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HPA Axis Abnormalities_Final

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>> Hello there and welcome back. You've probably heard the terms adrenal fatigue or adrenal burnout before, right? Well, today we're going to be talking about why these terms aren't completely accurate. The symptoms people experience are real and there is actually something going on with the adrenals. However, the more appropriate term for adrenal fatigue is HPA axis dysfunction. In this lecture, we're going to talk about how the function of the hypothalamic-pituitary-adrenal axis, known as the HPA axis for short, can break down and the impact that this has on a person's hormonal health. This way, when your clients talk about experiencing adrenal fatigue or burnout or they show the warning signs of HPA axis dysfunction, you'll understand exactly what is going on and how you can best be of service to them. Ready to get started? All right, let's begin by talking about this myth of adrenal fatigue. When the HPA axis is functioning normally, it maintains a diurnal pattern of cortisol release, high in the morning so you have energy to get things done and low at night to allow for restful sleep. Sounds good, right? However, when stress becomes chronic, that nice pattern begins to shift. So called adrenal fatigue happens when the adrenals have made so much cortisol they can no longer respond to the hormone ACTH, which is what stimulates the adrenals to produce the cortisol. Contrary to popular belief, the adrenals don't actually get fatigued. The body is still capable of making cortisol either in the adrenals or by converting progesterone. What's really going on is more of a signal malfunction. When cortisol production gets high enough to impair the ACTH signal from being effective, the whole system gets thrown out of whack by this communication breakdown. Constant stress shuts down primary functions like digestion, reproduction, growth, and rest. The body can only survive so long without these things. The body is intelligent and self-correcting, so when the signals for cortisol start to be ignored, the body tries to get itself back to its normal nutrition, reproduction, immune, and growth functions. The stress system keeps sending the signal out, but the body has stopped paying attention. Think of it like being in a loud coffee shop with a friend. At first, you see and hear everything around you, but after a while, you can shut it all out and focus just on your conversation. All that noise and distraction is still around you, but you are less stimulated by it. So now when an acute stressor shows up, like a physical threat or a severe illness, the body is now sluggish to respond to the stress because it reacts much more slowly to cortisol than it would if the system weren't so overworked. Interestingly, when people begin to have the symptoms of HPA axis dysfunction, their cortisol level is usually not low. The body is still making plenty of cortisol, but it's broken down by the body so fast that it doesn't show up on a regular cortisol test. This is where the original notion that the adrenals are fatigued come from. Special saliva and urine tests are necessary to measure the actual levels of cortisol. Be sure to refer your clients to a functional medicine practitioner who is familiar with this and knows how to interpret the test. Ultimately, when it comes to HPA axis dysfunction, the biggest issue isn't the cortisol levels but rather the pattern of cortisol production. When the body begins to move away from the normal pattern of high cortisol in the morning and low in the evening, your clients will most likely begin to experience symptoms such as insomnia, depression, fatigue, and brain fog. Now let's look at the hypothalamus which is the part of the brain that signals the pituitary and is very sensitive to stress. When the hypothalamus senses stress, it releases hormones that activate the pituitary, which then signals the adrenals to release cortisol. With short-term infrequent stress, this is a good thing. As soon as the stress ends, the body goes back to normal. It's kind of like when someone veers into your lane on the highway and you become hyper alert to avoid getting into an accident. Maybe you change lanes or the other car exits and then your cortisol drops back down to normal levels and all is well in the world. This is called the alarm phase of stress adaptation. Unfortunately, far too many people have in excess of these hyper alert moments. Over the long-term, this creates a state of stress resistance in which the body adapts to the emotional or physical stress and cortisol levels remain high or get completely thrown off schedule. The body tries to return to its normal everyday functions, but it also maintains high-blood sugar to have enough energy to respond to the stress. If the stress goes on for a long time, the body basically gives up and instead of responding to the stress, it now responds with exhaustion. In a state of exhaustion, the body can no longer continue to maintain its normal functions. Energy levels are low, brain function is decreased, and the immune system stops functioning. After enough time, this stage can become life threatening as the body can barely respond to illness or injury. As I touched on earlier, in healthy individuals, cortisol levels are high in the morning to facilitate activity, then they slowly taper off during the day so that they're low at the night to encourage sleep. When