Hi Deb, Bromley and Wesley
I take a very simplistic, rather macro and definitely not a scientifically informed approach to HPA hyperactivity. So, Deb and Wesley, I have to leave you to your expertise and stick to posting some general information. I’m lucky I was able to figure out that HPA hyperactivity tended to correlate with high levels of cortisol.
Sharon, you're our hormone expert.......what have you found about this?):
did you find the ACTH paradox, also? What do you make of that?
First, I want to be really clear I am not an expert on hormones or MS
. I started learning about hormones and MS at the same time since I associated my diagnosis with the radical decline and/or absence of hormones at my geezer age.
I didn’t find the ACTH paradox and don’t know what it is. I have read there are several ways to measure cortisol, the ACTH challenge test is only one.
In an odd way, it does make sense to discover that ACTH stays within normal limits in MS, though, because if ACTH was involved at all in MS, then the disease itself would either present itself as Addison's or Cushing's, not MS. Right? And for some strange reason, we don't even find Addison's or Cushing's as co-existing with MS!? How odd!!!A possible explanation for why Addison’s or Cushing’s don’t “co-exist” with MS
My lay person perspective on this is taken from a book, Adrenal Fatigue
, the 21st Century Stress Syndrome
, by James Wilson, who notes that
“So called “normal” lab values for cortisol include all but the most extreme values”, too much cortisol, more than 2 standard deviations above the mean, results in a diagnosis of Cushing’s Syndrome, and too little cortisol, more than 2 standard deviations below the mean, results in a diagnosis of Addison’s disease.
From what I’ve read, there aren’t any other diseases recognized with either too much or too little cortisol.
This made me wonder if MS then might be a disease of too much cortisol in PwMS that’s simply never been “diagnosed” or “detected” because routine lab tests for cortisol would be reported as normal in PwMS even if their cortisol levels were, for example, 1.5 times above average.
According to Harrison’s Principles of Internal Medicine
, 14th ed. Vol. 1. McGraw-Hill, p 1970, 1998).
“Most hormones have such a broad range of plasma levels within a normal population. As a consequence, the level of a hormone in an individual may be halved or doubled (and thus be abnormal for that person) but still be within the so-called normal range.”
Bromley, to the extent that HPA hyperactivity reflects high cortisol levels, here’s what I’ve found in a book entitled: The Cortisol Connection
, by Shawn Talbott, who is a nutritionist. From page 33, Table 4.1: Metabolic and Long-Term Health Effects of Elevated Cortisol Levels
Metabolic Effect (Cortisol-Induced
Increased appetite, accelerated muscle breakdown, suppressed fat oxidation, enhanced fat storage
Elevated cholesterol and triglyceride levels
Elevated blood pressure
Alterations in brain neurochemistry (involving dopamine and serotonin)
Physical atrophy (shrinkage) of brain cells
Insulin resistance and elevated blood-sugar levels
Accelerated bone resorption (breakdown)
Reduced levels of testosterone and estrogen
Suppression of immune-cell number and activity
Reduced synthesis of brain neurotransmitters
In one paragraph he says the same thing a different way (sort of artsy Bromley
Over the long term, elevated cortisol levels can be as detrimental to overall health as elevated cholesterol is for heart disease or excessive blood sugar is for diabetes. Aside from that, elevated cortisol levels make you fat, kill your sex drive, shrink your brain, squelch your immune system, and generally make you feel terrible.
The Cortisol Connection
book does go into stress and cortisol for us lay people, and does present general recommendations for controlling cortisol levels: the SENSE program. S= stress management; E = exercise; N= nutrition; S=supplements; and E = evaluation.
The goal is to have a healthy level of cortisol, not too much and not too little. The lab that did my saliva hormone testing recommended I read the book because of my high cortisol levels.
Now, you know I can’t do a post this long without mentioning hormones.
So, on to other hormones and the adrenal gland.
The research article Sex Hormones Modulate Brain Injury in MS
found worse MRI outcomes in 32 year olds with RRMS in sex hormones that are apparently primarily produced by our adrenal glands
. That is too little and too much testosterone in women and too much estradiol in men was associated with worse outcomes.
The book I mentioned earlier on Adrenal Fatigue
makes the point
that both male and female hormones are made in the adrenals of each person, regardless of gender.
In males, the adrenals provide a secondary source of testosterone and are the exclusive source of the female hormone estrogen (referred to collectively as estrone, estradiol and estriol.)
In females, the adrenals provide a secondary source of estrogen and progesterone, and are the nearly exclusive supplier of testosterone.
Interesting…..that’s all I can say.
I’m still voting for balanced hormones (including cortisol) to help manage MS.