Upload
greencrystal81
View
25
Download
0
Embed Size (px)
DESCRIPTION
adrenal fatigue
Citation preview
10/5/2012
1
ClinicalCorrectionforAdrenalandNeurotransmitterImbalances
ErinLommen,NDCEO&AssociateMedicalDirectorLabrixClinicalServices,Inc.Restorative2012
UnderstandthephasesofadrenaldysfunctionastheyrelatetoHPAandneuroendocrineactivity
ReviewHPAaxisandbrainphysiologyasitpertainstotheregulationofadrenalfunction
ObtainanoverviewofPTSDanditsramificationsasabasisforunderstandingroutineclinicalpresentationandtreatment
LearnnewtreatmentprotocolsbasedonadvancedprinciplesandrefineexistingtreatmentapproachesforthesuccessfultreatmentofHPAaxisdysfunctionandneuroendocrineimbalances.
Angina Asthma AutoImmunediseases Alzheimer's Cancer Cardiovasculardisease ChronicFatiguesyndrome DepressionandAnxiety Diabetes(adultonset,typeII) Fibromyalgia
Headaches Hypertension Hormonalimbalances Immunesuppression Irritableboweldisease Inflammatoryboweldisease Menstrualirregularities Premenstrualtension Rheumatoidarthritis Ulcerativecolitis Ulcers
Rheumatoidarthritisisassociatedwithlowcortisollevels.
RA symptomsofpainworseinthemorningandimprovingasthedaygoeson.
Theflatteningoftheirdiurnalrhythmisthoughttoplayaroleinthedisease.
LowdosecortisoltherapyhelpssymptomaticallywithRAandimprovestheslowingoftheprogressionofthedisease.
Stressasariskfactorinthepathogenesisofrheumatoidarthritis.Cutolo M,StraubRH.Neuroimmunomodulation. 2006;13(56):27782.Epub 2007Aug6.
10/5/2012
2
Engaginginamemorytaskactivatestheimmune
systemPassivelywatchingaviolentvideoweakensimmunity
OhioStateUniversityPsychophysiology,SeptemberOctober2001
dramaticallyincreasestheabilityofexogenouschemicalstopassthroughthebloodbrainbarrier.DuringtheGulfWar,Israelisoldierstookadrugtoprotectthemselvesfromchemicalandbiologicalweapons.Thispharmaceuticalagenunderusualcircumstances,isnotexpectedtocrosstheBBB,butresearchersobservedthatwiththestressofwar
Nearly25%ofthesoldierscomplainedofheadaches,nausea,anddizziness(symptomswhichoccuronlyifthedrugreachesthebrain).
HenceanincreasedthepermeabilityoftheBBB...
JournalofAppliedPsychology,October2000
GaryEvansandenvironmentalpsychologistsatCornellfoundthatlowlevelnoiseinopenstyleofficesresultedinhigherlevelsofstress,andlowertaskmotivation.
Fortyexperiencedfemaleclericalworkers(averageage37)wereassignedtoathreehourworkstudy toeitheraquietofficeoronewithlowintensityusualambientofficenoise(includingspeech).
Theworkersinthenoiseinclusiveenvironmentsexperienced:
significantlyhigherlevelsofstress(asmeasuredbyurinaryepinephrine)
made40%fewerattemptstosolveanunsolvablepuzzle,andmadeonlyhalfasmanyergonomicadjustmentstotheirworkstations,comparedtotheircolleaguesinquietoffices.
Thesimulatedopenofficenoiseelevatedworkers'urinaryepinephrinelevels,isindicativeofmotivationaldeficits:Participantswerealsolesslikelytomakeergonomic,posturaladjustmentsintheircomputerworkstationwhileworkingundernoisy,relativetoquiet,conditions.Posturalinvarianceisariskfactorformusculoskeletaldisorder.
Althoughparticipantsinthenoiseconditionperceivedtheirworksettingassignificantlynoisierthanthoseworkingunderquietconditionsdid,thegroupsdidnotdifferinperceivedstress.Pointstopotentialhealthconsequencesoflongtermexposuretolowintensityofficenoise
Evans,GaryW.;Johnson,DanaJournalofAppliedPsychology,Vol.85(5),Oct2000,779783.
Includedinnoiserelatedproblems: highbloodpressure pepticulcers cardiovasculardeaths strokes suicides degradationoftheimmunesystem, impairmentoflearning increaseinaggression decreaseincooperation
NewYorkTimes,March6,1990
SerotoninModulationofSensoryInputstotheLateralAmygdala:DependencyonCorticosterone, JournalofNeuroscience,15November1998,18(22)95299538,GraceEStutzmann,BruceSMcEwenandJosephELedoux
10/5/2012
3
Medicalinsider.com
Hypoadrenia (ICD10255.7billablediagnosis)code
Couldtherebeadditionalconsiderationsforwhatleadstohypoadrenia?
ICD10:F43.1isnotabillablediagnosiscodeandcannotbeusedtoindicateamedicaldiagnosis.
PTSDisamentalhealthconditionthat'striggeredbyaterrifyingevent.
Symptomsmayincludeflashbacks,nightmaresandsevereanxiety,aswellasuncontrollablethoughtsabouttheevent.
DysfunctionoftheHPAaxisinthestressresponsehasbeendocumentedinanumberofpsychiatricdisorders(Loetal.,2008;Pariante andLightman,2008;Sinha,2008),includingPTSD.
