Feeling tired all the time? Wake feeling exhausted, despite going to bed early? Feeling irritated and on edge? Do you have many vague symptoms? In our busy and fast-paced modern lives, we can find ourselves juggling many roles and responsibilities and we can commonly experience high levels of stress.  You may have heard the term ‘adrenal fatigue’, which is not supported by scientific literature.  HPA (hypothalamic pituitary adrenal) axis dysregulation is a much more accurate diagnosis.

The HPA axis is a term that relates to a group of endocrine glands that function as the hormonal communication system that manages our stress response. The ability for the HPA axis to cope with stress in day to day life is of great importance to many aspects of our health. This is because the HPA axis also regulates mood, digestion, immune system, drive, metabolism and energy levels. So if stress is experienced on a continual basis our finely balanced HPA axis many areas of our health will be impacted.  

Common symptoms of HPA axis dysregulation include;

  • Weakness
  • Muscle pain
  • Joint pain
  • Sore throat
  • Headaches
  • Dizziness upon standing
  • Increased heart rate
  • Abdominal pain
  • Depression
  • Apathy
  • Irritability
  • Sleep disturbances/Insomnia/waking feeling unrefreshed
  • Difficulty concentrating and remembering things 
  • Decreased ability to deal with stress
  • Confusion
  • Anxiety
  • Sleepiness
  • Difficulty waking up in the morning
  • Waking feeling unrefreshed.
  • Craving for salt, chips, or fast food.
  • Low sex drive.
  • Poor immunity or prolonged recovery time from illness 

When we see a group of symptoms, we need to find out where the body is not doing its job well. Symptoms are our signs that somewhere inside the body is not performing the right steps in sequence necessary to maintain health.  Once we know where that is happening, we can begin to learn more about exactly why and what to do about it.

The HPA axis consists of

1)  the hypothalamus (part of your brain);

It is the master regulator of the body and brain and is considered the control centre for the body’s autonomic (a fancy term for automatic) responses. It is located in the centre of the brain. When we experience stress (physical, emotional, etc, these will be explained in more detail below) it releases corticotropin-releasing factor (CRF) to activate the pituitary gland.

2)  the pituitary gland (just below the hypothalamus)

Often referred to as the master gland, it is responsible for controlling the hormones in the body. This pea-sized part of your brain releases hormones to stimulate other areas of the body. Some of the hormones include gonadotropin (gender/sex stimulating hormone) and growth hormones. The pituitary also releases the adrenocorticotropic hormone to trigger the adrenal glands.

3) the adrenal glands (two walnut sized glands that sit on top of the kidneys).

The kidneys are used to filter the blood and are in the centre of the body. This makes it an ideal location for a hormone that needs to affect the entire body, because all blood passes through the kidneys. The adrenal glands release several hormones; cortisol, aldosterone, adrenaline and noradrenaline, which regulate 4 key things: SUGAR, SALT, SEX hormones, and STRESS (the 4 Ss). These hormones then flow through the body, placing you in what’s called “fight or flight mode”.

When we experience stress, we respond with a primitive survival instinct called a “fight or flight” response, an inbuilt survival mechanism that is designed to save our lives from the immediate threat of danger. In the modern world our daily stressors are rarely life threatening, but they can be relentless and our bodies respond in the same way:- a call from the tax office, an argument with your partner, being stuck in a traffic jam – all of these can result in a similar fight or flight response. 

What does all of this mean?

Your body prepares you to either stay still and prepare to fight, or to run away (l like to use the analogy of being faced with a lion chasing us).  When adrenaline courses through your body, it acts as a stimulant to the heart, increasing the amount it pumps.  It also acts as a vasoconstrictor, narrowing blood vessels to increase blood pressure, causing the blood that would be in your brain to squeeze into the narrowed blood vessels in your muscles.  Your higher thought processes shut down, making you rely on lower, more basic functions because when fighting a lioness, you won’t be needing to know calculus or how to play chess. Respiration, or breathing rate, increases to allow for more oxygen. Noradrenaline causes you to be more aware, awake and focused. Cortisol will be released for several hours after encountering the stressor.  Once released into the body, cortisol raises the sugar in your bloodstream as a means of creating a burst of energy that would allow the body to face the potential threat or to flee.  Along with increasing energy, cortisol also suppresses the digestive system, (you won’t be worrying about digesting that salad you just ate as you have more important things to worry about such as how to stay alive and either run from the lion or stay and fight it).  Other digestive functions including nutrient absorption and excretion are also suppressed. Physiologically, your body does not want to exert the energy required to hold in waste, because that energy could be used elsewhere. Also, you may be unable to spit, because saliva is part of the eating processing.

In survival mode, the optimal amounts of cortisol, adrenaline, aldosterone and noradrenaline can be life saving. It helps to maintain fluid balance and blood pressure, while regulating some body functions that aren’t crucial in the moment, like reproductive drive, immunity, digestion and growth.

In healthy, low-stress individuals this entire HPA axis feedback loop works in harmony, only experiencing fleeting glimpses of these chemicals. But when these are chronically overproduced, the HPA axis eventually becomes desensitised to the negative feedback telling it to “calm down”, leading to chronic stress on the hypothalamus, pituitary gland and adrenal glands, which is called HPA axis dysregulation. 

