Re: Cortef - one more question

[Guest guest]

" Safe Uses of Cortisol " doesn't seem to address one question - who are

the people who Cortef doesn't work for?

The reason I ask is that when I was on Cortef in the past, though the

wrong dose, I walked into a new doctor's office (someone who

specialized in adrenal fatigue) and he was dismayed that I was on it.

So I said it made me feel better. And he said something like, " Of

course it does. It's a type of steroid. It would make anyone feel

better. " Thinking ahead to being in a similar situation again, I

really don't know how to address that statement. Because in the book,

it seemed like it made anyone with any problem feel better. But it is

a steroid...so of course it would...right?

I'm so confused I don't even know how to explain it...

Sharon

[Guest guest]

Hi ,

Thanks for your reply.

> so...was it the amount that you were taking that was concerning

to your doctor?

I was taking 10mg AM, 5mg Noon, prescribed by the previous doc who

was not that informed.

> Otherwise, I don't know that lower doses would have any " feel

good " effect because you're actually lowering total adrenal reserve

while on H/C. Did he say any more about it to you? And if he

specialized in adrenal fatigue, what was his protocol for that?

It seems to me people who specialize in adrenal fatigue go one of

two paths - compensate for the problem (Cortef) or try to fix the

problem (support the adrenals into full functioning). This doctor

was definitely the latter, and gave me glandulars, B vits, and lots

more. I think it helped some (and he would say it definitely helped)

but I'm not all the way healthy by a long shot and am rethinking the

value of this strategy. Wouldn't it be better to feel good instead

of spending years struggling? I can always take the rebuilding stuff

at the same time as the Cortef, then in the future see how my

adrenals are by seeing if I can get off the Cortef. At least that is

my current thinking.

But no, I really don't know anymore about his negative ideas on

Cortef. Maybe he didn't know how bad I felt as my saliva cortisol

test wasn't that bad (think I was on glandulars before the test). He

did have the book on his bookshelf - maybe he thinks it is

appropriate sometimes.

Can you say more about your comment, " you're actually lowering total

adrenal reserve while on H/C " ?

Thanks much,

Sharon

[Guest guest]

From Chapter 2 - Sources of Confusion, p.14

" Subreplacement Dosages. These are dosages less than normal

replacement dosages and, hence, are capable of suppressing

endogenous adrenal function only partly. It has been demonstrated

that when subjects with intact adrenals receive less than full

replacement dosages of cortisone acetate or cortisol, endogenous

adrenal function is suppressed only sufficiently to achieve a normal

total glucocorticoid level. For example, subjects receiving 20mg

(5mg four times) daily of cortisone acetate have their endogenous

adrenal steroid production decreased by approximately 60 percent,

and subjects receiving 10 mg (2.5mg four times) daily have their

adrenal steroid production decreased by approximately 30 percent.

The residual functioning tissue is adequate for apparently normal

responses to stresses such as respiratory or gastrointestinal

infections or even major surgery, but because of the possibility

that their reserve capacity to cope with stress or that their HPA

response to stress might be impaired, and because of recent evidence

that at least some autoimmune disorders are associated with a

defective HPA response to stress, it seems advisable to supplement

their cortisol dosage at times of any increased stress and

especially at times of surgery or similar severe stress as in

patients with more severe adrenocortical deficiency. Barker has

reported that adrenal insufficiency in the unstressed state does not

occur unless 90 percent or more of the cortical tissue is destroyed,

but the demands of varying degrees of stress upon the adrenals'

ability to respond have apparently not been studied, nor have the

long-term effects of stress, either acute or chronic, upon patients

with lesser degrees of adrenal deficiency been investigated. It is

therefore considered advisable to give patients taking

subreplacement dosages of cortisone or cortisol the same printed

instructions as those taking full replacement dosages. Subreplacemnt

dosages also avoid the complete suppression of endogenous adrenal

androgen production that probably causes a higher incidence in women

than in men of undesirable side effects such as osteoporosis when

larger dosages are taken for long periods. Many patients who need

subreplacement dosages have low adrenal reserve, so the

administration of such dosages actually improves the adrenals'

ability to respond to stress in these cases. "

> >From: Cindi <cindi22595@...>

>

> >Check Safe Uses Of Cortisol...but Jefferies says that " subjects

receiving

> >20 mg. daily of cortisone acetate (his studies were not with

> >hydrocortisone) have their endogenous adrenal steroid production

decreased

> >by approximately 60 percent, and subjects receiving 10 mg.

daily ....by 30

> >percent " .