10/5/2012
4
Experienceoftraumaorterror responseinvolvedisintensefear,horrororasenseofhelplessness Reliveexperiencesoftheevent,suchashavingdistressingimagesand
memories,upsettingdreams,flashbacksorevenphysicalreactions Attemptstoavoidsituationsorthingsthatremindthemofthetraumatic
eventorfeelasenseofemotionalnumbness feelingasifconstantlyonguardoralertforsignsofdanger,whichmay
makeitdifficulttosleeporconcentrate symptomslastlongerthanonemonth Thesymptomscausesignificantdistressinlifeorinterferewithabilitytogo
aboutyournormaldailytasks Staysawayfromplaces,events,orobjectsthatareremindersofthe
experience Feelingemotionallynumb Feelingstrongguilt,depression,orworry Losinginterestinactivitiesthatwereenjoyableinthepast Havingtroublerememberingthedangerousevent.
Beingeasilystartled Feelingtenseoronedge Havingdifficultysleeping,and/orhavingangryoutbursts. Angerandirritability Guilt,shame,orselfblame Substanceabuse Feelingsofmistrustandbetrayal Depressionandhopelessness Suicidalthoughtsandfeelings Feelingalienatedandalone Physicalachesandpains Strongfoodcravings(sugarandsimplecarbohydrate)
6.8%USApopulation Maybeashighas24%insubpopulations(military)
Kessleretal2005ab Millikenetal2007
ArecentmetaanalysisnotedthatlowerlevelsofbasalcortisolinplasmaandserumwerefoundinpatientswithPTSDcomparedtohealthycontrolswithnopriortraumaexposure,butnotnecessarilycomparedtocontrolswithahistoryoftraumaexposure(Meewisse etal.,2007).
YehudaandcolleaguesdemonstratedthatcombatveteranswithPTSDshowedgreatercortisolsuppressionthandidcombatveteranswithoutPTSDornormalcontrols(Yehudaetal.,1995)
Fatigue Weakness Unexplainedhairloss Nervousness Difficultybuildingmuscle Irritability Mentaldepression Difficultygainingweight Apprehension Hypoglycemia Palpitations(heart fluttering) Inability toconcentrate Excessivehunger Tendencytowards
inflammation Momentsofconfusion
Indigestion Feelingsoffrustration Poormemory Alternatingdiarrheaand
constipation Osteoporosis Lackofenergy
Autoimmunediseases Lightheadedness Dizzinessthatoccursuponstanding
Poorresistancetoinfections Lowbloodpressure Insomnia Food/inhalant allergies PMS Cravings forsweets Dryandthin skin Headaches Scantyperspiration Alcoholintolerance Lowbodytemperature
Developmentofthehumanadrenalzona reticularis:morphometricandimmunohistochemical studiesfrombirthtoadolescence.Hui XG,Akahira J,SuzukiT,Nio M,NakamuraY,SuzukiH,RaineyWE,Sasano H.JEndocrinol. 2009Nov;203(2):24152.Epub 2009Sep1.
MaternalseparationwithinthefirsttwoweeksafterdeliveryinducespermanentheightenedsensitivityoftheadrenalcortextoACTH.
Notonlythat,developmentofcortisolreceptorsthroughoutthebrainarepermanentlyinfluencedwhenbabiesaredeprivedofmaternalhandlingthefirstweeksoflife.
Thisresultsinanalteredcortisolresponsiveness,alteredstressregulation,alteredbehavioraladaptationandacceleratedbrainaging.
10/5/2012
5
EarlyHumanDevelopmentVolume84,Issue10 ,Pages689697,October2008
PrenatalSSRIexposurealteredHPAstressresponsepatternsandreducedearlyeveningbasalcortisollevels.
Thesefindingssuggestanearlyprogrammingeffectofantenatalmaternalmood,prenatalSSRIexposureandpostnatalmaternalcaregivingontheHPAsystem.
Thestressresponsesystemtoappropriatelyreact,adaptandrecoverfromthetraumaticevent.
NumerousbiologicalpathwayshavebeenimplicatedintheabnormalpathophysiologyofPTSD
CRHCorticotropinReleasingHormone HPAhypothalamicpituitaryAxis Noradrenergicnorepinephrine Serotonergicserotonin Glutamatergicglutamine
10/5/2012
6
Lifestylechanges(sedentary,increasedsugarandsimplecarbs)
Electronicinformationage(morescreengazinglessexercise)
Modernlife Morestimuli
"WorkersintheUnitedStatesareputtinginmorehoursthananyoneelseintheindustrializedworld." LawrenceJeffJohnson thechieflabormarketeconomist.
http://archives.cnn.com/2001/CAREER/trends/08/30/ilo.study/.August31,2001Posted:2:07AMEDT(0607GMT)
CRHactsasbothastresshormoneandaneurotransmitter.
CRHsecretionisincreasedincasesofanxietydisordersandsomeformsofdepression.
EuropeanJournalofPharmacologyin2008FlorianHolsboerandMarcusIsing
CRHisnotexclusivelyproducedinthehypothalamus:1. peripheralinflammatorysites2. inthethecaandstromalcellsaswellasincellsof
thecorporalutea3. cellsoftheendometrium
(ADHispresentwithCRHinsomehypothalamiccellsandisoftenreleasedsimultaneouslywithCRHandsynergizeswithit).
