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I’ve had CFS for the last 7 years and have had progressively worse IBS issues. I’ve recently been experimenting with the Paleo and SCD diets which are helping with the IBS especially increasing the transit time. I’m looking into cutting sugars and maybe shifting to more of a candida diet.
Regarding Testosterone/Cortisol:
I’ve had a pregressively worsening condition over the last few years. I have this REM sleep priapism every night. Some nights more severe than others. I have yet to determine any real cause and effect. Recently I have become aware of the relationship between Cortisol and Testosterone. I’m wondering if my Morning Testosterone is very high due to low Cortisol in the AM perhaps contributing to my REM condition or causing it. I suspect many nights usually 3am-7 or 8 I sleep with an erection the entire time. Sleeping on my stomach can help this problem sometimes which makes me wonder if it’s spinal related. This morning I woke at 7am wiped out completely with my usual problem. I took 1 IsoCort and back to sleep for an hour….For that hour I did not have my problem. Coincidence? Again I’m wondering about Testosterone.
I don’t know how to consistently help this problem but I know how I may make it worse. Exercise Recovery (weightlifting) will make the problem worse that evening. Sex usually makes it worse that evening. Activia Yogurt makes it VERY bad (thinking lactic acid). Whey protein (on workout days) seems to also contribute to worsening. Sun exposure will. Certain herbals (mostly strong antibiotic) have made it worse.
About Adrenal Involvement:
Recently I’ve been trying Low Dose Naltrexone (LDN) @ 4.5 mg at bedtime. Within 4-5 days I have been very wiped out in the morning. The familiar face of very low cortisol. This morning I mentioned taking an Isocort. I took a second and Maca and B5 this morning also just out of the house. If you know about LDN it’s supposed to help support the immune system and even help with autoimmune disorders (lowdosenaltrexone.org)
In the past when I’ve taken Thyroid supporting supplements my adrenals have gotten wiped out fairly quickly including (Gugglusterone, Forskolin and such).
Can anyone suggest why? Has anyone else experienced this? Does this indicate I”m on the right track and should look into getting on HC?
This guy @: http://sci.tech-archive.net/Archive/sci … 00074.html
says: “Autoimmune disease like Hashimoto’s can often be associated with other autoimmune disease like primary adrenal insufficiency. I would have been nice to see other confirmations such as with 21-OH adrenal antibodies. “
He indicates there is an autoimmune condition that attacks the adrenals? Could this be my answer? Wondering what testing I might do?
You have identified three problems:
1. Fatigue – which lasted for 7 years
2. Bowel problems – which you called “IBS issues”, which you imply involves diarrhea.
3. Erections during sleep in the early morning.There is a lot of information missing. Some questions:
1. Can you provide more information about what IBS issues you have? Irritable bowel syndrome, for example, includes those people who have diarrhea and those who have constipation.2. It was unclear. What is getting worse when you exercise, have sex, eat Activia yogurt, whey protein, use some antibiotics and when you expose yourself to the sun?
3. Why are morning erections a bad thing? For example, are they waking you up? Are they extremely painful? Is the penis becoming purple when it is erect for so long? How are they different from normal morning erections that men get or are trying to get back? Priapism is often a side effect of certain medications such as Viagra or Trazodone. It is actually a medical emergency which may need an injection of epinephrine to the penis or a surgical treatment to avoid strangulation of the penis.
Morning erections are not necessarily due to excessive testosterone. Many with high testosterone, yet other problems, don’t have morning erections. Generally, the stress system needs to be in a calm state, the immune system shouldn’t be in an inflammed state, and sufficient cortisol needs to be made, etc. etc. in order to have morning erections.
Many patients are very sensitive even to low dose Naltrexone to where it can sufficiently block opiate receptors and can cause problems. Even 4.5 mg is too high for them.
