What is Adrenal Fatigue? The Ultimate Guide to Your HPA Axis

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Wondering if you have adrenal fatigue (or HPA axis dysregulation)? Wanna really know what is adrenal fatigue?

Do you feel tired a lot? Have trouble falling asleep at night and then struggle to get out of bed in the morning? Does it seem like nothing helps you lose weight (especially to deflate that spare tire around your middle)? Any cravings for salty snacks?

Do you feel like you’re always stressed? Struggle with your mood? Find it hard to stay motivated? Worry that your metabolism is slow? Have low energy levels? Seem to get sick all the time?

Read on, my friend. Your adrenal glands and HPA axis may need some TLC.

I’m so excited to share this with you because it affects soooo many people! I’ve personally struggled with (and beat!!!) adrenal fatigue/ HPA axis dysregulation twice, and I know how amazing it can be to feel like you’re truly awake and energetic for your life!

Stress and fatigue have become so commonplace in today’s society that people joke about sticking Prozac in the water supply to help us all cope.

Doctors report that 20% of all visits are for fatigue, and this has been a common complaint among my patients.

A dentist told me recently that practically everyone should wear a mouth guard. He claims that stress levels are so high that most people are grinding their teeth while they sleep.

Adrenal fatigue, or more accurately HPA axis dysregulation, can produce a number of vague, debilitating symptoms that can be treated to free you up to live your dream life.

What Is Adrenal Fatigue or HPA Axis Dysregulation?

Some things are easier to explain “in person” than to write about, so step into my “office” (lol, or dining room). Let’s answer the question, “What is adrenal fatigue?”

The Main Players:

1. Adrenal Glands:

These glands are located on top of the kidneys and produce:

  • Mineralcorticoids- the main one is aldosterone, which regulates blood pressure and electrolyte balance
  • Glucocorticoids– the big one is cortisol (both basal, or baseline, level of cortisol and in response to stressful situations), which plays a big role in blood sugar levels, immune function, energy levels, and metabolism
  • Gonadocorticoids- some reproductive hormones made here (mainly androgens like testosterone) and DHEA (the starting material for things like estrogen, progesterone, testosterone, cortisol)
  • Catecholamines– mainly epinephrine (adrenaline) and norepinephrine (noradrenaline), which are released during times of stress (which can include stressful situations or things like serious illness); these are often referred to as the “fight or flight” hormones

2. HPA Axis Overview:

This is a complex system that regulates stress response, mood, motivation, metabolism, energy levels, your immune system.

It’s always TRYING to get to homeostasis, or a good balance of endocrine hormones.

Here’s a quick word of encouragement— If you think you have adrenal fatigue (technically HPA axis dysregulation), your body really is trying to help work with you to resolve this! Resetting different parts of the system can go a long way towards healing!!!

  • Hypothalamus- area of the brain that connects the autonomic nervous system and the endocrine system with the pituitary. It controls homeostasis by regulating sleep, energy levels, body temperature (together with the thyroid), hunger and thirst perception, and more
  • Pituitary Gland- often called “the master gland;” located in the brain and controls the endocrine system (thyroid, reproductive hormones, etc)
  • Adrenals- play a vital role in stress response, reproductive hormone precursors, regulation of blood pressure and electrolytes, immune system function, and inflammation level

The adrenal glands spark that fight or flight response, which was great back in the day when we were running away from an angry wooly mammoth. In this day and age, it’s seldom a life-threatening situation that triggers this cascade of crazy hormones.

Often, stressful work conditions, underlying chronic illness (stuff like leaky gut or a thyroid gland that’s not functioning optimally), sleep deprivation, and inflammatory foods can all spark this level of adrenal response.

Adrenal Fatigue Versus HPA Axis Dysregulation

According to MedPage Today, a reputable online medical journal, Adrenal Fatigue does not exist. It’s the concept that the adrenals release high levels of cortisol during times of stress and then essential burn out and cannot produce enough cortisol.

It is possible for someone to have adrenal glands that don’t make enough hormones. It’s called Addison’s disease, and they end up on cortisol replacement for life. It’s usually related to destruction of the adrenal glands.

HPA axis dysregulation IS a concept recognized by both the holistic health world and conventional medicine. There are almost 20,000 articles in PubMed (a large library of medical journals) on HPA axis dysregulation.

What is likely happening with the HPA axis is more like when someone develops Type 2 diabetes (the insulin-resistant kind). Here’s the theory:

  • You’re stressed, so your body makes lots of stress hormones to help you get through.
  • You have high levels of stress hormones for so long that the receptors become less sensitive to them
  • Your brain tells your adrenals to make more stress hormones because the body isn’t using the ones that you’re already making
  • This exposure to chronic stress makes it tough to get the HPA axis back into balance

Here’s the cascade response when you’re stressed:

  • Release of CRH (corticotropin-releasing hormone) from the hypothalamus
  • Triggers quick response of ACTH (adrenocorticotropic hormone) from the pituitary gland
  • Stimulates cortisol release from the adrenal glands
  • Cortisol has a receptor site in every cell in the body!! This leads to a widespread response (in the immune system, nervous system, endocrine system)

In a normal setting, elevated cortisol levels should turn off the CRH cascade. In HPA axis dysregulation, it’s like the everything gets stuck in the “on” position, and the body is not as sensitive to the cortisol that’s produced.

