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Re: OT RE:ACTH stim testing

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I think it's unfair to say " you're perpetuating the confusion " when

I've tried to take an honest analysis of all the facts.

Actually, Tish is very well respected and appreciated by many. And

there are actually a lot of folks who have sucessfully done lower

dose H/c but are afraid to tell their experiences. It seems anyone

who questions the 20 mg/4x a day dosing encounters hostility from

some I have found. And i've had my fair share...so let's agree to

disagree. I'm not looking for argument...I do like thoughtful

analysis.

cindi

>

>

> you are really wrong here. Try asking someone who takes cortef

how long it lasts. They will be glad to tell you.

> I was on a adrenal group. The peeps on that group were

sooooo sick and confused, then someone would post something very

confusing and sort of authoritative from Tish from NTH, and peeps

got way more confused. I had to unsub from the group, no one was

getting well at all.

> You are perpetuating this confusion!

> Gracia

>

>

>

> sorta.

> i think there are probably two important things to remember when

> looking at jefferies work.

>

> first, since his work....they have developed better ways to

assess

> what the body actually makes. i don't think that info should be

> disregarded. remember back in the 40s when they first started

with

> this, they were using 100 mg. plus...and they didn't know all

the

> adverse side effects. this has all has evolved over the last 1/2

> century in that they do know now the adverse side effects of

over-

> replacement. so although his figures may be slightly off, it

> doesn't negate the importance of the message at all.

>

> second, jefferies did work with cortisone acetate...and although

he

> said that cortisol was equal...what we do definitely know now is

> that hydrocortisone is 20% stronger than cortisone acetate.

That's

> why with h/c, addison's folks don't need 4x a day dosing. H/C

lasts

> longer in the body. So i think that information should also be

> applied to Jefferies work to see if it 3x a day dosing with H/C

is

> more appropriate.

>

> but to answer your question...mostly yes..with an average

> replacement dose being 20-25 mg....but this can vary according

to

> height and weight somewhat.

>

> As to your other question...there is some info that talks about

> which is more suppressive (the stronger ones like prednisone)

and of

> course the longer action in the body of h/c over cortisone

> acetate...but so far, i haven't run across exactly what you're

> asking about. Peatfield, however, does indicate that higher

doses

> may be needed because of digestive/absorbtion issues with the

> digestive tract. Since hypo and adrenal problems tend to cause

> digestive issues....one might speculate that a higher dose might

be

> needed initially, and then lowered as those issues resolved.

> cindi

>

>

> Recent Activity

> a.. 29New Members

> Visit Your Group

>

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>From: " Gracia " <circe@...>

>???? why? your history screams adrenal. I am a 5' 2 " female, actually

>not sure how much I weigh, let's say 140, and I take the same dose as

>Skipper. Where have you heard that low dose cortisol is dangerous?

>Maybe you need to ask peeps who have taken it.

>Gracia

Actually, the site she quoted has some interesting information, and suggests

a " safe dose " that shouldn't suppress the HPA axis -

http://www.endotext.org/adrenal/adrenal14/adrenal14.htm

" Side effects occur only with supraphysiologic doses of glucocorticoids and

not with proper replacement, which is equivalent to 12 to 15 mg of

hydrocortisone/ m2 body surface area per day "

*******

There's also a calculator that's easy to use at http://tinyurl.com/zslxc.

Based on your numbers, between 20 and 25 mg should be a " safe dose " which is

what you're already on. I can probably take a bit more than I am, which

isn't a surprise to me, as I always wondered about the weight difference

between me and the tall, thin blondes that Jeffries said commonly had

adrenal insufficiency.

Skipper

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I am sorry but I think Tish has succeeded in perpetuating fear and obfuscation. We get enough of that from conventional medicine. I think you are doing the same, making something fairly simple , complicated. I really trust Jefferies here and he recommends 2.5/5/7.5mg 4X a day so from 10-30mg/day. THE IMPORTANT PART IS FOUR TIMES A DAY DOSING.

Gracia

I think it's unfair to say "you're perpetuating the confusion" when I've tried to take an honest analysis of all the facts. Actually, Tish is very well respected and appreciated by many. And there are actually a lot of folks who have sucessfully done lower dose H/c but are afraid to tell their experiences. It seems anyone who questions the 20 mg/4x a day dosing encounters hostility from some I have found. And i've had my fair share...so let's agree to disagree. I'm not looking for argument...I do like thoughtful analysis. cindi---

..

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I for one took 20 mgs of cortef and on my last drs visit, my resting

pulse rate and blood pressure was way higher than on my last visit. I

was becoming more annoyed with things that never upset me so my dr

said that I was taking too much of the cortef and to lower my dose to

5 mgs.

