HPA Axis
I am a night shift worker, 9 p.m. to 7 a.m. shift, working a schedule of roughly seven nights on and 14 nights off. During my off time, I switch to a daytime schedule. Needless to say, I have some difficulty sleeping. I recently conducted the DUTCH Complete Test at about five nights out from my work schedule. While my cortisol level demonstrated some large swings, spiking to top end of normal at the second morning point and bottoming out to the low end of normal at the evening point and coming up to the high end of normal at the before bed point, it remained diurnal. Unfortunately, melatonin was well below normal at 1.2. My question is whether it’s better to supplement with melatonin or try to provide melatonin support through food. I currently only supplement with melatonin during my work weeks.
Chris Kresser: Yeah, it’s a really tough situation. I think I mentioned that having a more consistent shift schedule, where...
From an HPA axis perspective, what, if anything, would you suspect is going on with the following symptoms, which I’ve had described to me by several patients over the years: (1) energy crashes or symptom exacerbation at weekends or during holidays, and (2) extreme tiredness or mood problems as a reaction to waking up in the morning during, in the patient’s words, ‘the wrong sleep cycle’?
Chris Kresser: I don’t think they’re necessarily the same thing, although I agree with you that they’re both probably signs...
In the HPA-D unit, Chris explained that pregnenolone cannot actually be stolen to make cortisol, thereby decreasing DHEA, since they’re made in two different areas of the adrenal cortex, and if I have this, DHEA is typically low when cortisol is high probably due to enzymatic activity. Can you explain a little bit more about what’s actually going on with pregnenolone, if anything, when we’re under stress?
Chris Kresser: There’s still a whole lot we don’t understand about pregnenolone and particularly about DHEA. I mentioned that in...
How much variation do you see in cortisol on the DUTCH test when, for example, you didn’t sleep well one night, assuming normally you sleep well or had some other form of acute stress?
Chris Kresser: We would expect to see variation. Cortisol is a hormone that responds in a matter of minutes to...
Do you see potential HPA pathology with clients who decide to go back to sleep or hit the snooze button after their initial morning awakening?
Chris Kresser: That’s an interesting question. What we do see is a U-shaped curve in terms of sleep duration. We...
Do you see potential HPA pathology with clients who decide to go back to sleep or hit the snooze button after their initial morning awakening?
Chris Kresser: That’s an interesting question. What we do see is a U-shaped curve in terms of sleep duration. We...
If cortisol reduces inflammation, then why do people so often have elevated cortisol and high inflammation at the same time?
Dr. Amy Nett: This is a great question and I think Chris talked about some of the complexity of cortisol...
In a patient with high free cortisol and low metabolized cortisol, we were taught this week that thyroid function could play a role. Can you explain how? Maybe I mistaught myself, but I thought adrenal function worsened thyroid dysfunction. Maybe it’s bilateral, but could you specifically explain the mechanism of action for thyroid dysfunction inhibiting the metabolism of free cortisol? Separately, via the DUTCH testing, I’ve superficially learned that liver dysfunction can also negatively impact this conversion. What kind of liver dysfunction? Are we talking about detoxification or something else?
Chris Kresser: It’s true. High free cortisol and low metabolized cortisol, hypothyroidism is one of the causes of that imbalance,...
The HPA-D unit, you explained DHEA(S)”—That’s total DHEA in serum. Just confirm that that’s what you mean, and not DHEA-sulfate, which is DHEA-S with no parentheses as more sensitive. I had a patient for whom we did DUTCH testing, and her DHEA was in mid-normal ranges. She did a serum DHEA(S), and it showed low levels. How would you approach this?
Chris Kresser: This is another one of those nuances that’s also very confusing and somewhat complex, and you can refer...
I have a two-part question on a new patient. I’m wondering your initial thoughts and where you would be thinking on this case study besides initial workup with labs. A 25-year-old patient, often tired. Pushes through, but it’s a struggle. She was on Vyvanse for a year at the age of 20 and is off it completely. She has taken Sudafed to work through a cold and has noticed helpful cognitive benefits. She doesn’t want to take either of these amphetamines for obvious reasons, but she has tried different amino acids before, and they give her extreme headaches. Sleep is good, and she follows a Paleo diet and lifestyle, but energy and cognitive function are not optimal. She also mentioned it’s hard for her to sleep if she does not eat potatoes with dinner. Where would you start, and how would you start thinking in this case?
Chris Kresser: For sure, I would do a comprehensive workup, and an HPA axis assessment would be a big part...
