HPA axis dysfunction is a term you may have heard in Functional Medicine circles. It refers to how chronic stress breaks down the very system in the body needed for a healthy stress response.  

Stress is a big topic. We live in a stressful world. You don’t have to look further than the daily news or around your community to see that many are stressed, overwhelmed and dealing with a lot. 

Being in the middle of a pandemic unlike the world has seen before, stress levels are at an all-time high. I talk with patients each day who are experiencing anxiety, worry and stress in a deeply personal, yet collective way.  

As a Functional Medicine doctor I see first-hand how stress affects my patients’ health. Stress can be a trigger for an autoimmune disease or flare, stress can make it hard to bring blood sugar down with diabetes, stress triggers migraines, and the list goes on.

However, it isn’t always the obvious sources of stress that contribute to disease. Stress often hides in the body in the form of toxins. 

In this article, you will learn: 

  • What is the HPA axis? 
  • What is HPA axis dysfunction and what causes it?
  • How this relates to toxins 
  • The symptoms of HPA axis dysfunction 
  • Functional Medicine treatment of HPA axis dysfunction (Hint: look for the root cause) 
  • 6 ways to support your HPA axis 

What Is The HPA Axis? 

HPA axis stands for hypothalamic-pituitary-adrenal axis, which is a signaling pathway between your brain and adrenal glands. The job of the hypothalamus to maintain homeostasis and keep the body’s sleep, thirst, temperature and other systems in a steady state.

The hypothalamus interprets signals from the body and tells the pituitary signal of the release of hormones throughout the body.  


When the hypothalamus interprets stress, the pituitary signals the adrenal glands to release stress hormones. The adrenals are the small glands that sit above the kidneys that release the stress hormone cortisol and adrenaline in a “fight or flight” response

“Fight or flight” also refers to a stressed state or when the sympathetic nervous system is dominant. A classic example of this is when you come upon a predator in the woods. A tiger is chasing you, so you need these stress hormones to help you flee or fight in the moment.  

When the system is working well, elevated cortisol signals the hypothalamus and pituitary in the brain to reduce sending the signals to the adrenal.

When you’ve made it to safety from the tiger, the stress system shuts off and you return to a more relaxed, or parasympathetic, state.  

What Causes HPA Axis Dysfunction 

The HPA axis works best for those brief, acute stresses such as the tiger chasing you, or the modern equivalent. The axis fires up, you benefit from the extra energy the hormones provide, and then you return to baseline.

However, acute stress isn’t the type of stress most of us face these days. Chronic stress causing almost constant firing of the HPA axis is what leads to HPA axis dysfunction.  

You may have heard of the term adrenal fatiguewhich was used for quite some time in natural medicine to refer to the case where the adrenals burned out from producing too much cortisol.

HPA axis dysfunction is the more accurate term that refers to a problem anywhere along the axis that causes hormone imbalances and symptoms. In actuality, your body doesn’t ever “burn” out or run out of hormones. It’s much more complex than that. 

Think about it this way: if the system is constantly pumping out cortisol, even when the threats to safety are minor, the system gets desensitized to the stress signals. The result is a stress response that isn’t functioning properly. 

For anyone interested in insulin resistance and the path to diabetes, it’s quite similar.

Just as insulin resistance has a timeline where it progressively develops, so does “adrenal fatigue,” or HPA axis dysfunction. 

Where with insulin resistance your cells begin to be less sensitive to insulin and sugar builds up in the blood instead of getting into the cells effectively, with HPA axis dysfunction, your cells become less able to manage stress hormones constructively and efficiently. 

Stress is serious businessIt is clear that chronic stress is a risk factor for accelerating aging and chronic disease, makes it harder to lose weight, weakens the immune system and affects quality of life.  


Be resilient be immune online program

The Toxin Connection  

The typical sources of stress that we think of include trauma, financial stress, work stress and relationship issues. I’ve had patients say “I’m retired and in a good marriage. I don’t have any stress.”

But when we dig deeper, we uncover many other things that may be impacting their HPA axis.  

There can certainly be physical sources of stress that include not drinking enough water, eating a poor quality dietlack of sleep, and worry about the future. 

The current pandemic continues to be a source of stress for most people that I talk to, with all of the uncertainty about the future and fear around the illness or losing loved ones. I want to remind you that what you are feeling is normal 

In addition to all of these common stressors, there can also be environmentally-induced sources of stress. I’m talking about toxins.

The Environmental Protection Agency has over 85,000 chemicals in its inventory that’s over 85,000 man-made toxins in the environment. Humans today are exposed to more toxins than ever before, simply by eating, drinking, breathing and living in our modern environment.  

In my practice, toxins in the body are often the hidden, silent root cause to symptoms and disease.  

