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Low cortisol - can I continue on Paleo?

Answered on April 17, 2015
Created July 22, 2013 at 6:29 AM

Short medical / diet history:

In 2002, I gained about 77 lbs in just six months (going from 163 -> 240) due to depression diagnosis and mirtazapine medication. Have been the same weight (+/- 20 lbs) ever since, about 100 lbs overweight (I'm 30-year-old female, 5'6"). In 2003, I was (mis)diagnosed as bipolar, so I spent the next decade (until 2012) being treated with various drugs, mainly lithium and lamotrigine. I've had no mood swings since 2009 (when I entered psychotherapy) and have now spent about 1,5 years drug-free.

I've been trying to lose weight the past 10 years, with no remarkable results. Living in northern Europe, my diet previously used to be very low-fat, high on gluten and dairy, not that much fast food or processed sweets. In 2011, I started low-carb eating which helped to some extent but I didn't feel good on low carbohydrates (about 50 grams per day) and the excessive dairy consumption was making me sluggish. I switched to Paleo this year's April, so I've been eating Paleo around 3 months now.

I've been suffering from hypothyroid symptoms the past three years or so, and they've gradually gotten worse. I have a mild goiter which was discovered during ultrasound examination (I originally went in for problems with saliva glands). Since I was treated with lithium for years, I went in for thyroid panel every 3-6 months during those years to monitor my values and was told every time that they were "normal" (have been thinking of calling the hospital archives and actually asking for the precise values between 2006-2012).

Current situation:

My current thyroid values are TSH 1.73 mU/L, free T3 5.0 pmol/l (324.67 pg/dL), free T4 14 pmol/l (1.08 ng/dL). I was also tested for thyroid antibodies (TPO) which came back normal. Nothing in the thyroid results immediately would suggest that there's something wrong.

I recently got a new doctor to whom I told about the hypothyroid symptoms, and also other symptoms that have been bothering me in the past few years - irregular menstruation (I get my periods about 5 times a year, my cycle can be anything between 30-110 days), slowly but steadily decreasing sexual libido (really putting a strain on my marriage!), hirsutism, having persistent hypoglycemia even when eating (mainly) low carb even while on Paleo.

She ordered me tests for cortisol, prolactin, total testosterone and anti-nuclear antibodies (to rule out Sjogren's syndrome, since I suffer from dry eyes, mouth, sinuses and genitals). Results came back in normal for the testosterone (1.3 nmol/l or 37.46 ng/dL) and anti-nuclear antibodies (all normal), but my cortisol was low (117 nmol/l or 4.24 ug/dL) and my prolactin was elevated (722 mU/l or 34.05 ng/ml). I made an appointment with gynaecologist in few weeks for pelvic ultrasound to see whether the prolactin might be caused by PCOS.

Considering the my situation as whole, hypopituitarism might be one explanation for all my symptoms. My doctor will wait to hear the results from the gynaecologist before possible referring me to see an endocrinologist. She mentioned that testing for ACTH would at least differentiate whether the low cortisol is caused by my adrenals or the pituitary gland, but as she's just a GP she doesn't have the authority to order the tests herself.

Long story short - I've read that low carb and intermittent fasting wouldn't really work if you have low cortisol. I can keep maximum 3 hours between meals, after that my glucose levels plummet and I start feeling really shitty. I have non-alcoholic fatty liver, which probably means whatever is handled by liver isn't working on full speed. My hypoglycemia has gotten gradually worse - when I started low-carb in 2011, I could easily keep 6-10 hr breaks between meals once I reached ketosis, but now I feel that any carbs less than 100g/day will make me headachy, restless and shaky. I've added some rice and (sweet) potatoes to my daily meals, but in the current situation my weight isn't moving anywhere. I put my health first, but lot of the current problems I have now would be solved if I could lose some weight.

What type of foods and/or supplements would you suggest to support my adrenals during this time?

Fa0ce3cf1e3170666c2ab65a0b927714

(65)

on July 27, 2013
at 03:00 PM

I eat 3-5 eggs (with yolk) daily. I admit I don't eat liver or other inner organs, since I can't stand the taste (childhood traumas, hehe). I've made good progress with reversing the fatty liver so far, though. When it was first discovered in April 2012, my alanine aminotransferase (ALT) was 100, when the healthy range is 10-45 on women. After that I cut all the fructose out of diet in different forms and started supplementing milk thistle. When I went to being rechecked on June 2013, the ALT number was only 47 anymore (almost there!)

