Chris Kresser: Some of this might be personal, so I’m not going to read it, but the gist of the question is, how do gut issues contribute to low cortisol, and if you address the gut issues and the cortisol is still low, what to do.
Anything that causes a stress response in the body can eventually reduce cortisol levels. I mean, typically, if you remember the general adaptation syndrome, Hans Selye’s theory of how we respond, cortisol initially goes up, and then over time, it goes down. We know that it doesn’t always happen that way. Sometimes it can go down immediately in things like PTSD. Other times it can go up and just stay up, and it doesn’t really go down. We don’t understand exactly why. There are just different presentations in different patients. Gut dysbiosis and SIBO and other conditions like that are basically chronic stressors on the body, and so over time, that can deplete cortisol levels. So if you address the gut issues and the cortisol levels are still low, to me that suggests one of two possibilities: (1) There hasn’t been sufficient time for cortisol levels to recover, or (2) there are additional chronic stressors that are affecting the HPA axis and cortisol levels that have not yet been addressed. Looking at the timeline that you’ve provided, my guess is that there probably are other HPA axis stressors that haven’t been addressed yet.