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
• Fatigue
• Weakness
• Headaches

There are also studies^1,2,3 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.

Helpful Resources

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.

1.      John D. Guerry, Paul D. Hastings; In Search of HPA Axis Dysregulation in Child and Adolescent Depression; Clinical Child and Family Psychology Review; https://link.springer.com/article/10.1007/s10567-011-0084-5

2.     Harvard Health Publishing, Harvard Medical School; What causes depression? Onset of depression more complex than a brain chemical imbalance; https://www.health.harvard.edu/mind-and-mood/what-causes-depression

3.     Kazushige Mizoguchi, Hirotaka Shoji, Ryuji Ikeda, Yayoi Tanaka, Takeshi Tabira; Persistent depressive state after chronic stress in rats is accompanied by HPA axis dysregulation and reduced prefrontal dopaminergic neurotransmission; Pharmacology Biochemistry and Behavior; https://www.sciencedirect.com/science/article/pii/S0091305708002578

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We all know that when we’re stressed, we automatically tend to reach for foods that aren’t necessarily good for us. For some, it’s something sweet, smooth and comforting. For others, salty and crunchy are the name of the game. Doing this over any period of time clearly leads to weight gain and not feeling your best, so I’m not going to spend too much time on the obvious. What I want to do is go beyond stress eating and look at why stress causes weight gain in other ways and more importantly, what we can do about it.

My Stress Causing Weight Gain

In the spirit of keeping it real, I will fully disclose that my scale and my jeans say I’m gaining weight while writing this. It’s been a very stressful week. Like you, there’s a lot on my plate.  I’m finding myself walking around with my hands clinched and shoulders an inch and a half higher than they should be. Not the end of the world if that’s a once in a while kind of thing, but unfortunately, I, like many of you, find this is an all too common mode of operating. I also find that when I’m like this, even if I can avoid the pitfalls of stress eating, I still notice the numbers on the scale creeping up and my clothes not fitting quite right.

Why Does Stress Cause Weight Gain?

Dr. Keesha Ewers is an integrative medicine expert, board certified functional medicine provider and best-selling author. She compares it to a lion chasing a zebra. When the zebra is fleeing for its life, it knows it’s not safe to stop and go to the bathroom because obviously it would be caught but also because it can’t let go of any nutrients since it needs everything in its body to get away from the lion. “Our bodies are wired the same way a zebra is. Whenever we feel threatened, which can happen by listening to the news or being late for an appointment, then the body gets the signal that it’s not safe to lose weight because we have to hold onto everything for dear life.”

We, and the zebra, are able to react appropriately in fight or flight situations because our adrenal glands produce cortisol. Dr. Keesha says that’s “one of the stress hormones that’s released when the body believes, based on what the mind is telling it, that you have a lion on your tail.”  Unlike the zebra though, whose body can take a break when the true life and death situation is over, our way of life is full of stressors that can go on and on. These can range from dealing with elderly or disabled parents, having a big deadline for work, rushing from place to place or dealing with issues with your kids. When your body’s systems get the message that there’s a stressor, they’re going to kick into action as if a lion is right there. That’s when stress causes weight gain.

Dr. Heidi Hanna warns in her book Relax Your Fat Off that “Once stress is gone, cortisol levels should fall, but if stress persists, or if a person’s stress response gets stuck in the “on” position, cortisol may remain elevated.” That means the brain is going to try to conserve energy by slowing down metabolism and by storing and protecting fat in our body. It’s also going to look for as many calories as possible so that we’ll have the energy needed to deal with whatever’s causing us stress. Again, fine for the short term, but devastating for our health and our waistline if it goes on for too long.

“I’m Doing Everything Right and Still Not Losing Weight!”

Dr. Keesha has patients that come to her frustrated because they say they’re doing “everything right” and still not losing weight. They’re watching what they eat and exercising every day, but the weight simply isn’t coming off. While she agrees that cutting out unhealthy foods and adding in exercise and regular movement is the place to start, if you’re already doing those things and not getting results, you should look at your level of stress. “If your body is getting the signal that you’re not safe, then you’re not going to lose weight.”

Learning to Relax and Manage Stress

Dr. Keesha doesn’t tell her patients to “get rid of stress” because in many cases, that’s simply not possible. You can’t get rid of your aging parents or special needs child but learning to manage stress is very doable. Both of our experts say the stress response is a function of the body’s sympathetic nervous system, whereas the parasympathetic nervous system’s job is to keep us in balance. While both have important work to do, if we want to lose weight or stop gaining weight, we can’t let our sympathetic nervous system run the show.

According to Dr. Hanna, “To eliminate unnecessary fat stores for good, we need to train our body and brain to make extra calories less of a priority. We do this by convincing our systems that there is no emergency…which will help keep our biological stress responses in check.” That means that in addition to learning to manage stress, we have to learn to relax and let our body’s systems work the way they’re supposed to.

Here are some tips for doing that:

• Watch your language. Dr. Keesha says this isn’t referring to curse words. This is referring to what you’re saying internally. “If you have a very busy schedule, are you telling yourself that it’s a terrible state of being? Because if you are, then it is. But if you’re saying to yourself, ‘Gosh, I’m so lucky that I have this job that I love or that I’m raising these beautiful children, and I wouldn’t want to be doing anything else, or that I’m doing my life’s purpose in the world, and then all of a sudden, this is no longer a stressful environment that you’re living in.” Much of it is in your perception.
• Breathe. “When we are in our usual on-the-go mode,” Dr. Hanna says, “It’s easy to slip into a breathing pattern that is associated with the stress response: one that is short, rapid and shallow.” This causes “a cascade of the stress hormones because it signals to the brain that there must be some sort of emergency.” She advises bringing awareness to your breath and focusing on a more natural, relaxed breathing pattern because it tells the brain there’s no danger.
• Biofeedback, massage, meditation and yoga. Dr. Hanna encourages everyone to try these interventions because they’ve shown in studies to be the most promising for triggering the relaxation response and aiding in the weight loss process.
• Get enough sleep. Not only does it keep you from being cranky the next day, there’s important work that goes on in your body when you sleep. Dr. Keesha says this includes the release of the human growth hormone (which helps to regulate sugar and fat metabolism among other things), your liver starts to dump, and your lymphatic system engages by “picking up all the garbage on the outside of your cells.” All of this is necessary for your body’s mechanisms to be efficient, which, according to Dr. Keesha, is what your metabolism actually is – “efficiency of your biochemistry.”

Stress can hijack our health in a number of ways, with weight gain being among them. As we’ve seen here though, we can learn how to take control so that our body functions as the well-oiled machine it’s supposed to. We want our stress hormones to kick into gear when we need them, but we also want our body to understand that being stuck in traffic is not the same as having a lion coming after us. We can’t operate that way all of the time and feel our best. That’s why I for one will be doing a lot more to change my perception and to remember to breathe deeply. Care to join me?

Lean on Your Community

What can you do to better manage stress and learn to relax so that you can feel your best? You can reply in the comments section below or head over to the Peppermint Tea and Me Facebook page and leave your answers there. We look forward to hearing from you and supporting you!

Helpful Resources

It’s important to note that both Dr. Keesha Ewers and Dr. Heidi Hanna offer resources to help learn more about the impact of stress on our bodies. Dr. Keesha offers the Academy for Integrative Medicine health coach certification program, which enables women to learn more so that they can help themselves and/or other women. Dr. Hanna has a free stress survey that lets you explore your current relationship with stress and see how effectively you’re managing the stress in your daily life. 

I have no affiliation with either of these, but I do want to make sure and share information and resources that I believe would be helpful to you.

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