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My understanding of treating adrenal fatigue

Discussion in 'Adrenal Dysfunction' started by heapsreal, Apr 17, 2012.

  1. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    I have had a few trials of treating adrenal fatigue from different angles and different doses. Im starting to notice a benefit from treating adrenal fatigue but i have also been treating other ongoing issues but i thought i would list a few things that i have found through my experience as well as from what i have read. First i will say that i think adrenal fatigue can be measure by low dhea levels and or low cortisol.

    The worse your adrenals are the more likely to have an adverse reaction to treating them with 'normal' recommended doses of adrenal hormones etc

    I also think one has to start with slowly increasing dhea levels first before trying to increase cortisol through use of pregnenolone or hydrocortisol or glandulars. I currently have my dhea to a normal level and now when i use a small amount of pregnenolone that i have in the past, i dont get overstimulated by it like i once did. I think dhea helps counteract any negative aspects of increased cortisol levels one might get from pregnenolone. I found before having normal dhea i would get over stimulated by even low doses of preg, this doesnt seem to be happening now.

    Transdermal creams i think at the same dose are stronger then dhea or pregnenolone in pill form but not neccessarily better, maybe it works through a different pathway or metabolised differently.

    In men dhea can change/aromatise to estrogen so sometimes another product is need to stop this. I found low doses of arimidex very effective for this at 1/2mg twice a week. Men do better off keeping estrodiol levels within the lower 1/3 of the range. This also helps with losing weight.

    Most info on dhea refers it to a hormone that is used to make testosterone or estrogen. I think it has other aspects in its own right that arent really known. I think it helps with negative effects one can get from cortisol. And i also think it can help improve sleep through lowering inflammatory cytokines that are known to worsen sleep. I have been able to reduce my sleep med doses and i seem to be getting a better quality of sleep, i still get the odd bad night but on average things are improving in the sleep department. Also feel stamina has improved some.

    Normal recommended doses of dhea and pregnenolone are around 25-50mg per dose. I think many of us need to start at 5-10mg of dhea and slowly increase this until dhea levels are at the middle or upper third of normal range, then look at adding pregnenolone in doses of 5-10mg maybe upto 25-50mg depending on how one feels and what tests show. Once i was on the right track i started supplementing with dhea at 10mg a day and stayed at this dose for several weeks before increasing it to 20mg and stayed there for a few months and i am now on 25mg a day of dhea for the past few weeks. This has brought my low dhea level up from 2.1 to 7.1(normal 2.2-15.5). So i have increased my dhea dosage very slowly, in the past i have started at 50mg and ended up overstimulated and feeling like crap.

    Now i plan on trying to increase my cortisol levels abit more with pregnenolone to help with inflammation and joint pains from this. I have been using a dose of less then 5mg a day with no overstimulation like in the past, actually no changes at all but this could be because of the very low doses, but slow and steady wins the race. I feel dhea is helping reduce any problems with preg/cortisol. Im not sure how higher dose of preg i will go, at this stage just enough to help joint pains, crunching feeling like sand in my joints eases up. I think this will also help improve energy and recovery levels and hopefullly my immune function as i would like to be able to come off antivirals and antibiotics one day and i need my body top be running smoothly.

    I will say that this is still a work in progress and improvement has also come from antivirals and antibiotics for sinus issues. I dont think i could really single one thing out. Normally i would be wiped out when my working week is over and usually with a sick day taken amongst it, my days off would be spent doing nothing but resting in bed. Now when on days off i have been able to get into a few thinks that need doing around the house, also doing some very short, light workouts. Im not pushing myself to the limits but i am slowly expanding my boundaries.

    I think treating adrenal fatigue is apart of the puzzle of cfs that can help us to improve, married up with infection killing and immune boosting therapies as well as symptom management like sleep meds etc

    cheers!!!
  2. K2 for Hope

    K2 for Hope ALways Hoping

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    Should dhea be taken at bedtime?
  3. richvank

    richvank Senior Member

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    Hi, heapsreal.

    I appreciate reading about your experience with using DHEA first. I note that this agrees with Dr. Neil Nathan's approach, as discussed in his book "On Hope and Healing for Those Who Have Fallen Through the Medical Cracks." In fact, healing the adrenal glands is one of what he calls the "big six" issues, and in fact, it's the first one he considers, and he treats it with DHEA.

    Best regards,

    Rich
  4. madietodd

    madietodd Senior Member

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    Good timing! I've just added a new level to my adrenal support program. I was being lazy and depending on supplements: drenamin (http://www.standardprocess.com/display/StandardProcessCatalog.spi?ID=620) and adrenal response (http://www.innateresponse.com/product-p/40095.htm), which help a lot, but can't compensate for the chocolate that is the foundation of my diet.