IsthekeyregulatoroftheHPAaxis Alsoexertsmajorinfluenceonthewakeandsleepcycle CRHinducesincreasedwakingCRHisexcitatoryinthelocusceruleus (LC),amygdala,hippocampus,cerebralcortex,andsomeportionsofthehypothalamus.
10/5/2012
7
Inhumans,themajorityofthestudiessuggestthatthesleepofyoungindividualsisratherresistanttothearousingeffectsofCRH.
Incontrast,middleagedindividualsrespondedtoanequivalentdoseofCRHwithsignificantlymorewakefulnessandsuppressionofslowwavesleepcomparedtobaseline.
Basedonthesefindings,weconcludedthatmiddleagedmenshowincreasedvulnerabilityofsleeptostresshormones,possiblyresultinginimpairmentsinthequalityofsleepduringperiodsofstress.
Thesefindingssuggestthatchangesinsleepphysiologyassociatedwithmiddleageplayasignificantroleinthemarkedincreaseofprevalenceofinsomniainmiddleage.Also,peripheraladministrationofCRHisassociatedwithaREMsuppression,whichisstrongerintheyoungthaninthemiddleaged.
ourfindingsshowanimportantroleoffibroblastexpressedCRHintheproliferation,migration,andcytokineproductionofthesecellsprocessesassociatedwiththeskinresponsetoinjury.
OurdatasuggestthattheimmunomodulatoryeffectsofCRHmayincludeanimportant,albeitnotexploredyet,roleinepidermaltissueremodelingandregenerationandmaintenanceoftissuehomeostasis.
HumanCRH wasaseffectiveasACTH atstimulatingDHEA production;however,itwas70%lesspotentthanACTH atstimulatingcortisolproduction,indicatingthatitsactionswerepreferentiallydirectedtowardincreasingDHEAsynthesis.
TheJournalofClinicalEndocrinologyandMetabolismMay5,1998 CorticotropinReleasingHormoneDirectlyandPreferentiallyStimulatesDehydroepiandrosterone SulfateSecretionbyHumanFetalAdrenalCorticalCells1RogerSmith,SamMesiano,EngChengChan,ShaneBrownandRobertB.Jaffe
Regulatedbycorticotropinreleasinghormone(CRH)fromthehypothalamus
Increasesinresponsetolowlevelsofcirculatingcortisol
AlsoIncreasesinresponseto: Stress Fever AcuteHypoglycemia
WaterdeprivationincreasesACTHsecretionandadrenalsensitivitytoACTH
Newborns Geneticpolymorphism somepeoplemaypossessreceptorsontheadrenalglandthatarelesssensitivetoACTH.Thisisthoughttobeseenmoreofteninatopic individuals.
Teenagersdiurnalrhythmshiftsby12hours,withacortisolgraphpeakingatbetween9and10am(ratherthan68am).
Adrenalinnervationfromtheadrenalmedullafacilitatestheadrenalresponseduringstress.
(Chronobiol Int.2007;24(5):96990.Diurnalandseasonalcortisol,testosterone,andDHEArhythmsinboysandgirlsduringpuberty.Matchock RL,DornLD,Susman EJ.)
10/5/2012
8
Withinthefirst3monthsofbirththefetalzonevirtuallydisappearsandproductionofDHEAceases.
Theproductionofcortisolandaldosteroneremainsconstanthoweverandtheadrenalcortexappearstohaveonlytwozones:Zonafasciculata andtheZonaglomerulosa.
Developmentofthehumanadrenalzona reticularis:morphometricandimmunohistochemical studiesfrombirthtoadolescence.Hui XG,Akahira J,SuzukiT,Nio M,NakamuraY,SuzukiH,RaineyWE,Sasano H.JEndocrinol. 2009Nov;203(2):24152.Epub 2009Sep1.
Attention Learning Memory
(Wolf,2008).(Sargant andSlater,1940).
thereisalargebodyofevidencetosuggestthatthisfunctioningisaltered,andtheremayinfactbehyperactivenoradrenergicfunctioninPTSD.(evidencesupportsautonomichyperactivityinPTSD)
FurthermorethereareimportantreciprocalinteractionsthatexistbetweentheserotoninandNEsystems.ThefiringofNEneuronsintheLCisundertonicinhibitionbyprojectionsfromthedorsalraphe nucleus.TheuseofSSRIswhicheffectivelyallowincreased5HTtobereleasedindirectlyenhancesthisinhibitorytone(Szabo andBlier,2001)whichmaybeakeyfactoryinimprovingthehyperadrenergic stateinPTSD,andthedownstreamimprovementinamygdala activation.
10/5/2012
9
Synapse. 2001Dec15;42(4):20312.Serotonin(1A)receptorligands actonnorepinephrine neuronfiringthroughexcitatory
aminoacidandGABA(A)receptors:amicroiontophoretic studyintheratlocuscoeruleus.
Szabo ST,Blier P.SourceNeurobiologicalPsychiatryUnit,McGillUniversity,Montral,Canada.
RevealselevatedurineNElevelscomparedtohealthycontrolsinmilitarypersonnelwithPTSD
Oneofthemostimportantfunctionsofnorepinephrineisitsroleasthe neurotransmitter releasedfromthe sympatheticneurons affectingtheheart.
