What is hpa axis dysfunction?

Why HPA Axis Dysfunction May Be More Important Than Gut Health…

Ask any functional medicine doctor where chronic disease begins, and you’ll typically hear one consistent answer: in the gut!

So what the heck do I mean by stating that HPA axis dysfunction (whatever THAT is) may be even more important?

I realize this is a bold statement, and may even sound contrary to what I’ve said before. Let me be clear, I firmly believe, based on my own experience and emerging research, that gut health is a leading factor in the genesis of chronic disease. However…

…the more patients I treat with complex, chronic conditions the more I’ve realized we have to dig a little deeper. We have to ask more questions, like: what’s causing or contributing to the gut health issues? What’s causing the chronic inflammation? Why aren’t people getting better who are doing “all the right things”?

The conclusion that some of my most respected colleagues and I have come to is: it’s stress.

Specifically, chronic stress that causes what’s known as Hypothalamus Pituitary Adrenal (HPA) axis dysfunction. Or it’s better known (but less accurate names): adrenal fatigue, adrenal burnout, or adrenal insufficiency).

If you’re suffering from a diagnosis or symptoms that just won’t go away even though you’re doing “all the right things,” listen up! This could very well be the missing link to getting your life back.

What Exactly is HPA Axis Dysfunction, aka: Adrenal Fatigue?⁠

The “HPA” in HPA axis dysfunction refers to your hypothalamus, pituitary, and adrenal glands. Which are all part of your endocrine/hormonal system and communicate through what’s known as the HPA axis.⁠

Your hypothalamus, located at the base of your brain, acts as a traffic cop for the rest of your endocrine system, sending communication to the pituitary gland, which then signals the adrenals, thyroid, and ovaries to secrete hormones.⁠

The terms “adrenal fatigue” and “adrenal burnout” are considered myths by most endocrinologists1, and though many people suffer with real symptoms, the names are not entirely accurate. The adrenal glands (typically) don’t just burn out or lose function. Rather, the body becomes less sensitive to their hormones over time.

I think it’s important to note, however, that sometimes the adrenals do burn out… adrenal insufficiency is a recognized diagnosis characterized by lack of cortisol and other hormones. The most common cause is an autoimmune disease called Addison’s.

So What Causes HPA Axis Dysfunction?

In a word: stress…specifically, chronic stress.⁠ Just like in relationships, when our bodies are stressed, communication starts to break down.2

Here’s how that works:3

When you’re under stress, your hypothalamus releases Corticotropin Releasing Hormone (CRH), which signals the pituitary to release Adrenocorticotropic Hormone (ACTH) which triggers the adrenal glands to release the stress hormone cortisol.⁠

This triggers our fight or flight response, which is essential for dealing with acute periods of stress…like if you were chased by a wild animal or had to rescue your child from a sudden fall.⁠

However, since cortisol triggers a release of glucose to bolster your energy, while suppressing your digestive system, immune system, reproductive system, and insulin production, it’s not sustainable long-term.⁠

The tricky thing about chronic stress is the longer we’ve been “surviving” in this state, the more “normal” it feels to always feel tense, aggravated, on-edge, hyper, wired and tired, etc.

In fact, being “so stressed”, “exhausted”, and “busy, busy, busy!”, is often considered a sign of success. Which is unfortunate because it comes at the expense of our health, healing, and happiness.

I myself have had to learn to temper my ambitions on several occasions to heal from chronic disease, get through a tough emotional time, and/or avoid defaulting into that “chronic stress culture.” So I know the struggle we all face…especially as we become parents, build our careers, start businesses, try to save the world, etc.

The point is, while fight or flight is a God-send for getting you through acute phases of stress, you cannot exist in that state for long without experiencing body breakdown.

It’s also worth mentioning that maternal stress has been shown to predispose babies to HPA axis dysfunction.4, 5. So if you’re pregnant or thinking of becoming pregnant, NOW is a really good time to join the counter-chronic-stress-culture movement.

