Updated: Mar 11
Our body’s prime objective is to survive even to the detriment of other functions. The brain will always favour surviving rather than thriving and this is a normal physiological reaction to perceived risk or threat. Our ‘flight or fight’ response is crucial for getting us out of short or acute dangers but when we are exposing ourselves to chronic or long term stress this can set the stage for dysregulation and inflammation, driving or contributing to symptoms like fatigue, anxiety, imbalanced hormones (irregular or absent menses, infertility, loss of libido, PMT, hot flushes), tension and pain, depression and mood changes, low or nervous energy, gastrointestinal complaints, insomnia, premature aging, headaches, high or low blood pressure and cardiovascular symptoms like palpitations and increased risk of clotting, skin conditions and hair loss.
Stress is good for us in the short term. It can be motivating and allow us to set goals and get things done, but chronic stress which leads to worry and the resulting loss of resilience is damaging and sets the stage for ill health, pathology and disease.
When our nervous system is over taxed, most of its resources are spent defending our body against ‘attack’ or the perception of it and this begins to manifest as anxiety, panic attacks and stress. A healthy system can adapt to maintain its health but when this becomes overwhelmed, good health is diminished and we enter a state of depletion where the body begins to draw on its energy reserves. These reserves are necessary to allow us to restore balance or homeostasis and to normalize hormone levels. In the event of exposure to chronic stressors, we start to lose our vital energy and enter a state of heightened arousal, which over time, creates a loss of emotional and physical resilience, a rise in the body’s inflammatory processes and a decline in our ability to adapt.
Many people with chronic health issues are depleted and energetically exhausted or compromised. They have little energy to deal with life’s stressors and so the stressors seem more challenging or appear insurmountable. This process happens slowly over time and many aren’t aware of how depleted and imbalanced they are until something cracks or they are exhausted and at the end of their tether.
So how does our body react to stress and what happens biologically to set the stage for imbalance?
Modern life can be full of real and perceived pressures, kids complaining about what’s for dinner after a hard day at work, only 2 hours to complete that report your boss needs for a meeting tomorrow, boiler not working and all you wanted was a bath to relax at the end of the day. Our body responds to these situations by releasing hormones from the adrenal glands called cortisol, adrenaline and DHEA in response to hormonal secretions from the brain and pituitary gland to prepare us for the perceived ‘danger’. In response to these hormones, our body’s physiology alters, breathing and heart rate quicken, blood pressure goes up and glucose is released from stores to give us the necessary energy to get away. Other systems like digestion and immune functions are suppressed as these are not required for survival. This response works well when the threat is short lived and we can get back to normal again, however, stressors in our modern life can initiate this reaction often and ultimately results in a poorer stress response. Over time, chronic exposure leaves the body unable to get back to its normal, homeostatic state and sets the stage for imbalance (catching too many colds, viruses or infections, stubborn weight gain, hormonal symptoms, mood changes, panic attacks, anxiety, poor sleep and fatigue). With chronic stress, serotonin (our feel good neurotransmitter) receptors become less sensitive and cortisol and adrenaline increase.
The adrenal glands are a vital component of our energy delivery system. By releasing certain hormones in response to an energy demand they ensure that the body's use of energy matches it's daily needs or to meet the demands of an event or a stress (injury, safety, illness and fever). The hormones they emit are:
Adrenaline - released in periods of short term stress (seconds to minutes)
Cortisol - periods of stress lasting minutes to hours. Helps to buffer the effects of adrenaline
DHEA - periods of stress lasting hours and days. Helps to buffer the effects of cortisol
DHEA helps to rebuild tissue, regulates body weight, blood pressure and immune function and is used by the body to make the hormones testosterone and oestrogen, buffering the effects of cortisol to protect us from conditions like osteoporosis and sarcopenia (muscle wastage) which is important for our health, particularly for peri and menopausal women combined with the drop in estrogen. DHEA naturally declines with age so we need to be supporting our stress response to ensure that we get adequate amounts of this hormone. Low DHEA can indicate HPA exhaustion or low thyroid function. Women with good levels of DHEA levels tend to transition into a smoother menopause.
Too much or too little of cortisol or DHEA can lead to illness and loss of health and it is important that these two hormones are in balance with each other.
