Foundational Steps to Healing HPA Axis Dysfunction with Endo - a podcast by Jessica Duffin

So, now you’ve learnt all about the link between HPA axis dysfunction and endometriosis, in today’s episode I want to provide you with some of the core foundational strategies for healing HPA axis dysfunction. 

Before I dive in, I do want to state that healing HPA axis dysfunction can take some time, especially if you’re prone to living in the flight or fight response – so what I mean is, you’re default mode is feeling stressed, or anxious, or you spend a lot of time rushing around or over-committing yourself to endless to-do lists. If this sounds like you, don’t worry, that’s me too, and it’s many of my clients and for those of us who are like that, it can take some deep unlearning of these patterns before we can really get to see significant improvement. We can certainly feel better, and many do, but I think to really thrive and not keep returning to this cycle of low cortisol burnout, we need to change some of these habits.

So, for example, one of my clients loves to work and runs her own business like I do, so we make traction with her HPA axis dysfunction, but then if she goes through a busy period, her default mode is to put her sleep, and the strategies I’m about to share, on the backburner, because that’s always been her strategy. To push through, to keep going, to reach for perfection. And I totally get it, because I’m exactly the same too. So for her, we’ve seen improvement with her HPA axis, most definitely. She used to not be able to get out of bed! But we still have a long way to go because it’s a few steps forward and a few steps back.

And the same goes for me. I could feel a noticeable difference, I could feel my energy returning and my sleep schedule becoming normalised, and then I released the course, and it was incredible, but it was one of the hardest things I’ve ever done. Now moving forward, it won’t be like that, because I’ve now made the course, but beforehand, I was building a course from scratch and learning how to market a course – and it was more work than I think I’ve ever done in my life. So my cortisol levels really depleted again, and I’d love to see where they were after the course, but with the SIBO treatment I just couldn’t afford more testing on top. 

I feel like they’re getting back on track, but until my SIBO is fully resolved (and if there are any other infections, having them addressed too) I don’t think my cortisol will be at optimum levels. I think it will be good, much better than it’s been for most of my life, but the chronic SIBO and maybe an underlying mould infection will be keeping my body in a state of flight or fight, and I’ll explain about that a bit later in the episode.

The length of time it can take to recover from HPA axis really varies. I’ve seen studies showing it taking weeks to recover, whereas someone who is completely burnt out, like chronically fatigued, can’t get out of bed most days, that can take much longer. I did have one client like that, and I consulted with Dr Jessica Drummond, and she said to me, you know, this could take two years to heal, and we’re about a year in and she’s waking up early and working, but she’s not fully recovered yet. So, it’s a journey and just know that your healing will really depend on what’s happening in your life, in your body and the strategies you choose to implement, which will all become clear in time. 

So please don’t give up if it doesn’t feel like it’s working, because honestly, what I’m about to share we should ALL be doing every day, for optimum health and a healthy stress response and circadian rhythm, so it will be benefitting you, but it may take time for your cortisol levels to fully recover. 

What I suggest is, if you can afford to do so, take a CAR test, and again, I’ve linked to some options in the show notes, and then take another test after three months or sooner, if you’re feeling a difference, and then at another three months after that, just to see what your body is doing. You can usually tell, because you’ll notice changes in your energy, sleep, when you wake up, etc. but it can be helpful and just interesting really, to see what your levels do in response. 

So, what I’m going to share today is four of the key strategies, there are a couple more and there are some additional strategies and tools which can help, but to avoid overwhelm, I’m just going to provide you with some of the initial key steps. These may be enough on their own to heal your HPA axis or you may need to do some further work later on down the line, but these are some of the key foundations to get started.  

 

1.  Number one is a nice and simple strategy, get sunlight to your eyes for 30 minutes as soon as possible in the mornings.

