Question for Bob H

[Magyar]

Hi Bob,

Thanks for all the info. regarding adrenal insufficiency. I just got my saliva test back and tested positive for adrenal insufficiency. My DHEA/Cortisol ratio was 1,114. I'm not sure what this means. My 7 a.m. and 10 p.m. readings were below the reference range.

Anyway, I also have chronic D due to microscopic colitis, though it has improved somewhat since taking probiotics and other supplements prescribed by my MD.

Do you know anything about antinuclear antibodies? Mine measure 1,742 but the range is 0-99. My doctor is referring me to a rheumatologist to determine whether I have lupus or something else is going on.

I've been under the impression that you can't take Cortef long-term since it's a steroid. My doctor said I would develop thinning bones. In the meantime, I am taking licorice and drinking caffeine to get me through the day (and easing off the workouts since they drain me).

Any insight you could share would be appreciated.

Thanks,
Magyar

[bobh]

To begin, I am not a Dr. I think you know that... but that's my disclaimer.

My 7 a.m. and 10 p.m. readings were below the reference range.

Got it. so were mine. I assume you had symptoms, or you wouldn't have and the initiative to do this test. People with those readings don't' "wake up refreshed" and do not experience "restful sleep". Your body does not appear to be making enough Cortisol.

To my knowledge, the very most close thing to Cortisol that you can get in a pill is Cortef. It is more bio-identical than Prednisone or other cortico-steroids. The Cortisol that your body should be making so you don't feel like garbage for the first 1/2 of the day is a cortico steroid. Cortef is going to put there, what you are not putting there. The alternative is bad metabolism, as Dr Peatfield says here, and this is a different quote than the marathon one we had going last week:

So now you see why thyroid and adrenal hypo-function have to be considered together. Here’s a precept for you. Anyone with undiagnosed or unsatisfactorily treated hypothyroidism will sooner or later inevitably slip into adrenal exhaustion. May take months or years, but it will happen. Symptoms of adrenal exhaustion exaggerate pre-existing thyroid symptoms. There will be ongoing and endless fatigue, even less tolerance to cold, depression, dizziness (postural hypotension), body hair loss, pigmentation (especially in skin folds), poor response to treatments generally and an obviously weak immune system. Most particularly, if there is an adrenal malfunction – I still prefer to call this low adrenal reserve – the patient responds poorly to thyroid hormone, or rapidly gets ill and toxic on even quite small doses of thyroxine.

…Thyroid and adrenal dysfunction usually come together but in varying degrees of emphasis. They cause a down-regulation of all metabolic processes, hence these clients/patients are all hypometabolic. Metabolism, as I need not remind you, may be defined as the rate at which energy is produced and consumed by the tissues…

Adrenal hypo-function is a different kettle of fish entirely. The diagnosis is missed more decisively even than hypothyroidism because most clinicians only seem to think of it in terms of Addison’s disease. In fact, the adrenals can malfunction in degrees.

…Extremely valuable is the adrenal glandular concentrate…
If this proves unsatisfactory, which is uncommon and usually because the adrenals have been really badly damaged over a period of time, the use of the adrenal hormone, cortisol (hydrocortisone), 2.5 mg up to 25 mg, may be considered by the practitioner

http://www.i-c-m.org.uk/Journal/2006/feb/a02.htm

How is your thyroid? Is your Free T3 in the upper 1/3 of it's "normal" range? The thyroid and adrenals need to be considered together, they are the 2 pillars supporting your metabolism.

Do you know anything about antinuclear antibodies?

No, but I live about 25 miles from a nuclear power plant on the coast of California... Seriously, I have not studied that one.

I've been under the impression that you can't take Cortef long-term since it's a steroid. My doctor said I would develop thinning bones.

I disagree. Cortisol is vital for life, without it, you die. Your body makes Cortisol. Cortisol is a steriod. You can't make a blanket statement about all steriods, as though it was something a Pro-Football player takes. They are not all the same.

