HPA Axis Dysfunction

HPA axis dysfunction (HPA-D) is the more accurate term for the syndrome often referred to as “adrenal fatigue.” It is characterized by a diverse range of signs and symptoms, including (but not limited to) fatigue, insomnia, poor stress tolerance, muscle aches, anxiety, and increased susceptibility to colds and cases of the flu. It can be caused by high levels of perceived stress, circadian disruption (too much exposure to light at night, not enough exposure to light during the day, travel across time zones, etc), blood sugar dysregulation, and systemic inflammation.

HPA Axis Dysfunction by GoalsRx

Supplements are an essential part of the treatment of HPA-D, but diet and behavioral/lifestyle changes are crucial for recovery. Put simply—you cannot supplement yourself out of HPA-D.

Here is a list of diet, lifestyle, and behavioral changes that support the HPA axis.


Eat a moderate-carbohydrate diet
Most people with HPA-D have problems with blood sugar regulation, resulting in low blood sugar or sometimes a combination of high and low blood sugar. You’ll want to focus on a moderate carbohydrate diet, which means about 15 to 30% of your calories coming from carbohydrates (100 grams of carbohydrate on a 2,000-calorie diet or 125 grams on a 2,500-calorie diet).

Eat adequate protein, especially in the morning
Higher-protein diets reduce cravings and seem to regulate blood sugar. You should eat at least 0.8 to 1 gram of protein per pound of bodyweight daily. You should also eat a high-protein breakfast (40 grams). This has a stabilizing effect on blood sugar throughout the day.

Eat frequently throughout the day
To keep blood sugar levels stable, you should either eat five or six small meals per day or three regular meals with snacks in between. Choose whichever approach suits your preference and lifestyle best.
• Snacks and meals should always have some protein and fat, never just carbohydrates alone.

Avoid excess dietary potassium
If your adrenal fatigue is severe, and you experience low blood pressure, you may want to avoid high-potassium foods as potassium can lower blood pressure.
• These include bananas, dried figs, raisins, dates, potatoes, and sweet potatoes.

Ensure adequate salt intake
Extra salt in the diet can help increase blood pressure. If your HPA-D has caused you to have low blood pressure, you may want to start your day with a glass of water with one-half to one teaspoon of sea salt in it. You should also season your food to taste.

Avoid caffeine and alcohol
Caffeine is a stimulant, and it places additional stress on the body. Alcohol stresses the liver, which often functions suboptimally in HPA-D. It’s best to avoid caffeine entirely and limit alcohol consumption to two to three drinks per week or avoid it completely until your adrenals recover.

Behavior and lifestyle

Behavior and Lifestyle Changes by GoalsRx

Get adequate sleep and plenty of rest
There’s nothing more important for those with HPA-D than getting enough sleep and rest. Make seven to nine hours of sleep nightly a top priority.
• If you feel you need to take 15–20 minute naps during the day, do so as your schedule permits.

Be smart about exercise
Overtraining is another common cause of HPA-D. Signs of overtraining include difficulty recovering from workouts, a plateau or decrease in performance, fat gain despite regular exercise, insomnia, restlessness, anxiety, fatigue, muscle or joint pain, frequent illness, and depression.
• Deload high-intensity training every four to six weeks to reduce fatigue.

Be in contact with nature
Natural environments have rejuvenating and restorative effects, reduce stress, and alleviate mental and physical fatigue.
• Spending regular time outdoors in a natural environment is especially important for those with HPA-D.

Get pleasure, play, and connect
Many people with HPA-D are suffering from stress burnout. They’re exhausted, dispirited, and often feel depressed or “flat.” Pleasure, play, and social connection are all deeply nourishing and restorative—on both a physical and emotional level—and can provide a powerful antidote to the symptoms of HPA-D.

Stress management 

Along with poor sleep, psychological and emotional stress are primary contributors to HPA-D, and managing stress is a crucial part of the recovery process. It’s essential to make stress management as much (or even more) of a priority than the dietary changes and supplements.
      • Start slow and be gentle with yourself. The changes that occur with stress management are often not as immediate or evident as with diet and supplements, but they are long-lasting and profound.

Commit to regular (even daily) stress management practices such as meditation, deep belly breathing, journaling, etc.


• Vitamin C — 1,000 mg per day
• Vitamin D3 — 4,000 IU per day
• Omega-3 Fats (EPA/DHA) — 1,000 mg per day of combined EPA and DHA
• Magnesium — 400 mg per day of magnesium glycinate
• L-theanine — 200 mg per day
• Licorice Root — 500 mg per day
Dark chocolate (at least 70% cacao) — 2 ounces per day


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