    So I've gone back through Wilson's book (http://www.adrenalfatigue.org/), and am following his simple recommendations, including what to eat, and how frequently.

    He talks about DHEA in the book:

    "Approximately 25mg to 200mg is the accepted and normal dosage range for men [who test low]. Typically older men need more than younger men.... People often see improvement within 2-3 weeks of beginning DHEA. Be careful of overdosing...more than 200mg for men can create hostility....

    It is my clinical experience that women often do not do well on DHEA unless their adrenals are very fatigued. Levels as low as 10-25mg have produced symptoms of excess...."

    He advises women to take progesterone or pregnenolone...."althoughsome studies of women with chronic fatigue syndrome have found benefit from using 200mg of DHEA/day."

    I take 7mg/day. Since I started it at the same time as the adrenal supplements, I have no idea if it's helping. My doctor said to take it before bed, but if I found it energizing, switch to the morning.
  5. nanonug

    nanonug Senior Member

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    Unless you do some extra testing, you don't know if the problem is with the adrenal glands themselves (primary adrenal insufficiency) or with another portion of the HPA axis (secondary adrenal insufficiency). Addressing the adrenal glands, therefore, might be a stopgap measure but won't deal with the root cause. Challenging the adrenal glands with ACTH is the way to determine adrenal gland issues.
  6. adreno

    adreno 3% neanderthal

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    In my opinion, adrenal fatigue is nonsense. There is no evidence of it anywhere in the medical literature.

    On the other hand, there is pretty good evidence of the opposite, namely that the adrenal glands do not "tire". In Cushing's syndrome, the glands keep pumping out massive amounts of hormone for a lifetime.

    As nanonug says, if you pass a ACTH stim test, your adrenal glands are fine.
  7. alex3619

    alex3619 Senior Member

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    I am not sure about adrenal fatigue. I think adreno has valid concerns on the science. We do know however that there are problems with systems that depend on adrenaline - regulation, receptors and energy systems. That does not mean the treatments do not work. Clearly they do. It means there is doubt that the theory on which the treatments are based is accurate. I am also not sure about long term consequences, except I know of a few on DHEA who have had very long term improvement.

    Having said that there IS some evidence of adrenal damage in CFS. There was an old study (does anyone have a link?) where they measured the adrenal glands in CFS. They are shunken in about half of us. This is unlikely to be adrenal fatigue however. This is more likely to be simple biology - we are not using our adrenals, so they shrink. This could be an over-simplistic interpretation by me however: we simply do not know enough to say anything definitively. The reason the science has so little relevant data is there is so little relevant research. Its a black hole in medical knowledge.

    Bye, Alex
  8. madietodd

    madietodd Senior Member

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    Well, it's like a lot of stuff I try. If it makes a sustained difference I can directly trace to the new supplements, I don't care what the problem is called.

    My mom and sisters don't believe CFS is real. That's OK.
  9. garcia

    garcia Aristocrat Extraordinaire

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    I don't disagree. "Adrenal fatigue" is really just a shorthand (admittedly lazy) way to summarize the HPA-axis dysfunction that we have. However as you point out its an inaccurate description, since the problem lies not with the adrenals per se, but with the Hypothalamus / Pituitary. Also "adrenal fatigue" seems to imply all we need to do is replace abnormally low hormonal output. Whilst some of us do have abnormally low hormones, fixing our endocrine problems is not as straightforward as merely supplementing the missing hormones for many of us.

    I have low levels of both cortisol & dhea, however my adrenals are capable of producing great amounts of cortisol given certain treatments. However that state feels even worse (& even more pathological) than my normal low hormone state.

    IMHO HPA-axis dysfunction (along with excessive inflammation) is the bte noire of ME recovery.
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  10. xrunner

    xrunner Senior Member

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    I never had much luck with adrenal "fatigue" protocols. The Wilson's programme caused me to crash badly, most of his supplements felt like stimulants. DHEA makes me feel slightly better but gives me heart flutters after a while.

    And I don;t seem to be alone http://www.raysahelian.com/dhea.html

    In my case inflammation is directly linked to the problem. Anti-inflammatory herbs have the best effect on my hormones and sense of well-being without the uncomfortable side-effects of adrenal stimulants.
    garcia likes this.
  11. adreno

    adreno 3% neanderthal

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    The problem with assigning blame to the glands, is that treatment is then geared towards treating the wrong end of the HPA axis.

    Taking DHEA or Pregnenolone might help with symptoms, but is basically just hormone replacement. I haven't seen any evidence that they correct HPA axis dysregulation, or increase cortisol output, which is the main adrenal hormone that everyone here wants more of.

    Vitamin C and B5 also do not increase cortisol output. Licorice will prevent some breakdown of cortisol, but has other nasty side effects.

