How to address low cortisol?

[ErinElizabeth]

See here for my intro and labs.

I started NDT for Hashimotos about four weeks ago. The first week I felt like I had better energy but it dropped back to pre treatment levels and hasn't come back up since. Got my cortisol tested and levels were really low (<0.03-0.09) throughout the day.

I'm wondering what the peaty protocol would be to try in this situation. My naturopath recommended an adrenal glandular supplement but I feel like I read here that that wasn't considered a good idea so I'd love some help.

 

[sweetpeat]

Welcome to the forum, ErinElizabeth!

I commend you for getting so many labs done! Were these taken before or after you started changing your diet? Also (if you happen to know), at what point in your menstrual cycle were these done? You appear to be estrogen dominant. How much progest-e were you taking? Do you know about starting with a loading dose?

A few more quick things off the top of my head:
Estroban will help bring up the vitamin D, but sunlight would be even better, if you can manage it. For more reasons than vitamin D.

Selenium can help with the thyroid antibodies (it helped me, but no guarantees of course).

Your TSH is over 75? Am I reading that right? That could be the answer to your fatigued adrenals right there – they are filling in for your thyroid. If you can support the thyroid, your adrenals most likely will bounce back unless there is something wrong with the adrenals themselves. If you started the NDT four weeks ago, you should be about due for a thyroid re-check to see if you need a dosage change. Did your doctor mention anything about that? Checking pulse and temps would give some good info about metabolism as well.

Cholesterol will probably come down as you supplement the thyroid. Just be careful not to push the sugar too much at first if you were low carb before. Give your body time to adapt.

 

[Mittir]

Is that 75 TSH or 7.5?
RP thinks saliva tests are unreliable.
If your thyroid is working well then coritsol will be naturally low.
You will not need cortisol to compensate for low thyroid.
I did not see PTH in the lab. It would be a good idea to measure
PTH and prolactin in next lab.
I felt immediately better after adding thyroid, but i implemented
the dietary guideline before adding thyroid.
If you can post a detail description of your cronometer diet.
Are you doing raw carrot salad or cooked bamboo shoot.
In some cases, just adding these resolve hormonal issue.

 

[aguilaroja]

... If you can support the thyroid, your adrenals most likely will bounce back unless there is something wrong with the adrenals themselves. If you started the NDT four weeks ago, you should be about due for a thyroid re-check to see if you need a dosage change....Checking pulse and temps would give some good info about metabolism as well....

It seems the NDT supplementing is recent. Unless things are urgent, it is better to introduce support measures one at a time, to know what makes a difference. It would be difficult to fully adjust thyroid dosage over a few weeks, with very high TSH.

I agree with sweetpeat's view that titrating thyroid dosage may give a clearer picture before considering adrenal axis supplements. You will find other viewpoints on the web and from saliva-test-vendors, who favor using adrenal stress hormone supplementation early in a sequence.

In your post about labs, the total cholesterol is 246,

It has been known since the mid-20th century that high cholesterol is a hallmark of low thyroid function. In the short term, the lab result may suggest that dietary intake of cholesterol is adequate. That is something to watch as thyroid function improves, if the cholesterol lab test numbers move down. Low cholesterol intake itself can contribute to low hormone levels.

Another accessible early factor is using carrot fiber, bamboo shoots, or other aids to reduce endotoxin burden in digestion (mentioned by mittir-search the forum and raypeat.com).

There can be a role for, say, progesterone (mentioned by sweetpeat), pregnenolone, and small amounts of DHEA, but you are in an early phase of RP metabolic improvements. I have met many people who used adrenal extracts and "physiologic" cortisol supplements, but find these maneuvers usually to be secondary at best.

 

[aguilaroja]

[...RP thinks saliva tests are unreliable.
...It would be a good idea to measure PTH and prolactin in next lab....

Your lab test post mentioned "Cortisol, saliva test:
8:45am 0.08 mcg/dL; 12:00pm 0.09 mcg/dL; 4:15pm 0.03 mcg/dL; 10:30pm <0.03 mcg/dL"

Before concluding that there is a major low cortisol situation, get blood (serum) cortisol testing. Even with blood test confirmation, considering rapid adrenal/cortisol supplementation is better approached with caution.

There is no perfect test in medicine. Saliva testing is not necessarily conclusive. I will probably be flamed for this last part. But I have seen many cases where serum and saliva testing results differed greatly even when done at the same time.

Further, I have encountered many people where neither the saliva NOR serum testing offered enough guidance. Real improvement was made by basing supplementation on signs and symptoms, with labs as only an adjunct.

