What is Adrenal Fatigue? Meet Your HPA Axis
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Health Concerns

Is Adrenal Fatigue Real? Get Our Doctor’s Take.

October 15, 2019

Heard about adrenal fatigue? Parsley Health physician Rachael Gonzalez, M.D., explains what the condition *actually* is, and how it’s more complex than it sounds.

You’ve probably heard about adrenal fatigue, a diagnosis that’s becoming increasingly popular, especially in the world of health, wellness, and integrative and functional medicine. The term is used to describe a set of symptoms that occur as a result of chronic stress and the sustained activation of the body’s fight or flight response. But the truth is, adrenal fatigue is not a clinically appropriate diagnosis. Read on to find out why—and what we should be calling it instead. 

What is adrenal fatigue? 

“There are so many books and articles about adrenal fatigue, the term has become part of the lay culture,” says Dr. Rachael Gonzalez, a board-certified physician in both family medicine and integrative medicine at Parsley Health. A diagnosis of adrenal fatigue is often made when a patient presents with symptoms such as persistent fatigue, muscle weakness, depression, and low blood pressure. It’s thought to occur as a result of chronic stress, which overloads the adrenal glands, two small glands that sit on top of the kidneys and produce cortisol, the body’s stress hormone. 

But according to Dr. Gonzalez, the name and concept of “adrenal fatigue” oversimplifies what’s actually occurring in the body when it’s exposed to chronic stress. Instead, we should be using the term HPA axis dysfunction.

Adrenal fatigue versus HPA axis dysfunction: What’s the difference?  

“The stress response isn’t just one gland,” says Dr. Gonzalez, explaining that it’s more of a complex symphony involving the hypothalamic-pituitary-adrenal axis (hence the name “HPA axis” dysfunction). 

This symphony involves the adrenal glands, yes, but also the amygdala (the part of the brain that senses something scary or stressful in your environment), the hypothalamus (the part of the brain that initiates the stress response), and the pituitary gland, which receives messages from the hypothalamus and releases hormones that tell the adrenals to produce cortisol, among other things. With HPA axis dysfunction, constant activation of this symphony causes the communication between the hypothalamus and the pituitary and adrenal glands to go haywire, which leads to unhealthy changes in the way the body produces cortisol and other hormones and neurotransmitters related to the HPA axis, such as melatonin and epinephrine. 

As Dr. Gonzalez explains, “It’s an entire cascade of events that are happening way above the level of the adrenal glands.” When we focus on just the adrenals, we’re missing the full picture. “The term adrenal fatigue is a myth,” she says. 

Fatigue, weight gain, insomnia, PMS, or PCOS? We treat the root cause of hormonal imbalance so you can get back to feeling like yourself again.

What causes HPA axis dysfunction? 

First, it’s important to remember that stress isn’t an inherently bad thing. In fact, as Dr. Gonzalez points out: “We wouldn’t survive without it.” With that said, the stress response is meant to work acutely in dangerous situations; and then when the threat is over, the body is designed to immediately enter a recovery phase. According to Dr. Gonzalez, “What’s unique about humans is the concept of chronic, sustained stress.” When stress becomes chronic, “the fight or flight gets turned into something else,” she says. 

This can occur with grief or trauma, but really, it can affect anyone at any time. As Dr. Gonzalez explains, “What’s stressing people out is very different, but we’re all facing chronic and continued exposure to stressors.” 

Unfortunately, stress affects your body in more ways than one. “It does a lot to you metabolically; it causes sugar cravings, shuts down digestion, and it affects your sleep,” says Dr. Gonzalez. If this sounds familiar to you, and you’re concerned about the health of your HPA axis, it’s important to know the most common symptoms. 

HPA axis dysfunction symptoms 

Research has shown a link between HPA axis dysfunction and impaired cognitive function, inflammatory and autoimmune diseases, mood disorders, and more. “Chronic stress and HPA axis dysfunction affects every major organ system in the body,” says Dr. Gonzalez. Knowing this, it shouldn’t be a surprise to learn that the symptoms of HPA axis dysfunction are life-disrupting, vague, and widespread. Here are some of the important ones to look out for, according to Dr. Gonzalez: 

  1. Chronic fatigue 
  2. Waking up in the middle of the night and crashing in the afternoon 
  3. Weight gain and weight loss resistance 
  4. Cravings for caffeine, sugar, and carbs 
  5. Anxiety and depression 
  6. Muscle weakness and trouble exercising 
  7. A weakened immune system 
  8. Bloating and other leaky gut symptoms
  9. Memory loss and focus issues 

At Parsley Health, an HPA axis dysfunction diagnosis is made through a combination of medical history, an exam, and lab testing. “We can measure cortisol several times during the day using saliva or urine,” says Dr. Gonzalez. Healthy cortisol levels align with your sleep-wake cycle—meaning cortisol peaks in the morning and then decreases throughout the day to help you wind down for bed. This test would check to see if cortisol is doing what it should throughout the day; if it’s not, it’s a sign that something’s awry with your HPA axis.

How to heal from HPA axis dysfunction 

While it’s important to address major sources of stress, like toxic people and workplaces, if you have HPA axis dysfunction, getting back on your feet does not mean avoiding stress altogether. “We’re not going to get rid of stress anytime soon, so we need to create more of a tolerance to it,” says Dr. Gonzalez. 

A good place to start is identifying what’s most important in your life. As Dr. Gonzalez puts it: “See your energy as a bank account of commitments and try to scale back.” This is also a good time to go back to the basics, focusing on improving sleep hygiene, eating a healthy diet, and trying meditation. “Your body wants to heal, so try not to get in the way,” she says.

According to Dr. Gonzalez, caffeine also has a role to play here. “Coffee is often used as a form of self-medication to deal with fatigue,” she says; but caffeine can heighten the sense of alarm the body experiences and increase the release of catecholamines, the hormones secreted by your adrenal glands. As Dr. Gonzalez points out, “It’s not sustainable and can actually perpetuate the problem.” 

A final word on stress and HPA axis dysfunction 

Unfortunately, fatigue and burnout can tempt us to work even harder to overcompensate. “The more burnt out a person is, the harder they’ll work and they end up doing even more damage,” says Dr. Gonzalez. 

If you’re struggling with symptoms on HPA axis dysfunction and are having trouble getting a handle on chronic stress, don’t hesitate to reach out to your doctor for help. Chronic stress is no joke. In fact, according to Dr. Gonzalez, “it’s the root cause of maybe 90 percent of chronic diseases.” 

Parsley Health is the only medical practice that leverages personalized testing with whole body treatments.

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