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Case Study - Adrenals

Here's this month's Kalish Method of Function Medicine Case Review. Every month, we'll be sending you an educational email featuring a real patient who was treated by Dr. Kalish (or one of his students). We hope you enjoy and learn from these emails.

This is a true case history of a client referred to me from a CHEK practioner. The patient's identity has been changed, but the details have not. Andrea, at the time she came to see me, was a 23-year-old triathlete. She had just finished her competitive season. Her primary health complaints were trouble sleeping, irritability, and the fact that she was about 12 pounds heavier than she thought she should be. No matter what she did, she could not drop that weight.

Her initial consultation revealed chronic digestive problems, including indigestion, occasional diarrhea, and trouble with nausea during races. She also had a series of minor injuries from her sport that were annoying her.

In addition to a Functional Adrenal Stress Profile, I suggested that we order a digestive pathogen screen. I suspected she had H pylori (primarily because of the race nausea). Since the digestive system, if not functioning properly, can be a huge source of physiological stress, we weren't going to get anywhere with Andrea's case if she had latent digestive infections.

I've cropped out all the identifying data in this scan, but here are the relevant results. Her cortisol levels were high in the morning (often correlated with infection, particularly in digestive system). She also had high morning cortisol. The total cortisol and ratio between cortisol and DHEA were also high, but not high enough to be a primary concern. Andrea's DHEA was actually really good.

Her digestive lab report looked like this:

As you can see, Andrea had a blastocystis hominis infection. Infection with Blastocystis can produce the disease Blastocystosis. The most frequently described symptoms of Blastocystosis are abdominal pain, constipation, diarrhea.

Also present was H Pylori. H. Pylori is a bacterial infection of the stomach that can cause ulcers and is linked to stomach cancer. I have noticed a fairly reliable correlation between patients with race nausea and H. Pylori.

We started by evaluating Andrea's diet. She was consuming a lot of soy products. Soy is one of the most allergenic food of all, so we cut that from her diet. We also cut out wheat, which contains gluten. I wasn't sure if Andrea was gluten intolerant or not, but in order for her gut to heal, we needed to err on the safe side.

We kept her away from processed foods and got her cooking for herself most days of the week.

I referred Andrea to a local medical doctor for two different courses of antibiotics to eliminate her infections. We also started her on an adrenal supportive supplement program.

What was going on in this case was simple - the digestive infections and damage from her diet were a huge source of stress in her body. On top of her training, her body was struggling. The process of correcting her digestive system and balancing other stresses in her life took about 6 months.

Here's how her follow-up Functional Adrenal Stress Profile looked:

As you can see, her morning cortisol and evening cortisol came down. Her night time cortisol was still a little high, but we were able to address that with a cup of herbal tea and a promise to turn off the TV at 9:00.

Andrea naturally dropped the extra fat she had on her, and raced without injuries the following season. She stayed on an Adrenal Support program and we test her adrenals in the middle of each season just to stay on top of her recovery. She's now 26 and racing at a high level in Ironman triathlon events.

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