and Evaluation of the Dan Lukaczer ND

Transcription

1 Adrenal Dysfunction and Evaluation of the Adrenal Stress Profiles Dan Lukaczer ND

2 Inside the Presentation If you have a technical issue, type your question in this box and select send to : Host, then click send If you have a question or comment for the Presenters, type it here and then click send You can let us know you have a question by raising your hand using the WebEx control box. Your phone line will be un muted so you can ask your question. In full screen mode, click the? icon to ask a question

3 Review: Selye s General Adaptation Syndrome State 1: Arousal Both cortisol and DHEA increase with episodic stress, but recovery occurs to baseline This may be asymptomatic Stage 2: Adaptation Cortisol chronically elevated, and DHEA often declines Stressed, anxiety attacks, mood swings, depression State 3: Exhaustion Adrenal insufficiency / low cortisol and DHEA Depression and fatigue

4 HPA Arousal Cortisol Levels Stressor Time

5 Resiliency vs. Adaptation sol Levels Cortis Stressor Time

6 HPA Adaptation to Exhaustion sol Levels Cortis Stressor Time

7 So in This Model: With stress you get initial arousal and cortisol elevations (and sometimes DHEA elevations) Long term you may get adaptation with elevated cortisol and (eventually) depressed DHEA Eventually, with prolonged stress (exhaustion), you may get depressed R elevated cortisol and depressed DHEA th bl i l d t l d the problem is, people don t always respond symptomatically the same way to stress, and thus symptoms are not always a differentiator

8 Arousal and Consequent Adaptation and Cortisol Elevations Cortisol remains elevated for years Cortisol eventually falls with depletion Result: elevated cortisol Result: depressed cortisol

9 Looking at the Adrenal Stress Profile: Basic Patterns of Cortisol and DHEA

10 Normal Cortisol and Normal DHEA

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12 Elevated Cortisol and Normal or Elevated DHEA Arousal and Adaptation

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17 Elevated Cortisol and Depressed DHEA Adaptation and the Cortisol Steal

18 Cholesterol H Cortisol Steal Pregnenolone H 17 H pregnenolone H H H DHEA H Progesterone H 17 H progesterone H H Androstenedione H H H Estrone H H 11 deoxycorticosterone Corticosterone H H 11 deoxycortisol Cortisol H H Testosterone Estradiol H Corticosterone 18 H corticosterone H H H H Cortisol H H Cortisone Aldosterone H

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21 Normal Cortisol and Low DHEA Adaptation or Depletion?

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23 Depressed Cortisol Depressed DHEA Exhaustion Phase

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26 Some Additional Specific Adrenal Stress Profile Patterns That Come Up Frequently

27 Elevated Evening Cortisol

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32 Elevated Daytime Cortisol

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37 Review: Basics of Assessment and Treatment Always take a careful H & P Always check thyroid function thoroughly (labs, signs and symptoms)

38 Basics of Treatment Look to Determine and Eliminate Adrenal Stressors. Think about and evaluate: --Sources of pain --The GI connection --verall Inflammation/infection/immune dysregulation --Detox capacity (air, water, etc)

39 verall Clinical Approach Lifestyle modification Dietary modifications Possible elimination diet as indicated Nutritional supplements Botanicals Hormonal replacement

40 Basics of Treatment Lifestyle Issues: Exercise Meditation Yoga Psycho-Spiritual Development Social Connections Work Sleep Hygiene

41 verall Dietary Approach Low glycemic load, rich in phytonutrients (elimination diet or modified oligoantigenic diet) Educate on glycemic load (see your toolkit as an example) Frequent, regular meals/snacks (up to 6 per day) Unrefined carbohydrates with good-quality protein pote and doils s( (nuts, seeds) at all meals Avoid stimulants--caffeine, refined CHs (sugar, flour, bread, fruit juice), chocolate

42 verall Nutritional Supplementation Approach Good quality multiple with special attention to: B-complex (co-factors in hormone production) B5 pantothenic acid ( mg) B6 pyridoxine ( mg) Biotin (1000 mcg) Folic Acid ( mcg) Vitamin C (1-2 grams) and antioxidant blend Magnesium ( mg)

43 Basics of Treatment Basic Pattern: High Cortisol Conservative Management Adaptagens Rhodiola Ashwagandha St John s Wort Timed Phosphatidylserine Herbal Sleep Support: Melatonin, Valarian, 5-HTP etc

44 Basics of Treatment Basic Pattern: High Cortisol More Aggressive Management Sleep Medications Long Acting Benzodiazepines Anti Depressants Mood Stabilizers Antipsychotics

45 Basics of Treatment Basic Pattern: Low Cortisol and Low DHEA Conservative Management Adaptagens Panax Ginseng Licorice Root DHEA

46 Basics of Treatment Basic Pattern: Low Cortisol and Low DHEA More aggressive Management DHEA Cortef: physiologic dose Jeffries: The Safe Uses of Cortisol Antidepressants

47 Case # 1 60 year old male HPA Axis Questionnaire Low cortisol state t 19/64 Elevated cortisol state 10/28 Adrenal hyperplasia 4/12

48 Case # 1 60 year old male HPA Axis Questionnaire Fatigue Mild depression Trouble falling or staying asleep

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50 What s the Pattern? Elevated cortisol and depressed d DHEA Adaptation and cortisol steal

51 Case # 2 52 year old female HPA Axis Questionnaire Low cortisol state t 2/64 Elevated cortisol state 5/28 Adrenal hyperplasia 0/12

52 Case # 2 52 year old female HPA Axis Questionnaire Mild Fatigue Abdominal weight gain

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54 What s the Pattern? Elevated morning cortisol Adaptation with potential for fatigue/exhaustion later in the day

55 If you are interested in discussing the results from the ASI in one of the next two webinars,,please let us know by either ing us or faxing us. If you have a completed HPA Axis Questionnaire please fax that as well. danlukaczer@fxmed.com Fax:

56 Dates/Times for the next Webinars Monday, ctober 4pm PDT Monday, November 4pm PDT