Adrenal support is maintaining remission, Cortef

[mle_ii]

Hey Bob,

It's so nice to hear from you. I was hoping you were doing well.
Thank you for outlining what you've learned - this is a valuable service to the group.

How big a role do hormones play in MC, do you think?

Love, Marsha

I'm not Bob, but I do play one on TV... ;)

Anyway, I can see how it would effect those with MC. I've talked about this before elsewhere, but since Cortisol regulates the immune system then it being too low or too high is going to cause problems. If it's too high then you will get increased infections as it's suppressing the immune system. If it's too low then the immune system is going full bore and doesn't get a chance to turn off, thus you get a very sensitive immune system. So either way one would be set up to get a disease such as MC among other GI diseases. And considering that the GI tract has it's very own immune system should tell you something about how important it is that it's working properly.

Mike

[bobh]

Hey Bob,
It's so nice to hear from you. I was hoping you were doing well.

Thanks - and thanks for posting some stuff a few months ago that led me to discovering my Hashimoto thyroid diagnosis. Wouldn't have known otherwise.

How big a role do hormones play in MC, do you think?

Well I can only speak for myself really. It just hit me after a month of gradually building up my Cortisol levels (as I had almost none) that I was putting the missing corticosteroids that the body should have been putting there all along, and the Entocort-Prednisone FIXED my MC with the same anti-inflammatory quality of a cortico steroid. For me this seems to be a fact, for others - well I guess it wouldn't apply for them if they had normal adrenal function. I think the blood pressure test I mention above is a fast and definite way to find out, as well as the others on that link.

From what I have read, those with Hashi's, especially if untreated for a while, can expect to have adrenal function dragged down as it struggles to keep metabolism in the body. It adds stress to the adrenals, and that is the basic mechanics of it, stress, per the adreanl pioneer Hans Selye.

So yeah, I'm gonna go on record saying that hormones may play a big role in SYMPTOMATIC

[bobh]

but since Cortisol regulates the immune system then it being too low or too high is going to cause problems. If it's too high then you will get increased infections as it's suppressing the immune system.

High Cortisol also inhibits the body's ability to convert T4, the "storage" form of thyroid, to T3, the "active" form that actually enters the cell and is needed for every cells metabolism and production of energy.

High Cortisol, if you agree with Hans Selye's work, is a reaction to some form of stress. Could be fighting an infection, could be the stress of physical trauma, emotional trauma, as per the link higher up on this page. So, you would think that the increased cortisol would provide increased anti-inflammatory qualities, but if the cortisol is getting "burned up" dealing with stress, you could still have symptoms = low cortisol.

The folks at the adrenal-thyroid board all agree that the remedy to high cortisol (as you would have in the Adrenal Stress phases 1-3) is to take Cortef, just like you would for low cortisol. The reason is that it gives the adrenals a break from the stress they are trying to deal with that is raising the cortisol levels, and also the increased cortisol you are GRADUALLY and slowly adding to the body will be sensed by the pituitary, and thus the body's request for more cortisol will be lowered. It does this by lowering the ACTH coming from the pituitary, and things eventually normalize. That is also the solution for people with high cortisol at night, when it is supposed to be lowest, people that have trouble sleeping.

It's so nice to hear from you. I was hoping you were doing well.

Thanks, and I'm doing better after your post a few months ago kicked me in the head. "hey, I've got those symptoms - I bet I have Hashimoto's". And my labs proved it, and I am responding to Cortef + Armour's thyroid.

How big a role do hormones play in MC, do you think?

All I know is that I suffered for 15 years trying every diet, and over the counter remedy. Every IBS remedy sold. All the snake oil, and bought the "family pack" immodium and Pepto Bismal from Costco.

Bit the bullet and took Corticosteroids beginning September 2006 and the "D" was gone the next day and never came back.

Now I find my own body doesn't produce enough Corticosteroids, and for years I felt like the guy at the end of this drawing http://www.chronicfatigue.org/Selye%20large.html because my adrenal lab results are between stage 6 and 7.

So yeah, for me, Hormones are a big role in my SYMPTOMATIC MC. I would love to see Dr. Fine or someone in that position do a research project on adrenal function of a group of 100 people with symptomatic MC verses non-symptomatic normal people with normal BM, people who likely have at least average adrenals maintaining average anti-inflammatory Cortisol levels.

