HPA Axis Dysfunction (Adrenal Fatigue) and What It May Mean for You
Stress, Our Modern Lifestyle and the Toll They May be Taking on Our Health.
Let’s face it, the way we live our lives every day is full of stressors – both real and perceived. The food we eat, our commute to work and the toxins in our environment are just a few of these, but they’re all taking a toll on our bodies. One way this may show up is through what’s commonly referred to as “adrenal fatigue.” In reality, this syndrome of signs and symptoms that tells us our bodies aren’t functioning properly is more accurately called HPA Axis Dysfunction. Since this is an incredibly frustrating and often misunderstood condition, I read numerous studies and research articles and went to Dr. Daniel Gonzalez, a Certified Functional Medicine Doctor, to find out more. What I learned could help shed some light on what you or someone you know may be experiencing and how it could be treated with and without medical intervention.
What is HPA Axis Dysfunction?
HPA stands for hypothalamic – pituitary – adrenal axis. According Dr. Daniel, this system primarily regulates our body’s stress response, and if it’s not working correctly, neither will we. Chris Kresser M.S, L.Ac is the co-director of the California Center for Functional Medicine and the founder of the Kresser Institute. In this article on the topic, he explains that, “Stress activates the HPA axis and sets off a cascade of neuroendocrine signals that ultimately leads to the release of hormones and neurotransmitters like cortisol, norepinephrine (noradrenaline), and epinephrine (adrenaline).” This is what’s supposed to happen. It’s the way our bodies are meant to adapt and respond to the immediate changes and needs triggered by stress. But, if we’re in a chronic state of stress, according to Dr. Daniel, our bodies can’t maintain stability. The HPA axis simply wasn’t meant to work like that.
Dr. Daniel says there are many “feedback loops” associated with the HPA axis. “It’s your central nervous system, your metabolic system, immune function, gut function and cardiovascular system. All of these systems are going to be affected by the HPA axis.” In their review for the Point Institute on Chronic Stress and the HPA Axis, Thomas G. Guilliams Ph.D. and Lena Edwards M.D. agree that “Chronic and repeated stressors can lead to one or more forms of HPA axis dysregulation, altering appropriate cortisol secretion and affecting end-organ function.”
So, what’s causing all of this stress on our bodies? Dr. Daniel points to our modern lifestyle. He says it’s “our inability to adapt to the chronic stressful exposures caused by poor diet, which really translates to nutrient deficiencies; chemical toxicity; sleep deprivation; physical or emotional stress; lack of or too much exercise; and inflammation.”
While it’s very rare for someone’s adrenals to become so fatigued that they don’t produce enough hormones (Addison’s Disease), it is much more common for all of these stressors to cause our HPA axis to be overworked. This causes what Dr. Daniel calls a “constellation of signs and symptoms.”
Symptoms of HPA Axis Dysfunction
Depending on whether you have increased activity of the HPA axis or decreased activity, here are some of the primary ways that Dr. Daniel says HPA Axis Dysfunction or HPA-D might show up in our day to day lives.
- Difficulty sleeping
- Impaired exercise tolerance or recovery
- Waking up tired after a good six to eight hours of sleep
- A weakened immune system
- Brain fog
- Extreme hunger or irritation even after eating
- Palpitations, especially in the middle of the night – almost like a panic attack
There are also studies1,2,3 that point to depression as a symptom of HPA Axis Dysfunction.
How HPA Axis Dysfunction is Diagnosed
Since these symptoms can be indicative of many conditions, the first step is to see a traditional medical doctor and make sure that nothing else is going on. If their assessment is that “nothing is wrong” or they can’t pinpoint the cause of your symptoms, you may want to explore whether it could be HPA Axis Dysfunction. While it’s not always necessary to seek medical intervention for this, if you don’t see noticeable changes with lifestyle adjustments, you will probably want to see a trained professional such as a certified functional medicine doctor who has experience in treating the syndrome.
Dr. Daniel says that there are three categories of assessments he uses in diagnosing HPA Axis Dysfunction. He begins with the signs, symptoms and history of each patient. If he suspects HPA-D, he follows up with lab testing. This testing includes collecting samples in four different ways – blood, hair, saliva and urine. He says that testing in all four ways is important to do if possible because it can help to determine exactly what’s going on and how the patient should be treated. Dr. Daniel stresses that while lab testing is very helpful, it should never be used solely to diagnose HPA-D.
The third assessment he uses is the Perceived Stress Scale, which is a questionnaire that measures the degree to which situations in one’s life are seen as stressful. According to Dr. Daniel, this is important because what’s stressful to one person may not necessarily be stressful to another. The Perceived Stress Scale helps to quantify that.
How HPA Axis Dysfunction is Treated
Dr. Daniel recommends that if you’ve been to a medical doctor and they feel sure that nothing else is going on, if you have several to many of the symptoms listed above and you know that your way of life is conducive to causing HPA Axis Dysfunction, then it’s probably safe to assume that it’s HPA-D and you should start treating it as such. While every individual is different when it comes to how HPA-D can be corrected, Dr. Daniel advises that the best place to start for most people is their lifestyle – diet, sleep and stress management.
- Diet. Dr. Daniel believes that Paleo is a good starting point and would not advise anyone with HPA-D to go low-carb. That’s because “The main hormone that becomes dysregulated is cortisol, and cortisol appears to increase on a low carb diet and decrease on a moderate to high carb diet. For someone who has HPA-D, the diet itself can become a stressor.” That’s why Dr. Daniel says optimizing macros by figuring out the right amount of protein, fat and carbs for each person is important. Avoiding sugar, caffeine and processed foods are also all steps in the right direction in treating HPA-D.
- Sleep. Circadian rhythms and optimizing sleep patterns through light/dark cues are critical to addressing HPA-D. There are important hormonal functions that should and shouldn’t be happening when we sleep, and if we don’t get enough at the right times, those functions are thrown out of balance.
- Stress Management. Meditation, deep breathing, yoga and gentle exercise are all part of a good stress management plan that can help treat HPA-D.
If you try all of these things and still aren’t feeling any better, you should consider seeing a functional medicine doctor for a diagnosis and help with treatment. For instance, it may be that you need to address inflammation, but this may involve screening for and eradicating chronic infections like small intestinal bowel overgrowth or gut infections. Autoimmune reactions such as food sensitivities should also be addressed.
Dr. Daniel says that there is value in using supplements for HPA Axis Dysfunction, but they should not be looked at as the primary means of treatment. The three areas listed above should be given priority and then supplements can be used in addition. This is most effective if you’ve had lab testing done because a trained professional would know which supplements would be appropriate for your specific situation.
Identifying and treating HPA Axis Dysfunction can be very frustrating because it may seem nebulous or that you’re just “run down.” Dr. Daniel says that in most cases, there’s nothing further from the truth. He believes that no one should have to suffer with it needlessly because there is treatment. You just have to know what you’re dealing with first.
If you want to find out more about HPA Axis Dysfunction or adrenal fatigue, Dr. Daniel recommends Dr. Mark Hyman (see his informative video here) or Chris Kresser M.S, L.Ac as good resources. You can also contact Dr. Daniel for a free consult at drdaniel.com.
*This is just a sampling of the studies that link depression to HPA axis dysfunction.