When I first started the Eleven Eleven Wellness Center in the early ‘90s, my approach – what now usually goes by the name ‘integrative medicine’ -- usually needed a little explaining. That’s because my colleagues and I weren’t content to treat a symptom or a lab number. We wanted to understand how the different systems of the body interact, and how sometimes they fell out of balance, creating the health problems we were seeing in our patients. We went after the root causes of disease. 

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But the intervening decades have seen the rise of widespread access to health information online. And I’m seeing a new generation of patients no longer content to sit idly by and hope for the best at their annual physicals. These days, patients appreciate that so many aspects of their health are interconnected -- they have a much better understanding of how profoundly good health and longevity are impacted by what you eat, how well you rest, how much you move. But it’s not always easy to balance these lifestyle elements, and for a lot of my patients and readers, one of the toughest questions they wrestle with is how best to manage stress.

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Let’s face it, just about all of us hate the feeling of being under too much stress. Not only because being stressed feels lousy in the moment, but living with it, unrelieved, day in and day out, is a major starting point for physical dysfunction and disease, with ripple effects felt across virtually every cell in your body – a big potential downside to all that interconnection. One way to understand what’s going on? Technically speaking, it’s the disruption of the ‘HPA’ or ‘hypothalamic-pituitary-adrenal’ axis, which refers to the ongoing conversation between different body systems that, between them, regulate the response to stress, both acute and chronic. Disrupt your HPA axis long enough, and trouble follows; keep it on an even keel and you’ll unlock the secret to a much healthier, happier and, very likely, longer life. Sound good? Here’s what you need to know about the HPA axis, how to support yours, and how to tackle stress in new and more productive ways:  

Meet the three key players in your HPA axis.

If you haven’t heard about the HPA axis before, you’re not alone. It’s commonly used by the scientific community to refer to a complex network of mechanisms that affect energy levels, immune function, digestion, circadian rhythms, mood, the list goes on. A well-balanced HPA axis is the key to how your brain and body handle all the different challenges that may come your way, be they physical (for instance, lack of sleep), or psychological (for instance, emotional upset over something in your personal or professional life) or environmental (for instance, exposure to heat or cold). 

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Tending to the three pillars of the HPA axis – the hypothalamus, the pituitary gland and the adrenals -- is vital for your long-term well-being and your ability to fend off or come back more quickly from the inevitable occasional health challenges. Here’s the story on the trio and what they do:

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• Hypothalamus: The area inside your brain that’s often referred to as the command center, it’s in charge of responding to stress by secreting corticotropin-releasing hormone (CRH).
• Pituitary Gland: Located just below the hypothalamus, it responds to the CRH by secreting adrenocorticotropic hormone (ACTH) into the bloodstream.
• Adrenal Glands: When ACTH reaches the adrenal glands – you’ll find them just above the kidneys – it stimulates the production and release of cortisol, the primary stress hormone. With that cortisol release comes increased glucose availability to help boost energy, more glucose available to the brain to quickly boost function, and increased availability of substances that repair tissues.

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In other words, the HPA Axis summons your internal troops – but also knows when to tell them to back off. To take one example, in a well-functioning system, high cortisol levels produced by the adrenals signal to the hypothalamus and pituitary gland to reduce CRH and ACTH secretion, keeping the stress response from going overboard. 

Chronic stress sends your HPA axis off the rails.

While you may be familiar with the downsides of too much cortisol –  weight gain, high blood pressure, muscle weakness, severe fatigue – the stuff isn’t all bad. Far from it. When the system is in balance, cortisol actually enhances the body’s ability to respond to stress, enhancing energy production and keeping a lid on inflammation. The trick is to manage stress with healthy lifestyle habits (more on that in a minute), so that cortisol levels as don’t stay in a chronically elevated state, throwing off the communication between the three parts of the HPA axis. If that does happen, we’re talking chronic problems with immune function, mood (think, depression and anxiety), and sleep – the HPA axis is also involved in regulating the body's sleep-wake cycle. The entire system is a finely tuned feedback mechanism and when it becomes de-tuned, you’re looking at, long-term, increased risk of heart disease and stroke and adrenal gland disorders like Addison’s disease and Cushing’s syndrome. So, if you needed a reason to work on getting your stress levels under control, you’ve now got quite a list! 

