Skip to content
Call: 303-993-7910400 S. McCaslin Blvd, Suite 210, Louisville, Colorado 80027 | Get DirectionsFor Practitioners
Facebook page opens in new windowTwitter page opens in new windowPinterest page opens in new windowInstagram page opens in new windowYouTube page opens in new windowLinkedin page opens in new windowRss page opens in new window
Dr. Jill Carnahan, MD
Your Functional Medicine Expert!
Dr. Jill Carnahan, MDDr. Jill Carnahan, MD

Flatiron Functional Medicine Newsletter

Join Dr. Jills' health community today and receive health tips, recipes and recommended products for a healthier you!
Join today and get Dr. Jill's Paleo-licious Snack Ideas for free! We promise never to share your email with anyone.
  • HOME
  • MY STORY
  • ABOUT
    • About Us
    • What is Functional Medicine?
    • Mission Statement
    • Meet Dr. Jill C. Carnahan, MD, ABIHM, IFMCP
    • Meet The Team
    • Location
    • Fees
    • FAQs
    • Forms
    • Testimonials
    • For Practitioners
  • SERVICES
    • Services
    • Functional Medicine Consulting with Dr. Jill
    • Naturopathic Consulting with Dr. Nicole
    • Massage Therapy with Rene
    • Nutritional Consulting with Judy
    • Nutritional Consulting with Megan
    • Chiropractic Care with Dr. JoEllen
    • Nutrition therapy and Private Yoga with Haley
    • Infrared Sauna Detox Therapy
    • IV Infusion Therapy
  • PRESS KIT
    • Press Kit
    • In the Media
  • EVENTS
  • PODCAST
  • DR. JILL’s BOOK
  • BLOG
    • Dr. Jill’s Blog
    • Dr. Jill’s Podcasts
    • Dr. Jill’s Recipes
    • Dr. Jill on Facebook
    • Dr. Jill’s Instagram
    • Dr. Jill on LinkedIn
    • Flatiron Functional Medicine on LinkedIn
  • ONLINE STORE
    • Online Store
    • Products We Love
    • Dr. Jill’s Book
  • CONTACT
  • HOME
  • MY STORY
  • ABOUT
    • About Us
    • What is Functional Medicine?
    • Mission Statement
    • Meet Dr. Jill C. Carnahan, MD, ABIHM, IFMCP
    • Meet The Team
    • Location
    • Fees
    • FAQs
    • Forms
    • Testimonials
    • For Practitioners
  • SERVICES
    • Services
    • Functional Medicine Consulting with Dr. Jill
    • Naturopathic Consulting with Dr. Nicole
    • Massage Therapy with Rene
    • Nutritional Consulting with Judy
    • Nutritional Consulting with Megan
    • Chiropractic Care with Dr. JoEllen
    • Nutrition therapy and Private Yoga with Haley
    • Infrared Sauna Detox Therapy
    • IV Infusion Therapy
  • PRESS KIT
    • Press Kit
    • In the Media
  • EVENTS
  • PODCAST
  • DR. JILL’s BOOK
  • BLOG
    • Dr. Jill’s Blog
    • Dr. Jill’s Podcasts
    • Dr. Jill’s Recipes
    • Dr. Jill on Facebook
    • Dr. Jill’s Instagram
    • Dr. Jill on LinkedIn
    • Flatiron Functional Medicine on LinkedIn
  • ONLINE STORE
    • Online Store
    • Products We Love
    • Dr. Jill’s Book
  • CONTACT

Understanding HPA Axis Dysfunction (Hint: It’s Not Adrenal Fatigue)

You are here:
  1. Home
  2. Adrenal Health
  3. Understanding HPA Axis Dysfunction (Hint:…
HPA Axis

“Adrenal fatigue” is a term that’s been popularized by the health and wellness media – hey, even I’ve used it years ago. But I think it’s time to set the record straight and really dig into what’s going on.

Because the term adrenal fatigue has been used to describe HPA axis dysfunction so often, I don’t want to completely discredit it. There are still good resources out there using the incorrect term – and in some cases these aren’t quite hitting the nail on the head. So, I’d like to draw your attention to the fact that it’s being used incorrectly.

In addition to adrenal fatigue, adrenal exhaustion is another phrase that’s commonly thrown around. Both phrases are used to describe extreme fatigue usually brought on by regular stress and supposed reduced cortisol levels.

It turns out, science doesn’t support the process of adrenal fatigue as its most often explained – that stress causes low cortisol, which causes fatigue and other symptoms. Instead, that’s a slightly more complicated process worth taking the time to understand. Especially since it seems to affect so many.

