HPA Axis Dysfunction

In the intricate web of our body’s hormonal system lies a crucial regulator known as the HPA (Hypothalamic-Pituitary-Adrenal) axis. This axis plays a pivotal role in how we respond to stress, regulate mood, and maintain overall health. However, when the HPA axis becomes dysregulated, it can lead to a cascade of symptoms and health issues. Let’s delve into what HPA axis dysfunction entails, its causes, symptoms, and how it can be managed effectively.

So what is the HPA axis? The HPA axis is a complex interplay between three major glands, the hypothalamus, pituitary gland, and adrenal glands. The hypothalamus is located in the brain, it releases corticotropin-releasing hormone (CRH) in response to stress. The pituitary gland, also in the brain, secretes adrenocorticotropic hormone (ACTH) in response to CRH. The adrenal glands situated atop the kidneys, produce cortisol and other hormones in response to ACTH.

When everything is running smoothly, a person experiences a stressful situation which triggers the HPA axis, with an end result of cortisol secretion. That, in turn, releases glucose into the bloodstream for quick energy.

Problems arise when we start to live out of balance. If we start spiking the stress response without enough recovery, or we just have chronic stress, HPA dysfun.ction sets in. In a sense, we become cortisol resistant. Do you have difficulty falling asleep? Cortisol is the hormone that starts off our day and should decline at night (opposite of melatonin). If you have difficulty falling asleep, this may be a sign of HPA dysfunction. See below:

And the corresponding podcast:

When we say stress, we don’t just mean perceived stress, although that plays a crucial role. There are many forms of stress, and it can be helpful to categorize it into two categories; eustress and distress. Eustress is the ‘good’ stress. It’s the right amount of stress that we can recover from and come back stronger. Exercise is a form of eustress. The right amount of sun exposure is a form of eustress. Distress is a level of stress that we don’t respond well to; it’s too much. Something bad happens before we recover. A muscle tears, you get sick, or in the example of sun exposure, you get a bad sunburn. This is important to keep in mind because many of us try to mitigate stress with more stress, when sometimes we need the opposite. 

Some stressors that you may not consider, but certainly are, stressors:

• Blood sugar dysregulation

• Autoimmune disease

• Chronic inflammation

• Dehydration 

• Nutrient deficiency

• Poor sleep (this is a big one)

• Environmental exposures such as mold and endocrine-disrupting chemicals such as plastics

• Dental amalgams 

The body can only take so much stress, and when that overflows, symptoms develop. Then there tends to be a bit of a downward spiral. For example, chronic inflammation can trigger HPA axis dysfunction, and vice versa. So it becomes compounding. 

Managing HPA axis dysfunction can be tricky. It’s all about eliminating the stressors you have control over, and mitigating the ones you don’t. This is a challenging process, but the good news is that you don’t have to do it alone. Schedule a free call with us and we can help you sort this out.

Why Pain is Worse at Night and What You Can do about it

Most ailments get worse at night, whether you are sick, or you are dealing with pain. There’s a simple reason for it; well two. It’s from the lack of two things: cortisol and movement. 

Cortisol has a bad reputation as it’s known as the stress hormone. What that really means is that it’s the primary driver when your sympathetic nervous system is activated. This is the fight or flight response. I think of it as “on mode”. Cortisol liberates glucose from the muscle and liver into the bloodstream as a quick fuel source (as opposed to fats). When you are “on”, the body upregulates some systems of the body and downregulates others. This is a good thing as it prioritizes survival. 

The sympathetic nervous system suppresses systems that aren’t vital when there is an emergency. For example, the digestive system (which is why you shouldn’t watch the news when you eat), and the reproductive system are suppressed. The immune system, which is responsible for the inflammatory response, is suppressed. So cortisol is an extremely potent anti-inflammatory. In fact, cortisone and steroids like prednisone are synthetic cortisol. 

Remember that inflammation is the first step of the healing process and some powerful things happen during sleep to help you repair. So the combination of inflammation and repair at night is a good thing. Herein lies the problem. The body doesn’t have any vacant space so even a few cc’s of extra pressure hurts. We don’t want to suppress the immune system too much because we want healing to occur, however at a certain point, it becomes difficult to sleep which will impair healing. 

Below is an example of what the daily pattern of cortisol looks like:

As soon as light hits your eyes, the sympathetic nervous system is triggered and you get a spike to start your day. Many of my patients tell me that their pain is bad in the morning, but once they get moving, it starts to go away. In part, this is due to the anti-inflammatory effect of cortisol.

By the way, melatonin has basically the opposite effect:

I think of melatonin as the “off mode”. 

