Whether it’s the stresses of fluctuating midlife hormones, or juggling a million and one things to get through the week, you may be feeling depleted, run down, utterly drained or even jittery. Maybe sleep is eluding you altogether, condemning you to a Groundhog Day of symptoms.
Humans are primed to be resilient and to bounce back after adversity. It is true that your body is designed to handle a great deal yet there is only so much it can take before it starts to falter – or worse.
That’s burnout – a state of physical and emotional exhaustion, also referred to as ‘adrenal dysregulation’ or ‘HPA axis dysfunction’. The latter stands for hypothalamus-pituitary-adrenal axis dysfunction.
It's largely overlooked in conventional medicine and yet it is pervasive and contributes to dozens of health problems. Most of the clients who come to me have some sort of HPA axis dysfunction going on – even though they don’t realise it.
So now you’re wondering whether that might apply to your health...
Signs your body is under pressure
The signs of HPA axis dysregulation are widespread and may include any of the following (some of which might seem contradictory):
Allergies (environmental, food, chemical)
Craving salty foods
Early onset perimenopause/ menopause
Fatigue (especially in the morning or after a stressful event)
Low blood pressure
Sleep disturbances (insomnia, waking up)
Weight around midsection
Why this matters so much
You have two separate protective systems to ensure your survival: the stress response and the immune system.
The stress response - your fight-or-flight mechanism - is designed to protect you against external dangers. It is governed by the HPA axis and is activated only when you’re under threat. When there is no danger, it is inactive.
While the HPA axis is activated stress hormones are produced. At the same time functions that are non-essential in a fight-or-flight situation are suppressed – such as digestion, reproduction and cellular growth and repair.
The immune system protects us by fighting outside invaders, such as bacteria and viruses. The stress hormones released by the HPA axis block the immune system.
Knowing this, it is easy to see how something that seems minor at first glance – stress – could be messing with your health in different ways and different areas of your body.
If you’re feeling below par all the time, perhaps it is time to give your HPA some TLC.
How does the HPA axis work?
Several endocrine glands that secrete hormones and neurotransmitters are involved in the stress response:
The Hypothalamus is an area of the brain that links the nervous system and the endocrine system via the pituitary gland. It plays a crucial role in many functions including the release of chemicals involved in the stress response.
The Pituitary gland sits at the base of the brain and is often referred to as the master gland because it secretes so many essential hormones. It is divided into two lobes - anterior and posterior.
The Adrenal glands are two small structures located at the top of the kidneys. They produce adrenaline, noradrenaline and cortisol as well as other hormones involved in blood pressure balance, growth and reproduction.
Together, the three glands form the HPA axis.
In the face of danger, the initial response is governed by the sympathetic nervous system. It triggers the release of adrenaline and noradrenaline from the adrenal glands. These neurotransmitters kick in within a split second, causing physical changes we have all experienced when stressed or scared, such as an increased heart rate and sweating.
About 10 seconds later the hypothalamus registers elevated levels of adrenaline and triggers a cascade of hormones that will set off the stress response. It secretes a hormone called corticotropin-releasing hormone (CRH), which in turn stimulates the pituitary to release adrenocorticotropic hormone (ACTH) into the bloodstream. ACTH then travels to the adrenal glands via the bloodstream, where cortisol is secreted in response.
Fight or flight?
The brain’s reaction to acute stress is a means of survival in a potentially life-threatening situation – it doesn’t differentiate between an attack by a sabre-toothed tiger or a car beeping its horn as you step into the road. The stress hormones released enable the body to either run or fight. They cause blood sugar to rise, providing the energy required for physical exertion. At the same time, they widen the airways and increase your heart rate and blood pressure to transport sugar and oxygen to the muscles of the extremities that need them most right now.
To ensure an adequate supply to the muscles, blood is temporarily withdrawn from other areas, such as the digestive tract or the reproductive system. The capillaries near the surface of the skin contract to reduce bleeding in case of injury. Moreover, cortisol is a powerful painkiller, so if you get injured, you’re not going to know about it until later, enabling you to keep fighting for your life despite injury.
In addition, cortisol leads to increased excitability of the brain and has an anti-inflammatory effect, partly via a pronounced inhibition of the immune system. Thus, the brain is poised for split-second decisions to ensure survival, but it’s not great at conscious decision-making and logical thinking at that point.
