Aldosterone can be just as important as Cortisol
Low cortisol due to worn out adrenals is common among a large body of hypothyroid patients, and it can be necessary to supplement with cortisol, or bring it up with the T3CM. But along with cortisol, there’s another adrenal hormone that you may need to investigate with your doctor: aldosterone.
Much more about this in the revised STTM book here.
WHAT IS ALDOSTERONE? Aldosterone, a steroid hormone just like cortisol, is produced in the outer cortex of your Adrenals (along with cortisol, testosterone, DHEA, DHEAS, androstenedione and estrogens). Aldosterone is the principal of a group called mineralocorticoids, and it helps regulate levels of sodium and potassium in your body–i.e. it helps you retain needed salt, which in turn helps control your blood pressure, the distribution of fluids in the body, and the balance of electrolytes in your blood. It does all this by stimulating your kidneys to both take in more sodium while releasing excess potassium–a vital balance in your heath and well-being.
WHAT EXACTLY STIMULATES ALDOSTERONE PRODUCTION? Several things will stimulate your aldosterone secretion: when you potassium levels go too high, if there is less blood flow to your kidneys, or if your blood pressure falls. On the other side of the coin, aldosterone secretion will fall if your potassium levels fall, the blood flow in your kidneys increases, blood volume increases…or if you consume too much salt.
WHAT HAPPENS IF ALDOSTERONE GETS TOO HIGH OR LOW? When aldosterone gets too high (as it can under stress and as your cortisol goes too high), your blood pressure also gets too high and your potassium levels become too low. You can have muscle cramps, muscle weakness, and numbness or tingling in your extremities.
But when it gets too low, which can be common in some patients with cortisol deficiency, your kidneys will excrete too much salt, and it leads to low blood pressure; low blood volume; a high pulse and/or palpitations, dizziness and or lightheadedness when you stand; fatigue; a craving for salt. Symptoms of low aldosterone can also include frequent urination, sweating, a slightly higher body temperature, and a feeling of thirst, besides the craving of salt. Potassium can at first rise too high, then fall, as well.
A CLUE: Is your dog licking your legs? That is indicative of the salt wasting by low aldosterone.
Another clue that your aldosterone may be too low is being on high amounts of HC, such as 30-40 mg, and not getting good results…i.e. you seem to be continually chasing stable temps. (Before getting on HC, learn of a way to raise low cortisol with the T3CM.)
WHAT ROLE DOES ADDING SEA SALT AS A SUPPLEMENT PLAY? Adding salt, but specifically sea salt, can be beneficial to treat the symptoms of low aldosterone. Sea salt contains important trace minerals, whereas they are mostly removed from table salt. Recommended amounts daily are 1/4 to 1/2 tsp in water twice a day…and some go a little higher, if needed.
Bob, a patient with excellent knowledge of low aldosterone, states: People with low aldosterone sufferer from “Salt Wasting”, a medical term describing sodium leaving the body. When sodium is excreted it takes water with it, causing frequent urination and dehydration. The body will struggle to maintain a proper balance of sodium and potassium in the blood – and these levels often appear normal on blood tests. But within the cells of the body, improper balance of these minerals can lead to fatigue, and is the reason why the pupils will fluctuate when performing the “flashlight test”. Persons with low levels of aldosterone crave salt. If they will take a minimum of 1/2 teaspoon of Sea Salt daily their symptoms improve. The “Salt Wasting” still occurs, but the symptoms of improper electrolyte balance will often improve, and they will feel more energy.”
But….you have to be careful, as too much sodium supplementation can drive aldosterone down even lower, and can increase your thirst all over again. A more important supplement can be potassium, which supports aldosterone levels, especially if potassium levels are low.
HOW DO I TEST FOR ALDOSTERONE? Testing for aldosterone will be either a 24 hour urine test or a blood test–the latter which is more highly recommended to pursue with your doctor. It may also be important to avoid all salt for 24 hours before the test, and to be moving around for two hours before you test. 8 am is a good time to do the test since aldosterone levels would be at their highest in the early morning. It’s worthy to note that aldosterone levels can be doubled if you are pregnant, and are normally a little higher in children than in adults. For a complete picture, ask your doctor to include your renin for a complete picture, as well as sodium and potassium. See a testing facility without a prescription below.
You can also try a self-test–the pupil test, listed in Discovery Step Two on the Adrenal page. The blood pressure test from a supine position to standing can also point to your adrenals.
When lab testing, you are looking for 2 to 16 ng/dL if done laying down, and 5 to 41 ng/dL for upright. A good resource about results is here. There can be some variations for different lab facilities. More in Chapter 5.