 

What is HPA Axis Dysfunction?

First of all HPA stands for hypothalamic-pituitary-adrenal axis, and includes:

  • Hypothalamus – This is a region of your forebrain that connects the autonomic nervous system and the endocrine system with the pituitary gland. Your hypothalamus is important in maintaining bodily homeostasis – through regulating sleep, emotions, body temperature, hunger, thirst, and more.
  • Pituitary gland – This pea-sized gland is found at the base of the brain. The pituitary gland is considered the master gland because it regulates other endocrine glands.
  • Adrenal glands – Your adrenal glands sit on the top of your kidneys and produce important hormones such as adrenaline and cortisol.

Together these three parts work to regulate your stress response, mood, motivation, metabolism, energy levels, and immune system.

The various parts of the HPA axis work together in an interwoven series of webs. It’s much like your endocrine system which is often compared to an orchestra –  everything must work together to stay in tune. When any one point in the HPA axis isn’t running smoothly, it can affect the next series of reactions, which can affect the following, and on and on. In the case of HPA axis dysfunction, it’s like a domino effect that takes off after the body becomes desensitized to stress hormones.

Another way to think about HPA axis dysregulation is to compare it to insulin resistance, which can eventually results in diabetes. Similarly, when the body continuously produces stress hormones it eventually becomes less sensitive and the system can’t rebalance the body and restore homeostasis like it once could.

Let’s take a closer look at these hormones to get a better understanding of what I’m talking about.

 

The 4 HPA Axis Hormones

There are four important hormones when it comes to the hypothalamic-pituitary-adrenal axis:

  • Cortisol – Cortisol is the steroid hormone in the HPA axis that gets most of the attention but it’s actually only part of the problem. Cortisol sounds the alarm in times of stress, preparing the body for a physical response. Cortisol can be triggered by external and internal factors, meaning it can be kicked on by a fear-inducing boss as well as an unhealthy diet.
  • Corticotropin-Releasing Hormone (CRH) – Also called corticotropin-releasing factor (CRF). This is the stress hormone released by your hypothalamus that stimulates the pituitary gland causing it to release adrenocorticotropic hormone. This too can be caused by external or internal factors.
  • Adrenocorticotropic Hormone (ACTH) – As mentioned above, this hormone is released by your pituitary gland where it then causes the production of glucocorticoids in the adrenals.
  • Glucocorticoids – Cortisol is a glucocorticoid, but there are others within this family produced by the adrenal glands. Glucocorticoids are steroids, which help regulate immune system response primarily through reducing inflammation.

You probably noticed this has a cascading effect. CRH in the hypothalamus triggers the ACTH in the pituitary gland, which then triggers glucocorticoids in the adrenal gland. And on and on.

 

When Stress Gets Stuck Switched On

The concept of adrenal fatigue is that cortisol gets stuck switched on, which eventually wears out the adrenals. But the problem with this is that many people who believe they have adrenal fatigue often don’t have dysfunctional cortisol levels. Scientific literature backs this up. In fact,  in 2016 there was a systematic review published called, Adrenal Fatigue Does Not Exist, which summed up the loose and often poor description of adrenal fatigue along with proof that cortisol burnout is not in a thing.

However, HPA axis dysfunction, which is an alteration in stress response over time (after exposure to chronic stress) has been verified and associated with numerous diseases. In summary, HPA axis dysfunction it’s something we could work to understand a little better but in the meantime the existence of the HPA axis dysfunction suggests that we need to take reducing stress very seriously.

With that in mind, here 7 ways to reduce your stress levels.

 

5 Ways to Reduce Your Stress Levels

  1. Add meditation to your daily practice – Research shows that even 7 minutes a day can be beneficial.
  2. Take sleep seriously – This isn’t just about getting 7 to 8 hours every night, it’s about having good quality sleep as well. Make your bedroom a sleep sanctuary by kicking out family pets, using blackout curtains, eliminating sources of EMF, and of course, make sure you don’t have any undiagnosed sleep-disordered breathing conditions.
  3. Exercise, but not too much – In my patients with HPA axis dysfunction, I often see high-achieving people who over exercise. While exercise is great, too much can send stress hormones and inflammatory processes into overdrive.
  4. Stick to a schedule – Your body runs on multiple circadian rhythms and this includes your hormones. When you stick to a schedule, you make it easier for everything to run smoothly.   I am strict about getting to bed by 9:30pm in order to get a full 8 hours of sleep and function optimally.
  5. Work on being present – It’s easy to get wrapped up in our thoughts, worries about the future and obsessing over the past can take control. When we imagine stressful situations, we cause biochemical reactions in our bodies and this can turn on our stress response.