I felt like I was dying the last 20 years. Lack of cortisol is tied to so many things, the T3 has trouble getting in the cells and that is why you lack energy, the ATP energy cycle cannot occur properly. If you don't have adequate cortisol, you are sort of walking wounded, and as noted above, most Md's don't even know to look for it unless you have Addison's which is quite rare. It is ironic, as low Cortisol (I am not saying "no" cortisol) is not so rare, and if you gather a room full of people with chronic fatigue, it is going to be like 80% of the people in that room.

I had a major argument with a Dr on this topic a few weeks ago, and they could not even discuss the topic intelligently, hadn't read the "safe uses of cortisol" by Jeffery's, and he is not alone, he just happens to be a pioneer.

Check this one out, this is another "new" link for you folks on this board:
http://www.med-library.net/content/view/269/41/

and this one http://www.med-library.net/content/view/75/41/

I recently read something about Lupus being commonly associated with low cortisol, but I can't find that link right now.

This stuff is fairly mechanical, you have symptoms which prompt you to reach for getting labs, and it is there, or it isn't.

then you decide what to do about it. For someone with low adrenals, Cortef is the ticket. It's like taking a guy who is dying of thirst, and somebody says not to drink the water because tests have shown that the fluoride they put in it causes this and that. It's BS. If you are dying of thirst, you are going to drink pond scum and live. If your adrenals don't make enough cortisol, you can wish all day that they did, you can take all kinds of supplements - and people with "sort of OK" adrenals will benefit from those supplements. I didn't, and I tried lots of them for 20 years.

You have to "dance with the one that brought you" in terms of your body. If your metabolism is screwed, you should try the most holistic remedy first if you are spooky about meds. But the thyroid pioneer Dr Broda Barnes said in a lecture I recently listened to (taped in the 1970's) that these are bio-identical hormones (he was mainly referring to Armour's) and not in the same class as a "drug" although you do need a prescription.

I know I sound "down on Dr's" but I'm really not. I have great respect for anyone who is good in their field. There are some great ones out there. And Polly really rocks, I knew squat about MC and remember reading her informative write ups on MC when I first got my diagnosis. She took the time to do that, and helps people.

If you read the footnotes on those last links I sent you, and follow up on those pioneering Dr's you will see some more truly great MD's who are helping mankind. Dr. Hans Selye is one of those pioneers, and I posted some info on him on that other thread which I assume you read http://www.perskyfarms.com/phpBB2/viewtopic.php?t=5742
he is the guy who researched the Adrenal Stress Index, and resulting Adrenal Insufficiency, here is a chart summarizing his findings http://www.chronicfatigue.org/Selye%20large.html My adrenal test was between stage 6 and 7, and I felt like the guys on that chart. I don't feel like that anymore, and am definitely getting better.

[tex]

Hi Magyar,

It's good to "see" you here again.

Basically, AntiNuclear Antibodies (ANAs) are found in patients whose immune system is predisposed to cause inflammation against their own body tissues.

With an ANA test result that high, you almost certainly have an autoimmune issue, but it doesn't necessarily have to be lupus, it could be some other connective tissue disease. Other possibilities include

* Scleroderma
* Rheumatoid arthritis
* Sjogren's syndrome
* Hashimoto's thyroiditis
* Autoimmune hepatitis
* Some viral infections

Also, certain medications can cause an elevated ANA test result, including methyldopa (Aldomet) and tumor necrosis factor (TNF) blockers such as etanercept (Enbrel) and infliximab (Remicade). This information is from the Mayo Clinic:

http://www.mayoclinic.com/health/lupus/AN00655

Note that it has not been determined whether these antibodies cause disease, or are just a result of disease. Also, note that the top three items on that list from the Mayo CLinic, are systemic autoimmune diseases, whereas the rest of them are localized autoimmune diseases. Celiac sprue, all IBDs, multiple sclerosis, and Addison's disease, (adrenals), for example, are all localized autoimmune diseases. Therefore, I would expect, (though I'm just guessing here), that any of them could result in elevated ANA levels.

