Why can a single drink, a cup of coffee, or even secondhand smoke suddenly make someone with adrenal insufficiency feel terrible?

In this episode, Jake and Rachel take a deep dive into the My Adrenal Life article “Cigarettes, Vaping, Alcohol, Caffeine & Energy Drinks: Why ‘Normal’ Substances Can Be Dangerous with Adrenal Insufficiency.”

For most people, these substances are part of everyday life. A beer at a barbecue. A vape cloud drifting nearby. A latte to get through the afternoon. But for someone living with primary adrenal insufficiency (Addison’s disease), secondary adrenal insufficiency, tertiary adrenal insufficiency, or steroid-induced adrenal suppression, these same substances can interact with the body in very different ways.

The episode explores a key concept called the “physiologic buffer.” In healthy individuals, the body automatically releases cortisol when faced with chemical stressors like nicotine, caffeine, or alcohol. That cortisol surge helps stabilize blood pressure, blood sugar, inflammation, and the stress response.

But in adrenal insufficiency, that natural buffering system is impaired or absent. Without the ability to rapidly increase cortisol, the body can experience the full force of these stressors without the usual protective cushion.

Jake and Rachel break down how several common substances affect the body:

Nicotine and vaping

• rapid stimulation of the sympathetic nervous system

• adrenaline and norepinephrine surges

• heart rate and blood pressure changes

• potential autonomic instability when cortisol buffering is limited

• why high-concentration vape products may produce stronger spikes than expected

Alcohol

• interference with glucose production in the liver (gluconeogenesis)

• increased risk of low blood sugar

• dehydration and electrolyte shifts

• disrupted sleep that may leave the body more vulnerable the following day

• why symptoms of hypoglycemia can sometimes be mistaken for intoxication

Caffeine and energy drinks

• strong stimulation of the nervous system

• temporary masking of fatigue signals rather than restoring energy

• blood sugar swings, especially with sugary drinks

• dehydration effects that may be especially relevant for people with primary adrenal insufficiency who struggle with sodium balance

The episode also explores why reactions can be unpredictable. One day a cup of coffee may seem fine. Another day the same drink can trigger shaking, dizziness, or a crash. The hosts discuss a helpful way to visualize this through the idea of a “stress bucket.” Factors like illness, poor sleep, travel, emotional stress, hormonal changes, and physical exertion all add to the body’s overall load. When that bucket is already close to full, even a small additional stressor can cause symptoms.

Importantly, this episode is not about judgment or strict rules. Instead, it focuses on understanding the physiologic cost of certain substances so people with adrenal insufficiency can make informed choices about their own bodies.

Jake and Rachel also talk about practical awareness:

• recognizing when the body may already be under strain

• understanding that tolerance may change day to day

• avoiding stacking multiple stressors when possible

• and reframing these decisions as self-preservation rather than restriction

At its heart, this conversation highlights an important mindset shift: substances that are culturally “normal” can still have powerful biologic effects. For people living with adrenal insufficiency, learning how the body responds to those effects can be an important part of staying safe and stable.

Visit us at www.MyAdrenalLife.com and our Facebook Group for more education, community support, and resources for living with adrenal insufficiency.