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Please help with AM cortisol...

Discussion in 'Optimal Labs' started by Trinity, Apr 3, 2013.

  1. Trinity

    Trinity New Member

    Hi All,

    I have been struggling with an inverted cortisol rhythm and accompanying chronic insomnia for at least 4 years now (low AM cortisol, high PM cortisol). Up until January this year, I had been on 15-20 mg of Cortef per day in an effort to correct this imbalance. After continuing to struggle with my sleep and taking multiple ASI tests, I started to suspect that the Cortef might not be fixing the underlying problem. While it did boost my AM levels enough to mask the worst of the fatigue from a horribly disrupted sleep pattern, it never really seemed to fix the nighttime cortisol surges and sleep has been a constant struggle.

    In the beginning of this year I found Dr. Kruse's website and began to implement some of his suggestions.

    1) I started paying more attention to light cycles (getting light first thing in the AM and wearing blue blockers in the PM)

    2) I cleaned up my diet. My current diet can best be described as low-ish carb lacto-paleo . Based on prior food allergy testing, I do not have any evidence of dairy intolerance so I have been hesitant to eliminate dairy. I do, however, make an effort to purchase organic, pastured dairy products as much as possible.

    3) I began CT. I have been doing almost daily CT (cold water immersion for 30 minutes) for almost 3 months now and have seen some evidence of increased alpha-MSH (based upon a slight, but noticeable all over darkening of my very fair skin tone in the absence of significant sun exposure). I can now sit in 55 degree water for 30 minutes without any shivering during or after.

    My sleep is still a bit up and down, but has improved significantly from where it was a few months ago. I should also note that I've tapered my Cortef from 20mg down to 5mg per day.

    I recently did another ASI to gauge progress. While far from optimal, it showed a significant improvement (lowering) in my PM cortisol levels. Unfortunately, there was only a very modest improvement in my AM cortisol levels (they are still low normal). While I'm pleased to be sleeping somewhat better, my daytime mood, energy, and motivation could use some help. I can function, but I feel like a zombie and I can't muster up enough energy or motivation to do much more than the bare minimum most of the time. As a person who has always been successful and self motivated (prior to developing these issues), this is very frustrating.

    Basically, I need some advice about how to improve my AM cortisol. I am considering 2 options:

    1) increase cortef again -- tempting because i'm tired of feeling tired, unmotivated, and mildly depressed all of the time and my daytime mood and functioning was actually better when I was taking more cortef.

    2) try cycloset - i actually have a prescription for it, but have not filled it. I have a really good, open minded endocrinologist who agreed to let me try it. I am not diabetic, but my fasting blood sugar is not great (typically runs 100-110) and I am obese (5'5" and ~200 pounds). I have had the cycloset prescription for a couple of months now but have been hesitant to try it because I can't find any clear cut information about whether or not I could become dependent on it. After almost managing to finally get off the Cortef, the last thing I want to do is substitute one "addiction" for another. I had been hoping that the CT and light would improve this without having to resort to another drug.

    3) ? - maybe there is another option I don't know about -- please inform me if there is :) I am really tired of dealing with these hormonal problems. I've been struggling 5-7 years now. Since this all began in my mid twenties, I feel like I've lost some of the best years of my life to this. Its really depressing to think about dealing with this for the rest of my life.

    My current daily regimen is:

    25 mg DHEA
    25 mg 7-Keto DHEA
    50 mg Pregnenolone
    5 mg Cortef
    30 mcg cytomel - finally got the reverse t3 under control
    25 mcg synthroid
    100-200 mg progesterone (sublingual, 100 during 1st half of cycle, 200 during 2nd half)
    10,000 Vitamin D
    200 mg CoQ10
    400 IU vitamin E
    Daily probiotic
    Weekly Vitamin B injections

  2. shilohman

    shilohman New Member

    If I were you I would take the cycloset, up my 7-Keto DHEA, up my pregnenolone. The cycloset will help lower your AM cortisol and the DHEA/pregnenolone will help reduce the pregnenolone steal that you have.
  3. caroline

    caroline Moderator

    It sounds to me like you are doing quite lot of things to help yourself - I am certainly not an expert. Dr.K. always tells us that we didn't get broken overnite so it is going to take awhile to fix the stuff that needs fixing. I think you are making great progress especially with the C/T ...and I know Dr. K.is a fan of cytomel but, of course, it depends on your context....There are lots of people who have used cytomel here and I am sure someone will chime in....