If you’re wondering whether or not you have HPA axis dysfunction you can take my Quiz: Could you have Adrenal Fatigue? Here you’ll find 15 common symptoms that could indicate you might want to see a doctor who is experienced in this condition.

 

Resources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860380/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181830/

https://www.ncbi.nlm.nih.gov/pubmed/27557747

* These statements have not been evaluated by the Food and Drug Administration. The product mentioned in this article are not intended to diagnose, treat, cure, or prevent any disease.   The information in this article is not intended to replace any recommendations or relationship with your physician.  Please review references sited at end of article for scientific support of any claims made.

Categories: Adrenal Health, HormonesBy Dr. Jill C. Carnahan, MD, ABIHM, IFMCPJuly 26, 201814 Comments
Tags: adrenal fatiguefatigueFunctional MedicineHPA Axis Dysfunctionmeditationstress
Share this post
Share on FacebookShare on Facebook TweetShare on Twitter Pin itShare on Pinterest Share on WhatsAppShare on WhatsApp Share on LinkedInShare on LinkedIn

Author: Dr. Jill C. Carnahan, MD, ABIHM, IFMCP

https://www.jillcarnahan.com/

Dr. Jill is Your Functional Medicine Expert! She uses functional medicine to help you find answers to the cause of your illness and addresses the biochemical imbalances that may be making you feel ill. She'll help you search for underlying triggers contributing to your illness through cutting edge lab testing and tailor the intervention to your specific needs as an individual. She may use diet, supplements, lifestyle changes or medication to treat your illness but will seek the most gentle way to help your body restore balance along with the least invasive treatment possible. Dr. Jill is a functional medicine expert consultant and treats environmental and mold-related illness as well

Post navigation

PreviousPrevious post:Indian Shrimp CurryNextNext post:On Suicide – Why We Feel Alone in a Connected World

Related posts

emfs
EMFs and Children: What Kind of Impact Are EMFs Really Having on Our Kids?
August 15, 2022
Functional Medicine vs Integrative Medicine
Functional Medicine vs Integrative Medicine: A Deep Dive Into Which Is Better
September 1, 2021
eating-plastic-microplastics
Are You Eating Plastic? How Microplastics Might be Hiding Out on Your Dinner Plate
June 30, 2021
lead poisoning from water
Lead Toxicity: A Look at Why Lead Is so Hazardous to Your Health
June 2, 2021
bpa toxicity
The Truth About BPA and How to Avoid This Toxic Health Hazard
May 25, 2021
Aluminum in Everyday Products – Is It Really Safe?
May 17, 2021

14 Comments

  1. Addie says:
    August 9, 2018 at 7:22 am

    Dr. Carnahan,
    Do you ever precept new graduate NP’s? If not, do you know of any functional practitioner’s that do by chance? Thank you!

    Reply
  2. ann greenberger says:
    August 9, 2018 at 10:08 am

    Interesting
    Thank you for writing this. A saliva test showed myncortisol.levels were not good and I was treated with small dose of cortef. How does one treat HPA axis dysfunction?

    Reply
  3. Jason says:
    August 9, 2018 at 2:55 pm

    The one thing I will concur with, is that AF is a misleading simplified term, but I will also note that studies are not the be all end all of what reality is by any stretch of the imagination, too many are not worth the paper written on, too many variables, corruption, poorly designed etc etc and on and on, and the “Adrenal fatigue does not exist: a systematic review” study is just another prime example, it almost looks like something from Quackwatch, terrible.

    Reply
  4. Jane T. says:
    August 9, 2018 at 7:51 pm

    What labs are needed to test for HPA dysfunction?

    Reply
    • Jill Carnahan, MD says:
      August 10, 2018 at 11:25 am

      Hi Jane, I recommend either serum labs or Dutch hormone testing

      Reply
      • Dorothy Baker says:
        January 22, 2019 at 2:28 pm

        Can you please tell us the names of the tests for this condition? Is it related to thyroid disorders? Many of us have been looking for an explanation for why we tolerate thyroid hormone meds inconsistently. I feel so much better when able to take thyroid meds (compounded porcine extract), but after taking the lowest dose available for awhile, I start to feel unable to function when I take it & have to stop. This makes it very hard to live any kind of normal life. Any wisdom on why this happens & what to do abt it would be a godsend for many people. thank you.

