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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by whitmore on May 30, 2010, at 12:15:17
I'm convinced my depression,anxiety and ocd stem from too little cortisol caused by inadequate ACTH(secondary adrenal insufficiency, verified by saliva testing--controversial and not accepted by mainstream medicine). It fits in with all the evidence of seemingly random meds that have worked like a charm(birth control pills, which I can no longer take, SSRI's) or that have been spectacular failures(pretty much everything else). To test this theory, I am taking cortisol in the form of hydrocortisone. I am undertaking this as a 3 month trial and am under a doctor's care. Trouble is, I seem to need much higher doses than most. I am a tiny female and am already taking 31.5 mg a day, and experiencing low blood pressure, weight loss and cognitive problems. However, the mood issues are improved. I don't think this is either a safe or convenient long term therapy and need to find meds./supplements that will accomplish the same thing--i.e. raise ACTH/cortisol. I know the SSRI's do this, but would like to avoid them if possible. What else is there?
Thanks in advance.
Posted by Phillipa on May 30, 2010, at 12:49:44
In reply to Best meds. to raise cortisol/ACTH?, posted by whitmore on May 30, 2010, at 12:15:17
I'm sorry that's rough. I know first hand my Mother the don't take for long. Have you had your adrenal glands checked via ultrasound? As for meds no idea would like to learn. Good luck and you must have a great doc to look into it for you. Phillipa
Posted by whitmore on May 30, 2010, at 13:01:53
In reply to Re: Best meds. to raise cortisol/ACTH? » whitmore, posted by Phillipa on May 30, 2010, at 12:49:44
It's not an adrenal problem per se. It a pituitary problem.
Posted by Phillipa on May 30, 2010, at 13:05:57
In reply to Re: Best meds. to raise cortisol/ACTH?, posted by whitmore on May 30, 2010, at 13:01:53
They thought per MRI that I had a pituitary microadenoma second one was okay. Endo treating?
Posted by bleauberry on May 30, 2010, at 16:49:16
In reply to Best meds. to raise cortisol/ACTH?, posted by whitmore on May 30, 2010, at 12:15:17
HC is the best short term solution, but the current dose is much too high. That is begging for more problems than you began with. The adrenals will become overly lazy and withdraw from action when artificial HC does the job. What they need is a little assistance, a little rest, which means taking just a little bit to help them out. That is no more than 20mg max.
I know a couple people who had severe adrenal exhaustion who were much better after treatment with HC. However, this is important. One of them, his dose was only 2.5mg. The other, 5mg. The real key is this...adrernals take a long time to heal. In both of those cases, they were on those doses for a full year. It isn't the dose that matters as much as the time.
In the natural world, there is no better adrenal rejuvenator than Eleuthero (Siberian Ginseng, not a true ginsent). It has to be the concentrated tincture from HerbPharm, not a capsule or tablet. Unlike many internet claims or naturopath claims, this one actually has a ton of scientific data behind. But again, as with HC, the key is time. Eleuthero needs 6 months minimum to see improvements setting in, and then another 6 months to nail it.
Meds or stimulants can raise your adrenal activity, but they are your enemies. They will further weaken and destroy already exhausted adrenals. To prolong your own existing cortisol, you can take Licorice root supplements. They slow down the breakdown of cortisol, allowing what you have to last longer.
Isocort is a popular adrenal supplement at forums that deal with heavy metals, lyme, and candida, where adrenal exhaustion is almost universal. Basically, an adrenal cortex extract can help. For some, they need isocort, an herb like eleuthero, licorice, adrenal cortex extract, and HC all together. Each person is different and it takes some experimenting.
Diet is extremely important. And again, time is the most important factor. The worst things for trying to stimulate adrenals back to normalcy are sugars, caffeine, carbs, toxins, and infections. That means you want food choices that battle all of those.
There is an entire book written by a doctor on the topic of healing adrenals with food. In a nutshell, it involves mostly non-root veggies comprising 75% of each meal...raw or very slightly cooked, organic as much as possible, lots of purified water, lean meats and nuts. There are no donuts, pizzas, sodas, ice cream, or fast foods on the journey to healing.
Another common problem seen in adrenal exhaustion is gluten intolerance. And dairy intolerance. It is not unususal that the foods we love the most are the very ones making us the sickest, and we don't even realize it.
In a diet healing, the patient usually feels worse for a couple months. That's because yeast (candida) are dying off, the immune system is killing more stuff, toxins are being flushed out, and there is a lot of shift going on in the adrenal/thyroid axis.
I've dealt with all of these issues and have studied them inside and out. The best thing I can tell you is that it is a multipronged comprehensive approach. No single thing, such as HC, is going to heal you.
