May 8, 2017

Overview

When I first started planning this article, I was just going to cover steps 5 and 6 of Dr. Shoemaker’s protocol. In step 5, low male hormones (androgens) are corrected by supplementing DHEA and using the drug Human Chorionic Gonadotropin (HCG). During use, care is taken to check that DHEA is not inappropriately being converted into estrogen instead of testosterone.

Step 6 uses the drug DDAVP (Desmopressin) to raise the ADH (Antidiuretic Hormone) level in order to correct the concentration of salts in the body. DDAVP causes the body to hang onto more water. Many with CIRS urinate frequently and sweat a lot. Consequently, they are always dehydrated – their blood is too salty.

As it turns out, when you look at the treatment protocol for these two steps, you realize that generally nothing is to be done. In the case of androgens, DHEA and HCG should only be used when MSH is above 35. This is seldom the case for those with CIRS. Likewise, using DDAVP has risks and as a result should only be used when the person with CIRS just can’t tolerate urinating often or being thirsty all the time. Frequently, those with CIRS simply skip past steps 5 and 6 knowing that VIP should correct these parameters.

Given that the article wasn’t going to cover much, I decided to add in my Dr. Shoemaker notes on MSH (Melanocyte-Stimulating Hormone), ACTH (Adrenocorticotropic Hormone), and cortisol. In terms of MSH, Dr. Shoemaker explains that the hormones ADH, MSH, and VIP move together. When you raise VIP with nasal spray, the other two follow. Given that I’ve already covered VIP in another article and the fact that I’m going to cover ADH in this one, it made sense to cover MSH too.

With that said, the really interesting material begins with my Dr. Shoemaker notes on ACTH and cortisol. According to Dr. Shoemaker, low ACTH and low cortisol levels are to be left for VIP spray to correct. For those that haven’t been terribly impacted by CIRS, this makes sense. However, having now been on 4 doses of VIP for the last 3 months, the affect has been subtle. My brain seems a bit clearer and I don’t react to mold as much. That’s about it.

What is striking as it relates to ACTH and cortisol, is that in using VIP, it’s become clear that low cortisol and thyroid hormones are a big part of the symptoms I’m still experiencing and have been experiencing for a long time. Currently, my energy levels aren’t what they should be, I don’t handle stress well, I’m too quick to anger, and so on. By taking VIP and removing the mold factor, this has become clear.

The way that it looks is that for the last 5 plus years, I’ve confused a lot of mold symptoms with what are ultimately low cortisol and thyroid hormone symptoms. This revelation is both flabbergasted and infuriating. Here I’d been going along thinking all my symptoms were from mold when in fact only about 20% of them were directly from mold biotoxins. My best estimation to date is that 20% were coming from gut issues, 20% from MARCoNS, 20% from mold, 20% from adrenal/thyroid issues, and 20% from dental infections, parasites, and heavy metals.

Now when you read below, you’ll see that Dr. Shoemaker says explicitly that VIP will correct low cortisol and hypothyroidism. The recommendation is that those with CIRS should just muddle along with the symptoms of adrenal fatigue and hypothyroidism and this is what I’ve been doing. Only now, I realize just how devastating adrenal and thyroid issues can be and what a mistake this is.

So far, VIP has not corrected my low cortisol or hypothyroid labs. I do plan on using more than 6 doses of VIP daily as there is data that suggests this might make the difference. Nonetheless, I think you’re going to be really surprised to read about the symptom overlap between CIRS and adrenal/thyroid issues along with just how awful low cortisol and low thyroid hormones can be.

So here’s my really big point. From what I’ve learned, those that are suffering the worst from CIRS can be helped immensely by propping up the adrenals and thyroid. If you’ve read my other material, you know how bad CIRS was for me. I wanted to die. I now believe that waiting for VIP to correct the really devastating effects of adrenal and thyroid issues was a big mistake. As Dr. Kharrazian points out in “Why Do I Still Have Thyroid Symptoms”, there are 22 different reasons why a person’s thyroid hormones may not be working (hypothyroidism). In addition, all the books I’ve read say that taking small physiological doses of hormones to bring levels up to normal does not shut down the body’s production of the supplemented hormones. In other words, there are lots of ways to provide support.

So for years I walked around afraid of my own shadow, shaky and paranoid, too tired to take a leisurely stroll and too wired to ever get a good nights rest. And for what? Granted loading up with an battery of hormone creams, hydrocortisone, and thyroid hormones may not make sense, but there are lots of safe and very helpful alternatives.

As you’ll see below, I’ve included my notes from the 6 best books on the subject of adrenal and thyroid health that I’ve read. In addition, I provide a short synopsis of each book along with my impression of the most prescient material as it relates to CIRS. Related to the topic on hand, you’ll see that there are natural and safe ways to support the adrenals and thyroid. Again, I believe denying these remedies to those that suffer from CIRS is a big mistake.

For example, I can remember years ago having to fly across the country. By the time we landed, I was shaking, riddled with anxiety, and at my wits end. It was all too much. It was brutal. I thought that the plane must have been moldy. I was wrong.

As I reflect back and knowing what I do now, it’s very clear that these symptoms were simply a result of adrenal fatigue and hypothyroidism. My body could not handle the stress from flying – radiation, bad lighting, loud noise, emotional stress, etc. If only I’d known.

So Dr. Shoemaker suggests that adrenal fatigue is poorly defined and that his patient’s thyroid TSH values were mostly normal. Additionally, he saw that treating CIRS tended to repair hormone levels including cortisol. However, if you’re like me, by the time you get done reading my notes, you’ll be wondering if perhaps CIRS is a result of adrenal fatigue and hypothyroidism and not the other way around! Well, that may be overstating the case but what’s clear is that waiting for VIP to fix everything when there are lots of remedies to provide support is a big mistake especially for those that are going to end up with PTSD due to symptom severity.

Reader Alert: I’m going to “dive in near the deep end” when to comes to stress and thyroid hormones. Given that others have already done a nice job covering the fundamentals, there’s no need for me to rehash that material. For those that are not familiar with basic functions of the adrenal and thyroid glands, I would recommend that you watch the videos below and review the hormone diagrams.

Stress Hormone Videos & Diagrams

Steps 5 & 6: Androgens & ADH/Osmolality Plus ACTH/Cortisol & MSH
Dr. Shoemaker’s Protocol

Step 5: Androgens

• Men and women have androgen hormones like DHEA, testosterone, and androstenedione that are responsible for male features.
• DHEA, testosterone, and androstenedione are affected in 40-50% of those with CIRS.
• DHEA is an endogenous hormone produced within the body by the adrenal glands. DHEA is a precursor to male (androgens like testosterone) and female (estrogens) sex hormones.
• Don’t use aromatase inhibitors (Arimidex, Aromasin, Femara) or supplement with DHEA or testosterone when Melanocyte-Stimulating Hormone (MSH) is less than 35. Aromatase inhibitors block the enzyme aromatase, which converts testosterone into estrogen.
• According to Dr. Shoemaker, supplementing testosterone or another androgen prior to treating CIRS can suppress these hormones for a long time. This problem is much worse when VIP is low too because low VIP ramps up the enzyme aromatase that converts testosterone to the female hormones estrone and estradiol. He says, “The more testosterone the patients use, the worse their testosterone deficiency becomes!”
• When MSH is over 35, step 5 in Dr. Shoemaker’s protocol is to use DHEA at 25 mg taken three times a day and Human Chorionic Gonadotropin (HCG) injections of 125 mg per week (or sublingually) for 5 weeks. Monitor estrodial to make sure DHEA isn’t being inappropriately converted into estrogen.
• HCG is used to boast testosterone levels and repair hypogonadism (shrunken testis) in men that have done Testosterone Replacement Therapy. Dave Asprey discusses his experience with reversing tiny nuts with Dr. Tami Mergalia in Testosterone Supplementation, Skinny Fat, & Adrenal Fatigue – #206. HCG acts like Leutinizing Hormone (LH), is administered with a shot, and boasts testosterone levels for 5 days. According to Dr. West Conner, you need to cycle HCG at 500IU, one week on and three weeks off, so your body remains sensitive to its own LH. You also commonly need to take an Aromatase Inhibitor to prevent the conversion of testosterone to estrogen. In general, LH is made in the pituitary and signals the testes to make testosterone.
• For those with low MSH, hormones will often correct when VIP nasal spray is used at 4 times a day for 30 days.
• DHEA promotes TH-1 immune responses with suppression of TH-2 responses and this is helpful for those with CIRS – see Why Do I Still Have Thyroid Symptoms below.
• Notes from the talk Dr. Brook gave at the 2015 Mold Conference Saturday Presentations
  • Dr. Brook corrected hot-flashes in a CIRS woman with an aldosterone level of 15.8 (normal: 0-8.5) using spironolactone. Spironolactone is antiandrogen – reduces testosterone levels. You need to do a 24-urine test to see aldosterone levels.
  • 2OH/16OH Estrone ratio should be above 3 as this reduces the risk of breast cancer by 40%. If it’s low, use a low saturated fat diet with cruciferous vegetables.
  • You can lower estrogen levels using Myomin. This is helpful for men with high levels. Dr. Brook describes using Myomin along with a small 20mg dose of testosterone to help an older man with CIRS
  • After taking CSM, hormone receptor sites are unblocked in those with CIRS. Using small doses of bio-identical hormones to bring hormone levels into balance helps patients feel better and gives them the mental clarity required to get through treatment. Dr. Brook recommends using hormone replacement after someone with CIRS has been on CSM.

Step 6: ADH (Antidiuretic Hormone) – Osmolality

• ADH normal range: 1.0-13.3 pg/ml; Osmolality normal range: 280-300 mosmol)
• ADH is also called Vasopressin.
• ADH controls how much water your body holds onto in response to osmolality. Osmolality represents the balance of electrolytes (salts) to water in the body. The higher the osmolality the higher the concentration of salts in your body. Normally, when osmolality is high, ADH will go up proportionately causing your body to hang onto water thereby diluting the electrolytes.
• MSH, VIP, ADH, and Osmolality act together to regulate inflammation. Low MSH or VIP can lower ADH.
• Those with CIRS often have high osmolality and yet low ADH. As a consequence, even though their body is dehydrated, they end up having to urinate shortly after having a drink of water. Always being dehydrated hurts the body’s ability to heal.
• An example of using lab results to check if ADH and osmolality are in balance is as follows. If plasma osmolality (not urine osmolality) is 295 then ADH should be ((295-280)/(300-280))=(x/(13.3-1)) or (15/20)=(x/12.3) so x=9.225 and ADH should be around 1+9.225=10.225 ± 2.5. However, in CIRS individuals, it’s not uncommon to find osmolality is in the high range of normal while ADH is in the lower range of normal – you have to look at osmolality and ADH as a pair on the labs.
• ADH and osmolality will be imbalanced in about 80% of biotoxin people. Consequently, CIRS people will urinate and sweat more and may have migraines that last a week due to salty blood. In addition, those with pulmonary hypertension will often be diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS) – feel woozy and weak upon standing.
• It’s the salt deposited on the skin of those with CIRS from sweating that in effect turns them into a battery. They build up an electrical charge over their skin that then rapidly discharges producing a shock when they touch objects that are grounded – light switches, car doors, pets, etc. The chloride levels on the skin of those with CIRS is even higher than levels found on cystic fibrosis patients.
• Per step 6 in Dr. Shoemaker’s protocol, DDAVP (Desmopressin) is used to address low ADH. DDAVP is a synthetic drug replacement for vasopressin/ADH. In order to minimize water intake, it is given at bedtime. Dosage is 0.2mg every other night for a total of five doses (nine nights). DDAVP causes fluid retention and consequently weight gain. After the fifth dose, serum osmolality and ADH should be checked to ensure normal serum sodium levels. On rare occasions, serum sodium and osmolality go too low. If serum sodium is OK and symptoms persist, then dosing is increased to every evening for 10 days and then osmolality and ADH are rechecked. Folks with POTS and others may need to stay on DDAVP indefinitely. If needed, double and even triple the dose per day. Expect to see a reduction in urination, static shocks, thirst, and migraine headaches. DDAVP should be carried by those that suffer Von Willebrand Factors (VWF) nosebleeds as it stops bleeding.
• Taking DDAVP is not without risks. Given that VIP “raises all boats” including ADH, Dr. Shoemaker will skip addressing ADH if the patient doesn’t complain about thirst or frequent urination regardless of the degree of imbalance between osmolality and ADH, the amount of water consumed, or the frequency of urination.
• According to Dave Asprey, depleted glutathione (GSH) leads to low ADH. Raise GSH by repairing the methylation cycle.
• According to Dr. Ackerley, people with low ADH don’t interact well with others.