Low Dose Naltrexone is suppose to help reset the opiate receptors so that they are more sensitive to endogenous opioids or opioid pain medications. Low Dose Naltrexone is also suppose to help reduce inflammatory cytokine signaling from the brain’s microglial cells. This would help calm down the immune system from a pro-inflammatory state.
Generally, fatigue and bowel problems may involve multiple systemic problems. There may be problems in the nervous system, endocrine system (e.g. thyroid, adrenal function, etc.), immune system, metabolism and nutrition. There may be pathogenic bacterial and yeast infections in the gut – which can cause significant inflammatory and stress signaling – which can lead to fatigue and other problems.
Nutrition may be suboptimal but specific nutrients may need to be supplemented. For this testing needs to be done.
Generally, if one has one autoimmune disease, one can have multiple others. An assessment for this possibility is needed should this be found.
If there is a lot of pro-inflammatory signaling in the body contributing to adrenal dysregulation, then increasing thyroid hormone can be problematic. Care needs to be taken when increasing thyroid signaling since this can also increase immune cell activity including pro-inflammatory signaling. Generally, when cortisol levels are low, one has to be careful when adding thyroid hormone. Treating the causes of adrenal dysregulation first may be necessary otherwise a person can worsen in condition, e.g. with anxiety, loss of energy, palpitations, etc.
A medical evaluation, physical exam, and fairly extensive lab panel needs to be done in many cases to help identify as many of the problems that are occurring so that they can be specifically targeted in treatment.
If a person doesn’t determine what actually is wrong, then treatment tends to be trial and error and flying blind.
Thank you Dr. Mariano for the reply.
@DrMariano 2904 wrote:
You have identified three problems:
1. Can you provide more information about what IBS issues you have? Irritable bowel syndrome, for example, includes those people who have diarrhea and those who have constipation.Not diarrhea but loose stool, usually very yellow in color (not pale, yellow). Every few days loose enough to be called diarrhea. Often I fell awful until after I have a movement then much better. I often feel the stool is toxic.
@DrMariano 2904 wrote:
2. It was unclear. What is getting worse when you exercise, have sex, eat Activia yogurt, whey protein, use some antibiotics and when you expose yourself to the sun?
The REM sleep priapism is worse. The length of time of the erection, the intensity.
@DrMariano 2904 wrote:
3. Why are morning erections a bad thing? For example, are they waking you up? Are they extremely painful?
These aren’t the normal morning erections. The first time it happened it was VERY upsetting. I started getting them very sporatically. One every week or two then it started to be every night. The frequency seemed to increase after I did a herbal parasite cleanse.
@DrMariano 2904 wrote:
There may be pathogenic bacterial and yeast infections in the gut – which can cause significant inflammatory and stress signaling – which can lead to fatigue and other problems.
This is my number one theory at the moment. At times I’ve taken activated charcoal and felt much better
@DrMariano 2904 wrote:
Generally, if one has one autoimmune disease, one can have multiple others. An assessment for this possibility is needed should this be found.
I was reading about the Antinuclear Antibody test. Is that recommended here?
@DrMariano 2904 wrote:
If there is a lot of pro-inflammatory signaling in the body contributing to adrenal dysregulation, then increasing thyroid hormone can be problematic. Care needs to be taken when increasing thyroid signaling since this can also increase immune cell activity including pro-inflammatory signaling. Generally, when cortisol levels are low, one has to be careful when adding thyroid hormone. Treating the causes of adrenal dysregulation first may be necessary otherwise a person can worsen in condition, e.g. with anxiety, loss of energy, palpitations, etc.
Can you recommend any tests that would help determine the cause of adrenal dysregulation?
@DrMariano 2904 wrote:
If a person doesn’t determine what actually is wrong, then treatment tends to be trial and error and flying blind.
Thus is my last 7 years.
@sr727 2907 wrote:
Thank you Dr. Mariano for the reply.
Not diarrhea but loose stool, usually very yellow in color (not pale, yellow). Every few days loose enough to be called diarrhea. Often I fell awful until after I have a movement then much better. I often feel the stool is toxic.