I'll assume unless corrected that the TSH of 75 is correct and not a typo. That value is high but not unheard, and probably more common when thyroid-associated antibody tests are positive. The lab tests indicate other elevated markers of inflammation. If it is necessary to lobby your doctor for getting additional tests, such as PTH and prolactin, you can mention that you have concerns about other endocrine-immune function.

It is a big question "what" auto-immunity is, and Dr. Peat is one person working to fit those responses into a larger view of function.

“Aging is characterized by loss of lean body mass, immunodeficiency, and a variety of autoimmune reactions. My perennial argument has been that decreased thyroid and progesterone, associated with increased estrogen and stress hormones, are largely responsible for those changes.”
-Dr. Peat, quoted at http://www.functionalps.com/blog/2014/0 ... ar-energy/

 

[answersfound]

I would try some pregnenolone. Ray has said it can help provide a smoother response to thyroid. It helped me by preventing the adrenaline response from taking ndt.

 

[ErinElizabeth]

https://raypeatforum.com/forums/posts/98313/ commend you for getting so many labs done! Were these taken before or after you started changing your diet? Also (if you happen to know), at what point in your menstrual cycle were these done? You appear to be estrogen dominant. How much progest-e were you taking? Do you know about starting with a loading dose?

I stopped any semblance of low carb eating about 2 1/2 years ago when I realized my metabolism wasn't working right and I found Matt Stone. These labs were run just over a month ago and I starting implementing the peat ideas I found here after I got the results. In between those times I was trying to simply listen to my body and eat whatever I actually wanted without guilt and fear interfering (I'm still amazed at how my food cravings changed once everything was back on the menu). That process led to 60# gained over the course of my pregnancy and none of it lost after, but it also came with a much better ability to listen to my body and MUCH more mental peace without the noise of worrying about food all the time.

At the time the labs were taken my period still hadn't resumed postpartum (still nursing my 19 month old and it took almost as long to resume after my first son). My cycle resumed exactly a week after starting the thyroid and I think the labs were taken just about 3 weeks before that.

My doctor recommended 20mg of the progesterone but I did read all the recommendations to start high so I did. I tried for 5 drops 5 times a day. I don't recall precisely when the irritability really started but it clearly stopped when I stopped the progest-e.

Estroban will help bring up the vitamin D, but sunlight would be even better, if you can manage it. For more reasons than vitamin D.

Selenium can help with the thyroid antibodies (it helped me, but no guarantees of course).

Getting out of the house has been one of the REALLY HARD TO DO things that has come with my low energy. I know I should and I enjoy it when I do but getting the boys packed up and out the door is hard (we don't have a yard to play in).

I've been thinking about selenium, I'm keeping on the list but trying not to start 30 things at once.

Your TSH is over 75? Am I reading that right? That could be the answer to your fatigued adrenals right there – they are filling in for your thyroid. If you can support the thyroid, your adrenals most likely will bounce back unless there is something wrong with the adrenals themselves. If you started the NDT four weeks ago, you should be about due for a thyroid re-check to see if you need a dosage change. Did your doctor mention anything about that? Checking pulse and temps would give some good info about metabolism as well.

Yes, it's over 75, they didn't report the actual number, just gave me that it was really bloody high.

Cholesterol will probably come down as you supplement the thyroid. Just be careful not to push the sugar too much at first if you were low carb before. Give your body time to adapt.

The labwork was a free (yes, all that FREE!) panel by Boston Heart Diagnostics (I don't really get why, but I wasn't about to say no) so it included some really detailed cholesterol and lipid stuff that was pretty interesting but when their complimentary analysis told me my metabolic status was GOOD I wasn't too impressed. As stated above, I haven't been low carb for quite a while so I am pushing the sugar stuff and without significant overt effects so far other than I have absolutely ZERO craving for sweets anymore. Salty potatoes and cottage cheese on the other hand, I can't get enough of.

Baby boy needs me, I'll respond to the other posts later. I really appreciate the quality of thought and generosity shown on this forum I'm feeling really lucky to have found this place.

 

[ErinElizabeth]

https://raypeatforum.com/forums/posts/98315/ Is that 75 TSH or 7.5?
RP thinks saliva tests are unreliable.
If your thyroid is working well then coritsol will be naturally low.
You will not need cortisol to compensate for low thyroid.

My thyroid isn't working anywhere near well, so naturally low isn't an issue here, are there other situations in which a false low could be present? I only started the NDT two weeks before getting this test run.