        Reply
        • Jill Carnahan, MD says:
          January 26, 2019 at 3:57 pm

          I use 4 point adrenal cortisol testing with other hormones – DHEA, estradiol, estriol, estrone, testosterone, and metabolites

          Reply
  5. Gudrun M. Welder says:
    March 12, 2019 at 8:44 pm

    Whether you want to call it “HPA axis dysfunction” , “adrenal fatigue”, “cortisol imbalance” or “the effects of chronic stress” it’s all the same thing and I don’t think making a point about your term being better than other terms is really relevant in the end. We all know that chronic stress is harmful. I am not interested in who is using the most trendy terminology. Lets all try to keep our focus on how to be healthy not who has the newest name for a condition. Thank you for also including the solutions on how to help the condition.

    Reply
  6. Calum Gore says:
    May 15, 2019 at 1:34 am

    Very nice article, explaining the misconceptions about adrenal fatigue or adrenal exhaustion. HPA Axis is certainly something we should concentrate on in more scientific studies for people with chronic fatigue syndrome. However, from this article I also think in point 3 that you point out not to exercise to much. I’m sure this is not to over excite the HPA axis and cause panic attacks, which is exactly what I see to as well as CFS and problems I cannot thoroughly understand in the HPA axis. A really well done article, especially for an audience of all kinds.

    Reply
  7. tiffany grigorian says:
    June 10, 2019 at 5:27 am

    I’m 24 years old with major adrenal fatigue in the last stages. I literally feel apathetic. I have no energy this is all from chronic stress. I can’t even sleep haven’t slept for weeks no one is recognizing this. I’ve been to so many drs with the result telling me I’m fine. I’m so sick and fatigued I can barley function anymore please help

    Reply
  8. Savannah Bleue says:
    October 31, 2019 at 1:04 pm

    Thank you for this helpful article. I would like to point how however that the claim that low cortisol is not linked to HPA axis dsyregulation / dysfunction / adrenal fatigue is false. I’ve read through many case studies and here’s what I found

    1. Many case studies claiming that low cortisol levels are not associated with HPA axis dysfunction excluded participants with any neurological or mood disorders, such as depression. Depression is a symptom of more advantaged stages of HPA axis dysfunction, and low cortisol levels are not seen until more advanced stages either so basically this portion of the population have been excluded from many studies

    2. There are case studies that have examined HPA axis dysfunction as it relates to the more advanced stages, and categorized patients into different levels of “burnout”. Low cortisol levels were found to not be associated with burnout as a whole, but was seen in those with severe burnout.

    I dug deep into this topic because I personally had advanced HPA-Axis dysfunction and became frustrated with mainstream articles claiming that low cortisol wasn’t seen with HPA-D. I had 4 point cortisol tests that showed very low morning cortisol, and essentially a crash by noon, where it dipped to the levels it should be when you’re going to sleep. The levels remained low for the remainder of the day.

    Reply
  9. Kristin R says:
    January 8, 2020 at 5:07 pm

    Do you know of anyone who specializes in treating adrenal fatigue, HPA axis dysfunction, etc. My cortisol levels are crazy and DHEA-S is in 500’s and I’m a 27 year old female…. not many doctors in my area that help with this. Thanks!

    Reply
    • Jill Carnahan, MD says:
      January 10, 2020 at 8:03 pm

      https://www.jillcarnahan.com/2018/01/16/how-to-choose-a-good-integrative-and-functional-medicine-doctor/

      Reply
  10. Alex says:
    January 18, 2020 at 1:15 pm

    THANK YOU so much for writing this. Really well explained

    Reply

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Recipe Rating




Post comment

Search
Dr. Jill
Dr. Jill will help you search for underlying triggers contributing to your illness through cutting edge lab testing and tailor the intervention to your specific needs as an individual.
  • Address:
    400 S. McCaslin Blvd, Suite 210, Louisville, Colorado 80027
  • Get Directions
  • Phone:
    (303) 993-7910
  • Fax:
    (303) 993-4674
  • Specialty
    Functional Medicine Expert Trained in Family Medicine Board Certified Trained in Integrative Holistic Medicine

Find us on:

Facebook page opens in new windowTwitter page opens in new windowYouTube page opens in new windowRss page opens in new windowLinkedin page opens in new windowPinterest page opens in new windowInstagram page opens in new window
Testimonials

I certainly understand how Dr. Jill got so popular! Love watching her very interesting videos on the site and have signed up for the newsletter. She exudes such an air of competence, authenticity, intelligence and humility!

Karin
Karin

Good day Jill, you Motivated me very much. In the Last years, I prepared to become a registered German Naturopath (Heilpraktiker). The webinars of Functional Medicine Practitioners I attended as often as I could. Best wishes from Europe.

Norbert
Norbert

In my many years and many experiences with doctors… you guys have them beat, hands down. You guys are great.

