Re: Safety of Cortisol and Thyroid usage

[Guest guest]

Dear makeyourdayhappy,

I can't say that I have a good a knowledge of this as I would like,

but I don't think anyone does at this point, so I will say some

things that I think are true, based on the evidence available.

I think that it is clear that there are problems with the cortisol

levels in many PWCs, in the total cortisol secreted during a 24-hour

period, in the average time variation of the cortisol levels during

the day, and in the dynamic response of cortisol output to stressful

events. I think it is also clear that many of the symptoms and

signs in CFS (such as low blood sugar and low blood pressure) have

faulty cortisol output as their proximal (direct) cause. This is

not to say that CFS is the same as 's disease (primary

adrenal failure). Rather, cortisol disturbances are one of the

features of CFS.

I think it is also clear that many PWCs have a lower than normal

overall metabolic rate. The average metabolic rate is normally

under the control of the thyroid, so this suggests that thyroid

function should be examined in PWCs. This is not to say that low

thyroid function is the cause of the lower than normal metabolic

rate in many PWCs, but this is a possibility that should be checked.

Dr. Lowe has made thyroid supplementation a cornerstone of his

practice for treating fibromyalgia.

It is important to take a coordinated treatment approach to the

thyroid and adrenal issues, because one affects the other. Raising

thyroid hormone levels, for example, can exacerbate problems with

cortisol levels.

The cortrosyn test involves giving a person a relatively large dose

of a substance similar to the natural hormone ACTH, which normally

acts as the signal from the pituitary gland to the adrenal glands to

stimulate the secretion of cortisol and other adrenocortical

hormones. This test determines whether or not the adrenals are able

to secrete cortisol if given a large driving signal. A normal

cortrosyn test shows that the person does not have complete adrenal

failure ('s disease).

The bicycle ergometry test involves having the person undergo

aerobic exercise, and then measuring to see if the cortisol level in

the blood rises, as it normally should, since the aerobic exercise

constitutes a stress. This test looks at the dynamic function of

the entire HPA (hypothalamus-pituitary-adrenal)axis, rather than at

the adrenal function alone.

It is often found that a PWC will have a normal, or nearly normal

cortrosyn test, but will not have a normal response to the bicycle

ergometry test. It has also been found that the adrenals have

shrunken in size in many PWCs. These observations suggest that the

problem is not with the adrenal glands themselves in these PWCs, but

rather, it is higher up in the HPA axis, most likely in the

hypothalamus or in higher brain centers that feed signals to the

hypothalamus. This agrees with the conclusions reached by Mark

Demitrack, et al., who studied the operation of the HPA axis in CFS

several years ago.

The question is what to do about this. There were some early

experiments in which hydrocortisone (the same substance as cortisol)

was given to PWCs at doses of 25 to 35 mg per day for several

months. This did not prove to be beneficial, and it also made the

PWCs dependent on the supplemental hydrocortisone.

Other approaches have involved using lower dosages of

hydrocortisone, such as 5 or 10 mg per day, or using licorice, which

blocks the breakdown of natural cortisol, keeping its level in the

body higher. Dr. Jeffries has written a book about the

former. Dr. Baschetti in Italy has been the main proponent of the

licorice approach. Dave , on this list, has also advocated

use of licorice in the past.

Supplementing with low dose hydrocortisone or using licorice does

raise the cortisol level. The difficulty is that it still does not

restore the dynamic function of the HPA axis, so that the PWC still

does not have the proper moment-by-moment response to his or her

total stress state that a normal HPA axis provides. In addition,

taking supplemental hydrocortisone can cause the HPA axis to adjust

in such a way that the body become dependent on the supplement.

However, since the 24-hour averaged level of cortisol is low in many

PWCs, it does provide an improvement for many to use one of these

measures. Dave's most recent efforts in this area have involved

attempts to anticipate what his stress level is going to be, based

on the activities he is planning to engage in, and to adjust his

cortisol level ahead of time accordingly. This is a difficult thing

to do, and of course, it does not correct for unforeseen events that

raise a person's stress level. But it is an attempt to match the

cortisol level to the stress level in a better way than can be done

with regular cortisol dosing.

The late Dr. Poesnecker focused on the adrenal glands themselves,

believing that the glands themselves were fatigued in CFS. He

supplied nutrients particularly needed by the adrenals, as well as

adrenal cortical extract to build the tissue in the adrenals. He

reported some success with this approach.

