Adrenal Fatigue, HPA Axis Dysfunction, and the Toll That Hidden Stress Can Take on Your Body
We have discussed the term “adrenal fatigue” in previous newsletters, and why its symptoms occur often in mold-injured patients. The term “adrenal fatigue” may be a misnomer, though, for what is actually occurring in the body. Fatigue or exhaustion, cortisol imbalance (from testing) along with a history of acute or chronic stress led integrative and functional medicine practitioners to the idea that the adrenal glands were “fatigued” and eventually “exhausted” from constantly producing and dumping the stress hormone cortisol during periods of mental or emotional strain or tension. The thought was that prolonged adverse or very demanding circumstances, over the course of weeks, months, or years, would cause the adrenal glands to become dysregulated and lose normal function due to being “tapped out” and depleted. Through much research and treating increasing numbers of these patients in clinical practice, medical professionals now know the problem involves more than just the adrenal glands. The term hypothalamic-pituitary-adrenal or HPA axis dysfunction more clearly defines what is going on as its scientific backing indicates problems in the brain and central nervous system that are major pieces of the wired but tired, often debilitating condition.
What is HPA Axis Dysfunction?
Before we get into the dysfunction portion of this topic, it’s important to understand what the HPA axis is and what parts of the body it refers to.
Hypothalamus – This part of the brain, located at the base near the pituitary gland, plays an imperative role in many bodily functions. Its main job is to regulate hormone production, which affects a number of physiological processes such as body temperature, emotions, appetite, and sleep (among others). The hypothalamus connects the endocrine system to the nervous system.
Pituitary Gland – Sometimes called the “master gland”, the pituitary gland is the central piece of the endocrine system. It takes information from the hypothalamus, makes hormones the body needs, and disperses this information to other glands in the body so they can perform their essential functions.
Adrenal Glands – The adrenal glands are located just above the kidneys. Based on information received from the pituitary gland, the adrenals are in charge of making necessary hormones. While the adrenal glands produce many hormones, the most closely associated hormones with these small glands are adrenaline and cortisol.
These three areas of the body operate together to perform many essential functions across multiple systems, including the regulation of energy and stress levels, metabolism, and immune response. None of them are independent, and each relies on the other (at least in some way, if not directly) to function properly. At the same time, any imbalances across these systems can trigger a domino effect where the other systems are affected. There are three hormone classifications that can signal an imbalance:
Corticotropin-Releasing Hormone (CRH) – CRH is a stress hormone that is also sometimes called Corticotropin-Releasing Factor (CRF). It’s released by the hypothalamus.
Adrenocorticotropic Hormone (ACTH) – ACTH is released by the pituitary gland. The production of this hormone is triggered by the detection of CRH.
Glucocorticoids – Glucocorticoids are steroids released by the adrenal glands, and are triggered by the detection of ACTH. There are many types of glucocorticoids, and cortisol is one of them.
An abundance of one particular hormone can potentially cause issues. For example, if your body produces too much cortisol, your body will be “stuck” in fight or flight mode. This can lead to trouble sleeping or insufficient sleep, weight gain, and mood changes.
One study found that HPA axis dysfunction “has been found in a high proportion” of Chronic Fatigue Syndrome patients. The researchers of that study described the two conditions as being “associated.” The same study found there to be an “increased frequency of HPA axis dysregulation in females,” inferring that gender could play a role in this condition. While there is still much to be learned about HPA axis dysfunction, the researchers specifically noted that “the need for novel treatment strategies such as those which target the HPA axis is clear.”
“The HPA Axis controls everything from our cortisol and adrenaline and sex hormone secretion (from the adrenal glands) to how our body synthesizes those hormonal shifts (the pituitary) to how it responds to those shifts by releasing different hormones that communicate with our thyroid, our ovaries, our digestive tract, our temperature regulation, and even our growth patterns.”
So what does it look like when things aren’t functioning properly in that axis?
HPA Axis Dysfunction Symptoms
There are many different symptoms associated with HPA axis dysfunction, but the most common include:
Fatigue or exhaustion
Unexplained weight gain or loss
Poor sleep quality (even if you’re sleeping, you don’t wake feeling rested)
Trouble sleeping (falling asleep or staying asleep)
Poor immune response
Difficulty handling and/or managing stress
Brain fog (not being able to think clearly or remember things)
Sugar or salt cravings
Weak nails (that break easily)
Hair loss (sometimes resulting in bald patches)
Those that are familiar with the term “adrenal fatigue” may be thinking that these symptoms sound a lot like those associated with that condition. The research community has never been able to find conclusive evidence that the adrenal glands can actually be fatigued. Because of the lack of affirmative research, many medical professionals wouldn’t use such a diagnosis. What differentiates HPA axis dysfunction from adrenal fatigue as a diagnosis is the research and correlations to other essential functions. The hypothalamus, pituitary gland, and adrenal glands all work together on a daily basis, and it’s known that dysfunction in any of those body parts can cause issues.
