HPA Axis
I have a lot of colleagues and friends who have done a different popular functional medicine training.” I won’t ask which one. “In that training, they always check and treat HPA before gut treatment. The claim is that if there is an HPA issue then gut treatment will not be successful. Specifically, they say that with a low secretory IgA, the gut treatment won’t work. Of course, I want treatment to be effective. What do you think about this, especially the part about secretory IgA?
Dr. Amy Nett: So, I think I mentioned this in like the second question that we talked about today where...
I’m treating a female in her mid-30s for heavy cycles with debilitating PMS. She has two small children, runs a business, has insomnia since childhood so looking forward to addressing HPA axis with her after resolving gut dysbiosis. Her Doctor’s Data stool test shows Blastocystis in all three samples ranging from few to many. Butyrate is high, and secretory IgA is low at 8.1. Dysbiotic flora includes 2+ of geotrichum species, and my question is whether to add Yeastonil/A-FNG to the antimicrobial protocol due to the 2+ yeast and for how long? Also, is there anything to do regarding the high overall short-chain fatty acids at 20? Her Lactobacillus and Enterococcus are low at 1+. I wonder about adding anything in particular to restoring the gut protocol.
Dr. Amy Nett: I would say I might not wait to address the HPA axis until resolving gut dysbiosis, so...
What would I do about low 5-α reductase activity?
Dr. Amy Nett: Great question. It depends a little bit. What do the rest of the hormones look like? Because...
If patients are taking testosterone or growth hormone, in what way could this impact the HPA axis results? I know it’s not part of the course. I’d be interested in your view on these.
Chris Kresser: Regarding testosterone, if you’re ordering the Comprehensive DUTCH Panel, obviously it will affect the testosterone levels that show...
During the discussion of the DUTCH Hormone Test, you mentioned that gut issues can contribute to low free cortisol levels. Can you go over that connection again?
Chris Kresser: Sure. Gut issues could contribute to high cortisol, low cortisol, a combination of high and low cortisol, dysregulation...
There’s a patient that presents with a facetious hyperthyroid state because of too much thyroid medication, and Chris is saying that the patient has levels of cortisol that are too high but low levels of cortisone. I thought that when patients had hyperthyroid states they usually presented with the opposite. I’m confused. I think I understood the physiology that would make more sense. He states that oftentimes people with hyperthyroidism have troubles converting cortisol to cortisone, but he also said in the earlier cortisol/cortisone slide that patients with hyperthyroidism often present with high cortisone levels, so I don’t understand.
Chris Kresser: Well, it is all very confusing. I think, as a general comment, you have to remember that there’s...
From the HPA DUTCH section, part five, under ‘Why is cortisol elevated in obesity?’ I’m not clear on the hypothesis that obesity causes impaired cortisol-to-cortisone metabolism. This would not explain why cortisone metabolites show up in the urine. Wouldn’t there be less cortisone metabolites if the original cortisone conversion process is impaired?
Chris Kresser: I debated on how much detail to go into with this. The HPA axis is incredibly complex, and...
Do you have any updated info or comments on whether GABA crosses the blood-brain barrier and whether it’s useful for HPA-D or anxiety?
Chris Kresser: So, there appears to be some disagreement here, but the consensus, as far as I can understand it...
What’s your take on maca as a supplement for HPA-D? It’s an ingredient in some adrenal support products such as Integrative Therapeutics HPA Adapt. I’ve tried it on myself, but it disrupted my period. Being Chinese, we call it ‘unable to tolerate the yang’ or ‘a weakness that isn’t suited for replacement therapy with yang.’
Chris Kresser: Yeah, I look at it from that perspective too. Maca is pretty potent, and it can have a...