Your body relies on patterns, to set its internal rhythms and it especially relies on light and dark. Your circadian rhythm is essentially controlled by day light, so getting light exposure for 30 minutes in the mornings, is going to tell your brain what time of day it is. The light changes throughout the day, and your cortisol levels will respond to that, so getting that morning light is going to really help to raise your cortisol levels to healthy levels. Over time, this continued pattern will basically reset your internal body clock, and your circadian rhythm will be able to set its pattern to this once more and your cortisol levels will start rising when they should. 

You can get this light in a number of ways. It could be that you eat your breakfast in your garden in the mornings, if you have one, it could be that you sit by an open window to get ready, or you could go for a walk or commute to work ensuring you get lots of light along the way. As long as you are getting unfiltered light, so not through sunglasses or through a window, you’re all good. And if you can’t manage 30 minutes, just do as much as you can. 

 

2. Number two is probably the most important one, but I appreciate is often the hardest one. Get at least 7.5 hours sleep, minimum, each night, whilst also going to bed and waking at the same time every day. 

I know this sounds intense but let me explain why it’s important.

Your body needs regular sleep and wake times in order to know when to raise and when to lower cortisol. If you’re going to bed at 1am, of course you’ll struggle to go to bed at 9pm, because your cortisol isn’t low enough yet as it’s been programmed to lower around 1am, and if you have a flipped curve, as we discussed last week, where cortisol is rising at night, this training of a new sleep routine will be hard but will be essential to getting those cortisol levels down. 

It’s the same if your cortisol levels are low in the morning. If you’re going to bed late, then the body won’t be elevating your cortisol levels to their waking levels until about 8 hours later. Yes, they start rising before that, but not enough to wake you up, so if your alarm is going off and you’ve only had five or six hours sleep, your cortisol levels just won’t be high enough. 

So, if you have HPA axis dysfunction and your cortisol levels are low in the morning or generally low all the time, you can see why not having enough sleep or irregular waking hours is not going to help. The body needs to know when it should be elevating cortisol, and to do that, it needs a reliable pattern. We’re essentially resetting your alarm clock here. 

On top of that, the reason why our HPA axis is dysregulated is because of stress, and that comes from both physical and emotional stress, and a huge physical stressor on the body is lack of sleep. So, if we want to allow our HPA axis to regulate, we do need to invest in improving our sleep quality. 

Now this is of course easier said than done, so that sleep routine piece is going to take practice in order for your body to get into a rhythm, and in most cases, it’s going to take sleep hygiene practices. These are essentially strategies which help your cortisol levels to lower and melatonin levels to rise at night and improve your sleep quality. That’s a whole other podcast, but I have linked to an Instagram post I did on sleep hygiene strategies and of course, if you want to dive deeper, I cover both HPA axis and sleep optimisation in my course, which you can get on the waiting list for now – I’ve put the link in my show notes.

If you have insomnia, I understand and I go through cycles of this, which truthfully, I think this is down to a flipped cortisol curve because I so often default to living in a state of flight or fight, and I also truly think a large majority of insomnia cases are down to cortisol dysregulation. So, if this is you, rather than getting stressed about the sleep piece, perhaps look at working on all of the other areas, because they will start to regulate your cortisol levels, which over time, should help you to sleep. 

And I would start teaching your body a pattern of the same sleep times and wake times, if possible, even if you’re not getting to sleep, even if you’re not trying to – just sitting in bed and practice calming, restorative techniques to help lower cortisol at night. Don’t make the focus on getting to sleep, but rather on just lowering cortisol. So, a dark room, maybe candles or very soft lighting, breathing exercises, massage, listening to sleep stories (which you can now find on loads of meditation apps), just anything gentle or soothing and I hate to say this, but I would avoid watching TV, being on your phone or your laptop or computer like the plague. I know I’m often very careful with my language and say to do what works for you and to tailor each strategy, but there’s really no way around this one. Blue light from your TV, phone and laptop will elevate cortisol and suppress melatonin and not only that, but they’re also designed to engage, stimulate, and activate your brain, they’re not designed to help you wind down. 

If you need your phone for the meditation or sleep story, put it on night mode, ideally get an app that creates a red screen and wear blue light blocking glasses, and turn the brightness right down.