the HPA axis malfunctions, there are two possible effects. One, cortisol remains high all the time or, two, cortisol is low in the morning and high at night. The first one, high cortisol all the time, is considered to be classic HPA axis dysfunction. The second is less common but equally disruptive to the system. With either type of HPA axis dysfunction, symptoms may include anxiety, depression, brain fog, sleep problems, thyroid dysfunction, blood pressure issues, immune system compromise, poor blood sugar control, increased abdominal fat, increased appetite, fatigue, particularly during the morning and mid afternoon, slow wound healing, salt cravings, dizziness, especially when standing from a seated position, dry skin, low sex drive, poor muscle tone, and poor circulation. There are a number of factors that can contribute to HPA axis dysfunction, poor diet, processed foods, sugar, and factory-raised meats, inadequate sleep, shift work, especially, alternating shifts when the work times move around, electromagnetic fields, environmental toxins such as BPA and pesticides, caffeine, chronic and acute inflammation, and chronic psychological stress. These are a list of typical things that are considered stressors. However, a client's perceived stress is very important to consider. We all experience stress differently. For one client, a bad relationship, for example, might be extraordinarily stressful, and for another, that may feel fairly normal. When looking at how a client perceives stress, consider four factors which are often described by the handy acronym N-U-T-S, NUTS. Novelty, unpredictability, perceived threat, and sense of loss of control. It's important to take the time with all of your clients to get a good sense of how they define and experience stress and to verify just how much something may be bothering them. Your clients are the best experts on themselves. It's ineffective as a coach to assume how a client is feeling or experiencing something. Plus, they may not even realize it themselves until they are provided the opportunity to talk about it. Once you have created awareness around a specific problem, you can help them create and formulate a plan to address the stressor. Turning back now to the effects of dysregulated cortisol, a condition that can impact many other functions in the body. Dysregulated cortisol can impact sleep, sex hormone production, and thyroid function. How does this happen? Let's investigate further. First, high cortisol levels at night can interfere with sleep. Elevated cortisol can leave your clients feeling tired but wired at night and unable to either fall asleep or stay asleep. If a person can't actually fall asleep until very late, they wake up several times throughout the night, there is a good chance that cortisol may be out of whack. This often happens to people who are exposed to a lot of blue light at night, televisions, computer screens, tablets, and phones all have high blue light levels. This affects their circadian rhythm and decreases the secretion of melatonin. Melatonin is a hormone produced by the pineal gland in response to decreasing light levels. Its main job is to help the body prepare itself for sleep. Decreased melatonin disrupts the HPA axis, increasing cortisol at inappropriate times. Ideally, your clients should avoid these devices for at least an hour before they plan to go to sleep. There are also ways to decrease the output of blue light on laptops and tablets. Encourage your clients to begin decreasing their blue light exposure prior to bedtime. Whether blue light exposure is affecting their ability to sleep or not, everyone can benefit from unwinding and unplugging before bed. Another difficulty arises for people who do shift work where they work sometimes at night and sometimes during the day. This can disrupt the HPA axis causing increased cortisol at night. Clients who are working these kinds of jobs may want to consider how they can find a way to modify or change jobs to work on a consistent shift. Even working all night is better than alternating shift work as people do adjust their cortisol levels eventually to this. Rest is one of the best treatments for HPA axis dysfunction, but unfortunately, the cortisol that's produced in HPA dysfunction makes it difficult to slow the system down, inhibiting a person's ability to relax and sleep well. So now you see how cortisol operates during HPA axis dysfunction. Next up, we're going to discuss how HPA axis dysfunction affects estrogen, progesterone, and testosterone levels. Psychological stress and high levels of cortisol are linked with lower levels of estrogen because of a feedback loop that exists between the reproductive system and the HPA axis. Cortisol acts directly on the ovaries, instructing them to decrease the production and the release of estrogen and progesterone. When the HPA axis is geared up for stress, the functions of reproductive hormonal system gets put on the backburner. This is due to the way that our stress response prioritizes bodily functions. In order to give us the energy we need to escape from a threat, our body diverts resources from functions that aren't important in a life or death situation. The reproductive system is one of these functions. So in times of stress, ovulation is a much low priority because estrogen and progesterone levels go down. A client who has struggled to get pregnant or had a miscarriage may feel as though her body has failed her. As her coach, you can help reframe this by