Dr. Amy Nett: So, I think I mentioned this in like the second question that we talked about today where someone said I’m going to treat the gut and then the HPA axis. I would treat them concurrently. You’re absolutely right. I think in this course, the way things are presented, it’s, “Let’s talk about the gut. Let’s talk about HPA axis. Let’s talk about blood chemistry.” Chris had to organize the course in some sequential manner. That’s how it was organized, but that’s not necessarily how we’re going to approach a patient.
I think that gut and HPA axis issues can absolutely be approached concurrently. We always—well, sorry, I should never say always—99 percent of the time, if not 99.5 percent of the time, I am running a DUTCH Complete hormone profile while I’m running the SIBO breath test and stool testing because you’re absolutely right. These are interconnected. The low secretory IgA, as I mentioned earlier today, to me a low secretory IgA indicates there is a cortisol issue. It indicates there is an HPA axis issue. You’re absolutely right, but I would address these things concurrently because the other problem is, as we’ve talked about, so we’ve been talking a lot about the four primary drivers of HPA axis dysregulation. What is one of those drivers? Chronic infection and stress, right? Like perceived stress, not necessarily psychosocial stress but chronic illness. So I have patients who tell me, “Look. I’m a stay-at-home mom. I love my job. I have one kid, a happy marriage. I’m not stressed. I feel fine. Life is easy.” I say that’s great. That’s wonderful, but if we look at your gut, you have SIBO. You have Blastocystis. Your body interprets that as stress, or maybe you’re still eating dairy, and your Cyrex panel shows that that is stress. We have to remember that HPA axis issues can be coming from the gut as well.
Do I have to choose between which order I would go in treating GI and HPA axis issues? Hopefully not. Hopefully I can stress to the patient that we need to bring in pieces of both because they are so interconnected. If you have to choose, let’s look at how is this patient presenting. If a patient comes in with anxiety, insomnia, and panic attacks, they’re coming in waking up in the middle of the night with tachycardia, shortness of breath, severe insomnia, I will start with HPA axis issues. If a patient is coming in with bloating, constipation, food intolerances, gut pain, you know, something like that, okay, I’ll probably start with the gut. But for most people, at that case review appointment, that’s one of the reasons it’s a 75-minute appointment. I tell you, I want to probably increase mine to 90 minutes because there is a lot to talk about, and I think it’s important to explain to the patient we can’t untangle these, that unfortunately there is such strong brain-gut communication. To have the most effective treatment, I think you need to treat both of them concurrently. The amount of energy, resources that the patient has might determine how much you can layer in, but almost always, you can start Headspace, something—meditation, some sort of HPA axis support, but I don’t think that we should have to choose between which to treat first. I think we can start to address them both at the same time, and that will be the best approach. So, that’s my opinion.