Tired Of Being Tired? – HPA Axis Dysfunction

The Hypothalamus Pituitary Adrenal Axis

Is Stressed the New ‘Normal’?

Being bombarded 24/7 by news and social media, downtime is a thing of the past. We seem to have accepted being “stressed out” as normal. No, it’s not normal! In fact it is dangerous and can have detrimental effects on our bodies.

Traditionally, low levels of cortisol and DHEA in response to chronic stress have been often blamed  on “adrenal fatigue” or “adrenal exhaustion”. New research indicates that, it is not really a case of the adrenal system becoming fatigued, but rather a miscommunication between the brain’s HPA axis (hypothalamus-pituitary-adrenal axis) and the adrenals in response to continuous stress.

 

What is the HPA Axis?

There is a complicated communication pathway between the hypothalamus-pituitary in our brain, and the adrenal glands, known as the HPA-axis.

The H in HPA stands for Hypothalamus, a small part of the brain that has a vital role in maintaining homeostasis, i.e. to keep the human body in a stable, constant condition. The hypothalamus is the link between the endocrine and nervous systems and is responsible for the sleep-wake cycle, body temperature regulation, balancing bodily fluids, appetite control, sexual behaviour and reproduction.

The pituitary or the “master gland” is a pea-sized gland that sits at the base of the brain and is physically connected to the hypothalamus.  This very small gland produces an extraordinary number of hormones that our bodies needs, like Growth Hormone, Anti-Diuretic Hormone and Luteinizing Hormone.

Lastly, we have the adrenal glands. These two glands sit on top of each kidney and produce even more hormones than the pituitary gland does – steroid hormones like cortisol, sex hormones like DHEA, and stress hormones like adrenaline and dopamine. The hormones produced by the adrenals control chemical reactions over large parts of our bodies, including something you might have heard of called our ‘fight-or-flight’ response.

How our bodies response to a stressful situation

Back in time, when we were facing an imminent danger that could kill us right at that moment (like tiger looking for a human snack) we needed to get out of danger and protect ourselves. In modern society sudden wildlife encounters are rare now, but our body gets this signal almost on daily basis and we perceive non-threatening stressors as if they may very well kill us. When we think of stress, we often think of major life events (divorce, loss of loved one, major health concern, unemployment), but today, the most common stressors are the ones that often go unrecognised, operating chronically at low levels, resulting in profound negative clinical outcomes. Our daily stressors come from paying bills, traffic, rushing for work, public speaking, worrying about our kids, or asking someone on a date. On top of that, we have a tendency to miss on sleep, skip meals, drink litres of coffee, forget to drink water, and a whole mess of other lifestyle practices that sabotage the “safe” signal to our body. This confuses our brains.

How the HPA axis Works?

1. The brain senses a stressor
2. The hypothalamus gland releases corticotrophin-releasing hormone (CRH), which sends a message to the pituitary gland to produce adrenocorticotropic hormone (ACTH).
3. ACTH prompts the adrenals to make cortisol, adrenaline, and noradrenaline.
4. Cortisol, also called “the stress hormone” is released for several hours after encountering the stressor. Cortisol’s job is to pump you up to fight or flee. It alerts the liver to release stored sugar (glycogen) for instant energy. The adrenals also release adrenalin which raises heart and blood pressure. 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.
5. This cycle continues until the hormones reach the levels that the body needs, and then a series of chemical reactions begins to switch them off. 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 and tissue damage.
6. Once cortisol levels begin to decrease, the stress response stops, the body calms down, and hormone levels return to normal.

HPA Axis Dysfunction

Although the initial stages of the stress response are intended to promote survival, and should only last in the short term, chronic exposure to stressors may lead to periods of elevated cortisol levels that are not reduced appropriately by negative feedback inhibition, creating further HPA axis abnormalities and serious havoc on the body.

With repeated exposure to stressors the HPA axis remains on high alert (and can remain so perpetually). This means secretion of alarm chemicals can be fairly constant. In turn, the hypothalamus and pituitary glands can no longer maintain an appropriate level of sensitivity to cortisol’s negative feedback, which is meant to stop the alarms. The body can not return to homeostasis.

Acute or chronic stressors will eventually cause under-responsive or non-responsive HPA axis system, hence the popular terms “adrenal fatigue”/“exhaustion”.

