Being on high alert for too long can put you into adrenal overdrive. Learn how to shift from fight-or-flight mode into calmer states that help your body recover.

I see a lot of dark under-eye circles on the faces of patients in my practice — and I’m not a cosmetic surgeon. I’m a functional-medicine practitioner. My patients typically come in because they have a host of niggling symptoms that don’t make sense: They can’t lose weight, they feel chronically anxious, or they have eczema that won’t go away. About 25 percent have hypothyroidism; almost 50 percent have sleep problems. But what I realize right away is they feel tired, overwhelmed, and unable to get to the bottom of their to-do lists.

These patients are in a state of chronic stress, and their bodies are showing the signs. This condition is technically called “allostatic load,” and it occurs after the stress response has been activated for too long.

Our bodies are beautifully designed to handle short-term threats — the stress response makes us alert, energized, and able to withstand physical injury — but we’re not designed to stay in this hyper-vigilant state all the time. It wears us out.

We can’t eliminate all the high-pressure aspects of our lives, nor would we want to: We all need some stimulation to be healthy. Still, we can learn to recognize the signs that our bodies are stuck in fight-or-flight mode. And we can start to choose from the different stress responses that our bodies are also designed to deploy — ones that shift our systems away from chaos and toward rest and recovery.

Signs of Adrenal Overdrive

Getting stuck in survival mode leads to two conditions I see routinely in my practice: adrenal overdrive (when you can’t turn off the stress response) and adrenal overdrive with exhaustion (when you can’t turn it on). In the former, you feel wired and tired; in the latter, you’re so exhausted you can’t get moving.

These two types of adrenal malfunction show how the positive aspects of the survival system can become liabilities. For example, the energy from a big rush of blood sugar saves you when you need to battle or flee, but when blood sugar stays elevated for too long, it leads to insulin resistance and type 2 diabetes.

Likewise, adrenaline does a terrific job of raising your heart rate and constricting your blood vessels. But when this process goes on too long, hypertension can develop.

The first step to moving out of survival mode is knowing how to identify that you’re in it: You feel anxious, hyper-alert, and tense. You may notice that you’re “wired and tired” at night.

If you’re in adrenal overdrive with exhaustion, you might feel wiped out when you wake up in the morning, tired all day long, then wide awake with worry when you finally turn out the light at night. Because you can’t shut the vigilance off, you never really rest.

We often have no idea that these are symptoms of anything. We may think we’re “just tired,” or that anxious thoughts reflect a genuinely threatening reality. We might completely dismiss the idea of stress because we believe the circumstances shouldn’t be as challenging as they are — even though the difficulties of raising a wily teenager or meeting the demands of your job are intense.

In an achievement-oriented culture, we often feel ashamed if we can’t handle exorbitant amounts of pressure, because it seems like everyone else can. We think there must be some problem with us, and we keep quiet about it.

To a degree, these kinds of stress are a part of being alive. But most of us never get — or take — a break.

Checking our smartphones is often the first and last act of the day. We’re triggered by emails, headlines, and text messages right up until we go to bed — some of us even sleep with the TV on. Our schedules override the normal circadian rhythms that would have us going to sleep when it gets dark and waking up when it’s light.

Day in and day out, a range of stimuli we might never suspect are triggering our nervous systems, causing unrelenting stress that can do serious damage to our health over time.

When we learn to appreciate how intelligently our bodies are meant to behave in response to stress, and to identify when we’re stuck in the fight-or-flight response, easing into modes that rebuild and restore our health will become second nature. After all, our bodies are designed to support us. We just need to give them the chance.