An even more meaningfull research, though hard to do, would be to take one of those studies that Tex or someone posted a while back about the fairly high number of people found to have MC per colonoscopy, yet not having symptoms. Check THEIR levels of adrenal cortisol using the 4x a day saliva test (more accurate than the 1x blood test) and do the same on SYMPTOMATIC MC patients.

Hell, a Gastro with a large practice could just pick 3 people out of his own group of patients with symptoms, and 3 without, and personally pay for the adrenal lab tests instead of his next Mercedes payment, and get an indication if further research appears fruitfull.

While you are holding your breath to see if that happens - may want to just do your own adrenal lab test and see where you stand http://thecanaryclub.org/content/view/196/52/

[mle_ii]

FWIW here are some blood results from July 2005. Do these mean anything? Though who knows what they are now.

T3 Free, 324, 230-420 PG/DL
T-4 Free, 1.5, 0.8-1.8 NG/DL
TSH, 1.61, 0.40-5.50 MIU/L

[bobh]

Free T3: T3 is the active thyroid hormone, also called triiodothyronine, and can be the most important lab you will do. You can have a so-called normal TSH, but if your free T3 is low in the range, that is a strong sign of your hypothyroid status. As with the T4, it’s important to get your FREE T3 lab, not simply T3.

Though most of the T3 in your body is produced by the conversion of T4 to T3, there is also a direct release of T3 from the thyroid. T3 is the active hormone which is responsible for your overall good health, metabolism, immune strength, etc. A good level of T3 is what prevents chronic low grade depression, high cholesterol, dry skin and hair….the list is endless.

When patients get on Armour, their optimal dose is most often the amount that gets their free T3 at the top of the range, if not slightly over in some patients, with no hyper.
http://www.stopthethyroidmadness.com/re ... d-labwork/

Again, you could have antibodies (ever check?? I hadn't til I saw Marsha's post a while back) that make your FT3 even lower than the numbers show, as the T3 with antibodies renders some of it useless.

Our mantra at the adrenal-thyroid site is to go by symptoms. If you had no symptems, weren't fatigued, brain fog, sharp as a tack, I would say your labs are "normal".

If you have SYMPTOMS, I would say to get the FT3 in the upper 1/3 and see if you feel better. And along the way you would probably have bad reactions if you didn't also support the adrenals, which should be done first. I say that because you personally have labs and symptoms of low adrenals. I am going to make a bold statement: I think this protocol will help you.

I was trying thryoid meds at several points over the past decade, as my Dr's would dose by symptoms. I had labs like yours, "normal" but not in the upper 1/3. They never checked the adrenals, and taking thyroid without adrenal support for someone who needs it can push them into an "adrenal crisis" AKA Addisons crisis. Happened to me twice, abandoned the pgm.

Now I am following the dosing of that site, and feeling a lot better, and it is not a placebo effect. Not for me, I guarantee it is helping me. Your results may vary.

[artteacher]

Hey there guys,

Thank you so much for the discussion. I'm still going to make an appointment with a naturopathic MD in WA in June. He specializes in hormone work. I saw him about 8-9 years ago, when he ordered an adrenal test, and hormone tests, and said adrenals came back low. He had me take mega vit c, and ? something else to strengthen the adrenals (my mc was just starting, and it was before I got dramatically sick) .. I'd like to show him all these posts, order another adrenal test, (and whatever else would be helpful to him), and start over. Since then, I've had more complete bloodwork, showing lupus and MC, and Hashimoto's and hypothyroid. I would think he'll have more facts to work with now. And because of all your research, Bob, and the discussions here with Mike and everyone, I think I know how to help him help me better than last time.

Is it really possible that when I took prednisone in 1998-99 (prescribed by a rheumatolgist for lupus), that 20 mg wouldn't stop the D? I was still eating wheat and corn and everything (even some dairy) back then.

Do you have low blood pressure? I recently read that it is an overlooked cause of fatigue, even for normal people, and that it could be helped by eating more salt, drinking more water, or by an rx that helps you retain more water. Of course, if you have adrenal failure, it's more complicated, and I don't think that would be enough to remedy the situation, but it made me think about water, electrolytes, etc, and how important it is to be a good manager of your body's requirements.

