Chris Kresser: It always has to be balanced with the patient and the need for weight loss and what’s going on with their HPA axis. Generally we don’t recommend calorie-restricted approaches, whether they’re spontaneous or intentional, until the patient has stabilized in terms of their HPA axis dysfunction.
Of course that’s kind of a chicken and egg thing because we know that inflammation and glycemic dysregulation are two of the main triggers of HPA axis dysregulation. And so to some extent, you could argue that it might be hard to completely address that if the patient is so overweight and particularly obese. So we do often end up giving the patient ongoing HPA axis support while they’re doing a protein-sparing modified fast or potato type of diet.