The Role of the HPA Axis

In order to understand how adrenal issues and sex hormone imbalances manifest within the body, we need to understand how the Hypothalamus-Pituitary-Adrenal Axis functions.

The hypothalamus is a section of the brain, about the size of an almond, which has the important job of linking the nervous and endocrine systems together. The hypothalamus receives and sends inputs to and from other regions of the brain, as well as the nervous and immune systems, in order to regulate the secretion of hormones.

The hypothalamus is also is in charge of maintaining a state of homeostasis in the body. It does this by controlling many of the body’s key processes such as appetite, body temperature, heart rate, blood pressure, sleep cycles, fluid and electrolyte balance, as well as influencing the pituitary to release hormones.

The hypothalamus is in direct contact with the pituitary, a small, pea-sized, organ located at the base of the brain.  It is made up of two parts – the anterior lobe and posterior lobe.  The anterior lobe produces and releases hormones, while the posterior lobe only releases hormones. The hormones released by the pituitary regulate the functions of the other endocrine glands in the body (thyroid, adrenals, ovaries and testes).

Together the two glands form several functional axes, including the Hypothalamus Pituitary Adrenal axis, Hypothalamus Pituitary Thyroid axis and Hypothalamus Pituitary Gonad axis.

The hypothalamus could not do its job without the pituitary and the pituitary could not do its job without the hypothalamus.

The hypothalamus is directly affected by any kind of stress – real or perceived. Lack of sleep, an inflammatory diet, a virus or infection in the body, stress at work, fighting with your spouse or financial stress can all affect the hypothalamus.

When your body perceives something to be stressful, the hypothalamus releases corticotrophin-releasing hormone (CRH), which is then sent directly to the pituitary. In response, the pituitary releases adrenocorticotrophic hormone (ACTH).

ACTH is then sent directly to the adrenals, signaling to the adrenals to produce cortisol.

In a well functioning negative feed back loop the hypothalamus will sense the increased level of cortisol in the blood and slow down production of CRH.

However, this isn’t always how the feedback loop ends up working. When we are under chronic stress all of the time the hypothalamus continues to receive those signals (which tell it to continue the stress response and release more CRH), along with the signals from the already high levels of cortisol (signaling to slow down the stress response). The hypothalamus gets confused, and ends up choosing to listen to the signals telling it to produce more cortisol (because those are the life-threatening signals). This results in continued levels of high cortisol output. You can read more about what cortisol is here.

So what happens when our cortisol levels stay elevated?

There are two parts to the adrenal glands – the adrenal cortex and the adrenal medulla. The adrenal cortex is broken down into three different zones ( zona glomerulosa, zona fasciculata and zona reticularis)– all of which have different functions.

When the body is under chronic stress and the hypothalamus is continuously receiving signals to produce additional cortisol it results in more ACTH being sent from the pituitary to the zone of the adrenal cortex that produces cortisol (and less to the zones which creates sex hormones).

This can result in elevated cortisol levels (which may stay elevated for prolonged periods of time) and decreased sex hormone levels. But the issue here isn’t the adrenals – it’s the mixed signals the hypothalamus is receiving.

So as you can see, there is nothing “fatigued” about the adrenals. The adrenals are functioning just fine and doing their job of producing cortisol when signaled to do so. The issue lies with the mixed signals the hypothalamus is receiving.

So how do we get the body to stop sending mixed signals to the hypothalamus? We can start by reducing as much stress as possible – real or perceived, and making an effort to offset the stress we cannot reduce. We want to reduce the amount of time our body spends in fight or flight as much as possible. Spend more time in nature, turn off your cell phone occasionally, read and journal or do whatever alleviates stress for you.  You can read some of my favorite ways to reduce stress here.

