Adrenal Insufficiency and Hypothyroidism
The adrenal glands play an extremely important role in the body. They are, first and foremost, involved in immune function and the body’s stress response. They also regulate blood sugar levels, blood pressure, inflammation, blood vessel constriction, and electrolyte balance in the cells, among other things. They help mobilize protein for energy use by the body, and aid in carrying thyroid hormones from the blood to the cells.
Adrenal insufficiency is a condition in which the adrenal glands fail to produce proper amounts of steroid hormones and adrenalin, which are used by the body for all of the aforementioned processes. The condition is due to prolonged stress from disease, trauma, or toxins. Sometimes it is caused by adrenals that are inherently weak.
Based on my research and experience, I believe that adrenal fatigue is a principal, or triggering cause of illness in many people with tick-borne infections, chronic fatigue syndrome, and other conditions involving severe autonomic nervous system dysfunction. Adrenal insufficiency can cause detoxification problems, postural orthostatic tachycardia syndrome, dysautonomias, and other neuroendocrine problems (which are usually attributed to the effects of tick-borne infections). Adrenal insufficiency can be caused by tick-borne infections, but it can also be what triggers tick-borne illness. Since it is usually assumed to be a result of Lyme disease, in this chapter, I will focus on why it is also often a cause.
Adrenal Fatigue Symptoms
Below is a list of common adrenal fatigue symptoms. Most of these overlap with symptoms of chronic Lyme disease. Since chronic Lyme disease causes adrenal fatigue, it can be difficult to judge the primary cause of symptoms in a person with Lyme. Yet the primary cause of symptoms is important to know, for reasons that I will explain subsequently.
• Chronic fatigue
• Musculoskeletal pain
• Feeling “wired but tired”
• Needing to sleep more than eight hours per night
• Being tired in the morning, and awake at night
• Irritable bowel syndrome
• Hypotension (low blood pressure)
• Environmental and food allergies
• Hypoglycemia (low blood sugar)
• Sensitivity to sounds/light
• Feeling easily agitated by life’s stressors
• Multiple chemical sensitivities
• Food allergies
• Loss of libido
• Low body temperature
• Low energy
• Menstrual irregularities and PMS
• Heart palpitations
• Sugar and salt cravings
• Postural orthostatic tachycardia syndrome
Causes of Adrenal Fatigue
Infections weaken the adrenal glands, but so do many other stressors, including sugar, caffeine, alcohol, allergenic foods, environmental toxins, and, especially, emotional stress. Some people have a genetic predisposition to adrenal fatigue. It is often found in people who are tall, slender, sensitive, and intuitive.
The late Gerald Poesnecker, ND worked with adrenally fatigued patients for over forty years. He authored the book Chronic Fatigue Unmasked. Dr. Poesnecker found adrenal insufficiency to be a primary cause of chronic fatigue syndrome and other health conditions in many of his patients. In the introduction to his book, he wrote, “I feel that Chronic Fatigue Syndrome, as usually diagnosed, is usually identical with Adrenal Syndrome, and that these two conditions are caused by a gradual accumulation of small, but potent stresses that eventually create an overload of the immune system that the traditional prescription of time and rest is inadequate to correct.”
In his more than four decades_of work with patients, he discerned that most of his adrenal patients were sensitive and intuitive, with tendencies to overwork and take on too many burdens—conditions that triggered and/or perpetuated the problem. I have observed that living in fear,
perfectionism, and “fast-forward” mode are also characteristics that can cause or perpetuate adrenal fatigue. People with weak constitutions also tend to have weak adrenal glands.
Dr. Poesnecker hasn’t been the only practitioner to believe in adrenal fatigue as a primary cause of disease. Michael Lam, MD, on his website www.drlam. com, writes that many experts believe that adrenal fatigue precedes chronic fatigue syndrome and fibromyalgia. It causes the dysfunction of multiple organs and bodily systems, which leads to a multitude of problems.
Because the adrenal glands are strongly involved in immune function, people with adrenal insufficiency constantly battle infections. Their bodies are easily affected by stressors, from allergenic foods to financial woes to bad relationships. Tick-borne infections are part of their stressor package. While eliminating the infections may relieve some of the stress that has been placed upon their adrenal glands, if adrenal dysfunction preceded their infections, getting rid of these infections may be insufficient for their recovery. Further, many will not be able to eliminate the infections, because their adrenal insufficiency hasn’t been adequately treated. Their bodies can’t mount an effective immune response against the infections.
Scientific studies have proven that when the body is in a constant state of stress, its “fight or flight response” sympathetic nervous system is activated. This causes the adrenal glands to release high amounts of cortisol and adrenaline. If the response is chronic and prolonged, it weakens the adrenal glands and disables the immune system, allowing pathogens to flourish and toxins to accumulate in the body.