Anincreaseinnorepinephrinefromthesympatheticnervoussystemincreasestherateofcontractions.
Asa stresshormone,norepinephrineaffectspartsofthebrain,suchasthe amygdala,where attention andresponsesarecontrolled.
Alongwith epinephrine,norepinephrinealsounderliesthe fightorflightresponse,directlyincreasing heartrate,triggeringthereleaseof glucosefromenergystores,andincreasingbloodflowto skeletalmuscle.Itincreasesthebrain'soxygensupply.
Norepinephrinecanalsosuppressneuroinflammation whenreleaseddiffuselyinthebrainfromthe locusceruleus.
IndividualswiththisdisorderappeartodisplayabnormalitiesindifferentmeasuresofNEalongwithhypersensitiveadrenergicreceptorssuggestiveofanoverallenhancednoradrenergicstate.TheproposedneuralcircuitryimplicatedinPTSDisalsoinfluencedbythesecatecholaminergicalterations.IncreasedNAmaycontributenotonlytotheenhancedfearacquisitionandconditioningresponsesbytheamygdala,butalsotolossofprefrontalcontrolovertheamygdalathusimpairingextinctionofthefearresponse.
Studiesofglucocorticoids (GCs)andmemoryhaverevealedthatduringacutestress,elevatedGClevelsworkinconcertwithnoradrenergicactivationtoenhancetheprocessofencodingandconsolidatingemotionalmemories(Rozendaal etal.,2006).
OnemodelthathasbeenputforthhypothesizesthatthemPFC whichnormallyhasinhibitorycontroloverthenoradrenergicneuronsoftheLCandovertheHPAaxis,isrenderedineffectiveattimesofacutestressthuspermittingenhancedstimulationoftheamygdalabyGCsandNE,whichinturnenhancesencodingandconsolidationofthetraumaticmemory(Hurlemann,2008).
AdrenergicreceptorsinindividualswithchronicPTSDareparticularlysensitivetostimulationandpronetohyperactivity.
10/5/2012
10
SerotoninmodulatesHPAaxisandLongtermtreatmentwithSSRIappearstodecreaseHPAresponsivenessatthepituitarylevel
JNeuroendocrinol. 1999Jun;11(6):46571.Acuteandlongtermtreatmentswiththeselective
serotoninreuptakeinhibitorcitaloprammodulatetheHPAaxisactivityatdifferentlevelsinmalerats.
JensenJB,JessopDS,Harbuz MS,Mrk A,SnchezC,Mikkelsen JD.
Source:DepartmentofClinicalBiochemistry,Bispebjerg Hospital,Copenhagen,[email protected]
Incontrasttotheenhancingeffectsonencoding,similarlyelevatedGClevelsmayimpairdelayedmemoryretrieval,particularlyforemotionallyarousingmaterial(Buchananetal.,2006),againinthecontextofnoradrenergicactivationwithintheBLA.AninvertedUshapedcurvehasthusbeenproposedtoexplainhowmemoryretrievalisaffectedbycortisolconcentrations(Wolf,2008)andthisinturnmayexplainwhyindividualswithPTSDhavedifficultysubsequentlyrememberingcertainaspectsofthetrauma.
PrimaryexcitatoryneurotransmitterintheCNS PlayaroleinthepathophysiologyofPTSDinpartviaitsactions
ontheHPAaxis ViathemodulationofCRHreleaseinresponsetostress Changesinglutamatelevelsplayakeyroleininitiationand
maintenanceoftheHPAresponse. Hyperglutamatergic statemaybeimplicatedinPTSD Isalsothoughttoplayafundamentalroleinmemoryformation,
(akeyprocessofPTSD). Followingtraumaticevents,elevatedglutamatelevelsmayserve
toencodeandconsolidatetraumaticmemories,butalsoenhancehippocampaldamage(Joca etal.,2007).
PhasesofAdrenalDysfunction
10/5/2012
11
Stimulatesfatdepositsandcanresultinweightgain. Increasedfataccumulationaroundwaist. Increasesbloodpressure. Increasesproteinbreakdownthatcanleadtomuscle
loss. Causesdemineralizationofbonethatcanleadto
osteoporosis. Interfereswithskin'sabilitytoregenerationandheal. Causesdemineralizationofbonethatcanleadto
osteoporosis. Interfereswithskin'sabilitytoregenerationandheal. Cortisolisapowerfulantiinflammatoryagent.
SalivaryAdrenalProfile BasicNeurotransmitters Thyroidfunctiontests BasalBodytemps
Beforebeginninganytreatmentprotocolontheadrenalglandsaclinicalhistoryshouldbetakenandtestingshouldbedone.1.Saliva2. Serum3. Urine
10/5/2012
12
DiurnalCortisol=4Cortisols(AM,Noon,Eve,PM) 30minutes(afterawakening) Beforelunch Beforedinner Beforebedtime(preferablyatleastonehourafter
dinner).
DHEA(NOTDHEAS)*Totaloffivehormonetests
LabrixClinicalServicesETL,2008
Cortisol Awakening Response
0
5
10
15
20
25
0 15 30 45 60 75
Time post awakening (minutes)
Cor
tisol
(nm
ol/L
)
SalivaryCortisol:ABetterMeasureofAdrenalCorticalFunctionThanSerum.ViningRF,etal.AnnClinBiochem (1983)20:32935.