If you suspect you may have HPA axis dysfunction, elevated (or depleted) cortisol levels or sex hormone imbalances and are interested in comprehensive hormone testing you can contact me at veronica@veronicamcnelis.com

Clearing the Confusion about Cortisol

Cortisol tends to get a bad rap. And while it's true prolonged elevated cortisol levels are not good, cortisol in general is not bad. I hope to clear up some of the confusion about cortisol and "Adrenal fatigue" in this blog. 

Cortisol is a steroid hormone produced in the zona fasciculata within the adrenal cortex. It falls into the glucocorticoid class of hormones – meaning it plays a role in the metabolism of glucose.

Cortisol is released in response to stress and low blood-glucose levels. Cortisol will work to increase your blood sugar levels when they are low, suppress the immune system and to aid in the metabolism of protein, fat and carbohydrates.

Cortisol also follows a pattern of diurnal variation for circadian rhythm - meaning cortisol levels are highest in the morning after waking (you get a surge of cortisol within the first 15 minutes of waking, giving you energy) and slowly taper off throughout the day, until they reach their lowest point at about 3-4 hours after the onset of sleep (around 1am).

As you can see in the above example the patient's cortisol levels are above-range in the afternoon. Ideally all four measurements throughout the day would be in between the low and high range limits.

As you can see in the above example the patient's cortisol levels are above-range in the afternoon. Ideally all four measurements throughout the day would be in between the low and high range limits.

As I mentioned cortisol is released in relation to stress. This means cortisol is the hormone that is released when we enter ‘fight-or-flight’ mode. When we experience stress – real or perceived our cortisol levels rise. If we are truly in a fight-or-flight situation this greatly benefits us. We want our cortisol levels to rise when we are under stress, but we also want them to decrease again shortly after, as prolonged period of elevated cortisol do not benefit us.

Prolonged periods of high cortisol levels will lead to a wide variety of negative symptoms. Cortisol suppress the immune system, damages the hippocampus (leading to impaired learning), can lead to weight gain in the waist, and reduces bone formation.

When we are under prolonged periods of stress we begin to see problems with the HPA axis negative feedback loop. The hypothalamus is constantly being hit with signals telling it that there needs to be more cortisol in the body, so in response the hypothalamus releases more CRH. The pituitary then releases more ACTH and the adrenals in response attempt to produce more and more cortisol. The hypothalamus will then sense the increased levels of cortisol in the blood and try to down-regulate the production of CRH in response to the increased levels, but because the hypothalamus is still receiving other signals from the body telling it to make more cortisol, the hypothalamus begins to get confused. The hypothalamus listens to the signals telling it that your body needs more cortisol (because those are the life threatening signals), despite the adrenals basically trying to say to your hypothalamus “nope we’re good here – no more cortisol!!” (This is why the term ‘adrenal fatigue’ technically is not correct – it’s not that the adrenals are too tired to make cortisol, it’s that there is an issue somewhere in the HPA Axis. The only true “Adrenal Fatigue” is Addison’s Disease, also known as primary adrenal insufficiency, which is when the adrenals do not produce enough steroid hormones.)

This is when the person begins to enter the first phase of HPA Axis dysfunction. This first phase is called the acute phase. This is where we see high daily total free cortisol output – but the normal diurnal rhythm may be flawed, resulting in feeling wired at night, but exhausted in the morning. Other common symptoms in this phase include weight gain in the waist, increased blood sugar levels, increased inflammation in the body, immune system imbalances, trouble concentrating, and low libido to name a few.

Eventually the body can no longer sustain the high free cortisol levels, and free cortisol (not to be confused with total cortisol) levels start to drop. This is what we consider the compensatory phase of HPA Axis dysfunction. Total output of cortisol for the day is technically “in-range” in this phase but this is where symptoms really begin and the person starts to not feel well. We see circadian rhythm issues, sex hormone imbalances show up on lab work, neurotransmitters imbalances, elevated Cortisol to DHEA ratio, decreased memory, loss of muscle mass, along with the symptoms from the acute phase.