Before we go on, I want to emphasize an important point that’s often left out of discussions on chronic stress/HPA axis dysfunction: the mind-body connection.

There are physical and mental/emotional sources of chronic stress. Some of which are unavoidable, such as an acute or chronic disease, a recent injury, trauma, a new baby, the loss of a loved one, or a toxic marriage/work environment.

If you’re experiencing any of these (and we all do at some point) I urge you not to give up on yourself. Even during times of unavoidable stress, you can take steps to protect yourself even if you can’t fully escape the circumstances. We’ll look at some proven ways you can accomplish this coming up.

Symptoms of HPA Axis Dysfunction

Since HPA axis dysfunction causes elevated cortisol and low hormones levels across the board, it can result in the following symptoms:6, 7, 8, 9, 10, 11, 12, 13

  • Anxiety⁠
  • Autoimmune disease
  • Blood pressure imbalance
  • Blood sugar imbalance
  • Brain fog⁠
  • Chronic Fatigue Syndrome
  • ⁠Depression
  • Digestive disorders/Gut health issues
  • Fatigue (often extreme, like you can’t get enough sleep)⁠
  • Infertility
  • Inflammation⁠
  • Insomnia⁠
  • Low immunity⁠
  • Low libido
  • Mood swings⁠
  • PMS
  • PTSD
  • Seasonal affective disorder
  • Inflammatory skin conditions
  • Slow healing
  • Thinning hair
  • Thyroid issues⁠
  • Trouble with focus and concentration
  • Weight gain around the midsection and upper back

HPA Axis Dysfunction Also Affects The Vagal Nerve, A Critical Player In The Gut-brain Connection

What is the vagal nerve aka: vagus nerve? It’s the longest cranial nerve that meanders from your brain all the way to your gut, interacting with various organs and systems in its path.

This tree-like nerve works like a super-highway, shuttling information from brain to gut and everything in between. The vagus nerve is also the main component of your parasympathetic nervous system—which controls your rest-and-digest response and oversees other critical functions like mood, heart rate, and immune response.14

Unfortunately, chronic stress and HPA axis dysfunction can cause your vagal nerve to lose its tone over time. This creates a cascade of issues that can affect things like digestion, stress response, heart health, inflammatory response, your ability to relax, mental health, and others.

Fortunately, there’s been some great research into tools and lifestyle practices that will re-tone your vagus nerve and help reset your stress response, gut health, and help with HPA axis dysfunction…which we’ll explore next.

How To Heal And Deal With HPA Axis Dysfunction And Get A Handle On Chronic Stress

Let’s face it, life can get stressful. And I see this as an even bigger issue in patients with childhood trauma.

So let’s start working on it, shall we? Here are 13 ways to heal HPA axis dysfunction.

