Cortisol Insufficiency (also called "adrenal fatigue")
Adequate levels of cortisol are essential to health and quality of life. This fact is becoming
increasingly clear to doctors who are trying to help people by natural scientific methods. In fact,
cortisol is the foundation of the entire endocrine system. All other major hormones except
testosterone, counteract cortisol. If a person does not make sufficient cortisol, they cannot
tolerate or benefit from the restoration of their thyroid, estrogen, or DHEA levels. By trying to
restore hormones in suffering patients, and by performing sensitive saliva tests of cortisol
levels, Dr. Lindner has learned that cortisol deficiency is common, especially among women.
This fact accounts for women's much higher incidences of fatigue, anxiety, depression,
fibromyalgia, and autoimmune diseases. Many studies have demonstrated a hypoactive
hypothalamic-pituitary-adrenal system in persons with these problems. Interestingly, research
shows that the SSRI anti-depressants (Prozac, Paxil, Lexapro, etc.) act upon the brain to
increase ACTH production and cortisol levels. This is probably the most important mechanism
by which they alleviate many different kinds of symptoms, and also why it is so hard to stop
taking them (cortisol withdrawal).
This common form of partial cortisol insufficiency is completely ignored by conventional
medicine. The symptoms are just milder versions of those found in complete adrenal failure
(Addison's disease). They include fatigue, aches and pains, brain fog, allergies, frequent
infections, low blood pressure, low stress tolerance, anxiety, irritability, hypoglycemia, frequent
nausea, PMS/PMDD, autoimmune diseases, excessive sweating, chronic conjunctivitis, and
insomnia. Cortisol helps maintain the blood sugar level throughout the day. Hypoglycemia
refers to a low blood sugar that occurs when one delays eating for more than a couple hours.
The low blood sugar causes irritability, confusion, headaches, hot flashes, sweating, and
palpitations. Hypoglycemia can also awaken a person from sleep at night. Cortisol insufficiency
is often unmasked when a person takes thyroid hormone. Higher thyroid levels increase both
the metabolism of cortisol and the need for cortisol, thereby suppressing cortisol levels and
effects. Higher estradiol and progesterone levels in the latter half of the menstrual cycle block
cortisol's effects in women; so low cortisol is often the cause of severe PMS/PMDD and of
intolerance of estradiol and progesterone replacement in menopause. Most of the symptoms
of PMDD are identical to those of moderate adrenal insufficiency. For those who need it, cortisol
supplementation improves mood, energy, mental functioning, sleep quality and the ability to
handle physical and emotional stress. It helps with allergies and autoimmune diseases. We
all need optimal levels of this foundational hormone.
The problem of cortisol insufficiency usually does not lie in the adrenal glands. The brain-
hypothalamic-pituitary system is simply not secreting enough ACTH throughout the day to
stimulate sufficient cortisol production in the adrenal glands. Physicians are unaware of the
existence this partial secondary cortisol insufficiency because the usual serum AM cortisol test
with its very broad "normal" range is insensitive--it will only detect the most severe adrenal
gland failure (Addison's disease). They also perform an unphysiological ACTH stimulation test,
injecting 250 times more ACTH than the body could ever make, and declaring the patient
"sufficient" if their adrenal glands make a certain amount of cortisol! This test is always normal
in cases of partial cortisol insufficiency. To diagnose any hormone deficiency, one has to look
at the actual free levels and effects of the hormone in the person throughout an average day.
For cortisol, the best way to do this is with a diurnal salivary cortisol profile. This fact is being
increasingly recognized by conventional endocrinologists. Unfortunately, most doctors do not
do saliva testing, and the ranges that most labs report have extremely low lower limits that are
incompatible with optimal health. So physicians have no way of seeing the low free cortisol
levels in their patients with fatigue, depression, hypoglycemia, and chronic pain. They also have
no experience with physiological cortisol replacement, but have a lot of experience with the
damaging effects of pharmacologic doses of powerful non-natural “steroids” (e.g. prednisone,
dexamethasone). They inappropriately generalize this negative experience and are afraid to
prescribe cortisol long-term in physiological doses to restore optimal levels to those who need
it. They wrongly believe that any dose of cortisol taken long-term will cause Cushing's
syndrome. In addition, they suppress a patient's DHEAS levels whenever they prescribe a
"steroid", not realizing that they have created a severe deficiency of a major anabolic hormone.