    Anyway, since the problem is that the HPA axis is essentially downregulated, anything that increase cortisol output from the glands, will likely result in even further downregulation, due to feedback mechanisms.

    The key to "fixing" the problem is to normalize the CRH and ACTH signaling, in the hypothalamus and pituitary. But the thing is that especially CRH release is determined by a vast interplay of neurotransmitters, hormones and cytokines.

    The compounds with the most evidence for normalizing HPA axis activity are SSRIs. Also curcumin has some evidence of doing this. None of them fully restore HPA axis capability, though.

    Also, we do not really know if HPA axis downregulation is a cause or an effect. Though cortisol is anti-inflammatory, it will also cause viral infections to proliferate.

    Personally, after following Wilson's advice, and taking adrenal extracts, I developed bad dysautonomia after about six weeks. I don't know why, either it further dysregulated my HPA axis, or it caused my latent herpes infection to reactivate. My personal theory is the latter, as herpes virus antibodies has been shown to occupy muscarinic acetylcholine receptors and cause dysautonomia.

    I suspect that the immune system "trumps" the endocrine system, and that once the immune system is normalized, the HPA axis will be also. I also believe we cannot normalize the HPA axis without normalizing the immune system.
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  12. Ema

    Ema Senior Member

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    I totally disagree with this statement. The ACTH stim test is very good at detecting those with primary adrenal insufficiency but misses almost half of those with secondary adrenal insufficiency. Any test that misses almost half of the people who have a condition is a test that sucks in my opinion and should not be relied on as an exclusive measure of adrenal status.

    I actually think those of us with ME/CFS have a variation of HPA dysfunction that is not well described by the literature but more closely resembles secondary. Not very many people with ME/CFS will be able to identify their adrenal issues by an ACTH stim test and treatment will be missed causing patients to suffer. A saliva cortisol test is the best stopgap measure to determine free cortisol levels and is what most educated doctors use in their practice with patients not suspected of autoimmune Addison's disease.

    Back in the 1940s, doctors became frightened away from steroids based on side effects from super doses given to patients. Some sort of agreement was made to only treat adrenal issues in those with frank Addison's disease (or total failure of the adrenal glands). But now we know better - that it is illogical to assume that the glands either work perfectly or do not work at all. No one assumes that the pancreas would work like this - so why the adrenals? Not treating endocrine dysfunction based on antiquated knowledge amounts to malpractice in my opinion. But unfortunately the research will likely not improve in this area until there is a patentable drug available to market by a pharmaceutical company.

    Endocrine dysfunction is rampant in ME/CFS and to suggest that it shouldn't be treated appropriately with hormones including cortisol, DHEA and Florinef when necessary is ludicrous in my opinion. Many people (including myself) have had dramatic improvements when treating the hormone part of the puzzle. It's not easy and it is easy to make mis-steps in getting the form and dosing correct, but it can be done and the effects can be nothing short of miraculous.
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  13. nanonug

    nanonug Senior Member

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    That is my opinion, too (on both counts). Thank you for stating it so eloquently! :)
    garcia likes this.
  14. Ema

    Ema Senior Member

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    I agree that this is a worthy goal but a little hard to do in practice given the current knowledge base! In the meanwhile, the only way for many of us to get appropriate levels of hormones is through end hormone replacement.

    But at what cost? SSRIs come with a myriad of nasty side effects. And my understanding is that most SSRIs don't "normalize" HPA activity but rather increase cortisol by increasing serotonin. This may work temporarily but most people are left worse off and then addicted to a drug that is difficult at best and sometimes impossible to later discontinue without suffering terrible withdrawal symptoms.

    Cortisol is the heart of the immune system. One cannot fight infections at all without enough cortisol. During times of infection, the body produces vast amounts of cortisol to defeat viral or bacterial invaders. This is why those on HC have to stress dose up to twice their normal cortisol dose during times of illness. One has no hope in my opinion of ever getting rid of a chronic viral infection with less than optimal levels of cortisol...levels that may not be achievable using adrenal extracts or herbs but physiological doses of HC that do not carry the side effects of a typical (large) pharmacological dose.
  15. SaraM

    SaraM Senior Member

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    I put 50 mg Dhea under my tongue before bed, and take 25-50 mg pregnenolone in the morning, but I probably need to lower my dose.Have been taking these two for less than a month. Dhea in the morning makes me tired and dizzy, but it stopped my nightly palpitations. I have heard oral intake of hormones may enlarge the liver. Had an abdominal scan last week and they found some liver foci . Now doc wants to do a MRI. I was just taking some progesterone for a couple of months and I do not know if it caused the liver foci.A lot of the info in the following link applies to my CFS case:

    http://www.richardweinsteindc.com/disorders.htm#Irritable Bowel Syndrome, Ulcers, and Colitis:


    I have low Dhea and cortisol, although I passed adrenal challenge test and have enough ACTH in my system.