Here are some toxins that might be stressing your body out: 

You get the picture. Toxins create a burden in the body that can affect the function of every system and signaling pathway.

Toxins affect DNA expression, nutrient status and how we feel.

If the hypothalamus is always interpreting stress from the toxins in the body, eventually the HPA axis will stop working properly and efficiently. This can lead to a whole host of issues.  

What Are The Symptoms Of HPA Axis Dysfunction? 

The symptoms of HPA axis dysfunction are going to look different for each person. However, there are some common symptoms that I see frequently and these include:  

  • Hard to get out of bed in the morning, even after a full night’s sleep 
  • Need coffee and caffeine to “get going” and stay going throughout the day 
  • Fatigue – especially in the afternoon or all day long 
  • Decreased resiliency to stress 
  • Frequent colds, low immunity 
  • Increased inflammation in the body 
  • Brain fog, changes in memory or cognition 
  • Feeling “wired and tired” at night 
  • Insomnia 
  • Frequent urination at night 
  • Dizziness with standing and low blood pressure 
  • Low blood sugar, intense hunger 
  • Salt cravings 
  • Imbalances in thyroid hormones 
  • PMS symptoms and estrogen dominance  

How Do You Treat HPA Axis Dysfunction?  

As a Functional Medicine doctor, I can’t emphasize enough the importance of testing.

Since HPA axis dysfunction can occur at any point along the chain and present in different ways, it is important to understand each individuals unique imbalance in order to support it correctly.  

One test that I frequently use is a 4-point cortisol test. This is either a saliva or urine sample that is collected throughout the day to see your unique cortisol rhythm and how it compares to the ideal pattern.

Cortisol is supposed to be high in the morning and fall throughout the day. But some patients will be flat lined for the whole day or have a reversed curve where they spike in the evening. Other patients will have elevated cortisol all the time.

The information gathered from testing allows us to target specific herbs, nutrients, nutrition strategies, and lifestyle tools intentionally for when they will be most effective.

If you are interested in testing your hormones, – consider the Every Life Well™ DUTCH Panel – which gives you an inside look at the core hormonal markers affecting your body.

I also provide testing to patients for a variety of toxin exposures based on the full intake that we complete during a first visit.

It’s not enough to simply treat the HPA axis dysfunction; I’m always looking to treat the root cause. Unfortunately, often toxins play a role. 

If you are interested in testing for toxins, consider doing The GPL-Tox Non-Metal Chemical Profile.

6 Ways To Support Your HPA Axis 

Although my preference is to help each patient put together a personalized protocol for their personal situation and health goals, there are some common things that I consistently recommend for HPA axis dysfunction and symptoms 

  1. Find your daily rhythm. The HPA axis likes routine. This can look like eating meals at regular times each day and going to bed at the same time each night. Setting yourself up with a consistent schedule alleviates stress on the body and helps your HPA-axis reset
  2. Eat breakfast. Eat breakfast around the same time each day, ideally within the first hour of waking up. Choose a Paleo breakfast that centers on protein. This early, protein-rich breakfast helps to set your cortisol curve for the day and keep blood sugar balanced.
  3. Exercise, but not too much. For those with HPA axis dysfunction, exercise can be challenging because of fatigue, so I recommend starting with gentle exercise such as walking or light yoga. Too much cardio, for example, can add more stress to a stressed system. This is a time to use movement to restore, not to push new physical limits.
  4. Reduce stress. The first step is to identify sources of stress, both the obvious and hidden sources, and work on letting go of what you can. This also means consistently practicing tools to reduce stress such as meditation, mindset shifts and relaxation techniques. Building self-care habits into the daily routine is very important. For some patients, I even recommend limbic retraining techniques. Learn more about the limbic loop. Read about The Relationship Between Stress, Anxiety, Estrogen and Fear – How to Reduce It.
    how fear and stress
  5. Reduce exposure to toxins. Toxins are often hidden root causes, and since we can’t eliminate all exposures, it helps to reduce what we can control. This means choosing organic food, filtering water and indoor air, cleaning up mold damage (link to mold article) and choosing safe personal care, cleaning and home products. 
  6. Support the adrenals with supplements. Adrenal support can be used to correct an HPA axis imbalance or as added support during stressful times. Supplements that I often recommend include: 

In my practice, I talk about stress with my patients more often than not. Stress affects us all on a daily basis and more so during certain periods of life.

When we take a wider view of stress and look at all of the sources of stress including emotional stress, lifestyle stress and stress from our environment, it is clear that those of us alive on earth today have more stress than any group of humans before us.

I truly believe that knowledge is power, and when you know what stress you face and how it impacts your body, you can take realistic action to support your body. I’m here to guide you!