HPA Axis
Regarding cortisol-to-DHEA ratios on the DUTCH test, approximately what ratio is considered normal, and what is considered indicating catabolic, i.e., high cortisol compared to DHEA?
Chris Kresser: There’s not really a lot of literature that establishes a specific ratio, especially when it comes to using...
Chris mentions ‘We refer to stress-induced pathology as HPA dysfunction, but the reality is that stressors affect us via two primary mechanisms: the HPA axis and the SAS. I understand that these are intertwined, but my question is, isn’t it rather important to try to work out which one is dominant, or which one of these is dominantly out of whack in certain situations like waking up in the middle of the night because the physiology will be a bit different? If cortisol is too high at night, isn’t that really different than if adrenaline is high at night? I know the long-term solutions will be the same, but in the short term in terms of which supplements to use, etc.
Dr. Amy Nett: You know, I mean, it’s a good question, and I think there are probably definitely some nuanced...
I’m trying to work out which is the best saliva test for assessing cortisol awakening response for us in the U.K. The labs that I’m signed up with offer the four times cortisol, one times DHEA from three companies: Dunwoody, LabRx, and ZRT. Just wondered if you have any idea which is the most trustworthy of these, or maybe it doesn’t matter as we are not using the reference ranges anyway.
Dr. Amy Nett: Well, you’re right. So, all you want is values, not reference ranges, but that said, labs still...
I just want to clarify about cortisol, cortisone, and cortisol/cortisone metabolites. So, the metabolites, or once they’ve been metabolized, and there is no going back from there, cortisol is the active form. Cortisone is the inactive form. It can go back and forth between those. Can I run through cortisol and cortisone?
Dr. Amy Nett: Okay. So, in general, we have cortisol, which is made primarily in the adrenal glands. Cortisol is...
In a case study from the HPA-D unit, you mentioned a patient with high cortisol” or high free cortisol, I’m assuming he means. “… high cortisol metabolites and high cortisone. Additionally you mentioned the patient had eye floaters. Have you noticed any underlying dysfunctions specifically related to eye floaters?
Chris Kresser: Nothing comes to mind off the top of my head. I mean, hypertension could potentially cause that and...
We refer to stress-induced pathology as HPA dysfunction, but the reality is that stressors affect us via two primary mechanisms: the HPA axis and the SAS.’ I understand these are intertwined, but my question is, isn’t it rather important to try to work out which one is dominantly out of whack in certain situations such as waking up in the middle of the night because the physiology will be a bit different? If cortisol is too high at night, isn’t that really different to if adrenaline is high at night? I know the long-term solutions will be the same, but in the short term in terms of which supplements to use, is there a difference?
Chris Kresser: I haven’t found that to be an important clinical distinction. We talked a bit in the HPA axis...
Many of my clients have gut issues and HPA axis dysfunction, so what should I treat first, or is it okay to treat both together with the botanical protocol plus an HPA axis supplement?
Chris Kresser: Yes, this kind of goes back to Dean’s question as well. You have to evaluate on a case-by-case...
I’m somewhat confused about testing the HPA axis in terms of thyroid health and how this could confuse things. On page 14 of Datis Kharrazian’s thyroid book, he says, ‘In people with hypothyroidism, urinary excretion of several arena hormones decreases. So someone could appear to have an advanced case of adrenal fatigue when, in fact, they’re simply doing a poor job of clearing the hormones through the kidneys. He’s basically explaining that he prefers salivary testing. You briefly mentioned this in last week’s material how urinary cortisol metabolite measurement might become a means of diagnosing subclinical thyroid dysfunction in both hyperthyroid and hypothyroid. Do you agree with Datis that this is a problem with urine testing, and if so, are there ways around this or extra tests on top of the DUTCH Complete so the thyroid malfunction doesn’t get confused with HPA-D?
Chris Kresser: No, I don’t think it’s a problem because you’re testing free cortisol and metabolized cortisol in the urine,...
How long after you start HPA-D lifestyle management and supplements do you retest?
Chris Kresser: It depends on the severity of the dysfunction. If it’s really minor, we might retest as early as...
If we were attempt a CAR, cortisol awakening response, hack with salivary cortisol, can you remind us of how to analyze the results? If you have a quick example or even a made-up one, that would be excellent.
Chris Kresser: This is an example, including how to interpret it, is on slide number 21 in the DUTCH Test...
