adrenal recover

[Jean]

Dear Doctor,

Do you think that people who have hypothyroidism since many year’s recover from adrenal fatigue ?

I think it’s impossible.

When I begin HC, I feel little better and sometimes when I forget my HC caps for one day I don’t feel bad t all. Sometimes, when I wake up the morning I feel OK depiste I forget my HC caps.

At this times, 7 year’s on HC, I don’t feel well when I wake up. I need to wait 45 mn after my cortisol dose to feel good. I I forget my HC dose I feel bad.

My adrenal fatigue is more severe than before.

What wrong with this treatment, because Jefferies saidthat low dose HC doesn’t lower your internal production but help to heal adrenal. I disagree with Dr Wilson about adrenal fatigue.

I known many people like me that don’t recover from this ” adrenal fatigue”, may be it’s a real adrenal insufficiency.

[DrMariano2]

@Jean 701 wrote:

Dear Doctor,

Do you think that people who have hypothyroidism since many year’s recover from adrenal fatigue ?

I think it’s impossible.

When I begin HC, I feel little better and sometimes when I forget my HC caps for one day I don’t feel bad t all. Sometimes, when I wake up the morning I feel OK depiste I forget my HC caps.

At this times, 7 year’s on HC, I don’t feel well when I wake up. I need to wait 45 mn after my cortisol dose to feel good. I I forget my HC dose I feel bad.

My adrenal fatigue is more severe than before.

What wrong with this treatment, because Jefferies saidthat low dose HC doesn’t lower your internal production but help to heal adrenal. I disagree with Dr Wilson about adrenal fatigue.

I known many people like me that don’t recover from this ” adrenal fatigue”, may be it’s a real adrenal insufficiency.

The answer to your question is YES.

I use the term “hypothalamic-pituitary-adrenal axis dysregulation” these days instead of the term “adrenal fatigue” to better describe what is occurring.

The bulk of my practice generally involves seeing the most severely ill people with complicated illnesses, under extreme daily and often past traumatizing stress. Living, itself is difficult because many of my patients are either homeless, malnourished, living in poverty, under dangerous circumstances, with lack of family support, suffer abuse, are victims of crime, or have some combination or all of the above. And most if not all of them would die by the time they are between 50-60 years old with the usual psychiatric and physical health interventions. Hypothyroidism and HPA Axis Dysregulation occur in the vast majority of my patients. It is what I deal with day in and day out. Once a person develops a mental illness, I know that it takes multisystem failures to cause it.

The fact that one can even post to this forum means one is not as ill as most of the people I treat.

Once I began practicing a highly integrated form of medicine – combining psychology, psychiatry, neurology, endocrinology, immunology, metabolism, and nutrition – with my patients, I became very happy with the results I see. My patients, in general, have improved better than I could accomplish with conventional treatments. And, yes, I would say, the majority recover from HPA Axis dysregulation, and the others are in a recovering state, where the full pathophysiology is not yet addressed.

Note that HPA Axis Dysregulation is a prerequisite for destabilizing mood. Bipolar disorder, Depression, and anxiety disorders infrequently if not rarely occur without HPA Axis Dysregulation which causes impaired cortisol production.

Treatment with Hydrocortisone alone is a very incomplete treatment of HPA Axis Dysregulation.

When one has HPA Axis Dysregulation, the underlying pathophysiology involves problems with the nervous system, endocrine system, immune system, metabolism and nutrition. It is a systemic problem. It has to be approached systematically at several levels. There are numerous vicious signaling circuits that are started, which makes the condition self-perpetuating.