I did ok on it and in another week, I added in another 5 mgs to the

morning dose. On week three, I added in 5 mgs to my noon dose. Once I

got to 15 mgs, I felt it all coming back and he said we needed to

lower it again to 5 mgs. My resting heart rate plus my blood pressure

also went back up. He's taking cortef, too so I'm sure that he knows

what he's doing. He has patients on it for yrs and for me, I just

can't take the cortef anymore. I need to check my adrenals but if I

take anything for them, it'll be with the help of my chiropractor.

I've had the best of health care from him. lol

Sue

> >

> >

> > you are really wrong here. Try asking someone who takes

cortef

> how long it lasts. They will be glad to tell you.

> > I was on a adrenal group. The peeps on that group were

> sooooo sick and confused, then someone would post something very

> confusing and sort of authoritative from Tish from NTH, and peeps

> got way more confused. I had to unsub from the group, no one was

> getting well at all.

> > You are perpetuating this confusion!

> > Gracia

> >

> >

> >

> > sorta.

> > i think there are probably two important things to remember

when

> > looking at jefferies work.

> >

> > first, since his work....they have developed better ways to

> assess

> > what the body actually makes. i don't think that info should be

> > disregarded. remember back in the 40s when they first started

> with

> > this, they were using 100 mg. plus...and they didn't know all

> the

> > adverse side effects. this has all has evolved over the last

1/2

> > century in that they do know now the adverse side effects of

> over-

> > replacement. so although his figures may be slightly off, it

> > doesn't negate the importance of the message at all.

> >

> > second, jefferies did work with cortisone acetate...and

although

> he

> > said that cortisol was equal...what we do definitely know now

is

> > that hydrocortisone is 20% stronger than cortisone acetate.

> That's

> > why with h/c, addison's folks don't need 4x a day dosing. H/C

> lasts

> > longer in the body. So i think that information should also be

> > applied to Jefferies work to see if it 3x a day dosing with H/C

> is

> > more appropriate.

> >

> > but to answer your question...mostly yes..with an average

> > replacement dose being 20-25 mg....but this can vary according

> to

> > height and weight somewhat.

> >

> > As to your other question...there is some info that talks about

> > which is more suppressive (the stronger ones like prednisone)

> and of

> > course the longer action in the body of h/c over cortisone

> > acetate...but so far, i haven't run across exactly what you're

> > asking about. Peatfield, however, does indicate that higher

> doses

> > may be needed because of digestive/absorbtion issues with the

> > digestive tract. Since hypo and adrenal problems tend to cause

> > digestive issues....one might speculate that a higher dose

might

> be

> > needed initially, and then lowered as those issues resolved.

> > cindi

> >

> >

> > Recent Activity

> > a.. 29New Members

> > Visit Your Group

> >

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the same site (different page) also gives an addison's replacement

dosage...which basically equates to the same thing as the safe dose

of proper replacement. of course giving proper replacement should

not cause side effects. again, the question is whether it is wise

to be taking a full replacement dosage for AF.

Even Jefferies points out the loss of adrenal reserve...storage for

stresses. He said 60% loss at 20 mg. If we adjust that to H/c, it

would be 60% loss at 16 mg. Again, some folks think this is

fine...but then we still have folks on H/C after years...so where is

the healing by this protocol? aren't they really just taking a full

replacement dose and saying that's okay?

and when I read the sentence from this site:

Glucocorticoid treatment may not suppress the HPA axis at all, or it

may cause central suppression or complete adrenal gland atrophy (6).

that's when i went looking for more info on adrenal suppression

since this didn't really give much info at all.

cindi

>

>

> Actually, the site she quoted has some interesting information,

and suggests

> a " safe dose " that shouldn't suppress the HPA axis -

>

> http://www.endotext.org/adrenal/adrenal14/adrenal14.htm

> " Side effects occur only with supraphysiologic doses of

glucocorticoids and

> not with proper replacement, which is equivalent to 12 to 15 mg of

> hydrocortisone/ m2 body surface area per day "

> *******

>

> There's also a calculator that's easy to use at

http://tinyurl.com/zslxc.

> Based on your numbers, between 20 and 25 mg should be a " safe

dose " which is

> what you're already on. I can probably take a bit more than I am,

which

> isn't a surprise to me, as I always wondered about the weight

difference

> between me and the tall, thin blondes that Jeffries said commonly

had

> adrenal insufficiency.

>

> Skipper

>

> _________________________________________________________________

> Add fun gadgets and colorful themes to express yourself on Windows

Live

> Spaces

> http://clk.atdmt.com/MSN/go/msnnkwsp0070000001msn/direct/01/?

