Adrenal insufficiency

People with hypoglycemia can treat low blood sugar symptoms by:

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1. Cutting sugar and caffeine out of their diets, and increasing fiber. Excess sugar intake can stimulate insulin release for several hours, as this is how long it normally takes for food to be digested and absorbed. Because of the lack of fiber in the food, the carbohydrates are rapidly absorbed. This results in inappropriately high insulin levels when the blood sugar is beginning to drop because absorption of food is complete. This then drives down the blood sugars to hypoglycemic levels.

To add insult to injury, caffeine results in excess adrenaline being released with even mild drops in blood sugar. This is like being on a "hair trigger" for hypoglycemic symptoms.

2. Having frequent, small meals; and increasing their intake of proteins (which can maintain blood sugars by being slowly converted to glucose) and complex carbohydrates such as whole grains and vegetables. Fruit--not fruit juices, which contain concentrated sugar--can be eaten in moderation, about one to two servings a day, depending on the type of fruit.

3. Taking 250-500 micrograms of chromium twice a day often helps smooth out hypoglycemic symptoms.

More directly, treating the underactive adrenal problem with low doses of adrenal hormone usually banishes the symptoms of low blood sugar. One may use prescription hydrocortisone such as Cortef, or cortisol preparations which can be obtained without prescription, and these will be discussed in next month's column. Natural non-prescription remedies are also very helpful. These include:

1. Adrenal glandulars. I recommend Raw Adrenal by Enzymatic Therapy or Adrenal Soluble Fractions by Integrative Therapeutics. These contain the raw materials that the adrenal needs for healing.

2. Nutritional support--the highest levels of vitamin C are in the adrenal gland and this vitamin is critical for adrenal function as is Pantothenic acid. Both of these are present at high levels (along with chromium and 47 other nutrients) in my recommended vitamin powder (Energy Revitalization System by Integrative Therapeutics).

3. Licorice -- Take 2 to 3 grams (2,000 to 3,000 milligrams) of licorice root (not deglycyrrhizinated licorice [DGL]) twice a day for six to eight weeks. The patient may then taper off over a period of ten to fourteen days. Licorice can raise blood pressure or cause an overly high cortisol level if taken on an ongoing basis. It is best used short-term as a "jump-start" in raising cortisol levels. It also has antiviral properties, which can be very helpful in CFS.

4. After four to six weeks on licorice root, add 100-200+milligrams of Asian ginseng twice a day. This is safer than licorice. If it helps, it can be taken for an extended period (one to two years) in cycles of six weeks on and one to two weeks off.

5. Echinacea- 325 to 650 milligrams of encapsulated freeze-dried Echinacea plant or 1,000 to 2,000 milligrams of dried Echinacea root three times a day. Take it in cycles of six weeks on and two weeks off--if taken continuously, it stops working.

Licorice

Licorice acts as an adrenal stimulant and antacid. It contains glycyrrhizin, a compound that raises the body's levels of the adrenal hormone cortisol. This occurs because licorice slows the breakdown of cortisol produced by the body. As adrenal function is often sub optimal in CFIDS/FMS, licorice can be helpful. Licorice also protects against stomach ulcers, whether in its ordinary form or in the form of deglycyrrhizinated licorice (DGL), a type of licorice extract from which the glycyrrhizin has been removed. In several head-on studies against pharmaceutical antacids and acid inhibitors such as cimetidine (Tagamet), DGL was found to be at least as effective against stomach and duodenal ulcers.

Ginseng

Asian ginseng (Panax ginseng) is the most famous of all Asian medicinal plants. Because the chemical nature varies widely depending on where the plant is grown (with high activity of a compound designated ginsenoside-RG-1 in Asian plants and high activity of another compound, ginsenoside-RB-1 in American plants), it is important to know where it comes from. Asian ginseng has the properties we want in CFIDS/FMS, while American ginseng (Panax quinqefolium) may worsen symptoms. For example, Asian ginseng enhances energy, raises blood pressure, and improves adrenal function, while American ginseng lowers blood pressure and is a brain depressant. Asian ginseng has such a wide mix of health benefits that its name, Panax, comes from the Greek roots of pan (meaning "all") and akos (meaning "cure")--that is, "cure-all." In CFIDS/FMS, we are interested in its properties of increasing energy and improving adrenal function. Siberian ginseng (Eleutherococcus senticosus) has properties midway between American and Asian.

