I’m Permanently Tired – Do I Have HPA Axis Dysfunction?

by Fat Loss, Health, Hormones, Sleep

‘Beep, beep, beep’.

You stick your arm out of the cover and slam down on the snooze button.

“Just 5 more minutes” you say to yourself.

Or you’re on your 4th cup of coffee and it’s only 9 am.

Does this sound familiar?

HPA or Hypothalamic–pituitary–adrenal axis dysfunction is commonly known as adrenal fatigue or adrenal exhaustion. This widespread dysregulation affects a large number of people in the western world every year, although it is not always properly diagnosed or treated. And just to clarify – as the above descriptions are misleading – your adrenals themselves aren’t fatigued in the majority of cases!

Specifically, it refers to the interaction between your hypothalamus, pituitary gland, and adrenal glands. Your hypothalamus and pituitary gland are part of your brain and are located above your brainstem. Your adrenal glands are located on the top of your kidneys.

So your HPA axis is basically your body’s stress management system. Your body’s initial response to stress is mediated by your sympathetic nervous system which can increase your heart rate or cause you to sweat.

The adrenals produce several hormones, such as cortisol and adrenaline that play a key role in our “fight or flight” stress response to threatening situations. As a part of this release of hormones, we become more alert. Sugar is also released into the bloodstream to supply energy to fight or run. Liken it to our ancestors running away from something that could kill them, for instance. For that short period of time, they need all the energy and focus they could get. But the crucial part is, it’s only for a short period of time. 

Not all the time.

Unfortunately, in our modern-day life, stressors are everywhere. Because of chronic stress, the HPA axis is stimulated way too much. Over time, the adrenals can’t keep up with the demand. They are no longer able to make enough cortisol or other key hormones, which can cause them to get “burnt out”.

This can cause other effects too.

A 2009 review published in National Reviews in Endocrinology has linked continuous HPA axis activation to metabolic, cardiovascular, digestive, and immune system problems. You can read more here.

And a 2013 review published in Molecular Psychiatry has found that high cortisol may also result in depression. Read more here.

“So how do I know if my HPA axis is out of whack?” I hear you cry.

The first stage of HPA axis dysfunction is often characterised by an over-secretion of cortisol. As a result, you may notice rapid energy fluctuations throughout the day.  One minute you have too much energy, the next you feel extreme, unrelenting exhaustion. And so begins the vicious cycle: you struggle to fall asleep at night and wake up exhausted in the morning. So you drink coffee to stay alert, only to crash again hours later. Then at night you can’t fall asleep and wake up even more exhausted the next day.

In the second stage, the adrenals start to get burnt out so they don’t produce enough cortisol, and you end up with low levels. The energy fluctuations you get from stage one turn into more extreme exhaustion, followed by symptoms you will instantly notice such as weight gain, ‘brain fog’, hair loss (mainly in women) and low libido in men due to ‘cortisol steal.’ (This is where hormone production is directed toward cortisol and away from sex steroid hormones, such as testosterone).

It’s important to note these symptoms can vary between individuals and you may notice the number of symptoms increases as more body systems are affected.

Eventually, you reach the third stage. This is the one you really don’t want to reach.

The brain continues to tell the adrenal glands to make cortisol, but they cannot produce any. Tests in this phase can show very low cortisol levels or even a ‘flat line’. Symptoms include:

  • Waking up tired, or feeling fatigued throughout the day
  • A weak immune system, getting sick more often
  • Cognitive issues such as “brain fog”
  • Lower tolerance to stress, irritability, short temper
  • Trouble falling asleep
  • Weight gain, especially around the midsection
  • Hair loss in women
  • Low libido in men

So what can cause our HPA Axis to become dysfunctional?

Modern life is often a major source of stress for many people. It also leaves us with less time to engage in activities that naturally balance and reduce stress. Long commute times to work are the norm. We work longer hours generally, including evenings and weekends. As a result, we spend less time with our families and minimize the time we would normally be in nature recharging.

Our ancestors also had stress of course, but never there’s never been as much constant daily stress as we have today, combined with so little family interaction, community support, outdoor activities and most importantly, sunshine. It’s a shame that the majority of people have stepped away from the natural way of life that has been nourishing our minds and bodies for centuries.

Modern life has also led to a new type of eating, which includes “modern” processed or packaged foods, refined carbs and sugary drinks, with many artificial ingredients, toxins and chemicals we have never been exposed to before. It should not come as a surprise that this will affect your health over a period of time, yet it does to many!

