What is HPA Axis? What to do if you're experiencing fatigue and burnout and how Dr. Carrie Jones fixed mine

Are you experiencing burnout or fatigue? What about anxiety, weight gain, insomnia, or stress? These are all signs your HPA axis could be out of balance. We spoke with hormone expert, Dr. Carrie Jones, who helped correct mine to find out what exactly causes the HPA axis to become imbalanced in the first place. She explains that when the HPA axis is in a hypo or hyper state, it can affect your hormones, digestion and even the immune system. She also gives us tips on how to bring it back into balance, including helpful supplements and daily practices.

What is the HPA Axis?

The HPA Axis is short for the “Hypothalamic-Pituitary-Adrenal Axis.” It is the system that starts in the brain and ends with the hormones produced by the adrenal glands such as cortisol, epinephrine (adrenaline), DHEA-S, and aldosterone.

What happens to the body when the HPA Axis is out of balance? 

Since there are several hormones produced by the adrenal glands, when the HPA system is out of balance, peopleexperience a myriad of symptoms. For example, if the HPA axis is increased, people might experience heart racing, anxiety, insomnia, stress, weight gain, elevated glucose, elevated blood pressure, water retention and more. If the HPA axis is decreased, people might experience burnout, fatigue, blood sugar dysregulation, low blood pressure, dizziness on standing, muscle weakness, and more.

What causes the HPA Axis to get out of balance?

The HPA axis is designed to react to short-term (acute) stressors that our bodies come up against, then recover and “go back to baseline.” This includes every type of physical, psychological, emotional, or environmental stress. Even chronic dehydration, hypoglycemia, sleeplessness, and job burnout can cause huge problems with the HPA axis. Over time, these chronic stressors can take its toll and the HPA axis does not react the way that it used to, leading to dysfunction. This is why identifying and addressing stress coupled with stress reduction activities and rest/recovery are so important!

What are some of the symptoms of an imbalanced HPA Axis?

The symptoms depend on whether someone is in a more hyper or hypo state. If the HPA axis is hyperactive, people might experience heart racing, anxiety, insomnia, stress, weight gain, elevated glucose, elevated blood pressure, water retention and more. If the HPA axis is decreased or more hypoactive, people might experience burnout, fatigue, blood sugar dysregulation, low blood pressure, dizziness on standing, muscle weakness, and more.

Can you explain the difference between the sympathetic and parasympathetic nervous system?

The autonomic nervous system controls aspects of health such as heart rate, blood pressure, breathing rate, digestion, and parts of reproduction. It has two main divisions: the sympathetic and parasympathetic nervous system. The sympathetic nervous system prepares the body to “fight, flight or freeze” in stressful, concerning, or scary situations. When someone experiences a stress, the body perceives it as a threat and works to protect or prepare them. The parasympathetic nervous system does the opposite - it is all about “rest and digest,” relax and restore. There is also a third division known as the enteric nervous system in the gut.

How does an overactive sympathetic nervous system affect hormones?

Since the sympathetic nervous system prepares people to either fight, take flight, or freeze (shut down), this can have a huge impact on someone’s hormones. Remember, the healthy function of the hormone system is dependent on whether or not the body perceives them to be healthy enough and safe enough to reproduce. Of course, not everyone wants to have a baby BUT the body doesn’t know this. Therefore, when someone is in a state of stress inducing their sympathetic nervous system, reproduction is not important to survival at that time. Therefore, they may experience problems with their menstrual cycle, sperm production, and arousal! On testing, women may find their cortisol high, progesterone lower and estrogen (estradiol) relatively higher. Men may find their cortisol high, testosterone lower and estrogen (estradiol) higher.

How can it affect digestion?

People who experience a lot of stress on and within their body and who have a hyperactive sympathetic nervous system tend to report a multitude of digestive complaints as they are not able to ‘rest and digest’ like they should! This can include everything from increased heartburn due to the effect on the sphincter of the esophagus and the stomach acid to an increased reaction to foods they eat due to a thinning of the mucus layer in the intestines along with causing problems with little “gates” known as tight junctions. In addition, stress can affect peristalsis which are the wave-like movements that happen in the intestines pushing the food forward.  

How can someone go about finding out if their HPA Axis is out of balance?

First, find a healthcare provider who understands the HPA axis and will take the time to listen to your history and symptoms. Next, ask about testing the HPA axis which can be done a number of ways. While blood testing can give insights into some hormones, it’s not as helpful for cortisol which follows a circadian rhythm. My favorite test is the DUTCH Test for sex and adrenal hormones. This test is easily collected at home 4-5 times through the day then mailed back to the lab. The results are 6 pages long and cover several hormones such as the 3 estrogens and estrogen metabolism, testosterone, DHEA-S, progesterone, melatonin, cortisol through the day, and more.

Is it true that many chronic health issues clear up once the HPA Axis becomes balanced?

Since the HPA axis has such a huge influence on so many aspects of the body, many people do find their health issues greatly improved when their HPA axis improves. For example, a dysfunctional HPA axis could be the cause behind someone’s high blood pressure, insomnia, hair loss, fertility struggles, fatigue, blood sugar dysregulation, anxiety, erectile dysfunction and more.

What protocol do you recommend to balance the HPA Axis?

It depends on what their test results say about their adrenal hormones. For example, cortisol should rise in the morning on waking and fall throughout the day until it’s nice and low at night to sleep. However, if someone is low in the morning causing fatigue, but higher at night causing insomnia, I would treat this somewhat differently from someone who wakes with high cortisol and feels anxious or hypervigilant but crashes in the afternoon causing fatigue and hypoglycemia. This is why a proper workup is so helpful! The daily circadian rhythm is set and reset by the CLOCK genes in our brain! It’s heavily influenced by light and dark therefore I strongly recommend people get 10-15 minutes of full spectrum light on waking by going outside, opening a window, or using a full-spectrum light box. At night, do the opposite. Wind down before bed, dim the lights, get off of electronics and sleep in complete darkness. I also strongly recommend community and play for those who feel they are routinely in the “fight, flight or freeze” side of their nervous system. The body finds it hard to feel threatened or need to fight when you’re laughing, with your community, and having fun.

Which supplements are helpful in balancing the HPA Axis?

This also depends on what their test results say about their adrenal hormones. I do love both the holi (youth) and holi(mane) by Agent Nateur.  A quality multi-vitamin, B-vitamins, and vitamin C are generally helpful to the HPA axis as well. I’m a huge fan of tea and often drink a calming tea before bed that contains herbs such as chamomile and holy basil (known as Tulsi). Other herbal adaptogens besides holi (youth) include ashwagandha, rhodiola, eleutherococcus, and cordyceps might also be helpful but always talk with your healthcare provider.

What is one practice people can incorporate into their daily routine to help keep their HPA Axis balanced?

Besides using light and dark to your advantage and increasing laughter/play/community into your life, use your “no” button. I find that a number of people reach the point of feeling burned out because they give and give and give, but don’t give enough to themselves. To help improve this, practice setting boundaries, saying no (or no thank you), and stop burning the non-toxic candle at both ends! Your body will thank you.