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I used cortef but I'm not and have never been depressed. My dr said

that if you take cortef later than noon, it might keep you from being

able to fall asleep.

Sue

>

>

> FYI Broda Foundation actually recommneds prednisolone

(Deltacortril) over cortef! according to a person who called there.

Hertoghe uses both but says there is a difference--cortef is best used

for mental complaints like depression. DHEA is also good for

depression.

You don't want to onit the 4th dose of cortef, believe me.

gracia

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>From: " cindi22595 " <cindi22595@...>

>i agree my history screams adrenal. not questioning that.

>

>at your height/weight, the upper end of your full replacement dose

>is around 23 mg.

The text you gave for the dosage, is giving the amount at which side effects

can be avoided. The second paragraph below shows that those side effects it

intends to avoid includes adrenal suppression -

http://www.endotext.org/adrenal/adrenal14/adrenal14.htm

Side effects occur only with supraphysiologic doses of glucocorticoids and

not with proper replacement, which is equivalent to 12 to 15 mg of

hydrocortisone/ m2 body surface area per day

These side effects include the development of varying degrees of Cushing's

syndrome manifestations during therapy and secondary adrenal insufficiency

(adrenal suppression) after discontinuation of treatment. Growth retardation

is one of the major side effects of chronic daily glucocorticoid therapy in

children ( 23, 24).

**********************

Nowhere in the article is 's Disease mentioned. He refers to

" adrenal insufficiency " so if his purpose is to give a full replacement dose

for 's, that isn't clear. In fact, the article is about " adrenal

suppression " so I don't think he's really referring to the " full

replacement " dosage of an 's patient.

>

>Now here's the thing...when you went on H/C, it's probably because

>you were Not functioning at 100%....you could have been functioning

>at 70% (16 mg.) or less and thus 20 mg. really made you feel better.

>But has taking that much H/C strengthened or weakened your

>adrenals? And at that type of dose, I'd want to stress dose for

>something like dental work or maybe even a brisk walk...because

>natural adrenal reserve (storage) has been drastically reduced.

You're presuming the 23 mg is the amount her adrenals produce during the

day, which isn't what the article says. It tells how much is safe to avoid

side effects like adrenal suppression. That's not the same as how much

cortisol is produced.

The reserve issue is also an assumption on your part. You don't know that

reserve has been drastically reduced. In fact, if we have an emergency

situation you don't know if our adrenals are actually stronger and can

produce all the cortisol it needs to.

>The theory is, of course, that resting them strengthens them. But as

>Chris's link from SSTM points out, there doesn't seem to be much

>evidence of that.

I'll tell you my adrenals are a lot stronger than when I started. I don't

care much about the evidence, as medical science isn't particularly good.

If you think it is then how come Vioxx went to market? How come presription

drugs kill hundreds of thousands of people a year? How come the average

doctor looks at a lab slip and says, " It's in the normal range, you're OK "

but doesn't know that the median TSH is 1.5?

How come many of us have had to go to six or seven doctors before we found

adequate treatment?

You can look at medical research all you want, but if something works, why

do we need to know more?

The doctors would have you believe 2 minutes in the sun is going to kill

you, so you'd better go put on your sunscreen (as if that didn't have toxic

ingredients in it.) They allow genetically modified foods to be grown

without a major uprising to protect our health. They don't complain about

pesticides on the food supply or BGH in milk. So, what important work is

medical science and research doing for us? Mainly killing us with toxic

drugs they claim are safe, and not bothering to defend the safey of the food

supply, which probably causes a lot of illness today.

They don't stand up and say, " Gee mercury is a toxic mineral, maybe it's not

so wise to have in your mouth?

So it's a real possibility that some AF folks

>really do just need full replacement? I guess it depends on adrenal

>damage done.

It is possible. But, the article you referred to was talking about the safe

dosage to avoid side effects like adrenal suppression.

>

>But I don't see how most folks taking a full replacement dose is

>necessarily the best thing for their adrenals. If they are weak,

>they might want a different protocol to bring them up to 100%

>functioning instead of shutting them down and hoping they will

>bounce back.

>Cindi

You're right. That's why authors like who wrote " Adrenal

Fatigue " suggests " healing " the adrenals naturally. It's alleged that some

people can do that, probably those who haven't been to badly damaged, and

those who have years to wait to feel better.

YOu can use a different protocol, ours isn't the only one. But, it works

well for us.

Skipper

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I couldn't take the cortef after noon. If I did, I couldn't sleep. It

might not be a problem for others, tho. I do find that the iodoral tabs

let me sleep like a baby and I have no problem getting up at 5:00 AM.

