Posted by tealady on October 30, 2005, at 2:28:50
In reply to Would like some advice please, posted by TamaraJ on October 26, 2005, at 20:23:17
> I've recently started seeing a naturopath. Based on some initial testing, she says I have adrenal fatigue bordering on adrenal exhaustion. She will also be requisitioning bloodwork and doing saliva testing (for hormones). I would like to know what bloodtests I should ensure are done. I know she will do a full thyroid panel, including antibodies. And, she will test my iron and serum ferritun levels since I was severely iron deficient last year. I am just wondering what other tests would be important. Any advice would be appreciated.
Hi Tamara,I've been wiped out lately myself. I'm recovering from shingles brought on the pushing myself too much probably.. like uni at a quarter of full time load?, sigh.
I have exams this week.. so I'll try and answer this by copy and pasting a few of my posts.
It won't make as much sense as a purposely written reply, sorry, but I hope it's better than nothing:)1. I think you need cortisol saliva tests .. 4 times a day. Usually done about 8am, noon, around 4-6Pm and midnight.. or as close to that as you can stay awake for. Try to stay awake all day and have a usual day otherwise:)
The 8AM dose should be taken just after rising and fastingand before any effort or work .. before anything much if possible.Also cortisol blood test should be done.
8AM (fasting and before and straight out of bed and to lab.. you need a calm trip to lab)
and 4PM same day ..with a normal day.. preferably without an afternoon sleep if possible:-) The afternoon sleep helps restore cortsiol levels.
Note: must be done the same day.. both tests, not 8am one day and 4PM a different day
BOTH tests important to be done if possible. Below copy&paste refers to cortisol blood test levels"...which seemed to work for most was if over 15 (morning basal cortisol) (US) ..multiply by 28 (27.59) for our units...meant you were OK to start thyroid meds probably.
http://www.unc.edu/~rowlett/units/scales/clinical_data.html
http://www.sydpath.stvincents.com.au/other/Conversions/ConversionMasterF3Mid.htm
>Below just stating mine and others observations, and tried to then find some studies to back it up. Some docs may use 12-15(US) as a guideline for minimum levels to start thyroid meds. It is on the synthroid (etc) prescription inserts to make sure of adrenal function before beginning thyroid meds.(this can mean >6 though if only go by "lab normal ")
I tried to relate this as answer as what may have been happening if one's metabolism is suddenly kickstarted by a really good diet/supp program as you have undertaken as it may create a similar kickstart that thyroid meds do.,..causing an additonal stress on adrenals, if too lowish.
> Personally I felt it should be 17 to be sure, 15 was OK and under 12 was iffy..usually indicating need of adrenal support before and while start thyroid meds.
> My non medically educated Opinion ONly formed from is a couple of years observations.
>
> I've just gone looking and found this study (seeing as you like studies) (I think the "normal " ranges in the US are roughly 6-22 or 6-25 from memory
>
> Evaluation of the integrity of the hypothalamic-pituitary-adrenal axis by insulin hypoglycemia test.
>
> Erturk E, Jaffe CA, Barkan AL.
>
> Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109, USA.
>
> We retrospectively reviewed dynamic ACTH and cortisol responses to insulin hypoglycemia in 193 subjects with suspected ACTH deficiency to ascertain the predictive values of various diagnostic criteria. Based on the achievement of a peak cortisol level of 18 micrograms/dL or above, 133 subjects were classified as having an intact hypothalamic-pituitary-adrenal (HPA) axis, and 60 subjects were determined to have ACTH deficiency. Baseline and peak cortisol concentrations were strongly correlated (r = 0.63; P < 0.0001). Peak cortisol increased in parallel to ACTH increments, but plateaued at approximately 22 micrograms/dL at peak ACTH levels above approximately 75 pg/mL (r = 0.61; P < 0.0001). BASAL CORTISOL VALUES ABOVE 17 micrograms/dL or below 4 micrograms/dL were highly predictive of an intact or impaired HPA axis, respectively, but intermediate values had only limited sensitivity and specificity. The criteria of HPA axis integrity, defined as an increment in plasma cortisol of more than 7 micrograms/dL above the baseline or as a doubling of the baseline cortisol value, were associated with high false positive and false negative rates. We conclude that 1) the baseline morning serum cortisol concentration has very limited predictive power in differentiating between normal and impaired HPA function; 2) the use of criteria based on incremental changes in serum cortisol from baseline leads to unacceptably high false positive and false negative rates; and 3) insulin hypoglycemia is still the best indicator of the integrity of the response of the HPA axis to stress.
