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HPA Axis

HPA Axis

Has any connection been established between dysbiosis and hypothalamic-pituitary-adrenal axis dysfunction?

Dr. Amy Nett: There are a number of different ways that dysbiosis potentially contributes to HPA axis dysfunction. One of...

What do you recommend for someone who has adrenal fatigue and needs some safe starchy carbs but also has blood sugar issues?

Laura Schoenfeld: Good question, Angel. I actually see a lot of blood sugar issues in people that aren’t eating enough carbs...

Why does Chris call it “HPA axis dysfunction” versus “adrenal fatigue”?

Dr. Amy Nett: That was mentioned briefly in the Week One information, and Chris is going to go into that...

Follow-up from last Q&A, recent Q&A where he asked about a DUTCH result with high cortisol and cortisone with severely blunted cortisol awakening response that he hacked from the saliva kit,” which is really cool. Congrats for doing that. “I know sex hormones are not covered in this level. I’m just wondering if you could briefly help to interpret this result. Total DHEA normal, etiocholanolone normal, androsterone high normal at 2,391, testosterone high at 221, total estrogen high at 41.7. All estrogen metabolites high with methylation activity marker in the center of the gauge. Patient is not on a prescription. I’m curious of differential diagnosis for high sex hormones. Patient is a 32 year old male.

Chris Kresser: Let me go here and look at something. So when etiocholanolone is low or normal and DHEA is...

Twenty-four-year-old female, 5’3”, 163 with complaints of anxiety, depression, thirst, alternating IBS-C and -D, hormone imbalance and infertility, history of miscarriage, poor sleep quality, brain fog, hypertension, chronic headaches with normal brain MRI. Does use progesterone cream but no other prescription. DUTCH test pending. Blood panel: A1c at 4.8. Fasting glucose, 71, so lower end there for blood sugar. Ferritin, 50, middle of the range. Iron sat, 41 percent, same, TIBC, 320, was all normal. RBCs are lab-high at 5.66. Hemoglobin lab-high at 16.9. Hematocrit lab-high at 50. Urine specific gravity was 1, CRP normal, homocysteine, 7. Vitamin D, 28. Findings suggest dehydration, but urine is so dilute and frequent polydipsia seems paradoxical. The previous testing about a month ago confirms the RBC indices. Curious that this may be related to dysfunction of the renin angiotensin aldosterone and erythropoietin system. Or maybe we’re just overthinking this. Any thoughts?

Chris Kresser: No, I don’t think you’re overthinking this. I think it’s our job as functional medicine providers to follow...

Do you think with kids and neurological issues, is it ever appropriate to do the DUTCH test or use CBD oil or any of the HPA treatments? I know that pursuit isn’t analytical, doesn’t have ranges for kids, but it seems to make sense to explore HPA-D with this population.

Chris Kresser: I completely agree, Laura. I think that population is one of the most affected by HPA axis dysregulation,...

Any rough guides for DIM dosage to reduce high E3 and 4-OHE(1) with low 2-OHE(1) on DUTCH?

Dr. Amy Nett: Well, it depends how far out of range they are, because so I would most often use...

We’re just starting to get comfortable interpreting DUTCH. Noticed something that was confusing. They provide age-specific ranges for select markers like testosterone, androgen, metabolites, and total DHEA. But the dial indicators of the patient do not reflect the age-specific ranges for the patient. As an example, 62-year-old male patient, total DHEA was 3,761, age-specific range is 1,000 to 2,500, but the arrow is in the middle range of the dial. Which range should you use?

Chris Kresser: You should use the age-specific range. I’ve talked to Mark about this for a while. You know, they’ve...

How do you describe HPA axis dysregulation to patients without going into detail, the problems with the term adrenal fatigue. People seem to know what adrenal fatigue is but glaze over when I start talking about HPA-D. I don’t want to perpetuate the myth of adrenal fatigue, but I need an easy way to explain HPA-D.

Chris Kresser: I just say the HPA axis is the system that determines our stress tolerance and is affected by...

I’m hoping you can help with this troubling case. I know we’re not covering sex hormones specifically in ADAPT, but a client of mine has some irregularities in the background. I have limited experience related to these hormones. He’s 30 years old, asymptomatic male that came to me looking to optimize health. Very active in CrossFit, is a full-time coach and participant. Many years ago, at least five years ago, he was a bodybuilder and used anabolics but has abstained since. Ran the DUTCH complete. His total DHEA came back low normal and the downstream hormones came back very low. Testosterone was 4.9, which is very low. Estrogen, progesterone were both right at the bottom of the reference range. Seems his ability to produce all these hormones still affected by his previous steroid use. Even though he’s asymptomatic, I’m thinking I still need to work on increasing DHEA and probably, more importantly, his conversion to testosterone. Any thoughts on where to start with this? Anything else I should be aware of in this type of case?

Chris Kresser: Yeah. Good question. So I think the first thing I would do in this situation is to test...

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