So, what is in the short term imperative to your survival, has many significant negative impacts on your body when in this mode for an extended period of time.  The “fight or flight” response works in opposition to the “rest-and-digest” part of your nervous system. Therefore, it is common for people with HPA dysregulation to experience reflux, GORD (gastro oesophageal reflux disorder) and other digestive symptoms.  Too much cortisol can suppress the immune system, leading to you becoming frequently sick, catching one virus after another.  It can also cause high blood pressure, high sugar levels, decrease libido and contribute to obesity amongst other symptoms.  

It is also common for those suffering with HPA axis dysregulation to have high cholesterol. This may be due to fact that conversion of cholesterol into pregnenolone, which acts as a precursor to DHEA, progesterone, testosterone, cortisol and oestrogen is the rate limiting step for all adrenal steroid pathways. When the manufacturing capabilities of the adrenal glands are impaired or needed, as is the case of HPA axis dysregulation, elevated cholesterol levels may result.

Anxiety is another common symptom for those with HPA axis dysregulation.  Do you wake in the early morning hours anxious because you have so much going on? It is more likely because of adrenaline/cortisol surges causing you to wake up suddenly with your mind spinning in “fight or flight” from whatever your particular lions happen to be at the time (work, money, children etc)

So what are these stressors that can trigger you into “fight or flight”? 

Dr. Guilliams, who wrote “The Role of Stress and the HPA Axis in Chronic Disease Management” discusses four categories of stressors that lead to chronic HPA Axis dysregulation.

1. Perceived Stress

The HPA axis can easily be triggered by signals outside the body that are non-physical, which the brain perceives as threatening. NUTS is an acronym frequently used. Novelty of the event; new situations can increase stress. Unpredictability; when things change frequently and we feel outside our comfort zone. Perceived threat to body or ego; things that make us lose face, embarrass us or threaten us physically. Sense of loss of control; when we feel that we have no control over a situation.

2. Circadian Disruption

Circadian rhythms are physical, mental and behavioural aspects of our life that follow a roughly 24-hour cycle, responding primarily to light and darkness in an organism’s environment. The HPA axis is intimately tied to the mechanisms controlling circadian rhythm. Unfortunately, most people have the ability to ignore these important cues when choosing their work, social, sleeping and entertainment schedules. What this means is that working the night shift and sleeping during the day, not getting enough sunlight during the day, and the use of electronics at night, can lead to HPA axis dysfunction as well as many different metabolic dysfunctions like obesity and insulin resistance.

3. Blood sugar Dysregulation

Blood sugar dysregulation is the inability of your body to regulate your blood sugar levels, which can lead to hyper or hypoglycemia. Poor diet, lack of exercise and lack of sleep can not only dysregulate the HPA axis but it can cause blood sugar dysregulation. Cortisol is very important for regulating glucose. When you are stressed, the body raises cortisol levels and therefore can raise blood sugar levels. The rising epidemic of insulin resistance, obesity, and their related metabolic disorders has a complex cause-and-effect relationship with the increase of stress-related disorders.

4. Inflammation 

Cortisol is a powerful anti-inflammatory steroid. When someone has chronic inflammation, his or her body will signal the HPA axis to secrete more cortisol in order to decrease the inflammation. The increase in cortisol down regulates inflammatory pathways within tissues and immune cells.  This suppresses most other immune functions, which explains so many of the side effects of prednisone and other steroid drugs. Inflammation from food allergies, obesity, rheumatic diseases, or anywhere can be a HPA axis stressor.

How Do We Support the HPA Axis?

Supporting the HPA axis is extremely important in chronic disease management. It is important to support the central nervous system, the adrenal glands and the way in which cortisol signalling functions within the tissue.  Addressing the various health consequences of stress is imperative as is addressing  the axis of response itself. Restoring balance to the HPA axis is the primary goal of naturopathic treatment. It’s important to remember that changes may take weeks or months depending on duration and severity of symptoms.  

Suggestions that can be implemented include 

  • Stay away from inflammatory foods like gluten, sugar, grains and dairy.
  • Nutrient dense diet including healthy fats, proteins and fibre and reducing exposure to refined, processed and high sugar foods
  • Identify sensitivities and allergies and remove them from your diet/environment
  • Get tested and treated for any infections like Small Intestinal Bacterial Overgrowth (SIBO), candida overgrowth etc. that may be causing stress on the body.
  • Use tools like mindfulness training and yoga to help with the way you perceive stress.
  • Get plenty of sunlight and fresh air during the day and limit your time with electronics like TV, mobile phones, computers and artificial house lights at night.
  • Consider supplementing with adaptogenic herbs (rhodiola, licorice, siberian ginseng, withania, codonopsis), Vitamin C, B vitamins and phosphatidyl serine (working with a skilled practitioner is recommended).
  • Have adrenal gland hormones like cortisol, DHEA and sex hormones tested by a skilled practitioner so they can create a specific treatment protocol for you.  Cortisol is secreted in a circadian rhythm, meaning that the secretion changes throughout the day.  Ideally, cortisol is at its high point in the early morning hours, and follows a sharp curve where it lowers and reaches a low point at night. During sleep, cortisol then rises again to its high point in the morning. 

Ruth Griffiths

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