VenipunctureCausesRapidRiseinPlasmaACTH.Meeran Ketal.BrJClinPract (1993)47(5):2467.
SalivaryCortisol AnAlternativetoSerumCortisolDeterminationsinDynamicFunctionTests.AardalErikssonE,etal.ClinChem LabMed(1998)36(4):215222.
HormoneProfilesinHumansExperiencingMilitarySurvivalTraining.MorganCA,etal.BiolPsychiatry(2000)47:891901.
SalivaryCortisolDeterminedbyEnzymeImmunoassayisPreferabletoSerumTotalCortisolforAssessmentofDynamicHypothalamicPituitaryAdrenalAxisActivity.Gozansky WS,etal.ClinEndocrin (2005)63:336341.
Urine 13hoursafterrising(not1st morningvoid) Serotonin,norepinephrine,epinephrine,dopamine,glutamate,GABA
Received7June2010Receivedinrevisedform21July2010Accepted30July2010ReviewNeurotransmittersexcretedintheurineasbiomarkersofnervoussystemactivity:ValidityandclinicalapplicabilityDavidT.Marc,JosephW.Ailts,DanielleC.AiltsCampeau,MichaelJ.Bull,KellyL.Olson
Hydrocortisone(physiologicdosing)
DHEA Melatonin VitaminC VitaminB5 VitaminB6 VitaminE PhosphorylatedSerine 5 HTP LTyrosine LTheanine
Traceminerals Zinc Manganese Selenium Chromium Molybdenum Copper Iodine
Rhodiola Ashwagandha Panax Ginseng SiberianGinseng
Bioessays. 2008Aug;30(8):74456.Whatgoesonbehindcloseddoors:physiologicalversuspharmacologicalsteroidhormoneactions.Simons SSJr.SteroidHormonesSection,Bldg 10,Room8N307B,NIDDK/CEB,NIH,Bethesda,MD208921772,USA.
Phase0
Multivitamin/MultimineralOmega3EFAsVitaminD,IodineandProbiotics
10/5/2012
13
Phase1
PhosphorylatedSerine100mgTIDorattimeswhenelevatedVitaminsB5(500mg)TID,B6(50mg)TID,C(1000mg)TIDMelatonin(16mg)qhs ifcortisollevelselevatedatnightDHEA*Lifestylemodification:Deepbreathing,stressmanagement,exercise,optimaldietetc.
Phase2
VitaminsB5(500mg)TID,B6(50mg)TID,C(1000mg)TIDAdrenalglandularand/orherbaladaptogens inmorningandatnoon*AminoAcids:5HTP,ltyrosine,ltheanineLifestylemodification:Deepbreathing,stressmanagement,exercise,optimaldietetc.
Phase3
VitaminsB5(500mg)TID,B6(50mg)TID,C(1000mg)TIDAdrenalglandularand/orherbaladaptogens inmorningandatnoon.hydrocortisonesupplementation510mginAMand510mgatnoonMelatoninAminoAcids;5HTP,ltyrosine,ltheanineLifestylemodification:Deepbreathing,stressmanagement,exercise,optimaldietetc.
3options: Rx Compoundedcortisol Glandularstandardized
glandularRx
Tabletsareavailablefororaladministrationinthreestrengths:eachtabletcontainseither5mg,10mg,or20mgofcortisol.
Inactiveingredients:calciumstearate,cornstarch,lactose,mineraloil,sorbic acid,sucrose.
HOWSUPPLIEDTabletsareavailableinthefollowingstrengthsandpackagesizes:5mg(white,round,scored,imprintedCORTEF5)Bottlesof5010mg(white,round,scored,imprintedCORTEF10)Bottlesof10020mg(white,round,scored,imprintedCORTEF20)Bottlesof100 Rx
Cortisolcanbecompounded(intoanydoseyouchoose).
Especiallywhengivingthepatientdosesdifferentthan5mg,10mgor20mg
Canhaveregularreleaseandsustainedreleaseblend
(70:30ratio 70%reg.cortisol:30%slowreleaseagent)
10/5/2012
14
Sometimesstandardizedeachpelletcontains2.45mg ofcortisol.
Otheringredientsinclude:driedadrenalcortex,Echinacea,Prunus spp,Lomatium dissectumroot,lactoseandlactase.SampleDosingSchedule
I.30minutesafterawakening:14pellets(2.57.5mgcortisol)2.4hourslaterorbeforenoon:14pellets(2.57.5mgcortisol)3.321(am7.5mg,noon5.0mg,midafternoon2.55.0mg)
glandular
Shorthalflife 8to12hours1. Cortisone2. Cortisol
Cortisolismetabolizedinmosttissues,butprimarilyinthelivertobiologicallyinactivecompounds.Thehalflifeofcortisolmaybeprolongedinpatientswithhypothyroidism.
Inactivemetabolitesareexcretedbythekidneys.Negligibleamountsareexcretedinbile.