ACTH (Adrenocorticotropic Hormone) & Cortisol

• Normal range: ACTH – 8-37 pg/mL; Cortisol – a.m. 4.3-22.4 / p.m. 3.1-16.7 ug/dL
• ACTH is made by the pituitary and acts as a signal to the adrenals to make more cortisol. In early stages of Chronic Inflammatory Response Syndrome (CIRS), also known as Biotoxin Illness, both ACTH and cortisol will be high as the body tries to compensate for low Melanocyte-Stimulating Hormone MSH). High ACTH and cortisol also occur when the person is healing. High cortisol negatively impacts sleep cycles. In the chronic stage of CIRS, both ACTH and cortisol will be low. ACTH and cortisol are out of balance in 40% of CIRS people.
• Dr. Shoemaker warns that CIRS patients should never take steroids/cortisol as he’s concerned it will further suppress and even permanently damage ACTH production. ACTH is not addressed in Dr. Shoemaker’s protocol. In general, doctors are very concerned about the use of cortisone such as Prednisone (synthetic glucocorticoid class) due to misuse during the initial introduction of the drug. Additionally, immune suppressive drugs should not be used with CIRS as they suppress ACTH that then lowers cortisol levels. Cortisol is already imbalanced due to low MSH.
• However, according to Julia Ross and many doctors, natural hydrocortisone (HC) containing products like Cortef (bio-identical glucocorticoid class) have been found to be very safe and effective. Whereas supplementing with Pregnenolone or Progesterone was not found to be effective in addressing cortisol levels. Julia Ross – Amino Acid Therapy Professional Training Series
• Patients who take too much hydrocortisone (HC), or begin to recover adrenal function, will begin to feel a bit “speedy” indicating that hydrocortisone levels should be reduced. Other doctors say it’s better to take a desiccated adrenal glandular instead of HC because it contains all of the constituents of the entire gland and therefore has less risk of shutting down the adrenals. Note: Depleted glutathione (GSH) leads to low ACTH and the blunting of the HPA axis. As such, it’s important to make sure the methylation cycle is working optimally.
• In Dr. Ritchie Shoemaker on Chronic Inflammatory Response Syndrome, Dr. Shoemaker commented that he would see CIRS patients with normal cortisol levels of around 25 with really high ACTH that would correct by treating CIRS. Likewise, CIRS patients with low ACTH and low cortisol would also normalize after lowering inflammation and raising MSH using VIP. This also happened with low testosterone, low aromatase, and high estradiol.

MSH (Melanocyte-Stimulating Hormone)

• Normal range: 35-81 pg/mL – this value is according to Dr. Shoemaker’s protocol and is Lab Corp’s pre-2006 value. Lab Corp’s current “normal” is 0-40pg/mL.
• Like Vasoactive Intestinal Peptide (VIP), MSH is a master regulatory hormone that is part of the innate immune system.
• Leptin biding on the sites on the hypothalamus is the signal that triggers the production of MSH by cleaving MSH from the Pro-OpioMelanoCortin (POMC) peptide that it is bound to. Unfortunately, inflammatory cytokines bind onto sites of the hypothalamus normally reserved for Leptin. As a consequence of high cytokine counts, MSH is lowered and low MSH causes further lack of control over cytokines. As CIRS progresses, MSH falls.
• Low MSH is addressed in the last step of Dr. Shoemaker’s protocol with VIP. VIP raises MSH.
• When MSH and VIP are normal, people with susceptible genes will not develop CIRS.
• MSH regulates pituitary function that affects cortisol, ACTH, ADH, melatonin, estrogen, progesterone, and androgens.
• MSH, VIP, and ADH are interconnected. When one of the three falls then the others fall. Likewise, if one is raised, the other two also rise.
• Low MSH causes fatigue, often due to low or dysregulated cortisol and ACTH, and poor conversion of the thyroid hormones T4 to T3.
• Low MSH causes pain due to inflammation and reduced endorphin production.
• Low MSH causes chronic sleep disorders with non-restful, nonrestorative sleep – at least in part due to low melatonin levels.
• Low MSH causes appetite swings and weight gain.
• Low MSH results in impaired immune defenses.
• Mucus membrane health relies on adequate levels of MSH. When MSH is low, respiratory tract, gut, urinary tract, and skin membranes suffer. Consequently, MARCoNS get a foothold. Papers show that MSH is everywhere in the gut and is antimicrobial.
• The FDA banned MSH replacement drugs for no good reason as they had been used in the past with no ill effect.
• Dr. Jack Kruse says people suffering from chronic fatigue syndrome, fibromyalgia, Lyme, or mold biotoxins will have low MSH levels between 95-98% of the time. Dr. Kruse also states that folks with low MSH are more sensitive to the sun as their skin is unable to generate protective melanin. Furthermore and in contradiction to Dr. Shoemaker’s warnings about using cortisol and sex hormones, Dr. Kruse states that it’s important to reduce inflammation to nearly zero while using bio-identical hormones to bring levels up to the normal range based upon lab testing along with following his prescription for reducing leptin.
• CIRS’ key hormone – Melanocyte Stimulating Hormone (MSH)
• MSH: Its Role in Weight, Autoimmunity, Chronic Inflammation and CFS

Hypothyroidism Type 2 – Dr. Mark Starr

Hypothyroidism Type 2 Synopsis

Hypothyroidism Type 2 was the book that really “blew my hair back”. What’s exceptional in this book is the way in which hypothyroidism is defined and its connections to deleterious health impacts as described. Using older medical textbooks as a source, Dr. Starr describes hypothyroidism in a way that I hadn’t heard before. The typical symptom lists don’t come close to the detailed descriptions in this book. Additionally, the connections between hypothyroidism and a vast array of ill health effects are described in a way that really gives a person a feel for the illness. Related to CIRS, the symptom overlap is striking. Unlike any other book, by the time I reached the last page of this book, it was really clear that I needed to seriously look into hypothyroidism and adrenal fatigue.

Besides describing hypothyroidism well, Dr. Starr brings lots of practical experience honed after working with greats like Dr. Broda Barnes. In particular, I found it interesting that he felt supplementing iodine could often correct adrenal fatigue. In addition, he recommends smaller doses of iodine for Hashimoto’s. So long as selenium is included, he’s not afraid of using iodine. In fact, he recounts that iodine in excess of 1,000mg had been successfully used to treat serious illness before the introduction of antibiotics. In addition, I particularly liked his description of the various factors that can result in intolerance of thyroid hormone supplementation.

Probably the biggest take-away for me was the fact that hypothyroidism turns down the fires of life. It’s no wonder that those with hypothyroidism suffer from increased incidences of infection, gut issues, impaired liver and kidney function, and on and on. Related to CIRS, having hypothyroidism and trying to get better from CIRS is like entering a wrestling match against a behemoth with one arm tied behind your back. In my humble estimation, when thyroid function is impaired and doctors fail to stoke the body’s internal cellular engines with adrenal and thyroid support, this is tantamount to watching someone slowly drown all the while holding a life-ring.

Hypothyroidism Type 2 Notes

• Myxedema (mix-edema) or thickened skin is a telltale sign of hypothyroidism. Normally, skin on the outside of the upper arm can be lifted and is thin. Women have slightly thicker skin due to more subcutaneous fat. In the past, the presence of myxedema alone was sufficient to confer a diagnosis of hypothyroidism. Swelling from hypothyroidism begins below the eyes and often on the side of the upper arm. p.3, 5
• Basal Body Temperature: based upon the work of Dr. Broda Barnes, when waking underarm temperatures taken for 10 minutes before rising is below 97.8°F, hypothyroidism is often the culprit. Due to sinus and upper respiratory infections, oral readings are often higher and consequently misleading in those with hypothyroidism. If taking temperatures orally, Stop The Thyroid Madness recommends taking your temperature using a mercury-free thermometer for 5 minutes and then subtracting 0.5°F. p.17
• Pain of all types is commonly resolved after treating hypothyroidism. p.24
• Heart Attaches were dramatically reduced in the over 1,500 patients treated for hypothyroidism by Dr. Banes. Statistically, there should have been 72 deaths in this group from heart attaches when there was only 4. In On the Genesis of Atherosclerosis, clogged arteries is shown to be a direct result of hypothyroidism – not diet, cholesterol, smoking, diabetes, or high blood pressure. p.34, 39
• Diabetes, according to Dr. Barnes and Dr. Starr, is believed to be caused by hypothyroidism. Diabetes in Dr. Barne’s treated hypothyroid patient group was rare and none of those with diabetes ever develop complications like blindness, kidney failure, heart attacks, gangrene, nerve damage, and atherosclerosis. p.42
• Type I – Type II Hypothyroidism: Type I hypothyroidism is a result of low thyroid hormone levels. Type II hypothyroidism is when the body produces normal amounts of thyroid hormones according to labs but requires greater than normal levels due to genetically damaged mitochondria and environmental toxins. p.45, 61
• Mitochondria are the energy factories within cells. Adequate levels of thyroid hormones ensure those factories run optimally thereby keeping diseases involving the central nervous system, heart, muscles, kidneys, and hormone producing tissues at bay. Prevention of early death due to infection using antibiotics has resulted in defective mitochondrial DNA becoming more prevalent in the population. In the past, those with defective mitochondria developed hypothyroidism and typically died before reaching child bearing age. Life saving antibiotics has allowed those with defective mitochondria to live longer. Damaged mitochondria need higher than normal levels of thyroid hormones to function properly. Treating mothers before pregnancy results in normal thyroid babies. Note: Due to mitochondrial damage, Type II Hypothyroidism begins at birth thereby affecting the child early on. p.55-60, 85
• Environmental Toxins damage thyroid hormone receptors on cells and hamper the complicated process of thyroid hormone creation, storage, secretion, delivery, and use. p.61
• Alzheimer’s in Dr. Barne’s treated thyroid patients was non-existent. p.57
• Lab Testing misses those with Type II hypothyroidism and is not indicative of the degree of hypothyroidism. A autopsy study found that a medical history review resulted in a correct diagnosis 76% of the time while physical exams and lab work only produced correct diagnosis 12% and 11% respectively. Hypothyroidism should be diagnosed primarily based upon physical examination and a history review. Medical textbooks no longer contain the very helpful images showing the progression of hypothyroidism. p.70, 72, 75




• Hypothyroid Partial Symptom List p.84-169
• Top symptoms: chronic pain, depression, fatigue, can’t stand cold, constipation, dry puffy skin
• Energy: sluggish, dull, apathetic, listless or nervous, hyperactive, aggressive
• Babies: head is large with a puffy face, flat brow or a deeply furrowed nose, and deeply set eyes, poorly developed jaw and crowded teeth, birth is premature or delayed
• Children: noisy breathing, belly protrudes, short neck, joint defects, bed-wetting, sleepwalking, uncoordinated
• Teens: puberty is late or early (treatment reverses early development), lower IQ, behavioral disorders, short attention span (millions of kids take antipsychotic drugs)
• Growth Abnormalities: shorter or taller than average with arms and legs too short or too long – average shoe size in 70’s was 9 and is now 11
• Women: PMS, bad cramps, excess bleeding, endometriosis, ovarian cysts, miscarriage, infertility
• Hands and Feet: cold, claw feet, carpal tunnel syndrome, flat feet, pale nail beds, ingrown nails
• Face: puffy especially along jaw and above eyes, raised eyebrows keep swollen lids open, flared nostrils, thick lower lip, mouth wider horizontally, red checks and nose, pale skin around eyes
• Skin: dry, tingle, burns, insect crawling, acne (resolved in 90% of treated patients) Note: CIRS has unusual skin sensations.
• Aging prematurely, yellowish skin, fine (parchment) wrinkles
• Perspiration: usually less but occasionally more
• Hair: fine, thin, straight, hair loss, premature baldness
• Iron and Vitamin B12 deficient, alcoholism
• Eyes: poor night vision, cataracts, glaucoma, outer third of eyebrow thins
• Ears: standout, excess wax, frequent infections, tinnitus
• Mouth: gum disease, tooth decay, TMJ occurs more often
• Voice is hoarse with deliberate, slow, halted, problematic speech
• Heart: heart attacks, congestive heart failure, decreased pulse and flow, altered EKG, high blood pressure Note: Pulmonary hypertension is common in CIRS.
• Kidneys: arteries narrow leading to Grandular Kidneys
• Liver: congestion, slightly elevated enzymes, high cholesterol
• Lungs: infections, air hunger, asthma Note: CIRS patient have shortness of breath.
• Hypoglycemia (low blood sugar) Note: Use half the recommended insulin with adrenal fatigue.
• Gallbladder and Bladder: irritation, infections, stones
• Gut: colitis, diverticulitis, eating disorders, constipation, Candida
• Bleeding and Bruising: severe bleeding from nose, gums, bowels, bruise easy, blood clots Note: Von Willebrand Factors (VWF) cause nose bleeds in CIRS; Thyroid Hormones Reverse VWF
• Autoimmunity: lupus, rheumatoid arthritis (RA), Note: CIRS, lupus, and RA all relate to high C4a.
• Headaches, migraines, chronic pain, arthritis, CFS, fibromyalgia, cancer, obesity
• Weight Gain: eat a diet high in fat along with a moderate amount of protein. High protein diets slow metabolism requiring a one-third reduction in calories and increased natural desiccated thyroid to maintain the same weight.



