If you’re exhausted, overwhelmed, and have trouble focusing or finding your words, you may have adrenal fatigue (aka: HPA Axis Dysregulation). Learn how to know if you have it, and what to do about it!
Note from Dena: I’m excited to share this guest post on such an important topic. It was written by Marla Ramos, Dietetic Intern, as part of a research partnership between Back To The Book Nutrition and post-graduate nutrition students from the University of Houston.
Feeling exhausted? Overwhelmed? Not quite yourself?
Our bodies are made to be resilient. They can rise to the challenge when we need to meet a deadline, make a big decision, or escape a dangerous situation. If they’re healthy, our bodies also know how to calm down again (we call this returning to homeostasis) once the crisis is over.
But like many things, when our bodies are constantly bombarded with crisis after crisis, they can eventually burn out. What follows during that downward spiral can produce a variety of symptoms from cravings for sugar or salt to insomnia and fatigue. Left unchecked, the eventual outcome is HPA (Hypothalamic-Pituitary-Adrenal) axis dysregulation.
WHAT IS ADRENAL FATIGUE/HPA AXIS DYSREGULATION?
Hypothalamic-Pituitary-Adrenal Axis Dysregulation (HPA-D for short) is what many call “Adrenal Fatigue”, but the term HPA-D more accurately describes what is really going on in the body.
What does the HPA Axis Do?
In order to fully understand HPA-D, we need to first understand the HPA axis and how it works. They Hypothalamic-Pituitary-Adrenal Axis is just that – a network made up of the hypothalamus, pituitary, and adrenal glands.
The HPA axis is involved in:
- Fetal development of the lung, liver, and gut
- Maintaining blood glucose levels while asleep or fasting
- Control of the immune function
- Blood pressure regulation
- Thyroid hormone production
- Responding to acute stress (“Fight or Flight”)
When the brain senses a stressor (we will talk about different types of stressors later), the hypothalamus gland releases corticotrophin-releasing hormone (CRH), which binds at the pituitary gland signaling it to release adrenal corticotrophin hormone (ACTH), which then binds at the adrenal gland stimulating it to release cortisol (stress hormone), along with other hormones.
Cortisol then signals glucose release from the liver in order to prepare us for “fight or flight”. In preparation for this, blood pressure is increased and the immune system, the digestive system, and the reproductive system are all suppressed so as not to waste energy on processes unnecessary for fight or flight.
When enough cortisol has been produced, the hypothalamus is signaled to stop producing CRH, and the pituitary gland to stop producing ACTH. This is referred to as a negative feedback loop, and it protects our bodies from constantly being in the fight or flight mode, and in a state of chronic inflammation.
When the HPA axis is functioning properly, cortisol levels are at their highest in the morning (8-10 am), waking us up, gradually decreasing throughout the day, and at their lowest at night (midnight), allowing us to fall asleep.
Ok that’s it for today’s science lesson. 😉
WHAT CAUSES HPA-D?
The short answer is, stress. This isn’t just limited to perceived stress, either. In today’s world, our bodies are constantly bombarded by things that trigger a stress response from the HPA axis.
Common Sources of Stress
- Stressful situations, whether acute or chronic
- Big life events, whether positive or negative (weddings, deaths, etc.)
- Disrupted sleep
- Poor diet
- Stimulants (caffeine/sugar)
- Poor blood sugar control
- Exhaustive work schedule
- Excessive exercise
- Physical injury
- Food intolerances
- Dysbiosis (imbalance of gut bacteria)
- Chronic infections (H. pylori, etc.)
- Autoimmune conditions
HPA-D can lead to or exacerbate inflammation, compromised immune function, and other health conditions…and at the same time certain health conditions can lead to HPA-D. It is a vicious and complex cycle and we’re still learning more about how it works and what to do about it.
