HPA Axis Dysregulation: 7 Ways to Support a Healthy Stress Response
- Micala Stevenson, MS
- Oct 27, 2022
- 5 min read
Updated: Feb 7, 2023
Overview of HPA Axis Dysregulation
The HPA axis (hypothalamic-pituitary-adrenal axis) is the central hub in our body for the response to stress. It regulates the body's response to stressful situations by secreting stress hormones like cortisol, which increase the availability of energy, such as glucose and fatty acids stored in the liver. Normally, cortisol levels fluctuate throughout the day, but when faced with a stressful situation, they increase substantially. The HPA axis helps our body to control various bodily functions, including growth and metabolism. When chronically stressed, this system can become dysregulated, often resulting in physical and mental health consequences. Unfortunately, overexposure to stressful events has become common in our daily lives.
Functions of the HPA Axis
The HPA axis is a major neuroendocrine system that helps us respond to stressful stimuli. It consists of the hypothalamus, pituitary gland, and adrenal glands. The hypothalamus is a small structure in the brain located near the pituitary gland. This region of the brain controls several body functions, including the heart, blood pressure, and metabolism. The adrenal glands are located on top of the kidneys and secrete hormones like epinephrine, cortisol, DHEA, and aldosterone.
The HPA axis regulates the physiological response to stressors through a variety of feedback mechanisms. When we encounter an event that we perceive as stressful (e.g., speaking in public or getting stuck in traffic on our way to work), the sympathetic nervous system is stimulated and releases hormones such as epinephrine and norepinephrine. The release of these hormones causes physical responses like increased heart rate and activates the hypothalamus to release corticotropin-releasing hormone (CRH). The secretion of CRH signals the pituitary gland to secrete adrenocorticotropic hormone (ACTH) into the bloodstream. ACTH travels to the adrenal glands and binds to receptors on the outer layer of the glands called the adrenal cortices. This cascade of events causes the adrenal glands to release glucocorticoids like cortisol. Cortisol is often thought of as the stress hormone because its effects on the body help us respond appropriately to stress. For example, a primary function of cortisol is to increase blood glucose levels so our tissues have enough energy to respond to a stressor. The HPA axis regulates many functions including digestion, immunity, reproductive functions, sleep, blood pressure, mineral balance, and mood and behavior.
Disruptions in this process can result in a variety of symptoms
Symptoms of HPA Axis Dysregulation
HPA axis dysregulation has been associated with a range of health conditions including major depressive disorder, chronic fatigue syndrome, premenstrual syndrome, overtraining syndrome, neurodegenerative diseases, post-traumatic stress disorder, fibromyalgia, functional GI disorders, and autoimmune disease. In healthy individuals, there is a sharp increase in cortisol levels in the morning, which peak at about 30-45 minutes after waking and gradually decrease throughout the day. This pattern is referred to as the diurnal cortisol pattern or cortisol circadian pattern. Individuals with HPA axis dysregulation may experience altered cortisol patterns, which can show up in several different ways. One way to assess HPA axis function is by taking multiple salivary samples to get a picture of the overall diurnal cortisol pattern. Another important biomarker that is used to evaluate how the body responds to stress is the cortisol awakening response (CAR). The CAR assesses how our body responds to the stress of waking by measuring cortisol levels at waking, 30 minutes after waking, and 60 minutes after waking. In some cases, individuals may have normal free cortisol levels, but an under or active stress response, which can be seen by measuring the CAR. These imbalances are likely caused by overactivation of the HPA axis from prolonged periods of mental and/or physical stress (e.g., work/family/school-related stress, chronic sleep deprivation, chronic disease, severe caloric restriction, overtraining, and childhood trauma). Chronic activation of the HPA axis can eventually lead to hypoactivation and altered cortisol levels.