    Once again - You have made some really good progress in a couple of months .....maybe tighten up your diet?....epi paleo?
  4. caroline

    caroline Moderator

    sorry - my mistake ... you are asking about cycloset. I am sure others will offer more advice....
  5. andee

    andee Silver

    Trinity - wow you have done so much! And showing some really good improvement too. I have the same adrenal pattern of low-middle of range a.m. (which we both know really means way too low) and a previously very high level in the evening and night time - those p.m. levels have been coming down while the a.m. has been rising - but it's not perfect yet.

    Like you I have used cortef but decided not to use it any longer to crank up my a.m. cortisol - there must be a way to heal my adrenals. I found that when I used cortef or over-the-counter isocort I tended to keep increasing my doses cause I still felt exhausted. This did not help my adrenals...

    My adrenal profile has improved every time I've tested it over the past 4-5 months, since embarking on the Leptin Reset Also I do take Cycloset, and it really lowers my a.m. fasting blood sugar, which should mean it's restoring my dopamine levels. I do not feel any addictive energy around Cycloset, and recently forgot to pack it on a trip so just skipped it - that affected my blood sugar a bit but did not give me any kind of withdrawal feelings, if that's what you're concerned about.

    Anyway, here are a few questions I had for you -

    - Did you actually do the Leptin Reset, or just bits and pieces? Specifically, did you use the BAB? For me, that really was a metabolic reset.

    - How are your thyroid labs? Adrenals and thyroid are so intertwined, usually if one is off the other will be too. One relatively new protocol for healing adrenals without more cortef is to take a good portion of your Cytomel 3-4 hours before you officially get out of bed. This is when the adrenals should be kicking into high gear and the extra T3 helps them rock - at least that is the theory. I can find a link to that if you're interested. Or just look around at http://www.stopthethyroidmadness.com and you should find some posts.

    Like you I take cytomel (also originally started because of Reverse T3). Am now working my way back to Armour thyroid. Synthroid and other phramaceutical T4s make me gain half a pound a week regardless of how I eat - so I don't take any synthetic T4. Once I got my thryoid balanced, I shed about 20 pounds just eating lo-carb (which had never worked for me before) - and then the last 10 lbs went on epi-paleo - so I am thinking it might be helpful for you to look at your thyroid labs, including thyroid antibodies etc. if not done recently.

    If you're not at the top 10% of the range for Free T3 and have no reverse T3, there's room for improvement - you probably are aware of this but am mentioning it just in case. Also as you probably know, depression is one of THE top symptoms of hypothyroid.

    - I assume you're taking progesterone without estrogen because you're in the estrogen-dominant years... I'm past those years and find that if my estrogen level goes too low I get depressed and bloated and begin to crave carbs and gain weight till I raise my E.

    Anyway for me, I would check out the thyroid situation completely before going back to cortef and perhaps try an earlier morning dose of T3. I would also add an adrenal adaptogen - rhodiola is a good one - to help heal the adrenal imbalances naturally. And if you're curious about Cycloset, I can't see where that would be harmful as you endo has already approved it.

    Except for the early a.m. thryoid protocol, I am not aware of any way to repair low adrenals quickly - that's part of what's so frustrating about adrenal exhaustion.

    Before I forget -I think the sleep is one of the hardest things to correct - it is for me too - and lately Dr. K has emphasized the effects of artificial light and EMF on sleep - so you might think about your EMF exposure, over and above what you're already doing about artificial light.