I think that it's probably true that some PWCs have actual fatigue

of the adrenal glands themselves, but I also think that most PWCs

have a problem elsewhere in the HPA axis. The test results that you

report suggest that you are in the latter category.

Dr. L. , in his book Adrenal Fatigue, discusses the book

by Jeffries entitled " Safe Uses of Cortisol, " , and then says the

following: " Although there are different therapeutic regimens for

taking natural hydrocortisone, most conform to the normal 24-hour

cortisol secretion of approximately 20 mg of cortisol. Jeffries

recommends 5 or 7.5 mg orally before each meal and a bedtime. Other

alternative physicians use an initial dose of 12, 5, 2, and 1 mg at

8:00 a.m., 12:00, 3:00, and 6:00 p.m., respectively. If sleep

disturbances are part of the syndrome, 1 mg before bedtime might be

helpful. " Dr. recommends gradually lowering the dosage after

6 months, and does not recommend using supplemental hydrocortisone

for longer than 2 years. At this point, I think this is about the

best advice I've seen on hydrocortisone supplementation in CFS,

although I think Dave's efforts to more precisely match cortisol to

anticipated stress level are very interesting.

In regard to your question about the thyroid, I think it's important

for PWCs to have their thyroid hormone levels measured, including

TSH, T4 and T3, and including the " free " forms of the latter two. I

also think it's a good idea to measure the armpit temperature upon

awakening for a few days to see if it is averaging low, and to use

natural forms of the thyroid hormones when supplementation is

needed, such as Armour thyroid, both of which

Dr. Broda suggested. If the thyroid hormones are low, I think

that supplementation could be helpful. If they are not low, and the

armpit temperature is still low, then I think there are several

possibilities:

One is that even though the free T3 is at a normal level outside the

cells, it is not at a proper level or being properly utilized inside

the cells. A deficiency in selenium is a possible cause of this.

Many PWCs have mercury toxicity because of glutathione depletion,

and mercury can complex selenium so that it is not biochemically

available for the selenoenzymes that convert the thyroid hormones.

Supplementing selenium may help in this case. Supplementing thyroid

hormones may also help. I think it is worth a try.

If this doesn't help, another possibility is that there are partial

blockades in the intermediary metabolism, so that the thyroid

hormones are not able to speed up the metabolism as they normally

do. I think that this is the case in many PWCs. The recent

benefits that several PWCs have been reporting from the use of FIR

heaters and saunas suggest that this might be a helpful approach for

many in this situation. The applied heat appears to be able to

raise the metabolic rate in several PWCs for days after the use of

the heaters or saunas.

I think that's about all I have to contribute on this subject at

present.

Rich

> Is there anyone out there who knows about this subject? If your

> cortisol tested normal on a n A.M cortrosyn test (done over an

hour),

> but on a previous Bicycle ergonometry test your cortisol went down

> post exercise (vs. up), would cortisol be warranted. How do you

know

> what dose is efficacious, for how long, without supppressing the

> adrenal axis?

>

> What about thyroid. Does using it if you haven't seen test

results

> that say your T3 or T4 is ot of range, is it worth trying. I

> understand there may be a risk of osteoporosis and possibly other

> things.

>

> Also, has anyone seen Dr. J. Teitlebaum? What protocol did you go

> on? Did you go on Cortisol and/or thyroid even if your tests were

> negative? Have you seen an improvement? Was your

visit/experience

> with the protocol positive. How did it work for you if you

visited

> him from out of state re: being able to reach him if needed? Did

you

> have a local Dr. follow the protocol with you?

>

> Please only respongf if you have good knowledge of this as I am

> already confused based on what I have read thus far.

>

> Heartfelt Thanks.

[Guest guest]

Wow, Rich, great summation. Possibly explains why I cannot handle

stressful events anymore without sort of shutting down.

So what do you think about taking the hydrocortisone every 3 days, as

was recommended by someone on the list. And also, what about taking

the B vitamins prior to the hydrocortison, as another person insisted

is so important? Of course, Licorice is full of B vitamins.

penny

> > Is there anyone out there who knows about this subject? If your

> > cortisol tested normal on a n A.M cortrosyn test (done over an

> hour),

> > but on a previous Bicycle ergonometry test your cortisol went

down

> > post exercise (vs. up), would cortisol be warranted. How do you

> know

> > what dose is efficacious, for how long, without supppressing the

> > adrenal axis?