D396b126240f584bc358e6e4fd84e9e3

(455)

on July 22, 2013
at 10:12 PM

Also, the best way I've found to track progress with adrenal and thyroid issues is to record and plot your body temperature daily. Instructions found here: http://www.drrind.com/therapies/metabolic-temperature-graph

D396b126240f584bc358e6e4fd84e9e3

(455)

on July 22, 2013
at 09:57 PM

You're right, taking licorice with preexisting hypertension is not a good idea. You could try taking pregnenolone, which is a precursor to progesterone, which is a precursor to cortisol. This is the product I take: http://amzn.to/17zh9mI There are also adaptogenic herbs (like ashwagandha and eleuthero) that may help but there is a risk that they may lower cortisol even further. It is typical with adrenal issues to see serum potassium in the upper range of normal and sodium in the lower range of normal. How much salt are you consuming a day? I would try to get that higher.

1f9b52f29960095986234231d91e1967

(529)

on July 22, 2013
at 08:07 PM

(The Whole30 has an autoimmune protocol that might be worth looking into, and researching things like the Failsafe diet might be useful, too. Hopefully, I'll find more useful, pinpointed information, though...)

1f9b52f29960095986234231d91e1967

(529)

on July 22, 2013
at 08:04 PM

I haven't ever looked at it extremely closely, but the Whole30 looked potentially very good. And there were thoughts about raw dairy (if tolerated) being useful for lots of ailments (though there are also A1/A2 problems with cow milk.

1f9b52f29960095986234231d91e1967

(529)

on July 22, 2013
at 08:02 PM

I was dubious of the Four Hour Body diet, too, but I liked some of the ideas and approaches to fat-loss such as the ice baths, or preferentially directing foods towards storage in muscle vs. fat).

Fa0ce3cf1e3170666c2ab65a0b927714

(65)

on July 22, 2013
at 06:21 PM

I suffer from high blood pressure (varies, but on average 150/90 mmHg) so I need to cautious with licorice. I do sometimes drink a tea with licorice in it (https://shop.clipper-teas.com/organic-detox-infusion), haven't had any problems with it so far but I only drink it few times a week, so not much. My potassium and sodium levels have been fine so far - potassium was last checked to be 4.0 mmol/l (normal range 3.3-4.9) and sodium 138 mmol/l (range 137-145), but they've been both slowly dropping during the past year. That might also be due to bad adrenal function?

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5 Answers

1
D396b126240f584bc358e6e4fd84e9e3

on July 22, 2013
at 05:15 PM

Take licorice extract first thing in the morning. It's great for people with low cortisol because it conserves the cortisol your body does make. Here's the licorice I take - http://amzn.to/12Z432k

One important thing about taking licorice - you'll want to consume plenty of potassium as licorice can lower serum potassium levels.

There's no reason to abandon a paleo type diet but I would continue to consume about 100 / g a day of carbs from safe starches (white rice, sweet potatoes). Going too low on carbs requires the adrenals to produce extra cortisol to maintain proper blood glucose levels via gluconeogenesis. Getting 100 / g a day of carbs should minimize that extra burden on the adrenals.

D396b126240f584bc358e6e4fd84e9e3

(455)

on July 22, 2013
at 09:57 PM

You're right, taking licorice with preexisting hypertension is not a good idea. You could try taking pregnenolone, which is a precursor to progesterone, which is a precursor to cortisol. This is the product I take: http://amzn.to/17zh9mI There are also adaptogenic herbs (like ashwagandha and eleuthero) that may help but there is a risk that they may lower cortisol even further. It is typical with adrenal issues to see serum potassium in the upper range of normal and sodium in the lower range of normal. How much salt are you consuming a day? I would try to get that higher.

D396b126240f584bc358e6e4fd84e9e3

(455)

on July 22, 2013
at 10:12 PM

Also, the best way I've found to track progress with adrenal and thyroid issues is to record and plot your body temperature daily. Instructions found here: http://www.drrind.com/therapies/metabolic-temperature-graph

Fa0ce3cf1e3170666c2ab65a0b927714

(65)

on July 22, 2013
at 06:21 PM

I suffer from high blood pressure (varies, but on average 150/90 mmHg) so I need to cautious with licorice. I do sometimes drink a tea with licorice in it (https://shop.clipper-teas.com/organic-detox-infusion), haven't had any problems with it so far but I only drink it few times a week, so not much. My potassium and sodium levels have been fine so far - potassium was last checked to be 4.0 mmol/l (normal range 3.3-4.9) and sodium 138 mmol/l (range 137-145), but they've been both slowly dropping during the past year. That might also be due to bad adrenal function?

