Treatment Options for Adrenal Imbalances
If low cortisol:
Suspect: Some degree of adrenal insufficiency
Consider the following options:
- Lifestyle changes:
Stress reduction: chronic stress can fatigue the adrenals Rest, exercise, prayer, meditation, relaxation exercises
- Dietary changes:
Balance blood sugar: Lower calorie, high protein, high complex carbohydrate and high fiber diet
Nutritional supplements: High-grade multivitamin and mineral. Additional vitamin C, vitamin B-5, vitamin B-6, and zinc, as indicated
- Herbal Support:
“Adaptogenic” herbs: American or Korean ginseng (Panax spp.), Siberian ginseng (Eleuthrococcus senticosus), Withania (Withania somnifera)
Miscellaneous herbs: Licorice (Glycyrrhiza glabra) to prolong the half-life of cortisol, Sarsaparilla (Smilax spp.) is a cortisol precursor
- Glandular Support:
Adrenal, pituitary, others as indicated
- Hormone replacement therapy:
Cortisol, DHEA, pregnenolone, as indicated
- For herbal, glandular, and hormone replacement therapy, it is important to preserve or restore circadian rhythm by dosing in morning. May give 1/3 to 1/2 of morning dose at noon. Dosing later than noon is not advised.
If high cortisol:
Suspect: Some degree of adrenal hyperreactivity or hyperfunction, in response to environmental, physiological, or psychological stress
Consider the following options:
- Lifestyle changes:
Stress reduction, rest and relaxation, prayer, meditation, regular exercise, blood sugar stabilization, sufficient sleep, elimination of food allergies and restoration of normal bowel function
- Nutritional supplements:
High-grade multi-vitamin/mineral. Additional vitamin C, vitamin B-5, vitamin B-6 and zinc, as indicated. Phosphatidyl serine may re-sensitize the hypothalamus and pituitary to cortisol negative feedback.
- Herbal Support:
Nervine and “calmative” herbs: St. John’s wort (Hypericum), passionflower (Passiflora), valerian (Valeriana), skullcap (Scutellaria), and hops (Humulus lupulus)
Low dose adaptogens: Siberian ginseng (Eleuthrococcus senticosus) Withania (Withania somnifera)
- In cases of high cortisol or low DHEA or low DHEA/cortisol ratio consider using nervine and adaptogenic herbs with divided dosing throughout the day.
If low DHEA:
Suspect: A physiological response to stress, with shifting of the steroidogenic pathway to cortisol at the expense of DHEA
Consider the following options:
- Lifestyle, dietary
- DHEA or pregnenolone supplementation may be warranted
- Measuring testosterone and/or estradiol levels and intervene if necessary
If high DHEA:
Suspect: An abnormal physiological response to stress, with shifting of the steroidogenic pathway to DHEA at the expense of cortisol.
Rule out: Exogenous supplementation and polycystic ovary syndrome
Consider the following options:
- Lifestyle, dietary, and herbal options
- Measuring testosterone and/or estradiol levels and intervene if necessary
If low DHEA/cortisol ratio:
Suspect: A physiological response to stress, with shifting of the steroidogenic pathway to cortisol at the expense of DHEA
Consider the following options:
- Lifestyle, dietary, and herbal options. DHEA or pregnenolone supplementation may be warranted
- Measuring testosterone and/or estradiol levels and intervene if necessary
- Support immune function, if indicated
If high DHEA/cortisol ratio:
Suspect: An abnormal physiological response to stress, with shifting of the steroidogenic pathway to DHEA at the expense of cortisol.
Consider the following options:
- Lifestyle, dietary and herbal options as outlined under low cortisol
- Measuring testosterone and/or estradiol levels and intervene if necessary
If altered circadian rhythm of cortisol:
Suspect:
- Dysglycemia since cortisol will be secreted in response to a drop in blood sugar
- Disrupted sleep cycles
- Altered negative feedback of the HPA Axis
Consider the following options:
- Lifestyle, diet and herbal options as outlined under LOW CORTISOL
- Assess melatonin levels and treat accordingly
- Phosphatidyl serine may re-sensitize the hypothalamus and pituitary to cortisol negative feedback
- The essential fatty acid DHA to improve cellular receptor function of the HPA axis
