The general progression of human land use is an initial disturbance (e.g., deforestation, mining, agricultural expansion, overgrazing, and urbanization) that creates a sediment pulse to an estuary followed by dams that reduce sediment supply. We present a conceptual model of the effects of increasing followed by decreasing sediment supply that includes four sequential regimes, which propagate downstream: a stationary natural regime, transient increasing sediment supply, transient decreasing sediment supply, and a stationary altered regime. The model features characteristic lines that separate the four regimes. Previous studies of the San Francisco Estuary and watershed are synthesized in the context of this conceptual model. Hydraulic mining for gold in the watershed increased sediment supply to the estuary in the late 1800s. Adjustment to decreasing sediment supply began in the watershed and upper estuary around 1900 and in the lower estuary in the 1950s. Large freshwater flow in the late 1990s caused a step adjustment throughout the estuary and watershed. It is likely that the estuary and watershed are still capable of adjusting but further adjustment will be as steps that occur only during greater floods than previously experienced during the adjustment period. Humans are actively managing the system to try to prevent greater floods. If this hypothesis of step changes occurring for larger flows is true, then the return interval of step changes will increase or, if humans successfully control floods in perpetuity, there will be no more step changes.