    But honestly you have accomplished a lot since the beginning of the year! Wishing you continued improvement...
  6. JanSz

    JanSz Gold

    Consider eating according to (Epi-Paleo Rx).


    by calories count:
    (30%Proteins)+(70%Fat)+(Green and other very low gycemic index vegetables, practically 0% calories)
    Proteins=(50%shelfish)+ (some saltwater low on a food chain, fish) +(50% beef, pork, other mammals, eggs, no birds flesh)

    Another way to describe proteins:
    half, predominantly omega3 sources
    the other half,
    mostly omega6 sources
    for starters
    later 75%omega3, 25%omega6

    Fat=coconut oil, palm oil, olive oil, macadamian nuts/oil, walnuts, beef tally, lard, clarified butter

    Lately I have seen dr K recomending 60-80% fat, so, if you are able, go for 80%
    the more fat you eat the easier to loose weight

    spring water, mineral water, RO water only

    When eating Cycloset (at wakeup)
    monitor prolactin
    Personally I adjust dose by aiming at lower number in prolactin range, only minimally below it. Say aim at 4ng/mL

    Prolactin Female: 4.8-23.3 ng/mL

    Consider using NaturalThyroidHormone, either ERFA, Armour (by script),
    or Thyroid-S, or Thiroyd from internet

    You are eating equivalent of 145mcg T4 or 2.2grains of NaturalThyroid Hormones, NTH

    1grain=1Grain=(38mcg-T4)+(9mcg-T3)----->equivalent of 65mcgT4


    You should not be eating thyroid hormones until you have
    good morning cortisol levels
    micronutrients in good standing

    in this context, micronutrients are analytes measured by this test (plus iodine/iodide):

    Spectracell Comprehensive Nutritional Panel
    Get this test, make corrections per test results.
    Repeat test every 6 months until stabilized.

    Consider replacing you T3 & T4 with 2 grains of NTH
    change to
    100mg 7ketoDHEA

    Steroid Hormones

    Lets make attempt on getting rid of 5mg Cortef

    Use DHEA Micronized Lipid Matrix from Allergy Research

    Use enough of DHEA pills until your blood test (preferably at LabCorp shows:
    Women 275-400 μg/dL
    preferably top of range (unless xyz)

    Ideally in first half of cycle you want

    E2~30-40 pg/mL


    to get there, you are taking now
    50 mg Pregnenolone
    5 mg Cortef
    100-200 mg progesterone

    I suggest that
    you drop all above and replace it with
    as much
    pregnenolone MLM (Micronized Lipid Matrix 150mg tabs scored (from Nutricology)
    as it takes to get (progesterone~1.5ng/mL)
    when blood is drawn at LabCorp on a day 3-4 of menstrual cycle

    You may want to start with two of those tabs,
    then titrate up or down as per blood test results.

    for now
    you could keep the
    additional 100mg sublingual progesterone that you taking in second half,
    or drop it and replace with
    additional pregnenolone tab
    then draw blood on day 19-21


    Dr Kruse is a proponent of high P/E ratio, up to 500
    Dr Lam likes high P/E but up to 200

    You may want to aim at estradiol/estrogen numbers as per population averages
    (see my numbers above)
    but you may want to aim at larger progesterone values.
    Use table below to guide you.

    Ideally, using pregnenolone MLM should give you overall better result (and closer to natural ways).
    Your progesterone and cortisol levels should be more natural.
    I am a 73yo man.
    Since I figured to use MLM pregnenolone, I was able to get much better control over my Steroid Hormone Panel
    Doctors, even those who would give a lip service to pregnenolone are still missing great deal on it.

    It takes a while for swallowed pregnenolone to raise your morning cortisol.
    If you are going to bathroom 1-2 hrs before actual wakeup time, take first 150mg at that time.
    Otherwise, do not interrupt your sleep.
    But when you get up, take it right then and there.
    The next thing you do is to open window and look at the sun.
    Better, if you have backyard, go there (barefoot, scantly clothed) watch sun there.
    After 2-3 minutes outside, do BAB, or eat BAB standing on the grass.

    All this to improve morning cortisol.

    Inverted cortisol curve sometime responds to PhosphatidylSerine
    Doctor's Best Natural Brain Enhancers featuring GPC & PS


    Look there

    cont next page

    Last edited: Apr 4, 2013
  7. JanSz

    JanSz Gold

    cont from previous post

    Your demand for (pregnenolone MLM) will depend on your current pregnenolone level and overall response.
    This must be guided by blood tests.
    I am man. Man's pregnenolone levels are similar to women's, progesterone is similar to woman's but only in first half of cycle.

