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. But along with cortisol, there’s another adrenal hormone that you may need to investigate: aldosterone.
The outer cortex of your Adrenals produces the hormones cortisol, aldosterone, testosterone, DHEA, DHEAS, androstenedione and estrogens. And both cortisol (a glucocorticoid) and aldosterone (a mineralcorticoid) are vital and important players in your health and well-being. When your adrenals become fatigued, they don’t make enough cortisol. And though low cortisol does not always equal low aldosterone, there may be a significant body of thyroid patients who with their low cortisol have low aldosterone!
WHAT IS ALDOSTERONE? Aldosterone is the principal of a group of mineralocorticoids. 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.
WHAT HAPPENS IF ALDOSTERONE GETS TOO HIGH OR LOW? When aldosterone gets 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 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; and a craving for salt. Symptoms of low aldosterone can also include frequent urination, sweating, and a feeling of thirst, besides the craving of salt.
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.
WHAT ROLE DOES SALT PLAY? Being on a salt-restricted diet only makes low aldosterone levels worse. Adding salt, but specifically sea salt, can be beneficial, and is in fact recommended to all thyroid patients with 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 higher, if needed. If you end up needing a great deal more salt, you might have to consider Florinef, mentioned below.
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.”
Additionally, when the adrenals are not making aldosterone, a hormone from your kidneys increase–called renin. If the renin is low, you could have a pituitary problem.
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. 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.
IMPORTANT NOTE FOR WOMEN: it is strongly recommended to test your aldosterone in the first week of your menstrual cycle and not later. Just as in pregnancy, higher progesterone levels especially around mid-cycle and later can drive your aldosterone up, since aldosterone is made from progesterone.
WHAT MEDICATION DO I TAKE IF SEA SALT ISN’T ENOUGH TO TREAT MY LOW ALDOSTERONE? The treatment of choice is fludrocortisone acetate with the brand name Florinef. Chris, a pituitary patient who has worked with other patients for years, recommends that in working with your doctor, patients start with a quarter pill (25 mcg or .025 mg) and raise by that amount every 5 to 7 days until you get to 100 mcg. rather than starting out on 100 mcg. He states that you should notice it’s effects in 2 to 4 weeks, or 1 week if you go straight to 100 (the latter which causes problems in some patients). 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.
To read more, check out Bob’s full sticky here. From there, you can follow his links. And here’s his sticky titled Adrenal Hormones: testing and Treatment, which sums it all up well.
WHY DO I NEED BOTH FLORINEF AND CORTEF SINCE BOTH ARE STEROIDS? Florinef (fludrocortisone) and Cortef (hydrocortisone) are both synthetic steroids. But Florinef better imitates what Aldosterone does, and Cortef better imitates what cortisol does.
Florinef has greater mineralcorticoid activity, just like Aldosterone does.
Cortef has greater glucocorticoid activity, just like Cortisol 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.).
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.
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/
SUCCESS STORIES:
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.
