All About Adrenals:
Did you know that thyroid problems and adrenal issues go hand in hand? Through studying thyroid patients over the years, we have discovered that one cannot be optimal without the other being optimal. Doctors often ignore this fact, and patients are left wondering why they are still sick and exhausted even after treating their thyroid.
Signs of Adrenal Issues:
If you are hypothyroid and you have any of the following signs, you very possibly could be suffering from an adrenal problem. Symptoms can include anxiety for no apparent reason, extreme defensiveness where you feel like you must argue, intense startle response (even to small noises) internal shakiness, hyper-like symptoms when attempting to raise your naturally desiccated thyroid or T3 only medication, sleeping problems including insomnia, OR falling asleep easily but then waking repeatedly through the night, OR waking up at 3-4 a.m. and being unable to go back to sleep. You also may think you are sleeping “fine”, but may wake up feeling completely unrested, exhausted and drained. Some describe waking up with hang-over symptoms, even though they had no alcohol consumption. Some discover as they are working our as usual, they collapse with complete muscle failure, or take weeks to recover form a workouit vs days. (Exercise demands cortisol, thta you may be making too much of or too little!)
As stated above, adrenals and thyroid work hand in hand. When you have been mis-treated with T4 only medication such as Synthroid, Levoxyl, or the other synthetic T4 versions, when you have been under-dosed on NDT, because your doctor is driven by the TSH (pituitary hormone test) rather than your actual thyroid tests, or if you have had extreme stress of any kind, whether physical, mental, or any other kind, your adrenal glands were probably working extremely hard to keep you going. When any of these situations arise, the first response of your adrenal glands is to produce a huge amount of cortisol (our fight or flight hormone). At this point, you may have extremely high cortisol readings on a saliva test. However, if your adrenal glands continue to pump out this massive dose of adrenaline and cortisol, eventually cortisol begins to fall, as your body simply cannot keep up with the high demand. Once this happens, you will see low cortisol on various times of the cortisol test. If there is still no relief of whatever stress your body is going through, your cortisol can then plummet, and you will see low and very low readings on your saliva cortisol test. Once this happens, it can also cause your aldosterone to fall, causing a myriad of other symptoms.
What is cortisol and why do we need it?
Cortisol is a corticosteroid hormone, which is commonly known as your fight or flight hormone. Because most bodily cells have cortisol receptors, it affects many different functions in the body. Cortisol can help control blood sugar levels, regulate metabolism, help reduce inflammation, and assist with memory formulation. It has a controlling effect on salt and water balance and helps control blood pressure. Another vital function of cortisol is to help guide T3 into the cells. So, when adrenals are acting up, T3 is often not reaching your cells, which is vital to your overall health and wellbeing.
How does this affect my thyroid?
When your adrenals are not working properly, it has a direct impact on your thyroid and your treatment of your thyroid. Often low or high cortisol can cause a phenomenon called Pooling (again, for lack of a term, we still continue to use this), which is a simple way of saying your T3 begins to accumulate because it is no longer able to be properly utilized. This may be a gradual process that one does not even notice at first, often causing hypo symptoms to return. It may start being a bit more obvious when there is an increase in nervous feelings, anxiety, shakiness, dizziness, heart palpitations or irregular heartbeat with a high pulse, or any sort of inability to raise your thyroid medications.
What do you mean by cortisol pattern?
A normal pattern would be cortisol at the top of the range upon rising, and then falling in increments until at the very bottom of the range at night, enabling you to arise refreshed and sleep. This is called the Circadian Rhythm. An HPA Axis Dysregulation will not follow this pattern, will give you either too much cortisol at the wrong time of the day getting rid of i.e., Janie over uses it night, so you are unable to sleep) or too little (i.e. at morning waking, so you are unable to function properly). Doctors often direct a patient to a one-time blood test, an ACTH Stim test or a 24-hour urine test where all the samples are mixed and averaged out. These are tests for Adrenal Insufficiency Diseases. We are testing for HPA Axis Dysregulation, MUCH more common! None of these blood and urine tests reveal an accurate picture of what is going on over a 24-hour period, and therefore adrenal glands are left untreated or misdiagnosed, causing an inability to become optimal with your thyroid.
Testing for adrenal problems:
Because thyroid and adrenals work hand in hand, it is vital to test and treat cortisol levels. The very best way to see if your adrenal glands are struggling with an HPA Axis Dysregulation, is to test via a four-point saliva test. Over the years, various tests have been tried and studied and the most accurate that patient experience has revealed is the four-point saliva test, which measures free cortisol at the cellular level at four vital points of the day, upon rising, mid-day, evening and night.
Blood tests measure both bound and unbound cortisol and often doctors do not run them at all four times of the day, so you do not have an accurate picture of what your adrenals glands are doing in the case of an HPA Axis Dysregulation. FREE cortisol is what is available for use by your body. Blood cortisol measures TOTAL cortisol, so both bound (not usable) and unbound (usable) cortisol, these tests are for rare Adrenal Insufficiency Diseases. A four-point saliva test can be ordered on your own, and then the results are compared to our optimal cortisol chart. The reason we usually must order our own, is that most doctors do not understand the importance of where cortisol should sit at the four times of the day.
The four-point saliva test is imperative to show you what is actually happening at each time of the day. Over the years, studies have shown how people react to treating these patterns with natural supplements that allow their body to heal and return to a natural circadian rhythm.
To order the correct test, please see the link on cortisol testing. We also have a list of supplements and medications that can impact the saliva test. Before doing the test, please study the list carefully.