    I started with hardly detectable pregnenolone and progesterone levels.
    At first I had to go up to 900mg/day to reach good levels, that lasted few months.
    Latter, likely I reached saturation point and had to titrate down.
    I am in that phase now. I am using now 150mg/day (preg MLM).
    Now is two years since I started this program. I think I will likely settle at something higher than 150mg/day.

    As you may gather, this project requires patience and persistence and ability to track numbers.
    You have to be in charge,
    even willing doctor does not have a time to track so many numbers.
    Preferably build spreadsheet so you can monitor your progress.

    Quest Diagnostics
    Males (18-58 Years) 13-208 ng/dL
    Premenopausal Females (18-51 Years) 7-188 ng/dL

    Last edited: Apr 4, 2013
  8. nonchalant

    nonchalant Silver

    Thanks for the refresher/update on pregnenolone, JanSz. I didn't realize taking pregnenolone very early in the day could help raise cortisol.
    Trinity, please be sure to look at the sun just as it rises. You can look at it directly when it is low on the horizon. Hope it isn't TMI, but often after staring at it for a minute, I have to go inside to the bathroom because that brief exposure raises my cortisol and stimulates the bowels.

    Also, how is your sun exposure during the day? I find that it is a great source of energy if you can sit outside during lunch. It has been cloudy for several days here and though it is heresy in Texas to wish for the sun to come back...
    Last edited: Apr 4, 2013
  9. MsYo

    MsYo Silver

    Awesome post. This is very helpful.
  10. Trinity

    Trinity New Member

    Hi guys,

    Wow! I did not expect to get so much good feedback. Thank you all for your help :)

    I know there is still some room for improvement in my diet, but I've been trying to approach this as a lifestyle change rather than a "diet". Therefore, as much as I want to be "optimal", I am also aware of the need to ensure that the changes I make are sustainable for *me* in the long term.

    I am planning to make an effort to increase my seafood intake, but I'm not sure if I am ready to eat the amount of seafood Dr. K recommends on a daily basis ;) Right now I would estimate that I am somewhere around 75-100 carbs per day with my primary source of carbs being green vegetables and smaller amounts of organic whole milk, organic greek yogurt, low sugar fruits (primarily berries), nuts (primarily almonds and macadamias), and the occasional square of 86% dark chocolate. I also get a decent amount of fat, but no where near 80% of my calories. I have also made an effort to incorporate more omega 3 sources of fat into my diet including pastured butter, macadamia nut oil, and coconut cream. I would like to say that I only eat grain free pastured meat, but it tends to be very expensive and difficult to find around here so I usually settle for the publix green-wise brand. Although I eat a grain free, sugar free diet, I still haven't managed to entirely give up the artificial sweeteners and that is an area that I'm working on. I have cut back on them, but I still use some splenda sweetened syrup in my coffee and have the occasional diet coke.

    I understand that Dr. Kruse advocates a much lower carb, ketogenic diet and I do realize that reducing my carb intake might help facilitate weight loss, but I am hesitant to reduce my carbs that low right now. In the past I have tried to reduce carbs to a ketogenic level, but it wasn't sustainable for me due to severe adverse effects on my mood, energy, and sleep. A ketogenic level of carbs seems to significantly worsen my adrenal fatigue and cortisol problems. That may eventually change as my hormone function improves, but right now I need to balance my efforts to improve my diet and lifestyle with my ability to function at work and in my life. I am already struggling with mood and energy issues and I simply cannot afford to make them worse right now.

    I have not done the official leptin reset yet, but I have made an effort to incorporate the BAB and reduce snacking. Right now my breakfast consists of:

    - 2 scoops of unsweetened organic whey protein (~50 g protein)
    - 1 cup of organic, pastured milk (~ 10 g protein )
    - 1 tbsp unsweetened cocoa powder
    - 1 packet of stevia

    I am pretty sure that I am no where near leptin sensitive because the BAB does not seem to reduce my appetite at all. I am not sure why that is except that I'm probably insulin resistant with fasting blood sugars in the 100-110 range. I have also reduced my daytime snacking. I used to have small snacks mid morning and mid afternoon to prevent my blood sugar from crashing, but I don't seem to have those crashes as much anymore after cleaning up my diet and eliminating the sugar and grains. Although I seldom snack I have not yet succeeded in giving up my mid morning and early afternoon coffees. I have, however, switched over from using milk to using coconut cream in them since coconut cream has a negligible amount of carbs and sugar compared to milk.