0.5mgofdexamethazone =15mgcortisol Inadexamethazone suppressiontestusually1mgof
dex isgivenorally(i.e,30mgcortisol). 5mgprednisone=20mgcortisol Anormalstartingdoseofprednisoneisbetween5
60mg/day. MultipleSclerosistreatmentstartsat200mg/dayand
tapersto80mg/day.Cortisol
(hydrocortisone)Cortisone Prednisone Dexamethasone
20mg 25mg 5mg 0.75mg
Lowdosephysiologicalcortisolsupplementationdoesnotproducesignsorsymptomsofglucocorticoidexcessandhasnotbeenshowntocauseclinicallysignificantadrenalsuppression.20mgoforalhydrocortisonehasfarlessglucocorticoideffectonboneforexample,than5mgofprednisone(jodar 03)Studieshaveshownthat10mgand40mgofhydrocortisone(theamountincreasesdependinguponbodyweight(Mah 2004)doesnotcauseboneloss,suppressionofimmunesystem,weightgain,elevatedbloodsugar,elevatedbloodpressurethinningskin,easybruisingorsuppressionofendogenouscortisolproduction(Wichers 1999,McConnell2002,Danowski1962,SafeUsesofCortisolbyWilliamMck JefferiesMD)
Hypothalamopituitaryadrenalaxisdysfunctioninchronicfatiguesyndrome,andtheeffectsoflowdosehydrocortisonetherapy. evidencesupportspreviousfindingsofimpairedadrenalcortical
responsivity inCFS. lowdosehydrocortisonesupplementationisabletoincreasetheoverall
cortisolthroughput,suggestingthatthereisnot(over28d)acompensatoryswitchingoffofendogenouscortisolproduction.
thosewhorespondedtotreatment,hadasignificantdecreaseinfatigueascomparedtonormalpopulationlevels,therewasacorrespondingnormalizationofthebluntedcortisolresponsetohCRH challenge.
1. JClinEndocrinolMetab. 2001Aug;86(8):35455 leareAJ,MiellJ,HeapE,Sookdeo S,YoungL,Malhi GS,O'Keane V.
2. Jefferies,WilliamMcK.MD.SafeUsesofCortisol3rdeditionCharlesCThomasPublisher.LTD.ISBN0398075018
3. ThelowdoseACTHtestinchronicfatiguesyndromeandinhealthLucindaV.Scott1,SamiMedbak2,TimothyG.Dinan3Articlefirstpublishedonline:4JAN2002DOI: 10.1046/j.13652265.1998.00418.xClinicalEndocrinologyVolume48,Issue6,pages733737,June1998
4. LowDoseHydrocortisoneforTreatmentofChronicFatigueSyndromeARandomizedControlledTrialRobinMcKenzie,MD;AnnOFallon,RN;JanetDale,RN,MPH;MarkDemitrack,MD;Geetika Sharma,MD;Maria Deloria;DiegoGarciaBorreguero,MD;WilliamBlackwelder,PhD;StephenE.Straus,MD
10/5/2012
15
TheamountofDHEAneededtobringamalewithAddisonsdiseaseintonormalphysiologicalrangeis5070mg(Huntetal.2000).
Ifyouarefollowingphysiological(notreplacement)dosesyouwouldlikelynotexceed: Males2550mg/day Females1025mg/day
Improvementinmoodandfatigueafterdehydroepiandrosterone replacementinAddison'sdiseaseinarandomized,doubleblindtrial. Hunt PJ,etal.JClinEndocrinolMetab. 2000Dec;85(12):46506.
Secretedbythepinealgland Regulatescircadianrhythmandinducesleep. Cushing'ssyndromewasshowntohavesignificantlylowerlevelscomparedtohealthycontrolgroups.
Studiesalsohaveshownthatnightlyadministrationof2mgofmelatoninhavesupportedadrenalrecoveryafter6monthsofadministration
(Soszynskietal.1989;Brulsetal.2000;Pawlikowskietal.2002).
Ofallthevitaminsandmineralsinvolvedinadrenalmetabolism,vitaminCisprobablythemostimportant.Infact,themorecortisolmade,themorevitaminCused.VitaminCissoessentialtotheadrenalhormonecascadeandthemanufactureofadrenalsteroidhormones1
StudiesshowthatvitaminCcanattenuateandinfluencecortisol,inducinganantiinflammatoryresponsetoprolongedexerciseandstress.VitaminChasbeenshowntoreducetheelevationofcortisolinresponsetoheavyexercise.Inhumanstudies,3000mgofvitaminCdailymitigatedariseinbloodpressure,cortisol,andsubjectiveresponsetoacutepsychologicalstress
1)Dr.JamesL.WilsonistheauthorofAdrenalFatigue:The21stCenturyStressSyndrome.In19982)DiLuigietal.2001;Petersetal.2001a,2001b;Brodyetal.2002).
(CoA)thebasisfortheproductionofhemoglobin,bile,sexandadrenalsteroids,cholesterol,andotherbrainchemicalsandneurotransmitters.
Pantothenicaciddeficiencyresultsinadrenalinsufficiency,whichischaracterizedbyfatigue,headache,sleepdisturbances,nausea,andabdominaldiscomfort
PantothenicAcidAndPantethine,MichaelLam,MD,MPH(Tarasovetal.1985;Smithetal.1996;Murrayetal.1997).
B6(pyridoxine) isalsoacoenzymeinseveralofthebiochemicalpathwaysintheadrenalcascadeandplaysaroleinthefunctioningofthehypothalamic/pituitary/adrenal(HPA)axisthatmodulatesadrenalactivityandthestressresponse.
