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Understanding the HPA Axis + Stress Hormones

by Dr. Mitchell Rasmussen, DC, CFMP, FRC-ms

The primary 'system' governing our stress response is the HPA Axis. HPA= Hypothalamus, Pituitary Gland, and Adrenal Glands. The hypothalamus and pituitary are found in the brain. The adrenal glands are a pair of glands located just above the kidneys. Together, these structures work in concert to recognize and respond to stress using chemical messengers, aka hormones.

HPA Axis Anatomy brain and adrenals and stress hormones

When we are exposed to a stressor, the hypothalamus signals to the pituitary which in turn signals the adrenal glands to release stress hormones (cortisol and adrenaline). This is how the body copes with acute stress.

For acute stress (think, predator chasing you to eat you and you run to survive), this works great. The problem in modern times is not typically the life or death struggle, but the chronic “death by 1000

paper cuts” type of stress. Chronic stress keeps the HPA Axis constantly engaged. Your system is essentially stuck scanning for threats all day. This taxes the adrenal glands and also causes all sorts of bodily issues: mood dysregulation, gut mucosal breakdown (leaky gut), heartburn, sleep issues, libido changes, immune dysfunction, thyroid problems, appetite swings, and so on and so forth.

When we zoom out and look at the HPA Axis Feedback Loop, it gives us an idea of how dysfunction can manifest:

HPA Axis Feedback Loops

Notice how an ongoing stressor will continue to drive cortisol release, even though cortisol is inhibitory to the brain structures (giving negative feedback to the Hypothalamus + Pituitary) for stress hormone release. Over time, just as elevated blood sugars eventually lead to insulin resistance, the chronically elevated cortisol leads to 'cortisol resistance'.

<<Excess cortisol is floating around "knocking on the door" and no one is answering.>>

Because your cells have stopped responding to cortisol, they now begin secreting inflammatory substances as a response. (Yikes..) What is supposed to be an anti-inflammatory hormone has now RAMPED UP inflammation in the body.


Stress Hormones + Sex Hormones Interact

When under chronic stress (continued HPA Axis activation), the body shifts away from producing sex hormones and into producing more stress hormones. Evolutionarily, this makes sense. When we're running from predators or in the midst of a famine, this is NOT the time to procreate.

While the concept of 'pregnenalone steal' is still fairly new... we DO see clear correlations in clinical data of high stress hormones and low stress hormones. There is only so much substrate to make these chemical messengers (from Cholesterol), and when cortisol gets priority- little is left over to make sex hormones.

Steroid Hormone Pathways in the body downstream effect on stress

Stress directly causes or exacerbates every chronic condition we suffer from.

Stress hormones (like cortisol) are a contributor to leaky gut. Stress hormones elevate levels of certain immune mediators in the blood stream. The stress response, over time, even tends to make our cognition slow and our metabolism dysfunctional. Stress response, over time, tends to wreck us.

The body does what it can to cope, until it can’t anymore. When it can’t cope anymore; whatever underlying condition(s) we may have immediately become(s) exacerbated.


How To Improve The Stress Response:

1. Deep Breathing / Meditation / Something Similar

Daily mindfulness of deep breathing will teach the diaphragm to relax. Especially for those who suffer with racing thoughts and anxiety, using the diaphragm as a means into your Nervous System through your Vagus Nerve just makes sense. Belly breathing is good for a whole host of reasons; for stress management we want to better tap into the parasympathetic (rest/digest) state versus the sympathetic (fight/flight) state.

2. Laughter

Laughing helps increase activity of the parasympathetic nervous system. Seek out activities you enjoy, those that bring you peace and joy. Engage in these activities as often as possible; at least daily.

3. Sleep Hygiene

Getting to bed in alignment with your circadian rhythm is important. Early bedtimes and adequate sleep allow the adrenal glands to rest. Try to foster habits near bedtime that allow your body to kick into a resting state. This can include mitigating blue light exposure, avoiding big decisions, and establishing a regular routine.

4. Dietary Choices

Ideally, an adrenal support diet would avoid caffeine, simple carbohydrates, and partially hydrogenated vegetable oils. Good protein sources, fruits, vegetables, and healthy fats should be included. Small meals should be eaten perhaps a bit more frequently (hunger can kick you into the sympathetic state). Use mindful eating habits like adequately chewing your food and distraction-free meal times.

5. Adaptogenic herbs

Adaptogenic herbs help the body with a more balanced stress response. They help regulate stress hormone production, as well as help modulate cellular sensitivity to stress hormones. This in turn encourages a more appropriate bodily response to stress overall. Maca, rhodiola, corydalis, ashwagandha are just a few different adaptogens we use with great success clinically. <<Explore Supplements>>


If we get enough of our biochemistry working better, THEN your body should be better able to handle other stressors that come your way. We think about it kind of like patching up holes in a leaky boat. There might be 30 holes in the boat. Filling in one or two of them won't keep the boat floating for long. We need to fill in enough of the holes so that eventually, your body can functional well.

Mitchell Rasmussen Functional Medicine Doctor Denver Colorado

Dr. Mitchell Rasmussen, DC, CFMP serves as Director of Functional Medicine at The Facility in Denver, CO. He sees patients in-person and via Telehealth to get to the root cause of dysfunction and restore a state of well-being using nutritional intervention, supplementation, and lifestyle change.


Functional medicine Denver co

Want to work with a functional medicine doctor to run labs and assess nutrient status? Struggling with hormone imbalance, IBS, weight gain, mood changes? Let's look at BIOCHEMISTRY. Read more about Functional Medicine at The Facility here.

Not sure where to start?

CLICK HERE to schedule a FREE 15-Minute Consult with Kate to determine your best course of action!

Or reach out by email


Understanding the HPA Axis - Functional Medicine - The Facility Denver


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Dr. Mitchell Rasmussen - Doctor of Chiro
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