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.

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.