If someone does not work to decrease their stress levels, and increase their metabolic reserve they may enter the third phase, which is the exhaustion phase. In this phase free cortisol levels are low and generally the person is very fatigued. Symptoms of decreased free cortisol include fatigue, frequent illness, joint pain, muscle pain, low blood pressure, dizziness, weakness, increased thirst, digestive issues, depression/low mood and hypoglycemia. Normal every day activities like going to work or taking out the trash may seem overwhelming due to fatigue.

The three phases of HPA Axis Dysfunction

The three phases of HPA Axis Dysfunction

In these three phases what we are actually measuring is FREE cortisol. Free cortisol only makes up about 1% of the total cortisol output by your body, but is the active form of cortisol.

Cortisol can circulate in the body bound to a carrier protein, or it can circulate free. Bound cortisol does not have the ability to act in the body (it does not play a role in the important functions listed above – only free cortisol does).  We use free cortisol to assess the up and down daily cortisol pattern, but since free cortisol only makes up about 1% of the total cortisol output, it does not tell us how much cortisol is actually being made in the body. (Therefore when running lab work to assess your cortisol levels it is important to measure metabolized cortisol levels as well - which is another reason the term "adrenal fatigue" is technically incorrect. Total cortisol output may actually be in-range or even high, while free cortisol levels are low. So the adrenals actually aren't fatigued at all.)

Metabolized cortisol is the sum of three cortisol metabolites. Hormone metabolism is the process of hormones being processed by the body through the liver through phases I and II of detoxification, before they can be excreted out of the body. As the hormones undergo this process they are turned into metabolites. Metabolized cortisol gives us a better idea of total cortisol output from the adrenal glands.

Cortisone is the inactive form of cortisol. But don’t confuse cortisone with hydrocortisone. Hydrocortisone is cortisol. If you take a hydrocortisone supplement (usually in the form of a cream), you are taking active cortisol. However cortisone, the inactive form of cortisol, is converted from cortisol via an enzyme located in the kidneys, saliva glands and colon. Since cortisone is the inactive form of cortisol, it is not able to do all the important functions cortisol is able to, like balancing blood sugar and fighting against stress. Cortisol CAN be reactivated back into cortisone, through an enzyme located in the liver, fat tissue and nervous system - which is why it's important to measure cortisone levels as well!

So how do you begin to regulate your cortisol levels so they are in a healthy and optimal range again?

The first suggestion I have is learn to listen to your body. Does something feel off? Do you have any of the symptoms listed above? We live in a society where we glorify hustling and multi-tasking. We think pushing through it is what we are supposed to do, but that is only hurting us in the long-term.

Prioritize sleep and stress-reduction. Plan relaxing activities for yourself and make it a priority – whatever that means for you, whether it’s meditating, taking a bath, going for a walk, turning your phone off for a few hours or watching a comedy. I suggest to all my clients to find a way they can reduce stress daily – something that can be done easily without much effort each day, and also find something they can do weekly that may take up more time. Living in the 21st century it’s hard to reduce stress, I know. But you only get one body, make treating it right a priority.

Is social media distracting you from living in the present moment?

I deleted all of the social media apps off of my phone for the last 48 hours. And it was the most relaxing 48 hours I’ve had in a while.

Over those 48 hours I was able to be more present. I was able to fully enjoy sitting on the beach listening to the ocean waves. I was able to spend more time journaling and reading, because I wasn’t staring at my phone as much. I was able to really think about and consider everything happening in my life, instead of being side tracked by someone else’s life. 

Over those 48 hours I also realized how often I pick up my phone and open social media. It has become such a frequent and automatic habit, it’s amazing I manage to even get anything done. As someone who is building an online business, but is also a functional nutrition practitioner and realizes the negative impact that electronics and social media can have on health, this is something I really struggle with. There are days I wish social media or cell phones didn’t exist. Social media has taken away from the value and beauty of being present.