• Synthetic T4 thyroid hormone containing only T4 does not work for many with hypothyroidism and has many adverse side effects that can range from a rash to seizures. For T4 only to work, the body must be able to convert it into T3, T2, and T1. p.171, 174
• Natural Desiccated Thyroid (NDT) is far superior to synthetic T4 and should be taken on an empty stomach 20-30 minutes before meals. The average dose is 200mg – a little more than 3 “grains” where 1 grain is 64.8mg. Children should use 1.5 grains or less. Start slowly with 0.25-0.5 grains and raise by the same amount every month – most can’t start with 1 grain. Those with heart attack risk should start with 0.25 grains and increase very slowly to a maximum of 2 grain. Immediately lower dosage if waking basal temperature goes above 98.2°F. It may take 6-12 months before symptoms begin to abate and basal temperature may never return to normal even though symptoms clear. p177, 181
• Intolerance of NDT may be due to heavy metals or chemicals. Additionally, adrenal fatigue, iodine insufficiency, and Hashimoto’s may need to be treated to eliminate NDT intolerance. Without enough iodine, thyroid hormones may not work or be tolerated. When cortisol levels are low due to adrenal fatigue, NDT supplementation may lead to worsening of symptoms rather than improvement. Low magnesium, gut issues like Candida, and food allergies along with heavy metals and environmental toxins can cause bad reactions to NDT. Mercury is exceptionally toxic. Mold stymies NDT therapy. Some are allergic to the cornstarch filler in NDT and cortisol. Upon intolerance, stop or back down on dosage and go more slowly. An increase in heart rate by 10-15 beats is the main sign of intolerance. Try starting with 0.25 grains and increase by 0.25 every 2-4 weeks. p.178, 179, 182-183, 189
• Iron (ferritin) or selenium deficiency can result in hypothyroidism. Ferritin levels should be over 130ng/ml for child-bearing women and over 100ng/ml for the rest. Take 200-400mcg of selenium and 600-1,000mg of magnesium daily. p.182, 188
• Adrenal Fatigue can typically be addressed with 2.5mg of hydrocortisone (HC), natural cortisol, taken 2-3 times daily. Sometimes, up to 20-30mg are required daily. Prednisone, synthetic cortisol, got a bad rap due to excessive doses given in the early days. Taking NDT with HC eliminates problems with HC. Dr. Barnes felt is was best to start with NDT and then add in HC as HC can suppress thyroid function. The exception is when NDT isn’t tolerated. However, many doctors start with HC and then add in NDT 4-7 days later. When hydrocortisone is required, it should be increased slowly with NDT along with monitoring blood pressure and heart rate 1.5-2 hours after taking HC. If both blood pressure and heart rate rise, the HC just taken was not needed. On the other hand, if heart rate rises and blood pressure is normal, too much NDT is being used. Typically, iodine alone is enough to correct adrenal fatigue. When HC is required to address adrenal fatigue in spite of using iodine, jaw infections are likely the culprit as they severely tax the immune system – see PD-6/7 below. p.185-189, 247
• Hashimoto’s is defined as having antibodies TPO Ab or TG Ab to the thyroid enzyme TPO (Thyroid Peroxidase) or TG (ThyroGlobulin) although some with Hashimoto’s will have lab work that comes back negative. The body is attacking itself. Regardless of the antibody levels, treatment is the same. Eliminate allergic foods and use 1 drop of 2% Lugol’s iodine along with NDT. Dr. Starr has not found gluten to be an issue with Hashimoto’s in most. He doesn’t start with iodine on those with gluten intolerance who haven’t already been supplementing iodine. In those cases, he uses micrograms of various other forms of iodine after the patient is somewhat better – often uses topical procaine. Note: Roughly 16% of topically applied iodine is absorbed. Also, 1 drop of 2% Lugol’s contains 2.5mg of iodine. As such, the iodine uptake with 1 drop of 2% Lugol’s is (2.5×0.16)= 400mcg – this is congruent with the 550mcg recommended in Stop the Thyroid Madness II. p.241-245, 247
• Iodine deficiency due to depleted soils has resulted in greater incidences of hypothyroidism and goiters – swollen thyroid gland. In the past prior to antibiotics, those with hypothyroidism died young due to infections. However, modern medicine has enabled those with hypothyroidism to reach child-bearing age resulting in 80% of the population now having hypothyroidism! Low iodine can stymie treatment. Dr. Starr likes to start those with mild adrenal fatigue with Lugol’s iodine for a month to support the adrenal glands prior to adding in 0.25 grains of NDT. Start with 1 drop of 5% Lugol’s iodine, 6.25mg, on the skin and add an extra drop every week until applying 3-4 drops daily. Adverse reactions are not due to detoxing fluorine, chlorine, and bromine. Rather, per Dr. Kharrazine, iodine increases the thyroid enzyme TPO and this is problematic for those with Hashimoto’s TPO antibodies. Pregnant women shouldn’t use more than a drop. Grave’s disease has been successfully treated with 5 drops of Lugol’s iodine in water or juice 3 times daily for 2-3 days before taking 300mg of lithium carbonate 3 times daily. If unsuccessful after 2 weeks, add 500mcg of cobalt daily. The Great Iodine Debate 46, 53, 187, 243, 246
Caution!
A small percentage of people are hypersensitive to iodine. At a minimum, apply iodine to a small test patch of skin before using iodine in earnest. If you decide to use iodine, consider supplementing with selenium 200-400mcg daily to protect against Hashimotos. Note: Sea salt is an antidote for iodine reactions.
• Progesterone deficiency results in estrogen dominance especially in women. Supplementing progesterone helps with headaches, poor sleep, low sex drive, mood swings, and water gain. For men low in testosterone, creams are effective. Gaining weight and still feeling tired with progesterone supplementation is a sign of Candida overgrowth. p.195
• Clean water, food, and environment are essential to healing. Chemicals disrupt thyroid hormones. Soy hampers thyroid function. Phthalates from plastics disrupt thyroid and testosterone hormones. Pollutants impair the immune, nervous, and endocrine (hormone) systems with symptoms similar to hypothyroidism. For additional stressors, see Tired all the time? It’s Likely Adrenal Fatigue p.197-201, 211, p225
• PD-6/7 was developed by the dentist Dr. Armand DeFelice to help clear chemical sensitivities and heal dental infections. This detoxification therapy is applied topically and consists of a mixture of procaine, DMSO, parsley, oregano, rosemary, hydrogen peroxide, protomer, zinc, and iodine – see pages 248 and 249. Dr. Starr uses this mixture to detox Hashimoto’s patients so they’re able to tolerate iodine.

Stop the Thyroid Madness – Janie Bowthorpe

Stop the Thyroid Madness Synopsis

There are mold warriors and there are thyroid warriors. Janie Bowthorpe is the later. She’s been hosting the Stop the Thyroid Madness website, talking with, and learning from folks with adrenal and thyroid issues for a long time. Her first book, “Stop the Thyroid Madness“, is the compilation of knowledge learned through her own struggles to get proper treatment for hypothyroidism along with the experiences of the many others she’s helped.

Her website is a treasury trove. There you’ll find tons of helpful information including everything from where to find doctors, what lab work and labs to work with, a nifty T3/rT3 calculator, and even subjects like how to treat low cortisol levels using the Circadian T3 Method. The later of which is of particular interest to me as it appears that low cortisol is an issue and knowing that there is an additional option to glandulars and HC is helpful.

Relative to CIRS, what’s interesting to note is that Janie never says that there are a group of people that can never get off of supplemental hydrocortisone. Given the prevalence of CIRS, there has got to be a bunch of adrenal fatigue patients that are taking HC and also have CIRS. In other words, taking small physiological doses of supplemental hormones in order to bring levels up to their natural state is very helpful and does not cause issues later on when a person weans off them. For myself, I plan on holding off on HC and give glandulars and others a try first. Still, knowing HC is an option is useful.

Stop the Thyroid Madness Notes

• Synthetic T4 Problems: Many patients continue to be symptomatic using T4 only medications to treat hypothyroidism. The long list of lingering symptoms includes cold body parts, low-high temperature, fatigue, moodiness, acne, hair loss, dry skin, joint pain, and so on. p29
• Physiology: The adrenal glands produce many hormones. These include adrenaline to help deal with short term stress and cortisol to handle longer term stressors. Being exposed to long term stress from illness like hypothyroidism or CIRS can cause cortisol production to be chronically low. Stress from chronic illness comes in the form of physiological and emotional duress. Additionally, the whole range of chemicals we’re exposed to including chlorine and fluoride in drinking water may also be contributing factors. p68, 72

  

  The hypothalamus and pituitary gland are in the brain and produce a range of signaling hormones. For example, the hypothalamus sends TRH (Thyroid Releasing Hormone) to trigger the pituitary gland to send TSH (Thyroid Stimulating Hormone) to stimulate the butterfly shaped thyroid gland surrounding the “Adams apple” in the neck to produce more T3 and T4. The hormone T3 and T4 keep your internal fire burning strong. T3 also regulates serotonin and other neurotransmitters associated with anxiety. p140

  The pituitary gland also produces ACTH (Adrenocorticotropic hormone) to signal the adrenal glands sitting on top of the kidneys just under your ribcage in the back to produce cortisol for stress, LH and FSH to regulate sex hormones, growth hormones (GH) for bone and tissue repair along with ADH to control urination. My Note: Osmolality and ADH dysregulation is common in CIRS as a result of Leptin resistance in the hypothalamus causing low MSH production. p61, 64

  Low TSH in the face of hypothyroid symptoms may be due to the fact the various organs uptake T3 and T4 at different rates. As such, some symptoms may abate at lower levels of NDT while others will remain until a higher, optimal dosage is reached. p63

• Thyroid: The butterfly shaped gland surrounding the Adam’s apple produces 80-93% of the T4 hormone and 7-20% of the T3 hormone along with small amounts of T1, T2, and calcitonin for calcium regulation. T4 is inactive and acts as a stored form that can be converted into the active form T3. The hormone T3 is used by every cell in your body and impacts everything from energy production, brain function, metabolism, digestion, body temperature, heart health, blood pressure, and so on. p156
  
  There are numerous contributing factors to hypothyroidism including stress, aging, smoking, iodine and selenium deficiency, hormonal imbalance, eating large amounts of cruciferous vegetables and having a tonsillectomy. Thinning of the outer one-third of eyebrows is a classic hypothyroid symptom. p125, p155

