Hi guys. Today I went about talk about a topic that is very well unappreciated by traditional medicine. It was unappreciated by me. Except about 25 years ago, my wife and I were visiting our hometown in Madison, Wisconsin, and there was a pharmacy there and the guy who was running it met with us. His name is Wally. Wally owned Women’s International Pharmacy and we went to visit him because we were interested in, “How could you help people live longer and live better?” And after talking to him for a while, he really opened up our eyes. He was telling us about hormone replacement therapy and he named all the hormones that he was actually taking and one of them was hydrocortisone which was hard for me to believe. My background was emergency medicine and you didn’t give cortisol to anybody unless it was for a very short time because it was dangerous. Of course the miracle drug of the 50’s and 60’s was prednisone. If you had rheumatoid arthritis or some other chronic condition, doctors had synthesized then prednisone, which is about a five times strength hydrocortisone and they would give it to you and your pain would melt away and you would feel great, except not too long afterwards, you’d start looking funny. You get kind of a buffalo hump and your bones would degenerate and your blood pressure would go up. Some people got psychosis and the muscled wasted and they started retaining sodium and fluid and it was really bad and they were immune deficient. So, they could get all kinds of infections. Skin would break down. Blood vessels would break down. So, I said to him, “How can you give these people this stuff?” “or how could you take it yourself?” And he said, “Well like everything else, “there is a normal range where hormones have to be. “Cortisol is one of these very important hormones “that if it’s in the right range “your body will function well, “but if it’s not in the right range, your body won’t function well,” And for many people at that time and it’s even worse now, when they’re faced with chronic stressors over a long period of time, now, that could be a husband, a wife, a boss. It could be overtraining if they’re an athlete. It could be lack of sleep if they’re overworking. It could be chronic pain if they have some sort of a pain syndrome or injury. But all these feed into one pathway where it leads to cortisol being put out by the adrenal gland. The adrenal gland is in the back, above the kidneys. “Renal” is kidney and “adrenal” is right next to the kidney. So, they sit right on top of the kidneys and their job is partly to make cortisone. The adrenal glands have an outer part and they have an inner part. The inner part makes adrenaline or epinephrine and the outer part makes cortisone or hydrocortisone. So, he said that the average body in a day needed about 30 or 40 milligrams of hydrocortisone in order for it to cope with the normal day. If someone had a very stressful day, they were up all night, they had a term paper due, they had a big test coming up. Well, their body could produce way more than that. I remember in the emergency room, sometimes someone would come in where we knew that they had low adrenal function, or this disease, which is called Addison’s disease, where their adrenal glands are actually not working at all. That might have been from some sort of infectious insult where they couldn’t make cortisone and if they came in with an acute appendix or a heart attack we would give them 100 milligrams IV of cortisone, of hydrocortisone IV, and then every six hours give them more to carry them through. Because if you don’t have cortisone, what can happen is that your body cannot maintain its own blood pressure. You could go into shock and you can’t maintain your normal body. So, what he told me is that you could use this in small doses. In what are called physiologic doses. So, we’re not giving too much but we’re giving enough so that the body can keep up with what it needs all day long. So, in these people who have chronic fatigue or chronic pain or brain fog. Or they stand up and they get a little bit dizzy. Or their blood pressures are running too low or they start getting darkness of their skin where they didn’t have it before. This can be a sign that they just aren’t making enough cortisone. And so, what we can do when I see these symptoms: Fatigue. Malaise. Postural hypotension. That means when you stand up you have to hold it for a minute because your blood your blood pressure is not keeping up. Low blood pressure. Weakness. Brain fog. Chronic pain. Chronic nausea. Discomfort in your stomach. Sometimes diarrhea but the stomach tends to be bloated. Kind of distended. They just don’t feel well. They on my list are: “This person may have low cortisol.” The other thing is people who are hyper reactive because cortisol is anti-inflammation and it’s anti-allergy. And if you don’t have enough cortisol, if you have some kind of autoimmune condition, it’s gonna be up. Because the normal balancing hormone, the cortisol, isn’t there. And it sort of has free reign to be inflamed. Now, the normal cortisol curve, if we do a saliva hormone panel. So, we get one as soon as they wake up in the morning. Let’s call it 8 o’clock. It’s the highest it is in the day because the hormone that actually wakes you up from sleep is a boost of hydrocortisone. And that’s what gets you up in the morning. Now, one of the strongest things that I hear or that I ask patients, is, “When you wake up in the morning, “do you feel like you’re alert and bright and ready to go? “Or do you feel like you’re 