Are you so tired it’s debilitating? Do you suffer from insomnia? Are you constantly stressed and anxious? Hypothalamic-pituitary-adrenal (HPA) axis dysfunction could be to blame.

The Hypothalamic-Pituitary-Adrenal Axis Explained

You may be wondering, what exactly is hypothalamic-pituitary-adrenal axis dysfunction? That’s a great question! Let’s start with an explanation of the hypothalamic-pituitary-adrenal axis, or HPA axis for short. Essentially, it is a collection of neuroendocrine hormones and glands that control your stress response. This is an important part of the human body. Over the years, we got very good at responding to stress, and a lot of this is thanks to the HPA axis. This was an excellent development for our ancestors who were more frequently dealing with acute stressors, such as running from wild animals while hunting and gathering for example. However, the HPA axis doesn’t respond as well to the many different chronic stressors we all now face daily in our modern world.

What Is Hypothalamic-Pituitary-Adrenal Axis Dysfunction?

If you are exposed to the chronic stressors in your life for an extended period without relief, this can result in HPA axis dysfunction (HPA-D). This means your HPA axis will be unable to properly regulate the production of hormones, including your primary stress hormone, cortisol. When HPA-D throws your cortisol levels out of balance, you may find yourself with too much energy at night and too little during the day. This is reflected in your cortisol awakening response (CAR).

The CAR occurs when you wake up every morning. About 30 to 45 minutes after awakening, your cortisol levels peak. A 50% increase in cortisol levels is considered normal. Anything lower is deemed a blunted response and associated with an underactive HPA axis. If the increase is greater than 50%, this is a sign of an overactive HPA axis.

If you have HPA-D, your CAR will either be blunted or too high, which presents differently from person to person. Your cortisol levels may start off low and then peak at night, causing insomnia. Or your levels may stay below baseline all day, which would lead to continuous exhaustion.

In the beginning, an overactive HPA axis usually results in high cortisol levels. As time goes on, your HPA axis function can bottom out. This not only depletes your cortisol, but other hormone levels as well, including estrogen, progesterone, testosterone, and dehydroepiandrosterone. The effects of this can ripple through your whole body.

So, how do you know whether you have HPA-D or not? Below are lists of symptoms that can be found in those with both high and blunted cortisol levels. Please bear in mind that these are not definitive lists.

Symptoms of High Cortisol Levels

  • PMS/hormone imbalances
  • Infertility
  • Gut dysbiosis/leaky gut
  • Irritable bowel syndrome/SIBO that won’t go away
  • Anxiety/panic attacks
  • Inability to lose weight
  • Hypervigilance (feeling wired but tired)
  • High blood sugar (when diet is clean)
  • High blood pressure

Symptoms of Blunted or Low Cortisol Levels

  • Extreme fatigue
  • Brain fog
  • Depression
  • Low blood pressure & dizziness
  • Low blood sugar (you can’t skip meals without feeling horrible/hangry)
  • Extreme salt cravings
  • Weak immune system (you catch every bug you come into contact with)

Why Does HPA-D Leave You Perpetually Stressed Out & Chronically Fatigued?

The first aspect to consider is the dysfunction’s effect on neurotransmitters, which are responsible for our mood, cognition, and heart rate. HPA-D usually raises and lowers a variety of these neurotransmitters, including dopamine and serotonin, just to name a couple that you may recognize. Secondly, the hormonal effects of HPA-D can result in cognitive disruptions, slower metabolism, poor immunity, and a variety of other ailments that would leave a person feeling sluggish and foggy at best. Considering all of this, it only makes sense that HPA-D has been found in a high proportion of chronic fatigue syndrome (CFS) patients. CFS was classified as a neurological disease by the World Health Organization in 1993 and its symptoms include persistent fatigue, difficulty with memory and concentration, a disturbed sleep pattern, and severe muscular-skeletal pain.

Possible Causes

The symptoms can be absolutely debilitating, so if you suspect that you have HPA-D induced CFS, your first question might be, “why?” There are many possible causes that often link back to stress in one way or another. Below is a list of just a few of these causes.

1. Chronic Stressors

Those extended periods of stress mentioned earlier are one of the most common reasons for the spiking and eventual depletion of cortisol. This pattern is often seen in people who have experienced emotional trauma, especially when they were younger. According to research around 50% of CFS patients report at least one type of childhood trauma. This study also reports that childhood trauma is estimated to increase the risk of CFS between 6- and 8-fold with a graded relationship between the severity of the trauma and the risk of developing CFS.