The nervous system is often shifted to a stressed state – high norepinephrine, low dopamine, low serotonin, low GABA, high histamine, high pro-inflammatory cytokine signaling. Automatic defensive programs are activated in the nervous system, resulting in changes in sleep pattern, loss of energy, loss of motivation, changes in appetite, etc. The shift to a stressed state may be an uncovering of a naturally high stress nervous system or be a compensatory state for problems in the rest of the system. Most doctors don’t know how to treat the nervous system because they aren’t psychiatrists. One of my observations is that one often cannot optimize endocrine function with bioidentical hormone treatment without also addressing the nervous system when needed with nervous system treatments. One colleague, an internist, has learned to use some psychiatric medications (generally antidepressants, occasionally dopaminergic medications, occasionally sedatives) in addition to hormone and nutritional treatment. She achieves much better results than she would have if she only did hormone replacement and nutritional interventions. I told her she was doing psychiatry. She sends me the patients who need a more intense psychiatric treatment. As a psychiatrist, I have a much larger toolkit than she has.

The endocrine system may be off. Hypothyroidism over the long term forces the nervous system to compensate by shifting to a high stress state. This then forces the HPA Axis to become activated – until interactions with the immune system and the nervous system downregulate adrenal cortex cortisol and other cortex hormone production. The Renin-Angiotensin-Aldosterone system may be excessively active. Changes with aging may result in deficiencies such as hypogonadism, which impair control signaling over stress. Insulin resistance, which occurs immediately with increase norepinephrine signaling, leads to excessive insulin signaling, which depresses testosterone signaling, which leads to an increase in insulin resistance. Insulin resistance impairs nervous system function. It also may lead to, along with hypothyroidism, weight gain. Obesity leads to an increase in Leptin signaling – which is pro-inflammatory, as well as the release of pro-inflammatory cytokines from fat cells.

The immune system, generally, becomes overactivated. There is bidirectional communication between the immune system and nervous system and endocrine system. The increase in pro-inflammatory signaling and norepinephrine from the brain leads to more pro-inflammatory signaling from the immune system. Inflammatory reactions such as due to infection, lead to increased pro-inflammatory signaling. This can trigger more stress signaling, and trigger defensive nervous system programs – similar to instincts, but occurring at the autonomic, unconscious level.

Poor nutrition – which is the bulk of modern diets even those that seem nutritious – impairs metabolic function, which in turn impairs the reception of signals from the immune system, nervous system, and endocrine system. For example, iron deficiency or suboptimization, significantly impairs recovery of the HPA Axis. So long as ferritin levels are low, the adrenal can’t function well, no matter what the treatment. Low iron also forces a compensatory shift to a stressed nervous system. Suboptimal nutrition – including the lack of saturated fats and cholesterol in the diet, the lack of complex foods and highly dense nutritious meals – impairs metabolic function. Multiple areas in the world are minerally deficient – leading to minerally deficient vegetables. They look the same but don’t have the nutritional value of foods years ago. Fat soluble vitamin deficiencies are very frequent. Vitamin D deficiency is frequent – without Vitamin D, serotonin and dopamine signaling is impaired, insulin resistance worsens, etc. B-vitamin deficiencies prevent thyroid hormone from working.

These are just some of the physical aspects of HPA Axis dysregulation. There are complex interplays between the systems. The psychological and social aspects are another huge area to examine and treat.

When one sees the complex underpinnings of HPA Axis dysregulation – or “adrenal fatigue”, then one can see how Hydrocortisone treatment is only one limited aspect of treatment.

These days, in many patients, I often don’t even use hydrocortisone for treatment for severely ill patients. If anything, for many people it is too weak a treatment when there are much more pressing issues to address in the system. It can be very important, however, if trauma is present. Hydrocortisone and other glucocorticoids can be very effective in helping the brain avoid focusing on traumatic memories, and instead focus on the task at hand. In treating trauma, it is highly important to enable the person to compartmentalize and seal off traumatic memories in order to focus on the here-and-now. Traumatic memories only serve to overwhelmingly increase stress signaling, which sets up a domino effect on the entire system. Usually, patients with posttraumatic stress disorder have the lowest cortisol levels I see. Generally, when I see a cortisol below 5 (where ideally it should be around 17-20 in conventional units), I suspect posttraumatic stress disorder. PTSD can cause adrenal insufficiency.

