Cortisol & DHEA

December 15, 2007

Cortisol & DHEA Cortisol and DHEA are two of the most important hormones

produced by the adrenal gland. They are considered “stress hormones.” When you

are under stress (whether emotional, physical, or psychological), the adrenal

glands start producing cortisol and DHEA. Therefore levels of these two hormones

will increase. This helps our bodies cope with the stress. However, if the

stress become prolonged or chronic, the adrenal glands start to get fatigued,

and eventually the hormone levels will start to fall, and we may begin to show

physical, emotional, and psychological signs of chronic stress.

Cortisol Overview Cortisol, or hydrocortisone, is a natural hormone produced

by the adrenal gland, a small gland that sits on top of each kidney. It is the

main hormone among a whole family of hormones known as steroid hormones. Some

people do not produce enough cortisol to provide for their body’s needs.

The adrenal glands are a major component of the body’s natural defense against

stress, including any type of injury (including surgery), infection, or

emotional, physical or psychological stress. Repeated stress, infections, or

chronic illness can deplete the body’s adrenal reserves, and the ability to

produce adequate amounts of cortisol is affected.

Furthermore, adrenal hormone is necessary to maintain adequate blood sugar.

People with low adrenal reserve experience rapid drops in blood sugar

(hypoglycemia) during stress because there is not enough cortisol to maintain

sugar levels. In response, the body starts producing and secreting adrenaline,

which raises blood sugar but also causes anxiety. Therefore, people with low

adrenal cortisol are more prone to flare-ups of temper, nervousness or shaking,

palpitations, irritability, difficulty concentrating, salt cravings, sleep

disturbances, fear of situations that are even moderately stressful, and can

have panic attacks, fatigue, feel cold, and may have depression.

The adrenal glands also play a key role in reproductive function. Women with

low adrenal output can have skipped or irregular menstrual periods, unusual

menstrual bleeding, and are at greater risk for miscarriage or infertility.

Because of changes in the functions of the ovaries, women can also have

increased facial hair or acne.

During infections, the adrenal glands normally increase their output to double

or triple the amount of cortisol in the blood to help fight the infection.

During a viral infection, adrenal hormone is necessary to suppress

inflammation—people with low reserves are more prone to higher fever and body

aches. Therefore, people with low adrenal reserve may have increased

susceptibility to colds and infections, more prolonged infections, and are more

prone to allergies and arthritis.

Like persons with low thyroid function, people with low adrenal reserve

benefit from taking cortisol pills to make up for what the body is not

producing. The normal average daily production of cortisol is 30-40 mg

(milligrams). If you have adrenal insufficiency you may be producing only 15-20

mg per day. Taking an additional 5-20 mg of cortisol a day can support the

adrenals and improve health and well-being.

The big misunderstanding is that cortisol is the same as Prednisone (or

similar high-strength steroids, such as Medrol). Such medications, while useful

in select medical conditions, provide cortisone far in excess of the normal

physiologic needs of the body, and long-term use is associated with serious side

effects and medical complications, including: high blood pressure, weight gain

and bloating, immune suppression, osteoporosis, fungal infections, and a

tendency towards diabetes and stomach ulcers. Furthermore, within a short period

of time, medications like Prednisone actually can shut down the body’s normal

hormone production. These potential side effects have no relationship to

low-dose cortisol treatment!

Low-dose treatment with cortisol replaces only what your body is not

producing. In fact, even if your cortisol production is normal, an additional

5-20 mg of cortisol will not cause any appreciable side effects. Cortisol is

actually 5 times weaker than Prednisone, so 40 mg of Prednisone would be like

taking 200 mg of cortisol! Furthermore, unlike Prednisone, cortisol has very

short life span in the body. In other words, it gets cleared out of the body

before it has a chance to do any harm.

Many patients respond to proposed cortisone treatment by expressing fears

about how dangerous it is-- “My mother took it and it gave her ulcers, puffed

out her face, and put a hump on her back!“ Be reassured that cortisol is

completely different from Prednisone and used very differently.

Can cortisol levels be tested? Yes, but the “normal” laboratory values are so

broad that the test often misses people with subtle or moderate adrenal

insufficiency. For example, the standard laboratory range for cortisol is 8-22.

However, anything under 14 would be considered adrenal insuffiency, in spite of

it being in the “normal” range. Because cortisol is so safe, sometimes the best

“test” is simply beginning a trial of taking cortisol (based on your symptoms

and physical exam, of course).