JamesWilsonwebsite2010
Absorbsandneutralizesthesedamagingfreeradicalmoleculesinsidetheadrenalglands(VitaminCenhancesvitaminEsactivityinsidethecellbyregeneratingthecapacityofvitaminEtosequesterthefreeradicals).
WorkshandinhandwithVit.Ctokeeptheadrenalcascadefunctioning.
HighamountsofvitaminEarenecessaryinorderfortheadrenalstomaintainhighlevelsofsteroidproductionandrecoveradequately.
Bieri,JG;Evarts(1974)."Tocopherol:metabolism,biologicalactivityandsignificanceinhumanvitaminEnutrition".AmericanJournalofClinicalNutrition 27 (9):980986.PMID 4472121
10/5/2012
16
SevenForestsSanQi17(26tablets) StJohnss Wort (300mg) 5HTP(100mg*) LTheanine (50200mg) Melatonin16*mg Chamomile,ValerianRoot(asdirected)
Normalizeyoursleep Sleepmore Sleepattherighttimes(lightdarkcircadian
rhythms) Sleeplater(until8:30or9am) Balancehormones;adrenalsand
estrogen/progesterone Book:LightsOut
Takenonemptystomach30minutesawayfromfood
CrossthebloodbrainbarrierandinteractwithHPAaxisandneurotransmitterregulationThemonoamineneurotransmittersserotonin,dopamine,norepinephrine,andepinephrinedonotcrossthebloodbrainbarrier;therefore,peripheraladministrationoftheseneurotransmitterswillnotincreasecentralnervoussystemneurotransmitterlevels.Theaminoacidprecursorsoftheseneurotransmittersdocrossthebloodbrainbarrier.TheonlywaytoincreasecentralnervoussystemneurotransmitterlevelsisthroughadministrationofaminoacidPrecursors.
MartyHinz MDFoodandNutritionindiseaseManagement,Ch 29,pp465483 Birdsall TC.5Hydroxytryptophan:aclinicallyeffectiveserotoninprecursor.Altern MedRev.1998Aug;3(4):271280. PyleAC,Argyropoulos SV,NuttDJ.Theroleofserotonininpanic:evidencefromtryptophandepletionstudies.Acta
Neuropsychiatrica 2004;16:7984
Aphospholipid thatisastructuralcomponentofthebiologicalmembranesinanimalsandplants.
BluntstheHPAsensitivitybyalteringACTHandcortisol responses
(Monteleoneetal.1990;Kelly1999;Bentonetal.2001).
Alsoknownasoxitriptan Anaturallyoccurringaminoacid Chemicalprecursoraswellasmetabolicintermediateinthebiosynthesisoftheserotoninandmelatoninfromtrytophan
Chronicstressalsoactsinthebraintodecreaseserotonin.Serotoninactsinthebraintoenhancetheeffectsofleptin inthehypothalamus.
Adv Exp MedBiol. 1996;398:3739.Fibromyalgiaandmigraine,twofacesofthesamemechanism.Serotoninasthecommonclueforpathogenesisandtherapy.Nicolodi M,Sicuteri F.Interuniversity CentreofNeurochemistry,UniversityUnit,Florence,Italy.
Notconsideredanessentialaminoacidbecausethebodycansynthesizethisfromphenylalanine
Convertedintodopamineandnorepinephrine Underepisodesofstress,thebodymaynothavethecapacitytoproduceenoughtyrosinefromphenylalanine;therefore,supplementationsupportshormoneandNTproduction
IncreasesalertnessandmentalclarityIntJGenMed2011Hinz etal,publisherandlicenseeDoveMedicalPressLtd.AminoacidmanagementofParkinsonsdisease:acasestudyMartyHinz,1 AlvinStein,2 andThomasUncini31ClinicalResearch,NeuroResearch Clinics,Inc.,CapeCoral,FL,USA;2SteinOrthopedicAssociates,Plantation,FL,USA;3DBSLabs,Duluth,MN,USACorrespondence:MartyHinz,1008DolphinDr,CapeCoral,FL33904,USA,Tel+12186262220,Fax+12186261638,[email protected]
10/5/2012
17
Glutamicacidanalogderivative Aminoacidfoundingreentea Producesacalmingeffectinthebrain. Increasinggammaaminobutyric acid(GABA)(relaxer
andcreatesasenseofwellbeing). Helpmodulatemood Reducementalandphysical Improvescognition
Abeetal.1995;Kobayashietal.1998;Juneja etal.1999GomezRamirezM;Higgins,BA;Rycroft,JA;Owen,GN;Mahoney,J;Shpaner,M;Foxe,JJ(2007)."TheDeploymentofIntersensory SelectiveAttention:AHighdensityElectricalMappingStudyoftheEffectsofTheanine".ClinNeuropharmacol 30 (1):2538.KimuraK,Ozeki M,Juneja L,Ohira H(2007)."LTheanine reducespsychologicalandphysiologicalstressresponses".BiolPsychol 74 (1):3945.doi:10.1016/j.biopsycho.2006.06.006.PMID 16930802.HaskellCF,KennedyDO,MilneAL,Wesnes KA,Scholey AB(2008)."Theeffectsofltheanine,caffeineandtheircombinationoncognitionandmood".BiolPsychol 77 (2):11322
Antioxidantactivity Liverprotectionandantitoxin
activity Improvedbloodsugar
metabolism Lesscravingforalcoholor
sugar Improvedimmuneresistance Increasedenergyandstamina Improvedmuscletone
Increasedstrength Fasterrecovery Betterfocusand
concentration Lessanxiety Bettersleep Bettermotivationand
productivity Afeelingofwellbeing Bettermoods
Haveanormalizingeffectonthebodyandtobecapableofeithertoningdownorstrengtheningtheactivityofhyperandhypofunctioningsystems.
