Post by Chris Jackson on Nov 19, 2008 18:20:26 GMT -5
Keep in mind, this article contains my opinions and are not necessarily proved medical facts. The aim of this article is to express that taking steroids is not to be taken lightly, especially in self treating, but not scare anyone from using steroid to try to heal and treat their adrenals. Written by Chris Jackson July 23, 2006.
When it comes to cortisol replacement, I noticed from a long time ago to the present, the people who do best (tests showing more than fatigue) are taking 25 to 30 mg of Hydrocortisone. This I've seen from being on several Addison's groups, adrenal fatigue, pituitary and thyroid groups. I can't say how many times I've told someone that the 5, 10, 15, 20 mg they were taking obviously wasn't helping them. I've never seen anyone that I thought those low doses WERE helping them. I advocate taking the lowest possible dose that will make them feel good. Below 25 just doesn't seem to do it though.
If tests show primary fatigue (I go by if tests look fine, but they have slight symptoms of low cortisol. This is my opinion of how fatigue should be diagnosed, anything else is adrenal insufficiency, others may have a different opinion), then I've recommended a handful of times that they take the lower doses of 15 -20 mg to try and rest the adrenals and taper off after a month to see if the adrenals come back. The problem is I very rarely see numbers that suggest just fatigue as I define it.
Taking more than 15 mg does increase the risk that cortisol production will be permanently suppressed if trying to bring them back is the goal, but I have yet to hear anyone I've recomended or others who have recommended taking the lower doses to rest and heal their adrenals and those people say later that they tapered and their cortisol production came up and they felt their adrenals were healed (other mods on these forums say that they have seen this).
I think the most important thing is to consider before determining the dose is IF the adrenals might have a chance to get "fixed". I do take the idea of replacement suppressing the adrenals very seriously. I try to explain to people that suppressing the adrenals is not to be taken lightly when deciding treatment and that there is a chance that once the steroid is started, they could be on it for life.
In the last 3 years, I've seen around 7 people who said they cured their primary AI or fatigue and I agreed with 3 of them that they may have accomplished this. . I've never seen anyone retest (ASI, random cortisol, ACTH stim) to see what was really happening with their natural cortisol after weaning. Keep in mind that just because you are successful in weaning off of the steroid, even if you feel better, doesn't necessarily mean you actually healed your adrenals.
I have a theory of why healing adrenals is so difficult to impossible. By the time most people are diagnosed, they've had AI for many years and their adrenals are just to messed up to come back. I've never seen anyone say their AI was diagnosed just a few months after symptoms of AI started, not counting those who got spontaneous Addison's that almost kills them over night (I have seen a handful that went from totally healthy to Addison's almost killing them in a couple of weeks).
I do recommend everyone after 30 days try to slowly taper, just in case they might be lucky that their adrenals will be healed. If unsuccessful, try again at 60 and 90 days under a docs care. Secondaries are not likely to be successful tapering (since adrenals are not the problem) as their low acth will be suppressed more with the replacement and likely won't want to come up to even where it had been before when the tapering is tried.
If you find yourself in the debate of suppressive vs supportive dosing of cortisol, just ask them this question. "How many people have you seen say their cortisol production came back to healthy levels and they felt their adrenals were all the way healed after tapering and they had tests to support that" If they say they've seen this, ask them to give you names so you can ask them yourself and see if they have had testing to support their adrenals really are healed. They may be able to give names, but I bet none had further cortisol testing after tapering off the steroid.
That I've seen virtually no ones adrenals gets fixed after trying to taper the steroid is a big fact that is overlooked (again other mods on these forums say they have seen this, but in most if not all cases, no tests to confirm their adrenals really are healed) and I'm not sure why that is. Where are the people that healed their adrenals, why aren't they helping others do it?
How high a dose of steroid it takes to receive the proper amount of thyroid hormones? I suspect it takes a full dose because of the fact that it takes full suppression to reach an optimal dose.
(see this sticky forums.realthyroidhelp.com/viewtopic.php?t=239)
How to treat with and dose steroid properly is a debate that will never be settled. Interpreting tests and deciding treatment protocol is just to subjective.