Now finally, I know you’re probably thinking – what about the weekend? Well, research has shown that we need this consistent pattern all day, every day, but I know that’s not realistic, so I would just try to do your best. If you’re out late at a birthday, it’s a one off and I wouldn’t stress about it. If you’re at home and you just tend to stay up later at the weekends, see if you can curb that slightly and bring it closer to your normal bedtime. So, if you go to bed at 10pm normally, can you make it 11pm at the weekends? That kind of thing!

 

3. Number three is to eat at regular times and to balance your blood sugar. Just like with light exposure and sleep, eating at similar times can help give your body reliable patterns to set its internal rhythm to. So, if you can eat at roughly the same time each day, that’ll help. This pattern is less important that the first two, so don’t worry if sometimes you’re travelling or something and can’t eat at the same time, but roughly and as often as you can will be helpful.

But what is really important is blood sugar regulation. You know I’ve talked about this so many times by now, but high and low blood sugar are stressors to the body and activate the HPA axis stress response. And even if your cortisol levels are low, it’s still going to activate, it’s just going to be pumping out adrenaline in cortisol’s place and so the stress response will still be occurring, just of course, not as it should. And as long as we keep repeatedly stimulating that stress response, the HPA axis is going to stay dysregulated. 

I’ve shared how to regulate your blood sugar in previous episodes, so I’ll link to that for full details, but in short, we need to include protein, fat, fibre, and complex carbohydrates with every meal. And the general ratios for good blood sugar balance are 50% of your plate consisting of low starchy veg which provides you with fibre and complex carbohydrates, 25% of your plate consisting of protein, and the final 25% being split into healthy fats and starchier, yet complex carbohydrates. For fat, we want at least two golf ball size servings, so that could look like say about a third of a large avocado or two tablespoons of nuts and seeds, and with starchier complex carbs, it could be sweet potatoes or quinoa, or beans if you haven’t got them as your protein source, and the serving size you have really depends on your energy needs. Of course, if you look at it in relation to the other ratios, it’s not a huge serving, about a handful, but you might need to increase it if you have a very physical job or you’re very active. Be guided by how you feel! If you find you’re getting hungry soon after meals, first try increasing your fat and protein sizes. 

The other key strategies for balancing your blood sugar are to not allow yourself to get starving or super hungry before you eat – if you’re shaky or hangry, you’ve waited too long, and of course, try to keep refined carbohydrates, and added sugar to special occasions rather than everyday foods. If you want to understand this in more depth, have a listen to the episode I’ve linked to or a read of the articles I’ve added to the show notes, and my course also has an entire module on blood sugar balancing and its impact on endo and our hormones, and how to balance it. 

I know the idea of reducing certain foods can be triggering, so if this feels that way, then focus more on the balancing of your plate and all the wonderful foods you can add in, and on eating regularly. Of course, if you have a history of an eating disorder it is always best to work with a nutritionist, coach or dietician who can guide you, as well as a mental health practitioner. 

 

4. Number four is stress management. I know I said sleep was the most important, but actually it probably ties with stress management!

Now in order for our HPA axis to recover and get back to some kind of normal regulation, we need to stop chronically activating it. 

This means we need to learn how to move regularly out of flight or fight and manage our stress response, plus look at any areas that may be a source of stress that we can address. Of course, there’s always going to be some element of stress in our lives, but we can change how we cope with and respond to stress, and even how we perceive stress.

So firstly, let’s begin with the simpler changes. We want to practice moving out of the stress response, called the flight or fight response, and move into the rest and digest response on a regular basis. This is particularly important if your default mode is anxiety, stress, worry, fear, etc. because for you guys, most of the time you’re going to be in flight or fight, and that’s not good for the body. You know the impact that chronic stress can have on the HPA axis and on pain, from our last episode on this, but being in a constant state of flight or fight has far reaching effects on our health. 

