@misseschris 709 wrote:

First a brief rundown. Pretty much my whole adult life has been influenced by ‘adrenal issues’. I was diagnosed over 30 years ago by a forward thinking psychiatrist with adrenal insufficiency. I was at that time suffering from fatigue, depression and a feeling of spaceyness that never went away for 5 years. This doctor treated me with adrenal cortex extract IV and numerous nutritionals. I became much better and had a relapse 20 years ago when I had my twins. Again he got me on the right track and I was well until 3 and a half years ago when I reached menopause.

I was finally diagnosed with Hashimotos and low adrenals.

I haven’t been able to tolerate thyroid meds and stared following recommendations found on the internet forums regarding hc. I did not do well on hc, had constant stomach pain and could not sleep with adrenal aching. I also continued to not be able to tolerate thyroid meds. I weaned off of hc and started working on my sex hormones.

I was terribly deficient in est/ prog as I was a long distance runner and went into menopause with very little body fat. I also had uterine hemorrhaging for 2 years before menopause, so I became very anemic.

As soon as I started bioidentical estrogen and then progesterone, I felt much better but still had lingering low cortisol issues and low thyroid issues- but still not tolerating thyroid meds.

I have been, over the past year or so been working on nutritional balancing and sex hormone balancing which has been a slow and tedious process. Saliva testing for cortisol have always shown normal or high morning cortisol and then basically petering out to nothing at night. Night time is when my worst low cortisol symptoms arise. I have worked out and adrenal support system for myself and would like some input. It is kind of unusual but seems to be working for me.

When I take any for of cortisol in the morning I feel worse and my ACTH drops very quickly causing me insomnia at night. I cannot titrate slowly like most people and need to jump to 10-15mg as my adrenals down regulate very quickly. Sooo, what I do is this:

I take liquid ACE first thing in the morning
Then I take it again at noon

Then I take 4 isocort at 5pm as this is when I feel my cortisol starting to fall
I then take 2 isocort at bedtime
Then I take 2 more isocort if I wake before 1:30 am- any later and I don’t take it as it will downregulate my adrenals and I will feel worse.

This seems so backwards to what I should be doing but it is the way I feel best. I still cannot tolerate much in the way of thyroid meds- I use a small amount of Nutrimeds thyroid.

My TSH, by the way runs between 6-10.

I also take:
Biest 2X day
Progesterone cream 1X day
Pregnenolone 50mg
DHEA 5mg trandermally
mag citrate 400mg
ubiquinol 100mg
selenium 200mg/ methionine form
liquid liver 2/day

ferritin 56

zinc 25mg
vitamin c 1000mg
cod liver oil – don’t tolerate D3 well
Methylcobalamin 500mg have trouble tolerating that sometimes
2 tsp sea salt in water

Question is do you think the way I am treating my adrenals is detrimental in the long run- taking higher doses of adrenal support later in the day. By the way I have no trouble sleeping on the isocort I take in the evening and at night, in fact it helps me sleep.

Wow! Your psychiatrist is very forward thinking. But then, the psychiatrists of the 40s and 50s and 60s thought adrenal issues and other endocrine issues were part of the pathophysiology of mental illnesses – particularly the mood and anxiety disorders. Unfortunately, this was forgotten once excessive focus on neurontransmitters became the vogue for too long in psychiatry. The development of neurotransmitter modulators – such as the antipsychotics and antidepressants – unfortunately were one of the factors that led to this trend. They were the first widespread and partially effective treatments for mental illness. I say partially because psychiatrists often forget how poorly they work on their own.

What is ACE? I am not familiar with your use of this acronym.

Realize that IsoCort is hydrocortisone wrapped in protein. Jonathan Wright, MD, who has his own mass spectrometer, checked out the hydrocortisone content of IsoCort and found it had 2.5 mg of Hydrocortisone per 5 mg tablet. The reason that IsoCort is more tolerable than Hydrocortisone, itself, particularly to women, is that hydrocortisone is a signal for acid production in the stomach. This leads to problems including gastritis and stomach pain.

Thus you are taking hydrocortisone when taking IsoCort.