explaining that her body is actually functioning through intelligent design to protect her from a perceived threat. Once she understands that her body is actually just doing its job, she can move onto effective stress mitigating techniques that will help move the body out of the stressed state. So that's what happens with estrogen and progesterone, but how does HPA axis dysfunction effect testosterone? To answer this question, we need to start by taking a look at luteinizing hormone, LH, and follicle-stimulating hormone, FSH, which are named after their function in females, but they're actually produced by both sexes. LH and FSH are released by the pituitary gland. In the testes, LH stimulates testosterone secretion. FSH is important in the creation and maintenance of sperm production. Cortisol decreases the release of LH from the pituitary which then decreases testosterone release. Cortisol also acts directly on the Leydig cells in the male testes which also decreases testosterone production, so chronic stress is harmful to men by causing a drop in testosterone production. This can contribute to or worsen a condition known as low T, which is something we'll be discussing in more detail elsewhere in the course. I'd like to point out that long-term stress drives down testosterone production in women as well, not just in men. This is one of the key reasons for a deceased sex drive in both women and men. Finally, HPA axis dysfunction affects the thyroid. When the HPA axis stimulates cortisol, production of thyroid-stimulating hormones goes down. This decreases the activation of thyroid hormone from T4 to T3, the more active form. It also increases levels of reverse T3, which is an inactive form of thyroid hormone that's produced during stress or illness. High levels of reverse T3 can result in hypothyroidism or worsen a case of hypothyroidism that's already present. Additionally, it makes it more difficult to get accurate lab tests since most physicians order just a TSH test which remains normal even when reverse T3 is high. The take-home point to remember is that elevated cortisol negatively impacts the thyroid by creating an imbalance of thyroid hormone production that can lead to hypothyroidism. Cortisol also raises blood sugar, which over time causes insulin resistance. Insulin resistance has been shown to actually damage the thyroid cells and worsen Hashimoto's thyroiditis. What that looks like for your clients is increased hypothyroid symptoms including brain fog, irritability, weight gain, dry skin, brittle nails, straw-like hair, and even hair loss. Now so far, we've talked at length about high cortisol. But low cortisol levels can also have an impact on the body. Under certain circumstances, cortisol levels can dip below normal. This most commonly happens when a person stops taking steroid medications suddenly without tapering off. What happens here is that the adrenal glands have gotten lazy because they haven't needed to produce cortisol and it takes them some time to kick into gear and get back to work again. This can also happen when a client quits smoking. Did you know that this is actually one of the reasons why it's so hard to quit? When cortisol is low, it can cause fatigue or depression. This may translate to seasonal depression, chronic fatigue, fibromyalgia, and hypothyroidism. A low cortisol state also increases susceptibility to autoimmune and inflammatory diseases such as Hashimoto's thyroiditis or rheumatoid arthritis. If low cortisol happens during an acute illness or injury, it can be life threatening because the body is unable to raise blood pressure and increase the blood sugar as needed. When the HPA axis malfunctions, it's difficult to predict actual levels of cortisol, so proper testing is highly recommended. It's important to recommend that your clients undergo testing to check cortisol levels several times a day to determine what kind of HPA axis dysfunction they have. You don't want to just start guessing because it's not up to you to diagnose or treat them. So make sure to suggest a functional medicine practitioner who will be familiar with the tests for measuring daily cortisol levels. And that brings us to the end of our discussion about HPA axis dysfunction. We covered a lot of great information, so let's recap. First, we reviewed the causes and effects of HPA axis dysfunction. You should now have an understanding of why adrenal fatigue or adrenal burnout doesn't actually happen and what's really going on when chronic stress throws the system off balance. Next, we looked at the effect of HPA axis dysfunction on estrogen, progesterone, and testosterone, and the thyroid. You can help your clients foster a healthy HPA axis by helping them to achieve a less-stressful lifestyle by getting adequate sleep and removing sources of blue light in the evening. Now we want to hear from you. Have you experienced adrenal dysfunction? If so, please feel free to stop by the Facebook group and chat with your fellow students about how it affected you and the steps you took to reclaim your adrenal health. Next, be sure to complete the Adrenal Health Fill-in-the-Blanks handout and take the quiz for this module to test your knowledge on the topics we covered. Thanks so much for watching. See you soon.

Video Details

Duration: 18 minutes and 20 seconds
Language: English
License: Dotsub - Standard License
Genre: None
Views: 6
Posted by: ninaz on Mar 25, 2018

HPA Axis Abnormalities_Final

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