In addition to having a constitutional (genetic) or character predisposition to the condition, many people with adrenal insufficiency have either suffered from abuse or experienced many severe stressful events over their lifetime. Numerous studies have established that trauma plays a significant role in the development of chronic illness, especially in women. Female biochemistry tends to be more significantly altered by emotional trauma than male biochemistry.
In any case, the root cause of disease in people who have severe adrenal fatigue and Lyme isn’t always tick-borne infections. The infections are simply one manifestation of a suppressed immune system caused by
adrenal dysfunction, but their presence exacerbates the adrenal dysfunction. Therefore, healing requires placing a strong emphasis upon healing the adrenals, along with treating the infections. Because symptoms of adrenal fatigue overlap with those of chronic Lyme disease, and Lyme disease causes adrenal fatigue, it can be difficult to discern how much emphasis to place upon treating adrenal fatigue. A strong, supportive protocol for the adrenal glands must be undertaken, along with antimicrobial treatments, when adrenal fatigue precedes Lyme or is heavily implicated in the Lyme disease symptom picture. Extremely aggressive antimicrobial protocols can also make people with adrenal fatigue worse. Later in this chapter, I describe some treatments that are effective for healing the adrenal glands.
My Story of Adrenal Fatigue
I am passionate about the topic of adrenal insufficiency because I believe that it was a primary cause of my symptoms, along with tick-borne infections. I have suffered from symptoms of adrenal fatigue throughout my life, even for many years prior to becoming infected by a tick. Such symptoms have included moderate fatigue, back pain, brain fog, anxiety, hypoglycemia, and the phenomenon of being “wired yet tired.” I have always had more energy at night, and needed excessive amounts of sleep. My physical constitution, temperament, and character also fit the typical “adrenal fatigue profile,” which has been described by adrenal fatigue experts such as Dr. Poesnecker. And over the years, as I have studied adrenal fatigue and other disease conditions, and monitored my symptoms, I have discerned adrenal fatigue to be one of the main conditions that set the stage for me to become ill from tick-borne and other infections. The infections simply took advantage of a weakened immune system caused by adrenal fatigue.
I received treatment for tick-borne infections and environmental toxicity for approximately six years, and I believe that this was crucial for my healing. Infections and toxins cause serious damage to the body and must be eliminated. Yet eliminating infections and environmental toxins only minimally mitigated my symptoms. On the other hand, I have always
experienced radical improvements to my well-being whenever I have focused upon healing my adrenals, rather than attacking infections (regardless of how long I treated the infections). I have also seldom experienced severe Herxheimer reactions as a result of aggressive antimicrobial treatments, or such treatments would cause me to have extremely prolonged Herxheimer reactions (which can indicate detoxification problems caused by adrenal insufficiency). For this and other reasons, I believe that tick-borne infections were a secondary cause of my symptoms, and that the primary cause was immune dysfunction caused by weak adrenals.
I have communicated with other people with Lyme disease who also believe that their symptoms were directly caused by adrenal insufficiency and that this set the stage for them to become ill from tick-borne infections. These people say that treatments for tick-borne infections either made them worse or were only minimally helpful. One wonderful lady who suffers from Lyme disease, Anne Davis, in a personal message to me on October 8, 2011, wrote that she believed she would have had better outcomes with her Lyme treatments if she had been treated for adrenal insufficiency first. She wrote:
“In 2007, when I was finally diagnosed with chronic Lyme disease, I began treatments for Borrelia and Bartonella. And then once we started, and realized I had Babesia, all hell broke loose. I only did oral antibiotics/malaria meds . . . no IV . . . . In hindsight, I think I would have done much better if I hadn’t been dealing with a genetic detoxification issue; if we wouldn’t have busted up biofilms way too quickly; if we would have gone much slower on killing everything off; if my severe adrenal fatigue had been addressed first (but my LLMD [Lyme-literate medical doctor] didn’t know that this was why my thyroid [hormone levels] were scary rock-bottom low).” Later in the message, she adds, “I really wish LLMDs knew much more about detoxification/nutritional support/addressing severe adrenal fatigue [instead of just addressing the thyroid]—things that LLMDs seem to know best . . . I know more people [including myself ], who are working with an LLMD and an LLND . . . . So many people have severe adrenal fatigue, and I’ve heard so many stories about LLMDs putting them on blood pressure meds,
because their blood pressure is so low—instead of addressing the low [dysfunctional] adrenals. They just don’t know [that this is a major problem in people with Lyme disease].”
