Misconceptions about Adrenals and treatment
“Opinions” are like flies–they are everywhere!!
Do this: don’t do that! This causes this: this causes that.
“Who do I believe? What do I follow?”
The following represent common misconceptions about Adrenal treatment and are followed by better information and facts based on years of patient experiences and wisdom.
MISCONCEPTION #1: It’s okay to guess and treat supposed low cortisol without doing saliva testing, or to treat based on blood testing.
Patients found out the hard way several years ago that blood testing does not give accurate results, whereas saliva testing fits their symptoms. Turns out that blood testing is measuring both bound and unbound cortisol (and only up to 15% of cortisol is in an unbound, biologically active state), so many patients will get a “high” blood result when in reality, they can be quite low at that time.
Second, patients learned repeatedly that they need to see what’s going on at four key times in a 24 hour period, which saliva gives. Those four results reveal what treatment might be best.
And we learned the hard way that treating based on NO testing whatsoever can be problematic, as we might be treating the wrong thing!! Some symptoms of high cortisol can be similar to symptoms of low!
MISCONCEPTION #2: You need to fix adrenals before starting Natural Desiccated Thyroid; you should only be on T3
In the early years of patient experiences, we thought that all patients should be on T3-only in the presence of low cortisol in order to prevent excess RT3. We were wrong. As discovered by many over the years, a large body of low cortisol patients can tolerate “low doses” of Natural Desiccated Thyroid (NDT), such as 1 1/2 grains or less, without a problem. There are a few exceptions and each person has to figure that out.
It’s also been proven false that thyroid patients should be on NO thyroid hormones when working on their low cortisol. Why? Because we discovered that the cortisol we give ourselves needs something to work with, and thyroid hormones is the something.
MISCONCEPTION #3: Adaptogens work for low cortisol
This is another area where patient experiences have been gold: herbal adaptogens may have made some patients feel a little better, but they have done little to nothing for those whose saliva cortisol results proved low cortisol. i.e. even after several months of adaptogen use, patients who had low cortisol…still had low cortisol. The same has been true with essential oils.
Instead, adaptogen use has been the most helpful for those with healthy adrenal function, but where there is quite a bit of stress in one’s life.
Also, some “adaptogens” seem more targeted to lower “high cortisol”, such as Holy Basil or PS.
MISCONCEPTION #4: Hydrocortisone (HC) use can cause Addison’s
In the majority of cases, Addison’s disease, or Primary adrenal insufficiency, is an autoimmune issue, not an “HC use issue”. And Addison’s is very rare. The damage caused by the autoimmune attack, specifically to the adrenal cortex, causes insufficient amounts of cortisol (and could also negatively affect the release of aldosterone and certain sex hormones). US President John F. Kennedy had Addison’s, as may have the English writer Charles Dickens.
Other causes of damage to your adrenals, and even more rare than the autoimmune issue, include:
- Excessive blood loss (after a difficult childbirth, for example)
- Tuberculosis infection
- Certain fungal infections
- AID’s complications
- Amyloidosis (excessive buildup of protein)
- Certain genetic defects
Sometimes, literature will propose that if a person used high pharmacological doses, such as prednisone for extended periods of time for asthma or bowel disease, that could theoretically cause an “Addison’s-like crisis”, but it’s quite rare, as well. Thyroid patients with proven low cortisol don’t use high pharmacological doses of HC, and most don’t use prednisone, either. That’s why Daily Average Temps are used—to find the physiological doses (those which simply meet the daily needs of one’s body), not high pharmacological doses. See Chapter 5 in the revised STTM book about DATS.
MISCONCEPTION #5: HC will permanently shut adrenals down or cause them to atrophy.
As mentioned above, informed thyroid patients with saliva-tested proven low cortisol don’t attempt to use high “pharmacological” cortisol meds or amounts. They use “physiological” amounts (the amount which meets the daily needs of one’s body functioning) found by doing Daily Average Temp taking (see Chapter 5 in the revised STTM book) and comparing those averages to find stability in temps, as explained by Dr. Rind. As a result, the feedback loop is still intact to some degree and the adrenals do not shut down or atrophy.
MISCONCEPTION #6: Low dose HC, such as 20 mgs or less, is perfectly adequate for most low cortisol patients.
To the contrary, if saliva cortisol testing proves one has some fairly low cortisol results (especially three or more times in a day), 20 mg and less has backfired and resulted in worsening problems like excess adrenaline and more. Why? When we give ourselves cortisol (and we think this starts by 10 mg and higher), the body decides to tone down the messaging feedback to the adrenals. So now your adrenals produce even less, and you are giving yourself a small amount on top of the suppression of the feedback loop. i.e. it’s “suppressing” more than “replacing” what your body needs, causing the body to be alarmed, and excessive adrenaline symptoms are the result.
Most studies show that low dose HC use is only meant for short-term use, and we know it’s only meant for issues much less problematic than we tend get.
To see what we’ve learned as far as starting and raising HC, study chapter 6 in the revised STTM book. With OTC Adrenal Cortex, we have to guess how much to start on, since the cortisol within the product is not measured.
MISCONCEPTION #7: If you start on HC, you will have to be on it for life
Very false, reveal the experiences of many low cortisol patients. Several patients who used HC correctly, and who are now adequately treating their low cortisol, low B12, low iron and more, are now off and have stayed off.
Those who haven’t been able to get off may have other issues continuing to stress their adrenal function, such as certain genetics, Lyme disease, chronic inflammatory issues, inadequate treatment of one’s hypothyroidism, etc. i.e. it’s not HC use which results in people not getting off; it’s the continuation of other issues.
Effects of long term glucocorticoid use on pituitary-adrenal responses use http://www.nejm.org/doi/pdf/10.1056/NEJM199201233260403