The term ‘adrenal fatigue’ has become increasingly popular to describe the burnout experienced from chronic stress. While it is a catchy term, it’s misleading. In fact, it is not your adrenals getting tired from the beating they are under, it’s your brain and body revolting from all the stress. The brain-body connection through the HPA axis can cause cortisol dysregulation leading to a myriad of symptoms including feeling tired, burnt out and a desperate need for a sabbatical from life.

What is the HPA axis?

HPA stands for Hypothalamic-Pituitary-Adrenal and the dysfunction is the communication connection between these organs.

Let’s walk through a basic physiology lesson so you can better understand HPA Axis Dysfunction & your own body!

The hypothalamus is a portion of the brain that is the controller of the autonomic (unconscious control) nervous system & the pituitary gland. It coordinates your body temperature, thirst, hunger, and control of hormone release (through the pituitary gland)

When you feel a stressor (from inside or outside of the body) your hypothalamus tells your pituitary gland (through the hormone CRH) to secrete ACTH. This hormone (ACTH) stimulates your adrenal gland to produce cortisol to help deal with the stressor.

Cortisol is predominately used in blood sugar regulation, it is anti-inflammatory, & a natural pain killer – all great things to have when you’re trying to run from a bear.

Now-a-days, stressors are a bit different. As opposed to the crisis mode that our ancestors would be under to escape imminent danger, we are now experiencing tremendous daily stress that is wreaking havoc on our bodies. It’s not only external stressors such as financial or job related stress, it’s also internal stressors such as chronic infections, diabetes & other metabolic conditions, environmental toxins, amongst others. When you put your body under this constant stream of stress it affects the all the body systems.

So what happens?

As the stress continues (because let’s be honest, stress can be a process to decrease), your brain has continued stimulation to send signals for the adrenals to keep pumping out cortisol. Even your brain can get tired of sending out the same signals (it asks your body “how could you be running from a bear for 12 hours a day?”), so it down-regulates the signal to put out cortisol.

Another mechanism that happens is that your cells also get sick of all the cortisol that keeps being presented to them and tell their own receptors to stop listening to the signal! Over time, with the down regulation of cortisol output signals and the decreased sensitivity of the cells to the cortisol signal – you decrease overall production of cortisol. So now you feel tired, have trouble sleeping, anxiety, sudden weight gain, hormonal imbalances (and all the ‘fun’ symptoms that go along with that), getting sick easier, and much more.

This sounds like me; do I have HPA Axis Dysfunction?

We are in the modern era of medicine and the reality is we no longer have to guess when it comes to many of the biological processes that are happening in your body! There is a test called the Cortisol x 4. You pick a day that would represent a normal day to you. Don’t pick a day where you’re lounging on the couch watching Hallmark movies if that isn’t typical for you! You give 4 saliva samples in separate tubes at 4 times during the day – typically morning, before lunch, after lunch, and before bed. This gives us a graph of your cortisol activity throughout the day.

Example from a patient who was reporting fatigue, anxiety and continued stress:

As you can see, your cortisol is supposed to be highest in the morning and then slowly decreases over the course of the day and lowest at night to help you sleep. This patient’s cortisol was low at 3 points in the day, and optimal around 6pm when he reported his highest energy. This graph represents this patient has been under chronic stress for many years, and their body has now compensated by decreasing the amount of cortisol produced.

Reach out to a functional medicine practitioner to find out your cortisol rhythm graph!

We’re fighting fatigue, naturally. 

So what can you do about it?

First and foremost, you need to learn how to cope and process your emotional & life stressors. Whether that be through exercise, meditation, journaling, regular counseling, or whatever method works for you, you have to find an outlet for the external stressors. Take a mental health day, start a budget & stick to it, download a meditation app, or journal your feelings (and destroy the paper afterwards if you want no record of it!) but it is important to find a proper, non-destructive outlet to burn off this stress.

Second, you should work to decrease the internal stressors mentioned before (diabetes, metabolic disorders, autoimmunity, environmental toxins…) By healing from these diseases, you are taking an extra layer of stress off of your body, allowing for further HPA Axis healing.

Third, supplement with a natural product that can help modulate your stress response. It is important to note that using natural products without addressing the core cause of your HPA Axis Dysfunction is putting a band-aid on the issue. While the products may make you feel better, your main goal should be long term healing without the dependence on supplements.

Want more specific recommendations about diet, exercise, and holistic solutions to HPA axis healing? We are here to help you! Reach out for a free 15-minute consultation and find out more.

Dr. Cassie Wilder

Dr. Cassie Wilder is a registered Naturopathic Medical Doctor (NMD) and founder of MIMC. Her passion is empowering her patients through education, understanding, and support through their healing journey. After graduating from Iowa State University with a Bachelors of Science in Kinesiology and Health, Dr. Wilder earned her Doctorate of Naturopathic Medicine from Southwest College of Naturopathic Medicine & Health Sciences, a fully accredited and nationally recognized institution in Phoenix, AZ. During her clinical training, she received extensive hands-on training with many leading experts in the field of functional medicine and developed a passion for treating hormonal imbalances, thyroid disorders, cardiovascular concerns, and adrenal fatigue.