Treating Adrenal Insufficiency/Dysfunction
Healing from adrenal fatigue is tricky, because unlike infections or
environmental toxins, simply taking a few remedies or toxin binders won’t fix the problem. While adrenal-support remedies are helpful, they are usually insufficient by themselves. Adrenal dysfunction represents, at its core, an accumulation or mishandling of life’s stressors, on multiple levels. Yes, it is often the result of infections and environmental toxins, but it’s also the result of trauma, overworking, perfectionism, rushing through life, self-destructive behaviors, isolation, a poor diet, an inability to set healthy boundaries with people, and operating out of fear rather than trust.
Some people may have been born with a genetic predisposition to adrenal fatigue. Because the adrenal glands handle the body’s response to stressors of all kinds, healing them requires addressing all of the factors that caused the adrenal glands and the immune system to become weak in the first place. For some people, healing requires an entire revamping and restructuring of the way they think about, and “do,” life. Obviously, it’s not all about the Lyme infections.
While a proposition of this kind may seem overwhelming, addressing the root causes of adrenal dysfunction will render infectious and other causes of disease less important and easier to treat. It will also keep the body, spirit, and soul healthier over the long haul. It’s important to note,
however, that once infections are causing symptoms in the body, they must also be treated, along with the adrenal glands.
Whenever I have had the discipline, I have followed Dr. Lam’s website and personal recommendations for treating adrenal fatigue, and always experienced improvements to my overall well-being. I say, “whenever I have had the discipline,” because healing the adrenals is a multifaceted endeavor that requires discipline and a strong desire to get well, and most people
(including me) can’t eliminate all stressful or self-sabotaging behavior from their lives in order to fully heal. Hence the need for self-control and a powerful will to get well. At the same time, treatments in themselves can be a major source of stress, so doing what you can while accepting that you can’t do everything right is probably a better approach than trying to be perfect, since perfectionism perpetuates the condition.
Strategies for reducing or eliminating the emotional and lifestyle stressors that contribute to adrenal fatigue are described in Chapter Eight. For a more comprehensive look at how to heal adrenal fatigue, I recommend reading books devoted exclusively to the subject, some of which are recommended in the References and Resources section at the end of this book. I especially recommend Dr. Lam’s recently-released Adrenal Fatigue Syndrome, which provides an in-depth look at the causes of adrenal fatigue, the metabolic and other systemic dysfunctions that are created by adrenal fatigue, as well as treatments for the condition. For anyone wanting to learn more about this subject, this book is an essential resource.
In general, strategies for healing the adrenal glands include learning how to move through life with a sense of trust rather than fear, eliminating abusive relationships, learning to set healthy relational boundaries with others, getting involved in life, learning to rest, having down time every
day, living at a sane pace, eating well, eliminating workaholism, avoiding negative chatter, getting enough sleep at night, and healing past traumas that contribute to fearful, angry thinking and behaviors. Many
supplements and other remedies can also aid recovery. By themselves, they are insufficient for most people who suffer from moderately severe or severe adrenal fatigue, but they are an essential adjunct to lifestyle strategies for healing.
Unfortunately, confusion abounds in the medical field over the best way to treat adrenal dysfunction or insufficiency. There is also no such thing as a “one size fits all” approach to adrenal support. Adrenal supplements need to be prescribed according to individual biochemistry and the severity of the adrenal fatigue. Adrenal supplements are often misused and improperly prescribed because these factors aren’t taken into account. For example, in the concluding remarks of his article “Adrenal Fatigue Glandular and Herbal Therapy,” Dr. Lam writes:
“Herbs and glandulars are widely used and touted as possessing adaptogenic properties and marketed as tonics. They are popular with those with very mild Adrenal Fatigue, due to their stimulatory properties [which] increase energy and reduce fatigue. These stimulatory effects are more pronounced, the weaker the adrenals. [But] stimulants are the equivalent of giving too much gas and “flooding the engine” in a car. They put further stress on the adrenals to work harder and produce more energy, and end up further depleting the adrenal glands. While there may be short-term benefits [from them], this often produces a false sense of well-being that over time tends to fail.”
Some of the herbal remedies that Dr. Lam notes as being potentially too stimulatory for those with adrenal fatigue include: Siberian ginseng,
ashwagandha root, Panax ginseng, and licorice root. According to Dr. Lam, and depending upon how these herbs are used, they may increase stamina and decrease symptoms in the short run, but over the long haul, they can exhaust the adrenal glands even more. Dr. Lam also writes:
“While the use of glandulars and herbs have their places in
adrenal recovery, their use must be judicious to avoid
overstimulation, addiction, and withdrawal concerns. Short-term use in very mild cases [of adrenal fatigue] is acceptable, but it is best to proceed under the supervision of an experienced adrenal expert if adrenal weakness is pronounced. Always be on the alert [for] paradoxical or unusual reactions (such as excessive stimulation, excessive fatigue, cardiac palpitation, unstable blood pressure, insomnia, anxiety, and irritability) as warning signs of inappropriate use. . . .”
