Have you heard the term “adrenal fatigue” or been diagnosed with it?

Over the last several years, we’ve come to realize that this isn’t really the right terminology – the HPA Axis dysfunction is more appropriate.

HPA axis dysfunction includes more than just the adrenal glands. “Adrenal fatigue” can include fatigue or exhaustion often thought to be due to the adrenals wearing out due to cortisol imbalance after a history of acute or chronic stress.  Research has shown the problem involves more than just the adrenal glands – and doesn’t always cause fatigue or exhaustion.

Let’s take a deeper look at HPA axis dysfunction, what the condition means for patients, the symptoms they may be experiencing, how you can test for it, and the treatment options available.

What is the HPA Axis and HPA Axis Dysfunction?

It’s important to understand what the HPA axis is and what parts of the body it refers to.

1. Hypothalamus – part of the brain, located at the base near the pituitary gland, plays an imperative role in regulating hormone production.  These hormones then control various aspects such as body temperature, emotions, appetite, and sleep. The hypothalamus connects the endocrine system to the nervous system.
2. Pituitary Gland – sometimes called the “master gland,” is the center of the endocrine system. It takes signals from the hypothalamus, makes necessary hormones, and directs other glands and organs throughout the body.
3. Adrenal Glands – are located just above the kidneys, are responsible for making necessary hormones such as adrenaline and cortisol.

These three areas of the body work together (hence the term “axis”) to perform many essential functions throughout the body, including the regulation of energy and stress levels, metabolism, and immune response. None work independently, and each relies on the other to function properly. Any imbalances in these systems can dysfunction in a wide range of body systems.

There are three hormone classifications that can signal an imbalance:

1. Corticotropin-Releasing Hormone (CRH) – CRH is a stress hormone that is also sometimes called Corticotropin-Releasing Factor (CRF). It’s released by the hypothalamus.
2. Adrenocorticotropic Hormone (ACTH) – ACTH is released by the pituitary gland. Production of this hormone is triggered by the detection of CRH.
3. Glucocorticoids – Glucocorticoids are steroids released by the adrenal glands, and are triggered by the detection of ACTH. There are many types of glucocorticoids, and cortisol is one of them.

High or low levels of any of these hormones can cause wide ranging effects like:

1. Fatigue or exhaustion
2. Unexplained weight gain or loss
3. Poor sleep quality (even if you’re sleeping, you don’t wake feeling rested)
4. Trouble sleeping (falling asleep or staying asleep)
5. Poor immune response
6. Difficulty handling and/or managing stress
7. Brain fog (not be able to think clearly or remember things)
8. Difficulty concentrating
9. Increased anxiety
10. Depression
11. Sugar or salt cravings
12. Inflammation
13. Poor circulation
14. Brittle nails (that break easily)
15. Hair loss (sometimes resulting in bald patches)

When things are going well, this axis keeps everything stable.

However, when we are overworked, overburdened and aren’t resting and recovering enough, this axis shifts our system into running on stress hormones.

When you get to that point, your body is already stuck in the fight or flight response. You might feel wired, but tired at the same time. You might crash in the afternoon. You might find that you aren’t really that hungry, but then you can’t stop snacking at night. You might find that you are more forgetful than normal, your sex drive might plummet, and you may even find that bright lights really bother you. Then, you may experience a second wind late at night that keeps you up later than you’d like, even though you’re so tired.

It’s truly a vicious cycle.

What Causes HPA Axis Dysfunction?

The most common cause of HPA axis dysfunction is chronic stress – whether emotional, physical or psychological.

When the body constantly releases stress hormones, it doesn’t have enough time to relax, rest and rejuvenate. This can occur in the case of chronic stress, emotional trauma, unmanaged anxiety, blood sugar dysregulation, or even toxin exposures.

People who live in persistent high-stress situations due to high-pressure jobs, family drama, or money worries are all at risk for experiencing HPA axis dysfunction systems.

HPA Axis Repair

HPA axis dysfunction is reversible with lifestyle changes, dietary changes, and supplementation.

Lifestyle Changes

The most important lifestyle change you’ll need to make is to reduce your stress level. Depending on what is causing you stress, this may look different for different people.

Practice Yoga or Meditation

Meditation and/or yoga practice, and even learning breathing techniques can help keep your stress response under control.

Reduce Primary Stressors

Cut back on or fully eliminate any source of stress that you can.  This could mean getting a new job, spending less time with certain people, or simply putting you higher on your priority list (self-care).

Make Sleep a Priority

Getting the recommended seven to nine hours of sleep each night can be difficult for some, but if you’re experiencing HPA axis dysfunction symptoms, it’s critical to make sleep a priority in your life. Physical rest will help your body recover and improve your mental health. Using sleep trackers can be tremendously valuable for assessing the quality and quantity of sleep you’re getting.

Maintain a Balanced Diet

What we eat plays a major role in how our bodies can repair and function on a regular basis.  This is not about extreme dieting. Focus on eating natural whole foods, staying away from processed foods, sugar and white flour as much as possible. And of course, drink plenty of water to maintain good hydration.
You may want to avoid (or limit) alcohol and caffeine. Alcohol is a depressant, caffeine is a stimulant.  Both can contribute to changes in hormone status and the overall inflammation in the body.

Exercise

Exercise can be a big stress reliever – when done properly. Get up and get your body moving for at least 30 minutes each day. It doesn’t have to be rigorous or difficult.  Focus on finding something you enjoy or at least don’t dread.  It may be walking, hiking, or biking, kickboxing, or some resistance training. The point is to move your muscles, increase your circulation, breathe deeply and relax your mind. Exercising daily also helps you sleep better and lower your blood sugar levels.  Use caution not to overtrain though – overdoing exercise can add to the stressful state of the body.

Supplements to Support HPA Axis Function

Adaptogens are herbs that can help to counteract the effect that stress has on our bodies by working to stabilize the hypothalamus, pituitary gland, and adrenal glands for better resilience, repair, and homeostasis.

Some adaptogens are stimulating so that our bodies can harness extra strength, energy and clarity for a longer period of time. Some adaptogens are calming and can help reduce anxiety. All adaptogens help the body respond more normally to stress and return to a sense of calm and wellbeing faster.

Adaptogens have been found to have multiple positive effects such as:

1. Neuroprotective components
2. Anti-fatigue capabilities
3. Mood stabilizing abilities
4. Improve cognitive function
5. Stimulate the central nervous system

Adaptogenic Herbs

Adaptogenic herbs grow in every part of the world, which is why there are many to choose from. Each adaptogenic herb on this list has different potential benefits, but not every one of them will suit every patient’s unique needs.

1. Eleutherococcus senticosus (also known as Siberian ginseng or Eleuthero)
2. Rhodiola rosea (also known as Golden Root or Rose Root)
3. Astragalus
4. Cordyceps militaris
5. Gynostemma Pentaphyllum (also known as Jiaogulan)
6. Schisandra
7. Tulsi holy basil
8. Ashwagandha
9. American Ginseng
10. Panax Ginseng
11. Licorice Root
12. Turmeric/curcumin

Why Some Doctors Are Hesitant to Diagnose

HPA axis dysfunction is a more accepted diagnosis than adrenal fatigue, but because most primary care physicians focus on treating symptoms individually rather than looking for the underlying cause of the dysfunction.

A most holistic approach will help you identify the root cause so that you can repair that unique situation for true healing.

Francesca Quinn
Naturopathic Doctor Denver
(720) 310-0797
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