CONDITIONS RELATED TO HPA-D
- Insulin resistance
- Weakened immune system
- Alzheimer’s disease
- Cardiovascular disease
- Type 2 diabetes
- Memory loss
- Muscle wasting
- Chronic Fatigue Syndrome
- Sex hormone imbalance
- Thyroid dysfunction
(Sources: 6, 8, 14-19, 21)
HOW DO I KNOW IF I HAVE HPA-D?
The symptoms and signs of HPA-D, like many other conditions, can be non-specific and vast. You may not experience all of them, but combinations of these symptoms may prompt you to consider HPA-D as the cause of your symptoms and schedule an appointment with a holistic dietitian or other licensed functional medicine provider for evaluation.
SIGNS AND SYMPTOMS OF HPA-D
- Light headed/dizzy when you go from laying down to standing up
- Low blood pressure
- Low serum sodium (Hyponatremia)
- Dizziness when standing up
- Increased allergy/asthma symptoms
- Constantly getting sick
- Brain fog, forgetfulness all the time
- Sugar or salt cravings
- Belly fat
- Waking up feeling unrested, even with adequate sleep
- Decreased ability to handle stress
- Low libido
- Low blood sugar
- Exhausted by mid-morning
- Need for energy drinks to get you through the day
- Cold hands and feet
- Feeling tired, yet wired
- Poor exercise tolerance and recovery
- Hair loss
- Blurred vision
- Second wind in the evening
- Afternoon headaches
- Weak nails
- Difficulty losing weight
- Thyroid imbalances
HPA-D AND THE THYROID
The adrenal glands and the thyroid work closely together. This is why many of the symptoms for HPA-D resemble hypothyroid symptoms.
HPA-D can directly affect the thyroid’s function by increasing thyroid hormone resistance and depressing the body’s ability to convert thyroid hormone to its active form. This can lead to hypothyroid symptoms, even if thyroid hormone levels are normal.
HOW TO TEST FOR HPA-D
As with many other conditions, HPA-D should be confirmed by tests prior to starting any treatment to avoid unnecessary medication use. Because there are so many pieces to the puzzle that is HPA-D, you want to be sure that treatment is tailored to your personal situation.
There are two tests that are recommended for the detection of HPA-D.
- Saliva Test – Measures cortisol levels at four points throughout the day.
- DUTCH Test – (Dried Urine Test for Comprehensive Hormones) Comprehensive hormone test that combines the benefits of blood, urine, and saliva testing in one.
Note from Dena:
If you don’t already have a practitioner who can order these tests and discuss the results with you, I’d be happy to help! Contact me here for details and pricing.
HOW DO I TREAT HPA-D?
Treatment for HPA-D is multifaceted and full recovery can take 6-24 months, or even longer, depending on severity.
Below are five areas of treatment that should be addressed. Working with a holistic dietitian or other licensed provider can help you develop a thorough and individualized approach to accomplishing each of these.
1) TREAT THE UNDERLYING CAUSE – STRESS
Treating the underlying cause involves eliminating or at least doing less of the things that originally contributed to HPA-D.
- Financial stress
- Relationship stress
- Job stress
- Blood sugar dysregulation (blood sugar spikes and crashes)
- Inflammation caused by bodily injury
- Inflammation caused by dysbiosis (imbalance of gut microbes) or other gut issues
- Inflammation caused by autoimmune diseases or arthritis
- Circadian rhythm disruption (too much light at night, and not enough light during the day)
- Sleep disruption
(Sources: 3, 23, 26)
2) REBUILDING YOUR METABOLIC RESERVES
Rebuilding your metabolic reserves involves adding things to your life that will go a long way to allowing the HPA-axis to better respond to everyday stressors. Treating the underlying cause (stress) also helps the body rebuild its metabolic reserves.
- Eat a nutrient-dense diet that is neither too low or too high in carbohydrates (more on this in #3 below)
- Establish a bedtime routine (preferably before 10 pm so the body has enough time to heal itself)
- Manage the stress you can’t avoid – Learn to say no. Lower your standards. Look at situations differently
- Have fun, play, and do things for pleasure
- Exercise (but don’t overdo it!)