  Adding back small amounts of natural thyroid hormones to alleviate symptoms bolsters the immune system and stifles auto-immune responses. Note: I wonder if addressing hypothyroidism couldn’t help with the immune system failure in CIRS. p132

• Hypothyroid Symptoms
• Fatigue – Chronic Pain
• Dry Skin – Hair Loss
• Weight Gain
• Always Cold
• Depression – Fearful – Obsessive
• Dull – Brain Fog – Confusion
• Mental Weirdness
• Emotional Numbness p137, 158
• Long and Pathetic List of Hypothyroid Symptoms
• Thyroid Testing: Labs that are helpful in treating hypothyroidism are TSH, free T3, free T4, along with antibody tests for TPO Ab (Thyroid Peroxidase) and TG Ab (ThyroGlobulin). Unlike conventional medicine that solely looks at TSH to determine treatment, TSH should only be used to diagnose problems with the pituitary gland. More specifically, if the person has strong hypothyroid symptoms and TSH is low, then there may be a problem with the pituitary as it should be sending a strong TSH signal. p47, 65
• Thyroid Treatment: Natural desiccated thyroid (NDT) like Armour and NatureThroid not only contain T4, but also T3, T2, T1, and calcitonin. In most cases, NDT is far superior to synthetic T4 only drugs. One “grain” of NDT equals 60-65mg depending on the brand. The total dose should be divided over 4-6 doses through out the day with a greater amount taken in the morning. For those with gut issues, it’s best taken sublingually. p37, 55
  
  Typically, a person starts on one grain of NDT for no more than two weeks and then increases by one-half a grain every few weeks. At around three grains, its best to wait 4-6 weeks before deciding to incrementally increase the dosage further. Failure to increase the dosage after the first two weeks may greatly exacerbate symptoms. There may be a period of time after increasing the dosage where heart palpitations, itchiness, and the like are experienced before your body adjusts. Note: Dr. Starr recommends starting at 0.25 grains and increasing every month. p52, 151

  The correct dosage is reached when afternoon temperatures are 98.6, waking temperatures are no more than 98.2, symptoms are relieved, and free T3 is near the top of the range. It doesn’t matter how low TSH is. Expect skin softening, more energy, a sense of calm, better hormonal balance along with abatement of pain, depression, head aches, and hair loss. p53

  Some increase their NDT by 1/8-1/4 of a grain in winter months or when physically active. p56

  When adrenal fatigue causes hyper symptoms starting out on NDT, then NDT dosing should be delayed until Hydrocortisone (HC) levels reach 15 mg or more. p96

• Adrenals: The adrenals make epinephrine, norepinephrine (adrenaline), aldosterone, testosterone, DHEA, DHEAS, androstenedione, and estrogens. In addition, they make cortisol used to deal with long term stress and to help facilitate the absorption of thyroid hormones so you have lots of energy. Experiencing hyper-like symptoms when starting to treat with NDT is likely caused by adrenal insufficiency – unless you’re at 3 grains or more. If this happens, it can be helpful to have an “ACTH STIM” test performed to check that the pituitary gland is sending the ACTH signal to the adrenal glands to produce hormones like adrenaline and cortisol. In addition, saliva cortisol testing should be performed. p50, 70, 149
• Adrenals Fatigue Symptoms
• Anxiety – Nervous – Panic – Jumpy
• Can’t Handle Stress – Get Nauseas
• Impatient – Irritable
• Dizzy – Shaky – Light Headed
• Skin Sensitivity
• Heart Pounding
• Poor Sleep – Dark Circles Under Eyes
• Carbohydrate Crash – Hypoglycemia
• Crave Salt
• Unable to Focus or Interact with Others
• Emotionally Sensitive – Over React – Defensive
• Feelings of Doom, Paranoia, Rage
• Days to Recover from Stress
• Diarrhea and IBS Symptoms
• Flu Symptoms
• Feel Better After 6pm
• Weakness – Faint After Exertion
• Sweat Attacks – Frequent Urination
• Pain in Lower Back or Adrenal Area (just under lower ribs in back)
• Bi-polar Swings
• Phobias – Suicidal Ideation p74, 141


• Adrenal Testing: Adrenals may be tested by taking your temperature three times a day for about a week. The average of the three temperatures should not vary more than 0.2-0.3°F from day to day. Alternatively, you can also compare your blood pressure when lying down and immediately upon standing. The standing pressure should be 10-20 points higher. Ideally, the adrenals are checked by measuring saliva cortisol levels several times through out the day with a lab. Make sure to stop any cortisol supplementation for at least two weeks and don’t take any thyroid meds on the cortisol test day. As an aside, it should be noted that if you are also hypothyroid, cortisol levels may be skewed high as hypothyroidism slows the clearance of cortisol. p78
• Adrenal Treatment: For mild adrenal fatigue, diet, lifestyle, and supplementation with grandulars and herbs may be enough. For others, especially those with hypopituitarism, supplementation with small physiological doses of biologically identical Hydrocortisone (HC) like the brand Cortef during meals for at least 2 months and as long as a year or more is often required. Upon noticing no negative impact when a dose is missed, doses are very slowly tapered to zero at a rate of 1.5 mg every 2-3 weeks. pg107
  
  Although some literature says that levels of HC above 20 mg may permanently suppress adrenal function, patients commonly use up to 30 mg with some men requiring up to 50 mg in four divided doses. When Cortef isn’t enough, the stronger Medrol is the drug of choice. Weight gain is common with HC. Too much cortisol causes excess sweating and weight gain, bruising, red face, weakness, and mood swings. p83, 85, 95, 102

  If DHEA is low, then supplementing DHEA will increase estrogen and testosterone along with freeing up some of the upstream hormone pregnenolone. Since cortisol is made from pregnenolone, more available pregnenolone means potentially higher cortisol production. Note: According to Dr. Shoemaker, DHEA is often low in those with CIRS but should not be addressed until MSH is above 35. p93

  Licorice root slows the absorption of cortisol. Vitamin C and B1, B2, B3 (niacin), B5 (pantothenic acid) and B6 (pyridoxine) are helpful – see Dr. Wilson notes. A paleo-like diet, lots of rest and sleep, exercise, and 1/2 teaspoon of salt twice daily helps with adrenal fatigue. Freeze dried adrenal cortex from pigs (porcine) can be helpful. Zinc suppresses cortisol so take in the evening. p89, 98

  If night time levels of cortisol are high, sleep will be impaired. Per Dr. Lowe, taking Phosphatidyl Serine, or ideally Seriphos, just before bed can keep night time levels of cortisol low while increasing the amount of cortisol available during the day. Start with 2 capsules and increase up to 4 capsules if sleep isn’t improved. If you use Phosphatidyl Serine, use the form with no “complex”. p97

  When exposed to stress, you may increase HC dosing up to two-fold for three days and then taper off by lowering the dose by one-third every two days. p100

  When Reverse T3 (RT3) levels are chronically high perhaps due to the body defensively turning down the internal fires by converting T4 into the inactive RT3 form, pure T3 or in combination with NDT may be needed for a time. Excess RT3 may also be caused by low cortisol levels that prevent T4 from being turned into T3. As a result, excess T4 is converted in RT3. Levels of RT3 are high when the ratio of free-T3/RT3 is greater than 19 when free-T3 is in pg/mL and RT3 is in ng/dL. Once RT3 is lowered, slowly taper off pure T3 and start with one grain of NDT. p160, 162, 165




• Hashimoto’s: Up to 95% with Hashimoto’s have TG Ab or TPO Ab antibodies and 75% of those are women. Symptoms like swelling in the neck area, tightness when swallowing, and swinging between hyper and hypo symptoms. Hashimoto’s is treated with the same protocol as hypothyroidism. Taking 200-400 mg of Selenium daily may help lower Hashimoto antibodies. p123, 131, 132
• Aldosterone: Low levels of the hormone Aldosterones made by the adrenals results in lower levels of sodium (salt) due to frequent urination creating an imbalance with potassium. Symptoms include low blood pressure, palpitations, dizziness, light headedness upon standing, fatigue, salt craving, frequent urination, sweating, and being thirsty. Conversely, high aldosterone results in high blood pressure, muscle cramps and weakness, numbness and tingling in fingers and toes. Note: Low aldosterone sounds a lot like the Osmolality and ADH imbalance in CIRS. p104
• Iron: Ferritin (iron) levels below the target range of 70-90 can thwart treatment of hypothyroidism and is common in thyroid patients. Although most prevalent in women, men can suffer from low iron too due to poor gut absorption as hypothyroidism reduces stomach acid. Treatment with 200mg of elemental iron taken daily with food can take months. Levels should be re-checked occasionally as there can be setbacks. If constipated from iron supplementation, take magnesium. p54, 171
• Iodine: Low iodine levels will hamper thyroid treatment as T3 and T4 are made from iodine. Low test levels are commonly treated with 5% Lugol’s iodine on the skin – each drop has about 6.25mg. Per Dr. Abraham, a typically daily dose is 12.5mg with up to 50mg taken during initial treatment. Some with Hashimoto’s may experience an increase in antibodies – see Why Do I Still Have Thyroid Symptoms Notes. p57


Iodine Testing


Flechas Family Practice


• Nutrients: It’s important to check vitamin D levels as hypothyroidism reduces hydrochloric acid in the stomach and consequently digestion is impaired. Consider supplementing B12 (Methylcobalamin). p49, 172

Adrenal Fatigue: The 21st Century Syndrome – Dr. James Wilson

Adrenal Fatigue: The 21st Century Syndrome Synopsis

The opening bullet point in my notes from Dr. Wilson’s book, “Adrenal Fatigue: The 21st Century Syndrome“, is that the cortisol made by the adrenals is highly anti-inflammatory. Hello; CIRS is highly inflammatory. As such, not trying to support low adrenal function early on in the treatment of CIRS doesn’t make good sense.

Granted hydrocortisone (HC) may not be the first choice, but have you read the long list of symptoms in Dr. Wilson’s Adrenal Fatigue Questionnaire? I’m now convinced that some of the worst symptoms I experienced with CIRS like feeling shaky, fearful, and anxious were a result of low cortisol.

We know that Dr. Shoemaker says treating CIRS with his protocol raises cortisol levels. Nonetheless, asking anyone to go through the hell I went through for even a day is inhuman when there is support that won’t interfere and can be given immediately. Dismissing adrenal fatigue as a sort of “fad” diagnosis is a real disservice. Dr. Wilson has been helping folks with adrenal fatigue for a long time. He does say that biotoxins will impair recovery so it’s really important for those with CIRS to get to a clean place, start taking binders, and so on.

In addition to lots of good information on how to take care of yourself through diet, supplements, and lifestyle, it was interesting to read that looking at upstream hormones can be useful. In particular, I know I have low DHEA and low progesterone levels. While Dr. Shoemaker cautions against using DHEA until MSH is above 35, at a minimum it seems to make sense to add in progesterone when it is low as progesterone is the precursor hormone to cortisol. While Julia Ross says she hasn’t found progesterone to be helpful in raising cortisol levels, there are lots of other benefits to progesterone so it seems like its worth a try. Of course, making sure to monitor hormones with labs.