Cortisol Replacement Cortisol comes in 5 mg tablets, as a prescription

medication known as Cortef. It may also be compounded in a cream by a

compounding pharmacy.

Cortisol generally should not be taken in the evening or at bedtime.

Symptoms should improve within 3-4 weeks. If there are no changes in how you

feel, then it is unlikely that adrenal insufficiency is the root cause of your

symptoms, and the search continues to find the cause.

If you feel a little “too good,“ or if you begin to have trouble falling

asleep or feel a little bloated, either the dose of cortisol needs to be

decreased to a level that does not produce any side effects, or you do not need

the cortisol. Your doctor will determine what the correct course of action to

take is. Remember, there are essentially no risks to such a cortisol trial!

Avoid caffeine, or at most have minimal amounts, when taking cortisol.

Caffeine raises adrenaline levels, which can overstimulate your body and cause

anxiety reactions. Also avoid excess sugar or heavy carbohydrate diets. Both of

these raise blood sugar levels rapidly, releasing a surge of the hormone

insulin, which subsequently quickly lowers blood sugar and stresses the adrenal

system.

It may take several weeks to notice the benefits of cortisol treatment. It is

essential to get 8 hours of sleep, because the adrenals generally need that much

time to replenish their reserves and “recharge their batteries.“ As you continue

eating a proper diet, take the appropriate vitamin and nutritional supplements,

get enough sleep, and exercising, you will begin to notice more energy, less

fatigue, less anxiety, and a greater ability to tolerate stress.

DHEA Overview Dehydroepiandrosterone (DHEA) is the most abundant androgen

(male steroid hormone) secreted by the adrenal glands (small hormone producing

glands that sit on top of the kidneys), and to a lesser extent, by the ovaries

and testes. DHEA can also be converted into other steroid hormones, including

testosterone and estrogen. Considerable interest in DHEA has developed in recent

years with reports that it may play a role in the aging process. Circulating

levels of DHEA peak at age 25 and then steadily decline with age. DHEA levels in

70-year-old individuals tend to be roughly 80 percent lower than those in young

adults.

Some researchers consider DHEA a possible anti-aging hormone because DHEA

deficiencies in older individuals have been associated with a number of medical

conditions including breast cancer, cardiovascular disease, impaired memory and

mental function, and osteoporosis. In addition, population-based studies have

suggested that people with higher DHEA levels tend to live longer, healthier

lives than those with lower levels of DHEA. However, low levels of DHEA being

linked to certain diseases does not necessarily mean that DHEA supplements will

reduce the risk or improve the outcome of these conditions.

The United States Food and Drug Administration (FDA) removed DHEA supplements

from the market in 1985 due to false claims about health benefits. However,

since the passing of the US Dietary Supplement Health and Education Act of 1994,

DHEA has made its way back on the market and its popularity continues to grow.

Despite this growth and attention, support for the health claims, particularly

as tested on people, is lacking. Plus, given that DHEA products are sold as

dietary supplements, there is no control over their contents or the

manufacturing practices of the companies that make the supplements. One

independent evaluation found that the amount of DHEA in over the counter

products ranged from 0% to 150% of what the content stated on the label.

Uses / Indications Aging Given that DHEA levels decline with advancing age,

some researchers have investigated whether DHEA supplementation may slow or

prevent age-related declines in mental and physical function. Preliminary

results from the DHEAge study in France suggest that the hormone may slow bone

loss, improve skin health, and enhance sexual drive in aging adults,

particularly women older than 70 years of age. Animal studies that have shown a

boost in memory for older rats taking DHEA supplements. Results from human

studies, however, have been conflicting. Some studies have shown that DHEA

improves learning and memory in those with low DHEA levels, but other studies

have failed to detect any significant cognitive effects from DHEA

supplementation. Further studies are needed to determine whether DHEA

supplementation helps prevent or slow medical conditions associated with the

aging process.

Adrenal Insufficiency As mentioned earlier, DHEA is one of the hormones made

in the adrenal glands. When the adrenal glands do not make enough hormones, this

is called adrenal insufficiency. Women with this condition who were given DHEA

supplements reported improved sexuality and sense of well-being (including

decreased feelings of depression and anxiety). Only a doctor can determine if

you have adrenal insufficiency and if DHEA, along with other hormones, is

needed. Adrenal insufficiency can be a medical emergency, particularly when

first diagnosed. This is especially the case if your blood pressure is low,

which can cause you to experience dizziness or lightheadedness. Another reason

to seek medical attention right away in the case of adrenal insufficiency is

swelling of the ankles or legs.

