Aldosterone can be just as important as Cortisol
(Important note: STTM is an information-only site based on what many patients have reported in their treatment. Please work with your doctor. This is not meant to replace that relationship or guidance, and you agree to that by reading this website. See the Disclaimer.)
Much more about this in the revised STTM book here–strongly recommended that you have this book on hand.
What is aldosterone?
Aldosterone, a steroid hormone just like cortisol, is produced in the outer cortex of your Adrenals (along with cortisol, testosterone, DHEA, DHEAS, androstenedione and estrogens). Aldosterone is the principal of a group called mineralocorticoids, and it helps regulate levels of sodium and potassium in your body–i.e. it helps you retain needed salt, which in turn helps control your blood pressure, the distribution of fluids in the body, and the balance of electrolytes in your blood. It does all this by stimulating your kidneys to both take in more sodium while releasing excess potassium–a vital balance in your heath and well-being.
What exactly stimulates aldosterone production??
Several things will stimulate your aldosterone secretion: when you potassium levels go too high, when sodium goes low, if there is less blood flow to your kidneys, or if your blood pressure falls. On the other side of the coin, aldosterone secretion will fall if your potassium levels fall, the blood flow in your kidneys increases, blood volume increases…or if you consume too much salt. See https://en.wikipedia.org/wiki/Aldosterone
What happens if aldosterone gets too high or too low–the latter low quite common if one has an adrenal issue?
When aldosterone gets too high (as it can under stress and as your cortisol goes too high), your blood pressure also gets too high and your potassium levels become too low. You can have muscle cramps, muscle weakness, and numbness or tingling in your extremities.
But when it gets too low, which can be common in some patients with cortisol deficiency, your kidneys will excrete too much salt, and it leads to low blood pressure; low blood volume; a high pulse and/or palpitations, dizziness and or lightheadedness when you stand; fatigue; a craving for salt. Symptoms of low aldosterone can also include frequent urination, sweating, a slightly higher body temperature, and a feeling of thirst, besides the craving of salt. Potassium can at first rise too high, then fall, as well.
A CLUE: Is your dog licking your legs? That is indicative of the salt wasting by low aldosterone as reported by many patients!
Another clue that your aldosterone may be too low is being on high amounts of HC, such as 30-40 mg for women, and higher for men, or continually rising amounts of Adrenal Cortex,and not getting stable Daily Average Temps…i.e. you seem to be continually chasing those stable temps.
What role does adding sea salt play?
Adding salt, especially if lab results show that sodium is not optimal, can be beneficial to treat the symptoms of low aldosterone, report patients. Sea salt contains important trace minerals, whereas they are mostly removed from table salt. Recommended amounts daily are 1/4 to 1/2 tsp in water twice a day…and some go a little higher, if needed.
Bob, a patient with excellent knowledge of his own low aldosterone, states: People with low aldosterone sufferer from “Salt Wasting”, a medical term describing sodium leaving the body. When sodium is excreted it takes water with it, causing frequent urination and dehydration. The body will struggle to maintain a proper balance of sodium and potassium in the blood – and these levels often appear normal on blood tests. But within the cells of the body, improper balance of these minerals can lead to fatigue, and is the reason why the pupils will fluctuate when performing the “flashlight test”. Persons with low levels of aldosterone crave salt. If they will take a minimum of 1/2 teaspoon of Sea Salt daily their symptoms improve. The “Salt Wasting” still occurs, but the symptoms of improper electrolyte balance will often improve, and they will feel more energy.”
But….you have to be careful, says patient wisdom, as too much sodium supplementation can drive aldosterone down even lower, and can increase your thirst all over again, as experienced by some patients. A more important supplement can be potassium, which supports aldosterone levels, especially if potassium levels are low. Work with your doctor on this..and always test sodium and potassium first.
How do I test Aldosterone and what should I look for in the results?
Testing for aldosterone by practitioners will be either a 24 hour urine test or a blood test–the latter which is more highly recommended to pursue with your doctor. It may also be important to avoid all salt for 24 hours before the test, and to be moving around for two hours before you test. 8 am is a good time to do the test since aldosterone levels would be at their highest in the early morning. For a complete picture, ask your doctor to include your renin, as well as sodium and potassium. Here’s a facility where you can order your own aldosterone test, then take your slip to a draw facility.
NOTE: aldosterone levels can be doubled if you are pregnant, and are normally a little higher in children than in adults.
You can also try a self-test–the pupil test, listed in Discovery Step Two on the Adrenal page. The blood pressure test from a supine position to standing can also point to your adrenals.
We have noted that when someone has low aldosterone symptoms (less than optimal sodium levels, craving of salt, peeing more at night, sweating more, failure to find stable average temps for HC or ACE, blood pressure that does not rise when standing, etc), they tend to fall mid-range or lower in lab results. When someone does NOT have low aldosterone, then tend to fall ABOVE mid-range.
More in Chapter 6 in the revised STTM book.
