The HPA Axis and Healing Anxiety

Dr. Jolene BrightenPublished: Last Reviewed: Sex Hormones Leave a Comment

If you’re suffering from anxiety, you are not alone. In fact, anxiety affects 40 million U.S. adults or 18.1% of the total population every year. One of the key causes of chronic anxiety is HPA dysregulation, which is more commonly called “adrenal fatigue.” HPA dysregulation is a condition in which the communication between the brain (hypothalamus and pituitary) and the adrenal glands is dysfunctional, giving way to abnormal or ineffective hormone output from the adrenal glands. In this article, we’ll explore anxiety and how to leverage adaptogens to ease symptoms of anxiety.

As a doctor who helps women address the root cause of their hormone imbalance, I’ve successfully helped my patients eliminate anxiety and balance the hormones driving their symptoms.

All About Anxiety

Anxiety is more than just an “uncomfortable” feeling. It can be incredibly debilitating and manifest in physical symptoms such as gastrointestinal disorders, respiratory illness, and even cardiovascular disease.

Anxiety is a symptom of another underlying problem.

And while it very much feels like a disease of its own, I want you to understand that there is a root cause. In fact, anxiety is one of the many ways your body gives you the heads up that something internal is off.

This is why anti-anxiety medications don’t often work long-term. They mask the symptoms of anxiety without treating the root cause for the long haul. Now, I’m not judging you if you feel you need a medication and before you jump off, check with your doctor.

Anxiety medications can lead to side effects like nausea, weight gain, fatigue, low libido, and even new or worsening anxiety. That’s right, the medications you take for anxiety have been known to worsen anxiety!

For many women, the moment they stop an anxiety medication they start to feel anxious again, which makes sense if you haven’t gotten to the root of the issue.

In my clinic, I treat anxiety like the serious condition it is. When I was a new mom, I had undiagnosed autoimmune thyroid disease. This manifested itself as extreme anxiety, which was my body’s way of telling me something was wrong. And boy, did I feel it!

I understand first hand how anxiety can hijack your life. With my anxiety, I quickly realized how tempting it is to reach for anti-anxiety meds just to stop the intense, overwhelming sensation of anxiety for even a few moments.

But, just like you, I wanted to find natural ways to heal my anxiety without loading my body with more stressors, like medications and chemicals.

That’s where root cause medicine takes a huge leap over other practices. The philosophy is to address the problem at the base level so that you can eliminate symptoms for good without the need for a daily medication.

In my medical practice, we ask the question: “Where is your anxiety coming from?”

There are three common causes of anxiety: HPA dysfunction, compromised gut health, and nutrient deficiencies.

In this article, we’re talking about one specific root cause of anxiety: HPA dysregulation and I’m going to share with you some herbs that can help. What role does the adrenal system play in anxiety, and how can you approach this root cause to get rid of your anxiety once and for all.

Healing your HPA axis can heal your anxiety and related concerns.

What is the HPA Axis?

The hypothalamic-pituitary-adrenal (HPA) axis  is a set of three systems: the hypothalamus, the pituitary gland, and the adrenal gland. It’s a neuroendocrine system, meaning that it deals both with the brain and the hormones. The HPA axis is used to regulate a number of body processes, including stress response, digestion, immune system, mood and emotions, and sexuality.

The adrenals are two glands located right above the kidneys. These glands manage stress and produce the hormone cortisol, which is often known as the “stress” hormone. The more stress you feel, the more cortisol your adrenals will produce. The adrenals also produce adrenaline, aka epinephrine, which plays a role in our “fight or flight” response or in other words, hits the panic button in your brain.

When the HPA isn’t functioning properly, your body will go into a state of stress and anxiety that can be severely damaging to your overall health.

There are several conditions and lifestyle factors that can affect how your HPA axis operates:

  • Autoimmune disease
  • Blood sugar imbalances
  • Dehydration
  • Hormonal birth control
  • Gut dysfunction or dysbiosis
  • Infection
  • Inflammation
  • Medications
  • Nutrient depletions
  • Stress
  • Sleep disorders or poor sleep habits
  • Thyroid disease

Why does our body feel stress?

