Discuss relevant patterns that you might see on the BH205A and include

a discussion of how you might use clinical correlation to help you interpret those results. (10)

The cortisol sum is calculated from the standard four-point saliva assessments to determine the adrenal response at specific times during the day when levels are expected to fluctuate between morning, noon, afternoon and nighttime. 

The circadian rhythm is the day/night cycle that we are looking at the diurnal rhythm and variations of cortisol.   The four-point assessment will show a snapshot of circadian rhythm problems and we can pick up clues of hidden stressors that may drive up or lower cortisol levels leading to cortisol dysregulation.  It isn’t the result of just cortisol dysregulation but the HPA Axis function as well as the three parts of the adrenal cortex. 

When reviewing the test results, we need to rule out any emotional upsets, excess exercise sessions or even trauma that the client experienced the day they tested.  We are looking for patterns that will show clues to elevated cortisol levels and clinical correlation.  We will receive four cortisol measurements at the different times during the day and use the cortisol sum when charting the progressions of the HPA Dysfunction chart to identify the “phase” of dysfunction the client may be in based on clinical

Cortisol dysregulation clues to use in clinical correlation include:

  1. Elevated or relatively elevated AM cortisol reading:
    1. Pre-dawn blood sugar drops may invoke a rise in morning cortisol
    1. May be left over elevation due to immune response during the night as parasite infections – more active- drives up cortisol as anti-inflammatory and hidden stressor causes stress response.
  • Elevated or relatively elevated NOON reading: Check any sensitivities to-
    • Breakfast foods
    • Sensitivities to snack foods they consumed that morning before testing
    • Caffeine
    • Drugs
  • Elevated or relatively elevated AFTERNOON reading:
    • Allergies
    • Sensitivities
    • Environmental
  • Elevated or relatively elevated NIGHTTIME reading: 
    • Immune activity
    • Parasites
    • Infection

We need to evaluate the cortisol pattern and clinically correlate the cortisol fluctuations to the client’s main health complaints then compare to the HPA Axis Dysregulation phases as we look at the WHOLE picture.  We are looking for patterns, but we are not diagnosing.  We may see relative elevations and pattern that isn’t too high or too low of the optimal range but in relationship to the previous marker (as noon to morning) but we conduct our clinical correlation investigation to make sense of the big picture.   We look at the cortisol to DHEA-S ratio to see if any indication of cortisol dominance or catabolic activities.  We are getting a snapshot of the adaptive reserve and using results to determine current phase of the HPA Axis dysfunction and cortisol dysregulation in the three-phase model.   Then we create the DRESS FOR HEALTH SUCCESS protocol for the client based on clinical correlation of all the lab tests and their health complaints then retest every 30 to 90 days as needed to guide the client back to “normal”.  

Our job as FDN Practitioners is to check for HIDDEN Stressors that contribute to cortisol dysregulation – hormones, immune, digestion, detoxification, energy and nervous systems. The three-phase model chart is not used to diagnose a client’s condition, but rather to explain the relationship of the client’s main health complaints and the function of their HPA Axis.  A visual example may motivate a client to be more compliant to follow their suggested DRESS FOR HEALTH SUCCESS recommendations to help rebuild their adaptative reserve. 

Everyone handles stress differently and their adaptative reserve.  If we improve some of the external stressors, but the cortisol levels may not return quickly to optimal levels -homeostasis.  Sometimes a client’s body takes longer to heal, restore and rebuild hormone levels naturally.  The three-phase model just gives us the snapshot adaptive reserve, determines the client’s current phase of the HPA Axis dysfunction and cortisol dysregulation.  The baseline information is another tool to track improvements we are making for a client as we reduce stressors and retest 30 to 90 days (ideally).  The adaptation process it takes time to return to cortisol sum to the preferred range.  We are watching the changes the client has been making to see if we are providing the best recommendations to get their results as desired or else, we use the data from the labs to re-assess and take another approach or path towards healing. 

We are looking for clues—for healing opportunities from the lab tests as we put the pieces of the puzzle of METABOLIC CHAOS for each client based on their individuality.  We are working on forming our impression based on how well we do with our investigation and educating the client towards reaching optimal health, to thrive in life and improve vitality.  Everyone is a unique individual and each client will respond differently.  We don’t treat the lab tests, but we keep checking for hidden stressors. 

We use the three-phase model not to diagnose but to help explain the phases to the client and the impacts of chronic stress on the WHOLE individual.  The information provided will hopefully help motivate the client to be compliant to the DRESS for Health Success Protocol.  We are educating and guiding them to self-care and self-correct themselves out of METABOLIC CHAOS and restore health back to homeostasis.  We can help the client see the impacts of their chronic stress, hidden internal and external stressors, then compare to their health complaints/concerns and goals.  The client needs to take ownership of their stress management by seeing their levels of adaptive reserve versus amount of stress.  Healing and rebuilding take time and patience! 

We need to check hidden stressors and clinically correlate results against the 3-phase model instead of treating the lab results – the paper then supplement based on a number.  We can identify together what sources of external stress can we remove then do other lab tests to find other HIDDEN internal stressors.  Periodic lab testing to see the client’s progression in the HPA Axis dysfunction to bring it back to HPA Axis functioning at optimal levels is beneficial to the client to know if what they are doing is working or if we need to adjust the protocol.    The body may take a year to help the adrenal output or reserve to return back to baseline levels.  Rome wasn’t built in a day!  We spend years “living life as a race” to get us into this METABOLIC CHAOS, so we need to be patient, committed and motivated to rebuild and resolve METABOLIC CHAOS.

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