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HPA Axis

Is it appropriate to link the possibility if a person’s symptoms improve on a drug like Zoloft that they’re suffering from gut issues and that spending the money to do a Doctor’s Data stool test is well worth the investment? This patient has done a great deal of testing, but gut testing hasn’t been done for a few years. She’s cleared up many symptoms with the GAPS diet, etc., and eats very clean. She is being treated for Lyme, etc. Here is a communication from her after she started Zoloft: [This is the patient here.] I ended up in the ER about three weeks ago with a major panic attack and was diagnosed with depression and anxiety. I had not been sleeping well for months. I’m now on Zoloft and doing very well. A lot of the symptoms that were bothering me are gone. I also do not have any bad cramping or heavy bleeding with this period. I’m on day four. I honestly have just needed a break from obsessing about my health issues and have been enjoying it. I am meditating and doing yoga, listening to hypnosis videos, juicing a lot, and napping in the sun. [So this is back to Julie.] My question is, do you see gut dysbiosis or infections depleting serotonin and creating depression, anxiety, etc.? I would like her to proceed with the Doctor’s Data stool analysis, but want confirmation that it’s a good place to spend her money since financially she’s been very depleted with chronic health challenges. She has already completed DUTCH testing.

Chris Kresser:  This is a great question, and it actually points to a number of other questions that are perhaps...

I have a question about polycystic ovarian syndrome. Would you always recommend a very-low-carb diet for patients with PCOS?

Kelsey Kinney:  No, not necessarily. With carbohydrate intake, I really play it to the individual. If I have someone with...

A person with HPA-D is not hungry and feels nauseous in the morning. Anything to reduce nausea and still get a breakfast in?

Laura Schoenfeld:  That can be really tricky because one of the reasons why some people don’t have hunger in the...

I’m confused about what the test is really telling us if a patient has high or low cortisol metabolites in relation to free cortisol levels that are high or low. For example, if they have low free cortisol, but high metabolized cortisol, does there not need to be a treatment? Or are we going to get into this in the treatment section? I guess I’m having a hard time putting it all together as far as how to explain the physiology if you see altered levels of metabolites, or free cortisol or cortisone and then what to do about it.

Dr. Amy Nett: I think some of this is, you also have to put it into the clinical context. Because...

One of the case study answers says this patient would benefit from general adrenal-supporting nutrients such as vitamin C, magnesium, and B vitamins. In the exposome unit on HPA-D the only B vitamin listed as a suggested supplement is pantethine. How are B vitamins generally supportive for the adrenals? Is this answer suggesting something like a B complex?

Dr. Amy Nett: No, I think in this case it was probably meant to be pantethine. So adrenal-supporting nutrients like...
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