Potential symptoms and signs of exposure to long term levels of elevated cortisol
Blood pressure too high or too low (hypertension is a risk factor for menopausal women as well as men)
Craving salty foods due to loss of electrolyte balance and resulting loss of sodium in the adrenals
Fluid retention (electrolyte imbalances)
Low thyroid function (dry skin, hair loss, stubborn weight gain, constipation)
Low progesterone (PMS, breast tenderness, bloating, menstrual heaviness or pain, risk of fibroids etc)
Hypoglycaemic episodes - shaking, tremors, feeling ligh headed, dizzy, irritable, tired, craving sugar
Increased need for stimulants to give a feeling of energy
Energy dips throughout the day
Insomnia, difficulty falling asleep, waking up at night
Not feeling refreshed in the morning but a energy peak late evening or around midnight (2nd wind)
Fatigue and tiredness you can't shake
Aches and pains
Tension headaches and postural rigidity
Muscle wastage and bone thinning
Anxiety and low moods
Slow wound healing (cuts, bruises)
Increased incidence of colds, flu, respiratory infections, infections
Nervousness, irritability, agitation, panic attacks
Brain fogginess, lack of concentration
Loss of resilience to stressful events
Stubborn weight gain
Menstrual irregularities and fertility issues
Decline in sexual interest
Over reactive or decline in immune resilience (autoimmune conditions like Hashimotos, allergies, increased environmental and food sensitivities)
Many factors can play a role in how we react to a stressor and our perception of it is key. The stressor by itself plays no harmful role (unless it’s a physiological stress like running from a bear, sepsis or injury), it is our stress response that determines how we react to it and this can be very individual and shaped by our epigenetics, life events and exposure.
Factors like early childhood trauma, a traumatic event, social economic status, loneliness, exposure to environmental toxicants, pain, injury, addiction and our perception of the world and of our self and others can all play a role in how we manage stress. Early exposure to trauma tends to develop over time into lower resilience and a lower stress threshold; possibly due to a dysregulated feedback mechanism. Some people even pride themselves on working till the early hours not having time to eat properly, or sleep properly and being busy all the time. Stress is addictive and the importance we attach to our role in the world can exacerbate it. Rushing from A to B can make us feel vital. However, in truth, we end up running on empty and place ourselves at risk of a heart attack or stroke or some other degenerative disease. The energy being outputted isn’t sustainable and tends to be centred on the release of adrenaline and the feeling it creates (running on empty).
To be healthy we need to balance our outer energy with our inner and nourish ourselves with care, appropriate rest and good nutrition and if necessary, therapeutics like adaptogenic herbs and key nutrients to restore a more balanced and harmonized state.
As we require energy to restore homeostasis, the foundation of any healing protocol needs to focus on rebuilding energy and vitality. If we lack energy and vitality, we lack the resources to move us towards a healthier, more balanced state and regain our ability to adapt. We need to nourish, regenerate and tone our nervous system and support our liver, immunity and gut so we can meet every day stressors or long term anxieties with greater balance and emotional resilience.
Nutrition gives us the micronutrients (i.e. B vitamins, vitamin C, magnesium, zinc, iron) to break down the macronutrients (fats, carbohydrates, protein) to convert into energy. B vitamins and magnesium play a vital role in the nourishment of the nervous system and are depleted quickly when stressed. It is so important that we give ourselves the building blocks and nutrition to be able to meet difficult times in our lives with greater resilience and adaptation. Nutrient deficiencies can contribute to fluctuating moods, irritability, poor concentration, fatigue, poor sleep, depression and anxiety.
The use of therapeutics like adaptogenic herbs balance and nourish our systems, helping to heighten the power of resistance to manage stressors. They assist the body in its return to homeostasis or recovery and can provide the support, energy and clarity to be able to focus on longer term goals like addressing nutrient deficiencies and lifestyle whilst feeling symptom relief. They do not mask but nourish and support and are balancing and strengthening.
If you would like to understand how your cortisol and other hormones could be contributing to your symptoms there are several functional medicine tests available looking at salivary or urinary cortisol, DHEA, cortisol to DHEA ratios, or/and sIgA (low levels indicate reaction to long term stressors and loss of immune resilience (increase in allergies and food and environmental sensitivities or over reactive and dysregulated response (autoimmune conditions).
Other tests check for markers like pregnenolone which is the precursor hormone to DHEA and other hormones like progesterone and oestrogen, urine neurotransmitters (fatigue, low mood, anxiety) and hormonal levels and specific nutrient markers.
What next? What can we do to treat HPA Axis Insufficiency?
First it is important to rule out other reasons like thyroid or other underlying health conditions or iron or energy nutrient deficiencies (a standard blood panel is very useful)
Addressing lifestyle and educating on how better to meet psychological, environmental, dietary and physiological stressors whilst balancing the sympathetic response is a necessary part of restoring the HPA axis.
Start to reset the hormones by adopting a sleep hygiene routine and restricting stimulants (sugar, caffeine) and things like late evening blue screen activity
Incorporate nutritional guidance to balance blood sugar and provide minerals and electrolytes to help the body to rebalance it's fluid stores and increase hydration
Provide nutrition and meals which support and nourish the nervous system
Integrate targeted supplementation and adaptogens to balance the HPA axis and decrease sympathetic response
If you are tired but wired, hormonally feel 'all over the place', lack energy but struggle to sleep, are irritable or experiencing feelings of nervousness and agitation, anxious or depressed, fatigued, loss of stamina and/or slow recovery after exercise, low immunity (infections, colds, slow wound healing), craving sugar or salt and stimulants like caffeine, have tension headaches, irregular or painful menstrual cycles or unexplained infertility, heightened allergies or sensitivities, struggling with menopause symptoms, digestion up the wall or just not feeling yourself and would like to know more then get in touch to arrange a free chat.
For further information regarding testing and what markers are used click here.