Sue

>

> Lowe says that taking the last dose by 4 will eliminate problems with

> sleeping...keeping in mind he's talking about AF from hypothyroid.

> but i think many addison's folks just dose 2x a day...and so probably

> wouldn't be taking it after lunch.

> cindi

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There's nothing wrong with wanting to look at all aspects of the

cortisol therapy. I for one want to know what I'm doing to my body long

term. Thanks for bringing it up. When I read the messages, I completely

forget that I'm in the iodine group. Sorry!

Sue

>

> And I think Tish is a very wise and very smart lady who after

> accepting/using the 20 mg. H/C protocol...and finding that it was

> very difficult to get off of it...plus needing to stress dose - that

> she wanted to know why

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Dose only last for 3-4 hours. How on earth could 's patients dose 2X a day? they must be using synthetic time release.

Gracia

Lowe says that taking the last dose by 4 will eliminate problems with sleeping...keeping in mind he's talking about AF from hypothyroid.but i think many addison's folks just dose 2x a day...and so probably wouldn't be taking it after lunch. cindi>> I used cortef but I'm not and have never been depressed. My dr said > that if you take cortef later than noon, it might keep you from being > able to fall asleep.

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Cindi,

> Even Jefferies points out the loss of adrenal reserve...storage for

> stresses. He said 60% loss at 20 mg. If we adjust that to H/c, it

> would be 60% loss at 16 mg. Again, some folks think this is

> fine...but then we still have folks on H/C after years...so where is

> the healing by this protocol? aren't they really just taking a full

> replacement dose and saying that's okay?

I think this is wrong. Jefferies didn't say HC caused a loss of

adrenal reserve. He said it caused a loss of adrenal output. Then he

said that this " resting " would allow the adrenals to have a greater

reserve.

Sharon

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Cindi, it's the dose. Prednisolone (deltacortril) is a synthetic but again LOW DOSE. I have never encountered anyone in alternative med community who talked about time limits on taking Delta or cortef! BB docs just wouldn't do it like that. Only time I have heard about time limits is from NTH members.

Call BBF and ask them.

Gracia

we know prednisone is more HPA axis suppressive long term...so my question would be are they advocating prednisone for a hypo person for a couple of months? or are they advocating prednisone for life time or what? do you know?cindi

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wrong dose/not enough

gracia

I couldn't take the cortef after noon. If I did, I couldn't sleep. It might not be a problem for others, tho. I do find that the iodoral tabs let me sleep like a baby and I have no problem getting up at 5:00 AM.Sue>> Lowe says that taking the last dose by 4 will eliminate problems with > sleeping...keeping in mind he's talking about AF from hypothyroid.> but i think many addison's folks just dose 2x a day...and so probably > wouldn't be taking it after lunch. > cindi

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I feel somehow that we are making this conversation much harder than

it needs to be. In particular, I think we are making way too much of

what the initial dose should be. As you said, a relatively high

short term dose does no harm, and also digestion is one thing that

we cannot standardize between people. So some people really will

need to ingest more than your formula to get the effect. So,

whatever. Starting with the dose that the most people seem to feel

good on makes since to me. But the real question is how you monitor

yourself once on HC. I do believe not everyone needs the average

dose and I do believe that even if you need the average dose

initially, many people will at some point need less or none. So how

to negotiate this? As Skipper has been saying several times, perhaps

the ACHT test is a good tool. Certainly just trying to reduce is

good and informative, but it would be helpful to have labs that

target this question. But I also don't want to overstate the need

for labs. I think Jefferies did a really nice job of trying to

reduce HC in his patients and it seemed like they would find out

very quickly whether they needed the higher dose or not.

Sharon

> sorta.

> i think there are probably two important things to remember when

> looking at jefferies work.

>

> first, since his work....they have developed better ways to assess

> what the body actually makes. i don't think that info should be

> disregarded. remember back in the 40s when they first started

with

> this, they were using 100 mg. plus...and they didn't know all the

> adverse side effects. this has all has evolved over the last 1/2

> century in that they do know now the adverse side effects of over-

> replacement. so although his figures may be slightly off, it

> doesn't negate the importance of the message at all.

>

> second, jefferies did work with cortisone acetate...and although

he

> said that cortisol was equal...what we do definitely know now is

> that hydrocortisone is 20% stronger than cortisone acetate.

That's

> why with h/c, addison's folks don't need 4x a day dosing. H/C

lasts

> longer in the body. So i think that information should also be

> applied to Jefferies work to see if it 3x a day dosing with H/C is

> more appropriate.

