Do You Need Hydrocortisone For Low Adrenals?December 3, 2018
Sublingual Immunotherapy: A Solution for Food AllergiesDecember 10, 2018
A question I received recently asked a really important question that I want to share with you: Can you get off of hydrocortisone? In this article, I want to tell you a bit more about hydrocortisone and if you need to be on it, and what you can do to feel better in the future.
A Letter From A Reader
As always, I love receiving questions and comments from readers, so don’t be shy! All the way from sunny Naples, Florida, this question from Esme reads as such:
“Dear Dr. C, Earlier this year a functional doctor diagnosed me with adrenal fatigue and put me on a medication called Cortef. It seemed to give me more energy for a few weeks but then it quit working. Now, if I try to stop taking it I’m more tired than ever before. I was hoping that since you’re the adrenal expert you could help.”
Thank you so much for your question, and it would be my pleasure to dive deep into this question to help you (and anyone else) out. As it happens, I have seen this sort of thing come up about several different times.
It is always unfortunate when someone is put on a medication that becomes hard to discontinue, especially when they may not have needed it in the first place.
So, to answer this question properly, we really should break things down into three key concepts/questions. They are:
- Did you need to be on this medication?
- How can you come off of it?
- How can you get better from the condition formerly known as adrenal fatigue? (1)
Bottom Line: Esme, I really want to help you, and anyone else struggling with the same issue, get to the bottom of it and to start taking steps immediately to alleviate the issue. As we break these down, I hope we can get to a place where you can feel back to your best self again.
How Do You Know You Needed It?
This type of medication that Esme is mentioning is what we call a glucocorticoid, and it functions much in the same way as cortisol (one of the main glucose-regulating hormones from the adrenal glands). Who needs to be on a glucocorticoid, though?
Basically, a glucocorticoid is necessary for someone whose body is unable to make as much cortisol as they need. Here is the thing, though, there are many people who have low-cortisol levels throughout the day (and whenever they might be tested).
There is a big difference between being low in cortisol, and unintentionally low in cortisol. The major question that you need to ask yourself: Did your body mean to do that? In a lot of cases, especially as it concerns adrenal fatigue, your body meant to do that (to lower its cortisol levels).
Instances can occur, though, where the body did not intend to lower cortisol. In those cases, a glucocorticoid could help. The most common condition we know about is called Addison’s disease, and this is what we might consider the Hashimoto’s disease of the adrenals.
Addison’s disease is where the immune system breaks down the adrenal glands, rendering them unable to make adequate amounts of cortisol any longer. Most of these cases do benefit from glucocorticoid replacement.
Key Insight: However, low cortisol (and even really low cortisol) may be done by your body on purpose. Your body might feel boosted by a glucocorticoid mirroring the effects of cortisol, but it is ultimately not what your body is trying to accomplish.
The truth is that your body has a reason for lowering your cortisol. If you continue to load yourself up with cortisol, it is almost like hitting the gas on a car with engine troubles. Sure, you might go faster and feel less vulnerable, but at what cost? It is not a happy ending.
How do you know if you have Addison’s disease and need glucocorticoid? It is easier than you think, all you need is to take a simple test called ACTH, which can determine how much cortisol your brain is asking your adrenals to make (2).
If your scores are really high, it simply means that your body is not following through with the brain wants. But, if you have low cortisol and your ACTH scores are low, as well, then the adrenals are doing exactly as they are being asked.
All of this is far more relevant if someone has not yet begun treatment. However, if you are on treatment, let’s consider this: If an average-sized woman is taking 15 mg, per day, or less of our medication in question.
In those cases, that amount would not be enough to lower the ACTH scores drastically. If you still saw a normal amount of ACTH, with a dosage in that range, it would mean that your body is doing that on purpose.
If you were taking 15 mg or less, and the ACTH was elevated, that might mean that you still needed it. So, while it can be a little trickier to determine that while you are on treatment, but a good doctor can if they are really considering how much you are currently on.
What about a high dose of hydrocortisone? At that point, it would block the ACTH and make things much more complicated (effectively blocking the signal and muddying the results).
Bottom Line: In most cases what we commonly refer to as adrenal fatigue is not Addison’s disease. If you were diagnosed without either an ACTH or an adrenal antibody test, that would be enough to question just about any diagnosis of Addison’s disease.