Personally, I’ve found that I have a harder time trying to get my mind to calm down, but utilising stress relief methods for my body, practices that actually put us in rest or digest, then calms down my mind or at least takes me out of flight or fight, even if my mind is still ruminating. 

So, some strategies which calm down the stress response and put us into rest or digest include:

• Massage, any kind, but I really like abdominal massage like the I Love You massage for IBS issues or Arvigo massage for IBS, period pain and endo in general. These are really great to do before bed because they put your body into rest and digest but also support digestion overnight. I’ve linked to a free I Love You massage on YouTube, and you can learn Arvigo massage in one Zoom session with a therapist and then practice on yourself. I’ve put the links to both in the show notes.

• Tapping, also known as Emotional Freedom Technique is an exercise where we tap on the body – on the side of the hands, the eyebrows, side of the eyes, under the eyes, below the nose, on the chin, on the collarbone, under the arms and on the head, whilst repeating certain statements. The practice combines acupressure, originating from Chinese medicine, with more Western psychology practices. It’s now gathering a wealth of data behind it and has been shown to take us out of flight or fight and calm the stress response. It’s also been shown to reduce anxiety, depression, and pain, and is even helpful with managing SIBO! You can learn tapping with a practitioner, or you can use an app or watch free YouTube videos online. I’ve linked to an app I like in the show notes. 

• Yoga

• Mindfulness meditation

• Walking in nature

• Mild to moderate exercise (such as Pilates, brisk walking, Zumba, etc.)

• Being in community 

 All of these have been shown to reduce stress levels, taking us out of flight or fight and into the rest and digest state. And what I also love about these is that they’re a way to process trauma or emotion out of the body. Often if we don’t want to think about something that is distressing to us, or we don’t feel like we’re safe to express it in the moment, for whatever reason, and we store that tension in our bodies, which can lead to hypersensitive nerves firing off danger signals, triggering pain because the brain thinks we’re unsafe. But if we’re able to physically work off some of that emotion, the physically damaging effects of that stress response can be reduced. 

I’ve found it really helpful for me, being a health coach, it’s of course sometimes a stressful job because I am looking after people’s health and that in itself is a lot of pressure, but of course hearing about someone’s pain or distress is emotional, so afterwards I can sometimes feel worried or anxious. So often I’ll come off a call and I won’t really know how to think my way out of what I’m feeling, I struggle to soothe myself with just my thoughts, so I tap, or I get on my rebounder for five minutes, or I do some mindful breathing, or I do some of my weightlifting exercises, which I do at intervals throughout the day. And I sort of imagine myself shedding the stress as I do it. Not all the time, but especially when I’m jogging on my rebounder, I sort of see myself running the stress off, and it really, truly helps. It’s become a wonderful way for me to process my feelings. 

The next area to look at with stress is whether you have any past trauma that needs working through. I’ve been talking a lot over on Instagram about the ways in which childhood trauma, known as Adverse Childhood Events or experiences dramatically increases our chances of developing chronic pain, autoimmune diseases and chronic conditions, and the pathway for most of these developments is through HPA axis dysregulation, which has occurred due to chronic stress. If we haven’t worked through these past traumas, they can be subconsciously keeping us feeling unsafe, causing our bodies to be in a near constant state of flight or fight or easily stressed and activated. 

This could be a whole topic in itself, so my recommendation to get started with this healing process is to read my Instagram post first, and then I’ve linked to a couple of books, podcasts, and therapy resources to help you work through the trauma in the show notes.

We also need to look at how pain is triggering your stress response. Of course, the more stressed we are about our pain, the more unsafe our brain feels, and then the worse the pain gets, because it is our brain which creates pain and controls the intensity – and if the brain feels like there is a reason to make pain (so if the brain feels at threat or in danger in any way at all, and this could be as small as a stressful email) it will increase the pain levels. 