    I see my endocrinologist quarterly and he is pretty thorough about testing. Thankfully, I have decent insurance so most (but not all) of my labwork is covered.

    Here are my two most recent ASI tests:


    Time Me Range %
    8AM 4.38 3.5-6.3 32%
    12PM 2.19 1.4-2.8 55%
    4PM 1.85 .8-2.4 65%
    8PM 1.31 .6-1.6 71%
    12AM 1.15 .3-1.2 95%
    4AM 1.33 .3-1.7 72%

    DHEA: very bottom of the normal range

    PREVIOUS CORTISOL TEST RESULTS: Note this was right before i began CT

    Time Me Range %
    8AM 4.13 3.5-6.3 23%
    12PM 2.67 1.4-2.8 90%
    4PM 2.06 .8-2.4 40%
    8PM 1.12 .6-1.6 50%
    12AM 1.25 .3-1.2 105%
    4AM 1.87 .3-1.7 112%

    DHEA very bottom of the normal range

    As you can see, there is a noticeable improvement in PM cortisol (12 AM and 4 AM samples). Though they are still higher than optimal, they have comedown so that they are no longer out of range. AM cortisol also improved a little bit (from 23% of range to 32%) although I feel like it is still way too low for good AM functioning. When I took the second test I had also reduced my Cortef from ~20mg to ~5mg so the fact there was *any* increase in AM cortisol is probably a good sign.

    I agree that it would be nice to get off the Cortef once and for all and I'm seriously considering the cycloset option in addition to increasing my current DHEA and pregnenolone intake. I like your idea about taking the pregenolone before waking. I almost always wake up in the night so that shouldn't be a problem ;)

    I am also a bit confused about my DHEA. Between the first and second test I increased by DHEA from 15 to 25mg and added 25mg 7-keto DHEA. It does not, however, appear to have made any difference at all. As a woman with estrogen dominance I am concerned about overdoing the DHEA, but from my labs it looks like I definately need more. I am also uncertain when to take it since some information indicates that DHEA can reduce cortisol levels. I currently take 1/2 of the DHEA first thing in the AM and the other half at noon. I have wondered if the early AM DHEA might worsen my already deficient AM cortisol levels? Does anyone have any info on that? Currently, I am taking sublingual DHEA and pregnenolone from Douglas Labs. I am, however, interested in the micronized pregnenolone you mentioned.

    Yeah, there is probably still some room for improvement...When I began thyroid replacement, my TSH was only modestly elevated, but my reverse T3 was through the roof (50+) and my Free T3 was at the very bottom end of the range. It took me almost a year to work my way up to my current dose of cytomel (30 mcg) due to its tendency to worsen my adrenal fatigue and insomnia. Persistence did eventually pay off and I finally cleared out the reverse T3 about 6 months ago. I do realize that my Free T3 is probably still WAY too low, but I am hesitant to try to increase the cytomel much more while I'm still trying to taper the Cortef and improve my adrenal function. I have learned from my mistakes (after having several major crashes in the past resulting from trying increase my cytomel dose too quickly)!

    Eventually, I might consider switching over to a natural thyroid replacement like Armour. My endo is not completely opposed to prescribing natural thyroid replacement but for now he thinks I need a greater percentage of T3 than Armour provides (since with the adrenal fatigue I still have a tendency to convert most of the T4 into reverse T3).