>

> but to answer your question...mostly yes..with an average

> replacement dose being 20-25 mg....but this can vary according to

> height and weight somewhat.

>

> As to your other question...there is some info that talks about

> which is more suppressive (the stronger ones like prednisone) and

of

> course the longer action in the body of h/c over cortisone

> acetate...but so far, i haven't run across exactly what you're

> asking about. Peatfield, however, does indicate that higher doses

> may be needed because of digestive/absorbtion issues with the

> digestive tract. Since hypo and adrenal problems tend to cause

> digestive issues....one might speculate that a higher dose might

be

> needed initially, and then lowered as those issues resolved.

> cindi

>

>

>

>

>

> since Jefferies time, they have developed better studies

> >

> > So, if this is correct then Jefferies might agree that 21-24mg

is

> > what the body makes for itself, the theoretical replacement

dose,

> so

> > to speak? And he gave 35-40mg as the actual replacement dose to

> get

> > that effect?

> >

> > But you are saying that new research suggests that 12-15mg is

what

> > the body makes and 20-25mg is what is needed to get that effect?

> Or

> > did I get this wrong?

> >

> > And while we are on the topic of efficiency of cortisol meds, is

> > there any research that looks at the

> > efficiency/digestibility/availability of the different types,

> e.g.,

> > hydrocortisone, cortisol, and cortisol acetate?

> >

> > Sharon

> >

> > > that is correct...and i always talk in terms of the oral h/c

> > dose...it

> > > gets too confusing otherwise. and most articles/abstracts do

the

> > > same...refering to the oral h/c..exogeneous, not endogeneous.

> > >

> > > but the body makes around 10 mg. of h/c....i had that in one

of

> > the

> > > references.

> > > cindi

> > >

> >

> > > > I thought Jefferies said that 35-40mg was NOT what the body

> > produced,

> > > > but what was required to provide the body with a replacement

> > dose. He

> > > > then concluded that it was likely a digestion/availability

> > issue -

> > > > that only 60% of the cortisone taken was available.

> > >

> >

>

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right...taking over a replacement dose will of course cause adrenal

suppression...there would be no doubt about it. it would be a side

effect.

but as we've earlier discussed....at what point (mg.) adrenal

suppression occurs at sub-replacement dosages - is variable.

This page cites the addison's replacement dose - i think you'll find

it equates to " proper replacement " .

http://www.endotext.org/adrenal/adrenal13/adrenalframe13.htm

cindi

>

> >From: " cindi22595 " <cindi22595@...>

>

> >i agree my history screams adrenal. not questioning that.

> >

> >at your height/weight, the upper end of your full replacement dose

> >is around 23 mg.

>

> The text you gave for the dosage, is giving the amount at which

side effects

> can be avoided. The second paragraph below shows that those side

effects it

> intends to avoid includes adrenal suppression -

>

>

> http://www.endotext.org/adrenal/adrenal14/adrenal14.htm

> Side effects occur only with supraphysiologic doses of

glucocorticoids and

> not with proper replacement, which is equivalent to 12 to 15 mg of

> hydrocortisone/ m2 body surface area per day

>

> These side effects include the development of varying degrees of

Cushing's

> syndrome manifestations during therapy and secondary adrenal

insufficiency

> (adrenal suppression) after discontinuation of treatment. Growth

retardation

> is one of the major side effects of chronic daily glucocorticoid

therapy in

> children ( 23, 24).

> **********************

>

> Nowhere in the article is 's Disease mentioned. He refers

to

> " adrenal insufficiency " so if his purpose is to give a full

replacement dose

> for 's, that isn't clear. In fact, the article is

about " adrenal

> suppression " so I don't think he's really referring to the " full

> replacement " dosage of an 's patient.

>

> >

> >Now here's the thing...when you went on H/C, it's probably because

> >you were Not functioning at 100%....you could have been

functioning

> >at 70% (16 mg.) or less and thus 20 mg. really made you feel

better.

> >But has taking that much H/C strengthened or weakened your

> >adrenals? And at that type of dose, I'd want to stress dose for

> >something like dental work or maybe even a brisk walk...because

> >natural adrenal reserve (storage) has been drastically reduced.

>

> You're presuming the 23 mg is the amount her adrenals produce

during the

> day, which isn't what the article says. It tells how much is safe

to avoid

> side effects like adrenal suppression. That's not the same as how

much

> cortisol is produced.

>

> The reserve issue is also an assumption on your part. You don't

know that

> reserve has been drastically reduced. In fact, if we have an

emergency

> situation you don't know if our adrenals are actually stronger and

can

> produce all the cortisol it needs to.