So, changing the way we experience pain and perceive it is also important and of course, this and the above step about trauma can take some time. Don’t worry about that, don’t stress about having to get it all done. Put the easy practices in place, like maybe getting sunlight, trying tapping before bed, eating at the same times, balancing your blood sugar, etc. Put the practical bits in place and implement them over a time frame that feels manageable, and then when you feel strong enough to work on your pain perception or trauma, begin then. By this point, I would hope that you would have better cortisol levels and a more robust and healthy stress response, so you can actually better handle the work involved in these steps. 

So anyway, that was a side note on how to approach this, but back to actually changing the way we perceive our pain… Again, this is a podcast in itself but there are a few therapies and approaches to help you to do this. You could try:

• Acceptance and Commitment Therapy for pain

• Curable (which is a brain retraining app for chronic pain and I highly recommend it) 

• Mindfulness Based Pain Relief 

And there are a couple of great books I recommend too, so I’m going to link to those in the show notes.

Finally, we also want to look at physical stressors, but this where it can get a little complex. If you’re dehydrated, if you’re eating an inflammatory diet, if you’re over-exercising, sleep deprived, or have SIBO or gut health infections (or any underlying infection for that matter), chronic inflammation or nutrient deficiencies, these will all be stressors on the body and can make it harder to recover from HPA axis dysfunction. 

Now what I would say is that this is more advanced healing and I feel like for many people with HPA axis dysfunction, they need to have more energy and better cortisol levels to be able to take this stuff on, otherwise it can just feel too overwhelming, so I’m not going to dive into this today. 

Instead, what I will say is to focus on a nutrient dense diet rich in anti-inflammatory foods, so your body is well fed, is getting a good amount of nutrients and we aren’t fuelling the inflammation fire. You can of course also add one or two supplements to help lower overall inflammation, which we know is generally a problem for most people with endo, being an inflammatory disease, and I talk about my favourite anti-inflammatory supplements in episodes 130 and 131.  

Also make sure you’re drinking enough. The calculation to work out what your body needs at a minimum is to drink half your body weight in fluid ounces. So, you take your weight in pounds, so say someone was 100lbs, then you halve it, so we have 50lbs and then you just replace the pounds with fluid ounces, we’re not converting, just swapping. And if you’re very active, you’ll need more than that, this is just your minimum. I have linked to a water calculator in the show notes, which helps you to work out how much water you need if you’re very active or breast feeding, or something like that. 

You could also add some essential basic supplements too, like a multivitamin and minerals supplement and omega 3 fatty acids, to ensure you’re covering the basics. Now of course, if you’re not absorbing your food well due to gut health issues, or you’re deficient in a nutrient, these may not be enough, but again, I’m just covering the foundations.  

If in time you feel ready to get some thorough nutrient status tests and gut health tests, or to explore anything else you think may be going on in your body, of course, that will help, but I want to emphasise these foundations first, because they can make such a difference and can give you the strength for the bigger stuff. 

So, there’s the initial four steps. And what I wanted to emphasise, what should be underpinning all of this, is joy and fun. If this is stressing you out, then it won’t be helpful. So, we need to tailor the healing in a way that will make you feel pleasant feelings and that allows you to have fun or enjoy yourself, in whatever way that is. 

So, for example, instead of seeing a 10.30pm bedtime as a curfew, how can you make it feel luxurious? Can you turn your evening routine into a min spa retreat each night with a candle, an abdominal massage and calming music before bed? How can you spend more time with loved ones who you enjoy being around, in a way that feels joyful and nourishing to you? Can you go to restorative exercise classes with friends or have regular catch ups, so you feel supported and connected? Could you do things you enjoy more often, like heading to the cinema or doing fun activities? Are there things you stopped doing that brought you joy, which you can bring back into your life? Could you take a cooking course to learn how to make delicious but healthier desserts, so you can feed your body and taste buds, or could you get some new cookbooks to learn how to eat more fruits and veggies? Or maybe, if you don’t like cooking and can afford it, can you try a meal delivery service which offers you not just healthy meals, but more time for you to relax? 

Basically, whatever it is, make this healing path feel good. If it feels stressful, take a step back and think about how you can make this process more joyful.

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