Mother’s Immunity - this multi-mushroom blend provides nourishing full body support for stress hormones, immune function, nervous system resilience, gut health, and more. ✝︎

To learn more about supplementation, read: When To Take Vitamins For Maximum Benefit, Choosing A Supplement Delivery Method For Your Family, and How Long Should I Take Supplements? 3 Common Time Frames

Shop all of our Adrenal & Stress Supplements here!

Stress reduction and stress management are essential for healing from adrenal dysfunction. While it is not reasonable, possible, or even healthy to reduce stress all the way to zero, it is important to reduce it to a manageable level. When stress can’t be reduced or removed, stress management becomes even more important.

Ideas for stress reduction include delegating tasks (if help is available), hiring help (if financially possible), re-evaluating your personal standards (if appropriate), regular screen time breaks, setting and maintaining boundaries, creating a daily routine, and prioritizing your well-being.

Ideas for stress management include talking to friends, finding time for fun, spending time in nature, meditation, engaging in hobbies, doing things with your hands (drawing, crafts, cooking, etc), singing, dancing, breathing exercises, spiritual/religious practices, solitude, and enjoyable physical activity.

Sometimes we have blind spots about areas in our lives where stress can be reduced or managed. Working with a qualified therapist can be helpful.

To learn more about stress reduction and stress management, see: Adrenal Fatigue 101 — Plus My Favorite Adrenal Cocktail Recipe, Stress Relief For Kids, and Understanding Stress In Kids — Plus My Stress Support Drink Recipe

Adrenal dysfunction can significantly impact daily life and overall well-being, and when left untreated it can influence inflammation, energy levels, immune function, metabolism, mental health, quality of life, and more. While the symptoms of adrenal dysfunction can vary, it is common for this condition to be progressive, with many individuals progressing through three distinct phases.

Adrenal dysfunction can be addressed through lifestyle modifications, stress management, nutrition, and supplementation. When in doubt, it is important to consult a medical professional for personalized guidance.