Adrenal Disease

Natural Supplements to Treat Addisonian States

• DHEA
• Licorice
• Pantothenic Acid
• L-Theanine

DHEA
Aging and diseases associated with aging can cause a decline in critical hormones produced by the adrenal glands. Pregnenolone is converted into crucial antiaging hormones such as dehydroepiandrosterone (DHEA), estrogen, progesterone, and testosterone. DHEA supplementation may help to partly rectify hormone imbalances caused by age-induced adrenal insufficiency.

An article in the journal Clinical Endocrinology described a study of the effect of oral DHEA replacement therapy in women with Addison's disease (Gebre-Medhin et al. 2000). The researchers found that DHEA and DHEA-sulfate (DHEA-S) levels were restored to normal in those patients receiving 50 mg of DHEA, whereas the DHEA-S level was slightly above the normal reference value in those receiving 200 mg of DHEA. Circulating levels of androgens (androstenedione, testosterone, and testosterone/SHBG ratio) were normalized in all patients. No serious side effects were seen, but some of the patients experienced increased apocrine sweat secretion (apocrine glands are in the armpit, anal, genital, and breast areas and produce a strong odor), itchy scalp, and acne, all of which were reversed when DHEA was discontinued. The authors concluded that a daily replacement dose of 50 mg of DHEA results in near physiological levels of DHEA, DHEA-S, androstenedione, and testosterone in women with Addison's disease without severe side effects (Gebre-Medhin et al. 2000).

Another article described a randomized, double-blind study in which 39 patients with Addison's disease received 50 mg of oral DHEA daily for 12 weeks (Hunt et al. 2000). After DHEA treatment, levels of DHEA-S and delta- ( 4 ) -androstenedione rose from subnormal to within the adult physiological range. Total testosterone increased from subnormal to low normal with a fall in serum sex hormone-binding globulin in females, but with no change in either parameter in males. In both sexes, psychological assessment showed significant enhancement of self-esteem with a tendency for improved overall well-being. Mood and fatigue also improved significantly, with benefit being evident in the evenings. The authors concluded that DHEA replacement corrects this steroid deficiency effectively and improves some aspects of psychological function. These positive effects, in the absence of significant adverse events, suggest a role for DHEA replacement therapy in the treatment of Addison's disease. Studies suggest that low DHEA-S might be a prognostic marker and a sign of exhausted adrenal glands (Hunt et al. 2000; Beishuizen et al. 2002) . ( B b efore taking DHEA or pregnenolone, refer to the Foundation's precautions in the DHEA Replacement Therapy protocol and to the Autoimmune Diseases protocol for additional suggestions . ) .

Even mild Addison's disease requires expert physician intervention and supervision. Glucocorticoid and mineralocorticoid component drugs are prescribed for Addison's disease. Once cortisol levels are stabilized, the serum levels of DHEA should be evaluated to determine if DHEA replacement therapy is warranted. In the majority of cases, Addison's disease is caused by an autoimmune attack on the adrenal glands. DHEA has been shown to suppress inflammatory cytokines and thereby down - regulate autoimmune reactions in the body. In the past, infection, such as tuberculosis or meningitis, was the main cause.

Licorice
Licorice (Glycyrrhiza glabra and Glycyrrhiza uralensis) is grown in Europe and Asia . Licorice is a highly prized medicinal ly in Chinese medicine. It is used in almost all of the Chinese patent herbal formulas. Glycyrrhiza may be taken in a variety of ways, including as a tea. It helps to reduce the amount of hydrocortisone broken down by the liver, thereby reducing the workload of the adrenal glands. Licorice is a well-loved candy for children, although most commercial brands no longer contain real licorice. Instead commercial products use anise seed and sugar, which taste similar. It is best to stay with teas or supplements. Licorice was prescribed for Addison's disease until the 1930s. Licorice is also a demulcent (an oily substance that reduces irritation), which makes it soothing to the digestive tract. Deglycyrrhized licorice (DGL) is made by removing the glycyrrhizin. For the adrenal effects, only real licorice should be used, not DGL.

Long-term use of licorice containing more than 1 gram of glycyrrhizin (the amount in approximately 10 grams of licorice root) daily can cause increased blood pressure and water retention (edema) (Schambelan 1994). High doses of licorice should only be taken under the care of a qualified health professional.

