Tired? Stressed? HPA Axis Dysregulation

by | | Adrenals & Thyroid

HPA Axis Dysregulation 

Too much stress is a major contributor to nearly all disease but what is it exactly and how can you recover? Most people understand stress in the form of a time pressure, moving homes or financial worries but there are some physiological stressors that can outweigh these perceived stressors. Anything that interferes with the body’s ability to maintain homeostasis can be a chronic stressor and will lead to an HPA Axis dysregulation. The major ones I see in clinic are:

  • Blood sugar issues leading to insulin resistance and metabolic disorders.
  • Missing meals, under/overeating.
  • Circadian rhythm disruption from improper light exposure, lack of real rest, play and sleep.
  • Chronic inflammation from hidden gut infections, an elevated immune response, overwork and allergies.

Why is this not Adrenal Fatigue?

In the scientific literature adrenal fatigue is represented with just a few publications whereas the more accurate term HPA axis dysregulation has over 18 000 research papers. The reason is that this isn’t a case where the adrenal glands are tired and unable to function. In fact often cortisol is normal or high and the imbalance is occuring in how the brain and cells are responding to it. Cellular resistance to cortisol is one way the body responds to chronic stress. This is similar to insulin resistance which many people are familar with.

Testing for Stress

The brain is the control tower for the HPA axis which stands for the hypothalamus, pituatary and adrenal axis. These glands work together in a series of negative feedback loops which maintain homestasis. When there is a disruption it can be tricky to see what went off track. This is where the right lab work can be helpful. Saliva tests for free cortisol which is the most potent form and has been used to diagnose “adrenal fatigue”. The problem with this test is that 85% of those with low free cortisol have normal or high overall cortisol. This is where the replacement model of supplementing creates more problems. I use a urine lab that looks at the cortisol levels throughout the day. It also shows all the sex hormones and their metabolites which gives important information for treatment.

Chronic stress of any kind creates physiological changes ranging in severity depending on how long its been going on. An important part in recovering health requires long-term stress management. When we are in a heightened level of stress we respond to world differently and can create a cycle of more stress. I promote gradual change because this is what lasts. Shift tracks gradually instead of trying to stop the train and begine making these changes before it derails itself.

Am I going NUTS?

The NUTS acronym can be helpful in understanding stress. Stress usually includes these components:

Novelty: a feeling of a new situation

Unpredictability: a sense of touching something unknown

Threat or perceived threat to either the body or ego: as in chronic illness or the end of a marriage

Sense of loss of control: we actually have little control but we can, at times, control our response

These components exist in activities that are positive stressors as well like: applying for school, going on a date or starting a new job. Recognizing that not all stress is harmful is important. Increase your sense of control by gathering information and making informed decisions. Expand your time horizon or put it in perspective by looking at what’s happening within the context of your whole life. For example having a new baby can mean a lot less sleep but only for a few years. And finally remember to question your thoughts. Say an social event goes poorly and by the end of it your internal dialogue is something like “I said dumb things and I always do…I’m a failure…am doomed to always be alone…etc etc”.

This is an excellent time to check your head, sit down on a cushion and watch your thoughts. Meditation is by far the fastest, yes the fastest, way to transform belief systems and calm the nervous system so new habits and neuro pathways can form.

Symptoms that point to an HPA Axis dysregulation

There isn’t one set of symptoms or stressors that define this kind of imbalance. That being said here is a list of possible symptoms:

poor memory

weight gain or loss

brain fog


cold hands and feet

low libido

frequent illness

hunger that comes quickly with agitation


waking with a rapidly beating heart

trouble falling or staying asleep

postural hypotension

Living a Long Life with Vitality

In order to do this we must address the HPA axis and understand our own stress response. I know personally that the more joy and purpose I discover, the more I must look at how I manage my stress.

There will be times when stress becomes unmanagable. When this happens the best action we can take is allow for a period to recover. Listening deeply to the body for guidance is the most important resource. If accessing it on your own is difficult then reach out for support.

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