HPA axis dysfunction can show up in many different ways and has been associated with symptoms such as:
Fatigue
Insomnia
Non-restorative sleep
Feeling wired but tired
Brain fog
Anxiety
Depression
Dark circles under the eyes
Cravings for salt, sugar, caffeine
Water Retention
Inability to handle stress
Blood sugar imbalances
Unexplained weight gain or weight loss
Low blood pressure
Inflammation
Dizziness upon standing
Frequent infections
Feeling weak and shaky
Exercise intolerance
Weak muscles
Low libido
Intestinal hyper-permeability
Managing HPA Axis Dysregulation: 7 Ways to Support a Healthy Stress Response
Evaluating HPA axis function usually involves measuring biomarkers such as the overall diurnal cortisol pattern, CAR, and cortisol metabolites, which can be done by collecting several salivary and/or urine samples throughout the day. Three samples are taken to measure the CAR: one immediately upon waking, one 30 minutes after waking, and one 60 minutes after waking. Individuals with HPA axis dysregulation may exhibit either an exaggerated CAR or blunted CAR, indicating a dysfunctional response to stress. As with many health conditions, there is not one specific protocol available to normalize the HPA axis. Each case is unique and every person has a different set of antecedents, mediators, and triggers. However, there are several things you can start doing today to help support your stress response. For personalized guidance, consider working with a qualified healthcare professional who can help you identify imbalances within your stress response and help you manage HPA axis dysregulation.
Practice meditation: One of the best ways to improve the stress response is through meditation, which helps change how we view and react to stress. You can start by setting aside just three minutes every day. There are many techniques that have been shown to be helpful in managing stress, such as mindfulness meditation, which involves focusing on breathing and being aware of the present moment without judgment. If you have trouble quieting your mind or experience racing thoughts while you practice meditation, remember that you are still receiving the benefits and with time, you will gain better control of your thoughts. To help get you started, consider downloading an app that provides free meditations and music (e.g., Calm, Headspace, InsightTimer). The best part is that meditation is completely free and can be done just about anywhere!
Maintain a balanced diet: Severe caloric restriction and nutrient insufficiencies may lead to or exacerbate HPA axis dysregulation. Maintaining a balanced diet with high-quality carbohydrates (e.g., fruits, vegetables, whole grains, nuts, seeds), fat (e.g., fish, nuts, seeds, extra virgin olive oil, avocados), and protein (e.g., grass-fed beef, poultry, fish, legumes) provides the body with adequate macro and micronutrients and phytonutrients required for human health.
Reduce stressors: While it's not possible to completely eliminate stressful situations from our lives, it's always a good idea to take a look at our sources of stress and identify which ones are in our control and can be reduced or eliminated. This may mean changing jobs if possible, setting healthy boundaries with the people in our lives, reducing alcohol intake, addressing sleep issues, etc.
Vagus nerve stimulation: The vagus nerve is a major component of the parasympathetic (i.e., rest and digest) nervous system and helps our body relax after a stressful event. Stimulation of the vagus nerve has been shown to improve stress resilience, reduce anxiety, improve IBS symptoms, and may be helpful in treating stress-related psychiatric disorders. Some non-invasive ways to simulate the vagus nerve include cold water immersion, humming/singing/gargling, meditation, massage, exercise and taking slow-deep breaths.
Supplementation: Adaptogens are substances that help increase the body's resistance to stressors. Some common adaptogenic herbs include rhodiola, ashwagandha, licorice root, holy basil, American ginseng, Panax ginseng, Schisandra, and astragalus. Other supplements that support the HPA axis include B vitamins, magnesium, and certain probiotic strains.
Spend time in nature: Studies have shown that spending time in nature has a profound effect on stress hormone levels. Simply spending 20 minutes outside at least three times per week can lower cortisol levels and increase well-being.
Exercise: Exercise has numerous well-researched benefits, including stress reduction. Aim for at least 30 minutes per day of physical activity that you enjoy (e.g., yoga, hiking, weight training, biking, paddle boarding, volleyball, etc.).
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