Tex

[bobh]

Thanks for clarifying that Tex! Personally I have MC, CFS which is often considered some sort of auto-immune voodoo, and Hashimoto's thyroid which is an autoimmune attack on the thyroid. There are references about that on the first thread on the adrenal-Cortef topic http://www.perskyfarms.com/phpBB2/viewtopic.php?t=5742
And also mentions the 2 antibodies to test for. It is very common, I had heard of it - but no one thought to check for it, yet it is the most common reason for low thyroid.

Marsha (Art Teacher) mentioned her Hashi a while back, symptoms sounded familiar, I got mine checked, and the answers to my decades of symptoms finally unfolded.

With Hashi, you need to take a replacement dose (3 to 4 grains of Armour, spread out during the day like your own thyroid would). That will enable you to have functional thyroid hormones (not "bound" with antibodies that render them useless) and also reduce the antibody attack on the thyroid, it says that right on the Patient Instruction Leaflet.

I also have Vitiligo (white patches of no pigment on the skin) which I had heard was "autoimmune", but recently learned was also indicative of long term adrenal insufficiency, as per this chart from Dr Rind

Vitiligo (white spots or patches) in late stage. May tan too easily. In dark skin, darker on forehead, sides of face, around mouth and chin/jaw.

http://www.drrind.com/scorecardmatrix.asp

[Magyar]

Hi Bob and Tex,

Thanks for all the info. you both shared. It sounds like fixing the adrenal problem could fix the autoimmune problem. But, my MD doesn't want to prescribe Cortef until I see a rheumatologist, since she's more concerned about the antibodies than the adrenals. She's also putting me on a hypoallergenic diet, which is extremely restrictive. I hope there's a simple solution here. Taking Cortef and being done with it sounds so nice.

In the meantime, I am drinking green tea to get through the day and also taking licorice root, which is supposed to support the adrenals.

Thanks again for your insights.

Magyar

[bobh]

It sounds like fixing the adrenal problem could fix the autoimmune problem.

I would look at it from a slightly different angle.

We all want to be "done with this" and be fixed. Totally.

But for me, I have a long history of what my Dr calls a "constellation of symptoms". We would like for it to be simple. We would like to fix the adrenals, and have the autoimmune be gone, etc.

I look at it like this, you can't build a house on quicksand. We need to have a strong, basic metabolism. that is build on adequate Cortisol and thyroid hormones. That is the starting point. Without that, you have cold extremities, temps taken around 3pm range below 98.6, you have fatigue, the low Cortisol will give you more anxiety than you would otherwise, life is going to suck to varying degrees.

So you get that nice foundation, compact it, set up some form boards, lay down a bunch of rebar, pour a thick slab of concrete, let it cure for about 2 weeks, then start putting up walls.

I don't know that it will fix the autoimmune issues totally, but one of the Cortisol functions is to control inflammation that results from the body's immune reaction. I have to go to work and don't have time to dig up that link, but trust me on that one.

[mle_ii]

I think I asked this elsewhere, so sorry if this is a repeat question, but have either of you been checked for heavy metals or toxins in the body?

[bobh]

I wasn't.

At the risk of sounding like a broken record that keeps repeating itself, I personally would not start walking that road if I had labs and symptoms of low cortisol and thyroid. I would put the other stuff on my "to do" list.

That is how important I think the metabolism issue is, or at least for me, as mine had a long way to go in order to approach normal.

[Beth]

Hi Bob,

I was looking at the list of side effects of Cortef, and they don't look too promising. Have you been having any side effects? Some of my biggest worries are weight gain, acne, and hair growth. None of those things seem worth it to me to feel less tired, to be very honest. I'd rather look my best and pump myself up on Red Bull or whatever than become more energized and feel like I've lost control over my body's appearance. Know what I mean?

Beth

[bobh]

I was looking at the list of side effects of Cortef, and they don't look too promising. Have you been having any side effects?

My side effects include: more energy, not losing the first 1/2 of the day to brain fog, and the ability to take adequate levels of thyroid med (which I need per lab result) without having grief (caused by indadequate cortisol to tolerate the thyroid). ie the body's metabolism crawls up from the floor, but that puts some degee of strain on the adrenals to participate with that, and they couldn't handle it before, so you get symptoms like increased anxiety, and shakes from the adrenaline as that's all they can make anymore.