Yet, in a way I really do love social media. It has connected me to so many people around the world I now consider friends, who I would have never met without it. It has allowed me to help others whom I wouldn’t have had the chance to work with otherwise. 

But yet, it can make a big (negative) impact on our daily lives. How many times have you mindlessly ate way more than you intended to because you were staring at your phone or laptop while eating? How many times have you wasted an hour or more scrolling through social media when you could have been exercising or reading a book? How many times have you not been fully engaged in a conversation because you had your cell phone out? 

We do these things all the time, perhaps without even realizing it. Taking a social media hiatus, while brief, reminded me how important it is to be present. We only have the current moment. The past has gone, and the future isn’t here yet. The only opportunity we have to fully enjoy life and all it has to offer is in the present moment.

When we are living in the present we aren’t as concerned about what has happened in the past, or what may lie ahead in the future. I find I perceive things differently. When life is going full speed ahead, I’m stressed. I’m worried about what’s going to happen in a week or a month from now. I’m worried about getting everything on my to-do list done. 

But when I take the time to disconnect I am reminded that all I can do is what I am currently doing. I can get all those things on my to-do list done, but only if I stop stressing about the future so much and live in the present. 

How often have you had a long to-do list that you haven’t gotten through as fast you planned because you caught yourself looking at your phone every few minutes? How often have you taken an hour or two to do something that could’ve been done within 30 minutes if you weren’t so distracted by Facebook?

How frequently have you added more mental or emotional stress into your life because you were concerned about what was happening in someone else’s life? Because you fell into the comparison trap on while scrolling though Instagram?

I urge you to incorporate a day into your week where you don’t use social media. Or maybe a weekend every month, or even a full week every few months. See how you feel without it. I think you’ll find you actually aren’t missing out on much without social media, and in fact have been missing out on the present moment.

What would you do with all of your free mental time?

Developing a healthy relationship with food can be challenging. We are constantly being sold diets and cleanses and being told certain foods are "good" or "bad". Ads pop up on our computer screens trying to convince us "this super food will help you lose 10 pounds in three days!" or scaring us with "the #1 food that will make you gain belly fat" (which by the way was a banana, really?! a banana?).

It's hard to know what to believe. It's even harder to not feel some type of guilt or shame around eating certain foods when magazines and diet coaches are telling you you'll gain weight if you do. There's constantly a new diet or cleanse that promises in 10 days you can have the body you've been dreaming of. But chances are you've already tried tons of diets - I know I have. Some of the diets aren't actually that terrible - they tell you to focus on whole foods that are minimally processed. They tell you to eat an adequate amount of protein, carbohydrates and fat - which are important macronutrients are bodies need. But what these diets miss is the mental aspect. We can't eat this way forever. Especially if we haven't changed our mindset around food.

Most of us have been conditioned for so long to overthink food. We are constantly wondering what our next meal will be, or feeling guilty about the food we just ate. It takes up a lot of mental space. Personally, I spent years wasting time thinking about food that could have been time spent thinking about more important things - like my schoolwork or business plans. 

If you didn't struggle with food, what would you do with all of your free mental time?

Would you spend more time actually being present with your friends and family? Would you enjoy social events and actually be able to live in the moment instead of over-analyzing how to navigate the food table? Would you plan vacations or business ideas with less stress and more mental clarity?

I created #EmpoweredEatingEducation, a 6-week group coaching program to help women take their power back over food - resulting in additional free mental time to focus on the more important things in life, instead of the stress of making food choices. This program has been designed to help women heal their relationship with food, so they can make confident decisions around what they choose to eat. I've taken all of the tools and strategies I used to heal my relationship with food and put them into this 6-week coaching program. You can read more about the program and sign up here: https://veronicamcnelis.lpages.co/empowered-eating-education/

Our purpose in life is much greater than to stress about our food choices. We are meant to be creating, loving and living life to the fullest, not mentally weighed down by what we just ate.

 

If you're ready to find your food freedom you can join #EmpoweredEatingEducation here!