    TSH: 1.14 (.4 - 4.5)
    Free T3: 2.8 (2.3 - 4.2 pg / mL)
    Reverse T3: 6 (11-31 ng/dL)

    Yup, definately estrogen dominant. A couple of months ago, I did a full female hormone panel that tested E and P and multiple points accross the full monthly cycle. I suspected E
    dominance in spite of progesterone replacement (200mg sublingual in 2nd half of cycle) because my cycle was consistently 22-23 days. Here are the results:

    E (pg/ml) P(pg/ml)
    Day 2: 1.43 (1.3-4.3) 92 (50-100)
    Day 12: 4.77 (3.0-8.0) 217 (100-300)
    Day 14: 3.64 (1.0-5.1) 318 (200-600)
    Day 16: 3.44 (1.0-5.0) 371 (200-600)
    Day 18: 3.85 (3.0-6.5) 265 (100-600)
    Day 24: 2.72 (2.5-6.5) 182 (50-300)

    P/E ratio (extrapolated from Day 18 and Day 24 data points) : ~65

    As you can see, my E / P ratio still was not great even on 200mg of progesterone. In an effort to counteract the E dominance, for the past 2 months I have also added a couple of pumps of Life Flow bioidentical progesterone cream (40 mg) during the last 7-10 days of my cycle. It may be working because my most recent period increased to 27 days. 200 mg sublingual + 40 mg transdermal seems like an awful lot of progesterone, but maybe my body needs that much. I am now testing my E/P ratio monthly until I achieve an optimal and stable ratio. I think optimizing this ratio is key because the severity of my adrenal fatigue and insomnia appear to be strongly tied to my monthly cycle as evidenced by a long standing tendency for my sleep to tank badly in the week prior to my period.

  11. Trinity

    Trinity New Member

    Hi All,

    OK, so these are the changes I'm currently making.

    1) I've decided to try the cycloset. I am currently taking .8mg and will be slowly increasing (based upon severity of nausea side effect).

    2) I'm changing from Douglas labs sublingual pregnenolone to the reccommended MLM brand.

    Before I was taking 50mg pregnenolone:
    25mg sublingual preg first thing upon rising
    25mg sublingual preg at noon

    Now I'm taking 100-150mg pregnenolone:
    50mg MLM preg @ 4-5AM (if I wake up)
    50mg MLM preg first thing upon rising
    50mg MLM preg at noon

    3) I'm changing from Douglas labs sublingual DHEA to the reccommended MLM brand.

    Before I was taking 25mg DHEA and 25mg 7-Keto DHEA:
    12.5mg sublingual DHEA first thing upon rising
    25mg 7-Keto DHEA first thing upon rising
    12.5mg sublingual DHEA at noon

    Now I'm taking 50mg DHEA and 25mg 7-Keto DHEA:
    25mg MLM DHEA first thing upon rising
    25mg 7-keto DHEA first thing upon rising
    25mg MLM DHEA at noon

    Do those changes seem reasonable based upon my labs? I plan to retest early AM cortisol, DHEA, and testosterone (to make sure I'm not going out of range with that much DHEA) in a few weeks to see where things are heading.

    freeheartbk likes this.
  12. Trinity

    Trinity New Member

    DHEA and Pregnenolone changes...

    Hi All,

    OK, so these are the changes I'm currently making.

    1) I've decided to try the cycloset. I am currently taking .8mg and will be slowly increasing (based upon severity of nausea side effect).

    2) I'm changing from Douglas labs sublingual pregnenolone to the reccommended MLM brand.

    Before I was taking 50mg pregnenolone:
    25mg sublingual preg first thing upon rising
    25mg sublingual preg at noon

    Now I'm taking 100-150mg pregnenolone:
    50mg MLM preg @ 4-5AM (if I wake up)
    50mg MLM preg first thing upon rising
    50mg MLM preg at noon

    3) I'm changing from Douglas labs sublingual DHEA to the reccommended MLM brand.

    Before I was taking 25mg DHEA and 25mg 7-Keto DHEA:
    12.5mg sublingual DHEA first thing upon rising
    25mg 7-Keto DHEA first thing upon rising
    12.5mg sublingual DHEA at noon

    Now I'm taking 50mg DHEA and 25mg 7-Keto DHEA:
    25mg MLM DHEA first thing upon rising
    25mg 7-keto DHEA first thing upon rising
    25mg MLM DHEA at noon

    Do those changes seem reasonable based upon my labs? I plan to retest early AM cortisol, DHEA, and testosterone (to make sure I'm not going out of range with that much DHEA) in a few weeks to see where things are heading.


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