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HPA Axis

HPA Axis

Reading from this week’s recommendations, wondering if acetyl-CoA is connected to the supplement from the HPA dysfunction protocol acetyl-CH. Taking it, and I realize I don’t know much about the mechanisms by which we think it works.

Chris Kresser: Acetyl-CH is related in the sense that it’s really targeting acetylcholine. But it’s not the same and it’s...

Apex product NeuroFlam NT is recommended for high melatonin in the HPA-D treatment protocol. NeuroFlam is a very similar Apex product that additionally contains resveratrol and things like green tea extracts. I’ve yet to read or hear your take on resveratrol. Similar to curcumin, boswellia, etc.?

Chris Kresser: My take is that from what I’ve seen, supplemental resveratrol falls into the category of many supplemental antioxidants,...

If DUTCH is supposed to check the hormonal rhythms of a typical day, why discontinue coffee during collection if that’s part of a patient’s day? DUTCH collection sheets request stopping caffeine. Can one cup of decaf affect DUTCH? What about a small piece of dark chocolate?

Chris Kresser: It’s meant to affect a normal day, but caffeine has a rather immediate effect and so it’s recommended...

In a case study from the HPA-D unit, you mentioned a patient with high cortisol, high cortisol metabolites, high cortisone, and additionally that the patient had eye floaters. Have you noticed any underlying dysfunction specifically related to eye floaters?

Chris Kresser: I have noticed the correlation between HPA-D and eye floaters and I think just in layperson’s terms there...

I have a patient with a DUTCH first reading with low cortisol, low cortisone. Second reading was high cortisol, high cortisone after exercising. Third reading was within range. Fourth reading, cortisol was within range and high end of range cortisone. Her 24-hour cortisol and cortisone are above range, high end of range. This appears to be a result of the significantly elevated second reading, with a low first morning cortisol and significantly elevated second morning reading. What would be the best treatment strategy? She is being treated for hypothyroid, and we are currently doing an antimicrobial protocol.

Dr. Amy Nett: What are her symptoms, I think, would be my question? Let me try to summarize here. So,...

I mentioned in a postmenopausal DUTCH case study on one of the June calls that I might consider doing functional methylation testing. If I find a methylation issue popping up on the DUTCH test, what type of testing you do and what you do about it? I know we’re not going over this in class, but ideas on where to go from there.

Dr. Amy Nett: So if you’re doing a complete hormone profile, like the DUTCH complete hormone profile, there is a...

What makes cortisol and cortisone get metabolized more or less quickly if someone has low free cortisol and cortisone but high metabolites of both forms, for instance? Why might that be? If someone has high cortisol and low metabolites, what might be preventing it from being metabolized?

Dr. Amy Nett: Okay, so last week—I think we talked about this last week a little bit. So, I think...

I’m confused about your answer to Justine in the Q&A last week about case number three in Week 29. You said that insulin favors cortisol over cortisone. So insulin potentially favors cortisol and that it produces increased clearance of cortisol. But in case number three, the patient had low cortisol metabolites and high-normal free cortisol. To me, that doesn’t make sense with your explanation.

Dr. Amy Nett: Okay, so let me go back and pull that case up. Week 29, case three. Okay, so...

Vital Adapt was recommended, and I’m confused why that would be used because in the teaching Chris said that it was used in cases of low free cortisol, but hers is on the high end of normal.

Dr. Amy Nett: Yeah, that’s fair. I think this is one of those things where clinical judgment probably came into...

In case number four for Week 29, the patient had insulin resistance, but she presented in kind of the opposite presentation with high total metabolites, low free cortisol, and more cortisone.

Dr. Amy Nett: Okay, so let me go back and look at that one. So, case number four. Okay....

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