Adrenal Fatigue: The 21st Century Syndrome Notes

• Cortisol is a powerful anti-inflammatory. In response to stress, cortisol provides more glucose, mobilizes fats and proteins and also modifies immune reactions, heart rate, blood pressure, brain alertness, and nervous system responsiveness. Without sufficient cortisol, the body does not mount an adequate response to be able to deal with the stressor and liver function is impaired. p.135, 269, 273
• Hypoglycemia is common with hypoadrenia. p.162
• Adrenal Stressors include frequent or prolonged infections (lung, dental, etc.) and colds, allergies, rhinitis, asthma, fibromyalgia, chronic fatigue syndrome, alcoholism, heart disease, hypoglycemia, rheumatoid arthritis, and various other chronic physiological stressors. The longer and more severe the illness, the greater the likelihood that the adrenals become unresponsive. Likewise, type-A personalities that are always working and striving for perfection, head injury, toxic exposure, and a life crisis can overtax the adrenals. Poor diet and a stressful lifestyle can lead to adrenal fatigue. p.9, 15, 18, 47
• Hampered Adrenal Recovery can be due to gut dysbiosis, lack of sleep, biotoxins in Water Damaged Buildings (WDB), poor ventilation in combination with toxic fumes, sub-acute infections, dental infections, hypothyroidism, and anesthesia toxicity. Sensitive individuals need 2-3 months of Kyolic garlic and a liver cleanse to clear anesthesia from surgery. p.234
• Dr. Wilson’s Adrenal Fatigue Questionnaire Don’t use scores greater than 3. Be objective and don’t labor over any one question. “Past” refers to a time when you felt well.
• Adrenal Fatigue Testing
• Iris Test: In a dark room with a mirror, continuously shine a flashlight across an eye (not into it) and observe the pupil. For those with adrenal insufficiency, initially the pupil will contract but then dilate within 2 minutes for about 30-45 seconds while it rests before contracting again. p.78
• Blood Pressure Test: Lie down quietly for 10 minutes and then take a blood pressure reading and then take another reading immediately after standing. Healthy individuals will see a rise of 10-20mmHg. Note: If you’re dehydrated, you won’t see the normal rise in pressure. p.79
• Sergent’s White Line Test: Drag the button-end of a ball point pen across the abdomen hard enough to create a white line. Normally, the line will redden in a few seconds. For those with hypoadrenia, the white line will widen and remain white for about 2 minutes before turning red. This test works in 40% of cases. p.82
• Saliva Testing: Test four times during the day starting between 6:00-8:00 within one hour of rising, 11:00-12:00, 4:00-6:00, and 10:00-12:00 to establish a baseline. Additionally, it can be instructive to carry around a couple vials and test when under stress or when symptoms are worse – make sure to record the time and event. If you are supplementing cortisone, stop at least 1 week before testing. Realize that the lab range is based upon a bell curve. Those in the bottom 1/3 of the range are suspect. p.85, 93
• ACTH: ACTH (Adrenocorticotropic hormone) is the signal sent out by the pituitary gland in the brain to tell the adrenal glands to produce cortisol. When cortisol levels are low, performing an ACTH Challenge Test will indicate if the problem is due to tired adrenals unable to produce cortisol or whether the adrenals simply aren’t getting the ACTH signal. During the test, ACTH is introduced and the blood cortisol levels should at least double. p.93
• De-Stress to help the adrenals heal. This includes everything from changing jobs, avoiding people that rob energy, cleaning up diets, re-programming internal self-talk, laughing, taking breaks, improving sleep, and meditating. It takes 24-48 hours to recover from an alarm reaction. Note: I believe the reason some have good results from brain retraining techniques like Neurosculpting, DNRS, and EFT is a direct result of reduced cortisol demand. Consequently, the adrenals and thyroid are able to heal. p.126, 289
• Food should be eaten more often and meals should be smaller with the first meal before 10:00 am – never skip breakfast. Combine grains with protein and fat for each meal. Avoid fruit in the morning, addictive foods, allergic foods, chocolate, and alcohol. Use plenty of salt. Eat whole, natural foods. Avoid caffeine, soft drinks, milk, fruit juices, cola nut, Ephedra, and black tea. Drink quality water, green tea, rice milk, and nut milks. Sit down, breath, and chew food well. Use lab testing, pulse monitoring, or an elimination diet to pinpoint problematic foods. p.135, 161, 163, 172, 183, 207
• Diet & Supplements
• 30-40% Vegetables – half should be eaten raw or lightly cooked
• 30-40% Rice, Millet, Barley, Oats, Quinoa, Amaranth, Buckwheat
• 10-20% Meats
• 10-15% Beans, Seeds, Nuts
• 5-10% Fruits p.155
• Vitamins & Minerals p. 193-202
• Vitamin C is essential along with bioflavinoids in a ratio of 2:1. Cortisol uses up Vitamin C. Take enough Vitamin to bowel tolerance – typically, 2-4 grams but may be as high as 15-20 grams. Citrus Bioflavonoid Complex
• Vitamin E tocopherols 800IU
• Vitamin B3 Niacin 25-50mg
• Vitamin B5 Panothenic Acid 1,500mg
• Vitamin B6 50-100mg
• B Complex with B3:B6:B12 ratio of roughly 1.25:1.00:3
• Magnesium Citrate 400mg
• Calcium 750-1,000mg
• Zinc, Copper, Chromium, Molybdenum, Selenium, Manganese, and Iodine
• Herbs
• Licorice root helps buoy cortisol levels. The concern over increased blood pressure is overblown.
• Aswagandha (Withania somnifera) is an “adaptogen” that helps lower high cortisol and raise low cortisol. p.204
• Panex Ginseng Root is best used by men and raises cortisol – can cause acne and facial hair in women. p.204
• Siverian Ginseng Root helps the adrenals to repair. p.205
• Ginkgo Biloba is a good anti-oxidant. p.206
• Adrenal Cell Extracts are made from animal parts – typically pigs (porcine). Dr. Wilson’s Adrenal Rebuilder contains 830mg of porcine gonad, adrenal cortex, hypothalamus, and anterior pituitary, along with having some inositol. Extracts provide the building blocks for adrenal repair and only contain very slight amounts of hormones. Extracts were being used by tens of thousands of physicians in the 1930’s and were produced by leading pharmaceutical companies as late as 1968. p.210
• Dr. Wilson Supplements recommended in the video include: 125mg of B3 (niacin), B6, 1,200-1,500mg of pantothenic acid B5, 200-400mg magnesium citrate, and 2-4 grams of buffered slow release vitamin C along with porcine glandulars and adaptogens. Take Dr. Wilson’s Adrenal Fatigue Questionnaire to determine your level of adrenal fatigue. Recovery time: mild-6 months, moderate-6 to 12 months, severe 2 years. Typically, folks start to feel better in about a month. Over time, you get better and better and eventually don’t need as much supplementation – keep a journal.



Dr. Wilson Dosage Charts


• Dr. Wilson’s Severe Adrenal Fatigue Protocol requires taking 5 “Super Adrenal Stress Formula” and 6 “Adrenal C Formula” per day. This works out to 130mg of B3 (niacin), 150mg of B6, 1,200mg of pantothenic acid B5, 410mg magnesium citrate, 5,020mg of buffered slow release vitamin C. This is consistent with what is recommended in the video.
• Corticosteroids like the natural Hydrocortisone (HC) recommended in “Stop The Thyroid Madness” are much more powerful and in using them one runs the risk of shutting down adrenal function. Its use should be reserved for severe adrenal fatigue only at around 20mg daily. During use of HC, the adrenals shut down and have an opportunity to repair. After about 6 months, try to taper off slowly; adjust dosage accordingly and some may need HC for up to 2 years. Take 5-7.5mg doses with each meal and before bedtime or at 8:00, 12:00, 3:00, and 6:00pm. Don’t use synthetic corticosteroids like prednisone. p.213, 217
• DHEA produced by the adrenals is a precursor to testosterone and estrogens. When low, supplementing between 25-200mg in men makes sense – leaves more Pregnenolone to be made into cortisol. Women often get facial hair and acne so only use in severe cases. p.219




• Pregnenolone and Progesterone are upstream hormones that when low and supplemented lightens the load on the adrenals that would otherwise have to make these hormones from cholesterol – see diagram. Progesterone goes straight into cortisol. Women are frequently deficient in Progesterone resulting in a whole host of symptoms including PMS, Insomnia, Early Miscarriage, Painful/lumpy breasts, Unexplained weight gain, Cyclical headaches, Anxiety, and Infertility – see the work of Dr. John Lee who offers an excellent cream called ProgesterAll and also Dr. Lam’s article Progesterone Cream and Adrenal Fatigue Recovery. One pea-sized dab of ProgesterAll is 1/16th teaspoon and contains 5mg of progesterone. Menopausal women apply cream days 12-26 where day 1 is first day of period. Post-menopausal women apply 10-20mg of progesterone 24-26 consecutive days each month. p.220



Dr. John Lee’s Website


• Aldosterone is often low when cortisol is low as both cortisol and aldosterone come from progesterone – see diagram. Aldosterone is responsible for water retention and mineral balance. Low aldosterone results in dehydration and low sodium levels. For those with adrenal fatigue, simply drinking water or consuming potassium (fruit, sodas, electrolyte drinks) will make a person feel worse as the sodium/potassium ratio will be made even worse – sodium (salt) is the key. Drink salted water 2-4 times daily. Kelp powder has the correct ratio of potassium to sodium. p.285

Dr. Wilson’s Adrenal Fatigue Supplements

I have confirmed low cortisol based upon 24-hour saliva lab testing and wild fluctuations in daily average temperatures. I consider the use of hydrocortisone (HC) to raise cortisol levels as a last resort. My preference is to give my body what it needs and see if it can’t correct itself that way. Dr. Wilson’s Adrenal Fatigue Protocol uses four different supplements that I’ve looked over below.

Adrenal Rebuilder
Contains 830 mg of the desiccated parts of pigs (porcine) – gonad, adrenal cortex, hypothalamus, anterior pituitary, inositol, and calcium. Dr. Wilson believes it’s important to use all of these parts and not just the adrenal cortex. Any hormones have been removed so concerns expressed by Janie Bowthorpe regarding adrenaline won’t be an issue. I’m guessing the pigs are from the environmentally cleaner New Zealand. This is a key supplement and the cost for the “severe” protocol using 6 tablets is $2.70/day.

Herbal Adrenal Support Formula
Consisting of eleuthero, ashwagandha, maca, and licorice, I’m not convinced this alcohol based tincture is absolutely necessary but I’ve decided to really try to support my body and so will be using the drops. The cost for the “severe” protocol is $1.45/day.

Super Adrenal Stress Formula
This supplement contains supportive cofactors that includes 26mg of B3 (niacin), 30mg of B6, 240mg of pantothenic acid B5, 40mg of magnesium citrate, and 308mg of buffered slow release vitamin C. I’m getting all of this an more with my current daily supplements. As such, I will not be using this formula at a cost of $1.56/day for the “severe” protocol.

Adrenal C Formula
Once again, my daily supplements already contain the 42mg of magnesium citrate and 80mg of buffered slow release vitamin C in this formula. At a cost of $1.40/day for the “severe” protocol, I will not be adding in this supplement.

Why Do I Still Have Thyroid Symptoms? – Dr. Kaharrazian

Why Do I Still Have Thyroid Symptom Synopsis

Dr. Kaharrazian book, “Why Do I Still Have Thyroid Symptoms?” is packed full of really helpful information. Honestly, you really have to take your time and slowly go through the book to absorb all the information. I read the book several times before the main thrust of the book finally dawned upon me.

Specifically, Dr. Kaharrazian systematically goes through 22 different reasons why a person may be suffering from hypothyroidism – be symptomatic due to thyroid hormone function. However, and this is the key point, in only one of those cases is the use of thyroid hormone supplementation warranted. Said another way, there are a lot of people treating hypothyroid symptoms by taking natural desiccated thyroid (NDT) that should not be.

In particular, it’s possible to have hypothyroidism (poor thyroid hormone function) due to high testosterone, or high cortisol, or high estrogen, and so on. In all of those cases, there isn’t enough T3 being made or the body is resistant to T3. They all result in hypothyroidism. However, supplementing NDT doesn’t address the underlying cause and may very well do additional damage. The additional damage occurs because your body may over time resist NDT supplementation; the cells refuse to let any thyroid hormones in because the underlying cause isn’t being addressed. It makes me wonder how many folks are taking NDT when they really have gut dybiosis, low progesterone, low dopamine, and the like.

It’s really critical to take the time to go through all 22 cases and make sure you’re not hypothyroid because of one of the other 21 drivers before diving into NDT. Dr. Kaharrazian lays out what to look for in each case including labs. Happily, many of the cases can be ruled out with standard thyroid labs. Adding in a few other tests like ferritin, homocysteine, and progesterone take care of the rest. The other books I’ve read on hypothyroidism all elude to the importance of addressing the drivers listed by Dr. Kaharrazian, but this book systematically lays them out along with telling a person how to determine which one of them is the real culprit.

