How to safely & effectively use adrenal hormones and glandulars - Highly Effective Treatments for Pain and Fatigue

Townsend Letter for Doctors and Patients,  Dec, 2003  by Jacob Teitelbaum

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Adrenal hormones are essential for life. But, as with any hormone, too much can be dangerous. In the early studies using adrenal hormones, the researchers had no idea what dose was normal and what was toxic. When they gave injections of the hormone to patients, the patients' arthritis went away and they felt better. However, when they gave patients many times more than the normal amount, the patients became toxic and died. Because of this, the researchers became frightened and avoided using adrenal hormones whenever possible. Medical students were taught to avoid adrenal hormones unless no other treatment choices existed.

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The use of adrenal hormones needs to be put into perspective, however. Imagine if the early thyroid researchers had given their patients 50 times the usual dose of thyroid hormone. Thyroid patients would have routinely died of heart attacks. The thyroid researchers, though, were fortunate enough to stumble upon the body's healthy dose early on and to skip these negative outcomes. If they had not, people today would not be treated for an underactive thyroid until they displayed symptoms of very advanced thyroid disease (myxedema) and were nearly comatose. Medical science is just beginning to learn that a person can feel horrible and function poorly even with a minimal to moderate hormone deficiency.

Dr. Jefferies has found that as long as the adrenal hormone level is kept within the normal range, the main toxicity that a patient might experience is a slight upset stomach, due to the body not being used to having the hormone come in through the stomach. Taking the hormone with food usually helps. In addition, some patients gain a few pounds. This is because a low adrenal level can cause a person's weight to drop below the body's normal "set point," even if that set point is high because of CFIDS/FMS. However, any weight gain is often more than offset by the weight loss resulting from being able to exercise once again.

Many practitioners do not like to prescribe even low doses of adrenal hormone. Others are not legally able to. If you are a physician who is still uncomfortable with very low dose cortisol, I invite you to read Dr. William Jefferies' book on the safety of low-dose cortisone as well as our recent study (the full text of the study can be seen at www.vitality101.com). A study by R. McKenzie and colleagues at the N.I.H. Institute of Allergy and Infectious Diseases showed that what they called "low-dose" Cortef (25 to 35 milligrams a day) moderately helped CFIDS patients but caused some patients' adrenal glands to be suppressed. As noted in my letter to the editor printed in the Journal of the American Medical Association,' their dose was two to three times as high as most CFIDS patients need and this predictably and dramatically worsened the sleep disorder. Another study using 10 milligrams of Cortef a day in CFIDS and our studies of CFIDS/FMS patients showed significant benefit without significant toxicity using lower doses. Most patients only need 5 to 121/2 milligrams a day, equivalent to 1 to 3 milligrams a day of prednisone--a dose so low that most doctors have never prescribed it! Cortef is better than prednisone, though, for people with CFIDS/FMS. Most patients find that 5 to 10 milligrams of Cortef in the morning, 0 to 71/2 milligrams at noon, and 0 to 21/2 milligrams at 4 PM works best.

After feeling well for six to eighteen months, most people are able to begin slowly decreasing their adrenal hormone dosage, eventually discontinuing the treatment entirely. Some patients may benefit from staying on natural adrenal glandulars (see below) for longer periods or whenever they are experiencing fatigue and/or hypoglycemia.

What are Low Dose Cortef's Side Effects?

If the dose is too high, the patient may feel shaky and should lower it. If it causes upset stomach, have them take it with meals or lower the dose. Taken too late in the day, Cortef can disrupt sleep. Recently, studies have been published about osteoporosis with low-dose adrenal hormones, but even these studies do not use the very low doses that we are recommending. At a dose of over 20 milligrams a day, one can begin to see the other, much more toxic side effects of cortisol. I cannot recommend using higher doses unless benefits clearly outweigh the risks.

How Can I Tell if the Patient Needs Cortisol?

Dr. Jefferies recommended that all patients with unexplained persistent fatigue be given a therapeutic trial of 20 milligrams of Cortef daily. Although most patients do not need this much, I agree that a therapeutic trial is appropriate in the presence of unexplained disabling fatigue regardless of the test results. Nonetheless, testing can add significant information.

Unfortunately, I have found that salivary testing for hormones is very unreliable. This disappointed me because from a theoretical point of view they're wonderful. Sadly, I have found that they often give the opposite results of blood testing and, when this occurs, it is usually the blood test that fits the clinical picture. This has also been the experience of many other practitioners.