From an evolutionary point of view, the physical response to acute stress is perfectly designed to put the body on alert in case of imminent danger and to mobilise the energy required to fight or flee.
When acute becomes chronic
If acute stress persists, the body ends up in a permanent state of activation and the systems become exhausted. In addition to adrenaline, which impairs your ability to rest, large amounts of cortisol keep circulating in the blood. As cortisol massively suppresses immune reactions in the body, the immune system becomes weakened. Long-term stress, therefore, has a toxic effect on the body.
The stressors modern life has in store for you are rarely of the kind that requires you to run or fight so the historic stress response is no longer ideal.
Many people feel stressed all the time. Modern living means that we’re faced with a continuous parade of reasons to worry: a global pandemic, climate change, job losses, health threats, debt and loneliness, to name but a few. None of these is relieved by running or fighting but the worry can still trigger the same stress response.
With a constantly activated HPA axis, you may be left with high blood pressure, high blood sugar, palpitations, sleep disturbances, depression and tiredness. Add to that a suppressed immune system and you are more vulnerable to infection, inflammation and disease.
Stress is a presence in everybody’s life and much of it is nearly impossible to escape. However, that doesn’t mean that there’s nothing you can do here. There is.
You can take a long hard look at your life and health, eliminate the stressors that you can get rid of and increase your resilience to the stressors you cannot do anything about.
Stressors can lurk in unexpected places
When you talk about ‘stress’ most people will think of psychological stressors because that is what first comes to mind. But your body has physical stressors to contend with as well. If you are struggling with symptoms of HPA axis dysfunction, you need to consider both kinds.
These are easy to see in your own life. Most commonly, people feel stressed when they are overwhelmed with juggling relationships, family and work commitments. Then there may be financial worries, caring for a sick child or elderly parents, illness – whether your own or that of a loved one – and it can all get too much very quickly.
There could be more severe issues such as trauma or abuse, which, even if they occurred in the past, still have an impact on your stress levels today.
The less obvious stressors
Physical stressors may be more challenging to detect, although many are apparent. If you live in constant pain, need to take medication daily and can't ever get restful sleep, you'll know this is causing you stress.
But there are also the stealthier threats to the body that you cannot see and that you might not have considered - think toxic exposure through environmental chemicals, dental amalgams, mould or bacterial overgrowth in the gut. Food intolerance, unlike food allergies, tends not to be obvious. Invisible radiation, such as from frequent flying or electromagnetic fields (EMF), can cause havoc in the body, leaving you wondering what is going on.
Show your HPA axis some love
With so many factors playing a role in HPA dysfunction, no wonder you are overwhelmed. Doing anything about it seems like just another task on your to-do list that is already as long as your arm. And is there any point if stressors are coming at you from all directions? Absolutely! You can take it one day at a time, chipping away at the things that are stressing you out.
Start by getting rid of those tasks that add to your workload but that you do not really have to do.
Do you have to be head of the PTA at your child’s school? Do you have to produce a masterpiece bake for the village fête cake stall? Do you have to host a family lunch every Sunday? Do you have to volunteer at the homeless charity every week?
Of course all of those are commendable activities but if completing them is creating stress then remember the safety advice they give you on aeroplane - always put on your own oxygen mask first before helping others. Would the world really stop turning if you quit – at least for a while - to get your health back together again? Consider that you won’t be much good to anyone if you are constantly exhausted or sick even, because you are completely run down.
(Having said that, rewarding tasks like volunteering might actually boost your mood and add to your energy levels.)
Your Recharge Plan
Avoid stressful situations where you can. Be honest with yourself about the activities and tasks you do each week that drain your energy. Ditch what doesn’t serve you.
Schedule some daily me-time and put it in the diary. Do something just for your own pleasure. It could be reading a novel, painting, enjoying a quiet cup of tea in the garden, phoning your sister for a catch up, having a soak in the bath … Whatever it is, you must make time for you every day.
Learn techniques to direct your mind and body away from stress and into a restful state. The fight-or-flight response is automatic and can be triggered just by worry – justified or not – so relaxation must be learned and practised. Breathing exercises and guided meditations are perfect for this.