The HPA axis is intimately involved in our response to stress. Our perception or our body’s interpretation of stress is what kicks off the fight, flight, or freeze signals, or what is known as the sympathetic nervous system.

Back when there were legit stressors (like tigers looking for a human snack) we needed the ability to get out of harm's way and protect ourselves from the environment around us. The trouble is, in modern society our body gets this signal almost on the daily and it is relentless.

We aren’t faced with lions, tigers, and bears as often as we once were. Instead, we perceive non-threatening stressors as if they may very well kill us.

This is called evolutionary mismatch. This is when the environment has changed faster than our body can keep up with. And all this fight, flight or freeze business isn’t serving us as it once did.

Today, our daily stressors come from paying bills, public speaking, worrying about our kids, or asking someone on a date. These are legitimate stresses that we feel, but they’re often psychological stressors we put on ourselves. We aren’t facing an imminent danger that could kill us right at that moment.

On top of that, we modern humans have a tendency to skip meals, skip sleep, and a whole mess of other lifestyle practices that sabotage the “safe” signal to our body.

This confuses our brain. Our body is telling us we are going to die, but our brain can’t see a tiger, smell a tiger or hear a tiger, so what does it do? It hits the panic button hard because what’s worse than life-threatening danger? Not knowing what the heck it is or what you could possibly do about it.

Have you ever felt nervous or anxious but you weren’t sure why? You felt your heart racing and your palms sweating, but you couldn’t place the cause of it. Then, you start to feel even more anxious because you’re not sure why you’re anxious.

Your brain is responding to misplaced anxiety with more anxiety. This puts your body in “survival mode,” even though you don’t actually need to worry about survival when public speaking.

But that’s why getting up on stage can feel like a make or break moment. Your brain literally thinks that this stress can kill you based on evolutionary experience. It doesn’t have the complete capacity to separate out different types of anxieties.

What does fight or flight look like?

Fight or flight response is also called “acute stress response” or “hyperarousal.” This is the physiological reaction to some sort of stressor. When we feel this stress, our sympathetic nervous system flares up. This is the system that makes your eyes dilate, your heart race, your face flush, and your palms sweat. This system is literally preparing your body to flee. It expends energy, bumps heart rate, and causes blood to flow to the muscles in preparation to run away.

But this is meant to be an acute response, meaning it should only last in the short-term. These physiological changes like increased blood pressure and muscle tension are useful for the short-term when you have to escape a tiger.

But consistent, chronic exposure to this kind of stress and adrenaline can wreak serious havoc on the body.

Chronic exposure to the “acute stress response” can lead to

  • High blood pressure
  • Cardiovascular disease
  • Difficulty sleeping
  • Chronic fatigue
  • Intestinal issues
  • Skin problems, including skin aging
  • Weight fluctuations
  • Changes in sex drive
  • Anxiety disorders.

Today, chronic activation of the stress system can occur from daily stressors. Maybe you get stressed every time you sit in traffic. If you sit in rush hour traffic twice a day five days a week, you’re going through this “fight or flight” 10 times per week!

Or maybe you have a six-month project that’s stressing you out because you feel your career depends on it. Even when you aren’t actively thinking about the project, your body is subconsciously responding with anxiety to that project.

This puts your body into a long-term state of anxiety—whether or not you are conscious of the stressor.

This can then spur what is called “adrenal fatigue.”

Now I want to take a moment and share that while your adrenal symptoms and anxiety are very real, adrenal fatigue is not. Your adrenals (unlike your ovaries) should never give out. Instead, this is more accurately HPA dysregulation, that is your brain and adrenal communication is breaking down. You can read about how Adrenal Fatigue is not real in this article.

Ultimately, this consistent anxiety can lead to HPA dysregulation. Your adrenal glands can misfire hormones or become unresponsive to signals from the brain, which causes a fatigue, loss of libido, poor memory, depressed immune system, increased PMS symptoms, and hormonal imbalance. Without intervention, your HPA axis falls into a deeper state of dysfunction and stress.

Did you know that the birth control pill can lead to HPA dysregulation, adrenal issues, and a whole lotta inflammation? The synthetic estrogen in birth control is highly inflammatory. As we’ll discuss below, inflammation is a key cause of HPA dysfunction. Moreover, there’s a direct impact on the communication between the brain and adrenal glands when a woman is on the pill.

