This afternoon (12.45) I had the blood draw for: Adrenal auto-antibodies, Aldosterone, Renin, Potassium & Sodium. I've also had a short Synacthen test.
Stop The Thyroid Madness (For better, for worse) insist that salt is restricted the day before Aldosterone testing and that the arm is held at a perpendicular angle, after movement and in the morning when blood is being drawn. They also suggest Aldosterone is drawn in the follicular phase of the cycle as progesterone can interfere with Aldosterone apparently. I didn't see much harm in following these bits of advice, so I obliged. Although I'm not strictly in follicular phase my historic progesterone production has been poor, so I didn't worry too much about this. It's worth mentioning that neither the endo nor the nurses mentioned anything about these guidelines (and I'm not about to spend any spoons explaining the intricacies of my extra curricular reading so didn't bother to mention/ask about it)
For those who don't know how the Synacthen test works, they take a sample of blood cortisol, then they inject synthetic ACTH (adrenocorticotropic hormone). ACTH in a healthy person is secreted by the pituitary gland, travelling down to the adrenals stimulating them to secrete essential hormones (eg. cortisol, DHEA, aldosterone) Half an hour later cortisol blood levels are drawn again to see whether the adrenal glands respond to the ACTH by comparing the cortisol samples before and after the ACTH injection.
Due to highly predictable mayhem and bureaucratic shortcomings (even in this private setting) the tests have been performed at 12.45pm, but under organised circumstances should happen before 10am. The test is not fasted as this could raise cortisol levels.
Initially after the ACTH I didn't feel any effects, which I'm tentatively guessing suggests this is not a sign of pituitary issues, and potentially points more to the adrenals as they felt unresponsive to the presence of ACTH, however that is a guess and is based only on subjective experience, not a blood marker. I suppose really this subjective lack of response only rules the adrenals in, and doesn't necessarily rule the pituitary out. However, moving forward with that same argument I've been mulling over the hypothesis that the failure to respond to ACTH may mean that low thyroid output is not my primary reason for adrenal insufficiency... Since the HPT axis may in fact be operating. As the adrenal issues all began after prolonged ketosis, I'm now leaning into the theory of micronutrient deficiencies. Pantothenic Acid (B5) + Vitamin C are adrenals main food source (ncbi.nlm.nih.gov/pmc/articl... - not to suggest that I am a rat but I needed something quick to substantiate this 🙃) So I'll be experimenting with supplementation of those going forward (as well as the usuals).
Results should take 5 days.
Unconditional love to all those blighted by this hideous disease,
Oh for goodness sake, the whole point of the Stim is to stimulate the adrenals at a point they are supposed to secrete most, eg give their best response which is 9am or before, and not lunch time. They couldn't organise a p**s up in a brewery!
Years ago I had those labs tested as well but never had a Stim. Aldosterone signals the kidneys to retain sodium, and low aldosterone made me thirsty and hanker for salt. I still do often. Have you had electrolytes tested?
Aldosterone should balance with renin and interesting I never knew could be so influenced by luteal phase progesterone. Gonna go and read up on that now 😁. My adrenal foods are definitely Vit C, salt and anything that supports mitochondrial function which are basically the micronutrients.
Anyway, I hope the test was ok and thanks for sharing.
Hi Radd, thanks for the validation! It was such a hard morning… after being convinced to go back to a doctor (having sworn off the breed forevermore) I was in tears in a cafe nearby, which may even have added an additional variable to the cortisol testing 🤦♀️ The endo tried to reorganise everything remotely compensating for the cock up… eventually, after all the admin staff/nurses clucked about drinking from their TikTok water bottles and occasionally picking up a phone I got seen, but as you say… what real use this will be I dunno. I had come to the assumption that since it’s synthetically stimulated by the ACTH maybe/hopefully my adrenals will be nonethewiser to the time of day… 👀 but I suspect not. In any case, results will be incoming soon. Let me know if you find anything on the progesterone front!
And yes - renin, electrolytes were also tested and yes, I have unrelenting thirst and salt cravings 🙃
radd one query, when you say adrenal foods would be anything mitochondrial (so I guess C + Bs + lipoic acid) is that specific to adrenals or does that apply to all endorcrine tissues or perhaps to all organs?
