Bio-identical Hormone Therapy and Sage Advice 4 Women from

     With the fast paced world in which we live, more and more people are getting sick. When we are too stressed, our bodies do not function at their best.  If one has spent one’s adrenals, a program to heal them and regain health may include: the reduction of stressors, the use of foods, herbs and nutraceuticals, and medications like cortisol.

Dr. James Wilson’s book, Adrenal Fatigue: the 21st Century Stress Syndrome, out lines many of the restorative behaviors that help. Dr.  William Jefferies,Clinical Professor of Internal Medicine at the University of Virginia School of Medicine outlines the safe uses of cortisol in his book labeled the same, Safe Uses of Cortisol.
Dr Jeffries points out that cortisol’s replacement by prednisone undermined the safe use of cortisol.  When the adverse effects  of prednisone became apparent, both medications were maligned.  Like progesterone is not the same as progestins, cortisol is not the same as prednisone.  Progestins and prednisone have risks in their use and must be used very carefully.   The body makes progesterone and cortisol and knows how to use them.  We can use cortisol in careful ways to treat hormone dysfuntion.  The adrenals control so much of our endocrine system.  Giving women reproductive hormones when they really need adrenal or thyroid support is like fine tuning the engine of an auto that has no wheels. No woman should be put on thyroid medicine without evaluating adrenal status. Many times repairing the adrenals addresses thyroid dysfunction eliminating need for thyroid medicine. Thyroid medicine carries the risk of bone loss and cardiac alteration.

    When a women’s hormones are not in balance, we must not just give her estrogen and progesterone, without discovering exactly which hormones are not in balance.   Many women who have hot flashes do not realize that the adrenals, if overactive or deficient and not replenished, can cause hot flashes.  Yet we may be giving women estrogen to fix hot flashes and be exposing them to an excess of estrogen beyond their progesterone balancing levels and contributing to many reproductive cancers when they need adrenal support instead. We know what excess estrogen can do to the breast and endometrium.

When cortisol is found to be insufficient by laboratory studies, either, blood or saliva, a course of cortisol may repair damage in as little as 3 - 6 months.  No more than 20 mg of cortisol total through out the day should be used. Based on the patient’s studies the cortisol should be given to mimic the natural pattern of cortisol.  Highest in the am. 10 mgs.  Then 5 mg at noon . 2.5 mgs; at 4pm and 2.5 mg at bedtime.  The herb whole  licorice root extract may be used. Licorice slows the conversion of cortisol to cortisone acetate, allowing it to remain in its more active state longer. This herb needs to be used with caution due to it’s hypertensive potential.  No more than 35 mg a day should be used.

Diagnosis of adrenal fatigue should be made by signs and symptoms and laboratory testing. Keep in mind that Cortrosyn testing fails to diagnose adrenal deficiency 50 % of the time according the Chang study. Thus management needs to encompass all the diagnostic skills available. Sargeants line, pupillary response to indirect light. Lying, sitting and standing blood pressures in addition to signs and symptoms and laboratory findings.

Patients on cortisol should be seen every 3 months and parameters reassessed.  They should obtain and wear Medic alert jewelry to alert health care workers to the  fact that they use cortisol in case of unconsciousness in an accident were this history would be missed.


Some Signs and Symptoms of adrenal compromise are:

Sargeants line- white wide line created by the blunt line formation on the abdomen with an instrument, that is wider than the object used with delay in normal disappearance of red line.
Orthostatic blood pressure drop or lack of rise of 10 mm during blood pressure measurements.

Pupilary loss of constriction to direct light from the side of the eye.
Low blood pressure. 
High blood pressure
Costo-vertibral-angle back tenderness,  With or without discoloration of area
Hot flashes
Sleep disturbance
Weight gain
Bruising
Skin discolorations at folds of skin, elbows and knees.
Fatigue even with adequate sleep patterns.           

    Treatment consists of: investigation into the possible causes of adrenal dysfunction. Life style changes to lower stress and its affect on cortisol levels. Meditation, exercise, breathing exercises and lifestyle changes are crucial.

     Adrenal supplements are taken to rebuild the adrenals when they are low and cortisol inhibitors used to lower cortisol levels, Wilson’s supplements complement his book The quiz in the book guides patients to the correct restorative dosages of supplementation. Dr. Wilson says that with his program and lifestyle changes, persons with mild adrenal fatigue can recover in three to six months. In more sever cases, the recovery may take up to two years.