In adulthood, there are also plenty of traumas and general stress that can produce the same unhealthy results. HPA-D and CFS are often present in those living with toxic relationships, whether it’s between them and a partner, family member, friend, or even a coworker. Those struggling with a lack of purpose are also at risk. Succumbing to modern stressors while working overtime and scrolling devices filled with anxiety-inducing information for “entertainment” can also lead to HPA-D and CFS. These habits prevent us from spending the amount of time in nature that our bodies are meant for and crave.

2. Chronic Infections

There are other ailments that can negatively impact the HPA axis, and some of these are various infections. For example, Lyme disease, other tick-borne illnesses, Epstein–Barr virus, and even COVID-19 can mess with your cortisol levels. Along with their own symptoms, they can cause CFS as well.

3. Gut Problems

We often discuss the huge role the gut plays in every person, both body and mind. If something is amiss in that microbiome, it’s not unlikely that it will affect your HPA-axis too. Dysbiosis, SIBO, Candida, parasites, enzyme deficiencies, nutrient deficiencies, and food allergies or sensitivities can all be causes of HPA-D and CFS.

Available Treatments

There are ways to combat these causes and feel better. Treatments are available, but the first item of business should be running tests to determine what is happening in your unique situation. My test recommendations include Adrenocortex Stress profile with CAR, DUTCH Plus, and Doctors Data HUMAP. From there, you can explore a few categories of helpful changes that may alleviate your symptoms.

1. Self-Care & Joy

Since we’ve discovered that chronic stressors are such a significant cause of HPA-D and CFS, it’s crucial to remove those from your life when possible. It will be nearly impossible to have a healthy stress response if you are constantly exposing yourself to stressful situations. One of the biggest offenders that we see in our clinic are toxic relationships. If you have a job you hate, a partner you constantly fight with, or a relative that constantly knows how to push your buttons, you need to make a change! Surround yourself with people who lift you up and energize you, not people who constantly bring you down. Make time every day to get outside, exercise, and find activities that bring you joy and give you purpose. Connecting with nature and spirituality are also essential components of well-being. Don’t let the chaos of life overwhelm you. You are in control! Tell your time where to go, so you aren’t left wondering where it went.

2. Nutrition

This isn’t a call to go on a diet. Perhaps you’ve been focused on cutting calories for your health in the past, but that mindset must shift to ensuring that your body is getting plenty of nutrients that support your gut. Start by avoiding processed, refined foods. Reach for produce and other whole foods instead! Then eat them mindfully. Take the time to make conscious decisions about how much of what is going into your body and when. Turn off the TV, sit at the table, and enjoy a nice meal.

3. Sleep

To get good sleep, you may need to cut out more screen time than just while you’re eating. Not only should the TV be off while you’re actively trying to sleep, but disconnecting with technology altogether for an hour or two before starting your bedtime routine can help regulate your body, including your cortisol levels. Another important step to have in this routine is taking care of your hygiene. This can lead to better sleep, and better wellness overall.

4. Correct Imbalances

Assuming you start your health journey with accurate testing, another effective treatment is to work toward correcting any imbalances revealed in your results. Depending on the details of what’s happening in your body, you may need to replenish nutrient deficiency, correct gut dysfunction, improve hormone levels, or get a chronic infection under control. Since all of the body’s systems work together, you may need to take a multipronged approach to treating dysfunction.

5. Supplements

After making some positive changes to your lifestyle, adding supplements can be beneficial. Some of my recommendations include RootFix InstaCalm for stress management and RootFix NeuroZen for sleep. To target HPA-D and CFS right at the root, Cortisol Manager can be extremely helpful.

HPA-D is a serious problem with real consequences for many people in our society that often gets disregarded or ignored by the traditional medical community. If you think you may be struggling with HPA-D, the solution is not a pharmaceutical drug. The solution is a whole-body approach that identifies and corrects the root causes of the dysfunction.

At GrassRoots Functional Medicine, we’ve developed comprehensive programs that help you to gain clarity on the problem as well as a structured path to resolution. In our Adaption Programs, you will get comprehensive testing to take the guesswork out of the equation, accountability, and support every step of the way. Our team of health professionals will partner with you to make sure your concerns are heard, your needs are met, and – most importantly – that you achieve the best possible results. If you’re sick and tired of being sick and tired, it’s time for a new approach. Schedule a free discovery call with our Enrollment Coordinator today and reclaim the health and vitality you deserve!

About the Author: Dr. Seth Osgood is a Doctor of Nursing Practice, Board Certified Family Nurse Practitioner and Institute of Functional Medicine (IFM) Certified Practitioner. Dr. Osgood received his post-graduate training in Functional Medicine through the IFM and from working with Dr. Amy Myers. He has helped people from around the world improve their health utilizing a Functional Medicine approach.