Of course! The basic conditions for cellular life depend upon energy with every cell containing mitochondria (that should be) determined by that cells natural energy demand.
I don’t begin to understand the intricacies of the electron chain transport system but your post focusses on poor adrenal function and stress uses a load of energy (and toxic stress even more).
Stress can be good (excitement, exercise, etc) as well as negative as is a natural part of maintaining homeostasis. It triggers hormones (cortisol, adrenaline), activates the autonomic and central nervous systems effecting the immune system and metabolism, etc, and all driven by the energy metabolism and particularly how good mitochondrial function is.
Yes OK had thought so. Just wondered if there were anything particular about mitochondria in adrenal cells that were special, like a higher turnover or some such 🫣 yes I’ve read a lot about circadian and adrenal… leptin seems a big player?
Absolutely, and a shame it not routinely tested as common in hypo but apparently it is expensive. Leptin resistance negatively alters the thyroid hormone enzyme ‘deiodinase’ behaviours initiating a further hypo state.
after reading about leptin resistance and it’s relationship with the adrenals I paid to have mine tested, it is 37 and all I’ve read indicates 2-10 is the ideal range so there’s a lot to improve there… all of this came about as a result of prolonged ketosis. Definitely an interplay there that I’m still trying to crack.
I don’t know the numbers but high leptin usually means high low-grade inflammation, resulting in an inability to lose weight and having food cravings. Is this you? Have you got insulin resistance as well?
If you are interested in own glucose metabolism you might be interested in wearing a blood glucose monitor. I have signed up for the Zoe Nutrition Program but am not due to start until April. I couldn’t wait for the blood monitoring sensor (Miss Impatient 🙄) so got one to wear before hand (although now haven’t yet for various reasons). You can get one free from Abbott here …. Frefreestyle.abbott/uk-en/gett.... ..
The leptin test was through TDL and was around £200, it also took a long time to come back.
I can attest to those associations through lived experience - it's also associated with high adipose tissue (can also attest!) My leptin resistance/complete and utter wheels coming off the already quite compromised wagon began towards the end of my 18 months of ketosis.
I do also have insulin resistance (I say this because I have PCOS) though I don't have IR "on paper" - I have now found out that fasting insulin/HbA1c is not actually a very accurate marker of IR - which again, I can attest to. I say this because while deeply ketogenic for 18 months my BG markers were "pristine" but my insulin resistance was rampant if PCOS markers are anything to go by (although having been so hypothyroid for so many years, I do wonder if chronically low progesterone is more of the driving force for me and my PCOS than BG metabolism, but that's another post for another time). Additionally, a functional endocrinologist I saw for a few sessions told me that IR is a very complicated thing to measure, fasting I & HbA1c give insight but not a full picture and all my experience is enough to convince me she is right.
I wore a BG monitor for many months while ketogenic, but on reflection probably didn't get a lot of value from it as I flatlined the entire time (the whole point of being ketogenic!) as I was a very good little ketogenic girl much to my enormous detriment... I may invest again in one as an experiment now I live amongst carbohydrates again and the monitor actually becomes relevant.
I thought Keto was suppose to help reverse insulin and leptin resistance, but have come to the conclusion that only extremely well people have enough metabolic flexibility to withstand Keto.
HbA1c is also a poor marker of glucose levels when previous chronically elevated has damaged and shortened RBCs lifespan offering inadequate time for blood sugar to become glycated (artificially low HbA1c). On the flip side, research for a recently adopted low-carbs diet showed longer RBC lifespans again warping results (artificially high HbA1c). Also those who have or recently suffered from anaemia (some resulting low and iron deficiency resulting in high).
Have you tried supplementing progesterone cyclically (to lower LH and resulting androgens) and taking myo-inositol that helps regulate blood sugars, as well as being anti-inflammatory and anti-oxidant?
“have come to the conclusion that only extremely well people have enough metabolic flexibility to withstand Keto” 🎯🎯🎯🎯🎯🎯🎯🎯🎯🎯🎯
Keto is gaining more and more traction among unwell people. The issues with it are numerous - micronutrient deficiencies, gluconeogenesis burden, thyroid conversion compromise, raised rt3 (whether that means something detrimental I’m not entirely sure), muscle tissue breakdown, cortisol abnormalities, the list goes on and on but sugar is public enemy #1 and our collective nervous system seems to be “nuance-intolerant.” It’s essentially a hypometabolic state that induces short term inflammation benefits (thank you raised cortisol) at serious long term costs. I think Myhill is naive to blanket recommend this diet. The only long term studies we have in it are on epileptic children, and they developed kidney issues (altho in fairness their food sources is rancid seed oils and synthetic protein). Keto actually augments IR in initial stages.