IMPORTANT NOTE FOR WOMEN: It’s strongly recommended to test your aldosterone in the first week of your menstrual cycle (i.e. the week you start bleeding), or up until the beginning of the week after–this is when progesterone is at its lowest. Progesterone can drive your aldosterone up falsely, and progesterone begins to rise at the end of the second week of your cycle.
WHAT MEDICATION DO I TAKE IF SEA SALT/POTASSIUM ISN’T ENOUGH TO TREAT MY LOW ALDOSTERONE? The treatment of choice is fludrocortisone acetate with the brand name Florinef, a very potent steroid with mineralocorticoid properties . Patients and their wise doctors have learned to start with a quarter pill (25 mcg or .025 mg) and raise by that amount every 5 to 7 days until they get to 100 mcg. (0.1 mg) rather than starting out on 100 mcg. Many will note good effects fairly quickly; others may need at least two weeks.
Florinef is a very powerful treatment, thus the reason to start low and work up in low amounts every week or so, patients have noted. Going up to 100 mcg is common, but you’ll know if it’s too much if your blood pressure goes up and potassium takes a serious dive. Check with your doctor for further information. It’s also important to note that some patients who are already on HC (cortisol) may have to lower it to compensate for the glucocorticoid potency of Florinef. It’s also recommended to take your Florinef with sea salt mixed in water.
Another method patients use to check on their Florinef use is the laying down/standing up blood pressure test. See Discovery Step Two, Test one, here. Bottom line, when using Florinef, keep track of your blood pressure, your pulse, and your electrolytes sodium and potassium.
WHY DO I NEED BOTH FLORINEF AND CORTEF SINCE BOTH ARE STEROIDS? If someone is hypopituitary or wasn’t able to make the T3CM work well for them, and they know they have low aldosterone along with their low cortisol, why both steroid? Because Florinef (fludrocortisone) better imitates what Aldosterone does, and Cortef (hydrocortisone) better imitates what cortisol does.
Florinef has greater mineralcorticoid activity, just like Aldosterone does. To have mineralcorticoid activity means it controls electrolyte and water levels, mainly by promoting sodium retention in the kidney. (yours is low, thus the reason you urinate a lot, and lose salt because of that.).
Cortef has greater glucocorticoid activity, just like Cortisol does. To have glucocorticoid activity means it controls carbohydrate, fat and protein metabolism and is anti-inflammatory. It allows thyroid hormones to get to your cells.
So you can see that Cortef won’t help you retain salt, just as Florinef won’t help thyroid hormones get to your cells.
NEED GLUTEN-FREE ALDOSTERONE TREATMENT?
Barr Pharmaceuticals (the parent company is Teva Pharaceuticals), maker of generic florinef (for low aldosterone), claim that their product is gluten free. The starches are potato and corn sourced.
Go here to order your own tests.
Want to order your own labwork for aldosterone and renin, plus electrolytes?? STTM has created the right ones just for you to discuss with your doctor. Go here: https://sttm.mymedlab.com/
Need help interpreting your lab results? Go here: www.stopthethyroidmadness.com/lab-values/
Afraid of Florinef?? Here’s a blog post from a gal who loves her Florinef!
TED: I started taking Florinef (100ug) two weeks ago, before knowing the dosing from Chris (i.e. not to start on 100ug). Never had a problem, and felt the difference the first day. All positive. Going off salt to take the aldosterone test isn’t an option for me. I’d be in a coma long before the test date! I’m now on 40 mg Cortef, 120mg Armour, 100ug Florinef and feeling far better than I’ve felt in many years. I’m sure I’ll stumble along the way as I increase the Armour, but I think I’m prepared for that. My constant “background” headaches have virtually disappeared……incredible!!!
MICHELLE: I have been on .1 mgs florinef for about 2 months now and what a difference. Before Florinef, I would drink and drink water and still was so puffy. And talk about being dehydrated! I would wake in the morning dying of thirst. I was constantly breathless, and my hearttrate was over 100 resting. Since being on Florinef, I notice increased energy towards the end of the day. I’m not so dehydrated and I handle heat alot better. I also don’t feel so out of breath all the time. My pulse is now is 75-80. I don’t need to take as much salt, since I think I get enough from my foods. I do notice if it is really hot out and I am sweating alot, I might do 1/4 tsp of sea salt and I am ok. For me I know I am taking too much sea salt when my legs cramp.
Have a Florinef success story? Send it via the STTM Contact below and we’ll get your story up to inspire others. Keep it short like those above.
For more technical reading:
- Renal Tubular Effects of Hydrocortisone and Aldosterone in Normal Hydropenic Man: Comment on Sites of Action: http://www.jci.org/articles/view/105042
- Renal impairment resulting from hypothyroidism: http://ckj.oxfordjournals.org/content/1/6/440.full
- How progesterone affects aldosterone: http://press.endocrine.org/doi/full/10.1210/jc.2006-1154