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Dhea and Cortisol.

Director of the Fellowship in AntiAging, Regenerative, and Functional Medicine Codirector of the Master's Program in Medical Science with a concentration in Metabolic and Nutritional Medicine, University of South Florida College of Medicine

Cortisol is the only hormone in the body that increases with age. It is made by the adrenal glands. When a person is stressed, Cortisol levels elevate and then they should come right back down. This does not always happen in today's 365-24-7 world. Nowadays it is rare to find a person who is not "overbooked."

Carl Sandberg, a famous American poet, once wrote:
  Time is the coin of your life. It is the only coin
  you have, and only you can determine how it will be
  spent. Be careful lest you let other people spend it
  for you.

Stress can be harnessed to fuel success and achievement. However, if one's stress is to the point of "distress," then this is a problem. Cortisol levels rise also if a person is depressed. Likewise, progestin use has been shown to raise cortisol levels in some people. Furthermore, infections, toxic exposure, chronic pain, and inadequate sleep can cause cortisol levels to rise.

Cortisol has many functions in the body. It helps to balance blood sugar, aids in weight control, is part of the immune system response, helps build bone structure, is part of the stress reaction, is involved in protein synthesis, is anti-inflammatory, participates with aldosterone in sodium regulation, and is part of the hypothalamic-pituitary-adrenal axis. Elevated cortisol levels in the body have many consequences:

* decreased immunity

* increased osteoporosis risk

* fatigue

* irritability

* sugar cravings

* shakiness between meals

* confusion

* low energy

* night sweats/hot flashes [c] binge eating

* hypertension

* hypercholesterolemia

* hypertrigyceridemia

* hypertriglyceridemia

* insulin resistance/hyperinsulinemia

* increased risk of infections

* muscle weakness

* thin skin

* easy bruising

* weight gain around the middle

* sleep disturbances

* impaired hepatic conversion of T4 to T3

* focus and memory may not be assharp

The body requires basic nutrients in order for the adrenal glands towork at optimal levels. Vitamins Cand B are very important. Calcium, magnesium, zinc, copper, manganese, and selenium are minerals that areneeded. Sodium is also required foradrenal gland function. Sometimes apatient may just need a multivitamin to support the adrenal glands. Abnormal cortisol levels are associated with many diseases besides Cushing's disease and Addison's disease.

* menopause/andropause

* chronic fatigue syndrome

* fibromyalgia

* depression

* impotence

* anorexia nervosa

* insulin resistance/diabetes

* panic disorders


* infertility

* sleep disorders

* osteopenia/osteoporosis

* heart disease

* rheumatoid arthritis

* generalized memory loss/Alzheimer's disease

* irritable bowel syndrome

* exacerbations of multiple sclerosis

* brest cancer

Cortisol does not function alone in the body but is part of the hormonal symphony discussed in last month's article on sex hormones. If cortiso levels are high, then that decreases the making of progesterone and its activity. Cortisot competes with progesterone for the common receptors. Furthermore, when cortisol levels are elevated, thyroid hormone is more bound and less available for the body to use.

If the adrenal glands stop producing cortisol, the patient has Addison's disease. Adrenal fatigue, or hypoadrenalism, is when a person stays stressed all of the time; then the body still produces cortisol but at a much lower rate. Adrenal fatigue is one of the most pervasive and under-diagnosed syndromes of modern society. The following are signs and symptoms of adrenal fatigue:

* alcoholism

* allergies (environmental sensitivities and chemical intolerances)

* decreased immunity

* decreased sexual interest

* digestive problems

* drug addiction

* emotional imbalances

* emotional paralysis

* fatigue

* felling of being overwhelmed

* general feeling of "unwellness"

* hypoglycemia

* increased PMS, perimenopausal, and menopausal symptoms

* lack of stamina

* loss of motivation or initiative

* hypotension

* poor wound healing

* progressively poorer athletic performance

* sensitivity to light

* unresponsive hypothyroidism

* cognitive decline

If Cortisol levels are too high or too low, then stress reduction techniques are a key component of treatment. Prayer, meditation, tai chi, yoga, chi gong, breathing techniques, music, dancing, and nonstrenuous exercise may be therapeutic. Adaptogenic herbs and calming herbs may also be helpful. If cortisone levels are low and adaptogenic herbs are not effective, then adrenal extracts may be advantageous. Licorice root as a supplement may also be a valuable treatment modality if a person is not hypertensive. If cortisone levels still remain low and the patient does not have Addison's disease, then a subtherapeutic dose of Cortef may also be beneficial.

