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For most of our patients, chronic stress is a major component of what we work on. Stress plays such an important role in the maintenance of proper health, and when we are exposed to chronic stress, we can cause disruption in what is called the hypothalamic-pituitary-adrenal (HPA) axis. Stress is normal – but it shifting our hormones out of balance, isn’t!

The HPA Axis

The HPA Axis is an intricate part of the nervous system that connects our brain, the central nervous system, and our endocrine system (responsible for hormones and their production). It controls our response to stress, and regulates our immune system, mood, energy, and even digestion. When exposed to stress, acute or chronic, this can cause a disturbance in the HPA system, leading to adrenal dysfunction from cortisol imbalance.

You may have heard the term “adrenal fatigue” before – this is merely a general term for disruption in the HPA Axis, causing cortisol imbalances.

Cortisol Imbalance & Adrenal Dysfunction

Cortisol is the main hormone that is produced when we are exposed to stress. This is produced by our adrenal glands that sit on top of our kidneys. Normally, our cortisol levels rise and fall throughout the day following a circadian rhythm. Spiking high enough in the morning to maintain alertness and cognitive function, and decreasing low enough at night to promote relaxation and sleep.

So how do we know you have adrenal dysfunction? A big one – is testing. We offer the Adrenal Salivary Profile.

I test our cortisol patterns mainly through a 4-point saliva test. Saliva hormone testing measures the amount of hormone available to target tissues (the bioavailable amount), as well as providing 4 samples throughout the day to map out your cortisol curve. We want cortisol to spike highest in the morning, gently decrease throughout the morning and into the afternoon, and be lowest in the evening and at bedtime. Testing cortisol via blood does not provide this cortisol curve, and only is clinically useful to diagnose actual adrenal gland pathologies and diseases (like Cushing’s Syndrome or Addison’s Disease – too high or too low serum cortisol levels, respectively). What I am looking for is the adrenal function.

In addition to a 4 point cortisol test, I like to also measure the hormone DHEA, which is a marker for our adrenal RESERVE (aka how much do we have “left in the tank”).

Testing levels aside, what are signs of cortisol imbalance and how can we support it?

The 3 Stages of Adrenal Dysfunction

Phase 1: Alarm Phase

Chronically elevated cortisol or elevated evening cortisol

During initial HPA activation, or the alarm phase, the HPA Axis responds to stressors robustly. When we are exposed to a lot of high stress, it accumulates, resulting in a high output of cortisol, DHEA, and norepinephrine. This causes us to feel high-strung, anxious, and agitated.


  • Feeling tired but wired at night resulting in insomnia – mind racing at night, difficulty falling asleep or waking throughout the night often
  • Anxiety
  • Carbohydrate and sugar cravings for quick energy
  • Acute gastrointestinal issues
  • Possibly high blood pressure
  • Feeling jumpy, overstimulated, and chronically restless and stressed!

Phase 2: Resistance Phase

Steep drop in afternoon cortisol and irregular rebounding cortisol patterns

HPA Axis Resistance occurs when the HPA activation is sustained, as we are under chronic influence of cortisol. This is where we see abnormal cortisol curves, spiking and dropping at the wrong times during the day as our body is trying to figure out when to feel awake and alert, and when to sleep.

Fatigue, irritability, lower mood or depression can arise. A weakened immune system is very likely in this stage, and you can become predisposed to inflammatory conditions like muscle and joint pain, autoimmunity, and irritable bowel syndrome. Because our body is becoming resistant to the effects of cortisol and our other stress hormones, we often reach towards coping mechanisms such as tobacco or alcohol to remedy some of these feelings. The circadian sleep rhythm is affected, causing us to have either a major crash in energy in the afternoon, or a second wind in the evening. Our body starts to have resistance to the regular response since our body has been exposed to high levels of cortisol for so long.


  • Mid-day energy drops
  • Sleepiness
  • Caffeine and sugar cravings
  • Low exercise tolerance
  • Poor recovery from workouts

Phase 3: Exhaustion

Chronically low cortisol

At this stage of HPA Axis Dysfunction, we are at adrenal exhaustion and are experiencing major cortisol depletion.


  • Feelings of burnout
  • Feeling chronically fatigued/exhausted irrelevant of sleep
  • Poor immune function – constantly catching colds/flus, allergies
  • Strong cravings for carbohydrates, sugar, and processed foods
  • Sleep disturbances
  • Irritability
  • Poor resilience to stress

Does any of this resonate with you? Luckily, Naturopathic Medicine can help!

Depending on which phase you are in, there are specific treatments! We will discuss:

  • The best time to eat and what type of foods are best to eat (example: do we add in more protein? What time of day?)
  • The best time to exercise and what type of exercise (example: Do I exercise in the morning only? A HIIT workout or cardio?)
  • The best morning and evening routine (whether more stimulating activities, or more relaxing activities)
  • What nutrients may be missing (minerals vs. vitamins that should be added in or avoided)
  • What herbal interventions may be recommended to support proper function (herbs that increase cortisol, or herbs that blunt it)

So why are our adrenal glands so important to support? Cortisol also GREATLY influences our other hormones. Our estrogen, progesterone, testosterone, insulin, and thyroid, and more. Dysregulation in cortisol patterns can influence the other hormones in our body, creating even more bodily dysfunction! So we don’t just want to modulate our cortisol patterns for better energy, sleep, and stress management for ourselves. We want it to control all of our other hormones and their roles as well!

Stress is inevitable. Feeing overworked and overtired is common, but should not be normal.

Interested in having your cortisol patterns and adrenal glands evaluated? Book in today!

Dr. Shannon McGuire

About Dr. Shannon McGuire

Dr. Shannon McGuire is a naturopathic physician with a practice focus in digestion, hormones, autoimmunity, sleep & stress. She is proud to be practicing in her hometown of Kelowna and has a passion in helping her community in optimizing their health.