HPA Axis
I recently did a DUTCH test, and no previous experience with Precision Analytics, so trying to learn how to interpret results. Generally, it’s normal but wondering if you could explain one more time the swing between the cortisol and cortisone spectrum? I understand cortisol is the more available, so if someone tends to have normal levels of both but favors cortisone, does it mean that the body has directed some of the extra cortisol into cortisone because it’s not needed at that time? Is this flow back and forth constantly changing? Additionally, I know we’re not covering hormones specifically in this course, but the DHEA-S was normal. Testosterone was low. Could you briefly address some of the causes of low testosterone if there is no obvious HPA axis dysregulation, and progesterone is normal?
Chris Kresser: Regarding cortisol and cortisone, cortisol is the more active form. It’s not the more available form, a slight...
I have a question about my first DUTCH test with a 48-year-old menstruating female with complaints of fatigue and inflammation. She is thin but not overly, eats very healthy. No excessive exercise. SIBO negative. DUTCH was confusing. Low 24-hour cortisol, way low metabolized cortisol, low estrogen and testosterone, normal progesterone, DHEA low normal, 5-α reductase activity high. On the handout regarding patterns, low free cortisol with low total included things such as fibromyalgia, chronic pain, metabolic syndrome, etc. The only thing she does have was a serum borderline hemoglobin A1c of 5.6 and low insulin, so I ran a GTT, glucose tolerance test, and glucose was 91, 74, 67, 75. Insulin was 29, 18, 22, 11. So, I don’t know where to go about the blood sugar issue, or is there one? According to her endocrinologist, no, and/or the other hormone issues.
Chris Kresser: Some of the conditions I listed in the handout are the ones that have been explicitly identified in...
Would you recommend doing the DUTCH test while pregnant or nursing?
Chris Kresser: Sure, but you have to take into consideration that the patient is pregnant or nursing, and you...
If you can’t use DUTCH, since we can’t in New York, is it possible to use one, the 24-hour urine for total cortisol production of metabolites to the saliva test for diurnal variation? Is the 24-hour urine reference range for standard labs useful for functional assessment purposes, or would the range need to be refined?
Chris Kresser: Great question. I actually was doing exactly what you mentioned and also combining serum cortisol and DHEA testing...
In the HPA section where you talked about babies whose mothers experienced a lot of stress while in the womb and how sometimes they have lower cortisol response throughout their life, do you know at what time during gestation the stress typically would have occurred? I would guess earlier on in gestation when the brain is forming, but was curious what the research had shown. Also was curious if you had any recommendation for these patients or perhaps we would get to that in a later section when we talk about supplements that may be used for people with low cortisol?
Chris Kresser: Yea, this is a heartbreaking thing. It can happen in utero. It can happen even early on in...
I have a question about polycystic ovarian syndrome. Would you always recommend a very-low-carb diet for patients with PCOS?
Kelsey Kinney: No, not necessarily. With carbohydrate intake, I really play it to the individual. If I have someone with...
A person with HPA-D is not hungry and feels nauseous in the morning. Anything to reduce nausea and still get a breakfast in?
Laura Schoenfeld: That can be really tricky because one of the reasons why some people don’t have hunger in the...
I’m confused about what the test is really telling us if a patient has high or low cortisol metabolites in relation to free cortisol levels that are high or low. For example, if they have low free cortisol, but high metabolized cortisol, does there not need to be a treatment? Or are we going to get into this in the treatment section? I guess I’m having a hard time putting it all together as far as how to explain the physiology if you see altered levels of metabolites, or free cortisol or cortisone and then what to do about it.
Dr. Amy Nett: I think some of this is, you also have to put it into the clinical context. Because...
One of the case study answers says this patient would benefit from general adrenal-supporting nutrients such as vitamin C, magnesium, and B vitamins. In the exposome unit on HPA-D the only B vitamin listed as a suggested supplement is pantethine. How are B vitamins generally supportive for the adrenals? Is this answer suggesting something like a B complex?
Dr. Amy Nett: No, I think in this case it was probably meant to be pantethine. So adrenal-supporting nutrients like...