0
2f75ca2116bc93df929ebe05cdcc8ca1

on April 17, 2015
at 09:33 PM

I've just come across this post (2 years on) in my search for 'hypopituitarism and paleo'. Did you ever find a solution?

I had a head injury as a 6yr old child (fell over, hit a pole quite hard, got stitches). It healed and we thought nothing more of it. Now it looks like that might have been behind my health problems ever since. I had severe hypothyroid symptoms but my GP didn't want to know as my TSH was low (ie hyperthyroid). I've had chest infections, low immunity, eczema, asthma, memory & concentration issues, weight problems, temperature regulation problems, anxiety etc all my life, gradually worsening. 

I ended up getting a diagnosis of ADD (I too was a quiet, inattentive good girl) who did well at primary school but struggled more and more as time passed. I'm 41, have been on ritalin for 5 years, on and off anxiety meds over the years. Felt like a total basket case/hypochondriac with all my health/mind issues. Now that I know it's hypopituitarism, absolutely everything fits together and makes total sense. Even the fact that getting pregnant, staying that way and giving birth without dying was a total struggle. I can't believe I didn't have a bigger crash when I gave birth to my kids...

I too am struggling with my diet. I managed to fix my poor health a couple of years ago when I changed from a high carb diet with a lot of bread, crackers, chocolate etc to one that was higher in protein and healthy veg, oils etc. However when I really ramped up the fats and dropped the carbs right back, I put on 9kg and my health steadily deteriorated and I'm now practically bedridden. Can basically manage to do the laundry, the school run and cook the occasional meal. I'm back to my Dr in 1 week for the last of my results and hopefully will start a regime of medicines/hormones to get me back on track. As for diet, I'm now re-introducing some carbs, like porridge (plain), sweet potato, rice etc, until I can get my hypoglycemia under control. Would be interested to know how you went...

As a side note, supporting the adrenals because of the low cortisol (with things like licorice and herbs) is not going to help if it's your pituitary. The cortisol is likely sitting there in your adrenals, but unless the pituitary releases the trigger hormone (ACTH) that cortisol will just continue sitting there, waiting for instructions! 

0
5661757f5a7ad1d09c44d7b3ce9b533f

on July 24, 2013
at 01:44 AM

I have non-alcoholic fatty liver, which probably means whatever is handled by liver isn't working on full speed.

While I'm sure this answer addresses only one peice of the puzzle, a piece is still a piece. Non-fatty liver can apparently (IANAD) be addressed via choline:

http://wholehealthsource.blogspot.ca/2010/11/choline-and-fatty-liver.html

Choline is an essential nutrient that's required for the transport of fat out of the liver (8). NAFLD can be caused, and cured, simply by removing or adding dietary choline, and it appears to be dominant over other dietary factors including fat, sugar and alcohol.

http://blog.cholesterol-and-health.com/2010/11/sweet-truth-about-liver-and-egg-yolks.html

After studying the relevant literature and tracing it much further back in time than anyone else ever bothers to, I've come to the conclusion that neither fat nor sugar nor booze are the master criminals here. Rather, these mischeivous dudes are just the lackeys of the head honcho, choline deficiency. That's right, folks, it's the disappearance of liver and egg yolks from the American diet that takes most of the blame.

More specifically, I currently believe that dietary fat, whether saturated or unsaturated, and anything that the liver likes to turn into fat, like fructose and ethanol, will promote the accumulation of fat as long as we don't get enough choline. Once that fat accumulates, the critical factor igniting an inflammatory fire to this fat is the consumption of too much PUFA (polyunsaturated fat from vegetable and perhaps fish oils).

http://www.whfoods.com/genpage.php?tname=nutrient&dbid=50

Key research discoveries about choline came in the late 1930s, when scientists discovered that tissue from the pancreas contained a substance that could help prevent fatty build-up in the liver. This substance was named choline after the Greek word chole, which means bile. Since the 1930s, research has shown that choline is found not only in the pancreas and liver, but is also, in fact, a component of every human cell.

Research has also shown that the naming of choline after the Greek word for bile was highly appropriate. Bile, which is made in our liver, has the primary job of making fat compatible with water, so that fat-based substances can get transported around the body in the water-based world of our blood.