In fact, HPA dysregulation is common in women with post-birth control syndrome (PBCS).

Click here to learn more about how the birth control pill causes inflammation and adrenal dysfunction—which can, in turn, cause HPA-related anxiety.

How Does Cortisol Create Anxiety?

The adrenals also produce the stress hormone “cortisol.” When you have a dysfunction of the HPA system, your can adrenals start to overproduce cortisol, epinephrine, and norepinephrine…which I fondly refer to as Freak the F Out hormones when they go high.

These hormones signal the brain that the body is stressed and in “survival” mode. This means that the other processes in the body shut down to focus on survival. For example, high levels of cortisol can decrease sexual arousal and libido, because the body is trying to preserve life rather than create new life. Yeah, stress can rob you of your sex drive and orgasms. Lame.

High levels of cortisol are linked to weight gain, sleep disorders, hormonal imbalances, fertility issues, and anxiety. Studies have shown that adults with generalized anxiety disorder often have elevated cortisol levels.

High levels of cortisol can basically diminish the levels of other hormones in the body. In fact, stress has been linked to endocrine and thyroid disorders like Graves’ disease and obesity.

Learn more about the connection between anxiety and hormones here.

Adrenal dysfunction means a higher release of cortisol. High levels of cortisol results in anxiety and hormonal imbalance.

Another key disruptor of the HPA axis is inflammation. Inflammation anywhere in the body will put your body in a state of “stress.”

Inflammation can be caused by:

  • Autoimmune disease
  • Blood sugar imbalances
  • Chronic disease
  • Estrogen dominance
  • Hormonal imbalances
  • Infections (especially in the gut)
  • Insomnia and sleep disruption
  • Medications, like synthetic birth control

Basically, when there is inflammation in your body, your adrenal glands release cortisol as a means of dampening inflammation. Inflammation is a form of stress that demands your adrenal glands bring on the cortisol.

Relentless inflammation can do damage to your body and lead to a hormone imbalance.

Thus, inflammation causes a disruption in the HPA axis. This disruption of the HPA axis releases stress hormones that can actually worsen inflammation in response. It becomes a vicious cycle of anxiety and stress in the body. This stress and inflammation can lead to serious health concerns in the long run, like cardiovascular disease.

How do You Deal the HPA axis?

What can you do to get the HPA back to healthy functioning?

Restoring your HPA axis with functional medicine involves getting back to a healthy lifestyle that fights off stress, hormonal imbalance, and inflammation.

Reduce Stress

Reducing external stressors is the primary key to reducing your anxiety response. Minimizing stress can come in a variety of forms, so find the one that works best for you.

Meditation and an Intuitive Root Down

I recommend meditation for nearly all of my patients. This syncs the body and brain to promote deep relaxation and “turn off” your sympathetic system. Studies show that participating in mindfulness practices can reduce cortisol while improving brain, heart, and immune health.

I recommend a guided meditation if you’re new to the practice. Consider the Muse meditation device, which actually translates your brain signals into sounds so you can better understand the “activity” of your thoughts.

I love starting my day with meditation and an intuition root down because it consistently helps my productivity and regulates my response to whatever stressors I may face in my day.

Deep Breathing

Deep breathing also helps put your body into this relaxed state in a way that can relieve muscle tension caused by anxiety. Aim for 5-10 minutes once to twice daily. Simply close your eyes and focus on your breath. Feel your abdomen expand as you inhale, and release all tension as you exhale.

Get Outside

Spend more time outdoors as well. Studies show that being in nature can help promote a more relaxed state. Put down the phone and get some fresh air, and you’ll start to feel your stress melt away.  

Exercise Regularly

While you’re outside, get in some exercise. Research shows that physical activity is one of the best ways to reduce anxiety, balance hormones, and improve sleep patterns.

Be mindful of your exercise. If your life is bananas stressed out and crazy then engaging in highly stressful exercise may do more harm than good. When stress goes high, engage in walking, pilates, gentle yoga and body weight exercise.