  1. Get more quality and quantity of sleep—since HPA axis dysfunction can make you feel tired all the time, it can be hard to tell if you actually got a good night’s rest. To track this, I recommend (and use) an Oura ring which gives me data on my quantity and quality of sleep. Better sleep is absolutely essential to restoring optimal HPA axis function,15 so aim for 8-10 hours a night while you’re healing. And if you have trouble sleeping (because it can be a vicious cycle) talk to your doctor about adding melatonin, ashwagandha, l-theanine, magnesium, or other natural sleep aids.
  2. Just the right amount of exercise—stressed out adrenals do not like strenuous, lengthy workouts like marathons. However, exercise is important because it can help regulate cortisol, insulin, and glucose levels while boosting your mood and promoting sleep. Which means, you’ll have to find the right balance for you, and you have full license to tone down your workout a bit if you’re overtraining! I’ve become a Peloton fan post-pandemic, but yoga and walking are excellent for HPA patients. One of my favorite video platforms is Citizen Yoga on Demand. 
  3. Spending time in nature and disconnecting from technology—there is a ton of research to back up the dirt-cheap effectiveness of spending time outdoors to reduce stress. For example, the simple act of “grounding” aka: “earthing”, which means having direct contact with the earth via gardening, walking around barefoot, swimming in natural water, or using a grounding mat (more on that in the next point) significantly reduces cortisol levels and improves vagal nerve tone.16 Additional research shows that just 10 minutes a day of time spent in greenspace can be enough to reduce stress and enhance your well-being.17
  4. Meditation—meditation has been proven to help improve vagal nerve tone, reduce inflammation, and reduce stress.18 Plus these days, it’s really easy to learn how. Some of my favorite resources include: Muse Meditation Headband, HeartMath (heart rate variability training) and my newest obsession the PEMF Mat.
  5. Pulsed Electro-Magnetic Field (PEMF)—works by sending a low-level frequency throughout your body, similar to the Earth’s natural electrical frequency that you’d experience from walking outdoors barefoot, which recharges your cells and organs while helping reset your stress response. It also uses infrared technology to reduce pain and promote relaxation, and releases antioxidant-rich negative ions for even greater healing benefits. I use my PEMF Mat daily, and even more often when stress is really high — because it helps! Learn all about it here (plus use DRMAREN75 for $75 off!).
  6. Breathwork—slow, deep breathing stimulates activity of the vagal nerve, promotes better sleep, and activates our parasympathetic nervous system response.19 And you can do it from anywhere! I love doing the 4-7-8 breath and focusing on longer exhalations vs. inhalations. But any type of breathwork including Oujai breath, belly breathing, etc. will benefit your HPA axis.
  7. Sex and orgasms help too—chronic stress can really mess with your libido, but sex is also ahhh-mazing for stress relief, mental health, parasymptathetic nervous system response, heart rate variability, hormonal balance in some cases, and better immunity. All of which have a positive impact on HPA axis function and stress response.20
  8. Adaptogens—these powerful and ancient herbs have been used for centuries to help people adapt to stress and increase energy. And several studies have shown that they positively impact the immune-neuro-endocrine-system and HPA axis.21 In other words: they are one of your best tools to help mediate those inevitable, stressful times in life! My favorites are Ashwagandha and Rhodiola Rosea, but other adaptogens include ginseng, schisandra, goji berry, cordyceps, licorice, turmeric, and Tulsi (Holy Basil).
  9. Addressing underlying health issues—remember stress can be caused by physical and environmental issues too (known or unknown), especially those related to inflammation and toxins. So be sure you’re working with a functional medicine physician to help you diagnose and treat these at the root cause.
  10. Therapy—in cases of trauma, grief, or any mental/emotional pain that won’t go away, I recommend seeking the help of a qualified therapist. If you’re lucky, you may even find one trained in Functional Medicine as “holistic psychology” is becoming more popular. You can always check out: ifm.org/findapractitioner to search for one in your area.
  11. Dynamic Neural Retraining System (DNRS)—this is a really cool training program that helps get to the root cause of an overactive stress response by retraining your brain. It does this using a combination of mindfulness, meditation, and specific brain exercises that help to rewire the limbic system. The limbic system is intimately connected to your endocrine and autonomic nervous system and can become dysfunctional due to trauma—physical, mental, or emotional.
  12. Dance—any type of dancing, whether solo, with a partner, or a group of friends is excellent for reducing stress and increasing those lovely feel-good endorphins.22
  13. Alone time—taking time to relax and nourish your creative side, especially if you’re a busy mom or dad, is essential to healing from chronic stress. This could mean reading, cooking, drinking a cup of tea, taking a walk, whatever makes you feel restored. Make sure you take some time every day to refill your cup. I love to wake up early before my kids and enjoy my toxin-free coffee in peace.
  14. Community—did you know the effects of loneliness or social isolation has been compared to smoking a pack of cigarettes a day? That’s partly because feeling lonely causes an increased activation of the HPA Axis.23 The solution? Get involved in a community. I know it’s easier said than done sometimes, especially post-COVID, but it is extremely important to surround yourself with people who care. This could mean joining a Meetup group of some sort, taking a course, volunteering, joining a church, temple, mosque, etc. reconnecting with old friends, joining a moms or dads club, starting a book club, or hosting a party!  Whatever speaks to you, make sure to make some personal connections regularly for the sake of your health and happiness.