Phosphatidyl serine 100 to 500 mg daily in divided doses can inhibit cortisol. Even if the adrenal are overproducing cortisol and levels are high, the adrenal still need support in order not to end up being under producing as a result of glandular exhaustion. Supplementation is important in both cases of high and low cortisol conditions.  Other supplements that help with lowering elevated cortisol levels are: Theonine, Aswaganda, Holly Basil, Rhodiola and others. Herbalists and Licensed Accupucturists can guide persons with their safe uses.

 

     The goal of therapy is to discover the underlying cause of adrenal dysfunction, correct the underlying causes, and rebuild the adrenal glands.  My observation of patients I have referred to endocrine specialists have been that the normal testing done for adrenal disease finds no disease. ( thank goodness.) Patients are told that they are normal. Endocrine specialist are experts at treating disease but sometimes do not have the comfort level and time to treat dysfunction of adrenal glands.  The Endocrinologist in 2001 has an article stating the validity of saliva testing for evaluation and treatment.  Blood testing is not practical since blood draws themselves alter levels and are not available to patients 24 hours to test for patterns of cortisol production.( except for blood spot testing through ZRT labs. And insurance does not cover this testing in many cases.)  Twenty four hour urines are good at identifying disease but not diurinal cortisol patterns.

If patients have hypertension, cortisol and whole licorice root extract should not be used secondary to its hypertensive effects. Typically, low cortisol levels produce low blood pressure and high cortisol levels produce high blood pressure.  Cortisol is considered for short term therapy in addition to adrenal supplementation for adrenal restoration only for those patients whose tests reflect very low adrenal reserves.  The dosage of cortisol should not exceed 20 mg per day in divided doses highest in am to lowest at bedtime. Or just at the times of day when the cortisol levels are  the lowest. 

 
    In summary, patients should be on Hydrocortisone only briefly, only if their diurinal cortisol patterns are very low and flat, and for only three to six months to jump start the healing process. Follow up needs to be in that six month period. Patients need to receive written information about the side effects of cortisol. They should wear Medic alert bracelets or  something in writing in wallet and cell phone notes for caregivers in case of accidents where they may not be able to convey the fact that they are on cortisol therapy. 

Many times adrenal treatment consists of nutrition evaluation and treatment especially in the diagnosis of gluten intolerance and counseling for the improvement of good eating habits. Diet modifications may be key to treatment in most cases.

 See menopause section.      The transition into menopause can be difficult or easy. Some women ease into it with not much difficulty.  Some do not. The Key to easy transistion relies on intact adrenal  glands.  Preparing for menopause is one of the most important transitions for improved aging.  (Preparing for childbirth is very similar. studies show that pregnancy in the midst of adrenal challenges may have less favorable outcomes)  The key is in getting the adrenal glands in their best shape so they can provide for natural waining hormones that stay in balance and protect us. When the ovaries are running on empty so to speak, the rest of our smart bodies will go to work as long as they are well fed and cared for. If a woman enters menopause and does not have the ability to make enough hormones from the substrates available then an inflammatory cascade begins. The adrenals glands make the hormones that the ovaries cannot produce.
    This inflammatory cascade of cytokines then is like a runaway train. It is responsible for the middle we grow. That belly fat grows then starts making these inflammatory devils and next thing you know...  hot flashes from the cortisol disturbances created, osteoporosis, joint pain, neurologic inflammation in the brain that makes us the typical crazy menopausal nut cases that comedians and folklore embelish. You can then start pharmaceutical , non bio-identical hormones and bio-identical hormones. or compounded  bio-identical ones or adaptogenic herbs and nutrients to put out the fires created, but this may only slow the train down, not stop or reverse it.
     The key is to train like for an athletic event and to nourish the adrenals. One must discover any health risks and correct them before the body and specifically the adrenals need to be at their best. So you must be good to your bodies and heal and nourish them before menopause. They will then be able to perform like champs for us. ( The same applies to pregnancy outcomes. You must be adrenally sound in order to have the best pregnancy  outcome. )
           How do you do this you ask?  You find a provider who will look at all the correct markers and determine if you need any rebuilding. If you do need help, you make sure to heal your adrenals and keep them as healthy as possible.  I do this with a salivary evaluation by Diagnostechs at the cost of $120. This Adrenal Stress Index looks at your cortisol levels at four times during the day to see if your patterns are normal. In addition you are tested for other hormones that are part of the adrenal, allergy and metabolic  pathways.  Depending on your results, a plan for restoration can be formulated and retested to monitor progress. If you are found to be normal, you need only to learn how to nourish yourself well for the transition which includes good food choices specifically for you and a great concentration of omega 3’s and vitamin D3.
     If your adrenals are not healthy, you fix them by engaging in intensive corrective nutrition which may include nutrients for the brain and gut repair. The relationship between the gut and the brain is amazing and inextricably linked. If either is not healthy they create a negative influence on the adrenals.