How to Use Nutrition to Support Your HPA Axis

Lately, I have been working with an increasing number of nutrition clients with complex health issues, including Lyme disease and mold illness. Many of these individuals present with an impaired stress response, also referred to as HPA axis dysfunction. Left unaddressed, HPA axis dysfunction adversely impacts an array of body systems and can hinder your recovery from chronic illness. Targeted nutrition interventions can help immensely with HPA axis recovery as part of a comprehensive treatment protocol. Read on to learn about the effects of HPA axis dysfunction on your body and how specific nutrition interventions can help restore HPA axis balance.

What is the HPA Axis Dysfunction?

The HPA axis is a neuroendocrine system comprised of the hypothalamus, pituitary, and adrenal glands. It is your body’s primary stress-response system, coordinating your response to stress while also regulating digestion, your immune system, and energy utilization and expenditure. Throughout millions of years of hominid evolution, the HPA axis was elegantly designed to respond efficiently to acute stressors, such as being chased by a lion. However, it is poorly equipped to handle chronic stressors, which comprise the vast majority of the stressors we face in our modern world. Over time, unrelenting stress can trigger HPA axis dysfunction.

Some of the physiological effects of HPA axis dysfunction include:

  • Glucocorticoid excess, such as high cortisol (1)

  • A bottoming-out of cortisol and other steroid hormones such as estrogen, progesterone, DHEA, and testosterone (2)

  • Alterations in the gut microbiota (3)

  • Increased intestinal permeability (4)

  • Cognitive dysfunction (5)

  • Slowed metabolism (6)

  • Immune dysfunction (7)

The symptoms of HPA axis dysfunction include:

  • Chronic fatigue

  • Feeling extremely groggy upon waking in the morning, or slow to get going

  • Frequent yawning (this may be a sign that your nervous system is trying to “reset” itself)

  • Brain fog

  • Excessive appetite

  • Poor sleep

  • Poor athletic performance/physical endurance

  • Low mood or depression

The symptoms of HPA axis dysfunction share many similarities with other aspects of chronic illness; hormonal testing, such as a DUTCH test, can help determine whether your symptoms are related to HPA axis dysfunction, or triggered by something else.

Chronic Illness and the HPA Axis

Chronic illnesses, including Lyme disease and mold illness, take a significant toll on the HPA axis. First of all, having an illness that is unrecognized by mainstream medicine, largely untreatable through conventional means, and dismissed by loved ones and friends is incredibly stressful. This psychological stress directly impacts the HPA axis.

Secondly, when your body is constantly battling infectious invaders or toxins, such as mycotoxins, this further stresses the HPA axis. (8, 9) One very small study found that in patients with previous diagnoses of Lyme neuroborreliosis, patients who were still struggling with symptoms had a higher cortisol response to synthetic adrenocorticotropic hormone (ACTH, the “parent hormone” that stimulates cortisol release by the adrenal glands) compared to Lyme patients without current symptoms. (10) This suggests that HPA axis dysfunction may contribute to the pathogenesis of chronic Lyme disease.

In my own journey with complex chronic illness that began in my late teens, I wish I (and my healthcare providers) had known more about the HPA axis, as I am convinced that addressing this aspect of my physiology would have significantly accelerated my recovery.

Nutrition for HPA Axis Dysfunction

With the growing number of clients in my practice struggling with chronic illness and HPA axis dysfunction, I realized that I needed to develop some basic nutritional guidelines to support HPA axis recovery. To restore healthy HPA axis activity, you must resolve the underlying causes of HPA axis dysfunction, such as chronic infections, toxic exposures, and psychosocial stressors. However, nutrition can provide powerful adjunct support in your healing journey.

Don’t Restrict Calories or Carbohydrates – Especially If You are a Woman

All too often, I see my clients with HPA axis dysfunction on low-carbohydrate diets. Some are on a low-carb diet intentionally because they have gut issues and believe they must avoid all carbs; others are have inadvertently gone low-carb due to food sensitivities and a seriously restricted food repertoire. Unfortunately, low-carb is often more harmful than helpful when it comes to HPA axis dysfunction, especially in women.

The primary hormone that is dysregulated in HPA axis dysfunction is cortisol. Low-carbohydrate diets, including ketogenic diets, have been found to activate the HPA axis and increase cortisol. (11) Chronic dieting and caloric restriction also appear to increase cortisol. (12)

If your HPA axis is already imbalanced, a low-carb diet may act as yet another stressor on your body and worsen, rather than improve, your symptoms. Conversely, increasing carbs may actually help you lose weight by lowering cortisol and improving your HPA axis function! (12) In fact, a recent study found that increasing dietary carbohydrates are part of a whole foods diet reduced circulating cortisol and dampened psychological stress-related cortisol responsiveness. (13) Eating sufficient carbs may be especially important for women with HPA axis dysfunction, as estrogen has been found to potentiate stress responsivity. (14)

The types of carbs you eat are crucial, as carbohydrate foods with a high glycemic load may worsen HPA axis dysfunction by triggering blood sugar fluctuations and raising cortisol. (15) I typically find that Paleo-friendly carbohydrates, such as sweet potatoes, plantains, and whole fruit, are best tolerated by my clients who are in recovery from HPA axis dysfunction.