>

> Reducing production by 60% doesn't mean 60% weaker. With weak

adrenals, you

> can't keep up anyway yet your gland struggles to do so.

>

> Not suppressing the HPA axis keeps the adrenals working, just at

levels they

> are more able to handle without strain.

> >

> > I suppose this depends on whether you see adding hormone as

affecting

> >the feedback loop....or as a supplementation.

>

> Suppressing the feedback loop is a bad thing. Affecting the

feedback loop

> and putting less strain on the adrenals is not.

>

> Skipper

>

> _________________________________________________________________

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>

[Guest guest]

Cindi

> yep. that's the part i was quoting. dang..did you type all

that? surely not.

: )

> and Jefferies did use 40 mg. as the figure for total

replacement...which current research says is lower...so don't know

how that might change all that.

On pg 13 he says that the average daily production of cortisol by

human adrenals under basal conditions is 15-20mg, but this dose will

not maintain adrenalectomized patients. Studies indicate 35-40mg is

needed. " The discrepancy between the 20mg average daily production

by normal adrenals and the 35-40 mg necessary to suppress normal

adrenocortical activity implies that, when taken by mouth in tablet

form, even in divided doses, cortisone acetate or cortisol is only

approximately 60 percent as efficient as when the hormone is

naturally produced by the adrenals and released directly into the

blood in accordance with bodily needs. "

Sharon

[Guest guest]

Hi Skipper,

> It's not needed by people who produce adequate levels of cortisol.

However,

> nothing bad happens to them as their adrenals simply cut back

production a

> little. As long as the HPA axis isn't suppressed, it's not a problem.

How do you know if the HPA axis isn't suppressed? Would a person on HC

do labs for that?

> Take too much thyroid hormone, you'll feel like you're dying.

Definitely know that to be true....

> The hormones in natural levels generally make you feel NORMAL. They

don't

> generally give you false euphoria.

I know that is true for thyroid hormones but I'm not really getting that

for adrenal. I thought feeling really good was an effect of higher dose

prednisone? But I do get that subreplacement doses are not the same as

standard predisone treatment.

> The ones who don't like HC, like to push diet and glandulars and

Vitamins,

> particularly B vitamins.

That is true for mine.

> It doesn't make everyone feel better. That's not true. My wife has

high

> functioning adrenals. She tried hydrocortisone once, and did not like

the

> way she felt. Our thyroid doc gives HC to most hypo patients, because

the

> majority are low, so he keeps offering it to her (her cortisol level

is high

> but and others say that's what happens before they crash and is

a

> sign of fatigue, but hers stay high.) She took the offer once to see

what

> it would do, and she knew she didn't need it.

Good to know.

> I'm sure the alternative doctors who think they can " heal " the

adrenals in

> some cases without HC, are right. It's just the approach will take a

lot

> longer, be more expensive, and may or may not be as effective.

Well, that is it exactly. I've been with the latest doc for 2 years and

am not having a reasonable amount of energy yet. And my adrenal problems

have been around since 1999. In full swing that is. Building up I'm sure

before then. And yes, I've spent a lot of money too.

Do you have any recommendations on how to find a Cortef friendly doctor?

While I can go it on my own I prefer to have a sympathetic doc to order

labs once in a while.

Thanks again,

Sharon

[Guest guest]

Skipper

Would you mind consulting with me about how best to determine what symptoms I have and what they mean; and then of course the most pragmatic direct course of action; not one that would shock my system as I couldn't take too much at once.

I know you are busy, but it would be nice to have help as I am doing all my medical stuff alone.

Jane

[Guest guest]

Skipper, my cholesterol is 134, up from a low 4 years ago of 70. Whaa??

How would I raise it?

Jane

[Guest guest]

Gee Skipper, on second viewing, that appears to be kind of a tall order. Sorry to ask so much. I myself am 6 digests behind, so i don't even know if you've answered;-) My request sounds a bit thoughtless.

You are surely busy as well.

Jane

>>SkipperWould you mind consulting with me about how best to determine what symptoms I have and what they mean; and then of course the most pragmatic direct course of action; not one that would shock my system as I couldn't take too much at once.I know you are busy, but it would be nice to have help as I am doing all my medical stuff alone.>>