The topic has also been addressed before on PaleoHacks:

http://paleohacks.com/questions/14773/will-choline-protect-against-fatty-liver

Good luck. Hope this helps.

Fa0ce3cf1e3170666c2ab65a0b927714

(65)

on July 27, 2013
at 03:00 PM

I eat 3-5 eggs (with yolk) daily. I admit I don't eat liver or other inner organs, since I can't stand the taste (childhood traumas, hehe). I've made good progress with reversing the fatty liver so far, though. When it was first discovered in April 2012, my alanine aminotransferase (ALT) was 100, when the healthy range is 10-45 on women. After that I cut all the fructose out of diet in different forms and started supplementing milk thistle. When I went to being rechecked on June 2013, the ALT number was only 47 anymore (almost there!)

0
Fa0ce3cf1e3170666c2ab65a0b927714

on July 22, 2013
at 02:52 PM

Had to make an answer since the comment box was too small...

I've been reading 4-Hour Body but I'm bit wary when it comes to legumes, since their lectin content worries me. Since my body is clearly working subpar as it is, I want to avoid possible additional damage.

The Perfect Health Diet looks interesting, I might take a look at that.

I don't have the funding to travel to US to meet specialists, so I'm depending on the Finnish universal healthcare at the moment, which is more affordable to me (about 20 USD per visit). There are some private specialists here, but they're fully booked for at least a year onward, and each visit would cost me around 300 USD as I don't have a private health insurance, and in addition to the visit costs you'd have to pay extra for all the labwork etc. I'm currently on sick leave because of my condition, so the money is tight.

I've been reading that the hypopituitarism could be connected to previous head injuries, which I've had some, but they were in my childhood / early teens - these problems only gradually started after I gained the weight back in 2002. I remember making comments to my doctor about having memory problems back in 2006 when the lamotrigine was started, but then it was dismissed as side effect of the drug. Well, even drug free, I still have the problems... Went even see a specialist whether I would have an undiagnosed ADD to explain my struggles, but there's not enough data from my early years to support it. I never was hyperactive, more the inattentive type, so that would have gone unnoticed anyways since I was always the 'quiet, good girl'.

I strive to live by the Hippocrates quote "Let food be thy medicine and medicine be thy food", that's why I'm struggling to find information whether anything I put in my mouth could somehow reverse my condition. At it is now though, the 'master gland' seems to be slowly failing, and I can't seem to reverse it just with nutrition alone. If I was clearly suffering from some sort of autoimmune condition, it'd be easier to make adjustments, but now finding right things to eat seems to be like shooting in the dark.

1f9b52f29960095986234231d91e1967

(529)

on July 22, 2013
at 08:02 PM

I was dubious of the Four Hour Body diet, too, but I liked some of the ideas and approaches to fat-loss such as the ice baths, or preferentially directing foods towards storage in muscle vs. fat).

1f9b52f29960095986234231d91e1967

(529)

on July 22, 2013
at 08:07 PM

(The Whole30 has an autoimmune protocol that might be worth looking into, and researching things like the Failsafe diet might be useful, too. Hopefully, I'll find more useful, pinpointed information, though...)

1f9b52f29960095986234231d91e1967

(529)

on July 22, 2013
at 08:04 PM

I haven't ever looked at it extremely closely, but the Whole30 looked potentially very good. And there were thoughts about raw dairy (if tolerated) being useful for lots of ailments (though there are also A1/A2 problems with cow milk.

0
1f9b52f29960095986234231d91e1967

on July 22, 2013
at 09:42 AM

Hmmm.

The first thought that comes to mind is that low-carb doesn't necessarily work for all human beings.

The 4-Hour Body diet, for instance, was quite useful for many I know of for some fat loss but involves supplementation, legumes, and potentially cheat (calorie spike) days.

The Perfect Health Diet also makes Paleo-ish use of "safe starches". And, good/ideal/adequate carb-intake can differ greatly between different people.

That said, the health problems seem to be stemming from something, and perhaps if you have enough funding, seeking out someone like Chris Kresser (or some other talented doctor with an eye to looking at your entire medical history & detective-solving) as a client could be very beneficial if you have the resources. Health is very, very precious.

As far as supporting your adrenals & cortisol -- I will hopefully return with more research gathered, though any way of normalizing cortisol would probably impact weight-loss quite a lot, so weight gain (or maintenance at a high body fat %) might be linked to that.

Also, check for micronutrient deficiencies such as selenium (Brazil nuts daily can supposedly help with hypo-/hyper-thyroid, but I am not certain about the research.)

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