Stress and Adrenals: Restoring the HPA Axis

By Dr. Linda J. Dobberstein, DC, Board Certified in Clinical Nutrition

August 14, 2017

Stress and Adrenals: Restoring the HPA Axis
Stress. Every day stress of deadlines, traffic, weather, stressful news, and disharmonious relationships comes with the baggage of elevated stress hormones. Often, one can power through the situation and the stress response calms down. For many though, the stress remains a constant. After a while it becomes the new normal and the body's symptoms of stress become like white noise in the background. It's tuned out until the body reaches a crash point and then things fall apart. Life is a marathon of stressors. There is no private island that one can jet off to for years and have no stress. Rather, we need to help our brain and adrenal glands manage the daily wear-and-tear. This is essential to survive and thrive in today's busyness and maintain health.

Stress management involves the brain and the adrenal glands. The adrenal glands produce cortisol and DHEA, two of the main adrenal hormones that regulate stress responses. Other adrenals hormones like estrogen, progesterone, testosterone, pregnenolone, epinephrine, etc. are also affected by acute and chronic stress. There is a natural balance between all of these hormones in both hierarchy and inter-relationship. DHEA may especially help counterbalance stress-induced high cortisol. However, the release and demand for the hormones are directed by the brain.

The HPA axis (hypothalamic-pituitary-adrenal) is the command center and communication feedback system in the brain that senses stressors. Stressors can be infections, trauma, injury, surgery, food allergies, inadequate sleep, bad relationships, cold/hot weather, etc. Stressors disrupt the normal homeostasis of the body and must be managed. The HPA axis, or communications network, tells the adrenal glands to make more stress hormones or to subside production and maintain homeostasis.

When there is ongoing chronic stress, severe acute stress, PTSD, or early-life stress on unborn babies, infants, and young children, the HPA axis gets bent out of shape and may not bounce back due to the severe demands. The stress management center of the brain no longer works the same way and alters the natural rhythm of adrenal hormone production. This loss of equilibrium causes many of the symptoms of adrenal fatigue and adrenal distress rather than true cortisol deficiency or adrenal insufficiency. Gaining stability with the HPA axis and nourishing the adrenals helps the body cope with the chronic stress.

Adrenal Gland Stress Symptoms

Many symptoms reflect adrenal gland stress. Here are some common symptoms and
consequences of adrenal distress:

• Low blood pressure
• High blood pressure
• Fatigue
• Weakness
• Depression
• Anxiety, Irritability, Nervousness
• Mental fatigue
• Poor memory
• Low body temperature
• Low blood sugar (adrenal fatigue)
• Insulin resistance
• Dizziness upon standing
• Insomnia (sleep onset/sleep maintenance)
• Salt and sugar cravings
• Neck and shoulder muscle spasms
• Indigestion
• Diarrhea and/or constipation
• Dry, thin skin
• Lack of perspiration
• Loss of body hair, especially on calf muscle
• Heart palpitations
• Food allergies
• Soreness over short ribs in back
• Weight management difficulties
• Headaches
• Increased susceptibility to colds/flu
• Premenstrual and Perimenopause stress
• Chronic inflammation
• Autoimmune disorders
• Increased cancer risk
• Loss of muscle mass
• Burnout

Consequences of Adrenal and HPA Stress

Cortisol is necessary for the body to function, but when chronically imbalanced, there are consequences. Here are some of the more common consequences of this cortisol imbalance and the overworked, dysregulated HPA axis.

Thyroid, Diabetes, Leptin, and Heart Disease

Poor thyroid hormone conversion occurs as a result of cortisol stress. Elevated cortisol blocks the conversion of the basic thyroid hormone T4 into the active T3 thyroid hormone. It decreases TSH (thyroid stimulating hormone) production. It increases production of rT3, the inactive form of T3 thyroid hormone. This can create all of the symptoms of poor thyroid function. However, it is not a thyroid problem. It is a brain stress problem and reflects the need for HPA and stress support.

High stress and elevated cortisol causes insulin resistance which can lead to prediabetes, diabetes, leptin resistance and obesity. Central obesity/visceral obesity or weight gain around the internal organs is related with elevated cortisol.