There is a lot of other good information on the immune system and supplementation. Unfortunately, guidance regarding supplement dosage and when to use what herb isn’t given. This is really unfortunate. The suggestion seems to be that a person should work with a qualified practitioner for this information. As we all know, expert practitioners are few and far between. I hope some day Dr. Kaharrazian sees fit to write a detailed follow-up publication related to supplementation!

Why Do I Still Have Thyroid Symptom Notes

• Low Thyroid Hormone Symptoms (Hypothyroidism)
  • Weight Gain
  • Morning Headaches
  • Depression
  • Constipation
  • Sensitive to Cold
  • Numbness in Extremities
  • Muscle Cramps
  • Wounds Heal Slowly
  • Frequent Colds and Flu
  • Sleep a lot
  • Poor Digestion
  • Dry Skin
  • Dry or Brittle Hair
  • Hair Loss
  • Low Body Temperature
  • Swollen Face
  • Lose Outer Third of Eyebrows

• Hashimoto’s consists of the body attacking thyroid enzymes like Thyroid Peroxidase (TPO) and Thyroblobulin (TGB). The Thyroid Stimulating Hormone (TSH) can be at normal levels even though antibodies TPO Ab or TGB Ab are present. Using iodine exacerbates Hashimoto’s – In “Hypothroidism Type 2”, small doses are recommended. For those with Hashimoto’s, it is essential to be on a gluten and dairy free diet. Insulin resistance, polycystic ovary syndrome (PCOS), estrogen variability, Vitamin D deficiency, chronic inflammation, chronic infections, heavy metals, and environmental chemicals can all trigger Hashimoto’s. Folks with Hashimoto’s respond poorly to natural desiccated thyroid (NDT) – conversely in “Stop The Thyroid Madness”, NDT is the treatment of choice for Hashimoto’s. p.24, 27, 32, 36, 39, 90, 131
• Autoimmunity can result from eating too many carbohydrates resulting in blood sugar surges, parasitic infections, food intolerances, and chronic viral infections. Commonly, those with hypothyroidism also have an immune disorder. I’d say CIRS qualifies as an “immune disorder”! p.17, 46
• The TH-1 and TH-2 Sides of the Immune System need to be evaluated – ideally with testing. The TH-1 side uses natural and cytotoxic T-cells to rid the body of pathogens and the TH-2 side uses B-cell antibodies. Both sides use cytokines of various types that when in excess block receptor sites for thyroid hormones. Generally, the goal is to balance both sides by supporting the weaker side.
  
  However, in the case of an “antigen” like metals, pesticides, chemicals, mold, viruses, and parasites, the goal is to further stimulate the activated side of the immune system. Generally, mold, viruses, and parasites ramp up the TH-1 side while metals, pesticides, and chemicals ramp up the TH-2 side. Given this, for CIRS the TH-1 side should be further up-regulated by taking supplements that actually dampen down the TH-2 side. Always start with Vitamin D, fish oil, and glutathione to improve T-regulatory function. Note: T-reg cells are inappropriately plasticized into T-Effector cells in CIRS. p.49, 56, 62

 

TH-1 Up-Regulate / TH-2 Down-Regulate	TH-2 Up-Regulate / TH-1 Down-Regulate
(for mold, viruses, parasites)	(for metals, pesticides, chemicals)
• Astragalus	• Caffeine
• Echinacea	• Green Tea Extract
• Beta-Glucan Mushroom	• Resveratrol
• Glycyrrhiza (licorice)	• Grape Seed Extract
• Melissa Officinalis (lemon balm)	• Pine Bark Extract
	• White Willow Bark
	• Lycopene & Pycnogenol p.55

• Vitamin D is deficient in 90% of those with hypothyroidism due to a genetic weakness. Vitamin D, glutathione (GSH) and superoxide dismutase (SOD) all help regulate the immune system. Supplementing low Vitamin D can help regulate Hashimoto’s p.53, 118
• Thyroid Lab Work has a functional range for TSH of 1.8-3.0 mU/L, Total T4 is 6-12 ug/d, Free T4 is 1.0-1.5 ng/dL, free T3 is 300-450 pg/mL, Reverse T3 is 90-350 pg/mL, Thyroid Binding Globulin (TBG) is 18-27 ug/dl, and fasting glucose is 85-100 mg/dL. p.70-76
• Twenty-Two Different Drivers lead to hypothyroidism. Only one of them actually requires Natural Desiccated Thyroid (NDT). Issues such a blood sugar control, gut health, stress, slow liver, and hormone imbalances are the real drivers in the other 21 cases. Giving NDT in these other 21 cases may initially help the person to feel better but then may lead to thyroid hormone resistance and subsequently to irreversible low thyroid hormone production. Even “true” hypothyroidism can often be corrected early on with nutrition – before lab work shows high TSH and lower thyroid hormones. Addressing the real issue in the other 21 cases often corrects hypothyroidism without using NDT. Two or more drivers may be present at one time. p.76, 93
• Six Main Drivers of Hypothyroidism
1. Hypothyroidism – TSH is high along with free T3, free T4, total T4, free Thyroxine Index (FTI), and Resin T3 Uptake (T3U) being normal or low. Reverse T3 (rT3) is normal. Per Dr. Kharrazian, this is the only case requiring support in the form of NDT along with supplements like adaptogens. The thyroid is getting the signal to make hormones but isn’t making enough. Don’t use Tyrosine and test thyroid hormones frequently to monitor progress. Sometimes the labs are normal but the person is hypothyroid. p.76, 90, 93
2. Hypopituitarism – TSH is below 1.8 and T4 below 6 in the face of hypothyroid symptoms. The pituitary gland is fatigued due to prolonged stress (mental or physical), post-partum depression, or using NDT when really the problem is with the pituitary. Supplement adrenal extract along with herbals and minerals and stop using NDT. p.80
3. Excess Cortisol/Infection/Inflammation – TSH, free T4, total T4, FTI, and T3U are normal while free T3 and total T3 are low with negative antibodies and low or normal rT3. In this case, T4 isn’t being converted to T3 due to excess cortisol blocking the conversion or compromised cell membranes that can no longer convert T3 into T4 due to chronic infections or inflammation. My Note: CIRS definitely qualifies for long term inflammation and the feeling like you’re dying at least in the beginning stages of CIRS may very well be due to high cortisol suppressing thyroid function. p.82
4. High Testosterone – TSH, total T4, FTI, rT3, and antibodies are normal while free T4, T3U, and free T3 are high normal or high. This happens most often in women with polysystic ovary syndrome (PCOS) and insulin resistance, or that use too much testosterone cream, resulting in high testosterone and subsequently too much T4 being changed into T3 leading to resistance to T3.
5. High TBG – TSH, total T4, and rT3 are normal with no antibodies. Free T4, T3U, and free T3 are low along with FTI being low or normal. Thyroid Binding Globulin (TGB) binds onto free T3 and transports it around the body. Excess estrogen most often due to the pill or hormone supplementation results in too much TGB grabbing onto the free T3 making it unavailable to the body. p.83
6. T3 Resistance – All labs are normal along with no antibodies and yet the person is symptomatic. High cortisol due to chronic stress or high homocysteine can prevent the body from absorbing the T3 hormone. p.84
• All Drivers of Hypothyroidism
1. Low Serotonin – TSH below 1.8, T4 below 6, and low serotonin. p.174
2. Low Dopamine – TSH below 1.8, T4 below 6, and low dopamine. p.175
3. Inflammation – TSH below 1.8, T4 below 6, and inflammation from gut/viral infections, Lyme, food allergies, CIRS, chemicals, etc. p.177
4. High Prolactin – TSH and luteinizing hormone (LH) are low leading to low sex hormones. p.178
5. TPO Antibodies – suggests Hashimoto’s p.180
6. TGB Antibodies – suggests Hashimoto’s p.180
7. Low Progesterone – normal but depressed levels of TSH, T3, T4, and low progesterone. p.181
8. High Testosterone – up-regulates 5’deiodinase leading to too much T4 changed into T3. p.184
9. Low TPO – poor diet, guy dysbiosis, and low TPO. p.182
10. High TBG – TSH, total T4, and rT3 are normal with no antibodies. Free T4, T3U, and free T3 are low along with FTI being low or normal. p.184
11. Low TBG – TSH is normal while free T3 and free T4 are high most often from high estrogen or testosterone. p.185
12. High Cytokines – high TH-1 cytokines as in CIRS. Taking NDT doesn’t help. p.186
13. Low Vitamin A – common in anemia, liver disease, cirrhosis, and alcoholism. p.187
14. High Homocysteine – common with use of antacids, the pill, estrogen, Hypochlorydria/H.pylori infections. p.187
15. High Cortisol (2 cases) – TSH below 1.8, T4 below 6, and cortisol levels are high. May lead to cortisol resistance. p.178, 186
16. Down-Regulated 5’deiodinase (5 cases) – gut dysbiosis, inflammation, high cortisol, low serotonin, and low dopamine can all lead to the underperformance of the key enzyme 5’deiodinase that converts T4 to T3. The enzyme tetraidothyronine 5’deiodinase strips one iodine molecule off T4 to make T3. p.19, 182-184
    Note: Causality and nutritional support are outlined in Chapter 10.
• Iron Deficiency (anemia) blocks all forms of attempted thyroid support because iron is required by red blood cells to carry oxygen. In addition, a functional medicine doctor can look at an expanded blood test and see issues that produce hypothyroid like symptoms. These include gut and viral infections, adrenal stress, poor digestion, liver weakness, blood sugar issues, cholesterol imbalances, and such. p.87
• Fatty Acids are essential to hormone creation including thyroid hormones and should be taken in at a ratio of between 3:1 to 5:1 – Omega 3 to Omega 6. The Standard American Diet (SAD) is around 1:25! p.89
• Thyroid Peroxidase (TPO) is the enzyme responsible for making T3 and T4 in the thyroid. This is a complicated process that requires proper supplementation of selenium, copper, magnesium, zinc, niacin, riboflavin, P5P, and vitamin A. p.90
• Insulin Resistance occurs when blood sugar levels are always high due to a sugary diet. As a consequence, insulin is being constantly released and the cells eventually refuse to absorb any more insulin. Insulin facilitates the movement of glucose (sugar) into the cells wherein it’s converted to energy. With insulin resistance, the body converts the excess glucose that is no longer allowed in by the cells into fat. This conversion requires a lot of energy thereby making the person sleepy after meals – don’t have enough energy to stay awake. Symptoms include fatigue after eating, always hunger, can’t get enough sugar, urinating often, belly fat, can’t sleep, always hungry and thirsty, and can’t lose weight. In women, insulin resistance leads to high testosterone that subsequently leads to high T3 followed by resistance to T3 – see case 4 above. It should be noted that hypothyroidism slows insulin release and consequently the absorption of sugar so a person with hypothyroidism may not show a spike in blood sugar even though they experience hypoglycemia. p.100, 102, 108
• Hypoglycemia folks have chronically low blood sugar levels. Hypoglycemia most often results in low pituitary output but can contribute to the various other hypothyroidism cases. “Reactive Hypoglycemia” is when blood sugar dips low 2-5 hours after eating and is a precursor to insulin resistance. Symptoms of hypoglycemia include missing meals, craving salt and sugar, using caffeine, being jittery-agitated-nervous, being easily upset, having poor memory, eating relieves fatigue, having blurred vision, waking up in the night, and not being able to get out of bed in the morning. Avoid fasting and consider supplements like chromium, choline bitartrate, CoQ10, and bovine liver and adrenal glandulars. Everyone with hypoglycemia has insulin resistance and visa-versa to some degree. If blood sugar is too low or high, taking NDT isn’t going to help and may make matters worse. p.98, 107, 115, 170
• Blood Sugar Meters (glucometers) measure blood sugar levels. Levels should be between 80-100 before eating breakfast. Under 80 is hypoglycemic and over 100 may be insulin resistant. p.102
• Dr. Kharrazian’s Insulin Resistant Diet is an 8-week plan for clearing insulin resistance that starts with a fast lasting 3-5 days. During the fast, the person takes sips of water with freshly squeezed lemon or lime along with a touch of maple syrup, to address the tartness, every 10-25 minutes. Other than the water during the fast, rice protein powder along with nutrients to help detoxification, support the liver, and repair the gut are consumed. Later, foods like wheat, dairy, alcohol, and coffee are avoided while protein powder along with healthy foods are slowly reintroduced. My Note: I’ve heard of folks doing better after a “water-fast” diet and this may be due to the fact that they have blood sugar issues. p.110, 211

Dr. K’s Autoimmune Hypothyroidism Diet


• Regulate Blood Sugar by eating protein with breakfast and then every 2-3 hours along with limiting carbohydrate consumption in order to prevent feeling sleepy after meals. Additionally, eat a lot of vegetables, always eat fats and protein with fruits, and avoid sugary foods and stimulants like coffee. p.105, 106
• A Healthy Gut converts 20% of the storage form of the thyroid hormone T4 into the active form T3. Additionally, poor digestion leads to poor absorption of key thyroid nutrients, opens the gates to autoimmunity like Hashimoto’s, since the gut plays a key role in the immune system, and results in an over abundance of hormones like estrogen that are not broken down and subsequently contribute to hypothyroidism. Consequently, gut dysbiosis can cause hypothyrodism.
  