This can also lead to altered patterns of cortisol release.

A healthy cortisol release should give you a good peak of higher cortisol in the morning to signal that you should get up and out of bed. Then, it gradually decreases throughout the day so that you can go to bed in the evening.

An abnormal cortisol pattern can result in lower levels in the morning, making it hard to get up, and higher levels in the evening, making it a challenge to go to bed early or fall asleep quickly.

Symptoms of Adrenal Fatigue/HPA Axis Dysregulation

All of these are possible symptoms of adrenal fatigue. Do any of them sound familiar?

  • fatigue, lack of energy
  • trouble getting out of bed in the morning and you hit the snooze button frequently, but you feel a little better once your start moving (movement boosts that cortisol level) or have your coffee
  • mid afternoon energy crash but a second wind if you stay up past 10-11pm
  • brain fog or decreased memory
  • the sensation of being “tired and wired” (exhausted but you can’t turn your brain or body “off” to sleep or rest)
  • difficulty losing weight, especially around your middle (having a “spare tire”)
  • lowered immune system, frequently sick
  • cravings for salty foods
  • trouble falling asleep at night
  • trouble dealing with stress and tight deadlines; decreased ability to manage stress
  • you feel better when you’re less stressed, like on vacation or over a holiday
  • decreased libido
  • lightheadedness when you stand up too quickly
  • hypoglycemia (low blood sugar)
  • intense PMS
  • decreased muscle tone and stamina
  • neck pain or upper back pain
  • mild depression or anxiety
  • difficulty doing your normal daily activitities
  • thin, brittle nails
  • alternating diarrhea and constipation
  • lowered body temperature (<98.6)
  • heart palpitations (if you have this one, please see your doctor right away to be sure to rule out other serious medical conditions)

Possible Causes of Adrenal Fatigue

Lots of things can trigger your HPA Axis to get stuck in the “on” position. Possible causes can include:

  • PTSD (post traumatic stress disorder)
  • Gulf War Illness
  • Chronic Fatigue Syndrome
  • alcoholism
  • stress (both from a busy, stressful life or from a chronic illness, both diagnosed or undiagnosed like gluten intolerance, leaky gut, etc)
  • nutritional deficiencies
  • environmental toxins
  • chronic infections (SIBO, H. pylori, Lyme’s disease, EBV)
  • frequent intake of stimulants like caffeine, sugar
  • intense, excess exercise
  • negative emotions (chronic worry, negativity, anger, guilt)
  • chronic pain
  • surgery
  • sleep deprivation
  • high levels of stress (bad stressors like financial difficulties, death of a loved one, marital difficulties, parenting challenges but can also include good stressors like moving, getting married, having a baby)

Testing For Adrenal Fatigue

In the conventional medicine order, we’re looking for Addison’s Disease or Cushing’s Syndrome, and you check:

  • blood work for current cortisol level
  • ACTH stimulation test- cortisol levels are checked in the blood both before and after ACTH are given to see if cortisol responds appropriately

In integrative medicine, the most common way to check HPA axis function is through:

  • Saliva Testing at 4 specific times throughout the day. This checks cortisol and DHEA for the desired response at certain time. Saliva testing shows active hormones (blood testing shows hormones attached to carrier proteins) so this can give a more accurate picture of what is happening at a cellular level (as in, what you’ll feel and respond to). If you want to test right away at home, I highly recommend the Sleep and Stress Panel from EverlyWell to check your adrenal health (and use code EVERLYWELL to save 12% off your first order!).
  • Insulin- Induced Hypoglycemia- some practicioners will do this to test for Adrenal Insufficency. Glucose and cortisol are measured before and after a dose of fast-acting insulin to see if you experience hypoglycemia (low blood sugar)
  • Secretory IgA- This immune system protein is often on stool testing for leaky gut, and Secretory IgA is the first line of immune defense against pathogens, food allergies, and inflammatory response. If this is elevated, it can mean that you have HPA Axis dysregulation.
  • Methylation Labs- It can be valuable to test for MTHFR gene mutations, which can affect how well your body methylates, or “turns on,” B vitamins. Methylation also helps your body to break down adrenaline and noradrenaline appropriately, process neurotransmitters like dopamine and serotonin, and affects histamine levels. All of those affect your HPA axis and how you feel.

Treatments For Adrenal Fatigue

Because there are many different things that can lead to adrenal fatigue, there are many different options for improving it, too.

The treatment plan is usually individualized, but here are common things that are used to help patients feel better.

