Long illness, what is going wrong?

[menrfrommars]

Hello Dr M, i have just found your site and am very pleased you have set it up. i was hoping to ask you this question for along time, but haven’t seen you on the other forums for a while.
It’s a long one so i apologise in advance and it touches on mental illness and hormonal imbalance.

I am male, 37, happily married, financially secure and think i have a good life, but i am tired and have a cycle of good health/bad health. Last April i found out i have lower fertility (20m sperm, 50% motility, 4% morphology) and this has lead me to find out i had some hormone imbalances.

Prior to this i had been ill for 16 years (started aged 21). Initially diagnosed with post viral syndrome and then a year later with dysthymia depression. For 12 years solid i took one anti depressant a day and this was changed about 6 times in that time. I never felt that much better taking these AD’s, but i had no other explanation of what was wrong.

So last April i started to research my own health and got copies of my blood tests. i soon realised i had a thyroid problem. My TSH was 3.7 and free T4 was 12 (10-23 pmol/l).

last summer i stopped the anti d’s and started on armour. I am a lot healthier than before, but i am still not right. I am getting cycles of energy and then tiredness.

I am taking dr wilsons Adrenal dynamite and think this is helping me.
I have increased to 3 grains of armour recently
I have just started 25mgs DHEA
i take Vit C 3000mg a day and a multi vitamin.

i have tried HC last Autumn and felt really good on it (15mgs) but stopped it early this yr. i would prefer not to go on it.

I am 5ft 9 and weight 82kg’s. i am very fit and play a lot of sport. i have noticed this year that sport has been making me worse and so i have stopped playing certain things. i dont smoke and drink a small amount. i eat really well. Before all this happened (aged 21) i was a very sensitive person and not that confident really (although you wouldn’t know it). i would sweat a lot and so my thinkng is my nervous system was over active. i had a high sex drive and even though i have been ill all these yrs my sex drive has stayed high. my childhood was great until divorce aged 7. Life after that was pretty unhappy. i have had therapy in the early yrs of being unwell and this helped a lot.

I had an undescended testicle aged 9 and so only have one fully functioning. my testosterone level is ok, but was low last april after years of AD tablets. Currently T is 17 nmol (10-31).

i have done the saliva adrenal tests and these show i make normal cortisol in the morning, but it drops off very quickly. the dhea actually goes below range at noon and 4pm. i was low in B12 (329) and so supplement this now.

We are trying for a baby and i am really annoyed that i am ill, because the problem lies with me. two weeks ago i tried DHEA and i got the placebo effect again of improving health (lasted 8 days). i just became so well – loads of energy, hungry, higher sex drive, calmer mind and more focused. i finally thought i was going to be properly well and so my sperm would improve. sadly that has not happened and i became tired for most of last week. i improved yesterday a little, but am back to being 90% well and dont have my mega energy i know is in me. This has surfaced a lot in the last year, but is not very consistent. When i am like this i will want to do a lot of exercise. i mean after a hard days work last friday night i came home to go out again on my bicycle for 12 miles. Exercise is my drug when i feel well you see. Some have said i am damaging my adrenals by doing the exercise and i have cut it back a lot, but last week i felt so good i probably exercised 4 days in a row (football and cycling).

Do you have any insight into what is happening to me? do i need to increase the armour soon? should i stop doing any exercise? would st johns wort help ?

i have some blood test results from feb of this yr if you need to see them and i can give you the exact adrenal saliva reading.

Thanks for any help.

[Shaolin]

If you have been suffering from chronic post viral syndrome (as i also suffer unfortunately) you should be able to handle it to some extend without any adrenal supplements apart from dhea which is not that bad to use. Direct cortisol production is very little affected in such cases, its mostly a hippocampus/hypothalamic stimulus defect (either high increased inhibition to CNS or depleted signaling from the hippocampus/hypothalamus to lower levels). Its not that your adrenals havent got the ability to produce cortisol, like in hypothetically existent adrenal fatigue, but rather there is shifts in your stress perception,immune function and serotonin metabolism and this delays or hinders cortisol production under normal stimulus like awakening- . Have you tried sleeping late or not sleeping for one night to see if you feel better or not the next day or sleeping less hours one day and more the other to compensate??

In any case exercise and cognitive-behavioral therapy can improve you as also certain foods.