>

>

> >The theory is, of course, that resting them strengthens them. But

as

> >Chris's link from SSTM points out, there doesn't seem to be much

> >evidence of that.

>

> I'll tell you my adrenals are a lot stronger than when I started.

I don't

> care much about the evidence, as medical science isn't

particularly good.

> If you think it is then how come Vioxx went to market? How come

presription

> drugs kill hundreds of thousands of people a year? How come the

average

> doctor looks at a lab slip and says, " It's in the normal range,

you're OK "

> but doesn't know that the median TSH is 1.5?

>

> How come many of us have had to go to six or seven doctors before

we found

> adequate treatment?

>

> You can look at medical research all you want, but if something

works, why

> do we need to know more?

>

> The doctors would have you believe 2 minutes in the sun is going

to kill

> you, so you'd better go put on your sunscreen (as if that didn't

have toxic

> ingredients in it.) They allow genetically modified foods to be

grown

> without a major uprising to protect our health. They don't

complain about

> pesticides on the food supply or BGH in milk. So, what important

work is

> medical science and research doing for us? Mainly killing us with

toxic

> drugs they claim are safe, and not bothering to defend the safey

of the food

> supply, which probably causes a lot of illness today.

>

> They don't stand up and say, " Gee mercury is a toxic mineral,

maybe it's not

> so wise to have in your mouth?

>

> So it's a real possibility that some AF folks

> >really do just need full replacement? I guess it depends on

adrenal

> >damage done.

>

> It is possible. But, the article you referred to was talking

about the safe

> dosage to avoid side effects like adrenal suppression.

>

>

> >

> >But I don't see how most folks taking a full replacement dose is

> >necessarily the best thing for their adrenals. If they are weak,

> >they might want a different protocol to bring them up to 100%

> >functioning instead of shutting them down and hoping they will

> >bounce back.

> >Cindi

>

> You're right. That's why authors like who

wrote " Adrenal

> Fatigue " suggests " healing " the adrenals naturally. It's alleged

that some

> people can do that, probably those who haven't been to badly

damaged, and

> those who have years to wait to feel better.

>

> YOu can use a different protocol, ours isn't the only one. But,

it works

> well for us.

>

> Skipper

>

> _________________________________________________________________

> Share your special moments by uploading 500 photos per month to

Windows Live

> Spaces

> http://clk.atdmt.com/MSN/go/msnnkwsp0070000001msn/direct/01/?

href=http://www.get.live.com/spaces/features

>

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i would refer you back to jefferies info on 20 mg. and 60%.

Cindi

>

> >From: " cindi22595 " <cindi22595@...>

>

> >i agree my history screams adrenal. not questioning that.

> >

> >at your height/weight, the upper end of your full replacement dose

> >is around 23 mg.

>

> The text you gave for the dosage, is giving the amount at which

side effects

> can be avoided. The second paragraph below shows that those side

effects it

> intends to avoid includes adrenal suppression -

>

>

> http://www.endotext.org/adrenal/adrenal14/adrenal14.htm

> Side effects occur only with supraphysiologic doses of

glucocorticoids and

> not with proper replacement, which is equivalent to 12 to 15 mg of

> hydrocortisone/ m2 body surface area per day

>

> These side effects include the development of varying degrees of

Cushing's

> syndrome manifestations during therapy and secondary adrenal

insufficiency

> (adrenal suppression) after discontinuation of treatment. Growth

retardation

> is one of the major side effects of chronic daily glucocorticoid

therapy in

> children ( 23, 24).

> **********************

>

> Nowhere in the article is 's Disease mentioned. He refers

to

> " adrenal insufficiency " so if his purpose is to give a full

replacement dose

> for 's, that isn't clear. In fact, the article is

about " adrenal

> suppression " so I don't think he's really referring to the " full

> replacement " dosage of an 's patient.

>

> >

> >Now here's the thing...when you went on H/C, it's probably because

> >you were Not functioning at 100%....you could have been

functioning

> >at 70% (16 mg.) or less and thus 20 mg. really made you feel

better.

> >But has taking that much H/C strengthened or weakened your

> >adrenals? And at that type of dose, I'd want to stress dose for

> >something like dental work or maybe even a brisk walk...because

> >natural adrenal reserve (storage) has been drastically reduced.

>

> You're presuming the 23 mg is the amount her adrenals produce

during the

> day, which isn't what the article says. It tells how much is safe

to avoid

> side effects like adrenal suppression. That's not the same as how

much

> cortisol is produced.

>

> The reserve issue is also an assumption on your part. You don't

know that

> reserve has been drastically reduced. In fact, if we have an

emergency

> situation you don't know if our adrenals are actually stronger and

can

> produce all the cortisol it needs to.