Cortisol related diseases:
There are two major diseases that doctors will often test for. One is Cushing’s Disease, usually caused by an ACTH producing tumor on either the pituitary gland or the adrenal glands. This is a very rare disease, which causes extremely high cortisol. For the most part, high cortisol on a saliva test simply points to overworking adrenal glands, not to Cushing’s Disease. If you do have four extreme highs on a saliva test, you can ask your doctor for the most accurate test for Cushing’s which is the dexamethasone suppression test. This test will show if you have a tumor that is producing cortisol. If not, you can treat your high cortisol naturally, and bring your highs down to a normal level without any extreme interventions.
The other diseases that doctors like to check for are Primary Adrenal Insufficiency (Addison’s Disease) and Secondary Adrenal Insufficiency which are marked by extremely low cortisol and the inability to produce your own cortisol. Primary Adrenal Insufficiency is due to the adrenal glands themselves being unable to make cortisol, for various reasons, often benign tumors. Secondary Adrenal Insufficiency is due to an issue on the pituitary gland not sending the hormone ACTH to the adrenal glands that tells them to make cortisol. Again, these are very rare diseases, and most low cortisol on a saliva cortisol test, is a result of the overworking of the adrenal glands and can be treated safely with the supplement adrenal cortex taken in the right amounts in the right pattern (ACE) or if absolutely necessary HC. We do always try the least invasive method of raising our cortisol.
Heading in the right direction:
If you do have one or more of the symptoms pointing to an HPA Axis Dysregulation, do not be scared. With the help of a four-point saliva test, and all the information gleaned from thousands of thyroid/adrenal patients, the proper supplements can be taken at the proper times, and your cortisol pattern can return to normal, allowing your body to repair and your thyroid to become optimal.
Hormones and Adrenals:
It is important to understand that it is pointless to try to balance hormonal issues until the adrenal/blood sugar issues are addressed.
Chronic stress response in your body equals a chronic amount of cortisol being put out by your adrenal glands.
The Adrenals are responsible for making the glucocorticoids cortisol and adrenaline that regulate blood sugar and inflammation and the mineralocorticoids, the main one being aldosterone, that helps to regulate sodium and potassium. They are responsible for our fight or flight response to emergencies. Emergencies perceived by the adrenal glands can be anything from regular sugar consumption to emotional stress, digestive and or nutritional problems and diseases, like Hypothyroidism.
Let me explain briefly how blood sugar and adrenals are connected:
When we are consuming too much sugar, the pancreas pumps out as much insulin as it can to deal with blood sugar spikes in our blood. When this happens, we have a substantial drop in blood sugar after that substantial rise, and our energy production drops dangerously low. This is an emergency situation for the liver, which is trying to convert glycogen back into glucose (glycogenolysis). This takes time, and there is no time, so the adrenals now sensing this emergency put out cortisol and adrenaline to immediately bring up blood sugar levels. Our adrenal glands are meant to be there for emergencies only, but we have put them in the front line, eating high sugar diets and living lives filled with emotional stress, toxins stimulants, digestive issues and nutritional weaknesses. This causes the adrenals to not function as well as they should be.
The liver does many things; it turns off hormones that are in excess or are no longer working. These hormones have to be broken down and joined and removed from the body.
Chronically high cortisol levels inhibit the ability of the liver pathways to join the broken-down hormones and get rid of them.
The Pancreas which puts out insulin as it is needed, has insulin receptors on cells that will not respond properly to insulin when cortisol is chronically elevated. This puts a huge burden on the pancreas to put out even more insulin to be able to transport glucose into cells. Constantly putting out insulin leads to high insulin levels and all the issues that go along with that. Metabolic Syndrome, Insulin Resistance, and eventually full-blown Diabetes.
Adrenal function is a priority over reproduction, metabolic rate and other endocrine functions. Because of this, our adrenal glands are allowed to “steal” nutrients and precursors to hormones from other areas of the endocrine system as they see fit.
Precursor hormones like pregnenolone and DHEA, and even progesterone (hormones that can convert into other adrenal and sex hormones) should not be taken when the adrenals are depleted already. It is the adrenal glands that remove and condense pregnenolone from the bloodstream. The gonads (ovaries in women, testes in men) manufacture their own pregnenolone from cholesterol.
Making pregnenolone into cortisol is a catabolic process that requires extreme use of the body’s energy. Only so much pregnenolone can be made by the body.
The gonads will release pregnenolone to help make more cortisol when it is needed, depleting your sex hormones. Taking pregnenolone, progesterone or DHEA at this time will only fuel the adrenal stress response, further increasing cortisol production vie stealing of other hormones.
So, if our adrenal glands have been called upon to handle blood sugar regulation on a regular basis, to function in a constant state of fight or flight, pumping out cortisol and adrenaline on a regular basis, the only hope for them to survive, is to steal from other areas of the endocrine system, leaving the other areas of the endocrine system, depleted.
It is best to work on your blood sugar regulation and adrenals, work on getting your thyroid levels optimal and how you deal with stress BEFORE you begin to work on sex hormones, so that the adrenals have no need to steal hormones from other areas in the endocrine system.
Medical Studies showing the benefit of salivary cortisol:
Utility of salivary cortisol measurements in Cushing’s syndrome and adrenal insufficiency.
http://www.ncbi.nlm.nih.gov/pubmed/19602555
Automatic emotional information processing and the cortisol response to acute psychosocial stress:
http://www.ncbi.nlm.nih.gov/pubmed/20233956
Trait anxiety moderates the impact of performance pressure on salivary cortisol in everyday life:
http://www.ncbi.nlm.nih.gov/pubmed/16377094
The effects of perceived stress, traits, mood states, and stressful daily events on salivary cortisol:
http://www.ncbi.nlm.nih.gov/pubmed/8902896