You Have The Tools, Here’s How To Get Started

Healing HPA axis dysfunction is possible and essential if you want to fully recover from any type of chronic disease.

As I tell my patients, you can take all the best supplements and eat all the right foods in the world, but if your HPA axis is off and you’re chronically stressed out, you will not heal completely.

Sure, you may heal enough to feel better, get your lab markers within range, and get rid of your symptoms for a period of time. But, without addressing the chronic stress piece those pesky symptoms, or new ones, will crop up again. Annoying, but true.

Healing won’t happen overnight, and the process is different for everyone based on their individual lifestyle, health presentation, history, mental health, life circumstances, etc. But you can do it!

The first step is to choose 2 or 3 of those lifestyle recommendations listed above and commit to them. Even if it’s as simple as spending 10 minutes in nature every day and getting more sleep, those small changes can make a dramatic impact on your HPA axis function.

The next step would be to find a functional medicine physician well-versed in HPA axis dysfunction, to help you get to the next level of healing. That typically means taking a thorough health history, running lab work to check your hormonal/adrenal status, search for underlying infections and nutrient deficiencies, and create a custom program to help you heal and get on with your life.

If you’re located in Colorado, Michigan, or Texas I’d love to see if I can help. Click here to learn more about my approach to functional medicine and how to become a patient.

Not in my tri-state area? I’d still love to keep in touch (as I will likely broaden my scope of practice in the future). Click here to join the mailing list and/or join the fun on Instagram @drchristinemaren and @heymami.life. 



  1. https://pubmed.ncbi.nlm.nih.gov/27557747/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860380/
  3. https://onlinelibrary.wiley.com/doi/10.1002/cphy.c150015/figures
  4. https://pubmed.ncbi.nlm.nih.gov/20550950/
  5. https://pubmed.ncbi.nlm.nih.gov/16123758/
  6. https://www.nature.com/articles/s41380-019-0501-6
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181830/
  8. https://www.ncbi.nlm.nih.gov/books/NBK541120/
  9. https://pubmed.ncbi.nlm.nih.gov/30621143/
  10. https://pubmed.ncbi.nlm.nih.gov/18488870/
  11. https://pubmed.ncbi.nlm.nih.gov/26356039/
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5979578/
  13. https://pubmed.ncbi.nlm.nih.gov/30342071/
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859128/
  15. https://pubmed.ncbi.nlm.nih.gov/25905298/
  16. https://www.ncbi.nlm.nih.gov/pubmed/3344267
  17. https://www.frontiersin.org/articles/10.3389/fpsyg.2019.02942/full
  18. https://www.biologicalpsychiatryjournal.com/article/S0006-3223%2816%2900079-2/fulltext
  19. https://pubmed.ncbi.nlm.nih.gov/25234581/
  20. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1743-6109.2009.01677.x#ss41
  21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240259/
  22. https://www.researchgate.net/publication/334281938_DANCING_TO_RESIST_REDUCE_AND_ESCAPE_STRESS
  23. https://pubmed.ncbi.nlm.nih.gov/29972603/

About Dr. Maren

Christine Maren D.O., IFMCP is a board-certified physician and the founder of a virtual functional medicine practice in Colorado, Michigan, and Texas.  She is best know for her work in thyroid, gut and reproductive/ preconception health. Dr. Maren is board-certified by the American Board of Family Medicine and is an Institute for Functional Medicine Certified Practitioner (IFMCP)

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