1. What references do you have to support these side effects?

2. Are they giveing cortef to people who are difficient, in cortisol? If they aren't, then sure, you give someone too much cortisol and there will be side effects. It is called Cushings syndrome.

[Beth]

Hi Bob,

This is the link I was reading from. It's just a general list of symptoms you could see from being on Cortef:


http://www.drugdigest.org/DD/DVH/Uses/0 ... ef,00.html


It didn't mention anything about its use in treating adrenal fatigue. But the list is a little scary, I'd say.

Beth

[bobh]

pump myself up on Red Bull or whatever

That would help you live for today.

Folks, cortisol is a cortico-steroid the body makes, and needs to survive. If you have adequate supply, and your cortisol rhythm is normal (Beth I know yours isn't, per your labs) then you have no reason to open a bottle of Cortef.

If you are deficient in Cortisol, you can try the smaller guns (over the counter glandulars).

Dr's that specialize in Chronic Fatigue, like Teitelbaum says this on pg 12 of his book:

Dr William Jefferies' experience (and in mine as well) people with either low hormone production or a low reserve often respond dramatically to treatment with a low dose of adrenal hormone.

And on page 13

I prefer using prescription hydrocortisone such as Cortef instead of the adrenal glandulars available at health food stores.

I don't make a dime on this folks, and be sure to do your own research.

[bobh]

This is the link I was reading from.

Thanks Beth.

Keep in mind, I am reading this stuff from the perspective of someone with flat-lining adrenal Cortisol labs, and symptoms to match.

This is as far as I read on that link, and really it is about as far as I need to go to understand it:

Hydrocortisone is similar to natural steroid hormone produced by the adrenal gland.

It's really that simple. You either need new tires on your car, or you don't. sometimes it's a shade of grey, and you have to make a judgement call.

I was driving on "may pop's" for so long, that I jump at the chance to take a man-made equivalent of what my body no longer has.
----------------------------
I just read more on that link, and saw this:

Some side effects can be reduced by taking single daily doses in the morning.

Folks, I tried the single dose in the morning thing, and it just doesn't work. Whoever wrote this research article doesn't have the problem personally, I assure you.

Your own adrenals create Cortisol "on demand". It is the classic "fight or flight" thing.

Assuming you don't have a wild animal (or boss) attacking you, one should begin with very small doses, and ultimately end up with about 20mg Cortef divided in about 4 doses through the day. There are a variety of sources for that, including Dr. Peatfield, and pg 217 of Teitelbaum's book:

I treat with a therapeutic trial of 5 to 15 mg Cortef in the morning, 2.5 to 10 mg at lunchtime, and 0 to 2.5 mg at 4pm

[mle_ii]

The glucocorticoids that one gets put on for MC/LC/CC or other Colitis is way more potent than Cortef would be. And by potent I mean having negative effects.

It's similar to the following, your body needs water to survive right. So if you have too little water you get sick and could die, drink too much you get sick and could die, drink enough and you're healthy. Someone drinks too much water and dies, does that make water bad for you? Only to the extreem.

At the level's that bob and the references he's talking about it's like saying your body needs 1 liter of water so you drink 1 liter of water. Taking the glucocorticoids usually given to colitis folks is like drinking many liters. You could do this for a while without too much damage, but keep doing it and things will go wrong for sure. Drinking what you need doesn't.

[mle_ii]

Hey Bob, have you tried experimenting with tapering off the doses through the day? Given that the morning is supposed to be the largest production of cortisol and it tapers off through the day. Like say take 5 mg in the morning 2.5 at lunch and 2.5 at dinner. I think that 2.5 was the smallest does talked about.

Something like you said in your quote.

I treat with a therapeutic trial of 5 to 15 mg Cortef in the morning, 2.5 to 10 mg at lunchtime, and 0 to 2.5 mg at 4pm