When I moved to Miami in 2020, my nervous system was fried. My kitty had just died and I was so stressed over COVID and how awful LA was becoming. My cortisol levels were extremely low (more on this later!) and my HPA axis and adrenal function weren’t working like they should. I knew I had to make a change in my life and my body. Moving to Miami and living next to the ocean completely relaxed my nervous system. The waves at the beach were the perfect start to regulating my HPA axis and getting my cortisol levels back to a balanced state. What I’ve learned on this journey is that stress is always going to be there, but with the right tools, we can support and balance our bodies.
What is the HPA Axis and HPA Axis Dysregulation?
The hypothalamic–pituitary–adrenal (HPA) axis is part of the endocrine system. This is a chemical messenger system that connects the hypothalamus, the pituitary gland, and the adrenal glands. The HPA axis communicates between them through the use of hormones as messengers and plays an important role in how the body responds to stress.
The hypothalamus gland plays a big part in the HPA Axis and is part of our limbic system. Found in the brain, it's the central command center and controls the entire neuroendocrine system. It impacts everything from our sleep, sex drive, mood, temperature regulation, body weight, fluid, electrolyte balance, and more. The hypothalamus communicates directly with the pituitary and adrenal glands. Communication happens through hormones like cortisol and neurotransmitters like serotonin, dopamine, norepinephrine, epinephrine, acetylcholine, GABA, and glutamate. The HPA axis is also connected to the thyroid and the autonomic nervous system.
Whenever your body faces stress, the body experiences a stress response. This shifts our nervous system into action and triggers the release of hormones. The HPA axis works as a feedback loop, meaning that the output loops back around to become input.
Here's how it works:
- A stress response is triggered, which releases a hormone known as corticotropin (CRH).
- Then this triggers the release of adrenocorticotropic hormone (ACTH) from the pituitary gland.
- This travels through the bloodstream to the adrenal glands, where it triggers the release of cortisol (the stress hormone).
- Cortisol then prepares for 'fight or flight' and gets ready to activate the body for whatever needs to be faced.
What causes HPA Axis Dysregulation?
HPA axis dysregulation is predominantly driven by stress (real or perceived) and prolonged chronic stress over time.
Stress comes in so many forms, including:
- Unprocessed emotional trauma
- Nutrient deficiencies
- Toxic overload in the body
- Blood sugar dysregulation
- Sleep problems / lack of sleep / circadian rhythm disruption
- Stealth infections
In a healthy or resilient body, the stress response gets activated, completed, and then the hormones and neurotransmitters return to normal levels (known as down-regulating). This will take you back into your parasympathetic nervous system (known as rest and digest). However, when stress continues and the stress cycle never ends, we enter into a state of HPA axis dysregulation. This is when the neuroendocrine system dysregulates, too, keeping you in a state of prolonged fight or flight.
Long-term stress or chronic / prolonged periods of stress result in chronic overactivation of the HPA axis. It’s working as if it is ‘always on.’ This then dysregulates other systems, which modulates other bodily functions and systems. These also start working over time and can lead to side effects in our hormone, immune, and metabolic systems.
The stages of HPA Axis Dysregulation
- Stressed and wired: The sympathetic nervous system is activated and your brain and adrenals go into overdrive as you head into fight or flight. If you have high cortisol levels and feel stressed, you’ll feel on edge, anxious, nervous, ramped up, and you might have trouble sleeping.
- Stressed and tired: At this stage, the body starts to get confused. We start producing the wrong amounts of cortisol at the wrong time of the day, i.e. too much at night or too little in the morning when we can’t wake up. At this point, you might be able to meet the demands of getting through the day, but you crash right after. You occasionally might have bouts of energy, but the system is not functioning effectively.
- Exhaustion: By this point, your nervous system and adrenal glands can no longer keep up. Your high cortisol levels can turn into low cortisol after a prolonged period of HPA axis dysregulation. You might experience chronic fatigue, imbalanced blood sugar, mood disorders, anxiety, depression, hopelessness, autoimmune conditions, inflammation, and more.
What are the symptoms of HPA Axis Dysregulation?
HPA Axis Dysregulation can show up differently for everyone, but most commonly is seen as:
- Mood disorders (anxiety, panic attacks, depression, hopelessness)
- Thyroid dysfunction
- Low immune system/recurrent infections / getting sick constantly
- Blood sugar problems/increase in abdominal fat
- Brain fog
- Sleep issues/insomnia/waking up in the middle of the night and having trouble going back to sleep
- Hair loss/hair thinning
- Afternoon fatigue and headaches
- Chronic fatigue/fatigue (especially when you wake up)
- Feeling revved up and trouble calming down
- Low blood pressure
- Headaches after exercising
- Clenching or grinding your teeth
- Chronic lower or middle back pain
- Craving salty foods
- Seasonal or chronic allergies
- Pain in the inner side of the knees
- Dizziness when you stand up
- Difficulty losing weight or gaining/storing weight around the waistline
How can we test for it?