>
> PMID: 9661607 [PubMed - indexed for MEDLINE]
> (it's got a free full text..but I haven't read it)
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9661607&dopt=Abstract
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> Note..it also said 17 was a safe level for predicting normal adrenal function....love it when studies agree with observations
> ************************************
> Now WHY am I going on about basal adrenal levels needed before commencing thyroid meds....because when you start thyroid meds it really hits your adrenals hard as probably when your metabolism kicks in your adrenals are called to work harder then they are used to, and without these levels one goes into some degree of a kinda adrenal crisis..one crashes and one does not tolerate the thyroid meds..can get racing heart beats/or irregular racing and pounding etc, tendonitis, tight muscles, aches and pains all over, just crash in a heap, extreme fatigue, difficulty breathing... you have a great choice of symptoms
>
> So how does this relate to you?(I was talking to Lar here.. not you Tamara) I suspect that improving nutrition and taking phenylalanine etc would have a similar though lesser effect as commencing thyroid meds..so any adrenals which aren't functioning optimally will be put under a bit of strain...not as much as commencing thyroid meds..but the same kinda thing
>
well first copy & paste was mainly about what is a really good 8Am blood test level.
Also as you mentioned
blood tests for iron studies and ferritin.
and as usual get a copy of all test rsults.. and don't accept "normal" as a answer.
Healthy ferritin is around 50-100.
Symptoms of really tired and even more so depressed occur with me under 25. And I feel better at 35 than 25 too.Lactoferrin may help here... see my post on lately somewhere here.
TSH, FT4 and FT3 too if possibleThe other thing worth checking is your electrolyes..like potassium, magnesium, sodium,calcium etc, as well as phosphates, magnesium(may or may not be separate test).
These are all blood tests that I get.
I don't know about saliva tests..whether they refect the levels better or worse with these:)Licorice can lower potassium .. I think from memory.
Salt does help adrenals.. as does VitC(especially taken with some VitE., but see what your sodium levels are like first.
If sodium or potassium/ magnesium are out of balance, even within normal ranges you may be experiencing heartbeat irregularities, fatigue etc.Also siberian ginseng, B5 together with a balance of B's.
I like milk thistle too.. though its for the liver. Seems to help me sometimes with adrenal type fatigue symptoms.Good antioxidants help too.. VitC is one of these.
another copy and paste from a post of mine on here.."Best thing you can do for your adrenals is stay away from stress as much as possible...eat whole unprocessed type foods..like real fruit/veges/meat, exercise to your capacity..like a short walk if possible ..and rest as much as possible..put yourself first.I KNOW ..."not much here http://www.dr-bob.org/babble/alter/20040928/msgs/396586.html
might be something in here :-)
http://www.dr-bob.org/babble/alter/20031023/msgs/275599.htmlHope this helps a little. I'm tired and not thinking clearly:)
There are othere tests too.. I just don't kknow much about them.Antibody tests for thyroid and adrenals would be good too, but I don't think a naturopath would do those? Not sure though:-)
Selenium may help wit lowering antibody levels though.You can get blood selenium test done too.. mine was above range.. which may arguably possibly indicate a high mercury level :-)
Just posting this now as I won't be around for another week or so. Hope you get it in time to be of some help maybe. I know you have A LOT of this info already :-)
Jan (who hates getting dental work done)
poster:tealady
thread:572214
URL: http://www.dr-bob.org/babble/alter/20051025/msgs/573270.html