Themechanismoftheantistressoradaptogenic activitiesofradixeleutherococciappearstobethreefold. Extractsoftherootshaveanadaptogenic effect
thatproducesanonspecificincreaseinthebodysdefenseagainstexogenousstressfactorsandnoxiouschemicals.
Therootsalsostimulatetheimmunesystem Andpromoteanoverallimprovementinphysical
andmentalperformance."AdaptogensthatHelpwithAdrenalFatigue:GetGoingAgainwithNaturalHerbalRemedieshttp://www.suite101.com/content/adaptogensthathelpwithadrenalfatiguea162757#ixzz1EWWOrDIz
Alargestudyreviewedtheresultsofanumberofclinicaltrialsinvolving2,100healthymenandwomenages19to72.Subjectsweregivendosesofginsengrangingfrom2to16mloffluidextract,33percentethanol,fromonetothreetimesdailyforupto60days.Subjectshadincreasedmentalalertnessandworkoutput,enhancedathleticperformanceandimprovedworkquality.Theyalsoexhibitedanimprovedabilitytowithstandadverseconditionssuchasheat,noise,increasesinworkloadandphysicalexertion.
BullWorldHealthOrgan.1985;63(6):965981. Medicinalplantsintherapy* NormanR.Farnsworth,Olayiwola Akerele,AudreyS.Bingel,
Djaja D.Soejarto,andZhengang Guo
Effectiveatimprovingaperson'sabilitytowithstandstress: Improvedworkperformanceandquality Enhancesmentalfunction Increasesthereleaseofadrenocorticotropichormone(ACTH),whichstimulatesanincreaseinadrenalhormonesecretion.
Counteractstheshrinkageoftheadrenalglandcausedbycorticosteroiddrugs.
Murray,M.&Pizzorno,J.EncyclopediaofNaturalMedicine:499.Rocklin,Calif.:PrimaPublishing,1990.Shibata,S.,etal."Chemistryandpharmacologyofpanax,"EconMedPlantRes,1:21784,1985.
Immunomodulating Modifiesanxietyandotherpsychologicalcomplaints.
Whencortisolistoohigh,itlowersit,andifitistoolow,itraisesit.
Upadhaya,L.,etal."RoleofanindigenousdrugGeriforte onbloodlevelsofbiogenicaminesanditssignificanceinthetreatmentofanxietyneurosis," Acta Nerv Super, 32(1):15,1990.Ghosal,S.,etal."ImmunomodulatoryandCNSeffectsofsitoindosides IXandX,twonewglycowithanolides fromWithania somnifera," Phytother Res, 3(5):2016,1989.Bhattacharya,S.K.,etal."Antistressactivityofsitoindosides VIIandVIII,newacylsterylglycosides fromWithania somnifera," Phytother Res, 1(1):3237,1987.www.smartpublications.com.Wilson,James.Adrenal Fatigue.
10/5/2012
18
Promotesorenhancesimmunesystemfunction Stimulatestheadrenalcortex Inhibitsthebreakdownofadrenalhormonebytheliver,therebyincreasingcorticosteroidlevelsincirculation
Inhibitscortisol'sabilitytopromotethymusatrophy
1ProtocolJournalofBotanicalMedicine,1(4):194.Ayer,Mass.:HerbalResearchPublications,1996.2)Murray,M.&Pizzorno,J.,op.cit.,pp.60,61,67.3)Armanini,D.,Kargbowiak,I.,etal."Affinityofliquorice derivativesformineralocorticoid andglucocorticoid receptors,"Clin Endocrinol,19:60912,1983.
Diminishesfatigue Improvesattentionspan Improvesmemory; Makesworkersmoreproductive. Increasesthecapacityformental/cognitivework
Enhancespermeabilityofthebloodbrainbarriertodopamineandserotonin.
Rhodiola rosea instressinducedfatigue:adoubleblindcrossoverstudyofastandardizedextractSHR5witharepeatedlowdoseregimenonthementalperformanceofhealthyphysiciansduringnightduty.Darbinyan V,Kteyan A,Panossian A,Gabrielian E,WikmanG,WagnerH.Department ofNeurology,ArmenianStateMedicalUniversityPhytomedicine 2000;7(5):36571.
Usetryptophanif5HTPiscausingGIupset Balancing:neurotransmitters,sexhormonesandadrenalfunctionareallinterdependentandcorrectingonepositivelyaffectstheother
Nodirectfeedbackbetweenzona fasciculata andzona reticularistreateachzoneasifseparategland
Treatthepathwayaswellasthelevel TreatHPAdysfunctionfirstthenmayneedtotreathypoadrenia ifpresent
DHEA,melatoninand phosphoylated serinecanbeusedtoquietHPAdysfunction
ACTHisnotstimulatingincreasedandrogensinwomenwithMet.SyndromeandPCOS