Thanks again for the posts. Since I've hit the wall researching, you have no idea how grateful I am.

Sincerely, Marsha

[bobh]

.. I'd like to show him all these posts, order another adrenal test, (and whatever else would be helpful to him), and start over.

Because you have symptoms, and a history of low adrenals, you should just order the test, right now, today, online, without waiting for a Dr. http://thecanaryclub.org/content/view/196/52/ Then you walk in with facts, and it will give you time to do your own research. It is not a light decision to take Cortef, but if your own body isn't making enough, there isn't a whole lot of choice (aside from living with the fatigue, and complications of not getting T-3 into the cells, etc.)

If you are just "borderline" that is a fact you want to know too. Stay away from Cortef, try to fix it with smaller guns. If your cortisol rythems are fairly normal (the saliva test has readings when you wake up, just before bed, and 2 x in between) then taking Cortef will actually screw up the rythem. Your body senses the cortisol you are adding, lowers the ACTH, so less cortisol is requested from your adrenal cortex, and you "slump" in energy about 4 hours later.

For me, I don't care. I "slump" anyway, so I divide my daily allotment of Cortef up into about 4 or 5 doses for the day. I am PUTTING THERE a cortisol rythem that otherwise would not be occuring. Get the difference? That is the fork in the road, and the new - current lab test is your ticket to understanding if you are going to turn left or right.

My brother just saw a Dr. in Oregon who didn't even know adrenals and thyroid are related to each other in terms of metabolism and getting the T-3 into the cells, or high cortisol impairs the body's ability to convert the storage form T4, into the active form, T3. My brother walked in with adrenal lab tests showing really low cortisol and bad circadian rythem. But the MD wouldn't listen to any of it, was super arrogant, and that is fairly common, unless you have a sweetheart MD like Polly.

Do your own test, walk in knowing 99% of what you need to do before seeing the MD.

[bobh]

Is it really possible that when I took prednisone in 1998-99 (prescribed by a rheumatolgist for lupus), that 20 mg wouldn't stop the D? I was still eating wheat and corn and everything (even some dairy) back then.

All I know is that when my MD put me on 60mg Pred, my HORRIFIC 6 month flare was GONE the next morning. In hindsight, I think I could have acheived the same result with less. But I don't know if 20 would have done it - especially with a diet that wasn't perfect. 20mg = 80 mg of Cortisol, and the body normally makes about 40 to 60mg of cortisol unless it is fighting the flu in which case it can easily go up to 80, and as high as 200 max. So you would think that dose would have certainly help.

Do you have low blood pressure?

Yes, it is chronic for me, and that is a symptom of low cortisol.

[mle_ii]

My blood pressure is quite low as well. Can't remember the exact numbers, but I know it's low. There's been quite a few times where I see "stars" when standing up and once when getting up quickly I started to black out with tunnel vision but it went away just as fast. My HR has been low for some time as well, like say around 60. When I'm doing sprint intervals I can get it up to around 175 bpm. Strange how something like that doesn't make me dizzy, but standing up does sometimes. Dr did the laying down/standing up test and indeed my bp went down as well. I really hope I can get someone to help me figure this out soon as it's causing me problems at work, at home, and just plain anywhere.

What sucks even more is that I'm under an insane amount of stress due to problems with our 14 yo, and I'm not talking the "normal" teen problems either. :( That and seeing out it effects my wife and 4 yo daughter is very draining as well. When will it end?

Mike

[tex]

Mike,

Does your heart rate increase significantly when you stand? If so, that's known as Postural Orthostatic Tachycardia Syndrome, (POTS). It's defined as a heart rate increase of 30 bpm or more, or an increase to a rate of 120 bpm.

http://www.potsplace.com/pots_an_overview.htm

I hope you can resolve your teen problems - things like that can really compound your health problems, and make life miserable, in general.