Heart disease often coexists with diabetes and chronic high stress. Acute and chronic stress with dysregulated cortisol is definitely linked with cardiovascular diseases like high blood pressure, heart attacks, and atherosclerosis


Bone loss and increased risk of osteopenia and osteoporosis may be caused by chronic stress and elevated cortisol. It is well-known that steroid medications cause bone loss. Chronic elevated cortisol or subclinical hypercortisolism not due to medications can also lead to increased bone loss and osteoporosis. DHEA helps buffer bone loss caused by excess cortisol in these circumstances.

Depression, Anxiety, Neurodegeneration

Chronic stress, elevated cortisol, and low cortisol are major causes for depression and anxiety. Other adrenal hormones that occur with dysregulated cortisol, like low DHEA, progesterone, pregnenolone, testosterone, or estrogen also impair mood and lead to depression, anxiety, irritability, poor focus, and higher risk of neurodegenerative disorders like Alzheimer's disease. Imbalance of these hormones and stressed HPA axis may lead to feeling lethargic or fatigued, brain fog, forgetfulness, or poor motivation.

Recent information shows that when individuals with Alzheimer's are exposed to stress, the high cortisol response actually causes more amyloid-beta plaque to be released and form detrimental tangles within the brain. It is suspected that that Alzheimer's disease is associated with HPA dysfunction.

Research shows up that having adequate DHEA levels in the body is critical for those who suffer from major depression. DHEA helps to buffer against high cortisol. New information shows that individuals with depression who received DHEA supplementation responded better to treatment overall with or without an antidepressant SSRI medication.

Depression symptoms actually went into remission with DHEA support with or without the antidepressant. Depression may occur as a result of HPA dysfunction as cortisol levels are usually elevated at night rather than the morning. The adrenal glands still produce the cortisol, but at the wrong time of the 24-hour cycle.

Information about sleep, cortisol, and the HPA balance may be found in the article Taming the Mind At Night: Help for Insomnia

IBS, Leaky Gut Syndrome, Ulcers

Chronic stress and elevated cortisol breaks down the mucosal lining of the digestive tract. This makes you more likely to experience “leaky gut syndrome” or increased intestinal permeability. New onset or worsening of food allergies and food intolerances may occur. Development of irritable bowel syndrome or IBS is a consequence of high stress and elevated cortisol affecting the digestive tract lining. Stomach and small intestine ulcers may also occur. Bile acid and stress-induced acid indigestion may be problematic too. The list of disorders linked with stress and cortisol can go on and on.

Restoring Balance to the HPA Axis and Adrenal Glands

The consequences of chronic stress are often dismissed until something breaks down and you can no longer bounce back. This failure is a major cause of symptoms and is responsible for many doctor's visits. Ensure that you have the basics in place with rest, relaxation, diet, and restorative exercise like stretching and good musculoskeletal care.

Adequate sleep is absolutely critical. There is no way to repair HPA stress and adrenal dysfunction unless sleep is restored. Bedtime before midnight, ideally by 10 p.m. is critical. Those with adrenal fatigue and depletion may need to sleep in until at 8:00 or 9:00 a.m. for more restoration. Tied into HPA healthy function is the 24-hour circadian rhythm based on the natural light-dark cycle. It is important to reduce light pollution at night before and during sleep to help the natural circadian rhythm, destress the HPA axis, and help natural cortisol production in the morning.

Some individuals may need long-term DHEA or other adrenal hormone support and is best determined by a blood or saliva test. Lab tests are most helpful for those with multiple, chronic concerns or when one has plateaued with care or when symptoms are confusing. They provide great insight for how the HPA axis and adrenal glands are working.

If you have osteoporosis, heart disease, thyroid disease, insomnia, diabetes, PMS, depression or anxiety, there is likely an element of HPA axis dysfunction and cortisol/DHEA imbalances. If you react with a short fuse and have checked off the majority of the symptoms listed above, then HPA and adrenal support is essential.

No matter what the body is doing with adrenal stress and HPA function, nutritional support helps to reboot and balance the maladapted system over time. Stress is real. It is not going to go away. How we support our body with the daily demands determines how well we can withstand its effects. How are you doing today?

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