The amount of calories you need to eat each day to sustain healthy HPA axis function depends on a variety of factors, including your age, sex, body composition, and activity level. I continue to be surprised by the number of clients in my practice (females especially) who are eating insufficient calories. While this is a detailed discussion that varies on an individual basis, I think it is safe to say that eating 1,200 calories a day or less is absolutely insufficient for maintaining physical (and psychological) well being in a completely healthy person, let alone someone recovering from a chronic illness and HPA axis dysfunction.

Try Carb-Back Loading

Another way to fine-tune your carbohydrate intake to support your HPA axis is to practice carb back-loading. Carb back-loading is an eating strategy in which you eat the majority of your carbohydrates with your evening meal rather than spread throughout the day; while there is not much research yet on carb back-loading, I have found that it helps many of my clients maintain more stable blood sugar levels over the course of the day. Managing blood sugar is essential for HPA axis recovery, so anything we can do nutritionally to support healthy blood sugar is going to have downstream benefits on your HPA axis.

Maintain Consistent Mealtimes

Intermittent fasting is certainly popular right now! However, if you have HPA axis dysfunction, it may not be a healthy choice for you.

Intermittent fasting is certainly popular right now! However, if you have HPA axis dysfunction, it may not be a healthy choice for you.

If you are suffering from HPA axis dysfunction and are currently practicing intermittent fasting, you may want to consider giving fasting a break until your symptoms are improved. In my clinical practice, I’ve found that intermittent fasting, especially in women, can exacerbate symptoms of HPA axis dysfunction; again, this goes back to the potentiating effects of estrogen on stress responsivity in females.

If you are recovering from HPA axis dysfunction, I recommend that you limit your fasts to 13-14 hours overnight; this will give your body sufficient time to engage in cellular “cleaning” processes overnight and promote healthy gastrointestinal motility, without launching your body into a stressed-out state. In addition to engaging in shorter overnight fasts, I also recommend that you eat three meals a day, on a consistent schedule. Once your HPA axis is functioning better, you can reconsider incorporating intermittent fasting into your routine.

Eat a High-Protein Breakfast

Dietary protein is essential for maintaining blood sugar stability. I recommend that you aim for at least 1 g protein/kg body weight per day. Aim to eat at least 25 grams of protein with breakfast, as this may positively impact your blood sugar over the course of the day. Combining this high protein intake with a lower carb intake at breakfast has been found to significantly improve glycemic variability over the course of the day; (16) this reduced glycemic variability may, in turn, beneficially impact your HPA axis.

Fermented Foods

Fermented foods aren’t just good for your gut; research indicates that probiotics species commonly found in fermented foods can also support a healthy HPA axis by influencing the gut-brain axis! (17) If you aren’t already eating fermented foods, consider incorporating at least one serving per day to support your HPA axis. Sauerkraut, kimchi, and coconut or almond milk yogurt are good options.

Eat Vitamin C-Rich Foods

Vitamin C plays a critical role in the human stress response, and is rapidly used up by the body under conditions of chronic stress. (18) According to the authors of a recent study on the “adrenal-vitamin C axis:”

“Supplementation of ascorbic acid [vitamin C] in humans and animal models is associated with a decreased cortisol response after a psychological or physical stressor.”

— Hooper MH, et al. The adrenal-vitamin C axis: from fish to guinea pigs and primates. Critical Care. 2019; 23: 29.

Based on this research, restoring and maintaining a healthy vitamin C level appears to be essential for healthy HPA axis function. To bolster your vitamin C level, eat several servings daily of lightly-cooked broccoli or Brussels sprouts (light cooking preserves the water-soluble vitamin C content), bell peppers, papaya, kiwi, cantaloupe, citrus fruits, and strawberries.

Omega-3 Fatty Acids

Research shows that HPA-axis dysregulation is associated with low omega-3 fatty acid levels in the blood, and omega-3 fatty acid supplementation has been shown to reduce the biological stress response. (19, 20) I recommend that you include seafood in your diet 2-3 times a week and supplement with a combination of EPA/DHA at a dose of 3000-4000 mg per day to support the recovery of your HPA axis.

Green Tea

While a heavy intake of caffeine can exacerbate HPA axis dysfunction, I am of the opinion that green tea (which contains moderate amounts of caffeine) can be a perfectly healthy part of your recovery diet due to its beneficial effects on the HPA axis. Phytochemicals in green tea, such as l-theanine and EGCG, attenuate HPA axis hyperactivity while also alleviating inflammation and supporting gut health. (21)

A Processed, Western Diet Exacerbates the Biological Stress Response

Importantly, all of the nutrition interventions suggested here are best done in the context of an unprocessed, whole foods-based diet. Processed “Western” diets, high in sugar and fat, have been found to exacerbate the HPA axis-mediated stress response. (22) Therefore, removing the processed and refined foods that trigger this unhealthy response is essential for HPA axis recovery.

Nutrition + Lifestyle for Optimal HPA Axis Function

While nutrition goes a long way towards supporting the recovery of healthy HPA axis activity, lifestyle is equally important. Poor quality sleep, overexercising, spending too much time on social media and digital screens, unhealthy relationships, poor body image, and other psychosocial stressors take a huge toll on the HPA axis. These factors must be addressed alongside chronic infections, toxic exposures, and nutrition when developing a comprehensive protocol for HPA axis recovery.

Are you struggling with possible HPA axis dysfunction? Consider working with me! I am currently accepting new clients in my clinical nutrition practice. If you’re interested in diving deep into improving your health by working one-on-one with me, reach out to me here to schedule your discovery call. The discovery call will allow us to meet and talk together to decide if my nutrition services are the right fit for your needs. I look forward to connecting with you!

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