The best way to test your HPA Axis is by looking for adrenal fatigue via a saliva cortisol panel. This panel looks at your cortisol levels throughout the day rather than a one-time blood test, so it’s a lot more effective. It will help to navigate if you’re creating too much cortisol or not enough. You can also assess cortisol with a Dutch Test by working with a trusted doctor, functional medicine practitioner, or specialist.
What are the solutions?
It’s really important to address the root cause to make sure it doesn’t return. Healing the HPA Axis also involves nourishing the nervous system back to a healthy state and restoring the adrenal glands to functioning optimally.
For me, I work to regulate my HPA Axis by focusing on and incorporating:
- A strict sleep hygiene routine: This involves a pitch black bedroom to support optimal sleep, Nordic Natural sleep melatonin gummies, no phone in the bedroom (or other electronics when I sleep), limited blue light exposure before bed, reduced EMFs (cut your wifi off when you sleep), and a fixed bedtime at the same time every night. I aim for 10pm
- At night, I always avoid foods with MSG because these are high in glutamic acid.
- When I wake up, I balance my circadian rhythm by getting outside as soon as possible. I will also try and eat breakfast within one hour of waking up.
- I always take electrolytes in the morning and half a vial of Quinton Isotonics.
- I also always take holi (youth), a product I formulated with Dr. Will Cole with holi basil, an adaptogen that helps to regulate cortisol.
- Vitamin D3 and K2 from my friend Dr. Will Cole.
- Magnesium is one of the necessary nutrients for fighting adrenal fatigue. I swear by BioOptimizers Magnesium.
- When I found someone who calmed and made me feel good in my body, my pain and stress levels disappeared overnight. Sometimes our pain is emotional and our stress can level out when we feel supported and loved in life.
My other top tips include:
- Eating regularly throughout the day. Avoid intermittent fasting; instead, focus on aiming to regulate blood sugar levels through your diet, incorporating protein, complex carbohydrates, and healthy fats in each meal. Read more about how to regulate your blood sugar here with the Glucose Goddess.
- Reduce, or cut coffee, and if possible, never drink it on an empty stomach. High-quality hydration is really important. Make sure you are getting enough water and understand cellular hydration. Coconut water is a great alternative because the amount of potassium.
- Try to shift to lower-intensity workouts rather than HIIT, which can be very stressful on the body.
- Diffuse high-quality essential oils throughout the day to help you feel more relaxed or dab these onto the bottoms of your feet and spine. Lavender is particularly good at decreasing cortisol levels.
- Finally - salt! Start your day with a high-quality Himalayan mineral salt in water if you don’t have the Quinton Mineral vials. Also, a deep soak in an Epsom salt bath before bed each night is great. I love using holi (bath) which includes magnesium, an ingredient especially soothing to the nervous system.
Other supplements great for HPA Axis regulation and managing your stress response include:
- Vitamin C and Vitamin D, which are known as stress-managing nutrients.
- Fish oil: EPA/DHA
- B-complex vitamins because vitamin B12 deficiencies have been associated with stress on the adrenal cortex.
- Selenium, which is most often found in Brazil nuts. Selenium deficiency has been connected to negative adrenal function
- Phosphatidylserine is a phospholipid that can help normalize the HPA axis stress response and balance cortisol.
- Licorice root has been known to help increase DHEA in your body.
- Other adaptogenic herbs because research shows that these may help to mediate cortisol levels and the stress response within the body. Ashwagandha has been proven to help with stress resistance, stress management, stress-related nervous exhaustion, insomnia, and more. Rhodiola rosea is another adaptogenic herb shown to help normalize stress hormone levels. Adaptogenic mushrooms are also incredible, reishi especially. Reishi is a medicinal mushroom loaded with therapeutic properties that help to alleviate stress and help with sleep.
It’s also important to reduce screen time when possible, get out in nature, ground and connect with the earth, and work through past trauma that may be impacting cellular function and driving an ongoing stress response.
***THESE STATEMENTS HAVE NOT BEEN APPROVED OR REGULATED BY THE FDA. WE ARE NOT DOCTORS, THEREFORE ALWAYS CONSULT WITH YOUR DOCTOR FIRST***