I recommend moderate intensity five times per week. Aerobic exercise is can promote relaxation because it increases oxygen to the brain and reduces levels of stress hormones like adrenaline and cortisol. Plus, aerobic exercise releases endorphins, which are the “happy” chemicals that can make you feel more relaxed and optimistic after a workout.

Eat an Anti-Inflammatory Diet

Inflammation causes a disruption in the HPA axis, which leads to anxiety. So eating an anti-inflammatory diet can help minimize the inflammation that’s worsening your cortisol levels and driving your hormone imbalance. Reducing inflammation will improve your HPA axis function, enhance your immune system, and improve your sleep quality—which all helps to minimize anxiety.

An anti-inflammatory diet consists of whole foods that are high in antioxidants and fiber. Ditch sugar like the harmful drug it is because that can make anxiety skyrocket. Healthy fats, high quality proteins, fruits, and vegetables that are rich in nutrients and fiber are foundational in eliminating anxiety.

Eating a diet rich in vitamin C, B vitamins, and magnesium or taking a supplement with these can also help promote a healthy stress response. Consider Adrenal Support, which is a supplement that helps with optimal adrenal function.

Test if Caffeine Causes Your Anxiety

Avoid caffeine…at least for now. No, coffee is not the devil and it isn’t “the number one cause of adrenal dysfunction” as you may have read.

But caffeine can induce cause an increase in epinephrine or adrenaline and lead to more anxiety. How do you know if it is true for you? Cut it out for 2-4 weeks and then reintroduce. If your anxiety is off the chain when you bring it back in then you know caffeine is not your friend.

While you cut out the caffeine, consider bringing in decaf green tea, which contains L-theanine, an amino acid that can promote a state of calm.

Set a Sleep Schedule

Sleep is crucial to regulating cortisol levels. However, people with high anxiety often have sleep disorders as well. Sleep disorders can exacerbate anxiety, which further worsens the body’s cortisol levels and inflammation.

In a typical circadian rhythm, cortisol levels rise in the morning to help you wake up and drop low at night as melatonin rises. Bedtime is the time when your body “resets.”

For some people with high anxiety, this rhythm can be flipped and instead they produce high levels of cortisol at night and low levels of cortisol in the morning. This can a disruption in the circadian rhythm and cause fatigue during the day and sleeplessness at night. Not sleeping can worsen inflammation and illness, which further contributes to high anxiety.

You need to get your body back to a healthy sleep pattern to reduce these cortisol levels and have a restful night’s sleep.

For patients in my medical practice struggling with anxiety or sleep disturbance I recommend two supplements—Adrenal Calm. Adrenal Calm contains herbs that shift the nervous system away from fight or flight, promotes healthy levels of cortisol and helps take the edge off. 

Sleep tips:

  • Sleep at minimum seven hours each night.
  • Take Adrenal Calm after dinner
  • Wear amber glasses 2 hours before bed to get rid of the “blue screen” effect. This helps reduce cortisol and raise melatonin.
  • Sleep in a completely dark room with no light.
  • Low levels of white noise, like binaural delta rhythms, can help you fall and stay asleep.
  • Expose yourself to natural light when you wake. If you don’t get a lot of sun, try a natural light alarm clock.

Try Adaptogenic Herbs

Adaptogens are a group of herbs that are known for their ability to reduce stress and enhance adrenal function. They’re one of the most natural and effective ways to restore your body’s HPA axis to a happy, balanced state. I've formulated both Adrenal Support (daytime formula) and Adrenal Calm (night time formula) with adaptogenic herbs to support a healthy cortisol rhythm and adrenal function. 

I recommend the following adaptogenic herbs:

  • Rhodiola
  • Ashwagandha
  • Ginseng
  • Gotu Kola
  • Licorice Root
  • Eleutherococcus
  • Reishi Mushroom
  • Cordyceps
  • Maca

Learn more about how to heal adrenals with adaptogenic herbs here.

Work with an Expert

If you have a HPA dysfunction, talking to an expert is the clearest route towards health. Testing your adrenal glands and hormone levels can help uncover the root cause of your anxiety.

Are you ready to improve your mood and feel a whole lot more chill?

Of course you are!

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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.