Recovering from Adrenal Exhaustion

What natural supplements will help my adrenals recover?  —RN

Dear RN,

Taking cortisol or prednisolone (the drug-version of cortisol) is one way to help your adrenal glands recover.  Needed cortisol taken orally or transdermally is that much cortisol that your adrenal gland does not have to produce.  That decreases the hormone burden to your adrenal gland.

Adaptogens are natural plant substances that can have a beneficial effect on the adrenal glands.  But they are minimally effective when the adrenal gland is already exhausted.  They are not bad to take, just bad to rely upon as the only therapy, or primary therapy, for adrenal-involved fatigue conditions.

The best way to allow your adrenal gland to relax is to reduce the “need” for cortisol by normalizing the thyroid-mediated regulation of basal metabolic rate.  Adrenal hormones are the “back up” system for regulating body energy metabolism, and energy and stress pathologies always result when adrenal hormone becomes the default primary system due to inadequate thyroid signal.  The inadequacy of the thyroid signal can be a lack of thyroid hormone by normative standards (as measured by blood T3 and T4, which compare your blood levels to those of most people.  B more commonly, thyroid inadequacy results from other factors, like interference in hormone receptors in the membranes of the cell, nucleus and mitochondria, and like anti-metabolic (toxic) influences that counteract the thyroid signal.

Although doctors do not admit it, it is a scientific fact that none of the thyroid blood tests in commercial use today (TSH, T4, T3, rT3, antibodies) assess the thyroid hormone-receptor dynamic (or the metabolic rate derived therefrom).

But a thyroid trial bypasses the need to directly measure the hormone-receptor dynamic.  A thyroid trial, a slow (weekly), steady, sustained escalation of thyroid hormone, provides empirical data on changes in energy, wellbeing, strength, stamina, heart rate, body temperature, mood and sleep quality.

The escalation has to be weekly, because the TSH feedback loop, from the hypothalamus to the pituitary, operates on a 2-4 week timeframe.  The hypothalamus “listens” to the thyroid signal, and then tells the pituitary how mych TSH (thyroid stimulating hormone) to produce.  To assess increased thyroid signal, you have to stay ahead of the TSH negative-feedback loop.

The escalation has to be slow, because the body’s many compensations for a hypometabolic state need time to relax.  This would include inflammation through the PGE2 pathway, blood pH buffering systems, adjustments to antioxidant recycling (glutathione), activation of beta-oxidation (fat burning) pathways that keep blood triglycerides and free fatty acids from staying elevated, and much more.  Furthermore, body systems browned out by hypometabolism (neurotransmitter synthesis, digestive enzymes, liver enzymes, cholesterol and steroid biosynthesis,   collagen maturation, tissue healing, sleep deficit) need time to self-correct.  Many of these systems are connected to compensation mechanisms.  In addition, deferred maintenance can be a bitch.  Many people have been told “your thyroid is fine” by their doctors based on superficial TSH tests and statistically broadened T4 and T3 normative ranges, have had hypometabolism for decades.  A lot of damage accumulates in a year, let alone many decades.   Gut permeability, for example, directly feeds the inflammatory responses.  These can be meta-stable compensations, the undoing of which is not simple relaxation or attenuation of a single, independent influence.  Compensations can be tangled with each other.

A thyroid trial has to be sustained, because you need to empirically assess the shape of the inverted-U-shaped dose-response curve.  To do this, you have to go over the top of the curve, to find out what “too much” is, so that you can make an educated guess about the “right” amount.  The right amount is somewhere between “too litle” and “too much.”  This empirical “bracketing” of ideal thyroid influence has other advantages because it takes into account any anti-thyroid influences that may be present, like heavy metal burden (we all have some), estrogenic chemicals (from drinking bottled water, for example), or elevated polyunsaturated fatty acid levels (from taking flax or fish oils).

Many doctors do not understand the limited dangers of mild hyperthyroidism, having been taught in medical school by reference to acute hyperthyroid disease.  But mild hyperthyroidism is easy to measure (objectively), relatively easy to notice (subjectively), and quickly reversible.  The best thing to monitor is pulse rate.  Next, body temperature.  So if you can be conscientious with those two assessments, the dangers are trivial.  They are much, much less than the chronic and cumulative dangers of living with adrenal compensation for hypometabolism for decades.