1. Adrenal friendly diet.
2. Maintain a stable sleep/wake pattern.
3. Eleuthero tincture for at least 6 months.
4. Very low dose HC.
5. DMSA urine provoked test for heavy metals.
6. Study up on Lyme and Candida.
7. Possible isocort and/or licorice and/or adrenal cortex.Adrenals don't go bad for no reason. They are stressed by one or more of infections, toxins, metals, bad schedule, bad foods. The American lifestyle which we all consider perfectly fine and normal is actually a palace for disease promotion. No wonder we have the best medical system on the planet and yet disease continues to advance at an accelerated rate.
If an unsuspected infection or heavy metals are the root cause (very common at other forums), then the adrenals will never heal until those issues are attacked head on. For some that means low dose frequent dose DMSA chelation and/or anti-yeast anti-bacterial herbs. The whole time though, regardless, the adrenals need to be supported with every possible benefit you can give them. HC is only one of those. Anything over 20mg is actually an enemy and not a friend.
Posted by Phillipa on May 30, 2010, at 19:50:00
In reply to Re: Best meds. to raise cortisol/ACTH?, posted by whitmore on May 30, 2010, at 13:01:53
If it's pituitary my endo said I'd lactate. Are you? Have you checked into meds for pituitary? What is wrong with your pituitary do you know? Phillipa
Posted by whitmore on May 30, 2010, at 23:04:29
In reply to Re: Best meds. to raise cortisol/ACTH?, posted by bleauberry on May 30, 2010, at 16:49:16
I appreciate your lengthy reply, but I do not have adrenal fatigue as evidenced by prior ACTH stimulation test. My current physician concurs. I have secondary adrenal insufficiency caused by too little ACTH being produced by my pituitary. The root cause of this is unknown, but I suspect early childhood trauma coupled with genetic suseptability. Low dose HC makes matters worse in my case. The ACTH feedback loop senses cortisol and turns down ACTH production--but more than it should, so I'm actually worse off. Licorice also causes ACTH suppression--again, worse off. My adrenals do not need to rest, they need more stimulation. Isocort has been tried--same result. So really full replacement is required if I am to go the HC route. That having been said, my dose is not completely off the wall. I am an avid exerciser and have a high pressure job. However, I am looking for alternatives for multiple reasons. Firstly, I feel uncomfortable creating Addison's in myself and secondly I am uneasy doing something that is considered so dangerous by mainstream medicine. ACTH injections are an option which I'm looking into, but I'm wondering if there are any meds. apart from SSRI's which result in an ACTH increase. I have no Lyme antibodies and no evidence of heavy metal burden--tests have all been done.
Posted by SLS on May 31, 2010, at 6:11:56
In reply to Re: Best meds. to raise cortisol/ACTH? » bleauberry, posted by whitmore on May 30, 2010, at 23:04:29
What about mifepristone? Would low dosages work?
- Scott
Posted by SLS on May 31, 2010, at 6:22:47
In reply to Re: Best meds. to raise cortisol/ACTH? » whitmore, posted by SLS on May 31, 2010, at 6:11:56
> What about mifepristone? Would low dosages work?
Never mind. Bad idea.
Mifepristone elevates cortisol levels acutely, but reduces them chronically.
- Scott
Posted by bleauberry on May 31, 2010, at 18:04:19
In reply to Re: Best meds. to raise cortisol/ACTH? » bleauberry, posted by whitmore on May 30, 2010, at 23:04:29
It sounds like a complicated case.
Though I am not at all bringing up the topic of lyme, I did want to comment that any antibody test of lyme is about as useless as a pure guess. Lyme doesn't work that way. Those tests are of no value, despite their common usage.Any lyme expert can explain the ins and outs of that topic.
I wonder about the heavy metal test. Was it a provoked urine test? That is, urine sample, followed by a large DMSA dose, followed by 6 hours of urine collection after that dose? That is the only test that shows what metals are within your tissues. A blood test will not show the metals, because that's not where they reside except on exposure within the most recent 72 hours.
Sometimes even that test is not accurate, because DMSA can peel away layers of metals like an onion...the first layer might be copper but not lead or mercury. Those would come later after the copper was down. But most of the time, this test is quite revealing.
If you did the hair test, that is very tricky to read. Mine for example. The first showed high lead and mercury. I thought it was all bogus. I didn't buy into it. Two years later, the same test showed no lead, no mercury, and very oddly, not much of any other normal metals either. Then I did the DMSA urine test. Wow. Mercury was in the red, and lead was even higher than that. I still have no clue where the lead came from. It was a rather startling discovery that was not evident in either a blood test or a hair test.
Over time, mercury can so bizarrely mess up the transport of metals for normal bodily function that it even prevents its own movement into hair. Tricky tests to interpret.