IMPORTANT NOTE FOR WOMEN: It’s strongly recommended by practitioners to test your aldosterone in the first week of your menstrual cycle (i.e. the week you start bleeding), or up until the beginning of the week after–this is when progesterone is at its lowest. Progesterone can drive your aldosterone up falsely, and progesterone begins to rise at the end of the second week of your cycle.
What medication do I take if sea salt/potassium isn’t enough to treat my low aldosterone?
The treatment of choice by practitioners appears to be fludrocortisone acetate with the brand name Florinef, a very potent steroid with mineralocorticoid properties . Patients and their wise doctors have learned to start with a quarter pill (25 mcg or .025 mg) and raise by that amount every 7 to 10 days until they get to 100 mcg. (0.1 mg) rather than starting out on 100 mcg. Many will note good effects fairly quickly; others may need at least two weeks. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682549.html
Florinef is a very powerful treatment, thus the reason to start low, such as 1/4 of a tablet, and work up in low amounts every week or so, patients have noted. Going up to 100 mcg is common, but you’ll know if it’s too much if your blood pressure goes up and potassium takes a serious dive. Check with your doctor for further information. It’s also important to note that some patients who are already on HC (cortisol) may have to lower it to compensate for the glucocorticoid potency of Florinef. It’s also recommended to take your Florinef with sea salt mixed in water.
One of the best methods to see if each raise is the right one for you is taking your blood pressure when seated, then stand and take it again. The right amount will cause the second blood pressure to be higher. See Discovery Step Two, Test one, here. Bottom line, when using Florinef, keep track of your blood pressure, your pulse, and your electrolytes sodium and potassium.
**Study chapter 6 in the revised STTM book about Florinef use.
Why do I need both Florinef and HC or ACE if both are steroids?
If someone is hypopituitary or wasn’t able to make the T3CM work well for them, and they know they have low aldosterone along with their low cortisol, why both steroids? Because Florinef (fludrocortisone) better imitates what Aldosterone does, and Cortef (hydrocortisone) or Adrenal Cortex (ACE) better imitates what cortisol does.
Florinef has greater mineralcorticoid activity, just like Aldosterone does. To have mineralcorticoid activity means it controls electrolyte and water levels, mainly by promoting sodium retention in the kidney. (yours is low, thus the reason you urinate a lot, and lose salt because of that.).
Cortef has greater glucocorticoid activity, just like Cortisol does. To have glucocorticoid activity means it controls carbohydrate, fat and protein metabolism and is anti-inflammatory. It allows thyroid hormones to get to your cells.
So you can see that Cortef or ACE won’t help you retain salt, just as Florinef won’t help thyroid hormones get to your cells.
Need gluten-free aldosterone treatment?
Barr Pharmaceuticals (the parent company is Teva Pharaceuticals), maker of generic florinef (for low aldosterone), claim that their product is gluten free. The starches are potato and corn sourced.
Want to order your own labwork for aldosterone and renin, plus electrolytes?? STTM has created the right ones just for you to discuss with your doctor. Go here: https://sttm.mymedlab.com/
Need help interpreting your lab results base on patient experiences and wisdom? Go here: www.stopthethyroidmadness.com/lab-values/
Afraid of Florinef?? Here’s a blog post from a gal who loves her Florinef!
TED: I started taking Florinef (100ug) two weeks ago, before knowing the dosing from Chris (i.e. not to start on 100ug). Never had a problem, and felt the difference the first day. All positive. Going off salt to take the aldosterone test isn’t an option for me. I’d be in a coma long before the test date! I’m now on 40 mg Cortef, 120mg Armour, 100ug Florinef and feeling far better than I’ve felt in many years. I’m sure I’ll stumble along the way as I increase the Armour, but I think I’m prepared for that. My constant “background” headaches have virtually disappeared……incredible!!!
MICHELLE: I have been on .1 mgs florinef for about 2 months now and what a difference. Before Florinef, I would drink and drink water and still was so puffy. And talk about being dehydrated! I would wake in the morning dying of thirst. I was constantly breathless, and my hearttrate was over 100 resting. Since being on Florinef, I notice increased energy towards the end of the day. I’m not so dehydrated and I handle heat alot better. I also don’t feel so out of breath all the time. My pulse is now is 75-80. I don’t need to take as much salt, since I think I get enough from my foods. I do notice if it is really hot out and I am sweating alot, I might do 1/4 tsp of sea salt and I am ok. For me I know I am taking too much sea salt when my legs cramp.
Have a Florinef success story? Send it via the STTM Contact below and we’ll get your story up to inspire others. Keep it short like those above.
For more technical reading:
- Renal Tubular Effects of Hydrocortisone and Aldosterone in Normal Hydropenic Man: Comment on Sites of Action: http://www.jci.org/articles/view/105042
- Renal impairment resulting from hypothyroidism: http://ckj.oxfordjournals.org/content/1/6/440.full
- How progesterone affects aldosterone: http://press.endocrine.org/doi/full/10.1210/jc.2006-1154