IMO, the adrenal support via low-dose cortisol replacement therapy (bioidentical) or prednisolone (the hydrogenated pharmaceutical analog) is a prerequisite for a thyroid trial.  Adrenal and thyroid hormones are mutually dependent, and any instabilities of adrenal hormone will sabotage the assessments from the thyroid trial.  But with low-dose adrenal replacement, the thyroid trial has the highest likelihood of “dialing in” the thyroid hormone needed to restore primary energy regulation mechanisms, after which the adrenal support becomes unnecessary and can be titrated to zero.  After the adrenal support is successfully withdrawn, fine-tuning of the thyroid dose can be accomplished.  And with a large measure of biological competence re-established, you can then seek to optimize other energy-support systems and remove energy-sabotaging influences to try to reduce your thyroid dependence.

It takes less time to correct malfunctioning systems than it did to cause them in the first place.  You’ve been adrenally compromised for at least ten years and thyroid compromised for at least twenty years.  I SWAG that it will take you about three months to do the thyroid trial, another three months to overcome your sleep deficit, and about 1-2 years to restore your adrenal competency.

Sleep architecture would be on the “wish list” (dream team?) as a wonderful thing to to monitor during a thyroid trial.  Full EEG monitoring in a sleep lab is not only unaffordable, but impractical.  However, the Zeo device is affordable ($200) and practical (wearing a head-band to bed, and dumping the night’s data to your computer the next day).  Ask that it be prescribed!  Even though the single EEG sensor is grossly inadequate from any kind of scientific/technical perspective, this flaw is more than overcome by 1) the high bandwidth of data from nightly testing, and 2) testing in your own bed, in your own bedroom, in your own apartment (a highly beneficial effect on your brain’s reticular activating system).   So the low-quality sensor data of your sleep in a natural environment, day after day, is actually much better than a few high-quality sleep tests in a foreign sleeping environment (the sleep laboratory).

Please show this to your doctor.   —Steve

PS:  In specific answer to your question:  the same nutrients that benefit healing in your body will benefit your adrenal:  B-complex vitamins (coenzymes), electrolytes (macronutrients), trace minerals (micronutrients), medium chain triglycerides (for energy), aerobic exercise (can be daily), strength-training exercise (1-3 times per week only), water (hydration), air (breath)–you know, all the basics.   —Steve

PPS:  If you want a low-cost, accessible medical/scientific assessment of one fundamental aspect of adequate metabolic rate, ask your doctor to do potassium-utilization testing.  This correlates oppositely with cellular hydration, so it is very important in two different ways.   The expensive way to do this is to measure 1) serum potassium ($15), and 2) cellular potassium (about $100-200).  The inexpensive way to do it is to measure 1) serum potassium ($15), and 2) total-blood potassium ($15).  These two tests are both done on a serum-potassium testing device.  The serum sample is merely 10cc of whole blood, which the lab centrifuges (spins down) to separate the potassium-rich red and white blood cells from the serum, which is then “skimmed off” and tested in the serum equipment.  No rocket science involved.  The total-blood-potassium sample is 1cc of whole blood dissolved in 9cc of distilled or deionized water, which does not need to be centrifuged (but can be centrifuged to maintain standard procedure in the lab).  But there is a “standard procedure” that needs to be bypassed:  the lab techs are trained to throw away hemolyzed samples.  Lab technicians look at the serum samples for even the slightest hint of pink color, which occurs when red blood cells burst, which releases potassium and hemoglobin (which spoils the test, and colors the sample pink, respectively).  The more pink, the more spoiled the result.  But any pink is bad.  The 1cc-in-9cc sample will bright red (ultra-pink, to the max).  So your doc needs to put a note rubber-banded around the 1-in-9 sample that says, “Test hemolyzed sample.  Don’t discard!!!!!!!”  And I suggest adding another note rubber-banded around both samples which says, “One of these samples is a hemolyzed sample.  We know it is a hemolyzed sample.  The sample is deliberately hemolyzed, so do not discard it!  Run the hemolyzed sample through the serum-test equipment just before or just after the un-hemolyzed sample that is also enclosed.”  Then, when you get the results, multiply by ten to restore the units and correct for the ten-to-one dilution.  Then plot the results on a graph with serum reading on the Y axis and total-blood reading on the X axis.  Then draw an arrow from the center point (4.5 meq/l serum and 38 meq/l total-blood) to the test-result point.  If the arrow points down and to the right, you have hypometabolism.  This can be described as “potassium over-utilization” (or water under-utilization, or edema).  The length of the arrow is the severity.  If it points up and to the left, you have hypermetabolism (potassium under-utilization).  Up and to the right is potassium over-consumption (you really like veggies), and down and to the left is potassium deficiency (you hate veggies, or really like salted snack foods).  If you repeat this test as your thyroid slowly increases, you should see a trend where the test result moves from the fringes of the potassium-overutilization quadrant towards the center point.   —Steve