When a person develops hypothalamic-pituitary-adrenal axis dysregulation, which lowers cortisol production, norepinephrine signaling may end up being high – particularly at night. One of the reasons norepinephrine signaling is highest at night, I suspect, is that a defensive behavioral program is being triggered by the immune system, via pro-inflammatory signals. Pro-inflammatory signals are also released by the brain when norepinephrine signaling is high. Norepinephrine is the primary signal for stress. The purpose of high norepinephrine signaling at night is to cause a person to be awake at night. This is an old program which may deal with watching out for predators at night. Unfortunately, this causes dysfunction in the modern world. Cortisol/hydrocortisone, is one of the control signals on norepinephrine. It breaks the norepinephrine positive feedback loop with CRH (Corticotropin releasing hormone), which tends to keep norepinephrine at high levels.

Generally, one of the reasons norepinephrine signaling is high is to compensate for impaired energy production that is caused by the lack of thyroid hormone production and impaired energy production that is caused by a deficit in iron stores (low ferritin level). Norepinephrine, itself, is not only a signal for distress and wakefulness, it is also a signal for energy.

Excessive norepinephrine signaling leads to an activation of the immune system via an increase in brain pro-inflammatory cytokine signaling and direct norepinephrine signaling to immune system cells, which then release more pro-inflammatory cytokine signals. This in turn triggers defensive programs in the brain. One of them leads to adrenal problems – via hypothalamic-pituitary-adrenal axis dysregulation.

Generally, I do not see improvement in adrenal function unless iron stores become optimized (e.g. in women this is a ferritin of about 100-120). Treatment with cortisol/hydrocortisone primarily is a bandage treatment when cellular metabolism, itself, is impaired by suboptimal iron stores.

When hypothalamic-pituitary-adrenal axis dysregulation is significant, thyroid treatment becomes intolerable. A TSH > 5 indicates a huge deficit in thyroid signaling. The problem is that so long as a thyroid signal deficit is present, norepinephrine signaling remains compensatorily high, and HPA Axis dysregulation continues. Generally, once adrenal function is supported adequately, thyroid treatment may be started. However, if metabolic-nutritional problems exist, they would have to be addressed first, before adrenal function can be restored. With significant adrenal signaling problems, Levothyroxine is a more tolerable solution than one containing T3.

In women, progesterone is an option for adrenal signaling support. It provides precursors for the other signals including cortisol. It also helps reduce norepinephrine signaling via its metabolites, such as allopregnenolone, which works by increasing GABA sensitivity in the nervous system. As such it provides multiple pathways to treating HPA Axis dysregulation.

An inability to tolerate Vitamin D3 is interesting. What are the side effects of taking D3?

@misseschris 761 wrote:

Thank you Dr. Mariano for you in depth reply. I’m sorry- ACE is just Adrenal Cortex Extract- similar to isocort but with only negligible amounts of cortisone. I use a liquid drops form. It ‘seems’ to remind the adrenals to secrete cortisone. I use this in the morning because using anything in the morning that contains hydrocortisone, eg: cortef, isocort, even licorice reduces my ACTH too much and really lowers my cortisone for the rest of the day, and especially at night- hence using isocort only later in the day.

I have had trouble tolerating Vit D3 and Vitamin B12, I believe, because they allow my thyroid to function better- and that, in turn, stresses my adrenals- I experience low adrenal symptoms with them. I have been tolerating small amounts lately due, I think, due to my increased isocort use.

I appreciate your comments regarding iron and ferritin levels. I do believe this has been an issue for a long, long time with me. One interesting aspect of supplementing iron for me, even when I was menstruating and hemorrhaging, is that the supplemental iron would cause skin infections. I felt that the iron, for some reason wasn’t getting into the cells. I have been using Liquid Liver lately and have not had this problem- possibly due to the other synergistic effects- eg: copper, B12, etc. naturally occurring in the liquid liver. I am focusing on really trying to get my ferritin up, as I do agree with you that using any type of cortisone is a bandaid approach- and in the case of ACE- very expensive!

Allergy Research makes a product called ‘Ferritin’- a bovine protein that seems to work for me as well, any thoughts on this avenue to help increase ferritin levels?

Thank you again for this amazing and much needed website.

Sincerely,Chris

Heme iron – iron from blood – is much, much, much easier to absorb than elemental iron.

