Cortisol issues of any kind often come with low levels of Aldosterone, it is even more common with low cortisol.
What exactly is aldosterone?
Aldosterone is a steroid hormone, as is cortisol. Aldosterone is produced in the outer cortex of your adrenals (also produced there are cortisol, testosterone, DHEA, DHEAS, androstenedione and estrogens). Aldosterone is one of the important mineralocorticoids. It is essential for sodium conservation in the kidney, salivary glands, sweat glands and colon. It plays a central role in the regulation of blood pressure, plasma sodium, and potassium levels. It influences the reabsorption of sodium and excretion of potassium (from and into the tubular fluids, respectively) of the kidney, thereby indirectly influencing water retention or loss, blood pressure and blood volume. When dysregulated, aldosterone is pathogenic and contributes to the development and progression of cardiovascular and renal disease. As you can see, this is a rather important steroid hormone of yours!
What can activate aldosterone secretion?
Several things can activate your aldosterone secretion:
Potassium levels raising too high
Sodium drops too low
Reduced blood flow to your kidneys
Dropping of blood pressure
Several things can cause aldosterone secretion to drop:
Potassium levels fall
Increased blood flow in your kidneys
Increased blood volume
Eating too much salt.
What should I expect with high Aldosterone?
When aldosterone becomes too high your blood pressure also becomes too high and your potassium levels become too low. You can have muscle cramps, muscle weakness, and numbness or tingling in your extremities, poor vison, confusion and headaches, which are common symptoms of low potassium. High Aldosterone can happen due to stress and high cortisol.
What should I expect with low aldosterone?
Many with low cortisol (even those with a stray high cortisol shown on a four point in the day saliva cortisol test) end up with low aldosterone. Your kidneys will excrete too much salt, and it leads to frequent urination, low blood pressure, dizziness, lightheadedness when you stand (some actually pass out), low blood volume, a high heart rate, fatigue and salt cravings. Other symptoms of low aldosterone can also include sweating, a slightly higher body temperature, and a feeling of thirst, besides that intense craving for salt. Potassium can rise too high in the beginnings of low aldosterone, then fall, as it progresses lower.
Animals love to lick salt, a clue you may want to test Aldosterone is your pets licking your legs, arms, etc. The low aldosterone is pushing the salt out of your body, and it is on your skin.
Another clue that your aldosterone may be too low is not being able to find stable DAT’s and raising your HC or ACE too high (example for women might be 30-40 mg of HC, higher for men. Or if on ACE, 7, 6, 4, 1). Constantly chasing stable DAST’s at such high doses is highly indicative of low aldosterone.
Does sea salt help low aldosterone?
If your testing shows that Sodium is low (it often is with low aldosterone due to the salt wasting it causes), and your Aldosterone results come back as above mid-range, but not top of range, sea salt can help to alleviate the symptoms and stop the salt wasting. Unrefined sea salt or pink Himalayan salt contain all the trace minerals. Table salt has had all those minerals removed, this is why it is so very white! Patient experience has shown that adding in ¼ to ½ a teaspoon of unrefined sea salt or pink Himalayan salt van be very beneficial in low aldosterone. If testing sodium shows you still need more, you can add more. Remember, too much salt/sodium can reduce aldosterone even lower, testing sodium is important! Potassium also supports aldosterone, so this is extremely important to test as well, and raise when necessary. Potassium must be tested with the tourniquet OFF the arm, no fist pumping, gripping a ball, or fist clenching, these things will falsely elevate your potassium test results. (Pub-med and other medical studies have articles on this, and they are at the bottom of the page)
What is the best way to test aldosterone, and how do I know if I have an issue when they come back?
Practitioners often test aldosterone via a blood test or a 24-hour urine test, we have found the blood test to be preferable. It is important to have no salt intake for 24 hours before testing so as not to change the results. It is best to test 2 hours after waking, moving around as you usually would, as aldosterone is highest in the morning. Many will test around 8:00 AM. Progesterone affects aldosterone levels, because of this, cycling women test while menstruating when progesterone is at its lowest in the cycle. If you are supplementing progesterone, you will want to be off it for 2 weeks before testing. For the whole picture of what is going on, ask your practitioner to include renin, sodium and potassium in your testing.
NOTE: aldosterone levels can double while you are pregnant and are normally a little higher in children than in adults.
Is there anything I can do at home to help confirm I need to test aldosterone?
Blood pressure:
Take your blood pressure and compare two readings—one while lying down (some do while sitting, but lying down seems to be better) and one while standing. Wait for five minutes while lying down before taking the first reading. Stand up and immediately take the blood pressure again. (If you have dizziness on standing normally, please be sure to have someone with you when doing this)! In those with healthy aldosterone, it will rise 10-20 points in its push to get blood to your brain or at the very least, it will remain the same. If the blood pressure lowers after standing, you can suspect reduced adrenal function, and more specifically, an aldosterone issue. The amount the blood pressure drops when standing is often proportionate to the degree of hypoadrenalism. It is a good idea to do this test both in the morning and the evening, since the time of day can affect these readings in some people.
