Dr. Amy Nett: Yeah, so definitely ask questions with the live webinar with Chris next time. I know it was a bummer that he couldn’t do it live last time. I totally get your point. It is so many supplements. Let me tell you a little bit of what I do with some of these supplement protocols. I basically—it depends a little bit what else we’re treating and what their complaints are.
I’m going to go to the HPA protocol matrix, and I’m going to look at that a little bit to give you some of the guidelines. When I open up the HPA-D protocol matrix, the first one that comes up is high cortisol protocol. You’re right. There are one, two, three, four, five, six, seven, eight, nine, 10, 11, 12 options that are listed here. That’s a lot. I would probably never use all of those unless the patient came, and every one of their symptoms seemed related to high cortisol production. Then I might try them.
That said, as you gain familiarity with these, you’ll have more comfort with them, so what you might think about doing is choose five of these supplements throughout the whole protocol matrix. Just choose maybe HPA Balance, phosphatidylserine, Vital Adapt, Relora, and Acetyl-CH. Maybe choose, just for example, those five. Start using them and start seeing like what people’s reactions are, that sort of thing. Get a few, get comfortable with them rather than trying to bring in all of these at once. Once you feel comfortable with those initial five, then start layering in other things that you might feel comfortable with. That might be one approach, just so you gain experience, because I agree. I don’t like to use too many supplements that I’m not familiar with all with one patient.
If someone comes in, most often I’m going to be doing something with the gut, maybe something with some nutrient repletion, such as I’m going to be doing an antimicrobial protocol. Maybe they need some additional vitamin D or iron supplements, so I’m going to have a couple nutrients. Then I’m probably going to want to choose one to two things for HPA axis. So, that’s how I approach it in my kind of average standard patient. That’s only because I want to increase compliance. I find that if you give too many supplements, it’s going to be overwhelming, and it’s not going to happen. You can have the best intent. You can say antimicrobial protocol and then because of your adrenal profile, we also want to do this high cortisol protocol. Best intentions, and that might actually be an ideal approach until you get to the patient compliance piece of it, in which case the perfection of that plan might have a hole in it.
Let’s say I have a patient. I’m going to be doing antimicrobial protocol with him, and I think, uh oh, this patient also has really high cortisol, and the patient is telling me, “Uh, I feel kind of anxious and wired, and it’s a little bit uncomfortable. I’m having trouble sleeping.” Okay. I would go to the high cortisol protocol, and I would choose a couple supplements that I think are going to the biggest bang for the buck, so to speak. In this patient, it’s going to depend a little bit, but in this example, patient has high cortisol, feeling kind of wired, feeling kind of anxious. I would probably do HPA Balance. I like that one. I like the Relora, sensoril, and L-theanine. I might also choose phosphatidylserine. I think that can be calming, and it can help with sleep. Then I would also choose probably either Kavinace or CBD. I’m experimenting with the CBD oil a little bit in patients. It’s definitely a discussion I have with them and let them know I think we probably do need a little bit more research, but I find that it can be helpful, especially if the anxiety and sleep are pretty severe. If there are headaches or migraines, it can be helpful. In that example, I might say my go-to for that patient—I have to choose a limited number—I’m just going to choose three of these: HPA Balance, phosphatidylserine, and either Kavinace or CBD, depending on the person.
Let’s say I have that same patient, and he comes in with the same thing. We have to do an antimicrobial protocol, but he has really low cortisol, and he’s telling me he is just tired, dragging, and he can barely get out of bed in the morning. I would go to the low cortisol protocol that we have, and I would say, well, again, I’m just going to choose maybe one or two things. So, this person is really tired. He is kind of dragging in the morning. I would probably do Vital Adapt and adrenal glandulars. Adrenal glandulars can be really helpful for some people who are dragging in the morning. I’ve had a couple patients who say this is great. It’s kind of like a shot of espresso in the morning. I tell my patients that before they try adrenal glandulars because for some people, I want them to know it can be stimulating, that can be normal, and I don’t want you starting with three capsules at one time. Again, my go-to here for low cortisol, I would do Vital Adapt and adrenal glandulars.
If there is significant inflammation, you could choose boswellia or curcumin, and that I would sort of look at as a bigger inflammatory picture, but that might be considered for a third one. So similarly, you can kind of go through each one. I’m not going to do that because I think you get the point, but I’ll just mention briefly. So, a disrupted diurnal rhythm, if I were to be dealing with that, if I had to choose one or two go-tos, I personally like Relora and phosphatidylserine. Those are my go-to right now for a disrupted diurnal rhythm, but again, variation. I use Theanine Serene with Relora sometimes too, so that’s a nice one. Theanine Serene with Relora. So, I kind of mentioned those. High DHEA, probably I would go with HPA Balance on that one if I had to choose. Then, I think the other ones, maybe a little bit. So, elevated cortisol awakening response, again, if I had to choose, I would ask about their anxiety. If there is a lot of anxiety, I’d probably go with Kavinace or phosphatidylserine and otherwise HPA Balance. For the low cortisol awakening response, I would probably again do Vital Adapt and adrenal glandulars. Then normal HPA lab results, subjective HPA dysfunction, again there you are treating a little bit more based on the patient’s complaints and concerns, so I think that one is a little bit more straightforward.
Hopefully that helps you in terms of maybe how to start approaching it. Again, the more familiarity you get with these supplements, the easier it will be to decide which ones might work for that patient. The calming ones tend to be pretty well tolerated, so I don’t feel too cautious in starting those. Adrenal glandulars and adaptogens, even including Vital Adapt, can be a little bit more stimulating, so I do start at lower doses there. In terms of do I start one at a time, well, that’s just like with anything else. If the patient tells me, “Oh, I’m sensitive to just about everything,” then, yes, I start them one at a time. For my other patients who are like “Eh, I barely notice anything. I just want to get moving with treatment,” then I have them start everything at once if that’s what they prefer. If it doesn’t go well, then stop and back off. Okay, I think I got through all of your questions. Hopefully that helps a little bit, but let me know if there are other questions.