How to combat low Cortisol?

Updated: Mar 30

In this article we've described the most common symptoms and available diagnostic tests for adrenal fatigue and other cortisol disturbances:


https://www.yourendocrinehealth.com/post/adrenal-fatigue-testing-symptoms-and-effect-on-your-thyroid-explained


Today, we'd like to expand the list that we've touched upon in our last Instagram post:




So how should You start, What is step 1 ?


Fist of all You have to consult Your results of 4 point saliva cortisol test with Your doctor. Usually, You should get something like this:



From the results of this test, Your doctor will tell You the best solution to Your medical condition.


The therapy will depend on the amount of the cortisol that You have.


Solutions like: getting more sleep, reducing the caffeine intake or reducing Your body weight will definitely help most of the patients.


But let's get more specific!


1. Caffeine


Caffeine stimulates neuron activity in the brain. Neurons send message to your pituitary gland which in turn signals your adrenals to pump out adrenaline and cortisol. In too high amounts, caffeine puts you into fight or flight mode.


How much is healthy? 1-2 cups of tea or coffee daily are the healthy amounts (200-250 milligrams of caffeine a day).



2. Liquorice root


Liquorice or licorice is the root of Glycyrrhiza glabra. The liquorice plant is native to the Middle East, southern Europe, and Asia.


Licorice contains a potent compound called glycyrrhizic acid. This acid prevents the body from breaking down cortisol into cortisone.


That's why it can be useful for thyroid patients who have too low cortisol levels. 


When liquorice will be helpful?

When patient has low cortisol in 1 or 2 points during the day. Hence, it will work mostly for patients with mild adrenal fatigue and slightly lowered cortisol levels.


Will it work for patients with severely lowered cortisol levels?

It may work. However, we don't advise it as some of the patients report an increase in blood pressure. Solution to this would be increasing the potassium intake and reducing the dose of the supplement. but again it won't work for all of these patients.


Patients who react poorly to this supplement may need cortisol replacement therapy (explained later.


How much and for how long should You supplement?

Around 900mg a day should work for most patients. Supplement should be takes for around 4-8 weeks. Then we advise to make 2 weeks break and start another cycle.


P.S. Remember that Liquorice Root differs from licorice sweets. They won't help with anything...



3. Sleep more!


Sleep is particularly important with adrenal fatigue. When Your cortisol is imbalanced, You can have trouble falling asleep and staying asleep. A lot of the patients wake up in the middle of the night and stay up for a couple of hours.


All of these events stress You out even more. That's why it is important to develop a relaxing routine before falling asleep and making sure You're not cutting sleep and get at least 8 hours of sleep per night.



3. Exercise (but do not exaggerate)


Cortisol is a stress hormone and if too much, it causes inflammation in the body, which affects the TSH output in the brain and inhibits the conversion from T4 to the T3 (active form).⁣

So when does it happen?⁣

- Too much training volume (too many days or too long sessions) ⁣

- Too many moderate-intensity training (lactic energy system is involved too much) ⁣

- Not enough heavy weights training ⁣

Solution?⁣

- High-intensity training should only be done 2-3 times per week, max 30 minutes per training. ⁣

- Avoid moderate-intensity training⁣

- Stay in the low intensity, aerobic training zone, try Yoga, walking, Tai-Chi, slow hiking, low-intensity Pilates. Do it often, but remember to do it slowly. ⁣


4. Try DHEA


DHEA, also known as dehydroepiandrosterone or androstenolone. It is the precursor of testosterone and estrogen.


The test for dehydroepiandrosterone sulfate (DHEAS) is usually ordered along with the cortisol saliva test.


Based on the result, Your doctor will prescribe You the right dose of the medication. Usually, treatment should be started with a low dose to avoid side effects.



5. Adaptogens


Adaptogens are herbal pharmaceuticals. They act to prevent the effects of stress in the body. They maintain a stable balance in the hypothalamic, pituitary, and adrenal glands.


We frequently face numerous stressors in our life. It's often too much mental work, too much physical work, stressful family situation or something more severe like a disorder that puts our body in hormonal imbalance.


Our body tries to resist that stressor. It responds by releasing hormones like adrenaline that improve performance. However, it only works until a certain point, because we have a certain threshold of resistance.


Adaptogens increase the threshold and improve our resistance to stress.


So what are the examples of adaptogens? 

AshwagandhaRhodiolaReishi and Shiitake mushroom,  Holy BasilSiberian Ginseng, Korean Ginseng, North American Ginseng, Schisandra.


Which of the adaptogens are the strongest and which are the weakest?


So now You may be asking a question "Which one will work best for me and when should I use them"?


Well, it depends... like everything in medicine.


In general, Adaptogens will work best for patients who have mixed low cortisol levels. Thus, from the saliva test we will obtain a result for example HIGH-LOW-HIGH-LOW.


What's more, we usually recommend starting with Ashwagandha. You can see it is in the middle of the spectrum.


We've found that for most of the patients with hypothyroidism and mixed cortisol levels, this adaptogenic herb will be very helpful.


For small percentage of patients, however, it won't work as it's also a nightshade. Hence, when a person is suffering from hypothyroidism, adrenal fatigue and gut problems, it can actually worsen the symptoms.


It, fortunately, refers only to a small percentage of patients, but It's still important so it has to be monitored together with Your doctor.


6. Adrenal Glandulars


Adrenal glandulars is the solution to exhausted adrenals caused by overuse of stimulants such as caffeine. Adrenal glandular can be used along with adaptogens.


This glandular extract contains the outer cortex section of the bovine adrenal gland. It's important to get a supplement that is obtained from the Bovine that is free from Spongiform Encephalopathy (certified).


For who will they work?

For patients who have low cortisol but not extremely low.


7. Coenzyme Q10


Coenzyme Q10, also known as ubiquinone, is a coenzyme that is present in animals and most of the bacteria. It acts as an antioxidant, which protects cells from damage. It also plays an important part in the cell metabolism.


Coenzyme Q10 can be a very helpful supplement for both Hyperthyroid and Hypothyroid patients. We mostly recommend it for Hyperthyroid patients.


Why? because they're the most deficient in CoQ10 and it brings them benefits in terms of symptoms management as well as heart diseases and neurological diseases prevention.


For these patients, we recommend supplementing between 100mg and 250mg/day.


On the other hand, for patients with Hypothyroidism, supplementing with CoA10 is a more specific approach. We can't simply say that all of these patients should use it.


Why? Because some of the patients may not react well to it and worsening of the symptoms in few hypothyroid patients have been observed.


Take into consideration, however, that worsening of the symptoms in these patients can be correlated with the adrenal problem (which should be fixed before the thyroid) or impurities present in the supplement capsule.


The solution to this may be simply changing the brand of the supplement. That's the reason why every patient should be diagnosed and treated on an individual basis.


8. Hydrocortisone


Hydrocortisone is a prescription medication that contains the hormone cortisol. This is a solution to patients with very low cortisol levels.


Since it is a prescription medication, it has to be consulted with Your doctor concerning the proper dose and duration of the therapy.




9. Pregnenolone


Pregnenolone performs an important role in hormonal balance as a key precursor to cortisol, DHEA and progesterone.


It can be helpful, especially if used together with DHEA. Your doctor will prescribe You the right dose of the medication. Usually, treatment should be started with a low dose to avoid side effects.


10. B vitamins


Vitamins B will be specifically useful for people who aren't getting enough sleep.


An optimal formula for adrenal fatigue should include, per day: 75-140 mg of vitamin B3, 800-1200 mg of vitamin B5 and 100-150 mg of vitamin B6.













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