    Maddie, why Dr. wilson is against using dhea for women? How much pregnenolone one must take based on his book?


    Xrunner, what anti inflammatory herbs are helping you with your hormones?
  16. rlc

    rlc Senior Member

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    Hi nanonug, RE Unless you do some extra testing, you don't know if the problem is with the adrenal glands themselves (primary adrenal insufficiency) or with another portion of the HPA axis (secondary adrenal insufficiency). Addressing the adrenal glands, therefore, might be a stopgap measure but won't deal with the root cause. Challenging the adrenal glands with ACTH is the way to determine adrenal gland issues.

    Completely agree an ACTH stimulation challenge must be done on all patients with low cortisol. Low cortisol results are found in a large number of different conditions, I have noticed across CFS sites on the internet that having low cortisol is being said to be proof of having CFS, this is based on some studies that have shown this finding in some CFS patients, however a lot of this research has been based on mixed cohorts.

    This belief that low cortisol means the patient has CFS and that it should be treated with a variety of supplements has the potential to be extremely dangerous and even fatal if all other conditions that can cause low cortisol have not been ruled out first.

    Low Cortisol is listed as being caused by 47 different conditions see http://en.diagnosispro.com/differential_diagnosis-for/cortisol-lab-decreased/11102-153.html

    A lot of these conditions do get misdiagnosed as CFS because of the similarity of symptoms to those attributed to CFS, Patients not only need an ACTH stimulation test to help differentiate between primary, secondary and tertiary adrenal failure, other tests such as ACTH blood test and aldosterone blood test, and CRH need to be measured, there is a good graph on this site that explains what the results of these tests mean http://en.wikipedia.org/wiki/Adrenal_insufficiency Patients may also need scans such as CT and MRI to find the large variety of tumors that can cause low cortisol, there are also conditions like Hemochromatosis, Amyloidosis and Sarcoidosis that need to be ruled out.

    Unfortunately most of these conditions are not generally known, or if they are, there very poorly understood by the average GP, and good specialists are needed to diagnose almost all of the conditions that cause low cortisol.

    If anyone has low cortisol they need to make sure that all these conditions listed have been properly ruled out, taking supplements may provide some relief from these conditions but they will never cure them, however most of these conditions can be cured by other medical treatment, but a lot of them if they are not treated properly slowly progress to being fatal.

    So please everyone with low cortisol results make sure that all the other possible conditions that can cause low cortisol are properly ruled out before assuming that it is caused by CFS.

    All the best
  17. Sallysblooms

    Sallysblooms P.O.T.S. now SO MUCH BETTER!

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    I use 7 Keto DHEA. No problems with that. Pregnenalone is wonderful. I get hormones tested twice a year. My doctors have all bases covered for me.
  18. alex3619

    alex3619 Senior Member

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    Hi adreno and nanonug, this is close to my current working hypothesis. If Rituximab works, if it can be validated to be completely restorative in even a minority of patients, and temporarily restorative in the majority of patients, then the symptomology is B cell mediated. These B cells pump out an array of cytokines and probably some self targeted antibodies. If patients recover as we have been led to believe by the phase 2 clinical trial, then it follows that neurological issues must be restored following treatment of the immune system. Even if the issue is B cell carried infection (e.g. herpes viruses) this reasoning still follows.

    The only quandery about this is what is stopping the one third of non-responders from improving? Is it a dosage/protocol issue as some suggest? Is it due to comorbid conditions or other complications? Are these people suffering from a different condition with similar symptoms? Do these patients have serious spine or brain lesions that are resistant to healing? Or is there some other reason?

    This doesn't mean we shouldn't treat the hormone deficiences though, only that we should not expect too much from such treatment. It most probably will not be curative.

    Bye, Alex
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  19. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    I agree with you adreno that its not in the glands themselves but discussing that is another thread, i believe its a signalling problem in the HPA axis but people who have this problem will test low for dhea and or cortisol, some might just test low within the normal range which i dont think for many is optimal.
  20. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    Theres been no proof that dhea or pregnenolone cause a negative feedback problem, hydrocortisone maybe but i dont have any personal experience with it. Antidepressants for HPA problems doesnt seem to work in CFS as many just cant tolerate them.
    If you produce too much cortisol or supplement with too much hydrocort then you probably will supress your immune system but also have low cortisol levels can do the same thing, its not about cortisol being either good or bad, we need the right amount.

    The immune system trumps the endocrine, im not about saying one is better or stronger then the other, i have mentioned that its a combination of things that have helped, adrenal hormones, treating infections and immune system.

    it sounds like u havent had a good experience with trying to treat this, maybe its not an issue for u but its helped a few people. LIke i said, i have attacked it from a few different angles until i found what worked for me.

    cheers!!!

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