Impotence Studies suggest that DHEA supplementation may help impotent men

have and sustain an erection.

Osteoporosis Studies have shown that DHEA cream applied to the inner thigh

may boost bone density in older women.

Anorexia Nervosa Women with anorexia nervosa are at increased risk for bone

fractures and can develop osteoporosis at a younger age than women without

eating disorders. It has been observed that adolescents and young adults with

anorexia nervosa tend to have low levels of DHEA. Some studies suggest that DHEA

may help protect against bone loss in people who are anorexic.

Athletic Performance Although DHEA supplements are widely used by athletes

and body builders to boost muscle mass and burn fat, there is little evidence to

support these claims. There are no published studies of the long-term effects of

taking DHEA, particularly in the large doses used by athletes. Plus, the

building blocks of testosterone, including DHEA, may adversely affect

cholesterol in male athletes by lowering HDL ( " good " ) cholesterol.

Lupus Lupus is an autoimmune disorder. Autoimmune diseases are a group of

conditions in which a person's antibodies attack a part of their own body

because the immune system believes the body part is foreign. Studies have shown

that DHEA helps regulate the immune system and may play a role in the prevention

and/or treatment of certain autoimmune diseases.

A recent review of scientific literature found that DHEA supplementation may

reduce the need for medications and the frequency of flare-ups, enhance mental

function, and boost bone mass in women with lupus. Further studies are needed to

determine whether DHEA is safe and effective for both men and women with this

condition, however.

HIV DHEA levels tend to be low in individuals infected with the human

immunodeficiency virus (HIV), and these levels decline even further as the

disease progresses. In one small study, DHEA supplementation improved mental

function in men and women infected with HIV. However, studies have yet to

demonstrate whether DHEA supplementation can improve immune function in people

with this condition.

Depression In a preliminary study of individuals with major depression, DHEA

significantly improved symptoms of depression compared to placebo. However,

results of this study and others conducted to date on DHEA and depression are

not conclusive. The potential value of using DHEA for depression, therefore,

remains unclear, and the long-term effects of taking this supplement are

unknown.

Obesity The results of studies using DHEA to treat overweight people have

been conflicting. While animal studies have found DHEA to be effective in

reducing body weight, studies of men and women showed that DHEA produced no

change in total body weight, although total body fat and LDL ( " bad " ) cholesterol

did improve. These differences may be due to the fact that higher dosages were

used in the animal studies than in the human studies (such high doses would

cause intolerable side effects in people). Further studies are needed to

determine whether DHEA is an effective way to reduce body weight in obese

people. Until the safety and effectiveness of DHEA is fully tested, it is best

not to use this supplement for weight loss.

Menopause DHEA has gained some popularity among peri-menopausal women. They

often used the supplement to alleviate symptoms of menopause including decreased

sex drive, diminished skin tone, and vaginal dryness. In one recent study, DHEA

supplements did raise levels of certain hormones in post-menopausal women.

However, clinical studies regarding the value of DHEA for improving menopause

symptoms have had conflicting results.

Those who believe in the use of DHEA claim that it relieves the menopausal

symptoms described above without increasing the risk of breast cancer or cancer

of the endometrium (lining to the uterus). The risk of each of these cancers may

be increased with regular, prescription hormone replacement therapy. There is no

proof, however, that DHEA does not stimulate these cancers as well. Women with

breast cancer tend to have low levels of this hormone in their bodies. But

replacement may lead to either inhibition or stimulation of growth of breast

cancer cells.

Inflammatory Bowel Disease (IBD) DHEA levels appear to be low in people with

ulcerative colitis and Crohn's disease. It is premature to say whether DHEA

supplements have any impact, positive or negative, on these two bowel diseases.

Available Forms Most DHEA supplements are produced in laboratories from

diosgenin, a plant sterol extracted from Mexican wild yams. Some extracts from

wild yams are marketed as " natural DHEA. " Advertisers claim that these " natural "

extracts of diosgenin are converted into DHEA by the body. However, it takes

several chemical reactions to convert diosgenin into DHEA, and there is no

evidence that the body can make this conversion. For this reason, it is best to

look for labels that list DHEA rather than diosgenin or wild yam extract. Also,

it is important to select products that state it is " pharmaceutical grade. "

One way to avoid purchasing a product with contaminated DHEA is to purchase it

through a professional healthcare provider or in a custom compounded

prescription cream from a pharmacy.

DHEA is available in capsules, chewing gum, drops that are placed under the

tongue, and topical creams.

DHEA is a hormone produced in the body and is not obtained through the diet.