I received over-the-phone counsel from Dr. Lam for several months for my own case of adrenal fatigue and learned that taking too many supplements simultaneously also stresses the adrenal glands. The body has to break down and either utilize or discard the constituents of all those supplements, which takes energy. If you suffer from severe adrenal fatigue, taking a few well-selected remedies may be better than taking ten or twenty supplements every day. Because Dr. Lam diagnosed me as having severe adrenal fatigue, his protocol for me involved taking no herbal remedies, because he believed that these would be too stimulatory for my body. Instead, he prescribed nutrients to rebuild my adrenals, and an all-natural, low-glycemic diet, free of refined sugar, preservatives, additives, dairy and other inflammatory foods.
Following are some of the most all-around effective nutrients/supplements for treating adrenal fatigue. Most people with moderate to severe adrenal fatigue can safely benefit from these.
Liposomal Vitamin C
Vitamin C regenerates the adrenal glands. Most of the body’s vitamin C is utilized by the adrenals. Many vitamin C products, such as plain ascorbic acid, are ineffective and manufactured in a form that the body cannot use (they are also often corn-based, and many people with Lyme disease are allergic to corn). Liposomal nutrients, which are encased in fat, tend to be better absorbed by the body. People with severe adrenal fatigue should start on a low dose of liposomal vitamin C, around 500 mg, and work up to 2,000 mg or more per day if continual improvements are felt and they don’t “crash” on increased doses. Pure Horizon makes a tasty, effective liposomal vitamin C product called LipoNano C, which can be purchased at Supplement Clinic (www.supplementclinic.com).
This is a highly bioavailable metabolite of pantothenic acid, which also helps to rebuild the adrenal glands. People with severe adrenal fatigue should start out on a low dose and build up slowly. Dr. Lam prescribed a product called Pandrenal (also made by Pure Horizon) to me. I took three 300 mg capsules, twice daily.
Glutathione is an important antioxidant involved in detoxification. When the adrenals are fatigued, the body’s ability to produce glutathione is compromised. Glutathione acts as a potent liver detoxifier and helps to recycle inactive oxidized vitamin C back to an active form, once it has served its function in the body. Dr. Lam prescribed 2 tsp/day of a product called LipoNano Glutathione for me. As with LipoNano C and Pandrenal, LipoNano Glutathione may be purchased at Supplement Clinic: www. supplementclinic.com.
Note: While I believe the aforementioned remedies could be effective remedies for many with advanced adrenal fatigue, I recommend
consulting Dr. Lam or another hormone specialist for a customized treatment regimen. Also, I receive no financial incentive from Pure Horizon, Supplement Clinic, or any of Dr. Lam’s recommended product suppliers for the promotion of their products.
Amino acids are the building blocks of protein from which all tissue is made, and thus give our body substance. The proper proportion of a
variety of amino acids helps to rebuild and regenerate exhausted adrenals. Dr. Lam prescribes an amino acid product called Quantum to some of his patients for this purpose. This product may also be found at Supplement Clinic: www.supplementclinic.com.
Finally, freshly prepared chicken broth (not from a can or box) is very healing to the adrenal glands. Chicken bones and cartilage contain powerful substances that rebuild and strengthen adrenals. Drinking two to four cups
daily is an important component of the adrenal regeneration process. The fresher the chicken broth, the better.
People who suffer from severe adrenal fatigue may also require a prescription of hydrocortisone and/or fludrocortisone (if aldosterone levels are also low), but these are most often prescribed temporarily. Some doctors don’t advocate their use unless absolutely necessary. Supplemental steroid hormones are thought to give the adrenals a rest, so that they don’t have to produce as much of their own hormones. The hormones do this by replacing deficient levels of cortisol and aldosterone in the body. They do not, however, rebuild the adrenals. They should be taken in conjunction with a comprehensive adrenal-healing protocol.
That said, Dr. Lam writes on his website: www.drlam.com, that when hormonal homeostasis is severely disturbed, steroid hormone replacement, as well as adrenal glandular formulas, can make some people with severe adrenal fatigue feel worse instead of better. And steroids such as hydrocortisone aren’t without long-term side effects. Studies indicate that the adrenal glands can become dependent upon them, especially at higher doses. The consensus in the medical community, which seems to be based largely upon information found in the book Safe Uses of Cortisol by Jeffrey Bland, MD, is that hydrocortisone dosages of up to 20 mg daily are safe. My belief is that as all things in medicine, it depends upon the person. The medical community needs to learn more about the endocrine system before it can come to definitive conclusions about the safety of supplemental steroid hormones.