Jessica Hull
Jessica Hull

I just wanted to thank Dr. Carnahan and all the staff for a wonderful visit. What a great experience from start to finish. Of course, Dr. Carnahan is the icing on the cake! (Hmmm …need a healthier analogy) Anyway, I’m feeling excited optimistic, and hopeful after all these years of being sick. Again my thanks and blessings to you all. Warmly, Roberta

Roberta
Roberta

I just wanted to send a quick thank you for your time and advice today. I am so appreciative and I feel hopeful that the plan we have can really help me. I’ve been sick for a long time and recently I’ve been rather discouraged with where I’m at with my health. I believe that God has allowed our paths to cross and that He is going to use you help restore my body to health. Thank you for giving me hope. Blessings, Kara

Kara
Kara

I wanted to let you know you did an outstanding job at this past weekend at the IFM {Reversing Cognitive Decline} conference. I appreciate you sharing your personal health journey. You are a true inspiration!

Ronald Grisanti
Dr. Ronald GrisantiBoard Certified Chiropractic Orthopedist
Facebook
Jill Carnahan, MD
Functional Medicine Newsletter
Join Dr. Jills' health community today and receive health tips, recipes and recommended products for a healthier you!
Join today and get Dr. Jill's Paleo-licious Snack Ideas for free! We promise never to share your email with anyone.
Dr. Jill
Dr. Jill will help you search for underlying triggers contributing to your illness through cutting edge lab testing and tailor the intervention to your specific needs as an individual.
  • Address:
    400 S. McCaslin Blvd, Suite 210, Louisville, Colorado 80027
  • Phone:
    (303) 993-7910
  • Fax:
    (303) 993-4674

Find us on:

Facebook page opens in new windowTwitter page opens in new windowYouTube page opens in new windowRss page opens in new windowLinkedin page opens in new windowPinterest page opens in new windowInstagram page opens in new windowSoundCloud page opens in new window
Latest Podcasts
  • 131: Dr. Jill interviews Dr. Shelese Pratt on Gut Health with a Microbiome Deep Dive
    131: Dr. Jill interviews Dr. Shelese Pratt on Gut Health with a Microbiome Deep Dive
    December 1, 2022
  • Shaina Cahill
    130: Dr. Jill interviews Shaina Cahill, PhD on Fecal Microbiota Transplant
    November 28, 2022
  • #129: Dr. Jill interviews author Steven Kotler on Using Peak Performance & Flow States
    129: Dr. Jill interviews author Steven Kotler on Using Peak Performance & Flow States
    November 24, 2022
  • #128: Dr. Jill interviews Dr. Terry Wahls on Recovery from Multiple Sclerosis & Wahl’s Protocol
    128: Dr. Jill interviews Dr. Terry Wahls on Recovery from Multiple Sclerosis & Wahl’s Protocol
    November 19, 2022
Facebook
Jill Carnahan, MD
Dr. Jill Carnahan, MD

© 2023 Jill Carnahan. All Rights Reserved | Site by Yakadanda  | FAQS | Disclaimer | Financial Policy | Privacy Policy | Terms and Conditions

| Dr. Jill works as a functional medicine consultant in conjunction with your current health care team and is not considered a replacement for your primary care physician. She requires all new patients to have a primary care physician to cover emergencies and routine care and screening.

Go to Top
Flatiron Functional Medicine Newsletter
Thanks for Joining Me in the Microbiome Summit. Get Your Free Download Here
Join new and get your free copy of Paleolicious Snack Ideas. We promise never to share your email with anyone.
Flatiron Functional Medicine Newsletter
Join Dr. Jills' health community today and get SEVEN FREE health downloads
Join today and get Dr. Jill's Paleo-licious Snack Ideas for free! We promise never to share your email with anyone.
Functional Medicine Newsletter
Join Dr. Jills' health community today and receive health tips, recipes and recommended products for a healthier you!
Join today and get Dr. Jill's Paleo-licious Snack Ideas for free! We promise never to share your email with anyone.
Flatiron Functional Medicine Newsletter
Join Dr. Jills' health community today and receive health tips, recipes and recommended products for a healthier you!
Join today and get Dr. Jill's Paleo-licious Snack Ideas for free! We promise never to share your email with anyone.
Flatiron Functional Medicine Holiday Giveaway
Enter now to win your free Berkey Water Filtration Sysyem (my personal favorite).
We promise never to share your email with anyone.
RESOLVE YOUR MOLD EXPOSURE SYMPTOMS
Dr. Jill's long-awaited Miracle Mold Detox Box is finally here. This handcrafted and researched bundle includes all of the crucial pieces you need to release and flush out toxins in 30 days.
SHOP NOW