A normal functioning adrenal gland produces a whole array of hormones but of particular interest is cortisol. The adrenal gland of a healthy person produces about 20mg of cortisol each day which can increase 10 fold during periods of stress. Cortisol is responsible for maintaining normal blood sugar levels, it immobilises fat and protein stores for more energy, it is a anti-inflammatory, controls and modifies most blood cells that participate in immune and/or inflammatory reactions, effects blood vessels and therefore blood pressure, and electrolyte levels in the heart tissue, heart beat, as well as influencing the central nervous system controlling mood and behavior.
During stage 1 adrenal exhaustion cortisol levels increase in response to stress and declining levels of DHEA. During this stage elevated cortisol levels can increase obesity, cholesterol, blood pressure, alters brain chemistry which causes depression and anxiety, causes insulin resistance and osteoporosis, to name a few. Therefore it is important to take action and help reduce excessive levels. Due to the inverse relationship between DHEA and cortisol by supplmenting DHEA at this stage cortisol usally returns to normal of its own accord. In resistant cases where this does not occur extra supplementation with either 120mg of Beta Sitosterol with B vitamins or by using 600mg of phosphatidyl serine have been reported to reduce excessive cortisol levels. Our lab produces a combination capsule containing beta sitosterol with the B vitamins specifically formulated to reduce high cortisol -click here to order.
In cases where stage 1 is left untreated the adrenal exhaustion progesses into stage 2 and stage 3 where the extra supply of cortisol eventually runs out leaving depleted DHEA and cortisol levels resulting with chronic fatigue type symptoms. During this later stage adrenal exhaustion diminished cortisol levels results in inadequate control of its many and various functions (mentioned above) thus maintaining normal physiological function becoming nearly impossible and worsens fatigue like symptoms. It is in these cases where the patient can greatly benefit from a low dose cortisol supplement in combination with DHEA.
Unfortunately for many late stage adrenal exhaustion suffers cortisol is almost always ignored by doctors due to its undeserving bad reputation. The lucky few that may have a doctor open minded enough to use DHEA often still ignore cortisol. In this case the total picture is not being adequately treated so will only result with a limited improvement in symptoms.
In cases of chronic fatigue Dr Martin Pall, a professor of biochemistry, has explained the relationship of cortisol with the nitric oxide cycle (NO/ONOO). This cycle when out of control potentially being the cause of CFS. He hypothesised that “Cortisol (and other glucocorticoids) is known to lower the induction of the inducible nitric oxide synthase (iNOS) and may have a substantial role, therefore, in controlling nitric oxide levels. A deficient cortisol response to exercise may lead, therefore, to increased nitric oxide levels after exercise in CFS patients vs. controls, leading, in turn, to up-regulation of the NO/ONOO- cycle.” Potentially low cortisol levels in late stage adrenal exhaustion may increase the nitric oxide pathway and worsen symptoms.
Fears of Cortisol Use
Many physicians have a very negative reaction at the suggestion of supplementing cortisol when proven to be low. Cortisol’s bad reputation has to do with the fact that at higher pharmacological doses (50 to 100mg) cortisol can produce an array of undesirable side effects associated with hypercortisolism. However what is not known by many physicians is that at low physiological replacement doses (10 to 40mg) its long term use is considered safe and effective – as you are only replacing what the body requires for normal physiological functioning but is unable to produce itself due to illness. Remember a healthy body is meant to produce about 20mg a day for normal function and up to 200mg during periods of stress. If the body is unable to produce this amount then we need to supplement the difference for normal healthy function. The usual starting dose used is 10 to 20mg daily and is only increased in cases where further tests indicate more is required. Doses in excess of 40mg a day is usually where symptoms of hypercortisolism may result with long term use and is dose dependant. This means the higher the dose the more pronounced the side effects. However staying below this dose usually eliminates any side effects.
Suppression of the bodies own production of cortisol is another concern for most practitioners that prevents them from trying cortisol supplementation. What they do not understand is the fact that cortisol supplementation is only used when levels are shown to be low so in reality there is really very little adrenal function left to suppress anyway. There are far greater advantages in supplementing cortisol safely and achieving tremendous symptomatic relief rather than not using it due to concerns of suppressing an already underactive function and thus giving no relief for their patients. Once appropriate physiological levels have been achieved and the adrenal glands has had time to heal (6 to 18 months) the dose should be reduced gradually over time in order to overcome any adrenal suppression that may have occurred. In any case in healthy individuals complete suppression occurs at doses in excess of 40mg daily with only partial suppression at lower doses. Again staying below this dose minimizes any suppression that may occur.
Finally the catabolic effects of cortisol often feared can be prevented with concurrent treatment with an anabolic hormone such as DHEA which prevents the tissue wasting effects of cortisol. In addition the use of both hormones mimicks a healthy bodies normal reaction to stress consisting of increased production of both DHEA and cortisol in relatively equal amounts.
Cortisol can be used safely to help treat symptoms of fatigue due to late stage adrenal exhaustion and should only be used in cases where test results indicate levels are below the optimal range. Therefore if your test results indicate that your current levels are not in the middle to upper one third of the normal physiological range then you could possibly benefit from cortisol supplementation. Once supplementation has been initiated on either 10 to 20mg daily it should be monitored correctly through blood or saliva testing and appropriate dose adjustments made as required in order to achieve optimal physiological levels.
We only recommend the use of bioidentical cortisol, also known as hydrocortisone, as opposed to the much more potent synethic derivatives of cortisol such as cortisone acetate, prednisone or dexamethasone which all are more likely to produce unwanted side effects compared to cortisol.
The hormone precursor pregnenolone may be used as an alternative to cortisol to help boost the bodies own production of cortisol however this process relies on four consecutive enzyme conversions any of which may not occur efficiently thus bringing the whole process to a stand still resulting with little to no increase in cortisol levels. This method is less predictable and unsuccessful in many cases. It may require high doses of pregnenolone in some cases to achieve any significant cortisol production which can then upset the balance of other hormones as pregnenolone is a precursor for other hormones as well.
Synthetic derivatives of cortisol such as prednisone, methylprednisolone and dexamethasone work better for tempory relief of acute inflammatory diseases however cortisol is best for most long term treatments involving low energy or mood, fatigue, low blood pressure and low cortisol states.
- cortisol should not be used when it is not needed
- should not be used when anabolic hormone levels are insufficient to counter cortisols catabolic effects.