HPA Axis Dysfunction(Adrenal Fatigue)

Tired for no reason?
Having trouble getting up in the morning?
Need coffee, colas, salty or sweet snacks to keep going?
Feeling run down and stressed?
Cant fall asleep and/or stay asleep?

If you answered "yes" to one or more of these questions, you may be experiencing adrenal fatigue.

The adrenals are walnut-sized glands located on top of each kidney, and are important control centers for many of the body's hormones. The outer layer of the gland, called the adrenal cortex, produces hormones including cortisol, DHEA, estrogen and testosterone. The centers of the glands produce adrenaline, the hormone named after them.

The basic task of your adrenal glands is to rush all your body's resources into "fight or flight" mode by increasing production of adrenaline and other hormones. When healthy, your adrenals can instantly increase your heart rate and blood pressure, release your energy stores for immediate use, slow your digestion and other secondary functions, and sharpen your senses.

Every challenge to the mind and body creates a demand on the adrenal glands.

Unlike our ancestors, we live with constant, low-grade stress. Instead of occasional, acute demands followed by rest, we're constantly over-worked, under-nourished, exposed to environmental toxins and worrying about others - without a regular oasis of calm.

And the list of challenges is endless: lack of sleep, a demanding boss, the threat of losing your job, financial pressures, personality conflicts, yo-yo dieting, relationship turmoil, death or illness of a loved one, skipping meals, reliance on stimulants like caffeine and carbs, digestive problems, over-exercise, illness or infection, unresolved emotional issues from our past or present and more. The result is adrenal glands that are constantly on high alert. When the adrenal glands get to a stage where they unable to regulate cortisol to respond to normal stress of everyday life, it is referred to as HPA-D (hypothalamic-pituitary-adrenal axis dysfunction), more commonly referred to as adrenal fatigue or adrenal exhaustion.

Higher and more prolonged levels of circulating cortisol (like those associated with chronic stress) have been shown to have negative effects, such as:

Impaired cognitive performance
Dampened thyroid function
Blood sugar imbalances, such as hyperglycemia
Decreased bone density
Sleep disruption
Decreased muscle mass
Elevated blood pressure
Lowered immune function
Slow wound healing
Increased abdominal fat

Chronically lower levels of circulating cortisol (as in adrenal fatigue) have been associated with negative effects, such as:

Brain fog, cloudy-headedness and mild depression
Low thyroid function
Blood sugar imbalances, such as hypoglycemia
Fatigue - especially morning and mid-afternoon fatigue
Sleep disruption
Low blood pressure
Lowered immune function
Inflammation

If this sounds like you, one of your main underlying problems may be HPA-D/adrenal fatigue.

What is Cortisol?

In its normal function, cortisol helps us meet stressful challenges by converting proteins into energy, releasing glycogen (sugar) and counteracting inflammation. For a short time, that's okay. But at sustained high levels, cortisol gradually tears your body down. Sustained high cortisol levels destroy healthy muscle and bone, slow down healing and normal cell regeneration, co-opt biochemicals needed to make other vital hormones, impair digestion, metabolism and mental function, interfere with healthy endocrine function; and weaken your immune system.

Ideally, cortisol is elevated in the morning to help you get going, lower but steady throughout the day to sustain energy, then falls in the evening to support restful sleep, this is called the circadian rhythm. And what happens after a constant demand for help? Eventually, the HPA axis can’t keep up with the demand for cortisol, and cortisol levels become dysregulated. You end up with a dysregulated circadian rhythm and a maladaptive stress response. The dysregulation of the HPA axis is what we refer to as “adrenal fatigue syndrome”.

Adrenal fatigue is a likely factor in several medical conditions such as the following:

Fibromyalgia
Hypothyroidism
Chronic fatigue syndrome
Arthritis
Premature menopause

Testing for HPA-D(Adrenal Fatigue)

Until recently we used saliva testing. It allowed for needed multiple tests to get an accurate picture of the circadian rhythm or the bodily level of hormones throughout the entire day. Saliva tested the free hormones, which are the correct reflection of the bioactivity of the hormones available for use to the bodily tissues.

However, newer testing is now available that measures important metabolites that saliva can't. We can get a much more accurate picture of how your body is processing cortisol as well as producing it. This is called DUTCH (Dried Urine Testing Comprehensive Hormones) from Precision Analytics. 5 samples of urine are collected during the day and night. Strips of paper are dipped into the urine, allowed to dry and mailed to the lab. It is an extremely easy, non-invasive and relatively inexpensive test.

Conventional medicine will detect only the extremes of adrenal insufficiency, when damage to the adrenals has already occurred (Cushing's disease and Addison's disease). Yet, within those extremes, you can feel miserable and still be told your cortisol levels are normal. This is known as a "sub-clinical" pattern, where you are not sick enough to require Western treatment, but you feel terrible. This is exactly where a qualified practitioner of Functional Medicine is the best resource to provide help. By responding to early-stage symptoms of HPA dysregulation, we can reverse the developing dysfunction.

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