Hidden Triggers of the Sympathetic Stress Response Almost anything the body perceives as a threat can kick the sympathetic nervous system into gear and keep it there, which is why many of us can be perpetually triggered and not know it. Here are a few surprising factors that contribute to adrenal overdrive. In-Utero and Early-Childhood Experiences Some of us may have a lower stress “set point” because of exposures in utero or experiences during early child­hood, resulting in greater sensitivity to the stresses of daily life now. If your mother was worried about having enough food or money during her pregnancy with you, for example, you were exposed to the stress hormones coursing through her system. This can create a lower stress set point, potentially making you more reactive than someone whose mother had a more secure pregnancy. If you add adverse childhood experiences to this — like an abusive caregiver, or a death in the immediate family — it can lower your resilience even further. Perfectionism Being a perfectionist triggers the primal fear that if we don’t do everything, and do it just right, we’ll get kicked out of the social community. This fear stems from the time in our species’ history when we needed the group for protection, because a ­predator could easily eat us if we were alone. So perfectionism isn’t just anxiety about mistakes themselves; it’s anxiety that we’ve jeopardized our sense of belonging — which triggers the survival response. Learning to embrace your mistakes and vulnerabilities is a far better survival strategy. Low Blood Sugar When your blood sugar stays low for a long time, your body switches to an energy-conservation mode. It doesn’t know that you just skipped breakfast because you were busy; instead, it behaves as though you were entering an indefinite food shortage. Starvation is one of the original mortal threats, so when you’re hungry for too long, the body raises cortisol and sets the stress response in motion. Eating adequate amounts of good-quality protein and fat, and avoiding excess sugar (which yanks insulin around), helps keep the nervous system in balance. Food Intolerances Food sensitivities involve immune reactions. So when someone who is gluten intolerant eats gluten, his immune system releases an inflammatory cascade to vanquish the invader. The body treats inflammation as a crisis and fires up the stress response. This means if you regularly eat a food that your body doesn’t tolerate, it will continually provoke the stress response. Environmental Toxins Body-care products, air pollution, chemicals in the home — all contain toxins that can trigger the immune response and, by extension, the stress response. Genetics Two particular genes — MTHFR and COMT — influence the body’s ability to eliminate toxins. If you’re exposed to toxins and you carry alterations on either of these genes, your body won’t eliminate them as well as someone with no alterations. Additionally, people with an alteration on COMT don’t break down stress hormones as effectively. So when they get a hit of adrenaline, it stays in their systems. They generally can’t tolerate coffee and avoid roller coasters and scary movies, because they know that when they’re exposed to these kinds of stimulation, it will take a long time for them to calm down. Viral Infections Simmering viral infections stimulate the stress response in the same way that food sensitivities do, resulting in chronic inflammation that triggers a state of alarm in the body.

The Stress Alarm Stress can be stimulated by stressors that are concrete (for example, not having enough money to pay bills) and abstract (persistent perfectionism). Our bodies react the same way to any trigger that sends us into survival mode. Here’s the process: You perceive a danger, which might be an immediate threat (a car speeding toward you) or a perceived one (you hear a car backfire and are reminded of the sound of gunfire). This perception triggers your amygdala, the area of your brain associated with self-preservation memories. These memories helped our ancestors avoid plants that had made them sick at one time. Today, it helps us prepare for daily situations that we know to be stressful. Your amygdala sends an alarm message to your hypothalamus, which passes it along to your pituitary gland, which alerts your adrenal glands that they need to pump out the hormone cortisol. Cortisol acts to protect your body: It elevates your blood pressure so that if you bleed copiously you won’t go into shock. It mobilizes your immune system to fight infection. It dumps glucose into your bloodstream for an immediate surge of energy, along with insulin from your pancreas to mop up that glucose once the crisis is over. The threat message signals your medulla (which controls involuntary functions) to send an adrenaline burst. This jump-starts your heart rate, dilates your pupils, and makes you hyper-alert. You are now primed to escape, subdue, and survive a mortal threat.

Signs That You’re Stuck in Overdrive Here are a few ways you can tell if your body is having trouble downshifting to a calmer state: Experiencing food cravings: We often crave sweet or salty foods when we’re in adrenal overdrive because they provide energy and replenish our systems. When we’re not stressed, our cravings lessen. Feeling judgmental and picky: When we’re in survival mode, we naturally scan our surroundings for danger, and a “negativity bias” prevents us from missing any potential threats. When we’re stuck in overdrive and see only what’s wrong with everyone and everything, it can make us unpleasant and miserable. Waking up tired: If you go to bed at a decent hour but wake up feeling like you haven’t slept at all, this is a sign that your cortisol is not rising in the morning as it should, which happens when your adrenals have stopped producing enough of the hormone. Gaining belly fat: Not all fat cells are created equal, and the weight we gain around our midsections is often a signal that we’re experiencing a cortisol overload.