Debate continues within the medical community over whether steroid use, particularly hydrocortisone, is safe for people with chronic Lyme disease. Some doctors believe that if cortisol levels are lower than what they should be, bringing them to normal levels with physiological doses of supplemental hydrocortisone shouldn’t cause immune suppression. That it should, in fact, support immune function, because not having enough cortisol in the body is just as detrimental as having too much. Others say that people with Lyme disease should not, under any circumstances, take steroid hormones, since these can cause infections to flare. Whether or not this is true probably depends upon the person and amount of steroid hormone that is
taken. Some people with Lyme disease have become irrevocably sicker after taking steroid hormones. Doctors should consider very carefully whether to prescribe them to their patients.
The Adrenal Diet
Besides taking supplements, maintaining a proper diet is important for healing from adrenal fatigue. Any food that is inflammatory or allergenic will stress the adrenals. One of the functions of the adrenal glands is to release cortisol, to mediate the inflammatory response caused by allergenic foods. Caffeinated beverages and refined sugar are perhaps the biggest adrenal stressors. Other inflammatory agents include many grains and all pasteurized dairy, along with all genetically-modified non-organic and processed foods containing additives. More about the kind of diet that I recommend for people with chronic illness involving Lyme is discussed in Chapter Two. It’s important to remove all sources of inflammation from the body in order to heal the adrenal glands, including inflammation which is caused by unhealthy and allergenic food.
Eating small, frequent meals that include animal protein, healthy fats such as olive and coconut oil, and low-glycemic carbohydrates reduces adrenal stress and helps to combat the hypoglycemia that often accompanies adrenal fatigue. Skipping meals or eating large meals stresses the adrenals. Having a small amount of animal protein or some nuts before bedtime is also essential, as it helps to stabilize blood sugar levels during the night. Cooked stews and soups, filled with non-starchy vegetables and animal protein, are good meal choices for the adrenally fatigued. They stabilize blood sugar and are easy to digest. While some healthcare practitioners advocate eating high quantities of raw vegetables, people with adrenal fatigue tend to have low levels of stomach acid and cannot easily digest raw veggies. A combination of raw and cooked vegetables is probably better for most.
For more information on how to treat adrenal fatigue, please see the References and Resources section at the end of this book.
Diagnosing Adrenal Fatigue
A diagnosis of adrenal fatigue or insufficiency should be primarily based upon symptoms, along with lab test results. However, many lab tests are
inaccurate, which is why working with a doctor who understands the condition and can diagnose it by analyzing symptoms is important.
The most reliable lab test is a 24-hour saliva cortisol test, which measures the amount of free-circulating cortisol and other adrenal hormones. Practitioners who prescribe this test for their patients should be aware that some people can have test results that fall within the “normal” range and yet be symptomatic, while others may display few symptoms but have abnormal lab test results. This is because the range of what is considered to be normal varies from person to person. However, saliva cortisol tests can provide helpful insights about the severity of the adrenal insufficiency. For more information about how to accurately evaluate steroid hormone levels, especially cortisol, I recommend Janie Bowthorpe’s book, Stop the Thyroid Madness.
The Problem with High-Dose Antibiotic Protocols for People with Adrenal Fatigue
Many Lyme-literate doctors contend that high-dose antibiotic and herbal protocols are necessary to eliminate tick-borne infections. These protocols usually involve taking high doses of multiple antibiotics or antimicrobial substances, often intravenously, for many months, several years, or indefinitely. Pharmaceutical antibiotics not only deplete the body of healthy bacteria, especially in the gastrointestinal tract, but also stress the organs, including the adrenal glands. As the body eliminates neurotoxins generated by infectious-organism die-off, the adrenals are further taxed, since they play an important role in detoxification.
Of course, reducing the body’s infection load removes stress from the adrenals over the long run, which is a good thing. But it is a bit of a catch-22, since treating infections too aggressively can stress the adrenal glands to the point of making a person worse instead of better. While it may be necessary to use aggressive doses of medications to get rid of infections, doctors need to be careful to not exhaust their patients’ adrenals beyond their capacity to help the body to recover from Lyme. Besides Anne Davis, who was mentioned earlier in this chapter, I have spoken with dozens of people who, instead of improving, suffered an exacerbation of their symptoms after aggressive and prolonged antibiotic regimens. I believe that for some, this happened because their adrenal glands weren’t adequately supported during treatment, or their treatment regimens were too aggressive. I have also spoken with several Lyme-literate healthcare practitioners such as Marlene Kunold, a “Heilpraktiker” (health practitioner) in Germany, who contends that some will get worse on aggressive treatment regiments unless their adrenals are strongly supported.