It can be complex but may best be described like this: (and I paraphrase the words of Dr. Ashley Margeson, NMD here) “You’re wired, but exhausted at the same time. You crash in the afternoon. You aren’t really that hungry, but then you can’t stop snacking at night. You feel as if you have to make more lists than normal, your sex drive plummets, you forget simple things, and bright lights really start to bother you. Even though you’re feeling exhausted and overtired, you stay up late because you get a second wind and then you wake up once you fall asleep.”
It’s truly a vicious cycle and one that is very difficult to get out of.
What Causes HPA Axis Dysfunction?
The major and most common cause of HPA axis dysfunction is prolonged periods of stress. One of the biggest physical and mental stressors that I see in my patients are those in which mold and mycotoxins have interfered with life and health. Not only are there the physical inflammatory effects from mold exposure but the challenges of clearing the environment and finding a safe place to live can put enormous strain on the HPA axis. Additionally, people in consistently high-stress situations — medical students, attorneys, CEOs, and other C-level executives, and any other high-pressure job are all at risk of experiencing HPA axis dysfunction systems.
HPA Axis Dysfunction Tests
There is no single test for HPA axis dysfunction, but rather it is suspected when the overall hormonal system is imbalanced. This includes adrenals, thyroid, sex hormone, and growth hormone from the pituitary gland.
HPA Axis Normalization
HPA axis dysfunction is reversible with environmental and lifestyle changes. We do have to revisit our words of clean air, clean food, and clean water. You cannot get better if these things are not addressed!
The most important lifestyle change you’ll need to make is to reduce your stress level. Depending on what is causing you stress, this may look different for different people.
Practice Yoga or Meditation
A good place to start is by beginning a meditation or yoga practice (or both). Learning breathing techniques that help keep your stress response under control is a crucial skill to learn in the management of HPA axis dysfunction.
Reduce Primary Stressors
If you have addressed your physical environment, then dig deeper. If the main source of your stress is something you can cut out of your life (or reduce significantly), then you should consider doing so. This could mean a job change, speaking less often to a high-maintenance friend or family member, or simply making the choice to find time for yourself instead of overextending your commitments. Otherwise, find a way to channel your stress into something positive that helps you relax.
Make Sleep a Priority
Getting restorative sleep each night can be difficult for some, but if you’re experiencing HPA axis dysfunction symptoms, it’s critical to make sleep a priority in your life. Getting the physical rest you need will help your body and systems recover.
Maintain a Balanced Diet
It’s very important for people experiencing HPA axis symptoms to maintain a healthy balanced diet. Now is not the time for extreme dieting. Stick to a natural whole food, Mediterranean style diet, eat plenty of fruits and vegetables, and stay away from processed foods, sugar, and white flour as much as possible. And of course, drink plenty of water to maintain good hydration.
One thing you may want to avoid (or limit) for at least a little while is alcohol. As alcohol is a depressant, it might be a good idea to limit your intake for a bit.
Exercise can be a big stress reliever. Get up and get your body moving for at least 30 minutes each day. It doesn’t have to be rigorous or difficult, but you should do something you enjoy — something that helps you relax and clear your mind. It may be walking, hiking, biking (even if it’s on a stationary bike), or some light, weight training. The point is to move your muscles, increase your circulation, breathe deeply and relax your mind. Exercising daily also helps you sleep better.
Supplements Which Support HPA Axis Function
The most universally accepted supplements for supporting the HPA axis are vitamin C, B-vitamins, and adaptogenic herbs. Adaptogens help to counteract the effect that stress has on our bodies by working to stabilize the hypothalamus, pituitary gland, and adrenal glands. Specifically, adaptogens help to support the body for better resilience, repair, and homeostasis (equilibrium). A great supplement for this is Adrenal Boost formula by Micro Balance Health. Supporting the HPA can help:
- Protect your brain and memory;
- Increase energy levels and endurance;
- Stabilize your mood;
- Improve cognitive function;
- Stimulate your central nervous system.
As more than adrenal glands are involved in this process, however, it is important to look at and support each hormonal system, including the thyroid and sex hormones, as well as pituitary function. Great homeopathic support for all of these is CellTropin. It may not specifically be for each and all, the overall support it gives makes individual system treatment easier and more effective.
HPA axis dysfunction is a more accepted diagnosis than adrenal fatigue ever was, but because most primary care physicians may treat each symptom individually, they may not be looking for the underlying cause. However, integrative and functional medicine practitioners have known about and have been addressing this condition for at least a decade. They know what it looks like, so they’re better equipped to diagnose it. Integrative experts aim to get to the root of the problem and help correct it, rather than just mask the symptoms.
Everyone hit the mail on the head. I can attest to what you’ve all said. I have a trauma background, EBV and other herpes viruses that get reactivated by stressors such as mold illness, Covid and the mental/emotional stress I’ve experienced on top of everything else the last six years. Been through it all and it’s a ton of work to address it all and get relief. Fortunately, years of research have empowered me in my self-care and I have a good new functional doctor who is helping me through more rounds of testing and scans to get to the root of what is off in my endocrine system that is causing other systems to go haywire too. HPA-axis dysfunction, EBV and mold are no joke.
