Cortisol (Low levels often are called "adrenal fatigue")
Adequate levels of cortisol are essential to health and quality of life. Many studies have found
evidence of a hypoactive hypothalamic-pituitary-adrenal system in persons with fatigue, atypical
depression, fibromyalgia, and post-traumatic stress disorder. Moderate cortisol insufficiency is
completely ignored by conventional medicine; yet is very common. The symptoms are just
milder versions of those found in complete adrenal failure (Addison's disease). They include
fatigue, aches and pains, mental dysfunction, anxiety, allergies, frequent infections, low blood
pressure, low stress tolerance, hypoglycemia, frequent nausea, PMS/PMDD, excessive
sweating, and insomnia. 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 the metabolism of cortisol and thereby cause lower
cortisol levels. 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.
The problem of cortisol insufficiency is popularly known as "adrenal fatigue", but it usually does
not lie in the adrenal glands. It appears that 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 which is normal in cases of partial
secondary cortisol insufficiency. The best test of one's actual free serum cortisol levels
throughout a normal day is the diurnal salivary cortisol profile. This fact is being increasingly
recognized by conventional endocrinologists. Unfortunately, most doctors do not do saliva
testing throughout the day, and the ranges that most labs report have very low 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, DHEA is highly suppressed whenever one takes a steroid, yet
physicians never replace the DHEA. 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 does not produce signs or symptoms of
glucocorticoid excess and does not cause clinically significant adrenal suppression. 20mg of
oral hydrocortisone has far less glucocorticoid effect on bone than 5mg of prednisone (Jodar
03). Studies have shown that between 10mg and 40mg of hydrocortisone (the amount required
increases with body weight—Mah 04), does NOT cause bone loss, weight gain, elevated blood
sugar, elevated blood pressure, thinning skin, easy bruising, suppression of your immune
system, or even significant suppression of your ability to produce more cortisol when you need
it. (Jefferies 96, Wichers 99, McConnell 02, Danowski 1962). 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 steroidal and non-steroidal anti-inflammatory medicines doctors
prescribe every day (e.g. prednisone, methotrexate, Motrin®, Enbrel®, Mobic®, etc.). For those
who need it, it 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 important hormone. Interestingly, research shows that SSRI anti-
depressants (Prozac®, Paxil®, Lexapro®, etc.) act upon the brain to increase ACTH production
and cortisol levels. This may be one reason that they help alleviate many different kinds of
symptoms, and also why it is so hard to stop taking them.
Based on saliva cortisol results on hundreds of patients, Dr. Lindner has found that high
cortisol levels are actually quite rare--seen in just 1 to 2% 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 levels and effects;
including thyroid, estradiol, progesterone, and DHEA.
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. Many studies have found
evidence of a hypoactive hypothalamic-pituitary-adrenal system in persons with fatigue, atypical
depression, fibromyalgia, and post-traumatic stress disorder. Moderate cortisol insufficiency is
completely ignored by conventional medicine; yet is very common. The symptoms are just
milder versions of those found in complete adrenal failure (Addison's disease). They include
fatigue, aches and pains, mental dysfunction, anxiety, allergies, frequent infections, low blood
pressure, low stress tolerance, hypoglycemia, frequent nausea, PMS/PMDD, excessive
sweating, and insomnia. 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 the metabolism of cortisol and thereby cause lower
cortisol levels. 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.
The problem of cortisol insufficiency is popularly known as "adrenal fatigue", but it usually does
not lie in the adrenal glands. It appears that 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 which is normal in cases of partial
secondary cortisol insufficiency. The best test of one's actual free serum cortisol levels
throughout a normal day is the diurnal salivary cortisol profile. This fact is being increasingly
recognized by conventional endocrinologists. Unfortunately, most doctors do not do saliva
testing throughout the day, and the ranges that most labs report have very low 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, DHEA is highly suppressed whenever one takes a steroid, yet
physicians never replace the DHEA. 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 does not produce signs or symptoms of
glucocorticoid excess and does not cause clinically significant adrenal suppression. 20mg of
oral hydrocortisone has far less glucocorticoid effect on bone than 5mg of prednisone (Jodar
03). Studies have shown that between 10mg and 40mg of hydrocortisone (the amount required
increases with body weight—Mah 04), does NOT cause bone loss, weight gain, elevated blood
sugar, elevated blood pressure, thinning skin, easy bruising, suppression of your immune
system, or even significant suppression of your ability to produce more cortisol when you need
it. (Jefferies 96, Wichers 99, McConnell 02, Danowski 1962). 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 steroidal and non-steroidal anti-inflammatory medicines doctors
prescribe every day (e.g. prednisone, methotrexate, Motrin®, Enbrel®, Mobic®, etc.). For those
who need it, it 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 important hormone. Interestingly, research shows that SSRI anti-
depressants (Prozac®, Paxil®, Lexapro®, etc.) act upon the brain to increase ACTH production
and cortisol levels. This may be one reason that they help alleviate many different kinds of
symptoms, and also why it is so hard to stop taking them.
Based on saliva cortisol results on hundreds of patients, Dr. Lindner has found that high
cortisol levels are actually quite rare--seen in just 1 to 2% 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 levels and effects;
including thyroid, estradiol, progesterone, and DHEA.
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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