DHEA is also a player in the hormonal orchestra. This hormone is made by the adrenal glands and a small amount is likewise made in the brain and skin. DHEA production declines with age starting in the late 20s. By the age of 70, the body may only make one-fourth of the amount of DHEA that it made earlier in life. DHEA makes estrogen and testosterone in both men and women DHEA has various functions in the body:

* decreases cholesterol

* ecreases formation of fatty deposits

* increases bone growth

* promotes weight loss

* increases brain function

* increases lean body mass

* increases a sense of well-being

* helps one deal with stress

* supports the immune system

* helps the body repair itself and maintain tissues

* decreases allergic reactions

* lowers triglycerides

DHEA levels may be elevated when a person is stressed. If DHEA levels are raised, then an adrenal tumor must be ruled out. If a tumor is not present, then having the patient do stress-reduction techniques is very important. Adaptogenic herbal therapies and calming herbs have also been found to be beneficial.

Symptoms of DHEA excess:

* fatigue

* anger/irritability

* depression

* deepening of voice

* insomnia

* mood changes

* weight gain

* crease in facial hair particularly in women

* acne

* sugar cravings

* restless sleep

Low levels of DHEA can be due to menopause or andropause. Deficiencies of DHEA can also be secondary to long-term stress and/or cigarette smoking. Nicotine inhibits the production of 11 -beta-hydroxylase, which is needed to make DHEA. DHEA can be replaced like other hormones in the body. It is important before one considers DHEA hormone replacement that, if abnormal cortisol levels are present, they are treated as well. If DHEA levels are low and DHEA is prescribed, and cortisol levels are abnormal and not treated concomitantly, then DHEA levels can decline further.

DHEA replacement can increase muscle strength and lean body mass. It can also activate immune function, increase quality of life, improve sleep, and decrease joint soreness. Hormone replacement with DHEA can furthermore lower triglyceride levels and stop the damaging effects of stress on the body. It can also increase growth hormone levels.

Studies conducted at the University of Tennessee revealed that supplementing with DHEA produced a 30% reduction in insulin levels when compared with taking metformin alone. Supplementation also increased the body's sensitivity to insulin.

Case History

Paula is a 54-year-old female who presents to your office with the chief complaint that she is "stressed" all the time. She states that her coworkers have told her that she is bossy and now chews gum all the time, which drives the other people she works with "crazy." In her review of systems, she states that she is forgetful and has trouble making decisions, which is a new problem for her. She says that she feels anxious, has frequent headaches, and once or twice a week has experienced heart racing. She adds that the worse thing of all is that her sense of humor is now gone.

Her past medical history is unremarkable and her family history is positive for hypertension. Both of her parents are otherwise healthy and are in their late 80s. She is a social worker and has a lot of stress on the job. She also states that her home life is stressful since her husband was laid off last year.

Lab work brought in from her primary care physician revealed normal CBC, kidney, and liver studies. Her FBS was 95 and her cholesterol panel was normal.

Physical examination was normal except for an anxious woman who appeared older than her stated age.

Part of the evaluation of this patient should include a salivary test to evaluate levels of cortisol DHEA levels should also be measured. If abnormal levels of DHEA and/or cortisol are found, the patient should be treated as discussed above. Measuring her female hormones would also be helpful, along with thyroid studies. As part of the hormonal symphony, adrenal function must be optimized for at least six weeks before thyroid replacement is considered.

Next month we will look further at thyroid function as part of the hormonal symphony.


This article is an excerpt from: P.Smith, What You Must Know About Women's Homones. Garden City Park: Square One Publishers; 2010. References to this article are located in that text.

by Pamela W. Smith, MD, MPH
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Author:Smith, Pamela W.
Publication:Townsend Letter
Geographic Code:1USA
Date:Dec 1, 2011
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