The deadline to sign up is Sunday, June 18th at midnight, and the program officially begins Monday the 19th!

3 of My Favorite Ways to Benefit from Himalayan Sea Salt

Himalayan sea salt has been getting a lot of of good press over the past few years and for very good reasons. You may be wondering, "Is it actually that much better for me than regular old table salt?" or "Won't it still raise my blood pressure?". The answers are yes (it is MUCH better for you than table salt!) and no, it won't raise your blood pressure! 

What is Himalayan Sea Salt and where does it come from?

Himalayan sea salt is mined from ancient sea beds 5,000 feet below the Himalayan mountains in the Punjab region of Pakistan. It is over 99% pure, and contains 84 trace minerals (compared to table salt, which has been very heavily processed, stripped of minerals - except sodium and chloride - and bleached - and sometimes even contains added chemicals). You may have heard Himalayan sea salt also called pink salt, rock salt or Himalayan crystal salt.

Himalayan sea salt provides numerous benefits including, but not limited to, reducing asthma and improving respiratory problems, balancing the body's pH levels, purifying air, aiding digestion, improving hydration and mineral status of the body, balancing hormones and blood sugar (through improving insulin sensitivity), all resulting in improved sleep.

There are many different ways to reap the benefits of Himalayan sea salt. The following are my top 3 ways:

1. Eating it

I put Himalayan salt on everything. I think my friends and family are slightly concerned about this, and given what they've been lead to believe about salt in general I don't blame them. But here's why I'm not worried:

Blood pressure is regulated by sodium and potassium maintaining a specific ratio in the body. When sodium levels are too high compared to potassium, your body may not be able to maintain a healthy blood pressure level - potentially resulting in hypertension. Why regular old salt has gotten such a bum rap for raising blood pressure is because it has been stripped of it's natural potassium, but still contains sodium. So if you are eating a diet full of table salt and processed foods containing table salt, your sodium levels are bound to rise. But, unrefined salt like Himalayan sea salt still contains potassium.

Another amazing thing about Himalayan sea salt is that it helps us to digest our food. Stomach acid, otherwise known as hydrochloric acid, is needed in order to properly break down protein. When chloride (naturally found in salt) combines with hydrogen in the stomach, it forms hydrochloric acid. So that salt you add to your grass-fed steak has an added benefit besides just making it taste better.

2. Using Salt Lamps

I keep a salt lamp next to my computer at my work desk and have it turned on for the majority of the day. Salt lamps produce negative ions (in small amounts) which have the ability to neutralize the positive ions in the air. Positive ions are given off by pollen, dirt, dust, and electronics such as computers, televisions and microwaves. Negative ions have the ability to neutralize positive ions (the two bind together) resulting in purified air. (Negative ions naturally occur in nature in much larger quantities from sources like waterfalls, the ocean, sunlight and lightening.)

Salt lamps attract water to their surface and the water is quickly evaporated due to the heat being given off from the lamp (if you have a salt lamp and it appears wet or like it's sweating this is why). Water vapor in the air can carry mold, allergens and bacteria, so when this water vapor is attracted to the salt lamp it is removed from the air.   

3. Going to a Himalayan Salt Cave

Salt caves are an excellent way to relax. The earth is surrounded by a magnetic field that has the same frequency as our brains. All of the devices we are surrounded by everyday, such as cell phones, computers and microwaves, disrupt this frequency. Luckily, pure salt has the exact same frequency as the one which surrounds earth. Sitting in a salt cave (with no electronics!) can help to balance the frequency of your brain, resulting in a more relaxed state.

Sitting in a salt cave can also help to relieve respiratory conditions, reduce allergies and asthma plus so much more!

There are many additional ways to get the benefits from pure Himalayan salt, such as Himalayan salt sole, using salt in your Neti Pot or bath and using a salt inhaler. I urge you to add the benefits of pure salt into your daily life (and throw out your table salt!).