WEBINAR RECORDING: Adrenal Dysfunction & Integrative Treatment Strategies
Presented by Jim Paoletti, BS Pharmacy, FAARFM, FIACP – Director of Education at Power2Practice
Listen to/watch the recording below and download the slides by clicking here!
- Physiologic changes associated with chronic stress
- Various factors that affect the adrenals
- Assessing adrenal function
- Treatment strategies for different stages of adrenal dysfunction
Webinar Recorded: March 22, 2016
Jim Paoletti suggests this website as clinical endocrinology resource: endotext.org
Endotext.org is a Non-Profit web-based source of trustworthy information on endocrine disease written by physicians for physicians around the world. If you really want to know about Endocrine physiology and Disease, this is the place to come. It is comprehensive, authoritative, constantly up-dated (last update 5 Feb 2016), un-biased, and available without cost, directed to physicians, trainees, students, and other health professionals. This site covers the broad area of Clinical Endocrinology, emphasizing clinical endocrine practice, including the most current information on the manifestations of endocrine disease, diagnosis and treatment.
QUESTION: How do you find the tender spot for the adrenals, or is there a place to find this information, such as the handout?
ANSWER: The adrenal glands sit on top of the kidneys near the spine. There is a picture of this on page 257 in the book “Adrenal Fatigue, the 21st Century Syndrome” by Dr. James Wilson, or look at this page: http://www.endocrineweb.com/endocrinology/overview-adrenal-glands
QUESTION: How long does the energy go up for after taking a stimulant?
ANSWER: It varies highly with the type and quantity of stimulant. Nicotine and caffeine get into the bloodstream quickly but are metabolized fairly quickly too. A “sugar rush” occurs faster with the more easily the sugar source is absorbed (fruit juice is much faster than a carbohydrate), and the faster it is absorbed, the more quickly it dissipates. On an average, noticeable energy increases from stimulants usually only last 30-60 minutes.
QUESTION: How long does the patient do the compensation techniques for?
ANSWER: 15 to 20 minutes at a time, at least once every day would be great. Since many of these patients have time/scheduling I tell them to practice a compensation technique at least 10 minutes. The most important aspect is that they do it every day.
QUESTION: How do we choose which adaptogen to use, since the list (in the slides) is so large?
ANSWER: Personally, I would consider muscle testing to see which adaptogens would benefit each patient. Since that is not always an option, the best was is to a combination that contains 3-4 adaptogens. I prefer the Herbal Adrenal Support Formula (drops) by Dr. Wilson. (see www.adrenalfatigue.org). For patients that prefer a capsule, I use Cortisol Calm by Pure Encapsulations, although this is not purely adaptogens as it also contains L-theanine.
QUESTION: Do you recommend a B complex with high Vitamin B5, or do you give just Vitamin B5 – super adrenal stress formula
ANSWER: For adrenal support, I use Super Adrenal Stress Formula. It is a combination of the vitamins and minerals needed for adrenal support, along with a little 5HTP to help with food cravings.
If I do give B vitamins, it is usually as a combination. I prefer to give B12 subQ or sublingually.
QUESTION: What company has the super adrenal stress formula?
ANSWER: Dr. Jim WIlson’s company. See www.adrenalfatigue.org. I use a lot of his products because I have had such great success with them for years now.
QUESTION: What is the name of the Thyroid book that you suggested during the webinar?
ANSWER: “Overcoming Thyroid Disorders” by Dr. David Brownstein
QUESTION: How do we know when to use glandulars vs. adaptogens?
ANSWER: Adaptogens help reduce the HPA response to stressors. You may hear or read that they lower high cortisol and raise low cortisol. Actually, they cause less cortisol to be released in response to stressors, which prevents levels from going as high. Over time if less cortisol is excreted, then low cortisol levels come up. So they are good for any stage of adrenal dysfunction, and for anyone who is stressed a lot and would like to try to help prevent overworking their adrenals (Like most health professionals!)
Glandulars help weakened adrenal glands recover more quickly. I do not see them as a necessity. If the patient is overwhelmed by the expense and number of tablets they have to take, then they often become non-compliant. So I explain to patients that the adaptogens and vitamin/mineral support along with compensation techniques, adequate water intake, good protein, digestive enzymes, etc, that their adrenals should recover, usually in 3-6 months. Use of a glandular like Adrenal ReBuilder will speed up the recovery process somewhat. I do use glandulars initially if the patient is very fatigued and needs to increase their energy. If they can only do 2 things I have them take the glandular and the adaptogens.
QUESTION: What if you have MTHFR?
ANSWER: Patients with a MTHFR gene defect cannot convert folate properly to the active form methylfolate. These patients need to take a separate dose of methylfolate.
QUESTION: What if the patient is heavy metal toxic? Fix adrenals first or chelate first?
ANSWER: You can initiate heavy metal chelation and adrenal support at the same time.
QUESTION: Any particular lab that you would recommend for saliva testing?
ANSWER: ZRT laboratory (www.zrtlab.com) is, in my opinion, the best testing company—period. They are the only lab I know of that takes into consideration patient symptoms, dosage form and timing of the last dose into their reported ranges. ZRT also does urine testing (iodine and hormone metabolites) and dried blood spot testing, which can test for larger proteins like Vitamin D, thyroid hormones, FSH, etc. Blood spot testing is good for patients using sublingual hormones also.
QUESTION: How to stop the reverse T3 from converting if on armour already.
ANSWER: If conversion from T4 to the active T3 is inhibited, conversion to rT3 will increase. Addressing the possible causes of poor conversion (high cortisol, low zinc, low selenium, etc.) will address the high rT3.
QUESTION: Let’s say the adrenals are now adjusted, how do I add the T3 if already on armour and reverse T3 is high? Do I stop the armour and only use T3?
ANSWER: Address the possible causes of poor conversion. If the patient is doing poorly on the combination of T4 and T3 in Armour, then you could consider discontinuing the Armour and use only T3 (compounded, Slow Release).
QUESTION: Do you take patients off supplements prior to testing? If so, how long prior to testing?
ANSWER: Usually you do not need to stop supplements. If there is something that you are not sure interferes with the testing, check with the lab doing the testing.
QUESTION: What is your favorite panel with ZRT adrenal testing?
ANSWER: I most often use the Female Profile III and Male Profile III, where cortisol is tested 4 times a day.
If patient is on sublingual hormone therapy, I use a combo kit and measure cortisol in the saliva, but the sex steroids in dried capillary blood. I also like the combo kit for initial testing on makes because I can get PSA in the dried blood spot.
QUESTION: Do you prefer urine or saliva testing?
ANSWER: Overall I use saliva testing for the most part. Urine testing measures metabolites, not the hormones themselves, so I feel saliva gives me a better representation of the active hormone at the tissue receptors. Urine testing for metabolites is a great option, but one which unfortunately many of the patients I work with cannot afford.
About the Presenter:
Jim Paoletti, BS Pharmacy, FAARFM, FIACP, is the Director of Education at Power2Practice and a Clinical Consultant with over 30 years of experience creating and using bio-identical hormone therapies in both retail pharmacy and clinical practice.
Jim is a nationally recognized expert in pharmacy, BHRT and custom compounding, and has previously served as Director of Provider Education for ZRT Laboratory and Education Director for the Professional Compounding Centers of America.
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