- Have meaningful social connections (outside of social media)
- Spend time in nature
- Get in touch with your creative side (listen to music, visit an art museum, color)
- Find a purpose/volunteer
- Seek support for traumatic experiences
(Sources: 5, 24, 25)
3) EAT TO BALANCE BLOOD SUGAR AND NOURISH HORMONES
There are dietary changes that you can incorporate into your lifestyle to help support the healing process, and at the same time put less demand on the HPA axis.
- Eat a lower carbohydrate diet (150-200g/day) with limited sugar
- Eat carbohydrates with a protein or fat
- Eat regularly throughout the day – Promotes blood sugar regulation
- Consume a high quality sea salt – Salt restriction during this time places more demand on the HPA axis
- Consume adequate vitamin C, zinc, coppper, magnesium, and B vitamins, or discuss supplementation with your provider – All of these assist in HPA function
- Consume adequate fat soluble vitamins A, D, E, and K (and/or supplement with fermented cod liver oil)
- Consume probiotics daily (from cultured/fermented foods or probiotic supplements) – Will help heal dysbiosis
- Limit/avoid foods that stress the adrenal glands, including caffeine, sugar/sweeteners, processed foods, refined vegetable oils (soybean, canola, corn)
- Eat or drink calming foods like oysters, turkey, avocados, chamomile tea, and rooibos tea
(Sources: 1, 10, 11, 27)
4) SUPPLEMENT WITH ADAPTOGENIC HERBS
Adaptogenic herbs are herbs that help bring the body back to homeostasis (balance) by adapting to your individual needs – helping it recover from stress. There are a variety of herbs that can be used to support the proper functioning of the HPA axis. Below are some of the more commonly used ones.
Some herbs are contraindicated for some medical conditions, so it is always recommended that you speak with a qualified healthcare practitioner to determine which herbs are right for you.
- Ashwagandha (Withania somnifera)
- Eleuthero/Siberian ginseng (Eleutherococcus senticosus)
- Panax ginseng
- Astragalus root (Astragalus membranaceus)
- Schisandra (Schisandra chinensis)
- Rhodiola rosea
- Licorice root (Glycyrrhiza glabra)
(Sources: 29, 30)
- Rest when you feel tired
- Sleep 8-10 hrs a night
- Take time for yourself
- Go easy on exercise
We all know that life is about so much more than checking things off of our “To-Do List” (as satisfying as that may be), but it can be so (SO) hard to actually slow down and take care of our body’s needs, especially in our fast paced, high stress culture.
Cultivating healthy eating, exercise, and sleep habits, as well as setting realistic expectations of what we can handle, and surrounding ourselves with supportive relationships are all so critical for finding true and lasting health!
If you still feel you would benefit from one-on-one help to get to the bottom of your symptoms and help you create a personalized solution to overcome your symptoms, schedule your holistic nutrition coaching session today!
About the author: Marla Ramos is a Dietetic Intern, with a B.S. in Human Nutrition and Foods from the University of Houston. She has a particular interest in gut health due to her own personal experience with Crohn’s Disease.
Disclaimer: Information on this site is intended only for informational purposes and is not a substitute for medical advice. Always consult with a trusted healthcare provider before implementing significant dietary change. Read additional disclaimer info here.
- Marksteiner, K., Schoenfeld, L. (2013), Ask the RD: Adrenal Fatigue.
- Kresser, C. (2015) The Modern Lifestyle: A Recipe for Adrenal Fatigue.
- Leproult, R., et al. (1997) Sleep loss results in an elevation of cortisol levels the next evening, Journal of Sleep Research & Sleep Medicine, 20:10, 865-870.
- Juster, R, et al. (2011). A clinical allostatic load index is associated with burnout symptoms and hypocortisolemic profiles in healthy workers.
- Kresser, C., (2016) Exercise and “Adrenal Fatigue”.
- Myers, A. (2016) Everything you need to know about adrenal fatigue.
