Wisdom in treatment of adrenal issues
Please note that this is just reported wisdom and information and is not to be used in any way to replace the relationship and guidance of a doctor:
1) It is never wise to guess whether you have low cortisol, even if you “think” you do!
Symptoms of high cortisol can be similar to symptoms of low cortisol, patients noted repeatedly. Plus there are different variations of an adrenal problem which require different treatments–see below.
2) Saliva cortisol is the way to find out, NOT blood testing.
Blood testing is measuring the combination of bound and unbound cortisol, so patients saw they could look high when they were actually low, cellularly. This has happened to a lot of folks! Saliva will test you at four key times in a 24 hour period, and measures your cellular levels, which is key. Some do six times in a 24 hour period, but four gives good information. Places to order saliva testing are here. They even knew saliva was the way to go in 1983! (Note: saliva testing by Quest simply gives the ranges as “less than” or “more than” a particular number. We have found those useless for interpretation. NONE of the saliva facilities listed in the link above use Quest.) To order saliva testing, go here. (NOTE: Remember not to eat before any of your four saliva vial spits. Eating will either push cortisol too high, or if you already have low cortisol, can stress the adrenals even more.)
3) Treatment should be based on saliva testing that is no more than three months old.
Patients report learning the hard way that cortisol levels can change. So what was true three or more months ago, may not be the same now (even though it will be problematic), so you’d be treating the wrong thing today that was true then.
4) Saliva results have nothing to do with falling in the normal range!
Patients discovered, upon viewing the saliva results of many others who did not have a cortisol problem, that the results have to do with “where” they fall in ranges. See where folks fall when their cortisol levels are ideal here.
DIFFERENT KINDS OF ADRENAL ISSUES AS REVEALED BY SALIVA TESTING…and how we learned to treat them
1) High cortisol:
High cortisol results are defined as “two or more results together which are too high”. Examples include high morning and high noon….or high afternoon and high bedtime. Often the others are close to where they should be…or could also be high!! ,
Excessive progesterone supplementation has caused high cortisol in some women, but so can other issues like continued hypothyroidism, excess stress, active Lyme disease, etc. High cortisol can block the conversion of T4 to T3, favoring conversion to RT3 and putting you further into a hypothyroid state. See the RT3 information in the revised STTM book for more info, as well.
See the last chapter of the STTM II book which does an EXCELLENT job explaining why our cortisol first goes high…then why it can fall to low, by Dr. Lean Edwards. A highly recommended chapter!!
TREATMENT: Patients report using certain supplements like Holy Basil, zinc, PS etc to help lower the high results while correcting what was causing it. In turn, by lowering high cortisol, the other low cortisol results (if you have some lows) can come up.
2) A see-saw mix of highs and lows:
Picture up, down, up, down or vice-versa. An example is a morning result far over the range, very low noon result, overly high afternoon result. Picture a see-saw, which is different than having two highs in a row. This see-saw pattern is more the pattern of healthy adrenal function but one that is reacting to stress.
Both high cortisol and low cortisol can cause problems raising NDT, first causing hyper-like symptoms from excess adrenaline, then causing too much RT3.
TREATMENT: Since this is simply a stress pattern of healthy adrenal function, patients use certain adaptogens which help even out your body’s response to stress, both raising low and lowering high. Examples include Ashwagandha, Rhodiola, Relora, Eleuthero, Maca, Schisandra, etc. Patients will often combine them, or take alone. Patients also state they usually need more than the recommended dose on a bottle. Janie keeps these on hand to use if she’s going through prolonged stress. Many are described in Chapter 15 of the revised STTM book. Also see pages 106 – 108 in the revised STTM book.
3) Low Cortisol
Low Cortisol is defined when three or more are low (two of those results being low could also qualify). This is where the term “adrenal fatigue” comes into play, though it could also be called adrenal insufficiency or hypocortisolism (See the excellent Chapter 15 in the STTM II book–a highly recommended chapter!)
TREATMENT: When three or more are moderately low, patients report finding success in using over-the-counter Adrenal Cortex (ACE). If three or more are seriously low in the ranges, they turn to prescription HC aka hydrocortisone. With either, they use Daily Average Temperatures to find the right physiologic amount for their daily needs, not high pharmacological amounts. Cortisol is needed to allow T3 to enter our cells and to finally allow us to get out of our hypothyroid state–a strong reason many have adrenal issues in the first place. ACE or HC is used short-term while correcting all the issues that led to the adrenals tanking, then weaned. This is NOT like treatment for Addison’s or hypopituitary, they report.