>

>

> >The theory is, of course, that resting them strengthens them. But

as

> >Chris's link from SSTM points out, there doesn't seem to be much

> >evidence of that.

>

> I'll tell you my adrenals are a lot stronger than when I started.

I don't

> care much about the evidence, as medical science isn't

particularly good.

> If you think it is then how come Vioxx went to market? How come

presription

> drugs kill hundreds of thousands of people a year? How come the

average

> doctor looks at a lab slip and says, " It's in the normal range,

you're OK "

> but doesn't know that the median TSH is 1.5?

>

> How come many of us have had to go to six or seven doctors before

we found

> adequate treatment?

>

> You can look at medical research all you want, but if something

works, why

> do we need to know more?

>

> The doctors would have you believe 2 minutes in the sun is going

to kill

> you, so you'd better go put on your sunscreen (as if that didn't

have toxic

> ingredients in it.) They allow genetically modified foods to be

grown

> without a major uprising to protect our health. They don't

complain about

> pesticides on the food supply or BGH in milk. So, what important

work is

> medical science and research doing for us? Mainly killing us with

toxic

> drugs they claim are safe, and not bothering to defend the safey

of the food

> supply, which probably causes a lot of illness today.

>

> They don't stand up and say, " Gee mercury is a toxic mineral,

maybe it's not

> so wise to have in your mouth?

>

> So it's a real possibility that some AF folks

> >really do just need full replacement? I guess it depends on

adrenal

> >damage done.

>

> It is possible. But, the article you referred to was talking

about the safe

> dosage to avoid side effects like adrenal suppression.

>

>

> >

> >But I don't see how most folks taking a full replacement dose is

> >necessarily the best thing for their adrenals. If they are weak,

> >they might want a different protocol to bring them up to 100%

> >functioning instead of shutting them down and hoping they will

> >bounce back.

> >Cindi

>

> You're right. That's why authors like who

wrote " Adrenal

> Fatigue " suggests " healing " the adrenals naturally. It's alleged

that some

> people can do that, probably those who haven't been to badly

damaged, and

> those who have years to wait to feel better.

>

> YOu can use a different protocol, ours isn't the only one. But,

it works

> well for us.

>

> Skipper

>

> _________________________________________________________________

> Share your special moments by uploading 500 photos per month to

Windows Live

> Spaces

> http://clk.atdmt.com/MSN/go/msnnkwsp0070000001msn/direct/01/?

href=http://www.get.live.com/spaces/features

>

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I think it's sad folks have to personally attack others when they

disagree with their information. Again, Tish is a very smart woman and

is well respected by many, including myself. One thing she is not - is

confused.

cindi

>

>

> Tish doesn't understand that other hormones are involved when

adrenals are low. Low thyroid/low adrenal/low sex hormones. I am not

sure she understood about DHEA either. IMO she understood very

little. She was/is confused.

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do you not reduce reserve when you reduce total output? it seems

logical that if you reduce the function of the adrenals overall,

you've reduced normal reserve capacity. but i have someone who is

very knowledgeable about jefferies work that wrote me just a little

bit ago about this discussion here...so I'll ask him about it, since

i think this is an important point.

btw, this is the type discussion i like. honest inquiry without

attack. thank you for that.

cindi

>

> I think this is wrong. Jefferies didn't say HC caused a loss of

> adrenal reserve. He said it caused a loss of adrenal output. Then

he

> said that this " resting " would allow the adrenals to have a

greater

> reserve.

>

> Sharon

>

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h/c has half-life of 8-12 hrs...i guess that's how.

interesting, i've seen discussion that a time-released form would be

good--because some of the negative effects of H/C appear to be " too

much hitting the body at one time " type of adverse effect.

cindi

- In iodine , " Gracia " <circe@...> wrote:

>

>

> Dose only last for 3-4 hours. How on earth could 's

patients dose 2X a day? they must be using synthetic time release.

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no question--I am much stronger on cortef. I was going backwards without it. I work in a very stressful environment and am able to cope with all kinds of stress. I never feel that I am on the edge of an abyss. I almost never take more than 20mg/day.

gracia

i agree my history screams adrenal. not questioning that. at your height/weight, the upper end of your full replacement dose is around 23 mg. Now here's the thing...when you went on H/C, it's probably because you were Not functioning at 100%....you could have been functioning at 70% (16 mg.) or less and thus 20 mg. really made you feel better. But has taking that much H/C strengthened or weakened your adrenals? And at that type of dose, I'd want to stress dose for something like dental work or maybe even a brisk walk...because natural adrenal reserve (storage) has been drastically reduced. The theory is, of course, that resting them strengthens them. But as Chris's link from SSTM points out, there doesn't seem to be much evidence of that. So it's a real possibility that some AF folks really do just need full replacement? I guess it depends on adrenal damage done. But I don't see how most folks taking a full replacement dose is necessarily the best thing for their adrenals. If they are weak, they might want a different protocol to bring them up to 100% functioning instead of shutting them down and hoping they will bounce back. Cindi

..