3/4 dead “and you’re not sure if you’re even alive?” If the morning cortisol is down here, what people generally report is that they feel dead. “When I wake up in the morning, I feel dead.” Now, the morning is when it’s supposed to be the highest, then noon, then late afternoon, and then at bedtime, it’s supposed to go low. We will see people coming in with these symptoms and we’ll do a 24-hour saliva cortisol test and they might look like this. And the normal range is kind of like this. And they’re flat on the bottom. They’re not making any cortisol or hardly any or certainly not enough to cope with life. And so, these people, sometimes there’s treatments that you give people and they call you back in a week and they say, “You saved my life.” “You completely changed my life.” Because if I give them small doses of hydrocortisone 3 or 4 times a day, their curve goes up to here and they actually feel alive and their pain goes down, their inflammation goes down, their brain fog goes down, their hypotension corrects, it goes up. and they feel like, “I could go to work now.” “I could do some exercise now.” Because now we’re correcting their gland which is not making hydrocortisone and putting them in a physiologic range. Now, hydrocortisone is generally controlled by the brain, and in the pituitary, there’s a hormone called ACTH. That’s adrenocorticotropic hormone. It means the brain monitors the level of cortisol in the body. And when it isn’t enough, it sends this messenger to the adrenal gland to make more. Now, if the level is down here, the pituitary isn’t going to stop. It’s going to barrage the adrenal gland all day long. Make more, make more, make more. The gland’s already exhausted, it can’t even do anymore and the gland gets no break. If I give someone a little bit of hydrocortisone, Let’s say 2.5 milligrams in the morning, at noon, and in the afternoon. Or up to 7.5, 5, 2.5 milligrams hydrocortisone. Now, the brain gets the message that there’s cortisol in the body. It stops this. The gland stops being hammered by the pituitary and it can actually heal. Now, sometimes people have underlying problems with viruses or deficiencies or other things which we will correct, and in my experience, somewhere between 6 months and 2 years after starting this treatment, their adrenal gland actually heals and they start to make cortisol again. And what we find is, so they’re on 7.5 , 5, 2.5 and let’s say it’s 8, 10 months down the line. They’ll call me and they say, “Feels like I’m on too much cortisone. “Feels like it’s too much.” Good! That’s a good sign. It means your adrenal gland is healing. Okay, let’s drop it , 5, 5, 2.5. Or 5, 2.5, 2.5. We start to wean and then we get down to where they don’t need any hydrocortisone anymore because their gland actually corrected, the underlying problem that got them there in the first place corrected and now their body works right and all these symptoms then go away. Now, sometimes people, instead of having this curve, they have this curve but at night, it’s way up here. And they can’t sleep because now their body’s all jacked up. And what happened is they missed their window here of getting prepared to go to sleep and instead of doing something quiet or relaxing after the sun goes down they’re getting into arguments, they’re looking at emails, they get involved in a project and the normal body rhythm now kicks back in their cortisol and their adrenaline, and now they’re gonna be up for 3 hours because they can’t sleep. So, you got to watch that one too. Okay? And that’ll be one for another topic. If you have fatigue, malaise, you’re hyper reactive, you’re hyper sensitive, you stand up, you get a little bit dizzy., you’ve got brain fog, you’ve got pain, and your doctor is not helping you, then what you need is a 24 hour saliva cortisol test, there’s lots of labs in the country that do it, to see, “What does your curve look like?” and then you need a nutritional oriented doctor who can help you figure this out. I find that using cortisol works the best. Sometimes when people aren’t so bad, adrenal supplements will work and that’s fine. We’re just trying to look for the right solution. Hydrocortisone is a bioidentical hormone, it is not a drug. Prednisone is a drug. Decadron is a drug. These are very strong powerful drugs. And while sometimes they’re needed in an emergency, in this condition, they’re the wrong thing. But hydrocortisone is a bioidentical. It’s manufactured regularly so you can get it with a regular prescription or from a compounding pharmacy is actually better, and you have to find a doctor who knows how to do it and they can help you work through this thing so that you could literally get your life back. So, if you wake up in the morning and you feel dead, think about this and find somebody in your local area who can actually help you to figure this out and it could make a tremendous difference Okay? Hope that helps. Just want to add one more thing because there’s a bible on this and if your physician doesn’t know about it he can get the book and he can read it. The physician who discovered this stuff and who figured out was a family practice doctor, I think in Ohio in the 60’s and his name was William Jeffries and the book is called Safe Uses of Cortisol. It’s an excellent book. I think you can even download it on the internet. You can learn about it. Everything I told you here I learned from that . It’s really helpful and it’s the textbook on this and this is not taught in medical school, but your doctor could learn it and help a lot of people.