> >

> > What about thyroid. Does using it if you haven't seen test

> results

> > that say your T3 or T4 is ot of range, is it worth trying. I

> > understand there may be a risk of osteoporosis and possibly other

> > things.

> >

> > Also, has anyone seen Dr. J. Teitlebaum? What protocol did you

go

> > on? Did you go on Cortisol and/or thyroid even if your tests

were

> > negative? Have you seen an improvement? Was your

> visit/experience

> > with the protocol positive. How did it work for you if you

> visited

> > him from out of state re: being able to reach him if needed? Did

> you

> > have a local Dr. follow the protocol with you?

> >

> > Please only respongf if you have good knowledge of this as I am

> > already confused based on what I have read thus far.

> >

> > Heartfelt Thanks.

[Guest guest]

My thanks to Rich as well. It took me months to accumulate the same

information he summarized. In regards to the Every Third Day

hydrocortisone/licorice treatment, it worked well for me this

summer. However, toward the end of the summer, I crashed hard and

have yet to recover to pre-treatment levels.

Hydrocortisone still helps, but has lost most of its power to raise

my blood pressure and reduce chest pain. I can't but help think that

Rich is right that HPA problems are at play here. In addition,

supplementing only cortisol ignores the fact that your adrenals

produce over 80 other hormones. If you have exhausted adrenals, it

may well be that other critical hormones aren't being produced in

sufficient quantities either (e.g., epinephrine, which plays a key

role in blood pressure regulation, such as with neurally mediated

hypotension).

- don

> Wow, Rich, great summation. Possibly explains why I cannot handle

> stressful events anymore without sort of shutting down.

>

> So what do you think about taking the hydrocortisone every 3 days,

as

> was recommended by someone on the list. And also, what about taking

> the B vitamins prior to the hydrocortison, as another person

insisted

> is so important? Of course, Licorice is full of B vitamins.

>

> penny

>

[Guest guest]

Penny,

It's hard for me to suggest what you should do in regard to your

cortisol, since I don't know what your particular adrenal situation

is. The best tests to find out would be a cortrosyn test, a bicycle

ergometry cortisol test, and a DiagnosTechs Inc. adrenal stress

index test on your saliva. From these you could determine whether

you have abnormal cortisol levels, and if so whether the problem is

in the adrenal glands themselves or higher up in the HPA axis.

If hydrocortisone is needed, I think that spacing it out could help

to prevent your HPA axis from adapting to it and becoming dependent

on it.

With regard to the B vitamins and the other essential nutrients, I

think it's best to test for deficiencies before deciding how to

supplement. If this is not possible or practicable, then I favor

taking a high-potency general nutritional supplement such as Sparx

(www.krysalis-sparx.com) to supply the vitamins and minerals, an

undenatured whey protein supplement such as ImmunePro (available

from www.immunesupport.com) to supply the essential amino acids, and

a tablespoon per day of flax oil to supply essential fatty acids.

If you do this, you will have most of the bases covered in terms of

getting enough of the essential nutrients. Most PWCs could also

benefit from extra magnesium and injection of hydroxocobalamin

(vitamin B12).

Rich

> Wow, Rich, great summation. Possibly explains why I cannot handle

> stressful events anymore without sort of shutting down.

>

> So what do you think about taking the hydrocortisone every 3 days,

as

> was recommended by someone on the list. And also, what about

taking

> the B vitamins prior to the hydrocortison, as another person

insisted

> is so important? Of course, Licorice is full of B vitamins.

>

> penny

[Guest guest]

Don,

Did you try ACE before trying Dave's ETD? I thought I read some

earlier messages of yours that you trid ACE and also the glandulars

from wilson's web site.

From your experience, do you think adding ACE to

hydrocortisone/licorice is a good protocol? Are you still doing the

ETD or did you stop after your crash?

Since ACE has lot more hormones that the adrenals produce than just

cortisol, do you think adding ACE along with cortisol will take care

of the hormones that teh adrenals produce and be more helpful?