I am so glad I signed up to receive these emails. You hit the nail on the head. I’ve been suffering for so long & nobody has even come close to explaining all of these things that I deal with every day I tramp on from doctor to doctor, looking into their eyes seeing that they don’t believe me (or they just have no idea how to help me) and somewhere along the way, I gave up and stopped telling them what happened to me. I’ve been just pretending along, faking that I’m okay and going along w/what each new doctor, who has no idea what’s wrong w/me has to say. I’m sick of taking all these wrong medicines, however, the kind of help I need my medical insurance won’t pay for, from what I can understand. This article does give me hope to try, however, to show my doctors and try to reignite a fire under them and stop being stuffed like a Thanksgiving Turkey w/so many medications.
Yours is a story I hear all too often, unfortunately. Medicine as an art, rather than a series of protocols and meds has been pushed into the background. There are good and interested physicians out there; sometimes it takes finding one who is open to being somewhat educated by you and what you know to get the ball rolling in the right direction. Hang in there.
Thank you for this article. It defines me to a T. I have CPTSD from childhood and lifelong trauma, mold illness from exposure six years ago and have been under relentless intense legal stress for the last six years as well. I began treating diagnosed Candida nine years ago, but suspect I’ve have it most of my life after an unwell infancy and childhood full of antibiotics and related gut, allergy, asthma, skin and migraine issues. I have nearly all of the symptoms you mentioned, plus high blood pressure, cholesterol and insulin resistance, despite working to lower them. I often said over the last few years that I was stuck in fight or flight, dumping cortisol and adrenaline. I was also literally behaving in fight and flight ways as well, often on edge and escaping into food and shopping, my go-to feel-good addictions, which I then suffer consequences of and am facing, now that most of the stress, aside from many resulting systemic health issues, is behind me. My functional doctor suspects Hypercortisolism and I am doing the initial dexamethasone test in the next couple of weeks to try to get to the bottom of the seemingly interrelated imbalances. I am increasing exercise – yoga, swimming, walking, eating a healthy whole food plant-based diet, have been intermittent fasting for a year and am always detoxing. And I am actively trying to minimize stress and triggers. Praying that we get to the bottom of it and that I can heal. I was mentally and physically exhausted most of last year and couldn’t do much but rest and research, and finally started a battery of functional testing at year end when I was up to all the effort, which was stressful in and of itself. Fortunately, I am much better after a recent two-month getaway to Miami and implementing the aforementioned strategies. But, still a long way to go and this article was very helpful. I will print it and review with my doctor. I have used all the MicroBalance products for six years and swear by them. I believe they resolved my chronic sinusitis. And I take the supplements you mentioned, but from other companies as yours are new. Poster child here!
You are getting there and that is the best news! This is a long journey, especially since much began in childhood. I pray that you continue to find answers and things that help you specifically. Sometimes life seems very unfair, and it sounds like you have been working at this so hard. Sharing your story and helping others can bring its own reward in this path. My best to you!
Susan, thank you so much for the encouragement and for seeing me and my struggle. Life does feel unfair sometimes as my health challenges take most of my time, and being single, means I have to manage most things in life by myself, so I don’t have a lot of free time to relax and have fun, which I know is important and something I want in my life again. Despite everything, I try to stay positive and grateful for the blessings, like being able to help others from my research and experience. I always look forward to your articles and wisdom and appreciate everything you bring to the mold and chronic illness community.
Thank you for writing and for reading. We appreciate you as well. Hang in there. It is hard to stay patient, but healing will come.
This is the exact condition I’ve tried to explain to people for years now. I didn’t know the “wired but tired” symptoms actually had a name. Thank you for this article. It’s very much on point. I developed this condition through mold exposure. Mold is no joke!
Thank you for writing! I am glad the article was helpful.
Hello Dr. Tanner,
Recent studies have put a spot light on the EPSTEIN BARR VIRUS (EBV). It has been identified as a key risk factor in Long Covid and has been determined to be the actual cause of Multiple Sclerosis. For decades EBV was associated only with Mononucleosis but it is now understood that it can exist in a chronic active or reactivated form. One wonders what role VIRUSES like EBV might play in conditions such as HPA axis dysfunction, chronic fatigue, sleep disturbance, inflammatory disorders, anxiety, etc. Perhaps testing for viruses (just like testing for mold) is worthwhile when one suffers a chronic condition that cannot be definitely diagnosed and resolved.
Always appreciate your articles. Thank you.
Absolutely EBV and other viruses can make one both susceptible to the impacts of mold and make it more difficult to treat. I have also read about EBV and its link to long Covid. EBV virus never goes away once it has been contracted and is a very important part of the “total body load”. It can, however, exist in a non active form which is what we strive for using different modalities, and trying to help the individual immune system more resilient to the impacts of it and other viruses.
I think your description also looks very much like what one’s body experiences when they have a substantial trauma background. All these same things go haywire, and it is because your brain is rewired by the trauma to believe the body is still in trauma no matter how many years pass. Dr. Bessel van der Kolk talks about many of these same things.
Yes, trauma, both physical and emotional, can have lasting biological impacts on the body. It is important to always treat the whole person and not just their immediate symptoms to help them to achieve wellness. Thank you for writing and for continuing the conversation. Thank you also for sharing this information with other readers.