DHEA is the body's natural cortisol antagonist and prevents many of the negative effects of
excess cortisol. Again, it's another example of the use and misuse of pharmaceutical hormone
substitutes causing doctors to overlook the benefits and safety of balanced hormone
restoration.
Low-dose physiological cortisol supplementation accompanied by DHEA does not produce
signs or symptoms of glucocorticoid excess. Conventional replacement doses for Addison's
disease patients are 20 to 35mg/day. However, higher cortisol doses are needed in persons
who are replacing their DHEA, and are taking thyroid hormone as both of these suppress
cortisol levels and effects in the body. Cortisol supplementation, optimized to the lowest dose
that provides full clinical benefit, and combined with DHEA replacement, is just good medical
practice. It is more effective and far safer for inflammatory conditions than the alien "steroids"
and non-steroidal anti-inflammatory medicines doctors prescribe every day (e.g. prednisone,
methotrexate, Motrin®, Enbrel®, Humira®, Mobic®, etc.).
Based on saliva cortisol results on hundreds of patients, Dr. Lindner has found contrary to
common thinking, high cortisol levels are quite rare--seen in just 1% of patients seeking his
care. In persons with high cortisol levels, besides advising reducing the stresses that are
causing the high levels, Dr. Lindner restores the hormones that counteract cortisol; including
thyroid, DHEA, estradiol, and progesterone.
A person who requires cortisol supplementation to function and feel well didn't make enough
cortisol prior to therapy, and will most likely make less cortisol in response to stress when they
are taking cortisol due to the suppression of their own cortisol production. Therefore every
person on long-term cortisol replacement should take additional cortisol when ill and prior to
stressful activities. They should also wear some easily-noticed medical alert jewelry stating
that they have "Adrenal Insufficiency". There are many options today, including USB drives that
contain all relevant medical history. See this site for examples. The medical alert jewelry will
prompt medical care providers to look for a medical card. So patients should also carry a
medical card containing the diagnoses, personal identifying information, doctor's names and
contact numbers, and medications. One can create a medical card online. Patients can obtain
an emergency treatment card with specific recommendation for doctors here.
Recommended Reading:
Safe Uses of Cortisol by William Mck. Jefferies, M.D Website
Adrenal Fatigue by James Wilson, N.D., Ph.D Website
Adequate levels of cortisol are essential to health and quality of life. This fact is becoming
increasingly clear to doctors who are trying to help people by natural scientific methods. In fact,
cortisol is the foundation of the entire endocrine system. All other major hormones except
testosterone, counteract cortisol. If a person does not make sufficient cortisol, they cannot
tolerate or benefit from the restoration of their thyroid, estrogen, or DHEA levels. By trying to
restore hormones in suffering patients, and by performing sensitive saliva tests of cortisol
levels, Dr. Lindner has learned that cortisol deficiency is common, especially among women.
This fact accounts for women's much higher incidences of fatigue, anxiety, depression,
fibromyalgia, and autoimmune diseases. Many studies have demonstrated a hypoactive
hypothalamic-pituitary-adrenal system in persons with these problems. Interestingly, research
shows that the SSRI anti-depressants (Prozac, Paxil, Lexapro, etc.) act upon the brain to
increase ACTH production and cortisol levels. This is probably the most important mechanism
by which they alleviate many different kinds of symptoms, and also why it is so hard to stop
taking them (cortisol withdrawal).
This common form of partial cortisol insufficiency is completely ignored by conventional
medicine. The symptoms are just milder versions of those found in complete adrenal failure
(Addison's disease). They include fatigue, aches and pains, brain fog, allergies, frequent
infections, low blood pressure, low stress tolerance, anxiety, irritability, hypoglycemia, frequent
nausea, PMS/PMDD, autoimmune diseases, excessive sweating, chronic conjunctivitis, and
insomnia. Cortisol helps maintain the blood sugar level throughout the day. Hypoglycemia
refers to a low blood sugar that occurs when one delays eating for more than a couple hours.
The low blood sugar causes irritability, confusion, headaches, hot flashes, sweating, and
palpitations. Hypoglycemia can also awaken a person from sleep at night. Cortisol insufficiency
is often unmasked when a person takes thyroid hormone. Higher thyroid levels increase both
the metabolism of cortisol and the need for cortisol, thereby suppressing cortisol levels and
effects. Higher estradiol and progesterone levels in the latter half of the menstrual cycle block
cortisol's effects in women; so low cortisol is often the cause of severe PMS/PMDD and of
intolerance of estradiol and progesterone replacement in menopause. Most of the symptoms
of PMDD are identical to those of moderate adrenal insufficiency. For those who need it, cortisol
supplementation improves mood, energy, mental functioning, sleep quality and the ability to
handle physical and emotional stress. It helps with allergies and autoimmune diseases. We
all need optimal levels of this foundational hormone.