I started on the glandulars from wilson(it has thyroid, adrenal,

gonad and pituitary from porcine source). And also started on

licorice and ACE this week. Afetr 2 weeks , I want to add cortef, ACE

on the first day, licorice on the second day and nothing on the third

day. But would be taking teh glandulars on all days. Is this an OK

approach?

Thanks,

Gayathri.

In regards to the Every Third Day

> hydrocortisone/licorice treatment, it worked well for me this

> summer. However, toward the end of the summer, I crashed hard and

> have yet to recover to pre-treatment levels.

>

[Guest guest]

Yeah, I took ACE before and (at the end) of Dave's ETD therapy. I

also tried Dr. glandulars and then the late Dr. Poesnecker's

glandulars. Crashed anyway. I have an appointment with a

cardiologist to check for neurally mediated hypotension (NMH).

However, from what I understand of NMH, the brain fails to send the

necessary signals to the adrenals to produce/release more epinephrine

to speed up the heart when you stand up (hence, the blood pooling in

the legs and low blood pressure). Treating NMH can involve the

simulation of epinephrine release. However, if my adrenals are

exhausted, it stands to reason that this approach may just cause

another crash.

- don

> In regards to the Every Third Day

> > hydrocortisone/licorice treatment, it worked well for me this

> > summer. However, toward the end of the summer, I crashed hard

and

> > have yet to recover to pre-treatment levels.

> >

[Guest guest]

Hello,

I am one of the people experimenting with this currently. I usually

take 10-12mg of hydrocortisone/ day in divided doses, most in the

morning. But do not carve that in stone, as I may change my regimen

tomorrow. It does seem to be helping some, at ~ 4 weeks out.

I am also taking a small amount of T3, 7-10mcg/day.

Dr. Peatfield has a pretty good book on this subject, thyroid and

adrenal issues. It is called " The Great Thyroid Scandal " I

recommend it.

But, there is still a lot that is unknown. Btw, Rich's answer was

worth printing out.

Best,

Zippy

-----------------------------------------------------------------

> Is there anyone out there who knows about this subject? If your

> cortisol tested normal on a n A.M cortrosyn test (done over an

hour),

> but on a previous Bicycle ergonometry test your cortisol went down

> post exercise (vs. up), would cortisol be warranted. How do you

know

> what dose is efficacious, for how long, without supppressing the

> adrenal axis?

>

> What about thyroid. Does using it if you haven't seen test results

> that say your T3 or T4 is ot of range, is it worth trying. I

> understand there may be a risk of osteoporosis and possibly other

> things.

>

> Also, has anyone seen Dr. J. Teitlebaum? What protocol did you go

> on? Did you go on Cortisol and/or thyroid even if your tests were

> negative? Have you seen an improvement? Was your visit/experience

> with the protocol positive. How did it work for you if you visited

> him from out of state re: being able to reach him if needed? Did

you

> have a local Dr. follow the protocol with you?

>

> Please only respongf if you have good knowledge of this as I am

> already confused based on what I have read thus far.

>

> Heartfelt Thanks.

[Guest guest]

Rich wrote and excellent piece in response to the question of

supplementing hydrocortisol.

About the only thing I can add to this is that one needs first to

address their allergies and use a stragedy to avoid this reaction

before trying to supplement the adrenals.

I wourking on the theory now that lossely goes something like this:

Since cortisol serves as the brakes on the immune system, low adrenal

output (for whatever reasons) sets up a hyperimmune condition whereby

the PWC becomes allergic to many everyday chemicals and foods. These

allergies mostly are known as late-stage response type allergies, not

the instant type allergic reactions such as skin allergies and etc.

There can be a delayed reaction in the lungs to air pollution and to

exposure other than thru the gut, but the allergic reactions I'm

looking at now are mainly reactions from ingested chemicals and foods

and can be affected by things such as exercise and other factors

making identifing them extremely difficult.

The late-stage allergic response dumps a lot of histmine and other

TOXIN iterlukens and other agents used by the immune system to kill

invaders. An immune reaction can be extremely toxic to the body and

make the person feel like hell warmed over. In fact, in my opinion,

a great portion of the symptoms of CFS are not cause by any toxin or

virus or bacteria in the body, but rather are caused by our immune

system's own chemical battle staged against allergens. No one has

ever described the way it feels to be overloaded with histamine, IL-

6, IL-9, and Tumor Necrosis Factor and etc. all at the same time, but

my bet is that, if and when they do, they will describe something

very familar to chronic fatigue syndrome.