That’s interesting about damaged RBC, I can see how that makes sense and yes, I’ve used “Ovasitol” (d-ciro + myo inositol in ideal ratio) and it’s really improved my mood, the only downside is that it’s very expensive. I have used progest-E following Ray Peat research, but it made me tearful. I’m hesitant to add too many hormonal cooks to this endocrine kitchen, choosing to focus primarily on adrenal-thyroid in as isolated way as I can for the moment x
Ovasitol is only expensive because you are paying for the brand. There are others much cheaper that contain that same 40:1 ratio.
I had a read about aldosterone rising with progesterone levels. As we know aldosterone regulates blood volume and pressure and is usually regulated within the renin-angiotensin system. However, it also increase in line with progesterone during luteal phase, and pregnancy to maintain fluid/electrolyte balance during the volume expansion required for normal placental growth/development. Hence the fluid retention just before periods, and swollen legs in pregnancy. It all makes sense now 😬
I have taken inositol but not for PCOS. I had it suggested for metabolic syndrome as when diagnosed with Hashi after years of being left, I started Levothyroxine and plummeted into blood sugar issues. It was just called inositol so I don’t know what derivatives it contained as it was in the early days. I used to sprinkle it on my breakfast cereal.
Have you tried taking just myo-inositol for PCOS as the ovaries natural ratio is hugely more myo to d-ciro. It just gets reduced with the insulin resistance, but dependant upon genetic make up and lifestyle, not everyone needs extra d-ciro . Some people also take just myo in a folic acid combo. Myo is good for thyroid hormones too and often getting those working creates a cascade of other hormonal improvement.
I’ve never stuck with it tbh, but now we’ve discussed it I realise it’s an open goal really. I’m gonna dig out the ovasitol and look into some more myo, thanks! Do you know the mechanism behind its benefit on thyroid hormone?
There must be numerous mechanisms working at different levels far more than my understanding but a basic view is inositol accumulates in the thyroid follicular cells helping to make thyroid hormone, TSH has a number of signalling pathways including one that is inositol dependent, and it helps reduce TPOAb & TGAb’s. Research has shown when myo-inositol is paired with selenium a euthyroid state has been restored in in subclinical hypothyroid patients.
We make some inositol ourselves from glucose and the rest is found in foods. Then if our symptoms are caused by an inositol deficiency from glucose/insulin issues, supplementing extra can help restore balance and hopefully well being. It’s like any of these micro nutrients/trace elements that are essential for basic good health.
This is why focussing solely on the adrenals isn't a good idea but better to take a holistic view.
It’s good and offers a lot but be aware some of the terminology they use isn’t quite correct as things have moved forward. An example would be where they refer to ‘pooling’ T3 in the blood. T3 doesn’t ‘pool’ as in hang about continually increasing levels but may not work well because of poor cellular function.
I’ve found myself avoiding STTM (I think due to the quite dogmatic attitude?) but over time I’ve realised that they do tend to be correct again and again, even when I try to ignore what I’ve learned from them. Their terms are not too much of a concern for me at this point, but I realise “pooling” has been one of contention. And I will begin to care once I am well enough to practice nutrition.
lovely!! Thanks for sharing, hadnt come across this yet. Definitely needs to be part of the daily regimen… will add back in once I have a gap in the variables!
Yes, under ‘normal’ circumstance highest in the morning, stimulated by CRH (corticotropin-releasing hormone ) secreted by the hypothalamus . It acts to encourage cortisol release encouraging a negative feedback that decreases CRH.
But don’t forget mind and body is connected and everything (autonomic function, memory/psychomotor performance, activity/rest, etc) ruled by the SCN (suprachiasmatic nucleus) in the hypothalamus which may be influenced by other endocrine deficiencies or abnormalities many of us suffer after years of undiagnosed hypothyroidism.