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A balanced HPA axis can do your body a world of good.

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But wait, there’s more. With a balanced HPA axis, the upsides keep coming. You can look forward to some major health bonuses, including:

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1. Optimal stress response -- as in a body that responds appropriately to stress by releasing the right amount of cortisol to help you body manage acute stress efficiently.
2. Better recovery and resilience – that ability to bounce back quickly from stressful situations, and less risk for stress-related disorders.
3. Balanced energy levels – courtesy of more stable blood sugar levels delivering a consistent energy supply.
4. Healthier immune function – thanks to cortisol’s anti-inflammatory effects, which helps curb risk of chronic inflammatory diseases.
5. Better immune balance – as in more protection from infections while preventing the kind of immune system over-reactions that can lead to autoimmune conditions.
6. Improved mental health – with adequate cortisol levels supporting stable mood and taming risk for disorders like depression and anxiety.
7. Improved cognitive function—thanks to adequate cortisol levels that support cognitive functions such as memory, attention, and learning. 
8. Better cardiovascular, muscle and bone health – all of which benefit from balanced cortisol levels
9. A good nights sleep – here too, the HPA axis works its magic influencing circadian rhythms, regulating sleep patterns and improving sleep quality.
10. Better metabolic health – with balanced cortisol levels comes well-regulated appetite and body weight, and less risk of metabolic issues
11. Digestive health – healthy, balanced HPA axis function is great for encouraging healthy digestion and nutrient absorption, while also helping to prevent gastrointestinal issues linked to stress and cortisol imbalance.

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Keep your HPA axis happy with a few essential healthy habits, plus a few smart strategies.

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OK, so with all these upsides, the question is, not why, but how to balance your HPA axis and make sure all three are working together optimally? There are a few ways to go about it – but ultimately, it all starts with relaxation –and de-stressing your mind and body as often as possible. 

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I recommend starting a daily meditation practice – don’t worry, you can start with a few minutes a day and grow your practice from there – plus a few de-stressing techniques you can access in-the-moment to help defuse stress before it wrecks your day. Training yourself to knock stress down a few pegs whenever and wherever you need to is a fantastic tool to have in your de-stressing tool box and is essential to empowering yourself to keep your HPA axis on an even keel. 

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In addition to focusing on the healthy lifestyle basics -- healthy diet, plenty of movement, and truly restorative rest – making sure that relaxation and de-stressing techniques are part of the mix as well, to achieve that all-important HPA axis balance. But how to relax in this often chaotic, stress-inducing world? Here are a few techniques to tap into, starting today: 

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1. Meditation – Try this beginners guide to meditation to jump start your practice
2. Restorative yoga – a wonderful way to wind down your stress at the end of the day, and prepare your body for deeper, better sleep
3. De-stressing Abdominal Breathing – take a look at four ways to de-stress with simple breathing exercises
4. “Tapping” – also known as the Emotional Freedom Technique (EFT) is an acupressure-based set of moves that enable you to stimulate the vagus nerve by tapping on specific meridian points, helping to bust stress and relieve anxiety. To learn how, check out one of the many how to videos on YouTube.
5. Sauna sessions – though the dry saunas are excellent for relaxation, my favorite is the infared sauna which also promotes relaxation, healing and pain reduction
6. Red light theraphy  (RLT) – signing up for a few RLT sessions can help relieve anxiety and depression and tame stress by stimulating the production of serotonin and other neurotransmitters
7. Vagus Nerve stimulator devices – like Hoolest and Pulsetto, which can help you connect quickly with the vagus nerve that is essential to soothing your stress response‍
8. Supportive supplements  – a blend of nutrients and herbs known as ‘adaptogens’ help support healthy adrenal function (think “fight or flight” response) and help regulate a whole menu of hormones and neurotransmitters that influence energy and mood. Adaptogens like Rhodiola, ashwagandha, American ginseng, and eleuthero support a healthier response to stress and anxiety, as do anxiety-taming supplements like magnesium, L Theanine, GABA, and CatecholaCalm. Another well-tolerated option? CBD oil which can be enormously helpful – and non-addicting – for managing anxiety and encouraging relaxation without impairing or intoxicating.