Tex

[bobh]

My blood pressure is quite low as well. Can't remember the exact numbers, but I know it's low. There's been quite a few times where I see "stars" when standing up and once when getting up quickly

Yesterday I was at WalMart, and noticed they had several Blood Pressure testers, the digital ones are about $35, I bought the $16.95 one with the old fashioned guage on it, works fine. Here's what the guru on this says:
TEST ONE:
Take and compare two blood pressure readings—one while lying down and one while standing. Rest for five minutes in recumbent position (lying down) before taking the reading. Stand up and immediately take the blood pressure again. If the blood pressure is lower after standing, suspect reduced adrenal gland function. The degree to which the blood pressure drops while standing is often proportionate to the degree of hypoadrenalism. (Normal adrenal function will elevate your BP on the standing reading in order to push blood to the brain.)
http://www.stopthethyroidmadness.com/adrenal-info/

I used to have the same phenomena you describe, and it was chronic for decades. I am convinced my adrenal cortisol levels have been low since 1986. I did the BP test noted above, and my BP still drops a bit when I stand and take that reading. So I will have even more benifit as I continue working on adrenals, but I know it is better than it was a few months ago, before I started walking that path of taking cortisol to put there what the body isn't.

I really hope I can get someone to help me figure this out soon

Mike, do the labwork mentioned above, and send me a PM with the results, or post it on the forum if you want.

I will make a personal commitment to help you figure this out. You are going to get better.

One of the symptoms of weak adrenals, is how you react to stress, and the anxiety rather than "hey, I can handle this".

I used to get that "fear in the pit of the stomach" and "weak - can't cope" feeling when bad news - threat of unemployment - threat of forclosure on my house, etc hit me. Or just sitting there trying to sleep, you think about something, and get the anxiety thing.

I notice about 80% of that is GONE since I got my cortisol levels closer to normal. What you are talking about is just another symptom of low cortisol, and you have existing labs that say low cortisol. It is a no brainer. You just have to figure out if over the counter stuff is going to bring them back.

The over-the-counter glandulars, etc. didn't work for me. Taking cortef will "give them a little holiday" and you build up the cortisol levels following protocols from published MD's such as Peatfield and Jefferies. You can then try to wind down, and see if your adrenals can handle it, you wind down very gradually. This will tell you if you had Primary Adrenal Insufficency, and they healed, or Secondary (where the Pituitary isn't putting out the signal to make more cortisol) in which case you may need to be on cortisol for the rest of your life. For me, that is a better alternative than running a quart low for the rest of my life.

Alternately, for someone with less severe adrenal insufficiency, they shouldn't go near Cortef. It would just throw a wrench into their fairly normal cortisol rythem, they would have to be carefull not to skip doses during the day or the lowered ACTH would result in lowered Cortisol making them tired. So this isn't for everyone, but it is the needed protocol when the cortisol levels are toast. And to some extent if they are in the early "alarm" phases (see posts above on the 7 stages) because adding Cortisol will normalize the situation, lower the body's constant demand for cortisol (high ACTH levels) because of some stress (illnees, or other stress as noted on an earlier post). but if the cortisol labs look like this http://www.chronicfatigue.org/ASI%20Normal.html then you would not want to take cortef.

[cludwig]

Hi Everyone,

I need to get into this discussion....you all are talking about exactly what is going on with me. My problem is I have strange test results that don't form a clear picture.

Looking back on my tests before my hysterectomy, I had mild hyperthyroid problems with a low TSH. I had anxiety that I was able to control through regular exercise. Then I had my ovaries removed and my TSH went even lower...massive anxiety, muscle tightness and heart racing and D.

I started on a low dose estradiol and progesterone replacement therapy. I had a saliva test that said my cortisol was funky..not low but that my DHEA was too low. A blood test however said that both my cortisol and DHEA were fine. Then I had a urine ACTH stimulation test that said I had adrenal fatigue. So I am confused about what is going on.

My naturopath theorized that my liver has been really stressed dealing with the bad gallbladder that was removed a couple of months ago(one of the liver enzymes is elevated) and that it is not cleaning my blood efficiently to excrete toxins and this could be why the blood levels are higher than the excreted levels????? I just don't know.

She also said that the reason I am having such a large problem with having my ovaries removed is that usually a healthy adrenal gland will step in and compensate when they are removed and that I was already adrenal deficient and that is why my reaction was so severe.