Anyway....in my opinion, the very first step in recovery from Chronic

Fatigue Syndrome requires a super human effort to identify and avoid

chemical and food sensitivities. Unless you avoid the agents that

spark the immune response, you will not be able to gage any other

recovery program that you try! Therefore, it is mandatory to first

go on a strick rotation diet, keeping a detailed diary of what you

injest and your activity level since your activity will change the

allergic reaction going on inside. This rotation diet includes going

off EVERYTHING you are now taking into your body, uincluding your

favorite feel good drugs and vitamins.

> > Is there anyone out there who knows about this subject? If your

> > cortisol tested normal on a n A.M cortrosyn test (done over an

> hour),

> > but on a previous Bicycle ergonometry test your cortisol went

down

> > post exercise (vs. up), would cortisol be warranted. How do you

> know

> > what dose is efficacious, for how long, without supppressing the

> > adrenal axis?

> >

> > What about thyroid. Does using it if you haven't seen test

> results

> > that say your T3 or T4 is ot of range, is it worth trying. I

> > understand there may be a risk of osteoporosis and possibly other

> > things.

> >

> > Also, has anyone seen Dr. J. Teitlebaum? What protocol did you

go

> > on? Did you go on Cortisol and/or thyroid even if your tests

were

> > negative? Have you seen an improvement? Was your

> visit/experience

> > with the protocol positive. How did it work for you if you

> visited

> > him from out of state re: being able to reach him if needed? Did

> you

> > have a local Dr. follow the protocol with you?

> >

> > Please only respongf if you have good knowledge of this as I am

> > already confused based on what I have read thus far.

> >

> > Heartfelt Thanks.

[Guest guest]

No one has

> ever described the way it feels to be overloaded with histamine, IL-

> 6, IL-9, and Tumor Necrosis Factor and etc. all at the same time,

but

> my bet is that, if and when they do, they will describe something

> very familar to chronic fatigue syndrome.

>

> Anyway....in my opinion, the very first step in recovery from

Chronic

> Fatigue Syndrome requires a super human effort to identify and

avoid

> chemical and food sensitivities. Unless you avoid the agents that

> spark the immune response, you will not be able to gage any other

> recovery program that you try! Therefore, it is mandatory to first

> go on a strick rotation diet, keeping a detailed diary of what you

> injest and your activity level since your activity will change the

> allergic reaction going on inside. This rotation diet includes

going

> off EVERYTHING you are now taking into your body, uincluding your

> favorite feel good drugs and vitamins.

------------------------------------------

I will agree with Dave on some of this. Discovering what I was

sensitive to was one of this biggest things I have ever done to feel

better. However, I went through Herculean efforts to determine it,

fasting many days. Others will hopefully be able to follow a milder,

gentler course than I. Dr. Theron Randolph wrote a good book on

this that might be helpful to some. I seemed to have misplaced this

book. I hope I got that name right. Anyway, his program should be

good for many people.

Too, my genovations testing showed that I, like Carol Sieverling, was

genetically encoded to over produce certain cytokines. TNF alpha is

a biggy for me. Taking Beta 1,3 D Glucan, which is designed to raise

TNF alpha, made me feel terrible I believe the future will

reveal that many PWC's have problems like this.

My pondering is over gene expression. What role do heavy metals,

toxins, hypothyroidism, etc. play in gene expression, which would

then encourage expression of CFS symptomolgy?

Keep up the good work Dave

Zippy

btw, I think cancer patients, who have been given interlukens, really

felt like crap from it, did they not?

[Guest guest]

All we have to do is get some brave volunteer to agree to be

injected with hist, IL-6, IL-9 and TNF, and then not only will we know

if your theory is correct, but also maybe get more respect from the

mainstream medical community. ?

Dave, do you know how long hydrocortisone is good for once you get

a prescription? 2 years, 3 years, 10 years? Thanks,

Mike c.

Dave wrote (in part):

No one has

> ever described the way it feels to be overloaded with histamine, IL-

> 6, IL-9, and Tumor Necrosis Factor and etc. all at the same time,

but

> my bet is that, if and when they do, they will describe something

> very familar to chronic fatigue syndrome.