Adrenal stimulation. Hmmm. I just haven't come across that topic before. Well, I wonder, what about something like Ritalin? Why not an outright stimulant?
Other than that, I would still put a vote in for longterm Eleuthero tincture.
The only thing I am aware of that screws up the pituitary in the manner you describe is, well, heavy metals. With hardly any education on the topic, my first guess for stimulating the pituitary would be a stimulant like ritalin. ???
I do hope you get some answers. Someone somewhere must have some info that will be very enlightening for you. The best I can do is clarify some of the common errors in diagnosing lyme and heavy metals.
> I appreciate your lengthy reply, but I do not have adrenal fatigue as evidenced by prior ACTH stimulation test. My current physician concurs. I have secondary adrenal insufficiency caused by too little ACTH being produced by my pituitary. The root cause of this is unknown, but I suspect early childhood trauma coupled with genetic suseptability. Low dose HC makes matters worse in my case. The ACTH feedback loop senses cortisol and turns down ACTH production--but more than it should, so I'm actually worse off. Licorice also causes ACTH suppression--again, worse off. My adrenals do not need to rest, they need more stimulation. Isocort has been tried--same result. So really full replacement is required if I am to go the HC route. That having been said, my dose is not completely off the wall. I am an avid exerciser and have a high pressure job. However, I am looking for alternatives for multiple reasons. Firstly, I feel uncomfortable creating Addison's in myself and secondly I am uneasy doing something that is considered so dangerous by mainstream medicine. ACTH injections are an option which I'm looking into, but I'm wondering if there are any meds. apart from SSRI's which result in an ACTH increase. I have no Lyme antibodies and no evidence of heavy metal burden--tests have all been done.
Posted by Phillipa on May 31, 2010, at 19:34:58
In reply to Re: Best meds. to raise cortisol/ACTH?, posted by bleauberry on May 31, 2010, at 18:04:19
Whitmore no you don't want Addison's my Mother had it. From too much cortisone when first released. Pituitary tumors all easily removeable can cause what your're describing. Phillipa
Posted by alchemy on May 31, 2010, at 19:44:12
In reply to Re: Best meds. to raise cortisol/ACTH?, posted by Phillipa on May 31, 2010, at 19:34:58
I had this in my notes, but I don't know where I got it:
Acetylcholine levels in the brain may affect mood disorders, and supplemental choline can increase acetylcholine levels. In a preliminary trial, six people with bipolar disorder were given 1 to 2 grams of choline twice per day (2 to 4 grams per day). Five of the six had a significant reduction in manic symptoms, and four of the six had a reduction in all mood symptoms.49 No properly controlled trials have yet investigated the effects of choline in treating people with bipolar disorder.
Posted by SLS on June 1, 2010, at 5:17:39
In reply to Re: Best meds. to raise cortisol/ACTH?, posted by alchemy on May 31, 2010, at 19:44:12
Hi Alchemy.
> Acetylcholine levels in the brain may affect mood disorders, and supplemental choline can increase acetylcholine levels. In a preliminary trial, six people with bipolar disorder were given 1 to 2 grams of choline twice per day (2 to 4 grams per day). Five of the six had a significant reduction in manic symptoms,
I would be interested to see how unipolar depressives react to choline. Increases in choline produced by ACh cholinesterase inhibitors (donezepil, rivastigmine, physostigmine, galantamine) can actually induce depression.
- Scott
Posted by whitmore on June 1, 2010, at 19:19:41
In reply to Re: Best meds. to raise cortisol/ACTH?, posted by bleauberry on May 31, 2010, at 18:04:19
Thanks, again, Bleauberry. I did have a DMSA(sp?) challenge test, and the doctor, who I eventually felt was very untrustworthy in terms of $$, said the results were just normal(so likely to be so). Hair also. I know that this doesn't mean that this isn't the basic cause, but I've spent long enough going in circles that I no longer care. Yes, I could have 9 crowns removed at vast cost(and risk) and then chelate, only to find out that it makes no difference--and I've wasted thousands of $ and a couple more years. I may even go that route--but only at the same time as applying the band-aid--whatever that band-aid turns out to be. In any event, I'm not sure that pituitary damage is really reversible after chelation. I've heard of adrenals and thyroid repairing, but not the pituitary, have you?