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dang. i thought it was just me who thought they walked into the wrong

forum. i can vaguely remembering responding this morning to something

someone had said about h/c...and i even remember saying " back to

iodine? " at some point...and it just continues.

let's move on, folks..H/C discussion is probably best on an adrenal

forum i would think.

cindi

>

> There's nothing wrong with wanting to look at all aspects of the

> cortisol therapy. I for one want to know what I'm doing to my body

long

> term. Thanks for bringing it up. When I read the messages, I

completely

> forget that I'm in the iodine group. Sorry!

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well....i could go into what a prednisone replacement dosage

is...but i'm gonna drop it, okay?

but i will mention peatfield mentions " time limits " . But if someone

is still on 20 mg. h/c after 2 or 3 years, I would seriously wonder

if they are trying to " heal " their adrenals...or just taking h/c

replacement for life. If that's their decision based on their

situation - and they have made an informed decision, i'm not going

to argue with that.

cindi

>

>

> Cindi, it's the dose. Prednisolone (deltacortril) is a

synthetic but again LOW DOSE. I have never encountered anyone in

alternative med community who talked about time limits on taking

Delta or cortef! BB docs just wouldn't do it like that. Only

time I have heard about time limits is from NTH members.

> Call BBF and ask them.

> Gracia

>

> we know prednisone is more HPA axis suppressive long term...so

my

> question would be are they advocating prednisone for a hypo

person

> for a couple of months? or are they advocating prednisone for

life

> time or what? do you know?

> cindi

>

>

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well why couldn't i have said it that simply? :-)

yes.

I so often just hear the 20 mg. a day/4x a day mantra...and it seems

some of the rest of it (peatfield saying start with 2.5 and work up

as needed) is just forgotten.

thanks.

cindi

> > >

> > > So, if this is correct then Jefferies might agree that 21-24mg

> is

> > > what the body makes for itself, the theoretical replacement

> dose,

> > so

> > > to speak? And he gave 35-40mg as the actual replacement dose

to

> > get

> > > that effect?

> > >

> > > But you are saying that new research suggests that 12-15mg is

> what

> > > the body makes and 20-25mg is what is needed to get that

effect?

> > Or

> > > did I get this wrong?

> > >

> > > And while we are on the topic of efficiency of cortisol meds,

is

> > > there any research that looks at the

> > > efficiency/digestibility/availability of the different types,

> > e.g.,

> > > hydrocortisone, cortisol, and cortisol acetate?

> > >

> > > Sharon

> > >

> > > > that is correct...and i always talk in terms of the oral h/c

> > > dose...it

> > > > gets too confusing otherwise. and most articles/abstracts do

> the

> > > > same...refering to the oral h/c..exogeneous, not endogeneous.

> > > >

> > > > but the body makes around 10 mg. of h/c....i had that in one

> of

> > > the

> > > > references.

> > > > cindi

> > > >

> > >

> > > > > I thought Jefferies said that 35-40mg was NOT what the

body

> > > produced,

> > > > > but what was required to provide the body with a

replacement

> > > dose. He

> > > > > then concluded that it was likely a digestion/availability

> > > issue -

> > > > > that only 60% of the cortisone taken was available.

> > > >

> > >

> >

>

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this is not a personal attack. Please be clear about that. This is my assessment of her "information". It's very very confused. That does not mean she's a bad person etc. It means she is unwell.

Gracia

I think it's sad folks have to personally attack others when they disagree with their information. Again, Tish is a very smart woman and is well respected by many, including myself. One thing she is not - is confused. cindi>> > Tish doesn't understand that other hormones are involved when adrenals are low. Low thyroid/low adrenal/low sex hormones. I am not sure she understood about DHEA either. IMO she understood very little. She was/is confused.

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Cindi I take H/C. Dose lasts 3-4 hours. maybe my metabolism is different from other peeps.

gracia

h/c has half-life of 8-12 hrs...i guess that's how. interesting, i've seen discussion that a time-released form would be good--because some of the negative effects of H/C appear to be "too much hitting the body at one time" type of adverse effect. cindi- In iodine , "Gracia" <circe@...> wrote:>> > Dose only last for 3-4 hours. How on earth could 's patients dose 2X a day? they must be using synthetic time release.

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