How do you end up with low cortisol?
If you are under any form of stress, this can be emotional stress, physical stress, the body responds with releasing more cortisol and adrenaline. The fight or flight reaction. The body’s reason for doing this is to change amino acids into glucose (gluconeogenesis). The extra glucose gives the body energy to cope with the stress on it. Intense exercise has the same effect.
In those with Hypothyroidism or Hashimotos, cortisol tends to rise when we are not diagnosed, or have been treated with T4 only medications, like Synthroid or Levothyroxine, these cause stress to our body. Hashimoto’s tends to cause inflammation which also raises cortisol (another stress on the body). Inflammation can come from the actual attack on the thyroid, or those who are consuming gluten, and have a sensitivity to it, they are unaware of. Even those without Hashimoto’s who are not diagnosed or treated with T4 only medications can see their cortisol rise due to inflammation. However, the adrenals can only produce cortisol at these high amounts for so long before they begin to struggle, and may produce less and less, leaving you with low cortisol.
This is not Addison’s disease or Secondary Adrenal Insufficiency we are talking about, that is often caused by an a tumor on the adrenal glands or a diseased pituitary gland. This is something to work with a Doctor on and not something we really cover here.
Low cortisol encourages T4 to convert to the inactive hormone Reverse T3 instead of the active hormone, T3. We often see low Aldosterone with low cortisol as well.
How do I find out if I have low cortisol?
It is never suggested to guess if you have low cortisol! The symptoms of low and high cortisol are so often the same for many. Blood tests are not accurate to diagnose low cortisol caused by an HPA Axis Dysregulation. Blood cortisol testing measures both bound (not usable) and unbound (usable) cortisol. Blood cortisol measures at least 80% of bound cortisol, we want to see what is available for use. This means your blood test could show low cortisol when in fact it is optimal or high on a saliva cortisol test! We suggest testing with a 4 point in the day saliva cortisol test. Saliva testing only measures unbound (usable) cortisol.
A saliva cortisol test done four times in the day (the lab you choose needs to have full lab ranges with a bottom and top of range all four times, ZRT and Labrix are two we like).
You are looking for optimal results to look like this:
Waking – about the VERY top of the range
4 hours later – about top ¼ of the range
4-5 hours later – about mid-range
Bedtime – the EXACT bottom of the range
What kind of symptoms does low cortisol have?
Low and high cortisol often have similar symptoms (and this is why you will need to test to VERIFY what you indeed do have!). Some and certainly not all symptoms are: Nausea, shaking uncontrollably, highly defensive, overly sensitive to things/overreacting, diarrhea, pounding heart, high heart rate, feeling panicky, muscle weakness, clumsiness, hypoglycemic, pain in lower back (adrenals), less common in low cortisol, are sleep issues, but it can happen! Because the low cortisol encourages T4 to convert to the inactive hormone, Reverse T3, you begin to see hypo symptoms return, low body temperature, exhausted, hair may be falling out, weight gain, body aches etc.
Will my low cortisol fix itself if I reduce my stress?
Highly unlikely that if you leave this untreated with your body not making enough cortisol, the cortisol continues to drop. Your poor adrenal glands, they already worked overtime to keep pumping out high amounts of cortisol, eventually they too became overworked, and simply could not produce at that rate. In the beginning of the adrenals inability to produce at that rate we often see, low, high, low, high…or even low, low, high, high, or low, low, low high. Just like that bedtime high cortisol seems to be the most stubborn in its ability to keep producing high amounts of cortisol, much longer than any other time in the day, the waking low seems to be right up there in stubbornness! As part of your endocrine system, the adrenal glands produce hormones that give instructions to virtually every organ and tissue in your body, it is important that your body have enough cortisol!
Can I treat my low cortisol?
Yes! Depending HOW low your cortisol is will determine if you can go with supplements, can do CT3M or need a prescription for Hydrocortisone. Generally, cortisol that is not at the bottom of or below the range can be treated with over-the-counter Thorne ACE (Thorne Adrenal CortEx, (please be sure it is NOT the CortRex, as that contains the medulla which produces adrenaline-like hormones. We make too much adrenaline with adrenal fatigue, adding more does not help)! CT3M can be a great choice for low cortisol as well.
If your cortisol is all below range, or maybe one is at the bottom of the range, or the waking is below range you will want to find a Doctor who can test for adrenal insufficiency to rule that out before treating.
For information on CT3M, please see Paul Robinson’s website:
https://paulrobinsonthyroid.com/