Hydrocortisone – By Dr. Alan Christianson
Hey, there! Dr. Alan Christianson here, and I’m really happy to take time to do some Q&A with you all. We have some great questions submitted by our viewers. Here is one from Sarah M. She asks, “Do I need to take hydrocortisone for my crashed adrenals?”
You all may be familiar with a series I created that shows the different cortisol levels. You can have healthy levels like you’re “thriving”. Your levels can be way too high like you’re “stressed”. Your levels can be backwards like “wired and tired” or always low as in “crashed”. Apparently, Sarah was diagnosed at the crashed stage and was prescribed hydrocortisone. She further asks, “Do I need to take it, as it makes me gain weight and gives me yeast infections? I want to stop, but I am afraid to stop it fast.”
This is a really good question, Sarah, and brings up an important distinction. Your adrenal glands can have diseases, or they can have dysfunction. When they have a disease, it means your adrenals cannot do what your body wants them to do. Your body says to the adrenals, “Hey, make me a little cortisol,” and the adrenals can’t do it. Or, the body says, “Whoa! You’re out of control! Do not make so much cortisol!” but the adrenals keep cranking it out. These are what adrenal diseases look like. The medical terms for them are Addison’s disease, Cushing’s disease or Cushing’s syndrome. These conditions are real and serious, but they’re also rare. Both of these diseases are only affecting no more than a few people per million. If they are present or suspected, you should have tests done to diagnose them. There are simple tests, like blood tests and common urine tests, which show the disease pretty clearly.
Now, let’s talk about adrenal dysfunction. Adrenal dysfunction is when your body is not making healthy cortisol rhythms. This is not because your adrenals cannot do it. It’s because your body’s whole system that works with the adrenals is out of balance. So, when cortisol is low, as in the crashed state, it could seem logical to just give yourself more cortisol. Those that have Addison’s disease cannot make more cortisol, so their lives depend upon taking some version of cortisol to mimic what their bodies are incapable of producing. However, in the case of being crashed, the adrenals are making cortisol, but they are intentionally not making a lot. If you look at how the pituitary and the adrenals are interacting, the adrenals are doing just what they’re told. The pituitary is saying, “Just make a speck of cortisol. Do not make a ton,” and that is what they are doing. So, when we look at this scenario and think, “Oh, this is a disease (instead of a dysfunction). The body is unable to make cortisol. Let me give it more cortisol,” you are really violating homeostasis. You are really breaking your body’s attempt to regain balance. Your body could make more cortisol if it wanted to, but it does not want to. It is trying to rest itself. So, the trick is to help it rest faster and recover more quickly—not just give it something it’s already trying not to make.
It’s not a matter of putting more cortisol into the body, because it doesn’t want more cortisol. The body is intentionally lowering how much is being made. So, Sarah, assuming you don’t have Addison’s disease, you wouldn’t need to take hydrocortisone. You are right. Side effects like weight gain, yeast infections, bone thinning and unstable blood sugar are caused by it. (Even those who have adrenal disease and need hydrocortisone are at risk for these types of side effects.) So, yes, you can stop taking it, but it takes a tapering process. That will take some interaction with your doctor. The more you are taking, the more slowly you have to taper it. As an adult woman, your body would make about 25-30 milligrams a day by itself. So, if you’re taking that much hydrocortisone, it might be causing your body not to make much cortisone on its own right now. In this case, you want a very slow taper. On the other hand, if you’re taking 5 milligrams or less, that would be a smaller percent of your day’s total cortisol output. It might be 10-20 percent of what your body would make anyway. In that case, it doesn’t take as long of a tapering process to let your body make enough to fill in that gap. So, talk to your doctor about a tapering timeframe. It’s often no more than a few weeks to a few months.
Also, think more about strategies to help your crashed state improve. I see it time and time again where folks, who have very little cortisol output, can get a good adrenal rhythm back in as little as a month or two. They follow the principles of the Adrenal Reset Diet. They cycle their carbs and eat more clean foods. They add some light therapies or maybe a simple meditative technique.
Some people have said, “At first, when I took hydrocortisone, I had more energy.” We have to stop and think: Does this mean it was a good thing? You can take a lot of stimulates but not be moving your health into a greater state of vitality. So, sometimes, things that seem to help in the short term, might be working against your long-term goals. Unless you have adrenal disease, hydrocortisone is really not helpful to you.
So, that is a great question, Sarah. Get on the tapering process. You can stop the hydrocortisone, and you can get better. You can have better energy, sleep better and lose weight more easily.
Dr. Alan Christianson here, saying “Thank you,” and see you next time.