  As we age, stomach acid levels decline. Heartburn is not a result of too much stomach acid but too little – see What Really Causes Heartburn. Taking Betaine HCL with Pepsin and probiotics, making sure the gallbladder is working well, and ensuring regular daily bowel movements are all important to gut health. Sensitivity to perfumes is often a sign of Candida. Using an elimination diet like The Plan, stop eating inflammatory foods so the gut can heal – Dr. Kharrazian Autoimmune Gut Repair Diet. Foods can be reintroduced when lactuolose/mannitol test indicate the gut is no longer “leaky”. My Note: Those with CIRS have poor gut health due to low MSH. As such, it should come as no surprise that those with CIRS may also have hypothyroidism. p. 19, 121, 123, 130
• Adrenal Stress can cause hypothyroidism as high cortisol levels inhibit repair of the gut lining resulting in gut inflammation. Additionally, weak adrenals also diminish signaling from the hypothalamus and pituitary, increase Thyroid Binding Globulin (TGB), and reduce cell sensitivity to thyroid hormones. These all lead to hypothyroidism. Both physiological and mental stress results in adrenal fatigue – an inability to produce cortisol and other stress hormones. Stressors from eating carbohydrates and spiking your blood glucose levels, eating inflammatory foods, chronic infections and viruses, and environmental toxins all stress the adrenal glands. High adrenal output of cortisol from stress increases estrogen due to resultant liver fatigue along with reducing progesterone in women and testosterone men from pituitary fatigue. These hormonal imbalances can cause hypothyroidism. p. 136, 138




• Adrenal Saliva Testing is recommended and should include at least four tests through out the day along with DHEA. Dr. Kharrazian recommends an Adrenal Stress Index (ASI) test that consists of 4 cortisol tests, DHEA, Insulin (blood sugar control), Secretory IgA (when low gut health is low and more susceptible to parasites, mold, and viruses), 17-OH Progesterone (when high and cortisol low means adrenals can’t make cortisol), and gluten antibodies. It’s critical to do more than one round of testing and take the test during a normal day. Due to stress, initially both adrenal cortisol and DHEA levels will be high. With time, cortisol remains high and DHEA returns to normal, but eventually both cortisol and DHEA will be low. Note: Normal cortisol and high DHEA is not adrenal fatigue and may be due to ovaries making too much DHEA.
  
  To help the adrenals heal, Dr. Kharrazian recommends herbs like panax ginseng, Siberian ginseng, ashwagandha, and others to help the body adapt to stress, 2 grams of phosphatidylserine to regulate the stress response, and nutritional support like licorice, B vitamins, and others. Note: I also did an additional four tests throughout the night to determine if cortisol levels were high when I was trying to sleep necessitating the use of Seriphos. p. 140, 146, 147
• DHEA is the upstream hormone to the sex hormones and is low due to excess stress. The hormone Pregnenolone is “stolen” to make cortisol resulting in low DHEA. Women should be careful taking DHEA as it often leads to higher testosterone levels that can increase facial hair and acne. Don’t take more than 20mg of DHEA daily for more than a month. p. 158
• Phosphatidylserine (PS) in liposomal form along with a liposomal cream with licorice, B vitamins, and other nutrients were given to resort adrenal health. PS helps lower cortisol levels but Dr. Kharrazian also recommends high levels of liposomal PS for those with low cortisol. Note: Phosphatidyl serine is converted into phosphorylated serine in the gut. It takes 100 mg of phosphatidyl serine to make 20 mg of phosphorylated serine. Taking between 2-4 capsules of phosphorylated serine (Seriphos) before bed can be helpful for those with high night time cortisol. Seriphos lowers cortisol thereby promoting sleep and placing more cortisol in reserve for the daytime – Dr. Lowe. If you wake up between 2:00-4:00am, take 1 Seriphos with dinner and 2 more before 10:00pm. Don’t use Seriphos more than 3 months and take a 1-day break every month – Identifying And Correcting Elevated Cortisol Levels. p. 118, 152

 




• Hormone Imbalances can cause hypothyroidism. Skin creams can contain estrogen. Estrogen dominance can trigger hypothyroidism due to excess TBG that makes thyroid hormones unavailable. Flooding the body with hormone creams can irreparably damage the pituitary gland signaling along with taxing the liver that has to breakdown the excess hormones. A tired liver will allow partially broken down hormones back into the bloodstream resulting in a wide array of illnesses along with not being able to convert T4 into T3. Hormone tests do not measure synthetic hormones. As a consequence, the person may be loaded up with synthetic hormones and yet have low test levels of natural hormones.
  
  When Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) are low and other hormone levels are normal or low, then there is an excess of synthetic hormones trapped in the body. Synthetic hormone detox takes 30-90 days and involves taking herbs like tribulus terrestris, Peruvian maca, chasteberry and shepherd’s purse along with nutrients like daidzein, genistein, indole-3-carbinol, B6, methylation cofactors, and others. Additionally, it’s important to support the pituitary by taking porcine thyroid and pituitary glandulars along with supporting the liver and gallbladder with herbs like milk thistle, dandelion root, ginger, and so on. p.37, 157, 158, 159, 162
• Brain Neurotransmitters like serotonin and dopamine are important in the conversion of thyroid hormone T4 into the active form T3 in the brain along with affecting the level of Thyroid Stimulating Hormone (TSH). Feeling depressed, rage, paranoia, loss of enthusiasm, lack of joy, hopeless, worthless, reclusive, low sex drive, and distractible can all be due to low serotonin or dopamine. Blood sugar control is a key to healthy brain chemistry. Methylation including B12 supplementation is linked to dopamine levels. Although Tyrosine can suppress TPO levels, it is helpful for those with low dopamine levels. Additionally, supplements like mucuna pruriens, beta-phenylethylamine (PEA) and P5P can help raise dopamine levels. Supplements like 5-HTP St. John’s Wort, SAMe, and magnesium citrate can help raise serotonin levels. p.167, 169, 170
• At the back of the book, there is an excellent description of the benefit and importance of supportive supplements related to hypothyroidism – although it doesn’t include dosages 🙁 p. 191-236

Stop the Thyroid Madness II – Janie Bowthorpe

Stop the Thyroid Madness II Synopsis

Over a dozen doctors penned the chapters in Janie Bowthorpe’s follow-up book, “Stop the Thyroid Madness II”. Each chapter covers the basics on various topics related to hypothyroidism like stress, NDT, labs, nutrition, reverse T3, methylation, and so on. While much of the material will probably be known to those that have already done some reading on the subject, there are enough useful tips and kernels of wisdom to make the book worth reading.

Stop the Thyroid Madness II Notes

• Herbs: Ashwagandha increases T4 and it’s conversion to T3 and helps being able to deal with stress. Coleus forskohli increase thyroid hormones. Guggul stimulates the thyroid and conversion of T4 to T3. Rhodiola reduces anxiety and improves cortisol. Ginseng turns off inflammation and improves stress handling. Thyroid Stimulatory Action of Guggul – Commiphora mukul p.16, 43
• Supplements: Iodine, zinc, iron, potassium, chromium, selenium, magnesium, Vitamin A, Vitamin C, and Vitamin E are important for thyroid hormones. Vitamins B2 (riboflavin), B6 (Pyridozine), B9 (Folate), and B12 (Cobalamin) are also important. When low, DHEA supplementation can reduce TPO antibodies. p.10, 70, 126, 217
• Omega 3 when traveling can be taken as Vectomega or Krill oil – neither will spoil. p.131
• Iodine in high doses should not be used with Hashimoto’s. The data in the Yoon study of iodine and Hashimoto’s indicates 550mcg (0.55mg) of iodine should be used with Hasimoto’s. See Iodine and Your Thyroid p.129, 155
• Natural Descicated Thyroid (NDT): One grain is of NDT contains 38mcg of T4 and 9mcg of T3 along with inactive ingredients for a total of 60mg. Nature-Throid NDT doesn’t have artificial colors or flavors, corn, peanut, rice, gluten, soy, yeast, egg, or shellfish. NDT is often not required to fix hypothyroidism. It’s better to correct diet, the environment, and heal the body in general with methylation support, mitochondria supplements, phosphatidylcholine, and the like. Mitochondrial support includes D-Ribose, NADH, CoQ10, riboflavin (B2), and a little adenosylcobalamin (B12). p.56, 266
• It takes 6-12 weeks for TSH levels to equilibrate to changes in NDT dosing. p.98
• Iodine urine levels should be checked. p.100
• NDT therapy starts at 0.5 grains. p.102
• TSH above 2.5mIU/L on two or more labs taken 3-4 weeks apart may indicate hypothyroidism especially if antibodies are present. When NDT levels are high enough to clear symptoms, TSH will plummet and free T3 will be at the upper end of the range. p.96, 101
• Impaired conversion of T4 to T3 is caused by excess sugar, faltering liver and kidneys, heavy metals, pesticides, herbicides, and some drugs like Premarin and chemo. The body makes 30mcg of T3 and 100mcg of T4 daily. p.220, 231
• Deiodinase Enzyme strips one of the four iodine molecules from big protein T4 (levothyroxine) to make the active form of the thyroid hormone T3. In the face of poor diet, inflammation, or toxicity, deiodinase enzyme will convert T4 into reverse T3 (rT3). p.122
• Reverse T3/(rT3) ratios should be greater than 20 for free-T3/rT3 and greater than 10 for total-T3/rT3 when free-T3 is in pg/mL and RT3 is in ng/dL. Reverse T3 excess is treated by lowering the NDT dosage and adding in pure T3 or by using T3 only. Treating with NDT alone will not work. p.72, 253




• Gluten in grains produces chronic inflammation due to the fact that humans have only been eating grains for 10,000 years. This isn’t enough time for the gut to have developed the ability to digest grains. As such, gluten proteins easily leak through the gut and into the bloodstream wherein your immune system mounts an inflammatory response. Likewise, cereal grains, milk, soy, peanuts, and nightshades were not part of the diet 10,000 years ago. Inflammation reduces hormone production. p.11, 18
• Toxins such as bromide and fluoride cause problem when iodine is low. Heavy metals poison important enzyme pathways. Xenoestrogens in plastic, pesticides, herbicides, petroleum, and soy impair thyroid function too. Radioactive iodine from nuclear disasters is taken in when iodine is low. p.121
• Mold and Tick-borne Illnesses cause abnormal thyroid tests but treatment with NDT does not resolve symptoms. p.123
• Hashimoto’s can be caused by too much or too little iodine and low selenium. Take 200mcg of selenium daily. Selenium protects against iodine causing Hashimoto’s. Those with Hashimoto’s should take selenium for 2-4 weeks before starting iodine. Treat Hashimoto’s with NDT and low doses of iodine. p.140, 145, 154, 158, 165
• Chronic Stress leads to excess epinephrine and norepinephrine that then leads to high blood pressure, congestive heart failure, and myocardial infarction. p.218
• Methylation
  
  • Arsenic at 5 parts per million will inhibit TPO by 54%. The TPO enzyme is involved in making thyroid hormones. The EPA limit for arsenic in drinking water is 0.01 parts per million and this is well below 5 parts per million. However, arsenic is also in fruit, rice, and vegetables. Methylation is the detox pathway your body uses to eliminate arsenic and many other toxins. p.262
  • Methylation is important in making and clearing brain neurotransmitters, making cell membranes, removing toxins, immunity, and making creatine for muscle and speech. p.265
  • Sulfur should be limited as it lowers neurotransmitters and thyroid hormones. p.268
  • Folate serum levels that are high may be indicative of B12 deficiency. Test methylmalonic acid (MMA) and holotranscobalamin to determine if B12 is low. Methylation depends on B12. p.271
  • Homocysteine levels above 9 umol/L will increase SAH and consequently impair methylation. p.271
  • MTHFR A1298C – 1 copy: 20% less function, 2 copies: 40% less function
  • MTHRF C677T – 1 copy: 35% less function, 2 copies: 70% less function
  • MTHRF A129C and MTHFR C677T – 1 copy of each: 70% reduction
  • MTHFR Defects mean you can’t make as much methylfolate. Take methylfolate with methylcobalamin (B12), riboflavin (B2), eat uncooked green leafy veggies (B2), lower SAMe, and relax. Caution: Don’t supplement methylfolate and methylcobalamin if on psych, anti-seizure, or chemo drugs. Otherwise, try 400mcg of methylfolate and 500mcg of methylcobalamin. Take niacin if there is a bad reaction. p.275, 281
  • T3 Only Thyroid Support is problematic because T4 is needed to make riboflavin in its most active form called flaven adenine dinucleotide (FAD). FAD supports methylation. p.276
  • MTHFR Recommended Labs: Molecular Testing Labs, Spectracell Labs, and 23andMe.