Not only can these processed foods damage and stress our body, they often lack the basic nutrients our body needs to heal and restore. This is why it’s important to minimise these foods and use them as a treat or when you really can’t get anything else. 

And no, this doesn’t mean when you get in from work/travelling and can’t be bothered to cook!

Not surprisingly, many studies have shown that people who get less sleep have higher rates of breast cancer, dementia, Alzheimer’s disease and other health conditions. We don’t always pay enough attention to our sleep or consider how lack of it can affect us. Not having adequate sleep significantly impairs how our body functions, including the HPA axis and the adrenals. Sleep is essential in order for the body to detoxify, (forget those well-known juice diets!), heal damaged tissues, regenerate, and restore its reserves.

So make sure you’re getting quality sleep – that means going to bed before 11 and not laying in at the weekend.

Another type of stressor that can cause adrenal dysfunction is actual physical trauma which can be caused by an accident, injury, or surgery. Physical stress can also occur by overtraining or excessive exercise, often seen in athletes or those that are engaged in highly demanding activities such as marathons or ultra marathons. We also mustn’t overlook emotional trauma which can have a profound effect on the health of the HPA axis. This can include the loss of a loved one, a divorce or other stressful events.

If you are concerned that you might have HPA axis dysfunction or you have other health concerns and would like to feel great rather than merely surviving, email me and we can chat.

You start sweating, your heart rate increases, your digestion slows down, and your blood vessels constrict. You may even feel tension or pain. 

You may feel like running away. 

Particularly if you’ve had a letter from the ‘tax man’, or you’ve just had a minor altercation with someone in the car park.

Another way your body may react to stress is by shutting down or freezing. If your body feels real danger or senses that it can’t escape, the parasympathetic nervous system may kick in to create a shutdown. 

You may feel hopeless, numbness, shame, a sense of feeling trapped, disconnected. You may disassociate. You may feel nauseous, experience a decrease in your immune response, sexual desire, and sensation of pain. Your digestive system slows down, and you have difficulty speaking.

These experiences of flight-or-fight or shutdown are supposed to be short events. A healthy nervous system and the vagal nerve are supposed to ‘shake off’ this stress and bounce back to a calm, safe, and connected state. 

However, people who are experiencing poor vagal tone due to childhood abuse, trauma at any age, or other factors, are experiencing this response constantly. When fight-or-flight or shutdown becomes a chronic state, that’s a major problem. It increases the risk of both mental and physical health issues.

So how does good vagal tone affect our bodies?

  • Lowers blood pressure
  • Lowers heart rate
  • Manages stress and anxiety
  • Regulates mood
  • Decreases inflammation or pain
  • Delivers information between the brain and the gut
  • Provides sensory information from the throat, lungs, and heart
  • Regulates swallowing
  • Regulates speech

But – and this is important – Your vagus nerve doesn’t have to be damaged to not function correctly. Symptoms of poor vagal tone even without nerve damage may include:

  • Anxiety and or/depression
  • Poor emotional regulation
  • Lowered attention span
  • High stress
  • Being in ‘flight-or-fight’ mode constantly
  • Increased inflammation 
  • Pain

Chronic stress and poor sleep, childhood trauma, head injuries (even a seemingly minor bump to the head), poor breathing – yes, that’s a thing – chronic infections and high toxic load such as polluted air, tap water, and processed foods, are just a few of the things that can affect your vagal tone.

So now you’re thinking, a few of those things apply to me, what can I do to ‘test’ whether I do have poor vagal tone?

  1. Test your pupils – get someone to shine a light on your eye. The pupil needs to constrict for at least 10 seconds then dilate. If it takes less than 10 seconds to do this or doesn’t constrict at all, you probably have poor vagal tone.
  2. Heart rate variability – some smart watches measure this stat and it’s a good indicator of how much stress you are under. There should be a high variance on a regular basis (say around/over 60).
  3. Blood Pressure – your systolic pressure (the one on top) should be between 100-140 and your diastolic should be 70-90. If these measurements are repeatedly lower or higher than these ranges, this is an indication you have poor vagal tone.
  4. Going dizzy when moving quickly from a sitting/laying position to standing (also known as orthostatic hypertension), resulting in dizziness or lack of balance.

Your vagus nerve is one of the most important nerves in the body and is responsible for many important functions, including regulating your heart rate, blood pressure, digestion, breathing, and emotional state. If you experience some of the symptoms noted above, it may mean that you have a poor vagal tone, and your vagus nerve needs some attention. 

Your health can really be improved just by training this one thing, so no excuses!

Email me to discuss how we can improve your health and get you feeling great.