Some people get worse on antibiotic protocols for tick-borne infections because they stop their regimens prematurely, take inappropriate combinations of antimicrobial medications at the wrong doses, or don’t support their bodies’ detoxification processes. Other people’s glandular systems become overwhelmed by treatments. As a result, they are unable to mount a sufficient immune response against the infections. Still others may not be able to eliminate the toxins generated by infections, which again, can be due in part to adrenal insufficiency, since the adrenals aid in detoxification. Everyone who battles tick-borne infections suffers from some degree of adrenal stress. Yet those who had adrenal fatigue prior to getting Borreliosis and co-infections, may struggle more in their recovery, and even get worse on strong antimicrobial regimens.
Steven Bock, MD, in my book Insights into Lyme Disease Treatment, describes how he bases his treatments upon concepts found in Chinese medicine, which recognizes that people have varying constitutions and, therefore, require different treatments. People who are more “yin,” for example, tend to have weaker adrenal glands and may require a gentler approach to treatment. While many Lyme-literate doctors believe that an aggressive treatment approach is necessary for eliminating tick-borne infections, the situation is challenging for those with weak adrenal glands. A less-aggressive protocol that involves strong support for the adrenals may be more beneficial, depending upon whether aggressive treatments seem to produce no improvement after many months, or the body becomes severely weakened by them.
The Link between Adrenal Insufficiency and Hypothyroidism
Adrenal insufficiency affects thyroid hormone uptake and utilization and causes hypothyroidism. The thyroid gland supplies hormones to keep the metabolism in working order. Hypothyroidism is a condition in which the thyroid gland is either not functioning properly and is producing suboptimal levels of thyroid hormones, or the body isn’t utilizing those hormones properly. In the case of adrenal fatigue, hypothyroidism is caused by the latter condition. This is important to know because when thyroid hormone uptake and utilization have been affected by adrenal fatigue, both the thyroid and adrenals must be treated in order for a full recovery to occur.
Hypothyroidism is common in people with chronic illnesses such as Lyme disease, fibromyalgia, and chronic fatigue syndrome, and can be a major cause of symptoms in people with tick-borne infections. Often it occurs concurrently with adrenal insufficiency and is a direct result of it. Dr. Lam writes on his website (www.drlam.com): “Adrenal Fatigue is perhaps the most common cause of secondary low thyroid function, both clinically and sub-clinically. Low adrenal function often leads to low thyroid function, [which is] classically evidenced by high levels of thyroid binding globulin (a protein used to carry T4 and T3 in the bloodstream), low free T4, low free T3, high TSH, slow ankle reflex and low body temperature.”
When the adrenals are exhausted, their ability to handle the stress of normal bodily functions and the body’s energy requirements becomes compromised. In response to this, the body lowers its metabolic rate and energy output by down-regulating the thyroid function. This gives the adrenal glands an opportunity to rest and recover, since lower energy output and a slower metabolism means that they don’t have to work as hard to function. As the thyroid down-regulates its functioning, it decreases its production of T4 and T3 hormones. T4 is an inactive form of thyroid hormone, which the body converts to T3, the body’s most abundant and active form of thyroid hormone. When the adrenal glands are fatigued, the body also shuttles some of its available T4 toward the production of reverse T3 (rT3), another inactive form of thyroid hormone, which opposes and limits the function
of active T3. Thus, rT3 causes the body to slow down its metabolic activity by lowering the amount of T3 that is usable by the body and also inhibits the conversion of T4 to T3. This means that if adrenal fatigue is a primary cause of hypothyroidism, taking supplemental T4 hormone can worsen symptoms, since the body will tend to make rT3 from that T4 (instead of active T3), which then reduces the activity of whatever active thyroid hormone (T3) is already in the bloodstream! For this reason, people with moderate to severe adrenal fatigue often feel better by taking supplemental bioidentical T3 hormone, without any T4 added to the mix.
Adrenal insufficiency often results in hypothyroid symptoms and is the true cause of hypothyroidism in many with chronic illness involving Lyme disease. Unfortunately, many healthcare practitioners don’t realize that adrenal fatigue is the primary reason for their chronically ill patients’ hypothyroidism. By giving them supplemental thyroid hormone without treating their adrenal glands, they are actually making the problem worse. They are forcing the body to increase its metabolic rate, when what it really needs is to slow down, so that the adrenals, which play a vital role in immune function, can recover. As I previously mentioned, whenever adrenal insufficiency is a primary cause of hypothyroidism, both the adrenal insufficiency and hypothyroidism must be treated.