The REM sleep priapism is worse. The length of time of the erection, the intensity.
These aren’t the normal morning erections. The first time it happened it was VERY upsetting. I started getting them very sporatically. One every week or two then it started to be every night. The frequency seemed to increase after I did a herbal parasite cleanse.
This is my number one theory at the moment. At times I’ve taken activated charcoal and felt much better
I was reading about the Antinuclear Antibody test. Is that recommended here?
Can you recommend any tests that would help determine the cause of adrenal dysregulation?
Thus is my last 7 years.
Chronic diarrhea or irritable bowel syndrome may involve pathogenic bacteria or yeast colonizing the intestines. The immune system attempts to protect the body from the infection. But it can cause an increase in inflammatory signaling and stress. This leads to further downstream signaling and metabolic changes which can lead to fatigue.
There may be other causes for diarrhea, however. This includes parasitic infections, inflammatory bowel diseases, food allergies. They can also increase inflammatory and stress signaling.
It may be worthwhile to be evaluated by a gastroenterologist for at least evaluation since the causes of diarrhea are so numerous. Sometimes, endoscopy or colonoscopy or imaging studies may need to be done to determine the cause of diarrhea.
One possible hypothesis or explanation as to why priapism may occur is this: Generally, if the immune system is in an inflammatory signaling state, it may be difficult to obtain an erection. However, if the immune system in an inflammed state produces a substantial amount of nitric oxide – an oxidizing agent that white blood cells use as a weapon to kill bacterial cells – then the nitric oxide may increase blood flow into the penis, causing an erection, or even priapism at the extreme. In essence, the activated white blood cells are acting exactly like Viagra – increasing the production of nitric oxide. Nitric oxide in excess can also damage other cells of the body, leading to more inflammation.
There are numerous tests for autoimmune illnesses – such as the ANA. They are specific primarily for the illness tested. For example, Lupus needs a different set of lab tests from Rheumatoid Arthritis and Hashimoto’s Thyroiditis. It is important to have an evaluation, if an autoimmune problem is suspected, by at least an internist or other qualified physician to determine which autoimmune disease is suspected and the appropriate tests done. Otherwise, the number of tests that are possible is huge with often only a few coming up positive, if at all.
Adrenal dysregulation has multiple contributing causes. This spans a huge area including nervous system dysfunction, endocrine dysfunction, immune system dysfunction, metabolic and nutritional problems. For example, iron deficiency can impair nearly every system, can lead to increased norepinephrine signaling, then inflammatory cytokine signaling, impaired thyroid signaling, impaired nutrient uptake, then eventually adrenal dysregulation. A systemic evaluation is necessary as well as a diagnostic interview and exam.
Basic, general, initial testing for some of the more common pathophysiologies that I may order include:
Free T4, TSH,
Free T3, Total T3, Total T4,
Thyroglobulin Antibodies, Thyroid Peroxidase Antibodies,
Cortisol AM, DHEA-s, Pregnenolone, Progesterone,
Total Testosterone, Ultrasensitive Estradiol, LH, FSH,
Hemoglobin A1c, Fasting Insulin,
IGF-1,
Prolactin,
Comprehensive Metabolic Panel, CBC, Lipid Panel,
Urinalysis, Urine Drug Screen,
Ferritin, Serum Iron, Magnesium,
Random Urine Iodine (24-hour Urine Iodine if Random is not available),
Plasma Zinc,
Vitamin A (total retinol),
Vitamin D 25-hydroxy,
Vitamin B12, Folate,
Methylmalonic acid serum,
Homocysteine,
Fractionated Plasma Catecholamines,
Random Urine 5-HIAA,
H. Pylori IgG, Food Allergy Panel,
etc.I generally customize the testing depending on many factors including cost, amount of blood testing entails, health of the patient, etc. etc.
Other specialists, have their own set of tests and procedures.
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