Melatonin (sleep/wake cycle) hormone production/secretion is influenced by SCN and other biological and physiological regulations. ACTH is usually high with elevated cortisol and why we can’t sleep well when stressed but may be low with high cortisol when the pituitary doesn’t make enough (as in secondary adrenal failure), or high with low cortisol with adrenal failure or when adrenal reserves have just run low.
Fascinating, thanks for sharing. Interested to hear how you get on and your results. Despite the timings, what a palava.
i suppose the other aspect is not knowing how much we are absorbing of these micronutrients due to knackared digestive tracts, fementing gut sections etc etc. so many variables but we can and do try our best
horrible palava indeed! And yes… gut is definitely next on the menu! Until I sort out my thyroid function, my gut motility is so sluggish I am loathe to investigate what lurks there currently 🫣 c
Ha! No, I didn't read that but I could be wrong...
So I've done the gut/diet/supplement/nutrition protocols to absolute death. In fact I am now a nutritionist I've accrued so much knowledge I thought why not get a certificate to prove it 🙃. After much study and self-experimentation I've come to the conclusion that Metabolism (thyroid hormone) trumps leaky gut (diet protocols). It's impossible to disentangle the two, ofc, and there is enormous benefit in following a nutritionally dense diet but I am actively choosing to engage in optimising thyroid-adrenal hormones at this point after realising that no diet in the world is going to compensate for a low metabolic rate. My new understanding is that the gut will likely work itself out when thyroid-adrenal relations are optimal. Others' situations may differ to mine!
Ha! I would be ashamed to carry that title after spending time with this disease!
This post is going to require my brain to be working and today ain't da day unfortunately. I briefly skimmed it and I'm sorry that you had to go through so much to have the test done. I hope the results when they return lead to a path of wellness.
I found this post whilst I was looking for your name on the forum. I wanted to tag you on witchinghour's post. I went to my profile finally and saw the new name and was like who's this and realized it was you after I briefly skimmed this post.
I secretly affectionately call you and Regenallotment my GutsyGirls .
I got so tired of writing out the significance of cortisol to people about why their labs were optimal but they didn’t feel better that I decided to just make it my name and put the quotes in my bio 😂 but I enjoy gutsygirl much more! ❤️
Feeling slightly better after lunch and supplements so I decided to read your post. I'm sorry to hear that you werent tested on time but I'm glad they were able to get to you eventually. I look forward to hearing about your results in a few days and keep us updated on your experiment.
I have high hopes you will get to the bottom of your thyroid and adrenals and look forward to a possible name change after your triumphant success.
I should have added a y after guts since this disease takes a lot of guts to tackle
I just want to say here. I wish I understood this stuff. The description is …. I read a whole book on this. Theory, testing etc. Not a mention of thyroid. Anyone recommend something digestible/helpful to read on the subject?
well, opinions may vary but honestly I like the Stop The Thyroid Madness books. They’re very straight forwardly written, and include lots of elements that others don’t. If you don’t want to read that one then I’d recommend Barry Peatfield, Datis Kharrazian and maybe Isabella Wentz.
Hello don’tforgetcortisol - I’ve had all of the tests you mention but was declared ‘healthy’ by the endo who did them. I keep going back to the results as some of them were asterisked and no-one can explain why. Do you know anything about renin and aldosterone? I’m fairly convinced that my issues are pituitary based and I’m trying to drill down into these results before I see yet another endo.
If you post them (make your own post so they get enough attention) I am sure some here will help you Exactly as with thyroid, adrenal test results have "acceptable-I-Don't-Have-To-Do-Anything-To-Help-You-Get-Out-Of-My-Office" levels and then "optimal-OK-I-actually-want-to-live" levels. x
Hi, did you find out more about your renin and aldosterone? I just had high renin and very high aldosterone and indicated secondary hyper aldosterone suggested if renin was low it would be primary. I’m looking for more information
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Exactly as with thyroid, adrenal test results have "acceptable-I-Don't-Have-To-Do-Anything-To-Help-You-Get-Out-Of-My-Office" levels and then "optimal-OK-I-actually-want-to-live" levels. x
Within range baseline cortisol but failed Acth testing! What to do? 
Fluid Balance and Adrenal Fatigue Syndrome
Update #5: Back to front 