This articles intention is not to try to sway you from trying to heal your adrenals, but to show that of my observations of very many people, it is my opinion that the adrenals are extremely difficult to heal.
More stickies on supplement site
When it comes to cortisol replacement, I noticed from a long time ago to the present, the people who do best (tests showing more than fatigue) are taking 25 to 30 mg of Hydrocortisone. This I've seen from being on several Addison's groups, adrenal fatigue, pituitary and thyroid groups. I can't say how many times I've told someone that the 5, 10, 15, 20 mg they were taking obviously wasn't helping them. I've never seen anyone that I thought those low doses WERE helping them. I advocate taking the lowest possible dose that will make them feel good. Below 25 just doesn't seem to do it though.
If tests show primary fatigue (I go by if tests look fine, but they have slight symptoms of low cortisol. This is my opinion of how fatigue should be diagnosed, anything else is adrenal insufficiency, others may have a different opinion), then I've recommended a handful of times that they take the lower doses of 15 -20 mg to try and rest the adrenals and taper off after a month to see if the adrenals come back. The problem is I very rarely see numbers that suggest just fatigue as I define it.
Taking more than 15 mg does increase the risk that cortisol production will be permanently suppressed if trying to bring them back is the goal, but I have yet to hear anyone I've recomended or others who have recommended taking the lower doses to rest and heal their adrenals and those people say later that they tapered and their cortisol production came up and they felt their adrenals were healed (other mods on these forums say that they have seen this).
I think the most important thing is to consider before determining the dose is IF the adrenals might have a chance to get "fixed". I do take the idea of replacement suppressing the adrenals very seriously. I try to explain to people that suppressing the adrenals is not to be taken lightly when deciding treatment and that there is a chance that once the steroid is started, they could be on it for life.
In the last 3 years, I've seen around 7 people who said they cured their primary AI or fatigue and I agreed with 3 of them that they may have accomplished this. . I've never seen anyone retest (ASI, random cortisol, ACTH stim) to see what was really happening with their natural cortisol after weaning. Keep in mind that just because you are successful in weaning off of the steroid, even if you feel better, doesn't necessarily mean you actually healed your adrenals.
I have a theory of why healing adrenals is so difficult to impossible. By the time most people are diagnosed, they've had AI for many years and their adrenals are just to messed up to come back. I've never seen anyone say their AI was diagnosed just a few months after symptoms of AI started, not counting those who got spontaneous Addison's that almost kills them over night (I have seen a handful that went from totally healthy to Addison's almost killing them in a couple of weeks).
I do recommend everyone after 30 days try to slowly taper, just in case they might be lucky that their adrenals will be healed. If unsuccessful, try again at 60 and 90 days under a docs care. Secondaries are not likely to be successful tapering (since adrenals are not the problem) as their low acth will be suppressed more with the replacement and likely won't want to come up to even where it had been before when the tapering is tried.
If you find yourself in the debate of suppressive vs supportive dosing of cortisol, just ask them this question. "How many people have you seen say their cortisol production came back to healthy levels and they felt their adrenals were all the way healed after tapering and they had tests to support that" If they say they've seen this, ask them to give you names so you can ask them yourself and see if they have had testing to support their adrenals really are healed. They may be able to give names, but I bet none had further cortisol testing after tapering off the steroid.
That I've seen virtually no ones adrenals gets fixed after trying to taper the steroid is a big fact that is overlooked (again other mods on these forums say they have seen this, but in most if not all cases, no tests to confirm their adrenals really are healed) and I'm not sure why that is. Where are the people that healed their adrenals, why aren't they helping others do it?
How high a dose of steroid it takes to receive the proper amount of thyroid hormones? I suspect it takes a full dose because of the fact that it takes full suppression to reach an optimal dose.
(see this sticky forums.realthyroidhelp.com/viewtopic.php?t=239)
How to treat with and dose steroid properly is a debate that will never be settled. Interpreting tests and deciding treatment protocol is just to subjective.
This articles intention is not to try to sway you from trying to heal your adrenals, but to show that of my observations of very many people, it is my opinion that the adrenals are extremely difficult to heal.
More stickies on supplement site