Do you also have irritable bowel syndrome??

Nevertheless you have other concurrent problems too so i dont know to what extend that affects you too. Surprised though that you produce so much T with ONE testicle if i read correctly????

Noone knows exactly what and how is affected from viruses that last long in your body, what sort of enzymes change epigenetically, what sort of immune function gets altered, some state altered cellular others humoral immunity (in my case its lowered amount of CD4 cells and lowered ratio of CD4/CD8) – most of the people i know however with one or two chronic viral problems have lowered CD8 counts. This can be more detrimental to your overal state.

Have you checked you immune profile and complementary system function??

Regarding drops of cortisol levels after early morning that happens to most chronic fatigue syndrome patients, its due to the loss of activity of ACTH/loss of sensitivity and the increasing catecholamine levels in mid day. Your adrenals are not affected however, in very few cases has there been adrenal atrophy in CFS patients (probably less than 20%) most adrenal atrophy comes from antidepressant chronic use.

heck who knows, its such a complicated matter. I only so improvement wit DHEA supplementation but didnt bother long term concentrated on exercise mostly.

Dr. M should know much more to say, hope he answers this one

[DrMariano2]

@marsaday 549 wrote:

i eat really well.

i was low in B12 (329) and so supplement this now.

Generally, if one has low sperm count, then one may need the help of a reproductive endocrinologist/gynecologist to help get pregnant. One may need to get treated with Clomid or Chorionic Gonadotropin, for example, to try and stimulate sperm production. One may need sperm concentrating procedures and assisted fertilization procedures done (the initial procedure looks like one is using a turkey baster to place the sperm at the intended location during ovulation). One usually only has a small window each month after ovulation in which to get pregnant. Timing is crucial. Slow sperm may have difficulty traveling to the egg, thus may need help. As the last resort, the sperm may need to be forced into the egg to get fertilization.

Low sperm count may indicate nutritional deficiencies as one possible problem, aside from genetic problem and signaling problems.

When a person is “eating well”, I usually question this. The reason is that modern diets are not healthy.

When a person is low in B12, I know they are probably going to be low in the other fat soluble vitamins and other nutrients. They do not eat much animal meat with fat. They are on an unhealthy diet.

Nutrition is a huge and complicated area for discussion. It directly affects cellular metabolism and function. It one can go down to the biochemistry and atomic level when one looks at interactions and processes involved.

A good starting point for a person’s education about nutrition is the book, Nourishing Traditions by Sally Fallon: http://www.amazon.com/Nourishing-Traditions-Challenges-Politically-Dictocrats/dp/0967089735/ref=pd_rhf_p_t_1

I would generally recommend reading the book to learn about the benefits of high density nutrition – meaning traditional diets as opposed to modern, unhealthy diets.

[menrfrommars]

Chronic post viral was diagnosed 16 yrs ago. it is bullshit doctoring. This then morphed into depression. again more bullshit because i have never become well in this time even though i was treated for it.

Yes i do get IBS, but only when not well. so this is every few days basically. i will describe the symptoms i get when i become “unwell”:

Tired
Bloated stomach
Backside wind
Lack of thirst/appetite
Increase in fat on stomach
decrease in strength / stamina
poor breathing (not able to get big lung fulls of air into body)
skin becomes more pale

Dr M, i eat well, i dont eat processed food and i am a meat eater. i really dont believe my problems lie with nutrition.

We have been told to go for IVF, but i am waiting another 3 mths before i do a final sperm test. My sperm is slow moving you see.

Can you not see any solutions to what i have written. i have tried everything and i am still not getting any where. Do you think increasing the armour to 4 grains will help me?

Last summer/autumn i tried Hc and it really helped. i stopped taking the armour and became very unwell. but i am a bit reluctant to go back on the HC. if i do i only want to take 10mgs max.

i am getting to the end of trying to fix what has gone wrong with me. if i dont get my health back i will end my life. there is only so much a person can take. i have a potentially great life, but i cannot feel anything when i am ill. i am in discomfort most of the time when ill. then i get well for no reason and i feel relaxed and well, hungry and energetic.