In one study of 232 patients with "functional fatigue," those taking 80 milligrams of ginseng a day for six weeks experienced less fatigue than the placebo group. Concentration also improved.

Ginseng has been shown to reduce fatigue and improve exercise capacity. For most purposes, the usual dose of standardized Panax ginseng extract, containing 5 to 7 percent ginsenosides, is about 100 milligrams twice a day. Asian and Siberian ginseng (as well as echinacea and licorice) also support adrenal function. Other studies also suggest that Asian (Panax) ginseng may protect nerve cells and decrease cancer risk.

Remember, the potency of different forms of ginseng is quite variable. To treat symptoms of underactive adrenal glands, such as hypoglycemia and low blood pressure, use at least 100 milligrams of Asian ginseng (Panax ginseng) twice a day. Or you can take Siberian ginseng (Eleutherococcus senticosus), in dosages of 2,000 to 3,000 milligrams of dry powdered root, 300 to 400 milligrams of standardized concentrated extract, or 10 cc (2 teaspoons) of alcohol-based extract daily. When using either form of ginseng, take it for six weeks and then stop taking it for one to two weeks before resuming it. Continue this on-off cycle for one to two years or until you feel your ability to handle stress and infections has improved. Adding 500 to 2,000 milligrams of vitamin C a day will also support the adrenal glands. Ginseng is quite safe and well tolerated. Unlike licorice, it does not pose the risk of raising adrenal hormone levels too much.

Echinacea

Echinacea, also known as purple coneflower, is a member of the sunflower family and is indigenous to the rich prairie soils of midwest North America. It was the most commonly used herb in Native American healing traditions and has been the subject of over 350 studies.

Echinacea is also very useful as a general immune activator, stimulating the body's white blood cells (for example, natural killer cells and macrophages), which destroy viruses, bacteria, parasites, and yeast. Studies suggest that it can help the body fight off many different infections, including the flu, herpes, common cold viruses, staph and other bacterial infections (including sinusitis, bronchitis, childhood ear infections, and prostatitis) and Candida (yeast) infections. In one study of women with recurrent vaginal Candida, 60% of those treated with topical creams had recurrences six months later, as opposed to only 15% who also took Echinacea. This adds to its usefulness in CFS and fibromyalgia

Echinacea also can stimulate the adrenal glands. As noted above, the adrenals need a lot of vitamin C so I would take at least 500 milligrams of vitamin C a day with the echinacea. Adrenal vitamin C levels will otherwise drop while taking the echinacea, as the adrenals "wake up."

Although different species and parts of the echinacea plant each have their pros and cons, it is important to use a good brand. The importance of this is reflected in the estimate that over 50% of the echinacea sold in the United States was not echinacea at all, but was (the unrelated) Missouri snakeroot! Check the label to insure that the brand you use is actually echinacea. One way to do this is to use a standardized fresh-pressed juice that is noted on the bottle to have at least 2.4% beta-1,2-fructofuranosides. Proper dosing is important, as there tends to be an "all or nothing" effect--that is, too low a dose has no effect. It is also important to stop the Echinacea for seven to ten days every six to eight weeks or it may stop being effective.

Using these treatments can go a long way towards helping your patients' adrenals to heal. In the interim, it is also helpful to supply the actual adrenal hormones (cortisol and DHEA) as well. These will be discussed in next month's column.

by Jacob Teitelbaum, MD

Jacob Teitelbaum, MD is director of the Annapolis Research Center for Effective CFS/Fibromyalgia Therapies, which sees patients with CFS/FMS from all over the world (410-573-5389; www.EndFatigue.com) and author of the best selling book From Fatigued to Fantastic! His newest book Three Steps To Happiness! Healing Through Joy has just been released. He gives 2-day workshops on effective CFS/Fibromyalgia therapies for both prescribing and non-prescribing practitioners (see www.EndFatigue.com). He accepts no money from any company whose products he recommends and 100% of his royalty for products he makes is donated to charity.

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