HPA Axis

I have a lot of colleagues and friends who have done a different popular functional medicine training.” I won’t ask which one. “In that training, they always check and treat HPA before gut treatment. The claim is that if there is an HPA issue then gut treatment will not be successful. Specifically, they say that with a low secretory IgA, the gut treatment won’t work. Of course, I want treatment to be effective. What do you think about this, especially the part about secretory IgA?

Dr. Amy Nett: So, I think I mentioned this in like the second question that we talked about today where...

I’m treating a female in her mid-30s for heavy cycles with debilitating PMS. She has two small children, runs a business, has insomnia since childhood so looking forward to addressing HPA axis with her after resolving gut dysbiosis. Her Doctor’s Data stool test shows Blastocystis in all three samples ranging from few to many. Butyrate is high, and secretory IgA is low at 8.1. Dysbiotic flora includes 2+ of geotrichum species, and my question is whether to add Yeastonil/A-FNG to the antimicrobial protocol due to the 2+ yeast and for how long? Also, is there anything to do regarding the high overall short-chain fatty acids at 20? Her Lactobacillus and Enterococcus are low at 1+. I wonder about adding anything in particular to restoring the gut protocol.

Dr. Amy Nett: I would say I might not wait to address the HPA axis until resolving gut dysbiosis, so...

What would I do about low 5-α reductase activity?

Dr. Amy Nett: Great question. It depends a little bit. What do the rest of the hormones look like? Because...

If patients are taking testosterone or growth hormone, in what way could this impact the HPA axis results? I know it’s not part of the course. I’d be interested in your view on these.

Chris Kresser: Regarding testosterone, if you’re ordering the Comprehensive DUTCH Panel, obviously it will affect the testosterone levels that show...

Tests are pending. A 12-year-old autistic boy, equivalent to 4-year-old in all aspects. Struggled with sleep, has a lifetime of poor sleep quality, never slept well in his life. Moderate digestive problems, mostly related to motility. Developmental delays are severe. As a young infant, he suffered from infantile seizures and was prescribed ACTH. Seizures resolved. Autism was then diagnosed in early toddler years based on rare genetic disorder. Don’t know full details on the disorder beyond the current recorded case. I surmise that ACTH administration in a young infant may permanently disrupt the HPA axis if not addressed with a rebuild post prescription. I’m not sure that’s even possible with an infant. Obviously that didn’t happen with this boy 12 years ago. Now how to support this possible permanent alteration 12 years later? Does his body produce ACTH efficiently on its own if that production was bypassed for a formative length of time in early infancy? Or are all these thoughts a stretch? Here’s the good news: Parents were in tears of hope after talking about functional medicine with me. Twelve years searching, and our conversation was the first of its kind. What we are doing for people is legit and reshaping healthcare. I plan on ordering gut testing, hacked [indiscernible] if he will comply, and DUTCH.

Chris Kresser: Yeah, that’s a very interesting case and interesting hypothesis, and we do know, as I mentioned in the...

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HPA Axis

What would I do about low 5-α reductase activity?

If patients are taking testosterone or growth hormone, in what way could this impact the HPA axis results? I know it’s not part of the course. I’d be interested in your view on these.

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