- Wahls, T. (2016) 7 Signs you have adrenal fatigue.
- Wahls, T. (2016) Why so many people today have adrenal fatigue and don’t even know it.
- Cole, W. (2015) Constantly stressed and exhausted? 8 ways to heal from adrenal fatigue.
- Axe, J. 3 Steps to heal adrenal fatigue.
- Hurley, L., Morgan, A. (1952) Carbohydrate metabolism and adrenal cortical function in the pantothenic acid-deficient rat, Journal of Biological Chemistry, 195, 583-590.
- Demitrack, M., and Crofford, L. (1998) Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome, Annals of the New York Academy of Sciences, 840:1, 684-697, doi 10.1111/j.1749-6632.1998.tb09607.x.
- Daubenimier, J., Kristeller, J., Hecht, F., Maninger, N., Kuwata, M., Jhaveri, K., …Epel, E. (2011) Mindfulness intervention for stress eating to reduce cortisol and abdominal fat among overweight and obese women: An exploratory randomized controlled study, Journal of Obesity, doi: 10.1155/2011/651936.
- Brureau, A., Zussy, C., Delair, B., Ogier, C., Ixart, G., Maurice, T., Givalois, L. (2013) Deregulation of hypothalamic-pituitary-adrenal axis functions in an Alzheimer’s disease rat model, Neurobiology of Aging, 34:5, 1426-1439, doi: 10.1016/j.neurobiolaging.2012.11.015.
- Rosmond, R., Bjorntorp, P. (2000) The hypothalamic-pituitary-adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and strok, Journal of Internal Medicine, 247:2, 188-197.
- Incollingo Rodriguez, A., Epel, E., White, M., Standen, E., Seckl, J., Tomiyama, A. (2015) Hypothalamic-pituitary-adrenal axis dysregulation and cortisol activity in obesity: A system review, Psychoneuroendocrinology, 62, 301-318, doi: 10.1016/j.psyneuen.2015.08.014.
- Almela, M., Hidalgo, V., Villada, C., Espin, L., Gomez-Amor, J., Salvador, A. (2010) The impact of cortisol reactivity to acute stress on memory: Sex differences in middle-aged people, Stress, 14:2, 117-127, doi: 10.3109/10253890.2010.514671.
- Braun, T., Zhu, X., Szumowski, M., Scott, G., Grossberg, A., Levasseur, P….and Marks, D. (2011) Central nervous system inflammation induces muscle atrophy via activation of the hypothalamic-pituitary-adrenal axis, Journal of Experimental Medicine, 208:12, 2449-2463.
- Papadopoulos, A., Cleare, A. (2012) Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome, Nature Reviews Endocrinology, 8, 22-32, doi: 10.1038/nrendo.2011.153.
- Majzoub, J. (2006) Corticotropin-releasing hormone physiology, European Journal of Endocrinology, 155, S71-S76.
- Jeong, K., Jacobson, L., Widmaier, E., Majzoub, J. (1999) Normal suppression of the reproductive axis following stress in corticotropin-releasing hormone-deficient mice, Endocrinology, 140:4, 1702-1708.
- Kresser, C. (2017) Adrenal fatigue or HPA axis dysregulation? Kresser Institute.
- Circadian rhythms fact sheet. (2012) National Institute of General Medical Sciences.
- Kresser, C. (2011) 9 Steps to perfect Health -#6: Manage your stress.
- 6 Mindfulness exercises you can try today. Pocket Mindfulness.
- Cole, W., (2014) 11 Everyday toxins that are harming your thyroid.
- Cole, W. (2014) 13 Foods to help ease anxiety & stress.
- Rege, N., Thate, U., Dahanukar, S. (1999) Adaptogenic properties of six rasayana herbs used in Ayuvedic medicine, Phytotherapy Research, 13:4, 275-291.
- Wallace,E. Adaptogenic Herbs: Nature’s Solution To Stress.
- Axe., J. 7 Adaptogen Herbs to Lower Cortisol.