Overcoming Adrenal Fatigue – Kathryn Simpson

Overcoming Adrenal Fatigue Synopsis

Kathryn Simpson’s book, “Overcoming Adrenal Fatigue”, is a real gem. Written by someone who has a technical background and has recovered herself from hormonal and thyroid imbalances, the book is concise and gets right to the point. While the book does contain a handful of engaging antidotes, its main focus is on giving you the information you need to get better including lab ranges and supplement dosages. It’s a good read.

Overcoming Adrenal Fatigue Notes

• Pregnenolone is a precursor to progesterone and DHEA – see graph. Pregnenolone drops up to 60% by age 75. Up to 200mg daily is safe with 10-50mg typical for adrenal fatigue. p.12, 78
• Progesterone is a precursor hormone for cortisol, DHEA and sex hormones. Use at most 20mg for men and postmenopausal women, and up to 200mg for perimenopausal women – see the work of Dr. John Lee. p.78
• DHEA acts like cortisol improving immunity and reducing inflammation. Levels start to decline by age 20. Also, low cortisol lower DHEA. Excessive DHEA results in greasy hair and skin, acne, stinky perspiration, mood swings, anger, deeper voice, and facial hair. Optimal DHEA 280mcg/dL women blood, 200pg/mL women saliva, 400mcg/dL men blood, 250pg/mL men saliva. Test estrogen and testosterone levels when supplementing DHEA. p.13, 47, 58, 77
• Infections trigger high cortisol in an attempt to turn down the immune system. p.23
• Cortisol imbalances increase fat, trigger overeating and sugar cravings along with accelerating aging and causing depression-anxiety-fear. Excess cortisol causes thyroid hormone resistance resulting in hypothyroidism along with increasing the conversion of T4 into reverse T3. Optimal Saliva Cortisol Levels are 20-30nmol/L (5.8-8.7 ng/mL) morning, 7-11nmol/L (2-3.2 ng/mL) noon, 6-9nmol/L (1.7-2.6 ng/mL) evening, and 5nmol/L (1.4 ng/mL) night, 70mcg 24-Hour Collection. p.29, 31, 46, 57, 94
• Aldosterone levels may drop due to adrenal fatigue. My Note: Stress from CIRS lowers cortisol and consequently aldosterone possibly resulting in low blood pressure, fast heart rate, palpitations, dizzy upon standing, thirst, and frequent urination. Aldosterone and its signaling enzyme Renin go up when trying to hold onto water and salt (sodium). Test in upon waking before food. Optimal levels are 15ng/dL aldosterone standing, 7ng/dL aldosterone lying down, 141 nmol/L sodium, 4.3 nmol/L potassium, and 25 or greater aldosterone/Renin ratio. (Hertoghe 2006) p.48, 57
• ACTH is released by the pituitary to signal the adrenals to make cortisol, DHEA, and aldosterone. Optimal ACTH is 45mg/L. p.59
• Sex Hormones: Optimal Women are 120pg/mL estradiol, 13-23ng/mL luteal phase progesterone, 1.4ng/mL follicular phase progesterone, 35ng/dL testosterone. Optimal Men are 700ng/dL total testosterone, 250pg/mL free testosterone, 70ng/dL DHT, 25pg/mL estradiol, 1.2pg/mL progesterone, 3mIU/mL LH (under 8), and 2mIU/mL FSH (under 7). (Hertoghe 2006) p.62
• Growth Hormone optimal levels are 300ng/mL IGF-1, 3mg/L IGFBP3. (Hertoghe 2006) p.63
• Supplements: 800mg phosphatidylserine reduces cortisol when stressed, 250mg Ashwagandha reduces cortisol when stressed and increases T3 along with T4, 120mg Ginkgo Biloba reduces cortisol, 100-300mg ginseng balances low and high cortisol, Maca reduces cortisol, 100-200 Rhodiola Rosea reduces cortisol when stressed, salt evening meals to reduce urination at night, 25mg Guggul increases T3 (2 capsules of Nutrigold Guggul Gold), 10-50mg Coleus Forskohlii (1-5 drops of Coleus Forskohlii Dried Root Glycerite) increases thyroid hormones. p.70, 73,91
• Adrenal Support includes digestive enzymes, B vitamins, salt, Vitamin C, ginseng and licorice. p.79

My Take-A-Ways

So I want to make it clear that my notes are simply a smattering of the total content in these books. I basically took notes on material that I found interesting for one reason or another. Either they relate directly to mine or my wife’s situation or to CIRS. If you think adrenal fatigue or thyroid issue may be of concern, here’s a list of books I thought were useful along with notes to give you a sense for what they’re about.

That said, I now have to put together a plan for myself. I just got back some recent labs showing TSH at 3.7 on a scale of 0.36-3.74 along with free T3 and free T4 values in the low normal range. Based upon the writings of Dr. Kharrazian, this sounds like a case for some NDT. At a minimum, I’m able to rule out a lot of the other 21 cases as many of them are predicated on having TSH below 1.8. Also, it appears that my hypothalamus and pituitary are working OK as they’re sending out a strong TSH signal in the face of hypothyroid symptoms. As such, an ACTH STIM test and related testing shouldn’t be necessary.

Nonetheless, I do plan on retaking the iodine load test from Hakala as I’ve been supplementing iodine for a while now after the initial test came back low on iodine. Even with iodine supplementation, the most recent cortisol test came back low so iodine supplementation per Dr. Starr hasn’t been enough to reverse adrenal fatigue. He does say that this is often a result of dental infections. Even though I’ve had cavitation work done, I’m not convinced that the sites have been totally cleared of infection based upon how they feel.

In fact, this brings up an issue I’ve been thinking about as I was reading through the books and taking notes for you all. Namely, the authors state that infections, poor gut health, hypoglycemia, and so on contribute to adrenal fatigue and hypothyroidism and that these adverse health conditions need to be addressed in order to give relief to the adrenals and turn up thyroid hormones. At the same time, the reason a person has parasites, jaw infections, and autoimmunity is exactly because of low cortisol and thyroid hormone levels – low internal fire. It’s a “catch-22”.

So my diet can’t get any cleaner. My house has a super low ERMI. I’ve become an expert at avoiding mold. I don’t eat a lot of carbs and avoid sweats. My glucose readings are normal. Recent testing did come back positive for two different protozoa that according to conventional medicine are benign. Nevertheless, I do plan on treating for them along with taking potent essential oils to treat the Small Intestinal Bacterial Overgrowth (SIBO) I tested positive for. However, there’s no way I’m going back in anytime soon to have my jaw torn open again and I think rightly so. My hope is that by clearing up enough issues, I’ll be able to get cortisol and thyroid hormone levels up.

I do plan on re-testing thyroid hormones as it’s important to take at least a couple readings about a month apart; I’ve included the links of tests I’m looking at below. In addition, I’m going to recheck homocysteine mainly as it relates to methylation but also because it’s cheap. I may also throw in TGB even though my current labs along with Dr. Kharrazian’s work suggest it isn’t necessary.

I’ve recently done ferritin, testosterone, estrogen, progesterone, and DHEA testing. The first three were fine but DHEA and progesterone were both low. No surprises with DHEA but I do find it curious that progesterone is low. If you study the work of Dr. John Lee, progesterone deficiency is really prevalent among women. In my case, I’m seriously looking at supplementing with ProgesterAll. Progesterone is upstream to sex hormones, cortisol, and others. Although there seems to be some uncertainty as to whether it will actually be converted into cortisol, I feel OK with this choice as levels are low and I’ll retest to see where it’s ending up.

By the way, before I get in too deep with adrenal support, I plan on ramping up on VIP to see if VIP alone can’t correct cortisol and subsequently hypothyroid symptoms as Dr. Shoemaker suggests. So far, four doses a day for about 3 months hasn’t made much difference in this regard. I do want to give VIP the best possible chance before I start trying small physiological doses of progesterone and DHEA.

So for now, I plan on shying away from DHEA, testosterone, and especially hydrocortisone (HC). I recently ran MSH. If it comes back above 35, I may reconsider DHEA supplementation. HC sounds a bit like “playing with fire” so I’ll wait to see if Dr. Wilson’s glandulars and iodine supplementation can’t bring up cortisol levels. If not, then I’ll try adding in progesterone and DHEA. I recently did saliva cortisol testing during the day and night to establish a baseline.

Regarding hypothyroidism, about a month ago I tried one grain of NatureThroid for 2 weeks. At that point, I stopped because I was lying in bed awake for most of the night, felt really amped up, and eventually got bizarre feelings like my whole world was crashing in – not good. So it appears that there is an intolerance issue most likely from low cortisol. You can read over the various reasons for intolerance mainly under Dr. Starr’s notes.

Well, we’ll see how this all plays out. One point seems really clear to me now. I really believe that much of the “freak out” factor along with a lot of symptoms related to CIRS has to do with low cortisol and hypothyroidism. Both of them can cause anxiety, depression, and fear – not to mention a lot of other CIRS symptoms like weird skin sensations.

So Dr. Shoemaker says that CIRS patients have low cortisol and we know that low cortisol is going to push a person toward hypothyroidism. Dr. Shoemaker says TSH values were “normal” on patients he tested but did he use a functional or conventional range? When I was tested by him back in 2011, only TSH was done with a lab range of 0.4 – 4.5 mIU/L. I was at 1.87. Given that my current TSH is 3.7 (0.36-3.74.), it looks like I’ve been sliding into hypothyroidism over time. No surprises here, given the extreme stress from CIRS.

Well, that’s enough. If you’re getting seriously beaten up by CIRS, consider supporting your adrenals and thyroid. There are quite a few supplements that can help based upon your situation without having to directly take DHEA or testosterone against Dr. Shoemaker’s advice. I wish I’d figured this out years ago. Ugh, I’ve been cold forever – low basal temperature. Low body temperature means your internal fire is low and makes trying to recover from CIRS like entering a wrestling match with one arm tied behind your back.

Labs & Doctors

• STTM 2.3 Thyroid Panel $125 – 10% with code ULTA41012
  The STTM 2.3 Thyroid Panel – Ultimate panel contains 5 tests with 11 biomarkers.
• Adrenal Stress Profile $170
• TBG (Thyroxine Binding Globulin) $70
• Homocysteine $34
• Hakala Research – 24 Hour Urine Iodine Loading Test $70
• Growth Hormone (GH) $31 – see Dr. Hertoghe’s video
• Aldosterone $44
• Recommended Labwork – Stop the Thyroid Madness (I do not recommend TrueHealth Labs.)
• Thyroid Nation – Thyroid Friendly Doctors