Some healthcare practitioners prescribe their adrenally fatigued and
hypothyroid patients supplemental thyroid hormones (both T4 and T3, or just one or the other), along with adrenal gland nutrients and supportive herbal supplements. If only the thyroid is treated, and/or the adrenals aren’t adequately supported, the body will continue to down-regulate its thyroid activity as the adrenals become increasingly exhausted. Over time, patients will need increasingly higher amounts of supplemental thyroid hormone in order to effectively treat their symptoms, as their adrenals become more and more depleted.
Janie Bowthorpe, medical researcher and author of the book Stop the Thyroid Madness, believes that physiological doses of supplemental steroid hormones, especially the principal adrenal steroid hormone cortisol, are needed to heal the adrenals when they are severely depleted. She contends that natural treatments are likely to be insufficient. Because some people have problems absorbing supplemental cortisol, she notes that physiological doses for some may be as high as 40 mg/day, because not all of that will be absorbed and effectively utilized by the body. She contends that it is rare for someone to need doses that high. However, she has observed that most people need doses of 20–30 mg to feel better over the long haul.
Finding smart solutions to normalize both thyroid and adrenal gland function is vital for healing from chronic illness. For mild to moderate cases of adrenal fatigue, adrenal nutrients may be sufficient for healing, when given in conjunction with thyroid hormone precursors, such as iodine and L-tyrosine, or low doses of bioidentical T3. But for moderate to severe adrenal fatigue, which is most often the case for people with chronic illness, supplemental adrenal steroid hormones may need to be given in conjunction with moderate doses of bioidentical thyroid hormones. Adrenal nutrients such as Vitamin C and pantothenic acid (or pantethine) are effective for rebuilding burned-out adrenals, but their immediate effects upon the body are not as powerful as those experienced with adrenal steroid hormones such as cortisol and aldosterone. If doctors give their patients thyroid hormones without also giving them supplemental adrenal hormones (especially cortisol), it may put additional demands upon the adrenals to function and hinder their ability to recover.
Compromised adrenal function and the resulting compromised thyroid function will effectively prevent healing from Lyme disease—and cause many other problems.
Please bear in mind, my hypotheses and recommendations are based upon my experience and what I have learned from experts about adrenal fatigue and thyroid function. They are not based on double-blind, placebo-controlled trials or thousands of clinical outcome studies (which also have their limitations). I caution readers to not take my contentions as undisputed fact nor as the final authoritative word on thyroid/adrenal hormone treatment.
Many people with Lyme and other chronic illnesses pay attention to and support their adrenal glands, but their adrenals still fail to recover. This may be because they are constantly pushing them beyond their comfort level by taking supplemental thyroid hormones without also undertaking a comparatively strong adrenal regimen to compensate for the increased thyroid metabolism. It may also be that their adrenal function remains compromised due to infections, toxins, and other stressors. If they are able to remove these factors, they may be better equipped to tolerate supplemental thyroid hormone therapy.
All this said, doctors don’t generally advocate taking adrenal steroid
hormones for long periods of time because they are thought to shut down the body’s own production of adrenal hormones. Over time, a person’s immune function can be suppressed if the person is improperly dosed. Dr. McJefferies, in his book Safe Uses of Cortisol, contends that supplemental cortisol, at physiological doses of 20 mg or less daily, is safe for most people, but that higher doses will cause irreversible suppression of adrenal gland hormone production. Other physicians believe that even lower doses of cortisol, when taken for extended periods of time, can cause this problem. In any case, supplemental cortisol does not always improve symptoms.
Janie Bowthorpe, in her book Stop the Thyroid Madness, writes that some people can feel poorly on low doses of hydrocortisone, for different reasons. Sometimes, for instance, the adrenal glands will perceive the presence of the supplemental hormone in the body and shut down their own production of steroid hormones, which results in an even greater deficiency of cortisol and an exacerbation of symptoms. Bowthorpe contends that this adrenal suppression also happens when people take higher doses of steroid hormones, but that higher doses of steroids can compensate for what the body stops making when it senses the presence of the supplemental hormones. Bowthorpe has observed that people often require doses of at least 20 mg of cortisol daily to compensate for what the body stops making. She cautions those who are already taking thyroid hormone to temporarily decrease their thyroid hormone dosage when starting supplemental cortisol, or they may experience surges of adrenaline. This occurs as a result of the body uptaking massive amounts of T3 from the blood, which it was previously unable to utilize, since cortisol aids in thyroid hormone utilization. For more information about the relationship between thyroid and adrenal hormones, I highly recommend reading Bowthorpe’s book.
