HPA Axis Dysfunction and Chronic Stress

Even though 10,000 years have passed, our body’s physiology hasn’t changed much. When we face stress, our bodies still react as if we’re in survival mode—gearing up to fight, flee, or freeze. The catch? Our modern environment looks nothing like that of our ancestors. Yet, our bodies continue to interpret everyday stressors as if we’re being chased by a wild animal.

This mismatch can throw off an ancient system in the body known as the HPA axis (hypothalamic-pituitary-adrenal axis). It’s not that your daily stressors—like a constantly buzzing phone, a packed inbox, noisy neighbors, or rush hour traffic—are life-threatening. But your body doesn’t know that. Instead, it registers these ongoing pressures as serious threats, and the HPA axis kicks into overdrive.

But it’s not just external stress that takes a toll.

Internal stressors—such as poor digestion, nutrient deficiencies, chronic inflammation, or underlying health issues—can also activate the HPA axis. These hidden signals quietly strain the nervous system, reinforcing that same state of high alert.

The HPA axis—short for hypothalamic-pituitary-adrenal axis—acts as a communication network between three key endocrine glands: the hypothalamus, the pituitary gland, and the adrenal glands. Together, they help your body stay balanced and respond to stress.

These glands play a big role in regulating essential functions like your stress response, immune system, mood, digestion, and how your body uses energy.

However, when stress becomes chronic or the HPA axis gets out of sync, it can lead to a wide range of health challenges, including anxiety, depression, and metabolic imbalances.

Here’s how it works: when your body senses a threat—whether real or perceived—it signals the release of hormones like adrenaline and cortisol. These powerful chemicals set off a chain reaction throughout the body. These hormones cause numerous reactions in the body, including:

When adrenaline surges, it can:

• Raise blood sugar levels to provide quick energy
• Elevate blood pressure to boost circulation
• Enhance blood clotting to prepare for potential injury
• Speed up the heart rate to deliver oxygen more efficiently
• Reduce blood flow to the digestive system, slowing digestion
• Stimulate bladder activity
• Sharpen focus and heighten alertness (hypervigilance)

When cortisol levels rise, it can:

• Impair brain function, leading to brain fog
• Interfere with sleep quality and patterns
• Disrupt healthy digestion
• Raise the risk of cardiovascular disease and diabetes
• Weaken immune system regulation
• Trigger inflammation throughout the body
• Increase muscle tension
• Contribute to mood issues like anxiety and depression

While these life-saving stress responses help us in the short term—like escaping danger—chronic activation can take a serious toll on our health. Over time, it can contribute to:

• Diabetes
• Weight gain
• High blood pressure
• Dementia
• Heart attack or stroke
• Digestive issues, such as: Heartburn; Acid reflux; Indigestion; Hiatal hernia: Low stomach acid; SIBO (Small Intestinal Bacterial Overgrowth); Reduced digestive enzymes; and Imbalanced or less diverse gut microbiome
• Insomnia

Thankfully, your body often sends early warning signs of HPA axis dysregulation before chronic illness develops. These signs can show up with varying intensity and may come alongside other symptoms, depending on the severity of the dysregulation.

When the HPA axis becomes dysregulated, it often drains your energy—leaving you feeling chronically fatigued, even after a full night’s sleep. You might wake up tired, feel sluggish throughout the day, or struggle with a constant lack of energy that rest just doesn’t fix.

HPA axis dysregulation often throws off your body’s natural sleep-wake rhythm, making it harder to fall asleep or stay asleep through the night. As a result, you may struggle with insomnia or wake up feeling unrested—even after spending enough time in bed.

When the HPA axis becomes dysregulated, everyday stressors can trigger an exaggerated or prolonged stress response. As a result, you may find yourself feeling overwhelmed, anxious, or irritable in situations that normally wouldn’t bother you. You might also feel constantly “wired,” struggle to relax, experience sudden bursts of anger or frustration, or get stuck in cycles of rumination and constant worry.

Muscle tension leading to aches and pains, being easily startled, shakiness, racing heart, bloating and digestive issues, autoimmune issues, headaches, bruxism (grinding teeth), increased inflammatory symptoms and altered immune function, cold fingers and toes.

A functional medicine practitioner will actively help determine whether HPA axis dysregulation is contributing to your health symptoms. Additionally, she will assist you in developing a plan to regulate the HPA axis and, consequently, reverse symptoms before the disease progresses further.

Our holistic medicine practitioner supports patients in regulating the HPA axis through various strategies, including:

• Encouraging an anti-inflammatory diet like the Mediterranean diet, which reduces oxidative stress and inflammation. The antioxidant-rich foods help lower inflammation and reduce risks of high blood pressure, atherosclerosis, heart attacks, and strokes.
• Recommending supplements containing minerals and vitamins such as calcium, sodium, potassium, zinc, magnesium, and B vitamins to support stress hormones produced by the adrenal glands and thyroid.
• Prescribing exercise to reduce stress, improve mood, decrease anxiety, depression, anger, and body tension, and boost energy levels while considering individual health status—especially for those with chronic fatigue.
• Advising time spent in nature or outdoors to actively reduce cortisol levels.
• Suggesting regular breaks from screens.
• Promoting quality time with friends and loved ones.
• Guiding patients through meditation, yoga, and breath work for stress reduction.
• Teaching mindset techniques to avoid worry and rumination, led by our health coaches.
• Encouraging appreciation of positive events to enhance well-being.
• Offering cold water therapy for some patients under practitioner supervision after health assessment.
• Using herbal medicines such as kava, lavender, chamomile, passionflower, and skullcap, along with adaptogens like withania, rhodiola, and rehmannia to calm and support the nervous system.

Our bodies heal themselves remarkably well when we provide the right environment and support. At BionwoRx, we focus on understanding and navigating each individual’s unique story and circumstances. This approach enables us to deliver tailored care. If you need support, we stand ready to guide you on your journey to better health.