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How Stress Impacts Autoimmune Disease: The HPA-Axis

Updated: Mar 7, 2023

Chronic stress is a major issue facing society today, and it is no coincidence that we are also facing record-high numbers of chronic illnesses and autoimmune conditions. This is because of the intimate and complex relationship between stress and every system in the body.

The topic of this particular blogpost is HPA-axis dysfunction, which refers to how chronic stress breaks down the very system in the body needed for a healthy stress response.

What Is The HPA-Axis?

The HPA-axis stands for the hypothalamic-pituitary-adrenal axis, which is a signalling pathway between your brain and adrenal glands.

The job of the hypothalamus is 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 in a “fight or flight” response. “Fight or flight” also refers to a stressed state or when the sympathetic nervous system is dominant.

The Importance of Cortisol

Cortisol is extremely important for keeping our body systems in balance, as well as protecting our cells. For example:

  • It controls the strength of the immune system: Too much cortisol weakens the immune system, setting the motions for increased susceptibility to infections and cancer, while too little leads to an overactive immune system and autoimmune disease.

  • It helps to normalise blood sugar.

  • It regulates blood pressure and electrolyte balance.

HPA-Axis Dysfunction

The ability to handle stress, physical or emotional, is a cornerstone to human survival. Our body has a complete set of stress modulation systems in place, and the control centre is the adrenal glands. When these glands become dysfunctional, our body’s ability to handle stress and fight infections is decreased.

A classic example of this is if you were to come upon a bear in the woods (not very common in the UK it's true, but pretend with me!)... A bear is chasing you, so you need these stress hormones to help you flee or fight in the moment. The stress response hasn’t changed in thousands of years, so the perceived stress you experience sitting in traffic or presenting in a meeting exerts exactly the same response as being chased by a bear – the body can’t tell the difference!

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 bear, the stress system shuts off and you return to the rest and digest, or parasympathetic, state.

What Causes HPA Axis Dysfunction?

The HPA-axis works best for those brief, acute stresses such as the bear chasing you, or the modern equivalent – e.g. a work presentation. The axis fires up, you benefit from the extra energy and focus the hormones provide, and then you return to the parasympathetic 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.

HPA-Axis dysfunction used to be rare, but is now all too common because of our lack of relaxation and other factors, such as:

Physical: chronic pain, exercise, work, lack of sleep

Chemical: alcohol, caffeine, air pollutants, cleaning chemicals, skin care and beauty products, contaminated water

Mental: depression, worry, anxiety, long work hours

Emotional: suppressed emotions, anger, guilt, shame, sadness, fear

Nutritional: food intolerances and sensitivities, malabsorption and poor digestion, vitamin and mineral deficiencies, excess sugar

Trauma: injuries, burns, surgery, illness, infections, psycho-emotional-spiritual trauma

Psycho-Spiritual: troubled relationships, financial or career pressures, challenges, with life goals, spiritual alignment and general state of happiness

If the system is constantly pumping out cortisol, even when the threats to safety are minor, the system gets desensitised to the stress signals and the feedback loops fail to respond as normal. The result is a stress response that isn’t functioning properly.

Stress is serious business - chronic stress is a risk factor for accelerating ageing, chronic disease, infertility, autoimmunity and more. In fact Dr Rangan Chatterjee estimates that 90% of all cases he sees in General Practice have stress at the root.

Signs of HPA-Axis Dysfunction

  • Mild depression or anxiety

  • Multiple food and or inhalant allergies

  • Lethargy and lack of energy

  • Increased effort to perform daily task

  • Decreased ability to handle stress

  • Dry and thin skin

  • Low blood sugar

  • Low body temperature

  • Palpitation

  • Unexplained hair loss

  • Alternating diarrhoea or constipation

A Quick Note on Exercise

I wanted to write a quick note on exercise, HPA-axis dysfunction and women and those assigned female at birth, as there seems to be a pervasive belief (at least in Western cultures) that going hard in the gym is the goal for everyone and that running, HIIT, weight training, etc. is healthy, period. Let's dispel this myth!

When you get your heart pumping during exercise, your body burns the glucose in your bloodstream for energy. This supply lasts only about thirty minutes; after that, your body needs to find a replacement to keep your energy up. Where does your body turn? It calls on your adrenal glands, and they jump into action by pumping out the stress hormone cortisol, which converts stored fat into useable glucose so you have the energy to continue working out. Although the fat-burning part of this process may sound like a win-win for you, it comes with some serious side effects.

If you’re suffering with HPA-axis dysfunction, exercising too hard or for too long may cause your adrenal glands to become overstimulated. Over-exercising when you are already dealing with the effects of chronic stress will further strain your adrenals, exacerbate HPA axis dysfunction and likely leave you feeling depleted.

Eventually, HPA-axis dysfunction can spiral to a point where you struggle to get out of bed in the morning, struggle through your workouts and feel more exhausted than ever. It’s a no-win situation. You workout because you think you’re doing something healthy for your body – but really, you could be compounding endocrine imbalances.

What Is Recommended?

Exercise, but not too much.

It is recommended that individuals with HPA-axis dysfunction start with gentle exercise such as walking, gentle yoga, or yin yoga. Too much cardio or sessions over 30 minutes can add more stress to a stressed system. This is a time to use movement to restore, not to push new physical limits.

Once resilience is rebuilt and HPA axis function restores, premenopausal women can use Alisa Vitti's Cycle Syncing Method of exercising.

Quick Tips for Supporting Stress with Nutritional Therapy

  1. Find your daily rhythm. The HPA-axis likes routine. Eating meals at regular times each day and going to bed at the same time each night is important to resetting your stress response. Setting yourself up with a consistent schedule alleviates stress on the body and helps your HPA-axis reset.

  2. 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 individuals therapies such as EFT can be helpful.

  3. 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 mould damage and choosing safe personal care, cleaning and home products.

  4. Support the adrenals with supplements. (Taken under supervision of healthcare professional) Adrenal support at therapeutic dosages can be used to correct an HPA-axis imbalance or as added support during stressful times. Recommended supplements include:

  • B Complex

  • Magnesium

  • Vitamin C

Next Steps

Hi I'm Molly, I'm a UK-based Nutritional Therapist (DipION, mBANT, CNHC) and Self-Compassion Coach (MSc) serving my community in Harpenden and online. Here in my little online home, you'll discover the benefits of nutritional therapy and complementary therapies for autoimmune disease and chronic illness.

Want to understand more about nutrition for autoimmune diseases? Download my free recipe book and discover 12 Nutritionist-Certified Recipes to Help Alleviate the Symptoms of Autoimmunity & Chronic Illness.

If you’re ready to take the next step and get back to feeling amazing again, please book a FREE 1:1 call, in which I’d love to talk to you about your own individual diet, lifestyle, and self-care practices, share with you some personalised advice, and answer any questions you might have.


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