Pantothenic Acid
Pantothenic acid (vitamin B5) activates the adrenal glands. It is a precursor of acetyl CoA (a part of the Krebs's cycle which produces cellular energy) and acetylcholine (a primary neurotransmitter). Pantothenic acid deficiency results in adrenal insufficiency, which is characterized by fatigue, headache, sleep disturbances, nausea, and abdominal discomfort (Tarasov et al. 1985; Smith et al. 1996; Murray et al. 1997).

L-Theanine
L-theanine is an amino acid found in green tea that produces a calming effect in the brain. It works by increasing gamma-aminobutyric acid (GABA) that is a relaxer and creates a sense of well-being. L-theanine may be taken to help modulate mood and relieve stress in many health conditions (Abe et al. 1995; Kobayashi et al. 1998; Juneja et al. 1999).

Natural Supplements to Treat Cushing's Syndrome

• DHEA
• Vitamin C
• Phosphatidylserine
• Melatonin

DHEA
DHEA may help to protect against the overproduction of cortisol from the adrenal glands and enhance the immune system. This is an important factor since too much cortisol accelerates aging and causes immune system disorders. Studies show that DHEA deficiency may actually debilitate immune status (Wisniewski 1993; Morio et al. 1996).

Vitamin C
Studies show that vitamin C and aspirin can attenuate and influence cortisol, inducing an anti-inflammatory response to prolonged exercise and stress. Vitamin C has been shown to reduce the elevation of cortisol in response to heavy exercise. In human studies, 3000 mg of vitamin C daily mitigated a rise in blood pressure, cortisol, and subjective response to acute psychological stress ( Di Luigi et al. 2001; Peters et al. 2001a, 2001b; Brody et al. 2002).

Phosphatidylserine (PS)
Phosphatidylserine is a phospholipid that is a structural component of the biological membranes in animals and plants. In studies, supplemental PS has been shown to improve mood and blunt the release of cortisol in response to physical stress (Monteleone et al. 1990; Kelly 1999; Benton et al. 2001).

Melatonin
Melatonin is secreted by the pineal gland and functions to regulate circadian rhythm and induce sleep. Melatonin circadian secretion in patients with pituitary- or adrenal-dependent Cushing's syndrome was shown to be significantly lower compared to healthy control groups. Studies also have shown that nightly administration of 2 mg of melatonin increased the DHEA-S-cortisol ratio after 6 months of treatment (Soszynski et al. 1989; Bruls et al. 2000; Pawlikowski et al. 2002).

Natural Supplements to Treat Adrenal Fatigue

After an evaluation by a physician, if stress is determined to be the cause of adrenal fatigue, the first goal is to relieve the stressful situations as much as possible. Consider lifestyle changes, including diet modification and exercise. Limit the consumption of processed foods, and avoid alcohol and tobacco use because these substances put extra stress on the adrenal glands. Many supplements recommended for either Addison's disease or Cushing's syndrome may also be taken for general adrenal fatigue because they can help to support healthy adrenal function, reduce stress, and blunt the release of excess cortisol during stress. Consider the following:

• Vitamin C, 3000 mg a day
• DHEA, 50 mg a day
• L-theanine, 100-400 mg a day
• Pantothenic acid (vitamin B5), 1500 mg a day
• Melatonin, 300 mcg-6 mg (at bedtime)
• Phosphatidylserine capsules, 300 mg a day
• Licorice (Glycyrrhiza glabra), no more than 1000 mg of glycyrrhizin

Diet and Addison's Disease

A possible link between gluten sensitivity (celiac disease) and Addison's disease has been proposed. An article in the Journal of Endocrinological Investigation described a patient with celiac disease and multiple endocrine disorders, including autoimmune Addison's disease and hypothyroidism (Valentino et al. 1999). Over a 3-month period, on a gluten-free diet, the patient showed a marked clinical improvement accompanied by a progressive decrease in the need for thyroid and adrenal replacement therapies. After 6 months, the serum IgA antiendomysium antibody test (used to confirm celiac disease) became negative. After 12 months, a new jejunal biopsy showed complete mucosal recovery. (The jejunum is the middle third of the small intestine.) After 18 months on a gluten-free diet, the antithyroid antibodies titer decreased significantly, and thyroid substitutive therapy was discontinued. The authors proposed a link between autoimmune endocrine disease and celiac disease, noting that celiac disease is one of the causes for the failure of substitute hormonal therapy in patients with autoimmune thyroid disease (Valentino et al. 1999).