The problem of cortisol insufficiency usually does not lie in the adrenal glands. The brain-
hypothalamic-pituitary system is simply not secreting enough ACTH throughout the day to
stimulate sufficient cortisol production in the adrenal glands. Physicians are unaware of the
existence this partial secondary cortisol insufficiency because the usual serum AM cortisol test
with its very broad "normal" range is insensitive--it will only detect the most severe adrenal
gland failure (Addison's disease). They also perform an unphysiological ACTH stimulation test,
injecting 250 times more ACTH than the body could ever make, and declaring the patient
"sufficient" if their adrenal glands make a certain amount of cortisol! This test is always normal
in cases of partial cortisol insufficiency. To diagnose any hormone deficiency, one has to look
at the actual free levels and effects of the hormone in the person throughout an average day.
For cortisol, the best way to do this is with a diurnal salivary cortisol profile. This fact is being
increasingly recognized by conventional endocrinologists. Unfortunately, most doctors do not
do saliva testing, and the ranges that most labs report have extremely low lower limits that are
incompatible with optimal health. So physicians have no way of seeing the low free cortisol
levels in their patients with fatigue, depression, hypoglycemia, and chronic pain. They also have
no experience with physiological cortisol replacement, but have a lot of experience with the
damaging effects of pharmacologic doses of powerful non-natural “steroids” (e.g. prednisone,
dexamethasone). They inappropriately generalize this negative experience and are afraid to
prescribe cortisol long-term in physiological doses to restore optimal levels to those who need
it. They wrongly believe that any dose of cortisol taken long-term will cause Cushing's
syndrome. In addition, they suppress a patient's DHEAS levels whenever they prescribe a
"steroid", not realizing that they have created a severe deficiency of a major anabolic hormone.
DHEA is the body's natural cortisol antagonist and prevents many of the negative effects of
excess cortisol. Again, it's another example of the use and misuse of pharmaceutical hormone
substitutes causing doctors to overlook the benefits and safety of balanced hormone
restoration.
Low-dose physiological cortisol supplementation accompanied by DHEA does not produce
signs or symptoms of glucocorticoid excess. Conventional replacement doses for Addison's
disease patients are 20 to 35mg/day. However, higher cortisol doses are needed in persons
who are replacing their DHEA, and are taking thyroid hormone as both of these suppress
cortisol levels and effects in the body. Cortisol supplementation, optimized to the lowest dose
that provides full clinical benefit, and combined with DHEA replacement, is just good medical
practice. It is more effective and far safer for inflammatory conditions than the alien "steroids"
and non-steroidal anti-inflammatory medicines doctors prescribe every day (e.g. prednisone,
methotrexate, Motrin®, Enbrel®, Humira®, Mobic®, etc.).
Based on saliva cortisol results on hundreds of patients, Dr. Lindner has found contrary to
common thinking, high cortisol levels are quite rare--seen in just 1% of patients seeking his
care. In persons with high cortisol levels, besides advising reducing the stresses that are
causing the high levels, Dr. Lindner restores the hormones that counteract cortisol; including
thyroid, DHEA, estradiol, and progesterone.
A person who requires cortisol supplementation to function and feel well didn't make enough
cortisol prior to therapy, and will most likely make less cortisol in response to stress when they
are taking cortisol due to the suppression of their own cortisol production. Therefore every
person on long-term cortisol replacement should take additional cortisol when ill and prior to
stressful activities. They should also wear some easily-noticed medical alert jewelry stating
that they have "Adrenal Insufficiency". There are many options today, including USB drives that
contain all relevant medical history. See this site for examples. The medical alert jewelry will
prompt medical care providers to look for a medical card. So patients should also carry a
medical card containing the diagnoses, personal identifying information, doctor's names and
contact numbers, and medications. One can create a medical card online. Patients can obtain
an emergency treatment card with specific recommendation for doctors here.
Recommended Reading:
Safe Uses of Cortisol by William Mck. Jefferies, M.D Website
Adrenal Fatigue by James Wilson, N.D., Ph.D Website
For Health and Quality of Life
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