And, as you do this, keep in mind that your HPA axis WANTS to heal! It is trying to reset itself, so we’re just coming alongside it and giving it tools to get better.

You can do this, friend, and you will feel better again!

1. Stress Levels and Your Schedule

I realize that this can be a tough one! It’s like telling you, “hey, have you tried just being not stressed and feeling better?!” When you’re in the midst of crazy adrenal fatigue, this initially sounds like super un-helpful advice.

Here’s some practical steps to help you do this with these proven relaxation and stress-busting techniques:

  • Meditation (my faith is really important to me, and I meditate on Bible verses)
  • Yoga
  • Deep breathing
  • Lavender or Chamomile (essential oils or tea- this one is my favorite!)
  • Mindfulness- focus on where you are right now

Create a healthy schedule for yourself and STICK to it! It’s okay and it’s time to make your health a priority. Things to include in your daily schedule:

  • Make time for 7-8 hours of sleep, and do your best to go to bed before 11pm to avoid the second wind of cortisol
  • Do your best to get up at the same time every morning. Wake up and get up/start moving as the movement helps your body to release cortisol
  • Take two 20 minute “time outs” during the day to practice one or more of your stress busters
  • Have some mild to moderate exercise time; if you’re adrenals are really tapped out, start with just yoga or a gentle walk. As you start to feel a little better, this workout is my favorite for women!
  • Follow your Eat To Beat Adrenal Fatigue (see below) dietary suggestions

2. Address Underlying Health Issues

I have never seen adrenal fatigue on its own in my patients. There is always something else going on, too, and it must also be address to truly get better.

If your adrenal fatigue is related to past stressors or trauma (like mine was!), please seek out counseling with a licensed professional.

Many people need to work on healing up their leaky gut, thyroid function, and balancing reproductive hormones while working on their adrenals.

Some people may also need to address environmental toxins and heavy metal exposure during this process.

3. Vitamins and Supplements for Adrenal Fatigue

There are so many great things that may help! General vitamins and supplements:

  • B vitamins (especially B5, B6, B12 and folate); may need a methylated version if you have the MTHFR gene mutation. B vitamins tend to be depleted if you’ve followed a low carb diet (like Keto)
  • decrease inflammation levels with omega 3’s, curcumin, vitamin C
  • mineral salt can help to balance electrolytes
  • rooibos tea can play a role in balancing cortisol levels
  • magnesium to promote relaxation

Adaptogenic herbs can help to balance adrenal hormones. I love adaptogenics because they will adapt to what you need– they bring up abnormally low levels and lower unusually high ones. Please consider seeing a licensed and certified healthcare provider before starting new vitamins and supplements!

  • Ashawaganda
  • Rehmannia
  • Licorice root
  • Eleuthero ginseng
  • Holy basil
  • Rhodiola rosea
  • Schisandra

Occasionally, your healthcare provider may feel that you would benefit from something to increase your cortisol levels (usually in the morning or mid afternoon if you have super low levels then). They may use adrenal extract. Sometimes rosemary oil is used to decrease high cortisol levels.

4. Eat To Beat Adrenal Fatigue

Foods that help to heal the HPA Axis:

  • Stay well hydrated!
  • coconut
  • olives and olive oil
  • avocado
  • bone broth
  • nuts and seeds
  • mineral salt and kelp and seaweed
  • cruciferous vegetables (broccoli, cauliflower, etc)
  • complex carbohydrates (eaten with protein to avoid blood sugar spikes)

Foods to Limit or Avoid:

  • caffeine
  • sugar and artificial sweeteners
  • simple carbohydrates (white flour, white rice, white potatoes)
  • processed foods
  • hydrogenated oils

Related Posts:

5 Fast Fixes for Adrenal Fatigue— perfect for those days when You. Can’t. Even.

Holistic Health Focuses on All of You

As mentioned above, it’s highly unlikely that adrenal fatigue is the only thing contributing to how you feel right now. Check out the rest of this series to see what may be going on and how you can feel your best naturally!

Resources That I Love

…to help you be healthy naturally:

  1. Supercharge Your Weight Loss- Need a little extra “oomph” to help you stay on plan? Several of my friends recently introduced me to HealthyWage.  If you’re losing weight well with THM or if financial rewards motivate you to stay on track, then HealthyWage is perfect for you! 
  2. Save on Healthy Meat– ButcherBox is my new favorite way to buy antibiotic free, grass fed beef, pork, and chicken! It’s cheaper than I can get it in the local stores, and it comes right to my door! Use the code AP10 to get $10 off your first box and FREE nitrate-free bacon!! 
  3. Get Healthy Foods for Less- Thrive Market is like the online Costco for healthy groceries, and they even have healthy meat and seafood! We love saving money with wholesale prices on healthy groceries and products that get sent right to our home! Get an extra 25% OFF your first order when you sign up at Thrive Market HERE!

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    1. Yup! For most people, stevia in moderation seems to be okay. Just a word of caution- it tends to disagree with people who have an allergy to ragweed!

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