So you see that cortisol is lowest in the evening (in a healthy person). So that cold you’re fighting off, or that swollen knee gets worse. We don’t want to spike cortisol because that will inhibit melatonin production and it’ll be difficult to sleep. You may be thinking, “why not take an anti-inflammatory”? That will certainly reduce inflammation, but here is an important point. Inflammation and swelling are not the same thing. Inflammation is the initiation of the healing process, swelling is the waste product left behind. If there was a car accident on the highway, you wouldn’t want to set up a blockade before the scene of the accident; you’d want the ambulance to arrive. This is similar, you may be inhibiting the healing process. Not to mention it’s tough on the cardiovascular system and the gut. However, you do want to mitigate swelling.

So how do we do this? Swelling is handled by your lymphatic system. The lymphatic system is analogous to your cardiovascular system; where there are blood vessels, there are lymph nodes and channels. The cardiovascular system has a pump (the heart) to create circulation, whereas the lymphatic system does not. It relies on the pump action of muscles to create circulation. This is problem number 2 at night, you tend to not move as much so swelling is allowed to fester. This can also be the solution, gentle movement stimulates lymph flow. It doesn’t take much, and it works well.

Generally, you want to move the area that hurts in as pain free of a manner as possible, and then you’d want to follow up with belly breathing. The main duct of the lymph system is the cisterna chyli which rests under your diaphragm. So belly breathing presses on that duct and gets it to your upper chest where it drains. You may feel the urge to urinate after doing this and that’s a good thing, your body is getting rid of the waste. The bottom line is that you want to mitigate, rather than inhibit, the inflammation and swelling process. 

Here are some examples:

For low back pain:

For knee pain: 

For shoulder pain: 

Breathing and Stress

Breathing and Stress

Breathwork has been a popular topic lately, and for good reason. It has a big return on investment. There are surprisingly many ways to breathe, and for something we do so often, a subtle change can have a huge impact. This article will focus solely on how breathing and stress are related. 

This really boils down to the autonomic nervous system. We have two divisions, sympathetic (fight or flight) and parasympathetic (relax and digest). Our nervous system can go back and forth between these systems and it’s not like a switch, but rather a spectrum. In other words, reading an email from your boss may be mildly sympathetic while getting into a bar fight is highly sympathetic. 

When in a fight, or running from a bear, you need energy, and quickly. Our bodies can burn fats or carbs (glucose) for fuel. Carbs are more readily available so the body would rather use carbs in an emergency situation. Cortisol is the hormone involved in the stress response. Its job is to liberate glucose from the muscles and liver into the bloodstream. This is a good thing for an emergency, however long term chronic secretion can lead to issues. For example, if you are chronically stressed, you will have high levels of glucose in the blood which can lead to diabetes. This is the link between stress and weight gain. 

Our body is always trying to maintain homeostasis, or balance. For example, breathing through the right nostril is tied to the sympathetic nervous system, whereas breathing through the left nostril is parasympathetic. Breathing through both maintains balance. 

A similar thing happens with breathing. We can breathe diaphragmatically (belly breathing) or with our chest. Chest breathing is more associated with sympathetic activity, whereas belly breathing is more parasympathetic. Just picture someone in a fight, their chest is usually heaving unless they are acclimated to fighting like an MMA fighter, and are relaxed. 

It is quite common to develop a chest dominant breathing pattern. This is likely a product of our environment. The constant hustle and bustle, financial stress, relationship stress, watching the news, can all trigger the sympathetic nervous system. This is a trainwreck for long term health. Chronically elevated blood sugar and high blood pressure. Not good.

You can easily test this on yourself. Lay on your back and breathe. What rises first? Chest or belly? If it’s your chest, you can be sure that you are in a more sympathetic state. You can use this as an exercise; focus on belly rising first. This is a great way to wind down the day, especially if you have difficulty falling asleep. This will quickly put you into a parasympathetic state. 

Additionally, the sympathetic state increases muscle tone which makes sense if you are about to get into a fight. However, if you are dealing with muscle pain, it could be from increased muscle tone. So if you are trying to reduce pain, seeking the parasympathetic state will help the muscles relax. This, in part, is why massage can help. It engages the parasympathetic nervous system. 

In our current climate, I think that most people should seek parasympathetic activities. Reading a book, going for a walk in nature, massage, yoga, etc. are all parasympathetic. Breathing has a rapid effect on the nervous system, and it’s free and readily available to you.

I should also mention that nasal breathing stimulates nitric oxide production. Nitric oxide is a strong vasodilator and can additionally enhance relaxation.