One of my absolutely favorite foods is Dinuguan, a famous dish from the Philippines. It is a very sweet-tasting chocolate-colored pork stew made with pork, pork blood, vegetables. As a kid having a sweet-tooth, I would eat it up whenever I had a opportunity.

It is similar to the European-style blood sausage or British Black Pudding but in a stew form. It is also similar to an ancient Spartan dish known as Black Gruel.

If there is a Philipino Restaurant nearby, give it a try. I prefer the home-cooked Dinuguan.

Here is a description and recipe:

Dinuguan

Pork Dinuguan (also called dinardaraan in Ilocano, or pork blood stew in English) is a Filipino savory stew of blood and meat simmered in a rich, spicy gravy of pig blood, garlic, chili and vinegar.

The term dinuguan comes from the word dugo meaning “blood”. It is recognizably thick and dark, hence the Westernized euphemism “chocolate meat.” It is similar to the Singapore dish pig’s organ soup, differing in that it does not contain vegetables and has a characteristically thick gravy.

Due to the offal it is frequently considered an unusual or alarming dish to those in Western culture, though it is rather similar to European-style blood sausage, or British black pudding in a saucy stew form. It is perhaps closer in appearance and preparation to the ancient Spartan dish known as black gruel whose primary ingredients were pork, vinegar and blood. Dinuguan is often served with white rice or a Filipino rice cake called puto.

Estimated cooking time: 1 hour and 30 minutes

Ingredients:

• 1 k. of pork belly, cut into small cubes
• 350 g. of pork liver
• 4 c. of pig’s blood
• 3 chili peppers (siling haba)
• 1 head of garlic, crushed and minced
• 1 thumb-sized piece of ginger, minced
• 3 onions, halved and sliced thinly
• 1 pouch of sinigang mix good for 1 liter of broth
• 1 bay leaf
• salt
• pepper (optional)
• 1 tbsp. of cooking oil

Cooking Instructions:

• Refrigerate the pig’s blood until needed.
• Heat a heavy casserole.
• Pour in the cooking oil. When the oil starts to smoke, add the garlic and ginger.
• Saute until fragrant. Add the pork pieces and cook over high heat until the edges of the pork start to brown.
• Add the onions, chili peppers, bay leaf and sinigang mix and continue cooking until the onions are transparent.
• Season with salt and pepper, if using.
• Pour in just enough water to cover. Bring to a boil, lower the heat, cover and simmer for 30-45 minutes or until the pork is very tender.
• Add more water, a little at a time, if the liquid dries up before the pork is cooked.
• Meanwhile, minced the liver.
• Season with a little salt.
• When the pork is tender and most of the liquid has evaporated, take the pig’s blood out of the refrigerator.
• Transfer to a clean bowl. With you hands, mash solid masses to a pulp. Pour the mashed blood and the liquid into the casserole. Bring to a boil.
• Cook over medium heat, stirring, for about 5 minutes. Add the minced liver and cook for another minute or two.
• Add more salt if necessary.
• Serve the dinuguan hot with puto (sweet rice cakes) or steamed rice.

Seriously, if one wants to quickly raise ferritin quickly, this will do it better than an iron pill. And one would feel like one is eating real food, rather than a handful of pills.

Further, it does NOT cause constipation (a significant problem with iron pills).

For those who crave sweets, this is a very sweet delicacy.

Reference:

http://www.pinoyrecipe.net/filipino-pork-dinuguan-recipe-pork-blood-stew/

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What symptoms occur with Vitamin D and B12 supplementation? I am not really sure these are adrenal symptoms.

Realize that adrenal problems reflect problems in the nervous system and immune system when it comes to regulating adrenal cortex function.

In high density nutrition using traditional foods, occasionally eating organ meats is very useful to obtain nutrients. Liver is an excellent source of nutrients including the fat soluble vitamins. There was a time when eating liver was very popular. But people forgot how to cook it or it was never introduced into their diet by their parents. When nutrients are incorporated into real food (such as B12, A, D, and iron in liver), then problems with absorption and side effects, compared to supplement pills, are much reduced.

Cortisol treatment not only slows down ACTH production, it also reduces the production of Pregnenolone, Progesterone, Aldosterone, Testosterone, Androstenedione, Estradiol, etc. Perhaps the deficiency caused in these signals – many of which are calming – contributes to problems with Cortisol treatment.