Also, given the need to consider replacing also DHEA, Pregnenolone, Progesterone, Testosterone, Estrogen, Aldosterone when one does adrenal functional support treatment with hydrocortisone, one can also see that Hydrocortisone alone often can’t be done as monotherapy.

In closing, the whole system has to be considered when assessing “adrenal fatigue” in order to determine as much as possible, the systemic causes and the treatments for those causes. Only until this is done does recovery have a chance to occur.

One of the most important areas to start treatment is nutrition. It has to be optimized as much as one can afford in order to optimize cellular metabolism so hormones and other signals can work in the first place. This is why I recommend high density nutritious traditional diets – such as described in the book, Nourishing Traditions – a good starting point. If one can’t change the diet, supplements are needed. Supplements may be needed if the food itself is missing nutrients. If one can optimize nutrition first, it makes the rest of treatment much easier to accomplish.

[Jean]

Thank you for this great answer

I understand the complexity of the human physiology. I known that HPA dysregulation is so IMPORTANT.

Agribusiness and the food processing industry are powerful forces that have influenced high consumption of sugar, carbohydrates, unnatural toxic oils and fats, and other nutrient-devoid foods, toxins, and chemicals. That is because their main motivation is money!

They would have us convinced that we restrict our eating to only dead foods that have no nutritional value whatsoever, just so their pockets can be lined

I follow at this time, a good diet, llike the book that you speak- I Eat fat , esp saturated fat – coconut oil, butter, cream, , beef, lamb, goat, buffalo, etc.
I don’t overdo protein, just like % of ancestral culture
Healthy cultures around the world tend to consume roughly 10 to 20% of calories from protein:

Masai – 19%

Kitava – 10%

Tokelau – 12%

Inuit – 20%, according to Stefansson

Kuna – 12%
Sweden – 12%
United States – 15%
Human milk – 6%

I don’t eat poly Unsaturated Fats (just a low dose of PUFAs) and Trans Fats – they are present in most commercial mayonnaise, salad dressing, chicken fat, turkey fat, fried food, hydrogenated oil, etc. this fats can cause cancer, heart disease, immune system dysfunction, sterility, learning disabilities, growth problems and osteoporosis

My diet is /

Moderate protein intake from animal meats, cheese, eggs,
High intake of natural fats and oils.
moderate carbohydrates.

With this a good diet and good lifestyle and HRT, my CFS go down . I recover at 70 % my energy
Depiste a good diet I have no optimal Zinc, Iron, copper, vit E gamma (all are low)
My selenium is too high and my glutathion peroxidase & glutathion oxydé is high.

My fatigue come from to much mercury and lyme Who probably destroy the adrenal – I don’t known. I chelate with DMSA/R lipoic acid

I know that my residual fatigue go away when I take ritalin. I AGREE WITH YOU the importance fo the brain function and NERVOUS SYSTEM.

But the problem, after three day at 10 mg/day of ritalin, my brain NA is depleted and I’m worse than before (depress, more tired…)

I’ve trying to optmise my brain DA & NA with some tyrosine, deprenyl an B vitamins, but I improve only brain DA and not NA.

I don’t support any medication for depression like SSRI and NARI

I sure that my dysfunction come from brain NA. I explain why. If I take a inj of testo, the first day, my brain NA go up ,and I have a plenty of energy but just one day. If I take arimidex with T inj : nothing. Estrogen from testosterone is a good IMAO a = more NA

I don’t focus to much about my situation, but sometimes, this feeling of this brain fog is hard for working and creativity…Every thing like a moutain

Thank you again for this great answer.

[DrMariano2]

@Jean 705 wrote:

Depiste a good diet I have no optimal Zinc, Iron, copper, vit E gamma (all are low)

I know that my residual fatigue go away when I take ritalin. I AGREE WITH YOU the importance fo the brain function and NERVOUS SYSTEM.