Dosing Recommendations DHEA is not recommended for people under the age of

40, unless DHEA levels are known to be low (<130 mg/dL in women and <180 mg/dL

in men).

Pediatric DHEA supplements should not be used in children.

Adult Dosages for men and women differ. Men can safely take up to 50 mg/day,

but women should generally not take more than 25 mg/day, although up to 50 mg

has been used for women with anorexia, adrenal insufficiency, and other medical

conditions under medical supervision. DHEA is produced by the body primarily in

the morning hours. Taking DHEA in the morning will mimic the natural rhythm of

DHEA production. Positive effects have been noted at dosages as low as 5 mg/day

and the lower the dose the better.

Precautions Because of the potential for side effects and interactions with

medications, dietary supplements should be taken only under the supervision of a

knowledgeable healthcare provider.

DHEA generally is not recommended for people under 40 years of age, unless

DHEA levels are known to be low (less than 130 mg/dL in women and less than 180

mg/dL in men). People taking DHEA should have their blood levels monitored every

6 months.

No studies have been conducted on the long-term safety of DHEA.

Because DHEA is a precursor of estrogen and testosterone, patients with

cancers affected by hormones (such as breast, prostate, ovarian, and testicular

cancer) should talk to their physician before taking DHEA.

High doses of DHEA may inhibit the body's natural ability to make the hormone

and also may be toxic to liver cells. At least one case of hepatitis has been

reported.

In women (but apparently only negligibly in men) DHEA gets metabolized in

small amounts to estrogen and testosterone. Women should be aware of the risk of

developing signs of masculinization, such as loss of hair on the head, deepening

of the voice, hair growth on the face, weight gain around the waist, or acne.

Notify your health care provider if any of these symptoms occur. Other adverse

effects that have been reported include high blood pressure and reduced HDL

( " good " ) cholesterol.

The International Olympic Committee and National Football League recently

banned the use of DHEA by athletes because its effects are very similar to those

of anabolic steroids.

Possible Drug Interactions If you are currently being treated with any of the

following medications, you should not use DHEA without first talking to your

healthcare provider.

AZT (Zidovudine) In a laboratory study, DHEA enhanced the effectiveness of an

HIV medication known as AZT. However, scientific studies in humans are needed

before DHEA can be used for this purpose in people.

Barbiturates Animal studies suggest that DHEA may increase the effects of

barbiturates, a class of medications often used to treat sleep disorders

including butabarbital, mephobarbital, pentobarbital, and phenobarbital.

However, scientific studies in humans are needed before it is known whether this

same effect occurs in people and whether it is safe for DHEA and barbiturates to

be used together.

Cisplatin An animal study indicates that DHEA may increase the effectiveness

of an anti-cancer medication known as cisplatin; further studies are needed to

know if this effect applies to people.

Steroids Laboratory studies suggest that DHEA may increase the effects of

prednisolone, a steroid medication used to treat inflammation and other

disorders. Additional research is needed to determine if this effect applies to

people.

Estrogen It is possible that DHEA may influence the level of estrogen in the

body. For this reason, some women on estrogen replacement therapy may need to

adjust their dosage. This should be discussed with your healthcare provider.

Source: Adapted from University of land Medical Center, 2004.

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December 15, 2007

Thanks Roni,

Interesting stuff! I was on a high carbohydrate diet for years, being a

vegan. Now, I do eat wild salmon and eggs, as my B vitamins were low and so

was/is vitamin D. I used to be a caffine junkie, and the stress levels were

very high while in the Army. It was never ending, and then when I got out, I

remember having really serious anxiety attacks before the diagnosis of

hypothyroid (hashi). I wonder if my adrenals fell apart before the thyroid.

Blessings,

Roni Molin <matchermaam@...> wrote:

Cortisol & DHEA Cortisol and DHEA are two of the most important

hormones produced by the adrenal gland. They are considered “stress hormones.”

When you are under stress (whether emotional, physical, or psychological), the

adrenal glands start producing cortisol and DHEA. Therefore levels of these two

hormones will increase. This helps our bodies cope with the stress. However, if

the stress become prolonged or chronic, the adrenal glands start to get

fatigued, and eventually the hormone levels will start to fall, and we may begin

to show physical, emotional, and psychological signs of chronic stress.

Cortisol Overview Cortisol, or hydrocortisone, is a natural hormone produced by

the adrenal gland, a small gland that sits on top of each kidney. It is the main

hormone among a whole family of hormones known as steroid hormones. Some people

do not produce enough cortisol to provide for their body’s needs.