This is a tricky but essential one. Sleep is needed for your body to carry out necessary repair and maintenance. That includes your brain. During sleep, the spaces between brain cells widen and get ‘rinsed’. That way, the body cleans away waste products of metabolism and cell debris, including amyloids, the proteins linked to Alzheimer’s disease. This process takes approximately 8 hours; so do not cut back on your sleep, even if you think you don’t need it. Also, you cannot make up for lost sleep and a chronic sleep deficit significantly increases cortisol. In one study, sleeping 6 hours or less for seven consecutive nights raised cortisol levels in adults by between 50-80%. As you implement other parts of the plan you should see your sleep quality improve.
Exercise increases your feel-good hormones – endorphins - and improves mood, reduces anxiety and depression, burns that excess sugar and oxygen circulating in your system and improves sleep quality. Exercise may also increase body temperature and blood circulation in the brain. It even impacts the HPA axis and thus increases your resilience to stress. What’s not to like?
Studies found that rhythmic, aerobic exercise of moderate and low intensity that uses large muscle groups (e.g. jogging, swimming, cycling, walking) was the most effective when done for just 15 to 30 minutes a day for a minimum of three times a week in programmes of 10-weeks or longer.
However, over-exercising stimulates cortisol production – the opposite of what you want right now. So the key is not to overdo it. Gentle exercise is ideal, such as walking or yoga and tai chi, because they don’t just encourage the movement your body needs but also elicit the relaxation response.
What you eat matters. Everything that happens in your body is ultimately chemistry. The chemicals involved are the nutrients that come from your food and your body can only work with what you provide – or not.
- Don't diet right now: your body needs nutrient-dense food to recover and caloric restriction is just another stressor, stimulating cortisol secretion.
- Eat real food: you would not expect a petrol car to run on diesel. In the same way, the human body cannot function on a diet based on ultra-processed foods packed with sugar, salt, trans-fats and extra ingredients you cannot pronounce. The body just wasn’t made for that and needs proper fuel. Fruit, vegetables, whole grains, nuts, seeds, meat, fish, eggs, seafood, herbs and spices have worked for humans for millennia. That’s a sign.
- Follow a low-GL (glycaemic load) diet: overeating high-GL foods may contribute to permanently elevated cortisol, triggering a vicious cycle of chronic stress and unhealthy eating.
- Eat mindfully and chew slowly and thoroughly: this takes a load off your digestive system. Once you swallow, there is nothing more you can do to help, so make the most of it. Chewing also stimulates the production of digestive juices, providing stomach acid, digestive enzymes and bile. If you eat slowly, you are giving your digestive system time to get everything ready.
- Eat little but often: this is not normally what I would advocate but with HPA axis dysfunction, it is essential to keep blood sugar levels stable with regular meals. Be sure to include breakfast.
- Avoid stimulants: from caffeine, refined carbohydrates (sugar, flour, bread, fruit juices, baked goods, chocolate), nicotine and alcohol.
5) Reduce cortisol
That might sound flippant but there are plenty of hobbies and activities that have been shown to reduce cortisol levels:
- Create a happy playlist - music can reduce cortisol levels both before and during periods of stress - up to 66%
- Breathe - breathing exercises and meditation practice can reduce cortisol levels significantly - up to 20%.
- Connect – research found that the better our social support and relationships are, the more likely cortisol moves to within the healthy range.
- Laugh - studies demonstrated up to a 67% decrease in cortisol after the subjects watched funny videos.
- Join a choir - singing was found to significantly decrease cortisol after just one hour. A choir is also a community that helps you connect, great if you've just moved to a new area and don’t know anyone yet.
Ask for help
Once you have implemented your recharge plan – taking it one step at a time, so that no new stress ensues – you are likely to feel considerably better. The longer you stick to the plan, the more you will feel the benefits. However, sometimes there may be little or no improvement, even when diet, sleep, movement and relaxation are taken care of. That’s when you may need to go into detective mode to find the culprit(s).
Environmental toxins, leaky gut and food intolerance can cause havoc with your system. Long-term stress can significantly upset the balance of the gut microbiota and damage the intestinal lining, allowing toxic waste products and partially digested food to enter the bloodstream.
Now is the time to seek the help of a health professional. I can recommend various testing options that can help us understand your nutrient status, toxic load, food intolerances, the state of your microbiota and the likelihood of leaky gut. Once we know more, I can advise you on what measures to take and support you on your journey to better health.