Low cortisol like this is not treated as well with adaptogens, patients report. Adaptogens work far better with the stress response of healthy adrenal function, as seen in #2 above. Yes, some report they feel a bit better having very low cortisol and using adaptogen….but they continue to have that low cortisol, which will prevent you from getting out of your hypothyroid state.
POINTS OF INTEREST
1) Licorice Root (If you have slightly low cortisol at “one” particular time–this is not for those who have several times of low cortisol or seriously low cortisol)
Licorice root, with its glycyrrhizin content, is used to make slightly low cortisol more useable i.e. it prevents your liver from breaking down cortisol as much. Capsules or tea is used. It can’t be used long term, as it tends to raise blood pressure in some folks because it lowers potassium. But short term use has worked well for many. Or taking potassium at the same time might work.
2) Avoiding Adrenal glandular products
“Adrenal glandulars” are NOT the same as “Adrenal cortex”. Glandulars give you the entire gland. And it has a drawback: it contains adrenaline, which most low cortisol patients already make too much of, and you have to take quite a lot of adrenal glandulars to give you back the cortisol you need…thus more adrenaline. Also, like other adrenal supplements, you can never be sure how much cortisol is in each tablet, so you’ll still need to do Daily Average Temps if you use this.
3) Using Hydrocortisone when three or more times are seriously low
It’s extremely important to study Chapter 6 in the revised STTM book about what patients report learning in their successful use of HC. It also applies to ACE. Patients report using Daily Average Temp taking (DATs) to find the right amount, since this is not about high pharmacological amounts of cortisol. Knowing about stress dosing is also very important. It’s important to watch your sex hormones and calcium levels while on HC, as they can dive. HC or ACE use is short-term–long enough to correct all the issues which stress the adrenals, then a wean. It’s not like the protocol used for Addison’s or a permanent pituitary problem. Find a good doctor to work with on all this!
4) The T3 Circadian Method aka T3CM or CT3M
This is an ideal method if you just have low morning cortisol. This is a very safe protocol, and when done correctly, avoids the use of any of the above (though adaptogens can be used with it during the day, and some patients are using cortex and HC), and helps bring back better cortisol levels. Good detailed summary here. Many patients have found it isn’t enough if they also have low cortisol in the afternoon, or have seriously low cortisol all day. i.e it works for some, not for others
MISTAKES PATIENTS MAKE WITH THEIR ADRENALS
- Failing to do saliva testing: read all four points under TESTING above. Patients have repeatedly found it unwise to guess, or to even go by older saliva results. Blood cortisol has been a failure since it’s measuring both bound and unbound and implies you are okay or high when you are not.
- Using Isocort (which is now defunct), ACE or glandular when they didn’t need it: common when someone didn’t do saliva testing and is guessing. Or, if saliva does prove low cortisol, it’s too low for any of these to do the job well.
- Using Adrenal Glandulars for low cortisol when one already makes too much adrenaline: Unless stated otherwise, glandulars contains adrenaline, and if a patient has found themselves with hyper-like symptoms–higher heartrate, palps, anxiety–glandulars can end up contributing because of their adrenaline content!
- Using the T3CM when your levels are seriously low: the CT3M by itself works better for just low morning for most. There are some with more levels which are low that have had success, but some haven’t.
- Failing to do their Daily Average Temps when using Isocort, ACE or HC: This is a huge mistake, patients report, resulting is staying on too low a dose, or going too high. See The Temperature Test on page 82 of revised STTM book.
To read more, go here.
To order the revised STTM book with its two excellent chapters on adrenals, go here. Chapter 6 also applies to Cortex. Read, read, read! Your knowledge is important, both for you and in working with your doctor.
**Interesting information about your Circadian Rhythm: Cortisol levels reach lowest levels at around midnight, levels start to rise at around 02:00 to 03:00 and reach a peak at around 08:30. Cortisol levels then slowly decrease back to the nadir to complete the cycle over 24 h. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475279/