I just can't find anyone to help me make sense of this whole picture. I have the same issues with blood pressure problems when I stand up (used a blood pressure cuff to measure).
Was also wondering if an antidepressant would help with the anxiety and would that in turn help the adrenals to heal?
Last September I went on methimazole and that did help with the tightness and heart racing...started at 10mg and went down to 5 in Dec.


Since gallbladder surgery and breast biopsy it doesnt seem to be as effective.
Any guidance would be wonderful.

Love,
Cristi

[Reggie]

I got my results back from the Diagnos-Techs saliva test - well, most of them. They didn't seem to know I was male so the sex hormones are being recalibrated. The Canary Club doctor answered my late night email promptly this morning and said he'd get it fixed.

cortisol

8am, 8 (depressed, normal is 13-24)
11am 7 (normal 5-10)
4pm 2 (depressed 3-8)
11pm <.03 (depressed 1-4)

My DHEA is normal, 7 (normal is 3-10)

I'm not in to any of the adrenal stages of failure yet.

Thyroid
FSH - <600 (normal is 26-85) WHAT

T4 is .18, normal
T3 is .38, normal, as is my thyroid microsomal Ab,SIgA-what ever that is!

My TSH, T3 & T4 were normal in a blood test 11/11/06, as was my cortisol.

About 5 weeks ago, my mornings went to hell. I wake up early, anxious and depressed. If I get back to sleep I have nightmares. Around noon I return to what my wife calls the Real Reg. My pelvic pain used to start around 3 in the afternoon. Now it often starts before I get up.

I've mentioned this to health care providers, but only in passing because we've been concentrating on the pain problem while the D is under control. I started on Neurontin this week.

I'm going to take this to my doc, who will, I expect, want the tests repeated in a 'real' lab. I hope to be on meds for this within a week.

Any other insights on these numbers? I love having the option of doing my own tests when I want, even if it does cost money outside my insurance.

[tex]

Hi Cristi,

Bob is much more acquainted with this adrenal and thyroid stuff than I am, of course, and I assume he'll be along later, but in the meantime, I'll offer a couple of observations.

1. I'm not at all sure that your adrenals will ever recover sufficiently, if they have been in trouble for such a long period of time.

2. If you have a heart rate increase of 30 bpm or more, within 10 or 15 minutes of standing up, or if your heart rate goes to 120 bpm or more upon standing, you meet the definition for Postural Orthostatic Tachycardia Syndrome, (POTS). Along with the increased heart rate, a POTS patient will typically experience a decline in BP.

In addition, POTS

patients often exhibit numerous symptoms of autonomic nervous system dysregulation. It is the autonomic nervous system (ANS) that regulates the needed adjustments in vascular tone, heart rate and blood pressure upon standing. The ANS is also responsible for regulating a multitude of other organs and functions throughout the body. Some of these functions include temperature, pupil dilation and constriction, salivation and the digestive tract. A patient experiencing ANS dysregulation may experience abnormalities in the many organs and functions the ANS regulates.

Didn't you mention temperature deviation problems at one time? This quote is from this site, by the way:

http://www.potsplace.com/pots_an_overview.htm

Love,
Tex

P S I'm beginning to wonder it POTS might possibly be caused by a combination of the effects of adrenal insufficiency, and thyroid problems.

[cludwig]

Hi Tex,
Thanks for the info. I have low body temperature and low blood pressure but I have not kept track of my heart rate differences...just know that sometimes it races and sometimes it doesn't....but I will start keeping track of what it is doing and when. I did have a lot of problems with light sensitivity...perhaps pupil dilation....but not so much lately. From my journal I had concluded that it was caused by the entocort as it seemed to go away when I stopped taking that.

The endocrinologist that I saw only looked at the blood levels of thyroid and adrenals but completely ignored the fact that my ovaries were removed...they seem to only be interested in the thyroid and diabetes....and the naturopath wants to give me stuff to support the adrenals without knowing why the blood levels are not drastically off. I am motivated to get better but don't want to play the lab rat too much.

No one seems to know what is up with the low blood insulin levels...but that combined with the low temp, low blood pressure leave me with low energy...but a racing heart....strange combo.

The autonomic nervous system is something I will do some research on. Thanks Tex.

Love,
Cristi