Chris Kresser: Yes, it’s tricky. This is the type of case that we do see a lot as practitioners. You have to experiment quite a bit and see what works. I mean, sometimes a ketogenic, very low-carb diet can work well in this situation without addressing adrenal fatigue if you provide that patient with the HPA axis support while they’re doing that diet. Other times, you really just have to focus on the HPA axis first and just go 100 percent in trying to address that before you can start making significant progress metabolically. But generally, it’s not an either-or. It’s a both-and, and you have to kind of structure and layer the treatment in a way that you’re doing a little bit of each, taking a step forward in both directions in order to address that kind of patient.
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- What’s your recommendation for a 55-year-old woman who would like to get rid visceral fat but severely adrenal fatigued and insulin resistant? I know intermittent fasting is a fabulous way to bring down insulin, but adrenal functions are not up to par and might take a while to address that. What’s the option for a patient like her to lose weight? She tried intermittent fasting before, and she was not able to sleep at all for two nights straight. She’s considering to get bioidentical hormone therapy. Thyroid panel is surprisingly fine, but her hair has been thinning.
What’s your recommendation for a 55-year-old woman who would like to get rid visceral fat but severely adrenal fatigued and insulin resistant? I know intermittent fasting is a fabulous way to bring down insulin, but adrenal functions are not up to par and might take a while to address that. What’s the option for a patient like her to lose weight? She tried intermittent fasting before, and she was not able to sleep at all for two nights straight. She’s considering to get bioidentical hormone therapy. Thyroid panel is surprisingly fine, but her hair has been thinning.
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- For patients who appear to have HPA axis dysfunction on DUTCH but findings are also consistent with hypothyroidism, you would ask to search for a cause for the hypothyroidism and address that too, right?
- You mentioned that keto is not a great idea for those with HPA axis dysfunction. Is there data to suggest keto contributes to elevated cortisol or cortisol resistance? For those who may not lose weight on keto, is this most likely due to HPA-D?
- On the topic of steroids, what are the real long-term and short-term issues when someone is on them?
- I have a client diagnosed with polychondritis of the ear. She came in months ago. I suggested food elimination and she disappeared. She is back now after beginning some food elimination. I suggested the Paleo reset and avoiding nightshades and eggs. What testing would you think of right away? She’s also very sympathetic nervous system type and was interested in what HPA testing you might suggest if you use one.
- Do you have any experience using maca for low testosterone based on DUTCH test results? Patient has low libido, and his cortisol results are high free cortisol and low metabolized cortisol.
- Woman coming in wants to prep herself for getting pregnant—35, birth control since 16. A few months ago, she went off birth control, experienced very bad acne, and so she went back on. Says the acne was the reason she went on when she was 16. This is a very common story of course, and I’m sure many of you have seen this lots of times. Done comprehensive blood. She looks pretty good outside of some functional iron deficiency, lack of protein in her diet, possible HCl, and electrolyte imbalances. Advised Paleo reset and then hormone testing. What tests do you suggest, and should they be done when on birth control or at some point went off the pills? I want to prep well before she goes off BCs so she can have less symptoms and then regulate her conception.