When it comes to chronic fatigue and fibromyalgia the problem lies with a gland in our brains called our hypothalamus. This gland is responsible for initiating and regulating our hormones including thyroid hormones, cortisol, estrogen, progesterone and many more. The hypothalamus starts the process by sending hormones to another nearby gland called the pituitary. The pituitary continues the hormonal cascade by sending hormones to the thyroid, adrenals and ovaries. This stimulates them to make their own hormones that have effects at receptors around our body. Because it all starts with the hypothalamus, it’s easy to see that a problem there leads to problems everywhere.
All of these hormones do many different things in our bodies. They regulate our immune system, blood pressure, pulse rate, blood flow, metabolism, fluid retention, reproduction, weight, mental function, and mood. Hormonal systems are often suppressed in CFS and fibromyalgia.
In this post series I’ll go over each system, the hormones involved, symptoms of dysregulation, and what to do to bring each back into balance.
We’ll start with the adrenals…
What Are the Adrenal Glands?
The adrenal glands are responsible for immune function, fluid regulation and the stress response through cortisol, aldosterone, epinephrine and norepinephrine.
Many people with CFS and fibromyalgia have underactive adrenals. In the early stages the hypothalamus may try to stimulate the adrenals to produce cortisol, but over time they become exhausted. Depending on when you get testing, you may see high cortisol or low cortisol.
Symptoms of Dysfunctional Adrenals
Fatigue
Energy is like a roller coaster
Poor immunity leading to frequent infections
Hypoglycemia or low blood sugar - shaky, nervous, dizzy, irritable, better with sweets
Food cravings for sweets or salt
Low blood pressure and dizziness when standing
Can’t cope with stress, crashing during stressful times
What to Do About Adrenal Dysfunction
Hypoglycemia/low blood sugar - Cut sugar and caffeine out of the diet, eat frequent meals, increase protein and decrease simple carbohydrates. If you need to quickly increase your blood sugar, eat a piece of candy under the tongue.
Prescription hydrocortisone (Cortef) - This bioidentical cortisone mimics the body’s natural cortisol. It may help to heal the adrenals and get them responding to hypothalamic stimulation again. Those with CFS and fibromyalgia may have low cortisol leading to more pain and not be able to produce enough to reduce their pain. Cortef may help to alleviate the body pain associated with these conditions.
Hormones are self-controlling. When there’s a lot of hormone, it “turns down” the hypothalamic stimulation so you don’t get excess hormone. When there’s a little hormone, it “turns up” the hypothalamic stimulation so you get more hormone. When giving bioidentical hormones you want to give enough to help but not so much that it “turns down” the body’s own production.
Low doses of hydrocortisone can help without interfering with your own production. Suggested dosing is 5-12.5 mg per day not to exceed 20 mg per day for 6-18 months, then taper off.
Side effects can include upset stomach, which can be relieved by taking it with food. Weight gain may also happen, which is usually offset by the fact that you’ll have less pain and more energy so you’ll be able to be more active and sleep well again.
If you’ve heard any negative things about oral hydrocortisone just know that early studies used much more than the suggested dose above. Patients were given toxic levels and the studies considered “low dose” to be around 25-30 mg/day.
Natural Ways to Support the Adrenals
If prescription hydrocortisone isn’t available or you’d prefer not to use it there are other ways to support the adrenals too.
Increase salt intake and hydrate well - Aldosterone (aka vasopressin) is an adrenal hormone that helps your body absorb water. When aldosterone is low, which can be the case in CFS and fibromyalgia, you’ll have a hard time keeping fluid in the body and become thirsty and easily dehydrated. One simple way to improve this is to increase your salt intake and drink more water to keep yourself hydrated.
Adrenal glandulars or cortex - This is adrenal tissue from cows that gives your adrenals the materials they need to heal. The adrenals produce cortisol, aldosterone, androgens and DHEA in the outer part of the adrenals called the cortex so you may also see this type of product called “adrenal cortex.” Because this product is coming from animals, it’s important to use reputable companies for products like glandulars. I like to use Integrative Therapeutics, Klaire Labs, and Pure Encapsulations.
Vitamin C - The highest levels of this vitamin are found in the adrenals and brain. We excrete it during times of stress in our urine. Suggested dose: 500-1000 mg per day. Side effects can include loose stool if you take too much.
Pantothenic acid/B5 - A deficiency of this vitamin can cause the adrenals to shrink. Suggested dose: 100-150 mg daily.
Licorice (Glycyrrhiza glabra) - This is an herb I like to use when someone has low cortisol because it can slow down the breakdown of cortisol, making it last longer throughout your day. It can cause high blood pressure in some people so I wouldn’t recommend it if you have this issue. If you’re concerned about this you can also regularly check your blood pressure at home and stop taking the licorice if you notice it creeping up. Suggested dose: 200-400 mg daily, of a product containing 5% glycyrrhizic acid.
Chromium - This mineral is great for low blood sugar and insulin resistance. Suggested dose: 200 mcg daily.
Dehydroepiandrosterone (DHEA) - This is a hormone that’s produced by the adrenals and can be converted to other hormones like estrogen and testosterone. Low levels may result in fatigue. Suggested dose is 5-15mg per day. Side effects may include facial hair and acne with doses that are too high. Also be cautious with a history of breast cancer.
Stay tuned for the next article, where I’ll dive into thyroid hormones, explore the links between low thyroid function and CFS and fibromyalgia, and share practical tips to boost your thyroid health!
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In health,
Dr. Jamie
This website is not intended for the purpose of providing medical advice. All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.
Resources
Foundational Lecture: The HPA Axis. Dr. Carrie Jones. https://youtu.be/uMs50ZBa3tY
Teitelbaum, J. (2007). From Fatigued to Fantastic (3rd ed.). Avery.
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