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HPA Axis

Regarding the case studies part one, is there missing information on the DUTCH testing for the first case? I don’t see values for free cortisone that is being referred to in the example nor melatonin levels.

Dr. Amy Nett: I think that that case was just using an older DUTCH test where the free cortisone wasn’t...

I understand that if cortisol and cortisone are normal or high and cortisol metabolites are low, that could indicate hypothyroidism. But is this always the case and if not, what would you use to encourage the body to metabolize cortisol?

Dr. Amy Nett: Yeah, so it could be, so you’re saying high cortisol, okay. Cortisol and cortisone normal or...

Part three of the HPA case studies, page 2, she says, “Inflammation also increases cortisol-to-cortisone ratio, so inflammation causes the body to convert cortisol to cortisone. If this is the case, how come on page 7 when the case study person has low free cortisol and metabolites, but high cortisone, why isn’t this thought to be the reason?

Dr. Amy Nett: Inflammation can actually favor free cortisol over cortisone. Low free cortisol and high cortisone might actually suggest...

Are the adaptogenic herbs safe to use for cases of low and high cortisol? Or are the adaptogenic herbs safe to use for cases or low or high cortisol except for panax ginseng?

Chris Kresser: Yeah, I mean it kind of depends on which form of cortisol, like whether free cortisol is high...

I’m working with a 65-year-old client, he’s dealing with chronic insomnia for many years. He takes quetiapine”—I’m not familiar with that drug—“and losartana potassica, 25 mg for high blood pressure and Simbrinza eye drops. Besides having an acute buzzing in his ears each of the last six months, he considers himself healthy and strong. He’s been a very low, as you said, accidentally low-carb diet and gaining some weight in the last few years. He’s eating less than 1,000 calories per day and he’s 6 feet tall and weighs 200 pounds. He drinks most of his water intake while exercising, 1.5 L while he’s doing an hour of intense exercise a day, seven days a week. Even feeling tired, he works out every day and has lost almost all of his muscles. He describes it even with the sleep drugs, he’s a very light sleeper and before he falls asleep, he feels his body temperature go up and he starts sweating. He hasn’t had digestive symptoms. I’m working on HPA axis and also testing his gut, but your opinion is greatly appreciated.

Chris Kresser: Wow, at 6 feet tall and over 200 pounds he is in a severe caloric deficit and I...

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