I did not see PTH in the lab. It would be a good idea to measure
PTH and prolactin in next lab.

Is PTH parathyroid? I'll add both of those to my list of things to test.

I felt immediately better after adding thyroid, but i implemented
the dietary guideline before adding thyroid.
If you can post a detail description of your cronometer diet.
Are you doing raw carrot salad or cooked bamboo shoot.
In some cases, just adding these resolve hormonal issue.

I wish I'd remembered about Ray Peat earlier but sometimes I just need to rediscover something that I just wasn't ready for the first time around. I haven't been doing the carrot salad but I have been eating more carrots (more being once or twice a week instead of almost never). I'm a dive in head first - then crash and burn kinda person and I really want to succede here so I'm trying to find some semblance of gradual change as fast as I can so I don't implement a bunch of changes at once and end up dropping everything. Some changes are easier than others and while I enjoy crunching on a carrot sometimes I didn't like the carrot salad I made so it hasn't made it into regular rotation yet.

Chronometer tracking is another thing I have had trouble with follow thorough on, I think the most consecutive days I've tracked is two. And I've only managed one since starting thyroid treatment. I'll try tracking a few days in the next week and get that posted.

 

[ErinElizabeth]

https://raypeatforum.com/forums/posts/98317/ It seems the NDT supplementing is recent. Unless things are urgent, it is better to introduce support measures one at a time, to know what makes a difference. It would be difficult to fully adjust thyroid dosage over a few weeks, with very high TSH.

Treatment is very recent, intellectually I understand that it will take time to get things figured out but I can't help feeling disappointed that I'm not seeing more gains faster.

I agree with sweetpeat's view that titrating thyroid dosage may give a clearer picture before considering adrenal axis supplements. You will find other viewpoints on the web and from saliva-test-vendors, who favor using adrenal stress hormone supplementation early in a sequence.

After reading so much here this last month I'm in no hurry to deliberately increase stress hormones. I have been reading plenty about how helpful they are too though so that's why I'm here asking. :)

In your post about labs, the total cholesterol is 246,

It has been known since the mid-20th century that high cholesterol is a hallmark of low thyroid function. In the short term, the lab result may suggest that dietary intake of cholesterol is adequate. That is something to watch as thyroid function improves, if the cholesterol lab test numbers move down. Low cholesterol intake itself can contribute to low hormone levels.

Another accessible early factor is using carrot fiber, bamboo shoots, or other aids to reduce endotoxin burden in digestion (mentioned by mittir-search the forum and raypeat.com).

Historically I've never restricted cholesterol foods and have likely eaten quantities that would give a cholesterol fearing doc a heart attack. I cook with mostly butter and eat eggs a few times a week and have muscle meat 4-5 times a week and that's probably the lowest my cholesterol consumption has ever been. I could be wrong, but I doubt low cholesterol consumption is an issue (low absorption could be a different story but I don't have significantly poor digestion).

There can be a role for, say, progesterone (mentioned by sweetpeat), pregnenolone, and small amounts of DHEA, but you are in an early phase of RP metabolic improvements. I have met many people who used adrenal extracts and "physiologic" cortisol supplements, but find these maneuvers usually to be secondary at best.

It seems to me like you're suggesting I support my body with diet and thyroid and wait to see if that addresses the hormonal issues. Mostly that is what I would prefer. The reason I started the progest-e is I really wanted to avoid the long and excessively heavy bleeding next cycle and I was hoping it would help. Becoming unbearable to live with and having my 5 year old ask me how he could help me be happy again wasn't a tradeoff I'm willing to make though.

 

[ErinElizabeth]

https://raypeatforum.com/forums/posts/98326/ I would try some pregnenolone. Ray has said it can help provide a smoother response to thyroid. It helped me by preventing the adrenaline response from taking ndt.

Do you recall where he said that? I'm not feeling any adrenalin response from the NDT so I'm not sure what it might help.

 

[Mittir]

My thyroid isn't working anywhere near well, so naturally low isn't an issue here, are there other situations in which a false low could be present? I only started the NDT two weeks before getting this test run.

I was trying to say if you fix your thyroid then you do not have to worry about low cortisol.
Generally cortisol is very high in hypothyroid people. He also mentioned low thyroid and
nutritional deficiency are responsible for low cortisol. In either case, you will need to fix
thyroid and nutrition. He specifically mentioned vitamin A required for steroid production.
He mentioned that progesterone and pregnenolone can compensate for lack of adrenal.