The hypothalamic-pituitary-adrenal (HPA) axis plays a central role in the stress response and is implicated in a wide range of chronic health conditions. This review explores evidence-based perspectives on HPA axis dysregulation, its pathophysiology, diagnostic strategies, and integrative therapeutic approaches. Key contributing factors include psychological stress, genetic and epigenetic influences, dietary factors, gut health, immune system interactions, inflammation, toxins, and hormonal influences. Diagnostic methods such as serum cortisol levels, diurnal salivary cortisol profiles, and other tests are outlined. Therapeutic approaches emphasize the importance of the patient-provider relationship, stress reduction techniques, lifestyle modifications, dietary interventions, supplements, adaptogenic herbs, and other integrative therapies. Understanding HPA axis dysfunction through an integrative lens fosters individualized care and bridges the gap between conventional endocrinology and functional models, empowering providers to support patients with often-dismissed symptoms of fatigue, insomnia, mood instability, and impaired stress tolerance.

Purpose: The current investigation assessed the feasibility, acceptability, and efficacy of the Cooking Up Health (CUH) culinary medicine elective that was offered to medical students at Northwestern University's Feinberg School of Medicine. The elective included a combination of didactics, plant-based culinary sessions, and service learning, in which students translated nutrition and health connections to elementary school children in at-risk communities. Method: Nine medical students enrolled in cohort 1 and 12 in cohort 2. Students completed assessments before and after the course measuring confidence in nutrition and obesity counseling, attitudes toward nutrition counseling, personal dietary intake, and cooking confidence and behaviors. Results: The elective showed high feasibility and acceptability with strong class attendance (96%–99%) and retention (89%–100%). Over the course of the elective, students across both cohorts showed increased confidence in nutrition and obesity counseling (ps < 0.001), cooking abilities (ps < 0.01), and food preparation practices (ps < 0.04). Cohort 1 reported decreased meat consumption (p = 0.045), and cohort 2 showed increased fruit and vegetable intake (p = 0.04). Finally, cohort 2 showed increased knowledge and confidence regarding consuming a plant-based diet (ps < 0.002). Students reported an increased appreciation for the role of nutrition in health promotion and disease prevention and an intention to incorporate nutrition into patient care. Conclusion: This study provided preliminary evidence demonstrating feasibility, acceptability, and efficacy of the CUH culinary medicine elective for increasing medical students' confidence in nutrition and obesity counseling of patients and in their ability to use nutrition and cooking for personal self-care. Ultimately, this program of research may provide evidence to support widespread integration of CUH into medical education and has the potential to prepare medical students to properly advise patients on nutrition to combat the rising rates of obesity, diabetes, and preventable diseases related to nutrition.

The integration of diversity, equity, inclusion, and belonging (DEIB) principles into healthcare education is essential to ensure culturally sensitive and equitable healthcare delivery. In the domain of nutrition, food, and health, these principles are particularly vital, as diet and food choices are strongly linked to cultural identities and socioeconomic conditions. Despite a growth of DEIB initiatives in undergraduate and graduate medical education, there is a significant gap regarding guidelines for implementing DEIB principles in education around nutrition and food, including that for dietitians, allied health and medical professionals. A literature review was conducted, analyzing peer-reviewed articles and current practices in academic medical education to understand DEIB in nutrition, food, and health. The outcome was the creation of a three-tiered checklist titled “Checklist for Culturally Competent Education in Nutrition”. It serves as a roadmap to cultivate culturally competent, equitable, and inclusive healthcare professionals that emphasizes avoiding bias, enhancing awareness, and building practical skills for DEIB implementation around nutrition.

The use of dietary supplements by patients with chronic liver disease is prevalent and rising. Despite the known risks of dietary supplements, including hepatotoxicity, adulteration, and contamination, patients with chronic liver disease often turn to dietary supplements to support their liver and/or overall health but are not necessarily empowered with the information or guidance from their liver practitioner to do so. This article provides practitioners with a framework for balancing the risks and benefits of dietary supplements in patients with chronic liver disease, offering examples of independent resources and certifications to use this framework in clinical practice. We offer 3 common clinical scenarios to highlight how the use of this framework can improve communication and decision-making in clinical practice. By adapting principles from Integrative Medicine, this article advocates for a patient-centered approach to dietary supplements in patients with chronic liver disease, encouraging open dialogue between clinicians and their patients to facilitate informed decision-making and personalized care.