The high-cortisol phase may last years or reflect intense stressful situations and may lead to an adaptation within the HPA axis, resulting in reduced cortisol production.  However, the consequence of protecting the immune system by blunting cortisol production is not without consequence on other pathophysiological systems .

Cortisol is a potent anti-inflammatory hormone, and its dysfunction is likely to result in widespread inflammation. Inflammation produces free radical byproducts, and oxidative stress damage. Accumulation of free radicals over time underlies the ageing process, and oxidative stress may be responsible for widespread tissue degeneration.

 

Interestingly, with aging, the hypothalamus and pituitary are less sensitive to negative feedback from cortisol and both ACTH and cortisol levels rise as we age.

Older women secrete more cortisol in response to stress than do older men.

Young women, however, produce lower levels of cortisol in response to stress than do young men.

 

But what happens when all parties involved in the HPA axis stop communicating with one another?

In the short to medium term, chronically high cortisol leads to the following imbalances:

• Increased inflammation – cortisol has an anti-inflammatory effect during an acute stress situation however when cortisol is chronically high due to long term stress it can lead to inflammation.
• Blood sugar dysregulation and insulin resistance, which can lead to Type 2 diabetes.
•  Persistently elevated blood pressure becomes hypertension
• Poor sleep – difficulty falling asleep and waking up during the night due to a reduced release of our sleep hormone melatonin.
• Weight gain –  elevated cortisol causes us to crave excess sugar and carbs; in a twist of fate intended to protect us from famine and starvation, we store this excess energy in the form of fat for later use – predominantly as cholesterol and belly fat, a toxic form of fat that produces harmful inflammatory chemicals. Insulin resistance also leads to weight gain and difficulty to lose weight.
• Overload on the thyroid gland
• Reduced immune system – this can develop from cortisol’s continual immune suppressive effects when abnormally high for long periods.
• Increased activation of our immune system ultimately leads to immune system dysregulation. We get sick more often (or never get sick until we crash on our first day of vacation) and increase our risk of autoimmune disease and “inflammaging” (signs of poor aging)
• If the cortisol levels are persistently high for months or years, a complicated dysregulation in the communication in the HPA axis develops, and cortisol actually starts to decline below the levels which are required for healthy bodily functions, which leads to the following symptoms:

Chronic exhaustion

• Poor emotional, mental, or physical resilience and inability to handle stress
• Weight gain and difficulty to lose weight
• Lowered immunity and frequent bouts of illness
• Slow wound healing
• Anxiety
• Depression
• Brain fog, poor memory and poor concentration
• Sugar cravings
• Menstrual irregularities
• Inability to handle stress
• Low libido
• Poor muscle tone
• Cold hands and feet

 

Natural Therapies to help with HPA dysfunction and fatigue

Take control of known stressors

Stress may be unavoidable in life, but we have the capacity to control what we perceive as stressful and how they respond to it. Learning to perceive and respond to stressful situations in ways that do not stimulate the HPA axis is one of the keys to preventing HPA dysfunction.

Take sleep seriously

Ensuring that you are getting a decent night’s sleep is vital to maintaining optimal health and the health of your HPA axis. Poor sleep quality and quantity is directly related to HPA axis dysfunction. Sleep is crucial to regulating cortisol levels. In a typical circadian rhythm, cortisol levels rise in the morning to help you wake up and drop low at night as melatonin rises. Bedtime is the time when your body “resets.” For some people this rhythm can be flipped and instead they produce high levels of cortisol at night and low levels of cortisol in the morning. This can cause a disruption in the circadian rhythm and lead to fatigue during the day and sleeplessness at night.

Moderate, non-competitive exercise can be a valuable stress reducer that provides numerous other health benefits.  It’s important to be mindful as to the type of exercising you’re getting and how much. Those with chronic fatigue will benefit most from low-impact activities such as yoga, Pilates, and warm water aerobics, going out for a walk or a bike ride can do wonders for your stress levels, not to mention for your health.

Mindfulness Meditation

Studies show that participating in mindfulness practices can reduce cortisol while improving brain, heart, and immune health.

Deep Breathing

Deep breathing also helps put your body into relaxed state. Aim for 5-10 minutes once to twice daily. Simply close your eyes and focus on your breath. Feel your abdomen expand as you inhale, and release all tension as you exhale.