Doctors will also often do challenge tests, which are useful, and typically involve being given a tiny amount of ACTH (a synthetic version). From there, you can see just how much cortisol the adrenals make afterward.
Key Insight: If someone has poor cortisol output, they would have a low cortisol level unchanged by the addition of ACTH.
How Do You Come Off It?
If you knew for certain that you did not have Addison’s disease, how do you come off a glucocorticoid when you did not need it in the first place? The real trouble is that if even if you did not need it, yet took it, you can still have symptoms coming off of it.
This comes down to the fact that when you take cortisol, it greatly diminishes how your body makes cortisol altogether. Once you lower your own cortisol output, it takes more time (even more than before) to get that regulation back in order.
Key Insight: The trick is to approach things extremely gently and gradually, specifically with the help of a medical professional well-versed in cases just like these. From personal experience, I can say that all of our doctors at Integrative Health are prepared to handle cases just like these (and do so every day).
The main strategy is to take things slowly. The way that we do that at Integrative Health is by using a compounded cortisol. This is a little different from hydrocortisone, as a more active analog and in more exact quantities.
What it ultimately takes is a slow decrease, milligram by milligram, that is personalized to exactly your needs. At the slowest, it might be a milligram per week, or it might be a milligram per day. It all depends on you and your needs.
The tricky part is that you always want to make sure that your body is compensating, and you do that by tracking the following:
- Blood Proteins
- Glucose Levels
- Your Symptoms
If you are doing things slowly and gradually enough, and there is not an increased burden of stressors in your life, you should not see your symptoms worsen at all. If you go too fast, though, you can easily see things become worse.
It is hard when you are taking hydrocortisone to have your adrenal output become stronger. What happens there is that when you are taking it, your body decreases its own output even further. When you are on that, it becomes far more difficult to radically improve your baseline function.
Bottom Line: What does it take to get off hydrocortisone? It takes time, effort, and a commitment to understanding that your true health needs a day-at-a-time approach.
How Do You Heal Your Adrenals?
This is our final consideration for our topic today. In this scenario, your adrenals are not so much damaged as your body needs time to heal. The easiest way to start is with the Adrenal Quiz (3). This will give you a really great starting point, and a good read on where your adrenals are at (and what you can do about them).
Regardless of your levels from the Adrenal Quiz, the Adrenal Reset Diet is made to help. The basic concept here is that you are changing your carbohydrate levels to correspond with your cortisol slope (where carbs lower your cortisol, so you enjoy less in the morning and more in the evening).
Key Insight: Rebuilding your good “cortisol slope” is so important. That is why the Adrenal Reset Diet is based on this concept, and getting your health timed to perfection.
Your Adrenal Quiz results will also direct you to certain packs, which have particular ingredients based entirely on where you fall in the spectrum of adrenal health. Personally, I am not a fan of most adrenal supplements, but these ones are distinct to both your level and the time of day.
Treat Yourself Like A Baby
What do I mean by that? Well, new parents quickly realize that babies need to have a set schedule (like set rhythms). This concept of timing is one of the biggest things that can help your body’s circadian cycles.
Bottom Line: If you know the right times to do the right things, your health is definitely going to be heading in the right direction. Keep a strict regiment for following through on your health, and what you need to do, and you will be sure to benefit.
Did You Need To Be On Hydrocortisone?
Let’s summarize what we learned here today: If you did not have a confirmed diagnosis of Addison’s disease, the resounding answer should be that you did not need to be on hydrocortisone. Even though it might make you feel better at first, it does not work long term and will not move you towards better health overall.
How can you come off it? Well, slow and steady wins the race. If you work with the right team, within the right parameters, and with the right tools at your side (like the Adrenal Reset Diet and daily packs), then you can definitely take your health back into your own hands.
As I mentioned before, take the Adrenal Quiz (4) today to gain the knowledge you need to have about your health. From there, I look forward to hearing about your progress on the journey towards better health. Thanks again to Esme for her question today, and please feel free to continue writing to me. I cannot wait to hear from you.
Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet.
Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, and regain energy. Learn more about the surprising story that started his quest.