The issue of thyroid and adrenal treatment is a complicated one, and there are no definitive solutions for how to best concurrently treat adrenal and thyroid dysfunction. I’m not convinced that taking 20 mg or more of supplemental hydrocortisone daily is wise for people with chronic Lyme disease since there has been evidence that steroid use causes infections to flare; however, this may be because patients have typically been prescribed doses that exceed their bodies’ normal cortisol production levels. At the same time, I don’t believe that it is wise for people whose hypothyroidism is caused by adrenal insufficiency to take high doses of supplemental thyroid hormone if they don’t also strongly support their adrenal glands. Natural remedies for the adrenals may or may not be sufficient for this purpose. I would simply encourage people who have been diagnosed with hypothyroidism to consider adrenal insufficiency as a primary cause of their hypothyroidism, and to take steps to strongly support their adrenals before attempting to put together a treatment protocol for the thyroid.
Regardless of whether adrenal insufficiency is a primary cause of hypothyroidism, hypothyroidism must be corrected, because the thyroid is responsible for a plethora of metabolic processes in the body. Hypothyroidism can cause a myriad of symptoms, including fatigue, depression, brain fog, insomnia, and weight gain. Healing from chronic illness is difficult if the thyroid isn’t functioning optimally.
Testing Thyroid Function
Most generic TSH tests are inadequate for diagnosing hypothyroidism. Practitioners should order lab panels that measure total TSH, free T3, free and total T4, and reverse T3, along with antibody tests to rule out autoimmune thyroid (“Hashimoto’s”) disease.
As previously noted, high levels of reverse T3, an inactive form of thyroid hormone, counteract active thyroid hormone (T3) and prevent it from being effectively utilized by the body. Usually, even free T3 levels that are on the low end of the “normal” range indicate hypothyroidism, although if severe adrenal fatigue is also present, the body’s free T3 levels will be falsely elevated, since the body isn’t making enough cortisol to effectively uptake thyroid hormone from the blood into the cells (thus, high levels of thyroid hormone remain in the blood and distort test results). The British
physician Barry Durrant-Peatfield, in his book Your Thyroid and How to Keep It Healthy, contends that some people have high blood levels of thyroid hormone because their cells aren’t effectively utilizing it, due to low cortisol levels and other reasons.
Some healthcare practitioners believe that patients who test within the normal range on thyroid tests are really severely hypothyroid. Besides the above-mentioned problems with thyroid lab tests, everyone’s “normal” is different. What may be a high reading for one person may be a normal reading for another. For this reason, taking the body’s morning
temperature may be a more effective way of diagnosing hypothyroidism. A basal temperature of less than 98 degrees indicates hypothyroidism, while a temperature that fluctuates greatly throughout the day (and which is less than 98 degrees) indicates hypothyroidism caused by adrenal insufficiency.
Some people can manage symptoms of hypothyroidism by supplementing their diets with iodine and the amino acid L-tyrosine, constituents of thyroid hormone. The trace mineral selenium may also be needed to convert inactive thyroid hormone (T4) into the active form (T3). Other people may obtain good results by taking thyroid glandular formulas or homeopathic thyroid remedies. Because vitamin D and iron play a role in thyroid hormone utilization, taking these nutrients may also be helpful for those with deficiencies.
Many chronically ill people, however, aren’t able to effectively synthesize thyroid hormones from amino acids and iodine. They require a
prescription of bioidentical replacement T3/T4 hormones. Synthroid and other synthetic T4 products tend to be ineffective, since many people with Lyme disease cannot effectively convert T4 to T3 (the biologically active form of thyroid hormone), and instead make rT3 from T4. Such people do better by taking pure bioidentical T3 hormone until their adrenal insufficiency is adequately treated. Sadly, synthetic T4 is the only type of thyroid hormone replacement available in some countries, but compounded synthetic bioidentical T3/T4, or natural thyroid hormone preparations derived from porcine glands, are still available in the United States. These preparations are used in products such as Armour, Nature-throid, and Westhroid. Such products contain some T4, and may be less ideal for people with severely depleted adrenal glands, but they can be helpful for some. For others, pure bioidentical T3 (which can be obtained at compounding pharmacies throughout the United States) is a better option.
Healing from adrenal insufficiency requires a comprehensive treatment approach that includes a healthy diet, adrenal supplements, a gentler approach to treating infections, appropriate thyroid support, and lifestyle modifications that address the initial causes of adrenal fatigue. (Lifestyle modifications will be discussed in greater detail in Chapter Eight). These treatments are just as important as addressing tick-borne infections. Treating adrenal fatigue and the hypothyroidism that often results from it should not be regarded as an ancillary, or adjunct, component of recovery.