According to the National Adrenal Diseases Foundation (Great Neck, NY), individuals who have Addison's disease as well as other diseases of the adrenal glands are often misdiagnosed or go for long, distressful periods without a correct diagnosis.

Symptoms of adrenal diseases often mirror those of chronic fatigue syndrome, including steadily worsening exhaustion, a loss of appetite, and weight loss. In Addison's disease, blood pressure is low and becomes even lower when the person stands, producing lightheadedness. Because of salt loss, a craving for salty foods is common. Darkened skin may appear as an inappropriate tan on a person who is ill (NADF 1998).

Cushing's disease is the symmetrical overproduction of cortisol by the adrenal glands. Cushing's syndrome is a constellation of signs and symptoms due to chronic overexposure to adrenal corticosteroids. Symptoms may include central obesity, wasting of the arms and legs (thin extremities), a reddish moon face, buffalo hump, a protuberant abdomen, and pigmented stretch marks (striae). Many people experience severe fatigue, weak muscles, high blood pressure, and high blood sugar. Irritability, anxiety, and depression are also common.

Adrenal fatigue can be caused by constant stress or poor nutrition, which can deplete and weaken the adrenal glands. There are many symptoms associated with this disorder, mostly fatigue and weakness. In some fatigued patients, thyroid problems overlap or are concomitant with adrenal problems.

• If you suspect that you have some form of adrenal disease, seek professional medical treatment from a physician.
• Identify and relieve sources of stress. Consider meditation or other stress-relieving exercises.
• Consider lifestyle changes such as diet and exercise.
• Obtain baseline corticosteroid, DHEA, and pregnenolone levels.
• Avoid smoking. Nicotine in tobacco initially raises cortisol levels, but chronic use results in low DHEA, testosterone, and progesterone levels.
• Consider laboratory testing for celiac disease (gluten sensitivity) and starting a gluten-free diet.
• If available, consider physician-administered injections of ACE (adrenal cortical extract) from a reliable source for 3-7 days.
• Hydrocortisone tablets (one of several forms available by prescription) may be taken up to 4 times daily for 3-7 days to treat Addison's disease (adrenal insufficiency). Physician supervision is mandatory.

The following natural supplements are recommended for Addison's disease:

• DHEA, 50 mg daily and/or pregnenolone 50 mg daily, based on appropriate laboratory tests (see the DHEA Replacement Therapy protocol for more information and precautions).
• Licorice tea or capsules to provide glycyrrhizin, no more than 1000 mg of glycyrrhizin should be taken in a given day and physician supervision is advised to guard against blood pressure increase and water retention.
• Pantothenic acid (vitamin B5), 1500 mg daily.
• Vitamin C, 1000-3000 mg daily, in divided doses.
• L-theanine may be taken to help modulate mood and relieve stress, one 100-mg capsule up to 4 times a day.
• Phosphatidylserine, 100-300 mg daily.

The following natural supplements are recommended for Cushing's syndrome:

• DHEA, 50 mg daily, or pregnenolone, 50 mg daily, based on appropriate laboratory tests (see the DHEA Replacement Therapy protocol for more information and precautions).
• Vitamin C, 4000 mg daily, in divided doses.
• One enterically coated aspirin tablet (325 mg). (Enteric coatings prevent the tablet from dissolving in the stomach.)
• Phosphatidylserine, 300 mg daily.
• Melatonin, 300 mcg-6 mg nightly.

Physician supervision is essential. To guard against underlying micronutrient deficiencies that could contribute to adrenal disease, take a high-potency multinutrient supplement such as Vitamin Depot Online.com Mix (3 tablets 3 times a day).

For more information

Contact the American College for the Advancement of Medicine, (800) 532-3688, for a physician in your area who practices complementary medicine. Contact the National Adrenal Diseases Foundation for support, information, and education for individuals who have Addison's disease as well as other diseases of the adrenal glands, (516) 487-4992.

Product availability

DHEA and pregnenolone capsules, licorice capsules, pantothenic acid (vitamin B5), vitamin C powder and capsules, phosphatidylserine (PS) capsules, melatonin, and L-theanine can be ordered by telephoning (800) 544-4440 or by ordering online. ACE is not approved by the FDA for conventional use at this time.