[menrfrommars]

Note that when a person has low cortisol production because of hypothalamic-pituitary-adrenal axis dysregulation (which includes conditions previously referred to as adrenal fatigue), then addressing these problems may be more important than supporting adrenal output. Addressing the cause of the low adrenal output would more directly treat the problem – if the problem can be found. Often, for example, nutritional deficiencies are a cause of adrenal problems. Mental health and stresses are other causes. Etc. etc.

Dr m

you wrote this on another thread today. i will look into the nutrition for the adrenals, but i thought taking adrenal dynamite would help with this.

i will detail my adrenal results for you and would like to know if my cortisol production is that bad. compared to many it is not too bad at all:

june 2008 cortisol nmol/l

8am 34.9 (12-33)

noon 10.8 (10-28)

4pm 8.8 (6-11.8)

midnight 3.4 (1-5)

DHEA

8am 20.3 (11-25.1)

noon 4.9 (6.9-14)

4pm 4.9 (5.5-9)

midnight 6 (4-8)

[Shaolin]

Are those values of cortisol on Wilsons adrenal dynamite?? What does this product contain, i have seen it once in the past but not really interested in glandulars apart from armour.

Cortisol values look ok to a bit higher than normal..

I always wondered if during the first years of post viral syndrome i had higher or lower cortisol levels. I guess, depending on my immune status they must have been a bit lower, just slightly but then never tested back then. Nevertheless i only felt tired in the mornings and major symptom was IBS and difficulty studying for prolonged periods of time. This however depends, theres people who have been infected with EBV or Cytomegalovirus or HHV6 or stealth viruses or combinations of those viruses and had much more debilitating symptoms than me..

Dr. M have you treated CFS patients and managed to improve their higher intellectual capabilities somehow?? Im really interested in that, since i wanna get back to the 8-10 hours studying a day. Now its maximally 2 hours and this is so low quality studying i keep forgetting things and get dizziness and confusion 🙁

I guess in my case a bit of dhea or some other slight anabolic hormone could help me get much better, never tried it though up untill i got finasteride in my body and this REALLY messed things up.

I could live ok with post viral syndrome, just couldnt perform or compete with others in the university like before i had to go slowly on studying not overpressure my self like before but i could at least play sports and work. Now after finasteride,overtraining and adrenal fatigue i cant do a lot ,just sit around and wait to see if things improve 🙁 I hope i change this soon because its unbearable

post more tests if you have man, blood tests and so on

its very difficult to see from just them saliva tests what might be going on

* i have also considered in the past to take an antiviral like Valganciclovir but dont know which virus exactly hit me, i presume something but am not sure, need to do some testing. Anyways now i first need to fix hormones

[DrMariano2]

When it comes to treating chronic fatigue with any patient, one has to first determine what the contributing factors are at four levels:

1. Are there structural problems which contribute? For example, is there central nervous system damage that would prevent full recovery no matter that the treatment since we don’t have treatments to extensively rebuild whole brain systems.

2. Are there signaling problems? For example, are their problems with suboptimal thyroid hormone, suboptimal hypothalamic-pituitary-adrenal axis function, excessive or suboptimal norepinephrine system function, excessive pro-inflammatory cytokine signaling?

3. Are there metabolic-nutritional problems? For example, does a person have suboptimal nutrition? Nearly everyone I see has nutritional problems. Modern foods do not provide as much nutrition as traditional foods.

4. Are there psychological issues that cause physiologic distress, that impair function?

Once the pathophysiology is determined, then it is a matter of addressing each problem as well as can be done to improve function.

Do people with chronic fatigue syndrome improve? Yes. Nearly all do.

From my standpoint, chronic fatigue syndrome is a complex multifactorial problem – just as mental illness is. Many of the same underlying contributing factors to mental illness underlie chronic fatigue syndrome except for perhaps the psychological issues, though this is a significant factor in many.

[menrfrommars]

the adrenal saliva test was taken without me taking any supplements.

Adrenal dynamite contains vit b’s, macca, licorice root and other stuff. google it and check out the ingredients.

i am now taking cortef at 10mg a day (2.5 am, 5mg lunch and 2.5mg evening. i seem to be ok.

i do play a lot of sport and am very energetic when functioning normally.

just get these down days every week or so.

i saw the endo today and they are happy to give me thyroxine. been on armour, but i want treatment with the health system. i will see how i go on it at 100mgs.

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