HPA Axis
What do you make of a saliva test with a very low cortisol all the way through the day, and then a ratio of cortisol to DHEA-S of one, DHEA-S being twice the high end of the range?
Dr. Amy Nett: Okay, so if I’m understanding this Justine, and you might need to clarify if I’m not interpreting...
I can see it’s necessary to do a DUTCH test to see the abnormal cortisol metabolites, or to see the cortisol metabolites. But with the DHEA so high, what might this mean? I keep reading about DHEA being high with PCOS, but no one really elaborates about it. Can you? What’s the mechanism behind it? What does it then cause to happen? Is it something to really worry about or not? If so, how can it be lowered?
Dr. Amy Nett: Okay, so here we’re talking about a woman with high DHEA and you’re asking about DHEA and...
What is the way to figure out if sulfation is upregulated or downregulated?
Dr. Amy Nett: Okay. So I think what you’re talking about here is what we talked about this week was...
Just ran a DUTCH test on a 60-year-old postmenopausal female. She complains of sleep issues, hot flashes. Essentially, slightly elevated afternoon cortisol, low DHEA-S, elevated melatonin. She takes melatonin on and off but didn’t for a couple days before entering the test. Below-range progesterone, estrogen, metabolism. Thoughts?
Dr. Amy Nett: And so she’s been postmenopausal for about five to seven years, and then I’m guessing that the...
Chris mentions in the exposome unit on HPA axis dysfunction that if a patient is having low blood pressure to consider limiting high-potassium foods. To what extent do you think this is necessary? For example, would a medium banana and half an avocado in one day be too much? If the patient starts taking half to one teaspoon of sea salt in the morning, can they be a little more liberal with the potassium in the foods they’re eating? Lastly should the patient be monitoring blood pressure throughout the day? If so, how often and when?
Dr. Amy Nett: Yeah, so a lot of answers to each of these questions are going to depend to some...
From the HPA DUTCH section, the example of glucocorticoids creating low cortisol, low metabolites. The patient used hydrocodone, not steroids. Was that a typo or is the use of opioids a pathway that somehow leads to low cortisol?
Dr. Amy Nett: Yeah, so opioids actually inhibit HPA axis at multiple levels. I think I realized that when I...
The DUTCH test is supposed to be done around days 19 to 22 of a woman’s cycle. However, what if it’s timed wrong and it’s done three to five days late? Is the test then useless?
Dr. Amy Nett: No, the test isn’t useless. You just are going to have to consider that the test is...
On the DUTCH test, it only says no caffeine after lunch on day one of the test. I assume this means until the next day to the final collection. Can people get a false reading from caffeine withdrawal effect?
Chris Kresser: Yeah, I’ve been meaning to ask Mark Newman about the instructions there. I think that’s intentional. With all...
If someone has very low cortisol and low cortisol metabolites, would exercise be a way to raise it if they weren’t too tired?
Chris Kresser: I would be very cautious with exercise in a patient with very, very low free and total cortisol....
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: Some of this might be personal, so I’m not going to read it, but the gist of the...