It’s important to measure one’s blood pressure with your arm perpendicular to your body i.e. about the same height as your heart and RESTING your arm on something, so you are not using your muscles to hold your arm up.
Pupil test:
This primarily tests your levels of aldosterone. You will need to be in a dark room with a mirror. From the side (not the front), shine a flashlight or penlight towards your pupils and hold it there for about a minute. Carefully observe the pupil. With healthy levels of aldosterone, your pupils will constrict, and will stay small the entire time you shine the light from the side. In low aldosterone, the pupil will get small, but within 30 seconds, it will enlarge again or obviously flutter in its attempt to stay constricted. Why does this occur? Because low aldosterone causes a lack of proper amounts of sodium and an abundance of potassium. This imbalance causes the sphincter muscles of your eye to be weak and to dilate in response to light.
Patient experience has shown that when someone has low aldosterone symptoms (less than optimal sodium levels, craving of salt, urinating more at night, sweating more, failure to find stable daily average temps for HC or ACE, blood pressure that does not rise when standing, etc.), they tend to fall mid-range or lower in lab results. When someone does NOT have low aldosterone, they tend to fall at the top of the range.
IMPORTANT NOTE FOR WOMEN: It’s strongly recommended by practitioners to test your aldosterone in the first week of your menstrual cycle (i.e. the week you start bleeding),
or up until the beginning of the week after–this is when progesterone is at its lowest. Progesterone can drive your aldosterone up falsely,
and progesterone begins to rise at the end of the second week of your cycle.
Is there medication I can take for very low aldosterone?
Fludrocortisone acetate is the medication most Dr’s use. The brand name was Florinef, yet that seems to be no longer available, many still call it that. Florinef is a steroid with mineralocorticoid properties. Patient experience has shown that starting with a 1/4 pill (0.025 mcg or 0.25 mg) and raising by that same amount every 7-10 days until they get to 100 mcg (0.1 mg) rather than beginning at such a high dose. This should be taken with sea salt mixed in water for the best results. Many notice fairly quickly they are doing better, others may need about 2 weeks.
Florinef is a very powerful treatment, one reason we begin low and work up every 7-10 days, as we want to use the least amount that is therapeutic for us. Going up to 100 mcg is common, but some need less. You will know if you are on too much if if your blood pressure raises too high and your potassium drops significantly.
Some who are on HC, find that they have to lower their dose of HC, due to the glucocortocoid potency of Florinef.
Please discuss this with your Dr for more information.
Blood pressure readings at laying down and standing as described above, should be done at each raise to see if that standing blood pressure has raised. The right amount of Florinef will have the blood pressure at standing higher than the blood pressure laying down. It is VERY important that you track your blood pressure, pulse, and your sodium and potassium levels while treating with Florinef.
Why would I need both Florinef AND HC or ACE since they are all steroids?
Florinef better imitates what Aldosterone does and HC or ACE better imitate what cortisol does. Florinef has more mineralocorticoid activity like aldosterone does. This means it controls potassium, sodium and water levels by encouraging sodium retention in your kidneys. When aldosterone is low, you urinate frequently losing sodium because of that.
HC or ACE better imitate what cortisol does. They have glucocorticoid activity like cortisol does. This means they control carbohydrate, fat and protein metabolism and are anti-inflammatory. They allow thyroid hormones to get into your cells.
So, what this shows you is that HC or ACE will not help you to retain sodium and Florinef will not help to get thyroid hormones into your cells!
Gluten-free aldosterone treatment: Barr Pharmaceuticals (the parent company is Teva Pharmaceuticals) is a maker of generic Florinef, they claim that their product is gluten free. The starches are potato and corn sourced.
For more detailed medical reading:
Renal Tubular Effects of Hydrocortisone and Aldosterone in Normal Hydropenic Man: Comment on Sites of Action: http://www.jci.org/articles/view/105042
Renal impairment resulting from hypothyroidism:
http://ckj.oxfordjournals.org/content/1/6/440.full
How progesterone affects aldosterone:
https://academic.oup.com/jcem/article/91/10/3981/2656555?fbclid=IwAR3jHOtRuCabb8lbHuhTwAeW-BRMs5Kvk1ZQJFO8XP50PDVUbnn-BjwkAXA
Information of Fludrocortisone (Florinef) https://medlineplus.gov/druginfo/meds/a682549.html
Potassium being drawn with no tourniquet on:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662091/
About blood pressure dropping at standing: https://www.texasheart.org/heart-health/heart-information-center/frequently-asked-patient-questions/should-my-diastolic-pressure-change-when-i-stand-up/