The HPA axis is a complex set of feedback interactions among the hypothalamus, the pituitary gland, and the adrenals. These interactions form a huge part of the neuroendocrine system which controls digestion, immune function, mood and emotions, sexuality, energy storage, and expenditure. The HPA axis is the uniting system for interactions of the glands, hormones, and parts of the brain that mediate the general adaptation syndrome also called (GAS). GAS is described as the human physiological response to prolonged stress.
The Stress Response
Prolonged stress from external stressors may continually elevate the HPA axis and affect the balance of hormones.
Balancing Cortisol
Under normal conditions, cortisol peaks before awakening and decreases throughout the day. When cortisol levels are blunted upon awakening, this can indicate HPA axis disruption. Cortisol secretion should ideally peak between 6 am and 8 am and naturally decline throughout the day and the lowest levels are reached between 6 pm and 8 pm.
Symptoms of Stress to identify the stress response stage
Early-Stage Symptoms
Early-stage symptoms: high stress, appears high strung, anxious, agitated, occasional sleeplesness, but little fatigue (‘tired but wired’) and a higher pulse.
Labs to assess at early-stage symptoms: Cortisol, DHEA, Blood Pressure, and Blood Glucose.
Elevated: Cortisol, DHEA, Blood pressure (sitting to standing), Fasting blood glucose.
Within normal limits to low: Serotonin.
Mid-Stage Symptoms
Mid-stage symptoms: moderate stress and tired.
Labs to assess at mid-stage symptoms: Serotonin.
Elevated: IL-6 and CRP.
Within normal limits: Cortisol, DHEA, and Serotonin.
Low: Serotonin.
Late-Stage Symptoms
Late-stage symptoms: fatigued/exhausted, very tired in the evening, occasional sleeplessness (difficulty falling asleep and staying asleep and a low pulse.
Labs to assess at late-stage symptoms: Cortisol, DHEA, Serotonin, and Blood Pressure.
Low: Cortisol, DHEA, Serotonin, Blood pressure (sitting to standing)
Lifestyle and Nutritional Support
Incorporating lifestyle, nutritional, and behavioral recommendations can help support healthy HPA axis function.
- Regular movement/exercise
- Have regular bed times and obtain deep, restful sleep (ideally uninterrupted sleep that cycles through the 4 different sleep stages)
- Meditation
- Yoga
- Breathwork
- Moving slowly throughout the day so that the body catches up to the mind
- No smoking
- Avoid or limit alcohol and sugar consumption
- Identify and remove food intolerances
supplements recommended for early-stage
- Ashwagandha (Withania somnifera): caution with long-term consistent use (<2-3 months)
- L-Theanine: amino acid found in green tea and matcha
- Magnolia (Magnolia officinalis): interacts with receptors for the neurotransmitter GABA
- Phosphatidylserine (PS): has been shown to support an adaptive cortisol response to stress
supplements recommended for Mid-stage
- Rhodiola: (Rhodiola rosea) is an adaptogen that that helps to reduce occasional fatigue and improve mood.
- Holy basil: (Ocimum tenuiflorum) may increase dopamine and serotonin levels during stress.
- Eleuthero: (Eleutherococcus senticosus) supports adrenal function, regulates neurotransmitters, and may increase resistance to stress
- Ashwagandha: (Withania somnifera)
- Maca: (Lepidium meyenii)
supplements recommended for Late-stage
- Vitamin B1 (thiamine)
- Vitamin B2 (riboflavin)
- Vitamin B5 (pantothenic acid)
- Vitamin B6 (pyridoxine): co-factor for almost 50 different enzymes and plays a role in the production of neurotransmitters such as serotonin, dopamine, epinephrine, norepinephrine, and GABA.
- Forskolin
- Licorice
supplements recommended for Late-stage Sleep Support
- Melatonin
- Curcumin
- L-Theanine: has been shown to increase serotonin and dopamine levels in which may promote muscle relaxation and improved sleep.
- Glycine
- 5 HTP: (L-5-Hydroxytryptophan) is a serotonin precursor that supports sleep regulation.
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