Eat an Anti-Inflammatory Diet

Inflammation causes a disruption in the HPA axis. So eating an anti-inflammatory diet can help minimize the inflammation that’s worsening your cortisol levels and driving your hormone imbalance. Reducing inflammation will improve your HPA axis function, enhance your immune system, and improve your sleep quality,  minimize anxiety and balance your moods.

An anti-inflammatory diet consists of whole foods that are high in antioxidants and fiber. Ditch sugar like the harmful drug it is. Healthy fats, high quality proteins, fruits, and vegetables that are rich in nutrients and fiber.

Follow a gluten free, grain free, sugar free diet. Buy organic if possible.

Include foods in your diet like fresh nuts and seeds, grass fed meat, oily fish (wild salmon, trout, mackerel, sardines, anchovies, free range or organic if possible poultry and eggs, plenty of green leafy vegetables (spinach, kale, bok choy, broccoli ), fresh berries, healthy fats (olive oil, avocado, flaxseed oil, coconut oil), fresh herb, fermented foods (sauerkraut, kimchi, kefir), turmeric, ginger, beetroot.

Add Some Special Supplements Called Adaptogens

Adaptogens are safe yet effective choices for building energy and fortunately they are abundantly grown in the earth’s garden. They help increase the general capacity of the human body to adapt to stress and they increase resistance to disease.

They are not localised to a specific body organ but have a “normalising” effect (restorative rather than curative) on the imbalances caused by physical or emotional stress.

Here are some great options:

• Withania somnifera – the herb that has been shown to increase energy and mental alertness during the day has also been shown in research to lower cortisol levels.

• Rhodiola rosea has been used traditionally to promote physical endurance and longevity. This wonder herb may also help to manage fatigue, depression and impotence. The chemicals rosavins and salidrosides in rhodiola have a normalizing effect on increased cortisol levels.

• Panax ginseng is a well-known herb that has been attributed to balancing hormonal levels and decreasing cortisol overproduction. This herb has been in use for thousands of years and is thought to combat many stress-related ailments.

 

Nutrients to Nourish Your Adrenals

Vitamin C is the fuel that keeps your adrenal gland functioning. In fact, your body stores most if its Vitamin C in the adrenal glands. When under stress, there is greater potential to lose Vitamin C via your urine. To restore levels, aim for 2,500mg per day and then take at least 1,000mg daily to optimise adrenal and immune function.

The B vitamins are all essential and a Vitamin B5 (Pantothenic Acid) deficiency causes your adrenal glands to shrink. Aim for 100-150mg per day of B vitamins.

Energy levels are also dependant upon adequate supplies of Magnesium and Coenzyme Q10. Magnesium is best absorbed in citrate form. The antioxidant CoQ10 is often low when cortisol is low. Aim for 150-300mg per day.

The production of cortisol requires the amino acids Phenlyalanine and tyrosine.

The body has a certain amount of resilience and ability to repair. Stressors such as infection, toxicity, poor diet, inflammation and emotional stress may lead to depletion of the body’s reserves. As the HPA tries to adapt to the chronic stressors it may in turn lead to hyper or hypocortisolaemia.

Salivary sampling is the most reliable way to measure adrenal hormone output.

We recommend a saliva test measuring DHEA and cortsiol levels four times throughout the day, to get an accurate picture of the body’s cortisol response. The Adrenal Hormone Profile is an easy to use test kit and the samples can be taken in the comfort of your own home.

Click here to book in for a Free Initial Consultation with our Naturopath and learn how to care for your body so you can lower your stress and start living a happy life again!

 

References:

Kara E. Hannibal, Mark D. Bishop, Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation, Phys Ther. 2014 Dec; 94(12): 1816–1825.  Published online 2014 Jul 17. doi: 10.2522/ptj.20130597

Matousek RH, Dobkin PL, Pruessner J. “Cortisol as a marker for improvement in mindfulness-based stress reduction.” Complement Ther Clin Pract. 2010 Feb;16(1):13-9. doi: 10.1016/j.ctcp.2009.06.004. Epub 2009 Jul 4., https://www.ncbi.nlm.nih.gov/pubmed/20129404

Guilliams TG. The role of stress and the HPA axis in chronic disease management. Point Institute, Stevens Point, WI. 2015:22.

Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016 Aug 24;16(1):48.

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