Posted by bleauberry on June 1, 2010, at 20:34:33
In reply to Re: Best meds. to raise cortisol/ACTH?, posted by whitmore on June 1, 2010, at 19:19:41
> Thanks, again, Bleauberry. I did have a DMSA(sp?) challenge test, and the doctor, who I eventually felt was very untrustworthy in terms of $$, said the results were just normal(so likely to be so). Hair also. I know that this doesn't mean that this isn't the basic cause, but I've spent long enough going in circles that I no longer care. Yes, I could have 9 crowns removed at vast cost(and risk) and then chelate, only to find out that it makes no difference--and I've wasted thousands of $ and a couple more years. I may even go that route--but only at the same time as applying the band-aid--whatever that band-aid turns out to be. In any event, I'm not sure that pituitary damage is really reversible after chelation. I've heard of adrenals and thyroid repairing, but not the pituitary, have you?
Well, personally, no. In the book Amalgam Illness by PHd Andrew Cutler, pretty much every bodily malfunction has the potential to return to normal when the influence of the metals is removed.
I wonder if your crowns have mercury in them? If so, forget the whole pituitary thing, you'll want to get them out period for a thousand other reasons that haven't showed up yet. But do it as you can, bit by bit, methodical, no hurry, as long as it eventually is behind you. Worth the money? That's a huge yes. The low dose frequent dose chelation part of it, later on, is very cheap and easy.
Anything could have knocked the pituitary out of whack. Metals is only one. I was thinking about that today. A traumatic event in your life, maybe one you don't even remember from childhood, could have set off a chain reaction in genetic coding that had an impact. A virus of one kind or another. Maybe it was a defect programmed right from the start. Any kind of psychological or chemical insult could have done it. Who knows.
Right off the top of my head I can't help but think a stimulant would be made to order. Yes? No? I mean, apparently your adrenals are strong and fit, right? They just aren't being sent the right commands? If I got that right, then a stimulant would instantly send the right commands. The stimulant would send the signals that the pituitary would be if it was operating properly. Maybe?
Honestly, I don't know. Just thinking out loud.
Funny what you said about the doc calling the DMSA test "normal". Mine did too. Here's what was stunning. There were three levels on a graph...green, yellow, red. My pre-DMSA urine was in the low green for most metals, some not even visible at all. In the post DMSA urine, lead had come from practically invisible blasting through the yellow zone and just barely touching the red zone. Mercury was right on its tail, ending in the high yellow zone after barely even being visible as a tiny speck in the green prior to DMSA. But as the doctor saw it, none of the metals went into the middle of the red. So it was called "normal".
Another doctor was astounded. He pointed out that the lead level had increased, pre-to-post, by over 400%, the mercury about 300%, cadmium about 250%, arsenic 200%, from one single dose of DMSA. Now, it takes a long time to chelate metals out of tissues. What that one test dose did was just barely scratch the surface.
Several clinicians have made it clear to me that no amount of lead or mercury is safe. There is no safe limit. Some people might not have symptoms. That gives a false sense of security in assuming that some amount of mercury is safe for everyone. Not true. For some, even the tiniest amount is very harmful. A doctor said if there is any mercury at all on the chart, even if it is in the so-called "normal" green zone, that is already too much mercury. It is a toxic time we live in. But because we don't think about it and we don't see people dropping dead rapidly from pesticides or amalgams, we assume they aren't doing any harm.
Maybe relevant to this discussion, maybe not, but just thought you would find it interesting. It's not often I get to talk to someone else who has had these tests. Thaks for being there. It is great talking with you. I hope you will keep me and us informed on your journey in the coming weeks and months.
Posted by Hombre on June 1, 2010, at 23:29:56
In reply to Re: Best meds. to raise cortisol/ACTH? » whitmore, posted by bleauberry on June 1, 2010, at 20:34:33
How about piracetam?
Wiki:
"Piracetam improves the function of the neurotransmitter acetylcholine via muscarinic cholinergic (ACh) receptors which are implicated in memory processes.[14] Furthermore, Piracetam may have an effect on NMDA glutamate receptors, which are involved with learning and memory processes."
Posted by Dr. Bob on June 2, 2010, at 18:06:28
In reply to Re: Best meds. to raise cortisol/ACTH? » whitmore, posted by bleauberry on June 1, 2010, at 20:34:33
> In the book Amalgam Illness by PHd Andrew Cutler, pretty much every bodily malfunction has the potential to return to normal when the influence of the metals is removed.
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book, a movie, or music without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though.
Thanks!
Bob
Posted by desolationrower on June 6, 2010, at 13:56:14
In reply to Re: Best meds. to raise cortisol/ACTH?, posted by Hombre on June 1, 2010, at 23:29:56
> How about piracetam?
>
> Wiki:
>
> "Piracetam improves the function of the neurotransmitter acetylcholine via muscarinic cholinergic (ACh) receptors which are implicated in memory processes.[14] Furthermore, Piracetam may have an effect on NMDA glutamate receptors, which are involved with learning and memory processes."acetylcholine is something completely different to adrenocorticotropic hormone (ACTH)
-d/r
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