But the problem, after three day at 10 mg/day of ritalin, my brain NA is depleted and I’m worse than before (depress, more tired…)

Ritalin, despite being a relatively mild stimulant, is actually excessive for many people with HPA Axis Dysregulation and suboptimal cortisol signaling.

Increasing Norepinephrine is generally not the best idea for most people with HPA Axis Dysregulation with suboptimal cortisol signaling. The reason is that it worsens this condition. This is why a person only lasts a short time. Brain norepinephrine is not depleted. The rise in norepinephrine from treatment with Ritalin worsens immune system overactivity, leading to worsened HPA Axis Dysregulation.

Unless Cortisol production is at least 12 or more, I generally would avoid a stimulant unless it is a last resort.

If Zinc, Iron, Copper, vitamin E are all low, the diet is NOT good enough.

Meats are a good source of these. I would wonder if animal protein intake isn’t high enough.

Note that nutrient dense diets can vary. The traditional Eskimo and Masai diet is essentially totally meat and fat. It is a healthy diet.

If the foods themselves are deficient in nutrients, then supplements have to have to be used.

If the above nutrients are deficient, then the primary problem is a metabolic problem. The cells themselves do not function well. Thus cortisol production is low because the adrenal cortex itself can’t make it. Nearly every enzyme involved in cortisol production has iron as part of its structure.

[Jean]

Thank

Yes it’s a true I eat meat 3 times a week and red meat only 1 times every 2 week with eggs every day.

Now, I understand the IMPORTANCE of cellular nutrition, she need to be optimum

I think many people like me forget the importance of minerals.

Best regards,

[hardasnails1973]

Unfortunately our soils are 50-60% depleted then when our grand parents where growing. Even with the “organic food” revolution it is still grown in the same nutrient deficient soils. The only type of organic food worth buying is the organic meat, eggs, milk. The qualifications to be considered certified organic is falsely promoted. One is better off buying store bought veggies and fruits at cheaper prices then paying 3 times the normal price. One client came in for proper hormone evaluation and asking her what she ate I told her eating is very healthy but unbalanced. She was convinced that she ate 100% organic spending $600 dollars a month on groceries for a 130 lbs female she would would not need a multivitamin. As the consultation went on I mentioned how the soils where depleted and even though she was eating good she was not meeting the nutrient requirements for good health. Eventually I convinced her to get the FIA testing to verify nutrient deficiencies. I predicted what she was deficient in with 80% accuracy. From her symptoms ,labs report and being on birth control I suspected hypothyroidism and cortisol imbalances. Taking this information into consideration and my past experience it was obvious she did not factor in birth control which was the biggest culprit. When her results came back there where 8 nutrient deficiencies and I had predicted 6 of them. I wish I had a picture of her expression when she saw the results.

When explained to her why these where occurring then she really began to understand just how people are so mislead thinking that they get all the nutrients in even the most “healthy” diet. I explained to her if one would factor out the birth control then results would have been considerably different. She spent over 600 a month on all this organic food when the simple solution was to simply get a good multivitamin/mineral which is highly bioavailable.

[Jean]

it’s good answer.

I agree with you that soil are depleted on vitamins, minerals….

May be your are right because I eat 100 % organic food but I have some mineral deficiency.

But what do you eat ? I’m not sure that a pescticide/irradied food with a good multiviamins/minerals is the solution. I disagree with junk food and supplement.

Food is the best medecine and many supplement doesn’t work very well, the bio disponibility is important.

I know that organic diet is not the paradise solution and I agree with you that it’s very expensive.

What brand do you take for iron, zinc, B12 ? I known that micro nutriments is so important for methylation.

Thank

[Bella6]

I think this is one of the most informative posts I’ve ever read on any message board.

I wish more doctors would “get with it” and realize how simply complex (or complexly simple) this is.

Seems they just want to take a “one shot stop” approach with this– they either just address thyroid, just address adrenals and/or know nothing about how sex hormones even fit in with it all.
Add in aldosterone, pregnenolone and such– and they have no clue.

Thanks again for sharing this information.

[Author]

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